October 2011 Arizona Thoracic Society Notes

The October Arizona Thoracic Society meeting was held on 10/18/2011 at Scottsdale Shea beginning at 6:45 PM. There were 17 in attendance representing the pulmonary and radiology communities.

Prior to the case presentations, a discussion was initiated by Ewa Lupa-Laskus regarding the usefulness of procalcitonin, particularly in the ICU. The consensus of the group was that, although it was of moderate sensitivity and specificity, it added to the armamentarium for clinical decision-making, particularly regarding continuing or stopping antibiotics. Numerous physicians reported difficulty in getting laboratories to run the test. Strategies were discussed regarding how to obtain this test sufficiently quickly to be clinically useful.

It was discussed why the attendance was low. Part of this was attributed to cancellation of the September meeting because of a last moment loss of sponsorship. However, we now have sponsorship through 2012. It was felt that an e-mail reminder, either the day before or the day of the meeting, might improve attendance. Also, a newsletter summarizing the meeting, publications in the Southwest Journal of Pulmonary and Critical Care, appropriate announcements, etc were thought to be good ideas. This will be distributed by e-mail through Mary Kurth.

Two cases were presented by Lewis Wesselius from the Mayo Clinic:

A 22-year-old woman was referred after developing respiratory failure over 2 weeks. She was intubated because of respiratory failure. Thoracic CT revealed “crazy paving,” which is characteristic finding in pulmonary alveolar proteinosis (PAP). It consists of patchy, bilateral geographic areas of ground-glass opacity associated with interlobular septal thickening. Although the CT scan was suggestive, it was not diagnostic of PAP but a prior lung biopsy was consistent with the diagnosis. For this reason the patient underwent whole lung lavage and was begun on GM-CSF. She improved, was extubated and discharged from the hospital. A serum anti-GM-CSF antibody returned positive. Although she improved, she was unable to continue the GM-CSF therapy because for financial reasons.  She had recurrence of her disease requiring lung lavage but did not improve to the extent she had previously. Discussion centered on diagnosis and management of PAP.

2.   A late middle-aged man with an incidental finding on chest x-ray

A 61-year-old man was seen in the ER because of chest pain. This was not cardiac in origin and spontaneously resolved. Pulmonary function testing revealed a reduction in the DLCO and a thoracic CT for pulmonary embolism showed typical crazy paving. Lung biopsy was typical of PAP.  Although GM-CSF therapy was offered, the patient refused because he was asymptomatic. His DLCO spontaneously improved, follow up thoracic CT showed improvement in ground-glass opacity and associated interlobular septal thickening, and he remains well without therapy.

At the end of the case presentations, George Parides presented a plaque to the president of the Arizona Thoracic Society, Rick Helmers, thanking him for his service. Rick will be leaving for Chicago at the end of November.

There being no being further business the meeting was adjourned at 7:45. The next meeting is scheduled for Tuesday, November 8, at Scottsdale Shea.

Richard A. Robbins, M.D.

Michael B. Gotway, M.D.