Publications by authors named "Sujith V Cherian"

67 Publications

52-Year-Old With Epistaxis, Hemoptysis, Hoarseness, and Weight Loss.

Chest 2021 Apr 6;159(4):e225-e230. Epub 2021 Apr 6.

Divisions of Pulmonary, Critical Care and Sleep Medicine, University of Texas Health-McGovern Medical School, Houston, TX.

Clinical Presentation: A 52-year-old man presented with hemoptysis of 2 weeks' duration. He had been experiencing hoarseness, right-sided pleuritic chest pain, subjective fevers, chills, night sweats, and 10 pounds weight loss for the previous 2 months. He additionally reported severe frontal headaches, nasal congestion, and intermittent epistaxis, which had been present for a year before his current presentation. He had worked in construction and denied tobacco or illicit drug use.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.chest.2020.10.057DOI Listing
April 2021

Predictive factors for success of awake proning in hypoxemic respiratory failure secondary to COVID-19: A retrospective cohort study.

Respir Med 2021 05 2;181:106379. Epub 2021 Apr 2.

Department of Internal Medicine, Divisions of Critical Care, Pulmonary and Sleep Medicine, University of Texas Health Science Center at Houston, McGovern Medical School, TX, 77030, USA. Electronic address:

Background: Awake prone positioning has been recommended as an adjunctive measure in spontaneously breathing patients with hypoxemic respiratory failure during the COVID-19 pandemic. It remains uncertain as to how long this should be implemented, what variables to follow and who would be the ideal candidates for this adjunctive therapy.

Methods: A retrospective chart review of patients admitted from April to August 2020 within our institution with multifocal pneumonia and hypoxemic respiratory failure secondary to COVID-19 who underwent awake-proning for at least 3 hours was conducted.

Results: Improvement in respiratory parameters including ROX (SpO2/Fio2/ Respiratory Rate) indices and inflammatory markers within 4 days of institution of awake proning predicted a higher chance for success of this strategy in preventing need for mechanical ventilation. Moreover, benefits of awake proning were limited to patients with mild to moderate ARDS.

Conclusions: Awake prone positioning can be safely performed with improvement in oxygenation. However, its institution may be beneficial only in patients with mild to moderate ARDS and requires careful evaluation of respiratory parameters and serum inflammatory markers to avoid a delay in endotracheal intubation and consequent increase in mortality rates.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.rmed.2021.106379DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8018785PMC
May 2021

Diagnostic yield of electromagnetic navigational bronchoscopy: A safety net community-based hospital experience in the United States.

Ann Thorac Med 2021 Jan-Mar;16(1):102-109. Epub 2021 Jan 14.

Divisions of Critical Care, Pulmonary and Sleep Medicine, McGovern Medical School, University of Texas Health, Houston, TX, USA.

Introduction: Electromagnetic navigational bronchoscopy (ENB) is an excellent tool to diagnose peripheral pulmonary nodules, especially in the setting of emphysema and pulmonary fibrosis. However, most of these procedures are done by interventional pulmonologists and academic tertiary centers under general anesthesia. Studies evaluating the diagnostic utility of this tool in safety-net community hospitals by pulmonologists not formally trained in this technology are lacking. The objective was to evaluate the diagnostic yield of ENB done in such a setting and its associated complications.

Methods: Retrospective chart review of consecutive ENB procedures over 5 years from 2014, since its inception in our institution-a safety-net community based hospital was performed. Multiple variables were analyzed to assess their impact on diagnostic yields.

Results: After exclusion criteria were applied, 72 patients with 76 procedures were eventually included within our study, with an overall 1-year diagnostic yield of 80.2%. Sensitivity for malignancy was 73% and negative predictive value of 65%. Primary lung cancer was the most common diagnosis obtained, followed by tuberculosis (TB). The overall complication rates were low, with only 1 patient (1.3%) requiring hospitalization due to pneumothorax needing tube thoracostomy. No deaths or respiratory failures were noted within the cohort. The only significant variable affecting diagnostic yield was forced expiratory volume in 1 s. The presence of emphysema did not affect diagnostic yield.

Conclusions: ENB is safe and feasible with a high diagnostic success rate even when performed by pulmonologists not formally trained in interventional pulmonology in low resource settings under moderate sedation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/atm.ATM_388_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7908899PMC
January 2021

Safety and incidence of complications associated with bronchoscopy in an obese population.

Clin Respir J 2021 Jun 11;15(6):670-675. Epub 2021 Mar 11.

