We describe a 56-year-old man with the new onset of hemoptysis, increasing in frequency and magnitude, initially diagnosed and treated as pulmonary embolism. Bronchoscopy, computed tomography, and thoracic aortography were performed twice before the diagnosis was made. Thirteen years previously, the patient underwent thoracic aortic interposition graft placement for aortic laceration as a result of a motor vehicle accident. The second aortogram demonstrated a small pseudoaneurysm at the expected proximal graft suture line. Aortobronchial fistula, a rare cause of hemoptysis, was diagnosed. The patient underwent successful resection of the graft and placement of a new dacron interposition graft. All cultures, including blood, sputum, and operative specimen cultures, were negative. The patient is alive and well 1 year following surgery.

We report two cases of tracheobronchomegaly with differing presentations. The radiologic, fiberoptic bronchoscopic, and clinical findings as well as management of this rare condition are reviewed.

Two adult patients with cor triatriatum, which was shown by echocardiography and magnetic resonance imaging (MRI) using both spin-echo and cine-MR techniques, are presented. Spin-echo MRI clearly demonstrated an anatomical relationship between the membrane and pulmonary veins or left atrial appendage, which was not clear on transthoracic echocardiography. In addition, cine-MRI depicted abnormal flow through the fenestration of the anomalous membrane (case 1 and 2) and shunted flow through the associated atrial septal defect (case 2).

Six patients with the acquired immunodeficiency syndrome (AIDS) who suffered eight spontaneous pneumothoraces between January 1990 and January 1993 underwent videothoracoscopy. The predominant macroscopic findings, found in four patients on five occasions, were white-yellow nodules dispersed throughout the lung surface. In addition, in one patient, these lesions were associated with multiple small apical bullae and, in another, a large reddish nodule with several smaller white satellite nodules was noted on the parietal pleura. Methenamine silver stain of biopsy samples of both the visceral and parietal nodules in these patients showed the presence of Pneumocystis carinii. May-Grunwald-Giemsa stain of brushing samples of visceral lesions revealed P-carinii in two patients. In one of these patients, previously performed bronchoalveolar lavage (BAL) had not yielded P-carinii. On two occasions, the thoracoscopic findings were unremarkable, although in one of these patients, computed tomography (CT) had shown a large thick-walled cyst near the left hilum and BAL revealed P-carinii. Talc poudrage through the thoracoscopic cannula followed by chest tube drainage was performed in all patients and was successful in treating three of five with proved P-carinii pneumonia-related pneumothorax. The etiology of pneumothorax in AIDS and the diagnostic and therapeutic utility of videothoracoscopy in these patients are discussed.

We describe the clinical and pathologic findings of a patient with mixed blastoma-germ cell malignancy primary in the lung. Serum alpha-fetoprotein levels were elevated at presentation, and normalized with anti-germ cell chemotherapy. The resection specimen contained massively necrotic germ cell tumor with viable mature neural tissue, plus viable biphasic blastoma with stromal bone and skeletal muscle differentiation. It is not clear whether the germ cell component represents unusual differentiation of a somatic cell line or whether the blastoma component represents an unusual pattern of teratomatous differentiation.

Reported herein is a second case of a patient who developed adult respiratory distress syndrome secondary to babesiosis. The features of acute lung injury after babesiosis will be described.