Lung Mass Research Articles

Understanding the significance of adipose tissue in the inflammatory response to COVID-19

AimAbdominal adipose tissue is closely related to inflammatory parameters. During the Coronavirus disease (COVID-19) pandemic, inflammatory markers determined the prognosis of the patients. The study aims to investigate the prognostic value of abdominal adipose tissue and its compartments, CRP (C-reactive protein), and NLR (neutrophil to lymphocyte ratio) in patients with COVID-19. Materials and methodsA retrospective analysis was conducted on 381 patient records with positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Reverse transcription polymerase chain reaction (RT-PCR) results and low-dose chest computerized tomography (CT) scans between January 1, 2021, and May 30, 2021, at a single center. The study included 270 patients after excluding those under 18 years, with contrast-enhanced CT scans, inappropriate CT images, existing lung masses, or a history of abdomen/thorax operations. Patient demographics, chronic diseases, laboratory results, adipose tissue measurements, and the presence and score of findings on chest CT were noted. ResultsTo evaluate the prognosis of the patient group, the group was divided into two groups, hospitalized and non-hospitalized individuals. The group of hospitalized individuals had significantly higher levels of total severity score (TSS), total adipose tissue (TAT), visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), CRP, and NLR parameters compared to the non-hospitalized group (p < 0.05). In the multivariate logistic regression analysis, age, TSS, SAT, and CRP levels were found to independently have a significant effect (p < 0.05) in discriminating between hospitalized and non-hospitalized patients. ConclusionOur study shows that abdominal adipose tissue, especially subcutaneous compartment and related comorbidities increase the risk of hospitalization for COVID-19 infection. In the current era of widespread COVID-19 variants, healthcare professionals can use these parameters to assess hospitalized patients and provide a prognostic tool. Advances in knowledgeThis study analyzed abdominal adipose tissue and inflammatory parameters associated with COVID-19 infection. The contrast with other studies is that SAT value was determined as a significant independent variable. This indicates that there is a need for more studies on this subject.

Multiple organs injury and myocardial energy metabolism disorders induced by isoproterenol

The study sought to assess the detrimental effects of isoproterenol (ISO) on major organs and investigate the potential reversibility of these adverse reactions in mice. Male mice were divided into normal control, 0.2 mg/kg.d and 3.0 mg/kg.d ISO groups, and were subcutaneously administered of the respective doses for 14 consecutive days. Subsequently, a recovery period experiment was conducted, replicating the aforementioned procedure, followed by an additional 2-week recovery period for the mice. Following 14 consecutive days of administration, mice treated with ISO exhibited notable cardiac damage manifested by abnormal ECG patterns, dysregulated energy metabolism, elevated cardiac hypertrophy, and increased heart pathological score. Additionally, the administration of ISO resulted in liver and kidney damage, as evidenced by increased pathological score, serum albumin level, and urea level. Lung damage was also observed, indicated by an increase in lung pathological score. Furthermore, the administration of ISO at a dosage of 3.0 mg/kg.d resulted in a decrease in liver mass index, serum iron content, and an increase in lung mass index. After a 2-week recovery period, mice treated with ISO showed abnormalities in ECG patterns and dysregulated myocardial energy metabolism, accompanied by a decrease in serum iron content. Histopathological examinations revealed continued pathological changes in the heart and lung, as well as significant hemosiderin deposition in the spleen. Furthermore, the group treated with ISO at a dosage of 3.0 mg/kg.d showed an increase in serum AST and TP levels. In summary, the study demonstrates that both 0.2 mg/kg.d and 3.0 mg/kg.d doses of ISO can induce damage to the heart, liver, lung, kidney, and spleen, with the higher dose causing more severe injuries. After a 2-week withdrawal period, the liver, kidney, and thymus injuries caused by 0.2 mg/kg ISO shows signs of recovery, while damage to the heart, lung, and spleen persists. The thymus injury mostly recovers, with minimal kidney pathology, but significant damage to the heart, liver, and lung remains even after the withdrawal period for the 3.0 mg/kg ISO dose.

