Chest
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The insertion of a subclavian central venous catheter is generally associated with a high rate of success and a favorable risk profile. The use of ultrasound for procedural guidance has been demonstrated to further increase the rate of success and reduce the risk of specific mechanical complications, especially in patients with difficult surface anatomy. Many individual ultrasound techniques have been described in the literature; this article presents a systematic approach for incorporating these tools into bedside practice and includes a series of illustrative figures and narrated video presentations to demonstrate the techniques described.
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Review Case Reports
A 76-Year-Old Woman With Incidental Right Middle Lobe Atelectasis.
A 76-year-old nonsmoking woman visiting from Honduras for the last 6 months with no known medical history originally presented to the ED complaining of abdominal pain. While in the ED, an incidental right middle lobe collapse was found on CT abdomen scan. Review of systems was positive for a chronic productive cough with white sputum for 3 years. She denied association with fevers, chills, night sweats, hemoptysis, appetite changes, or weight loss.
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Comparative Study
Use of Computed Tomography to Quantify Progression and Response to Treatment in LAM.
In lymphangioleiomyomatosis (LAM), infiltration of the lungs with smooth muscle-like LAM cells results in cystic destruction and decline in lung function, effects stabilized by sirolimus therapy. LAM lung disease is followed, in part, by high-resolution CT scans. To obtain further information from these scans, we quantified changes in lung parenchyma by analyzing image "texture." ⋯ Increased cyst score was associated with increased texture degradation near cysts. Sirolimus treatment improved lung texture surrounding cysts and stabilized cyst score. Eleven texture properties were associated with FEV1, Dlco, cyst score, and response to sirolimus. Texture analysis may be valuable in evaluating LAM severity and treatment response.
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Review Case Reports
A Diagnostic Conundrum: Progressive Tubular Lung Mass in Asymptomatic Young Woman.
A 39-year-old female avid marathon runner presented with an abnormal chest radiograph obtained during preoperative evaluation prior to bilateral knee replacement because of osteoarthritis. As shown in Figure 1, chest radiograph revealed a focal nodular opacity in the middle lobe. She did not have any prior imaging for comparison.
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This study aimed to evaluate the prevalence of atrial fibrillation (AF) in hospital encounters with end-stage COPD on home oxygen admitted for COPD exacerbation. ⋯ AF prevalence in hospital encounters with end-stage COPD increased from 2003 to 2014. Better management strategies for patients with end-stage COPD comorbid with AF are needed, especially in elderly individuals.