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Respirology Case Reports

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https://www.readbyqxmd.com/read/28096998/treatment-with-nintedanib-for-acute-exacerbation-of-idiopathic-pulmonary-fibrosis
#1
Hiromi Tomioka, Hirohito Takada
There is currently no effective treatment for acute exacerbation of idiopathic pulmonary fibrosis (IPF). We herein report the case of a patient with acute exacerbation of IPF which was treated with nintedanib, an intracellular inhibitor of tyrosine kinases, and showed improvement of the condition. An 84-year-old man with IPF was admitted to our hospital because of dry cough and worsening of dyspnoea within last 1 month. He presented with hypoxemia, and chest high-resolution computed tomography (HRCT) revealed new, bilateral multifocal ground-glass opacities superimposed on the background of lung fibrosis...
March 2017: Respirology Case Reports
https://www.readbyqxmd.com/read/28096997/bronchial-tree-shaped-mucous-plug-in-cystic-fibrosis-imaging-guided-management
#2
Ignazio Salamone, Baldassare Mondello, Maria Cristina Lucanto, Simona Cristadoro, Mariangela Lombardo, Mario Barone
We report the case of a 17-year-old boy with cystic fibrosis (CF) who presented with persistent cough; after starting intravenous antibiotics for Pseudomonas aeruginosa he underwent a computed tomography (CT) scan of the chest. CT revealed extensive consolidation in the right lower lobe with relative bronchus obstruction; the cause of bronchial obstruction was detected in the mediastinal window, corresponding to a bronchial tree-shaped, thick, tenacious mucous plug. This was extracted 48 h after unresponsive bronchial washing and endobronchial instillation of rhDNAse, using foreign-body forceps, with subsequent resolution of cough...
March 2017: Respirology Case Reports
https://www.readbyqxmd.com/read/28096996/recurrent-haemoptysis-as-a-symptom-of-severe-pulmonary-vein-stenosis-a-rare-complication-of-catheter-ablation-in-atrial-fibrillation
#3
Jan Romantowski, Krzysztof Kuziemski, Alicja Janowicz, Alicja Siemińska, Edyta Szurowska, Ewa Jassem
A pulmonary vein stenosis is a known adverse event of catheter ablation in atrial fibrillation. However, it should be considered due to high frequency of such procedures. Haemoptysis, a symptom of severe stenosis, is often misdiagnosed as other different diseases. We present a case report of a 52-year-old patient with recurrent haemoptysis, dyspnoea, and fatigue, which turned out to be complication after catheter ablation. Successful treatment with drug-eluting stent (DES) was implemented with vast clinical improvement and follow-up...
March 2017: Respirology Case Reports
https://www.readbyqxmd.com/read/28035284/transcaval-biopsy-of-a-mediastinal-mass-compressing-the-superior-vena-cava
#4
Anthony Logaraj, Philip Edwards
Imaging-guided percutaneous chest biopsy is a commonly performed procedure and considered the minimally invasive gold standard for histopathological investigation of thoracic masses. Recognized complications include pneumothorax, air embolism, and seeding of the biopsy tract. We describe a novel approach to diagnostic sampling of a mediastinal mass in a critically unwell patient using a transjugular hepatic biopsy needle. Transcaval mediastinal biopsy may represent a safer alternative to percutaneous biopsy of mediastinal masses in critically unwell patients...
March 2017: Respirology Case Reports
https://www.readbyqxmd.com/read/27999676/recurrent-pneumothorax-related-to-diffuse-dendriform-pulmonary-ossification-in-genetically-predisposed-individual
#5
Amy Po Yu Tsai, John C English, Darra Murphy, Don D Sin
Diffuse pulmonary ossification (DPO) is a rare disease with unknown pathogenesis, clinical manifestations, and treatment options. This report describes the diagnosis of DPO in an otherwise healthy 26-year-old man with recurrent spontaneous pneumothorax. His father was diagnosed with a similar lung condition in his 30's with computed tomography (CT) images that were strikingly similar to those of the patient. This report suggests that DPO can induce spontaneous pneumothorax and its pathogenesis may have a possible genetic predisposition that needs further research...
