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Progressive Dysphonia: Ortner Syndrome

A 68-year-old woman with known idiopathic heart failure and severe reduced ejection fraction was admitted for aggravation of dyspnea and recurrent dysphonia over the past 6 months, progressing to constant hoarseness. Vitals signs were normal. Laboratory tests showed normal hemoglobin and white blood cell count, increased levels of N-terminal pro-brain natriuretic peptide (NT-proBNP; 10574 pg/mL), […]

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man holding his chest

Advanced Therapies for Massive Pulmonary Embolism

The report by Secemsky et al1 in this issue of The American Journal of Medicine illustrates the current management of pulmonary embolism at the Massachusetts General Hospital (MGH). A Pulmonary Embolism Response Team sees all patients in whom pulmonary embolism is diagnosed by computed tomography. The team manages these patients during their hospitalization and after discharge for up […]

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Computed tomography of the chest demonstrated bilateral pulmonary nodules.

Not All It’s CrAged Up to Be: Disseminated Cryptococcosis

Phenomena known as cognitive biases, when applied to the details of a patient’s medical history, evidently steered the first attempts at diagnosis in the wrong direction. A 60-year-old man presented after 6 weeks of progressively worsening fevers, weight loss, malaise, night sweats, and confusion. Originally, the fevers were intermittent and low grade at 37.7°C (99.9°F). […]

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Computed tomography of the chest. (A) Before treatment, with right pulmonary infiltrates. (B) After 1 year of itraconazole, with marked improvement.

Sickle Cough: A Case of Nonresolving Pneumonia

A 26-year-old female graduate student with sickle-cell disease presented with fever, dyspnea, and right shoulder pain. Computed tomography of the chest demonstrated right middle and lower lobe infiltrates (Figure, A). She was diagnosed with pneumonia, acute chest syndrome, and vaso-occlusive crisis and prescribed 5 days of amoxicillin-clavulanic acid.   She was readmitted 1 month later […]

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Bronchoscopy showing pill fragments (arrow) with intense inflammatory granulation response with bronchial stenosis.

Unusual Cause of Persistent Cough: ‘Pill Aspiration’

A 57-year-old woman with carcinoid syndrome was referred to the pulmonary clinic by her primary care physician (PCP) for persistent cough for the past 6 weeks. She was evaluated by her PCP approximately 6 weeks earlier for cough, which the patient thought started after she had aspirated one of her medications. Results from initial clinical […]

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(A) Skin impairment. Papulonodular skin lesions on the tip of the nose, from 3 to 10 mm, characteristic of sarcoidosis: firm, nonedematous, noninflammatory, nonpainful, nonpruriginous, with predominant facial involvement. (B) Endoscopic view (right nasal fossa) showing a major mucosae thickening. (C) Numerous uniform circumscribed nests of non-caseating granulomata which are characterized by the paucicity of lymphocytes and absence of necrosis.

Skin and Nasal Involvement: Look for Sarcoidosis!

  Sarcoidosis is a systemic, noncaseating, granulomatous disease affecting young adults between the ages of 25 and 40 years, most often of Black origin (35.5/100,000 vs 10.9 in the White population). Although the lower respiratory tract is affected in 90% of cases, ear, nose, and throat locations are very uncommon, with a prevalence varying between […]

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