Lower Lobe Of Left Lung Research Articles

Ruptured Lung Abscess with Empyema Thoracis without Pneumothorax in Children - A Rare Presentation

A 5-month-old male infant was admitted with the complaints of cough & fever for 18 days and respiratory distress for 4 days. He was febrile, tachypneic (RR-58/min) with SpO2 - 94% on 2 L/min with face mask with left sided restricted chest movement with diminished breath sound. Initially he was diagnosed as left sided pleural effusion. Chest x-ray was suggestive of encysted pleural effusion (left). CT of chest revealed collapsed left lower lobe with pleural effusion and inflammatory changes in left upper lobe. Per operative finding showed pleural thickening, adhesion of oblique fissure, and perforated lower lobe of left lung. And finally infant was diagnosed as ruptured lung abscess of lower lobe of left lung with empyema thoracis. The patient was managed with decortication with segmental resection, and inj. linezolid after getting C/S and recovered.

Anomalous systemic arterial supply to the left basal lung with a calcified abnormal vessel: a case report

BackgroundAnomalous systemic arterial supply to the normal basal segment of the left lower lobe is a congenital abnormality of the lung, frequently and is generally diagnosed at a young age. Surgery is generally recommended if symptoms such as blood sputum or fever are observed. Resection of the abnormal artery is often performed at an early age, with only few reports of surgery being performed at an older age. In addition, to the best of our knowledge, there are no reports on surgical treatment of abnormal calcified vessels to date. Herein, we have presented a case in which a calcified aberrant vessel of lung was resolved surgically.Case presentationA 65-year-old female, previously diagnosed with anomalous systemic arterial supply to the left normal basal segment of the left lung lower lobe of lung was under observation on the basis of being asymptomatic.The patient presented to the emergency room with the chief complaint of blood in the sputum and she was referred to our hospital for a surgery. Computed tomography showed circumferential calcification of the intima of the abnormal vessel, which might have contributed to incomplete resection of the artery if automatic sutures were used. Thus, the abnormal vessel was ligated and dissected using pledgeted 4–0 polypropylene sutures and vessel clips under open thoracotomy followed by left lower lobectomy. The patient was discharged seven days after surgery without any serious surgical complications.ConclusionsVascular congenital anomalies of the lung are often operated at a young age presenting due to the associated symptoms. However, even if the disease is discovered incidentally and does not cause any symptoms or calcification in the aberrant artery, early surgical intervention is important due to the possibility of calcification occuring in the future. This can help minimize the degree of surgical invasion.

Abstract 3343: Durable response to osimertinib monotherapy as first line treatment in stage IVB lung adenocarcinoma with atypical EGFR L747P mutation

Abstract Background: Targeted therapy plays a critical role in NSCLC with a certain type of mutation. Osimertinib is a third generation EGFR tylosine kinase inhibitor (TKI) which is primarily indicated for NSCLC with EGFR exon 19 deletions or exon 21 L858R mutations. Although use of osimertinib is currently limited to patients with common EGFR mutations, it has been reported that patients with NSCLC harboring uncommon EGFR mutations demonstrated response to EGFR TKIs. Herein, we present a case of advanced adenocarcinoma of the lung with atypical EGFR L747P mutation that revealed a noteworthy durable response to osimertinib monotherapy as first line treatment. Case presentation: A 47-year-old woman with no smoking history presented with new-onset hemoptysis and cough. A chest CT scan showed a lobulated, spiculated 38 mm left upper lung mass with innumerable bilateral pulmonary nodules. CT-guided biopsy demonstrated adenocarcinoma of lung with PD-L1 1-2%. Subsequent PET-CT scan revealed hypermetabolic neoplasm in the left lower lobe with scattered area of abnormal focal FDG uptake within the liver. Brain MRI showed unremarkable findings. The patient was diagnosed with stage IVB adenocarcinoma of lung with multiple hepatic metastases. Circulating tumor DNA (ctDNA) NGS assay showed EGFR L747P [0.3% of variant allele frequency (VAF)] and tissue NGS assay revealed EGFR L747P missense variant c.2239_2240delinsCC (22.8% of VAF). The patient was started on osimertinib 80 mg daily. Follow up CT scan in six week demonstrated decrease in size of the left lower lobe lung mass to 32 mm. She has maintained durable SD for six months without any adverse effects. Most recent follow-up CT scan after eight months from the treatment demonstrated SD of the mass in the left lower lobe and less prominent numerous pulmonary nodules. Discussion: It has not been reported that osimertinib monotherapy is used as first line therapy in NSCLC with EGFR L747P mutation. We report the case of durable response to osimertinib in patients with advanced NSCLC with EGFR L747P mutation. Our case highlights the potential efficacy of osimertinib to NSCLC with atypical EGFR mutation. Although there was a clinical trial to explore clinical activity of osimertinib in patients with NSCLC harboring uncommon EGFR mutation, EGFR L747R mutation was not investigated at that time. To date, there are no ongoing clinical trials on the use of osimertinib in NSCLC with EGFR L747P mutation. Further investigations are warranted to confirm the efficacy of osimertinib in this type of mutation. Citation Format: Horyun Choi, Yeun Ho Lee, Jinah Kim, Leeseul Kim, Na Hyun Kim, Young Kwang Chae. Durable response to osimertinib monotherapy as first line treatment in stage IVB lung adenocarcinoma with atypical EGFR L747P mutation [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3343.

