Pulmonary gold toxicity.

A 52-year-old, white female developed low-grade fever, cough, and dyspnea after 8 weeks treatment with sodium aurothiomalate for rheumatoid arthritis. The patient had severe hypoxemia associated with bilateral pulmonary infiltrates. Dramatic clinical improvement followed prednisone therapy.

Pulmonary thromboembolism. 1. Current concepts in pathogenesis and diagnosis.

Thrombosis results from the dynamic interaction of venous stasis, hypercoagulability, and endothelial injury. Protection against thrombosis may be lost if there is deficiency of any of the factors that mediate platelet deaggregation, block fibrin deposition, or initiate fibrinolysis. A thrombus lodged in the pulmonary arterial circulation may remain hemodynamically and clinically silent or produce hemodynamic, clinical, and radiographic alterations. Although no signs and symptoms are specific to the condition, pulmonary thromboembolism can be diagnosed clinically if predisposing factors are taken into consideration. Diagnostic procedures include contrast venography, right heart catheterization, ventilation/perfusion lung scanning, and pulmonary angiography.

Pulmonary thromboembolism. 2. New trends in prophylaxis and therapy.

Although low-dose heparin therapy is the technique most commonly used for prophylaxis of pulmonary thromboembolism, its usefulness is being questioned. Platelet deaggregation prophylaxis with either aspirin or dipyridamole, or both, apparently is a reasonable alternative, but further studies are needed. For treatment of pulmonary thromboembolism, continuous conventional-dose heparin therapy is the approach of choice. It has the highest therapeutic/toxic ratio and is the most effective technique for prevention of clot propagation. The patient's fibrinolytic network must be intact, however, if clot degradation is to occur. Fibrinolytic therapy with urokinase or streptokinase should be restricted to use in patients with massive pulmonary embolism in whom hemodynamics are unstable. Caval interruption and pulmonary embolectomy have lower benefit/risk ratios than do the medical alternatives and are rarely used for pulmonary thromboembolism.

Endobronchial lipoma causing unilateral absence of pulmonary perfusion.

Endobronchial lipoma is a slowly growing benign neoplasm of the large bronchi, which, if left untreated, has a significant morbidity and mortality. Endobronchial lipoma is still rare, with only 50 reported cases in the English literature, including the following case. This case illustrates the sequela of main-stem occlusion of the airway due to this tumor and, to our knowledge, represents the first reported case of unilateral absence of pulmonary perfusion due to an endobronchial lipoma. Proposed mechanisms for unilateral absence of perfusion due to an endobronchial lipoma are discussed.

Legionnaires' disease: an atypical pneumonia.

Given the present state of the art, any case of apparent pneumonia that is not responding to optimum therapy, or of "viremia" which appears to be progressively deteriorating, should be considered Legionnaires' disease and treated accordingly until proven otherwise. Titers for antibody to the disease in serum obtained during the acute and convalescent stages should always be determined in such cases. This may initially prove to be a rather wasteful and expensive procedure. However, only by carefully studying these titers can the elusive course of the disease be better delineated and techniques perfected that may allow earlier diagnosis and thus reduction in mortality.