Chest Disease Reports

Miliary Tuberculosis in In Vitro Fertilization pregnancy: a series of three cases with a history of hypothyroidism

2024-04-16T14:31:30+00:00

In Vitro Fertilization (IVF) pregnancy is associated with a higher risk of tuberculosis as compared to normal pregnancy. This increased risk remains unexplained. Most of the reports are based on small case series, and the risk profile is not well described. Hypothyroidism has not been described as a potential risk factor in any series. In this case series, we elaborate on the profile of three military tuberculosis cases of IVF pregnancies, all having hypothyroidism history as the common factor, and were referred to our super-specialty center with the onset of symptoms during the late first or mid-second trimester of pregnancy. All three cases were diagnosed on X-ray chest Posterior-Anterior (PA) view, showing miliary tuberculosis and a known case of hypothyroidism. Antitubercular treatment was started. In this report, we describe the clinical course and unfavorable outcomes of these three cases.

A giant intrapulmonary malignant teratoma - a rare case presentation

2024-04-05T09:00:05+00:00

Germ cell tumors such as teratomas are unusual and most commonly occur in the gonads. Extra-gonadal teratomas are rare, and the thorax, especially the mediastinum, is the commonly involved extra-gonadal site. Teratoma of the intrapulmonary region is rare and often involves the left upper lobe of the lung. In this report, we describe a case of a 20-year-old male diagnosed with an intrapulmonary malignant teratoma arising from the left lower lobe. Teratomas emerging from the lungs present with vague symptoms like breathing difficulty, cough, and hemoptysis. We report this rare appearance of malignant intrapulmonary teratoma that originated from the left lower zone of the lung.

A curious case of idiopathic eosinophilic pleural effusion post swimming pool diving

2024-03-21T07:32:53+00:00

Eosinophilic pleural effusion is defined as pleural effusion with >10% eosinophil count. Even though the mechanism underlying eosinophilic pleural effusion is poorly understood, it is considered to be caused by pleural fluid sequestration of bone marrow-derived eosinophils. Even though there is a wide spectrum of diseases recognized to be associated with eosinophilic pleural effusion, including pleural irritation, trauma (hemothorax, pneumothorax, thoracic surgery), malignancy, parasitic infection, drug/toxin-induced and pulmonary embolism; almost 25% of cases remain idiopathic. We herein report a curious case of eosinophilic pleural effusion, which has developed post blunt trauma to the chest, sustained after diving into a swimming pool. The patient was extensively evaluated for possible etiologies but was found negative for any underlying known pathology that could lead to eosinophilic pleural effusion.

Epicardial Adipose Tissue and cardiovascular disease: unmasking the hidden culprit

2024-01-24T15:05:48+00:00

The role of Epicardial Adipose Tissue (EAT) has evolved in the latest years from a passive energy repository to a dynamic contributor in cardiovascular health. This case discusses the role of EAT in residual cardiovascular risk and the potential benefits of GLP-1 receptor agonist liraglutide in mitigating its effects. We describe the case of a 62-year-old male patient, obese, hypertensive, and with a history of ischemic heart disease, was admitted to the emergency room complaining palpitations and shortness of breath. The ECG showed atrial fibrillation with rapid ventricular response with evidence of a new-onset left bundle branch block. The echocardiogram revealed heart-rate dependent regional dyskinesias, while both echocardiogram and CT scan evidenced the presence of EAT. Intrastent restenosis in the left anterior descending artery was found and treated with percutaneous revascularization. The patient was initiated on liraglutide to address residual cardiovascular risk. Follow-up showed reduced Low-Density Lipoprotein Cholesterol (LDL-c) and High-Sensitivity C-Reactive Protein (hs-CRP) levels, as well as decreased EAT thickness and Body Mass Index (BMI). EAT’s contribution to residual cardiovascular risk underscores the need for targeted interventions and treatments. Glucagon-Like Peptide-1 Receptor Agonists (GLP-1-RA) like liraglutide offer promise in addressing this risk, representing a potential venue for therapeutic exploration.

Bronchoscopic bronchial brush cytology: an underutilized modality for diagnosing lung cancer in resource limited facilities: a case series of nine patients

2024-01-31T09:15:39+00:00

Lung cancer incidence is on the rise with increasing industrialization across the globe. Early diagnosis is the key to a better prognosis. In the current scenario, in developing countries, the majority are diagnosed late, when surgical or curable treatment is not possible, and only palliative treatment options are left. Bronchoscopy is the most widely used modality for the diagnosis of lung cancer. Perhaps, all its accessories are not widely used. Bronchial brush is an easy, cost effective, easily available, without significant complication rates, safe, feasible, with high specificity which offers early preliminary report where biopsy is not possible. It should be used along with biopsy to increase the yield and accuracy in all suspected lung cancer patients who require bronchoscopy.

