A melting, encapsulated, calcified pulmonary nodule in a healthy 51-year-old woman: a case report.

BACKGROUND: Foreign body aspiration is less common in healthy adults, which makes diagnosis difficult. Early detection of smaller/sharp foreign bodies in the distal airway is more difficult because patients might have no symptoms and imaging studies could appear normal. Here we describe the course of a small, sharp foreign body (chicken bone) lodged in the distal airway of a healthy middle-aged woman. The chicken bone was initially thought to be an old calcified tuberculoma. However, it was encased in a dilated bronchus without obvious surrounding lymphadenitis or parenchymal infiltration, and it melted with time. Two years later, histopathological examination revealed that the calcified lesion was an aspirated chicken bone with a concomitant tuberculoma. CASE PRESENTATION: A 51-year-old woman showed an old calcified tuberculoma in the upper right lung lobe during routine examinations. It was "encased" in a dilated bronchus, although it was not raised from the surrounding lung parenchyma. The size of the calcified part decreased ("melted") with time, and the surrounding inflammation progressed 2 years later, a phenomenon never described in association with tuberculosis. Bronchoscopy revealed a fragment of chicken bone lodged in the next two branches of the upper right posterior bronchus. Surgical segmentectomy was performed, and histopathological examination revealed that the calcified lesion was formed by a fragment of chicken bone as well as a tuberculoma. Eventually, the patient recalled an episode of choking on a chicken bone 5 years ago; she believed that she had coughed it out completely at that time. CONCLUSIONS: The "melting" and "encased" phenomena observed in the present case could be useful imaging findings for early detection of small foreign body aspiration in the distal airway.

Systemic air embolism after percutaneous computed tomography-guided lung biopsy due to a kink in the coaxial biopsy system: a case report.

BACKGROUND: Systemic air embolism is a rare but potentially life-threatening complication of percutaneous computed tomography (CT)-guided lung biopsy. The incidence might be underestimated because of failure to diagnose this adverse event in asymptomatic patients; early recognition is difficult. CASE PRESENTATION: We report the case of a 73-year-old man with systemic air embolism, a complication of percutaneous CT-guided lung biopsy, due to a kink in the coaxial biopsy system. Serial post-procedure CT scans demonstrated the causal relationship. CONCLUSIONS: Sequential post-biopsy CT scans demonstrated a causal relationship between this systemic air embolism and percutaneous biopsy, and allowed the radiologist to track the course of the emboli and their resolution. Awareness of air entry via the introducer needle and an early post-biopsy CT scan are crucial for early detection of systemic air embolism. If air embolism occurs in an asymptomatic patient, we recommend performing a delayed chest CT scan to follow the air's course.

Risk factors of pneumothorax after CT-guided coaxial cutting needle lung biopsy through aerated versus nonaerated lung.

PURPOSE: To compare the risk factors of developing a pneumothorax after computed tomography-guided lung biopsy in cases in which aerated lung is traversed and in cases in which aerated lung is not traversed. MATERIALS AND METHODS: The records of 381 patients from July 2005-December 2009 were retrospectively reviewed. Multivariable analysis of patient demographic characteristics, lung lesion characteristics, and biopsy procedure details was performed with respect to the development of pneumothorax. RESULTS: Among 381 patients, 249 biopsies traversed aerated lung tissue, and 132 biopsies did not traverse aerated lung tissue. Patients in whom aerated lung tissue was traversed had a significantly higher rate of pneumothorax. When aerated lung was not traversed, lesion size (≤ 2 cm vs > 2 cm; P = .025) and pleural-lesion angle (odds ratio = 1.033/degree; P = .004) were associated with pneumothorax. When aerated lung was traversed, location (middle vs upper; P = .009) and a transfissure approach (yes vs no; P = .001) were associated with pneumothorax. CONCLUSIONS: When aerated lung was not traversed, lesion size and pleural-lesion angle were associated with pneumothorax, and when aerated lung was traversed, location and a transfissure approach were associated with pneumothorax.

Accuracy of ultrasonography and magnetic resonance imaging in diagnosing carpal tunnel syndrome using rest and grasp positions of the hands.

