November 2012 Arizona Thoracic Society Notes

A dinner meeting was held on Wednesday, 11/28/2012 at Scottsdale Shea beginning at 6:30 PM. There were 20 in attendance representing the pulmonary, critical care, sleep, infectious disease, pathology, and radiology communities.

Dr. George Parides stated he was unable to find further information on treating patients begun on biologicals for RA who developed a + QuantiFERON.

Four cases were presented:

1. Dr. Suresh Uppalapu, a pulmonary fellow at Good Samaritan/VA, presented a case of a 29 yo woman with a rash and a myriad of nonspecific complaints. She had recently been a contestant in a reality TV show. Just prior to admission she developed a neurologic complaints including incontinence. Her CXR was negative but CT of the chest showed scattered areas of ground glass opacities peripherally. A MRI of the brain revealed nonspecific abnormalities. CBC showed an elevated eosinophil count of 8%. Coccidioidomycosis antigen was negative. An LP was performed which showed a protein of 144 mg/dL, a glucose of 33 mg/dL, and 553 cells/mm3 with 79% eosinophils. Biopsy revealed angiostrongylus. She is being treated with albendazole and steroids and is improving.
2. Dr. Tom Colby, pulmonary pathologist from the Mayo Clinic, presented a case of a 61 yo man who presented with fever, chills and renal failure. He had diffuse patch ground glass opacities and a WBC scan localized to the lung. Open lung biopsy showed intravascular lymphocytes which stained positively for the B cell marker CD79a. The patient is receiving chemotherapy
3. Dr. Tim Kuberski, chief of Infectious Disease at Maricopa Medical Center, presented a 56 yo homeless man with schizophrenia and alcoholism who was found to have Mycobacterium kansasii about a year ago. He was begun on INH, rifampin, ethambutol, and PZA. He was lost to follow up but returned with a LUL cavity and respiratory failure. He was intubated and placed on mechanical ventilation. Bronchoalveolar lavage was AFB+. He was again begun on INH, rifampin, ethambutol, and PZA. When he failed to improve after several weeks he was treated with moxifloxacin, azithromycin and amikacin. A repeat BAL was Coccidioidomycosis antigen positive although the serum Coccidioidomycosis antigen negative. He was treated with amphotericin and was improving.
4. Dr. Jessica Hurley, a pulmonary fellow at St. Joseph, presented a 60 yo woman who underwent lung transplantation in May, 2012 for sarcoidosis. She developed progressive hypoxia and was intubated. CT scan showed multiple small nodules surrounded by ground glass opacities and mediastinal adenopathy. A VATS biopsy was performed which showed spindle shaped CD34+ positive cells consistent with Kaposi’s sarcoma. Her Mycophenolate was stopped and she was begun on doxorubicin.

There being no further business, the meeting was adjourned at about 8 PM. There being no meeting in December, the next meeting is Wednesday, January 23, 2013 at 6:30 PM at Scottsdale Shea.

Richard A. Robbins, MD

CCR Representative

Arizona Thoracic Society

Reference as: Robbins RA. November 2012 Arizona thoracic society notes. Southwest J Pulm Crit Care 2012;5:270-1. PDF

May 2011 Arizona Thoracic Society Notes

A dinner meeting was held at Scottsdale Shea Medical Center on May 12, 2011 from 6:30-8:00 PM. The meeting was not held at the usual time because of the upcoming American Thoracic Society meeting in Denver. Twenty-four were in attendance including representatives from the pulmonary, pulmonary pathology and chest radiology communities. A projector has been donated to the Arizona Thoracic Society by the Phoenix Pulmonary and Critical Care Research and Education Foundation for use at these meetings. Seven cases were presented and discussed:

1. Jud Tillinghast presented a case and a CT scan of an over distended endotracheal tube. Discussion centered on the need to measure cuff pressure.

2. Jessica Hurley presented a case of influenza H1N1 in pregnancy. The case will presented at the American Thoracic Society meeting in Denver later this week.

3. Thomas Colby presented a case of an intravascular B cell lymphoma. Discussion centered on the pathologic appearance of this tumor.

4. Cristian Jivcu presented a case of a large cell B cell lymphoma.  Discussion detailed the pathologic appearance and classification of B cell lymphomas.

5. Thomas Colby presented a case of a patient with restrictive lung disease. Biopsy revealed vascular proliferation with veins in the vascular bundle. No one could recall a similar case.

6. Emad Wissa presented a case of tracheopathia osteochondroplastica. Discussion centered on the usually benign nature of the disease

7. Lewis Wesselius presented a case of a patient with relapsing polychondritis who failed anti-inflammatory therapy and eventually required stents to maintain tracheal patency.

Mike Gotway gave a short presentation on the differing CT appearance of tracheal calcification, comparing and contrasting tracheopathia osteochondroplastica and amyloidosis.

Richard A. Robbins, MD