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Respiratory Medicine Case Reports

Nikos Schizas, Achileas Lazopoulos, Dimitris Krimiotis, Thomas Rallis, Dimitris Paliouras, Apostolos Gogakos, Fotis Chatzinikolaou, Pavlos Sarafis, Philip Domeyer, Paul Zarogoulidis, Theodora Tsiouda, Chrysanthi Sardeli, Stella Laskou, Charilaos Koulouris, Efstathios Pavlidis, Stylianos Mantalobas, Dimitris Giannakidis, Isaak Kesisoglou, Konstantinos Sapalidis, Nikos Barbetakis
Minimal diagnostic procedures are conducted regularly by the radiologists for several lesions within the body. The usual methodology is biopsy with a needle, either fine needle aspiration or core biopsy. The guidance is under CT or U/S. Fine needle aspiration has usually small diameter in comparison to the core biopsy. In any case the radiologist will choose the appropriate method based on the site of the lesion and safety of the patient. Pneumothorax and hemothorax are adverse effects that can be managed either on site with the help of a small catheter, however; there are cases where video-assisted thoracic surgery is needed in order to manage a more severe case...
2018: Respiratory Medicine Case Reports
Konstantinos Grapatsas, Vasileios Leivaditis, Ioannis Panagiotopoulos, Konstantinos Spiliotopoulos, Efstratios Koletsis, Manfred Dahm, Christoforos Kosmidis, Stella Laskou, Paul Zarogoulidis, Athanasios Katsaounis, Efstathios Pavlidis, Dimitrios Giannakidis, Charilaos Koulouris, Stylianos Mantalovas, Fotis Konstantinou, Aikaterini Amaniti, Alexandru Munteanu, Valeriou Surlin, Konstantinos Sapalidis, Isaak Kesisoglou
Deep accidental hypothermia is an unusual clinical entity in developed countries. We report a case of a 30 year old male Caucasian patient with accidental severe hypothermia who was transferred to the emergency department of our hospital after prolonged exposure in the urban city's night environment cold as a result of alcohol and drugs abuse. The patient was found unconscious in the first early hours from onlookers. The time that the patient remained unconscious is unknown. During the transfer to the hospital because of cardiac arrest cardiopulmonary resuscitation began...
2018: Respiratory Medicine Case Reports
Nadir Demirel, Roberto Ochoa, Megan K Dishop, Tara Holm, William Gershan, Gail Brottman
A 2-month-old female with worsening cough, respiratory distress and an abnormal chest X-ray was referred to our institution for further evaluation of suspected scimitar syndrome. She was found to have normal pulmonary venous drainage with a large patent ductus arteriosus and severe pulmonary arterial hypertension. Chest CT was suggestive of interstitial lung disease. Wedge lung biopsy revealed alveolar simplification and patchy pulmonary interstitial glycogenosis. A definitive diagnosis of Filamin A deficiency was made with genetic studies...
2018: Respiratory Medicine Case Reports
Su-Jin Oh, Ki-Eun Hwang, Eun-Taik Jeong, Hak-Ryul Kim
We report first case of pulmonary siderosis appearing as a consolidation upon radiological examination and being misdiagnosed as pneumonia. A 59-year-old man visited our hospital with a cough and sputum that had persisted for more than a month. He had undergone chest computed tomography (CT) after abnormal findings on chest X-ray at other hospitals. Based on the chest CT results, he was diagnosed with pneumonia. He was then administered antibiotics for 3 weeks, but there was no improvement. We identified the patient's occupational history first, and then performed bronchoalveolar lavage and chest CT-guided transthoracic lung biopsy...
2018: Respiratory Medicine Case Reports
Swarna Arumugam, Raghu Raju, Andrew G Nicholson
Here we report a case of Pulmonary Hyalinising Granuloma (PHG) presenting with mild to moderate FDG positive nodules in an individual with a high risk of cancer. We explore the considerations in interpreting imaging findings and assess the benefits and risks of undertaking invasive investigations such as tissue biopsy. We highlight the importance of reaching an accurate diagnosis of this benign condition on our patients and their future outlook.
2018: Respiratory Medicine Case Reports
Brandon Nokes, Andrew S Tseng, Rodrigo Cartin-Ceba, Fadi Shamoun, Clinton Jokerst, Lester Mertz
Behçet disease is a rare multisystem condition associated with HLA-B51 positivity that commonly afflicts individuals of Turkish or Middle Eastern descent, less than 10% of whom have pulmonary involvement. Behçet-related pulmonary vasculitis is an uncommon and heterogeneous group of conditions, often with associated pulmonary artery thrombus formation. These microthrombi can result in a misdiagnosis of acute pulmonary embolism. Anticoagulation therapy can be difficult, as blood thinners increase the risk of pulmonary hemorrhage without affording the same benefits as in pulmonary embolism management...
