North Carolina Thoracic Society

Sarcoidosis varies in how active and how severe it is for each person and over time. Many individuals with sarcoidosis require long-term treatment to prevent disease progression. Learn more: https://www.thoracic.org//p/resources/sarcoidosis-pt-1.pdf

As part of Lung Disease Week at the ATS (https://www.thoracic.org//2/lung-transplant-week/index.php) join us on April 15 at 1pm ET for a virtual roundtable di...scussion Lung Transplant: Pulmonary Fibrosis and the Big Picture of Lung Disease. This discussion is a collaborative effort between the ATS Public Advisory Roundtable (PAR), the Lung Transplant Foundation, and the Pulmonary Fibrosis Foundation. The main speakers will be Timothy P.M. Whelan, MD, of MUSC Health Medical University of South Carolina and Kamyar Afshar, DO of the University of California San Diego. Other discussants will be Jeff Goldstein, founder of the Lung Transplant Foundation and Jennifer Mefford, Vice President of Corporate Partnerships at the Pulmonary Fibrosis Foundation. Register here: https://register.gotowebinar.com/regist/4863272284876291083 See more

Are you suffering from COPD? Live better and live longer with pulmonary rehabilitation. Pulmonary rehabilitation not only has potential to help you feel better and be more independent, but also to live longer. Find more information here: http://www.livebetter.org/

Watch Lung Ultrasound for the Diagnosis and Management of Acute Respiratory Failure, from the Open Critical Care Grand Rounds Collective video playlist: https://youtu.be/RBOsbOIWCXE

Drs. Kyle Hogarth and Susan Garwood share their firsthand experience using MONARCH, the first robotic-assisted bronchoscopy platform. Hear about a strong Monar...ch bronchoscopy program in a dynamic academic & community setting. Join us to learn and discuss their insights. #MONARCH, #roboticBronchoscopy 4/6/21 @ 6:30pm ET sponsored by Auris Health https://www.pathlms.com/american-thoracic-so/webinars/18879 See more

Speakers will discuss the role of novel genomic testing, from nasal swab to Percepta GSC and tumor profiling, in improving the diagnosis and treatment of lung cancer patients today and in the future. Register here! https://www.pathlms.com/american-thoracic-so/webinars/18858

Can you answer the latest Wednesday Checkup? Post your answer in the comments then check back in on Thursday for the correct answer. An 18-year-old woman presen...ts as a transfer from an outside hospital for further evaluation and treatment for shortness of breath. She was last in her usual state of health 4 years ago when she noted slowly progressive shortness of breath, initially noted while playing soccer. She was evaluated by her primary care physician who performed pulmonary function tests and treated her with bronchodilators for presumed asthma. Her symptoms stabilized, but she noted worsening of shortness of breath to the point where she could not walk farther than 50 feet on flat ground along with new onset of lower extremity edema 2 months prior to presentation at our institution. Further, she complained of symptoms suggestive of Raynaud’s phenomenon. The patient was subsequently referred for a computed tomography of the chest (Figure 1) and ultimately underwent a video-assisted thorascocopic surgery with biopsy (Figures 2 and 3). After the surgery, the patient experienced prolonged hypoxemia, prompting an echocardiogram that revealed substantial elevation of the estimated right ventricular systolic pressure (90 mmHg), dilated right ventricle and dilated right atrium. Right heart catheterization was performed and revealed a mean right atrial pressure of 18 mmHg, mean pulmonary artery pressure of 59 mmHg, cardiac index of 3.2 L/min/m2, and pulmonary capillary wedge pressure of 13 mmHg. Based upon these values, the patient was started on intravenous epoprostenol. A few days after initiation of epoprostenol, the patient developed worsening shortness of breath. She was subsequently transferred to our institution for further evaluation and treatment. Physical Exam: On arrival, the patient appeared dyspneic at rest, heart rate 100 BPM, blood pressure 118/60, respiratory rate 26, with oxygen saturation of 94% on 50% supplemental oxygen by face mask. The head exam was normal. The JVP was 8 cm above the sternal angle. Cardiac exam revealed an accentuated second heart sound without a right ventricular heave or extra heart sound. Bilateral basilar crackles were heard. The abdomen was nontender with normal bowel sounds, but pulsatile hepatomegaly was noted. Peripheral edema was noted. Lab: Hemoglobin 8.0 mg/dL (baseline 12.0 mg/dL); serum creatinine normal; no hematuria or casts in urine; antinuclear antibody positive 1:320; anticentromere antibody positive; all other vasculitis serologies negative. The patient was started on therapy and subsequently improved. She was weaned off supplemental oxygen by the time of discharge. Figure 1: Chest CT. On parenchymal windows, the CT of the chest demonstrates diffuse bilateral patchy infiltrates in an alveolar pattern, as well as interlobular septal thickening. There is no pleural effusion noted. Figure 2: Pathology. Interlobular septal vein showing complete occlusion (arrow). Note the partial occlusion in the branch extending into alveolated tissue (short arrow) outlined by the Movat stain. Figure 3: Pathology. Large pulmonary vein showing complete luminal obliteration by loose connective tissue, highlighted by a MOVAT stain that outlines the medial elastic tissue. What is the most likely diagnosis? A. Idiopathic pulmonary arterial hypertension B. Pulmonary veno-occlusive disease associated with limited scleroderma C. Lupus pneumonitis and alveolar hemorrhage D. Pulmonary capillary hemangiomatosis E. Idiopathic dilated cardiomyopathy and pulmonary venous hypertension

PH is a different problem than high blood pressure in the whole body (systemic hypertension). PH puts stress on the right side of the heart because the muscles ...on the right side are not used to pushing blood out to the lungs against such high pressures. Over time, the right side of the heart is strained and begins to fail. Learn more: https://www.thoracic.org//resou/pulmonary-hypertension.pdf See more

Can you answer the ATS Quick Hits? A 72-year-old female with a history of diabetes mellitus and hypertension presented to the ED with complaints of left-sided c...hest pain that started after an argument with her caregiver. See more: https://www.thoracic.org//quick-h/the-pain-in-my-heart.php See more

The ATS Critical Care Training Forum is back! Join us Tuesday, 1/26 at 8pm ET for Updates in COVID-19 Critical Care: Questions and Some Answers, moderated by Laura Crotty Alexander, MD. Register here: https://thoracic.zoom.us//tJIlf-GspjovG9LNxm47u8ueG4EHPTSQ

Don’t miss the free webinar: The COVID-19 Pandemic and A Treatment Approach for Hospitalized Patients on 1/27 at 6:30pm ET. This program will cover the epidemio...logy of the current COVID-19 pandemic and show where demographic disparities exist. Information on the clinical trials, efficacy and safety data, and FDA labeling of a treatment option will also be presented. Register here: https://www.pathlms.com/american-thoracic-so/webinars/17786 See more

True peace is not merely the absence of tension; it is the presence of justice.Martin Luther King Jr.

New podcast: COVID-19: Creating Safer Hospital Environments. IDSA Board member John Lynch, M.D., FIDSA, & SHEA/IDSA member Erica Shenoy, M.D., FIDSA discuss how... to create safe environments across medical facility departments while treating COVID-19 patients. This episode was produced in partnership with the Society for Healthcare Epidemiology of America. Listen here: https://www.idsociety.org//covid19-creating-safer-hospita/ See more

An ECMO machine can help save a person’s life, but it does not treat the disease or injury that led to the heart and lung failure. Learn more: https://www.thoracic.org//patie/resources/what-is-ecmo.pdf #ATSLungFact