Thitiporn Suwatanapongched

Primary polymorphous low-grade adenocarcinoma of the bronchus: Complete tumor removal with bronchoscopic resection

Primary polymorphous low-grade adenocarcinoma (PLGA) is an uncommon malignant tumor arising from the minor salivary glands, but its occurrence as a primary tumor of the tracheobronchial tree is very rare. Herein, we have reported a rare case of endobronchial PLGA in a 56-year-old woman presenting with chronic cough and progressive exertional dyspnea. Chest CT clearly demonstrated an endobronchial tumor obstructing the distal part and bifurcation of the left main bronchus and causing distal atelectasis. She underwent rigid bronchoscope with electrocautery and bronchoscopic resection of the tumor. PLGA was diagnosed histologically. Subsequent left pneumonectomy was performed and showed no evidence of residual tumor.

Thoracic endometriosis with catamenial haemoptysis and pneumothorax: computed tomography findings and long-term follow-up after danazol treatment.

Thoracic endometriosis (TE) is an uncommon disorder affecting women of childbearing age. We herein report clinical and thin-section computed tomography (CT) findings of two cases, in which one woman presented with catamenial haemoptysis (CH) alone and another woman presented with bilateral catamenial pneumothoraces (CP) coinciding with CH, a rare manifestation of TE. The dynamic changes demonstrated on thin-section chest CT performed during and after menses led to accurate localisation and presumptive diagnosis of TE in both patients. Following danazol treatment, the patient with CH alone had a complete cure, while the patient with CP and CH had an incomplete cure and required long-term danazol treatment. We discuss the role of imaging studies in TE, with an emphasis on the appropriate timing and scanning technique of chest CT in women presenting with CH, potential mechanisms, treatment and patient outcomes.

Acute respiratory failure secondary to eosinophilic pneumonia following influenza vaccination in an elderly man with chronic obstructive pulmonary disease

Summary Acute respiratory failure with diffuse pulmonary opacities is an unusual manifestation following influenza vaccination. We report herein a patient with chronic obstructive pulmonary disease who developed fever with worsening of respiratory symptoms and severe hypoxemia requiring ventilatory support shortly after influenza vaccination. Bronchoalveolar lavage was compatible with acute eosinophilic pneumonia. Rapid clinical improvement was observed 2 weeks after systemic corticosteroid treatment, followed by radiographic improvement at 4 weeks. No disease recurrence was observed at the 6-month follow-up.

Puzzling Bronchial Trifurcation

Unexpected and puzzling variations in bronchial anatomy might be discovered during bronchoscopy. The occurrence of congenital tracheobronchial anomaly is estimated to range between 1% and 12% of the overall population.[1][1] We present 2 rare cases of congenital bronchial anomaly that were

A case of recurrent pneumothorax related to oral methylphenidate.

Primary spontaneous pneumothorax (PSP) commonly occurs in young, tall, and thin males, without any identifiable cause except for emphysema-like changes (ELCs). However, other risk factors may be overlooked. Herein, we report the case of a 19-year-old male who presented with recurrent spontaneous pneumothorax while taking oral methylphenidate.

A 76-Year-Old Man With Anemia, Bone Pain, and Progressive Dyspnea

76-year-old man presented with left-sided hip pain radiating to the leg and foot for 4 weeks. He was a former smoker. The patient’s medical history included coronary artery disease, benign prostatic hypertrophy, and mild chronic renal impairment (serum creatinine, 1.5 mg/dL). Other previous blood chemistry tests and chest radiographs obtained 6 months earlier were unremarkable. The plain radiographs of the lumbosacral spine revealed only mild degenerative changes. Two weeks later, the patient developed progressive dyspnea and dry cough without fever, orthopnea, or paroxysmal nocturnal dyspnea. On examination, he looked distressed and was tachypneic. Fine crepitations were heard bilaterally in the lower lungs. Both legs were edematous. There was a hard, nonpainful palpable mass at the sternum. Other physical examinations and neurologic signs were normal.

Chronic Klebsiella pneumonia: a rare manifestation of Klebsiella pneumonia.

K. pneumoniae can present as two forms of community-acquired pneumonia, acute and chronic. Although acute pneumonia may turn into necrotizing pneumonia, which results in a prolonged clinical course, it often has a rapidly progressive clinical course. In contrast, chronic Klebsiella pneumonia runs a protracted indolent course that mimics other chronic pulmonary infections and malignancies. Herein, we present two cases of chronic Klebsiella pneumonia. The diagnosis was made by microorganism identification, as well as absence of other potential causes. Clinical and radiographic findings improved after a prolonged course of antibiotic therapy.

Assessment of diaphragmatic function parameters by intensive care ultrasound compared to conventional parameters during spontaneous breathing trial

Ultrasound can demonstrate the characteristics of the diaphragm functions that involve to the weaning process.

Expiratory air trapping during asthma exacerbation: Relationships with clinical indices and proximal airway morphology

OBJECTIVES To semi-quantitatively assess expiratory air trapping (AT(exp)) and structural changes in the proximal airways in asthma during asthma exacerbation (AE) and to explore the relationships among AT(exp), clinical indices, and proximal airway changes. METHODS Paired inspiratory-dynamic forced expiratory CT scans of 36 asthmatics (30 women, 6 men; mean age, 49.2±18.9 years) performed during AE were retrospectively reviewed for the total AT(exp) score (summed scores [extent grading (0-4)×pattern grading (1-4)] of the twelve lung zones), morphologic parameters and expiratory bronchial collapse (BC(exp)) of the proximal airways. The relationships of the score with clinical indices and proximal airway morphology (normalized by body surface area [BSA]) were analyzed. A p value of <0.05 was considered statistically significant. RESULTS The mean total AT(exp) score was 110.1±43.4 (range, 8-166). It was higher in the lower zones and in patients older than 60 years, having BMI of <27.5 kg/m(2), and peak expiratory flow rate (PEFR) of <60% predicted. Correlation existed between the score and age (r=0.331), BMI (r=-0.375), BSA (r=-0.442), % predicted PEFR (r=-0.332), right upper lobe apical segmental bronchus (RB1)-wall area (WA)/BSA (r=0.467), %RB1-WA (r=0.395), and RB1-bronchial wall thickness (BWT)/BSA (r=0.378). The score showed no correlation with BC(exp) and other morphologic bronchial parameters. Area under receiver-operating-characteristic curve 0.724 (95% CI) showed that the score of 110 could discriminate patients with PEFR of <60% predicted from those with PEFR of ≥60% predicted. CONCLUSION During AE, there was a high prevalence of extensive AT(exp) which was correlated with patients age, BMI, BSA, AE severity and RB1 morphology but not correlated with BC(exp).

A Patient With Subcutaneous Emphysema Following Endotracheal Intubation

Difficult intubation can be found in 11% of emergency tracheal intubations.[1][1] Predictors of difficult tracheal intubation have been described, such as mouth opening, Mallampati classification, atlanto-occipital joint extension, mandibulohyoid distance, inter-incisor distance, thyromental