{"title":"Chest swelling with adenopathy: Don’t forget tuberculosis","authors":"Hanadi Abid, Sonia Toujani, Jamel Ammar, Adel Marghli, Leila Slim, Saoussen Hantous, Aida Ayadi, Agnès Hamzaoui","doi":"10.1016/j.rmedc.2010.04.001","DOIUrl":"https://doi.org/10.1016/j.rmedc.2010.04.001","url":null,"abstract":"<div><p>Tuberculosis (TB) of the chest wall is far less frequently encountered than pulmonary infection and represents between 1% and 2% of TB overall. We report the case of 24-year-old woman presented with a swelling on the right side of the chest, cervical and right supraclavicular adenopathy, anorexia and weight loss, over a period of 1 month. Chest computed tomography revealed an abscess in the right lateral chest wall. There were no pleuropulmonary or bone lesions. Biopsy of supraclavicular node showed nonspecific inflammatory lesions. Bacterial examination of needle aspiration biopsy specimen from the chest wall abscess disclosed <em>Staphylococcus aureus</em>. Despite adequate antibiotic, no improvement was obtained. After resection of the abscess, histopathological examination confirmed the diagnosis of tuberculosis and acid-fast bacilli grew on aspiration fluid. Tuberculosis infection should be considered if an infection process failed to respond to anti infectious agents.</p></div>","PeriodicalId":89478,"journal":{"name":"Respiratory medicine CME","volume":"4 1","pages":"Pages 47-49"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rmedc.2010.04.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137091595","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}
José Meireles, Sara Neves, Alexandra Castro, Margarida França
{"title":"Spontaneous pneumomediastinum revisited","authors":"José Meireles, Sara Neves, Alexandra Castro, Margarida França","doi":"10.1016/j.rmedc.2011.03.005","DOIUrl":"https://doi.org/10.1016/j.rmedc.2011.03.005","url":null,"abstract":"<div><p>Spontaneous pneumomediastinum is defined as free air within the mediastinum, not associated with trauma. Causes include exercise, drugs, asthma, vomiting, difficult labour and Valsalva maneuvers. It’s a rare, usually benign and self-limited condition, more prevalent in young males. The triad of thoracic pain, dyspnoea and subcutaneous emphysema is typical.</p><p>We report a case of a 23 year old man presenting to the emergency room complaining of odynophagia, thoracic pain and neck swelling. He had fever and productive purulent cough in the previous week. He had no abnormal findings but subcutaneous emphysema. We found a pneumomediastinum without pneumothorax, treated conservatively with complete resolution.</p><p>Although frightening, this condition usually has good prognosis without specific treatment, other than avoidance of the cause.</p></div>","PeriodicalId":89478,"journal":{"name":"Respiratory medicine CME","volume":"4 4","pages":"Pages 181-183"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rmedc.2011.03.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137226493","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":"Pulmonary Erdheim-Chester disease: A response to predonisolone","authors":"Kumi Yoneda Nagahama , Takuo Hayashi , Tetsutaro Nagaoka , Ryota Kanemaru , Shinsaku Togo , Toshio Kumasaka , Toshimasa Uekusa , Kuniaki Seyama , Kazuhisa Takahashi","doi":"10.1016/j.rmedc.2010.08.002","DOIUrl":"https://doi.org/10.1016/j.rmedc.2010.08.002","url":null,"abstract":"<div><p>Erdheim-Chester disease (ECD) is a rare non-Langerhan’s cell histiocytosis of unknown origin, involving multiple organs. The patient with ECD described here is a 38-year-old man who was admitted to the hospital with dyspnea on exertion. His chest radiograph revealed a diffuse reticulonodular shadow. After the video-assisted thoracoscopic surgery was performed, he was diagnosed as having ECD. A brown eruption on his left temple, when tested by skin biopsy, proved to be ECD. No lesions other than these on the lung and skin were identified, and oral administration of predonisolone successfully treated both of them. Although recovery has followed the administration of predonisolone and chemotherapy for several patients with pulmonary ECD, this is the first report that predonisolone alone provided clinical and objective recovery from pulmonary ECD. This outcome indicates that, of all the many treatments tried for ECD, steroids may become the first-line therapy for pulmonary involvement.</p></div>","PeriodicalId":89478,"journal":{"name":"Respiratory medicine CME","volume":"4 2","pages":"Pages 81-84"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rmedc.2010.08.