DOCSLIB.ORG

Pneumatosis Intestinalis in COVID-19

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Pneumatosis Intestinalis in COVID-19 BMJ Open Gastroenterol: first published as 10.1136/bmjgast-2020-000434 on 9 June 2020. Downloaded from Case report Pneumatosis intestinalis in COVID-19 Simone Meini ,1 Chiara Zini,2 Maria Teresa Passaleva,1 Anna Frullini,1 Francesca Fusco,2 Roberto Carpi,2 Fiorella Piani1 To cite: Meini S, Zini C, ABSTRACT coexpressed not only in alveolar type 2 cells, Passaleva MT, et al. Introduction COVID-19 is a respiratory illness due to but also in the enterocytes of the ileum and Pneumatosis intestinalis in novel severe acute respiratory syndrome coronavirus COVID-19. colon, suggesting that the virus can invade BMJ Open Gastro 2 (SARS-CoV -2), described in December 2019 in 3 2020;7:e000434. doi:10.1136/ the digestive tract. Wuhan (China) and rapidly evolved into a pandemic. bmjgast-2020-000434 Faecal–oral transmission is a possible route Gastrointestinal (GI) tract can also be involved. of SARS- CoV-2 transmission: SARS- CoV-2 Case presentation A 44- year- old man was hospitalised Received 4 May 2020 for COVID-19- associated pneumonia. A rapid recovery can be detected in stool in about 50% of Revised 19 May 2020 patients with COVID-19; however, there is Accepted 29 May 2020 of respiratory and general symptoms was observed after 1 week of treatment with lopinavir/ritonavir plus no clear correlation between gastrointes- hydroxychloroquine and broad-spectrum antibiotics tinal (GI) symptoms and detectable virus in 3 4 (piperacillin–tazobactam plus teicoplanin). No GI the stool. It has been reported that up to symptoms were reported during hospitalisation, but 11.4% of patients with COVID-19 present a lung contrast-enhancement CT (CE-CT) excluding with at least one GI symptom, such as nausea, thromboembolism showed, as collateral finding, vomiting or diarrhoea: they present fever intraperitoneal free bubbles not present on a previous CT over 38.5°C, fatigue, shortness of breath and examination; the subsequent abdominal CE-CT described headache more frequently than patients pneumatosis intestinalis (PI) involving the caecum and the without GI symptoms; moreover, aspartate right colon. Ciprofloxacin plus metronidazole was started, copyright. aminotransferase (AST) resulted significantly and the 2-week follow-up CT showed the complete 5 resolution of PI. increased in this subgroup. Discussion The pathogenesis of PI is poorly understood. It is therefore increasingly evident that PI involving the caecum and right colon has been although COVID-19 is mainly an acute described for HIV and Cytomegalovirus infections, but, respiratory disease, the GI system can be to our best knowledge, never before in COVID-19. We involved. Unfortunately, knowledge about hypothesise a multifactorial aetiopathogenesis for PI, with the extrapulmonary involvement is scarce, a possible role of the bowel wall damage and microbiota and it is of utmost importance that every http://bmjopengastro.bmj.com/ impairment due to SARS-CoV -2 infection, and we suggest previously unknown clinical expression is a conservative management in the absence of symptoms. promptly reported, in order to assist other clinicians who could again meet it, and to allow to better understand the pathogenesis of a still elusive infectious syndrome. INTRODUCTION Starting in December 2019 from Wuhan (Hubei province, China), a novel corona- CASE PRESENTATION virus, designated severe acute respiratory A 44- year- old man presented to the emer- syndrome coronavirus 2 (SARS-CoV -2), has gency department on 20 March 2020, after 9 on September 26, 2021 by guest. Protected caused an international outbreak of a respira- days of persisting fever over 39°C, productive © Author(s) (or their employer(s)) 2020. Re- use tory illness (COVID-19), rapidly evolving into cough and chest pain, despite treatment with permitted under CC BY- NC. No a pandemic. amoxicillin–clavulanate and paracetamol. No commercial re- use. See rights The clinical spectrum varies from asymp- GI symptoms were reported. Clinical history and permissions. Published tomatic or self- limiting mild forms, occur- was negative; no smoking history or drugs by BMJ. ring in most cases, to severe progressive use was reported. The patient reported only 1Medicina Interna, Azienda USL Toscana centro, Ospedale Santa pneumonia with acute respiratory distress about an isolated anal fissure, sometimes Maria Annunziata, Firenze, Italy