Months Of Pneumonia Research Articles

PULMONARY HYPOPLASIA SECONDARY TO PULMONARY ARTERY STENOSIS: SURGICAL FIX FOR RECURRENT PNEUMONIA?

SESSION TITLE: Global Case Report Posters SESSION TYPE: Global Case Reports PRESENTED ON: October 18-21, 2020 INTRODUCTION: Introduction Congenital bronchopulmonary vascular malformations include a wide spectrum of disorders that compromise one or more of the three main systems of the lung (lung parenchyma, arteries and veins). The stage of gestation where disruption of the pulmonary vessels occurs determines the severity of lung affectation and alveolarization, ranging for segmentary affectation or the complete pulmonary hypoplasia. We present a case of primary pulmonary hypoplasia secondary to pulmonary artery stenosis. CASE PRESENTATION: A 11-year-old boy with history of recurrent pneumonia is evaluated in clinic. He was first admitted to the intensive care unit at age 40 months for pneumonia. Since then, he has had multiple admissions for recurrent pulmonary infections and wheezing treated with beta agonists. His chest x-ray revealed a marked decrease in volume in the right lung, with ipsilateral mediastinal shift. Computerized tomography angiography showed generalized bronchiectasis, main bronchus and pulmonary artery hypoplasia in the right side, with a significant reduction in lung volume. The left lung was hyperinflated and had compensatory emphysema. Scintigraphy revealed a total absence of perfusion in the right lung. Right heart catheterism was consistent with pulmonary artery stenosis. Patient underwent right pneumonectomy. He developed pneumonia and hydrothorax in the postoperative period, and was treated conservatively with antibiotics and incentive spirometer use. Repeat imaging showed a decrease in pleural effusion size. He had clinical improvement and he was discharged home with ambulatory follow up. DISCUSSION: Pulmonary hypoplasia is frequently associated with other malformation, including abnormalities of the thoracic cavity, masses and amniotic fluid disorders. When severe, it is generally diagnosed prenatally or shortly after birth. It can also be associated with congenital heart defects and in rare cases, no cause can be found. The severity of symptoms and their time of occurrence is defined by the degree of hypoplasia present in the patient. There have been reports of diagnosis in adulthood, presenting with recurrent respiratory infections. Clinical exam can show a shorter hemitorax of the affected side, intercostal spaces or diminished breath sounds. Imaging studies like CT can aid diagnosis, showing deviation of the mediastinum to the affected side, thinner vasculature and enlarg. CONCLUSIONS: Pulmonary hypoplasia secondary to pulmonary artery stenosis might present as recurrent respiratory infections and hospitalization. In cases with severe hypoplasia where lung function is severely compromised, pneumonectomy can be considered. Reference #1: Katayama Y, Kusagawa H, Komada T, Shomura S, Tenpaku H. Bronchopulmonary foregut malformation. Gen Thorac Cardiovasc Surg. 2011;59(11):767-770. doi:10.1007/s11748-010-0763-z Reference #2: Abrams, M., Ackerman, V. & Engle, W. Primary Unilateral Pulmonary Hypoplasia: Neonate through Early Childhood — Case Report, Radiographic Diagnosis and Review of the Literature. J Perinatol 24, 667–670 (2004). https://doi.org/10.1038/sj.jp.7211156 Reference #3: Papadopoulos D, Misthos P, Chorti M, et al. Unilateral pulmonary hypoplasia in an adult patient. Monaldi Arch Chest Dis. 2018;88(1):829. Published 2018 Jan 29. doi:10.4081/monaldi.2018.829 DISCLOSURES: No relevant relationships by Amarilys Alarcon-Calderon, source=Web Response No relevant relationships by ISMAR LOPEZ MURALLES, source=Web Response No relevant relationships by LUIS PEREZ MANCILLA, source=Web Response No relevant relationships by Shubert Iván Quiñónez Najera, source=Web Response

Pulmonary Mucormycosis in a Patient with Crohn Disease on Immunosuppressive Medications including Infliximab

Case presentation A 68-year-old man presented to hospital with a two-day history of increasing shortness of breath, left-sided pleuritic chest pain and chills. His medical history was significant for longstanding Crohn disease (>55 years) requiring multiple bowel resections in the 1970s in addition to high-dose corticosteroid therapy. For the past five years, he had been maintained on infliximab with only low-dose steroids for iatrogenic adrenal insufficiency. Additional medical problems included short gut syndrome, hypothyroidism and bronchiectasis; there was no history of diabetes. He experienced two hospital admissions in the preceding six months for pneumonia, one of which was due to Pneumocystis jirovecii confirmed by open lung biopsy. His medications on this admission included budesonide 6 mg orally three times daily, azathioprine 100 mg orally twice daily, infliximab 600 mg intravenously every four weeks, levothyroxine 25 µg orally daily, atovaquone 1500 mg orally daily, and salbutamol and ipratropium inhalers as needed. His most recent dose of infliximab was one month before admission. A physical examination revealed signs of consolidation in the left lung. His complete blood count included a white blood cell

Severe Myelosuppression and MRSA Infection as the Presentation of Perinatal HIV Infection

Severe Myelosuppression and MRSA Infection as the Presentation of Perinatal HIV Infection

A community-based study of acute respiratory infections among preschool children in Syria.

