Pneumothorax occurs more frequently in people with Human immunodeficiency virus infection in comparison with the general population. In most cases it is secondary the underlying pulmonary disorder, especially pulmonary infections. Though Pneumocystis jiroveci pneumonia is most common pulmonary infection associated with pneumothorax, other infections, non-infective etiology and iatrogenic causes are also encountered. Pneumothorax in these patients are associated with persistent bronchopleural fistula, prolonged hospital stay, poor success with intercostal tube drain, frequent requirement of surgical intervention and increased mortality. Optimal therapeutic approach in these patients is still not well-defined.

Fungal pneumonia is classically found in neutropenic patients. There is increase in concern about this entity in nonneutropenic critically ill patients. Aspergillus is the main offending organism. Although Candida is frequently found in respiratory sample in intensive care unit (ICU) it is always colonization rather than pneumonia. Other than neutropenia, chronic obstructive pulmonary disease and long-term steroid use are the main risk factors for invasive pulmonary aspergillosis in an ICU setting. Treatment in a nonneutropenic patient is only considered if the culture of Aspergillus comes positive in respiratory sample in the background of risk factors.

Context: Etiology and clinical spectrum of mediastinal diseases are very wide. Clinico-radiological pattern of mediastinal diseases depends on the size, location and etiology. Hence, noninvasive approach to these cases sometimes leads to diagnostic dilemma. Aims: We performed a prospective study over a 1-year period with the objective of evaluation of diagnostic yields and risk of trans thoracic ultra sound (TTUS) and computed tomography (CT) guided fine-needle aspiration cytology (FNAC) and Tru-cut biopsy along with comparison of cost-effectiveness among mediastinal diseases where clinical and noninvasive imaging could not conclude the diagnosis. Materials and Methods: A prospective study of mediastinal diseases of the adult population without having any diagnosis admitted in a tertiary care hospital in Eastern India was performed after clearance of the ethical committee of the institute. Fifty cases of mediastinal diseases were seen during the study period. One patient sometimes had undergone more than one procedure. The choice of a procedure depended upon the location of the lesion, need of further detail and patient's financial status. During the calculation of diagnostic yield of procedure, conclusive results and concordant results to more invasive procedures were considered. Statistical Analysis Used: Statistical analysis was performed using MedCalc ^® Version 11.3.3.0 for analysis of data. Results: Among 50 patients TTUS guided FNAC were conducted in 26 (52%) occasions and CT guided FNAC were conducted in 26 (52%) occasions. TTUS guided Tru-cut biopsy were done in eight cases (16%), and CT guided Tru-cut biopsy were done in 32 cases (64%). CT guided Tru-cut biopsy had higher diagnostic yield (96.87%) than TTUS guided Tru-cut biopsy (75%). TTUS guided, and CT guided procedures had similar complication rates. Conclusion: Tru-cut biopsy if applicable is much superior to FNAC for a definite diagnosis of the mediastinal diseases. TTUS guided invasive procedures are very much cost-effective and comparable with CT guided invasive procedures in respect to risk and diagnostic yields.

Congenital cystic adenomatoid malformations (CCAMs), also known as congenital pulmonary airway malformation is a developmental, non-hereditary, hamartomatous abnormality of lung with unknown etiology. It is a rare disease with an incidence of 1 in 25,000 to 1 in 35,000. It is a disease of infancy with most of the cases diagnosed within first 2 years of life. We report autopsy findings of two fetuses with CCAM (Stocker Type I and IV) with brief review of literature.

Tuberculosis (TB) is a chronic granulomatous inflammation involving usually the lung parenchyma and hilar lymph nodes. Extrapulmonary involvement is seen in about 15-20% of all cases of TB (EPTB). But breast TB is rare form of EPTB. We present a case of an immunocompetent male presenting with tubercular mastitis associated with chest wall extension. The rarity of this case lies in the site of involvement (chest wall), the way of presentation, and because of the immunocompetent status of the patient.

Hypereosinophilia is a condition which coexists with a wide variety of allergic, infectious, paraneoplastic, and various systemic illnesses. These disorders may differ in severity varying from self-limiting to life-threatening on the basis of etiology. It is well-known fact that hypereosinophilia can occur in relation with a solid tumor; however, exact numbers of incidence are unknown. We present a case report of peripheral eosinophilia in a case of adenocarcinoma of the lung; a relation which is not frequently described in known literature.

Wegener's granulomatosis (WG) is an uncommon autoimmune disease with multi-system involvement that manifests as vasculitis, granulomatosis, and necrosis. While its standard form involves the upper and lower respiratory tracts and kidneys, it may essentially involve any organ. We present a case in a young female patient presenting with symptoms of cough with expectoration, fever, dyspnea and chest discomfort, having cavitating lesion in right upper lobe and nodule in left upper lobe with bilateral paranasal sinus involvement on computed tomography. Allergic rhino-sinusitis with pulmonary tuberculosis was suspected, and patient was investigated further. Upon further investigation, renal involvement was detected, and serology revealed cytoplasmic antineutrophil cytoplasmic antibody. WG was suspected and was proven by histopathology of nasal tissue which revealed necrotizing granulomas.

Pulmonary embolism (PE) and venous thrombosis is a common complication in lung cancer patients with a high misdiagnosis rate and high mortality. However, when an undiagnosed lung cancer patient presents as PE, cancer as a cause may not always be explored. We present a case of a young male patient presenting with venous thromboembolism causing massive pleural effusion, leading to the diagnosis of epidermal growth factor receptor mutation positive adenocarcinoma, showing good response to gefitinib therapy.

Tubercular splenic abscess is an extremely rare entity among immunocompetent individuals. Here we describe two cases of tubercular splenic abscess in immunocompetent individuals, the first had to undergo emergency splenectomy for pain abdomen. The second case presented with pyrexia of unknown origin where pus aspirated from spleen stained positive for acid fast bacilli. Both had favorable response to anti-tubercular therapy. Tuberculosis although uncommon should be kept as a differential diagnosis of splenic abscess presenting with pain abdomen or pyrexia of unknown origin with multiple hypodense lesions in spleen on imaging.

The chylothorax is not a common presentation, and bilateral chylothorax in patients with chronically high central venous pressure secondary to venous thrombosis is a rare in incidence. We reported a case of bilateral chylothorax in a patient of chronic deep vein thrombosis (DVT) in central veins with chronic thromboembolic pulmonary hypertension who presented with 2 weeks history of increased breathlessness, bilateral chest discomfort and weakness. Work-up with chest X-ray and ultrasonography-chest showed gross left sided and mild right sided pleural effusion, thoracocentesis was consistent with chylothorax. Contrast enhanced computed tomography-chest showed multiple collateral formation of left side subclavian vein, venous Doppler showed old DVT in right and left subclavian veins and two-dimensional echocardiogram showed finding of severe pulmonary hypertension. After 24 h of fasting and conservative management, pleural drain became clear and decreased in the amount. Patient's video assisted thoracoscopic surgery was done, and thoracic duct was ligated and cut down at diaphragmatic level and bilateral talc pleurodesis done. Patient improved clinically and radiologically.