Cryptogenic organising pneumonia: an unusual cause of pleuritic chest pain

2021 ◽  
Vol 14 (1) ◽  
pp. e238514
Author(s):  
Rebecca Ceci Bonello ◽  
Etienne Ceci Bonello ◽  
Christian Vassallo ◽  
Edward Giles Bellia
Keyword(s):  
Chest Pain ◽  
Inflammatory Markers ◽  
White Cell Count ◽  
Clinical Status ◽  
Lower Lobe ◽  
Pleuritic Chest Pain ◽  
Ct Guided ◽  
Atypical Pathogens ◽  
Ct Guided Biopsy ◽  
The Right

A 76-year-old woman presented with a 2-hour history of pleuritic chest pain with no other associated symptoms. Blood investigations revealed raised inflammatory markers and an elevated white cell count. On chest radiograph, an airspace shadow indicative of a consolidation was prominent. This was followed by a CT scan of her thorax which showed a spiculated lesion in the right upper lobe, a lesion in the posterior segment of the left lower lobe and mildly enlarged right hilar lymph nodes. She was started on dual antibiotic therapy; however, the patient’s clinical status and inflammatory markers did not improve. A bronchoscopy was performed which excluded malignancy and atypical pathogens. CT-guided biopsy confirmed the presence of cryptogenic organising pneumonia. Prednisolone 50 mg daily was prescribed with quick resolution of symptoms.

Ectopic spleen presenting as a slowly enlarging lung nodule in the right lower lobe following gastric pull up operation

2021 ◽  
Vol 14 (2) ◽  
pp. e237912
Author(s):  
Anas Alfahad ◽  
Rima Hussain ◽  
Mamatha Devaraj ◽  
Alexandr Svec
Keyword(s):  
Case Report ◽  
Oesophageal Cancer ◽  
Lung Nodule ◽  
Lower Lobe ◽  
Ct Guided ◽  
Ectopic Spleen ◽  
Guided Biopsy ◽  
Ct Guided Biopsy ◽  
The Right ◽  
Gastric Pull Up

This is a case report of an elderly man who was investigated at our respiratory clinic for slowly enlarging right lower lobe lung nodule on the background of oesophageal cancer diagnosed more than 11 years ago with gastric pull up. CT guided biopsy confirms the diagnosis of intrathoracic ectopic spleen.

scholarly journals Nodular Pulmonary Amyloidosis: A Case over Fourteen Years

2021 ◽  
Vol 2 (2) ◽  
pp. 038-041
Author(s):  
A Ekladious ◽  
L Fish ◽  
C De Chaneet ◽  
C Cox
Keyword(s):  
Chest Pain ◽  
Case Reports ◽  
Pulmonary Function Tests ◽  
Lower Lobe ◽  
Cervical Lymphadenopathy ◽  
Pleuritic Chest Pain ◽  
Ct Guided ◽  
History Of ◽  
Pulmonary Amyloidosis ◽  
Insight Into

A 75-year-old man presented with pleuritic chest pain, haemoptysis and dyspnoea. Imaging found multiple pulmonary nodules, concerning for malignancy. CT-guided biopsy was consistent with amyloid. The patient has a history of pulmonary amyloidosis, with a single nodule resected 14 years prior. This case allows comparison between imaging fourteen years apart, providing insight into the progressive nature of these benign nodules. Nodular pulmonary amyloidosis is a rare condition with few case reports published. Of those published, few are of nodular amyloidosis in the absence of underlying neoplastic aetiology. This case presents a 14-year interval of a patient with nodular amyloidosis, allowing insight into disease progression which has not previously been well described. A 75-year-old man presented to a regional hospital in Australia with right sided pleuritic chest pain, and a 2-week history of productive cough, haemoptysis, dyspnoea and reduced exercise tolerance. Further questioning revealed a 3-month history of worsening dyspnoea, haemoptysis and cough, with no orthopnoea, paroxysmal nocturnal dyspnoea or weight loss. The patients’ past medical history included resection of an amyloid tumour from the left lower lobe of the lung in 2004, ex-smoker with a 30-pack year history, significant occupational asbestos exposure through work as a diesel mechanic, and hypercholesterolaemia. The patient lives at home with his partner and is independent with the activities of daily living. On examination, the patient appeared well, in no respiratory distress. Observations were within normal limits, with oxygen saturations of 94% on room air, respiration rate of 18. On auscultation, there were late inspiratory crackles, as well as decreased hepatic dullness to percussion. There was a central trachea and no palpable cervical lymphadenopathy. Cardiovascular examination was unremarkable, and the patient was euvolaemic. Abdominal examination was unremarkable with no palpable organomegaly, and he did not have a rash or skin abnormalities seen. The initial investigations were conducted to investigate a potential lung malignancy underlying malignancy, based on the appearance on CT scan. The patient advised us that he had a previous diagnosis of primary pulmonary amyloidosis, first diagnosed 14 years ago. The diagnosis was made after a chest x-ray and CT showed a nodule, suspicious for cancer. Pulmonary function tests were performed and he was referred to a Cardiothoracic surgeon for consideration of a left lower lobectomy. He was treated with a wedge resection. Histopathology from this specimen showed primary pulmonary amyloidosis. There was a delay in the understanding of how the patient came to have this rare diagnosis, as it took five days for the medical records to be sourced from the archive.

