Monday, March 13, 2017

Case of the Week 438

I apologize that this week's case is rather disturbing - and not in usual the creepy crawly parasite way.

The following structure was coughed up by a 70-year-old woman with advanced stage lymphoma. She had recently received chemotherapy consisting of rituximab, ifosfamide, carboplatin and etoposide (R-ICE). At the time, she was quite ill and in the intensive care unit. Likely identification?


11 comments:

Brett Hendel-Paterson said...

If critically ill, I'd say strongyloides, but I don't know what I'm looking at here. Looks like she coughed up half of her alveoli!

Anonymous said...

Hmmm . . . I'm leaning toward a bronchial cast of some sort - perhaps related to her chemotherapy. would want to "dig around" in there a bit using the stereoscope to be sure, but don't think it's a helminth.

Anonymous said...

Definitely not a parasite. After searching for compatible images, my guess is like this: The seemingly segmented portion resembles the end portion of a bronchus and the tubular portion being the terminal bronchiole leading to the alveoli.
Trust me, I have been wrong before and this is my only guess.
Florida Fan

infectiologue said...

Bronchial cast makes sense; I've seen similar from the colon, but much larger than this.

Anonymous said...

A tracheo-bronchial pseudomembrane....? diphtheria?
Congratulations, Bobbi, on your ten years!
bw in vt

Anonymous said...

Ascaris lumbricoides. This is rare in US, but it could be coughed up.

Kathy Murray Leisure, MD said...

Agree w Ascaris lumbricoides, by size and head conformation. See Case 456 for a video of these worms alive in a small intestine by endoscopy...ugh!

William Sears said...

Not a parasite, definitely. Bronchial Cast would be my guess.

Anonymous said...

Answer, please?

Bobbi Pritt said...

It's now posted online - just scroll down the web page.

Anonymous said...

Thanks!