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Respiratory Medicine Case Reports

Felix Reyes, Vytas Vaitkus, Mohammad Al-Ajam
Cocaine is a commonly abused recreational drug in the United States. An adult man developed non-specific pleuritic chest pain, pharyngitis and odynophagia after inhaling cocaine. Initial laboratory results revealed eosinophilia. Bronchoalveolar lavage also showed eosinophilia in the lavage fluid. These findings suggested the diagnosis of eosinophilic pneumonia. Chest imaging revealed scattered bilateral opacities and interstitial infiltrates. After initiation of systemic corticosteroids, the patient reported symptomatic resolution and radiographic clearance was achieved at 2 months follow up...
2018: Respiratory Medicine Case Reports
Carlos Romero, Daryelle S Varon, Salim Surani, Joseph Varon
We present the case of a 61-year-old gentleman with history of stage IV esophageal cancer presented to the emergency department with the complaints of dyspnea on exertion and cough of 1-month duration. Patient had undergone resection of distal esophagus 4 years' prior this admission. Chest radiograph revealed a large right pleural effusion and, a computed tomography scan of the chest revealed a portion of the effusion herniating between the ribs in the right hemithorax. Thoracentesis was performed with improvement in patient's dyspnea and overall condition...
2018: Respiratory Medicine Case Reports
Adel Asaad, Kimberley Cao, Mark Rumbak
Indoor air pollution appears to be a major environmental and public health hazard for large numbers of the underdeveloped world's population. A detailed environmental history is important for making diagnosis in most individuals from foreign rural settings with nonspecific respiratory symptoms. In this report, we describe an illustrative case of domestically acquired particulate lung disease (DAPLD) or "hut lung" in a 65-year-old Sudanese male who immigrated to the United States in 1986. He presented with symptoms of chronic productive cough and dyspnea...
2018: Respiratory Medicine Case Reports
Yuhei Ito, Hirokazu Toyoshima, Takehiro Suzuki, Keisuke Iwamoto, Hajime Sasano, Hidetoshi Itani, Shigeto Kondo, Motoaki Tanigawa
Lung abscess has been considered to be a rare complication of pneumococcal infection, and most cases are reported to be Streptococcus pneumoniae serotype 3. A 67-year-old man presented with fever and was diagnosed to have lung abscess caused by S. pneumoniae serotype 6B. The minimal inhibitory concentration (MIC) of penicillin for the isolate was 1 μg/mL. He was treated with high-dose intravenous sulbactam/ampicillin as definitive therapy based on susceptibility testing for S. pneumoniae and recovered successfully without surgical intervention...
2018: Respiratory Medicine Case Reports
Shingo Satoh, Takayuki Shiroyama, Motohiro Tamiya, Shingo Nasu, Ayako Tanaka, Satomu Morita, Naoko Morishita, Hidekazu Suzuki, Norio Okamoto, Tomonori Hirashima
Pneumonitis is a serious adverse event of EGFR-TKI treatment. Although several cases of EGFR-TKI rechallenge after EGFR-TKI-induced pneumonitis have been reported, little is known about post-pneumonitis osimertinib rechallenge. We describe a 69-year-old never-smoking Japanese woman with postoperative recurrent lung adenocarcinoma retreated with osimertinib after osimertinib-induced pneumonitis. Although osimertinib rechallenge must be carefully chosen based on risk/benefit analysis, osimertinib rechallenge after osimertinib-induced pneumonitis may be an option, with limited alternative therapeutic options...
2018: Respiratory Medicine Case Reports
Yuttiwat Vorakunthada, Weerapong Lilitwat
Tracheobronchomalacia (TBM) is characterized by weakness of cartilaginous supporting structures of tracheal and bronchial walls, resulting in central airway obstruction. It is a rare condition that can occur after prolonged intubation. Here, we report a 26-year-old, alcoholic male who had TBM, mild subglottic, and severe tracheal stenosis following 2 weeks of intubation. Subglottic and tracheal stenosis can occur after extubation but TBM is uncommon. The exact mechanism is still unknown but post-intubation TBM is a life-threatening condition with high morbidity and mortality if left untreated...
2018: Respiratory Medicine Case Reports
Nazhan Afeef Mohd Ariff, Mohd Zulfakar Mazlan, Mohd Erham Mat Hassan, Praveena A/P Seevaunnamtum, Wan Fadzlina Wan Muhd Shukeri, Nik Abdullah Nik Mohamad, Shamsul Kamalrujan Hassan, Kamaruddin Jaalam, Mohamad Hasyizan Hassan, Sanihah Che Omar, Chandran Nadarajan, Irfan Mohamad
Introduction: Bronchoscopy is a commonly used procedure in the context of aspiration in the Intensive Care Unit setting. Despite its ability to remove mucus plug and undigested gastric contents, aspiration of gastric content into the trachea is one of the most feared complications among anesthesiologist. Discussion: The scenario is made worst if the aspiration causes acute hypoxemic respiratory failure immediately post intubation. However, in the event of desaturation, the quick decision to proceed with bronchoscopy is a challenging task to the anesthesiologist without knowing the causes...
