Pulmonary
The Southwest Journal of Pulmonary and Critical Care publishes articles broadly related to pulmonary medicine including thoracic surgery, transplantation, airways disease, pediatric pulmonology, anesthesiolgy, pharmacology, nursing and more. Manuscripts may be either basic or clinical original investigations or review articles. Potential authors of review articles are encouraged to contact the editors before submission, however, unsolicited review articles will be considered.
May 2018 Pulmonary Case of the Month
Kenneth K. Sakata, MD
Department of Pulmonary Medicine
Mayo Clinic Arizona
Scottsdale, AZ USA
History of Present Illness
A 70-year-old man was referred because of new anemia and a heme-positive stool. Esophagogastroduodenoscopy (EGD) was performed which revealed gastritis. Ascites developed and a chest x-ray noted a left pleural effusion. He was managed with weekly high-volume thoracentesis and paracentesis. He was referred to pulmonary medicine.
Past Medical History, Social History and Family History
He has a history of coronary artery disease having undergone coronary bypass grafting in 2016. He also has type 2 diabetes mellitus managed by diet and recently diagnosed orthostasis. He smokes about ½ pack of cigarettes per day but does not drink alcohol. He denies any inhalational exposures. He is Native American and works as a judge. There is no family history of any similar disorders.
Physical Examination
- No acute distress
- Slight bruise to left eye
- No lymphadenopathy
- Decreased breath sounds on left
- Protuberant distended abdomen
- Significant left leg edema
- Discoloration of a few nails
A point of contact ultrasound is performed (Figure 1).
Figure 1. Image from the point of contact ultrasound.
What should be done next? (Click on the correct answer to proceed to the second of seven pages)
- Needle biopsy of pleural mass
- Thoracentesis
- Thoracic surgery consultation for video-assisted thorascopic surgery (VATS)
- 1 and 3
- All of the above
Cite as: Sakata KK. May 2018 pulmonary case of the month. Southwest J Pulm Crit Care. 2018;16(5):237-44. doi: https://doi.org/10.13175/swjpcc059-18 PDF