Lower Lobe Of Left Lung Research Articles

A rare case of intestinal obstruction due to tuberculosis.

A 19-year-old previously healthy patient presented with severe abdominal pain. A contrast-enhanced CT scan identified ileal obstruction and lower left lung lobe changes suggestive of an inflammatory process. Diagnostic laparoscopy revealed ileal distension, hyperemia, and whitish nodules on the serosa. Acid-fast bacilli staining was positive, confirming Mycobacterium tuberculosis infection. The patient improved with a tuberculosis regimen. Intestinal TB often affects the ileocecal area and presents with symptoms like abdominal pain and obstruction. Diagnosis is confirmed by AFB staining, and treatment mirrors pulmonary TB, though surgery may be needed for complications.

The BCOR-rearranged sarcoma involving the lung: Diagnosis with clinical outcome and literature review.

BCOR-rearranged sarcomas (BRS) constitute relatively newly described sarcomas, which, within the musculoskeletal sites, usually occur in the bones, followed by soft tissues. Primary BRS involving the visceral organs is very rare, and only a single case is reported in the lung. These tumors share overlapping morphological and immunohistochemical (IHC) features with other neoplasms, such as synovial sarcoma, Ewing sarcoma, as well as carcinosarcoma, the latter especially when occurring in the visceral organs. BCOR immunostaining is useful in triaging a tumor for molecular diagnosis, which constitutes the "essential" diagnostic criterion for these tumors. To report an extremely rare case of a BRS, confirmed by BCOR-rearrangement by fluorescence in situ hybridization (FISH), primarily occurring in the lung, emphasizing the diagnostic approach and management, along with review of literature. An18-year-old boy presented with complaints of left-sided chest pain, along with cough, fever, loss of appetite, and weight. On radio imaging, there was a complete collapse of the left lower lobe of lung with moderate pleural effusion. The biopsy showed a biphasic tumor comprising primitive round cells admixed with spindle cells. Immunohistochemically, the tumor cells were positive for BCOR, TLE1, and p53. FISH showed BCOR gene rearrangement. A diagnosis of primary BRS of lung was offered. The patient had a favorable response to the chemotherapy regime. BRS is an ultra-rare tumor, which rarely involves visceral organs. The lung is an exceptionally rare site, with only single reported case previously. An exact confirmation by molecular testing has treatment-associated implications. A review of similar reported cases is presented herewith.

Legionella Pneumophila Presenting as a Rare Cause of Acute Thrombocytopenia: A Case Report and Review of Literature.

Legionella pneumophila can cause a wide spectrum of clinical manifestations, ranging from a mild flu-like illness to fulminant multi-organ involvement, characterised by severe pneumonia, diarrhoea, encephalopathy, shock, hepatic dysfunction and renal failure. Very rarely, it can be associated with haematologic conditions such as thrombotic thrombocytopenic purpura (TTP), haemolytic uraemic syndrome (HUS) and immune thrombocytopenic purpura (ITP). We report a rare case of L. pneumophila causing ITP and review previously published cases of thrombocytopenia associated with Legionellosis in the literature. A 53-year-old male presented with fevers, chills, a productive cough and severe haemoptysis. Blood work was remarkable for leukocytosis, severe thrombocytopenia and hyponatraemia. Computed tomography (CT) imaging showed left lower lobe lung consolidation, and a peripheral blood smear showed giant platelets consistent with ITP. Legionella urine antigen testing returned positive. He was treated with intravenous immunoglobin, steroid taper and a ten-day course of azithromycin, which led to normalisation of his platelet count and resolution of the pneumonia. L. pneumophila can lead to complement-mediated destruction of platelets resulting in ITP. Antibodies against L. pneumophila can also cross-react with the enzyme ADAMTS13, inhibiting its function and resulting in TTP and HUS. Additionally, L. pneumophila can infect vascular endothelial cells causing their death and stimulating release of von Willebrand factor (vWF) multimers into the bloodstream, promoting thrombosis and platelet consumption. It is important for internists to consider L. pneumophila in the differential for any patient presenting with pneumonia and severe thrombocytopenia. Earlier detection and intervention can lead to prevention of critical bleeding and better outcomes. Legionella pneumophila is rarely associated with different haematologic disorders resulting in severe bleeding diathesis as well as thrombosis.It is important for internists to consider Legionella pneumophila in the differential diagnosis for any patient presenting with pneumonia and severe thrombocytopenia.Earlier detection and intervention can lead to prevention of critical bleeding and better outcomes.

