Case Reports in Pulmonology The latest articles from Hindawi © 2018 , Hindawi Limited . All rights reserved. Use of Extracorporeal Membrane Oxygenation in Postpartum Management of a Patient with Pulmonary Arterial Hypertension Mon, 15 Jan 2018 00:00:00 +0000 Current guidelines do not recommend pregnancy in patients with pulmonary arterial hypertension (PAH). This is due to the associated high mortality, which both dissuades PAH patients from becoming pregnant and encourages termination of pregnancy due to high maternal mortality risk. As a result, there is a lack of data and, consequently, there are only general guidelines available for management of pregnancy in PAH patients. Additionally, novel therapeutic strategies such as extracorporeal membrane oxygenation (ECMO), although used in the management of nonpregnant PAH patients as a bridge to lung transplantation, have not been used to treat cardiopulmonary collapse in pregnant PAH patients. In an attempt to bridge this paucity of data, we report the successful use of ECMO in resuscitation and management of a pregnant PAH patient who experienced cardiopulmonary collapse following a caesarian section. Humna Abid Memon, Zeenat Safdar, and Ahmad Goodarzi Copyright © 2018 Humna Abid Memon et al. All rights reserved. Seizure and Pulmonary Embolism: A Differential That Can Save a Life Sun, 17 Dec 2017 07:25:29 +0000 Seizures is a relatively common presentation with a wide differential diagnosis. However, seizures presenting secondary to underlying pulmonary emboli are rare and, without prompt recognition and management, this easily treatable condition can be potentially fatal. The few available case reports discussing seizures and PE reveal a high mortality rate which underscores the importance of prompt diagnosis. A 38-year-old woman presented to the emergency room having experienced loss of consciousness and a generalized tonic-clonic seizure at home. In the emergency room, her presenting signs and symptoms included tachycardia, worsening dyspnea, mild hypoxemia, and elevated D-dimer. Pertinent history findings revealed she recently received depot hormonal contraceptive treatments. Her initial workup included an EKG which showed sinus tachycardia without evidence of right heart strain. Subsequently a chest CT with angiography revealed massive bilateral pulmonary emboli. DVT studies also revealed a unilateral acute DVT. The patient was promptly started on therapeutic anticoagulation and stabilized. Fortunately, the patient remained symptom-free and eventually was discharged with close follow-up. The goal of this report is to make clinicians more aware of the possibility that seizures, along with the appropriate clinical findings, can be caused by acute PE. Seyedmohammad Pourshahid, Sneha Dedhia, Shakeeb Hakim, Mohamed Barakat, and Dennis Genin Copyright © 2017 Seyedmohammad Pourshahid et al. All rights reserved. A Rare Case of Metastatic Choriocarcinoma of Lung Origin Thu, 07 Dec 2017 08:18:39 +0000 Choriocarcinoma is part of the spectrum of gestational trophoblastic disease that occurs in women of reproductive age. Although the most common metastatic site of choriocarcinoma is the lung, primary pulmonary choriocarcinoma is rare. To diagnose primary pulmonary choriocarcinoma, the patient should have no previous gynecologic malignancy, have elevated human chorionic gonadotropin, and have pathological confirmation of the disease excluding gonadal primary site of the tumor. Due to the paucity of data, there are no guidelines for treatment. Prognosis of this malignancy is extremely poor. We report a rare case of metastatic primary lung choriocarcinoma in a 69-year-old postmenopausal woman who was treated with combination of surgery, chemotherapy, and radiation. The patient had a good outcome and is doing well after 1-year follow-up. Parth Rali, Jianwu Xie, Grishma Rali, Mayur Rali, Jan Silverman, and Khalid Malik Copyright © 2017 Parth Rali et al. All rights reserved. Pulmonary Neuroendocrine Cell Hyperplasia Associated with Surfactant Protein C Gene Mutation Thu, 09 Nov 2017 08:40:16 +0000 Familial interstitial lung disease (ILD) is defined as presence of ILD in 2 or more family members. Surfactant protein C (SFTPC) gene mutations are rare, but well-known cause of familial ILD. We reported a 20-year-old male, who was referred for lung transplantation. He was symptomatic at age 3 and underwent surgical lung biopsy at age 6, which revealed a nonspecific interstitial pneumonia (NSIP) pattern. Genetic workup revealed a novel SFTPC mutation in the first intron with a C to A transversion. At age 21, he underwent bilateral lung transplantation. Explanted lung histology suggested NSIP. In