Segment Of Right Lower Lobe Research Articles

Intracranial tuberculoma in human immunodeficiency virus-infected patient: a case report

Intracranial tuberculoma is one of the most devastating forms of Mycobacterium tuberculosis infection, presenting in 1% of all tuberculosis cases. This condition is significantly associated with high morbidity and mortality and frequently occurs in immunocompromised patients such as patient with human immunodeficiency virus (HIV) infection. Symptoms of intracranial tuberculoma include headache, nausea, vomiting, ataxia, diplopia, hemiparesis, and seizure. We reported a 34-years-old male patient presented with progressive left side weakness for 1 month prior to admission. Patient also complained of intermittent fever, headache, productive cough, night sweats, and unintentional weight loss. On neurological examination, power of left upper and lower limb was 3. Patient had a positive test result for HIV serologic examination. Chest X-ray showed infiltrate in the apical segment of right lower lobe of the lung. Mycobacterium tuberculosis was found on sputum gene expert examination. Head computed tomography (CT) scan showed multiple hypodense lesions with contrast enhancement in right caudate nucleus and right lentiform nucleus, suggestive for tuberculoma. Patient was treated with fixed-dose combination of antituberculosis, corticosteroid, and other symptomatic medication and showed a significant clinical improvement.

POS-133 CASE REPORT OF DISSEMINATED KLEBSIELLA INFECTION IN T2DM LEADING TO CKD

K. pneumoniae can present as two forms of community-acquired pneumonia, acute and chronic. Although acute pneumonia may turn into necrotizing pneumonia, which results in a prolonged clinical course, it often has a rapidly progressive clinical course. In contrast, chronic Klebsiella pneumonia runs a protracted indolent course that mimics other chronic pulmonary infections and malignancies. The Klebsiella pneumoniae bacteria usually affects the right upper lung lobe and results in the creation of a cavity, as well as pus-producing tissue death.K. pneumoniae is an aggressive microorganism, accounting for 0.5 to 5% of pneumonia cases. It can lead to cavitation (30-50% of cases) and necrotising pneumonia (NP) within a short period of time (days). Case : 40 year old male with a history of diabetes mellitus (DM) was admitted 20 days back patient was admitted and treated for DKA and LRTI discharged after treatment. Patient readmitted 20 days later with complaints of right sided loin pain, high grade fever of 8 days, cough with expectoration for one month, pyuria for 5 days and anuria for one day. Patient readmitted On admission – P-96/min, BP-140/90 mmhg, RR-26/min, Spo2-96% with O2. On evaluation patient was found to have raised creat (8mg/dl) initiated on hemodialysis. Patient ultrasound showed of left sided bulky kidney with acute pyelonephritis. CXR showed cavitatory lesion in middle lobe of right side lung. 5days Later patient complaint of increased left loin pain repeat USG showed left sided psoas abscess so CT showed no any evidence of communication of pyelonephritis with abscess. Pigtail drain was placed for psoas abscess, culture which was positive for klebsiella. Sputum culture was positive for klebsiella, A diagnosis of dissiminated klebsiella infection was made. In spite of all necessary investigations and treatment patient was dialysis dependent, patient deteriorated over time and could not be saved. Investigations :Tabled 1ParametersValuesHemoglobin9.8 gm/dlTotal leukocyte counts25,500/cummPlatelets2.4 lac/cummUrea104 mg/dlCreatenine4.2 mg/dlSerum Na136 mmol/lSerum K4.5 mmol/lBilirubin1.5 mg/dlSGOT/SGPT45/32Calcium7.6 mg/dlPhosphorus5.8 mg/dlUric acid6.2 mg/dlHbA1c10.5%Urine examinationAlb ++ Sug + Epi cells 1-2/min Pus cells - plenty RBC - 1-2/hpf24 hr urinary protein1.5 gm/day Open table in a new tab Sputum culture & Pus culture – klebsiella Sputum for MTB - negative Fundus – moderate NPDR CXR – Cavitatory lesion in right lung middle zone USG – RK – 12.5*5.9cm, LK – 13.6*6.2cm mod dilation of pelvicalyceal system bilateral bulky kidneys with left acute pyelonephritis. CT abd – left psoas bulky with evidence of 8*2.5 cm well defined hypodense collection within. CT chest – Thick walled cavitatory lesions with surrounding consolidation noted in medial segment of right middle lobe, postero-basal segment of right lower lobe, superior segment of left lower lobe We conclude that patients with immunocompromised state like Diabetes mellitus are more prone to disseminated infections which can lead to high morbidity and mortality. Good glycemic control, early diagnosis and effective management with could be key role in managing a diabetic patient.

