Delayed targeted atelectasis in a case of bronchoscopic lung volume reduction with endobronchial valves.

A woman in her late 60s with severe chronic obstructive pulmonary disease (COPD) and emphysema underwent bronchoscopic lung volume reduction (BLVR) with endobronchial valves (EBV) to address hyperinflation. The initial EBV placement has led to partial lobar atelectasis of the left lower lobe and resulted in significant improvement in the patient's symptoms and lung function. However, valve migration occurred later due to pneumothorax unrelated to valves, leading to suboptimal clinical improvement. The patient achieved delayed full lobar atelectasis 21 months after EBV placement, which led to a significant clinical improvement. The patient decided to be delisted from the lung transplant list due to the improvement. This case highlights the importance of considering delayed atelectasis as a possible outcome of EBV placement and suggests the need for further exploration of the long-term implications and associations of this procedure.

Pneumatic stenting in the surgical candidacy assessment for cough variant expiratory central airway collapse.

Expiratory Central Airway Collapse (ECAC) is a multifactorial, underdiagnosed entity that poses unique challenges. Airway stenting is used as a predictor for successful outcomes after central airway stabilization surgery via tracheobronchoplasty (TBP). This approach may pose suboptimal performance in certain ECAC variants. We hypothesize that Continuous Positive Airway Pressure (CPAP), used as a pneumatic stent, could be a non-invasive alternative to evaluate surgical candidacy in cough-predominant ECAC presentations. We report on a 67-year-old female with a history of chronic cough and confirmed ECAC. After optimization of medical therapy without significant relief and unsuccessful stent trial. We opted to perform CPAP trial during exercise, the patient exercised on a treadmill, and CPAP was applied at two levels (9 cmH2O, 11 cmH2O). The use of CPAP was associated with resolution of cough and a decrease in exercise-related perceived exertion. Applying CPAP during exercise may be a promising alternative to stent trials to determine patients' candidacy for surgical management of cough-predominant ECAC.

Recurrent pleural effusion from ovarian hemangioma: A rare pseudo-Meigs syndrome presentation.

Pleural effusion is a common condition related to various diseases such as heart failure, malignancies, and pneumonia. Ovarian hemangioma is a rare type of female genital tumour and can rarely cause pleural effusion. In this case, we present a 48-year-old female with repeated episodes of recurrent right-sided pleural effusion over 1 year with no clear aetiology. Abdominal computed tomography revealed a large left ovarian mass. After surgical removal of the mass, the repeated pleural effusion episodes ceased, and histopathology analysis reported a rare ovarian hemangioma. Pseudo Meigs' syndrome is a triad of an ovarian tumour, ascites, and hydrothorax that rarely presents with ovarian hemangioma; both effusions are eradicated after removing the tumour.

COVID-19 infection: Strategies on when to discontinue isolation, a retrospective study.

OBJECTIVE: Add to available understanding of COVID-19 to help decrease further spread of SARS-CoV-2 by providing protocol providers can consider when giving patients recommendations to retest as well as length of time for self-isolation. METHODS: We retrospectively collected data from the electronic medical record of patients in the Mayo Clinic Florida's COVID Virtual Clinic. Hundred and eighteen patients with detectable results for the virus were followed. Data reviewed in this study included (1) length of time from detectable to undetectable results; (2) length of time from onset of symptoms to undetectable result; (3) length of time from resolution of fever to undetectable result. RESULTS: Fifty-three percent of studied patients eligible for discontinuation of self-isolation had detectable viral RNA, and therefore, underwent repeat testing. In these patients, the mean from the date of their first detectable result to attaining an undetectable result was 14.89 days. The mean time for onset of symptoms to undetectable testing was 21.5 days. CONCLUSIONS: Hundred and eighteen patients with detectable results for SARS-CoV-2 were followed in the Mayo Clinic Florida COVID Virtual Clinic; 53% of patients still showed detectable viral RNA despite meeting CDC guidelines for discontinuation of self-isolation, prompting us to propose following a more cautious guideline that other providers could consider as a strategy to discontinue self-isolation, including increasing length of days since symptom onset.