Case Reports in Pulmonology https://www.hindawi.com The latest articles from Hindawi © 2017 , Hindawi Limited . All rights reserved. An Unusual Presentation of Congenital Lobar Emphysema Mon, 24 Apr 2017 08:53:14 +0000 http://www.hindawi.com/journals/cripu/2017/6719617/ Congenital lobar emphysema is an uncommon bronchopulmonary malformation characterized by lobar overinflation and accompanying alveolar septum damage that leads to compression atelectasis of the lung parenchyma and displacement of mediastinal structures, with the resultant ventilation-perfusion mismatch. We present a case of a 33-year-old lady with progressive exertional dyspnea. Chest radiograph findings lead to the suspicion of congenital lobar emphysema, which was then confirmed by a computed tomography (CT) scan. This condition is most commonly identified in newborns, with very few cases being reported in adults. Lobectomy remains the treatment of choice and in general has good outcome. Daniel Arnaud, Joseph Varon, and Salim Surani Copyright © 2017 Daniel Arnaud et al. All rights reserved. Bronchus Associated Lymphoid Tissue Lymphoma Presenting with Immunodeficiency and Multiple Pulmonary Nodules Mon, 13 Mar 2017 06:57:53 +0000 http://www.hindawi.com/journals/cripu/2017/4804378/ Bronchus Associated Lymphoid Tissue Lymphoma (BALTOMA) is a rare subgroup of pulmonary non-Hodgkin’s lymphomas (NHLs) comprising less than 1% of all cases. It constitutes 3.6% of all extranodal lymphomas and only 0.5–1% of primary pulmonary malignancies. They are usually low grade B-cell lymphomas and are considered to originate from the mucosa associated lymphoid tissue (MALT) of the bronchi. Here, we represent a rare case of BALTOMA presenting with immunodeficiency and multiple pulmonary nodules. Sermin Borekci, Murat Ozbalak, Ezel Ersen, Hilal Akı, Muhlis Cem Ar, and Sema Umut Copyright © 2017 Sermin Borekci et al. All rights reserved. Successful Extubation Using Heliox BiPAP in Two Patients with Postextubation Stridor Wed, 08 Mar 2017 07:03:26 +0000 http://www.hindawi.com/journals/cripu/2017/1253280/ Postextubation stridor is associated with significant morbidity. It commonly results in extubation failure after established medical treatment fails, such as nebulized epinephrine and/or intravenous steroids. The role of heliox (i.e., combination of helium and oxygen) in managing patients with postextubation stridor has not been fully established. We report two cases of postextubation stridor successfully treated with heliox delivered with bilevel positive airway pressure (BiPAP) after failure of standard medical therapy. Pragya Punj, Premkumar Nattanmai, Pravin George, and Christopher R. Newey Copyright © 2017 Pragya Punj et al. All rights reserved. Nocardia brasiliensis Infection Complicating Cryptogenic Organizing Pneumonia Tue, 28 Feb 2017 09:44:01 +0000 http://www.hindawi.com/journals/cripu/2017/9567175/ Pulmonary nocardiosis is a severe and uncommon opportunistic infection caused by Nocardia species. We present a patient with cryptogenic organizing pneumonia who was receiving long-term immunosuppressive therapy, whose treatment course was complicated by cutaneous and pulmonary nocardiosis. Tissue cultures confirmed Nocardia brasiliensis. Nocardiosis should be a diagnostic consideration for patients treated with long-term immunosuppression who have worsening pulmonary symptoms and relapsing pustular skin lesions. Alison M. Fernandes, Jason C. Sluzevich, and Isabel Mira-Avendano Copyright © 2017 Alison M. Fernandes et al. All rights reserved. A Rare Presentation of Sarcoidosis as a Pancreatic Head Mass Tue, 21 Feb 2017 00:00:00 +0000 http://www.hindawi.com/journals/cripu/2017/7037162/ Sarcoidosis is a multisystem granulomatous syndrome of unknown etiology with noncaseating epithelioid granulomas being the pathognomonic pathological finding. Sarcoidosis most commonly involves the lungs and involvement of the gastrointestinal (GI) tract is uncommon. Pancreatic sarcoidosis is very rare, especially when it is the presenting feature of sarcoidosis and can masquerade as pancreatic cancer. Tissue infiltration in pancreatic sarcoidosis can lead to either a diffuse nodular appearance or a mass-like lesion. We present an interesting case of a 47-year-old woman with