| Case Reports |
Negative pressure wound therapy with instillation without open-window thoracostomy for empyema
Kayo Okamoto, Kumiko Matsumoto, Norichika Iga, Seiji Komatsu DOI: 10.1002/rcr2.417
Here we present the cases of two patients with refractory empyema after intrathoracic irrigation and drainage, who underwent a new treatment with negative pressure wound therapy with instillation and dwell time (NPWTi-d) but without open-window thoracostomy (OWT) using the fistula of the thoracic drain. We called this treatment non-OWT NPWTi-d. Both the patients recovered. Non-OWT NPWTi-d may be a new option to treat empyema. |
Massive haemoptysis from right middle lobe bronchus managed by customized silicon stents
Weihua Xu, Hongwei Wang, Haidong He, Huiping Hu, Haihua Lu, Guozheng Li DOI: 10.1002/rcr2.418
Here we report a patient with bronchiectasis who developed massive haemoptysis. Two straight customized silicone stents were used to control haemoptysis. |
A 27-year-old female presented with diffuse alveolar haemorrhage due to breast angiosarcoma with lung metastasis
Po-Hsin Lee, Yun-An Chen, Pin-Kuei Fu DOI: 10.1002/rcr2.419
We report a case of a 27-year-old female with the diagnosis of primary breast angiosarcoma developing DAH. This raised our concern that angiosarcoma with lung metastasis may present with diffuse alveolar haemorrhage (DAH) and should be considered as an important fatal differential diagnosis of DAH. |
Tension hydrothorax secondary to small cell lung cancer
Eleah Danielle Porter, David John Finley, Joseph David Phillips DOI: 10.1002/rcr2.420
Tension hydrothorax is uncommon and a malignant aetiology is rare. Here we present a case of malignant tension hydrothorax secondary to small cell lung cancer and highlight management strategies to prevent the life-threatening complication of re-expansion pulmonary oedema. |
Dyspnoea and restrictive lung disease due to mediastinal and pleural lipomatosis in morbid obesity
Jen Yuh Lim, Kim A McAnulty, Catherina L Chang DOI: 10.1002/rcr2.421
Exertional dyspnoea in obesity is common and may be due to a number of factors. We report a case of large volume mediastinal and pleural lipomatosis causing significant dyspnoea in an obese individual. This is a rare complication of obesity and should be considered in obese patients when other causes of dyspnoea have been excluded. |
A case of pulmonary lymphoproliferative disorder presenting rapidly progressive respiratory failure
Kohei Fujita, Kenjiro Ishigami, Hiroyuki Tanaka, Koki Moriyoshi, Tadashi Mio DOI: 10.1002/rcr2.422
A 72-year-old woman presented with acute onset of shortness of breath and fatigue over several days, and was found to be in acute respiratory failure. Computed tomography of the chest revealed massive ground-glass opacity and partial crazy-paving appearance with multiple nodules across all the lobes of the lung and a large mass in the right lower lobe. She was diagnosed with B-cell lymphoma and the abnormal lung shadow was considered to be a result of a pulmonary lymphoproliferative disorder (PLD). PLD is known to present with various radiographic patterns. However, the progression of PLD is usually slow, and acute respiratory failure is very rare. Physicians should be aware that acute respiratory failure can be caused by PLD. |
Mediastinal emphysema after long-distance flight with ketoacidosis and underlying diabetes mellitus type 1
Gracia Lana Ardila Pardo, Wolfgang Michael Kübler Martin, Witzenrath, Jörg-Wilhelm Oestmann DOI: 10.1002/rcr2.423
Spontaneous pneumomediastinum (SPM) is a rare differential diagnosis of acute chest pain and dyspnoea. Clinical symptoms may be subtle. A number of risk factors increase the chance of SPM. SPM normally regresses spontaneously within a few days. We present a 21-year-old female with diabetes mellitus type 1 diagnosed with SPM which improved after four days with conservative treatment. |
Phlegmasia cerulea dolens: a rare cause of shock
Christopher Bob Lewis, Matthew Kevin Hensley, Julie Elizabeth Barrett, Steven Burke Van Norman, Alexander Stuart Taylor, Jeffrey Craig Horowitz DOI: 10.1002/rcr2.424
Phelgmasia cerulea dolens (PCD) is a rare cause of shock that can complicate deep venous thrombosis and carries a high risk of mortality. We present a case of extensive bilateral lower extremity deep vein thrombosis associated with an inferior vena cava filter, which rapidly progressed to PCD and refractory shock. |
