Successful Treatment of Bulla with Endobronchial Valves

Emphysematous bullae are a complication of end-stage COPD. Patients with large bullae and poor respiratory function have limited treatment options. Surgical resection is a recognized treatment, but functional improvement after bullectomy is not satisfactory in patients with forced expiratory volume in 1 s (FEV1) < 35% predicted. When this 59-year-old male end-stage COPD patient was assessed, he was cachectic and lung function tests showed a FEV1 of 0.56 L (19% predicted) and a RV of 7 L (314% predicted), while 6MWT was 315 m and MRC dyspnea score was 4. Chest X-ray revealed a massive bulla of 10 cm in diameter in the right middle lobe. A fibrobronchoscopy was performed under local anesthesia and 2 Zephyr 4.0 valves were placed in the right middle lobe. Chest X-ray and CT scan performed 36 days later showed the complete resolution of the bulla. Seven months later, the patient demonstrated an improvement in FEV1 (+30%) and a decrease in RV from 314 to 262% predicted. This case report shows that the Zephyr valves may be successfully used to treat a large bulla in the right middle lobe in a patient with diffuse emphysema and severely impaired lung function.

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Radiographic Abnormalities in Acute Asthma in Children

PEDIATRICS ◽

10.1542/peds.54.4.442 ◽

1974 ◽

Vol 54 (4) ◽

pp. 442-449

Author(s):

Peyton A. Eggleston ◽

Byron H. Ward ◽

William E. Pierson ◽

C. Warren Bierman

Keyword(s):

Acute Asthma ◽

Middle Lobe ◽

Pulmonary Complications ◽

Common Finding ◽

X Ray ◽

Age Dependent ◽

Chest X Ray ◽

Right Middle Lobe ◽

Asthma In Children ◽

The Right

To determine the incidence of radiographic abnormalities in acute asthma of children and adolescents, and to examine the contribution of the chest x-ray to their care, 515 asthma admissions were reviewed. Of these, 479 had admission chest films, 22.3% of which were abnormal. Significant perihilar infiltrates were the most frequent abnormality seen; atelectasis, especially of the right middle lobe, was the next most frequent. Pneumomediastinum was also a common finding. Both pneumomediastinum and infiltrates were strikingly age-dependent: 15.5% over 10 years old had pneumomediastinum; none under 2 years old had this complication; infiltrates occurred in nearly 25% of younger children but in only 8.3% over 10 years old. Since pulmonary complications substantially alter therapeutic management, a chest x-ray should be part of the initial evaluation of any child hospitalized with acute asthma.

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Atypical Infections in Chronic Myeloid Leukaemia- Staphylococcus furunculosis and Aspergillosis

Journal of Advanced Research in Medicine ◽

10.24321/2349.7181.202004 ◽

2020 ◽

Vol 07 (01) ◽

pp. 17-19

Author(s):

Sharon T Mathews ◽

Keyword(s):

Chronic Myeloid Leukemia ◽

Myeloid Leukemia ◽

Blast Crisis ◽

Middle Lobe ◽

Imatinib Therapy ◽

X Ray ◽

Chest X Ray ◽

Right Middle Lobe ◽

One Year ◽

The Right

Incidence of opportunistic infection in patients of Chronic Myeloid Leukemia (CML) on Imatinib therapy is low. We report a case of a 47 year old lady, a known case of CML for one year on imatinib therapy who presented with CML in blast crisis with Staphylococcus furunculosis. Two weeks later she developed fever, cough and expectoration. She had cavitatory lesion in the right middle zone on chest x-ray. CECT Chest was suggestive of aspergilloma in right middle lobe. Infections in chronic myeloid leukemia are not very common. Also, developing such infections within such a short span of time, within one year of initiation of imatinib therapy is also rare. Hence, this case of CML with Staphylococcal furunculosis and Aspergillosis is being reported.

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Prolonged RNA shedding of the 2019 novel coronavirus in an asymptomatic patient with a VP shunt

BMJ Case Reports ◽

10.1136/bcr-2020-237720 ◽

2020 ◽

Vol 13 (9) ◽

pp. e237720

Author(s):

Firas El-Baba ◽

Danielle Gabe ◽

Allan Frank

Keyword(s):

