Acute Onset Of Respiratory Distress Research Articles

Unruptured giant lateral thoracic meningocele: extremely rare cause of cerebrospinal fluid (CSF) hypotension in neurofibromatosis type 1.

Neurofibromatosis type 1 (NF1) is a multisystem neurocutaneous disorder. Scoliosis and dural ectasia are features of the associated mesodermal dysplasia. Lateral thoracic meningoceles can develop in NF1 and progressively enlarge due to cerebrospinal fluid (CSF) pulsations. Large meningoceles can cause compressive symptoms in the thorax. We are reporting a case of a NF1 presenting with acute onset respiratory distress, who also had chronic orthostatic headaches. CT chest showed unruptured enlarging bilateral lateral thoracic meningoceles causing lung compression. MRI of the brain and spine showed features of CSF hypotension, explaining the headaches. CSF hypotension with unruptured meningoceles is extremely rare. Management of the condition is challenging since surgical removal is prone to complications due to underlying mesodermal abnormalities. Cystoperitoneal shunting to relieve lung compression may worsen CSF hypotension. A shunt with a programmable valve allowed controlled drainage and successfully relieved lung compression without worsening of orthostatic headaches in our case.

Simultaneous Presentation of Swimming-Induced Pulmonary Edema in a Set of Monozygotic Twin Elite Maritime Warfare Candidates: A Novel Case Report.

Swimming-induced pulmonary edema (SIPE) is an incompletely understood condition that is often seen in U.S. special operations candidates participating in maritime qualification training courses. We present a case of two monozygotic twins with the simultaneous onset of acute respiratory distress during a crucible event of a maritime assessment and selection course. Subsequent pulmonary ultrasonography in both candidates showed wedge-shaped hyperechoic lines (B-lines) extending from the pleural interface into the interstitium. Chest radiography of both candidates revealed bilateral asymmetric hazy opacities consistent with SIPE. Both candidates recovered with supportive measures but were medically removed from training. Given the near-identical exposures of the candidates to the same ambient and water temperatures, duration of water submersion, magnitude of physical stressors, and viral colonization, this case study suggests that there may be underlying genetic factors, in addition to environmental factors, that predispose individuals to developing SIPE. Further benchtop and clinical research must be performed to identify potential genetic polymorphisms that contribute to the development of SIPE and to investigate safe interventions that address the underlying etiologies of SIPE pathophysiology.

An 8-year-old boy with diffuse cystic pulmonary tuberculosis: An intriguing story

Diffuse cystic lung disease due to pulmonary tuberculosis (TB) is rare. We describe an 8-year-old boy who presented with acute onset respiratory distress while on a compliant anti-tubercular treatment for a recently diagnosed pulmonary TB. On clinical examination, hypoxemia, clubbing, and features of the right-sided heart failure were observed. High-resolution computed tomography of the chest revealed extensive cystic lung parenchymal changes with ground glassing and consolidation, and echocardiography indicated the presence of pulmonary arterial hypertension. His treatment included supplemental oxygen, sildenafil, prednisolone, and anti-tubercular drugs. At the two-year follow-up, the patient showed complete clinical recovery and resolution of cysts on the chest X-ray.

A large pericardial cystic lymphangioma presenting as acute-onset respiratory distress in a child: a case report