syndrome requiring mechanical ventilation slightly bleeding, diagnosed 20 years ago. 2Radiologia, Azienda USL and intensive care support, to sepsis or septic COVID-19 was diagnosed by reverse Toscana centro, Ospedale Santa shock, ultimately causing death.1 It has been transcriptase-PCR (RT-PCR) testing for Maria Annunziata, Firenze, Italy described2 that SARS- CoV-2 uses the ACE2 SARS-CoV -2 on nasopharyngeal swab. At Correspondence to receptor for cell entry and the serine protease admission, plain film of the chest showed Dr Simone Meini; TMPRSS2 for S protein priming: both these a right infrahilar opacity and a bilateral simonemeini2@ gmail. com proteins play a crucial role, and are highly peripheral reticular pattern. The following Meini S, et al. BMJ Open Gastro 2020;7:e000434. doi:10.1136/bmjgast-2020-000434 1 BMJ Open Gastroenterol: first published as 10.1136/bmjgast-2020-000434 on 9 June 2020. Downloaded from Open access laboratory studies resulted altered: C-reactive protein an almost complete remission of cough, and needing for (CRP) 16.64 mg/dL, procalcitonin (PCT) 0.29 ng/mL, very low flow oxygen support (1 L/min). CRP decreased ferritin 1966 ng/mL, D- dimer 1248 ng/mL, international to 3.43 mg/dL, and D-dimer to 1027 ng/mL. At the same normalized ratio (INR) 1.53, and lactate dehydroge- time, however, we observed altered levels of AST (143 nase (LDH) 380 U/L. Except for minimal neutrophilia, UI/L, after 2 days further increasing to 353 UI/L) and ALT the blood count was normal, and interleukin-6 levels (150 UI/L, then 378 UI/L), and hyperammonaemia (113 (<3.0 pg/mL), AST (38 UI/L), alanine aminotransferase μg/dL), with persisting normal values of cholinesterase, (ALT) (28 UI/L), and bilirubin (1.20 mg/dL) resulted bilirubin, and alkaline phosphatase; gamma- glutamyl within the normal limits. Hepatitis serological tests were transferase only slightly increased (71 UI/L). In the compatible with previous vaccination for hepatitis B virus. hypothesis of iatrogenic acute liver damage, we promptly Blood and urine cultures and Legionella pneumophila and interrupted the treatment with lopinavir/ritonavir and Streptococcus pneumoniae urinary antigens were negative. hydroxychloroquine, avoiding further administration of Lopinavir/ritonavir 400/100 mg plus hydroxychloro- paracetamol (last administration 48 hours earlier), main- quine 200 mg, both two times a day, were started. Given taining only therapy with teicoplanin, also because its the persistence of high fever and productive cough, putative efficacy to inhibit the first stage of SARS-CoV -2 and the slightly increased level of PCT, in suspicion of viral life cycle in human cells,6 and adding intravenous a secondary bacterial infection resistant to the previous acetylcysteine; moreover, enoxaparin was discontinued. therapy with amoxicillin–clavulanate, intravenous teico- Lactulose at an average daily dose of 25 mL was adminis- planin 400 mg one time a day (after loading dose) plus tered for the next 6 days. Ultrasound (US) examination of piperacillin–tazobactam 4.5 g three times a day were the abdomen did not report any particular finding. The started. Moreover, subcutaneous enoxaparin 4000 UI was lung high- resolution CT showed bi-basal dorsal consolida- administered one time a day for prophylaxis of venous tions associated with traction bronchiectasis, especially at thromboembolism. the level of right inferior lobe, compatible with COVID-19 After 6 days, the patient had a clear improvement of pneumonia (figure 1A); no particular abdominal finding general conditions, with resolution of fever from 48 hours, was depicted in the lower scans (figure 1B). copyright. http://bmjopengastro.bmj.com/ on September 26, 2021 by guest. Protected Figure 1 CT scans performed for the lung evaluation. (A) First lung CT coronal multiplanar reconstruction (MPR) shows ground glass areas with consolidation in association with bronchiectasis located especially at the level of right inferior lobe. (B) First CT axial abdomen image does not describe any particular finding. (C) Second lung CT coronal MPR demonstrates partial resolution of the consolidation previously described with residual ground glass opacity. (D) Second contrast-enhancement axial abdomen image shows free air bubble within the gastrohepatic space (arrows). 