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RESPIRATORY DISEASES (103 journals)                     

Showing 1 - 104 of 104 Journals sorted alphabetically
Advances in Respiratory Medicine     Open Access   (Followers: 7)
Advances in Thoracic Diseases     Open Access  
American Journal of Respiratory and Critical Care Medicine     Full-text available via subscription   (Followers: 257)
American Journal of Respiratory Cell and Molecular Biology     Full-text available via subscription   (Followers: 20)
American Review of Respiratory Disease     Full-text available via subscription   (Followers: 4)
Angiologia e Cirurgia Vascular     Open Access   (Followers: 1)
Annals of the American Thoracic Society     Full-text available via subscription   (Followers: 17)
Annals of Thoracic Medicine     Open Access   (Followers: 6)
Archives of Pulmonology and Respiratory Care     Open Access   (Followers: 1)
Archivos de Bronconeumología     Full-text available via subscription  
Archivos de Bronconeumología (English Edition)     Full-text available via subscription   (Followers: 1)
Asthma Research and Practice     Open Access   (Followers: 2)
BMC Pulmonary Medicine     Open Access   (Followers: 5)
BMJ Open Respiratory Research     Open Access   (Followers: 7)
Breathe     Open Access   (Followers: 5)
Canadian Journal of Respiratory, Critical Care, and Sleep Medicine     Hybrid Journal   (Followers: 1)
Canadian Respiratory Journal     Open Access   (Followers: 3)
Case Reports in Pulmonology     Open Access   (Followers: 3)
Chest     Full-text available via subscription   (Followers: 102)
Chest Disease Reports     Open Access   (Followers: 2)
Chronic Respiratory Disease     Hybrid Journal   (Followers: 9)
Clinical Lung Cancer     Hybrid Journal   (Followers: 6)
Clinical Medicine Insights : Circulatory, Respiratory and Pulmonary Medicine     Open Access   (Followers: 3)
Clinical Pulmonary Medicine     Hybrid Journal   (Followers: 2)
COPD Research and Practice     Open Access   (Followers: 1)
COPD: Journal of Chronic Obstructive Pulmonary Disease     Hybrid Journal   (Followers: 16)
Current Opinion in Pulmonary Medicine     Hybrid Journal   (Followers: 10)
Current Pulmonology Reports     Hybrid Journal  
Current Research in Tuberculosis     Open Access   (Followers: 3)
Current Respiratory Care Reports     Hybrid Journal   (Followers: 2)
Current Respiratory Medicine Reviews     Hybrid Journal   (Followers: 5)
Der Pneumologe     Hybrid Journal   (Followers: 1)
Egyptian Journal of Chest Diseases and Tuberculosis     Open Access   (Followers: 3)
ERJ Open Research     Open Access   (Followers: 3)
Eurasian Journal of Pulmonology     Open Access  
European Clinical Respiratory Journal     Open Access   (Followers: 4)
European Respiratory Journal     Full-text available via subscription   (Followers: 39)
European Respiratory Review     Open Access   (Followers: 7)
Experimental Lung Research     Hybrid Journal   (Followers: 1)
Expert Review of Respiratory Medicine     Hybrid Journal   (Followers: 5)
Heart & Lung: The Journal of Acute and Critical Care     Hybrid Journal   (Followers: 14)
Heart, Lung and Circulation     Full-text available via subscription   (Followers: 9)
Indian Journal of Respiratory Care     Open Access   (Followers: 3)
Indian Journal of Tuberculosis     Full-text available via subscription  
Influenza and Other Respiratory Viruses     Open Access   (Followers: 3)
International Journal of Chronic Obstructive Pulmonary Disease     Open Access   (Followers: 3)
Journal of Association of Chest Physicians     Open Access   (Followers: 2)
Journal of Asthma     Hybrid Journal   (Followers: 5)
Journal of Asthma Allergy Educators     Hybrid Journal   (Followers: 5)
Journal of Bronchology & Interventional Pulmonology     Hybrid Journal   (Followers: 5)
Journal of Clinical Tuberculosis and Other Mycobacterial Diseases     Open Access  
Journal of Heart and Lung Transplantation     Hybrid Journal   (Followers: 12)
Journal of Respiratory Medicine     Open Access   (Followers: 5)
Journal of Respiratory Research     Open Access   (Followers: 2)
Journal of Tuberculosis Research     Open Access   (Followers: 1)
Jurnal Respirasi     Open Access  
Karger Kompass Pneumologie     Full-text available via subscription   (Followers: 1)
Kindheit und Entwicklung     Hybrid Journal  
Lung     Hybrid Journal   (Followers: 3)
Lung Cancer     Hybrid Journal   (Followers: 16)
Lung Cancer International     Open Access   (Followers: 2)
Lung Cancer: Targets and Therapy     Open Access   (Followers: 3)
Lung India     Open Access   (Followers: 1)
Multidisciplinary Respiratory Medicine     Open Access   (Followers: 4)
npj Primary Care Respiratory Medicine     Open Access   (Followers: 2)
Open Journal of Respiratory Diseases     Open Access   (Followers: 2)
Open Respiratory Medicine Journal     Open Access   (Followers: 2)
Paediatric Respiratory Reviews     Hybrid Journal   (Followers: 11)
Pediatric Quality & Safety     Open Access  
Pediatric Respirology and Critical Care Medicine     Open Access   (Followers: 1)
Pulmonary Circulation     Open Access   (Followers: 4)
Pulmonary Medicine     Open Access   (Followers: 3)
Pulmonary Pharmacology & Therapeutics     Hybrid Journal   (Followers: 2)
Pulmonary Therapy     Open Access   (Followers: 2)
Pulmonology and Respiratory Research     Open Access   (Followers: 2)
Respiratory Care     Full-text available via subscription   (Followers: 11)
Respiratory Investigation     Full-text available via subscription   (Followers: 1)
Respiratory Medicine     Hybrid Journal   (Followers: 18)
Respiratory Medicine : X     Open Access  
Respiratory Medicine Case Reports     Open Access  
Respiratory Medicine CME     Hybrid Journal  
Respiratory Medicine Extra     Full-text available via subscription   (Followers: 1)
Respiratory Physiology & Neurobiology     Hybrid Journal   (Followers: 4)
Respiratory Research     Open Access   (Followers: 1)
Respirology     Hybrid Journal   (Followers: 5)
Respirology Case Reports     Open Access  
Revista Americana de Medicina Respiratoria     Open Access  
Revista Chilena de Enfermedades Respiratorias     Open Access  
Revista Inspirar     Open Access  
Revista ORL     Open Access  
Revista Portuguesa de Pneumologia     Open Access  
Sarcoidosis Vasculitis and Diffuse Lung Disese     Full-text available via subscription   (Followers: 3)
Seminars in Respiratory and Critical Care Medicine     Hybrid Journal   (Followers: 14)
Sleep Medicine Reviews     Hybrid Journal   (Followers: 17)
The Clinical Respiratory Journal     Hybrid Journal   (Followers: 3)
The International Journal of Tuberculosis and Lung Disease     Full-text available via subscription   (Followers: 8)
The Lancet Respiratory Medicine     Full-text available via subscription   (Followers: 35)
Therapeutic Advances in Chronic Disease     Open Access   (Followers: 7)
Therapeutic Advances in Respiratory Disease     Open Access   (Followers: 1)
Thorax     Hybrid Journal   (Followers: 38)
Translational Respiratory Medicine     Open Access   (Followers: 1)
Tuberculosis     Hybrid Journal   (Followers: 12)
Tuberculosis Research and Treatment     Open Access   (Followers: 3)
Пульмонология     Full-text available via subscription  

