DOCSLIB.ORG

Cb October 05

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Cb October 05 consultant on call RESPIRATORY MEDICINE Feline Asthma and Bronchitis Philip Padrid,RN,DVM,Family Pet Animal Hospital,Chicago,Illinois,and Ohio State University & University of Chicago Profile GEOGRAPHIC DISTRIBUTION asthma,” results from a complex interplay None recognized. of activated T lymphocytes, antigen, anti- gen-processing cells, various cytokine pro- DEFINITION teins and chemical messengers, and activat- Chronic bronchitis and asthma are both SIGNALMENT Siamese and Siamese-related breeds appear ed eosinophils and other inflammatory cells chronic inflammatory diseases that occur in to be at risk. Cats of any age may develop in the bronchial mucosa. The inflammatory the lower airways (bronchi and bronchioles). chronic bronchial disease, although young results of these processes include excessive In practice, it is often difficult to distinguish and middle-aged cats (1 to 8 years) most mucus secretion, airway wall edema, and, in between the two disorders. Chronic bronchi- commonly have the disorder. Male and asthmatic patients, bronchoconstriction. tis is defined in part by the presence of a female cats appear to be equally at risk. Airway muscle hypertrophy and hyperplasia daily cough; asthma is defined in part by are more common in asthmatic than in acute bronchoconstriction that may resolve bronchitic airways. Basement membrane spontaneously or with treatment. CAUSES thickening is a feature of asthma in humans Bronchoconstriction may or may not cause Unknown. The causes of asthma and bron- but has not consistently been found in cats. cough in an individual cat (known as cough- chitis probably differ. The most common causes of asthma in humans include house variant asthma). Thus, cats with a daily SIGNS cough may have either disorder, while cats dust mites, feline “dander,” and cockroach- Cough, mucus production, wheeze, open- without cough may have asthma but do not es; chronic bronchitis is the result of ciga- mouth breathing, and exercise intolerance have chronic bronchitis. Both disorders may rette smoke in humans, although this directly resulting from the pathophysiologic result in wheeze and exercise intolerance. association has not been shown in cats. derangements described above. Finally, human asthma is a syndrome in RISK FACTORS which the causes may vary greatly, including HISTORY allergy, exercise, and cold air, in individual Unknown. In humans with asthma, there is Cough and increased respiratory rate and patients. For purposes of this discussion, a 50% chance of developing asthma if both effort are common to asthma and chronic asthma in cats refers to allergic asthma. parents are asthmatic. Living indoors or out- doors is not causally associated with devel- bronchitis. There is usually a gag/choke or swallow at the end of the cough, signifying GENETIC IMPLICATIONS opment of chronic bronchitis or asthma in excess mucus production. Asthmatic Several “asthma genes” have been implicat- cats. Cigarette smoke increases symptoms in patients may have symptom-free periods, ed in the pathophysiology of human asth- human patients with established disease; whereas a daily cough is the defining fea- ma, and this is also an active area of passive cigarette smoke has been linked to ture of bronchitis. research in veterinary medicine. The Siamese bronchial disease in children. No data con- breed seems to be overrepresented, sug- firm this phenomenon in cats, although gesting an inherited trait. common sense suggests that exposure to cigarette smoke is probably harmful. Diagnosis INCIDENCE/PREVALENCE There are no precise actuarial data. Chronic PATHOPHYSIOLOGY PHYSICAL EXAMINATION bronchial disease (both bronchitis and asth- Unknown. In humans, cigarette smoke caus- Physical examination may be unremarkable. ma) probably affects 0.75% to 1% of the es cough, airway wall thickening, and hyper- Most cats with chronic bronchitis or asthma feline population in general and may affect trophy of the mucus-secreting apparatus. have increased bronchovesicular lung 5% of the Siamese breed. Asthma is more complex and is better sounds heard diffusely. Wheeze may be thought of as a “syndrome” with many heard, especially during expiration. causes. The most common form, “allergic continues consultant on call ..................................................................................................................NAVC clinician’s brief.....october.2005.....37 consultant on call C ONTINUED Respiratory rate may be increased, and tis is peribronchial cuffing, often described Bronchoscopy is usually not necessary for there may be nasal flaring. Cyanosis occurs as doughnuts or tram lines (Figure 1). diagnosis. Pulmonary function testing is in severe cases. Other common causes of cough and used to determine airway hyperresponsive- increased respiratory effort include pneumo- ness in asthmatic persons. This technology is DIAGNOSIS/DIFFERENTIAL DIAGNOSIS nia, heart failure, cancer, and heartworm dis- now available to approximate airway