BackgroundLymphangiomas are rare benign malformations of the lymphatics that occur due to blockage of the lymphatic system during fetal development. They commonly occur in the neck and axilla, while involvement of the pericardium is rare. We report herein the case of a 16-month-old Sri Lankan child with a large pericardial cystic lymphangioma presenting with sudden-onset shortness of breath.Case presentationA 16-month-old Sri Lankan boy presented with sudden-onset dyspnea for 1-day duration following a febrile illness that lasted 2 days. On examination, he was afebrile and had subcostal, intercostal, and suprasternal recessions, with a respiratory rate of 50 breaths per minute. He had a loud expiratory grunt. The chest expansion was reduced on the right side, which was dull to percussion. Auscultation revealed a marked reduction of air entry over the right lower and mid zones. Chest X-ray showed a well-demarcated opacity involving the lower and mid zones of the right hemithorax associated with a tracheal shift to the opposite side. Ultrasound scan of the chest revealed fluid-filled right hemithorax suggesting a septate pleural effusion. A contrast-enhanced computed tomography scan of the thorax showed a large multiloculated extrapulmonary cystic lesion involving the right hemithorax with a mediastinal shift towards the left side associated with displacement of the right-side mediastinal structures. He underwent mini-thoracotomy and surgical excision of the cyst. A large cyst originating from the pericardium was observed and excised during surgery. Histological examination revealed a lesion composed of cysts devoid of a lining epithelium but separated by connective tissue, mature adipose tissue, and lymphoid aggregates. The child showed complete recovery postoperatively with full expansion of the ipsilateral lung.ConclusionWe report the case of a patient with cystic lymphangioma who was perfectly well and asymptomatic until 16 months of age. This case report presents the very rare occurrence of a large cystic lymphangioma originating from the pericardium. It highlights the importance of considering rare possibilities and performing prompt imaging in situations of diagnostic uncertainty to arrive at an accurate diagnosis that can be lifesaving.

Old drugs, new tricks: leveraging known compounds to disrupt coronavirus-induced cytokine storm

A major complication in COVID-19 infection consists in the onset of acute respiratory distress fueled by a dysregulation of the host immune network that leads to a run-away cytokine storm. Here, we present an in silico approach that captures the host immune system’s complex regulatory dynamics, allowing us to identify and rank candidate drugs and drug pairs that engage with minimal subsets of immune mediators such that their downstream interactions effectively disrupt the signaling cascades driving cytokine storm. Drug–target regulatory interactions are extracted from peer-reviewed literature using automated text-mining for over 5000 compounds associated with COVID-induced cytokine storm and elements of the underlying biology. The targets and mode of action of each compound, as well as combinations of compounds, were scored against their functional alignment with sets of competing model-predicted optimal intervention strategies, as well as the availability of like-acting compounds and known off-target effects. Top-ranking individual compounds identified included a number of known immune suppressors such as calcineurin and mTOR inhibitors as well as compounds less frequently associated for their immune-modulatory effects, including antimicrobials, statins, and cholinergic agonists. Pairwise combinations of drugs targeting distinct biological pathways tended to perform significantly better than single drugs with dexamethasone emerging as a frequent high-ranking companion. While these predicted drug combinations aim to disrupt COVID-induced acute respiratory distress syndrome, the approach itself can be applied more broadly to other diseases and may provide a standard tool for drug discovery initiatives in evaluating alternative targets and repurposing approved drugs.

Imaging Diagnosis: Thoracic radiographic features of toxoplasmosis in a 14-month-old Red Kangaroo (Macropusrufus).

A privately owned 14-month-old intact female red kangaroo (Macropus rufus) was presented for acute onset respiratory distress and lethargy. On presentation, the kangaroo was laterally recumbent, tachypneic, dyspneic, lethargic, and obtunded. Thoracic radiographs revealed a severe diffuse mixed pulmonary pattern (alveolar pattern superimposed on a bronchial pattern) and subjective mild generalized cardiomegaly. Due to the severity of clinical signs and grave prognosis, euthanasia was elected. Postmortem examination was consistent with systemic toxoplasmosis. Histopathology and immunohistochemistry staining on infected tissues confirmed Toxoplasma gondii. This is the first published report of radiographic findings for confirmed toxoplasmosis in a red kangaroo or marsupial.