Paranoid Schizophrenia ◽

Middle Lobe ◽

Psychiatric Facility ◽

Vp Shunt ◽

Viral Shedding ◽

Chest X Ray ◽

Right Middle Lobe ◽

Novel Coronavirus ◽

The Right ◽

Inpatient Psychiatric Facility

A 33-year-old man with paranoid schizophrenia and a ventriculoperitoneal (VP) shunt was sent to our institution from an inpatient psychiatric facility due to concerns for the 2019 novel coronavirus (COVID-19). Per the facility, the patient had a fever and non-productive cough. On admission, the patient was afebrile and lacked subjective symptoms. A RNA reverse transcriptase PCR (RNA RT-PCR) test for COVID-19 was positive. A chest X-ray contained a small patchy opacity in the right middle lobe and another in the retrocardiac region concerning for pneumonia. Inflammatory markers were mildly elevated. He remained COVID-19 positive and asymptomatic for 36 days. This case details one asymptomatic carrier’s course with persistently positive COVID-19 nasopharyngeal swabs. It demonstrates that a VP shunt could be a possible predisposition for prolonged viral shedding.

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Hydropneumothorax Revealing a Pneumoblastoma in Children

Case Reports in Pediatrics ◽

10.1155/2020/8879661 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4

Author(s):

Karima El Fakiri ◽

Ghizlane Draiss ◽

Noureddine Rada ◽

Mohammed Bouskraoui ◽

Abderrachid Hamdaoui ◽

...

Keyword(s):

Outer Segment ◽

Middle Lobe ◽

High Grade ◽

Cystic Lesions ◽

Type Ii ◽

Pathological Study ◽

X Ray ◽

Thoracic Drainage ◽

Chest X Ray ◽

The Right

Pneumoblastoma is a rare primary childhood tumor. We report the observation of an infant aged 2 years and 8 months who presented with dry cough and dyspnea. The physical examination found mixed pleural effusion syndrome on the right. The chest X-ray revealed a right pneumothorax. Biology has shown leukocytosis at 16,000/mm3. The CT scan revealed parenchymal air cystic lesions affecting the outer segment of the middle lobe mimicking a pulmonary malformation. Thoracic drainage brought back 100 ml of the fluid. Two months later, when a pyopneumothorax appeared, a medium lobectomy was performed. Pathological study specimen showed a high-grade type II pneumoblastoma The extension assessment identified a secondary hepatic location. Chemotherapy has been indicated. This observation illustrates the diagnosis challenge of pneumoblastoma in children.

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Endometriosis of the Lung: Case Report and Literature Review

10.21203/rs.3.rs-141435/v1 ◽

2021 ◽

Author(s):

Jin Yao ◽

Hong Zheng ◽

Hui Nie ◽

Jia-jia Huang ◽

Na Tan ◽

...

Keyword(s):

Case Reports ◽

Treatment Options ◽

Middle Lobe ◽

Thoracic Drainage ◽

Pulmonary Endometriosis ◽

Lower Lung ◽

Right Middle Lobe ◽

Gynecological Disease ◽

The Right

Abstract Background: Lung endometriosis is an extremely rare gynecological disease. Literature reports suggest that most patients will show generic symptoms such as hemoptysis, pneumothorax, and hemopneumothorax, which can often result in misdiagnosis. There are case reports of 18 patients with lung endometriosis describing clinical manifestation, imaging changes, treatment and prognosis. To provide further information on this rare disease, we present a case of pulmonary endometriosis and a review of lung endometriosis.Case presentation: We report on a 19-year-old female who was admitted to hospital due to repeated menstrual hemoptysis for 3 months. Computed tomography during menstruation showed patchy high-density shadows sized approximately 0.5 cm × 0.5 cm × 0.5 cm in the right middle lobe of the lung. Following menstruation, hemoptysis and changes on CT imaging disappeared. Thoracoscopic right middle lobectomy, right lower lung repair, and closed thoracic drainage were performed. Postoperative histopathology confirmed lung endometriosis. There was no recurrence of symptoms after 6 months of follow-up. Conclusions: We review the literature on factors associated with lung endometriosis, diagnosis, and treatment options. We propose that the diagnosis for lung endometriosis should be made by comprehensively integrating patient reproductive history, clinical and imaging details as well as histopathology. Surgical resection appears to be an effective treatment for lung endometriosis.

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Endometriosis of the lung: case report and literature review

10.21203/rs.3.rs-135229/v1 ◽

2020 ◽

Author(s):

Jin Yao ◽

Hong Zheng ◽

Hui Nie ◽

Jiajia Huang ◽

Na Tan ◽

...

