Mandibular metastasis with pulmonary cannon balls: Presentation of follicular carcinoma thyroid

Swelling of the jaw due to metastatic lesions needs careful search for an occult malignancy. Thyroid carcinoma is a rare cause of jaw bone metastasis. A 70-year-old female presented in our chest clinic with progressive shortness of breath for last 1-month and associated painful swelled right jaw for last 4 months. Her computed tomography scan thorax showed bilateral cannon ball metastasis involving all lobes of the lung. Fine-needle aspiration cytology (FNAC) from radiographically evident osteolytic lesion of the mandible was suggestive of metastatic carcinoma probably of thyroid origin. Ultrasonography of the thyroid gland revealed well-defined hypoechoic nodule (measuring about 2 cm × 1.8 cm) with few foci of calcification. FNAC from the thyroid nodule followed by immunocytochemistry was suggestive of follicular carcinoma of the thyroid. We report a very rare presentation, as jaw metastasis in follicular carcinoma of the thyroid

Squamous cell carcinoma lung: Presented with bilateral lower limb deep venous thrombosis with gangrene formation

Bilateral venous thrombosis due to underlying malignancy is a rare entity. It is worthy to search for malignancy in patients of bilateral venous gangrene. Our patient presented with severe bilateral leg pain as a result of venous gangrene. There was associated left sided massive pleural effusion with scalp nodule. Fine needle aspiration cytology of scalp nodule revealed metastatic squamous cell carcinoma and fiber optic bronchoscopy guided biopsy from growth at left upper lobe bronchus confirmed the case as squamous cell carcinoma lung. It was rare for squamous cell carcinoma lung to present as bilateral venous gangrene with anticardiolipin antibody negative

Malignant Peripheral Nerve Sheath Tumour in a Patient of Type 1 Neurofibromatosis

Malignant peripheral nerve sheath tumours (MPNST) constitute a rare type of soft tissue sarcoma which arises from peripheral nerves or Schwann cells, perineural cells or fibroblasts. MPNST is a rare neoplasm affecting 1 in 1,00,000 population. Here we report a case of a 36 year old male who presented to us with an upper abdominal swelling for last 3 months. At first ,a diagnosis of type 1 neurofibromatosis type 1(NF-1) was made. Contrast enhanced CT scan abdomen and thorax revealed presence of a complex, heterogenous mass in upper abdomen with extension towards left hemithorax. Histopathological examination done from true cut biopsy specimen of the mass was suggestive of malignant peripheral nerve sheath tumour. Positivity of tumour cells on immunohistochemistry to S-100 established the diagnosis of MPNST in type 1 neurofibromatosis. In conclusion, it was a rare case of MPNST in a patient of NF-1. DOI: http://dx.doi.org/10.3329/jom.v13i2.12761 J Medicine 2012; 13 : 219-221</jats:p

A rare case of ethambutol induced pulmonary eosinophilia

Antitubercular drug (ATD) induced eosinophilic lung disease is a rare phenomenon. It usually occurs due to isoniazid and para amino salicylic acid. A 34-year-male of sputum positive pulmonary tuberculosis, on antitubercular drugs (rifampicin, isoniazid, ethambutol, and pyrazinamide) for last 3 weeks, presented with generalized arthralgia and maculopapular rash for last 2 weeks and shortness of breath for last 1 week. Chest X-ray and High resolution computerized tomographic scan thorax showed bilateral peripheral airspace opacification. Bronchoalveolar lavage revealed 51% eosinophils of total cellularity (1200/cmm) confirming the diagnosis of pulmonary eosinophilia. ATD was stopped for 2 weeks and then reintroduced one by one. Patient again developed similar kind of symptoms with reintroduction of ethambutol. According to criteria for drug induced pulmonary eosinophilia, he was diagnosed as a case of ethambutol induced pulmonary eosinophilia

Approach to unequal hilum on chest X-ray

Hilum is a tricky part in chest X-ray (CXR) for understanding. Anatomically, pulmonary arteries and veins, major bronchi, and lymph nodes with pulmonary arteries contributed most of the radiographic density of the hila with superior pulmonary veins making a smaller contribution. Though both hila should be indistinguishable in size and density, we do not get equal hila in majority of CXRs. Rotational malpositioning must be kept in mind, while interpreting CXRs of unequal hilum. For interpreting hilum, we should search for four factors shape, radiopacity, proportionate size, absolute size, hilar angle, contour of pulmonary artery. There are numerous causes of hilar enlargement. It is the clinical presentation which will help in tapering the differential diagnosis. Asymmetric hilum is a challenging subject for pulmonologists. Interpretation of unequal hilum depends on findings of detail history, meticulous clinical examination, and appropriate investigation

Pulmonary embolism due to factor V leiden mutation causing worsening of asthma

Worsening of asthma is usually caused due to noncompliance to medications. The incidence of pulmonary arterial hypertension (PAH) due to asthma is very rare. There are many case reports where PAH was wrongly diagnosed as asthma. Pulmonary hypertension can be associated with asthma and makes a controlled asthma worsened. In our patient pulmonary embolism diagnosed by transesophageal echocardiography due to factor V leiden mutation was the responsible factor for pulmonary hypertension. After proper treatment of pulmonary embolism his asthma gets controlled again

Congenital Bochdalek′s hernia in a 18-year-old boy

Adult presentation of congenital Bochdalek′s hernia is rare. Here we report the case of a 18-year-old boy who presented to us with dyspnea, low grade fever, and cough for whom the diagnosis of congenital Bochdalek′s hernia was confirmed by computed tomography (CT) scan of thorax after barium ingestion. Problems of this adult presentation because of difficulty in diagnosis, operative management, and rudimentary lung were properly and successfully dealt with in our case. We concluded that before undergoing operation in adult Bochdalek′s hernia, thorough check-up is necessary as rudimentary lung may not expand resulting in ventilatory insufficiency during postoperative phase