Mechanical insufflation –exsufflation for airway clearance in adults with cystic fibrosis
We present two cases where this modified version of MI‐E was used as an adjunct to traditional ACT in adults during an acute exacerbation of CF. (Source: Respirology Case Reports)
Source: Respirology Case Reports - February 28, 2018 Category: Respiratory Medicine Authors: Madeline Gaynor, Jamie Wood Tags: Case Report Source Type: research

Narrow ‐band imaging thoracoscopy in pleural amyloidosis
We report the case of a 68‐year‐old male non‐smoker suffering from shortness of breath for 1 year. He was referred to our institution for a definitive diagnosis. Both chest X‐ray and computed tomography scans showed bilateral hydrothorax with no pleural thickening. We performed flexi‐rigid thoracoscopic pleural biopsy on the right side with a single port under local anaesthesia. Multiple white nodules were seen in parietal and visceral pleura, and these nodules were small and flat under white light. Narrow‐band imaging demonstrated pathognostic findings on parietal pleura. Irregular dilative vessels were seen a...
Source: Respirology Case Reports - February 27, 2018 Category: Respiratory Medicine Authors: Yuki Kanno, Naoki Furuya, Mariko Okamoto, Akira Noguchi, Takeo Inoue, Masamichi Mineshita Tags: Case Report Source Type: research

Malignant pleural mesothelioma presenting with remitting –relapsing pleural effusions: report of two cases
We present two cases in which the presenting pleural effusion spontaneously resolved but recurred (in one case, multiple times), leading to further investigations that revealed an underlying malignant pleural epithelioid mesothelioma. These cases demonstrate the need for clinicians to be aware that remitting effusions can occur in the context of pleural malignancy and should be kept under observation, with a low threshold for further investigation if relapse occurs. Malignant effusions are typically persistent and progressive. Spontaneously resolving effusions are commonly presumed to be benign. We present two cases in wh...
Source: Respirology Case Reports - February 23, 2018 Category: Respiratory Medicine Authors: Sanjeevan Muruganandan, Deirdre Brigid Fitzgerald, Y C Gary Lee Tags: Case Report Source Type: research

Thin laryngeal foreign bodies in infants: diagnostic potential of MDCT
We report two cases of 10‐month‐old male infants, each with a thin radiolucent FB lodged between the vocal folds that was detected with low‐dose multidetector computed tomography (MDCT) and thin‐slice reconstruction. Both infants presented with symptoms of respiratory airway inflammation at clinical examination and negative neck and chest radiographs. FBs were removed by direct laryngoscopy, without complications. In our experience, low‐dose MDCT with thin‐slice reconstruction is particularly useful for diagnosis in cases of suspected FB aspiration with uncertain clinical presentation and negative radiographic ...
Source: Respirology Case Reports - February 15, 2018 Category: Respiratory Medicine Authors: Antonella Concerto, Marco Cavallaro, Carmela Visalli, Anna Maria Bagnato, Ugo Barbaro, Ignazio Salamone Tags: Case Report Source Type: research

Critical airway compression caused by a large mediastinal tumour with spontaneous haemorrhage
We report the case of a 77‐year‐old woman presenting with out‐of‐hospital cardiac arrest, which was then interpreted as an acute, life‐threatening critical airway compression by a huge mediastinal tumour without appropriate diagnosis. Emergency extracorporeal membrane oxygenation was cannulated for sufficient respiratory support after spontaneous circulation was regained. After the multidisciplinary team, involving thoracic surgeons, discussed the resectability of the mediastinal tumour, the patient underwent successful resection of the mediastinal tumour through a median sternotomy. The pathological report demon...
Source: Respirology Case Reports - February 15, 2018 Category: Respiratory Medicine Authors: Shih ‐Peng Liu, Hung‐Che Chien, Chun‐Ku Chen, Chih‐Cheng Hsieh, Chien‐Sheng Huang Tags: Case Report Source Type: research

Lung parenchymal involvement of primary bone marrow follicular lymphoma: a rare case study
We presented a rare case of primary bone marrow follicular lymphoma that infiltrated the lung parenchyma. In cases suspected to be malignant lymphoma, immunohistochemistry or other genetic examination is important even if 18F‐fluorodeoxyglucose (18F‐FDG) uptake on positron emission tomography‐computed tomography (PET‐CT) seems to be a false‐positive because of the possibility of a sarcoid reaction. (Source: Respirology Case Reports)
Source: Respirology Case Reports - February 14, 2018 Category: Respiratory Medicine Authors: Hiroyuki Minemura, Hiroshi Hojo, Miwako Saito, Takefumi Nikaido, Tomoko Suzuki, Katsunao Niitsuma Tags: Case Report Source Type: research

