Successful prone positioning after recent caesarean section in severe ARDS with postpartum pulmonary haemorrhage
We report a patient with severe acute respiratory distress syndrome (ARDS) and bleeding diathesis post ‐caesarean section resulting from acute chorioamnionitis with septic shock in whom prone positioning was a rescue procedure to improve oxygenation in the context of the patient's severe condition. AbstractA 35 ‐year‐old Thai women (gravida 3, para 0) at 36 weeks and five days of gestation was admitted to a delivery room due to premature rupture of membrane. She was diagnosed withEscherichia coli with extended ‐spectrum beta‐lactamase (ESBL) chorioamnionitis and septic shock leading to signs of fetal distr...
Source: Respirology Case Reports - October 13, 2020 Category: Respiratory Medicine Authors: Vorakamol Phoophiboon, Thitiwat Sriprasart Tags: Case Report Source Type: research

Granulomatosis (Wegener's granulomatosis) with polyangiitis presented as pulmonary manifestation: a case report
The diagnosis of vasculitis is often delayed because several other disorders may mimic the same clinical manifestations; therefore, the knowledge of the main radiographic and high ‐resolution computed tomography (HRCT) findings, in association with clinical, laboratory, and serum data, often enables non‐invasive diagnosis of pulmonary vasculitis. AbstractPulmonary vasculitis can be the manifestation of several systemic illnesses such as primary systemic vasculitis, collagen vascular diseases, and systemic diseases associated with autoantibodies. It may be associated with granulomatous, eosinophilic, lymphoplasmacytic a...
Source: Respirology Case Reports - October 13, 2020 Category: Respiratory Medicine Authors: Qusay Jummaa Lazim, Sinan Shakir Gheni Atrah, Khalid Jawad Mutlag, Haider Saadoon Qasim Alhilfi, Ahmed Muhi Fahad, Ahmed Salih Alshewered Tags: Case Report Source Type: research

The focal hepatic hot spot sign with lung cancer in computed tomography
We present this sign in a 60‐year‐old man with superior vena cava obstruction caused by lung cancer. Key messageThe focal hepatic hot spot sign appears as an area of intense focal wedge ‐shaped enhancement of the quadrate lobe (segment IVa) of the liver in the arterial and venous phase. If this sign appears on enhanced computed tomography of the abdomen, obstruction of thoracic central venous must be considered, especially when clinical symptoms are unclear. (Source: Respirology Case Reports)
Source: Respirology Case Reports - October 7, 2020 Category: Respiratory Medicine Authors: Van Trung Hoang, Nhu Quynh Vo, Cong Thao Trinh, Hoang Quan Nguyen, Vichit Chansomphou, Trong Binh Le Tags: Clinical Image Source Type: research

COVID ‐19 rehabilitation delivered via a telehealth pulmonary rehabilitation model: a case series
We present the rehabilitation journey of our first three cases, and discuss patient management and outcomes via a telehealth pulmonary rehabilitation model of care AbstractInternational statements have suggested the pulmonary rehabilitation (PR) model as an appropriate rehabilitation option for people recovering from coronavirus disease 2019 (COVID ‐19). In this case series, we present our COVID‐19 telehealth rehabilitation programme, delivered within a PR setting, and discuss the management of our first three cases. All patients were male, with a median age of 73 years. Following hospital discharge, the patient...
Source: Respirology Case Reports - October 6, 2020 Category: Respiratory Medicine Authors: Sally L. Wootton, Meredith King, Jennifer A. Alison, Sri Mahadev, Andrew S. L. Chan Tags: Case Series Source Type: research

Worsening respiratory failure in an adult hydrocephalic patient with a ventriculo ‐pleural shunt
We present a case of an adult hydrocephalic patient with a ventriculo ‐pleural shunt in situ presenting with worsening respiratory failure in the setting of a massive cerebrospinal fluid hydrothorax. AbstractVentriculo ‐pleural (VPL) shunt insertion is performed in hydrocephalic patients when alternative sites of cerebrospinal fluid (CSF) diversion are contraindicated. These include patients with peritoneal complications from ventriculo‐peritoneal shunts. Despite its utility, VPL shunts are uncommon. Hydrothor aces should be considered as a potential cause of dyspnoea in the setting of a VPL shunt. We present a case ...
Source: Respirology Case Reports - September 25, 2020 Category: Respiratory Medicine Authors: Edmond Wong, Vishnu Jeganathan, Samuel Wreghitt, Gavin Davis, Hari Wimaleswaran, Mark E Howard Tags: Case Report Source Type: research

