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Background: Alpha-1 antitrypsin (AAT) deficiency is a genetic risk factor for chronic obstructive pulmonary disease (COPD) but prevalence data in acutely exacerbated Indian patients is limited. This study determined AAT deficiency rates and correlations with inflammation and lung function among hospitalized patients with COPD. Methods: A total of 106 patients hospitalized for acute COPD exacerbations were prospectively enrolled from June 2016 to February 2018 in Kerala, India, excluding any with known AAT deficiency. Serum AAT levels were quantified and correlated with C-reactive protein (CRP) levels as well as postbronchodilator spirometry. Results: Mean serum AAT level was 1.48 ± 0.27 g/L. No AAT deficiency cases were identified, although AAT and CRP both significantly increased during flares. AAT levels positively correlated with FEV1, FVC, and FEV1/FVC ratios. Patients with lower AAT had worse pulmonary status. Conclusion: Despite finding no AAT deficiency in this regional Indian cohort, further studies across expanded, more diverse populations are warranted to definitively establish prevalence nationwide. Temporal monitoring of AAT kinetics could help gauge exacerbation trajectories.

Wheeze as a respiratory symptom is commonly described in obstructive airway diseases. However, wheeze can occur in many other diseases apart from airway obstruction. Pulmonary embolism presenting as wheeze is not uncommon and clinician treating diseases with wheezing should be aware of the rarer conditions such as pulmonary embolism. Here, we present the case of a wheezing disorder treated as asthma initially and diagnosed with pulmonary embolism on a detailed workup due to poor clinical response.

Multiple cystic lung diseases represent a group of uncommon disorders that can present a diagnostic challenge due to their resemblance with much more common conditions such as cystic bronchiectasis. It is a common practice that cystic lung diseases without other systemic features are often diagnosed as bronchiectasis. This is very often encountered in conditions such as congenital pulmonary airway malformations. Ignorance about the existence of this lung condition can lead to missed or delayed diagnosis. High-resolution computed tomography of the chest helps to define the morphological aspects and distribution of lung cysts, as well as associated findings.

Hypersensitivity pneumonitis (HP), which is otherwise known as extrinsic allergic alveolitis, is a clinical syndrome characterized by diffuse interstitial involvement secondary to exposure to organic antigens. The diagnosis of HP relies on the clinical evaluation of a number of features, including a history of significant exposure to potentially causative antigens, physical examination, chest computed tomography (CT) scan appearances, bronchoalveolar lavage (BAL) lymphocytosis, and, in selected cases, histology. Now the entity is classified as nonfibrotic HP and fibrotic HP. Here we review the recent literature to highlight the new classification.

Signet-ring cell adenocarcinomas (SRCCs) are rare tumors that most commonly originate from the stomach, colon, or breast. Lung as a site of the primary signet-ring variant of adenocarcinoma is extremely uncommon. Primary SRCC of the lung is a highly aggressive variant of adenocarcinoma with characteristic clinicopathological features. Here, we present a case of a young female with a rapidly progressive tumor in the left lung with metastasis to the pleura, pericardium, and lymph nodes having a histopathological proof of primary adenocarcinoma with signet-ring features.

Bronchiolocentric interstitial pneumonia is a unique entity with few cases reported in the literature. It is characterized by the pattern of bronchiolocentric injury to the lung in the absence of known causes and its clinical presentation may mimic nonspecific interstitial pneumonia (NSIP) or chronic hypersensitivity pneumonia. It is considered an aggressive disease with a prognosis somewhere between idiopathic pulmonary fibrosis and NSIP. Here, we report a case of idiopathic bronchiolocentric interstitial pneumonia, which was initially suspected as chronic hypersensitivity pneumonitis, but histopathological features suggested predominantly bronchiolocentric inflammation and fibrosis.

Background: Tracheobronchial anomalies are rare clinical entities and often asymptomatic in nature. Some patients may experience symptoms such as cough, recurrent pneumonia, or hemoptysis. Tracheal bronchus is one of the rarer forms of tracheobronchial anomalies, which may be seen during routine bronchoscopy. Knowledge and understanding of tracheal bronchus is important for diagnosing symptomatic patients and performing certain procedures, including bronchoscopy and endotracheal intubation. Objective: The objective is to study the clinical profile, diagnosis, and management of tracheal bronchus detected during routine bronchoscopy in a tertiary care setting. Methods: This study was a retrospective analysis of hospital data of patients undergoing fiberoptic bronchoscopy for 2 years in a tertiary care setting. Results: There were 150 bronchoscopies performed during the period. A total of 42 anomalies were detected in 35 (23.33%) patients. Three patients had tracheal bronchus (2%). Conclusions: This retrospective study evaluated the presence of tracheal bronchus among patients who underwent bronchoscopy in a tertiary care hospital in Kerala, India. This study revealed that tracheal bronchus was present in 2% of all bronchoscopies done during that period.

