case_images: PMC9852504_01
case_images: The dynamic changes in enhanced chest CT images at different time points. Mediastinal (top) and lung window (bottom). (A) At admission, Chest CT showed a mediastinal mass measuring 7.76 x 4.55 cm (arrow). (B) During discharge, Chest CT showed a decrease in the size of mediastinal mass to 5.53 x 4.51 cm (arrow). (C) After six months of treatment, Chest CT showed obvious absorbance of the mediastinal lesions. (D) One and a half years follow-up Chest CT showed obvious absorbance of the mediastinal lesions.
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case_images: F1
case_images: C-reactive protein level was high (90.61 mg/L), and a procalcitonin level was slightly increased (0.173 ng/ml). Contrast-enhanced chest CT revealed a large mediastinal mass measuring approximately 7.76 x 4.55 cm (Figure 1A). One month after treatment, the patient improved, and their Chest CT showed a decrease in the size of the mediastinal mass (Figure 1B). His CT showed significant improvement in the mediastinal mass size (Figure 1C). At one and a half years of follow-up, the patient recovered well, and no complications were noted (Figure 1D).
case_images: Three-dimensional anatomical structures were reconstructed using a VBN system (archimedes virtual bronchoscopy navigation system). (A) Intraluminal view and puncture sight (green). (B) Axial view of the location of the mediastinal lesion (green dot). (C) Coronal view of the location of the mediastinal lesion (green dot). (D) VBN image showed the target lesion (green dot) and the route for TBNA (light blue line). (E) the anatomical structure of the mediastinal mass and bronchial tree.
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case_images: PMC9852504_01_fsurg-09-983074-g002.jpg
case_images: F2
case_images: The VBN system shows the bronchial tree, the anatomical structure of the mediastinal mass and visualizes the best path to reach the mediastinal mass (Figures 2A-E).
case_images: Ultrasound images of EBUS-TBNA. (A) Convex-probe ultrasound demonstrates the hypoechoic lesion (arrows), while the endoscopic Doppler image reflects the blood flow within the right atrium. (B) EBUS-TBNA was performed using a 22-gauge needle.
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case_images: PMC9852504_01_fsurg-09-983074-g003.jpg
case_images: F3
case_images: With the guidance of the VBN system, the bronchoscope was navigated to the target bronchus and advanced to the lesion, and then EBUS-TBNA was performed to obtain purulent exudate (Figures 3A-D).
case_images: (A) H&E stain for the biopsy showed more purulent secretions and a few lymphocytes and macrophages (X40). (B) Kinyoun stain for the samples on the aspirate smear showed numerous weakly acid-fast and branching filamentous rod bacteria (X100). (C) The biopsy samples were incubated at 35  C for 7 days and formed milky colonies floating on the medium liquid surface. The medium liquid was clarified.
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case_images: PMC9852504_01_fsurg-09-983074-g004.jpg
case_images: F4
case_images: Biopsy showed more purulent secretions and a few lymphocytes and macrophages (Figure 4A). Microscopic analysis revealed numerous weakly acid-fast and branching filamentous rod bacteria were identified from the samples on the aspirate smear, and a presumptive microbiological diagnosis (Nocardia) was made (Figure 4B). And after seven days of culture, the cultures of purulent exudates ultimately grew the Nocardia species (Figure 4C).