[Pulmonary sarcoidosis diagnosed in 2 cases suspected to be neoplasms]

Two young patients suspected of neoplasms were admitted to Thoracic Surgery Department of Institute of Tuberculosis in first case (35-years old woman) chest x-ray showed atelectasis of upper right lobe, enlarged lymph nodes of mediastinum and right hillium-lymphoproliferative process was suspected. Repeated bronchoscopies revealed narrowing of upper right bronchus and in biopsy--granulomas with small focus of necrosis were found. Tuberculosis was not excluded. During short antituberculous treatment progression of lung lesions and enlarged supraclavicular lymph node were observed. Following biopsy confirmed sarcoidosis. Treatment with prednisone was successful. In second case the chest x-ray showed large masses in both lungs suspected of seminoma metastases. Lung biopsy made during thoracotomy revealed sarcoidosis.

[Lung changes during the course of non-Hodgkin's lymphoma in a patient with rhematoid arthritis with secondary Sjogren's syndrome]

A case of 51 years old woman with 12-years history of rheumatoid arthritis and secondary Sjoegren's syndrome, who developed EBV-associated diffuse large B-cell lymphoma (Lymphomatoid granulomatosis type) involving lungs, lymph nodes and bone marrow was described.

[Echocardiography improves the chance of conclusive results in spiral computed tomography of suspected pulmonary embolism]

While highly specific for detecting thromboembolism in proximal pulmonary arteries, spiral computed tomography (spiral CT) cannot reliably exclude pulmonary embolism. Therefore "negative" spiral CT in patients with high clinical probability of acute pulmonary embolism should be considered as non-conclusive. The goal of our study was to check whether echo/Doppler could stratify patients with suspected pulmonary embolism according to the chance of obtaining a conclusive spiral CT result. Echo/Doppler recordings of 51 patients (27 F, mean aged 50 +/- 19) admitted to ICU with high probability of acute pulmonary embolism were compared with the results of spiral CT of pulmonary artery. Pulmonary embolism was revealed by spiral CT in 36 pts. who at echocardiography were found to have shorter acceleration time (AcT 86 +/- 27 vs 117 +/- 7 ms, p < 0.00001) and right ventricle enlargement (PK 30 +/- 5 vs 25 +/- 2 mm p < 0.0001). The velocity of tricuspid regurgitation (TVPG) could not be measured in 19 patients. Among patients with long AcT (> or = 120 ms) or without right ventricle enlargement 8 of 14 and 14 of 28 patients, respectively had no intrapulmonary clots at spiral CT. Echo/Doppler helps in preselection of patients in whom confirmation of PE with spiral CT is highly probable. In patients without indirect echocardiographic sings of pulmonary embolism, despite high clinical probability the chance of a conclusive spiral CT is 40-50%. This should be kept in mind when selecting the most effective diagnostic strategy in individual cases.

[Thrombectomy in a patient with a mobile clot in the inferior vena cava--case report]

Switching from heparin to acenocoumarol was complicated by severe retroperitoneal bleeding in a 50-years old patient with massive pulmonary embolism and deep venous thrombosis. The haematomas were evacuated by surgical procedure. Planned insertion of a vena cava filter was abandoned because of a mobile clot in inferior vena cava (IVC) reaching above renal veins as evidenced by spiral computed tomography (SCT). Patient was transferred to the Surgical Department of Medical Academy in Warsaw where thrombectomy was performed. In spite of mechanical and pharmacological methods of venous thrombosis prophylactic, thrombectomy was complicated by massive proximal deep venous thrombosis of right leg and distal part of IVC. Patient was successfully treated with UFH i.v. followed by low molecular weight heparins. No bleeding complications were observed. Screening for thrombophilia and cancer were negative. This case report is an example of difficulties in clinical management in a patient who has both life-threatening thromboembolic disease and bleeding.

[Pneumonia and panophthalmitis as first signs of pneumococcal endocarditis]

A case of pneumonia associated with pneumococcal endocarditis of bicuspid aortic valve complicated by pneumococcal meningitis and panophthalmitis successfully treated by antibiotics and late valve replacement was described.

[Spinal tuberculosis]

The cases of 32-year-old man and 42-year-old women are presented. Their history illustrates difficulties in the diagnosis of tuberculosis of the vertebral column. The patients suffered significant pains in the lumbar region lasting one year. Despite the presence of some abnormalities in lumbar vertebrae on x-rays no examinations were ever performed to establish the diagnosis. Lumbago and osteoporosis were considered as the cause of complaints. Aetiology was confirmed only when patients developed disseminated tuberculosis of the lungs. Antituberculous chemotherapy was successful and brought a fast improvement in general status of the patients.

[Disseminated lung tuberculosis in a patient with undiagnosed chronic hip joint tuberculosis]

A case of a 69-year male patient is reported. His history is an illustration of difficulties in the diagnosis of hip joint tbc. Patient suffered from severe pain in the right hip and thigh while walking for 25 years. Despite abnormal bone structure confirmed by several X-rays, no other examinations were ever performed to establish possible diagnosis. The patient was told to have "an inflammation" or "degeneration" of the bone. Anti-inflammatory and analgesic agents were given him to enable walking for years. Untreated tuberculosis resulted in the complete destruction of the proximal end of thigh bone and unilateral hip joint. Etiology was confirmed when the patient developed disseminated lung tuberculosis. Antitubercular drugs proved effective and brought about fast improvement of patient's health. On completion of chemotherapy, surgical treatment of the affected bones was performed.