Three subtypes of achalasia have been defined using esophageal manometry. Several studies have reported that symptoms are experienced differently among men and women, regardless of subtype. All subtypes could have some impact on the appearance of respiratory symptoms and lung complications due to compression of the trachea or aspiration of undigested food. The aim of this research was to analyze the differences in respiratory symptoms and radiographic presentation of lung pathology depending on the diameter and achalasia types. One or more respiratory symptoms were reported in 48% of 114 patients, and all of them had two or more gastrointestinal symptoms. The symptom score (SS) is statistically significant for the prediction of subtype 1 (area under the curve = 0.318; p < 0.001, cut-off score of 6.5 had 95.2% sensitivity) and subtype 2 (area under the curve = 0.626; p = 0.020, cut-off score of 7.5 had 93.1% sensitivity). The most common type was subtype 2 (50.8%), and although only 14 patients had subtype 3, they had the largest esophageal diameter (mean 5.8 cm). The difference in esophageal diameter was significant between subtype 1 and 3 (p = 0.011), subtype 2 and subtype 3 (p = 0.011). Nine patients (6%) had mega-esophagus (four patients in type 1, three in type 2 and two in type 3). More than half of all patients (51.7%) had at least one parenchymal lung change on CT scan. Recurrent micro-aspirations led to changes in the structure of the airways and lung parenchyma such as ground glass (GGO) and nodular changes (12%) and fibrosis (14.5%), and they had higher esophageal diameters (p < 0.001). Patients with chronic lung CT changes had significantly higher esophageal diameter than with acute changes (p < 0.001). Awareness of the association of achalasia and lung disorders is important in early diagnosis and treatment. More than half (57.5%) of patients with achalasia had some clinical and/or structural pulmonary abnormalities. All three subtypes had similar respiratory symptoms, meaning they cannot be used to predict the subtype of achalasia; on the contrary, SS can predict the first two subtypes. A higher diameter of the esophagus is associated with chronic structural lung changes. Although unexpected, the pathological radiological findings and diameter were significantly different in subtype 3 patients, but those parameters cannot lead us to a specified subtype.
Introduction. Intracavitary aspergilloma is the consequence of a saprophytic infection of the lung with cavitary disease. Pulmonary tumorlet are nodular proliferations of the neuroendocrine cells less than 5 mm in diameter. Both aspergilloma in the bronchiectatic cavity of the lung and pulmonary tumorlet has rare been seen. Case Outline. We present a 71-year-old woman with a medical history of recurrent pneumonia complicated with cough and hemoptysis. Computed tomography (CT) scan of the chest showed pulmonary soft tissue mass in the right lower lobe of the lung 42 ? 50 mm in diameter. Direct microscopy of the specimens of bronchioalveolar lavage showed spores of Aspergillus. Galactoman Ag test was also positive. Right lower lobectomy and mediastinal lymph node sampling was performed via thoracotomy. Pathohistological findings showed aspergilloma with the presence of pulmonary tumourlet and diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) in the lymphovascular spaces. Five years follow up showed no abnormalities on the CT scan, and the patient remained alive without medical problems. Conclusion. The concomitant occurrence of bronchiectasis, aspergilloma as well as precancerous lesions such as pulmonary tumourlet and DIPNECH is rare and further increases the risk of developing malignant tumors as well as recurrent infections. Therefore, surgical treatment can prevent the development of premalignant lesions and the occurrence of recurrent infections accompanied by dyspnea and hemoptysis as the main symptoms. The question of the connection between pulmonary tumourlet and chronic inflammatory lung diseases is raised. We hope that future researches will provide answers to this question.
Introduction/Objective. The systemic autoimmune diseases (SAD) can cause a variety of pulmonary and pleural abnormalities. The aim of this paper is to review clinical and radiological characteristics of a series of patients with systemic autoimmune disease hospitalized at a tertiary level facility. Methods. In this retrospective study, we reviewed the clinical and imaging findings in patients diagnosed with SAD at the Teaching Hospital of Pulmonology during a nine-year period. Results. The 84 patients group (mean age of 53.8 years) consisted of 64 women and 20 men. Fifty-eight out of 84 patients suffered from collagen vascular disease (CVD) and 26/84 had systemic vasculitis. Fatigue was a dominant symptom (75.8% in CVD, and 69.2% in vasculitis). Cough, hemoptysis, and fever were more frequent in patients with vasculitis. Fibrosis was the most common radiological manifestation of CVD (26/58), followed by pleural effusion (18/58) and consolidation (10/58). Irregular opacities were dominant radiologic finding in vasculitis (10/26), followed by nodules (8/26). Histological confirmation of systemic autoimmune disease was obtained in 28.6% patients, in 58/84 patients the diagnosis was based on positive serologic test and clinico-radiological manifestations, in two cases, on clinical and radiological features according to defined criteria. Conclusion. Pleuropulmonary manifestations of systemic autoimmune diseases are usually expressed in the sixth decade of age, predominantly in women. Clinical findings and positive serologic tests suggest diagnosis of systemic autoimmune diseases. Fibrosis is the most common radiologic pattern found in almost a half of the patients with CVD and irregular opacities are most common findings in vasculitis. [Project of the Serbian Ministry of Education, Science and Technological Development, Grant no. 175046]
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