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Respirology Case Reports

Masayuki Nakayama, Shinichi Yamamoto, Naoki Kaneko, Naoko Mato, Takuji Suzuki, Koichi Hagiwara
An 89-year-old man was hospitalized with severe pneumonia. Chest computed tomography showed a foreign body in the left main bronchus. We moulded a three-dimensional (3D) model of the foreign body with a low-cost 3D printer and found it had the shape of a tooth. We simulated grasping the model with several forceps and succeeded in grasping it with a retrieval net and shark-tooth forceps. Bronchoscopy was performed after his respiratory condition improved. We found a dental foreign body that had accidentally moved and become stuck in the right upper bronchus...
October 2018: Respirology Case Reports
Lin Tong, Guixiang Gan, Chen Xu, Ling Yuan, Zhuozhe Li, Huayin Li
Mantle cell lymphoma (MCL) is a rare type of B-cell non-Hodgkin's lymphoma that commonly affects extranodal sites; however, tracheobronchial involvement is rare. We report the case of a 65-year-old male who presented with cough and dyspnoea. A chest computed tomography (CT) revealed irregular wall thickening of the trachea and bilateral bronchi and bilateral bronchiectasis. A bronchoscopy revealed a diffuse irregular surface of the tracheal and bilateral bronchial mucosa and polyposis-like lesions. He was diagnosed with MCL based on an endobronchial biopsy, and then, the diagnosis was confirmed with a biopsy of the fluorodeoxyglucose (FDG)-avid nasal mucosal soft tissue...
October 2018: Respirology Case Reports
Akihiro Yoshimura, Taisuke Tsuji, Yuka Kawaji, Yoshiko Hirakawa, Hitoji Uchiyama, Noriya Hiraoka
The patient, a 70-year-old woman with diffuse large B-cell lymphoma (DLBCL), developed haemorrhagic cystitis associated with the BK virus (BKV) and adenovirus type 11. Moreover, chest computed tomography showed ground-glass opacity (GGO) in the bilateral upper lobe, and we performed bronchoalveolar lavage (BAL). The BKV DNA load was elevated not only in blood but also in BAL fluid (BALF), leading to the diagnosis of BKV pneumonia. After administering cidofovir, the respiratory symptoms and GGO abated. Therefore, detection of BKV DNA in BALF is useful for diagnosing BKV pneumonia...
October 2018: Respirology Case Reports
Makoto Hibino, Kazunari Maeda, Shigeto Horiuchi, Minoru Fukuda, Tetsuri Kondo
There is a broad differential diagnosis for interstitial shadows on chest computed tomography in rheumatoid arthritis patients, especially those previously treated with immunosuppressant drugs. We report an immunocompromised rheumatoid arthritis patient in respiratory failure with diffuse ground-glass opacities (GGOs), who was diagnosed with pulmonary lymphangitic carcinomatosis as the initial presentation of prostate cancer. He was successfully treated with chemohormonal androgen deprivation therapy, including bicalutamide, leuprorelin acetate, denosumab, and docetaxel...
October 2018: Respirology Case Reports
Meng-Fang Shen, Teressa Reanne Ju, Chi Chan Lee, Chih-Yen Tu
Pulmonary alveolar proteinosis (PAP) is a rare disease diagnosed pathologically by the build up of surfactant in the alveolar spaces. Establishing a diagnosis usually requires invasive procedures such as bronchoalveolar lavage and forceps biopsy to obtain tissue specimens. Infrequently, surgery is required when histopathological results from other modalities are equivocal. Cryobiopsy has emerged as a novel technique for obtaining lung tissues in pulmonary diseases. Recently, cryobiopsy has been used to diagnose diffuse parenchymal lung disease, but it has rarely been used for the diagnosis of PAP...
August 2018: Respirology Case Reports
Noni Novisari Soeroso, Ella Rhinsilva, Luhur Soeroso
Silicone injections, although well known for their adverse effect, are still widely used around the world. Pneumonitis after an injection of silicone liquid has been reported in several patients. Silicone liquid injection is frequently administered to transgender individuals into the buttocks area but is rarely used for the breasts. We report a case of presumed pneumonitis following breast silicone liquid injection. A 36-year-old woman was admitted due to shortness of breath three days after silicone liquid injection...
