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2018| May-June | Volume 35 | Issue 3
Online since
April 26, 2018
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POSTGRADUATE EDUCATION
Egg and banana sign of severe pulmonary arterial hypertension
Satyam Veean, William Nixon, Jayanth Keshavamurthy
May-June 2018, 35(3):261-262
DOI
:10.4103/0970-2113.231220
PMID
:29697088
The egg and banana sign can be seen on chest computed tomography (CT) in patients with severe pulmonary arterial hypertension (PAH). It is identified by the presence of the pulmonary artery (PA) lateral to the aortic arch with the aortic arch being described as the banana and the PA as the egg.
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ORIGINAL ARTICLES
Air pollution and environmental risk factors for altered lung function among adult women of an urban slum area of Delhi: A prevalence study
Shweta Arora, SK Rasania, D Bachani, Asha Gandhi, SK Chhabra
May-June 2018, 35(3):193-198
DOI
:10.4103/lungindia.lungindia_263_17
PMID
:29697074
Background:
Household and ambient air pollution are jointly responsible for about 7 million premature deaths annually. Women living in slums, with unhealthy environment, both indoors and outdoors, particularly those living close to industrial and/or vehicular pollution zones due to multiple sources of air pollution, are at the higher risk of having impaired lung function tests.
Objective:
The aim of this study was to estimate the prevalence of abnormal lung functions and to identify the environmental risk factors associated with them among adult women of 18–59 years.
Materials and Methods:
A total of 550 women aged 18–59 years were approached in a representative urban slum. Five hundred consented to participate and 299 had prebronchodilator spirometry satisfying ATS standards. House visits to assess environmental conditions were conducted to determine their association with forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC). Chi-square test was used to test the association of risk factors with lung functions. ANOVA was used to test the association of mean values of FEV1 and FVC with age.
Results:
Out of 299 participants with acceptable spirometric curves, 5% had reduced FEV1/FVC ratio than the normal and 26.8% and 17.4% had lower values than predicted for FVC and FEV1, respectively. Altered lung function was related to age, tobacco smoking, and history of respiratory disease.
Conclusions:
Both ambient and household air pollution have a deleterious pulmonary effect on long-term women residents of a representative urban slum in Delhi.
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REVIEW ARTICLE
Primary pulmonary lymphoproliferative neoplasms
Victoria K Tang, Praveen Vijhani, Sujith V Cherian, Manju Ambelil, Rosa M Estrada–Y-Martin
May-June 2018, 35(3):220-230
DOI
:10.4103/lungindia.lungindia_381_17
PMID
:29697079
Pulmonary lymphoproliferative neoplasms are rare lung tumors and account for <1% of all lung tumors. Among them, primary pulmonary lymphomas (PPL) constitute the majority, which include Non-Hodgkin's lymphoma (NHL) that comprise of mucosa-associated lymphoid tissue lymphoma, diffuse large B-cell lymphomas and other rare types of NHL and lymphomatoid granulomatosis. HL, which arises secondary to contiguous spread from the mediastinum, is the rarest type of PPL. Other entities described within the umbrella of pulmonary lymphoproliferative neoplasms include pleural lymphomas and posttransplant lymphoproliferative disorders (PTLD) – which occurs in the poststem cell and organ transplant patients. These neoplasms although rare, have a favorable prognosis, which does not depend on disease resectability. Moreover, with its nonspecific presentation, diagnosis is challenging, which often leads to delayed diagnosis or misdiagnosis in many cases. Therefore, knowledge of this entity is important for the practicing pulmonologist. This review article aims to describe the clinical presentation, diagnosis and management of primarily the entities within PPL, as well as pleural lymphomas and PTLD.
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EDITORIAL
Asthma and obstructive sleep apnea: More than an association!
Ramakant Dixit
May-June 2018, 35(3):191-192
DOI
:10.4103/lungindia.lungindia_241_17
PMID
:29697073
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PICTORIAL CME
Lung contusion
Padmanabhan Arjun, Akbar Abdul Najeeb, Rahul Ramachandran
May-June 2018, 35(3):263-264
DOI
:10.4103/lungindia.lungindia_81_17
PMID
:29697089
Lung contusion usually follows blunt trauma to the chest. If not properly diagnosed and adequately treated, it could at times be fatal as well. This case is being presented to highlight the radiological findings of this condition.
