The American journal of emergency medicine
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Case Reports
Acute respiratory distress attributed to sirolimus in solid organ transplant recipients.
Pulmonary toxicity has frequently been recognized as a potentially serious complication associated with sirolimus therapy. It consists of a wide spectrum of syndromes most characterized by the presence of lymphocytic alveolitis and lymphocytic interstitial pneumonitis. The most commonly presenting symptoms are fever and dyspnea. ⋯ Here, we reported 2 severe cases of acute respiratory distress attributed to the therapy of sirolimus in solid organ transplant recipients. Although the diagnostic course was difficult, withdrawal of sirolimus and temporary administration of steroids eventually resulted in a rapid recovery in both 2 patients. In addition, possible mechanisms, clinical characteristics, approach to diagnosis, and treatment strategies of sirolimus-induced pulmonary toxicity were also discussed in this article.
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Pulmonary embolism (PE) can be a potentially fatal condition and requires early diagnosis. It is a frequently underdiagnosed, underestimated, and undertreated disease because of various features and nonspecific clinical presentation. Laboratory D-dimer test, lung scan, and echocardiography can help in making the diagnosis. ⋯ We report a case of pulmonary embolism mimicking pulmonary artery dissection by initially using images from computed tomography. Further evaluation of the computed tomographic images using coronal plane confirmed the diagnosis of pulmonary embolism. Because the treatment modalities are completely different between the 2 diseases, we emphasize that 2 different orthogonal planes are necessary for diagnosis using computed tomographic image examination.