Lophomonas blattarum - A blunder!

Background: Lophomonas blattarum is a parasite colonising gut of cockroaches. There are 136 case reports from immunocompromised patients and children suffering from respiratory tract infections. Here we report a case where broncho alveolar lavage fluid from a child showed structures which convincingly appeared like a flagellate parasite but was later confirmed to be ciliocytophthoria. Case Description: A 5 y old female child hailing from rural southern India came with complaints of cough, cold and abdominal pain since 6 m. In view of increased severity of symptoms, high grade fever and cavitatory lesions in the lung, the child was referred to our centre. We considered the differential diagnoses - Hydatid cyst, Tuberculosis, non infectious causes of lung cyst. Investigations showed Eosinophilia and raised ESR. CT scan of chest showed consolidation with cavities involving apical segment of right lower lobe, anterior segment of left upper lobe suggestive of infective etiology. Broncho alveolar lavage fluid was negative for acid fast bacilli and TB PCR. On wet mount examination, motile structures appearing to have tuft of flagella were seen. Modified Trichrome stain showed numerous inflammatory cells and pyriform shaped structures with tuft of flagella arranged irregularly at one pole. Inner structures were not appreciated very clearly and a presumptive diagnosis of the parasite Lophomonas blattarum was made. The patient was treated with metronidazole 7.5 mg/kg body weight for 10 d awaiting further results. Child improved symptomatically and discharged. Discussion: Since it was difficult to do the molecular tests, we sent the micrscopic photographs and videos to CDC Diagnostic Assistance team to help us solve the case. They confirmed it to be ciliocytophthoria. Bronchial epithelial cells are cylindrical with basal nuclei and a visible terminal bar just beneath the regularly arranged cilia at the other end. This was a learning experience for us to differenciate the cells from the parasite. We now routinely perform special stains on samples found to have motile structures like these. Conclusion: Lophomonas blattarum rarely causes human disease more often misdiagnosed because the movement of the flagellate parasite resembles the motion of detached ciliated bronchoepithelial cells when brochoalveolar lavage fluid is examined under the microscope.

Pulmonary light chain deposition disease: a case series and literature review.

BackgroundLight chain deposition disease (LCDD) is a systemic disorder typically characterized by non-amyloid monoclonal immunoglobulin light chain deposition in tissues. LCDD is recognized as a multisystem disease, in which the kidneys and liver are often affected. However, it is rarely encountered as a localized pulmonary disease. This study set out to characterize the clinical manifestations and features of pulmonary light-chain deposition disease (PLCDD) by conducting a retrospective analysis of clinical data obtained from patients, with the aim of improving clinical understanding of PLCDD.MethodsData from inpatients diagnosed with PLCDD at Shanghai Pulmonary Hospital (Shanghai, China) between January 2010 and December 2018 were retrospectively collected and analyzed.ResultsA total of 4 PLCDD patients confirmed with PLCDD by pulmonary tissue biopsy were analyzed. All of the patients were female and were found by physical examination. Chest images of each patient’s lungs showed multiple cystic cavities with nodules. A history of Sjogren’s syndrome was present with 1 patient, 2 patients were diagnosed with Sjogren’s syndrome after surgery (including 1 diagnosed with Sjogren’s syndrome in the 8th year of follow up), and 3 patients had leukopenia. The longest follow-up period was 8 years. During the follow-up period, 2 patients developed pulmonary lesions (1 patient had an enlarged original cystic lesion in basal segment of right lower lobe 2 years after surgery, while the other developed new nodules 7 years after surgery).ConclusionsPLCDD is characterized by multiple cystic changes with nodules in both lungs and can be easily complicated by lymphoid diseases such as Sjogren’s syndrome. The clinical symptoms cannot be characterized, and the diagnosis depends on lung biopsy.

Spectrum of Chest CT Findings in a Familial Cluster of COVID-19 Infection.

