Abstract: 

No abstract available. Manuscript truncated after 150 words. A 73-year-old woman with a history of eosinophilic granulomatosis with polyangiitis (EGPA), and heart failure with preserved ejection fraction presented to the hospital with acute pancreatitis and developed acute (on-chronic) hypoxic respiratory failure during treatment. Her previous EGPA complications included interstitial lung disease (ILD) as well as GI, skin, and cardiac involvement. She was being treated with rituximab and mepolizumab at the time of admission. However, this treatment had not improved her skin rashes, late-onset asthma, or arthralgias.

At admission, the patient was on a baseline of 3L oxygen, which worsened to 7-12L upon beginning IV fluids. The patients' labs were pertinent for B-type natriuretic peptide (BNP) 9378 pg/ml (normal <100pg/ml, increased from _~2000 2-months prior), lipase 702 U/L (normal , 0-160) and an absolute eosinophil count of 390cells/µL  (normal 0-500). The transthoracic echocardiogram results were unchanged from four months prior, and diuresis failed to improve oxygen needs, raising the …

URL: https://www.swjpcc.com/imaging/2025/8/2/august-2025-medical-image-of-the-month-crazy-paving-in-a-cas.html

Abstract: 

No abstract available. Article truncated after 150 words. A 32-year-old healthy meat packing plant worker was hospitalized for shortness of breath. He normally worked on the kill floor of a local pork processing plant. On the day he was seen he had been reassigned, just for the day, to the room where brine was mixed and hams were placed into it for curing. The hams were smoked after the curing and were not smoked in that room. He developed shortness of breath and he was taken to the Nebraska Medicine emergency room.

He was a native of Myanmar and spoke English poorly Physical examination revealed a man who appeared to be about the stated age severely short of breath with a respirator rate of 36-40 breaths/min. He was febrile at 38.6° C and tachycardic at 116 beats/min. His physical examination was otherwise normal except for a question of rales at the bases.

Which of the following should be …

URL: https://www.swjpcc.com/pulmonary/2025/8/1/august-2025-pulmonary-case-of-the-month-respiratory-failure.html 

Abstract: No abstract available. Article truncated after first 150 words. A 73-year-old woman with a past medical history including coronary artery disease (CAD), prior myocardial infarction (MI), cardiomyopathy, hypertension, obstructive sleep apnea (OSA) on CPAP, gastroesophageal reflux disease (GERD),and a history of pulmonary embolism on apixaban presented to the emergency department with six hours of chest pain. She described the pain as pressure-like, radiating from beneath the left breast to the left axilla and back. She also reported associated nausea without vomiting and poor oral intake but maintained normal bowel movements. She denied fever, chills, dyspnea, vomiting, diarrhea, constipation, or abdominal pain. The patient recalled a similar episode during her MI ten years prior, prompting her to seek medical care.

Vital signs were stable. Cardiac workup included serial troponins, both of which were negative (at 8 and 7 respectively), and an electrocardiogram (EKG) showing normal sinus rhythm without ST-T wave abnormalities. Chest x-ray (Figure 1) demonstrated a retrocardiac opacity suggestive …

URL: https://www.swjpcc.com/imaging/2025/7/2/july-2025-medical-image-of-the-month-a-case-of-severe-hiatal.html 

Abstract: No abstract available. Article truncated after 150 words. Clinical History: A 36-year-old woman with a history of unspecified anemia, treated with occasional iron infusion, and Hashimoto thyroiditis presented to the Emergency Room with complaints of chest pain, sharp and non-radiating worsening in the supine position and improving with sitting upright and leaning forward, blurred vision, bilateral upper extremity weakness and numbness, and intermittent subjective low-grade fever. These symptoms had been present for about 1 month prior to presentation in the Emergency Room.

The patient’s past medical history was otherwise unremarkable. She is a 20-pack-year smoker with no allergies. Her past surgical history was remarkable only for bilateral breast augmentation, tonsillectomy, and 2 C-sections. Her only medications included a multivitamin and vitamin D3 supplementation.

The patient’s vital signs included a blood pressure of 115/71 mmHg, a pulse rate of 95 / minute, a respiratory rate of 18 / minute and a temperature of 38.4°C. Pulse oximetry on room air …

URL: https://www.swjpcc.com/imaging/2025/7/1/july-2025-imaging-case-of-the-month-a-growing-lung-nodule-in.html 

