Idiopathic bronchiolitis obliterans with organizing pneumonia presenting with spontaneous hydropneumothorax and solitary pulmonary nodule

The first case of idiopathic bronchiolitis obliterans with organizing pneumonia (BOOP) presenting as solitary pulmonary nodule with spontaneous hydropneumothorax is reported in a 54-year-old man. A wedge resection of the right lower lobe was performed to show typical histological features of BOOP. This case report demonstrates that BOOP has a very diverse clinical manifestation and stresses the need to include solitary pulmonary nodule with hydropneumothorax in the spectrum of BOOP.     

孤立性肺结节病变性质临床鉴别诊断预测模型的初探

目的探讨孤立性肺结节的良恶性鉴别诊断的有效方法。方法回顾性分析44例孤立性肺结节患者的临床特点,血清学指标及其鉴别诊断效果,并建立临床预测模型。结果44例肺内孤立性结节患者中,恶性肿瘤占19例,良性肿瘤占25例。单因素分析结果患者的年龄、结节大小、结节边界、肿瘤病史、CEA、CA125及miR．21、miR-27b和miR-193b在良恶性孤立性肺结节患者间具有显著差异,多因素判别分析并建立Fisher线性判别函数,交互验证一致函数与原始个案的符合率为93％。结论除患者的一般情况、影像学表现和常规血清标记物外,microRNAs也是鉴别孤立性肺结节良恶性的良好指标,具有重要临床意义。     

Pulmonary endarteritis and subsequent pulmonary embolism associated with clinically silent patent ductus arteriosus

A 49-year-old man without heart murmur was admitted with fever because of bacteremia following a tooth extraction. Antibiotics rapidly alleviated the fever; however, a small nodule in the pulmonary artery was identified on computed tomography (CT). When the patient experienced chest discomfort with fever, CT demonstrated the absence of the nodule and the appearance of an abnormal lung opacity, and echocardiography showed turbulent retrograde flow in the pulmonary artery. We had the rare opportunity to follow a case of pulmonary bacterial endarteritis and subsequent pulmonary embolism with clinically silent patent ductus arteriosus (PDA) that was confirmed by 3-dimensional CT.     

Mycobacterium abscessus pulmonary infection presenting as a solitary pulmonary nodule

Nontuberculous mycobacterial pulmonary infection is a rare cause of a solitary pulmonary nodule. All previously reported cases were caused by Mycobacterium avium complex, and a solitary pulmonary nodule caused by other NTM species has been very rarely reported. We describe the first case of Mycobacterium abscessus infection presenting as a solitary pulmonary nodule in a 51-year-old asymptomatic adult patient.     

Severe refractory hypoxaemia in submassive pulmonary embolism: a surrogate marker of severe right ventricular dysfunction and indication for thrombolysis

The role of thrombolysis in pulmonary thromboembolism is controversial. We describe a case of life-threatening acute pulmonary embolism where thrombolysis was successfully administered because of extreme refractory hypoxaemia. We suggest that profound refractory hypoxaemia in this clinical setting was due to the combination of severe right ventricular dysfunction and shunting from pulmonary infarction. The shunt was not likely to have resolved in the short term, but right ventricular function and hypoxaemia improved with clot lysis. Similar clinical presentations should prompt active consideration of thrombolysis.     

Sj?gren's syndrome with solitary nodular pulmonary amyloidosis]

We describe a case of limited pulmonary amyloidosis with Sj?gren syndrome. A 58-yr-old woman was referred to our hospital because of an abnormal chest radiograph (solitary small nodule) that was examined to investigate the cause of a persistent cough. A chest CT revealed a solitary small nodule in the left lower lung field. The specimens obtained by thoracoscopic surgery showed AL (kappa) amyloid deposits with lymphoplasmacytic infiltrate. Immunofixation of the serum and concentrated urine failed to demonstrate monoclonal immunoglobulins, and no amyloid deposits in the stomach were detected. She was subsequently diagnosed as having primary Sj?gren's syndrome. Nodular pulmonary amyloidosis with Sj?gren syndrome is very rare condition, and most cases present multiple nodules. As far as is known, this is the first report of a solitary nodule in pulmonary amyloidosis with Sj?gren syndrome.     