2 Meini S, et al. BMJ Open Gastro 2020;7:e000434. doi:10.1136/bmjgast-2020-000434 BMJ Open Gastroenterol: first published as 10.1136/bmjgast-2020-000434 on 9 June 2020. Downloaded from Open access Lung US examination performed regularly starting non- dependent portions mainly involving the caecum from the admission showed a progressive resolution of and the right colon, compatible with pneumatosis the subpleural consolidations. The patient completely intestinalis (PI); no filling defects were depicted in the recovered and did not report any other symptom; the lumen of abdominal aorta and its branches, no portal laboratory examinations repeated after 6 days from venous air was found, and no free fluid collection was the previous ones confirmed the normalisation of CRP found (figure 2A,B). (0.41 mg/dL), PCT (0.05 ng/mL) and AST (34 UI/L; Given the complete absence of symptoms
Load more

Recommended publications
  • Intestinal Obstruction Due to Pneumatosis Intestinalis ALED W
    Postgrad Med J: first published as 10.1136/pgmj.43.504.680 on 1 October 1967. Downloaded from 680 Case reports Intestinal obstruction due to pneumatosis intestinalis ALED W. JONES F. M. COLE M.B., Ch.B., D.Path. M.D. Assistant Lecturer Lecturer Department ofPathology, University of Manchester PNEUMATOSIS intestinalis is a condition characterized Four years previously he had a perforated ulcer by the presence of numerous gas-filled cysts, most repaired surgically; no note was made at the time commonly found in the sub-serosa of the wall of the of any other lesion within the abdominal cavity. small intestine. Nearly 300 cases have been described Three years prior to admission he had a haema- and the literature of the adult cases has been re- temesis requiring blood transfusion. A barium meal viewed by Koss (1952), and those occurring in at this time suggested a certain amount of pyloric childhood and infancy by MacKenzie (1951). hold-up which was probably due to pylorospasm Although the cysts are frequently associated with caused by the duodenal ulcer; a second barium meal other intestinal lesions, they themselves are usually 1 year later showed no delay in gastric emptying. symptomless and rarely give rise to complications. For 6 months prior to the present admission he Those complications which have been described had, in addition to his ulcer pain, suffered a second include pneumo-peritoneum and intestinal obstruc- type of abdominal pain. This pain was situated in tion. Cysts can cause obstruction in several ways, the lower abdomen; it was intermittent, lasting up to one of which is by the formation of fibrous bands 1 week at a time, colicky in type and unrelieved by and strictures in relation to them, The following antacids.
    [Show full text]
  • Pneumatosis Intestinalis Induced by Osimertinib in a Patient with Lung
    Nukii et al. BMC Cancer (2019) 19:186 https://doi.org/10.1186/s12885-019-5399-5 CASEREPORT Open Access Pneumatosis intestinalis induced by osimertinib in a patient with lung adenocarcinoma harbouring epidermal growth factor receptor gene mutation with simultaneously detected exon 19 deletion and T790 M point mutation: a case report Yuki Nukii1, Atsushi Miyamoto1,2* , Sayaka Mochizuki1, Shuhei Moriguchi2, Yui Takahashi2, Kazumasa Ogawa2, Kyoko Murase2, Shigeo Hanada2, Hironori Uruga2, Hisashi Takaya2, Nasa Morokawa2 and Kazuma Kishi1,2 Abstract Background: Pneumatosis intestinalis is a rare adverse event that occurs in patients with lung cancer, especially those undergoing treatment with epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKI). Osimertinib is the most recently approved EGFR-TKI, and its usage is increasing in clinical practice for lung cancer patients who have mutations in the EGFR gene. Case presentation: A 74-year-old woman with clinical stage IV (T2aN2M1b) lung adenocarcinoma was determined to have EGFR gene mutations, namely a deletion in exon 19 and a point mutation (T790 M) in exon 20. Osimertinib was started as seventh-line therapy. Follow-up computed tomography on the 97th day after osimertinib administration incidentally demonstrated intra-mural air in the transverse colon, as well as intrahepatic portal vein gas. Pneumatosis intestinalis and portal vein gas improved by fasting and temporary interruption of osimertinib. Osimertinib was then restarted and continued without recurrence of pneumatosis intestinalis. Overall, following progression-free survival of 12.2 months, with an overall duration of administration of 19.4 months (581 days), osimertinib was continued during beyond-progressive disease status, until a few days before the patient died of lung cancer.
