ObjectiveTo analyze the clinical presentations and radiological characteristics of pulmonary vein stenosis after radiofrequency ablation. MethodsClinical and radiological data of 2 patients with pulmonary vein stenosis after radiofrequency ablation for atrial fibrillation were retrospectively analyzed and literatures were reviewed. ResultsBoth patients had undergone circumferential pulmonary vein isolation. The symptoms appeared approximately 2 months after the operation. The major symptoms were cough, hemoptysis, exacerbation of dyspnea and chest pain. Both patients were misdiagnosed as other diseases such as pneumonia in other hospitals, and the anti-infection therapy was invalid. Both CT scans showed parenchymal exudative consolidation with varying degrees of interstitial septal thickening and small nodules. Both patients were confirmed as pulmonary vein stenosis by CT angiography. Literature review identified 21 cases of pulmonary vein stenosis after radiofrequency ablation for atrial fibrillation. The main clinical features are hemoptysis, chest pain, shortness of breath and cough. The most common features of thoracic radiological imaging are consolidation, groud-glass attenuation, pleural effusion and interstitial septal thickening. ConclusionsIf a patient presents with hemoptysis, dyspnea, chest pain or other clinical manifestations after ablation therapy and image findings show parenchymal exudative consolidation with interstitial septal thickening and multiple small nodules, the possibility of pulmonary vein stenosis should be considered. Contrast-enhanced CT combined with pulmonary vein imaging technology can clearly show the opening diameter of each pulmonary vein and its branches, so it is an important non-invasive examination method for the evaluation and diagnosis of pulmonary vein stenosis.
Objective To improve the knowledge of cryptogenic organizing pneumonia ( COP) , and reduce misdiagnosis and mistreatment. Methods The medical records of 22 patients with biopsy-proven COP from January 2006 to October 2011 were retrospectively reviewed. The clinical presentation, laboratory data, radiographic results and treatment were collected and analyzed. Results The clinical presentations were nonspecific, and the most common symptomof COPwas cough ( 95. 45% ) . The laboratory data analysis revealed that elevated erythrocyte sedimentation rate in 71. 43% of the COP patients. The COP patients usually presented with a restrictive ventilation dysfunction and decreased diffuse function on pulmonary function test. The most common patterns of lung abnormality on chest CT scan were bilaterally multifocal patchy consolidation or ground-glass opacification ( 63. 64% ) , which distributed along the bronchovascular bundles or subpleural lungs. Patchy consolidation with air bronchograms was also a common feature ( 54. 55% ) . Migration over time and spontaneous remission of consolidation were important pointers.Histopathology by transbronchial lung biopsy was a valuable means for diagnosis. The majority of COP patients were non-response to antibiotics, but responded rapidly and completely to oral administration of corticosteroids with good prognosis. Conclusions The clinical presentations and laboratory data of COP patients are nonspecific. Initial imaging findings of COP are similar with pneumonia. Strengthening the recognition of COP is conducive to reducing misdiagnosis and reasonable antibiotics use.
ObjectiveTo investigate the clinical characteristics and predicting factors for death in critically ill patients with severe community-acquired pneumonia (CAP). MethodA total of 143 hospitalized patients with severe CAP between January 2009 and December 2012 were included and their clinical data were retrospectively analyzed. According to the clinical outcome, patients were divided into survival group and death group, and their clinical features and laboratory test results were compared, and multivariate regression analysis was conducted to search for predicting factors for death. ResultsIn this study, a total of 118 patients survived and 25 patients died, and the mortality rate was 17.5%. The number of underlying diseases in the two groups were different, and death group had more patients with 3 kinds of diseases than the survival group[76.0% (19/25) vs. 22.8% (13/57), P<0.05]. The intubation rate in the death group was significantly higher than that in the survival group[84.0% (21/25) vs. 33.1% (39/118), P<0.05], and the arterial blood pH value (7.15±0.52 vs. 7.42±0.17, P<0.05), HCO3- concentration[(18.07±6.25) vs. (25.07±5.44) mmol/L, P<0.05], PaO2[(58.92±35.18) vs. (85.92±32.19) mm Hg (1 mm Hg=0.133 kPa), P<0.05] and PaO2/FiO2[(118.23±98.02) vs. (260.17±151.22) mm Hg, P<0.05)] in the death group were significantly lower than those in the survival group. And multivariate regression analysis indicated that the number of underlying diseases[OR=0.202, 95%CI (0.198, 0.421), P=0.003], PaO2[OR=1.203, 95%CI (1.193, 1.294), P=0.011] and PaO2/FiO2[OR=0.956, 95%CI (0.927, 0.971), P=0.008] were independent predictors of death in the patients with severe pneumonia. ConclusionsPatients who died of severe pneumonia often had severe illnesses before admission, and the number of underlying diseases and PaO2 have highly predictive value for death.
