Medical Blog - Part 5

Color Doppler Diagnosis of Left Ventricular Pseudoaneurysm: DiscussionLeft ventricular pseudoaneurysm formation results usually as a complication of acute myocardial infarction. However, this anomaly can be associated with several other etiologies. Until recently, a firm diagnosis of this entity relied on cardiac angiography. The advent of two-dimensional echo cardiography made feasible the noninvasive identification of the false aneurysm, but in certain cases, the characteristic narrow neck communicating between the left ventricle and the false chamber can not be seen. The combined utilization of pulsed wave Doppler can help to establish a firm diagnosis in these circumstances, by detecting a turbulent systolic flow pattern across the point of communication, even if the connection between both chambers is not clearly visualized. diabetes medications

Prognostic and surgical implications of true and false left ventricular aneurysms are very different. The distinction between these two entities can be established before cardiac catheterization by means of two-dimensional echocardiography and radionuclide imaging. Both methods, however, as well as LV angiography, may fall in such distinction when the size of the communication between the LV and the accessory chamber cannot be definitely assessed. Pulsed Doppler echocardiography may be a useful complement, providing a comprehensive evaluation of flow dynamics. Color flow mapping represents a new step in this subset, with the great advantage of displaying spatial oriented flow patterns. To our knowledge this is the first case of a postsurgical LV pseudoaneurysm detected by two-dimensional color Doppler echocardiography. buy paxil online

On the fourth hospital day, hemoptysis occurred after repositioning the endotracheal tube. Bronchoscopy showed moderate tracheitis and blood in both mainstem bronchi. A large blood clot was removed from the right side. A bleeding site could not be identified. Culture of the bronchial washings grew normal flora. An AFB smear was negative and cytologic findings were benign. Computed chest tomography (Fig 3) demonstrated a mass in the upper part of the left chest. The radiologist thought it was extrapleural and lay between the great vessels and the left lung. The adjacent left upper lobe had areas of consolidation. Bilateral effusions were present. The aorta was heavily calcified, but no aneurysm was seen. Images obtained after contrast did not reveal an intimal flap. A chest surgeon was consulted and felt the patient was not a surgical candidate regardless of diagnosis. No further diagnostic studies were done. The patient was supported with blood products and antibiotics, but massive hemoptysis occurred and the patient died. buy zoloft online

Fatal Hemoptysis Due to Lung Abscess and Pulmoaortic FistulaMassive hemoptysis is a well known complication of lung abscess. Pathologic studies suggest that this is usually due to erosion of the infection into a pulmonary artery. We wish to present an unusual case of massive hemoptysis complicating lung abscess in which the infection eroded into the thoracic aorta. We have been unable to find a similar case in the literature. In addition to a case presentation, the roentgenographic and pathologic features will be discussed. actos tablets

BAL is a procedure considered to have a low incidence of complications and has not been associated with pneumothorax in patients with interstitial lung disease. The pathophysiology of BAL-induced pneumothorax is not clear, but presumably is related to the associated airway obstruction, with impaired pressure equilibration of entrapped intra-alveolar gases, interstitial dissection of air, and, finally, decompression into the pleural cavity. Pneumothorax and hydropneumothorax have been reported to occur in patients with pulmonary alveolar proteinosis following whole lung BAL. The unit volume of “alveolar flooding would be similar in subsegmental BAL and total lung lavage. Upwards of 40 to 60 percent of BAL fluid is not removed by suctioning, depending on the severity of the destructive parenchymal process. The retained fluid may promote local gas trapping as a consequence of the loss of the protective decompression mechanism of collateral ventilation acting via channels at both the alveolar and bronchiolar levels. Collateral flow has been previously reported to be impaired in the dog lung when water is injected into a lobe. Also, obstruction of sublobar segments at low lung volumes in animal models results in a greater outward acting stress on the alveolar wall (alveolar pressure gradient) as a result of pulmonary interdependence. The potential significance of these factors in the pathogenesis of pneumothroax would be further enhanced with BAL of a subsegment of the middle lobe, as done in this case, since there is only a single interface with another segment. canadian neightbor pharmacy

Bronchoalveolar Lavage-induced PneumothoraxFiberoptic bronchoscopy (FOB) is associated with various complications, including cough, bronchospasm, and hypoxia. Pneumothorax has been known to occur following FOB when transbronchial, brush, or endobronchial biopsies are performed. Complications associated with bronchoal-veolar lavage (BAL) include fever, pneumonitis, bleeding, stridor, and bronchospasm. Use of FOB with BAL alone has, to our knowledge, not been reported to result in pneumothorax. The purpose of this report is to consider that patients with pneumonia as a result of the destructive nature of the inflammatory process are predisposed to developing pneumothorax as a complication of BAL. canadian drug mall

The nodular lesions in the biopsy materials consisted of homo geneous material without internal structures surrounded by inflammatory mononuclear cells. They displayed the green birefringence characteristic of amyloid when viewed under polarized light after Congo red staining (Fig 4). As the plasma cells in the vicinity of amyloid deposits showed strongly positive to the anti-kappa chain antibody by immunoperoxidase staining, they might be thought of as localized monoclonal proliferation, but the plasma cells in the bronchiolar wall yield polyclonal immunoglobulin staining. The biopsy specimens from lip, stomach, rectum, bone marrow, and bronchus did not contain amyloid deposits. The bone marrow samples showed no evidence of proliferation and atypism of plas-macytes or lymphocytes. The diagnosis was nodular pulmonary amyloidosis. We administered prednisolone 40 mg/day for the management of dyspnea and the patient could have a symptomatic relief. However, the bullae did not disappear or diminish in size. canadian neightbor pharmacy