Bilateral Lung Lesions Research Articles

Beyond the Usual Suspects: Unmasking a Rare Pulmonary Co-Infection

This case report presents a 33-year-old male farmer with community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) pneumonia complicated by Leptospirosis. The patient presented with a 2.5-month history of high-grade fever, chest pain, and weight loss. Investigations revealed multiple cavitary lesions in bilateral lungs. Blood cultures were positive for MRSA, and ELISA for leptospira was positive. The patient was successfully treated with vancomycin and anticoagulation therapy and discharged.

Clinical Features and Risk Factors for Outcome in Hemodialysis Patients with COVID-19 after Complete Liberalization of Epidemic Control in China

Introduction: Patients undergoing hemodialysis (HD) are highly vulnerable during the COVID-19 pandemic. We aimed to investigate the risk factors associated with the severity of COVID-19 and death after the complete liberalization of epidemic control in China. Methods: We followed the outcomes of the HD patients of Central Hospital of Dalian University of Technology, from December 6, 2022, to January 8, 2023. The non-contrast-enhanced chest computed tomography (CT) was performed on all COVID-19-infected hospitalized patients. We recorded the patient’s clinical characteristics, demographic features, vaccination history, treatments, and lung lesions. Odds ratios and 95% confidence intervals were calculated using logistic regression models to identify independent risk factors for COVID-19-related severity and mortality. Results: This study included a total of 858 HD patients, of which 660 were infected with COVID-19. The mean age was (55.61 ± 14.61) years, with a median (interquartile range) dialysis duration of 44.5 (69.5) months. Over half (60%) of the study participants were male, and the majority had hypertension as a comorbidity. Multivariable analysis revealed that age, pre-dialysis diastolic pressure, fever, white blood cell (WBC) count, potassium, β2-microglobulin level, and calcium were independent risk factors for disease severity, while platelets, urea nitrogen, serum chlorine and creatinine were identified as independent protective factors. Furthermore, total iron-binding capacity and vaccination were found to be independent protective factors against mortality, and WBC count was an independent risk factor for in-hospital mortality (p < 0.05). The most frequent CT finding among hospitalized patients with chest symptoms was patchy shadow or pleural effusion, observed in 64.8% of cases. More than half of the patients exhibited bilateral lung lesions, and over 60% involved two or more lobes. Conclusion: The majority of HD patients are susceptible to COVID-19. Demographic, clinical features, and laboratory indicators can be used to predict the severity and mortality associated with COVID-19. Our findings will assist clinicians in identifying markers for the early detection of high mortality risk in HD patients with COVID-19.

Comparison of clinical, laboratory and radiological characteristics between COVID-19 and Chlamydia psittaci pneumonia: a multicenter retrospective study

Chlamydia psittaci pneumonia (CPP) exhibits similar characteristics as of COVID-19 with respect to clustering outbreaks and onset symptoms. This study is aimed at exploring the different clinical manifestations of both pneumonias to establish a simple nomogram to distinguish them. This multicenter, retrospective, case–control study compared two independent cohorts of patients with CPP or COVID-19. The risk factors of CPP were analyzed using multivariate logistic regression, which was used to establish the nomogram. Both patients with CPP and COVID-19 exhibited similar clinical symptoms. As compared to patients with COVID-19, a higher proportion of patients with CPP had nervous system symptoms. Patients with CPP had higher inflammatory indicators, creatine kinase, and lower lymphocyte and albumin. They also had lower proportions of ground-glass opacity and bilateral lung involvement than COVID-19 patients. Furthermore, patients with CPP had higher 30 day mortality as well as higher rates of severe pneumonia, septic shock, and ICU admission. Multivariate logistic regression showed that nervous system symptoms, lymphocytes, creatine kinase, bilateral lung lesions, and ground-glass opacity were risk factors for CPP. Incorporating these five factors, the nomogram achieved good concordance index of 0.989 in differentiating CPP from COVID-19, and had well-fitted calibration curves. Despite similar clinical characteristics, nervous system symptoms, lymphocyte, creatine kinase, lesions in bilateral lungs, and ground-glass opacity may help in differentiating the pneumonias. These were combined into a clinically useful nomogram for rapid and early identification of CPP to avoid misdiagnosis and help in the decision-making process.

