Council of Chapter Representatives, American Thoracic Society 2011

The Council of Chapter Representatives (CCR) met on Saturday, May 14, at the American Thoracic Society meeting in Denver, CO. Nineteen were in attendance. The meeting was called to order at 10:00 AM by Carolyn Welsh, Chair CCR.

Roll call demonstrated that representatives from Arizona, California, the District of Columbia, Hawaii, Michigan, Ohio, Oklahoma, Oregon, and Washington/Alaska were in attendance.

The ATS President's Address was given by Dean Schraufnagel. He highlighted the Society's accomplishments and positive financial status.

The ATS Executive Director echoed these positives.

Representatives from the ATS Government Relations, Gary Ewart and Nuala Moore, discussed ATS's lobbying activities.

The list of Outstanding Clinician nominees with a brief biography was read by Dr. Welsh. The nominees included:

• George Chaux (California)
• Randall Reves (Colorado)
• Stephen Nathan (Metro DC)
• Dorothy White (deceased, New York)
• Michelle Harkins (New Mexico)
• John Handy-Oregon.

Dr. Harkins was elected as the outstanding clinician.

CCR business discussions included:

• ATS management of chapters
• Councilor term limits
• In person vs. virtual meetings

The CCR voted to request the ATS Board of Directors to suspend the requirements for membership numbers and the term limits for Counselors for 2 years due to the low numbers of members and members willing to serve as Counselors. It was also voted to have 2 meetings per year rather than 1 as this year.

An officer slate was presented by the nominating committee for the upcoming year and accepted by the CCR. Officers will be:

• Dona Upson, Chair (New Mexico)
• Linda Nici, Chair-Elect (Rhode Island)
• Samya Nasr, Secretary/Treaurer (Michigan)
• Carol Welsh, Immediate Past Chair (Colorado)

There being no further business the meeting was adjourned at 1:00 PM.

Richard A. Robbins, MD

May 2011 Arizona Thoracic Society Notes

A dinner meeting was held at Scottsdale Shea Medical Center on May 12, 2011 from 6:30-8:00 PM. The meeting was not held at the usual time because of the upcoming American Thoracic Society meeting in Denver. Twenty-four were in attendance including representatives from the pulmonary, pulmonary pathology and chest radiology communities. A projector has been donated to the Arizona Thoracic Society by the Phoenix Pulmonary and Critical Care Research and Education Foundation for use at these meetings. Seven cases were presented and discussed:

1. Jud Tillinghast presented a case and a CT scan of an over distended endotracheal tube. Discussion centered on the need to measure cuff pressure.

2. Jessica Hurley presented a case of influenza H1N1 in pregnancy. The case will presented at the American Thoracic Society meeting in Denver later this week.

3. Thomas Colby presented a case of an intravascular B cell lymphoma. Discussion centered on the pathologic appearance of this tumor.

4. Cristian Jivcu presented a case of a large cell B cell lymphoma.  Discussion detailed the pathologic appearance and classification of B cell lymphomas.

5. Thomas Colby presented a case of a patient with restrictive lung disease. Biopsy revealed vascular proliferation with veins in the vascular bundle. No one could recall a similar case.

6. Emad Wissa presented a case of tracheopathia osteochondroplastica. Discussion centered on the usually benign nature of the disease

7. Lewis Wesselius presented a case of a patient with relapsing polychondritis who failed anti-inflammatory therapy and eventually required stents to maintain tracheal patency.

Mike Gotway gave a short presentation on the differing CT appearance of tracheal calcification, comparing and contrasting tracheopathia osteochondroplastica and amyloidosis.

Richard A. Robbins, MD

April 2011 Arizona Thoracic Society Notes

A dinner meeting was held at Scottsdale Shea Medical Center on April 12, 2011 from 6:30-8:00 PM. Twenty-seven were in attendance including representatives from the pulmonary and chest radiology communities. Six cases were presented and discussed:

1. Alexis Christie and Rick Helmers presented a case of acute respiratory failure in a 51 year old woman who had an “ARDS”-like picture, an initially negative bronchoscopy with bronchoalveolar lavage and a non-specific open lung biopsy. The bronchoalveolar lavage eventually cultured influenza A. Discussion centered on whether the patient should have received corticosteroids.

