Browsing by Author "Koegelenberg, Coenraad Frederik Nicolaas"
Now showing 1 - 5 of 5
Results Per Page
- ItemFatal tumour pulmonary embolism(Wiley Open Access, 2017) Masoud, Salim Rashid; Koegelenberg, Coenraad Frederik Nicolaas; Van Wyk, Abraham Christoffel; Allwood, Brian W.A 30-year-old female with no significant past medical history was referred to our facility with sudden onset of shortness of breath. She had a low clinical probability for pulmonary thromboembolism and a computed tomography angiogram showed enlarged pulmonary arteries but no in situ thrombi. She developed recurrent episodes of hypotension and hypoxia, and was transferred to the intensive care unit where she died despite active resuscitation. An autopsy revealed extensive lymphatic and pulmonary vascular tumour emboli as the immediate cause of death. Pulmonary tumour embolism is a very rare cause of death, but can occur in patients who have an occult neoplasm.
- ItemManagement of chronic obstructive pulmonary disease—A position statement of the South African Thoracic Society : 2019 update(AME Publishing, 2019-10-06) Abdool-Gaffar, Mohamed Sabeer; Calligaro, Gregory; Wong, Michelle Lianne; Smith, Clifford; Lalloo, Umesh Gangaram; Koegelenberg, Coenraad Frederik Nicolaas; Dheda, Keertan; Allwood, Brian William; Goolam-Mahomed, Akhter; van Zyl-Smit, Richard NellisENGLISH ABSTRACT: Chronic obstructive pulmonary disease (COPD) is a significant cause of death and disability in both developed and developing countries. It is increasing in frequency and demands increasing utilisation of healthcare resources.
- ItemThe real value of endobronchial ultrasound(Health and Medical Publishing Group, 2015) Vorster, Morne Johan; Schubert, Pawel Tomasz; Koegelenberg, Coenraad Frederik NicolaasEndobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has become a standard procedure worldwide, used in conjunction with bronchoscopy to obtain biopsies for mediastinal disorders. A 67-year-old man with a 40 pack-year smoking history presented with a 2-year history of hoarseness and weight loss. He also had a history of asbestos exposure. On examination under anaesthesia a lesion of the right false vocal fold was found and histology showed a moderately differentiated infiltrating keratinising squamous carcinoma. The question posed was whether this mass could be ascribed to metastatic supraglottic carcinoma or if it was indeed a metachronous primary bronchus carcinoma, as the treatment of these two malignancies differs significantly. Traditional bronchoscopy with TBNA is the least invasive procedure to obtain a cytological diagnosis, but the proximity of the aorta and pulmonary arteries and the mass being 14 mm from the bronchus would have made sampling by means of this procedure near impossible. We used EBUS to localise the mass and noted the position of the major vessels on Doppler ultrasound. Real-time ultrasound guidance allowed us to bridge the tissue plane between the mass and bronchial lumen using the longer EBUS needle and to obtain a fine-needle aspirate of the mass, which proved to be a keratinising squamous carcinoma. We describe this case in which EBUS-TBNA was pivotal in reducing the number of invasive procedures in a patient with metastatic supraglottic carcinoma.
- ItemSyncope due to tracheal adenoid cystic carcinoma(Wiley Open Access, 2019-07-02) Bots, Eva Marianne Theresa; van Wyk, Abraham Christoffel; Janson, Jacques Teran; Wagenaar, Riegardt; Paris, Gerald; Koegelenberg, Coenraad Frederik NicolaasWe present a case of a 34‐year‐old male who presented with syncope secondary to a large adenoid cystic carcinoma (ACC) of the distal trachea. A computed tomography and flexible bronchoscopy showed almost complete occlusion of the distal trachea. Resection with curative intent was performed, but resection margins were unfortunately not clear. The patient was subsequently offered adjuvant radiotherapy. Tracheal tumours comprise a small proportion of respiratory tract neoplasm, accounting for only about 2% of airway malignancies. Squamous cell carcinoma is the most common tracheal tumour, followed by ACC. Symptoms are usually attributable to the intraluminal component of the tumour causing an obstruction of the airway, resulting in stridor, dyspnoea, wheezing, haemoptysis, and cough. Syncope as a presenting symptom is exceedingly rare.
- ItemUltrasound-assisted transthoracic diagnostic techniques(Stellenbosch : University of Stellenbosch, 2011-12) Koegelenberg, Coenraad Frederik Nicolaas; Bolliger, Chris T.; Diacon, Andreas H.; Wright, Colleen A.; University of Stellenbosch. Faculty of Health Sciences. Dept. of Medicine. Internal Medicine.ENGLISH ABSTRACT: Although transthoracic ultrasonography is a well established modality, it is still underutilised by chest physicians. The aim of this research project was to investigate the feasibility, diagnostic yield and safety of ultrasound(US)-assisted transthoracic biopsies performed by clinicians in various settings relevant to daily practice of respiratory medicine. We conducted four clinical trials which are summarised below: 1. In a prospective study on the feasibility of US-assisted transthoracic fine needle aspiration (TTFNA) of drowned lung secondary to a proximal mass lesion, a novel indication for US-assisted TTFNA was described. TTFNA passes >20mm from the visceral pleura had a sensitivity of 74.2% and were also more likely to contain malignant cells than more superficial passes. The surprisingly high yield and the fact that no serious complications were observed validated this approach, which may be an alternative to bronchoscopy. 2. In the largest single-centre study on US-assisted TTFNA with rapid on-site evaluation (ROSE) and cutting needle biopsy (CNB) in the setting of superior vena cava (SVC) syndrome ever reported, we were able to accurately diagnose 96% of all patients who presented with an associated mass lesion that abutted or infiltrated the chest wall. No pneumothoraces or major haemorrhage was caused. We also validated the single-session approach, and were able to conclude that US-assisted TTFNA (with ROSE) is the initial investigation of choice in suspected bronchogenic carcinoma, whereas both TTFNA and CNB need to be performed in all other cases. 3. We continued to validate the novel single-session sequential approach in a study on anterosuperior mediastinal masses. US-assisted TTFNA with ROSE was performed on 45 consecutive patients, immediately followed by CNB where a provisional diagnosis of epithelial carcinoma or probable tuberculosis (TB) could not be established. An accurate cytological diagnosis was made in 73.3%, and was more likely to be diagnostic in epithelial carcinoma and TB than all other pathology (p<0.001). CNB yielded a diagnosis in 88.2%. Overall 93.3% of patients were diagnosed by the single-session approach. No pneumothorax or major haemorrhage was observed. 4. In a prospective study, we compared US-assisted Abrams and Tru-Cut needle biopsies with regard to their yield for pleural TB. Pleural biopsy specimens obtained with Abrams needles contained pleural tissue in 91.0% of cases and were diagnostic in 81.8%, whereas Tru-Cut needle biopsy specimens only contained pleural tissue in 78.7% (p=0.015) and were diagnostic in 65.2% (p=0.022). In conclusion, we investigated the feasibility of US-assisted biopsies performed by respiratory physicians in various settings, and consistently found acceptable to very high diagnostic yields with minimal complications. Furthermore, we were able to validate a novel indication for US-assisted TTFNA (US-assisted TTFNA of drowned lung), validate the use of a single-session sequential approach (USassisted TTFNA with ROSE followed by CNB where indicated) in at least two clinical settings (SVC syndrome and anterosuperior mediastinal masses) and we were able to show that US-assisted Abrams needle biopsy is superior to Tru-Cut needles biopsy when histological confirmation of TB pleuritis is required.