Coronary Air Embolism Secondary to Percutaneous Lung Biopsy: A Systematic Review.

To determine mortality and morbidity associated with coronary air embolism (CAE) secondary to complications of percutaneous lung biopsy (PLB) and illicit-specific risk factor associated with this complication and overall mortality, we searched PubMed to identify reported cases of CAE secondary to PLB. After assessing inclusion eligibility, a total of 31 cases from 26 publications were included in our study. Data were analyzed using Fisher's exact test. In 31 reported cases, cardiac arrest was more common after left lower lobe (LLL) biopsies (n=4, 80%, p=0.001). Of these patients who suffered from cardiac arrest, CAE was found more frequently in the right coronary artery (RCA) than other locations but did not reach statistical significance (n=5, 62%, p=0.39). At the same time, intervention in the LLL was significantly associated with patient mortality (n=3, 60%, p=0.010). Of the patients who died, CAE was more likely to have occurred in the RCA, but this association was not statistically significant (n=4, 57%, p=0.33). LLL biopsies have a statistically significant correlation with cardiac arrest and patient death. More research is needed to examine the effect of the air location in the RCA on patient morbidity and mortality.

Psychiatric disorder does not preclude adequate continuous positive airway pressure titration.

Obstructive sleep apnea (OSA) is a highly prevalent disorder associated with significant morbidity and multiple complications. A large proportion of patients with OSA also have a coexisting primary psychiatric disorder. The effect of psychiatric disorders on the ability to tolerate continuous positive airway pressure (CPAP) titration is not known. In this study, whether the presence of psychiatric disorders precludes the patients' ability to tolerate CPAP titration for OSA was investigated. A retrospective chart review on a sample of 284 patients who underwent sleep studies in a single-center, university-based Veterans Affairs hospital was performed. A total of 143 patients with OSA who underwent titration of CPAP therapy were identified. The prevalence of psychiatric disorders between patients who tolerated titration and those who did not tolerate it was compared using the χ² test. The percentages of patients with psychiatric disorders who tolerated and did not tolerate CPAP were 33.6% and 33.3%, respectively. No statistically significant difference between the 2 groups (χ² = 0.051 with 1 degree of freedom; P = 0.82) was found. The predominantly male patient population, exclusion of mild OSA, lack of data about the level of control of the psychiatric symptoms and the sleep technicians not being blinded to the patients' psychiatric diagnoses were some of the limitations of this study. No significant difference existed in the prevalence of psychiatric disorders between patients intolerant to CPAP titration and those who tolerated CPAP for OSA.

Lung scedosporiosis in human immunodeficiency virus/acquired immunodeficiency syndrome.

A 31-year-old African American woman with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) (recent CD4 count of 66/mm) presented to the emergency room with a tension pneumothorax that required an emergent chest tube placement. Computed tomography scan showed fungus balls in multiple lung cavities and surrounding infiltrates. The patient showed remarkable improvement with voriconazole suggesting aspergillosis. However, the patient was serologically negative for Aspergillus and other common fungal infections. Because of a persistent air leak, surgical intervention was needed. The histological finding was consistent with invasive mycosis, and cultures were positive for Scedosporium apiospermum. Literature review showed that, among patients with HIV/AIDS, Scedosporium can present from focal localized to systemic disease, is resistant to traditional antifungal agents, and may respond to prompt management with voriconazole.