A surgical case: patient with left lower lobe lung cancer with a common trunk in the inferior pulmonary vein.

... The authors would like to thank Editage (www.editage.jp) for the English language editing. This report received no funding from any agency in the public, commercial and non-profit sectors. European Journal of Cardio-Thoracic Surgery thanks Vanessa Diaz-Ravetllat and the other, anonymous reviewer(s) for their contribution to the peer review process of this article.

Treatment of massive hemoptysis after thoracic aortic aneurysm repair

BackgroundMassive hemoptysis after thoracic aortic aneurysm (TAA) repair is a rare but potentially lethal condition. Endovascular management is a challenging treatment option due to the complexity of culprit vessel access.Case presentationAn 81-year-old woman was referred to our hospital with massive hemoptysis. She had a history of graft replacement and thoracic endovascular aortic repair (TEVAR) for dissecting TAA. Computed tomography (CT) showed massive atelectasis with hematoma in the left lower lung lobe adjacent to the descending aortic aneurysm treated with TEVAR. Contrast-enhanced CT revealed a pseudoaneurysm and proliferation of abnormal vessels at the peripheral side of the left pulmonary ligament artery (PLA) in the atelectasis. The PLA continued to the right subscapular artery via a complex collateral pathway. Diagnostic angiography of the right subcapsular artery revealed a pseudoaneurysm and abnormal vessels at the peripheral side of the left PLA with a systemic-pulmonary artery shunt. Transcatheter arterial embolization (TAE) for the left PLA via the collateral pathway with N-butyl cyanoacrylate achieved complete embolization. The patient’s hemoptysis was controlled and she was discharged.ConclusionsHere we presented a case of massive hemoptysis due to PLA disruption that occurred after TAA repair. TAE via a complex collateral pathway is a feasible and effective treatment for hemoptysis, even in patients who have undergone surgical or endovascular TAA repair.

Temporary positive expiratory pressure (TPEP) as an alternative approach in the treatment of persistent atelectasis in a patient with Steinert disease: a case report.

We describe the clinical case of a patient affected by Steinert disease with persistent dyspnea complicated by a complete obstructive atelectasis of left lower lung lobe. The atelectasis has been successfully treated using the TPEP machine, with resolution of radiological pattern and improvement of the symptoms.

