Severe localized re-expansion pulmonary oedema: An unusual instance.

A lobar re-expansion pulmonary oedema (REPO) after pleural drainage procedure is rare and usually asymptomatic. We report a 56-year-old man with severe left lower lobar REPO after tube thoracostomy drainage of a loculated hydro-pneumothorax of 2 days' duration with underlying chronic obstructive pulmonary disease. The clinical manifestations were immediate and disproportionate to the radiological extent of REPO. The severity of lobar REPO was probably related to the pre-existing emphysematous changes and airway obstruction. Supplemental oxygen and intermittent pleural drainage led to clinical recovery within 24 hours, followed by radiological clearance of alveolar opacities within 3 days.

Pneumonitis following diesel fuel siphonage.

Petroleum diesel is a complex mixture of liquid hydrocarbons and mainly used as fuel in transport vehicles. The practice of manual siphoning of diesel from fuel tanks is common in developing countries but hydrocarbon pneumonitis due to diesel siphonage is rarely reported. We report pneumonitis following diesel fuel siphonage in a 30-year-old driver. Initially patient had severe nausea and vomiting followed by chest pain and breathlessness after three days. In our case, induced sputum was diagnostic as against majority of cases where bronchoscopy was used as diagnostic tool. Recovery was complete with medical treatment.

Fatal re-expansion pulmonary oedema in a mechanically ventilated patient.

Fatal course of re-expansion pulmonary oedema (REPO) is infrequent and very rarely documented in mechanically ventilated patients. We report a case of fatal REPO following tube thoracostomy for a right-sided pneumothorax in an elderly patient of chronic obstructive pulmonary disease (COPD) with respiratory failure on mechanical ventilation.

Unusual complication of cervical tuberculous lymphadenopathy.

Lymphadenopathy is the most common form of extrapulmonary tuberculosis; cervical region being the most frequent site. Yet, tuberculous cervical lymphadenopathy is rarely associated with Internal Jugular Vein (IJV) thrombosis. We report right IJV thrombosis with isolated cervical tuberculous lymphadenopathy in a 22-year-old woman. Anti-tuberculous treatment resulted in complete regression of lymphadenopathy but anticoagulation treatment failed to restore the caliber of thrombosed IJV to normal. Thrombosis of adjacent IJV is a potential complication of delay in diagnosis and treatment of cervical lymphnode tuberculosis.

Unusual thoracic manifestation of metastatic malignant melanoma.

Massive pleural effusion due to metastatic malignant melanoma is rare. We report a case of bilateral (massive on left side) pleural effusion as a metastatic manifestation of cutaneous malignant melanoma. In our case, successful outcome of pleurodesis with vincristine is significant as this agent is rarely used.

Chronic thromboembolic pulmonary hypertension.

Chronic thromboembolic pulmonary hypertension (CTEPH) is an uncommon consequence of acute pulmonary embolism. We report CTEPH in a 58-year-old male who had pleurisy with a small haemorrhagic pleural effusion three months ago. The six-month course of anti-coagulation therapy failed to resolve thromboemboli completely or improve pulmonary hypertension. Computed tomographic pulmonary angiography (CTPA) is useful for the diagnosis as well as for the followup of chronic pulmonary thromboembolism.

Pulmonary nocardiosis due to Nocardia farcinica in a renal transplant recipient.

Nocardia farcinica is an infrequent cause of nocardiosis among the renal transplant recipients and it has not been reported so far from India. We report a case of pulmonary nocardiosis due to N. farcinica in a 32-year-old woman with hypothyroidism and post-renal transplant status, currently on immunosuppressive therapy (prednisolone, azathioprine and tacrolimus). The N. farcinica isolate was susceptible to trimethoprim-sulfamethoxazole (TMP-SMZ), linezolid, imipenem, gentamicin but resistant to ceftriaxone, ciprofloxacin, tobramycin, erythromycin, amoxycillin-clavulanic acid and tetracycline. Treatment with TMP-SMZ and linezolid resulted in marked clinico-radiological improvement but after two weeks both of the drugs had to be stopped due to severe pancytopenia as adverse effect of their use. Currently, the patient is on imipenem and remains stable after four weeks of treatment. In N. farcinica infections, multi antibiotic resistance and toxicity of some specific drugs enhances the risk of therapeutic failure in renal transplant recipients.

Paediatric tonsillectomy: parental experience and outcomes.

OBJECTIVE: To evaluate parental experience, satisfaction and outcomes following their child's tonsillectomy surgery. DESIGN: Structured postal questionnaire sent to the parents or guardians of 77 sequential children undergoing elective day-case tonsillectomy. SUBJECTS: Seventy-seven children with a mean age of 6.25 years (range three to 17 years) undergoing day-case tonsillectomy predominantly for recurrent acute tonsillitis, upper airway obstruction or a combination of these symptoms; 63.6 per cent of the parents or guardians of these children responded to the questionnaire. RESULTS: There was overall satisfaction with the operation, and positive health outcomes. CONCLUSIONS: Despite the current public health agenda to limit access to routine high volume operations such as childhood tonsillectomy on economic grounds, the users of this service rated the outcomes and benefits of the procedure highly.

Successful outcome of medical therapy in a case of acute massive pulmonary thromboembolism presenting with saddle thromboembolus.

Antemortem diagnosis of acute massive pulmonary thromboembolism (PTE) with a large thromboembolus at the bifurcation of the pulmonary trunk (saddle thromboembolus) is difficult, as most patients either die or are too ill for any diagnostic imaging. We report a case of massive PTE where constrast enhanced computed tomographic (CECT) scan of chest detected a saddle thromboembolus and showed its resolution with anticoagulant treatment. In our case, the presenting feature was unusual massive PTE as there was no haemodynamic instability or hypoxaemia.

Anaphylactic reaction due to paracetamol.

A 58-year old woman had anaphylactic reaction two hours after oral administration of paracetamol. She was treated conservatively and responded favourably. This incident is being reported as anaphylaxis to paracetamol which is rare. Whenever there is history of allergy to other non-narcotic analgesic drugs, paracetamol sensitivity should be tested under medical supervision.

Nocardial hydropneumothorax.

Pleural involvement in nocardiosis is rarely reported from India. A case of hydropneumothorax due to Nocardia asteroides in a patient with diabetes mellitus is reported. Tube thoracostomy drainage and therapy with trimethoprim-sulphamethoxazole for seven months prevented reaccumulation of pleural fluid and improved the general condition but failed to expand the lung. Bronchoscopy may be useful if multiple sputum examinations are negative in diagnosing pulmonary nocardiosis.

Re-expansion pulmonary oedema: revisited.

A case of re-expansion pulmonary oedema (RPO) following chest tube insertion for left spontaneous pneumothorax is reported. There were no severe symptoms and routine chest radiograph done four hours after tube thoracostomy showed features of pulmonary oedema in the re-expanded left lung. RPO is an uncommon complication of rapid pleural drainage of air or fluid with potentially serious cardiopulmonary manifestations but appears to run a benign course if there is no prior systemic hypoxaemia and if pneumothorax is drained without suction. Chest radiograph should be done routinely within four hours after chest tube insertion for early detection of RPO.