Solitary pulmonary nodule due to Mycobacterium fortuitum

We report the case of an asthmatic man in whom a solitary pulmonary nodule was discovered after an episode of self-limited hemoptysis. Infection was suspected after initial response to empirical antibiotic therapy, and the pathogen was later identified to be a rare mycobacterium. The pulmonary nodule resolved without surgery after oral quinolone therapy. Mycobacterium fortuitum should be added to the list of possible causes of solitary pulmonary nodule in Spain.     

Diagnostic approach to solitary pulmonary nodule

The solitary pulmonary nodule is a common radiologic abnormality that is often detected incidentally. Many malignant and benign diseases can present as a solitary pulmonary nodule on a chest roentgenogram. It is important to differentiate malignant nodules from benign nodules in the least invasive way and to make as specific and an accurate diagnosis as possible. In this paper, a diagnostic approach to the solitary pulmonary nodule was discussed.     

Case of recurrence of AA type primary solitary pulmonary amyloidosis]

The patient was a 64-year-old asymptomatic man. His chest X-ray film, at age 61, showed a solitary nodule in the right middle lobe. Thoracoscopic surgery was performed. The nodule was pathologically diagnosed as a solitary nodular amyloidosis. After 3 years, his chest CT showed a solitary nodule in the left upper lung. Thoracoscopic surgery for the pulmonary nodule was performed again, and it was also pathologically diagnosed as a solitary nodular amyloidosis with AA type amyloid protein. Solitary nodular pulmonary amyloidosis is usually AL type, and few cases of solitary AA type amyloidosis have been reported. We reported a rare case of recurrence of solitary pulmonary amyloidosis.     

Primary pulmonary meningioma manifesting as a solitary pulmonary nodule with a false-positive PET scan

Primary pulmonary meningioma is very rare, with about 30 cases reported in the English literature. These lesions are usually benign, grow slowly, and have an excellent prognosis. However, they can mimic any other pulmonary tumor, as the most common presentation is as a solitary pulmonary nodule. We report a case of a primary pulmonary meningioma manifesting as a solitary lung nodule with a very high metabolic activity on the positron emission tomography, mimicking a primary lung cancer.     

Causes and presenting features of pulmonary infarctions in 43 cases identified by surgical lung biopsy

BACKGROUND: Although pulmonary infarction is usually associated with pulmonary thromboembolism, it can occur with other disorders such as vasculitis, angioinvasive infections, sickle-cell disease, tumor embolism, and pulmonary torsion. STUDY OBJECTIVE: To identify causes and presenting features of pulmonary infarctions diagnosed by surgical biopsy in a consecutive series of patients encountered at a single institution. DESIGN: Retrospective review. SETTING: Tertiary care, referral medical center. PATIENTS: Forty-three patients with pulmonary infarction identified on surgical lung biopsy over a period of 7 years, January 1996 through December 2002. RESULTS: The median age of these 43 patients was 55 years (range, 22 to 85 years); 17 patients (40%) were women, and 26 patients (60%) were men. Thirty-five patients (81%) had a smoking history. Twenty-eight patients (65%) presented with solitary or multiple lung nodules/masses of undetermined etiology. The underlying cause was identifiable in 31 cases (72%) based on a review of clinical, laboratory, radiologic, and histopathologic data. The two most common causes were pulmonary thromboembolism (18 cases, 42%) and pulmonary infections (5 cases, 12%). Thromboembolic pulmonary infarctions typically presented as solitary or multiple nodules located in the subpleural regions. Other causes included diffuse alveolar damage in two cases (5%), pulmonary torsion in two cases (5%), and one case each of lung cancer, amyloidosis, embolotherapy, and catheter embolism. In 12 cases (28%), the underlying cause was not directly identifiable but was probably due to previous pulmonary thromboembolism. CONCLUSION: We conclude that although pulmonary thromboembolism is the most common cause of pulmonary infarction identified by surgical lung biopsy, a variety of other causes are clinically encountered, including infections, inflammatory or infiltrative lung diseases, pulmonary torsion, malignancy, and nonthrombotic embolism. Pulmonary infarction should be considered in the differential diagnosis of peripheral lung nodules or masses.     

