Gilda Diaz-fuentes, MD




Nonspecific symptoms are among the obstacles to diagnosis Pulmonary alveolar proteinosis: An easy-to-miss diagnosis key words: Alveolar proteinosis, Surfactant, Whole lung lavage

May 01, 2007

abstract: Pulmonary alveolar proteinosis (PAP) is characterized by the accumulation of lipoproteinaceous material in the alveoli. The most common symptoms are dyspnea on exertion and nonproductive cough. Weight loss, fatigue, chest pain, and hemoptysis have also been reported. Chest radiographs typically show bilateral, symmetrical airspace disease with an ill-defined nodular or confluent pattern, which gives a "bat wing" appearance, as is seen in heart failure. Pulmonary function tests usually demonstrate mild restrictive disease. Findings on examination of sputum specimens or bronchoalveolar lavage fluid can suggest the diagnosis; however, open lung biopsy is the diagnostic gold standard. Whole lung lavage remains the standard of care for PAP and is warranted in patients with severe dyspnea and hypoxemia. Subcutaneous human recombinant granulocyte-macrophage colony-stimulating factor appears to be a promising alternative to whole lung lavage for symptomatic patients. (J Respir Dis. 2007;28(5):177-184)

Diffuse alveolar hemorrhage in a patient with SLE

March 01, 2007

The authors present a case in which the initial manifestation of systemic lupus erythematosus (SLE) was diffuse alveolar hemorrhage (DAH), which is a rare presentation that carries a high risk of death. The patient failed to respond to standard therapy but was successfully treated with plasmapheresis.

Case In Point: Persistent left superior vena cava in an elderly man with pneumonia

October 01, 2006

The authors report the incidental finding of a persistent left superior vena cava (PLSVC) during the routine placement of a left subclavian central line in an elderly man with acute renal failure.