addition there was pulmonary neuroendocrine cell (PNEC) hyperplasia and carcinoid tumorlets. His mother had undergone lung transplantation several years earlier, and her explanted lung showed similar pathology. SFTPC mutations are inherited in an autosomal dominant pattern. Various types of ILD have been associated with SFTPC mutation including NSIP, usual interstitial pneumonia (UIP), and desquamative interstitial pneumonia (DIP). PNEC hyperplasia has been described to occur in association with lung inflammation but has not been previously described with familial ILD associated with SFTPC mutation. Norlalak Jiramethee, David Erasmus, Lawrence Nogee, and Andras Khoor Copyright © 2017 Norlalak Jiramethee et al. All rights reserved. Daptomycin-Induced Acute Eosinophilic Pneumonia: Late Onset and Quick Recovery Wed, 01 Nov 2017 07:49:51 +0000 Background. Daptomycin is a cyclic lipopeptide antibiotic that provides great coverage for gram positive cocci. From the early years of daptomycin use, concerns were raised regarding the pulmonary side effects of daptomycin and potential development of acute eosinophilic pneumonia (AEP) secondary to daptomycin therapy. Discussion. AEP could be idiopathic or induced by drugs or toxins. It is a distinct entity from atopic diseases and autoimmune, parasitic, or fungal infections that can also cause pulmonary eosinophilia. Multiple medications are associated with acute eosinophilic pneumonia. Multiple cases of daptomycin-induced AEP have been reported in the literature. Diagnosis of AEP is based on clinical history, laboratory tests, and radiographic studies. Obtaining bronchoalveolar lavage or lung biopsy is needed to confirm the diagnosis. Timing of the drug use and clinical presentation is crucial in the diagnosis of drug-induced AEP. Discontinuation of the offending drug and systemic corticosteroids are the mainstay treatment with great outcomes and recovery. Conclusion. We present a case of AEP caused by daptomycin, with complete recovery after discontinuation of daptomycin and administration of steroids. The patient had AEP after almost 6 weeks of daptomycin therapy which has never been reported in literature and our patient achieved complete recovery with appropriate management. Mohamad Rachid, Khansa Ahmad, Meghan Saunders-Kurban, Aelia Fatima, Aditya Shah, and Anas Nahhas Copyright © 2017 Mohamad Rachid et al. All rights reserved. Purulent Appearing Material in an Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration of Mediastinal Lymph Node: A Diagnostic Challenge Thu, 19 Oct 2017 07:04:32 +0000 Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has increasingly been performed for the diagnosis and staging of thoracic malignancies. Findings of a necrotic lymph node raise concern for infectious process and malignancy. A hypoechoic area on ultrasound/EBUS within a lymph node without blood flow is suggestive of pathologies like infections or malignancy. Inspection of the fluid could suggest a diagnosis; clear aspirates usually suggest bronchogenic or mediastinal cysts and purulent material suggests abscesses or necrotic lymph nodes. Growing tumor cells require a blood supply; if the vascular stroma is insufficient due to rapidly growing malignant tumors this could lead to large central areas of ischemic necrosis. Necrotic aspiration of lymph nodes is not always of infectious etiology. Aspiration of fluid in EBUS-TBNA is a rare occurrence, and malignancy should be considered when purulent fluid material is obtained. We present an elderly woman who underwent bronchoscopy with EBUS-TBNA for evaluation of upper lung nodule and mediastinal lymphadenopathy. Pus-like material was obtained on needle aspiration and endobronchial biopsy and mediastinal core biopsy revealed squamous cell carcinoma. Damaris Pena, Gilda Diaz-Fuentes, and Sindhaghatta Venkatram Copyright © 2017 Damaris Pena et al. All rights reserved. Hemoptysis following Talc Pleurodesis in a Pneumothorax Patient Mon, 16 Oct 2017 00:00:00 +0000 The purpose of this article is to report a case of hemoptysis occurring in combination with secondary spontaneous pneumothorax following chemical pleurodesis by talc. A Japanese male with cancer of renal pelvis was found with the left pneumothorax and multiple lung metastases. A computed-tomography scan revealed severe emphysema throughout the lungs. Talc pleurodesis was employed to arrest air leakage. The patient developed hemoptysis 45 minutes after talc injection into the thorax. This is the first report of hemoptysis following talc pleurodesis. The agent could induce severe inflammation in capillary vessels of the lung following visceral pleura infiltration. Yusuke Kakiuchi, Fumihiro