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Primary Pulmonary Leiomyosarcoma : an Extremely Rare, Difficult-to-Manage Case of Lung Cancer Binharyanto, Adlan Pratama Binharyanto; Ngakan Putu Parsama Putra; Ungky Agus Setyawan; Dini Rachma Erawati; Hendy Setyo Yudhanto
Malang Respiratory Journal Vol. 5 No. 2 (2023): September Edition
Publisher : Universitaas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mrj.2023.005.02.05

Abstract

Background: Primary Pulmonary Leiomyosarcoma (PPL) known as <0.5% of total lung cancer. Histopathological examinations are the pillars of PPL diagnosis as clinical manifestations and radiological features are usually not specific. Treatments of PPL include surgical resection, radiotherapy, and chemotherapy. Case Illustration: A 51-year-old male, smoker, with a productive cough for 2 weeks, accompanied by chest pain, weight loss, and loss of appetite. Imaging studies showed a solid mass in the right lung, which was confirmed through bronchoscopy, cytology, histology, and immunohistochemistry evaluations. Bronchoscopy showed an intraluminal mass in the right main bronchus suggesting malignancy. Immunohistochemistry of Desmin and Smooth Muscle Actin, which were positive, confirmed the diagnosis of PPL of the right lung stage T4N1M1a IVA. Discussion: Surgical resection is the gold standard treatment for PPL whose clinical conditions and tumor spread still allowed for safe operation. Surgical resection did not undergo because already in stage IVA. Radiotherapy and chemotherapy can be added for patients who are unable to have surgery. There are no guidelines regarding chemotherapeutic regimens that are recommended for PPL. Cisplatin/carboplatin and etoposide are two chemotherapeutic agents that are commonly used in other variants of lung cancer. Cisplatin is successful in 5-23% of patients and etoposide is successful in 8%. Doxorubicin and ifosfamide are usually used for soft tissue sarcoma too. After administration of 4 cycles of carboplatin/etoposide, a chest CT scan with contrast recist shows the progression of PPL. Conclusion: Carboplatin and etoposide have been long used as therapy for lung cancer. Currently, available literature shows that their effectiveness in PPL is still considered low. Nevertheless, more studies are needed to further explore the possibilities of using carboplatin and etoposide in PPL patients. Keywords: chemotherapy, lung cancer, primary pulmonary leiomyosarcoma
Gene Muatatuion Changes in Adenocarcinoma Lung Cancer Patient With Left Pyopneumothorax Nurandhini, Marsha; Suryanti Dwi Pratiwi; Yani Jane R. Sugiri; Dini Rachma Erawati; Hendy Setyo Yudhanto
Malang Respiratory Journal Vol. 7 No. 1 (2025): March 2025 Edition
Publisher : Universitaas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mrj.2025.007.01.06

Abstract

Introduction: Adenocarcinoma is the most common subtype of lung cancer, around 40% of lung cancer cases worldwide. It’s specific to epidermal growth factor receptor (EGFR) mutation. Lung cancer can be risk factor and increases the mortality rate of pyopneumothorax (12.8% higher in cancer patients). Case Illustration: A 69 year old woman, non smoker, who is diagnosed with lung adenocarcinoma (Exon 18 and 21 mutation) in May 2021 and came to emergency room with complaints of worsening shortness of breath. Cloudy-yellow pleural fluid was drained during thoracocentesis procedure. Imaging study using thorax CT scan showed a left lung mass obliterating bronchial segments 1/2, 3 and left hydropneumothorax. The patient was later diagnosed with pyopneumothorax and thorax drain procedure was performed. Antibiotic therapy was based on culture result. Through a following ctDNA (circulating tumor DNA) test, the mutations change to Exons 19 and 20 T790M. Discussion: Pyopneumothorax in this patient can occur due to disorder in the integrity of the host defense mechanisms, which then develops infection in the pleural cavity. The T790M mutation is found in 50-60% cases that are resistant to tyrosin kinase inhibitors (TKI). Third-generation TKI is main option for this condition, however, platinum-based chemotherapy can be considered, as in the case above, where third-generation chemotherapy cannot be given due to limitation of insurance coverage. Conclusion: Lung cancer can be associated with occurance of pyopneumothorax. Genetic mutation changes can occur due to resistance mechanisms. Giving platinum-based chemotherapy can be considered in such cases. Keywords: lung adenocarcinoma, genetic mutation, pyopneumothorax
RADIOGRAPHIC APPROACH FOR EVALUATING LUNG ABSCESS IN A PATIENT WITH SYSTEMIC LUPUS ERYTHEMATOSUS Oktavinayu Sari Latif; Dini Rachma Erawati
International Journal of Radiology and Imaging Vol. 4 No. 01 (2025): International Journal of Radiology and Imaging
Publisher : Department of Radiology, Medical Faculty, University of Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.ijri.2025.004.01.1

