Pulmonology Commons^™

Beyond The Clot: A Rare Case Of Extensive Dvt And Pulmonary Embolism Revealing May-Thurner Syndrome, Jorge A. Aboytes, Jose J. Loayza, Ivan Mogollon, Daniel Pena, Michelle Lopez

Research Colloquium

Introduction: Deep vein thrombosis (DVT) in young adults is uncommon and typically associated with identifiable risk factors. In cases where DVT occurs without apparent provocation, congenital anatomical anomalies should be considered. May-Thurner Syndrome (MTS), a vascular compression disorder involving the left iliac vein, is a frequently overlooked cause of iliofemoral DVT in young individuals, particularly women.

Case Presentation: A 28-year-old woman with no significant medical history presented with acute left leg swelling, pain, and discoloration, along with new-onset dyspnea and chest discomfort. She had recently transitioned to a contraceptive patch and reported reduced mobility due to fatigue. Imaging confirmed left …

Extracorporeal Rescue In Massive Pulmonary Embolism: A Case Of Chronic Thromboembolic Pulmonary Hypertension Unveiled, Kenzo Ramos, Kari Gorder

Journal of Shock and Hemodynamics

Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare yet curable cause of pulmonary hypertension from unresolved pulmonary emboli. We present the case of a 48-year-old man with progressive dyspnea and leg swelling, who was found to have bilateral pulmonary emboli with right heart strain. He developed cardiac arrest during thrombectomy, requiring emergent veno-arterial extracorporeal membrane oxygenation (V-A ECMO). Further evaluation revealed acute emboli superimposed on CTEPH. After incomplete thrombectomy and persistent instability, he underwent successful pulmonary endarterectomy with ECMO decannulation, leading to recovery of right ventricular function and discharge in stable condition. This case illustrates that previously unrecognized CTEPH may …

From Villi To Alveoli: Lung Involvement In Celiac Disease – A Narrative Review, Mateusz Marzec, Patrycja Cecha

Journal of Community Hospital Internal Medicine Perspectives

Background:

Celiac disease (CD) is a chronic, immune-mediated enteropathy triggered by gluten that affects about 1% of the population and may present with extraintestinal manifestations. Pulmonary complications are considered rare and are poorly characterized. Lane-Hamilton syndrome is the best described lung manifestation, but data suggests a broader spectrum of respiratory involvement.

Methods:

We performed a narrative review with structured search strategy of PubMed and Embase (January 1, 1970 – December 1, 2025) using the terms celiac/coeliac and lung, pulmonary, respiratory, hemoptysis, hemosiderosis, alveolar hemorrhage, interstitial lung disease, alveolitis, bronchiectasis …

Questionnaire-Based Identification And Participation In Lung Cancer Screening In Sweden, Julie Barta

Division of Pulmonary, Allergy, and Critical Care Medicine Faculty Papers

No abstract provided.

Fluoroquinolone Use And Risk Of Pneumothorax In Adults Hospitalized With Community Acquired Pneumonia: A Retrospective Cohort Study, Steven Yi B. S., Saurav Sumughan B.S., Jessica Cobb M. D., Erika J. Yoo

Department of Medicine Faculty Papers

Objectives: The objective of this study is to examine the relationship between fluoroquinolone exposure and pneumothorax risk in patients hospitalized with pneumonia.

Methods: This retrospective cohort study used the TriNetX US Collaborative Network. We defined two mutually exclusive cohorts of hospitalized adults based on exposure to antibiotic classes commonly used to treat community acquired pneumonia: fluoroquinolone (ciprofloxacin, moxifloxacin, levofloxacin, and ofloxacin) versus nonfluoroquinolone (amoxicillin, azithromycin, ceftriaxone, and doxycycline). Patients with connective tissue disorders were excluded. The primary outcome was the occurrence of pneumothorax within 60 days. We used Cox proportional hazards regression to estimate hazard ratios (HRs) adjusted for demographics, …