Clinical analysis of primary lung tumors in 56 children

Objective: To investigate the clinical manifestation, pathological type, treatment and prognosis of primary lung tumors in children. Methods: We collected and retrospectively analyzed the clinical manifestation, pathological type, therapeutic method and prognosis of 56 primary lung tumors patients who diagnosed from 2009 to 2019 in Guangzhou Women and Children Medical Center. Results: There were 56 patients identified as the primary lung tumors, including pleuropulmonary blastoma (PPB, n=28), pulmonary inflammatory myofibroblastic tumor(IMT, n=20), mucoepidermoid carcinoma(n=6), infantile hemangioma (n=1), pulmonary sclerosing hermangioma(n=1). Respiratory symptoms were the most manifestation at the time of diagnosis including 26 patients with cough, 3 with hemoptysis, and 17 with dyspnea. Others included 15 with fever, 3 with chest pain, and 2 with epigastiric pain. The primary tumor of 18 cases were located in the lower lobe of left lung, 11 cases in the lower lobe of right lung, 10 cases in the upper lobe of left lung, 7 cases in the upper lobe of right lung, 6 cases in the middle lobe of right lung, and 4 cases in pulmonary hilum. Among the 56 patients, 41 patients underwent thoracotomy, 13 thoracoscopy, and 2 fiberoptic bronchoscopy. Five patients with type Ⅰ PPB were still alive at the end of follow-up without chemotherapy. Among 5 patients with type Ⅱ PPB, 2 patients without chemotherapy died after recurrence, 3 patients suffered postoperative chemotherapy were still alive at the end of follow-up. All of the 18 patients with type Ⅲ PPB underwent postoperative chemotherapy with IVADo regimen. Recurrence occurred in 6 cases, distant metastasis occurred in 3 cases, and cancer-related deaths occurred in 8 cases. For 20 patients with IMT, recurrence occurred in 5 of 13 patients experienced wedge resection, 1 of 6 patients experienced lobectomy and 1 of 6 underwent fiberoptic bronchoscopy, respectively. For 6 mucoepidermoid carcinoma patients, lobectomy was carried on 5 patients, wedge resection on 1 patient, all of them were still alive at the end of follow-up. One hermangioma patient underwent fiberoptic bronchoscopy and other 1 sclerosing hermangioma patient underwent wedge resection, both of them were still alive at the end of follow-up. Conclusions: The clinical manifestations of the primary lung tumors in children are nonspecific. Complete resection and achieving negative marginattribute to the excellent outcome. Adjunctive treatment such as chemotherapy is necessary for patients with type Ⅱ and type Ⅲ PPB.

Solitary pulmonary metastasis after meningioma surgery of the head: a case report

BackgroundMeningioma is the most common type of benign primary brain tumor that is rarely associated with distant metastasis. No established treatment strategy for metastatic meningiomas exists to date. Herein, we report a case of solitary pulmonary metastasis of meningioma detected 2 years after neurosurgical resection of the primary tumor.Case presentationA 75-year-old male patient underwent neurosurgical resection of a convexity meningioma (World Health Organization grade II atypical meningioma), followed by postoperative radiotherapy for the residual tumor. Two postoperative years later, a solitary 10-mm pulmonary nodule in the left lower lung lobe was detected on chest computed tomography. The patient underwent video-assisted thoracoscopic left lower lobectomy for suspected pulmonary metastasis of meningioma. The pathological diagnosis was solitary pulmonary metastasis of meningioma. No sign of further recurrence was noted at 8 months postoperatively.ConclusionsWe present a rare and unique surgical case of solitary pulmonary metastasis of meningioma. Further investigation is necessary to establish the standardized treatment strategy for metastatic meningiomas.

Congenital pulmonary airway malformation in adults: A case series

Introduction. Two-thirds of patients with congenital pulmonary airway malformation are asymptomatic at birth, but during life they may develop symptoms such as recurrent respiratory infections. The purpose of this paper is to present three cases of adult patients in whom congenital pulmonary airway malformation was diagnosed and treated at the Institute for Lung Diseases of Vojvodina, along with the clinical course of the disease and the therapeutic procedure. Case Report 1. A 24-year-old female with a medical history of asthma and recurrent signs of lower respiratory tract infections was referred to a thoracic surgeon. Computed tomography of the chest and clinical features were consistent with a congenital lung disease. A left lower video-assisted thoracoscopic lobectomy was performed. Histopathological analysis confirmed type II congenital pulmonary airway malformation with pulmonary sequestration. Case Report 2. A 41-year-old male with a history of left-sided spontaneous pneumothorax at the age of 16 was referred to a thoracic surgeon due to moderate hemoptysis, one month after hospital treatment of left-sided bronchopneumonia. On chest computed tomography, multiple cystic lesions were found in the left lower lung lobe. Thoracotomy and left lower lobectomy were performed. Histopathological analysis confirmed type I congenital pulmonary airway malformation. Case Report 3. The third patient was a 16-year-old male with a history of juvenile asthma and recurrent right-sided bronchopneumonia. Sings of necrotizing pneumonia, lung abscess, and mediastinal lymphadenomegaly were found in the affected lobe. Thoracotomy and right lower lobectomy were performed. Histopathological analysis confirmed type II congenital pulmonary airway malformation. Conclusion. In children and young adults with recurrent small airway inflammation, congenital lung malformation should be considered in the differential diagnosis.

