Right lower lobectomy for a patient with a history of right upper lobectomy: A case with preservation of the right middle lobe

A 75-year-old female was referred to the neurology outpatients department with a 6 month history of progressive amnesia and cognitive decline as well as symptoms/signs suggestive of a sensory neuropathy. Past medical history included TIA, cervical spondylosis and recent investigation for hyponatraemia which had been attributed to SIADH. She had been a smoker with a 50+pack year history and consumed minimal alcohol. An MRI brain scan demonstrated bilateral hippocampal T2 hyperintensity. A lumbar puncture demonstrated normal CSF constituents and negative viral PCRs. Full autoimmune and paraneoplastic screening was undertaken which was all normal except for a positive anti-Hu antibody. A CT-TAP highlighted a mass lesion in the right middle lobe of the lung and biopsy confirmed small cell lung cancer (T1aN2M0). A diagnosis of anti-Hu antibody related paraneoplastic syndrome was made and an initial treatment course of IV Methylprednisolone was administered. The patient’s cancer was treated with chemotherapy and adjuvant radiotherapy. Despite a good response with regard to her tumour and hyponatraemia, the patient did not improve significantly cognitively. This case highlights the need for awareness of the combination of symptoms/signs of the described ‘anti-Hu syndrome’ with paraneoplastic sensory neuropathy and/or encephalomyelitis.

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Right lower lobectomy after right upper lobectomy for multiple metastases in lung cancer of the right lower lobe: Benefit of middle lobe preservation

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2007.02.054 ◽

2007 ◽

Vol 134 (4) ◽

pp. 1078-1080 ◽

Cited By ~ 9

Author(s):

Hisashi Iwata ◽

Takuji Kiryu ◽

Koyo Shirahashi ◽

Shinsuke Matsumoto ◽

Masafumi Matsui ◽

...

Keyword(s):

Lung Cancer ◽

Lower Lobe ◽

Middle Lobe ◽

Lower Lobectomy ◽

Multiple Metastases ◽

The Right ◽

Middle Lobe Preservation ◽

Right Lower Lobectomy

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Bronchobiliary fistula: a rare postoperative complication of spilled gallstones from laparoscopic cholecystectomy

BMJ Case Reports ◽

10.1136/bcr-2021-243198 ◽

2021 ◽

Vol 14 (7) ◽

pp. e243198

Author(s):

Nanditha Guruvaiah ◽

Janardhana Ponnatapura

Keyword(s):

Laparoscopic Cholecystectomy ◽

Bronchial Tree ◽

Middle Lobe ◽

High Morbidity ◽

Quadrant Pain ◽

Bronchobiliary Fistula ◽

Recurrent Pneumonia ◽

History Of ◽

Right Middle Lobe ◽

The Right

Bronchobiliary fistula (BBF) is defined as the abnormal connection between the biliary system and the bronchial tree, which presents clinically as an irritant cough with bilioptysis. Many conditions can lead to its development. We present a case of an acquired BBF in a 61-year-old man with a significant history of spilled gallstones from a prior laparoscopic cholecystectomy and subsequent presentation of intermittent right upper quadrant pain and recurrent pneumonia. Imaging studies revealed a liver and subdiaphragmatic abscess with right middle lobe pneumonia and a BBF traversing the right hemidiaphragm. The patient was surgically managed by takedown of fistula with drainage of the abscess and removal of spilled gallstone, followed by a resection of the right middle lobe. While previous studies indicate spilled gallstones are benign, this case demonstrates its potential for serious complications. Therefore, early diagnosis and proper management is essential as BBF has a high morbidity and mortality rate.

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BRONCHIECTASIS IN CHILDHOOD

PEDIATRICS ◽

10.1542/peds.4.2.231 ◽

1949 ◽

Vol 4 (2) ◽

pp. 231-248

Author(s):

C. ELAINE FIELD

Keyword(s):

Lower Lobe ◽

Middle Lobe ◽

Childhood Illnesses ◽

Breathing Exercises ◽

Postural Drainage ◽

Significant Difference ◽

History Of ◽

Right Middle Lobe ◽

Bronchial Dilatation ◽

The Right

Non-aeration of alveoli is a feature common to the childhood illnesses predisposing to bronchiectasis and is regarded as the important factor in the aetiology of the disease, infection playing a subsidiary part. Pulmonary collapse is therefore regarded as a prebronchiectatic state and in order to assess its importance two groups of cases have been studied: (1) 272 cases of pulmonary collapse; (2) 99 cases in which the diagnosis of bronchiectasis was doubtful at first examination. Pulmonary collapse was seen most frequently in the right middle lobe and left lower lobe. It was usually persistent in the left upper lobe but frequently the right lower lobe reexpanded. The duration of cough, according to the history, was commonly of three months' duration ion or less in cases of pulmonary collapse that reexpanded, in contrast to the long history of two years or more in the majority of cases that developed bronchiectasis. Of the 272 cases of pulmonary collapse, only 157 reexpanded without permanent bronchiectatic changes. It was not uncommon, however, to find temporary bronchial dilatation in this group, the bronchi returning to normal calibre when the collapse reexpanded—a condition described as reversible bronchiectasis. The treatment recommended for pulmonary collapse includes steam inhalations, postural drainage, and breathing exercises. Unless foreign body is suspected, immediate bronchoscopy is no longer considered necessary. No significant difference in the incidence of reexpansion of the lung was found between the cases treated with bronchoscopy and those treated without. Ninety-nine cases were classified as doubtful bronchiectasis when first seen. Of these, 47.5% suffered from asthma, a disease frequently difficult to differentiate from bornchiectasis. Forty of the 99 cases have now developed true irreversible bronchiectasis after a period of three or more years. It was necessary to observe cases showing doubtful bronchial dilatation over a period of years, the bronchograms being repeated at intervals in order to determine the permanently diseased parts.

