A 44-year-old man presented with progressively increasing nonproductive cough associated with a sensation of heaviness over the upper chest for 7 months. He had no dyspnea, fever, hemoptysis, chest pain, headache, or weight loss. His clinical examination was unremarkable. Complete blood hemogram, coagulation profile, blood sugar, and results of renal and liver function tests were normal; ECG and spirometry results were also normal. A posteroanterior view on chest radiograph showed a right paratracheal stripe. A contrast-enhanced CT scan of the chest revealed a right paratracheal mass extending to the precarinal area, measuring 33 Â 54 mm with internal hypoattenuation (0 Hounsfield unit) surrounded by an imperceptible wall, associated with narrowing of the superior vena cava (SVC) (Fig 1).Endobronchial ultrasonography (EBUS) was performed in the semi-recumbent position with the BF-UC180F convex probe echo-bronchoscope (Olympus America) via the oral route. The procedure was performed under IV conscious sedation (combination of IV midazolam and fentanyl), augmented with topical anesthesia with 2% lidocaine solution, along with continuous low-flow nasal oxygen and hemodynamic monitoring. Sequential scanning at a frequency of 7.5 MHz along the tracheal wall enabled the identification of an anechoic structure extending along the right paratracheal area, measuring w40 Â 70 mm distally and extending anteriorly over the precarinal area. EBUS-guided transbronchial needle aspiration (EBUS-TBNA) was performed at its most dependent distal end with a 21-gauge EBUS-TBNA needle (ViziShot single-use aspiration needle; Olympus America) (Fig 2, Video 1). Following puncture, suction was applied by using the VacLok negative pressure syringe (Merit Medical Systems) with a suction pressure of 20 cm H 2 O of air (Video 2). A total of 35 mL of clear straw-colored fluid was aspirated (Fig 2).

Introduction and Aim: Interstitial lung disease (ILD) is a heterogeneous disorder that share common clinical, radiographic, and physiological features. Most patients with ILD usually experience an exertioninduced dyspnea as first symptom. A noticeable change in oxygen saturation was noticed in ILD patients while exercise. The study objective was to ascertain the functional parameter that correlates best with ILD by comparing age, sex, and smoking history with different ILD pattern. Materials and Methods:A proforma (including Six Minute Walk Test and Pulmonary Function Test with lung diffusion capacity) for one-year period (September 2014 -November 2015) was taken for the 40 included participants. The study includes patients with Interstitial Lung diseases diagnosed by clinical, radiological and spirometric parameters. The study tests the sensitivity and the specificity of six-minute walk test versus lung carbon monoxide diffusing ability.Results: A total of 40 participants were included (19 were males and 21 were females). 12 were smokers and 28 were non-smokers. 20 patients belonged to Usual Interstitial Pneumonia (UIP) pattern, 14 were Non-Specific Interstitial Pneumonia (NSIP) and 6 were others. The mean±SD spirometric parameters were FEV1/FVC=101.71±16.752, FVC=55.29±17.322, FEV1=57.66 ± 20.246. Conclusion:There was no statistical significance between age, gender, smoking and ILD patterns. Spirometer and diffusion capacity indices co-relate best with NSIP pattern of ILD in our study. In a resource limited setting, clinical and radiological assessment of ILD with six-minute walking distance and spirometry should or need not be supplemented by DLCO for severity assessment.