TEST - Book of PDFs-01_Johnson_Johnson-CHEST 2016

01_Johnson_Johnson-CHEST 2016_CMS PC.pptx

Pdf Summary

Case 2:<br />A 65-year-old female presents with new swelling over the left side of her chest. Physical examination reveals a soft tissue mass in the left breast. There is no lymph node enlargement. Pulmonary examination is normal. The patient has a history of hypertension, tobacco use, and uterine fibroids. She is currently taking Toprol XL and Clonazepam. Her last mammogram was negative. A chest ultrasound shows a 4.4 cm mass with internal echoes and blood flow. A CT chest is recommended. The CT reveals findings consistent with blastomycosis, a fungal infection caused by Blastomyces dermatitidis. The patient's symptoms include fever, cough, shortness of breath, weight loss, and fatigue. Treatment for uncomplicated pulmonary blastomycosis includes itraconazole for 6-12 months.<br /><br />Case 3:<br />A 52-year-old female presents with new onset dyspnea on exertion. She also reports a catch when taking a deep breath. Physical examination reveals crackles in the lungs. Pulmonary function tests show normal spirometry and lung volumes. A chest x-ray and high-resolution CT chest are obtained. Laboratory workup is negative. Bronchoscopy with biopsy is inconclusive. The patient is diagnosed with hypersensitivity pneumonitis (HP), which is confirmed by clinical, radiographic, physiologic, and histopathological findings. HP is divided into different phases - acute, sub-acute, and chronic. The patient's symptoms and imaging findings are consistent with sub-acute HP. Farm exposure from horseback riding is considered the likely cause. The patient opts for antigen avoidance instead of glucocorticoid therapy.<br /><br />Sources: The cases were discussed by Dr. Jessica Johnson, a Pulmonary and Critical Care Medicine Fellow at Loyola University Medical Center. Information about blastomycosis and its treatment was sourced from UpToDate and the Clinical Practice Guidelines of the Infectious Diseases Society of America. Information about hypersensitivity pneumonitis and its diagnosis was sourced from Murray and Nadel's Textbook of Respiratory Medicine, UpToDate, American Thoracic Society, and the American Journal of Respiratory and Critical Care Medicine.

Keywords

swelling

left side

chest

soft tissue mass

breast

blastomycosis

fungal infection

pulmonary examination

hypersensitivity pneumonitis

farm exposure

CHEST Annual Meeting