ABSTRACT
Coccidioidomycosis is an endemic disease of the Western hemisphere. The cases in non-endemic areas are mostly imported. Determining a history of exposure is critical for performing the diagnosis of coccidioidomycosis, especially for cases occurring in a non-endemic area. In this study, a 71-year-old Chinese male presented to our hospital with chronic cough and malaise, and was found to have a mass in the middle lobe of right lung. He had been visiting Arizona, USA for four months before admission. Pulmonary coccidioidomycosis was confirmed by the results of histopathological examination after lobectomy. Typical microscopic features of Coccidioides are definitely diagnostic, but need be differentiated from other budding yeast infection or carcinoma histopathologically.
Subject(s)
Coccidioidomycosis/diagnosis , Lung Diseases, Fungal/diagnosis , Aged , Arizona/ethnology , China , Coccidioidomycosis/microbiology , Humans , Lung Diseases, Fungal/microbiology , Male , TravelABSTRACT
OBJECTIVE: To explore the clinical characteristics of primary tracheal tumors and therefore to improve the diagnosis and treatment. METHODS: A retrospective analysis of the clinical data of 8 patients with primary tracheal tumors admitted to our department during the period of May 1994 to May 2006 was performed, with detailed description of the clinical manifestations, chest radiography, fiberoptic bronchoscopy, lung function measurements, treatment and prognosis for 4 cases. RESULTS: Seven patients presented with irritable cough and progressive inspiratory dyspnea, mostly misdiagnosed as asthma or chronic bronchitis. Examination by fiberoptic bronchoscopy confirmed the diagnosis of tracheal tumor in all the cases. One case with benign neurinoma and 2 cases with adenoid cystic carcinomas had a long-term postoperative remission. Two cases of squamous cell carcinoma with severe tracheal stenosis got rapid symptom remission after intervention of tracheal stent by fiberoptic bronchoscopy and argon plasma coagulation. One patient with adenoid cystic carcinoma refused any treatment. One patient with squamous cell carcinoma lost follow-up after surgery. One patient with adenocarcinoma died of progressive deterioration after 2 month chemotherapy. CONCLUSIONS: Primary tracheal tumors occur infrequently and early clinical symptoms are unspecific. Early diagnosis can be made by chest CT and fiberoptic bronchoscopy. Benign tracheal tumors can be resected, and for some low-grade malignant tumors surgical resection and postoperative radiotherapy can improve long term survival. Intervention with fiberoptic bronchoscopy to unresectable diseases can lead to symptom remission and thus improve patient's life quality.
Subject(s)
Carcinoma, Adenoid Cystic/diagnosis , Carcinoma, Adenoid Cystic/therapy , Tracheal Neoplasms/diagnosis , Tracheal Neoplasms/therapy , Adenocarcinoma/diagnosis , Adenocarcinoma/therapy , Adult , Aged , Carcinoma, Adenoid Cystic/surgery , Carcinoma, Squamous Cell/diagnosis , Carcinoma, Squamous Cell/therapy , Female , Humans , Male , Middle Aged , Retrospective Studies , Tracheal Neoplasms/surgeryABSTRACT
OBJECTIVE: To evaluate the efficacy and safety of large-volume whole lung lavage in the treatment of severe pulmonary alveolar proteinosis (PAP). METHODS: Five severe PAP patients underwent large-volume whole lung lavage under general anaesthesia using a double lumen endotracheal tube. Suction was used for returning fluid. The volume of lavage and return volume and the return rate were calculated. The efficacy was evaluated according to the improvement of symptoms, amelioration of chest radiograph or chest CT scan and the changes of pulmonary function and artery blood gas analysis. RESULTS: After lavage, the symptoms, pulmonary function and artery blood gas were markedly improved, and the chest radiographs showed dissipation of lung consolidation. No severe complications were observed in the 5 cases. CONCLUSION: Large-volume whole lung lavage is an effective and safe therapeutic method in the treatment of PAP.
