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At least 325 records · Page 18Linked to original sources
PubMed1989

Unexplained right hilar mass.

A right hilar mass was found on a computed tomographic (CT) scan in a 40-year-old man who presented with fever, sore throat, and general malaise. Initial testing ruled out various bacterial and viral infections and carcinoma. The patient's condition continued to deteriorate, and the mass as seen on repeat CT scan increased in size. Surgical biopsy of sections of the right lower lobe confirmed the diagnosis of histoplasmosis. Most histoplasmosis infections are asymptomatic, and even those that are not are usually self-limited and require only observation. When treatment is required, ketoconazole (Nizoral) now provides a less toxic alternative to amphotericin B (Fungizone).

Adult↗
PubMed1990

Pulmonary disease in AIDS patients.

Pulmonary disease remains a major complication of the human immunodeficiency virus (HIV). Over the past decade several changes in the pattern of disease have occurred. Pneumocystis carinii pneumonia (PCP) remains the most common opportunistic pathogen in AIDS patients, though its incidence on bronchoscopy has declined and empiric therapy often occurs without a specific diagnosis. Changes in the management of patients with PCP have included different dosages and routes of administration for chemotherapy, improved overall survival, and a recent increase in the number of patients surviving episodes of respiratory failure. In addition, infection with mycobacteria tuberculosis (M.Tb.) has emerged as a major public health problem. The pattern of M.Tb. is distinct from non-immunocompromised patients though response to therapy usually occurs.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Pulmonary nodules and masses after lung and heart-lung transplantation.

The authors assess clinical and radiographic findings of pulmonary nodules and masses after lung and heart-lung transplantation. One hundred and fifty nine patients who survived at least 3 months after lung and heart-lung transplantation were followed by serial chest radiographs for a median of 27 months. Single or multiple lung nodules or masses were noted at chest radiography in 15 (9.4%) of 159 patients. Imaging findings and causes of these nodules and masses were reviewed retrospectively. Infection was found in 10 (6%) of 159 patients. Specific pathogens (11 pathogens in 10 patients) were Aspergillus (n = 4), Mycobacteria (n = 4), and other bacteria (n = 3). Noninfectious causes were found in 5 (3%) of patients and included B-cell lymphoma (n = 2), bronchogenic carcinoma (n = 2), and pulmonary infarcts (n = 1). Nodules and masses appeared a median of 11 months after transplantation (range: 0.2 to 36 months). Five patients (33%) had single lesions; the other 10 (67%) patients had multiple lesions (range 2 to 50). Aspergillus lesions were most commonly located in the upper lobes, were cavitary in three of four patients, and all were fatal. Nodules and masses arose in the transplanted lung in 12 (80%) of the patients, and in the native lung in 3 (20%) of the patients (2 bronchogenic carcinoma, 1 M. tuberculosis simulating bronchogenic carcinoma). Nodules and masses detected by chest radiography are not uncommon (9.4%) after lung and heart-lung transplantation. Infections are more common than noninfectious causes of posttransplant nodules and masses. Specific clinical and imaging characteristics may provide clues to etiology.

Adolescent↗
PubMed1985

Fine needle aspiration of the lung: a study of 53 consecutive cases.

We reviewed our fine needle aspirations of the lung and chest on 53 consecutive patients from January 1979 through June 1982. Almost all of the patients had been studied by sputum and bronchial cytology and many by bronchial or transbronchial biopsy, but none of the patients had a definitive diagnosis. All of the lung aspirates were done in the department of radiology, using a 22 gauge Chiba disposable needle and the Wright-Giemsa stain. Twenty-four cases (45%) were diagnosed as malignant and ten cases (19%) were considered suggestive. Nineteen cases (36%) were read as negative for malignant cells, but in six of these cases (11% of total) we were able to make the diagnosis of an infectious process based on characteristic cytologic findings.

Adult↗
PubMed1993

Cryptococcal pneumonia occurring as an infiltrative mass simulating carcinoma in an immunocompetent host: plain film, CT, and MRI findings.

Cryptococcosis, a potentially fatal pulmonary infection, rarely occurs in advanced form in immunocompetent individuals. Radiographic findings are variable and include single and multiple mass-like infiltrates, nodules, and segmental infiltrates. MRI manifestations of pulmonary cryptococcosis have not been reported previously. We have compared MRI, CT, and plain film radiographic findings in a case of multisegmental cryptococcal pneumonia occurring as a mass simulating carcinoma in an immunocompetent individual; we have also discussed the differential radiographic evaluation of pulmonary cryptococcosis.