reac- There are no clinical signs or laboratory ease. These disorders usually create radi- tivity in awake, nonrestrained cats (Buxco tests available in general practice that are ographic abnormalities that differ from the box, Buxco Electronics; Wilmington, NC). pathognomonic for asthma or bronchitis. We classic findings of hyperinflation and pursue diagnostic testing in cats with bronchial markings seen in chronic bronchi- Skin testing for the presence of antigen- cough, tachypnea, and/or wheeze to deter- tis or asthma. specific IgE has been proposed as a way to mine the presence of other common causes determine an underlying “cause” of allergic of these signs—for example, heart failure, Both bronchitic and asthmatic cats have asthma. However, the biological response of pneumonia, pulmonary cancer, respiratory excessive airway mucus. Nonseptic neu- mast cells in skin often differs from that of parasitism, and inhaled foreign bodies. trophils are the predominant cell type in mast cells in the airways to the same anti- bronchial fluid. Eosinophils may predomi- gen in the same cat. For this reason, the LABORATORY FINDINGS/IMAGING nate in bronchial fluid from asthmatic cats, author does not yet recommend this manner Asthmatic cats often present with a history although healthy cats also frequently harbor of testing. of sudden onset of labored breathing that is large numbers of eosinophils in the respira- quickly relieved with some combination of tory tract. POSTMORTEM FINDINGS oxygen, bronchodilators, and steroids. In • Bronchitic and asthmatic airway epitheli- some cases, the only sign is chronic or inter- We also measure pulse oximetry in cats um may thicken (hypertrophy), evolve to a mittent cough. Patients with chronic bron- breathing room air to determine the relative different structure (metaplasia), or simply chitis have a history of chronic daily cough degree of impaired oxygen exchange. In become damaged (erosion or ulceration). with gag/choke or swallow at the comple- general, a pulse oximeter reading of 95% or • Bronchitic and asthmatic goblet cells and tion of the cough, representing excessive above (PaO2 of approximately 80 mm Hg or submucosal glands may enlarge and pro- mucus secretion. above) is considered stable; a reading of duce excessive amounts of a particularly 90% or below (PaO2 of approximately 60 thick form of mucus. The most common radiographic change mm Hg or below) is considered extremely • Asthmatic bronchial smooth muscle will common to both feline asthma and bronchi- unstable. often spasm and may undergo hypertro- phy and/or hyperplasia. These changes are associated with cellular infiltration of the bronchial mucosa and sub- mucosa. This tissue may also become ede- matous. See Figures 2 and 3. Treatment INPATIENT OR OUTPATIENT Asthmatic and bronchitic patients may pres- ent in various stages of distress. The deci- sion to hospitalize these patients is made on a case-by-case basis. In addition to clinical criteria, patients with a pulse oximeter read- 1 ing of 95% or higher are often treated as outpatients; those with readings of 90% or This lateral thoracic radiograph demonstrates classic features of feline asthma, including hyperinflation and peribronchial infiltration (doughnuts and tram lines). MDI = metered-dose inhaler 38....october.2005.....NAVC clinician’s brief ....................................................................................................................consultant on call Prednisone is gradually tapered over a 2- week period to allow the inhaled medica- tion to achieve its full effect. Bronchodilators Albuterol is given by inhalation as needed in the same manner as steroids. Albuterol can be given every one-half hour for 4 to 6 2 3 hours if needed in a crisis. Oral drugs can be used for cats that cannot tolerate inhaled A cross section from the large airway of a cat This large airway from a cat with chronic bronchitis with asthma, demonstrating the classic findings of demonstrates goblet cell hypertrophy and a mucus albuterol. The pharmacokinetics of theo- smooth muscle hypertrophy, invagination of plug. Airway smooth muscle is normal and there is phylline are well described in the feline epithelium (bronchoconstriction), and luminal exu- no evidence of bronchoconstriction, thus distinguish- species; however, in the author’s experience, date. ing bronchitis from asthma. the response to terbutaline (0.1 mg/kg PO Q 12 H) is more consistent. Cats in status asth- below are frequently hospitalized and treat- and the medication fills the spacer. The
Load more

Recommended publications
  • Chest Radiology: a Resident's Manual