2018: Respiratory Medicine Case Reports
Matthew Hensley, Benjamin H Singer
Lidocaine allergy presents a unique difficulty for both patients and providers who undergo/perform bronchoscopy. We present a case of a 73 yo male with severe lidocaine allergy who successfully underwent bronchoscopy with chloroprocaine topical anesthesia and discuss alternative topical anesthetic agents that may be used in this special situation.
2018: Respiratory Medicine Case Reports
Takahiko Sakaue, Masaki Tominaga, Takashi Niizeki, Yoshiaki Zaizen, Ken Matsukuma, Masamichi Koganemaru, Tomoaki Hoshino, Takuji Torimura
Lymphangioleiomyomatosis (LAM) is a rare and progressive neoplastic disease of young woman, characterized by the proliferation of abnormal smooth muscle-like cells (LAM cells) in the lungs and axial lymphatics. A 44-year-old woman was referred to our hospital because pleural effusion was detected during a health checkup. She had chylothorax, chylous ascites, and chyluria, and her computed tomography scan showed a solid tumor in the pelvis. Surgical biopsy was performed; she was diagnosed as having LAM. We could not control the fluid collection and chyluria using standard medical treatments...
2018: Respiratory Medicine Case Reports
Sumit Fogla, Vaishali M Pansare, Luis G Camero, Uzma Syeda, Naveen Patil, Arun Chaudhury
We report the case of a 68-year-old gentleman who presented with musculoskeletal chest pain which appeared suddenly when he bent over with his dog. The chest pain was localized to the left lower chest and increased with movement and deep breathing. The patient did not complain weight loss, night sweat, fever or chill. He complained of mild cough, with expectoration of whitish mucus. Imaging revealed cavitary chest lesion in the right upper lobe, which was initially suspected to be lung cancer. The patient had a 50-year-old history of smoking 2 packs per day...
2018: Respiratory Medicine Case Reports
Ana Gomez-Larrauri, Simon Galloway, Rob Niven
Achalasia is an uncommon oesophageal motor disorder characterized by failure of relaxation of the lower oesophageal sphincter and muscle hypertrophy, resulting in a loss of peristalsis and a dilated oesophagus. Gastrointestinal symptoms are invariably present in all cases of achalasia observed in adults. We report a case of a 34 year-old female patient with long standing history of asthma-like symptoms, labelled as uncontrolled and steroid resistant asthma with no gastrointestinal manifestations. Thoracic CT scan revealed a massive oesophagus due to achalasia, which caused severe tracheomalacia as a result of tracheal compression...
2018: Respiratory Medicine Case Reports
Irena Hammen, Achhe Lal Yadav
A 16-year-old girl presented with intermittent left chest pain and breathlessness on exertion for last 4 months with one episode of haemoptysis. There has been loss of appetite and weight loss of 4 kg over a period of 1 month. A chest radiograph revealed a large mass like opacity with pleural effusion in the left lung field. Computerized Tomography scanning (CT scanning) and Positron Emission Tomography/Computerized Tomography scanning (PET/CT scanning) demonstrated a 7 cm round, cystic lesion in the anterior mediastinum...
2018: Respiratory Medicine Case Reports
Konstantinos Grapatsas, Zoi Tsilogianni, Vasileios Leivaditis, Sotirios Kotoulas, Christoforos Kotoulas, Efstratios Koletsis, Ilias Stylianos Iliadis, Manfred Dahm, Georgia Trakada, Lemonia Veletza, Anastasios Kallianos, Haidong Huang, Christoforos Kosmidis, Michael Karanikas, Vasilis Thomaidis, Konstantinos Porpodis, Paul Zarogoulidis
Pneumomediastinum is a rare clinical entity that concerns the clinicians in the emergency department. We present a case of a patient with spontaneous pneumomediastinum (Hamman's syndrome) that presented to our hospital's emergency department with cervical subcutaneous emphysema. A conservative treatment with observation was performed. The patient after 24 hours of observation was discharged with a suggested follow-up.
2018: Respiratory Medicine Case Reports
Tomohiro Sakamoto, Akira Yamasaki, Yoshihiro Funaki, Tomoya Harada, Ryota Okazaki, Yasuyuki Hasegawa, Yuriko Sueda, Takehito Fukushima, Masahito Morita, Akihiro Yamamoto, Masahiro Kodani, Eiji Shimizu
A 62-year old man was admitted to our hospital with a 2-week complaint of a dry cough, general fatigue, and dyspnea on effort. He has been an onion farmer for several years and developed these symptoms after cleaning up onion peels with air compressors. A chest roentgenogram and computed tomography showed a ground glass shadow in the bilateral upper lung field. Cellular analysis of the bronchoalveolar lavage fluid showed elevated total cell numbers and lymphocytes. Transbronchial lung biopsies revealed a non-caseating granuloma with both epithelioid cells and Langhans giant cells...
