Respirology Case Reports最新文献

A 62-year-old woman with a history of papillary thyroid carcinoma presented to our hospital with fever and cough and was diagnosed with stage IV non-small cell lung carcinoma (NSCLC). One year after chemoimmunotherapy, a re-biopsy of the left pleural tumour lesion was performed. Histological analysis revealed papillary thyroid carcinoma. Another biopsy was performed on the primary tumour, and the histological analysis of the primary tumour lesion confirmed NSCLC. BRAF V600E mutations were detected in both left pleural metastatic lesions of papillary thyroid carcinoma and the primary tumour of NSCLC. Dabrafenib and trametinib reduced both tumour lesions. Here, we report a rare case of concomitant BRAF V600E-mutated NSCLC and pleural metastasis from papillary thyroid carcinoma.

A 63-year-old male was diagnosed with a combination of three concurrent diseases: stage 4 lung adenocarcinoma, ipsilateral mycobacterium avium complex (MAC) pleural effusion, and advanced HIV. He has been successfully treated for each diagnosis. At 2 years from presentation he continues on immunotherapy, with his pleural culture clear of MAC, and he has an undetectable HIV viral load. An indwelling pleural catheter was inserted for management of the recurrent malignant pleural effusion. We describe our management approach to a combined malignant and MAC related effusion in a patient with co-existing advanced HIV.

A 61-year-old male was brought to the Emergency Department with severe shortness of breath, a throbbing headache, sweating, nausea, vomiting and diarrhoea after the administration of an acetazolamide tablet (250 mg) at a private ophthalmology clinic. On presentation, a chest X-ray was performed, showing diffuse alveolar opacities bilaterally, indicating pulmonary oedema, as seen in CT chest also. However, his echocardiogram revealed a normal ejection fraction with no signs of ischemia. He was subsequently diagnosed with non-cardiogenic pulmonary oedema (NCPE) and was immediately started on high-flow oxygen, later requiring mechanical ventilation. The patient was admitted to the Critical Care Unit with supportive treatment, including IV fluids and antibiotics, without steroid administration. Four days later, he was extubated and subsequently discharged from the ICU, followed by discharge from the hospital. Our case revolves around a rare yet potentially fatal episode of NCPE secondary to Acetazolamide use.

Bronchial dehiscence is a known complication following lung transplantation. In cases involving extensive airway necrosis and air leaks, bronchoscopic placement of self-expanding metallic stents provides an effective and safe management strategy. These stents facilitate granulation and tissue reepithelialization. We present a case of bronchial anastomotic dehiscence size mismatch after a lung transplant. This complication was successfully managed using three stents placed via a telescoping technique with flexible bronchoscopy.

Neurogenic pulmonary edema (NPE) is acute pulmonary edema triggered by an injury to the central nervous system. NPE associated with epileptic seizures is less common and not well known to recur. We report a case of a 51-year-old woman with NPE with recurrent epileptic seizures. The patient was brought to our hospital with two episodes of clonic convulsions. Imaging studies obtained on admission showed bilateral infiltration in the upper lobes of both lungs. The patient was discharged after receiving antiepileptic drugs. NPE may recur with epileptic seizures.

We present the case of a 42-year-old woman on oral contraceptives that presented to the emergency department with pain and swelling in the left lower limb. Diagnosis of extensive deep vein thrombosis was established. A few minutes later, she exhibited signs of shock and hemodynamic instability, thus raising suspicion of high-risk acute pulmonary thromboembolism. Prior to the administration of fibrinolytic treatment, a bedside transthoracic echocardiography was performed that excluded right ventricular dilatation. Then, the study was complemented with a thoraco-abdominal computed tomography scan that demonstrated a large retroperitoneal hematoma as the cause of the shock. In conclusion, a transthoracic echocardiography should be performed before initiating thrombolytic therapy in hemodynamically instable patients with strong suspicion of high-risk pulmonary embolism.

Pulmonary alveolar proteinosis (PAP) is a rare disease caused by accumulation of sediment within alveoli. Cryptococcosis a fungal infection typically presenting with central nervous system (CNS) and pulmonary disease. Granulocyte-macrophage colony-stimulating factor antibodies are associated with PAP and elevated risk of cryptococcosis. The usual interval from cryptococcal infection to the onset of PAP spans several years. Here, we describe a case of a 24-year-old Aboriginal Australian woman with no prior medical history, who presented with seizures from CNS cryptococcosis, and subsequently developed rapidly progressive hypoxic respiratory failure secondary to autoimmune-PAP within weeks of initial presentation. The rate and degree of respiratory failure necessitated urgent bilateral whole lung lavage (WLL) whilst on venovenous-extracorporeal membrane oxygenation. Our report hopes to increase recognition of PAP in the Australian population, document the utility and risks of bilateral WLL in the critically unwell patient and provide an updated literature review of PAP and cryptococcal infection.

Even though endobronchial lipoma is rare, it can mimic malignancy and lead to significant complications such as progressive dyspnea and subsequent lung infections related to endobronchial obstruction. We present a case of endobronchial lipoma located in the trachea causing almost complete tracheal obstruction. The patient's dyspnea disappeared after undergoing bronchoscopic excision of the mass.

Robotic-assisted bronchoscopy (RAB) has improved lung nodule evaluation, but its feasibility to biopsy aortopulmonary lymph nodes remains underexplored. This study explored the safety and effectiveness of RAB for sampling aortopulmonary lymph nodes suspected of malignancy. We conducted a literature review on RAB for aortopulmonary lymph node biopsy and present a case of a patient with a history of malignancy. Using the Ion Endoluminal System, we navigated to the anterior segment of the left upper lobe to access a subaortic lymph node in a patient with a history of mantle cell lymphoma. Biopsy confirmed disease recurrence. Our literature review identified seven patients who underwent RAB to assess aortopulmonary lymph nodes, with most findings showing small-cell lung cancer. Our study reports an 88% diagnostic yield, and no complications associated with the procedure. RAB is a safe and effective approach for biopsying aortopulmonary lymph nodes.

This human metapneumovirus pneumonia case, mimicking bacterial pneumonia, exhibited distinct features, including contact with a cold patient and CT findings of multilobar airway-centric opacities with bronchial wall thickening. Even if point-of-care viral testing becomes widely available, recognising cases that warrant such tests remains crucial for improving community-acquired pneumonia management.