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Wang L, Liu J, Yang H, Peng L. Diffuse cystic lung disease caused by tuberculosis infection: Case series. J Infect Public Health 2023; 16:526-530. [PMID: 36801632 DOI: 10.1016/j.jiph.2023.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 02/09/2023] [Accepted: 02/12/2023] [Indexed: 02/15/2023] Open
Abstract
Diffuse cystic lung disease (DCLD) is a complex disease that can be caused by various reasons. Although the chest CT scan plays a vital role in suggesting the etiology of DCLD, it is apt to lead to misdiagnosis simply based on the CT image of the lung. Here, we report a rare case of DCLD caused by tuberculosis and misdiagnosed as pulmonary Langerhans cell histiocytosis (PLCH). A 60-year-old female DCLD patient with a long-term smoking history was admitted to the hospital because of a dry cough and dyspnea, and the chest CT scan showed diffuse irregular cysts in both lungs. We considered the patient to be PLCH. To alleviate dyspnea, we chose to give her intravenous glucocorticoids. However, she developed a high fever during the use of glucocorticoids. We performed flexible bronchoscopy and bronchoalveolar lavage. Mycobacterium tuberculosis (specific sequence reads: 30) was detected in BALF. She was finally diagnosed with pulmonary tuberculosis. Tuberculosis infection is one of the rare causes of DCLD. We have discovered thirteen similar cases by searching Pubmed and Web of Science. For DCLD patients, glucocorticoids should not be used blindly unless the existence of a tuberculosis infection is ruled out. TBLB for pathology and bronchoalveolar lavage fluid (BALF) for microbiological detection are helpful for diagnosis.
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Affiliation(s)
- Lu Wang
- Department of Respiratory Medicine, The First Hospital of Jilin University, Changchun, China
| | - Jingwei Liu
- Department of Respiratory Medicine, The First Hospital of Jilin University, Changchun, China
| | - Huahong Yang
- Department of Respiratory Medicine, The First Hospital of Jilin University, Changchun, China
| | - Liping Peng
- Department of Respiratory Medicine, The First Hospital of Jilin University, Changchun, China.
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Zhang F, Qin S, Xia F, Mao C, Li L. Case report: Streptococcus pneumoniae pneumonia characterized by diffuse centrilobular nodules in both lungs. Front Med (Lausanne) 2023; 9:1007160. [PMID: 36703900 PMCID: PMC9871572 DOI: 10.3389/fmed.2022.1007160] [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: 07/30/2022] [Accepted: 12/20/2022] [Indexed: 01/12/2023] Open
Abstract
Background Streptococcus pneumoniae (S. pneumoniae) is the most common pathogen in community-acquired pneumonia (CAP) and takes the form of lobar pneumonia as typical computed tomography (CT) findings. Various patterns of radiological manifestation have also been reported in patients with S. pneumoniae pneumonia; however, the appearance of diffuse centrilobular nodules in both lungs is rarely reported. Case presentation We report the case of a patient with a history of chronic lymphocytic leukemia (CLL) for 9 years who presented with new-onset fever, cough, excess sputum, and shortness of breath for 1 week. He was given intravenous antibacterial (cephalosporin) treatment for 4 days, but his condition did not improve and dyspnea became more serious. The chest CT indicated diffuse centrilobular nodules in both lungs at admission. Patient's bronchoalveolar (BAL) fluid was sent for metagenomic next-generation sequencing, which only supported a diagnosis of S. pneumoniae infection. His condition improved gradually after antimicrobial treatment (moxifloxacin) and a follow-up CT showed that the diffuse centrilobular nodules in both lungs were absorbed completely. Conclusion This case highlights a rare CT presentation of S. pneumoniae pneumonia that should alert clinicians, so as to avoid taking unnecessary treatment measures.
