| Case series |
Pleural fluid milkshakes: three cases with different aetiologies
Nai-Chien Huan, Hooi Ann Tan, Hema Yamini Ramarmuty, Subramaniam Ponnuvelu, Shivaanand Letcheminan, Kunji Kannan Sivaraman Kannan
DOI: 10.1002/rcr2.1116
Contrary to popular belief, the classical milky appearance of pleural fluid is seen in less than half of patients with chylothorax. In this case series, we present three patients with biochemically proven chylothorax: each with a different presentation, pleural fluid appearance, underlying cause, management strategy, and clinical outcome. Lymphoma, tuberculosis, and presumed amyloidosis are underlying causes in our patients. |
Using cryobiopsy with Radial EBUS in high-bleeding-risk, peripheral pulmonary lesions (PPL): description of cases and technique
Samantha Herath
DOI: 10.1002/rcr2.1125
This case series describes four patients with peripheral pulmonary lesions (PPL), undergoing cryobiopsy with radial EBUS for suspected lung cancer, and later diagnosed to have a PPL deemed to be of a high bleeding risk. The use of cryobiopsy with radial ultrasonic examination for the vasculature of the PPL, bronchial blocker use, and airway protection as well as an expert team preserved the safety of the procedure. |
Cough remedy leading to chronic cough: An unusual airway foreign body-Clove
M D Varunn, R Jayakumar, Chandrakant Tarke, Kishan Srikanth Juvva, D Senthil
DOI: 10.1002/rcr2.1130
Clove has been used traditionally for its medicinal values and is commonly used as a cough remedy. In this case series, we report 4 cases of this unusual airway foreign body which were essentially consumed with an intention to prevent cough, but unfortunately became the reason for their cough. |
| Case reports |
Eradication of post-lobectomy mucormycosis and bacterial empyema with intrapleural antimicrobial therapy in a patient with surgically resected Mycobacterium xenopi (non-tuberculous Mycobacteria) pulmonary infection
Charlotte Wigston, Emily Woolnough, Ohide Otome, Lucas Sanders, Edward Fysh
DOI: 10.1002/rcr2.1101
We present a 57-year-old gentleman who developed chronic mucormycosis (Cunninghamella sp.) and bacterial (Enterococcus sp.) empyema in a high-risk post-lobectomy space in the setting of a non-expandable lung following non-tuberculous mycobacterial infection. This was successfully treated with a combination of systemic and intrapleural therapies. |
Combining three-dimensional fluoroscopy guide system with single-use bronchoscopes for diagnosis of peripheral lesions: First two cases
Filippo Patrucco, Andrea D'Alessio, Marco Brambilla, Piero Emilio Balbo
DOI: 10.1002/rcr2.1113
Pulmonary peripheral lesions (PPLs) diagnosis is usually performed using a guidance system that combines bronchoscopes and diagnostic tools. We report two cases of PPLs sampling procedures combining the use of aScope 5 single-use bronchoscope and CIOS 3D Spin Mobile fluoroscopy system. The use of ever-new disposable bronchoscopes for sampling peripheral lesions is a viable alternative to reusable bronchoscopes for advanced bronchoscopy procedures. |
Portopulmonary hypertension: Success with combined medical treatment
María Hernández, Violeta Esteban, Paloma Ruiz, Ignacio Boira, Phillip Wickmann, José N Sancho-Chust, Joan Gil
DOI: 10.1002/rcr2.1114
We present a patient with portopulmonary hypertension (POPH) successfully treated with the combination of tadalafil and macitentan. |
Anti-synthetase syndrome associated interstitial lung disease after combination dual immune checkpoint inhibition
Peter T Bell, Thomas Beaton, Matthew Terrill, David Gillis, John Goddard
DOI: 10.1002/rcr2.1115
In this study, we describe the first reported case of antisynthetase syndrome; characterized by circulating anti-EJ (glycyl) t-RNA synthetase antibodies accompanied by relapsing, fibrosing and treatment-resistant interstitial pneumonitis. This case study highlights the need to also consider rarer phenotypes of ICI-induced inflammatory lung injury beyond conventional 'ICI pneumonitis' in the diagnostic workup of these patients. Differentiating between rare forms of CTD-ILD (in particular IIM-ILD) and conventional ‘ICI pneumonitis’ has important implications for the expected natural history and optimal treatment paradigms after immunotherapy. |
Multiple complications of advanced IPF in an individual patient presentation
Thomas Ledger, Stanley Braude
DOI: 10.1002/rcr2.1118
We report a patient with advanced idiopathic pulmonary fibrosis (IPF), who in a single presentation experienced three complications of the disease: an acute exacerbation, spontaneous pneumomediastinum, and platypnoea-orthodeoxia syndrome. Despite there being no definitive evidence-based treatment for an acute exacerbation, we report a marked improvement with high-dose steroids. This case also highlights the importance in IPF patients of considering pneumomediastinum as a cause of non-cardiac chest pain, as well as platypnoea-orthodeoxia in those with positional dyspnoea. |
A rare case of melioidosis presenting as pericarditis and pneumonia in a patient with poorly controlled diabetes mellitus
Cheuk Cheung Derek Leung, Ching Man Ngai, Chun Kit Wong, Yu Hong Chan
DOI: 10.1002/rcr2.1119
A rare case and diagnostically challenging case of melioidosis presenting as pericarditis and pneumonia in a patient with poorly controlled diabetes mellitus. |
Pulmonary embolism or COVID-19 pneumonia? A case report
