No abstract

The following report outlines the case of a 76-year-old gentleman who presented to the hospital with acute interstitial pneumonitis, a rare and rapidly progressive type of idiopathic interstitial pneumonia. The patient initially presented with a three-week history of progressive shortness of breath and cough which was subsequently diagnosed as community acquired pneumonia. Treatment with oral antibiotics was unsuccessful resulting in re-presentation the following week with type one respiratory failure (hypoxemia without hypercapnia). Investigations revealed widespread inflammatory changes consistent with an acute inflammatory process -neutrophilia, elevated D-dimers, raised C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), as well as bilateral interstitial infiltrates on chest radiograph. Intravenous steroids, antibiotics and antiviral medications were initiated before an urgent transfer to the intensive care unit was required for intubation. An open lung biopsy, in conjunction with the clinical picture, confirmed the diagnosis of acute interstitial pneumonitis. The significance of this report is to highlight the rapid and destructive clinical course of a rare type of pneumonitis, which initially presented as a routine and innocuous diagnosis in our patient.

The following report describes the case of a 43-year-old male smoker that was referred to the rapid access lung clinic with haemoptysis, chest pain, and axillary lymphadenopathy-a clinical picture that raised concern for a possible underlying malignancy. Preliminary investigations revealed elevated D-dimers, low-volume haemoptysis, and a normal chest X-ray, which lowered the index of suspicion. However, computed tomography (CT) pulmonary angiogram identified a right hilar mass, several parenchymal cysts, and a large mediastinal mass. In addition, a left-sided adrenal lesion was also discovered following CT abdomen pelvis, potentially indicating metastatic disease. Fortunately, a positron emission tomography scan failed to detect any metabolic activity in either the right hilar mass, left adrenal lesion or the anterior mediastinal mass. CT-guided biopsy identified the mediastinal mass as a low-grade spindle cell tumour. Due to its large size, the mass was surgically resected and confirmed to be a deep benign fibrous histiocytoma. The significance of this report is to highlight a clinical presentation suggestive of malignancy but actually resulting from a rare variant of a benign tumour. The constellation of regional lymphadenopathy, respiratory and gastrointestinal symptoms, lung cysts, an adrenal tumour, and a mediastinal mass appeared to suggest a progressive disease pattern more commonly associated with malignancy.

The following case report describes a unique presentation of primary malignant fibrous histiocytoma (MFH) originating in the right ventricle. A 71-year-old male presented to the emergency department with tachycardia, dyspnea, tachypnea, and left leg pitting edema, seven weeks following a right total hip arthroplasty. Six weeks prior to presentation, the patient was diagnosed with pulmonary embolism and five pulmonary nodules based on computed tomography (CT) angiography. Laboratory studies at this time indicated anemia of chronic disease, consistent with results from six weeks earlier. Broncho-alveolar lavage (BAL) cytology suggested adenocarcinoma. CT angiography demonstrated a dramatic increase in the amount and extent of the pulmonary nodules previously noted in addition to an unresolved embolus of the right upper lobe. CT-guided biopsy was performed and confirmed a definitive diagnosis of non-small cell lung cancer. Two days after CT-guided biopsy, the patient developed acute hypotension and hypoxic respiratory failure rapidly progressing to asystole and subsequent death. Autopsy revealed a primary intra-cavitary malignant fibrous histiocytoma in the right ventricle, and multiple nodular tumours throughout the lung parenchyma with chest wall invasion. These findings allowed for a revision of the diagnosis and clinical-pathological picture. This case illustrates the limitations of radiological imaging in visualizing vascular structures, and the continued importance of autopsy in achieving a complete and correct pathological diagnosis. Moreover, this case draws light to the unclear diagnostic criteria for MFH and lack of effective treatment options. The longest documented survival of MFH is eight years, which was achieved with orthotopic cardiac transplantation.

This case presentation relates to a 53 year old male, cachectic in appearance, who presented with progressively worsening dyspnoea, cough, intermittent haemoptysis and a history of nasal dryness ongoing over five months. The patient had received multiple courses of oral antibiotics for suspected community acquired pneumonia with no significant improvement. He was referred to our Respiratory Department for further evaluation of his symptoms. His HRCT showed right middle lobe consolidation with central cavitations. Furthermore, the transbronchial biopsy had been performed and the cytological examination revealed lipid laden macrophage with interstitial inflammatory changes. With return to the patient over the counter drug history, he described the frequent use of petroleum jelly to alleviate the symptoms of nasal dryness. This is the first report case of exogenous lipoid pneumonia presented with haemoptysis and cavitations in the HRCT.