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Aurangabadkar GM, Choudhary SS, Khan SM, Jadhav US, Wagh PB, Ali SN. Post-tubercular Unilateral Lung Destruction: A Complicated Case. Cureus 2023; 15:e40035. [PMID: 37425496 PMCID: PMC10325140 DOI: 10.7759/cureus.40035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 06/06/2023] [Indexed: 07/11/2023] Open
Abstract
Pulmonary tuberculosis is associated with long-term complications that affect both the respiratory and cardiovascular systems. We present the case of a 65-year-old male patient who presented with chief complaints of productive cough and breathlessness for the last four years. Further radiological investigations revealed a left-sided destroyed lung with left lung collapse and deviation of the mediastinum towards the left side. The patient responded well to treatment with broad-spectrum antimicrobial drugs and mucolytics.
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Affiliation(s)
- Gaurang M Aurangabadkar
- Respiratory Medicine, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (Deemed University), Nagpur, IND
| | - Sumer S Choudhary
- Respiratory Medicine, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (Deemed University), Nagpur, IND
| | - Shafee M Khan
- Respiratory Medicine, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (Deemed University), Nagpur, IND
| | - Ulhas S Jadhav
- Respiratory Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (Deemed University), Wardha, IND
| | - Pankaj B Wagh
- Respiratory Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (Deemed University), Wardha, IND
| | - Saood N Ali
- Respiratory Medicine, NKP Salve Institute of Medical Sciences and Lata Mangeshkar Hospital, Nagpur, IND
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Davies-Barrett AM, Owens LS, Eeckhout PA. Paleopathology of the Ychsma: Evidence of respiratory disease during the Late Intermediate Period (AD 1000-1476) at the Central Coastal site of Pachacamac, Peru. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2021; 34:63-75. [PMID: 34153817 DOI: 10.1016/j.ijpp.2021.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/27/2021] [Accepted: 06/02/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To investigate evidence for maxillary sinusitis and pulmonary inflammation in archaeological skeletons dating to the Late Intermediate Period (AD 1000-1476) at the site of Pachacamac, Peru. MATERIALS Thirty-nine individuals (male, female, and unknown sex; 16+ years age-at-death) were analyzed for inflammatory periosteal reaction (IPR) on the visceral (inner) surfaces of the ribs, and 16 individuals were analyzed for evidence of maxillary sinusitis. METHODS All individuals were macroscopically examined for bony changes in the maxillary sinuses and new bone formation on the ribs according to pre-established criteria. RESULTS Some 33.3% (13/39) of individuals had IPR on the ribs and 93.8% (15/16) had bony changes in the maxillary sinuses. CONCLUSIONS Respiratory disease was likely prevalent in people buried at Pachacamac during the Late Intermediate Period. A number of factors may have increased the risk of developing respiratory disease, including exposure to poor air quality and increased crowding and social mixing, resulting from pilgrimage to this important ritual center. SIGNIFICANCE This paper represents one of the first systematic analyses of evidence for respiratory disease in Peruvian and South American human skeletal remains, demonstrating the suitability of the region for further study. LIMITATIONS A limited sample was available for analysis. Additionally, the site's skeletal preservation was excellent, meaning the sample available for assessment of maxillary sinusitis was smaller, being limited to individuals with post-mortem breakage. FURTHER RESEARCH The results of this study should stimulate further much needed systematic investigation of evidence for respiratory disease in other Peruvian and South American populations.
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Affiliation(s)
- Anna M Davies-Barrett
- School of History, Archaeology and Religion, Cardiff University, John Percival Building, Colum Drive, Cardiff, CF10 3EU, United Kingdom.
