Tag Archives: Pulmonology

Orientation Fast Facts: Pulmonary Hypertension

During orientation today, Dr. Kelly Chin of the Division of Pulmonary and Critical Care Medicine gave the incoming interns an introduction to pulmonary hypertension.

  • There are five groups of PH: (1) PAH, (2) PH from left sided heart disease, (3) PH from lung disease, (4) PH from chronic thromboembolisms, and (5) miscellaneous
  • Left-sided heart disease and lung disease are by far the most common causes of PH
  • Findings concerning for PH are present in 1% of the population, 10% of patients receiving an echocardiogram for another reason
  • Suspect PH if RVSP >40 mmHg with RA or RV dilation or dysfunction on echocardiogram
  • PH is confirmed if mean PAP>/= 25 mmHg

Bronchiectasis 101

Below are some key points regarding bronchiectasis:

  • Damage to the airways causing them to widen and become scarred. This causes impaired clearance of mucous resulting in buildup and recurrent lung infections.
  • Congenital etiologies (cystic fibrosis, primary ciliary dyskinesia, alpha-1 antitrypsin deficiency) versus acquired (post-infection, idiopathic, aspiration, immunodeficiency, auto-immune, ABPA).
  • Patients presents with chronic cough and sputum production. Affects women more than men.
  • Typically diagnosed by high resolution CT scan.
  • At risk for chronic colonization by Pseudomonas.
  • Typical infectious organisms include H. influenzae, Pseudomonas, Moraxella catarrhalis, Mycobacterium, Staph.
  • Treatment: Treat underlying condition, antimicrobrial therapy, surgical resection, lung transplant for end stage disease.

O’Donnell. CHEST. 2008.

Pneumonia – The Basics!

What antibiotic should I give if I’m concerned my patient has pneumonia? Do I need to send them to the floor, ICU, or outpatient? Should I even check a procalcitonin?

Today Dr. Eric Mortensen from the division of general internal medicine at UT Southwestern addressed these questions in a fantastic lecture on pneumonia. Check out his slides below as well as an earlier blog post in which Dr. Mortensen did a Q&A regarding his recent article from JAMA looking at azithromycin use for pneumonia.

How high is too high? Updated!

This week, Julie Lin (PGY-02) gave a great talk on high altitude sickness of her resident update talk. Below are her slides from the presentation. Also, click on the click below to read the article from NEJM by Bartsch and Swenson about acute high altitude illness.

Acute High-Altitude Illnesses

Dr. Biff Palmer, Professor of Internal Medicine and Division of Nephrology at UTSW, authored the following articles below regarding high altitude illness. Specifically, he discusses the role of hypoxia inducible factor (HIF) in causing reduced appetite and increased energy expenditure as well as an overview of the condition. Of note, Dr. Palmer has reached the “Seven Summits” so he definitely knows a thing or two about this topic! Click on the links below!

Ascent to Altitude as a Weight Loss Method: The Good and Bad of Hypoxia Inducible Factor Activation

Physiology and pathophysiology with ascent to altitude


Friday, December 19th

Housestaff vs Faculty

Starting at noon in D 1.520

The faculty took the win last year in a close battle,
but the housestaff are ready to take back the crown!

(hint: read the blog)

Holiday Bowl and Xmas Sweater

What’s that in your pleural space?

Parapneumonic Effusions

Parapneumonic effusions are effusions that occur in the pleural space adjacent to bacterial pneumonia.
  • Uncomplicated: exudative, normal pH/glucose and negative gram stain/culture
  • Complicated: exudative, low pH (<7.20), a low glucose and and often loculated
  • Empyema: pus and organism visible on gram stain, although cultures maybe negative
Indications for Thoracentesis
  • free flowing, layers > 25mm on a lateral decubitus film or CT
  • loculated
  • associated with thickened parietal pleura on CT scan, a finding suggestive of empyema
  • clearly delineated by US
Pleural Fluid Studies
  • See here for our previous review of pleural fluid studies
  • Large loculated or complicated parapneumonic effusion: chest tube
  • Empyema: chest tube and VATS with debridement +/- decortication
  • Same bugs that cause pneumonia: strep pneumo most common. Others include Strep milleri, Staph aureus and Enterobacteriaceae
  • Anaerobic bacteria have been cultured in 36 to 76% of empyema; Fusobacterium, Prevotella, Peptosteptococcus , Bacteroides.
  • Always cover for anaerobes (hard to culture so treat empirically)