CC: Follow up pulmonary nodule. History of Present Illness: Ms. Lynehan is a very pleasant 34-year-old woman who I had seen previously in July 2014 for the evaluation of a right upper lobe pulmonary nodule. She is currently asymptomatic. She carries a diagnosis of carcinoid, which was resected from the right lower lobe. She additionally had a right upper lobe nodule that was resected, which was found to be a granuloma. Since that time, bronchoscopy has been performed which grew Mycobacterium avium complex. She was seen and evaluated by Peter Sebeny, MD of infectious diseases, who opted not to treat her given her lack of symptoms. Her last CT scan was in January 2015. She is here today primarily for her six month follow up CT scan. …show more content…
Pulse 65. Blood pressure 134/81. O2 sat 97% on room air. General: Well developed, well nourished. No apparent distress. Appears stated age. Lungs: Clear to auscultation bilaterally. No wheezes, rales, or rhonchi. Symmetric chest expansion. Breathing nonlabored. Imaging: CT scan of the chest dated September 2, 2015, which was personally reviewed demonstrates a subpleural opacity at the right lung apex, which appears to have decreased in size since the last study. The small subpleural opacity of the medial right lung apex with a predominately band like configuration is decreased in size since the last study measuring approximately 1.7 x 0.5 cm in the axial plane on axial imaging 19 previously measuring 1.8 x 0.7 cm. They are certainly a qualitative decrease as well. Impression/Plan: Ms. Lynehan has a right pulmonary nodule most consistent with scarring given the radiographic features. I am encouraged that there has been a decrement in its size. Certainly, there has been no progression. I would recommend this time repeat scanning in six months with noncontrast CT scan of the chest. Ms. Lynehan may follow up with me after the CT scan has been completed or sooner on an as needed
Examination revealed an oxygen saturation of 98% and blood pressure of 145/90. Oropharyngeal inspection revealed significant crowding (Mallampati class 3) with macroglossia. Chest auscultation was clear and two heart sounds were audible with nil else.
A 73-year old female presented to St Vincents Emergency Department, with a 3 week history of progressive dyspnoea, cough, and lethargy, on a background of a 6-year history of Multiple Myeloma. Just prior to presentation, she had also developed a fever.
She had a two week history of feeling generally unwell, complaining of tiredness and lethargy. She had no other significant symptoms. Her past history includes well controlled asthma and anxiety. She was a smoker of 20 cigarettes per day. She was taking amitriptyline, Symbicort (budesonide and formoterol inhaler). She had no significant family history of medical illness and had no clinical findings on examination. Blood tests showed corrected calcium of 4.22mmol/L (NR 2.20 -2.60) with suppressed paired PTH of 1.45pmol/L (NR1.60- 6.9). Her renal function was initially impaired, but normalized with rehydration. Her liver function tests, full blood count, vitamin D, myeloma screen and serum ACE levels were all within normal limits. Ultra sound scan (USS) of kidneys, USS of parathyroid and computerized tomography (CT) of thorax, abdomen and pelvis were all reported as normal with no cause found for her
Systemic arterialization of the lung without sequestration is a rare condition often diagnosed following investigation of an incidental cardiac murmur or based on abnormal chest X ray or CT of the thorax, as most patients are asymptomatic. Thoracic CT is the most useful diagnostic test as it demonstrates both the bronchial and vascular anatomy of the lung while CT angiography can clearly depict the origin of the aberrant systemic artery, avoiding invasive techniques for the diagnosis.
Healthy lung tissue is predominately soft, elastic connective tissue, designed to slide easily over the thorax with each breath. The lungs are covered with visceral pleura which glide fluidly over the parietal pleura of the thoracic cavity thanks to the serous secretion of pleural fluid (Marieb, 2006, p. 430). During inhalation, the lungs expand with air, similar to filling a balloon. The pliable latex of the balloon allows it to expand, just as the pliability of lungs and their components allows for expansion. During exhalation, the volume of air decrease causing a deflation, similar to letting air out of the balloon. However, unlike a balloon, the paired lungs are not filled with empty spaces; the bronchi enter the lungs and subdivide progressively smaller into bronchioles, a network of conducting passageways leading to the alveoli (Marieb, 2006, p. 433). Alveoli are small air sacs in the respiratory zone. The respiratory zone also consists of bronchioles and alveolar ducts, and is responsible for the exchange of oxygen and carbon dioxide (Marieb, 2006, p. 433).
