Pulmonary Academy

Patient A 64 years old heavy smoker man presented with progressively worsening dyspnea and productive cough over the preceding three months. Presentation Physical examination was unremarkable, and vital signs were stable. Chest CT demonstrated: Diffuse centrilobular emphysema; A spiculated mass in the right lower lobe (RLL); Mild bilateral lower-lobe reticulation Procedures Flexible bronchoscopy revealed mucosal thickening in the RLL bronchus. Endobronchial biopsy and bronchoalveolar lavage (BAL) were performed. Histopathological examination confirmed invasive adenocarcinoma. Plan The patient was referred to the oncology service for staging and further management.

#ABG #VBG

DDx: CPFE (Combined Pulmonary Fibrosis and Emphysema); PPFE (Pleuroparenchymal Fibroelastosis); Fibrotic Hypersensitivity Pneumonitis; Smoking-Related Interstitial Fibrosis (SRIF)

Patient A 73 years old man with 40 pack-year smoking history presented with progressive exertional dyspnea for one year, with noticeable worsening over the preceding three months. Presentation The patient was lean and comfortable at rest without apparent respiratory distress. Resting oxygen saturation was 86% on room air. Pulmonary function testing demonstrated a restrictive ventilatory defect. HRCT of the chest revealed diffuse emphysema, predominantly involving the upper lobes, along with multilobar pleural-based fibrotic, traction bronchiectasis and honeycomb changes predominantly in the upper lobes; enlargement of the pulmonary artery with PA/Ao ratio >1, suggestive of pulmonary hypertension. Echocardiography showed an ejection fraction of 45% and an estimated pulmonary artery pressure (PAP) of 47 mmHg. Serologic evaluation for connective tissue disease-associated interstitial lung disease was negative. Assessment The overall findings were most consistent with Combined Pulmonary Fibrosis and Emphysema (CPFE) with atypical upper lobe-predominant pleuroparenchymal fibrotic changes, complicated by pulmonary hypertension and chronic hypoxemic respiratory failure. Plan Long-term oxygen therapy was initiated. The patient was evaluated for antifibrotic treatment and pulmonary rehabilitation, with close follow-up for progression of interstitial lung disease and pulmonary hypertension.

#Spirometry #PFT #Respiratory_volume

#Iran #Homeland #IranMyLove 🏛 Shushtar Historical Hydraulic System: A Masterpiece of Ancient Engineering Located in southwestern Iran, the Shushtar Historical Hydraulic System is widely regarded as one of the most remarkable engineering achievements of the ancient world. Originating during the Achaemenid era and further developed under the Sassanian Empire, this sophisticated complex consists of dams, bridges, canals, tunnels, watermills, and irrigation networks designed to harness and distribute the waters of the Karun River. The system provided water for agriculture, powered industrial mills, and supported the growth of one of the region’s most important urban centers. At the heart of the complex is the Gargar Canal, an artificial waterway that diverts river water through an intricate network of tunnels and channels. Together, these structures transformed vast areas of arid land into fertile agricultural fields and demonstrated an extraordinary understanding of hydraulic engineering. In 2009, the Shushtar Historical Hydraulic System was inscribed on the UNESCO World Heritage List and recognized as a “masterpiece of creative genius.” More than 1,500 years after its construction, the system remains a testament to the ingenuity, innovation, and scientific knowledge of ancient Persian engineers—an enduring symbol of sustainable water management long before the modern era.

#COPD #Emphysema #Bullae Patient A 70 years old man, heavy smoker (35 pack-years), with known diagnosis of COPD on long-term bronchodilator therapy and home oxygen supplementation, presented with acute exacerbation of chronic respiratory symptoms, characterized by increased shortness of breath and increasing oxygen requirement. Chest CT demonstrated marked pulmonary hyperinflation with diffuse centrilobular emphysema. A giant bulla was identified in the right lower lobe (RLL). Plan The patient was managed as an acute exacerbation of advanced COPD with optimization of bronchodilator therapy, oxygen supplementation, and supportive care.

Teaching Points Post-tuberculous destroyed lung is an important late complication of pulmonary tuberculosis and may present decades after completion of treatment. Hemoptysis in these patients may result from chronic inflammation, bronchiectasis, or hypertrophied bronchial arteries.

#TB #Destructive_lung #Bronchiectasis Patient The patient was 73 years old man with history of successfully treated pulmonary tuberculosis 30 years earlier presented with hemoptysis till 3 days before admission. Chest CT scan demonstrated extensive right lung destruction consistent with post-tuberculous sequelae. Sputum examination for acid-fast bacilli (AFB smear) was negative. The patient received antibiotic treatment and supportive management, resulting in clinical improvement and resolution of hemoptysis.

#Gout subcutaneous tophi lesions in a man with gout

Educational points: Bilateral upper lobe mass-like lesions in elderly smokers should raise strong suspicion for primary lung malignancy. Poorly differentiated carcinoma is often associated with aggressive behavior and may require immunohistochemistry (IHC) for precise classification. Bronchoscopy with BAL and endobronchial/transbronchial biopsy remains an important diagnostic approach in centrally accessible lesions.

#Cough #Lung_mass #Bronchoscopy #Carcinoma Patient An 80-year-old woman with a history of hookah smoking presented with progressive dyspnea for the past 3 years, with worsening of symptoms during the last 3 months. Presentation Chest CT scan revealed bilateral upper lobe mass-like lesions. Procedures The patient underwent bronchoscopy. BAL and bronchial biopsy (BB) samples were obtained. Pathology Histopathologic evaluation of the specimens demonstrated poorly differentiated carcinoma.

#Asthma

#Iran #IranMyLove #Homeland

Teaching Points Recurrent respiratory infections since childhood should raise suspicion for an underlying cause of bronchiectasis. Negative sputum cultures do not exclude chronic airway infection; bronchoscopy may improve microbiologic yield. Pseudomonas isolation in bronchiectasis is associated with more severe disease, frequent exacerbations, and higher hospitalization risk. Hemoptysis in bronchiectasis is commonly related to active airway inflammation and infection.

#Bronchiectasis #Infection #Hemoptysis Patient The patient was 36 years old man with history of recurrent respiratory infections since childhood, who had two hospital admissions during the past year due to fever, productive cough, and hypoxemia. He presented with non-massive hemoptysis. Presentation Chest CT demonstrated multiple cystic bronchiectatic changes with mucus impaction in the RLL and ground-glass opacity in the LLL. One sputum culture was previously negative. Procedures Bronchoscopy revealed purulent secretions in the RLL and RML, with mild mucopurulent secretions in the LLL. Bronchial secretion culture was positive for Pseudomonas aeruginosa. Plan Findings were compatible with infected cystic bronchiectasis with Pseudomonas colonization/infection. Targeted anti-pseudomonal antibiotic therapy and airway clearance strategies were recommended. Further evaluation for underlying etiologies of bronchiectasis, including immunodeficiency disorders and primary ciliary dyskinesia, was considered.