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   2017| January-February  | Volume 34 | Issue 1  
    Online since December 30, 2016

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Mechanisms of hypoxemia
Malay Sarkar, N Niranjan, PK Banyal
January-February 2017, 34(1):47-60
DOI:10.4103/0970-2113.197116  PMID:28144061
Oxygen is an essential element for life and without oxygen humans can survive for few minutes only. There should be a balance between oxygen demand and delivery in order to maintain homeostasis within the body. The two main organ systems responsible for oxygen delivery in the body and maintaining homeostasis are respiratory and cardiovascular system. Abnormal function of any of these two would lead to the development of hypoxemia and its detrimental consequences. There are various mechanisms of hypoxemia but ventilation/perfusion mismatch is the most common underlying mechanism of hypoxemia. The present review will focus on definition, various causes, mechanisms, and approach of hypoxemia in human.
  15,479 2,716 -
Pulmonary tuberculosis - An emerging risk factor for venous thromboembolism: A case series and review of literature
Amitesh Gupta, Parul Mrigpuri, Abhishek Faye, Debdutta Bandyopadhyay, Rupak Singla
January-February 2017, 34(1):65-69
DOI:10.4103/0970-2113.197110  PMID:28144063
One-third of patients with symptomatic venous thromboembolism (VTE) manifest pulmonary embolism, whereas two-thirds manifest deep vein thrombosis (DVT). Overall, 25%–50% of patients with first-time VTE have an idiopathic condition, without a readily identifiable risk factor, and its association with tuberculosis (TB) is a rare occurrence. Deep venous thrombosis has been associated with 1.5%–3.4% cases of TB. Early initiation of anti-TB treatment along with anticoagulant therapy decreases the overall morbidity and mortality associated with the disease. We report three cases of DVT associated with pulmonary TB who were diagnosed due to high index of suspicion as the risk factors for the development of DVT were present in these cases.
  4,239 524 -
Electronic cigarette, effective or harmful for quitting smoking and respiratory health: A quantitative review papers
Gholamreza Heydari, Arezoo Ebn Ahmady, Fahimeh Chamyani, Mohammadreza Masjedi, Lida Fadaizadeh
January-February 2017, 34(1):25-28
DOI:10.4103/0970-2113.197119  PMID:28144056
Background: In recent years, electronic cigarettes (ECs) have been heavily advertised as an alternative smoking device as well as a possible cessation method. We aimed to review all published scientific literature pertaining to ECs and to present a simple conclusion about their effects for quitting smoking and respiratory health. Methods: This was a cross-sectional study with a search of PubMed, limited to English publications upto September 2014. The total number of papers which had ECs in its title and their conclusions positive or negative regarding ECs effects were computed. The number of negative papers was subtracted from the number of positive ones to make a score. Results: Of the 149 articles, 137 (91.9%) were accessible, of which 68 did not have inclusion criteria. In the 69 remaining articles, 24 studies supported ECs and 45 considered these to be harmful. Finally, based on this evidence, the score of ECs (computed result with positive minus negative) was −21. Conclusion: Evidence to suggest that ECs may be effective and advisable for quitting smoking or a safe alternative for smoking is lacking and may instead harm the respiratory system. However, further studies are needed.
