Diagnosis of bronchogenic cysts is possible with computed tomography, but half of all cases present as soft tissue densities. Two such cases are highlighted where asymptomatic bronchogenic cysts that presented as soft tissue masses were evaluated by endobronchial ultrasound (EBUS). After studying the ultrasound image characteristics, the diagnosis was confirmed using EBUS-guided transbronchial needle aspiration (EBUS-TBNA). The first case had ultrasound findings of an anechoic collection, and the aspirate was serous with negative microbiologic cultures. The second was an echogenic collection within a hyperechoic wall. Needle aspirate was purulent and cultured Haemophilus influenza. The diagnosis of a bronchogenic cyst complicated by infection was made, and the lesion was surgically resected. This potential for EBUS in the diagnosis of bronchogenic cysts and in identifying complications such as infection should be considered in the management of such cases.
Positron emission tomography with CT for the evaluation and follow-up of solitary pulmonary nodule and NSCLC can provide additional useful information to conventional radiology for treatment planning and a non-invasive determination of prognosis. However, physicians need to be aware of the limitations of this imaging modality, particularly when tuberculosis has a high prevalence in the population.
Pulmonary sclerosing hemangioma is a rare benign tumor for which surgical excision is curative with an excellent prognosis. It often mimics malignancy, making it a diagnostic and management challenge. We reviewed the clinical, radiological, and histopathological characteristics as well as the surgical management of our patients to assess the potential pitfalls in management. All 19 patients who underwent surgical biopsy between January 1999 and December 2009 with a final histopathological diagnosis of pulmonary sclerosing hemangioma were reviewed retrospectively. The median age was 48 years, 89.5% were female, 89.5% were Chinese, and 68.4% were asymptomatic. There were no specific diagnostic radiological characteristics; 1 of 3 patients who underwent combined positron-emission and computed tomography had a false-positive result. Preoperative attempts at establishing a diagnosis were successful in 20% of patients who had invasive procedures. Intraoperative frozen-section evaluation for pulmonary sclerosing hemangioma had an error rate of 25% and a deferred rate of 31%, resulting in nearly half of our patients undergoing unnecessary extensive surgical procedures. We hope to heighten awareness of this diagnosis, thereby increasing the index of suspicion and minimizing errors in diagnosis.
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