Respirology Case Reorts

Loveleen Mangla, Rohit Vadala, Shirish Kumar Kadli, Deepak Prajapat, Deepak Talwar
DOI: 10.1002/rcr2.630

We describe three cases who presented with haemoptysis, which on further evaluation were diagnosed as isolated tracheobronchial amyloidosis, and a review of literature.

Santhakumar Subramanian, Venugopal Jaganathan, Deepak T. Hari, Deepak Thangaraju
DOI: 10.1002/rcr2.634

Melioidosis is an emerging disease in India. Mediastinal abscess is rare in melioidosis. We have reported three such cases. Endobronchial ultrasound helped in diagnosis.

Xiong Khee Cheong, Andrea Yu-Lin Ban, Mohamed Faisal Abdul Hamid
DOI: 10.1002/rcr2.648

We described three patients with complex pleural effusions who received intrapleural fibrinolysis therapy with different bleeding risks.

Ayan Sabih, Claire Russell, Catherina L Chang
DOI: 10.1002/rcr2.655

Thunderstorm asthma had previously been considered unlikely to occur in New Zealand (NZ), given its local weather patterns. Storm events on 2 December 2017 led to increased asthma presentations at Waikato Hospital in Hamilton. Analyses of patient presentations led us to conclude that these presentations were similar to international descriptions of thunderstorm asthma. This is the first time such presentations have been reported in NZ.

Li Yang, Ting Wang, Mingjian Ge, Min Zhang, Youde Cao, Shuliang Guo
DOI: 10.1002/rcr2.615

Here, we present an extremely rare case of coexistence of lung squamous cell carcinoma with mucosa-associated lymphoid tissue (MALT) lymphoma presenting as progressive lung ground-glass nodules.

Shreya Bhushan, Vikas Goyal, Cameron Ward, Muddassir Rashid, Nitin Kapur
DOI: 10.1002/rcr2.620

Tracheal and bronchial varices are rare, especially in children. We report the first presentation of bronchial varices and haemoptysis in a child, six years after a Fontan procedure for tricuspid atresia. She had tortuous mediastinal and transpleural arterial collaterals on imaging and subsequently underwent embolization of these collaterals with haemoptysis settling after this.

Boon Hau Ng, Nik Nuratiqah Nik, Abeed Mohamed Faisal Abdul Hamid, Chun Ian Soo, Hsueh Jing Low, Andrea Yu-Lin Ban
DOI: 10.1002/rcr2.621

Indwelling pleural catheter (IPC) is a useful tool for refractory malignant pleural effusions (MPEs). Its use in benign pleural effusions comes mainly from retrospective studies, case series, and case reports. Lupus effusion is common, causes minimal symptoms, and usually responds to either steroid therapy or immunosuppressants. We describe a 52-year-old woman whose first presentation of systemic lupus erythematosus (SLE) was a pleural effusion refractory to steroids and immunosuppressants. She successfully achieved spontaneous pleurodesis with intermittent IPC drainage at three months.

Yuto Akiyama, Kohei Horiuchi, Yasushi Kondo, Hiroki Kabata, Makoto Ishii, Koichi Fukunaga
DOI: 10.1002/rcr2.622

Here, we report a case of non-severe coronavirus disease 2019 (COVID-19) complicated by pulmonary embolism (PE), which indicates that the possibility of PE should consistently be considered, even in non-severe cases of COVID-19 without any risk of thrombosis.

Boon Hau Ng, Nik Nuratiqah Nik Abeed, Mohamed Faisal Abdul Hamid, Chun Ian Soo, Hsueh Jing Low, Andrea Yu-Lin Ban
DOI: 10.1002/rcr2.624

We describe a 69-year-old woman with underlying diffuse large B-cell lymphoma of the colon 16 years ago in remission, who presented with a new problem of refractory chylothorax. It was successfully treated with continuous positive airway pressure (CPAP) ventilation in tandem with talc pleurodesis.

