An 81-year-old man with collapse of the right upper and middle lobes

Article Abstract:

An 81-year old man was admitted to the hospital because of a mass in his chest and weight loss. Two years earlier, he began to experience a loss of appetite and to lose weight; by the time of this hospitalization he had lost almost 40 pounds. During the months prior to his admission, he became increasingly clumsy, and suffered from memory loss and confusion. A definitive diagnosis was not achieved in spite of blood tests and thoracentesis, or needle aspiration of fluid from the chest cavity. Two bronchoscopies and a mediastinoscopy were performed; these procedures use an endoscope, or flexible tube with an optical system, to visually examine the bronchi, and the mass of organs, tissues and vessels separating the right and left lungs. Among the diagnoses considered were a number of cancerous and noncancerous conditions, including malignant lymphoma, various disorders of the lymphatic system, pulmonary tuberculosis, and fibrosing mediastinitis (a rare disease of the mediastinum, or heart, large vessels, windpipe, esophagus and other tissues separating the lungs). The clinical diagnosis was fibrosing mediastinitis, or development of fibrous tissue that limits chest wall motion, impairs lung function, and pulls the mediastinum toward the diseased side. Cell examination of the first bronchoscopic biopsy failed to show malignant melanoma, probably because the sample contained extensive dead (necrotic) tissue. The diagnosis of malignant melanoma was positively made with a second biopsy, in which less necrotic tissue was present. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Melanoma

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A 17-week-old boy with a left posterior intrathoracic mass

Article Abstract:

The case is reported of a 17-week-old boy who appeared normal at delivery (by cesarean section) but in mild respiratory distress. The infant had been diagnosed as having a mass, visible on X-ray, in the chest cavity on the left side. He was admitted to the hospital at the age of seven weeks, and during his hospitalization the mass was observed. At 17 weeks, the infant was admitted again for further evaluation. A discussion is presented of the cysts or tumors in the mediastinum (the organs and tissues that separate the lungs) that could cause such symptoms in a newborn. One possibility was pulmonary sequestration, in which a mass of lung tissue is present that does not communicate with the normal respiratory tract. In one form of this disease, the extralobar form, the abnormal tissue has its own pleura (covering membranes) and has been called an accessory lung. It is often associated with diaphragmatic hernia, in which the abdominal organs develop abnormally and protrude into the chest cavity. The infant underwent surgery and a sequestered segment of lung was found and easily removed. Its histopathological appearance is described. The tissue was not malignant, but removal was indicated because of respiratory problems, and to verify that malignancy was not present. The infant recovered without complications. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abnormalities, Infants (Newborn), Newborn infants

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A 44-year-old man with tracheal narrowing and respiratory stridor

Article Abstract:

A 44-year-old man was admitted to a hospital with shortness of breath and difficulty clearing respiratory secretions. A CT scan of his chest revealed a severe narrowing of his trachea. The trachea is the medical term for the windpipe that leads from the nose and mouth down to the lungs. Doctors examined his trachea with a rigid bronchoscope. Even the smallest bronchoscope could not be inserted without great difficulty. The trachea was very narrow and contained many nodules. He was diagnosed with tracheopathia osteoplastica. This is a benign disease caused by nodules in the trachea that can deform it considerably.

Trachea, Tracheal stenosis

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