Divisions of Critical Care, Pulmonary and Sleep Medicine, McGovern Medical School at the University of Texas Health Sciences Center, Houston, TX, USA.

Introduction: The safety of bronchoscopy in obese patients and those with obstructive sleep apnea (OSA) is unclear. Our objective was to evaluate the incidence of complications during bronchoscopy under moderate sedation in obese patients and to assess the impact of OSA, body mass index (BMI), and duration of the procedure.

Methods: We performed a retrospective study in adult patients undergoing bronchoscopy from January 2010 to August 2019. All patients with BMI > 30 kg/m were included. Logistic regression analyses were used to identify the factors associated with all-complications and respiratory complications.

Results: A total of 345 obese patients were identified. The average BMI in our cohort was 35.3 ± 5.1 kg/m . During the pre-procedure risk assessment, 165 (47.8%) patients were labelled as "suspected OSA." The most common doses of sedation given during the bronchoscopies were fentanyl 50 mcg (34.5%) and midazolam 3 mg (33.6%). The incidence of major complications was 0.6% and minor complications were 41.2%. Minor respiratory (22.9%) and cardiac (26.4%) complications were common. No deaths occurred due to bronchoscopy. Factors that were associated with increased respiratory complications were female gender, suspected OSA, and bronchoscopy duration 20-30 minutes and bronchoscopy duration greater than 1 hour.

Conclusion: Bronchoscopy under moderate sedation performed in obese patients is safe; however, increased risk may exist with females, increased procedure time, and suspected OSA.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/crj.13342DOI Listing
June 2021

Clinical, radiology, pathologic patterns and outcomes of vaping related pulmonary injury in a single institution; A case series.

Respir Med 2020 11 20;173:106153. Epub 2020 Sep 20.

Divisions of Pulmonary, Critical Care and Sleep Medicine University of Texas Health- McGovern Medical School, TX, 77030, USA. Electronic address:

Since March 2019, E-cigarette or Vaping product associated lung injury (EVALI) has become an ongoing epidemic with more 2600 cases reported in the span of a few months in the United States. EVALI is defined as acute lung injury that develops secondary to the use of e-cigarettes or vaping products within the previous 90 days after exlusion of other possible inciting factors. Vitamin E acetate is believed to play a significant role in its pathogenesis. Treatment involves use of corticosteroids and further avoidance of these products. We describe a case series of 8 patients with EVALI, their clinical course and outcomes. All patients showed an excellent response to corticosteroids. In our experience, prognosis of EVALI is excellent, with complete resolution of symptoms in patients who followed up at 8 weeks.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.rmed.2020.106153DOI Listing
November 2020

A 35-Year-Old Woman With Progressive Dyspnea and Cough.

Chest 2020 09;158(3):e103-e106

Divisions of Pulmonary, Critical Care and Sleep Medicine, University of Texas Health, McGovern Medical School, Houston, TX.

Case Presentation: A 35-year-old woman with no known medical history presented to the ED with complaints of progressive dyspnea for several months. The patient also reported episodic cough with yellow to green sputum production. She denied fever, chills, weight loss, or hemoptysis. She also denied any history of previous lung diseases in her family. She denied any history of tobacco or recreational drug use or any exposures. She was originally from El Salvador and immigrated to the United States approximately 3 years earlier. She was evaluated in El Salvador at age 15 for "lung issues" but had never received a formal diagnosis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.chest.2020.02.068DOI Listing
September 2020

Pediatric size phlebotomy tubes and transfusions in adult critically ill patients: a pilot randomized controlled trial.

Pilot Feasibility Stud 2020 8;6:112. Epub 2020 Aug 8.

Division of Critical Care Medicine, Department of Internal Medicine, The University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 1.434, Houston, TX 77030 USA.

Background: Transfusion of red blood cells (RBC) is common, can have adverse effects, and is a costly and limited resource. Interventions that reduce iatrogenic blood losses could reduce transfusions. The objectives of this pilot trial were to assess the feasibility (acceptability of the intervention and suitability of eligibility criteria) and potential effectiveness of pediatric size phlebotomy tubes in adult critically ill patients.