Wedge extended bronchoplasty with caliber adjustment by membranous suture.

Extended bronchoplasty for the left lower lobe lung tumors with interlobar lymph node involvement is a useful surgical technique for avoiding pneumonectomy. Typically, sleeve bronchoplasty, in which the superior division bronchus and the left main bronchus are separated and anastomosed, is chosen due to the difference in caliber of the anastomosis; herein, we report a wedge extended bronchoplasty in which the superior division bronchus and the left main bronchus were not completely separated. The main point of this technique is to adjust the difference in caliber by suturing the main bronchial membranes.

SIMPLIFID LUNG ULTRASOUND IN DIAGNOSIS OF HEART FAILURE WITH PRESERVED EJECTION FRACTION IN ARTERIAL HYPERTENSION

Objective: About 30% of patients with heart failure (HF) have normal Ejection Fraction (HFpEF). Pulmonary congestion is useful marker of HFpEF. The aim of this study was to determine the efficacy of ultrasound in patients with DHF. Design and method: We studied 250 patients with Arterial Hypertension and III-IV NYHA class HF from which 70 patients had HFpEF (group 1) and 100 patients Left Ventricular Diastolic Dysfunction but without signs of HF (control, group 2). All participants undergone standard Echo Cardiography. Sonographic evaluation of a lung was done in horizontal or vertical positions of patient, from 10 points of thoracic wall (5 points from each side), which corresponded to the projection of lower, middle and upper lobes of a right lung and upper and lower lobes of left lung. Results: In patients with HFpEF we significantly often found multiple (3 or more) B-lines or Comet tail Phenomenon (CTPh), which was registered in 91.1%. In 40.0% of control group patients, we also registered B-lines, but the count of them was less than 3 lines per each registration point (the difference between control an HF groups was significant). The count of points from where the CTPh was registered was 6.8 in HFpEF gr. and 0.7 in control. The B-lines were registered from 3 or more points of thoracic wall in 82.86% of patients of I gr and only 5% in II gr participants. In HF groups CTPh was prominent and multiple while in the control group it was single and short lasting, like lightening. There was good correlation between the count of B-line registration points from the thoracic wall and the heart failure NYHA class (r=0.56), left ventricular systolic (r=0.40) and diastolic (r=0.32) diameters and negative MAPS and TAPS (r=-0.42 and 0.41 respectively). Conclusions: Thoracic US is a sensitive and accurate method for evaluation pulmonary congestion in patients with AH and HFpEF. The US sign of pulmonary congestion in HF are B-lines or Comet tail phenomenon, which is protracted, prominent, multiple and registered from larger area of thoracic wall (3 points or more).

Lack of Reactivation of Latent Tuberculosis despite PD-1 Immunotherapy and Chemotherapy: A Case Report and Systematic Review

Background: Programmed Death 1 (PD-1) has a controversial role in the treatment of Tuberculosis (TB). Several clinical cases of TB development have been reported by administration of anti–PD-1 antibodies for patients with advanced unresectable cancers. Case presentation: In this article, we report an interesting case about a male patient with history of cured pulmonary tuberculosis and a 4-month history of repeated hemoptysis. Imaging showed one mass in the lower lobe of left lung and the other in the left upper lobe. The diagnosis of Non-Small-Ccell Lung Cancer (NSCLC) was determined by biopsy specimens in the lower lobe nodule and cured pulmonary tuberculosis determined by past medical history. He was given neoadjuvant treatment with an anti–PD-1 inhibitor and chemotherapy. He underwent surgery. Pathological examination revealed Mtb in left upper lobe nodule but previous imaging showed without reactivation and slight reduction in tubercular infection inflammation. The left lower lobe nodule was poorly differentiated carcinoma. Conclusions: Overall, the role of immune checkpoint inhibitors in patients with cancers and latent tuberculosis infection is inconclusive. Although we cannot establish whether patients with stage IIIA NSCLC and concurrent latent pulmonary tuberculosis after surgical evaluation can receive a PD-1 and chemotherapy as neoadjuvant therapy without the activation of pulmonary tuberculosis, our case endorses the need of further evaluation.

