July 2018 Arizona Thoracic Society Notes

The July 2018 Arizona Thoracic Society meeting was held on Wednesday, July 25, 2018 at the HonorHealth Rehabilitation Hospital beginning at 6:30 PM. This was a dinner meeting with case presentations. There were 8 in attendance representing the pulmonary, critical care, sleep, infectious disease and radiology communities.

At the beginning of the meeting several issues were discussed:

• The dwindling attendance at these meetings. It was decided to again reach out to the pulmonary fellowship programs at Mayo, University of Arizona Phoenix and University of Arizona Tucson.
• The two recent cases of pharmacists refusing to dispense medications was discussed without coming to a consensus. One physician said he would refuse to submit prescriptions to the Peoria Walgreens.
• Discussion regarding the Tobacco 21 which had been killed in committee by Rep. Jeff Weninger was tabled until the next meeting.

There were 2 case presentations:

1. Dr. Lewis Wesselius presented a 67-year-old woman who had increasing shortness of breath. She was started on prednisone by another physician and her dyspnea improved although it recurred when her prednisone was tapered. Unfortunately, she gained 30 lbs. while on the prednisone. The patient did not smoke. She had a few crackles at her right base but otherwise the physical examination was normal. She desaturated with exercise. Her CT scan showed ground glass opacities with multiple small cysts. PFTs were restrictive with a DLCO of 55% of predicted. She was further questioned about additional symptoms and stated she had dry mouth and eyes for years. Rheumatology consultation was ordered, her SSP and SSA were both positive, and she had a diagnosis of Sjogren’s syndrome made. Because she was symptomatic it was thought she needed to treatment but she did not want to take prednisone again. For this reason, she was begun on mycophenolate.
2. Dr. Gerald Schwartzberg presented a 62-year-old man who was seen in the office with shortness of breath. Physical examination was normal and he had normal PFTs. He was admitted to the hospital a couple of weeks later after a trip with a pulmonary embolus. Discussion centered on when a CT angiogram should be ordered. There was a consensus that a CT-angiogram did not need to be done in all patients complaining of dyspnea but no consensus on criteria for whom it should be ordered.

The meeting was adjourned about 8 PM. The next meeting will be on September 26 at 6:30 PM at HonorHealth Rehabilitation Hospital.

Richard A. Robbins MD

Editor, SWJPCC

Cite as: Robbins RA. July 2018 Arizona thoracic society notes. Southwest J Pulm Crit Care. 2018;17(1):41. doi: https://doi.org/10.13175/swjpcc095-18 PDF

February 2012 Arizona Thoracic Society Notes

The February Arizona Thoracic Society meeting was held on 2/21/2012 at Scottsdale Shea beginning at 6:30 PM. There were 25 in attendance representing the pulmonary, radiology, and thoracic surgery communities.

A presentation on elevated IgE was given by Dr. Cristian Jivcu a second year pulmonary fellow at the Good Samarian/VA program to follow up the two cases presented last month Dr. Swartzberg. (Click here for the slides used in the presentation)

Multiple cases were presented:

Dr. Gerald Swartzberg presented two cases. The first was an 86 yo with an enlarging mass in the right lower chest. Biopsy had previously revealed the mass to be a benign spindle cell tumor. There was no invasion of the chest wall or evidence of metastases consistent with the tumor’s benign pathology. Despite the tumor appearing to occupy nearly ¼ of the lower chest, the patient was asymptomatic. Most continued observation although thoracic surgery thought it could be safely debulked.

The second case presented by Dr. Swartzberg was a 58 yo with a pulmonary embolism who had been anticoagulated for 6 years. Unfortunately, the patient had a recurrent embolism after the anticoagulation was stopped. The patient is now back on anticoagulation and asymptomatic but had a removable inferior vena cava filter placed. Discussion centered on whether it was appropriate to remove the filter. None knew of a randomized trial and no consensus could be reached.

Dr. Cristian Jivcu presented a case of a 52 yo patient with ulcerative colitis who initially presented at another VA with shortness of breath and fever. Work up eventually resulted in VATS lung biopsy which revealed organizing pneumonia. The patient was started on corticosteroids and transferred to the Phoenix VA where he was admitted and became increasingly short of breath. CT scan revealed a “reverse halo” sign. A routine blood gas detected 12% methemoglobin. At that time it was discovered the patient had been started on dapsone for PCP prophylaxis. The symptoms improved when the dapsone was stopped.

Dr. Syed Zaidi presented two cases from Maricopa Medical Center. The first was a 36 yo with a 2 week history of cough and fever. Chest X-ray was thought to be abnormal in the right lower chest and for this reason a CT scan was ordered. An interlobar pulmonary sequestration was discovered with the blood supply arising from below the diaphragm. Discussion centered on whether the sequestered lung should be removed.

Dr. Zaidi’s second case as a 23 yo with AIDS and a past medical history of pneumocystis pneumonia, Kaposi’s sarcoma and Candida infection who presented with severe cough. CT scan showed adenopathy in the mediastinum and scattered groundglass opacities. Bronchoscopy showed an ulcerating mass in the right bronchus intermedius. Biopsy revealed Mycobacterium avium-intracellulare. Dr. Zaidi’s literature review revealed that endobronchial lesions secondary to M. avium-intracellulare had previously been reported in AIDS and other immunocompromised patients.  

There being no further business the meeting adjourned at 8:00 PM. The next meeting will be on Tuesday, March 20, 6:30 PM at Scottsdale Shea.

Richard A. Robbins, M.D.

Reference as: Robbins RA. February 2012 Arizona thoracic society notes. Southwest J Pulm Crit Care 2012;4:40-1. (Click here for a PDF version of the Notes)