Primary CD20 ‐positive mediastinal diffuse large B‐cell lymphoma
We reported a patient with PMBCL diagnosis and good response to treatment. AbstractPrimary mediastinal B ‐cell lymphoma (PMBCL) is a rare tumour with different characteristics from other type of lymphomas. Clinical manifestations may vary and cause delay in diagnosis and management. We present a 22‐year‐old patient with symptoms of shortness of breath, weight loss, and night sweats. Laboratory st udies only showed a markedly high lactate dehydrogenase (LDH) level and thoracic computed tomography (CT)scan revealed a large mediastinal mass. Core biopsy‐guided CT scan was performed and the pathological and immunohisto...
Source: Respirology Case Reports - September 23, 2020 Category: Respiratory Medicine Authors: Wulyo Rajabto, Dimas Priantono Tags: Case Report Source Type: research

Severe Nocardia pneumonia in an immunocompromised patient with alpha ‐1 antitrypsin deficiency
We describe the case of a patient with a severe necrotizing pneumonia who was chronically immunosuppressed with steroids and has alpha ‐1 antitrypsin deficiency. AbstractPulmonary nocardiosis is an uncommon pulmonary infection that is more likely found in immunocompromised patients with underlying chronic lung disease. The presentation of pulmonary nocardiosis is widely variable and shares features with other types of pulmonary infections. Nocardia is also not as easily isolated on standard culture mediums and hence more difficult to identify. We describe the case of a patient with a severe necrotising pneumonia who was ...
Source: Respirology Case Reports - September 23, 2020 Category: Respiratory Medicine Authors: Daryl E. C. Y. Chan, Dima Hamed, Daniel Lennon, Peter Wark Tags: Case Report Source Type: research

Idiopathic hypereosinophilic syndrome in remission with benralizumab treatment after relapse with mepolizumab
We report a patient with idiopathic hypereosinophilic syndrome (I ‐HES) who achieved remission with benralizumab after relapsing on mepolizumab. We believe this report may help develop novel therapeutic strategies for I‐HES. AbstractWe report a patient with idiopathic hypereosinophilic syndrome (I ‐HES) who achieved remission with benralizumab after relapsing on mepolizumab. An 83‐year‐old man was admitted to Showa General Hospital after presenting with hypoxaemia and multiple erythematous lesions. He showed a marked increase in blood eosinophil count. Skin biopsy revealed an invasion o f eosinophils in the dermi...
Source: Respirology Case Reports - September 22, 2020 Category: Respiratory Medicine Authors: Koki Fujii, Hidenori Takahashi, Nami Hayakawa, Yoshinobu Iwasaki Tags: Case Report Source Type: research

Interrelated atrial fibrillation and leaks triggering and maintaining central sleep apnoea and periodic breathing in a CPAP ‐treated patient
We report the case of a 71 ‐year‐old obese continuous positive airway pressure (CPAP)‐treated man who developed an acute cardiac failure (ACF) triggered by atrial fibrillation. CPAP data downloaded from the CPAP software (Rescan®) retrospectively demonstrated the progressive development of a high residual central apnoe a–hypopnoea index (AHI) with Cheyne–Stokes respiration (CSR). The AHI decreased after cardioversion allowing normalization of cardiac rhythm and function. Raw data extracted from CPAP software showed a gradual decrease in the periodic breathing cycle length related to a simultaneous imp...
Source: Respirology Case Reports - September 21, 2020 Category: Respiratory Medicine Authors: Arnaud Prigent, Anne ‐Laure Serandour, Régis Luraine, Jean Sébastien Poineuf, Christian Bosseau, Jean‐Louis Pépin Tags: Case Report Source Type: research

Hyper ‐progressive disease after immune checkpoint inhibitor in SMARCA4‐deficient small‐cell lung carcinoma
Herein, we report a patient with SMARCA4 (switch/sucrose non ‐fermentable‐related, matrix‐associated, actin‐dependent regulator of chromatin, subfamily A, member 4)‐deficient small‐cell lung carcinoma (SCLC) who had hyper‐progressive disease (HPD) after the first immune checkpoint inhibitors (ICI) treatment. A 35‐year‐old man was treated wit h nivolumab, subsequent to cytotoxic chemotherapy. A week after nivolumab initiation, chest computed tomography revealed marked increase in pleural effusion in the right lung and chest wall dissemination of the tumour, which concur with the definition of HPD. This is ...
Source: Respirology Case Reports - September 20, 2020 Category: Respiratory Medicine Authors: Yosuke Chiba, Toshinori Kawanami, Kei Yamasaki, Keigo Uchimura, Atsuji Matsuyama, Kazuhiro Yatera Tags: Case Report Source Type: research

