ABSTRACT
A 51-year-old woman had localized interstitial pneumonia that rapidly progressed to involve all lung fields. After 9 days of conventional mechanical ventilation, pneumothorax developed in the presence of an obstruction of the right main bronchus. Bronchoscopy and endobronchial biopsies revealed NTB involving the tracheobronchial tree distal to the tip of the endotracheal tube, with complete obstruction of the right main bronchus by hard, eschar-like material. Tracheal mucosa proximal to the tip of the endotracheal tube was normal. Subsequent bronchoscopy, 20 days later, showed marked resolution of NTB. Though a frequent complication of mechanical ventilation in the neonate, NTB as a complication of conventional mechanical ventilation has not previously been recognized in an adult. Necrotizing tracheobronchitis should be suspected in adults who have had mechanical ventilation and who are experiencing ventilatory difficulties, after routine problems have been treated or excluded.
Subject(s)
Bronchitis/etiology , Respiration, Artificial/adverse effects , Tracheitis/etiology , Bronchitis/pathology , Female , Humans , Middle Aged , Necrosis , Pneumothorax/etiology , Pulmonary Fibrosis/therapy , Tracheitis/pathologyABSTRACT
Pneumocystis carinii pneumonia is a frequent manifestation of the acquired immunodeficiency syndrome (AIDS). It commonly presents with nonproductive cough, fever, and dyspnea. We report this case of P carinii pneumonia presenting with hemoptysis, since to the best of our knowledge, hemoptysis has not been reported to be a presenting manifestation of P carinii pneumonia. Autopsy revealed multiple lung cavities.
Subject(s)
Acquired Immunodeficiency Syndrome/complications , Hemoptysis/etiology , Opportunistic Infections/complications , Pneumonia, Pneumocystis/complications , Female , Humans , Lung/pathology , Middle AgedABSTRACT
Percutaneously inserted pigtail nephrostomy catheters were used to treat empyemas in 12 patients. Thoracic computed tomographic (CT) scan and fluoroscopy were used to localize precisely and place the catheters into loculated collections of fluid. Percutaneous catheter drainage (PCD) of empyema was successful in seven of seven patients (100%) in whom standard tube thoracostomy (STT) had initially failed and in three of five patients (60%) who had PCD as the initial drainage procedure. Overall, PCD was successful in treating empyema in ten of 12 patients (83%). The procedure was well tolerated and there were no complications. PCD is a safe and effective method for drainage of loculated empyemas as the initial procedure or after STT has failed.
Subject(s)
Drainage/methods , Empyema/therapy , Acute Disease , Adult , Aged , Catheters, Indwelling , Drainage/instrumentation , Empyema/diagnostic imaging , Evaluation Studies as Topic , Female , Fluoroscopy , Humans , Male , Middle Aged , Retrospective Studies , Tomography, X-Ray ComputedABSTRACT
Cytomegalovirus (CMV) is frequently isolated from respiratory secretions of human immunodeficiency virus (HIV)-infected patients. Even in the presence of histopathologic evidence of CMV cytopathic abnormalities, the true clinical significance of CMV pneumonitis is not well established. Airways disease is increasingly recognized in HIV-infected patients, but its etiology is unclear. We describe an HIV-infected patient who presented with fever, wheeze, and micronodular interstitial infiltrates and developed severe hypercapnic and hypoxemic respiratory failure. Open lung biopsy showed necrotizing bronchiolitis with cytopathic changes characteristic of CMV infection; no other pathogens were isolated. He responded well to treatment with ganciclovir.
