Sunday, January 15, 2017


       Sometimes I see patients that I can not figure out as to why they have so many problems or why certain things happen to certain people. Many years ago I went to see one of my professors, who taught us Preventive and Social Medicine, who was hospitalized for heart attack. He was 50 some years old and had heart attack. He said that 'I don't smoke , I don't drink, I do not have high blood pressure or diabetic ,then why did I get the heart attack.'I did not have answer.I find myself in such situation many times . So the story that I am going to tell is one such case.
     I had seen this patient for several years and she had many major problems and I had treated her and referred her to Mayo clinic and UF. She had repeated episodes of coughing blood and many other issues. I could not find any reason and nor did Mayo Clinic. But the UF did find some abnormal blood vessels and did cauterization of the same. She continued to have same problem and so I sent her back to get the cauterization  done . So this would have been her 4th or so procedure to stop the bleeding. She went there and had the procedure done on Friday and came back on Saturday. She was fine on Sunday.She started having shortness of the breath on Monday and so she called 911 and they brought her to the ER on Monday evening. So I get a call from the ER MD that she was there and the chest X-ray showed 'complete collapse 'of the left lung. She was put on BIPAP. She was admitted to ICU. So the ICU doctor called me and told me that she was admitted and she wanted to see me. So I saw her in the morning of Tuesday. She had second X-Ray and the left lung was still collapsed. I saw the notes of 3 doctors and saw their plan. Patient needed Bronchoscopy. My suspicion was that after the cauterization, she must have had some bleeding and had some blood clots that blocked the left bronchial tube and so the secretions could not come out. So the lung collapsed. So she needed to have the bronchoscopy and sucking out of the blood clots or the mucous to 'open' the lung. She did not want to be intubated and put on respirator. But without doing that it was impossible to do the procedure. The suction channel of the bronchoscope was too small and we might have gotten in trouble. So I called a chest surgeon and he agreed to do it and the patient agreed.So the bronchoscopy was done under anesthesia and had to be left on respirator. I saw the new chest X-ray and it had shown 50%improvement but was not 100%clear. So I decided to do the bronchoscopy again. The patient agreed and so I did the bronchoscopy.
       What I saw surprised. Her left bronchial tube was quite narrowed. There were plenty of mucous plugs and I lavage with saline . But my main concern was that the narrowing of the bronchus. My concern was that unless that we treated , she would get the collapse of the lung again. But I had to confirm it first as the narrowing was MY IMPRESSION. No one else had suggested it , nor at UF nor in ICU nor the surgeon who did the brochoscopy. So I spoke to the radiologist and ordered High resolution CT scan . It showed that left bronchus was quite narrowed, it was less that half the size. I called a interventional lung specialist and asked him to look at the CT scan and he agreed . So he did the balloon dilatation of the left bronchus and then we got her of the respirator.
      So this patient had complications to the treatment ,which I have not heard any other patient getting it. The disease is rare, the treatment is rare and the complication that occurred is I guises is rare

No comments:

Post a Comment