    Chest Radiology: A Resident's Manual Bearbeitet von Johannes Kirchner 1. Auflage 2011. Buch. 300 S. Hardcover ISBN 978 3 13 153871 0 Format (B x L): 23 x 31 cm Weitere Fachgebiete > Medizin > Sonstige Medizinische Fachgebiete > Radiologie, Bildgebende Verfahren Zu Inhaltsverzeichnis schnell und portofrei erhältlich bei Die Online-Fachbuchhandlung beck-shop.de ist spezialisiert auf Fachbücher, insbesondere Recht, Steuern und Wirtschaft. Im Sortiment finden Sie alle Medien (Bücher, Zeitschriften, CDs, eBooks, etc.) aller Verlage. Ergänzt wird das Programm durch Services wie Neuerscheinungsdienst oder Zusammenstellungen von Büchern zu Sonderpreisen. Der Shop führt mehr als 8 Millionen Produkte. 1 Heart Failure Acute left heart failure is most commonly caused by a hyperten- " Compare pulmonary vessels that are equidistant to a central sive crisis. Radiographic signs on the plain chest radiograph ob- point in the respective hilum. tained with the patient standing include: " Compare the diameter of a random easily identifiable superior " Redistribution of pulmonary perfusion lobe artery (often the anterior segmental artery is most easily " Presence of interstitial patterns (Kerley lines, peribronchial identifiable) with the diameter of the corresponding ipsilateral cuffing) bronchus (Fig. 1.62). " Alveolar densities with indistinct vascular structures (ad- vanced stage) As the pulmonary artery and corresponding ipsilateral bronchus " Pleural effusions are normally of precisely equal diameter, a larger arterial diameter is indicative of redistribution of perfusion (Fig. 1.63). The diagnos- All of these signs are essentially attributable to increased fluid tic criteria of caudal-to-cranial redistribution cannot be evaluated content in the abnormally heavy “wet” lung. The fluid accumula- on radiographs obtained in the supine patient.
    [Show full text]
  • Common Pediatric Pulmonary Issues
    Common Pediatric Pulmonary Issues Chris Woleben MD, FAAP Associate Dean, Student Affairs VCU School of Medicine Assistant Professor, Emergency Medicine and Pediatrics Objectives • Learn common causes of upper and lower airway disease in the pediatric population • Learn basic management skills for common pediatric pulmonary problems Upper Airway Disease • Extrathoracic structures • Pharynx, larynx, trachea • Stridor • Externally audible sound produced by turbulent flow through narrowed airway • Signifies partial airway obstruction • May be acute or chronic Remember Physics? Poiseuille’s Law Acute Stridor • Febrile • Laryngotracheitis (croup) • Retropharyngeal abscess • Epiglottitis • Bacterial tracheitis • Afebrile • Foreign body • Caustic or thermal airway injury • Angioedema Croup - Epidemiology • Usually 6 to 36 months old • Males > Females (3:2) • Fall / Winter predilection • Common causes: • Parainfluenza • RSV • Adenovirus • Influenza Croup - Pathophysiology • Begins with URI symptoms and fever • Infection spreads from nasopharynx to larynx and trachea • Subglottic mucosal swelling and secretions lead to narrowed airway • Development of barky, “seal-like” cough with inspiratory stridor • Symptoms worse at night Croup - Management • Keep child as calm as possible, usually sitting in parent’s lap • Humidified saline via nebulizer • Steroids (Dexamethasone 0.6 mg/kg) • Oral and IM route both acceptable • Racemic Epinephrine • <10kg: 0.25 mg via nebulizer • >10kg: 0.5 mg via nebulizer Croup – Management • Must observe for 4 hours after
    [Show full text]
  • Radiologic Assessment in the Pediatric Intensive Care Unit
    THE YALE JOURNAL OF BIOLOGY AND MEDICINE 57 (1984), 49-82 Radiologic Assessment in the Pediatric Intensive Care Unit RICHARD I. MARKOWITZ, M.D. Associate Professor, Departments of Diagnostic Radiology and Pediatrics, Yale University School of Medicine, New Haven, Connecticut Received May 31, 1983 The severely ill infant or child who requires admission to a pediatric intensive care unit (PICU) often presents with a complex set of problems necessitating multiple and frequent management decisions. Diagnostic imaging plays an important role, not only in the initial assessment of the patient's condition and establishing a diagnosis, but also in monitoring the patient's progress and the effects of interventional therapeutic measures. Bedside studies ob- tained using portable equipment are often limited but can provide much useful information when a careful and detailed approach is utilized in producing the radiograph and interpreting the examination. This article reviews some of the basic principles of radiographic interpreta- tion and details some of the diagnostic points which, when promptly recognized, can lead to a better understanding of the patient's condition and thus to improved patient care and manage- ment. While chest radiography is stressed, studies of other regions including the upper airway, abdomen, skull, and extremities are discussed. A brief consideration of the expanding role of new modality imaging (i.e., ultrasound, CT) is also included. Multiple illustrative examples of common and uncommon problems are shown. Radiologic evaluation forms an important part of the diagnostic assessment of pa- tients in the pediatric intensive care unit (PICU). Because of the precarious condi- tion of these patients, as well as the multiple tubes, lines, catheters, and monitoring devices to which they are attached, it is usually impossible or highly undesirable to transport these patients to other areas of the hospital for general radiographic studies.