Successful Therapeutic Leukapheresis in a Patient of Lobar Pneumonia with Hyperleukocytosis: A Case Report

ABSTRACT Hyperleukocytosis is a rare and potentially life-threatening condition that can cause leukostasis and organ dysfunction. This case report describes the case of a 69-year-old female who presented with fever, drowsiness, and consolidation in the left lung lower lobe. Initial investigations showed an increased total leukocyte count (TLC) of 89 × 103/μL, which further increased to 111.9 × 103/μL despite treating with intravenous antibiotics. A bone marrow biopsy revealed myeloid hyperplasia, but the BCR-ABL fusion gene test was negative. Due to symptomatic leukostasis and rapid deterioration of the patient’s condition, therapeutic leukapheresis (TL) was performed. During the first sitting, the device parameters were optimized for maximum platelets and the leukocytes removal. The second sitting of TL was carried out on the next day and the TLC was further reduced to 22.3 × 103/μL. The patient’s general condition and mental status improved significantly and she was taken off the mechanical ventilation and discharged after 7 days with a TLC count of 14.59 × 103/μL. She was regularly followed up for the next 3 months and the counts have remained within normal limits. The case reports highlight that TL may be helpful in similar clinical conditions with symptomatic leukostasis.

Omicron variant and pulmonary involvements: a chest imaging analysis in asymptomatic and mild COVID-19.

To identify clinical characteristics and risk factors for pulmonary involvements in asymptomatic and mildly symptomatic patients infected with SARS-CoV-2 Omicron variant by chest imaging analysis. Detailed data and chest computed tomography (CT) imaging features were retrospectively analyzed from asymptomatic and mildly symptomatic patients infected with Omicron between 24 April and 10 May 2022. We scored chest CT imaging features and categorized the patients into obvious pulmonary involvements (OPI) (score > 2) and not obvious pulmonary involvements (NOPI) (score ≤ 2) groups based on the median score. The risk factors for OPI were identified with analysis results visualized by nomogram. In total, 339 patients were included (145 were male and 194 were female), and the most frequent clinical symptoms were cough (75.5%); chest CT imaging features were mostly linear opacities (42.8%). Pulmonary involvements were more likely to be found in the left lower lung lobe, with a significant difference in the lung total severity score of the individual lung lobes (p < 0.001). Logistic regression analysis revealed age stratification [odds ratio (OR) = 1.92, 95% confidence interval (CI) (1.548-2.383); p < 0.001], prolonged nucleic acid negative conversion time (NCT) (NCT > 8d) [OR = 1.842, 95% CI (1.104-3.073); p = 0.019], and pulmonary diseases [OR = 4.698, 95% CI (1.159-19.048); p = 0.03] as independent OPI risk factors. Asymptomatic and mildly symptomatic patients infected with Omicron had pulmonary involvements which were not uncommon. Potential risk factors for age stratification, prolonged NCT, and pulmonary diseases can help clinicians to identify OPI in asymptomatic and mildly symptomatic patients infected with Omicron.

THU012 Incidental Pituitary Adenoma In A Patient With Ectopic ACTH Secreting Cushing Syndrome - A Diagnostic Conundrum

Abstract Disclosure: M.S. Nali: None. R.R. Yatavelli: None. Background: Cushing’s syndrome (CS) is a rare condition with an estimated incidence of 2-3 cases/million. Endogenous CS can be divided into ACTH -dependent (80%) and ACTH Independent (20%) with Ectopic Cushing’s syndrome (ECS) accounting for 10-20% of all cases of ACTH-dependent CS. Herein we present a case with indolent onset ACTH-dependent CS who on initial work-up showed a pituitary microadenoma raising the suspicion for Cushing disease, but the source of excess ACTH was found to be from a pulmonary neuroendocrine tumor. Clinical Case: A 44-yr-old female with history of type 1 DM, Obesity, BMI 43.60, Sleep apnea was evaluated elsewhere for suspected Cushing’s due to increased insulin requirements and progressive weight gain. Outside labs showed cortisol of 4.5 ug/dl on 1 mg DST &amp; 8 mg DST cortisol was 3 ug/dl. MRI of the pituitary showed a 3.5x 2.8x 1.8 mm microadenoma &amp; she was initially presumed to have Cushing’s disease secondary to pituitary microadenoma. The patient was seen by neurosurgery who referred to endocrine for localization of cortisol excess by IPSS. Clinically she had moon facies, hirsutism, dorsocervical fat pad, violaceous striae on abdomen. On further laboratory evaluation her ACTH: 88 (0-46) and random cortisol 14 ug/dl with normal rest of pituitary hormones. Her 24-hour urine free Cortisol was 45ug/d (3.5 - 45) and late-night salivary cortisol: 74 &amp;&amp;lt;50 (Ref. range &amp;lt;100 ng/dl) on couple of nights, respectively. Due to non-suppressed cortisol on high dose DST, a CT chest was obtained which showed a 2cms non calcified nodule in the left lower lobe of lung. Transbronchial biopsy was performed, cytopathology showed well differentiated neuroendocrine tumor, likely carcinoid and stained strongly positive for ACTH confirming ectopic ACTH producing tumor. Gallium-68 Dotatate Scan showed abnormal increased uptake in the known left lung nodule. The patient was recommended for surgical removal of neuroendocrine tumor, but she could not tolerate anesthesia and had to undergo stereotactic body radiation therapy (SBRT) for the lung lesion. Repeat ACTH levels 2 months post SBRT showed the ACTH levels were elevated and lesion was still persistent on imaging, however on discussion with rad oncology, the neuroendocrine tumors tend to take longer to show response on imaging and plan is to repeat imaging and biochemical work up in couple of months. Conclusion: The diagnosis of CS and recognizing the source of hormonal excess poses significant challenges Pituitary adenomas are incidentally discovered in up to 10% of the normal population &amp; IPSS is advised for patients with ACTH-dependent Cushing's syndrome and an adenoma smaller than 6 mm, however in patients with equivocal findings, it is important to look for other sources of ACTH prior to any invasive procedure. The source of ectopic ACTH secretion should be established after diagnosis because the excision of an ACTH-producing tumor can be curative. Presentation: Thursday, June 15, 2023