Current Practices And Variations Among Pediatric Severe Asthma Programs In The United States-The North American Severe Pediatric Asthma Consortium., Kristina Gaietto, Nadia Krupp, Avani V. Shah, Erhan Ararat, Samantha H. Averill, Sachin Baxi, Matejka Cernelc-Kohan, Jeffrey M. Chambliss, Heather De Keyser, Monica Federico, Bob Geng, Akilah A. Jefferson, Parisa Kaviany, Lila C. Kertz, Kirsten Kloepfer, Allyson Larkin, Sydney Leibel, Tanya Martinez-Fernandez, Samira Naime, Robert D. Pesek, Dinesh K. Pillai, Deepa Rastogi, Katherine Rivera-Spoljaric, Kristie R. Ross, Franziska J. Rosser, Tregony C. Simoneau, Jade Tam-Williams, Kelan G. Tantisira, William Anderson, Jonathan M. Gaffin, Theresa W. Guilbert, Erick Forno

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Severe and difficult to treat asthma in children is a complex condition causing significant morbidity and associated healthcare costs. While treatment guidelines exist for severe asthma, optimal treatment approaches for the pediatric population are less well established. Furthermore, best practices regarding real world management and implementation of guidelines for the severe pediatric asthma population are lacking. In order to provide care for this population, institutions around the United States have developed multidisciplinary severe pediatric asthma programs (SPAPs). In recent years, the North American Severe Pediatric Asthma Consortium (NASPAC) was established as a mechanism for SPAPs to collaborate and share …

Assessing Clinician Preference For Redirection Of Care In Neonatal Tracheostomies, Gabriella Destefano, Alla Kushnir, Perri Donenfeld

Cooper Rowan Medical Journal

A spectrum of indications exists for the implementation of neonatal tracheostomies, ranging from short-term airway control to congenital airway anomalies. The decision to initiate long-term mechanical ventilation is multifaceted and can be influenced by factors such as physician preferences, caregivers’ attitudes, and comorbidities. It is important to have an ethical framework in place to guide the treatment of preterm neonates who may require long term mechanical ventilation. This study examines physician perspectives on the ethics of neonatal tracheostomy, focusing on the treatment of infants with bronchopulmonary dysplasia. A mixed methods study, consisting of demographic information and 5 clinical vignettes centering …

A Qualitative Exploration Of Spirituality In People Living With Dyspnea And Serious Illness, Leah Mccann Klug

All Poster Presentations

No abstract provided.

Impact Of Race And Acculturation On Lung Cancer Screening Eligibility: A Multicenter Lung Cancer Cohort Study, Eunji Choi, Christine S. Shusted, Harrison Yang, Haley M. Evans, Julia G. Katcher, Yiwey Shieh, Anil Vachani, Katharine Rendle, Julie A. Barta

Division of Pulmonary, Allergy, and Critical Care Medicine Faculty Papers

No abstract provided.

Safety And Efficacy Of Outpatient Thoracentesis: A Retrospective Analysis, Brooke Ruane, Msn, Crnp, Brian Schonewald, Md, Christine S. Shusted, Mph, Christopher Mcgrath, Md, Frances Mae West, Md, Prarthna Chandar, Md

Division of Pulmonary, Allergy, and Critical Care Medicine Posters

Objectives

• To examine the patient population, procedural indications, and clinical outcomes associated with a clinic-based outpatient thoracentesis program.
• To evaluate the safety, feasibility, and cost implications of an advanced practice provider (APP)-driven model for pleural effusion management.

Pneumomlpred: Innovating Pneumonia Management With Guideline Adherence Review And Explainable Machine Learning-Based Mortality Prediction - A Single-Centre Retrospective Study, Kamel A. Samara, Hiba Jawdat Barqawi, Saryia Adra, Batool Aldaher, Drishti D. Kampani, Enad Haddad, Hebah Soudan, Islam Ibrahim Anwar, Mohamad Besher Adi, Omar Hamadi, Yumna Almour, Mohamed Nassef, Zaher Al Aghbari, Eman Abu-Gharbieh

Abington Jefferson Health Papers

Introduction: Community-acquired pneumonia (CAP) is one of the leading causes of death globally. Changing antibiotic resistance profiles, paucity of reliable CAP mortality prediction models, and ageing populations will increase its burden. This study aims to evaluate adherence to CAP management guidelines as well as develop an ML-based mortality prediction model.