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An Elusive Case of Tuberculous Meningitis in a Young Man With Altered Mental Status. J Emerg Med 2022; 63:551-556. [DOI: 10.1016/j.jemermed.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 06/08/2022] [Accepted: 07/09/2022] [Indexed: 12/05/2022]
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Pervaiz A, Inany M, Nguyen HQ, Jacques SM, Alshabani K. A Pregnant Woman With Hemoptysis and Diffuse Pulmonary Nodules. Chest 2021; 160:e651-e656. [PMID: 34872680 DOI: 10.1016/j.chest.2021.07.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/19/2021] [Accepted: 07/17/2021] [Indexed: 11/29/2022] Open
Abstract
CASE PRESENTATION A 22-year-old woman who was 36 weeks pregnant presented with a 4-day history of cough, hemoptysis, and exertional dyspnea. She had no fever, night sweats, or weight loss. The review of system was otherwise negative. Her medical history was notable for a spontaneous first-trimester abortion a year ago. At that time, she had a transvaginal ultrasound scan that showed a gestational sac with no fetal movement. A post-abortion ultrasound scan revealed no residual fetal parts.
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Affiliation(s)
- Amina Pervaiz
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, MI
| | - Mohammed Inany
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, MI
| | - Huy Q Nguyen
- Department of Pathology, Hutzel Women's Hospital/ Harper University Hospital, Wayne State University School of Medicine, Detroit, MI
| | - Suzanne M Jacques
- Department of Pathology, Hutzel Women's Hospital/ Harper University Hospital, Wayne State University School of Medicine, Detroit, MI
| | - Khaled Alshabani
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, MI.
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Elia D, Torre O, Cassandro R, Caminati A, Harari S. Ultra-rare cystic disease. Eur Respir Rev 2020; 29:29/157/190163. [PMID: 32878971 PMCID: PMC9489057 DOI: 10.1183/16000617.0163-2019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 03/20/2020] [Indexed: 12/11/2022] Open
Abstract
Diffuse cystic lung diseases include a group of heterogeneous disorders characterised by the presence of cysts within the lung parenchyma, sometimes showing a characteristic computed tomography scan pattern that allows diagnosis. The pathogenetic mechanisms underlying cyst formation in the lung are still not clear and a number of hypotheses have been postulated according to the different aetiologies: ball-valve effect, ischaemic dilatation of small airways and alveoli related to infiltration and obstruction of small vessels and capillaries that supply the terminal bronchioles and connective tissue degradation by matrix metalloproteases. A wide number of lung cyst diseases have been classified into six diagnostic groups according to the aetiology: neoplastic, congenital/genetic, lymphoproliferative, infective, associated with interstitial lung diseases, and other causes. This article focuses on lymphangioleiomyomatosis, pulmonary Langerhans cell histiocytosis and Erdheim–Chester disease, Birt–Hogg–Dubé, follicular bronchiolitis and lymphocytic interstitial pneumonia, light-chain deposition disease and amyloidosis, congenital lung disease associated with aberrant lung development and growth, and cystic lung disease associated with neoplastic lesion. These cystic diseases are epidemiologically considered as ultra-rare conditions as they affect fewer than one individual per 50 000 or fewer than 20 individuals per million. Despite the rarity of this group of disorders, the increasing use of high-resolution computed tomography has improved the diagnostic yield, even in asymptomatic patients allowing prompt and correct therapy and management without the need for a biopsy. Diffuse cystic lung diseases show a characteristic CT scan pattern that often allows for diagnosis, even in asymptomatic patients, allowing prompt correct therapy and management without the needing of a biopsyhttps://bit.ly/2wIUKet
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Dai HY, Guo SL, Shen J, Yang L. Pulmonary benign metastasizing leiomyoma: A case report and review of the literature. World J Clin Cases 2020; 8:3082-3089. [PMID: 32775390 PMCID: PMC7385613 DOI: 10.12998/wjcc.v8.i14.3082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/16/2020] [Accepted: 06/30/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Pulmonary benign metastatic leiomyoma (PBML), which is very rare, is a type of benign metastatic leiomyoma (BML). Here, we report a case of PBML, finally diagnosed through multidisciplinary team (MDT) discussions, and provide a literature review of the disease.
