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Carcinoid tumors of the lung are an uncommon malignancy that can rarely lead to carcinoid syndrome. Carcinoid tumors represent less than 1% of all lung cancers. This case describes a rare presentation in which a previously asymptomatic woman began to experience tachycardia, shortness of breath, and anxiety after biopsy of a pulmonary carcinoid tumor. Chest CT, histology, and clinical course supported the diagnosis and the patient's symptoms quickly resolved with medication. Ultimately, surgical removal of the tumor led to complete resolution of symptoms.

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Computer tomography (CT)-guided percutaneous core biopsies are currently the gold standard in diagnostic procedures for patients with bone lesions of unknown kind. CT-guided biopsies can lead to misdiagnosis or repetition of biopsies in case of small or heterogeneous lesions. We hypothesize that molecular image guidance could be used to optimize the biopsy strategy, by supporting the detection of heterogeneous lesions or lesions without radiographic substrate. To evaluate this hypothesis, we investigated if and how the addition of 2-deoxy-2-18F-fluoro-D-glucose-positron emission tomography (18F-FDG-PET)/CT could augment routine CT-guided bone biopsies. To this end, 106 patients who underwent a CT-guided bone biopsy between April 2019 and April 2020, obtained from either a vertebral or peripheral bone, were included. Patients were divided into 2 groups: 36 patients received an 18F-FDG-PET/CT scan prior to their CT-guided bone biopsy (PET group), while 70 patients only had a morphological CT scan (CT group). Histopathology was used to categorize biopsies into five subgroups (inconclusive, benign, malignant or infectious disease, or normal tissue). In the PET group, the number of conclusive biopsies was significantly higher compared to the CT group (N = 33/36 (92%) versus N = 53/70 (76%); p < 0.05). Furthermore, the number of first-try biopsies was lower in the PET group compared to the CT group (1.9 vs. 2.54, p = 0.051). In conclusion, 18F-FDG-PET/CT imaging significantly increased the success rate of first-try CT-guided bone biopsies by showing less inconclusive biopsies and misdiagnosis.

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OBJECTIVE: The primary goal of this study was to establish the current microbial trends in vertebral osteomyelitis/discitis (VOD) amid the opioid epidemic and to determine if intravenous drug use (IVDU) predisposes one to a unique microbial profile of infection. METHODS: The authors performed a retrospective cohort study consisting of 1175 adult patients diagnosed with VOD between 2011 and 2022 at a single quaternary center. Data were acquired through retrospective chart review, with pertinent demographic and clinical information collected. RESULTS: Staphylococcus aureus was the most cultured organism in both the IVDU and non-IVDU groups at 56.1% and 40.7%, respectively. In the IVDU cohort, Serratia marcescens was the next most prevalently cultured organism at 13.9%. CONCLUSIONS: The present study demonstrates that in the IVDU population S. marcescens is an organism of high concern. The potential for Serratia spp. infection should be accounted for when selecting empirical antimicrobial therapy in VOD patients.

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Littoral cell angioma (LCA) is a rare vascular tumor of the spleen that often requires histopathological analysis for diagnosis due to non-specific imaging features. The current approach is either splenectomy or image-guided percutaneous biopsy which carries notable procedure-associated morbidity and limited accuracy. We present a novel case of LCA successfully diagnosed with endoscopic ultrasound fine-needle aspiration biopsy (EUS-FNAB), demonstrating its potential to reduce the morbidity associated with traditional percutaneous biopsy methods. This case highlights EUS-FNAB's advantage in minimizing complications and its effectiveness in diagnosing vascular tumors of the spleen, supporting its inclusion in the diagnostic algorithm for splenic lesions. Further cases are encouraged to explore EUS-FNAB's role in diagnosing rare vascular tumors such as LCA to establish its efficacy and safety profile.

