| Case Reports |
Multiple huge "cluster" and "galaxy" signs on chest radiography in a patient with pulmonary tuberculosis
Miku Oda, Takeshi Saraya, Tatsuya Shirai, Narishige Ishikawa, Masachika Fujiwara, Hajime Takizawa DOI: 10.1002/rcr2.398
In this article, we present a unique case of active pulmonary tuberculosis, with multiple huge "cluster" signs like fireworks, together with multiple "galaxy" signs. The repeated acid-fast sputum smears and both bronchial washings were all negative for Mycobacterium tuberculosis, but the acid-fast culture of sputum taken soon after the first bronchoscopy, and pleural fluid, turned out to be positive for M. tuberculosis at six weeks after admission. The present case clearly demonstrates that the "galaxy" and "cluster" signs are red herring signs of the low rates of isolating M. tuberculosis, which should be differentiated from pulmonary sarcoidosis. |
Bronchoscopic observation with linked colour imaging
Shinichi Yamamoto, Tomoki Shibano, Masaya Sogabe, Hideki Negishi, Sayaka Mitsuda, Shunsuke Endo DOI: 10.1002/rcr2.399
We report two cases of the comparison of diagnosis made with linked color imaging (LCI) and conventional white-light imaging (WLI) on the same patients. Both mucosal inflammatory and malignant lesions were better visible with LCI in comparison to WLI. |
Pleural empyema in a patient with a perinephric abscess and diaphragmatic defect
Pei Sze Carmen Tan, Arash Badiei, Deirdre B Fitzgerald, Yi Jin Kuok, Y C Gary Lee DOI: 10.1002/rcr2.400
Pleural infection as a complication of ascending urological infection is rare, and the mechanism often unclear. We report a complicated case of pleural infection and perinephric abscess in a patient who presented with a large right-sided pleural effusion. |
Transformation of epidermal growth factor receptor T790M mutation-positive adenosquamous carcinoma of the lung to small cell carcinoma and large-cell neuroendocrine carcinoma following osimertinib therapy: an autopsy case report
Shuhei Moriguchi, Hironori Uruga, Takeshi Fujii, Yoichi Yasunaga, Yui Takahashi, Kazuma Kishi DOI: 10.1002/rcr2.402
Resistance mechanisms to osimertinib are of two types: epidermal growth factor receptor (EGFR) dependent, such as point mutations containing C797S, and EGFR independent, such as bypass signal pathway or histological transformation to small cell lung carcinoma (SCLC) and large-cell neuroendocrine carcinoma (LCNEC). Here, we report an autopsy case with EGFR T790M-positive adenosquamous carcinoma that transformed to EGFR T790M-negative SCLC and LCNEC after osimertinib therapy. |
Lung adenocarcinoma and anti-transcriptional intermediary factor 1-gamma positive dermatomyositis complicated with spontaneous oesophageal rupture
Takeshi Saraya, Masaki Tamura, Keisuke Kasuga, Masachika Fujiwara, Hajime Takizawa DOI: 10.1002/rcr2.403
A 58-year-old man presented with a two-month history of facial erythema and dry cough. After testing he was diagnosed with co-occurring transcriptional intermediary factor 1-gamma (TIF1-γ) positive dermatomyositis (DM) and lung adenocarcinoma. He subsequently developed muscle weakness and was administered oral prednisolone but developed TIF1-γ positive DM-associated oropharyngeal dysphagia complicated by spontaneous oesophageal rupture. Despite treatment, he gradually deteriorated and died from progression of chemoresistant lung cancer six months later. |
Non-parallel anti-tumour effects of pembrolizumab: a case of cardial tamponade
Motoko Tachihara, Masatsugu Yamamoto, Masako Yumura, Asuka Yoshizaki, Kazuyuki Kobayashi, Yoshihiro Nishimura DOI: 10.1002/rcr2.404
We present the case of a 70-year-old man with stage IV lung adenocarcinoma. He was treated with pembrolizumab, a programmed cell death-1 inhibitor, as a first-line therapy. After six cycles of pembrolizumab, he suddenly developed cardiac tamponade. With the exception of newly massive malignant pericardial effusion, the other malignant lesions improved. Pembrolizumab was continued and the patient has shown a durable response for two years. |
Management of recurrent haemoptysis in malignancy with combined TISSEEL and intrabronchial valves
James Di Michiel, Corinna Pan, Alvin Ing, Tajalli Saghaie DOI: 10.1002/rcr2.406
It is hypothesized that intrabronchial valves would stabilize the fibrin sealant and prevent expectoration or migration. Here we describe the use of combination TISSEEL and intrabronchial valves for the management of recurrent haemoptysis secondary to malignancy. This combination therapy, to the best of our knowledge, represents a novel intervention for palliative management of this condition. |
An atypical pneumonia
Benjamin Gerhardy DOI: 10.1002/rcr2.407
We present the first documented case of small vessel vasculitis, manifesting with renal and pulmonary failure, in a patient with underlying HIV. |
Successful management of pleural infection with very low dose intrapleural tissue plasminogen activator/deoxyribonuclease regime
Jodi Andrea Hart, Arash Badiei, Y C Gary Lee DOI: 10.1002/rcr2.408
We report a case of a complex parapneumonic effusion in a patient with coagulopathy that was successfully treated with a very low dose tissue plasminogen activator (1 mg) and deoxyribonuclease (5 mg) regime. |
| Clinical Images |
Spontaneous aspiration of a long tree twig as foreign body
Kosuke Hashimoto, Kyoichi Kaira, Kunihiko Kobayashi, Yoshitake Murayama, Hiroshi Kagamu DOI: 10.1002/rcr2.401
Spontaneous aspiration of a long tree twig as foreign body is extremely a rare condition. The presence of a permanent tracheal stoma in a laryngectomized patient should be considered as a predisposing factor for foreign body aspiration. |
