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A rare manufacturing defect in the endotracheal tube 气管插管的罕见制造缺陷
Pub Date : 2024-01-01 DOI: 10.4103/jacp.jacp_59_23
Kathiravan Thangavel, S. Chowdhury, Hirok Roy
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引用次数: 0
Post-COVID-19 pulmonary fibrosis with prognostic risk factors: A study in the hilly state of North India COVID-19后肺纤维化与预后风险因素:北印度丘陵地区的一项研究
Pub Date : 2024-01-01 DOI: 10.4103/jacp.jacp_35_23
S. Thakur, A. Jhobta, Sai Kalyani, Sunil Sharma, C. Thakur
Context: Coronavirus disease 19 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS CoV-2). As it is a novel coronavirus infection, its acute as well as long-term pulmonary alterations in terms of radiological imaging and pathology need to be explored. Aim: To analyze the risk factors associated with the development of pulmonary fibrosis in post-COVID-19 patients. Settings and Design: A retrospective study in a tertiary center in a hilly state of North India. Methods and Material: A retrospective study was carried out in a hilly state of North India during the second wave of the COVID-19 pandemic. A baseline computed tomography (CT) within 1 month and a follow-up CT within 3–6 months of the onset of patients’ symptoms was done. The patients were assigned two groups based on the presence of fibrosis [reticular pattern (inter/intralobular septal thickening), parenchymal bands, bronchiectasis, and/ or honeycombing] on follow-up CT. The patients’ demographic profiles, clinical records, blood laboratory findings, treatment given, baseline CT, and follow-up CT findings were compared between the fibrosis and non-fibrosis groups. Statistical analysis used: The data entry was done in the Microsoft EXCEL spreadsheet, and the final analysis was done with the use of Statistical Package for Social Sciences (SPSS) software, IBM manufacturer, Chicago, USA, ver 25.0. Results: Of the total 72 patients, two had no abnormality on baseline CT. Forty (57.14%) out of 70 patients already had fibrosis on baseline CT, which increased to involve 47 (67.14%) patients on follow-up CT. It was analyzed that old age, smoking, comorbid status, low SpO2, longer hospitalization, lymphopenia, and increased severity of COVID-19 disease were independent risk factors for the development of pulmonary fibrosis in post-COVID-19 pneumonia. Conclusions: A better understanding of the underlying mechanism and pathogenesis can help in filling up of gaps in risk stratification of COVID-19.
背景:冠状病毒病 19(COVID-19)是由严重急性呼吸系统综合征冠状病毒 2(SARS CoV-2)引起的。由于它是一种新型冠状病毒感染,因此需要从放射影像学和病理学方面探讨其急性和长期肺部改变。目的:分析 COVID-19 后患者发生肺纤维化的相关风险因素。设置和设计:在印度北部丘陵邦的一家三级中心进行的一项回顾性研究。方法和材料:在 COVID-19 第二波流行期间,在印度北部丘陵邦开展了一项回顾性研究。研究人员在患者发病后 1 个月内进行了基线计算机断层扫描(CT),并在 3-6 个月内进行了随访计算机断层扫描。根据随访 CT 上是否出现纤维化[网状模式(小叶间隔间/小叶内增厚)、实质带、支气管扩张和/或蜂窝状],将患者分为两组。比较了纤维化组和非纤维化组患者的人口统计学特征、临床记录、血液化验结果、所接受的治疗、基线 CT 和随访 CT 结果。统计分析:数据录入在 Microsoft EXCEL 电子表格中完成,最终分析使用美国芝加哥 IBM 制造的社会科学统计软件包 (SPSS) 软件,版本 25.0。结果在 72 名患者中,有两名患者的基线 CT 未见异常。70 名患者中有 40 人(57.14%)在基线 CT 上已出现纤维化,而在随访 CT 上又增加到 47 人(67.14%)。据分析,高龄、吸烟、合并症、低SpO2、住院时间长、淋巴细胞减少症和COVID-19疾病严重程度增加是COVID-19后肺炎患者发生肺纤维化的独立危险因素。结论更好地了解COVID-19的潜在机制和发病机理有助于填补COVID-19风险分层方面的空白。
