A 42 year old lady presented with dyspnea and 3 episodes of hemoptysis since 1 day. Her chest radiograph revealed mild peripheral fibrosis & volume loss in right lung, subsequent HRCT confirmed the findings with additional diagnosis of absence of the right main pulmonary artery. This was further confirmed on digital subtraction angiography and the right lung was solely supplied by the systemic circulation. The conventional angiography did not demonstrate any active extravasation or blush to suggest active bleeder. Empirical embolization was not attempted due to a risk of pulmonary infarction. Patient was managed symptomatically and conservatively.This condition is important to recognize in the list of differential diagnoses for pulmonary artery abnormalities and any acquired causes of pulmonary vasculature obstruction must be ruled out on imaging modalities.

Sjögren’s syndrome (SS), which is characterized by lymphocytic infiltration of the exocrine glands, is the second most common multisystem autoimmune disease after rheumatoid arthritis. Pulmonary involvement ranges from 9% to 20% and it usually occurs as an airway disease or interstitial lung disease. Pulmonary arterial hypertension (PAH) is a very rare condition in SS. In SS-associated PAH, the functional class of patients is usually World Health Organization (WHO) Class III/IV and there is no specific treatment regimen. In addition to nonspecific medical treatment for PAH, treatment of the underlying disease and supportive therapy are important. The aim of this manuscript was to present a case of SS-related PAH (SRP) followed under bosentan and iloprost combination therapy.

Pulmonary artery dissection (PAD) is a rare condition that is usually observed in cases with underlying pulmonary arterial hypertension. However, there are several factors related to the etiology of the disease. Presently described is a case of PAD that developed secondary to trauma. A 42-year-old man presented with left chest pain after a fall from a height. His past medical history and physical examination were unremarkable except for pain in the left hemithorax. He had no other complaints. All routine laboratory blood tests were normal. A radiological examination revealed left hilar enlargement and lower lobe PAD. Medical treatment was prescribed. The general condition of the patient was good and as there were no other symptoms, a conservative approach was pursued. In this case, there was pulmonary hypertension, and it is thought that the trauma led to PAD. This is extremely rare in the literature.

Thoracic involvement in non-Hodgkin's lymphoma is generally seen as mediastinal-hilar lymphadenopathy or with pulmonary parenchymal involvement. Isolated chest wall involvement in non-Hodgkin's lymphoma is rare. Described here is the case of a patient with non-Hodgkin's lymphoma who had undergone excision and reconstruction and presented at the clinic with an infected mass lesion with a left anterosuperior location.

Although human beings have known of hydatid cysts for 2000 years, it is still an important public health problem even today, especially in areas where it is endemic. A 41-year-old male patient consulted the clinic with left back pain. A thorax computed tomography image showed a cystic, expanding mass in the 9th and 10th ribs and the vertebral transverse process, with apparent destruction. Costal hydatid cyst accounts for less than 1% of all cases. There were 38 cases reported in 1978 and 60 in 2010. Although it is endemic, there are few cases reported in our country. An unusual localization of hydatid cyst may lead to an incorrect or late diagnosis. Hydatid cyst should definitely be kept in mind in the differential diagnosis of all lesions, especially in areas where it is endemic.

The removal of foreign bodies from the pleural cavity via video-assisted thoracoscopic surgery (VATS) has seldom been reported in the literature. This is a description of the case of a 31-year-old female patient who presented with secondary pneumothorax due to a foreign body. The patient did not have any information about the foreign body. The metallic object was successfully removed with VATS, and it was discovered that the object was a broken injection needle. This inexplicable circumstance issue was referred to the legal department of the hospital. Videothoracoscopic removal is the safest procedure for intrapleural foreign objects.

Primary pleural liposarcoma is a rare tumor; only a few cases have been reported in the literature. Presently described is the case of a 77-year-old female with a right pleural-based tumor misinterpreted as loculated pleural effusion, who was suffering from chronic right-sided chest pain. Radical resection of the tumor was performed and revealed a well-differentiated pleural liposarcoma. This case is discussed with a review of the literature.