Early diagnosis of idiopathic pulmonary haemosiderosis: increased haemosiderin ‐laden macrophages in repeat bronchoscopy
We report a case of IPH that was diagnosed early by confirming the presence of an increased number of haemosiderin‐laden macrophages with alveolar haemorrhage in repeat bronchoscopy. We wanted to highlight that decreased but sustained attenuation of ground‐glass opacities on high‐resolution computed tomography does not always correlate with successful remission in patients with IPH. Repeat bronchoscopy can be useful in the early recognition of IPH, especially in the case of sustained opacities a few months after alveolar haemorrhage. Idiopathic pulmonary haemosiderosis (IPH) is a diagnosis of exclusion, which is cha...
Source: Respirology Case Reports - February 7, 2018 Category: Respiratory Medicine Authors: Yuichi Mukai, Toshihiko Agatsuma, Gen Ideura Tags: Case Report Source Type: research

Reversible platypnoea –orthodeoxia syndrome in post‐tuberculosis bronchial stenosis
We present an unusual observation of platypnoea–orthodeoxia syndrome in a young woman with acute atelectasis due to post‐tuberculosis bronchial stricture. Imaging revealed complete middle and right lower lobe atelectasis with a partially aerated right upper lobe. In the sitting posture, there was positional worsening of dyspnoea associated with an increase in the alveolar‐arterial oxygen gradient and shunt fraction. The likely mechanism was due to gravitational difference in ventilation–perfusion matching. The platypnoea–orthodeoxia syndrome was reversible following balloon dilatation of the bronchial...
Source: Respirology Case Reports - February 7, 2018 Category: Respiratory Medicine Authors: Geak Poh Tan, John Arputhan Abisheganaden, Soon Keng Goh, Akash Verma Tags: Case Report Source Type: research

Orthodeoxia as a presentation of intravascular large B cell lymphoma
Intravascular large B cell lymphoma (IVLBCL) is a rare and aggressive subtype of diffuse large B cell lymphoma, of which clinical presentations are highly variable among geographical areas. A case series of IVLBCL patients from Asian countries reported the disease to be more aggressive and associated with hemophagocytic syndrome than in cases from Western countries. Although published articles recently revealed hypoxemia as a presentation in IVLBCL patients, orthodeoxia has never been documented. A 71‐year‐old man presented with prolonged fever, cough, exertional dyspnoea, and orthodeoxia, later developing hypoxemic re...
Source: Respirology Case Reports - February 1, 2018 Category: Respiratory Medicine Authors: Nophol Leelayuwatanakul, Napplika Kongpolprom Tags: Case Report Source Type: research

Pleuroparenchymal fibroelastosis after haematopoietic stem cell transplantation without graft ‐versus‐host disease findings
We report the case of a patient with PPFE after HSCT. The patient experienced pneumothorax repeatedly despite surgical treatment. A surgical specimen demonstrated PPFE findings, without evidence of GVHD. In this case, development of PPFE was not associated with GVHD, and immunosuppressive therapy did not improve pulmonary function. Surgical biopsy is recommended for precise treatment and elucidation of pathogenesis in each suspected PPFE patient. We report the case of a patient with pleuroparenchymal fibroelastosis (PPFE) after haematopoietic stem cell transplantation (HSCT). A surgical specimen showed PPFE findings, with...
Source: Respirology Case Reports - January 29, 2018 Category: Respiratory Medicine Authors: Tamio Okimoto, Yukari Tsubata, Megumi Hamaguchi, Akihisa Sutani, Shunichi Hamaguchi, Takeshi Isobe Tags: Case Report Source Type: research

Successful treatment by tolvaptan of the syndrome of inappropriate antidiuretic hormone secretion that may be associated with chemotherapy ‐induced tumour lysis in a patient with small‐cell lung carcinoma
Here, we report the case of a patient with small‐cell lung carcinoma (SCLC) who developed the syndrome of inappropriate antidiuretic hormone secretion (SIADH). This syndrome may be associated with chemotherapy‐induced tumour lysis. Our patient was successfully treated with tolvaptan. A 70‐year‐old man was diagnosed with SCLC and was treated with carboplatin and etoposide. Episodes of hyponatremia occurred after every four cycles of chemotherapy that achieved tumour reduction; however, the hyponatremia was improved by temporary administration of tolvaptan. In SIADH associated with chemotherapy‐induced tumour lysis...
Source: Respirology Case Reports - January 26, 2018 Category: Respiratory Medicine Authors: Koichi Miyashita, Shun Matsuura, Hyogo Naoi, Masaru Tsukui, Naoki Koshimizu, Takafumi Suda Tags: Case Report Source Type: research

Facial flushing on upper limb exertion: a rare presentation of superior vena cava obstruction
We describe an unusual presentation of CIED infection in a patient with abandoned pacemaker leads. A 27‐year‐old male presented with facial flushing on upper but not lower limb exertion due to superior vena cava (SVC) obstruction, as well as pleuritic chest pain due to septic emboli. This was successfully treated with antibiotics and complete endovascular extraction of the pacemaker leads. Upper limb exertional facial flushing may be a useful clinical sign for the diagnosis of SVC obstruction. This case report also describes a rare presentation of CIED infection. A 27‐year‐old male with infection of abandoned pace...
Source: Respirology Case Reports - January 25, 2018 Category: Respiratory Medicine Authors: Michael Plunkett, James Wethasinghe, Brendon O ’Donoghue, Nigel Lever, Conroy Wong Tags: Case Report Source Type: research

