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Respiratory Medicine Case Reports

Darius Kang Lie Aw, Matthew Zhen Wei Tan, Anthony Chau Ang Yii, Dorothy Hui Lin Ng
In the last twenty years, the field of bronchoscopy has become increasingly more complex and invasive. It is now widely used in the management of pulmonary diseases and has the benefit of low mortality and complication rates. Overall incidence of complications and mortality reported ranges around 1% and 0.02% respectively. Common complications of bronchoscopy include pulmonary haemorrhage, desaturation, pneumothorax, and pulmonary oedema. However, facial and neck petechiae associated with subcutaneous hemorrhage post-bronchoscopy has not been reported before in the literature...
2016: Respiratory Medicine Case Reports
Santiago Sánchez Pardo, Javier Duque, Javier Enrique Fajardo
Glomus tumors are uncommon tumors that are originated from smooth muscle cells of the neuromioarterials glomus bodies located in the arteriovenous anastomoses subcutaneous tissue or deep dermis of the extremities, mainly in the palms of the hands, wrists and subungual areas of the fingers. Carcinoid tumor, as the glomus tumor, can show an organoid pattern, increased vascularity, and uniform, round cells with eosinophilic cytoplasm, but usually are positive for cytokeratin and always stained with chromogranin and synaptophysin showing negative for smooth muscle markers which is presented in our case...
2016: Respiratory Medicine Case Reports
Hidenori Katsumi, Masaki Tominaga, Morihiro Tajiri, Shigeki Shimizu, Yuki Sakazaki, Takashi Kinoshita, Masaki Okamoto, Tomotaka Kawayama, Tomoaki Hoshino
A 66-year-old woman was referred to our hospital for investigation of interstitial lung disease. She had spent most of her time in a shrine, and had always been exposed to vaporized paraffin from burning candles. Chest High-resolution computed tomography (HRCT)showed ground-glass attenuation with thickening of septal lines, wh create the so-called "crazy-paving appearance". Although bronchoalveolar lavage(BAL) and transbronchial biopsy were performed to aid in diagnosis, the findings did not reveal any conclusive information...
2016: Respiratory Medicine Case Reports
Alexandros Stamatopoulos, Davide Patrini, Efstratios Koletsis, Elaine Borg, Reena Khiroja, Martin Hayward, David Lawrence, Nikolaos Panagiotopoulos
IgG4-related disease (IgG4-RD) is a fibroinflammatory condition that can affect practically every organ. Although it was first identified in pancreas and salivary glands, major organs like liver, biliary tree, kidney, thyroid glands and lungs are commonly involved, sometimes resulting in organ failure. We describe a case of an 41-year-old man presented with back pain after a rotator cuff injury. A Computed Tomography (CT) revealed incidentally a right lower lobe paravertebral lesion extending across the T5 and T6 vertebral levels and invading into the adjacent pleural surface...
2016: Respiratory Medicine Case Reports
Giuseppe Dilorenzo, Michele Telegrafo, Giuseppe Marano, Michele De Ceglie, Amato Antonio Stabile Ianora, Giuseppe Angelelli, Marco Moschetta
Metastatic pulmonary calcification (MPC) is a rare pathological condition consisting of lung calcium salt deposits which commonly occurs in patients affected by chronic kidney disease probably for some abnormalities in calcium and phosphate metabolism. CT represents the technique of choice for detecting MPC findings including ground glass opacities and partially calcified nodules or consolidations. We present a case of MCP in a patient affected by hepato-renal autosomic-dominant polycystic disease; chest CT revealed extensive lobar-segmental parenchymal calcification with a peculiar cauliflower shape which we called "calcified cauliflower" sign...
2016: Respiratory Medicine Case Reports
Hironobu Tsubouchi, Nobuhiro Matsumoto, Shigehisa Yanagi, Yasuji Arimura, Masamitsu Nakazato
Sepsis is a life-threatening condition caused by the inflammatory response to invading organisms. Polymyxin B-immobilized fiber column direct hemoperfusion (PMX-DHP) is used to reduce blood endotoxin levels and modulate circulating inflammatory cytokine levels in sepsis patients. Here we report that severe sepsis caused by an infection of the gram-negative bacterium Pantoea agglomerans in a patient with small cell lung carcinoma was treated successfully with antibiotics and PMX-DHP. The patient, a 49-year-old Japanese male smoker whose condition was complicated with hyponatremia due to SIADH (syndrome of inappropriate secretion of antidiuretic hormone), rapidly developed sepsis and disseminated intravascular coagulation (DIC) after the administration of cisplatin and irinotecan...
