Left Chest Pain Research Articles

Ruptured solitary fibrous tumor of the pleura with hemothorax: a case report

BackgroundThe majority of the patients with a solitary fibrous tumor (SFT) of the pleura are asymptomatic, and rupture of an SFT with hemothorax is rare.Case presentationA 48-year-old man was taken by ambulance to our hospital because of sudden onset of left chest pain. Two months before the referral, a tumor was detected in the left upper lobe of the lung by screening computed tomography at another hospital, and further observation was recommended, because the tumor was suspected to be benign. Our contrast-enhanced computed tomography analysis of the chest revealed a solid tumor (5 cm in diameter) with an irregular enhancement effect close to the pericardium and pleural effusion in the left thoracic cavity. Pleural effusion was not detected in the previous imaging analysis. CT number of the pleural effusion was 40 HU, and the pleural effusion was suspected to be hematogenous. Therefore, rupture of the tumor with bleeding was suspected as the cause of the effusion because of the sudden onset. Preoperative diagnosis was a mediastinal tumor, such as a teratoma, because the tumor was close to the pericardium. Thoracoscopic surgery was performed with the patient in the right lateral decubitus position; bloody pleural effusion was observed and drained. The tumor originated from the visceral pleura of the left upper lobe of the lung and was resected with a surgical stapler. Macroscopic analyses of the resected tumor indicated that bleeding were caused by the rupture of the tumor at the defect of the capsule wall. The operation took 63 min. The postoperative pathological diagnosis was a benign SFT. Hemorrhage was observed just under the capsule wall of the tumor. The postoperative course of the patient was uneventful, and he was discharged 2 days after surgery.ConclusionsEven when an SFT is neither huge nor malignant, rupture can occur, and resection should be considered regardless of the size or malignant characteristics. After an SFT rupture, careful follow-up is needed to monitor for the intrathoracic recurrence or dissemination of the tumor.

Cardiac Angiosarcoma with Unusual Cytologic Features Causing Cardiac Tamponade in a Young Adult Patient

Abstract Introduction/Objective Cardiac angiosarcoma is a rare endothelial malignancy with poor prognosis, frequent metastasis, and short median survival of only a few months. The disease has a wide age spectrum and can occur in young adult patients. The cytological diagnosis of cardiac angiosarcomas is challenging as cases are rare and its cytology is not extensively described or reported in literature. Here, we describe a rare case of cardiac angiosarcoma with unusual cytologic features. Methods/Case Report Our patient is a 30 year old male presenting with three days of worsening dyspnea and palpitations and was discovered on ultrasound to have large pericardial effusion compressing the right ventricle and causing cardiac tamponade. CT/MRI imaging revealed a 4.5 x 4.3 x 2.6 cm mass inside the right ventricle with extra- cardiac invasion through the pericardium and into the anterior mediastinum. Pericardiocentesis yielded 1.5 liters of hemorrhagic, brown, pericardial fluid with elevated LDH and protein levels. Cytology of the pericardial fluid revealed numerous tumor cells occurring singly or in monolayered, acinar clusters or cohesive spheres containing amorphous, eosinophilic cores made of collagen as evidenced on trichrome stain. The tumor cells possessed hyperchromatic, irregular, variably sized nuclei, prominent nucleoli, and cytoplasmic vacuoles. The tumor cells were positive for vimentin, CD31, and CD34, and showed high Ki67 proliferation index > 50%. A catheter-mediated biopsy of the right ventricular mass revealed spindled and epithelioid tumor cells strongly positive for CD31, CD34, and vimentin, focally positive for Factor VIII and AE1/AE3, and showing high Ki67 proliferation index of roughly 50%. The cytological, histological, and immunohistochemical findings were most consistent with cardiac angiosarcoma as the diagnosis. The patient eventually developed worsening chronic left chest pain and expired from cardiac arrest six months after his diagnosis. Results (if a Case Study enter NA) NA Conclusion We report a rare case of cardiac angiosarcoma with unusual cytologic features, manifesting as acinar clusters and cohesive spheres with collagenous cores that are not typical of malignant endothelial neoplasms. Currently there are no effective, standardized therapies that can significantly prolong survival for this malignancy, and treatment is often palliative. The cytological diagnosis of cardiac angiosarcoma is challenging given the rarity of this disease and the paucity of literature describing its cytology.

