Analysis of the Internal Structure of Peripheral Pulmonary Lesions Using Endobronchial Ultrasonography: Linear Arcs Pattern

Analysis of the Internal Structure of Peripheral Pulmonary Lesions Using Endobronchial Ultrasonography: Linear Arcs PatternType Ib, Homogeneous Pattern Without Vessels and Bronchioles: Eight lesions (6.5%) were classified as type Ib (Fig 8). No blood vessels were seen within the lesion by EBUS. Mottled or linear hy-perechoic areas were scant. The internal echoes were homogeneous. Similar to the situation with type Ia lesions, ultrasound attenuation was small, and even tissue 15 to 20 mm from the probe could be visualized clearly. The type Ib group of lesions included one case of moderately differentiated squamous cell carcinoma, four cases of organizing pneumonia, and three cases of tuberculoma. online antibiotics

Type II: Hyperechoic Dots and Linear Arcs Pattern
Type IIa, Hyperechoic Dots and Linear Arcs Without Vessels: Thirteen lesions (10.5%) were classified as type IIa (Fig 9). All 13 lesions were well-differentiated adenocarcinomas that had replaced the alveolar epithelium. No blood vessels could be visualized within the lesions by EBUS. Hyperechoic dots or hyperechoic linear arcs (primarily around the probe) were distributed irregularly within the lesions. The presence of residual air in the alveoli is characteristic of well-differentiated adenocarcinomas, which grow to replace the alveolar epithelium. The air remaining in the alveoli hampered the visualization of blood vessels within the lesions and obscured the margins of the lesions.
Type IIb, Hyperechoic Dots and Linear Arcs With Patent Vessels: Eleven lesions (8.9%) were classified as type IIb (Fig 10). The majority of lesions (eight) were well-differentiated adenocarcinomas that had proliferated and replaced the alveolar epithelium while preserving the blood vessels within the lesion. In the EBUS images, the blood vessels showed little or no compression or stenosis within the lesion, and the internal echoes were relatively homogeneous. Hyperechoic dots, distributed irregularly within the lesions, corresponded to residual air in the alveoli, which is a characteristic of well-differentiated adenocarcinoma.
Fig8
Figure 8. EBUS images of a type Ib lesion. No blood vessels were seen within the lesion. Mottled or linear hyperechoic areas were scarcely visible. The internal echoes were hypoechoic and homogeneous.
Fig9
Figure 9. EBUS images of type IIa lesions. No blood vessels could be visualized within the lesions. Hyperechoic dots (< 1 mm in diameter) or hyperechoic linear arcs (primarily around the probe) were distributed irregularly within the lesions.
Fig10
Figure 10. EBUS images of a type IIb lesion. Blood vessels (arrow), almost free of compression or stenosis, were visible within the lesions, and the internal echoes were relatively homogeneous. Hyperechoic dots (< 1 mm in diameter) were distributed irregularly within the lesions, corresponding to the presence of residual air in the alveoli.

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