Abstract

Systemic lupus erythematosus is a complicated autoimmune disease that presents in various organs, one of which is the lungs. We reported a 20-year-old female patient complaining of cough with phlegm, shortness of breath, chest pain radiating to the right shoulder, and a fever two weeks before admission. The patient was examined by thoracic radiography and thoracic CT scan with contrast. They found cavities with air-fluid levels and ground-glass opacity around them, with the results of sputum microbiological examination showing Klebsiella pneumoniae infection. The patient was then given antibiotic therapy. During an evaluation a month after therapy, the air-fluid level reduced, but the consolidation remained. The patient underwent sputum microbiological examination again and presented with MDR Klebsiella pneumoniae, which was then given therapy according to the results of antibiotic sensitivity. At the evaluation, the consolidation reduced, and the patient experienced clinical improvement. Risk factors for lung abscess in SLE patients are immune dysregulation, disease activity, and immunosuppressive therapy given to patients. Both conventional radiographs and CT scans have their place for approaching the diagnosis of lung abscesses in SLE patients. Thus, they should be performed to consider the appropriate management for SLE patients.
THE CORRELATION OF HEMOGLOBIN LEVELS AND EXTENT OF LESION IN THORAX RADIOGRAPHY EXAMINATION OF PULMONARY TUBERCULOSIS PATIENTS Muhammad Zacky Hafiyyan Maulana; Dini Rachma Erawati; Yuyun Yueniwati
International Journal of Radiology and Imaging Vol. 4 No. 01 (2025): International Journal of Radiology and Imaging
Publisher : Department of Radiology, Medical Faculty, University of Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.ijri.2025.004.01.3

Abstract

Hemoglobin is an important protein in erythrocytes that is useful for transporting oxygen throughout the body. Changes in hemoglobin levels are often associated with medical disorders, which are diagnostic indicators for several diseases, including pulmonary tuberculosis. Tuberculosis diagnosis is often carried out through a thorax radiography examination by looking at the extent of the lesion (minimal, moderate advanced, or far advanced). Low hemoglobin levels (anemia) are associated with biomarkers of tuberculosis severity. The objective of this research is to ascertain the correlation between hemoglobin levels and the extent of lesions in thorax radiography examination of patients with pulmonary tuberculosis. In this observational research, secondary data from patient medical records is analyzed. The subjects of this research were pulmonary tuberculosis patients at Dr. Saiful Anwar General Hospital, East Java, Indonesia. Using the Chi-square test, the data from 55 subjects were analyzed, and the findings showed a p-value < 0.001. With a p-value < 0.05, this research shows that hemoglobin levels are significantly correlated with the extent of lesions from thorax radiography examinations of pulmonary tuberculosis patients.
THE EVOLUTION OF RADIOLOGICAL IMAGES IN A 4-MONTH-OLD INFANT WITH CONGENITAL PULMONARY AIRWAY MALFORMATION: A CASE REPORT Sigiro, Rahel Margareth Febriana; Dini Rachma Erawati
International Journal of Radiology and Imaging Vol. 2 No. 01 (2023): International Journal of Radiology and Imaging
Publisher : Department of Radiology, Medical Faculty, University of Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776//ub.ijri.2023.002.01.2

Abstract

Congenital pulmonary airway malformation, formerly known as congenital cystic adenomatoid malformation, is a heterogeneous group of cystic and non-cystic pulmonary lesions marked with the overgrowth of primary bronchioles, which is associated with an abnormal bronchial tree that does not have cartilage. A 4-month-old boy came with a complaint of productive coughs since he was 3 weeks old, fever since the age of 2 months, and shortness of breath. The patient was once hospitalized due to pneumonia and suspected tuberculosis. After undergoing serial chest radiographs, the results showed multiple cysts that were dominant in the lower lobe of both lungs with surrounding infiltrates. Through the confirmation of a chest CT scan, there were small, multiple cysts with a size of <2 cm in both lungs, connected to the bronchial branch, accompanied by consolidation with an air bronchogram suggestive of type 2 congenital pulmonary airway malformation. Congenital pulmonary airway malformation is a rare case that usually requires serial chest radiographs to assist in the establishment of its diagnosis and a CT scan for a definitive diagnosis of its lesions. Keywords: CPAM, congenital, pulmonary malformation, imaging
CURVULARIA PULMONARY FUNGAL INFECTION ASSOCIATED WITH IMMUNOCOMPROMISED PATIENT: HOW CT SCAN COULD HELP IN MAKING DIAGNOSIS Kristina Paskalita Kero; Dini Rachma Erawati
International Journal of Radiology and Imaging Vol. 2 No. 02 (2023): International Journal of Radiology and Imaging
Publisher : Department of Radiology, Medical Faculty, University of Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776//ub.ijri.2023.002.02.5

