Journal of Bronchology & Interventional Pulmonology, 2016
Deployment of a bifurcation (Y) stent is often required in patients with airway obstruction or fi... more Deployment of a bifurcation (Y) stent is often required in patients with airway obstruction or fistulization near the tracheal carina. Herein, we describe our experience with placement of self-expanding metallic Y stents. This was a retrospective analysis of data of consecutive subjects who underwent placement of self-expanding metallic Y stent over 2 years at 6 different centers. We describe the technique, complications, and outcomes of metallic Y stent placement at the tracheal carina. Thirty-eight subjects (25 men) with a mean age of 54.8 years underwent Y stent placement. The most common underlying disease was carcinoma of the esophagus (65.8%). The most common indication for stent insertion was central airway obstruction in 30 (78.9%) subjects followed by airway-esophageal fistula. Respiratory failure was present in 17 (44.7%) subjects at admission. The Y stent was deployed using either the rigid (n=32) or the flexible (n=6) bronchoscope, and was successfully placed in 37 of the 38 (97.4%) subjects. There was rapid improvement in symptoms and subsequent resolution of respiratory failure after stent placement. There was no periprocedural mortality and few stent-related complications. On follow-up at 12 weeks, 18 patients had died due to progression of the underlying disease. The insertion of a metallic Y stent results in immediate palliation of malignant airway obstruction or airway fistulization near the tracheal carina with rapid improvement of symptoms.
Journal of Bronchology & Interventional Pulmonology, 2015
Evaluation of mediastinal lymphadenopathy in children is challenging and surgical procedures (med... more Evaluation of mediastinal lymphadenopathy in children is challenging and surgical procedures (mediastinoscopy/thoracotomy) are usually performed wherever tissue sampling is required. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a widely utilized and minimally invasive modality for evaluation of mediastinum (lymphadenopathy, masses, and nodal staging in patients with lung cancer) in adults. Smaller size of pediatric trachea potentially limits the use of EBUS. The EBUS bronchoscope can also be introduced into the esophagus for mediastinal evaluation and sampling, a technique described as transesophageal bronchoscopic ultrasound-guided fine-needle aspiration (EUS-B-FNA). We herein report the successful utilization of EUS-B-FNA to obtain diagnostic mediastinal lymph node sampling in a 3-year-old child. The procedure was accomplished under moderate conscious sedation without any procedural complications. EUS-B-FNA, by obviating entry of EBUS scope into small pediatric trachea and reduced anesthesia requirement can evolve into an extremely useful modality for evaluation of pediatric mediastinal lymphadenopathy.
A 35-year-old lady was seen in the outpatient clinic owing to fever, cough with mucopurulent expe... more A 35-year-old lady was seen in the outpatient clinic owing to fever, cough with mucopurulent expectoration, and breathlessness for the duration of 1 month. She had history of similar episodes treated with antibiotics four times during last 2 years. There was no history of recurrent sinusitis, diarrhea, and skin or soft tissue infection. She had no history of diabetes mellitus or steroid intake. She denied any history of facial trauma or dental infection in the past. There was no history of tuberculosis in her or in the family. Radiograph and CT scan of the chest revealed right upper lobe consolidation. Flexible fibreoptic bronchoscopy revealed multiple nodules at opening of right upper lobe bronchus. This clinicopathological conference describes the details of differential diagnoses, difficulties in achieving the final diagnosis and management of such patient.
Indian Journal of Pathology and Microbiology, 2015
Primary pulmonary leiomyosarcomas are rare and diagnostically challenging group of neoplasms appr... more Primary pulmonary leiomyosarcomas are rare and diagnostically challenging group of neoplasms approximately constituting 0.2-0.5% of all primary lung malignancies. They originate from the smooth muscle cells of the bronchial wall, blood vessels or from the pulmonary interstitium. Here we present a case of 45 year old male with history of chronic cough, breathlessness and chest pain for few months. Clinical and radiological workup showed a left upper lobe lung mass. Endobronchial ultrasound guided (EUS) needle biopsy of the mass on histopathology confirmed leiomyosarcoma. Further through evaluation ruled out the possibility of metastasis. A final diagnosis of primary leiomyosarcoma of lung was made and patient was planned for surgical management.