Hoarseness, breathiness, scratchy/rough voice, the "lump in your throat" sensation, shooting pains from ear to ear, the need to breathe in deeper than usual ... these are all symptoms that a nodule can cause. A nodule is basically a small growth and looks like a bump on your vocal folds. This growth occurs from vocal abuse, misuse, and overuse. A healthy, normal vocal chord often has smooth, white mucosal surfaces and has no irregular objects on your vibrating borders. But when you abuse your vocal chords by putting force and tension upon them, the vibrations go into an "overload" and can cause too much friction on them. Eventually a type of bruise forms called a hematoma and a layer of fibrous tissues form into a soft or hard bump, AKA a nodule. Usually two nodules would form on each side of a vocal fold where the friction was extensive.
Although lung cancer is generally operable, by using either traditional open surgery, or one of the less intrusive and more sophisticated video-assisted thoracoscopic surgeries (VATS), often it may not be considered to be the best option for a patient. Where ill-health is a factor, or either the size and location of the tumor is deemed to be a consideration, other forms of treatment may well have to be considered.
J.P., a 58 year old female, presents to the Emergency Room on March 18th. She has a past medical history of cervical cancer, atheroembolism of the left lower extremity, fistula of the vagina, peripheral vascular disease, neuropathy, glaucoma, GERD, depression, hypertension, chronic kidney disease, and sickle cell anemia. She complains of right lower extremity pain accompanied by fatigue, a decreased appetite, increased work of breathing, burning on urination, and decreased urine output for three days.
Mary was seen today following her redo bronchoscopy. Unfortunately, there was not much mucus seen and as such I suspect that the right middle lobe collapse and the lingular collapse are going to be a chronic change. Despite this though, Mary does seem to be coping well with this and up until ten days ago was only coughing very occasionally and was not describing any issues with breathlessness. Ten days ago though, she had a viral infection that progressed to a green cough and she did start seven days of doxycycline that completely cleared things up. She stopped this three days ago and has started to have a return of the green sputum, but without any other significant symptoms. I have suggested she complete another seven days. It is likely
Shoemark, A., Ozerovitch, L. and Wilson, R. 2007. Aetiology in adult patients with bronchiectasis. Epub, 101 (6), pp. 1163-70.
I have Florida White show rabbits and a common problem with them is discoloration of their white fur. This is usually due to urine, feces, and their surroundings. When showing a Florida White, the number of points allocated to the condition of fur is twenty out of the total one hundred points ( FWRBA, 2014, page seven, paragraph five ) . Five points of this is for color ( FWRBA, 2014, page seven, paragraph six ) . This many points can mean the difference between Best of Breed or Best of Show, or going home without a ribbon. All because of a small urine stain. I wanted to find out what method of cleaning would remove stains the best to return them to their natural white fur color.
Chest X-ray showed increased translucent mass and a small pleural effusion on the left lower lobe. Even looking at the x-ray, the left lower lobe was complete opacity and the mass was easily seen. After being admitted, she was diagnosed with pneumonia and pulmonary emphysema. Later on during the day, she was experiencing dyspnea, high temperatures, and striking pain. She was taken to the operating room for thoracoscopy, washout, and drainage of a presumed emphysema. A segment of necrotic lung inferior to the left lower lobe was identified adjacent to the left diaphragm. After the surgery, she had no further symptoms. Histology showed conformation of extralobe pulmonary sequestration. This is the first report case of pulmonary sequestration mimicking emphysema. A review of the literature found three cases of pulmonary sequestration with torsion in children, all presenting with pain. Ages between 11 and 13, showed a rapid growth in this rare
Cardiovascular System: He does not experience any chest pain or palpitation. He does not have dyspnea or leg swelling.
The patient has high temperature-sign of fever, a very fast pulse rate (tachycardia), and chest wheezing when listened to using a stethoscope (Harries, Maher, & Graham, 2004, p.
Spirometry performed today has come back normal with no bronchodilator response and normal range gas transfer. Chest auscultation remains clear.