Primary pancreatic Ewing sarcoma with metastases on FDG PET/CT

BackgroundEwing sarcoma (ES) is a highly aggressive malignant tumor most commonly affecting long bones. Extraskeletal Ewing sarcoma (EES) is a malignant tumor with aggressive behavior carrying bad prognosis with pancreas being an extremely rare primary site. We present a case of histopathologically proven EES of the pancreas in a young female who presented with abdominal pain. 18F-fluorodeoxyglucose positron emission tomography (18F FDG PET/CT) is a useful modality for detecting distant metastases in EES. It helps in diagnosis, localizing the primary, its extension, optimal treatment planning and evaluation of response to standard treatments available.Case presentationAn 18-year-old female presented with complaints of progressive abdominal pain and distention since 6 weeks. Physical examination was suggestive of a solid large mass in the upper left abdomen and decreased breath sounds with dullness in the left lower lung fields. On Contrast enhanced computed tomography (CECT) imaging, a large heterogeneously enhancing mass was seen arising from pancreas along with retroperitoneal lymphadenopathy. A moderate sized left sided pleural effusion with atelectasis of lower lobe of left lung was also noted. Histopathological analysis was suggestive of pancreatic ES following which the patient underwent five cycles of chemotherapy. Following this, she underwent 18F FDG PET/CT which showed hypermetabolic large mass arising from body and tail of pancreas with areas of internal necrosis along with left adrenal metastasis, retroperitoneal lymphadenopathy, a massive left pleural effusion and compressive atelectasis of left lower lobe. The patient expired within a week following PET/CT.ConclusionsEES most often presents in the late stage of the disease with vague symptoms. Timely diagnosis and initiation of treatment is of utmost importance considering the aggressiveness of the tumor. Establishing a diagnosis of Ewing sarcoma is especially difficult when the mass is arising from the pancreas. Imaging, histopathology and immunohistochemistry (IHC) play a key role in accurate diagnosis of such masses. 18F FDG PET/CT can be useful for detecting local and distant spread, operability, treatment planning and evaluation of response to chemotherapy.

Bronchopulmonary sequestration A rare congenital anomaly presented in an adult female patient

Pulmonary sequestration is a congenital anomaly of lung parenchyma without a normal connection to the tracheobronchial tree and an anomalous systemic arterial supply. The presentation of this condition is variable ranging from no symptoms to hemoptysis. We report a case of pulmonary sequestration in an adult female who presented with recurrent chest infections. Her chest x-ray showed non-homogenous opacity in left lower lobe of lung and CT scan findings were suggestive of intralobar pulmonary sequestration in left lower lobe having arterial blood supply from the descending aorta and venous drainage in left inferior pulmonary vein. She subsequently underwent resection of the left, lower lobe of the lung.