scholarly journals P040 An unusual case of giant cell arteritis

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Jessica Ellis ◽  
Keziah Austin ◽  
Sarah Emerson
Keyword(s):  
Inflammatory Markers ◽  
Illicit Drugs ◽  
Unusual Case ◽  
Temporal Arteritis ◽  
White Cell Count ◽  
Healthcare Providers ◽  
Temporal Artery ◽  
Low Grade ◽  
Temporal Artery Biopsy ◽  
The Right

Abstract Background/Aims  A 49-year-old female of Nepalese heritage was referred with right-sided headache, scalp tenderness, and a painful swelling overlying the right temple. She denied any visual or claudicant symptoms but felt systemically unwell with a fever. There were no symptoms suggestive of an inflammatory arthritis, underlying connective tissue disease or vasculitis. She was normally fit and well with no past medical history. She did not take any regular medications and denied using over the counter or illicit drugs or recent travel. On review she had a low grade fever. There was a large tender, erythematous swelling overlying the right temple. Bilaterally the temporal arteries were palpable and pulsatile. Peripheral pulses were normal with no bruits. There was no evidence of shingles (HSV) or local infection. Full systemic examination revealed no other abnormalities. Laboratory tests showed: PV 2.56, CRP 101, total white cell count 14.38 (eosinophils 0.4), albumin 33, Hb 115. Urine dip was normal. Renal function, liver function and immunoglobulins were normal. ANCA was negative. Hypoechogenicity surrounding the right frontal branch of the right temporal artery was seen on ultrasound. There were no discrete masses suggestive of cysts, abscess or tumours. Temporal artery biopsy confirmed the presence of vasculitis; histology demonstrated transmural lymphohistiocytic inflammation, disruption of the elastic lamina and intimal proliferation. Prednisolone was started at 40mg daily. Four weeks after initially presenting she was asymptomatic and her inflammatory markers had normalised. Methods  The case is discussed below. Results  Temporal arteritis, or GCA, is primarily a disease of older adults; with age 50 often used as an inclusion criteria, and is more common in Caucasian populations. Limited reports exist of GCA in younger cohorts, but these are rare. An important differential in younger patients, such as ours, is juvenile temporal arteritis. This rare localised vasculitis affects almost exclusively the temporal artery. It is typically a disease of young males, who present with non-tender temporal swelling. Systemic symptoms are unusual and inflammatory markers are normal. Clinical or laboratory evidence of organ involvement, peripheral eosinophilia or fibrinoid necrosis on histology should prompt consideration of an AAV or PAN. Incidence of GCA increases in correlation with Northern latitude, with highest rates reported in Scandinavian and North American populations. GCA is rare in Asian populations. Higher diagnostic rates in countries where physicians have increased awareness of GCA proposed as an explanation for this difference; however differences in incidence are still observed between Asian and Caucasian populations presenting to the same healthcare providers. Conclusion  GCA is an uncommon diagnosis in younger and non-Caucasian patients. Thorough investigation through ultrasound and biopsy helped increase our diagnostic confidence in this unusual case. Rheumatologists must be alert to atypical presentations in order to deliver prompt and potentially sight-saving treatment. Disclosure  J. Ellis: None. K. Austin: None. S. Emerson: None.

scholarly journals Percutaneous C-Arm Free O-Arm Navigated Biopsy for Spinal Pathologies: A Technical Note

