Solitary fibrous tumour of lung.

Fibrous tumours arising entirely within the substance of the lung are rare. We report one such rare case in whom the diagnosis was established after surgical removal.

Chest wall metastasis of squamous cell carcinoma of larynx.

Distant metastases in squamous cell carcinoma of head and neck are most often to the lung, liver and bone. They rarely metastasise to chest wall. We report a 60-year-old male patient who initially presented with an abscess over the anterior chest wall that was initially treated for infective pathology. Due to lack of response, cytological examination was performed that turned out to be metastasis from carcinoma larynx.

Obstructing mass lesion of epiglottis: it can be tubercular.

We report a case of 60-year old male who had difficulty in breathing as well as in swallowing. On examination, he was found to be having proliferative growth of epiglottis and right aryepiglottic fold mimicking neoplasm. So emergency tracheostomy was performed and biopsy taken. He was found to be having asymptomatic miliary mottling on routine x-ray chest PA view. Further on HRCT, it turned out to be lesion suggesting tubercular etiology. Histopathology (epiglottic biopsy) report confirmed the whole process as tubercular. The patient recovered promptly in due course with anti-tubercular treatment. Point remains to be seen that if we can avoid tracheostomy and its complications in such cases.

Role of ultrasonography and computed tomography in complicated cases of tuberculous cervical lymphadenitis.

AIM: To evaluate complicated cases of tuberculous cervical lymphadenitis by ultrasonography and computed tomography in order to detect more lymph nodes, and to study their lesions. MATERIAL AND METHODS: Total 27 patients of tuberculous cervical lymphadenitis previously proved bacteriologically or histopathologically on anti-tuberculosis treatment (ATT) presenting with complications were taken for study. Each case was subjected to ultrasound (USG) and computed tomography (CT) of involved area. Based on USG and CT findings, patients were subjected to repeat fine needle aspiration cytology (FNAC) of involved lymph node or drainage of pus. RESULTS: On USG, all lesions were hypoechoic and showed necrosis. Other findings were: sharp margins in 70.4 %, hilum in 22.2 %, abnormal surrounding tissue in 85.2 %, matting in 37 %, calcification in 29.6 % and posterior enhancement in 22.2 % patients. On CT, majority of lesions were with central low density (CLD) in 16 (59.3 %), followed by large confluent low density (LCLD) in 7 (25.9 %), multilocular central low density (MCLD) in 4 (14.8 %) and homogeneous soft tissue density (HSTD) in 2 (7.4 %) patients. Necrotising granulomatous lymphadenitis was the most common diagnosis in 17 (63%), followed by necrotising in 6 (22.2 %) and granulomatous in 4 (14.8 %) patients. Fifteen (55.5 %) patients were positive for AFB on ZN smear examination. In 17 patients, culture and sensitivity test for Mycobacterium Tuberculosis from lymph node aspirate was done and 12 (70.6 %) patients were found culture positive. Out of these, 2 (16.7 %) were found to be multi-drug resistant (MDR) cases. CONCLUSION: USG and CT modalities are complementary in diagnosis and management of tuberculous lymphadenitis presenting with complications. USG helps in better localization of site for biopsy/FNAC procedure and drainage of pus with high diagnostic yield. While CT helps in better anatomical localization of lymph nodes not usually detected on clinical examination.

Superior vena cava syndrome caused by pulmonary amoebic abscess.

Isolated pulmonary amoebiasis without involvement of liver and other systems is extremely rare. Its presentation with superior vena cava (SVC) syndrome is not well documented. The case of 38-year-old male who developed SVC syndrome due to a large pulmonary amoebic abscess, which initially mimicked a pulmonary neoplasm with distal lung abscess is presented here. Subsequent bacteriological examination of the aspirated pus and the sputum along with suggestive serology confirmed the diagnosis of pulmonary amoebic abscess.

Bilateral spontaneous pneumothorax in silicosis.

Occurrence of pneumothorax in silicosis is rare and when it occurs, pneumothorax is usually unilateral. We report here a patient with accelerated silicosis who presented with bilateral spontaneous pneumothoraces occurring simultaneously. The rarity of its clinical presentation in the form of bilateral simultaneous spontaneous pneumothorax combined with the typical clinical and radiological features of accelerated silicosis with tuberculosis make us to report this case.

Middle lobe syndrome due to Tuberculous etiology A series of 12 cases.

The term right middle lobe syndrome (RMLS) is often used in clinical practice though it has no consistent definition. Inflammatory lesion, malignant tumors followed by bronchiectasis are considered as the most common etiological factors for RMLS. Here we describe 12 cases of RMLS due to tuberculous etiology diagnosed over a period of 6.5 years at our Institute. They were diagnosed using conventional methods and responded to anti-tubercular treatment with favourable outcome. The cases are being presented here to highlight the fact that tuberculosis, though not frequently reported in published literature, is an important etiological factor and must be considered for differential diagnosis when RMLS is evaluated particularly in regions where the prevalence of tuberculosis is high as it responds to anti-tubercular chemotherapy remarkably.

Tubercular Osteomyelitis of Mandible.

Tubercular osteomyelitis of mandible is an extremely rare condition, particularly in comparison to pyogenic infections and neoplastic diseases involving the mandible. We report a case of tubercular osteomyelitis of mandible in an old chronic smoker woman initially suspected of neoplasia, proved later on as primary tubercular osteomyelitis in absence of a primary focus.

