Monday, May 19, 2014
I was looking up history on a BAL (bronchoalveolar lavage).
36 y/o male S/P "accidental" inhalation of BC powder.
So they were looking for aspiration pneumonia. And maybe some other surprises. They pre-ordered a fungal stain.
The cytotech screened this case as negative for fungus. I agreed, but I saw something funny that almost looked like a hyphae. There were some markings suggestive of septa. I was in 90% agreement with the tech, but decided I'd better show my partner since I'd thought about it.
"So how do you 'accidentally' inhale BC powder? Did you run out of cocaine and think it might make a nice substitute? Were you taking meds for a hangover and confuse it with your cocaine? Have you ever heard of taking BC powder?"
"No Giz, that's weird. But I hear kids are doing crazy things with Benadryl these days. You never know."
"Really? Benadryl? I remember taking half of one during fellowship to knock myself out a time or two. And it stressed the hell out of me that I would be too snowed if one of the kids woke up in the middle of the night needing me. How the hell can you abuse Benadryl?"
He agreed with me negative on the fungus. "Did you polarize it?"
I was so focused on is this or is this not a possible septate hyphae on the GMS that I hadn't done that yet.
We polarize and analyze slides for foreign material. It's so pretty - looks like stars in the sky. Sure enough, this guy's BAL looked like a planetarium. When I was describing it to my boyfriend he commented, "Sounds like whatever he does on a regular basis was cut with broken glass." It could have been. The stars are not regular, they are heterogeneous. Like tiny bits of broken glass in your lungs. I think I might have a good angle to discourage drugs when my kids hit middle school.
Posted by Gizabeth Shyder