Cavitary Lesions Research Articles

YIELD OF INDUCED SPUTUM IN CLINICALLY DIAGNOSED PULMONARY TUBERCULOSIS

Background:- Direct sputum smear examination is used as a basic diagnostic tool in the diagnosis of pulmonary tuberculosis. But difficulty in obtaining adequate sputum is the main cause of failure of bacteriological diagnosis. Alternative methods of obtaining sputum specimens are frequently needed in those patients with clinicoradiological suspicion of TB who are unable to expectorate or are smear negative. Aim:- To assess the yield of smear positivity of induced sputum (SI) with hypertonic saline nebulisation, broncho-alveolar lavage fluid and Rifampicin resistance in clinically diagnosed pulmonary TB who have no/inadequate sputum. Materials and Methods:- In the present cross-sectional observational study, we analysed the smear positivity of AFB in induced sputum of patients at Veer Surendra Sai Institute of Medical Science & Research, Burla, Odisha, India, from November 2018 to October 2020. A total of 100 patients with clinically diagnosed pulmonary TB who were unable to produce adequate sputum fulfilling inclusion criteria were included in the study. 10 ml of 3% hypertonic saline was injected into the nebulizer reservoir device. The assembly was connected to the jet nebulizer. The patients were instructed to inhale and exhale the mist of the nebulized solution through the mouth piece only. The inhalation of hypertonic saline was interrupted every 5 min, so that the patient could expectorate the sputum into a clean sterile sputum container. The sputum samples were stained with auramin-rhodamin stain and examined for AFB, also same samples were subjected for CBNAAT(cartridge based nucleic acid amplification test). Selected sputum induction(SI) CBNAAT negative patients are also underwent bronchoscopy and BAL fluid was subjected for CBNAAT. Results:- Out of 100 clinically diagnosed tuberculosis patients, 49% of cases had only infiltration, 45% cases had consolidation,17% had infiltration with fibrosis,16% cases with cavitary lesions and 6% had miliary lesions in chest X -ray. 17(17%) cases became induced sputum smear positive, 30(30%) cases became induced sputum CBNAAT positive. All induced sputum CBNAAT positive cases were rifampicin sensitive. No rifampicin resistance was detected. Out of 70 patients with SI CBNAAT negative, 21 patients with highly clinico radiological suspicion underwent bronchoscopy and 4(19%) patients become post bronchoscopy sputum AFB positive. Out 21 patients 8(38%) patients become BAL CBNAAT positive and all are rifampicine sensitive. Conclusion:- Induced sputum and BAL fluid are better alternative methods for diagnosis in patients with clinico-radiological suspicion of TB who are unable to expectorate or are smear negative and no rifampicin resistant cases were detected throughout this study.

Ciliated muconodular papillary tumor of the lung with cavitary change: A case report with 11‐year preoperative follow‐up

Ciliated muconodular papillary tumor (CMPT) is a rare benign lung tumor characterized by ciliated columnar cells, mucous cells, and basal cells. Herein, we report a case of CMPT with 11 years of preoperative follow‐up, depicting the natural course of the tumor and changes in computed tomography (CT) findings. A 39‐year‐old man had a 5‐mm solid pulmonary nodule in the right lower lobe that had slowly grown and transformed into a thin‐walled cavitary lesion. Right lower lobe lobectomy was performed and the tumor was confirmed to be a CMPT. Although it is difficult to diagnose CMPT with CT findings alone, CMPT should be considered as a possible diagnosis when a slowly growing nodule undergoes cavitary changes.

Risk Factors for the Development of Nontuberculous Mycobacteria Pulmonary Disease during Long-Term Follow-Up after Lung Cancer Surgery.