18 F-FAPI for Imaging Metastatic Perivascular Epithelioid Cell Neoplasm.

We compared 18 F-FAPI and 18 F-FDG PET/CT findings of metastatic perivacular epitheliod cell tumor in a 23-year-old woman. Apart from showing strong uptake of a left upper lung mass that showed moderate uptake on 18 F-FDG, 18 F-FAPI PET/CT additionally presented hypermetabolism in diffuse multifocal lesion throughout the body. This case suggests that 18 F-FAPI PET/CT might play a more beneficial role than 18 F-FDG PET/CT in identifying and assessing the extent of perivascular epithelioid cell tumors.

Abstract WMP67: Pump Brain - A Leading Cause of Cortical Cerebral Microbleeds

Introduction: A major cause of cerebral microbleeds (CMBs) is underrecognized and has been attributed to cerebral amyloid angiopathy (CAA) throughout modern medicine. CMBs are acquired by patients undergoing cardiopulmonary bypass (CPB). CPB is utilized for heart and lung transplants, aorta repairs, valve surgeries, mass resections, and coronary artery bypass grafting (CABG) which alone accounts for 400k patients per year. CABGs can be done off CPB in certain patients. Due to their distribution, these CMBs are attributed to CAA, leading to confounding research and suboptimal patient care, especially in those requiring anticoagulation. Methods: This was a single-center, IRB approved, retrospective cohort study of patients who underwent CPB and had postop MRI between 11/1/11 and 3/1/23. Preop and additional postop MRIs were analyzed if available. Outcomes included number and distribution of CMBs, presence of superficial siderosis, FAZEKAS, and CPB duration. We also analyzed MRIs of patients who had off CPB CABG during the same period. Results: Out of 60 patients who underwent CPB, 60 had predominantly cortical CMBs on postop MRI, with a mean of 50 CMBs, and mean age of 61. The 6 patients who had CABG off CPB had 0 CMBs. Higher CMBs were associated with longer CPB duration and with procedures that are associated with more blood loss (p&lt; 0.05). Despite having CMBs, no CPB patients had superficial siderosis, and they had relatively low FAZEKAS scores. Nineteen of the CPB patients had future MRIs and had no evidence of CMB progression. Conclusion: Cortical CMBs are associated with procedures that use CPB and are not seen in off CPB CABG. The CMBs may be related to utilization of cardiotomy suction that exclusively uses roller pumps. CBP related CMBs are a unique clinical entity that is not associated with the progressive cognitive changes and bleeding risk of CAA. While no significant short-term changes are noted, their mechanism and natural history requires further investigation.

Enhancing diagnostic precision: Electromagnetic navigation bronchoscopy with cryobiopsy in pulmonary and mediastinal lesions – A case study

IntroductionA minimally invasive approach in the diagnosis of peripheral pulmonary lesions may pose a challenge for thoracic surgeons when selecting the most appropriate technique. Electromagnetic navigation bronchoscopy (ENB) is an innovative technique used in the diagnosis of lung tumors.AimEvaluation of the merits of ENB in patient manifesting undiagnosed pulmonary and mediastinal lesions, while concurrently investigating its influence on the determination of the ultimate therapeutic strategy.Case studyThe 73-year-old male patient with a suspicious lung mass was admitted to the hospital for diagnosis and subsequent treatment. The patient underwent an invasive diagnosis of lung and mediastinum using ENB with cryobiopsy. The histopathological examination revealed adenocarcinoma and lymphoma cells, ultimately guiding the initiation of appropriate therapeutic measures.Results and DiscussionAmong the available methods, those with the highest diagnostic yield and safety should be chosen. Precise diagnosis of pulmonary lesions holds paramount importance for guiding appropriate treatment in cases of suspected malignancy.ConclusionsENB with cryobiopsy proves effective diagnosis in case of peripheral lesions that are difficult to access for classical techniques.

The first report of endobronchial ultrasound-guided transbronchial needle aspiration from an intraparenchymal lung mass in a child: Advances in pediatric EBUS.

