{"title":"Chest swelling with adenopathy: Don’t forget tuberculosis","authors":"Hanadi Abid, Sonia Toujani, Jamel Ammar, Adel Marghli, Leila Slim, Saoussen Hantous, Aida Ayadi, Agnès Hamzaoui","doi":"10.1016/j.rmedc.2010.04.001","DOIUrl":"https://doi.org/10.1016/j.rmedc.2010.04.001","url":null,"abstract":"<div><p>Tuberculosis (TB) of the chest wall is far less frequently encountered than pulmonary infection and represents between 1% and 2% of TB overall. We report the case of 24-year-old woman presented with a swelling on the right side of the chest, cervical and right supraclavicular adenopathy, anorexia and weight loss, over a period of 1 month. Chest computed tomography revealed an abscess in the right lateral chest wall. There were no pleuropulmonary or bone lesions. Biopsy of supraclavicular node showed nonspecific inflammatory lesions. Bacterial examination of needle aspiration biopsy specimen from the chest wall abscess disclosed <em>Staphylococcus aureus</em>. Despite adequate antibiotic, no improvement was obtained. After resection of the abscess, histopathological examination confirmed the diagnosis of tuberculosis and acid-fast bacilli grew on aspiration fluid. Tuberculosis infection should be considered if an infection process failed to respond to anti infectious agents.</p></div>","PeriodicalId":89478,"journal":{"name":"Respiratory medicine CME","volume":"4 1","pages":"Pages 47-49"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rmedc.2010.04.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137091595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
José Meireles, Sara Neves, Alexandra Castro, Margarida França
{"title":"Spontaneous pneumomediastinum revisited","authors":"José Meireles, Sara Neves, Alexandra Castro, Margarida França","doi":"10.1016/j.rmedc.2011.03.005","DOIUrl":"https://doi.org/10.1016/j.rmedc.2011.03.005","url":null,"abstract":"<div><p>Spontaneous pneumomediastinum is defined as free air within the mediastinum, not associated with trauma. Causes include exercise, drugs, asthma, vomiting, difficult labour and Valsalva maneuvers. It’s a rare, usually benign and self-limited condition, more prevalent in young males. The triad of thoracic pain, dyspnoea and subcutaneous emphysema is typical.</p><p>We report a case of a 23 year old man presenting to the emergency room complaining of odynophagia, thoracic pain and neck swelling. He had fever and productive purulent cough in the previous week. He had no abnormal findings but subcutaneous emphysema. We found a pneumomediastinum without pneumothorax, treated conservatively with complete resolution.</p><p>Although frightening, this condition usually has good prognosis without specific treatment, other than avoidance of the cause.</p></div>","PeriodicalId":89478,"journal":{"name":"Respiratory medicine CME","volume":"4 4","pages":"Pages 181-183"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rmedc.2011.03.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137226493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Pulmonary Erdheim-Chester disease: A response to predonisolone","authors":"Kumi Yoneda Nagahama , Takuo Hayashi , Tetsutaro Nagaoka , Ryota Kanemaru , Shinsaku Togo , Toshio Kumasaka , Toshimasa Uekusa , Kuniaki Seyama , Kazuhisa Takahashi","doi":"10.1016/j.rmedc.2010.08.002","DOIUrl":"https://doi.org/10.1016/j.rmedc.2010.08.002","url":null,"abstract":"<div><p>Erdheim-Chester disease (ECD) is a rare non-Langerhan’s cell histiocytosis of unknown origin, involving multiple organs. The patient with ECD described here is a 38-year-old man who was admitted to the hospital with dyspnea on exertion. His chest radiograph revealed a diffuse reticulonodular shadow. After the video-assisted thoracoscopic surgery was performed, he was diagnosed as having ECD. A brown eruption on his left temple, when tested by skin biopsy, proved to be ECD. No lesions other than these on the lung and skin were identified, and oral administration of predonisolone successfully treated both of them. Although recovery has followed the administration of predonisolone and chemotherapy for several patients with pulmonary ECD, this is the first report that predonisolone alone provided clinical and objective recovery from pulmonary ECD. This outcome indicates that, of all the many treatments tried for ECD, steroids may become the first-line therapy for pulmonary involvement.</p></div>","PeriodicalId":89478,"journal":{"name":"Respiratory medicine CME","volume":"4 2","pages":"Pages 81-84"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rmedc.2010.08.