Keyword(s):

Case Reports ◽

Treatment Options ◽

Middle Lobe ◽

Thoracic Drainage ◽

Pulmonary Endometriosis ◽

Lower Lung ◽

Right Middle Lobe ◽

Gynecological Disease ◽

The Right

Abstract Background:Lung endometriosis is an extremely rare gynecological disease. Literature reports suggest that most patients will show generic symptoms such as hemoptysis, pneumothorax, and hemopneumothorax, which can often result in misdiagnosis. There are case reports of 18 patients with lung endometriosis describing clinical manifestation, imaging changes, treatment and prognosis. To provide further information on this rare disease, we present a case of pulmonary endometriosis and a review of lung endometriosis.Case presentation:We report on a 19-year-old female who was admitted to hospital due to repeated menstrual hemoptysis for 3 months. Computed tomography during menstruation showed patchy high-density shadows sized approximately 0.5 cm × 0.5 cm × 0.5 cm in the right middle lobe of the lung. Following menstruation, hemoptysis and changes on CT imaging disappeared. Thoracoscopic right middle lobectomy, right lower lung repair, and closed thoracic drainage were performed. Postoperative histopathology confirmed lung endometriosis. There was no recurrence of symptoms after 6 months of follow-up. Conclusions: We review the literature on factors associated with lung endometriosis, diagnosis, and treatment options. We propose that the diagnosis for lung endometriosis should be made by comprehensively integrating patient reproductive history, clinical and imaging details as well as histopathology. Surgical resection appears to be an effective treatment for lung endometriosis.

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Bronchopulmonary dysplasia in extremely premature infant with congenital lobar emphysema: a case report

BMC Pediatrics ◽

10.1186/s12887-021-02772-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Bingchun Lin ◽

Huitao Li ◽

Chuanzhong Yang

Keyword(s):

Premature Infant ◽

Bronchopulmonary Dysplasia ◽

Premature Infants ◽

Gestational Age ◽

Middle Lobe ◽

Severe Respiratory Distress ◽

Congenital Lobar Emphysema ◽

X Ray ◽

Chest X Ray ◽

Lobar Emphysema

Abstract Background Congenital lobar emphysema (CLE) is a congenital pulmonary cystic disease, characterized by overinflation of the pulmonary lobe and compression of the surrounding areas. Most patients with symptoms need an urgent surgical intervention. Caution and alertness for CLE is required in cases of local emphysema on chest X-ray images of extremely premature infants with bronchopulmonary dysplasia (BPD). Case presentation Here, we report a case of premature infant with 27 + 4 weeks of gestational age who suddenly presented with severe respiratory distress at 60 days after birth. Chest X-ray and computed tomography (CT) indicated emphysema in the middle lobe of the right lung. The diagnosis of CLE was confirmed by histopathological examinations. Conclusions Although extremely premature infants have high-risk factors of bronchopulmonary dysplasia due to their small gestational age, alertness for CLE is necessary if local emphysema is present. Timely pulmonary CT scan and surgical interventions should be performed to avoid the delay of the diagnosis and treatment.

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AB0796 THE EVALUATION OF LUNG DIAGNOSTIC PROCEDURE AT THE ONSET OF INFLAMMATORY RHEUMATIC DISEASES WITH INTERSTITIAL LUNG DISEASE

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.3119 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 1422.3-1423

Author(s):

T. Hoffmann ◽

P. Oelzner ◽

F. Marcus ◽

M. Förster ◽

J. Böttcher ◽

...

Keyword(s):

