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

In the endemic area of tuberculosis, there are many cases that present tuberculosis as a solitary pulmonary nodule (SPN) on chest radiographs. The objective of this study is to evaluate the diagnostic yield of transbronchial lung biopsy (TBLB) under fluoroscopic guidance in SPNs such as lung cancer or pulmonary tuberculoma in areas with high prevalence of tuberculosis. One hundred and seventy patients with SPNs on chest radiographs were included in the study; all had negative sputum smears for tubercle bacilli and no malignancy by sputum cytology before bronchoscopy. Transbronchial lung biopsy and brushing were performed, routinely, under fluoroscopic guidance. Of 170 patients, 120 (70.6%) had lung cancer (including three with metastatic cancer), 40 (23.5%) patients had pulmonary tuberculosis (Tb), and the remaining 10 (5.9%) patients had other benign pulmonary lesions. The overall diagnostic rate in SPNs was 62.4% (106 of 170). Transbronchial lung biopsy and brushing revealed a diagnostic sensitivity of 70.0% in lung cancer (84 of 120) and a sensitivity of 55% in Tb (22 of 40). In addition, TBLB and brushing also provided rapid microscopic identification of Tb in 18 of 40 patients (45%, including 15 by TBLB, one by brushing smear, and two by postbronchoscopic sputum). The percentage of positive diagnosis correlated with diameter of the SPN. Solitary pulmonary nodules with diameter less than 2 cm were diagnosed in only 35.3% of cases (6 of 17; cancer 40% vs. Tb 29%). In contrast, the diagnostic rates in SPNs with diameters 2-4 cm and greater than 4 cm were 64.5% (78 of 121; cancer 72.0% vs. Tb 62.5%) and 68.8% of cases (22 of 32), respectively. Diagnostic bronchoscopy under fluoroscopic guidance is a useful tool in evaluation of patients with a peripheral pulmonary nodule since it may provide additional information to minimize unnecessary thoracotomy and give way for proper medication as early as possible.
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PMID:Diagnostic value of transbronchial lung biopsy under fluoroscopic guidance in solitary pulmonary nodule in an endemic area of tuberculosis. 873 5

We reviewed MRI studies of 60 patients presenting with extradural compressive myeloradiculopathy secondary to vertebral disease to assess the imaging features which may help in differentiating tuberculous from neoplastic disease. Spin-echo T1-, proton density-and T2-weighted images were available for all patients and fast low-angle shot images with a low flip angle for 21 patients. Contrast-enhanced images were available for 28 patients. There were 41 patients with tuberculosis and 19 patients with neoplastic disease (metastases 11, lymphoma 6, plasmacytoma 1, and giant cell tumour 1). Discovertebral disease with or without involvement of the posterior arch was a feature not only of tuberculous spondylitis (30 patients) but also of metastases (6). The remaining 11 patients with tuberculosis had "atypical" involvement (vertebral body with or without posterior arch in 8 and posterior arch alone in 3) described as typical of neoplasms. This "typical" involvement was seen in metastases (5), lymphoma (6) and the 2 primary bone tumours. The presence of an abscess helped in differentiating tuberculosis from neoplasia in 22 of the 41 patients with tuberculosis and was absent in all with neoplasms. The presence of bone fragments in 16 patients (8 with and 8 without an abscess) was found to be specific for tuberculosis. In the absence of an abscess or bone fragments, image-guided biopsy is essential to establish the diagnosis.
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PMID:Problems in distinguishing spinal tuberculosis from neoplasia on MRI. 881 92

In addition to metastases, the differential diagnosis of pulmonary nodules also includes tuberculosis, sarcoidosis, and silicosis. Rarer diseases such as amyloid tumors, rheumatic nodules, and plasma-cell granulomas can, depending on the clinical situation, be the cause of this finding. For the example of the clinical picture of pulmonary hyalinizing granuloma, the differential diagnosis of multiple pulmonary nodules is illustrated under consideration of the pathognomonic, morphologic observations.
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PMID:[Differential diagnosis of multiple pulmonary coin lesions--pulmonary hyaline granuloma]. 886 95

Kikuchi-Fujimoto's disease (histiocytic necrotizing lymphadenitis) is a benign, self-limited disease of unknown cause that often presents with persistently enlarged cervical lymph nodes that are unresponsive to antibiotic therapy. The disease should be considered in the differential diagnosis of cervical lymphadenopaty: viral infection, tuberculosis, hyperplastic lymphadenopathy, and metastatic disease. It can be confused histologically with malignant lymphoma.
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PMID:[Kikuchi-Fujimoto disease (histiocytic necrotizing lymphadenitis)]. 892 94

Local hepatic tuberculosis without active pulmonary or miliary tuberculosis is an uncommon diagnosis. Even less common is the finding of a nodular form of local hepatic tuberculosis. There is a growing incidence of the disease related to human immunodeficiency virus. The authors report a case of pseudotumoral hepatic tuberculosis in a patient without AIDS, manifesting as prolonged fever, diagnosed previously as metastatic liver. Imaging studies of the liver and laparoscopic findings suggested metastatic disease. The correct diagnosis was made by histology of biopsies obtained in laparoscopy, which is an easy and cheap method, with less morbidity and mortality than surgical intervention. The case report illustrates the difficulty in reaching the correct diagnosis, most often confused with carcinoma of the liver, primary or metastatic. A greater awareness of this rare clinical entity may prevent needless surgical intervention since the majority of patients respond well to antituberculous chemotherapy.
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PMID:[Pseudotumorous hepatic tuberculosis: laparoscopic appearance]. 899 69

