Respiratory Medicine CME RSS feed: Current Issue. Respiratory Medicine CME publishes articles relevant to the continuing medical and professional development of researchers and practitioners with an interest in adult and paediatric medicine, epidemiology, immunology and cell biology, physiology, occupational disorders, and the role of allergens and pollutants. Respiratory Medicine CME publishes commissioned CME related articles and Case Reports . The journal is published online only on a quarterly basis. Access the journal online at http://www.resmedcme.com/ Click here to take a CME test . Respiratory Medicine CME tests are accredited by The European Board for Accreditation in Pneumology (EBAP).http://www.resmedcme.com/?rss=yesElsevier Inc.en © 2010 Elsevier Ltd. All rights reserved. Respiratory Medicine CME1755-0017322010 © 2010 Elsevier Ltd. All rights reserved. healthpermissions@elsevier.comhttp://www.resmedcme.com/article/PIIS175500171000028X/abstract?rss=yesSummary: Tuberculosis (TB) is a major infectious disease killing nearly two million people, mostly in developing countries, every year. The increasing incidence of resistance of Mycobacterium tuberculosis strains to the most-effective (first-line) anti-TB drugs is a major factor contributing to the current TB epidemic. Drug-resistant strains have evolved mainly due to incomplete or improper treatment of TB patients. Resistance of M. tuberculosis to anti-TB drugs is caused by chromosomal mutations in genes encoding drug targets. Multidrug-resistant (resistant at least to rifampin and isoniazid) strains of M. tuberculosis (MDR-TB) evolve due to sequential accumulation of mutations in target genes. Emergence and spreading of MDR-TB strains is hampering efforts for the control and management of TB. The MDR-TB is also threatening World Health Organization’s target of tuberculosis elimination by 2050. Proper management of MDR-TB relies on early recognition of such patients. Several diagnostic methods, both phenotypic and molecular, have been developed recently for rapid identification of MDR-TB strains from suspected patients and some are also suitable for resource-poor countries. Once identified, successful treatment of MDR-TB requires therapy with several effective drugs some of which are highly toxic, less efficacious and expensive. Minimum treatment duration of 18–24 months is also long, making it difficult for health care providers to ensure adherence to treatment. Successful treatment has been achieved by supervised therapy with appropriate drugs at institutions equipped with facilities for culture, drug susceptibility testing of MDR-TB strains to second-line drugs and regular monitoring of patients for adverse drug reactions and bacteriological and clinical improvement.Recent advances in the diagnosis and treatment of multidrug-resistant tuberculosisSuhail Ahmad, Eiman Mokaddas10.1016/j.rmedc.2010.08.001Respiratory Medicine CME 3, 2 (2010)Respiratory Medicine CME32S1755-0017(10)X0003-3CME Article5161http://www.resmedcme.com/article/PIIS1755001709000621/abstract?rss=yesAbstract: A 24-year-old male presented with hemoptysis, off and on, which was gradually increasing. The patient had four chest roentgenograms, which depicts various stages of aspergilloma formation in preexisting cavity. The diagnosis of aspergilloma was made and patient underwent lobectomy.Aspergilloma in preexisting cavity – serial chest roentgenograms can help in diagnosisMohammad Shameem, Nazish Fatima, Rakesh Bhargava, Zuber Ahmad, Abida Malik10.1016/j.rmedc.2009.05.011Respiratory Medicine CME 3, 2 (2010)Respiratory Medicine CME32S1755-0017(10)X0003-3Case Reports6264http://www.resmedcme.com/article/PIIS175500170900061X/abstract?rss=yesAbstract: A case report describing a rare cause of stones expectoration – lithoptysis – in a 57-year-old female with chronic pulmonary sarcoidosis. During the follow-up two episodes of lithopysis were observed. Chronic pulmonary sarcoidosis may be a rare cause of lithoptysis.Lithoptysis in coincidence with chronic pulmonary sarcoidosisP. Stranska, A. Slovakova, J. Homolka10.1016/j.rmedc.2009.05.007Respiratory