Eosinophilia as a treatable trait in three patients with asthma and COPD
The combination of asthma and chronic obstructive pulmonary disease (COPD) in an individual can present significant challenges to achieving satisfactory outcomes. More recently, the concepts of precision medicine and treatable traits have arisen as promising tools to improve care for this group. In this series, we present three cases of patients with features of both asthma and COPD in addition to peripheral blood eosinophilia. The novel implementation of personalized management of the individual based on this treatable trait (eosinophilia) resulted in significant benefits. These benefits included improvement in symptoms, ...
Source: Respirology Case Reports - January 18, 2018 Category: Respiratory Medicine Authors: James Michael Ramsahai, Jodie Simpson, Peter Wark Tags: Case Series Source Type: research

Issue Information
(Source: Respirology Case Reports)
Source: Respirology Case Reports - January 11, 2018 Category: Respiratory Medicine Tags: Issue Information Source Type: research

Cryptococcal pleural infection in a recurrent pleural effusion: a case report
We describe a 38‐year‐old male who presented with a lymphocytic exudative right pleural effusion and a raised pleural fluid adenosine deaminase (ADA) level. He was initially treated for pleural tuberculosis, but presented again with worsening pleural effusion 6 weeks later. A thoracoscopic pleural biopsy revealed chronic nodular granulomatous pleuritis with cryptococcal organisms present. The repeat pleural fluid culture was positive for Cryptococcus neoformans. He was started on intravenous amphotericin B and oral flucytosine for 1 week, and then continued on oral fluconazole. He was subsequently diagnos...
Source: Respirology Case Reports - January 10, 2018 Category: Respiratory Medicine Authors: Audrey Chuan Rui Wee, Ju Ee Seet, Jonathen Venkatalacham, Sze Khen Tan Tags: Case Report Source Type: research

Marijuana “bong” pseudomonas lung infection: a detrimental recreational experience
We report a case of marijuana smoking via a “bong” device, which has resulted in severe Pseudomonas aeruginosa necrotizing pneumonia treated with conservative medical therapy. This case highlights the importance of recognizing that life‐threatening pneumonia can potentially be linked to marijuana and “bong” usage. Complicated cases should be considered for early surgical intervention. Marijuana remains a popular recreational psychoactive substance that can be smoked through a water pipe. We report a case of marijuana smoking via a “bong” device that resulted in severe, life‐threaten...
Source: Respirology Case Reports - December 22, 2017 Category: Respiratory Medicine Authors: Agni Nhirmal Kumar, Chun Ian Soo, Boon Hau Ng, Tidi Hassan, Andrea Yu ‐Lin Ban, Roslina Abdul Manap Tags: Case Report Source Type: research

Low ‐voltage electricity‐induced lung injury
We report a case of bilateral pulmonary infiltrates and haemoptysis following low‐voltage electricity exposure in an agricultural worker. A 58‐year‐old man standing in water reached for an electric watering machine and sustained an exposure to 220 V circuit for an uncertain duration. The electricity was turned off by another worker, and the patient was asymptomatic for the next 10 h until he developed haemoptysis. A chest radiograph demonstrated bilateral infiltrates, and chest computed tomography (CT) revealed ground‐glass opacities with interstitial thickening. Evaluations, including electrocardiogram, ser...
Source: Respirology Case Reports - December 22, 2017 Category: Respiratory Medicine Authors: Thai Truong, Thuong Vu Le, David L. Smith, Stephen P. Kantrow, Van Ngoc Tran Tags: Case Report Source Type: research

Desquamative interstitial pneumonia complicated by diffuse alveolar haemorrhage
We report a rare case of desquamative interstitial pneumonia (DIP) with diffuse alveolar haemorrhage (DAH). A 56‐year‐old man diagnosed with DIP by surgical lung biopsy 2 years ago was admitted to our hospital because of severe acute respiratory failure. The DIP had progressed despite smoking cessation. On admission, the patient appeared extremely ill, and physical examination revealed respiratory distress. The patient required mechanical ventilation. High‐resolution computed tomography showed diffuse ground glass opacity in both lungs. The bronchoalveolar lavage fluid was bloody, and numerous haemosiderin‐laden al...
Source: Respirology Case Reports - December 22, 2017 Category: Respiratory Medicine Authors: Ayako Matsuo, Nobuhiro Matsumoto, Akiko Kitamura, Hironobu Tsubouchi, Shigehisa Yanagi, Masamitsu Nakazato Tags: Case Report Source Type: research