a 10-pack-year history of smoking who presented with sharp epigastric pain, weight loss, and elevated lipase level. CT and MRI imaging showed a 4 cm × 5 cm heterogeneous pancreatic mass with a dilated pancreatic duct and peripancreatic lymphadenopathy. Endoscopic ultrasound guided FNA revealed noncaseating granulomas with no evidence of malignancy or atypical infection. CT of the chest revealed bilateral mediastinal and hilar adenopathy with calcification, without any parenchymal abnormalities, and her angiotensin-converting enzyme level was elevated at 170 U/L. The clinical picture pointed to the diagnosis of pancreatic sarcoidosis. Given the severity of gastrointestinal symptoms related to pancreatic sarcoidosis, prednisone therapy at 0.5 mg/kg/day was initiated with complete resolution of symptoms at 8 weeks. Shruti Mony, Pradnya D. Patil, Rebekah English, Ananya Das, Daniel A. Culver, and Tanmay S. Panchabhai Copyright © 2017 Shruti Mony et al. All rights reserved. Solitary Endobronchial Papilloma with Malignant Transformation and Concomitant TB Infection: Case Report and Literature Review Wed, 08 Feb 2017 00:00:00 +0000 http://www.hindawi.com/journals/cripu/2017/1606432/ We are reporting a case of solitary endobronchial papilloma located in posterior segment of the left upper lobe of the lung with malignant transformation and negative human papilloma virus (HPV) strains in a 40-year-old Saudi nonsmoker man. The patient had a concomitant tuberculosis (TB) infection. The patient received appropriate treatment in the form of anti-TB medication and surgical resection of the squamous cell carcinoma followed by chemotherapy. There was no evidence of tumor recurrence, resulting in a complete cure. We are reporting the case as well as a literature review related to the topic. Mohammed Al Ghobain Copyright © 2017 Mohammed Al Ghobain. All rights reserved. Postpneumonectomy Compression of the Mitral Annulus: Rare Vascular Complication in Sportive Patient Mon, 26 Dec 2016 07:35:59 +0000 http://www.hindawi.com/journals/cripu/2016/9575894/ Numerous postpneumonectomy complications exist. We present a rare clinical case of postpneumonectomy exertional dyspnea revealing compression of the mitral annulus by the descending aorta. The patient was 42-year-old former smoker with pulmonary emphysema. He has been operated on, in 2012 (i.e., right pneumonectomy). Before the surgery, the patient was a recreational runner. However, after some months, it was difficult for the patient to resume running. Cardiopulmonary exercise testing indicated moderate exercise intolerance with important oxygen desaturation. More interestingly, a decrease of low oxygen pulse was noticed from the first ventilatory threshold with no electrical modification on the electrocardiogram. This decrease was indicative of a decline in stroke volume. The thoracic scan revealed a right pneumonectomy pocket with a liquid abnormal content. Moreover, the mediastinum had shifted toward the pneumonectomy space and the left lung was distended and emphysematous. Echocardiography revealed a major change in the mediastinal anatomy. The mitral annulus was observed to be compressed by the rear wall of the descending aorta. The diagnosis of postpneumonectomy syndrome or platypnea-orthodeoxia syndrome was ruled out in this patient. Mitral annular compression by the descending aorta is rare complication, which must be researched in patients with postpneumonectomy exertional dyspnea. David Debeaumont, Susana Bota, Jean-Marc Baste, Marie Bellefleur, Dimitri Stepowski, Florence Vincent, Tristan Bonnevie, Francis-Edouard Gravier, Marie Netchitailo, Catherine Tardif, Alain Boutry, Jean-François Muir, and Jérémy Coquart Copyright © 2016 David Debeaumont et al. All rights reserved. Extracorporeal Lung Support as a Bridge to Diagnosis of Pulmonary Tumor Embolism Wed, 14 Dec 2016 11:55:11 +0000 http://www.hindawi.com/journals/cripu/2016/3257084/ Bridging to diagnosis is an emerging technique used in end-stage cardiorespiratory failure that prolongs a patient’s life using various modalities of extracorporeal lung support (ECLS) to achieve antemortem diagnosis. Pulmonary tumor embolism occurs when cell clusters travel from primary malignancies through venous circulation to the