February 2012 Arizona Thoracic Society Notes

The February Arizona Thoracic Society meeting was held on 2/21/2012 at Scottsdale Shea beginning at 6:30 PM. There were 25 in attendance representing the pulmonary, radiology, and thoracic surgery communities.

A presentation on elevated IgE was given by Dr. Cristian Jivcu a second year pulmonary fellow at the Good Samarian/VA program to follow up the two cases presented last month Dr. Swartzberg. (Click here for the slides used in the presentation)

Multiple cases were presented:

Dr. Gerald Swartzberg presented two cases. The first was an 86 yo with an enlarging mass in the right lower chest. Biopsy had previously revealed the mass to be a benign spindle cell tumor. There was no invasion of the chest wall or evidence of metastases consistent with the tumor’s benign pathology. Despite the tumor appearing to occupy nearly ¼ of the lower chest, the patient was asymptomatic. Most continued observation although thoracic surgery thought it could be safely debulked.

The second case presented by Dr. Swartzberg was a 58 yo with a pulmonary embolism who had been anticoagulated for 6 years. Unfortunately, the patient had a recurrent embolism after the anticoagulation was stopped. The patient is now back on anticoagulation and asymptomatic but had a removable inferior vena cava filter placed. Discussion centered on whether it was appropriate to remove the filter. None knew of a randomized trial and no consensus could be reached.

Dr. Cristian Jivcu presented a case of a 52 yo patient with ulcerative colitis who initially presented at another VA with shortness of breath and fever. Work up eventually resulted in VATS lung biopsy which revealed organizing pneumonia. The patient was started on corticosteroids and transferred to the Phoenix VA where he was admitted and became increasingly short of breath. CT scan revealed a “reverse halo” sign. A routine blood gas detected 12% methemoglobin. At that time it was discovered the patient had been started on dapsone for PCP prophylaxis. The symptoms improved when the dapsone was stopped.

Dr. Syed Zaidi presented two cases from Maricopa Medical Center. The first was a 36 yo with a 2 week history of cough and fever. Chest X-ray was thought to be abnormal in the right lower chest and for this reason a CT scan was ordered. An interlobar pulmonary sequestration was discovered with the blood supply arising from below the diaphragm. Discussion centered on whether the sequestered lung should be removed.

Dr. Zaidi’s second case as a 23 yo with AIDS and a past medical history of pneumocystis pneumonia, Kaposi’s sarcoma and Candida infection who presented with severe cough. CT scan showed adenopathy in the mediastinum and scattered groundglass opacities. Bronchoscopy showed an ulcerating mass in the right bronchus intermedius. Biopsy revealed Mycobacterium avium-intracellulare. Dr. Zaidi’s literature review revealed that endobronchial lesions secondary to M. avium-intracellulare had previously been reported in AIDS and other immunocompromised patients.  

There being no further business the meeting adjourned at 8:00 PM. The next meeting will be on Tuesday, March 20, 6:30 PM at Scottsdale Shea.

Richard A. Robbins, M.D.

Reference as: Robbins RA. February 2012 Arizona thoracic society notes. Southwest J Pulm Crit Care 2012;4:40-1. (Click here for a PDF version of the Notes)

January 2012 Arizona Thoracic Society Notes

The January Arizona Thoracic Society meeting was held on 1/11/2012 at Scottsdale Shea beginning at 6:30 PM. There were 30 in attendance representing the pulmonary, radiology, thoracic surgery and allergy communities.

Al Thomas was voted to be clinician of the year nominee from Arizona.

A progress report for 2011 was given by Rick Robbins on the Southwest Journal of Pulmonary and Critical Care (for a summary of the presentation click here).

Multiple cases were presented:

1. George Parides presented a 64 year old with a second PPD which was positive. A discussion regarding interpretation of PPDs ensued.
2. Gerald Swartzberg presented two cases-both had in common a markedly elevated IgE level. These cases created a discussion of the differential diagnosis of an elevated IgE and how to approach patients with this laboratory abnormality.
3. Paul Conomos presented 2 cases. One was a patient with a pericardial cyst and the other a subcarinal mass. Discussion centered on how to manage patients with asymptomatic subcarinal masses.
4. Cristian Jivcu presented a case of a left upper lobe 7 cm mass. Bronchoscopy with bronchoalveolar lavage was negative. The patient was followed with complete resolution.
5. Henry Luedy presented a 79 yo with an interstitial lung disease probably secondary to chronic aspiration for 5 years with complete radiologic resolution.
6. Joshua Jewell presented a case of pneumonia with empyema. Rather than decoritcation the patient was treated with thoracostomy drainage and TPA and DNAase with complete resolution over several weeks.
7. Manny Mathew followed with a similar case of a pleural effusion treated with TPA which also resolved. Discussion occurred on when it was appropriate to treat patients conservatively with chest tube drainage compared to aggressively with decortication.

There being no further business the meeting adjourned at 8:00 PM. The next meeting will be on Tuesday, February 21, 6:30 PM at Scottsdale Shea.

Richard A. Robbins, M.D.

Reference as: Robbins RA. January 2012 Arizona thoracic society notes. Southwest J Pulm Crit Care 2012;4:4. (Click here for a PDF version of the Notes)