PURPOSE: To compare the accuracy of ultrasonography and magnetic resonance imaging (MRI) in diagnosing carpal tunnel syndrome (CTS) in both the rest and grasp positions. We postulated that the diagnostic accuracy could be improved by imaging hands in the grasp position rather than in the rest position. METHODS: Fifty patients with CTS and 45 healthy volunteers received a package of questionnaires and had a physical examination and a nerve conduction study. Ultrasonography and MRI images were recorded in both the rest and grasp positions for each participant. RESULTS: There were significant differences between the patients and the healthy volunteers regarding patient-reported outcomes, the results of physical examinations, the nerve conduction studies, and the ultrasonography and MRI imaging. The area under the receiver operating characteristic curve of ultrasonography was significantly improved by measuring the bowing of the flexor retinaculum in the grasp position than by measuring that in the rest position. The diagnostic accuracy of ultrasonography was similar to that of MRI when we used a combination of the measurements of the cross-sectional area of the median nerve in the rest position and the bowing of the flexor retinaculum in the grasp position. CONCLUSIONS: The accuracies of MRI and ultrasonography for diagnosing CTS were improved by measuring the bowing of the flexor retinaculum in the grasp position. Ultrasonography can be an adequate screening method for CTS if clinicians combine the cross-sectional area of the median nerve in the rest position and the bowing of the flexor retinaculum in the grasp position. TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic I.

Pneumocystis jirovecii pneumonia presenting as a solitary pulmonary granuloma due to unclean continuous positive airway pressure equipment: a case report.

Continuous positive airway pressure (CPAP) therapy can spread infections if the equipment is not cleaned properly. We report a case of Pneumocystis jirovecii pneumonia likely spread by unclean CPAP equipment and accessories. A 48-year-old man with severe obstructive sleep apnea was using CPAP equipment that had never been cleaned for 5 years. He experienced intermittent mild fever for 6 weeks. His chest images showed a solitary pulmonary granuloma. Pneumocystis jirovecii was identified from the bronchoalveolar fluid, the CPAP mask, and the air tubing. The fever subsided immediately after changing to a clean CPAP device. We prescribed sulfamethoxazole 400 mg and trimethoprim 80 mg twice daily for 1 month. Three months later, the pulmonary granuloma disappeared, and P. jirovecii was absent in the bronchoalveolar fluid. Poorly cleaned CPAP devices could harbor P. jirovecii and spread pulmonary infection in immunocompetent persons. Appropriate cleaning of CPAP equipment is essential to minimize infection risk. CITATION: Jao L-Y, Su W-L, Chang H-C, Lan C-C, Wu Y-K, Yang M-C. Pneumocystis jirovecii pneumonia presenting as a solitary pulmonary granuloma due to unclean continuous positive airway pressure equipment: a case report. J Clin Sleep Med. 2022;18(6):1717-1721.

Mucoid impaction mimicking multiple metastatic lung cancer.

The most common etiology of multiple pulmonary nodules is metastatic lung cancer. Although benign etiologies have been reported, mucoid impaction less commonly presents as multiple pulmonary nodules. Herein, we report the case of an 81-year-old demented man who presented with multiple pulmonary nodules due to mucoid impaction. Chest radiographs revealed rapid resolution after tracheostomy and adequate mucus clearance. We suggest that mucoid impaction may present as multiple pulmonary nodules mimicking multiple metastatic lung cancer.

Hypersensitivity pneumonitis due to unclean continuous positive airway pressure equipment.

Hypersensitivity pneumonitis is a potentially fatal immunological lung disease caused by occupational or environmental exposure to specific antigens. Here, we report on an obstructive sleep apnea patient whose hypersensitivity pneumonitis was aggravated because of the use of unclean continuous positive airway pressure equipment. This report shows that careful history taking is important when diagnosing hypersensitivity pneumonitis. Sleep specialists should be aware of the risks related to unclean continuous positive airway pressure equipment use, and obstructive sleep apnea patients should be instructed and monitored in the regular cleaning of their equipment.