An 72 year old woman is admitted with an exacerbation of COPD, requiring mechanical ventilation. On the third day she develops abdominal pain and distension. She has no nausea or vomiting and continues to pass flatus. Abdominal exam reveals symmetrical distension, tympany on percussion, and no rebound tenderness although deep palpation produces pain.
Electrolytes are normal and there is no increase in the anion gap.
Aspergillus antibodies may be measured in serum, but are not diagnostic of invasive disease. In this setting of chronic steroid use, bronchoscopy with biopsies and washings for smear and culture is probably the best approach, not only to confirm Aspergillus , but also to rule out malignancy. If the hempotysis becomes troublesome, bronchial artery embolization has been effective. The information that follows it cannot be checked, nor has it been subjected to any analysis other than some vague tally in the speaker's memory. The Symposium is an annual event organized by the University of Dayton School of Law and the Wright State University School of Medicine.