Swyer-James-Macleod Syndrome: A Rare Entity.

Swyer-James-MacLeod syndrome is a radiological entity characterised by hyperlucency of one or more lobes or of the entire lung associated with decreased number and diameter of ipsilateral peripheral pulmonary vessels resulting in difficult visibility of the arterial network, and unobstructed bronchial system. We report the case of a 12-year-old girl who presented with chief complaint of pain in the chest. Chest radiograph (postero-anterior view) showed hyperlucent left lung field with increased lung volume and shift of the mediastinum to the right side. Contrast-enhanced computed tomography (CECT) of the chest showed hyperlucency and diminished vascularity in the upper lobe and lingula of left lung with hyperinflation of the pulmonary parenchyma. On the basis of clinical and radiological findings, the patient was diagnosed to have Swyer-James-MacLeod syndrome.

Unilateral agenesis of the lung: a rare entity.

BACKGROUND: Agenesis of the lung, a rare congenital anomaly, arises or develops when there is disruption of evolution of the primitive lung bud, leading to complete absence of the lung, bronchi, and the main pulmonary artery. With right-sided agenesis, a variety of cardiac and other congenital malformations are more commonly seen, leading to a poor prognosis. CASE REPORT: A young female, aged 15 years, presented with complaints of sore throat and cough. Her x-ray of the chest showed a homogeneous opacity in the middle and lower zones on the right side with marked shift of the mediastinum to the right side. Upon investigation, she was diagnosed with agenesis of the right lung with scoliosis, without any other congenital anomaly. CONCLUSIONS: Especially in adults, it requires a high level of good clinical judgement to identify and diagnose this congenital aberration, as they are often wrongly diagnosed as more common diseases associated with unilateral opaque hemithorax on x-ray. Hence, when confronted with an opaque hemithorax with shift of the mediastinum to the affected side in a young person, "agenesis of the lung" should be an important differential diagnosis while investigating the case.

Complicated hydatid cyst and "air bubble" sign: a stepping-stone to correct diagnosis.

BACKGROUND: Hydatid cyst, or Echinococcosis, is an important helminthic zoonotic disease in humans that commonly affects the liver and lungs. Uncomplicated hydatid cysts, seen as round opaque lesions on chest radiography, are easily diagnosed, whereas complicated cysts (infected and or perforated) may change the radiographic appearance of the hydatid cyst, causing an incorrect diagnosis and delayed treatment. Although in radiology many signs have been described, the "air bubble" sign, seen in the mediastinal window of CECT as a single or multiple small rounded radiolucent areas with sharp margins within the periphery of a solid mass lesion, is being recognized as a sign with high sensitivity and specificity in the diagnosis of complicated hydatid cysts. CASE REPORT: A 32-year-old female on anti-tubercular treatment for the past 3 months without any improvement was admitted to our hospital. CECT of the chest revealed a mass-like lesion with the "air bubble" sign. After 15 days the patient had a vigorous bout of coughing, leading to expectoration of pieces of whitish yellowish gelatinous membrane for the next 3 days. The ELISA result for Echinococcus was highly positive. On the basis of the "air bubble" sign, positive serology, and expectorated pieces of the membrane, the patient was diagnosed as having a complicated hydatid cyst. CONCLUSIONS: Due to the varied presentations of complicated hydatid cyst, the knowledge and awareness of various signs in radiology associated with the hydatid cyst, in particular the "air bubble" sign, is imperative in making a prompt and accurate diagnosis of a complicated hydatid cyst.

Idiopathic pulmonary artery aneursym.

Idopathic pulmonary artery aneurysm (PAA) is a rare lesion. Clinical experience with this condition is limited and current knowledge is mainly derived from autopsy findings. We report a patient who came to us with complaints of chest pain, breathlessness on exertion and pedal oedema and was diagnosed to have PAA.

Cryptococcal meningitis associated with tuberculosis in HIV infected patients.

Opportunistic infections are common complications of advanced immuno-deficiency in individuals with Human Immunodeficiency Virus (HIV) infection. Following involvement of the lung, the central nervous system (CNS) is the second most commonly affected organ. We report two cases of concurrent cryptococcal meningitis and tuberculosis (TB) in HIV infected persons. A high suspicion of multiple opportunistic infections should be kept in mind in HIV seropositive individuals.

Eosinophilic pleural effusion and giardiasis: A causal or a casual relationship?

A case of bilateral eosinophilic pleural effusion with coincidental intestinal infestation of giardia lamblia is being reported. After reviewing the possible causes of this type of pleural effusion, no clinical or laboratory data were obtained which could explain this condition except giardiasis. Moreover the clearance of pleural effusion with the treatment of giardia with metronidazole suggests giardia as the probable cause of bilateral eosinophilic pleural effusion.

Tubercular hepatic abscess--a rare presentation.

Hepatic tuberculosis is one of the rare forms of extra-pulmonary tuberculosis. The focal or nodular form presenting as tuberculoma or abscess is uncommon. Hepatic tuberculosis without involvement of lungs or other organs is even rarer. We report a rare case of primary tubercular liver abscess without involvement of any other organ of body.

Contra-lateral paradoxical pleural effusion during antituberculous chemotherapy.

A 24-year old male developed left sided pleural effusion 10 days after the start of anti tubercular chemotherapy for right-sided pleural effusion and parenchymal lesion. This effusion seemed to be a paradoxical response as it resolved on follow up.