Blunt chest trauma can injure ribs, vertebra, or sternum and, in turn, lead to lung injury of various severities. However, trauma to the scapula is very rare and it suggests heavy impact on the chest wall during fall. Here, we discuss a case of a traffic accident where multiple ribs and scapula on the right side are fractured. This, in turn, precipitated contusion of the lung.

Coronavirus disease 2019 after its origin in Wuhan, China, had spread globally and was declared as a pandemic by the WHO on March 11, 2020.? The WHO identifies it as a controllable pandemic with the key role existing in precautionary measures to curb the recent global crisis. The current diagnostic methodologies include the rapid antigen test, serology tests to detect antibodies, and the real-time polymerase chain reaction.? Anecdotal experiences have shown that imaging characteristics are crucial in the diagnosis and management of the disease as radiological evidence of disease appears before the clinical manifestations and evolves overtime as the disease progresses, which is useful in predicting the stage, severity, and prognosis of the disease. Owing to few specific features and early changes, computed tomography scan is more sensitive than a chest roentgenogram in highlighting these changes.

Subacute invasive pulmonary aspergillosis (IPA) is an indolent cavitating infectious process which can mimic other chronic lung infections such as tuberculosis. This usually occurs in mildly immunosuppressed individuals and clinically evolves over weeks to months. Radiological presentation is in the form of thick-walled cavity with or without mycetoma, fibrosis, and pleural invasion. Here, a case of subacute IPA in a middle-aged female with rheumatoid arthritis is reported, highlighting a rare radiological appearance.

A case of fever, cough, and hemoptysis in a young female which could not be diagnosed by routine investigations is presented here. Confirmatory diagnosis was established after a long period of 2 years. Difficulty in diagnosis itself points to a rare cause for this presentation. The case is presented here with expert comments from specialists working in related specialties.

Tuberculosis (TB) can affect various organs besides the lungs. Among the extrapulmonary sites, pleura and gastrointestinal tract are the second- and sixth-most common sites, respectively. Pleural involvement usually occurs in the form of pleural effusion, and the sites most commonly involved in gastrointestinal TB are the peritoneum and ileocecal area. Here we present an interesting case of a 23-year-old female who presented to the gastroenterologist with symptoms of dysphagia, regurgitation of food, and weight loss. Esophagogastro duodenoscopy showed an esophageal ulcer which was confirmed to be due to TB. Incidentally, this patient also had multiple pleural nodules due to TB. This case is unique since there is a simultaneous occurrence of two different sites of occurrence of extrapulmonary TB.

Background: Predictors of survival for interstitial lung disease (ILD) in the Indian population have not been studied. The primary objective of the study was to assess the Modified-Gender Age and Physiology (M-GAP) score to predict survival in patients with ILD seen in clinical practice. We also analyzed the role of demographic and radiological characteristics in predicting the survival of patients with ILD. Materials and Methods: In the ILD India registry, data were collected from 27 centers across 19 cities in India between March 2012 and June 2015. A single follow-up was conducted at 18 centers who agreed to participate in the follow-up in 2017. M-GAP score (range 0–5) was calculated with the following variables: age (≤60 years 0, 61–65 years 1, and >65 years 2), gender (female 0, male 1), and forced vital capacity% (>75% 0, 50%–75% 1, and >75% 2). A score of 0–3 and score of 4 and 5 were classified into Stage 1 and 2, respectively. Other predictors of survival, such as the history of tuberculosis, smoking, and the presence of honeycombing on computed tomography scan, were also evaluated. Results: Nine hundred and seven patients were contacted in 2017. Among them, 309 patients were lost to follow-up; 399 were alive and 199 had died. M-GAP was significantly associated with survival. Similarly, other predictors of survival were ability to perform spirometry (hazard ratio [HR]: 0.49, 95% confidence interval [CI]: 0.34–0.72), past history of tuberculosis (HR: 1.57, 95% CI: 1.07–2.29), current or past history of smoking (HR: 1.51, 95% CI: 1.06–2.16), honeycombing (HR: 1.81, 95% CI: 1.29–2.55), a diagnosis of connective tissue disease -ILD (HR: 0.41, 95% CI: 0.22–0.76), and sarcoidosis (HR: 0.24, 95% CI: 0.08–0.77). Conclusion: In a subgroup of patients with newly diagnosed ILD enrolled in ILD India registry and who were available for follow-up, M-GAP score predicted survival. Honeycombing at the time of diagnosis, along with accurate history of smoking, and previous history of tuberculosis were useful indices for predicting survival.

