Synovial sarcoma (SS) is highly malignant tumor that occurs mainly in adolescents and young adults and is usually seen in the extremities. However, primary SS arising from the lung is extremely rare, accounting for 0.3% to 1.3%. Primary pulmonary SS (PPSS) is an extremely aggressive malignant tumor that can invade adjacent organs or give distant metastases. Besides clinical evaluation and imaging methods for definitive diagnosis, immunohistochemical examination is must. We report a case of elderly male with left lung mass lesion invading into the pericardium and left-sided pleural effusion with a history of smoking. Positron emission tomography (PET)–computerised tomography (CT)-guided trucut biopsy from lung mass lesion led to the diagnosis, and thoracoscopic pleural biopsy showed the pleural involvement with final diagnosis of PPSS (monophasic type). There are no guidelines for optimal treatment due to the rarity of such tumors. Current treatment includes resectional surgery and adjuvant chemotherapy and/or radiotherapy. But because of advanced age and poor performance status, our patient was not candidate for any treatment but palliation.

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Background: Diaphragm thickness measurement by ultrasonography (USG) has been shown to be a good surrogate of diaphragmatic functions. However, data regarding reliability of diaphragm thickness measurement by critical care physicians among patients with sepsis is limited. Aims and Objective: This study was designed to assess the variability and reliability of diaphragm thickness measurement on USG by critical care physician in patients with sepsis. Materials and Methods: Study included patients with sepsis who were admitted between March 2015 and December 2016 in a tertiary care center. Three readings of diaphragm thickness were recorded separately during inspiration and expiration using B-mode of USG. Mean [standard deviation (SD)] of variation and intraclass correlation coefficient (ICC) in the measurement were calculated for assessment of variability and reliability, respectively. Results: Four hundred twenty measurements on 70 patients were included in the study. Mean (SD) variation for 1st, 2nd, and 3rd measurement during expiration were 0.233 (0.027) mm, 0.231 (0.029) mm, and 0.233 (0.029) mm, respectively. During inspiration mean (SD) variation for 1st, 2nd, and 3rd measurement were 0.285 (0.033) mm, 0.283 (0.031) mm, and 0.283 (0.033) mm, respectively. The ICC [95% confidence interval (CI)] among 1 vs. 2, 1 vs. 3, and 2 vs. 3 readings taken during expiration were 0.930 (0.889–0.956), 0.919 (0.873–0.949), and 0.940 (0.905–0.963), respectively. During inspiration, ICC (95% CI) among 1 vs. 2, 1 vs. 3, and 2 vs. 3 readings were 0.949 (0.919–0.968), 0.940 (0.905–0.962), and 0.945 (0.914–0.966), respectively. Overall ICC for three readings of diaphragmatic thickness during expiration and inspiration were 0.930 (0.898–0.954); P < 0.001 and 0.945 (0.919–0.963); P < 0.001, respectively. Conclusion: The measurement of diaphragm thickness using USG by critical care physicians among patients with sepsis is reliable with minimal variability.

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Extensive clinical experience has shown that rifampicin is well tolerated, but on rare occasions, it can cause life-threatening adverse reactions such as acute renal failure and thrombocytopenia. Throbocytopenia is mostly encountered with isoniazid and pyrazinamide. Rifampicin is an essential component of the treatment regimen for tuberculosis. We are reporting a case of rifampicin-induced thrombocytopenia which was being treated for pulmonary tuberculosis. The physician treating tuberculosis patients must be aware of this rare life-threatening complication.

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A 40-year-old female with cough, bronchorrhea of 500 ml/day, and breathlessness since 5 months was found to have bilateral ground glass opacities (GGOs) in the lung on contrast-enhanced computed tomography of thorax (CECT thorax). Bronchoscopy was normal. Pulmonary function tests were deranged. She was taken for an open-lung biopsy under local anesthesia. Biopsy from suspicious areas of right upper lobe and lower lobe via a minithoracotomy was s/o bronchoalveolar carcinoma. Patient received pemetrexed + gefitinib therapy on immunohistochemistry and survived for 18 months postcompletion of chemotherapy. Bronchorrhea was reduced after initiation of chemotherapy.

