Ala Eddin Sagar

Invasive pulmonary aspergillosis in a steroid-dependent asthmatic

A 51-year old Caucasian female with a history of severe persistent asthma that is steroid-dependent with multiple prior intubations presented with 2 weeks of progressive shortness of breath associated with a cough productive of yellow sputum. She denied any fever, runny nose, recent travel or sick contacts but admits to unintentional weight loss. She tried increasing her prednisone dose at home (up to 100 mg/day) without significant relief. On physical examination, she was noted to be tachycardic and in mild respiratory distress with an inability to lie flat. She had diffuse inspiratory and expiratory wheezing on auscultation. Her WBC count on admission was noted to be elevated at 24.6 109/L and shewas found to be in respiratory alkalosis on ABGwith a pH of 7.57, pCO2 of 26 and oxygen saturation of 90% on room air. She had a positive pneumococcal urinary antigen and her PCR nasal swab demonstrated rhinovirus was present. Her initial CT scan displayed subtle ground glass opacities in bilateral upper lobes. Despite treatment for community-acquired pneumonia with levofloxacin,

Clinical and Histopathologic Correlates and Management Strategies for Inflammatory Myofibroblastic tumor of the lung. A case series and review of the literature

Inflammatory myofibroblastic tumor (IMT) is a mesenchymal neoplasm that may arise in soft tissues of nearly every organ. Although IMTs are the most common lung tumors in pediatric populations, these tumors are extremely rare in adults, constituting less than 1% of adult lung tumors. IMTs are characterized by proliferating spindle cells with variable inflammatory component. The biological behavior of lung IMTs in adults is highly unpredictable, which confounds diagnosis and treatment. We retrospectively investigated patients with pulmonary lesions and the histopathologic diagnosis of inflammatory myofibroblastic tumor or its synonymous names (Plasma Cell Granuloma, xanthogranuloma, inflammatory pseudotumor, fibroxanthoma, and fibrous histiocytoma) at the MD Anderson Cancer Institute in the period between August 2000 and August 2016. We describe 7 adult cases of IMT of the lung that were diagnosed at MD Anderson Cancer Center. These cases highlight the tumor’s variability in terms of clinical presentation, histopathology, and biologic behavior, and underscore the challenges in the management of these rare lung neoplasms.

Complete Heart Block Following Cold Saline Lavage during Bronchoscopy

nationwide survey by the Japan Society for Respiratory Endoscopy. Respir Res. 2013;14:50. 4. Al-Qadi MO, Maldonado F. Focal tracheal stenosis due to intramural hematoma following endobronchial ultrasound-guided transbronchial needle aspiration. J Bronchology Interv Pulmonol. 2014;21:274–276. 5. Vincent B, Huggins JT, Doelken P, et al. Successful real-time endobronchial ultrasound-guided transbronchial needle aspiration of a hilar lung mass obtained by traversing the pulmonary artery. J Thorac Oncol. 2006;1:362–364.

Pulmonary embolism caused by thrombin-based haemostatic matrix

A 38-year-old woman underwent an outpatient L5/S1 discectomy. The procedure was complicated by intraoperative bleeding, and haemostasis was achieved using a thrombin-based haemostatic matrix (TBHM). She presented to our facility on postoperative day 5 with left-sided chest pain and dyspnoea. CT pulmonary angiography (CTPA) showed a heterogeneous filling defect with mixed attenuation and a ‘pseudoair pattern’ in the left main pulmonary artery (figure 1). Duplex ultrasound of the upper and lower extremities was negative for venous thrombus. An echocardiogram was normal. Pulmonary angiography showed occlusion of the basal branches of the left pulmonary artery (figure 2). Therapeutic …