Use of sputum induction for establishing diagnosis in suspected pulmonary tuberculosis.

Setting: Department of Tuberculosis and Chest Diseases, Pt. B.D. Sharma PGIMS, Rohtak. Aim: The study was undertaken to find out the yield in the diagnosis of the smear negative pulmonary tuberculosis by sputum induction with hypertonic saline. Methodology: 5ml hypertonic saline was administered through ultrasonic nebuliser for a maximum of 30 minutes. Results: One hundred patients suspected of pulmonary tuberculosis either smear negative with spontaneous sputum or having inadequate/no sputum were studied. Ninety-seven patients produced adequate amount of sputum after hypertonic saline induction. Thirty-eight were found positive for AFB on sputum microscopy after induction. Conclusions: Hypertonic saline induction produces better quality and adequate sputum, thereby increasing yield of smear positive pulmonary tuberculosis.

Evaluation of cholinesterase to differentiate pleural exudates and transudates.

AIMS AND OBJECTIVES: The present study was undertaken to evaluate the usefulness of pleural fluid cholinesterase (PChE) level in pleural fluid and its ratio to serum cholinesterase (P/SChE) in order to differentiate transudates and exudates and to compare their diagnostic efficacy with the Light's criteria. MATERIAL AND METHODS: A total of 110 patients of pleural effusion of diverse etiology were studied. Eighty patients were of exudative pleural effusion of tubercular, malignant or parapneumonic origin and 30 patients were of transudative effusion. Cholinesterase was estimated in the pleural fluid and serum in all the patients. RESULTS: The mean PChE and P/S ChE were significantly higher in exudates as compared to transudates (p < 0.001). P/S ChE was 0.79 +/- 0.45 and 0.14 +/- 0.11 in exudates and transudates, respectively. When a cut-off value of 469 IU/L for PChE was taken for the diagnosis, it was found that 10% of exudates and 2.5% of transudates were misclassified. However percentage of misclassification decreased to 1.25% in exudates and 3.3% in transudates when the cut-off value of 0.24 for P/S ChE ratio was used. Using Light's criteria, a sensitivity of 91.25% and specificity of 90% with positive predictive value (PPV) of 96.05% and negative predictive value (NPV) of 79.42% was observed. However using P/S ChE, the PPV was 98.75% and NPV was 96.67%. CONCLUSIONS: The estimation of PChE and P/SChE ratio had better discriminatory capacity than Light's criteria. It is cost effective and more specific, therefore its routine estimation is recommended.

Diaphragmatic paralysis and hoarseness of voice due to mediastinal tuberculous lymphadenitis.

The most frequent cause of diaphragmatic paralysis and hoarseness of voice is involvement of phrenic nerve and recurrent laryngeal nerve by a thoracic malignancy. Here, we describe a patient who developed diaphragmatic paralysis and hoarseness of voice due to mediastinal tuberculous lymphadenopathy, which is not a common etiological factor leading to it.

Fatal pyothorax: a rare complication of retropharyngeal abscess.

Fatal pyothorax following a massive acute retropharyngeal abscess in an adult is reported. Acute non-tuberculous retropharyngeal abscess usually develops following a penetrating injury due to a foreign body or endoscopy. Microbial isolates are mixed and consists of aerobic and anaerobic organisms. It may lead on to mediastinitis since there is a potential communication between the two spaces. Immediate cervical, pleural and mediastinal surgical drainage along with appropriate antibiotics can be life saving.

Role of chest CT scan in determining etiology of primary spontaneous pneumothorax.

BACKGROUND: Spontaneous pneumothorax occurs subsequent to a disruption in the continuity of visceral pleura and escape of air into pleural space. It is usually difficult, sometimes impossible to detect evidence of pulmonary pathology by clinical or conventional radiographic methods. Computed tomography provides additional informations not obtainable with conventional diagnostic modalities. METHODS: To determine the role of CT scan in the aetiological diagnosis and subsequent management of patients with primary spontaneous pneumothorax, a perspective study was undertaken. RESULTS: A total of 40 patients with spontaneous pneumothorax with normal skiagram chest after management of pneumothorax, were included in the study. In 75% of these cases, CT revealed underlying lung pathology as a cause for primary spontaneous pneumothorax. CONCLUSION: Our study shows that CT scan is a useful imaging modality in determining the aetiology of primary spontaneous pneumothorax.

Pulmonary chondroid hamartoma with unusual presentation.

Large-sized pulmonary chondroid hamartomas are very uncommon. We report a case of a 40-year-old male patient with a large sized chondroid hamartoma occupying almost the whole of one hemithorax, presenting with superior vena caval obstruction, left vocal cord palsy and adrenal involvement.

Left vocal cord paralysis and aortic arch aneurysm: an unusual presentation.

Recurrent laryngeal nerve in its course, follows a path that brings it in proximity to numerous structures. These structures can interfere with its function by pressure or by disruption of the nerve caused by disease invading the nerve. We report aortic aneurysm and atherosclerotic plaque as a rare cause of left vocal cord paralysis.

Screening of early detection of lung cancer.

Methods for detecting early lung cancers, carcinoma in situ, and dysplastic lesions of the tracheobronchial tree ultimately aim to eradicate them before they become invasive. This approach is being developed to detect early stage lung cancer, when treatment is more likely to be curative. This review describes the recent developments in lung cancer screening and the possible impact on management of lung cancer.