Simultaneous unilateral thoracoscopic resection of bilateral pulmonary sequestration

BackgroundIntra-lobar (ILS) and extra-lobar lung (ELS) sequestrations represent rare congenital lung malformations. Despite their benign nature, the lesions pose risks such as recurrent pulmonary infections, hemoptysis, congestive heart failure, and tumor development. Pulmonary sequestration (PS) typically manifests in two forms, ILS and ELS, with bilateral occurrence being exceptionally rare and mostly requiring bilateral thoracic surgery.Case presentationA 9-year-old child, who initially presented with bilateral lung lesions without respiratory symptoms, was diagnosed with PS following a chest computed tomography scan. The surgical approach was determined based on the absence of inflammation and the clear demarcation of the lesions from normal lung tissue, highlighted by a unique tissue connection between the ILS and ELS across the chest cavities. We used a novel method wherein the left ELS was successfully pulled into the right chest cavity and both sequestrations were concurrently resected. Postoperative recovery was smooth, with no complications or residual lesions.ConclusionsOur findings highlight the importance of thorough preoperative planning with enhanced computed tomography. Simultaneous unilateral thoracoscopic surgery can be a viable, less invasive option for treating bilateral PS, offering benefits such as reduced recovery time and better cosmetic outcomes.

Nd-YAG laser-assisted pulmonary metastasectomy: initial experience from a tertiary care cancer center in India.

Pulmonary metastasectomy is recommended for metastatic lung lesions when R0 resection is possible, the primary site is in controlled status, surgery is of low risk, and extrathoracic metastases are absent. We present the initial experiences of laser-assisted surgery (LAS) for pulmonary metastatic lesions from a tertiary care cancer center in India. All patients undergoing non-anatomical pulmonary metastasectomy between September 2022 and January 2023 for synchronous and metachronous lesions, operated on by a single consultant thoracic oncosurgeon in a tertiary care center of India, were identified from a prospective database. Ten patients with 124 metastatic lesions were included in the study. A hybrid approach (video-assisted thoracoscopic surgery (VATS) with mini-thoracotomy) was performed. Measurements of total lesion volume and lung parenchyma resected were taken from the final histopathological analysis of the intraoperative sample. LAS was performed for 102 lesions and stapled wedge resection for 22 lesions. Evidence of malignancy was noted in 88/102 (86.3%) of the lesions excised. Patients with LAS had advantages of parenchyma preservation, less postoperative morbidities, and shorter hospital stays. LAS of pulmonary metastatic lesions addresses more lesions in a single sitting; the bilateral lung lesions can be operated and has parenchyma preserving and good sealant properties. The online version contains supplementary material available at 10.1007/s12055-024-01723-8.

Establishment of a Predictive Model for Acute Respiratory Distress Syndrome in Patients with Bacterial Pneumonia.

Community-acquired pneumonia (CAP) is a global health concern due to its high rates of morbidity and mortality. Bacterial pathogens are common causes of CAP. It is one of the most common causes of acute respiratory distress syndrome (ARDS), a common severe respiratory system manifestation threatening human health. This study aimed to establish a predictive model for ARDS in patients with bacterial pneumonia, which was conducive to early identification of the occurrence and effective prevention of ARDS. We collected the clinical data of hospitalized patients with bacterial pneumonia in Affiliated Huzhou Hospital of Zhejiang University School of Medicine from January 2022 to November 2022. The independent risk factors for ARDS in patients with bacterial pneumonia were determined by univariate and multivariate binary logistic regression analyses. The nomogram was constructed to display the predictive model, and the receiver-operating characteristic curve was plotted to evaluate the predictive value of ARDS. This study included 254 patients with bacterial pneumonia, of which 114 developed ARDS. The multivariate logistic regression analysis revealed age [odds ratio (OR) = 1.041, P = 0.003], heart rate (OR = 1.020, P = 0.028), lymphocyte count (OR = 0.555, P = 0.033), white blood cell count (OR = 1.062, P = 0.033), bilateral lung lesions (OR = 7.352, P = 0.011) and pleural effusion (OR = 2.512, P = 0.002) as the independent risk factors for ARDS. The predictive model was constructed based on the six independent factors, which was valuable in predicting ARDS with area under the curve of 0.794. The predictive model was beneficial to evaluate the disease progression in patients with bacterial pneumonia and identify ARDS. Further, our nomogram might help doctors predict the incidence of ARDS and conduct treatment as early as possible.