Medicine CME 3, 2 (2010)Respiratory Medicine CME32S1755-0017(10)X0003-3Case Reports6567http://www.resmedcme.com/article/PIIS1755001709000608/abstract?rss=yesAbstract: Chemotherapy for cancer patients with chronic renal failure, undergoing hemodialysis (HD), has not been well established. A 78-year-old woman with chronic renal failure due to hypertensive nephropathy, undergoing HD, was diagnosed with small-cell lung cancer (SCLC) with multiple-organ metastases. She was treated with 4 cycles of carboplatin (CBDCA) and etoposide (ETP) chemotherapy and a partial response was achieved. She remained progression-free for at least 12 months after the completion of chemotherapy. Pharmacokinetic analysis (PK) revealed that both agents were rapidly eliminated by HD; however, the remnant platinum remained longer in the plasma. Chemotherapy with CBDCA and ETP was effective and could be safely administered to a patient with SCLC undergoing HD.Successful treatment with carboplatin and etoposide in a small-cell lung cancer patient undergoing hemodialysisYoung Hak Kim, Tadashi Mio, Yumi Hamamoto, Michiaki Mishima10.1016/j.rmedc.2009.05.006Respiratory Medicine CME 3, 2 (2010)Respiratory Medicine CME32S1755-0017(10)X0003-3Case Reports6870http://www.resmedcme.com/article/PIIS1755001709000591/abstract?rss=yesAbstract: A young Turkish woman presented with abdominal sepsis. Terminal ileal Crohn's disease was diagnosed on histology. She was treated with intravenous steroids and bowel resection but required multiple laparotomies for recurrent peritonitis. Isoniazid-resistant Mycobacterium tuberculosis was cultured from sputum. Treatment of tuberculosis was complicated by a long post-operative period of non-functioning bowel, which necessitated intravenous agents.Management of isoniazid-resistant pulmonary tuberculosis in patient with non-functioning bowel on the intensive care unitKatherine M. Coyne, Anton L. Pozniak10.1016/j.rmedc.2009.05.002Respiratory Medicine CME 3, 2 (2010)Respiratory Medicine CME32S1755-0017(10)X0003-3Case Reports7172http://www.resmedcme.com/article/PIIS175500170900058X/abstract?rss=yesAbstract: Chronic obstructive pulmonary disease (COPD) is present in 10.1% of the population and is the fourth leading cause of death in the United States while the prevalence of asthma in adults is 6.7%. Patients presenting to primary care offices with lower respiratory tract symptoms like dyspnea and wheezing are often diagnosed with COPD or asthma and started on treatment. There are uncommon conditions like Mounier-Kuhn syndrome (MKS) that can present with similar symptoms and it is important for the primary care physician to keep them in mind when evaluating patients. It is important to identify MKS, as early recognition can lead to better management and prevention of complications. We describe a case of an older gentleman with recurrent symptoms of shortness of breath and intermittent spells of productive sputum who was misdiagnosed with COPD for years. Our diagnosis was supported by a clinical history and confirmed by radiographic evidence.Mounier-Kuhn syndrome masquerading as obstructive lung diseaseAtman Shah, Abubakr A. Bajwa, Akram Khan10.1016/j.rmedc.2009.05.009Respiratory Medicine CME 3, 2 (2010)Respiratory Medicine CME32S1755-0017(10)X0003-3Case Reports7375http://www.resmedcme.com/article/PIIS1755001709000578/abstract?rss=yesAbstract: Appearance of new opacity on the X-ray may simulate a disease and lead to the battery of test to confirm the disease. We are reporting case report when the patient with pleural effusion presented with the new opacity on follow up chest X-ray.New opacitySaurabh K. Singh, Deepak K. Pandey, Zuber Ahmad, Rakesh Bhargava10.1016/j.rmedc.2009.05.005Respiratory Medicine CME 3, 2 (2010)Respiratory Medicine CME32S1755-0017(10)X0003-3Case Reports7677http://www.resmedcme.com/article/PIIS1755001709000554/abstract?rss=yesAbstract: Anastomosis of the tracheal ends requires sufficient mobilization of the trachea because excessive tension is the principal cause of anastomotic insufficiency. Several