Yohei Matsui, Tadaaki Yamada, Naoko Masuzawa, Shinshichi Hamada, Koichi Takayama, Osamu Hiranuma
DOI: 10.1002/rcr2.625

Here, we report a patient with non-small cell lung cancer-not otherwise specified (NSCLC-NOS) with high PD-L1 expression and aberrant granulocyte colony-stimulating factor (G-CSF) production, in whom monotherapy with the anti-PD-1 antibody pembrolizumab was effective as an initial treatment.

Ritsuya Shiiba, Daisuke Himeji, Kiichiro Beppu, Kousuke Marutsuka, Masahiro Mitsuoka, Kazuki Nabeshimaa
DOI: 10.1002/rcr2.626

Here, we report the case of a 37-year-old pregnant Japanese woman with bronchial mucoepidermoid carcinoma, recurrent asthmatic symptoms, and pneumonia that we treated successfully via interventional bronchoscopy and surgery. At one-year follow-up, the patient was disease-free and her baby was growing well.

Sen-Ei Shai, Yi-Ling Lai, Hsiao-Wen Tang, Shih-Chieh Hung
DOI: 10.1002/rcr2.627

We report the first case of incomplete metalloptysis linger pneumonia after the wedge resection of organizing pneumonia, with complete recovery by removal of residual clips, where clips from the staple cartridges had been applied on the periphery of the lung migrated and been incompletely expectorated.

Yusuke Ochi, Motoyasu Kato, Masahiro Fujioka, Mika Hayashi, Haruhi Takagi, Kazuhisa Takahashi
DOI: 10.1002/rcr2.628

We present a rare case of symptomatic thrombocytopaenia associated with nintedanib treatment in a patient with idiopathic pulmonary fibrosis (IPF).

Chu-Pin Pai, Chih-Ming Lin, Yi-Chen Yeh, Chien-Sheng Huang, Biing-Shiun Huanga
DOI: 10.1002/rcr2.629

Synchronous triple thymic carcinomas and thymoma have not been reported. The finding of this case report supports the hypothesis of malignant transformation of thymoma to thymic carcinoma.

Samantha Herath, Natalie Kruit, Adam Eslick, Nicole Giroya
DOI: 10.1002/rcr2.631

We describe the surprise finding of haemorrhagic endobronchial casts causing complete ventilation failure in the first patient placed on extracorporeal membrane oxygenation (ECMO) for coronavirus disease 2019 (COVID-19) in Australia. Removal of casts with international bronchoscopy procedures leads to the restoration of ventilation.

Gil Myeong Seong, Chang Lim Hyun, Jonggeun Lee, Changhwan Kima
DOI: 10.1002/rcr2.632

We report a case of large cell carcinoma identified during differential diagnosis of diffuse alveolar haemorrhage in a patient with haemoptysis.

Jin-Gun Cho, Devesh Thakkar, Peter Buchanan, Nicole Graf, John Wheatleya
DOI: 10.1002/rcr2.633

We describe the clinical progress of siblings who initially presented with an undifferentiated paediatric interstitial lung disease at birth which was eventually diagnosed in adulthood as pulmonary surfactant dysfunction due to ATP-binding cassette subfamily A member 3 (ABCA3 ) mutations. Clinical deterioration was due to progressive pulmonary hypertension and a moderate decline in forced expiratory volume in 1 sec (FEV1), rather than progression of the interstitial lung disease.

Hiroyuki Miura, Jun Miura, Keisei Tachibana, Shinichi Gotoa
DOI: 10.1002/rcr2.635

Solitary fibrous tumour of the pleura (SFTP) is a rare neoplasm. Moreover, cavity formation associated with SFTP is extremely rare. To our knowledge, only one such case has been previously reported.

Noriko Hayama, Hiroaki Ihara, Yuichirou Honma, Yukinari Itoigawa, Kyoichi Kaira, Mitsuhiro Fujii
DOI: 10.1002/rcr2.636

The incidence of immune checkpoint inhibitor (ICI)-induced gastritis is relatively rare, compared with colitis, but a massive immunoreaction caused by ICIs can induce severe gastritis. Thus, gastritis should be considered when patients taking ICIs complain of any gastrointestinal symptoms.