March 2017: Respirology Case Reports
https://www.readbyqxmd.com/read/27999675/mechanical-insufflation-exsufflation-for-an-individual-with-duchenne-muscular-dystrophy-and-a-lower-respiratory-infection
#6
Emma Koenig, Bhajan Singh, Jamie Wood
Duchenne muscular dystrophy (DMD) is an X-linked recessive myopathy associated with progressive muscle weakness and wasting, loss of ambulation, respiratory insufficiency, weak cough, repeated respiratory infections, and ultimately death from respiratory failure in early adulthood. Mechanical insufflation-exsufflation (MI-E) devices, such as the CoughAssist®, are used in individuals with neuromuscular weakness to augment cough and help clear secretions; however, there is no consensus on the optimal treatment regimen...
March 2017: Respirology Case Reports
https://www.readbyqxmd.com/read/28078088/immunoglobulin-g4-related-disease-presenting-as-a-pulmonary-nodule-with-an-irregular-margin
#7
Tetsuyuki Okubo, Yumiko Oyamada, Masaya Kawada, Yo Kawarada, Shuji Kitashiro, Shunichi Okushiba
We report a case of immunoglobulin G4 (IgG4)-related lung disease presenting as a solitary pulmonary nodule with an irregular margin on computed tomography. The nodule showed a high standardized uptake value on positron emission tomography. A malignant pulmonary tumour could not be excluded. Middle lobectomy was performed. Histological analysis revealed marked lymphoplasmacytic infiltration and storiform fibrosis. Immunostaining indicated the presence of IgG4-positive plasma cells. A definitive diagnosis of IgG4-related disease was confirmed...
January 2017: Respirology Case Reports
https://www.readbyqxmd.com/read/28078087/clostridium-difficile-infection-in-cystic-fibrosis-an-uncommon-but-life-threatening-complication
#8
Francesco Piccolo, Anna Sze Tai, Hooi Ee, Siobhain Mulrennan, Scott Bell, Gerard Ryan
Adults with cystic fibrosis (CF) have significant rates of asymptomatic Clostridium difficile carriage and are frequently exposed to risk factors for C. difficile infection (CDI). Despite this, the rate of reported CDI in CF is low. We describe three cases of near fatal CDI in adults with CF and review the literature regarding presentation, management, and recurrence prevention. Early recognition is important as the clinical presentation may be atypical and the illness can be severe and even life-threatening...
January 2017: Respirology Case Reports
https://www.readbyqxmd.com/read/28031842/fatal-tumour-pulmonary-embolism
#9
Salim Rashid Masoud, Coenraad Frederik Nicolaas Koegelenberg, Abraham Christoffel van Wyk, Brian William Allwood
A 30-year-old female with no significant past medical history was referred to our facility with sudden onset of shortness of breath. She had a low clinical probability for pulmonary thromboembolism and a computed tomography angiogram showed enlarged pulmonary arteries but no in situ thrombi. She developed recurrent episodes of hypotension and hypoxia, and was transferred to the intensive care unit where she died despite active resuscitation. An autopsy revealed extensive lymphatic and pulmonary vascular tumour emboli as the immediate cause of death...
January 2017: Respirology Case Reports
https://www.readbyqxmd.com/read/28031841/long-term-outcome-of-nitinol-stenting-to-treat-asphyxia-caused-by-postpneumonectomy-syndrome
#10
Jiro Abe, Toru Hasumi, Ryota Tanaka, Yasuki Saito, Keishi Kanma, Satomi Takahashi
The long-term outcome of nitinol stents introduced into a patient with postpneumonectomy syndrome is described. Postpneumonectomy syndrome is a rare but crucial complication after pneumonectomy characterized by severe dyspnoea and recurrent airway infection caused by compression of the main bronchus. Surgical correction of mediastinal displacement and endobronchial stent placement are two major treatments for this complication; however, endobronchial stenting may be limited to those who are not suitable for operative procedures because long-term management is difficult in terms of controlling airway infections...