Primary Lung Adenocarcinoma in Pregnancy: A Case Report

Case Report: This is a unique case of metastatic primary lung adenocarcinoma diagnosed in a 25-year-old G3P2002 at 15 weeks of gestation. The patient presented with acute onset of left chest and shoulder pain. Evaluation revealed anaplastic lymphoma kinase (ALK) positive, primary lung adenocarcinoma with metastasis to the liver and right adrenal gland. Treatment with palliative Alectinib 450 mg twice daily was initiated at 18 weeks gestation and increased to Alectinib 600 mg twice daily at 27 weeks gestation. Uncomplicated delivery occurred via spontaneous vaginal delivery following scheduled induction at 39 weeks and 2 days. There are few cases of lung cancer in pregnancy, and none which describe delivery at term in a patient with metastatic disease. This case provides insight on the treatment of ALK positive metastatic lung cancer during the second and third trimesters of pregnancy without necessitating preterm delivery or cesarean section.

Spontaneous intercostal artery bleeding occurring simultaneously in numerous vessels during antithrombotic therapy with mechanical circulatory support: a case report

BackgroundIntercostal artery bleeding often occurs in a single vessel; in rare cases, it can occur in numerous vessels, making it more difficult to manage.Case presentationA 63-year-old Japanese man was admitted to the emergency department owing to sudden chest and back pain, dizziness, and nausea. Emergency coronary angiography revealed myocardial infarction secondary to right coronary artery occlusion. After intra-aortic balloon pumping, percutaneous coronary intervention was performed in the right coronary artery. At 12 hours following percutaneous coronary intervention, the patient developed new-onset left anterior chest pain and hypotension. Contrast-enhanced computed tomography revealed 15 sites of contrast extravasation within a massive left extrapleural hematoma. Emergency angiography revealed contrast leakage in the left 6th to 11th intercostal arteries; hence, transcatheter arterial embolization was performed. At 2 days after transcatheter arterial embolization, his blood pressure subsequently decreased, and contrast-enhanced computed tomography revealed the re-enlargement of extrapleural hematoma with multiple sites of contrast extravasation. Emergency surgery was performed owing to persistent bleeding. No active arterial hemorrhage was observed intraoperatively. Bleeding was observed in various areas of the chest wall, and an oxidized cellulose membrane was applied following ablation and hemostasis. The postoperative course was uneventful.ConclusionWe report a case of spontaneous intercostal artery bleeding occurring simultaneously in numerous vessels during antithrombotic therapy with mechanical circulatory support that was difficult to manage. As bleeding from numerous vessels may occur during antithrombotic therapy, even without trauma, appropriate treatments, such as transcatheter arterial embolization and surgery, should be selected in patients with such cases.

Combined resection of lung cancer and thoracic aortic wall with simultaneous thoracic aortic endografting: a case report

