Introduction: Cardiac involvement, particularly myocardial infiltration in primary mediastinal lymphoma, is a rare occurrence with an incidence of only 9% in known cases of primary malignancy. Neoplasm infiltration into the myocardium manifests through direct invasion, hematogenous spread, transvenous invasion through the great veins, or lymphangitic spreading in the mediastinal. Myocardial infiltration in lymphoma presents a grim prognosis and its treatment may be associated with specific risks, such as myocardial rupture. Various imaging modalities may detect cardiac involvement, with cardiac magnetic resonance (CMR) imaging considered the gold standard. CMR enables clear delineation of myocardial infiltration, making it valuable for local staging, pretreatment planning, and evaluating treatment response. Case Presentation: : A 37-year-old woman patient was diagnosed with primary mediastinal large B-cell lymphoma. Mild chest discomfort and shortness of breath were observed 3 months before hospital admission. A thorax CT scan showed a heterogeneous contrast-enhancing mass with a central necrotic area in the anterior mediastinum. Following thoracotomy and tumor debulking, the patient complained of severe crushing chest pain radiating to her back, accompanied by new T wave inversion on ECG and elevated cardiac troponin levels a week after surgery. Coronary angiogram results showed a normal coronary artery. Subsequent cardiac MRI showed tumor infiltration into the anterior pericardial space, as well as the myocardium of the left and right ventricles. Chemotherapy was promptly initiated, resulting in a gradual improvement of symptoms. Conclusions: In this study, we discuss the use of 3D-CRT in the re-irradiation of NPC with its limitation on obtaining optimum dose sculpture compared to more sophisticated and widely spread modalities like IMRT. However, with careful planning, we can still obtain optimum tumor dose, minimize OAR dose, and subsequently late toxicities that come after. We hope that this study can bring hope to centers with limited facilities, and we suggest further studies on reirradiation, especially in OAR dose tolerance guidelines.
Background: Pulmonary sequestration is a very rare congenital abnormality of the lung, which was responsible for 0.15-6.4% of all cases of congenital lung formation disorders. Pulmonary sequestration is often seen as recurrent pneumonia, accompanied by complaints of chest pain, shortness of breath and hemoptysis. Conventional angiography is the gold standard for diagnosing pulmonary sequestration and for demonstrating arterial supply and venous drainage. The optimal therapy for pulmonary sequestration is operative resection to avoid infection and damage to the lung parenchyma. Case Report: We reported a case of 43-years old-male with pulmonary sequestration, previously diagnosed with a lung tumor with massive left pleural effusion and pneumonia. A series of diagnostic tests found no malignant cells. During FNAB with CT scan guiding, we found an image of a fungus ball, thus, he was diagnosed with Aspergillosis. The patient was planned to undergo VATS. There were complications during the operation, thus, a lobectomy with an open thoracotomy was performed, and an arterial anomaly was found from the abdominal aorta. The operation was successful and the patient was able to carry on with his normal activities.Conclusion: Establishing a definite diagnosis of pulmonary sequestration is very difficult, and in this case, it was done through lobectomy with thoracotomy and through a multidisciplinary approach.
