Case Reports in Pulmonology The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Pulmonary Mycobacterium kansasii Infection Mimicking Malignancy on the 18F-FDG PET Scan in a Patient Receiving Etanercept: A Case Report and Literature Review Mon, 20 Oct 2014 06:41:42 +0000 A 66-year-old male presented with chest pain, malaise, generalized weakness, and weight loss. He had been receiving etanercept injection for rheumatoid arthritis. Chest X-ray revealed a right upper lobe mass. Chest computed tomography (CT) showed a right apical mass, highly suggestive of a Pancoast tumor. The thoracic fluorine-18 fluoro-deoxy-glucose (18F-FDG) positron emission tomography (PET) scan demonstrated significantly high metabolic pulmonary lesions with the standardized uptake value (SUV) of 12.5, consistent with lung cancer. The patient underwent bronchoscopy and bronchoalveolar lavage (BAL). BAL cytology was negative for malignant cells. BAL acid fast bacilli (AFB) smears were positive, and Mycobacterium kansasii was eventually isolated. He received a 12-month course of rifampin, isoniazid, and ethambutol. Interval resolution of pulmonary lesions was noted on follow-up serial CT chest studies. There has been increasing incidence of nontuberculous mycobacterial infections reported in patients treated with the antitumor necrosis factor-alpha (anti-TNF-alpha) agents. Infectious foci have an increased glucose metabolism which potentially causes a high FDG uptake on the 18F-FDG PET scan, leading to undue anxiety and cost to the patients. This is the first reported case of pulmonary M. kansasii infection with a positive thoracic 18F-FDG PET study mimicking malignancy in a patient on etanercept. Zaw Min and Mohan Amlani Copyright © 2014 Zaw Min and Mohan Amlani. All rights reserved. Multicentric Spinal Tuberculosis with Sternoclavicular Joint Involvement: A Rare Presentation Mon, 20 Oct 2014 00:00:00 +0000 Background. Tuberculosis is a chronic disease which may have varied presentations. Though pulmonary tuberculosis is the commonest, extrapulmonary tuberculosis involving skeletal system is often seen. Individuals with poor nourishment and immunological status are especially susceptible for disseminated and multicentric tuberculosis. Case Report. We here present a case of tuberculosis involving multiple anatomical locations in an immune-competent patient which was diagnosed with radiological studies and confirmed with histological examination. Patient was put on multidrug antitubercular therapy and responded well to the treatment with improvement in clinical and radiological picture. Clinical Relevance. This report of a rare case makes us aware of the varied presentations which tuberculosis can present with. It should be kept as a differential diagnosis in patients with cough and fever but not responding to conventional treatment. This is even more important in countries with poor socioeconomic conditions. Balaji Saibaba, Umesh Kumar Meena, Prateek Behera, and Ramesh Chand Meena Copyright © 2014 Balaji Saibaba et al. All rights reserved. Lipoid Pneumonia in a Gas Station Attendant Wed, 08 Oct 2014 08:33:15 +0000 The exogenous lipoid pneumonia, uncommon in adults, is the result of the inhalation and/or aspiration of lipid material into the tracheobronchial tree. This is often confused with bacterial pneumonia and pulmonary tuberculosis due to a nonspecific clinical and radiologic picture. It presents acutely or chronically and may result in pulmonary fibrosis. We describe here a case of lipoid pneumonia in a gas station attendant who siphoned gasoline to fill motorcycles; he was hospitalized due to presenting with a respiratory infection that was hard to resolve. The patient underwent bronchoscopy with bronchoalveolar lavage, which, on cytochemical (oil red O) evaluation, was slightly positive for lipid material in the foamy cytoplasm of alveolar macrophages. Due to his occupational history and radiographic abnormalities suggestive of lipoid pneumonia, a lung biopsy was performed to confirm the diagnosis. The patient was serially treated with segmental lung lavage and showed clinical, functional, and radiological improvement. Gladis Isabel Yampara Guarachi, Valeria Barbosa Moreira, Angela Santos Ferreira, Selma M. De A. Sias, Cristovão C. Rodrigues, and Graça Helena M. do C. Teixeira Copyright © 2014 