Monaldi Archives for Chest Disease <p><strong>Monaldi Archives for Chest Disease</strong> is an international scientific journal of the <em>Istituti Clinici Scientifici Maugeri</em>, Pavia, Italy, dedicated to the advancement of knowledge in all fields of cardiopulmonary medicine and rehabilitation. <!--It is published in two series: the “Cardiac Rehabilitation and Prevention Series” (volume, even numbers) which, since 2002, is the official journal of the Italian Association for Cardiovascular Prevention, Rehabilitation and Epidemiology (GICR-IACPR); and the “Pulmonary Medicine and Rehabilitation Series” (volume, odd numbers).--></p> <p><strong>Monaldi Archives for Chest Disease</strong> publishes original articles, new methodological approaches, reviews, opinions, editorials, position papers on all aspects of cardiac and pulmonary medicine and rehabilitation, and, in addition, provides a forum for the inter-exchange of information, experiences and views on all issues of the cardiology profession, including education. Accordingly, original contributions on nursing, exercise treatment, health psychology, occupational medicine, care of the elderly, health economics and other fields related to the treatment, management, rehabilitation and prevention of cardiac and respiratory disease are welcome.</p> <p><strong>Monaldi Archives for Chest Disease</strong> promotes excellence in the profession of cardiology and pneumology through its commitment to the publication of research, support to continuous education, and encouragement and dissemination of ‘best practice’.</p> <p>This journal does not apply charge for publication to Authors as it is supported by institutional funds.</p> PAGEPress Scientific Publications, Pavia, Italy en-US Monaldi Archives for Chest Disease 1122-0643 <p><strong>PAGEPress</strong> has chosen to apply the&nbsp;<a href="" target="_blank" rel="noopener"><strong>Creative Commons Attribution NonCommercial 4.0 International License</strong></a>&nbsp;(CC BY-NC 4.0) to all manuscripts to be published.<br><br> An Open Access Publication is one that meets the following two conditions:</p> <ol> <li>the author(s) and copyright holder(s) grant(s) to all users a free, irrevocable, worldwide, perpetual right of access to, and a license to copy, use, distribute, transmit and display the work publicly and to make and distribute derivative works, in any digital medium for any responsible purpose, subject to proper attribution of authorship, as well as the right to make small numbers of printed copies for their personal use.</li> <li>a complete version of the work and all supplemental materials, including a copy of the permission as stated above, in a suitable standard electronic format is deposited immediately upon initial publication in at least one online repository that is supported by an academic institution, scholarly society, government agency, or other well-established organization that seeks to enable open access, unrestricted distribution, interoperability, and long-term archiving.</li> </ol> <p>Authors who publish with this journal agree to the following terms:</p> <ol> <li>Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.</li> <li>Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.</li> <li>Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.</li> </ol> Isolated tension pneumoperitoneum following endobronchial ultrasound-guided transbronchial needle aspiration complicated by cardiac peri-arrest: A case report <p>Transbronchial needle aspiration under endobronchial ultrasound guidance (EBUS-TBNA) is recommended for the diagnosis and staging of lung cancer. Major complications following EBUS-TBNA are uncommon. We report a case of isolated tension pneumoperitoneum following EBUS-TBNA under deep sedation in an 80-year-old male patient affected by a right hilar mass suspicious for lung cancer. At the end of the procedure, the patient suddenly manifested desaturation, severe bradycardia and hypotension, and abdominal distension. After resuscitation, in the suspect of intraperitoneal free air, needle decompression led to respiratory and hemodynamic improvement. A total body CT-scan showed isolated pneumoperitoneum without signs of gastrointestinal perforation, confirmed by a subsequent upper digestive contrast study. The patient recovered well without the need of surgical exploration. Isolated tension pneumoperitoneum can be an exceptional complication of EBUS-TBNA; a conservative treatment can avoid unnecessary surgery in the absence of peritonism.</p> Piergiorgio Muriana Angelo Carretta Paola Ciriaco Francesca Rossetti Giampiero Negri ##submission.copyrightStatement## 2018-12-12 2018-12-12 88 3 10.4081/monaldi.2018.999 A malignant wheeze! <p>Asthma is a common disorder presenting with nonspecific features, which may mimic other conditions such as tracheal tumors. Tracheal tumors are often misdiagnosed as asthma. We report a case of a 38-year female who was being worked up for persistent wheeze that was initially attributed to acute asthma, only to be later discovered as tracheal tumor. A high index of suspicion for alternative diagnoses must be kept in mind while evaluating a patient who presents with clinical features suggestive of asthma, but fails to respond to standard therapy. The present case report emphasizes the fact that not all wheezes are asthma. <strong></strong></p> Kashyap Goyal Subodh Kumar Mayank Mishra Ritisha Bhatt Adabala Vijay Babu Mukesh Tripathi ##submission.copyrightStatement## 2018-11-29 2018-11-29 88 3 10.4081/monaldi.2018.972 A case of bleomycin-induced lung toxicity <p>A 64-year-old female was admitted for dry cough, dyspnea, fever, loss of appetite, and weight loss. Past medical history revealed scoliosis, cholecystectomy, and Hodgkin lymphoma. ABG values were: pH: 7.42, pCO<sub>2</sub>: 40.2 mm Hg, pO<sub>2</sub>: 61.4 mm Hg. Chest CT showed cystic lesions, emphysema, ground glass, and reticular opacities. ABG values worsened under 8L/min nasal oxygen. The patient underwent bilevel positive airway pressure (BiPAP) and methylprednisolone 60 mg/day bid was commenced. The final diagnosis was respiratory insufficiency due to bleomycin toxicity. The patient deceased on the sixth day after transfer to the intensive care unit. Bleomycin is an effective chemotherapeutic agent used for Hodgkin lymphoma treatment. It causes significant lung toxicity in half of the patients. Clinicians should always remember that bleomycin toxicity may lead to fatal complications in patients with comorbid conditions. We present this case to remark the possible consequences of bleomycin toxicity and the precautions taken to preclude bleomycin-induced pulmonary complications are discussed.</p> Cuneyt Tetikkurt Deniz Ongel Seza Tetikkurt ##submission.copyrightStatement## 2018-11-06 2018-11-06 88 3 10.4081/monaldi.2018.981 Acquired tracheoesophageal fistula repair, due to prolonged mechanical ventilation, in patient with double incomplete aortic arch <p>We report a case of the repair of an acquired benign tracheoesophageal fistula (TEF) after prolonged mechanical invasive ventilation. Patient had an unknown double incomplete aortic arch determining a vascular ring above trachea and esophagus. External tracheobronchial compression, caused by the vascular ring, increasing the internal tracheoesophageal walls pressure determined by endotracheal and nasogastric tubes favored an early TEF development. The fistula was repaired through an unusual left thoracotomy and vascular ring dissection. TEFs are a heterogeneous group of diseases affecting critically ill patients. Operative closure is necessary to avoid further complications related to this condition. Pre-operative study is mandatory to plan an adequate surgical approach.</p> Davide Zampieri Alessandro Pangoni Giuseppe Marulli Federico Rea ##submission.copyrightStatement## 2018-10-30 2018-10-30 88 3 10.4081/monaldi.2018.974