PULMONARY CYSTIC ECHINOCOCCOSIS

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: A lung nodule in an elderly patient almost always raises concern for lung cancer, irrespective of risk factors. While lung cancer remains foremost in the clinicians mind, a thorough occupational history may provide clues implicating a different diagnosis of more uncommon etiologies of lung nodule, such as in our case. CASE PRESENTATION: A 74 year old male with a history of hypertension and prostate cancer in remission presented to his primary care physician with 3 months of dry cough and chest pain. He had no smoking history. Vital signs showed a blood pressure of 170/93 mmHg, with other vital signs within normal limits. Physical examination and laboratory analysis was unrevealing. A chest radiograph showed a 2.9 centimeter (cm) left lower lobe nodule. Computerized tomography scan (CT) of the chest demonstrated a lobular left lower lobe lung nodule measuring 3x2x2 cm with smooth margins. Fluorodeoxyglucose (FDG)-positron emission tomography (PET) scan failed to reveal any other avid regions. A robotic left lower lobe wedge resection was performed, revealing a cystic membranous spherical lesion that spilled fluid when incised. Frozen section pathology showed a hydatid cyst containing innumerable Echinococcus granulosus organisms. He was started on albendazole therapy. It was later discovered that the patient was in the Army and deployed to rural southern Vietnam for 5 months in his youth, where he was working in farms and with wild animals, swimming through dirty water and drinking contaminated water. When back in the United States, he did cross country trips, riding mules in Utah. He also lived in Hawaii for 3 years with a dog. Echinococcus serology was negative. Repeat CT scan showed no other hydatid lesions and no other liver lesions. The patient completed 1 month total of albendazole and has recovered. DISCUSSION: Only a minority of lung involvement in E. granulosus infection coincides with liver cysts (20-40%). The lower lobes of the lung are commonly involved (60%). Patients may be asymptomatic, have cough, hemoptysis or even anaphylaxis (1). Differentiating an unruptured cyst from other pulmonary pathology such as malignancy, can be difficult radiographically. One Turkish study reports 7 patients in a 4 year span who had surgical removal of a presumed malignancy but were found to have a hydatid cyst (2), and can be a common occurrence in endemic areas. Chest imaging usually reveals a homogenous well-circumscribed lesion with smooth lobulated margins. If the bronchus is eroded, air is introduced into the cyst and may appear as a crescent of air (crescent sign) (3). CONCLUSIONS: Obtaining an extensive travel and exposure history may substantially alter the differential diagnosis of such lesions, and assist in diagnostic and management considerations. REFERENCE #1: Morar R, Feldman C. Pulmonary echinococcosis. Eur Respir J. 2003 Jun;21(6):1069-77. doi: 10.1183/09031936.03.00108403. PMID: 12797504. REFERENCE #2: Çobanoğlu U, Aşker S, Mergan D, Sayır F, Bilici S, Melek M. Diagnostic Dilemma in Hydatid Cysts: Tumor-Mimicking Hydatid Cysts. Turk Thorac J. 2015 Oct;16(4):180-184. doi: 10.5152/ttd.2015.4606. Epub 2015 Oct 1. PMID: 29404100. REFERENCE #3: Garg MK, Sharma M, Gulati A, Gorsi U, Aggarwal AN, Agarwal R, Khandelwal N. Imaging in pulmonary hydatid cysts. World J Radiol. 2016 Jun 28;8(6):581-7. doi: 10.4329/wjr.v8.i6.581. PMID: 27358685. DISCLOSURES: No relevant relationships by Oleg Epelbaum, source=Web Response No relevant relationships by Daniel Greenberg, source=Web Response No relevant relationships by Ravi Manglani, source=Web Response No relevant relationships by Fouzia Shakil, source=Web Response No relevant relationships by Helena Tomac Pavosevic, source=Web Response

Clinical characteristics of patients infected with Chlamydia pneumoniae in Beijing from 2015 to 2019

