176
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MacDonald-Nethercott M, Ples D, Woitek R, Beddowes E. Ossified diagnosis: sarcoidosis masquerading as metastatic breast cancer. BMJ Case Rep 2021; 14:14/5/e237516. [PMID: 33972292 PMCID: PMC8112402 DOI: 10.1136/bcr-2020-237516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 40-year-old woman was referred to the Breast Unit with a solid lump in her right breast. Investigations revealed an invasive lobular carcinoma. The patient underwent a right-sided mastectomy and sentinel lymph node (LN) biopsy, which confirmed axillary LN involvement. The postsurgery staging CT showed unusual enlargement of mediastinal and hilar LN bilaterally. This was consistent with positron emission tomography/CT and MRI, which further established the presence of several bone lesions. Determining the pathology within the LN and bones was pivotal in providing an accurate diagnosis and deciding subsequent management. However, histopathological analysis of the initial endobronchial ultrasound-guided fine-needle aspiration biopsy of mediastinal LN failed to identify definitive metastatic breast cancer cells. The case was extensively discussed in several multidisciplinary team meetings. Collective evidence, including clinical presentation, comparative imaging analysis, and further biopsies confirmed sarcoidosis with bone involvement-mimicking metastatic disease.
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177
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McDonald JP, Law NL, Haggstrom JA, Kruse MJ. T-cell lymphoma in a man with persistent dyspnea and unusual dependent pulmonary interstitial thickening. BMJ Case Rep 2021; 14:14/5/e241884. [PMID: 33972301 PMCID: PMC8112426 DOI: 10.1136/bcr-2021-241884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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178
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Gary P, Gianniosis M, Ryu J, Flynn S. Chylothorax as a complication of Waldenström macroglobulinaemia with a patient's perspective. BMJ Case Rep 2021; 14:14/5/e241707. [PMID: 33962927 PMCID: PMC8108664 DOI: 10.1136/bcr-2021-241707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Chylothorax has rarely been reported as a pleuropulmonary complication of Waldenström macroglobulinaemia (WM). In general, when a unilateral effusion is discovered particularly in patients with a history of cancer or active malignancy, a broad differential including chylothorax needs to be considered. We present the case of a 50-year-old woman found to have chylothorax secondary to progression of WM as confirmed by cytology and presence of MYD88 L265P mutation in the pleural fluid specimen and subsequent resolution with chemotherapy. This review centres particularly on non-traumatic causes of chylothorax with a focus on WM and includes a unique patient perspective.
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179
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Ladzinski AT, Mehta A, Dykstra BJ, Sharghi SM. Diffuse alveolar haemorrhage in the setting of eosinophilic pneumonia. BMJ Case Rep 2021; 14:14/4/e241672. [PMID: 33906878 PMCID: PMC8088248 DOI: 10.1136/bcr-2021-241672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 65-year-old woman who presented with a constellation of symptoms, including cough with haemoptysis, fever, chills and hypoxia along with weight loss, was found to have diffuse alveolar haemorrhage. After a myriad of investigations returned normal, an open lung biopsy was performed, which revealed the diagnosis to be subacute eosinophilic pneumonia. This is one of its kind of rare presentations where eosinophilic pneumonia presents as diffuse alveolar haemorrhage and has been reported only five times prior to this.
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180
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Doolan E, Ryan A. Solitary choroidal granuloma. BMJ Case Rep 2021; 14:14/4/e243238. [PMID: 33906870 PMCID: PMC8076941 DOI: 10.1136/bcr-2021-243238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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181
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182
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Abstract
SARS-CoV-2 has resulted in a global pandemic and an unprecedented public health crisis. Recent literature suggests the emergence of a novel syndrome known as 'long COVID', a term used to describe a diverse set of symptoms that persist after a minimum of 4 weeks from the onset of a diagnosed COVID-19 infection. Common symptoms include persistent breathlessness, fatigue and cough. Other symptoms reported include chest pain, palpitations, neurological and cognitive deficits, rashes, and gastrointestinal dysfunction. We present a complex case of a previously well 28-year-old woman who was diagnosed with COVID-19. After resolution of her acute symptoms, she continued to experience retrosternal discomfort, shortness of breath, poor memory and severe myalgia. Investigations yielded no significant findings. Given no alternative diagnosis, she was diagnosed with 'long COVID'.