Hirofumi Watanabe, Kazuhiro Asada, Toshihiro Shirai, Hiroko Torii, Koji Yoshimura, Kimihide Kusafukaa
DOI: 10.1002/rcr2.638

There are many immune-related adverse events (irAEs) induced by immune checkpoint inhibitors; however, irAEs associated with type 2 inflammation are less known. We report a case of eosinophilic airway inflammation and eosinophilic chronic rhinosinusitis simultaneously during combination therapy with nivolumab and ipilimumab for renal cell carcinoma.

Rohit Vadala, Dhruv Talwar, Deepak Talwar
DOI: 10.1002/rcr2.637

This study highlights the recurrent non-traumatic idiopathic chylothorax with proposed algorithmic approach to undiagnosed milky or turbid blood-tinged pleural effusion.

Mohamed Faisal, Siti Nurhanis, Nik Nuratiqah, Nik Abeed, Boon Hau Ng, Andrea Yu-Lin Bana
DOI: 10.1002/rcr2.639

We describe the successful use of a single low-dose intrapleural (IP) alteplase in both indwelling pleural catheter blockage and symptomatic loculation drainage, following a failed therapy with six doses of IP streptokinase.

Yusuke Kunimatsu, Nozomi Tani, Izumi Sato, Yuri Ogura, Kazuki Hirose, Takayuki Takedaa
DOI: 10.1002/rcr2.641

Chest computed tomography (CT) showed non-segmental reticular shadow and ground-glass opacity predominantly spreading over the lymphatic tract, including the centrilobular and perilymphatic areas. 18F-fluorodeoxyglucose (FDG) positron emission tomography/CT showed significant FDG accumulation in the lung fields, indicating the proliferative and reversible status of immunoglobulin G4-related lung disease (IgG4-RLD).

Reina Hara, Yukihiro Yano, Fukuko Okabe, Tomoki Kuge, Masahide Mori, Koji Urasaki
DOI: 10.1002/rcr2.642

We report the case of a 72-year-old man with asbestos-related disease, firstly benign asbestos pleural effusion and subsequently diffuse pleural thickening, which progressed over 11 years and finally presented chronic respiratory failure. After his death, moderate asbestos body concentration was proven in his autopsy-derived lung tissue.

Chi-Kang Teng, Wen-Chien Cheng, Chieh-Lung Chen, Ting-Han Chen, Yun-Shan Lin, Chih-Yen Tu
DOI: 10.1002/rcr2.644

In this report, we present a case of endobronchial metastases from a primary embryonal carcinoma.

Bapti Roy, Mark C Teh, Yi Jin Kuok, Y C Gary Lee
DOI: 10.1002/rcr2.646

Pulmonary migration of intrapleural drugs via a bronchopleural communication is a rare and poorly described complication of intrapleural tissue plasminogen activator/deoxyribonuclease (tPA/DNase) therapy. We report the first detailed case of a bronchopleural communication after intrapleural tPA/DNase instillation. Despite this, the patient made an uneventful recovery from the pleural infection without requiring surgical drainage.

Hiroaki Nagano, Akiko Maeda, Takashi Kato, Ryoichi Kitamura, Wataru Higashiura
DOI: 10.1002/rcr2.647

This case was a very unique in that a strange foreign body in the bronchi remained for a long time and massive haemoptysis was caused by dilation of the bronchial artery.

Amy O'Brien, James Campling, Hugh Goodman, Catherina L Chang
DOI: 10.1002/rcr2.650

We report a case of concurrent new diagnoses of confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and acute myeloid leukaemia (AML). The implications of severe immunocompromise are unclear in the context of infection with SARS-CoV-2. We describe the clinical course of coronavirus disease 2019 (COVID-19) in this case, review the existing literature on SARS-CoV-2 in the immunocompromised patient, and finally the implications for managing her haematological neoplasm.

Sheng-Yuan Wang, Chia-Tse Weng, Lili Cheng, Tang-Hsiu Huang
DOI: 10.1002/rcr2.651

We describe an atypical case of relapsing polychondritis that involved solely the tracheal cartilages and presented clinically as non-specific airway symptoms. Timely diagnosis and treatment through a multidisciplinary approach is crucial to prevent subsequent serious complications.

