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We are learners & Resident doctors in Respiratory Medicine & Radiology, sharing interesting cases fr

05/09/2025

"From Lung Disease Hunt to Airway Rescue: The CT Surprise"

65 year old female, was refered to PCCM OPD for suspicison for ILD. As part of her ILD work up, she was planned for a CT Thorax. The parenchyma showed typical features of UIP pattern, but on closer look, something was not right! A hyperdense structure was seen in the left main bronchus. On enquiry, the patient recollected that she had aspirated a chicken bone 4 years back, but did not tell anyone as she did not have any significant symptoms!
As the patient had an underlying ILD, we planned to remove the foreign body under conscious sedation using a flexible bronchoscopy.
HFNC was used to oxygenate the patient during the procedure.
Bronchoscopy confirmed the presence of the bone in left main bronchus. Using flexible forceps, the foreign body was grasped and removed slowly under vision.

Courtsey: Department of Pulmonary, Critical Care and Sleep Medicine, Safdarjung Hospital, New Delhi

09/08/2025

Thinking beyond the obvious!

We recently encountered this case
70/F, Ex smoker
Presented with history of shortness of breath and cough for 6 months. Patient was being treated as COPD elsewhere but had persistent symptoms despite bronchodilators. She was referred to Safdarjung hospital for further management. She underwent a CT thorax which showed left upper lobe collapse with an endobronchial mass.
Bronchoscopy was done and after clearing the secretions, a whitish lesion ? Foreign body was seen occluding the entire left upper lobe.
The lesion could be removed using just suction and after removing the lesion it was realized that it was a piece of peanut.
After the peanut was removed, mucus plug was cleared from lingual and post procedure X ray showed expanded upper lobe.
On enquiry, the patient could not recollect any episode of aspiration.

Learning Point:
- Not every case of breathlessness in an elderly smoker is due to COPD
- If no significant improvement is seen with bronchodilators, further evaluation for other etioligies should be done
- Complete armatarium of instruments should be kept ready for foreign body extraction, but sometimes simple suction can be the winning tool

Courtesy - Department Of Pulmonary, Critical Care and Sleep Medicine, Safdarjung Hospital

19/07/2025

Everything and anything can be tuberculosis!
Endobronchial tuberculosis (EBTB) is something which is usually missed and most patients present with complications like endobronchial stricture causing obstruction. Almost 20% to 50% of patients with pulmonary parenchymal TB have associated EBTB. Bronchoscopy and biopsy at the time of presentation of symptoms of TB is the diagnostic investigation for EBTB.
We recently came across this young female, underwent bronchoscopy for pulmonary TB and the endobronchial picture showed typical rice like nodules of EBTB.
Apart for standard ATT, role of corticosteroids in EBTB is currently controversial and needs large scale studies.

This is the question that I would like to ask my seniors/collegues – Have you ever used steroids for EBTB and what has been your experience?

Courtesy: Department of Pulmonary, Critical Care and Sleep Medicine, Safdarjung Hospital, New Delhi

22/08/2023

USG thorax has become an important part of POCUS (Point of care ultrasonography).
The algorithm to follow in USG thorax is depicted in image 1. This is called the BLUE protocol (Bedside lung ultrasound in emergency)
It's a quick and easy bed side tool to perform in patients who present with acute respiratory distress.
Image 2 shows a USG view of pleural effusion. Apart from the BLUE protocol, it's also important to evaluate patients for presence of pleural effusion and USG is a very sensitive investigation to pick up even minimal pleural collection

04/03/2023

Anthracotic pigments in smoker's airway as seen on bronchoscopy
.md

31/05/2022

Smoking ci******es has been associatef with a number of diseases - COPD, Asthma, cancers of the lung, oral cavity, larynx etc.
The most important step towards reducing the symptoms due to these diseases is to quit smoking.
All smokers should be encouraged to give up smoking and be refered to specialist to help with this difficult task.
***co ***coday ****ne

03/05/2022

World Asthma Day 2022
Even though many people are getting treated for asthma, breakthrough symptoms are common because of non compliance and the social stigma with the use of inhalers. But we need to spread the awareness that inhalers are infact life saving in asthma and social pressures should not discourage people from its use.

06/04/2022

Interesting case of Pulmonary alveolar proteinosis.
DDs of crazy paving on CT chest:
ARDS
Acute Lung Injury
Pulmonary alveolar proteinosis
Crytogenic organizing pneumonia
Lymphangitis carcinomatosa
Drug induced ILD
Radiation induced ILD

18/03/2022

Reading Chest X-rays carefully is very important for a Pulmonologist.
Basics can never be replaced😊

10/07/2021

A fluid mismatch crises
Management of fluid balance in ICU is very important. Accurate measuring of input anf output with monitering of central venous pressure is very critical, specially in patients on ventilators or post operative patients who are nil per oral

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