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183
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Raita Y, Camargo CA, Liang L, Hasegawa K. Leveraging "big data" in respiratory medicine - data science, causal inference, and precision medicine. Expert Rev Respir Med 2021; 15:717-721. [PMID: 33818245 DOI: 10.1080/17476348.2021.1913061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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184
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Willems JIA, Mostard GJM, Mostard RLM, Buijs J, van Twist DJL. Aortic intramural haematoma associated with the use of nintedanib. Br J Clin Pharmacol 2021; 87:4467-4469. [PMID: 33856065 DOI: 10.1111/bcp.14861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/19/2021] [Accepted: 04/01/2021] [Indexed: 11/30/2022] Open
Abstract
We report a 74-year-old patient who developed an acute aortic syndrome (AAS) with intramural haematoma (IMH) during treatment with nintedanib, a tyrosine kinase inhibitor. As we suspected a role for nintedanib, this was immediately interrupted. Four months later, a computed tomographic angiography (CTA) showed significant regression of the IMH. Therefore, we state that, when patients use nintedanib and develop acute chest or back pain, diagnostic work-up for AAS should be considered. Furthermore, other risk factors for AAS, such as hypertension, genetic diseases and comedication should be taken into account when prescription of medication of this class is considered.
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185
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Malik B, Abdelazeem B, Ghatol A. Pleural lipoma: when to intervene. BMJ Case Rep 2021; 14:14/4/e243175. [PMID: 33853823 PMCID: PMC8054074 DOI: 10.1136/bcr-2021-243175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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186
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Kim Y, Park D, Chung C. Right middle lobe obstruction associated with synchronous endobronchial carcinoid and aspergillosis. SAGE Open Med Case Rep 2021; 9:2050313X211009426. [PMID: 33912347 PMCID: PMC8047926 DOI: 10.1177/2050313x211009426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 03/15/2021] [Indexed: 11/15/2022] Open
Abstract
Pulmonary carcinoids originate from neuroendocrine cells of the lung and comprise 0.5%-5% of all lung malignancies. Endobronchial carcinoids are rare, low-grade malignant tumors that occasionally coexist with other infectious diseases, including tuberculosis and nontuberculous mycobacterial infection. We treated a 63-year-old woman who presented with a right middle lobe obstruction. A chest computed tomography scan demonstrated a mass-like lesion in the right middle lobe with mediastinal lymphadenopathy. She underwent an exploratory operation after 2 weeks of antibiotic treatment. The pathology revealed a right middle lobe bronchial carcinoid tumor and aspergillosis. Chest computed tomography scans have revealed no recurrence of the carcinoid or aspergillosis during the 5-year follow-up.
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187
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Kumar S, Joshi D. Pulmonary mucormycosis in immunocompetent hosts diagnosed by bronchioalveolar lavage. BMJ Case Rep 2021; 14:e240180. [PMID: 33846183 PMCID: PMC8047986 DOI: 10.1136/bcr-2020-240180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 11/03/2022] Open
Abstract
Mucormycosis is a rare infection caused by Mucorales fungi belonging to Zygomycetes class. It can present with spectrum of symptoms and signs based of organ involvement. Common forms of mucormycosis includes rhinocerebral, cutaneous, gastrointestinal, pulmonary, disseminated and miscellaneous forms involving bones, breast, kidney and central nervous system. Pulmonary mucormycosis usually present with fever, cough, haemoptysis and is usually seen in immunocompromised patients like patients with diabetes or leukaemia, or those on chemotherapy or immunosuppressive therapy and rare in immunocompetent patients (6.25% of cases). Pulmonary mucormycosis can be diagnosed by radiological imaging studies, bronchoalveolar lavage (BAL) and histopathological evaluation of biopsy of the lesion; however, the gold standard is a positive fungal culture. Here, we describe two cases of pulmonary mucormycosis diagnosed by BAL in an immunocompetent patient.
