Serial lobar lung lavage in pulmonary alveolar proteinosis.

Pulmonary alveolar proteinosis (PAP) is a rare disease with worldwide distribution and an estimated incidence of 0.36 cases per million. We report a case of a PAP coexisting with Pneumocystis jiroveci pneumonia and Mycobacterium tuberculosis infection. The patient was treated with serial lobar lung lavages, GM-CSF, cotrimoxazole, and antituberculosis drugs. His PaO2 on room air improved from 45.7 to 63.8 torr and pulmonary functions normalized (FVC 81.2%, FEV1 95.3%, FEV1/FVC 91.8). A high-resolution computed tomography scan of the thorax showed clearing of both lower lobes. Whole-lung lavage is used in the treatment of PAP, but it may worsen the hypoxemia and lead to hemodynamic instability during the procedure. To the best of our knowledge, there are no reports of bronchoscopic serial lobar lung lavages in cases of PAP performed in India. This method can be performed in bronchoscopic suites having general anesthesia facilities without the requirement of special gadgets.

Intracardiac thrombi in extracardiac disorders: an autopsy study.

INTRODUCTION: Intracardiac thrombi (ICT), more commonly encountered at autopsy, are well documented with underlying cardiovascular disease. Occurrence of ICT in systemic diseases without an intrinsic cardiac disorder is rare. The aim of this autopsy study was to highlight such an occurrence. METHODS: From 1996 to 2010, cases with ICT unrelated to primary cardiac disorders were selected at autopsy and analyzed. Clinical and investigational data were obtained from the medical records. The location, morphology, size, and histological appearance of the thrombi were noted. The thrombi were then classified on the basis of their location, nature, and histology (fresh and/or organized); this was correlated with the clinical setting. RESULTS: Among a total of 11,724 autopsies performed in 15 years, 276 patients (2.4%) had ICT. Of these, 45 patients (0.4%) had ICT that were unrelated to primary cardiac diseases. There were 25 men and 20 women with a mean age of 46.1 years. Antemortem diagnosis was not made in any of these patients. Eight patients each (35.6%) showed isolated left-sided and multichambered involvement, while the rest of the hearts (64.4%) had thrombi in the right-sided chamber(s). The recognizable risk factors were underlying cancers (24.4%), prolonged immobilization (20%), systemic lupus erythematosus (6.7%), pregnancy (4.4%), nephropathy (4.4%), primary antiphospholipid antibody syndrome (2.2%), and ulcerative colitis (2.2%). However, 16 patients (35.7%) had no obvious predisposing factor, although investigations for prothrombotic markers had not been done. Diabetes mellitus, chronic alcoholism, and deep vein thrombosis of the lower limbs had been clinically documented in some of them. The cause of death in most patients (73.3%) had been related to pulmonary and/or systemic thromboembolism. CONCLUSIONS: This autopsy study emphasizes the great need for a higher index of suspicion of in situ thrombosis in the heart in hypercoagulable states so as to curtail the morbidity and mortality of the primary disease process.

Rhabdomyoma of the right atrium: report of a case.

Rhabdomyomas are the most common primary cardiac tumors in childhood, and are considered to be congenital lesions. They are uncommon in adolescents and adults due to their tendency for spontaneous regression. Majority of them are located in the ventricular chambers, and are also associated with tuberous sclerosis. The indications for surgery include hemodynamic compromise and intractable arrhythmias. We describe a right atrial rhabdomyoma in a previously healthy 16-year-old girl who presented with palpitation and dizziness of recent onset. Postoperative evaluation had not revealed stigmata of tuberous sclerosis.

Cardiovascular lesions in leptospirosis: an autopsy study.

OBJECTIVES: Leptospiral involvement of the cardiovascular system often remains an under-estimated critical clinical factor. This report studied the cardiovascular changes in fatal cases of leptospirosis in Mumbai city, India in the year 2005. METHODS: This is a year's retrospective study of autopsied cases of leptospirosis, selected on the basis of clinical criteria. The demographic details, clinical presentation, and investigations were noted. Detailed gross examination of the cardiovascular system was carried out and multiple sections were taken. RESULTS: Forty-four cases of leptospirosis in the year 2005 formed 3.52% of the autopsies performed. The highest number of cases (25 patients) was seen in the month of August that corresponded to the deluge on the 26th of July. The majority (86%) were adults; all presented as acute febrile illness that terminated with severe respiratory insufficiency. Involvement of the cardiovascular system was found in 41 cases, an incidence of 93.2%. Clinical evidence of cardiac affection was not noted in most. Gross cardiac features noted were cardiomegaly and petechiae in one or more layers. The predominant feature on histopathological examination was the presence of interstitial myocarditis (100% of cases), with involvement of the epicardium/endocardium (39%), valves (36%), coronary arteries (51%) and aorta (56%). CONCLUSIONS: Correlating the autopsy, leptospirosis can be visualized as an infective systemic vasculitis. The unusual manifestation of pulmonary hemorrhagic syndrome in these cases camouflaged the cardiovascular involvement.