Cystic fibrosis, pleural effusion, methemoglobinemia, penetrating lung injury due to blank cartridge gunshot, and lung complications from silicone implants are just some of the unique case studies to be addressed at the upcoming CHEST Annual Meeting 2015. The conference, which will take place between October 24 and 28 at the Palais des congrès de Montréal in Canada is expected to bring together physicians and investigators from all over the world to discuss unique cases of pulmonary and sleep disorders as well as critical care, as announced by the American College of Chest Physicians in a press release.
Two rare cases of methemoglobinemia due to the use of the recreational drug known as “Jungle Juice” or “popper” will be presented on Monday, October 26, by physicians from the New York University Langone Medical Center. The drug became popular in the 1960s and contains acetone and isobutyl nitrate. The case study details a woman, 33 years old, and her husband, 39, both of whom are emergency room physicians, having arrived at the emergency room presenting with toxic drug ingestion.
The women first started experiencing vomiting, diarrhea and a seizure, and both suffered severe cyanosis, and were hypotensive and hypoxemic despite high flow oxygen. The physicians later realized that the couple had methemoglobinemia, a disease characterized by an altered state of hemoglobin incapable of unloading oxygen due to an oxidation of ferrous iron. The condition can cause tissue hypoxia, but after being treated with IV methylene blue and hydration, the symptoms resolved within six hours.
Investigators from the Konya Education and Research Hospital, in Turkey, will also be at the conference to host a presentation on a case report of penetrating lung injury caused by a close-range blank cartridge pistol shot. The presentation is titled “Invisible bullets,” and will take place on Tuesday, October 27. The patient highlighted in the case study was a 17-year-old male that entered the hospital with a chest injury — a single wound in the chest and no exit wound. The patient suffered left hemopneumothorax, lacerations and contusion of the left lung, and was submitted to left thoracotomy with wedge resection of lingular segment of upper lobe.
The aim of this case study is to call attention for the dangers of blank cartridges, which don’t contain a bullet but are powerful enough to penetrate soft tissue and bones at close range. The cartridges were initially created for military training, but are now used for other purposes, including use by criminals due to their low price and easy accessibility. Despite the fact that the patient in question was discharged nine days later with no other complaints, the cartridges can cause severe injuries, particularly to the lungs when shot at close range, and even death.
A case of the rare parasitic infection called trichinellosis will be presented by researchers from the UC Davis Medical Center in Sacramento, who will host the presentation on Wednesday, October 28. The patient in the case is a 47-year-old man who experienced a week of worsening fevers, edema and myalgia, having progressed to hypercapnic respiratory failure. As the disease worsened, the patient was transferred to the ICU and submitted to noninvasive ventilation. The physicians also observed that the patient had decreasing lung volumes, decreased bilateral excursion, and profound leukocytosis in his blood count.
Trichinellosis is a disease caused by a parasite that can be present in raw meat that results in a decrease of diaphragmatic function associated with the amount of larvae, duration of infection, and inflammatory response to the infection. The investigators later learned that the patient was a hunter, and had caught and eaten a wild bear three weeks earlier. A parasitic evaluation confirmed Trichinella antibodies and the patient was treated with albendazole and prednisone. In addition, samples of the bear meat were later confirmed by microscopy and PCR as T spiralis.
In addition, three very different cases related to complications from silicone implants will be presented at the conference. The first of them will be hosted by a research team from the University of Kansas School of Medicine in Kansas City, on Tuesday, October, 27. A 36-year-old patient diagnosed with cystic fibrosis (CF) entered the hospital with partial small bowel obstruction and reported that she had been submitted to a right upper lobe lobectomy eight months prior and a bilateral breast augmentation 13 years earlier. The physicians treated the obstruction with medication and the patient was supposed to be discharged when she noticed that her right breast implant was missing.
Slippage of the breast implant had occurred previously with the patient, and the implant had always been repositioned using a Valsalva maneuver. However, this time the entire right beast implant had migrated into the right chest cavity with a small right pleural effusion, which could have led to an implant leak. The physicians submitted her to an exploratory surgery that confirmed that the implant was intact in the right pleural space and they noticed a 5 x 3 cm defect in the thoracic wall that enabled the migration of the implant. The investigators closed the defect and are now asking other physicians to consider this risk for their CF patients. Since cystic fibrosis patients are particularly at risk of body image disorders, it can lead them to more frequently search for cosmetic procedures that can result in unintended consequences such as the one highlighted in this case study.
Also related to implants is the case to be presented by the Jersey City Medical Center on Tuesday, October 27. The case of a 44-year-old women features a rare cause for the development of pleural effusion. The patient entered the center experiencing left side chest pain with worsening shortness of breath for three weeks. She did not experience coughing, sputum production, fever or chills, but had been submitted to bilateral mastectomy and breast augmentation surgery with silicone implants six weeks prior. The physicians confirmed the diagnosis of left side pleural effusion and started a treatment with empiric antibiotics.
The physicians suspected a foreign body reaction to the implants or either ruptured or infected implants, and requested analysis by a breast surgeon. They conducted exploratory surgery and observed significant inflammation and mild fluid collection, but no rupture. Following the procedure, the patient’s symptoms improved significantly, while mesothelial cells, macrophages, and lymphocytes, without malignant cells were observed in a cytologic examination.
The third case of lung complications related to silicone implants will be presented by researchers from the John H. Stroger Jr. Hospital in Chicago, on Tuesday, October 27. A 29-year-old women was the subject of a rare but severe complication of gluteal augmentation after entering the hospital with worsening dyspnea, chest pain and dry cough. The patient was experiencing the symptoms for five days and denied smoking, the use of illicit drugs, recent travel or sick contacts.
The woman was severely sick with scattered crackles in all lung zones, high levels of white blood cells, and extensive air space opacities. Her condition became worse and she was transferred to the ICU, where she was treated with methylprednisolone via IV daily and noninvasive ventilation. Three days later, her condition improved significantly and she was discharged with supplemental oxygen and a tapering dose of prednisone. The researchers also aim to call attention for the risk of pulmonary silicone embolus, which has as rare but existent consequence acute pneumonitis syndrome.
The American College of Chest Physicians, publisher of the journal CHEST, is hosting its annual meeting for the 81st time. The association is a global leader in accelerating innovative chest medical education, clinical research and care to improve patient outcomes. The main purpose of the American College of Chest Physicians, which includes 18,700 members worldwide, is to advance prevention, diagnosis and treatment of chest conditions.
In September, the Irving, Texas-based company Reata Pharmaceuticals, Inc, also announced that it will present initial data evaluating bardoxolone methyl in patients with pulmonary arterial hypertension (PAH) who are on stable background therapy during the 2015 American College of Chest Physicians Annual Meeting. Bardoxolone methyl is an experimental, oral once daily antioxidant inflammation modulator (AIM) that has received orphan drug designation for the treatment of PAH by the U.S. Food and Drug Administration (FDA).
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