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188
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Chong WH, Ibrahim A, Saha BK. Not all nodules with PET hypermetabolic activity are malignant: a case of lung granuloma in ulcerative colitis. BMJ Case Rep 2021; 14:14/4/e242154. [PMID: 33846194 PMCID: PMC8048001 DOI: 10.1136/bcr-2021-242154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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189
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Evans RE, Herbert S, Owen W, Rao D. Case of e-cigarette or vaping product use-associated lung injury (EVALI) in London, UK. BMJ Case Rep 2021; 14:14/4/e240700. [PMID: 33837028 PMCID: PMC8043006 DOI: 10.1136/bcr-2020-240700] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We present a case of a 38-year-old man with no medical comorbidities who presented to the hospital with haemoptysis and shortness of breath on a background of vaping home-manufactured cannabis oil. He developed e-cigarette or vaping product use-associated lung injury (EVALI) visible on chest X-ray requiring oxygen, and corticosteroid treatment before making a recovery. Research reports that the contents vitamin E acetate and tetrahydrocannabinol are frequently found in substances acquired from informal sources which increase the likelihood of EVALI developing. Further research into their synergistic effect is ongoing. Although safer than smoking, vaping is not risk free and EVALI should be considered in patients presenting with respiratory disease.
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190
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Akbar S, Advani R, Aggarwal R. Bilateral spontaneous chylothorax presenting as a left-sided neck mass. BMJ Case Rep 2021; 14:14/4/e240320. [PMID: 33827873 PMCID: PMC8030682 DOI: 10.1136/bcr-2020-240320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A previously well 36-year-old woman presented with a 2-day history of a tender left-sided neck mass associated with left-sided otalgia and odynophagia. On examination, there was a diffuse, tender swelling of the left anterior triangle of the neck with extension onto the anterior chest wall. Ultrasound and CT scans of the neck revealed extensive inflammatory changes in the soft tissues of the neck and a chest X-ray showed blunting of both costophrenic angles. A diagnostic pleural aspiration was subsequently performed and yielded chyle. The patient was commenced on total parenteral nutrition and placed on a low-fat diet; symptoms completely resolved within 5 days, and at follow-up at 6 weeks, there were no further episodes or complications. Bilateral spontaneous chylothorax is a rarely reported phenomenon in the literature; it has been reported in females following the possibility of minor physical exercise such as stretching or hyperextension of the neck.
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191
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Kadowaki T, Yano S. Morphine in acute chronic obstructive pulmonary disease exacerbation. BMJ Case Rep 2021; 14:e239739. [PMID: 33827869 PMCID: PMC8030681 DOI: 10.1136/bcr-2020-239739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 11/04/2022] Open
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192
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Ibrahim S, Velez MI, Soni NJ, Proud KC. Delayed pneumothorax after transbronchial lung biopsy. BMJ Case Rep 2021; 14:e240985. [PMID: 33820805 PMCID: PMC8029879 DOI: 10.1136/bcr-2020-240985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2021] [Indexed: 11/04/2022] Open
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193
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Walsh L, McCarthy C, Henry M. Autoimmune pulmonary alveolar proteinosis and idiopathic pulmonary haemosiderosis: a dual pathology. BMJ Case Rep 2021; 14:e241048. [PMID: 33811096 PMCID: PMC8023637 DOI: 10.1136/bcr-2020-241048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2021] [Indexed: 02/04/2023] Open
Abstract
Pulmonary alveolar proteinosis (PAP) is a rare pulmonary condition which leads to excessive accumulation of proteinaceous material within the alveoli. Idiopathic pulmonary haemosiderosis (IPH) is another orphan lung disease and results in recurrent alveolar haemorrhage. This case study describes a case of these two rare pathologies occurring together. A man in his 50s presented with a 6-week history of haemoptysis and worsening dyspnoea. A CT scan of the thorax showed multifocal, bilateral ground glass opacification with a wide differential diagnosis. Full autoantibody screen including myositis panel and coeliac screen were negative. Bronchoscopy with bronchoalveolar lavage and tissue from a transbronchial lung cryobiopsy were non-diagnostic. Tissue from a video-assisted thoracoscopic surgery biopsy confirmed a diagnosis of PAP with IPH as a second separate pathology. The association of IPH and PAP has not previously been described. We discuss these conditions and postulate how and if they may be related.