    [Show full text]
  • 1979 Publications of the Staff of Henry Ford Hospital
    Henry Ford Hospital Medical Journal Volume 27 Number 4 Article 2 12-1979 1979 Publications of the Staff of Henry Ford Hospital Follow this and additional works at: https://scholarlycommons.henryford.com/hfhmedjournal Part of the Life Sciences Commons, Medical Specialties Commons, and the Public Health Commons Recommended Citation (1979) "1979 Publications of the Staff of Henry Ford Hospital," Henry Ford Hospital Medical Journal : Vol. 27 : No. 4 , 310-337. Available at: https://scholarlycommons.henryford.com/hfhmedjournal/vol27/iss4/2 This Article is brought to you for free and open access by Henry Ford Health System Scholarly Commons. It has been accepted for inclusion in Henry Ford Hospital Medical Journal by an authorized editor of Henry Ford Health System Scholarly Commons. Henry Ford Hosp Med Journal Vol 27, No 4, 1979 1979 Publications of the Staff of Henry Ford Hospital Selected Abstracts and Titles Edited by George C. Bower, MD Abstracts Alam M, Madrazo AC, Magilligan DJ, Goldstein S. Mmode and two dimensional echocardiographic features of porcine valve dysfunction. Am J Cardiol 1979;43:502-09. We present the echocardiographic featuresof degeneration of nine loss ofthe cusp detail. In five patients severe regurgitation due to a glutaraldehyde-fixed porcine xenograft valves implanted in eight tear in one or more cusps developed in the valve in the mitral patients. These features occurred 11 to 68 months after implanta­ position. M mode echocardiography in all five patients revealed on tion and were correlated with surgical and necropsy findings. the valve systolic or diastolic fluttering echoes, or both. The two Acute bacterial endocard itis in three other patients 47 to 52 months dimensional echocardiogram demonstrated thickened cusps with before valve degeneration was recognized.
    [Show full text]
  • Pneumatosis Cystoides Intestinalis
    vv Clinical Group Archives of Clinical Gastroenterology ISSN: 2455-2283 DOI CC By Monica Onorati1*, Marta Nicola1, Milena Maria Albertoni1, Isabella Case Report Miranda Maria Ricotti1, Matteo Viti2, Corrado D’urbano2 and Franca Di Pneumatosis Cystoides Intestinalis: Nuovo1 Report of a New Case of a Patient with 1Pathology Unit, ASST-Rhodense, Garbagnate Milanese, Italy 2Surgical Unit, ASST-Rhodense, Garbagnate Artropathy and Asthma Milanese, Italy Dates: Received: 09 January, 2017; Accepted: 07 March, 2017; Published: 08 March, 2017 Abstract *Corresponding author: Monica Onorati, MD, Pathology Unit, ASST-Rhodense, v.le Carlo Forla- Pneumatosis cystoides intestinalis (PCI) is an uncommon entity without the characteristics of a nini, 45, 20024, Garbagnate Milanese (MI), Italy, disease by itself and it is characterized by the presence of gas cysts within the submucosa or subserosa Tel: 02994302392; Fax: 02994302477; E-mail: of the gastrointestinal tract. Its precise etiology has not been clearly established and several hypotheses have been postulated regarding the pathogenesis. Since it was fi rst described by Du Vernoy in autopsy specimens in 1730 and subsequently named by Mayer as Cystoides intestinal pneumatosis in 1825, it has https://www.peertechz.com been reported in some studies. PCI is defi ned by physical or radiographic fi ndings and it can be divided into a primary and secondary forms. In the fi rst instance, no identifi able causal factors are detected whether secondary forms are associated with a wide spectrum of diseases, ranging from life-threatening to innocuous conditions. For this reason, PCI management can vary from urgent surgical procedure to clinical, conservative treatment. The clinical onset may be very heterogeneous and represent a challenge for the clinician.
