scholarly journals PneumocystisPneumonia Presenting as an Enlarging Solitary Pulmonary Nodule

2016 ◽  
Vol 2016 ◽  
pp. 1-4
Author(s):  
Krunal Bharat Patel ◽  
James Benjamin Gleason ◽  
Maria Julia Diacovo ◽  
Nydia Martinez-Galvez

Pneumocystispneumonia is a life threatening infection that usually presents with diffuse bilateral ground-glass infiltrates in immunocompromised patients. We report a case of a single nodular granulomatousPneumocystispneumonia in a male with diffuse large B-cell lymphoma after R-CHOP therapy. He presented with symptoms of productive cough, dyspnea, and right-sided pleuritic chest pain that failed to resolve despite treatment with multiple antibiotics. Chest X-ray revealed right lower lobe atelectasis and CT of chest showed development of 2 cm nodular opacity with ground-glass opacities. Patient underwent bronchoscopy and biopsy that revealed granulomatous inflammation in a background of organizing pneumonia pattern with negative cultures. Respiratory symptoms resolved but the solitary nodular opacity increased in size prompting a surgical wedge resection which revealed granulomatousPneumocystispneumonia infection. This case is the third documented report ofPneumocystispneumonia infection within a solitary pulmonary nodule in an individual with hematologic neoplasm. AlthoughPneumocystispneumonia most commonly occurs in patients with HIV/acquired immunodeficiency syndrome and with diffuse infiltrates, the diagnosis should not be overlooked when only a solitary nodule is present.

2006 ◽  
Vol 61 (2) ◽  
pp. 171
Author(s):  
Joon Hyun Cho ◽  
Jong Pil Jung ◽  
Hee Jeong Cha ◽  
Chang Ryul Park ◽  
Sung Ryul Kim ◽  
...  

2021 ◽  
Vol 10 (20) ◽  
pp. 4795
Author(s):  
Jan F. Gielis ◽  
Lawek Berzenji ◽  
Vasiliki Siozopoulou ◽  
Marloes Luijks ◽  
Paul E. Y. Van Schil

Pulmonary ossifications have often been regarded as rare, post-mortem findings without any clinical significance. We have investigated the occurrence of pulmonary ossifications in patients undergoing thoracic procedures, and how this may affect the differential diagnosis of solitary pulmonary nodules. In addition, we have performed a literature search on the occurrence and possible pathogenesis of these ossifications. From January 2008 until August 2019, we identified pulmonary ossifications in 34 patients who underwent elective pulmonary surgery. Pre-operative imaging was unable to differentiate these ossifications from solid tumors. A definitive diagnosis was made by an experienced pathologist (VS, ML). The PubMed database was researched in December 2019 with the search terms “pulmonary ossifications”; “heterotopic ossifications”; and “solitary pulmonary nodule”. In total, 27 patients were male, with a mean age of 63 ± 12 years (age 41 to 82 on diagnosis). All lesions were identified on thoracic CT and marked for resection by a multidisciplinary team. A total of 17 patients were diagnosed with malignancy concurrent with ossifications. There was a clear predilection for the right lower lobe (12 cases, 35.3%) and most ossifications had a nodular form (70.6%). We could not identify a clear association with any other pathology, either cancerous or non-cancerous in origin. Oncologic or pulmonary comorbidities did not influence patient survival. Pulmonary ossifications are not as seldom as thought and are not just a curiosity finding by pathologists. These formations may be mistaken for a malignant space-occupying lesion, both pre-and perioperatively, as they are indistinguishable in imaging. We propose these ossifications as an underestimated addition to the differential diagnosis of a solitary pulmonary nodule.


2009 ◽  
Vol 2009 (sep06 2) ◽  
pp. bcr0420091738-bcr0420091738 ◽  
Author(s):  
M. Y M Saeed ◽  
A. H Ahmed ◽  
N. B Elhassan ◽  
A. M Elhassan

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Shigenari Nukaga ◽  
Hiroaki Murakami ◽  
Kazuma Yagi ◽  
Ryosuke Satomi ◽  
Takahiko Oyama ◽  
...  

Abstract Background Pleural effusion and pleuritis are uncommon manifestations of Mycobacterium avium complex pulmonary disease. Pleuritis caused by Mycobacterium avium complex pulmonary disease presenting as a solitary pulmonary nodule is extremely rare. The pathogenesis of Mycobacterium avium complex pleuritis has not been elucidated. However, it has been suggested that secondary spontaneous pneumothorax from Mycobacterium avium complex pulmonary disease is one of the causes of Mycobacterium avium complex pleuritis. Case presentation A 67-year-old Japanese woman who presented with a solitary pulmonary nodule developed a transient pneumothorax after transbronchial biopsy. A definitive diagnosis of solitary pulmonary nodule could not be made on bronchoscopy, so video-assisted thoracoscopic surgery was performed 1 month after bronchoscopy. On the day of hospitalization for the procedure, a left-sided pleural effusion appeared on a chest radiograph. Thickening of the parietal and visceral pleura and numerous scattered white small granules were seen on thoracoscopy. Histologic examination of the resected left lower lobe and a biopsy of the parietal pleura showed Mycobacterium avium complex solitary pulmonary nodule and Mycobacterium avium complex pleuritis. Conclusion Iatrogenic pneumothorax can be a cause of pleuritis in a patient with Mycobacterium avium complex pulmonary disease. Clinicians should watch for the appearance of secondary pleuritis after transbronchial biopsy even in a patient with localized disease such as Mycobacterium avium complex solitary pulmonary nodule.