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194
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Vollsæter M, Skjoldmo A, Røksund O, Hilland M, Andersen T. Tailoring NIV by dynamic laryngoscopy in a child with spinal muscular atrophy type I. Clin Case Rep 2021; 9:1925-1928. [PMID: 33936616 PMCID: PMC8077329 DOI: 10.1002/ccr3.3905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 01/05/2021] [Accepted: 01/17/2021] [Indexed: 12/04/2022] Open
Abstract
Dynamic laryngoscopy during noninvasive (NIV) respiratory therapy is feasible and may facilitate optimal and individualized treatment in patients with chronic respiratory failure, also in children.
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195
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Povey J, Rutherford E, Levy J, Muniraju T. Relapse of treated anti-GBM disease following hair dye use. BMJ Case Rep 2021; 14:14/4/e240543. [PMID: 33795274 DOI: 10.1136/bcr-2020-240543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
An 18-year-old woman was treated for acute kidney injury (AKI) secondary to antiglomerular basement membrane (GBM) disease with prednisolone, cyclophosphamide and plasma exchange. She also had epistaxis at initial presentation with no other organ involvement and achieved good recovery of her kidney function. Two weeks after completing induction treatment, she re-presented with further AKI and pulmonary haemorrhage. She was recommenced on plasma exchange and steroids and was given rituximab. She recovered from her illness with significant improvement to her kidney function. The cause of her relapse was thought to be possibly due to the use of hair dye. This case highlights the importance of acknowledging potential environmental exposures to prevent relapses of disease. We were also able to demonstrate a case of successful treatment of anti-GBM disease with rituximab.
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196
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Blanchard PY, Ruppert AM, Faure M, Nion N. [The advanced practice nurse in post-COViD-19 respiratory follow up]. SOINS; LA REVUE DE RÉFÉRENCE INFIRMIÈRE 2021; 66:32-34. [PMID: 33775300 DOI: 10.1016/s0038-0814(21)00056-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The setting up of an advanced practice nursing activity to monitor patients with severe or very severe pneumonia associated with Severe Acute Respiratory Syndrome Coronavirus 2, is a reponse to the population's new health care needs and a massive influx of patients. The skills of the advanced practice nurse are mobilised in this context in order to carry out prevention missions and screening for potential sequelae which could lead to chronic respiratory failure.
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197
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Stefanidis K, Konstantelou E, Yusuf GT. Incomplete lung torsion following spontaneous pneumothorax. BMJ Case Rep 2021; 14:e242127. [PMID: 33782074 PMCID: PMC8009222 DOI: 10.1136/bcr-2021-242127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2021] [Indexed: 11/04/2022] Open
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198
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Mitsui S, Tauchi S. Tension pyopneumothorax. BMJ Case Rep 2021; 14:e242197. [PMID: 33766977 PMCID: PMC7996364 DOI: 10.1136/bcr-2021-242197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2021] [Indexed: 11/04/2022] Open
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199
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Rodrigues D, Valério M, Costa T. Re-expansion pulmonary oedema after spontaneous pneumothorax treatment with chest tube placement. BMJ Case Rep 2021; 14:e241734. [PMID: 33762292 PMCID: PMC7993174 DOI: 10.1136/bcr-2021-241734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2021] [Indexed: 11/03/2022] Open
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200
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Lorentzen T, Madsen H, Lausten-Thomsen MJZ, Bygum A. Spontaneous pneumothorax as a clinical manifestation of neurofibromatosis type 1. BMJ Case Rep 2021; 14:14/3/e238694. [PMID: 33737277 PMCID: PMC7978331 DOI: 10.1136/bcr-2020-238694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Neurofibromatosis type 1 (NF1) is a genetic disorder affecting the skin, nervous system, eyes and bones. Pulmonary involvement is unknown to many physicians. Yet, patients may be affected by lung bullae and cysts, which represent an increased risk for secondary spontaneous pneumothorax (SSP). We present a 56-year-old patient with a pathogenic variant of the NF1 gene, who suffered from NF1 with lung manifestations and recurrent SSP. It is essential to identify the patients having an increased risk of developing SSP as preventive surgery seem to decrease the risk of new events. Pneumothorax can be a clinical manifestation of NF1 but is not yet widely acknowledged as such.
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