The patient was a 5-year-old boy who was transported to our hospital for a paroxysmal cough, disturbance of consciousness, tonic-clonic convulsions and labored breathing. The patient's respiratory failure persisted after the convulsions remitted, and the presence of an endobronchial foreign body was suspected based on the findings of chest CT performed the following day. A peanut was subsequently removed from the right main bronchus using a bronchoscope with tracheal intubation and bag valve mask ventilation. Immediately after removal, the patient rapidly developed exacerbated hypoxemia, and a reduction in right lung lucency was noted on chest radiography. He was therefore diagnosed with type II postobstructive pulmonary edema, and his condition improved within a short period of time.

The aspiration of foreign bodies may induce various infectious diseases, including actinomycosis, and its association with foreign bodies has been reported. We encountered a patient who developed Actinomyces-induced lung abscess associated with aspiration of cedar leaves. The patient was a 56-year-old Japanese woman who aspirated decorative cedar leaves contained in a lunch box while eating a meal, and coughing and bloody phlegm occurred thereafter. A mass was noted in the right lower lobe of the lung on plain chest computed tomography on the first consultation, and granules of Actinomyces were noted on transbronchial lung biopsy. Long-term antibiotic administration was performed, but no improvement was obtained. Thus, right lower lobectomy was performed. On postoperative pathologic examination, cedar leaves were present in the bronchus, bacterial colonies adhered to these, and there was surrounding inflammatory cell infiltration, mainly involving histiocytes and lymphocytes. This is the first report of Actinomyces associated with aspiration of cedar leaves. When the foreign body cannot be removed, it may be difficult to improve the condition by antibiotic administration alone, and surgery may be necessary.

A 58-year-old man presented with right-sided chest pain. Radiography and computed tomography showed a pleural effusion in the right chest and a mass in the right hilum. Thoracentesis showed a hemothorax. The carbohydrate antigen (CA) 19-9 level in the pleural effusion was very high, requiring differentiation from malignancy. Positron emission tomography showed no significant fluorodeoxy glucose (FDG) accumulation. Magnetic resonance imaging revealed a cystic lesion. The tumor was resected for both a diagnosis and treatment. A pathological examination demonstrated a bronchogenic cyst. An immunohistochemical study suggested that the cyst was the source of the hemothorax and the high CA19-9 level.

Background: Recently, advances in bronchoscopic techniques such as bronchial valves have been increasing in value for Chronic Obstructive Pulmonary Disease (COPD). Bronchial valve therapy has been proven to be useful for patients with lobar heterogeneous emphysema and complete fi ssure. In this study, we measured emphysema scores and fi ssure integrity in patients with emphysema, then classifi ed these based on computed tomography image patterns to examine which patients were candidates for bronchial valve therapy. Methods: Between February 2013 and May 2014, we studied 40 consecutive patients with CT-detected emphysema. Quantitative CT imaging analysis was performed using software. Emphysema scores per lobe were converted to the Likert scale, where a score of 1 equals 1 to 25%, 2 (26 to 50%), 3 (51 to 75%), and 4 (76 to 100%). Lobar heterogenity of more than or equal to a 2-unit difference was needed between the adjacent lobes. The heterogeneous group was divided into complete and incomplete fi ssure groups. Fissure integrity scores of 80% and < 80% were defi ned as complete and incomplete fi ssure integrity, respectively. Results: Forty patients were classifi ed into either a heterogeneous group (5 patients), or a homogeneous group (35 patients). The heterogeneous group was then divided into a complete fi ssure group (2 patients) or incomplete fi ssure group (3 patients). In the homogeneous group, 14 patients were classifi ed into the complete fi ssure group and 21 patients to the incomplete fi ssure group. This study revealed that, of the 40 patients who were indicated, only 2 patients met the criteria of heterogeneous and complete fi ssure for bronchial valve therapy. Conclusion: We attempted to select candidates for bronchoscopic lung volume reduction with valve using VIDA Apollo software. However, we could not recruit a suffi cient number of outpatients with CT-detected emphysema.