Non-tuberculous mycobacterial lung disease (NTMLD) is diagnosed in 3-6% of patients (pts) with predisposing chronic lung diseases such as COPD and cystic fibrosis. We reported previously the occurrence of NTMLD due to M. kansasii in 6/156 CTEPH pts (3.8%) treated in our centre from 2002 to 2008. The aim of the present study was to analyse the possible causes of NTMLD development in CTEPH pts. Methods: Clinical data, chest CT scans and hemodynamic variables of 156 CTEPH pts were analysed. Reconstructions were obtained to allow for better visualisation of lung density on chest CT scan. Results: Marked mosaic perfusion of grade 3-4 was significantly more frequent on CT scans in CTEPH pts who developed NTMLD in comparison to the others (100% vs 64%, p=0.024). Moreover NTMLD, described as focal consolidations with cavitation and satelite micronodules, developed in the areas of lung hypoperfusion. Pulmonary artery diameter on chest CT scan was 40 (36-42) mm in NTMLD pts comparing to 35 (26 -62) mm in the remaining ones (p=0.015). CTEPH patients with NTMLD were slimmer than the others: BMI were 23.4 (17.6-27.7) kg/m2 and 28.45 (15.6-55.1) kg/m2 respectively, p=0.039. NTMLD pts had also lower cardiac indexes and lower mixed venous blood oxygen saturation in comparison to the group without mycobacteriosis. Conclusions: Vascular pathology resulting in the areas of hypoperfusion within the lungs is probably the reason of growing susceptibility to NTMLD in CTEPH. This phenomenon might be responsible for local defence disturbances. The disease occurrence in younger and slimmer group of CTEPH pts is also observed.
The occurence of chylothorax is uncommon and usually is caused by trauma or neoplastic process of the mediastinum. Primary lymphatic lesions of the lungs are extremly rare. One of them is lymphangiomatosis—diffuse lesions characterized primarily by an increased number of complex anastomosing lymphatic channels in which dilatation is secondary phenomenon. These lesions can involve lungs, mediastinum and pleura. The prognosis for the patients with this disease limited to the thorax is guarded and progressive although some patients have realtively indolent course. We present 2 patients : 18-years old boy and 17-years old girl. admitted to hospital because of chylothorax. The diagnostic did could not allow to discover disruption of thoracic duct, even during thoracoscopy. In material taken from the pleura and mediastinum during exploratory thoracotomy—diffuse pulmonary lymphangiomatosis was found. CT examination of the chest revealed osteolysis of the spine. The girl died after 6 weeks from the first symptoms and boy is observed for 18 months with symptoms of progressive restrictive lung disease.
A 62-year-old, obese woman, smoking 10 pack/year was admitted to the National Tuberculosis and Lung Diseases Research Institute to diagnose small, round opacities revealed by routine chest X-ray examination. These lesions had been observed for 5 years. The patient had been treated for psoriasis, hypertension, and insulin-independent diabetes. On admission she was in good condition, complaining of a slight productive cough as well as intermittent osteoarticular pain. Physical examination revealed cutaneous psoriatic lesions, slight edema of the lower limbs, and clubbed fingers. Tuberculin test was positive. Chest Computer Tomography scanning showed partially calcified nodules (up to 1 cm in diameter) located in the middle and base areas of both lungs. No evidence of hilar nor mediastinal lymph node enlargement was seen. Lung specimens displayed intraalveolar and intravascular growth of neoplastic cells. Immunohistochemical expression of Factor VIII, CD31 and CD34 antigens was present. Pulmonary epithelioid haemangioendothelioma was diagnosed. After 6 months of observation, progression of the disease was shown. Interferon alpha treatment was introduced. During the therapy, a slight regression of pulmonary changes was noticed and since then stabilization of the disease was observed.