Pneumocystis pneumonia (PCP) is common among HIV patients, but it is rare in patients with autoimmune diseases such as systemic lupus erythematosus (SLE). Some of the risk factors related to PCP in SLE patients include a high steroid dose, greater disease activity, renal involvement, and lower lymphocyte and CD4+ counts. Described herein is the case of a 23-year-old female with SLE who was treated with high-dose steroid therapy. She was admitted to the clinic with a dry cough and a prolonged fever persisting since the tapering of the steroid dose. High-resolution computed tomography of the thorax revealed intraseptal thickening, subpleural nodules, and enlargement of the 4L, 6, and 7 lymph nodes. A laboratory examination of an induced sputum sample using polymerase chain reaction was positive for Pneumocystis jirovecii. Trimethoprim/sulfamethoxazole was administered for 14 days and clinical improvement was observed.

Pulmonary actinomycosis is a severe clinical condition that may cause death if unrecognized. It may occur in patients who were previously healthy or may develop in patients with chronic immunosuppressant conditions. Presently described is a rare case of massive pulmonary hemorrhage with a related angioinvasive Actinomyces infection. A 52-year-old formerly immunocompetent man was admitted to the hospital due to blood-streaked sputum. A computed tomography image of the thorax taken after the patient’s clinical status suddenly worsened revealed total collapse of the left lung. No tumoral lesion was observed, but extensive necrosis of the mucosa of both main bronchi with massive hemorrhaging in the left main bronchus was seen in an urgent bronchoscopy performed in the intensive care unit. A histopathological examination of the mucosal punch biopsy demonstrated aggregates of filamentous Gram-positive organisms indicating Actinomyces infection. Selective embolization of a branch of the feeding artery was successful to control the hemorrhage, but necrotizing pneumonia emerged and the patient could not be discharged from the intensive care unit. He was later lost despite 40 days of treatment with intravenous penicillin-G antifungal therapy. Pulmonary angioinvasive infections like actinomycosis must be kept in mind in the absence of bronchial carcinoma or other frequently encountered diseases in cases of massive pulmonary hemorrhage.

Right middle lobe syndrome (RMLS) is a rare but important clinical entity that is characterized by recurrent or chronic collapse of the middle lobe of the right lung, but which may also involve the lingula of the left lung. In this case report, a 52-year-old female presented with typical constitutional symptoms of tropical disease like cough, fever, and shortness of breath. Chest radiology documented RMLS and bronchoscopy was key to the evaluation of this case, as a sputum examination was inconclusive. Transbronchial needle aspiration (TBNA) of the lymph node and bronchoalveolar lavage (BAL) specimens were tested and Mycobacterium tuberculosis (MTB) of the hilar lymph nodes on the right side was confirmed using the GeneXpert MTB/RIF assay. Four anti-tuberculosis treatment drugs were initiated and maintained for a total of 8 months with steroids as an adjunct in tapering dosages for 4 weeks. Complete clinical and radiological recovery was documented and confirmed bronchoscopically. A high index of suspicion is important when managing RMLS cases and all possible measures should be taken to confirm diagnosis.

A tracheal-esophageal fistula (TEF) is a connection between the esophagus and the trachea. It may be congenital or acquired. TEF seen in adults is usually acquired. TEF is a life-threatening condition, and must be treated appropriately. This case report is a description of a case of TEF due to stent migration occurring after an Ivor Lewis operation and esophageal stent implantation.

Pneumomediastinum is defined as an abnormal accumulation of air within the mediastinum. It occurs most often when increased alveolar pressure leads to alveolar rupture, and less frequently when there is perforation of the tracheobronchial tree. Pressure gradients then allow air to spread via the fascia to the surrounding soft tissues, mediastinum, and/or retroperitoneum. This is a report of a case of pneumomediastinum following endobronchial ultrasound–guided fine needle aspiration (EBUS/TBNA) of the mediastinal lymph nodes, widely regarded as a safe procedure.

