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Respirology

Respirology Case Reorts

Table of Contents for
Volume 05 Issue 5
September 2017

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Case Reports

A bronchial fibroepithelial polyp with abnormal findings on auto-fluorescence imaging
Naomi Saito, Masahiro Yamasaki, Wakako Daido, Sayaka Ishiyama, Naoko Deguchi & Masaya Taniwaki
DOI: 10.1002/rcr2.244

Bronchial fibroepithelial polyps may display auto-fluorescence imaging (AFI) positivity; however, the lesion displays benign behaviour. The diagnosis of bronchial fibroepithelial polyps should not be confused by AFI positivity, and unnecessary surgical intervention should be avoided.

Swyer-James-MacLeod syndrome – a rare diagnosis presented through two adult patients
Sumit Mehra, Thilini Basnayake, Henrik Falhammar, Subash Heraganahally &Suryakant Tripathi
DOI: 10.1002/rcr2.245

Swyer-James-MacLeod syndrome (SJMS) is a rare disorder that manifests as unilateral hyperlucent lung with expiratory air-trapping and is a result of post-infectious acute obliterative bronchiolitis. It is often misdiagnosed. It is important to recognize the condition to achieve better prognosis and also to prevent inappropriate treatment.

Metastatic pancreatic carcinoma masquerading as cystic lung disease: a rare presentation
Emily Stern, Taha Huseini, YiJin Kuok & Fiona Lake
DOI: 10.1002/rcr2.246

This case describes a 52-year-old gentleman who presented with acute type 1 respiratory failure and diffuse cystic change on high-resolution computed tomography (HRCT). Transbronchial biopsy revealed enteric differentiated adenocarcinoma exhibiting lepidic spread, and autopsy confirmed a pancreatic primary. This case demonstrates that pancreatic malignancy can present with cystic lung disease and acute respiratory failure.

"Lazarus response" of nivolumab in a frail patient with non-small-cell lung cancer
Takayuki Takeda, Mayumi Takeuchi, Yurika Nishimi, Masahiko Saitoh & Sorou Takeda
DOI: 10.1002/rcr2.247

Lung cancer has aggressive behaviour which often progresses rapidly with disseminated disease and leads to poor performance status (PS) in patients. Since cytotoxic chemotherapy is not recommended under these conditions, there are currently no alternative therapeutic options other than providing supportive care. Immune checkpoint inhibitors have been developed, but their efficacy and tolerability have not been fully investigated in patients with poor PS. We describe a case of "Lazarus response" of nivolumab in a frail patient with non-small-cell lung cancer.

An intimal sarcoma of pulmonary artery mimicking pulmonary embolism: a case report and literature review
Xiaojing Liu, Jun Hou, Xiangdong Wang & Zhihong Chen
DOI: 10.1002/rcr2.248

Pulmonary artery intimal sarcoma is a highly aggressive disease, and is most often misdiagnosed as pulmonary thromboembolism (PTE) due to the similar clinical symptoms and its rarity, which leads to the use of inappropriate treatments such as prolonged anticoagulant therapy. We reported a case of pulmonary artery intimal sarcoma in a patient who was misdiagnosed as having PTE. Pathology after surgery confirmed malignant disease. We concluded that when a patient presents with mild clinical manifestations yet with strong imaging manifestations, pulmonary artery malignancy should be suspected.

Propionibacterium acnes pleural empyema following medical thoracoscopy
Hannah Lawrence, Thomas Moore, Karmel Webb & Wei Shen Lim
DOI: 10.1002/rcr2.249

We present a rare case of Propionibacterium acnes pleural empyema 3 weeks following medical thoracoscopy and subsequent intercostal drain insertion for 3 days in a 75-year-old man. We postulate that pathogenesis may be associated with inoculation at the time of thoracoscopy or via biofilm formation on the intercostal drain. This case highlights the potential for this pathogen to cause clinically significant disease post thoracoscopy and pleural drainage.

