Subject(s)
Arthritis, Rheumatoid/complications , Arthritis, Rheumatoid/diagnosis , Multiple Pulmonary Nodules/etiology , Anti-Inflammatory Agents/therapeutic use , Arthritis, Rheumatoid/drug therapy , Female , Humans , Middle Aged , Multiple Pulmonary Nodules/diagnostic imaging , Multiple Pulmonary Nodules/drug therapy , Prednisone/therapeutic use , RadiographyABSTRACT
The authors present an unusual case of torsades de pointes (Tdp) in an elderly woman with a history of aortic stenosis, status post aortic valve replacement. She was admitted for atrial fibrillation with a slow ventricular response. At the time of admission, the patient was asymptomatic and not taking any medications known to be associated with QT prolongation. During hospitalization, she developed episodes of Tdp without any provocable cause. This case highlights the occurrence of Tdp secondary to conduction disturbance caused by aortic valve surgery.
Subject(s)
Aortic Valve Stenosis/surgery , Bradycardia/complications , Heart Valve Prosthesis Implantation/adverse effects , Torsades de Pointes/etiology , Aged , Atrial Fibrillation/etiology , Bradycardia/etiology , Bradycardia/physiopathology , Bradycardia/therapy , Electrocardiography , Female , Humans , Pacemaker, Artificial , Torsades de Pointes/physiopathology , Torsades de Pointes/therapy , Treatment OutcomeABSTRACT
IV heroin use is associated with several well-described complications, including noncardiogenic pulmonary edema, aspiration pneumonitis, ARDS, pneumonia, lung abscess, septic pulmonary emboli, and atelectasis. Foreign-body granulomatosis may develop when drug users inject solutions containing crushed oral tablets in which talc is used as filler and can be complicated by pulmonary fibrosis. The effects are distinct from pulmonary edema, which may occur acutely with heroin injection. We describe the case of a young female patient who was an IV heroin user who also smoked cigarettes, and presented with progressive dyspnea, hypoxia, and bilateral lung infiltrates. The final pathologic diagnosis in this case was one that had not been previously reported in IV heroin users.
Subject(s)
Cryptogenic Organizing Pneumonia/etiology , Heroin Dependence/complications , Substance Abuse, Intravenous/complications , Adult , Cryptogenic Organizing Pneumonia/diagnostic imaging , Cryptogenic Organizing Pneumonia/pathology , Female , Granuloma, Foreign-Body/etiology , Granuloma, Foreign-Body/pathology , Humans , Tomography, X-Ray ComputedABSTRACT
The evaluation of patients presenting with multinodular pulmonary disease provides an important clinical challenge for physicians. The differential diagnosis includes an extensive list of benign and malignant processes making the management of these cases frequently problematic. With the introduction of high-resolution CT (HRCT) scanning, the ability to assess various patterns of diffuse multinodular disease has evolved into an essential part of the diagnostic process. The purpose of this article is to develop an approach to the diagnosis of multinodular parenchymal disease using HRCT scan pattern recognition as a point of departure.