A rare epidermal growth factor receptor H773L/V774M compound mutation in advanced non-small-cell lung cancer with poor response to epidermal growth factor receptor tyrosine kinase inhibitor
Lun-Che Chen, Jin-Yuan Shih, Chong-Jen Yu, Ching-Yao Yang DOI: 10.1002/rcr2.425
Here, we report a case of advanced non-small-cell lung cancer with a rare epidermal growth factor receptor (EGFR) exon 20 H773L/V774M compound mutation, which demonstrated poor clinical response to afatinib, a second-generation EGFR-TKI with pan-human EGFR blocking activity. The anti-cancer treatment was shifted to platinum-based chemotherapy, which resulted in a partial response. |
Severe mediastinitis over a month after endobronchial ultrasound-guided transbronchial needle aspiration
Kana Kurokawa, Tetsuhiko Asao, Ryo Ko, Tetsutaro Nagaoka, Kenji Suzuki, Kazuhisa Takahashi DOI: 10.1002/rcr2.426
Mediastinitis is a concerning acute or subacute complication of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). The median time of mediastinitis onset is approximately 12 days after EBUS-TBNA. Here we present the first report, to the best of our knowledge, of mediastinitis occurring over a month after EBUS-TBNA in two patients. |
Transoesophageal ultrasound-guided bronchoscopic aspiration of a superior mediastinal tumour using the BF-UC290F instrument
Daisuke Minami, Yuki Takigawa, Hiroe Kayatani, Ken Sato, Keiichi Fujiwara, Takuo Shibayama DOI: 10.1002/rcr2.427
The BF-UC290F is a third-generation, reliable, Olympus, endobronchial, ultrasound-guided, needle aspiration endoscope. We report a case with a superior mediastinal mass diagnosed via endoscopic, ultrasound-guided, bronchoscopic fine-needle aspiration using the BF-UC290F. |
Mycobacterium shimoidei, a rare non-tuberculous mycobacteria pathogen identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry
Hiroaki Nagano DOI: 10.1002/rcr2.428
The purpose of this study is to communicate the potential utility of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry for identification of Mycobacterium shimoidei that is not identifiable by DNA-DNA hybridization. This is essential for choice of the appropriate antimicrobial treatment. Notably, this is also the first identification of M. shimoidei in Okinawa, the southernmost and only prefecture categorized as subtropical in Japan. |
An unusual endobronchial lesion: expanding the differential diagnosis
Rachel Leonard, Charles Schultz, Sarah Hadique DOI: 10.1002/rcr2.429
Here, we report a case of a 73-year-old male who presented to the hospital after a motor vehicle collision, with incidentally found pulmonary nodule and kidney mass. He was eventually diagnosed with high-grade synovial sarcoma, one of only seven cases to date of primary endobronchial synovial sarcoma that have been reported. A review of the cases and literature is carried out. |
Bronchiectasis in the setting of aplasia of the epiglottis
Puwakdandawe Weerasinghe, Rahul Thomas, Brent Masters, Nitin Kapur DOI: 10.1002/rcr2.430
Aplasia of the epiglottis is a rare airway abnormality requiring airway and feeding interventions. We report a case of bronchiectasis in the setting of congenital aplasia of the epiglottis, secondary to early-life aspiration events in a 2-year-old male with recurrent lower respiratory track infections. |
Acute shortness of breath due to reoccurrence of an intrapericardial bronchogenic cyst
Damian Gimpel, Joseph Conway, Felicity Meikle, Zaw Lin, David John McCormack, Adam El-Gamel DOI: 10.1002/rcr2.431
A 71-year-old woman presented with dysphagia and acute shortness of breath. Surgical history included a prior thoracotomy overseas for a bronchogenic mesothelial cyst 19 years before. Computed tomography demonstrated a mass within the posterior mediastinum. A median sternotomy was performed, and after removal of the cyst, repair of the left atrium and pulmonary vessels was undertaken due to the invading nature of the cyst. Irrespective of the method of approach in redo surgery, complete resection must be performed in order to minimize the chance of recurrence, relieve symptoms, eliminate risk of infection, and prevent malignant degeneration. |