Abstract

Pulmonary fungal infections can be found in immunocompetent and immunocompromised patients. The Curvularia species of fungi are rarely seen in humans. These fungi can be clinically significant and cause a range of disease processes, particularly in immunocompromised patients. We present a 24-year-old male patient diagnosed with SLE 5 years ago, complaining of fever five days before hospital administration concerning pneumonia. A CT scan revealed consolidation and multiple lung nodules compatible with a fungal pulmonary infection. The result of the sputum culture indicated Curvularia. A chest radiograph showed infiltrates with consolidation in the middle-lower lobes of both lungs. Early and second CT-scan findings revealed ground-glass opacity surrounding multiple irregular nodules (halo signs), cavitary nodules, and reverse halo signs. Afterward, the result of the patient’s sputum culture demonstrated fungal growth of the Curvularia species. The patient then underwent fungal treatment with fluconazole and voriconazole. The patient showed improvements, and a follow-up chest CT scan revealed the resolution of the lesion after fungal treatment. CT-scan examination, clinical condition, and microbiology culture can help diagnose Curvularia pulmonary fungal infection in immunocompromised patients.   Keyword: Phaeohyphomycosis; Curvularia; Halo sign; Reverse halo sign
Active Male Smoker with Active Pulmonary Tuberculosis, COPD, Covid-19, Klebsiella Pneumonia, Multiple Bullae and Secondary Bilateral Pneumothorax Mohammad Faridza Setyo Hadikusumab; Susanthy Djajalaksana; Rezki Tantular; Dini Rachma Erawati
Malang Respiratory Journal Vol. 7 No. 2 (2025): Volume 7 No 2, September 2025 Edition
Publisher : Universitaas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mrj.2025.007.02.02

Abstract

Introduction: The first reported case in the world of an active male smoker with active pulmonary tuberculosis, chronic obstructive pulmonary disease (COPD), Covid-19, Klebsiella pneumonia, multiple bullae and secondary bilateral pneumothorax. The clinical presentation of secondary bilateral pneumothorax is highly variable, ranging from mild shortness of breath to tension pneumothorax and can result in very severe conditions. This case report aims to discuss the clinical challenges, diagnostic, and treatment approach, as well as follow-up of a male smoker diagnosed with active pulmonary TB, COPD, Covid-19, Klebsiella pneumonia, multiple bullae, and secondary bilateral pneumothorax. Case: Patient’s history, physical examination, supportive examination, and management strategies were documented and analyzed. A 47-year-old male active smoker with a history of shortness of breath in the last 2 weeks which has gotten worse since the last 1 day. The patient came to Lawang Hospital, an x-ray showed left tension pneumothorax, then was referred to Saiful Anwar Hospital. CXR from Saiful Anwar Hospital shows bilateral pneumothorax with left tension pneumothorax. The patient underwent two chest tube insertions with an interval of 2 days between insertions. The covid-19 PCR results were positive. Sputum bacteriological test showed Klebsiella pneumoniae infection. Thorax CT-scan with contrast showed multiple cysts and bullae on bilateral hemithorax and bilateral ground glass opacity on tree in bud with suspected active pulmonary TB. The bacteriological examination for tuberculosis was negative with a suspicion of COPD due to an active smoking habit. The patient is still being treated with anti-tuberculosis drugs, antibiotics, and antivirals, and showed improvement. Conclusion: Cases of secondary bilateral pneumothorax with active pulmonary TB, COPD, Covid-19, Klebsiella pneumonia, multiple bullae in active smoking patients with subtle clinical features are quite rare, which frequently results in misdiagnosis during thoracic assessments and may exacerbate the patient's condition. Clinicians must remain vigilant for potential underlying diseases in such cases.