Solitary pulmonary nodule—a case of peripheral adenocarcinoma with rapid metastasis

Currently, lung cancer has rapidly become the malignancy with the highest morbility and motality in China, with an overall 5-year survival rate of only 10-15%. Early diagnosis and surgical excision is critically important to increase the survival rate of patients with lung cancer and improve their prognosis. However, patients with early lung cancer often have no specific symptom or sign, manifest radiologically only as solitary pulmonary nodules (SPNs). Here we describe a patient presenting with SPN, which was confirmed to be lung adenocarcinoma with pleural metastasis 23 days later.KEYWORDS : Solitary pulmonary nodules (SPNs), adenocarcinoma, pleural metastasis, EGFR mutationsCurrently, an accepted definition of solitary pulmonary nodules (SPNs) is a single, clearly defined, radioopaque lesion in the lung surrounding entirely by air-containing lung tissue, in a diameter less than or equal to 3 cm, without atelectasis, hilar enlargement or pleural effusion (1,2). SPNs can be either benign or malignant. Their most common causes include infections and local inflammation. They often represent the lung malignancies, particularly small adenocarcinoma and bronchoalveolar carcinoma (

When to suspect pulmonary embolism in a patient with deep venous thrombosis?

The approach to take in trying to establish or disprove a diagnosis of pulmonary embolism in the presence of deep vein thrombosis is the subject of some controversy nowadays. Systematic perfusion lung scan can be proposed, given the mediocre specificity of the clinical symptoms of embolism or the high frequency of asymptomatic pulmonary embolism. This strategy, however, is not validated in terms of cost-efficacy. In practical terms, favourable evolution and the low rate of recurrent embolism observed with a well executed anticoagulant treatment pleads against systematic scintigraphy. Because of its moderate sensitivity, systematic echocardiography probably should not be an element of the assessment of asymptomatic pulmonary embolism. The advent of spiral CT scan in the management of such patients could however make it necessary to reconsider this position, by allowing complete venous and pulmonary examination in thrombo-embolic disease.     

The efficacy of tocilizumab in a patient with pulmonary arterial hypertension associated with Castleman’s disease

Castleman’s disease is a highly heterogeneous clinical-pathological entity that belongs to the lymphoproliferative disorders and is associated with pulmonary arterial hypertension (PAH) in some patients. It is linked to excessive immune stimulation by interleukin-6 (IL-6), which is also involved in the pathogenesis of PAH. A 31-year-old woman with Castleman’s disease demonstrated PAH characterized by severe right heart failure. Since she was resistant to various conventional therapies including steroids, prostacyclins, bosentan, and sildenafil, tocilizumab (anti-IL-6 receptor antibody) therapy was started. Her clinical course was followed for 6 months, with significant improvement without any adverse effect. This is the first reported case of use of tocilizumab in addition to steroids and conventional PAH therapy in a patient with PAH associated with Castleman’s disease.     

Combined disease with pulmonary arterial hypertension and pulmonary venous hypertension revealed after treatment of heart failure with preserved ejection fraction in a case with primary Sjögren syndrome

A 49-year-old woman with primary Sjögren syndrome initially developed pulmonary venous hypertension (PVH) due to heart failure with preserved ejection fraction. Endomyocardial biopsy specimens showed mild myocardial fibrosis. Pulmonary arterial hypertension (PAH) was revealed after the treatment with diuretics. During the treatment for PAH using upfront combination with pulmonary vasodilators and immunosuppressants, the patient developed combined disease with PAH and PVH. A careful hemodynamic assessment is necessary in such cases.     

Adjuvant interferon gamma in patients with drug – resistant pulmonary tuberculosis: a pilot study

Background  

Tuberculosis (TB) is increasing in the world and drug-resistant (DR) disease beckons new treatments.     

Bilateral pulmonary artery aneurysms with protein C and protein S deficiency in a patient with Behçet's disease

Beh?et's disease is a chronic inflammatory disorder of unknown aetiology, characterized by recurrent attacks. Pulmonary artery aneurysm is a rare but serious complication of Beh?et's disease. We describe a patient with Beh?et's disease and protein C and S deficiency who developed bilateral pulmonary artery aneurysms.     

Intralobar pulmonary sequestration (a nonentity?)