Methods: We conducted a pilot, randomized controlled trial in the medical intensive care unit (ICU) of a university-affiliated, tertiary care referral hospital from November 2017 to September 2018. A total of 200 patients with hemoglobin of at least 7 g/dL and without bleeding were randomized to pediatric or adult size phlebotomy tubes. Stratification was according to baseline hemoglobin (7-9.49 g/dL, 9.5-11.99 g/dL, and 12 g/dL or greater). Acceptability was measured via the number of blood test recollections and the number of patients that discontinued the use of pediatric tubes. The suitability of patient eligibility criteria was determined by identifying baseline characteristics associated with RBC transfusions. Potential effectiveness was estimated from the time to RBC transfusion or to hemoglobin level below 7 g/dL.

Results: The use of pediatric tubes was acceptable as patients experienced a low number of tests recollections (on average 1 every 57 days), and none of the participants discontinued their use. The baseline hemoglobin category was the only factor that appeared to be independently associated with RBC transfusions. A total of 6 patients (6%) in the pediatric tube group and 11 patients (11%) in the adult tube group (hazard ratio, 0.69; 95% CI, 0.25 to 1.9) received an RBC transfusion or reached hemoglobin below 7 g/dL. Almost all of these patients (16 of 17 participants) had baseline hemoglobin of 7-9.49 g/dL.

Conclusions: This pilot study suggests that pediatric phlebotomy tubes are acceptable to patients and can therefore be used in adult ICU patients. A future study should focus on patients with hemoglobin levels below 9.5 g/dL, as these patients have a high risk of transfusions. This intervention has the potential of being successful in selected patients. A definitive trial is warranted.

Trial Registration: ClinicalTrials.gov, NCT03286465. Retrospectively registered on September 18, 2017.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s40814-020-00657-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7414662PMC
August 2020

88-Year-Old Woman With an Incidental Lung Mass.

Arch Bronconeumol (Engl Ed) 2020 May 8. Epub 2020 May 8.

University of Texas Health Science Center at Houston, Department of Pulmonary, Critical Care and Sleep Medicine, Houston, TX, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.arbres.2020.03.033DOI Listing
May 2020

E-Cigarette or Vaping Product-Associated Lung Injury: A Review.

Am J Med 2020 06 13;133(6):657-663. Epub 2020 Mar 13.

Divisions of Pulmonary, Critical Care, and Sleep Medicine, University of Texas Health- McGovern Medical School, Houston.

Since its introduction in the US market in 2007, the use of electronic nicotine delivery systems, colloquially referred to as e-cigarettes or "vaping" products, has increased substantially, particularly among high school children and young men. With the legalization of marijuana within multiple states in the United States and thus, coincident change in the public perception of its risk, the availability of multiple tetrahydrocannabinol (the psychoactive agent in marijuana)- and cannabidiol (a nonpsychogenic agent in marijuana)- containing vaping products has also increased tremendously. Since March 2019, there has been an ongoing epidemic of acute lung injury secondary to the use of e-cigarettes, with over 2600 cases and 60 deaths reported all over the United States; the term e-cigarette- or vaping product-associated lung injury is used. E-cigarette- or vaping product-associated lung injury is defined by the 1) presence of pulmonary infiltrates in imaging; 2) use of electronic nicotine delivery systems within the previous 90 days; and 3) absence of other possible causes such as infection, cardiac, neoplastic, or rheumatologic causes. A significant proportion of patients hospitalized with e-cigarette- or vaping product-associated lung injury have required admission in the intensive care unit, with mechanical ventilation needed in up to one-third of patients. Corticosteroids, supportive care, and further avoidance of vaping products remain the cornerstone of treatment. Although generally associated with an excellent prognosis, older patients and patients with underlying cardiac and pulmonary conditions are at risk for higher mortality and morbidity. This review article aims to describe e-cigarette- or vaping product-associated lung injury, its pathogenesis, clinical and radiological manifestations, and management.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.amjmed.2020.02.004DOI Listing
June 2020

Endobronchial Hamartoma: A Rare Cause of Chronic Cough.

Mayo Clin Proc 2019 11;94(11):2170

Divisions of Pulmonary, Critical Care and Sleep Medicine, University of Texas Health-McGovern Medical School, Houston, TX. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.mayocp.2019.04.043DOI Listing
November 2019

Empyema "Necessitated" by Indwelling Pleural Catheter: A Unique Complication.

Am J Respir Crit Care Med 2020 03;201(6):e17-e18

Division of Critical Care Medicine and.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1164/rccm.201906-1167IMDOI Listing
March 2020

Lung Hyperlucency: A Clinical-Radiologic Algorithmic Approach to Diagnosis.

Chest 2020 01 26;157(1):119-141. Epub 2019 Jul 26.

