Tahir Khan

An Unusually Aggressive Large Cell Carcinoma of the Lung: Undiagnosed until Autopsy

Large cell carcinoma (LCC) of the lung has a rapid mean volume doubling time (VDT) of around 67-134 days. In some cases of LCC where the VDT is extremely rapid, clinical presentation may mimic acute lung pathologies such as pneumonia. We describe a rare presentation of an aggressive LCC of the lung with an estimated VDT of around two weeks. A 52-year-old male with a history schizophrenia presented with fever, cough, and dyspnea for three weeks duration. His medical history was significant for a recent admission six weeks before current presentation for myocardial infarction (MI) and pneumonia. Chest radiograph during the current admission showed a new right lung infiltrate and he was treated for healthcare-associated pneumonia. However, the patient developed acute respiratory failure due to right lung collapse requiring intubation and mechanical ventilation. An urgent bronchoscopy revealed an obstructing endobronchial mass in right mainstem bronchus. A computed tomography (CT) scan of the chest showed encasement of right upper and lower lobe bronchus with extensive mediastinal lymphadenopathy. The patient expired within the next 24 hours. The autopsy showed undifferentiated LCC of lung metastatic to the regional lymph nodes. Of note is the fact that the patient had CT chest in his prior admission which showed no signs of lung or mediastinal mass. We report a case of LCC which manifested as pneumonia over a six-week period with a calculated doubling time of 14.1 days. Oxidative stress secondary to recent MI and schizophrenia may have a role in the unusual aggressiveness in this case.

Vanishing Lung Syndrome: Compound Effect of Tobacco and Marijuana Use on the Development of Bullous Lung Disease – A Joint Effort

Marijuana use has been increasing across the United States due to its legalization as both a medicinal and recreational product. A small number of case reports have described a pathological entity called vanishing lung syndrome (VLS), which is a rare bullous lung disease usually caused by tobacco smoking. Recent case reports have implicated marijuana in the development of VLS. We present a case of a 47-year-old man, who presented to our hospital with shortness of breath, fevers and a productive cough. On physical exam, he was tachypneic with audible stridor and absent right sided breath sounds. Laryngoscopy showed a retropharyngeal abscess, and chest radiography showed a possible right pneumothorax. Chest computed tomography (CT) showed bilateral bullous emphysematous lung disease with a giant bulla occupying most of his right lung field. He was placed on mechanical ventilation and treated with broad spectrum antibiotics in the intensive care unit, where he developed acute respiratory distress syndrome (ARDS). He continued to decline, and developed disseminated intravascular coagulation, after which he succumbed to his disease.