           

Similar Journals
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Respiratory Medicine CME
Number of Followers: 0  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1755-0017
Published by Elsevier Homepage  [3203 journals]
  • Chronic thromboembolic disease and necrotizing granulomatous vasculitis
           – A case report
    • Abstract: 2011
      Publication year: 2011
      Source:Respiratory Medicine CME, Volume 4, Issue 4

      A 32 year old male presented to our services with severe, progressive breathlessness. Following a detailed clinical work-up he was found to have severe pulmonary arterial hypertension due to chronic thromboembolic disease. No risk factor for venous thromboembolism,was identified at this time. Vasculitic screen including anti-neutrophil cytoplasmic antibody (ANCA) was normal. He was referred for pulmonary artery endarterectomy which was performed successfully and with good initial improvement in his symptom complex. He represented with breathlessness four months later. He was diagnosed with necrotizing granulomatous vasculitis (known formerly as Wegner's Granulomatosis). While an association between necrotizing granulomatous vasculitis and venous thromboembolic disease is well described, to our knowledge this is the first case of a patient with chronic thromboembolic pulmonary hypertensive disease subsequently developing fulminant necrotizing granulomatous vasculitis.

      PubDate: 2012-12-17T18:06:18Z
       
  • A 42-year-old man with progressive dyspnea and a rapidly growing mass
    • Abstract: 2011
      Publication year: 2011
      Source:Respiratory Medicine CME, Volume 4, Issue 4

      Malignant fibrous histiocytoma (MFH), also known as undifferentiated high grade pleomorphic sarcoma, accounts for 20–24% of all soft tissue sarcomas in the US. Peak incidence is in the fifth and sixth decades of life, with a 2:1 male to female distribution. MFH is usually seen in the soft tissues of the extremity and involvement of the lung is rare. We report a case of pleural MFH in a patient with previous pleuro-pulmonary tuberculosis for which he had a lobectomy.

      PubDate: 2012-12-17T18:06:18Z
       
  • Intracardiac thrombus in Behcet’s disease: A rare case in the United
           States
    • Abstract: 2011
      Publication year: 2011
      Source:Respiratory Medicine CME, Volume 4, Issue 4

      Behcet’s disease is a rare systemic disorder which is associated with an underlying vasculitis. Most cases of BD occur in Asia and North American cases are rare. Patients often present with aphthous ulcers and have a number of other clinical findings including genital lesions, skin lesions (folliculitis, erythema nodosum, and acne), and uveitis. Hemoptysis and cough in BD may be a sign of pulmonary involvement with include pulmonary artery aneurysms (PAA). Intracardiac thrombus is another rare occurrence in BD but should be suspected if there is a right heart mass detected on imaging. We present a case of suspected BD who presented with hemoptysis and was diagnosed with PAA and intracardiac thrombus. His aphthous ulcers were not diagnoses until subsequent hospitalization for hemoptysis. Clinicians should be aware of unusual presentations of BD because of the associated high mortality.

      PubDate: 2012-12-17T18:06:18Z
       
  • A pulmonary abscess, beware of lung cancer!
    • Abstract: 2011
      Publication year: 2011
      Source:Respiratory Medicine CME, Volume 4, Issue 4

      A pulmonary abscess is defined as necrosis of the pulmonary parenchym caused by microbial infections. The most common organisms are anaerobe bacteria. Local conditions, host resistance and infecting agents all play a role in the formation of pulmonary abscesses. An underlying endobronchial obstructing lung cancer predisposes for the development of a pulmonary abscess. The diagnosis of lung cancer can often be made with computed tomography (CT) of the chest combined with bronchoscopy and cytological analysis of the abscess fluid. We present two patients with a pulmonary abscess caused by an underlying lung cancer. Although in both cases the differential diagnosis was malignancy at first presentation, the diagnosis could not be made definitively prior to surgery, despite intensive investigations with even CT guided biopsies and mediastinoscopy.

      PubDate: 2012-12-17T18:06:18Z
       
  • Bronchial artery embolization: Managing ruptured pulmonary artery venous
           malformation – A case report
    • Abstract: 2011
      Publication year: 2011
      Source:Respiratory Medicine CME, Volume 4, Issue 4

      A young 19 year old boy reported to the emergency with complaints of productive cough and mild haemoptysis over three days duration. Initial investigations were within normal limits. Symptoms suddenly aggravated and his condition deteriorated severely before further sophisticated investigations could be carried out. Urgent diagnostic bronchoscopy indicated it to be a case of spontaneously ruptured micro-vascular Pulmonary Arterio-Venous Malformation (PAVM) which was further confirmed on performing pulmonary angiography. Diameter of the feeding vessel was narrow causing difficulty in negotiating for coil embolotherapy. Occlusion of the bleeding artery was finally achieved by pushing in gel foam particles through the vessel. The boy recovered completely and remained asymptomatic one month after the intervention. PAVM is a relatively rare medical emergency where timely diagnosis and therapeutic embolization of the feeding vessel can be lifesaving as indicated in this case report.

      PubDate: 2012-12-17T18:06:18Z
       
  • Cryptogenic organizing pneumonia due to ortho-phenylenediamine
    • Abstract: 2011
      Publication year: 2011
      Source:Respiratory Medicine CME, Volume 4, Issue 4

      Cryptogenic organizing pneumonia (COP) is a rare, potentially serious respiratory disease which may be idiopathic or secondary to other conditions. Exceptionally, cases of COP of occupational origin have been reported. We present the case of a laboratory researcher who developed COP after prolonged exposure to ortho-phenylenediamine. The diagnosis was made after a specific inhalation challenge (SIC). After clinical and radiological resolution, the patient has avoided the causal agent and remains asymptomatic.

      PubDate: 2012-12-17T18:06:18Z
       
  • Pulmonary adiaspiromycosis: The first reported case in Turkey
    • Abstract: 2011
      Publication year: 2011
      Source:Respiratory Medicine CME, Volume 4, Issue 4

      Adiaspiromycosis is a world wide airborne infection and is a pulmonary disease in humans caused by the fungus Chrysosporium parvum var crescens (Emmonsia parva). It is caused by inhalation of spores of the saprophytic soil fungus. The spherules induce a granulomatous reaction, in which a single spherule is surrounded by a fibronecrotic and suppurative or fibrous granuloma. The disease can be localized and asymptomatic, or disseminated, occasionally severe, or even fatal. Reticulonodular infiltrates are the most common radiographic manifestations, with localized infiltrates occurring occasionally. We present a case with bilateral diffuse interstitial micronodular infiltration and granulomatous inflammation in the lung. The larvae of adiaspiromycosis visualized in the center of granulomatous inflammation by histopathologic examination of the lung biospy specimens. We aimed to discuss the very rare cause of diffuse interstitial and granulomatous inflammation of lung.