Objective: To aralyze the clinical characteristics of Chlamydia pneumoniae infection in Beijing. Methods: Based on Beijing Respiratory Pathogen Surveillance System, acute respiratory infection patients were recruited from 35 different types of sentinel hospitals in Beijing. Their epidemiological and clinical data were systematically collected and clinical specimens were also obtained. Nuclear acid testing was performed for 30 types of respiratory pathogens (including Chlamydia pneumoniae). The identified patients of Chlamydia pneumoniae infection were divided into two groups, the acute upper respiratory tract infection (AURI) group and pneumoniae group. The differences in clinical characteristics, laboratory examination and prognosis were compared by using independent sample t test, Mann-Whitney U test, χ2 test or Fisher's exact probability test. Results: A total of 119 patients of Chlamydia pneumoniae infection were included, including 12 patients in the AURI group and 107 patients in pneumoniae group. Chlamydia pneumoniae infection mainly occurred in people aged from 5 to 44 years, accounting for 81.5% (97/119). The three most common clinical symptoms were cough (92.4%, 110/119), fever (88.8%, 95/107), and sputum production (76.5%, 91/119). White blood cell counts increased in 39.3% (46/117) of patients. Neutrophile granulocyte proportion increased in 39.7% (46/116) of patients. Platelet count increased in 36.9% (41/111) of patients. An increase of the creatine kinase MB isoenzyme (CKMB) was observed in 12 pneumonia patients (24.5%, 12/49). Radiological examination showed that 90.6% (87/105) of patients in the pneumoniae group had pulmonary parenchymal changes; the lesion occurred most commonly in the lower right lung lobe (34.3%, 36/105) and the lower left lung lobe (27.6%, 29/105). Although 73.8% (79/107) of patients in the pneumoniae group were hospitalized, no case received intensive care unit or mechanical ventilation. As to outcomes, one patient developed respiratory failure and 6 patients suffered myocardial injury. No death was observed in this study. The median days of hospitalization and course of illness for pneumonia patients M(P25,P75) were 10.0 (7.0, 13.0) days and 18.0 (13.5, 22.0) days, respectively. Conclusion: Generally, Chlamydia pneumoniae infections in Beijing from 2015 to 2019 were mild, and the main clinical manifestations were cough, fever and sputum. However, most patients in the pneumoniae group caused by Chlamydia pneumoniae still required hospitalization but with a better outcome.

Comparison of two different lung ultrasound imaging protocols in COVID-19 pneumonia.

PurposeThe aim of this study was to determine the effectiveness of two different lung ultrasonography (LUS) methods that can be used in the diagnosis of coronavirus disease 2019 (COVID-19) and to investigate their correlations with computed tomography (CT).MethodsIn this prospective, randomized, and single-blind study, 60 patients with COVID-19 were included. The patients were randomized to either the 12-zone LUS group (n=30) or the 14-zone LUS group (n=30). The correlation between LUS and thoracic CT scores was evaluated. As a secondary outcome measure, the characteristic features of the findings of thoracic CT and LUS were examined.ResultsThe study was completed with a total of 59 patients. Moderate and high correlations were found between the total CT and LUS scores in the 12-zone and 14-zone study groups. There were no statistically significant differences in the lesion types detected in patients using LUS and CT (P>0.05). The left lung lower lobe CT scores were statistically significantly lower in the 14-zone study group than in the 12-zone group (P=0.019). The left lower lobe CT and LUS scores were highly correlated in the 14-zone group (P<0.001, r=0.902).ConclusionThe results of our study indicated that the two different LUS examination methods performed in different patients had similar findings in terms of the diagnosis and their correlations with CT results.

Diagnosing Disseminated Nocardiosis in a Patient With COVID-19 Pneumonia

Signs and symptoms of atypical pneumonia include fever, shortness of breath, cough, and chest pain. During the coronavirus disease 2019 (COVID-19) pandemic, identifying other causes of febrile respiratory illness in patients who tested positive for COVID-19 has been very challenging. Concerns over infecting healthcare personnel and other patients can impede further evaluations like bronchial lavage, lung biopsies, and other invasive tests. A very high index of suspicion, perhaps unreasonably so, is required to perform invasive tests to investigate alternative possible causes of the illness. We present the case of a 63-year-old man who presented to the hospital with dyspnea. Chest X-ray demonstrated a consolidation in the left lower lobe lung field with a possible underlying mass, and the patient tested positive for COVID-19. He received the standard treatment for COVID pneumonia at the time in our institution (remdesivir and dexamethasone), empiric antibiotics for community-acquired pneumonia, and was eventually discharged home with supplemental oxygen. Several days later, the patient returned to the hospital again with worsening dyspnea and was readmitted. Persistent illness and worsening imaging prompted bronchoscopy. The bronchoscopy showed narrowing of the airway in the left upper lobe, and Nocardia asteroides was isolated from bronchial aspirate. The isolation of Nocardia prompted an investigation for central nervous system involvement with an magnetic resonance imaging (MRI) of the head. The MRI demonstrated multiple bilateral ring-enhancing lesions in the brain. To our knowledge, this is the first reported case of disseminated nocardiosis superimposed on COVID-19 pneumonia.