A challenging diagnosis of malignant mesothelioma with osteosarcomatous differentiation metastasizing to bone
We present a case of bony metastasis from a rare histological subgroup of malignant pleural mesothelioma. The diagnosis was challenging; however, modern immunohistochemistry and molecular testing provided a diagnostic opportunity and potentially saved further unnecessary investigation. AbstractMalignant pleural mesothelioma (MPM) is an insidious primary neoplasm of the pleura that can be challenging to diagnose and is commonly considered to be only locally invasive. We present the case of a 74 ‐year‐old male who presented with clinical features of MPM but from whom pleural fluid and biopsies initially suggested benign ...
Source: Respirology Case Reports - September 18, 2020 Category: Respiratory Medicine Authors: Michael Brown, Hubertus Jersmann, Thomas Crowhurst, Chris Van Vliet, Gareth Crouch, Arash Badiei Tags: Case Report Source Type: research

Management of necrotizing pneumonia with bronchopleural fistula caused by multidrug ‐resistant Acinetobacter baumannii
This report highlights our approach and management for patients with severe NP caused by multidrug ‐resistant microorganisms including timing to perform surgery and choice of antimicrobial treatment. AbstractWe report the case of a 53 ‐year‐old male that presented to our hospital with a history of a brain tumour. He was hospitalized 10 days prior in another hospital. Before surgery, he complained of mild cough. Routine chest radiography demonstrated right upper lobe consolidation which was diagnosed as hospital‐acquired p neumonia. Broad‐spectrum empirical antimicrobial was initiated. After surgery, his cl...
Source: Respirology Case Reports - September 14, 2020 Category: Respiratory Medicine Authors: Allen Widysanto, Maranatha Liem, Karina Dian Puspita, Cindy Meidy Leony Pradhana Tags: Case Report Source Type: research

Empyema thoracis complicated by anaemia as caused by occult bonelet aspiration
We describe the successful treatment of an adult patient who presented to our hospital with the serious condition of empyema complicated by anaemia due to occult bonelet aspiration. AbstractA 62 ‐year‐old man was referred to our medical centre with productive cough and high fever over the span of one week, as well as the affiliated symptoms of chronic cough and dizziness for more than six months. Computed tomography (CT) of the thorax was performed and analysed revealing lobulated empye ma with thick pleura and two foreign body (FB) retentions in the right lower lobe bronchus. The patient proceeded to thoracoscopic dec...
Source: Respirology Case Reports - September 9, 2020 Category: Respiratory Medicine Authors: Sen ‐Ei Shai, Yi‐Ling Lai, Hsiao‐Wen Tang, Shih‐Chieh Hung Tags: Case Report Source Type: research

Relapsing paradoxical reaction in miliary tuberculosis: a case report and literature review
We report an elderly patient who developed PR associated with respiratory failure following ATT for miliary TB, with radiological and pathological documentation. He responded to corticosteroids, but relapsed twice when the dose was reduced. It is imperative to be familiar with this form of PR to a void diagnostic pitfalls and initiate appropriate therapy. (Source: Respirology Case Reports)
Source: Respirology Case Reports - September 8, 2020 Category: Respiratory Medicine Authors: Abdullah Mobeireek, Nasser A. Al Shekail Tags: Case Report Source Type: research

Issue Information
Respirology Case Reports, Volume 8, Issue 8, November 2020. (Source: Respirology Case Reports)
Source: Respirology Case Reports - September 7, 2020 Category: Respiratory Medicine Tags: Issue Information Source Type: research

Pleural effusion revealing a ruptured mediastinal mesothelial cyst
This report describes a rare case of pleural effusion revealing a ruptured mediastinal mesothelial cyst in a 28 ‐year‐old man. The diagnosis of this complicated mesothelial cyst relied on intraoperative and anatomopathological findings. He underwent videothoracoscopy with resection of the cyst. Outcomes were favourable. (Source: Respirology Case Reports)
Source: Respirology Case Reports - September 7, 2020 Category: Respiratory Medicine Authors: Ahmed Ben Saad, Saousen Cheikh Mhamed, Asma Migaou, Asma Achour, Naceur Rouatbi, Samah Joobeur Tags: Case Report Source Type: research

Massive haemoptysis caused by a long ‐standing foreign body in the airway
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. AbstractThe presence of foreign bodies (FB) in the airway is a potentially life ‐threatening event. We encountered a rare case of long‐standing bronchial FB complicating with intermittent massive haemoptysis in a 42‐year‐old man. He denied any prior history of aspiration. The FB was buried deep in the bronchial epithelium and could not be removed using bronchoscopy. Bro nchial angiography revealed marked dilation of the inferior lobe branch of the...
Source: Respirology Case Reports - September 2, 2020 Category: Respiratory Medicine Authors: Hiroaki Nagano, Akiko Maeda, Takashi Kato, Ryoichi Kitamura, Wataru Higashiura Tags: Case Report Source Type: research

