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Greenfield Filter MigrationAn 82-year-old woman was admitted to the hospital with severe dilated cardiomyopathy. The condition was alcohol-induced and had been diagnosed about 12 years earlier. The patient was taking angiotensin-converting enzyme inhibitors and diuretics.
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Immunosuppression and Infection Risk in SOT RecipientsWith the introduction of immunosuppressive drugs, solid organ transplant (SOT) has progressed such that potential recipients significantly outnumber available organs. In 2007, there were 14,394 donors of 28,353 organs, but 98,645 persons were on a waiting list as of March 2008.1
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More Doubt Cast on CPAP for Reducing CVD Risk in Sleep Apnea PatientsSome find new meta-analysis results disturbing; others say they underscore the need for more focused research.
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A case of progressive shortness of breath in a patient with emphysemaA 71-year-old man who had received a diagnosis of emphysema 12 years ago was referred by his primary care physician to the pulmonary clinic. His symptoms were well controlled until a few months ago, when he complained of mild shortness of breath on physical activity. However, the shortness of breath worsened and became a significant limiting factor. He also had a persistent dry cough.
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Mucous Membrane Necrosis Secondary to OTC Bronchodilator OveruseA 35-year-old man was hospitalized with severe dehydration secondary to necrosis of the throat. He found oral intake impossible because of severe discomfort when swallowing. The patient took no prescription medications; he had not been hospitalized or seen by a medical practitioner recently.
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Polycystic Ovary Syndrome: Update on When to SuspectPolycystic ovary syndrome (PCOS) is the most common endocrinopathy among reproductive-aged women; the prevalence is 5% to 10%.1 Like women with PCOS, affected adolescents often present with irregular menses, hirsutism, and acne. However, despite widespread agreement that the metabolic derangements of PCOS arise during puberty, the condition is diagnosed more often in adults than in adolescents.
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How to Have All Day EnergyIt is late afternoon, your eyes start to droop, head starts to nod, and you feel like someone slipped you a mickey. You rifle through drawers, pockets, or cupboards desperately foraging for chocolate to get you through the afternoon.
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Multidisciplinary Asthma Care: It Takes a VillageEffective asthma care requires attention to comorbidities, complications, and human characteristics of each patient. Speakers at CHEST 2015 described "the village."
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Spinal Epidural LipomatosisA 62-year-old man who was receiving long-term corticosteroid therapy for Wegener granulomatosis presented with progressive leg weakness over 1 week. He had the stigmata of Cushing syndrome: moon facies, truncal obesity, and a dorsocervical fat pad.
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Pneumococcal Pneumonia Presenting as New-Onset SeizureA febrile 65-year-old woman who had suffered a new-onset seizure was brought to the emergency department. The patient-a cigarette smoker-was not coughing and had neither chest pain nor a significant medical history. Her temperature was 39.4°C (103°F). She had nuchal rigidity and Kernig's and Brudzinski's signs of meningeal irritation. Lung auscultation revealed signs of right middle lung consolidation. Her white blood cell count was 1,200/µL. A chest film, seen here, showed a masslike density in the right midlung.
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Spontaneous Embolization of a Thrombus-in-TransitChest pain and dyspnea of acute onset prompted a 49-year-old man to seek urgent medical attention. Two months earlier, he had sustained fractures to the right arm and both ankles after a 25-ft fall. Ten days before presentation, the patient’s rehabilitation physician had discontinued daily enoxaparin because of improved mobility and a presumed decreased risk of thromboembolism.
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Renal Infarction: An Unusual Complication of Cocaine AbuseA 63-year-old African American man presented with severe epigastric pain of 1 day's duration. The pain was sharp and continuous and radiated toward the left flank. There were no aggravating or relieving factors or previous similar episodes.
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Benzocaine-induced methemoglobinemia in bronchoscopyBenzocaine-induced methemoglobinemia has been a well-documented illness that is usually simple to cure but can be life-threatening if not recognized. As the use of "scope" procedures becomes more commonplace, the early recognition of hypoxemia resulting from methemoglobinemia is essential. The authors report a case of benzocaine-related methemoglobinemia following bronchoscopy.
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Editorial Comment: Tenofovir-Related Nephrotoxicity–Who's At Risk?Fanconi syndrome is generally characterized by evidence of proximal renal tubulopathy (ie, decreased renal reabsorption and increased urinary excretion of filtered proteins, potassium, glucose, phosphate, amino acids, and calcium).
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GoutA 73-year-old man was admitted to the hospital with pain in his hands, feet, and elbows. The patient, an alcoholic, had a 20-year history of hypertension and diabetes. Deformities of the hands and feet had developed during the past 5 years. Tophi were present over both ear lobes. The serum uric acid level was 15 mg/dL.
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Aspiration PneumoniaA 72-year-old nursing home resident was hospitalized with fever, chills, and rigors of 2 days' duration. The nursing home staff reported the patient had dysphagia after a recent stroke.
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Liver AbscessThree weeks after undergoing gastric bypass surgery for obesity, a 64-year-old woman presented with fatigue, chills, and abdominal pain of 2 days' duration. She denied shortness of breath, nausea, vomiting, changes in bowel habits, melena, and hematochezia. The patient had no significant past medical history.