The aim of this study is to determine the cumulative incidence of, and the risk factors for, the development of nontuberculous mycobacteria pulmonary disease (NTM-PD) following lung cancer surgery. We retrospectively analyzed patients with non-small cell lung cancer who underwent surgical resection between 2010 and 2016. Patients who met all the diagnostic criteria in the NTM guidelines were defined as having NTM-PD. Additionally, we classified participants as NTM-positive when NTM were cultured in respiratory specimens, regardless of the diagnostic criteria. We followed 6503 patients for a median of 4.89 years, and NTM-PD and NTM-positive diagnoses occurred in 59 and 156 patients, respectively. The cumulative incidence rates of NTM-PD and NTM-positive were 2.8% and 5.9% at 10 years, respectively. Mycobacterium avium complex was the most commonly identified pathogen, and half of the NTM-PD patients had cavitary lesions. Several host-related factors (age > 65 years, body mass index ≤ 18.5 kg/m2, interstitial lung disease, bronchiectasis, and bronchiolitis) and treatment-related factors (postoperative pulmonary complications and neoadjuvant/adjuvant treatments) were identified as risk factors for developing NTM-PD and/or being NTM-positive after lung cancer surgery. The incidences of NTM-PD and NTM-positive diagnoses after lung cancer surgery were not low, and half of the NTM-PD patients had cavitary lesions, which are known to progress rapidly and often require treatment. Therefore, it is necessary to raise awareness of NTM-PD development after lung cancer surgery.

Impact of chronic co-infection in pulmonary Mycobacterium avium complex disease after treatment initiation

BackgroundThe impact of co-infection with other pathogenic microorganisms after initiation of treatment for Mycobacterium avium complex pulmonary disease (MAC-PD) has not been clearly described. This study sought to clarify the clinical outcomes of co-infection with MAC after antimycobacterial therapy for MAC.MethodsCo-infection status was defined as the detection of pathogenic microorganisms other than MAC in at least two consecutive sputum cultures 6–24 months after initiation of treatment. Chest computed tomography (CT) findings and culture results were compared between co-infection and MAC alone groups.ResultsThe co-infection and MAC alone groups comprised 12 and 36 patients, respectively. The proportion of patients with sputum culture positive for MAC after 24 months of therapy did not differ significantly between the two groups [25% (3/12) vs. 16.7% (6/36); p = 0.671]. The proportion of patients with improved chest CT score after 24 months of starting treatment compared to baseline was significantly lower for the co-infection group than for the MAC alone group [16.7% (2/12) vs. 79.4% (27/34); p < 0.001]. In the co-infection group, median CT score values at 12 and 24 months did not differ from baseline. However, the MAC alone group showed significant improvement at 12 and 24 months compared with baseline.ConclusionsIn the patient group with co-infection of other pathogenic microorganisms after treatment initiation for MAC there was no impact on therapeutic efficacy compared to the MAC alone group. However, therapeutic intervention interfered with improvement in chest CT findings such as nodule formation, bronchiectasis, infiltration, and cavitary lesions.

Cavitary lung disease in hospitalized patients: Differences between melioidosis and tuberculosis.

To differentiate cavitary lung lesions caused by melioidosis and tuberculosis is challenging, especially in endemic countries. A study with a matched-sampling method (16 cavitary pulmonary melioidosis vs. 16 cavitary pulmonary tuberculosis) showed characteristics of bacterial infection more obvious and severe in the melioidosis patients, which were useful to distinguish two conditions.

Bilateral thoracic radiographs increase lesion detection in horses with pneumonia or pulmonary neoplasia but do not bring any additional benefit for inflammatory or diffuse pulmonary disease.

