Dipak Mukherjee

A Young Woman With Severe Chest Pain After Undergoing Endobronchial Ultrasound-guided Transbronchial Needle Aspiration for a Large Mediastinal Mass.

A 33-year-old woman with chest pain and hemoptysis was found to have a large mediastinal mass. As the radiology imagings were inconclusive, she underwent diagnostic endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA). After the procedure she developed mediastinitis, which required video-assisted thoracoscopic surgery excision and intravenous antibiotics. Bronchogenic cysts are rare congenital anomalies. Traditionally, surgical resection has been recommended as the first-line treatment option for both symptomatic and asymptomatic bronchogenic cysts due to concerns of late complications, including malignant transformation. Recently, there have been a number of case reports of bronchogenic cysts been diagnosed and treated successfully using EBUS-TBNA. We present a case in which EBUS-TBNA was performed for a definitive diagnosis of cystic lesion in the mediastinum.

Loculated Pneumothorax Due To A Rare Combination Resulting In An Interesting Chest Radiograph.

A 35 years old man presented with acute onset left sided pleuritic chest pain and shortness of breath. On evaluation, he was found to have an interesting chest radiograph which showed a loculated pneumothorax with collapse of the left upper lobe and lingula but fully expanded left lower lobe. He is a known asthmatic who had allergic broncho pulmonary aspergillosis (ABPA) previously with left upper lobe and lingular collapse secondary to mucous plugging. This resolved on treatment with steroids and itraconazole. An interesting combination of events is proposed to explain the current presentation. CT scan chest and blood tests confirmed this sequence of events. He was appropriately treated resulting in complete clinical and radiological recovery. The events leading to the presentation and the likely physiological background for this interesting chest radiograph are discussed.

‘High-risk’ patients with chronic obstructive pulmonary disease (COPD) have a poor prognosis and need to be able to access palliative care services

To assess the care need of COPD patients who have high risk of recurrent admissions and death. We have collected data prospectively on a group of patients with COPD who have had three or more admissions in the previous year or who have been referred to the COPD multidisciplinary team (MDT) or both

Integration of hospital and community COPD services including pulmonary rehabilitation can improve patient care and reduce hospital stays

Introduction: Integration of community respiratory care including pulmonary rehabilitation (PR) and oxygen services with hospital based care and in-reach into the acute hospital by the community team has the potential for early discharge and increased PR. Methods: We have carried out a series of nested audits into the use of a discharge bundle and the effect of community respiratory team in-reach into an acute hospital serving a population of 450,000 and the rate of uptake and referral for PR for these patients. Results: During 2015 there were 1420 referrals to the community respiratory team, 773 from hospital, and 647 from primary care. 98% had COPD. Average co-morbidity rate was 2.6/patient, 27% >3. In January 2015 only 59% of in patients were referred to the community team, but by May/June 75%, and Sept-Nov 2015 85%. Community in-reach reviewed 207 patients in 2015, 27% of those with COPD were discharged the same day. From Apr2015-Feb 2016 701 patients were referred for PR v 300 for PR in all of2014-5.501 were referred fro oxygen services. Over years hospital rates of admission for COPD have been rising, 2012-3v2014-5 789v839. But since the start of the integrated service admissions have fallen, Jan-June 2014 v 2015, 404 v 390, (4%); Sept-Nov 2014 v 2015, 210 v 197, (6.2%). Length of stay has also fallen, April-Oct 2014 v 2015; 7.4 v 6.1 days which may reflect early discharge practices. Conclusion: A respiratory service integrated between hospital and community including PR and oxygen services leads to higher rates of referral for PR , and less admissions with shorter length of stay when previously admission rates were steadily climbing.