Hydatid Cyst Presenting With Endobronchial Rupture.

Diagnosis of lung hydatidosis becomes difficult with unusual radiographic findings especially with rupture of hydatid cyst. Here we present the case of a patient who presented with hydatid cyst with endobronchial rupture. A 40-year-old woman presented with a 3-year history of cough with mucoid expectoration, breathlessness on exertion, intermittent fever and leftsided chest pain. Chest radiograph and computed tomography of chest showed a mass obstructing the left main bronchus and post-obstructive cavity formation. Fluorodeoxyglucose positron emission tomography (FDG-PET) showed uptake [maximum standardised uptake value (SUVmax) 2.5 G/mL) in left lower lobe cavity. Fibreoptic bronchoscopy showed obstruction of the left main bronchus with white gelatinous material. After the bronchoscope was withdrawn, the patient expectorated large quantities of this material. Histopathological examination of the aspirated membrane showed laminated acellular layer and focal inner germinal layer suggestive of hydatid cyst.

Hypersensitivity Pneumonitis Following Exposure to Lovebirds.

A 54-year-old man was referred for evaluation of respiratory symptoms of cough and breathlessness of 4 years. The symptoms had a temporal relationship with keeping lovebirds (Agapornis roseicollis) as pets. His vital parameters were within normal limits. Physical examination revealed clubbing, exercise desaturation and bilateral bibasilar crackles on chest auscultation.

Primary achalasia with pneumoesophagus and bronchopleural fistula causing right lung collapse and bronchiectasis.

A 35-year-old male non-smoker, presented with a history of recurrent respiratory tract infections, associated with intermittent haemoptysis and haematemesis since childhood. His vital parameters were normal with pulse oximetry saturation of 97% on room air. On physical examination, clubbing was observed. Chest auscultation revealed tubular type of bronchial breath sounds over the right hemithorax.

Pneumoconioses.

Occupational lung diseases are caused or made worse by exposure to harmful substances in the work-place. “Pneumoconiosis” is the term used for the diseases associated with inhalation of mineral dusts. While many of these broadspectrum substances may be encountered in the general environment, many occur in the work-place for greater amounts as a result of industrial processes; therefore, a range of lung reactions may occur as a result of work-place exposure. Physicians in metropolitan cities are likely to encounter pneumoconiosis for two reasons: (i) patients coming to seek medical help from geographic areas where pneumoconiosis is common, and (ii) pneumoconiosis caused by unregulated small-scale industries that are housed in poorly ventilated sheds within the city. A sound knowledge about the various pneumoconioses and a high index of suspicion are necessary in order to make a diagnosis. Identifying the disease is important not only for treatment of the individual case but also to recognise and prevent similar disease in co-workers.

Doughnut sign on FDG-PET scan in a ruptured lung hydatid cyst.

A 13-year-old girl, complained of fever and cough with mucoid expectoration associated with episodes of streaky haemoptysis. Past history was not significant. On examination vital signs were normal with a pulse oximetry saturation of 98 percent. Chest examination revealed decreased breath sounds in the left mammary and infra-mammary area.

Pulmonary rehabilitation in resource poor settings.

Pulmonary rehabilitation is an important component in the management of chronic obstructive pulmonary disease (COPD) and other chronic respiratory diseases. The goal of rehabilitation is to evaluate various systems, treat optimally, improve dyspnoea and health-related quality of life. It is a multi-disciplinary approach and involves a physician, a psychiatrist, a dietician and a physiotherapist. However, in a resource-poor setting, even an experienced physician alone may suffice. Exercise training is the backbone of pulmonary rehabilitation, which may be hospital-based or home-based. Though, the previous trials have shown benefit with hospital-based rehabilitation, several recent studies have demonstrated significant improvement in the 6-minute walk test and quality of life even with unsupervised, home-based pulmonary rehabilitation. In the resource-poor settings, the goal of rehabilitation may be achieved by incorporating regular unsupervised exercise in daily routine. This is not only better accepted and more suitable but is also more feasible for the lifelong maintenance of rehabilitation.

Ambulatory chest drainage.

Chest drainage is usually performed using the underwater drain consisting of re-usable glass units attached to the intercostal tube. Ambulatory chest drainage devices that use a mechanical one-way valve are an alternative to the traditional underwater drain. These devices consist of the flutter valve, flutter bags, chest seals and stoma bags. They are less bulky and allow the patient to be ambulatory, thus, reducing the risk of complications from immobility. Recent evidence shows that the ambulatory devices may be safe and effective for treatment of both pneumothorax and pleural effusion and even in out-patient care.

Rayon lung in a non-flocking industry worker.

We report a case of a 65-year-old male working in a rayon (synthetic fibre) manufacturing industry who developed interstitial lung disease. The diagnosis was established by thoracoscopic lung biopsy.

Chronic obstructive pulmonary disease: knowing what we mean, meaning what we say.

Chronic obstructive pulmonary disease (COPD) is defined in several different ways using different criteria based on symptoms, physiological impairment and pathological abnormalities. While some use COPD to mean smoking related chronic airway disease, others include all disorders causing chronic airway obstruction. When COPD is used as a broad descriptive term, specific disorders that cause chronic airway obstruction remain under-diagnosed and the prevalence estimates vary considerably. The lack of agreement over the precise terminology and classification of COPD has resulted in widespread confusion. Terminology includes definition, diagnostic criteria, and a system for staging severity. Recently, COPD is defined more clearly and diagnosed using precise criteria that include tobacco smoking greater than 10 pack years, symptoms and airway obstruction on spirometry. A multi-dimensional severity grading system, the BODE (body mass index, obstruction, dyspnoea, and exercise tolerance) index has been designed to assess the respiratory and systemic expressions of COPD. This review proposes that the broad group of chronic disorders of the airways (with or without airway obstruction) be called chronic airway disease (CAD). The term COPD should be used exclusively for tobacco smoking related chronic airway disease. Chronic airway obstruction or obstructive lung disease may be used to define those conditions with airways obstruction caused by factors other than tobacco smoking. The aetiology may be appended to the label, for example, chronic airway obstruction/obstructive lung disease associated with bronchiectasis, chronic airway obstruction/obstructive lung disease associated with obliterative bronchiolitis or chronic airway obstruction/obstructive lung disease due to biomass fuel/occupational exposure.