      PubDate: 2012-12-17T18:06:18Z
       
  • An unusual case of hoarseness of voice related to corticosteroid treatment
    • Abstract: 2011
      Publication year: 2011
      Source:Respiratory Medicine CME, Volume 4, Issue 4

      Invasive aspergillus infection of the larynx is extremely rare. This report describes the case of a 56-year-old lady with Chronic Obstructive Pulmonary Disease receiving long-term inhaled corticosteroids who presented with a four-week history of progressive hoarseness, dyspnoea and cough. Sputum cultures at the time isolated Aspergillus fumigatus. She was commenced on a trial of Itraconazole for presumed Allergic Bronchopulmonary Aspergillosis. Due to the duration and nature of her symptoms, vocal cord biopsies were taken which revealed abundant colonies of the fungus A. fumigatus infiltrating skeletal muscle. Inhaled corticosteroids were discontinued and the patient was switched to voriconazole. She continues to make a protracted recovery and is being closely monitored.

      PubDate: 2012-12-17T18:06:18Z
       
  • Idiopathic constrictive bronchiolitis with rapidly progressive
           bronchiectasis and Mycobacterium kansasii infection
    • Abstract: 2011
      Publication year: 2011
      Source:Respiratory Medicine CME, Volume 4, Issue 4

      Constrictive bronchiolitis results in airways obstruction with progressive lung hyperinflation causing dyspnea and eventual respiratory failure. There are many known causes including rheumatic diseases, infections and toxic inhalations. We describe a 58-year-old man with no preexisting lung disease who suffered rapid loss of lung function with hyperinflation over months in association with rapidly progressive radiographic bronchiectasis. Airway cultures grew Mycobacterium kansasii, Pseudomonas aeruginosa and Aspergillus fumigatus; lung biopsy showed constrictive bronchiolitis that was clinically idiopathic. His respiratory symptoms and pulmonary function rapidly improved within a week of high-dose corticosteroid therapy. We suggest that a diagnosis of constrictive bronchiolitis should be considered in patients with a combination of new rapidly progressive lung hyperinflation and worsening bronchiectasis. We hypothesize that the bronchiolitis-associated bronchiectasis may occur from a predisposition for secondary infections known to cause large airway wall damage. Identification and adequate treatment of these infections is critical if concurrent high-dose corticosteroid therapy is attempted to alleviate the constrictive bronchiolitis.

      PubDate: 2012-12-17T18:06:18Z
       
  • Allergic bronchopulmonary aspergillosis presenting with cough variant
           asthma with spontaneous remission
    • Abstract: 2011
      Publication year: 2011
      Source:Respiratory Medicine CME, Volume 4, Issue 4

      A 60-year-old woman presented with a dry cough without dyspnea or wheezing. Chest CT showed an image of mucoid impactions, which were identified as mucoid impactions by bronchofiberscopy. Aspergillus niger was cultured from her mucus. Her serum total IgE was 5150 IU/ml. Precipitins and IgE specific for Aspergillus were positive. She had no history of asthma and no evidence of bronchoconstriction by pulmonary function tests. Thus, a diagnosis was made of allergic bronchopulmonary aspergillosis without asthma. She refused to take oral corticosteroids, although she improved spontaneously. However, her dry cough persisted. Her cough was relieved by administering an inhaled β-2 agonist; therefore, cough variant asthma was diagnosed. She was treated with an inhaled corticosteroid and her cough resolved completely.

      PubDate: 2012-12-17T18:06:18Z
       
  • An incidental finding of a lung lesion in a patient with systemic
           sclerosis
    • Abstract: 2011
      Publication year: 2011
      Source:Respiratory Medicine CME, Volume 4, Issue 4

      We present the case of a 59-year-old lady, who was found to have an incidental finding of a lung lesion on a CxR following percutaneous endoscopic gastroscopy tube insertion. Subsequently a computerised tomography scan was performed which suggested primary lung malignancy and CT guided biopsy was arranged. Pathological analysis revealed actinomycosis infection. We discuss the clinical, radiological and pathological findings in actinomycosis and how it can often be mistaken for lung cancer. This may put patients at risk of unnecessary morbidity or even unwarranted surgery and therefore clinicians should have a high clinical suspicion of thoracic actinomycosis, especially if a patient has underlying risk factors, such as aspiration.

      PubDate: 2012-12-17T18:06:18Z
       
  • Spontaneous pneumomediastinum revisited
    • Abstract: 2011
      Publication year: 2011
      Source:Respiratory Medicine CME, Volume 4, Issue 4

      Spontaneous pneumomediastinum is defined as free air within the mediastinum, not associated with trauma. Causes include exercise, drugs, asthma, vomiting, difficult labour and Valsalva maneuvers. It’s a rare, usually benign and self-limited condition, more prevalent in young males. The triad of thoracic pain, dyspnoea and subcutaneous emphysema is typical. We report a case of a 23 year old man presenting to the emergency room complaining of odynophagia, thoracic pain and neck swelling. He had fever and productive purulent cough in the previous week. He had no abnormal findings but subcutaneous emphysema. We found a pneumomediastinum without pneumothorax, treated conservatively with complete resolution. Although frightening, this condition usually has good prognosis without specific treatment, other than avoidance of the cause.

      PubDate: 2012-12-17T18:06:18Z
       
  • A forty-year old man with advanced acquired immune deficiency syndrome and
           bilateral pulmonary infiltrates
    • Abstract: 2011
      Publication year: 2011
      Source:Respiratory Medicine CME, Volume 4, Issue 4

      This report describes a 40-year old man with a history of acquired immunodeficiency syndrome (AIDS) diagnosed with Pneumocystis jiroveci pneumonia (PJP) twice prior to this admission, who presented with 3 days of fever, non-productive cough and shortness of breath. The patient was treated empirically for PJP, but his condition deteriorated rapidly and he expired despite resuscitative efforts. The bronchoalveolar lavage (BAL) and blood cultures grew Cryptococcus neoformans. Very few cases of disseminated cryptococcosis presenting as acute respiratory failure have been reported. Cryptococcosis is a common opportunistic infection that should be considered in patients with AIDS presenting with bilateral pulmonary infiltrates and fever.

      PubDate: 2012-12-17T18:06:18Z
       
  • The pulmonary radiologic findings of rheumatoid arthritis
    • Abstract: 2011
      Publication year: 2011
      Source:Respiratory Medicine CME, Volume 4, Issue 4

      The rheumatoid arthritis (RA) is can affect multiple organs and tissues including the lung. Several pleuropulmonary manifestations are associated with rheumatoid arthritis involving the lung parenchyma, pleura, airways, and vasculature. The various pulmonary radiological findings have been defined in patients with RA. In this study, we aimed to retrospectively evaluate of the pulmonary radiologic findings in the five patients with RA. In the present study, pleural effusion, hydropneumothorax, chylothorax, pulmonary micronodular, macronodular and necrobiotic nodular lesions, pleural plagues, ground glass opacity and interstitial lung diseases were defined according to chest radiographs and computed tomography. The most common pulmonary radiologic findings were pulmonary nodules in three of patients, necrobiotic nodule in two of patients, pleural plague in two of patients and pleural effusion in two patients. The one of them had hydropneumothorax. Interstitial lung diseases were defined in two of patients. In conclusion, the pulmonary changes may be accompanied as a systemic component of the RA. If these changes are well recognized, they can help in the diagnosis of the RA.