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Takayasu’s arteritis (TA) is a rare, systemic, inflammatory large-vessel vasculitis of unknown etiology resulting in a granulomatous inflammation of the aorta and its major branches. It most commonly affects the women of childbearing age. Pulmonary artery involvement is very rare. We, hereby, report a case of TA presenting with fever and hemoptysis due to pulmonary artery involvement.

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Bochdalek hernia (BH) is a rare occurrence in adults. Even rare is recurrence after surgical repair. The case presented here is rare case of large Adult Bochdalek hernia which recurred after failed surgical repair after many years in a elderly female who could pass through the stress of two full term pregnancies. Clinicians should be aware that large Bochdalek hernia can persist in adults despite surgical repair which can pose as a diagnostic and management challenge.

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Granulomatosis with polyangiitis (GPA) is an uncommon disease entity characterized by necrotizing granulomatous inflammation and pauci-immune vasculitis of predominantly medium and small vessels. It mainly effects the upper respiratory tract and the renal system. It rarely engulfs other systems like the eye and hearing apparatus. We hereby report an interesting case involving simultaneous involvement of bilateral central retinal artery and hearing loss as presenting illness in a case of GPA.

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Background & Objective: Pleural fluid culture is the standard of diagnosis for infectious etiology in parapneumonic effusion and empyema. However, the sensitivity is poor in tertiary centers due to prior antibiotic therapy. Newer nonculture-based molecular diagnostics are emerging as effective alternatives for microbial diagnosis. This prospective study evaluates the efficacy of Syndrome Evaluation System (SES), a multiplex molecular diagnostic test, in establishing the microbial etiology of empyema and clinical correlations of SES results with severity, interventions, and outcomes. Materials and Methods: Pleural fluid samples from 31 adult patients clinically diagnosed with empyema/complicated parapneumonic effusion were subjected to routine culture and SES. Routine laboratory tests, imaging, and antibiotic therapy were instituted as per standard care. Results: SES had 2.6-fold higher detection rate as compared to pleural fluid culture. A total of 16 samples (52%) were positive for pathogens on SES, whereas only six samples (20%) were positive on culture. SES was 83.33% concordant with culture. SES results were available within 24 h as compared to >72 h for culture. Prevalence of Gram-negative bacteria was 73.1%. SES positives were significantly associated with severity of disease and need to conduct more invasive procedures like thoracotomy and decortication. SES negatives had superior clinical outcomes compared to SES positives. Conclusion: SES has higher yield in microbial diagnosis compared to standard culture. It is sensitive, specific, and provides valuable information regarding a number of clinical correlates associated with empyema and complicated parapneumonic effusion. SES opens up new possibilities in understanding pathogenesis, management, and outcome in empyema.

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Respiratory tract diseases are public health problems, and these diseases affect the air passages, including the nasal passages, the bronchi, and the lungs. They range from acute infections, such as pneumonia and bronchitis, to chronic conditions such as asthma and chronic obstructive pulmonary disease. The prevalence of chronic respiratory morbidity among females is significantly higher compared to the general population of the country. It is a conditions affecting the organs and tissues that make gas exchange possible and includes conditions of the upper respiratory tract, trachea, bronchi, bronchioles, alveoli, pleura and pleural cavity, the nerves, and muscles of breathing. Females had respiratory illness were also higher among the users of tobacco and alcohol. Respiratory diseases range from mild and self-limiting, such as the common cold, to life-threatening entities such as bacterial pneumonia, acute asthma, and lung cancer. When women must cope with respiratory disease in the face of significant psychological, social, or cultural challenges, such as depression, economic burdens, competing family responsibilities, or disease stigma, the risk of nonadherence may increase. Women response with drugs is a big issue, because women of child-bearing age were excluded from participating in clinical studies, and information regarding gender-dependent responses to drugs in general and to respiratory drugs specifically has been lacking.

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