Studies were made on radiological and pathological changes of the lung in leukemias, based on 139 cases of leukemia treated at the First Department of Internal Medicine, Nagoya University School of Medicine during 1960 through 1970, and also analysis were performed on clinical factors contributing to the appearance of abnormal chest roentgenogram.
Abnormal chest roentgenograms were found in 79 of 139 cases (41 of 70 cases with acute yelogenous leukemia, 13 of 21 cases with acute paramyeloblastic leukemia, 11 of 14 acute monocytic leukemia, 1 of 1 case of erythroleukemia, 6 of 20 cases with acute lymphatic leukemia, and 6 of 12 cases with chronic mylogenous leukemia).
Types of abnormal roentgenological findings frequently observed, involved mottled and infiltrative shadows.
Pathological changes observed in lungs of 57 cases out of 59 autopsyed leukemic cases were as follows: leukemic infiltration in 19, hemorrage in 31 cases and infection in 22 cases (with common bacteria in 15 cases, with fungus in 7, with tubercle bacilli in 3 and with cytomegal virus in 3).
Comparative study of chest roentgenograms and pathological findings of lungs revealed that micronodular and reticular shadows represent malignant cell infiltrations and infiltrative shadows infection and/or hemorrage.
In case of leukemias abnormal chest roentgenological findings were seen more frequently in those patients treated since 1968 than in those treated before that year, and they were more frequent in those patients that died of infection than in those that died of other causes. Abnormal chest roentgenological findings were also frequent in patient who suffered from granulocytopenia or lymphopenia or febrile episode above 38°C, or received antileukemic chemotherapy, especially after corticosteroids treatment with 60mg or more of predonisolone per day.
The accumulate rate of appearance of abnormal chest roentgenograms was 61.8% after 6 weeks therapy with three antileukemic drugs in combination including corticosteroids.
The prognosis of the cases with abnormal chest findings was found to be serious and 65.4% of the cases were dead 4 weeks after appearance of abnormal chest findings.
Withdrawal of corticosteroid and initiation of antimicrobial treatment with 2 or more of antibiotics are recommended when abnormal chest roentgenological findings are observed.

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1) Abnormal pleural findings were observed in chest roentgenograms in 10 sarcoidosis patients out of 64 histologically proved sarcoidosis cases. Ten cases with abnormal findings consisted of 3 cases showing sisappearance of cost pleural angle and 7 cases showing swelling of hair lines between upper and middle lobe. In one case of the former group non caseating epitheloid cell granuloma was found by pleural biopsy, and 5ml of exsudate was drawn.
2) Pleural reaction in sarcoidosis was observed more frequently in long-standing cases than in cases with short duration. The pleural reaction often appeared coincidently with the exacerbation of pulmonary sarcoidosis. The pleural lesion in sarcoidosis was slight in degree in most of the cases, but sometimes exacerbated in several times. The prognosis of the lesion, usually, seemed to be favorable.

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In this paper we describe a new method to get a histological diagnosis from patients with lung diseases.
Our new method is performed under intubation anesthesia using an optical glass-fiber thoracoscopy through a small skin incision, of approximately 1.5cm. After having carried out the thorough observation of the lung surface with the optical glass-fiber thoracoscopy, lung biopsy is performed subsequently with forceps, looking at the lung lesion. When the biopsy is over, meticulous hemostasis of the bleeding of the lesion is then made by electrocoagulation, not by hemostats nor by ligations. And air leakage is completely subsided by applying tissue adhesive, made of cyanoacrylate, Alonalpha R. The involved lung is reflated through intratracheal tube, after ascertaining that bleeding and air leakage from the lesion is no more observed. Usually we did not use the drainage tube.
We have performed this new lung biopsy, named
“Trans-thoracoscopic lung biopsy”, on patients with various pulmonary and pleural diseases. Of all 11 biopsies performed, one revealed an alveolar cell carcinoma (disseminated type), one alveolar proteinosis, two sarcoidosis of the lung, one miliary tuberculosis, three pulmonary fibrosis, two primary pulmonary carcinoma and one metastatic pulmonary carcinoma. In each case a histological diagnosis was obtained.
We conclude that the “Trans-thoracoscopic lung biopsy” is especially indicated in cases with disseminated lung shadows, in chest Roentgenogram, as it is possible to be applied repeatedly before and after treatments.

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Patient was a 62-year-old male with chief complaint of left scapulalgia and fever of about 9 months duration before hospitalisation. He had suffered from three past episodes of pleuritis. Chief findings on admission were diffuse swelling on upper chest without reddening or fluctuation, and remittent fever. The liver, spleen and lymph nodes were not palpable. Chest X-ray film showed only pleural thickning of the left side. The histological examination of the swelled lesion on the left upper thorax revealed reticulum cell proliferation with lymphocytic infiltration and a small number of giant cells surrounding nectoric mass. Reticullum cells showed scanty atypical figures, so tuberculous change was mastly considered.
The patient underwent costectomy and curettement of the abscess on diagnosis of costal caries with cold abscess. Postoperatively, he suffered from remittent fever and exsudative pleuritis. He expired 11 months after the onset of his symptomes.
Autopsy findings showed reticullum cell sarcoma of the left upper chest wall.

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