February 2012 Arizona Thoracic Society Notes
Thursday, February 23, 2012 at 11:48AM
Rick Robbins, M.D. in IgE, dapsone, endobronchial Mycobacterium avium-intracellulare, hyper IgE sydrome, methemoglobinemia, parasites, pleural spindel cell tumor, pulmonary embolism, pulmonary sequestration, retrievable inferior vena cava filter

The February Arizona Thoracic Society meeting was held on 2/21/2012 at Scottsdale Shea beginning at 6:30 PM. There were 25 in attendance representing the pulmonary, radiology, and thoracic surgery communities.

A presentation on elevated IgE was given by Dr. Cristian Jivcu a second year pulmonary fellow at the Good Samarian/VA program to follow up the two cases presented last month Dr. Swartzberg. (Click here for the slides used in the presentation)

Multiple cases were presented:

Dr. Gerald Swartzberg presented two cases. The first was an 86 yo with an enlarging mass in the right lower chest. Biopsy had previously revealed the mass to be a benign spindle cell tumor. There was no invasion of the chest wall or evidence of metastases consistent with the tumor’s benign pathology. Despite the tumor appearing to occupy nearly ¼ of the lower chest, the patient was asymptomatic. Most continued observation although thoracic surgery thought it could be safely debulked.

The second case presented by Dr. Swartzberg was a 58 yo with a pulmonary embolism who had been anticoagulated for 6 years. Unfortunately, the patient had a recurrent embolism after the anticoagulation was stopped. The patient is now back on anticoagulation and asymptomatic but had a removable inferior vena cava filter placed. Discussion centered on whether it was appropriate to remove the filter. None knew of a randomized trial and no consensus could be reached.

Dr. Cristian Jivcu presented a case of a 52 yo patient with ulcerative colitis who initially presented at another VA with shortness of breath and fever. Work up eventually resulted in VATS lung biopsy which revealed organizing pneumonia. The patient was started on corticosteroids and transferred to the Phoenix VA where he was admitted and became increasingly short of breath. CT scan revealed a “reverse halo” sign. A routine blood gas detected 12% methemoglobin. At that time it was discovered the patient had been started on dapsone for PCP prophylaxis. The symptoms improved when the dapsone was stopped.

Dr. Syed Zaidi presented two cases from Maricopa Medical Center. The first was a 36 yo with a 2 week history of cough and fever. Chest X-ray was thought to be abnormal in the right lower chest and for this reason a CT scan was ordered. An interlobar pulmonary sequestration was discovered with the blood supply arising from below the diaphragm. Discussion centered on whether the sequestered lung should be removed.

Dr. Zaidi’s second case as a 23 yo with AIDS and a past medical history of pneumocystis pneumonia, Kaposi’s sarcoma and Candida infection who presented with severe cough. CT scan showed adenopathy in the mediastinum and scattered groundglass opacities. Bronchoscopy showed an ulcerating mass in the right bronchus intermedius. Biopsy revealed Mycobacterium avium-intracellulare. Dr. Zaidi’s literature review revealed that endobronchial lesions secondary to M. avium-intracellulare had previously been reported in AIDS and other immunocompromised patients.  

There being no further business the meeting adjourned at 8:00 PM. The next meeting will be on Tuesday, March 20, 6:30 PM at Scottsdale Shea.

Richard A. Robbins, M.D.

Reference as: Robbins RA. February 2012 Arizona thoracic society notes. Southwest J Pulm Crit Care 2012;4:40-1. (Click here for a PDF version of the Notes)

 

Article originally appeared on SOUTHWEST JOURNAL of PULMONARY & CRITICAL CARE (http://www.swjpcc.com/).
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