Hemopneumothorax in a COPD patient treated with noninvasive positive pressure ventilation: the risk of attendant anticoagulation.

Noninvasive positive pressure ventilation (NIPPV) modalities have been proven to be effective in the setting of exacerbations of chronic obstructive pulmonary disease (COPD). Reported complications include pneumothorax, increased work of breathing, gastric distension and air embolism. This case demonstrates that patients with severe COPD on anticoagulant therapy are potentially at risk for the serious complication of combined lung barotrauma and hemorrhage while on acute NIPPV therapy. This is the first reported case of hemopneumothorax complicating NIPPV therapy.

Severe exertional dyspnea in a patient with localized emphysema.

The case of a middle-aged, male smoker who presented with progressive severe dyspnea is described. The cause of the progressive severe dyspnea remained unexplained after a comprehensive history, physical examination, chest radiograph, electrocardiogram and spirometry. Subsequent investigations resulted in a diagnosis of localized pulmonary emphysema. Detailed exercise testing helped uncover the physiological basis of the patient's extreme dyspnea.

Unilateral hypertrophic osteoarthropathy secondary to infected aortobifemoral graft and aortoenteric fistula.

Localized hypertrophic osteoarthropathy is a reported manifestation of--and an important diagnostic clue to--infection of an aortic graft and aortoenteric fistula, two complications of vascular bypass surgery that carry a significant risk of mortality. This clue may lead to the early diagnosis essential to a successful outcome. The authors describe a patient with localized unilateral hypertrophic osteoarthropathy secondary to infection of an aortobifemoral graft and aortoenteric fistula.