    [Show full text]
  • Respiratory Distress in Pediatrics
    Hindsight is 20/20 Karen A. Santucci, M.D. Professor of Pediatrics Yale-New Haven Children’s Hospital October 9, 2014 Disclosure No Financial Relationships Personal Financial Disclosure Case 1 Toddler siblings are jumping on the couch Larger one lands on top of the smaller one, both landing on the tile floor The smaller child cries out and develops respiratory distress. 911 activated Vitals: RR 62, HR 168, afebrile, crying EMS is transports her to the nearest hospital Case Progression Upon arrival, oxygen saturation in 70’s and severe respiratory distress Supplemental oxygen not helping! Decreased breath sounds bilaterally! No reported tracheal deviation Difficult to ventilate and oxygenate! Bilateral chest tubes are placed! She’s Intubated! Still difficult to ventilate and oxygenate! Case Progression Differential Diagnoses? Differential Diagnoses? Pulmonary contusion? Traumatic pneumothorax? Hemothorax? Crush injury? Transection? Underlying problem????? -Asthma -Pneumonia -Cystic fibrosis Perplexing Case Pediatric Pearl If it doesn’t make sense, go back to the basics. What were they doing right before the fall? Something We Don’t See Everyday! or Do We???? What the Heck!! Epidemiology 92,166 cases reported to Poison Centers in 2003 Peak incidence 6 months to 3 years 600 children die annually Majority present to EDs 2003 Annual Report of the American Association of Poison Control Centers Toxic Exposure Surveillance System Am J Emerg Med 2004; 22:335-404 Foreign Bodies Food Coins Toys Munchausen Syndrome by
    [Show full text]
  • Post Lung Transplant Complications: Emphasis on CT Imaging Findings
    Post Lung Transplant Complications: Emphasis on CT Imaging Findings Rashmi Katre, MD Carlos S Restrepo, MD Ameya Baxi, MD Learning Objectives • To identify the pulmonary complications and pathological processes which may occur after lung transplantation • To describe the role of imaging in post transplant patients with emphasis on the CT imaging findings of the select relevant entities None of the authors has any financial disclosure to make. The authors declare that there is no conflict of interest Introduction • Lung transplantation has been widely accepted as a treatment of choice among patients with end stage lung disease. • Past experiences have shown its efficacy in improving the longevity as well as quality of life in many patients. Nevertheless, it is not devoid of complications which may vary from trivial and treatable entities to life threatening conditions. • The complications can be divided into plural, pulmonary and airway diseases such as; hyperacute, acute, and chronic rejection including bronchiolitis obliterans organizing pneumonia; pulmonary infections; bronchial anastomotic complications; pleural effusions; pneumothoraces, lung herniation, pulmonary thromboembolism; upper-lobe fibrosis; primary disease recurrence; posttransplantation lymphoproliferative disorder. • Imaging , especially CT is crucial in early detection, evaluation and diagnosis of these complications, in order to decrease the morbidity and mortality associated with certain conditions. This educational exhibit addresses the pathological processes after lung transplantation and discusses the role of imaging, with emphasis on CT imaging findings. Reperfusion Edema Ischemia-reperfusion injury is a noncardiogenic pulmonary edema that typically occurs more than 24 hours after transplantation, peaks in severity on postoperative day 4, and generally improves by the end of the 1st week.
