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   2015| May-June  | Volume 32 | Issue 3  
    Online since May 5, 2015

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Lung ultrasound: Present and future
Ashish Saraogi
May-June 2015, 32(3):250-257
DOI:10.4103/0970-2113.156245  PMID:25983411
The scope of lung ultrasound (LUS) in emergency and critical care settings has been studied extensively. LUS is easily available at bedside, free of radiation hazard and real time. All these features make it useful in reducing need of bedside X-rays and CT scan of chest. LUS has been proven to be superior to the bedside chest X-ray and equal to chest CT in diagnosing many pleural and lung pathologies. The first International Consensus Conference on Lung Ultrasound (ICC-LUS) has given recommendations for unified approach and language in major six areas of LUS. The LUS diagnosis is to be given after integration of findings of both lungs. The BLUE protocol is first LUS-based systematic approach in diagnosing pleural and lung pathologies. The protocol suggested in this article includes history and conventional clinical assessment along with LUS features.
  5,611 1,612 -
Management of latent tuberculosis infection: An evidence-based approach
Madhukar Pai, Camilla Rodrigues
May-June 2015, 32(3):205-207
DOI:10.4103/0970-2113.156210  PMID:25983402
  3,420 877 -
Evaluation of the radiological sequelae after treatment completion in new cases of pulmonary, pleural, and mediastinal tuberculosis
Balakrishnan Menon, Gaki Nima, Vikas Dogra, Santosh Jha
May-June 2015, 32(3):241-245
DOI:10.4103/0970-2113.156233  PMID:25983409
Background: Residual radiological lesions may persist even after successful treatment of tuberculosis. There is insufficient data as to the nature and magnitude of these opacities in the treated cases of tuberculosis. Aims and Objectives: This study evaluates the nature and magnitude of residual radiological opacities and of complete radiological resolution in new successfully treated cases of tuberculosis. Design: Four hundred and forty one new cases of pulmonary, pleural or mediastinal tuberculosis were radiologically evaluated by chest x-ray, PA view, at the start and end of a successful treatment, which was as per the World Health Organization (WHO), Revised National Tuberculosis Control Program (RNTCP), and Directly Observed Treatment, Short-Course (DOTS) guidelines. Patients with a previous history of tuberculosis or other lung conditions, treatment failure, retreatment cases, and multidrug tuberculosis (MDR-TB) cases were excluded. Results: Residual x-ray lesions were seen in 178 cases of tuberculosis (40.36%). Complete radiological resolution was seen in 263 cases (59.64%). Of the residual lesions, 67.4% were parenchymal were parenchymal in nature, 23.59% were pleural lesions and 8.99% were mediastinal lesions. Out of the 126 sputum-positive cases, 70% (n = 88)had residual lesions on chest x-ray whereas of the 315 sputum-negative cases 28.5%, (n = 99) had radiological residual lesions. Conclusion: Residual radiological opacities are seen in a large proportion of treated cases of tuberculosis (40%). Pulmonary lesions show more residual lesions (67%) than pleural (23%) and mediastinal lesions (9%).
  2,488 555 -
Paragonimus westermani infection in lung: A confounding diagnostic entity
Shivani Kalhan, Pankaj Sharma, Sonia Sharma, Neha Kakria, Sharmila Dudani, Anshu Gupta
May-June 2015, 32(3):265-267
DOI:10.4103/0970-2113.156248  PMID:25983414
Paragonimiasis is a food-borne parasitic zoonosis caused by the genus Paragonimus. Fresh water snails, crabs, and crayfish are the first and second intermediate hosts, respectively. Humans acquire this infection by ingesting uncooked/undercooked crustaceans. Laboratory diagnosis of Paragonimiasis is done by demonstration of ova in the sputum/feces/pleural fluid or by serology. A case of pulmonary Paragonimiasis is presented herewith; the patient having been diagnosed with pulmonary tuberculosis earlier. The aim of this presentation is to highlight this entity so that it is considered in the differential diagnosis in a case of hemoptysis.