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引用次数: 0
Wegener’s granulomatosis versus pulmonary tuberculosis: a dilemma 韦格纳肉芽肿病与肺结核:两难选择
Pub Date : 2024-01-01 DOI: 10.4103/jacp.jacp_53_23
Amita Mason, V. Jethani, Rahul Kumar, Yogesh Preet Singh
The most common cause of bilateral pulmonary cavities with constitutional symptoms in an endemic country like India is pulmonary tuberculosis (PTB). Pulmonary manifestations in systemic vasculitis are very diverse, ranging from nodules, consolidation, and cavity. Wegener’s granulomatosis (WG) is a systemic disease commonly affecting the lungs. Diffuse alveolar hemorrhage (DAH) is a life-threatening and relatively rare pulmonary manifestation of WG. Here, we report a case of a young male diagnosed with WG mimicking PTB with hypoxic respiratory failure who responded to aggressive treatment with cyclophosphamide, high-dose steroids and high-flow nasal cannula support (HFNC).
在印度这样的地方病流行国家,导致双侧肺空洞并伴有全身症状的最常见原因是肺结核(PTB)。全身性血管炎的肺部表现多种多样,包括结节、合并症和空洞。韦格纳肉芽肿病(WG)是一种常见于肺部的全身性疾病。弥漫性肺泡出血(DAH)是WG的一种危及生命且相对罕见的肺部表现。在此,我们报告了一例年轻男性患者的病例,他被诊断为WG,并伴有缺氧性呼吸衰竭,在接受环磷酰胺、大剂量类固醇和高流量鼻插管支持(HFNC)的积极治疗后,病情有所好转。
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引用次数: 0
Assessment of the value of 6-min walk test to predict the severity of interstitial lung disease among Indian patients 评估 6 分钟步行测试对预测印度患者间质性肺病严重程度的价值
Pub Date : 2024-01-01 DOI: 10.4103/jacp.jacp_54_23
Anantha Krishna Sompalli, Sateesh Rao Kailasa, Varun Pulugundla, Naveen Chandra Reddy Kotha, Pawan Kumar Sharma, Gopala Krishnaiah Velisela, Mohammed Soheb Sadath Ansari
Introduction: The prevalence of interstitial lung disease (ILD) is increasing. High-resolution computerized tomography (HRCT), despite having limitations, remains the choice of method for diagnosis and assessment of severity of ILD. Objective: To determine the efficacy of 6-min walk test to assess the severity of the ILD compared to HRCT. Methodology: A cross-sectional study was done among 40 patients with ILD in a tertiary hospital in Hyderabad. The data included age, gender, smoking, HRCT, 6-min walk test, spirometry, diffusion lung capacity and medical history. Mann–Whitney U test, Kruskal–Wallis test, and ROC curve were used to determine the outcomes. Results: The mean age of participants was 57.18 + 13.01 years. 62.5% never smoked. Overall, 50% had severe ILD, and the rest had mild to moderate. The distance walked per 6-min, SpO2 before and SpO2 after, was significantly lower (p = 0.001; 0.002; <0.001, respectively) among patients with severe ILD than mild or moderate. The sensitivity and 1-specificity of the distance walked in 6-min to detect the severity of ILD was 0.90 and 0.31, respectively; sensitivity and 1-specificity of SpO2 before the test was 0.81 and 0.34, while that of SpO2 after the test was 0.90 and 0.17, respectively. Conclusion: This study found that the 6-min walk test is highly sensitive and specific for predicting the severity of ILD among patients. All three components of the 6-min walk test: distance, oxygen saturation before, and oxygen saturation after the test significantly lowered and were independent predictors of severe ILD.