Gladis Isabel Yampara Guarachi et al. All rights reserved. Dual Primary Malignancy: A Rare Organ Combination Tue, 07 Oct 2014 09:12:48 +0000 A 63-year-old female smoker was evaluated for lump over the right breast, fine needle aspiration cytology of which showed infiltrating ductal carcinoma. Investigations also revealed the presence of left upper lobe mass lesion, the biopsy of which suggested small cell carcinoma. The existence of two malignancies having different histopathologies at anatomically distinct sites suggests the diagnosis of dual primary malignancy involving the breast and the lung which, being a rare combination, prompted us to report the case. Preetam Acharya, Anand Ramakrishna, Tanuj Kanchan, and Rahul Magazine Copyright © 2014 Preetam Acharya et al. All rights reserved. Goodpasture’s Syndrome and p-ANCA Associated Vasculitis in a Patient of Silicosiderosis: An Unusual Association Thu, 02 Oct 2014 13:36:08 +0000 Introduction. Goodpasture’s syndrome is a rare clinical entity and is characterized by circulating autoantibodies which are principally directed against the glomerular/alveolar basement membrane. The etiology of Goodpasture’s syndrome is still unknown. Lung involvement occurs as a result of lung injury and the exposure of new epitopes to the immune system. Recently, several studies have suggested the role of silica as one of etiological factors in ANCA associated vasculitis and glomerulonephritis. Materials and Methods. We present a case of a 40-year-old welder with silicosiderosis, who developed anti-GBM disease with p-ANCA positivity. Case Report. Patient presented to an emergency with gradually increasing breathlessness along with renal failure and died after short hospital stay. Autopsy pathology findings revealed crescentic glomerulonephritis with linear glomerular basement membrane antibody deposition, splenic vasculitis, pulmonary haemorrhage, and pulmonary silicosiderosis. Conclusion. This case reinforces the role of environmental triggers like exposure to silica, metal dust, and tobacco in pathogenesis of Goodpasture’s syndrome and p-ANCA associated vasculitis. Amanjit Bal, Ashim Das, Dheeraj Gupta, and Mandeep Garg Copyright © 2014 Amanjit Bal et al. All rights reserved. Sclerosing Xanthofibroma of the Rib That Mimics a Very Aggressive Malignant Tumor of the Thoracic Wall Tue, 23 Sep 2014 07:22:05 +0000 Sclerosing xanthofibroma is a benign lesion generally of flat bones that is thought to be caused by a reactive response to intramedullary hemorrhage following chest wall trauma. We are reporting a case of a 56-year-old man that was complaining of a dump pain on the right back and a swelling right in this place for several weeks. The radiology was suggesting an aggressive malignant tumor of the chest wall and probably metastasis in both lungs meanwhile the patient was in good state and very active. The surgery was decisive for the diagnosis that, to the fortune of the patient, it was sclerosing xanthofibroma. F. Caushi, D. Xhemalaj, I. Bani, I. Skenduli, B. Gega, H. Hafizi, and A. Mezini Copyright © 2014 F. Caushi et al. All rights reserved. Aspiration of Barium Contrast Sun, 21 Sep 2014 11:40:54 +0000 The aspiration of barium contrast is a rare complication that may occur during studies of the digestive tract. Barium is an inert material that can cause anywhere from an asymptomatic mechanical obstruction to serious symptoms of respiratory distress that can result in patient death. We present the case of a 79-year-old male patient in whom we observed the presence of contrast medium residue in the lung parenchyma as an incidental finding during hospitalization. When the patient’s medical file was reviewed, images were found of a barium swallow study that the patient had undergone months earlier, and we were able to observe the exact moment of the aspiration of the contrast material. The patient had been asymptomatic since the test. Cristina Fuentes Santos and Bárbara Steen Copyright © 2014 Cristina Fuentes Santos and Bárbara Steen. All rights reserved. Pancoast’s Syndrome due to Fungal Abscess in the Apex of Lung in an Immunocompetent Individual: A Case Report and Review of the Literature Thu, 11 Sep 2014 06:04:46 +0000 Malignant tumours in the apices of the lungs, especially bronchogenic carcinoma (Pancoast tumours), are the most common cause of