Myeloid osseous metaplasia of the lung: A case report.

Pulmonary osseous metaplasia is a disease in which mature bone is found within the parenchyma of the lung. The current study presents a case of pulmonary osseous metaplasia in a 64-year-old female. The patient was previously diagnosed with transitional cell carcinoma (TCC) of the lower ureter. During a routine check-up, an enhancing basal lung nodule was found on chest computed tomography scan, which was suspected to be metastatic lung disease. The patient underwent a thoracoscopic resection of the nodule. The histopathological examination of the specimen confirmed it to be myeloid osseous metaplasia. The disease usually has no significant complications and can also be found in association with other pulmonary diseases. Very limited information is available on the phenomenon; therefore, there is no exact treatment guide for clinicians to follow. In conclusion, myeloid osseous metaplasia of the lung is a rare finding, and based on this report, it may be associated with TCC.

Thoracic outlet syndrome caused by superior mediastinal mass: A case report.

INTRODUCTION: Thoracic outlet syndrome (TOS) caused by superior mediastinal soft tissue mass has never been reported in the literature, the aim of this study is to discuss a case of TOS caused by a superior mediastinal mass in which the histopathological examinations of the mass showed vascular malformation. CASE REPORT: A 45-year-old female presented with left upper limb pain and numbness for three months, associated with swelling and attacks of shortness of breath. Imaging studies showed soft tissue mass involving the superior mediastinum. The condition of the patient deteriorated and the signs and symptoms of TOS became clearer, all provocative tests and nerve conduction studies were positive. The patient underwent thoracic outlet decompression. The patient did not respond and the symptoms deteriorated further. After a multidisciplinary board discussion, the patient was prepared for median sternotomy under general anesthesia. A total resection of the mass was done. The patient was totally relieved a few hours after the operation. DISCUSSION: The etiology of TOS can be multifaceted. Several factors contribute to its onset, and these can be categorized as congenital or acquired. Congenital causes include anatomical anomalies such as a cervical rib, or an elongated transverse process of the cervical vertebrae. These anatomical deviations can reduce the size of the thoracic outlet and make it prone to compression. CONCLUSION: Although it is rare, TOS could be due to superior mediastinal mass and the treatment of choice is total resection either through median sternotomy or thoracoscopic procedure.

The clinical manifestations and treatment outcomes of Behçet's disease: A single-center experience.

Background and Aims: Behçet's disease is a chronic, multisystemic, and relapsing inflammatory disorder. It lacks a permanent cure, the focus of treatment is on mitigating symptoms, decreasing the frequency and severity of relapses, and preventing life-threatening complications. This study aims to report the experience of a single center in managing patients with Behçet's disease and discuss the treatment outcomes. Methods: This study was a retrospective case series conducted over 2 years. All cases were clinically diagnosed according to the International Criteria for Behçet's Disease. The extracted data were demographics, family history, clinical findings, criteria scores, treatment, and outcomes. Results: A total of 31 patients were included, consisting of 13 males (42%) and 18 females (58%). Most cases were over the age of 30, and both genders were nearly equally distributed among age groups. The most commonly affected site was the oral cavity, observed in 96.77% of cases. Genital, cutaneous, and vascular involvements were more common in males, while females were more likely to have oral, ocular, and musculoskeletal involvements. For various treatment regimens, oral, cutaneous, vascular, and musculoskeletal involvements showed complete response in all cases. Among cases with genital involvement, complete response was achieved in seven cases (41.2%), while four cases (23.5%) showed only partial response, and six cases (35.3%) experienced recurrence. In cases with ocular involvement, only partial responses were observed. Conclusion: Oral, cutaneous, vascular, and musculoskeletal involvements may have a higher likelihood of a complete response to treatment regimens. However, genital involvement may be the most recurrent manifestation, followed by ocular involvement.

Pseudo­Wellens syndrome in an elderly female patient with pulmonary embolism: A case report.

