[Show abstract][Hide abstract] ABSTRACT: We report a case of platypnea-orthodeoxia that developed in a 64-year-old Japanese woman during an episode of rapidly progressive interstitial pneumonia with polymyositis. Pulmonary infiltrates were predominant in the bilateral lower lobes. The patient was treated successfully with early administration of immunosuppressive therapies and polymyxin B-immobilized fiber column-direct hemoperfusion, and her platypnea-orthodeoxia improved with resolution of the underlying parenchymal lung disease. Reports of platypnea-orthodeoxia syndrome with interstitial pneumonia are extremely rare. The recognition that platypnea-orthodeoxia syndrome may occur in multiple disease states, including interstitial pneumonia, is crucial to the understanding of this perplexing disorder.
[Show abstract][Hide abstract] ABSTRACT: An elderly woman diagnosed with multiple myeloma (MM) in 2007 had improved with chemotherapy. She had severe kyphosis and a diaphragmatic hernia (DH), but no respiratory symptoms. In 2011, because of thoracic deformity and emaciation, we advised her to continue the previously prescribed domiciliary noninvasive positive pressure ventilation (NPPV) therapy for chronic type II respiratory failure. However, she refused to continue NPPV. She was later admitted for deterioration in respiratory status and carbon dioxide (CO2) narcosis. We believed her low adherence to domiciliary NPPV caused CO2 narcosis; hence, we advised her to continue domiciliary NPPV and she complied. In May 2012, the now 79-year-old patient was admitted for acute exacerbation of chronic respiratory failure and CO2 narcosis. Chest imaging suggested that DH had caused a deterioration of her status. She underwent laparoscopic diaphragmatic hernia repair. Operative findings revealed a retrosternal hernia sac, and she was diagnosed as having a Morgagni hernia (MH). Her respiratory status subsequently improved. We hypothesize that NPPV increased intra-abdominal pressure, thereby worsening the MH and exacerbating respiratory failure. We believe that clinicians should be cautious when prescribing NPPV for MH patients.
[Show abstract][Hide abstract] ABSTRACT: A 78-year-old man had fatigue and appetite loss for 5 months. He had been receiving low-dose methotrexate for rheumatoid arthritis. Computed tomography revealed multiple pulmonary infiltrations and muddiness of the fatty tissue surrounding the right kidney, ureter wall thickening, and hydroureter/nephrosis, which were suspected retroperitoneal fibrosis. Lung biopsy revealed polymorphic/lymphoplasmacytic lymphoproliferative disorder. Methotrexate withdrawal resulted in spontaneous regression. Therefore, retroperitoneal lesion may account for the diagnosis as having retroperitoneal lymphoproliferative disorder, not retroperitoneal fibrosis.
[Show abstract][Hide abstract] ABSTRACT: A 61-year-old woman being treated with methotrexate (MTX) 8-10 mg/week and prednisolone 2.5 mg/day for rheumatoid arthritis presented with a 1-week history of increasing fever and dry cough. The patient deteriorated with administration of antibiotics. Chest CT scan showed bilateral diffuse ground-glass opacities. Analysis of bronchoalveolar lavage fluid (BALF) revealed marked neutrophilia (65.2% of total cells). The specimen from transbronchial lung biopsy showed a non-specific interstitial pneumonia pattern. Following withdrawal of the MTX, her pulmonary infiltration, clinical symptoms and laboratory findings gradually improved. Therefore, she was diagnosed as having MTX-induced pneumonitis. Lymphocytosis in BALF has been identified as a characteristic of MTX-induced pneumonitis, particularly in late onset of this disease. However, the BALF in our patient was neutrophilic. Although neutrophilia in BALF of patients with drug-induced pneumonitis is usually associated with poor outcome, rare cases of good outcome do exist.
[Show abstract][Hide abstract] ABSTRACT: We herein report the case of a 68-year-old man with a history of allogeneic hematopoietic stem cell transplantation for acute myelocytic leukemia in whom graft-versus-host disease (GVHD) developed in the gastrointestinal tract and liver five months after transplantation. In that same period, chest computed tomography showed infiltration in both upper lungs. We performed bronchoscopy to clarify the GVHD and pulmonary infection. Nocardia nova was identified in the bronchoalveolar lavage fluid, and we diagnosed the patient as having pulmonary nocardiosis. Because the differential diagnosis is important for the medical management of GVHD and pulmonary infection, performing bronchoscopy is essential for making an appropriate and rapid diagnosis.