Ingenuity of minimally invasive thoracoscopic lobectomy for undiagnosed pulmonary tumour
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. AbstractA 51 ‐year‐old man was referred to our hospital, with a dumbbell‐shaped nodule measuring 40 mm in the right upper lobe of the lung. He was a current smoker with diabetes mellitus and bronchial asthma. The transbronchial biopsy was performed. However, definitive diagnosis was not obtained from the excised specimens. Bacterial culture of bronchial lavage fluid also yielded nega...
Source: Respirology Case Reports - September 2, 2020 Category: Respiratory Medicine Authors: Sumitaka Yamanaka, Takashi Yoshimatsu, Takeaki Miyata, Hanae Higa Tags: Case Report Source Type: research

Bronchopleural communication following intrapleural doses of tPA/DNase for empyema
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. AbstractIntrapleural tissue plasminogen activator (tPA) and deoxyribonuclease (DNase) therapy is a new treatment for pleural infection. Clinical experiences of tPA/DNase therapy, and its complications, are cumulating. We present a patient with multiloculated empyema but no initial evidence of a bronchopleural fistula. She was treated with antibiotics and chest tube drainage of the basal collection ...
Source: Respirology Case Reports - August 30, 2020 Category: Respiratory Medicine Authors: Bapti Roy, Mark C. Teh, Yi Jin Kuok, Y. C. Gary Lee Tags: Case Report Source Type: research

Bronchoscopic visualization of a cavity in entirety: an unusual finding
It is unusual to be able to visualize an entire cavity with such clarity. Key messageIt is unusual to be able to visualize an entire cavity with such clarity. (Source: Respirology Case Reports)
Source: Respirology Case Reports - August 30, 2020 Category: Respiratory Medicine Authors: Deebya Raj Mishra, Narendra Bhatta, Achyut Bhakta Acharya, Avatar Verma, Rejina Shahi, Niharika Shah Tags: Clinical Video Source Type: research

Relapsing polychondritis with isolated tracheal involvement and airway ‐only symptoms
We report an unusual case of RP with isolated tracheal involvement and very non‐specific symptoms of exertional dyspnoea and dry cough. The initial chest radiograph showed long‐ segment narrowing of the trachea, and the computed tomography of the chest revealed thickened cartilaginous walls of the trachea, while the posterior membranous portion was spared. The tracheal narrowing was readily observed under bronchoscopy. The patient was treated with oral prednisolone. Althoug h the subsequent course was transiently complicated by an episode of severePneumocystis jirovecii pneumonia with acute respiratory distress syndrom...
Source: Respirology Case Reports - August 30, 2020 Category: Respiratory Medicine Authors: Sheng ‐Yuan Wang, Chia‐Tse Weng, Lili Cheng, Tang‐Hsiu Huang Tags: Case Report Source Type: research

Thunderstorm ‐related asthma can occur in New Zealand
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. AbstractThunderstorm asthma is induced by specific weather conditions causing breakdown and widespread distribution of allergens. Thunderstorm asthma had previously been considered unlikely ...
Source: Respirology Case Reports - August 30, 2020 Category: Respiratory Medicine Authors: Ayan Sabih, Claire Russell, Catherina L. Chang Tags: Case Series Source Type: research

SMARCA4 ‐deficient lung tumour that presented with haemoptysis and progressed rapidly
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. AbstractThe case of a heavy ex ‐smoking man in his early 70s who presented with haemoptysis and died following rapid progression is presented. The tumour excised by surgery was mostly composed of monotonous large rhabdoid cells showing prominent nucleoli and eosinophilic cytoplasm. On immunohistochemistry with SMARCA4 (BRG‐1) , the tumour cells ...
Source: Respirology Case Reports - August 30, 2020 Category: Respiratory Medicine Authors: Mari Inoue, Tatsuji Enomoto, Masashi Kawamoto, Naoto Mikami, Hidehiko Kuribayashi, Noriyuki Saeki Tags: Case Report Source Type: research

Recurrent non ‐traumatic idiopathic chylothorax: a diagnostic dilemma with therapeutic challenge
This study highlights the recurrent non ‐traumatic idiopathic chylothorax with proposed algorithmic approach to undiagnosed milky or turbid blood‐tinged pleural effusion. AbstractChylothorax is an uncommon pleural effusion characterized by the presence of chyle in the pleural space. Malignancy, trauma, and infections such as tuberculosis and filariasis can result in chylothorax. The chyle is an odourless and white liquid; however, around 50% of chylothorax is not milky (serosanguineous) and 10% of chylothorax is idiopathic which can pose a diagnostic dilemma. We propose a systematic approach which includes pleural flui...
Source: Respirology Case Reports - August 29, 2020 Category: Respiratory Medicine Authors: Rohit Vadala, Dhruv Talwar, Deepak Talwar Tags: Case Report Source Type: research

