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A24. HEART AND LUNGS: "BETTER TOGETHER"最新文献

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Code Blue Due to CO2 蓝色警报,由于二氧化碳
Pub Date : 2022-05-01 DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1135
D. Ahmed, Denae Ford, N. Motayar
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引用次数: 0
Atrioesophageal Fistula following Catheter Ablation for Atrial Fibrillation: A Rare Cause of Hematemesis 房颤导管消融后的房食管瘘:一种罕见的呕血原因
Pub Date : 2022-05-01 DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1144
C. Iyer, L. Boppana, B. Tan, S. Liang
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引用次数: 0
Acute Eosinophilic Pneumonia Caused by Cigar Smoking 吸雪茄引起的急性嗜酸性肺炎
Pub Date : 2022-05-01 DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1127
S. Faryad, M. Ali, J. Meeker
Introduction: Eosinophilic lung diseases (ELD) are a group of conditions that are characterized by pulmonary eosinophilia. Acute eosinophilic pneumonia (AEP) may be idiopathic in many patients, however, changes in smoking habits and drug use can trigger the disease. Case: A 24-year-old female presented to the emergency room with dyspnea for 1 week. She also had productive cough, fever of 38.7C (101.7F) and chest tightness. Although she had been vaping for the past year she switched to heavy cigar smoking 3 weeks prior to admission. Vital signs on presentation were blood pressure 127/72 mmHg, heart rate 122 beats/min, respiratory rate 28/min, oral temperature 37.4°C (99.4°F) and oxygen saturation 88% on room air. Lung exam revealed mild rhonchi. Blood work showed leukocytosis 29.13 x 103/mcL (N:4-12 x 103/mcL) with neutrophilia 26.6 x 103/mcL (N: 1.60-7.71 x 103/mcL), mild lymphopenia 1.07 x 103/mcL and a normal metabolic panel. SARS-CoV-2 PCR was negative 3 times. CT chest revealed consolidative opacities involving the right lung more than left and small bilateral pleural effusions. The patient was provided supplemental oxygen via nasal cannula and started on ceftriaxone and azithromycin for community acquired pneumonia. She rapidly declined requiring endotracheal intubation for invasive mechanical ventilation. Antibiotic coverage was broadened to vancomycin, piperacillin-tazobactam, doxycycline and levofloxacin. Further negative work up included viral pathogen panel, respiratory cultures, HIV screening, fungal antibodies, urine pneumococcal and legionella antigens, ANA and ANCA, and serum next-generation sequencing. She developed peripheral eosinophilia on hospital day 2 which peaked at 3.29 x 103/mcL (N: 0.0-0.40 x 103/mcL) on day 6. Bronchoscopy revealed no organisms on gram stain and there was no alveolar hemorrhage. Cell count from bronchoalveolar lavage (BAL) was not available. She was started on methylprednisone 60 mg every 6 hours IV for presumed AEP with marked improvement over the next 48 hours. She was discharged home shortly thereafter on an 8 week steroid taper. Discussion: AEP has been associated with new onset or resumption of cigarette smoking. Our patient had an acute onset febrile illness rapidly progressing to hypoxic respiratory failure, initial peripheral neutrophilic leukocytosis with subsequent peripheral eosinophilia, patchy bilateral ground glass and consolidative opacities with small pleural effusions, and immediate response to steroids. Prognosis is excellent if the disease is recognized and treated promptly. Conclusion: AEP is a rare cause of acute respiratory failure that can be confidently diagnosed with careful history, a constellation of symptoms and signs, and BAL eosinophilia (>20-25%).
嗜酸性粒细胞肺病(ELD)是一组以肺嗜酸性粒细胞增多为特征的疾病。急性嗜酸性粒细胞性肺炎(AEP)在许多患者中可能是特发性的,然而,吸烟习惯和药物使用的变化可引发该疾病。病例:一名24岁女性因呼吸困难1周就诊于急诊室。她还咳嗽,发烧38.7摄氏度(101.7华氏度),胸闷。虽然她在过去的一年里一直在吸电子烟,但在入院前三周,她开始吸大量的雪茄。就诊时的生命体征为血压127/72 mmHg,心率122次/分,呼吸率28次/分,口腔温度37.4°C(99.4°F),室内空气氧饱和度88%。肺部检查显示轻度肺气。血液检查显示白细胞增多29.13 × 103/mcL (N:4-12 × 103/mcL),中性粒细胞增多26.6 × 103/mcL (N: 1.60-7.71 × 103/mcL),轻度淋巴细胞减少1.07 × 103/mcL,代谢组正常。SARS-CoV-2 PCR阴性3次。胸部CT显示右肺实变性混浊多于左肺,双侧胸腔少量积液。患者通过鼻插管补充氧气,并开始使用头孢曲松和阿奇霉素治疗社区获得性肺炎。她迅速拒绝需要气管插管进行有创机械通气。抗生素覆盖范围扩大到万古霉素、哌拉西林-他唑巴坦、多西环素和左氧氟沙星。进一步的阴性工作包括病毒病原体小组、呼吸道培养、艾滋病毒筛查、真菌抗体、尿液肺炎球菌和军团菌抗原、ANA和ANCA,以及血清下一代测序。患者住院第2天出现外周嗜酸性粒细胞增多,第6天达到峰值3.29 × 103/mcL (N: 0.0-0.40 × 103/mcL)。支气管镜检查未见革兰氏染色及肺泡出血。支气管肺泡灌洗(BAL)细胞计数未见。她开始服用甲基强的松60mg / 6小时静脉注射,以预防AEP,在接下来的48小时内有明显改善。她出院后不久,8周类固醇逐渐减少。讨论:AEP与新发或重新吸烟有关。我们的患者有急性发热性疾病,迅速发展为缺氧呼吸衰竭,最初的外周嗜中性粒细胞增多,随后的外周嗜酸性粒细胞增多,斑片状双侧磨玻璃和实性混浊伴少量胸腔积液,并立即对类固醇有反应。如果疾病被及时发现和治疗,预后很好。结论:AEP是一种罕见的急性呼吸衰竭病因,可以通过仔细的病史、一系列症状和体征以及BAL嗜酸性粒细胞增多(>20-25%)来确诊。
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引用次数: 0
Conservative Management of an Iatrogenic Left Bronchial Injury Following Double-Lumen Endotracheal Tube Placement 双腔气管内置管后医源性左支气管损伤的保守治疗
Pub Date : 2022-05-01 DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1121
S. Guru, M. Assaad, P. Saththasivam, F. Siddiqui, N. McElhaney
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引用次数: 0
Arid Airways: Broadening the Differential 干旱航空公司:扩大差异
Pub Date : 2022-05-01 DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1138
J. Mansour, N. Lee, R. Abdelghani, C. Bojanowski
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引用次数: 0
期刊
A24. HEART AND LUNGS: "BETTER TOGETHER"
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