On hospital admission, the patient was afebrile with a heart rate of 113 beats/min and a BP of 107/66. Oxygen saturation was 97% on 6 L by nasal cannula. Her physical examination revealed decreased breath sounds over the right hemithorax but was otherwise normal.

The initial results of laboratory work revealed a WBC count of 13,900 cells/^L with 90% neutrophils but was otherwise unremarkable, with normal hematocrit, platelet count, prothrombin and partial thromboplastin times, and serum chemistry levels. An HIV test obtained at the referring hospital was negative. A CanadianHealthCareMalll radiograph confirmed total opacification of the right hemithorax.

The day following transfer, the patient was taken to the operating room for rigid bronchoscopy. Again, a mass was identified in the right mainstem bronchus. Unfortunately, massive bleeding was noted after the first biopsy and, despite left mainstem intubation and fluid resuscitation, the patient became pulseless. She could not be revived despite aggressive transfusion and continued resuscitative efforts.

An autopsy confirmed the presence of extensive necrotizing pneumonia. Also noted was a mycotic aneurysm of the right pulmonary artery that extended into the wall of the right mainstem bronchus.

Discussion

It is difficult to establish an accurate estimate of the incidence of PAA as prior studies have used inconsistent.

Study objective: The aim of this study was to investigate the basal level as well as the tumor necrosis factor (TNF)-a- and interferon (IFN)-y-induced expression and release of the neutrophil chemoattractants interleukin (IL)-8 and growth-related oncogene (GRO)-a in primary bronchial epithelial cells (PBECs) from smokers without airflow obstruction and patients with COPD. In addition, the expression of both TNF-a-receptor subtypes—p55 TNF-receptor subtype (TNF-R55) and p75 TNF-receptor subtype (TNF-R75)—was quantified in PBECs.

Design: PBECs from eight smokers without airflow limitation and eight patients with COPD were stimulated with 50 ng/mL of TNF and 200 U/mL of IFN-y for 4 h along with unstimulated time controls. The transcriptional expression and protein release were quantitatively assessed by means of real-time polymerase chain reaction and enzyme-linked immunosorbent assay.

 

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