Chest CT features of COVID-19 pediatric patients presented with upper respiratory symptoms

BackgroundAn outbreak of coronavirus disease 2019 (COVID-19) infection caused by a novel coronavirus began in December 2019 in Wuhan in central China that affect the children and adult and causes respiratory disease. This study aimed to highlight the CT features of pediatric patients with COVID-19 with upper respiratory symptoms.ResultsThe mean age of the 53 patients who enrolled in this study were 14.06 ± 4.12 years (range 1-18 years). Majority (75.5%) of them were adolescent. Running nose and fever were the most common symptoms. Forty-four (83%) patients had normal CT with no ground glass opacity (GGO) or consolidation, only 9 patients showed lung opacities; 5 cases showed consolidation, 2 cases with GGO, while consolidation with GGO was noted in another 2 patients. Among these 9 patient, six (66.7%) of them show unilateral lung opacities with peripheral distribution of these opacities in eight (88.9%) patients. The most frequently affected lobes were right and left lower lung lobes that were noted in 6 out of 9 patients with lung opacities (66.7%) in each lobe. Bronchitis was predominant in 23 (43.4%) cases.ConclusionsRT-PCR is a gold slandered test in the diagnosis of COVID-19 in children with upper respiratory tract symptoms as Chest CT cannot standalone as a diagnostic tool owing to high prevalence of normal chest CT in these patients. However, in case of lung affection, the presence of unilateral, peripheral consolidation with lower lobe predominance, in addition to bronchial wall thickening should be considered as a hallmark of chest CT in diagnosis of pediatric patients with COVID-19 with upper respiratory symptoms.

ETV6-NTRK3 translocation-associated low-grade mucinous bronchial adenocarcinoma: A novel bronchial salivary gland-type non-small cell lung cancer subtype

IntroductionNTRK fusion genes have been found in several solid tumors, among which NSCLC and sarcoma. Novel NTRK translocation-related tumors are still being discovered. MethodsWe report a 49-year-old patient with a mass in the left lower lung lobe that was resected. This specimen was analyzed and sequenced using targeted DNA next generation sequencing (NGS) and anchored-multiplex-PCR (AMP) targeted RNA NGS. ResultsOn pathological evaluation, a peribronchial mucinous neoplasm with a unique morphology was found. RNA NGS analysis showed anETV6-NTRK3 translocation in a low-grade mucinous bronchial adenocarcinoma. ConclusionsThis entity represents a novel subtype of non-small cell lung cancer, which we would like to term ‘ETV6-NTRK3 translocation-associated low-grade mucinous bronchial adenocarcinoma’.

