A 55-year-old man with a small right lung and a right-sided heart.

A healthy 55-year-old man without known medical problems presented for a routine physical examination and was found to have an abnormal ECG. He denied chest pain, dyspnea, palpitations, dizziness, or syncopal episodes. He also denied orthopnea, paroxysmal nocturnal dyspnea, and lower-extremity edema. His exercise capacity had been excellent. He was a lifelong nonsmoker and never had lung problems.

Pneumothorax ex-vacuo or "trapped lung" in the setting of hepatic hydrothorax.

BACKGROUND: Hepatic hydrothorax is a major pulmonary complication of liver disease occurring in up to 5-10% of patients with cirrhosis. CASE PRESENTATION: We report four observations of the development of pneumothorax ex-vacuo or trapped lung in the setting of hepatic hydrothorax. The diagnosis of trapped lung was made based on the presence of a hydropneumothorax after evacuation of a longstanding hepatic hydrothorax with failure of the lung to re-expand after chest tube placement in three of the four cases. Two patients underwent surgical decortication with one subsequent death from post-operative bleeding. The other two patients remarkably had spontaneous improvement of their "trapped lung" without surgical intervention. CONCLUSIONS: While pneumothorax ex-vacuo is a known phenomenon in malignant effusions, to our knowledge, it has never been described in association with hepatic hydrothoraces. The pathophysiology of this phenomenon remains unclear but could be related to chronic inflammation with development of a fibrous layer along the visceral pleura.

An unintended consequence: fatal amiodarone pulmonary toxicity in an older woman.

Amiodarone pulmonary toxicity represents the most serious adverse reaction from amiodarone use. It remains underdiagnosed and can have a variable presentation. The elderly population is at increased risk for amiodarone pulmonary toxicity. Thus, clinicians should prescribe the lowest dosage possible in the elderly and have a low threshold to discontinue the amiodarone for anyone with unexplained fatigue, dyspnea, cough, or weight loss. We present the case of an 89-year-old female who presented with a several month history of fatigue and recent development of dyspnea on exertion and a dry cough. She had been taking amiodarone for 1 year secondary to atrial fibrillation. Chest x-ray and chest CT revealed multilobar airway opacities. An infectious work-up was negative and a transbronchial biopsy revealed prominent intra-alveolar foamy macrophages, consistent with amiodarone pulmonary toxicity. Despite the prompt discontinuation of her amiodarone and a trial of intravenous steroids, the patient succumbed to respiratory failure. The risk factors, clinical presentation, diagnosis, treatment, and prevention of amiodarone pulmonary toxicity are discussed.

Meperidine-induced seizure after revision hip arthroplasty.

Musculoskeletal injuries secondary to seizures are well documented and have a variable incidence. Meperidine (Demerol [Abbott, Abbott Park, IL]) has been used for many years in the postoperative setting for pain control; however, in high doses, it has been associated with seizure. We report the case of patient who experienced a tonic-clonic seizure 5 days after hip revision surgery, resulting in dissociation of the socket from the acetabulum with an associated acetabular fracture. In this patient, meperidine administered for patient-controlled analgesia within recommended range caused the seizure.