Complaints Of Dyspnea Research Articles

P268 Laryngeal Mucormycosis: does mucor take the voice away?

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PMObjectiveThis case aims to highlight a unique presentation of Mucormycosis.Methods and ResultsA 57-year-old retired office supervisor, presented to the ENT department with complaints of hoarseness of voice ending with almost complete dysphonia over 6 months. There were no complaints of stridor, dyspnea or dysphagia. He had no history of prior surgery or tracheal intubation. On examination, a lesion over his right vocal cord was noted (Fig. 1) and underwent surgical excision of the lesion.HPE of the lesion (Fig. 2) showed hyperplastic stratified squamous epithelium which was partly ulcerated and covered by thick bands of necro-inflammatory material. Within the necrotic material were seen broad aseptate fungal hyphae. Beneath the necrotic material was inflamed granulation tissue with fibrosis. No tissue or vascular invasion was noted as per the report, however there was a recurrence of the lesion after 15 days.ID team opinion was sought in view of need for antifungals. Owing to financial constraints, CT chest could not be done, but his chest X-ray was normal. His HbA1c was 7.5%, which was suggestive of newly detected diabetes mellitus (DM).In this case, even though no angioinvasion or tissue invasion was reported, the presence of hyphae in the area of necrosis, the presence of inflammatory local tissue reaction, coupled with newly detected DM, prompted the ID team to advise treatment with amphotericin B followed by suspension posaconazole (GR was not available at the that time). The patient was not willing for treatment at the time. However, local recurrence of the lesion occurred 2 weeks later. Surgical resection along with posaconazole, TDM and close follow-up was advised. However, the patient was lost to follow-up, possibly due to loss of confidence in us?ConclusionThe importance of sending every surgically excised tissue for histopathology and culture has been highlighted by this case. Early ID opinion and AF therapy could have averted recurrence and loss of patient confidence. Chronic Granulomatous form of mucormycosis though rare, needs timely diagnosis and treatment in the form of surgical resection as well as systemic antifungal therapy.

Decreasing degrees of dyspnea in chronic obstructive pulmonary disease patients through combination of breathing exercises and relaxation

Shortness of breath (dyspnea) is a common symptom that accompanies patients with Chronic Obstructive Pulmonary Disease (COPD). Management of dyspnea in patients with COPD is not only using pharmacological therapy but also non-pharmacological therapy. Non-pharmacological therapy for patients with COPD covers three main aspects: breath, mind, and functional processing. Along with the development of complementary therapy in nursing science, nursing interventions that can be done at home begin to be in great demand because of their low cost and time effectiveness. One of the interventions is providing breathing exercises and relaxation for patients with COPD to reduce the dyspnea complaints, increase the strength of breathing muscles and prevent the hospital re-admission due to acute exacerbation. This study aimed to see the effectiveness of the combination of Pursed Lip Breathing (PLB) and Progressive Muscle Relaxation (PMR) on the degree of dyspnea. This quasi-experimental study was conducted with a pre and post-test design approach with 20 respondents in each group. The results showed significant differences in the degree of dyspnea after the combination of PLB and PMR (p < 0.05). The results from this study recommend improving the development of complementary therapy programs in nursing education and services by modifying nursing care standards with the combinations of PLB and PMR for patients with COPD.

The Effect of Preoperative Anxiety on Postoperative Symptoms in Patients Without a History of Anxiety Scheduled for Coronary Artery Bypass Grafting

The aim of this study was to measure the level of preoperative anxiety in patients scheduled for coronary artery bypass grafting (CABG) to assess the relationship between anxiety and postoperative symptoms.
 Materials and Methods. This descriptive study was conducted at a single university hospital from February to November 2021. Seventy-four CABG patients who completed the Anxiety Specific to Surgery Questionnaire, the Visual Analogue Scale, the Modified Borg Scale, the Rhodes Index of Nausea, Vomiting and Retching were included in the study. The data were analyzed by the mean, standard deviation, frequency distribution, Mann-Whitney U Test, and Spearman’s correlation analysis.
 Results. The average age of participants was 65.55 ± 8.35; 66.2% of them were males. The ASSQ total scores of female participants were significantly higher as compared to male participants (p < 0.05). There was a statistically significant positive relationship between the levels of anxiety in patients before CABG and the levels of postoperative pain and dyspnea severity (p < 0.05).
 Conclusions. Patients were found to experience predominantly moderate to severe anxiety before CABG, and increased dyspnea complaints and pain in the postoperative period. A coordinated, multidisciplinary approach to preoperative training of healthcare professionals may offer a promising way to provide more efficient and productive services.

