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Last 50 Pulmonary Postings

(Click on title to be directed to posting, most recent listed first)

March 2025 Pulmonary Case of the Month: Interstitial Lung Disease of
   Uncertain Cause
December 2024 Pulmonary Case of the Month: Two Birds in the Bush Is
   Better than One in the Hand
Glucagon‐like Peptide-1 Agonists and Smoking Cessation: A Brief Review
September 2024 Pulmonary Case of the Month: An Ounce of Prevention
   Caused a Pound of Disease
Yield and Complications of Endobronchial Ultrasound Using the Expect
   Endobronchial Ultrasound Needle
June 2024 Pulmonary Case of the Month: A Pneumo-Colic Association
March 2024 Pulmonary Case of the Month: A Nodule of a Different Color
December 2023 Pulmonary Case of the Month: A Budding Pneumonia
September 2023 Pulmonary Case of the Month: A Bone to Pick
A Case of Progressive Bleomycin Lung Toxicity Refractory to Steroid Therapy
June 2023 Pulmonary Case of the Month: An Invisible Disease
February 2023 Pulmonary Case of the Month: SCID-ing to a Diagnosis
December 2022 Pulmonary Case of the Month: New Therapy for Mediastinal
   Disease
Kaposi Sarcoma With Bilateral Chylothorax Responsive to Octreotide
September 2022 Pulmonary Case of the Month: A Sanguinary Case
Electrotonic-Cigarette or Vaping Product Use Associated Lung Injury:
   Diagnosis of Exclusion
June 2022 Pulmonary Case of the Month: A Hard Nut to Crack
March 2022 Pulmonary Case of the Month: A Sore Back Leading to 
   Sore Lungs
Diagnostic Challenges of Acute Eosinophilic Pneumonia Post Naltrexone
Injection Presenting During The COVID-19 Pandemic
Symptomatic Improvement in Cicatricial Pemphigoid of the Trachea
   Achieved with Laser Ablation Bronchoscopy
Payer Coverage of Valley Fever Diagnostic Tests
A Summary of Outpatient Recommendations for COVID-19 Patients
   and Providers December 9, 2021
December 2021 Pulmonary Case of the Month: Interstitial Lung
   Disease with Red Knuckles
Alveolopleural Fistula In COVID-19 Treated with Bronchoscopic 
   Occlusion with a Swan-Ganz Catheter
Repeat Episodes of Massive Hemoptysis Due to an Anomalous Origin 
   of the Right Bronchial Artery in a Patient with a History
   of Coccidioidomycosis
September 2021 Pulmonary Case of the Month: A 45-Year-Old Woman with
   Multiple Lung Cysts
A Case Series of Electronic or Vaping Induced Lung Injury
June 2021 Pulmonary Case of the Month: More Than a Frog in the Throat
March 2021 Pulmonary Case of the Month: Transfer for ECMO Evaluation
Association between Spirometric Parameters and Depressive Symptoms 
   in New Mexico Uranium Workers
A Population-Based Feasibility Study of Occupation and Thoracic
   Malignancies in New Mexico
Adjunctive Effects of Oral Steroids Along with Anti-Tuberculosis Drugs
   in the Management of Cervical Lymph Node Tuberculosis
Respiratory Papillomatosis with Small Cell Carcinoma: Case Report and
   Brief Review
December 2020 Pulmonary Case of the Month: Resurrection or 
   Medical Last Rites?
Results of the SWJPCC Telemedicine Questionnaire
September 2020 Pulmonary Case of the Month: An Apeeling Example
June 2020 Pulmonary Case of the Month: Twist and Shout
Case Report: The Importance of Screening for EVALI
March 2020 Pulmonary Case of the Month: Where You Look Is 
   Important
Brief Review of Coronavirus for Healthcare Professionals February 10, 2020
December 2019 Pulmonary Case of the Month: A 56-Year-Old
   Woman with Pneumonia
Severe Respiratory Disease Associated with Vaping: A Case Report
September 2019 Pulmonary Case of the Month: An HIV Patient with
   a Fever
Adherence to Prescribed Medication and Its Association with Quality of Life
Among COPD Patients Treated at a Tertiary Care Hospital in Puducherry
    – A Cross Sectional Study
June 2019 Pulmonary Case of the Month: Try, Try Again
Update and Arizona Thoracic Society Position Statement on Stem Cell 
   Therapy for Lung Disease
March 2019 Pulmonary Case of the Month: A 59-Year-Old Woman
   with Fatigue
Co-Infection with Nocardia and Mycobacterium Avium Complex (MAC)
   in a Patient with Acquired Immunodeficiency Syndrome 
Progressive Massive Fibrosis in Workers Outside the Coal Industry: A Case 
   Series from New Mexico
December 2018 Pulmonary Case of the Month: A Young Man with
   Multiple Lung Masses
Antibiotics as Anti-inflammatories in Pulmonary Diseases
September 2018 Pulmonary Case of the Month: Lung Cysts
Infected Chylothorax: A Case Report and Review
August 2018 Pulmonary Case of the Month
July 2018 Pulmonary Case of the Month
Phrenic Nerve Injury Post Catheter Ablation for Atrial Fibrillation
Evaluating a Scoring System for Predicting Thirty-Day Hospital 
   Readmissions for Chronic Obstructive Pulmonary Disease Exacerbation
Intralobar Bronchopulmonary Sequestration: A Case and Brief Review

