I need any input on this one. Remember the woman with dyspnea and isolated DLCO?
Spiro normal
HRCT - normal
Dobutame echo - normal
Exercise test - normal lung but reached AT early
EMG - normal
Hematocrit - normal
Well, all I have with this dyspneic (on exertion) patient is a low DLCO and an abnormal anerobic threshold, both of which are real - so what would you do next? I'm at a loss.
Wednesday, June 08, 2005
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I can't reconcile the DLCO and the abnormal AT but I would still pursue the myopathy route.
Even with a normal EMG?
How about getting her checked by John Wald (he is the neurologist who does the w/up for those myopathies for FJM).
On the spiral CT: "No evidence of pulmonary emboli"
As for neurology, the EMG was normal.
Actually, mitochondrial disease will give you a normal EMG and you can get an abnormal DLCO (because of over oxygen decrease and subsequent aneorbic metabolism) so I think I will send her for a muscle biopsy via neurology.
Yea, I think a mitochondrial myopathy is the last stone to turn over before starting all over. PE protocol CT should be pretty good for detecting chronic small emboli, which is what this would be if it were PE. Pulmonary VOD can rarely occur sporadically, but should have an abnormal echo.
Dr. Wald is now at Foote Hospital, if you're interested. He's the guy that FJM refers patients to for eval of mitochondrial myopathy. By the way, have you checked aldolase, CPK, and anti-cholinesterase antibodies?
The CK was normal. I didn't get an aldolase or anti-cholinesterase (but if she had myasthenia gravis the EMG would be abnormal I would think - and her's was normal).
Yea, I'd expect the EMG to be abnormal in MG...just one of those last-ditch tests we get before looking for a mitochondrial myopathy (which I should read more about---I just sent my patient (41 year old with dyspnea) to neuro for similar findings...
Apparently there is a nice article in cleveland clinic about mitochondrial muscle disease a few years back. I should loook that up...
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