Objective To improve the knowledge of pulmonary mucormycosis through summarizing the clinical features and treatment of the disease. Methods A retrospective analysis was conducted on two cases of mucormycosis. The literature review was carried out with " pulmonary mucormycosis” as the research terms respectively in CNKI and Pubmed database. Search time ranged from January 2000 to June 2016. Results The first case was a 61-year-old male patient complained of cough, expectoration and dyspnea for 5 days. Chest computerized tomography (CT) showed lung nodules in the right upper lobe and bronchial cut off sign of apical bronchus. The patient received bronchoscopic examination and pathological findings indicated mucormycosis. Amphotericin B was recommended for the treatment. The patient recovered after treatment and was discharged. The second case was a 44-year-old female patient admitted to our hospital due to cough accompanied with expectoration and fever for over 10 days. Chest CT scan showed multiple double-pulmonary circular nodules and cavities with different sizes and clear boundary. The maximum cavity diameter was about 1.8cm, and the density of soft tissue was found in the part of the cavity. The patient received CT-guided percutaneous lung biopsy and pathological findings indicated fungal hyphae which was accorded with mucor infection. The patient received amphotericin B, voriconazole and posaconazole treatment, but with bad curative effect. She gave up therapy and died one week later after discharged. A total of 6 literatures were reviewed in above-mentioned databases. The clinical manifestations were nonspecific and the patients were likely to accompany with other diseases. The duration from the onset of symptoms to exact diagnosis was 37.5 days. Chest CT scan and pathological examination played important roles in the diagnosis of mucormycosis. Proper antifungal treatment could improve the prognosis. Conclusions Mucormycosis is a rare invasive fungal disease with high mortality. The clinical manifestations are nonspecific. Early diagnosis and appropriate treatment contribute to better prognosis.
Objective To enhance the understanding of the primary salivary glandtype lung cancer (PSGLC) and improve the diagnostic rate of the disease. Methods The clinical data of 41 patients with PSGLC pathologically confirmed in West China Hospital between October 2009 and October 2015 were analyzed in terms of clinical features, therapy and prognosis. Results All the 41 patients (21 males and 20 females) accounted for 0.22% (41/18 738) of the primary malignant lung tumor diagnosed in the same period. The patients aged from 16 to 72 with the median age of 43.6. The disease course was 1 month to 6 years, and 12 had smoking history. There were 23 cases of adenoid cystic carcinoma, 15 of mucoepidermoid carcinoma and 3 of acinic cell carcinoma. The symptoms, chest-computed tomography and fiberbronchoscopy examination had no specificity. There were 34 patients who had undergone surgery, in whom 3 had fiberbronchoscopy, 4 had oral traditional Chinese medicine treatment, 5 had chemotherapy and radiotherapy at the same time, 9 received chemotherapy only, and 4 recived radiotherapy only. Follow-up period lasted for 2-65 months, with the median time of 38 months. Two patients had recrudescence, 6 patients had distant metastasis and 1 patient died. Conclusions PSGLC have no specific clinical features; its diagnosis basically rely on pathological examination. After comprehensive treatment mainly on surgery, the prognosis of the disease is better than other malignant lung cancers.
