Pneumothorax is a relatively common clinical problem which can occur in individuals of any age. Irrespective of aetiology (primary, or secondary to antecedent lung disorders or injury), immediate management depends on the extent of cardiorespiratory impairment, degree of symptoms and size of pneumothorax. Guidelines have been produced which outline appropriate strategies in the care of patients with a pneumothorax, while the emergence of video-assisted thoracoscopic surgery has created a more accessible and successful tool by which to prevent recurrence in selected individuals. This evidence based review highlights current practices involved in the management of patients with a pneumothorax.
We present details of a man who was originally diagnosed with sarcoidosis, based on a combination of nodal granulomatous inflammation and radiology confirming bilateral hilar lymphadenopathy with pulmonary infiltrates. The patient subsequently developed splenomegaly and idiopathic thrombocytopenic purpura (ITP) and, latterly, a severe cavitating pneumonia. Serum immunoglobulins were checked, confirming panhypogammaglobulinaemia, and his diagnosis was revised to common variable immune deficiency (CVID). CVID is a heterogeneous condition, which can mimic sarcoidosis with granulomatous organ involvement and is commonly complicated by autoimmune disorders, including ITP. Prompt recognition is important to allow early introduction of immunoglobulin replacement therapy to decrease infection frequency, reduce development of secondary disease complications and retard progression of tissue damage. Given the potential for misdiagnosis and delay in recognition of CVID, serum immunoglobulin measurement should be a first-line investigation in patients with suspected sarcoidosis, even if the presentation is ‘typical’. Current international sarcoidosis guidelines should be revised accordingly.
Background: Distinguishing between a bullae and pneumothorax can sometimes be difficult especially in the absence of pre-existing lung disease, leading to inappropriate intervention. Case presentation: We report the case of a well 32-year-old male who presented with a year's history of insidious onset breathlessness. A routine chest radiograph was thought to show a large pneumothorax. He had chest drains placed with no radiological improvement. A VATS procedure revealed a giant bulla. Conclusion: This case highlights the importance of correlating clinical assessment with radiological findings. Early CT imaging should be considered prior to pleural intervention in clinically stable patients.
Our case report describes an unusual cause of a mediastinal mass. The patient is a current smoker with a background of neurofibromatosis (NF) type 1 who presented with a right apical mass. Initial investigations suggested a probable malignant cause. The final diagnosis was one of a haematoma from a ruptured thyrocervical aneurysm. The association between neurofibromatosis and vascular aneurysms is an often unrecognised but documented phenomenon. We would like to raise an awareness of this infrequent presentation, as it is associated with a high mortality and may be prevented by early diagnosis.
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