    [Show full text]
  • Bronchial Anthracofibrosis
    Published online: 2021-07-26 THORACIC IMAGING Bronchial anthracofibrosis: The spectrum of radiological appearances Ashok Shah1,2, Shekhar Kunal1, Rajesh Gothi3 1Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, 2Senior Consultant, Department of Pulmonary and Sleep Medicine, Max Super Speciality Hospital, Shalimar Bagh, 3Department of Imaging, Max Super Speciality Hospital, Saket, New Delhi, India Correspondence: Prof. Ashok Shah, F‑168/E, Rajouri Garden, New Delhi ‑ 110 027, India. E‑mail: [email protected] Abstract Bronchial anthracofibrosis (BAF), caused by long‑standing exposure to biomass fuel smoke, has emerged as a distinct pulmonary disease. It is usually seen in elderly females who have worked long hours in poorly ventilated kitchen full of smoke due to incomplete combustion of biomass fuel. The diagnosis is confirmed on bronchoscopic visualization of bluish‑black anthracotic pigmentation along with narrowing/distortion of the affected bronchus. BAF has been associated with clinical conditions such as pulmonary tuberculosis, chronic obstructive pulmonary disease, pneumonia, and malignancy. Tuberculosis, once thought to be the causative agent for BAF, is now considered to be an association. BAF has a diverse radiological presentation and the presence of associated clinical conditions often confound the radiological picture. The imaging features of BAF include primary imaging characteristics, which pertains to the disease entity directly, and secondary features based on the presence of associated conditions. High‑resolution computed tomography findings of multifocal bronchial narrowing and peribronchial cuffing are considered to be specific diagnostic features of BAF. In addition, the diagnostic probability is increased in the presence of mediastinal adenopathy and collapse/atelectasis with middle lobe syndrome being the most common presentation.
    [Show full text]
  • Pleural Effusion
    1 เอกสารประกอบการสอน เรื่อง รังสีวิทยาระบบทางเดินหายใจ: การเลือกส่งตรวจและแปลผลภาพรังสีทรวงอก (Radiology of the chest: methods of investigation and plain film interpretation) โดย แพทย์หญิงวรรณพร บุรีวงษ์ 2 แผนการสอน หัวข้อ รังสีวิทยาระบบทางเดินหายใจ: การเลือกส่งตรวจและแปลผลภาพรังสีทรวงอก ผู้สอน พญ. วรรณพร บุรีวงษ์ เวลา 3 ชั่วโมง วัตถุประสงค์ เพื่อให้นิสิตแพทย์สามารถ 1. บอกวิธีการตรวจและข้อบ่งชี้ในการส่งตรวจทางรังสีวิทยาของระบบทางเดินหายใจได้ 2. บอกท่าที่ใช้ถ่ายภาพรังสีทรวงอก และความเหมาะสมของเทคนิคที่ใช้ในการถ่ายภาพได้ 3. สามารถอธิบายโครงสร้างและอวัยวะภายในของร่างกายที่พบบนภาพรังสีทรวงอกได้ เนื้อหาหัวข้อ 1. วิธีการตรวจทางรังสีวิทยาของระบบทางเดินหายใจ ได้แก่ Plain chest radiography (CXR), Computed tomography (CT), CT angiography, Magnetic resonance imaging (MRI), Ultrasonography, Angiography และ Radionuclide study 2. ลักษณะทางกายวิภาคเบื้องต้นของระบบทางเดินหายใจ (Normal anatomy of the chest) 3. ภาพถ่ายรังสีทรวงอกแบบปกติ (Normal chest radiography) การจัดประสบการณ์เรียนรู้ 1. บอกวัตถุประสงค์และบอกเนื้อหา 5 นาที 2. สอนบรรยายหัวข้อต่างๆ 60 นาที 3. กิจกรรม/สอนแสดง 90 นาที 4. สรุปเนื้อหาบทเรียน 15 นาที 5. นิสิตซักถาม 10 นาที สื่อการสอน 1. เอกสารประกอบการสอน 2. Power point ทั้งภาพนิ่งและ animation 3. ภาพถ่ายทางรังสี วิธีประเมินผล 1. ข้อสอบ Multiple choice question 5 ตัวเลือก 2. ข้อสอบบรรยายภาพถ่ายทางรังสี OSCE 3 หนังสือและเอกสารอ้างอิง 1. Sutton D. Textbook of radiology and imaging. 6th ed. China: Churchill Living stone, 1998 2. Herring W. Learning radiology: recognizing the basics. 2nd ed. Philadelphia: Elsevier Mosby, 2007. 3. Armstrong P,