    [Show full text]
  • Computed Tomography Colonography Imaging of Pneumatosis Intestinalis
    Frossard et al. Journal of Medical Case Reports 2011, 5:375 JOURNAL OF MEDICAL http://www.jmedicalcasereports.com/content/5/1/375 CASE REPORTS CASEREPORT Open Access Computed tomography colonography imaging of pneumatosis intestinalis after hyperbaric oxygen therapy: a case report Jean-Louis Frossard1*, Philippe Braude2 and Jean-Yves Berney3 Abstract Introduction: Pneumatosis intestinalis is a condition characterized by the presence of submucosal or subserosal gas cysts in the wall of digestive tract. Pneumatosis intestinalis often remains asymptomatic in most cases but may clinically present in a benign form or less frequently in fulminant forms. Treatment for such conditions includes antibiotic therapy, diet therapy, oxygen therapy and surgery. Case presentation: The present report describes the case of a 56-year-old Swiss-born man with symptomatic pneumatosis intestinalis resistant to all treatment except hyperbaric oxygen therapy, as showed by computed tomography colonography images performed before, during and after treatment. Conclusions: The current case describes the response to hyperbaric oxygen therapy using virtual colonoscopy technique one month and three months after treatment. Moreover, after six months of follow-up, there has been no recurrence of digestive symptoms. Introduction form or less frequently in fulminant forms, the latter Pneumatosis intestinalis (PI) is a condition in which condition being associated with an acute bacterial pro- submucosal or subserosal gas cysts are found in the wall cess, sepsis, and necrosis of the bowel [1]. Symptoms of the small or large bowel [1]. PI may affect any seg- include abdominal distension, abdominal pain, diarrhea, ment of the gastrointestinal tract. The pathogenesis of constipation and flatulence, all symptoms that may lead PI is not understood but many different causes of pneu- to an erroneous diagnosis of irritable bowel syndrome matosis cystoides intestinalis have been proposed, [5].
    [Show full text]
  • An Unusual Cause of Subcutaneous Emphysema, Pneumomediastinum and Pneumoperitoneum
    Eur Respir J CASE REPORT 1988, 1, 969-971 An unusual cause of subcutaneous emphysema, pneumomediastinum and pneumoperitoneum W.G. Boersma*, J.P. Teengs*, P.E. Postmus*, J.C. Aalders**, H.J. Sluiter* An unusual cause of subcutaneous emphysema, pneumomediastinum and Departments of Pulmonary Diseases* and Obstetrics pneumoperitoneum. W.G. Boersma, J.P. Teengs, P.E. Postmus, J.C. Aalders, and Gynaecology**, State University Hospital, H J. Sluiter. Oostersingel 59, 9713 EZ Groningen, The Nether­ ABSTRACT: A 62 year old female with subcutaneous emphysema, pneu­ lands. momediastinum and pneumoperitoneum, was observed. Pneumothorax, Correspondence: W.G. Boersma, Department of however, was not present. Laparotomy revealed a large Infiltrate In the Pulmonary Diseases, State University Hospital, Oos­ left lower abdomen, which had penetrated the anterior abdominal wall. tersingel 59, 9713 EZ Groningen, The Nether­ Microscopically, a recurrence of previously diagnosed vulval carcinoma lands. was demonstrated. Despite Intensive treatment the patient died two months Keywords: Abdominal inftltrate; necrotizing fas­ later. ciitis; pneumomediastinum; pneumoperitoneum; Eur Respir ]., 1988, 1, 969- 971. subcutaneous emphysema; vulval carcinoma. Accepted for publication August 8, 1988. The main cause of subcutaneous emphysema is a defect 38·c. There were loud bowel sounds and abdominal in the continuity of the respiratory tract. Gas in the soft distension. The left lower quadrant of the abdomen was tissues is sometimes of abdominal origin. The most fre­ tender, with dullness on examination. Recto-vaginal quent source of the latter syndrome is perforation of a examination revealed no abnonnality. The left upper leg hollow viscus [1]. In this case report we present a patient had increased in circumference.
