Pulmonology Commons^™

A Rare Case Of Esophageal Perforation: Esophageal Perforation Following Cervical Spine Hardware Removal, Amira Al-Nabolsi, Jessica Kopchia, Cameron Hubbard, Hussein Hamade, Mouhamed Shatila

Conference Presentation Abstracts

An esophageal perforation is an uncommonly encountered life-threatening emergency that can lead to leakage of gastric contents into surrounding esophageal tissue. It is most commonly due to iatrogenic injury, typically involving endoscopy, intubation, or esophageal surgery. We describe an unusual case of esophageal perforation secondary to the removal of infected cervical spine hardware. A 73-year-old male with cervical spine central stenosis with history of an anterior cervical spinal fusion of C5-C7 over 40 years ago presented to the emergency department at the request of his pulmonologist. A CT scan of the neck was obtained in the outpatient setting, as the …

Development Of Parapneumonic Effusion In A Patient Using Kratom, Emma Glover, Morgan Kiryakoza, Nader Mina

Conference Presentation Abstracts

Introduction: “Kratom” refers to both Mitragyna speciosa, a tree native to Southeast Asia, and to its products, derived from the tree’s leaves, which are marked as an herbal supplement. Kratom is an herbal supplement with both opioid and stimulant-like effects. While there are no approved uses for kratom by the U.S. Food and Drug Administration, it is frequently used by individuals to manage withdrawal symptoms and cravings (especially related to opioid use), pain, fatigue, and mental health disorders. Furthermore, because kratom is unregulated, it can contain contaminants, including heavy metals and harmful bacteria. This case details the development of parapneumonic …

Not Your Typical Recurrent Pericarditis Patient!, Tarek Alsibai, Naomi Cret, Shaiva G. Meka

Conference Presentation Abstracts

No abstract provided.

From Immune Checkpoint Inhibition To Intubation, Sabena Toor, Samridhi Gulati, Shaiva G. Meka

Conference Presentation Abstracts

No abstract provided.

Pleural Epithelioid Hemangioendothelioma: An Ultra Rare Etiology For Recurrent Pleural Effusion, Ali Khreisat, Paul Bozyk

Conference Presentation Abstracts

Introduction Epithelioid hemangioendothelioma (EHE) is an extremely rare sarcoma of vascular origin. EHE has an incidence of less than 0.1 per 100,000 patients per year. It can involve multiple organs; pleural involvement is relatively rare and under-reported in the medical literature. We present a unique case of pleural EHE presenting with recurrent pleural effusion, severe pleuritis, scarring, and trapped lung syndrome. Case presentation A 54-year-old Caucasian female was referred to the pulmonary clinic for two months of progressive dyspnea, fatigue, and right pleuritic chest pain. Initial chest x-ray showed a large right pleural effusion. Thoracentesis identified exudative lymphocyte predominant pleural …

Calculating Differences In Surrogate Lung Perfusion Measurements Between Smokers And Nonsmokers As A Biomarker To Assess Their Potentials For Developing Chronic Obstructive Pulmonary Disease, A Prakash, A Nowacki, Y K. Liu, J Cisneros-Paz, Girish Nair, E Castillo

Conference Presentation Abstracts

Purpose: COPD (chronic obstructive pulmonary disease) is a collection of lung diseases that complicates breathing and causes irreversible lung damage. Given that it is a progressive disease, early detection is crucial for managing its symptoms. We recently developed a method for calculating pulmonary blood mass change (PBMC) apparent on paired inhale/exhale non-contrast computed tomography (CT) scans as a quantitative surrogate for lung perfusion. Our long term objective is to develop a PBMC biomarker for predicting COPD progression. As a first step, we hypothesize that PBMC is significantly lower for non-COPD smokers versus non-COPD non-smokers. Methods: CT scans from 77 healthy …

Quantifying Disease Progression In Copd Patients By Forecasting Pft Scores Using Extracted Features From Non-Contrast Ct, A T. Luong, C J. Herrera, E Young, Y K. Liu, A Nowacki, J Cisneros-Paz, Girish Nair, E Castillo

Conference Presentation Abstracts

Purpose: Currently there is no validated method for quantifying risk of disease progression in chronic obstructive pulmonary disease (COPD). We aim to address this by predicting whether a patient will worsen using a machine learning model trained on basic patient information, current pulmonary function values, FEV1 and FVC, and extracted features from a non-contrast CT scan. Disease severity is characterized by these pulmonary function values, and by extension disease progression can be determined by the change in these values between future timepoints. Methods: XGBoost, a popular classification library that utilizes gradient boosted trees, was used to define an ensemble model …

