Chest
-
Pulmonary pneumatoceles are uncommon but generally benign, thin-walled parenchymal air collections arising in association with acute pneumonia. Rarely, they may attain such size as to severely affect respiration. We describe the percutaneous placement of multiple drains in a patient with pneumonia due to atypical measles and large pneumatoceles. Decompression via tubes resulted in improved ventilation and acceleration of recovery.
-
We investigated the effects of short-term oxygenation changes upon the neuromuscular respiratory drive (airway occlusion pressure [P0.1]), minute ventilation (VE), and respiratory rate (RR) in 12 acute lung injury patients undergoing pressure support ventilation. We ventilated the patients first at a high level (H1) of oxygenation, then at intermediate (I), at low, and again at the high (H2) level. The H1 and H2 periods showed no differences. ⋯ Differences in RR, VE, and rapid shallow breathing index were significant at step H1 versus I. Changes in P0.1 appeared to be higher when the H1 value was higher than normal. An arterial oxygenation target higher than the generally accepted 60 mm Hg level may decrease both RR and VE.
-
Case Reports
Right upper lobe pulmonary edema caused by acute mitral regurgitation. Diagnosis by transesophageal echocardiography.
Unilateral pulmonary edema is a distinctly unusual clinical entity, often misdiagnosed initially as one of the more common causes of focal lung disease. Predominantly lobar pulmonary edema is rarer still. We report a case of right upper lobe pulmonary edema caused by the acute onset of severe mitral regurgitation. ⋯ The majority of cases of right upper lobe pulmonary edema have been associated with mitral regurgitation. In addition to confirming the presence of mitral regurgitation, transesophageal echocardiography proved useful in delineating the mechanism for edema formation. It detected differential gradients between the right and left pulmonary venous systems and documented the direction of the regurgitant flow.
-
As a result of many interacting variables, including crowded shelters and limited access to health care, homeless persons are at high risk for tuberculosis. Using traditional approaches, control of tuberculosis in this population has been difficult. Decision analysis was used to investigate the cost-effectiveness of BCG (bacillus Calmette-Guérin) vaccination in persons attending homeless shelters. ⋯ Using conservative assumptions, a vaccine that was at least 40 percent effective would result in a net cost savings. If the efficacy of the vaccine were 50 percent, $4,000 would be saved, 12 life-years gained, and 23 cases of active tuberculosis prevented for every 1,000 persons vaccinated. Further study of the BCG vaccine in homeless persons and other populations at risk is warranted.
-
Letter Case Reports
Pneumothorax complicating BiPAP therapy for Pneumocystis carinii pneumonia.