A longitudinal community-based study of the epidemiology of acute respiratory infections (ARI) in children less than 5 years old was carried out in a low income peri-urban area of Syria. A total of 1030 children were followed up by weekly morbidity surveillance for a period of 24 weeks, starting September 1989. The results revealed that, on average, a child suffered 3.4 episodes of ARI per 100 child-days at risk. The average prevalence of ARI was 23 per cent of time of observation. The peak age-specific incidence occurred in children 6-12 months old for cough/cold, and in children 0-5 months for pneumonia. Male children experienced higher incidence and prevalence of ARI. The most frequently reported symptoms were nasal discharge and cough.

Unruptured interstitial pregnancy

Mrs. R. H., white, aged twenty-nine years, had been married ten years, and had three chiIdren Iiving and weII, the fourth, born in I 919, having died after five months of pneumonia. She had had one earIy abortion without complications. AI1 the Iabors and puerperia were normal. Menstruation began at the age of 14. It is of the twenty-eight day type, Iasts three days, and the flow is moderate, and without pain. The patient’s Iast menstrua1 period ended February 3, 1925. In ApriI she used “sIippery elm sticks” to induce an abortion. The next day she had some uterine bIeeding, foIIowed in two days by chills and fever and general malaise. On ApriI 22 she was admitted to the hospital. There was generahzed tenderness throughout the Iower abdomen. The fundus was large and very tender with marked induration and tenderness in the region of both adnesae. A diagnosis was made of peIvic peritonitis, metritis and perimetritis. Her hemogIobin was 32 per cent, WAC. 11,500, P.M.N., 79 per cent. Her temperature was 100’ F., pulse I IO, respirations normaI. She remained in the hospita1 for eight days, at the end of which time her temperature returned to normal, and she was feeIing quite weI1. She was seen again in the Out-Patient Department June 14, because of a severe pain through the lower abdomen, more marked on the right side, At that time the vagina1 mucosa was bIue, the cervix was enIarged and soft, there was a mass which rose within a finger breadth of the umbilicus. This mass was irregularIy softened and felt Iike a normaIIy progressing pregnancy. Because of the temperature of 99.4’ F. and the severe pain, the patient was again admitted to the hospital. Her temperature soon feI1 to normal, and she was discharged at the end of the second day. On JuIy 2 she was examined again. The uterus seemed about the size of a five months’ pregnancy. There was great tenderness in the region of both tubes and ovaries, more marked apparentIy on the left side. Her temperature was 99.8” F., and she compIained of some frequency and dysuria and pains in the Ieft Iower quadrant. On July 21 the patient began having a few cramps, which were foIlowed by a bloody vagina1 discharge. July 23 she had a sudden gush of fluid. The next day the uterus was a IittIe smalIer than formerly, and there was Iess tenderness in the abdomen. We thought at that time that the patient would abort. On August 20 she was examined again, and the uterus seemed definiteIy smaIIer than previously. The patient said she had been having a fouI-smelIing brownish discharge, with some bright blood at times. When seen in September she had been feeIing quite weI1; there had been a IittIe bright red discharge; the uterus was definiteIy smaIIer, but stiI1 considerabIy Iarger than normal. She was examined the first of October. At that time the uterus was about the size of a three months’ pregnancy and rather hard and freeIy movable, and the cervix was closed. She returned to the hospitat October IS, stating that for the previous twenty-four hours she had been having considerable bleeding. The uterus was about the same size as that at the Iast examination, at which time it was felt that the patient should be curretted, and this was done in August. The left waI1 of the uterus seemed about norma thickness. The right cornu was about 2 inches thick, feeling Iike an intramural fibroid in this region. The uterine cavity itself did not contain any product of pregnancy. It was curretted, but nothing abnormal was obtained. Pathologica examination showed no suggestion of feta1 tissue. The patient made an uneventfu1 recovery from this, and left the hospital three days later. On November 19 she returned. The emargement in the right cornu of the uterus was about the size of a basebaI1. It was discrete, firm and not tender. The uterus was quite movabIe. We made a diagnosis then of fibromyoma of the uterus. In December she was examined again, and at that time we advised operation for fibromyoma. * From the Gynecological Division of the Henry Ford HospitaI.