  2,232 346 -
Indications for performing flexible bronchoscopy: Trends over 34 years at a tertiary care hospital
Ankit Amar Gupta, Inderpaul Singh Sehgal, Sahajal Dhooria, Navneet Singh, Ashutosh Nath Aggarwal, Dheeraj Gupta, Digambar Behera, Ritesh Agarwal
May-June 2015, 32(3):211-215
DOI:10.4103/0970-2113.156213  PMID:25983404
Background and Aim: Due to its easy maneuverability, patient comfort and documented safety as an outpatient procedure, flexible bronchoscopy (FB) has replaced rigid bronchoscopy for routine diagnostic use. Herein, we report our 34-year experience with outpatient performance of FB. Materials and Methods: This was a retrospective analysis of all FB procedures performed between September 1979 and November 2013 (period I: 1979-1990; period II: 1991-2000; period III: 2001-2013) in a tertiary care hospital. Demographic profile of patients, indications for performing FB, and annual and seasonal trends were noted from the records. Results: A total of 24,814 bronchoscopies were performed during the study period. The mean (SD) age of patients (71.6% males) was 48.4 (15.5) years. The number of procedures performed per decade showed an absolute increase by 322%. The most common indication for FB was suspected bronchogenic carcinoma (32.2%) followed by pulmonary infections (18.6%) and interstitial lung diseases (13%). The proportion of annual cases due to interstitial lung diseases (3.9% in period I to 16.2% in period III) increased over the years, whereas disorders such as hemoptysis and pleural effusion showed a declining trend as an indication for FB. A seasonal trend was observed for diseases such as sarcoidosis, bronchogenic carcinoma and pulmonary infections. Six deaths were encountered during the study period in patients undergoing FB. Conclusion: FB is increasingly being performed in the diagnosis of respiratory disorders and is a safe outpatient procedure. Although bronchogenic carcinoma remains a common indication for performing FB, benign conditions such as pulmonary infections and sarcoidosis constitute important indications in the Indian scenario.
  1,914 432 -
Necrotic mediastinal lymph node enlargement in a middle-aged female
Karan Madan, Irfan Ismail Ayub, Deepali Jain, Anant Mohan, Randeep Guleria
May-June 2015, 32(3):293-295
DOI:10.4103/0970-2113.156260  PMID:25983424
  1,876 208 -
The evolution of flexible bronchoscopy: From historical luxury to utter necessity!!
Preyas J Vaidya, Joerg D Leuppi, Prashant N Chhajed
May-June 2015, 32(3):208-210
DOI:10.4103/0970-2113.156212  PMID:25983403
  1,594 342 -
Pleuropulmonary blastoma in adolescence: A rare tumor beyond first decade of life
Mukesh K Yadav, Manphool Singhal, Anmol Bhatia, Rakesh Kapoor, Nalini Gupta, Niranjan Khandelwal
May-June 2015, 32(3):281-284
DOI:10.4103/0970-2113.156255  PMID:25983419
Pleuropulmonary blastoma (PPB) is a unique dysontogenetic and a primitive neoplasm occuring almost exclusively in the first decade of life, as a pulmonary- and/or pleural-based tumor with cystic, solid, or combined cystic and solid features. It is characterized histologically by a primitive, variably mixed blastematous and sarcomatous tissues. These tumors are usually associated with a poor prognosis. However, with a multimodality treatment approach, the survival of the patient can be prolonged. We herein report two cases of PPB in adolescence, a rare presentation beyond first decade of life with a short review of literature.