      PubDate: 2012-12-17T18:06:18Z
       
  • Recurrent pneumonia due to esophageal migration of the gastrostomy MIC-Key
           tube remnant causing proximal esophageal obstruction
    • Abstract: 2011
      Publication year: 2011
      Source:Respiratory Medicine CME, Volume 4, Issue 4

      A 16 years old female with history of cerebral palsy, juvenile rheumatoid arthritis and severe scoliosis presents for recurrent pneumonia. Multiple prior plain films demonstrate progressive increased consolidation confined to the left lower lobe. Subsequently, a CT of the chest was preformed which showed a plastic gastrostomy (MIC-Key tube) bumper in the proximal esophagus causing severe tracheal narrowing. The patient underwent endoscopic removal of the gastrostomy bumper without incident.

      PubDate: 2012-12-17T18:06:18Z
       
  • Misleading chest radiograph in a case of allergic bronchopulmonary
           aspergillosis
    • Abstract: 2011
      Publication year: 2011
      Source:Respiratory Medicine CME, Volume 4, Issue 4

      We present a case of apparent convincing bilateral hilar lymphadenopathy on a chest radiograph, which on further investigation was found to be allergic bronchopulmonary aspergillosis with symmetrical bilateral apical lower lobe infiltrates. This case demonstrates the role of three-dimensional imaging for disorders of the hila and mediastinum, which are poorly delineated on plain radiography.

      PubDate: 2012-12-17T18:06:18Z
       
  • A case of hemothorax resulting from perforation of an esophageal
           diverticulum
    • Abstract: 2011
      Publication year: 2011
      Source:Respiratory Medicine CME, Volume 4, Issue 4

      Esophageal diverticula are usually asymptomatic and clinically insignificant. We report a case of a hemothorax resulting from perforation of an esophageal diverticulum. A 45-year-old man complained of severe back pain. Computed tomography of the chest showed a mediastinal mass. On the next day, a left pleural effusion was revealed, which was a hemothorax. Gastrointestinal fiberscopy suggested perforation of the esophagus; an esophagectomy was performed, and the patient was diagnosed with a pathologic perforation of the esophageal diverticulum. This is the only report of a hemothorax resulting from perforation of an esophageal diverticulum in the English literature to date.

      PubDate: 2012-12-17T18:06:18Z
       
  • Superior vena cava obstruction due to total implantable venous access
           devices in cystic fibrosis: Case series and review
    • Abstract: 2011
      Publication year: 2011
      Source:Respiratory Medicine CME, Volume 4, Issue 3

      As the life expectancy of patients with cystic fibrosis (CF) improves, treatment related morbidity is increasingly recognised. Totally implantable venous access devices (TIVADs) offer reliable long term central venous access but are associated with recognised complications including venous thrombosis. Superior vena cava obstruction (SVCO) however has been rarely reported in this setting. We report a single CF centre’s experience of SVCO associated with TIVADs in patients with CF, followed by a review of the published literature on risk factors, preventative strategies and treatment approaches.

      PubDate: 2012-12-17T18:06:18Z
       
  • Invasive pulmonary aspergillosis in an immunocompetent patient
    • Abstract: 2011
      Publication year: 2011
      Source:Respiratory Medicine CME, Volume 4, Issue 3

      Aspergillosis is the group of diseases caused by the Aspergillus species, which cause a broad spectrum of disease, ranging from hypersensitivity reactions to direct angioinvasion. The major forms of pulmonary aspergillosis range from aspergilloma with a relatively benign course to invasive pulmonary aspergillosis, which is uniformly fatal. Invasive pulmonary aspergillosis more commonly occurs in immunocompromised patients, with a rapidly progressing course leading to death. We report a case of an immunocompetent patient who developed fatal pneumonia secondary to Aspergillus fumigatus.

      PubDate: 2012-12-17T18:06:18Z
       
  • Hypocortisolism induces chronic respiratory failure
    • Abstract: 2011
      Publication year: 2011
      Source:Respiratory Medicine CME, Volume 4, Issue 3

      Hypocortisolism is an uncommon condition. Its association with myopathy and respiratory failure has only rarely been described. We report the case of a 52 year-old woman presenting with progressive dyspnoea. Work-up revealed a severe restrictive syndrome with hypoxaemia. Further investigations showed hypocortisolism of pituitary origin. Response to hydrocortisone allowed us to conclude to an unusual case of hypocortisolic myopathy affecting the respiratory muscles.

      PubDate: 2012-12-17T18:06:18Z
       
  • An uncommon hazard: Pulmonary talcosis as a result of recurrent aspiration
           of baby powder
    • Abstract: 2011
      Publication year: 2011
      Source:Respiratory Medicine CME, Volume 4, Issue 3

      A previously healthy 52-year old woman presented to the hospital with a 6-month history of progressive dyspnea. Associated symptoms included a persistent dry cough that started 2 months prior admission and an unintentional weight loss of 20 pounds over the course of her illness. On lung examination revealed fine bilateral end-inspiratory crackles in both lower and upper lobes. Radiographic studies showed evidence of interstitial lung disease. The patient underwent bronchoscopy were transbronchial biopsies were taken and showed fibrosis of bronchial walls and lung parenchyma with prominent non-necrotizing granulomata that contained abundant polarizing crystalline material. Once the pathologic findings were known, the patient was re-interviewed. She reported that for the last 20-years, she used baby talcum powder regularly at least twice a day, usually after bathing for personal hygiene. In addition, she habitually applied it to her bed sheets nightly. She was started on prednisone at a dose of 0.5 mg/kg/day, which was gradually tapered and then maintained on a dose of 5 mg daily. Her symptoms rapidly improved over weeks to the point whereshe no longer required home oxygen therapy.

      PubDate: 2012-12-17T18:06:18Z
       
  • Disseminated BCG disease: A case report
    • Abstract: 2011
      Publication year: 2011
      Source:Respiratory Medicine CME, Volume 4, Issue 3

      Disseminated BCG disease is a rare life-threatening complication of BCG administration, characterised by miliary pulmonary nodules. Presentation can mimic tuberculosis, both in symptoms and on radiological imaging. Here we report a case of disseminated BCG disease following intravesical BCG treatment for superficial bladder cancer that responded to anti-tuberculous treatment and corticosteroids, and briefly review the literature on disseminated BCG disease.