2018: Respiratory Medicine Case Reports
Mitsuhiro Kamiyoshihara, Hitoshi Igai, Fumi Ohsawa, Ryohei Yoshikawa, Tomohiro Yazawa
Schwannomas commonly arise in the torso, extremities, and mediastinum. However, no interlobar lymph node (#11i) lesions have ever been reported. This is a thought-provoking case, because it involved a schwannoma arising in a lymph node mimicking metastatic pulmonary carcinoma. A 72-year-old man was diagnosed with primary pulmonary carcinoma, and 18F-fluorodeoxyglucose (FDG) positron emission tomography demonstrated high FDG uptake in the primary lesion and in #11i, which suggested metastasis (clinical stage IIA)...
2018: Respiratory Medicine Case Reports
Tomoyuki Naito, Hiroki Hayashi, Takeru Kashiwada, Yoshinobu Saito, Shinji Abe, Kaoru Kubota, Akihiko Gemma
A 41-year-old woman presented complaining of cough and purpura for one month. On her first visit, a blood test demonstrated peripheral blood eosinophilia, but chest radiography showed no abnormalities. However, 2 days after the first visit, she went to the emergency room because of fever and right-sided chest pain. Contrast-enhanced computed tomography of the chest showed pulmonary embolism and air space consolidation. Thrombosis was present in the popliteal vein. Bronchoscopy revealed alveolar hemorrhage and increased eosinophils in the bronchoalveolar lavage fluid, and a skin biopsy demonstrated a perivascular eosinophilic infiltrate...
2018: Respiratory Medicine Case Reports
Dana Kay, Ali Ataya, Xiuli Liu, Jena Auerbach, Dan Urbine
Hypereosinophilic syndrome (HES) is characterized by a persistently elevated eosinophil count associated with eosinophil-related end-organ damage and thromboembolic events, in the absence of an identifiable cause. We present a case of idiopathic HES with evidence of peripheral and tissue eosinophilia while on high dose prednisone, associated with muscle tension dysphonia, colitis, and jackhammer esophagus. The patient was treated with the interleukin-5 inhibitor, Mepolizumab, with resolution of symptoms including dyspnea, diarrhea and dysphonia...
2018: Respiratory Medicine Case Reports
Yusuke Katsumata, Jun Ikari, Nozomi Tanaka, Mitsuhiro Abe, Kenji Tsushima, Yoko Yonemori, Koichiro Tatsumi
A 67-year-old woman with fever and cough was diagnosed with eosinophilic pneumonia because of eosinophilia and increased eosinophil levels in the bronchoalveolar lavage fluid and transbronchial biopsy lung specimens. However, prednisolone therapy at a previous hospital was ineffective. Histological findings from thoracoscopic lung and lymph node biopsies were consistent with multicentric Castleman's disease (MCD). Since specimens also showed prominent eosinophil and IgG4 -positive plasma cell infiltration, it was difficult to distinguish IgG4 -related disease (IgG4 -RD) from MCD...
2018: Respiratory Medicine Case Reports
M I Shafi, S Liaquat, D Auckley
Diffuse alveolar hemorrhage (DAH) can be a serious and life threating condition. Illicit substance use has been associated with DAH, with cocaine being the most widely reported. Marijuana use has been associated with pulmonary complications in the form of pneumomediatsium, pneumothorax, bullous disease, and pulmonary aspergillosis. We present a case of diffuse alveolar hemorrhage (DAH) resulting from marijuana inhalation, a finding rarely described in the literature. A 21-year-old male presented with several episodes of hemoptysis after drinking alcohol and smoking marijuana...
2018: Respiratory Medicine Case Reports
Kenneth K Sakata, Darlene R Nelson, John J Mullon, David E Midthun, Eric S Edell, Ryan M Kern
Introduction: Central airway obstruction (CAO) often requires repeated interventional procedures which offer variable efficacy, a time-limited effect, and have inherent limitations. Paclitaxel has been used to prevent restenosis in blood vessels. The literature describing the use of paclitaxel to prevent recurrent airway stenosis is limited. We sought to describe our experience using a paclitaxel-coated balloon (PCB) for CAO. Material and methods: We performed a retrospective review of all patients who underwent PCB airway dilation...
2018: Respiratory Medicine Case Reports
Toyoshi Yanagihara, Yuzo Yamamoto, Naoki Hamada, Kunihiro Suzuki, Saiko Ogata-Suetsugu, Eiji Harada, Tetsuzo Tagawa, Minako Fujiwara, Mikiko Hashisako, Junya Fukuoka, Yoichi Nakanishi
We report a case of recurrent idiopathic pulmonary hemosiderosis after a long-term remission presented with Sjögren's syndrome. The patient was diagnosed with IPH due to repeated pneumonia and blood sputum in his childhood. He was admitted to our hospital due to exertional dyspnea and dry cough with bilateral ground-glass opacity in chest computed tomography at the age of 32. Video-assisted thoracoscopic surgery was performed and the specimens showed nonspecific interstitial pneumonia pattern with diffuse, chronic alveolar hemorrhage, suggesting recurrence of IPH...