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Background Lung carcinoma is a leading cause of death worldwide. Histological subtype of lung adenocarcinoma is an important indicator of patient's outcome as it is helpful in surgical planning and guidance of prognosis. Objective To determine the diagnostic efficacy of computerized tomography-guided core needle biopsy (CNB) in identifying the histopathological subtype of lung adenocarcinoma. Methods and materials This is a retrospective, descriptive study including clinical data of 73 patients irrespective of their age and gender, who underwent computerized tomography-guided CNB for lung masses at the Department of Pathology, Aznostics - the Diagnostic Centre, Lahore, Pakistan from January 01, 2019 to June 30, 2023. Data collected was analyzed via Google Form (Google Inc., Mountainview, CA) and Statistical Package for Social Sciences (IBM SPSS Statistics for Windows, Version 24, released 2016; IBM Corp., Armonk, New York, United States) and was sent to statistician for descriptive analysis. Categorical data was used for calculating frequency and percentage, while continuous data was computed as mean and standard deviation. Results Seventy-three patients with adenocarcinoma underwent pulmonary biopsy. The mean age of included patients was 64.88 ± 11.39 year with a male predominance of 61.64%. Upper lobe was commonly affected by adenocarcinoma lung in 57.53% patients and 58.90% cases involved the right lung. The most common subtype was acinar with 51.65% followed by solid with 17.58% cases. Computerized tomography-guided CNB showed a diagnostic yield of 75.34% and identified histological subtypes of lung adenocarcinoma in 55 cases. Conclusion Computerized tomography-guided CNB is a useful, yet minimally invasive diagnostic tool to identify the histological subtype of lung adenocarcinoma. It not only helps in planning the surgical and adjuvant management of the patients, but also guides the patient-prognosis.

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A tuberculous aneurysm is an uncommon extrapulmonary tuberculosis and is usually fatal. The best way to treat it involves a combination of open surgery and medical treatment. However, it can be challenging to diagnose a tuberculous aneurysm. In this report, we describe a patient with a tuberculous aneurysm who was treated with stent-graft replacement and CT-guided biopsy for diagnosis, followed by nine months of anti-tuberculosis therapy. Despite one week of anti-tuberculous therapy, her fever persisted. A CT scan revealed new, well-defined nodules measuring 1-2mm in the lungs and hepatomegaly, indicating complications of miliary tuberculosis. After three weeks after the CT-guided biopsy, Mycobacterium tuberculosis grew from the arterial wall tissue, leading to the diagnosis of a tuberculous aneurysm complicated by miliary tuberculosis. The patient's aneurysm disappeared on follow-up CT scans, and the patient has been under observation for five years without a relapse. This rare case of tuberculous aneurysm can provide lessons for countries with a low prevalence of tuberculosis. This suggests the possibility of treatment with stent-graft replacement and anti-tuberculous medication and the usefulness of CT-guided biopsy for microbiological and pathological diagnosis.

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INTRODUCTION: The onset of the COVID-19 pandemic, with urgent implementation of safety protocols limiting the number of on-site personnel, essentially terminated the use of rapid on-site evaluation (ROSE) for computed tomography (CT)--guided lung biopsies at our institution. The diminished use of ROSE during the pandemic prompted us to reevaluate the potential value of ROSE for CT-guided lung biopsies. MATERIALS AND METHODS: We retrospectively identified all CT-guided lung biopsies from 2017 to 2022. Associations between the use of ROSE, adequate diagnostic and ancillary testing (programmed death-ligand 1 immunohistochemistry and next-generation sequencing) outcomes, and other factors such as the number of passes performed and lesion size, were evaluated. RESULTS: Nine hundred twelve CT-guided lung biopsies were performed from 2017 to 2022; 171 (19%) utilized ROSE. The use of ROSE had been steadily decreasing prior to the pandemic but was essentially eliminated with the onset of the pandemic. By univariable analysis, the employment of ROSE was more likely to be associated with an adequate final diagnosis (odds ratio = 2.14, 95% confidence interval: [1.24-3.70], P = 0.006) and successful molecular testing (odds ratio = 2.16, 95% confidence interval: [1.11-4.21], P = 0.024). However, those associations were not present in multivariable analyses that incorporated the number of passes performed or lesion size. There were no differences in diagnostic adequacy or ancillary testing yields when comparing the periods 2017-2019 and 2020-2022, despite declining use of ROSE. CONCLUSIONS: If ROSE is not requested for CT-guided lung biopsies, proceduralists should err on the side of performing more, rather than fewer, passes, particularly for smaller lesions.