An elderly woman with a mediastinal granulosa cell tumour: a rare presentation
We report a case of a woman who had a metastatic (GCT) in her mediastinum 40 years after treatment of the initial neoplasm. Surgical resection of the mediastinal mass revealed a low‐grade epithelioid neoplasm with coffee bean‐shaped nuclei and immunohistochemical stains that were consistent with metastatic GCT. Metastatic granulosa cell tumour (GCT) in the mediastinum is a rare occurrence. We report a case of a woman who had a metastatic (GCT) in her mediastinum about 40 years after treatment of the initial neoplasm. (Source: Respirology Case Reports)
Source: Respirology Case Reports - December 22, 2017 Category: Respiratory Medicine Authors: Garrett M. Harp, Gregory N. Matwiyoff, Steven J. Escobar, Keith E. Thompson, Addie Alkhas, Alfredo R. Ramirez Tags: Case Report Source Type: research

Acute progression of aspergillosis in a patient with lung cancer receiving nivolumab
A 65‐year‐old man with chronic progressive pulmonary aspergillosis (CPPA) was admitted for the treatment of lung adenocarcinoma while receiving an immune checkpoint inhibitor, nivolumab. The tumour responded well to the therapy, but the cavity of CPPA became large in contrast to the tumour after 20 courses of therapy. He was diagnosed as having exacerbation of CPPA and successfully and concurrently treated with an antifungal agent and nivolumab. Since there was absence of obvious immunosuppression and the presence of a drastic effect on tumour remission during nivolumab therapy, this phenomenon suggested that the trigg...
Source: Respirology Case Reports - December 22, 2017 Category: Respiratory Medicine Authors: Naohiro Uchida, Kohei Fujita, Koichi Nakatani, Tadashi Mio Tags: Case Report Source Type: research

Acute onset of ulcerative colitis during chemoradiotherapy for anaplastic lymphoma kinase ‐positive lung adenocarcinoma
We report a case of acute onset of ulcerative colitis (UC) during chemoradiotherapy in a patient with anaplastic lymphoma kinase (ALK)‐positive lung adenocarcinoma. A 46‐year‐old male patient with an abnormal chest shadow was referred to our hospital. He was diagnosed with lung adenocarcinoma, clinical stage T1aN3M0 and stage IIIB. Concurrent chemoradiotherapy was selected for his initial therapy. After two cycles of cisplatin and vinorelbine administration, he experienced persistent diarrhoea and anorexia. Findings of the colonoscopy revealed a pancolitis type of UC. After discontinuation of chemotherapy, oral admin...
Source: Respirology Case Reports - December 22, 2017 Category: Respiratory Medicine Authors: Kohei Fujita, Yoshinori Mizumoto, Koki Moriyoshi, Norio Araki, Tadashi Mio Tags: Case Report Source Type: research

A case of pulmonary cyst and pneumothorax after bronchial thermoplasty
We describe a case of pneumothorax preceded by pulmonary cyst development after BT. (Source: Respirology Case Reports)
Source: Respirology Case Reports - December 22, 2017 Category: Respiratory Medicine Authors: Akifumi Funatsu, Konomi Kobayashi, Motoyasu Iikura, Satoru Ishii, Shinyu Izumi, Haruhito Sugiyama Tags: Case Report Source Type: research

Pleuritis associated with primary Sjogren syndrome
We herein present a case of a 71‐year‐old woman with primary Sjogren's syndrome (SjS), who developed bilateral pleural effusion and ground glass opacity during treatment with low‐dose prednisolone. The pleural effusion and bronchoalveolar lavage fluid revealed elevation of lymphocytes. Thoracoscopic pleural biopsy showed infiltration of lymphocytes with no evidence of other diseases, confirming SjS‐related pleuritis. Therefore, we initiated 20 mg prednisolone and pleural effusion was rapidly resolved. Our results indicate that SjS can be rarely complicated with pleuritis. In addition, thoracoscopic pleural b...
Source: Respirology Case Reports - December 22, 2017 Category: Respiratory Medicine Authors: Chiaki Hosoda, Yusuke Hosaka, Kai Ryu, Akira Kinoshita, Keisuke Saito, Kazuyoshi Kuwano Tags: Case Report Source Type: research

Lung cancer development in the patient with granulomatosis with polyangiitis during long term treatment with cyclophosphamide: first documented case
We report a rare case of GPA with lung cancer developed while taking long‐term cyclophosphamide (CPA). (Source: Respirology Case Reports)
Source: Respirology Case Reports - December 22, 2017 Category: Respiratory Medicine Authors: Midori Toriyama, Etsuko Tagaya, Tomoko Yamamoto, Mitsuko Kondo, Yoji Nagashima, Jun Tamaoki Tags: Case Report Source Type: research