 

For complete pulmonary listings click here.

The Southwest Journal of Pulmonary and Critical Care publishes articles broadly related to pulmonary medicine including thoracic surgery, transplantation, airways disease, pediatric pulmonology, anesthesiolgy, pharmacology, nursing  and more. Manuscripts may be either basic or clinical original investigations or review articles. Potential authors of review articles are encouraged to contact the editors before submission, however, unsolicited review articles will be considered.

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Tuesday
Nov012016

Tobacco Company Campaign Contributions and Congressional Support of the Cigar Bill

Richard A. Robbins, MD

Phoenix Pulmonary and Critical Care Research and Education Foundation

Gilbert, AZ USA

Abstract

Although it is widely held that campaign contributions influence support for legislation, the impact of contributions is unclear. Despite lack of a tobacco growing or manufacturing constituency, many members of Congress (MOC) in the Southwest support the pro-tobacco Traditional Cigar Manufacturing and Small Business Jobs Preservation Act of 2015 (HR 662/S 441), aka the "Cigar Bill". The association between campaign contributions from tobacco companies (2006-16) with cosponsor for the Cigar Bill were examined. There was a highly significant correlation with 92% of Southwest MOC who cosponsored the Cigar Bill having received campaign contributions. In contrast, 31% of those who did not cosponsoring the bill had received tobacco company campaign contributions (p<0.001 by Fisher's Exact Test). These data demonstrates a highly significant correlation between campaign contributions and legislative support for the "Cigar Bill".

Introduction

It is generally accepted that campaign donations buy influence from elected legislators. However, a review by Powell (1) states that "political scientists have had great difficulty determining whether and how much influence contributions have on the legislative process". Studies have been inconsistent with some demonstrating a linkage between campaign contributions and influence while others do not, suggesting that there are other influences in addition to contributions. Powell (1) has pointed out that the influence of donations is likely to occur early in the legislative process such as during cosponsorship for legislation or earmarks.

The Traditional Cigars Manufacturing and Small Business Jobs Preservation Act of 2015 (HR 662/S 441, aka the "Cigar Bill"), would permanently exempt hand-rolled and certain machine-rolled cigars from any sort of FDA regulation. This legislation is opposed by at least 20 medial and public health organizations including the American Thoracic Society (ATS), the parent organization of the state thoracic societies including those in the Southwest US (2). The ATS states that  “HR 662 would undermine the science-based process created by the Tobacco Control Act for determining the appropriate level of oversight of tobacco products. The bill would prohibit FDA from promulgating any public health protections related to 'traditional large and premium cigars'. The bill would specifically exempt from FDA oversight some machine made cigars, including those which can cost as little as $1.00. It also could allow some flavored cigars to qualify for an exemption. Inexpensive and flavored cigars such as strawberry, grape, cherry, and chocolate, are exactly the type of cigars attractive to young people.” Furthermore, the bill would create a giant regulatory loophole for the cigar industry to exploit, including advertising to children, growing the candy-flavored cigar market and returning to false advertising tactics such as "light" or "low tar", and allowing certain machine rolled cigars to be widely distributed.

The Southwest US is not a major center for tobacco growing or manufacturing (3). Furthermore, tobacco consumption tends to be low in Southwest US (4). Therefore, the Southwest is a good area to study the influence of campaign contributions on legislative behavior because of the lack of the confounding influence of a constituency that makes a living by tobacco growing or manufacturing and even has a low prevalence of smokers. In this context, we examined the correlation between prior campaign contributions to MOC and their cosponsorship of the "Cigar Bill".