Acute tracheal trauma and chronic tracheal collapse in an asthmatic mature pony

SummaryA 17‐year‐old cross‐bred pony gelding was presented for acute onset of respiratory distress and an inspiratory honking noise. He had been previously diagnosed with moderate mastocytic equine asthma and chronic tracheal collapse on endoscopy (grade 3/4). At admission, predominantly inspiratory dyspnoea with open mouth breathing, hypoxaemia and hypercapnia were present. Cervical and thoracic radiographs showed severe tracheal collapse from the mid‐cervical region to the thoracic inlet and a moderate generalised bronchial pattern. Due to the poor prognosis, euthanasia was elected. On post‐mortem examination, some granulomatous nodules compatible with tracheobronchopathia osteochondroplastica were present in the tracheal lumen, and the entire trachea was laterally flattened. This uncommon laterolateral collapse was more severe at the thoracic inlet and in the mid‐cervical area, where a peritracheal haematoma was detected. A blunt trauma that exacerbated the tracheal collapse was suspected. Tracheal histology revealed degenerative changes. Degeneration of tracheal cartilage and connective tissue can be a predisposing factor to chronic collapse and recurrent episodes of inspiratory and expiratory distress. It is unknown whether chronic tracheal collapse is an independent condition or a consequence of an underlying lung disease.

CLINICAL PROFILE OF PATIENTS WITH ACUTE EPICHLOROHYDRIN POISONING - AN OBSERVATIONAL STUDY

Epichlorohydrin is an organochlorine compound and a epoxide. It is a colourless liquid with a pungent, garlic like odour, moderately soluble in water, but miscible with most polar organic solvents. It is used in the production of glycerol, plastics, epoxy glues and resins, epoxy diluents and elastomers. Epichlorohydrin is a common chemical used in industry and Accidental exposure to Epichlorohydrin can occur in workers working in glycerol, plastics, epoxy glues and resins, epoxy diluents and elastomer factories.To study the clinical profile of patients with Acute Epichlorohydrin Poisoning And identify the frequency and nature of lung involvement.30 patients of age 18 and above with Acute Epichlorohydrin poisoning were included in the study. Symptomatology and History, ABG, chest Xray and Hrct chest findings were included in the clinical profile. Distribution of responses were examined using frequencies and percentages and cross tabulation were done between various subgroups.All the patients had accidental direct exposure to Epichlorohydrin. All the patients presented with acute onset respiratory distress and dry cough. Burning sensation and redness and watering from eyes with watering from nose were present in all the patients. Burning sensation in the throat was present in two third of the patient. Two third of the patients developed ARDS and of them 60 % developed moderate to severe ARDS. Two thirds of the patient required ICU admission and out of them 60 % required NIV support and rest 40% were managed by Oxygen via Facemask. Rest one third patient required admission in general ward. All the patients show heterogenous opacities in chest Xray. All the patients show patchy areas of consolidation with Ground Glass changes in HRCT Chest. Two third of the patients show pleural effusion in both Chest Xray and HRCT Chest and out of them 80 % patients show bilateral pleural effusion.ARDS of varying degree with mucosal irritation is the most common presenting feature of patients with ACUTE EPICHLOROHYDRIN POISONING. Pneumonia with HRCT chest showing Ground Glass Opacities are common.

Naloxone-associated pulmonary edema following recreational opioid overdose.

Describe a series of patients who developed naloxone-associated pulmonary edema after recreational opioid use. Single center retrospective case series of patients who developed pulmonary edema following the prehospital administration of naloxone. Academic, urban safety-net hospital. Adults with recreational opioid overdose who developed naloxone-associated pulmonary edema, defined as the acute onset of respiratory distress, hypoxemia, and radiographic pulmonary edema after naloxone administration for opioid intoxication, provided that gas exchange and chest imaging rapidly improved and pulmonary aspiration of gastric contents was not clinically suspected. Ten adults (median age 23years, 90% male) met our case definition for naloxone-associated pulmonary edema. Implicated opioids were heroin in 8 patients and methadone and oxycodone in 1 patient each. The median total dose of naloxone was 4.25mg (interquartile range [IQR] 3.3-9.8) prior to the onset of clinically-apparent pulmonary edema. Seven patients received invasive mechanical ventilation for a median of two days (IQR 0.8-5), one of whom received veno-venous extracorporeal membrane oxygenation support, and all survived to hospital discharge. Severe acute pulmonary edema may follow naloxone administration after recreational opioid overdose. Acute care clinicians should be aware of this potentially life-threatening adverse effect of naloxone.