Diagnostics ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. 636
Author(s):  
Masato Tanaka ◽  
Sumeet Sonawane ◽  
Koji Uotani ◽  
Yoshihiro Fujiwara ◽  
Kittipong Sessumpun ◽  
...  
Keyword(s):  
Histopathological Examination ◽  
Correct Diagnosis ◽  
Standard Technique ◽  
Percutaneous Biopsy ◽  
Technical Note ◽  
Spinal Tumors ◽  
Histopathological Diagnosis ◽  
Ct Guided ◽  
Ct Guided Biopsy ◽  
The Right

Background: Percutaneous biopsy under computed tomography (CT) guidance is a standard technique to obtain a definitive diagnosis when spinal tumors, metastases or infections are suspected. However, specimens obtained using a needle are sometimes inadequate for correct diagnosis. This report describes a unique biopsy technique which is C-arm free O-arm navigated using microforceps. This has not been previously described as a biopsy procedure. Case description: A 74-year-old man with T1 vertebra pathology was referred to our hospital with muscle weakness of the right hand, clumsiness and cervicothoracic pain. CT-guided biopsy was performed, but histopathological diagnosis could not be obtained due to insufficient tissue. The patient then underwent biopsy under O-arm navigation, so we could obtain sufficient tissue and small cell carcinoma was diagnosed on histopathological examination. A patient later received chemotherapy and radiation. Conclusions: C-arm free O-arm navigated biopsy is an effective technique for obtaining sufficient material from spine pathologies. Tissue from an exact pathological site can be obtained with 3-D images. This new O-arm navigation biopsy may provide an alternative to repeat CT-guided or open biopsy.

Twenty-three year-old with pleuritic chest pain

Heart ◽  
2018 ◽  
Vol 105 (6) ◽  
pp. 464-469
Author(s):  
Karina P Gopaul ◽  
Helen M Parry ◽  
Damien Cullington
Keyword(s):  
Chest Pain ◽  
Congenital Heart ◽  
White Cell Count ◽  
Coarctation Of The Aorta ◽  
List Type ◽  
Pleuritic Chest Pain ◽  
Reactive Protein ◽  
Pulmonary Angiogram ◽  
Night Sweats ◽  
Ct Pulmonary Angiogram

Clinical introductionA 23-year-old woman followed at another medical centre for congenital heart disease (CHD) presented to our emergency clinic with 3 weeks of bilateral pleuritic chest pain. She returned from holiday in Greece 6 weeks earlier where a tattoo and nasal piercing had been performed. There was no history of night sweats or fever.Her temperature was 37.5°C, heart rate 120 beats/min, oxygen saturations 94% on room air and blood pressure 110/74. Her chest was clear and there was systolic murmur on auscultation. The chest radiograph showed peripheral bilateral lower zone atelectasis. The ECG demonstrated sinus tachycardia. The haemoglobin was 11.2 g/dL, white cell count 10.18×109/L, C-reactive protein 67 mg/L (normal <5 mg/L) and D dimer=430 ng/mL (normal <230 ng/mL).A pulmonary embolus was suspected and a CT pulmonary angiogram was performed (figure 1).QuestionBased on the CT findings, what is the most likely underlying congenital heart lesion in this patient?Bicuspid aortic valveCoarctation of the aortaFontan circulationParachute mitral valveVentricular septal defectFigure 1CT pulmonary angiogram (coronal views).

scholarly journals Development of a Large Pneumatocele in a Patient Recovering from COVID-19 Pneumonitis

2021 ◽  
Author(s):  
Frances Hampson ◽  
Waleed Salih ◽  
Jennifer Helm Jennifer Helm
Keyword(s):  
Chest Pain ◽  
Hospital Admission ◽  
Clinical Significance ◽  
Prone Position ◽  
Rare Case ◽  
Lower Lobe ◽  
Sudden Onset ◽  
Chest Drain ◽  
Ct Guided ◽  
Initial Imaging

A 39-year-old man presented with severe COVID-19 pneumonitis requiring hospital admission. He represented three days following discharge with sudden onset breathlessness and chest pain. Initial imaging suggested the presence of a left pneumothorax. Following further clinical decline a plan was made to insert a CT guided chest drain. However, imaging in the prone position for the procedure unexpectedly revealed a large left lower lobe pneumatocele with only a very small pneumothorax. Events and appearances suggest that this is a rare case of delayed COVID-19 pneumonitis-related pneumatocele formation. We will discuss the clinical significance of this entity.