| | - Lawrence S Owens
- University of Winchester. Sparkford Road, Winchester, SO22 4NR, United Kingdom; University of South Africa, Preller Street, Muckleneuk, Pretoria, 0002, South Africa
| | - Peter A Eeckhout
- Faculté de Philosophie et Sciences Sociales CP133/01, Université libre de Bruxelles, Av. F. Roosevelt 50, 1050, Brussels, Belgium
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Davies-Barrett AM, Antoine D, Roberts CA. Inflammatory periosteal reaction on ribs associated with lower respiratory tract disease: A method for recording prevalence from sites with differing preservation. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2019; 168:530-542. [PMID: 30613938 PMCID: PMC6491975 DOI: 10.1002/ajpa.23769] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 09/07/2018] [Accepted: 12/09/2018] [Indexed: 12/23/2022]
Abstract
Objectives Inflammatory periosteal reaction (IPR) on the visceral surfaces of the ribs has been used in bioarchaeology as an indicator of lower respiratory tract disease. This article presents a detailed method for recording IPR on the ribs, even those in severely fragmented states, with the objectives of increasing the consistency of recording and producing true prevalence rates for skeletons so as to improve data comparability between future bioarchaeological studies of lower respiratory tract disease. Materials and methods The presence and prevalence of respiratory‐related IPR were recorded from three different Sudanese cemetery sites using a detailed method for identifying and recording IPR. Sites with variable preservation were chosen to test the applicability of the method. A flowchart to aid in identification of bony changes is presented. The method requires the recording of IPR on three separate sections of the rib (neck, angle, and shaft) and the allocation of ribs into rib cage regions of upper, upper‐middle, middle, lower‐middle, and lower. Results Results demonstrate differences in the distribution of IPR between sites and verify the method's applicability to archeological sites with various levels of skeletal preservation. Discussion While crude prevalence rates can indicate the number of individuals experiencing lower respiratory tract disease within a site, this method can provide information about the distribution of IPR within the rib cage. This should lead to new ways of distinguishing respiratory diseases within archeological populations. This method also allows for comparability between well‐preserved and lesser‐preserved sites by accommodating for rib fragmentation.
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Affiliation(s)
- Anna M Davies-Barrett
- Department of Ancient Egypt and Sudan, The British Museum, London, United Kingdom.,Department of Archaeology, Durham University, Durham, United Kingdom
| | - Daniel Antoine
- Department of Ancient Egypt and Sudan, The British Museum, London, United Kingdom
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Varona Porres D, Persiva O, Pallisa E, Andreu J. Radiological findings of unilateral tuberculous lung destruction. Insights Imaging 2017; 8:271-277. [PMID: 28197882 PMCID: PMC5359149 DOI: 10.1007/s13244-017-0547-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 01/26/2017] [Accepted: 02/01/2017] [Indexed: 01/15/2023] Open
Abstract
Objectives The aim of this report is to identify the radiological findings of unilateral tuberculous lung destruction (UTLD). Materials and methods Thirteen patients with (UTLD) were reviewed from 1999 to 2014. Only patients with radiological evidence of absence of pulmonary parenchyma preserved were included. Clinical and demographic data were obtained and radiological studies (chest radiograph and CT) were retrospectively reviewed. Results The left lung was more commonly involved (85%). The following radiological findings were found in all cases: a decrease in the diameter of the pulmonary vessels of the affected lung, herniation of the contralateral lung and hypertrophy of the ribs and/or thickening of extrapleural fat. Two radiological patterns were identified: UTLD with cystic bronchiectasis (85%) and UTLD without residual cystic bronchiectasis (15%). Forty-six per cent of cases had respiratory infection symptoms with presence of air-fluid levels in the affected lung as the most common finding in these patients. Conclusions Total unilateral post-tuberculous lung destruction is an irreversible complication with the following main radiological features: predominantly left-sided location, decreases in the diameter of the ipsilateral pulmonary vessels, herniation of the contralateral lung and hypertrophy of the ribs and/or thickening of extrapleural fat. Teaching Points • Unilateral tuberculous lung destruction is an irreversible complication of tuberculosis. • Left-side predominance and herniation of the contralateral lung are characteristic. • Decreased diameter of the ipsilateral pulmonary vessels occurred in all patients. • The pattern with residual cystic bronchiectasis is the most frequent. • Superimposed non-tuberculous infections may affect the destroyed lung.