Symplified pulmonary ultrasound in heart failure patients with preserved systolic function

Abstract Funding Acknowledgements Type of funding sources: None. Background About 1/3 of patients with heart failure (HF) have normal Ejection Fraction (HFpEF). Pulmonary congestion and Oedema is useful marker of HFpEF. The aim of this study was to determine the place of pulmonary ultrasound in patients with DHF. Methods We studied 250 patients with II-IV NYHA class HF from which 70 patients had HFpEF (I gr) and 100 patients Left Ventricular Diastolic Dysfunction but without signs of HF (control, II gr). All participants undergone standard EchoCG examination. Sonographic evaluation of a lung was done in horizontal or vertical positions of patient, from 10 points of thoracic wall (5 points from each side), which corresponded to the projection of lower, middle and upper lobes of a right lung and upper and lower lobes of left lung. Results In patients with HF we significantly often found multiple (3 or more) B-lines or "Comet tail Phenomenon" (CTPh), which was registered in 91.1%. In 40.0% of control group patients we also registered B-lines, but the count of them in was less than 3 lines per each registration point (the difference between control an HF groups was significant). The count of points from where the CTPh was registered was 6.8 in HFpEF gr. and 0.7 in control gr. The B-lines where registered from 3 or more points of thoracic wall in 82.86% of patients of I gr and only 5% in II gr participants. In HF groups CTPh was prominent, protracted and multiple while in the control group it was single and short lasting, like lightening. There was good correlation between the count of B-line registration points from the thoracic wall and the heart failure NYHA class (r=0.56), left ventricular systolic (r=0.40) and diastolic (r=0.32) diameters and negative MAPS and TAPS (r=-0.42 and 0.41 respectively). Conclusion Thoracic US is sensitive and accurate method for evaluation pulmonary congestion in patients with HFpEF. The US sign of pulmonary congestion in HF are B-lines or "Comet tail phenomenon", which is protracted, prominent, multiple and registered from larger area of thoracic wall (3 points or more).

Colorectal cancer metastases in thyroid: case report and literature review

BackgroundThe thyroid gland is an uncommon site for metastatic deposits from non-thyroid malignancies, occurring in only 1.4 - 3% of surgical specimens where malignancy is suspected. It is even rarer for the source of thyroid metastases to be of colorectal origin. In most cases reported, colorectal metastases in the thyroid occurs many years later after the primary colorectal cancer has been diagnosed and treated. In this unique case, a primary sigmoid carcinoma metastasised to the thyroid gland and presented synchronously as a thyroid nodule.Case presentationWe describe a case of a 64-year-old Caucasian woman who presented with clinical features of metastatic cancer of unknown origin. Her medical history included underlying hyperthyroidism. She had a large pelvic mass adjacent to the sigmoid colon, a left lower lobe lung mass and a suspicious nodule in the left thyroid lobe. A fine-needle aspiration biopsy of the thyroid nodule was performed, which remarkably showed malignant cells originating from primary colorectal cancer on immunohistochemical staining. The patient was managed with palliative chemotherapy given the poor prognosis due to disseminated colorectal malignancy.ConclusionsColorectal adenocarcinoma metastases can rarely present as a metastatic thyroid nodule. Fine-needle aspiration should be performed in suspicious thyroid nodules and may be the least invasive way of identifying a metastatic colorectal or other non-thyroidal malignancy in patients presenting with an unknown primary. The pathologist should be vigilant to this possibility and specific immunohistochemical markers should be used to ensure accurate diagnosis.In thyroid metastases, the prognosis is ultimately determined by the primary tumour but thyroidectomy still has a role in alleviating compressive symptoms and can potentially improve survival in selected cases.

Expression of HSP27 and BAX/BCL-2 apoptosis factor in silicosis rat model of fibrosis

