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We report a case of intrathoracic malignant peripheral nerve sheath tumor in a 65-year old woman revealed after a few-month history of progressive dyspnea, appetite and body mass loss. The chest magnetic resonance (MR) examination revealed the presence of a large tumor occupying the mediastinum and a major portion of the right hemithorax. The diagnostic tumor sample was obtained by parasternal biopsy in local anesthesia. The surgical resection of the tumor could not be performed due to its excessive size, intrathoracic involvement and bad respiratory reserves of a patient. The chemotherapy and irradiation were performed as palliative measures. The lethal outcome appeared 10 months after the diagnosis was established.

Objective. The relationship between specific causative organisms and development of ARDS in pneumonia patients has not been explored. Several case reports have described the development of ARDS in patients with Legionella pneumonia. The aim is of this study was to determine frequency and outcomes of ARDS in patients with Legionella Pneumonia. Methods. A retrospective cohort study of patients with Legionella pneumonia hospitalized at two Mayo Clinic Rochester hospitals was conducted. To identify the patients with Legionella pneumonia we searched the Mayo Clinic Life Sciences System (MCLSS) database from 01/01/2003 to 12/31/2007. Electronic medical records of patients with active Legionella pneumonia based on positive cultures and/or urinary antigen were reviewed. ARDS was diagnosed on the basis of the criteria of the North American/European consensus conference definition. Results. We identified 15 patients with microbiologically proven Legionella pneumonia of whom 11 were admitted to the intensive care unit (ICU), 6 required mechanical ventilation and 5 met the criteria for ARDS. Age (median 42 vs. 50 years, p=0.32) and gender (4/10 vs. 1/5 female, p=0.60) were similar in patients with and without ARDS. Septic shock was present in 4 of the 5 patients with ARDS and only 1 without. Patients with ARDS had longer ICU length of stay (median 9 vs. 1 days, P=0.03). Only one patient (from the ARDS group) died in the hospital. Conclusion. In this retrospective study ARDS occurred in one third of patients with microbiologically proven Legionella pneumonia and was associated with prolonged length of ICU stay.

Acute lung injury and its more severe form acute respiratory distress syndrome (ARDS) are characterized by diffuse impairment of alveolocapillary membrane in the settings of different predisposing conditions such as sepsis, trauma and shock. Many intrahospital exposures, including aspiration, delayed resuscitation, high tidal volume mechanical ventilation and non critical use of transfusions may contribute or worsen ARDS. Therapy is targeted to treatment of predisposing condition, life supportive measures and prevention of nosocomial complications. Rigorous adherence to lung-protective mechanical ventilation is critical to prevent ventilator induced lung injury and decrease mortality. Although survival of ARDS patients has improved in the last decades ARDS mortality rates are still high and survivors encounter significant physical and psychological impairments