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137401430","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":"Elevated D-dimer is not always pulmonary embolism","authors":"Vikas Pathak, Iliana Samara Hurtado Rendon, Padmini Muthyala","doi":"10.1016/j.rmedc.2010.05.006","DOIUrl":"https://doi.org/10.1016/j.rmedc.2010.05.006","url":null,"abstract":"<div><p>Serum D-dimer is elevated in several chest emergencies, including Acute Coronary Syndrome (ACS), Venous Thromboembolism (VTE) and Acute Aortic Dissection (AAD). Because of its simplicity and easy availability its use beyond the exclusion of VTE has grown in recent years. There is an increasing trend towards using the test to exclude AAD, where there are no other sensitive screening tests.</p><p>We present a patient suspected to have pulmonary embolism (PE) based on chest pain and elevated D-dimer, gets a computed tomography with angiogram (CTA) and turns out to have an AAD.</p></div>","PeriodicalId":89478,"journal":{"name":"Respiratory medicine CME","volume":"4 2","pages":"Pages 91-92"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rmedc.2010.05.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137401435","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}
Emer Kelly, Catherine M. Greene, Tomas P. Carroll, Noel G. McElvaney, Shane J. O’Neill
{"title":"Alpha-1 antitrypsin deficiency","authors":"Emer Kelly, Catherine M. Greene, Tomas P. Carroll, Noel G. McElvaney, Shane J. O’Neill","doi":"10.1016/j.rmedc.2011.04.001","DOIUrl":"https://doi.org/10.1016/j.rmedc.2011.04.001","url":null,"abstract":"<div><h3>Objective</h3><p>To review the topic of alpha-1 antitrypsin (AAT) deficiency.</p></div><div><h3>Method</h3><p>Narrative literature review.</p></div><div><h3>Results</h3><p>Much work has been carried out on this condition with many questions being answered but still further questions remain.</p></div><div><h3>Discussion and conclusions</h3><p>AAT deficiency is an autosomal co-dominantly inherited disease which affects the lungs and liver predominantly. The clinical manifestations, prevalence, genetics, molecular pathophysiology, screening and treatment recommendations are summarised in this review.</p></div>","PeriodicalId":89478,"journal":{"name":"Respiratory medicine CME","volume":"4 1","pages":"Pages 1-8"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rmedc.2011.04.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"92013239","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}
Ramadass Satya, Arya Bagherpour, Melanie Christofferson, Radhika J. Satya
{"title":"Large saddle pulmonary embolism in patient with previously placed IVC filter: A case report of successful Angiojet thrombectomy","authors":"Ramadass Satya, Arya Bagherpour, Melanie Christofferson, Radhika J. Satya","doi":"10.1016/j.rmedc.2010.11.005","DOIUrl":"https://doi.org/10.1016/j.rmedc.2010.11.005","url":null,"abstract":"<div><p>Saddle pulmonary embolisms are life threatening and are uncommon after IVC filter placement. Management of PE is difficult, and emergent thrombolysis is sometimes the only option left if the patient is hemodynamically unstable. We present a rare case of an acute saddle pulmonary embolism in a patient with an intact infrarenal IVC filter presenting with hemodynamic instability.</p></div>","PeriodicalId":89478,"journal":{"name":"Respiratory medicine CME","volume":"4 3","pages":"Pages 133-135"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rmedc.2010.11.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137088771","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}
A. Moreland, K. Kijsirichareanchai, R. Alalawi, K. Nugent
{"title":"Pulmonary alveolar proteinosis in a man with prolonged cotton dust exposure","authors":"A. Moreland, K. Kijsirichareanchai, R. Alalawi, K. Nugent","doi":"10.1016/j.rmedc.2011.01.003","DOIUrl":"https://doi.org/10.1016/j.rmedc.2011.01.003","url":null,"abstract":"<div><p>A 59-year-old man presented with severe paroxysms of cough associated with dyspnea. His CT scan showed diffuse bilateral ground glass opacifications. His bronchoalveolar lavage fluid was consistent with pulmonary alveolar proteinosis. Transbronchial biopsy, microbiological studies, and cytology did not identify any alternative diagnosis. The patient had a history of working as a textile loom technician for thirty-one years and had significant exposure to cotton dust. He responded well to whole lung lavage with improvement of symptoms, gas exchange, and CT scan. This patient represents the third reported case of pulmonary alveolar proteinosis associated with cotton dust exposure. We suggest that cellulose might be useful in animal models of pulmonary alveolar proteinosis.</p></div>","PeriodicalId":89478,"journal":{"name":"Respiratory medicine CME","volume":"4 3","pages":"Pages 121-123"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rmedc.2011.01.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137088775","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}
