Digital Gangrene and Pulmonary Consolidation in a Young Girl with Takayasu Arteritis

ABSTRACT Takayasu arteritis is a large-vessel vasculitis most commonly affecting women of childbearing age. The disease process is usually slow and smoldering, presenting over months to years. Digital gangrene is an uncommon manifestation of Takayasu arteritis because of the formation of good collateral circulation. Similarly, although pulmonary artery involvement is well described, pulmonary parenchymal involvement is very rare. We are reporting a case of a young girl with Takayasu arteritis presenting with digital gangrene and pulmonary consolidation, which was treated successfully with a combination of aggressive systemic immunosuppression and anti-coagulants. The possible mechanism for gangrene along with the confounding diagnostic possibility of co-existing tuberculosis have been discussed.

538. The Role of N-acetylcysteine on Post Covid-19 Pulmonary Fibrosis

Background Covid 19 have long lasting complications, from myalgia, body weakness to life debilitating strokes, and pulmonary fibrosis. Several mechanisms had been described but mostly viral or autoimmune which causes damages which leads to Acute respiratory distress syndrome. There is no approved treatment as of this time. Antifibrotic drugs use had been limited due to hepatoxicity, on top of Covid 19 hepatopathy. This study aims to describe the role of N-acetylcysteine on Post COVID 19 pulmonary fibrosis as an alternative treatment. Methods Patients are admitted at Baguio General Hospital and Medical Center at the COVID wards. Patients are COVID confirmed by RT PCR nasopharyngeal swab. Patient who are classified as severe were given Dexamethasone, Enoxaparin and Remdesivir for 5-10 days. Patients who are not weaned off from O2 support underwent Chest CT scan. Patients with Extensive Fibrosis were then consented to undergo High Dose IV Infusion of N-acetylcysteine. (150mg/kg in 1st hour, 50mg/kg next 4 hours and 100mg/kg last 20 hours). Repeat Chest CT Scan was done. Results Peripheral Bilateral Ground Glass Opacities and Pulmonary Consolidation was seen on pre-treatment CT Scans. Repeat CT scans showed significant regression of Ground Glass Opacities and Pulmonary Consolidation. CT SCAN pre and post treatment Conclusion High dose N-acetylcysteine showed promising results on Post COVID 19 Pulmonary Fibrosis. Disclosures All Authors: No reported disclosures

Double-chambered right ventricle masquerading as bipartite right ventricle

A 10-day-old neonate with pulmonary consolidation was referred for echocardiography to rule out CHD. At first glance, the morphology appeared to be a bipartite right ventricle with normal tricuspid and pulmonary valves. In-depth analysis, however, of the images showed a double-chambered right ventricle, in which the inlet and outlet portions of the right ventricle were isolated from the apical component of the right ventricle, which itself communicated with the left ventricle through a ventricular septal defect. There was a normal pulmonary valve and tricuspid annulus.

Primary Hodgkin lymphoma of the lung arising with hemoptysis and pulmonary consolidation: a case report

Classic Hodgkin lymphomas are neoplasms originating from lymphoid tissue. Primary extranodal classic Hodgkin lymphoma (PE-cHL) of the lung is rare. A 37-year-old Caucasian male was referred to our hospital for recurrent episodes of hemoptysis, cough and bronchitis. A CT scan showed a massive left upper lung consolidation, which was positive at the PET scan. After several inconclusive tests and no benefit from medical therapies, the patient underwent a left upper lobectomy; pathology report showed a classical type Hodgkin lymphoma with no lymph-nodes involvement. Four cycles of adjuvant chemotherapy were administered with no toxicity. At the last follow up 14 months after surgery, the patient is alive and free from disease. Primary extranodal classical Hodgkin lymphoma of the lung is a rare entity, but it should be considered as a differential diagnosis in young patients with pulmonary consolidation even without systemic symptoms.

Clinical analysis of adenovirus pneumonia with pulmonary consolidation and atelectasis in children

Objective To assess the clinical characteristics of 168 children with adenovirus pneumonia complicated by pulmonary consolidation and atelectasis. Methods We retrospectively studied patients with adenovirus pneumonia complicated by pulmonary consolidation and atelectasis admitted to Xiamen Children’s Hospital from March 2019 to August 2019. In total, 168 patients were recruited and divided into a severe group and non-severe group according to disease severity. Clinical results were assessed. Results All children had fever and cough, 29 had wheezing, and 82 had dyspnea. Pleural effusion was found in 53 patients. Mixed infections were present in 95 patients. A total of 105 patients received hormone therapy, 72 received intravenous gamma globulin, and 103 underwent bronchoscopy, among whom 6 were found to have bronchial casts. Of the 168 children, 166 were cured and two died. The patients were divided by disease severity, with 82 in the severe group and 86 in the non-severe group. The two groups showed significant differences in the fever course, pleural effusion, mixed infections, hemoglobin concentration, procalcitonin concentration, and lactate dehydrogenase concentration. Conclusion A long fever course, mixed infection, pleural effusion, decreased hemoglobin concentration, and increased procalcitonin and lactate dehydrogenase concentrations may be associated with more severe adenovirus pneumonia.