Pancreatic cancer - the insidious disease

Pancreatic cancer is one of the most aggressive forms of malignant disease, often with a long asymptomatic course, early metastases to distant organs and with an extremely poor prognosis. Here we present the case of a 70-year-old female patient, who was hospitalized in a pulmonology institution with a severe general condition. Due to bilateral lung changes seen on the chest radiograph, she was under suspicion for pneumonia, respiratory insufficiency and had elevated markers of inflammation. On physical examination, paraumbilically on the right, a subcutaneous swelling had been palpated with a harder consistency measuring 7 cm in diameter. She presented an ulcerated umbilicus with a purulent discharge. Nineteen hours after admission, a fatal outcome occurred and the autopsy proved an extended malignant disease (pancreatic ductal adenocarcinoma (aT3N2M1, Stage IV)) with multiple metastases. It is necessary to adhere to the differential diagnostic algorithm of bilateral lung lesions. Each umbilical nodule should arouse suspicion of the existence of malignant diseases in the abdominal-pelvic region. Therefore, it is of great importance to raise people?s awareness about taking control of their health.

Adoption value of support vector machine algorithm-based computed tomography imaging in the diagnosis of secondary pulmonary fungal infections in patients with malignant hematological disorders.

This study aimed to assess the feasibility of diagnosing secondary pulmonary fungal infections (PFIs) in patients with hematological malignancies (HM) using computerized tomography (CT) imaging and a support vector machine (SVM) algorithm. A total of 100 patients with HM complicated by secondary PFI underwent CT scans, and they were included in the training group. Concurrently, 80 patients with the same underlying disease who were treated at our institution were included in the test group. The types of pathogens among different PFI patients and the CT imaging features were compared. Radiomic features were extracted from the CT imaging data of patients, and a diagnostic SVM model was constructed by integrating these features with clinical characteristics. Aspergillus was the most common pathogen responsible for PFIs, followed by Candida, Pneumocystis jirovecii, Mucor, and Cryptococcus, in descending order of occurrence. Patients typically exhibited bilateral diffuse lung lesions. Within the SVM algorithm model, six radiomic features, namely the square root of the inverse covariance of the gray-level co-occurrence matrix (square root IV), the square root of the inverse covariance of the gray-level co-occurrence matrix, and small dependency low gray-level emphasis, significantly influenced the diagnosis of secondary PFIs in patients with HM. The area under the curve values for the training and test sets were 0.902 and 0.891, respectively. Therefore, CT images based on the SVM algorithm demonstrated robust predictive capability in diagnosing secondary PFIs in conjunction with HM.

Prognostic Factors and Outcomes in Advanced Stage Lung Cancer Patients with COVID-19 Omicron Variant Infection.

We study the characteristics and outcomes in lung cancer patients with COVID-19 Omicron variant infection. Hospitalized lung cancer patients with advanced-stage disease and laboratory-confirmed COVID-19 Omicron infection were included. Pneumonitis involving at least 25% of lung parenchyma on CT scans, accompanied by symptoms and oxygen saturation below 93%, were criteria for enrollment. Pneumonitis severity was graded using CTCAE v5.0. Treatment included Paxlovid, prednisolone, anticoagulation, and ventilation. Initial data, radiographic findings, and outcomes were compared. Logistic regression was employed to determine risk factors for in-hospital mortality. Fifteen patients (median age: 65 years; 80.0% males) were included. 73.3% improved and were discharged, 20.0% died, and 6.7% remained intubated. Initial symptoms included cough (100.0%), fever (73.3%), and shortness of breath (53.3%). Symptoms resolved in discharged patients. Median fever duration was 3.5 days, and respiratory symptom recovery took 26 days. Three patients died due to respiratory failure from Omicron pneumonia. Lower oxygen saturation, reduced lymphocyte/neutrophil ratio on day 7, and diffuse bilateral lung lesions were poor prognostic factors. This study underscores the importance of prompt intervention and early diagnosis for lung cancer patients infected with the COVID-19 Omicron variant. Lower oxygen saturation, decreased lymphocyte/neutrophil ratio on day 7, and diffuse lung lesions on CT scans were associated with worse outcomes. Clinicians should prioritize timely and comprehensive management to improve survival rates in this population.

Ketamine for Super-Refractory Status Epilepticus in Palliative Care. A Case Report and Review of the Literature.

