Case Reports in Pulmonology最新文献

{"title":"One Lung Soldier: A Ventilation Conundrum in a Postpneumonectomy Syndrome Complicated by Acute Respiratory Syndrome.","authors":"Jaskaran K Purewal,&nbsp;N F N Sakul,&nbsp;Nikhita R Balabbigari,&nbsp;Alberto Nenninger,&nbsp;Nisha Kotecha","doi":"10.1155/2020/5476794","DOIUrl":"https://doi.org/10.1155/2020/5476794","url":null,"abstract":"<p><p>Postpneumonectomy syndrome involves mediastinal shift causing dynamic airway obstruction via compression of the main bronchus and distal trachea. A few case reports describe the development of ARDS in patients with postpneumonectomy syndrome. Reeb et al. (2017) describe the mortality of postpneumonectomy ARDS anywhere from 33% to 88%. One may encounter difficulty in intubation and ventilation as parameters based on ideal body weight may not apply. Prone positioning ventilation and ECMO have been successfully used in isolated cases. We present such a case and highlight challenges in management. A 70-year-old male Vietnam veteran with remote history of right pneumonectomy thirty years prior presented with fever, cough, and dyspnea. Physical exam was significant for T 36.3°C, BP 162/73, heart rate 145 BPM, RR 22 breaths/minute, ht. 1.72 m, and wt. 78 kg, with transmitted right lung sounds and rhonchi on the left. Labs showed WBC 23.92/nL and procalcitonin 0.84 ng/mL. CXR showed left infiltrate and opacification of right hemithorax with right mediastinal shift. EKG showed atrial fibrillation. He was started on broad spectrum antibiotics for pneumonia, but deteriorated, and was intubated for respiratory distress from ARDS. Vasopressors were initiated for shock. Given the history of pneumonectomy, he was initially ventilated with lower tidal volumes (320 mL). However, incremental changes were made to tidal volumes, and ETT was repositioned several times for hypoxia. Epoprostenol and cisatracurium were also initiated. Positional changes would lead to sudden desaturation; hence, prone positioning ventilation was not done. He was not considered for ECMO due to his pneumonectomy status. Unfortunately, his condition worsened progressively and he expired. The guidelines for ARDS are well established. However, postpneumonectomy patients are unique as seen in our patient. It is unclear whether an endobronchial tube advanced into the left bronchus could have helped difficult airway management resulting from suspected postpneumonectomy syndrome as suggested by CXR. Higher tidal volumes were also unsuccessful in alleviating hypoxia and led to persistently elevated plateau pressures and driving pressures as high as 23, which was inconsistent with our goal of lung protective ventilation. Few case reports describe the successful use of prone positioning ventilation or ECMO in postpneumonectomy patients with ARDS. Although not well studied, low tidal volumes supported with ECMO may have been a favorable strategy for our patient.</p>","PeriodicalId":52364,"journal":{"name":"Case Reports in Pulmonology","volume":"2020 ","pages":"5476794"},"PeriodicalIF":0.0,"publicationDate":"2020-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/5476794","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37787453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spontaneous Pneumomediastinum and Diffuse Subcutaneous Emphysema after Methamphetamine Inhalation.","authors":"Michael Agustin,&nbsp;Gabriel David,&nbsp;Ji Yeong Kang,&nbsp;Ornusa Teerasukjinda","doi":"10.1155/2020/7538748","DOIUrl":"https://doi.org/10.1155/2020/7538748","url":null,"abstract":"<p><p>Methamphetamines are commonly abused drugs for their stimulant and euphoric effects. Inhaled and intravenous use may cause damage to the respiratory system. Spontaneous pneumomediastinum is a condition where changes in intrathoracic pressure leads to alveolar rupture and dissection of air along the tracheobronchial tree. Massive subcutaneous emphysema may result from pneumomediastinum which may compromise the central airway. In this case report, we present an unusual case of spontaneous pneumomediastinum and severe subcutaneous emphysema following inhalation of methamphetamine. This case emphasizes the rising concern on the acute respiratory complications of methamphetamine use.