Spinal muscular atrophy (SMA) type 2 is a neuromuscular disorder of childhood with high morbidity and mortality caused by the deletion of SMN1 gene (gene 1 of motor neuron survival), located at chromosome 5. It is the respiratory complications that account for the majority of deaths in SMA. This report describes an 18-year-old male patient diagnosed with SMA type 2, who had shortness of breath for 2 weeks and cough for 1 week. CT-Thorax revealed left lung collapse due to mucoid impaction in the left main bronchus. Bronchoscopy was challenging in this case due to severe kyphoscoliosis, and impacted mucus was extracted using bronchoscopy-guided forceps biopsy. Repeat X-ray of the chest following treatment showed no evidence of collapse, and patient was discharged in a stable condition with mucolytics and antibiotics.
Follicular dendritic cell sarcoma is a rare low grade malignant neoplasm that arises from follicular dendritic cells in lymphoid tissue germinal centres and accounts for 0.4% of all soft tissue sarcomas. It is extremely rare to have pulmonary follicular dendritic cell sarcoma with endobronchial extension and as an anterior mediastinal mass with mediastinal lymph node involvement. We present the case of a 34-year-old male non-smoker who had been experiencing chest pain for three months. A lobulated left peri-hilar mass with endobronchial spread into the left main bronchus and mediastinal lymphadenopathy was identified on a chest CT. The bronchoscope-guided cryobiopsy of the endobronchial mass was inconclusive. After a thorough multidisciplinary discussion, the patient underwent left sided pneumonectomy, mediastinal mass resection, and systematic lymph node dissection. Histologic examination using immunohistochemistry revealed follicular dendritic cell sarcoma.
Pulmonary tuberculosis has diverse clinical presentations. Cysts in the lung can arise due to large number of causes out of which tuberculosis is very rare. We report two immunocompetent cases of pulmonary tuberculosis who presented with multiple cysts in the lung parenchyma. The diagnosis was confirmed by the transbronchial lung cryobiopsy in first case and by analysis of bronchoalveolar lavage fluid in the second. Both had spontaneous pneumothorax which was treated with chest drain and pleurodesis. Both showed an excellent response to anti-tubercular therapy and steroids. Tuberculosis presenting as cystic lung disease is atypical and rare.
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