Evaluation of clinical profiles, imaging findings and antituberculosis treatment outcome in granulomatous mastitis: An Indian scenario.

BACKGROUND: The management of choice for granulomatous mastitis (GM) has yet to be determined but few studies have demonstrated that anti-tubercular treatment (ATT) could be an effective alternative therapeutic option. Hence, the objective of the current study is to determine the clinical feature, radiological imaging findings, and histopathological examination results exhibited by GM and tuberculosis (TB)-proven GM as well as to evaluate the ATT clinical outcome in GM patients. METHODS: The study was performed on 68 GM patients who were referred to the department of pulmonology by the breast clinic (from January 2018 to August 2021). Study populations were categorized into two groups GM and TB-proven GM patients and all were prescribed with standard ATT regimen and were continuously followed up. SPSS version 25 was employed for statistical assessment. RESULTS: Our study showed that 6 patients from GM and 4 patients from the TB-proven GM group got relapsed. For patients who displayed partial remission, ATT treatment was started after assessing the side effects potential. 14.6% (n = 6) and 7.4% (n = 2) patients who initially demonstrated partial remission were also completely cured. ATT treatment curable rate was determined to be 90% (n = 37) and 81.5% (n = 22) for GM and TB-proven GM patients correspondingly. Therefore, the current study demonstrated nil significant differences between groups. CONCLUSION: The current study warrants that ATT therapy could be an effective and better treatment of choice for GM patients irrespective of their clinical condition.

Allergic bronchopulmonary aspergillosis presenting as complete lung collapse with respiratory failure.

Allergic bronchopulmonary aspergillosis (ABPA) is an allergic fungal disease that commonly complicates the natural course of patients with asthma and cystic fibrosis. Patients with ABPA commonly present with recurrent pulmonary infiltrates or bronchiectasis. They also experience difficulty treating asthma. Characteristic radiological findings include central bronchiectasis and high-attenuation mucus. Complete unilateral lung collapse is an uncommon presentation of ABPA, with few cases reported in published literature. We present a case of a man in his mid-40s, with acute cerebrovascular disease, who subsequently developed neurological deterioration, compounded by development of respiratory failure attributed to a complete left lung collapse, requiring invasive mechanical ventilation. Initially suspected to have aspiration pneumonia, he was eventually diagnosed with ABPA and was treated accordingly. This case illustrates an uncommon aetiology for complete lung collapse in this clinical setting and serves to remind us to consider ABPA as a differential diagnosis in such patients as well.

Endovascular stenting for malignant superior vena cava syndrome - Case series and review of literature.

The treatment of malignant superior vena cava syndrome (SVCS) revolves around radiotherapy and chemotherapy to relieve symptoms with surgery being ruled out due to the advanced stage of malignancy. Primary placement of endovascular stent for palliation of malignant SVCS is not commonly reported in the literature. Here, we present two cases of malignant superior vena cava syndrome with successful relief of symptoms after the placement of endo vascular stent.

Lung Parenchymal and Endobronchial Metastases From Ovarian Carcinoma.

Ovarian cancer is the seventh most common cancer in women and the eighth most common cause of cancer death in the world with an overall 5-year survival rate of <50%. (1) The most common age of presentation is at the perimenopausal age group and two-thirds of them present with advanced stage of disease. (2) Thoracic metastases occur in up to 50% of patients. Pleural effusion is the most common presentation of thoracic metastases in these patients, whereas pulmonary parenchymal metastases, lymphangitis, and nodal involvement are less commonly reported. (3) Tracheobronchial involvement is rare with few cases reported in literature. Herewith, we are presenting a case of ovarian cancer in a young female with both lung parenchymal and endobronchial metastases. Bronchoscopy revealed endobronchial tumor in right lower lobe bronchus part of which was covered by yellowish necrotic material. Biopsy showed metastatic ovarian malignancy complicated by aspergillosis. She was started on oral itraconazole along with supportive management following which hemoptysis stopped.

Predictors of asthma-chronic obstructive pulmonary disease overlap syndrome in patients with chronic obstructive pulmonary disease from a tertiary care center in India.

BACKGROUND: There is dearth of literature on asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS) in India. The aim was to compare clinical characteristics between patients with ACOS and non-ACOS COPD and to identify clinical predictors of ACOS in patients with COPD. METHODS: We conducted a retrospective study by reviewing data collected from patients performing spirometry at our hospital. Those with postbronchodilator FEV1/FVC <70% were included in the study. Among them, those with significant reversibility (change in FEV1or FVC by 12% and 200 ml postbronchodilator) were diagnosed with ACOS and the rest were considered to have non-ACOS COPD. Data on the 2 groups were compared and statistical analysis was performed. RESULTS: Out of a total of 324 patients, 100 of them had postbronchodilator FEV1/FVC <70%. Of them, 45 and 55 were diagnosed with ACOS and non-ACOS COPD, respectively. Patients with ACOS had significantly higher postbronchodilator FVC volumes and FVC % predicted values (P < 0.05), had higher reported wheeze (P = 0.02) and ankle edema (P < 0.05), were more likely to be smokers (P = 0.01) with lower smoking index (P = 0.03), and had frequent (≥2) ER visits (P = 0.04). However, very frequent (≥3 per year) hospital admissions (P < 0.01) with higher rates of invasive mechanical ventilation (P = 0.02), and pulmonary hypertension diagnosed by two-dimensional echocardiography (P < 0.01) were significantly higher in the non-ACOS group. The two groups did not differ with respect to history of atopy, family history of wheeze, compliance to inhaler therapy, or blood absolute eosinophil counts. CONCLUSION: Our study highlights how the ACOS phenotype may clinically differ from their counterparts elsewhere, making it a clinical challenge to identify them in India.