Acute eosinophilic pneumonia masquerading as multiple pulmonary embolisms.

A 47-year-old previously healthy man was admitted to the hospital with a 5-day history of fever, dry cough, and dyspnoea. Thoracic radiographs and CT scan showed extensive bilateral consolidation predominantly involving the central portions of the upper lung lobes, along with multiple scattered nodules. On taking a thorough history, it was found that the patient had visited a gritty 100-year-old Japanese folk house 1 week ago. An urgent bronchoscopy was performed, and the results were consistent with the findings of acute eosinophilic pneumonia (AEP). The patient's respiratory distress resolved within 10 days without treatment. Hence, even in an AEP case with atypical radiological presentations, careful history taking can lead to a rapid diagnosis.

Efficacy of diaphragmatic breathing in patients with chronic obstructive pulmonary disease.

This study investigated the effects of diaphragmatic breathing (DB) on ventilation and breathing pattern, seeking to identify predictors of its efficacy in patients with chronic obstructive pulmonary disease (COPD). Twenty-nine patients with moderate and severe COPD were monitored using respiratory inductance plethysmography and metabolic gas analysis. After 4 minutes of natural breathing, subjects completed 2 minutes of DB followed by 4 minutes of natural breathing. Dyspnea was measured using a visual analogue scale. Diaphragmatic mobility was assessed using chest radiography. DB was associated with a significant increase in tidal volume and reduction in breathing frequency, leading to higher ventilation and oxygen saturation, with a reduction in dead space ventilation and ventilatory equivalent for carbon dioxide. A total of 10 subjects with moderate (5) and severe (5) COPD performed DB with asynchronous thoracoabdominal motion, worsening the dyspnea, and decreasing the gain of tidal volume. Diaphragmatic mobility, inspiratory muscular strength, lower scores for dyspnea and hypoxemia as well as coordinated thoracoabdominal motion are associated with effective DB. In patients with COPD, DB can improve breathing pattern and ventilatory efficiency without causing dyspnea in patients whose respiratory muscular system is preserved.

Effects of high-intensity inspiratory muscle training following a near-fatal gunshot wound.

BACKGROUND AND PURPOSE: Severe injuries sustained during combat may classify individuals as undeployable for active service. It is imperative that every effort is made to optimize physical function following such injuries. CASE DESCRIPTION: A 38-year-old man sustained a gunshot wound during armed combat. The bullet entered via the left axilla and exited from the right side of the abdomen, resulting in severe thoracic and abdominal injuries. Five months later, he continued to describe severe dyspnea on exertion. During a cardiopulmonary exercise test on a cycle ergometer, he achieved a maximum rate of oxygen uptake of 2,898 mL·min(-1) (114% predicted) and maximum power of 230 W (114% predicted). His maximum forced inspiratory flow was 5.95 L·s(-1), and inspiratory reserve volume at test end was ∼80 mL. The test was terminated by the patient due to dyspnea that was too severe to tolerate. Video fluoroscopy demonstrated impaired right hemidiaphragm function. The main goals of therapy were to reduce dyspnea on exertion and to enable return to full work duties. A program of high-intensity, interval-based threshold inspiratory muscle training (IMT) was undertaken. OUTCOMES: An average of 5 sessions of IMT were completed each week for 10 weeks. During a repeat cardiopulmonary exercise test, the patient achieved a similar power and maximum rate of oxygen uptake. His maximum forced inspiratory flow increased by 48% to 8.83 L·s(-1), and he was limited by leg fatigue. DISCUSSION: High-intensity IMT was safe and well tolerated. It was associated with improvements in maximum forced inspiratory flow and changed the locus of symptom limitation during high-intensity exercise from dyspnea to leg fatigue.

Shrinking lung syndrome in pregnancy complicated by antiphospholipid antibody syndrome.

BACKGROUND: Shrinking lung syndrome is characterized by pulmonary compromise secondary to unilateral or bilateral paralysis of the diaphragm. CASE: Shrinking lung syndrome was diagnosed in a patient with antiphospholipid syndrome after a cesarean delivery at 28 4/7 weeks of gestation. Signs and symptoms included unexplained right-side chest pain, dyspnea, tachypnea, and absent breath sounds at the right base of the lungs. After initiation of corticosteroids, her symptoms resolved. CONCLUSION: Although seen in association with systemic lupus erythematosus, shrinking lung syndrome has not been described with antiphospholipid syndrome or during pregnancy. Diagnosis and awareness are important because treatment with moderate- to high-dose corticosteroids appears to improve the clinical outcome.

Deep vein thromboembolism after arthroscopy of the shoulder: two case reports and a review of the literature.

BACKGROUND: Deep vein thrombosis (DVT) has an incidence of 1 case per 1000 inhabitants in the general population and it is very rare after arthroscopy of the shoulder. Therefore, the current guidelines do not advise the administration of DVT prophylaxis in shoulder arthroscopy procedures. CASES PRESENTATION: We describe two cases of thrombosis of the arm after shoulder arthroscopy on a total of 10.452 shoulder arthroscopies performed during a period of ten years. One of two patients was further complicated by a bilateral pulmonary microembolism. In these two clinical cases the complication developed despite the absence of risk factors such as a concomitant neoplasm, thrombophilia, smoking habit, or a long duration of the procedure. CONCLUSIONS: The DVT after shoulder arthroscopy procedure remain a very rare complication. However, in view of the growing number of patients undergoing this procedure, this figure is expected to rise. The clinician surgeon should take in mind this possible complication that normally appears in the first 3 weeks after surgery, so to perform anti-coagulant treatment. Further clinical studies are therefore warranted to assess the true risk of VTE. In fact, the presence of "minor" predisposing factors that are not routinely studied, as well as the postoperative immobilization period, are potential risk factors that, associated with the invasiveness of the arthroscopy procedure, could trigger a thromboembolism.

Video-assisted thorascopic removal of migratory acupuncture needle causing pneumothorax.

We report the case of a 25-year-old African-American man presenting to the Henry Ford Hospital emergency department with acute dyspnea secondary to a pneumothorax resulting from a migratory acupuncture needle. The patient received acupuncture treatment approximately 5 years prior to this presentation for treatment of posttraumatic chronic right shoulder pain. Chest radiography revealed retained needles in his right shoulder girdle and a needle overlying the thoracic cage with an attendant pneumothorax. Catheter aspiration for simple pneumothorax provided immediate symptomatic relief. Video-assisted thoracoscopy was then used to remove the migratory acupuncture needle from the chest wall. The patient recovered without complication and was discharged to home.