A CASE OF VAPING-RELATED LUNG INJURY MIMICKING COVID-19

TOPIC: Tobacco Cessation and Prevention TYPE: Medical Student/Resident Case Reports INTRODUCTION: E-cigarette and vaping associated lung injury (EVALI) was first recognized in 2019 and can present with acute onset respiratory distress mimicking that of COVID-19. It is important to consider in a young patient with a significant vaping history. CASE PRESENTATION: A 19-year-old male with a history of anxiety, depression, and delusional disorder presented with worsening dyspnea, fever and productive cough, nausea, vomiting, diarrhea for 1 week. He had gone to urgent care where he had tested negative for COVID19 twice and was started on Azithromycin. He denied any exposure to COVID positive individuals but reported that his siblings' school had a recent outbreak. Vitals on admission were temperature 100.3F, Heart rate 121, Respiratory rate 24, Blood Pressure 157/97, pulse oximetry 81% on Room Air, improved after 6L supplemental oxygen. Labs significant for leukocytosis of 19.4K, normal procalcitonin, ESR >130, ferritin 443, LDH 694, CRP 358. Urine drug screen positive for THC (tetrahydrocannabinol). Urine was negative for Legionella and Strep pneumoniae. COVID testing were negative on 3 separate occasions. Chest x-ray showed mild-moderate pulmonary congestion, but no effusions. Chest CTA showed patchy parenchymal interstitial infiltrates bilaterally, suspicious for nonspecific pneumonitis/atypical viral pneumonia or pulmonary edema, but no pulmonary embolus. Blood cultures and sputum cultures negative.On further questioning, he attested to vaping and smoking marijuana through a bong; he had recently bought a new THC product off the street for vaping that contained vitamin E acetate. Given his history of vaping and his failed treatment with antibiotics, we considered EVALI. He was started on prednisone 40mg daily and 5 day course of Azithromycin and Ceftriaxone. On the 4th day of hospitalization, he showed significant clinical improvement and was no longer requiring oxygen supplementation. The patient was discharged on Day 5. Repeat chest xray 5 days after discharge showed no evidence of active disease. DISCUSSION: EVALI is a diagnosis of exclusion; it can mimic atypical and viral pneumonias, most notably COVID-19. Vitamin E acetate is the main causative agent, resulting in an acute lung injury with findings of acute fibrinous pneumonitis, diffuse alveolar damage, or organizing pneumonia. Patients are usually treated with supportive care, antibiotics, and systemic steroids. The COVID19 pandemic poses a diagnostic challenge to accurately diagnose cases of EVALI due to the similar presentation of both diseases: acute to subacute respiratory symptoms with gastrointestinal symptoms, ground-glass opacities on CT, and elevated inflammatory markers. CONCLUSIONS: Similar to COVID19, EVALI can also be fatal, and should not be overlooked as a diagnosis. A thorough history is imperative in reaching a diagnosis, and can save PPE use, and decrease hospitalization cost. REFERENCE #1: "Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products." Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 27 Nov. 2020, www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html#overview. REFERENCE #2: Blount, Benjamin C., et al. "Vitamin E Acetate in Bronchoalveolar-Lavage Fluid Associated with EVALI." New England Journal of Medicine, vol. 382, no. 8, 2020, pp. 697–705., doi:10.1056/nejmoa1916433. REFERENCE #3: Hollingsworth, Helen. UpToDate, 9 Feb. 2021, www.uptodate.com/contents/e-cigarette-or-vaping-product-use-associated-lung-injury-evali?search=evali&source=search_result&selectedTitle=1~13&usage_type=default&display_rank=1#H4113759245. DISCLOSURES: No relevant relationships by Rebecca Greenspan, source=Web Response No relevant relationships by Areej Khan, source=Web Response No relevant relationships by Manpreet Mann, source=Web Response No relevant relationships by Krishnaveni Sirigaddi, source=Web Response

Correlation Between the Ratio of Oxygen Saturation to Fraction of Inspired Oxygen and the Ratio of Partial Pressure of Oxygen to Fraction of Inspired Oxygen in Detection and Risk Stratification of Pediatric Acute Respiratory Distress Syndrome.

