November 2015 Arizona Thoracic Society Notes

The November 2015 Arizona Thoracic Society meeting was held on Wednesday, November 18, 2015 at the Scottsdale Shea Hospital beginning at 6:30 PM. This was a dinner meeting with case presentations. There were 14 in attendance representing the pulmonary, critical care, sleep, and radiology communities. 

There were 3 case presentations:

1. Dr. Gerald Schwartzberg presented a case of a 56-year-old man with a history of diabetes, alcoholism and tobacco abuse who has a history of Mycobacterium avium-intracellulare (MAI) with a residual thin-walled cavity in his right upper lobe (RUL). After quitting drinking and smoking and years of being asymptomatic, he presented with hemoptysis. Chest x-ray showed increasing density in the RUL. CT scan showed an intracavitary density in his previous cavity presumably a fungus ball. Sputum cultures are pending. Discussion followed on management of fungus balls. Bronchoscopy was recommended to view the bronchial anatomy to exclude other diagnosis as well as obtaining additional cultures. The consensus of the group was operative intervention if possible. If not, bronchial artery embolization was offered as an alternative.
2. Dr. Schwartzberg presented a second case of a middle-aged woman with a past history of Valley Fever who was treated and left with a negative serology and a pulmonary nodule. She has developed rheumatoid arthritis and is being considered for biological therapy. The question was whether she should received fluconazole during therapy. No one knew of any data but the group advised caution and suggested fluconazole during immunosuppressive therapy.
3. Dr. Lewis Wesselius presented a case of an 18-year-old with a prior diagnosis of Ehlers-Danlos syndrome. CT scan revealed multiple lung cysts. Dr. Wesselius reviewed Ehlers-Danlos syndrome and congenital pulmonary airway malformations (CPAM) (1,2). CPAM, previously known as congenital cystic adenomatoid malformation, is a developmental lesion of the lung comprising single or multiple cysts of uniform or varying sizes arising from anomalous growth of airways. Most of the cases are identified in infants and neonates with respiratory distress. Rarely, CPAM can present in adulthood with recurrent chest infections, pneumothorax, hemoptysis, or dyspnea. Dr. Michael Gotway showed CT scans of several additional patients.

There being no further business, the meeting was adjourned about 7:45 PM. The next meeting will be in Phoenix on Wednesday, January 27,2016 at 6:30 PM. A change of venue was discussed and will be announced prior to the meeting.

Richard A. Robbins, MD

Editor, SWJPCC

References

1. Dowton SB, Pincott S, Demmer L. Respiratory complications of Ehlers-Danlos syndrome type IV. Clin Genet. 1996;50(6):510-4. [CrossRef] [PubMed]
2. Baral D, Adhikari B, Zaccarini D, Dongol RM, Sah B. Congenital pulmonary airway malformation in an adult male: a case report with literature review. Case Rep Pulmonol. 2015;2015:743452. [CrossRef] [PubMed] 

Cite as: Robbins RA. November 2015 Arizona thoracic society notes. Southwest J Pulm Crit Care. 2015;11(5):233-4. doi: http://dx.doi.org/10.13175/swjpcc143-15 PDF

September 2012 Arizona Thoracic Society Notes

A dinner meeting was held on 9/26//2012 at Scottsdale Shea beginning at 6:30 PM. There were 18 in attendance representing the pulmonary, critical care, sleep, pathology, and radiology communities.

A discussion was held on Pending Premium Cigar Legislation HR. 1639 and S.1461, the "Traditional Cigar Manufacturing and Small Business Jobs Preservation Act of 2011”. This bill would exempt "premium cigars" from FDA oversight.  The definition of premium cigars is so broad that candy flavored cigars, cigarillos and blunts would be exempted from FDA regulation.  Teenage cigar smoking is increasing and this legislation may result in a further increase. The Arizona Thoracic Society is opposed to this bill. Dr. Robbins is to put a link on the Southwest Journal of Pulmonary and Critical Care website linking to the ATS website. This will enable members to contact their Congressmen opposing this legislation.

A discussion was also held on a proposed combined Tucson/Phoenix meeting. George Parides and Ken Knox have been discussing a combined meeting between the Arizona Thoracic members in Tucson and Phoenix in Casa Grande. Dr. William Peppo, chairman of medicine at Midwestern University, made the suggestion that perhaps the University of Arizona video link between the Tucson and Phoenix campus could be used to hold combined meetings. It was decided to pursue this possibility.

Two cases were presented:

1. Rick Robbins presented a case of a 56 yo man with chronic cough and exertional dyspnea. He had mild restrictive disease and scattered areas of a reticular pattern and ground glass opacities on chest x-ray and CT scan of the chest. Bronchoscopy with bronchoalveolar lavage revealed 60% lymphocytes which were predominately CD8+. VATS was consistent with hypersensitivity pneumonitis. A careful history and hypersensitivity serology did not reveal an etiology of the hypersensitivity pneumonitis. It was pointed out that a pervious series revealed that 25% of chronic hypersensitivity cases had no identifiable etiology. A discussion ensued about how far to investigate the patient’s environment for an etiology. The consensus was that an aggressive, thorough investigation was probably warranted.
2. Tom Colby presented a case of a 26 year old man with recurrent hemoptysis and pneumothoracies. An open lung biopsy revealed holes in the lung and areas with abnormal scarring. The patient eventually proved to have Ehlers Danlos syndrome characterized by joint hypermobility. None had seen a similar patient but Dr. Colby related he had seen this pattern on lung biopsy previously and since the disease occurs once in every 5000 births, he wondered if the disease was more common than reported.

There being no further business, the meeting was adjourned at 7:45 PM. The next meeting is scheduled for October 24 at Scottsdale Shea 6:30 PM.

Richard A. Robbins, MD

CCR Representative

Arizona Thoracic Society

Reference as: Robbins RA. September 2012 Arizona thoracic society notes. Southwest J Pulm Crit Care 2012;5:149-50. (Click here for a PDF version of the notes)