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CLINICAL CASES

Sarcoidosis or sarcoid-like reaction associated to malignant tumors?

Daniela Jipa, Alina Croitoru, Diana Pascal, Vasile Grigorie, Diana Leonte, Claudia Toma, Miron Bogdan
Sarcoidosis or sarcoid-like reaction associated to malignant tumors?
Malignancy can be associated with sarcoidosis, which can be discovered before, during neoplasia or in the follow-up period of malignant tumors. Any diagnosis of sarcoidosis in patients with a history of malignancy can be a sarcoid-like reaction secondary to cancer, but it can also be a different disease. It is essential to know whether there is an association of two concomitant different diseases or it is a sarcoid-like reaction in patients with neoplasia. It is important to differentiate these two situations, because it can change the therapeutic approach.

Accidental discovery of foreign body aspiration through tracheostomy inlet

Radu Crișan-Dabija, Antigona Carmen Trofor, Traian Mihăescu
Accidental discovery of foreign body aspiration through tracheostomy inlet
The risk of foreign body aspiration is significantly higher in patients with permanent tracheostomy due to bypassing the larynx and natural barriers. We present the case of a 60-year-old patient with a larynx tumor surgically removed in 2013 and permanent tracheostoma, who refused to wear a cannula. He addressed the emergency room for symptoms of arterial hypertension, and presenting dyspnea, headaches and cough. During the examination, a chest X-ray was indicated and two irregular right supraclavicular opacities were discovered. He was redirected to our pulmonology clinic for specialized investigations under the suspicion of pulmonary metastasis. The fibro-bronchoscopy showed a soft process on the internal wall of the left main bronchus (LMB), bleeding easily on touch. Biopsy showed inflammatory tissue with no tumoral aspects. The CT examination showed a metallic foreign body (approximately 4 cm long) enclaved in the LMB wall, piercing it and missing the left pulmonary vein by millimeters. Under general anesthesia, an attempt of extraction via fibro-bronchoscopy was successful. It amazed us to learn that the foreign body was a green syringe needle (gauge 21) probably aspirated 3 years ago during a post operatory routine tracheostoma cleansing.