</p>","PeriodicalId":52364,"journal":{"name":"Case Reports in Pulmonology","volume":"2020 ","pages":"7538748"},"PeriodicalIF":0.0,"publicationDate":"2020-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/7538748","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37766164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of Bronchiectasis in HIV Patients among an Urban Population.","authors":"Veena Dronamraju, Navneet Singh, Justin Poon, Sachi Shah, Joseph Gorga, Hector Ojeda-Martinez, Samy McFarlane","doi":"10.1155/2020/8903809","DOIUrl":"10.1155/2020/8903809","url":null,"abstract":"<p><p>Bronchiectasis is characterized by permanent destruction of the airways that presents with productive cough, as well as bronchial wall thickening and luminal dilatation on computed tomographic (CT) scan of the chest; it is associated with high mortality. Accumulating data suggests higher rates of bronchiectasis among the HIV-positive population. This case series involves 14 patients with bronchiectasis and HIV followed at two major urban institutions from 1999 to 2018. Demographics, clinical presentation, microbiology, radiographic imaging, and outcomes were collected and compiled. Mean age was 42 years (range 12-77 years). 36% had a CD4 count greater than 500 cells/mm³, 28% had a CD4 count between 200 and 500 cells/mm³, and 36% had AIDS. 43% were treated for Pneumocystis jiroveci pneumonia (PJP) and 50% for Mycobacterium avium complex (MAC) infection. 21% had COPD, 7% had asthma, and 7% had a history of pulmonary aspergillosis. Two patients were followed up by pulmonary services after diagnosis of bronchiectasis on CT. The timeline of the follow-up in these cases was within months and after three years respectively. It is posited that the prevalence of bronchiectasis in HIV patients may be underestimated. Improving recognition and management of bronchiectasis could help diminish rehospitalization rates.</p>","PeriodicalId":52364,"journal":{"name":"Case Reports in Pulmonology","volume":"2020 ","pages":"8903809"},"PeriodicalIF":0.0,"publicationDate":"2020-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7063221/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37744592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful Use of Hyperbaric Oxygen as Adjunctive Therapy for a Nonhealing Venous Ulcer in a Patient with Systemic Sclerosis and Pulmonary Arterial Hypertension: A Case Report and Review of the Literature.","authors":"Isaac Biney,&nbsp;Tina Dudney,&nbsp;Mitchell Goldman,&nbsp;Lee Carder,&nbsp;Elise Schriver","doi":"10.1155/2020/4750375","DOIUrl":"https://doi.org/10.1155/2020/4750375","url":null,"abstract":"<p><p>Skin ulcers are a common complication of systemic sclerosis (SSc) that can significantly impact the quality of life. There have been recent reports on the use of hyperbaric oxygen therapy (HBO₂T) in the management of nonhealing systemic sclerosis skin ulcers. The effect of HBO₂T on pulmonary arterial hypertension (PAH), another common and potentially life-threatening complication of SSc, is unclear with literature on the subject lacking. We present the case of a 65-year-old female with limited SSc complicated by severe PAH and a nonhealing left lower extremity venous ulcer. HBO₂T was successfully used as an adjunct in her management resulting in complete resolution of the venous ulcer and improved quality of life without any adverse effects on her pulmonary arterial hypertension.</p>","PeriodicalId":52364,"journal":{"name":"Case Reports in Pulmonology","volume":"2020 ","pages":"4750375"},"PeriodicalIF":0.0,"publicationDate":"2020-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/4750375","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37744591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spontaneous Chylothorax following Septic Pulmonary Embolization.","authors":"Michael Agustin,&nbsp;Michele Yamamoto,&nbsp;Chawat Tongma,&nbsp;Leslie Anne Chua,&nbsp;Michael Torres,&nbsp;Scott Shay","doi":"10.1155/2020/3979507","DOIUrl":"https://doi.org/10.1155/2020/3979507","url":null,"abstract":"<p><p>Chylothorax is the occurrence of chyle (lymph) in the pleural cavity secondary to damage of the thoracic duct. It is a rare form of pleural effusion which appears as a milky white turbid fluid. Malignancy is the leading cause of nontraumatic chylothorax while inadvertent surgical injury to the thoracic duct is the major cause of traumatic chylothorax. We report a case of spontaneous left-side chylothorax following septic pulmonary embolization (SPE) with Methicillin-Resistant Staphylococcus aureus (MRSA). This is a rare case of a nonmalignant, nontraumatic, and nontuberculous spontaneous chylothorax which was conservatively treated with fibrinolysis and diet modification.