Objective: To measure the correlation between the ratio of oxygen saturation to fraction of inspired oxygen [SpO2/FiO2 (SF)] and the ratio of partial pressure of oxygen to fraction of inspired oxygen [PaO2/FiO2 (PF)] among children diagnosed with acute respiratory distress syndrome (ARDS).Methodology: A cross-sectional study was conducted at the pediatric intensive care unit (PICU), National Institute of Child Health (NICH), Karachi, a tertiary care government hospital, from November 2020 to July 2021. One hundred twenty children (of either gender) having the age range of 2 months to 16 years, admitted to PICU with acute onset of respiratory distress, were included in the study. We measured SpO2, PaO2, FiO2 and calculated SF and PF ratios. SPSS (version 23) (Armonk, NY: IBM Corp) was used to analyze data, and the Spearmen's correlation test was applied to measure the relationship between SF and PF ratios.Results: A total of 120 children were included, the mean age was 40.58±38.88 months and 67 (55.8%) were males. The mean FiO2 was 76.33%, the mean PaO2 and SpO2 were 100.35 mmHg and 94.37%, respectively. The mean PF ratio was 156.34, and the mean SF ratio was 156.45. There was a strong correlation between the SF ratio and the PF ratio (r=0.688; p=0.001).Conclusion: This study has shown that there is a strong correlation between the SF and PF ratios, and a statistically substantial agreement has been observed.

Vascular air embolisation and expansile sphenopalatine sinus haematoma secondary to a fracture of the rostral skull in a horse

Vascular air embolisation and expansile sphenopalatine sinus haematoma secondary to a fracture of the rostral skull in a horse

A radiolucent bronchial foreign body in a two‐ and a half‐month‐old Labrador Retriever with acute onset respiratory distress

AbstractA two‐ and a half‐month‐old intact male Labrador Retriever was presented to the Texas A&M University Veterinary Medical Teaching Hospital for acute onset respiratory distress with concern for a potential foreign body. Upon intake by the emergency service, the puppy was exhibiting expiratory dyspnoea. Radiographs revealed marked gas distension of the oesophagus and stomach. No radiopaque foreign bodies were identified. Bronchoscopy revealed a dark brown foreign body in the right middle lobe bronchus. The foreign material was pliable and crumbled upon removal attempts with a snare retrieval device. The majority of the foreign body was removed en masse; it most closely resembled faecal material. Three‐view thoracic radiographs performed 1 day post‐endoscopy revealed aspiration pneumonia. The dog was discharged from the hospital with doxycycline, and the pneumonia was nearly resolved at the 1‐week recheck. The dog was sent home with another 2 weeks of doxycycline and made a full recovery at home.

Diaphragmatic hernia and unilateral renal agenesis in a crab-eating fox (Cerdocyon thous)

An approximately 3-month-old crab-eating fox (Cerdocyon thous) was found by environmental authorities in the State of Paraiba, Northeastern Brazil and referred to a wildlife care center. The fox was presenting respiratory distress and it was referred to the Veterinary Hospital of the Federal University of Paraiba (UFPB) for ancillary testing. Abdominal and thoracic ultrasound and radiographies were performed. These imaging tests indicated the fox had a possible diaphragmatic hernia and ectopic kidney. The imageology results were confirmed on necropsy, which revealed a postero-lateral focal discontinuity of the dorsal aspect of the diaphragmatic muscle with protrusion of the gastrointestinal tract into the thoracic cavity. The stomach and intestinal loops were filled with gas and obliterated the visualization of the heart and lungs. Additionally, only the right kidney was found, and no vestigial left kidney was identified. Congenital diaphragmatic hernias are not commonly observed in wildlife but should be considered as a potential differential diagnosis for acute onset of respiratory distress in young carnivores.