BackgroundCombined resection of lung cancer and the thoracic aortic wall with thoracic aortic endografting has been reported. However, whether the resection and endografting should be performed simultaneously or in two steps remains controversial.Case presentationA 68-year-old man was referred to our hospital because of left chest pain. Chest contrast-enhanced computed tomography revealed a huge tumor of the left lower lung lobe, and invasion to the aortic wall was suspected. Bronchoscopic examination was performed, revealing squamous cell carcinoma with a programmed death ligand 1 expression level of 90%. The clinical stage was T4N0M0 stage 3A. After neoadjuvant chemotherapy and radiotherapy, we performed one-stage surgery with the patient in the right lateral decubitus position and the left inguinal region exposed for femoral vessel isolation. Posterolateral thoracotomy was performed with making a latissimus dorsi muscle flap. The pulmonary artery, vein, and left lower bronchus were cut with a stapler. After hilar isolation, we evaluated the involvement of the descending aorta and marked the area of the involved aortic wall by a surgical clip. Using the left femoral artery approach, a GORE TAG conformable thoracic stent graft was delivered to the descending aorta. After thoracic aortic endografting, the involved aortic wall was resected and the left lower lobe of the lung and resected aortic wall were resected en bloc. The adventitial defect was covered by the latissimus dorsi muscle flap. The operating time was 474 min, and the blood loss volume was 330 mL. The postoperative pathological diagnosis was adenocarcinoma with an epidermal growth factor receptor mutation of exon 19 deletion. The residual viable tumor was 7 mm in diameter and close to the resected aortic wall. The patient’s postoperative course was uneventful. Five days after surgery, chest contrast-enhanced computed tomography revealed no endoleak or stent migration. Three months after surgery, he was alive with neither recurrence nor stent graft-related complications.ConclusionsOne-stage surgery involving combined resection of lung cancer and the thoracic aortic wall with simultaneous thoracic aortic endografting in the right lateral decubitus position with the left inguinal region exposed is safe and acceptable.

Boerhaave syndrome: A rare cause of sudden chest pain

A 81-year-old man with previous history of arterial hypertension presented to the emergency department with sudden left chest pain and dyspnea, after having two episodes of non-bloody vomiting. He was hypotensive, tachycardic, with absent breath sounds on the left.

Navigating challenges: a case report on complications in clavicle fracture management with 'K' wire fixation

Orthopaedic metallic pins and wires are commonly used for the fixation of fractures and dislocations, with the shoulder girdle being one of the common areas for their application. Despite recent precautionary measures, complications related to migration of these devices into the pleural cavity continue to be reported. We present a case of a Kirschner wire (K-wire) migration from a left clavicle fracture to the first rib, highlighting the importance of vigilance and immediate intervention in such cases. A 35-year-old female, previously operated for a left clavicle fracture using K-wire and tension band wiring, presented with left shoulder and chest pain eight years later. Radiological investigations revealed a broken K-wire in the pleural cavity, with one portion near the acromio-clavicular region and the other at the posterior aspect of the first rib. Surgical intervention was performed, involving the removal of the K-wire from the chest cavity and clavicle, with subsequent patient recovery. The migration of orthopaedic pins and wires into the chest cavity is a rare but well-documented complication. Previous reports have demonstrated severe consequences, including cardiovascular complications and fatalities. Theories explaining wire migration include muscle action, shoulder mobility, negative intrathoracic pressure during respiration, regional bone resorption, gravitational forces, and even capillary action. To minimize such complications, subcutaneous K-wire ends should be bent, and restraining devices should be used. Close clinical and radiographic follow-up is essential until the pins and wires are removed after achieving the therapeutic goal. In case of migration, prompt removal is necessary to prevent fatal complications. This case report emphasizes the significance of vigilance and proper precautions when using orthopaedic pins and wires for shoulder girdle fractures. Timely intervention is crucial to mitigate severe complications associated with migration. Sharing experiences and lessons learned can contribute to the safer application of these fixation devices in orthopaedic practice.

