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1786. A 37-Year-Old Man With Structural Focal Epilepsy and Paroxysmal Nocturnal Breathing Arrests.
A 37-year-old male patient was referred to our sleep laboratory with suspected sleep-disordered breathing. His partner reported periods of breathing arrest accompanied by an odd expiratory noise during sleep, occurring on a near to weekly basis. The patient stated that he was able to sleep well, did not have excessive daytime sleepiness, and was not subjectively aware of any disordered breathing at night. He had a history of structural epilepsy following perinatal trauma, with secondary generalized tonic/clonic seizures, preceded by sensory oral misperceptions. The patient was medicated with phenytoin (100 mg), and reported being seizure-free within the last year. He said that he was otherwise in good health.
1787. A 16-Year-Old-Girl With Asthma, Palpable Purpura, and Hypereosinophilia.
作者: Jasmine Singh.;Shivani Randev.;Pankaj Kumar.;Vidushi Mahajan.;Phiza Aggarwal.;Aman Sharma.;Vishal Guglani.
来源: Chest. 2022年161卷5期e305-e308页
A 16-year-old girl presented to the ED with complaints of loose stools, abdominal pain, and rash over her legs for the last 7 days. There was no history of fever, vomiting, oral ulcers, or mucosal bleeds. In the past, she had received a diagnosis of asthma. She had been taking oral montelukast every day for the past year and using a formoterol-budesonide dry powder inhaler irregularly, only during episodes of acute exacerbations. There was a history of significant but undocumented weight loss. On day 3 of hospital admission, she developed numbness over her right foot.
1788. A 31-Year-Old Man With Fever, Atypical Chest Pain, and Mediastinal Mass.
作者: Harpreet Singh.;Bryan S Benn.;Chinmay T Jani.;Mohammad Abdalla.;Thomas S Fredeen.;Jonathan S Kurman.
来源: Chest. 2022年161卷5期e299-e304页
A 31-year-old Asian male never-smoker living in the upper Midwest with a past medical history of congenital bilateral hearing loss sought treatment with a 1-week history of fever, fatigue, right-sided pleuritic chest pain, shortness of breath, productive cough with mild intermittent hemoptysis, night sweats, and unintentional 10-lb weight loss over 4 weeks. He was adopted from South Korea as an infant, and thus the family history was unknown. He worked in the heating, ventilation, and air conditioning business, performing installations and repairs. There was no known exposure to animals, caves, rivers, lakes, or wooded areas. He travelled to South Korea and New Hampshire approximately 9 months previously. He did not take any medication.
1789. A 43-Year-Old Woman With Fatigue, Pancytopenia, and Mediastinal Adenopathy.
A 43-year-old woman without significant medical history was admitted with fatigue for 2 months. Before her current presentation, she had experienced several weeks of heavy menstrual bleeding and easy bruising. She denied night sweats, weight loss, chills, sore throat, neck swelling, rash, joint pain, cough, fever, or shortness of breath. The patient admitted a 20-year half-pack per day smoking habit that she had not been able to quit. She denied significant occupational or environmental exposures, a family history of malignancy, or current use of medications.
1790. A 68-Year-Old Woman With Refractory Cough and Insidious Tracheal Thickening.
作者: Hana Serajeddini.;Yaron Shargall.;Jean-Claude Cutz.;Parameswaran Nair.
来源: Chest. 2022年161卷5期e287-e291页
A 68-year-old woman presented to a subspecialty complex-airways-disease clinic with chronic cough. She had a 10-pack-year history of smoking, quit over 35 years ago, and had mild atopy (dust mite) and mild rhinitis. She did not have any relevant occupational exposure or comorbidities. Her cough was relentless day and night, associated with incontinence, vomiting, and social and functional impairment. It had been present for years, though it changed in nature over time. She also reported one to two episodes of streaky hemoptysis. She had not noticed significant benefit with nasal or inhaled corticosteroids, but short bursts of prednisone had temporarily modestly improved her cough.
1791. Cavitating Lung Disease Associated With Sudden Death.
作者: Simon Proctor.;John Gilbert.;Christopher Barnett.;Marc Agzarian.;Jeffrey J Bowden.