  3,570 532 -
Evaluation of plasma leptin, tumor necrosis factor-α, and prealbumin as prognostic biomarkers during clinical recovery from acute exacerbations of chronic obstructive pulmonary disease
Anant Mohan, Sneh Arora, Arvind Uniyal, Rosemary Poulose, Kalpana Luthra, RM Pandey, Randeep Guleria
January-February 2017, 34(1):3-8
DOI:10.4103/0970-2113.197101  PMID:28144052
Background: Inflammatory and nutritional biomarkers have an important bearing on outcomes of acute exacerbations of chronic obstructive pulmonary disease (AECOPD), but the temporal profile of these compounds during an acute episode is unclear. Patients and Methods: Plasma leptin, prealbumin, and tumor necrosis factor-alpha (TNF-α) were estimated at baseline and before hospital discharge in patients with AECOPD. Results: A total of 82 patients were evaluated (66 males; mean (standard deviation) age, 61.6 (10.1) years. Of these, 74 subjects (90.2%) were current or former smokers, with median (range) pack-years of 15 (0–96), duration of COPD of 8 years (range, 2–25 years) and duration of current symptoms being 5 days (range, 1–30 days). Majority (41.5%) had type I (severe) exacerbation. During the current episode, 46 patients (58.9%) required mechanical ventilation for a median of 6 days (range, 1–34). The median duration of hospital stay was 13 days, (range, 1–110). At discharge, significant reduction was observed in dyspnea, total leukocyte count, erythrocyte sedimentation rate (ESR), partial pressure of carbon dioxide, hemoglobin, urea, creatinine, potassium, aspartate transferase, and TNF-α levels compared to baseline, whereas arterial pH, PO2, serum albumin, prealbumin, and leptin significantly improved. No difference was seen in leptin, prealbumin, and TNF-α between patients with mild/moderate and severe exacerbation, or between patients who required or did not require mechanical ventilation. Change in leptin correlated with body mass index and change in ESR; no associations were observed between leptin, prealbumin, and TNF-α with other clinico-laboratory variables. Conclusion: Plasma levels of novel inflammatory and nutritional biomarkers, i.e., leptin, TNF-α, and prealbumin are altered in AECOPD episodes and lag behind other parameters during recovery. These biomarkers are not reliable predictors of clinical outcomes in these patients.
  2,973 417 -
Current trends of management of respiratory diseases by pulmonologists: Results of National Conference of Pulmonary Disease - 2015 survey
Sheetu Singh, Nishtha Singh
January-February 2017, 34(1):13-18
DOI:10.4103/0970-2113.197093  PMID:28144054
Context: Respiratory diseases are a common problem in our country and these are associated with significant morbidity and mortality. Aims: The aim of the paper was to analyze the pattern of diagnostic tests used and treatment prescribed for common respiratory diseases. Settings and Design: A total of 1028 pulmonologists, either member of Indian Chest Society or delegate attending the National Conference of Pulmonary Diseases (NAPCON) 2015, participated in the online survey. Subjects and Methods: The survey included questions pertinent to common respiratory diseases such as pulmonary tuberculosis (PTB), bronchial asthma, chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis (IPF), and pneumonia. Results: Investigation used for severity assessment and diagnosis of PTB, was sputum for acid-fast bacilli (83.5%), for IPF was high-resolution computed tomography chest (85.6%), for severe pneumonia was arterial blood gas analysis (69.3%), for asthma was spirometery and peak flow (96.8%) and for COPDs was spirometry (87.2%). The most popular choice of treatment for PTB was directly observed treatment short course (55.7%), for bronchial asthma, it was long-acting beta agonist with inhaled corticosteroids (LABA + ICSs) (41.1%), for COPD, it was LABA, ICS, and long-acting muscarinic antagonist (LABA + ICS + long-acting muscarinic antagonist) (32.4%) and for IPF, it was pirfenidone and N acetyl cysteine (38.3%). About 67.5% of doctors preferred hospitalization for patients with severe pneumonia. About 84.5% pulmonologists ordered diagnostic tests and 55.5% prescribed treatment as per current guidelines. Conclusions: The majority of doctors (70.1%) in our survey followed recommended guidelines for respiratory disease diagnosis and treatment. However, there is a need for upgradation of treatment strategies currently used by doctors.
