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- Oct 3, 2003
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67 dude with hx adenocarcinoma s/p RULectomy last year, chemo, rads, with post surgical R phrenic/recurrent laryngeal injury and resultant R hemidiaphragmatic paralysis, supposedly disease free has now a 7d hx of progressive interstitsal infiltrates bilaterally with old effusion on R post op.
BAL, afb, gimesa, galactomannin, quantiferon, viral, fungal, piss antigen, hiv all neg. only one temp of 100.6. on crap loads of abx including vori for good measure. pao2 80 on 80% hiflo NC, RR 30 for DAYS, paco2 44 for DAYS. dudes been fish mouthin for DAYS. no want da tube.
Anypoops pulm taps the loculated effusion. post lobectomy/pneumonectomy chest cavities are supposed to filled with fluid no? lung has been trapped there for at least a year post op so i wouldnt have bothered tapping especially if the infiltrates were bilateral.
onc doesnt think its lymphangitic spread.
anyways here is fluid from pleura (dude has normal white count): ph 7.5, ldh 6000 (plasma is 680) protein low, glucose <20. 700tnc's with 300rbc's, 50:50 neut and lymph. 1+ wbc on gram. no organism. cytology pending.... the glucose and ldh are the only impressive numbers on there.
Labeled as exhudative parapneumonic, clinda started...,IR consulted for pig tail (that lung will NEVER reexpand), all by our pulm service. I think its a BS diagnosis and a flippen pigtail is only gonna cause trouble. i think dude needs a vats with bx if he's willing to get trached.
Thoughts? I consulted ID to bail us out of the never ending oncology antibiotic spiral.
BAL, afb, gimesa, galactomannin, quantiferon, viral, fungal, piss antigen, hiv all neg. only one temp of 100.6. on crap loads of abx including vori for good measure. pao2 80 on 80% hiflo NC, RR 30 for DAYS, paco2 44 for DAYS. dudes been fish mouthin for DAYS. no want da tube.
Anypoops pulm taps the loculated effusion. post lobectomy/pneumonectomy chest cavities are supposed to filled with fluid no? lung has been trapped there for at least a year post op so i wouldnt have bothered tapping especially if the infiltrates were bilateral.
onc doesnt think its lymphangitic spread.
anyways here is fluid from pleura (dude has normal white count): ph 7.5, ldh 6000 (plasma is 680) protein low, glucose <20. 700tnc's with 300rbc's, 50:50 neut and lymph. 1+ wbc on gram. no organism. cytology pending.... the glucose and ldh are the only impressive numbers on there.
Labeled as exhudative parapneumonic, clinda started...,IR consulted for pig tail (that lung will NEVER reexpand), all by our pulm service. I think its a BS diagnosis and a flippen pigtail is only gonna cause trouble. i think dude needs a vats with bx if he's willing to get trached.
Thoughts? I consulted ID to bail us out of the never ending oncology antibiotic spiral.
