Multifocal Recurrent Lung Opacities in a Renal Failure Patient
Pulmonary vasculitides include a broad variety of disorders having in common inflammation and destruction of the blood vessels within the lung. Granulomatosis with polyangiitis (GPA), formerly known as Wegener granulomatosis, is an antineutrophil cytoplasmic antibody (ANCA)-associated small-vessel vasculitis that affects a number of organ systems, and is the most common of the ANCA-associated vasculitides. GPA affects a broad age range, most commonly presenting in middle-aged adults. The classic triad of GPA, the combination of upper-airway disease (sinusitis, otitis media, ulcerations, tracheobronchial stenoses), lower-re...
Source: Clinical Pulmonary Medicine - August 27, 2016 Category: Respiratory Medicine Tags: Images in Pulmonary Medicine Source Type: research
Congenital Pulmonary Airway Malformation
We present a review of the epidemiology, the pathophysiology, radiographic findings, treatment modalities, and recently published studies on the subject. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - August 27, 2016 Category: Respiratory Medicine Tags: Colleagues Source Type: research
The Diagnosis and Treatment of Antisynthetase Syndrome
Antisynthetase syndrome is an autoimmune condition, characterized by antibodies directed against an aminoacycl transfer RNA synthetase along with clinical features that can include interstitial lung disease (ILD), myositis, Raynaud’s phenomenon, and arthritis. There is a higher prevalence and increased severity of ILD in patients with antisynthetase syndrome, as compared with dermatomyositis and polymyositis, inflammatory myopathies with which it may overlap phenotypically. The diagnosis is made by a multidisciplinary approach, synthesizing rheumatology and pulmonary evaluations, along with serologic, radiographic, and o...
Source: Clinical Pulmonary Medicine - August 27, 2016 Category: Respiratory Medicine Tags: Interstitial, Inflammatory & Occupational Lung Disease Source Type: research
Ranula: A Rare Cause of Airway Obstruction
We present a case of a 34-year-old man requiring intensive care unit admission for closer airway monitoring due to rapid progression of a simple ranula. Airway obstruction resolved promptly with steroids and antibiotics. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - August 27, 2016 Category: Respiratory Medicine Tags: Critical Care/Respiratory Care Source Type: research
The Prevalence and Predictors of Obstructive Sleep Apnea in Bariatric Surgery Candidates
Thirty-five percent of the population that is above 20 years of age has been found to be suffering from obesity. Obstructive sleep apnea (OSA) is one of the most common diseases among the obese population. Weight loss is not only a remedy for OSA, it also prevents other complications of obesity. Bariatric surgery is also being used nowadays for weight loss in morbidly obese patients. OSA screening is one of the prerequisites for bariatric surgery. The aim of this study was focused on determining the prevalence and defining predictors of OSA among the multiethnic bariatric surgery patients of New York City. We retrospective...
Source: Clinical Pulmonary Medicine - August 27, 2016 Category: Respiratory Medicine Tags: Topics in Pulmonary Medicine Source Type: research
Hepatic Hydrothorax: Diagnosis, Clinical Implications, and Management
Hepatic hydrothorax is a relatively rare complication seen in patients with liver cirrhosis and portal hypertension. It can have serious consequences such as spontaneous bacterial empyema. The pathogenesis of pleural fluid accumulation is thought to be due to pleuroperitoneal blebs that rupture and cause diaphragm defects, allowing a unidirectional flow from the peritoneal to the pleural cavities. Diagnosis requires ruling out other causes of pleural effusion and evaluating for pleural infection. Treatment options aim at decreasing fluid production (salt restriction, diuretics), decompressing the portal system, and rare su...
Source: Clinical Pulmonary Medicine - August 27, 2016 Category: Respiratory Medicine Tags: Topics in Pulmonary Medicine Source Type: research
Inhaled Mannitol as a Therapeutic Medication
Airway diseases, such as asthma, bronchiectasis, and cystic fibrosis (CF), are characterized by excessive secretion of mucus that fails to clear from the airways due to insufficient hydration at the airway surface. Failure to clear this mucus results in chronic cough, persistent inflammation, recurrent infective exacerbations, a poor quality of life, and an increased risk of morbidity and mortality. Inhaled dry powder mannitol, being an osmotic agent, improves hydration at the airway surface, which in turn improves the physical properties of mucus and facilitates its clearance. These changes once sustained have been shown ...
Source: Clinical Pulmonary Medicine - August 27, 2016 Category: Respiratory Medicine Tags: Obstructive Airways Disease Source Type: research
Are We Assessing Patients’ Experiences of Breathlessness Accurately During Spontaneous Breathing Trials?
