Two studies—one conducted in Philadelphia, and the other in San Francisco—demonstrate that crowding in the emergency department (ED) is associated with a delay in providing antibiotic therapy for patients with pneumonia.
Journal Of Respiratory Diseases
To what extent are patients with obstructive sleep apnea syndrome (OSAS) at increased risk for postoperative complications? Are there any specific interventions that reduce the risks?
ABSTRACT: The diagnosis of invasive pulmonary aspergillosis remains
challenging because of atypical clinical presentations,
comorbid diseases, and the difficulty in culturing Aspergillus by
standard microbiological techniques. Serial monitoring with
CT scans of the chest and serological markers can help with
early identification in high-risk patients, such as hematopoietic
stem cell transplant recipients. The most common radiographic
findings are single or multiple nodules, wedge-shaped
pleural-based infiltrates, and cavities. The halo sign is the most
suggestive clue to aspergillosis and is manifested by a macronodule
surrounded by a perimeter of ground-glass opacity.
(J Respir Dis. 2008;29(10):405-410)
A 51-year-old man with a long history of alcohol abuse and heavy cigarette smoking presented to our hospital with worsening of a chronic cough, which had become productive of thick green sputum and was associated with posttussive emesis. He denied fevers and chills but had a recent and unintentional weight loss of about 5 kg. He had a history of squamous cell carcinoma of the right tonsil, which remained in remission for more than 4 years after chemotherapy, radiation therapy, and resection. There was no recent history of travel or any occupational exposures or known contacts with tuberculosis or animals (wild or domestic).
The differential diagnosis for
endobronchial lesions includes
but is not limited to
neoplastic causes, benign tumors,
infections, and foreign
objects. We report a case of an
unusual cause of endobronchial
This question deserves a broad answer, considering how much has changed since the old high-resolution CT (HRCT) scans with 1-mm slices and 1-cm intervals.1-3 The advent of multidetector row CT has had a significant effect on the versatility and diagnostic capabilities of CT in general. Coupled with novel processes of image postprocessing—including quantification of lung disease using advanced software—the availability of multiplanar projections and the opportunity to perform virtual bronchoscopy have led to an improvement in what is available for the evaluation of COPD.
ABSTRACT: Patients with rheumatoid arthritis (RA) often have
pulmonary manifestations, such as interstitial lung disease.
The most common cause of upper airway obstruction is cricoarytenoid
arthritis. Patients often complain of a pharyngeal foreign-
body sensation or hoarseness, but some present with severe
stridor. Bronchiolitis obliterans is characterized by a rapid
onset of dyspnea and dry cough, with inspiratory rales and
squeaks on examination. This presentation, particularly in middle-
aged women with seropositive disease, distinguishes bronchiolitis
obliterans from other pulmonary manifestations of
RA. High-resolution CT may be more sensitive than pulmonary
function tests for detecting small-airways disease, and it frequently
shows moderate to severe air trapping on expiratory
images. (J Respir Dis. 2008;29(8):318-324)
We describe a case of sulfasalazine-
induced pneumonitis in
a complex medical patient.
This case illustrates the potential
for drug-induced pulmonary
disease and the vigilance
needed in evaluating patients
with subacute respiratory decompensation.
and treatment most
likely prevented the progression
of acute respiratory failure
and, possibly, irreversible
lung injury or death.
A 35-year-old woman presented to the emergency department (ED) with vague abdominal complaints. The patient had a complex medical history that included diverticulosis and relapsing polychondritis. Initially, her polychondritis was limited to involvement of the ears and nose. Within the past few years, however, her polychondritis flares had been associated with progressive dyspnea, which prompted intermittent and then long-term use of high-dose oral corticosteroids.
ABSTRACT: The most common causes of chylothorax are neoplasm-
particularly lymphoma-and trauma. The usual presenting
symptom is dyspnea resulting from the accumulation
of pleural fluid. The diagnosis of chylothorax is established by
measuring triglyceride levels in the pleural fluid; a triglyceride
level of greater than 110 mg/dL supports the diagnosis. The initial
approach to management involves chest tube drainage of
the pleural space. The administration of medium-chain triglycerides
as a source of fat is often useful. If drainage remains unchanged,
parenteral alimentation should be started. Surgical
intervention is indicated if conservative management is not
successful or if nutritional deterioration is imminent. If chylothorax
persists after ligation of the thoracic duct, options may
include percutaneous embolization, pleuroperitoneal shunt,
and pleurodesis. (J Respir Dis. 2008;29(8):325-333)