tag:blogger.com,1999:blog-12660458.post111575577940460226..comments2023-09-01T10:33:09.297-04:00Comments on Pulmonary Roundtable: Subacute dyspnea in a previously healthy 41 year old.Unknownnoreply@blogger.comBlogger14125tag:blogger.com,1999:blog-12660458.post-1117831932033098962005-06-03T16:52:00.000-04:002005-06-03T16:52:00.000-04:00This comment has been removed by a blog administrator.Jeff Hhttps://www.blogger.com/profile/01209432708535732499noreply@blogger.comtag:blogger.com,1999:blog-12660458.post-1116450945551859762005-05-18T17:15:00.000-04:002005-05-18T17:15:00.000-04:00Thanks for the input, but no, there is nothing to ...Thanks for the input, but no, there is nothing to suggest MG in this patient. She has some moderate pulmonary hypertension, and we are starting to diurese her while awaiting cardiopulmonary exercise testing. I'm now suspecting Primary Pulmonary HTN with the RADS/Asthma an intriguing but possibly unrelated finding.Jeff Hhttps://www.blogger.com/profile/01209432708535732499noreply@blogger.comtag:blogger.com,1999:blog-12660458.post-1116400760286266172005-05-18T03:19:00.000-04:002005-05-18T03:19:00.000-04:00I'm not a doctor ... patient. If her vision hadn't...I'm not a doctor ... patient. <BR/><BR/>If her vision hadn't been normal, I'd be hollaring a zebra here ... check for Myasthenia Gravis. Her description of the breathing problems sound exactly what most of us feel like in the early days of the onset of the disease, or in a mild flare. Complete with cough. (trying to keep the throat open, when it feels like it's collapsing in on itself ...yes, I know it's not, but it feels that way) <BR/><BR/>How is her chewing and swallowing? <BR/>Does she need to rest her head on her hand? <BR/> <BR/>Does any of these symptoms get better with rest, worse with use? <BR/><BR/>ok, shutting up now.Dreaming againhttps://www.blogger.com/profile/15717590226520457326noreply@blogger.comtag:blogger.com,1999:blog-12660458.post-1116076161271370632005-05-14T09:09:00.000-04:002005-05-14T09:09:00.000-04:00Yea, I like RADS as well, as part of it. Still, I...Yea, I like RADS as well, as part of it. Still, I don't have an explanation for the restriction. Nor would I expect this degree of persistent dyspnea from RADS, especially not after several weeks of treatment with inhaled steroids and bronchodilators.Jeff Hhttps://www.blogger.com/profile/01209432708535732499noreply@blogger.comtag:blogger.com,1999:blog-12660458.post-1116023184992386372005-05-13T18:26:00.000-04:002005-05-13T18:26:00.000-04:00So the effusion is probably nothing. I like the R...So the effusion is probably nothing. I like the RADS theory more now, secondary to something in the thinner, like toluene.Jenningshttps://www.blogger.com/profile/04930453447603683057noreply@blogger.comtag:blogger.com,1999:blog-12660458.post-1116005313695915782005-05-13T13:28:00.000-04:002005-05-13T13:28:00.000-04:00There is no tamponade. The anti-dsDNA came back t...There is no tamponade. The anti-dsDNA came back today--it's negative. The echo was read as "(subtle) inferior wall hypokinesis, mildly enlarged right sided chambers, preserved LV function, and a small pericardial effusion.Jeff Hhttps://www.blogger.com/profile/01209432708535732499noreply@blogger.comtag:blogger.com,1999:blog-12660458.post-1115934343500232952005-05-12T17:45:00.000-04:002005-05-12T17:45:00.000-04:00SLE would explain the pericardial effusion. Howeve...SLE would explain the pericardial effusion. However, from the description it does not look like she is in tamponade. She could still have RADS and a pericarditis and they may be unrelated to each other in etiology.Baleeirohttps://www.blogger.com/profile/03993066135160692535noreply@blogger.comtag:blogger.com,1999:blog-12660458.post-1115924337077796992005-05-12T14:58:00.000-04:002005-05-12T14:58:00.000-04:00The flow volume loop was narrowed and coved, and t...The flow volume loop was narrowed and coved, and