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ORIGINAL ARTICLES
Surgical management of stage III pediatric empyema thoracis
Aditya Pratap Singh, Arvind Kumar Shukla, Pramila Sharma, Jyotsna Shukla
May-June 2018, 35(3):209-214
DOI
:10.4103/lungindia.lungindia_227_17
PMID
:29697077
Aim and Objective:
This study aims to report 100 pediatric patients of empyema thoracis treated by open decortication, highlighting the presentation, delay in referral, operative findings, the response to surgical intervention, and follow-up.
Materials and Methods:
All the children who underwent open decortication for stage III empyema thoracis during the study period January 2015–December 2016 were included. Preoperative workup included hemogram, serum protein, chest radiographs, and contrast-enhanced computed tomographic (CECT) scan of the chest.
Results:
One hundred (65 males, 35 females) (age 2 months–13 years, mean 4.5 years) were operated during a 2-year period. Among them, 90% patients were referred 3 weeks after the onset of disease. Intercostal chest drainage (ICD) had been inserted in (95) 95% cases. Thickened pleura, multiloculated pus, and lung involvement were invariably seen on CECT scan. Bronchopleural fistula was present in five patients. Decortication and removal of necrotic tissue were performed in all the patients. Mean duration of postoperative ICD was 4 days. Follow-up ranged from 1 month to 2 years (mean 12 months). There was no mortality. Five patients had proven tuberculosis. Only 10% presented within the early period of the disease.
Conclusion:
The duration of the disease had a direct relationship with the thickness of the pleura and injury to the underlying lung. Delayed referral causes irreversible changes in the lung prolonging recovery. Meticulous open surgical debridement gives gratifying results. The status of the lung at the end of surgery is a major prognostic factor.
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High-resolution computerized tomography changes in diffuse parenchymal lung disease from chronic hypersensitivity pneumonitis related to bird antigen
Parthasarathi Bhattacharyya, Sanjukta Dasgupta, Mintu Paul, Dipanjan Saha, Sayoni Sengupta, Pinak Pani Bhattacharyya
May-June 2018, 35(3):215-219
DOI
:10.4103/lungindia.lungindia_293_17
PMID
:29697078
Background:
Chronic hypersensitivity pneumonitis (HP) is the most common cause of diffuse parenchymal lung disease (DPLD) in India. There is no data regarding the avian antigen exposure-associated DPLD from the country.
Methods:
Chronic HP from exposure to avian antigen was diagnosed when the high resolution computerized tomography (HRCT) showed features for HP and was supported by the history of exposure to pigeons, the presence of precipitin antibodies (IgG) to avian antigen in high titre with negative rheumatoid factor, antinuclear antibody, and no clinical clue for a collagen vascular disease. The HRCT changes were noted on Likert scale (0–5) in terms of affection of peripheral and/or axial involvement, reticulation, honeycombing, haze, mosaic, traction bronchiectasis, pleural reactions, features of pulmonary hypertension, and air cysts. Cardiomegaly and independent cardiac chamber enlargement were also recorded.
Results:
The lower lobes were predominantly (65.6%) affected with similar frequency (78.1) of peripheral and axial parenchymal affection. The parenchymal changes in HRCT were haze or ground-glass opacity (100%), mosaic appearance (93.75%), reticulations (68.75%), traction bronchiectasis (34.3%), air cysts (21.8%), and honeycombing (9.37%). Pleural reactions, though not described so far, were found in 50% of cases. Features of pulmonary hypertension (87.5%), cardiomegaly (50%), left and right atrial enlargement (81.2% and 78.1%), and right ventricular enlargement (31.2%) were the common echocardiography findings.
Conclusion:
Chronic HP from avian exposure shows predominantly lower lobe involvement with haze, reticulation, features of pulmonary hypertension, and pleural reactions as common HRCT findings. The likelihood of pulmonary hypertension appears high and although honeycombing is often present, the classical UIP pattern has not been found.
