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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The diagnosis of peripheral lung foci may prove difficult. In addition to transthoracic puncture under X-ray fluoroscopy or CT control, ultrasound-guided puncture was shown to be a useful alternative. A prerequisite, however, is that the lesion should extend up to the pleura. This overview covers 97 original papers, of which 26 mainly consisted of lung punctures in a total of 1876 patients. The accuracy in carcinomas and metastases was 70 to 97%, on average markedly higher than 90%. Benign lesions are histologically more difficult to distinguish; here the accuracy is 70%. Partly due to pre-selection the method has a very low rate of complications. The rate of pneumothorax is 2.6%, those requiring drainage are about 1%. Haemoptyses occur 1-2% of the punctures, most commonly in cases of chronic pneumonia; colour-coded Duplex sonography is especially recommended in these cases because of the strong and regular vascularisation. The rate of complication increases in direct proportion to needle thickness. The possibilities of ultrasound-guided lung abscess drainage are also discussed. An intrathoracic lesion that is accessible to ultrasound imaging should be punctured today under ultrasound guidance, as this procedure is minimally stressful for the patient, is accurate, has a low rate of complications and is also cost effective.
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PMID:[Ultrasound-guided transthoracic puncture]. 1067 67

An 11-year-old girl with osteosarcoma in the left distal femur, developed unilateral spontaneous pneumothorax. Pneumothorax was found at the initial presentation, but chest CT failed to reveal pulmonary metastases, bullae or blebs.
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PMID:Spontaneous pneumothorax without any detectable pulmonary metastases in a patient with osteosarcoma. 1074 26

Cigarette smoking is the leading cause of preventable death in the United States. Smoking adversely affects many organ systems, but especially the lung. Carcinoma of the lung and chronic obstructive pulmonary disease account for most smoking-associated respiratory morbidity and mortality, and their association with smoking is both well established and widely recognized. Cigarette smoking also is associated with differences in the incidence, severity, or natural history of a broad array of other respiratory illnesses, ranging from the common cold to pneumothorax, pulmonary hemorrhage, and various interstitial lung diseases. Interestingly, while the general effect of smoking on respiratory diseases is adverse, in the cases of sarcoidosis and hypersensitivity pneumonitis smoking may actually be associated with a decrease in the incidence of disease. In this article, the author briefly discusses some of the pulmonary and systemic effects of smoking that might mediate its effects on an array of lung diseases, then comprehensively reviews less common or less well-recognized smoking-affected lung diseases such as pulmonary infections, spontaneous pneumothorax, Goodpasture's syndrome, eosinophilic granuloma and other interstitial lung diseases, and pulmonary metastatic disease.
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PMID:Other smoking-affected pulmonary diseases. 1076 94

Hemopneumothorax and hemoperitoneum coincide rarely in nontraumatic cases. Here, a 70-year-old male presented a left axillary lymph node and was diagnosed as having metastatic squamous cell carcinoma. Under the same diagnosis, another lesion developed in the right femur and was resected. One year later, computed tomography detected another tumor in the left adrenal gland. Shortly afterwards, left pneumothorax developed and a chest operation revealed hemopneumothorax due to a ruptured cavitary form of large cell carcinoma. The serum showed a human chorionic gonadotropin-beta level of 1,100 ng/ml. At three-months later, he died of hemoperitoneum. The autopsy demonstrated hepatic metastases and a ruptured adrenal metastasis; microscopy showed marked trophoblastic and squamous cell changes in these organs. This patient was unique in that the rupture of the pulmonary and the adrenal lesions caused clinical manifestation.
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PMID:Hemopneumothorax and hemoperitoneum in a case with large cell carcinoma of the lung. 1079

Secondary spontaneous pneumothorax (SSP) is a rare complication of chemotherapy for pulmonary metastases and to the best of our knowledge, only 28 cases have been described, most of which occurred in patients with osteosarcoma or germ cell tumors. We present herein the case of a 56-year-old woman in whom bilateral and recurrent SSP was caused by the rupture of pulmonary lacunae induced by chemotherapy, given for bilateral lung metastases secondary to breast carcinoma. Our experience of this case led us to conclude that: patients with pulmonary metastases may develop bilateral and/or recurrent pneumothoraces following chemotherapy; computed tomography scan is essential for defining the cause of SSP; and closed chest tube drainage remains the therapy of choice, while chemical pleurodesis may also be used to prevent recidivant SSP.
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PMID:Bilateral recurrent pneumothorax complicating chemotherapy for pulmonary metastatic breast ductal carcinoma: report of a case. 1081 90