Charles Pirlet , Emmanuel Beck , André J. Scheen , Bernard Duysinx , Jean-Louis Corhay
{"title":"Hypocortisolism induces chronic respiratory failure","authors":"Charles Pirlet , Emmanuel Beck , André J. Scheen , Bernard Duysinx , Jean-Louis Corhay","doi":"10.1016/j.rmedc.2011.01.006","DOIUrl":"https://doi.org/10.1016/j.rmedc.2011.01.006","url":null,"abstract":"<div><p>Hypocortisolism is an uncommon condition. Its association with myopathy and respiratory failure has only rarely been described. We report the case of a 52 year-old woman presenting with progressive dyspnoea. Work-up revealed a severe restrictive syndrome with hypoxaemia. Further investigations showed hypocortisolism of pituitary origin. Response to hydrocortisone allowed us to conclude to an unusual case of hypocortisolic myopathy affecting the respiratory muscles.</p></div>","PeriodicalId":89478,"journal":{"name":"Respiratory medicine CME","volume":"4 3","pages":"Pages 107-108"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rmedc.2011.01.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137088779","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}
Daniel Smith , David Reid , Richard Slaughter , Philip Masel , Anna Tai , Scott Bell
{"title":"Superior vena cava obstruction due to total implantable venous access devices in cystic fibrosis: Case series and review","authors":"Daniel Smith , David Reid , Richard Slaughter , Philip Masel , Anna Tai , Scott Bell","doi":"10.1016/j.rmedc.2010.12.005","DOIUrl":"https://doi.org/10.1016/j.rmedc.2010.12.005","url":null,"abstract":"<div><p>As the life expectancy of patients with cystic fibrosis (CF) improves, treatment related morbidity is increasingly recognised. Totally implantable venous access devices (TIVADs) offer reliable long term central venous access but are associated with recognised complications including venous thrombosis. Superior vena cava obstruction (SVCO) however has been rarely reported in this setting. We report a single CF centre’s experience of SVCO associated with TIVADs in patients with CF, followed by a review of the published literature on risk factors, preventative strategies and treatment approaches.</p></div>","PeriodicalId":89478,"journal":{"name":"Respiratory medicine CME","volume":"4 3","pages":"Pages 99-104"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rmedc.2010.12.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137088781","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":"An uncommon hazard: Pulmonary talcosis as a result of recurrent aspiration of baby powder","authors":"Czul Frank , Lascano Jorge","doi":"10.1016/j.rmedc.2011.02.001","DOIUrl":"https://doi.org/10.1016/j.rmedc.2011.02.001","url":null,"abstract":"<div><p>A previously healthy 52-year old woman presented to the hospital with a 6-month history of progressive dyspnea. Associated symptoms included a persistent dry cough that started 2 months prior admission and an unintentional weight loss of 20 pounds over the course of her illness. On lung examination revealed fine bilateral end-inspiratory crackles in both lower and upper lobes. Radiographic studies showed evidence of interstitial lung disease. The patient underwent bronchoscopy were transbronchial biopsies were taken and showed fibrosis of bronchial walls and lung parenchyma with prominent non-necrotizing granulomata that contained abundant polarizing crystalline material. Once the pathologic findings were known, the patient was re-interviewed. She reported that for the last 20-years, she used baby talcum powder regularly at least twice a day, usually after bathing for personal hygiene. In addition, she habitually applied it to her bed sheets nightly. She was started on prednisone at a dose of 0.5 mg/kg/day, which was gradually tapered and then maintained on a dose of 5 mg daily. Her symptoms rapidly improved over weeks to the point whereshe no longer required home oxygen therapy.</p></div>","PeriodicalId":89478,"journal":{"name":"Respiratory medicine CME","volume":"4 3","pages":"Pages 109-111"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rmedc.2011.02.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137088783","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}