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Obstructive Lung Diseases: Obstructive Lung Disease |

Where's the Lung?

Yi Hern Tan, MMed; Jessica Quah, MMed
Author and Funding Information

Singhealth Residency, Singapore, Singapore


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(4_S):A402. doi:10.1016/j.chest.2016.02.417
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SESSION TITLE: Obstructive Lung Disease

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, April 17, 2016 at 11:45 AM - 12:45 PM

INTRODUCTION: A 59 year old with chronic obstructive lung disease (COLD) presents with symptoms of acute infective exacerbation. The radiological findings and management are reviewed.

CASE PRESENTATION: A 59 year old Eurasian male with an 80 pack-year smoking history presented with coryzal symptoms for two days, with worsening dyspnea and productive sputum. He has ischaemic heart disease and is receiving anti-platelet therapy. He also has COLD for which he has not been compliant with outpatient reviews and medications. Initial assessment showed SpO2 93% on room air, and his arterial blood gas was pH 7.42 pO2 62 mmHg, pCO2 34 mmHg and HCO3 22 mmol/L. His chest radiograph demonstrated areas of lucency in bilateral upper lobes; this raised clinical suspicion of bilateral pneumothoraces. His CT thorax demonstrated extensive bullous disease with no pneumothorax. He received antibiotics, corticosteroids and nebulized bronchodilators but developed worsening respiratory distress. A trial of non-invasive ventilation was unsuccessful and he was intubated. The patient was extubated after 3 days of mechanical ventilation. Swabs performed on admission confirmed Influenza A infection. He progressed well in the ward, was initiated on Tiotropium and Symbicort inhalers and discharged.

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