January 2017: Respirology Case Reports
https://www.readbyqxmd.com/read/28031840/concomitant-t790m-mutation-and-small-cell-lung-cancer-transformation-after-acquired-resistance-to-epidermal-growth-factor-receptor-tyrosine-kinase-inhibitor
#11
Kohei Fujita, Young Hak Kim, Akihiko Yoshizawa, Tadashi Mio, Michiaki Mishima
A 70-year-old man was admitted to our hospital with an abnormal chest X-ray shadow. Bronchoscopy revealed an adenocarcinoma tumour with an epidermal growth factor receptor (EGFR) exon 19 deletion. Positron emission tomography-computed tomography scanning and magnetic resonance imaging showed advanced stage IV lung cancer. He was treated with erlotinib as a first-line drug, which maintained a clinical response for 16 months. After disease progression, a re-biopsy was done from the tumour in the right lower lobe...
January 2017: Respirology Case Reports
https://www.readbyqxmd.com/read/28031839/a-massive-pleural-based-desmoid-tumour
#12
Talha Mahmud, Guness Mal, Farhan Ahmed Majeed, Siaw Ming Chai, Y C Gary Lee
A 49-year-old Pakistani male presented with "heaviness" in his chest. Chest radiograph and computed tomography (CT) confirmed a massive left-sided pleural-based opacity. Three years ago, he was investigated for a left-sided lymphocytic, exudative pleural effusion following an episode of dengue fever. Tube thoracostomy removed 1.3 L of fluid. Pleural biopsy and bronchial washings were non-contributory. He received empirical anti-tuberculosis treatment and remained asymptomatic until this presentation. To investigate the new pleural mass, he underwent a video-assisted thoracoscopic surgery, which revealed a 2...
January 2017: Respirology Case Reports
https://www.readbyqxmd.com/read/28031838/stromal-micropapillary-predominant-lung-adenocarcinoma-a-rare-histological-phenotype-with-poor-prognosis
#13
Takamitsu Hayakawa, Shogo Tajima, Masaru Tsukui, Yusuke Takanashi, Hiroshi Neyatani, Kazuhito Funai
An extremely rare case of stromal micropapillary predominant lung adenocarcinoma is presented in this study. A 70-year-old woman visited our hospital because of an abnormal shadow on chest X-ray. Chest computed tomography revealed a nodule in the left lower lobe and a mass in the left upper lobe. She underwent an exploratory thoracotomy owing to the suspicion of advanced lung cancer. Pathological examination of the left lower lobe nodule revealed tumour cells with more than half the tumour cells showing stromal micropapillary pattern (SMP), consisting of tumour cells invading the fibrotic stroma...
November 2016: Respirology Case Reports
https://www.readbyqxmd.com/read/28031837/carcinomatous-pleuritis-and-pericarditis-accompanied-by-pulmonary-tuberculosis
#14
Munechika Hara, Shin-Ichiro Iwakami, Naohisa Matsumoto, Taichi Miyawaki, Ryo Wada, Kazuhisa Takahashi
Although both lung cancer and pulmonary tuberculosis (TB) commonly occur in clinical practice, little attention has been paid to their coexistence. A 62-year-old female was admitted with acute dyspnoea secondary to cardiac tamponade. During her admission, a mass lesion harbouring air bronchograms in the right upper lobe rapidly increased in size. Surgical lung, pericardial, and pleural specimens yielded TB from a nodule in the right upper lobe and lung adenocarcinoma from the pericardium and pleura. Anti-tuberculous therapy was administered and gefitinib was subsequently started after the positive identification of epidermal growth factor receptor (EGFR) mutation (exon 19 deletion)...
November 2016: Respirology Case Reports
https://www.readbyqxmd.com/read/28031836/pulmonary-alveolar-proteinosis-a-case-report-and-world-literature-review
#15
Armando J Huaringa, Wassem H Francis
Pulmonary alveolar proteinosis (PAP) is a lung disorder which was first described in 1958 by Rosen et al. and is indeed rare disease with a prevalence of 0.1 per 100,000 individuals. PAP is characterized by abnormal accumulation of pulmonary surfactant in the alveolar space, which impairs gas exchange leading to a severe hypoxemia. Pulmonary surfactant is an insoluble proteinaceous material that is rich in lipids and stains positive with periodic acid-Schiff (PAS). The most common type of PAP is the so-called autoimmune or idiopathic type...