mobilization and release techniques can be used to reduce some of the anastomotic tension of the trachea. Of these, Montgomery's suprahyoid release technique is a surgical method that severs three muscles above the hyoid bone: the mylohyoid, geniohyoid, and genioglossus. Of these, we present the suprahyoid release technique here because we believe that it is superior to the other mobilization techniques, particularly supralaryngeal release. This is the first report to approach this subject from both anatomical and functional perspectives. In summary, we performed a tracheoplasty requiring a suprahyoid release for a 55-year-old female with adenoid cystic carcinoma as an oncologic emergency. We should master the supralaryngeal release, particularly wide resection of the trachea, because this technique provides sufficient mobilization, with no dysphagia or complications.Tracheoplasty using a suprahyoid release for adenoid cystic carcinoma: Report of an oncologic emergency caseMitsuhiro Kamiyoshihara, Toshiteru Nagashima, Takashi Ibe, Seiichi Kakegawa, Izumi Takeyoshi10.1016/j.rmedc.2009.05.010Respiratory Medicine CME 3, 2 (2010)Respiratory Medicine CME32S1755-0017(10)X0003-3Case Reports7881http://www.resmedcme.com/article/PIIS1755001709000542/abstract?rss=yesAbstract: Severe hypothyroidism is associated with a wide spectrum of pulmonary and cardiovascular disorders. However, it rarely presents with pleural effusion. A 57-year-old woman presented with a stroke and left-sided pleural effusion was suspected of having hypertensive cardiomyopathy. During the treatment with diuretics, her renal function deteriorated and she developed a complete respiratory insufficiency, which led us to the definitive diagnosis. Therapy with thyroid hormone resulted in significant clinical improvement and the pleural effusion disappeared. Myxedema is easily missed when myxedema and pitting edema are simultaneously present in one subject. Severe hypothyroidism should be considered in the differential diagnosis of unexplained pleural effusion.A 57-year-old woman with a stroke and left-sided pleural effusionKaren Fijlstra, Christian F. Melissant, Ivo van der Lee10.1016/j.rmedc.2009.05.003Respiratory Medicine CME 3, 2 (2010)Respiratory Medicine CME32S1755-0017(10)X0003-3Case Reports8284http://www.resmedcme.com/article/PIIS1755001709000530/abstract?rss=yesAbstract: Fixed drug eruption is a manifestation of T-cell mediated drug hypersensitivity. We report, clinically confirm and highlight the occurrence of a fixed drug eruption with cross-reactivity between structurally related, though distinctly classified, antibiotics frequently used in the treatment of cystic fibrosis.Fixed drug eruption: Aztreonam and ceftazidime cross-reactivity in cystic fibrosis, a case reportHywel L. Cooper, Chris Pickard, Henry Marshall, Mary Carroll, Peter S. Friedmann10.1016/j.rmedc.2009.05.008Respiratory Medicine CME 3, 2 (2010)Respiratory Medicine CME32S1755-0017(10)X0003-3Case Reports8586http://www.resmedcme.com/article/PIIS1755001709000529/abstract?rss=yesAbstract: The safety of bronchoscopy and specifically transbronchial biopsy has not been studied in patients with bronchiolitis obliterans. We discuss two patients with bronchiolitis obliterans as a complication of graft versus host disease following allogeneic stem cell transplant. Both underwent bronchoscopy and transbronchial biopsy, which was complicated by pneumothoraces. Patients with bronchiolitis obliterans have an increased risk of spontaneous air leak syndromes. Although no data exists regarding the safety of transbronchial biopsies in patients with airflow obstruction in general, they appear to have increased rates of pneumothoraces following transthoracic biopsies. It is important to consider the potentially increased risk of pneumothoraces when deciding to pursue bronchoscopy and transbronchial biopsy in patients with bronchiolitis obliterans.Bronchiolitis obliterans and the risk of pneumothorax after transbronchial biopsyShiva Rahmanian, Karen L. Wood10.1016/j.rmedc.2009.05.001Respiratory Medicine CME 3, 2 (2010)Respiratory Medicine CME32S1755-0017(10)X0003-3Case Reports8789http://www.resmedcme.com/article/PIIS1755001709000487/abstract?rss=yesAbstract: Idiopathic pulmonary hemosiderosis (IPH) is one of the rare causes of diffuse alveolar hemorrhage (DAH), and usually occurs in children. The mechanism underlying this disease development has not been defined. During the acute phase, death due to massive alveolar hemorrhage and subsequent severe respiratory failure with multiple organ failure often occurs. We report a case of IPH which occurred in an advanced-aged adult during following thyroidectomy for chronic thyroiditis. Following surgery this 83-year-old male developed acute onset dyspnea and pulmonary hemorrhage. In a search for underlying causes, no disorders were found and the only finding was the presence of anti-thyroid antibody. Systemic corticosteroid therapy was effective and he fully recovered. To our knowledge, this is the second documentation of IPH in association with chronic thyroiditis.Diffuse alveolar hemorrhage with chronic thyroiditis in an advanced-age adultMasanori Fujii, Nobuaki Miyahara, Yasushi Tanimoto, Nagio Takigawa, Masahiro Tabata, Arihiko Kanehiro, Katsuyuki Kiura, Mitsune Tanimoto10.1016/j.rmedc.2009.04.006Respiratory Medicine CME 3, 2 (2010)Respiratory Medicine CME32S1755-0017(10)X0003-3Case Reports9092http://www.resmedcme.com/article/PIIS1755001709000475/abstract?rss=yesAbstract: Background: There is an increasing use of positron emission tomography with [18F]fluoro-2-deoxy-d-glucose (FDG-PET) for differential diagnosis between lung malignancy and other pulmonary diseases such as infection. However, false-positive FDG-PET images mimicking lung cancer can occur in pulmonary infection.Objective: This study was to describe a case of cryptococcal pneumonia with false-positive FDG-PET image mimicking metastatic lung cancer.Patient and results: We analyzed the clinical features and chest CT and FDG-PET characteristics of a case of pulmonary cryptococcosis that was initially suspected to have lung metastasis of gastric cancer and treated by surgery. During a follow-up, the 49 years old, female patient with a 7-year history of gastric adenocarcinoma showed a 1.0-cm nodule in the right lower lobe of lung on her chest CT scan with an accumulation of FDG (SUV=4.5) on her PET image. With a clinical diagnosis of suspected lung metastatic cancer, the lung wedge resection was then performed. Histological analysis of the resected nodule confirmed a diagnosis of cryptococcal pneumonia.Conclusion: The FDG-PET image is not particularly helpful in segregating pulmonary infection from lung malignancy in certain cases. Surgical resection is recommended for both diagnosis and treatment of pulmonary cryptococcosis.A case of cryptococcal pneumonia with false-positive [18F]fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET) image mimicking lung metastatic cancerCheng Ji, Chunhua Ling, Bin Zhang, Haodong Xu10.1016/j.rmedc.2009.04.005Respiratory Medicine CME 3, 2 (2010)Respiratory Medicine CME32S1755-0017(10)X0003-3Case Reports9394http://www.resmedcme.com/article/PIIS1755001709000463/abstract?rss=yesAbstract: ‘Summer-type relapsing fever’ is the most prevalent form of hypersensitivity pneumonitis in Japan. It is usually caused by hypersensitivity to Trichosporon cutaneum – a seasonal mould which thrives in homes with damp, decayed wood, damp mats and bedclothes. The disease has been rarely described outside Japan. We report the first documented case of summer-type hypersensitivity pneumonitis in Europe – in this case caused by hypersensitivity to the mould Cladosporium herbarum.Summer-type relapsing fever (hypersensitivity pneumonitis) secondary to Cladosporium herbarum in the domestic environmentA. Dushianthan, C. Owen, A. Dawson, JH. Edwards, NK. Harrison10.1016/j.rmedc.2009.04.004Respiratory Medicine CME 3, 2 (2010)Respiratory Medicine CME32S1755-0017(10)X0003-3Case Reports9597http://www.resmedcme.com/article/PIIS1755001709000451/abstract?rss=yesAbstract: We report a rare case of chest tuberculoma with tumor-like appearance