lungs, causing respiratory failure through inflammatory and venoocclusive pathways. Due to its nonspecific symptomatology, pulmonary tumor embolism remains an elusive diagnosis antemortem. Herein, we bridge a patient who presented in acute respiratory failure to the diagnosis of pulmonary tumor embolism from a gastric signet-ring cell carcinoma using ECLS modalities including venoarterial extracorporeal membrane oxygenation and centrally cannulated Novalung pumpless extracorporeal lung assist. We demonstrate the utility of this approach in diagnostically uncertain cases in unstable patients who are potentially acceptable ECLS and transplant candidates. Vishnu Vasanthan, Kieran Halloran, Lakshmi Puttagunta, and Jayan Nagendran Copyright © 2016 Vishnu Vasanthan et al. All rights reserved. Airway Complications from an Esophageal Foreign Body Mon, 12 Dec 2016 08:54:07 +0000 http://www.hindawi.com/journals/cripu/2016/3403952/ Introduction. Foreign body impaction (FBI) in the esophagus can be a serious condition, which can have a high mortality among children and adults, if appropriate diagnosis and treatment are not instituted urgently. 80–90% of all foreign bodies trapped in the esophagus usually pass spontaneously through the digestive tract, without any medical or surgical intervention. 10–20% of them will need an endoscopic intervention. Case Report. We hereby present a case of a large chicken piece foreign body impaction in the esophagus in a 25-year-old male with mental retardation. Patient developed hypoxemic respiratory failure requiring intubation. The removal required endoscopic intervention. Conclusions. Foreign bodies trapped in the upper gastrointestinal tract are a serious condition that can be fatal if they are not managed correctly. A correct diagnosis and treatment decrease the chances of complications. Endoscopic treatment remains the gold standard for extracting foreign body impaction. Ismael Garcia, Joseph Varon, and Salim Surani Copyright © 2016 Ismael Garcia et al. All rights reserved. Primary Pulmonary Meningioma Simulating a Pulmonary Metastasis Wed, 16 Nov 2016 08:43:29 +0000 http://www.hindawi.com/journals/cripu/2016/8248749/ Primary pulmonary meningiomas represent a rare tumor entity. Few cases have been reported in the English medical literature, and they have almost all been solitary and benign in nature, with the exception of several extremely rare cases. We report herein a case of PPM that raised suspicion of a pulmonary metastatic tumor initially, as it was depicted as a single, round, small, ground-glass opacity pulmonary nodule on a chest computed tomography scan, in a 55-year-old man with a history of buccal cancer. Increased awareness of the clinical and radiologic characteristics of this rare category can assist a multidisciplinary team to perform adequate management. Chun-Mao Juan, Mei-Ling Chen, Shang-Yun Ho, and Yuan-Chun Huang Copyright © 2016 Chun-Mao Juan et al. All rights reserved. Teppanyaki/Hibachi Pneumonitis: An Exotic Cause of Exogenous Lipoid Pneumonia Mon, 14 Nov 2016 08:58:42 +0000 http://www.hindawi.com/journals/cripu/2016/1035601/ Exogenous lipoid pneumonia (ELP) is a rare type of inflammatory lung disease caused by aspiration and/or inhalation of fatty substances and characterized by a chronic foreign body-type reaction to intra-alveolar lipid deposits. The usual clinical presentation occurs with insidious onset of nonspecific respiratory symptoms and radiographic findings that can mimic other pulmonary diseases. Diagnosis of ELP is often missed or delayed as it requires a high index of suspicion and familiarity with the constellation of appropriate history and radiologic and pathologic features. We herein report a case of occupational exposure to tabletop “Teppanyaki” entertainment cooking as a cause of ELP, confirmed by surgical lung biopsies in a 63-year-old Asian woman who worked as a Hibachi-Teppanyaki chef for 25 years. Franck Rahaghi, Ali Varasteh, Roya Memarpour, and Basheer Tashtoush Copyright © 2016 Franck Rahaghi et al. All rights reserved. Streptococcus intermedius Causing Necrotizing Pneumonia in an Immune Competent Female: A Case Report and Literature Review Sun, 06 Nov 2016 13:32:23 +0000 http://www.hindawi.com/journals/cripu/2016/7452161/ We report a case of a 52-year-old immunocompetent Caucasian female treated for necrotizing Streptococcus intermedius pneumonia and review available literature of similar cases. Our patient presented with respiratory failure and required hospitalization and treatment in the intensive care unit. Moreover, she required surgical drainage of right lung empyema as well as decortication and resection. The review of literature revealed three cases of S. intermedius pneumonia, one of which was a mortality. Comparison of the published cases showed a highly varied prehospital course and radiological presentations, with a symptomatic phase ranging from 10 days to five months. Radiological findings varied from an isolated pleural effusion to systemic disease with the presence of brain abscesses. Immunocompetence appears to correlate well with the overall prognosis. In addition, smoking appears to be an important risk factor for S. intermedius pneumonia. In 2 (50%) of cases, pleural fluid analysis identified S. intermedius. In contrast, no organism was found in our patient, necessitating the acquisition of lung tissue sample for the diagnosis. In conclusion, both medical and surgical management are necessary for effective treatment of S. intermedius pneumonia. The outcome of treatment is good in immunocompetent individuals. Faris Hannoodi, Israa Ali, Hussam Sabbagh, and Sarwan Kumar Copyright © 2016 Faris Hannoodi et al. All rights reserved. Right Lung Agenesis with Tracheal Stenosis due to Complete Tracheal Rings and Postpneumonectomy Like Syndrome Treated with Tissue Expander Placement Tue, 01 Nov 2016 09:06:04 +0000 http://www.hindawi.com/journals/cripu/2016/4397641/ Congenital lung agenesis is an extremely rare condition with an estimated prevalence of 34 in 1,000,000 live births. It is often associated with other congenital malformations of the skeletal, cardiovascular, urogenital, and gastrointestinal systems. We discuss the case of a 5-month-old who presented with increasing stridor over 1 month. Imaging revealed right lung agenesis, complete dextromalposition of heart, and compression of distal trachea. An intrathoracic saline tissue expander was placed which marked improved distal tracheal stenosis. In patients who are symptomatic it becomes imperative to perform surgeries to increase survival as was the case in this patient. Yashwant Agrawal, Sandeep Patri, and Jagadeesh K. Kalavakunta Copyright © 2016 Yashwant Agrawal et al. All rights reserved. Biphasic Malignant Pleural Mesothelioma Masquerading as a Primary Skeletal Tumor Wed, 31 Aug 2016 10:52:48 +0000 http://www.hindawi.com/journals/cripu/2016/7560929/ Biphasic malignant pleural mesothelioma is a rare malignant tumor, usually presenting as a pleural-based mass in a patient with history of chronic asbestos exposure. We herein report a case of a 41-year-old man who presented with chest pain and had a chest computed tomography (CT) scan suggestive of a primary skeletal tumor originating from the ribs (chondrosarcoma or osteosarcoma), with no history of asbestos exposure. CT-guided core needle biopsies were diagnosed as malignant sarcomatoid mesothelioma. Surgical resection and chest wall reconstruction were performed, confirming the diagnosis and revealing a secondary histologic component (epithelioid), supporting the diagnosis of biphasic malignant mesothelioma. James Benjamin Gleason, Basheer Tashtoush, and Maria Julia Diacovo Copyright © 2016 James Benjamin Gleason et al. All rights reserved. Systemic Air Embolism Associated with Pleural Pigtail Chest Tube Insertion Wed, 17 Aug 2016 13:12:14 +0000 http://www.hindawi.com/journals/cripu/2016/4053748/ Pleural pigtail catheter placement is associated with many complications including pneumothorax, hemorrhage, and chest pain. Air embolism is a known but rare complication of pleural pigtail catheter insertion and has a high risk of occurrence with positive pressure ventilation. In this case report, we present a 50-year-old male with bilateral pneumonia who developed a pneumothorax while on mechanical ventilation with continuous positive airway pressure mode. During the placement of the pleural pigtail catheter to correct the pneumothorax, the patient developed a sudden left sided body weakness and became