Treatment for a giant lung bulla

This is a 22 year old female with no prior respiratory complaints.  She devloped a bronchitis in February and May, 2008 and had a CXR that suggested bullous disease in the RUL.  PFT’s showed normal spirometry and the diffusion capacity was 89% predicted.  She had no respiratory illness as an infant.

Her CT scan showed the following

Which of the following would you recommend?

1) Leave the bulla alone, no Rx recommended, inform to go to ED with SOB or pain

2) Recommend Scuba diving lessons to utilize hyperbaric conditions to shrink the bulla

3) Refer for an experimental endobronchial valve to deflate the bulla

4) Refer to thoracic surgery for surgical bullectomy

5) Insert a Heimlich valve to permit deflation of the bulla through chest wall

I include a reference regarding 1 way valves:valve

34 year old female with SOB and abnormal CT

This 34 year old female presented for evaluation with 2 months of increasing shortness of breath, chest tightness and cough.  There was minimal sputum production, but she is uncomfortable at night and had to sleep with 2 pillows.  Wheezing had been present but she did not respond to steroids, albuterol or Symbicort. Her lab data was normal except for a positive mono test.  She was not exposed to any aerosols.  She is a non-smoking, non-drug using female with 2 children living in a rural enviroment.

The CT images are shown:

What are possible diagnoses and how would proceed at this time

Hypoxia in a 50 year old female

This patient arrives with hypoxia despite supplemental oxygen and this radiograph.  Why do you think the film is abnormal and what is the diagnosis?

Air in the pleural space

 

 

 

This patient is a 67 year old female who had a chronic right pleural effusion.  A thoracentesis in March did not reveal a cause.  She presented in May to HH with a pain in her left chest and increased sputum production for 2 weeks. A CT scan was done.  What do you think was responsible for the air in the pleural space?

Diffuse Ground glass infiltrates

This is a 57 year old black female who had been a smoker but stopped 1 yr ago . She complained of increasing shortness of breath over 1 year.  She had undergone PFT’s that showed reduced FVC (59%) predicted and FEV1 (72% predicted).  Her total lung capacity was 71 % predicted.  She was unable to do a diffusion capacity.  The intial chest radiograph was read as normal.  Representative images from her CT scan are above

Do you think this is an abnormal scan? Would you perform a diagnositic procedure? If abnormal, suggest a diagnosis compatible with the CT scan.

 

Holes in the lung

 

This is a 55 year old female who has sustained 2 pneumothoracies and had bilateral pleurodesis.  Otherwise she is mildly short of breath.  PFT’s show an FEV1 of 69% predicted an FEV1/FVC ratio of .50.  Her DlCO is 79% of predicted.  She has not smoked and the alpha-1 level is normal

Please offer a differential diagnosis

 

Diffuse infiltrates in an EMT

This is a 35 year old EMT who presented to HH with severe SOB and hypoxia.  He was feeling well, but the day before admission applied waterproofing aerosol to his boots outside in a well ventilated area for 20 minutes.  The next day he was SOB and came to the emergency room.  He was a smoker but did no elicit drugs.  He revovered over the next 24 hours.  He has no known systemic disorder

What is the cause of the lung injury?

Benign lung nodule

This 67 year old female had severe COPD.  She was found to have lung nodules on her chest CT scan. There was low grade uptake on PET scan.  She underwent a needle biopsy that was negative for malignancy, but sustained severe bleeding and this required transfer to SMH .  Because of severe lung disease, no open biopsy was done.  Approximately 1 year later, she had an open lung biopsy in California and a benign abnormality was discovered. 

Please contribute to the differential diagnosis of these abnormalities.

Hypoxia in an elderly male

  

Recently, there was a chest conference pertaining to the CT in Langerhan’s cell histiocytosis. 

This 81 year old male presented to the emergency room with severe hypoxia.  He had been a long-time smoker, and had been short of breath over the last year.  A CT scan was done and images are below. 

Do you think the CT scan is most compatible with 1) emphysema 2) idiopathic pulmonary fibrosis 3)pulmonary fibrosis with emphysema 4) end-stage langerhan’s cell histiocytosis 5) end stage sarcoidosis?