Cryptococcosis↗
PubMed2003

F-18 fluorodeoxyglucose positron emission tomography in pulmonary cryptococcoma.

Cryptococcosis is not uncommon. Potential interpretation pitfalls should be kept in mind when fluorodeoxyglucose (FDG) positron emission tomography (PET) is used for differentiating pulmonary nodules and for discriminating infection from malignancy, especially in areas where the prevalence of granulomatous infection is high and in immunocompromised patients. In this case, a nodular mass was shown on chest radiography and computed tomographic (CT) scanning. A consolidated infection or a bronchioloalveolar carcinoma was suspected because the CT scan showed air bronchograms within the mass and another perihilar infiltration. The FDG PET scan clearly delineated the lesion and had intermediately high glucose uptake (standard uptake value, 3.8-4.0), which led to the exclusion of the possibility of bronchioloalveolar carcinoma because most of these tumors had normal or mildly increased FDG accumulation. Cryptococcoma was finally diagnosed. Hence, the CT scan and FDG PET played complementary roles in the differential diagnosis of this nodular mass.

Cryptococcosis↗
PubMed2005

Large cryptococcoma mimicking lung cancer in an HIV-negative, type 2 diabetic patient.

Pulmonary cryptococcoma is an unusual disease in immunocompetent patients. The typical radiologic findings are single or multiple small nodules. We describe a case of a large pulmonary cryptococcoma in a 69-year-old patient, who presented with generalized weakness and poor appetite. Computed tomography of the chest showed a large mass that was strongly suggestive of lung cancer. Pulmonary cryptococcal infection was diagnosed by transthoracic needle biopsy. Human immunodeficiency virus testing was negative. The mass resolved with 200 mg daily of oral fluconazole over the course of 6 months.

Aged↗
PubMed1994

Cloning and disruption of the gene encoding an extracellular metalloprotease of Aspergillus fumigatus.

Aspergillus fumigatus secretes a serine alkaline protease (ALP) and a metalloprotease (MEP) when the fungus is cultivated in the presence of collagen as sole nitrogen and carbon source. The gene encoding ALP was isolated and characterized previously. We report here the cloning and the sequencing of the gene encoding MEP. Genomic and cDNA clones were isolated from A. fumigatus libraries using synthetic oligonucleotides as probes. Stretches of the deduced amino acid sequence were found to be in agreement with the N-terminal amino acid sequence of MEP and with internal peptide sequences. The amino acid sequence of the enzyme contains a putative active-site sequence HEYTH homologous to the active site of other bacterial and eukaryotic zinc metalloproteases. Sequence analysis reveals that MEP has a pre-proregion consisting of 245 amino acid residues preceding the 388 amino acid residues of the mature region (molecular mass of 42 kDa). An alp mep mutant, deficient in proteolytic activity at neutral pH in vitro, was constructed and tested for pathogenicity in a murine model. No difference in pathogenicity was observed between the wild-type strain and the alp mep double mutant, suggesting that ALP and MEP are not essential for the invasion of the lung tissues by A. fumigatus.

Amino Acid Sequence↗
PubMed2005

Bronchoscopy in the diagnosis and surveillance of respiratory infections in lung and heart-lung transplant recipients.

Fiberoptic bronchoscopy (FOB) with bronchoalveolar lavage (BAL) and transbronchial biopsies (TBB) is a widely used method to detect respiratory infections and to differentiate them from other postoperative complications in lung transplant (LTX) recipients, but the usefulness of surveillance FOBs is not yet established. The aim of this study was to evaluate the usefulness of FOB in the diagnosis and surveillance of infections in LTX recipients. We reviewed all the consecutive 609 FOBs performed on 40 lung or heart-LTX recipients between February 1994 and November 2002. The overall diagnostic yield was 115/190 (61%) and 43/282 (15%) for clinically indicated and surveillance FOBs respectively (P < 0.001). Infection was established by bronchoscopic samples in 96/190 (50.5.%) of the clinically indicated FOBs and 34/282 (12.1%) of the surveillance FOBs (P < 0.001). The diagnostic yield of the clinically indicated FOBs was highest (72%) from 1 to 6 months post-transplant (P = 0.04). Pneumocystis carinii was detected in 23 (4.9%) of the bronchoscopic specimens and 15 (65%) of the P. carinii infections were detected during adequate chemoprophylaxis. To conclude, in LTX recipients clinically indicated FOB has a good diagnostic yield in detecting infections and other postoperative complications, whereas the information received from surveillance FOB has remained less significant. With current prophylaxis and screening strategies FOB is still required to detect P. carinii infections.

Adolescent↗