Thoracic Splenosis in the Setting of Abdominal Trauma

The uncommon case of thoracic splenosis is presented in this paper. A patient presents to the hospital with the complaint of dyspnea on exertion. He is incidentally found to have thoracic splenosis. The case of thoracic splenosis is a vital topic to discuss in order to accurately diagnose, recognize, treat symptoms, and explore how it can exacerbate pulmonary or cardiology pathology.

EGFR-Mutated Pulmonary Choriocarcinoma Combined With Adenocarcinoma

A 78-year-old woman with no history of smoking presented to our hospital with complaints of wet cough and exertional dyspnea that had worsened progressively in 1 week. Physical examination result revealed reduced air entry into the right side of the chest. Imaging result by computed tomography revealed an 8.6 cm-sized mass in the right middle-to-lower lobes and multiple nodules in the bilateral lobes of the lung (Fig. 1). Subsequently, multiple masses in the liver, vertebrae, and uterus were detected.

Concurrence of IgG4-related disease and Kimura disease with pulmonary embolism and lung cancer: a case report

BackgroundImmunoglobulin G4 (IgG4)-related disease (IgG4-RD) is a systemic disease that involves the infiltration of IgG4-positive plasma cells in multiple organs. Kimura disease (KD) presents as subcutaneous masses on the head and neck, frequently accompanied by eosinophilia and high immunoglobulin E (IgE) levels. Here, we report a rare case of concurrence of IgG4-RD and KD with manifestations of asthma, pulmonary embolism, and central diabetes insipidus accompanied by lung carcinoma.Case presentationA 65-year-old Chinese male with an eight-year history of KD was admitted to our hospital with complaints of dyspnea and expectoration for one month. Laboratory examination showed a considerable elevation in the serum eosinophil count and total IgE and IgG4 levels. Chest enhanced computed tomography showed filling defects in the right pulmonary artery and a nodule in the left inferior lobe. Pancreatic enhanced magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography showed a swollen pancreatic tail and local stricture of the pancreatic duct section of the common bile duct. Enhanced MRI of the pituitary gland showed thickening of the pituitary stalk. Additionally, immunohistochemistry of the specimens collected eight years prior revealed IgG4-positive cells. Following the diagnosis of IgG4-RD with KD, glucocorticoids with immunosuppressants were initiated; there was a prompt improvement in the patient’s condition. One-year post-discharge, the patient underwent wedge-shaped resection of the lung due to enlargement of the pulmonary nodule, and the pathology revealed lung squamous carcinoma.ConclusionsThis case presents a rare clinical condition in which the concurrence of IgG4-RD and KD causes various rare manifestations including asthma, pulmonary embolism, central diabetes insipidus, and complicated lung carcinoma. This highlights the importance of monitoring for malignancies in IgG4-RD patients during follow-up.

Giant right coronary artery aneurysm with vena cava superior fistula: a case report and radiological findings

BackgroundGiant coronary artery aneurysms (GCAA) are a rare disease entity with an estimated incidence of 0.02%. Atherosclerosis is the most common underlying factor in adulthood. Management guidelines lack the support of large-scale studies.Case presentationWe present a case of a 58-year-old Caucasian male with complaints of stable dyspnea who was found to have a GCAA of the right coronary artery (RCA). Further evaluation revealed an aneurysm of 5.0 cm in diameter with a tortuous course, fistulation to the distal vena cava superior, and mass effect on the left atrium. Surgical deroofing and ligation of the aneurysm with venous bypassing of the right coronary artery were performed. There were no postoperative complications. Cardiac function had improved at 1-month follow-up and remained improved at 1-year follow-up.ConclusionsDiagnosis and treatment strategy concerning GCAA remain challenging. Surgical treatment is advised in cases of giant aneurysms, multivessel disease, left main coronary artery (LMCA) involvement, mechanical complications (fistula, compression, or rupture), and concomitant valve surgery. Coronary angiography remains the gold standard for evaluation. However, coronary computed tomography angiography (CCTA) and cardiac magnetic resonance imaging (CMR) can add an important value for the clinician to assess myocardial viability and planning of surgical intervention.

Primary pulmonary epithelioid inflammatory myofibroblastic sarcoma: a rare entity and a literature review.