Drug ‐induced interstitial lung disease associated with dasatinib coinciding with active tuberculosis
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. AbstractA 69 ‐year‐old woman was diagnosed with a breakpoint cluster region‐Abelson‐positive chronic myeloid leukaemia and treated with dasatinib for 14 months. She presented with one month of high‐grade fever and persistent dry cough. Chest computed tomography revealed non‐segmental subpleural con solidation, ground‐glass opacities, and interlobular septal thickening. The bronc...
Source: Respirology Case Reports - August 26, 2020 Category: Respiratory Medicine Authors: Nozomi Tani, Yusuke Kunimatsu, Izumi Sato, Yuri Ogura, Kazuki Hirose, Takayuki Takeda Tags: Case Report Source Type: research

Tracheobronchial rhinosporidiosis: an uncommon life ‐threatening benign cause of airway obstruction
In this report, we present a 30 ‐year‐old man with a history of recurrent nasal polyp who presented with cough, shortness of breath, haemoptysis, and a radiological feature of right lung collapse on imaging. He was diagnosed with rhinosporidiosis based on histopathological examination of bronchoscopic biopsy specimen taken fro m the right principal bronchial mass. Shortly after hospitalization, he developed acute respiratory distress requiring emergency bronchoscopic intervention. A pinkish mulberry‐like tracheal and right bronchial mass was removed endoscopically with cauterization of the base of the lesion. On long...
Source: Respirology Case Reports - August 26, 2020 Category: Respiratory Medicine Authors: Nirmal Kanti Sarkar, Md. Mofizur Rahman Mia, Md. Rejaul Hasan Tags: Case Report Source Type: research

Co ‐diagnoses of acute myeloid leukaemia and COVID‐19: presentation and management implications
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. AbstractWe report a case of concurrent new diagnoses of confirmed severe acute respiratory syndrome coronavirus 2 (...
Source: Respirology Case Reports - August 24, 2020 Category: Respiratory Medicine Authors: Amy O'Brien, James Campling, Hugh Goodman, Catherina L. Chang Tags: Case Report Source Type: research

Short ‐course intrapleural alteplase and DNase in complex effusion with bleeding risk
We described three patients with complex pleural effusions who received intrapleural fibrinolysis therapy with different bleeding risks. AbstractPleural infection is an important clinical problem with significant morbidity. In poorly draining complex pleural effusions, the current management favours a less invasive image ‐guided placement of smaller bore catheters and adjunctive intrapleural fibrinolysis therapy (IPFT). We describe our experience of using IPFT in three patients with different bleeding risks with complex pleural effusions. The first was a 30‐year‐old with transfusion‐dependent β‐thalassemi a ...
Source: Respirology Case Reports - August 24, 2020 Category: Respiratory Medicine Authors: Xiong Khee Cheong, Andrea Yu ‐Lin Ban, Mohamed Faisal Abdul Hamid Tags: Case Series Source Type: research

Bronchosubcutaneous fistula manifesting as massive subcutaneous emphysema treated successfully by endobronchial Watanabe spigots
In this report, we describe a successful endoscopic bronchial occlusion using endobronchial Watanabe spigots for bronchosubcutaneous fistula manifesting as massive subcutaneous emphysema. AbstractA bronchosubcutaneous fistula (BF) is an abnormal communication between the bronchus, pleural cavity, and subcutaneous tissue. Treatment of BF has been documented rarely. We describe a successful endoscopic bronchial occlusion using endobronchial Watanabe spigots (EWSs) for BF manifesting as massive subcutaneous emphysema (SE). A 78 ‐year‐old woman developed delayed localized SE following a surgical pleural biopsy for the diag...
Source: Respirology Case Reports - August 23, 2020 Category: Respiratory Medicine Authors: Masahiro Yanagiya, Noriko Hiyama, Hideyuki Takeshima, Kazuhiro Usui, Jun Matsumoto Tags: Case Report Source Type: research

Radiographic change over 11 years in a patient with asbestos ‐related pleural disease
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. AbstractAsbestos ‐related pulmonary conditions such as benign asbestos pleural effusion (BAPE) and diffuse pleural thickening (DPT) can develop after many years of asbestos exposure. These conditions cause progressing constrictive deficit in pulmonary function which may ...
Source: Respirology Case Reports - August 18, 2020 Category: Respiratory Medicine Authors: Reina Hara, Yukihiro Yano, Fukuko Okabe, Tomoki Kuge, Masahide Mori, Koji Urasaki Tags: Case Report Source Type: research

Pseudoaneurysm after total arch replacement mimicking malignant lymphadenopathy
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. Key messagePseudoaneurysm 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. (Source: Respirology Case Reports)
Source: Respirology Case Reports - August 18, 2020 Category: Respiratory Medicine Authors: Yosuke Chiba, Kei Yamasaki, Hiroaki Ikegami, Kazuhiro Yatera Tags: Clinical Image Source Type: research