Methods: This retrospective, chart review included all CAP cases between 2016 and 2021. Variables collected included patients' demographics, comorbidities, vitals, laboratory, imaging, and culture findings, as well as initial and targeted antibiotic regimens. Data was pre-processed and analysed in python-3. Adherence to the American thoracic society/infectious diseases society of America …

Nudging Implementation Of Low Tidal Volume Ventilation: A Stepped Wedge, Cluster Randomized Trial, Meeta Prasad Kerlin, Michael O. Harhay, Fan Li, Dylan S. Small, Yingying Lu, Wei Wang, Barry D. Fuchs, Mark E. Mikkelsen, Teresa Tran, Aerielle Belk, Jasmine A. Silvestri, Tamar Klaiman, Stefania Scott, Elizabeth Levy, Michael W. Sjoding, Rachel Kohn, Karsten J. Roberts, Rinad S. Beidas, Scott D. Halpern

College of Health Professions Faculty Papers

BACKGROUND: "Nudges" embedded in the electronic health record (EHR) facilitate desired decisions while preserving autonomy and may provide a scalable strategy to overcome the common implementation barrier of lack of knowledge about a best practice. We sought to test whether EHR-based nudges targeting two intensive care unit (ICU) clinician groups would safely increase evidence-based use of low tidal volume ventilation.

METHODS: We performed a stepped-wedge, cluster randomized, hybrid type 3 effectiveness-implementation trial in 12 ICUs from February 2021 to May 2023 to test three nudges targeting clinicians responsible for order entry and respiratory therapists responsible for operationalizing orders and documentation. …

Barriers To Asthma Management And Specialty Care Among Low-Income Families In South Jersey, Sally Park, Courtney Ray-Fofana, Christal Onwuegbule

Rowan-Virtua Research Day

Asthma is a chronic respiratory condition that remains a significant public health concern, particularly among low-income and underserved populations. This poster presents a focused review of existing literature and publicly available data to examine barriers to asthma management and access to specialty care in South Jersey, with emphasis on counties such as Camden, Atlantic, and Cumberland.

Data were synthesized from sources including PubMed, the New Jersey Department of Health, and the National Institutes of Health to evaluate asthma prevalence, disease burden, and the impact of social determinants of health. Current estimates suggest that approximately 8.8%–9.0% of adults in New Jersey …

Comparison Of Ecg Features, Cardiac Biomarkers, And Clinical Outcomes In Three Waves Of Hospitalized Covid-19 Pneumonia Patients With Cardiovascular Events, Yuchen Han, Jahnavi Sunkara, Tshura S Ali, Harideep Samanapally, Vidyulata Salunkhe, Fnu Deepti, Emma C. Huang, Justin J. Huang, Maiying Kong, Jiapeng Huang

The University of Louisville Journal of Respiratory Infections

Background

Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is a rapidly evolving virus that can severely impact the cardiovascular system. With new variants, it is important to characterize wave-specific (defined by dominant circulating variants) clinical changes.

Methods

A multi-center retrospective cohort study of patients hospitalized with SARS-CoV-2 community acquired pneumonia at eight adult acute-care hospitals in the city of Louisville, KY was conducted. Patients hospitalized with Coronavirus Disease 2019 (COVID-19) community acquired pneumonia who experienced a cardiovascular event between March 2020 and July 2022 were included in this analysis. Variant assignment was based on temporal prevalence rather than genomic confirmation, and …

Qualitative Beta-2-Adrenoceptor Signaling In The Regulation Of Human Airway Epithelia Mucin And Cytokine Production, Fred Graumuller, Diana Cervantes, Tung O. Chan, Niccolette Schaunaman, Dominic R. Villalba, Burton F. Dickey, Julia K. L. Walker, Hong Wei Chu, Raymond B. Penn

Division of Pulmonary, Allergy, and Critical Care Medicine Faculty Papers

BACKGROUND: Numerous in vivo studies have demonstrated beta-2-adrenoceptor (β2AR) -agonism as permissive in the development of allergic lung inflammation, and have implicated the arrestin-dependent signaling arm of the β2AR in mediating this effect. However, the specific cell type(s) mediating β2AR regulation of allergic lung inflammation remain unestablished.