Pseudo-Wellens syndrome refers to any electrocardiogram (ECG) pattern that mimics Wellens syndrome with no critical left anterior descending (LAD) artery-associated coronary artery disease. The present study describes a rare case of pseudo-Wellens syndrome associated with pulmonary embolism. A female patient presented with chest tightness for 72 h. The precordial examination and heart sounds were normal. A mild bilateral lower pitting leg edema with a superficial varicose vein was observed. The levels of C-reactive protein (98.80 mg/l) and D-dimer (7599.9 ng/ml) were abnormal. An electrocardiogram presented a biphasic inversion of the T-wave in precordial leads in the pain-free interval. Coronary angiography did not reveal any notable findings. A computed tomography pulmonary angiography demonstrated an acute pulmonary embolism. The patient received unfractionated heparin (20,000 IU) by intravenous infusion. She was discharged on rivaroxaban (15 mg) twice daily for 21 days. The inverted T-wave specificity, sensitivity and positive predictive values for LAD stenosis are 89, 69 and 86% respectively. This indicates that ECG alternations with the properties of Wellens syndrome do not always guarantee its occurrence, and in the presence of a normal coronary artery, the condition may be pseudo-Wellens syndrome. The case described herein suggests that clinicians need to carefully screen patients that have pulmonary embolisms with an abnormal electrocardiographic pattern in order to prevent unnecessary intervention.

Post COVID-19 hemorrhagic pericardial effusion; A case report with literature review.

INTRODUCTION: Pericardial effusion (PE) related to COVID-19 has rarely been observed, with most reported cases being non-hemorrhagic. This study aims to present a rare case of post-COVID-19 hemorrhagic PE. CASE REPORT: A 44-year-old male presented with shortness of breath upon exertion, palpitation, and left-sided chest tightness. He was a recently recovered from COVID-19. He was conscious, oriented, tachypneic, and tachycardic. Chest examination revealed a mixture of fine and coarse crackles along with muffled heart sounds. He had elevated D-dimer, C-reactive protein, prothrombin time, and aPTT. Computed tomography pulmonary angiogram showed acute pulmonary thromboembolism involving the posterior segmental lobar branch of the left lower lobe with concomitant pulmonary infarction. Echocardiography showed severe PE without diastolic collapse. Pericardial drainage was performed and by the 2nd day, there was no more effusion. On the 7th day, the patient developed severe complications which led to cardiac arrest. DISCUSSION: PE is a collection of fluid in the pericardium. It has been rarely observed in relation to COVID-19, both during and after the viral infection. If PE is suspected, Echocardiography can be used to confirm its diagnosis. There is no standard management for these cases and only non-hemorrhagic patients with mild to moderate effusion can be treated using conservative measures. CONCLUSION: Hemorrhagic PE can be a rare but possible post-COVID-19 sequel, and echocardiography can be used to confirm its diagnosis. Drainage is necessary to resolve the effusion.

Recurrent spontaneous subcutaneous emphysema of unknown origin: A case report with literature review.

Introduction: Subcutaneous emphysema caused by a surgical operation is known as surgical emphysema, and if the cause is unknown, it is known as spontaneous subcutaneous emphysema. The current study aims to report a rare case of recurrent spontaneous SE of unknown origin. Case report: A 27-year-old male patient presented with swelling of the chest, neck, and face that had started 20 days prior. There was crepitation on palpation. Pulmonary function tests were normal. Laryngoscopy showed a normal larynx. Bronchoscopy showed a normal bronchial tree except for some redness in the trachea and left main bronchus. Computed tomography of the chest with contrast showed subcutaneous emphysema in the anterior chest and lower neck.The patient reported a similar condition 3 years prior resulting in swelling of the upper left chest with an associated pneumothorax that was treated with tube thoracostomy. Workup including VATS was done to find the underlying cause but no cause was found. Discussion: The pathogenesis is the same as in the most cases. Air that is driven into the interstitial tissues around the pulmonary vasculature gradually moves back toward the lung's hilum, resulting in pneumomediastinum. The air gradually spreads to the soft tissues of the neck, face, chest, and limbs, resulting in widespread subcutaneous emphysema. Conclusion: Spontaneous subcutaneous emphysema without known origin is a rare condition that may resolve by conservative treatment.

Post COVID-19 pulmonary fibrosis; a meta-analysis study.