HomeRadiology: Cardiothoracic ImagingVol. 2, No. 1 PreviousNext Images in Cardiothoracic ImagingFree AccessPulmonary ImagingSpectrum of Chest CT Findings in a Familial Cluster of COVID-19 InfectionTianzhu Liu*, Peikai Huang*, Hailong Liu, Lesheng Huang, Ming Lei, Wangdong Xu, Xiaolu Hu, Jun Chen, Bo Liu Tianzhu Liu*, Peikai Huang*, Hailong Liu, Lesheng Huang, Ming Lei, Wangdong Xu, Xiaolu Hu, Jun Chen, Bo Liu Author AffiliationsFrom the Department of Radiology, Guangdong Hospital of Traditional Chinese Medicine, Zhuhai, 519000, China (T.L., P.H., H.L., L.H., M.L., W.X., X.H., J.C.) and Department of Radiology, Guangdong Hospital of Traditional Chinese Medicine, No. 111 Dade Road, Guangzhou, 510000, China (B.L.).Address correspondence to B.L. (e-mail: [email protected]).Tianzhu Liu*Peikai Huang*Hailong LiuLesheng HuangMing LeiWangdong XuXiaolu HuJun ChenBo Liu Published Online:Feb 13 2020https://doi.org/10.1148/ryct.2020200025MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In * The authors contributed equally to this work.On January 29, 2020, a 43-year-old woman presented with a 4-day history of fever, cough, sputum production, and dyspnea. She had a recent history of travel to Wuhan (the center of the COVID-19 outbreak [formerly known as 2019 novel coronavirus]) with her 15-year-old son. Her temperature was 38°C (100.4°F) and she had coarse breath sounds on auscultation. Chest CT showed peripheral multifocal ground-glass opacities (Fig 1a). Her son also presented with prolonged fever (11 days), but without respiratory symptoms. On examination, his temperature was 39°C (102.2°F), and lungs were clear on auscultation. Chest CT showed centrilobular ground-glass nodules in the left lung (Fig 1b). The patient’s 43-year-old husband, who met the definition for a contact person (1), was asymptomatic on screening, but tested positive for COVID-19 on sputum real-time polymerase chain reaction test, as did the son and the wife. His chest CT was unremarkable (Fig1c), and he eventually developed fever on the following day.Figure 1a: (a) Unenhanced CT image in a 43-year-old woman shows multiple ill-defined ground-glass opacities in the lateral segment of right lower lobe and the posterior segment of left lower lobe. (b) Unenhanced CT image in a 15-year-old male patient shows subtle nodular ground-glass opacities in the posterior segment of left lower lobe. (c) Unenhanced CT image in a 43-year-old man shows normal lungs.Figure 1a:Download as PowerPointOpen in Image Viewer Figure 1b: (a) Unenhanced CT image in a 43-year-old woman shows multiple ill-defined ground-glass opacities in the lateral segment of right lower lobe and the posterior segment of left lower lobe. (b) Unenhanced CT image in a 15-year-old male patient shows subtle nodular ground-glass opacities in the posterior segment of left lower lobe. (c) Unenhanced CT image in a 43-year-old man shows normal lungs.Figure 1b:Download as PowerPointOpen in Image Viewer Figure 1c: (a) Unenhanced CT image in a 43-year-old woman shows multiple ill-defined ground-glass opacities in the lateral segment of right lower lobe and the posterior segment of left lower lobe. (b) Unenhanced CT image in a 15-year-old male patient shows subtle nodular ground-glass opacities in the posterior segment of left lower lobe. (c) Unenhanced CT image in a 43-year-old man shows normal lungs.Figure 1c:Download as PowerPointOpen in Image Viewer This familial cluster exemplifies the spectrum of clinical and radiologic presentation that can be encountered in those infected by COVID-19 (2, 3). This heterogeneity should be a focus for future investigations looking into susceptibilities related to the individual’s immune response and the stage of disease.Disclosures of Conflicts of Interest: T.L. disclosed no relevant relationships. P.H. disclosed no relevant relationships. H.L. disclosed no relevant relationships. L.H. disclosed no relevant relationships. M.L. disclosed no relevant relationships. W.X. disclosed no relevant relationships. X.H. disclosed no relevant relationships. J.C. disclosed no relevant relationships. B.L. disclosed no relevant relationships.* The authors contributed equally to this work.Keywords: Adults, Breast, CT, Infection, Inflammation Authors declared no funding for this work.

