Respiratory Medicine Extra最新文献

Mucormycosis is an acute and rapidly developing fungal infection that complicates immunosuppressed patients suffering from diabetic ketoacidosis and serious immunosuppression. It typically has a rapid fulminant course resulting to death. We report a patient who was admitted for diabetic ketoacidosis and pulmonary mucormycosis with an indolent and benign outcome, despite nonoptimal therapy.

A 37 yr old lady in her 14th week of her second pregnancy presented to chest clinic with breathlessness. Over the preceding month she had gradual onset of exertional breathlessness limiting her activities of daily living. Examination and routine blood tests were unremarkable and she declined a chest radiograph. Her symptoms progressed and she allowed us to perform a chest radiograph, which revealed a large right sided pneumothorax. This was aspirated successfully. During the final few months of her pregnancy she had a further episode of symptomatic ipsalateral pneumothorax, which was treated successfully with aspiration. She delivered a healthy baby via uncomplicated caesarean section under a spinal anaesthetic at term. A chest radiograph taken 2 d post-partum showed normal lung fields with no pneumothorax. Unfortunately, 2 weeks later she developed her third ipsalateral pneumothorax and this was treated conservatively pending video-assisted thoracoscopic surgery and pleurodesis, which occurred a few weeks later. At VATS the appearance of her lungs was grossly abnormal and a biopsy was sent for histological analysis. After a HRCT and specialist staining of her lung biopsy the diagnosis of lymphangioleiomyomatosis was established.

We report a clinical case of a young woman with recurrent haemoptysis.

In this case, we wish to highlight the contribution to diagnosis of computed tomography (CT) showing anomalous vessels in left lower lobe. The image of digital intravenous arteriography subtraction (DIVAS) revealed the absence of normal lung vessels in that area and the aortography with selective arteriography showed two aberrant arteries originated from the thoracic aorta and an unusual venous return trough the azygous and hemiazygous systems. Usually, the venous drainage of intralobar sequestration is via the pulmonary veins.

Isolated pulmonary cryptococcosis (IPC) accounts for just over 30% of this fungal infection and is rare among immunocompetent individuals. Since it has polymorphic manifestations, it is not always suspected and often misdiagnosed. To help establish a differential diagnosis for these pulmonary lesions, six cases of IPC in nonimmune-impaired hosts are reported.

An 84-year-old patient reporting increased coughing, dyspnea and whitish phlegm was admitted to hospital with a tentative diagnosis of pneumonia and metapneumonic pleural effusion. Biochemical and microbiological analyses of pleural fluid were compatible with empyema, but pleural fluid cytology showed non-small-cell bronchogenic carcinoma. A few days after admission, perforation of the small intestine with tumoral infiltration was detected. Urgent surgery was followed by postoperative death. This case appears to reinforce the arguments for including cytological examination as routine when pleural fluid is analysed.

Symptomatic pleural effusion following ventriculoperitoneal (VP) shunt insertion is very rare. We report our experience with three patients with VP shunt and massive pleural effusion. The three were seen multiple times in the emergency room before diagnoses were reached. Awareness of this possible complication may prevent futile surgical interventions or redundant treatments.

A case presentation of syncope during forced exhalation and cough paroxyms due to an endobronchial neoplasm in the left mainstem bronchus,; clinical findings and mechanism of syncope are reviewed.

The diagnosis of miliary tuberculosis (TB) may be a challenging task for the physician. Pancreatitis is an extremely rare presentation of miliary TB. A healthy 31-year-old American male was admitted because of severe nausea, anorexia, malaise and night sweat for 4 days. He was febrile and his physical examination was unremarkable. The chest X-ray (CXR) was normal and the computed tomographic (CT) evaluation of the abdomen was consistent with pancreatitis. On the 12th day in the hospital, he complained of dyspnea and his chest CT showed bilateral ground-glass opacities. Subsequent bronchoscopy was not diagnostic. Open lung biopsy (OLBx) revealed multiple necrotizing granulomas. The patient responded to antituberculous therapy and was discharged home 3 weeks later. Miliary TB is a curable disease, which can take many forms. A high index of clinical suspicion and diagnostic persistence are required for diagnosis. Early diagnosis and treatment of miliary TB nurtures better outcomes.

A 51 years old male patient was referred for dyspnoea on minimal exertion associated with a severe hypoxemia (PaO₂=66 mmHg) and respiratory alkalosis. Investigations led to the diagnosis of hepatopulmonary syndrome. PaO₂ increased from 60 to 75 mmHg after one hour of i.v. almitrine bismesylate infusion, and it remained at 85 mmHg after 3 months of further per os treatment. This case of hepatopulmonary syndrome is the first to be persistently improved by almitrine bismesylate. Increase of PaO₂ would at least delay the hepatic transplantation.

Re-expansion pulmonary oedema (REPO) is associated with a variety of clinical disorders including chest tube drainage of pneumothorax. It is an uncommon complication with varied presentation. Patient may be mildly symptomatic or may present with life threatening complication requiring immediate treatment. The mechanism and management of REPO differs from that of cardiogenic pulmonary oedema. We present two patients, one with life threatening REPO and other with no symptoms, detected on chest radiograph. Pathogenesis, management and prevention is discussed along with review of literature.