Search

Churg–Strauss syndrome, also known as eosinophilic granulomatosis, is one of the antineutrophilic cytoplasmic antibody (ANCA)-associated vasculitis associated with asthma and peripheral eosinophilia. Here, we present a case of a 50-year-old male, known asthmatic presenting with cough, dyspnea, fever, and lower limb purpura. On evaluation found to have perinuclear ANCA positivity; a nerve conduction study showed mononeuritis multiplex, and he was diagnosed with Churg–Straus syndrome.

Primary mediastinal large B-cell lymphoma (PMBCL) is a rare subtype of lymphoma with female predominance. Lymphomas are divided into Hodgkin's lymphoma (accounts for 10% of all lymphomas) and nonHodgkin's lymphoma. Pulmonologist often comes across lymphoma which can present as a mediastinal mass. PMBCL is an example of such a condition which represents 2%–3% of nonHodgkin lymphoma cases. This case report is about two male patients with PMBCL who presented with mediastinal mass, which was diagnosed by histopathological examination.

Sarcoidosis is a granulomatous diseases of unknown origin with pulmonary and extrapulmonary involvement including the hematological system leading to various complications like anemia, lymphopenia etc. One such complication is arteriovenous malformations which occurs as a rare complication of sarcoidosis and it requires a prompt diagnosis and management.

Aim: To assess the role of computed tomography (CT) chest in correlating with the severity and outcome of COVID-19 Patients. Background and Materials and Methods: A prospective study was done on 160 hospitalized patients who were COVID-19 positive by reverse transcription-polymerase chain reaction in Apollo Hospital, Greams Road, Chennai, India. We collected epidemiological data, comorbidities, clinical manifestations, oxygen requirement, and CT chest details of all patients. All images were reviewed by a single consultant radiologist and CT chest severity scoring was done as per the guidelines published in the American Journal of Radiology. CT chest severity score (CTSS) was then compared with clinical severity and various parameters. Results: This study included 160 hospitalized COVID-19 patients with a mean age of 61 ± 13.97 years. Male (74.4%) patients were more when compared to female patients (25.6%). Majority of the patients were belong to mild category (44.38%), followed by severe (28.7%) and moderate (26.8%) categories. Fever (73.8%) was the most common symptom. Diabetes mellitus (57.5%) was the most common comorbidity of COVID-19 patients in our study, followed by hypertension (55%). The average CTSS of mild category was 7.4 ± 4.7; for moderate category, the mean CTSS was 14.6 ± 5.78; and for severe category, it was 18.3 ± 5.28. There was increasing trend of severity score, as clinical severity increases which was statistically significant (P = 0.0001). The mean CTSS of patients who required no oxygen, low flow oxygen, high flow oxygen, noninvasive ventilation, and intubated patients was 8.3 ± 5.71, 14.84 ± 5.39, 18.17 ± 5.7, 18.17 ± 6.04, and 22.18 ± 4.07, respectively, which was statistically significant (P = 0.0001). The mean CTSS of patients discharged without oxygen requirement was 11.09 ± 6.48 and patients discharged with oxygen requirement was 18.09 ± 6.12 (P = 0.001). The mean CTSS of patients who died was 20.27 ± 4.62. Conclusion: There was a significant correlation between CT chest severity score and clinical severity and oxygen requirement. CT chest is one of the best screening tools for rapid identification as well as to predict the clinical severity; thereby, it helps the clinician in managing the COVID-19 patients at crucial points during the progression of disease.