Nodular pulmonary vasculitis in a twelve-year-old boy

A 12-year-old boy presented with left shoulder pain during physical exercise and complained of uncommon sweating and fatigue. Diagnostic evaluation revealed a solitary pulmonary nodule in the left upper lobe. All laboratory values were within normal limits, except for an elevated level of antineutrophil cytoplasmic antibodies directed against myeloperoxidase (p-ANCA). Surgery was performed, and pathological examination showed a localized granulomatous vasculitis. Antineutrophil cytoplasmic antibodies directed against affinity purified proteinase 3 (p-ANCA) concentrations returned to baseline within 6 months, and the patient has done well during a follow-up period of 2 years. While nodular vasculitis is known to occur in Wegener's granulomatosis, to the best of our knowledge, this case represents the first c-ANCA negative primary pulmonary vasculitis in childhood.     

Mycobacterium intracellulare pulmonary infection which co-existed and mimicked lung cancer

We report a case of Mycobacterium intracellulare (M. intracellulare) pulmonary infection with co-existing lung cancer and presenting as a solitary pulmonary nodule requiring differentiation from lung cancer. Computed tomography showed two nodules (20 mm) with spicula formation and pleural indentation on the right lower lobe of the lung (right S6 and S8). Transbronchial biopsies from the right S6 and S8 nodules revealed mycobacteriosis and adenocarcinoma, respectively. Thereafter, a right lower lobectomy was performed. Cases of pulmonary M. intracellulare disease with solitary nodule are rare. Moreover, M. intracellulare pulmonary infection with co-existing lung cancer is extremely rare.     

Pulmonary Mycobacterium avium disease with a solitary pulmonary nodule requiring differentiation from recurrence of pulmonary adenocarcinoma

A 56-year-old man with a past history of surgical resection of a primary pulmonary adenocarcinoma in the right upper lobe was admitted to our hospital because of a rapidly increasing solitary nodule (50x30 mm) in the right S5 followed on the chest computed tomography (CT) for three months. Although we suspected recurrence of the pulmonary adenocarcinoma and performed a CT-guided lung biopsy, we could not make a definite diagnosis. Therefore, to rule out recurrence of the primary pulmonary adenocarcinoma completely, a partial surgical resection of the right middle lobe was performed and a caseating epitheloid granuloma with acid-fast bacilli was found. As the causative pathogen, Mycobacterium avium complex (MAC) disease should be considered in the differential diagnosis of a rapidly increasing solitary nodule through this peculiar case of pulmonary MAC disease.     

Recurrence of pulmonary sclerosing hemangioma

A 57-year-old woman with a solitary nodule in the left lung underwent a wedge resection, which resulted in total removal of the tumor. Pathological examination confirmed it to be a pulmonary sclerosing hemangioma. The patient did not receive any postoperative adjuvant therapies. Ten years later, a nodule reappeared at the same site and another wedge resection was performed.Pathological examination once again confirmed the diagnosis of sclerosing hemangioma. However, the recurrence of pulmonary sclerosing hemangioma is very rare; thus, we report here on one clinical case in detail.     

A case of acute pulmonary embolism and acute myocardial infarction with suspected paradoxical embolism after laparoscopic surgery

Summary We describe the case of a 59-year-old Japanese man who had an acute pulmonary embolism in addition to acute myocardial infarction after a laparoscopic cholecystectomy. The posterior descending coronary artery was totally occluded, and direct percutaneous transluminal balloon angioplasty was performed. The pulmonary embolism was diagnosed by lung perfusion scanning and was treated with anticoagulant therapy. A patent foramen ovale and right-to-left atrial shunting of blood were detected by contrast transesophageal echocardiography. Paradoxical embolism is a rare complication of pulmonary embolism and may have been responsible for the acute myocardial infarction in our patient.     

