Laryngeal aspergilloma: a complication of inhaled fluticasone therapy for asthma

Primary laryngeal aspergillosis in immunocompetent patients is rare.We describe a case of a 59-year-old woman with laryngeal aspergillosis thought to be second-ary to long-term inhaled fluticasone therapy. Laryngeal aspergillosis may be an underrecognized complication of inhaled corticosteroid therapy

Inescapable Fibrosis: The Development of Desquamative Interstitial Pneumonia Post-Lung Transplantation Performed for a Patient with Idiopathic Pulmonary Fibrosis

Interstitial lung disease is characterised by a combination of cellular proliferation, inflammation of the interstitium and fibrosis within the alveolar wall. A 58-year-old man was referred for lung transplantation after developing worsening dyspnoea and progressive hypoxaemic respiratory failure from idiopathic pulmonary fibrosis. Three years later, he developed desquamative interstitial pneumonia in his transplanted lungs, and despite augmentation of immune suppression, he had a progressive decline in his lung function and exercise capacity. Interestingly, in our case, the histopathology obtained post transplant strongly goes against the recurrence of usual interstitial pneumonia/idiopathic pulmonary fibrosis; rather, two separate interstitial disease processes have been identified

High riding pericardial recess: Findings on EBUS TBNA

We report for the first time 2 cases of right paratracheal pericardial recess cysts identified by endobronchial ultrasound (EBUS) and subsequently aspirated by transbronchial needle aspiration. High riding pericardial cyst is a recently identified radiologic entity, which can mimic a right paratracheal lymph node. EBUS transbronchial needle aspiration is often performed in this site to aspirate tissue for pathologic diagnosis. On ultrasound, cystic structures appear black as do blood vessels. Although there are other features to identify blood vessels on ultrasound, it can be disconcerting to initially see a black lesion where the proceduralist was expecting to see a lymph node. The EBUS appearances are described, showing a cystic lesion above the azygous vein and medial to the superior vena cava. The use of color Doppler by EBUS was particularly useful in confirming the presence of a cystic structure as opposed to a blood vessel in this location

Persistent left superior vena cava complicating haemodynamic monitoring. A case report

Flow-directed, balloon-tipped catheterization of the right heart via a persistent left superior vena cava is described. The embryonic origin of the superior vena-caval system is briefly reviewed, and the left superior vena cava is discussed with respect to its clinical and surgical importance and methods of diagnosis

Sexual health issues after lung transplantation: importance of cervical screening

To determine the incidence and outcomes of human papillomavirus infection and cervical abnormalities after lung transplantation, we performed a retrospective cross-sectional study of all 166 female recipients who underwent transplantation between February 1989 and June 2001 at our institution. The incidence of low-grade epithelial abnormality of the cervix, cervical intra-epithelial neoplasia (CIN) 1, and the earliest pre-cancerous changes of the cervical epithelial cells, CIN 3, in the post-transplant cohort was 42.2 and 30, respectively, per 1,000 women screened compared with 8.3 and 6.2 per 1,000 women screened (20-69 years old) in a large reference population. We conclude that the incidence of cervical abnormalities in lung transplant recipients is significantly greater than in the general population. The importance of regular surveillance in immunosuppressed patients to decrease the burden of disease from this potentially fatal but treatable condition is emphasized

Chlamydia pneumoniae infection after lung transplantation

Background: Chlamydia pneumoniae is established as a common agent of acute respiratory tract infection and has been implicated in the pathogenesis of asthma and chronic obstructive pulmonary disease. Airway disease is a prominent cause of morbidity and mortality after lung transplantation. We investigated the role of C pneumoniae as a pulmonary pathogen after Jung transplantation

Association of minimal rejection in lung transplant recipients with obliterative bronchiolitis

The clinical significance of minimal acute rejection (grade A,) in lung transplant recipients is unknown. We prospectively analyzed 1,159 transbronchial lung biopsies in 184 patients. Two hundred seventy-nine biopsies in 128 participants confirmed A, histology at a mean postoperative day of 229 +/- 340. Sixty four of 255 surveillance A, lesions progressed to high-grade acute rejection by 3 months of follow-up, whereas 40 developed new lymphocytic bronchiolitis. Twenty-four A, biopsies were symptomatic, with only two cases progressing to high-grade rejection after steroid therapy. Seventy-eight of 184 patients experienced multiple (greater than or equal to 2) A, biopsies in the first 12 months after transplant. Bronchiolitis obliterans syndrome developed in 68% of patients with multiple A(1) lesions at a mean of 599 +/- 435 days, compared with 43% of patients with one or less A, lesions at a mean of 819 +/- 526 (p = 0.022). Eighteen patients experienced multiple A, biopsies after transplant in the absence of high-grade rejection episodes yet also developed earlier obliterative bronchiolitis (456 +/- 245 days, p = 0.020). We conclude that for A(1) transbronchial lung biopsies, the conventional treatment of observation only is now challenged even in patients who are asymptomatic. Patients who experience multiple A(1) lesions develop an earlier onset of obliterative bronchiolitis and may warrant alternative immunosuppressive strategies