August 2018: Respirology Case Reports
Jaideep Vazirani, Christiaan Yu, Robert Stirling
The exact incidence of foreign body aspiration among adults is unknown, and its clinical presentation is vastly divergent. We report the previously undescribed occurrence of cockroach aspiration in an adult, presenting with a "crawling sensation" in his chest. Flexible endobronchial examination revealed a foreign body impacted in the lingula, resembling the Australian cockroach Periplaneta australasiae. Partial extraction via biopsy forceps was performed and complicated by acute hypoxia on disimpaction, requiring a brief period of bag/mask ventilation...
August 2018: Respirology Case Reports
Lewis Xiao, Anil Kookana, Robert McClure, Subash Heraganahally
Non-caseating granulomatous pulmonary conditions resembling sarcoidosis secondary to industrial/occupation exposure to magnetite iron ore dusts have been rarely documented in the literature. This is a case report of a 58-year-old blast crew member involved in iron ore/magnetite mining who presented with a 12-month history of chronic dry cough. High-resolution computed tomography revealed bilateral interstitial opacities. Lung biopsy demonstrated sarcoid-like granulomatous inflammation. Oral corticosteroid treatment improved the cough...
August 2018: Respirology Case Reports
Nattawat Jantarangsi, Poonchavist Chantranuwatana, Naricha Chirakalwasan
A 66-year-old Thai man with underlying asthma, history of traumatic right haemothorax, and sigmoid carcinoma with bladder invasion developed productive cough, whitish sputum, dyspnoea, and wheezing for 2 months. Physical examination showed generalized expiratory wheezing in both lungs. Computed tomography scan of the chest revealed diffuse thickening of bronchial wall, predominantly at lower lobes; several various sizes of pulmonary nodules; diffuse interlobular septal thickening; multiple enlarged mediastinal lymph nodes and hilar lymph nodes; and right pleural effusion...
July 2018: Respirology Case Reports
Naoki Arai, Kenji Nemoto, Shuji Oh-Ishi, Mizu Nonaka, Kenji Hayashihara, Takefumi Saito
Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) caused by methimazole (MMI) is known to be relatively rare; therefore, the optimal therapeutic approach for these cases remains to be established. A 59-year-old man who was treated with MMI for a diagnosis of Graves' disease was referred to our hospital because of progressive haemoptysis. The patient was diagnosed with diffuse alveolar haemorrhage (DAH) secondary to AAV based on increased inflammatory reactions with positive myeloperoxidase-ANCA in the serum and the results of bronchoalveolar lavage fluid...
July 2018: Respirology Case Reports
Yuya Aono, Tatsuru Eifuku, Tomohiro Uto, Jun Sato, Shiro Imokawa, Takafumi Suda
The "crazy paving" appearance consists of ground-glass opacity superimposed on a network of linear opacities on thin-section computed tomography (CT) images of the lung. This finding has been described in a variety of diseases but is extremely rare in patients with non-specific interstitial pneumonia (NSIP). We describe a 45-year-old woman with biopsy-proven NSIP associated with clinically amyopathic dermatomyositis that showed a "crazy paving" appearance on thin-section CT of the lung. Clinicians should include NSIP in the differential diagnosis in patients presenting with "crazy paving" appearance on thin-section chest CT...
July 2018: Respirology Case Reports
Hiroyuki Miura, Jun Miura, Hiroshi Hirano
Mediastinal cysts with Mullerian differentiation are characterized by oestrogen receptor and progesterone receptor positive cell linings. We treated four patients with mediastinal cysts with Mullerian differentiation. All patients were female, from 46 to 52 years old, and had BMIs greater than 26 kg/m2 . All but one patient with cough were asymptomatic. The tumours were located in the paravertebral areas around the Th-1-7 vertebrae. There was no left/right difference. All of the preoperative diagnoses were bronchial cysts...
July 2018: Respirology Case Reports
Shyamala Pradeepan, Peter Wark
We report a case of Pseudomonas pharyngitis in a cystic fibrosis (CF) patient not known to have prior colonization of Pseudomonas. We believe that this is one of the first cases of pseudomonas pharyngitis in a CF patient.
July 2018: Respirology Case Reports
Akane Ishida, Masahide Oki, Hideo Saka, Yukio Seki
Lung hernia is a rare condition defined as the external protrusion of lung tissue from the thorax, which usually occurs after trauma or thoracic surgery. A chest computed tomography while performing the Valsalva manoeuvre is useful for a definitive diagnosis.