    [Show full text]
  • Peribronchial Cuffing Rather Than Consolidation Pneumonia Or Not? P-CXR
    21.04.23 KSEM spring conference: Pediatric images, what we have to focus on P-CXR Essential viewpoints for pediatrics in ED1 Ajou Univ. School of Medicine Department of emergency medicine Jung Heon Kim P-CXR I have nothing to disclose .“Normal” chest AP .Pneumonia or not? .Appendix .Take-home message P-CXR Am I normal? “Normal” chest AP P-CXR My residents: “What (the hell) is normal chest AP?” The answer is… It is inherently difficult… Check expiration & rotation Why? Young kids (<4 y): poor cooperation when taking pictures “Normal” chest AP P-CXR . AP view: trapezoid thorax & horizontal ribs . Small-looking lungs - CT ratio: 60%–65% (false cardiomegaly) - Elevated diaphragm . False (+) findings - Thymus: look like mediastinal mass - Trachea: slightly Rt-deviated - Air bronchogram: bronchial branching around hilum . Lat view (optional): retrosternal “white” “Normal” chest AP P-CXR Check expiration & rotation Findings Expiration Diaphragm at 8th post rib or higher (cf, 6th ant. rib) Under-aerated (“whitish lung”) & Rt-deviated trachea Triangular hemi-thorax (ribs: oblique > horizontal) “Larger”-looking heart & thymus Rotation T-spinous proc is midway between 2 med ends of clavicles “Normal” chest AP P-CXR Expiration WIN! vs 8 8 th Diaphragm at slightly higher than 8 post rib ( Diaphragm at 9th post rib (5th ant rib) 4th ant rib) More trapezoid hemi-thorax Triangular hemi-thorax & larger heart “Normal” chest AP P-CXR Rotation WIN! vs Diaphragm at 8th post rib (6th ant rib) Diaphragm at 8th post rib (5th ant rib) Triangular hemi-thorax Trapezoid
    [Show full text]
  • The Added Value of the Lateral Chest Radiograph for Diagnosing
    ,0$-ǯ92/20ǯ-$18$5<2018 ORIGINAL ARTICLES The Added Value of the Lateral Chest Radiograph for Diagnosing Community Acquired Pneumonia in the Pediatric Emergency Department Michalle Soudack MD1,3, Semion Plotkin MD2,3, Aviva Ben-Shlush MD1, Lisa Raviv-Zilka MD1,3, Jeffrey M. Jacobson MD1, Michael Benacon MD2,3 and Arie Augarten MD2,3 Departments of 1Pediatric Imaging and 2Pediatric Emergency Medicine, Safra Children’s Hospital, Sheba Medical Center, Tel Hashomer, Israel 3Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel nia (CAP), and a recent review reiterated and stressed the need ABSTRACT: Background: Opinions differ as to the need of a lateral radio- for both fontal and lateral views for infants and children with graph for diagnosing community acquired pneumonia in lower respiratory tract symptoms [1,2]. children referred to the emergency department. A lateral radio- The lateral chest radiograph assists in the localization and graph increases the ionizing radiation burden but at the same characterization of findings seen on the frontal view. Certain time may improve specificity and sensitivity in this population. “blind areas,” such as the retro-cardiac space, are better visual- Objectives: To determine the value of the frontal and lateral ized with the lateral view. However, despite the IDSA guide- chest radiographs compared to frontal view stand-alone images lines, opinions differ as to the need for the lateral view, in part for the management of children with suspected community due to the extra radiation exposure [2-9]. acquired pneumonia seen in a pediatric emergency department. In this study we aimed to determine the added value of the Methods: Chest radiographs from 451 children with clinically lateral chest radiograph for children with suspected CAP.