Page 1. Analgesia and Sedation in the ICU: clinical pearls on usage according to patient characte... more Page 1. Analgesia and Sedation in the ICU: clinical pearls on usage according to patient characteristics Julia Vu Doctor of Pharmacy Student Temple / VHUP Rotation Block Summer 2010 [email protected] Page 2. Sedation and analgesia: a ventilation case ...
We read with great interest the article by Almagro et al 1 in this issue of CHEST (see page 972 )... more We read with great interest the article by Almagro et al 1 in this issue of CHEST (see page 972 ). In this article, the authors proposed a new index for short-and intermediate-term prognoses among patients with COPD: the CODEX (comorbidity, obstruction, dyspnea, and previous severe exacerbations) index. However, a few important points should be highlighted before this index is accepted into clinical practice.
Tracheal penetration of esophageal self-expanding metallic stents (SEMS) with/without tracheoesop... more Tracheal penetration of esophageal self-expanding metallic stents (SEMS) with/without tracheoesophageal fistula (TEF) formation is a rare occurrence. We report the case of a 66-year-old female patient with advanced esophageal squamous cell carcinoma who had undergone palliative esophageal stenting on three occasions for recurrent esophageal stent obstruction. On evaluation of symptoms of breathing difficulty and aspiration following third esophageal stent placement, tracheal erosion and TEF formation due to the tracheal penetration by esophageal stent were diagnosed. The patient was successfully managed by covered tracheal SEMS placement under flexible bronchoscopy.
Benign endobronchial tumors are uncommon. Bronchoscopic removal is the preferred modality of trea... more Benign endobronchial tumors are uncommon. Bronchoscopic removal is the preferred modality of treatment although surgery may be required in some cases. Rigid bronchoscopy is usually recommended in the management of these tumors. However, flexible bronchoscopy is also used in many centers. We present a case of endobronchial lipoma, where an unusual complication during flexible bronchoscopic resection using snare forceps necessitated urgent rigid bronchoscopy. This case highlights the importance of rigid bronchoscopy in the management of endobronchial tumors. We believe that with a large benign endobronchial tumor in tracheal or main-stem bronchus, physicians should initially employ rigid bronchoscopy, switching to flexible if more peripheral treatment is required.
Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di clinica tisiologica e malattie apparato respiratorio, Università di Napoli, Secondo ateneo, 2011
Diagnostic and interventional radiology (Ankara, Turkey), 2009
Aspergillosis may complicate the course of a patient in an immunocompromised state. However, Aspe... more Aspergillosis may complicate the course of a patient in an immunocompromised state. However, Aspergillus infection is rarely encountered in an immunocompetent host. We present an extremely rare case of Aspergillus chest wall involvement associated with extensive mediastinal lymphadenopathy in an immunocompetent host. A chest wall lesion was the initial indication of underlying nodal disease. We highlight the importance of obtaining early tissue samples in these cases to enable prompt treatment.
A 52-year-old heavy smoker presented with history of abdominal pain of 2-month duration. He devel... more A 52-year-old heavy smoker presented with history of abdominal pain of 2-month duration. He developed cough and streaky haemoptysis for 15 days. Physical examination revealed mildly tender and enlarged nodular liver palpable upto the right iliac fossa. Contrast-enhanced CT examination of the thorax and abdomen (figure 1A) was performed which showed a right upper lobe lung mass (figure 1B) along with multiple variable-sized hypoechoic and cystic space-occupying lesions replacing the entire liver architecture (figure 1C). Serum transaminases and serum bilirubin were elevated 10-fold and 3-fold, respectively. Possibilities considered were hepatocellular carcinoma with pulmonary metastasis or extensive liver metastasis from primary lung carcinoma. Ultrasoundguided fine-needle aspiration cytology examination from the liver (figure 1D) confirmed the diagnosis of metastatic small cell lung cancer (SCLC). In view of poor performance status (ECOG-3), the patient's relatives refused chemotherapy and opted for best supportive care alone.
