Pulmonary agenesis is defined as the complete absence of one or both lungs, including the bronchi, bronchioles, vasculature and lung parenchyma. Most of these malformations are detected in early childhood. A residual number remains asymptomatic and undiagnosed until adulthood. The clinical presentation is wide, ranging from asymptomatic to respiratory complaints like dyspnoea, respiratory distress and a history of recurrent lung infections. This case presents a 54-year-old woman with complaints of coughing, dyspnoea for medium exertion and wheezing for a couple of months. Based on the results of complementary diagnosis methods, right pulmonary agenesis was diagnosed without other malformations. Simultaneously, an asthma diagnosis was also performed. The treatment of pulmonary agenesis is symptomatic. Simultaneous cardiovascular malformations could require surgical interventions. This case demonstrates that pulmonary agenesis may remain undiagnosed, be identified incidentally, and have a good and long prognosis.
Anti-TNF agents, namely adalimumab, are safe drugs that represent an important arsenal in the treatment of immune-mediated inflammatory diseases. “Paradoxical effects” have been described with their use. A sarcoidosis “like” reaction induced by these agents is rare and is characterized by a systemic granulomatous reaction indistinguishable from sarcoidosis. We present a 55-year-old male patient, with axial spondyloarthritis, treated with with adalimumab. About 17 months under this therapy, he complained of dry cough and wheezing. Chest CT showed a peri-lymphatic and pericisural micronodular pattern and hilo-mediastinal lymph nodes, suggestive of sarcoidosis. Angiotensin converting enzyme was increased. Assuming the hypothesis of a sarcoidosis-like reaction secondary to adalimumab this therapy was discontinued with progressive improvement in the patient's complaints and in the radiological changes.
Benign metastasizing leiomyoma is a rare disease occurring mainly in premenopausal women with a history of uterine leiomyoma, which is most commonly characterized by pulmonary metastases. The pathogenesis of this condition is poorly understood. Usually patients are asymptomatic or present unspecific symptoms. Pathological examination combined with immunohistochemistry is essential for the diagnosis. Treatment depends on the age, hormonal status, symptoms and extent of the lesions, with surgical resection being the most effective treatment. We report the case of a 72-year-old woman with a history of total hysterectomy due to myomas 30 years earlier that presented persistent dry cough. Her chest computed tomography revealed multiple small nodules in the pulmonary parenchyma. Given the small dimensions and difficult accessibility of the nodules, surgical biopsy was made for histopathological examination and immunohistochemical staining, which were compatible with metastasizing leiomyoma. Treatment with letrozole was initiated and well tolerated.
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