Intralobar pulmonary sequestration has generally been considered a congenital malformation in which an accessory lung bud develops, is enveloped by normal lung, and retains its systemic arterial supply. Also usually included in the "sequestration spectrum" are aberrant arteries to normal lung with either normal or anomalous venous connection. We reviewed all surgical pathology specimens and autopsies performed at Texas Children's Hospital from 1955 through 1984. There were 15 cases with an aberrant systemic artery to normal or abnormal lung. Nine were cases of structurally normal lung with an aberrant systemic artery, and five were cystic adenomatoid malformations with a systemic artery. In one older child some features of intralobar sequestration were present, but a major bronchial connection was retained. We propose that most intralobar sequestrations represent either cystic adenomatoid malformations that clinically are unrecognized until they become secondarily infected or developmentally normal lung supplied by a systemic artery.     

Diabetes insipidus presentation before renal and pulmonary features in a patient with Wegener’s granulomatosis

We report a case of a 47-year-old woman with Wegeners granulomatosis complicated by central diabetes insipidus. The patient had initially seronegative polyarthritis which mostly responded well to methotrexate and steroid therapy. Eight months later the patient suffered from polyuria and polydipsia. There were no abnormalities of the anterior pituitary hormones. MR images showed only loss of brightness of the posterior pituitary. Extensive evaluation of the patient revealed the presence of ANCA, in c-ANCA pattern and also PR3 positivity. Three months later findings of glomerulonephritis, as suggested by an active urine sediment and gradual proteinuria, and, finally, asymptomatic pulmonary nodules completed the clinical picture of Wegeners disease within 1 year. Renal biopsy showed crescent formation in two glomeruli, consistent with ANCA-related glomerulonephritis which showed pauci-immün depositions by direct immunofluorescence. Diabetes insipidus symptoms mostly regressed; renal and pulmonary findings completely disappeared with glucocorticoid and pulse cyclophosphamide treatment. These findings show that diabetes insipidus may rarely develop early in the disease process and ANCA positivity was directly indicative of Wegeners granulomatosis before the classic clinical signs of the disease.     

Transcatheter embolization of coronary to pulmonary artery fistula with coronary steal phenomenon—a case report

Percutaneous transcatheter closure technique of a coronary artery fistula with a coil was performed in a 32-year-old man who had stable angina pectoris and myocardial ischemia in thalium myocard scintigraphy. Complete closure of the fistula without any complications was confirmed by angiography after the procedure. Angina pectoris disappeared and thalium scintigraphy was normal after the transcatheter embolization of fistula.     

Is sitaxsentan a good therapeutic option for pulmonary arterial hypertension associated with connective tissue disease?

Agents that indiscriminately block endothelin receptors have been shown to cause moderate improvements in the outcomes of patients who have pulmonary arterial hypertension (PAH) as a complication of connective tissue disease (CTD). Girgis et al. investigated the effects of sitaxsentan, a selective endothelin receptor type A antagonist, in patients with CTD and comcomitant PAH. After 12 weeks of treatment, patients who received sitaxsentan showed more improvement from baseline compared with those receiving placebo in terms of exercise capacity, hemodynamics and physical-health-related quality of life. At the end of the extension study (median total follow-up 26 weeks), 16 of the 41 patients with CTD had an improvement of at least one New York Heart Association functional class compared with at the start of sitaxsentan therapy. The effects of sitaxsentan observed in the CTD group were comparable to those seen in the idiopathic PAH group. The authors concluded that treatment with sitaxsentan might be beneficial in patients with PAH associated with CTD.     

Idiopathic pulmonary fibrosis: a nervous cough?

Little is known about the mechanisms which generate cough in patients with diffuse parenchymal lung disease. This article outlines some of the possible mechanisms which cause cough in patients with idiopathic pulmonary fibrosis (IPF). It goes on to discuss what is currently known about the enhanced cough reflex which afflicts patients with this condition, and describes recent evidence for enhanced expression of neurotrophins in the lungs of these patients. Preliminary data indicating that corticosteroids can reduce the cough reflex response to capsaicin and substance P in IPF offer hope that more specific therapies may be developed in the future.     

Takayasu’s arteritis presenting with bilateral pulmonary granulomatosis

Takayasu’s arteritis (TA) is a vasculitis characterized by inflammation and obliteration of intermediate to large-size arteries. We report a case of Takayasu’s arteritis with a presentation of bilateral pulmonary nodular infiltrates in a 21-year-old man. An open-lung biopsy showed characteristic changes of extra-vascular granulomatosis. To our knowledge, this has not been described previously in the literature.