Graduating less than a month ago, Kimberley Grady, M.D., is already making an impression for a case report she wrote as a fourth-year student at the Wayne State University School of Medicine.
Dr. Grady, Class of 2014, was captivated by the rarity of a case she encountered during her rotation at Harper University Hospital's Medical Intensive Care Unit in Detroit.
She presented the resulting abstract, "Coil Embolization of Pulmonary Arteries as a Palliative Treatment of Diffuse Type I Hepatopulmonary Syndrome," at the American College of Physicians Internal Medicine 2014 meeting April 10-12 in Orlando, Fla.
In May, Dr. Grady was informed that a manuscript of the case, co-authored by Professor of Medicine Ayman Soubani, M.D., was accepted for publication in Respiratory Care, a peer-reviewed journal published by the American Association of Respiratory Care. Use of the medical procedure together with the related diagnosis has not been outlined in academic literature before.
"It is an honor to have my case accepted at both the American College of Physicians National Meeting and in Respiratory Care. It was a great experience traveling to Florida with my current and future colleagues to not only present my case report, but also to learn from other students' presentations," she said.
The patient she wrote about came to the Detroit Medical Center hospital with shortness of breath, and required high levels of supplemental oxygen.
"He was determined to have underlying liver disease secondary to his alcohol abuse and hepatitis infection. His history, physical exam and supplemental diagnostic tests indicated that he had Type I Hepatopulmonary Syndrome," she said.
Type I Hepatopulmonary Syndrome is defined by low blood oxygen levels in a patient with underlying liver disease. The low blood oxygen is secondary to the diffuse dilation of the pulmonary vasculature, which results in inefficient oxygen exchange. The treatment of choice for the disease is liver transplantation, because the diseased liver is the source of the lung issue, Dr. Grady added.
"However, our patient was not a candidate for liver transplantation because of his active alcohol abuse, lack of social support and his psychiatric instability. Since he was unable to leave the hospital with such high oxygen requirements and he was not a candidate for liver transplantation, we needed to find a safe and effective alternative treatment," she said.
He underwent right heart catheterization. Multiple coils were placed in the branches of the pulmonary arteries that had become dilated secondary to his liver disease. The procedure reduced the blood flow through the dilated pulmonary arteries that had ineffective oxygen exchange. His oxygen requirements significantly decreased and remained stable three months after the procedure.
Dr. Grady wrote the case report voluntarily because of the rarity of Hepatopulmonary Syndrome, and because coil embolization as a palliative treatment for Type I Hepatopulmonary Syndrome was not reported in literature as a safe and effective treatment for patients who are not a candidate for liver transplantation.
"I would like to thank Dr. Ayman Soubani, Division of Pulmonary, Critical Care and Sleep Medicine at the Detroit Medical Center, for his guidance during both the case investigation and the preparation of the abstract and manuscript," she said. "Also, I would like to thank Dr. Srinath Gowda, Division of Pediatric Cardiology at DMC, for his assistance in the development and performance of the coil embolization procedures as a treatment plan for this patient with Type I Hepatopulmonary Syndrome."
Dr. Grady graduated from the School of Medicine with high distinction because of comprehensive honors in her first, second and third year of medical school. She is now an internal medicine resident at the University of Michigan.