Chest
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The harm associated with imaging abnormalities related to lung cancer screening (LCS) is not well documented, especially outside the clinical trial and academic setting. ⋯ The use of invasive procedures to resolve false-positive findings was uncommon in the clinical practice of a nonuniversity LCS program that adhered to a nodule management algorithm and used a multidisciplinary approach. Incidental findings considered benign but clinically important resulted in invasive procedure rates that were similar to those for false-positive findings and frequently had clinical value.
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An 18-year-old man with no noted medical history from Northern India presented with history of fever for 15 days and nocturnal cough for 10 days. He denied breathlessness or wheeze. ⋯ There was no recent exposure to a patient with TB or history of substance misuse. The patient had sought medical care 7 days before presentation for the same symptoms, and after a chest radiograph was obtained, the patient was started on an antitubercular regimen.
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Case Reports
An 80-Year-Old Man With Respiratory Insufficiency After Intravesical Mycobacterium bovis BCG Immunotherapy.
An 80-year-old man came to the ED with fever, hematuria, and overall discomfort for 1 week. His medical history included a superficial urothelial carcinoma of the bladder for which he was adjunctively treated with intravesical Mycobacterium bovis BCG (bacillus Calmette-Guérin) immunotherapy for several months. The patient was admitted to the hospital and was initially treated with cephalosporins for a suspected complicated urinary tract infection, but his symptoms did not improve. Ten days after the initial admission, the patient developed hypoxemic respiratory failure during an episode of fever and cold chills and was admitted to the ICU.
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A 53-year-old woman with no significant past medical history came to her local ED after a witnessed generalized tonic-clonic seizure. CT scan imaging of the head revealed a left frontal lobe hypodensity concerning for a mass with surrounding edema. In the previous month, she had undergone ambulatory evaluation for a subacute cough that had more recently become productive of bloody sputum. ⋯ She had no pets. There was no history of recent dental procedures. She was transferred to our institution for neurosurgical evaluation.
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Editorial Comment
Improving Outcomes for ARDS in Sub-Saharan Africa: The Time Is Now.