Author(s):  
Che-Liang Chung ◽  
Wei-Chang Huang ◽  
Hung-Ling Huang ◽  
Chun-Shih Chin ◽  
Meng-Hsuan Cheng ◽  
...  

Abstract Background Histologic diagnosis of granuloma is often considered clinically equivalent to a definite diagnosis of pulmonary tuberculosis (TB) in endemic area. Optimal management of surgically resected granulomatous inflammation in lung with negative mycobacterial culture results, however, remains unclear. Methods From seven medical institutions in northern, middle, and southern Taiwan between January 2010 and December 2018, patients whose surgically resected pulmonary nodule(s) had histological features suggestive of TB but negative microbiological study results and who received no subsequent anti-TB treatment were identified retrospectively. All patients were followed up for 2 years until death or active TB disease was diagnosed. Results A total of 116 patients were enrolled during the study period. Among them, sixty-one patients (52.6%) were clinically asymptomatic, and 36 (31.0%) patients were immunocompromised. Solitary pulmonary nodule accounted for 44 (39.6%) of all cases. The lung nodules were removed by wedge resection in 95 (81.9%), lobectomy in 17 (14.7%), and segmentectomy in 4 (3.4%) patients. The most common histological feature was granulomatous inflammation (n=116, 100%), followed by caseous necrosis (n=39, 33.6%). During follow-up (218.4 patient-years), none of the patients developed active TB. Conclusions In patients with surgically resected culture-negative pulmonary granulomas, the incidence rate of subsequent active TB is low. Watchful monitoring along with regular clinical, radiological, and microbiological follow-up, instead of routine anti-TB treatment, may also be a reasonable option.


Author(s):  
Luca Bertolaccini ◽  
Andrea Viti ◽  
Matteo Salgarello ◽  
Giancarlo Gorgoni ◽  
Alberto Terzi

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
N. Asemota ◽  
M. J. Rouhani ◽  
L. Harling ◽  
H. Raubenheimer ◽  
A. C. De Souza ◽  
...  

Minimal access surgery is increasingly popular to reduce postoperative morbidity and enhance recovery. We present a case of a patient who underwent bilateral minimally invasive thoracic and cardiac surgery. An 81-year-old woman was diagnosed with T1aN0M0 left upper lobe small-cell lung cancer and underwent single-port left video-assisted thoracoscopic surgery (VATS) upper lobectomy in 2016. She developed a contralateral right lower lobe nodule and underwent a single-port right VATS wedge resection of the lower lobe nodule, subsequently confirmed as necrotising granulomatous inflammation with acid-fast bacilli, consistent with previous tuberculosis (TB) infection. On postoperative day 1, she had an episode of self-reverting ventricular tachycardia and bradycardia. Subsequent myocardial perfusion scan and coronary angiogram showed significant LV dysfunction and severe coronary artery disease with a left main stem (LMS) lesion. After agreement at MDT, an Endo-ACAB (endoscopic atraumatic coronary artery bypass grafting) was performed, via 3 ports, with the left internal mammary artery anastomosed to left anterior descending artery. She recovered well postoperatively and was discharged. Multiple sequential minimally invasive procedures are now routine and can be performed safely in patients with a complex combination of pathologies. In this case, bilateral single-port (anatomic and nonanatomic) lung resections were undertaken followed by coronary revascularisation with a total of 5 minimal access ports.


1994 ◽  
Vol 1 (1) ◽  
pp. 25-28 ◽  
Author(s):  
Janet L. Albright ◽  
Rick I. MacArthur ◽  
Julie A. Swain ◽  
Alan T. Tran ◽  
Alex G. Little

The approach to patients with indeterminate pulmonary nodules is poorly defined. Should every pulmonary nodule be biopsied, is needle biopsy adequate, and other questions are challenges. Video assisted thoracic surgery or thoracoscopy has added a new diagnostic possibility which is evaluated in this paper. Fifty-five patients underwent thoracoscopy for diagnosis of a solitary pulmonary nodule. There were few complications and mortality was zero. A definitive diagnosis was obtained in all patients, although one required a second thoracoscopic wedge resection and 10 required conversion to an open thoracotomy.As discussed in the paper, thoracoscopy provides the opportunity for safely establishing a definitive diagnosis in all patients with solitary nodules and the authors believe will become a standard part of the evaluation of these patients.


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