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Arizona Thoracic Society Notes

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November 2018 Arizona Thoracic Society Notes
September 2018 Arizona Thoracic Society Notes 
July 2018 Arizona Thoracic Society Notes
March 2018 Arizona Thoracic Society Notes
January 2018 Arizona Thoracic Society Notes
November 2017 Arizona Thoracic Society Notes
September 2017 Arizona Thoracic Society Notes
March 2017 Arizona Thoracic Society Notes
January 2017 Arizona Thoracic Society Notes
November 2016 Arizona Thoracic Society Notes
July 2016 Arizona Thoracic Society Notes
March 2016 Arizona Thoracic Society Notes
November 2015 Arizona Thoracic Society Notes
September 2015 Arizona Thoracic Society Notes
July 2015 Arizona Thoracic Society Notes
May 2015 Arizona Thoracic Society Notes
March 2015 Arizona Thoracic Society Notes
January 2015 Arizona Thoracic Society Notes
November 2014 Arizona Thoracic Society Notes
September 2014 Arizona Thoracic Society Notes
August 2014 Arizona Thoracic Society Notes
June 2014 Arizona Thoracic Society Notes
May 2014 Arizona Thoracic Society Notes
April 2014 Arizona Thoracic Society Notes
March 2014 Arizona Thoracic Society Notes
February 2014 Arizona Thoracic Society Notes
January 2014 Arizona Thoracic Society Notes
December 2013 Arizona Thoracic Society Notes
November 2013 Arizona Thoracic Society Notes
October 2013 Arizona Thoracic Society Notes
September 2013 Arizona Thoracic Society Notes
August 2013 Arizona Thoracic Society Notes
July 2013 Arizona Thoracic Society Notes
June 2013 Arizona Thoracic Society Notes
May 2013 Council of Chapter Representatives Notes
May 2013 Arizona Thoracic Society Notes
April 2013 Arizona Thoracic Society Notes 
March 2013 Arizona Thoracic Society Notes
March 2013 Council of Chapter Representatives Meeting 
and “Hill Day” Notes
February 2013 Arizona Thoracic Society Notes
January 2013 Arizona Thoracic Society Notes
November 2012 Arizona Thoracic Society Notes
October 2012 Arizona Thoracic Society Notes
September 2012 Arizona Thoracic Society Notes
August 2012 Arizona Thoracic Society Notes
August 2012 Special Meeting Arizona Thoracic Society Notes
June 2012 Arizona Thoracic Society Notes
May 2012 Council of Chapter Representatives Meeting
May 2012 Arizona Thoracic Society Notes


For a complete list of the Arizona Thoracic Society notes click here.

The Arizona Thoracic Society meets every other month in Phoenix, usually on the fourth Wednesday of odd numbered months, from 6:30-8:00  PM at Scottsdale Healthcare Shea Hospital located at Shea and 90th Street in Phoenix. During these meetings dinner and case presentations occur.



March 2012 “Hill Day” and Council of Chapter Representatives Meeting Notes

As part of “Hill Day” the Council of Chapter Representatives meant on March 28-29, 2012 in Washington, D.C.

The meeting began with a bus trip to the Rayburn House Office Building at 7 AM sharp on Wednesday. A breakfast meeting was held with presentations by one of the ATS lobbyists, Gary Ewart; Rep. Jim McDermott (D, WA), a former psychiatrist, on the Affordable Care Act (ACA); and representatives from the EPA and AMA.

Richard Robbins, Arizona CCR representative, and Ann Schneidman, RN from Hospice of the Valley, along with Dale Dirks from the ATS and Dr. Christine Fukui from Hawaii traveled to the Congressional offices. The group met with several representatives from the Arizona Congressional Delegation including:

  • Rep. Ben Quayle (R-AZ-3) and Rachel Dresen, Rep. Quayle’s legislative director
  • Rep. Raúl Grijalva (D-AZ-7) and Kelsey Mishkin, Rep. Grijalva’s legislative assistant
  • Cassie Sonn, legislative assistant office of Rep. David Schweikert (R-AZ-5)
  • Judith Gheuens, health counsel to the office of Sen. Jon Kyl (R-AZ)
  • Greg Kuhn, legislative correspondent office of Sen. John McCain (R-AZ)

Four issues were discussed and ATS handout on each was presented:

The Council of Chapter Representatives (CCR) met on Thursday, March 29. Nine attendees and 3 ATS staff were in attendance with one representative participating by conference call. The meeting was called to order at 9:00 AM by Dona Upson, Chair CCR.