Novel hybrid cryo ‐radial method: an emerging alternative to CT‐guided biopsy in suspected lung cancer. A prospective case series and description of technique
We report six prospective patients who underwent this procedure in our institution. R‐EBUS samples were obtained via conventional sampling methods (needle aspiration, forceps biopsy, and cytology brush), followed by a cryobiopsy. An endobronchial blocker was placed near the planned area of biopsy in advance and inflated post‐biopsy to minimize the risk of bleeding in all patients. A chest X‐ray was performed 1 h post‐procedure. All the PPLs were visualized with R‐EBUS. The mean diameter of cryobiopsy samples was twice the size of forceps biopsy samples. In four patients, cryobiopsy samples were superior in size a...
Source: Respirology Case Reports - December 22, 2017 Category: Respiratory Medicine Authors: Samantha Herath, Elaine Yap Tags: Case Series Source Type: research

Issue Information
(Source: Respirology Case Reports)
Source: Respirology Case Reports - December 21, 2017 Category: Respiratory Medicine Tags: Issue Information Source Type: research

Pulmonary nocardiosis in a patient with idiopathic CD4 T ‐lymphocytopenia
Idiopathic CD4 T‐lymphocytopenia (ICL) is a rare immunodeficiency characterized by low CD4 T‐lymphocyte count, which usually manifests with opportunistic infections. Nocardia as an opportunistic pathogen infecting patients with this condition has rarely been reported. Here, we describe the case of a 46‐year‐old male who presented with lung mass and respiratory and systemic symptoms and was eventually diagnosed with pulmonary nocardiosis. A workup for predisposing immunodeficiencies suggested a picture of ICL. This case illustrates the importance of considering ICL as a possible predisposing condition when an otherw...
Source: Respirology Case Reports - December 21, 2017 Category: Respiratory Medicine Authors: Vivek Jayaschandran, Sandra Gjorgova ‐Gjeorgjievski, Haamid Siddique Tags: Case Report Source Type: research

Lung injury associated with electronic cigarettes inhalation diagnosed by transbronchial lung biopsy
A 46‐year‐old healthy man developed respiratory distress, night sweats, fever, and weight loss after using electronic cigarettes (e‐cigs) for approximately 1 month. He presented to the hospital when the symptoms worsened 2 months after onset. The findings of bronchoalveolar lavage (BAL) fluid examination and the following transbronchial lung biopsy examination led to the diagnosis of acute alveolitis: intra‐alveolar fibrosis accompanied with exudate containing abundant lipid‐laden macrophages, eosinophils, and neutrophils. Eventually, e‐cig–induced acute lung injury was diagnosed. The sympto...
Source: Respirology Case Reports - November 17, 2017 Category: Respiratory Medicine Authors: Masayuki Itoh, Kazutetsu Aoshiba, Yoriko Herai, Hiroyuki Nakamura, Tamiko Takemura Tags: Case Report Source Type: research

Lung Mycobacterium avium developed after removing an acupuncture needle from the lung
We present a case of lung Mycobacterium avium that developed after removing a broken acupuncture needle from the lung. (Source: Respirology Case Reports)
Source: Respirology Case Reports - November 8, 2017 Category: Respiratory Medicine Authors: Mikihito Saito, Hajime Kasai, Kengo Shimazu, Takashi Urushibara, Tomohiko Iida, Toshihide Shinozaki Tags: Case Report Source Type: research

Lupus pneumonitis presenting with high titre of anti ‐Ro antibody
We report a 21‐year‐old female who was newly diagnosed as having SLE with nephritis and who suddenly developed right lung opacity and rapidly progressed to severe hypoxaemia despite the use of broad‐spectrum antibiotics. The serum titre of anti‐Ro antibody was greater than 240 U/mL. She underwent lung biopsy and lupus pneumonitis was confirmed by the pathological findings. Subsequently, she showed a favourable response to plasma exchange, steroid pulse therapy, and mycophenolate mofetil (MMF) treatment. For SLE patients with pulmonary infiltrates, high degree of clinical suspicion of lupus pneumonitis is req...
Source: Respirology Case Reports - October 27, 2017 Category: Respiratory Medicine Authors: Mei ‐Chuan Chen, Yueh‐Lin Wu, Kai‐Ling Lee, Kevin S. Lai, Chi‐Li Chung Tags: Case Report Source Type: research

Idiopathic pulmonary vein thrombosis?
Idiopathic pulmonary vein thrombosis (PVT) is a rare disease which is likely under‐diagnosed because of nebulous presentations. Accurate diagnosis is essential to prevent complications. (Source: Respirology Case Reports)
Source: Respirology Case Reports - October 24, 2017 Category: Respiratory Medicine Authors: Timothy J Barreiro, Venkateswara K Kollipara, David J Gemmel Tags: Case Report Source Type: research