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Sliding Hiatal Hernia and T-Cell Lymphoblastic LymphomaClinical Images to Help You Hone Your Diagnoses
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Acute hypoxemic respiratory failure as a manifestation of urinothoraxIn the case described here, hypoxemic respiratory failure occurred secondary to a right-sided pleural effusion associated with an obstructive uropathy. The patient, a 75-year-old man with a history of benign prostatic hypertrophy (BPH), presented with a gradual onset of shortness of breath, tachypnea, and oliguria. Renal ultrasonography and CT scanning revealed bilateral hydronephrosis. A right thoracentesis yielded fluid with characteristics consistent with urinothorax. The patient was given medication for BPH, taught how to do self-straight catheterization, and scheduled for an outpatient cystoscopy. At follow-up, his chest radiograph showed no effusions.
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Fixed Drug Eruption in a Woman With Severe MigrainesA 51-year-old woman with severe migraines sought evaluation of a dozen round black macules on her hands, forearms, and legs. A few of the lesions had first appeared 1 year earlier; the remainder had erupted since then.
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Bilobar pulmonary sequestration: A rare case involving 2 adjacent lobesWe present a case of a 20-year oldman with massive hemoptysisresulting from pulmonarysequestration that involved 2lobes (the right lower and middlelobes). Preoperative embolizationand subsequent surgicalbilobectomy were performed.Although the patienthad a difficult and prolongedpostoperative course, he eventuallyhad a full recovery.
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Identifying drug-induced lung injury in a patient with rheumatoid arthritisWe describe a case of sulfasalazine-induced pneumonitis ina complex medical patient.This case illustrates the potentialfor drug-induced pulmonarydisease and the vigilanceneeded in evaluating patientswith subacute respiratory decompensation.Proper recognitionand treatment mostlikely prevented the progressionof acute respiratory failureand, possibly, irreversiblelung injury or death.
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Chronic Venous Disease: Evaluation of the Various ManifestationsA description of the evaluation of the various manifestations of chronic venous disease.
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Man With a Potentially Life-Threatening Waterborne InfectionA 79-year-old man presents to theemergency department with a painfullesion on his right forearm. Three daysearlier, he had scratched his arm whileremoving crabs from a trap. Initially,the scratch had bled slightly, and hehad self-treated with an over-the-counterantibiotic ointment and an adhesivebandage.
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Managing COPD, part 2: Acute exacerbationsAbstract: The standard therapies for acute exacerbations of chronic obstructive pulmonary disease include short-acting bronchodilators, supplemental oxygen, and systemic corticosteroids. For most patients, an oxygen saturation goal of 90% or greater is appropriate. Bilevel positive airway pressure (BiPAP) is usually beneficial in patients with progressive respiratory acidosis, impending respiratory failure, or markedly increased work of breathing. However, BiPAP should not be used in patients with respiratory failure associated with severe pneumonia, acute respiratory distress syndrome, or sepsis. Systemic corticosteroids are appropriate for moderate to severe acute exacerbations; many experts recommend relatively low doses of prednisone (30 to 40 mg) for 7 to 14 days. Antibiotic therapy is controversial, but evidence supports the use of antibiotics in patients who have at least 2 of the following symptoms: increased dyspnea, increased sputum production, and sputum purulence. (J Respir Dis. 2005;26(8):335-341)
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Using ultrasonography in the diagnosis and management of pleural diseaseABSTRACT: The increasing availability of bedside ultrasonographyallows for more timely diagnosis and treatment of pleuraleffusion while limiting the patient's exposure to radiation. Thedynamic signs characteristic of pleural effusions includerespirophasic changes in the shape of the fluid collection, floatingmovements of atelectatic lung, and the plankton sign. Ultrasonographyalso is an efficient means of excluding pneumothoraxwhen rapid diagnosis is needed or after interventionssuch as central line placement, lung or pleural biopsy, or thoracentesis.The diagnosis of a pneumothorax relies on the absenceof dynamic signs such as "lung sliding." Static signs, suchas the comet tail artifact, or consolidated lung parenchyma orlung tissue that contains a solid mass, also can be useful in excludingpneumothorax. Ultrasonography can be used to guidefine-needle aspiration and core biopsies of pleural nodules,pleural thickening, and subpleural lung masses. (J Respir Dis.2008;29(5):200-207)
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Worsening Neurological Symptoms in an Older Man With History of Rectal CancerA 65-year-old man, who was lost to follow-up after abdominal-perineal resection for rectal adenocarcinoma 9 months earlier, presents with progressively worsening neurological symptoms, including bilateral hearing loss, dizziness, gait disturbance, ataxia, and blindness in the right eye.
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Dyspnea and chronic bronchitis in a man with ulcerative colitisThe authors report a case of idiopathic eosinophilic pneumonia in a man with sclerosing cholangitis and ulcerative colitis associated with features of sarcoidosis.
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Transient ST Elevations and Conduction Delay After Traumatic Fracture of the SternumA 25-year-old man with no significant medical history was attempting to move a heavy container when he lost control and became pinned between the container and a concrete pole.
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Bronchoscopy Clinic: Emerging options for managing foreign-body aspirationEndobronchial foreign bodies can be life-threatening, but once they are detected, they can usually be removed, leading to prompt resolution of symptoms. Chest radiography and CT scanning can be helpful in some cases, but bronchoscopy is necessary for definitive diagnosis and treatment.
