Journal Of Respiratory Diseases

Coccidioidomycosis risk in patients with diabetes or rhematological disease

Nov 24, 2008

•Coccidioides species, the cause of coccidioidomycosis, are endemic to the desert soils of the southwestern United States as well as northern Mexico and limited areas of Central and South America. The organisms can become airborne with disruption of the soil, either through natural causes or activities of humans or animals. Nearly all Coccidioides infections are acquired through the inhalation of airborne arthroconidia (spores).

The technique of adult flexible bronchoscopy: Part 1

Oct 24, 2008

ABSTRACT: Flexible bronchoscopy was clinically introduced by
Shigeto Ikeda in 1968 and is now used widely for diagnostic
and therapeutic interventions. A combination of advancing
technology and ingenuity has fostered the development of an
expanded array of devices and applications. The newer video
bronchoscopes offer higher-resolution images than fiberoptic
bronchoscopes. The advantages of fiberoptic technology are
lower cost and greater technical ease of adapting to smallerdiameter
bronchoscopes. Hybrid bronchoscopes have an imaging
lens and fiberoptic bundles that transmit the viewing
image to a charge couple device (CCD) chip in the body of the
operator end of the bronchoscope. The digital image is transmitted
from the CCD chip to the external processor for viewing
on a monitor, for digital storage, or for printing. (J Respir Dis.
2008;29(11):423-428)

Primary synovial sarcoma presenting as an endobronchial mass

Oct 24, 2008

Endobronchial primary synovial
sarcoma is an extremely
rare pulmonary tumor. We report
the case of a 58-yearold
man who presented with
a right-sided endobronchial
mass, which was diagnosed as
primary synovial sarcoma on
the basis of histological appearance
and immunohistochemical
staining. To the best
of our knowledge, this is only
the third case report of endobronchial
primary synovial
sarcoma.

Pulmonary hypertension in the elderly, part 1: Evaluation

Oct 23, 2008

ABSTRACT: Pulmonary arterial hypertension (PAH) is an increasingly
recognized cause of dyspnea in elderly patients. The
initial workup typically includes electrocardiography, chest radiography,
echocardiography, and pulmonary function tests. If
echocardiography shows signs of PAH, the diagnosis should be
confirmed by right heart catheterization. Radiographic evidence
of long-standing PAH includes enlargement of the central
pulmonary arteries with abrupt narrowing of the more distal
branches, giving a "pruned-tree" appearance, and right ventricular
(RV) enlargement. The classic radiographic signs of RV
enlargement include increased transverse diameter of the
heart, elevation of the cardiac border on the posteroanterior
view, and narrowing or loss of the retrosternal airspace on the
lateral projection. (J Respir Dis. 2008;29(11):443-450)

A covert cause of hypoxemia: Intravascular pulmonary lymphoma

Oct 23, 2008

We describe a patient with intravascular
pulmonary lymphoma
who presented with
progressive dyspnea and hypoxemia
with normal chest radiographic
findings. After an
unrevealing noninvasive evaluation,
a high-grade B-cell
intravascular lymphoma was
diagnosed by bronchoscopy
with transbronchial biopsy.
Treatment with a modified
CHOP regimen resulted in resolution
of the patient’s hypoxemia
and exercise limitation.
Although intravascular pulmonary
lymphoma rarely presents
with pulmonary symptoms,
it should be considered
in the differential diagnosis of
patients presenting with hypoxemia
and normal chest radiographic
findings.

Invasive pulmonary aspergillosis, part 2: Treatment

Oct 23, 2008

ABSTRACT: In general, the management of invasive pulmonary
aspergillosis is based on antifungal therapy and reversal of immunosuppression.
Voriconazole is the preferred treatment in
most cases. Liposomal preparations of amphotericin B, caspofungin,
and posaconazole are alternatives in patients who
cannot tolerate voriconazole or have refractory aspergillosis.
Prophylaxis in high-risk patients has gained popularity with
the availability of oral extended-spectrum azoles; posaconazole
is approved for prophylaxis in patients with acute leukemia,
myelodysplastic syndrome, and graft versus host disease.
(J Respir Dis. 2008;29(11):429-434)

A case of progressive shortness of breath in a patient with emphysema

Oct 23, 2008

A 71-year-old man who had received a diagnosis of emphysema 12 years ago was referred by his primary care physician to the pulmonary clinic. His symptoms were well controlled until a few months ago, when he complained of mild shortness of breath on physical activity. However, the shortness of breath worsened and became a significant limiting factor. He also had a persistent dry cough.

Pneumomediastinum as a complication of diabetic ketoacidosis

Oct 23, 2008

I read with interest the Chest Film Clinic on pneumomediastinum by Weinstock, Boiselle, and Roberts in the August issue (What caused this woman's pneumomediastinum? J Respir Dis. 2008;29:314-317). In the discussion of the differential diagnosis, the authors did not mention the occurrence of mediastinal emphysema in diabetic ketoacidosis, which was described in 4 patients by Beigelman and associates1 in 1969.

Identifying the predictors of asthma-related death

Oct 23, 2008

Death caused by asthma is not traditionally thought to be especially common, but it is important to note that asthma often plays a contributing and probably unrecognized role even if it is not often listed as the cause of death on a death certificate. Because early response to asthma exacerbations can make a crucial difference, it is important to develop patient action plans in the outpatient setting well before an attack occurs. However, since busy clinicians must prioritize their educational efforts, identifying who is most at risk for death from asthma is all the more important.

Diagnosing asthma in seniors: An algorithmic approach

Oct 1, 2008

ABSTRACT: The diagnosis of asthma in older persons may be
complicated by a number of factors, including atypical presentations
and comorbid conditions, such as chronic obstructive
pulmonary disease and congestive heart failure (CHF). A
high index of suspicion for the diagnosis of asthma is warranted
in patients with isolated dyspnea or cough. The diagnosis
should be based on demonstration of reversible airway
obstruction on pulmonary function tests. Additional tests that
may be useful in the initial evaluation include chest radiography,
arterial blood gas analysis, and standard electrocardiography.
CT may help exclude pulmonary embolism and certain
neoplasms that can masquerade as asthma. High-resolution
CT scans are valuable when pulmonary function test
results are consistent with interstitial lung disease. When the
diagnosis is uncertain, measurement of brain natriuretic peptide
can help distinguish between obstructive lung disease and
CHF. (J Respir Dis. 2008;29(10):391-396)

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