Pulmonary Langerhans cell histiocytosis in adults: A case report.

BACKGROUNDLangerhans cell histiocytosis (LCH) is a rare disease of unknown aetiology. While it may affect any organ of the body, few cases of solitary lung involvement are published in the literature. Here, we report a rare case of pulmonary LCH (PLCH) in an adult.CASE SUMMARYA 52-year-old male presented to hospital in July 2018 with complaints of progressively worsening cough with sputum, breathlessness, easy fatigability, and loss of appetite since 2016, and a 32-year history of heavy cigarette smoking (average 30 cigarettes/d). Physical examination showed only weakened breathing sounds and wheezing during lung auscultation. Chest computed tomography (CT) showed irregular micronodules and multiple thin-walled small holes. Respiratory function tests showed a slight decrease. Ultrasonic cardiogram showed mild tricuspid regurgitation and no pulmonary hypertension. Fibreoptic bronchoscopy was performed with transbronchial biopsies from the basal segment of right lower lobe. LCH was confirmed by immunohistochemistry. The final diagnosis was PLCH without extra-pulmonary involvement. We suggested smoking cessation treatment. A 3-mo follow-up chest CT scan showed clear absorption of the nodule and thin-walled small holes. The symptoms of cough and phlegm had improved markedly and appetite had improved. There was no obvious dyspnoea.CONCLUSIONImaging manifestations of nodules, cavitating nodules, and thick-walled or thin-walled cysts prompted suspicion of PLCH and lung biopsy for diagnosis.

Common and Uncommon Variations of Pulmonary Venous Drainage in Patients Undergoing Thoracoscopic Lobectomy.

Variations in pulmonary venous anatomy should not be undermined by thoracic surgeons during procedures which involve the pulmonary veins. We have identified vascular anomalies in 25 of 346 patients undergoing video-assisted thoracoscopic surgery lobectomy at our Thoracic Surgery Unit, between December 2016 and November 2018. Some vascular anomalies described have not been reported in recent literature and include right V7 draining into the middle lobe pulmonary vein, accessory right V6 behind the bronchus intermedius, two V6 from the apical segment of left lower lobe, two V6 from the apical segment of right lower lobe, and one of them draining into the superior pulmonary vein. Thoracic surgeons should be aware of this type of anomalies because failure in the preoperative or intraoperative identification of the pulmonary venous variations may lead to serious complications.

Treatment of medial-basal segment of right lower lobe

Treatment of medial-basal segment of right lower lobe

P2.02-005 A Rare Clinical Presentation Of EGFR-Mutant Non-Small Cell Lung Cancer With Oligo-Acrometastasis

44% of acrometastasis are originated from primary lung tumors and metastasis to digits is seen in 0.2% of patients with lung cancer. After clinical staging, amputation or radiotherapy are most often therapeutic options for pain palliation. We want to present an oligo-acrometastasis of fourth proximal phalanx of left hand from EGFR-mutant non-small cell lung cancer. A 58-year-old man was admitted with pain and swelling in fourth finger of his left hand (Figure 1A). Magnetic resonance imaging (MRI) of left upper extremity showed destruction by a soft tissue measuring about 30x17 mm on the distal part of fourth proximal phalanx of left hand (Figure 1B-C). Three phase bone scan with technetium-99m methylene diphosphonate (MDP) revealed increased radiotracer uptake in the fourth finger. Diffuse increased uptake is seen at the left wrist secondary to the old fracture and trauma in both blood pool and metabolic phases and hypertrophic osteoartropathy in both tibia (Figure1E-F). Computed thorax tomography (CTT) revealed a 25x21 mm lobulated contour lesion in the posterior segment of right lower lobe (Figure 1H). CT-guided biopsy was performed and pathological examination showed non-small cell lung carcinoma-not otherwise specified (NSCLC-NOS). A 24x27x24 mm mass with SUV-max value 9.85 in the right lower lobe, right tracheobronchial and right hilar lymphadenopathies 13 mm in diameter was detected (SUV-max: 7.51) on PET-CT. Patient was staged as T1bN2M1b with oligoacrometastasis. His finger was amputated from metacarpophalangeal level and surgery margin was negative for tumor. Pathological diagnosis was metastatic NSCLC-NOS harboring EGFR-21L858R mutation. After curative treatment of acrometastasis, concurrent chemo-radiotherapy was planned for primary lung cancer as a therapeutic approach. He is still under treatment. Oligometastatic disease by acral involvement in NSCLC is extremely rare. Curative treatment approach should be consider for both primary tumor and metastasis side.