A saccular superior vena cava aneurysm with unique diagnostic computed tomography findings
A saccular superior vena cava aneurysm is a rare venous aneurysm that presents as mediastinal mass lesions. An evaluation using contrast‐enhanced computed tomography is indispensable for the diagnosis. (Source: Respirology Case Reports)
Source: Respirology Case Reports - October 23, 2017 Category: Respiratory Medicine Authors: Tetsuya Yokoyama, Taro Setoguchi, Kazuo Sakamoto, Shun Mashimoto, Daisuke Eto, Hiroshi Wataya Tags: Clinical Image Source Type: research

Traumatic left main bronchial rupture: delayed but successful outcome of robotic ‐assisted reconstruction
Tracheobronchial injuries are rare but life‐threatening conditions in patients with blunt thoracic trauma. The diagnosis and management of such injury may often be delayed due to other concomitant severe injuries. No reported case of a robotic‐assisted bronchial reconstruction has ever been performed for a traumatic bronchial injury. A 23‐year‐old male suffered from traumatic left main bronchial (LMB) rupture with an initial presentation of pneumothorax and pneumomediastinum that eventually progressed to left main bronchus fibrosis and total obstruction, which led to left lung atelectasis and consolidation. Minimal...
Source: Respirology Case Reports - October 23, 2017 Category: Respiratory Medicine Authors: Hu ‐Lin C. Wang, Cheng‐Hung How, Heng‐Fu Lin, Jang‐Ming Lee Tags: Case Report Source Type: research

Issue Information
(Source: Respirology Case Reports)
Source: Respirology Case Reports - October 16, 2017 Category: Respiratory Medicine Tags: Issue Information Source Type: research

Pulmonary schistosomiasis mimicking IgG4 ‐related lung disease
IgG4‐related disease (IgG4‐RD) is a systemic fibroinflammatory disease characterized by tumefactive lesions in various organ systems, including the lungs. Clinical and radiological manifestations of IgG4‐RD are relatively non‐specific, and we report a case highlighting the importance of histopathological confirmation in cases of suspected IgG4‐related lung disease. A 44‐year‐old male with significantly elevated serum IgG4 levels, patchy consolidation on thoracic CT imaging, and cough was referred with suspected IgG4‐related lung disease. However, surgical lung biopsy revealed an unexpected diagnosis of pulm...
Source: Respirology Case Reports - October 16, 2017 Category: Respiratory Medicine Authors: Timothy Baird, Caroline L Cooper, Richard Wong, Naomi Runnegar, Gregory Keir Tags: Case Report Source Type: research

Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia diagnosed by tranbronchoscopic cryoprobe biopsy technique
Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) remains a poorly understood clinical entity. It is currently classified as a premalignant condition by the World Health Organization (WHO). Symptoms are similar to those associated with obstructive lung disease, including breathlessness and cough. The presentation is often initially ascribed to other diseases such as asthma or chronic obstructive pulmonary disease. Here, we present what we believe is the first described case of DIPNECH diagnosed by transbronchoscopic cryoprobe biopsy. The patient presented with chronic cough, dyspnoea, pulmonary functio...
Source: Respirology Case Reports - October 5, 2017 Category: Respiratory Medicine Authors: Ravi Patel, Carolina Collazo ‐Gonzalez, Arthur Andrews, Jean Johnson, Mark Rumbak, Maxwell Smith Tags: Case Report Source Type: research

Wheezing and dyspnoea caused by aberrant left innominate artery
We present a rare case of a branching anomaly of the aortic arch that resulted in wheezing and dyspnoea. The patient was a 60‐year‐old male with severe wheezing from babyhood, originally diagnosed with severe bronchial asthma. On auscultation, the inspiratory and expiratory wheezes appeared when the patient leaned forward. He also had difficulty in swallowing solid mass. Tests for airway reversibility and hyperresponsiveness were negative, and asthma treatment was ineffective. He had a right aortic arch. A barium oesophagogram and endoscopic examination indicated narrowing of the oesophagus from behind. Three‐dimensi...
Source: Respirology Case Reports - October 5, 2017 Category: Respiratory Medicine Authors: Masamichi Hayashi, Kazuyoshi Imaizumi, Hidekazu Hattori, Hiroshi Toyama, Mitsushi Okazawa Tags: Case Report Source Type: research

Thoracic splenosis: diagnosis without invasive investigations
This case report describes a case of thoracic splenosis. Splenosis is often interpreted as malignancy on initial imaging. Case reports described in the literature reveal that diagnosis is most often confirmed with invasive investigations. A 99 m technetium‐labelled sulphur colloid scan when used with single photon emission computed tomography/computed tomography (SPECT/CT) is highly specific for splenic tissue and more readily available and time efficient than other modalities used for this purpose. Awareness of this may prevent unnecessary or dangerous invasive diagnostic procedures. This image illustrates a cas...
Source: Respirology Case Reports - September 21, 2017 Category: Respiratory Medicine Authors: Kirryn Williams, Graham Simpson Tags: Clinical Image Source Type: research

