ClinicalTrials.gov; No.: NCT00886847; URL: www.clinicaltrials.gov

Background Pulmonary radiological findings of the novel coronavirus disease 2019 (COVID-19) have been well documented and range from scattered ground-glass infiltrates in milder cases to confluent ground-glass change, dense consolidation, and crazy paving in the critically ill. However, lung cavitation has not been commonly described in these patients. The objective of this study was to assess the incidence of pulmonary cavitation in patients with COVID-19 and describe its characteristics and evolution. Methods We conducted a retrospective review of all patients admitted to our institution with COVID-19 and reviewed electronic medical records and imaging to identify patients who developed pulmonary cavitation. Results Twelve out of 689 (1.7%) patients admitted to our institution with COVID-19 developed pulmonary cavitation, comprising 3.3% (n = 12/359) of patients who developed COVID-19 pneumonia, and 11% (n = 12/110) of those admitted to the intensive care unit. We describe the imaging characteristics of the cavitation and present the clinical, pharmacological, laboratory, and microbiological parameters for these patients. In this cohort six patients have died, and six discharged home. Conclusion Cavitary lung disease in patients with severe COVID-19 disease is not uncommon, and is associated with a high level of morbidity and mortality.

In patients with lung masses and evidence of mediastinal adenopathy without evidence of distant metastatic disease, a common clinical question is whether to perform biopsy of the peripheral lung lesions or the lymph nodes fi rst. When there are discrete enlarged lymph nodes on CT scan or PET scan without direct A ccurate staging is critical to the effective treatment of lung cancer. For patients without evidence of distant metastatic disease, assessment of the mediastinal lymph nodes is important, since the status of these nodes will determine treatment. 1,2 Clinical assessment of the mediastinal lymph nodes is guided by noninvasive imaging modalities, such as CT scan and PET scan. The median sensitivity and specifi city of CT scanning for identifying malignant involvement of mediastinal nodes is 61% and 79%, respectively. 3 The sensitivity of PET scanning is conditional upon whether the nodes are enlarged on CT scan. If the lymph nodes are enlarged on CT scan, the median sensitivity and specifi city of PET scan is 100% and 78%, respectively. If the lymph nodes are not enlarged on CT scan, the median sensitivity and specifi city of PET scan is 82% and 93%, respectively. 3 Because of the limited predictive value of both CT scanning and PET scanning, current guidelines recommend that patients with mediastinal adenopathy by CT scan or PET scan undergo lymph node sampling to ensure accurate staging.

Malignant pleural effusions are a common clinical problem in patients with primary thoracic malignancy and metastatic malignancy to the thorax. Symptoms can be debilitating and can impair tolerance of anticancer therapy. This article presents a comprehensive review of pharmaceutical and nonpharmaceutical approaches to the management of malignant pleural effusion, and a novel algorithm for management based on patients' performance status.

Integrating new technologies such as PET-CT and endobronchial ultrasound into the initial evaluation of patients can save unnecessary diagnostic procedures and lead to more rapid and accurate staging.

Background: Deciding what risks to disclose before a procedure is often challenging for clinicians. Consecutive patients undergoing elective fibreoptic bronchoscopy were randomised to receive simple or more detailed written information about the risks of the procedure and the effects on anxiety and satisfaction levels were compared. Methods: A 100 mm anxiety visual analogue scale (VAS) and a modified Amsterdam preoperative anxiety (scored 4-20) scale (APAIS) were completed before and after reading the designated information leaflet. Following bronchoscopy, subjects completed a satisfaction questionnaire. Results: Of 142 consecutive patients, 122 (86%) (mean age 57.8 years, 53% male) completed the study. Baseline demographic, clinical and anxiety measures were similar in the two groups. Those who received more detailed risk information had significantly greater increase in anxiety levels than those who received simple information on both the VAS (mean 14.0 (95% CI 10.1 to 17.9) vs 2.5 (95% CI 21.4 to 6.4), p,0.001) and the APAIS (1.73 (95% CI 1.19 to 2.26) vs 0.57 (95% CI 0.05 to 1.10), p,0.001). Almost twice as many of those receiving detailed risk information reported that they felt they had received too much information about complications or that the information they had received about bronchoscopy had been worrying. Conclusions: Provision of more detailed risk information before bronchoscopy may come at the cost of a small but significant increase in anxiety.

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We describe 2 cases of mediastinal abscess developing after endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in patients with thoracic malignancies. The first case was that of a 68-year-old male patient with a history of colon cancer presenting with new mediastinal adenopathy. EBUS-TBNA confirmed metastatic colon adenocarcinoma; however, he developed fever and atrial fibrillation 32 days after the procedure and was diagnosed with mediastinal abscess. The patient was successfully treated with antibiotics. The second case was that of a 66-year-old previously healthy male who presented for evaluation of cough. Imaging showed a right paratracheal mass and he underwent EBUS-TBNA sampling, which showed malignant cells. Eight days after the procedure the patient developed fever and was diagnosed with mediastinal abscess. The second patient was treated with antibiotics and several debridements; however, he was eventually transitioned to hospice care because of a continued spread of his cancer. Although rare, mediastinal infection is a complication of endoscopic mediastinal needle aspiration.