ABSTRACT
A 31-year-old pregnant woman with no remarkable past medical history presented with mild hypoxemia, which worsened after she underwent cesarean section. To determine the cause of hypoxemia, we performed chest computed tomography after the cesarean section and found a pulmonary arteriovenous fistula of the A10-V10 shunt in the lower lobe of the right lung and V10 had expanded to 12 mm. Forty-nine days after giving birth, the patient underwent thoracoscopic right lower lobectomy. The results of blood gas analysis improved after surgery; before surgery, the partial pressure of oxygen was 66.4 Torr, which increased to 98.4 Torr after surgery. The patient was discharged on the ninth day after surgery. Pulmonary arteriovenous fistula may be exacerbated by changes in cardiac output and circulating blood volume during pregnancy. If hypoxemia progresses after pregnancy, pulmonary artery fistula must be identified.
ABSTRACT
75-year-old man had the right lower lobe resected because of pulmonary adenocarcinoma (stage IIB) and received 4 courses of postoperative chemotherapy 4 years earlier. Thereafter, he continued to complain of cough, sputum, and progressive exertional breathlessness. The preoperative chest CT showed ground glass opacity (GGO) at the bottom of both lung fields, and over time the GGO changed to honeycombing with traction bronchiectasis. He was administered prednisolone, clarithromycin, and pirfenidone but with little improvement. He exhibited hypoxemia (PaO<sub>2</sub> 56 mmHg) and was admitted. An interview revealed that he had worked in the poultry farming business for 45 years having had contact with and breeding 3,000 game fowl at the time of hospitalization. We suspected bird-related hypersensitivity pneumonitis. Results of the reaction to pigeon dropping extracts (PDE) were high, with PDE IgG 0.697 and PDE IgA 0.445. He was diagnosed with chronic bird-related hypersensitivity pneumonitis. Although the chest CT appearance was difficult to distinguish from that of idiopathic interstitial pneumonia, the test for PDE and the interview were useful for reaching a diagnosis.
ABSTRACT
Catamenial pneumothorax (CP) is defined as a form of thoracic endometriosis syndrome (TES) and the clinical manifestations and management of this disease are not consensual. Successful treatment depends on how closely pulmonary specialists and gynecologists work together. Such being the circumstances, we reviewed our experience with CP in terms of treatment and follow-up. We treated surgically many patients with pneumothorax during the period from 1989 to 2014, of which eight cases had endometriosis on the diaphragm, lung or pleura histologically. The median age at the time of operation was 37 (range, 17 to 41). CP was right-sided in seven of the eight patients (87.5%). Six patients underwent an examination with diagnostic laparoscopy and five had positive findings. The median period of follow-up after surgery was 33.5 months (range, 4 to 129 months). Two patients had no recurrence without hormonal therapy. Six other patients experienced a recurrence of pneumothorax, although two patients received dienogest after surgery. The use of only dienogest or both GnRHa and dienogest prevented recurrence in all patients. CP is a critical condition that requires prompt action, so after surgical treatment, the choice of hormonal therapy with a high rate of patient compliance are needed. No recurrence occurred in young patients who had only surgical treatment, suggesting that there were some associations between age and recurrence. Since we succeeded in preventing recurrence after using GnRHa in all cases, we recommend GnRHa or dienogest following GnRHa for the first choice of hormonal therapy after surgery. However, treatment with only dienogest could achieve successful results with no recurrence, so more case studies need to be done to make the best treatment choice for each case.
ABSTRACT
Thymic epithelial tumors are treated with reference to the Masaoka staging system. In 1999, the World Health Organization published a histologic classification of thymomas. The WHO classification was revised in 2004. There is a general consensus that it is as important a prognostic factor in primary thymoma and thymic carcinoma patients as the Masaoka staging system. In the present study, a total of 25 cases of thymic epithelial tumors (21 thymoma cases and 4 thymic carcinoma cases) treated from 1991 through 2005 in our hospital were reclassified based on the new WHO classification. The thymoma cases consisted of four at Masaoka's stage I, 11 cases at stage II and six cases at stage III, whereas according to the WHO classification they were categorized into seven B1 type tumors, eight B2 type, four B3 type and two unclassifiable cases. Of the four thymic carcinoma cases, one belonged under Masaoka's stage II, another under stage III and two under stage IV. One thymic carcinoma case resulted in death. There were no fatalities from thymomas. Most of the thymomas at Masaoka's stage III came under WHO type B2 and B3, showing a high incidence of local infiltration. Since either the WHO classification or the Masaoka staging system is an important factor for determining the course of treatment, we concluded that both should be utilized clinically.