July 2018: Respirology Case Reports
Kei Sonehara, Toshitaka Shomura, Masanori Yasuo, Atsuhito Ushiki, Hiroshi Yamamoto, Masayuki Hanaoka
A 74-year-old man, who had undergone thoracoplasty for tuberculous sequelae 54 years earlier, was referred to our hospital with a chief complaint of dyspnea. He had recently received mechanical ventilation due to pneumonia. However, although the pneumonia had improved, extubation was prevented by the presence of hypercapnic respiratory failure with tracheal stenosis due to compression of the right aortic arch and the left common carotid artery. Bypass surgery was performed, during which the left subclavian artery was placed over the left common carotid artery...
July 2018: Respirology Case Reports
Samaneh Shafiee, Alan Adno, Bruce French, Cherynne Johansson, Anthony Frankel, Jonathan P Williamson
Malignancy complicates one in a thousand pregnancies. The most frequently diagnosed of these are breast, cervical, melanoma, ovarian, and haematological neoplasms. Tumours of respiratory origin are very uncommon during pregnancy. We present a case of tracheal adenoid cystic carcinoma (ACC), a rare type of primary airway tumour, diagnosed in a pregnant woman. To our knowledge, this is the third reported case of tracheal ACC complicating pregnancy. We discuss potential barriers to timely diagnosis of malignancies during pregnancy and consider optimal management strategies, taking into account the potential harm to the mother and foetus in a field with a limited evidence base...
July 2018: Respirology Case Reports
Saeko Takahashi, Xu Chieko, Tetsuya Sakai, Shigemichi Hirose, Morio Nakamura
Nivolumab has been increasingly used for a range of malignancies, and a variety of immune-related adverse events (irAEs) have been reported with its use. Nivolumab-induced sialadenitis (inflammation of salivary glands) and xerostomia (dry mouth) have been reported to occur in 0.03% and 0.05% respectively, but there have been no case reports published about these side effects. Sialadenitis is not a life-threatening irAEs, but xerostomia can become irreversible if not recognized and treated as it can otherwise lower quality of life and result in susceptibility to infection...
July 2018: Respirology Case Reports
Chien-Feng Lee, Chun-Ta Huang, Sheng-Yuan Ruan
Massive pulmonary haemorrhage is a life-threatening and difficult-to-manage condition. In certain circumstances, traditional approaches for haemoptysis may not be effective. Here, we report a 64-year-old man presenting with dyspnoea and leg oedema. He was diagnosed with microscopic polyangiitis due to positive perinuclear anti-neutrophil cytoplasmic antibody and other supportive evidence. His hospital course was complicated with massive pulmonary haemorrhage, which led to hypoxic respiratory failure, shock, and pulseless electrical activity...
July 2018: Respirology Case Reports
Rahul H Mehta, Jeffrey Hoag, Amit Borah, Emil Abramian
Cryoprobe biopsies are routinely performed by the interventional pulmonologist. Diagnostic yields are larger, with complication rates that are equal to or lower than that of traditional forceps biopsies. We will specifically evaluate one instance where a cryoprobe biopsy led to an alveolo-pleural fistula that did not resolve with simple tube thoracostomy. An endobronchial valve was placed and successfully resolved the pneumothorax and persistent air leak.
July 2018: Respirology Case Reports
Jamie Wood, Abbey Sawyer, Siobhain Mulrennan, Andrew Bullock
Tricuspid atresia (TAt) is a complex congenital heart defect (CHD) characterized by the absence of the tricuspid valve and right ventricular hypoplasia requiring surgery in childhood, the Fontan procedure. We present a case of a 21-year-old male with TAt and cystic fibrosis (CF), who underwent a Fontan procedure in childhood, presenting to an adult CF clinic with severe deterioration in his respiratory status and multi-organ dysfunction associated with CF. This report describes problems associated with the management of a CF respiratory exacerbation and extrapulmonary manifestations of CF in the unique situation of a Fontan circulation, a circulation with absence of a subpulmonary ventricle and pulsatile pulmonary arterial blood flow where maintenance of systemic cardiac output is totally dependent on good respiratory function and low pulmonary artery pressures...
July 2018: Respirology Case Reports
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