Primary Pulmonary Sarcoma Coinfected with Pulmonary Tuberculosis: A Case Report

Introduction: Pulmonary tuberculosis (TB) and malignancy are conditions with similar respiratory diseases and they are even known to coexist simultaneously. Therefore, accurate diagnosis of each disease is crucial to ensure precise treatment. This case study showed the coexistence of pulmonary TB and primary pulmonary sarcoma.Case Presentation: A 62-year-old male presented with a 3-month history of dyspnea, which worsened within 3 days. Before hospitalization, there were complaints of left chest pain, fatigue, loss of appetite, weight loss within 5 months, and night sweats. The patient who was a heavy smoker had experienced hemoptysis in the past 5 months. Upon physical examination, an increased respiratory rate and decreased oxygen saturation level. Furthermore, there were asymmetrical thorax movements, dull percussion on the left side, and decreased vesicular breathing sound on the left hemithorax, with no rhonchi or wheezing. A chest x-ray showed a destroyed left lung, while scanning confirmed left lung atelectasis and indicated a suspected mass within or around the left bronchus causing total obstruction in the main left bronchus. The bronchoscopy procedure identified a mass blocking the left main bronchus. However, a biopsy yielded inconclusive results. A rapid molecular test of TB detected Mycobacterium tuberculosis, which was discovered to be Rifampicin sensitive. As a result, the patient was treated daily with 4 fixed drug combinations for anti-TB. Despite the treatment, the complaint was not resolved within the next 3 months, as there was still a disease of cough in the form of mass-like phlegm, which uncovered a malignancy focus cell with differential diagnosis of pleomorphic sarcoma and sarcomatoid carcinoma.Conclusions: Lung malignancy not only overlapped with but also occurred simultaneously alongside lung TB. Therefore, it was crucial to establish a clear diagnosis in patients with chronic respiratory disease.

P09 A catastrophic decline: a significant skin rash in a patient presenting with catastrophic antiphospholipid syndrome

P09 A catastrophic decline: a significant skin rash in a patient presenting with catastrophic antiphospholipid syndrome

Symptom Presentation among Women with Suspected Ischemia and No Obstructive Coronary Artery Disease (INOCA).

Identifying ischemic heart disease (IHD) in women based on symptoms is challenging. Women are more likely to endorse non-cardiac symptoms. More than 50% of women with suspected ischemia have no obstructive coronary disease (and thus, INOCA) and impaired outcomes during follow-up. We aimed to identify symptoms having predictive capacity for INOCA in women with clinical evidence of coronary ischemia. We included 916 women from the original WISE cohort (NCT00000554) who had coronary angiography performed for suspected ischemia and completed a 65-item WISE symptom questionnaire. Sixty-two percent (n = 567) had suspected INOCA. Logistic regression models using a best subsets approach were examined to identify the best predictive model for INOCA based on Score χ2 and AICc. A 10-variable, best-fit model accurately predicted INOCA (AUC 0.72, 95% CI 0.68, 0.75). The model indicated that age ≤ 55 years, left side chest pain, chest discomfort, neck pain, and palpitations had independent, positive relationship (OR > 1) to INOCA (p < 0.001 to 0.008). An inverse relationship (OR < 1) was observed for impending doom, and pain in the jaw, left or bilateral arm, and right hand, interpreted as INOCA associated with the absence of these symptoms (p ≤ 0.001 to 0.023). Our best-fit model accurately predicted INOCA based on age and symptom presentation ~72% of the time. While the heterogeneity of symptom presentation limits the utility of this unvalidated 10-variable model, it has promise for consideration of symptom inclusion in future INOCA prediction risk modeling for women with evidence of symptomatic ischemia.

Coexistence of pulmonary tuberculosis and small cell lung carcinoma: A significant problem in tuberculosis-endemic country?

Pulmonary tuberculosis and lung cancer are public health problems, causing significant morbidity and mortality worldwide. The coexistence of the two diseases has rarely been reported while their causative association has been noticed leading to diagnosis delayed and prognosis worsening. In this case report, we present the case of a patient with coexistence of pulmonary tuberculosis and small cell lung carcinoma. A 54-year-old male was presented with the complained of lower left chest pain for six months, which was getting worse four days before admission to the hospital. The patient also complained of cough and decreased appetite and weight loss. Initial chest X-ray revealed an infiltrate and cavity in the upper right lung and inhomogeneous consolidation in the left paracardial. After the patient was diagnosed with pulmonary tuberculosis and was given anti-tuberculosis drugs for two months, the cavity and consolidation decreased with no clinically significant improvement. We performed a bronchoscopy with suspicion of lung cancer and a forcep biopsy in which small cell carcinoma was confirmed. The patient received two cycles of chemotherapy and anti-tuberculosis was continued for four months. During the observation in the fourth month, there was a reduction in the tumor size. This case highlights that similarity of clinical symptoms between pulmonary tuberculosis and lung cancer often lead to misdiagnosis of both. Therefore, in the absence of complete clinical and radiological improvement in pulmonary tuberculosis patients, the coexistence of lung cancer should be considered. This also highlights that early diagnosis is critical for the favorable outcome.