Interferon gamma releasing assays (IGRAs) are extensively used in the diagnosis of latent tuberculosis infections. Comparing to tuberculin skin test (TST) they lack false positive results in the populations vaccinated with BCG, and in most non-tuberculous mycobacteria (NTM) infections. Nevertheless, Mycobacterium kansasii, Mycobacterium marinum, and Mycobacterium szulgai may induce positive IGRAs due to RD1 homology with Mycobacterium tuberculosis. The aim of the study was to investigate the possible influence of NTM respiratory isolates on the results of IGRAs. 39 patients (23 females and 16 males) of median age 61 years, with negative medical history concerning tuberculosis, entered the study. Identification of NTM was performed using the niacin test and molecular method GenoType CM test (Hain Lifescience). QFT-Plus was performed in 17 patients, T-SPOT-Tb - in 23 patients. Chest X-rays and a high-resolution computed tomography of the chest have been reviewed by the experienced radiologist blinded to the results of IGRAs, in search of past tuberculosis signs. Positive IGRAs results were obtained in three out of 39 patients (8%): 22% of patients with M. kansasii isolates and 18% of patients with radiological signs on HRCT that might be suggestive of past tuberculosis. Positive IGRAs correlated with radiological signs suggestive of past tuberculosis (r = 0.32, p = 0.04), and on the borderline with isolation of M. kansasii (r = 0.29, p = 0.06). These findings may suggest that a positive IGRAs result, in our material, could depend mostly on asymptomatic past Tb infection. The cross-reactivity of M. kansasii isolates with IGRAs was less probable; nevertheless, it requires further investigations.Interferon gamma releasing assays (IGRAs) are extensively used in the diagnosis of latent tuberculosis infections. Comparing to tuberculin skin test (TST) they lack false positive results in the populations vaccinated with BCG, and in most non-tuberculous mycobacteria (NTM) infections. Nevertheless, Mycobacterium kansasii, Mycobacterium marinum, and Mycobacterium szulgai may induce positive IGRAs due to RD1 homology with Mycobacterium tuberculosis. The aim of the study was to investigate the possible influence of NTM respiratory isolates on the results of IGRAs. 39 patients (23 females and 16 males) of median age 61 years, with negative medical history concerning tuberculosis, entered the study. Identification of NTM was performed using the niacin test and molecular method GenoType CM test (Hain Lifescience). QFT-Plus was performed in 17 patients, T-SPOT-Tb – in 23 patients. Chest X-rays and a high-resolution computed tomography of the chest have been reviewed by the experienced radiologist blinded to the results of IGRAs, in search of past tuberculosis signs. Positive IGRAs results were obtained in three out of 39 patients (8%): 22% of patients with M. kansasii isolates and 18% of patients with radiological signs on HRCT that might be suggestive of past tuberculosis. Positive IGRAs correlated with radiological signs suggestive of past tuberculosis (r = 0.32, p = 0.04), and on the borderline with isolation of M. kansasii (r = 0.29, p = 0.06). These findings may suggest that a positive IGRAs result, in our material, could depend mostly on asymptomatic past Tb infection. The cross-reactivity of M. kansasii isolates with IGRAs was less probable; nevertheless, it requires further investigations.
In the Department of Medicine at the Institute of Tuberculosis and Lung Diseases 50 LGM inferior vena cava filters have been inserted since 1993. Indications for filters placement were as follows: recurrent pulmonary embolism (PE) despite anticoagulation-16 patients (pts), severe bleeding complications of thrombolytic or anticoagulant therapy-9 pts, contraindications for thrombolytic and/or anticoagulant treatment-3 pts, massive PE-6 pts, chronic thromboembolic-major vessel pulmonary hypertension (CTEPH)-18 pts, extensive deep vein thrombosis of lower limbs or vena cava inferior in patients with urgent indications for surgery-10 pts. In every patient diagnostic procedures were performed after 1, 3, 6, 12, 24 and 36 months of follow-up period. Only one non-fatal episode of recurrent PE was documented. Other complications were rare and insignificant. The LGM inferior vena cava filters are effective and safe in such selectively chosen group of patients.
Wstęp: W ostatnich latach w większości krajów Europy i w Stanach Zjednoczonych jest notowany wzrost częstości zakażeń układu oddechowego prątkami niegruźliczymi. Nie ma jednak zgodności opinii na temat wpływu różnych czynników na rozwój mykobakteriozy płuc w tej grupie chorych. Celem niniejszej pracy retrospektywnej było poszukiwanie czynników ryzyka mykobakteriozy płuc, w grupie chorych, u których wyhodowano prątki niegruźlicze z dróg oddechowych. Materiał i metody: Badaną grupę stanowiło 73 chorych, 23 mężczyzn i 50 kobiet, mediana wieku wyniosła 62.2 roku, z dodatnimi wynikami posiewów plwociny/wydzieliny oskrzelowej w kierunku prątków niegruźliczych, uzyskanymi w latach 2010–2015. Wyniki: Mykobakteriozę płuc (według American Thoracic Society/Infectious Diseases Society of America) rozpoznano u 36 chorych, kolonizację dróg oddechowych—w 37 przypadkach. Mykobakteriozę rozpoznawano istotnie częściej u chorych zakażonych M. kansasii, M. abscessus i M. avium/M. intracellulare w porównaniu z chorymi zakażonymi M. xenopi, M. gordonae i M. fortuitum (p < 0.0001). Wśród chorych na mykobakteriozę, w porównaniu z grupą z kolonizacją prątkami niegruźliczymi, było istotnie więcej kobiet niż mężczyzn (p < 0.007) oraz więcej chorych z wywiadem przebytej gruźlicy płuc lub mykobakteriozy (odpowiednio 28% i 8%, p = 0.038). Wykazano, że zakażenie M. kansasii, płeć żeńska oraz przebyta gruźlica lub mykobakterioza były istotnymi czynnikami predykcyjnymi aktualnego rozpoznania mykobakteriozy płuc. Wniosek: W badanej grupie chorych ryzyko zachorowania na mykobakteriozę było istotnie większe u kobiet, osób zakażonych M. kansasii oraz z przebytą gruźlicą lub mykobakteriozą płuc w przeszłości.
