Background: In 1883, Leyden described percutaneous lung biopsy, but it was not until 1970’s that image guided fine needle chest biopsy gained widespread acceptance. Haaga and Alfidi reported CT-guided thoracic biopsy in 1976. Currently, CT-guided core biopsy is playing an increasing role in the diagnosis of benign as well as malignant diseases, cellular differentiation, somatic mutation analysis, and molecular finger print analysis. Small tissue biopsy obtained through minimally invasive methods have become the primary diagnostic tools for the pathologic characterization and testing of lung masses Aim: To evaluate the diagnostic accuracy and complications of CT guided transthoracic lung (core) biopsy in radiologically visible lung lesions Materials and methods: One hundred and one patients who underwent CT guided transthoracic needle aspiration lung biopsy (TNAB) for radiologically visible lung lesions were studied. After obtaining informed consent, the patient was appropriately positioned depending on the site of the lesion. A coaxial 18G biopsy needle (by cook) was used for biopsy. An immediate CT screening was done post procedure to r/o complications. Results: Transthoracic needle aspiration biopsy was diagnostic in 88% (89/ 101) of patients. In case of malignancy even the histological type of tumor was known and adequate tissue was present for molecular sampling. The complication rate (pneumothorax) following CT guided biopsy was 5% (5/101)with 1%(1/101)requiring ICD insertion. One patient had minimal haemoptysis which subsided with conservative management. Conclusion: CT guided lung biopsy is a safe, cost effective and useful procedure for determination of different lung lesions with diagnostic challenge. The complication rates are very few in experienced hands.

Introduction: Mediastinal lymphadenopathy is expected to be the common mediastinal masses because this is caused by high prevalent diseases like tuberculosis, lung cancer metastasis, lymphoma and sarcoidosis etc. Mediastinal lymphadenopathies are difficult to biopsy since they are nearer to major vessels and airways and located commonly in the middle compartment. Hence mediastinal lymphadenopathy is under represented in many studies since unable to obtain tissue diagnosis. The newer techniques EBUS and EUS are made easier to approach the mass like lymphadenopthy in middle mediastinum with less complication. Objective: To know the effectiveness of real-time EBUS in the evaluation of mediastinal lymphadenopathy. Methodology: In our study 50 cases of mediastinal lymphadenopathy diagnosed by CT scan chest which were subjected to EBUS guided real time TBNA of mediastinal nodes. TBNA Specimens were sent for histopathological examinations and reports were collocated and analyzed. Results: Among 50 cases of mediastinal lymphadenopathy, arrived diagnosis in EBUS TBNA in 42 cases and inconclusive results in other 8 cases. Among 42 cases, tuberculosis in 17 cases [34%], malignancy in 16 cases [32%], sarcoidosis in 8 cases [16%], sub acute inflammation in 1 case [2%]. Conclusion: Before the advent of EBUS, Percutaneous transthoracic needle biopsy/FNAC (under CT or ultrasound guidance) or surgical procedures [VATS or Mediastinoscopy] were considered as the initial method of choice in evaluation of mediastinal lesions. EBUS techniques has demonstrated utility in the diagnosis of mediastinal lymphadenopathy secondary to malignancy, tuberculosis and sarcoidosis and easier and lesser complication than more invasive procedures like VATS or mediastinoscopy.

Evidence - based medicine is the norm of the day. Ever increasing recognition of marked phenotypic heterogeneity amongst patients with defined ‘severe asthma’ calls for precise, individualised patient-based treatment. Although international research has identified several clinical and inflammatory phenotypes of severe asthma, one of the innumerable hurdles that must be overcome in daily practice, is bridging of the knowledge gap between researchers and Physicians dealing with asthmatic patients in their daily clinical practice. While more enterprise is required to comprehend the relation between these phenotypes and their elemental disease mechanisms and pharmacological treatment responses, in-depth cognizance of these clinical and inflammatory phenotypes provide a good embarkation point for addressing disease heterogeneity in severe asthma in day to day practice. This review brings to the reader, comprehensive information on the clinical and inflammatory asthma phenotypes, their associations and related biomarkers and aims to emphasise the importance of recognition of these phenotypes in order to bring individualised patient management to the beside.

Ever since the initial discovery in the early 1990s, microRNAs have become the focus of a multitude of conditions from basic biology to clinical applications in both diagnostic and prognostic strata. Previously they were believed to be of no biological relevance. Even in diseases of the lung, microRNAs have been analyzed in the pathophysiology, as drivers of disease, potential treatment targets, and serum biomarkers; however, much is yet to be understood about these non-coding RNAs for us to fully realize their potential therapeutic use. Here, we give a brief insight into their role in major respiratory diseases unearthed so far and the road ahead to better understand this potential biomarker.

Melioidosis has varied clinical presentation involving different organs with pneumonia as common pulmonary presentation. Isolated mediastinal lymphadenopathy as presentation is rare. Herein, we describe a case of Melioidosis identified by endobronchial ultrasound guided transbronchial needle aspiration of subcarinal lymph node. This case stresses the need for clinical suspicion of melioidosis in patients from endemic areas and the role of endobronchial ultrasound in diagnosing it.

Mediastinal cysts account for 20% of all mediastinal masses. A 22-year-old pregnant female was admitted for delivery. She developed dyspnea on the 3rd day of delivery. Chest X-ray revealed a large right hydropneumothorax and tube thoracostomy was done. She was referred to us for further management. We decided to operate. At surgery, a ruptured cystic lesion was seen in the posterior mediastinum separate from all three lobes. It was communicating with the bronchus. The cyst was excised completely and bronchial communication was sutured. The lung expanded completely. Post operative period was uneventful. Histopathology revealed it to be a bronchogenic cyst.

Chylothorax is a rare clinical entity characterized by a milky white fluid within the pleural space. It is a rare condition in which damage or obstruction of the thoracic duct results in chyle leakage into the pleural space. The most common causes are surgical or nonsurgical trauma, neoplasms, tuberculosis and venous trombosis. Lymphoma accounts for 70% of the neoplastic cause, while other malignant causes are very rare. Chylothorax occurs most commonly on the right side and B/L chylothorax is a very rare presentation. We present a case of B/L chylothorax secondary to adenocarcinoma of lung.

Fibrous Dysplasia is a non inherited skeletal developmental abnormality, where normal bone is replaced by fibrous tissue and poorly formed area of immature bone. Monostotic lesions are 80% of the cases; and Polyostotic lesions are characteristic component of specific syndromes. It is usually detected in 1^st and 2^nd decade of life as an incidental finding and can cause occasionally dull aching pain². The clinical course is variable and depends upon the extent and location of the lesion. Fibrous Dysplasia is the most common benign rib lesion^3,4. In this case report, we describe a patient with large progressively increasing in size symptomatic rib tumour diagnosed as benign lesion with biopsy and underwent successful resection surgery.

Pulmonary agenesis is an extremely rare congenital anomaly defined as a complete absence of the lung parenchyma, bronchus, and pulmonary vessels. In case of complete unilateral agenesis, no pleural cavity can be found on the affected side. More than 50% of children with lung aplasia die within five years of birth but some individuals live a normal life span with their deformity and may be asymptomatic throughout life. Respiratory tract infections are the greatest danger in these individuals. We report a case of left lung aplasia with bronchiectasis in a young-aged adult who was treated for tuberculosis and was referred to our institute for persistent cough.