METHODS: To explore the potential contribution of airway epithelia in this phenomenon, we compared the ability of ractopamine (RP), recently identified as a Gs-biased beta-agonist, to that of the unbiased/balanced beta-agonist albuterol (ALB), on IL-13-stimulated mucin and cytokine production in human airway epithelia cultures in air-liquid interface (HAE).

RESULTS: ALB, which activates both …

Persistent Wheezing In An Adolescent Patient, Matilda Dervisevic, Stephen Cliff

Posters

No abstract provided.

Ecmo As A Bridge To Lung Transplant For Refractory Rapidly Progressive Interstitial Lung Disease, Matthew Moritz, Omar Pandhair

Books, Presentations, Posters, Etc.

Anti-melanoma differentiation-associated gene 5 (MDA-5) antibody is most frequently associated with dermatomyositis with various degrees of clinical manifestations including rapidly progressive interstitial lung disease (RP-ILD), inflammatory arthritis, vasculopathy, and other cutaneous findings. Clinically amyopathic dermatomyositis (CADM) is frequently associated with RP-ILD and has high mortality rates. Here we present a case of anti-MDA5 associated RPILD but without other features of dermatomyositis that did not respond to standard immunosuppressive therapy. A 41-year-old woman with recently diagnosed interstitial lung disease and polyarthritis previously on methotrexate presented with progressive dyspnea and worsening hypoxemic respiratory failure. She was previously admitted for respiratory failure two …

Pulmonary Pseudomyxoma Peritonei, Hannah Kirk, Do, Omar Pandhair

Books, Presentations, Posters, Etc.

Introduction: Pseudomyxoma peritonei (PMP) is an intra -abdominal cancer occurring in one to four out of one million patients. It begins as a mucinous adenocarcinoma of the appendix that implants on other peritoneal surfaces, spreading into gelatinous ascites. Treatment consists of hyperthermic intraperitoneal chemotherapy (HIPEC) and cytoreductive surgery (CRS). Extra -abdominal metastases are rare. We present the case of a patient who underwent treatment for PMP and was found to have lung nodules over a decade later. Case Presentation: A 73 -year -old woman with pseudomyxoma peritonei presented to the emergency department with progressive dyspnea and unintentional weight loss. Twenty …

Hyperglycemia And Mycoplasma Pneumoniae Cards Toxin Impacts On Lung Epithelial And Fibroblast Injury And Recovery, Alejandra Y. Delgado, Naila Villagomez, Shuri Magdalene

Posters - 2026

Mycoplasma pneumoniae CARDS toxin induces cytotoxicity and inflammation in lung epithelial cells²·¹⁰·¹¹, while hyperglycemia independently elevates ROS and disrupts fibroblast repair¹·⁵·⁸, contributing to the heightened respiratory infection severity seen in diabetic patients¹. However, the interaction between hyperglycemic conditions and CARDS toxin-induced lung injury remains unexplored.

This study investigates how increasing high-glucose (HG) pre-conditioning modifies CARDS toxin-induced injury and recovery in A549⁶ and IMR-90⁷ cells compared to normal glucose (NG ≈ 5mM) controls. We hypothesized that increasing glucose pre-conditioning concentrations would produce a dose-dependent increase in CARDS toxin-induced oxidative stress¹² and inflammatory cytokine production¹⁵ in IMR-90 and A549 compared with normal …

Prevalensi Covid-19 Derajat Berat Dan Kritis Saat Admisi Pada Pasien Penyakit Reumatik Autoimun Dan Faktor-Faktor Yang Berhubungan, Mulia Destini, Anna Ariane, Mira Yulianti, Aulia Rizka, Ikhwan Rinaldi, Arif Mansjoer, Hasan Maulahela, Syahidatul Wafa

Jurnal Penyakit Dalam Indonesia

Introduction. Patients with autoimmune rheumatic diseases are known to be more vulnerable to severe and critical infections, including COVID-19. Although it is no longer classified as a pandemic, SARS- CoV-2 infection still persists, and several surges of cases have been reported, including in Indonesia. To date, no data are available regarding the prevalence of severe and critical COVID-19 at admission in patients with autoimmune rheumatic diseases in Indonesia and the associated factors. This study aimed to determine the prevalence of severe and critical COVID-19 at admission in patients with autoimmune rheumatic diseases at Dr. Cipto Mangunkusumo National General Hospital, …

