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The ectopic adrenocorticotropic hormone (ACTH) syndrome is an uncommon cause of hypercortisolism, which should be considered in patients with hypokalemic metabolic alkalosis and hypertension in the context of lung neoplasm. We report a 60-year-old male patient with severe hypertension, metabolic alkalosis, and hypokalemia as the initial manifestations of an ACTH-secreting small cell lung carcinoma. Ectopic Cushing's syndrome should always be ruled out in patients with severe hypertension and hypokalemia.

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Urinothorax is classically described as the formation of urinoma as a result of retroperitoneal leakage and accumulation of urine in the pleural cavity. Since respiratory manifestations could be uncommon or rare and dominated by urological signs, which could be due to secondary or obstructive uropathy; the diagnosis of urinothorax warrants high clinical suspicion. We report such an uncommon case of urinothorax in a patient with chronic kidney disease admitted to a tertiary industrial hospital and treated successfully. Increased awareness among the physicians of such a rare clinical entity may facilitate prompt diagnosis and appropriate clinical management.

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Reexpansion pulmonary edema is an uncommon complication of the treatment of lung atelectasis, pleural effusion or pneumothorax and pathogenesis is unknown. An elderly male patient presented to us with right-sided pleural effusion. 2 h after thoracentesis, he felt chest discomfort and increased breathlessness. His chest examination showed right-sided crackles. Chest radiograph showed right-sided heterogeneous opacity in right lower zone consistent with unilateral pulmonary edema. He was managed conservatively along with bilevel positive airway pressure ventilator support. His condition improved gradually and was discharged successfully after 2 days.

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Enlargement of the mediastinal lymphatic glands is a common presentation of intrathoracic tuberculosis (TB) in children. However, usually, the mediastinal TB nodes enlarge to 2.8 ± 1.0 cm. In this report, we describe a case of anterior mediastinal lymphnode TB seen as huge mass (7 cm) on computed tomography (CT) thorax without respiratory or food pipe compromise despite anterior mediastinum being an enclosed space. CT guided biopsy of the mass cultured Mycobacterium TB complex which was resistant to isoniazide, rifampicin, streptomycin ofloxacin, moxifloxacin, and pyrazinamide. Hence, we report primary multi drug resistant TB presenting as anterior mediastinal mass as a rare case report.

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Contrast-enhanced multidetector computed tomography scan is most widely used technique in the assessment of various thoracic pathologies. The role of triphasic study in the evaluation of abdominal pathologies, mainly liver, is well-known, but for chest pathologies are not yet well-established. We report a case of cirrhosis of the liver with the mediastinal lesion, investigations done for diagnosis and role of multiphasic study in picking up final diagnosis. Hence, it is suggested, even though, multiphasic study is not routinely done, sometimes it will be helpful in the diagnosis of tricky chest lesions.

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A 36-year-old previously healthy male presented with subacute onset of shortness of breath and chest pain. He was diagnosed with bilateral extensive pulmonary embolism (PE). In the absence of any predisposing factors, an extensive workup for unprovoked thrombophilia was done. During the course of his illness, the patient developed anasarca and was diagnosed to be suffering from nephrotic syndrome (NS), secondary to membranous glomerulopathy. Although, thrombotic complications are commonly associated with NS, it is unusual for PE to be the primary presenting feature in these patients.

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Neurogenic pulmonary edema (NPE) is defined as acute pulmonary edema after a sudden neurologic insult. It develops after a significant central nervous system insult such as trauma, hemorrhage or seizures and can occur both in adults and children. A 6-year-old male child, known case of cerebral palsy was brought to the emergency department in status epilepticus. He had severe respiratory distress with pink frothy secretions pouring from the mouth. Clinical and radiological examination was suggestive of NPE. Child was immediately ventilated and all supportive measures were started. Child showed marked improvement within 48 h of admission with diuresis and positive end-expiratory pressure (PEEP) assisted ventilation.

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Linezolid (Lnz) is the first oxazolidinones to be developed and introduced in clinical use. Its use is growing by day and day in the treatment of resistant pulmonary tuberculosis (TB). Lnz has been associated with adverse hematological effects, primarily thrombocytopenia. But pancytopenia is a very rare complication. Myelosuppression is a rare and a serious side effect of Lnz. Here, we present a case of extensively drug-resistant pulmonary TB, which was started on Lnz. Patient returned 1-month back with clinical presentation suggestive of pancytopenia which was confirmed on bone marrow aspiration and was attributed to the use of Lnz. Patient improved on stopping the Lnz and adding steroid for a short course. This case report emphasizes the importance of both the use of Lnz for well-defined indications and appropriate hematological monitoring during the course of treatment.

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Connective tissue diseases (CTDs) (or collagen vascular diseases) represent a heterogeneous group of immunologically mediated disorders that affects many organs of the body including pleura. Frequency, presentation, and prognosis of pleural involvement depend on the underlying CTD. Connective tissue disorders may be heritable such as Marfan syndrome, Ehlers-Danlos syndrome, and osteogenesis imperfecta; and autoimmune such as systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), systemic sclerosis, mixed connective tissue disease (MCTD), Sjögren's syndrome (SS), dermatomyositis (DM), and polymyositis (PM). The subject of this review is to describe the variety of pleural disorders observed in the most frequent types of CTD: SLE, RA, scleroderma, SS, DM, PM, and MCTD.

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