Journal of Bronchology & Interventional Pulmonology, 2016
Deployment of a bifurcation (Y) stent is often required in patients with airway obstruction or fi... more Deployment of a bifurcation (Y) stent is often required in patients with airway obstruction or fistulization near the tracheal carina. Herein, we describe our experience with placement of self-expanding metallic Y stents. This was a retrospective analysis of data of consecutive subjects who underwent placement of self-expanding metallic Y stent over 2 years at 6 different centers. We describe the technique, complications, and outcomes of metallic Y stent placement at the tracheal carina. Thirty-eight subjects (25 men) with a mean age of 54.8 years underwent Y stent placement. The most common underlying disease was carcinoma of the esophagus (65.8%). The most common indication for stent insertion was central airway obstruction in 30 (78.9%) subjects followed by airway-esophageal fistula. Respiratory failure was present in 17 (44.7%) subjects at admission. The Y stent was deployed using either the rigid (n=32) or the flexible (n=6) bronchoscope, and was successfully placed in 37 of the 38 (97.4%) subjects. There was rapid improvement in symptoms and subsequent resolution of respiratory failure after stent placement. There was no periprocedural mortality and few stent-related complications. On follow-up at 12 weeks, 18 patients had died due to progression of the underlying disease. The insertion of a metallic Y stent results in immediate palliation of malignant airway obstruction or airway fistulization near the tracheal carina with rapid improvement of symptoms.
Journal of Bronchology & Interventional Pulmonology, 2015
Evaluation of mediastinal lymphadenopathy in children is challenging and surgical procedures (med... more Evaluation of mediastinal lymphadenopathy in children is challenging and surgical procedures (mediastinoscopy/thoracotomy) are usually performed wherever tissue sampling is required. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a widely utilized and minimally invasive modality for evaluation of mediastinum (lymphadenopathy, masses, and nodal staging in patients with lung cancer) in adults. Smaller size of pediatric trachea potentially limits the use of EBUS. The EBUS bronchoscope can also be introduced into the esophagus for mediastinal evaluation and sampling, a technique described as transesophageal bronchoscopic ultrasound-guided fine-needle aspiration (EUS-B-FNA). We herein report the successful utilization of EUS-B-FNA to obtain diagnostic mediastinal lymph node sampling in a 3-year-old child. The procedure was accomplished under moderate conscious sedation without any procedural complications. EUS-B-FNA, by obviating entry of EBUS scope into small pediatric trachea and reduced anesthesia requirement can evolve into an extremely useful modality for evaluation of pediatric mediastinal lymphadenopathy.
A 35-year-old lady was seen in the outpatient clinic owing to fever, cough with mucopurulent expe... more A 35-year-old lady was seen in the outpatient clinic owing to fever, cough with mucopurulent expectoration, and breathlessness for the duration of 1 month. She had history of similar episodes treated with antibiotics four times during last 2 years. There was no history of recurrent sinusitis, diarrhea, and skin or soft tissue infection. She had no history of diabetes mellitus or steroid intake. She denied any history of facial trauma or dental infection in the past. There was no history of tuberculosis in her or in the family. Radiograph and CT scan of the chest revealed right upper lobe consolidation. Flexible fibreoptic bronchoscopy revealed multiple nodules at opening of right upper lobe bronchus. This clinicopathological conference describes the details of differential diagnoses, difficulties in achieving the final diagnosis and management of such patient.
Indian Journal of Pathology and Microbiology, 2015
Primary pulmonary leiomyosarcomas are rare and diagnostically challenging group of neoplasms appr... more Primary pulmonary leiomyosarcomas are rare and diagnostically challenging group of neoplasms approximately constituting 0.2-0.5% of all primary lung malignancies. They originate from the smooth muscle cells of the bronchial wall, blood vessels or from the pulmonary interstitium. Here we present a case of 45 year old male with history of chronic cough, breathlessness and chest pain for few months. Clinical and radiological workup showed a left upper lobe lung mass. Endobronchial ultrasound guided (EUS) needle biopsy of the mass on histopathology confirmed leiomyosarcoma. Further through evaluation ruled out the possibility of metastasis. A final diagnosis of primary leiomyosarcoma of lung was made and patient was planned for surgical management.
