A 63-year-old man with a history of chronic obstructive pulmonary disease (COPD) and angina was hospitalized for exacerbation of the COPD. His medications on admission included theophylline 300 mg b.i.d., metaproterenol inhaler q4h, diltiazem 30 mg q.i.d., and a 5 cm nitroglycerin patch. Chest x-ray revealed a right upper lobe (RUL) infiltrate that was treated with intravenous antibiotics. A subsequent x-ray showed an RUL mass. CAT scan revealed a 3 cm lesion and hilar adenopathy.
Arterial blood gas analyses on room air showed: pH 7.35, PaCO2 42 mmHg, PaO2 56 mmHg. Hemoglobin was 16 gm/dl, hematocrit 48%; other chemical analyses were normal. ECG showed normal sinus rhythm with a vertical axis and incomplete right bundle branch block. Pulmonary function tests revealed moderate to severe obstructive lung disease, with a maximal breathing capacity (MBC) that was 55% of predicted, and a forced expiratory volume in 1 second (FEV1) of 1.5L. A presumptive diagnosis of bronchogenic carcinoma was made, and the patient was scheduled for a right upper lobectomy. Isolation of the affected lung was requested.
KeywordsChronic Obstructive Pulmonary Disease Pulmonary Capillary Wedge Pressure Right Bundle Branch Block Pulmonary Lobectomy Nondependent Lung
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