Nosocomial pulmonary mucormycosis with fatal massive hemoptysis.

We postulate that the previously healthy woman reported here developed abnormal host defense mechanisms because of acute renal failure, metabolic acidosis, hyperglycemia, and glucocorticosteroid administration. Pneumonia unresponsive to antibiotics terminated in massive fatal hemoptysis that was due to mucormycosis with rupture of the pulmonary artery into the tracheobronchial tree.

Lymphomatoid granulomatosis presenting as central neurogenic hyperventilation.

A patient with lymphomatoid granulomatosis and focal transformation to lymphoma limited to the central nervous system presented with severe central neurogenic hyperventilation. The hyperventilation resolved as the underlying pathologic condition was treated with prednisone and cyclophosphamide.

Hypouricemia, inappropriate secretion of antidiuretic hormone, and small cell carcinoma of the lung.

The hospital records of 106 patients with small cell carcinoma of the lung were reviewed to determine if hypouricemia accompanied hyponatremia (less than 130 mmole/L) and if coexistent hypouricemia and hyponatremia were predictive of the presence of the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Thirty-seven patients were excluded because of insufficient data or factors that would affect the uric acid level. Six of eight patients with SIADH had hypouricemia. The coexistence of hypouricemia and hyponatremia predicted SIADH reliably (6/6 patients), but hypouricemia alone had a low predictive value (46%) since it was seen in seven of 61 patients without SIADH.

Pulmonary gallium concentration in the adult respiratory distress syndrome.

Accumulation of radioactive gallium-67 citrate was observed in the lungs of a patient with postoperative adult respiratory distress syndrome. We believe that the primary mechanism of uptake of gallium is related to interstitial inflammation and repair of pulmonary tissue, rather than to a nonspecific increased alveolocapillary permeability to gallium.

Effect of inhaled atropine or metaproterenol in patients with chronic airway obstruction and therapeutic serum theophylline levels.

Twenty-one patients with stable chronic obstructive pulmonary disease (mean FEV1 = 0.98 L) and high-normal serum theophylline levels (15-20 micrograms/ml) were evaluated in a randomized, double-blind fashion for additional bronchodilator response to aerosolized normal saline, atropine, or metaproterenol. Patients were classified as responders (R; n = 9) or nonresponders (NR; n = 12) to inhaled isoproterenol when they were taking no medications. Atropine and metaproterenol caused a significant additional increase in FEV1 for R (p less than .05), whereas only atropine resulted in a significant increase for NR (p less than .05). For R, the increase due to atropine was significantly greater compared to metaproterenol (p less than .05). We conclude that inhaled atropine (an anticholinergic drug) may be preferable to inhaled metaproterenol (a beta-adrenergic agonist) when additional bronchodilation is needed in patients with chronic obstructive pulmonary disease and high-normal serum theophylline levels.

Bilateral diaphragmatic paralysis as a possible paraneoplastic syndrome from renal cell carcinoma.

Bilateral diaphragmatic paralysis is rare. We describe a patient with bilateral diaphragmatic paralysis who died 18 months after initial presentation and who was found to have renal cell carcinoma. At autopsy, no intrathoracic tumor was found that would explain the diaphragmatic paralysis. We believe that this may represent a paraneoplastic syndrome caused by renal cell carcinoma.

Bronchoalveolar lavage and technetium-99m glucoheptonate imaging in chronic eosinophilic pneumonia.

A patient with chronic eosinophilic pneumonia was evaluated using bronchoalveolar lavage, technetium-99m glucoheptonate, and transbronchial lung biopsy. Bronchoalveolar lavage revealed 43 percent eosinophils and correlated well with results of transbronchial lung biopsy. Technetium-99m glucoheptonate lung imaging demonstrated intense parenchymal uptake. After eight weeks of corticosteroid therapy, the bronchoalveolar lavage eosinophil population and the technetium-99m glucoheptonate uptake had returned to normal. We suggest that bronchoalveolar lavage, with transbronchial lung biopsy, is a less invasive way than open lung biopsy to diagnose chronic eosinophilic pneumonia. The mechanism of uptake of technetium-99m glucoheptonate in this disorder remains to be defined.

Technetium-99m glucoheptonate imaging in lung cancer and benign lung disease: concise communication.

We prospectively studied technetium-99m glucoheptonate (Tc-GHA) uptake in 58 patients with newly diagnosed lung cancer and in 20 patients with pulmonary inflammatory disease or metastatic carcinoma. Fifty-three (91%) primary tumors accumulated Tc-GHA: squamous cell 20/22, adenocarcinoma 7/7, large cell 10/11, and small cell 16/18. Intensity of tumor uptake was greatest in small-cell cancer. Supraclavicular metastases were detected in two patients. Fourteen patients with mediastinal evaluation by Tc-GHA imaging and trispiral tomography underwent mediastinoscopy or thoracotomy. Five of ten patients with negative mediastinum by tomography and Tc-GHA imaging showed metastases by biopsy (false-negative Tc-GHA). Less intense accumulation of Tc-GHA was observed in 18/20 cases of pulmonary inflammatory disease or pulmonary metastases. Although Tc-GHA accumulates by an unknown mechanism in primary lung cancer, we cannot recommend its use in detecting mediastinal spread of lung cancer due to its unacceptably high false-negative rate.

Abnormal left cardiac border due to an atherosclerotic coronary artery aneurysm.

A 57-year-old man had an aneurysm of the left anterior descending coronary artery that appeared as a bulge of the left cardiac border on plain chest roentgenograms. The aneurysm enlarged over a four-year period, and death resulted from myocardial infarction. The importance of recognizing this uncommon cause of an abnormal left cardiac border is stressed because further investigation by coronary angiography should be done before resection or bypass of the aneurysm.