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 

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 …

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

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

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

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

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 …

Abstract: No abstract available. Article truncated after 150 words. A 62-year-old woman with a history of hypertension, hypothyroidism, alcohol use, unexplained weight loss, and anorexia (for which she had been prescribed megestrol 3 months earlier) presented with alarming swelling in her left lower extremity. The swelling started in the left leg but progressively involved the entire left lower extremity over the course of a week. Patient also reported worsening chest pain and shortness of breathing starting 3 days prior to presentation. No cough or hemoptysis, no fevers or chills. She had a 45 pack-year smoking history. Her physical exam showed sinus tachycardia with heart rate 108 beats per minute, blood pressure 110/70 mm Hg, SpO2 was reading at 88% on room air. There was no jugular venous distention. Her heart sounds were normal, and her chest was clear upon auscultation. Patient was placed on supplemental oxygen. A chest X-ray (CXR) revealed mass-like cavitary lesions in both lungs. Routine laboratory …

URL: https://www.swjpcc.com/imaging/2025/3/2/march-2025-medical-image-of-the-month-an-unusual-case-of-pul.html

Abstract:

No abstract available. Manuscript truncated after 150 words. 

History of Present Illness

A 58-year-old man complained of gradually increasing shortness of breath. He denied any cough. An outside chest x-ray is reported as showing mild bilateral interstitial changes.

Past Medical History, Social History, and Family History

• He has a history of rheumatoid arthritis and has complaints of mild joint stiffness and soreness. He has taken mycophenolate for several years which has made no difference in his symptoms.
• He has never smoked and denies any occupational exposure.
• There is no family history of lung disease.

Physical Examination

• Vital Signs: SpO2 95% on room air but declined to 88% with ambulation.
• Chest: A few scattered inspiratory crackles noted.
• Cardiovascular: Regular rhythm without murmur.
• Extremities: No clubbing or edema. No evidence of synovitis or joint inflammation
• Skin: Slightly raised, pink, scaly lesions on elbows and knees.

Which of the following are indicated?

1. Dermatology consult
2. Pulmonary function testing
3. Connective ...

URL: https://www.swjpcc.com/pulmonary/2025/3/1/march-2025-pulmonary-case-of-the-month-interstitial-lung-dis.html

Abstract: 

No abstract available. Article truncated after 150 words. Clinical History: A 72-year-old man presents to his physician with chest pain. The patient awoke 2 weeks earlier with right-sided chest pain, thought to be the result of a pulled muscle. However, the pain did not remit over the next 2 weeks. The patient also complained of a mild cough productive of white sputum and some mild intermittent shortness of breath improving with albuterol. The patient denied fever.

The patient’s past medical history was remarkable for seasonal allergies, especially dust exposure, treated with fluticasone, and occasional wheezing, treated as needed with an albuterol inhaler. The patient was also diabetic and had hypertension and a history of hypothyroidism. The patient’s past surgical history included right knee total arthroplasty and lithotripsy for renal stones. The patient denied allergies, smoking, and illicit drug use. His medications included fluticasone, albuterol, amlodipine, atorvastatin, ramipril, sitagliptin-metformin, levothyroxine, and probiotics.   

The patient’s vital signs included a blood …

URL: https://www.swjpcc.com/imaging/2025/2/1/february-2025-imaging-case-of-the-month-a-wolf-in-sheeps-clo.html

Abstract: 

No abstract available. Article truncated after 150 words. Given all the commotion that has been occurring in Washington over the Gaetz and Hegseth nominations, preparations for mass deportation, birthright citizenship, and government DEI programs, several healthcare news stories have flown under the radar. Below is a summary.

Science is reporting that yesterday the Trump administration imposed several restrictions on the National Institutes of Health (NIH) which will have an impact on grants and scientific exchange (1). These included the abrupt cancellation of meetings including grant review panels, communications “pause”, a freeze on hiring, and an indefinite ban on travel. The moves have generated extensive confusion and uncertainty at the nation’s largest research agency, which has become a target for Trump’s political allies. For example, officials halted midstream a training workshop for junior scientists, called off a workshop on adolescent learning minutes before it was to begin, and canceled meetings of two advisory councils. Panels that were scheduled to …

URL: https://www.swjpcc.com/news/2025/1/23/trump-administration-assaults-nih-and-who-rfk-jrs-nomination.html

Abstract: 

No abstract available. Editorial truncated after 150 words. President-elect Donald Trump has nominated several controversial figures for cabinet positions. On November 14, Trump announced Robert F. Kennedy Jr. as his choice for Health and Human Services (HHS) secretary (1). Although several of Trump’s nominees are marginal, I could not have imagined a worse choice than Kennedy. As many cringe at the thought of a number of Trump’s nominees, I join many of my fellow healthcare providers and scientists in their abhorrence at Kennedy’s nomination.

