Articles: function.
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COPD Case Report PostersSESSION TYPE: Case Report PosterPRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PMINTRODUCTION: A giant bulla is defined as an air space in the lung that occupies at least 30% of the hemithorax. Indications for surgical resection are controversial but most commonly include dypnea due to compression of adjacent lung tissue or spontaneous pneumothorax. Previous authors have suggested including mediastinal shift as an indication, but outcome data is lacking. We present a unique case of a 71-year-old patient with bullous emphysema which resulted in compression of the dextrocardial structures. ⋯ The following authors have nothing to disclose: B. Jakub Wilhelm, Aniket Sakharpe, Leopoldo Baccaro, Stanley Ogu, Richard AngelicoNo Product/Research Disclosure Information.
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Interstitial Lung Disease CasesSESSION TYPE: Case ReportsPRESENTED ON: Saturday, March 22, 2014 at 09:00 AM - 10:00 AMINTRODUCTION: The course of adult Pulmonary Langerhans cell Histiocytosis (PLCH) is variable and unpredictable [1]. Conventional therapy is mainly based on smoking cessation. If the patient is severely symptomatic or the disease shows radiological or physiological deterioration after a short observation period, a course of steroids should be given. Chemotherapeutic drugs,like 2-chlorodeoxyadenosine, may be effective in childhood forms of disseminated LCH, but there is far too little experience with these agents in adult pulmonary LCH patient [1]. ⋯ The following authors have nothing to disclose: Juan Cruz Rueda, Julián Ceballos Gutiérrez, Ana Fulgencio, Jose Manuel Gonzalez de Vega, Ana Dolores Romero OrtizNo Product/Research Disclosure Information.
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Cardiovascular Case Report Posters IISESSION TYPE: Case Report PosterPRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PMINTRODUCTION: We present a case of progressive hypoxemia with platypnea-orthodeoxia developing after lung resection surgery for lung cancer. ⋯ Symptoms of hypoxemia with platypnea-orthodeoxia are concerning for shunt physiology. The differential diagnosis includes sources of intracardiac (ASD, PFO) and intrapulmonary shunting. He had a prior intracardiac shunt on an earlier echo but not on the post-operative study. He had no evidence of other cardiac causes such as pericardial effusion, constrictive pericarditis or aortic aneurysm. He had an interstitial lung disease by CT scan but this was unchanged radiographically. There was no evidence of other pulmonary causes such as COPD, thromboembolic disease or an intrapulmonary shunt (arteriovenous malformation). He had no history of liver disease with shunt from cirrhosis or history of kyphoscoliosis. Platypnea-orthodeoxia was first described in 1949 and major causes are intracardiac shunts and intrapulmonary shunts. The intracardiac shunts are right-to-left and most often include atrial septal defect, patent foramen ovale or fenestrated atrial aneurysm. Other causes include pericardial effusion, lobectomy, pneumonectomy or upper abdominal surgery. This occurs from preferential blood flow towards the atrial septum that is accentuated by altered intracardiac anatomy, compliances of the right and left heart, pulmonary vascular resistance and transient right to left pressure gradients associated with respiratory and positional changes. This is generally not associated with pulmonary hypertension and atrial right-to-left shunting has been reported despite normal right-sided pressures. A right-to-left shunt is more likely to appear after a right-sided lung resection with most patients having symptoms develop a month to several months afterwards. Noncardiac causes can include intrapulmonary shunting, such as thromboembolic disease and AVMs, or cirrhosis and kyphoscolisoss. The key to diagnosis is clinical suspicion of symptoms of dyspnea and hypoxemia, induced or worsened by an upright posture. In conclusion, interatrial shunting through a PFO or ASD is a rare but clinically significant condition after thoracic surgery. There are several underlying etiologies and can occur in the immediate postoperative period or can be more delayed.Reference #1: Interatrial Shunting After Major Thoracic Surgery: A Rare but Clinically Significant Event. Ann Thorac Surg 2012;93:1647-51Reference #2: Dyspnoea and hypoxaemia after lung surgery: the role of interatrial right-to-left shunt. Eur Respir J 2006; 28: 174-181Reference #3: Platypnoea-orthodeoxia syndrome. Heart 2000;83:221-223DISCLOSURE: The following authors have nothing to disclose: Nitin Bhatt, Ulysses MagalangNo Product/Research Disclosure Information.
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Asthma PostersSESSION TYPE: Poster PresentationsPRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PMPURPOSE: Despite optimal treatment, some asthmatic remain symptomatic with frequent exacerbations and persistent obstruction of the airways. Tiotropium addition is associated with reduced risk of exacerbations and sustained bronchodilatation(BD). Objectives: Characterization of asthmatic patients with optimized treatment and treated with tiotropium. Assess the role of tiotropium in symptomatic control and lung function. ⋯ The following authors have nothing to disclose: Ana Gonçalves, Ricardo Lima, Ivone Pascoal, João Moura, Miguel Guimarães, Raquel Duarte, Aurora CarvalhoNo Product/Research Disclosure Information.
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Infectious Disease Case Report Posters ISESSION TYPE: Case Report PosterPRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PMINTRODUCTION: MonoMAC is a rare syndrome characterized by a haplodeficiency of GATA2 gene products resulting in monocytopenia, B-cell and NK-cell lymphopenia, and an increased susceptibility to atypical infections1 Since its discovery in 2010, there have been only 28 other cases described in the literature. The lack of widespread familiarity with this disease impedes early identification and often leads to mistreatment with near-fatal consequences. Here we describe a case of MonoMAC which eluded diagnosis for over one year. ⋯ As our patient exemplifies, a heightened awareness of this new entity is important to avoid misdiagnosis and inappropriate treatment with chronic steroids given the potential of devastating iatrogenic complications.Reference #1: Vinh et al. Blood 2010;115:1519-1529DISCLOSURE: The following authors have nothing to disclose: Jason Schnack, Aarti Mittal, Ching-Fei ChangNo Product/Research Disclosure Information.