unresponsive. An air embolism was identified in the right main cerebral artery, which was fatal. Emad Alkhankan, Ahmad Nusair, Rida Mazagri, and Mohammed Al-Ourani Copyright © 2016 Emad Alkhankan et al. All rights reserved. Postpartum Tuberculosis: A Diagnostic and Therapeutic Challenge Tue, 16 Aug 2016 06:28:09 +0000 http://www.hindawi.com/journals/cripu/2016/3793941/ Tuberculosis (TB) infection in pregnant women and newborn babies is always challenging. Appropriate treatment is pivotal to curtail morbidity and mortality. TB diagnosis or exposure to active TB can be emotionally distressing to the mother. Circumstances can become more challenging for the physician if the mother’s TB status is unclear. Effective management of TB during pregnancy and the postpartum period requires a multidisciplinary approach including pulmonologist, obstetrician, neonatologist, infectious disease specialist, and TB public health department. Current guidelines recommend primary Isoniazid prophylaxis in TB exposed pregnant women who are immune-suppressed and have chronic medical conditions or obstetric risk factors and close and sustained contact with a patient with infectious TB. Treatment during pregnancy is the same as for the general adult population. Infants born to mothers with active TB at delivery should undergo a complete diagnostic evaluation. Primary Isoniazid prophylaxis for at least twelve weeks is recommended for those with negative diagnostic tests and no evidence of disease. Repeated negative diagnostic tests are mandatory before interrupting prophylaxis. Separation of mother and infant is only necessary when the mother has received treatment for less than 2 weeks, is sputum smear-positive, or has drug-resistant TB. This case highlights important aspects for management of TB during the postpartum period which has a higher morbidity. We present a case of a young mother migrating from a developing nation to the USA, who was found to have a positive quantiFERON test associated with multiple cavitary lung lesions and gave birth to a healthy baby. Vijay Kodadhala, Alemeshet Gudeta, Aklilu Zerihun, Odene Lewis, Sohail Ahmed, Jhansi Gajjala, and Alicia Thomas Copyright © 2016 Vijay Kodadhala et al. All rights reserved. Subcutaneous and Pulmonary Dirofilariasis with Evidence of Splenic Involvement Mon, 08 Aug 2016 16:31:41 +0000 http://www.hindawi.com/journals/cripu/2016/8212387/ Cases of human dirofilariasis have been reported in several countries around the world, including a large number in the Atlantic and Gulf Coast regions of the United States. Most commonly, these cases have subcutaneous or pulmonary involvement; however, there have been few reports of dirofilariasis involving structures such as large vessels, mesentery, the spermatic cord, and liver. We present a case of an unusual presentation of human dirofilariasis presenting as a shoulder abscess and what is presumed to be pulmonary and splenic involvement in a 55-year-old female. Adarsha Selvachandran and Raymond J. Foley Copyright © 2016 Adarsha Selvachandran and Raymond J. Foley. All rights reserved. Endobronchial Cartilage Rupture: A Rare Cause of Lobar Collapse Mon, 25 Jul 2016 09:20:54 +0000 http://www.hindawi.com/journals/cripu/2016/8178129/ Endobronchial cartilage rupture is a rare clinical condition, which can present in patients with severe emphysema with sudden onset shortness of breath. We present a case of a 62-year-old male who presented to our emergency department with sudden onset shortness of breath. Chest X-ray showed lung hyperinflation and a right lung field vague small density. Chest Computed Tomography confirmed the presence of right middle lobe collapse. Bronchoscopy revealed partial right middle lobe atelectasis and an endobronchial cartilage rupture. Endobronchial cartilage rupture is a rare condition that can present as sudden onset shortness of breath due to lobar collapse in patients with emphysema and can be triggered by cough. Bronchoscopic findings include finding a collapsed lung lobe and a visible ruptured endobronchial cartilage. A high index of suspicion, chest imaging, and early bronchoscopy can aid in the diagnosis and help prevent complications. Osama Dasa, Nauman Siddiqui, Mohammed Ruzieh, and Toseef Javaid Copyright © 2016 Osama Dasa et al. All rights reserved. Erratum to “Endobronchial Enigma: A Clinically Rare Presentation of Nocardia beijingensis in an Immunocompetent Patient” Sun, 17 Jul 2016 09:20:47 +0000 http://www.hindawi.com/journals/cripu/2016/1950463/ Nader Abdel-Rahman, Shimon Izhakian, Walter G. Wasser, Oren Fruchter, and Mordechai R. Kramer Copyright © 2016 Nader Abdel-Rahman et al. All rights reserved. Primary Pulmonary Amebiasis Complicated with Multicystic Empyema Sun, 10 Jul 2016 07:48:44 +0000 http://www.hindawi.com/journals/cripu/2016/8709347/ Amebiasis is a parasitic infection caused by the protozoan Entamoeba histolytica. While most infections are asymptomatic, the disease could manifest clinically as amebic dysentery and/or extraintestinal invasion in the form of amebic liver abscess or other more rare manifestations such as pulmonary, cardiac, or brain involvement. Herein we are reporting a case of a 24-year-old male with history of Down syndrome who presented with severe right side pneumonia complicated with multicystic empyema resistant to regular medical therapy. Further investigation revealed a positive pleural fluid for E. histolytica cysts and trophozoites. The patient was diagnosed with primary pleuropulmonary amebiasis and he responded promptly to surgical drainage and metronidazole therapy. In patients from endemic areas all physicians should keep a high index of suspicion of amebiasis as a cause of pulmonary disease. Ali Zakaria, Bayan Al-Share, and Khaled Al Asad Copyright © 2016 Ali Zakaria et al. All rights reserved. A Case of Tuberculous Meningitis with Tuberculoma in Nonimmunocompromised Immigrant Mon, 20 Jun 2016 12:40:50 +0000 http://www.hindawi.com/journals/cripu/2016/9016142/ We present a case of tuberculous (TB) meningitis in nonimmunocompromised immigrant worker who initially presented with headache and later with generalized tonic clonic seizures and disseminated tuberculosis. Parth Rali, Hammad Arshad, and Eric Bihler Copyright © 2016 Parth Rali et al. All rights reserved. An Unusual Association in an Uncommon Disease: Two Cases of Spontaneous Pneumomediastinum Associated with Pneumorrhachis Tue, 26 Apr 2016 12:50:07 +0000 http://www.hindawi.com/journals/cripu/2016/5092157/ Pneumomediastinum, the presence of free air in the mediastinum, is described as spontaneous pneumomediastinum when there is no apparent cause such as trauma, surgery, interventional procedures, or intrathoracic infections. Pneumorrhachis is a rare clinical condition, consisting of intraspinal air. The main causes are iatrogenic, traumatic, and nontraumatic. Spontaneous mediastinum is usually associated with subcutaneous emphysema and, occasionally, with pneumothorax; however, its association with pneumorrhachis is extremely rare. Here, we present two rare cases of spontaneous pneumomediastinum associated with pneumorrhachis caused by vigorous coughing. Luís Martins, Patrícia Dionísio, Susana Moreira, Alda Manique, Isabel Correia, and Cristina Bárbara Copyright © 2016 Luís Martins et al. All rights reserved. Severe Acute Pulmonary Toxicity Associated with Brentuximab in a Patient with Refractory Hodgkin’s Lymphoma Sun, 17 Apr 2016 14:13:58 +0000 http://www.hindawi.com/journals/cripu/2016/2359437/ Acute pulmonary toxicity associated with brentuximab appears to be a rare but serious adverse effect that can be potentially fatal. We report the case of a twenty-nine-year-old female with Hodgkin’s lymphoma who was treated with brentuximab and later presented with severe acute pulmonary toxicity; she improved after the discontinuation of brentuximab and administration of antibiotics and glucocorticoid therapy. Currently there is very little data in the literature in regard to the clinical manifestations and characteristics of patients taking brentuximab and the potential development of acute severe pulmonary toxicity, as well as the appropriate therapeutic approach, making this particular case of successful treatment and resolution unique. Yasmin Sabet, Saul Ramirez, Elizabeth Rosell Cespedes, Marimer Rensoli Velasquez, Mateo Porres-Muñoz, Sumit Gaur, Juan B. Figueroa-Casas, and Mateo Porres-Aguilar Copyright © 2016 Yasmin Sabet et al. All rights reserved. Mediastinal Mature Teratoma Revealed by Empyema