Respiratory Medicine Extra最新文献

Spontaneous regression is partial or complete reduction of a malignant tumor without treatment or in the presence of therapy that is considered inadequate to exert a significant influence on neoplastic disease. We report herein a patient with lung cancer who had a spontaneous regression of scalp metastasis with no treatment performed. This is the first report of the spontaneous regression of scalp metastasis of lung cancer. The patient should be carefully followed up to chart his unusual clinical course.

Glomus tumours are distinctive neoplasms arising in the cells of the glomus body. Histologically they resemble modified smooth muscle cells. It usually occurs over the limbs. However, several unusual sites of occurrence have been described. These include the patella, chest wall, bone, heart, stomach, eyelid, lung, rectum, etc. Tracheal tumours have been described.

We discuss a case of glomus tumour arising from the proximal trachea in a 43-year old male with complaints of intermittent hemoptysis and chest pain, and describe resection of this tumour using a rigid bronchoscopic technique.

An overview of tracheal glomus tumours is presented.

Mediastinal bronchogenic cysts are frequently detected incidentally in adults. Here, we present a unique case of atypical clinical course of bronchogenic cyst beneath the carina, which ruptured into the pericardium. We could not diagnose definitely at initial admission, even though the massive pericardial fluid was exudative with high carbohydrate antigen (CA) 19-9 production. The fluid cytology was negative for malignancy. Five years later, the regrown and unruptured bronchogenic cyst caused atrial fibrillation by impinging on the heart with a high level of serum CA19-9. After resection of the CA19-9-enriched cyst by thoracoscopic surgery, he was discharged without recurrence of atrial fibrillation or any chest symptoms, and the serum CA19-9 level decreased to within the normal range. Differential diagnosis of cytology negative pericardial effusion with high CA19-9 production may be difficult, however, intrapericardial rupture of bronchogenic cyst should be considered in some patients.

Though pulmonary lymphangioleiomyomatosis (LAM) is a rare disease that affects women in the reproductive years, there have been some reports in postmenopausal women, and even a few reports of pulmonary LAM in postmenopausal women without exogenous estrogen. This is the first report describing progression of pulmonary LAM after menopause. Physicians should be aware that pulmonary LAM could progress after menopause, although the course might run slower than that of LAM in the younger patients.

We present the case of a 15 yr-old male who was referred to the respiratory department for investigation of a chronic cough that was severely affecting his daily activities. He had previously been diagnosed with “psychogenic cough” in another institution. A bronchoscopy was performed which revealed mucosal abnormality on the posterior wall of the trachea. Biopsies of these lesions were suggestive of a viral aetiology and subsequent PCR analysis of the tracheal biopsy detected human papilloma virus (HPV) DNA subtypes 11 and 16.

HPV isolated to the trachea without evidence of more proximal involvement is rare. In our discussion, we present the aetiology, risk factors, treatment and complications of this condition. This case highlights the importance of a complete assessment of cough in all cases as recently described in the American College of Chest Physicians’ guidelines on the diagnosis and management of cough.

A 35-year-old male was hospitalized with hypoxemic respiratory failure and newly diagnosed acute myelogenous leukemia. After initial improvement with chemotherapy and broad spectrum antibiotics, including antifungal therapy with voriconazole, a new right upper lobe pulmonary 1.6 cm nodule was discovered during workup for persistent fever. Respiratory failure recurred and repeat CT revealed that the nodule had become a necrotic mass involving the right upper lobe, chest wall, and mediastinum, which biopsy showed to be mucormycosis. Therapy was changed to amphotericin, but the patient died. As this case demonstrates, optimal management of patients with suspected invasive fungal disease mandates a vigorous diagnostic evaluation, especially in the face of new or evolving radiographic findings. Antifungal therapies are not equal in their ability to treat non-aspergillus molds, and as such may not address the responsible pathogen. The potential downside of empiricism and diagnostic delay is demonstrated here.

Xylitol has many uses, such as in dentistry and as a sweetening agent, and is synthesized from fungus by fermentation. According to some publications, xylitol has no adverse effects on the lungs in either healthy people or patients with cystic fibrosis, but no studies have examined the effects of long-term exposure. Here, we report a patient who developed occupational asthma due to xylitol as confirmed with provocation tests.

The location of echinococcal cysts inside pulmonary artery is extremely rare. We report a case of a 51-year-old patient with known surgical excision for hepatic hydatid cyst 14 years previously. He was admitted for a chest pain and haemoptysis. Angioscan showed multiple echinococcal cysts in both lungs and partial occlusion of a distal branches of the left pulmonary artery by hydatid cyst. CT scan of the abdomen revealed residual cavity in the liver. After medical therapy with albendazole, the patient was free of symptoms 12 months later.

There are increasing reports of opportunistic cryptococcal infections with an ever expanding number of patients with acquired immune deficiency syndrome (AIDS). We report a case of a 50 years old male, who presented with history of prolonged fever and had pleural effusion which was positive for Cryptococcous neoformans. He was detected to be HIV positive and was treated with fluconazole. He showed significant resolution of signs and symptoms over 3 weeks and HAART was added with fluconazole

Paragonimiasis is an infectious disease caused by Paragonimus westermani and usually manifests as pulmonary disease. Cutaneous paragonimiasis is very rare, and the correct diagnosis is delayed in most cases. Here we report two cases of cutaneous paragonimiasis with pulmonary lesion in Korea. The first case presented as a chest wall mass and pleural effusion with no lung lesions on chest radiographs or computed tomography. Biopsied materials showed fibrosis and eosinophilic inflammation. A definite diagnosis was made by identifying eggs of P. westermani in the sputum and specific antibody in the serum by ELISA. The second case manifested as multiple lung lesions and two subcutaneous nodules in the left lateral thigh and left flank area. Excision biopsy of the subcutaneous nodules identified adult worm of P. westermani with surrounding eosinophilic granulomas.