  1,581 268 -
Correlation of severity of chronic obstructive pulmonary disease with health-related quality of life and six-minute walk test in a rural hospital of central India
Sachin R Agrawal, Rajnish Joshi, Ajitprasad Jain
May-June 2015, 32(3):233-240
DOI:10.4103/0970-2113.156231  PMID:25983408
Background: Chronic obstructive pulmonary disease (COPD) patients experience a progressive deterioration and disability leading to worsening of their health-related quality of life (HRQoL) and functional exercise capacity. We performed this study to identify the correlation of HRQoL assessed by St George's Respiratory Questionnaire (SGRQ) and the functional exercise capacity assessed by the six-minute walk test (6MWT) with severity of COPD defined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria among spirometry-confirmed COPD patients, admitted in a tertiary care rural hospital. Materials and Methods: The study included 129 spirometry-confirmed COPD patients defined by the GOLD criteria from a tertiary care hospital in central India. They underwent HRQoL measurement using the disease-specific (SGRQ). Functional exercise capacity was measured by 6MWT, as per the American Thoracic Society (ATS) guidelines. Statistical Analysis: We analyzed the various SGRQ scores and six-minute walk distance (6MWD) percentage predicted with various stages of COPD using the Student's t-test. The Pearson's correlation coefficient (r) was used to assess the relationships between various SGRQ scores and 6MWD with FEV 1 % predicted. Results: We found that COPD patients with GOLD III and IV, but not GOLD II, had significantly poor HRQoL measured by SGRQ, as compared to patients with mild COPD (GOLD I). An inverse linear relation was found between 6MWD and the severity of COPD. Correlation of FEV 1 % predicted with various SGRQ scores varied from - 0.40 to - 0.53, with a maximum correlation of FEV 1 % predicted with an SGRQ symptom score (- 0.53) and SGRQ total score (- 0.50). A strong positive correlation was found between 6MWD and FEV 1 % predicted (0.57). Conclusions: Staging COPD according to the GOLD guidelines does correspond to important differences in the HRQoL of COPD patients having severe disease, but not for mild disease, whereas, the functional exercise capacity of COPD patients deteriorates in a linear fashion with the severity of disease assessed by the GOLD staging criteria.
  1,441 400 -
Miliary tuberculosis disease complicated by Pott's abscess in an infant: Seven year follow-up
Gulsum Iclal Bayhan, Gonul Tanir, Zeynep Gokce Gayretli Aydın, Yasemin Tasci Yildiz
May-June 2015, 32(3):258-261
DOI:10.4103/0970-2113.156246  PMID:25983412
A 20-month-old boy presented with 1-year history of persistent fever, cough, and progressive abdominal distention. Abdominal ultrasonography showed hepatomegaly and multiple calcifications in the liver and spleen. Thoracic computed tomography showed multiple mediastinal lymph nodes and consolidation in both lungs. Additionally, there was a 2-cm thick retroperitoneal soft tissue mass destroying the T7-8 and L1-L2 vertebral bodies. The patient was preliminarily diagnosed with miliary tuberculosis (TB) and Pott's disease, and began administering anti-TB treatment consisting of isoniazid, rifampin, ethambutol, and pyrazinamide. Acid-resistant bacilli analysis and mycobacterial culture of the biopsy specimen of Pott's abscess were positive. Mycobacterial culture and PCR of gastric aspirate were also positive. The patient's condition progressively improved with anti-TB treatment and he received 12 months of antiTB therapy. At the end of the treatment all of the patient's symptoms were relieved and he was well except for kyphosis. Miliary TB complicated by Pott's abscess is a very rare presentation of childhood TB. The presented case shows that when Pott's abscess is diagnosed and surgically corrected without delay, patients can recover without squeal.
  1,586 246 -
Pulmonary hydatidosis in a tertiary care hospital
Rajpal Singh Punia, Reetu Kundu, Usha Dalal, Uma Handa, Harsh Mohan
May-June 2015, 32(3):246-249
DOI:10.4103/0970-2113.156241  PMID:25983410
Background: Hydatid disease is caused by the larval stage of Echinococcus. Liver is the most commonly involved organ followed by the lungs. Pulmonary hydatidosis can be primary or secondary. The disease may be asymptomatic for several years. Cause of concern is the fatal anaphylaxis, which may be life threatening. Materials and Methods: The present retrospective study is over a period of ten years (2003-2012). The demographic data including the clinical features, radiological findings, other organ involvement, surgical and medical management done and histopathological findings were compiled from the records. Results: During the study period a total of eight cases, five male and three female, with age ranging from eight to 43 years were diagnosed as pulmonary hydatid disease. Five patients had presented with complicated cysts. Six patients had solitary cysts involving the lung while bilateral lung involvement was seen in two cases. One patient had multiple pulmonary cysts. Three patients had associated cysts in liver and two in spleen. Surgical lobectomy was done in four cases. Histopathology showed acellular laminated ectocysts in all the cases, whereas endocyst with brood capsules was seen in five cases. Conclusions: Pulmonary hydatidosis is not uncommon. Anaphylaxis, although rarely seen, may be a disastrous event. High index of clinical suspicion and mass awareness for interruption of transmission of parasite can lead to proper treatment and possible eradication.