of which diagnosis was made by surgery. A 40-year-old woman presented to our hospital with a complaint of a right chest mass. Her past history was pulmonary tuberculosis. One year prior to this presentation, she was treated. Chest MRI revealed a solid and oval mass in the right lateral chest wall. Then, surgical resection was performed. Histopathological examinations revealed caseous necrosis, epithelioid cell granuloma, and multinucleated Langhans' giant cells, but no neoplastic cell was found. We confirmed that the mass was clinically compatible with tuberculoma. The characteristic presentation of the chest wall tuberculosis is abscess, which is frequently cystic, doughy, or soft. However, there is no report with chest wall tuberculoma as the initial presentation of tuberculous lesion arising in chest wall in a review of the English literature.Chest wall tuberculoma with tumor-like appearanceMitsuhiro Kamiyoshihara, Takashi Ibe, Yasuk Iwasaki, Atsushi Takise, Hideaki Itou, Izumi Takeyoshi10.1016/j.rmedc.2009.04.003Respiratory Medicine CME 3, 2 (2010)Respiratory Medicine CME32S1755-0017(10)X0003-3Case Reports98100http://www.resmedcme.com/article/PIIS175500170900044X/abstract?rss=yesAbstract: An accessory fissure not due to anomalous course of azygos vein in the right upper lobe is rarely documented. We report such an accessory fissure between the apical and posterior segments of right upper lobe through computed tomographic (CT) scan of chest in a case of chronic obstructive pulmonary disease. A contrast enhanced CT scan study of chest is useful to determine whether the accessory fissure in the right upper lobe is an azygos fissure or not.An unusual accessory fissure in the right upper lobeK. Gowrinath, Rahul Magazine, Chandrakant M. Shetty, Paresh Desai10.1016/j.rmedc.2009.04.007Respiratory Medicine CME 3, 2 (2010)Respiratory Medicine CME32S1755-0017(10)X0003-3Case Reports101102http://www.resmedcme.com/article/PIIS1755001709000438/abstract?rss=yesAbstract: Tracheal diverticulum is a rare clinical entity. It can be caused due to either congenital or acquired weakness of the tracheal wall. A tracheal diverticulum is usually asymptomatic or present with non-specific symptoms like pharyngeal discomfort and cough. Diagnosis is confirmed using computed tomography, showing the presence of paratracheal air collections. Sometimes, communication between tracheal lumen and cyst can be visualized. In general, conservative treatment of symptoms is proposed although there is no consensus about it. We report a case of a middle-aged man presenting with progression of chronic cough and recurrent respiratory infections. A diagnosis of tracheal diverticulum was made based on a computed tomography, revealing typical right-sided dorsolateral paratracheal cysts with suggestion of tracheal communication.A 64-year-old man with chronic cough and recurrent respiratory infectionsWelmoed Reitsma, Martin J. Visser, Folgert de Vries, Peter van Hengel10.1016/j.rmedc.2009.03.005Respiratory Medicine CME 3, 2 (2010)Respiratory Medicine CME32S1755-0017(10)X0003-3Case Reports103105http://www.resmedcme.com/article/PIIS1755001709000426/abstract?rss=yesABSTRACT: Background: A variety of severe clinical situations, such as organ failure, can determine low serum T3 state in euthyroid patients. Recently various low triiodothyronine (T3) states have been correlated with a poor prognosis in cardiac and respiratory patients. These conditions could have an important impact especially in hypothyroidism.Aim: We described one case admitted to our respiratory intensive care unit (RICU) in comatose state, suffering from acute respiratory failure due to pneumonia with untreated subclinical hypothyroidism complicated by low T3 state.Results: In this patient the treatment with levothyroxin alone was ineffective while replacement therapy with synthetic sodic liothyronine proved effective and lead to clinical improvement.Conclusion: The low T3 state is common in RICU patients and this finding could be very important in clinical practice especially when hypothyroidism might be complicated