The first report of endobronchial ultrasound-guided transbronchial needle aspiration from an intraparenchymal lung mass in a child: Advances in pediatric EBUS.

Pulmonary Tuberculosis Mimicking a Lung Cancer: a Case Series

Tuberculosis (TB) is an infectious disease that is caused by Mycobacterium tuberculosis. Despite TB being a preventable and curable disease, it still remains to be one of the leading causes of mortality worldwide and continues to be prevalent. TB can manifest in multiple systems, but its primary target is the lungs. Pulmonary TB can present differently depending on the patient's immune status and comorbidities. One atypical presentation of TB is lung mass, which can mimic lung malignancy and cause diagnostic delays.In this case series, we report on four cases in which TB was initially suspected to be lung malignancy. All four patients had lung masses on diagnostic imaging; microbiological testing was positive in only two of the patients and bronchoscopic abnormalities were seen in two of those. In two of the four cases, caseating granulomas were present on biopsy. All four patients attained clinical and radiologic resolution.In conclusion, despite years of knowledge and the prevalence of TB, atypical presentations can still cause diagnostic delays and unnecessary interventions. This case series provides examples of TB mimicking lung cancer, so considering TB as a differential diagnosis for patients presenting with a lung mass is crucial.

18F-FDG PET/CT anatomic and metabolic guidance in CT-guided lung biopsies

PurposeTo evaluate the role of Fluorine-18 fluorodeoxyglucose (18F-FDG) PET/CT as a metabolic guide in increasing the accuracy, diagnostic yield and safety of CT-guided percutaneous needle lung biopsy (PNB). Methods and MaterialsRetrospective analysis of 340 consecutive patients with suspicious lung nodules, masses or extensive disease that underwent lung biopsy over a 3-year period. Patients were divided into three groups; those that had PET/CT prior to the biopsy, those that had PET-CT following the biopsy and those who did not undergo PET-CT. Correlation was made with the histopathological result. Results353 PNBs were performed (median lesion size 30 mm, 7–120 mm) with overall diagnostic rate of 83.9 % (95.8 % malignant). Biopsy success rate was 88.8 % with PET-CT pre-PNB, versus 78.9 % of 175 PNB without PET-CT upfront (p < 0.01 Fisher exact test). Correct targeting to PET-CT-maximum activity area (MAA) was present in 87.1 %. Biopsy success rate was 88.8 % for PNBs targeting the PET-CT-MAA region and only 52.8 % for PNBs not targeting the PET-CT-MAA (p < 0.0001). PET-CT pre-PNB had higher rates of PET-CT-MAA targeting compared to PET-CT post PNB (91.0 % v 80.0 %, p = 0.01). The availability of PET-CT before the PNB lead to significantly increased biopsy success rates in patients with a mass (OR:7.01p = 0.004), compared to a nodule (p = 0.498) or multiple nodules (p = 0.163). Patients with a PET-CT pre-PNB underwent fewer PNB passes (mean 2.6 v 3.1, p < 0.0001 Mann Whitney U). Serious complications were less common in PET-CT pre-PNB group (4.5 % v 10.9 %, p < 0.05). Pre-PNB PET-CT performance improvement applied to all 3 radiologists and was greatest for masses and infiltrative abnormalities. ConclusionMetabolic information provided by 18F-FDG PET/CT and PNB localisation to the PET-CT maximum activity region is associated with higher diagnostic biopsy rates especially in masses and appears to account for improved performance, less needle passes and complications when available pre-biopsy.