</p>","PeriodicalId":52364,"journal":{"name":"Case Reports in Pulmonology","volume":"2020 ","pages":"3979507"},"PeriodicalIF":0.0,"publicationDate":"2020-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/3979507","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37717256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case Series of Vaping-Induced Lung Injury in a Community Hospital Setting.","authors":"Mohammed Ali,&nbsp;Kashmala Khan,&nbsp;Mihir Buch,&nbsp;Manuel Ramos-Ramirez,&nbsp;Munish Sharma,&nbsp;Seema Patel,&nbsp;Saiara Choudhury,&nbsp;Humayun Anjum,&nbsp;Alamgir Khan,&nbsp;Salim Surani","doi":"10.1155/2020/9631916","DOIUrl":"https://doi.org/10.1155/2020/9631916","url":null,"abstract":"<p><p>Acute and subacute injury to the lung parenchyma can be caused by multiple products. Over the past few years, vaping (also known as E-cigarettes) has become a popular trend and has been considered \"safer\" alternative to smoking cigarettes, especially among young adults. The use of E-cigarettes has rapidly increased, and according to the most recent report by CDC released at the end of December 2019, 2,506 cases and more than 54 associated deaths due to vaping/E-cigarette-associated lung injury were reported. Though vitamin E acetate and tetrahydrocannabinol (THC) have been found in most of the bronchoalveolar lavage samples, there are still small numbers of cases that have not reported to using THC-containing compounds. Research looking into other possible constituents in E-cigarettes that can account for the etiology of disease and effects of vaping as it relates to pulmonary physiology still remains limited and uncertain. We hereby present a case series of 5 patients who were admitted primarily for respiratory symptoms of cough, dyspnea, and fevers and were diagnosed with vaping-induced pulmonary injury.</p>","PeriodicalId":52364,"journal":{"name":"Case Reports in Pulmonology","volume":"2020 ","pages":"9631916"},"PeriodicalIF":0.0,"publicationDate":"2020-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/9631916","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37664783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vaping Is Not Safe: A Case of Acute Eosinophilic Pneumonia following Cannabis Vapor Inhalation.","authors":"Daniel Antwi-Amoabeng,&nbsp;Raheel Islam","doi":"10.1155/2020/9496564","DOIUrl":"https://doi.org/10.1155/2020/9496564","url":null,"abstract":"<p><p>There is a well-established association between inhalational exposures and acute eosinophilic pneumonia (AEP). The most reported exposure is cigarette smoking. Here, we present a case of progressive shortness of breath and nonproductive cough in a college student with no significant medical history, approximately 10 days after inhaling cannabis aerosols on two separate occasions. He was started on empiric antibiotics and bronchodilators without improvement. He was diagnosed with AEP based on peripheral eosinophilia and high-resolution CT image results. He made rapid recovery on intravenous glucocorticoids. Vaping has gained popularity among young adults mainly due to the perception that it is a safe alternative to smoking. This case shows that there may be a false sense of security with vaping. Vaping poses a yet-to-be quantified public health threat, which requires further studies.</p>","PeriodicalId":52364,"journal":{"name":"Case Reports in Pulmonology","volume":"2020 ","pages":"9496564"},"PeriodicalIF":0.0,"publicationDate":"2020-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/9496564","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37634418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Follicular Bronchiolitis: Two Cases with Varying Clinical and Radiological Presentation.","authors":"Delyse Garg,&nbsp;Mohit Mody,&nbsp;Chaitanya Pal,&nbsp;Pratik Patel,&nbsp;Christina Migliore,&nbsp;Christine Minerowicz,&nbsp;Nikhil Madan","doi":"10.1155/2020/4564587","DOIUrl":"https://doi.org/10.1155/2020/4564587","url":null,"abstract":"<p><p>Follicular bronchiolitis (FB) is a rare bronchiolar disorder