A rare cause of pediatric respiratory distress: pulmonary embolism

Pediatric Pulmonary Embolism (PE) is a very rare condition as compared to adults. However, the incidence of pulmonary embolism in children is increasing as a result of accurate and timely diagnosis. Authors hereby reporting a 7-year-old female child who presented to us with acute onset respiratory distress and hypotensive shock, with no other significant illness in the past. The diagnosis of pulmonary embolism was made based on chest x ray, electrocardiogram and echocardiography. After ascertaining the diagnosis of PE, child was started on unfractionated heparin infusion along with other supportive measures. But the child went into refractory shock followed by asystole, could not be revived. Pulmonary embolism is a rare and potentially fatal, condition that often goes unrecognized among the pediatric population. There should be high index of suspicion on PE in a child who presented with sudden onset respiratory distress with other supportive radiological, 2d echo and lab findings.

1684. Clinical Profile and Outcome of Scrub Typhus-Related Acute Respiratory Distress Syndrome in Adults Presenting to a Tertiary Care Hospital in North India

BackgroundTo study the clinical profile and outcome of adult patients presenting with Scrub typhus ARDS in emergency at our institute.MethodsProspective observational study which included 126 adult patients presenting to emergency department at, PGIMER Chandigarh, a tertiary care referral institute in northwestern India with acute febrile illness with ARDS (acute onset respiratory distress within one week of fever or new/worsening respiratory symptoms with PaO2/FiO2 ratio less than 300 with PEEP or CPAP more than 5 cm H2O from January 2016 to December 2017.All the patients consenting for the study underwent detailed clinical evaluation and investigated for the etiology as per standard protocol followed at our institute with special emphasis to rule out tropical illnesses like scrub typhus, malaria, leptospirosis, dengue and H1N1 influenza. Patients were followed till discharge.ResultsOut of 126 patients eligible for the study, 45.2% were males and 54.8% were females. 47.6% were admitted in the monsoon/post-monsoon period. In addition to fever and dyspnea, cough (75.8%), hepatomegaly (56%), myalgia (63%), splenomegaly (31.3%), pedal edema (34.2%), pallor (40.4%), and vomiting (48.4%) were the common symptoms observed. Scrub typhus in 33.3%, followed by H1N1 influenza in 15.8%, co-infections in 12.6%, leptospirosis in (4.76%), dengue in (3.96%) and malaria in 3.17% of the patients, were the most common etiologies encountered. In 26.9% patients, no definite infective etiology could be found. Among the scrub typhus patients, 16 required ventilation. SOFA score of more than 6 was noted in 24 (57.14%) patients with scrub typhus as compared 9 (47.3%) patients with H1N1 infection. 12.1% of patients with scrub typhus succumbed to their illness when compared with 36.8% of patients with H1N1 infection. At admission in emergency female sex (P = 0.048), age less than 45 years, (P = 0.020), abdominal pain (P = 0.011), presence of hepatosplenomegaly (P = 0.001/0.010), thrombocytopenia <150,000 (P = 0.001), transaminitis (P = 0.00) were significant predictors of a diagnosis of scrub typhus when compared with a non-scrub typhus etiology of patients with fever and ARDS.ConclusionScrub typhus is an important, treatable tropical infection causing ARDS especially in monsoon/post-monsoon seasons in Northwestern India.Disclosures All authors: No reported disclosures.

