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Clinical Cases
Published in S. J. Copley, J. P. Kanne, D. M. Hansell, Thoracic Imaging, 2014
S. J. Copley, J. P. Kanne, D. M. Hansell
Bronchial atresia is a rare congenital anomaly. Patients may present with recurrent chest infections as in this case; but at least 50% are asymptomatic, and the abnormality is discovered as an incidental finding. The commonest lobe to be affected is the left upper lobe (64%), followed by the left lower lobe (14%), and the right middle and lower lobes (8%). Involvement of more than one lung segment is extremely rare. The anomaly is due to focal obliteration of a proximal segmental or subsegmental bronchus, with normal development of distal structures. A bronchocele results from accumulation of mucus within distal bronchi. The lung distal to the atretic bronchus is underventilated: ventilation occurs by collateral air drift, and the surrounding lung is hyperlucent; air trapping may be confirmed on expiratory radiographs or CT. The diagnosis can often be made on the plain radiograph: typically the bronchocele is a rounded, branching opacity adjacent to the hilum surrounded by hyperlucent lung. An air–fluid level sometimes occurs, but this is rare. CT demonstrates the features more elegantly than chest radiography and allows for more accurate delineation of lobar anatomy. On MRI, a bronchocele characteristically returns high signal on both T1- and T2-weighted images, although the disadvantage of the technique is its inability to demonstrate the surrounding hyperlucent lung.
Efficacy of nebulized liposomal amphotericin B in the treatment of ABPA in an HIV/HBV co-infected man: Case report and literature review
Published in Journal of Asthma, 2019
Magali Garcia, Gwénaël Le Moal, Jacques Cadranel, France Roblot, Cendrine Godet
A 56-year-old HIV1/HBV co-infected Caucasian man with medical history of asthma and chronic obstructive pulmonary disease (COPD) presented with cough, increasing dyspnea, and general weakness. He had been diagnosed with HIV1/HBV positive 20 years before and treated since 1997. He had a recent CD4 count of 483 cells.mm−3 (17%) and an HIV-1 viral load <50 copies mL−1 under Highly Active Anti Retroviral Therapy (HAART) regimen (darunavir/ritonavir 600/100 mg twice a day, etravirine 200 mg twice a day). He had not been suffering from any opportunistic infection. Laboratory investigations showed an elevated peripheral blood eosinophil count (1.222 cells µL−1), total immunoglobulin (Ig)E (749 IU mL−1), specific anti-Aspergillus fumigatus IgE levels at 28.1 kU.L−1, and the presence of specific anti-A. fumigatus precipitins in the serum (two lines). A thoracic computed tomography (CT) scan revealed left apical condensation with right bronchiectasis associated with bronchocele (Figure 1A). The association of poorly controlled asthma, COPD, and clinical, biological and radiological presentations supported the diagnosis of allergic bronchopulmonary aspergillosis (ABPA).
A Review of Primary Thyroid Lymphoma: Molecular Factors, Diagnosis and Management
Published in Journal of Investigative Surgery, 2019
Efstathios T. Pavlidis, Theodoros E. Pavlidis
PTL occurs in patients with Hashimoto's autoimmune lymphocytic thyroiditis at a rate of 0.5%. It manifests as a rapidly enlarged bronchocele that causes symptoms due to the pressure of surrounding structures and is associated with hypothyroidism signs and the detection of positive antithyroid antibodies.12 Moreover, autoimmune thyroiditis is considered a risk factor for the development of PTL (typically manifested in disease cases lasting from 20 to 30 years), with potentially an 80-fold risk compared to individuals without autoimmune thyroiditis.3,13