Endobronchial metastasised endometrial stromal sarcoma

A 43-year-old woman presented with cough and gradually aggravating exertional dyspnoea of 5 months’ duration. She had undergone a hysteromyomectomy for myoma uteri 3 years previously. Chest CT revealed a...

Congenital Bronchoesophageal Fistula Diagnosed in Late Adulthood

Introduction: A 69-year-old man with a history of right thoracotomy with decortication and drainage of empyema 34 years ago, presented with a 25-year history of dysphagia and coughing up of food and liquids and recurrent respiratory infections. EGD 8 years ago showed possible achalasia and mid-esopha-geal diverticulum. Recent evaluation for pneumonia included barium esophagram showing a fistula from the lower esophagus to the right lower lobe bronchi. CT showed right lower lobe bronchiectasis, infiltrate and dilated esophagus but did not visualize a fistula. EGD revealed a 3mm fistula in the middle third of the esophagus and no other lesions in the esophagus. Bronchoscopy showed no endobronchial lesions but could not initially identify the fistula site. EGD was performed simultaneously with bronchoscopy and saline with methylene blue was injected through the esophageal side of the fistula using an ERCP cannula. Bronchoscopy revealed passage of air bubbles and methylene blue through a bronchus [posterior subsegment of the superior basal segment of right lower lobe (B8a)], localizing the exact fistula site. He had surgical repair involving division of the fistula tract with intercostal muscle-flap interposition. There was no persistent fistula on EGD and esophagram. Congenital bronchoesophageal fistula (BEF) is rare in adults but can be unrecognized for years, with symptom duration varying from 5-50 years before diagnosis. Age at diagnosis ranges from 9-83 years. Symptoms include cough, frequent respiratory infections, hemoptysis and bouts of cough when swallowing liquids (Ohno’s sign). Barium esophagram is the most sensitive test compared to endoscopy and bronchoscopy. Complications include recurrent pneumonia, abscess and bronchiectasis. Definitive treatment involves surgical closure of the fistula tract, with interposition of viable tissue such as intercostal muscle to prevent refistulization. The insidious course of congenital BEF, the absence of surrounding inflammation and adherent lymph nodes, and our patient’s history support a congenital nature of the fistula. In summary, we illustrated a case of congenital bronchoesophageal fistula diagnosed in late adulthood by barium esophagram, confirmed by simultaneous EGD and bronchoscopy and managed by surgical repair.Figure 1: (A) EGD of esophageal side of fistula. (B) Bronchoscopy showing methylene blue leaked through bronchial side of fistula when methylene blue was instilled into the fistula during EGD.

Three Cases of ALCAPA with Associated Anomalies

There are several potential issues that affect the treatment and diagnostic pattern of anomalous left coronary artery arising from the pulmonary artery. We report three cases of infants who presented with anomalous left coronary artery arising from the pulmonary artery with severe left ventricular dysfunction and severe mitral regurgitation along with associated anomalies. One patient had congenital lobar emphysema of the right midde lobe. Another patient had left main stem bronchus compression, collapse of basal segments of left lower lobe and panlobular emphysema in medial basal segment of right lower lobe. The third patient had cleft lip and palate. All patients underwent successful repair. The hemodynamic stability was compromised when the infant with congenital lobar emphysema had spontaneous pneumothorax after extubation and she needed an intercostal drainage. The infant with lung collapse had to be reintubated on the second day since she became hypoxic due to recollapse of the lung once the airway positive pressure was removed. She needed chest physiotherapy, vigorous endotracheal suctioning and inhaled bronchodilator therapy. The patient who had cleft palate succumbed to aspiration pneumonitis in the postoperative period. Follow-up of other two patients after three months showed very good improvement in left ventricular systolic function.