  2,949 432 -
Rapid diagnosis and shorter regimen for multidrug-resistant tuberculosis: A priority to improve treatment outcome
Rajendra Prasad, Nikhil Gupta, Amitabh Banka
January-February 2017, 34(1):1-2
DOI:10.4103/0970-2113.197118  PMID:28144051
  2,687 569 -
Epidemiological profile of acute respiratory distress syndrome patients: A tertiary care experience
Rahul Magazine, Shobitha Rao, Bharti Chogtu, Ramkumar Venkateswaran, Hameed Aboobackar Shahul, Umesh Goneppanavar
January-February 2017, 34(1):38-42
DOI:10.4103/0970-2113.197097  PMID:28144059
Background: Acute respiratory distress syndrome (ARDS) is seen in critically ill patients. Its etiological spectrum in India is expected to be different from that seen in western countries due to the high prevalence of tropical infections. Aim: To study the epidemiological profile of ARDS patients. Setting: A tertiary care hospital in Karnataka, India. Materials and Methods: Retrospective analysis of 150 out of the 169 ARDS patients diagnosed during 2010–2012. Data collected included the clinical features and severity scoring parameters. Results: The mean age of the study population was 42.92 ± 13.91 years. The causes of ARDS included pneumonia (n = 35, 23.3%), scrub typhus (n = 33, 22%), leptospirosis (n = 11, 7.3%), malaria (n = 6, 4%), influenza (H1N1) (n = 10, 6.7%), pulmonary tuberculosis (n = 2, 1.3%), dengue (n = 1, 0.7%), abdominal sepsis (n = 16, 10.7%), skin infection (n = 3, 2%), unknown cause of sepsis (n = 18, 12%), and nonseptic causes (n = 15, 10%). A total of 77 (51.3%) patients survived, 66 (44%) expired, and 7 (4.7%) were discharged against medical advice (AMA). Preexisting comorbidities (46) were present in 13 survivors, 19 nonsurvivors, and four discharged AMA. History of surgery prior to the onset of ARDS was present in one survivor, 13 nonsurvivors, and one discharge AMA. Mean Acute Physiology and Chronic Health Evaluation (APACHE) II, APACHE III, and Sequential Organ Failure Assessment scores in survivors were 9.06 ± 4.3, 49.22 ± 14, and 6.43 ± 2.5 and in nonsurvivors 21.11 ± 7, 86.45 ± 23.5, and 10.6 ± 10, respectively. Conclusion: The most common cause of ARDS in our study was pneumonia, but a large percentage of cases were due to the tropical infections. Preexisting comorbidity, surgery prior to the onset of ARDS, higher severity scores, and organ failure scores were more frequently observed among nonsurvivors than survivors.
  2,778 432 -
Primary mediastinal lymphomas, their morphological features and comparative evaluation
Riti Aggarwal, Seema Rao, Shashi Dhawan, Sunita Bhalla, Arvind Kumar, Prem Chopra
January-February 2017, 34(1):19-24
DOI:10.4103/0970-2113.197115  PMID:28144055
Background: Primary mediastinal lymphoma is an uncommon tumor. Hodgkin's lymphoma (HL), primary mediastinal B-cell lymphoma (PMBCL), and T-lymphoblastic lymphoma are the most common primary mediastinal lymphomas. Key morphological and immunohistochemistry (IHC) features play a very crucial role in diagnosis as well as further categorization. Materials and Methods: In this study, the morphological spectrum and histological features of 32 cases of primary mediastinal lymphomas diagnosed over 5 years were studied and morphological and IHC features of PMBCL versus HL were compared. Features of PMBCL were also compared against a control group of systemic diffuse large B-cell lymphoma. Results: Although PMBCL and HL are known to show overlapping morphological features, it was observed that presence of clear cells and compartmentalizing fibrosis in PMBCL; and classical Reed–Sternberg cells and dense inflammatory background in HL are important morphological clues while evaluating the biopsies. PMBCL showed diffuse, strong and uniform CD20 positivity; whereas CD30 showed focal/patchy, weak to moderate and heterogeneous expression, wherever found positive. As against this, HL showed diffuse, strong and uniform CD30 positivity; and focal/patchy, weak to moderate and heterogeneous CD20 expression, if found positive. CD20, CD3, and CD30 were sufficient in most of the cases while diagnosing PMBCL and HL. Conclusion: This study emphasizes the critical examination of IHC markers. Only positive expression in neoplastic cells is not sufficient to make a diagnosis, equal importance should be given to percentage, intensity, pattern, and type of positivity. Apart from basic IHC described above; CD15, leukocyte common antigen and fascin played an important role in differentiating HL and PMBCL in select doubtful cases.