Practice Patterns And Inpatient Outcomes In Lung Abscess: A Cross Sectional Study, Saikou Saidy, Ali Iqbal, Saqib H. Baig

Division of Pulmonary, Allergy, and Critical Care Medicine Faculty Papers

Background: Lung abscess is typically managed with antibiotics, but drainage procedures are sometimes performed when there is inadequate clinical response or when source control is needed. Real-world inpatient practice patterns remain incompletely described in contemporary U.S. data. Our aim was to evaluate national inpatient practice patterns, predictors of procedural intervention, and associated in-hospital outcomes and resource utilization among patients hospitalized with lung abscess managed conservatively, with bronchoscopic drainage, or with percutaneous drainage.

Methods: Using the National Inpatient Sample (NIS) (2016–2018), we identified adult (18 years and older) hospitalizations with a principal diagnosis of lung abscess [International Classification of Diseases, 10th …

Issue 17: Pulmonary & Critical Care Insider, Bharat Bajantri Md, Sarah Ellsworth Mls, Stephanie Subart Pharmd

Critical Care & Pulmonary

Pulmonary & Critical Care Insider Issue 17

Compiled by Bharat Bajantri, MD, and librarian Sarah Ellsworth, MLS for the clinicians of the Pulmonary and Critical Care team of Parkview.

The Pulmonary & Critical Care Insider newsletter was created by Dr. Bharat Bajantri, MD and Sarah Ellsworth, MLS in 2023 as a form of current awareness for current practice at our hospital, Parkview Health.

Topics: 

• Management of Uncomplicated Gram-Negative Bacteremia
• Complicated Urinary Tract Infection Guidelines Update
• Ketamine vs Etomidate for RSI
• STORM-PE 
• Lung Ultrasound–Guided Weaning
•  D-Dimer for Pulmonary Embolism
• Extubation Failure
•  A Multimodal, physiology-Driven approach to pleural effusions
• Dexmedetomidine for Hyperactive …

Leappt: Leveraging Generative Artificial Intelligence-Pediatric Pulmonology Training. Curriculum And Content Development., Alvin Singh, Erin Khan, Mary Moffatt

Manuscripts, Articles, Book Chapters and Other Papers

After redesigning the curriculum of the pediatric pulmonology fellowship program at Children's Mercy-Kansas City, leadership continued to make changes based on feedback from a faculty survey concerned about the quality and structure of didactics. These changes included leveraging generative artificial intelligence to create a detailed course content outline containing specific objectives and study points for each subject related to pediatric pulmonology. Using the content outline as a foundational reference for learners, fellowship leadership continues to enhance the curriculum by creating testing questions, flipped classroom sessions and evaluations, and hope that these specific changes will help address decreased passing rates on …

A Rare And Challenging Polymicrobial Pleural Infection Involving Cupriavidus Pauculus In A Patient With Rheumatoid Arthritis And Multiple Complications, Moiz Ahmed Khan, Syeda Samiya Kamal, Muhammad Muneeb, Summaya Zafar

The University of Louisville Journal of Respiratory Infections

A 58-year-old female with a 15-year history of rheumatoid arthritis (RA) and a history of treatment consisting of methotrexate, hydroxychloroquine, leflunomide, and chronic prednisolone therapy, presented with fever, productive cough, dyspnea, and left leg cellulitis. She developed septic shock complicated by tension pneumothorax requiring emergency thoracostomy and non-ST-elevation myocardial infarction (NSTEMI). Pleural fluid culture grew Cupriavidus pauculus, a rare environmental gram-negative bacillus, alongside Burkholderia cepacia and Candida parapsilosis, indicating polymicrobial infection which was most likely predisposed by patient's immunosuppressed state from RA and prolonged steroid use. Treatment consisted of trimethoprim/sulfamethoxazole, meropenem, fluconazole, and cardiopulmonary support, and culminated in …

Exercise Performance In Ordinary Children And Adolescents: Baseline, Pandemic, And Post-Pandemic, Abby Skiena, Gina D'Aloisio, Ms, Takeshi Tsuda, Md

Alpha Omega Alpha Research Symposium Posters

Background: The COVID-19 pandemic might have created considerable negative impacts on the physical fitness of ordinary adolescents, which may pose a major threat to long-term cardiovascular health.