Published studies describing the effects of bilateral radiographic projections on the detection of equine pulmonary lesions are currently lacking. The objectives of this retrospective, single center, observational study were to compare unilateral and bilateral thoracic radiographic projections for the detection of pulmonary lesions in a group of horses. Based on their clinical diagnosis, 167 adults and foals with bilateral thoracic radiographs were classified as having pneumonia (n=88), inflammatory or diffuse pulmonary disease (n=72), and pulmonary masses (n=7). After an initial interrater repeatability test, right-to-left and left-to-right projections were anonymized and independently interpreted by a radiologist blinded to the clinical diagnosis. Scores were attributed for each pattern/lesion (alveolar, interstitial, bronchial, nodules/masses, cavitary lesions) and each quadrant. Agreement between scores from each projection was evaluated with Bland-Altman plots. Lesions identified on one side but not on the contralateral projection were considered discordant. There was no preferential lateralization of pulmonary lesions. The prevalence of discordance was 14.4%, 9.0%, and 4.2% for alveolar pattern, nodules/masses, and cavitary lesions, respectively. Up to nine horses (10.2%) with pneumonia could have been misdiagnosed. A pulmonary mass would have been missed in one case. For inflammatory or diffuse disease, discordance was slight, and the addition of contralateral projections had no impact on radiographic interpretation. In conclusion, in horses with pneumonia or neoplasia, bilateral projections, or adding at least one contralateral caudoventral view, increased the probability of identifying pulmonary lesions. In horses with inflammatory or diffuse disease, bilateral thoracic radiography provided no additional benefit.

Treatment outcomes of the interstitial lung disease subtype of unclassifiable type Mycobacterium avium complex pulmonary disease

BackgroundWe aimed to investigate treatment outcomes according to the presence or absence of cavitary lesions in patients with the interstitial lung disease (ILD) subtype of unclassifiable type Mycobacterium avium complex (MAC) pulmonary disease (PD). MethodsStudy subjects were enrolled at a tertiary referral center in South Korea from 2001 to 2020. Among patients with MAC-PD who had ILD as an underlying disease, 38 patients who were diagnosed with the ILD subtype of unclassifiable MAC-PD and who received treatment for ≥1 year were selected for this study. Treatment outcomes in terms of microbiological cure at 1 year were retrospectively analyzed for these patients. ResultsThe mean age of the patients was 64.4 ± 12.9 years, and 63.2% were male. The presence of cavitary lesions was noted in 68.4% (26/38) patients. A usual interstitial pneumonia pattern was the predominant type of ILD, which was identified in 26 (68.4%) patients. The overall 1-year microbiological cure rate of the 38 patients was 65.8% (25/38). Of the 26 patients with cavitary lesions, microbiological cure at 1 year was achieved in 14 patients (53.8%), which is significantly lower than that in patients without cavitary lesions (91.7%, 11/12, p = 0.030). ConclusionsA clear difference in treatment outcomes was noted in the ILD subtype of MAC-PD according to the presence or absence of cavitary lesions.

Adenocarcinoma in situ detected on a thin-walled lung cavity: a case report

BackgroundCavitary lesions pathologically diagnosed as adenocarcinoma in situ (AIS) have been rarely reported. The examination of these type of lesions is necessary for a better understanding of the mechanisms underlying their formation and development of more efficient diagnostic and treatment strategies. Here, we present the case of a patient with cavitary lung carcinoma, diagnosed as AIS, who underwent partial resection.Case presentationA 72-year-old man presented with an abnormal shadow on chest radiography. Computed tomography findings showed a nodule in the right upper lobe, which was later diagnosed as an adenocarcinoma via transbronchial biopsy. A thin-walled cavity with partial thickening in the right lower lobe was also noted. We suspected that the thin-walled cavitary lesion was malignant, and performed wedge resection during a right upper lobectomy. AIS was diagnosed based on the histopathological findings of the thickened part of the thin-walled cavity.ConclusionsThis study highlights that, although rare, AIS may be observed in cavitary lung carcinoma cases, particularly in thin-walled lesions.

