Background. Diffuse parenchymal lung diseases (DPLDs) represent a group of disorders with overlapping clinical and radiological features. Lung biopsy is usually required to make an aetiological diagnosis of DPLD. Open lung biopsy which is still considered as the gold standard for the diagnosis of DPLDs, is associated with significant mortality and morbidity. Transbronchial lung biopsy (TBLB) through fibreoptic bronchoscope is safe and less invasive method in patients with DPLDs. Objectives. To describe the diagnostic yield and complications of TBLB in patients with DPLD seen at our centre. Methods. We prospectively studied patients with DPLD who underwent TBLB over a 2-year period. Results. A total of 102 patients were enrolled in the study. TBLB confirms a diagnosis in 80 (78.4%) patients. Granulomatous inflammation (30 [37.5%]), non-specific interstitial pneumonia (15 [18.7%]), neoplasia (13 [16.2%]) were the most common histological findings. No procedure-related mortality was observed. Seven (6.8%) patients developed pneumothorax. Major bleeding that requires admission to intensive care unit was reported in 1 (0.9%) patient only. Conclusions. Transbronchial lung biopsy is a safe and useful procedure for diagnosis of DPLDs. The yield of TBLB is high when centrilobular and perilymphatic involvement is found radiologically. At least four to six biopsies per TBLB should be taken to improve the overall yield of TBLB.

Background. Bronchial asthma and tuberculosis (TB) are two of the common diseases seen in developing countries, and most of the patients with bronchial asthma require life-long therapy with steroids. Objectives. To estimate the frequency of pulmonary TB among bronchial asthma patients treated with corticosteroids. Methods. Patients with bronchial asthma who have been on steroid therapy were enrolled. Diagnosis of TB was made by history, clinical examination, and laboratory tests findings. Results. Of 100 patients with bronchial asthma, 11 patients developed pulmonary TB (4 sputum-positive, 7 sputumnegative). Of the 60 patients who were on oral steroids, 52 were taking steroids for more than 2 years; of them, 10 (19%) patients developed pulmonary TB. Of the 40 patients who were on inhaled steroids, 80% were using it for more than 2 years; 1 (3.2%) of them developed pulmonary TB. Conclusion. Systemic corticosteroid therapy significantly increases the risk of pulmonary TB in patients with bronchial asthma.

Background. In chronic obstructive pulmonary disease (COPD), systemic effects of the disease result in structural and/or biochemical alterations in structures or organs other than the lungs. Microalbuminuria (MAB) is an importantC risk factor for cardiovascular disease, and it may be seen due to hypoxaemia in patients with COPD. Objective. Present study was undertaken to find the presence of MAB in COPD and relationship of MAB with clinical and physiological parameters in stable patients with COPD. Methods. Sixty patients with COPD and 50 healthy controls were enrolled in the study. Spot urinary albumin/creatinine ratio, smoking history, spirometry, blood gases, body mass index, kidney function tests and BODE index (body-mass index, airflow obstruction, dyspnoea and exercise) were assessed. Frequency of MAB was compared between cases and controls. Results. Of 60 cases, 50 (83%) were males and 10 (17%) were females. In patients with COPD, MAB was found in all of them (100%) while in controls only 4 (10%) had MAB (p<0.0001). Conclusion. In the present study, MAB was seen in all the patients with COPD and MAB levels were significantly high in COPD cases compared with asymptomatic smokers with normal spirometry.

Interstitial lung disease (ILD) constitutes a heterogeneous group of non-neoplastic conditions characterised clinically by restrictive lung function, radiologically by reticulonodular type of infiltrates and pathologically by inflammation, alveolare-damage and fibrosis, predominantly involving the alveolar interstitium. Definitive categorisation of subtypes of ILDs is important as the prognosis and treatment is different in each case. Pathologist and radiologist play a major and equal role in the proper diagnosis of each case. Hence, multi-disciplinary team approach including respiratory clinician, surgeon, radiologist and pathologist is a must in all cases, as non-specific histopathological diagnosis can become a specific diagnosis on clinical-pathological and radiological discussion.

Aeromonas is a known pathogen causing diarrhoeal disease and the most common clinical manifestation is acute gastroenteritis. Extra-intestinal infections by Aeromonas species, such as empyema, are rare. We describe a case of spontaneous bacterial empyema in an immunocompetent male who recovered after antibiotic therapy and drainage.

We report a case of a 45-year-old male patient with sudden onset dyspnoea, cough and streaky haemoptysis. The patient was already being treated with anti-tuberculosis drugs by a general practitioner for suspected tubercular pleural effusion for the last 8 months. Computed tomography-pulmonary angiography revealed pulmonary thrombo-embolism. As patient have high plasma homocysteine values, further work-up of the patient including a detailed history taking, physical and laboratory examination established a diagnosis of systemic lupus erythematosus (SLE). Patient was treated with heparin, vitamin B12 and folic acid supplementation in addition to corticosteroids, along with supportive and symptomatic treatment. However, the progressive course the illness resulted in the development of chronic interstitial pneumonia and he succumbed to the illness.

Coccidioidomycosis is a chronic granulomatous infection caused by dimorphic fungus Coccidioides spp. Sporadic cases of this infection have been reported globally in non-endemic regions those are primarily associated with travel to areas of high endemicity in the United States of America, Central and South America. The manifestations of coccidioidomycosis are not very different from tuberculosis (TB), and therefore, can be mis-diagnosed as TB, especially in areas with high prevalence of TB. We present a case of a middle-aged Indian male who travelled to USA and subsequently developed cough, fever, malaise, cutaneous nodules and discharging sinuses that were mis-diagnosed as TB; till a histopathological examination and fungal culture established the diagnosis of coccidioidomycosis of the lung with dissemination to the skin. He was successfully treated with oral itraconazole without any recurrence.

Long standing untreated tropical pulmonary eosinophilia (TPE) generally results in interstitial lung disease (ILD), as underlying chronic inflammation heals by fibrosis. The presentation of TPE as ILD is a rare entity. A patient was evaluated for persistent cough over two years. High resolution computed tomography of the chest was suggestive for ILD in this case. The patient was diagnosed, however, with TPE based on persistent high eosinophil count, positive antifilarial antibody and dramatic response to diethylcarbamazepine. Follow-up HRCT of the chest after 16 months of treatment showed complete resolution of ground-glass opacities. A significant improvement in spirometry was also noted.

Epithelioid sarcoma is a rare soft tissue tumour in young adults. These are broadly classified into proximal and distal tumours; proximal tumours being less common and more aggressive than the distal tumours. The tumour is more common in males. We present a rare clinical presentation of epithelioid sarcoma with involvement of chest wall and chest cavity. Surgical excision with wide margin excision is the treatment of choice followed by chemotherapy. However, regular follow-up is advised as these tumours have high rate of recurrence.