    [Show full text]
  • Spontaneous Benign Pneumoperitoneum Complicating Scleroderma in the Absence Ofpneumatosis Cystoides Intestinalis
    Postgrad Med J (1990) 66, 61 - 62 i) The Fellowship of Postgraduate Medicine, 1990 Postgrad Med J: first published as 10.1136/pgmj.66.771.61 on 1 January 1990. Downloaded from Spontaneous benign pneumoperitoneum complicating scleroderma in the absence ofpneumatosis cystoides intestinalis N.J.M. London, R.G. Bailey and A.W. Hall Department ofSurgery, Glenfield General Hospital, Leicester, UK. Summary: We describe a 64 year old woman with a 3-year history ofscleroderma who presented as an emergency with increasing painless abdominal distention. Radiological investigations revealed a pneumoperitoneum in the absence ofeither visceral perforation or pneumatosis cystoides intestinalis. This is only the fourth report of spontaneous benign pneumoperitoneum complicating scleroderma without pneumatosis cystoides intestinalis. The possible aetiology of this condition is discussed. Introduction Serious gastrointestinal involvement is present in 60 mmHg. The abdomen was grossly distended, approximately 50% of patients with scleroderma.' soft, non-tender and tympanitic on percussion. Spontaneous pneumoperitoneum is a rare comp- Urgent laboratory investigations showed a normal lication ofthe disease and is usually associated with haemoglobin and white cell count. Abdominal copyright. pneumatosis cystoides intestinalis.2 We report a (Figure 1) and chest X-rays revealed a large case of spontaneous pneumoperitoneum in a pneumoperitoneum and although there was small patient with scleroderma in whom there was no bowel and colonic dilatation there was no evidence of either visceral perforation nor of radiological evidence of a localized point of obs- pneumatosis cystoides intestinalis. truction within the bowel. Because the clinical picture was not compatible with a visceral perforation a peritoneal lavage was Case report performed.
    [Show full text]
  • Emergent Treatment of Epidural Pneumatosis and Pneumomediastinum Developed Due to Tracheal Injury: a Case Report
    CASE REPORT Emergent Treatment of Epidural Pneumatosis and Pneumomediastinum Developed Due to Tracheal Injury: A Case Report Trakeal yaralanma sonucu gelişen pnömomediastinum ve epidural pnömotozisin acil tedavi yaklaşımı: Olgu sunumu Türkiye Acil Tıp Dergisi - Turk J Emerg Med 2010;10(4):188-190 Ali KILIÇGÜN,1 Suat GEZER,2 Tanzer KORKMAZ,3 Nurettin KAHRAMANSOY4 Departments of 1Thoracic Surgery, SUMMARY 3Emergency Medicine, and 4General Surgery Abant Izzet Baysal University Faculty of The presence of air in epidural space is called epidural pneumatosis. Epidural pneumatosis is a rarely encountered Medicine, Bolu; phenomenon in emergency medicine practice. A 10-year-old patient was admitted with cervical trauma due to a 2Department of Thoracic Surgery, bicycle accident. Subcutaneous emphysema, pneumothorax, pneumomediastinum and epidural pneumatosis were Düzce University Faculty of Medicine, Düzce detected. Pretracheal fasciotomy after tube thoracostomy and closed underwater drainage were performed. Since sufficient clinical improvement could not be observed, tracheal exploration and primary repairment were performed. Only after these interventions, epidural pneumatosis and pneumomediastinum completely regressed. The case is presented due to its rarity and with the purpose to remind clinicians of epidural pneumatosis in tracheal injuries. Key words: Emergency surgery; surgery; tracheal rupture. ÖZET Epidural pnömatozis epidural boşlukta hava bulunmasıdır. Epidural pnömatozis acil tıp pratiğinde nadir rastlanılan bir durumdur. On yaşında bisiklet kazası sonucu servikal travma geçiren hastada klinik olarak subkutan amfizem, radyolojik olarak pnömotoraks, pnömomediastinum ve epidural pnömatozis geliştiği izlendi. Hastaya sol tüp tora- kostomi + kapalı sualtı drenajı takibinde pretrakeal fasyanın açılması işlemi uygulandı. Yeterli düzelme izlenmeme- si üzerine trakea eksplore edildi ve primer onarım yapıldı. Bu tedaviler sonrası epidural pnömatozis, pnömomedias- tinum ile birlikte tamamen geriledi.