Pulmonary, Critical Care & Sleep Medicine, Lenox Hill Hospital, New York, NY; Medicine and Radiology, Barbara and Donald Zuckerberg School of Medicine at Hofstra/Northwell, New York, NY. Electronic address:

Areas of diminished lung density are frequently identified both on routine chest radiographs and chest CT examinations. Colloquially referred to as hyperlucent foci of lung, a broad range of underlying pathophysiologic mechanisms and differential diagnoses account for these changes. Despite this, the spectrum of etiologies can be categorized into underlying parenchymal, airway, and vascular-related entities. The purpose of this review is to provide a practical diagnostic algorithmic approach to pulmonary hyperlucencies incorporating clinical history and characteristic imaging patterns to narrow the differential.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.chest.2019.06.037DOI Listing
January 2020

Developmental lung anomalies in adults: A pictorial review.

Respir Med 2019 08 11;155:86-96. Epub 2019 Jul 11.

Vice Chair of Education, Director, Cardio-Thoracic Radiology, USA; University of Texas Health Science Center -UT Health, San Antonio, TX, USA. Electronic address:

Developmental lung anomalies represent a heterogeneous group of diverse, yet related abnormalities that involve the lung parenchyma, pulmonary vasculature or a combination of both-which usually present prenatally and in early childhood. However, a substantial number of cases go unnoticed during childhood and present either incidentally or with recurrent respiratory infections progressing into adulthood. Defective development of the tracheobronchial tree and the pulmonary vasculature are proposed to cause these developmental anomalies. Encountering these lung anomalies in adults is a diagnostic challenge given their rarity and they are often mistaken as other serious pathological conditions, resulting in unnecessary diagnostic tests and procedures. The developmental lung anomalies in adults can be broadly divided into three categories: bronchopulmonary anomalies encompassing congenital bronchial atresia, bronchogenic cysts, congenital lobar emphysema and congenital pulmonary airway malformations. Vascular anomalies include pulmonary agenesis-aplasia- hypoplasia complex, unilateral absence of the pulmonary artery, pulmonary artery sling, partial anomalous pulmonary venous return, pulmonary venous varix and pulmonary arteriovenous malformations. Finally combined lung parenchymal-vascular anomalies of the lung involve hypogenetic lung (scimitar) syndrome and bronchopulmonary sequestration. This article discusses the spectrum of these developmental anomalies of the lung, their etiopathogenesis, clinical and radiographic presentations in adults and management in brief.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.rmed.2019.07.011DOI Listing
August 2019

A 45-Year-Old Woman With Multiple Pulmonary Nodules and Sjögren Syndrome.

Chest 2019 02;155(2):e51-e54

Divisions of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of Texas Health Science Center at Houston-McGovern Medical School, Houston, TX.

Case Presentation: A 45-year-old woman presented for evaluation for 3 months of coughing and dyspnea. A recent chest CT scan done for workup of her symptoms revealed a 2-cm right-sided pulmonary nodule. She had a medical history of Sjögren syndrome, hypertension, and obesity. She also noted a weight loss of 30 lb over the last 3 years. She denied smoking, alcohol consumption, illicit drug use, or occupational exposures. A chest radiograph done 3 years prior did not reveal any pulmonary nodules. She had no personal or family history of arteriovenous malformations, hamartomas, or any malignancies and had been up to date with her breast cancer screening. She was treated with courses of hydroxychloroquine and mycophenolate mofetil for her Sjögren syndrome and did not have a history of opportunistic pulmonary infections. She denied any recent travel or exposure to TB.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.chest.2018.08.1077DOI Listing
February 2019

Clinical Characteristics and Etiologies of Miliary Nodules in the US: A Single-Center Study.

Am J Med 2019 06 16;132(6):767-769. Epub 2019 Jan 16.

Divisions of Critical Care, Pulmonary and Sleep Medicine, Department of Internal Medicine. Electronic address:

Background: Miliary nodules have been typically described as a radiological manifestation of disseminated tuberculosis. However, miliary nodules are known to occur in a wide variety of conditions. The primary objective of the study was to identify clinical characteristics and etiologies of miliary nodules within our institution.

Methods: Using International Classification of Diseases, Ninth and Tenth Revision codes, electronic medical records were used to retrospectively identify 53 patients who fulfilled criteria of miliary nodules over the last 10 years. Demographic and clinical data were extracted for all the patients in this cross-sectional study.