Endobronchial metastases from a primary embryonal carcinoma
In this report, we present a case of endobronchial metastases from a primary embryonal carcinoma. AbstractWe report the case of a 24 ‐year‐old man who presented with chief complaints of shortness of breath and haemoptysis; chest radiography revealed complete collapse of the left lung. Bronchoscopy revealed an endobronchial tumour with complete obstruction of the left main bronchus. Cryosurgical excision was performed; tissue pathology confirmed the diagnosis of metastatic embryonal carcinoma. The patient underwent a right orchiectomy followed by a bleomycin + etoposide + cisplatin (BEP) chem...
Source: Respirology Case Reports - August 18, 2020 Category: Respiratory Medicine Authors: Chi ‐Kang Teng, Wen‐Chien Cheng, Chieh‐Lung Chen, Ting‐Han Chen, Yun‐Shan Lin, Chih‐Yen Tu Tags: Case Report Source Type: research

Penetrating pulmonary injury caused by a steel rod
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. Key messageIn stable patients with penetrating thoracic trauma, a careful radiological assessment should be taken into account for a correct surgical management. (Source: Respirology Case Reports)
Source: Respirology Case Reports - August 17, 2020 Category: Respiratory Medicine Authors: Dario Amore, Emanuele Muto, Dino Casazza, Marcellino Cicalese, Marco Rispoli, Carlo Curcio Tags: Clinical Image Source Type: research

Endobronchial hamartoma coexisting with lung cancer
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 betwee n EH and malignant bronchial nodules, thus careful examination is warranted. Key messageClinicians should be careful when examining a case with endobronchial hamartoma with concurrent malignant disease because radiographic imaging and symptoms cannot clearly differentiate between both diseases. (Sour...
Source: Respirology Case Reports - August 17, 2020 Category: Respiratory Medicine Authors: Seigo Miyoshi, Eiji Sugimoto, Mayu Kawakami, Yoshihiro Taguchi, Naohiko Hamaguchi, Osamu Yamaguchi Tags: Clinical Image Source Type: research

Melioidosis —role of endobronchial ultrasound
We report three cases of mediastinal melioidosis where EBUS ‐guided fine needle aspiration (FNA) aided in early diagnosis. (Source: Respirology Case Reports)
Source: Respirology Case Reports - August 14, 2020 Category: Respiratory Medicine Authors: Santhakumar Subramanian, Venugopal Jaganathan, Deepak T. Hari, Deepak Thangaraju Tags: Case Series Source Type: research

IgG4 ‐related lung disease progressing to respiratory failure
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). AbstractImmunoglobulin G4 (IgG4) ‐related disease (IgG4‐RD) is a systemic immune‐mediated, fibroinflammatory disorder categorized as proliferative or fibrotic depending on the responsiveness of ...
Source: Respirology Case Reports - August 10, 2020 Category: Respiratory Medicine Authors: Yusuke Kunimatsu, Nozomi Tani, Izumi Sato, Yuri Ogura, Kazuki Hirose, Takayuki Takeda Tags: Case Report Source Type: research

ABCA3 deficiency from birth to adulthood presenting as paediatric interstitial lung disease
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. AbstractPaediatric disorders of pulmonary surfactant may occur due to mutations involving surfactant proteins B and C, and ATP ‐binding casse...
Source: Respirology Case Reports - August 6, 2020 Category: Respiratory Medicine Authors: Jin ‐Gun Cho, Devesh Thakkar, Peter Buchanan, Nicole Graf, John Wheatley Tags: Case Report Source Type: research

Re ‐establishing indwelling pleural catheter patency with alteplase after failure of streptokinase
We report a 53 ‐year‐old woman with stage IVA lung adenocarcinoma and recurrent MPE. Two months post insertion, the IPC was blocked with residual effusion and presence of new loculations. Attempts to restore patency with six doses of intrapleural (IP) streptokinase failed. She was referred to our centre for fu rther management. We used a single dose of 2.5 mg IP alteplase which was successful in establishing patency of the IPC and draining the effusion. This case highlights the safety and efficacy of IP alteplase via IPC following a failed instillation of streptokinase. (Source: Respirology Case Reports)
Source: Respirology Case Reports - August 5, 2020 Category: Respiratory Medicine Authors: Mohamed Faisal, Siti Nurhanis, Nik Nuratiqah Nik Abeed, Boon Hau Ng, Andrea Yu ‐Lin Ban Tags: Case Report Source Type: research