CASE SUMMARY A 55-year old asymptomatic woman was found to have bilateral multiple lung nodules on a chest high-resolution computed tomography (HRCT) scan. Her medical history included total hysterectomy for uterine leiomyoma. The patient was diagnosed with PBML, on the basis of her clinical history, imaging manifestations, and computed tomography (CT)-guided percutaneous lung puncture biopsy, via MDT discussions. As the patient was asymptomatic, she received long-term monitoring without treatment. A follow-up of chest HRCT after 6 mo showed that the PBML lung nodules were stable and there was no progression.
CONCLUSION For patients with a medical history of hysterectomy and uterine leiomyoma with lung nodules on chest CT, PBML should be considered during diagnosis based on the clinical history, imaging manifestations, CT-guided percutaneous lung puncture biopsy, and MDT discussions.
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Affiliation(s)
- Hai-Yun Dai
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Shu-Liang Guo
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Jian Shen
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Li Yang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
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Diffuse smoking-related lung diseases: insights from a radiologic-pathologic correlation. Insights Imaging 2019; 10:73. [PMID: 31312909 PMCID: PMC6635572 DOI: 10.1186/s13244-019-0765-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 07/02/2019] [Indexed: 01/12/2023] Open
Abstract
Cigarettes are well-recognized risk factors responsible for the emergence of a variety of pathologic conditions affecting both the airways and the lungs. Smoking-related lung diseases can be classified as chronic obstructive pulmonary disease (COPD) and several types of interstitial diseases, such as pulmonary Langerhans cell histiocytosis, bronchiolitis, desquamative interstitial pneumonitis, acute eosinophilic pneumonia, and interstitial fibrosing lung diseases. The evidence of combined lower lung fibrosis and predominant upper lung emphysema is renowned as a distinct clinical entity, named combined pulmonary fibrosis and emphysema. Although computerized tomography permits an adequate classification and distinction of these diseases, the clinical, imaging, and histological features often overlap and coexist in a single patient. Therefore, a combined radiologic and pathologic approach, in the appropriate clinical setting, is useful for best comprehension and distinction of these entities. Our goals are to describe the imaging features in smoking-related lung diseases and how the pathological manifestations translate on high-resolution computerized tomography.
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Ropars C, Kerjouan M, Larible C, Llamas Gutierrez F, Léderlin M, De Latour B, Desrues B, Jouneau S. [Lung metastases of pancreatic adenocarcinoma: Watch for the second train!]. Rev Mal Respir 2019; 36:738-741. [PMID: 31230848 DOI: 10.1016/j.rmr.2019.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 04/11/2019] [Indexed: 01/15/2023]
Abstract
Pulmonary metastases due to a pancreatic cancer are difficult to diagnose and demonstrate a wide range of radiological patterns. We report the case of a 37-year-old female patient, without past medical history, with multicystic lung disease in a context of chronic abdominal pain, fatigue and weight loss. After several months of diagnostic delay, pathological examination of surgical lung biopsies led to the diagnosis of secondary deposits of pancreatic cancer. The clinical and radiogical situation deteriorated quickly with the development of alveolar consolidation and Aspergillus superinfection was then diagnosed. This case illustrates the value of an early decision to undertake surgical lung biopsy in the work-up of multicystic lung disease when cancer is suspected. In addition, in the specific context of cancer, faced with clinical and/or radiological deterioration, it is essential to look for infection, particularly aspergillosis.
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Affiliation(s)
- C Ropars
- Service de pneumologie, hôpital Pontchaillou, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France.
