Background: It is important to confirm preoperative tracheobronchial invasion to enable the selection of the most appropriate treatment. Objective: This study was performed to compare the usefulness of computed tomography (CT), magnetic resonance image (MRI) and bronchoscopy by endobronchial ultrasonography (EBUS) for the assessment of invasion of thyroid or esophageal cancer in cases with suspected tracheobronchial invasion. Methods: In cases with suspected contact between the tumor and tracheobronchial wall, CT, MRI and EBUS indicated deformity of the tracheobronchial wall due to the adjacent mass. The final diagnosis was based on surgical and histological results, and/or clinical follow-up. Results: Fifty-four patients were included in this study. Based on the findings of CT, MRI and EBUS, invasion was suspected in 29, 28 and 25 patients, respectively. Seventeen patients did not undergo surgery based on the results of CT, MRI and bronchoscopy with EBUS. Final diagnosis was intact trachea or bronchial adventitia in 26 patients and invasion in 28 patients. The sensitivity and specificity of CT, MRI and EBUS for invasion were 59 and 56, 75 and 73, and 92 and 83%, respectively. The accuracy of EBUS was significantly greater than that of CT in the present study (p = 0.0011). The accuracy of EBUS was significantly different from that of CT and MRI in the surgically treated patients (p = 0.005 and p = 0.032, respectively). Conclusion: EBUS is the most useful technique for determining the depth and extent of tumor invasion into the airway wall. The combination of MRI and EBUS will contribute to surgical planning in patients with esophageal and thyroid cancer.

The patient was a 30-year-old

The standard treatment of adenoid cystic carcinoma (ACC) of the airway is surgery if possible, since survival rate is better than other treatments including radiotherapy. Although ACC shows frequent recurrence during the long term follow up unless there has been a complete resection (negative surgical margin), no further treatments are recommended. This report describes how argon plasma coagulation using flexible bronchoscopy has been successfully employed in the treatment of ACC after conventional therapy in one case of recurrence after surgery and two cases of inoperable patients. All of the patients are alive and healthy more than six years after diagnosis.

A 71-year-old male, who had been followed up after being treated with chemo-radiotherapy for non-small cell lung cancer (adenocarcinoma), rapidly developed dyspnea and mild fever. Radiographs showed left pleural effusion and cardiomegaly, and echocardiographic examination revealed echo-free space, suggesting a pericardial effusion. The patient was treated conservatively without any surgical procedures such as pericardiocentesis. Disappearance of the echo-free space was followed by development of pericardial constriction within two months. At post-mortem examination, a direct extension to the pericardium from the primary lesion of the right upper lobe through the mediastinum was observed. The rapid development of pericardial constriction is extremely rare in patients with malignant pericarditis.

Patients with end-stage lung disease can undergo living-donor lobar lung transplantation (LDLLT), with survival rates improving every year. We herein report the 20-year follow-up findings of the first patient who underwent LDLLT in Japan. A 24-year-old woman with primary ciliary dyskinesia became ventilatordependent after severe respiratory failure and right-sided heart failure following repeated respiratory infections. In 1998, she underwent LDLLT and received her sister's right lower lobe and her mother's left lower lobe. Although the patient required 21 hospitalizations and developed unilateral bronchiolitis obliterans syndrome, she is in good physical condition and lives without restriction at 20 years after undergoing LDLLT.