P-08 Ectopic Cushing Syndrome in a patient with small cell lung cancer

Abstract Introduction Ectopic Cushing's syndrome (ECS) is a rare endocrine disorder caused by the autonomous secretion of ACTH from a tumor apart from the hypophysis. ECS is the second most common paraneoplastic syndrome associated with small cell lung cancer (SCLC). Due to the aggressive nature of the syndrome, ECS is difficult to diagnose. Most patients present electrolyte disturbances and muscle weakness rather than the typical clinical features of CS. Clinical Case A 70-year-old female patient hospitalized due to pleural effusion was referred for worsening hyperglycemia. She had no previous history of diabetes mellitus. She had a history of 90 pack-years of smoking and chronic obstructive pulmonary disease. The laboratory results were: fasting plasma glucose 216 mg/dl; creatinine, 0.81 mg/dl; sodium, 138 mmol/l; potassium, 3.1 mmol/l; HbA1c, 8.3%; Arterial blood gas analysis revealed metabolic alkalosis (pH 7.63, HCO3 53.6 meq/L). Due to resistant hypokalemia, the patient was evaluated for CS. The patient's ACTH level was 415.5 pg/ml and cortisol level was 63.44 μg/dl. Table 1 shows the tests perfomed for the diagnosis of CS. Pituitary MRG revealed no pathology. IPSS could not be performed as it is not available at our center. A suspicious mass in the right lung was observed on the thorax CT. The pathology of the cytology sample from the pleural effusion revealed SCLC. A chemotherapy regimen containing cisplatin was initiated. Intravenous potassium and acetazolamide treatment were administered for resistant hypokalemia. However, the patient died one month after diagnosis due to type 2 respiratory failure. Conclusion Ectopic secretion of ACTH accounts for 10–15% of CS. ECS is usually caused by mainly SCLC (45%), thymic carcinoma (15%), bronchial carcinoid (10%) and pancreas islet-cell carcinoma (10%). ECS is reported to occur in 1.6%–4.5% of patients with SCLC. IPSS is the most reliable examination for ECS. For ECS, surgery remains the optimal treatment. Some reports showed that metyrapone, ketoconazole and octreotide are effective but not widely used. In our case, the presence of resistant hypokalemia, metabolic alkalosis, and worsening hyperglycemia with the lack of classic clinical features of CS led us to suspect ECS. ECS has a higher incidence of hypokalemic alkalosis than other causes of Cushing's syndrome (&amp;gt;90% vs. 10%). Excessive amounts of adrenal steroids with the inhibition of the enzyme 11β-hydroxysteroid dehydrogenase may cause this pathology. This enzyme normally converts cortisol to cortisone avoiding the mineralocorticoid action of cortisol. In conclusion, although rare, in cases where conditions such as metabolic alkalosis, resistant hypokalemia, with the absence of classic clinical features of CS, the possibility of ectopic CS should be kept in mind.Table 1.Laboratory results of the patient

Genomic structural variation is associated with hypoxia adaptation in high-altitude zokors.

Zokors, an Asiatic group of subterranean rodents, originated in lowlands and colonized high-elevational zones following the uplift of the Qinghai-Tibet plateau about 3.6 million years ago. Zokors live at high elevation in subterranean burrows and experience hypobaric hypoxia, including both hypoxia (low oxygen concentration) and hypercapnia (elevated partial pressure of CO2). Here we report a genomic analysis of six zokor species (genus Eospalax) with different elevational ranges to identify structural variants (deletions and inversions) that may have contributed to high-elevation adaptation. Based on an assembly of a chromosome-level genome of the high-elevation species, Eospalax baileyi, we identified 18 large inversions that distinguished this species from congeners native to lower elevations. Small-scale structural variants in the introns of EGLN1, HIF1A, HSF1 and SFTPD of E. baileyi were associated with the upregulated expression of those genes. A rearrangement on chromosome 1 was associated with altered chromatin accessibility, leading to modified gene expression profiles of key genes involved in the physiological response to hypoxia. Multigene families that underwent copy-number expansions in E. baileyi were enriched for autophagy, HIF1 signalling and immune response. E. baileyi show a significantly larger lung mass than those of other Eospalax species. These findings highlight the key role of structural variants underlying hypoxia adaptation of high-elevation species in Eospalax.

Local imaging to interpret tumor size in F18 fluorodeoxyglucose positron emission tomography/CT in lung cancers.