Pancoast’ syndrome which presents with shoulder or arm pain radiating along the medial aspect of forearm and weakness of small muscles of hand with wasting of hypothenar eminence due to neoplastic involvement of C8 and T1 and T2 nerve roots of brachial plexus. There are a number of benign conditions which may lead to Pancoast’s syndrome; fungal abscess located in the apex of lung is one of them. Oral or intravenous antifungals are the treatment of choice in this case and complete recovery is usual, whereas, surgical resection followed by chemoradiotherapy is the treatment of choice in case of Pancoast’s syndrome due to lung cancers. Hence, tissue diagnosis is mandatory. Here, we report a case of apical fungal abscess causing Pancoast’s syndrome in an immunocompetent individual of 35 years of age to raise the awareness among the clinicians regarding this rare clinical entity. Anirban Das, Sabyasachi Choudhury, Sumitra Basuthakur, Sibes Kumar Das, and Angshuman Mukhopadhyay Copyright © 2014 Anirban Das et al. All rights reserved. Primary Tubercular Chest Wall Abscess in a Young Immunocompetent Male Wed, 10 Sep 2014 06:27:16 +0000 Chest wall tuberculosis is a rare entity especially in an immunocompetent patient. Infection may result from direct inoculation of the organisms or hematogenous spread from some underlying pathology. Infected lymph nodes may also transfer the bacilli through lymphatic route. Chest wall tuberculosis may resemble a pyogenic abscess or tumour and entertaining the possibility of tubercular etiology remains a clinical challenge unless there are compelling reasons of suspicion. In tuberculosis endemic countries like India, all the abscesses indolent to routine treatment need investigation to rule out mycobacterial causes. We present here a case of chest wall tuberculosis where infection was localized to skin only and, in the absence of any evidence of specific site, it appears to be a case of primary involvement. Shweta Sharma, R. K. Mahajan, V. P. Myneedu, B. B. Sharma, and Nandini Duggal Copyright © 2014 Shweta Sharma et al. All rights reserved. Eradication of Burkholderia cepacia Using Inhaled Aztreonam Lysine in Two Patients with Bronchiectasis Tue, 09 Sep 2014 05:31:14 +0000 There are not many articles about the chronic bronchial infection/colonization in patients with underlying lung disease other than cystic fibrosis (CF), especially with non-CF bronchiectasis (NCFBQ). The prevalence of B. cepacia complex is not well known in NCFBQ. The vast majority of published clinical data on Burkholderia infection in individuals with CF is comprised of uncontrolled, anecdotal, and/or single center experiences, and no consensus has emerged regarding treatment. We present two cases diagnosed with bronchiectasis (BQ) of different etiology, with early pulmonary infection by B. cepacia complex, which was eradicated with inhaled aztreonam lysine. A. Iglesias, I. Artiles, J. J. Cabanillas, R. Álvarez-Sala, and C. Prados Copyright © 2014 A. Iglesias et al. All rights reserved. Tracheomalacia Treatment Using a Large-Diameter, Custom-Made Airway Stent in a Case with Mounier-Kuhn Syndrome Mon, 08 Sep 2014 12:01:48 +0000 Mounier-Kuhn Syndrome (MKS) is a rare congenital disease that presents with abnormal enlargement in the central airways. In MKS, tracheomegaly is accompanied by difficulty in expelling recurrent lung infections and bronchiectasia. We presented a patient with MKS where commercially made stents were inadequate for stabilization and a custom-made, self-expandable metallic stent with a diameter of 28 mm and length of 100 mm was used. Chest pain that was thought to develop due to the stent and that disappeared after stent removal may be considered the main complication leading to stent removal. Continuous positive airway pressure therapy (CPAP) therapy was planned for the control of symptoms, which re-emerged after stent removal. This case is presented as an example that complications developing due to the stent as well as patient noncompliance may lead to stent removal, even when useful results are obtained from treatment of MKS. Cengiz Özdemir, Sinem Nedime Sökücü, Levent Karasulu, Sedat Altın, and Levent Dalar Copyright © 2014 Cengiz Özdemir et al. All rights reserved. Tracheal Penetration and Tracheoesophageal Fistula Caused by an Esophageal Self-Expanding Metallic