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Rheumatoid arthritis (RA) is an inflammatory multisystemic disease characterized by erosive arthritis with many extra-articular manifestations. Pleuropulmonary manifestations are frequently seen in patients with RA. Risk factors include male gender, severe erosive arthritis, high titers of rheumatoid factor, subcutaneous nodules, smoking, genetic predisposition, and the presence of other extra-articular manifestations of RA. We report a patient known to have RA presenting with multiple lung nodules. A 35-year-old female patient, known to have seropositive RA, was diagnosed 10 years ago. She was on oral corticosteroids (OCS) 5 mg daily, Upadacitinib 15 mg daily, and methotrexate (MTX) 20 mg weekly. The patient was referred for pulmonary medicine evaluation because of the finding of multiple lung nodules on chest imaging. A routine chest X-ray conducted as a part of the general evaluation showed a nodular opacity in the right lower lobe. Subsequently, a high-resolution CT (HRCT) scan of the chest was carried out and showed multiple pulmonary nodules. At the time of evaluation, she had no active respiratory symptoms with no signs of respiratory distress. As she was an active smoker, the decision was to proceed with a CT-guided biopsy besides full clinical, hematological, biochemical, and microbiological evaluations. The histopathological findings suggested a rheumatoid nodule with no evidence of malignant or infectious causes. No specific therapy was added at the time being, and the patient was monitored with regular follow-ups. Differentiation of rheumatoid lung nodules from other causes, such as malignancy and infectious causes, is essential. A biopsy with histopathological evaluation is a must in those with a high likelihood of malignancy, such as smokers. In addition to that, comprehensive clinical, hematological, microbiological, and radiological evaluations are required. Rheumatoid lung nodules are usually asymptomatic, with no specific therapy needed apart from the general management of RA with glucocorticoid, immunosuppressive, and biologic therapies.

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Objectives: The purpose of this study was to compare the diagnostic efficacy of PET/CT-aided CT-guided and routine CT-guided transthoracic needle biopsy for lung lesions. Methods: A total of 458 patients with suspicious lung lesions were referred for CT-guided biopsy, with 227 patients assigned to the PET/CT group and 231 patients assigned to the CT group. The clinical characteristics and diagnostic yield were compared between the two groups. Furthermore, conducting subgroup analysis to evaluate the differences of diagnostic success or failure between the two groups. Results: The sensitivity and diagnostic accuracy rate differed significantly (P = 0.035, P = 0.048). In the PET/CT group, the values were 95.7% and 96.3%, respectively, while in the CT group, they were 90.1% and 91.9%. When considering non-diagnostic cases, the overall diagnostic success rate increased markedly in PET/CT group (93.0% vs. 83.1%, P = 0.001). In our subgroup analysis, the PET/CT group demonstrated superiority in detecting lesions larger than 3 cm (OR, 4.81; 95CI%, 2.03 - 11.36), while showing a moderate effect in lesions smaller than 3 cm (OR, 1.09; 95CI%, 0.42 - 2.81). Significant effect modification was observed in large lesions in the PET/CT group (P for interaction = 0.023). Conclusions: 18F-FDG-PET/CT enhances the diagnostic efficacy of CT-guided transthoracic needle biopsy for lung lesions, and the incremental value can be modified by lesion size, particularly when the diameter is larger than 3 cm.