Epithelioid inflammatory myofibroblastic sarcoma (EIMS) is an aggressive subtype of inflammatory myofibroblastic tumor (IMT) harboring anaplastic lymphoma kinase (ALK) gene fusions and is associated with high risk of local recurrence and poor prognosis. Herein, we present a young, non-smoking male who presented with complaints of cough and dyspnoea and was found to harbor a large right lower lobe lung mass. Biopsy showed a high-grade epithelioid to rhabdoid tumor with ALK and desmin protein expression. The patient initially received 5 cycles of crizotinib and remained stable for 1 year; however, he then developed multiple bony metastases, for which complete surgical resection was performed. Histopathology confirmed the diagnosis of EIMS, with ALK gene rearrangement demonstrated by fluorescence in situ hybridization. Postoperatively, the patient is asymptomatic with stable metastatic disease on crizotinib and has been started on palliative radiotherapy. EIMS is a very rare subtype of IMT that needs to be included in the differential diagnosis of ALKexpressing lung malignancies in young adults.

Electrocardiogram findings in a patient with myocardial infarction and atrial fibrillation

A 91-year-old female with a history of hypertension and atrial fibrillation presented to the emergency department with complaints of dyspnea and severe substernal chest pain that began 1 hour prior to presentation. She described the pain as tight and radiating to her left shoulder. The patient’s current medications included oral Apixaban and Lisinopril, but she was non-compliant with her medications.

Accuracy of PoCUS in Diagnosing Acute Dyspnea in ED

Introduction: Acute dyspnea is a common symptom in the emergency department (ED). Diagnosis and management of patients presenting with acute dyspnea is one of the major challenges for physicians in the ED. A correct diagnosis is frequently delayed and difficult to ascertain, and clinical uncertainty is common, explaining the need for rapid diagnosis and a management plan. The standard approach to dyspnea often relies on radiologic and laboratory results, causing an excessive delay before adequate therapy is started. The use of an integrated point-of-care ultrasonography (PoCUS) approach can shorten the time needed to formulate a diagnosis, while maintaining an acceptable safety profile. Materials and Methods: This was a prospective study on 88 patients aged above 18 years who came with a complaint of acute dyspnea to emergency room of a tertiary care center in Mangalore, Karnataka, over a period of 1 year from September 2017 to September 2018. Results: The accuracy of PoCUS in diagnosing acute dyspneic patients was found to be 93.8% in our study. Conclusion: PoCUS is a great tool in all emergency settings to deliver a better care.

Congenital Cystic Adenomatoid Malformation of the Left Lung Presenting in an Adult

A 37-year-old male presented with complaints of cough and dyspnoea on exertion since childhood. His general physical examination was unremarkable. Respiratory examination showed ipsilateral volume loss with bronchial breathing in all the areas of left side. Other systems examination was normal.

A Report of Three Cases Presenting to the Emergency Department due to Near-Drowning

Introduction: The frequency of drowning increases with the warming of the weather, especially in summer months. In this paper, the clinical features, radiological imaging and laboratory values of three patients who presented to the emergency department due to near-drowning are discussed comparatively. 
 Case Report: In Case 1 and 3, advanced life support was applied at the scene and spontaneous circulation was restored. Case 2 presented with the complaint of dyspnea. Cases 1 and 3 died after being admitted to the intensive care unit, while Case 2 was discharged with full recovery. 
 Conclusion: Diffuse ground-glass opacities were detected in the early thorax computed tomography imaging of all three cases. In addition, there were early increases in laboratory values in all three cases, with the highest increases being observed in aspartate aminotransferase, alanine aminotransferase and creatinine kinase values. This suggests that tissue perfusion disorder develops in the early period.

A Case of Progressive Bleomycin Lung Toxicity Refractory to Steroid Therapy

Bleomycin is a common chemotherapy agent used to treat germinative tumors. Bleomycin-induced lung injury (BILI) is an uncommon but devastating adverse effect of its use. It occurs in 10-20% of patients receiving bleomycin, and the initial diagnosis is usually made by new-onset respiratory symptoms and reduced diffusing capacity for carbon monoxide (DLCO). Mainstay treatment includes discontinuing bleomycin, corticosteroids, and supplemental oxygen if needed. We present a case of a 38-year-old male who was found to have a severe presentation of bleomycin-induced lung injury after chemotherapy for metastatic mixed germ cell testicular cancer. During his course, he was treated with the standard of care regimen of corticosteroids and salvage therapy with infliximab but ultimately died from complications of his illness. This case report is noteworthy because our patient had progressive bleomycin-induced lung injury, despite discontinuing bleomycin many months prior, consistent high-dose corticosteroid treatment, and even salvage therapy. In all patients on bleomycin, pulmonary function monitoring is essential, and any complaints of dyspnea should prompt concern for bleomycin-induced lung injury. If initial treatment does not improve their condition, more aggressive measures may be necessary.