    [Show full text]
  • Pediatric Surgery and Medicine for Hostile Environments
    PEDIATRIC SURGERY AND MEDICINE FOR HOSTILE ENVIRONMENTS Kevin M. Creamer, MD • Michael M. Fuenfer, MD MY MEDI AR CA S L E D T E A P T A S R T D M E T E I N N T U B O E R T D TU EN INSTI Second Edition Pediatric Surgery and Medicine for Hostile Environments Second Edition Borden Institute US Army Medical Department Center and School Health Readiness Center of Excellence Fort Sam Houston, Texas Office of The Surgeon General United States Army Falls Church, Virginia i The test of the morality of a society is what it does for its children. —Dietrich Bonhoeffer (1906–1945) ii This book is dedicated to the military medical professional in a land far from home, standing at the bedside of a critically ill child. iii Dosage Selection: The authors and publisher have made every effort to ensure the accuracy of dosages cited herein. However, it is the responsibility of every practitioner to consult appropriate information sources to ascertain correct dosages for each clinical situation, especially for new or unfamiliar drugs and procedures. The authors, editors, publisher, and the Department of Defense cannot be held responsible for any errors found in this book. Use of Trade or Brand Names: Use of trade or brand names in this publication is for illustrative purposes only and does not imply endorsement by the Department of Defense. Neutral Language: Unless this publication states otherwise, masculine nouns and pronouns do not refer exclusively to men. The opinions or assertions contained herein are the personal views of the authors and are not to be construed as doctrine of the Department of the Army or the Department of Defense.
    [Show full text]
  • Download This PDF File
    DIAGNOSE THIS A 45-Year-Old Male with New Onset Shortness of Breath Kristen Ralph MD, MSc1, Adam Dmytriw MD MSc2, Robert Miller MD3 1Faculty of Medicine, Dalhousie University 2Department of Medical Imaging, University of Toronto 3Department of Radiology, QEII Health Sciences Centre A 45 year-old male presented to the ED for the second time in one week, complaining of shortness of breath and low grade fever, taken at home with an oral What is the most likely diagnosis? thermometer. He had recently completed treatment for lymphoma. He denied chest pain, but admitted that A. Congestive heart failure he had noticed some new swelling in his legs. He was B. ARDS or shock lung admitted with a diagnosis of presumed pneumonia C. Lymphangitic carcinomatosis and rapidly deteriorated, requiring intubation 12 D. Acute pulmonary hemorrhage hours following admission to the ICU. A portable E. Bilateral pneumonia anteroposterior (AP) chest x-ray was taken to check placement of this tubes and lines (Figure 1). Figure 1. Anteriorposterior (AP) portable chest radiograph DMJ • Spring 2015 • 41(2) | 8 Diagnose This: Male with Shortness of Breath Answer configuration. The chest x-ray can also demonstrate or rule out other potential causes of the patient’s The correct answer is "A". symptoms. Chest x-ray has a moderate specificity of about 76-83% but has a low sensitivity of 67-68%.6 ARDS would be incorrect as it classically presents as bilateral, peripheral airspace disease. It is not The gold standard test for evaluating heart failure is lymphangitic carcinomatosis as this disease classically a transthoracic echocardiogram (TTE).
    [Show full text]
  • CHEST RADIOLOGY Patterns and Differential Diagnoses This Page Intentionally Left Blank
    Any screen. Any time. Anywhere. Activate the eBook version of this title at no additional charge.rge. Expert Consult eBooks give you the power to browse and find content, view enhanced images, share notes and highlights—both online and offline. Unlock your eBook today. Visit Scan this QR code to redeem your 1 expertconsult.inkling.com/redeem eBook through your mobile device: 2 Scratch off your code 3 Type code into “Enter Code” box 4 Click “Redeem” 5 Log in or Sign up 6 Go to “My Library” It’s that easy! Place Peel Off Sticker Here For technical assistance: email [email protected] call 1-800-401-9962 (inside the US) call +1-314-447-8200 (outside the US) Use of the current edition of the electronic version of this book (eBook) is subject to the terms of the nontransferable, limited license granted on expertconsult.inkling.com. Access to the eBook is limited to the first individual who redeems the PIN, located on the inside cover of this book, at expertconsult.inkling.com and may not be transferred to another party by resale, lending, or other means. CHEST RADIOLOGY Patterns and Differential Diagnoses This page intentionally left blank Seventh Edition CHEST RADIOLOGY Patterns and Differential Diagnoses James C. Reed, MD Professor of Radiology University of Louisville Louisville, Kentucky 1600 John F. Kennedy Blvd. Ste 1800 Philadelphia, PA 19103-2899 CHEST RADIOLOGY: PATTERNS AND DIFFERENTIAL DIAGNOSES ISBN: 978-0-323-49831-9 SEVENTH EDITION Copyright © 2018 by Elsevier, Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the Publisher.
    [Show full text]