Quantifying Disease Progression In Copd Patients By Forecasting Pft Scores Using Extracted Features From Non-Contrast Ct, A T. Luong, C J. Herrera, E Young, Y K. Liu, A Nowacki, J Cisneros-Paz, Girish Nair, E Castillo

Conference Presentation Abstracts

Purpose: Currently there is no validated method for quantifying risk of disease progression in chronic obstructive pulmonary disease (COPD). We aim to address this by predicting whether a patient will worsen using a machine learning model trained on basic patient information, current pulmonary function values, FEV1 and FVC, and extracted features from a non-contrast CT scan. Disease severity is characterized by these pulmonary function values, and by extension disease progression can be determined by the change in these values between future timepoints. Methods: XGBoost, a popular classification library that utilizes gradient boosted trees, was used to define an ensemble model …

Quantifying Copd Disease Severity With Ct-Derived Perfusion Imaging, A Nowacki, G Nair, Y Liu, C J. Galban, C Stevens, E Castillo

Conference Presentation Abstracts

Purpose: CT-derived perfusion (CTP) is a novel image processing modality that quantifies pulmonary perfusion from non-contrast inhale/exhale CT image pairs. While existing imaging markers for COPD primarily depend on morphological features or HU thresholding, CTP provides a quantitative marker of blood flow and has been shown to identify disease progression prior to the appearance structural abnormalities. In this study, we assess the potential utility of CTP as a disease severity marker for COPD. Methods: CTP was computed from high-resolution inhale-exhale CT scans for 785 patients with a Global Initiative for Obstructive Lung Disease (GOLD) score ranging from 0 to 4 …

Physics-Informed Machine Learning For Estimating Pulmonary Perfusion From Non-Contract 4dct, Y Liu, A Nowacki, R Castillo, Y Vinogradskiy, G Nair, C Stevens, E Castillo

Conference Presentation Abstracts

Purpose: Novel methods have been developed for functional avoidance that proposes to use 4DCT to derive lung ventilation and perfusion images. Previous methods for quantifying lung perfusion on non-contrast 4DCT rely either on HU-based physical models or black-box deep learning models. While deep learning typically achieves higher accuracies in image processing tasks, physical models provide a rationale for model predictions. The purpose of this study is to introduce a biophysics-informed machine learning method for estimating pulmonary perfusion from noncontrast 4DCT. Our approach is designed to combine the predictive power of neural networks with the interpretability of physical modeling, with the …

Impact Of Serum Igg Levels Against Sars-Cov-2 On Clinical Outcomes For Hopitalized Covid Patient, Bipin Ghimire, Bijaya Thapa, Nishant Aggarwal, Luai Madanat, Melinda Sager, Daniel O'Connor, Alexandra Halalau

Conference Presentation Abstracts

BACKGROUND: The SAR-CoV-2 pandemic continues to negatively impact the healthcare system globally with over 800,000 deaths in the United States and millions more worldwide. The cases are rising despite availability of vaccines. For most immunocompetent patients these vaccines will generate a humoral response and also a memory T-cell response. Few if any studies have reported data that measure anti-spike IgG titers and also correlate those titers with clinical outcomes in the instance of breakthrough infection.

METHODS: We conducted a pilot prospective observational clinical study enrolling 30 immunocompetent patients who were admitted with a positive SARS-CoV-2 PCR. Leftover blood from admission …

Diffuse Alveolar Hemorrhage Due To Hydralazine-Induced Lupus, P Boshara, E Calvo-Ayala

Conference Presentation Abstracts

Introduction: Hydralazine is a known cause of drug-induced lupus. Rarely, it’s been reported to cause major organ-threatening complications, manifesting as kidney disease and CNS involvement. It’s also been associated with ANCA-positive vasculitis primarily involving the kidney, with uncommon pulmonary complications. We report a unique case of hydralazine-induced lupus presenting as diffuse alveolar hemorrhage (DAH) in the absence of renal disease or ANCA-positive vasculitis, which was successfully treated with systemic steroid monotherapy. Case description: The patient is an 86 year-old female with a history of chronic immune thrombocytopenia who presented to the hospital due to one week of dyspnea and hemoptysis. …

