Accurate localisation of small or non-palpable pulmonary lesions is critical for successful minimally invasive resection. Indocyanine green (ICG)-soaked embolisation coil placement is an emerging fluorescence-guided marking method, typically applied to subpleural nodules. We present a four-patient case series-the first in Germany-where ICG-soaked embolisation coils were placed using ultrathin bronchoscopy, a standard cytology brush catheter and cone beam CT (CBCT) guidance, without robotic bronchoscopy. Lesions were confirmed with radial endobronchial ultrasound (EBUS), and resection was performed via uniportal video-assisted thoracoscopic surgery (VATS). Marking was successful in all cases without complications. One patient underwent dual-coil placement to enable three-dimensional bracketing of a non-subpleural lesion, facilitating precise anatomical resection. Histologies included squamous cell carcinoma (n = 1), adenocarcinoma (n = 1), hamartoma (n = 1) and typical carcinoid (n = 1). All patients achieved R0 resections. ICG-soaked coil placement via ultrathin bronchoscopy is a safe, reproducible and effective localisation technique, even in centres without robotic navigation systems. This series demonstrates feasibility across diverse lesion locations and expands the applicability of fluorescence-guided thoracic surgery to more centrally oriented nodules.
Background: Gastrointestinal bleeding (GIB) is a common and serious complication in patients with left ventricular assist devices (LVADs), contributing to significant morbidity, prolonged hospitalization, and increased healthcare costs. We evaluated national trends, demographic disparities, and outcomes of GIB in hospitalized LVAD patients. Methods: We analyzed adult (≥18 years) LVAD hospitalizations in the National Inpatient Sample (2016–2021), identifying internal LVADs using ICD-10-PCS code 02HA0QZ. GIB was defined using ICD-10-CM codes and classified into upper (UGIB) and lower (LGIB) sources. Survey-weighted logistic and linear regression models assessed associations with mortality, length of stay (LOS), and total charges. Subgroup analyses explored sex and racial disparities. Results: Among 20,785 weighted adult LVAD admissions, 9.8% had GIB. Of these, 72.3% had LGIB and 31.0% had UGIB. Patients with GIB were older (59.2 vs. 54.8 years) and more likely to be female (43% vs. 40%) and Black (9.2% vs. 7.8%). GIB was associated with longer LOS (+15.3 days, 95% CI: 12.0–18.5), higher charges (+$316,031, 95% CI: $212,435–$419,627), and greater in-hospital mortality (OR 1.69, 95% CI: 1.25–2.29; p < 0.001). Female patients with GIB had higher odds of mortality (OR 1.37) and increased LOS (+5.6 days), though this was not statistically significant. Racial disparities were evident: Black patients with GIB had longer LOS (+8.9 days), while Asian/Pacific Islander patients had shorter LOS (–23.3 days, p < 0.001). From 2016 to 2021, GIB prevalence rose modestly (from 9.4% to 10.7%, p = 0.33), with no significant change in mortality trends (p = 0.13). Conclusions: GIB complicates nearly 1 in 10 LVAD hospitalizations, with lower GI bleeds being most common. GIB is independently associated with higher mortality, LOS, and costs. Persistent gender and racial disparities highlight the need for targeted strategies to improve outcomes in this high-risk population.
Sarcoidosis is a multisystem granulomatous disease in which osseous involvement is uncommon and most often affects the small bones of the hands and feet, whereas axial skeletal disease remains underrecognized and may mimic metastatic malignancy. A 72-year-old man with longstanding pulmonary sarcoidosis and moderate persistent asthma was incidentally found to have multifocal sacral and iliac bone lesions on lumbar spine magnetic resonance imaging (MRI) obtained for evaluation of back pain and radiculopathy. These lesions were radiologically suspicious for osseous metastases, prompting systemic staging with fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-CT) and referral to hematology/oncology. PET-CT demonstrated low-level FDG uptake within the sacral and iliac lesions, diffuse splenic hypermetabolism, and calcified mediastinal and hilar lymph nodes compatible with prior granulomatous disease, but no hypermetabolic lymphadenopathy or dominant osseous mass. CT-guided biopsy of a left iliac crest lesion revealed focal non-necrotizing granulomas negative for acid-fast bacilli, fungal organisms, and malignancy, establishing the diagnosis of osseous sarcoidosis in the context of systemic disease. The patient's back pain improved with conservative measures, and he remained without progressive pulmonary or skeletal symptoms under multidisciplinary surveillance. This case highlights that vertebral and pelvic bone lesions in older patients with granulomatous lung disease may represent sarcoidosis rather than metastatic cancer and underscores the importance of tissue confirmation when imaging findings are indeterminate.
Chronic occult aspiration is an underrecognized cause of airway-centered and interstitial lung disease and can mimic inflammatory or fibrotic pulmonary disorders. Microcrystalline cellulose, a widely used pharmaceutical excipient, can provoke a foreign body giant cell reaction when aspirated into the lower respiratory tract. Because aspirated material may be focal, it can be missed on small biopsy specimens, delaying diagnosis and leading to inappropriate treatment. We report a case of a 54-year-old woman with progressive exertional hypoxemia and diffuse ground-glass opacities initially concerning for interstitial lung disease. Transbronchial lung cryobiopsy demonstrated polarizable foreign material consistent with microcrystalline cellulose, accompanied by a foreign body giant cell reaction, establishing aspiration-related lung disease. This case emphasizes the importance of considering pill excipient aspiration in patients with recurrent aspiration risk and highlights the diagnostic value of transbronchial lung cryobiopsy in unexplained interstitial lung disease.
BACKGROUND:Social media (SM) has emerged as a tool for health-related usage among US adults, including cancer screening promotion. Here, we aimed to assess the differences in health-related SM use between US and foreign-born adults and the relationship between health-related SM use and colorectal (CRC) screening practices. METHODS:Using data from the fifth edition of the National Cancer Institute's Health Information National Trends Survey (HINTS 5), cycle 2, we compared the differences in health-related SM use between US and foreign-born adults and the effects of SM use on CRC screening by country of birth. We included adults aged 50-75 and excluded participants with a history of CRC. The primary endpoint was CRC screening, which was determined by self-reported CRC screening using colonoscopy, sigmoidoscopy, or stool occult blood testing. RESULTS:Our study included 1,812 adults, of whom 236 (13.0%) were foreign-born. Most participants (72.1%) reported undergoing CRC screening. Interestingly, we found no discernible difference in health-related SM use [odds ratio [OR] 0.91; 95% CI (0.49, 1.69)] between US and foreign-born adults. Furthermore, our analysis revealed that SM use did not influence CRC screening practices among either group (US-born: 0.88 [95% CI: 0.50, 1.52], foreign-born 0.52 [0.10, 2.51]). CONCLUSION:Contrary to previous studies, which showed a positive relationship between SM use and satisfactory health-related practices, we found that although foreign-born adults use SM as much as US-born adults, there was no significant relationship between SM use and CRC screening.
