1/400. Persistent pneumatoceles associated with systemic leukocyte abnormalities.Three patients with leucocyte related immune deficiency developed pneumatoceles during acute bacterial pneumonia. A fourth patient with chronic granulomatous disease of childhood developed persistent lung cysts following pulmonary abscesses. The pneumatoceles persisted without significant change for one year to five years. In 25 immunologically normal patients, pneumatoceles that were associated with acute bacterial pneumonia resolved in 3 weeks to 11 months. Perhaps alterations in leukocytic function and in local inflammatory response result in fibrotic cellular reaction and sequestration of parenchymal air collections, precluding their resorption.- - - - - - - - - - ranking = 1keywords = lung (Clic here for more details about this article) |
2/400. Extraction of a rubber bullet from a bronchus after 1 year: complete resolution of chronic pulmonary damage.inhalation of a foreign body (FB) into the bronchial tree rarely occurs asymptomatically and, if leading to recurrent pneumonia, can be very difficult to diagnose. The present report deals with the case of a 10-year-old boy who had three episodes of pneumonia in the left lower lobe caused by the asymptomatic inhalation of a FB 12 months before. Standard thoracic CT, done during the third episode, revealed a slight reduction in the volume of the left lung with air bronchograms, multiple areas of bronchiectasis, and parenchymal consolidation of a segment of the lower lobe. Flexible fiberoptic bronchoscopy revealed a FB at the distal end of the left lower lobar bronchus, surrounded by granulation tissue and fully obstructing the anterior basal segmental bronchus. High-resolution CT (HRCT) images showed an inverted C-shaped image obstructing a bronchus. Removal of the FB was successful only with rigid bronchoscopy under total anesthesia. The FB was an air-pistol rubber bullet that the boy remembered playing with 12 months before. Two months after removal of the FB (ie, 14 months from its asymptomatic inhalation) and treatment with oral steroids, antibiotics, and respiratory physiotherapy, the patient recovered completely, and HRCT showed complete normalization of the lung. We conclude that, when the radiographic density of the FB is greater than the surrounding pulmonary parenchyma, HRCT can reveal the FB, and diagnostic flexible fiberoptic bronchoscopy can be avoided.- - - - - - - - - - ranking = 2keywords = lung (Clic here for more details about this article) |
3/400. Jarcho-Levin syndrome: report on a long-term follow-up of an untreated patient.Jarcho-Levin syndrome is a genetically transmitted rare entity characterized by multiple vertebral and rib anomalies. The multilevel skeletal involvement causes short stature, neck and thoracic cage deformities, and restrictive lung disease that is usually the cause of early death. The authors describe a 33-year follow-up of a patient with this syndrome who represents, to their best knowledge, the longest survival of a patient with this entity.- - - - - - - - - - ranking = 1keywords = lung (Clic here for more details about this article) |
4/400. Ectopic thymic tissue: a cause of emphysema in infants.Ectopic thymic tissue can present a diagnostic dilemma when it is located in the posterior mediastinum. The diagnosis can be made by awareness of it and by use of computed tomography (CT) and magnetic resonance imaging (MRI). Rarely, ectopic thymus are reported to cause airway obstruction. In infants ectopic thymic tissue should also be considered in the differential diagnosis of secondary pneumonias and emphysema especially located in the upper lung zones.- - - - - - - - - - ranking = 1keywords = lung (Clic here for more details about this article) |
5/400. hypersensitivity pneumonitis among workers cultivating tricholoma conglobatum (shimeji).We report five cases of hypersensitivity pneumonitis among workers cultivating tricholoma conglobatum (shimeji). After having worked for 5 to 20 years, they began to notice symptoms of cough, sputum, and dyspnea. They were diagnosed as having a hypersensitivity pneumonitis based on clinical features, bronchoalveolar lavage and transbronchial lung biopsy. By the double immunodiffusion test, precipitating lines between shimeji spore antigen and sera were observed in all of the patients. By enzyme-linked immunosorbent assay, the antibody activities against shimeji and three species of fungi (cladosporium sphaerospermum, penicillium frequentans, and scopulariopsis species) were significantly higher in the sera of the patients than in those of normal subjects who were cultivating shimeji. Although it is not clear what causes this disease, these findings may be helpful in determining the specific antigen.- - - - - - - - - - ranking = 1keywords = lung (Clic here for more details about this article) |
