Not all that Wheezes is Asthma.

We want to highlight the presentation of a 75-year-old female who was initially managed as asthma and subsequently diagnosed with concurrent excessive dynamic airway collapse (EDAC).

Alveolar Air Leak Syndrome a Potential Complication of COVID- 19-ARDS - Single Center Retrospective Analysis.

BACKGROUND: Alveolar air leak comprising of pneumothorax, pneumomediastinum, and subcutaneous emphysema in the ongoing COVID 19 pneumonia have been increasingly reported in literature. These air leaks were also recognized in the severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS) and H1N1 viral pandemics. Here we review the incidence and outcomes of alveolar air leaks over 400 patients admitted to our tertiary care institution for moderate-severe COVID-19 pneumonia. METHODS: We performed a retrospective audit of moderate to severe COVID-19 cases admitted to our hospital. Patients who were recognized as either a spontaneous pneumothorax, pneumomediastinum, pneumopericardium and subcutaneous emphysema were identified. Their clinical features and characteristics were thoroughly documented and clinical outcomes were gathered. Each case has been presented as a brief synopsis. RESULTS: During the audit period, we reviewed over 670 patients, out of these 419 patients required intensive care for moderate to severe disease. 10 patients developed Pneumothorax, pneumomediastinum, pneumopericardium and/ or subcutaneous emphysema - referred to as Alveolar Air leak syndrome; The incidence of alveolar air leak was found to be 2.39%. 6 patients did not survive the resultant complication. CONCLUSION: Spontaneous alveolar air leaks are a rare but definite complication of COVID-19 viral pneumonia and may occur in the absence of mechanical ventilation. ICU Clinicians must be alert about the diagnosis and treatment of this complication.

Oesophageal intramural pseudodiverticulosis presenting as non-resolving pneumonia: A sinister cause diagnosed by EUS-B-FNA.

We report a case of an oesophageal intramural pseudodiverticulosis leading to a mediastinal collection caused by Candida glabrata presenting as a non-resolving pneumonia and mimicking an oesophageal mass. The patient was a 60-year-old diabetic male who was referred from another hospital and presented with a history of low-grade fever and breathlessness. His computed tomography (CT) of the chest disclosed a mediastinal mass alongside the oesophagus with pleural collection. Endobronchial ultrasound scope was inserted through the oesophagus (EUS-B) and fine-needle aspirate was taken from the mass. The cultures of specimen from the mediastinum grew drug-resistant C. glabrata. The patient was managed with oral voriconazole along with oesophageal stenting after which he showed remarkable recovery. Repeat CT revealed a near-complete reduction of the mediastinal infection. The case highlights the need of a high degree of suspicion, right approach to diagnostic work-up and appropriate histopathological and microbiological examination of clinical specimens.

Concurrent massive hemoptysis and acute pulmonary embolism: A therapeutic dilemma.

Pulmonary Embolism and Massive hemoptysis are two very potentially fatal emergencies in Respiratory medicine practice. These two conditions are kind of antagonizing conditions requiring completely different and pharmacologically opposite nature of treatment. We hereby present the case of a 37-year old young male presented to our Hospital with massive hemoptysis, who on evaluation also had a concurrent large pulmonary embolism. The bleed was managed with bronchial artery embolization followed by anticoagulation therapy from a day later for embolism. This case report gives an insight on to how to manage a practical therapeutic challenge which is the concurrence of a massive hemoptysis and life threatening pulmonary embolism.

Necrotizing lymphadenitis: Not always tuberculosis, its Kikuchi-Fujimoto's disease.

Kikuchi-Fujimoto's disease is an uncommon self limiting, benign cause of generalised lymphadenopathy with fever. It can present as a triad of fever, night sweats and lymphadenopathy which resembles more common causes like tuberculosis and lymphoma. Being an endemic country a patient may be treated on the lines of tuberculosis often. We present case of a young female who was diagnosed as Kikuchi-Fujimoto's disease after not responding to antitubercular treatment. Pathologists and Clinicians must be aware of this condition to prevent unnecessary treatment.

Tuberculosis: oral alveolus and pulmonary alveoli coexisting.

Tuberculosis of the oral cavity is uncommon in this antibiotic era. We report a case of a long standing non-healing ulcer of the right upper maxillogingival sulcus, found to be tuberculosis of a rather unusual site in the oral cavity, the alveolus.