The Pulm PEEPs podcast will be providing regular episodes delving into the world of pulmonary and critical care medicine. Our mission with this platform is to provide learners of all levels multiple formats to engage in pulmonary and critical care education that you can access anytime, anywhere. We will be bringing you case reports of classic teaching cases that we have encountered accompanied by infographics on high-yield points from each case, roundtable chats with experts and leaders in the field of PCCM, and series of Top ICU and Top Pulmonary consults.
All content for PulmPEEPs is the property of PulmPEEPs and is served directly from their servers
with no modification, redirects, or rehosting. The podcast is not affiliated with or endorsed by Podjoint in any way.
The Pulm PEEPs podcast will be providing regular episodes delving into the world of pulmonary and critical care medicine. Our mission with this platform is to provide learners of all levels multiple formats to engage in pulmonary and critical care education that you can access anytime, anywhere. We will be bringing you case reports of classic teaching cases that we have encountered accompanied by infographics on high-yield points from each case, roundtable chats with experts and leaders in the field of PCCM, and series of Top ICU and Top Pulmonary consults.
107. Fellows’ Case Files: University of Kansas Medical Center KUMC
PulmPEEPs
1 month ago
107. Fellows’ Case Files: University of Kansas Medical Center KUMC
After a brief hiatus, we are excited to be back today with another Fellows’ Case Files! Today we’re virtually visiting the University of Kansas Medical Center (KUMC) to hear about a fascinating pulmonary presentation. There are some fantastic case images and key learning points. Take a listen and see if you can make the diagnosis along with us. As always, let us know your thoughts and definitely reach out if you have an interesting case you’d like to share.
Meet Our Guests
Dr. Vishwajit Hegde completed his internal medicine residency at University of Kansas Medical Center where he stayed for fellowship and is currently a second year Pulmonary and Critical Care medicine fellow.
Dr. Sahil Pandya is an Associate Professor of Medicine and Program Director of the PCCM Fellowship at KUMC.
Case Presentation
Imaging
Infographic
Key Learning Points
1) Initial frame & diagnostic mindset
* Young (26), subacute → chronic dyspnea/cough with diffuse pulmonary nodules; avoid premature closure on TB.
* Use a Bayesian approach: combine pre-test probability (epidemiology, exposures, tempo) with targeted tests to decide next steps.
* Always confirm TB when possible (micro/path + resistance testing); empiric RIPE may be reasonable but shouldn’t replace tissue when stakes are high.
2) Imaging pearls—nodular pattern recognition
* Ask three things: craniocaudal distribution, symmetry, central vs peripheral.
* Partner with neuroradiology for pattern nuances; treat seizures but keep searching for the unifying diagnosis.
4) Lab/serology strategy
* Broad infectious workup (AFB × multiple, fungal serologies), HIV and basic immune screen.
* Negative/indeterminate tests don’t end the search—revisit history (e.g., Ohio travel → histo/blasto risk).
5) “Tissue is the issue”—choosing the procedure
* For diffuse nodules with mediastinal adenopathy and stable patient: EBUS-TBNA + BAL, consider transbronchial or cryobiopsy.
* Cryobiopsy pros: larger, less crush artifact, better for molecular testing; cons: ↑ bleeding/pneumothorax vs forceps.
* VATS still best for certain ILD questions or if less invasive routes are non-diagnostic—but weigh patient preferen...
PulmPEEPs
The Pulm PEEPs podcast will be providing regular episodes delving into the world of pulmonary and critical care medicine. Our mission with this platform is to provide learners of all levels multiple formats to engage in pulmonary and critical care education that you can access anytime, anywhere. We will be bringing you case reports of classic teaching cases that we have encountered accompanied by infographics on high-yield points from each case, roundtable chats with experts and leaders in the field of PCCM, and series of Top ICU and Top Pulmonary consults.
