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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.


Entries in COPD (3)


March 2015 Arizona Thoracic Society Notes

The March 2015 Arizona Thoracic Society meeting was held on Wednesday, March 25, 2014 at the Scottsdale Shea Hospital beginning at 6:30 PM. This was a dinner meeting with case presentations. There were 14 in attendance representing the pulmonary, critical care, sleep, radiology and oncology communities.

Dr. Richard Robbins made a presentation entitled "The History of Exhaled Nitric Oxide Measurement" focusing on the development of exhaled nitric oxide in the early 1990's.

There were 3 case presentations:

  1. Sandra Till, a third year pulmonary fellow at the Good Samaritan/VA program, presented an elderly man admitted to the Phoenix VA with an exacerbation of chronic obstructive pulmonary disease (COPD). His CT findings showed with centrilobular emphysema, bronchial edema, and scattered ground glass opacities. It was felt that the CT findings most likely represented a bronchiolitis from his exacerbation of COPD.
  2. Richard Robbins presented a 49 year old man with a positive PPD and Gold QuantiFERON who has extensive psoriasis and had biological therapy with etanercept recommended. He had an extensive past medical history of diabetes and sleep apnea secondary to obesity which resolved with gastric bypass. His liver was palpable at his right costal margin and his liver enzymes were mildly elevated. Chest x-ray was normal. Most felt that therapy for latent tuberculosis was indicated with some recommending isoniazid, others recommending rifampin and others recommending both drugs. He was treated for one month with isoniazid and his liver enzymes all declined into the normal range. He has begun etanercept and 6-9 months of isoniazid therapy are planned.
  3. Stephanie Fountain, a second year internal medicine resident from the Good Samaritan/VA program presented an elderly man with a history of adenocarcinoma of the pancreas treated with chemotherapy and radiation in Chicago just prior to moving to Phoenix. He presented with abdominal pain secondary to an ileus which spontaneously improved. A CT scan performed during the abdominal evaluation showed multiple small nodules and some scattered ground glass opacities which was reminiscent of idiopathic interstitial pneumonia with cystic changes. Biopsy showed adenocarcinoma which special stains were most consistent with a pancreas primary. Discussion ensued about this unusual presentation CT presentation of metastatic pancreatic cancer.

The next meeting in Phoenix will be at Scottsdale Shea on Wednesday, May 27 at 6:30 PM.

Richard A. Robbins, MD

Editor, SWJPCC

Reference as: Robbins RA. March 2015 Arizona thoracic society notes. Southwest J Pulm Crit Care. 2015;10(3):149. doi: PDF


July 2013 Arizona Thoracic Society Notes

The first Arizona Thoracic Society meeting in Tucson was held on Wednesday, 7/24/2013 at Kiewit Auditorium on the University of Arizona Medical Center campus beginning at 6:30 PM. There were 36 in attendance representing the pulmonary, critical care, sleep, pathology and radiology communities. Dinner was sponsored by Accredo Health Group.

A brief discussion was held of plans to have the December 2013 meeting in Tucson on a weekend as part of the University of Arizona winter pulmonary meeting.

There were 4 cases presented:

  1. Mohammad Dalabih presented a case of a 48 yo woman with respiratory failure cared for by Gordon Carr, Linda Snyder, and himself. Radiology findings were discussed by Isabel Oliva. Lung biopsy showed acute fibrinous and organizing pneumonia rather than ARDS and was presented by Richard Sobonya.
  2. Franz Rischard presented a case of a 61 year old with progressive dyspnea and moderate COPD with evidence of pulmonary hypertension. Radiologic work up was presented by Dr. Oliva. It was determined the patient had primary hypertension and Dr. Rischard discussed how to separate pulmonary hypertension from COPD from primary pulmonary hypertension.
  3. Nathaniel Reyes presented a 50 year old woman with a history of granulomatous polyangiitis (GPA, formerly known as Wegener’s granulomatosis) who was pANCA+ but cANCA-. She developed diffuse alveolar hemorrhage. Dr. Soboyna reviewed pathology of GPA. Dr. Reyes discussed the ANCA+ vasculities. Some rheumatologists no longer consider GPA and microscopic polyangitis separate diseases but part of the same spectrum.
  4. Gordon Carr presented a case of a 65 year old man who died of an exacerbation of idiopathic pulmonary fibrosis (IPF). Dr. Sobonya reviewed the autopsy and pathology findings of IPF.

There being no further business the meeting was adjourned at about 8:15 PM. The next meeting is scheduled for Wednesday, August 28, 6:30 PM in Phoenix at Scottsdale Shea Hospital.  

Richard A. Robbins, M.D.

Reference as: Robbins RA. July 2013 Arizona thoracic society notes. Southwest J Pulm Crit Care. 2013;7(1):50. doi: PDF 


April 2011 Arizona Thoracic Society Notes

A dinner meeting was held at Scottsdale Shea Medical Center on April 12, 2011 from 6:30-8:00 PM. Twenty-seven were in attendance including representatives from the pulmonary and chest radiology communities. Six cases were presented and discussed:

1. Alexis Christie and Rick Helmers presented a case of acute respiratory failure in a 51 year old woman who had an “ARDS”-like picture, an initially negative bronchoscopy with bronchoalveolar lavage and a non-specific open lung biopsy. The bronchoalveolar lavage eventually cultured influenza A. Discussion centered on whether the patient should have received corticosteroids.

2. Lew Wesselius presented a 55 year old man evaluated for renal transplant secondary to chronic renal failure from polycystic kidney disease. The patient was asymptomatic but found to have lower lung nodules on CT which were thought to be pulmonary arteriovenous malformations. The patient was referred for embolization. The invasive radiologist identified these as pulmonary varices. No therapy was given. A brief review of pulmonary varices was done by Dr. Wesselius and Mike Gotway discussed the radiographic appearance.

3. Gerald Swartzberg presented a case of a 64 year old woman with a rash on her palms, fever and multiple pulmonary nodules. Cultures and coccidiomycosis serology were negative. The patient was found to have coccidiomycosis on video-assisted thoracic surgery. Discussion centered on the 70% sensitivity of coccidiomycosis serology.

4. Gerald Swartzberg presented a second case of a 55 year old man with dyspnea, a 20 pack-year smoking history, and lower lobe fibrosis. The PFTs were presented which demonstrated a mixed obstructive and restrictive disease with a diffusing capacity of 47% of predicted. Most thought this was a case of COPD with idiopathic pulmonary fibrosis. Management was discussed.

5. John Roehrs presented a case of 52 year old woman with dyspnea with a normal chest x-ray and spirometry. However, on echocardiogram pulmonary hypertension was found with right atrial and ventricular enlargement. A bubble study demonstrated an atrial septal defect. Right-sided cardiac catherization confirmed the elevated pulmonary artery pressure and demonstrated an O2 step up at the atrial level. Discussion centered on therapy with most suggesting cardiology evaluation for a percutaneous closure of the ASD.

6. Christian Jivcu and Manny Mathew presented a case dyspnea of a man who had Hodgkin’s disease in 1987 who had received radiation therapy. CXR revealed bilateral pleural effusions which were exudative. A chest CT scan revealed mediastinal lymphadenopathy. At operation he was found to have mesothelioma which even in retrospect was not recognizable on his CT scan. The patient had no known asbestos exposure. Discussion focused on the association between prior radiation therapy and mesothelioma.

Richard A. Robbins, MD