Results: The diagnosis of tuberculosis was made in 15 (28.3%) patients, sarcoidosis in 12 (22.6%), silicosis in 7 (13.2%), extrathoracic malignancy in 5 (9.4%), and histoplasmosis in 4 (7.6%) patients. Four of 9 HIV patients had histoplasmosis. There was 1 case each of hypersensitivity pneumonitis, Pneumocystis jiroveci pneumonia, Mycobacterium-avium complex, Epstein-Barr virus pneumonia, cryptococcosis, aspergillosis, and primary lung cancer. Sputum was positive for acid fast bacilli in 4 cases (28%), and bronchoscopy had a 57% successful yield in miliary tuberculosis.

Conclusion: Our study is the largest single-center data review evaluating the etiology of miliary nodules within the United States; most of the data exist in case reports.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.amjmed.2018.12.030DOI Listing
June 2019

A 32-Year-Old Man With HIV Infection, Pleural Effusions, and Lymphadenopathy.

Chest 2018 11;154(5):e147-e151

Divisions of Critical Care, Pulmonary and Sleep Medicine, Department of Internal Medicine, The University of Texas Health Science Center at Houston-McGovern Medical School, Houston, TX.

Case Presentation: A 32-year-old man presented with fever, nonproductive cough, diffuse lymphadenopathy, and polyarticular pain for 2 weeks. His medical history included HIV diagnosed 10 years ago, anal intraepithelial neoplasia, Kaposi sarcoma, and herpes simplex virus-2 infection. The patient was not receiving antiretroviral therapy or antibiotic prophylaxis, and his last known CD4 count a month before was 45 cells/mm. He was prescribed a course of doxycycline by his primary care physician, which did not improve his symptoms.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.chest.2018.05.013DOI Listing
November 2018

Salvage therapies for refractory hypoxemia in ARDS.

Respir Med 2018 08 3;141:150-158. Epub 2018 Jul 3.

Pulmonary, Critical Care and Sleep Medicine, U C San Diego School of Medicine, USA. Electronic address:

Acute Respiratory Distress Syndrome (ARDS) is a condition of varied etiology characterized by the acute onset (within 1 week of the inciting event) of hypoxemia, reduced lung compliance, diffuse lung inflammation and bilateral opacities on chest imaging attributable to noncardiogenic (increased permeability) pulmonary edema. Although multi-organ failure is the most common cause of death in ARDS, an estimated 10-15% of the deaths in ARDS are caused due to refractory hypoxemia, i.e.- hypoxemia despite lung protective conventional ventilator modes. In these cases, clinicians may resort to other measures with less robust evidence -referred to as "salvage therapies". These include proning, 48 h of paralysis early in the course of ARDS, various recruitment maneuvers, unconventional ventilator modes, inhaled pulmonary vasodilators, and Extracorporeal membrane oxygenation (ECMO). All the salvage therapies described have been associated with improved oxygenation, but with the exception of proning and 48 h of paralysis early in the course of ARDS, none of them have a proven mortality benefit. Based on the current evidence, no salvage therapy has been shown to be superior to the others and each of them is associated with its own risks and benefits. Hence, the order of application of these therapies varies in different institutions and should be applied following a risk-benefit analysis specific to the patient and local experience. This review explores the rationale, evidence, advantages and risks behind each of these strategies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.rmed.2018.06.030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6186150PMC
August 2018

Primary pulmonary lymphoproliferative neoplasms.

Lung India 2018 May-Jun;35(3):220-230

Department of Internal Medicine, Divisions of Critical Care, Pulmonary and Sleep Medicine, UT Health- McGovern Medical School, Houston, Texas, USA.

Pulmonary lymphoproliferative neoplasms are rare lung tumors and account for <1% of all lung tumors. Among them, primary pulmonary lymphomas (PPL) constitute the majority, which include Non-Hodgkin's lymphoma (NHL) that comprise of mucosa-associated lymphoid tissue lymphoma, diffuse large B-cell lymphomas and other rare types of NHL and lymphomatoid granulomatosis. HL, which arises secondary to contiguous spread from the mediastinum, is the rarest type of PPL. Other entities described within the umbrella of pulmonary lymphoproliferative neoplasms include pleural lymphomas and posttransplant lymphoproliferative disorders (PTLD) - which occurs in the poststem cell and organ transplant patients. These neoplasms although rare, have a favorable prognosis, which does not depend on disease resectability. Moreover, with its nonspecific presentation, diagnosis is challenging, which often leads to delayed diagnosis or misdiagnosis in many cases. Therefore, knowledge of this entity is important for the practicing pulmonologist. This review article aims to describe the clinical presentation, diagnosis and management of primarily the entities within PPL, as well as pleural lymphomas and PTLD.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/lungindia.lungindia_381_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5946555PMC
April 2018

Heimlich Maneuver-Induced Diaphragmatic Rupture and Hiatal Hernia.