Chronic COVID 19 Related Disease Requiring Lung Transplantation with Calcified Cavitary Lesions in Explanted Lungs

IntroductionBilateral cavitary lung lesions with calcification in a patient with chronic COVID requiring transplantation are described.Case Report46-year-old woman presented for lung transplant with respiratory failure due to COVID-19 pneumonia following remdesivir, decadron, tocilizumab and baricitinib therapy. Cavitary upper lobe lung lesions were noted on imaging with negative cultures. She was started on VV ECMO as a bridge to bilateral lung transplant. Explanted lungs were consolidated and fibrotic with bilateral upper lobe calcification surrounding cavitary lesions. Varied microscopic pathology included NSIP pattern of inflammation, and foci of airway centered inflammation with giant cells suggesting chronic hypersensitivity reaction. The calcification was reminiscent of dendriform/metastatic calcification, and involved areas of necrotic/mummified parenchyma.SummaryCavitation as a late stage complication of COVID19 has been described in rare cases and is considered atypical. The constellation of findings in our case, including cavitary lesions with associated dendriform like calcifications are unique and maybe attributable to COVID19 itself +/- exacerbation of underlying chronic lung disease +/- intercurrent infection, or COVID19 related cavitation with superimposed secondary changes due to ECMO treatment. Bilateral lung transplantation has a reasonable short-term prognosis for patients with end stage respiratory failure secondary to COVID19; examination of these native lungs may expand our concept of COVID19 related chronic lung injury patterns.

Pulmonary Amyloidoma: A Rare Entity Complicating a Post-Heart Transplant Course

<h3>Introduction</h3> Heart transplantation (HT) is a viable, life-prolonging therapy for patients with severe cardiac amyloidosis. Unique amyloid-related pathology may complicate their care. We present a case of a rare manifestation of amyloidosis complicating a post-HT course. <h3>Case Report</h3> A 51-year-old female with cardiac AL amyloidosis (treated with daratumumab, cyclophosphamide, bortezomib, and dexamethasone) and chronic kidney disease was transferred for advanced options evaluation. She presented in cardiogenic shock and PEA arrest requiring escalation to venoarterial-ECMO. Admission sputum culture was positive for <i>Enterobacter cloacae</i>. CT scan revealed right lower lobe consolidation with a 5cm cavitary lesion concerning for aspiration pneumonia. Broad spectrum antibiotics were initiated. Given near-complete resolution of her light chains on chemotherapy, Oncology agreed to proceed with transplantation. She was emergently listed as status 1 and underwent heart-kidney transplantation. One-week post-HT, she developed severe leukocytosis and abdominal discomfort but remained afebrile with only mild dyspnea. Abdominal CT incidentally noted an 11cm right lower lobe cavitary lung lesion. Dedicated CT chest raised concern for aspergilloma or other necrotizing pneumonia (Figure 1). Bronchoalveolar lavage had unremarkable fungal and viral studies but did reveal <i>Acinetobacter</i>. Antibiotics were appropriately adjusted. VATS was attempted but required conversion to thoracotomy with right lower lobectomy. Pathology revealed necroinflammatory findings and Congo-red stain-positive material both inside the cavity and extensively deposited within the cavity walls. These findings were consistent with pulmonary amyloidoma. <h3>Summary</h3> Though rare, pulmonary amyloidomas may be incidentally found as large cavitating lesions amongst patients with systemic amyloidosis. In the post-HT patient, they may serve as a nidus for infections and appear similar to necrotizing pneumonias, resulting in delays in diagnosis.

To evaluate the clinical characteristics and microbiological findings in children with suspected pulmonary tuberculosis

