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2282. A Pregnant Woman With Hemoptysis and Diffuse Pulmonary Nodules.
作者: Amina Pervaiz.;Mohammed Inany.;Huy Q Nguyen.;Suzanne M Jacques.;Khaled Alshabani.
来源: Chest. 2021年160卷6期e651-e656页
A 22-year-old woman who was 36 weeks pregnant presented with a 4-day history of cough, hemoptysis, and exertional dyspnea. She had no fever, night sweats, or weight loss. The review of system was otherwise negative. Her medical history was notable for a spontaneous first-trimester abortion a year ago. At that time, she had a transvaginal ultrasound scan that showed a gestational sac with no fetal movement. A post-abortion ultrasound scan revealed no residual fetal parts.
2283. Interlobular Septal Thickening in a Young Man With Dyspnea.
作者: Samiksha Gupta.;Miloni Parmar.;Cody Cox.;Chirin Orabi.;Heyyan Khalil.;Salim Daouk.;Brent R Brown.
来源: Chest. 2021年160卷6期e645-e650页
A 30-year-old man with a history of childhood asthma, a 15-pack-year smoking history, and methamphetamine abuse was intubated and started on mechanical ventilation because of acute hypoxic respiratory failure after experiencing progressive dyspnea and a nonproductive cough over the previous year. During the previous 3 months, he had multiple clinic visits, with chest radiographs showing diffuse, bilateral, reticulonodular opacities and small bilateral pleural effusions and was treated for community-acquired pneumonia. Testing for COVID pneumonia was negative, and he failed to respond to antimicrobial therapy. Physical examination on admission showed diffuse fine crackles bilaterally on lung auscultation. Admission laboratory test results were unremarkable.
2284. A 31-Year-Old Man With Seizures, Brain Lesion, and Lung Nodules.
作者: Luis Patricio Maskin.;Matias H Garcia Hernandez.;Martin E Stryjewski.;Pablo Oscar Rodriguez.
来源: Chest. 2021年160卷6期e639-e643页
A 31-year-old man was admitted to our hospital with a recent history of generalized seizures. Three months earlier, he started with intermittent hemoptysis. CT scan showed a cavitary lung lesion in the upper segment of the right inferior lobe (RIL). Because of his job as a social worker in a high-risk population, he started treatment for Mycobacterium TB; however, the BAL culture result was negative. At the time of his current admission, he has continued taking rifampicin, isoniazid, pyrazinamide, and levofloxacin. He denied the use of any illicit drugs or alcohol. He had no history of smoking. One year earlier, he visited Southeast Asia, Oceania, and South Africa for several months. He reported a weight loss of 7 kg since then. Except for a recurrent oral candidiasis, he did not have a relevant medical history. His family history was notable for mother with lupus, and brother with sarcoidosis.
2285. A 37-Year-Old Man With Bronchial Asthma and Unexplained Hypoxemia.
作者: Mohamed Bilal Azam.;Sanjeev Chhabra.;Shailesh Agrawal.;Prashant Sharma.;Kuruswamy Thurai Prasad.;Reena Das.;Ritesh Agarwal.;Valliappan Muthu.
来源: Chest. 2021年160卷6期e633-e638页
A 37-year-old man presented with breathlessness and wheeze of 3 weeks' duration. There was no chest pain, cough, palpitation, pedal edema, or fever. For the past 12 years, he had been experiencing episodic breathlessness and wheeze, which improved with inhaled salbutamol. He also had symptoms of nasal obstruction, nasal discharge, and sneezing. There was no history of smoking, substance abuse, or the use of any over-the-counter medication. The current episode of bronchial asthma exacerbation was managed with bronchodilators and systemic glucocorticoids. Despite symptomatic relief and clinical improvement, his oxygen saturation remained at 75% to 80%, and he was referred to our facility for further evaluation.
2286. A 39-Year-Old Woman With Synchronous Endobronchial and Adrenal Tumors.
作者: Harpreet Singh.;Chinmay T Jani.;Mohammed Abdalla.;Andrii Puzyrenko.;Jonathan S Kurman.;Bryan S Benn.
来源: Chest. 2021年160卷6期e629-e632页
A 39-year-old woman with systemic lupus erythematosus that was complicated by end-stage renal disease that had required a deceased donor renal transplant 16 years ago was referred for evaluation of chronic, nonproductive cough for 2 years. She was a lifetime nonsmoker whose condition was maintained on prednisone 5 mg daily, tacrolimus 3 mg twice day, mycophenolate mofetil 500 mg twice a day for her immunosuppression regimen, valacyclovir 500 mg twice a day for prophylaxis, and clonidine 0.1 mg daily and metoprolol succinate 100 mg twice daily for hypertension.
2287. A 45-Year-Old Man With Acute Chest Pain, Fever, and Dyspnea After Tooth Extraction.
作者: Hiroki Tashiro.;Koichiro Takahashi.;Tetsuro Haraguchi.;Kazuki Jinnouchi.;Shinya Kimura.;Naoko Sueoka-Aragane.
来源: Chest. 2021年160卷6期e623-e628页
A 45-year-old Japanese man underwent wisdom tooth extraction. He developed right chest pain 2 days later, followed by continuous fever with dyspnea 2 weeks after the tooth extraction, and then came to our hospital. He complained of cough and purulent sputum.
2288. Juvenile Dermatomyositis and Acute Respiratory Failure in a Teen.
A 17-year-old previously healthy Taiwanese girl presented with syncope on a background of 1 month of weakness, polyarthritis, and heliotrope rash. Her presentation and investigations, which included an elevated creatine phosphokinase level and diffuse myositis on lower limb MRI, were consistent with juvenile dermatomyositis (JDM).
2289. Successful Total Tracheal Replacement by Cryopreserved Aortic Allograft in a Patient Post-COVID-19 Infection.
作者: Cecilia Menna.;Claudio Andreetti.;Mohsen Ibrahim.;Anna Maria Ciccone.;Antonio D'Andrilli.;Giulio Maurizi.;Domenico M Massullo.;Silvia Fiorelli.;Erino A Rendina.
来源: Chest. 2021年160卷6期e613-e617页
This is the first report to our knowledge of a successful total tracheal replacement in a post-COVID-19 patient by cryopreserved aortic allograft. The graft was anastomosed to the cricoid and carina; a silicon stent was inserted to ensure patency. The patient was extubated on the operative table and was immediately able to breathe, speak, and swallow. No immunosuppression was administered. Three weeks after surgery, the patient was discharged from hospital in excellent health, and was able to resume his normal lifestyle, work, and activity as an amateur cyclist. Two months after surgery, the patient assumes aerosol with saline solution three times per day and no other therapy; routine bronchoscopy to clear secretions is no longer needed.
2290. Intrapleural Hyaluronidase in Viscous Malignant Mesothelioma Pleural Effusion.
Malignant pleural effusion is common in mesothelioma. We report a case of viscous recurrent malignant mesothelioma pleural effusion. The viscosity was due to the presence of hyaluronic acid and resulted in prolonged drainage time. The use of intrapleural hyaluronidase significantly reduced fluid viscosity and drainage duration. No adverse reactions were noted. This novel case highlights the feasibility and safety of the use of intrapleural hyaluronidase in the management of hyaluronic acid-rich viscous malignant pleural effusion.
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