Mediastinal Haemangioma with Pericardial Effusion: A Rare Entity

Mediastinal haemangioma is a rare benign vascular tumour. A young male presented with complaints of cough and dyspnoea. Serial chest radiographs were suggestive of progressive mediastinal widening and cardiomegaly. Pericardiocentesis revealed haemorrhagic fluid which was negative for microbiology and malignant cells. Patient was unresponsive to antituberculosis treatment and steroids. Computed tomography (CT) of thorax revealed an anterior mediastinal mass lesion with pericardial effusion which on biopsy was found to be a mediastinal haemangioma.

SILENT HYPOXIA IN COVID-19: IS IT MORE DANGEROUS? A RETROSPECTIVE COHORT STUDY

TYPE: Late Breaking Abstract TOPIC: Critical Care PURPOSE: Silent hypoxia is the presence of hypoxia in absence of subjective experience of breathing discomfort. The aim of our study is to explore differences in disease outcomes in patients with silent hypoxia compared to patients with dyspneic hypoxia. METHODS: We retrospectively reviewed data of COVID-19 patients who were hypoxic at the time of presentation. Clinical, laboratory and treatment parameters were compared. Multivariate logistic regression models were fitted to identify the factors predicting mortality. RESULTS: Among 2080 patients with COVID-19 admitted to our hospital, 811 patients were hypoxic with SpO2<94% at the time of presentation. Out of 811 patients,174 (21.45%) did not have complaints of shortness of breath since the onset of COVID-19 symptoms. 5.2% of patients were completely asymptomatic for COVID-19 and were found to be hypoxic only on pulse oximetry. The case fatality rate in patients with silent hypoxia was 45.4% as compared to 40.03% in hypoxic patients admitted with complaints of dyspnea (P=0.202). The odds ratio of death was 1.1 (95% CI 0.41-2.97) in the patients with silent hypoxia after adjusting for baseline characteristics, laboratory parameters, treatment, and in-hospital complications, which did not reach statistical significance (P=0.851). CONCLUSIONS: Silent hypoxia may be the only presenting feature of COVID-19. Since the case fatality rate is comparable between silent and dyspneic hypoxia, it should be recognized early and treated as aggressively as dyspneic hypoxia for improving disease outcomes. CLINICAL IMPLICATIONS: Silent hypoxia and dyspneic hypoxia have similar outcomes, it is of paramount importance to do pulse oximetry in every patient diagnosed with SARS-CoV-2 infection. DISCLOSURE: Nothing to declare. KEYWORD: Silent Hypoxia

RIGHT SIDED DIAPHRAGMATIC EVENTRATION: A RARE CASE REPORT

Introduction: Eventration of hemidiaphragm is dened as the permanent elevation of all or part of the diaphragm, without defects of continuity in which the involved muscles of the diaphragm are being replaced partly or in full by a bro membranous sheet. Incidence of congenital eventration is 1 in 10,000. Complete and partial eventration both can occur. Complete eventration of the right hemidiaphragm with asthma in an adult female, as presented in this patient, is rarely seen. Case Presentation: A middle aged female presented with complaints of dyspnea and dry cough. Chest examination revealed decreased movements and breath sounds on right side in inframammary, infraaxillary, and infrascapular areas along with bilateral wheeze. Plain Chest radiograph followed by CT thorax was done which revealed an elevated right hemidiaphragm. Possibility of diaphragmatic eventration and paralysis was made. Later on, uoroscopic sniff test was performed. Discussion: Patients are generally asymptomatic however obese patients are usually symptomatic. Conventional chest radiography has been found to be a useful modality for assessment of the functional status of an elevated diaphragm as the evaluation of the shape of an elevated diaphragm may preclude the need for uoroscopic sniff test. However, uoroscopy is necessary to conrm between diaphragmatic paralysis and eventration. Conclusion: It is difcult to distinguish diaphragmatic eventration from paralysis clinically. In our case, diagnosis was made based on radiological ndings and conrmed by nerve conduction study. Patients are managed conservatively but symptomatic patients require surgery.