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CASE REPORTS
Pasteurella multocida
pneumonia in an immunocompetent patient: Case report and systematic review of literature
Stella Pak, Damian Valencia, Jenna Decker, Victor Valencia, Yusuf Askaroglu
May-June 2018, 35(3):237-240
DOI
:10.4103/lungindia.lungindia_482_17
PMID
:29697081
Pasteurella multocida
infection is most commonly associated with the immunocompromised, mostly in the form of soft-tissue infection, although other sites of infection are still possible and have been reported in the immunocompetent. We report a case of an immunocompetent male with a history of exposure to carrier organisms without portal of entry who developed
P. multocida
pneumonia with bacteremia. We undertook a focused review of literature of previously reported cases of
P. multocida
pneumonia in patients with chronic obstructive pulmonary disease. This literature review supports the use of penicillins as the first line of treatment over macrolides. Considering the high mortality rates with
P. multocida
bacteremia, it is important for clinicians to maintain a high level of suspicion for this organism in any patient with a history of carrier species exposure.
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CASE SERIES
Series of rare lung diseases mimicking imaging patterns of common diffuse parenchymal lung diseases
Kiran Batra, Riham Dessouky, Yasmeen M Butt, Vibhor Wadhwa, Jose R Torrealba, Craig Glazer
May-June 2018, 35(3):231-236
DOI
:10.4103/lungindia.lungindia_291_17
PMID
:29697080
Diffuse parenchymal lung diseases (DPLDs) encompass a variety of restrictive and obstructive lung pathologies. In this article, the authors discuss a series of rare pulmonary entities and their high-resolution computed tomography imaging appearances, which can mimic more commonly encountered patterns of DPLDs. These cases highlight the importance of surgical lung biopsies in patients with imaging findings that do not show typical imaging features of usual interstitial pneumonia.
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ORIGINAL ARTICLES
The levels of pro-fibrotic cytokines in pulmonary tuberculosis with minimal and extensive lesions
Triwahju Astuti, Iin Noor Chozin, Nevy Shinta Damayanti, Dian Nugrahenny
May-June 2018, 35(3):204-208
DOI
:10.4103/lungindia.lungindia_396_17
PMID
:29697076
Background:
There are very few studies about the mechanism of fibrosis in tuberculosis (TB). This study aimed to determine the levels of tumor necrosis factor-α (TNF-α), insulin-like growth factor-1 (IGF-1), and transforming growth factor-β1 (TGF-β1) in pulmonary TB patients with minimal and extensive lesions.
Materials and Methods:
Cross-sectional observational study design was used to observe the pulmonary TB patients with minimal and extensive lesions, and also healthy controls, each consisting of ten patients.
Results:
The plasma levels of TNF-α, IGF-1, and TGF-β1 in pulmonary TB groups were higher compared to the healthy controls. The TNF-α level in the minimal lesion of TB group was higher than the level in the extensive lesion but not significant (
P
= 0.741). The IGF-1 level in the minimal lesion of TB group was significantly (
P
= 0.007) increased compared to the extensive lesion. While the TGF-β1 level in the minimal lesion of TB group was significantly (
P
= 0.005) lower than the level in the extensive lesion.
Conclusion:
In extensive lesion of TB group, there are differences in the levels of TNF-α, IGF-1, and TGF-β1 compared to the minimal lesion of TB group as well as the healthy controls. The extent of lesions on chest radiograph also describes the state of ongoing pulmonary fibrosis which can be shown by the differences in the levels of pro-fibrotic cytokines.
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CASE REPORTS
Cryptococcosis with bird's eye manifestation: A case report
HS Suhas, Ketaki Utpat, Unnati Desai, Manoj Vedpathak, Jyotsna M Joshi
May-June 2018, 35(3):256-258
DOI
:10.4103/lungindia.lungindia_397_17
PMID
:29697086
Cryptococcosis is a menacing opportunistic infection most commonly affecting immunocompromised individuals. Its occurrence in immunocompetant individuals is uncustomary. Disseminated cryptococcosis is subtile in immunocompetent individuals. Cryptococcosis presenting with myriad of symptoms with involvement of lung, meninges, hematological system is rare. We present to you a unique case of disseminated cryptococcosis presenting as bilateral pulmonary nodular opacities with peripheral eosinophilia and meningitis along with a narration of the enthralling diagnostic process.