  2,676 330 -
Respiratory viruses in acute exacerbations of chronic obstructive pulmonary disease
Parvaiz A Koul, Hyder Mir, Shabir Akram, Varsha Potdar, Mandeep S Chadha
January-February 2017, 34(1):29-33
DOI:10.4103/0970-2113.197099  PMID:28144057
Objective: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) cause significant morbidity, mortality, and an inexorable decline of lung function. Data from developed countries have shown viruses to be important causes of AECOPD, but data from developing countries like India are scant. We set out to determine the contribution of viruses in the causation of hospitalized patients with AECOPD. Methods: Twin nasopharyngeal/oropharyngeal swabs collected from 233 patients admitted with an acute AECOPD and tested for respiratory viruses including respiratory syncytial virus A and B, parainfluenza were (PIV) 1, 2, 3, and 4, human metapneumovirus (hMPV) A and B, influenza A and B, enterovirus, corona NL65, OC43, and 229E viruses, adenovirus 2 and 4, rhinovirus, and bocavirus, by duplex real time reverse-transcription polymerase chain reaction (qRT-PCR) using CDC approved primers and probes. Samples positive for influenza A were subtyped for A/H1N1pdm09 and A/H3N2 whereas influenza B samples were subtyped into B/Yamagata and B/Victoria subtypes, using primers and probes recommended by CDC, USA. Results: Respiratory viruses were detected in 46 (19.7%) cases, influenza A/H3N2 and rhinoviruses being the most common viruses detected. More than one virus was isolated in four cases consisting of hMPV-B + adeno-2 + Inf-B; rhino + H3N2, PIV-1 + rhino; and PIV-1+ hMPV-B in one case each. Ancillary supportive therapeutic measures included bronchodilators, antibiotics, steroids, and ventilation (noninvasive in 42 and invasive in 4). Antiviral therapy was instituted in influenza-positive patients. Three patients with A/H3N2 infection died during hospitalization. Conclusions: We conclude that respiratory viruses are important contributors to AECOPD in India. Our data calls for prompt investigation during an exacerbation for viruses to obviate inappropriate antibiotic use and institute antiviral therapy in viral disease amenable to antiviral therapy. Appropriate preventive strategies like influenza vaccination also need to be employed routinely.
  2,261 538 -
A severe Mycoplasma pneumoniae pneumonia inducing an acute antibody-mediated pulmonary graft rejection
Sarah Demir, Julien Saison, Agathe Sénéchal, Jean-Francois Mornex
January-February 2017, 34(1):85-87
DOI:10.4103/0970-2113.197104  PMID:28144069
A 40-year-old cystic fibrosis woman with a history of double-lung transplantation 2 years previously was admitted for a progressive respiratory distress. Physical examination revealed fever (39°C) and diffuse bilateral lung crackles. Laboratory findings included severe hypoxemia and inflammatory syndrome. Bronchoalveolar lavage and serological test were positive for mycoplasma pneumonia. As the patient did not improve after 3 days of antibiotics and donor-specific HLA antibodies had been detected, an acute antibody-mediated graft rejection was treated with high-dose corticosteroids, plasma exchange, intravenous immunoglobulin, and rituximab. The patient rapidly improved. Unfortunately, 6 months after this episode, she developed a bronchiolitis obliterans syndrome with a dependence to noninvasive ventilator leading to the indication of retransplantation. This case illustrates the possible relationship between infection and humoral rejection. These two diagnoses should be promptly investigated and systematically treated in lung transplant recipients.
  2,604 178 -
The minimum volume of pleural fluid required to diagnose malignant pleural effusion: A retrospective study
Huimin Wu, Rahul Khosla, Prashant K Rohatgi, Suman S Chauhan, Edina Paal, Wen Chen
January-February 2017, 34(1):34-37
DOI:10.4103/0970-2113.197120  PMID:28144058
Background: Pleural fluid cytology is a quick and accurate method to diagnose malignant pleural effusions. The optimal volume of fluid for cytological analysis has not yet been identified, and clinical recommendation based on some published clinical experiences has been to send large volumes of fluid for cytological analysis. A quality improvement initiative at our institution was conducted to determine the volume of fluid sufficient for a diagnosis of malignant pleural effusion. Materials and Methods: The study was approved by the Institutional Review Board. All pleural fluid specimens that were divided into three volumes (25 mL, 50 mL, and 150 mL) and sent for cytological examination were reviewed. Results: A total of 74 samples from 60 individual patients were evaluable. Thirty-six patients (60%) had a previous diagnosis of malignancy. Of the 74 specimens, 26 (35.1%) were positive for malignancy. The detection rate for malignant pleural effusion by cytology for 25 mL, 50 mL, and 150 mL were 88.5%, 96.2%, and 100.0%, respectively (P = 0.16). Two specimens that were negative in the 25 mL samples turned out to be positive in the 50 mL and 150 mL samples. One specimen was negative in the 25 mL and 50 mL samples but positive in the 150 mL sample. Conclusions: Our study did not show any statistically significant difference in the detection of malignant effusion in the 25 mL, 50 mL, and 150 mL group.