Masahiro Yanagiya, Noriko Hiyama, Hideyuki Takeshima, Kazuhiro Usui, Jun Matsumoto
DOI: 10.1002/rcr2.652

In this report, we describe a successful endoscopic bronchial occlusion using endobronchial Watanabe spigots for bronchosubcutaneous fistula manifesting as massive subcutaneous emphysema.

Nirmal Kanti Sarkar, Md. Mofizur Rahman Mia, Md. Rejaul Hasan
DOI: 10.1002/rcr2.653

Tracheobronchial rhinosporidiosis is a rare benign cause of endobronchial obstruction and poses challenge for diagnosis and management. We report a 30-year-old man who developed acute hypoxaemia by a rapidly growing rhinosporidial mass causing central airway obstruction. Emergency bronchoscopic intervention saved his life.

Nozomi Tani, Yusuke Kunimatsu, Izumi Sato, Yuri Ogura, Kazuki Hirose, Takayuki Takeda
DOI: 10.1002/rcr2.654

Drug-induced interstitial lung disease (ILD) and immunosuppression are known to develop in a dose-dependent manner, and we herein describe the first case of dasatinib-induced ILD which coincided with active tuberculosis.

Mari Inoue, Tatsuji Enomoto,Masashi Kawamoto, Naoto Mikami, Hidehiko Kuribayashi, Noriyuki Saeki
DOI: 10.1002/rcr2.656

We present the case of a heavy ex-smoking man in his early 70s who presented with haemoptysis and died following rapid progression. The excised tumour was diagnosed as a SMARCA4-deficient thoracic sarcoma. This is a disease that progresses rapidly and has a poor prognosis.

Sumitaka Yamanaka, Takashi Yoshimatsu, Takeaki Miyata, Hanae Higa
DOI: 10.1002/rcr2.657

This study describes video-assisted thoracic surgery (VATS) with minimal chest incisions to prevent chronic post-operative intercostal neuralgia and paraesthesia, using a small subxiphoid incision only to remove the specimen.

Masahiro Yamasaki, Masaya Taniwaki, Shota Nakano, Naoko Matsumoto, Shinji Nabeshima, Noboru Hattori
DOI: 10.1002/rcr2.623

Multiple patchy pulmonary consolidations that are unresponsive to antibiotics and/or exist at peri-bronchial sites and bloody bronchoalveolar lavage may effectively help clinicians diagnose granulomatosis with polyangiitis.

Dario Amore, Emanuele Muto, Dino Casazza, Marcellino Cicalese, Marco Rispoli, Carlo Curcio
DOI: 10.1002/rcr2.640

Penetrating thoracic injuries by metallic rod are relatively rare. Here, we present the case of a stable patient with penetrating thoracic trauma where a careful radiological assessment helped us to perform a correct surgical management.

Seigo Miyoshi, Eiji Sugimoto, Mayu Kawakami, Yoshihiro Taguchi, Naohiko Hamaguchi, Osamu Yamaguchi
DOI: 10.1002/rcr2.643

We present the case of a 70-year-old man diagnosed with endobronchial hamartoma (EH) with concurrent malignant disease. Hamartomas are rarely identified as endobronchial lesions and only a few cases of EH with concurrent malignant disease are reported. Radiographic imaging and symptoms cannot reliably differentiate between EH and malignant bronchial nodules, thus careful examination is warranted.

Yosuke Chiba, Kei Yamasaki, Hiroaki Ikegami, Kazuhiro Yatera
DOI: 10.1002/rcr2.645

Pseudoaneurysm should be considered in the differential diagnosis when the computed tomography (CT) findings show a mediastinal mass in patients with a history of cardiovascular surgery even if such surgery occurred over two decades previously.

Deebya Raj Mishra, Narendra Bhatta, Achyut Bhakta Acharya, Avatar Verma, Rejina Shahi, Niharika Shah
DOI: 10.1002/rcr2.649

It is unusual to be able to visualize an entire cavity with such clarity.