The ATS President’s address was given by Nick Hill, ATS President 2011-2. His remarks included a discussion of ATS goals including the ATS’ new emphasis on advocacy.

An advocacy update was presented by Gary Ewart, ATS Government Relations.  

Eric Yeager, from Colorado, was selected for the ATS Outstanding Clinician Award for 2012. Our own Al Thomas was one of the finalists along with Mitchell Rashkin from Ohio.

CCR business discussions included:

  • Committee Updates
  • CCR Representatives on Committees for 2012-3
  • A report from Dona Upson on the new requirements for recertification by the American Board of Internal Medicine (not yet announced) which will take effect on January, 2013. ATS is striving to meet those requirements beginning with the ATS 2012 International Meeting.
  • Renaming of Wegner’s granulomatosis
  • An announcement that it will shortly be possible for members to change their identifier information (telephone, address, e-mail, etc.) on the ATS website.

The meeting was adjourned at 11:30 AM.

Richard A. Robbins, MD

Arizona, CCR Representative

Reference as: Robbins RA. March 2012 "Hill Day" and Council of Chapter Representatives meeting notes. Southwest J Pulm Crit Care 2012;4:69-70. (Click here for PDF version)


March 2012 Arizona Thoracic Society Notes

The March 2012 Arizona Thoracic Society meeting was held on 3/20/2012 at Scottsdale Shea beginning at 6:30 PM. There were 21 in attendance representing the pulmonary, allergy, radiology, and thoracic surgery communities.

Dr. Allen Thomas, the Arizona nominee for ATS Clinician of the Year, was recognized. Voting for will be on 3/29/2012 at the ATS Council of Chapter Representatives meeting in Washington, D.C.

Multiple cases were presented:

1. Dr. George Parides presented a case of 46 year old female who complained of mild shortness of breath. A chest x-ray revealed a large left pleural effusion. Thoracentesis showed that the fluid was an exudate but cytology and cultures were negative. A repeat chest x-ray showed a large left lower lobe mass and a CT scan showed a 24X21 cm mass in the left lower chest. Surgical resection was performed and was a benign fibrous tumor of the pleura on histology. Discussion ensued that there have been several of these reported at the Arizona Thoracic Society and perhaps these are not as rare as commonly thought. Rick Helmers pointed out that these tumors can be associated with hypoglycemia.

2. Gerald Swartzberg presented on diaphragmatic paralysis. The initial sniff test had been negative but a repeat was positive. Discussion ensued about the sensitivity and specificity of the sniff test. Although no one could recall specific numbers, most thought that the sniff test was fairly good. This evolved into a discussion of the usefulness of diaphragmatic placation (render the flaccid hemidiaphragm taut by oversewing the membranous central tendon and the muscular components of the diaphragm) and how long to wait for phrenic nerve generation before performing placation.

3. John Roehrs presented a case of 75 yo rock miner from Globe who had very severe oxygen dependent COPD and pulmonary hypertension. He was found to have a lung nodule which was followed and increased in size after 6 months and was now 2 cm. PET scan showed the nodule to have increased uptake of about 2.8 SUV. Treatment of the patient was extensively discussed. Most thought that an operative intervention was contraindicated because of his COPD and pulmonary hypertension. Obtaining a coccidioidomycosis serology was suggested although most thought this likely a lung cancer. Following the patient without intervention was suggested by most.

4. Dr. Swartzberg presented a second case of a 32 year old Filipino man who was referred by a dermatologist had biopsied a skin lesion on the chest and found coccidioidomycosis. He was treated for 6 months with fluconazole and the coccidioidomycosis complement fixation tests had been 1:2 to 1:4. Al Thomas pointed out that he had seen several patients with apparent direct inoculation into the skin. Discussion ensued about how long to treat coccidioidomycosis in this situation. Although there was agreement that there was no data available, most advocated longer rather than shorter treatment.

There being no further cases, the meeting was adjourned at 8:00 PM. The next meeting is scheduled for April 17.

Richard A. Robbins, M.D.

