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Medical Image of the Week: Endovascular Intervention for Life-threatening Hemoptysis

By: Low S-W, Ateeli H

Abstract: No abstract available. Article truncated at 150 words. Idiopathic pulmonary arterial hypertension (PAH) is an uncommon life threatening disease characterized by a progressive increase in pulmonary vascular resistance with subsequent right ventricular failure and death. Hemoptysis is known to be one of the complications in PAH patients although the exact incidence and mechanism of hemoptysis remains unclear (1,2). Ours is a case of a 40-year-old woman with known severe idiopathic pulmonary hypertension who was admitted for recurrent episodes of hemoptysis for the past one month. On her first presentation with non-massive hemoptysis, she underwent elective embolization with Amplatzer® vascular plug (St. Jude Medical, St. Paul, MN USA) of the aorto-pulmonary collaterals. These included a large collateral off the right subclavian artery, right internal mammary artery and a large collateral off the descending aorta to the right lung (Video 1). Her hemoptysis resolved. She was admitted seven days’ post first embolization with massive hemoptysis, and immediately underwent repeat embolization …



Medical Image of the Week: Fibrosing Mediastinitis

By: Knox KS, Arteaga VA

Abstract: Histoplasmosis is endemic to the Midwest US and commonly causes an acute infection that presents as a subacute pneumonia. Chronic sequelae of histoplasmosis range from asymptomatic nodules to debilitating fibrosing mediastinitis (1). Mediastinal fibrosis represents exuberant scarring in response to histoplasmosis infection. Fibrosis may occlude airways (Figure 1A, arrow head) obstruct pulmonary arteries (figure 1B, arrow) or veins and impinge upon the esophagus and other vital structures residing in the mediastinum. Chest imaging shows subcarinal or mediastinal widening. CT scans may reveal fibrotic encasing of mediastinal structures and calcification of regional lymph nodes. Recurrent and often serious hemoptysis results from lung or airway damage and vascular compromise. Respiratory failure can occur. Treatment rarely includes stenting of airways or surgery (2). Vascular stenting may be indicated in some cases. Regardless, these difficult cases must be referred to centers with experience in histoplasmosis related complications.



February 2017 Imaging Case of the Month

By: Gotway MB

Abstract: No abstract available. Article truncated after the first page. Clinical History: A 49-year-old man presented with complaint of slow worsening of shortness of breath over a period of several months. He was otherwise healthy with no significant past medical history. Laboratory data, include white blood cell count, coagulation profile, and serum chemistries were within normal limits. Oxygen saturation on room air was 94%. Frontal and lateral chest radiographs (Figure 1) were performed. Which of the following statements regarding the chest radiograph is most accurate? 1. Frontal and lateral chest radiography shows a right paratracheal mass; 2. Frontal and lateral chest radiography shows basal reticulation suggesting possible fibrotic disease; 3. Frontal and lateral chest radiography shows left-sided lung nodules; 4. Frontal and lateral chest radiography shows lobulated left-sided pleural disease; 5. Frontal and lateral chest radiography shows numerous small nodules. …



In Defense of Eminence-Based Medicine

By: Willis BC

Abstract: No abstract available. Article truncated at 150 words. To arms, august compatriots! Our very way of life is threatened by the hordes of barbarians at our gates. Armed not with pitchforks and torches, but with Cochrane reviews, “multicenter randomized controlled trials”, the Interwebs, and “tablet computers”, they besiege our traditions and values, and threaten our place in the hierarchy of medicine. In no uncertain terms, they want to remove us from our place of reverence, from our position of respect, and replace us with guidelines, pathways, and protocols. To do nothing is to perish. We must stand together, and fight this tide, or be swept away in the tidal wave of journals and statistical analyses buffeting our land. Join or Die! For generations, we have preserved our careers and medicine itself by strictly honoring a system based on “eminence-based medicine” or “EBM”. This is the practice of making the same sound decisions with increasing confidence over an impressive …



Salary Surveys Report Declines in Pulmonologist, Allergist and Nurse Incomes

By: Robbins RA

Abstract: No abstract available. Article truncated at 150 words. The 2016 Medscape Physician Compensation Report relates that orthopedic surgeons and cardiologists earn on average the most of those physicians surveyed ($443,000 and $410,000 annually) (1). Pulmonologists and critical care physicians fell in the middle of the spectrum of physician incomes ($281,000 and $306,000 respectively). Allergists were at the lower end ($205,000). Physicians in each category earned more or the same in 2016 than in 2015 except pulmonologists and allergists which were down compared to 2015 incomes of $296,000 ($15,000 decline) and $243,000 ($38,000 decline). As in years past, the survey is nonscientific. Physicians were asked to provide their annual compensation for patient care including salary, bonus, and profit sharing if employed, earnings after taxes, and deductible business expenses (but before income tax) if in private practice. The reason for the decrease is unclear but self-employed physicians (i.e., private practice) earned substantially more than employed physicians ($64,000 more for men …