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Affiliation(s)
- Diego Varona Porres
- Hospital Vall d´Hebrón. Radiology department, Passeig Vall d´Hebrón 119, 08035, Barcelona, Spain.
| | - Oscar Persiva
- Hospital Vall d´Hebrón. Radiology department, Passeig Vall d´Hebrón 119, 08035, Barcelona, Spain
| | - Esther Pallisa
- Hospital Vall d´Hebrón. Radiology department, Passeig Vall d´Hebrón 119, 08035, Barcelona, Spain
| | - Jordi Andreu
- Hospital Vall d´Hebrón. Radiology department, Passeig Vall d´Hebrón 119, 08035, Barcelona, Spain
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Porres DV, Morenza OP, Pallisa E, Roque A, Andreu J, Martínez M. Learning from the pulmonary veins. Radiographics 2014; 33:999-1022. [PMID: 23842969 DOI: 10.1148/rg.334125043] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The purpose of this article is to review the basic embryology and anatomy of the pulmonary veins and the various imaging techniques used to evaluate the pulmonary veins, as well as the radiologic findings in diseases affecting these structures. Specific cases highlight the clinical importance of the imaging features, particularly the findings obtained with multidetector computed tomography (CT). Pulmonary vein disease can be broadly classified into congenital or acquired conditions. Congenital disease, which often goes unnoticed until patients are adults, mainly includes (a) anomalies in the number or diameter of the vessels and (b) abnormal drainage or connection with the pulmonary arterial tree. Acquired disease can be grouped into (a) stenosis and obstruction, (b) hypertension, (c) thrombosis, (d) calcifications, and (e) collateral circulation. Pulmonary vein stenosis or obstruction, which often has important clinical repercussions, is frequently a result of radiofrequency ablation complications, neoplastic infiltration, or fibrosing mediastinitis. The most common cause of pulmonary venous hypertension is chronic left ventricular failure. This condition is difficult to differentiate from veno-occlusive pulmonary disease, which requires a completely different treatment. Pulmonary vein thrombosis is a rare, potentially severe condition that can have a local or distant cause. Calcifications have been described in rheumatic mitral valve disease and chronic renal failure. Finally, the pulmonary veins can act as conduits for collateral circulation in cases of obstruction of the superior vena cava. Multidetector CT is an excellent modality for imaging evaluation of the pulmonary veins, even when the examination is not specifically tailored for their assessment.
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Affiliation(s)
- Diego Varona Porres
- Department of Radiology, Hospital Vall d'Hebrón, Passeig Vall d'Hebrón 119, 08035 Barcelona, Spain.
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Byun CS, Chung KY, Narm KS, Lee JG, Hong D, Lee CY. Early and Long-term Outcomes of Pneumonectomy for Treating Sequelae of Pulmonary Tuberculosis. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2012; 45:110-5. [PMID: 22500281 PMCID: PMC3322180 DOI: 10.5090/kjtcs.2012.45.2.110] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 10/24/2011] [Accepted: 11/18/2011] [Indexed: 11/16/2022]
Abstract
Background Pneumonectomy remains the ultimate curative treatment modality for destroyed lung caused by tuberculosis despite multiple risks involved in the procedure. We retrospectively evaluated patients who underwent pneumonectomy for treatment of sequelae of pulmonary tuberculosis to determine the risk factors of early and long-term outcomes. Materials and Methods Between January 1980 and December 2008, pneumonectomy or pleuropneumonectomy was performed in 73 consecutive patients with destroyed lung caused by tuberculosis. There were 48 patients with empyema (12 with bronchopleural fistula [BPF]), 11 with aspergilloma and 7 with multidrug resistant tuberculosis. Results There were 5 operative mortalities (6.8%). One patient had intraoperative uncontrolled arrhythmia, one had a postoperative cardiac arrest, and three had postoperative respiratory failure. A total of 29 patients (39.7%) suffered from postoperative complications. Twelve patients (16.7%) were found to have postpneumonectomy empyema (PPE), 4 patients had wound infections (5.6%), and 7 patients required re-exploration due to postoperative bleeding (9.7%). The prevalence of PPE increased in patients with preoperative empyema (p=0.019). There were five patients with postoperative BPF, four of which occurred in right-side operation. The only risk factor for BPF was the right-side operation (p=0.023). The 5- and 10-year survival rates were 88.9% and 76.2%, respectively. The risk factors for late deaths were old age (≥50 years, p=0.02) and low predicted postoperative forced expiratory volume in one second (FEV1) (<1.2 L, p=0.02). Conclusion Although PPE increases in patients with preoperative empyema and postoperative BPF increases in right-side operation, the mortality rates and long-term survival rates were found to be satisfactory. However, the follow-up care for patients with low predicted postoperative FEV1 should continue for prevention and early detection of pulmonary complication related to impaired pulmonary function.