Germ cell tumor impersonating as a pleuropericardial cyst: a rare phenomenon

2024-01-31T10:58:35+00:00

A Mixed Germ Cell Tumor (MGCT) is a rare tumor with a low degree of differentiation. The most common sites are yolk sac and astrocytoma. Usually, it is gonadal, but in 5% of cases, it can present as extragonadal. The most common extragonadal site is the mediastinum, where the mediastinal mass sometimes mimics thymoma, lymphoma, pericardial cyst, and also occasionally causes pericardial tamponade. The presentations vary, ranging from accidental findings on routine radiography to life-threatening respiratory and cardiovascular compromission. We present an extragonadal MGCT case presenting as a mediastinal mass with symptoms of 1 year duration. The diagnosis was confirmed on Histopathological Examination (HPE) of surgically excised specimen. Given a possible life-threatening condition, a timely diagnosis is required.

Talus osteomyelitis - tubercular or not?

2024-01-30T14:32:43+00:00

Tuberculosis is a communicable infective disease caused by Mycobacterium tuberculosis (MTB). The most commonly involved organ is the lung (Pulmonary tuberculosis), however, MTB can affect any organ other than lungs; in this cases, it is known as Extrapulmonary Tuberculosis (EPTB), which can lead to significant morbidity and mortality. Patients with EPTB can rarely develop ankle or foot arthritis, which usually is either misdiagnosed or diagnosed very late, leading to complications. Early diagnosis and timely treatment are very important to prevent permanent functional disability, thus a high suspicion, even in the absence of specific symptoms, is a must. We report a rare case of osteoarthritis of talus which was tubercular, and in which the patient responded well to treatment.

Synchronous multiple neuroendocrine primary lung cancer with endobronchial extension in a never smoker - An unusual manifestation

2024-01-26T14:51:01+00:00

Synchronous Lung Cancer primaries (SLC) are uncommon, with diverse underlying histology, constituting only a small proportion. The scarcity also poses a challenge in formulating a standardized diagnostic approach. Consequently, the diagnostic and staging challenges for SLC are heightened, particularly when the tumors are located on opposite sides of the chest. We report an exceptionally rare phenomenon in synchronous multiple primary lung cancers with simultaneous occurrence of two neuroendocrine tumors with endobronchial extension, small cell carcinoma and typical carcinoid tumor. Immunohistochemistry proved valuable in confirming the diagnosis. Given the poor prognosis associated with such cases, an accurate diagnosis is crucial for determining appropriate treatment options.

Radiological distribution of bronchiectasis could be a clue for an infrequent cause of chronic cough

2024-01-25T15:28:21+00:00

Foreign Body Aspiration (FBA) in the elderly is an uncommon but potentially life-threatening condition in the acute setting, but it can also persist in the clinical setting of neglected foreign body with chronic and subtle respiratory symptoms. Chest computed tomography scan can overlook radiolucent foreign bodies but prominently focal lesion and bibasilar bronchiectasis in the appropriate clinical setting should increase the suspicion of FBA. Here we reported a 75-year-old female patient with chronic cough induced by neglected airway foreign body. Bronchoscopic removal of the foreign body was performed successfully, and her cough improved enormously after that.

Hearing loss, why bronchial tree may be involved?

2024-01-25T15:28:18+00:00

A 62-years-old man former occasional smoker was hospitalized for progressive hearing loss and Magnetic Resonance Imaging (MRI) detected multiple round hyperdense lesions in each cerebral hemisphere. Total body Computed Tomography (CT) scan showed a lobulated consolidative lesion on the right lung lower lobe associated to conglomerate lymph nodes (11R) suspected for primary lung cancer. Endoscopy showed an endobronchial invasion and integrated endobronchial ultrasound did not demonstrate any accessible lymph node for sampling. Forceps biopsy report on the endobronchial specimen led to histopathological diagnosis of metastatic melanoma. Skin and ophthalmologic examinations were negative for suspicious pigmented lesions findings and patient had no history of familiarity for melanoma. Malignant melanoma is rarely observed to metastasize to endobronchial tissue and it is represented only in the 4.5% of cases. The vast majority of endobronchial metastases are metachronous, even after several years. Nevertheless, the anachronous manifestations are possible.