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Osteosarcoma stands as one of the primary mesenchymal bone neoplasms commonly encountered in clinical practice. This malignancy often presents with a wide range of distinctive imaging characteristics. Here, we present a unique case wherein a delayed diagnosis of high-grade osteosarcoma occurred due to the absence of an osteoid matrix in the initial imaging studies. A 61-year-old female, initially presented with a left humeral fracture. As the healing of the fractured bone was delayed and the possibility of a pathologic fracture was considered, a CT-guided biopsy was performed. Histological examination of the biopsy sample initially suggested an osseous leiomyosarcoma. The lack of osteoid matrix on radiographs including aggressive intra-medullary mass seen on MRI, combined with the patient's age, appeared consistent with a diagnosis of leiomyosarcoma of bone. As a result, the initial diagnosis was not called into question. Due to neurovascular involvement, this led to a forequarter amputation. However, upon microscopic examination of the amputation specimen, certain areas exhibited features indicative of malignant osteoid deposition, ultimately supporting a revised diagnosis of high-grade osteosarcoma. This case underscores the critical importance of considering the limitations of core biopsy samples, especially when dealing with suspected limb masses associated with pathological fractures. Radiographs and CT scans can prove invaluable in ruling out subtle adjacent osteoid, and ultimately a multidisciplinary approach to the diagnosis of osteosarcoma is imperative to ensure accurate identification.

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INTRODUCTION: The purpose is to clarify the safety and clinical contribution of computed tomography (CT)-guided percutaneous needle-biopsy for patients with cervical spine lesion. MATERIAL AND METHODS: Between June 2015 and August 2022, CT-guided percutaneous needle biopsies were performed for 15 cervical spine lesions of 15 patients (8 male, 7 female; 2-81 years old). The technical success, clinical contribution, and safety were evaluated. Technical success was defined as the completion of the biopsy procedure. Clinical contribution was defined as any contribution to the therapeutic strategy. Safety was assessed by the Common Terminology Criteria for Adverse Events, version 5.0. RESULTS: The technical success rate was 100%. In all 15 patients, nontarget organs (e.g., major vessels, spinal cord) could be avoided. The post-biopsy histological diagnoses were myeloma (n = 2), metastatic adenocarcinoma (n = 2), chordoma (n = 2), Langerhans cell histiocytosis (n = 3), and one case each of malignant lymphoma, schwannoma, pyogenic spondylitis, non-pyogenic spondylitis, degenerative change, and non-pathological fracture. All of these diagnoses contributed to the therapeutic strategy decisions. One case of grade 2 pain was observed, but no complications with grade 3 or more were observed during or after the biopsies. CONCLUSION: CT-guided percutaneous needle biopsies for cervical spine lesions were safe and clinically beneficial.

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PURPOSE: Although CT-guided biopsies of the calvarium, skull base, and orbit are commonly performed, the best approaches, efficacy, and safety of such procedures remain scantly described in the literature. This retrospective review of percutaneous biopsies illustrates several approaches to challenging biopsy targets and provides a review of procedural planning considerations and histopathologic yield. METHODS: A retrospective review of CT-guided biopsies of the skull base, calvarium, and orbit between 1/1/2010 and 10/30/2020 was conducted. Patient demographics and procedural factors were recorded, including lesion size and location, biopsy approach, and needle gauge. Outcomes were also noted, including CT dose length product, complications, and histopathologic yield. RESULTS: Sixty-one CT-guided biopsies were included in the final analysis: 34 skull base, 23 calvarial, and 4 orbital lesions. The initial diagnostic yield was 32/34 (94%) for skull base lesions, with one false-negative and one non-diagnostic sample. Twenty-one of twenty-three (91%) biopsies in the calvarium were initially diagnostic, with one false-negative and one non-diagnostic sample. In the orbit, 4/4 biopsies were diagnostic. The total complication rate for the cohort was 4/61 (6.6%). Three complications were reported in skull base procedures (2 immediate and 1 delayed). A single complication was reported in a calvarial biopsy, and no complications were reported in orbital biopsies. CONCLUSION: Percutaneous CT-guided core needle biopsies can be performed safely and with a high diagnostic yield for lesions in the skull base, calvarium, and orbit.