2018: Respiratory Medicine Case Reports
Kimikazu Takeuchi, Kazuhiko Nakayama, Mitsumasa Okano, Naoki Tamada, Hideya Suehiro, Yuto Shinkura, Kenichi Yanaka, Hiroyuki Onishi, Hidekazu Tanaka, Toshiro Shinke, Noriaki Emoto, Ken-Ichi Hirata
Clinical efficacy of combination therapy using vasodilators for pulmonary arterial hypertension (PAH) is well established. However, information on its safety are limited. We experienced a case of primary Sjogren's syndrome associated with PAH where the patient developed pulmonary edema immediately after the introduction of upfront triple combination therapy. Although the combination therapy successfully stabilized her pre-shock state, multiple ground glass opacities (GGO) emerged. We aborted the dose escalation of epoprostenol and initiated continuous furosemide infusion and noninvasive positive pressure ventilation (NPPV), but this did not prevent an exacerbation of pulmonary edema...
2018: Respiratory Medicine Case Reports
Diamantis I Tsilimigras, Anargyros Bakopoulos, Ioannis Ntanasis-Stathopoulos, Maria Gavriatopoulou, Demetrios Moris, Georgios Karaolanis, Eleftherios Spartalis, Stylianos Vagios, Maria Kalfa, Charitini Salla, Dimitrios V Avgerinos
Clear cell tumor of the lung (CCTL) is an extremely rare neoplasm with about 50 cases reported in the literature so far. CCTL belongs to a family arising from putative perivascular epithelioid cells and is otherwise named as "sugar tumor" due to its high cellular glycogen concentration. Due to its rarity, diagnostic features of this entity are not widely known and this usually leads to misdiagnosis. Herein, we report a case of benign CCTL, which was primarily evaluated intraoperatively by FNA cytology and then by a pathological examination of the resected tumor...
2018: Respiratory Medicine Case Reports
Macarena R Vial, George A Eapen, Roberto F Casal, Mona G Sarkiss, David E Ost, Erik Vakil, Horiana B Grosu
The standard approach to staging of lung cancer in patients with pleural effusion (clinical M1a) is thoracentesis followed by pleural biopsies if the cytologic analysis is negative. If pleural biopsy findings are negative, endobronchial ultrasound-guided transbronchial needle aspiration is used to complete the staging process and, in some cases, obtain diagnosis. In this case series we report 7 patients in which a combined procedure was performed for staging of known or suspected lung cancer. We found that the combined approach was both feasible and safe in this case series...
2018: Respiratory Medicine Case Reports
Raquel López-Reyes, Alberto García-Ortega, Ana Torrents, Laura Feced, Pilar Calvillo, Eugenia Alejandra Libreros-Niño, Juan Escrivá-Peiró, Dolores Nauffal
Background: Pulmonary Vein Thrombosis (PVT) is a rare and underdiagnosed entity produced by local mechanical nature mechanisms, vascular torsion or direct injury to the vein. PVT has been described in clinical cases or small multicenter series mainly in relation to pulmonary vein stenosis, metastatic carcinoma, fibrosing mediastinitis, as an early surgical complication of lung transplantation lobectomy and radiofrequency ablation performed in patients with atrial fibrillation, although in some cases the cause is not known...
2018: Respiratory Medicine Case Reports
Teppei Inoue, Akihito Tsunoda, Eriko Nishimoto, Kohei Nishida, Yuka Komatsubara, Rintaro Onoe, Junko Saji, Masamichi Mineshita
A 51-year-old male patient was receiving treatment for Mycobacterium abscessus infection for approximately 10 years. However, as his condition gradually progressed to type II respiratory insufficiency, he was referred to our hospital, which was near his home. Computed tomography on his first visit revealed an abscess in the right lower lobe. Because respiratory insufficiency was evident, he was admitted the same day. We began treatment with meropenem, amikacin, and clarithromycin, but his symptoms did not improve...
2018: Respiratory Medicine Case Reports
Paul Zarogoulidis, Haidong Huang, Chong Bai, Christoforos Kosmidis, Konstantinos Porpodis, Anastasios Kallianos, Lemonia Veletza, Georgia Trakada, Naim Benhassen, Wolfgang Hohenforst-Schmidt
Lung cancer is still underdiagnosed mainly due to lack of symptoms. Most patients are diagnosed in a late stage where unfortunately only systematic therapy can be applied. Fortunately in the last five years several novel therapies and combinations have emerged. However; in certain situations local therapeutics modalities have to be applied in order to solve emergency problems as in the case that we will present. Convex-EBUS probe was used along with a novel method of ventilation which keeps PCO2 concentration satisfyingly low...
2018: Respiratory Medicine Case Reports
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