March 2013 Arizona Thoracic Society Notes

A dinner meeting was held on Wednesday, 3/20/2013 at Scottsdale Shea beginning at 6:30 PM. There were 14 in attendance representing the pulmonary, critical care, sleep, infectious disease, nursing, and radiology communities.

Copies of the book “Breathing in America: Diseases, Progress, and Hope” were distributed.

Three cases were presented:

1. Tim Kuberski, infectious diseases from Maricopa, presented a 49 year old woman with a history of alcoholism who presented with RML pneumonia. Despite azithromycin and cephtriaxone she developed progressive respiratory failure and a right pleural effusion. A right chest tube was placed. Cultures of blood and the pleural fluid were negative. She was suspected of having an anaerobic infection. Follow-up CT scan showed abscess formation in her RML with areas of dense consolidation on the left and a left pleural effusion. Discussion focused on whether RML resection should be performed. Most favored a surgical approach.
2. Andrew Goldstein, thoracic surgery, presented a 48 year old man with a large extrathoracic chest mass who presented with hematuria. The hematuria eventually proved to be secondary to bladder cancer. On CT the approximate 7 cm mass appears to be growing from the manubrium. Biopsy of the mass revealed transitional cell carcinoma. There are clinically no other metastasis. The sternal tumor was resected and the patient has done well and has returned to work.
3. Tom Ardiles, pulmonary from Maricopa, presented 21 yo woman who presented with pneumonia after a cardiac arrest. She has a history of alcohol and dextroamphetamine abuse. Her procalcitonin levels were elevated. She developed right lower lung consolidation and a right pneumothorax. Sputum grew Pseudomonas. CT shows diffuse grown glass opacities and pneumomediastinum and intertidal emphysema. She has had progressive consolidation on chest x-ray and persistent respiratory failure. A right pleural effusion developed and was drained which also cultured Pseudomonas. She is gradually improving on oscillatory ventilation and antibiotics.

There being no further business, the meeting was adjourned at about 8 PM. The next meeting is Wednesday, April 24, 2013 at 6:30 PM at Scottsdale Shea.

Richard A. Robbins, MD

CCR Representative

Arizona Thoracic Society

Reference as: Robbins RA. March 2013 Arizona thoracic society notes. Southwest J Pulm Crit Care. 2013;6(3):148. PDF