Respirology Case Reports最新文献

A third of patients with non-Hodgkin's lymphoma (NHL) develop pleural effusion during the disease course for various reasons. In most cases, lymphoma-related pleural effusion is a manifestation of widespread systemic disease, signifying a high tumour burden and therefore, a poorer prognosis. On the other hand, primary pleural lymphomas (PPLs) exhibit exclusive or dominant involvement of serous cavities, without detectable solid tumour masses. PPL is an uncommon disease and is of two types: primary effusion lymphoma (PEL) and diffuse large B-cell lymphoma associated with chronic inflammation (DLBCL-CI). PPLs not related to PELs and DLBCL-CIs are exceedingly rare. Herein, we describe four patients with biopsy proven B-cell NHL. One had no extra-pleural involvement at the time of diagnosis, indicating PPL. In all cases, histopathological examination of pleural biopsies obtained via medical thoracoscopy (MT) were crucial in clinching the final diagnosis. Clinicians are alerted to the potential relationship between exudative effusion and NHL as well as the role of MT in the diagnosis of B-cell NHL.

A man in his 40s was incidentally found to have a large right sided apical pleural based mass on imaging. This was further investigated with a CT-guided biopsy. Histological and immunohistochemical analysis of the tissue revealed a diagnosis of a Schwannoma: a rare, slow-growing benign nerve sheath tumour. Only a handful of pleural based Schwannomas have been documented in the literature. They account for about 0.2% of lung tumours. The patient was referred to cardiothoracic surgery who advised surgical resection of the mass, which he is awaiting. Here, we report a rare case of a pleural based Schwannoma which was diagnosed incidentally on chest x-ray.

Chylothorax contains an abundant amount of immunoglobulins and white blood cells, leading to the belief that superimposed pleural infection is unlikely. We report two cases of biochemically confirmed chylothorax due to cirrhosis, complicated by superimposed pleural infection following repeated pleural interventions. These findings highlight the potential for superimposed infection in chylothorax and challenge the belief in the bacteriostatic effect of chyle. Clinical vigilance is essential to consider this possibility if features of infection arise during the management of chylothorax.

Plastic bronchitis is rare in adult pulmonology and has a wide range of aetiology. Cast analysis is key in narrowing down the differential diagnosis of plastic bronchitis. If suspected of having lymphocytic PB, complete imaging to evaluate thoracic lymphatics is important to find out the potential causes for PB.

Giant cell tumour of the tibia with pulmonary metastasis is very rare and the malignancy usually appears several years after the initial lesion. Imaging at the earliest instance is highly beneficial since surgical resection to remove the metastases raises survival rates; therefore, relentless follow-up in GCT is vital.

Pleural empyema is a severe condition associated with high morbidity and mortality. Treatment usually consists of pleural drainage with chest tube or surgery, in combination with antimicrobial treatment. Severe pneumonia can evolve in a necrotizing pneumonia, given a higher susceptibility to the occurrence of bronchopleural fistulas with persistent air leaks. This complicates recovery, and surgery may not always be the optimal treatment. We present a case involving a 17-year-old female patient who experienced a post-operative persistent air leak due to necrotizing pneumonia after video-assisted thoracic surgery decortication for empyema, which was successfully treated using an endobronchial valve. After 6 months the valve was removed without complications. Follow-up imaging and lung function revealed a limited area of atelectasis and minimal pleural thickening with normal lung volumes.

We report the long term follow up of a now 66-year-old male with laryngo-tracheobronchial amyloidosis. The patient initially presented with dysphonia and dyspnoea. He was diagnosed with laryngeal reflux and asthma. Seven years later, the patient underwent cross sectional thoracic imaging showing diffuse thickening of the distal trachea and proximal main bronchi. The patient's FEV1 and FVC remained stable over 13 years and no intervention was required.

Large amount of caseating overlying on bronchus were detected under bronchoscopy in our case. Bronchoalveolar lavage is a major method for diagnosing tuberculosis (TB). TB dissemination caused by bronchoalveolar lavage is very rare. In this case, the patient developed fever after bronchoalveolar lavage and CT confirmed acute dissemination. This might be related to caseating EBTB.

Pulmonary carcinoids are uncommon malignant neoplasms, believed to derive from specialized neuroendocrine cells known as Kulchitsky cells. We evaluated a 69-year-old female presenting symptoms consistent with carcinoid syndrome, such as intermittent flushing and diarrhoea, along with complaints of shortness of breath and cough. Imaging revealed bilateral lung nodules, confirmed by biopsy to be carcinoid tumours. The treatment of choice for carcinoid tumours is complete surgical resection. Nonetheless, individualized management plans are crafted based on the tumour's location and the patient's respiratory function as these present challenges to anatomical resection of tumours.

Reduced generation of multiple motile cilia (RGMC) represents a rare variant of Primary Ciliary Dyskinesia (PCD), associated with CYCLIN-O (CCNO) mutations. We report a novel compound mutation in the CCNO gene in an adult Chinese Singaporean exhibiting chronic productive cough since childhood and recurrent sino-pulmonary infections. Low nasal nitric oxide and bronchiectasis suggests PCD. Bronchoscopy for epithelial and nasal brushings for ciliary studies were repeated after adequate treatment of lower respiratory tract infections. Demonstration of oligo-cilia via transmission electron microscopy, and detection of CCNO mutation through genetic analysis were utilized to diagnose RGMC. Repeated courses of antibiotics including nebulised antibiotics were used to treat recurrent infections and exacerbations. Airway clearance techniques, immunizations and collaboration with otorhinolaryngologist form part of the long-term management. Heightened clinical suspicion and adherence to established diagnostic algorithms are essential for timely recognition of this entity.