by low T3 state. This report suggest that in this case only the addition of T3 to T4 replacement therapy may improve clinical status.Hypothyroidism complicated by low T3 state: An issue in intensive care unitElvio Scoscia, Stefano Baglioni10.1016/j.rmedc.2009.03.004Respiratory Medicine CME 3, 2 (2010)Respiratory Medicine CME32S1755-0017(10)X0003-3Case Reports106108http://www.resmedcme.com/article/PIIS1755001709000414/abstract?rss=yesAbstract: Melioidosis is a rare infectious disease that is very prevalent in certain areas of the world, namely Thailand and certain parts of Northern Australia. There are only 29 cases being reported in the UK since 1988. With air transport industry getting more and more readily available and affordable, it is important to recognise this disease especially those who have recently travelled to those endemic regions. We report a case of a man who presented with pulmonary melioidosis after recent travel to Thailand.A case of pulmonary melioidosisJ. Lie, S. Maxwell, C. Keeling-Roberts, D. Dev10.1016/j.rmedc.2009.04.002Respiratory Medicine CME 3, 2 (2010)Respiratory Medicine CME32S1755-0017(10)X0003-3Case Reports109110http://www.resmedcme.com/article/PIIS1755001709000396/abstract?rss=yesAbstract: As compared to aspergilloma which is usually developed after complication of tuberculosis in India, endobronchial aspergilloma is a rare disease entity. We report a rare case of endobronchial aspergilloma which is presented radiologically as a solitary pulmonary nodule. A 24-year-old male presented to the Department of Tuberculosis and Chest Diseases with moderate to severe hemoptysis for the last three months. Chest X-ray (PA view) showed ill-defined homogenous shadow in the right upper zone. CECT Thorax review showed intrabronchial mass in the posterior segment of the right upper lobe. CT-guided FNAC was performed, which reveals Aspergillus hyphae mixed with sputum and necrotic material, without any evidence of malignancy. Fibreoptic bronchoscopy was done, it reveals a ball-like region, occluding partially, the lumen of the posterior segment of right upper lobe with hyperemia. The ball was movable. Biopsy was performed and it revealed a partially eroded lining of metaplastic squamous epithelium, overline of chronically inflamed granulation tissue and scar intermingled with fungal hyphae. Serological test for Aspergillus precipitin was positive. The ball was removed using forceps and basket. Endobronchial aspergilloma may be present as solitary pulmonary nodule on chest X-ray. Bronchoscopic and endobronchial biopsies are invaluable in the diagnosis of endobronchial aspergilloma.Endobronchial aspergilloma – Presenting as solitary pulmonary noduleMohammad Shameem, Rakesh Bhargava, Zuber Ahmad, Nazish Fatima, Abida Malik10.1016/j.rmedc.2009.03.006Respiratory Medicine CME 3, 2 (2010)Respiratory Medicine CME32S1755-0017(10)X0003-3Case Reports111112http://www.resmedcme.com/article/PIIS1755001709000384/abstract?rss=yesAbstract: Despite classical identification of immune response impairment in sarcoidosis, such as anergy to delayed skin tests, the characterization of contributing mechanisms are still uncertain and infectious events complicating the course of the disease are unfrequent. Rarely, additional quantitative T-cell defects are reported in association with the disease. Although mechanisms of lymphocyte disorders are unknown, lymphocytopenia is usually revealed by an opportunistic infection.We report the case of an 18-year-old man, with pulmonary sarcoidosis, treated by corticoids, who developed cryptococcal meningitis. A CD4+ T-cell defect was simultaneously discovered, which was not influenced by corticoid arrest, persisted following infection resolution and control of sarcoidosis. In vitro experiments were performed in parallel, demonstrating a restricted CD4+ T-cell proliferation hypo-responsiveness to both IL-2 and lectin. In addition, rhIL-2 subcutaneously administrated failed to restore peripheral T-cell count.A multi-visceral sarcoidosis associated to CD4-lymphocytopenia is rarely reported and highly