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The Role And Safety Of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration In The Diagnosis And Management Of Infected Bronchogenic Mediastinal Cysts In Adults, Hazim S. Bukamur, Emad Alkhankan, Haitem Mezughi, Nancy J. Munn, Yousef R. Shweihat

Yousef R. Shweihat

Bronchogenic and other duplication cysts are congenital abnormalities that can present at any age including adulthood years. They are usually asymptomatic and discovered incidentally on radiological imaging of the chest. They are commonly treated by surgical resection. Recently, endobronchial ultrasound has been used to assist in diagnosis when radiologic imaging is not definitive. Endobronchial ultrasound has been used rarely to drain infected cysts, a rare complication of the bronchogenic cyst. We present a unique case of an infected large bronchogenic cyst treated with endobronchial ultrasound drainage combined with conservative medical therapy. We also review the scarce available literature describing such …

Pembrolizumab Reactivates Pulmonary Granulomatosis, Majdi Al-Dliw, Mohammed Megri, Ibrahim M. Shahoub, Gaurav Sahay, Teresa I. Limjoco, Yousef Shweihat

Yousef R. Shweihat

Sarcoid like reaction is a well-known entity that occurs as a consequence to several malignancies or their therapies. Immunotherapy has gained a lot of interest in the past few years and has recently gained approval as first line therapy in multiple advanced stage malignancies. Pneumonitis has been described as complication of such therapy. Granulomatous inflammation has been only rarely reported subsequent to immunotherapy. We describe a case of granulomatous inflammation reactivation affecting the lungs in a patient previously exposed to Pembrolizumab and have evidence of a distant granulomatous infection. We discuss potential mechanisms of the inflammation and assert the importance …

Pneumonia Due To A Rare Pathogen: Achromobacter Xylosoxidans, Subspecies Denitrificans, Hesham Awadh, Munthir Mansour, Obadah Aqtash, Yousef Shweihat

Yousef R. Shweihat

Achromobacter xylosoxidans, subspecies denitrificans, is a gram-negative rod recently implicated as an emerging cause of infection in both immunosuppressed and immunocompetent populations. Few cases are reported in literature involvingmultiple body systems. Diagnosis depends on cultures of appropriate specimens, and management usually is by administration of appropriate antibiotics(usually agents with antipseudomonal activity).We report a rare case of pneumonia due to infection with this organism, in a patient with preexisting bronchiectasis secondary to chronic aspiration.

Bronchopleural Fistula Resolution With Endobronchial Valve Placement And Liberation From Mechanical Ventilation In Acute Respiratory Distress Syndrome: A Case Series, Haris Kalatoudis, Nikhil Meena, Fuad Zeid, Yousef Shweihat

Yousef R. Shweihat

Patients who have acute respiratory distress syndrome (ARDS) with persistent air leaks have worse outcomes. Endobronchial valves (EBV) are frequently deployed after pulmonary resection in noncritically ill patients to reduce and eliminate bronchopleural fistulas (BPFs) with persistent air leak (PAL). Information regarding EBV placement in mechanically ventilated patients with ARDS and high volume persistent air leaks is rare and limited to case reports. We describe three cases where EBV placement facilitated endotracheal extubation in patients with severe respiratory failure on prolonged mechanical ventilation with BPFs. In each case, EBV placement led to immediate resolution of PAL. We believe endobronchial valve …

Severe Pneumomediastinum Complicating Ebus-Tbna, Yousef Shweihat, James D. Perry Iii, Nancy Munn

Yousef R. Shweihat

Pneumomediastinum infrequently complicates diagnostic bronchoscopy. Increased airway or alveolar pressure results in air leaks to the mediastinum through existing or induced defects. Excessive cough, recurrent episodes of increased abdominal pressure, vomiting, or sneezing can all induce spontaneous pneumomediastinum. Less commonly it has been documented with lung or neck infections, esophageal or tracheal tears, and rapid increases in altitude such as during plane flights or scuba diving, with mechanical ventilation, substance abuse, and after bronchoscopy. Pneumomediastinum may be, but is not always, associated with pneumothorax.

Is Chest Tube Insertion With Ultrasound Guidance Safe In Patients Using Clopidogrel?, Wissam Abouzgheib, Yousef R. Shweihat, Nikhil Meena, Thaddeus Barrter

Yousef R. Shweihat

Background and objective: Drainage of the pleural space is a common procedure.The safety of chest tube insertion in patients using clopidogrel has not been investigated.

Methods: Ultrasound-guided chest tube insertions performed on 24 patients who were being actively treated with clopidogrel were retrospectively reviewed.

Results: No excessive bleeding occurred in any of these patients.

Conclusions: Given the known effects of clopidogrel on platelet function, these results were interpreted as indicating that clopidogrel therapy is a relative but not an absolute contraindication to chest tube insertion, if an experienced operator places a small-bore tube under ultrasound guidance.

Esophageal Diagnosis Of A Malignant Aspergilloma, Muneer Al Zoby, Nancy Munn,, Yousef Shweihat

Yousef R. Shweihat

A 59-year-old male patient developed a new 4 cm × 6 cm cavitary left upper lung lesion over a 2 months period. The patient had a prior history of a surgically resected Stage IA non-small cell lung cancer in the right upper lobe 3 years prior. He was treated for possible infection with radiographic improvement on subsequent imaging. Further imaging after 3 months revealed an oval soft tissue density within the cavity with air crescent sign. Bronchoscopy with transbronchial biopsies showed an acute and chronic granulomatous inflammation. Aspergillus fumigatus was noted on culture and voriconazole was initiated. Subsequent imaging showed …