Trilok Chand

Endotracheobronchial lymphoma: Two unusual case reports and review of article

The tracheobronchial origin of non-Hodgkins lymphoma (NHL) is a very rare presentation, and there are only a few case reports of primary tracheal or endobronchial NHL. We have two cases of primary tracheobronchial NHL; one case was incidentally diagnosed as anaplastic large cell lymphoma of endobronchial origin when a comprehensive workup and surgery were carried out for an endobronchial aspergilloma which was actually sitting on top of lymphoma. The second patient was a case of myelodysplastic syndrome who presented with acute respiratory distress; on thorough workup, he was found to have endotracheal B-cell lymphoma. Both cases were responding well with standard chemotherapy. The mortality in these kinds of patients is due to disease progression or airway compromise and treatment complications.

A case of hypoplasia of left lung with very rare associations with congenital absence of left pulmonary artery and right-sided aortic arch

The absence of one of the pulmonary artery with associated hypoplasia of lung and great vessel abnormality is a rare finding. The incidence of this rare congenital abnormality is around 1 in 200,000 live birth. The absence of the left side pulmonary artery is again uncommon, and associated cardiac malformations are usually tetralogy of fallot or septal defects rather than an aortic arch defect. Our case is a unique case in It’s associated congenital anomalies. He was presented with recurrent pneumothorax and hemoptysis, and on thorough workup, he was diagnosed to have an absence of left pulmonary artery with hypoplasia of the left lung and associated right-sided aortic arch. The patient’s family has declined the surgical option, and he was managed conservatively and kept in close follow-up.

Pseudomonas species as an uncommon culprit in transbronchial needle aspiration of mediastinal lymph node

Mediastinal lymphadenopathy due to various infective agents such as Mycobacterium and fungus, due to sarcoidosis, lymphoma, and metastasis is often seen. Ordinary bacteria have rarely been reported to cause necrotizing, usually suppurative granulomatous reactions. We report a case of mediastinal lymphadenopathy due to Pseudomonas infection, in a patient of chronic kidney disease on maintenance hemodialysis, who presented with fever, breathlessness, and low blood pressure.

A case of autopneumonectomy without any symptoms

Autopneumonectomy simply describes the autolysis or almost complete destruction of the lung tissue without any surgical removal of the lung. This is not a common occurrence but is sometimes observed in areas where tuberculosis (TB) is endemic. The patients are usually diagnosed when they come to the hospital either with complications related to autopneumonectomy or a postpneumonectomy-like syndrome. Rarely, these patients remain asymptomatic until late age. Our case was an elderly female with an abnormal chest X-ray, who was referred to us for respiratory clearance for the surgical fixation of the fracture of the neck of femur. The history revealed that she had some chest infection and/or pulmonary TB in childhood that explained the autopneumonectomy. The patient underwent a successful surgery and was discharged with advice to follow-up for any chest complaints in the future. The following core competencies are addressed in this article: Patient care, Medical knowledge.

Bilateral chylothorax in a patient with chronic central vein thrombosis and chronic thromboembolic pulmonary hypertension

The chylothorax is not a common presentation, and bilateral chylothorax in patients with chronically high central venous pressure secondary to venous thrombosis is a rare in incidence. We reported a case of bilateral chylothorax in a patient of chronic deep vein thrombosis (DVT) in central veins with chronic thromboembolic pulmonary hypertension who presented with 2 weeks history of increased breathlessness, bilateral chest discomfort and weakness. Work-up with chest X-ray and ultrasonography-chest showed gross left sided and mild right sided pleural effusion, thoracocentesis was consistent with chylothorax. Contrast enhanced computed tomography-chest showed multiple collateral formation of left side subclavian vein, venous Doppler showed old DVT in right and left subclavian veins and two-dimensional echocardiogram showed finding of severe pulmonary hypertension. After 24 h of fasting and conservative management, pleural drain became clear and decreased in the amount. Patients video assisted thoracoscopic surgery was done, and thoracic duct was ligated and cut down at diaphragmatic level and bilateral talc pleurodesis done. Patient improved clinically and radiologically.