ABSTRACT
Mycetoma is defined as a fungus ball that fills a preexisting lung cavity, most frequently being of tuberculous or sarcoid etiology. The most frequently isolated fungus is the species of Aspergillus, but other fungi such as Fusarium or Zygomycetes can also be present. Most patients lack symptoms. However, presentation may also be with hemoptysis, which can be massive and life-threatening. We describe the case of a 50-year-old man with a history of prior pulmonary tuberculosis, with recurrent episodes of cough and hemoptysis. He was diagnosed to have mycetoma in the left upper lobe cavity. The mycetoma was extracted through bronchoscopy under general anesthesia using a cryoprobe. Treatment was completed with amphotericin B instilled in the cavity and the patient was placed on oral itraconazole. This is the first case report to date in which cryotherapy was used to remove a mycetoma.
Subject(s)
Bronchoscopy/methods , Cryotherapy/methods , Fusariosis/therapy , Lung Diseases, Fungal/therapy , Mycetoma/therapy , Amphotericin B/administration & dosage , Amphotericin B/therapeutic use , Antifungal Agents/administration & dosage , Antifungal Agents/therapeutic use , Cough/diagnostic imaging , Cough/therapy , Fusariosis/diagnostic imaging , Fusariosis/physiopathology , Hemoptysis/diagnostic imaging , Hemoptysis/etiology , Hemoptysis/therapy , Humans , Instillation, Drug , Lung Diseases, Fungal/diagnostic imaging , Lung Diseases, Fungal/physiopathology , Male , Middle Aged , Mycetoma/diagnostic imaging , Mycetoma/physiopathology , Radiography , Recurrence , Tuberculosis, Pulmonary/complicationsABSTRACT
We describe the use of an endoscopy face mask with a perforated membrane, which allows a nasogastric tube for continuous noninvasive ventilation in acute hypercapnic respiratory failure, in 2 patients who developed gastric distention. This interface was able to avoid most nonintentional leaks through the mask, as compared with a conventional approach, improving ventilation efficiency. To our knowledge, this is the first case report of an endoscopy face mask used in noninvasive ventilation for this specific side effect.