Bronchial mucoepidermoid carcinoma, recurrent asthmatic symptoms, and pneumonia presenting in pregnancy
We report the case of a 37 ‐year‐old pregnant Japanese woman (34th week of gestation) with a left main bronchus mucoepidermoid carcinoma. She had left lower lung pneumonia episodes for eight weeks that had been associated with bronchial asthma. Bronchoscopy revealed a membranous endobronchial tumour obstructing most of th e left main bronchus. We delivered the baby without any problems by caesarean section, followed by tumour cauterization using a rigid bronchoscope under general anaesthesia. After that, we performed a sleeve resection of the main left bronchus. At one‐year follow‐up, the patient was disease‐fr e...
Source: Respirology Case Reports - August 4, 2020 Category: Respiratory Medicine Authors: Ritsuya Shiiba, Daisuke Himeji, Kiichiro Beppu, Kousuke Marutsuka, Masahiro Mitsuoka, Kazuki Nabeshima Tags: Case Report Source Type: research

Solitary fibrous tumour of the pleura arising in a pulmonary cavity
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. AbstractSolitary fibrous tumour of the pleura (SFTP) arising in a cavity is extremely rare. A 66 ‐year‐old Japanese male presented with an abnormal shadow on his chest X‐ray. Chest computed tomography showed a cavity of approximately 18 mm in diameter between the upper and lower lobes that contained a solid nodule within. Under the thoracoscope, the peduncle cystic tumour was removed wi th sufficient surgical margi...
Source: Respirology Case Reports - August 2, 2020 Category: Respiratory Medicine Authors: Hiroyuki Miura, Jun Miura, Keisei Tachibana, Shinichi Goto Tags: Case Report Source Type: research

Tracheobronchial amyloidosis: an uncommon disease with a common presentation
We describe three cases who presented with haemoptysis, which on further evaluation were diagnosed as isolated tracheobronchial amyloidosis, and a review of literature. AbstractAmyloidosis is an uncommon heterogeneous and multi ‐systemic disease characterized by extracellular amyloid deposition. The size of proteins varies and forms a part of local disease or systemic process. Light chain amyloidosis (AL) is the most prevalent form of systemic amyloidosis which may also be seen in localized disease. Isolated tracheobronc hial amyloidosis (TBA) is rather unusual with local amyloid deposition which may pose a diagnostic di...
Source: Respirology Case Reports - August 1, 2020 Category: Respiratory Medicine Authors: Loveleen Mangla, Rohit Vadala, Shirish Kumar Kadli, Deepak Prajapat, Deepak Talwar Tags: Case Series Source Type: research

Large cell carcinoma of the lung presenting as diffuse pulmonary infiltrates with haemoptysis
We report a case of large cell carcinoma identified during differential diagnosis of diffuse alveolar haemorrhage in a patient with haemoptysis. AbstractDue to rapid advances in our understanding of the molecular pathogenesis of non ‐small cell lung cancer (NSCLC), the 2015 World Health Organization (WHO) classification has defined large cell carcinoma (LCC) as a subtype that is lacking glandular or squamous cells, and any neuroendocrine differentiation. Accordingly, LCC is one of the rarest subtypes of NSCLC. LCC usually pre sents as a large peripheral tumour with prominent necrosis and its specific characteristics are ...
Source: Respirology Case Reports - July 30, 2020 Category: Respiratory Medicine Authors: Gil Myeong Seong, Chang Lim Hyun, Jonggeun Lee, Changhwan Kim Tags: Case Report Source Type: research

Severe gastritis due to pembrolizumab treatment in a lung cancer patient
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. AbstractImmune checkpoint inhibitors (ICIs) are known to induce gastrointestinal adverse events. Colitis occurs most frequently, and gastritis is less common. A few case reports of gastritis induced by ICIs have indicated that colitis induced by cytotoxic T ‐lymphocyte antigen‐4 (CTLA‐4) resembles inflammatory bowel disease (IBD...
Source: Respirology Case Reports - July 29, 2020 Category: Respiratory Medicine Authors: Noriko Hayama, Hiroaki Ihara, Yuichirou Honma, Yukinari Itoigawa, Kyoichi Kaira, Mitsuhiro Fujii Tags: Case Report Source Type: research

Eosinophilic airway inflammation and eosinophilic chronic rhinosinusitis during nivolumab and ipilimumab
We report a case of eosinophilic airway inflammation and eosinophilic chronic rhinosinusitis simultaneously during combination therapy with nivolumab and ipil imumab for renal cell carcinoma. AbstractImmune ‐related adverse events (irAEs) are induced by immune checkpoint inhibitors (ICIs) which are administered for many cancers. There are many irAEs such as endocrine abnormalities, interstitial lung disease, and colitis. However, irAEs associated with type 2 (T2) inflammation are less known. We herei n report a 71‐year‐old woman who developed eosinophilic airway inflammation and eosinophilic chronic rhinosinusitis (E...
Source: Respirology Case Reports - July 29, 2020 Category: Respiratory Medicine Authors: Hirofumi Watanabe, Kazuhiro Asada, Toshihiro Shirai, Hiroko Torii, Koji Yoshimura, Kimihide Kusafuka Tags: Case Report Source Type: research