Reference as: Robbins RA. March 2012 Arizona thoracic society notes. Southwest J Pulm Crit Care 2012;4:67-8. (Click here for a PDF version of the Notes)


February 2012 Arizona Thoracic Society Notes

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)



January 2012 Arizona Thoracic Society Notes

The January Arizona Thoracic Society meeting was held on 1/11/2012 at Scottsdale Shea beginning at 6:30 PM. There were 30 in attendance representing the pulmonary, radiology, thoracic surgery and allergy communities.

Al Thomas was voted to be clinician of the year nominee from Arizona.

A progress report for 2011 was given by Rick Robbins on the Southwest Journal of Pulmonary and Critical Care (for a summary of the presentation click here).

Multiple cases were presented:

  1. George Parides presented a 64 year old with a second PPD which was positive. A discussion regarding interpretation of PPDs ensued.
  2. Gerald Swartzberg presented two cases-both had in common a markedly elevated IgE level. These cases created a discussion of the differential diagnosis of an elevated IgE and how to approach patients with this laboratory abnormality.
  3. Paul Conomos presented 2 cases. One was a patient with a pericardial cyst and the other a subcarinal mass. Discussion centered on how to manage patients with asymptomatic subcarinal masses.
  4. Cristian Jivcu presented a case of a left upper lobe 7 cm mass. Bronchoscopy with bronchoalveolar lavage was negative. The patient was followed with complete resolution.
  5. Henry Luedy presented a 79 yo with an interstitial lung disease probably secondary to chronic aspiration for 5 years with complete radiologic resolution.
  6. Joshua Jewell presented a case of pneumonia with empyema. Rather than decoritcation the patient was treated with thoracostomy drainage and TPA and DNAase with complete resolution over several weeks.
  7. Manny Mathew followed with a similar case of a pleural effusion treated with TPA which also resolved. Discussion occurred on when it was appropriate to treat patients conservatively with chest tube drainage compared to aggressively with decortication.

There being no further business the meeting adjourned at 8:00 PM. The next meeting will be on Tuesday, February 21, 6:30 PM at Scottsdale Shea.

Richard A. Robbins, M.D.

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


November 2011 Arizona Thoracic Society Notes

The November Arizona Thoracic Society meeting was held on 11/8/2011 at Scottsdale Shea beginning at 6:30 PM. There were 22 in attendance representing the pulmonary and radiology communities.

Three cases were presented:

1. Henry Luedy, a pulmonary fellow from Good Samaritan/VA, presented a case of Lemiere’s disease. Lemierre's disease is a form of thrombophlebitis usually caused by Fusobacterium and usually affects young, healthy adults. Lemierre's disease develops most often after a sore throat caused by some bacterium of the Streptococcus genus has created a peritonsillar abscess. Deep in the abscess, anaerobic bacteria which are part of the normal oral flora such as Fusobacterium can flourish. These anaerobic bacteria penetrate from the abscess into the neighboring jugular vein in the neck and there they cause sepsis or septic emboli.

2. Alexis Christie, a pulmonary fellow at the Mayo Clinic, presented an unusual case of pulmonary embolism. Discussion centered on unusual presentations of pulmonary embolism.

3. Rick Robbins presented a case of lymphocytic interstitial pneumonia developing in a man with long standing systemic lupus erythematosis.

At the end of the case presentations, George Parides was elected the new Arizona Thoracic Society president. He thanked the outgoing president, Rick Helmers, for his service. Rick will be leaving for Chicago at the end of November.

A discussion of the goals and objectives of the Arizona thoracic society ensued. Jud Tillinghast raised the possibility of an educational meeting involving physicians with interest in pulmonary, critical care and sleep medicine throughout the Southwest. Many thought such a meeting might be valuable. Dr. Robbins will contact members of the pulmonary community and determine if there is any interest.

There being no being further business the meeting was adjourned at 7:45. The next meeting is scheduled for Wednesday, January 11, 2012, at Scottsdale Shea. Meetings are scheduled for 10 months of 2012 as follows:

Wednesday, January 11

Tuesday, February 21

Tuesday, March 20

Tuesday, April 17

Tuesday, May 15

Tuesday, June 19

No meeting in July

Tuesday, August 21

Tuesday, September 18

Tuesday, October 16

Tuesday, November 20

No meeting in December.


Richard A. Robbins, M.D.