Bronchoscopy is a safe and commonly performed procedure for diagnostic as well as therapeutic indications. Bronchoscopy is also an aerosol-generating procedure, and due to the risk of severe acute respiratory syndrome coronavirus 2 transmission during the procedure, routine bronchoscopy has been discouraged by multiple professional societies, despite any solid evidence. There are only a few reports of bronchoscopy in patients with coronavirus disease 2019 in the literature. Bronchoscopy in this patient population plays a crucial role not only in the diagnosis of coronavirus disease 2019 but also in the identification of secondary bacterial or fungal infections and in directing appropriate antimicrobial therapy. Bronchoscopy with therapeutic interventions may be lifesaving. Based on the literature, the risk of coronavirus disease 2019 transmission appears to be low among bronchoscopists and other healthcare workers when appropriate personal protective equipment is used. Bronchoscopy in patients with coronavirus disease 2019 should be strongly considered when clinically indicated.
Congenital bronchial atresia is rarely symptomatic in adults. Recurrent lung infection and pneumothorax are the feared complications of this otherwise benign condition. The objective of this article is to present a case of congenital bronchial atresia manifesting as pulmonary hypertension in a 66 year-old patient. While doing so, we highlight the relevant knowledge accrued in medical literature with regards this rare condition. Finally, with the revelation that congenital bronchial atresia may cause severe pulmonary hypertension later in life, perhaps a less conservative approach to management may be warranted in younger adults and children with this condition.
INTRODUCTION: Majority of VTs of chronic ischemic disease are subendocardial in origin, though up to 12-17% of VTs can originate from an epicardial focus. Prevalence can be as high as 25-35% in dilated nonischemic cardiomyopathy.CASE PRESENTATION: 80 year old male with no significant cardiac history presented with worsening dyspnea (NYHA I to NYHA III) over a period of 3 months with episodic dizziness. He underwent Holter monitoring, which showed 7% episodes of monomorphic non-sustained VT coinciding with symptoms. Echocardiogram showed preserved left and right ventricular systolic function. Stress testing to rule out ischemia revealed a possible of reversible posterior basal ischemia but cardiac catheterization was negative for obstructive coronary artery disease. His symptoms did not improve with long acting beta blockers. On a follow up visit, he was again noted to have long runs of slow NSVT and admitted for initiation of medical cardioversion with amiodarone which was discontinued due to prolonged QTc interval. On close inspection of EKG by electrophysiologists, it was determined that the source of his VT was epicardial as against the more commonly seen endocardial focus. Cardiac MRI was negative for structural abnormalities or scars. Patient opted for a trial of medical therapy with sotalol instead of radiofrequency ablation. Since discharge, he was admitted 3 more times with VT storm before he agreed for a successful VT ablation.
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