Kennedy has long promoted anti-vaccine misinformation and public-health conspiracy theories (2,3). Since the onset of the COVID-19 pandemic, he has emerged as a leading proponent of COVID-19 vaccine misinformation (4). Many of his false public health claims have targeted prominent figures such as Anthony Fauci, Bill Gates, and Joe Biden. He has written books, including The Real Anthony Fauci (5) and A Letter to Liberals (6), perpetuating his lies. Kennedy has insinuated that HIV …

URL: https://www.swjpcc.com/editorials/2025/1/7/robert-f-kennedy-jr-nominated-as-hhs-secretary-choices-for-s.html 

Abstract: 

No abstract available. Manuscript truncated after 150 words. A 58-year-old man presented to our pulmonary service for a second opinion concerning his interstitial lung disease (ILD), which had been diagnosed as rheumatoid arthritis associated ILD. The patient had a positive rheumatoid factor (barely) at an outside institution, but no other test results or historical or physical exam findings to suggest rheumatoid arthritis. He was being treated with mycophenolate, but did not feel that he was improving. To the contrary, there had been a recent decline in his overall lung function. The only other relevant medical history is psoriasis. The patient is a lifelong nonsmoker. Resting pulse oximetry was 95% on room air with a brief desaturation to 88% during ambulation, which quickly recovered with rest. The patient’s vital signs were otherwise normal. Physical exam findings were normal aside from mild cutaneous findings of plaque psoriasis. Results from pulmonary function testing at an outside institution were available, revealing a …

URL: https://www.swjpcc.com/imaging/2025/1/2/january-2025-medical-image-of-the-month-psoriasis-with-pulmo.html 

Abstract: 

No abstract available. Manuscript truncated after 150 words. History of Present Illness

A 35-year-old was injured at work earlier that day. He fell approximately 10 feet while power washing a hog confinement pen from inside the bucket of a skid loader. He complained of pain in his left foot. He had struck his head but denied loss of consciousness. He was admitted to an outside hospital ICU for observation.

PMH, SH, and FH

He has no chronic medical conditions and has never been hospitalized.

He has never smoked and only drinks socially. He is single.

His mother died at 55 of heart disease. His father and 6 brothers and sisters are all healthy.

Physical Examination

He is 5’5” and weighs 193 pounds. There is a head laceration and he has tenderness in his left foot. Otherwise, his physical examination is normal.

Radiology

A foot x-ray reveals fractures of the left second and third metatarsals. Head CT was interpreted …

URL: https://www.swjpcc.com/critical-care/2025/1/1/january-2025-critical-care-case-of-the-month-a-35-year-old-a.html 

Abstract: 

No abstract available. Manuscript truncated after 150 words. The edifice of academic journals is predicated on the process of peer review. Inevitably it is subject to the vagaries of the individual perspectives and biases of the reviewers. However, there has not been a useful, equitable or viable alternative that would secure a level of quality control in the research domain (1). Given the inevitable human components of range of knowledge, potential biases  and sometimes lazy thinking, it is certainly not a perfect system. Certainly, a worthy paper occasionally is rejected, or a badly flawed paper is accepted. However, in the absence of a better process, it is the gold standard.

Historically, peer review has been an altruistic endeavor. Researchers understood that their reviews contributed to the scientific process by improving the quality of reported information and providing an imprimatur to the reported findings (2); reviewing was an obligation to the scientific community (3). However, there are other benefits …

URL: https://www.swjpcc.com/editorials/2024/12/16/if-you-want-to-publish-be-part-of-the-process.html

Abstract: 

Background: The goal of the study was to develop a pilot program to assess point-of-care ultrasound (POCUS) knowledge and proficiency via a bootcamp-style education. The primary endpoints were to objectively identify trainees’ ability and interest to learn POCUS.

Methods: A POCUS education program was designed for 41 post-graduate-year-1 trainees’ orientation in an internal medicine residency program. Trainees were provided brief lectures on lower extremity veins, lung, and abdominal pathologies before proceeding to stations to practice ultrasound skills. An anonymous test was completed by each participant before and after they were provided lectures and practice time. The percent correct for each question before and after the intervention was compared using a paired t-test. The study was determined to be exempt by the University of Arizona IRB review.

Results: Primary outcomes found that 100% of the trainees improved on their knowledge of ultrasound based on a post-didactic assessment, and all questions except for one was statistically significant. The average pretest correct was 46% and posttest correct 84% (p<.001). Feedback on the sessions was assessed using Word Cloud. A higher number of trainees reported interest in applying POCUS to clinical practice after the session. The bootcamp was helpful when using videos, case examples, and small groups. Areas of improvement included providing more practice time, feedback on images obtained, and teaching cardiac ultrasound.

Conclusion: Internal medicine trainees were able to effectively learn the basics of POCUS, and they were more likely to use ultrasound after gaining knowledge.

URL: https://www.swjpcc.com/general-medicine/2024/12/14/point-of-care-ultrasound-bootcamp-training-a-pilot-program-f.html