Internal Medicine 01/2014; 53(12):1391-5. · 0.97 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A 39-year-old man was admitted for spontaneous pneumothorax. He underwent pulmonary resection to correct the lesion causing the air leakage, and a pathological diagnosis of pulmonary pleomorphic carcinoma was made because we thought that the pneumothorax developed due to the direct rupture of necrotic neoplastic tissue into the pleural cavity. After the operation, the patient received chemotherapy, during which multiple cystic metastases gradually developed in the lung that caused repeated occurrences of pneumothorax. Clinicians must be careful to recognize that pneumothorax can also be a complication of primary and various metastatic pulmonary malignancies.
[Show abstract][Hide abstract] ABSTRACT: We report a case with an atypical presentation of descending necrotizing mediastinitis (DNM). A 47-year-old woman with a medical history of untreated type 2 diabetes mellitus and influenza type A virus infection 2 weeks prior to admission was referred to our hospital complaining of right cervical pain and right upper limb swelling. A chest enhanced computed tomographic (CT) scan showed a ring-enhanced mass-like shadow extending from the right sternomastoid muscle down to the right upper mediastinum, compressing the right subclavicular vein. We diagnosed the patient as having DNM based on a physical examination and the CT findings. Because the abscess extended from deep in the neck to the upper mediastinum and right upper pleural space, emergent abscess debridement and drainage was required. After hospitalization, antibiotics (Ampicillin/Sulbactam 12 g/day) were also administered based on Gram-stain findings from the drainage fluid, which showed Gram-positive cocci resembling a string of beads. A culture of the drainage fluid identified Streptococcus agalactiae. Aggressive abscess drainage and early antibiotic therapy resulted in a favorable response. She was discharged without complications on the 33rd hospital day. DNM is well known as a rare but lethal disease. In this case, the presence of diabetes mellitus and post-influenza infection might have been risk factors for a serious S. agalactiae infection. Early aggressive therapy and adequate drainage are recommended for patients with DNM.
Kansenshogaku zasshi. The Journal of the Japanese Association for Infectious Diseases 11/2012; 86(6):768-72.
[Show abstract][Hide abstract] ABSTRACT: We encountered a case of limited-disease small cell lung cancer with episodic syncope. The frequency of the syncopal attacks increased with the increase in the tumor size, thus a relationship was suspected to exist between the SCLC and syncope. Syncope was evaluated by history taking, 24-hour ECG monitoring, and coronary angiography. As orthostatic hypotension and cardiac disease could be excluded, we finally diagnosed this case as neurally mediated syncope. Serum tests for anti-Hu and anti-Yo antibodies were negative. A temporary pacemaker was inserted for sick sinus syndrome. This patient showed good response to the chemotherapy. No further syncopal attacks were observed after the second course of chemotherapy. Here, in addition we review four cases of SCLC with episodic syncope. Interestingly, in all cases, the tumor was located in the left hilum in close vicinity of the afferent vagal nerve (C-fibers) and mechano-receptor. Therefore, we thought that the mechanism underlying the syncope was mechano-receptor hypersensitivity.
Internal Medicine 01/2011; 50(20):2367-9. · 0.97 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A serious complication following primary lung cancer surgery on patients with interstitial pneumonia (IP) is the postoperative acute exacerbation of IP. Because few studies have examined the feasibility of using video-assisted thoracic surgery (VATS) on these patients, we reviewed our experience with this technique.
We examined 78 patients; 11 had IP (IP group) and 67 did not (non-IP group).
Patients in the IP group were older than those in the non-IP group (p = 0.097), and they had a significantly higher incidence of squamous cell carcinoma than patients in the non-IP group (p = 0.002). Dominating the IP group, though not statistically significant, were males, the intention to undergo VATS, and limited surgery. VATS was performed on 10 lesions in the IP group and on 45 in the non-IP group. No surgery-related exacerbation of preoperative IP or development of postoperative IP was found in either group.
VATS is the preferred surgical choice for lung cancer patients with IP.
Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia. 08/2010; 16(4):236-41.
[Show abstract][Hide abstract] ABSTRACT: A 69-year-old woman underwent resection of a solitary fibrous tumor (SFT) of the left pleura in April 1997 and of locally recurrent SFT in the left thoracic cavity in September 2003. A postoperative follow-up chest CT scan in March 2005 revealed pleural thickening at two sites of the left thoracic cavity. A further chest CT scan performed in September of the same year showed the enlarging tendency of the lesions, suggesting SFT recurrence, for which surgery was performed in January 2006. The two resected tumors were benign SFT, and were diagnosed as locally recurrent SFT in the left thoracic cavity. It has been reported that despite its benign histopathology, pleural SFT recurs more than once after surgery, and the interval between recurrences tends to shorten from the second recurrence. In this patient, the tumor recurred twice and showed a rapidly enlarging tendency at the time of the second recurrence, suggesting the need for careful follow-up at short intervals.
Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia. 07/2009; 15(3):178-81.
[Show abstract][Hide abstract] ABSTRACT: We performed successful surgery for lung cancer after confirming the anatomical abnormality of a tracheal bronchus by three-dimensional multidetector-row computed tomography (3D-MDCT) bronchography and angiography. Tracheal bronchus is unusual, and right upper lobectomy for lung cancer would rarely be performed in a patient with a tracheal bronchus. Most clinicians are unfamiliar with the anatomy of a right upper lobe that includes a tracheal bronchus. Preoperative 3D imaging of the tracheal bronchus and its related vessels familiarized us with the anatomy of this patient before the operation. Thus, we recommend preoperative 3DMDCT bronchography and angiography, especially for patients with a possible bronchial anomaly.
Surgery Today 02/2008; 38(9):841-3. · 1.21 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A 63-year-old man was referred to our hospital due to an abnormal shadow found on a chest CT scan. The CT scan showed a cystic tumor with a central high density in the right upper mediastinal area. The preoperative diagnosis was teratoma in the right upper mediastinal area. Video-assisted thoracic surgery was performed. The tumor was about 3cm in size and originated from the right vagal nerve. Microscopic findings of the resected specimen showed loose growth of spindle cells, in which a myxomatous framework was observed in the peripheral area as well as extended vessels, with thrombis, Verocay bodies, and a nuclear palisading pattern confirmed in the central area. The histological diagnosis was schwannoma originating from the mediastinal vagal nerve. This case was thought to be rare and difficult to diagnose by preoperative imaging findings. Postoperative hoarseness due to dysfunction of the right recurrent nerve occurred. Careful consideration should be given to the indication of video-assisted thoracic surgery for neurogenic mediastinal tumors since postoperative dysfunction may occur.
Nihon Kokyūki Gakkai zasshi = the journal of the Japanese Respiratory Society. 07/2007; 45(6):499-502.
[Show abstract][Hide abstract] ABSTRACT: A 62-year-old woman, who had received immunosuppressive treatment for myasthenia gravis, was admitted to our hospital for the treatment of a right pulmonary tumor. In October 2003, a chest computed tomography showed a nodule-like lesion in the right lung. Two years later, the lesion was shown to have increased in size, and a right upper lobectomy was performed using video-assisted thoracic surgery. A tumor biopsy showed histological features of bronchioloalveolar carcinoma. It has been reported that malignant tumors occur more frequently in patients with myasthenia gravis with concurrent thymoma. Therefore, such patients need to be followed closely for a long period of time for any possible malignant tumor occurring in different organs. In addition, protection of the bronchial stump may be necessary to prevent a bronchial fistula, because wound healing can be delayed due to immunosuppressive treatment.
Nihon Kokyūki Gakkai zasshi = the journal of the Japanese Respiratory Society. 03/2007; 45(2):198-201.
[Show abstract][Hide abstract] ABSTRACT: A 57-year-old man was admitted to our hospital because of fever, cough and polyarthralgia. A physical examination revealed polyarthritis and saddle nose. Chest computed tomography showed stenosis of the trachea and both main bronchi. Relapsing polychondritis (RP) was diagnosed, and steroid therapy was started. Dyspnea at rest appeared suddenly. Bronchoscopy showed stenosis from the trachea to both main bronchi. An expandable metallic stent (Ultraflex) was placed in the trachea and both main bronchi. After the procedure, bronchoscopy showed a widely patent airway, and his symptoms were improved. Since airway complications of RP can be fatal, tracheobronchial stent placement should be considered in the management of RP with airway stenosis.
Nihon Kokyūki Gakkai zasshi = the journal of the Japanese Respiratory Society. 01/2007; 44(12):997-1001.
[Show abstract][Hide abstract] ABSTRACT: A 71-year-old man was admitted to the urological section of our hospital because of hematuria. Cystoscopy revealed a bladder tumor. Transurethral resection of the bladder tumor (TUR-Bt) was performed. This tumor was diagnosed pathologically as bladder cancer (transitional cell carcinoma pT2). His chest computed tomogram showed multiple thin-walled cavitary nodules in both lungs. The pathological images of the specimen that was resected by video assisted thoracic surgery (VATS) showed transitional cell carcinoma. A diagnosis of pulmonary metastasis from bladder cancer was made. This is a rare case.
Nihon Kokyūki Gakkai zasshi = the journal of the Japanese Respiratory Society. 11/2006; 44(10):771-4.