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   Table of Contents - Current issue
Coverpage
July-December 2019
Volume 7 | Issue 2
Page Nos. 51-79

Online since Thursday, June 20, 2019

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REVIEW ARTICLE  

Management of parapneumonic effusion and empyema p. 51
Sarvinder Singh, Santosh Kumar Singh, Ajai Kumar Tentu
DOI:10.4103/jacp.jacp_24_18  
Parapneumonic effusions are pleural effusions that occur in the pleural space adjacent to a bacterial pneumonia. When bacteria invade the pleural space, a complicated parapneumonic effusion or empyema may result. Empyema is collection of pus in pleural cavity. If left untreated, complicated parapneumonic effusion/empyema leads to chronic encasement and pleural thickening. Simple parapneumonic effusions can be managed conservatively with appropriate antibiotics, but complicated parapneumonic effusions often require some kind of drainage along with antibiotics. Delay in treatment is associated with high morbidity and mortality. Clinically it is diagnosed with persistent fever, stony dull tender percussion, and absent breath sounds. Majority of cases are due to anaerobic infection. Gram-positive as well as Gram-negative organisms are also implicated. Many cases may have mixed organisms. Tuberculosis should be suspected if no organism is grown in empyema. Chest skiagram, thoracic ultrasound, and CT scan help in localization of effusion and detection of loculations. Confirmation is done by thoracocentesis and pleural fluid analysis, which shows exudate with polymorphonuclear leukocytosis. Management includes well-selected antibiotics and drainage by tube thoracostomy. Intrapleural fibrinolytics have been used in multiloculated complicated parapneumonic effusions with success. Advent of thoracoscopy and VATS has left very few cases requiring surgical decortication. Properly treated parapneumonic effusions have good prognosis.
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CASE REPORTS Top

Long-Standing Asymptomatic Neck Swelling Presenting With Cannonball Metastasis: An Unusual Case Report p. 59
Ruchi Arora Sachdeva, Sachet Dawar, Sunil Nagar, Deepali Parashar, R. K. Chandoke, Mukta Pujani
DOI:10.4103/jacp.jacp_2_19  
The purpose of this article is to report a case of a 38-year-old man with complaint of dry cough. The physician noticed a neck swelling that was never investigated because it did not cause any serious trouble to the patient. Diagnostic workup revealed primary follicular thyroid carcinoma with cannonball secondaries in lungs, contrary to female and elderly age group preponderance.
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Successful treatment of bronchorrhea with gefitinib in a patient with bronchioloalveolar cell lung carcinoma p. 63
Sibes Kumar Das, Bhaswati Ghoshal, Anirban Das
DOI:10.4103/jacp.jacp_3_19  
Bronchorrhea is defined as production of more than 100 mL watery sputum per day. Although found in several diseases and disorders, it is classically described in bronchioloalveolar cell lung carcinoma. It hampers the quality of life of the patient with lung cancer. Several treatment options are available for relief of this distressing symptom; however, none of them are effective in all cases. We herein report a case of a female with bronchioloalveolar cell lung carcinoma who presented with bronchorrhea. She showed dramatic symptomatic improvement with therapy with gefitinib.
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Bronchioloalveolar Carcinoma: A Case Series p. 66
Saurabh Karmakar, Ronal Naorem, Mohd H.G Ansari, Zafar Neyaz, Hira Lal, Alok Nath
DOI:10.4103/jacp.jacp_22_18  
Bronchioloalveolar carcinoma (BAC) is a rare subtype of adenocarcinoma of lung with distinct features and distinctive characteristics. We present a case series of four patients of BAC who underwent evaluation for nonresolving pneumonia. All the patients were nonsmokers and ranged in age from 25 to 78 years. BAC was suspected because of characteristic clinicoradiological features, and the analysis of fine-needle aspiration biopsy specimen confirmed the diagnosis. Clinicians should be aware of this presentation of BAC, which would lead to early detection and improved outcome.
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Valproic acid-induced diffuse alveolar hemorrhage: a rare case report from South India p. 70
Priyadarshini Raykar, Eti Ajit, Anup Banur, Kushal Bondade
DOI:10.4103/jacp.jacp_26_18  
Valproic acid (VPA) is an antiepileptic drug that is widely used in various seizure disorders both in adults and in children. Hematological and coagulation abnormality is a well-known adverse effect associated with VPA. However, VPA-induced diffuse alveolar hemorrhage is a rare entity. We are reporting one such case of VPA-associated diffuse alveolar hemorrhage.
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Autobullectomy: A rare case of spontaneous resolution of infected giant bullae p. 74
Shubhra Jain, Vinod Joshi, Jitendra Kumar Sharma
DOI:10.4103/jacp.jacp_20_18  
Introduction: Bullous lung disease is a common presentation in patients with chronic obstructive pulmonary disease (COPD). The giant pulmonary bulla occupies one third of involved hemithorax and characterized by the existence of centrilobular emphysema in non bullous lung. Sometimes air reabsorbs spontaneously leading to shrinkage and regression of bulla known as autobullectomy. Mechanism of autobullectomy remains unclear. Here, we report a patient with infected bulla who experienced complete resolution after antifungal treatment. Case History: A 63 year old mal with history of twenty pack years of tobacco smoking came to the pulmonary outpatient department with complains of left side chest pain, cough with mild expectoration and low grade fever since five days. Patient also had blood tinged sputum since three days. His chest X-Ray PA view showed a thin walled cavity with air fluid level on the left upper zone with a few calcified parenchymal foci. Patient had symptomatic improvement after two weeks of antifungal treatment. Repeat skiagram chest and CECT chest showed complete resolution of bulla. Discussion: There are two hypotheses which can explain occurrence of bulla: Conclusion: Spontaneous resolution of giant bulla also known as autobullectomy is an ignorant event and follows an infection trigger. The early suspicion and diagnosis by the treating physician can avert the need for a surgical bullectomy in these patients and decline the morbidity and mortality. Our case is of interest not only because of the rarity with which spontaneous regression has been reported in the literature but also because the source of infection was fungal.
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CHEST IMAGE Top

Water lily or Camelotte sign in pulmonary hydatid cyst − an orphan disease p. 76
Sudheer Tale, Soibam Pahel Meitei, Mrudula Kolli
DOI:10.4103/jacp.jacp_23_18  
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LETTER TO EDITOR Top

Primary pulmonary synovial sarcoma: is it worth all the hard work? p. 78
Mahmood Dhahir Al-Mendalawi
DOI:10.4103/jacp.jacp_10_19  
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Preferred healthcare destination for tuberculosis care p. 79
Sora Yasri, Viroj Wiwanitkit,
DOI:10.4103/jacp.jacp_12_18  
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