Non-invasive ventilation – palliative care for an oncology patient

Abstract Patients with neoplastic lung disease experience a decreased quality of life due to progressive respiratory dysfunction. The inclusion of non-invasive ventilation (NIV) in the management plan of these patients has been effective in relieving symptoms of acute respiratory failure, reducing respiratory effort and increasing sleep quality. A 48-year-old patient diagnosed with pulmonary adenocarcinoma (radio-chemo-treated) and COPD presented to the ER with the complaints of thoracalgia, dyspnoea and daytime fatigue. Initial tests showed hypoxemic respiratory failure, mild obstructive sleep apnoea syndrome and right medium pleural effusion. CPAP therapy was initiated but not tolerated by the patient and, therefore, we switched to NIV – BPAP (spontaneous mode) with satisfactory results. The literature indicates that NIV therapy has proved superior to oxygen therapy in cancer patients, relieving dyspnoea in patients with hypoxemic respiratory failure (regardless of PaCO2 level). Moreover, NIV-treated patients required lower doses of opioids and reported an improved quality of life.

Catheter ablation of sustained idiopathic right ventricular outflow tract tachycardia in a pregnant patient without fluoroscopy

In 2020, our department has performed 739 operations on nonpregnant patients. Additionally, 545 highly successful nonfluoroscopic catheter ablation of cardiac arrhythmias were routinely performed using a three-dimensional navigation system, including 47 patients with idiopathic ventricular tachycardia (VT) from the right ventricular outflow tract (RVOT).&#x0D; A 38-year-old female patient with a structurally normal heart was admitted to our hospital in 1011 weeks of her third pregnancy because she sustained recurrent 166 regular heartbeats per minute, wide QRS-complex tachycardia with left bundle branch morphology, and frequent premature ventricular contractions on Holter monitoring with complaints of presyncope and dyspnea. Standard antiarrhythmic drugs failed to control tachycardia. This case report presents our initial successful experience of the rescue zero-fluoroscopy catheter ablation of sustained poorly tolerated idiopathic RVOT tachycardia in a pregnant patient. Our result suggests that this technique may be considered in the few rare cases in which drug-resistant, sustained frequent VT is accompanied by hemodynamic compromise with fluoroscopy contraindication.&#x0D; AIM: Diagnostic algorithm of idiopathic sustained drug-resistant, poorly tolerated VT and the possibility of radiofrequency catheter ablation in the most vulnerable first trimester of pregnancy without fluoroscopy were presented in our case report.

Hypertrophic cardiomyopathy: literature review and case report

Introduction. Hypertrophic cardiomyopathy is an autosomal dominant genetic disease. The signs and symptoms of disease vary in terms of history and clinical course, ranging from the development of acute heart failure or even sudden death, while other patients may remain asymptomatic throughout life. At the same time, there is a lack of correlation between the genotype and the phenotype of the disease. Thus, within a family, of two members carrying the same genetic abnormality, one may present a clinical manifestation of severe heart failure, the other remaining asymptomatic. Clinical case presentation. In this paper, we report a case of a 34-year-old male who comes to see a cardiologist with complaints of moderate-intensity dyspnea, general weakness, and fatigue installed during the post-COVID-19 recovery period. Management and results. The evolutionary positive dynamics of the disease on the prescribed treatment is followed, as well as the diagnostic criteria for hypertrophic cardiomyopathy. Discussion. The discussed clinical case of acute cardiac failure in adult otherwise healthy mail is of interest because it rises clinical combinations that were not debated previously: primary diagnosed hypertrophic cardiomyopathy combined with COVID-19, post-COVID-19 isolated myocarditis, hypertrophic cardiomyopathy associated with myocarditis and infection COVID-19. If the suspicion of hypertrophic cardiomyopathy is confirmed, the eventual perianesthetic management of such a patient will change radically. The article presents details of the pathophysiology of hypertrophic cardiomyopathy and key elements for maintaining hemodynamic goals

An obstructive upper respiratory emergency in a pregnant Belgian blue heifer

In this case report, the surgical intervention and aftercare are described of an upper airway obstruction in a two-and-a-half year old, seven-months pregnant Belgian blue heifer. The animal had been referred to the Clinic for Ruminants (University of Liège) for complaints of stridor and dyspnea and suffered from necrotic laryngitis, complicated by the formation of an obstructive granuloma. Emergency tracheotomy was performed to save the life of the cow and its calf. Through the use of a self-retaining cannula, the modified tracheotomy site could be kept patent until the calf was born and the pathology resolved two months after admission. Healing of the larynx was checked and documented by use of nasal and retro-tracheal endoscopy.