Miku Oda

Calcium oxalate crystal deposition in a patient with Aspergilloma due to Aspergillus niger

Discrimination between aspergilloma and chronic necrotizing pulmonary aspergillosis (CNPA) based on radiological findings can difficult. We describe a patient with aspergilloma and organizing pneumonia that was possibly caused by Aspergillus niger infection and radiologically mimicked CNPA. A postmortem histological analysis showed diffuse alveolar damage that had originated in peri-cavitary lung parenchyma. Calcium oxalate or Aspergillus niger was located inside, but not outside the cavity in the right upper lobe. Calcium oxalate or other unknown hyphal bioactive components might provoke severe lung inflammation not only adjacent to the cavity, but also on the contralateral side.

Fluorodeoxyglucose (FDG) uptake in pulmonary rheumatoid nodules diagnosed by video-assisted thoracic surgery lung biopsy: two case reports and a review of the literature

Two cases of rheumatoid nodules evaluated by fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) and video-assisted thoracic surgery (VATS) biopsy are reported. The first case was that of a 44-year-old woman who presented with a cavitated nodule with intense standardized uptake values (SUVs) both in the early (max 3.4) and delayed (max 4.4) phases, suggesting malignancy. However, after VATS biopsy, she was diagnosed as having a rheumatoid nodule with vasculitis. The second case was that of a 74-year-old woman admitted with bilateral lung nodules, two of which showed intense early (max 2.2) and delayed (max 6.0) phase SUVs, and mild early (max 0.6) and delayed (max 0.9) phase SUVs. These two nodules were finally proven to be a lung cancer and rheumatoid nodule without vasculitis, respectively. These cases show that rheumatoid nodules with an enhanced inflammatory process, such as vasculitis, can appear false-positive for malignancy on FDG-PET/CT scan images.

The Role of Vital Signs in Predicting Cardiac Tamponade in Asymptomatic Patients with Malignancy: Associated Pericardial Effusion

Background: Cardiac tamponade is a potentially life-threatening complication in patients with advanced lung cancer or other metastatic malignant diseases. However, few reports described how to assess the risk for developing cardiac tamponade in asymptomatic patients with pericardial effusion. Methods: The medical records of all patients with malignancy-associated cardiac tamponade diagnosed between April 2006 and June 2012 at Kyorin Hospital were retrospectively reviewed. This study mainly focused on the correlation between the duration between the first recognition of pericardial effusion on computed tomography and cardiac tamponade diagnosis and the vital signs at each point. Results: We identified 17 patients with malignancy-associated cardiac tamponade, mainly due to lung cancer (n=11, adenocarcinoma; n=1, non-small cell carcinoma; n=1, large cell neuroendocrine carcinoma; n=1, small cell carcinoma; and n=1, squamous cell carcinoma) followed by malignant mesothelioma (n=1), and an unknown cause (n=1). Among 17 patients with cardiac tamponade, the systolic blood pressure at the time of malignancy diagnosis was significantly higher than that at the onset of cardiac tamponade (average±SD, 115±13 vs 95±25 mm Hg; p=0.014), whereas heart rate (HR) and cardiothoracic ratio (CTR) determined on chest radiography were significantly higher at the onset of cardiac tamponade (HR, 84±15 bpm vs 111±30; p<0.001) (CTR, 49±7% vs 71±4.9; p=0.001). The correlation coefficient between the days from the first recognition of pericardial effusion on thoracic computed tomography to cardiac tamponade diagnosis and the gap of vital signs at each point such as ΔHR (r=−0.422, p=0.345) and ΔCTR (r=−0.212, p=0.647) was not statistically significant. Conclusion: This preliminary study demonstrated that increased HR and CTR are essential signs for predicting malignancy-associated cardiac tamponade.

Clinical significance of respiratory virus detection in patients with acute exacerbation of interstitial lung diseases

Abstract Background The impact of viral infections on acute exacerbations in idiopathic pulmonary fibrosis (IPF) and/or non-IPF interstitial lung disease (ILDs) has been scarcely described. Objectives To elucidate the frequency of virus infections in patients with IPF or non-IPF ILDs including idiopathic interstitial pneumonia (IIP) or connective tissue disease (CTD)-associated pneumonia, and its influence on their short-term mortality. Methods We prospectively enrolled adult patients with acute exacerbation of IPF and non-IPF ILDs who were admitted to the hospital during the last 3 years, and examined the respiratory samples obtained from nasopharyngeal, sputum, and bronchoalveolar lavage fluid. Results A total of 78 patients were identified, consisting of 27 patients with acute exacerbation of IPF and 51 patients with non-IPF ILDs (IIP: n = 27, CTD-associated IP: n = 24). Of all patients, 15 (19.2%) had viruses detected in their respiratory samples including the human herpesvirus 7 (HHV7; n = 4) and cytomegalovirus (CMV) plus HHV7 (n = 3). The proportion of virus infections in the IPF and non-IPF ILDs groups was comparable. The Kaplan-Meier survival curves over 60 days revealed a lower survival probability in the virus positive group (n = 15, 60%) than in the virus negative group (n = 60, 83.3%, p < 0.05). However, the virus infection itself could not predict the 60-day survival probability using simple logistic regression analysis. Conclusions Viral infections, mostly CMV or HHV7, were identified in both patients with acute exacerbation of IPF and non-IPF ILDs, but the clinical significance on short-term mortality or isolation itself from respiratory samples remains to be determined.

