SummaryFive cases of documented traumatic herniated nucleus pulposis are presented all occurring within the cervical region. The incidence of herniated disc in cervical spinal cord injury is O· 7° o. The incidence of herniated disc in bilateral facet dislo cations is 2·3°0. The common features are radicular pain, incomplete syndrome, and bilateral facet dislocations. A routine myelogram is the most helpful test to establish the diagnosis.

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Erdheim-Chester disease (ECD) is a very rare disorder with only approximately 600 cases reported in the literature. ECD has been recently reclassified as a histiocytic dendritic cell neoplasm. The clinical spectrum ranges from asymptomatic tissue accumulation of histiocytes to invasive tissue infiltration, which can cause fulminant multisystem failure. It typically presents with bone pain and constitutional symptoms. Extraosseous manifestations are not uncommon. ECD-associated interstitial lung disease has been described in 20%-35% of patients. Diagnosis is primarily by tissue biopsy and immunohistochemistry showing xanthogranulomas composed of foamy histiocytes that stain positive for CD68, CD14 and CD163 and negative for CD1á and langerin. We report a case of ECD in a young man with cardiopulmonary involvement who presented with haemoptysis and dyspnoea.

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INTRODUCTION: Concurrent chemoradiation therapy (CCRT) is the standard of care for inoperable locally advanced nonsmall cell lung cancer (NSCLC). Intensity modulated radiation therapy (IMRT) is an advanced radiation delivery technique that customizes radiation dose distribution effectively reducing the dose to adjacent normal tissue. Rarely does this modality cause toxicity beyond esophagitis and pneumonitis. 1 This is a case of a patient who received IMRT and subsequently acquired a fatal bronchoesophageal fistula (BEF). CASE PRESENTATION: A 51-year-old woman with a history of lung adenocarcinoma, T4N3M1, presented with nausea and vomiting with oral intake. She also reported fever, dyspnea, and right-sided chest pain. Patient was undergoing CRT with weekly carboplatin and paclitaxel. At the time of presentation, she had received 9 cycles of chemotherapy and 52 Gy of IMRT targeting her mediastinal mass. Physical exam was remarkable for tachycardia, tachypnea and diffuse rales. CT thorax showed a thickwalled air collection posterior to the right mainstem bronchus (RMB) with marked consolidation of the right lung. Patient was treated with antibiotics and underwent fiberoptic bronchoscopy that revealed necrotic RMB with absent posterior wall and no definable distal anatomy. Subsequent esophagogastroduodenoscopy showed an esophageal perforation with direct communication into the mediastinum and RMB. Anatomy was not amenable to stenting and patient subsequently expired after family decided to pursue comfort measures. DISCUSSION: CCRT has been the preferred modality of treatment for inoperable locally advanced NSCLC for years given its survival benefits. However, this does come with increased risk of esophageal toxicity. Patients with gastrointestinal symptoms and persistent infiltrates must be evaluated to ensure absence of a BEF. This case highlights that further investigation is warranted into optimal treatment duration, dose, and fraction schedules to limit severe toxicity in this patient population. CONCLUSIONS: The formation of a BEF following concurrent CRT, though rare, can be a devastating and lethal event. As new technology in radiation therapy emerges, this case underscores the continued vigilance that must be sought in identifying patient and tumor specific characteristics that predict adverse outcomes.