RESUMO
We report a case of left upper lobe torsion in a patient who had a pneumothorax as a complication of subclavian venous access for an elective neurosurgical operation. Despite appropriate management of the pneumothorax, the patient's chest radiograph did not improve. Computed tomography of the chest was concerning for left upper lobe torsion. Fiberoptic bronchoscopy revealed near complete obstruction of the left upper lobe bronchus. Review of computed tomography imaging before and after bronchoscopy and subsequent thoracotomy confirmed lobar torsion. Consideration of lobar torsion in the differential diagnosis of patients with persistently abnormal chest imaging despite appropriate management after complications of routine procedures is important for early recognition and intervention of a potentially life-threatening problem.
RESUMO
Left ventricular noncompaction (LVNC) is a multifactorial structural abnormality of the myocardial wall characterized by prominent trabeculae and deep trabecular recesses. LVNC may present as a congenital or acquired defect characterized by 2 distinct tissue layers: a spongy, noncompacted inner myocardium and a thin, compacted outer myocardium. Patients with LVNC are prone to thromboembolic events, either due to deep trabeculations in the noncompacted myocardium or due to arrhythmias accompanying the defect. There are sparse data concerning treatment options for patients with LVNC who fail medical management. We present 2 such patients with LVNC who, following failed medical management, received a left ventricular assist device (LVAD): one for long-term management and one as a bridge to transplant. Both were managed successfully without thromboembolic events to date. The success of these cases suggests that LVAD placement is a viable therapy in patients with LVNC as a bridge to transplant or as long-term management.
RESUMO
Tularemia is a zoonotic disease caused by Francisella tularensis that can be transmitted to humans when they handle rabbits, receive tick bites, consume contaminated water, or inhale aerosolized particles. We present the case of a 51-year-old white man with rheumatoid arthritis who was taking immunosuppressive medications and presented with tularemia. Our patient acquired the typhoidal form of tularemia, which is a severe systemic illness that manifests with fevers, headaches, myalgias, vomiting, diarrhea, and neurological symptoms, due to his immunocompromised state. The diagnosis was made through biopsy of a pulmonary nodule found incidentally on computed tomography scan.