Aquaphobia: A Case Report on the Unique Presentation of a Specific Phobia

<h3>Introduction</h3> Aquaphobia is an irrational fear of water that is classified as a specific phobia. Specific phobias are a type of anxiety disorder that cause persistent and unrealistic fear triggered by an object, person, animal, activity, or situation. The National Institute of Mental Health states that approximately 19.2 million American adults suffer from some form of a specific phobia. They often present early in life but it is important to recognize that the geriatric population may develop phobias too, especially as they experience the negative effects of medical conditions. Previous studies report up to a 10% phobia prevalence rate in people 65 or older, with specific phobias accounting for 2.1% of this group. Adult phobias often last many years and will not subside unless treated appropriately. Those who suffer from specific phobias tend to avoid the trigger and, in certain situations, this can have a major detriment to quality of life. Here, we present the case of a 69-year-old male who developed aquaphobia while undergoing treatment for non-small cell lung cancer. <h3>Methods</h3> The patient was seen and treated by the psychiatry team through multiple telehealth evaluations over a four-month period. <h3>Results</h3> Case: JY is a 69-year-old male with the diagnosis of non-small cell lung cancer, 80 pack-year smoking history, COPD, chronic kidney disease, and no past psychiatric history. He was diagnosed in 2019 after a CT chest scan showed left upper lobe and right lower lobe lung nodules. He underwent a complex surgical procedure followed by chemotherapy and radiotherapy. In June 2020, he experienced coughing spells and distressing shortness of breath and underwent thoracentesis, which confirmed malignant pleural effusion. Shortly after thoracentesis, JY presented for initial psychiatry telehealth evaluation accompanied by his wife. Following this procedure, he had been experiencing persistent and irrational fear of water. He reported episodes of intense anxiety and shortness of breath associated with any activity that involved water, including looking at a glass of water, drinking water, shaving, washing dishes, or showering. The sight of water elicited an immediate anxious reaction where he started to gasp for air and felt that he was going to die. As a result, he began to avoid situations that required contact with water. He stopped showering and shaving and he avoided drinking water to the point of frequently experiencing thirst and dehydration. He recognized that his fear was irrational and believed his condition severely interfered with his life. He was diagnosed with aquaphobia based on history and DSM-5 Criteria. He was started on sertraline 25mg daily which was titrated up to 200mg daily. Quetiapine was added as an adjuvant with a dose of 12.5mg PO QAM, noon, and 50mg bedtime. The patient was referred to psychotherapy but was unable to attend sessions. However, during telehealth sessions the psychiatrist was able to provide psychoeducation about the patient's condition and guided breathing exercises; the patient found this to be helpful. After four months of treatment, the patient reported significant improvement in symptoms and was to resume activities that involved exposure to water. <h3>Conclusions</h3> Anxiety disorders in older adults reduce quality of life yet these disorders have received little attention in the literature. In this poster, we will discuss the unique presentation of aquaphobia in an elderly patient and the potential causes and treatment options. This case highlights that specific phobias can develop in the geriatric population particularly as they experience the long-term sequelae of medical conditions. In the case of JY, it is hypothesized that his feeling of choking while drinking water, in the setting of shortness of breath due to malignant pleural effusions, triggered an irrational fear of water. The development of this condition severely decreased the patient's quality of life and had negative effects on his overall health. Effective therapeutics to aquaphobia include a pharmacological approach as well as Cognitive Behavioral Therapy (CBT) or exposure therapy. These treatments allow patients to regain control of reactions to stress and stimulus in the presence of water. In the case of JY, a pharmacological approach was found to be successful. Phobias can severely affect quality of life in the elderly and it is therefore important to promptly recognize the diagnosis to quickly enact treatment modalities. <h3>Funding</h3> No funding was provided for this case report.

Next-generation sequencing facilitates differentiating between multiple primary lung cancer and intrapulmonary metastasis: a case series

BackgroundIn lung cancer management, differential diagnosis between multiple primary lung cancer (MPLC) and intrapulmonary metastasis (IMP) is a critical point that is of direct therapeutic and clinical importance. However, this process often suffers from absence of a gold standard, resulting in equivocal cases. Herein, we present a series of three cases, in which genomic alteration patterns revealed by next-generation sequencing (NGS) facilitated the differential diagnosis between MPLC and IMP.Case presentationCase 1 was a 57-year-old female with two separate lesions in the upper lobe and the lower lobe of left lung, which were both histopathologically determined as T2aN0M0 adenocarcinomas. NGS identified an EGFR L858R in one lesion and an EGFR 20 exon insertion in the other one, suggestive of double primary malignancies. The patient underwent wedge resections and received an adjuvant treatment of icotinib and chemotherapy. She had a disease-free survival (DFS) of 19 months and counting. Case 2 was a 55-year-old female with multiple small lesions in both lungs. Histopathological examinations of resected lesions from right upper lobe revealed three subtypes: atypical adenomatous hyperplasia of alveolar epithelium, adenocarcinomas in situ and minimally invasive adenocarcinoma. NGS identified two different BRAF driver mutations G466E and V600_K601delinsE in two lesions of adenocarcinoma in situ, and a BRAF K601E in a lesion of minimally invasive adenocarcinoma. Case 3, a 68-year-old male, had the right upper lobe lesion histophathologically classified as a stage T3NxM0 mixed adenoneuroendocrine carcinoma and the left upper lobe lesion as a stage T1aN0M0 adenocarcinoma. NGS performed with different loci of surgical tissues revealed a rare sensitizing EGFR mutation G719A shared by the right upper lobe lesion and lymph node, and two EGFR mutations L861Q and G719S in left upper lobe lesion. The patient received icotinib treatment postoperatively and achieved a stable disease with a progression-free survival of 5 months.ConclusionOur cases provide evidence for utility of NGS in facilitating diagnosis and treatment decisions.