ObjectiveTo observe the clinical and pathological features of choroidal malignant melanoma (CM). MethodsA retrospective case study. From 2011 to 2021, paraffin specimens from 15 eyes of 15 CM patients diagnosed by pathological examination in the Department of Pathology, the Second Affiliated Hospital of Soochow University were included in the study. The age, gender, clinical manifestations, treatment plan and pathological examination results of patients were collected retrospectively through the hospital information system. The clinical characteristics, immunohistochemical staining and molecular pathological characteristics were analyzed. ResultsAmong the 15 cases, 8 males and 7 females. The average age was 61. All patients were monocular paroxysm. There were 8 cases of decreased vision, blurred vision and dark shadow in front of the eyes; 1 case had red eye, lacrimation and purulent secretion; 2 cases had visual loss and no light perception; 4 cases had retinal detachment. The average diameter of the tumors was 1.4 cm. The general appearance of the tumor was hemispherical, “mushroom-shaped” or flat diffuse. Most of the tumor cells were arranged in solid, flaky and cross clusters, and some of them were arranged in false “chrysanthemum form” around the blood vessels with necrosis. In 15 eyes, spindle-cell type, epithelioid type and mixed cell type were 6, 2 and 7 eyes, respectively. The cytoplasm was partly double stained or eosinophilic, partly clear, and partly rich in pigment. The cells had poor adhesion, marked atypia, rough chromatin, frequent mitotic figures, and prominent nucleoli . Immunohistochemical staining was positive for HMB45, SOX10, S100 and Melan-A in 15 patients, but negative for epithelial markers AE1/3, lymphatic markers LCA, neuroendocrine markers CgA and Syn. Genetic testing results showed that none of the patients found C-KIT, BRAF, NRAS gene mutations. Fifteen patients were followed up for 8-96 months, of which 12 survived and 3 died after recurrence and/or metastasis. ConclusionCM has no specific clinical clinical manifestations, and he diagnosis depends on histological morphology and immunohistochemical staining.
Objective To propose the terminology of acoustic hypersensitivity, and investigate its clinical features and relationship with tinnitus. Methods A total of 214 patients with acoustic hypersensitivity or tinnitus as their first chief complaint were recruited and studied between January 2014 to January 2016. Detailed information of clinical manifestations, accompanying symptoms and related medical history were collected in the patients with acoustic hypersensitivity. Patients were instructed to complete the Hyperacusis Questionnaire and the Self-rating Anxiety Scale. The Tinnitus Evaluation Questionnaire was used to evaluate tinnitus severity in patients with tinnitus. Results Among the patients with acoustic hypersensitivity as their first chief complaint, 93.3% had tinnitus; 47.3% of the patients with tinnitus as their first chief complaint had acoustic hypersensitivity and the prevalence of acoustic hypersensitivity increased as the tinnitus severity increased. In terms of onset of the two symptoms, simultaneous acoustic hypersensitivity and tinnitus occurred in 55.1% of the patients, acoustic hypersensitivity occurred after tinnitus in 34.7% of the patients, and acoustic hypersensitivity occurred before tinnitus in 10.2% of the patients. Most patients with acoustic hypersensitivity as the first chief complaint felt uncomfortable to any sounds that are louder than usual. The main manifestations included feeling disturbed, echoing in the ear or head, ear fullness or pain. Discomfort in 68.6% of the patients disappeared when there was no environmental sound. It was found that hearing loss, ear fullness, vertigo, and anxiety were usually present in patients with acoustic hypersensitivity, and 28.6% of the patients with acoustic hypersensitivity had a history of noise exposure. Conclusions Acoustic hypersensitivity occurs together with tinnitus for the majority of time, which shows a close relationship between these two symptoms. However, acoustic hypersensitivity shows different clinical manifestations from tinnitus. It is important to unify the terminology and standardize the concept of acoustic hypersensitivity among clinicians. It is also critical to conduct more clinical research in terms of diagnosing and evaluating acoustic hypersensitivity.
ObjectiveTo investigate the clinical features of Pulmonary Langerhans' cells histiocytosis (PLCH). MethodsFour cases of PLCH diagnosed by histopathologic examination between August 2004 and September 2013 were retrospectively analyzed. ResultsFour male patients aged from 19 to 46 year old, including three smokers. The main symptoms were chest tightness, cough, and dyspnea. Pneumothorax was presented in two cases, and tuberculosis was in one. The chest high resolution CT (HRCT) revealed lung cysts, nodles, and reticular changes predominantly in the upper and middle lung fields. The pathological Langerhans' cells infiltration were found in the histological biopsy of lesions of the 4 cases. All of the patients were positive in the immuno-histological staining for the S-100 and CD1a antigens. Two cases were positive in Langrin staining (other two patients didn't underwent the staining). Two of the 4 patients were given oral steroid, and the symptoms were improved in one of them. The case with pulmonary tuberculosis improved in symptoms and CT results showed the absorption of the lesion after anti-tuberculosis therapy. Three cases were not followed up. ConclusionPLCH patients were mainly young adults, often presented with chest tightness, cough, and dyspnea. The clinical features of chest HRCT are bilateral cysts, nodules and reticular changes. The disease may be defined by the finding of pathologic Langerhans' cells or the positive staining for CD1a antigens or Langerin.