      PubDate: 2012-12-17T18:06:18Z
       
  • Intrapleural administration of Pulmozyme for pleural empyema
    • Abstract: 2011
      Publication year: 2011
      Source:Respiratory Medicine CME, Volume 4, Issue 3

      Empyema is a severe complication of different diseases and traumas. Management of this complication is difficult and should comprise general and local procedures. The general procedure is mainly based on administering wide-spectrum antibiotics. Local management depends on general condition, but in all cases the essential procedure is inserting a drain into the pleural cavity and evacuation the pus. Sometimes pus is very thick and its evacuation and re-expansion of the lung is rather impossible. In these patients surgical procedures are required. The use of intrapleural enzymes to aid drainage was first described in 1949 by Tillett and Sherry using a mixture of streptokinase and streptococcal DNase (deoxyribonuclease). 1 In recent years purified streptokinase has come into widespread use, but recent studies suggest that it has no effect on pus viscosity. DNase reduces pus viscosity and may be more useful in treatment. 2 We report a case of intrapleural administration of Pulmozyme (alfa dornase – deoxyribonuclease (HOFFMANN-LA ROCHE AG) in dosage 2×2,5 mg with a good effect caused by changes in pus viscosity.

      PubDate: 2012-12-17T18:06:18Z
       
  • Biphasic flow volume curve due to obstruction of main bronchus by
           bronchogenic cyst
    • Abstract: 2011
      Publication year: 2011
      Source:Respiratory Medicine CME, Volume 4, Issue 3

      The biphasic curve or bicompartmental flow volume obtained during the forced maneuver is the characteristic of the obstruction of a main bronchus. We report the case of a 64-year-old woman, with progressive dyspnea, coughing and wheezing localized in the left hemithorax, who had been diagnosed with bronchial asthma and was not responding to treatment. The flow volume curve showed an end inspiratory arm configuration compatible with unilateral obstruction of a main bronchus. Chest computed tomography with three-dimensional reconstruction showed a left main bronchus compression by a cyst formation, the bronchoscopy confirmed the obstruction. At surgery a bronchogenic cyst was resected. After the procedure, dyspnea, cough, expectoration and wheezing disappeared. The postoperative flow volume curve showed a normal configuration. We are not aware of a previous report of a biphasic flow volume curve due to a mediastinal bronchogenic cyst. The flow volume curve is a noninvasive procedure useful in the diagnosis of unilateral obstruction of a main bronchus.

      PubDate: 2012-12-17T18:06:18Z
       
  • Bronchoalveolar carcinoma on a background of chronic extrinsic allergic
           alveolitis in a spice miller – A case report
    • Abstract: 2011
      Publication year: 2011
      Source:Respiratory Medicine CME, Volume 4, Issue 3

      A case of bronchoalveolar carcinoma developing on a background of chronic extrinsic allergic alveolitis is discussed highlighting the likely increased risk of lung malignancies in chronic organic hypersensitivity pneumonitis and the need for further cohort studies and possible impact on occupation related safety and compensation.

      PubDate: 2012-12-17T18:06:18Z
       
  • Pulmonary alveolar proteinosis in a man with prolonged cotton dust
           exposure
    • Abstract: 2011
      Publication year: 2011
      Source:Respiratory Medicine CME, Volume 4, Issue 3

      A 59-year-old man presented with severe paroxysms of cough associated with dyspnea. His CT scan showed diffuse bilateral ground glass opacifications. His bronchoalveolar lavage fluid was consistent with pulmonary alveolar proteinosis. Transbronchial biopsy, microbiological studies, and cytology did not identify any alternative diagnosis. The patient had a history of working as a textile loom technician for thirty-one years and had significant exposure to cotton dust. He responded well to whole lung lavage with improvement of symptoms, gas exchange, and CT scan. This patient represents the third reported case of pulmonary alveolar proteinosis associated with cotton dust exposure. We suggest that cellulose might be useful in animal models of pulmonary alveolar proteinosis.

      PubDate: 2012-12-17T18:06:18Z
       
  • A rare cause of pleural effusion
    • Abstract: 2011
      Publication year: 2011
      Source:Respiratory Medicine CME, Volume 4, Issue 3

      A 35-year-old lady presented with left sided pleuritic chest pain. A chest radiograph revealed a small left pleural effusion. She had a ventriculo-peritoneal (VP) shunt placed age 8, for spina bifida complicated by hydrocephalus, and was wheelchair bound but otherwise well. The pleural effusion grew asymptomatically but rapidly over the 3 days after admission to reach a complete white out of her left hemithorax. Preliminary investigations did not identify a cause for her pleural effusion but a CT scan revealed intrapleural tracking of her left VP shunt, ending intraperitoneal. Pleural fluid was positive for beta-2-transferrin, diagnostic for VP shunt leakage. Thoracic complications of VP shunts, other causes of cerebrospinal fluid pleural leak and the underlying pathophysiology in this case are discussed.

      PubDate: 2012-12-17T18:06:18Z
       
  • Silicone breast implant-induced lymphadenopathy: 18 Cases
    • Abstract: 2011
      Publication year: 2011
      Source:Respiratory Medicine CME, Volume 4, Issue 3

      Background There is renewed concern regarding the adverse effects of silicone breast implants, particularly regarding implant rupture. Silicone leak can spread to regional lymph nodes, and remote organs, sometimes mimicking malignancy. The aim of this study was to determine the clinical and radiologic features, pathologic findings, and outcome associated with silicone-induced lymphadenopathy in patients with silicone breast implants. Methods Retrospective review of cases of silicone-induced lymphadenopathy after breast implant encountered at Mayo Clinic Rochester between 1998 and 2008. Results We identified 18 cases of silicone-induced lymphadenopathy (axillary, supraclavicular, internal mammary, and mediastinal). Fifteen patients had breast reconstruction and 3 breast augmentation. Most patients experienced symptoms. One patient had pulmonary opacities, retroperitoneal lymphadenopathy, hypercalcemia, and confirmed silicone in the thyroid, and the omentum. Imaging included mammography, chest CT, breast MRI and PET scan. Lymph node biopsies and/or breast implant removal confirmed the diagnosis with characteristic granulomatous inflammation and giant cell reaction and/or implant rupture. Conclusions Silicone-induced lymphadenopathy can be confused for malignancy or recurrent breast cancer in patients with breast implants. Silicone breast implant ruptures are relatively uncommon, but are under-recognized. Silicone usually migrates to the axillary lymph nodes but may migrate to other lymph nodes as well as extranodal sites.

      PubDate: 2012-12-17T18:06:18Z
       
  • A case report: Primary amiloidosis associated with immunoglobulin A type
           multiple myeloma
    • Abstract: 2011
      Publication year: 2011
      Source:Respiratory Medicine CME, Volume 4, Issue 3

      Primary (AL type) amyloidosis is the most common form of systemic amyloidosis. The morbidity arises from extracellular deposition of immunoglobulin light chain (LC) fibrils in some organs such as the kidneys, heart and bowel. Primary amyloidosis and multiple myeloma both involve clonal plasma cell proliferation. Distinctive haematological and biochemical laboratory findings may help in early diagnosis. Here we present a 60-year-old man with an exceptional clinical course of an Ig A type multiple myeloma with generalized amyloidosis, causing nephrotic syndrome, complete intestinal colitis and malabsorbtion. Our comprehensive overview of this rare and often fatal disease aims to increase the awareness of AL type amyloidosis. This may facilitate earlier diagnosis and thus allow initiation of prompt and specific therapies, which are indispensable in order to improve disease prognosis.