A lung cancer masquerader

A 58-year-old man presented with 3 months history of hemoptysis. He denied having fever, night sweats, chest pain, shortness of breath, orthopnea, loss of appetite or unintentional weight loss. He had 60 pack-year history of smoking, quit 5 years ago. He did not drink alcohol and never used illicit drugs. He worked as a welder for 30 years and reported no history of sick contacts or travel abroad. His past history was remarkable for hypertension, chronic obstructive pulmonary disease. He had right upper lobectomy 5 years ago for suspicious pulmonary nodule in an outside facility. He was informed that his nodule was related to his occupational exposure. His medications which adequately controlled his pulmonary symptoms were inhaled tiotropium and albuterol. On physical examination, his vital signs revealed a temperature of 37.1°C, BP of 135/81 mmHg, heart rate of 85/min, respiratory rate of 16/min and O2 saturation of 97% on room air. He appeared comfortable and not in acute respiratory distress. Chest examination showed scar of previous right-sided thoracotomy, otherwise, no additional breath sounds. There was no clubbing or cyanosis. The remainder of the examination was unremarkable. Laboratory tests showed WBC 5.6 × 109/l, hemoglobin 13.0 g/dl and pletlets 180 × 109/l. INR 1.19 and PTT 25.6 s. His basic biochemical profile and urine analysis were normal. The chest radiograph (CXR) showed a 1.5 cm multiform density nodular shadow in the right upper zone (Figure 1). A computed tomographic scan (CT) showed a 1.5 cm solitary nodular shadow in the superior segment of right lower lobe with no hilar or mediastinal lymphadenopathy (Figure 2). The 18F-fluorodeoxyglucose and positron emission tomography (FDG-PET) scan showed a focal area of increased uptake (standard uptake values—SUV—of up to 3.8) at the site of the right …

Pulmonary Tuberculosis Mimicking Lung Cancer on Radiological Findings: Evaluation of Chest CT Findings in Pathologically Proven 76 Patients

Copyrights © 2012 The Korean Society of Radiology Purpose: To evaluate chest CT features of pulmonary tuberculosis mimicking lung malignancy. Materials and Methods: We retrospectively reviewed chest CT findings for 76 consecutive patients (21-84 years, average: 63 years; M : F = 30 : 46) who underwent an invasive diagnostic procedure under the suspicion of lung cancer and were pathologically diagnosed as pulmonary tuberculosis by bronchoscopic biopsy (n = 49), transthoracic needle biopsy (n = 17), and surgical resection (n = 10). We categorized the chest CT patterns of those lesions as follows: bronchial narrowing or obstruction without a central mass-like lesion (pattern 1), central mass-like lesion with distal atelectasis or obstructive pneumonia (pattern 2), peripheral nodule or mass including mass-like consolidation (pattern 3), and cavitary lesion (pattern 4). CT findings were reviewed with respect to the patterns and the locations of the lesions, parenchymal abnormalities adjacent to the lesions, the size, the border and pattern of enhancement for the peripheral nodule or mass and the thickness of the cavitary wall in the cavitary lesion. We also evaluated the abnormalities regarding the lymph node and pleura. Results: Pattern 1 was the most common finding (n = 34), followed by pattern 3 (n = 23), pattern 2 (n = 11) and finally, pattern 4 (n = 8). The most frequently involving site in pattern 1 and 2 was the right middle lobe (n = 14/45). However, in pattern 3 and 4, the superior segment of right lower lobe (n = 5/31) was most frequently involved. Ill-defined small nodules and/or larger confluent nodules were found in the adjacent lung and at the other segment of the lung in 31 patients (40.8%). Enlarged lymph nodes were most commonly detected in the right paratracheal area (n = 9/18). Pleural effusion was demonstrated in 10 patients. Conclusion: On the CT, pulmonary tuberculosis mimicking lung cancer most commonly presented with bronchial narrowing or obstruction without a central masslike lesion, which resulted in distal atelectasis and obstructive pneumonitis. Pulmonary Tuberculosis Mimicking Lung Cancer on Radiological Findings: Evaluation of Chest CT Findings in Pathologically Proven 76 Patients 영상소견에서 폐암의태성의 폐결핵: 조직병리학적으로 진단된 76명의 환자에서 흉부 전산화단층촬영(CT) 소견에 대한 연구

Pulmonary sclerosing haemangioma presented like intra-lobar sequestration

Fig. 1. (A) This contrast computed tomography chest scan shows an oval heterogeneously enhancing mass with abundant peripheral vascularity of size 5.3 cm 3.5 cm 4.6 cm noted in the lateral basal segment of right lower lobe. Punctate calcification noted within the mass. Alveolar opacities noted in right lower lobe lateral, medial and posterior basal segments. (B) This spiral angiographic computed tomography chest scan shows the vascular ovoid mass lesion in the right lung lower lobe fed by an anomalous artery from right renal artery. Venous drainage noted into right inferior pulmonary vein. The above features are suggestive of right lower lobe intra-lobar sequestration.

