Zuber Ahmad

Mediastinal hydatid cyst rupturing into the pleural cavity associated with pneumothorax: case report and review of the literature.

Hydatid disease remains a serious health problem in Mediterranean countries. Living in a rural area is an important risk factor for the disease. Hydatid cysts are usually located in the liver, lungs and brain. Mediastinal hydatid disease is very rare and has been noted only anecdotally in the literature. The present article reports a case of a mediastinal hydatid cyst rupturing into the pleural cavity, which was associated with pneumothorax of the same side. The patients previous chest x-rays (posteroanterior and left lateral views) showed a well-defined mediastinal mass on the left side, and contrast-enhanced computed tomography of the thorax (taken a few days after the chest x-ray) showed multiple round-to-oval soft tissue opacities with partial collapse of the left lung. An indirect hemagglutination test for echinococcus was positive. Even after two weeks of intercostal tube drainage, the patients condition did not improve. During thoracotomy, multiple daughter cysts were found in the pleural cavity, and the diagnosis of a hydatid cyst was confirmed after histopathological examination.

Traumatic pulmonary pseudocyst: a case report.

Traumatic pulmonary pseudocyst is a rare clinical event that may occur following chest trauma. This complication usually occurs as a result of blunt trauma and rarely, due to a penetrating injury. We report an unusual case of a 10-year-old boy who developed a left-sided pneumothorax along with a traumatic pulmonary pseudocyst when he was hit by a cricket ball while playing.

Role of fine-needle aspiration cytology in evaluating mediastinal masses.

Background: Fine-needle aspiration cytology is an important and useful investigation and is considered next to imaging in the diagnosis of mediastinal lesions. We carried out this study in the Department of TB and respiratory diseases JNMC Aligarh from March 2000 to March 2002 with the following aims. Objectives: To make etiological diagnosis of mediastinal lesions, determine the pathological type of the tumor in cases of malignancy and evaluate the role of fine-needle aspiration cytology in staging of bronchogenic carcinoma. Materials and Methods: A total of 56 patients were included in this study who had mediastinal mass with or without lung lesions on chest X-ray or computed tomography scan. Of these patients, 36 had mediastinal mass only and 20 had mediastinal mass with parenchymal lesion. Results: In the present study, of 56 patients, 36 had mediastinal masses and 20 had pulmonary mass. Conclusion: Percutaneous fine-needle aspiration is an easy and reliable method for reaching a quick tissue diagnosis in pulmonary and mediastinal masses.

Unusual presentation of tuberculosis

Mediastinal mass is not an unusual entity. It occurs mostly due to lymphoma, thymoma, germ cell tumours, granulomatous diseases, and so on. Tuberculosis is an uncommon cause of mediastinal mass. It is rarely suspected when it is presented in such an unusual way. We report here a case of a 35-year-old male who presented with mediastinal mass, which was later confirmed as a case of tuberculosis on histopathological examination. He was successfully treated with anti-tubercular drugs.

Herniation of pulmonary bulla--a case report.

Herniation of lung is an abnormal protrusion of the lung beyond the confines of the thoracic cage. Thoracic lung hernias are classified as cervical, intercostal, diaphragmatic or mediastinal. Each of these types can be either congenital or acquired. Acquired hernias can be spontaneous, posttraumatic or pathologic as a result of neoplastic or inflammatory process. Bullae are thin walled structures with a diameter more than 1 cm. They are most commonly seen in the upper portion of the lung. The underlying disease process is characterized by abnormal enlargement of the air spaces distal to the terminal bronchioles accompanied by destruction of their walls. These anatomic changes result in decreased elastic recoil, increased airway resistance and decreased maximal expiratory flow rate. The lung became hyperinflated and may demonstrate focal areas of bulla formation.. This causes overinflation and even burst of bulla into pleural cavity resulting in pneumothorax. We report a case where overinflated bulla herniated across the anterior mediastinum into the opposite hemithorax. This case is the first of its kind.

The role of laboratory investigations in evaluating abdominal tuberculosis.