      PubDate: 2012-12-17T18:06:18Z
       
  • Large saddle pulmonary embolism in patient with previously placed IVC
           filter: A case report of successful Angiojet thrombectomy
    • Abstract: 2011
      Publication year: 2011
      Source:Respiratory Medicine CME, Volume 4, Issue 3

      Saddle pulmonary embolisms are life threatening and are uncommon after IVC filter placement. Management of PE is difficult, and emergent thrombolysis is sometimes the only option left if the patient is hemodynamically unstable. We present a rare case of an acute saddle pulmonary embolism in a patient with an intact infrarenal IVC filter presenting with hemodynamic instability.

      PubDate: 2012-12-17T18:06:18Z
       
  • Paragonimiasis: An unusual cause of Cor pulmonale; A case report
    • Abstract: 2011
      Publication year: 2011
      Source:Respiratory Medicine CME, Volume 4, Issue 3

      Paragonimiasis is a parasitic disease caused by the trematode Paragonimus. It follows ingestion of raw or improperly cooked or prickled crab and crayfish. Adult worms can survive for 20 years. A 42-year-old rural dweller was seen at the chest unit with a three month history of cough, chest pain and haemoptysis and a ten week history of bilateral leg swelling. He recalled that his problem dated back to 18 years ago when he first had cough with rusty brown sputum and chest pain. He was treated for pulmonary tuberculosis even though sputum examination did not reveal any AAFB on two occasions. Further enquiries showed that he had enjoyed fishing and hunting for crabs in his adolescent years and ate the young crabs raw. Abnormal findings were mild central cyanosis, pitting leg and scrotal edema jugular venous pulsation was elevated with tender hepatomegaly. Sputum for ova of paragonimiasis which was positive. Packed cell volume was 55%, ESR of 15 mm in the 1st hour. Chest radiograph: patchy opacities, tubular shadowing and prominent pulmonary conus. Echocardiography showed dilated right atrium and ventricle without septal and valvular lesions. Sputum AAFB, A diagnosis of Cor pulmonale due to Paragonimiasis was made and patient treated with Praziquantel. The patient improved markedly and repeated X-ray showed some improvement in the features. Paragonimiasis is an important tropical lung disease. The most frequent symptoms are cough and haemoptysis. The radiological features include cavities, cysts, calcified nodules all of which make differentiation from pulmonary tuberculosis difficult. In endemic areas, patients who complain of cough and haemoptysis should have their sputum examined by an experienced microbiologist for paragonimiasis.

      PubDate: 2012-12-17T18:06:18Z
       
  • Pulmonary tuberculosis masquerading as community acquired pneumonia
    • Abstract: 2011
      Publication year: 2011
      Source:Respiratory Medicine CME, Volume 4, Issue 3

      Pulmonary tuberculosis usually has a smouldering onset and progression, and patients typically present with the symptoms of cough, weight loss, anorexia, night sweats and malaise that is usually present for a few weeks before presentation. A 22-year old man presented with symptoms, signs and radiological features of an acute severe community acquired pneumonia(CAP), a presentation that can delay the diagnosis of TB, and cause institution of antibiotics that may transiently cause clinical improvement, only to be followed by deterioration. We discuss the features that should make a physician suspect that possibility of TB, and illustrate how in a high-burden country, even in the absence of these features, TB must be considered in the differential diagnosis of any patient presenting with a CAP.

      PubDate: 2012-12-17T18:06:18Z
       
  • Persistent left superior vena cava identified during central line
           placement: A case report
    • Abstract: 2011
      Publication year: 2011
      Source:Respiratory Medicine CME, Volume 4, Issue 3

      Introduction A persistent left superior vena cava is found in 0.3–0.5% of the general population and in up to 10% of patients with a congenital cardiac anomaly. It is the most common thoracic venous anomaly and is usually asymptomatic. Being familiar with such anomaly could help clinicians avoid complications during placement of central lines, Swan-Ganz catheters, PICC lines, dialysis catheters, defibrillators, and pacemakers. Case presentation We describe a case of persistent left superior vena cava that was noted after placement of a central line. Mr JJ is a 41 year old African American man who was hospitalized for evaluation and management of alcoholic necrotizing pancreatitis. He required multiple central lines placements. He was noted to have a persistent left superior vena cava that was not recognized initially and thus lead to an unnecessary extra central line placement. Discussion This anatomic variant may pose iatrogenic risks if it is not recognized by the clinician. A central catheter that tracks down the left mediastinal border may also be in the descending aorta, internal thoracic vein, superior intercostal vein, pericardiophrenic vein, pleura, pericardium, or mediastinum. Conclusion Our case is significant because the patient had two extra central venous catheter placements. This case strongly demonstrates the importance of knowing the thoracic venous anomalies.

      PubDate: 2012-12-17T18:06:18Z
       
  • A case of bacteremia due to Burkholderia cepacia in a patient without
           cystic fibrosis
    • Abstract: 2011
      Publication year: 2011
      Source:Respiratory Medicine CME, Volume 4, Issue 3

      Burkholderia cepacia is a pathogen usually causing infection to immunocompromised or hospitalized patients. It is also associated with infections in patients with underlying lung disease, such as cystic fibrosis and chronic granulomatous disease. We present a case of B. cepacia bacteremia in a patient with COPD who was hospitalized due to type II respiratory failure. We speculate that B. cepacia, as a chronic colonizer, may cause infections in patients with lung disease other than cystic fibrosis. Previous antibiotic administration may have a role in development of such infections.
      Highlights ► B. cepacia is a pathogen usually causing infection mainly to patients with underlying lung disease, such as cystic fibrosis, or a compromised immune status. ► It is not commonly found in patients with chronic obstructive pulmonary disease. ► B. cepacia, as a chronic colonizer may cause infections in patients with lung disease other than cystic fibrosis, such as COPD. ► Previous administration of broad-spectrum antibiotics may be a factor contributing in the development of such infections.

      PubDate: 2012-12-17T18:06:18Z
       
  • A very unusual iatrogenic tracheal foreign body
    • Abstract: 2011
      Publication year: 2011
      Source:Respiratory Medicine CME, Volume 4, Issue 3

      We present the occurrence of the free distal aspect of a screw which belongs to cervical vertebra implant penetrated the trachea and resulted in tracheal obstruction. This occurrence has not been previously reported in the English literature. This event occurred, four years ago following a cervical vertebra implant surgery for herniated nucleus pulposus. The patient has been suffering from dyspnea after the surgery. Patient had been diagnosed as chronic asthma bronchiale and given asthma medications by different doctors since the operation. The patient presented to our hospital with the same complaints. Her pulmonary function test revealed upper airway obstruction, thereupon we ordered a neck tomography. The tomography showed a foreign body in the trachea of the patient. The implant and the screw were safely removed. The patient’s complaints are recovered after removal. Her pulmonary function test was improved.