Chest pain and recurrent chylothorax: an unusual presentation of malignant pleural mesothelioma
David R Darley, Emily Granger & Allan R Glanville
DOI: 10.1002/rcr2.250

Malignant mesothelioma presenting with recurrent chylous effusion is rare. We describe a young patient who presented with central chest pain and subsequently a left-sided chylous pleural effusion. The diagnosis was made on pleural biopsy via video-assisted thoracoscopic surgery (VATS). Our case demonstrates the utility of thoracic magnetic resonance imaging (MRI) and the difficulties associated with pleural cytology and cervical lymph node biopsy in the establishment of a diagnosis of mesothelioma.

Retropharyngeal lipoma causing obstructive sleep apnoea
Paul Leong, Stephen Kleid & Darren Mansfield
DOI: 10.1002/rcr2.251

We present the case of a middle-aged man whose obstructive sleep apnoea (OSA) was caused by a retropharyngeal lipoma, with complete resolution after transoral excision. Lipomas causing OSA are rare, and this represents the seventh reported case in the literature.

Reduced ventilation-perfusion (V/Q) mismatch following endobronchial valve insertion demonstrated by Gallium-68 V/Q photon emission tomography/computed tomography
Paul Leong, Pierre-Yves Le Roux, Jason Callahan, Shankar Siva, Michael S Hofman and Daniel P Steinfort
DOI: 10.1002/rcr2.253

Endobronchial valves (EBVs) are increasingly used in severe emphysema. Using Gallium-68 ventilation-perfusion (V/Q) photon emission tomography (PET)/computed tomography (CT), we report a pilot case in which PET/CT findings were discordant to standard quantitative CT analysis. We deployed valves in a lobe where benefit was not predicted with standard quantitative CT, and found significant clinical improvement and improved V/Q matching on repeat imaging.

Pulmonary arteriovenous malformations complicated by splenic infarction and abscess
Jun Naito, Hajime Kasai, Masaki Suga, Toshihiko Sugiura, Nobuhiro Tanabe and Koichiro Tatsumi
DOI: 10.1002/rcr2.254

Pulmonary arteriovenous malformation (PAVM) is an abnormal blood vessel connecting a pulmonary artery and a vein, and is accompanied by paradoxical embolism to other organs due to a right-to-left shunt. We report the case of a 66-year-old woman with PAVM complicated by splenic infarction and abscess.

Pathological features of explant lungs with fibrosis in autoimmune pulmonary alveolar proteinosis
Manabu Ono, Ryoko Saito, Junya Tominaga, Yoshinori Okada, Shinya Ohkouchi and Tamiko Takemura
DOI: 10.1002/rcr2.255

We report a case of autoimmune pulmonary alveolar proteinosis (aPAP) with progressive fibrosis occurring in a 46-year-old woman. Despite several whole lung lavage (WLL) and granulocyte-macrophage colony-stimulating factor (GM-CSF) treatment, fibrosis progressed and bilateral lung transplantation was performed. Computed tomography (CT) suggested IP-like fibrotic changes, but pathological analysis of explant lungs showed it was not the case and suggested that the dysfunction of alveolar macrophage in removing the excess surfactant of alveolar spaces had an important role in the fibrogenesis in aPAP.

Metastatic squamous cell carcinoma of the lung mimicking multiple bone abscesses
Yuki Haruta, Yuki Kataoka, Hiroshi Ito, Taro Mori and Masaki Matsuo
DOI: 10.1002/rcr2.256

Squamous cell carcinoma of the lung is known to metastasize to the bones, but a presentation similar to bone abscess is rare. We encountered a case with bone metastases that mimicked bone abscess, which delayed the diagnosis of squamous cell lung carcinoma. Metastatic squamous cell lung carcinoma may have imaging characteristics of bone abscess and should be considered in the differential diagnosis of such lesions.

Tracheal granuloma 7 years after extubation
Kazuhisa Nakashima, Tateaki Naito, Masahiro Endo, Takashi Nakajima and Toshiaki Takahashi
DOI: 10.1002/rcr2.252

Tracheal granuloma can cause severe stenosis long after extubation. When a patient with a history of endobronchial intubation has an intratracheal tumour, we should consider the possibility of this condition.

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