A newborn boy with respiratory distress, an opacified left hemithorax, and a mediastinal shift

Article Abstract:

A case is described of a newborn boy admitted to the hospital with a mass in the left side of the chest and respiratory distress. The boy had been born the previous day in a different hospital. During pregnancy, the mother had high blood pressure, but the history of medications she used was not complete. She denied using drugs or alcohol or smoking during pregnancy. The baby was delivered vaginally at 37 weeks gestation. When he was brought to the hospital on the day after birth, he was placed in the special-care nursery and given oxygen for respiratory distress. Chest X-rays showed an opacity of the left lung and a shift of the mediastinum, the structure of tissues separating the lungs. Other examinations included listening to breath sounds and analysis of blood gases, as well as evaluation of heart function. Over the first several days in the hospital, his respiratory distress improved, but lung function did not become normal. One possible diagnosis was congenital lobar emphysema involving retention of fluid in the affected lung. Surgery was performed and a part of the left lung was removed. In response to this procedure, the rest of the left lung expanded, and the baby had a good recovery. Examination of the lung tissue removed showed an abnormal structure of the airways in part of the lung, which was diagnosed as polyalveolar lobe of lung. This condition is sometimes described as a type of congenital lobar emphysema, but whether it is truly emphysema is controversial. Seven months later, the infant was well, with normal lung function. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abnormalities, Causes of, Birth defects, Lungs, Lung, Respiratory distress syndrome, Alveoli

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A 57-year-old man with increasing dyspnea and a mediastinal mass

Article Abstract:

A 57-year-old man was admitted to the hospital for progressively severe dyspnea (difficulty breathing) and evident blockage of the windpipe (tracheobronchial obstruction). In childhood, he had recurrent episodes of inflammation of the pharynx (the air passage from the nose to the larynx in the throat), and did not have large reserves of breath. He smoked a pack of cigarettes a day from age 20, but was forced to quit after dyspnea developed at age 34. When he was 45 years of age an X-ray of the chest revealed a lesion in the right lower lobe of his lung. The dyspnea became worse during the next five years when examination by bronchoscope (an apparatus for inspecting the interior of the bronchi or branches from the lower windpipe into the lungs) revealed a fibrotic area around the main bronchus; surgery to free the bronchus was unsuccessful. Drug therapy with albuterol and theophylline was ineffective. Eventually CT scan, computerized tomography, performed a few months prior to this admission revealed a mass of calcium in a lymph node which was severely constricting the right bronchus. After further evaluation it was concluded that the patient was suffering from a very rare complication of an infection known as Histoplasma capsulatum, which is endemic to the great river valleys of the eastern and central U.S. where he was raised. The complication of fibrosing (or sclerosing) mediastinitis, also known as collagenosis, had caused the patient's debilitating symptoms. Surgery removed the calcified mass, and the patient recovered.

Complications and side effects, Histoplasmosis, Medical examination, Mark, Eugene J., Mediastinum, Nardell, Edward A.

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A 79-year-old woman with an osteolytic lesion of the spine and increasing paraparesis after a fall

Article Abstract:

A case of an unusual vertebral fracture in a 79 year-old woman who was admitted to the hospital because of pain in her back and increasing loss of neurologic control is presented. The patient had been in good health until she tripped and fell. Following this apparently mild injury she was unable to walk because of pain and so she was taken to a different hospital. She had a history of mild arthritis and diagnosed osteoporosis, decreased mineralization of the bones. She had suffered for more then 30 years with diabetes mellitus, but had only recently been treated with insulin. Diagnostic imaging by CAT scanning and magnetic resonance imaging, techniques for examining both the bone and soft tissues of her back, showed a clear fracture of her twelfth thoracic vertebra. The severity of the fracture relative to what appeared to be a very minor injury evoked much discussion, particularly concerning the possibility that the fracture and bone destruction might have been caused by a tumor. Following pathologic examination of injuries to the skeleton and microscopic evidence obtained following a bone biopsy, a definitive diagnosis of diffuse idiopathic skeletal hyperostosis or Forestier's disease was finally made.

Spinal osteophytosis, Anas, Peter P., Rosenthal, Daniel I.

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