Cases reported "Bronchiectasis"

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1/10. A resuscitated case from asphyxia by large bronchial cast.

    A 62-year-old woman with bronchiectasis suffered from asphyxia due to a large bronchial cast that obstructed the bronchial tree. Immediate bronchoscopic suction of a bronchial cast of 17 cm in length through the intubated tube relieved the patients without any complications. Large bronchial casts appear to be rare in this century but it should be considered in patients with acute exacerbation of excessive sputa not only in patients with asthma or allergy but also in patients with respiratory tract infection.
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2/10. Carcinoid tumourlets associated with diffuse bronchiectasis and intralobar sequestration.

    Innumerable carcinoid tumourlets may develop within pulmonary lobes should there be scarring from intralobar sequestration; these tumourlets may, in turn, be the cause of chronic lung disease. This report documents the incidental detection of multifocal carcinoid tumourlets in the lung of a 65-year-old man who had repeated episodes of lung infection, progressive dyspnea and haemoptysis; he lived at high altitude. The left lower lobe of the lung was resected surgically, during which procedure an aberrant systemic arterial supply was noticed. The patient had diffuse bronchiectasis and intralobar sequestration. The latter implies the development of abnormal lung tissue located within lobar tissue--but which does not communicate with the bronchial tree; it is supplied with arterial blood from a branch of the aorta--arising either above or below the diaphragm. There was loss of demarcation between the sequestered lung and the surrounding lower lobe lung parenchyma. The proliferation of pulmonary neuroendocrine cells in the form of tumourlets, had probably occurred as an adaptive response to the chronic hypoxia experienced. The combination of intralobar sequestration, bronchiectasis and carcinoid tumourlets, although uncommon, may arise when intralobar sequestration of the lung has not been resected at an incipient stage.
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3/10. Regression of bilateral bronchiectasis with inhaled steroid therapy.

    bronchiectasis is defined as pathological and permanent dilatation of the bronchial tree. Affected patients suffer from chronic sputum production and usually slowly progressive airway destruction as a result of continued airway infection and inflammation. Regression of bilateral bronchiectasis has never been reported in the English literature. We report the case of a 60-year-old woman with longstanding progressive idiopathic bilateral bronchiectasis whose respiratory symptoms, including sputum, rapidly disappeared after commencement of inhaled budesonide. Repeat computed tomography assessment 40 months after commencement of inhaled steroid therapy, showed partial regression of bronchial dilation and resolution of small airways sepsis. In the absence of other possible explanations for the partial resolution of the bronchiectasis, the present case suggests a possible benefit of inhaled steroid therapy in bronchiectasis.
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4/10. bronchiectasis simulating pulmonary metastases on iodine-131 scintigraphy in well-differentiated thyroid carcinoma.

    Differentiated thyroid cancer is an uncommon disease that carries a good prognosis when treated adequately. Radioiodine treatment is often used as an adjunct to surgery because this has been associated with increased survival, particularly in the presence of iodine-avid soft tissue metastases. Multiple different false-positive scans can occur in the absence of residual thyroid tissue or metastases. Recognition of these potential false-positive iodine-131 (I-131) scans is critical to avoid the unnecessary exposure to further radiation from repeated therapeutic doses of radioactive iodine. We report a case of physiological uptake of radioactive iodine in the bronchiectatic bronchial tree bilaterally, potentially masquerading as pulmonary metastases.
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5/10. CT bronchoscopy in the diagnosis of Williams-Campbell syndrome.

    Williams-Campbell syndrome, a rare disorder, is characterized by a congenital deficiency of cartilage, typically involving the fourth to the sixth order bronchi, and resulting in expiratory airway collapse and bronchiectasis. The authors report a patient with Williams-Campbell syndrome with type II respiratory failure due to extensive cystic bronchiectasis and secondary emphysema. CT of the thorax showed the affected bronchi had characteristic ballooning on inspiration and collapse on expiration. Three-dimensional images of the tracheobronchial tree were constructed from a volume of data acquired by thin-slice CT scanning. Apart from confirming expiratory collapse of the affected bronchi, these images revealed an absence of the cartilage ring impressions in the bronchial wall, extending bilaterally from the mainstem down to subsegmental bronchi, suggesting cartilage deficiency.
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6/10. Preoperative evaluation of bronchiectasis by computed tomography.

    A patient with known lingular bronchiectasis is presented for whom CT was used as the sole preoperative radiographic method to exclude disease in the remainder of the bronchial tree. The patient has remained symptom free for 12 months following lingulectomy. The potential of CT to obviate the need for bronchography in the preoperative staging of bronchiectasis is discussed.
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7/10. Grassheads in the tracheobronchial tree: two different outcomes.

    Many vegetable foreign bodies can produce serious pulmonary complications because of chemical irritation to the airway. Barley grass, a type of grasshead, does not induce such a reaction because of its resistance to organic decay. Complications which may occur are illustrated by the clinical course of two patients with aspiration of this foreign body. In the first patient the grasshead entered the trachea with the flowering unit first and the stem following. In the second patient the stem entered the trachea first. Recurrent pneumonias were noted in the first patient. Despite its presence in the right stem bronchus for three years, no further episodes of pneumonia followed its removal. In the second patient the grassheads could not be removed endoscopically. They migrated into the right lower lobe producing pneumonia and ultimately resulting in a brain abscess. The difference of entry of the same foreign body into the trachea, stem first versus flowering unit first, is an essential factor in altering the clinical outcome.
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8/10. Tracheobronchiomegaly: report of two cases with widely differing symptomatology.

    Two cases of tracheobronchiomegaly are reported to call attention to this disease. physicians must be mindful of this entity as another cause of recurring pneumonia which may be treatable. Various proposed etiologies for this syndrome are reviewed. The findings in and interpretation of our cases and those in the literature suggest that tracheobronchiomegaly is a congenital anomaly differing from others of the tracheobronchial tree because of its spectacular radiological appearance. The two following cases typify different presentations of this syndrome. One is largely asymptomatic; the other demonstrates super-infection of stagnant secretions, making the patient functionally bronchiectacic with progressive suppurative pulmonary destruction. The authors believe that aggressive management designed to mobilize airway secretions is indicated. There is usually no place for surgery in this disease beyond establishing the diagnosis.
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9/10. mortality following adenotonsillectomy in a patient with Williams-Campbell syndrome.

    Adenotonsillectomy is a commonly performed procedure that can greatly change airway pressure in patients with obstructive sleep patterns related to enlarged tonsils and adenoids. A case is presented in which a patient with a rare subclinical form of Williams-Campbell syndrome died after outpatient adenotonsillectomy. This case report illustrates how patients with structural abnormalities of the tracheobronchial tree can be at increased risk for complications when undergoing surgical procedures that impact airway dynamics.
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10/10. pulmonary artery band migration producing endobronchial obstruction.

    pulmonary artery banding is used in infants to temporarily control excessive pulmonary blood flow. There are reports of band migration including intact bands eroding through the pulmonary artery. The patient presented here had bronchiectasis and eventual destruction of his right middle and lower lobes 5 years after pulmonary artery banding and subsequent definitive cardiac corrective surgery. After undergoing a right middle and lower lobectomy, recurring postoperative respiratory distress prompted repeat bronchoscopy where the original pulmonary artery band was identified and removed. It is hypothesized that this band migrated through the pulmonary artery and into the tracheobronchial tree where it led to obstruction and subsequent destruction of the right middle and lower lobes. awareness of this potential complication is important for pediatric surgeons who so often care for patients with a past history of cardiac surgery.
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