2. Lew Wesselius presented a 55 year old man evaluated for renal transplant secondary to chronic renal failure from polycystic kidney disease. The patient was asymptomatic but found to have lower lung nodules on CT which were thought to be pulmonary arteriovenous malformations. The patient was referred for embolization. The invasive radiologist identified these as pulmonary varices. No therapy was given. A brief review of pulmonary varices was done by Dr. Wesselius and Mike Gotway discussed the radiographic appearance.

3. Gerald Swartzberg presented a case of a 64 year old woman with a rash on her palms, fever and multiple pulmonary nodules. Cultures and coccidiomycosis serology were negative. The patient was found to have coccidiomycosis on video-assisted thoracic surgery. Discussion centered on the 70% sensitivity of coccidiomycosis serology.

4. Gerald Swartzberg presented a second case of a 55 year old man with dyspnea, a 20 pack-year smoking history, and lower lobe fibrosis. The PFTs were presented which demonstrated a mixed obstructive and restrictive disease with a diffusing capacity of 47% of predicted. Most thought this was a case of COPD with idiopathic pulmonary fibrosis. Management was discussed.

5. John Roehrs presented a case of 52 year old woman with dyspnea with a normal chest x-ray and spirometry. However, on echocardiogram pulmonary hypertension was found with right atrial and ventricular enlargement. A bubble study demonstrated an atrial septal defect. Right-sided cardiac catherization confirmed the elevated pulmonary artery pressure and demonstrated an O2 step up at the atrial level. Discussion centered on therapy with most suggesting cardiology evaluation for a percutaneous closure of the ASD.

6. Christian Jivcu and Manny Mathew presented a case dyspnea of a man who had Hodgkin’s disease in 1987 who had received radiation therapy. CXR revealed bilateral pleural effusions which were exudative. A chest CT scan revealed mediastinal lymphadenopathy. At operation he was found to have mesothelioma which even in retrospect was not recognizable on his CT scan. The patient had no known asbestos exposure. Discussion focused on the association between prior radiation therapy and mesothelioma.

Richard A. Robbins, MD

March 2011 Arizona Thoracic Society Notes

A dinner meeting was held at Scottsdale Shea Medical Center on March 15, 2011 from 6:30-8:00 PM. Fifteen were in attendance including representatives from the pulmonary and chest radiology communities. A brief presentation was made by Rick Robbins of current ATS activities. Five cases were presented and discussed: 1. Gerald Swartzberg presented a case of a 73 year old with dyspnea and severe restrictive physiology but without evidence of pulmonary fibrosis. Discussion centered on sniff testing and the possibility of bilateral diaphragmatic paralysis. 2. Henry Luedy presented a case of a thoracic duct-cutaneous fistula draining lymph percutaneously. The patient was not considered a surgical candidate and radiologic evaluation and nonsurgical interventions were discussed. 3. George Parides presented a case of a 47 year old with shrinking lung nodules and microscopic hematuria. Discussion centered on microscopic polyangitis and the most expeditious diagnostic tests. 4. George Parides presented a second case of a 79 year old who is asymptomatic but with an incidental finding of scattered lung nodules. Discussion centered on atypical mycobacterium and the necessity of diagnosis versus observation.  5. John Roehrs presented a case of a 53 year old woman with dyspnea and mild pulmonary hypertension discovered to have a patent foramen ovale. Discussion centered on management including correction and anticoagulation.

Richard A. Robbins, MD

February 2011 Arizona Thoracic Society Notes

A dinner meeting was held at Scottsdale Shea Medical Center on February 15 from 6:30-8:00 PM. Twenty were in attendance including representatives from the pulmonary, chest radiology, and thoracic surgery communities. Several cases were presented and discussed: 1. Metastatic testicular cancer by Henry Luedy 2. A left pleural effusion with an inverted diaphragm was presented by Allen Thomas. Michael Gotway showed several cases from his teaching files of reexpansion pulmonary edema. A discussion ensued afterwards regarding the volume of fluid which can be safely removed at one time. The thoracic surgeons noted that they have removed large volumes during video-assisted thorascopy without any adverse consequences. It was felt that up to 1-1.5 liters could be removed safely but larger volumes probably required manometry; 3. Manny Mathew showed a case of hydropneumothorax after resection of a Coccidiodes cavity with subcutaneous air and multiple air-fluid levels including in the soft tissues. Discussion centered on management; and 4. Evan Schmitz presented a case of Nocardia in an immunocompromised host with a low FEV1 emphasizing the importance of aggressively pursuing the diagnosis.

Richard A. Robbins, MD