BACKGROUND:Non-small cell lung cancer (NSCLC) is the leading cause of cancer mortality worldwide. The recommended approach for mediastinal staging is a combination of both positron emission tomography- computed tomography (PET-CT) and endobronchial ultrasound (EBUS). Data on the correlation of PET-CT uptake to EBUS cytology and surgical lymph node biopsy is scarce. PATIENTS AND METHODS:Of 379 patients diagnosed with NSCLC, 65 underwent preoperative PET-CT, EBUS, and surgical lymph node biopsies. The correlations between EBUS cytology, fluoro-deoxy glucose (FDG) uptake (SUVmax) by PET-CT, and surgical biopsy were analyzed. RESULTS:About 229 lymph nodes derived from 65 patients were sampled, of which 67 lymph nodes had data from EBUS, PET-CT, and surgical biopsy. 58 nodes were negative in all modalities; 6 were malignant on EBUS but negative on surgical biopsy; 2 were malignant for both modalities; and one was EBUS negative but malignant in surgical staging. EBUS sensitivity was 89% with a negative predictive value of 98%. Six patients were upstaged after surgery due to inaccessible lymph nodes (at stations 5 and intralobar) for EBUS. No malignant lymph nodes had maximum standardized uptake (SUVmax) lower than 2.9. CONCLUSION:EBUS has high sensitivity and specificity rates, however it misses intralobar and station 5 lymph nodes which might upstage the patient after surgery. In cases when there is a high suspicion for malignant lymph nodes inaccessible to EBUS, other invasive strategies or neoadjuvant treatment should be considered. PET-CT was shown to be accurate in ruling out but not ruling in lymph node involvement.

BACKGROUND AND OBJECTIVE:The risk of bacteremia following bronchoscopy procedures is well studied but limited data exists on bacteremia following Endo-Bronchial Ultrasound (EBUS) Guided Trans-Bronchial Needle Aspiration (TBNA). This prospective study aimed to assess bacteremia incidence following EBUS-TBNA, compare the findings to other studies made for various bronchoscopy procedures and evaluate the necessity of antibiotic prophylaxis. METHODS:We prospectively collected blood cultures pre- and post-procedure from 100 patients who underwent EBUS-TBNA in a single large center. RESULTS:The study revealed a 3 % bacteremia following EBUS-TBNA with no correlation between bacteremia and lymph node location or size. CONCLUSION:The results align with prior bronchoscopy studies, suggesting bacteremia rates range between 2 % and 7 %, with no clear association with procedure type.

Reversed halo sign (RHS) is a radiological feature described as a focal, rounded area of ground-glass opacity surrounded by a ring of consolidation. In this report we describe two unique radiological cases demonstrating diffuse bilateral infiltrates with multiple RHSs in chest CT scans. Both patients were ultimately diagnosed as having tuberculosis (TB) and had been exposed to silica in the past. This report presents for the first time an association between silica exposure and RHS on CT scans among TB patients. It highlights the importance of having a high index of suspicion for TB in similar scenarios.

A 57-year-old female presented with sudden shortness of breath and migratory pulmonary infiltrates on imaging, which corresponds with a diagnosis of cryptogenic organizing pneumonia. Initial treatment with corticosteroids showed only mild improvement during follow-up. BAL was performed and revealed diffuse alveolar hemorrhage. Immune testing showed positive P-ANCA with positive MPO, leading to a diagnosis of microscopic polyangiitis.

Division of Pulmonary Medicine, Rambam Health Care Campus, Technion-Israel Institute of Technology, Haifa, Israel Disclosure: There is no conflict of interest or other disclosures.

BACKGROUND:Post mild COVID-19 dyspnea is poorly understood. We assessed physiologic limitations in these patients.METHODS:Patients with post mild COVID-19 dyspnea (group A) were compared (pulmonary function tests, 6-min walk test (6MWT), echocardiography and cardiopulmonary exercise test (CPET)) to post moderate/severe COVID-19 (group B) and to CPET and spirometry of patients with unexplained dyspnea (group C).RESULTS:The study included 36 patients (13 in A, 9 in B and 14 in C). Diffusion capacity was lower in group B compared to group A (64 ± 8 vs. 85 ± 9% predicted, p = 0.014). 6MWT was normal and similar in both patient groups. Oxygen uptake was higher in group A compared to groups B and C (108 ± 14 vs. 92 ± 13 and 91 ± 23% predicted, p = 0.013, 0.03, respectively). O2 pulse was normal in all three groups but significantly higher in the mild group compared to the control group. Breathing reserve was low/borderline in 2/13 patients in the mild group, 2/9 in the moderate/severe group and 3/14 in the control group (NS).CONCLUSIONS:Patients with post mild COVID-19 dyspnea had normal CPET, similar to patients with unexplained dyspnea. Other mechanisms should be investigated and the added value of CPET to patients with post mild COVID-19 dyspnea is questionable.

OBJECTIVES As life expectancy continues to rise, the burden of cardiovascular disease among older people is expected to increase, making cardiovascular prevention in older people an issue of growing interest and public health importance. We aimed to explore the long-term effects of adherence to statins on mortality and cardiovascular morbidity among older adults. DESIGN A historical population-based cohort study using routinely collected data. SETTING Clalit Health Services Northern District. PARTICIPANTS We followed members of Clalit Health Services aged 65 years or older who were eligible for primary cardiovascular prevention for a period of 10 years. MEASUREMENTS We fitted Cox regression models to assess the association between the adherence to statin therapy and all-cause mortality and cardiovascular morbidity, adjusting for cardiovascular risk factors and associated morbidity as time-updated variables. RESULTS The analysis included 19 518 older adults followed during 10 years (median = 9.7 y). All-cause mortality rates were 34% lower among those who had adhered to statin treatment, compared with those who had not (hazard ratio [HR] = .66; 95% confidence interval [CI] = .56-.79). Adherence to statins was also associated with fewer atherosclerotic cardiovascular disease events (HR = .80; 95% CI = .71-.81). The benefit of statin use did not diminish among beyond age 75 and was evident for both women and men. CONCLUSION Adherence to statins may be associated with reduced mortality and cardiovascular morbidity among older adults, regardless of age and sex.