Respirology Case Reports最新文献

A 28-year-old man aspirated a tooth into his right lower lobe bronchus following a high-speed motor vehicle accident. Initial retrieval attempts failed with a flexible bronchoscope, but a cryoprobe successfully dislodged and retrieved the tooth. Cryoprobe should be considered for bronchoscopic foreign body removal when conventional methods are unsuccessful.

Granular cell tumours are rare, mostly benign masses that arise from Schwann cells. Their pathophysiology is poorly understood, but the lesions are often seen in the breast, tongue, and skin. In this case report, we discuss a 34-year-old patient with recurrent pneumonia. The patient had several comorbidities, and was intubated due to respiratory distress and eventually placed on tracheostomy. During the procedure, she was noted to have a right middle lobe endobronchial lesion. It was excised and identified as a granular cell tumour. The patient was later weaned off the ventilator and discharged without any complications.

An 80-year-old man with a history of Bence-Jones potein (BJP) λ-type multiple myeloma (MM), which had been in remission for 16 years, was examined for shortness of breath and was found to have bilateral pleural and pericardial effusions. A pleural fluid test and a pleural biopsy under local anaesthesia performed by a previous physician failed to make the diagnosis. Despite diuretic therapy, his condition necessitated frequent thoracentesis. The patient was referred to our hospital and thoracoscopic pleural and pericardial biopsies performed under general anaesthesia revealed λ-type AL amyloidosis, indicating a relapse of MM. Despite drug therapy for MM, the patient died from aspiration pneumonia. The case underscores the importance of considering amyloidosis in differential diagnoses for refractory effusions, especially in patients with a history of MM, even after long-term remission.

A 66-year-old male from Myanmar presented with 3 months of cough and constitutional symptoms. He was an ex-tobacco user with no significant medical or exposure history. Chest x-ray showed ill-defined bilateral opacities and a left pleural effusion. Chest CT revealed two right lower lobe masses, and a moderate-sized left pleural effusion. PET-CT demonstrated hypermetabolic uptake in the thickened nodular pleura, pericardium, and hilar/mediastinal lymph nodes. EBUS-TBNA of the right lower paratracheal node and TBLB of the right lower lobe mass yielded epithelioid granulomas comprising multinucleated giant cells, epithelioid histiocytes and lymphoplasmacytic cells. Thoracoscopy revealed hard, whitish mass-like parietal pleural plaques, and pleural biopsy revealed identical histopathologic results. His symptoms resolved quickly after commencing prednisolone 25 mg daily. Chest CT at 6 months demonstrated near complete resolution of the parenchymal masses and pleural effusion. We highlight this unique case of pleuroparenchymal sarcoidosis mimicking metastatic lung cancer in a tuberculosis-endemic region.

Acquired bronchobiliary fistula (ABBF) is very rare among the complications that occur in patients with hepatocellular carcinoma (HCC) after treatment. Although surgery and drainage have been the main methods for treating ABBF for a long time, they are not entirely suitable for patients with refractory ABBF resulting from HCC therapy. In this study, we present four cases of ABBF caused by HCC treatment, who were treated using selective bronchial occlusion (SBO). Among the 4 patients with ABBF treated with SBO, 3 cases successfully blocked ABBF with SBO, and the treatment success rate was 75%. All successfully treated patients reported disappearance of symptoms of bilioptysis and cough was alleviated. No life-threatening adverse reactions were reported following SBO intervention, and no deaths occurred. We believe that the use of video bronchoscopy to place a self-made silicone plug in the bronchus to treat refractory ABBF is a feasible palliative treatment, which can significantly improve the condition of ABBF patients.

Here we report a rare case of immunoglobulin G4 (IgG4)-related pleural disease diagnosed using a thoracoscopic pleural biopsy. A 66-year-old man was admitted to our hospital with right-dominant bilateral pleural effusions and gradually worsening dyspnoea. Chest radiographs revealed right-dominant pleural effusions, while chest computed tomography showed bilateral pleural effusions without parenchymal lesions. Although the bilateral pleural effusions were exudative with an increased number of lymphocytes, the definitive diagnosis was initially elusive. High IgG4 levels in the serum and pleural effusions were observed. A pathological evaluation of a right pleural biopsy specimen collected via video-assisted thoracoscopic surgery showed fibrosis-associated lymphoplasmacytic infiltration, 45-60 IgG4-positive plasma cells per high-power field, and an IgG4/immunoglobulin G ratio of 40%. Consequently, the patient was diagnosed with IgG4-related pleural disease. The bilateral pleural effusions improved after corticosteroid therapy.

A 72-year-old man with productive cough and wheezing was referred to our institution for a growing mass shadow and central bronchiectasis in the right lower lobe on computed tomography. Based on the symptoms, elevated Aspergillus-specific immunoglobulin E levels, and radiological findings, allergic bronchopulmonary mycosis (ABPM) was suspected according to the Japanese clinical diagnostic criteria. The patient refused bronchoscopic examination, and oral prednisolone (0.5 mg/kg/day) improved the symptoms; however, the mass shadow continued to grow. Subsequently, bronchoscopy revealed mucus plugs and an endobronchial tumour with a whitish surface. The tumour was surgically resected, and the pathological diagnosis was a coexistence of ABPM and pulmonary pleomorphic carcinoma. To the best of our knowledge, this is the first case of ABPM developing at the site of pulmonary pleomorphic carcinoma. Careful bronchoscopic examinations and histopathological evaluations of the surgical specimen led to a prompt and accurate diagnosis.