To study the expression of heat shock protein 27(HSP27), BAX and BCL-2 apoptosis in silicosis rat model, and to explore the correlation between HSP27 and BAX and BCL-2 apoptosis. Silicosis model was established by the oropharyngeal and endotracheal intubation. Forty SPF healthy adult Wistar male rats were randomly divided into 4 groups, with 10 rats in each group. Silicosis group for 6 weeks(feeding for 6 weeks), silicosis group for 8 weeks(feeding for 8 weeks): oropharyngeal and tracheal perfusion of 50 mg/mL SiO_2 suspension 1.0 mL/mouse; Model control group for 6 weeks and model control group for 8 weeks: 1.0 mL saline was infused into the oropharynx and trachea. Immunohistochemical staining was used to detect the expression of HSP27, BAX and BCL-2 in the right lower lung of silicosis model group at 6 and 8 weeks and model control group at 6 and 8 weeks. Western blot was used to detect the protein expression of HSP27, BAX and BCL-2 in the left lower lobe lung tissue of silicosis model group at 6 and 8 weeks and model control group at 6 and 8 weeks, respectively. Immunofluorescence staining was used to detect the colocalization of HSP27 with pro-apoptotic factor BAX and HSP27 with anti-apoptotic factor BCL-2. Compared with the model control group at 6 weeks and 8 weeks, the expression of HSP27 and pro-apoptotic factor BAX in fibrotic region increased, and the expression of anti-apoptotic factor BCL-2 decreased in silicosis model group at 6 weeks and 8 weeks(P&lt;0.05). Immunofluorescence staining showed that there was colocalization of HSP27 and pro-apoptotic factor BAX in the fibrotic region. Correlation analysis showed that the correlation coefficient between HSP27 and pro-apoptotic factor BAX was r=0.94, indicating a positive correlation between them, while the correlation coefficient between HSP27 and anti-apoptotic factor BCL-2 was r=-0.81, indicating a negative correlation between them. High expression of HSP27 and pro-apoptotic factor BAX and low expression of anti-apoptotic factor BCL-2 exist in silicosis rats, and their expression is correlated.

SARS-CoV-2 parainfection associated Landry -Guillain- Barre Syndrome (LGBS) in a term pregnant women: A clinical conundrum.

Sir Guillain-Barre Syndrome (GBS) is a rare neurological disease that is characterized by progressive weakness in legs and arms, areflexia, or decreased tendon reflexes in weak limbs.[1] Evidence of GBS cases associated with SARS-CoV-2 infection has recently been reported.[2] Though GBS is considered mostly a post-infectious, immune-mediated disease, it might also occur during the infectious phase in some cases. Herein, we report first case of SARS-CoV-2 parainfection associated GBS in a term pregnant patient. A 22 year primigravida at 36 weeks of gestation, presented with acute onset of quadriparesis since 3 days and cough since 2 days. Patient c/o weakness in all four limbs, sudden onset, started distally in both lower limbs which progressed to involve upper limbs. On examination, she was tachypneic with respiratory rate of 32-34 breaths/min. She maintained saturation of 97% on ventimask at 0.4 fraction of inspired oxygen. On motor examination, in lower limb she had power of 2/5 at both ankle and knee joints. At hip joint, she had power of 1/5. In upper limb, she had power of 3/5 at both the shoulders and 4/5 at both the elbow joints. Deep tendon reflexes were absent. Her blood investigations were normal except for total serum bilirubin which was 3.2 mg/dl. She also tested SARS CoV-2 reverse transcriptase positive. Since she had no prior history of any gastrointestinal infection, she was diagnosed as SARS-CoV-2 parainfection associated Landry -Guillain- Barre Syndrome (LGBS) with respiratory involvement. In view of the worsening motor weakness and decline in respiratory functions, she was planned for urgent caesarean section. After preoxygenation, rapid sequence induction was done using thiopentone sodium and rocuronium and intubated with oral cuffed endotracheal tube with 7.0 mm internal diameter. She was ventilated using controlled mode with peak inspiratory pressure of 22 cm water, positive end expiratory pressure 5 and maintained on sevoflurane + oxygen at minimum alveolar concentration of 0.7-1. After delivery of baby, oxytocine infusion was started at 5 IU/h and injection fentanyl 50 μg was administered. Post-surgery she was shifted unreversed to COVID-19 intensive care unit (ICU). In ICU, she was administered intravenous immunoglobulins gram once a day (OD) for 4 days, low molecular weight heparin 0.6 ml OD, injection dexamethasone 6 mg twice a day, and Tablet Gabapentin 300 mg at night. Her CSF analysis showed total protein of 31.5 mg/dl and glucose levels of 68.9 mg/dL. During her ICU stay, she developed collapse and consolidation of left lung lower lobe with left sided pleural effusion, which resolved over next few days after she was tracheostomized. After 10 days of her ICU stay, she tested SARS-CoV-2 reverse transcriptase negative. Thereafter, she was shifted to non-COVID-19 ICU where she was gradually weaned from ventilatory support. Her nerve conduction study was performed which reported complete absence of compound muscle action potential (CAMP) with normal sensory nerve action potential (SNAP) suggestive of Acute Motor Axonal Polyneuropathy (AMAN) [Table 1]. She was shifted to medical ward for rehabilitative care. She was discharged from the hospital and was mobilized using wheel chair. There was complete return of motor power in upper limbs.Table 1: Nerve conduction study parameters of the patientTo the best of our knowledge, this is the first reported case of SARS-CoV-2 parainfection associated LGBS in term pregnant patient. She presented with short history of acute onset of muscle weakness accompanied by cough which gradually worsened and required assisted ventilation. As patient had already reached term, emergent caesarean section followed by management according to SARS-CoV-2 protocols was done. Guillain barre syndrome (GBS) worsens in postpartum period due to restoration of cellular immunity, with increase in delayed type of hypersensitivity which was adaptively depressed during pregnancy.[3] In an observational multicentre study, thirty GBS cases associated with COVID-19, stated COVID-19-associated GBS as being predominantly demyelinating and more severe than non-COVID-19 GBS.[4] Tekin et al.[5] have reported occurrence of LGBS in pregnant patient who had preceding SARS-CoV-2 infection. The patient developed muscle weakness in postpartum period, which recovered after receiving intravenous immunoglobulins. The prognosis of SARS-CoV-2 parainfection associated LGBS in term pregnant patient is still unclear and requires early recognition of danger signs for timely management and favorable outcome. Thus, clinical course of SARS-CoV-2 parainfection associated LGBS during pregnancy is highly complicated, due to presence of non-specific signs and symptoms and carries high risk of maternal morbidity. Early identification and multidisciplinary involvement are essential for diagnosis and good outcome. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Gestational Choriocarcinoma Manifesting as Spontaneous Hemothorax in Third Trimester of Pregnancy: A Case Report