Methods

Campaign Contributions

Tobacco company political action committee (PAC) contributions to Congressional candidates was obtained from the Campaign for Tobacco-Free Kids website (5). Contributions from the years listed (2006-14) were summed and no effort was made to separate recent from more past contributions. The data was examined for Southwest US Congressmen from Arizona, New Mexico, Colorado, California, Nevada and Hawaii. Appendix A shows contributions to individual Congressmen.

Cosponsorship of the "Cigar Bill"

HR 662 and S 441 were introduced in the 2015 Congress by Rep. Bill Posey (R-FL-8) and Sen. Bill Nelson (D-FL) respectively. Cosponsorship was obtained from Congress.gov (6,7). The bill was cosponsored by 165 members of the US House and 20 members of the US Senate. MOC who did or did not the "Cigar Bill" from Arizona, New Mexico, Colorado, California, Nevada and Hawaii are identified in Appendix B.

Statistics

The relationship between cosponsorship for the "Cigar Bill" and tobacco campaign contributions was done by Fisher's exact test using a 2X2 contingency table. Amounts of campaign contributions were expressed as mean + SD. The Mann-Whitney U test was used to calculate comparisons of the amounts of campaign contributions.

Results

Eighty-four percent of Southwest MOC who cosponsored the "Cigar Bill" had received tobacco campaign contributions. In contrast, only 31% of Southwest MOC not cosponsoring the "Cigar Bill" had received tobacco company campaign contributions (p<0.001 by Fisher's Exact Test). Furthermore, the amount of contributions was larger for those cosponsoring the bill $14024 + $18384 compared to those who did not $4165 + $11240 (p<0.01 by Mann-Whitney U test).

Discussion

This manuscript shows a relationship between tobacco campaign contributions and cosponsorship of the pro-tobacco "Cigar Bill". Furthermore, the campaign amounts tended to be larger to those supporting the legislation compared to those who did no cosponsor the bill. Taken together these data suggest an influence of campaign contributions on legislation.

There is no doubt that cigarette smoking is harmful. Cigarette use among adults and high school students is decreasing compelling US tobacco companies to search for new markets (8). The cigar market, especially the flavored cigar market, represents one strategy to increase tobacco consumption and profits. Flavored cigar and cigarette use is increasing in US middle and high school students (9). Tobacco manufacturers have a history of modifying their products to avoid public health protections or attain lower tax rates (2). Therefore, tobacco companies supporting the "Cigar Bill" is not surprising. By removing regulation the tobacco companies can increase advertising to children and grow the candy-flavored cigar market. Furthermore, it seems likely that cigar manufacturers will modify their products or change their manufacturing processes to qualify for the exemptions provided by the "Cigar Bill" thus increasing the number of cigars on the market.

The title of the HR 662/S 441 is deceiving. The Traditional Cigar Manufacturing and Small Business Jobs Preservation Act is titled to conjure up images of small businesses hand-rolling premium cigars. However, many of the cigars being manufactured would not appear to be the large, thick, and expensive cigars manufactured with fine tobacco but rather small, thin, cheap cigars that are often flavored. There is little tobacco growing or manufacturing in the Southwest US making it difficult for the Congressmen to claim that they are supporting local small business. The lack of a constituency raises the question of why Southwest Congressmen are supporting this bill.  

This manuscript has several limitations. First, it seems likely that more recent campaign contributions might have greater legislative influence. However, we do not have campaign contributions after 2014 and made no effort to separate more recent from past tobacco company campaign contributions. Second, receiving tobacco company campaign contributions and cosponsoring the "Cigar Bill" does not necessarily represent cause and effect. It seems likely that tobacco companies would be more likely to support legislators that they perceive are sympathetic. Third, as pointed out by Powell (1), the issue of buying influence is likely more complex. For example, at least 2 of the legislators in Arizona object to smoking on religious grounds but have taken tobacco company contributions.  

Political support for any candidate is a complex issue. However, during this election year voters might wish to examine the behavior of their elected representatives and factor in support of pro-tobacco legislation when casting their ballot.