Clinico-radiological profile of 25 patients with mediastinal lymphadenopathy due to tuberculosis, Hodgkin's lymphoma and metastases is presented. The main objective was to study the signal intensity pattern of the mediastinal lymph nodes both in plain and contrast enhanced magnetic resonance imaging (MRI), and find out its potential value in the diagnosis. Fifteen patients of tuberculous mediastinal lymphadenopathy, 5 patients of Hodgkin's lymphoma and 5 patients of metastatic lymphadenopathy were studied by 1.5 T Siemens, Magnetom. Both intensity and enhancement pattern were evaluated. Tuberculous lymph nodes appeared isointense in both T1WI and T2WI. On contrast administration multiple hypointense foci were seen in 14 out of 15 patients. The metastatic lymph nodes revealed solitary or multiple hyperintense central foci in T2WI, whereas the lymphomatous lymph nodes revealed heterogenous intensity. Though the lymphomatous nodes revealed mild to moderate type of enhancement, the metastatic nodes revealed dense enhancement of the multiple foci which were seen in noncontrast images. Hence, the MR characteristics of the mediastinal nodes may be useful index in evaluating the aetiology of the mediastinal lymphadenopathy.
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PMID:MR evaluation of the mediastinal lymph nodes. 910 Apr 7

The macronodular form of hepatic tuberculosis is a very rare disease characterized by tumor-like tuberculomas or abscesses. Correct diagnosis is hampered by ambiguous clinical and radiological findings. We present a case of solitary tuberculosis of the liver without evidence of extrahepatic tuberculous manifestations. The lesions mimicked metastatic disease of a coincidentally found kidney tumor. Diagnosis could only be made by histologic examination of repeated percutaneous liver biopsies. Antituberculous treatment lead to a complete retrogression of hepatic changes while the kidney tumor (histologically a renal cell carcinoma) was removed surgically. As a liver biopsy provides the only means of diagnosing local nodular tuberculosis, which is treatable, we conclude that it should be performed on every unclear tumorous lesion of the liver.
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PMID:[Isolated tuberculosis of the liver coincident with renal cell carcinoma]. 917 70

Up to 20% of pleural effusions remain undiagnosed despite history-taking, physical examination, thoracentesis, and percutaneous closed pleural biopsy. The next diagnostic procedure used is often thoracoscopy under general anesthesia in an operating room. We report a technique for beside pleuroscopy and pleural biopsy that can be done without assistance of surgeons. We performed video-assisted pleuroscopy with a rigid cysto-ureteroscope in seven patients with pleural effusion that remained undiagnosed despite extensive clinical evaluation. A sterile 19.8 Fr. rigid cysto-ureteroscope was placed into the pleural space under local anesthesia. Pneumothorax was induced to enhance visualization of the surfaces. Forceps-biopsy specimens were taken of suspicious lesions on the parietal pleural. In three patients the pleural surface appeared smooth and in two the parietal pleural surface was studded. A localized coin-like lesion was seen in one patient, and extensive fibrinogenic adhesions and diffuse opacity of the parietal pleura was seen in another. Using this bedside procedure, we diagnosed pleural tuberculosis in three patients and pleural metastases of adenocarcinoma in one. When done under local anesthesia with a rigid cyst-ureteroscopy, video-assisted pleuroscopy can be a safe and useful diagnostic aid in patients with undiagnosed pleural effusion.
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PMID:[Video-assisted bedside pleuroscopy under local anesthesia: use of a rigid cystoureteroscope in patients with undiagnosed pleural effusion]. 921 5

In 50 lung cancers (25 small cell lung cancers, 17 squamous cell carcinomas, 8 adenocarcinomas) pulmonary, mediastinal and cervical lymph node-metastases were analyzed. Lymph-node "skipping" was demonstrated in 46% of the investigated tumors. In seven of these cases the lymph nodes were skipped, which showed complete hyalinization as a consequence of preexisting anthracosilicosis. In 5 other tumors additional lymph nodes with preserved structure were skipped by the metastatic process. Fibrosis of lymphatic tissue after tuberculosis or exposure to ionizing radiation were further reasons for lymph-node skipping. The skipping of intact lymph nodes can be explained by anatomically demonstrable intra- and perinodal short circuit connections. Apart from that, preexisting lymph node changes (silicosis, fibrosis) play an important part.
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PMID:[Discontinuous lymph node metastases ("skipping") in malignant lung tumors]. 932 38

Bilateral suprahyoid lymphangiectomy have been made in 95 patients because of suspicion of submandibular lymph nodes metastases. The patients with lip carcinoma have been previously treated with surgery, surgery and radiotherapy or with radiotherapy followed by surgery. Histological examinations have revealed lymph node metastases in 62 (65.3%) patients, in 31 (32.6%) patients histology has been negative and in 2 (2.2%) patients lymphonodular tuberculosis has been stated. Authors have analyzed 3, 5 and 10 years survivals in 65 patients after suprahyoid lymphangiectomy during lip cancer treatment.
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PMID:[Suprahyoid lymphangiectomy in patients treated for lip cancer]. 945 66


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