pulmonary lab. hpi 24 yo male pt w/ cf presents to er with 4 day hx of fevers, chills, hemoptysis,...
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Pulmonary Lab
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HPI
• 24 yo male pt w/ CF presents to ER with 4 day hx of fevers, chills, hemoptysis, and thick purulent sputum production
• He has failed outpatient abx therapy
• Pt has been hospitalized 4x in the last year for recurrent PNAs
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PMH/PSH
• Recurrent PNAs• Pancreatic insufficiency (malabsorption)• GERD
• G-tube• Rt sided port
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Social Hx
• Pt is non-compliant with home meds
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Results of Testing
• Sputum cultures– Multidrug resistant pseudomonas aeruginosa– MSSA– Acinetobacter
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Chest Xray• This diagram is a Chest
Radiograph of Cystic Fibrosis (CF) Diffuse Interstitial Disease. This frontal chest X ray in CF shows diffuse interstitial disease with bronchiectasis and nodular densities of mucoid impaction.
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Chest CT
• Multicystic space within the base of the left lower lobe which is continuous with the small airways and is representative of cystic bronchiectasis.
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Hospital Course
• Pt progresses to respiratory failure• Placed on ventilator• Becomes septic• Unable to wean from vent• Pt expires from sepsis and respiratory failure
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Gross Specimen CF Lungs
Bronchiectasis
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H&E Low Power Lung, CF
• 1.5x
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H&E High Power CF, Lung
• Section of a dilated bronchi with florid acute on chronic inflammation of the bronchial wall and surrounding interstitial fibrosis.
5xBronchiectasis
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Treatments for CF, Lung
• Broad spectrum abx• Duonebs• PFTs• Chest physiotherapy – helps pt expectorate sputum• Bronchodilators• Dornase alpha – cleaves DNA, decreases viscosity• Inhaled hypertonic saline – hydrates lung secretions• Anti-inflammatories • Lung Tansplant