  1,823 362 -
Radial endobronchial ultrasound for the diagnosis of bronchoscopically invisible lesions: First case series from India
Kedar Ravi Hibare, Rajiv Goyal, Chetan Nemani, Rao Avinash, Bajpai Ram, Batra Ullas
January-February 2017, 34(1):43-46
DOI:10.4103/0970-2113.197100  PMID:28144060
Background: A peripheral, bronchoscopically invisible pulmonary lesion is a diagnostic challenge. Transthoracic needle aspiration has long been the investigation of choice but runs the risk of pneumothorax (up to 44%). Newer technologies like radial endobronchial ultrasound (R-EBUS) offer a safer approach. We present our results of R-EBUS in the diagnosis of bronchoscopically invisible lesions. This is the first large case series from India. Aims: (1) To determine the yield of R-EBUS for the diagnosis of bronchoscopically invisible lesions. (2) To compare the yields of forceps versus cryobiopsies in the diagnosis of these lesions. Setting: Tertiary care cancer center. Design: Prospective study. Methods: Consecutive patients presenting between January and October 2015 with bronchoscopically invisible peripheral pulmonary lesions were included. R-EBUS was used to localize and sample the lesion and the yields were analyzed. Yields of cryo and forceps biopsy were compared where both methods had been used. Data were analyzed using SPSS version 22. Results: A definite diagnosis obtained in 67.3% (37/55) patients with no major complications. No significant difference was found in yield between: (1) small (<3 cm) and large (>3 cm) lesions: (46.2% versus 78.6%, P = 0.38). (2) central and adjacent lesions: 61.5% versus 70%. (3) forceps and cryobiopsy (n = 28, 75% versus 67.9% P = 0.562). Conclusions: R-EBUS is a safe procedure in our setting and its yield is comparable to that reported in literature. The yield of central and adjacent lesions and forceps or cryobiopsy appears similar. Further refinements in the technique could improve yield.
  1,748 271 -
Respiratory disease terminology: Discordance between pulmonologists and patients
Nishtha Singh, Sheetu Singh, Nirmal Kumar Jain, Virendra Singh
January-February 2017, 34(1):9-12
DOI:10.4103/0970-2113.197092  PMID:28144053
Context: A number of local dialects and languages exist in India, which leads to a single disease being addressed by a number of names which may overlap with other disease names also. This creates misunderstanding and is a hindrance to effective patient–doctor communication. Aims: The paper aims to find out how effectively the name of the respiratory disease is communicated to the patient. The terminology used by patients to describe their disease was also noted at limited level. Settings and Design: The study was conducted in the form of parallel cross-sectional surveys, among pulmonologists and patients. Methods: Among the members of the Indian Chest Society and those attending the National Conference on Pulmonary Diseases (NAPCON-2015), 1028 pulmonologists participated in the online survey which was the first part of the study. The term used to address the common respiratory disease was inquired in the survey. To find the response of patients, a questionnaire was given to the patients attending four respiratory disease clinics of a city. They were inquired about the name of respiratory disease they were suffering from. Results: Pneumonia was the disease which was communicated with exact terminology by 898 (87.4%) doctors to their patients. In contrast, idiopathic pulmonary fibrosis was communicated with precise terminology by only 171 (16.6%) doctors. Pulmonary tuberculosis was exactly told by 708 (69%), asthma by 731 (71.1%), and chronic obstructive pulmonary disease by 593 (57.7%) doctors. However, only 17.6% of the 1122 patients participating in the survey had a knowledge of the name of disease they were suffering from. Conclusions: The exact terminology of the common respiratory diseases is not effectively used by many doctors and most of the patients. The study identifies an important gap in patient–doctor communication, and therefore, highlights the need of effective patient education.