Yamaguchi, Makoto Hayashi, and Yusuke Shikama Copyright © 2017 Yusuke Kakiuchi et al. All rights reserved. Symptomatic Patent Foramen Ovale with Hemidiaphragm Paralysis Mon, 16 Oct 2017 00:00:00 +0000 Dyspnea accounts for more than one-fourth of the hospital admissions from Emergency Department. Chronic conditions such as Chronic Obstructive Pulmonary Disease, Congestive Heart Failure, and Asthma are being common etiologies. Less common etiologies include conditions such as valvular heart disease, pulmonary embolism, and right-to-left shunt (RLS) from patent foramen ovale (PFO). PFO is present in estimated 20–30% of the population, mostly a benign condition. RLS via PFO usually occurs when right atrium pressure exceeds left atrium pressure. RLS can also occur in absence of higher right atrium pressure. We report one such case that highlights the importance of high clinical suspicion, thorough evaluation, and percutaneous closure of the PFO leading to significant improvement in the symptoms. Hussain Ibrahim, Adnan Khan, Shawn P. Nishi, Ken Fujise, and Syed Gilani Copyright © 2017 Hussain Ibrahim et al. All rights reserved. Multifocal Pulmonary Granular Cell Tumor Presenting with Postobstructive Pneumonia Sun, 15 Oct 2017 00:00:00 +0000 Granular cell tumor (GCT) is a neoplasm of Schwann cell origin. Its presence in the aerodigestive tract is uncommon and becomes a diagnostic challenge on initial presentation. Our case is of a 59-year-old woman who presented to the emergency department with a history of productive cough and dyspnea associated with fever and chest pain. An initial chest X-ray (CXR) showed a right middle lobe consolidation with follow-up Computed Tomography (CT) scan showing a mass in the right bronchus. Bronchoscopy revealed a polypoid, sessile granular mass in the right bronchus intermedius with multiple white lesions in trachea, left main bronchus, and right upper bronchi. Histology revealed a benign GCT. Bronchoalveolar lavage from the right middle lobe grew Streptococcus pneumoniae. Patient was treated with intravenous levofloxacin during hospital stay and discharged on a 7-day course of oral antibiotics to be followed as outpatient but was lost to follow-up. GCT can present as a polypoid tumor causing recurrent postobstructive pneumonia. Surgical resection is the most successful treatment option. The tumor is more common in third and fourth decade of life and our patient is the oldest patient, according to our knowledge, to have a GCT. Samid M. Farooqui, Muhammad S. Khan, Laura Adhikari, and Viral Doshi Copyright © 2017 Samid M. Farooqui et al. All rights reserved. Orthodeoxia without Platypnea in Hereditary Hemorrhagic Telangiectasia in the Presence of a Cerebral Abscess and Multiple Pulmonary Arteriovenous Malformations: Unusual Complications and Transcatheter Endovascular Treatment Thu, 12 Oct 2017 00:00:00 +0000 Hereditary hemorrhagic telangiectasia is a rare autosomal-dominant condition affecting visceral blood vessel development. Cerebral and most commonly pulmonary arteriovenous malformations are found in the majority of symptomatic patients. The most common complications include embolic strokes and cerebral abscesses, which have been attributed to abnormal vessel communications. Platypnea orthodeoxia is a rare condition that presents dyspnea and oxygen desaturation when adopting an upright position and is relieved on decubitus. The association between hereditary hemorrhagic telangiectasia, pulmonary arteriovenous malformations, and platypnea orthodeoxia has been described in medical literature; however, orthodeoxia as a single entity without platypnea has not been described yet, especially associated with complications of this hereditary condition. We present the case of a 38-year-old male with persistent headaches, in whom a cerebral lesion was detected. Orthostatic tachycardia and severe orthodeoxia without platypnea were evidenced during physical examination. The patient was subsequently diagnosed with hereditary hemorrhagic telangiectasia and underwent cerebral abscess drainage as well as transcatheter endovascular closure of multiple pulmonary arteriovenous malformations. For this reason, the concept of platypnea orthodeoxia syndrome needs further revision. Patients presenting refractory hypoxemia should warn physicians to initially evaluate their oxygen saturation measurements during standing and decubitus position, even though platypnea may not be present. Carlos Salazar, Jacky Bruce Blank, and Veronica Palmero Copyright © 2017 Carlos Salazar et al. All rights reserved. A Case Report on VT from TV: DVT and PE from Prolonged Television Watching Tue, 03 Oct 2017 07:19:59 +0000 Pulmonary embolus (PE) and deep vein thrombosis are diagnoses that are commonly made in the emergency department. Well known risk factors for thromboembolic events include immobility, malignancy, pregnancy, surgery, and acquired or inherited thrombophilias, obesity, cigarette smoking, and hypertension. We present a case of a 59-year-old female who watched TV and developed leg swelling and was found to have PE and DVT. Alan Lucerna, James Espinosa, Lindsey Ackley, Philip Carhart, Douglas Stranges, and Risha Hertz Copyright © 2017 Alan Lucerna et al. All rights reserved. A Rare Case of Idiopathic Plastic Bronchitis Mon, 02 Oct 2017 00:00:00 +0000 Plastic bronchitis is a rare disorder characterized by formation of large, branching bronchial casts, which are often expectorated. We present an interesting case of a 35-year-old woman who presented for evaluation of a chronic cough productive of voluminous secretions. Clinical and radiological examination confirmed a total left lung atelectasis without any pathological mediastinal node. Flexible bronchoscopy demonstrated tenacious, thick, and sticky whitish secretions blocking the left stem bronchus. This material was extracted, and inspection demonstrated a bronchial cast, whose pathological analysis revealed necrotic epithelial cells, some eosinophils, and Charcot-Leyden crystals. Two days after bronchoscopy, the patient rejected more bronchial casts, and dyspnea improved. Control of chest x-ray revealed complete left lung aeration and the diagnosis of idiopathic plastic bronchitis was obtained. This article shows the interest in clinical practice to evoke the diagnosis of plastic bronchitis in front of a productive chronic cough. Our case illustrates a rare clinical presentation represented by an atelectasis of an entire lung. Mohammed Raoufi, Leila Achachi, Fatima Zahra Mrabet, Laila Herrak, Mustapha El Ftouh, Najoua Bourhroum, and Nezha Ouazzani Taibi Copyright © 2017 Mohammed Raoufi et al. All rights reserved. Rare Congenital Aberrant Left Superior Pulmonary Vein Discovered with Central Line Placement in a Patient with Critical Cardiorespiratory Collapse Wed, 13 Sep 2017 00:00:00 +0000 Background. Partial anomalous pulmonary venous connection is a rare congenital vascular disorder that may be asymptomatic. Left-sided connections with the innominate vein are discovered infrequently and those without an atrial septal defect are extremely rare. Case. A 66-year-old male was found to have an anomalous left pulmonary vein when a central venous catheter was inserted for management of hypoxemia. In addition to the connection with the left innominate vein an echocardiogram revealed no atrial septal defect. Computed tomography arteriography was used to define the anomaly. Conclusion. Left superior vein partial anomalous pulmonary venous connection with the left innominate vein was discovered incidentally on insertion of central venous catheter. The otherwise innocuous anomaly can become a significant variable when treating critical cardiopulmonary collapse. Spencer Knox, Mario Madruga, and S. J. Carlan Copyright © 2017 Spencer Knox et al. All rights reserved. Acute Low-Dose Hydralazine-Induced Lupus Pneumonitis Tue, 08 Aug 2017 06:32:53 +0000 A 35-year-old female was started on hydralazine 10 mg orally three times a day for treatment of postpartum hypertension. Three months later, after multiple unsuccessful courses of prednisone and antibiotics for presumed pneumonia and asthma exacerbations, her respiratory symptoms progressed in severity and she developed resting hypoxia. Previous diagnostic work-up included spirometry with a restrictive pattern, chest CT showing bilateral basilar consolidation, negative BAL, and nonspecific findings on lung biopsy of mild inflammatory cells. Review of systems was positive for arthralgia, lymphadenopathy, paresthesia, and fatigue that began four weeks after starting hydralazine. A clinical diagnosis of hydralazine-induced lupus (HIL) with pneumonitis was made. Antihistone antibodies were positive supporting a diagnosis of HIL. Management included cessation of hydralazine and a prolonged steroid taper. Within days, patient began improving symptomatically. Six weeks later, CT chest showed complete resolution of infiltrates. Genetic testing revealed she was heterozygous for N-acetyltransferase 2 (intermediate acetylator). Drug-induced lupus should be considered in patients with lupus-like symptoms taking medications with a known association. While the majority of HIL cases occur with high doses and prolonged treatment, cases of low-dose HIL have been reported in patients who are slow acetylators. Sarah K. Holman, Donique Parris, Sarah Meyers, and Jason Ramirez Copyright © 2017 Sarah K. Holman et al. All rights reserved. Primary Pulmonary Lymphoma Presenting with Superior Vena Cava Syndrome in a Young Female Tue, 08 Aug 2017 00:00:00 +0000 Primary Pulmonary Diffuse Large B Cell Lymphoma (PPDLBCL) is an extremely rare entity, which exhibits an aggressive behavior by compressing local blood vessels. It represents only 0.04% of all lymphoma cases and is extremely rare in young age. We present a case of a primary pulmonary lymphoma with superior vena cava syndrome (SVCS) in a young female. 