Lymphoepithelioma-like carcinoma of lung – a case report

We report a case in 49-year-old Asian female who presented with a radio-dense mass in the posterobasal segment of right lower lobe, located in a subpleural location. Sectioning showed a well defined, firm, circumscribed, nodular tumour 30 × 30 × 25 mm in a subpleural location leading to puckering of the overlying pleura. Three subcarinal lymph nodes were also submitted. Histopathology showed the nodule was a poorly differentiated carcinoma, forming a syncytium of tumour cells with vesicular nuclei. Accompanying the tumour was heavy lymphoid infiltrate, infiltrating within and surrounding the tumour mass. Tumour cells were postive for AE1/AE3, p63 and EBV ISH. Keratin 7 and 20 were negative. One of three lymph nodes contained metastatic carcinoma. Lymphoepithelioma-like carcinoma of the lung occurs as an EBV-associated neoplasm. The virus may be demonstrated by expression of latent membrane protein-1 and EBV-deoxyribonucleic acid in tumour cells by immunohistochemistry, and in situ hybridisation for EBV-encoded small nuclear ribonucleic acid. It needs to be distinguished histologically from large cell lymphoma, germ cell tumour, poorly differentiated squamous cell carcinoma and mucoepidermoid carcinoma. A thorough evaluation of other primary sites such as the nasopharynx should be done to exclude a metastatic tumour. The behaviour of lymhoepithelioma-like carcinoma is highly variable, ranging from apparently curable (by excision) to highly aggressive with extensive disease at presentation.

A case report of the presence of cavitation in apical segment of right lower lobe

A Case Report of the Presence of Cavitation in Apical Segment of Right Lower Lobe Jiayan ZHANG, Diansheng ZHONG Department of Respiratory Medicine, Tianjin Medical University General Hospital, Tianjin 300052, China Corresponding author: Diansheng ZHONG, E-mail: zhongdsh@hotmail.com This study was supported by grants from the National Natural Science Foundation of China (to Diansheng ZHONG)(No.30971307) and Tianjin Natural Science Foundation (to Diansheng ZHONG)(No.10JCYBJC13700).

BRONCHOESOPHAGEAL FISTULA AND DYNAMIC BRONCHOSCOPY.

BRONCHOESOPHAGEAL FISTULA AND DYNAMIC BRONCHOSCOPY.

KLIPPEL FEIL SYNDROME WITH PULMONARY CYST.