Diagnostic Difficulty in Pseudotumoral Form of Pulmonary Tuberculosis: A New Case

The pseudotumoral form of tuberculosis is rare in healthy immunocompetent patients. This form can mimic benign and malignant tumors. The diagnosis is confirmed by bacteriological and/or different histological samples. In this specific case, the patient presented with cough, left chest pain, fatigue and fever. The chest computerized tomography (CT) scan revealed an inhomogeneous mass that initially appeared to be a primary tumor. However, further investigation was required to establish an accurate diagnosis. Histopathological examination of the biopsy samples obtained through bronchoscopy did not indicate any evidence of neoplasia. Bronchoalveolar lavage (BAL) was positive for Mycobacterium tuberculosis, and real-time PCR for detecting M. tuberculosis was positive. Two transparietal punctures were performed and histological analysis revealed nonspecific inflammation. Pulmonary TB was diagnosed and a therapeutic regimen was prescribed with good clinical, biological and radiological improvement. This case emphasizes the diagnostic challenges associated with the pseudotumoral form of tuberculosis. It highlights the importance of considering tuberculosis in the differential diagnosis, even when the radiographic images and clinical history suggest an alternative diagnosis, particularly in areas where tuberculosis is endemic.

Epipericardial fat necrosis in chest CT and MRI: a case report of an unusual cause of chest pain associated with the initial diagnosis of undifferentiated connective tissue disease

BackgroundEpipericardial fat necrosis (EFN) is a benign and self-limited condition of unknown cause with a good prognosis, usually affecting otherwise healthy patients. Clinically, it presents with severe acute left pleuritic chest pain, often leading the patient to the Emergency Room (ER).Case presentationA 23-year-old male, smoker (5 pack-years), was evaluated in the ER due to left pleuritic chest pain, worsening with deep breathing and Valsalva maneuver. It was not associated with trauma and did not present other symptoms.The physical examination was unremarkable. The arterial blood gases while breathing room air and the laboratory tests, including D-dimers and high-sensitivity cardiac Troponin T, were normal. The chest radiograph, electrocardiogram, and transthoracic echocardiogram showed no abnormalities.A computed tomography (CT) pulmonary angiogram showed no signs of pulmonary embolism but depicted at the left cardiophrenic angle a focal 3 cm ovoid-shaped fat lesion with stranding and thin soft tissue margins, consistent with necrosis of the epicardial fat, which was confirmed by magnetic resonance (MRI) of the chest.The patient was medicated with ibuprofen and pantoprazole, with clinical improvement in four weeks. At a two-month follow-up, he was asymptomatic and presented radiologic resolution of the inflammatory changes of the epicardial fat of the left cardiophrenic angle on chest CT. Laboratory tests revealed positive antinuclear antibodies, positive anti-RNP antibody, and positive lupus anticoagulant. The patient complained of biphasic Raynaud’s phenomenon initiated five years ago, and a diagnosis of undifferentiated connective tissue disease (UCTD) was made.ConclusionsThis case report highlights the diagnosis of EFN as a rare and frequently unknown clinical condition, which should be considered in the differential diagnosis of acute chest pain. It can mimic emergent conditions such as pulmonary embolism, acute coronary syndrome, or acute pericarditis. The diagnosis is confirmed by CT of the thorax or MRI. The treatment is supportive and usually includes non-steroidal anti-inflammatory drugs. The association of EFN with UCTD has not been previously described in the medical literature.