  1,510 287 -
Vascular air embolism after contrast administration on 64 row multiple detector computed tomography: A prospective analysis
Kushaljit S Sodhi, Akshay K Saxena, Guruprasadh Chandrashekhar, Anmol Bhatia, Sunit Singhi, Ritesh Agarwal, Niranjan Khandelwal
May-June 2015, 32(3):216-219
DOI:10.4103/0970-2113.156216  PMID:25983405
Background: Vascular air embolism is being progressively reported as a nonfatal event with increase in use of computed tomography (CT) as a diagnostic modality. This study was undertaken to study the frequency and site of vascular air embolism in patients undergoing contrast-enhanced CT (CECT) and analyze CT parameters that influence its prevalence and final outcome. Materials and Methods: This was a prospective study approved by departmental ethics committee. Presence and location of air emboli in 200 patients who underwent CT scan of chest on a 64 detector scanner was recorded. We analyzed the role of various factors that could influence the prevalence of air embolism after injection of contrast in CECT scans. These factors included the amount of contrast injected, rate of flow of injection of contrast, site of injection of contrast, and size of intravenous access line. Results: Iatrogenic vascular air emboli were seen in 14 patients (7% of total). The locations of air emboli were main pulmonary artery in 12 (6% of total), left brachiocephalic vein in 3 (1.5% of total), right atrial appendage in 4 (2% of total), and superior vena cava (SVC) in 1 (0.5%) patient. There was no association between volume of contrast, flow rate, site and size of intravenous access, and presence of air emboli. Conclusion: Radiologists as well as referring physicians should be aware of vascular air embolism, which can occur after contrast injection in patients undergoing CT scan. Age, volume of contrast, flow rate of pressure injector, and site and size of venous cannula do not influence the likelihood or incidence of detection of venous air emboli on CT scans.
  1,460 281 -
Evaluation of short-term use of nocturnal nasal continuous positive airway pressure for a clinical profile and exercise capacity in adult patients with obstructive sleep apnea-hypopnea syndrome
Amrit K Goel, Deepak Talwar, Sushil K Jain
May-June 2015, 32(3):225-232
DOI:10.4103/0970-2113.156226  PMID:25983407
Background and Aim: The obstructive sleep apnea-hypopnea syndrome (OSAHS) is a common chronic respiratory disease, characterized by repetitive complete or partial collapse of the upper airway during sleep. The clinical spectrum extends between stoppage of breathing, snoring, daytime somnolence, and fatigue, to serious cardiovascular disease, stroke, metabolic syndrome, increased morbidity, and mortality. We aim to evaluate the short-term use of nasal continuous positive airway pressure (nCPAP) therapy for the clinical profile and exercise capacity of patients with OSAHS. Patient Selection: Twenty patients diagnosed with moderate-to-severe OSAHS were enrolled in the study (study group - 15; clinically and PSG-matched control group - 5). Materials and Methods: Each patient was clinically evaluated for sleep-related symptoms, and also assessed with spirometry, the six-minute walk test (6MWT), and a symptom-limited incremental cardiopulmonary exercise test (CPET). The study group patients were administered nCPAP therapy for eight hours each night for four weeks, while the control group patients were just observed. They were re-assessed after four weeks and the data were statistically analyzed between the two groups. Results: The study group patients showed a significant (P- < 0.05) improvement in the OSAHS symptoms-the Epworth sleepiness score, six-minute walk distance; duration of exercise, power output, peak oxygen uptake, anaerobic threshold, diastolic blood pressure, dyspnea, and fatigue-in comparison with the control group patients. The improvement in exercise capacity following nCPAP therapy was attributed to the relief of disabling the OSAHS symptoms and improved cardiovascular, ventilator, and musculoskeletal functions. Conclusion: All OSAHS patients must be treated with nCPAP.