Background and Objectives: Tuberculosis (TB) continues to be a major health problem in developing countries like India. Abdominal TB is defined as an infection of the peritoneum, or hollow or solid abdominal organs with Mycobacterium tuberculosis (Mtb). The gastrointestinal tract is one of the most frequent sites of extrapulmonary involvement in TB. The present study was undertaken to evaluate the role of laboratory investigations in the diagnosis of abdominal TB. Materials and Methods: The study was conducted on 300 patients admitted to various departments of our hospital from November 2005 to October 2007. Detailed histories and thorough clinical examinations together with relevant hematological, biochemical, cytological, radiological, and histopathological investigations were carried out in suspected cases of Koch′s abdomen. Results: Erythrocyte sedimentation rates with positive results were seen in 79.3% patients. Serological test enzyme-linked immunosorbent assay was performed on only 30 patients and was found to be positive for IgG, and IgM in 25 cases with a sensitivity of 83%. Thirteen out of 15 cases were positive for adenosine deaminase done on ascitic fluid. The results of the two patients who underwent Mtb polymerase chain reaction (PCR) were consistent with TB. Out of 21 image-guided fine-needle aspiration cytology (FNAC) cases, 10 (48%) of the positive cases showed caseating necrosis while 7 (33%) had noncaseous necrosis. Stain for acid-fast bacilli (AFB) was performed on all cases and was positive in 42 cases (38.8%). Lymph node biopsy was done in 95% of the cases. Conclusions: Serological investigations have a limited value, while PCR is a highly specific test. Since cost restricts its use, only two patients in our study could afford it. BACTEC is more sensitive and faster than culture techniques for the diagnosis of mycobacterial infections. FNAC is a reliable, cost effective alternative, and 81% diagnostic yield in the present study suggests that ultrasound guidance is a useful tool. Histopathological evaluation with positive AFB staining remains the gold standard for diagnosing abdominal TB. However, although the demonstration of AFB in aspirates and tissue sections is a definitive diagnostic method for TB, the positivity for AFB is variable.

Frontal bone tuberculosis presenting with blindness in a 14-year-old girl: a case report

IntroductionThe occurrence of tuberculosis in the flat bones of the skull is very rare. Only eight cases of tuberculosis of the frontal bone have been reported in the literature.Case presentationA 14-year-old girl of Asian ethnicity presented with gradual loss of vision. A computed tomography scan of her head showed a diffuse, homogeneously ill-defined hyperdense lesion of size 2.9 × 5.3 cm (anteroposterior × thickness) involving the right orbit. Biopsy of the lesion confirmed the presence of epithelioid cells and Langerhans giant cells with caseous material. After surgical debridement with antitubercular treatment, the patient had an uneventful recovery.ConclusionAlthough rare, tuberculosis can affect the flat bones of the skull. Tuberculosis of the frontal bone can be included in the differential diagnosis of blindness.

Correlation of exhaled carbon monoxide level with disease severity in chronic obstruction pulmonary disease

Introduction: Amplification of airway inflammation and its destruction due to oxidative stress is a major step in the pathogenesis of chronic obstruction pulmonary disease (COPD). Exhaled carbon monoxide (eCO) may be quantified to evaluate the airway inflammation and oxidative stress in such patients. Objectives: To assess the disease severity of COPD and treatment response by measuring eCO as a biomarker. Materials and Methods: COPD patients diagnosed according to the global initiative for chronic obstructive lung disease guidelines and healthy individuals as controls were selected. One hundred and fifty patients with COPD and 125 controls were included in the study. Participants were further subdivided on the basis of their smoking habits. Clinical examinations and spirometry were done to diagnose COPD by following the standard protocol. eCO was measured using a piCO + Smokerlyzer (Breath CO Monitor, Bedfont Scientific Ltd., Kent, UK). It was a single-center cross-sectional study. Results: Mean (± standard error of mean) CO levels in ex-smokers with COPD were higher (5.21 ± 1.546 ppm; P < 0.05) than in nonsmoking controls (1.52 ± 0.571 ppm) but were lower than in current smokers with COPD (12.55 ± 4.514 ppm; P < 0.05). eCO levels were higher in current smokers with COPD (12.55 ± 4.514 ppm; P < 0.05) compared to healthy smokers (9.71 ± 5.649). There was a negative correlation between eCO and forced expiratory volume in 1 s (FEV1) in COPD (r = −0.28; P < 0.05). The mean eCO level was decreased (6.291–4.332; P < 0.001) with improvement in lung function (FEV1 38.75%–50.65%: P < 0.05) after treatment with inhaled steroid. Conclusion: Our study concludes that quantification of eCO level in COPD varies with different grades of airway obstruction and to measure the treatment response. Measuring the level of eCO can be used to assess the indirect assessment of airway inflammation, oxidative stress, and severity of airway obstruction in COPD patients.