2016: Respiratory Medicine Case Reports
P Mencarini, R Bellagamba, A Oliva, P Ghirga, M L Giancola, A Corpolongo, T Ascoli Bartoli, P De Nardo, A Baiocchini, F Del Nonno, P Narciso, E Nicastri
The diagnosis of sarcoidosis in a patient living with HIV infection is an uncommon event and a challenge for clinicians. Clinical manifestations are variable and fluctuating depending to adherence to ARV therapy and to the level of CD4 count. We analyze here one chronic case in which sarcoidosis appeared clinically two years after pulmonary tuberculosis. The course of the disease was influenced and prolonged by frequent interruptions of antiretroviral therapy. Moreover the diagnosis and the decision to treat have been delayed by the need of exclusion of other pathologies, principally tuberculosis reactivation/reinfection, other mycobacterial diseases, hematologic malignancies...
2016: Respiratory Medicine Case Reports
Takashi Oide, Kazuhiro Yasufuku, Kiyoshi Shibuya, Ichiro Yoshino, Yukio Nakatani, Kenzo Hiroshima
We report a 38-year-old woman with a left lung tumor presenting as obstructive pneumonia. Bronchoscopic examination revealed a polypoid tumor filling the left main bronchus. The tumor was partially resected by a snaring procedure for diagnostic purposes. Microscopic examination revealed a submucosal tumor located underneath normal bronchial epithelium. The tumor was composed of sheets of uniform oval to cuboidal cells encompassing numerous blood vessels. Immunohistochemically, the tumor cells exhibited smooth muscle markers, but were negative for neuroendocrine markers...
2016: Respiratory Medicine Case Reports
Dicle Kaymaz, Pınar Ergün, İpek Candemir, Tuğba Çiçek
Chronic necrotizing pulmonary aspergillosis (CNPA) is a rare form of pulmonary aspergillosis. The radiological findings in CNPA are very diverse. We present a mildly imunosuppresive, elderly 71-year-old woman with the diagnosis of chronic necrotizing pulmonary aspergillosis presenting as transient migratory thoracic mass.
2016: Respiratory Medicine Case Reports
Fumio Imamura, Takako Inoue, Madoka Kimura, Kazumi Nishino, Toru Kumagai
In January 2003, a 55-year old, non-smoking woman visited our hospital to undergo treatment for T4N0M0 pulmonary adenocarcinoma of the left lung. Until death in October 2015, she received over 20 lines of treatment including a second line therapy with gefitinib, which showed long response. In March 2014, she noticed the left axillar lymph node swelling. Aspiration cytology of the lymph node revealed the presence of adenocarcinoma harboring EGFR exon 19 deletion (Ex19del) but not T790M. Concomitant ALK translocation of variant 1 was also detected...
2016: Respiratory Medicine Case Reports
Tony S Brar, Neeka Akhavan
This is a 78 year old male with a past medical history of coronary artery disease (CAD), chronic obstructive pulmonary disease (COPD), hypertension (HTN), and gastroesophageal reflux disorder (GERD) who presented to the emergency room with worsening shortness of breath (SOB) and low-grade fevers for one week prior to admission. He was originally diagnosed with healthcare associated pneumonia (HCAP) and an acute on chronic COPD exacerbation and treated with prednisone, inhalers, ipratropium/albuterol, and broad-spectrum antibiotics...
2016: Respiratory Medicine Case Reports
Talha Mahmud, Adnan Shafiq, Abdul Hafeez, Muhammad Saqib, Sidrah Farooq
18-year-old lady was admitted through emergency department after she accidently aspirated a long sewing machine needle into her airways. Upon examination, she was anxious with normal vital signs and without any respiratory distress with SpO2 of 98% on air. Systemic examination was normal except slightly reduced breath sounds intensity on right lower side of chest. Her chest radiograph revealed needle in right lower lobe but it was not visualized on bronchoscopic examination of airways up to sub segmental level...
2016: Respiratory Medicine Case Reports
Kevin Gipson, Ryan Avery, Heena Shah, Derek Pepiak, Rodolfo E Bégué, John Malone, Luke A Wall
Löffler syndrome, a fulminant eosinophilic pneumonitis associated with the larval migratory phase of human parasites, is rarely reported in the United States. A previously healthy 8-year-old male was hospitalized with tachypnea, cough, hypoxemia, and fever of one week's duration. History revealed exposure to pigs on his family's farm in southernmost Louisiana, where the patient was responsible for cleaning the farm's pigpens. His fingernails were soiled and extremely short, with the edge of the nail bed exposed secondary to onychophagia...
