Nihon Kokyuki Gakkai zasshi = the journal of the Japanese Respiratory Society最新文献

A 68-year-old woman was brought by ambulance because of sudden choking sensation and dyspnea after coughing. A physical examination showed hoarseness and blood-stained sputum. A chest computed tomography (CT) showed bilateral diffusely-distributed ground-glass opacity. A bronchoscopy examination revealed a large nodule on the left larynx and bloody bronchoalveolar lavage fluid. We diagnosed negative pressure pulmonary hemorrhage (NPPH) based on suspected upper-airway obstruction, but it resolved without further treatment. We found no other causes. We report a rare case of NPPH due to a giant vocal cord nodule.

Lung cancer occasionally accompanies pulmonary hypertrophic osteoarthropathy (PHO) as a paraneoplastic syndrome. Here, we present an atypical case of pleomorhic carcinoma with PHO. A 59-year-old man with cough and arthralgia in both ankles was referred to our hospital and we made a diagnosis of PHO based on the typical findings in bone scintigram. Chest CT showed a 7 cm tumor in the right lung which was cytologically diagnosed as non-small cell cancer (cT2N2M0, stage IIIA). After resection of the tumor, his arthralgia and abnormal uptakes on bone scintigram disappeared. The final pathological diagnosis of the tumor was pleomorphic carcinoma. During adjuvant chemotherapy (cisplatin plus vinorelbine), relapsed lesions in the right pleural space were found. However, no symptoms of PHO were reported by the patient. Following the change of the regimen to carboplatin plus paclitaxel, the relapsed tumor went into complete remission, and this patient has now survived for three years without recurrence.

We report two patients with intravascular large B-cell lymphoma who presented with fever and dyspnea. Serum level of lactate dehydrogenase (LDH) and soluble interleukin-2 receptor (sIL-2R) levels were extremely high in both cases. Chest CT revealed tumor mass and ground glass opacity in one patient, and no abnormality in another patient who had severe hypoxemia. Their perfusion ventilation lung scintigraphy demonstrated multiple defects, and gallium scintigraphy showed abnormal accumulation in both lungs, and the spleen. Both patients were successfully treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). Initial chemotherapy was followed by high dose systemic chemotherapy with peripheral blood stem cell support. Intravascular large B-cell lymphoma should always be considered in the differential diagnosis of fever and hypoxemia with elevated serum LDH and sIL-2R, regardless of the chest CT findings.

A 73-year-old woman with polymyositis, who had received corticosteroids and immune-suppressive agents, was admitted to our hospital because of general fatigue and severe cough. Chest X-ray film and CT scan showed a large tumor shadow in the left upper lobe and several ground-glass opacities (GGOs) scattered in both lungs. As the white blood cell and C-reactive protein levels were elevated, pnueumonia was suspected and antibiotics were administered. Subsequently, Nocardia spp. was cultured from the sputum and pulmonary nocardiosis was established. She gradually recovered after sulfamethoxazole-trimethoprim (ST) administration. The pretreatment serum beta-D-glucan level was highly elevated and decreased in parallel with clinical feature. In general, ST should be administered for 6 months to treat pulmonary nocardiosis in a compromised host. It is possible that P3-D-glucan may be a useful marker to treat pulmonary nocardiosis in patients with polymyositis.

Background: Although bronchoscopy has an important role in the diagnosis of lung cancer, more invasive procedures, such as CT-guided biopsy or surgery, are needed when transbronchial approaches fail.

Objective: We investigated the usefulness of endobronchial ultrasonic-transbronchial needle aspiration (EBUS-TBNA) for lung cancer diagnosis.

Subjects and methods: We retrospectively evaluated 122 cases who were finally diagnosed to have lung cancer from among 388 cases who underwent bronchoscopy because of abnormal shadows on their chest X-ray or CT. When bronchoscopic approaches were possible, conventional transbronchial lung biopsy or cytology (conventional approaches) were done. EBUS-TBNA was added whenever mediastinal or hilar lymph nodes enlarged to more than 1 cm in diameter, or if there were lesions attached to the lower respiratory tract. The diagnostic accuracy of conventional approaches and EBUS-TBNA were assessed.