Klippel Feil Syndrome (KFS) is a rare malformation due to congenital fusion of two or more cervical vertebrae (synostosis) resulting in brevicollis [1]. A triad of brevicollis, limited neck movements and a low hairline results in this syndrome. It is associated with various systemic anomalies. However, lung parenchymal lesion has not been described with this syndrome. A case of Klippel Feil syndrome with associated unilateral pulmonary cyst is being reported for its rarity. Case Report 6 year old female child, 2nd in birth order of 3 siblings of non-consanguinous parents, was born by term vaginal delivery with uneventful perinatal period. She achieved all motor and mental milestones normally. She was noticed to have deformity of neck, back and restricted neck movements since 1½ years of age. Presently she was admitted with an episode of generalized tonic clonic seizure. There was no focal neurodeficit or evidence of meningitis. Examination revealed weight – 13.5 Kg, height – 104 cms and normal vital parameters. She was having short webbed neck with restricted neck movements and low hairline. There was Sprengel deformity of left scapula with restricted movements of neck, scoliosis of dorsal spine with convexity to left. Systemic examination was within normal limit. X-ray cervico-dorsal spine showed occipitalization of Atlas with fusion of posterior elements of C3-4 vertebrae. There was marked cervico-dorsal scoliosis and kyphoscoliosis with convexity to left. Multiple cervico-dorsal hemi-vertebrae and fused vertebrae were seen. Left scapula was small, triangular and elevated. Multiple rib anomalies were present. X-ray chest revealed 2 cms translucent rounded shadow in RMZ. CECT neck and chest showed a cystic lesion in the apical segment of right lower lobe besides brevicollis. MRI of cervico dorsal spine showed fusion of bodies of C6-D1 vertebrae. The intervening disc spaces were rudimentary. Spinal cord was normal in size, contour, morphology and signal intensity. Dural ectasia was noted al C4-D2 level. The findings were consistent with KFS. CT scan cranium did not show any focal lesion. EEG showed generalized cerebral dysfunction. USG abdomen and echo study were within normal limit. Fig. 1 Photograph of child showing classical features of Klippel Feil syndrome (short neck, low hair line. Sprengel deformity) Discussion KFS was first described by Klippel and Feil in 1912 based on fusion of cervical vertebrae [1]. The incidence is about 1:42000 births with female preponderance of about 65% cases [2]. Short neck, low hairline, restriction of neck movements and fusion of at least 2 cervical segments are the cardinal features of this syndrome. It has autosomal mode of inheritance with variable expression, however, sporadic cases are also seen. The main underlying abnormality is failure of normal segmentation of cervical somites during 3rd and 8th weeks of gestation. The exact initiating factor for the same is not known. Three forms of syndromes have been identified based on type and extent of congenital malformation of vertebral column, features of which are shown in Table-1. TABLE 1 Types of Kippel – Feil Syndrome Fig. 2 CT scan of chest showing congential pulmonary cyst in right lower lobe Fig. 3 MRI scan of cervico-dorsal spine showing fusion of cervical spine The anomaly may be a part of serious problem in early neural tube development such as anencephaly, cervical meningomyelocele, syringomyelia or syringobulbia. CNS anomalies comprise paraplegia, hemiplegia, cranial nerve palsies, macrocephaly, hydrocephalus and mental retardation. Other associated anomalies which occur with this syndrome are deafness (30%) [3], congenital heart defects, commonest being ventricular septal defect, rarely patent ductus arteriosus and coarctation of aorta [4]. The musculoskeletal anomalies include thoracic scoliosis, spina bifida occulta, Sprengel deformity, abnormalities of ribs, webbing of neck, hypoplastic thumb, supernumery digits and unilateral hypoplasia of Pectoralis Major muscle. The latter is called as Poland anomaly if it is associated with syndactyly, hypoplasia of nipple and areola and facial asymmetry. Genitourinary anomalies including unilateral renal agenesis, horseshoe kidney, absent vagina and ovarian agenesis may be present. Dental abnormalities, cleft lip, cleft palate, abnormalities of gastro-intestinal tract, lung and skin may also be associated. Differential diagnosis include bilateral Sprengel deformity, occipitalization of CI vertebra, and acquired post inflammatory (Diskitis, Rheumatoid arthritis) or post-traumatic fusion. Treatment consists of correcting the associated anomalies wherever it is possible and appropriate genetic counselling. In our case, the features of classical triad of KFS were present along with Sprengel deformity, scoliosis and seizures. An interesting hither-to not described finding was that of presence of unilateral pulmonary cyst in right middle zone. Perfusion-ventilation imbalance, decrease ventilatory turnover and expiratory flow from the alveolar space resulting from impaired respiratory mechanism leading to respiratory failure and pulmonary hypertension on account of kyphoscoliosis has been reported in literature [5]. In our case the presence of pulmonary cyst is likely to aggravate the process of respiratory failure and development of pulmonary hypertension.

A case of benign fibrous mesothelioma of the pleura

Benign fibrous mesothelioma of the pleura is a relatively rare neoplasm originated from pleural mesothelial cell, often asymptomatic or presenting with a specifical sign. One of the main problems, concerns the preoperative differential diagnosis, mainly because it is difficult to differentiate between benign and malignant type. A 62-year old woman presented with recurrent chest pain. The chest radiography in a patient was suspected localized pleural mesothelioma. The chest computed tomography scan showed that mass like lesion of well marginated ovoid shape with homogenous attenuation on anterior-basal segment of right lower lobe. After resection of a pleural mass by thoracoscopic extirpation from right hemithorax, Localized benign fibrous mesothelioma of the pleura was confirmed by pathology and immunohisto-chemical staining. We report here one case of pleural benign fibrous mesothelioma with some considerations on its diagnosis and treatment.