In 2019 a man was referred to Royal Adelaide Hospital with worsening breathlessness and a productive cough. He was a 47 year old electrician with a history of tobacco smoking who’d been well before the onset of symptoms. Over a couple of admissions the patient’s condition progressed to type 2 respiratory failure. While the ultimate explanation for this presentation was a bit of a unicorn, the dramatic escalation of examinations and interventions runs through some textbook respiratory medicine; ECMO, infectious diseases, bronchoscopy, CT, interpretation of blood gases and the alveolar gas equation, stenting and ultimately transplantation. This is discussed in the careful manner expected of a long-case presentation in the physician training exams.

Guest
Dr Thomas Crowhurst FRACP (Northern Adelaide Local Health Network)

Hosts
Associate Professor Stephen Bacchi (Lyell McEwin Hospital; University of Adelaide)
Dr Brandon Stretton (Central Adelaide Local Health Network)

Production
Produced by Stephen Bacchi and Mic Cavazzini. Music licenced from Epidemic Sound includes ‘Rockin’ for Decades’ by Blue Texas and ‘Brighton Breakdown’ by BDBs. Image created and copyrighted by RACP. Editorial feedback kindly provided by RACP physicians Aidan Tan and Fionnuala Fagan.

Key Reference (spoiler alert)

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Case report of severe bronchial web-like stenoses after 'surviving the unsurvivable' [BMC Pulm Med. 2019]

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