A 29-year-old man with a medical history of chronic rhinosinusitis presented with a 6-month history of chronic nonproductive cough and mild exertional dyspnea. Five years ago, at the time of his chronic rhinosinusitis diagnosis, he underwent a chest radiograph that revealed an ill-defined opacity in the middle zone of the left lung, suspicious for neoplasm, and was subsequently lost to follow-up, until he presented now with cough and dyspnea. There was no history of hemoptysis, epigastric discomfort/burning sensation, dysphagia, or post-tussive vomiting associated with cough. Exertional dyspnea was graded as modified Medical Research Council grade 1, and it was not associated with any diurnal or postural variations (orthopnea/trepopnea), chest pain, palpitations, or pedal edema. There was no history of fever, malaise, weight loss, or audible wheeze. The patient had no significant medical history of asthma, COPD, nasal obstruction, urticaria, or other chronic respiratory conditions. He did not smoke and reported no significant occupational or environmental exposures to allergens. There was no history of TB contact or recurrent respiratory infections. Additionally, there was no family history of similar respiratory findings or conditions. During the intervening years, the patient remained asymptomatic until his presentation with the new concerns.

A 20-year-old previously healthy man presented to our hospital with a 2-week history of dull aching pain localized to the anterior chest wall, specifically in the sternum region. The pain was non-radiating and was exacerbated by physical activity or deep inspiration. There was no associated swelling, redness, or deformity of the chest wall. There were no associated systemic symptoms such as fever, weight loss, night sweats, and fatigue. Additionally, there was no history of recent respiratory infections, coughing, wheezing, dyspnea, hemoptysis, palpitations, edema, or orthopnea to suggest pulmonary or cardiac involvement. The patient was of Indian ethnicity and has been living in India since birth. However, he had no known exposure to individuals with active pulmonary TB. The patient reported no history of trauma, repetitive physical strain, or prior surgical interventions, such as sternotomy or chest wall procedures. His medical history was unremarkable, with no prior hospitalizations or chronic illnesses. There was no personal or family history of autoimmune disorders, such as ankylosing spondylitis, rheumatoid arthritis, or psoriatic arthritis, and he specifically denied symptoms such as morning stiffness, joint swelling, or peripheral joint pain that might suggest an inflammatory or autoimmune disorder. The absence of gastrointestinal or urogenital symptoms further reduced the likelihood of reactive arthritis or other systemic conditions. Relevant negatives also included no history of smoking, immunosuppressive therapy, or conditions such as diabetes or HIV that could increase susceptibility to infections.

We present the case of a 69-year-old woman with a 25-year history of psychosis, managed with risperidone, who developed refractory tachypnea and alkalosis over 2 weeks. Despite multidisciplinary evaluation, she was initially misdiagnosed with psychogenic hyperventilation. Ultimately, a diagnosis of respiratory dyskinesia (RD) was established, and substantial clinical improvement was achieved after initiation of a vesicular monoamine transporter 2 (VMAT2) inhibitor. The substantial effectiveness of this therapy was confirmed over a 7-month follow-up period, with monitoring of both clinical symptoms and arterial blood gas parameters. This case highlights the diagnostic challenges posed by RD and underscores the potential utility of VMAT2 inhibitor as a novel therapeutic option.

A 44-year-old man, who does not smoke, presented for investigation of a right mediastinum lesion as revealed on a routine radiograph that was performed as a requirement of his life insurance. The patient reported no associated symptoms. He did not report shortness of breath, cough, sputum, fever, chest pain, or hemoptysis. The remaining review of symptoms was also negative for issues such as muscle weakness, weight loss, night sweats, fatigue, skin rash, and visible, palpable, or painful lymphadenopathy. His medical history was unremarkable, and he did not receive any regular medication. The patient's professional occupation was not related to special exposure and he did not report alcohol consumption, illicit drug use, or any recent travel.