Thu, 07 Apr 2016 06:35:41 +0000 http://www.hindawi.com/journals/cripu/2016/7869476/ Teratomas are germ cell tumors, manifested with a great variety of clinical features; the most common extragonadal site is the anterior mediastinum. In this case, we report the patient with a large mature mediastinal teratoma with several components of ectodermal and endothermal epithelium. A 24-year-old female patient presented with history of persistent chest pain and progressively aggravating dyspnea for the previous 3 months. A chest X-ray showed a large opacity of the entire left hemithorax. Transcutaneous needle aspiration revealed a purulent fluid. The tube thoracostomy was introduced and the effusion was evacuated. Some weeks later, patient was seen in emergency for persistent cough and lateral chest pain. CT scan revealed a mass of the left hemithorax. The mass showed heterogeneous density, without compressing mediastinum great vessels and left hilar structures. Lipase value was elevated in needle aspiration. The patient underwent a total resection of the mediastinum mass via a left posterolateral thoracotomy. Microscopy revealed a mature teratoma with cystic structures. The patient subsequently made a full recovery. This case provide benign mediastinal teratoma with total atelectasis of left lung and elevated lipase value in needle transcutaneous aspiration; this event is explained by pancreatic component in the cystic tumor. Total removal of the tumor is adequate treatment for this type of teratoma and the prognosis is excellent. Mohammed Raoufi, Laila Herrak, Anas Benali, Leila Achaachi, Mustapha El Ftouh, Salma Bellarbi, Charaf Tilfine, and Firdaous Taouarsa Copyright © 2016 Mohammed Raoufi et al. All rights reserved. Stent-in-Stent Technique for the Treatment of Proximal Bronchial Restenosis after Insertion of Metallic Stents: A Report of Two Cases Thu, 24 Mar 2016 11:40:47 +0000 http://www.hindawi.com/journals/cripu/2016/6742349/ Endoscopic treatment of a bronchial restenosis previously treated by insertion of a partially covered self-expandable metallic stent (SEMS) can be difficult. Classically, after recanalization of the bronchus, the stent is removed and replaced by a more adapted one. We report on two cases of proximal bronchial restenosis treated by insertion of an additional stent inside the lumen of the previously inserted stent using the stent-in-stent (SIS) technique. The indications for the initial stent were malignancy in Patient 1 and posttransplant bronchial stenosis in Patient 2. Restenosis occurred at the proximal end of the stent within months in both cases. Stent removal and insertion of a new stent were considered, but this option was discarded because of an excessive risk of bronchial perforation and preference towards an alternative approach. In both cases, a second customized SEMS was placed using the SIS technique after ablation of the proximal end stenosis of the stent by argon plasma coagulation and/or dilation with a balloon. Recanalization of the bronchus was achieved in both cases without complications. The SIS technique is a valuable alternative to removal of SEMS in case of proximal bronchial restenosis. Benjamin Bondue, Pascal Schlossmacher, Christiane Knoop, Isabelle Etienne, Sylvie Luce, Youri Sokolow, and Dimitri Leduc Copyright © 2016 Benjamin Bondue et al. All rights reserved. TINF2 Gene Mutation in a Patient with Pulmonary Fibrosis Sun, 20 Mar 2016 13:28:54 +0000 http://www.hindawi.com/journals/cripu/2016/1310862/ Pulmonary fibrosis is a frequent manifestation of telomere syndromes. Telomere gene mutations are found in up to 25% and 3% of patients with familial disease and sporadic disease, respectively. The telomere gene TINF2 encodes an eponymous protein that is part of the shelterin complex, a complex involved in telomere protection and maintenance. A TINF2 gene mutation was recently reported in a family with pulmonary fibrosis. We identified a heterozygous Ser245Tyr mutation in the TINF2 gene of previously healthy female patient that presented with progressive cough due to pulmonary fibrosis as well as panhypogammaglobulinemia at age 52. Retrospective multidisciplinary evaluation classified her as a case of possible idiopathic pulmonary fibrosis. Telomere