Synopsis: The first prospective, multicenter study designed to assess health care workers’ subjective assessments of patient breathlessness during spontaneous breathing trials demonstrated that practitioners underestimated their patients’ experience of breathlessness.
Source: Haugdahl, H, Storli, S et al. Underestimation of patient breathlessness by nurses and physicians during a spontaneous breathing trial. Am J Respir Crit Care Med. 2015; 192(12): 1440–1448. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - May 1, 2016 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
Endobronchial Valve Placement: Too Much Risk for the Benefit?
Synopsis: the STELVIO trial randomized patients without collateral interlobar ventilation to receive endobronchial valves or standard care as a treatment for severe COPD. Although improvement in the lung function and the exercise capacity was observed in the valve group, a significant rate of pneumothorax was also observed.
Source: Klooster K, Ten HAcken NHT, Hartman JE et al. Endobronchial valves for emphysema without interlobar collateral ventilation. NEJM. 2015; 373: 2325–35. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - May 1, 2016 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
The Role of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration in the Diagnosis and the Subtyping of Lymphoma in the Mediastinum
Endobronchial ultrasound-guided transbronchial needle aspiration is a commonly performed procedure in patients with mediastinal lymphadenopathy. Its role has been widely established in the diagnosis and the staging of lung cancer and other benign disease, but there is still debatable evidence regarding its role in the diagnosis, the subtyping, and the treatment of lymphoproliferative diseases. Consequently, there are no guidelines or statements to guide the choice of diagnostic modality in such cases. We review the available literature to evaluate the myth that endobronchial ultrasound-guided transbronchial needle aspirati...
Source: Clinical Pulmonary Medicine - May 1, 2016 Category: Respiratory Medicine Tags: Clinical Myths and Evidence-based Medicine Source Type: research
Multiple Pneumatoceles in a 6-Week-Old Infant
We report a case of community-acquired Panton-Valentine leukocidin secreting MRSA necrotizing pneumonia in a previously well 6-week-old infant, who presented with multiple pneumatoceles. This case highlights the possibility of emerging community-acquired MRSA pneumonia in healthy infants. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - May 1, 2016 Category: Respiratory Medicine Tags: Images in Pulmonary Medicine Source Type: research
Hypersensitivity Pneumonitis
Hypersensitivity pneumonitis (HP) is a syndrome caused by an exaggerated immune response to the inhalation and subsequent sensitization to a variety of environmental antigenic particles. The pathogenesis remains unclear; however, a “two-hit hypothesis” implicating a pathologic interaction between an environmental antigen and the immune system of a susceptible host seems likely as only a minority of the exposed individuals develop HP. The presentation may be acute, as in bird fancier’s lung, the classical form of HP, or more insidiously as the subacute form of chronic HP caused by repeated low-level antigenic exposure...
Source: Clinical Pulmonary Medicine - May 1, 2016 Category: Respiratory Medicine Tags: Topics in Pulmonary Medicine Source Type: research
Bedside Ultrasound for Assessing Patients in Shock
Patients in shock require rapid assessment and intervention, often before laboratory studies have returned or complete radiographic studies can be obtained. In such situations, clinician-performed diagnostic ultrasound provides a useful adjunct to the traditional clinical tools of history and physical examination. This review describes multiple easily acquired ultrasound examinations to be performed at the bedside by the primary clinician to provide new windows into the underlying etiology of a shock state. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - May 1, 2016 Category: Respiratory Medicine Tags: Colleagues in Respiratory Medicine Source Type: research
Pirfenidone in Lung Interstitial Diseases: Indications and How to Evaluate its Effects
This article aims to review some of the most relevant articles concerning pirfenidone, with a summary of its indications, previous studies that support its use, possible adverse effects, and the clinical monitoring of patients. We also have hypothesized the potential use of pirfenidone in other interstitial lung diseases. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - May 1, 2016 Category: Respiratory Medicine Tags: Interstitial, Inflammatory and Occupational Lung Disease Source Type: research
Nebulized Antibiotics for Ventilator-associated Pneumonia: Next Steps After the Meta-analyses
Ventilator-associated pneumonia (VAP) represents a major clinical challenge for all physicians caring for critically ill patients. Important concerns regarding the optimum treatment regimen for the management of pulmonary infections—such as the choice of antibiotic, the dosing, the duration of therapy, and drug delivery to the infected tissue—play an even more prominent role in the management of VAP. Patients with VAP are usually severely ill and have already been exposed to prolonged periods of intensive care; therefore, the safety margin for error is narrowed. Nebulized antibiotics represent a promising way to delive...
Source: Clinical Pulmonary Medicine - May 1, 2016 Category: Respiratory Medicine Tags: Critical Care/Respiratory Care Source Type: research
