PneumonPub Date : 2023-04-24DOI: 10.18332/pne/157587
K. Lyroni, E. Vasarmidi, N. Tzanakis, K. Antoniou
{"title":"Lung infiltrates and fever: Is it pneumonia or not?","authors":"K. Lyroni, E. Vasarmidi, N. Tzanakis, K. Antoniou","doi":"10.18332/pne/157587","DOIUrl":"https://doi.org/10.18332/pne/157587","url":null,"abstract":"1 A 62-year-old man presented in the emergency department with fever and dry cough. He was a current smoker (20 pack-years), obese (ΒΜΙ: 43 kg/m2), and he started treatment for benign prostate hyperplasia following an episode of macroscopic hematuria about two months ago (unavailable laboratory tests at that time). No other past medical history was reported. Physical examination on admission revealed crackles in lung lower parts. PCR test for SARS-CoV-2 was negative. Blood tests showed increased C-reactive protein, anemia, and hypoalbuminemia, while arterial blood gas analysis displayed hypoxemia (pO2: 69 mmHg, pCO2: 36 mmHg, pH: 7.47, HCO3: 26 mmol/L). The chest X-ray showed infiltrates in both lungs (Figure 1). He was admitted at the Respiratory Department, and he was treated with antibiotics with a provisional diagnosis of community acquired pneumonia. In less than 24 hours after admission, he experienced hemoptysis. A thorough work-up was initiated measuring urine dipstick, which showed proteinuria and hematuria, and blood autoantibodies titers were ordered. Chest CT scan findings included ground glass opacities (GGOs) and crazy paving; and patchy GGOs associated with smooth septal thickening. Additionally, ‘air bronchogram’; visualization of bronchial structures containing air in the context of consolidation areas, and ‘dark bronchus sign’; and darker bronchus in the context of GGOs, are shown (Figure 2). These findings indicate hemorrhagic alveolitis or edema, thus the provisional diagnosis was alveolar hemorrhage. Vasculitis was put forward as the most probable diagnosis, as those abnormalities, along with the bilateral, para-hilar distribution (Figure 2), are common in diffuse alveolar hemorrhage associated with vasculitis. Therefore, the patient was to be subjected to plasma exchange. At that time he was rapidly deteriorating, experiencing massive hemoptysis and severe respiratory failure, and was transferred to the intensive care unit. The patient was intubated but did not manage to be stabilized and died a few hours later. The next day, serology revealed high titer of MPO/p-ANCA antibodies and the final diagnosis was ANCA-associated vasculitis with lung and renal involvement. Herein, we described a patient who presented with symptoms typical for pneumonia, who deteriorated a few hours after admission. The rapid progression and the presence of hemoptysis led to a rethink of the provisional diagnosis. ANCA-associated vasculitis (AAV) represents systemic, small-vessel vasculitis and is characterized by the loss of tolerance to neutrophil antigens and the development of autoantibodies to the neutrophil proteins MPO and PR3. They are considered to be rare with a prevalence of 46–184 per million people1. Lung involvement is well described in ANCA-associated small vessel vasculitis2, and a recent study found that the majority of patients with ANCA-associated small vessel vasculitis, who were admitted with acute respiratory failure, experience","PeriodicalId":42353,"journal":{"name":"Pneumon","volume":"5 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2023-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83782701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
PneumonPub Date : 2023-03-29DOI: 10.18332/pne/159280
R. Costa, Anita Paiva, J. Maciel, P. Fernandes, A. Magalhães
{"title":"Surgery for pulmonary giant bullae","authors":"R. Costa, Anita Paiva, J. Maciel, P. Fernandes, A. Magalhães","doi":"10.18332/pne/159280","DOIUrl":"https://doi.org/10.18332/pne/159280","url":null,"abstract":"Elective bullectomy is rarely performed in chronic obstructive pulmonary disease patients. Selecting patients who will benefit the most from surgery is a challenging process. We report a case of a patient who underwent elective bullectomy to reduce symptoms and the severity of the exacerbations. One year after surgery he maintains improvement in quality of life despite the underlying emphysema. It is hard to identify only one test to predict which patients will benefit from the surgical treatment, but relief of symptoms in chronic obstructive pulmonary disease patients should be a priority over pulmonary function.","PeriodicalId":42353,"journal":{"name":"Pneumon","volume":"31 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2023-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78232840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