length-measurement indicated normal telomere length in the peripheral blood compartment. This is the first report of a TINF2 mutation in a patient with sporadic pulmonary fibrosis, which represents another association between TINF2 mutations and this disease. Furthermore, this case underlines the importance of telomere dysfunction and not telomere length alone in telomere syndromes and draws attention to hypogammaglobulinemia as a manifestation of telomere syndromes. T. W. Hoffman, J. J. van der Vis, M. F. M. van Oosterhout, H. W. van Es, D. A. van Kessel, J. C. Grutters, and C. H. M. van Moorsel Copyright © 2016 T. W. Hoffman et al. All rights reserved. Tracheobronchomegaly as a Cause of Bronchiectasis in an Adult Sun, 28 Feb 2016 12:17:37 +0000 http://www.hindawi.com/journals/cripu/2016/5049406/ Mounier-Kuhn syndrome (MKS) is a rare congenital anomaly characterized by dilated trachea and main bronchi due to atrophy of the elastic fibers and smooth muscle cells of the trachea and major airways. Patients of MKS can have varied presentation. The diagnosis is established radiologically and bronchoscopically. There is no specific treatment for MKS. We present an adult man with MKS who presented with recurrent respiratory tract infection. The diagnosis was confirmed by imaging study and fiberoptic bronchoscopy. Vishnukanth Govindaraj, Madhusmita Mohanty Mohapatra, Balla Nagamalli Kumar, and Suryakala Narayanasami Copyright © 2016 Vishnukanth Govindaraj et al. All rights reserved. Community-Acquired Moraxella catarrhalis Bacteremic Pneumonia: Two Case Reports and Review of the Literature Thu, 18 Feb 2016 11:26:18 +0000 http://www.hindawi.com/journals/cripu/2016/5134969/ Moraxella (formerly Branhamella) catarrhalis was discovered at the end of the nineteenth century, and for many decades it was considered to be a harmless commensal of the upper respiratory tract. It is a Gram-negative, aerobic diplococcus considered to be the third most common pathogen isolated in childhood sinusitis and otitis media and in adult chronic lower respiratory disease, as well as an etiological agent of pneumonia in immunosuppressed patients or those with chronic obstructive pulmonary disease. Moraxella catarrhalis pneumonia is rarely associated with bacteremia. Here, we present two cases of community-acquired Moraxella catarrhalis bacteremic pneumonia. Miguel Angel Ariza-Prota, Ana Pando-Sandoval, Marta García-Clemente, David Fole-Vázquez, and Pere Casan Copyright © 2016 Miguel Angel Ariza-Prota et al. All rights reserved. Key Features in the Management of Pulmonary Carcinosarcoma Thu, 18 Feb 2016 07:06:35 +0000 http://www.hindawi.com/journals/cripu/2016/2020146/ Pulmonary carcinosarcoma represents a category of extremely rare tumours accounting for 0.1% of all lung malignancies. It is defined as a poorly differentiated non-small-cell carcinoma that contains a component of sarcoma or sarcoma-like elements. These biphasic tumours typically have a poor prognosis due to late diagnosis and early metastases. Preoperative tissue diagnosis is usually difficult due to the heterogeneity of the tumour, with biopsies often just reflecting one element of the tumour. By means of a case illustration and review of the literature, we discuss the optimal management of patients with pulmonary carcinosarcoma. Nikolaos Panagiotopoulos, Davide Patrini, Benjamin Adams, Jonathan Pararajasingham, Rajeev Shukla, Elaine Borg, Martin Hayward, and David Lawrence Copyright © 2016 Nikolaos Panagiotopoulos et al. All rights reserved. Acute Respiratory Failure due to Neuromyelitis Optica Treated Successfully with Plasmapheresis Wed, 17 Feb 2016 11:35:12 +0000 http://www.hindawi.com/journals/cripu/2016/1287690/ Neuromyelitis Optica (NMO) is a demyelinating autoimmune disease involving the central nervous system. Acute respiratory failure from cervical myelitis due to NMO is known to occur but is uncommon in monophasic disease and is treated with high dose steroids. We report a case of a patient with NMO who developed acute respiratory failure related to cervical spinal cord involvement, refractory to pulse dose steroid therapy, which resolved with plasmapheresis. Massa Zantah, Timothy B. Coyle, and Debapriya Datta Copyright © 2016 Massa Zantah et al. All rights reserved.