We report a case of super refractory status epilepticus uncontrolled by multiple anti-seizure medications in an individual with acute liver failure due to hepatic cirrhosis and an obstructive ileocecal mass plus multiple bilateral lung lesions presumed to be metastatic. A ketamine infusion was initiated late in his hospitalization which eliminated the convulsive seizures in less than an hour. The abatement of convulsive seizures allowed his grieving wife to return to her husband's bedside to witness the withdrawal of life sustaining treatment and be present during the final 24 hours of his life. We review the medical literature on the role of Intravenous (IV) Ketamine in the treatment of super refractory status epilepticus.

Viral-bacterial pneumonia in COVID-19: clinical and laboratory characteristics of patients and a spectrum of bacterial pathogens

Objective. To study the clinical and laboratory data of patients with viral-bacterial pneumonia caused by SARS-CoV-2, to evaluate the spectrum of bacterial causative agents and their sensitivity to antibacterial drugs.Materials and methods. 50 cases of viral-bacterial pneumonia associated with the COVID-19 infection were analyzed. The gender-age structure of patients, clinical and laboratory data, degree of disease severity and concomitant diseases were studied. Microbiological examination of sputum and bronchoalveolar lavage (BAL) was performed by bacteriological method using an automatic microbiological analyzer. Identification of the selected cultures and the determination of their sensitivity to antibacterial drugs were provided.Results. The average age of the patients in the studied group was 71,1 ± 14,8 years. 90% of patients had concomitant diseases, mainly of cardiovascular system. The secondary bacterial infection was diagnosed on 13,0 ± 5,0 day from the disease onset and was characterized by bilateral lung lesions. The most common etiological factors of bacterial pneumonia were the microorganisms of the Enterobacteriaceae family — 37%, Staphylococcus aureus — 23% and Acinetobacter baumannii — 13%. The isolated strains were characterized by drug resistance to aminopenicillins, cephalosporins, fluoroquinolones, aminoglycosides and carbapenems.Conclusion. The high level of resistance of bacterial pneumonia causative agents isolated from patients with SARS-CoV-2 infection to antimicrobial drugs requires wider use of reserve drugs and implementation of other treatment strategies.

ОТДАЛЕННЫЕ РЕЗУЛЬТАТЫ ЛЕЧЕНИЯ COVID-19-АССОЦИИРОВАННЫХ ПНЕВМОНИЙ У ПАЦИЕНТОВ ГРОДНЕНСКОЙ ОБЛАСТИ

COVID-19 causes an acute and often severe form of viral pneumonia. Aim of the study: To evaluate the long-term results of treatment of COVID-19-associated pneumonia according to control computed tomography findings in patients of Grodno region. Material and methods. A retrospective analysis of medical records of 170 patients of Grodno University Clinic was carried out. The long-term results of treatment of COVID-19-associated pneumonia in 20 patients were evaluated. Results. The average age of the patients was 59 years. The patients with a moderate form of the disease accounted for 77.6%. Respiratory failure was noted in 75.3% of cases. According to computed tomography of the chest, all patients had bilateral interstitial lung lesions of varying degree: CT1 – 28.8%, CT2 – 51.2%, CT3 – 17.6%, CT4 – 2.4%. Conclusions. Analysis of the long-term results of treatment according to CT data after 3-5 months showed that complete recovery was achieved in 35.0% of patients, and interstitial changes in the lungs persisted in 65.0% of cases. After 6-12 months, 3 patients achieved complete recovery, and 2 patients had minimal interstitial changes.

One-stage VATS surgery for synchronous bilateral lung lesion: a safe and feasible procedure

BackgroundSynchronous bilateral lung lesions are emerging as a common but tricky disease for surgical management. Whether one or two-stage surgery should be taken remains in debate. We retrospectively analysed 151 patients who underwent one and two-stage Video Assisted Thoracic Surgery (VATS) to investigate the safety and feasibility of the two surgical approaches.MethodsA total of 151 patients were included in the study. Propensity score matching was performed to minimize the baseline characteristics difference between one and two-stage groups. Clinical factors including in-hospital days after surgery, chest tube drainage days, types and severity of post-operative complications were compared between the two groups. Logistic univariate and multivariate analyses were used to find the risk factors for post-operative complications. Nomogram was built to select the low risk candidates for the one-stage VATS.ResultsAfter propensity score matching, 36 one-stage and 23 two-stage patients were enrolled. The age (p = 0.669), gender (p = 0.3655), smoking status (p = 0.5555), pre-operative comorbidity (p = 0.8162), surgical resection (p = 0.798) and lymph node dissection (p = 9036) were balanced between the two groups. There was no difference in post-surgery hospital days (8.67 ± 2.68 versus 8.46 ± 2.92, p = 0.7711) and chest tube retaining days (5.47 ± 2.20 versus 5.46 ± 1.95, p = 0.9772). Moreover, post-operative complications also showed no difference between one-stage and two-stage groups (p = 0.3627). Univariate and multivariate analysis revealed that advanced age (p = 0.0495), pre-surgical low haemoglobin (p = 0.045) and blood loss (p = 0.002) were risk factors for post-operative complications. Nomogram built with the three risk factors showed reasonable predictive value.ConclusionsOne-stage VATS for synchronous bilateral lung lesion patients was proved to be a safety procedure. Advanced age, pre-surgical low haemoglobin and blood loss may predict complications after surgery.