简介间质性肺病(ILD)的发病率正在上升。高分辨率计算机断层扫描(HRCT)虽然有其局限性,但仍是诊断和评估间质性肺病严重程度的首选方法。研究目的确定 6 分钟步行测试与 HRCT 相比在评估 ILD 严重程度方面的有效性。方法:横断面研究在海得拉巴的一家三级医院对 40 名 ILD 患者进行了横断面研究。数据包括年龄、性别、吸烟、HRCT、6 分钟步行测试、肺活量测定、肺弥散容量和病史。采用 Mann-Whitney U 检验、Kruskal-Wallis 检验和 ROC 曲线确定结果。结果显示参与者的平均年龄为 57.18 + 13.01 岁。62.5%的人从不吸烟。总体而言,50%的人患有重度 ILD,其余为轻度至中度。重度 ILD 患者每 6 分钟的步行距离、步行前的 SpO2 和步行后的 SpO2 均显著低于轻度或中度患者(分别为 p = 0.001;0.002;<0.001)。6 分钟步行距离检测 ILD 严重程度的灵敏度和特异性分别为 0.90 和 0.31;检测前 SpO2 的灵敏度和特异性分别为 0.81 和 0.34,而检测后 SpO2 的灵敏度和特异性分别为 0.90 和 0.17。结论本研究发现,6 分钟步行测试对预测 ILD 患者的严重程度具有高度敏感性和特异性。6 分钟步行测试的三个组成部分:距离、测试前的血氧饱和度和测试后的血氧饱和度均显著降低,是严重 ILD 的独立预测指标。
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引用次数: 0
Two young adults presenting with breathlessness and recurrent chest infection: a major miss!!! 两名年轻成人出现呼吸困难和反复胸腔感染:重大失误
Pub Date : 2024-01-01 DOI: 10.4103/jacp.jacp_6_23
V. Marwah, Robin Choudhary, Virender Malik, Naveen Yadav
Dyspnea is of multi-factorial etiology, and in young adults, obstructive airway disease is the commonest cause. We are reporting two cases of young adults who presented with breathlessness and recurrent episodes of respiratory tract infections since childhood associated with poor physical development. They were referred to our hospital for an evaluation of suspected lung collapse. The evaluation revealed it to be an unusual case of right lung hypoplasia presenting in the second decade, and which was not associated with any other systemic anomaly in the first case, while the second case was diagnosed as a case of left pulmonary aplasia with right tracheal bronchus and double SVC drainage. The treating physicians should have a high clinical suspicion about developmental pulmonary disorders while treating young patients with recurrent episodes of pneumonia.
呼吸困难的病因是多方面的,在年轻人中,阻塞性气道疾病是最常见的病因。我们报告了两例青壮年病例,他们自幼呼吸困难,反复发作呼吸道感染,身体发育不良。他们被转诊到我院,接受疑似肺塌陷的评估。评估结果显示,第一个病例是一例不寻常的右肺发育不全病例,在第二个病例中,右肺发育不全与其他系统异常无关;而第二个病例被诊断为一例左肺增生病例,伴有右气管支气管和双侧 SVC 引流。主治医生在治疗反复发作肺炎的年轻患者时,临床上应高度怀疑发育性肺部疾病。
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引用次数: 0
Persistent residual lung abnormalities as final outcome in recovered severe COVID-19 pneumonia with lung function abnormalities in spirometry: Pulmonologist and radiologist perspective 肺功能异常的 COVID-19 重症肺炎康复者的最终结果是肺部持续残留异常:肺科医生和放射科医生的观点
Pub Date : 2024-01-01 DOI: 10.4103/jacp.jacp_62_23
Shital Patil, Aditi Gatagat, Sheetal kumar Gatagat
Coronavirus-related (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) global pandemic has caused significant mortality and morbidity globally in the last 3 years. In the present case report, a 51-year-old man presented in the outdoor unit for shortness of breath on exertion with a history of severe coronavirus disease-2019 (COVID-19) pneumonia resulted in acute respiratory distress syndrome with hospitalisation in the intensive care unit 1 year back and required high-flow nasal cannula (HFNC) with noninvasive ventilatory support (NIV) for 2 weeks. He was offered oxygen supplementation at home with antibiotics for 3 months and there was no requirement of oxygen and some respiratory symptoms even after 1 year. His high-resolution computed tomography thorax documented at 1 year of discharge from the hospital revealed typical interstitial opacities labelled as persistent residual lung abnormalities (RLAs) that are predominantly reticular and linear opacities in peripheral parts of lungs without honeycombing within typical pleural-based areas with parenchymal bands and minimally altered lung architecture and preserved lung volume.