27-year-old African American female presented with fever, cough, and facial puffiness for 2 weeks and unintentional weight loss. Chest examination showed decreased breath sounds and dullness on percussion on right side. Labs were normal except for mild leukocytosis, high lactate, and lactate dehydrogenase. Chest X-ray showed a large right side infiltrate with pleural effusion but chest CT showed 10 × 14 × 16 cm mass in the right lung without hilar and mediastinal lymphadenopathy. CT guided biopsy of the right lung mass was done and large B cell lymphoma was diagnosed. She received “involved field radiation” because of the bulky tumor size and superior vena cava involvement prior to R-CHOP to which she responded well. PPDLBCL should be considered as one of the differentials in a young patient with a large lung mass, which needs timely diagnosis and management. Divya Salhan, Prakash Verma, Tun Win Naing, Ebad Ur Rehman, Saroj Kandel, Danillo Enriquez, Joseph Quist, and Frances Schmidt Copyright © 2017 Divya Salhan et al. All rights reserved. Arterial Thoracic Outlet Syndrome Treated Successfully with Totally Endoscopic First Rib Resection Sun, 06 Aug 2017 00:00:00 +0000 Thoracic outlet syndrome (TOS) is a constellation of signs and symptoms caused by compression of the neurovascular structures in the thoracic outlet. TOS may be classified as either neurogenic TOS (NTOS) or vascular TOS: venous TOS (VTOS) or arterial TOS (ATOS), depending on the specific structure being affected. The basis for the surgical treatment of TOS is resection of the first rib, and it may be combined with scalenectomy or cervical rib resection. Herein, we describe a case of arterial thoracic outlet syndrome which was successfully treated with totally endoscopic video-assisted thoracoscopic surgery (VATS) first rib resection. Sofoklis Mitsos, Davide Patrini, Sara Velo, Achilleas Antonopoulos, Martin Hayward, Robert S. George, David Lawrence, and Nikolaos Panagiotopoulos Copyright © 2017 Sofoklis Mitsos et al. All rights reserved. Intercostal Artery Laceration: Rare Complication of Thoracentesis and Role of Ultrasound in Early Detection Wed, 02 Aug 2017 06:53:49 +0000 Hemothorax is a rare but potentially fatal postthoracentesis complication. Early clinical signs may be nonspecific resulting in diagnostic delay. A high index of suspicion is vital for early diagnosis and intervention to avoid further bleeding. Following procedure, early bedside ultrasound findings can be vital for early detection. We report a case of massive hemothorax in a 63-year-old male following therapeutic thoracentesis. Diagnosis was made following highly suggestive sonographic findings prompting thoracotomy and lacerated intercostal artery cauterization. Wissam Mansour, Ghassan Samaha, Sandy El Bitar, Ziad Esper, and Rabih Maroun Copyright © 2017 Wissam Mansour et al. All rights reserved. A Rare Case of Aortoatrial Fistula from Streptococcal Endocarditis Wed, 05 Jul 2017 00:00:00 +0000 We represent an unfortunate case of postinfluenza streptococcal endocarditis in a 34-year-old healthy male. He presented with hypoxic respiratory failure and was found to have mitral and aortic valve vegetation. Hospital course was complicated by the presence of an aortoatrial fistula from an aortic root abscess, persistent septic shock, and multiorgan failure. Hammad Arshad, Meilin Young, and Parth Rali Copyright © 2017 Hammad Arshad et al. All rights reserved. An Unusual Presentation of Congenital Lobar Emphysema Mon, 24 Apr 2017 08:53:14 +0000 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 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 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 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 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 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 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 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 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 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 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 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.