References

  1. Powell LW. The influence of campaign contributions on legislative policy. The Forum: A Journal of Applied Research in Contemporary Politics 2013;11(3):339-55. [CrossRef]
  2. American Thoracic Society. ATS opposes cigar bill in Congress. ATS Perspectives. Available at: https://www.thoracic.org/about/ats-perspectives/ats-opposes-cigar-bill-in-congress.php (accessed 8/9/16).
  3. Statistica. Statistics and facts about the tobacco industry. Available at: http://www.statista.com/topics/1593/tobacco/ (accessed 8/9/16).
  4. Campaign for tobacco-free kids. Key state-specific tobacco-related data & rankings. Available at: https://www.tobaccofreekids.org/research/factsheets/pdf/0176.pdf (accessed 8/9/16).
  5. Campaign for Tobacco-Free Kids. Tobacco company political action committee (pac) contributions to Federal candidates. Available at: https://www.tobaccofreekids.org/what_we_do/federal_issues/campaign_contributions/ (accessed 8/9/16).
  6. Congress.gov. H.R.662 - Traditional cigar manufacturing and small business jobs preservation act of 2015. Available at: https://www.congress.gov/bill/114th-congress/house-bill/662/cosponsors (accessed 8/9/16).
  7. Congress.gov. S.441 - Traditional cigar manufacturing and small business jobs preservation act of 2015. Available at: https://www.congress.gov/bill/114th-congress/senate-bill/441/cosponsors?q=%7B%22search%22%3A%5B%22S441%22%5D%7D&resultIndex=1 (accessed 8/9/16).
  8. Centers for Disease Control. Trends in current cigarette smoking among high school students and adults, United States, 1965–2014. Available at: http://www.cdc.gov/tobacco/data_statistics/tables/trends/cig_smoking/ (accessed 8/9/16).
  9. King BA, Tynan MA, Dube SR, Arrazola R. Flavored-little-cigar and flavored-cigarette use among U.S. middle and high school students. J Adolesc Health. 2014 Jan;54(1):40-6. [CrossRef] [PubMed]

Cite as: Robbins RA. Tobacco company campaign contributions and congressional support of the cigar bill. Southwest J Pulm Crit Care. 2016;13(4):187-90. doi: http://dx.doi.org/10.13175/swjpcc076-16 PDF

Saturday
Oct012016

October 2016 Pulmonary Case of the Month

Coya T Lindberg, BS1

Ryan R Nahapetian, MD2

F Zahra Aly, MD, PhD, FRCPath3

 

1University of Arizona College of Medicine Tucson, Tucson, AZ

2Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Arizona, Tucson, AZ

3Brody School of Medicine at East Carolina University, NC

 

Pulmonary Case of the Month CME Information

Members of the Arizona, New Mexico, Colorado and California Thoracic Societies and the Mayo Clinic are able to receive 0.25 AMA PRA Category 1 Credits™ for each case they complete. Completion of an evaluation form is required to receive credit and a link is provided on the last panel of the activity. 

0.25 AMA PRA Category 1 Credit(s)™

Estimated time to complete this activity: 0.25 hours

Lead Author(s): Coya Lindberg, BS.  All Faculty, CME Planning Committee Members, and the CME Office Reviewers have disclosed that they do not have any relevant financial relationships with commercial interests that would constitute a conflict of interest concerning this CME activity.

Learning Objectives:
As a result of this activity I will be better able to:

  1. Correctly interpret and identify clinical practices supported by the highest quality available evidence.
  2. Will be better able to establsh the optimal evaluation leading to a correct diagnosis for patients with pulmonary, critical care and sleep disorders.
  3. Will improve the translation of the most current clinical information into the delivery of high quality care for patients.
  4. Will integrate new treatment options in discussing available treatment alternatives for patients with pulmonary, critical care and sleep related disorders.

Learning Format: Case-based, interactive online course, including mandatory assessment questions (number of questions varies by case). Please also read the Technical Requirements.

CME Sponsor: University of Arizona College of Medicine at Banner University Medical Center Tucson

Current Approval Period: January 1, 2015-December 31, 2016

Financial Support Received: None

 

A 49-year-old man presented with chest discomfort to an outside medical facility in Arizona. He was previously healthy and had no chronic medical diseases. Physical examination was unremarkable and he was afebrile. A chest X-ray was performed (Figure  1).

Figure 1. Initial chest x-ray

Which of the following is most likely? (Click on the correct answer to proceed to the second of five panels)

  1. There is a large right chest mass
  2. There is a loculated pleural effusion in the minor fissure
  3. There is a right ventricular aneurysm
  4. There is right lower lobe consolidation
  5. There is right middle lobe consolidation

Cite as: Lindberg CT, Nahapetian RR, Aly FZ. October 2016 pulmonary case of the month. Southwest J Pulm Crit Care. 2016;13(4):152-8. doi: http://dx.doi.org/10.13175/swjpcc096-16 PDF

Thursday
Sep012016

September 2016 Pulmonary Case of the Month

Lewis J. Wesselius, MD

Department of Pulmonary Medicine

Mayo Clinic Arizona

Scottsdale, AZ

Pulmonary Case of the Month CME Information

Members of the Arizona, New Mexico, Colorado and California Thoracic Societies and the Mayo Clinic are able to receive 0.25 AMA PRA Category 1 Credits™ for each case they complete. Completion of an evaluation form is required to receive credit and a link is provided on the last panel of the activity. 

