December 2024 Pulmonary Case of the Month: Two Birds in the Bush Is Better than One in the Hand

By: VonEssen SG

Abstract: 

No abstract available. Article truncated after 150 words.

History of Present Illness

A 48-year-old man is referred for dyspnea on exertion and a nonproductive cough. He was well until 6 months prior to this visit. He feels he has had “flu-like symptoms” over the past month.

PMH, SH, and FH

He has had intermittent atrial fibrillation controlled by digoxin but also clopidogrel as an anticoagulant. He has symptoms of hay fever and had asthma as a child.

He has never smoked and rarely drinks. Pets include two dogs and a cat. He is a university English literature professor and his office is an old building but the building is clean and well maintained.  Hobbies include playing guitar in a rock-n-roll band.

His family history is unremarkable.

Physical Examination

His physical examination including  lungs and cardiovascular examination is unremarkable.

Which of the following are indicated  for further workup?

1. Chest X-ray
2. Electrocardiogram (ECG)
3. Pulmonary function testing (PFTs) …

URL: https://www.swjpcc.com/pulmonary/2024/12/1/december-2024-pulmonary-case-of-the-month-two-birds-in-the-b.html 

Glucagon‐like Peptide-1 Agonists and Smoking Cessation: A Brief Review

By: Robbins RA

Abstract: The glucagon‐like peptide 1 (GLP-1) agonists such as semaglutide (Ozempic®, Wegovy®) and tirzepatide (Mounjaro®) have shown efficacy inducing weight loss in both diabetics and non-diabetics. According to the incentive sensitization theory of addiction, these drugs may prove useful in addictive disorders such as nicotine addiction. Animal data has been suggestive of a potential positive effect but early human studies have been mixed. This manuscript reviews the theory of addiction as well as the few animal and human studies available. Further human studies are needed to show GLP-1 agonist efficacy in smoking cessation.

URL: https://www.swjpcc.com/pulmonary/2024/11/5/glucagonlike-peptide-1-agonists-and-smoking-cessation-a-brie.html

November 2024 Medical Image of the Month: A Case of Short Telomeres

By: Jokerst CE, Stib M, Rojas C, Gotway MB

Abstract: 

No abstract available. Article truncated after 150 words. A 50-year-old woman was referred to our institution for further evaluation of her ILD. Her history of present illness began during the COVID-19 pandemic, when she noticed that she had trouble climbing stairs while wearing a mask. She also had a slowly progressive cough which, at first, she attributed to seasonal allergies. Eventually her symptoms prompted pulmonary function testing at an outside institution, which showed moderately severe restriction with a DLco 40% of predicted. Chest x-ray (Figure 1) and chest CT (Figure 2) demonstrated findings of pulmonary fibrosis. The patient worked as an accountant and was a life-long nonsmoker. No concerning exposure history and no history of any medications associated with pulmonary fibrosis. Her family history is remarkable for a brother diagnosed with IPF at age 49, currently status post lung transplant. Her sister and father were both diagnosed with alpha-1-antitrypsin (both died in their 50’s). The patient also reports …

URL: https://www.swjpcc.com/imaging/2024/11/2/november-2024-medical-image-of-the-month-a-case-of-short-tel.html 

November 2024 Imaging Case of the Month: A Recurring Issue

By: Gotway MB

Abstract: 

No abstract available. Manuscript truncated after 150 words. Clinical History: A 65-year-old woman with a history of orthotopic liver transplantation 2 years earlier for non-alcoholic steatohepatitis presented to the Emergency Room for chronic fatigue, malaise, nausea and vomiting, and generalized weakness. She denies shortness of breath, hemoptysis, or productive cough. Her post liver transplant course was complicated by wound infection, biliary stricture requiring ERCP with stent placement, and Clostridium difficile colitis. Prior to her liver transplant the patient had chronic renal insufficiency which has been slowly progressing (creatinine of 2.8 mg/dL, estimated GFR of 17.6 mL) and she was currently undergoing renal transplant evaluation. The patient also has a past medical history of coronary artery disease requiring bypass grafting surgery, hypothyroidism requiring hormone replacement, and type II diabetes not requiring specific therapy. Her past surgical history included cholecystectomy and hysterectomy.

The patient is a lifelong non-smoker, she reports an allergy to penicillin and amoxicillin (hives), and she does …

URL: https://www.swjpcc.com/imaging/2024/11/1/november-2024-imaging-case-of-the-month-a-recurring-issue.html 

October 2024 Medical Image of the Month: Lofgren syndrome with Erythema Nodosum

By: Jamison M

Abstract: 

No abstract available. Article truncated after 150 words. A 33-year-old man with a past medical history of non-metastatic right sided testicular cancer status post radical orchiectomy 10 years prior presented to the emergency department for 1 week of bilateral lower extremity swelling and pain. He had associated shortness of breath, right sided chest pain, fatigue, and night sweats. Physical exam revealed bilateral ankle swelling with erythema and warmth and there was noted an erythematous nodule over the medial right knee and anterior right thigh (Figure 1). He was tachycardic to a rate of 110 bpm, but otherwise had an unremarkable physical exam and review of systems. 

The lower extremity lesions were consistent with erythema nodosum. Sarcoidosis was an amounting differential but as this is a diagnosis of exclusion, alternate causes needed to be ruled out. Deep vein thrombosis was excluded. CT angiogram did not show pulmonary embolus but it did show diffuse multifocal sub centimeter pulmonary nodules measuring …

URL: https://www.swjpcc.com/imaging/2024/10/2/october-2024-medical-image-of-the-month-lofgren-syndrome-wit.html