Am J Med Sci 2018 Apr 6;355(4):e13. Epub 2018 Jan 6.

Divisions of Pulmonary, Critical Care and Sleep Medicine, University of Texas Health, McGovern Medical School, Houston, Texas.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.amjms.2017.11.009DOI Listing
April 2018

A 64-Year-Old Woman With an Incidental Pulmonary Nodule.

Chest 2018 04;153(4):e81-e84

Divisions of Pulmonary, Critical Care and Sleep Medicine, University of Texas Health Science Center at Houston- McGovern Medical School. Houston, TX. Electronic address:

Case Presentation: A 64-year-old Latin American woman was referred for evaluation of an incidental pulmonary nodule. She had originally presented to her primary care physician with complaints of abdominal pain warranting a CT scan of the abdomen, which revealed a right lower lobe pulmonary nodule. She denied any complaints of shortness of breath or cough. Review of systems was unremarkable and medical history was significant for hypertension only. She also denied primary or secondary tobacco exposure or any recreational drug abuse. Patient denied any recent travels and resided in Houston, Texas. There was no family history of malignancy or lung disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.chest.2017.09.017DOI Listing
April 2018

Adenolipoma of the Bronchus. A Rare Entity.

Am J Respir Crit Care Med 2018 02;197(4):520-521

1 Division of Critical Care Medicine.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1164/rccm.201710-2003IMDOI Listing
February 2018

Current Concepts in Pathogenesis, Diagnosis, and Management of Smoking-Related Interstitial Lung Diseases.

Chest 2018 08 5;154(2):394-408. Epub 2017 Dec 5.

Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN.

Tobacco exposure results in various changes to the airways and lung parenchyma. Although emphysema represents the more common injury pattern, in some individuals, cigarette smoke injures alveolar epithelial cells and other lung cells, resulting in diffuse infiltrates and parenchymal fibrosis. Smoking can trigger interstitial injury patterns mediated via recruitment and inappropriate persistence of myeloid and other immune cells, including eosinophils. As our understanding of the role of cigarette smoke constituents in triggering lung injury continues to evolve, so does our recognition of the spectrum of smoking-related interstitial lung changes. Although respiratory bronchiolitis-interstitial lung disease, desquamative interstitial pneumonia, pulmonary Langerhans cell histiocytosis, and acute eosinophilic pneumonia have a well-established association with tobacco use, its role and impact on idiopathic pulmonary fibrosis, combined pulmonary fibrosis and emphysema, and connective tissue disease-related interstitial lung diseases is still ambiguous. Smoking-related interstitial fibrosis is a relatively newly appreciated entity with distinct histopathologic features but with unclear clinical ramifications. Increased implementation of lung cancer screening programs and utilization of CT scans in thoracic imaging have also resulted in increased identification of "incidental" or "subclinical" interstitial lung changes in smokers, the ensuing impact of which remains to be studied.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.chest.2017.11.023DOI Listing
August 2018

Spontaneous Pneumomediastinum in Dermatomyositis.

Am J Med Sci 2017 Dec 4;354(6):e11. Epub 2017 Jul 4.

Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, Texas.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.amjms.2017.06.027DOI Listing
December 2017

A 53-Year-Old Man With a Bronchial Mass and Multiple Bone Lesions.

Chest 2017 11;152(5):e115-e119

Department of Pathology, The University of Texas-MD Anderson Cancer Center, Houston, TX.

Case Presentation: A 53-year-old man was admitted with complaints of back pain of 3 months' duration along with numbness and weakness in his left upper and lower extremities. He denied any respiratory complaints or anorexia but did report an 11 kg weight loss over the last 3 months. He had no other significant medical history and denied any history of cigarette smoking or recreational drug use. Family history was significant for prostate cancer in his father.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.chest.2017.06.018DOI Listing
November 2017

Vasculitis due to levamisole-adulterated cocaine.

Postgrad Med J 2018 01 29;94(1107):61. Epub 2017 Sep 29.

Department of Internal Medicine, The University of Texas Health Science Centre at Houston, Houston, Texas, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/postgradmedj-2017-135162DOI Listing
January 2018