Diagnostic Value of Vascular Endothelial Growth Factor, Transforming Growth Factor-β, Interleukin-8, and the Ratio of Lactate Dehydrogenase to Adenosine Deaminase in Pleural Effusion

PurposeWe studied the diagnostic value of cytokines, including vascular endothelial growth factor (VEGF), transforming growth factor-β (TGF-β), and interleukin-8 (IL-8), and the ratio of lactate dehydrogenase (LDH) to adenosine deaminase (ADA) in pleural fluid.MethodsProspective analysis of 44 inpatients or outpatients with pleural fluid, from December 2016 to March 2017 was conducted.ResultsWe enrolled patients with malignant pleural effusion (MPE, N = 15), empyema (N = 11), parapneumonic effusion (PPE, N = 7), chronic renal failure (CRF)/chronic heart failure (CHF) (N = 7), and tuberculous pleural effusion (TBPE, N = 4). The pleural fluid values of IL-8 and VEGF were significantly higher in empyema patients than in CRF/CHF or PPE patients. In all patients, the pleural fluid VEGF and IL-8 values were significantly positively correlated (r = 0.405, p = 0.006; r = 0.474, p = 0.047, respectively). TGF-β was elevated in patients with empyema, PPE, TBPE, and MPE. The pleural LDH-to-ADA ratio in patients with MPE or empyema/PPE was significantly higher than in patients with CRF/CHF or TBPE. LDH and ADA levels correlated significantly only in patients with MPE (r = 0.648, p = 0.009) and empyema/PPE (r = 0.978, p < 0.001).ConclusionsVEGF and IL-8 production in the pleural cavity appear to accelerate the progression of PPE to empyema, by enhancing vascular permeability associated with inflammation. Sequential sampling would be needed to confirm this. The pleural LDH/ADA ratio may be a useful diagnostic tool for discriminating between various pleural effusion etiologies.

A Novel Diagnostic Scoring System to Differentiate between Legionella pneumophila Pneumonia and Streptococcus pneumoniae Pneumonia

Objective We investigated a novel diagnostic scoring system to differentiate Legionella pneumophila pneumonia from Streptococcus pneumoniae pneumonia. Methods We retrospectively reviewed the clinical data of 62 patients with L. pneumophila pneumonia (L-group) and 70 patients with S. pneumoniae pneumonia (S-group). Results The serum sodium (Na) levels tended to be lower according to the severity [age, dehydration, respiratory failure, orientation disturbance, low blood pressure (A-DROP)] score in the L-group. On a multivariate analysis, we found that four factors were independent predictive markers for inclusion in the L-group: relative bradycardia [hazard ratio (HR) 5.177, 95% confidence interval (CI): 1.072-24.993, p=0.041], lactate dehydrogenase (LDH) levels ≥292 IU/L (HR 6.804, 95% CI: 1.629-28.416, p=0.009), C-reactive protein (CRP) levels ≥21 mg/dL (HR 28.073, 95% CI: 5.654-139.462, p<0.001), and Na levels ≤137 meq/L (HR 5.828, 95% CI: 1.411-24.065, p=0.015). Furthermore, a total score [ranging from 0 to 4, the sum of the points for each factor (0 or 1)] ≥3 points indicated a higher probability of inclusion in the L-group than in the S-group. The diagnostic accuracy of a total score of 3 had a sensitivity of 36.3%, specificity of 100%, and area under the curve of 0.682 (95% CI: 0.558-0.806, p=0.004), and that of a total score of 4 had a sensitivity 27.4%, specificity of 98.2%, and area under the curve (AUC) of 0.627 (95% CI: 0.501-0.754, p=0.045). The diagnostic accuracy had low sensitivity but high specificity. Conclusions We found four markers that might be useful for differentiating L-group from S-group and created a novel diagnostic scoring system.

Memory of World War II with loud atypical friction rub due to pulmonary asbestosis

An 87-year-old healthy woman was admitted to our hospital with progressive dyspnoea on effort since the preceding 6 months. She had a history of total gastrectomy, performed 5 years earlier. She was a non-smoker and worked as a business manager. She did not abuse drugs. During World War II, when she was 15 years old, she worked for a year in a factory manufacturing the brake pads of fighter planes using copious amounts of asbestos. Physical examination revealed the presence …

Acute eosinophilic pneumonia masquerading as multiple pulmonary embolisms

A 47-year-old previously healthy man was admitted to the hospital with a 5-day history of fever, dry cough, and dyspnoea. Thoracic radiographs and CT scan showed extensive bilateral consolidation predominantly involving the central portions of the upper lung lobes, along with multiple scattered nodules. On taking a thorough history, it was found that the patient had visited a gritty 100-year-old Japanese folk house 1 week ago. An urgent bronchoscopy was performed, and the results were consistent with the findings of acute eosinophilic pneumonia (AEP). The patients respiratory distress resolved within 10 days without treatment. Hence, even in an AEP case with atypical radiological presentations, careful history taking can lead to a rapid diagnosis.