Respiratory Medicine Extra最新文献

Lipoid pneumonia, which results from aspiration of mineral oil, animal oil, or vegetable oil, is a rare lung disease. This study was designed to investigate the clinical features of lipoid pneumonia in Korea. We collected data regarding the demographic and clinical characteristics in 40 patients aged ⩾20 years who had suffered from lipoid pneumonia in Korea between 1965 and 2006. Our three cases of lipoid pneumonia were added. There were 31 male patients and 9 female patients, and the mean age was 57 years. The mean length of time from ingestion of causative agents to the establishment of diagnosis was 359 days. The most common causative agent was shark liver oil (37 cases, 93%). The definitive diagnosis was established by bronchoalveolar lavage in 15 cases (40%), and open-lung biopsy in 4 cases (11%). Lipoid pneumonia was successfully treated by the discontinuation of the causative agent in most cases. Lipoid pneumonia in Korea mainly occurred in male adults aged more than 50 years, and the most common causative agent was animal oil. The duration of taking oil was shorter by a mean of 1 year than that in other foreign countries.

Computed tomography (CT)-guided fine needle aspiration (FNA) is a safe and effective procedure in the evaluation of undetermined pulmonary lesions. Most of the times FNA is a technique that leads to diagnosis in case of malignancies and benign tumors. Transthoracic FNA has a yield comparable to bronchoscopy for the diagnosis of infections and especially of rare opportunistic infections in immunosuppressed individuals. In this article we describe a case of Nocardia asteroides lung abscess that was diagnosed with CT-guided FNA, in a patient treated with corticosteroids for retroperitoneal fibrosis.

We report a case of bulla formation in usual interstitial pneumonia (UIP) after a 5-year follow-up, proven by open lung biopsy, in a 35-year-old Korean man with dermatomyositis. Chest computed tomography showed marked bulla formation and bilateral hydrothorax. To our knowledge, the end result of UIP is honeycombing, respiratory failure, and infection. We postulate that if patients show good compliance in dealing with their UIP, the next form of honeycombing is bulla formation. This is the first report of bulla formation in UIP with dermatomyositis after long-term follow-up.

Subcutaneous emphysema can occur idiopathically or as a consequence of invasive procedures. While it normally does not lead to any significant medical problems, it can add to patient discomfort. Other described techniques to treat subcutaneous emphysema have been ineffective or associated with complications. Successful utilization of a fenestrated subcutaneous angiocatheter for treatment of severe subcutaneous emphysema has been described in the literature. This case report serves as a literature review, as well as additional evidence to the efficacy of its use in the absence of complications.

In this report, we describe an unusual case of disseminated tuberculosis (DTB) with pulmonary infiltrates, pleural effusion, miliary tuberculosis (MTB), cervical and mediastinal lymphadenopathy, tubercular arthritis, psoas abscess and severe anemia. Although the patient was immunocompetent, the disease had a gradual and unexpected progression. Tuberculosis can be present in multiple sites, especially in patients from areas where tuberculosis is endemic. An early diagnosis and prompt initiation of anti-tuberculosis treatment for appropriate duration ensures recovery even in complicated cases. In the malign forms of tuberculosis, treatment must be extended for a year or more. Response to anti-tuberculosis treatment was favorable in this case.

We describe a 50-year-old man diagnosed with chronic exogenous lipoid pneumonia due to inhalation of paint spray. CT scan revealed multiple pulmonary nodules in both lungs. Resected specimens showed clusters of foamy macrophages in alveolar spaces, suggesting lipoid pneumonia. Long time inhalation of a small amount of paint oil may lead to lipoid pneumonia showing rare patterns such as multiple pulmonary nodules without surrounding parenchymal abnormal shadows. Five months later, some nodules increased still more in size, and some revealed reversed halo sign on CT. This case also suggests that reversed halo sign can be shown in lipoid pneumonia.

The pulmonary hypertension that develops in chronic pulmonary thromboembolic diseases is caused by both mechanical obstruction of the vascular lumen and vascular remodeling, with pathological features similar to those of idiopathic pulmonary arterial hypertension (IPAH). The therapeutic efficacy of pulmonary thromboendarterectomy (PTE) in surgical candidates with chronic thromboembolic pulmonary hypertension (CTEPH) is well-established [Doyle RL, McCrory D, Channick RN, Simonneau G, Conte J. Surgical treatments/interventions for pulmonary arterial hypertension: ACCP evidence-based clinical practice guidelines. Chest 2004;126:63S–71S]. For CTEPH patients who are ineligible for PTE, therapeutic effects of various vasodilators in treatment of IPAH have been demonstrated. Although sildenafil, a phosphodiesterase type-5 inhibitor, has been reported to have short- and long-term benefits in terms of hemodynamics and functional status for inoperable CTEPH patients [Ghofrani HA, Schermuly RT, Rose F, Wiedemann R, Kohstall MG, et al. Sildenafil for long-term treatment of nonoperable chronic thromboembolic pulmonary hypertension. Am J Respir Crit Care Med 2003;167:1139–41; Sheth A, Park JE, Ong YE, Ho TB, Madden BP. Early haemodynamic benefit of sildenafil in patients with coexisting chronic thromboembolic pulmonary hypertension and left ventricular dysfunction. Vascul Pharmacol 2005;42:41–5], its role in CTEPH treatment for PTE candidates unwilling to undergo operation has not been explored specifically. We present the case of a 50-year-old female CTEPH patient who was a traditional candidate for PTE with poor clinical response to 3 months of anticoagulant therapy, where dramatic improvements were achieved after adding on 4 months of sildanefil treatment. Her treatment course is detailed, and we discuss the potential therapeutic effects of sildenafil for CTEPH.

Inflammatory pseudotumor (IPT) of the lung is rare benign tumor which is in fact, nonneoplastic unregulated growth of inflammatory cells. Although plasma cells with reticuloendothelial elements are often seen, this kind of tumors is often described as a “plasma cell granuloma”. The lungs and airways are involved in the majority of cases, however, the mediastinum, thoracic lymph nodes and other structures are rarely affected (1). This benign entity of unknown origin is often locally invasive requiring extensive pulmonary resection (2). Because inflammatory pseudotumors mimic malignant tumors both clinically and radiologically, the radiologist should be familiar with this entity and help avoid unnecessary radical surgery when possible by including pseudotumor in the differential diagnosis (3). Radiographic findings as well as computed tomography are esential diagnostic procedures for malignancy distinction. Very slow growth, transformation to a sarcoma and regression (spontaneously or after corticosteroid therapy) have been described in the in clinical course of IPT (4).

We report the case of a non-immunocompromised male patient, who developed exogenous lipoid pneumonia complicated with Mycobacterium fortuitum infection. The association of exogenous lipoid pneumonia with atypical mycobacterial infection is uncommon but well-recognized.