demonstrative of the related risk for an opportunistic infection development. In context, the absence of lectin and IL-2 effects on in vitro CD4+ T-cell proliferation assays and the inefficiency of in vivo rhIL-2 on T-cell count have been infrequently reported and suggested the presence of a defective intracellular signaling pathway, responsible for T cell defect.Lymphocytopenia-associated sarcoidosis: CD4+ T-cell hypo-responsiveness to IL-2 and lectinNathalie Freymond, Christophe Malcus, Yves Pacheco, Gilles Devouassoux10.1016/j.rmedc.2009.04.001Respiratory Medicine CME 3, 2 (2010)Respiratory Medicine CME32S1755-0017(10)X0003-3Case Reports113115http://www.resmedcme.com/article/PIIS1755001709000323/abstract?rss=yesAbstract: A 21-year-old male, presented with dull aching chest pain, shortness of breath. CECT thorax reveals lobulated mediastinal mass containing soft tissue predominantly in superior and anterior mediastinum with a few foci of calcification seen along septae. CT guided FNAC was suggestive of teratoma. The patient underwent surgical resection.Mature mediastinal teratoma in adultMohammad Shameem, Syed M. Danish Qaseem, M. Azfar Siddiqui, Naveed Nazir Shah, Asrar Ahmad10.1016/j.rmedc.2009.02.009Respiratory Medicine CME 3, 2 (2010)Respiratory Medicine CME32S1755-0017(10)X0003-3Case Reports116117http://www.resmedcme.com/article/PIIS1755001709000311/abstract?rss=yesAbstract: Pulmonary hypertension is an increasingly recognised complication of sarcoidosis that arises from a variety of physiological mechanisms, including pulmonary fibrosis, granulomatous vasculitis, and circulating vasoactive mediators. We present the case of a young man with sarcoidosis complicated by fatal pulmonary hypertension due to extrinsic compression of the major pulmonary vessels by mediastinal granulomatous inflammation and lymphadenopathy.Pulmonary hypertension in sarcoidosis, caused by extrinsic compression of major pulmonary vesselsPaul Sexton, Margaret Wilsher, David Milne10.1016/j.rmedc.2009.02.008Respiratory Medicine CME 3, 2 (2010)Respiratory Medicine CME32S1755-0017(10)X0003-3Case Reports118119http://www.resmedcme.com/article/PIIS175500170900030X/abstract?rss=yesAbstract: Pleuropulmonary blastoma is a dysontogenetic neoplasm of childhood, histologically characterized by a primitive variably mixed blastematous and sarcomatous appearance. It presents a pattern of rapid growth and is associated with a poor prognosis. We report the case of a 13-month-old girl, consulting for wheezing, dyspnea and loss of appetite. Chest X-ray revealed a mediastinal deviation with a clear appearance of the right lung. Computed tomography showed a voluminous emphysematous bulla of the right lung and atelectasis of the lower lobe. The final diagnosis was made on the basis of histological features of a cystic tumour, showing blastematous elements associated with sarcomatous compound confirming the diagnosis of pleuropulmonary blastoma type I. Subsequent chemotherapy was performed. Four years after the operation, the child is well with no evidence of disease recurrence or metastasis.Pleuropulmonary blastoma: Cystic tumour misdiagnosed as an emphysematous bullaA. Chadli-Debbiche, E. Ben Brahim, R. Jouini, N. Labbene, S. Sayed, M. Ben Ayed, N. Kaâbar10.1016/j.rmedc.2009.02.007Respiratory Medicine CME 3, 2 (2010)Respiratory Medicine CME32S1755-0017(10)X0003-3Case Reports120122http://www.resmedcme.com/article/PIIS1755001709000281/abstract?rss=yesAbstract: A 24 years old female was presented with a 2 weeks history of fever (high grade), cough, fatigue, shortness of breath, chest pain right side and low back ache. Patient prefers to lie towards right side. CECT thorax reveals empyema thoracic with paravertebral extension. Patient was put on IV antibiotic according to culture and sensitivity. Clinical and Radiological improvement was evident after 1 week.Empyema thoracic presenting as low back acheMohammad Shameem, Nazish Fatima, Jamal Akhtar, Asrar Ahmad10.1016/j.rmedc.2009.02.005Respiratory Medicine CME 3, 2 (2010)Respiratory Medicine CME32S1755-0017(10)X0003-3Case Reports123124