0.25 AMA PRA Category 1 Credit(s)™

Estimated time to complete this activity: 0.25 hours

Lead Author(s): Lewis J. Wesselius, MD.  All Faculty, CME Planning Committee Members, and the CME Office Reviewers have disclosed that they do not have any relevant financial relationships with commercial interests that would constitute a conflict of interest concerning this CME activity.

Learning Objectives:
As a result of this activity I will be better able to:

  1. Correctly interpret and identify clinical practices supported by the highest quality available evidence.
  2. Will be better able to establsh the optimal evaluation leading to a correct diagnosis for patients with pulmonary, critical care and sleep disorders.
  3. Will improve the translation of the most current clinical information into the delivery of high quality care for patients.
  4. Will integrate new treatment options in discussing available treatment alternatives for patients with pulmonary, critical care and sleep related disorders.

Learning Format: Case-based, interactive online course, including mandatory assessment questions (number of questions varies by case). Please also read the Technical Requirements.

CME Sponsor: University of Arizona College of Medicine at Banner University Medical Center Tucson

Current Approval Period: January 1, 2015-December 31, 2016

Financial Support Received: None

 

History of Present Illness

The patient is a 52 year-old woman with prior renal transplant in 1998 due to complications of pre-eclampsia. She had a recent decline in renal function leading to re-transplant on June 23 of this year. She was admitted to the hospital on July 8th with ventricular tachycardia. Treatment with amiodarone was begun with no further ventriuclar tachycardia. She is also taking usual anti-rejection medications.

Past Medical History, Social History and Family History

Other than the renal transplantation she has no other significant past medical history and has never smoked. Family history is noncontributory.

Physical Examination

Physical examination was unremarkable other than the surgical wounds associated with her renal transplants.

Radiography

Her chest x-ray is shown in Figure 1.

Figure 1. Admission chest radiograph.

What should be done at this time? (Click on the correct answer to proceed to the second of four panels)

  1. Discontinue the amiodarone
  2. Empiric antibiotics
  3. Plasma brain naturetic peptide (BNP)
  4. 1 and 3
  5. All of the above

Cite as: Wesselius LJ. September 2016 pulmonary case of the month. Southwest J Pulm Crit Care. 2016;13(3):101-7. doi: http://dx.doi.org/10.13175/swjpcc086-16 PDF

 

Monday
Aug012016

August 2016 Pulmonary Case of the Month

Anjuli M. Brighton, MB, BCh, BAO

Kathryn E. Williams, MB, BCh, BAO

Lewis J. Wesselius, MD

 

Pulmonary Department

Mayo Clinic Arizona

Scottsdale, AZ USA

 

Pulmonary Case of the Month CME Information

Members of the Arizona, New Mexico, Colorado and California Thoracic Societies and the Mayo Clinic are able to receive 0.25 AMA PRA Category 1 Credits™ for each case they complete. Completion of an evaluation form is required to receive credit and a link is provided on the last panel of the activity. 

0.25 AMA PRA Category 1 Credit(s)™

Estimated time to complete this activity: 0.25 hours

Lead Author(s): Anjuli M. Brighton, MB.  All Faculty, CME Planning Committee Members, and the CME Office Reviewers have disclosed that they do not have any relevant financial relationships with commercial interests that would constitute a conflict of interest concerning this CME activity.

Learning Objectives:
As a result of this activity I will be better able to:

  1. Correctly interpret and identify clinical practices supported by the highest quality available evidence.
  2. Will be better able to establsh the optimal evaluation leading to a correct diagnosis for patients with pulmonary, critical care and sleep disorders.
  3. Will improve the translation of the most current clinical information into the delivery of high quality care for patients.
  4. Will integrate new treatment options in discussing available treatment alternatives for patients with pulmonary, critical care and sleep related disorders.

Learning Format: Case-based, interactive online course, including mandatory assessment questions (number of questions varies by case). Please also read the Technical Requirements.

