June 2025 Medical Image of the Month: Neurofibromatosis-Associated Diffuse Cystic Lung Disease

By: Ali A

Abstract: 

No abstract available. Article truncated after 150 words. A 61-year-old man with a history of neurofibromatosis type 1 (NF1) and NF1-associated cystic lung disease presented for a routine follow-up visit 5 years post-bilateral lung transplantation.  The patient’s physical examination revealed multiple cutaneous neurofibromas, consistent with his diagnosis of NF1 (Figure 1).  Additionally, he had a prior tracheostomy scar; he temporarily required tracheostomy post lung transplant surgery.

Pre-Transplant History:

The patient had progressive chronic hypoxic respiratory failure, requiring home oxygen supplementation at up to 8 L/min. His medical history included a 15-pack-year smoking history, though he quit smoking 16 years prior to his lung transplant.  His diagnostic workup prior to transplant consisted of a high-resolution computed tomography (HRCT) of the chest, which  revealed diffuse cystic lung disease with intervening ground-glass opacities (Figure 2), an echocardiogram, which demonstrated severe pulmonary hypertension, and pulmonary function tests (PFTs), which  showed a combined restrictive and obstructive pattern with severely reduced DLCO at 25%. …

URL: https://www.swjpcc.com/imaging/2025/6/2/june-2025-medical-image-of-the-month-neurofibromatosis-assoc.html 

June 2025 Pulmonary/Critical Care Case of the Month: Hemoptysis from a Very Unusual Cause

By: Raschke RA, Kayani A, Gotway MB

Abstract: 

No abstract available. Article truncated after 150 words. A 23-year-old man presented to our hospital emergency room (ER) with one week of non-productive cough and mild pleuritic chest pain followed by 24 hours of hemoptysis, producing about a teaspoon of bright red blood every 15 mins. His blood pressure was 146/83, HR 103, RR 16, temperature 98.6 F. and room air oxygen saturation was 96%. He was in no respiratory distress and his physical examination was unremarkable. 

Initial laboratory studies including a white blood cell count, serum electrolytes, glucose, and renal function, liver indices, a coagulation profile, a procalcitonin level, and a urinalysis were all within normal limits. A PCR for SARS-CoV-2, influenza and RSV was negative.

Which of the following are true regarding massive hemoptysis?

1. It can be defined by as little as 150ml (about a half cup) of hemoptysis per day
2. Urgent bronchoscopy is indicated to remove obstructive blood clots, and to localize and …

URL: https://www.swjpcc.com/pulmonary/2025/6/1/june-2025-pulmonarycritical-care-case-of-the-month-hemoptysi.html

May 2025 Medical Image of the Month: Aspirated Dental Screw

By: Osueni A, Vasudevan A, Gajendiran AP, Arul G, Gunasekaran K

Abstract: 

No abstract available. Article truncated after 150 words. An 80-year-old man with no significant past medical history presented to the emergency department with cough following a routine dental procedure. He reported intermittent coughing but denied chest pain, shortness of breath, palpitations, or dizziness. On physical examination, he appeared comfortable, with stable vital signs and no signs of respiratory distress. Cardiovascular, respiratory, and neurological examinations were unremarkable. A chest radiograph (Figure 1A) revealed a metallic foreign body in the right main bronchus. Laboratory investigations were within normal limits. Given the radiologic findings and stable clinical status, the patient was intubated and underwent flexible bronchoscopy. The procedure revealed a grayish metallic foreign body lodged in the right middle lobe bronchus (Figure 1C), which was successfully removed using a snare technique. No bleeding, trauma, or complications were observed. The extracted object measured 2.5 cm (Figure 1D) and appeared as a silver metallic dental screw with a sharp, broad base. Bronchial secretions …

URL: https://www.swjpcc.com/imaging/2025/5/2/may-2025-medical-image-of-the-month-aspirated-dental-screw.html

May 2025 Critical Care Case of the Month: Where’s the Rub?

By: Rashke RA, Weisman E

Abstract:

No abstract available. Article truncated after 150 words. Chief Complaint: A 70-year-old woman with a 13-year history of Crohn’s disease presented with two days of severe generalized myalgias, progressive pleuritic chest pain and malaise, followed by the acute onset of  confusion and oxygen desaturation. History of Present Illness: She had been admitted one week earlier with bloody diarrhea and cramping lower abdominal pain, presumptively diagnosed with a Crohn’s flair and treated with solumedrol 40mg Q12 hourly. An esophagogastroduodenoscopy (EGD) and colonoscopy were performed on the second hospital day, showing angiodysplastic gastric lesions with stigmata of recent bleeding, and severe inflammation with serpentine ulceration of the rectum through the cecum. The angiodysplastic lesions were treated with argon plasma coagulation and colonic biopsies were performed. The patient received 2 units of packed red blood cells. She was discharged the next day on prednisone 40mg and pantoprazole 40mg daily.

She was only home a few hours when she experienced onset of …

URL: https://www.swjpcc.com/critical-care/2025/5/1/may-2025-critical-care-case-of-the-month-wheres-the-rub.html

US Attorney Demands CHEST Assurance of “Viewpoint Diversity”

By: Campion J, Gali B, Kuhn BT, Mathew M, Peterson M, Quan SF, Robbins RA, Su G, Wang A, Welsh C

Abstract: 

No abstract available. Article truncated after 150 words. NBC News is reporting on a Facebook posting of a letter from the acting U.S. attorney for the District of Columbia to the editor of a CHEST. The letter implies that the medical journal was partisan and asks a series of questions about how the publication protects the public from misinformation; whether it included competing viewpoints; and whether CHEST was influenced by funders or advertisers (1). The letter from acting U.S. Attorney Ed Martin states, “It has been brought to my attention that more and more journals and publications like CHEST Journal are conceding that they are partisans in various scientific debates”.  Martin goes on to state that “you [CHEST] have certain responsibilities”

The letter was originally posted on X by Dr. Eric Reinhart, a clinician based at Northwestern. Reinhart described the letter as designed to “intimidate” and called it “fascist tactics.” The letter caught the attention of First Amendment …

URL: https://www.swjpcc.com/editorials/2025/4/26/us-attorney-demands-chest-assurance-of-viewpoint-diversity.html