Patient with URI and Lobe Lesion on Chest X-Ray

​BY MARGARET MARY S. LANDEL, DO; &CARLA DUGAS, DOA 59-year-old otherwise healthy man presented with an upper respiratory illness of four weeks' duration. His initial presentation to his primary care physician one month prior included a nonproductive cough and low-grade fever, which lasted approximately two weeks until his internist ordered a chest x-ray. That showed a 3 cm well-circumscribed right lower lobe lesion, and was followed by a contrast enhanced chest CT. The chest CT was concerning for pulmonary neoplasm, and he received an interventional radiology-guided biopsy of the lesion. Results were still pending at the time of ED presentation.​The patient's primary care physician had prescribed a seven-day course of Levaquin for presumed community-acquired pneumonia (CAP) before he presented to the ED. The patient's fever remained elevated after day three, and he began to worsen, at which point he was switched to clindamycin.The patient had had a prior total thyroidectomy for thyroid carcinoma as well as previously being diagnosed with hyperlipidemia and benign prostatic hypertrophy. His medications include Synthroid, Avodart, Lipitor, and clindamycin. Social history was negative for tobacco or alcohol. He was currently training for the Ironman competition and was an avid runner and CrossFit member. He had traveled to Jamaica three months earlier and to Loredo, TX, two weeks prior to his ED visit.His initial vitals at presentation were blood pressure of 112/84 mm Hg...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research

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Publication date: Available online 14 October 2019Source: The Lancet Respiratory MedicineAuthor(s): Jane S Lucas, Stephanie D Davis, Heymut Omran, Amelia ShoemarkSummaryPrimary ciliary dyskinesia is a genetically and clinically heterogeneous syndrome. Impaired function of motile cilia causes failure of mucociliary clearance. Patients typically present with neonatal respiratory distress of unknown cause and then continue to have a daily wet cough, recurrent chest infections, perennial rhinosinusitis, otitis media with effusion, and bronchiectasis. Approximately 50% of patients have situs inversus, and infertility is common....
Source: The Lancet Respiratory Medicine - Category: Respiratory Medicine Source Type: research
Publication date: Available online 14 October 2019Source: Respiratory Medicine Case ReportsAuthor(s): Takeshi Matsumoto, Yusuke Kusakabe, Masamitsu Enomoto, Naoki Yamamoto, Kensaku Aihara, Shinpachi Yamaoka, Michiaki MishimaAbstractPulmonary actinomycosis reportedly forms 15% of all cases of actinomycosis, and pulmonary Actinomyces odontolyticus is particularly rare. A 60-year-old man with a hoarse voice was referred to our hospital. Lung squamous cell carcinoma was diagnosed at the clinical tumor-node-metastasis stage of cT2N2M0, and concurrent chemoradiotherapy was initiated. Further, a small cavity was also detected in ...
Source: Respiratory Medicine Case Reports - Category: Respiratory Medicine Source Type: research
DiscussionIntestinal TB most commonly affected region is the ileocaecal, accounts for 64% of the incidence of gastrointestinal TB. The main reasons for the predilection of ileocaecal region are due to relatively longer faecal static, the abundant of lymphoid tissue, a neutral pH environment and absorptive transport mechanisms that allow swallowed mycobacterium to be absorbed. Intestinal TB may pose similar symptoms as those found in pulmonary TB, yet patients most commonly presenting with abdominal pain. Bacteriological signs and histopathological findings are gold standard for ITB diagnosis. Therapy for ITB includes pharm...
Source: Respiratory Medicine Case Reports - Category: Respiratory Medicine Source Type: research
We report 13 cases (11 males/2 females) of SPM. The average age was 31 ± 0.85 years. The most common precipitating factor was asthma attack. The onset symptoms were mainly chest pain (11 cases). Synchronous pneumothorax was found in 5 cases and it was bilateral in 2 patients. The evolution was marked by the spontaneous resorption. SMP is an underrecognized cause of chest pain in young adults. Chest radiography is usually sufficient for the diagnosis, and further diagnostic procedures are generally not necessary. The prognosis is often favorable.
Source: Respiratory Medicine Case Reports - Category: Respiratory Medicine Source Type: research
We describe a case of a 59-year-old male with esophageal adenocarcinoma undergoing chemotherapy presenting with a right upper lobe necrotizing pneumonia secondary to B. cereus with consequent massive hemoptysis.
Source: Respiratory Medicine Case Reports - Category: Respiratory Medicine Source Type: research
Publication date: Available online 14 October 2019Source: Pulmonary Pharmacology &TherapeuticsAuthor(s): Huda Badri, Jaclyn A. SmithAbstractCough is mediated by vagal afferent fibres innervating the larynx and proximal airways. Pre-clinical studies suggest that vagal C fibres produce Substance P, one of the tachykinin family of neuropeptides, which has been shown to enhance cough via the neurokinin-1 (NK-1) receptor and studies in animal models have also shown that NK-1 antagonists are effective at blocking induced cough. In the past, tachykinin receptor antagonists have yielded disappointing results in treating asthma...
Source: Pulmonary Pharmacology and Therapeutics - Category: Respiratory Medicine Source Type: research
Discussion Iodine enhancement images can be used to calculate CT perfusion maps of blood flow, and compared with 80 kVp images, results showed only a small difference of 1 mL/100 mL/min in blood flow in healthy tissue, whereas patient radiation exposure was increased for dynamic DECT. Perfusion maps calculated based on iodine-enhancement images showed lower blood flow in fatty tissues surrounding the pancreas, indicating reduced susceptibility to residual patient breathing motion during the acquisition.
Source: Investigative Radiology - Category: Radiology Tags: Original Articles Source Type: research
Objectives The goals of this study were to compare the efficacy of the new manganese-based magnetic resonance imaging (MRI) contrast agent Mn-PyC3A to the commercial gadolinium-based agents Gd-DOTA and to Gd-EOB-DTPA to detect tumors in murine models of breast cancer and metastatic liver disease, respectively, and to quantify the fractional excretion and elimination of Mn-PyC3A in rats. Methods T1-weighted contrast-enhanced MRI with 0.1 mmol/kg Mn-PyC3A was compared with 0.1 mmol/kg Gd-DOTA in a breast cancer mouse model (n = 8) and to 0.025 mmol/kg Gd-EOB-DTPA in a liver metastasis mouse model (n = 6). The fractional...
Source: Investigative Radiology - Category: Radiology Tags: Original Articles Source Type: research
This study aims at prospectively evaluating an adapted DWI sequence ex vivo and in vivo in oncologic patients undergoing abdominal MRI. Methods This institutional review board–approved, prospective study included phantom measurements, volunteer examinations, and oncologic patient examinations of the abdomen. Fifty-seven MRI examinations in 54 patients (mean age, 58 years; range, 21–90 years) were included into the analysis. The MRI examination were performed at a 1.5 T MRI scanner (MAGNETOM Aera; Siemens Healthcare, Erlangen, Germany) and included both a standard EPI-DWI (s-DWI; b = 50, 900 s/mm2) and an ada...
Source: Investigative Radiology - Category: Radiology Tags: Original Articles Source Type: research
Updated guidelines on community-acquired pneumonia focus on reducing inappropriate use of antibiotics and emphasize the need for more research on diagnostics and therapeutics.Medscape Medical News
Source: Medscape FamilyMedicine Headlines - Category: Primary Care Tags: Pulmonary Medicine News Source Type: news
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