DZI19-45: Pulmonary Pathology Society 2019
From MGH Learn Pathology
Request details
- Request type Faculty
- Subspecialty Pulmonary Pathology
- Topic Pulmonary Pathology Society 2019
- Presenter Mino-Kenudson, Mari,MD
| Case | Clinical history | Requester |
|---|---|---|
| Case | Clinical history | Requester |
|
| 43-year-old woman with grey hair presented with progressive exertional dyspnea over the past 6 months; otherwise • healthy. She works at a tea shop. Her 39-year-old brother was recently diagnosed to have hypersensitivity pneumonitis and myelodysplastic syndrome. Her pulmonary function tests showed moderate restrictive ventilatory defect and Chest-CT scan with apical predominant subpleural and peribronchovascular consolidations and ground glass opacities. BAL revealed normal differential cell count and a transbronchial biopsy was non diagnostic. A diagnostic wedge biopsy was performed. | Em99 |
|
| 65-year-old woman presented with painful disability over left hip for months and imaging studies revealed a tumor over left hip in favor of solitary metastasis. In addition • chest CT also showed a 2.8 cm enhancing soft tissue lesion in right lower lung. The patient underwent wide excision of left acetabulum tumor and RLL lobectomy with lymph node dissection. | Em99 |
|
| 17 year-old-woman with no previous significant clinical history presented with rapidly progressive dyspnea on exertion in the past 3 months. Her chest CT scan revealed features of pulmonary hypertension and some patchy ground glass opacities. She developed acute right ventricular failure associated with severe pulmonary hypertension and pulmonary thrombosis 2 months after the presentation and combined lung and heart transplantation was performed. | Em99 |
|
| 65-year-old man with relapsed/refractory acute myeloblastic leukemia • with chemotherapy courses complicated by prior polymicrobial bacteremia and presumed multifocal fungal pneumonia • who received a non-myeloablative double donor cord blood transplant • followed by tacrolimus + methotrexate graft-versus-host-disease prophylaxis • complicated by BK viruria without viremia • discharged on neupogen and prophylactic acyclovir + posaconazole • with blood cell count recovery • who was admitted to the ED with neutropenic fever (101°F). He was administered meropenem and admitted to Liquid Oncology • where he was persistently febrile and neutropenic • with negative infectious workup. He became hypoxic • and chest CT showed multifocal pulmonary nodules suspicious for fungal pneumonia. Blood quantitative PCR for BK virus was positive but below the limit of quantification of the assay. His antibiotics were broadened to include vancomycin • azithromycin • and amphotericin. His hypoxia and fever progressively worsened • and he was transferred to the MICU • where he was intubated for hypoxic and hypercapnic respiratory failure. Despite aggressive resuscitation • vasopressors • and broad-spectrum antibiotic and antifungal therapy • he developed progressively worsening shock and hypoxic respiratory failure. Comfort measures were instituted and he passed away. An autopsy was requested. | Em99 |
|
| 78-year-old woman with never-smoking history and no notable past medical history presented with several months of cough. Imaging showed a 3 cm mass in the left upper lobe that was FDG-avid. | Em99 |