6/400. amoxicillin/clavulanate-associated hepatic failure with progression to stevens-johnson syndrome.OBJECTIVE: To describe a patient who developed hepatic failure, stevens-johnson syndrome (SJS), and died after receiving amoxicillin/clavulanate therapy. CASE SUMMARY: A 37-year-old white man without significant past medical history received a 10-day course of amoxicillin/clavulanate for treatment of pneumonia. Thirty-two days after starting amoxicillin/clavulanate, he developed jaundice, rash, pruritus, and increasing fatigue. On further evaluation, with the exclusion of toxicity from other drugs or diseases, the time course to development of cholestatic jaundice correlated with the use of amoxicillin/clavulanate. The patient consequently died with progressive hepatic failure, renal failure, and SJS. DISCUSSION: Hepatic injury has been reported with amoxicillin/clavulanate. signs and symptoms of jaundice and pruritus may appear up to to six weeks after stopping therapy. Most cases of liver injury have been benign and reversible on discontinuation of the amoxicillin/clavulanate. Reported hepatic reactions have been mainly cholestatic, with some mixed cholestatic/hepatocellular liver function test abnormalities. CONCLUSIONS: Clinicians should be aware of amoxicillin/clavulanate as a drug capable of causing hepatitis with eventual systemic dysfunction. While recovery is usually complete following withdrawal of the drug, in patients with rash associated with hepatic dysfunction, renal insufficiency, or other unusual symptoms, earlier consideration of initiating systemic steroids or liver transplantation referral, in hopes of avoiding progressive systemic response, might be worthwhile.- - - - - - - - - - ranking = 0.018606249200184keywords = injury (Clic here for more details about this article) |
7/400. Rheumatoid arthritis associated with methotrexate-induced pneumonitis: improvement with i.v. cyclophosphamide therapy.Pneumonitis is one of the most serious adverse effects associated with low-dose weekly methotrexate (MTX) therapy. Immediate cessation of MTX, and the introduction of oxygen therapy and glucocorticoids usually results in a dramatic improvement in the pulmonary toxicity. We report here a case of MTX-induced pneumonitis in a patient with rheumatoid arthritis (RA). Severe hypoxemia and interstitial infiltration in both lung fields did not respond to the withdrawal of MTX and the administration of oxygen and steroid pulse therapy. When intravenous cyclophosphamide (CYC) pulse therapy was initiated, however, rapid physiologic and radiographic improvement was seen. Our case suggests that CYC treatment may have a beneficial effect on MTX-induced pneumonitis that is resistant to steroid therapy.- - - - - - - - - - ranking = 1keywords = lung (Clic here for more details about this article) |
8/400. Interstitial pneumonitis following mitozantrone, chlorambucil and prednisolone (MCP) chemotherapy.We describe two cases of interstitial lung disease in patients with non-Hodgkin's lymphoma who were treated with combination chemotherapy including mitozantrone. In both we had radiological and histological evidence of interstitial lung disease, with patterns of organizing pneumonia and hypersensitivity without a clear aetiological agent. Clinical resolution occurred on withdrawal of chemotherapy. One patient required a course of corticosteroid treatment. To date, both patients are well and in remission, and there has been no recurrence of their respiratory disease. We postulate that these observations are hitherto undescribed pulmonary abnormalities secondary to mitozantrone therapy.- - - - - - - - - - ranking = 2keywords = lung (Clic here for more details about this article) |
9/400. Acute mercury vapour poisoning in a shipyard worker--a case report.Acute mercury vapour poisoning is a serious, potentially fatal but fortunately rarely encountered problem. It is most commonly due to industrial accidents. The vapour is a direct respiratory tract irritant as well as a cell poison, exerting its greatest effects in the lungs, nervous system, kidneys and liver. We present a case of mercury vapour poisoning in a shipyard workers presenting as an acute chemical pneumonitis, which resolved with aggressive supportive therapy. Further investigations later revealed transient mild neuropsychiatric symptoms, and residual peripheral neuropathy. No chelation therapy was instituted. The detailed investigative work that led to the discovery of the source of mercury is also presented. This case alerts us to the potential hazard to shipyard workers who may work in ships previously carrying oil contaminated with mercury. There have been no previous reports of mercury poisoning in shipyard workers. A high index of suspicion leading to early diagnosis and institution of appropriate supportive measures in suspected cases can be life-saving.- - - - - - - - - - ranking = 1keywords = lung (Clic here for more details about this article) |
10/400. Pyrofluid inhalation in "fire-eaters": sequential findings on CT.We report the sequential computed tomography (CT) findings in two fire-eaters after accidental inhalation of pyrofluid. The initial chest radiographic findings were ambiguous and the interpretation of the radiographs was biased by clinical history unrelated to fire eating. On CT, pneumatoceles were the major findings in both patients. The pneumatoceles resolved rapidly, leaving only minimal scarring. Our cases illustrate the sequential evolution of pneumatoceles in fire-eaters after the inhalation of pyrofluid and documents the rapidity with which the lesions regress. The rare accidental inhalation of pyrofluid in fire-eaters may produce a puzzling clinical and radiographic picture and can be confused with other lung disorders.- - - - - - - - - - ranking = 1keywords = lung (Clic here for more details about this article) |
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