  1,674 293 -
Re-discovering the heimlich valve: Old wine in a new bottle
Ajay Narasimhan, Shivanraj Ayyanathan, Rajavenkatesh Krishnamoorthy
January-February 2017, 34(1):70-72
DOI:10.4103/0970-2113.197111  PMID:28144064
A 14-year-old boy came to our outpatient department with pleuritic chest pain and dyspnea. He was found to have a loculated empyema on the right side. He was taken up for surgery and decortication was done. He developed air leak in the postoperative period. When the air leak did not settle until the 10th day, we decided to attach the atrium Pneumostat, a modified version of the Heimlich valve to his Intercostal drainage tube and sent him home. On further follow-up, his lung expanded, and ICD could be removed. The patient remains well until the current follow-up. We present this case in an attempt to change the perceptions about various options available to drain the chest. The Heimlich valve appears to be a more compliant option than the conventional underwater seal drainage in terms of early mobility, reduced length of stay, and patient compliance.
  1,614 198 -
Investigating a unilateral pleural effusion: A tale of a medical error and diagnostic delays
Suminda Welagedara, Tokyo Moe Swe, Krishna Bajee Sriram
January-February 2017, 34(1):82-84
DOI:10.4103/0970-2113.197108  PMID:28144068
We report the case of an elderly Asian man where a medical error and diagnostic delays obscured the diagnosis of pleural tuberculosis (TB). The patient was hospitalized for evaluation of a unilateral pleural effusion. Initially, the patient was subjected to a pleural aspiration on the wrong side due to a lack of bedside ultrasound guidance. Subsequently, the patient underwent several investigations but not a blind closed pleural biopsy (BCPB) due to a lack of equipment. Furthermore, the patient was deemed to be too sick to undergo a thoracoscopic pleural procedure. Eventually, a bronchoscopy was performed, and washings from the right upper lobe were cultured, which established the diagnosis of TB. This case highlights the need to use bedside ultrasound in the investigation of pleural effusions, the role of BCPB especially in frail patients and finally the utility of bronchoscopy in establishing a diagnosis of pleural TB.
  1,492 272 -
Definitive radiotherapy for inoperable adenoid cystic carcinoma of the trachea: A rare case report
Virendra Bhandari, Desh Deepak Ladia, Mehlam Kausar, Amit Varma
January-February 2017, 34(1):73-75
DOI:10.4103/0970-2113.197117  PMID:28144065
Adenoid cystic carcinoma (ACC) of the trachea is rare; it represents 1% of all respiratory tract cancers. It is generally considered as a slow-growing, with prolonged clinical course. Most patients present with dyspnea, and the symptoms often mimic those of asthma or chronic bronchitis. Surgical resection is the mainstay of treatment often combined to radiotherapy because of close surgical margins. When surgery is not possible, most tumors respond to radiotherapy alone which often results in long periods of remission. There is no consensus on the best treatment for locally advanced inoperable ACC of trachea. This case report describes a 51-year-old woman unresectable ACC of trachea due to comorbid conditions, successfully managed by intensity modulated radiotherapy. At 8 months follow-up, the patient is healthy and asymptomatic.
  1,526 235 -
Erosion of esophageal stent into left main bronchus causing airway compromise
S Aneeshkumar, L Sundararajan, Rajan Santosham, Rajkumar Palaniappan, Ubal Dhus
January-February 2017, 34(1):76-78
DOI:10.4103/0970-2113.197114  PMID:28144066
Covered or uncovered self-expanding metal stents are currently used for the palliative treatment of neoplastic esophageal strictures or compressions and esophageal leaks or fistulas due to malignancies. Erosion of esophageal stents into the respiratory tract is a rare complication and that too has been reported mostly as an early complication within few days or weeks. Here, we present the case of a 31-year-old female, who presented with a late complication of an esophageal stent eroding into the left main bronchus causing respiratory distress. She was stented for a benign corrosive esophageal stricture following caustic soda ingestion 3 years ago. She underwent a thoracotomy and closure of esophagobronchial fistula along with laparoscopic esophagectomy and gastric pull through. Postoperatively, patient developed an anastomotic leak which was corrected by placing a temporary stent.
