August 2013 pulmonary case of the month: aids for diagnosis

No abstract available. Article truncated at 150 words. History of Present Illness An 80 year old man was referred for evaluation of cough, weakness and weight loss over 2-3 months. He had a chest radiograph 6 weeks ago showing a right lower lobe infiltrate. He was treated with levofloxacin and prednisone without improvement. PMH, SH, FH He had a history of hypertension, type 2 diabetes mellitus, hyperlipidemia, and hypothyroidism. He was born in China, had lived in Philippines, Hong Kong and Phoenix, the later for the last 23 years. He was lifetime nonsmoker and rarely used ethanol. He had no pets, unusual exposures, and no known tuberculosis exposure (last skin test was negative 10 years ago). His father died at age 79 from coronary artery disease. His mother had “intestinal cancer”. He has a sister with diabetes mellitus. Medications Atorvastatin 10 mg/day Doxazosin 2 mg/day Levothyroxin 50 mcg/day Metformin 500 mg bid Metoprolol

April 2013 pulmonary case of the month: a suffocating relationship

No abstract available. Article truncated at 150 words. History of Present IllnessA 70 year old woman from Oregon was referred by urology for evaluation of an abnormal thoracic CT scan. She was asymptomatic. PMH, SH, FHShe has a prior history of retroperitoneal fibrosis with ureteral obstructions requiring stents and a transient ischemic attack in 2009. During 2012 she developed hypertension and a thoracic CT was done. She has never smoked and is a widowed housewife. There is no family history of lung disease, although her husband died from lung cancer. Her present medications include: amlodipine 10 mg/day, oxybutynin (Ditropan XL) 10 mg/day, and prednisone 5 mg daily. Physical ExaminationHer physical examination was unremarkable. RadiographyHer chest CT scan is shown in Figure 1. Figure 1. Representative thoracic CT static images from mediastinal windows (panels A-C) and lung windows (panel D-F).Which of the following is true regarding the CT scan?1.There is a right

May 2012 pulmonary case of the month: things are not always as they seem

No abstract available. Article truncated at 150 words. History of Present Illness A 69 year old woman was seen for side effects of corticosteroids. She is a winter visitor to Arizona. She was hospitalized in March 2008 with increased dyspnea and cough and had an abnormal CT chest. A VATS lung biopsy was performed. The pathology of the lung biopsy interpreted as bronchiolitis obliterans. She was started on prednisone 60 mg/day.Subsequently, she returned to Minnesota and was seen by rheumatologist with a diagnosis made of possible rheumatoid arthritis. She was treated with methotrexate (12.5 mg weekly) and continued prednisone at 20 mg/day from 2008 to 2011. At that time a question was raised of methotrexate lung toxicity and it was stopped but she continued on prednisone 20 to 40 mg/day. She is currently having issues with steroid side effects and seen for a second opinion.PMH, SH and FHShe has a history of knee and other

January 2013 pulmonary case of the month: maybe we should call GI

No abstract available. Article truncated at 150 words. History of Present Illness A 55 year old man from Arizona was undergoing a renal transplant evaluation because of polycystic kidney disease. He was referred for an abnormal chest x-ray. He was a nonsmoker and there were no respiratory symptoms. PMH, FH and SH He has a long history of polycystic kidney disease, hypertension, gout, and a history of a kidney stone. He is a life-long nonsmoker. There is no significant family history including polycystic kidney disease. He works as a border patrol agent and is originally from Honduras. His present medications include:•Allopurinol•Amlodipine•Atenolol•Hydralazine•Sodium bicarbonate Physical Examination His blood pressure is elevated at 142/84, but otherwise his physical examination is unremarkable. Chest X-ray His chest X-ray is below (Figure 1). Figure 1. PA (Panel A) and lateral (Panel B) chest x-ray. The chest x-ray was interpreted as showing bilateral lower lobe

February 2014 pulmonary case of the month: faster is not always better

No abstract available. Article truncated at 150 words. History of Present Illness A 56 year old woman with a history of rheumatoid arthritis (RA) for 26 years was seen as an outpatient. She has a recent history of increased cough, sputum and dyspnea. PMH, FH, SH She was originally from India but had lived in Singapore from 2011 to June 2013 before moving to Phoenix. In 2009, she was diagnosed with Mycobacterium avium-intracellulare (MAI) on bronchoscopy and started on azithromycin, ethambutol, and rifabutin. She was unable to tolerate rifabutin but was continued on ethambutol and azithromycin. She had been on etanercept for her RA which was held after the diagnosis of MAI. She had negative sputum cultures for MAI in September 2012 and her ethambutol and azithromycin were stopped. In May 2013 she had increased symptoms and bronchoscopy demonstrated Pseudomonas and nontuberculous mycobacterium (NTM). She was treated with cefipime/ciprofloxacin for 6 weeks prior to moving to Phoenix. She