Results: The number of cases diagnosed as lung cancer by conventional approaches was 79 cases (64.8%) among the 122 cases examined. Of the 43 cases undiagnosed by these procedures, 27 cases were diagnosed as lung cancer by EBUS-TBNA. Thus, 106 cases (86.9%) were diagnosed as lung cancer using conventional approaches plus EBUS-TBNA. No severe complications were observed in all the subjects.

Conclusion: EBUS-TBNA is a safe and useful approach for the diagnosis of lung cancer together with staging.

A 63-year-old woman had abnormal shadows on a chest radiograph taken on a medical examination during treatment for rheumatoid arthritis. The chest radiograph showed linear and reticular shadows and ground glass opacities in the bibasilar lung fields. Though we considered rheumatoid arthritis due to joint disorder and a positive reaction for serum anti-CCP antibody, there were no bone lesions or articular narrowing on radiographs of the fingers. We diagnosed antisynthetase syndrome after we obtained a positive reaction for serum anti-PL-7 antibody. Antisynthetase syndrome demonstrates findings similar to those of rheumatoid arthritis, and this disease should be taken into consideration if chest computed tomography demonstrates consolidation with predominant patchy and irregular bronchovascular bundle thickening with a subpleural distribution.

A 74-year-old man was referred to our hospital with complaint of dyspnea and left pleural effusion. The pleural effusion was exudative and lymphocytic with elevation of adenosine deaminase (ADA). Antitubercular agents were administered on a diagnosis of tuberculous pleuritis, but the pleural effusion did not improve. After he had been followed up with diuretic agents during about 2 years, he suffered cardiac tamponade and right pleural effusion. We diagnosed primary effusion lymphoma based on the cytology findings of the pleural effusion. The measurement of ADA activity in pleural effusions was useful for diagnosis of tuberculous pleuritis, but not only tuberuculous pleuritis but also lymphoma or other diseases can show elevation of ADA activity in pleural effusions.

A 69-year-old man who had had a history of abnormal chest radiograph was admitted. Chest computed tomography showed an 18 x 18 mm apparently-circumscribed mass in the right posterior-basal segment. We performed right lower lobe wedge resection via video-assisted thoracic surgery to establish a definitive diagnosis. The mass was an apparently-circumscribed, gray and solid tumor, the microscopic findings of which included diffuse proliferation of plasma cells with an abnormal profile. Immunohistochemical staining revealed IgG-kappa light chain monoclonality. Absence of M protein in the serum and urine was confirmed. Bone-marrow puncture and positron-emission tomography revealed normal findings. Thus a diagnosis of extramedullary plasmacytoma (EMP) of the lung was made. We report trends of the immunoglobulin isotype of EMP in Japan. Since it has been reported that some of the cases in EMP progress to multiple myeloma (MM), careful observation and follow-up is needed hereafter. In the present case, no recurrence or progress to MM was observed within the first year after surgery.

The patient was a 70-year-old woman. She was admitted to our hospital complaining of fever and dyspnea. Chest CT scan showed a 50 x 30-mm tumorous shadow in S6 of the left lung and honeycomb lung in both lower lobes. As the result of cytodiagnosis with ultrasonic echo, adenocarcinoma was diagnosed. Clinical stage was IIIA (T3N2M0). We selected carboplatin and paclitaxel with bevacizumab as first-line chemotherapy, but at 7 days after the initiating it, the chest X-ray showed left pneumothorax. A chest drainage tube was placed in the left thoracic cavity. The patient was treated repeatedly pleurodesis with minocycline and OK-432. The pneumothorax required 3 weeks to cure. We selected carboplatin and paclitaxel without bevacizumab for the second course, and the pneumothorax did not recur. Pneumothorax was a serious adverse event associated with bevacizumab-containing chemotherapy. It is necessary to be aware of the possibility of pneumothorax when we treat lung adenocarcinoma with bevacizumab-containing chemotherapy.