Carbon Monoxide ◽

Interstitial Lung Disease ◽

Lung Function ◽

Lung Disease ◽

Sensitivity And Specificity ◽

Lung Function Test ◽

Inflammatory Rheumatic Diseases ◽

X Ray ◽

Function Test ◽

Chest X Ray

Background:Interstitial lung disease (ILD) in inflammatory rheumatic diseases (IRD) is associated with increased mortality. Moreover, the lung is one of the most effected organs on IRD. Consequently, screening methods were required to the detect ILD in IRD.Objectives:The objective of the following study is to evaluate the diagnostic value of lung function test, chest x-ray and HR-CT of the lung in the detection of ILD at the onset of IRD.Methods:The study is designed as a case-control study and includes 126 patients with a newly diagnosed IRD. It was matched by gender, age and the performance of lung function test and chest x-ray. The sensitivity and specificity were verified by crosstabs and receiver operating characteristic (ROC) curve analysis. The study cohort was divided in two groups (ILD group: n = 63 and control group: n = 63). If possible, all patients received a lung function test and optional a chest x-ray. Patients with pathological findings in the screening tests (chest x-ray or reduced diffusing capacity for carbon monoxide (DLCO) < 80 %) maintained a high-resolution computer tomography (HR-CT) of the lung. Additionally, an immunological bronchioalveolar lavage was performed in the ILD group as gold standard for the detection of ILD.Results:The DLCO (< 80 %) revealed a sensitivity of 83.6 % and specificity of 45.8 % for the detection of ILD. Other examined parameter of lung function test showed no sufficient sensitivity as screening test (FVC = Forced Vital Capacity, FEV1 = Forced Expiratory Volume in 1 second, TLC = Total Lung Capacity, TLCO = Transfer factor of the Lung for carbon monoxide). Also, a combination of different parameter did not increase the sensitivity. The sensitivity and specificity of chest x-ray for the verification of ILD was 64.2 % versus 73.6 %. The combination of DLCO (< 80 %) and chest x-ray showed a sensitivity with 95.2 % and specificity with 38.7 %. The highest sensitivity (95.2 %) and specificity (77.4 %) was observed for the combination of DLCO (< 80 %) and HR-CT of the lung.Conclusion:The study highlighted that a reduced DLCO in lung function test is associated with a lung involvement in IRD. DLCO represented a potential screening parameter for lung manifestation in IRD. Especially patients with suspected vasculitis should receive an additional chest x-ray. Based on the high sensitivity of DLCO in combination with chest x-ray or HR-CT for the detection of ILD in IRD, all patients with a reduced DLCO (< 80%) should obtained an imaging of the lung.Disclosure of Interests:None declared

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Pulmonary Tuberculosis mimicking a right Eventration on Radiography: The falsity of single view radiograph in the diagnosis of a precursor of pulmonary disease: A Case Report

Babcock University Medical Journal (BUMJ) ◽

10.38029/bumj.v4i1.65 ◽

2021 ◽

Vol 4 (1) ◽

pp. 33-37

Author(s):

John Ogunkoya ◽

Oluwatosin Yetunde Adesuyi

Keyword(s):

Pulmonary Tuberculosis ◽

Lower Lobe ◽

Middle Lobe ◽

The Body ◽

Single View ◽

Lymph Node Enlargement ◽

History Of ◽

Chest X Ray ◽

The Right ◽

High Index Of Suspicion

Background: The diaphragm is one of the most important muscles of respiration in the body separating the abdomen from the thorax. Abnormalities of the diaphragm could be congenital or acquired, morphological or functional while pulmonary infection e.g. pulmonary tuberculosis, is implicated in its etiology. Case presentation: A 63-year- old man with six weeks history of cough productive of yellowish sputum. Chest X-ray showed a uniform well-circumscribed opacity in the right lower lobe abutting on or in continuum with the right diaphragm consistent with a diaphragmatic hump. Sputum Gene Xpert was positive for Mycobacterium tuberculosis. Chest CT scan revealed bilateral lymph node enlargement with hyperdense lesions in the anterior basal segment of the right lower lobe and medial bronchopulmonary segments of the right middle lobe. He was treated for 6 months with first-line anti-tuberculosis drugs. Discussion: The incidence of the diaphragmatic hump on chest radiograph worldwide and among Nigerians is unknown. The association of diaphragmatic hump with chest infection has been well document. The association of diaphragmatic hump with pulmonary tuberculosis is uncommon. Conclusion: A high index of suspicion is needed to diagnose pulmonary tuberculosis with atypical clinical and radiological presentations. Such prompt diagnosis will aid the treatment of the disease.

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CLINICAL STUDY OF PAIN IN RIGHT ILIAC FOSSA

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i8.1365 ◽

2020 ◽

Vol 4 (8) ◽

Author(s):

Saurabh Kothari ◽

Manjula Kothari ◽

Shree Mohan Joshi ◽

Kalp Shandilya

Keyword(s):

Iliac Fossa ◽

Signs And Symptoms ◽

Clinical History ◽

X Ray ◽

Pain Abdomen ◽

Detailed Clinical History ◽

Right Iliac Fossa Pain ◽

Chest X Ray ◽

The Right ◽

Appendicular Mass

Background: A mass in the right iliac fossa is a common diagnostic problem encountered in clinical practice, requiring skill in diagnosis. Methods: 100 patients with signs and symptoms of right iliac fossa mass admitted in Hospital were identified and were studied by taking detailed clinical history, physical examination and were subjected to various investigations like x ray erect abdomen, chest x-ray, contrast x-ray . Result: In this study of out of 100 cases, 65.00% of cases were related to appendicular pathology either in the form of appendicular mass or appendicular abscess. There were 12.00% cases of ileocaecal tuberculosis. Conclusion: Appendicular lump remains the most common cause for right iliac fossa pain. Ileocaecal tuberculosis is one of the most important differential diagnoses for pain abdomen. Keywords: Appendicular Mass, Ileocaecal Tuberculosis, Carcinoma Caecum, Right Iliac Fossa Mass.

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