From Head To Hilum: Angiosarcoma With Pulmonary Metastasis, Tanaz Salimnia, Lauren A. Abplanalp, Raashi Chawla, K Hughes, R Ghandchi, Matthew Weatherhead, Sanjay Dogra

Conference Presentation Abstracts

With an estimated five-year survival of less than 40 percent, angiosarcomas are rare and often misdiagnosed fataltumors originating from blood or lymphatic vessels with a predilection for the head and neck. They account for 1percent of all soft tissue sarcomas and are often mistaken for benign mimickers leading to the late-stage diagnosiswhen the body is already riddled with metastatic disease with the lung being the most common site of metastases.This case illustrates the myriad of pulmonary complications associated with this uncommon but fatal vasoformativemalignancy. The patient is a 73-year-old male diagnosed with angiosarcoma of the right scalp status post excision,reconstruction, …

Differential Impact Of Static Lung Compliance On Need For Reintubation In Mechanically Ventilated Covid-19 Positive And Negative Patients, L A. Abplanalp, F Ionescu, O Gomez Rojas, E Castillo, G B. Nair

Conference Presentation Abstracts

Rationale: The decision to liberate from mechanical ventilation (MV) remains the result of multi-disciplinary discussion based on imperfect clinical tools such as the rapid shallow breathing index and spontaneous breathing trials. We have previously shown that static lung compliance (Cp) can help identify patients at high risk of reintubation despite meeting traditional criteria. In this study, we hypothesized that low Cp may not explain the reintubation risk in the distinct pathophysiologic scenario of COVID-19. Methods: This was a retrospective, multi-center analysis of COVID-19-negative (Dec. 2017-Dec. 2019) and -positive patients (Mar.-Oct. 2020) who required MV and were liberated during the same …

Hex Of The Dex: Dexmedetomidine Induced Malignant Hyperthermia In Myotonic Dystrophy, K Almerico, T Salimnia, S Dogra

Conference Presentation Abstracts

Dexmedetomidine is an alpha2 agonist that has been shown to have anxiolytic, analgesic, and sedative properties making it a popular medication in the intensive care unit. Over the years, its use has become more widespread. Thus, there have been more adverse events, most notably hypotension and bradycardia. Over the past few years the side effect of hyperthermia has grown to recognition with various case reports being documented. We report a case of dexmedetomidine induced malignant hyperthermia (MH) up to 42.2 degrees Celsius in a patient with underlying myotonic dystrophy that resolved within 24 hours of discontinuing the medication. The patient …

Pulmonary Cement Emboli: An Underreported Phenomenon Or Rare Kyphoplasty Complication, A Cimino, A Alchakaki

Conference Presentation Abstracts

Kyphoplasty is an intervention to treat and stabilize painful vertebral compression fractures by injecting Polymethymethacrylate (PMMA) cement in the vertebral cavity. It has become increasingly important procedure in pathologic compression fracture treatment. Pulmonary cement embolism (PCE) happens by leakage of cement through the venous plexus or retrograde migration in the arterial vessels to aorta. It was reported as a rare complication of this procedure (3.5%) but others have suggested that because of paucity in symptoms, PCE is often overlooked and can happen in up to 28.6% of kyphoplasty patients. PCE cause a wide spectrum of symptoms ranging from asymptomatic to …

A Study To Compare Baseline Functional Residual Capacity And Forced Vital Capacity As A Predictor Of Mortality And Hospitalization In A Cohort Of Mild To Moderate Interstitial Lung Disease, O R. Gomez Rojas, E Naeem, F Ionescu, E Castillo, G B. Nair

Conference Presentation Abstracts

Background Forced Vital Capacity (FVC) is a common parameter used to assess disease progression in patients with Interstitial lung disease (ILD) and acts as a surrogate for mortality. Previous studies suggest Functional Residual Capacity (FRC) may be an earlier predictor of disease progression in ILD. In this study, we compared ability of baseline FRC to FVC to predict one-year-mortality and respiratory related hospitalization in patients with mild to moderate ILD. Methods We retrospectively analyzed a prospective cohort of ILD patients attending a multidisciplinary ILD program from Jan 2017 to Oct 2021 at a large Health care system. Patients who had …

Identifying Novel Subphenotypes In Covid-19 Using Protein Biomarkers, A Spicer, P A. Verhoef, C Lopez-Espina, A Bhargava, L Schmalz, M Sims, A V. Palagiri, K V. Iyer, M J. Crisp, A Halalau, N Maddens, A Espinosa

