Respirology Case Reports最新文献

Acute exacerbation of interstitial pneumonia (IP-AE) is a type of severe respiratory failure that occurs in patients with chronic interstitial pneumonia. Herein, we report a case of multiple pulmonary thrombi caused by antiphospholipid antibody syndrome (APS), which required differentiation from IP-AE in a patient with chronic interstitial pneumonia. A 77-year-old male patient presented with acute respiratory failure and bilateral ground-glass opacities on chest computed tomography (CT), which initially indicated IP-AE. However, the contrast-enhanced CT scan revealed multiple pulmonary thrombi, and the laboratory examination showed positivity for antiphospholipid antibodies. The patient was diagnosed with APS and was successfully treated with anticoagulant therapy and systemic corticosteroids. The pulmonary manifestations of APS may mimic those of IP-AE and may be under-recognised. Thus, APS should be considered in the differential diagnosis of acute respiratory deterioration in patients with interstitial pneumonia.

An elderly man had branching pulmonary opacities. PET-CT showed uniform FDG avidity extending from central to peripheral bronchi. Bronchoscopy confirmed urothelial carcinoma metastasis. We propose the 'golden glove' sign-branching uptake favouring neoplastic spread over mucoid impaction-and recommend including lymphangitic metastasis in the differential diagnosis and prompt histologic confirmation.

A patient with EGFR-mutant lung cancer developed leptomeningeal carcinomatosis years after osimertinib-induced ILD. With no other treatment options, palliative osimertinib rechallenge led to rapid neurological improvement and radiological response, without ILD recurrence. This case highlights the potential of carefully monitored osimertinib rechallenge for symptomatic relief in exceptional cases.

Foreign body aspiration is uncommon in adults and may present without a clear aspiration history. We describe an adult patient with persistent lobar collapse and severe pneumonia in whom bronchoscopy revealed an occult endobronchial foreign body causing airway obstruction.

Empyema and Boerhaave syndrome are both life-threatening conditions. We present a patient who suffered from Boerhaave syndrome complicated by left empyema, who had sepsis controlled with adequate pleural drainage and timely endoscopic oesophageal repair. A preceding history of vomiting with the occurrence of polymicrobial empyema with Candida involvement should prompt the suspicion of Boerhaave syndrome, despite the absence of classical Mackler's Triad. Early recognition of these interlinked conditions is essential for facilitating prompt management. Intravenous and oral contrast-enhanced computed tomography is crucial in evaluating the thoracic space and identifying an oesophageal leak. Intravenous antibiotics and repair of the oesophageal perforation can help to control sepsis and improve clinical outcome. Endoscopic repair is a viable alternative to surgical repair in select patients and can be considered even in those with a delayed presentation.

We report a case illustrating the role of parametric response mapping (PRM) in detecting and monitoring small airway disease (SAD) related to occupational inhalational exposure. A 52-year-old woman, a lifelong never-smoker with chronic occupational exposure to metal cutting-fluid fumes and metal particles, presented with exertional dyspnea and moderate airflow obstruction. PRM CT revealed PRM-functional small airway disease (PRM-fSAD) of 15.7% and PRM-emphysema of 0.2%. After 1.5 years of increased unprotected exposure, PRM-fSAD rose to 46.2%, with stable spirometry but reduced diffusing capacity and more frequent exacerbations. Following workload reduction and consistent mask use, PRM-fSAD decreased to 2.8% accompanied by symptomatic and functional improvement. This case supports PRM as a reliable imaging biomarker for early detection of exposure-related SAD, even before spirometric decline, and highlights the potential reversibility of occupational lung injury with timely intervention.

Immunoglobulin G4-related disease (IgG4-RD) is a fibroinflammatory condition that can involve multiple organs, including mediastinal lesions. Transbronchial mediastinal cryobiopsy has recently emerged as a novel sampling technique that improves diagnostic yield for mediastinal lesions, particularly in rare tumours and benign disorders, compared to endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Here we report a case of IgG4-RD presenting with hilar and mediastinal lymphadenopathy successfully diagnosed by transbronchial mediastinal cryobiopsy using a ø1.7 mm cryoprobe. The diagnosis was established in accordance with the 2020 revised comprehensive diagnostic criteria for IgG4-RD, after exclusion of infectious and lymphoproliferative disorders. Endoscopic mediastinal cryobiopsy may represent a valuable and minimally invasive strategy for diagnosing mediastinal diseases.

Shrinking lung syndrome (SLS) is an infrequent complication of systemic lupus erythematosus (SLE). A 41-year-old woman with a 10-year history of SLE presented with dyspnea, chest pain, and dry cough. She had poor medication compliance and multiple hospitalizations over 3 years for similar symptoms, without a definitive diagnosis. Imaging revealed bilateral basal atelectasis and an elevated right hemidiaphragm, while pulmonary function tests (PFTs) showed a restrictive pattern. Other lung and cardiac conditions were excluded, leading to a diagnosis of SLS. Treatment with rituximab, prednisolone, and theophylline improved PFTs, chest pain, cough, and dyspnea at follow-up. Clinicians should consider SLS in SLE patients with dyspnea and characteristic imaging, as delayed diagnosis may increase morbidity.

Foreign body aspirations more commonly occur in children and the elderly. There are many challenges in their diagnosis and management, with both acute and chronic complications. Bronchoscopy is the preferred management approach for airway evaluation and retrieval of an aspirated foreign body. The availability of ultra-thin bronchoscopes, advanced imaging, and robotics allows interesting new options for the management of foreign body aspiration. An ingested foreign body tends to pass naturally through the gastrointestinal tract but may also require endoscopic removal in case of complications. We explore the challenges in the management of an aspirated dental implant that migrated from the bronchial tree to the gastrointestinal tract in this unique case.

A profoundly immunocompromised man developed a large cavitary lung lesion producing black, viscous aspirate, with culture confirming Candida krusei. This rare manifestation underscores that atypically dark aspirates from lung cavities should raise suspicion for invasive fungal infection and prompt early antifungal therapy in patients with severe cellular immunodeficiency.