| | - M Kerjouan
- Service de pneumologie, hôpital Pontchaillou, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France
| | - C Larible
- Service d'oncologie médicale, centre Eugène-Marquis, avenue de la Bataille Flandres-Dunkerque, 35042 Rennes cedex, France
| | - F Llamas Gutierrez
- Service d'anatomopathologie, hôpital Pontchaillou, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France
| | - M Léderlin
- Service de radiologie, hôpital Pontchaillou, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France; LTSI, Inserm U1099, université de Rennes 1, 2, avenue du Pr Léon-Bernard, 35043 Rennes, France
| | - B De Latour
- Service de chirurgie thoracique et cardiovasculaire, université de Rennes 1, hôpital Pontchaillou, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France
| | - B Desrues
- Service de pneumologie, hôpital Pontchaillou, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France; Université de Rennes 1, 2, avenue du Pr Léon-Bernard, 35043 Rennes, France
| | - S Jouneau
- Service de pneumologie, hôpital Pontchaillou, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France; Irset UMR 1085, université de Rennes 1, 2, avenue du Pr Léon-Bernard, 35043 Rennes, France
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Escalon JG, Richards JC, Koelsch T, Downey GP, Lynch DA. Isolated Cystic Lung Disease: An Algorithmic Approach to Distinguishing Birt-Hogg-Dubé Syndrome, Lymphangioleiomyomatosis, and Lymphocytic Interstitial Pneumonia. AJR Am J Roentgenol 2019; 212:1260-1264. [PMID: 30888864 DOI: 10.2214/ajr.18.20920] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. Birt-Hogg-Dubé (BHD) syndrome, lymphangioleiomyomatosis (LAM), and lymphocytic interstitial pneumonia (LIP) frequently present as isolated cystic lung disease and can be challenging to distinguish. If imaging findings are otherwise unremarkable, the radiologist is unaided by ancillary CT findings in narrowing the diagnosis. We hypothesized that the distribution and morphologic features of lung cysts could be used to differentiate BHD syndrome, LAM, and LIP. Therefore, the purpose of this study was to characterize the CT appearances of these conditions and create a practical CT-based algorithm to differentiate among them. MATERIALS AND METHODS. The study was a retrospective review of the CT images of 16 patients with BHD syndrome, 17 patients with LAM, and 14 patients with LIP. On the basis of the data collected, a CT-based algorithm was created, and the CT images were reviewed again. RESULTS. Lower lung-predominant cysts were significantly more likely to be found in patients with BHD syndrome (100% of patients) or LIP (71-93% of patients) than in patients with LAM (6-12% of patients), who were more likely to have diffuse cysts. Compared with patients with LIP or LAM, patients with BHD syndrome were significantly more likely to have elliptical (floppy) paramediastinal cysts (88-94% of patients with BHD syndrome, 36-43% of patients with LIP, and 6-12% of patients with LAM) or a disproportionate number of paramediastinal cysts (69-88% of patients with BHD syndrome, 0-14% of patients with LIP, and 0-6% of patients with LAM). Our algorithm enabled differentiation of BHD syndrome, LAM, and LIP with a high level of accuracy and high interreader agreement (κ = 0.809). CONCLUSION. Radiologists can use the proposed CT-based algorithm to prospectively and confidently suggest one of these disorders as the favored diagnosis. Of importance, this will allow diagnosing the disorder early and accurately, screening for comorbidities, and prevention of potential complications.
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Affiliation(s)
- Joanna G Escalon
- Department of Radiology, National Jewish Health, Denver, CO
- Present address: NewYork-Presbyterian/Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065
| | | | - Tilman Koelsch
- Department of Radiology, National Jewish Health, Denver, CO
| | - Gregory P Downey
- Department of Medicine, National Jewish Health, Denver, CO
- Department of Pediatrics, National Jewish Health, Denver, CO
- Department of Biomedical Research, National Jewish Health, Denver, CO
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado, Aurora, CO
- Department of Immunology and Microbiology, University of Colorado, Aurora, CO
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, CO
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Primary Sjögren's syndrome with diffuse cystic lung changes developed systemic lupus erythematosus: a case report and literature review. Oncotarget 2017; 8:35473-35479. [PMID: 28415674 PMCID: PMC5471070 DOI: 10.18632/oncotarget.16010] [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: 01/23/2017] [Accepted: 03/02/2017] [Indexed: 11/25/2022] Open
Abstract
Sjögren's syndrome (SS) is a chronic inflammatory autoimmune disease that can occur as a unique existence (primary Sjögren's syndrome) or merge with other systemic diseases like systemic lupus erythematosus (SLE), rheumatoid arthritis or systemic sclerosis (secondary Sjögren's syndrome). Data on the two diseases occurrence order are inadequate. Primary Sjögren's syndrome (pSS) may relatively uncommonly lead to diffuse cystic lung changes. We represent a female who was diagnosed pSS with diffuse cystic lung alterations developed SLE two years later. SS was diagnosed on account of the existence of dryness of eye and mouth, Schirmer's test, biopsy of the minor salivary glands of her lip, positive anti-SSA and anti-SSB antibody in the serum. Chest computed tomography image showed bilateral diffuse cystic changes with a wide variation in cyst size and distribution. SLE was finally diagnosed based on bilateral lower limb skin rash, gonarthritis and omarthritis, low level of complement, antinuclear antibody 1:640 and positive antibodies to double-stranded DNA. Improvement was achieved with therapy of corticosteroids, hydroxychloroquine and antibiotics. This report provides us clinical, diagnosis and treatment perception of SS-onset SLE as patient presenting diffuse cystic lung changes.
