Rammohan Gumpeni, MD




Primary synovial sarcoma presenting as an endobronchial mass

October 24, 2008

Endobronchial primary synovialsarcoma is an extremelyrare pulmonary tumor. We reportthe case of a 58-yearoldman who presented witha right-sided endobronchialmass, which was diagnosed asprimary synovial sarcoma onthe basis of histological appearanceand immunohistochemicalstaining. To the bestof our knowledge, this is onlythe third case report of endobronchialprimary synovialsarcoma.

Chylothorax: A review of current management strategies

July 29, 2008

ABSTRACT: The most common causes of chylothorax are neoplasm-particularly lymphoma-and trauma. The usual presentingsymptom is dyspnea resulting from the accumulationof pleural fluid. The diagnosis of chylothorax is established bymeasuring triglyceride levels in the pleural fluid; a triglyceridelevel of greater than 110 mg/dL supports the diagnosis. The initialapproach to management involves chest tube drainage ofthe pleural space. The administration of medium-chain triglyceridesas a source of fat is often useful. If drainage remains unchanged,parenteral alimentation should be started. Surgicalintervention is indicated if conservative management is notsuccessful or if nutritional deterioration is imminent. If chylothoraxpersists after ligation of the thoracic duct, options mayinclude percutaneous embolization, pleuroperitoneal shunt,and pleurodesis. (J Respir Dis. 2008;29(8):325-333)

Wheezing in a 52-Year-Old Woman With a History of Colon Cancer

April 01, 2006

A 52-year-old woman was admitted tothe hospital with progressive shortnessof breath of 2 days’ duration. Bronchialasthma had been diagnosed 6 monthsearlier; inhaled corticosteroids, bronchodilators,and leukotriene antagonistswere prescribed. Despite aggressivetreatment, the patient’s dyspneaand wheezing worsened.