Aim: The aim of the present study to evaluate the clinical Characteristics and Microbiological Findings in Children with Suspected Pulmonary Tuberculosis. Methods: After receiving clearance from the protocol review committee and the institutional ethics committee, the prospective observational study was carried out at the Department of......................... This research covered 100 patients. According to the Revised National Tuberculosis Control Program (RNTCP) guidelines published in the Technical and Operational Guidelines for Tuberculosis Control in India 2016, children aged 6 months to 18 years who present with constitutional symptoms such as persistent fever >2 weeks without a known cause and/or unremitting cough for >2 weeks and/or weight loss of 5% in three months or no weight gain in the previous three months along with any one of the following findings, i.e., his The radiology department performed a chest X-ray and reported findings indicative of tuberculosis, such as hilar and paratracheal lymphadenopathy, parenchymal lesions, and cavitatory lesions. Results: The study covered 100 juvenile patients with an average age of 12.044.96 years. In the research, 58 percent of the individuals were older than 11 years old. The study had a female predominance. Only 44 (44%) male patients participated in the trial, compared to 56 (56%) female patients. The most prevalent complaint was fever (84 percent), followed by cough (76 percent). Other major symptoms at the start of the disease were weight loss (88 percent), lack of appetite (86 percent), and shortness of breath (16 percent). Haemoptysis, chest discomfort, and shortness of breath were less common. Out of 100 participants, 22% tested positive for Mycobacterium tuberculosis, whereas the remaining 78 percent tested negative by both ZN staining and CBNAAT. The proportion of CBNAAT positive patients with cavitation on chest X-ray was 63 percent, which was substantially higher than the national average (p-0.0018). Conclusion: We determined that females were more likely than males to be infected with tuberculosis. The study also discovered that patients with clinical findings indicative of pulmonary Koch's do not necessarily have positive sputum CBNAAT. Sputum positivity was shown to be substantially related to a cavitatory lesion on a chest X-ray.

Role of thoracic ultrasonography in diagnosis of different chest diseases

Background Thoracic ultrasonography (TUS) is a low-cost, noninvasive, practical, and rapid method for visualization of different respiratory disorders. Previous reports showed a high sensitivity, specificity, and diagnostic accuracy (96.8%) of TUS in the diagnosis of different chest diseases. Objective The aims were to assess the diagnostic accuracy of chest ultrasound (US) in the diagnosis of different chest diseases and to compare its accuracy with currently available imaging techniques. Patients and methods A prospective study was conducted on 213 patients. The patients were categorized according to their respiratory disorders into five groups (parenchymal, pleural, vascular, airway disease, and diaphragmatic dysfunctions). Chest radiography, computed tomography, and TUS were done for each group and were compared together. US chest examination was done using gray-scale (B-mode) or time-motion mode (M-mode). Results In patients with pneumonia, the sensitivity of US and radiography was 97.5 and 90.6%, respectively. In interstitial group patients, the sensitivity of US and radiography was 95.7 and 100%, respectively. In patients with lung mass, the sensitivity of US and radiography was 88.2 and 94.1%, respectively. In patients with cavitary lesion, the sensitivity of US and radiography was 100 and 87.5%, respectively. The sensitivity of US in detecting pleural effusion was 100% with accuracy of 100%. However, chest radiography showed 93.1% sensitivity and accuracy in detecting pleural effusion. The sensitivity and accuracy of both US and chest radiography in detecting vascular diseases were the same. Conclusion TUS is a useful tool in the diagnosis of different respiratory disorders especially in the diagnosis of pleural and diaphragmatic disorders. In addition, US offers a number of advantages of being easily performed by clinicians at the point of care, inexpensive, and avoiding exposure to radiation.

Cranial air embolism after transthoracic lung biopsy: A case report of a rare complication

Cerebral air embolism is a rare and fatal complication of computed tomography-guided transthoracic lung biopsy. Lesions with pulmonary vein involvement—especially cavitary lesions—require particular care during procedures performed with a guided needle. Only 2 ml of an air embolism reaching the cerebral arteries is fatal, and a 1-ml cardiac air embolism can be fatal. Hyperbaric oxygen therapy should be started immediately to reduce mortality and ensure recovery among patients who develop unconsciousness and extremity paralysis during or after the procedure including when diagnosed with cranial CT imaging. Hyperbaric oxygen therapy has been reported to reduce mortality by up to 7% and reduces neurological deficits after 48 hours—even in delayed cases. Thus, transthoracic lung biopsy is important for the diagnosis of peripheral lung masses. Here, we present a rare complication after this procedure. Our goal here was to contribute to early diagnosis and treatment by creating awareness.