在过去 3 年中,冠状病毒相关疾病(严重急性呼吸系统综合征冠状病毒 2 [SARS-CoV-2])的全球大流行在全球范围内造成了大量死亡和发病。在本病例报告中,一名 51 岁的男子因用力呼吸时气促而到室外病房就诊,并有严重冠状病毒病-2019(COVID-19)肺炎病史,导致急性呼吸窘迫综合征,1 年前曾在重症监护病房住院治疗,需要高流量鼻插管(HFNC)和无创呼吸支持(NIV)治疗 2 周。他在家中接受了为期 3 个月的氧气补充和抗生素治疗,1 年后已不再需要氧气,也没有出现一些呼吸道症状。出院 1 年后,他的高分辨率计算机断层扫描胸腔显示出典型的间质不透明,被称为 "持续性残留肺异常(RLA)",主要是肺外周部分的网状和线状不透明,在典型的胸膜区域内没有蜂窝状,有实质带,肺结构改变很小,肺容积保留。
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引用次数: 0
A radiolucent cystic lesion in a chest radiograph of a breathless child − a case report 一名呼吸困难儿童胸片上的放射性囊性病变--病例报告
Pub Date : 2024-01-01 DOI: 10.4103/jacp.jacp_56_23
Neeraj Sharma, Kunal Kumar, Robin Chaudhary, Amit Pathania
A radiolucent cystic lesion is a common finding on chest radiographs of children presenting with acute breathlessness, and congenital pulmonary airway malformation (CPAM) is a relatively uncommon cause of it. The majority of children with CPAM present with respiratory distress of varying severity in the neonatal period. Here, we discuss the case of an 18-month-old child who had a recent history of worsening breathlessness, and on thorough evaluation, he was diagnosed as having CPAM (type 1 variant). Inadvertent chest tube insertions should be avoided in these cases, as it can worsen the underlying condition. A computerized tomography (CT) chest scan plays a key role in diagnosing and assessing the therapeutic intervention in these cases. Surgical resection of the lesion is curative and has an excellent prognosis in the majority of cases of type 1 CPAM.
放射状囊性病变是急性呼吸困难患儿胸片上的常见病变,而先天性肺气道畸形(CPAM)是导致这种病变的相对少见的原因。大多数 CPAM 患儿在新生儿期都会出现不同程度的呼吸困难。本文讨论的病例是一名 18 个月大的患儿,他最近出现呼吸困难加重的病史,经过全面评估,他被诊断为 CPAM(1 型变异)。在这些病例中,应避免无意中插入胸管,因为这会加重潜在的病情。计算机断层扫描(CT)胸部扫描在诊断和评估这些病例的治疗干预方面起着关键作用。对大多数 1 型 CPAM 病例来说,手术切除病灶是治愈性的,而且预后良好。
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引用次数: 0
A rare case of extraosseous Ewing’s sarcoma 一个罕见的骨外尤文氏肉瘤病例
Pub Date : 2024-01-01 DOI: 10.4103/jacp.jacp_1_24
Sandeep Rana, Robin Choudhary, M. Kirti, Deepak Mulajkar, S. Shivani
Ewing’s sarcoma (ES) is a rare and highly aggressive tumour of neuroectodermal origin. Primary pulmonary ES is extremely rare and difficult to distinguish from other lung tumours due to its similar presentation and nonspecific symptoms. It requires a deliberate interplay of imaging, histopathological exam, immunohistochemistry (IHC) and genetic analysis to confirm the diagnosis. Here we present a rare case of extra osseus ES.
