Urinothorax Caused by Xanthogranulomatous Pyelonephritis

Xanthogranulomatous pyelonephritis is a rare form of chronic pyelonephritis that generally afflicts middle-aged women with a history of recurrent urinary tract infections. Its pathogenesis generally involves calculus obstructive uropathy and its histopathology is characterized by replacement of the renal parenchyma with lipid filled macrophages. This often manifests as an enlarged, nonfunctioning kidney that may be complicated by abscess or fistula. This case details the first reported case of xanthogranulomatous pyelonephritis complicated by urinothorax, which resolved on follow-up chest X-ray after robot-assisted nephrectomy

The role and safety of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis and management of infected bronchogenic mediastinal cysts in adults

Bronchogenic and other duplication cysts are congenital abnormalities that can present at any age including adulthood years. They are usually asymptomatic and discovered incidentally on radiological imaging of the chest. They are commonly treated by surgical resection. Recently, endobronchial ultrasound has been used to assist in diagnosis when radiologic imaging is not definitive. Endobronchial ultrasound has been used rarely to drain infected cysts, a rare complication of the bronchogenic cyst. We present a unique case of an infected large bronchogenic cyst treated with endobronchial ultrasound drainage combined with conservative medical therapy. We also review the scarce available literature describing such an approach and its potential complications and add recommendations based on our experience in managing these anomalies

Chemotherapy-related acute respiratory distress syndrome in germ cell tumors: a literature review

Germ cell tumors (GCTs) are one of the more curable solid cancers in men. Approximately 8500 men are diagnosed with GCTs in the USA. The majority of patients survive due to the availability of effective treatment. Fewer than 400 men are estimated to die from their disease . Among those, there is a subset of patients with metastatic GCTs receiving chemotherapy who rapidly develop progressive respiratory failure and die during the early phase of their treatment course. In this review, we searched the available literature for reported cases and retrospective series of chemotherapy-associated acute respiratory distress syndrome in GCTs. We aim to determine whether a different approach from current treatment guidelines could be considered to prevent this catastrophic chemotherapy-related event

Candida krusei Empyema Thoracis: A Community-Acquired Infection Requiring a High Index of Suspicion

Empyema thoracis is a serious condition characterized by the accumulation of purulent fluid in the pleural cavity, typically following a pneumonia, subdiaphragmatic abscess, or esophageal rupture. Fungal empyema thoracis is a rare form of this condition with especially high mortality, in which the most frequently isolated fungus is Candida spp. This article presents a 74-year-old female with Candida krusei pneumonia and a complicated hospital course, initially presenting with nausea, vomiting, and dysphagia. She was initially suspected to have community-acquired pneumonia and was started on azithromycin and ceftriaxone. Worsening respiratory function led to the diagnosis of hydropneumothorax. Pleural fluid and an independent sample of pus and pleural tissue grew Candida krusei, giving the diagnosis of fungal empyema. With further respiratory deterioration, the patient was intubated and switched to piperacillin/tazobactam and micafungin. Decortication with extensive pleural peel and removal of foul-smelling pus and food particles within the chest was performed. This further lead to confirmation of esophageal perforation, and she was started on voriconazole and meropenem. After developing septic shock, the patient was managed with phenylephrine and vasopressin. Finally, after improving she was weaned off pressors and extubated, followed by an esophagogastroduodenoscopy (EDG) with pneumatic balloon dilation and WallFlex stent placement. This patient’s case demonstrated an example of empyema thoracis, which required a high index of suspicion since the presentation was with a community-acquired infection. Candida empyema thoracis may be a complication of operation, gastroesophageal fistula, and spontaneous esophageal rupture. On the other hand, the course of this patient’s hospital stay progressed from esophageal perforation to Candida krusei pneumonia, empyema, and pneumothorax. Thus, community-acquired fungal empyema should be considered in patients with respiratory symptoms and suspected esophageal perforation; nevertheless, after a diagnosis of fungal empyema, esophageal perforation should also be ruled out in addition to other causes like pneumonia, subphrenic abscess, and hematogenous spread. Improved communication between clinicians and microbiologists can lead to early diagnosis and a reduction in the morbidity and mortality of this condition

Atypical rapid onset Scleroderma Renal Crisis (SRC) complicated with diffuse alveolar hemorrhage and pleuro-pericardial effusions in a patient with recently diagnosed breast cancer and a positive anti-RNA polymerase III Ab.: A case report