the TLC was 75% predicted. I called it a mixed defect--definite restriction and, based on the reversibility, significant obstruction as well. I did give her Advair and albuterol, and she feels that her cough improved but her dyspnea did not. I got her ANA back today, and it's + at 1:320, speckled pattern. The anti-dsDNA is pending. The echo has been done, but I don't have the results yet.Jeff Hhttps://www.blogger.com/profile/01209432708535732499noreply@blogger.comtag:blogger.com,1999:blog-12660458.post-1115918723515689342005-05-12T13:25:00.000-04:002005-05-12T13:25:00.000-04:00BTW, what did the flow-volume loop look like?BTW, what did the flow-volume loop look like?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-12660458.post-1115913163372730552005-05-12T11:52:00.000-04:002005-05-12T11:52:00.000-04:00I still like some of JJ's ideas Re: an airway comp...I still like some of JJ's ideas Re: an airway component. The FVC is reduced but was the TLC normal? She had some physiologic response to albutrol. Did u give her a therapeutic trial of bronchodilators?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-12660458.post-1115815035472623182005-05-11T08:37:00.000-04:002005-05-11T08:37:00.000-04:00You are right about the myocarditis. It turns out...You are right about the myocarditis. It turns out that toluene is one case of that. Actually the whole case can be explained with a diagnosis of myocarditis.Jenningshttps://www.blogger.com/profile/04930453447603683057noreply@blogger.comtag:blogger.com,1999:blog-12660458.post-1115814707464259642005-05-11T08:31:00.000-04:002005-05-11T08:31:00.000-04:00This comment has been removed by a blog administrator.Jenningshttps://www.blogger.com/profile/04930453447603683057noreply@blogger.comtag:blogger.com,1999:blog-12660458.post-1115813138961801472005-05-11T08:05:00.000-04:002005-05-11T08:05:00.000-04:00My initial thoughts, given the onset and restricti...My initial thoughts, given the onset and restrictive pattern to her spirometry were acute/subacute HP or BOOP due to an inhalational toxin. The HRCT only showed the dependent changes-no air trapping or upper lobe ground glass, and between her initial presentation and follow-up (3 weeks), she stayed away from her home and the remodeling, but failed to improve. So I'm less enthused about HP.<BR/><BR/>RADS is a good thought, but doesn't explain her restriction (not much air-trapping: the RV/TLC is 133%). And how does toluene fit in with a pericardial effusion? Now, I'm leaning a myocarditis/pericarditis. I wonder if that could account for her initial chest tightness, and if the cough was an associated URI.Jeff Hhttps://www.blogger.com/profile/01209432708535732499noreply@blogger.comtag:blogger.com,1999:blog-12660458.post-1115762004268932212005-05-10T17:53:00.000-04:002005-05-10T17:53:00.000-04:00Obviously the chemical exposure is the likely sour...Obviously the chemical exposure is the likely source: Paint thinners are known to cause bronchospasm. I would think it is airway chemical-induced hyperreactivity; RADS vs asthma. The latter more likely at least based on the 1 week latency. What goes against this is the lowish DLCO. (What was the RV/TLC ratio in terms of any airtrapping. Lack of mosaic pattern may not necessarily rule out more subtle airtrapping.)<BR/><BR/>Hypersensitvity pneumonitis? If there was any toluene in the paint thinner, this could be one avenue to pursue.<BR/><BR/>In terms of the low DLCO with a rapid HR on exercise, tolune has been known to cause pulmonary hypertension. I would get an echo to evaluate this. <BR/><BR/>The cardiac effusion would bring us back to the hypersensitvity angle again, with tolunene being a possibility.<BR/><BR/>A BAL for cell count and diff might be helpful in this regard.<BR/><BR/>That's all my comments for now. I'll add more when I see what ya'll think.Jenningshttps://www.blogger.com/profile/04930453447603683057noreply@blogger.com