This study aimed to determine the thoracic and extra-thoracic extension of the disease in patients diagnosed with lung cancer and who had whole-body F18-fluorodeoxyglucose positron emission tomography/CT imaging and to investigate whether there is a relationship between tumor size and extrathoracic spread. A total of 308 patients diagnosed with lung cancer were included in this study. These 308 patients were first classified as group 1 (SPN 30 mm>longest lesion diameter ≥10 mm) and group 2 (lung mass (longest lesion diameter ≥30 mm), and then the same patients were classified as group 3 (nodular diameter of ≤20 mm) and group 4 (nodular size of >20 mm). Group 1 was compared with group 2 in terms of extrathoracic metastases. Similarly, group 3 was compared with group 4 in terms of frequency of extrathoracic metastases. F18 fluorodeoxyglucose positron emission tomography/CT examination was used to detect liver, adrenal, bone, and supraclavicular lymph node metastasis, besides extrathoracic metastasis. Liver, bone, and extrathoracic metastasis in group 1 was statistically lower than in group 2 (p<0.001, p<0.01, and p=0.03, respectively). Liver, extrathoracic, adrenal, and bone metastasis in group 3 was statistically lower than that in group 4 (p<0.001, p=0.01, and p=0.04, p<0.01, respectively). The extrathoracic extension was observed in only one patient in group 3. In addition, liver, adrenal, and bone metastases were not observed in group 3 patients. Positron emission tomography/CT may be more appropriate for cases with a nodule diameter of ≤20 mm. Performing local imaging in patients with a nodule diameter of ≤20 mm could reduce radiation exposure and save radiopharmaceuticals used in positron emission tomography/CT imaging.

A Physics-informed Deep Neural Network for Harmonization of CT Images.

An adversarial generative network was trained on virtual CT images acquired under various imaging conditions using a virtual imaging platform with 40 computational patient models. These models featured anthropomorphic lungs with different levels of pulmonary diseases, including nodules and emphysema. Imaging was conducted using a validated CT simulator at two dose levels and varying reconstruction kernels. The trained model was tested on an independent virtual test dataset and two clinical datasets. On the virtual test set, the harmonizer improved the structural similarity index from 79.3 ±16.4% to 95.8 ±1.7%, normalized mean squared error from 16.7 ±9.7% to 9.2 ±1.7%, and peak signal-to-noise ratio from 27.7 ±3.7dB to 32.2 ±1.6dB. Moreover, the harmonized images yielded more precise quantification of emphysema-based imaging biomarkers for lung attenuation, LAA-950 from 5.6 ±8.7% to 0.23 ±0.16%, Perc15 from 43.4 ±45.4 HU to 20.0 ±7.5 HU, and Lung Mass from 0.3 ±0.3 g to 0.1 ±0.2 g. In clinical data, the harmonizer reduced biomarker variability by an average of 70%. For lung nodules, harmonized images improved the detectability index by 6.5-fold and DNN-based precision by 6%. The proposed harmonizer significantly enhances image quality and quantification accuracy in CT imaging. The study demonstrated the potential utility of image harmonization for consistent CT image quality and reliable quantification, which is crucial for clinical applications and patient management.

Acute Toxicity of Aqueous Extract from Bredemeyera floribunda Root Bark in an Animal Model

The medicinal plant Bredemeyera floribunda Willd. is used to treat cardiovascular disease, chronic fatigue, low libido, as well as increased diuresis. However, studies considering the toxicity of this plant are scarce. Develop an aqueous extract of B. floribunda considering traditional use and determine the average lethality (LD50), signs, and symptoms of toxicity. The B. floribunda extract was obtained by immersing the root bark in ultrapure water for 18 hours at 4°C, under constant stirring. The test extract was administered in a single dose of 2.000 mg/kg by gavage to rats. Signs and symptoms of toxicity were determined according to the Hippocratic screening test and compared with the control group. In addition, a necropsy was performed for macroscopic evaluation of the organs in the abdominal cavity. A powder was obtained from aqueous extracts that showed the same organoleptic characteristics and emulsification capacity as those presented by the fresh root when prepared according to popular tradition. The LD50 was greater than the test dose with three animals surviving. On the other hand, necropsy of dead rats showed necrosis and reduction in lung mass, in addition to the presence of foam and excessive distension of the stomach and intestines. The main symptoms of toxicity were anesthesia, ataxia, sedation, loss of muscle strength, and excessive drowsiness in the first 24 hours. There was no difference between the control and extract groups with regard to body mass, food, and water intake, as well as in macroscopy of the heart, liver, lungs, intestines, spleen, pancreas, and kidneys. The aqueous extract of the B. floribunda was considered nontoxic or of very low toxicity. However, it is capable of altering the activity of the central nervous system and causing disorders in the respiratory and digestive systems.