Stent Wed, 03 Sep 2014 06:19:55 +0000 Tracheal penetration of esophageal self-expanding metallic stents (SEMS) with/without tracheoesophageal fistula (TEF) formation is a rare occurrence. We report the case of a 66-year-old female patient with advanced esophageal squamous cell carcinoma who had undergone palliative esophageal stenting on three occasions for recurrent esophageal stent obstruction. On evaluation of symptoms of breathing difficulty and aspiration following third esophageal stent placement, tracheal erosion and TEF formation due to the tracheal penetration by esophageal stent were diagnosed. The patient was successfully managed by covered tracheal SEMS placement under flexible bronchoscopy. Karan Madan, Arun Venuthurimilli, Vineet Ahuja, Vijay Hadda, Anant Mohan, and Randeep Guleria Copyright © 2014 Karan Madan et al. All rights reserved. Radiation Pneumonitis after Radiotherapy of Neck Lymphoma Thu, 28 Aug 2014 12:41:48 +0000 Radiotherapy is still one of the effective means for treatment of malignant tumors up to now. Particularly, it is an indispensable effective measure for treatment of some lymphoma patients. In routine work, radiation pneumonitis (RP) is the most significant complication of acute treatment-related toxicities in lung cancer; however, serious radioactive pneumonia is rare for the radiotherapy of neck lymphoma because the volume of the lungs affected by radiation dose was very small. We report a lymphoma case, where the patient had undergone radiotherapy for the bilateral neck and bilateral supraclavicular/infraclavicular area. Following completion of radiotherapy, the patient developed severe radiation pneumonitis. Min Wei, Jun Cai, Tao Tong, Shihua Yu, Yonghua Yang, Weijia Zhang, and Jiyuan Yang Copyright © 2014 Min Wei et al. All rights reserved. The Management of Near-Fatal Hemoptysis with Left Secondary Carinal Y Stent Wed, 27 Aug 2014 11:59:59 +0000 Massive hemoptysis can be a life threatening condition and needs urgent treatment in lung cancer. In the fiberoptic bronchoscopy of a fifty-two-year-old who was admitted with hemoptysis, left upper lobe upper division orifice was seen totally obstructed with a submucosal infiltration. One hour after the mucosal biopsies, massive hemoptysis occurred. Urgent rigid bronchoscopy was performed. The left main bronchus was occluded by sterile gauze. After cleaning of the coagulum patient was intubated and charged to intensive care unit. The next day, rigid bronchoscopy was repeated and the bleeding was observed to continue from the left upper lobe. Removing the gauze, 14 × 10 × 10 mm silicon Y stent was inserted in the left main bronchus after adjustments were made. Bleeding was stopped after insertion of the stent and patient could be extubated. In this case a successful control of hemoptysis was sustained after insertion of a customized silicon stent was presented. Levent Dalar, Cengiz Özdemir, Sinem Sökücü, Levent Karasulu, and Sedat Altın Copyright © 2014 Levent Dalar et al. All rights reserved. Malignant Extra Renal Rhabdoid Tumour Presenting as Central Airway Obstruction Wed, 27 Aug 2014 08:14:42 +0000 Rhabdoid tumours are one of the most aggressive childhood neoplasms associated with high mortality. The commonest age group affected is children less than five years of age. Rhabdoid tumour presenting as an endoluminal tracheal mass leading to central airway obstruction has not been previously reported. We describe the case of a 17-year-old male patient where malignant rhabdoid tumour masqueraded as bronchial asthma leading to a delayed diagnosis of upper airway obstruction by tracheal growth. Histopathological examination and immunohistochemistry confirmed the diagnosis of malignant rhabdoid tumour. Karan Madan, Amanjit Bal, Ritesh Agarwal, and Ashim Das Copyright © 2014 Karan Madan et al. All rights reserved. Endobronchial Tuberculosis: Two Case Reports and Review of the Literature Mon, 18 Aug 2014 12:37:55 +0000 Endobronchial tuberculosis commonly affects young patients and presents as acute or insidious onset cough, wheeze, low grade fever, and constitutional symptoms. Although endobronchial lesions usually result in sputum positivity for acid fast bacilli (AFB), a false negative sputum or absence of radiological lesions may result in delayed diagnosis. On the other hand, sputum positivity