  1,399 339 -
Retropharyngeal abscess as a rare presentation of pulmonary tuberculosis
Meera Ekka, Sanjeev Sinha
May-June 2015, 32(3):262-264
DOI:10.4103/0970-2113.156247  PMID:25983413
A tubercular retropharyngeal abscess is rare in immunocompetent adults. In the case of a tubercular retropharyngeal abscess, it is usually due to cervical spine tuberculosis and is seen mostly in children. A 19-year-old female patient presented to our Medicine Outpatient Department (OPD) at All India Institute of Medical Sciences (AIIMS) with odynophagia and neck pain for two months, without any other constitutional symptoms. On evaluation, she was diagnosed with tubercular retropharyngeal abscess along with pulmonary tuberculosis, without involvement of the cervical spine. This patient was successfully treated by antituberculosis drug therapy alone, without any need for surgical drainage.
  1,449 210 -
Case report: Non-small-cell lung carcinoma presenting as a foot swelling
Mithun Chacko John, Varun Goel, Srikant Tiwari, Vineet Talwar, Nivedita Patnaik
May-June 2015, 32(3):292-293
DOI:10.4103/0970-2113.156259  PMID:25983423
  1,294 270 -
A disintegrin and metalloprotease 33 polymorphism association with COPD in long-term tobacco smokers of the ethnic Kashmiri population of India
Sonaullah Shah, Amir Rashid, Zaffar A Shah, Rafi Ahmad Jan, Umar Hafiz Khan, Imtiyaz A Bhat, Suhail Mantoo, Tajamul H Shah, Parvaiz A Koul
May-June 2015, 32(3):220-224
DOI:10.4103/0970-2113.156222  PMID:25983406
Background: Chronic obstructive pulmonary disease (COPD) is characterized by an interaction of various environmental influences especially cigarette smoking and genetic determinants. The prevalence of this disease is ever increasing and characterization of the genetic determinants of the disease has been undertaken globally. The 'A disintegrin and metalloprotease 33' (ADAM 33) gene is one candidate gene that has been studied. Objective: Our objective was to investigate whether single nucleotide polymorphisms in ADAM33 gene are associated with COPD in long-term tobacco smokers in the ethnic Kashmiri population of northern India. Materials and Methods: This was a randomized case-control study, which included 78 stable COPD (GOLD stage11-IV) patients, who were compared with 77 age- and sex-matched long-term tobacco smokers (>20 pack years) without any evidence of COPD. Polymorphic analysis for three single nucleotide polymorphisms (SNPs), (T1, T2, and Q1) of the ADAM33 gene was done by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) followed by sequencing. The data were analyzed by descriptive statistics and comparative evaluation was done by parametric/non-parametric tests. Results: The analysis of the T1, T2, and Q1 SNPs, revealed that the frequencies of the T2GG, T1GG, and the Q1AG genotypes were significantly higher in patients with COPD in comparison with the controls (P < 0.001). Similarly, the T1G and T2G allele frequency was higher in the patients than in the controls (p = 0.177 and 0.43, respectively). Conclusion: Three SNPs of the ADAM33 gene were significantly associated with COPD in the Kashmiri population of India. This study establishes the possible role of ADAM33 SNPS in the causation of COPD. Further studies across different geographical areas in the country will unravel the contribution of this gene in the causation of COPD in India.
  1,211 259 -
Right ventricular thrombus with pulmonary artery aneurysm in a young male: A rare presentation of Behçet's disease
Chand Bhandari, Lalit Rathi, Mridul Gupta, Jaikishan Khatri
May-June 2015, 32(3):274-277
DOI:10.4103/0970-2113.156253  PMID:25983417
We describe an adolescent patient presenting with hemoptysis. Detailed clinical work up of the patient showed right ventricular thrombus and bilateral pulmonary artery aneurysms along with the prescribed criteria for the diagnosis of Behcet's disease. Younger age of the patient was another distinctive feature of this case. Six months of therapy with cyclophosphamide and prednisolone resulted in near complete clinicoradiological response.
  1,232 228 -
Eluding normal variant
Roopkamal Sidhu, Ankush Dhanadia, Harshad Shah, Nirmala Chudasama
May-June 2015, 32(3):289-291
DOI:10.4103/0970-2113.156258  PMID:25983422
  1,182 199 -
Tracheal schwannoma: Completely resected with therapeutic bronchoscopic techniques
Barney Thomas Jesudason Isaac, Devasahayam Jesudasan Christopher, Balamugesh Thangakunam, Mayank Gupta
May-June 2015, 32(3):271-273
DOI:10.4103/0970-2113.156252  PMID:25983416
Tracheal schwannomas are rare benign tumors of the trachea. There are only a few reported cases in the literature. Surgeons have generally resected these tumors, whereas bronchoscopists have attempted to remove them bronchoscopically. We report a case of tracheal schwannoma which was completely resected using bronchoscopic techniques.