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OBJECTIVE: The purposes of this study were (1) to establish the feasibility and safety of an imaging-guided technique for intraosseous pressure (IOP) measurement in a large cohort of patients, and (2) to compare IOP values between normal and diseased bone marrow. METHODS: Adult patients undergoing CT-guided marrow biopsy were prospectively and consecutively enrolled from November 2020 to February 2022. IOP measurements were obtained connecting the biopsy needle to a monitoring device using a standard arterial line setup. Clinical data including sex, age and pathology results were obtained. Student t test and Pearson correlation were used for continuous variables comparisons. Univariable analyses were performed using Fisher's exact test. A P value of .05 was considered statistically significant. RESULTS: A total of 139 participants were initially enrolled, and four were excluded during technique optimization. There were no complications related to the measurement technique. Ninety participants (90/135, 67%) had histology confirming marrow pathology. The participants in the diseased marrow group were older than those in the normal marrow group (63 ± 14 vs. 55 ± 14 years; P < .01). There was no difference in mean IOP between both groups (66 ± 23 vs. 64 ± 28 mmHg; P = .69). There was no correlation between mean arterial blood pressure and mean IOP (P = .08). CONCLUSION: There was no difference in IOP measurements between patients with normal and diseased marrow undergoing CT-guided biopsy. IOP does not appear to be influenced by systemic blood pressure. No complication occurred during the procedures.

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Purpose: To assess the efficacy and safety of a low-dose, computed tomography (CT)-guided transthoracic biopsy of lung and pleural lesions. Material and methods: A total of 135 low-dose, CT-guided transthoracic lung and pleural lesions biopsies were performed. A cutting needle was utilized in 124 cases, and fine needle aspiration biopsy was performed in 14 cases. In all cases, 14- to 22-gauge biopsy needles were used. Results: Diagnostic material was obtained in 111 (82.2%) patients. In 97 (71.8%) cases neoplastic lesions were found, predominantly adenocarcinoma and non-small cell carcinoma. In 14 (12.6%) cases non atypical cells were reported. Biopsy failed to obtain material suitable for histopathological examination in 24 (17.7%) cases. Complications occurred in 31 patients, including pneumothorax in 28 patients and haematoma in 3 cases. Conclusions: Based on the obtained results, it can be stated that low-dose, CT-guided transthoracic biopsy of lung and pleural tissues is an accurate and safe procedure. Also, it is linked to a low risk of complications such as a small pneumothorax.

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Background: As lung cancer is one of the most significant factors seriously endangering human health, a robot-assisted puncture system with high accuracy and safety is urgently needed. The purpose of this investigation was to compare the safety and effectiveness of such a robot-assisted system to the conventional computed tomography (CT)-guided manual method for percutaneous lung biopsies (PLBs) in pigs. Methods: An optical navigation robot-assisted puncture system was developed and compared to the traditional CT-guided PLB using simulated lesions in experimental animals. A total of 30 pulmonary nodules were successfully created in 5 pigs (Wuzhishan pig, 1 male and 4 females). Of these, 15 were punctured by the optical navigation robot-assisted puncture system (robotic group), and 15 were manually punctured under CT guidance (manual group). The biopsy success rate, operation time, first needle tip-target point deviation, and needle adjustment times were compared between groups. Postoperative CT scans were performed to identify complications. Results: The single puncture success rate was higher in the robotic group (13/15; 86.7%) than in the manual group (8/15; 53.3%). The first puncture was closer to the target lesion (1.8±1.7 mm), and the operation time was shorter (7.1±3.7 minutes) in the robotic group than in the manual group (4.4±2.8 mm and 12.9±7.6 minutes, respectively). The angle deviation was smaller in the robotic group (3.26°±2.48°) than in the manual group (7.71°±3.86°). The robotic group displayed significant advantages (P<0.05). The primary complication in both groups was slight bleeding, with an incidence of 26.7% in the robotic group and 40.0% in the manual group. There was 1 case of pneumothorax in the manual group, and there were no deaths due to complications in either group. Conclusions: An optical navigation robot-assisted system for PLBs guided by CT images was developed and demonstrated. The experimental results indicate that the proposed system is accurate, efficient, and safe in pigs.