CAN CEMENT TAKE OUR BREATH AWAY? AN INTERESTING CASE OF PULMONARY EMBOLISM AFTER KYPHOPLASTY

SESSION TITLE: Monday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Pulmonary cement embolism (PCE) refers to embolization of polymethyl methacrylate into the lungs. Patients are most often asymptomatic, but reports have been made were patients present symptomatically after PCE. We report a case of a 61-year-old man who had a vertebral kyphoplasty and presented 2 days later with acute onset respiratory distress and found to have a fatal PCE in the setting of multiple comorbidities. CASE PRESENTATION: 61-year-old male with medical history of HIV, DM, HTN, ESRD on HD, presented with worsening back pain. The back pain started after a mechanical fall. Imaging revealed a T12 burst fracture.Patient underwent an uncomplicated kyphoplasty of T11, T12, L1 vertebrae, did well post-operatively and was discharged. Patient presented back to ED on same day of discharge with complaints of acute onset shortness of breath. On arrival, Patient appeared in severe respiratory distress. His physical examination was remarkable for decreased breath and crackles bilaterally. Due to increased work of breathing, he was intubated and placed on mechanical ventilation in the ED. Initial CXR showed increased hyperdense perihilar opacities. The clinical presentation was concerning for embolic vertebroplasty material (IMG1). This was confirmed with a CTA (IMG2) which reported extensive vertebroplasty cement embolism to the pulmonary arteries and enlargement of the pulmonary arteries. Patient was admitted to the ICU for mechanical ventilation and open cardiac surgery to remove cement from the lungs was considered, but patients status continued to deteriorate in the following 24 hours. He was hemodynamically unstable requiring large doses of vasopressors and requiring immediate hemodialysis. Patient had an episode of PEA arrest after which family decide to withdraw care. DISCUSSION: In this case, a Chest X ray showed pulmonary infiltrates and an increase in perihiliar opacities compatible with embolic vertebroplasty at the ER after 72 hours post procedure. Although most patients remain asymptomatic according to different authors, it has been reported cases in which patients develop symptoms months, and even until 10 years after procedure. PCE after kyphoplasty is a complication that happens according to different series as low as 3.5% up to high as 28.6% . Percutaneous kyphoplasty has been reported with less possibility to develop Pulmonary cement embolism than vertebroplasty. The presence of comorbidities in a patient of the older age increased the possibilities of fatal outcome in this patient. CONCLUSIONS: Percutaneous kyphoplasty one of the main complications of this procedure has been the development of PCE which if detected early with a high index of suspicion has an overall good prognosis. In those patients with serious co-morbidities and kyphoplasty, closer monitoring should be done in order to detect the onset of symptoms and to provide adequate treatment to avoid fatal outcomes. Reference #1: M.I. Syed, S. Jan, N.A. Patel, A. Shaikh, R.A. Marsh, R.V. Stewart. Fatal Fat Embolism after Vertebroplasty: Identification of the High-Risk Patient. American Journal of Neuroradiology Feb 2006, 27 (2) 343-345. Reference #2: Dash A, Brinster DR. Open heart surgery for removal of polymethylmethacrylate after percutaneous vertebroplasty. Annals of Thoracic Surgery. 2011;91(1):276–278 Reference #3: Nishant Sinha, Vivek Padegal, Satish Satyanarayana,and Hassan Krishnamurthy Santosh. Pulmonary cement embolization after vertebroplasty, an uncommon presentation of pulmonary embolism: A case report and literature review DISCLOSURES: No relevant relationships by Gustavo Avila, source=Web Response no disclosure on file for Yash Jobanputra; No relevant relationships by Purva Sharma, source=Web Response

An Unusual Case of Stridor: Severe Tracheal Narrowing Secondary to Esophageal Food Impaction.

Foreign body impaction (FBI) in the esophagus has the potential to be a serious condition with a high mortality rate. Although the majority of foreign bodies trapped within the esophagus pass spontaneously, some do require endoscopic intervention. This case discusses a 95-year-old-female with a history of cerebral vascular accident who presented with acute onset respiratory distress with inspiratory stridor. The patient denied any episodes of choking or foreign body sensation. Further imaging revealed a large food bolus within the esophagus with extensive tracheal narrowing. The patient was diagnosed promptly and successfully managed endoscopically. This case presentation emphasizes the need to maintain a high index of clinical suspicion for FBI in high-risk populations, especially when the patient’s history makes it unlikely. In the setting of respiratory complications, airway protection remains a priority, but an accurate diagnosis with timely intervention is paramount.

