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5081. Characteristics and Outcomes of Small Cell Lung Cancer Detected by CT Screening.
Previous studies with a limited number of patients have reported divergent findings on whether screening can detect small cell lung cancer (SCLC) at an earlier stage and whether there might be a survival benefit.
5082. COPD Pathogenesis: Finding the Common in the Complex.
Developing an effective treatment for COPD, and especially pulmonary emphysema, will require an understanding of how fundamental changes at the molecular level affect the macroscopic structure of the lung. Currently, there is no accepted model that encompasses the biochemical and mechanical processes responsible for pulmonary airspace enlargement. We propose that pulmonary emphysematous changes may be more accurately described as an emergent phenomenon, involving alterations at the molecular level that eventually reach a critical structural threshold where uneven mechanical forces produce alveolar wall rupture, accompanied by advanced clinical signs of COPD. The coupling of emergent morphologic changes with biomarkers to detect the process, and counteract it therapeutically, represents a practical approach to the disease.
5083. A 63-Year-Old Man With Recurrent Dyspnea.
A 63-year-old man presented with a 12-month history of recurrent dyspnea, dry cough, fatigue, and weight loss. He denied chest pain, fever, or chills. Chest radiographs during those months revealed bilateral pleural effusions, and he was subjected to serial thoracenteses. Pleural fluid analyses suggested invariably a transudate, and he had received an empirical antiheart failure regimen for several months. However, his symptoms did not improve. He reported no smoking or alcohol use and his medical history was unremarkable.
5084. A 67-Year-Old Woman With a "Shrunken" Left Lung and Recurrent Pneumonia.
A 67-year-old woman was referred to our institution for nonresolving pneumonia and abnormal chest images. She was in her usual state of health until 1 month prior to referral when she started having fever, chills, dry cough, and chest pain. She presented initially to an urgent care facility that diagnosed her with bilateral pneumonia and left-sided volume loss on chest radiography. She was given azithromycin, but her fever did not resolve in the weeks following the antibiotic course. Previous to these symptoms she was able to play tennis and worked full time as the director of a charter school.
5085. Spelunking Meckel Cave: A 31-Year-Old With Diplopia and Loss of Taste and Smell.
A 31-year-old woman presented to the ED with a loss of taste and smell of 2 months' duration and a frontal headache, bilateral facial numbness, photophobia, and horizontal diplopia that was worse with far vision of 2 weeks' duration. A review of systems revealed mild nausea and decreased appetite without weight loss. She denied any cardiopulmonary symptoms, specifically no cough or shortness of breath. Her medical history was notable for arthralgias. The patient was diagnosed with ankylosing spondylitis, for which she had been taking etanercept for several months. She consumed minimal alcohol and had no history of tobacco or drug use or recent travel. Her family history was unremarkable.
5088. Smoking-Related Diffuse Cystic Lung Disease.
作者: Nishant Gupta.;Thomas V Colby.;Cristopher A Meyer.;Francis X McCormack.;Kathryn A Wikenheiser-Brokamp.
来源: Chest. 2018年154卷2期e31-e35页
Exposure to cigarette smoke can lead to a variety of parenchymal lung diseases, including diffuse cystic lung diseases (DCLDs). Lymphangioleiomyomatosis (LAM) is the prototypical DCLD and has a characteristic appearance on high-resolution CT (HRCT). We present a series of four patients with DCLD on HRCT who were referred to our institution with a presumed diagnosis of LAM and who were found instead to have smoking-related injury of the small airways on histopathological analysis. We submit that cigarette smoke-induced small airway injury can present as DCLD on HRCT in a pattern that can mimic LAM. A detailed history of cigarette smoke exposure should be obtained in patients presenting with DCLD, and imaging features should not be used in isolation to establish a firm diagnosis of LAM.
5096. Optimal Seat Location to Reduce Risk of Thromboembolic Event on Long-Distance Flights: Analysis of 246,766 Seats on the Five Top Airway Companies.
作者: Guinemer Sylvie.;Lisa Weisslinger.;Hayatte Akodad.;Frédéric Adnet.;Frédéric Lapostolle.
来源: Chest. 2018年154卷2期459-460页 |