Pleural Aspergillosis Complicating Chronic Cavitary Pulmonary Aspergillosis in a Tuberculosis Sequel: About One Case

Introduction: Pleural aspergillosis is a rare pathology; it is defined by an infection of the pleural cavity by an opportunistic fungus of the genus Aspergillus. Observation: We report the case of a 24-year-old female patient treated for pulmonary tuberculosis complicated by a left pyopneumothorax drained for 5 months. The reason for consultation 3 months after stopping the antibacillary treatment was a purulent bronchial syndrome, left chest pain with a tingling sensation and exertional dyspnea. Clinical examination revealed an aerated effusion syndrome in the left hemithorax. Chest imaging showed a left pneumothorax with thickening of the visceral pleura and a left upper lobar alveolar focus with clearing within it. Aspergillus serology was positive. The patient had undergone video-assisted thoracoscopy, which revealed the presence of false membranes and whitish deposits of mycotic appearance. The biopsy of the pseudomembranes was in favor of pleural aspergillosis. The patient was put under antifungal treatment for 6 months with a good clinical and radiological evolution. Conclusion: Aspergillus is a mycelial fungus formed by filaments that penetrate the airways by inhalation of its spores. Pleural localizations are rare. Sequelae of tuberculosis, broncho pleural fistulas, pleural drainage and pulmonary resection are considered the main conditions predisposing to infection of the pleural space by aspergillus. The diagnosis is confirmed by pleural fluid culture or pleural biopsy.

Adjuvant multimodal treatment for spinal intradural extramedullary capillary hemangioma with subpial growth: illustrative case.

Spinal intradural extramedullary capillary hemangiomas are rare vascular lesions. Although total resection is the first treatment, the efficacy of adjuvant therapies, such as steroid or radiation therapy, has not been investigated. A 74-year-old man presented with progressive back pain, gait disturbance, and left chest pain. Spinal magnetic resonance imaging (MRI) revealed an intradural extramedullary lesion at the middle thoracic level. Preoperatively, systemic steroid administration improved his chest pain and reduced the tumor size. The authors performed tumor extirpation. Because the tumor strongly adhered to the pia matter, in short, the tumor accompanied with partial subpial growth, subtotal resection was performed, leaving a thin layer of the tumor. A pathological examination revealed capillary hemangioma. His gait disturbance showed rapid improvement. Stereotactic cyber knife treatment was performed for the residual tumor at 1 month after the operation. Serial MRI showed a gradual decrease in the tumor size and no recurrence at 2 years after the operation. When a tumor adheres to the spinal cord or nerve root, immoderate total resection should not be performed to avoid exacerbating the clinical symptoms. Adjuvant therapies, such as a systemic steroid administration or radiation therapy, may provide satisfactory control of spinal capillary hemangiomas.

A 52-Years Old Male Patient With Aorta Regurgitation Et Causa Rheumatic Heart Desease In Cut Meutia Regional General Hospital

Rheumatic heart disease (RHD) is an acquired heart disease with heart valve disorder that persists due to previous acute rheumatic fever, mainly affecting the mitral valve (75%), the aorta (25%), rarely affecting the tricuspid valve, and never affecting the valves lungs. A 52-year-old male patient, domiciled in Mutiara (Alue Awe) Lhokseumawe City, Indonesia. Come for outpatient treatment at Polyclinic of Cut Meutia Hospital. Patients are who routinely go to the polyclinic every month to take medicine. The patient complains of left chest pain, shortness of breath, heart palpitations, cough, tired easily during activities, especially during strenuous activities. History of Diabetes Mellitus is denied, history of hypertension (+). The patient admitted that he was diagnosed with rheumatic heart disease at the age of 19 years. The patient has been undergoing treatment for 33 years by routinely complete checks related to his heart every year and regularly taking medication at the polyclinic every month. The patient admitted at junior high school age he often experienced attacks of fever that went up and down accompanied by pain in the throat. Physical examination found: Compos Mentis (E4V5M6), BP:140/40 mmHg, HR : 92x/i, RR: 23x/i, T; 37.1°C, SpO2 : 95%. Chest examination showed vesicular breath sounds, Rhonki (-), Wheezing (-), Diastolic murmur (+).Echocardiography showed an EF of 70%. AR Severe, MR Moderate. AML Prolapse, Calcification (+), LV Dilatation, LVH Eccentric