2018: Respiratory Medicine Case Reports
Randi Connor-Schuler, Daniel Hrabec, Julio Pinto Corrales
Pulmonary emboli (PE) are commonly encountered events with presentations ranging from benign incidental findings to obstructive shock. We present a case of a 20 year old male with nephrotic syndrome who suffered complete cardiovascular collapse with cardiac arrest in the setting of a massive PE, requiring open surgical embolectomy and ECMO support. We reviewed the literature on massive PE's focusing on the use of ECMO and success of the rarely performed open embolectomy for the treatment of obstructive shock from a massive PE...
2018: Respiratory Medicine Case Reports
Pureepat Arttawejkul, Napplika Kongpolprom
A 56-year-old previously healthy female presented with chronic productive cough and fever. Chest X-ray revealed right middle lung opacities. Sputum acid fast bacilli smear was positive, however polymerase chain reaction was negative for Mycobacterium tuberculosis . Further investigations were pursued, which identified Mycobacterium asiaticum. Appropriate therapy with isoniazid, rifampin and clarithromycin for total 18 months (including pyrazinamide and ethambutol for first 4 months) resulted in clinical and radiographic improvement...
2018: Respiratory Medicine Case Reports
Kartikeya Rajdev, Abdul Hasan Siddiqui, Uroosa Ibrahim, Shivika Agarwal, Juan Ding, Michel Chalhoub
Sarcomatoid carcinoma (SC) of the lung is a rare and aggressive biphasic lung tumor with a 5-year survival of 20%. Early detection and treatment is the only way to improve outcomes in patients with SC of the lung. We present a case of primary SC identified early based on high suspicion. A 56-year-old female with a history of chronic obstructive pulmonary disease (COPD) presented with hemoptysis and exertional dyspnea. Chest X-ray revealed right upper lobe (RUL) opacity and patient was started on antibiotics for pneumonia...
2018: Respiratory Medicine Case Reports
Konstantinos Grapatsas, Severin Schmid, Benedikt Haager, Torsten Loop, Bernward Passlick
Advances in extracorporeal membrane oxygenation (ECMO) have allowed safe performance of complex thoracic surgical procedures that were impossible before. Application of ECMO in general thoracic surgery is extremely rare, but allows life-saving procedures in patients in whom one-lung ventilation cannot be carried out safely. We present the case of a 66 year old man who underwent a challenging veno-venous ECMO assisted segmentectomy for a second primary lung cancer. One-lung ventilation was not feasible due to previous lobectomy on the contralateral side and consequent lack of respiratory function...
2018: Respiratory Medicine Case Reports
Tiffany Winstone, Cameron J Hague, Andrew Churg, Joanne L Wright, Robert Schellenberg, Chris Ryerson
Hypersensitivity pneumonitis (HP) is characterized by inflammation of the lung parenchyma that is induced by exposure to an inhaled organic antigen. We present a case of recurrent, acute HP caused by repeated transient exposure to a down sleeping bag in a patient with a family history of chronic bird-associated hypersensitivity pneumonitis. The patient's recurrent symptoms, changes in physiology, and radiographic findings coincided with repeated exposure to this source. It was later confirmed that the patient's sister had also developed chronic HP from recurrent exposure to household birds...
2018: Respiratory Medicine Case Reports
Makoto Hibino, Yuka Otsuka, Kazunari Maeda, Shigeto Horiuchi, Minoru Fukuda, Tetsuri Kondo
A previously healthy 44-year-old Japanese man with a 5-month history of lumbago presented to the emergency department with acute respiratory failure caused by pneumonia, and was immediately intubated. Computed tomography revealed a lung mass, pleural effusion, and multiple osteolytic lesions; however, the results of thoracentesis and bronchial brushing were not definitive. We performed a bone tumor biopsy guided by diffusion-weighted magnetic resonance imaging (DW-MRI) with mechanical ventilation, which enabled the diagnosis of ALK rearrangement-positive lung adenocarcinoma...
2018: Respiratory Medicine Case Reports
Lakshmi Saladi, Dmitry Lvovsky
Central airway obstruction, a frequently encountered emergency, is usually associated with blood clots, tumors, foreign bodies or mucus plugs. Airway obstruction due to blood clots can be seen as a complication of lung malignancies, infections, bronchiectasis, arteriovenous malformations or pulmonary infarction. In patients with long standing blood clots, the thrombus gets organized and firmly adherent to the airway. The diagnosis is often misleading as these clots mimic tumors clinically and on imaging. Hemoptysis is the most common presenting symptom though many patients can be asymptomatic...
2018: Respiratory Medicine Case Reports
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