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137401430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Elevated D-dimer is not always pulmonary embolism","authors":"Vikas Pathak, Iliana Samara Hurtado Rendon, Padmini Muthyala","doi":"10.1016/j.rmedc.2010.05.006","DOIUrl":"https://doi.org/10.1016/j.rmedc.2010.05.006","url":null,"abstract":"<div><p>Serum D-dimer is elevated in several chest emergencies, including Acute Coronary Syndrome (ACS), Venous Thromboembolism (VTE) and Acute Aortic Dissection (AAD). Because of its simplicity and easy availability its use beyond the exclusion of VTE has grown in recent years. There is an increasing trend towards using the test to exclude AAD, where there are no other sensitive screening tests.</p><p>We present a patient suspected to have pulmonary embolism (PE) based on chest pain and elevated D-dimer, gets a computed tomography with angiogram (CTA) and turns out to have an AAD.</p></div>","PeriodicalId":89478,"journal":{"name":"Respiratory medicine CME","volume":"4 2","pages":"Pages 91-92"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rmedc.2010.05.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137401435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Emer Kelly, Catherine M. Greene, Tomas P. Carroll, Noel G. McElvaney, Shane J. O’Neill
{"title":"Alpha-1 antitrypsin deficiency","authors":"Emer Kelly, Catherine M. Greene, Tomas P. Carroll, Noel G. McElvaney, Shane J. O’Neill","doi":"10.1016/j.rmedc.2011.04.001","DOIUrl":"https://doi.org/10.1016/j.rmedc.2011.04.001","url":null,"abstract":"<div><h3>Objective</h3><p>To review the topic of alpha-1 antitrypsin (AAT) deficiency.</p></div><div><h3>Method</h3><p>Narrative literature review.</p></div><div><h3>Results</h3><p>Much work has been carried out on this condition with many questions being answered but still further questions remain.</p></div><div><h3>Discussion and conclusions</h3><p>AAT deficiency is an autosomal co-dominantly inherited disease which affects the lungs and liver predominantly. The clinical manifestations, prevalence, genetics, molecular pathophysiology, screening and treatment recommendations are summarised in this review.</p></div>","PeriodicalId":89478,"journal":{"name":"Respiratory medicine CME","volume":"4 1","pages":"Pages 1-8"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rmedc.2011.04.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"92013239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"An unusual case of hoarseness of voice related to corticosteroid treatment","authors":"R. Naseer, L.J. Buck, M. Small, M. Munavvar","doi":"10.1016/j.rmedc.2011.03.008","DOIUrl":"https://doi.org/10.1016/j.rmedc.2011.03.008","url":null,"abstract":"<div><p>Invasive aspergillus infection of the larynx is extremely rare. This report describes the case of a 56-year-old lady with Chronic Obstructive Pulmonary Disease receiving long-term inhaled corticosteroids who presented with a four-week history of progressive hoarseness, dyspnoea and cough. Sputum cultures at the time isolated <em>Aspergillus fumigatus</em>. She was commenced on a trial of Itraconazole for presumed Allergic Bronchopulmonary Aspergillosis. Due to the duration and nature of her symptoms, vocal cord biopsies were taken which revealed abundant colonies of the fungus <em>A.</em> <em>fumigatus</em> infiltrating skeletal muscle. Inhaled corticosteroids were discontinued and the patient was switched to voriconazole. She continues to make a protracted recovery and is being closely monitored.</p></div>","PeriodicalId":89478,"journal":{"name":"Respiratory medicine CME","volume":"4 4","pages":"Pages 170-171"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rmedc.2011.03.008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137225860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Qureshi Zeeshan, Ramadass Satya, Radhika J. Satya, Jacob P. Pickering, Nabeel Qureshi