with presence of signs on chest radiology may lead to consideration of parenchymal TB as the primary diagnosis and the coexistence of endobronchial lesions may be missed until sequelae of the latter ensue. Besides, in elderly patients, consideration of other differentials like malignancy and pneumonia may lead to misdiagnosis. Hence, bronchoscopy is essential for confirmation of endobronchial TB. We hereby report two cases of endobronchial TB which stress the importance of bronchoscopic diagnosis for timely institution of treatment and prevention of permanent sequelae, respectively. Anshum Aneja, Uma Maheswari Krishnaswamy, Vijayashree Thyagaraj, Riyaz P. Moideen, and Mantha Satya Padmaja Copyright © 2014 Anshum Aneja et al. All rights reserved. An Osteolytic Metastasis of Humerus from an Asymptomatic Squamous Cell Carcinoma of Lung: A Rare Clinical Entity Tue, 12 Aug 2014 09:24:05 +0000 Advanced lung cancer is complicated by skeletal metastases either due to direct extension from adjacent primaries or, more commonly, due to haematogenous dissemination of neoplastic cells. Lumber spine is the most common site for bony metastases in bronchogenic carcinoma. Proximal lone bones, especially humerus, are unusual sites for metastases from lung primaries. Small cell and large cell varieties of lung cancer are most commonly associated with skeletal dissemination. It is also unusual that an asymptomatic squamous cell carcinoma of lung presents with painful, soft tissue swelling with osteolytic metastasis of humerus which is reported in our case. Systemic cytotoxic chemotherapy, local palliative radiotherapy, adequate analgesia, and internal fixation of the affected long bone are different modalities of treatment in this advanced stage of disease. But the prognosis is definitely poor in this stage IV disease. Anirban Das, Sudipta Pandit, Sibes k. Das, Sumitra Basuthakur, and Somnath Das Copyright © 2014 Anirban Das et al. All rights reserved. Tracheobronchial Foreign Body Aspiration: Dental Prosthesis Mon, 04 Aug 2014 10:39:29 +0000 It is important to extract foreign bodies for avoiding life-threatening complications. They can lead to death if they are not treated. Different signs and symptoms could occur according to the complete or partial airway obstruction. Foreign body aspiration is a rare incident in adults. The organic foreign materials such as foods are found to be aspirated more commonly and are usually settled in the right bronchial system. However, dental prosthesis and teeth aspirations are rare in literature. In our study, a 52-year-old male patient who had aspirated the front part of his lower dental prosthesis accidentally is presented and the foreign body is extracted by using rigid bronchoscopy. There are many causes of aspiration but dental prosthetic aspirations should be kept in mind during sleep. For this reason, dental apparatus must be taken out while asleep. Ataman Köse, Dilek Kostak, Erol Aramagan, Aslıhan Durak, Nur Sezin Seçkin, Serdar Süha Dönmez, and Hüseyin Melek Copyright © 2014 Ataman Köse et al. All rights reserved. Radiographically Severe but Clinically Mild Reexpansion Pulmonary Edema following Decompression of a Spontaneous Pneumothorax Sun, 03 Aug 2014 11:42:21 +0000 The case is a 48-year-old female who presented with mild dyspnea on exertion and cough with unremarkable vital signs and was found to have a large right sided pneumothorax. She underwent small bore chest tube decompression with immediate reexpansion of the collapsed lung. However, she rapidly developed moderate hypoxemia and radiographic evidence of reexpansion pulmonary edema (REPE) on both the treated and contralateral sides. Within a week, she had a normal chest X-ray and was asymptomatic. This case describes a rare complication of spontaneous pneumothorax and highlights the lack of correlation between symptoms, sequelae, and radiographic severity of pneumothorax and reexpansion pulmonary edema. Proposed pathophysiologic mechanisms include increased production of reactive oxygen species with subsequent loss of surfactant and increased vascular permeability, and loss of vasoregulatory tone. William E. Harner and Eric A. Crawley Copyright © 2014 William E. Harner and Eric A. Crawley. All rights reserved. Primary Pulmonary Synovial Sarcoma: A Very Rare Presentation Sun, 03 Aug 2014 08:51:25 +0000 Synovial sarcoma (SS) is a rare tumor originating from mesenchymal tissue and accounting for approximately 5–10% of all soft tissue sarcomas. A rare case of primary pulmonary SS in an asymptomatic 18-year-old man admitted to our hospital for investigation of a 6 × 6.5 cm, oval-shaped, well-delineated pleural based peripheral mass in the left lower lobe in his thorax CT is presented. Left lower lobectomy was done. Immunohistochemically, tumor cells were positive for cytokeratin, epithelial membrane antigen (EMA), and vimentin so that the histopathological diagnosis was compatible with biphasic spindle cell type SS in the lung. Ekrem Cengiz Seyhan, Sinem Nedime Sokucu, Gulsah Gunluoglu, Nurdan Simsek Veske, and Sedat Altin Copyright © 2014 Ekrem Cengiz Seyhan et al. All rights reserved. High-Flow Nasal Cannula Therapy in a Patient with Reperfusion Pulmonary Edema following Percutaneous Transluminal Pulmonary Angioplasty Tue, 15 Jul 2014 00:00:00 +0000 A 62-year-old woman with Wolff-Parkinson-White syndrome was with recent worsening of dyspnea to New York Heart Association functional status Class III. The patient was diagnosed as having central type chronic thromboembolic pulmonary hypertension. By cardiac catheterization, her mean pulmonary artery pressure was 53 mmHg with total pulmonary resistance 2238 dynesseccm−5. After medical therapies with tadalafil, furosemide, ambrisentan, beraprost, and warfarin were initiated, percutaneous transluminal pulmonary angioplasty (PTPA) was performed. Following PTPA, life-threating hypoxemia resulting from postoperative reperfusion pulmonary edema developed. High-flow nasal cannula therapy (HFNC) was applied, and 100% oxygen at 50 L/min of flow was required to keep oxygenation. HFNC was continued for 3 days, and the patient was discharged on 8th postoperative day with SpO2 of 97% on 3 L/min of oxygen inhalation. Because of the simplicity of the technique, the lower cost of equipment, and remarkable patient tolerance to the treatment, we speculate that HFNC can take over the post of noninvasive ventilation as first-line therapy for patients with acute respiratory failure. Kiyoshi Moriyama, Toru Satoh, Akira Motoyasu, Tomoki Kohyama, Mariko Kotani, Riichiro Kanai, Tadao Ando, and Tomoko Yorozu Copyright © 2014 Kiyoshi Moriyama et al. All rights reserved. Sarcoidosis Incidentally Diagnosed: A Case Report Tue, 08 Jul 2014 00:00:00 +0000 Sarcoidosis is a chronic, granulomatous condition with unknown cause. Because most of the patients are free of clinical symptoms, sarcoidosis should be considered in differential diagnosis if noncaseous granuloma is noted in biopsies, performed for other reasons. With no clinical symptoms, our patient was diagnosed with sarcoidosis upon identifying noncaseous granuloma in the lymph node biopsy material collected during the laparoscopic operation, performed for gallbladder polyp. Besir Kesici, Ahmet Burak Toros, Levent Bayraktar, and Adem Dervisoglu Copyright © 2014 Besir Kesici et al. All rights reserved. Endobronchial Lipomatous Polyp: A Rare Benign Tumor of the Lung Sun, 25 May 2014 08:26:57 +0000 Endobronchial lipomatous polyp is a rare nonmalignant tumor of the lung. It comprises 5% of the benign lung tumor, with the majority of benign tumors being hamartoma. Lipomatous polyp often leads to endobronchial lesion, associated with postobstructive pneumonia, hemoptysis, and atelectasis. We hereby present a case and discussion of an elderly man with endobronchial lipomatous polyp, presenting as recurrent pneumonia. Salim Surani, Karen Allen, Saherish Surani, and Joseph Varon Copyright © 2014 Salim Surani et al. All rights reserved. Intestinal Type of Lung Adenocarcinoma in Younger Adults Sun, 23 Mar 2014 11:21:03 +0000 Intestinal type of lung adenocarcinoma (ILADC) was initially described by Tsao and Fraser in 1991. Morphology and immunophenotype of ILADC are the same as in colorectal adenocarcinoma. Rectocolonoscopy must be performed to exclude colorectal origin of adenocarcinoma. Colorectal adenocarcinoma claimed to be genetically similar to an ILADC. Patients. We describe 24- and 26-year-old patients of both genders who went under surgery because of a lung tumor mass detected on CT scan. ILADC was diagnosed on resected lung specimens. According to positivity of Cytokeratin20, CDX-2, and Villin, respectively, and