    [Show full text]
  • Residents Day Virtual Meeting Henry Ford Health System
    May 7, 2021 Residents Day Virtual Meeting Hosted by: Henry Ford Health System - Detroit Internal Medicine Residency Program Medical Student Day Virtual Meeting Sponsored by: & Residents Day & Medical Student Day Virtual Program May 7, 2021 MORNING SESSIONS 6:45 – 7:30 AM Resident Program Directors Meeting – Sandor Shoichet, MD, FACP Via Zoom 7:30 – 9:30 AM Oral Abstract Presentations Session One Abstracts 1-10 9:00 – 10:30 AM Oral Abstract Presentations Session Two Abstracts 11-20 10:30 AM – 12:00 PM Oral Abstract Presentations Session Three Abstracts 21-30 KEYNOTE SESSON COVID Perspectives: 1. “ID Perspective: Inpatient Work and Lessons from Infection Control Point of View” – Payal Patel, MD, MPH 12:00 – 1:00 PM 2. “PCCM Perspective: Adding Specific Lessons from ICU Care/Burden and Possible Response to Future Pandemics” – Jack Buckley, MD 3. “Pop Health/Insurance Perspective – Population Health/Social Net of Health/Urban Under-Represented Care During COVID” – Peter Watson, MD, MMM, FACP AFTERNOON SESSIONS RESIDENTS PROGRAM MEDICAL STUDENT PROGRAM Residents Doctor’s Dilemma™ 1:15 – 2:00 PM Nicole Marijanovich MD, FACP 1:00 – 1:30 pm COVID Overview – Andrew Jameson, MD, FACP Session 1 Residents Doctor’s Dilemma™ 2:00 – 2:45 PM 1:30 – 2:15 am COVID – A Medical Students Perspective Session 2 Residents Doctor’s Dilemma™ 4th Year Medical Student Panel: Post-Match Review 2:45 – 3:30 PM 2:15 – 3:00 pm Session 3 of Interviews Impacted by COVID Residents Doctor’s Dilemma™ Residency Program Director Panel: A Residency 3:30 – 4:15 PM 3:00 – 3:45
    [Show full text]
  • Pneumatosis Intestinalis Associated with Pulmonary Disorders
    J Korean Soc Radiol 2019;80(2):274-282 Original Article https://doi.org/10.3348/jksr.2019.80.2.274 pISSN 1738-2637 / eISSN 2288-2928 Received May 9, 2018 Revised June 13, 2018 Accepted July 25, 2018 Pneumatosis Intestinalis *Corresponding author Sung Shine Shim, MD Department of Radiology, Associated with Pulmonary Mokdong Hospital, Ewha Womans University School of Medicine, Disorders 1071 Anyangcheon-ro, Yangcheon-gu, Seoul 07985, 폐병변과 연관된 장벽 공기증 Korea. Tel 82-2-2650-5380 1 1 1 Youngsun Ko, MD , Sung Shine Shim, MD * , Yookyung Kim, MD , Fax 82-2-2650-5302 2 E-mail [email protected] Jung Hyun Chang, MD 1 Department of Radiology, Mokdong Hospital, Ewha Womans University School of Medicine, This is an Open Access article distributed under the terms of Seoul, Korea 2 the Creative Commons Attribu- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, tion Non-Commercial License Ewha Womans University School of Medicine, Seoul, Korea (https://creativecommons.org/ licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduc- tion in any medium, provided the Purpose To determine the clinical features, imaging findings and possible causes of pneuma- original work is properly cited. tosis intestinalis (PI) in thoracic disorder patients. Materials and Methods From 2005 to 2017, Among 62 PI patients, four of PI related with tho- racic disease (6%) were identified. Medical records were reviewed to determine the clinical pre- ORCID iDs Sung Shine Shim sentation, laboratory findings and treatment at the time of presentation of PI. Two experienced https:// chest radiologists reviewed all imaging studies and recorded specific findings for each patient.
