Background: Pulmonary nodules are among the most frequent and medically relevant incidental findings, but are easily overlooked – especially when discovered incidentally during hospitalization. While CT imaging has become an invaluable tool for expedited medical evaluation, its use has been associated with an increasing number of incidental findings, the handling of which creates both medical [...]

Background: The Choosing Wisely campaign discourages CT imaging in low-risk patients with suspected pulmonary embolism (PE) (e.g., low clinical probability and negative d-dimer). Few studies have investigated patient, provider, or operational characteristics associated with overuse of CT imaging. One possible approach to this research question is to examine variability in diagnostic yield (i.e., the percentage [...]

Background: Pulmonary arterial hypertension (PAH) is a progressively debilitating disorder characterized by sustained increases in pulmonary vascular resistance and pulmonary arterial pressure, which eventually leads to right-sided heart failure. Current therapies for PAH work predominately as vasodilators to target symptoms, rather than focusing on the initial signals that promote disease progression. These therapies have proved [...]

Background: Pulmonary embolism (PE), refers to obstruction of the pulmonary artery or one of its branches by material (thrombus, tumor, air or fat) that originated elsewhere in the body.Wells criteria must be part of the clinical assessment for PE. With these criteria, we can classify patients as high probability (>6 pts), moderate (2 to 6 [...]

Background: Until the advent of novel oral anticoagulants (NOACs), Warfarin was the only oral agent available for the treatment of deep venous thrombosis (DVT) and Pulmonary embolism (PE). Bridging with parenteral anticoagulation until warfarin reaches a full therapeutic level often results in prolonged hospitalization. Rivaroxaban, Dabigatran, Apixaban, Edoxaban were approved by the FDA for DVT [...]

Background: Chronic Obstructive Pulmonary Disease (COPD) is the 4th leading cause of death and a major driver of healthcare utilization worldwide. Established guidelines exist for hospitalized patients with COPD yet adherence to these has been found in multiple studies to be low. Our question is which Quality Improvement system changes best reduce healthcare utilization and [...]

Case Presentation: A 54-year-old never-smoker female with hypothyroidism and rheumatoid arthritis on etanercept presented with intermittent hemoptysis. Three days prior, she reported coughing ~100mL of frank blood and clots (Figure 1) over the course of 24 hours, with smaller volumes over the next two days (~50 mL total). She recounted a similar episode of hemoptysis [...]

Case Presentation: A 62-year-old male with past medical history of type 2 diabetes mellitus, coronary and peripheral arterial disease, heart failure with reduced ejection fraction, history of peripheral arterial embolism, history of stroke, vascular dementia and hypertension who presented with sudden onset of shortness of breath associated with cough and chest pain for one day. [...]

Case Presentation: A 56-year-old male with WHO Group I/III pulmonary hypertension (PH), Gold Stage III COPD, and right ventricular failure presented with several weeks of gradually worsening dyspnea. One month prior, he was hospitalized for an acute exacerbation of PH and was discharged on an increased dose of ambrisentan after excluding intra-atrial shunting. On the [...]

Case Presentation: A 50 year-old African American male with type 2 diabetes requiring insulin, end stage renal disease on peritoneal dialysis, coronary artery disease, infertility, chronic pancreatitis, alcohol use disorder, and recent influenza presented with fever and cough. He was afebrile, hypotensive, tachycardic, and tachypneic with a leukocytosis and bibasilar consolidations on chest x-ray. He [...]