Scleroderma associated Pulmonary–Renal Syndrome is a rare but severe complication with a poor prognosis and high mortality. A high index of suspicion is needed for early recognition of this potential complication in patients with systemic sclerosis and institution of appropriate treatment. With more data showing an increased association between scleroderma and malignancy, a heightened vigilance should also be exercised in patients with malignancy and scleroderma-like presentation. We report of a case rapid onset systemic sclerosis complicated by acute renal failure and diffuse alveolar hemorrhage in a woman with stage IIB right breast cancer and elevated RNA Polymerase III IgG Ab. To our knowledge, this the first case of a patient with breast cancer associated with systemic sclerosis and pulmonary-renal syndrome. Keywords: Systemic sclerosis, Pulmonary-renal syndrome, Scleroderma renal crisis, Diffuse alveolar hemorrhage, Breast cancer, Positive anti-RNA polymerase III Ab, Pleural effusion, Pericardial effusio

Urinothorax Caused by Xanthogranulomatous Pyelonephritis

Xanthogranulomatous pyelonephritis is a rare form of chronic pyelonephritis that generally afflicts middle-aged women with a history of recurrent urinary tract infections. Its pathogenesis generally involves calculus obstructive uropathy and its histopathology is characterized by replacement of the renal parenchyma with lipid filled macrophages. This often manifests as an enlarged, nonfunctioning kidney that may be complicated by abscess or fistula. This case details the first reported case of xanthogranulomatous pyelonephritis complicated by urinothorax, which resolved on follow-up chest X-ray after robot-assisted nephrectomy

Pneumocystis Jirovecii (carinii) pneumonia causing lung cystic lesions and pneumomediastinum in non-HIV infected patient

Pneumomediastinum is a rare, potentially life-threatening complication of PCP that occurs in HIV-positive and HIV-negative patients. We are presenting a rare case pneumomediastinum caused by pneumocystis Jirovecii pneumonia in a HIV-negative patient with history of diffuse B-cell lymphoma on R CHOP chemotherapy. What is unique about our case is that the patient developed pneumomediastinum while in the hospital, on atovaquone that improved when switched to clindamycin and primaquine with improvement in her respiratory status. Another interesting point is that diagnosis was entertained due to the characteristic CT scan finding of ground glass opacities with cystic lung lesions and pneumomediastinum in an immunocompromised patient who was started on empirical treatment for PCP. The diagnosis was eventually confirmed with PCP PCR. Keywords: Pneumomediastinum, Pneumocystis Jirovecii (carinii), Lung cystic lesion

Cushing Syndrome Due to Ectopic Adrenocorticotropic Hormone Secretion by a Pulmonary Carcinoid Tumor in a Patient with Pneumoconiosis

Objective: Sites with a high prevalence of pneumoconiosis are especially challenging to physicians. The presence of pneumoconiotic nodules on chest computed tomography (CT) scans makes it difficult to localize the source of ectopic adrenocorticotropic hormone (ACTH). Because of false-positive results that may occur with the use of fluorine 18-fluorodeoxyglucose positron emission tomography CT (PET/CT) scans, alternative imaging modalities are needed. Methods: Gallium 68-dodecanetetraacetic acid tyrosine-3-octreotate (68Ga-DOTATATE) is a positron emitter-labeled somatostatin analog used with PET/CT. 68Ga-DOTATATE may improve the diagnostic accuracy of localizing ectopic ACTH-secreting carcinoid tumors in patients with pneumoconiosis by reducing false-positive results. Results: We describe a patient with pneumoconiosis and Cushing syndrome due to ectopic ACTH from a pulmonary carcinoid tumor, highlighting challenges in diagnosis and management. Conclusion: Prospective studies comparing fluorine 18-fluorodeoxyglucose PET/CT with 68Ga-DOTATATE PET/CT for diagnosis of bronchial carcinoid tumors in patients with ectopic ACTH and pneumoconiosis are highly needed. We also review the scarce available literature and provide recommendations based on our experience

Pulmonary alveolar microlithiasis diagnosed with radiography, CT, and bone scintigraphy

Pulmonary alveolar microlithiasis is rare disease characterized by accumulation of calcium phosphate microlithis in the alveoli. The pathogenesis relates to mutation in the gene SLC34A2 (solute carrier family 34 member 2) located on chromosome 4p15.2, which produces a defective sodium-phosphate cotransporter in alveolar epithelial type-2 cells, making these cells unable to clear phosphorus released during recycling of surfactant [1]. Keywords: SLC34A2 gene, Alveolar microlithiasis, Interstitial lung disease, Bone scan scintography of the lung, Hypoxemia, Lung calcificatio