Effect of different oxygen concentrations developing pulmonary atelectasis of neonates during anesthesia: a randomized controlled trial

Objectives: This study sought to evaluate the effect of different oxygen concentrations on the development of pulmonary atelectasis in neonates during anesthesia with mechanical ventilation using ultrasound. Methods: Sixty-three neonates undergoing laparotomies were randomly divided into three groups. A: FiO2 = 30%, B: FiO2 = 40%, C: FiO2 = 50%. Ultrasound was performed to guide pulmonary resuscitation maneuvers after tracheal intubation and before tracheal extubation and performed at the end of surgery in each group to evaluate lung consolidation. The following parameters were assessed: (1) primary observation index: pulmonary consolidation score; (2) secondary observation index: area of pulmonary atelectasis, changes in oxygenation index, pulmonary atelectasis, and the incidence of hypoxemia; (3) pulmonary complications at 72 hours postoperatively. Results: There was a significant difference in pulmonary consolidation scores between the 30% and 50% groups (p < 0.001) and the 40% and 50% groups (p < 0.01); the difference between the 30% and 40% groups was not significant (p > 0.05). The incidence of pulmonary atelectasis was 82.54%. Pulmonary atelectasis occurred in the posterior (81%) and in the right posteriolateral positions (51%). There was a significant change in the oxygenation index before and after pulmonary ultrasound-guided re-expansion before recruitment (T1) compared to after preoperative recruitment (T2) (p < 0.001) and before postoperative recruitment (T3) compared to after postoperative recruitment (T4) (p < 0.001). 6 children in the 30% oxygen concentration group developed mild hypoxemia and 2 children developed moderate hypoxemia; while no hypoxemia occurred in the remaining two groups. No pulmonary complications occurred at 72 hours postoperatively. Conclusions: 40% FiO2 may be the oxygen concentration that neither causes significant pulmonary atelectasis nor hypoxemia during the maintenance of mechanical ventilation during neonatal anesthesia. However, there may also be lower lung consolidation scores and no hypoxemia between 30% oxygen concentration and 40% we have not studied it. Pulmonary atelectasis is present in most anesthetized patients and occurs mainly in gravity-dependent areas, more on the right than on the left side. Pulmonary ultrasound-guided pulmonary recruitment maneuvers can significantly improve neonatal pulmonary gas exchange function.

OUTPATIENT PULMONOLOGY: LUNG ULTRASOUND EXAMINATION

Epidemiological situation associated with coronavirus disease (COVID-19) widespread in the world, changes the approaches to healthcare provision. The field of respiratory medicine, especially in an outpatient setting, also adapts in terms of organization and technology. The optimization of diagnostics during the initial or follow-up examination of patients by means of focused lung ultrasound (FLUS), will help to expand the pulmonologist�s diagnostic and therapeutic capabilities at current conditions. The aim of the study was to evaluate diagnostic features of FLUS in combination with classical methods such as chest percussion and auscultation in an outpatient setting in patients with COVID-19 at the convalescence stage, based on the results of retrospective data analysis. Materials and methods. The analysis included data from 14 patients (8 men and 6 women, mean age (49,6 � 12,8) years) with typical set of clinical, laboratory and instrumental manifestations of COVID-19, who were examined by a pulmonologist at the convalescence stage after cessation of the self-isolation period. FLUS was performed routinely in suspected or clinically evident signs of pulmonary opacity. Results. In 10 (71.4 %) patients characteristic auscultatory signs associated with pulmonary consolidation were found. In majority of cases (12 � 85.7%) focal and/or diffuse inerstitial syndrome (IS) was revealed by FLUS, accompanied by typical auscultatory pattern (bronchial or weakened vesicular breathing sound, bronchophonia, crepitations) and/or percussion abnormalities (dullness over the lung). The results of retrospective analysis of FLUS data in COVID-19 patients suggested a persistent focal and/or diffuse IS up to 63 days of illness in avarage. The obtained data analysis revealed statistically significant (p = 0.03), weak, negative (Tau = - 0.41) relationship between the disease duration and auscultatory and percussion data, in the presence of ultrasound signs of lung opacity. Conclusions. Auscultation and percussion are valuable diagnostic markers, but their value for detection of pulmonary consolidation decreases after 30 days of COVID-19. FLUS qualitatively complements the diagnostic effectiveness at outpatient pulmonologist� examination when it is necessary to evaluate IS presence in lung parenchyma. The number of subjects and the heterogeneity of the group impose certain limitations on interpreting of the results. Further extensive research is needed to implement this method into routine clinical practice. Key words: COVID-19, focused lung ultrasound.