    [Show full text]
  • Pneumatosis Intestinalis in Solid Organ Transplant Recipients
    1997 Review Article Pneumatosis intestinalis in solid organ transplant recipients Vincent Gemma1, Daniel Mistrot1, David Row1, Ronald A. Gagliano1, Ross M. Bremner2, Rajat Walia2, Atul C. Mehta3, Tanmay S. Panchabhai2 1Department of Surgery, 2Norton Thoracic Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA; 3Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA Contributions: (I) Conception and design: D Row, RA Gagliano, TS Panchabhai; (II) Administrative support: RM Bremner, R Walia; (III) Provision of study materials or patients: V Gemma, D Mistrot, TS Panchabhai; (IV) Collection and assembly of data: V Gemma, D Mistrot, TS Panchabhai; (V) Data analysis and interpretation: RA Gagliano, RM Bremner, R Walia, AC Mehta, TS Panchabhai; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Tanmay S. Panchabhai, MD, FCCP. Associate Director, Pulmonary Fibrosis Center/Co-Director, Lung Cancer Screening Program, Norton Thoracic Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA; Associate Professor of Medicine, Creighton University School of Medicine, Omaha, NE, USA. Email: [email protected]. Abstract: Pneumatosis intestinalis (PI) is an uncommon medical condition in which gas pockets form in the walls of the gastrointestinal tract. The mechanism by which this occurs is poorly understood; however, it is often seen as a sign of serious bowel ischemia, which is a surgical emergency. Since the early days of solid organ transplantation, PI has been described in recipients of kidney, liver, heart, and lung transplant. Despite the dangerous connotations often associated with PI, case reports dating as far back as the 1970s show that PI can be benign in solid organ transplant recipients.
    [Show full text]
  • Case Report Pneumomediastinum, Pneumopericardium, and Epidural Pneumatosis Following Adenotonsillectomy: a Very Rare Complication
    Hindawi Case Reports in Otolaryngology Volume 2018, Article ID 4531364, 4 pages https://doi.org/10.1155/2018/4531364 Case Report Pneumomediastinum, Pneumopericardium, and Epidural Pneumatosis following Adenotonsillectomy: A Very Rare Complication Feride Fatma Go¨rgu¨lu¨ ,1 Ays¸e Selcan Koç ,1 and Orhan Go¨rgu¨lu¨2 1Radiology Department, Adana City Research and Training Hospital, University of Health Sciences, Adana, Turkey 2Otorhinolaryngology Department, Adana City Research and Training Hospital, University of Health Sciences, Adana, Turkey Correspondence should be addressed to Feride Fatma G¨org¨ul¨u; [email protected] Received 4 February 2018; Revised 8 July 2018; Accepted 29 July 2018; Published 19 August 2018 Academic Editor: Kamal Morshed Copyright © 2018 Feride Fatma Go¨rg¨ul¨u et al. *is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Adenotonsillectomy is a common surgical otolaryngology procedure that is associated with several complications, including hemorrhage, odynophagia, damage to teeth, taste disorders, atlantoaxial subluxation, lingual edema, infection, and injury of the carotid artery. Pneumomediastinum, pneumopericardium, and epidural pneumatosis are an extremely unusual condition in children with adenotonsillectomy. Treatment should be conservative in the majority of cases and based on benign self-limiting course of these diseases; early recognition can prevent further complications. *e combination of pneumomediastinum with epidural pneumatosis, pneumopericardium, retropharyngeal-prevertebral pneumatosis, axillar-perihumeral pneumatosis, and subcutaneous emphysema is also a very rare condition. We present a unique case with the radiological findings of air in all of these areas in a 6-year-old male child with adenotonsillectomy.
    [Show full text]