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Lung and pleural metastases
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
Certain types of adenocarcinoma may mistakenly be diagnosed as lobar pneumonia on initial chest radiographs. Invasive mucinous adenocarcinoma and adenocarcinoma with papillary pattern on histology may mimic pneumonia on chest radiography (35). Coexisting pulmonary findings on CT scan, such as associated subcentimetre nodules (which can be ground glass and cavitary) or scattered areas of ground glass in other regions of the lung, should raise suspicion for this disease (Figure 29.22) (36,37). On rare occasions, cyst-like changes in the consolidation may develop, which can be mistaken for cavitary pneumonia or bronchiectasis. Lymphadenopathy is unusual and is therefore not helpful in distinguishing tumour from infection. Ground glass with septal thickening, sometimes called ‘crazy paving’, is an unusual pattern for lung cancer, but is well described (Figure 29.23) (38,39).
A rare case of cytomegalovirus causing respiratory failure and a large pericardial effusion
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Leah Burkovsky, Wahab M. Kahloan, Aashish Acharya, Gayatri Nair, Ricardo A. S. Conti
Cytomegalovirus (CMV) is seroprevalent in a majority of the population around the world but causes symptoms in only a small proportion of infected individuals [1]. Immunocompetent patients are usually asymptomatic, but when symptoms are present, it can resemble a mononucleosis-like infection [2]. Immunocompromised patients can eventually have a severe presentation. The most common presentations of CMV in patients with human immunodeficiency virus (HIV) are retinitis, colitis, and esophagitis. CMV pneumonitis is extremely uncommon [3]. This is a rare case of a severe presentation of CMV in a patient with HIV, in which CMV was responsible for the patient’s significant pulmonary and cardiac presentation. The patient presented with hypoxic respiratory failure secondary to cavitary pneumonia and a large pericardial effusion at risk of tamponade. CMV was the only pathogen found in the bronchoalveolar lavage (BAL) and pericardial fluid.
Hemorrhagic pneumonia and upper lobe pulmonary cavitary lesion caused by Streptococcus pyogenes
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Gayatri B Nair, Harish Gopalakrishna, Ricardo Conti
Among the various causes of pneumonia associated with hemoptysis and upper lobe cavitary lung lesion, mycobacterium tuberculosis is one of the main differentials, especially in patients from endemic areas for tuberculosis[1]. Occasional cases of cavitary pneumonia occur due to Streptococcus pneumoniae, Hemophilus influenzae or Staphylococcus aureus. Group A streptococcus [GAS] is rarely described as a cause for this entity [2]. GAS is a gram-positive coccus in chains which is ubiquitous mostly associated with skin and soft tissue infections, pharyngitis, and toxic shock syndrome. Approximately 10% of GAS infections present as pneumonia [3]. Even though rare, it is important to have an early diagnosis of GAS as it can be rapidly progressing and fatal because of its presentation as hemorrhagic pneumonia and sepsis [4].