Nick Patel

Tracheobronchial Pseudomembrane Secondary to Aspergillosis

Pseudomembrane formation of the tracheobronchus is a unique process noted in a number of disease entities. The significance of this condition needs proper attention as tracheobronchial pseudomembranes have been described throughout most medicine disciplines. We present here a case of tracheobronchia

Hyperparathyroidism accompanying multiple myeloma.

Hypercalcemia is a manifestation of a variety of both benign and malignant diseases. These conditions are not mutually exclusive, and we present a case report of a patient first diagnosed with the classic findings of multiple myeloma who, after appropriate therapy, demonstrated persistent hypercalcemia and was found on further testing to have an elevated parathormone level (PTH) and scintigraphic evidence of a benign parathyroid adenoma. Hypercalcemia responded to excision of the parathyroid adenoma. There are only 18 similar cases reported in the medical literature.

The role of computed tomography bronchography in the management of bronchopleural fistulas.

The management of complex bronchopleural fistulas (BPFs) remains a major diagnostic and therapeutic challenge to all chest physicians. Successful management of a fistula revolves around treatment of the associated empyema cavity first. Definitive repair should be accomplished expeditiously to minimize the number of procedures performed. When treatment is protracted, secondary complications are more likely to develop and survival is adversely affected. Diagnosis and localization of a BPF is therefore paramount; however, it is sometimes difficult and may require multiple imaging studies and bronchoscopies. Herein, we describe our experience with computed tomography bronchography as a new technique for diagnosis and localization of difficult BPF. In addition, other modalities for diagnosis and medical management are discussed along with a relevant review of the literature.

A case of endobronchial leiomyoma and carcinoma in situ treated with electrocautery using flexible bronchoscopy

An 82-year-old woman presented with dyspnea, fever, cough, and an endobronchial mass in the right main stem bronchus. Initial bronchoscopy revealed 80% obstruction of the distal right main bronchus by an exophytic tumor mass. Endobronchial biopsy of the mass revealed squamous cell carcinoma in situ. A repeat flexible bronchoscopy was performed to obtain a deeper biopsy for definitive diagnosis and to relieve the obstruction. A hot forceps biopsy using electrocautery (20 W) was performed; no significant bleeding was encountered. A less vascular tumor was suspected because of the minimal bleeding, which led to the decision to ablate and excise the entire mass using electrocautery. The hot forceps biopsy of the endobronchial lesion revealed leiomyoma and no further evidence of carcinoma in situ. Follow-up bronchoscopy at 3 and 6 months showed no recurrence. Flexible bronchoscopy with electrocautery spared an elderly patient from a higher risk procedure and general anesthesia. This approach may be considered as an option for high-risk patients with vascular lesions.

Correlation of a scintigraphic pulmonary perfusion index with hemodynamic parameters in patients with pulmonary arterial hypertension.

Purpose To determine whether the perfusion index (PI) can be used as a noninvasive measure to diagnose and predict the severity of disease in patients with pulmonary arterial hypertension (PAH). Materials and Methods Twenty-two patients were included in this retrospective investigation: 9 controls and 13 patients with PAH. Controls had no evidence of PAH [mean pulmonary arterial pressure (MPAP) ⩽25 mm Hg and pulmonary capillary wedge pressure ⩽18 mm Hg]. The study patients had PAH (MPAP ≥25 mm Hg and pulmonary capillary wedge pressure ⩽18 mm Hg) and no diagnosis of pulmonary embolism. Due to the retrospective nature of the study, the PI was calculated from the posterior perfusion image of a ventilation perfusion scan. The PI was computed as the sum of differences versus control for the 9 deciles above background. Receiver operating characteristic curve analysis was used to compare PI with other parameters for predicting PAH. Results Linear correlations of PI were found to be significant with the following parameters: pulmonary vascular resistance (r=0.81, P=0.00009), total pulmonary vascular resistance (MPAP/cardiac output) (r=0.80, P=0.00013), pulmonary artery systolic pressure (r=0.73, P=0.00018), MPAP (r=0.72, P=0.00022), pulmonary diastolic pressure (r=0.53, P=0.01), and right atrial pressure (r=0.50, P=0.03). Using logistic regression, the PI was significant in separating patients with PAH from controls (&khgr;2=5.6, P=0.02). Conclusion The data suggest that PI can be used for the noninvasive diagnosis and measurement of severity of PAH.