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

April 2025 Medical Image of the Month: An Unfortunate Case of Mimicry

By: Ali A, Abdulla M

Abstract: No abstract available. Manuscript truncated after 150 words. A 63-year-old African American woman with a 30-pack-year smoking history (quit 12 years prior) presented to the emergency room with a persistent cough, throat pain, significant weight loss (15 pounds over 6 months), exertional dyspnea, hoarseness, and fatigue. She denied dysphagia or GERD symptoms and had no other significant medical history. Over four months, she received three courses of antibiotics for presumed lobar pneumonia based on chest X-ray findings.  There was no significant clinical improvement, prompting her current visit to the ED.  The patient appeared ill and in discomfort. Her vital signs included a blood pressure of 108/73 mmHg (right arm, lying), pulse of 96 bpm, temperature of 99.3 °F (37.4 °C, oral), respiratory rate of 18 breaths/min, and SpO₂ of 91% on room air. Her BMI was 27 kg/m². Physical examination revealed a prominent right supraclavicular lymph node and diminished air entry at the right lung base with a …

URL: https://www.swjpcc.com/imaging/2025/4/2/april-2025-medical-image-of-the-month-an-unfortunate-case-of.html

April 2025 Critical Care Case of the Month: Being Decisive During a Difficult Treatment Dilemma

By: VonEssen SG

Abstract:

No abstract available. Article truncated after 150 words.

History of Present Illness

A 71-year-old woman was seen in the emergency department with acute onset of shortness of breath. The patient was well until 3 days prior to admission when she developed pain and swelling in her right calf and ankle. She self-treated with ibuprofen and elevation. She was improving until the afternoon of admission she developed fatigue, dyspnea on exertion, and shortness of breath and came to the emergency department.

Past Medical History

• Partial adrenal insufficiency after resection of pituitary tumor in 1992
• Growth hormone deficiency, treated with augmentation therapy
• Hypothyroidism due to pituitary tumor and Hashimoto’s thyroiditis
• Gastroesophageal reflux disease
• Prediabetic
• Hypertension
• Iron deficiency, treated with daily iron
• Colon polyps (adenomas)
• Gluteal tendinopathy, right hip
• COVID-19 a month prior to admission with minimal symptoms

Surgical History

• Appendectomy at age 16
• Resection of pituitary macroadenoma at age 38
• Operations for herniated lumbar disks at age 47, 49 and …

URL: https://www.swjpcc.com/critical-care/2025/4/1/april-2025-critical-care-case-of-the-month-being-decisive-du.html