Recurrent Pneumonia in a Child: Identifying an Underlying Pulmonary Sequestration

Abstract Background: Pulmonary sequestration is a rare foregut abnormality, accounting for a small percentage of lung malformations, with intralobar type being more common than extralobar. Clinical Description: A 10-year-old girl presented with recurring symptoms of breathlessness, cough, chest pain, and intermittent fever since 6 months of age. Earlier, she had been hospitalized four times in the past, and even received antitubercular treatment, but without any relief. Evaluation at our hospital revealed a cystic mass in the left lower lung with anomalous feeding vessels, leading to a diagnosis of pulmonary sequestration. Management and Outcomes: Surgical correction in the form of lobar resection and ligation of the feeding vessels was done. The patient’s symptoms significantly improved postoperatively, and there were no complications or recurrence during follow-up. Conclusion: Pulmonary sequestration is a rare abnormality. Misdiagnosis as a common respiratory infection can delay appropriate management. Surgical treatment through lobar resection can dramatically alleviate symptoms.

Renal Pelvic Cancer with Multiple Lung Metastases in a Patient with Polycystic Kidney Disease, Initially Diagnosed as Non-small Cell Lung Cancer: An Autopsy Case Report.

A 64-year-old man with autosomal dominant polycystic kidney disease (ADPKD) on hemodialysis presented with multiple lung masses. A computed tomography (CT)-guided biopsy revealed non-small-cell lung cancer (NSCLC). A cavitary mass in the right lung indicated primary NSCLC (cT2N1M1a, stage IVA). Pembrolizumab was initiated because of a high programmed death-ligand 1 (PD-L1) expression (90%). On day 10 post-treatment, he developed acute respiratory failure with diffuse ground-glass opacities on chest CT, indicative of pembrolizumab-induced lung injury. Despite steroid pulse therapy, the patient died on day 13. An autopsy revealed left renal pelvic cancer with lung metastases, highlighting the diagnostic challenges in ADPKD.

Exploring Histologic Emphysema in a Rural Lobectomy Cohort: Insights and a Review Correlations of Histologic Emphysema

Exposure to cigarette smoking is extensive in rural Appalachia where one in four adults’ smokes. The clinical implications of this habit are evident among patients with some of the highest national rates for chronic obstructive pulmonary disease (COPD), lung cancer, and pulmonary fibrosis. Individuals undergoing surgical lung resection for suspicious lung nodules or masses at a major rural academic center in the area demonstrated an excessive burden of histologic emphysema (73.5%). This destructive process of the alveoli was linked to a significant burden of comorbid conditions, various radiologic patterns of interstitial lung diseases and interstitial lung abnormalities, histologic fibrosis, inflammatory processes (respiratory bronchitis, desquamative interstitial pneumonia, peribronchiolar metaplasia), anthracosis, and lung cancer. Physiologically, this combination of injuries imposed substantial limitations. Findings presented may enhance the understanding of concurrent changes occurring in the smoker. The complex inter-relationships and disparities between clinical COPD, radiologic and histologic emphysema are defined. While emphysema remains an irreversible pathology, associated inflammatory and fibrotic conditions are possibly amenable to earlier smoking cessation strategies and available disease-modifying therapies.

