Idiopathic pulmonary vein thrombosis?

Idiopathic pulmonary vein thrombosis (PVT) is a rare disease which is likely under-diagnosed because of nebulous presentations. Accurate diagnosis is essential to prevent complications.

Congenital pulmonary airway malformation in a 36 year-old female.

Congenital pulmonary airway malformation (CPAM), previously known as congenital cystic adenomatoid malformation (CCAM), is an inborn abnormality of the lower respiratory system. Most often diagnosed in the perinatal period, these anomalies usually present with tachypnea, cyanosis, and respiratory distress. However, rare cases are asymptomatic and undiagnosed until adulthood.

A Man With Intractable Convulsion.

Tetanus is a rare disease in the United States. Fewer than 40 cases are reported annually because of the high incidence of vaccination. Recognition of the clinical presentations is important because laboratory recovery of pathogen is only 30%, and toxin detection is rare because of consumption at motor neurons. We report a case of tetanus in an elderly man who had a reaction to tetanus vaccination as a child and was nonvaccinated through adult life.

Mediastinal mass in a 25-year-old man.

A 25-year-old black man presented with left-sided chest pain and cough for 3 days. His pain was pressure-like and nonradiating and was aggravated with movement and relieved when the patient lay at a 45° angle. The patient denied fevers, chills, night sweats, and swelling but reported gaining 4 to 6 kg (10 to 15 lbs) in the past few months. His cough had started 2 weeks prior with yellow mucus production but he denied facial swelling or tenderness. He had no chronic medical conditions and was not taking medications. He had no known exposure to chemicals, fumes, or dust and no history of tobacco or alcohol abuse.

Accessory cardiac bronchus.

Accessory cardiac bronchus is a poorly recognized, usually asymptomatic, congenital abnormality of the bronchial tree. Recognition of bronchial anomalies is important since they are associated with clinical complications including recurrent episodes of infection, hemoptysis, and in some cases malignancy.

Giant bullae emphysema.

Bullous lung disease, a variant of the emphysematous process, can come in different forms and presentations, both histologically and radiographically. Giant bulla (GB) is the rarest form of bullous lung disease. Onset of disease to duration to symptoms is unclear. Presenting symptoms include cough, chest pain, and progressive dyspnea. Differentiating between other cystic lung diseases or developmental/congenital anomalies is vital. While most patients with bullous lung disease can be managed medically, those with giant bulla should be referred for careful surgical evaluation. The authors describe GB, highlight the role of imaging, and discuss the evaluation and pathophysiology of this rare presentation.

Iatrogenic tracheal stenosis presenting as persistent asthma.

Although the incidence of post-intubation tracheal stenosis has markedly decreased with the advent of large volume, low pressure endotracheal tube cuffs, it still occurs, commonly in patients after prolonged intubation. We report a case of tracheal stenosis that developed after a brief period of endotracheal intubation, and that was misdiagnosed and treated as asthma and panic attacks.

Methacholine challenge testing: identifying its diagnostic role, testing, coding, and reimbursement.

Methacholine challenge testing (MCT), also sometimes described as bronchoprovocation testing, is widely performed for both research and diagnostic purposes. MCT is clinically useful when the patient presents with a history of symptoms suggesting asthma, but spirometry findings are normal. Typically, MCT is performed in a pulmonary function laboratory, a clinic, or a physician's office. MCT requires time, effort, and understanding. Two standard testing regimes are identified along with proper coding and reimbursement methodologies.

Noninvasive ventilation.

Noninvasive positive-pressure ventilation (NPPV) is the delivery of mechanical-assisted breathing without placement of an artificial airway such as an endotracheal tube or tracheostomy. During the first half of 20th century, negative-pressure ventilation (iron lung) provided mechanical ventilatory assistance. By the 1960s, however, invasive (ie, by means of an endotracheal tube) positive-pressure ventilation superseded negative-pressure ventilation as the primarily mode of support for ICU patients because of its superior delivery of support and better airway protection. Over the past decade, the use of NPPV has been integrated into the treatment of many medical diseases, largely because the development of nasal ventilation. Nasal ventilation has the potential benefit of providing ventilatory assistance with greater convenience, comfort, safety, and less cost than invasive ventilation. NPPV is delivered by a tightly fitted mask or helmet that covers the nares, face, or head. NPPV is used in various clinical settings and is beneficial in many acute medical situations. This article explores the trends regarding the use of noninvasive ventilation. It also provides a current perspective on applications in patients with acute and chronic respiratory failure, neuromuscular disease, congestive heart failure, and sleep apnea. Additionally, it discusses the general guidelines for application, monitoring, and avoidance of complications for NPPV.

Malignant mesothelioma: a case presentation and review.

Diffuse malignant mesothelioma is the most common primary tumor involving the pleura. Unfortunately, it also poses the most difficulty for physicians to diagnose and treat. Latency from the time of initial asbestos exposure, clinical features of chest pain and dyspnea, and radiographic findings of pleural effusion or pleural thickening are the characteristic features. Pathologic verification remains challenging. The primary distinctions to be made are between reactive and neoplastic mesothelial processes and between malignant mesothelioma and metastatic adenocarcinoma. Adequate tissue sampling is important to help diagnose malignant mesothelioma. This article describes a rare subtype of mesothelioma and illustrates the difficulty in establishing the diagnosis. Also included is a discussion of the clinical features, diagnostic dilemmas, and unsatisfactory outcome associated with this disease.

An approach to interpreting spirometry.

Spirometry is a powerful tool that can be used to detect, follow, and manage patients with lung disorders. Technology advancements have made spirometry much more reliable and relatively simple to incorporate into a routine office visit. However, interpreting spirometry results can be challenging because the quality of the test is largely dependent on patient effort and cooperation, and the interpreter's knowledge of appropriate reference values. A simplified and stepwise method is key to interpreting spirometry. The first step is determining the validity of the test. Next, the determination of an obstructive or restrictive ventilatory patten is made. If a ventilatory pattern is identified, its severity is graded. In some patients, additional tests such as static lung volumes, diffusing capacity of the lung for carbon monoxide, and bronchodilator challenge testing are needed. These tests can further define lung processes but require more sophisticated equipment and expertise available only in a pulmonary function laboratory.