Mediastinal peripheral T ‐cell lymphoma diagnosed by repeated biopsies after an initial diagnosis of fibrosing mediastinitis
This report suggests that the presence of malignant lymphoma should be considered in cases of mediastinal tumours, and repeated biopsies may be occasionally needed for consistent diagnosis. Initial needle biopsy and video‐assisted thoracoscopic biopsy revealed the pathological diagnosis of fibrosing mediastinitis for mediastinal mass. However, other laboratory features suggested that the diagnosis of fibrosing mediastinitis might not be correct. Finally, a fourth biopsy established the diagnosis of mediastinal PTCL‐NOS. (Source: Respirology Case Reports)
Source: Respirology Case Reports - September 18, 2017 Category: Respiratory Medicine Authors: Naoko Kakuta, Mitsuhiro Sumitani, Arata Sugitani, Kenji Nakahama, Yuzo Miki, Seichi Syoji Tags: Case Report Source Type: research

The novel 19G endobronchial USS (EBUS) needle samples processed as tissue “core biopsies” facilitate PD‐L1 and other biomarker testing in lung cancer specimens: case report and the view point from the Respiratory Physician and the Pathologist
We report a case of metastatic adenocarcinoma with the only accessible site of biopsy being a hilar lymph node. Using the 19G core‐biopsy needle and processing the microbiopsy samples in formalin provided more material for predictive biomarker testing, including PD‐L1 immunohistochemistry, when traditional processing was inadequate. This case highlights the need for close multidisciplinary discussions between the pathologist and the respiratory physician regarding emerging biomarkers and novel biopsy techniques to obtain maximum utility of the tools and avoid repeated procedures for the patient. The novel 19G EBUS nee...
Source: Respirology Case Reports - September 10, 2017 Category: Respiratory Medicine Authors: Samantha Herath, Wendy A Cooper Tags: Case Report Source Type: research

Fatal diffuse alveolar haemorrhage mimicking acute exacerbation in idiopathic pulmonary fibrosis treated with nintedanib
A 75‐year‐old man was referred to our hospital with a 1‐year history of persistent dry cough and progressive dyspnoea on exertion. He was treated with aspirin due to thrombosis of internal carotid artery. He was diagnosed with idiopathic pulmonary fibrosis (IPF)/usual interstitial pneumonia (UIP), and started on inhaled N‐acetylcysteine therapy and pirfenidone. Since his clinical condition progressively deteriorated after 6 months, he was switched from pirfenidone to nintedanib. As a result, his general condition worsened rapidly. He was diagnosed with acute exacerbation (AE) of IPF, and was treated with met...
Source: Respirology Case Reports - August 27, 2017 Category: Respiratory Medicine Authors: Keishi Sugino, Yasuhiko Nakamura, Muneyuki Sekiya, Hiroshi Kobayashi, Kazutoshi Shibuya, Sakae Homma Tags: Case Report Source Type: research

Issue Information
(Source: Respirology Case Reports)
Source: Respirology Case Reports - August 11, 2017 Category: Respiratory Medicine Tags: Issue Information Source Type: research

Concurrence of nivolumab ‐induced interstitial lung disease and cancer invasion
In conclusion, nivolumab‐related ILD and cancer invasion may concur and aggressive biopsy should be considered if nivolumab‐related ILD is refractory to immunosuppressive therapy. Nivolumab‐related intersitital lung disease (ILD) may concur with cancer invasion in non‐small‐cell lung cancer (NSCLC) patients. These conditions are difficult to distinguish from each other by computed tomography (CT) findings, and in such cases, aggressive biopsy should be considered. (Source: Respirology Case Reports)
Source: Respirology Case Reports - August 11, 2017 Category: Respiratory Medicine Authors: Osamu Kanai, Koichi Nakatani, Kohei Fujita, Misato Okamura, Tadashi Mio Tags: Case Report Source Type: research

Reduced ventilation –perfusion (V/Q) mismatch following endobronchial valve insertion demonstrated by Gallium‐68 V/Q photon emission tomography/computed tomography
We report a pilot case in which V/Q‐PET/CT demonstrated discordant findings compared with quantitative CT analysis, and directed left lower lobe EBV placement. The patient experienced a significant improvement in 6‐min walk distance (6MWD) without change in spirometry. Post‐EBV V/Q‐PET/CT demonstrated a marked decrease in unmatched (detrimental) V/Q areas and improvement in overall V/Q matching on post‐EBV V/Q‐PET/CT. These preliminary novel findings suggest that EBVs improve V/Q matching and may explain the observed functional improvements. Endobronchial valves (EBVs) are increasingly used in severe emphysema...
Source: Respirology Case Reports - August 10, 2017 Category: Respiratory Medicine Authors: Paul Leong, Pierre ‐Yves Le Roux, Jason Callahan, Shankar Siva, Michael S Hofman, Daniel P Steinfort Tags: Case Report Source Type: research