Haemorrhagic bronchial casts causing complete ventilatory failure in a COVID ‐19 patient on ECMO
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. AbstractCoronavirus disease 2019 (COVID ‐19) was identified as causing an unusual pneumonia in Wuhan in late 2019 and rapidly evolved to a pandemic. We present a case of an otherwise well 55‐year‐old female patient who had seemingly mild symptoms when she presented to the emergency dep...
Source: Respirology Case Reports - July 27, 2020 Category: Respiratory Medicine Authors: Samantha Herath, Natalie Kruit, Adam Eslick, Nicole Giroy Tags: Case Report Source Type: research

De novo thymic carcinoma or malignant transformation: a myasthenic patient presented with multiple mediastinal tumours
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. AbstractA 63 ‐year‐old man presented with bilateral ptosis, and detailed evaluation confirmed ocular myasthenia gravis with three anterior mediastinal masses on computed tomography (CT) of the chest. Extended thymectomy was performed, and pathology revealed two thymic carcinoma and one thymoma. After surgery , the patient is free from recurrence. Synchronous triple thymic carcinomas and thymoma have not been reported. The finding of ...
Source: Respirology Case Reports - July 22, 2020 Category: Respiratory Medicine Authors: Chu ‐Pin Pai, Chih‐Ming Lin, Yi‐Chen Yeh, Chien‐Sheng Huang, Biing‐Shiun Huang Tags: Case Report Source Type: research

Incomplete metalloptysis linger pneumonia after a wedge resection of the lung for organizing pneumonia
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. AbstractA 40 ‐year‐old man had considered himself to be robust, with the exception of an earlier diagnosis of hepatitis C. He underwent a wedge resection of the lung, at the left upper lobe (LUL), mimicking an anterior mediastinal tumor. A pathology report showed a 5 × 5 × 2.5&thin...
Source: Respirology Case Reports - July 15, 2020 Category: Respiratory Medicine Authors: Sen ‐Ei Shai, Yi‐Ling Lai, Hsiao‐Wen Tang, Shih‐Chieh Hung Tags: Case Report Source Type: research

Thrombocytopaenia during nintedanib treatment in a patient with idiopathic pulmonary fibrosis
We present a rare case of symptomatic thrombocytopaenia associated with nintedanib treatment in a patient with idiopathic pulmonary fibrosis (IPF). AbstractA 72 ‐year‐old Japanese man was diagnosed with idiopathic pulmonary fibrosis (IPF), and treatment with nintedanib was initiated. Ten months after nintedanib treatment initiation, his serum platelet levels gradually decreased until it reached 14,000/mm2 and he was admitted to our hospital. At admission, his serum platelet ‐associated immunoglobin G level was markedly increased, and bone marrow biopsy showed megakaryocytic hyperplasia. We suspended nintedanib treatm...
Source: Respirology Case Reports - July 15, 2020 Category: Respiratory Medicine Authors: Yusuke Ochi, Motoyasu Kato, Masahiro Fujioka, Mika Hayashi, Haruhi Takagi, Kazuhisa Takahashi Tags: Case Report Source Type: research

Advanced G ‐CSF‐producing non‐small cell lung cancer‐not otherwise specified, with favourable response to pembrolizumab monotherapy
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. AbstractAdvanced granulocyte colony ‐stimulating factor (G‐CSF)‐producing lung tumours are generally refractory to platinum‐based chemotherapy and are associated with poor prognosis. However, therapeutic strategies for these tumours remain unknown. A 74‐year‐old man was diagnosed with non‐small cell lung ...
Source: Respirology Case Reports - July 15, 2020 Category: Respiratory Medicine Authors: Yohei Matsui, Tadaaki Yamada, Naoko Masuzawa, Shinshichi Hamada, Koichi Takayama, Osamu Hiranuma Tags: Case Report Source Type: research

Bronchial varices in a child with tricuspid atresia six years post Fontan correction
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. AbstractTracheal and bronchial varices are rarely found in children. However, they have been described in adults with failing Fontan circuits or secondary to vascular pathology, such as portal and pulmonary hypertension. We report the presentation of haemoptysis and bronchial varices in a child, six years after ...
Source: Respirology Case Reports - July 15, 2020 Category: Respiratory Medicine Authors: Shreya Bhushan, Vikas Goyal, Cameron Ward, Muddassir Rashid, Nitin Kapur Tags: Case Report Source Type: research