Small cell lung cancer and bronchopulmonary carcinoid tumors are the most common causes of an ectopic release of adrenocorticotropic hormone (ACTH) release. In this article, a patient with Cushing syndrome caused by an ACTH-releasing bronchial carcinoid tumor is presented. A 65-year-old female patient was admitted to the emergency service with the complaints of blurred consciousness and loss of speech, and was diagnosed with hypoglycemia, hypopotassemia, hypercortisolemia, and a high ACTH level. Magnetic resonance images (MRI) of the pituitary gland and the abdomen revealed no pathology. Since the pituitary MRI was normal, and her central/peripheral ACTH gradient was less than 2 in bilateral inferior petrosal sinus sampling, it was considered to be a case of ectopic ACTH release. A thorax computed tomography (CT) revealed a 12x10 mm subpleural nodule at the right upper lobe apical segment. Pathological fludeoxyglucose involvement was not observed in PET–CT imaging. The patient underwent video-assisted thoracoscopic surgery wedge resection under general anesthesia and was diagnosed with typical bronchial carcinoid based on a histological study. She was discharged (in that condition) on the fifth postoperative day. Although the survival rate in patients with ectopic Cushing syndrome caused by carcinoid tumor has been reported to be 70%, the prognosis in patients over 60 is worse. The surgical elimination of the source is the most significant step in treatment.

A 60-year-old male patient with a diagnosis of colon adenocarcinoma was admitted to the clinic with complaints of a cough and shortness of breath. A thorax computed tomography image of the right main bronchus taken during follow-up of the patient revealed an invasive mass lesion in the right hilar region. The patient was referred to the pulmonology department for evaluation in terms of a primary lung tumor. The patient underwent a bronchoscopy. A widespread endobronchial lesion beginning at the right main bronchus and intensifying at the entrance of the middle lobe was detected. Biopsies were performed in both bronchial trees. The biopsy results confirmed colon adenocarcinoma metastasis, which was supported by immunohistochemical findings. Since the radiological appearance resembled primary lung cancer and endobronchial metastasis of colon adenocarcinoma is rare, the outcome of the case was deemed appropriate.

Peutz-Jeghers syndrome (PJS) is a rare, autosomal dominant genetic disease. There is an increased prevalence of cancer in the PJS. A 48-year-old male patient with PJS was admitted to the clinic with bilateral consolidated areas in the thorax observed on a computed tomography image. A bronchoscopy revealed a tumorous lesion in the mucosa in the right upper lobe anterior segment. Pathological analysis of a sample led to a diagnosis of bronchioloalveolar carcinoma.

Pneumothorax is a rare entity in the course of sarcoidosis, yet the rupture of subpleural blebs or bullae or the necrosis of subpleural granulomas may be pathogenic agents responsible for spontaneous pneumothorax. In the case presented, there was intense initial pulmonary paranchymal involvement in the bilateral lung zones. Though there was a good clinical and radiological response to systemic corticosteroid therapy, unilateral pneumothorax occurred following 2 months of treatment. A tube thoracostomy and underwater sealed drainage was performed. This case is presented with a discussion of the literature as a rare example of sarcoidosis.

Pulmonary alveolar microlithiasis (PAM) is a rare, idiopathic lung disease that leads to alveolar deposition of calcium phosphate microliths. Most patients are asymptomatic, but radiological features are quite marked and are nearly pathognomonic. Bone scintigraphy can be useful in the detection of early pulmonary calcifications. The imaging findings of a 65-year-old male patient who was diagnosed with PAM are described in this report. He presented with nonspecific chest pain, shortness of breath, wheezing, and a cough ongoing for 4 years. There was fine reticular and nodular infiltration seen on a chest X-ray. Chest computed tomography images revealed bilateral, diffuse, fine, calcified interstitial nodules and nodular septal thickening in the middle and lower lung zones. A whole body bone scintigraphy with technetium-99m methylene diphosphonate (Tc-99m MDP) revealed bilateral, diffuse uptake in the pulmonary parenchyma.

Pleural involvement in nocardiosis is rare and usually accompanies pulmonary paranchymal involvement. In the case presented here, the patient had been treated with a systemic corticosteroid for a long time for temporal arteritis. He was continuing the treatment when he was referred to our clinic for a diagnosis of the pleural disease. Following a positive pleural culture result for Nocardia, trimethoprim/sulfamethoxazole treatment was initiated. Clinical and radiological improvement was observed with treatment. Pleural nocardiosis should be kept in mind in the differential diagnosis of cases of pleural effusion with an unknown origin, particularly among immunosuppressed patients.