Prediction factors in surgical treatment of intragrawn kidney cancer metastasis

Background . The incidence of distant metastases of intrathoracic localization in kidney cancer, including intrathoracic lymph nodes, makes the problem of identifying and introducing knowledge about prognostic factors into clinical practice when using the surgical treatment of this disease urgent. Aim . To identify prognostic factors in the surgical treatment of intrathoracic metastases of renal cancer. Materials and methods . In this work, a retrospective analysis was carried out of a group of 100 patients with intrathoracic cancer metastases, almost who underwent surgical treatment in the form of removal of distant metastases. We analyzed the clinically significant factors associated with the prevalence of the tumor process in the lungs, which could affect the long-term results of treatment, as well as the influence of various instrumental research methods on the frequency of detection of intrathoracic lesions. In addition, the influence of the choice of surgical approach and the volume of surgery on the long-term survival of this group of patients was analyzed. Results . 40 (40 %) patients had synchronous and 60 (60 %) had metachronous lung metastases. 63 (63 %) had open and 36 (36 %) – thoracoscopic surgery, 1 (1 %) patient underwent a transdiaphragmatic resection. 70 (70 %) patients had atypical lung resections. 5-year overall survival was 53.4 %, 5-year progression-free survival – 43.1 %. There was no postoperative mortality and no grade 3–4 morbidity. Following factors were associated with an overall survival during a single-factor analysis: bilateral lung lesions (р &lt;0.0001), R0 resection (р = 0.002), Munich scale (р = 0.007). Only bilateral lung lesion were associated with an overall survival during a multifactor analysis (р = 0.001). Conclusions . Removal of intrathoracic metastases of kidney cancer in the lung can lead to long-term survival in a significant number of patients. Achieving R0 resection is the main goal of surgical treatment.

CORRELATION OF BLOOD SUGAR WHEN ENTER THE HOSPITAL WITH INCIDENCE OF PNEUMONIA ON INPATIENTS COVID-19 AT THE JAKARTA HOSPITAL IN THE PERIOD MARCH – DECEMBER 2020 AND THE REVIEW ACCORDING TO THE ISLAMIC POINT OF VIEW

The lungs are the ones that have large amounts of angiotensin converting enzyme 2 (ACE2) receptors, so there are symptoms in the lungs due to infection with the SARS-CoV-2 virus. Radiological results from COVID-19 generally show a picture of pneumonia. Chronic disease diabetes mellitus is one of the diseases that is a major risk factor for COVID-19. This is because diabetics experience hyperglycemia, impaired immune function, vascular complications and comorbidities. In addition, diabetes mellitus can also guarantee the condition of COVID-19 due to a dysfunctional response of pro-inflammatory cytokines in patients with diabetes mellitus. Thus, COVID-19 patients with diabetes had a wider distribution of bilateral lung lesions compared to other groups. The data used in this study used secondary data with quantitative data types. The source of the research data was taken from the data of patients diagnosed with COVID-19 at the Jakarta Hospital for the March - December 2020 period who met the research inclusion criteria. It was found that in COVID-19 patients with diabetes, the majority had pneumonia as many as 25 patients (69.64%) and in COVID-19 patients without diabetes, the majority had pneumonia as many as 79 patients (51.3%). By referring to the results of statistical analysis, the resulting p-value is 0.075 which proves that there is no significant relationship between blood sugar and the incidence of pneumonia in COVID-19 patients at the Jakarta Hospital for the period March - December 2020.