A case of pulmonary Mycobacterium intracellulare infectious disease with a solitary pulmonary nodule in the peripheral lung field]

A 63-year-old woman was admitted to our hospital because of a solitary nodule (20 x 20 mm) in the right S3 which was first detected during a health examination. Because radiological findings for the nodule, such as pleural indentation and spicula on chest CT led us to suspect a pulmonary adenocarcinoma, we could not completely rule out lung cancer and performed a bronchoscopic examination on the third day after admission. However, no definite diagnosis could be made. Therefore, video-assisted thoracic surgery (VATS) was performed, and a caseating epitheloid granuloma with acid-fast bacilli was found. Initially, we administered antituberculous drugs for pulmonary tuberculoma, but then changed to combined chemotherapy using RFP, EB, CAM and SM after identification of Mycobacterium intracellulare by a culture test of resected tissue. We report a rare case with a solitary nodule caused by pulmonary Mycobacterium intracellulare infectious disease which is indicative of lung cancer.     

Streptokinase and heparin versus heparin alone in massive pulmonary embolism: A randomized controlled trial

To test the efficacy of thrombolytic therapy in massive pulmonary embolism, we conducted a prospective randomized controlled trial. Eight patients were randomized to receive either 1,500,000 IU of streptokinase in 1 hour through a peripheral vein followed by heparin or heparin alone. All patients had major risk factors for deep vein thrombosis (DVT) and were considered to have high clinical suspicion for pulmonary embolism (PE). At baseline all patients had a similar degree of systemic arterial hypotension, pulmonary arterial hypertension, and right ventricular dysfunction. The time of onset of cardiogenic shock in both groups was comparable (2.25 ±0.5 hours in the streptokinase group and 1.75 ±0.96 hours in the heparin group). The four patients who were randomized to streptokinase improved in the first hour after treatment, survived, and in 2 years of follow-up are without pulmonary arterial hypertension. All four patients treated with heparin alone died from 1 to 3 hours after arrival at the emergency room (p=0.02). Post-thrombolytic therapy the diagnosis of PE was sustained in the streptokinase group by high probability V/Q lung scans and proven DVT. A necropsy study performed in three patients in the heparin group showed massive pulmonary embolism and right ventricular myocardial infarction, without significant coronary arterial obstruction. The results indicate that thrombolytic therapy reduces the mortality rate of massive acute pulmonary embolism.     

多层螺旋CT和MR肺动脉成像诊断急性肺动脉栓塞的对比研究

目的探究多层螺旋CT肺动脉造影和MR肺动脉成像对急性肺动脉栓塞(PE)疾病的的诊断价值。方法对2014年1月~2015年1月我院临床诊断为急性肺栓塞病接受住院治疗的120例患者进行分组,分组依据为随机数字表法,分为采用多层螺旋CT肺动脉造影诊断的CT组和采用MR肺动脉成像诊断的MR组,每组60例,对两组的诊断价值进行比较。结果两组患者经过检查对PE的显示率均为100%,且两组患者栓子栓塞部位比例相当,无统计学差异(P0.05),PE的间接征象有马赛克征、心包积液、肺动脉高压、胸腔积液、肺段梗死、局限性肺纹理稀疏,两组患者具体征象无统计学差异(P0.05)。结论对急性肺动脉栓塞的患者采用MR肺动脉成像进行诊断较为方便,准确率也高,是一种简便、快捷、无创、有效的诊断方法,值得在临床上推广应用。     

Evaluation of the solitary pulmonary nodule

The solitary pulmonary nodule represents a common diagnostic challenge for clinicians. While most are benign, a significant number represent early, potentially curable lung cancers. With the increased utilisation of chest computed tomography, solitary pulmonary nodules are increasingly being identified and with lung cancer screening programmes now on the horizon globally, it is crucial clinicians are familiar with the evaluation and management of solitary pulmonary nodules. Through the evaluation of patient risk factors combined with computed tomography characteristics of solitary pulmonary nodules, including size, growth rate, margin characteristics, calcification, density and location; a clinician can assess the risk of malignancy. This article provides an up to date review of the imaging features of both benign and malignant solitary pulmonary nodules to assist in the identification of nodules that require histological confirmation or ongoing surveillance. In addition, we summarise the newly updated Fleischner Society Guidelines that provide clinicians with a framework for the evaluation and management of solitary pulmonary nodules.