  1,146 196 -
Laryngeal metastasis from lung cancer
Umasankar Kalai, Karan Madan, Deepali Jain, Anant Mohan, Randeep Guleria
May-June 2015, 32(3):268-270
DOI:10.4103/0970-2113.156249  PMID:25983415
Metastatic tumors of the larynx are rare. The most common tumors metastasizing to the larynx are melanoma and renal cell carcinoma. Bronchogenic carcinoma metastasizing to the larynx has been rarely described. Herein, we report the case of a 49-year-old, chronic smoker, who incidentally had a laryngeal growth detected during flexible bronchoscopy examination for evaluation of suspected lung cancer. Histopathological examination of the laryngeal nodule and the biopsy obtained from the main bronchus growth confirmed the diagnosis of metastatic squamous cell carcinoma to the larynx from primary lung cancer.
  1,126 206 -
A rare case of dengue and H1N1 co-infection: A deadly duo
Vineet Behera, Nardeep Naithani, Asif Nizami, Rajeev Ranjan
May-June 2015, 32(3):299-300
DOI:10.4103/0970-2113.156263  PMID:25983427
  1,045 219 -
Cannon-ball pulmonary metastases as a presenting feature of stomach cancer
Rakesh Agarwal, Jotideb Mukhopadhyay, Durjoy Lahiri, Amrita Biswas, Pranab Maity
May-June 2015, 32(3):300-302
DOI:10.4103/0970-2113.156264  PMID:25983428
  1,003 166 -
A rare bronchial anomaly presenting as a paracardiac mass
Pankaj Gupta, Mahesh Prakash, Ashutosh Nath Aggarwal, Niranjan Khandelwal
May-June 2015, 32(3):278-280
DOI:10.4103/0970-2113.156254  PMID:25983418
Abnormal bronchi arising from trachea and main bronchi are rare and usually clinically silent. These bronchial variations, however, pose a significant diagnostic challenge related to their variable presentation and perhaps the low level of awareness among clinicians and radiologists. Complications including recurrent infections, hemoptysis, and rarely malignancies may arise, if the diagnosis is delayed. We came across a patient with chronic cough in whom endoscopic and imaging evaluation, including fine-needle aspiration cytology (FNAC), proved non-diagnostic. Thorough evaluation of multidetector computed tomography (MDCT) performed in our department, however, revealed an accessory cardiac bronchus with rudimentary lung parenchyma in the paracardiac location. This case highlights the importance of meticulous airway evaluation on MDCT in all patients referred with respiratory symptoms.
  918 165 -
Aberrant arterial supply to left lung
Yasir Peringattuthodiyil, Devasahayam Jesudas Christopher, T Balamugesh, S Saheer
May-June 2015, 32(3):287-288
DOI:10.4103/0970-2113.156257  PMID:25983421
  845 189 -
EUS-B-FNA: Pulmonologist's viewpoint: Whose tube is it anyway?
Pattabhi Raman Ranganathan Vallandramam, Mahadevan Sivaramakrishnan, Arjun Srinivasan
May-June 2015, 32(3):285-286
  743 213 -
Unusual presentation of pulmonary nocardiosis as pyopneumothorax in HIV
Aswini Kumar, Aswanth Reddy, Kumar Satagopan
May-June 2015, 32(3):295-296
DOI:10.4103/0970-2113.156261  PMID:25983425
  715 149 -
Right bronchial artery from left common carotid artery: A rare anomalous origin
Mukesh K Yadav, Anmol Bhatia, Niranjan Khandelwal
May-June 2015, 32(3):297-298
DOI:10.4103/0970-2113.156262  PMID:25983426
  724 130 -
Different fractionation regimes in palliative thoracic radiotherapy: Some facets
Mukesh Sharma, Purnima Thakur, Vikas Fotedar, Manish Gupta
May-June 2015, 32(3):302-303
DOI:10.4103/0970-2113.156265  PMID:25983429
  675 164 -