Methods: Healthy adolescents (ages 11 to 18) who underwent cardiopulmonary exercise testing (CPET) were grouped into baseline (~ 3/2020), pandemic (4/2020 ~12/2022), and post-pandemic (1/2023~ 5/2024) periods. Data are shown as mean ± standard deviation.

Results: Peak oxygen consumption (VO2/kg) and peak work rate (WR/kg) were significantly reduced during pandemic in both sexes and did not improve during post-pandemic in males (Table 1). The decline of peak oxygen pulse (OP/kg) …

Characterizing The Effects Of Antimuscarinics On Rhoa Signaling, Zuhra Tukhtamisheva, Elizabeth L. Mcduffie, Jordan Lee, Steven S. An, Reynold A. Panettieri Jr., Charles Scott

Alpha Omega Alpha Research Symposium Posters

Purpose: Airway hyperresponsiveness in asthma is driven by acetylcholine-mediated activation of the muscarinic acetylcholine 3 receptor (M3R), promoting bronchoconstriction, mucus hypersecretion, and airway remodeling. Despite directly targeting this pathway, antimuscarinics remain adjunctive rather than first-line therapy, suggesting a disconnect between biological rationale and clinical efficacy. Recent work from the Scott Lab at Thomas Jefferson University demonstrates that M3R in human airway smooth muscle (HASM) cells drives muscle shortening through G_12/13–driven RhoA signaling rather than through G_q/11-dependent calcium flux. We therefore investigated whether clinically prescribed antimuscarinics effectively inhibit G_12/13-dependent RhoA signaling in HASM cells.

Methods: …

Mycobacterium Shimoidei: A Case Report Of A Rare Nontuberculous Mycobacterial Infection In An American Patient With A Favorable Outcome, Madison Baker, Farah Majdoub, Asad Nasir

Advances in Clinical Medical Research and Healthcare Delivery

Non-tuberculous mycobacteria (NTM) are common environmental pathogens, but they are an uncommon cause of illness. One such mycobacteria, Mycobacterium shimoidei, was discovered in 1968 and found to cause a respiratory illness in 1975. Since then, fewer than 100 cases have been reported worldwide. Symptoms can include cough, fever, weight loss, and hemoptysis This report describes an American patient with no travel history who was found to have significant pulmonary disease caused by this rare non-tuberculous mycobacteria.

High-Flow Oxygen Therapy In Ild Exacerbations: An Imperfect Therapy, Kathleen Spritzer, Jesse Roman, Ross Summer, Gautam George

Division of Pulmonary, Allergy, and Critical Care Medicine Faculty Papers

No abstract provided.

Improving False Code Blue Rates In The Hospital, Edrianna Mae Ablola, Muhammad Siddiqi, Veronica Phung, Sivatej Sarva

Gulf Coast Division GME Research Day 2026

No abstract provided.

A Cost-Consequence Analysis Of The Children’S Administration Oxygenation Strategies Trial (Coast) In Severe Pneumonia, Orlagh U. Carroll, Richard Grieve, Sarah Kiguli, Peter Olupot-Olupot, Robert Opoka, Charles Engoru, Florence Alaroker, Abner Tagoola, Mainga Hamaluba, Eva Nabawanuka

Paediatrics and Child Health, East Africa

Oxygen supplementation is a recommended treatment for children with severe pneumonia or hypoxaemia. The open, fractional-factorial Children’s Oxygen Administration Strategies Trial (COAST) recruited Kenyan and Ugandan children with severe pneumonia and hypoxaemia. Participants in the severe hypoxaemia stratum (SpO₂ <  80%) were randomised to high-flow nasal therapy (HFNT) or low-flow oxygen (LFO), and in the hypoxaemia stratum (SpO₂ 80–91%) to HFNT, LFO or permissive hypoxaemia (ratio 1:1:2). The trial stopped early and there is ongoing uncertainty about the clinical benefits of the alternative strategies. There is a lack of evidence about the relative costs, of alternative oxygen delivery for critically-ill children in low- and middle- income countries. We used data from COAST to conduct a cost-consequence analysis …