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Affiliation(s)
- Chun Sung Byun
- Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Korea
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Sehitogullari A, Bilici S, Sayir F, Cobanoglu U, Kahraman A. A long-term study assessing the factors influencing survival and morbidity in the surgical management of bronchiectasis. J Cardiothorac Surg 2011; 6:161. [PMID: 22152759 PMCID: PMC3261112 DOI: 10.1186/1749-8090-6-161] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2011] [Accepted: 12/11/2011] [Indexed: 11/25/2022] Open
Abstract
Background Although the prevalence of bronchiectasis decreased significantly in developed countries, in less developed and in developing countries, it still represents a significant cause of morbidity and mortality. The aim of this retrospective study is to present our surgical experiences, the morbidity and mortality rates and outcome of surgical treatment for bronchiectasis. Methods We reviewed the medical records of 129 patients who underwent surgical resection for bronchiectasis between April 2002 and April 2010, at Van Training and Research Hospital, Thoracic Surgery Department. Variables of age, sex, symptoms, etiology, and surgical procedures, mortality, morbidity and the result of surgical therapy were analyzed retrospectively. Results Mean age was 21.8 year (the eldest was 67 year, the youngest was 4 years-old). Male/female ratio was 1.86 and 75% of all patients were young population under the age of 40. Bilateral involvement was 14.7%, left/right side ratio according to localization was 2.1/1. The most common reason for bronchiectasis was recurrent infection. Surgical indications were as follows: recurrent infection (54%), hemoptysis (35%), empyema (6%), and lung abscess (5%). There was no operative mortality. Complications occurred in 29 patients and the morbidity rate was 22.4%. Complete resection was achieved in 110 (85.2%) patients. Follow-up data were obtained for 123 (95%) of the patients. One patient died during follow-up. The mean follow-up of this patient was 9 months. Mean postoperative hospitalization time was 9.15 ± 6.25 days. Significantly better results were obtained in patients who had undergone a complete resection. Conclusions Surgical treatment of bronchiectasis can be performed with acceptable morbidity and mortality at any age. The involved bronchiectatic sites should be resected completely for the optimum control of symptoms.
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Affiliation(s)
- Abidin Sehitogullari
- Van Training and Research Hospital, Department of Thoracic Surgery, Van, Turkey.
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Al-Kattan KM, Essa MA, Hajjar WM, Ashour MH, Saleh WN, Rafay MA. Surgical results for bronchiectasis based on hemodynamic (functional and morphologic) classification. J Thorac Cardiovasc Surg 2005; 130:1385-90. [PMID: 16256793 DOI: 10.1016/j.jtcvs.2005.06.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2005] [Revised: 05/20/2005] [Accepted: 06/30/2005] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This study was a prospective evaluation of surgical indications and outcomes for unilateral and bilateral bronchiectasis according to hemodynamic (functional and morphologic) classification. METHODS Between January 1998 and January 2004, the morphologic features (cystic versus cylindric) by chest computed tomography and the hemodynamic features (perfused versus nonperfused) by lung ventilation/perfusion scan were determined in 66 patients with bronchiectasis (53 unilateral and 13 bilateral). The indication for surgical resection in both groups was the presence of localized areas of cystic, nonperfused bronchiectasis. RESULTS In the unilateral bronchiectasis group, there were 28 female and 25 male patients with an average age of 37.5 +/- 3.8 years (range 6-40 years). Pneumonectomy was performed in 10 cases (8 left and 2 right), and lobectomy or bilobectomy was performed in 43. In the bilateral group, there were 7 male and 6 female patients with an average age of 42 +/- 5.4 years (range 9-55 years). Pneumonectomy was performed in 2 cases, lobectomy in 5, and bilateral staged lobectomy in 6. There was 1 postoperative death (1.5%), and morbidity was 18% (12 patients). Four patients required reexploration for bleeding, 4 had prolonged air leak develop, 3 acquired pulmonary infections, and 1 had localized empyema develop. During a mean follow-up of 52 months (range 24-82 months), 48 patients were considered cured (73%) and 17 had symptomatic improvement (26%). Pseudomonas infection and underlying chronic obstructive airway disease were poor prognostic factors (P < .05). CONCLUSION The hemodynamic (functional and morphologic) classification provides an accurate functional classification for bronchiectasis. Its application in determining the indications and extent of surgical resection is superior to morphologic classification alone. Curative resection can be achieved in both unilateral and bilateral bronchiectasis with acceptable morbidity.
