Chest
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Case Reports
A Case Report of Portopulmonary Hypertension Precipitated by Transjugular Intrahepatic Portosystemic Shunt.
We report here a case of portopulmonary hypertension following transjugular intrahepatic portosystemic shunt.
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A 44-year-old man presented to the ED with acute massive hemoptysis and hypoxia. His history was notable for 1 year of progressively worsening shortness of breath at both rest and with exertion. He denied chest discomfort and endorsed near syncope while driving in recent months. He recently had been treated with antibiotics for two episodes of presumed pneumonia, based on right lower lobe opacification on chest radiography.
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A 51-year-old woman with a history of diabetes mellitus and anemia sought treatment at the emergency room for a 2-month history of dry cough and shortness of breath and a 1-week history of substernal chest tightness. One month before her presentation, she was seen at a separate hospital for dyspnea and was found to be anemic. She underwent chest radiography and CT scanning of the chest that was unrevealing to the cause of dyspnea. ⋯ Medications included an oral diabetic medication. She had no significant family history. She never smoked and had no history of illicit drug or alcohol use.
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A 54-year-old man sought treatment at the ED for a productive cough with green phlegm of approximately 6 months' duration that was accompanied by a 10-pound weight loss, night sweats, and occasional subjective fevers. He had made several prior visits to the ED for the cough and was hospitalized 4 months earlier for similar symptoms, at which time he underwent a bronchoscopy with BAL and was discharged with antibiotics for presumed pneumonia. ⋯ The patient had a past medical history of grade III follicular lymphoma for which he completed six cycles of bendamustine 4 years before presentation and had been in remission since. He was a never smoker, had a recent travel history to the Dominican Republic 8 months before admission, and had no recent sick contacts.
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Although resuscitation with IV fluids is the cornerstone of sepsis management, consensus regarding their association with improvement in clinical outcomes is lacking. ⋯ In this single-center retrospective study, we found that by broadly defining respiratory failure as an increase in oxygen requirements, a conservative initial IV fluid resuscitation strategy did not correlate with decreased rates of hypoxemic respiratory failure.