Concomitant Pulmonary Tuberculosis and Invasive Aspergillosis Infection in an Immunocompetent Host.

Pulmonary tuberculosis (TB) is a common infection in developing countries and is associated with low socioeconomic status. It is considered a serious infection due it its long-term sequelae. Post-TB lung disease decreases life expectancy and increases the risk of recurrent TB infection. It also significantly increases the risk of other bacterial and fungal infections. Aspergillosis develops in the cavitary lesions of TB, worsening them and resulting in a deteriorating clinical situation. Concomitant pulmonary TB (PTB) and invasive aspergillosis is uncommon, particularly in the absence of factors that suppress the immune system. In this report, we describe the case of a healthy young adult without previous structural lung damage who presented with primary PTB and acute invasive aspergillosis infection, discuss the treatment dilemma and provide a literature review.LEARNING POINTSAspergillosis can mimic tuberculosis (TB) infection.Concomitant pulmonary TB and invasive aspergillosis is uncommon.The co-administration of antifungal and anti-TB medications presents significant therapeutic challenges.

Bruns–Garland syndrome precipitated by anti-tuberculous therapy in a patient with type 2 diabetes mellitus

India has a high prevalence of tuberculosis as well as diabetes mellitus, and both contribute to a major disease burden. Diabetes mellitus increases the risk of tuberculosis. Patients with diabetes are more prone to develop cavitary lesions than non-diabetics. Tuberculosis can worsen the glycemic status of an individual and anti-tuberculous drugs like Rifampicin can interact with oral anti-diabetic drugs, further worsening the glycemic control. This can result in complications related to diabetes, like diabetic amyotrophy. We hereby report the case of a 69-year-old gentleman with diabetes mellitus, who developed uncontrolled blood sugars, leading to Bruns Garland syndrome or diabetic amyotrophy on starting anti-tuberculous therapy for sputum positive pulmonary tuberculosis.

Neutrophils and lymphocytes in relation to MMP-8 and MMP-9 levels in pulmonary tuberculosis and HIV co-infection

BackgroundMatrix metalloproteinase (MMP) activity has an important role in lung cavitary formation occurred in pulmonary tuberculosis (TB). Low number and viability of CD4 + T-lymphocytes in patients with TB/HIV co-infection leads to impaired neutrophils production, causing further impaired MMPs production. ObjectiveTo explore association of neutrophils and lymphocytes count to MMP-8 and MMP-9 among pulmonary TB patients with cavitary lesion and HIV co-infection. MethodsWe conducted a cross-sectional study using a purposive sampling technique among patients with non-cavitary TB (n = 50), cavitary TB (n = 50) and TB/HIV (n = 27). Complete blood count was examined, including neutrophils and lymphocytes count. MMP-8 and MMP-9 were measured from plasma samples using ELISA method. Statistical analysis was conducted to determine the relation between neutrophils, lymphocytes and MMPs. ResultMMP-8 and MMP-9 were positively correlated with neutrophils, but not to lymphocytes in all groups. Neutrophils, lymphocytes, and MMP-9 were significantly lower in TB/HIV co-infection, whereas MMP-8 was higher compared to new pulmonary TB. Interestingly, in cavitary TB, low lymphocytes were significantly correlated with higher level of MMP-8 and larger extent of lung affected. ConclusionMMP-8 and MMP-9 are associated with neutrophil count, suggesting that neutrophils contribute significantly to their secretion. MMP-8 is significantly higher in TB/HIV co-infection and extent of lung damage in cavitary TB with lower lymphocyte count. This study suggests that lower lymphocyte level is related to higher neutrophil orchestrated inflammation, leading to tissue destruction.

