Ingestion of silicone and fat by these alveolar macrophages has also been postulated to result in modulation of pulmonary immunoregulatory mechanisms and provoke an exaggerated inflammatory response. These suggest a common pathophysiologic mechanism involving the coagulation system in both FES and SES. Notably, most patients with SES meet Schonfield criteria for fat embolism syndrome where the presence of petechial hemorrhages, chest x-ray changes, hypoxemia, tachycardia, tachypnea, confusion and fever are used to determine CDK inhibitor a cumulative score.1 While treatment is largely supportive with supplemental oxygen and high

dose steroid administration constituting the mainstay of therapy, the use of adjunct salvage mechanical ventilation techniques, and recruitment maneuvers like prone ventilation have been suggested to improve oxygenation.2 The present patient appeared to be in ARDS from pulmonary silicone embolism and presented issues of futility of care exacerbated by unprecedented high doses of silicone injection. These facilitated a progressively rapid decline in her clinical course. She rapidly deteriorated despite application of evidence based

protocols for treatment of ARDS, and lapsed into pulseless electrical activity, expiring 3 h post intubation. Illicit use of injectable silicone is on the rise in the United States and abroad. With this comes an increasing incidence of related morbidities and fatalities. A high index of suspicion selleck for SES should be triggered in patients with neurologic or pulmonary symptoms and recent exposure to liquid silicone. No funding GPX6 source. Ayodeji O. Adegunsoye MD – Contributed to the drafting, data collation and writing the article. Stephen Matchett MD – Contributed to the drafting and editing of the article. Dominic J. Valentino III DO

FCCP – Contributed to the drafting and editing of the article. The authors have no conflict of interest. “
“Lung transplantation (Ltx) is an accepted therapy for patients with end-stage lung disease and offers a major survival benefit in selected patients. The most important indications are chronic obstructive pulmonary disease (COPD) (29%) and idiopathic pulmonary fibrosis (IPF) (24%) besides cystic fibrosis and pulmonary arterial hypertension.1 The incidence of lung cancer is 4.1% in patients after Ltx, this is 20–25 times higher than in the general population.2 Diagnosis is often difficult in IPF patients because of the diffuse lung abnormalities due to the underlying fibrosis. Moreover, the lung cancer may mimic a pulmonary infection. We describe three patients who were transplanted for idiopathic pulmonary fibrosis and who developed a primary lung cancer. Patient A, a 48-year old male with IPF presented 7 years after successful single Ltx with dyspnoea, weight loss and cough. At that time he was renovating his house.