Comparison of clinical, laboratory and radiological characteristics between Chlamydia psittaci and adenovirus pneumonias: a multicenter retrospective study

ObjectivesPneumonia caused by Chlamydia psittaci is a significant global public health issue. Symptom onset and laboratory characteristics may be confused with those of other respiratory viral infections, including adenovirus pneumonia. We aimed to determine differences in clinical presentations and establish a simple nomogram to differentiate C. psittaci and adenovirus pneumonias. MethodsWe conducted a multicenter retrospective study in 10 tertiary general hospitals to compare patients with either C. psittaci (n = 78) or adenovirus (n = 102) pneumonia. A multivariable logistic regression model was used to identify risk factors of C. psittaci pneumonia that were used to establish a nomogram. ResultsC. psittaci and adenovirus pneumonia showed certain similar clinical symptoms, including fever, dyspnea, and fatigue, but differed in other characteristics. The multivariate logistic regression showed that age, sex, nervous system symptoms, lymphocyte count, C-reactive protein level, and bilateral lung lesions were risk factors for C. psittaci pneumonia. After incorporating these six factors, the established nomogram achieved a good concordance value (0.949 [95% CI 0.917-0.982]) in differentiating the types of pneumonia, with well-fitting calibration curves. ConclusionDespite having similar clinical features, the variables of age, sex, nervous system symptoms, lymphocytes, C-reactive protein levels, and bilateral lung lesions were combined into a clinically useful nomogram for the rapid and early differentiation of C. psittaci pneumonia from adenovirus pneumonia. This nomogram may help improve treatments and clinical outcomes.

PSUN377 Use of Novel Therapy in Management of Metastatic Parathyroid Cancer

Abstract Introduction Parathyroid cancer (PC) is a rare malignant tumor which represents &amp;lt;1% of patients with primary hyperparathyroidism (PHPT). With less than 1000 reported cases, PC is the rarest endocrine cancer. Complicating its rarity, is the known resistance to radiation and chemotherapy, and complete surgical resection is the only curative treatment available. Genomic sequencing targeted therapy has shown encouraging results. We hereby present a case where Pembrolizumab was used in treatment of metastatic PC. Case A 50 year old lady with a history of nephrolithiasis, hypercalcemia(HC) presented for evaluation of neck mass. She had a recent admission to outside hospital for HC, dehydration, bone pain, polyuria, constipation and workup was suggestive of PHPT with Calcium(Ca) 13.2mg/dL and PTH 1,500pg/ml. Neck ultrasound demonstrated a 3 cm nodule in the left thyroid and fine needle aspiration was suspicious for malignancy. She underwent left hemithyroidectomy, and left parathyroidectomy. PTH levels pre-, intra- and postoperatively were 680, 220, 20 pg/ml respectively with normalization of Serum Ca. Histopathology revealed high grade PC with lymphovascular and perineural invasion. Postoperatively she received adjuvant radiotherapy. Ten months later CT Neck surveillance revealed a 4cm Left prevertebral(PV) mass with recurrence of bone pain, PTH 110pg/ml, and Ca-11.2mg/dL. Parathyroid scan showed Left PV mass and Left level 2 lymph node. PET/CT later revealed fluorodeoxyglucose avidity of the recurrent mass, as well as bilateral lung, right ventricle, and pelvic lesions. Incisional biopsy confirmed carcinoma consistent with PC. Her neck lesions were deemed unresectable. Germline mutation testing confirmed Next Generation Sequencing: PDL1 5% by CPS, TMB 10 mut/Mb, IDH2, JAK1, KMT2C, NF1, PIK3RI. On the basis of TMB &amp;gt;10 mut/Mb Pembrolizumab was then initiated with good response, noting improvement in symptoms, and normalization of Ca 8.7mg/dL and PTH 35pg/ml. Within 4 months of therapy Surveillance CT showed an approximate 40% reduction in tumor burden noting decrease in size of neck mass and lesions in lungs, right ventricle, and pelvis. Discussion Approximately 10%-30% of PCs have metastasis at presentation, most commonly to the lung, bone, or liver. However they can often develop local recurrence and or distant metastases despite early intervention. Surgical resection remains the mainstay of treatment, and is often used to decrease tumor burden which has been shown to improve morbidity. However when surgical resection is not an option, newer approaches using gene sequence targeted therapy may be an attractive option in the future as was demonstrated in this patient. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