Introduction; Pulmonary fibrosis is a frequently reported COVID-19 sequela in which the exact prevalence and risk factors are yet to be established. This meta-analysis aims to investigate the prevalence of post-COVID-19 pulmonary fibrosis (PCPF) and the potential risk factors. Methods; CINAHL, PubMed/MEDLINE, Cochrane Library, Web of Science, and EMBASE databases were searched to identify English language studies published up to December 3, 2021. Results; The systematic search initially revealed a total of 618 articles - of which only 13 studies reporting 2018 patients were included in this study. Among the patients, 1047 (51.9%) were male and 971 (48.1%) were female. The mean age was 54.5 years (15-94). The prevalence of PCPF was 44.9%. The mean age was 59 years in fibrotic patients and 48.5 years in non-fibrotic patients. Chronic obstructive pulmonary disease was the only comorbidity associated with PCPF. Fibrotic patients more commonly suffered from persistent symptoms of dyspnea, cough, chest pain, fatigue, and myalgia (p-value < 0.05). Factors related to COVID-19 severity that were associated with PCPF development included computed tomography score of ≥18, ICU admission, invasive/non-invasive mechanical ventilation, longer hospitalization period, and steroid, antibiotic and immunoglobulin treatments (p-value < 0.05). Parenchymal bands (284/341), ground-glass opacities (552/753), interlobular septal thickening (220/381), and consolidation (197/319) were the most common lung abnormalities found in fibrotic patients. Conclusion, About 44.9% of COVID-19 survivors appear to have developed pulmonary fibrosis. Factors related to COVID-19 severity were significantly associated with PCPF development.

Myocardial infarction following COVID-19 vaccine administration; a systematic review.

Introduction: Covid-19 vaccines have been assessed in randomized trials, which are designed to establish efficacy and safety, but are insufficient in power to detect rare adverse outcomes. Among the adverse cardiac events associated with mRNA COVID-19 vaccines are inflammations (e.g., pericarditis or myocarditis), thrombosis, and ischemia. Objective: This systematic review aims to evaluate the reported cases of myocardial infarction (MI) after COVID-19 vaccinations. Method: Web of Science, MEDLINE on OVID, PubMed, and Google Scholar were searched for English-language papers published until March 25, 2022. Results: This study included 15 papers (10 case reports and 5 case series). In total, 20 individuals were included who had received COVID-19 vaccines and experienced MI. Males (55%) reported more adverse occurrences than females (45%) across the majority of event categories. The mean time from the administration of the vaccine to the onset of symptoms was 2 days (0-10 days). The AstraZeneca vaccine was responsible for more than half of the reported events. In the majority of cases, the event developed after receiving the first dose of vaccination. Conclusion: MI related to COVID19 vaccination is a rare, but serious and life-threatening condition. Chest discomfort should be regarded as a warning sign, particularly in people who have been administered a dose of the vaccine within the previous two days.

Post COVID-19 pulmonary complications; a single center experience.

INTRODUCTION: Although the rate and severity of complications after coronavirus 2019 disease (COVID-19) resolution is currently unknown, evidence regarding their presence is increasing in the literature. This study presents a series of cases with post COVID-19 short-term pulmonary complications. METHODS: This is a single center retrospective case series study. The demographic and clinical data were collected from the center's electronic records. All the included cases were confirmed COVID-19 patients who had pulmonary complications even after their recovery. RESULTS: Nineteen COVID-19 patients were involved in this study. Fourteen of them were male (73.7%) and only 5 (26.3%) cases were female, with a mean age of 52.05 years (26-77). All of the patients developed severe COVID-19 and were admitted to intensive care unit (ICU). The average infection duration was 13.5 days (10-21). The most common complaints after recovery from COVID-19 were shortness of breath, fever, and hemoptysis. Computed tomography scan showed different pulmonary abnormalities between the cases. Different surgical procedures were performed for the patients according to their conditions, such as decortications, lobectomy, and bullectomy. More than half of the patients (n = 10) recovered and were discharged from hospital without complications, five patients were admitted to the ICU, 3 cases developed mucormycosis, and one case passed away. CONCLUSION: Following the resolution of COVID-19, patients may experience severe pulmonary complications that may last for months and can affect quality of life, ICU admission, or even death.