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Ectopic thyroid: The great mimicker
Yazdan Raji, Supriya Gupta, Darko Pucar, Jayanth H Keshavamurthy
May-June 2018, 35(3):248-250
DOI
:10.4103/lungindia.lungindia_141_17
PMID
:29697084
Ectopic thyroid tissue is very rare, but its prevalence increases in those with thyroid pathology. It typically occurs due to aberrant development of the thyroid gland during its migration to the pretracheal region. In this report, there are two cases of mediastinal ectopic thyroid tissue discussed, which were initially considered to be malignancies. The hospital course, diagnostic workup, including the use of computed tomography and positron emission tomography scans, and the characteristic features of the tissue are examined here. Due to the imaging characteristics, it is important to consider ectopic thyroid tissue as a differential diagnosis for mediastinal masses as encountered in these cases. Asymptomatic ectopic thyroid tissue is usually treated medically; however, patients in both of our cases opted for surgical resection of the masses even after confirmation of the origin of the tissues.
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A diagnostic challenge: An incidental lung nodule in a 48-year-old nonsmoker
Blake Eric Christianson, Supriya Gupta, Shikhar G Vyas, Helena Spartz, Jayanth H Keshavamurthy
May-June 2018, 35(3):251-255
DOI
:10.4103/lungindia.lungindia_212_17
PMID
:29697085
A 43-year-old female with a medical history of renal stones, hypertension, diabetes mellitus Type 2, and depression presented to her urologist with bilateral flank pain. She complained of worsening exertional dyspnea over the last several months with recent weight gain. She also endorsed night sweats and intermittent, scant hemoptysis over the past year. She denied fever, chills, nausea, vomiting, diarrhea, constipation, hematuria, or excessive joint or muscle pain. Physical examination was unremarkable. Computed tomography scan of abdomen and pelvis demonstrated bilateral nonobstructing renal stones and a 1.8 cm × 1.7 cm nodular opacity in the right lower lobe of the lung, not present on previous scan 1 year prior. Surgical wedge resection was performed and subsequent pathologic examination demonstrated a 1.2 cm × 0.6 cm × 0.5 cm soft, gelatinous well-demarcated mass in the right lower lobe wedge specimen without gross evidence of necrosis or hemorrhage confirming colloid adenocarcinoma of the lung.
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LETTERS TO EDITOR
Evaluation of inhalational techniques of pressurized metered-dose inhaler with spacer in asthma patients
P Ravikumar, MK Raghavendra, G Bai Priyadarshini
May-June 2018, 35(3):279-280
DOI
:10.4103/lungindia.lungindia_211_17
PMID
:29697097
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1,043
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CASE REPORTS
Paraneoplastic syndrome associate with solitary fibrous tumor of pleura
Apurwa Karki, John Yang, Sudheer Chauhan
May-June 2018, 35(3):245-247
DOI
:10.4103/lungindia.lungindia_118_17
PMID
:29697083
Solitary fibrous tumor (SFT) is a rare mesenchymal tumor and several paraneoplastic syndromes have been related to it. We report the case of a 60-year-old male initially admitted to rule out cerebral vascular accident with the final diagnosis of SFT associated with paraneoplastic cerebellar degeneration and hypoglycemia. The diagnosis was confirmed by computed tomography-guided lung biopsy.
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Vintage meets contemporary: Use of rigid TBNA in the era of real-time imaging – first report from India
Ajmal Khan, Alok Nath, Hira Lal, Narendra Krishnani, Aarti Agarwal
May-June 2018, 35(3):241-244
DOI
:10.4103/lungindia.lungindia_418_17
PMID
:29697082
In the modern era, real-time imaging-guided transbronchial needle aspiration (TBNA) has completely replaced the traditional surgical approaches to sample the mediastinal lesions for diagnosis and cancer staging. However, there is a limited role of these innovations in the presence of critical airway narrowing due to a further decrease in cross-sectional area of the airway proportionate to the outer diameters of the scope. Rigid TBNA with airway control by rigid bronchoscopy is one alternative which can be used for mediastinal sampling when modern technique is impracticable. Herein, we report the use of rigid TBNA, an underutilized old method to sample the mediastinal lesion in a patient with severe orthopnea secondary to tracheal compression by mediastinal mass.