Mediastinal lymphohemangioma is a very rare, benign, congenital malformation. Mediastinal lymphohemangioma originates from local proliferation of lymphatic vessels. This disorder is accountable for 4.5% among all mediastinal tumors. Most lymphohemangiomas are found in the neck and axillary region among children, whereas only 1% are found in the mediastinum and tend to occur in individuals aged over 20 years old. A proper understanding is needed to be able to make a diagnosis and perform effective management of mediastinal lymphohemangiomaIn this case report, a woman with a diagnosis of mediastinal lymphohemangioma, established through a multidisciplinary approach covering the fields of pulmonology, thoracic and cardiovascular surgery, radiology, and anatomical pathology.Keywords: Mediastinal Lymphohemangioma, Core Biopsy, Thoracotomy
Tuberculosis is a contagious disease and is one of the ten leading causes of death in the world. Abnormalities in the hematology system, such as anemia, become one of the complications due to tuberculosis infection. The erythrocyte index becomes a benchmark for determining anemia based on its size and appearance. In tuberculosis patients, tuberculosis lesions can be seen in a thorax radiography examination. Therefore, the objective of this study was to determine the correlation between the erythrocyte index and the extent of tuberculosis lesions in thorax radiography. This study was an observational study using the cross-sectional method by taking 61 samples of patients' medical records in Saiful Anwar Hospital, which was conducted from January 2022 to December 2023. In this study, data obtained that MCV, MCH, and MCHC, which included in erythrocyte index value, did not have a correlation with the extent of tuberculosis lesion (p=0.656, p=0.484 and p=0.953, respectively, using Kruskal Wallis method). This could occur because tuberculosis patients only experienced anemia with a reduced number of erythrocytes without affecting their size and appearance. The conclusion of this study is that the erythrocyte index does not have a correlation with the extent of tuberculosis lesions.
Congenital pulmonary airway malformation, formerly known as congenital cystic adenomatoid malformation, is a heterogeneous group of cystic and non-cystic pulmonary lesions marked with the overgrowth of primary bronchioles, which is associated with an abnormal bronchial tree that does not have cartilage. A 4-month-old boy came with a complaint of productive coughs since he was 3 weeks old, fever since the age of 2 months, and shortness of breath. The patient was once hospitalized due to pneumonia and suspected tuberculosis. After undergoing serial chest radiographs, the results showed multiple cysts that were dominant in the lower lobe of both lungs with surrounding infiltrates. Through the confirmation of a chest CT scan, there were small, multiple cysts with a size of <2 cm in both lungs, connected to the bronchial branch, accompanied by consolidation with an air bronchogram suggestive of type 2 congenital pulmonary airway malformation. Congenital pulmonary airway malformation is a rare case that usually requires serial chest radiographs to assist in the establishment of its diagnosis and a CT scan for a definitive diagnosis of its lesions. Keywords: CPAM, congenital, pulmonary malformation, imaging
Background: Lung cancer is the most common cause of cancer-related death globally. Moreover, metastatic cancer from the lungs frequently occurs and is commonly identified at the first diagnosis. The primary cancer must be identified in order to establish the most effective treatment. However, colonic metastases are rare with incidence of 0,1%.
Aim: This report describes an unusual case of colonic metastases from lung adenocarcinoma.
Methods: Patient (58-year-old male) was examined with Fiber Optic Bronchoscopy and core biopsy in the lungs, and the results were suspicious for squamous cells. The patient had severe abdominal pain and bloating for 1 week and had signs of gastrointestinal obstruction in his second visit. The result of urgent laparotomy was adenosquamous and the result of immunohistochemical examination was negative P40 and positive Napsin A in both lungs and colon.
Results: The lung biopsy result indicated squamous cell and the ceccum showed adenosquamous. The immunohistochemical examination using P40 and Napsin A of both lung and ceccum specimens indicated that the lung was the primary source of metastases to the colon.
Conclusion: The patient suffered from a squamous cell lung tumor and reported severe abdominal pain due to metastases to the colon with adenosquamous results.
Tuberculosis is a contagious disease and is one of the ten leading causes of death in the world. Abnormalities in the hematology system, such as anemia, become one of the complications due to tuberculosis infection. The erythrocyte index becomes a benchmark for determining anemia based on its size and appearance. In tuberculosis patients, tuberculosis lesions can be seen in a thorax radiography examination. Therefore, the objective of this study was to determine the correlation between the erythrocyte index and the extent of tuberculosis lesions in thorax radiography. This study was an observational study using the cross-sectional method by taking 61 samples of patients' medical records in Saiful Anwar Hospital, which was conducted from January 2022 to December 2023. In this study, data obtained that MCV, MCH, and MCHC, which included in erythrocyte index value, did not have a correlation with the extent of tuberculosis lesion (p=0.656, p=0.484 and p=0.953, respectively, using Kruskal Wallis method). This could occur because tuberculosis patients only experienced anemia with a reduced number of erythrocytes without affecting their size and appearance. The conclusion of this study is that the erythrocyte index does not have a correlation with the extent of tuberculosis lesions.