Surprise evidence of a bronchial rent in a case of pulmonary Koch’s posted for lung decortication using the one-lung ventilation protocol

Tracheobronchial injury is a potentially life-threatening clinical scenario. In the case of surprise evidence of bronchial wall tear while doing lung surgery, tracheal tube extubation and post-operative management pose a challenge to the anaesthesiologist. We present a case of a 16-year-old girl, a known case of pulmonary Koch’s taking anti-Koch’s treatment, admitted with hydropneumothorax, who was posted for left lung decortication. She presented with complaints of left-sided chest pain and cough since 3 months and a weight loss of 13 kg in 3 months. An inter-costal drain was inserted on the left side.Her high-resolution computed tomography thorax showed multiple cavitatory lesions with ground glass opacities in right lung parenchyma,Hydropneumothorax from the upper lobe to lower lobe of the left lung; consolidation, calcification in the left lower lobe; mediastinal shift toward the right.In the Operation theatre, the patient was pre-oxygenated, induced with Inj Propofol + Inj Fentanyl + Inj Suxamethonium according to the patient’s weight, and intubated with a 28 Fr’ left-sided double lumen tube (DLT). Left-sided decortication was performed uneventfully. On conclusion of surgery, while checking for leaks, it was noted that the exhaled tidal volume was unacceptably low and a rent on the left main bronchus of around 2 x 2 cm with scarred borders was detected, which was repaired with tissue patch suturing by the surgeons. After closure, the DLT was removed and re-intubation was performed with endotracheal tube no. 6. The patient was shifted to the intensive care unit, electively ventilated, and gradually weaned off in 2 days. Then, the patient was discharged in a week.To conclude, meticulous planning, vigilant monitoring of vital parameters, and close communication between the surgeons and the anaesthesiologists are essential to timely manage a life-threatening complication.

Pneumothorax secondary to a Pulmonary Bullae in a dog

Background: Pulmonary bullae are thin-walled cavitary lesions within the subpleural parenchyma. They are a result of the destruction, dilatation and coalescence of bordering alveoli and their rupture is the most common cause of pneumothorax in dogs. Radiographic and CT imaging are excellent tools for identifying and quantifying pneumothorax. Surgical treatment is considered standard for treatment of pneumothorax consequential to pulmonary bullae. The aim of this report was to describe a case of pneumothorax secondary to pulmonary bullae in a dog.Case: A 5-year-old male crossbreed dog, weighing 11.5 kg, was presented to the Uberaba’s Veterinary Hospital due to becoming easily tired in the previous 3 weeks, and its worsening in the last 2 days by presenting panting. The dog’s guardian did not witness any traumas, but informed that the animal resided with other 14 dogs and also that it frequently collided the thorax against the door when it came down from the bed. Physical examination showed diaphragmatic breathing, inspiratory dyspnea and stridor lung sound. Thoracocentesis revealed presence of air in the pleural cavity and pneumothorax. Radiographic images confirmed this condition. The dog stayed in the hospital and chest drains were placed. Since the amount of sucked air did not reduce with time and due to the emergence of subcutaneous emphysema, the dog went through exploratory thoracotomy that revealed impairment of the right caudal lung lobe, proceeding to lobectomy. The dog stayed in the hospital with chest drains until the contents of the suctions reduced significantly. With the removal of the drains, the dog was sent home and had a full recovery. Histopathology of the impaired lung revealed pulmonary bullae.Discussion: The dog from this report presented clinical signs consistent with pneumothorax, such as dyspnea, diaphragmatic breathing and exercise intolerance. Radiography of the chest region revealed images consistent with this condition, as it is an excellent tool for identifying it. This dog’s guardian was unable to confirm if there was occurrence of trauma due to the large number of cohabitants. In dogs, spontaneous pneumothorax commonly results from the rupture of pulmonary bullae, and these bullae may result from trauma, infectious diseases, thrombosis, obstructive, neoplastic, congenital or idiopathic conditions. Except from trauma, there were no evidence to support any of the other causes of pulmonary bullae in this case. Traumatic injuries are very common in veterinary medicine, and blunt thoracic traumas with consequential pneumothorax are especially common. The emerging of subcutaneous emphysema, as happened with this dog, is frequently associated with pneumomediastine, and rarely has pathophysiologic impairments. The patient stayed in the hospital for support therapy and thoracocentesis, corroborating with literature; but since there was no improvement, it went through exploratory lobectomy, which revealed impairment of the right caudal lung lobe, proceeding to its exeresis. Surgical intervention is standard procedure in these cases. Histopathology of the impaired lung suggested the presence of pulmonary bullae. In literature, histopathological definitions for this condition are inconsistent, but usually locate the bullae within the pulmonary parenchyma, having walls less than 1 mm thick. Through radiology, unlike with cysts, identifying pulmonary bullae is challenging. In conclusion, this report showed that pulmonary bullae should be considered as a differential diagnose in patients showing pneumothorax considering it is hard to identify through imaging, and that it is important to adopt early therapy and surgical intervention for better outcomes.Keywords: dyspnea, panting, pulmonary lobectomy, thoracotomy, chest drain.Titulo: Pneumotórax secundário a bolha pulmonar em cão.Descritores: dispneia, ofegante, lobectomia pulmonar, toracotomia, dreno torácico.