Aim: The aim of the study was to compare various clinical scoring systems used in detecting pulmonary embolism (PE) in adults in Tertiary Care Hospital in South India. Materials and Methods: Prospective study was done in Apollo Hospital, Greams Road, Chennai, from January 2016 to December 2017. Sixty-five patients with suspected PE were included in the study. Details such as age, sex, pulse rate, and blood pressure were collected. Probability of PE was calculated with all four clinical scoring systems (Wells score, simplified Wells score, revised Geneva score, and simplified revised Geneva score) and compared with computed tomography–pulmonary angiography which was considered the gold standard. Results: This study included 65 patients with suspected PE. Among 65 patients, 39 (60%) were male and 26 (40%) were female. PE was present in 23 (35.4%) patients, of which 14 (60.9%) were male and 9 (39.1%) were female, but the difference was not statistically significant (P = 0.916). Wells score had a sensitivity of 87%, specificity of 67%, positive predictive value (PPV) of 59%, and negative predictive value of 90%. Simplified Wells score had a sensitivity of 91%, specificity of 50%, PPV of 50%, and negative predictive value of 91%. The revised Geneva score had a sensitivity of 70%, specificity of 52%, PPV of 44%, and negative predictive value of 76%. Simplified revised Geneva score had a sensitivity of 65%, specificity of 57%, PPV of 45%, and negative predictive value of 75%. Conclusion: From this study, we were able to infer that the simplified Wells score had high sensitivity and Wells score had high specificity in the diagnosis of PE. Simplified revised Geneva score had the least negative predictive value. It is very important to have a high index of suspicion for the diagnosis of PE and the clinical predictability scores are valuable tools in this regard.

A 46-year-old female, with no previous history of respiratory complaints, was found to have a lesion in the left lower zone on chest X-ray during preoperative evaluation for undergoing hysterectomy in view of vaginal prolapse. Computed tomography (CT) of the chest showed a well-defined lobulated pleural-based lesion with smooth margins in the left lower lobe measuring 9.3 cm × 5.3 cm. She underwent CT-guided lung biopsy which showed a mesenchymal neoplasm. Hence, uniportal Video assisted thoracoscopic surgery (VATS) was done and a biopsy Histo-pathological examination (HPE) sent showed pleomorphic spindle cells with little cytoplasm and immunohistochemistry showed vimentin, CD34, STAT 6 positivity, and pan-cytokeratin negativity, consistent with solitary fibrous tumor of the pleura.

A 48-year-old male presented with complaints of occasional dry cough and sneezing for the past 4 months and high-resolution computed tomography chest done showed tree in bud and patchy nodular opacities in the right upper lobe and right middle lobe. He underwent bronchoscopy and bronchoalveolar lavage Gene X-pert Mycobacterium Tuberculosis (MTB) was not detected, but cytology showed granulomas and hence he was started on empirical antituberculous therapy (Isoniazid, Rifampicin, Pyrazinamide and Ethambutol (HRZE) regimen). His acid-fast bacilli C/S reports during follow-up showed growth of Mycobacterium Avium complex (MAC). Drug sensitivity testing was done and then he was started on oral rifampicin, ethambutol, and azithromycin and this regimen was continued for the next 6 months.

Melioidosis is caused by Burkholderia pseudomallei, which is normally present in soil, endemic in the tropical and subtropical regions. It has a varied clinical presentation from presenting with acute symptoms and sepsis and rarely presenting as subacute to chronic disease. In this article, we have discussed the spectrum of presentation of melioidosis such as mediastinal lymphadenopathy, cavitating pneumonia, and pleural effusion.

Mediastinal tumors are commonly found in the anterior mediastinum, among which thymic tumors and lymphoma are the most common ones. Germ cell tumors constitute about 10%–15% of mediastinal tumors. Among which seminoma is an uncommon tumor. These mediastinal masses usually present with complaints of cough, chest pain, or symptoms of superior vena cava obstruction. Here, we report a case of mediastinal seminoma in a young adult presenting with complaints of syncope.

In our day-to-day practice, as a pulmonologist, the mediastinal lymphadenopathy is a common finding, the cause of which is difficult to diagnose. Although in endemic countries like India, tuberculosis is the common cause, there are also other causes which are associated with it. Therefore, it is important to get a tissue diagnosis before we arrive at a conclusion.