AbstractGestational trophoblastic neoplasia (GTN) is an aggressive malignancy arising from the trophoblastic tissue. It is rarely seen in association with advanced intrauterine pregnancy. Most common manifestations are due to bleeding caused by the rich vascularity of trophoblastic tissue. We describe here a case of a 28-year-old female patient who presented to us at 32 weeks of pregnancy with sudden onset dyspnea and hemodynamic instability. On evaluation, imaging techniques revealed a gross left hemothorax requiring intercostal tube insertion for stabilization. Emergency thoracotomy and hemothorax drainage were performed wherein a tumor mass in the lower lobe of left lung was identified and resected. Histopathological examination confirmed the diagnosis of choriocarcinoma. Beta HCG levels were found to be elevated. Final diagnosis of a FIGO stage IV high-risk gestational choriocarcinoma was made. Following this, six cycles of multi-agent EMA-CO chemotherapy was administered to the patient. Patient had an excellent response to treatment with documented serial fall in β HCG levels and she continues to be in remission after 6 months of follow-up. In conclusion, in the circumstance of any pregnant women presenting with abnormal bleeding symptoms such as hemothorax, choriocarcinoma as a cause should be considered for early diagnosis and effective management.

PSUN380 A Case of Sclerosing Epithelioid Fibrosarcoma With Metastases to the Thyroid

Abstract Background Sclerosing Epithelioid Fibrosarcoma (SEF) is a rare form of soft tissue sarcoma, often presenting in the soft tissues of the extremities. This tumor is characterized by slow growth, often with local recurrences and/or distant metastases. First described in 1995, subsequent case reports and case series have demonstrated that metastases are primarily to the lung, pleura and bone, but can occur anywhere. Treatment is primarily by wide excision and adjuvant chemotherapy or radiotherapy. However, treatment of this rare form of sarcoma is often unsatisfactory. Clinical case A 36-year-old female, had for 30 years presented with a slowly enlarging mass on the left axilla. She had no constitutional symptoms and had previously been in good health. She was first diagnosed with SEF when she presented with abdominal pain where workup showed elevated Lipase 8,098 U/L (73-393 U/L) and Amylase 976 U/L (25-115 U/L). CT scans showed an ill-defined hypodense focus in the body of the pancreas, with incidental findings of a mixed intensity ovoid lesion in the left erector spinae, and heterogeneously enhancing ovoid masses in the left axilla, left lateral chest wall, left lower lung lobe, and the liver. Biopsy of the left axillary mass showed a round cell sarcoma consistent with Sclerosing Epithelioid Fibrosarcoma. PET scan confirmed widespread metastases to the lungs, pancreas, abdominal wall, left thigh and scalp. She underwent wide excision of the masses in the left axilla, thigh, and scalp. Adjuvant chemotherapy with Doxorubicin and Ifosfamide was then initiated. 6 months after starting treatment, she reported a rapidly enlarging anterior neck mass. She denied tremors, palpitations, any change in weight, heat/cold intolerance, changes in bowel movement, fatigue or muscle weakness. On physical examination there was a 2×2 cm, firm, non-tender, palpable nodule on the right thyroid lobe. Thyroid function tests were as follows: TSH 0.52 uIU/mL (0.55-4.78 uIU/mL), FT4 1.27 ng/dL (0.89-1.76 ng/dL), FT3 2.84 pg/mL (2.30–4.20 pg/mL). On thyroid ultrasound there was a 2.6×1.8×2.4 cm, mixed hypoechoic, solid, lobulated nodule in the upper to middle third of the right thyroid lobe, and a 0.3×0.2×0.3 cm hypoechoic solid nodule in the lower third of the left thyroid lobe. FNAB showed hypercellular smears with atypical round to spindle-shaped cells arranged in singly and loose to crowded clusters. She underwent total thyroidectomy, and histopathologic examination was consistent with a multifocal metastatic Sclerosing Epithelioid Fibrosarcoma. She was subsequently started on Levothyroxine replacement. Conclusion This case, to our knowledge, is the first reported case of Sclerosing Epithelioid Fibrosarcoma (SEF) metastatic to the thyroid. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Carcinoma Ovary with Lung Metastasis: A Rare Case Report