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Abstract
Cystic lung disease (CLD) is a group of lung disorders characterized by the presence of multiple cysts, defined as air-filled lucencies or low-attenuating areas, bordered by a thin wall (usually < 2 mm). The recognition of CLDs has increased with the widespread use of computed tomography. This article addresses the mechanisms of cyst formation and the diagnostic approaches to CLDs. A number of assessment methods that can be used to confirm CLDs are discussed, including high-resolution computed tomography, pathologic approaches, and genetic/ serologic markers, together with treatment modalities, including new therapeutic drugs currently being evaluated. The CLDs covered by this review are lymphangioleiomyomatosis, pulmonary Langerhans cell histiocytosis, Birt-Hogg-Dube syndrome, lymphocytic interstitial pneumonia/follicular bronchiolitis, and amyloidosis.
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Affiliation(s)
| | - Eun Joo Lee
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
- Correspondence to Eun Joo Lee, M.D. Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Korea University Anam Hospital, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, Korea Tel: +82-2-920-5048 Fax: +82-2-929-2045 E-mail:
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Abstract
Benign metastasizing leiomyoma (BML) is a rare and poorly characterized disease affecting primarily premenopausal women. Asymptomatic patients are often diagnosed incidentally by radiographs or other lung-imaging procedures performed for other indications, and the diagnosis is eventually confirmed by biopsy. Patients with BML are usually treated pharmacologically with antiestrogen therapies or surgically with oophorectomy or hysterectomy. Antiestrogen therapy is typically efficacious and, in general, most patients have a favorable prognosis. Asymptomatic patients with a confirmed diagnosis of BML, may be followed conservatively without treatment.
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Affiliation(s)
- Gustavo Pacheco-Rodriguez
- Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10, Room 5N307, 9000 Rockville Pike, Bethesda, MD 20892-1434, USA
| | - Angelo M Taveira-DaSilva
- Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10, Room 6D05, MSC-1590, 9000 Rockville Pike, Bethesda, MD 20892-1590, USA
| | - Joel Moss
- Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10, Room 6D05, MSC-1590, 9000 Rockville Pike, Bethesda, MD 20892-1590, USA.
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Li CW, Li MH, Li JX, Tao RJ, Xu JF, Cao WJ. Pulmonary Langerhans cell histiocytosis: analysis of 14 patients and literature review. J Thorac Dis 2016; 8:1283-9. [PMID: 27293848 DOI: 10.21037/jtd.2016.04.64] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Pulmonary Langerhans cell histiocytosis (PLCH) is an orphan disease in respiratory medicine, which most affects adult smokers. The purpose of this article was to discuss the clinical features, especially the radiologic features of PLCH patients during their hospitalization through a retrospective analysis on clinical data. Furthermore, the current literature was also reviewed. METHODS Between December 2008 and June 2012, 14 patients with PLCH were assessed at Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China. Among these patients, seven patients were diagnosed through tissue biopsy from the lung and one patient from enlarged cervical lymph nodes; the rest of six patients were diagnosed based on the clinical-radiological data. The data consisting of demographics, clinical presentation, smoking habits, pulmonary function tests (PFTs) and radiographic image from the medical records was analyzed retrospectively. RESULTS The average age of patients (11 males and 3 females) was 42.79 (±13.71) years old. All male patients and one female patient had a long smoking history. The common manifestations were cough and exertional dyspnea. Spontaneous pneumothorax was found in three patients. Varieties of pulmonary shadows such as nodular, cystic, patch-like and cord-like were revealed by chest computed tomography (CT) examination. Large Langerhans cells (LCs) were discovered in biopsy tissue by immunohistochemical stains. CONCLUSIONS PLCH is still an orphan disease and maybe related to smoking. Clinical symptoms such as cough and exertional dyspnea are non-specific. We shall pay attention to recurrent pneumothorax as clinically it is associated with PLCH. The characteristic radiological manifestation is cystic or nodular shadow in the lungs, which plays crucial roles in diagnosing PLCH.