September 2014 pulmonary case of the month: a case for biblical scholars

No abstract available. Article truncated after 150 words. History of Present Illness: A 66-year-old man was seen in consultation. He had been followed since 1998 for bronchiectasis. He had a prior history of multiple skin infections with abscess formation requiring drainage beginning when he was in his 20's. He presented with increased recent sputum production, greenish in color. PMH, FH, SH: He had a history of multiple skin infections, multiple pneumonias and osteomyelitis in addition to the bronchiectasis. There was a positive family history of coronary artery disease and childhood cancer in a sister. He had smoked cigars in the remote past, but none since the age of 25. Physical Examination: General: short stature, scoliosis, SpO2 98% on RA; Chest: few scattered crackles, no wheezes; Cardiovascular: regular rate and rhythm with no murmur noted; Extremities: No clubbing, cyanosis or edema. Spirometry: FVC 69% of predicted; FEV1 76% of predicted. Which of the following should be performed at this ..

July 2015 pulmonary case of the month: a crazy case

No abstract available. Article truncated after the first page. History of Present Illness: A 23-year-old woman presented in 2008 at outside institution with dyspnea and diffuse pulmonary infiltrates. She required intubation. After a surgical lung biopsy, she was transferred to the Mayo Clinic Hospital for further care. Past Medical History: She has had a history of progressive dyspnea for several months, otherwise negative. Physical Examination: Vital signs are stable. SpO2 94% on FiO2 of 0.4. She is intubated and there is a chest tube in her right chest. Otherwise the physical examination is unremarkable. Radiography: A thoracic CT scan was performed (Figure 1). Which of the following are present on the thoracic CT scan? 1. Diffuse ground-glass opacities; 2. Interlobular septal thickening and intralobular reticular thickening; 3. Right-sided pneumothorax; 4. 1 and 3; 5. All of the above ..

November 2013 pulmonary case of the month: dalmatian lungs

No abstract available. Article truncated after 150 words. History of Present Illness A 36 year old woman was referred to the pulmonary clinic at Mayo Clinic Arizona. In early May 2013 she developed headache and blurred vision. She was referred to a neuroopthalmologist who diagnosed a 6th cranial nerve palsy. She had a brain MRI and lumbar puncture (LP). Both were reported as normal. She was treated with corticosteroids and improved. She was tapered off prednisone in late May and developed discomfort in her left ear with hearing loss and tinnitus. Some left facial asymmetry was noted. She was treated with intra-tympanic steroid injections as well as oral steroids with some improvement. Her last dose of corticosteroids was 3 weeks prior to being seen. At the beginning of August she developed speech and swallowing difficulties and was neurologically diagnosed with palsies in 4th, 6th, 8th, 9th, 10th and 11th cranial nerves. Other symptoms included photophobia and a non-productive

January 2015 Arizona thoracic society notes

No abstract available. Article truncated at 150 words. Dr. Jud Tillinghast was presented a plaque in recognition of being chosen by his colleagues as the Arizona Thoracic Society Physician of the Year In 2014. Dr. Rajeev Saggar made a presentation entitled "Pulmonary fibrosis-associated pulmonary hypertension: a unique phenotype". This presentation focused on new echocardiographic methods of assessing right ventricular (RV) function and the pathophysiology of RV dysfunction. Dr. Saggar presented data from a paper he authored on parenteral treprostinil in patients with idiopathic pulmonary fibrosis and pulmonary artery hypertension which was published in Thorax (1). There were 2 case presentations, both from the Phoenix VA by Dr. Elijah Poulos: 1. A 65 year-old man presented with cough and chills. His past medical history included multiple myeloma treated with chemotherapy, radiation therapy to spine and bone marrow transplant. He had a prior vertebroplasty. His symptoms did not improve with doxycycline. Computerized tomography angiography was done and showed areas of ..

February 2018 pulmonary case of the month

No abstract available. Article truncated after first page. History of Present Illness: A 75-year-old woman was diagnosed with a thymic carcinoid tumor in April, 2015 (Figure 1). This was treated with surgical resection followed by radiation therapy. She began having cough and dyspnea 1 to 2 months later and in August, 2015 had a thoracic CT scan of her chest (Figure 2). Which of the following are true? 1. Bronchoscopy should be performed; 2. She should be given an empiric course of antibiotics; 3. The most like diagnosis is radiation pneumonitis. 4. 1 and 3; 5. All of the above.