来源: Chest. 2022年161卷5期e279-e285页
A 16-year-old boy presented with 6 days of left iliac fossa pain. He had a medical history of right subtalar dislocation and appendicitis requiring laparotomy 3 years earlier, complicated by wound dehiscence. His family history was significant for his brother's sudden death 3 weeks prior after a 12-month illness with intermittent epigastric pain, weight loss, and hemoptysis. Travel history was significant for travel to the Philippines 3 years prior, in which he spent time in the hospital for appendicitis.
1792. An Infant With Interstitial Lung Disease of Rare Cause.
作者: Cong Li.;Huishan Zhang.;Jiali Mo.;Yanqiong Wang.;Danyu Song.;Penghui Wu.;Yan Xiong.;Jianxing Qiu.;Guangfa Wang.;Leping Ye.
来源: Chest. 2022年161卷5期e273-e278页
An 11-month-old boy was admitted to our hospital because of "recurrent cough with intermittent dyspnea for more than 8 months, aggravated for 1 month." The baby began experiencing a recurrent milk-choking problem within 1.5 months after birth. He had been hospitalized four times, but the symptoms recurred. One month previously, the symptoms were aggravated and a chest CT scan performed at outside hospital showed interstitial changes. Pediatric bronchoscopy revealed bronchial inflammatory features, with hemosiderin-laden macrophages being found in BAL fluid (BALF). Also, periodic acid-Schiff (PAS) staining showed positive results, which indicated the possibility of pulmonary alveolar proteinosis (PAP) or idiopathic pulmonary hemosiderosis (IPH).
1793. Middle Mediastinal Mass Compressing the Pulmonary Trunk in a Patient With a History of Breast Cancer.
作者: Camila Greggianin.;Kazuhiro Yasufuku.;Leung Chu Tong.;Gurmohan Dhillon.;Geneviève C Digby.
来源: Chest. 2022年161卷5期e265-e272页
A 61-year-old White woman, nonsmoker, was referred to Respirology for evaluation of small pulmonary nodules discovered incidentally on surveillance imaging 3 years after breast cancer treatment. She had a remote left breast ductal carcinoma in situ treated with lumpectomy followed by radiation therapy, and recurrent stage 1 breast cancer (estrogen receptor/progesterone receptor-positive, human epidermal growth factor receptor 2-negative) treated with mastectomy, axillary lymph node dissection, and reconstructive surgery, followed with adjuvant chemotherapy, radiation therapy, and letrozole maintenance. Her other medical conditions included compensated cirrhosis secondary to nonalcoholic fatty liver disease, type 2 diabetes, hypertension, OSA, restless legs syndrome, obesity, anxiety, and depression. She reported no dyspnea or constitutional symptoms.
1794. New-Onset Exertional Dyspnea in a Young Patient With Previous Blunt Chest Trauma.
作者: Pasquale Valerio Falzone.;Luca Nai Fovino.;Massimo Napodano.;Benedetta Giorgi.;Monica De Gaspari.;Stefania Rizzo.;Martina Perazzolo Marra.;Manuel De Lazzari.
来源: Chest. 2022年161卷5期e259-e263页
A 16-year-old male patient was admitted to our Cardiology Department for new-onset exertional dyspnea (NYHA functional class II-III). He had no family history of cardiovascular diseases, no cardiovascular risk factors, and an unremarkable medical history, except for a blunt chest trauma after a motorbike accident 2 years earlier.
1795. A "Catlike Cry" as a Symptom of Congenital Tracheoesophageal Fistula.
作者: Seshiru Nakazawa.;Toshiki Yajima.;Kazuki Numajiri.;Natsuko Kawatani.;Fumiaki Aoki.;Ken Shirabe.
来源: Chest. 2022年161卷5期e255-e257页
Congenital tracheoesophageal fistula is usually diagnosed at an early age, but may remain undetected into adulthood if atresia is absent and if the fistula is small. A tracheoesophageal fistula should be suspected in patients with unexplained episodes of respiratory distress or pneumonia; however, more subtle signs can be an important symptom for early recognition of the disease. Ono's sign is a well-known symptom of tracheoesophageal fistula, characterized by paroxysmal coughing triggered by swallowing of fluids. In the present case, air movement between the esophagus and the trachea through the fistula caused a high-pitched sound, which the patient described as a "catlike cry." The high-pitched sound ceased after surgical closure of the fistula. We report here the symptom of "catlike cry" as one manifestation of tracheoesophageal fistula.
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