A curious case of exploding cannonball

Pulmonary cavitary lesions with pneumothorax are very common in chest imaging and usually pose diagnostic challenge to clinicians Pneumothorax with a cavitary lesion is a rare occurrence in primary and metastatic lung cancer. A 40-year-old male presented with cough with whitish expectoration, right loin pain, loss of weight and appetite for 3 months and difficulty in breathing for 2 days. Chest x-ray was suggestive of right-side pneumothorax with bilateral nodular opacities in all zones. Contrast-enhanced computed tomography (CECT) thorax and abdomen revealed a non-homogenous large mass in the right kidney with hydronephrotic changes with cavitary lesions in bilateral lungs. Urine cytology was suggestive of urothelial carcinoma. Thus, a diagnosis of urothelial cancer with cavitating metastasis leading to secondary spontaneous pneumothorax was made. Herein, we aim to highlight that cavitating metastasis should be considered in a case of pneumothorax with bilateral lung nodules.

A RARE CASE OF TRIPLE PNEUMONIA: TB, COCCIDIOIDOMYCOSIS, AND COVID-19

TYPE: Late Breaking Case Report TOPIC: Chest Infections INTRODUCTION: This is a case of concurrent pulmonary infections with mycobacterial tuberculosis, coccidioidomycosis, and SARS-COV-2 in an otherwise immunocompetent host. CASE PRESENTATION: A 62-year-old male with no known medical history presented with three weeks history of worsening non-productive cough, dyspnea and pleuritic chest pain with associated small volume hemoptysis, twelve-pound weight loss, intermittent fevers and night sweats. The patient’s vital signs were normal except for a temperature of 38.2C. Physical exam showed a well-nourished man with no abnormal findings. Initial labs were significant for pancytopenia, a positive COVID PCR nasopharyngeal swab, and negative HIV. Chest x-ray showed bilateral opacities and a subsequent computed tomography angiogram of chest showed bilateral multiple thick-walled cavitating lung lesions in the upper lobes and bilateral scattered ground glass opacities suggestive of COVID pneumonia. Further work-up resulted in induced sputum showing acid fast bacilli which speciated Mycobacterium tuberculosis 3 weeks later. Serology revealed positive IgM antibodies to Coccidioides by quantitative immunodiffusion and negative IgG by complement fixation. Cocci-Direct PCR was negative twice. Fungal culture from induced sputum grew Paecilomyces formosus. DISCUSSION: The patient likely had both these conditions and more recently acquired SARS-COV-2. There is no literature regarding a triple infection but, an excellent case series was done by Cadena et al that looked at 44 cases of PTB/Coccidioidomycosis co-infection. They found a significantly higher mortality rate compared to monoinfection. Such a coinfection in a patient with severe COVID-19 could become potentially devastating. CONCLUSIONS: Treatment was initiated with rifampin, isoniazid, pyrazinamide, ethambutol, and fluconazole. He was discharged in good health. DISCLOSURE: Nothing to declare. KEYWORD: Coccidioidomycosis

Clinical analysis of subxiphoid single-port thoracoscopic surgery for simultaneous bilateral lung lesion resection

ObjectiveTo investigate the efficacy and safety of simultaneous subxiphoid single-port thoracoscopic resection of bilateral lung lesions.MethodsThis retrospective study analyzed the clinical data of 72 patients who underwent resection of bilateral lung lesions at the Department of Thoracic Surgery in the First Affiliated Hospital of University of Science and Technology of China between August 2020 and January 2022. Surgery-related parameters were compared between patients who underwent subxiphoid single-port thoracoscopy (subxiphoid group, 36 patients) and patients who underwent intercostal single-port thoracoscopy (intercostal group, 36 patients).ResultsCompared to the intercostal group, the subxiphoid group exhibited significantly better postoperative catheterization time (P = 0.013), postoperative thoracic drainage, postoperative visual analog scale pain scores at 24 and 48 h, and incision pain and numbness at 1 and 3 months after surgery (all P < 0.05). There were no significant differences in operation time, intraoperative blood loss, or postoperative complications between the two groups (all P > 0.05). There were no cases of perioperative mortality, conversion to thoracotomy, or serious complications in either group.ConclusionSubxiphoid single-port thoracoscopic surgery for simultaneous resection of bilateral lung lesions is safe and effective, reduces postoperative acute and chronic pain, decreases trauma, allows faster recovery, and is more consistent with the concept of minimally invasive surgery than bilateral intercostal single-port thoracoscopy. Thus, this subxiphoid single-port thoracoscopic surgery approach should be considered for clinical application.