ObjectiveTo investigate the clinical characteristics of non-tuberculous mycobacterium (NTM) pulmonary disease and pulmonary tuberculosis, as well as the bacterial distribution of NTM pulmonary disease. Methods The bacterial distribution and clinical characteristics of 104 patients with NTM lung disease hospitalized in Jiangxi Provincial People’s Hospital from May 2017 to May 2020 were retrospectively analyzed, as well as the clinicplal characteristics of 155 patients with tuberculosis hospitalized during the same period. Results The age of NTM lung disease group [(60±15) years] was higher than that of tuberculosis group [(55±19) years]. There were statistically significant differences in basic diseases (such as malignant tumor, type 2 diabetes, old tuberculosis, bronchiectasis), laboratory examination (such as blood routine examination, albumin) and chest imaging characteristics between the two groups (P<0.05). There was no significant difference in clinical symptoms (such as cough, sputum or fever) (P>0.05). The common underlying diseases of NTM lung disease were malignant tumor (29%), bronchiectasis (21%), chronic obstructive pulmonary disease (19%), etc. The common clinical symptoms of NTM lung disease included cough, sputum, fever, hemoptysis, chest tightness and shortness of breath, and other non-specific respiratory symptoms. The common manifestations of NTM lung disease on chest high-resolution CT (HRCT) included patchy images (82%), mediastinal lymph node enalargement (35%), pleural thickening (31%), pleural effusion (26%) and other signs. The isolates of NTM included Mycobacterium avium (50%), Mycobacterium intracellulare (21%), Mycobacterium chelonae/abscessus (14%), Mycobacterium fortuitum (5%), Mycobacterium gordonae (4%), Mycobacterium gilvum (3%), and Mycobacterium smegmatis (3%). Multivariate Logistic regression analysis showed that advanced age (OR=1.027) was a risk factor for NTM lung disease. Conclusions The clinical manifestations of NTM lung disease and tuberculosis are similar and difficult to distinguish. For male patients over 60 years old with malignant tumor, old tuberculosis, bronchiectasis and other basic diseases, and the chest HRCT findings are mainly bronchiectasis, NTM lung disease should be actively excluded. There is little difference in clinical manifestations between different strains of NTM lung disease, and the treatment cycle of NTM lung disease is long and easy to be interrupted, requiring enhanced follow-up.
ObjectiveTo improve the knowledge of pulmonary actinomycosis.MethodsThree cases of pulmonary actinomycosis in this hospital and 65 cases reported in China were analyzed retrospectively.ResultsAmong the 68 patients 49 were male and 19 were female aged 6 to 77 years old. The most common clinical manifestations were cough, sputum and fever. Inflammatory indicators was slightly elevated. The most common site was on the right upper lung. The typical CT manifestations were the low-density liquefaction necrotic zone in the center of the mass with vacuoles of different sizes, namely, "air-space consolidation". Positron emission computed tomography showed a mild metabolic increase in lesions. The 68 patients were confirmed by surgery, CT guided percutaneous lung puncture or bronchoscopic biopsy. The average time of the diagnosis was 10 months while the longest time was 6.4 years. The rate of first diagnosis was 5.9%. Forty-one cases were treated with antibiotics alone and 12 cases were treated with simple operation, the rest were treated by antibiotics combined with surgical treatment. The cure rate was 88.7%. Although active treatment was conducted 3 patients in this hospital were not cured.ConclusionsThe clinical features of pulmonary actinomycosis are atypical and the misdiagnosis rate is high. When pulmonary actinomycosis is suspected, it should be fully communicated with the microbiologist to ensure the cultivation in anaerobic environment and extension of the incubation cycle. Tissue culture and pathological biopsy should be actively performed. Treatment depends on antibiotics or surgery with good prognosis, but for some cases the prognosis is not optimistic.