Pneumothorax complicating small-bore feeding tube placement.

Small-bore Silastic feeding tubes are being used with increasing frequency for short- and long-term enteral hyperalimentation. We present three cases where these flexible tubes were passed into the tracheobronchial tree and then out into the pleural space. The result in each case was a pneumothorax or hydropneumothorax. These cases were collected at one community hospital over a 6-month period. A review of the current literature reveals reports of 10 similar cases. We conclude that, although the exact incidence of pleural complications of small-bore feeding tubes is unknown, it is not insignificant. The traditional methods of assessing proper nasogastric tube placement are inadequate when applied to these small tubes. Only a chest roentgenogram can assure placement in the stomach. Education of hospital staff on methods to avoid malposition of feeding tubes has resulted in an absence of pulmonary complications over a subsequent 1-year period.

Reactive airway dysfunction syndrome in three police officers following a roadside chemical spill.

The reactive airway dysfunction syndrome (RADS) is a recently described syndrome in which bronchial hyperreactivity and asthmatic symptoms develop in previously healthy individuals after a single large exposure to an irritating gas, fume, or vapor. We report a cluster of three Philadelphia police officers who developed RADS after a common exposure to toxic fumes from a roadside truck accident. Results of initial pulmonary function testing were normal in all three, and methacholine challenge was required for diagnosis in two out of the three. This syndrome needs to be recognized by physicians dealing with environmental or industrial medicine as a potential cause of loss of work or inability to perform on the job. Also, there is a potential for multiple individuals to develop this syndrome from a single incident.

Angiosarcoma presenting as diffuse alveolar hemorrhage.

Angiosarcoma has been reported as occurring in both postirradiation and postradical mastectomy patients. Described is a patient, postmastectomy and irradiation, with alveolar hemorrhage secondary to angiosarcoma. Angiosarcoma, primary or metastatic to lung, should be included in the differential diagnosis of diffuse alveolar hemorrhage in this patient population.

Sarcoma of the pulmonary artery.

A patient is described in whom clinical presentation, V/Q scan, and pulmonary angiogram were consistent with pulmonary embolus. No improvement occurred despite therapy with heparin. When sent for surgical embolectomy, sarcoma of the pulmonary artery was diagnosed. This entity, though rare, should be considered in the differential diagnosis of pulmonary vascular disease.

Sarcoidosis and aspergilloma. The role of surgery.

Fibrocystic pulmonary disease is a common sequel of chronic pulmonary sarcoidosis, and the subsequent development of intracavitary aspergillomas is frequent, especially in black patients. Pulmonary hemorrhage from aspergilloma is second only to cardiorespiratory failure as the cause of death in sarcoidosis. Opinions regarding the role of resectional surgery are conflicting. We report observations on 38 patients with biopsy evidence of antecedent sarcoidosis and cultural or serologic identification of Aspergillus species as cause of the fungus balls. Pulmonary fibrosis was bilateral and extensive in most cases, making surgical treatment perilous. Ten patients had moderate impairment of pulmonary function. Seven had surgical resection with six satisfactory results and one death. Three patients in this category have not required surgery. Twenty-eight patients had severely compromised pulmonary function. Surgery was performed in seven because of intractable bleeding; four survived, but three later died of respiratory failure. Of the 21 in this category not treated by surgery, six survived, four died of hemorrhage and 11 of respiratory failure. Of the 37 patients with aspergilloma whose status is known, 19 are dead, 14 survived with positive precipitins and four, all treated surgically, recovered. It is concluded that surgical treatment of aspergilloma in patients with sarcoidosis should be avoided if possible, but is inescapable in a third of cases.

Lumbar spinal abscess managed conservatively. Case report.

The authors report the case of a patient with spinal abscess in whom operation was withheld because of severe concomitant medical problems. Conservative management resulted in apparent cure.