March 2017 Arizona Thoracic Society Notes

The March 2017 Arizona Thoracic Society meeting was held on Wednesday, March 22, 2017 at the HonorHealth Rehabilitation Hospital beginning at 6:30 PM. This was a dinner meeting with case presentations. There 11 attendance representing the pulmonary, critical care, sleep, thoracic surgery and radiology communities.

There was a discussion of supporting the Tobacco 21 bill which had been introduced into the Arizona State Legislature. The bill was assigned to the House Commerce Committee but was not scheduled for a hearing by the Chair-Representative, Jeff Weninger from Chandler. It seems likely that the bill will be reintroduced in the future and the Arizona Thoracic Society will support the bill in the future.

Three cases were presented:

1. Dr. Bridgett Ronan presented a 57-year-old man with cough and shortness of breath. His physical examination and spirometry were unremarkable. A thoracic CT scan showed large calcified and noncalcified pleural plaques and mediastinal lymphadenopathy. A bronchoscopy showed some mild thickening and a cobblestone appearance of the LUL bronchus. Bronchoalveolar lavage was unremarkable. Biopsy of the LUL bronchus showed noncaseating granuloma. Discussion ensued of whether this was sarcoidosis. Most agreed that calcified pleural plaque-like lesions would be unusual for sarcoidosis and that further investigation with complete pulmonary function testing and perhaps VATS was warranted. Most favored not treating the patient empirically with corticosteroids.
2. Dr. Lewis Wesselius presented a 41-year-old man was referred because of cough, hemoptysis and recurrent pneumothorax. His thoracic CT showed scattered nodules, some cavitated, with surrounding ground glass opacities. He eventually came to open lung biopsy. A tentative diagnosis of Ehlers-Danlos was made. This will be the April 2017 Pulmonary Case of the Month (click to be directed to the case which will be posted on 4/1/17). Please see the entire case presentation for details and discussion.
3. Dr. Rick Robbins presented a case from Dr. Michael Gotway of a 48-year-old non-smoking woman with a history of hysterectomy and right oophorectomy, and cholecystectomy, otherwise previously healthy, who presented with a spontaneous pneumothorax. Her thoracic CT scan showed multiple small cysts. She also had follicular lesions on her face. Biopsy of the facial lesions revealed fibrofolliculomas, or hamartomas of the hair disc. Fibrofolliculomas with lung cysts are relatively specific for Birt Hogg Dubé syndrome. This case was the November 2015 Imaging Case of the Month (click to be directed to the full presentation). Please see the entire case presentation for details and discussion.

There being no further business, the meeting was adjourned about 8 PM. The next meeting will be in Phoenix on Wednesday, May 24, 2017 at 6:30 PM at HonorHealth Rehabilitation Hospital.

Richard A. Robbins, MD

Cite as: Robbins RA. March 2017 Arizona thoracic society notes. Southwest J Pulm Crit Care. 2017;14(3):125-6. doi: https://doi.org/10.13175/swjpcc038-17 PDF