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988
112
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LETTERS TO EDITOR
Use of fentanyl-dexmedetomidine in conscious sedation for thoracoscopy
Vinod Kumar, Prashant Sirohiya, Nishkarsh Gupta, Karan Madan
May-June 2018, 35(3):277-278
DOI
:10.4103/lungindia.lungindia_431_17
PMID
:29697095
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Pulmonary agenesis: A rare entity
Sunil Vyas, Theres Mathew, Manish Advani, Devesh Meena
May-June 2018, 35(3):275-276
DOI
:10.4103/lungindia.lungindia_294_17
PMID
:29697094
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COMMENTARY
Identifying the levels of pro-fibrotic cytokines in pulmonary tuberculosis
Ajay Kumar Verma
May-June 2018, 35(3):259-260
DOI
:10.4103/lungindia.lungindia_39_18
PMID
:29697087
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930
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CASE LETTERS
Seven years in the trachea
Abdelfattah Ahmed Touman, Vlasios V Vitsas, Angelakis S Leonidas, Grigoris K Stratakos
May-June 2018, 35(3):272-274
DOI
:10.4103/lungindia.lungindia_325_17
PMID
:29697093
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211
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RADIOLOGY QUIZ
Breathless with stones!
Uma Devaraj, Priya Ramachandran, Uma Maheswari
May-June 2018, 35(3):265-267
DOI
:10.4103/lungindia.lungindia_101_17
PMID
:29697090
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CASE LETTERS
Dumbbell posterior mediastinal schwannoma invading trachea: Multidisciplinary management – weight off the chest
Abhijeet Singh, Vallandramam R Pattabhiraman, Arjun Srinivasan, Sivaramakrishnan Mahadevan
May-June 2018, 35(3):269-272
DOI
:10.4103/lungindia.lungindia_459_17
PMID
:29697092
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876
86
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LETTERS TO EDITOR
Catheter pinch-off syndrome
Vipul D Yagnik
May-June 2018, 35(3):278-279
DOI
:10.4103/lungindia.lungindia_401_17
PMID
:29697096
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795
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CASE LETTERS
Rare cystic lung disease in patients presenting with abdominal mass
Ashesh Dhungana, Subodh Regmi, Ajit Thapa, Deepa Niroula
May-June 2018, 35(3):268-269
DOI
:10.4103/lungindia.lungindia_255_17
PMID
:29697091
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757
88
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ORIGINAL ARTICLES
Relationship of asymmetric dimethylarginine levels with disease severity and pulmonary hypertension in chronic obstructive pulmonary disease
Elif Torun Parmaksız, Ali Inal, Banu Salepci, Sevda Comert, Ali Fidan, Nesrin Kiral, Coşkun Doǧan, Benan Caglayan
May-June 2018, 35(3):199-203
DOI
:10.4103/lungindia.lungindia_11_17
PMID
:29697075
Background:
Asymmetric dimethylarginine (ADMA) has emerged as a risk marker for many conditions related to pulmonary hypertension (PH); however, little is known about ADMA and symmetric dimethylarginine (SDMA) plasma concentrations in chronic obstructive pulmonary disease (COPD). Our interest centers on the role of ADMA in regulation of endothelial function in COPD and secondary PH. The aim of the present study was to evaluate the serum ADMA, SDMA, and L-arginine concentrations in COPD and its association with PH.
Methods:
Patients with diagnosis of COPD underwent pulmonary function tests, echocardiography, and laboratory investigations including ADMA, SDMA, and L-arginine.
Results:
Serum concentrations of ADMA, SDMA, and L-arginine tend to increase as COPD progresses. Patients with PH had higher concentrations of ADMA, SDMA, and L-arginine compared to cases with normal pulmonary arterial pressure (PAP); the difference was not statistically significant.
Conclusions:
Our results show that increased ADMA, SDMA, and L-arginine concentrations are associated with increased PAP measurements in patients with COPD, however, the relationship is not statistically significant.
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