Ovarian cancer is the most lethal gynecological malignancy. Despite advances in chemotherapy, five year survival rate of advanced ovarian cancer patients with peritoneal metastasis remains around 30%. The most significant prognostic factor is stage and most patients present at an advanced stage with peritoneal dissemination. There is often no clearly identifiable precursor lesion, therefore, the events leading to metastatic disease are poorly understood. Solitary lung metastasis is extremely rare. We report the case of a 39-year-old woman who was admitted to our department with a lung mass. She had a past history of ovarian cancer 6years ago for which she underwent Cytoreductive surgery and HIPEC in august 2016. Histopathology report suggestive of High-grade serous carcinoma. She received adjuvant chemotherapy. She was on follow up and PET scan shows two soft tissue density nodules noted in left lung lower lobe largest 2.8×2.5cm. Left lower lobectomy was performed. Microscopically, the tumor was a high-grade serous carcinoma and was diagnosed as an ovarian cancer metastasis.

Comparison of chest CT features between progressive and nonprogressive patients with COVID-19 pneumonia: A meta-analysis.

Objective:The aim of this study was to compare the radiographic features of patients with progressive and nonprogressive coronavirus disease 2019 (COVID-19) pneumonia.Methods:PubMed, Embase, and Cochrane Library databases were searched from January 1, 2020, to February 28, 2022, by using the keywords: “COVID-19”, “novel Coronavirus”, “2019-novel coronavirus”, “CT”, “radiology” and “imaging”. We summarized the computed tomography manifestations of progressive and nonprogressive COVID-19 pneumonia. The meta-analysis was performed using the Stata statistical software version 16.0.Results:A total of 10 studies with 1092 patients were included in this analysis. The findings of this meta-analysis indicated that the dominating computed tomography characteristics of progressive patients were a crazy-paving pattern (odds ratio [OR] = 2.10) and patchy shadowing (OR = 1.64). The dominating lesions distribution of progressive patients were bilateral (OR = 11.62), central mixed subpleural (OR = 1.37), and central (OR = 1.36). The other dominating lesions of progressive patients were pleura thickening (OR = 2.13), lymphadenopathy (OR = 1.74), vascular enlargement (OR = 1.39), air bronchogram (OR = 1.29), and pleural effusion (OR = 1.29). Two patterns of lesions showed significant links with the progression of disease: nodule (P = .001) and crazy-paving pattern (P = .023). Four lesions distribution showed significant links with the progression of disease: bilateral (P = .004), right upper lobe (P = .003), right middle lobe (P = .001), and left upper lobe (P = .018).Conclusion:Nodules, crazy-paving pattern, and/or new lesions in bilateral, upper and middle lobe of right lung, and lower lobe of left lung may indicate disease deterioration. Clinicians should formulate or modify treatment strategies in time according to these specific conditions.

This video is going to show you how it works to identify the target nodule by using positioning method of 3D localization based on anatomical landmarks. A 71 years old male patient with a mixed ground glass nodule was found in the lower lobe of left lung. First, the head of the transverse process of the vertebral body as point

This video is going to show you how it works to identify the target nodule by using positioning method of 3D localization based on anatomical landmarks. A 71 years old male patient with a mixed ground glass nodule was found in the lower lobe of left lung. First, the head of the transverse process of the vertebral body as point