尤文氏肉瘤(ES)是一种罕见的高度侵袭性神经外胚层肿瘤。原发性肺埃文肉瘤极为罕见,由于表现相似且无特异性症状,很难与其他肺部肿瘤区分开来。它需要通过影像学、组织病理学检查、免疫组化(IHC)和基因分析等方法进行综合分析才能确诊。在此,我们介绍一例罕见的骨外ES。
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引用次数: 0
Carcinoid tumorlet/typical carcinoid of the lung: An incidental bronchoscopic finding and cytological dilemma 类癌小瘤/肺部典型类癌:支气管镜偶然发现和细胞学难题
Pub Date : 2024-01-01 DOI: 10.4103/jacp.jacp_55_23
Ankit Pandey, Priyadharshini Bargunam, Mukul Saini, Snehashish Kundu, Manish Sharma
Carcinoid tumors of the lung are low-grade neuroendocrine tumors with the potential to progress to high-grade tumors. Diagnosing a typical carcinoid of the lung/tumorlet is a tough nut to crack, especially in their early stages when there is no well-defined lesion in the imaging. Besides, differentiating a carcinoid from low-grade adenocarcinomas of the lung cytologically is quite challenging due to their similar morphology. We report a case of typical carcinoid of lung/tumorlet in a 42-year-old male who presented with hemoptysis. Flexible fibreoptic bronchoscopy revealed a bump in the right middle bronchus. Bronchial biopsy showed a cellular smear with a monotonous round to oval bland-looking cells distributed in singles and in acini, having a high nuclear-cytoplasmic ratio, scant cytoplasm, regular round nuclei, and inconspicuous nucleoli. No atypical mitotic figures or necrosis were seen. With these features, a cytological diagnosis of a typical carcinoid was made. Biopsy was not attempted again due to the small size of the lesion and inaccessibility. Serum chromogranin levels were elevated, confirming the diagnosis. The PET scan was unremarkable. The patient was referred to medical oncology for further management. This report will create awareness about diagnosing early carcinoid/tumorlet, especially with the increasing use of bronchoscopy and cytological diagnostic caution of overdiagnosis of malignancy.
肺类癌是低级别神经内分泌肿瘤,有可能发展为高级别肿瘤。诊断典型的肺类癌/小瘤是一件难事,尤其是在早期,影像学上没有明确的病灶。此外,由于类癌与肺部低级别腺癌形态相似,因此从细胞学角度区分类癌也颇具挑战性。我们报告了一例典型的类癌肺/小瘤,患者为一名 42 岁男性,出现咯血症状。柔性纤维支气管镜检查发现右侧中间支气管有一个凸起。支气管活检显示,细胞涂片上有单个圆形至椭圆形的平淡细胞,分布在单个细胞和棘细胞中,核质比高,胞浆稀少,核圆形规则,核仁不明显。未见异常有丝分裂或坏死。根据这些特征,细胞学诊断为典型类癌。由于病灶较小,无法触及,因此没有再次尝试活检。血清嗜铬粒蛋白水平升高,证实了诊断结果。PET 扫描结果无异常。患者被转到肿瘤内科接受进一步治疗。本报告将提高人们对早期类癌/肿瘤诊断的认识,尤其是随着支气管镜检查和细胞学诊断的使用越来越多,对恶性肿瘤过度诊断的警惕性也越来越高。
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引用次数: 0
Post-obstructive lung collapse due to mucus plug 粘液堵塞导致阻塞后肺塌陷
Pub Date : 2024-01-01 DOI: 10.4103/jacp.jacp_36_23
Aravind K. Raj, Neenu Najeeb, Vithal Chintalwar, K. Utpat, U. Desai
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引用次数: 0
期刊
The Journal of Association of Chest Physicians
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