scholarly journals P1498 Right atrial thrombus in a young septic patient with lymphoma

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
S Habjan ◽  
B Erzen ◽  
M Miklic ◽  
A Skarlovnik
Keyword(s):  
Staphylococcus Aureus ◽  
Right Atrium ◽  
Inflammatory Markers ◽  
Clinical Status ◽  
Left Knee ◽  
Blood Cultures ◽  
Right Atrial ◽  
Atrial Thrombus ◽  
The Right ◽  
And Staphylococcus Aureus

Abstract Background Catheter-related right atrial thrombosis is a rare, but potentially life threatening complication in patients with central venous catheters (CVCs). Echocardiography is an indispensable tool in the diagnosis of right atrial thrombosis. We present a case of a young man with lymphoma, Staphylococcus aureus sepsis and a peripherally inserted central catheter (PICC) who had a septic thrombus in the right atrium. Case summary A 23-year-old male patient with recently diagnosed Hodgkin’s lymphoma had an inserted PICC for the purpose of chemotherapy application. Three days after the first chemotherapy application a thrombosis of the cephalic and subclavian veins at the site of PICC was found. The PICC was removed and the patient was treated with therapeutic doses of dalteparin. A day after the discovery of thrombosis, the patient became clinically septic, with high inflammatory markers and Staphylococcus aureus was isolated from his blood cultures. He was promptly treated with flucloxacillin. Due to pain in his left knee, a knee puncture was performed, and Staphylococcus aureus was isolated also from the knee synovial fluid. A transthoracic echocardiography revealed a 2.8 x 2.8 cm sessile thrombus on the lateral wall of the right atrium. There were no vegetations on the tricuspid or other valves. Due to increasing pain in his left knee and an increase in inflammatory markers a synovectomy was performed. After the operation the clinical status improved and the inflammatory parameters decreased. A magnetic resonance imaging of the heart was performed, which confirmed the thrombus described by echocardiography and excluded the presence of abscesses. All the time the patient was treated in the intensive care unit with standard heparin, flucloxacillin, and piperacillin/tazobactam due to neutropenia. The inflammatory markers slowly decreased and all further blood cultures were negative. Follow-up echocardiography after 16 days of antibiotic and anticoagulant therapy revealed that the mass in the right atrium, attached on the lateral atrium wall, was slightly smaller than before. The mass was centrally un-echogenic with echogenic cover, appearing as a partial regression of the septic thrombus with a central colliquation. The heart valves remained free of vegetations. There was a minor pericardial effusion, with no signs of constriction. Due to improved clinical status the patient was able to start with chemotherapy again after a pause of three weeks. Conclusion The patient had three important risk factors for thrombosis: PICC, sepsis and malignancy. Echocardiography is an important tool for mass diagnosis and the exclusion of vegetations in a septic patient. Often there is a need for further specification of the mass etiology or for the exclusion of other pathology, like abscesses in our case. Magnetic resonance is an important tool that can complement the echocardiographic examination. Abstract P1498 Figure. Right atrial thrombus

scholarly journals Bilateral Breast Lumps as a Presentation of Disseminated Squamous Cell Carcinoma of Lung

2014 ◽  
Vol 7 ◽  
pp. CCRep.S13832
Author(s):  
Pramila Dharmshaktu ◽  
Ankur Jain ◽  
Naresh Gupta ◽  
Abhilasha Garg ◽  
Seema Kaushal
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Lower Lobe ◽  
Malignant Cells ◽  
Rare Presentation ◽  
Ct Guided ◽  
The Past ◽  
Breast Lumps ◽  
The Right

We present the case of a 65-year-old female who presented to our hospital with nodular swelling in her breast that first appeared in the right upper quadrant 10 months earlier, followed by involvement of the left upper quadrant along with nodular swelling in the right inguinal region for the past six months. She was also complaining of breathlessness on exertion and right-sided pleuritic chest pain for the past one year. Her chest X-ray showed well defined consolidation in the right lower lobe of the lung with pleural effusion. Further pleural tap showed malignant cells with squamous differentiation. Fine needle aspiration cytology (FNAC) from breast lumps was suggestive of malignant cells with morphology of cells likely to be squamous. CT-guided biopsy of the lung mass showed moderately differentiated squamous cell carcinoma of the lung. She succumbed to her illness following severe respiratory distress. Breast lump secondary to lung malignancy is very rare. Squamous cell carcinoma presenting as breast metastasis is a very rare presentation and reported in few cases. No previous case reporting bilateral breast lumps as a presentation of squamous cell carcinoma of the lung could be found in the literature.