November 2016: Respirology Case Reports
https://www.readbyqxmd.com/read/28031835/pulmonary-lymphoepithelioma-like-carcinoma-with-echinoderm-microtubule-associated-protein-like-4-anaplastic-lymphoma-kinase-eml4-alk-fusion-gene
#16
Naoko Ose, Teruka Kawai, Daisuke Ishida, Yuko Kobori, Yukiyasu Takeuchi, Hidetoshi Senba
A pulmonary lymphoepithelioma-like carcinoma (PLELC) is similar to a lymphoepithelioma, a subtype of nasopharyngeal carcinoma and commonly associated with Epstein-Barr virus infection which is a rare tumour and classified in the group of "other and unclassified carcinoma" in the latest 2015 World Health Organization (WHO) classification. Some reports of lymphoepithelioma-like carcinoma (LELC) have noted an epidermal growth factor receptor (EGFR) mutation, whereas none have noted a mutation of the echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase (EML4-ALK) fusion gene...
November 2016: Respirology Case Reports
https://www.readbyqxmd.com/read/28031834/birt-hogg-dub%C3%A3-syndrome-in-an-indonesian-patient-with-folliculin-gene-mutation
#17
Wiwien Heru Wiyono, Fariz Nurwidya, Hario Baskoro, Andika Chandra Putra
Birt-Hogg-Dubé (BHD) syndrome is a rare autosomal dominant disorder that affects the skin, kidney, and lungs. Affected individuals have an increased risk of developing multiple cysts in the lungs and a spontaneous pneumothorax. Germline mutations in the folliculin (FLCN) gene have been confirmed as the aetiology of BHD syndrome. A 51-year-old Indonesian female presented with recurrent spontaneous pneumothorax, multiple cysts in both lungs, and a renal cyst on magnetic resonance imaging (MRI). Blood sampling was performed to extract genomic DNA from peripheral blood leucocytes...
November 2016: Respirology Case Reports
https://www.readbyqxmd.com/read/28031833/respiratory-bronchiolitis-associated-interstitial-lung-disease-with-obvious-paraseptal-emphysema
#18
Yun Zhou, Zhiyi He, Jing Bai, Xiaoning Zhong
Respiratory bronchiolitis-associated interstitial lung disease (RBILD) is a distinct clinical-pathological disease described almost exclusively among cigarette smokers. Normally, the most common manifestations in computed tomography findings of RBILD are central and peripheral bronchial wall thickening, centrilobular nodules, ground glass opacity, and mild centrilobular emphysema in the upper lobes. In this study, we report a current smoker presenting with diffuse ground glass opacity in the entire lungs along with paraseptal emphysema...
November 2016: Respirology Case Reports
https://www.readbyqxmd.com/read/28031832/effectiveness-of-afatinib-in-lung-cancer-with-paralytic-ileus-due-to-peritoneal-carcinomatosis
#19
Haruki Kobayashi, Kazushige Wakuda, Toshiaki Takahashi
A 61-year-old never-smoking woman with stage IV lung adenocarcinoma with initially unknown epidermal growth factor receptor (EGFR) status, lung metastasis, pleural dissemination, and malignant pleural effusion in 2007 received 10 prior anti-cancer regimens including gefitinib as second- and ninth-line treatments, with minimal efficacy with gefitinib. EGFR mutation analysis performed in pleural effusion specimens during ninth-line gefitinib was negative. In 2015, she developed progressive disease with peritoneal dissemination...
November 2016: Respirology Case Reports
https://www.readbyqxmd.com/read/28031831/intestinal-perforation-due-to-paradoxical-reaction-during-treatment-for-miliary-tuberculosis
#20
Miwako Saitou, Tomoko Suzuki, Katsunao Niitsuma
A 61-year-old man was being treated for poor nutritional status. He had been on weekly methotrexate 6 mg and daily tacrolimus 1 mg and prednisolone 18 mg for 8 years due to dermatomyositis. On further workup, he was initially detected to have ileocecal ulcer with subsequent development of diffuse miliary shadows on chest radiograph. He was diagnosed as having ileocecal with miliary tuberculosis (TB). While receiving anti-tuberculous therapy, there was initial improvement of TB-related symptoms and he had no conditions that interfered with the efficiency of the anti-tuberculous therapy...
November 2016: Respirology Case Reports
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