negativity of Cytokeratin7, TTF-1, Napsin-A, SurfactantB, MUC-1, and MUC-2, respectively, ILADC was diagnosed. KRAS mutation was detected in tumor tissue of the male patient. Conclusion. Rectocolonoscopy is the only relevant method for distinguishing the intestinal type of lung adenocarcinoma from metastatic colorectal carcinoma because immunohistochemistry and detection of mutation status are frequently the same in both types of adenocarcinoma. More investigations are needed for further understanding of ILADC in purpose of personalized lung carcinoma therapy particularly introducing detection of mutation status, especially in younger patients. Jelena Stojsic, Milica Kontic, Dragan Subotic, Marko Popovic, Dragana Tomasevic, and Jelena Lukic Copyright © 2014 Jelena Stojsic et al. All rights reserved. Improvement with Infliximab of a Disseminated Sarcoidosis in a Patient with Crohn’s Disease Thu, 06 Feb 2014 13:18:09 +0000 Sarcoidosis and Crohn’s disease are systemic granulomatous disorders affecting the lung and the intestine, respectively, with variable involvement of other organs and are seldom associated. While anti-TNFα is a recognized treatment of Crohn’s disease, its usage is discussed in sarcoidosis. A 42-year-old man presented with an 11-year-long history of Crohn’s disease; upon discovery of an abnormal chest CT scan the diagnosis of multivisceral sarcoidosis was made and, later, a treatment with an anti-TNFα agent, infliximab, was started, because of worsening Crohn’s disease recurrences. CT scan demonstrated net regression of pulmonary opacities and hepatosplenic lesions. Pathologies obtained from the intestinal tract and the bronchi of the patient were, respectively, characteristic of Crohn’s disease and sarcoidosis leading to the diagnosis of both diseases. We report a rare case of steroid resistant Crohn’s disease associated with multivisceral sarcoidosis, treated successfully by an anti-TNFα agent, infliximab. Nader Chebib, Fabrice Piégay, Julie Traclet, François Mion, and Jean-François Mornex Copyright © 2014 Nader Chebib et al. All rights reserved. Organizing Pneumonia Preceding Rheumatoid Arthritis Tue, 28 Jan 2014 07:26:11 +0000 Rheumatoid arthritis patients are susceptible to interstitial lung disease, and joint manifestations of rheumatoid arthritis usually precede lung involvements by several years. Organizing pneumonia, as the first manifestation of rheumatoid arthritis, is extremely rare, and its clinical features remain currently unknown. We present a case and a literature review of patients who were pathologically diagnosed with organizing pneumonia first and met the diagnostic criteria of rheumatoid arthritis later. In this review, we observed the following: (1) patients with organizing pneumonia preceding rheumatoid arthritis have a high prevalence of rheumatoid factor or anticyclic citrullinated peptide antibodies; (2) almost all patients developed rheumatoid arthritis within one year after the diagnosis of organizing pneumonia. We suggest that patients with organizing pneumonia and positive for either rheumatoid factor or anticyclic citrullinated peptide antibody should be cautiously followed up regarding the development of rheumatoid arthritis, particularly during the first year after the diagnosis of organizing pneumonia. Yoshiaki Kinoshita, Atsuhiko Sakamoto, and Kouko Hidaka Copyright © 2014 Yoshiaki Kinoshita et al. All rights reserved. Vanishing Lung Syndrome in a Patient with HIV Infection and Heavy Marijuana Use Wed, 08 Jan 2014 07:02:16 +0000 Vanishing lung syndrome (VLS) is a rare and distinct clinical syndrome that usually affects young men. VLS leads to severe progressive dyspnea and is characterized by extensive, asymmetric, peripheral, and predominantly upper lobe giant lung bullae. Case reports have suggested an additive role of marijuana use in the development of this disease in young male tobacco smokers. We herein report a case of a 65-year-old Hispanic male previously diagnosed with severe emphysema and acquired immune deficiency syndrome (AIDS), with a history of intravenous heroin use and active marijuana smoking who presents to the emergency department with severe progressive shortness of breath he was found to have multiple large subpleural bullae occupying more than one-third of the hemithorax on chest computerized