Embryonal Rhabdomyosarcoma of The Lung: A Common Tumor with Atypical Primary Site

Introduction: Embryonal rhabdomyosarcoma is the commonest type of rhabdomyosarcoma in children. Its common primary sites include but not limited to head and neck, genitourinary, and extremities. However, embryonal primary pulmonary rhabdomyosarcoma is extremely rare. Case presentation: Our patient, 5 years old male presented with a four-week history of progressive worsening shortness of breath. The patient also had previous history of recurrent pneumonitis. On imaging, contrast enhanced chest CT demonstrated 16.1 x 13.1 x 13.3cm predominantly cystic mass with solid component on the right hemithorax. Metastatic workup was none revealing. Hence, open thoracotomy was done to cut out the mass, and sample was sent for histopathologic and immunohistochemistry assessment. Microscopy revealed pleomorphic round to oval to spindle blue cells in myxoid stroma along with anaplastic cells. Furthermore, the cells immunohistochemically reacted positively for smooth muscle actin, myogenin, and vimentin. Hence, the mass was confirmed to be embryonic type rhabdomyosarcoma of the lung. Accordingly, chemotherapy commenced, and he was given three cycles. Unfortunately, the patient died after three months. This case underscores the importance of suspecting primary pulmonary rhabdomyosarcoma in patients with recurrent bouts of pneumonic symptoms. Moreover, primary pulmonary rhabdomyosarcoma should be part of the differential diagnosis for lung mass with mixed components (cystic and solid). Conclusion: Finally, embryonic rhabdomyosarcoma showing anaplastic cells tends to have unfavorable prognosis.

INFLAMMATORY RENAL PSEUDOTUMOR IN WEGENER'S GRANULOMATOSIS: INITIAL MANIFESTATION OF A CASE

We report a case of a 37-year-old woman who was treated in the emergency department with low back pain and intermittent cough for 7 days. Computed tomography and magnetic resonance imaging of the abdomen and pelvis revealed an expansive, heterogeneous formation with ill-defined limits, measuring 6.3 x 5.1 cm, in the upper third of the left kidney and a second expansive formation located in the lower pole of the left kidney, measuring 5.1 x 5.9 x 6.4 cm. She then underwent uneventful left videolaparoscopic radical nephrectomy. After the procedure, the patient progressed with prostration, decreased general condition and cough with brownish secretion, in addition to complaining of decreased visual and hearing acuity. She underwent laboratory and imaging tests, revealing bilateral cavitated lung masses that proved to be a case of Wegener's granulomatosis. Treatment with pulse therapy was initiated, but the patient died days later. This is the 11th case described in the scientific literature and serves as a warning to guide the management of this rare clinical condition, especially with regard to the presentation of inflammatory renal pseudotumor.

Trapped Lung as a Sequela of Dramatic Tumor Shrinkage of Lung Cancer.

Herein, we report a case of 72-year-old man who had L858R EGFR-mutated lung adenocarcinoma. Chest computed tomography revealed a large lung mass that had completely replaced the right upper lobe. Although the mass dramatically shrank after initiating chemotherapy, non-malignant pleural effusion appeared. Because diffuse pleural thickening and shrinking of the thoracic cage gradually became apparent, the patient was diagnosed with trapped lung. Despite the stabilization of his lung cancer, he experienced severe dyspnea and significant weight loss, ultimately leading to a decreased performance status. Chest physicians should recognize that trapped lung can develop as a sequela of dramatic tumor shrinkage in lung cancer.

Claw Hand in Parsonage Turner syndrome

An elderly patient with an extensive smoking history presented with acute severe right-hand pain and evolving weakness with patchy sensory deficit. He had minimal relief from multiple analgesics, gabapentin, and acupuncture. Motor deficits in his right-hand progressed. A nerve conduction study confirmed motor-predominant polyneuropathy and magnetic resonance imaging (MRI) of his C-spine and brachial plexus ruled out apical lung mass or other structural lesions. A positive GalNAc-GD1a ganglioside antibody (IgG) was noted. A diagnosis of immune mediated neuralgic amyotrophy or Parsonage-Turner Syndrome was made. Intravenous immune globulin (IVIG) was started with partial improvement in motor function, six months later. Although this patient did not have SARS-CoV-2 infection nor was he recently vaccinated, this case is of interest to hospital-based internists as the Covid pandemic has seen an increase in the in reported cases of neuralgic amyotrophy worldwide due to the virus itself as well as the associated COVID-19 vaccines.