2016: Respiratory Medicine Case Reports
N S Harsha, H S Sandeepa, S Hemantha Kumar, B Prakash, K Jayalakshmi
Radiographic findings of thick walled cavities in the lungs are typically seen in mycobacterial infections, malignant lesions, fungal infections, pulmonary vasculitis or other inflammatory lesions of the lungs. Necrotizing infections of the lungs caused by gram negative bacteria (Klebsiella, Psudomonas, Legionella) and Staphylococcus aureus may also form cavities of varying thickness, with consolidation. Escherichia coli pneumonia causing pulmonary cavities is very rare and the few cases reported are of pneumatocele formation...
2016: Respiratory Medicine Case Reports
Elizabeth Manuely González Revilla, Araceli Abad Fernandez, María Teresa Río Ramirez, Sara Calero Pardo, María Antonia Juretschke Moragues
Granulomatosis with polyangiitis (GPA) is the name that has been used in recent years for Wegener's granulomatosis. This condition is a systemic inflammatory disease characterised by necrotizing vasculitis that affects small and medium-sized blood vessels (capillaries, arterioles, venules and arteries). The granulomatous inflammation affects the respiratory system; it also commonly affects the kidney and can very rarely affect large vessels such as the aorta and the surrounding retroperitoneal tissue. Early diagnosis and treatment is of vital importance because of the high risk of dissection and of obstruction of retroperitoneal structures...
2016: Respiratory Medicine Case Reports
Sameep Sehgal, Vamsidhar Velcheti, Sanjay Mukhopadhyay, James K Stoller
A 58-year-old woman with stage 4 adenocarcinoma of the lung being treated with pembrolizumab developed dyspnea, non-productive cough, and a right middle lobe infiltrate. Complete resolution of the infiltrate with cessation of pembrolizumab, initiation of prednisone and no antibiotic therapy suggested drug-associated lung toxicity as the cause. While the programmed death-1 (PD-1) inhibitors -pembrolizumab and nivolumab - have been implicated as a cause of diffuse or multifocal pulmonary infiltrates, the current case represents, to our knowledge, the first instance of a unilobar, focal infiltrate associated with their use...
2016: Respiratory Medicine Case Reports
Kathrin Fricke, Stanislav Tatkov, Ulrike Domanski, Karl-Josef Franke, Georg Nilius, Hartmut Schneider
Chronic obstructive pulmonary disease (COPD) with hypercapnia is associated with increased mortality. Non-invasive ventilation (NIV) can lower hypercapnia and ventilator loads but is hampered by a low adherence rate leaving a majority of patients insufficiently treated. Recently, nasal high flow (NHF) has been introduced in the acute setting in adults, too. It is an open nasal cannula system for delivering warm and humidified air or oxygen at high flow rates (2-50 L/min) assisting ventilation. It was shown that this treatment can improve hypercapnia...
2016: Respiratory Medicine Case Reports
Khalid Mahmood, Muhammad Ubaid, Aamer Mahmood
Pulmonary alveolar microlithiasis is a rare diffuse lung disease characterized by widespread sand-like intra-alveolar calcifications (calcospherites composed of calcium and phosphorus). Around 800 cases have been reported in the literature to date. We report here a case of a 35 years old female with prolonged h/o of exertional dyspnoea and mild cough. Clinical examination was mostly normal. Her Chest X-Ray revealed bilateral multiple nodular opacities (sand storm appearance). CT Scan chest showed diffuse micronodular calcifications with septal thickening, compatible with alveolar microlithiasis...
2016: Respiratory Medicine Case Reports
Justin M Segraves, Megan M Dulohery
Primary spontaneous pneumothorax (PSP) occurs most frequently in young, tall, lean, male smokers without any known underlying lung disease. It is an important diagnosis to make promptly in order to prevent progression to obstructive shock. We present a case report of a young, male, former-smoker and polysubstance abuser with no prior lung history that developed acute dyspnea at rest and was found to have a large right pneumothorax on chest x-ray. A pig-tail catheter was utilized, but his course was complicated by a recurrent tension pneumothorax...
2016: Respiratory Medicine Case Reports
Andrew Burkett, Niamh Coffey, Eva Tomiak, Nha Voduc
Birt-Hogg-Dube syndrome (BHDS) is a rare form of classically cystic lung disease that may present with spontaneous pneumothorax. The associated skin manifestations (fibrofolliculomas) are not always present. This article describes a case of spontaneous pneumothorax secondary to bullous emphysema in an otherwise healthy gentleman caused by a novel mutation in the folliculin (FLCN) gene.
2016: Respiratory Medicine Case Reports
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