  1,556 171 -
Flexible bronchoscopic argon plasma coagulation for management of massive hemoptysis in bronchial Dieulafoy's disease
Karan Madan, Ashesh Dhungana, Vijay Hadda, Anant Mohan, Randeep Guleria
January-February 2017, 34(1):99-101
DOI:10.4103/0970-2113.197096  PMID:28144074
Dieulafoy's disease is an uncommon condition, the usual site of occurrence being the gastrointestinal tract. The condition refers to the presence of a dysplastic submucosal artery with mucosal vascular branches that has propensity to cause recurrent bleeding. Dieulafoy's disease of the bronchus is rare. Herein, we describe the case of a 26-year-old male who presented with recurrent bouts of hemoptysis and bronchial Dieulafoy's disease was diagnosed. Flexible bronchoscopy was performed, and argon plasma coagulation (APC) of the bleeding lesion was done. The procedure was successful and was followed by complete eradication of the vascular malformation and cessation of hemoptysis. APC is a useful tool in the armamentarium of an interventional pulmonologist that can allow rapid and safe control of bleeding from superficially located and bleeding endobronchial lesions, and can be easily and effectively applied using a flexible bronchoscope.
  1,290 249 -
Role of radial endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of pulmonary nodules: Case report and literature review
Sahajal Dhooria, Inderpaul Singh Sehgal, Nalini Gupta, Ashutosh Nath Aggarwal, Digambar Behera, Ritesh Agarwal
January-February 2017, 34(1):61-64
DOI:10.4103/0970-2113.197094  PMID:28144062
The diagnosis of pulmonary nodules can be made using several methods including computed tomography (CT)-guided fine-needle aspiration (FNA), radial endobronchial ultrasound (EBUS)-guided sampling techniques (transbronchial lung biopsy [TBLB], transbronchial brush, bronchoalveolar lavage, or transbronchial needle aspiration [TBNA]), or occasionally with convex probe (CP) EBUS-TBNA. While CT-guided FNA is associated with a high (25%) rate of pneumothorax, the CP-EBUS cannot reach lesions beyond the interlobar region. Radial EBUS-guided TBLB and transbronchial brushing are excellent modalities in the evaluation of peripheral pulmonary lesions. However, these techniques cannot access lesions that are located adjacent to the proximal segmental bronchus, due to the presence of a cartilaginous wall. Herein, we describe a 58-year-old man, who presented with a lung nodule in the right middle lobe, wherein radial EBUS-guided TBNA proved to be the most appropriate diagnostic modality. We also discuss the current utility of radial EBUS-guided TBNA in day-to-day practice.
  1,241 277 -
A randomized, double-blind study comparing the efficacy and safety of a combination of formoterol and ciclesonide with ciclesonide alone in asthma subjects with moderate-to-severe airflow limitation
Madhu Sudan Barthwal, Shailesh Meshram
January-February 2017, 34(1):111-112
DOI:10.4103/0970-2113.197102  PMID:28144080
  1,307 168 -
Fatal hemoptysis due to ruptured peripheral pulmonary artery pseudoaneurysm
Bhumika Vaishnav, Arvind Bamanikar, Vivek Singh Rathore, Vinit Kumar Khemka
January-February 2017, 34(1):106-107
DOI:10.4103/0970-2113.197107  PMID:28144077
  1,307 141 -
Effective communication, the heart of the art of medicine
Parvaiz A Koul
January-February 2017, 34(1):95-96
DOI:10.4103/0970-2113.197122  PMID:28144072
  1,246 194 -
Perpetual dilemma: Pleural or parenchymal/congenital or acquired solitary cystic lesion with fluid level
Deepak Talwar, Onkar Jha, Rahul Kumar Sharma, Rajat Saxena
January-February 2017, 34(1):88-91
DOI:10.4103/0970-2113.197121  PMID:28144070
Congenital cystic adenomatoid malformations (CCAMs) are rare congenital, nonhereditary developmental anomalies of the lung with unknown etiology. CCAM is predominantly a disorder of infancy with the majority of the cases being diagnosed within the first 2 years of life. When CCAM presents in adults, it represents a diagnostic dilemma and requires careful evaluation. We here report a case of large solitary congenital pulmonary cystic adenomatoid malformation with infection and hemorrhage, which was diagnosed as encysted hydropneumothorax on computerized tomography scans but turned out to be infected pulmonary cystic adenomatoid malformation after surgical excision.
