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ILD Case Report Posters IISESSION TYPE: Case Report PosterPRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PMINTRODUCTION: HIGM are a set of disorders with intrinsic B-lymphocyte defects with class switching. This results in high or normal levels of IgM, but low or no production of other immunoglobulins, leading to immunodeficiency. At the same time, uncontrolled B-cell activation without class switch triggers lymphoproliferation and autoimmune phenomena. ⋯ A combination of Rituximab with immunoglobulin replacement could be a safe and effective therapy to control infection, lymphoproliferation and autoimmunity in patients with HIGM.Reference #1: Hennig C, Baumann U, Ilginus C, Horneff G, Foell J, Hansen G. Successful treatment of autoimmune and lymphoproliferative complications of patients with intrinsic B-cell immunodeficiencies with rituximab. Br J Haematol. 2010 Feb;148(3):445-8DISCLOSURE: The following authors have nothing to disclose: Rachel Jen, Bradly Biagioni, Pearce Wilcox, Bob SchellenbergNo Product/Research Disclosure Information.
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Cardiovascular CasesSESSION TYPE: Case ReportsPRESENTED ON: Saturday, March 22, 2014 at 04:15 PM - 05:15 PMINTRODUCTION: Primary cardiac tumors are extremely rare with a prevalence of 0.02% in pooled autopsy studies. Lymphomas involving the heart have a prevalence between 1% to 2% of primary cardiac tumors. Diagnosis usually requires tissue biopsy either by open surgical tissue resection or image-guided biopsy. We report a case of a patient who found to have a primary cardiac T-cell lymphoma (PCTCL) of the right atrium (RA) diagnosed by biopsy guided by intracardiac echocardiography (ICE). (1, 2)CASE PRESENTATION: A 66-year-old woman who presented with a 2 month history of progressive shortness of breath and orthopnea. Her ejection fraction decreased from 65% to 35% over a 4 year period. Coronary computed tomography angiography (CTA) revealed normal coronary arteries and a RA mass vs thrombus (Fig 1). A cardiac MRI with contrast was performed and the characteristic of the mass was suggestive of a lymphoma (Fig 2). Patient subsequently underwent percutaneous transcatheter biopsy of the RA mass using fluoroscopic and ICE guidance. Pathologic specimens demonstrated a T-cell lymphoma. ⋯ Patients with PCTCL typically remain asymptomatic until the mass leads to either obstruction of circulation, embolization, interference with valve function, decreased myocardial contractility or conduction disturbances. Histological diagnosis is made by biopsy and typically requires an open-chest procedure under general anesthesia. Transcatheter biopsy with transesophageal echocardiography guidance also requires general anesthesia. However, ICE imaging allows transcatheter biopsy of an intracardiac mass, especially of the right atrium. This can be made under direct visualization with conscious sedation, minimizing the risk for perforation. (3)CONCLUSIONS: Intracardiac mass biopsy using ICE is an attractive modality which provides precise localization of cardiac structures under conscious sedation. This case illustrates successful use of imaging to minimize risk in the assessment of a cardiac mass.Reference #1: Reynen K. Frequency of primary tumors of the heart. Am J Cardiol 1996;77:107-10.Reference #2: Lam KY, Dickens P, Chan AC. Tumors of the heart. A 20-year experience with a review of12,485 consecutive autopsies. Arch Pathol Lab Med 1993;117:1027-31.Reference #3: Kuppahally S.,Litwin S. Endomyocardial Biopsy of Right Atrial Angiosarcoma Guided by Intracardiac Echocardiography. Cardiology Research and Practice Volume 2010, Article ID 681726DISCLOSURE: The following authors have nothing to disclose: Ahmed Al-Badri, Sean Wilson, Chad Klinger, Carlos RuizNo Product/Research Disclosure Information.
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Pleural Disease/Pleural Effusion PostersSESSION TYPE: Poster PresentationsPRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PMPURPOSE: Pleural exudative effusion (PE) is a common finding in many pathological conditions including infections, malignancies, and cardiac failure. A high level of plasma BNP or serum pro BNP could determine a benign nature and exclude a diagnostic thoracoscopy. Aim of the study: to identify a relation between the level of plasma BNP and histological diagnosis by medical thoracoscopy, and to establish BNP diagnostic cut-off levels. ⋯ The following authors have nothing to disclose: Pier Canessa, Irene Morelli, Lorenza Bancalari, Massimiliano Sivori, Daniele Bertoli, Enrico Battolla, Gianfranco MazzottaNo Product/Research Disclosure Information.
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Pediatric PostersSESSION TYPE: Poster PresentationsPRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PMPURPOSE: Non-invasive ventilation (NIV) is frequently used in pediatric intensive care units for patients requiring an escalated level of respiratory support. Recent literature suggests that utilizing NIV in acute respiratory failure may prevent tracheal intubation, and also promotes early extubation in specific patient populations. However, there is little data available regarding complications associated with NIV in pediatric patients. We present a case series of five pediatric patients that developed pneumothorax while on the RAM cannula. ⋯ The following authors have nothing to disclose: Beth Johnson, Gwenyth FischerNo Product/Research Disclosure Information.