Primary Pulmonary Artery Sarcoma Confined to the Left Pulmonary Artery.

Primary pulmonary artery sarcomas (PPAS) are extremely rare tumors that are often mislabeled as pulmonary emboli (PE). PPAS usually involve the pulmonary trunk and are histologically classified as leiomyosarcoma, spindle cells sarcoma, fibrous histiocytoma, or undifferentiated sarcoma. Our case involved a 78-year-old man with an undifferentiated PPAS confined to the left pulmonary artery that was initially misdiagnosed as a PE. After a month-long delay in treatment in which the patient was prescribed warfarin, the correct diagnosis was made. Pulmonary artery endarterectomy and left lung pneumonectomy were performed, and he survived for 18 months before disease recurrence and death. Our case helps illustrate some of the clinical and radiographic findings that help distinguish PPAS from PE.

The Use of Tranexamic Acid for Upper Gastrointestinal Bleeding by Medical and Surgical Intensivists: A Single Center Experience.

BACKGROUND: Tranexamic acid (TXA) may be beneficial in the management of upper gastrointestinal bleeding (UGIB). We sought to investigate how frequently intensivists at our academic institution use TXA for patients with UGIB, and to investigate whether the utilization rate of TXA differs between surgical and medical intensivists, and provide an updated literature review on the subject. METHODS: We performed a retrospective cohort study of patients admitted for UGIB to the surgical intensive care unit (SICU) and the medical intensive care unit (MICU) at our academic healthcare facility (University of Florida Health - Shands Hospital) from January 1, 2013 to December 31, 2016. The patients were categorized as receiving or not receiving TXA. The overall utilization rate of TXA was calculated, and the utilization rates for the MICU and SICU were compared using a two-sample test for equality of two proportions with continuity correction. RESULTS: The study cohort included a total of 1,829 patients with a diagnosis of UGIB. Of those, 988 were treated in the MICU and 841 were treated in the SICU. Of the 988 patients in the MICU, six received TXA (0.61%), while 10 (1.19%) of the 841 patients in the SICU received TXA. The overall utilization rate of TXA was 0.87%. The odds of receiving TXA in the SICU were 1.97 times greater than in the MICU (odds ratio (OR): 1.97, 95% confidence interval (CI): 0.74 - 5.2, P = 1.83). CONCLUSIONS: Our study suggests that TXA may be underused in the management of UGIB, and that the utilization rate does not differ significantly between surgical and medical intensivists.

Pulmonary arterial hypertension and acute respiratory distress syndrome in a patient with adult-onset stills disease.

Adult-onset Still's disease (AOSD) is an inflammatory disorder characterized by recurrent fevers, arthralgia, leukocytosis, and a salmon-colored rash. Diagnosis is made based on the Yamaguchi criteria. Various cardiac and pulmonary manifestations have been described in association with AOSD, including acute respiratory distress syndrome (ARDS) and pulmonary arterial hypertension (PAH). We describe the first case of both PAH and ARDS in a patient with AOSD who, despite aggressive therapy, declined rapidly and ultimately died. There was concern for pulmonary veno-occlusive disease given the rate of her decompensation, but this was found not to be the case on autopsy. Treatment of AOSD with cardiopulmonary involvement requires rapid identification of AOSD followed by aggressive immunosuppression.