Chest
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A 64-year-old man with a past medical history of alcoholic cirrhosis with resultant hepatorenal syndrome requiring kidney and liver transplantation 10 years previously sought treatment at the ED with progressive lower-extremity edema and dyspnea. After noting worsening shortness of breath and cough as an outpatient, he had been referred to a pulmonary clinic and was undergoing a workup for interstitial lung disease (ILD). ⋯ He was also receiving chronic immunosuppression with tacrolimus and mycophenolate mofetil. He had noted worsening of edema since starting prednisone.
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A 60-year-old man with a history of COPD, uncontrolled diabetes (hemoglobin A1c, 10.6%), obesity (BMI, 33.4), and a family history of Ehlers-Danlos syndrome came to the ED with several hours of acute-onset severe left mid-axillary pleuritic chest pain without alleviating factors. The pain had no specific triggers, including activities or heavy meals. It was associated with nausea, chills, and diaphoresis; also, it was preceded by a few weeks of subacute flulike symptoms for which he did not seek medical attention. He denied previous similar symptoms, recent trauma, or surgeries.
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A 49-year-old woman presented to the ED with sudden onset abdominal pain, nausea, and vomiting. Her medical history included an uncomplicated gastric lap band surgery 9 years ago and subsequent removal of lap band after 6 years. ⋯ The patient denied smoking and heavy alcohol consumption. She was currently employed as a scrub technician in a local surgical center.
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Hypersensitivity pneumonitis (HP) is an inflammatory and/or fibrotic disease affecting the lung parenchyma and small airways. It typically results from an immune-mediated reaction provoked by an overt or occult inhaled antigen in susceptible individuals. ⋯ Given the high prevalence of foam in pillows and mattresses, mold in foam in bedding may explain many HP cases with a previously unrecognized cause. Early identification and avoidance of foam in bedding may prevent HP progression to end-stage pulmonary fibrosis and death.
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A 58-year-old woman was referred to our department with a cough of 1 year duration; her condition was unresponsive to the administration of inhaled steroid and beta-2 agonists. She denied the presence of dyspnea, chest pain, or other extrapulmonary symptoms. She was a never-smoker with a negative medical history and no occupational or domestic exposures. There was no history of cancer, gastroesophageal reflux disease, asthma, allergic rhinitis, or other allergies.