      PubDate: 2012-12-17T18:06:18Z
       
  • Continuous versus on-demand pharmacotherapy of allergic rhinitis: Evidence
           and practice
    • Abstract: 2011
      Publication year: 2011
      Source:Respiratory Medicine CME, Volume 4, Issue 2

      This review aims to compare continuous with on-demand pharmacotherapy of allergic rhinitis by focusing on pharmacodynamic, pharmacokinetic, safety, effectiveness, cost and cost-effectiveness considerations. A working party of experts reviewed and discussed the literature and guidelines, and conducted a qualitative analysis of the Summary of Product Characteristics of specific medicines. With respect to medicines, the working party limited itself to antihistamines, nasal corticosteroids and leukotriene antagonists. Based on a review of the evidence from a multidisciplinary perspective, this article makes pharmacotherapeutic recommendations that are easy, functional and applicable to daily practice in primary care. The pharmacotherapeutic evidence for continuous versus on-demand treatment of allergic rhinitis was limited. Clearly, for corticosteroids, their mechanism of action in allergic rhinitis of reducing allergic inflammation requires continuous therapy at least for the duration of symptoms. For H1-antihistamines, some trials suggest that continuous treatment is preferable but more studies are needed to confirm this conclusion. For both H1-antihistamines and nasal corticosteroids safety data indicate that continuous treatment may be given without fears of adverse consequences, although a distinction can be made between the first and the second generation antihistamines. With regard to the cost and cost-effectiveness implications of continuous therapy versus on-demand therapy, more studies are necessary before definitive conclusions may be made.

      PubDate: 2012-12-17T18:06:18Z
       
  • A large tracheal capillary hemangioma treated with interventional
           bronchoscopy
    • Abstract: 2011
      Publication year: 2011
      Source:Respiratory Medicine CME, Volume 4, Issue 2

      The most frequent causes of hemoptysis are infectious diseases, malignant tumors, cardiovascular disorders, and inflammatory diseases. Lobular capillary hemangioma (LCH) has rarely been reported as a cause of hemoptysis. This vascular lesion usually presents on the skin or mucous membranes, and lesion predominantly affects children with a mean age of approximately six years. It typically presents as a solitary glistening red vascular papule or nodule, prone to ulceration and bleeding. The following case illustrates the occurrence of an LCH of the tracheal mucosa treated with interventional bronchoscopy.

      PubDate: 2012-12-17T18:06:18Z
       
  • An unusual pleural effusion
    • Abstract: 2011
      Publication year: 2011
      Source:Respiratory Medicine CME, Volume 4, Issue 2

      A 36-year old woman presents with cough and breathlessness. She had a history of hydrocephalus with a ventriculo-atrial shunt. Chest radiograph demonstrates a large right-sided pleural effusion. Diagnostic thoracentesis revealed a clear colorless transudative pleural effusion.

      PubDate: 2012-12-17T18:06:18Z
       
  • Bronchiolitis obliterans with organizing pneumonia associated with
           Aspergillus fumigatus
    • Abstract: 2011
      Publication year: 2011
      Source:Respiratory Medicine CME, Volume 4, Issue 2

      Bronchiolitis obliterans organizing pneumonia (BOOP) was described in 1985 as a distinct entity, with different clinical, radiographic, and prognostic features than the airway disorder obliterative bronchiolitis and the interstitial fibrotic lung disorder usual interstitial pneumonia/idiopathic pulmonary fibrosis. The BOOP pattern may be idiopathic or may occur secondary to some of the following clinical conditions: Idiopathic pulmonary fibrosis, Wegener granulomatosis; at the wall of lung abscesses, lymphomas, other neoplasms or after healing of infectious diseases. At these conditions, clinical symptoms are primarily due underlying disorders. We presented a case of BOOP mimicking a malignant disorder and occurring after Aspergillus infection in a patient with chronic obstructive pulmonary disease.

      PubDate: 2012-12-17T18:06:18Z
       
  • Pulmonary adenocarcinoma masquerading as diffuse inflammatory interstitial
           lung disease
    • Abstract: 2011
      Publication year: 2011
      Source:Respiratory Medicine CME, Volume 4, Issue 2

      Pulmonary adenocarcinoma has long intrigued both internists and pulmonologists because it seems to have unique epidemiologic, pathologic and clinical features. We report a case of multifocal well-differentiated adenocarcinoma, mimicking honeycombing and diffuse inflammatory interstitial lung disease.

      PubDate: 2012-12-17T18:06:18Z
       
  • Two cases of stem cell therapy for pulmonary hypertension: A clinical
           report
    • Abstract: 2011
      Publication year: 2011
      Source:Respiratory Medicine CME, Volume 4, Issue 2

      In this report we discuss two cases of patients with Pulmonary Arterial Hypertension. Both patients were evaluated and were recommended therapy according to current acceptable guidelines. Despite these recommendations, each patient sought on their own accord, additional therapy in the form of stem cell therapy. They subsequently received an infusion of stem cells into their pulmonary circulation. Objective and subjective measures were followed prior to and following infusion. After a review of each case we briefly discuss the decisions a physician must face when a patient seeks therapies not proven safe or effective by a governing authority.

      PubDate: 2012-12-17T18:06:18Z
       
  • Nocardia and Mycobacterium fortuitum infection in a case of lipoid
           pneumonia
    • Abstract: 2011
      Publication year: 2011
      Source:Respiratory Medicine CME, Volume 4, Issue 2

      Exogenous lipoid pneumonia is a potential problem with any form of oil aspiration. The association of Mycobacterium fortuitum with lipoid pneumonia is a rare occurrence and ascribed to as yet-unknown interplay between the oil in the pulmonary parenchyma and the waxy Mycobacterial cell wall. We describe a case of lipoid pneumonia due to “oil aspiration”, complicated by infection with Mycobacterium fortuitum as well as Nocardia, in an individual with no obvious immune deficiencies.

      PubDate: 2012-12-17T18:06:18Z
       
  • Pneumomediastinum in interstitial lung disease-A case report
    • Abstract: 2011
      Publication year: 2011
      Source:Respiratory Medicine CME, Volume 4, Issue 2

      Pneumomediastinum (PM) is a relatively rare disease and is defined as changes in pressure gradients within the thoracic cavity secondary to increases in intrathoracic pressure which ultimately leads to rupture of alveoli and dissection of air along the fascial planes of the tracheobronchial tree. PM differs from secondary pneumomediastinum in that the latter, by definition, requires a pathologic etiology. Although the presence of secondary pneumomediastinum on radiographic imaging may be the result of significantly serious events such as chest trauma, esophageal rupture, or infection with gas producing organisms, the natural history of PM tends to be benign and self-limiting, resolving over approximately one week. In this report we describe a case of a patient with underlying pulmonary fibrosis presenting with persistent dyspnea found to have pneumomediastinum on computed tomography (CT) that resolved completely over a 3 day period with the use of high concentration oxygen therapy.