Conference Presentation Abstracts

RATIONALE: COVID-19 is widely heterogeneous in presentation, even across patients with similar demographics and medical history. Identification of subphenotypes based on host immune responses that are biologically discrete and predict outcomes may enable personalized COVID-19 therapies. Accordingly, using a composite of electronic health record (EHR) data and 36 research biomarkers, we sought to compare COVID-19 immune responses across patients of varying disease severity, identify subphenotypes within hospitalized COVID-19 patients, and test for heterogeneity of treatment effect (HTE) to intravenous corticosteroids across these subphenotypes. METHODS: In this multicenter retrospective analysis of prospectively collected data, patients presenting to three medical centers from …

Pneumothorax Ex Vacuo As Initial Presentation Of Endobronchial Tuberculosis By Mycobacterium Bovis, Olga Romina Gomez Rojas, Matthew Weatherhead, Matthew Hicks, Christopher Dado, Abdulgadir Adam

Conference Presentation Abstracts

INTRODUCTION: Mycobacterium bovis infection in humans is an extremely rare entity. M. tuberculosis and M. bovis are clinically and radiographically indistinguishable, hence, genotype-based identification is required. Management and outcomes of M. bovis infection are not well described. We present the first case of endobronchial tuberculosis secondary to M. bovis in an immunocompetent host. DESCRIPTION: A 19 year old woman without past medical history presented to the emergency department for sudden onset left-side chest pain and dry cough. A preoccupational evaluation noted a positive tuberculin skin test with normal chest-xray. Physical exam significant for absent breathing sounds in the left upper …

Tpn-Induced Excipient Lung Disease, Tanza Salimnia, Raashi Chawla, Rameen Ghandchi, Dhiviyan Valentine, Ping Zhang, Christopher Dado, Paul Bozyk

Conference Presentation Abstracts

INTRODUCTION: Patient is a 73 year old female with past medical history of colon cancer status post colectomy/ ileostomy with ileal conduit on chronic total parenteral nutrition (TPN) who presented to the hospital for fatigue and hypotension. She reported that the night prior, she had an 8 hour lapse in her memory and a sensation of dyspnea. In the ED, she was hypotensive and hypoxic. CTA of the chest was notable for a small and nonocclusive right lower lobe embolism, massive right heart strain with RV/LV 1.5 as well as innumerable bilateral centrilobular micronodules. The above findings were not present …

Synergistic Bleomycin Toxicity And Evali: A Lethal Combination, Daniel O'Connor, Nader Mina, Hira Iftikhar

Conference Presentation Abstracts

Introduction: Both vaping and bleomycin-based chemotherapy regimens are known risk factors for acute lung injury. Few, if any, cases are documented in the literature of these insults co-occurring. Case description: A 20-year-old male was diagnosed with Stage III testicular cancer in Autumn of 2020. He began BEP (bleomycin-etoposide-platinum), of which he completed three cycles before developing pulmonary sequelae. Social history was notable for marijuana use and vaping, including during his active chemotherapy, to help with cancer-related nausea, anxiety, and anorexia. Winter 2021, he visited the ED for dizziness, fatigue, and diarrhea, felt to be consistent with chemotherapy side effects, but …

Massive Pulmonary Embolism After Pfizer Vaccine, Samiksha Pandey, Bipin Ghimire, Emma Herrmann, Dilip Khanal

Conference Presentation Abstracts

Introduction Vaccines against COVID -19 have been reported to cause venous thromboembolism (VTE). To our knowledge, this is the first case to report the massive, near-fatal Pulmonary Embolism (PE) associated with BNT162b2 Covid-19 (Pfizer/BioNTech) vaccine and discuss the associated risk factors for PE. Case 41-year-old, non-smoker, female on OCP, presented for syncope and seizure-like activity. Upon presentation, she was obtunded and tachypneic. Initial labs showed leukocytosis, mild anemia, and thrombocytopenia, respiratory and metabolic acidosis. She deteriorated quickly to cardiac arrest requiring Cardiopulmonary Resuscitation and intubation. Tissue Plasminogen Activator administered for possible PE. Computed Tomography Angiography (CTA) pulmonary confirmed sagittal pulmonary …

Infective Endocarditis Due To Streptococcus Salivarius Presenting As Septic Arthritis, Mishita Goel, Zachary Johnson, Manishkumar Patel, Raashi Chawla, Tanaz Salimnia

Conference Presentation Abstracts

No abstract provided.