Respirology Case Reports最新文献

Tuberculous lymphadenitis is generally more severe in patients with HIV infection. We present an HIV-negative patient with multidrug-resistant tuberculosis who developed severe, extensive lymphadenitis involving multiple extrapulmonary regions. This clinical image highlights that marked lymph node involvement may occur in HIV-negative patients presenting with pronounced systemic symptoms.

Severe infections caused by Klebsiella ozaenae are extremely rare, and their clinical characteristics remain poorly defined. We report a case of Klebsiella ozaenae sepsis with severe lung abscesses in a malnourished patient with psychiatric disease, requiring 3 months of antimicrobial therapy for complete resolution.

Intrathoracic lipomas are rare benign tumours that may attain considerable size before detection. We report a 38-year-old woman in whom a huge intrathoracic lipoma was incidentally identified on chest radiography during preoperative assessment. Computed tomography demonstrated a large, well-circumscribed fat-attenuation lesion occupying nearly the entire right hemithorax, causing near-total lung collapse and mediastinal shift. Image-guided biopsy confirmed a benign lipoma. This case highlights the characteristic imaging features of intrathoracic lipoma and underscores the importance of histopathological confirmation to exclude liposarcoma, even in asymptomatic patients with marked thoracic compression.

Massive hemoptysis from dual bronchial artery malformations necessitated emergent embolization. Extensive jelly-like endobronchial clots caused complete lobar collapse refractory to suction. We used cryoextraction to achieve rapid en-bloc removal of arborizing casts with prompt radiographic resolution.

A 49-year-old man with severe airway stenosis and SVC syndrome underwent urgent Y-stent placement before diagnosis. Subsequent EUS-B-FNA enabled adenocarcinoma diagnosis. This case highlights that transbronchial biopsy in marked stenosis risks fatal obstruction; thus, transesophageal biopsy should be prioritised to ensure safe diagnosis and genomic testing.

Chylothorax poses a clinical challenge, especially in resource-limited settings where diagnosis and treatment require innovation. This report details the successful use of octreotide in a 37-year-old female with non-traumatic chylothorax secondary to a mediastinal mass. She presented with chylothorax symptoms, and imaging showed a mediastinal mass, but tissue biopsy was refused, and advanced interventions were unavailable. Octreotide infusion reduced chest tube output and led to the complete resolution of chylothorax. This case demonstrates that octreotide can provide effective symptom control and clinical stabilisation in mediastinal mass-associated chylothorax when surgical or advanced options are not feasible, serving as a bridge for further workup and treatment planning.

COVID-19 pneumonia is a strong radiological mimicker of pulmonary alveolar proteinosis (PAP), making their differentiation difficult. PAP is a rare diffuse lung disease caused by the accumulation of surfactant lipoproteins within the alveoli, resulting in impaired gas exchange and respiratory failure, with an estimated prevalence of 3.7-6.2 cases per million. This report presents a rare case of PAP complicated by COVID-19 pneumonia in a 42-year-old man who presented with chills, fatigue, dyspnea and fever. Clinical, laboratory and radiological features were thoroughly assessed. High-resolution CT revealed a crazy-paving pattern with patchy consolidations, diffuse ground-glass opacities and septal thickening. Early recognition of lung diseases with overlapping imaging features is essential to guide management and prevent adverse outcomes. The coexistence of PAP and COVID-19 was associated with rapid clinical deterioration and poor prognosis. Further studies are needed to clarify underlying mechanisms and optimise treatment strategies.

NUT carcinoma is a rare and highly aggressive malignancy, particularly when arising in the thorax. Radiotherapy is commonly used for symptom palliation; however, radiotherapeutic response patterns in thoracic NUT carcinoma remain poorly characterised. We report a 22-year-old woman with thoracic NUT carcinoma who demonstrated markedly heterogeneous responses to palliative radiotherapy across metastatic sites. A thoracic lesion causing superior vena cava (SVC) syndrome showed sustained radiographic improvement after irradiation, whereas a pelvic bone metastasis progressed shortly after single-fraction radiotherapy despite transient symptom relief. Although differences in delivered radiation dose likely contributed to these outcomes, this case illustrates practical considerations in palliative radiotherapy for thoracic NUT carcinoma, including effective symptom control for SVC syndrome and the limited durability of single-fraction radiotherapy for bone metastases. This case highlights practical considerations in palliative radiotherapy for thoracic NUT carcinoma and provides an educational perspective for respiratory physicians involved in multidisciplinary cancer care.

A 66-year-old man with a 20-year history of recurrent haemoptysis presented with mild bronchiectasis and linear opacities detected on chest computed tomography (CT). The lesion was followed up annually and gradually enlarged into a mass over 10 years. Multiple bilateral pulmonary nodules were noted at 78 years of age. Surgical biopsy revealed malignant melanoma without evidence of other primary lesions on dermatological examination or positron emission tomography-CT. The patient was treated with nivolumab and achieved stable disease for 8 months before discontinuation owing to immune-related adverse events. Rapid disease progression was observed, and the patient died 14 months after initiating immunotherapy. Autopsy demonstrated extensive metastatic dissemination and marked tumour necrosis with CD8+ T-cell infiltration in the lung tumour, indicating a therapeutic response to nivolumab. These findings highlight the potential association between chronic airway inflammation and tumour development and suggest that immunotherapy could play a role in treating PMML.

Patients with poor Eastern Cooperative Oncology Group performance status (ECOG PS) ≥ 3 may be considered for systemic chemotherapy when the decline is driven by reversible tumour-related factors, but assessing reversibility is often difficult, and some patients ultimately receive best supportive care. We report the case of a 76-year-old man with extensive-stage small cell lung cancer (SCLC) whose condition declined to PS 3 due to obstructive jaundice from pancreatic metastasis and a painful femoral fracture. Biliary stenting improved hepatic function; however, after the first cycle of carboplatin and etoposide, the femur fractured completely, requiring bipolar hemiarthroplasty. Postoperatively, PS improved, enabling the continuation of chemotherapy with carboplatin, etoposide and atezolizumab. Imaging demonstrated regression consistent with partial response, and PS improved to 1. This case emphasises that repeated PS assessment and multidisciplinary management of reversible conditions, including obstructive jaundice and a pathological fracture, can facilitate systemic therapy in poor-PS SCLC.