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A Rare Case of a Toxic Thyroid Nodule Found in a Hypothyroid Patient on Levothyroxine Therapy

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.1869 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A915-A915

Author(s):

Tiffany Purewal ◽

Christopher Lesniak ◽

Andrew Ravin ◽

Jennifer Cheng

Keyword(s):

Thyroid Nodule ◽

Hashimoto’S Thyroiditis ◽

Thyroid Nodules ◽

Middle Lobe ◽

Hashimoto's Thyroiditis ◽

Hot Nodule ◽

History Of ◽

Right Middle Lobe ◽

The Right ◽

Hypothyroid Patients

Abstract Introduction: A hyperfunctional thyroid nodule can lead to symptoms of overt or subclinical hyperthyroidism but the association between a hyperfunctional thyroid nodule and hypothyroidism has not been well reported. We present a patient with a prior history of hypothyroidism previously controlled on Levothyroxine who later presented with an enlarging hot nodule. Case Presentation: A 62-year-old female with a history of factor V Leiden, hypothyroidism on levothyroxine therapy, and a meningioma presented to an outpatient clinic with complaints of fatigue, constipation, and 37-pound weight loss in one year. She was diagnosed with hypothyroidism 7 years ago after delivering her third child, but the underlying cause of her disease was unknown. She began taking levothyroxine 50mcg every morning after her diagnosis. She reported compliance and proper pill taking technique. Physical examination revealed a palpable thyroid nodule. The patient had a previous work up for thyroid nodules with a thyroid uptake and scan a few years prior, which showed a 1.42 x 0.96 x 1.87 cm hot nodule at the right middle lobe with a 24-hour uptake of 15.3%. The patient was asymptomatic at that time and thyroid function tests were within normal limits. She was instructed to continue taking levothyroxine. Repeat RAI Uptake scan at the time of her presentation to our office again showed the right middle lobe hot thyroid nodule with an increased 24-hour uptake of 27.5%. Ultrasound showed bilateral thyroid nodules and a hypervascular solid nodule measuring 2.28 x 1.27 x 1.9 cm that has increased in size. Lab work at this visit revealed a TSH of 0.329 uIu/mL, and free T4 of 1.25 ng/dL. Due to her low TSH and clinical presentation, the levothyroxine was discontinued. Anti-thyroid peroxidase antibodies were obtained to assess for Hashimoto’s Thyroiditis but were found to be normal. The patient was later referred to an endocrine surgeon for a total thyroidectomy. Conclusion: Although uncommon, hyperfunctional nodules in hypothyroid patients can create a confusing clinical picture with overlapping symptoms of underactive and overactive thyroid disease. It has been reported that patients with Hashimoto’s Thyroiditis can have hot nodules and coexisting hypothyroidism but the prevalence of hyperfunctional nodules in hypothyroid patients without Hashimoto’s Thyroiditis, as in this case, is not well-documented. Patients with hypothyroidism are treated with Levothyroxine but if coexisting hyperfunctional nodules are not detected, the patient may develop thyrotoxicosis. Clinicians should be aware of this rare but potentially life-threatening clinical condition.

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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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Successful video-assisted thoracoscopic management of the right middle lobe torsion: A rare complication of right upper lobectomy – A report of two cases

Lung India ◽

10.4103/lungindia.lungindia_254_19 ◽

2020 ◽

Vol 37 (6) ◽

pp. 530

Author(s):

MohanVenkatesh Pulle ◽

BelalBin Asaf ◽

HarshVardhan Puri ◽

Arvind Kumar

Keyword(s):

Rare Complication ◽

Middle Lobe ◽

Video Assisted ◽

Right Middle Lobe ◽

The Right

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Alveolar adenoma: A rare lung tumor

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh0708461s ◽

2007 ◽

Vol 135 (7-8) ◽

pp. 461-464 ◽

Cited By ~ 2

Author(s):

Jelena Stojsic ◽

Branislava Milenkovic ◽

Jelena Radojicic ◽

Malina Percinkovski

Keyword(s):

Pulmonary Nodule ◽

Solitary Pulmonary Nodule ◽

Lung Tumor ◽

Fibrous Tissue ◽

Surgical Excision ◽

Middle Lobe ◽

Benign Lung Tumor ◽

Right Middle Lobe ◽

Malignant Alteration ◽

The Right

Introduction Alveolar adenoma belongs to the group of benign epithelial tumors. Histogenesis of alveolar adenoma is a combination of proliferation of alveolar pneumocytes and fibrous tissue originating from septal mesenchyma. Case outline A sixty-nine-year old female patient was hospitalized for clinical examination and surgery of well defined and homogenous timorous lesion in the right middle lobe causing pleural pain. Bronchoscopic examination with biopsy did not resolve etiology of the disease. Tumorectomy was performed. Timorous nodule had a multicystic appearance and histologically, histochemically and immunohistochemically, an alveolar adenoma was estimated. Five years after surgery, the patient feels well, without respiratory symptoms and signs of recurrence or malignant alteration, respectively. Conclusion Alveolar adenoma is a rare benign lung tumor, most frequently presented as a solitary pulmonary nodule. After complete surgery, the tumor neither relapses nor malignantly alters. Surgical excision is curative. It is necessary to take into consideration alveolar adenoma, too, when a solitary pulmonary nodule is diagnosed.

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