Fibrosing mediastinitis is a rare disease, mostly associated with previous granulomatous diseases, such as histoplasmosis, tuberculosis, or sarcoidosis. We present a case of 42-year-old woman with sarcoidosis, who had developed fibrosing mediastinitis and pulmonary hypertension. Contrast-enhanced computer tomography showed abnormal, bilateral, solid tissues surrounding the hila and mediastinum. Magnetic resonance imaging showed: abnormal, intermediate signal tissue in the mediastinum, surrounding hila, narrowing both lower lobe arteries and both lobe bronchi, left upper lobe atelectasis, and contrast enhancement of mediastinal infiltration. The patient was treated with steroids for 14 months (initial dose of prednisone was 1 mg/kg/day, then tapered) with clinical and radiological improvement. We reviewed the literature concerning fibrosing mediastinitis. The various causes of that disorder, the radiological manifestation, and possible treatment modalities are discussed. The causes of pulmonary hypertension in our patient are another aspect of the article. It could be associated with both the fibrosing mediastinitis and the sarcoidosis.
In the case of 53 years old woman LGM filter was inserted over renal veins. Indications for those procedures were: vena cava thrombosis in distal part of vena cava what not allowed to place filter below renal veins, malignancy, planned surgery, proximal deep vein thrombosis and past history of pulmonary embolism. Indications for suprarenal placement of vena cava filters and results of such as procedure were discussed.
Intraluminal caval filter placement can be applied in order to prevent pulmonary embolism. When surgery has to be performed in the patient with proximal deep venous thrombosis anticoagulant therapy should be reduced and filter placement is indicated. Temporary filter appears an interesting option, as it can be removed shortly after surgical intervention, when contraindications to anticoagulation no longer exist. However, obligatory removal of a temporary device in case of suspected filter or vena cava thrombosis emerges as a new clinical problem. We present a ease of 20 year old woman with proximal deep venous thrombosis and high risk of pulmonary embolism in whom temporary vena caval filter with heparin infusion were chosen as a method of perioperative pulmonary embolism prevention.
Benign metastasizing leiomyoma (BML) is a rare condition in middle-aged women with a history of uterine leiomyomata. It ischaracterized by the proliferation of, usually multiple, smooth muscle nodules. Approximately 100 cases have been reportedin the literature, and the lungs were the most common site of metastases.We report a case of 52-year-old obese woman (BMI 31), hospital worker, smoker, admitted to the hospital with exertionaldyspnoea, night sweats, loss of weight, and productive cough.Hysterectomy for a uterine leiomyoma was performed 9 years earlier. In addition, a history of two episodes of superficialvein thrombosis 3 and 2 years before admission was noted. Chest X-ray and subsequently CT chest examinations revealedmultiple, non-calcified nodules within the middle and lower parts of both lungs. Specimens obtained by transbronchialbiopsy (TBLB) and from open lung biopsy displayed benign muscle cell proliferation compatible with BML. The levels of sexhormones were characteristic for the menopause; therefore, observation was advised. Additionally, Streptococcuspneumoniae was cultured from bronchial washing, and bronchitis was diagnosed. Antibiotics, bronchodilators, andmucolytics were administered, and dyspnoea and cough with expectoration were diminished. Two years later pulmonarylesions have been stable; however, she has put on weight. Subsequently the patient has developed deep vein thrombosiswith pulmonary embolism. Anticoagulant treatment was introduced, with some improvement.
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