PneumonPub Date : 2023-03-21DOI: 10.18332/pne/157586
M. Sionidou
{"title":"Pregnancy in cystic fibrosis in the era of CFTR modulators: A case series","authors":"M. Sionidou","doi":"10.18332/pne/157586","DOIUrl":"https://doi.org/10.18332/pne/157586","url":null,"abstract":"Table 2, her respiratory","PeriodicalId":42353,"journal":{"name":"Pneumon","volume":"15 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2023-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74628310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
PneumonPub Date : 2023-03-21DOI: 10.18332/pne/157585
M. Tavares, Filipa Fernandes, É. Almeida
{"title":"Massive hemoptysis in a patient with pulmonary tuberculosis complicated by cavitation with an air crescent sign","authors":"M. Tavares, Filipa Fernandes, É. Almeida","doi":"10.18332/pne/157585","DOIUrl":"https://doi.org/10.18332/pne/157585","url":null,"abstract":"the air crescent sign is a characteristic imaging finding of aspergilloma, it can be found in other entities including tuberculosis 2 , neoplasms (particularly bronchial carcinoma), Rasmussen’s aneurysm, and intracavitary clots. Other, rarer causes include foreign bodies, thick pus, dehydrated caseous material, teratoma, and hydatid disease 3,4 .","PeriodicalId":42353,"journal":{"name":"Pneumon","volume":"26 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2023-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89917776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
PneumonPub Date : 2023-02-15DOI: 10.18332/pne/157588
Etienne Ceci Bonello, Rebecca Bianco, C. Gouder
{"title":"Knowledge of fractional exhaled nitric oxide use among doctors working in a local respiratory department","authors":"Etienne Ceci Bonello, Rebecca Bianco, C. Gouder","doi":"10.18332/pne/157588","DOIUrl":"https://doi.org/10.18332/pne/157588","url":null,"abstract":"cut-off of <12 months and ≥12 months working in our respiratory department was set to check whether there is a statistical significance in the knowledge of FeNO testing amongst these two categories. The participants working in the department for <12 months are junior trainees currently rotating in the ABSTRACT INTRODUCTION The aim of this survey is to assess the knowledge regarding fractional exhaled nitric oxide (FeNO) testing among our junior and senior physicians currently working within the respiratory department. METHODS All medical doctors above foundation level working in the respiratory department for at least 3 months at Mater Dei Hospital were asked to complete a questionnaire with a total of 19 true or false questions. Questions were based on current international guidelines and recommendations. RESULTS Our cohort included a total of 25 doctors. The mean age of experience working as a physician was 8 years; 84% of doctors (n=21) were aware that FeNO testing is available at our hospital. Questions assessing clinical indications and interpretation of FeNO in asthma and different respiratory conditions showed overall significantly better results between junior and senior trainees (p=0.013), though still lacking in certain aspects especially in conditions unrelated to asthma. CONCLUSIONS Our results show that doctors working in our department are overall knowledgeable about the use of FeNO in relation to the diagnosis and management of asthma. However, its use and interpretation in relation to other respiratory conditions and co-morbidities is lacking. This emphasizes the need to educate local respiratory trainees further on FeNO testing.","PeriodicalId":42353,"journal":{"name":"Pneumon","volume":"160 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2023-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85359138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
PneumonPub Date : 2023-01-30DOI: 10.18332/pne/157584
E. Fouka, K. Samitas, P. Bakakos
{"title":"Ten years of the website for patients with asthma (www.myasthma.gr) by the Asthma Working Group of\u0000the Hellenic Thoracic Society","authors":"E. Fouka, K. Samitas, P. Bakakos","doi":"10.18332/pne/157584","DOIUrl":"https://doi.org/10.18332/pne/157584","url":null,"abstract":"","PeriodicalId":42353,"journal":{"name":"Pneumon","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2023-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83714083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}