Nahid Borna, Maryam Niksolat, Behnam Shariati, Vahid Saeedi, Leila Kamalzadeh
DOI: 10.1002/rcr2.1121
During the COVID-19 pandemic, a high index of suspicion is required for the timely diagnosis of pulmonary embolism, especially in patients with identifiable risk factors. This is specifically true for patients who cannot express their symptoms due to neurocognitive disorders. |
Pseudoprogression during induction treatment with nivolumab plus ipilimumab combined with chemotherapy for metastatic lung adenocarcinoma: A case report
Yusuke Kunimatsu, Yukari Kano, Rei Tsutsumi, Izumi Sato, Mai Tanimura, Keiko Tanimura, Takayuki Takeda
DOI: 10.1002/rcr2.1122
Reports on pseudoprogression during chemoimmunotherapy remain scarce, with only one case of treatment with carboplatin and pemetrexed combined with pembrolizumab. Pseudoprogression during dual immunotherapy with chemotherapy remains unreported. We present the case of pseudoprogression after the first cycle of dual immunotherapy with chemotherapy in a 55-year-old male with invasive mucinous adenocarcinoma. |
Video-assisted surgical diagnosis and pleural adhesion management in catamenial pneumothorax: A case and literature review
Irandi Putra Pratomo, Muhammad Arza Putra, Lidia Giritri Bangun, Isti Mardiana Soetartio, Maria Angela Putri Maharani, Irene Sinta Febriana, Dicky Soehardiman, Prasenohadi Prasenohadi, Tutug Kinasih
DOI: 10.1002/rcr2.1123
A 32-year-old woman with a history of endometriosis visited an emergency ward with a chief complaint of dyspnea and right-sided chest pain. A chest X-ray showed a right pneumothorax. The patient underwent a video-assisted thoracoscopy and talc pleurodesis, during which we found multiple perforations in the tendinous part of the diaphragm. |
Catheter-directed thrombolysis as an emergent intervention for failed vacuum thrombectomy of pulmonary embolism
Syed H Haq, Jordan Hinegardner-Hendricks, Cliff Cole, Amanda Laird, Sidra R Shah, Sandeep M Patel, William Cole
DOI: 10.1002/rcr2.1124
In this manuscript, we present a novel regimented treatment modality for pulmonary embolism in high-risk patients who have failed mechanical thrombectomy. |
Difficult removal after bronchial filling of an endobronchial Watanabe spigot with N-butyl-2-cyanoacrylate for intractable pneumothorax: A case report
Tomoaki Nakamura, Shosei Ro, Chie Morita, Naoki Kanomata, Atsushi Kitamura
DOI: 10.1002/rcr2.1126
This case report, involves a 52-year-old man who had previously developed a right pneumothorax during treatment for COVID-19 and who we successfully treated through implanting four endobronchial Watanabe spigots (EWS) in the right B1 and B3 in two phases and spraying N-butyl-2-cyanoacrylate (NBCA), we report on the surgical and technical challenges we faced 12 months later, when the decision was made to remove the EWS. Therefore, careful consideration of the indications for this procedure is necessary. |
Tracheal stenosis following tracheotomy in a COVID-19 patient
Mohamed Tayeb Salaouatchi, Linda Spinato, Said Sanoussi, Maria do Carmo Filomena Mesquita
DOI: 10.1002/rcr2.1127
We highlight the importance of the early recognition and management of post tracheotomy tracheal stenosis in patients with persistent respiratory difficulty as stridor in order to improve the management and prognosis of these patients. |
Use of the 1.1 mm cryoprobe through the radial EBUS GS (without the need for a bronchial blocker) to obtain samples safely in diagnosing PPL
Samantha Herath
DOI: 10.1002/rcr2.1128
We report two cases where the 1.1 mm cryoprobe was used and the cryobiopsy was extracted through the Radial EBUS GS whilst the bronchoscope remained in the bronchial tree with excellent control of bleeding due to the tamponading of the GS as well as the ability to attend to bleeding as soon as it occurred due to the bronchoscope being inside the airway. This method of obtaining the cryobiopsy through the GS and keeping the bronchoscope in the airway improved the safety of cryobiopsy for PPL. Further studies are required to assess the consistency of yield and safety of this method. |
Successful baricitinib treatment of refractory anti-synthetase syndrome associated with interstitial lung disease
Keishi Sugino, Hirotaka Ono, Mikako Saito, Masahiro Ando, Eiyasu Tsuboi
DOI: 10.1002/rcr2.1129
Interstitial lung disease (ILD) in patients with anti-synthetase syndrome (ASS) is often a severe and progressive disease that requires a lengthy treatment course involving multiple agents. We present a case of refractory ASS-ILD successfully treated with baricitinib after the failure of several other treatments. Bariticinib shows promise as a salvage treatment for patients with refractory ASS-ILD. |
| Clinical images |
Immune checkpoint inhibitor-related haemophagocytic lymphohistiocytosis in a patient with non-small cell lung carcinoma
Setsuko Oyama, Tatsuya Shirai, Yukiko Abe, Maya Tsuchiya, Toshiya Inui, Kozo Suhara, Satoshi Noto, Mitsuhiro Kamimura
DOI: 10.1002/rcr2.1117
Hemophagocytic lymphohistiocytosis (HLH) is a rare complication of immune checkpoint inhibitors (ICI), and moreover, presents several weeks or months after initiation of ICI treatment making it difficult to diagnose. We present a case, in whom pancytopenia with fever and hyperferritinaemia led us to suspect HLH. Early diagnosis of ICI-related HLH is essential for a better outcome. |