Page 1. Analgesia and Sedation in the ICU: clinical pearls on usage according to patient characte... more Page 1. Analgesia and Sedation in the ICU: clinical pearls on usage according to patient characteristics Julia Vu Doctor of Pharmacy Student Temple / VHUP Rotation Block Summer 2010 [email protected] Page 2. Sedation and analgesia: a ventilation case ...
We read with great interest the article by Almagro et al 1 in this issue of CHEST (see page 972 )... more We read with great interest the article by Almagro et al 1 in this issue of CHEST (see page 972 ). In this article, the authors proposed a new index for short-and intermediate-term prognoses among patients with COPD: the CODEX (comorbidity, obstruction, dyspnea, and previous severe exacerbations) index. However, a few important points should be highlighted before this index is accepted into clinical practice.
Tracheal penetration of esophageal self-expanding metallic stents (SEMS) with/without tracheoesop... more Tracheal penetration of esophageal self-expanding metallic stents (SEMS) with/without tracheoesophageal fistula (TEF) formation is a rare occurrence. We report the case of a 66-year-old female patient with advanced esophageal squamous cell carcinoma who had undergone palliative esophageal stenting on three occasions for recurrent esophageal stent obstruction. On evaluation of symptoms of breathing difficulty and aspiration following third esophageal stent placement, tracheal erosion and TEF formation due to the tracheal penetration by esophageal stent were diagnosed. The patient was successfully managed by covered tracheal SEMS placement under flexible bronchoscopy.
Benign endobronchial tumors are uncommon. Bronchoscopic removal is the preferred modality of trea... more Benign endobronchial tumors are uncommon. Bronchoscopic removal is the preferred modality of treatment although surgery may be required in some cases. Rigid bronchoscopy is usually recommended in the management of these tumors. However, flexible bronchoscopy is also used in many centers. We present a case of endobronchial lipoma, where an unusual complication during flexible bronchoscopic resection using snare forceps necessitated urgent rigid bronchoscopy. This case highlights the importance of rigid bronchoscopy in the management of endobronchial tumors. We believe that with a large benign endobronchial tumor in tracheal or main-stem bronchus, physicians should initially employ rigid bronchoscopy, switching to flexible if more peripheral treatment is required.
Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di clinica tisiologica e malattie apparato respiratorio, Università di Napoli, Secondo ateneo, 2011
Diagnostic and interventional radiology (Ankara, Turkey), 2009
Aspergillosis may complicate the course of a patient in an immunocompromised state. However, Aspe... more Aspergillosis may complicate the course of a patient in an immunocompromised state. However, Aspergillus infection is rarely encountered in an immunocompetent host. We present an extremely rare case of Aspergillus chest wall involvement associated with extensive mediastinal lymphadenopathy in an immunocompetent host. A chest wall lesion was the initial indication of underlying nodal disease. We highlight the importance of obtaining early tissue samples in these cases to enable prompt treatment.
A 52-year-old heavy smoker presented with history of abdominal pain of 2-month duration. He devel... more A 52-year-old heavy smoker presented with history of abdominal pain of 2-month duration. He developed cough and streaky haemoptysis for 15 days. Physical examination revealed mildly tender and enlarged nodular liver palpable upto the right iliac fossa. Contrast-enhanced CT examination of the thorax and abdomen (figure 1A) was performed which showed a right upper lobe lung mass (figure 1B) along with multiple variable-sized hypoechoic and cystic space-occupying lesions replacing the entire liver architecture (figure 1C). Serum transaminases and serum bilirubin were elevated 10-fold and 3-fold, respectively. Possibilities considered were hepatocellular carcinoma with pulmonary metastasis or extensive liver metastasis from primary lung carcinoma. Ultrasoundguided fine-needle aspiration cytology examination from the liver (figure 1D) confirmed the diagnosis of metastatic small cell lung cancer (SCLC). In view of poor performance status (ECOG-3), the patient's relatives refused chemotherapy and opted for best supportive care alone.
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Papers by Karan Madan