Connected simultaneous rupture of the diaphragm and pericardium via congenitally fused site due to blunt trauma

BackgroundIn severe blunt trauma, multiple organ injuries are often observed. Patients with a ruptured diaphragm and pericardium are referred to as having pericardio-diaphragmatic rupture. However, few studies have reported a narrowly defined case of connected rupture of the diaphragm and pericardium via their congenitally fused site along with an abdominal visceral herniation and cardiac luxation into the thoracic cavity.Case presentationA 78-year-old man presented to our hospital with left chest pain caused by a traffic accident. Contrast-enhanced computed tomography revealed a left diaphragmatic rupture and an intestinal herniation into the thoracic cavity. Surgical repair of the diaphragm was performed, and pericardial rupture was noted during surgery. It was considered that the laceration had spread via the congenitally fused site of the diaphragm and pericardium. The diaphragm was sutured, but the pericardium was left open because the laceration was large and the risk of cardiac incarceration was thought to be low. One year after the operation, no recurrence of diaphragmatic hernia was observed and any circulatory symptoms were not occurred.ConclusionsIn cases of diaphragmatic laceration extending to the fused site of the pericardium, connected pericardial rupture should also be considered. It would be challenging to detect without intraoperative findings, and it is desirable to observe both the thoracic and abdominal cavities.

Multiple pulmonary masses with diffuse cystic lesions

A 50-year-old female patient, presenting with a past history of Reynaud's syndrome, xerostomia and xerophthalmia, was admitted to Fujian Provincial Hospital because of coughing for 10 days and left anterior chest pain for 1 day. Chest imaging showed multiple nodules and masses, and diffuse cystic lesions in both lungs. Based on the differential diagnosis of multiple pulmonary masses and diffuse cystic lesions respectively, autoantibodies, radionuclide dynamic imaging of the parotid, positron emission tomography-CT, CT-guided percutaneous transthoracic needle biopsy, and other examinations were performed. The diagnosis of diffuse large B-cell lymphoma stage ⅣA (lung, parotid gland) and Sjögren's syndrome was confirmed. By analyzing the imaging features and pathogenesis in detail, the diffuse cystic lesions of both lungs were considered to be related to lymphocytic interstitial pneumonia caused by Sjögren's syndrome. The pulmonary space-occupying lesions in the lungs were significantly absorbed after RCHOP regimen for lymphoma.

Adult congenital horseshoe lung with bilateral pulmonary sequestration: A case report

Horseshoe lung (HL) is an infrequent congenital lung anomaly. Its main feature is that the lower lungs on both sides extend behind the pericardium and fuse across the midline, usually accompanied by pulmonary dysplasia. It is reported that 80% of HL is relevant to the abnormal return of some pulmonary veins from the right lung to the inferior vena cava or right atrium (scimitar syndrome). Most patients are within 5years old, most commonly within 1 year old, but HL may also have no apparent clinical symptoms or mild symptoms. This case is a 36-years-old adult female who developed left chest pain more than a month ago and continued to worsen for 10days. The patient also had repeated pulmonary infection with cough and expectoration.

Spontaneous Hemothorax by Pulmonary Arteriovenous Malformation during Pregnancy

Abstract Background: Pulmonary arteriovenous malformation (PAVM) is a rare vascular malformation that may cause hemothorax, especially during pregnancy. Case Description: A 25-year-old woman presented sudden-onset left chest pain, dizziness, and dyspnea in the 27th week of gestation. Computed tomography angiography showed left pleural effusion with complete hemithorax opacification and an aneurysmal PAVM. She exhibited hemorrhagic shock and received emergency exploratory video-assisted thoracic surgery. A ruptured PAVM was identified and stopped by wedge resection in the upper lobe of the left lung. The patient's postoperative clinical course was uncomplicated. She subsequently delivered a healthy live baby vaginally at 41 weeks gestation. Conclusion: PAVM should be considered in pregnant women with hemothorax. Emergency thoracoscopic surgery is the best treatment option.