With modern treatment modalities it is possible to obtain a long survival in patients with non-seminomatous testicular cancer. Chemotherapy is the mainstay of treatment in metastatic cases. High-dose chemotherapy and autologous peripheral blood stem cell transplantation is a good salvage treatment for recurrent cases. However, the modality has serious complications. We present a rare case of recurrent spontaneous pneumothorax due to rupture of residual cystic lesions after high-dose chemotherapy in a patient with pulmonary metastases. Such a situation has been rarely reported.
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PMID:Recurrent spontaneous pneumothorax following high-dose chemotherapy in a patient with non-seminomatous testicular cancer with pulmonary metastases. 1093 8

Typical radiologic findings of a pulmonary metastasis include multiple round variable-sized nodules and diffuse thickening of interstitium. In daily practice, however, atypical radiologic features of metastases are often encountered that make distinction of metastases from other nonmalignant pulmonary diseases difficult. A detailed knowledge of the atypical radiologic features of a pulmonary metastasis with a good understanding of the histopathologic background is essential for correct diagnosis. Squamous cell carcinoma is regarded as the most common cell type of a cavitating metastasis, but metastatic nodules from adenocarcinomas and sarcomas also cavitate occasionally. Calcification can occur in a metastatic sarcoma or adenocarcinoma, which makes differentiation from a benign granuloma or hamartoma difficult. Peritumoral hemorrhage results in areas of nodular attenuation surrounded by a halo of ground-glass opacity. Pneumothorax commonly occurs in metastases from an osteosarcoma. Air-space consolidation is often seen in cases of metastases from gastrointestinal tract malignancies. Even though tumor emboli in pulmonary arteries can be seen at computed tomography, diagnosis is difficult because they are located in small or medium arteries. A common radiologic appearance of an endobronchial metastasis is an atelectasis. In cases of an endobronchial or a solitary pulmonary metastasis, differentiation between bronchogenic carcinoma and metastasis is difficult. Dilated vascular structures within the mass can be seen in metastatic sarcomas. A sterilized metastasis after chemotherapy is radiologically indistinguishable from a residual viable tumor. Benign tumors such as uterine leiomyomas and giant cell tumors of the bone rarely metastasize to the lung.
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PMID:Atypical pulmonary metastases: spectrum of radiologic findings. 1125 4

An 81-year-old woman developed a necrotic plaque and a surrounding purple-red, irregularly shaped macule on her scalp. The diagnosis of angiosarcoma was confirmed histologically. A wide surgical excision was made followed by a split-thickness skin graft from her right buttock. Nine months later, she noticed a dark purple-red lesion on the donor site which grew rapidly into a large mass. Histological examination revealed irregular clefts and vascular channels lined by atypical endothelial cells. Lung metastasis and pneumothorax were also noted. The secondary tumor appeared to represent Koebner phenomenon in a patient with angiosarcoma of the scalp.
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PMID:Koebner phenomenon on skin graft donor site in cutaneous angiosarcoma. 1170 15

The optimal treatment for hepatocellular carcinoma (HCC) is surgical resection. However, only a small percentage of patients are operative candidates. CT-guided percutaneous radiofrequency ablation (RFA) has been shown to be efficacious in treatment of unresectable HCC. CT-guided RFA, however, may fail to detect small intrahepatic metastases and tumor thrombi, which thus minimizes possible gains from the procedure. Recent advances in laparoscopic ultrasound have greatly improved the accuracy in detecting intrahepatic HCC metastases many of which were missed by CT. Combining intraoperative laparoscopic ultrasound with laparoscopic RFA greatly utilizes advances in both fields and is technically feasible. Our objective is to introduce a novel operative combination of laparoscopic ultrasound with laparoscopic RFA in treatment of HCC. Childs class B patients with unresectable HCC were considered for this study. Twelve patients underwent laparoscopic ultrasound and RFA of 17 lesions. Tumors ranged from 0.27 to 7 cm in diameter. Laparoscopic ultrasound identified tumor not detected preoperatively in one patient (8.3%). A single pneumothorax was the only complication. A single patient (8.3%) had recurrent disease and accounted for the only mortality in the study. We conclude that the use of both laparoscopic ultrasound and RFA is an excellent use of existing technology. The procedure combines improved tumor localization with the means to treat patients with unresectable disease. Because RFA is a relatively recent development long-term results are not yet available. Randomized prospective studies comparing RFA with other modalities will determine the ultimate utility of this procedure.
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PMID:Laparoscopic ultrasound with radiofrequency ablation in cirrhotic patients with hepatocellular carcinoma: technique and technical considerations. 1176 26

A rare case of multifocal osteosarcoma metastatic to kidney, lung and lymph nodes is presented. Radiological findings included multiple foci of sclerotic lesions involving the axial and peripheral skeleton, a heterogeneous renal mass with areas of calcification, multiple pulmonary metastases with pneumothorax, and partially calcified enlarged mediastinal and abdominal lymph nodes.
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PMID:Renal involvement in multifocal osteosarcoma. 1196


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