associated with hyperplasia of the bronchial-associated lymphoid tissue (BALT). It is characterized by the development of lymphoid follicles with germinal centers in the walls of small airways. It falls under the category of lymphoproliferative pulmonary diseases (LPDs) and commonly occurs in relation to connective tissue disease, immunodeficiency, infections, interstitial lung disease (ILD), and inflammatory airway diseases. Computerized tomography (CT) findings include centrilobular nodules with patchy ground glass infiltrate, tree-in-bud findings, and air trapping. It can very rarely present as diffuse cystic lung disease. We present two cases of FB. The first case is associated with Human Immunodeficiency Virus (HIV) infection and asthma with diffuse cystic changes on the CT. The second case is associated with reactive airway disease and gastroesophageal reflux disease (GERD) with the classic centrilobular nodules and ground glass opacities on the CT.</p>","PeriodicalId":52364,"journal":{"name":"Case Reports in Pulmonology","volume":"2020 ","pages":"4564587"},"PeriodicalIF":0.0,"publicationDate":"2020-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/4564587","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37634416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Goiter in a Patient with Pulmonary Arterial Hypertension Treated with Epoprostenol.","authors":"Shaadi Abughazaleh,&nbsp;Zeenat Safdar","doi":"10.1155/2020/1617253","DOIUrl":"https://doi.org/10.1155/2020/1617253","url":null,"abstract":"<p><p>A 35-year-old female with pulmonary arterial hypertension (PAH) who presented with complaints of progressively worsening dysphagia, facial swelling, and shortness of breath, was found to have a large goiter. In patients treated with epoprostenol for long periods of time, thyroid disease is common. Most cases of thyroid disease describe thyrotoxicosis and hyperthyroid statues, but our case was a patient on long term IV epoprostenol presenting with a superior vena cava-syndrome (SVC) like appearance and airway compromise found to have a goiter incidentally during workup.</p>","PeriodicalId":52364,"journal":{"name":"Case Reports in Pulmonology","volume":"2020 ","pages":"1617253"},"PeriodicalIF":0.0,"publicationDate":"2020-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/1617253","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37664781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spontaneous Hemopneumothorax: A Rare Cause of Unexplained Hemodynamic Instability in a Young Patient.","authors":"Antonio Higor Marques Aragão,&nbsp;Letícia Aguiar Fonseca,&nbsp;Flávio Clemente Deulefeu,&nbsp;Israel Lopes Medeiros,&nbsp;Rafael Fernandes Viana de Araújo,&nbsp;Carlos Alberto da Cruz Neto,&nbsp;Antero Gomes Neto","doi":"10.1155/2020/5026759","DOIUrl":"https://doi.org/10.1155/2020/5026759","url":null,"abstract":"<p><p>Spontaneous hemopneumothorax is a rare and potentially life-threatening disorder which complicates about 1-12% of patients presenting with spontaneous pneumothorax and has a remarkable predilection for male patients. It may present with signs of hypovolemic shock without apparent cause. While there are no specific guidelines for the management of patients diagnosed with such condition, wide debate in the literature relating to patient selection for surgery remains unresolved, and recently there seems to be a trend increasingly favorable towards early surgical intervention. Video-assisted thoracic surgery emerges as an excellent option for stable patients and has now been considered the gold standard treatment for spontaneous hemopneumothorax. We report the case of a 17-year-old male patient who presented to the emergency department with a history of sudden chest pain and dyspnea, with no previous evidence of trauma. On admission, the patient presented with hypotension, tachycardia, and cutaneous pallor. Chest X-ray showed hydropneumothorax on the left hemithorax; then, chest tube was placed with an initial drainage of 2000 ml of blood.</p>","PeriodicalId":52364,"journal":{"name":"Case Reports in Pulmonology","volume":"2020 ","pages":"5026759"},"PeriodicalIF":0.0,"publicationDate":"2020-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/5026759","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37634417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}