Aspergilloma is a mass-like fungus ball consisting of Aspergillus fumigatus. Aspergilloma occurs in patients with pulmonary structural abnormalities in which the presence of a previous cavity is the predisposing factor that most often results in Aspergillus colonization, especially in tuberculosis endemic countries. 28 y.o and 33 y.o female , complained of hemoptysis, chest pain, weight loss, and a history of TB treatment. The chest X-ray and CT scan revealed a solid lesion with an “Air-crescent sign†indicating Aspergilloma lesion. Patients were given symptomatic, anti-fungal drugs, and supported by embolization procedure to reduce hemoptysis. The patient's condition began to improve after treatment. Imaging findings in x-rays and CT scans that point to Aspergilloma will help doctors in further management to provide a better prognosis for the patient.
Background: Leptomeningeal disease occurs in 3-5% of patients with lung cancer, mainly adenocarcinoma subtype. Adenocarcinoma is the most common histological finding in Asian women.
Case: A 51-year-old woman with right-sided bronchogenic adenocarcinoma T4N3M1c Std IVB mutation(+) developed decreased vision, severe bilateral sensorineural deafness and psychiatric disorders after receiving Gefitinib 15 months. There was no evidence of brain metastasis from brain MRI. From evaluation of chest CT-scan, we found the disease was progressive and no Mutation Detected from ctDNA, so Gefitinib was discontinued.
Conclusion: We found some difficulties in evaluating side effects of therapy and disease progression due to patient's condition in the form of decreased total vision, severe sensorineural deafness, and psychiatric disorders. However, because no radiological evidence of brain metastases was found, we suspect this patient suffered from leptomeningeal disease.
Keywords: Lung Cancer, Adenocarcinoma, Gefitinib, Leptomeningeal Disease
Introduction : Chylothorax is an uncommon medical condition caused by the accumulation of chylous fluid in the pleural space. Chylothorax has no predilection for sex or age. The prevalence after various cardiothoracic surgeries is 0.2% to 1%. Mortality and morbidity rates are around 10%. Respiratory distress may occur due to compression of the lung by the accumulated fluid. Management and approaches to treating the condition require multidisciplinary therapy, starting from non-pharmacological, pharmacological, to interventional management. Case Report : A 57-year-old Man patient was referred to the emergency room with chief complaint of shortness of breath. Reduced breathing sound on both lung fields. No previous history of cancer or thoracic surgery were found. X-ray examination had found bilateral pleural effusion. Thoracocentesis and pleural fluid analysis was performed with total of 6800 cc serosanguinous, whitish fluid was extracted from both of the lung. The patient was diagnosed with chylothorax. Lymphangiography and embolization was performed on the leak on left thoracic duct (T10) from right lymph node. Antibiotic was also given to treat the community acquired pneumonia that could be one of the possible etiology on this patient. Dietary modification with low fat diet and Ocreotide was also given to this patient as one of the treatment modalities. Discussion : The diagnosis of Chylothorax on this patient was established based on pleural fluid analysis and evidenced by lymphangiography examination by the presence of a leak in the thoracic lymphatic duct. Various modalities to diagnose this condition have been carried out with inconclusive results. Non-pharmacological, pharmacological and radiological interventions with embolization through lymphangiography are proven to be able to stop leaks and reduce symptoms in this patient. Conclusion : Chyle leak to the pleural space may compress the lung and cause respiratory distress. Combinaton of thoracocentesis, embolization of the leakage, dietary intake modification and administration of ocreotide may help prevent further chylous fluid accumulation.
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