{"title":"Recurrent pneumonia due to esophageal migration of the gastrostomy MIC-Key tube remnant causing proximal esophageal obstruction","authors":"Qureshi Zeeshan, Ramadass Satya, Radhika J. Satya, Jacob P. Pickering, Nabeel Qureshi","doi":"10.1016/j.rmedc.2011.03.002","DOIUrl":"https://doi.org/10.1016/j.rmedc.2011.03.002","url":null,"abstract":"<div><p>A 16 years old female with history of cerebral palsy, juvenile rheumatoid arthritis and severe scoliosis presents for recurrent pneumonia. Multiple prior plain films demonstrate progressive increased consolidation confined to the left lower lobe. Subsequently, a CT of the chest was preformed which showed a plastic gastrostomy (MIC-Key tube) bumper in the proximal esophagus causing severe tracheal narrowing. The patient underwent endoscopic removal of the gastrostomy bumper without incident.</p></div>","PeriodicalId":89478,"journal":{"name":"Respiratory medicine CME","volume":"4 4","pages":"Pages 193-195"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rmedc.2011.03.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137225888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ramadass Satya, Arya Bagherpour, Melanie Christofferson, Radhika J. Satya
{"title":"Large saddle pulmonary embolism in patient with previously placed IVC filter: A case report of successful Angiojet thrombectomy","authors":"Ramadass Satya, Arya Bagherpour, Melanie Christofferson, Radhika J. Satya","doi":"10.1016/j.rmedc.2010.11.005","DOIUrl":"https://doi.org/10.1016/j.rmedc.2010.11.005","url":null,"abstract":"<div><p>Saddle pulmonary embolisms are life threatening and are uncommon after IVC filter placement. Management of PE is difficult, and emergent thrombolysis is sometimes the only option left if the patient is hemodynamically unstable. We present a rare case of an acute saddle pulmonary embolism in a patient with an intact infrarenal IVC filter presenting with hemodynamic instability.</p></div>","PeriodicalId":89478,"journal":{"name":"Respiratory medicine CME","volume":"4 3","pages":"Pages 133-135"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rmedc.2010.11.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137088771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Moreland, K. Kijsirichareanchai, R. Alalawi, K. Nugent
{"title":"Pulmonary alveolar proteinosis in a man with prolonged cotton dust exposure","authors":"A. Moreland, K. Kijsirichareanchai, R. Alalawi, K. Nugent","doi":"10.1016/j.rmedc.2011.01.003","DOIUrl":"https://doi.org/10.1016/j.rmedc.2011.01.003","url":null,"abstract":"<div><p>A 59-year-old man presented with severe paroxysms of cough associated with dyspnea. His CT scan showed diffuse bilateral ground glass opacifications. His bronchoalveolar lavage fluid was consistent with pulmonary alveolar proteinosis. Transbronchial biopsy, microbiological studies, and cytology did not identify any alternative diagnosis. The patient had a history of working as a textile loom technician for thirty-one years and had significant exposure to cotton dust. He responded well to whole lung lavage with improvement of symptoms, gas exchange, and CT scan. This patient represents the third reported case of pulmonary alveolar proteinosis associated with cotton dust exposure. We suggest that cellulose might be useful in animal models of pulmonary alveolar proteinosis.</p></div>","PeriodicalId":89478,"journal":{"name":"Respiratory medicine CME","volume":"4 3","pages":"Pages 121-123"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rmedc.2011.01.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137088775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Daniel Smith , David Reid , Richard Slaughter , Philip Masel , Anna Tai , Scott Bell
{"title":"Superior vena cava obstruction due to total implantable venous access devices in cystic fibrosis: Case series and review","authors":"Daniel Smith , David Reid , Richard Slaughter , Philip Masel , Anna Tai , Scott Bell","doi":"10.1016/j.rmedc.2010.12.005","DOIUrl":"https://doi.org/10.1016/j.rmedc.2010.12.005","url":null,"abstract":"<div><p>As the life expectancy of patients with cystic fibrosis (CF) improves, treatment related morbidity is increasingly recognised. Totally implantable venous access devices (TIVADs) offer reliable long term central venous access but are associated with recognised complications including venous thrombosis. Superior vena cava obstruction (SVCO) however has been rarely reported in this setting. We report a single CF centre’s experience of SVCO associated with TIVADs in patients with CF, followed by a review of the published literature on risk factors, preventative strategies and treatment approaches.</p></div>","PeriodicalId":89478,"journal":{"name":"Respiratory medicine CME","volume":"4 3","pages":"Pages 99-104"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rmedc.2010.12.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137088781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}