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Affiliation(s)
- Cheng-Wei Li
- 1 Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Soochow University, Suzhou 215006, China ; 2 Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Man-Hui Li
- 1 Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Soochow University, Suzhou 215006, China ; 2 Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Jiang-Xiong Li
- 1 Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Soochow University, Suzhou 215006, China ; 2 Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Ru-Jia Tao
- 1 Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Soochow University, Suzhou 215006, China ; 2 Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Jin-Fu Xu
- 1 Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Soochow University, Suzhou 215006, China ; 2 Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Wei-Jun Cao
- 1 Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Soochow University, Suzhou 215006, China ; 2 Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
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Zamora AC, White DB, Sykes AMG, Hoskote SS, Moua T, Yi ES, Ryu JH. Amyloid-associated Cystic Lung Disease. Chest 2016; 149:1223-33. [PMID: 26513525 DOI: 10.1378/chest.15-1539] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 10/02/2015] [Accepted: 10/09/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Amyloid-associated cystic lung disease is rare. It can be associated with collagen vascular disease (CVD). We aimed to describe the clinical, radiology, and pathology findings of this entity. METHODS We reviewed the records of subjects having biopsy-proven pulmonary amyloidosis with cystic lung disease demonstrated at high-resolution computed tomography (HRCT). Demographic characteristics, association with CVD and lymphoproliferative disorders, pulmonary function, and pathology results were reviewed. HRCT appearance was analyzed for number, size, distribution, and morphology of cysts and nodules. RESULTS Twenty-one subjects (13 female, eight male; median age, 61 years) with cystic pulmonary amyloidosis were identified. The most common pulmonary function patterns were normal (42%) and obstructive (32%). The most common associated CVD was Sjögren syndrome (10 of 12). Nine subjects had no CVD. Cysts tended to be multiple (≥ 10 in 14 of 21, 67%), round (21 of 21, 100%), or lobulated (20 of 21, 95%); thin-walled (< 2 mm in 17 of 21, 81%); and of small (< 1 cm in 21 of 21, 100%) to moderate (1-2 cm in 17 of 21, 81%) size. Peribronchovascular (19 of 21, 90%) and subpleural (19 of 21, 90%) cysts were typically present. Seventeen (81%) subjects had lung nodules, which tended to be numerous (≥ 10 in 10 of 17, 59%; 4-9 in six of 17, 35%). At least one calcified nodule was present in 14 of 17 subjects (82%). Pulmonary mucosa-associated lymphoid tissue lymphoma (MALToma) was diagnosed in seven subjects (33%). CONCLUSIONS Amyloid-associated cystic lung disease can occur with or without underlying CVD. Cystic lesions in the lung are commonly numerous, often are peribronchovascular or subpleural, and are frequently associated with nodular lesions that are often calcified. MALToma was a relatively frequent association.