  1,237 167 -
Incidental detection of a curved radiopacity on the chest X-ray
Mandeep Garg, Nidhi Prabhakar
January-February 2017, 34(1):97-98
DOI:10.4103/0970-2113.197105  PMID:28144073
  1,206 185 -
Erratum: Fat embolism syndrome

January-February 2017, 34(1):114-114
DOI:10.4103/0970-2113.197123  PMID:28144082
  1,064 154 -
Multislice computed tomography and virtual bronchoscopy diagnosis of interbronchial fistula
Venkatraman Indiran
January-February 2017, 34(1):92-94
DOI:10.4103/0970-2113.197103  PMID:28144071
Although tuberculosis is a rather common disease in the Indian subcontinent, tracheobronchial involvement in tuberculosis is still rare. Fistula formation between bronchi is very rare considering that only four cases have been published in the English literature. We present a case of multislice computed tomography (CT) and virtual bronchoscopy diagnosis of interbronchial fistula in a patient with tuberculosis along with a review of literature of the same. This happens to be the smallest of the interbronchial fistula identified on imaging so far and the first case from the Indian subcontinent. This is also the first instance where the diagnosis appears to have been made using only multislice CT generated virtual bronchoscopy without the aid of fiber optic bronchoscopy.
  1,006 149 -
Primary pleural leiomyosarcoma - A rare entity
Ankit Kumar Sinha, Arjun Khanna, Deepak Talwar, Charul Dbaral
January-February 2017, 34(1):104-105
DOI:10.4103/0970-2113.197095  PMID:28144076
  1,001 147 -
Large posterior mediastinal schwannoma in a 45-year-old woman
Uvie U Onakpoya, Bamidele O Adeniyi, Joel O Eyekpegha, Akinwumi B Ogunrombi
January-February 2017, 34(1):109-110
DOI:10.4103/0970-2113.197109  PMID:28144079
  1,016 112 -
Stenting of critical tracheal stenosis with adjuvant cardio-pulmonary bypass
Himanshu Bhardwaj, Ahmed Awab, Houssein A Youness, Brent Brown
January-February 2017, 34(1):79-81
DOI:10.4103/0970-2113.197106  PMID:28144067
Severe and critical central airway obstruction causing impaired ventilation and/or oxygenation can impose tremendous challenges on the interventional pulmonologist. Near total airway obstruction can rapidly evolve into potentially fatal complete airway occlusion during bronchoscopic airway manipulation under moderate sedation; as well as during the induction of the general anesthesia. Although there are currently interventional pulmonary procedures available to tackle the critical airway obstruction in extreme situations, cardio-pulmonary bypass should be considered prior to the intervention to maintain the adequate gas exchange during the procedure. Orotracheal intubation with mechanical ventilation in this situation can be fatal itself if the obstructing airway lesion functions as a “one way valve” allowing air to follow distally during inspiration but impeding expiratory flow leading to gas trapping, high intrathoracic pressure, tension pneumothorax, and ultimately a cardiac arrest.
  983 122 -
Author's reply
Sundeep Santosh Salvi, Abhijit Vaidya, Rahul Ramesh Kodgule, Jaideep Gogtay
January-February 2017, 34(1):112-113
DOI:10.4103/0970-2113.197113  PMID:28144081
  987 101 -
Sharpener blade: An unusual tracheobronchial sharp foreign body in a child
Bhushan Kathuria, Viresh Arora, Raman Wadhera, Surender Singh
January-February 2017, 34(1):102-103
DOI:10.4103/0970-2113.197098  PMID:28144075
  950 123 -
Amphoric abdomen: An unusual finding
Milind Baldi, Inderpaul Singh Sehgal, Sahajal Dhooria, Ritesh Agarwal
January-February 2017, 34(1):108-108
DOI:10.4103/0970-2113.197112  PMID:28144078
  959 103 -