Osteopontin mediates murine transfusion-related acute lung injury via stimulation of pulmonary neutrophil accumulation

AbstractTransfusion-related acute lung injury (TRALI) is one of the leading causes of transfusion-related fatalities and is characterized by the onset of acute respiratory distress within 6 hours upon blood transfusion. Specific therapies are unavailable. Preexisting inflammation is a risk factor for TRALI and neutrophils (polymorphonuclear neutrophils [PMNs]) are considered to be the major pathogenic cells. Osteopontin (OPN) is a multifunctional protein expressed at sites of inflammation and, for example, is involved in pulmonary disorders, can regulate cellular migration, and can function as a PMN chemoattractant. We investigated whether OPN is involved in TRALI induction by promoting PMN recruitment to the lungs. Using a previously established murine TRALI model, we found that in contrast to wild-type (WT) mice, OPN knockout (KO) mice were resistant to antibody-mediated PMN-dependent TRALI induction. Administration of purified OPN to the OPN KO mice, however, restored the TRALI response and pulmonary PMN accumulation. Alternatively, blockade of OPN in WT mice using an anti-OPN antibody prevented the onset of TRALI induction. Using pulmonary immunohistochemistry, OPN could be specifically detected in the lungs of mice that suffered from TRALI. The OPN-mediated TRALI response seemed dependent on macrophages, likely the cellular source of OPN and OPN polymerization, and independent from the OPN receptor CD44, interleukin 6 (IL-6), and other PMN chemoattractants including macrophage inflammatory protein-2 (MIP-2). These data indicate that OPN is critically required for induction of antibody-mediated murine TRALI through localization to the lungs and stimulation of pulmonary PMN recruitment. This suggests that anti-OPN antibody therapy may be a potential therapeutic strategy to explore in TRALI patients.

Inhibition of mesenchymal stromal cells’ chemotactic effect to ameliorate paraquat-induced pulmonary fibrosis

BackgroundParaquat (PQ) poisoning is one of the leading causes of suicide attempts in China signature by acute onset of respiratory distress with massive matrix production resulting in progressive pulmonary fibrosis. There is no specific antidote and mortality remains high without effective treatment available. The cellular mechanisms underlying PQ-induced pulmonary fibrosis remain largely unknown. ObjectivesTo determine the origin of mesenchymal stem cells (MSCs) migrated to the lung after PQ exposure and their roles in PQ-induced pulmonary fibrosis, to further explore the possible mechanisms involved in these processes, and to help finding novel therapies. MethodsWe used a combination of lineage tracking techniques to investigate the contributions of several cells of MSCs, marked by Nestin or CXCL12, and traced their co-expression of α-smooth muscle actin (α-SMA), a marker for fibrosis, or their co-location with matrix production, marked by collagen-1 production (Col1-GFP) following PQ exposure. Then, we used a CXCL12flox/flox; Prx1-Cre mice and a pharmacologic agent AMD3100 to selectively deplete chemotactic mechanism of the MSCs, and tested pro-fibrotic pathways, fibrotic processes and survival of mice after PQ exposure. ResultsOur results showed that after paraquat exposure, the residential Nestin + MSCs were quickly expanded and contributed to extracellular matrix production. Moreover, when we used a CXCL12flox/flox; Prx1-Cre mice to selectively deplete chemotactic mechanism of the MSC, we found that PQ exposure in these mice failed to activate pro-fibrotic pathways including TGF-β, Wnt and EGFR signaling. Furthermore, when the chemotactic effect of MSCs via CXCL12 was blocked by a pharmacologic agent, AMD3100, it alleviated the development of the fibrotic process and improved survival rate in mice exposed to PQ. ConclusionCollectively, our data suggest paraquat intoxication rapidly activated Nestin + MSCs and that blocking chemotactic effects of MSCs by perivascular CXCL12 inhibition may effectively protect pulmonary injury following paraquat exposure. Our results revealed a novel mechanism for post-PQ lung injury and indicated a novel therapeutic option to attenuate fibrosis induced by paraquat.