Early alveolar macrophage response and IL-1R-dependent T cell priming determine transmissibility of Mycobacterium tuberculosis strains

Mechanisms underlying variability in transmission of Mycobacterium tuberculosis strains remain undefined. By characterizing high and low transmission strains of M.tuberculosis in mice, we show here that high transmission M.tuberculosis strain induce rapid IL-1R-dependent alveolar macrophage migration from the alveolar space into the interstitium and that this action is key to subsequent temporal events of early dissemination of bacteria to the lymph nodes, Th1 priming, granulomatous response and bacterial control. In contrast, IL-1R-dependent alveolar macrophage migration and early dissemination of bacteria to lymph nodes is significantly impeded in infection with low transmission M.tuberculosis strain; these events promote the development of Th17 immunity, fostering neutrophilic inflammation and increased bacterial replication. Our results suggest that by inducing granulomas with the potential to develop into cavitary lesions that aids bacterial escape into the airways, high transmission M.tuberculosis strain is poised for greater transmissibility. These findings implicate bacterial heterogeneity as an important modifier of TB disease manifestations and transmission.

Prevalence of Latent Tuberculous Infection in Patients With Nontuberculous Mycobacterial Lung Disease and Colonization: A Prospective Study in an Intermediate Tuberculosis Burden Country.

BackgroundControlling latent tuberculosis infection (LTBI) is important in eliminating tuberculosis (TB); however, the prevalence of LTBI has rarely been studied in patients with nontuberculous mycobacterial (NTM) lung disease (LD) and colonization (LC).MethodsWe prospectively recruited subjects with NTM isolated from sputum mycobacterial cultures from December 2011 to June 2019. NTM-LD and NTM-LC were defined according to the American Thoracic Society guidelines. Patients with negative cultures were recruited as controls. Patients with a history of active TB or positive TB cultures were excluded. LTBI was confirmed using a QuantiFERON-TB Gold In-tube test. The prevalence and factors associated with LTBI were analyzed.ResultsA total of 406 participants were enrolled, including 171 in the NTM-LD group, 153 in the NTM-LC group, and 82 in the control group. The prevalence of LTBI was higher in the NTM-LD and NTM-LC groups than in the controls (21.6%, 20.9%, and 6.1%; P = .006). Multivariable analysis showed that old age (adjusted odds ratio [aOR], 1.021, per year increment; P = .042), NTM-LD (aOR, 4.030; P = .005), NTM-LC (aOR, 3.610; P = .011, compared with the controls), and pulmonary cavitary lesions (aOR, 3.393; P = .034) were independently associated with LTBI.ConclusionsThe prevalence of LTBI was higher in the patients with NTM-LD and NTM-LC than in the controls. Old age, pulmonary cavitation, and NTM isolated from sputum were associated with a higher risk of LTBI.