Metastatic squamous cell carcinoma of the lung mimicking multiple bone abscesses
Squamous cell carcinoma of the lung is known to metastasize to the bones, but a presentation similar to bone abscess is rare. We encountered a case with bone metastases that mimicked bone abscess, which delayed the diagnosis of squamous cell lung carcinoma. A 67‐year‐old man presented with a left upper lung infiltrate and lytic lesions on the left first rib and right fifth rib. In consideration of a possible infectious process, cultures of the aspirate from the right fifth rib lesion and blood were taken; however, results were non‐specific. Thereafter, bronchoscopic biopsy of the left upper lung nodule and ultrasound...
Source: Respirology Case Reports - July 25, 2017 Category: Respiratory Medicine Authors: Yuki Haruta, Yuki Kataoka, Hiroshi Ito, Taro Mori, Masaki Matsuo Tags: Case Report Source Type: research

Pathological features of explant lungs with fibrosis in autoimmune pulmonary alveolar proteinosis
In this study, we report a case of aPAP with progressive fibrosis occurring in a 46‐year‐old woman. She had undergone several repetitions of whole lung lavage (WLL) for 7 years and granulocyte‐macrophage colony‐stimulating factor (GM‐CSF) inhalation for 3 months; however, the progression of fibrosis was not hindered. Eventually, she was treated with bilateral lung transplantation. The computed tomography (CT) image suggested pulmonary fibrotic changes in her lung similar to usual interstitial pneumonia. However, the pathological analyses of explant lungs revealed that the fibrosis was not similar to...
Source: Respirology Case Reports - July 21, 2017 Category: Respiratory Medicine Authors: Manabu Ono, Ryoko Saito, Junya Tominaga, Yoshinori Okada, Shinya Ohkouchi, Tamiko Takemura Tags: Case Report Source Type: research

Tracheal granuloma 7 years after extubation
Key message Tracheal granuloma can cause severe stenosis long after extubation. When a patient with a history of endobronchial intubation has an intratracheal tumour, we should consider the possibility of this condition. Tracheal granuloma can cause severe stenosis long after extubation. When a patient with a history of endobronchial intubation has an intratracheal tumour, we should consider the possibility of this condition. (Source: Respirology Case Reports)
Source: Respirology Case Reports - July 20, 2017 Category: Respiratory Medicine Authors: Kazuhisa Nakashima, Tateaki Naito, Masahiro Endo, Takashi Nakajima, Toshiaki Takahashi Tags: Clinical Image Source Type: research

Pulmonary arteriovenous malformations complicated by splenic infarction and abscess
We report the case of a 66‐year‐old woman with PAVM complicated by splenic infarction and abscess. Although the PAVM had been detected on a chest image 2 years previously, and she had been advised to have further investigations, she decided not to follow this further at the time. She then visited our hospital complaining of worsening dyspnoea on exertion. Detailed examinations revealed splenic infarction and abscessation due to PAVM. PAVM embolization was performed after antibiotic treatment. It is very rare for PAVM to be complicated by splenic infarction and abscess. Regardless of its size, embolization of a P...
Source: Respirology Case Reports - July 20, 2017 Category: Respiratory Medicine Authors: Jun Naito, Hajime Kasai, Masaki Suga, Toshihiko Sugiura, Nobuhiro Tanabe, Koichiro Tatsumi Tags: Case Report Source Type: research

Retropharyngeal lipoma causing obstructive sleep apnoea
We present the case of a middle‐aged man whose obstructive sleep apnoea (OSA) was caused by a retropharyngeal lipoma, with complete resolution after transoral excision. Lipomas causing OSA are rare, and this represents the seventh reported case in the literature. We present the case of a middle‐aged man whose obstructive sleep apnoea (OSA) was caused by a retropharyngeal lipoma, with complete resolution after transoral excision. Lipomas causing OSA are rare, and this represents the seventh reported case in the literature. (Source: Respirology Case Reports)
Source: Respirology Case Reports - July 9, 2017 Category: Respiratory Medicine Authors: Paul Leong, Stephen Kleid, Darren Mansfield Tags: Case Report Source Type: research

An intimal sarcoma of pulmonary artery mimicking pulmonary embolism: a case report and literature review
We reported a case of pulmonary artery intimal sarcoma in a patient who was misdiagnosed as having PTE. Pathology after surgery confirmed malignant disease. We concluded that when a patient presents with mild clinical manifestations yet with strong imaging manifestations, pulmonary artery malignancy should be suspected. Pulmonary artery intimal sarcoma is a highly aggressive disease, and is most often misdiagnosed as pulmonary thromboembolism (PTE) due to the similar clinical symptoms and its rarity, which leads to the use of inappropriate treatments such as prolonged anticoagulant therapy. We reported a case of pulmonary...
Source: Respirology Case Reports - June 28, 2017 Category: Respiratory Medicine Authors: Xiaojing Liu, Jun Hou, Xiangdong Wang, Zhihong Chen Tags: Case Report Source Type: research