CME Sponsor: University of Arizona College of Medicine at Banner University Medical Center Tucson

Current Approval Period: January 1, 2015-December 31, 2016

Financial Support Received: None

 

History of Present Illness

The patient is 54-year-old man with type 1 diabetes mellitus admitted for diabetic ketoacidosis (DKA). He complained of somnolence, nausea and vomiting and right foot pain. He had been admitted 2 weeks earlier for right foot gangrene. He had been receiving daptomycin for his right foot gangrene.

PMH, SH and FH

He had a previous history of osteomyelitis, perianal abscess, maxillary abscess, Candida esophagitis, transient ischemic attack, and peripheral vascular disease. He had previous amputations along with thrombectomy/ embolectomy/bypass. He was a former Marine and construction worker with ongoing cigarette use. Family history was noncontributory.

Physical Examination

  • Febrile to 38.2ºC
  • Crackles bilaterally
  • Transmetatarsal stump with dry gangrene

Radiography

An admission chest x-ray was performed (Figure 1).

Figure 1. Admission portable AP of chest.

Which of the following are appropriate at this time? (Click on the correct answer to proceed to the second of four panels)

  1. Blood and wound cultures
  2. Empiric antibiotics including coverage for Staphylococcus aureus
  3. Intravenous insulin and fluids
  4. Serially monitor renal function and electrolytes
  5. All of the above

Cite as: Brighton AM, Williams KE, Wesselius LJ. August 2016 pulmonary case of the month. Southwest J Pulm Crit Care. 2016;13(2):40-5. doi: http://dx.doi.org/10.13175/swjpcc070-16  PDF 

Friday
Jul012016

July 2016 Pulmonary Case of the Month

Kashif Yaqub, MD

Robert Viggiano, MD

Imran S. Malik, MD

Zayn A. Mian

 

Department of Pulmonary Medicine

Mayo Clinic Arizona

Scottsdale, AZ USA

 

Pulmonary Case of the Month CME Information

Members of the Arizona, New Mexico, Colorado and California Thoracic Societies and the Mayo Clinic are able to receive 0.25 AMA PRA Category 1 Credits™ for each case they complete. Completion of an evaluation form is required to receive credit and a link is provided on the last panel of the activity. 

0.25 AMA PRA Category 1 Credit(s)™

Estimated time to complete this activity: 0.25 hours

Lead Author(s): Kashif Yaqub, MD.  All Faculty, CME Planning Committee Members, and the CME Office Reviewers have disclosed that they do not have any relevant financial relationships with commercial interests that would constitute a conflict of interest concerning this CME activity.

Learning Objectives:
As a result of this activity I will be better able to:

  1. Correctly interpret and identify clinical practices supported by the highest quality available evidence.
  2. Will be better able to establsh the optimal evaluation leading to a correct diagnosis for patients with pulmonary, critical care and sleep disorders.
  3. Will improve the translation of the most current clinical information into the delivery of high quality care for patients.
  4. Will integrate new treatment options in discussing available treatment alternatives for patients with pulmonary, critical care and sleep related disorders.

Learning Format: Case-based, interactive online course, including mandatory assessment questions (number of questions varies by case). Please also read the Technical Requirements.

CME Sponsor: University of Arizona College of Medicine at Banner University Medical Center Tucson

Current Approval Period: January 1, 2015-December 31, 2016

Financial Support Received: None

 

History of Present Illness

A 53 year-old woman presented to the emergency department with dyspnea over 3 weeks. There was no cough, wheezing or other complaints.

Past Medical History, Social History and Family History

She has no significant past medical history. She was a nonsmoker. Family history was unremarkable.

Physical Examination

Decreased breath sounds over the left lower chest but otherwise unremarkable.

Laboratory Evaluation

  • Elevated white blood cell count with a left shift
  • Na+ 130 mEq/L
  • 10-20 RBCs on urinalysis

Radiographic Evaluation

A CT angiogram of the chest was performed for possible pulmonary embolus (Figure 1).

Figure 1. Representative images from the thoracic CT in lung windows (A) and soft tissue windows (B).

Which of the following is appropriate at this time? (Click on the correct answer to proceed to the second of six panels)

  1. Biopsy of left pleural mass
  2. Bone marrow aspiration
  3. Diuretics for congestive heart failure
  4. Empiric antibiotics for empyema
  5. Thoracentesis

Cite as: Yaqub K, Viggiano R, Malik IS, Mian AZ. July 2016 pulmonary case of the month. Southwest J Pulm Crit Care. 2016;13(1):1-8. doi: http://dx.doi.org/10.13175/swjpcc051-16 PDF