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Affiliation(s)
- Ana C Zamora
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
| | | | | | - Sumedh S Hoskote
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Teng Moua
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Eunhee S Yi
- Division of Anatomic Pathology, Mayo Clinic, Rochester, MN
| | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
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Fielli M, Avila F, Saino A, Seimah D, Fernández Casares M. Diffuse cystic lung disease due to pulmonary metastasis of colorectal carcinoma. Respir Med Case Rep 2016; 17:83-5. [PMID: 27222791 PMCID: PMC4821331 DOI: 10.1016/j.rmcr.2015.12.006] [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: 11/22/2015] [Revised: 12/22/2015] [Accepted: 12/23/2015] [Indexed: 11/15/2022] Open
Abstract
The diffuse cystic lung diseases (DCLDs) are a pathophysiologically heterogeneous processes characterized by the presence of multiple thin-walled, air-filled spaces within the pulmonary parenchyma. The most common causes of DCLD are lymphangioleiomyomatosis (LAM) and pulmonary Langerhans cell histiocytosis (PLCH). DCLD develops rarely as a result of malignancy, typically secondary to metastases from peripheral sarcomas and mesenchymal tumors. DCLD have also been reported in a variety of other metastatic disease such as adenocarcinoma. Our case describes a patient with DCLD as a result of metastatic colorectal adenocarcinoma.
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Affiliation(s)
- Mariano Fielli
- Pulmonary Section, Department of Internal Medicine, Hospital Nacional Posadas, Buenos Aires, Argentina
| | - Fabio Avila
- Pulmonary Section, Department of Internal Medicine, Hospital Nacional Posadas, Buenos Aires, Argentina
| | - Agustina Saino
- Pathology Department, Hospital Nacional Posadas, Buenos Aires, Argentina
| | - Deborah Seimah
- Pathology Department, Hospital Nacional Posadas, Buenos Aires, Argentina
| | - Marcelo Fernández Casares
- Pulmonary Section, Department of Internal Medicine, Hospital Nacional Posadas, Buenos Aires, Argentina
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Jolissaint JS, Kilbourne SK, LaFortune K, Patel M, Lau CL. Benign metastasizing leiomyomatosis (BML): A rare cause of cavitary and cystic pulmonary nodules. Respir Med Case Rep 2015; 16:122-4. [PMID: 26744676 PMCID: PMC4681982 DOI: 10.1016/j.rmcr.2015.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Accepted: 09/17/2015] [Indexed: 12/16/2022] Open
Abstract
Benign metastasizing leiomyomatosis (BML) is a rare cause of pulmonary lesions found in reproductive age women who have undergone a hysterectomy for uterine leiomyoma. Given the relative rarity of the disease, the management of these lesions varies from surgical (oopherectomy) or medical antiestrogen hormonal therapy to clinical observation and survelliance. The disease generally presents asymptomatically with multiple, well-defined pulmonary nodules discovered incidentally on imaging. We report an atypical presentation of a 46-year-old woman with incidentally found bilateral pulmonary cavitating nodules and cysts, concerning for lymphangioleiomyomatosis (LAM), who was ultimately diagnosed with BML.
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Key Words
- BAL, Bronchoalveolar lavage
- BML, Benign metastasizing leiomyomatosis
- Benign metastasizing leiomyomatosis (BML)
- Benign or congenital lesions
- CTPA, Computed tomography pulmonary angiogram
- ER, Estrogen receptor
- GnRH, Gonadotropin-releasing hormone
- HMB-45, Human melanoma black-45
- LAM, Lymphangioleiomyomatosis
- Lung histology
- Lung pathology
- Lymphangioleiomyomatosis (LAM)
- POD, Post-operative day
- PR, Progesterone receptor
- SMA, Smooth muscle actin
- VATS, Video-assisted thoracoscopic surgery
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Affiliation(s)
- Joshua S Jolissaint
- University of Virginia School of Medicine, University of Virginia Health System, 1215 Lee Street, Charlottesville, VA, 22903, USA
| | - Sarah K Kilbourne
- University of Virginia, Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Virginia Health System, 1215 Lee Street, Charlottesville, VA, 22903, USA
| | - Kristen LaFortune
- University of Virginia, Department of Pathology, University of Virginia Health System, 1215 Lee Street, Charlottesville, VA, 22903, USA
| | - Manojkumar Patel
- University of Virginia, Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Virginia Health System, 1215 Lee Street, Charlottesville, VA, 22903, USA
| | - Christine L Lau
- University of Virginia, Department of Surgery, University of Virginia Health System, 1215 Lee Street, Charlottesville, VA, 22903, USA
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