How to cite this article:
Fernandes L, Gulati N, Mesquita AM, Sardesai M, Fernandes Y. Quantification of Emphysema in Chronic Obstructive Pulmonary Disease by Volumetric Computed Tomography of Lung. Indian J Chest Dis Allied Sci 2015; 57 (3):155-160.
Background and Objectives. Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease with small airway inflammation and emphysema. Emphysema is permanent enlargement of air spaces distal to terminal bronchioles accompanied by destruction of alveolar walls. These morphological changes can be studied on quantitative computed tomography (CT).
Methods. Thirty-four patients diagnosed to have COPD as per Global Initiative for Chronic Obstructive Lung Disease guidelines underwent chest CT using full inspiration with low dose radiation protocol. Pulmo-CT® software was used to analyse the scans. The primary aim was to quantify emphysema and emphysema clusters and secondary aim was to assess correlation between percentage emphysema and lung function.
Results. Their mean [standard deviation (SD)] age was 66.4 (7.0) years; 11 (32.4%) were current smokers (median pack years 45.5). Their mean (SD) forced expiratory volume in the first second (FEV1%) was 55.6 (17.6), mean (SD) % emphysema was 26.8 (11.1), mean (SD) lung density was –848.35 (29.5) Hounsfield units (HU), median (interquartile range) %cluster class 4 emphysema was 22.4 (13.5–32.6). There was no significant difference in %low attenuation volume (%LAV) in current and ex-smokers (p=0.4); across various severity grades of COPD (p=0.15). Further, no significant correlation was observed between %emphysema and post-bronchodilator FEV1%.
Conclusions. Volumetric CT can detect and quantify emphysema. Majority of emphysema clusters in COPD are >25mm. The %emphysema does not correlate to the severity of the disease. Quantitative CT is a good objective method to study emphysema and can be used to phenotype COPD radiologically.
Objective. The present study was undertaken to explore the clinico-pathological profile of bronchogenic carcinoma among females.
Methods. One hundred and twenty-four female patients with histopathologically proven bronchogenic carcinoma who were hospitalised in the Department of Pulmonary Medicine, King George's Medical University, Lucknow from July 1985 to February 2007 were retrospectively studied.
Results. Their mean age was 61 years; 12.9 % of these were less than 40 years of age. Of these, 79% of female patients of lung cancer were first regarded as pulmonary tuberculosis; 76% belonged to rural area. Use of biomass fuel and kerosene oil exposure was the predominant risk factors evident among the 116 non-smoker women. Adenocarcinoma was observed in 43.5%, followed by squamous cell carcinoma in 33.1% and the remaining 23.4% cases were small cell carcinoma. The majority (77.4%) of non-small cell lung cancer (NSCLC) patients had advanced stage disease (IIIb and IV) and 58 % of small cell lung cancer (SCLC) patients had limited disease and 42 % of SCLC patients had extensive disease at the time of diagnosis.
Conclusion. Adenocarcinoma was found to be the most common histopathological type of bronchogenic carcinoma among these females.
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Panchadhyayee P, Saha K, Saha I, Ta RK, Ghosh S, Saha A, Barma P, Mitra M. Rapidly Fatal Silicosis Among Jewellery Workers Attending a District Medical College of West Bengal, India. Indian J Chest Dis Allied Sci 2015; 57 (3):165-171.
Background. Silicosis is a slowly progressive chronic occupational lung disease, developed after a prolong period of exposure to high concentration of silica dust.
Methods. In this longitudinal study, we enrolled old and new silicosis patients (n=19; 8 jewellery polishers, 11 from other occupations) seen at our Pulmonary Medicine Department from June 2009 to December 2012 to document the course of illness as per their occupational exposure.
Results. Six of the eight jewellery polishing workers had developed silicosis within five years of exposure, while six of the 11 other workers with other occupational exposure had developed silicosis after exposure of 10 years or more. Mean duration of exposure was significantly less among jewellery polishing workers compared to other workers (3.4±1.7 versus 9.3±4.1; p=0.001). Mean duration of illness (months) (14.9±5.8 versus 28.5±16.5; p=0.040) were significantly less among the jewellery polishing workers compared to other workers. At the end of the study period, all eight jewellery polishing workers with silicosis had died while four of the 11 patients with other occupational exposure had died.
Conclusion. Silicosis among jewellery polishing workers was found to be more severe and progressive compared to silicosis due to other occupational exposures, in our study.
We present the case of a 62-year-old male with chronic obstructive pulmonary disease and poorly controlled diabetes mellitus who presented with haemoptysis. A radiograph of the chest showed a right lower parahilar opacity which on the contrast enhanced computed tomography was seen to be an irregular, spiculated mass localised to the middle lobe. Considering malignancy as the most probable diagnosis, a bronchoscopic endobronchial biopsy was performed which surprisingly established pulmonary actinomycosis as the diagnosis. The patient was successfully managed with amoxicillin and clavulanic acid and glycaemic control.
Primary malignant melanoma of the lung (PMML) is an extremely rare tumour with only sporadic case reports. We report the occurrence of PMML in a 58-year-old female. Although extremely rare, it must be considered in the differential diagnosis of bronchogenic carcinoma and a detailed systemic examination must be done to rule out any primary skin or eye involvement.
We present the case of a 45-year-old male diagnosed to have carcinoma base of tongue, whose chest radiograph showed bilateral lung infiltrates and was referred for evaluation of suspected pulmonary metastases. Diagnostic evaluation confirmed the diagnosis of smear-positive pulmonary tuberculosis.
A Raghu Kanth,
A Vinay Kumar,
Hydatid disease is a parasitic disease caused by the larval form of Echinococcus granulosus. Most common sites are liver, lungs, and brain. The disease is rarely present in the mediastinum. We report the rare instance of a 52-year-old female who presented with hydatid disease in the uncommon location of posterior mediastinum.
Vinaya S. Karkhanis,
J. M. Joshi,
Jyotsna M. Joshi
Diagnosis of lung hydatidosis becomes difficult with unusual radiographic findings especially with rupture of hydatid cyst. Here we present the case of a patient who presented with hydatid cyst with endobronchial rupture. A 40-year-old woman presented with a 3-year history of cough with mucoid expectoration, breathlessness on exertion, intermittent fever and leftsided chest pain. Chest radiograph and computed tomography of chest showed a mass obstructing the left main bronchus and post-obstructive cavity formation. Fluorodeoxyglucose positron emission tomography (FDG-PET) showed uptake [maximum standardised uptake value (SUVmax) 2.5 G/mL) in left lower lobe cavity. Fibreoptic bronchoscopy showed obstruction of the left main bronchus with white gelatinous material. After the bronchoscope was withdrawn, the patient expectorated large quantities of this material. Histopathological examination of the aspirated membrane showed laminated acellular layer and focal inner germinal layer suggestive of hydatid cyst.
Pavankumar R. Biraris,
Vikram M. Rathi,
Zarir F. Udwadia
A 17-year-old female diagnosed to have multidrug-resistant pulmonary tuberculosis (MDR-TB), presented with Poncet's arthritis which responded to second-line anti-TB treatment. Poncet's disease is more commonly present in association with extra-pulmonary TB and involves large and small joints. However, our patient had pulmonary MDR-TB and small joint involvement.