tomography (CT), characteristic of vanishing lung syndrome. The patient was mechanically ventilated and later developed a pneumothorax requiring chest tube placement and referral for surgical bullectomy. Surgical bullectomy has shown high success rates in alleviating the debilitating symptoms and preventing the life threatening complications of this rare syndrome. This case further emphasizes the importance of recognizing VLS in patients with severe emphysema and heavy marijuana smoking. Basheer Tashtoush, Fernando Gonzalez-Ibarra, Roya Memarpour, Anas Hadeh, and Laurence Smolley Copyright © 2014 Basheer Tashtoush et al. All rights reserved. Pulmonary Embolism with Vertebral Augmentation Procedures Mon, 09 Dec 2013 15:12:40 +0000 With the prevalence of an aging American population on the rise, osteoporotic vertebral fractures are becoming a common occurrence, resulting in an increase in vertebral augmentation procedures and associated complications such as cement leakage, vertebral compressions, and pulmonary embolism. We describe a patient who presented with respiratory distress three years following kyphoplasty of the lumbar vertebra. Computed tomography (CT) angiogram of the chest confirmed the presence of polymethylmethacrylate (PMMA) cement in the lung fields and pulmonary vessels. We conducted a systematic review of the published literature identifying effective management strategies for the treatment of vertebroplasty-associated pulmonary embolism. Swetha Bopparaju, Joseph Varon, and Salim Surani Copyright © 2013 Swetha Bopparaju et al. All rights reserved. Diffuse Alveolar Hemorrhage due to Acute Mitral Valve Regurgitation Sun, 08 Dec 2013 14:37:05 +0000 Diffuse alveolar hemorrhage (DAH) can be caused by several etiologies including vasculitis, drug exposure, anticoagulants, infections, mitral valve stenosis, and regurgitation. Chronic mitral valve regurgitation (MR) has been well documented as an etiological factor for DAH, but there have been only a few cases which have reported acute mitral valve regurgitation as an etiology of DAH. Acute mitral valve regurgitation can be a life-threatening condition and often requires urgent intervention. In rare cases, acute mitral regurgitation may result in a regurgitant jet which is directed towards the right upper pulmonary vein and may specifically cause right-sided pulmonary edema and right-sided DAH. Surgical repair of the mitral valve results in rapid resolution of DAH. Acute MR should be considered as a possible etiology in patients presenting with unilateral pulmonary edema, hemoptysis, and DAH. Creticus P. Marak, Parijat S. Joy, Pragya Gupta, Yana Bukovskaya, and Achuta K. Guddati Copyright © 2013 Creticus P. Marak et al. All rights reserved. Transition from Hepatopulmonary Syndrome to Portopulmonary Hypertension: A Case Series of 3 Patients Sun, 10 Nov 2013 15:54:48 +0000 Hepatopulmonary syndrome (HPS) and portopulmonary hypertension (PPHTN) are the two major pulmonary vascular complications of liver disease. While HPS is characterized by low pulmonary vascular resistance, PPHTN is defined by the presence of elevated pulmonary vascular resistance. Given these seemingly opposing pathophysiologic mechanisms, these conditions were traditionally felt to be mutually exclusive. In this series, we present three patients with severe hepatopulmonary syndrome who had spontaneous resolution of their HPS with the subsequent development of PPHTN. To our knowledge, this is the largest case series presented of this phenomenon in nontransplanted patients. One proposed mechanism for the occurrence of this phenomenon involves dysregulation of the same vascular signaling pathway, which may lead to both pulmonary vascular dilatations and pulmonary arterial remodeling in the same patient. Another theory involves the possible differential binding of endothelin-1, a vasoactive signaling peptide that induces vasoconstriction when bound to receptor A and vasodilation when bound to receptor B. Although the mechanisms for this phenomenon remain unclear, it is important to be vigilant of this phenomenon as it may change the patient's overall treatment plan, especially in regard to appropriateness and timing of liver transplant. Radhika Zopey, Irawan Susanto, Igor Barjaktarevic, and Tisha Wang Copyright © 2013 Radhika Zopey et al. All rights reserved.