Background. Cardiopulmonary exercise testing (CPET) is a non-invasive, objective and provides relevant information for clinical decision making. The purpose of the present study was to evaluate the cause for unexplained breathlessness by performing cardiopulmonary exercise testing. Methods. We carried out a retrospective analysis of CPET performed for 51 patients with unexplained breathlessness over a one-year period. Cardiopulmonary exercise testing was done by maximum symptom limited incremental protocol on a treadmill. Results. The mean age was 45 years (range 20-74 years). Mean body mass index (BMI) was 26.4; 7 (14%) subjects had a normal BMI, 12 (23%) were overweight, 30 (59%) were obese and 2 (4%) were underweight. Thirty-one (61%) patients achieved anaerobic threshold (AT). Based on the AT percentage criteria, 4% were classified as diseased, 17% as deconditioned, 20% as sedentary and 20% as normal. Fourteen (27%) patients had VO2 max >80% predicted. In the final analysis, 11 (22%) patients had ventilatory limitation, 16 (31%) had cardiovascular, 9 (17%) had mixed pulmonary and cardiac, 3 (6.5%) had musculoskeletal limitation and 3 (6.5%) had obesity as exclusive cause for breathlessness. Nine (17%) had normal studies with abnormal perception of breathlessness and they were advised to gradually increase their exercise levels. Conclusions. Cardiopulmonary exercise testing is a useful tool in the evaluation of dyspnoea disproportionate to clinical findings and standard tests. Although CPET points out the organ causing dyspnoea, organ specific investigation is required to plan the management.

Background. Chronic obstructive pulmonary disease (COPD) is a major cause of disease burden worldwide. Patients with COPD have impaired quality-of-life due to dyspnoea, frequent exacerbations, limitation of exercise capacity, muscle dysfunction, and malnutrition. Hence, pulmonary rehabilitation should be considered as a part of management of patients with COPD. Present study emphasises on the efficacy of pulmonary rehabilitation in improving the long-term well-being of patients with COPD. Methods. Fifty patients with COPD were included and were followed up at 8, 24, 48 and 96 weeks. Patients were taught exercises to strengthen the lower limb muscles, breathing exercises along with upper limb exercises. Results. The outcomes recorded after 96th week of rehabilitation programme were as follows: dyspnoea grade at (4.1±1.06 versus 1.6±0.6 with paired ‘t’ test of 20.8328, p<0.0001), health-related quality-of-life (HRQoL) (57.7±11.6 versus 38.7±10.6, ‘t’ test 75.9631, p<0.0001), forced expiratory volume in one second (FEV1) (43.1±16.0 versus 40.3±16.0, ‘t’ test 19.1064, p<0.0001) FEV1/forced vital capacity (FVC) (0.86±0.11 versus 0.80±0.12, ‘t’ test 17.0750, p<0.0001). Conclusion. Pulmonary rehabilitation reduces dyspnoea, increases the exercise capacity and improves qualityof-life, reduces frequent exacerbations, thus, improves overall well-being of patients with COPD, resulting in reduction of significant cost of health burden on society indirectly.

Kerosene (paraffin or lamp oil), the liquid hydrocarbon is a common household commodity of low-income families in developing countries used for cooking and lighting lamps. Still, kerosene is rarely ingested with suicidal intent by adolescents or adults. Pneumonitis is the most frequent manifestation of kerosene aspiration but bilateral pleural effusion is very rare. Kerosene being an irritant may cause dermatitis upon direct contact with skin. We report for the first time acute contact dermatitis and bilateral pleural effusion with pneumonitis in a 17-year-old adolescent girl following suicidal attempt with kerosene. Pleural fluid was exudative and kerosene induced bilateral pleural effusion and skin lesions resolved within two weeks of conservative treatment.

Agenesis of lung is a rare congenital anomaly. It is usually detected in early childhood as a result of pulmonary symptoms and associated cardiovascular, gastrointestinal or genitourinary anomalies. Diagnosis may be late in adulthood or later in life in asymptomatic patients. Patients often present with repeated chest infections. We present a case of left lung agenesis in a 40-year-old female patient, who presented with progressive breathlessness due to severe bronchiectatic changes in contralateral right lung using computed tomography (CT) of the thorax and CT pulmonary angiography.

Diaphragmatic hernias are commonly congenital and usually present in childhood. In adults presentation may differ from being asymptomatic to presenting with life-threatening complications, like obstruction or strangulation. Hernias with omentum as content may be misdiagnosed as mass lesions. Chest radiograph helps in establishing the diagnosis only in one-third of cases as radiographic picture varies depending on the content of hernia. Although with the use of helical computed tomography (CT) the sensitivity of detection of diaphragmatic defects has increased considerably but magnetic resonance imaging due to its multiplanar imaging capability and superior soft tissue contrast is the most reliable diagnostic modality in cases with uncertain CT diagnosis. We report a case of an anterior diaphragmatic hernia presenting as a large homogeneous opacity in an adult female.

A 35-year-old male patient presented with complaints of breathlessness and left-sided chest pain of five days duration. Physical examination revealed a left-sided massive pleural effusion, right-sided moderate pleural effusion and pericardial effusion. Laboratory examination revealed a high triglyceride content in the pleural and pericardial fluids suggestive of chylous pleural effusion and chylopericardium. Further investigations confirmed the diagnosis of malignant lymphoma (thymic large B-cell lymphoma). The report was confirmed with immunohistochemistry markers, by tru-cut biopsy from mediastinal mass. Bilateral chylothorax with chylopericardium is a rare entity and this condition secondary to lymphoma has a poor prognosis.