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A New Variant of Combined Pulmonary Fibrosis and Emphysema From Second-Hand Smoke: A Case Report and Review of Literature.

Khan R, Tulpule S, Iroka N, Sen S, Mathew T, Islam M, Yousif A, Longo S - J Clin Med Res (2015)

Bottom Line: Patients presenting with such findings are usually found to be heavy smokers or former smokers.No prior research has presented a documented case of such a fatal condition in a young person with no prior history of smoking.As most published studies have attributed these findings as a secondary response to a history of smoking, other etiologies and risk factors have yet to be properly analyzed resulting in prolonged hospital course and often missed diagnoses.

View Article: PubMed Central - PubMed

Affiliation: Internal Medicine Department, Raritan Bay Medical Center, 530 New Brunswick Ave., Perth Amboy, NJ 07733, USA.

ABSTRACT
The findings of combined pulmonary fibrosis along with emphysema have been increasingly recognized in the medical literature. Patients presenting with such findings are usually found to be heavy smokers or former smokers. Their presentations begin with severe respiratory distress that gets progressively worse. They are found to have low diffusion capacity (DLCO) although spirometry will show preserved lung volumes. No prior research has presented a documented case of such a fatal condition in a young person with no prior history of smoking. In this case report, we discuss the presentation, diagnosis, and management of a young 29-year-old non-smoker with increasing shortness of breath with a complicated hospital course discovered to have an abnormal variant or presentation of "combined pulmonary fibrosis and emphysema" (CPFE). As most published studies have attributed these findings as a secondary response to a history of smoking, other etiologies and risk factors have yet to be properly analyzed resulting in prolonged hospital course and often missed diagnoses.

No MeSH data available.


Related in: MedlinePlus

CTA chest: tree-in bud changes in right lower lobe without clear signs of emphysema.
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Figure 1: CTA chest: tree-in bud changes in right lower lobe without clear signs of emphysema.

Mentions: On physical examination, the patient was tachycardia with a heart rate of 118, blood pressure of 111/72, respiratory rate of 24, and was saturating 88% on room air. At the time, she was afebrile with a temperature of 99.1 °F. Significant findings on examination showed diffuse rhonchi bilaterally with crackles on lung examination. Laboratory data demonstrated hemoglobin of 13, hematocrit of 39, white blood cell of 10.9, and platelets of 344,000. Sodium was 136, potassium 3.8, chloride 98, bicarbonate 21, blood urea nitrogen 15, creatinine 1.0, and glucose of 113. Troponins were negative. D-dimer was elevated at 0.71 and CT angiogram (CTA) was conducted to rule out pulmonary embolism. CTA of the chest was negative for pulmonary embolism but showed tree-in bud changes in the right upper lobe suspicious for an infectious or inflammatory process (Fig. 1). Similar findings were also seen in the right lower lobe. There were linear changes in the lower lobes bilaterally which most likely represented atelectasis and there was a 7.6 mm nodule in the left lower lobe.


A New Variant of Combined Pulmonary Fibrosis and Emphysema From Second-Hand Smoke: A Case Report and Review of Literature.

Khan R, Tulpule S, Iroka N, Sen S, Mathew T, Islam M, Yousif A, Longo S - J Clin Med Res (2015)

CTA chest: tree-in bud changes in right lower lobe without clear signs of emphysema.
© Copyright Policy - open access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4554223&req=5

Figure 1: CTA chest: tree-in bud changes in right lower lobe without clear signs of emphysema.
Mentions: On physical examination, the patient was tachycardia with a heart rate of 118, blood pressure of 111/72, respiratory rate of 24, and was saturating 88% on room air. At the time, she was afebrile with a temperature of 99.1 °F. Significant findings on examination showed diffuse rhonchi bilaterally with crackles on lung examination. Laboratory data demonstrated hemoglobin of 13, hematocrit of 39, white blood cell of 10.9, and platelets of 344,000. Sodium was 136, potassium 3.8, chloride 98, bicarbonate 21, blood urea nitrogen 15, creatinine 1.0, and glucose of 113. Troponins were negative. D-dimer was elevated at 0.71 and CT angiogram (CTA) was conducted to rule out pulmonary embolism. CTA of the chest was negative for pulmonary embolism but showed tree-in bud changes in the right upper lobe suspicious for an infectious or inflammatory process (Fig. 1). Similar findings were also seen in the right lower lobe. There were linear changes in the lower lobes bilaterally which most likely represented atelectasis and there was a 7.6 mm nodule in the left lower lobe.

Bottom Line: Patients presenting with such findings are usually found to be heavy smokers or former smokers.No prior research has presented a documented case of such a fatal condition in a young person with no prior history of smoking.As most published studies have attributed these findings as a secondary response to a history of smoking, other etiologies and risk factors have yet to be properly analyzed resulting in prolonged hospital course and often missed diagnoses.

View Article: PubMed Central - PubMed

Affiliation: Internal Medicine Department, Raritan Bay Medical Center, 530 New Brunswick Ave., Perth Amboy, NJ 07733, USA.

ABSTRACT
The findings of combined pulmonary fibrosis along with emphysema have been increasingly recognized in the medical literature. Patients presenting with such findings are usually found to be heavy smokers or former smokers. Their presentations begin with severe respiratory distress that gets progressively worse. They are found to have low diffusion capacity (DLCO) although spirometry will show preserved lung volumes. No prior research has presented a documented case of such a fatal condition in a young person with no prior history of smoking. In this case report, we discuss the presentation, diagnosis, and management of a young 29-year-old non-smoker with increasing shortness of breath with a complicated hospital course discovered to have an abnormal variant or presentation of "combined pulmonary fibrosis and emphysema" (CPFE). As most published studies have attributed these findings as a secondary response to a history of smoking, other etiologies and risk factors have yet to be properly analyzed resulting in prolonged hospital course and often missed diagnoses.

No MeSH data available.


Related in: MedlinePlus