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Affiliation(s)
- Khaled M Al-Kattan
- Division of Thoracic Surgery, Department of Surgery, King Khalid University Hospital, Riyadh, Saudi Arabia.
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Haciibrahimoglu G, Fazlioglu M, Olcmen A, Gurses A, Bedirhan MA. Surgical management of childhood bronchiectasis due to infectious disease. J Thorac Cardiovasc Surg 2004; 127:1361-5. [PMID: 15115993 DOI: 10.1016/j.jtcvs.2003.11.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The purpose of this study was to estimate operative risk and to identify indicators of adverse prognosis in patients undergoing resection for childhood bronchiectasis. METHODS From January 1985 to February 2001, patients undergoing resection for bronchiectasis were studied. The indications for operation were failure of medical therapy in 33 patients (94.2%) and hemoptysis in 2 (5.7%). The mean duration of symptoms was 4.2 years (range, 1-9 years). Surgical treatment included lobectomy in 17 patients (48.5%), pneumonectomy in 7 (20%), lobectomy plus segmentectomy in 5 (14.2%), bilobectomy in 2 (5.7%), and segmentectomy in 4 (11.4%). RESULTS The operative mortality rate was 2.8%, and the morbidity rate was 17.6%. The mean follow-up in 34 patients was 5.4 years (range, 1-12 years). Overall, 22 patients (64.7%) were asymptomatic after surgery. Clinical improvement was noticed in 8 patients (23.5%), and no improvement was noticed in 4 (11.7%). Complete resection resulted in a significantly better clinical outcome than incomplete resection (P <.05). CONCLUSIONS Surgery for childhood bronchiectasis can be performed with low mortality and morbidity. Complete resection should be performed when possible.
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Affiliation(s)
- Gokhan Haciibrahimoglu
- Yedikule Hospital for Chest Disease and Thoracic Surgery Center, Department of Thoracic Surgery, Istanbul, Turkey.
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Ashour M, Al-Kattan KM, Jain SK, Al-Majed S, Al-Kassimi F, Mobaireek A, Al-Hajjaj M, Al-Zear A. Surgery for unilateral bronchiectasis: results and prognostic factors. TUBERCLE AND LUNG DISEASE : THE OFFICIAL JOURNAL OF THE INTERNATIONAL UNION AGAINST TUBERCULOSIS AND LUNG DISEASE 1996; 77:168-72. [PMID: 8762853 DOI: 10.1016/s0962-8479(96)90033-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
SETTING King Khalid University Hospital referral centre for thoracic surgery, Riyadh, Saudi Arabia. OBJECTIVE To assess the results of surgery and factors influencing its outcome in patients with unilateral bronchiectasis. DESIGN A retrospective analysis of 40 patients with unilateral bronchiectasis who were operated upon consecutively at King Khalid Hospital, between July 1987 and May 1993. RESULTS Left-sided disease was seen in 60% (n = 24) and right-sided in 40% (n = 16) of the patients. The entire lung was involved in 30% of cases (n = 12). Of these, the left lung was totally involved in 22.5% (n = 9) and the right in 7.5% (n = 3). A lobectomy was performed on 21 patients, basal segmentectomy with preservation of apical segment on 7, and pneumonectomy on 12. There was no operative mortality in this series. Six patients (15%) developed postoperative complications, bleeding (n = 4) and prolonged air leak (n = 2). During an average follow-up period of 30.7 months (+/- 15.4 months), 29 patients (72.5%) were cured and the remaining 11 (27.5%) improved. No patients with Pseudomonas aeruginosa infection (n = 3) or obstructive airway disease (n = 5) were cured (P = 0.02 and P = 0.002 respectively). CONCLUSION Curative resection for selected patients with unilateral bronchiectasis can be performed safely with good results and low morbidity. Pseudomonas aeruginosa infection and obstructive airway disease have an adverse effect on postoperative cure.
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Affiliation(s)
- M Ashour
- Division of Thoracic Surgery, King Khalid University Hospital, Riyadh, Saudi Arabia
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