Congenital pulmonary airway malformations (CPAMs) are considered part of a spectrum of bronchopulmonary foregut malformations. Diagnosis is usually made during the antenatal or neonatal period, and is rarely diagnosed in adults. The spectrum of clinical presentations varies from asymptomatic cases to recurrent respiratory tract infections or respiratory insufficiency in adulthood. Here, we report the case of an adult female who presented with a history of recurrent respiratory tract infections since childhood. Radiological findings were in favor of bilateral CPAM. Bilateral CPAM in an adult patient is extremely rare, and it is mostly managed as bronchiectasis.

Context: Multiple environmental factors are associated with development of hypersensitivity pneumonitis (HP), and diagnostic algorithms for the diagnosis of HP have been proposed in recent perspectives. Aims: We analyzed the data of patients with HP from interstitial lung disease (ILD)-India registry. The analysis was performed to (1) find the prevalence of HP, (2) reclassify HP as per a recently proposed classification criterion to assess the level of diagnostic certainty, and (3) identify the causative agents for HP. Setting and Designs: This was a prospective multicenter study of consecutive, consenting adult patients with new-onset ILD from 27 centers across India (March 2012–April 2015). Materials and Methods: The diagnoses were based on prespecified working clinical criteria and multidisciplinary discussions. To assess strength of diagnosis based on available clinical information, patients with HP were subclassified into definite HP, HP with high level of confidence, and HP with low level of confidence using a recent classification scheme. Results: Five hundred and thirteen of 1084 patients with new-onset ILD were clinically diagnosed with HP and subclassified as HP with high level of confidence (380, 74.1%), HP with low level of confidence (106, 20.7%), and definite HP (27, 5.3%). Exposures among patients with HP were birds (odds ratios [OR]: 3.52, P < 0.001), air-conditioners (OR: 2.23, P < 0.001), molds (OR: 1.79, P < 0.001), rural residence (OR: 1.64, P < 0.05), and air-coolers (OR: 1.45, P < 0.05). Conclusions: About 47.3% of patients with new-onset ILD in India were diagnosed with HP, the majority of whom were diagnosed as HP with a high level of confidence. The most common exposures were birds, cooling devices, and visible molds.

Background: Pleural effusion is a common diagnostic dilemma for the pulmonologist. A histological diagnosis would many a time steer the way to an accurate diagnosis of the aetiologies of pleural effusions. This study has compared two methods for obtaining histological specimens in cases of undiagnosed pleural effusions. Aim: To compare the efficacy of closed pleural biopsy with Abrahm’s needle and medical thoracoscopic biopsy in the diagnosis of undiagnosed exudative pleural effusions at a tertiary care setting. Study Design: Randomized controlled study. Study Period: November 2008–October 2010. Methodology: All patients who were admitted with pleural effusions underwent a clinical workup for pleural effusions. Light’s criterion was used to differentiate between exudative and transudative pleural effusions. Those patients with exudative pleural effusions, who did not have a specific diagnosis, were included in the study. Fifty eight patients were included in the study and they were randomized into 2 Groups of 29 patients each. One group was subjected to medical thoracoscopic pleural biopsy and the other to closed pleural biopsy with Abrahm’s needle. Demographic, clinical and biochemical characteristics, diagnostic yields and the complications among the two groups were compared. Result: Medical thoracoscopy has a diagnostic yield of 86.2% with complication rate of 10.3% compared to 62.1% and 17.2% respectively in closed pleural biopsy group. Conclusion: Medical thoracoscopic pleural biopsy had a better diagnostic yield with a lower complication rate as compared to closed pleural biopsy with Abrahm’s needle.