A Rare Presentation of a Large Embryonal Rhabdomyosarcoma at Retroperitoneal Region with Intra-thoracic Extension & Misdiagnosed as Lower Respiratory Tract Infection: A Case Report

Introduction: We are reporting a case of 18 year old boy who presented with features of lower respiratory tract infections and labelled as suffering from left suprarenal gland tumor. However, after complete evaluation, it is diagnosed as left retroperitoneal tumor extending into left thoracic cavity with involvement of left lower lobe lung. He underwent debulking surgery. Rhabdomyosarcoma (RMS ) originates from immature striated muscle and it is considered as the most aggressive malignant mesenchymal tumor. The most common location of RMS is head and neck region. The retroperitoneal presentation of embryonal RMS is extremely rare. The four histological features of RMS, classified by WHO are embryonal, alveolar, pleomorphic and spindle cell or sclerosing. Pleomorphic RMS has worse prognosis. The incidence of embryonal tumors is higher in males with bimodal age distribution, between 2-6 years and second peak between 10-18 years. Their detection is incidental when the size is small and as the size enlarges, symptoms helps in detection. Due to its rarity at retroperitoneal location, there is a lack of literature over the adjuvant treatment. As the size enlarges at retroperitoneal region, enblock resection with clear margins becomes a difficult task and if planned for R0 resection, multiorgan resection escalates surgical morbidity rate. Conclusion: It is a rare location of embryonal rhabdomyosarcoma at retroperitoneal region with rare presentation of intra-thoracic infiltration. R0 resection is the principle goal of surgical excision of retroperitoneal sarcoma.

An optimistic point in COVID-19 pandemic: a case report of large adult congenital cystic adenomatoid malformation

BackgroundCovid-19 pandemic is a major health calamity causing global crisis involving every aspect of the society. CT chest has become an essential diagnostic investigation and as a prognostic tool for assessment for COVID-19 bronchopneumonia. This case report is about an incidental unexpected finding in a young female, who underwent CT chest screening with suspicion of COVID-19 bronchopneumonia.Case presentationA 29-year-old female came with the complaints of sore throat, myalgia, and fever for the past 3 days. She was referred to our department for plain screening CT chest to rule out COVID 19 infection. She was an active sports person since childhood. CT chest revealed a large well-defined bullous cystic lesion of size 16 × 9.5 × 9.5 cm in the left lung lower lobe with partial sparing of its superior, anterior, and posterior basal segments. Imaging diagnosis of large bullous cystic lesion with emphysematous changes was made. No features of COVID 19 bronchopneumonia. Thoracoscopy-guided lobectomy was done, and tissue was sent to histopathological examination. Final diagnosis was large type 1 congenital cystic adenomatoid malformation with mucinous metaplasia. Our case is unique in the sense that large adult CCAM with mucinous metaplasia of the epithelium is a rare presentation. Further it was diagnosed as a part of COVID 19 screening.ConclusionCCAM presentation in adult is rare. Asymptomatic CCAM lesion of this size diagnosed during COVID 19 chest CT screening was rarely described.

Primary pulmonary mucoepidermoid carcinoma: Cyto-histologic correlation and review of the literature

Preoperative fine needle aspiration diagnosis and cyto-histologic correlation of primary pulmonary mucoepidermoid carcinoma have rarely been described in detail in the literature. A 26-year old male presented at our institution with cough, bloody sputum, and a 4.3 cm left lower lobe lung mass. He was accurately diagnosed with pulmonary mucoepidermoid carcinoma on preoperative aspiration cytology. The patient subsequently proceeded to left lower lobectomy, confirming the diagnosis. In this article, we present a detailed report of primary pulmonary mucoepidermoid carcinoma describing the cytologic and histologic morphologic features, its differential diagnosis with review of the literature.