scholarly journals A Case of Radiation Fibrosis Appearing as Mass-Like Consolidation after SBRT with Elevation of Serum CEA

2010 ◽  
Vol 2010 ◽  
pp. 1-4 ◽  
Author(s):  
Kotaro Terashima ◽  
Yoshiyuki Shioyama ◽  
Satoshi Nomoto ◽  
Saiji Ohga ◽  
Takeshi Nonoshita ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Short Interval ◽  
Primary Lung Cancer ◽  
Dorsal Side ◽  
Ct Guided ◽  
Radiation Fibrosis ◽  
Ct Guided Biopsy ◽  
Serum Cea ◽  
The Right

We report a case of radiation fibrosis appearing as mass-like consolidation, which was difficult to distinguish from local recurrence. A 72-year-old woman was diagnosed as having primary lung cancer (cT1N0M0 stage IA) in the right upper lobe and was treated with SBRT of 48 Gy in 4 fractions. After 12 months, mass-like consolidation appeared around the irradiated area, and after 13 months, it had increased in size. FDG-PET revealed high uptake (SUVmax=5.61) for the consolidation. CT-guided biopsy was performed, but we could not confirm the diagnosis. Considering her poor respiratory function and her age, short-interval follow-up was performed. After 15 months, the consolidation enlarged at the dorsal side, and carcinoembryonic antigen (CEA) became elevated (14.6 ng/mL). Serum KL-6 (436 U/mL) and SP-D (204 ng/mL) were also elevated. However, after 16 months, serum CEA slightly decreased. The consolidation gradually retracted on follow-up CT images. CEA, KL-6, and SP-D were also decreased by degrees. After 40 months, there is no evidence of local recurrence.

scholarly journals Pyothorax-associated Lymphoma: a Case Report and Review

2020 ◽  
Author(s):  
Fangyuan Dong ◽  
Yongzhi Wu ◽  
Sufen Wang ◽  
Guomin Sun ◽  
Qinqin Zhang ◽  
...  
Keyword(s):  
Chest Pain ◽  
Rare Disease ◽  
Single Case ◽  
Lower Lobe ◽  
Final Diagnosis ◽  
Patient Treatment ◽  
Ki 67 ◽  
Chronic Empyema ◽  
The Right ◽  
Fdg Pet Ct

Abstract Background: Pyothorax-associated lymphoma is a rare disease with variations in endemic prevalence. PAL arising from a posttraumatic empyema are a rare occurrence.Case presentation: a male patient, 83 years old. Twenty years earlier, the patient fell from a height, sustaining a fracture to the right rib, which improved after conservative treatment. In September 2018, the patient had right chest pain (ribs 9–10). In February 2019, the chest pain became worse during sleep. CT examination showed inflammation of the right lower lobe, chronic empyema on the right with subdiaphragmatic infection, fibrosis of the right lung, atherosclerosis, thickening of the left pleura with rib destruction, and membranous calcification around the lesion. After 5 days of treatment with cefoperazone, sulbactam sodium, and ornidazole, the patient’s chest pain did not improve. The results of 18F-FDG PET/CT showed the following: a solid mass in the lower right thoracic cavity. Immunohistochemistry showed that the tumor cells were negative for CD20 and CD3, positive for background mature T lymphocytes, positive for Pax-5, positive for MUM-1, Ki-67 (70%, +); AE1/AE3, CD138, Bcl-6, CD10, CD5, CD56, MPO (-); CD79α (part +), EMA (part +), CD38 (+), bcl-2 (+). In situ hybridization (CISH): EBER+. Mini-CHOP chemotherapy was implemented on April 11, 2019. The patient stopped taking analgesics on the day of chemotherapy. The pain disappeared one week later, and the EBV-DNA fell to the normal range. In the later stage, the family members of the patient declined further patient treatment and reexamination. The patient’s condition worsened in July 2019 and he died on September 25, 2019.Conclusion: Pathological morphology is vital important to make a final diagnosis and avoid misdiagnosis or miss diagnosis. This case is described by a combination of imaging and pathological examinations that reports the clinical pathological diagnosis and treatment process of a single case of pyothorax-associated lymphoma, and it provides some diagnostic information regarding the rare disease of PAL.

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