      PubDate: 2012-12-17T18:06:18Z
       
  • Pulmonary Erdheim-Chester disease: A response to predonisolone
    • Abstract: 2011
      Publication year: 2011
      Source:Respiratory Medicine CME, Volume 4, Issue 2

      Erdheim-Chester disease (ECD) is a rare non-Langerhan’s cell histiocytosis of unknown origin, involving multiple organs. The patient with ECD described here is a 38-year-old man who was admitted to the hospital with dyspnea on exertion. His chest radiograph revealed a diffuse reticulonodular shadow. After the video-assisted thoracoscopic surgery was performed, he was diagnosed as having ECD. A brown eruption on his left temple, when tested by skin biopsy, proved to be ECD. No lesions other than these on the lung and skin were identified, and oral administration of predonisolone successfully treated both of them. Although recovery has followed the administration of predonisolone and chemotherapy for several patients with pulmonary ECD, this is the first report that predonisolone alone provided clinical and objective recovery from pulmonary ECD. This outcome indicates that, of all the many treatments tried for ECD, steroids may become the first-line therapy for pulmonary involvement.

      PubDate: 2012-12-17T18:06:18Z
       
  • Primary pulmonary follicular lymphoma
    • Abstract: 2011
      Publication year: 2011
      Source:Respiratory Medicine CME, Volume 4, Issue 2

      Primary malignant lymphomas of the lung are very rare. Most of them are extranodal marginal zone B-cell lymphoma of MALT type. Primary follicular lymphoma of the lung is extremely rare. A 50-year-old woman presented with cough and sputum, and consulted to a private hospital, where she was pointed out to have abnormal lung shadow by chest X–P. She was admitted to our hospital for scrutiny. Imaging modalities including CT, MRI, and PET revealed a small (15 mm in diameter) nodule in the right middle lobe beneath the pleura. No other tumors were found by these techniques. A biopsy revealed a lymphoid proliferation. Clinical cytology was negative. A wedge resection with wide margins was performed. Grossly, the resected lung specimen contained a white solid mass measuring 12 × 13 × 13 mm. Microscopically, the mass was composed of follicular proliferation of atypical lymphocytes. There were no tingible body macrophages, and normal follicular polarity was absent. Mild infiltrative growth from the surrounding lung was present. Lymphoepithelial lesions were not recognized. The atypical lymphocytes consisted of centrocytes, centroblasts, and small lymphoid cuffs. The centroblasts are seen in 3–5 per a high power field. The immunophenotypes were CD45 +, CD5 +, CD10 +, CD23 +, cyclin D1 −, CD20 +, CD21 +, CD79α +, bcl-2 +, bcl-6 −, CD3 −, CD45RO −, CD30 −, CD15 −, κ-chain +, and λ-chain −. The Ki-67 labeling was 36%. The overall appearances suggested that the lesion was primary pulmonary follicular lymphoma, grade I. Discussion of differential diagnosis from nodular lymphoid hyperplasia, extranodal marginal zone lymphoma of MALT type, and mantle cell lymphoma was made.

      PubDate: 2012-12-17T18:06:18Z
       
  • Wheezing and exertional dyspnea in a 74-year old woman
    • Abstract: 2011
      Publication year: 2011
      Source:Respiratory Medicine CME, Volume 4, Issue 2

      A 74-year old woman suffering from increasing dyspnea was admitted to the university clinic hospital. She had been diagnosed with asthma for a period of ten years prior to admission. Fiberoptic bronchoscopy revealed a circumscript tumour occluding the left main bronchus immediately above the left upper lobe. The diagnosis of endobronchial hamartoma was established by forceps biopsies during fiberoptic bronchoscopy.

      PubDate: 2012-12-17T18:06:18Z
       
  • Elevated D-dimer is not always pulmonary embolism
    • Abstract: 2011
      Publication year: 2011
      Source:Respiratory Medicine CME, Volume 4, Issue 2

      Serum D-dimer is elevated in several chest emergencies, including Acute Coronary Syndrome (ACS), Venous Thromboembolism (VTE) and Acute Aortic Dissection (AAD). Because of its simplicity and easy availability its use beyond the exclusion of VTE has grown in recent years. There is an increasing trend towards using the test to exclude AAD, where there are no other sensitive screening tests. We present a patient suspected to have pulmonary embolism (PE) based on chest pain and elevated D-dimer, gets a computed tomography with angiogram (CTA) and turns out to have an AAD.

      PubDate: 2012-12-17T18:06:18Z
       
  • Very long standing fever in an immunocompetent host
    • Abstract: 2011
      Publication year: 2011
      Source:Respiratory Medicine CME, Volume 4, Issue 2

      We present a case of 7 years history of recurrent febrile syndrome associated with constitutional symptoms. Extensive investigations failed to identify an etiological agent. Actually, the patient presents herself with a chest wall tumor and supraclavicular adenopathy. Computerized tomography (CT) disclosed chest wall abscess, adjacent costal lytic lesions, pulmonary fibrosis in the left centrohilar area, mediastinal lymphadenopathy, pericardial effusion, partial portal vein thrombosis, multiple hepatic and splenic hypodense lesions and abdominal lymphadenopathy. The anatomo-pathological examination of chest wall abscess and supraclavicular adenopathy revealed epithelioid cell granuloma with caseous necrosis. The evaluation for immunocompromised status has found no significant anomaly. Antituberculosis chemotherapy resulted in resolution of fever and clinical improvement. Final diagnosis: disseminated tuberculosis (lymph node, chest wall abscess, pericardial, hepatic, splenic and pulmonary') complicated with partial portal vein thrombosis in an immunocompetent host.

      PubDate: 2012-12-17T18:06:18Z
       
  • Acute eosinophilic pneumonia associated with the inhalation of phosgene
           gas under the presence of cigarette smoking
    • Abstract: 2011
      Publication year: 2011
      Source:Respiratory Medicine CME, Volume 4, Issue 2

      Cigarette smoking has been thought to be a cause of some cases of acute eosinophilic pneumonia (AEP). However, it is not understood why such patients do not show any apparent symptoms for several weeks from the beginning of smoking to the onset of the illness. Here, we describe a case of AEP that may suggest that an irritant like toxic gas may be necessary for the development of AEP under the presence of smoking habit. The diagnosis of AEP was made by close examinations including chest computed tomography, bronchoalveolar lavage fluid (BALF) and transbronchial lung biopsy. Even after the patient’s symptoms completely improved, both the total count of eosinophils and the concentration of eosinophilic cationic protein (ECP) in BALF were still elevated. A smoking provocation test revealed a tiny recurrence of ground-glass opacity in both lung fields, but he did not show any symptoms of AEP again. Concerning this case, it is suggested that cigarette smoking initiated the continuous eosinophil accumulation to the lungs and the inhalation of phosgene gas promoted the development of AEP. We suggest that not only cigarette smoking but also an additional irritant such as toxic gas might be necessary for the development of cigarette smoking-related AEP.

      PubDate: 2012-12-17T18:06:18Z
       
  • Alpha-1 antitrypsin deficiency
    • Abstract: 2011
      Publication year: 2011
      Source:Respiratory Medicine CME, Volume 4, Issue 1

      Objective To review the topic of alpha-1 antitrypsin (AAT) deficiency. Method Narrative literature review. Results Much work has been carried out on this condition with many questions being answered but still further questions remain. Discussion and conclusions AAT deficiency is an autosomal co-dominantly inherited disease which affects the lungs and liver predominantly. The clinical manifestations, prevalence, genetics, molecular pathophysiology, screening and treatment recommendations are summarised in this review.

      PubDate: 2012-12-17T18:06:18Z
       
 
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