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BACKGROUND/AIM: This is a retrospective evaluation of whether percutaneous direct puncture biopsy of lung lesions contacting to the pleura is justified. PATIENTS AND METHODS: Between August 2016 and July 2021, 163 consecutive patients (100 males, 63 females with a median age of 73 years) who had malignant lung tumors measuring 0.6-12.4 cm (median, 2.9 cm) that contacted to the pleura and underwent percutaneous lung biopsy under computed tomography fluoroscopic guidance using an 18-gauge end-cut needle were examined. The trajectory was direct puncture in 80 patients (49.1%, 80/163), and trans-lung in 83 patients (50.9%, 83/163). Diagnostic yield and major adverse event rates of direct and trans-lung puncture biopsies were compared. RESULTS: No difference was found in diagnostic yield between direct puncture and trans-lung biopsies (93.8% vs. 98.8%, p=0.11). Major adverse events were major pneumothorax (n=13/163, 8.0%), pleural dissemination (n=18/163, 11.0%), and hemothorax requiring arterial embolization (n=1/163, 1.0%). Direct puncture caused major pneumothorax significantly less than trans-lung puncture did (0%, 0/80 vs. 15.7%, 13/83, p<0.001). No significant difference was found between the two biopsy methods regarding the incidence of pleural dissemination (11.0%, 11/80 vs. 8.4%, 7/83, p=0.32). CONCLUSION: Direct puncture biopsy of malignant lung tumors contacting to the pleura is justified.

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We present the case of a 32-year-old healthy male who presented with a three-month history of insidious onset pain and swelling over the right tibia. Initial radiographs and imaging pointed to a diagnosis of subacute osteomyelitis, as there was no cortical destruction, periosteal reaction, or soft tissue involvement. The patient underwent surgery for osteomyelitis. However, the histopathology and immunohistochemistry (IHC) findings pointed to a possible B-cell lymphoma diagnosis. The patient was referred to a tertiary-level oncology centre, where a repeat biopsy and positron emission tomography (PET) scan confirmed a diagnosis of primary bone lymphoma (PBL). Treatment was initiated immediately in the form of a combination of chemotherapy and radiotherapy, and the progress was followed up with further scans at four-month intervals. The patient achieved remission nine months after the initiation of treatment.

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Response evaluation of carbon-ion radiotherapy poses a diagnostic challenge. Due to its functional aspects, fluorodeoxyglucose positron emission tomography (FDG/PET) has a role in the diagnosis of photon radiation therapy. In addition, several studies suggested that FDG/PET may be useful to select the optimal site for performing a diagnostic biopsy. Here, we report a 73-year-old female in which FDG/PET was effective in determining the recurrence of liposarcoma and the therapeutic effect. Based on the results of FDG/PET, we could make a pathologic definitive diagnosis and selectively performing carbon-ion radiotherapy for active tumors.

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Pulmonary nodules are a frequent finding on imaging, especially given screening guidelines for lung cancer with low dose computed tomography (CT) scan. Here, we report a case with a single pulmonary nodule in a patient exposed to coal dust and asbestos. The nodule had benign features, but it showed an increase in size on repeated imaging. A CT-guided biopsy followed by mass spectrometry of the sample identified the nodule as the AL subtype of amyloidoma. A bone marrow biopsy was without evidence for malignancy including lymphoma. Nodular pulmonary amyloidosis (NPA) is rare, and a biopsy is required to establish the diagnosis. NPA generally does not affect lung function or impact survival; thus NPA does not require specific therapy. This case is the first documented case associated with coal-dust exposure. High-risk patients need to be followed longitudinally due to association of amyloidosis with lymphoma and other systemic conditions.

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Computed tomography (CT)-guided percutaneous core needle biopsy of the lung is a frequently performed interventional radiological procedure. Most complications are minor and self-resolving. However, a rare but potentially fatal complication is that of systemic air embolism, especially when to the cerebral or coronary arteries. This study reports a case of delayed (12 hours after initial biopsy) air embolism in the cerebral arteries that resulted from an otherwise uncomplicated biopsy of a lung nodule. It is vital for early diagnostic confirmation and appropriate treatment if possible, though maximal efforts at prevention are still recommended.