scholarly journals Nodular Pulmonary Amyloidosis: A Case over Fourteen Years

2021 ◽  
Vol 2 (2) ◽  
pp. 038-041
Author(s):  
A Ekladious ◽  
L Fish ◽  
C De Chaneet ◽  
C Cox
Keyword(s):  
Chest Pain ◽  
Case Reports ◽  
Pulmonary Function Tests ◽  
Lower Lobe ◽  
Cervical Lymphadenopathy ◽  
Pleuritic Chest Pain ◽  
Ct Guided ◽  
History Of ◽  
Pulmonary Amyloidosis ◽  
Insight Into

A 75-year-old man presented with pleuritic chest pain, haemoptysis and dyspnoea. Imaging found multiple pulmonary nodules, concerning for malignancy. CT-guided biopsy was consistent with amyloid. The patient has a history of pulmonary amyloidosis, with a single nodule resected 14 years prior. This case allows comparison between imaging fourteen years apart, providing insight into the progressive nature of these benign nodules. Nodular pulmonary amyloidosis is a rare condition with few case reports published. Of those published, few are of nodular amyloidosis in the absence of underlying neoplastic aetiology. This case presents a 14-year interval of a patient with nodular amyloidosis, allowing insight into disease progression which has not previously been well described. A 75-year-old man presented to a regional hospital in Australia with right sided pleuritic chest pain, and a 2-week history of productive cough, haemoptysis, dyspnoea and reduced exercise tolerance. Further questioning revealed a 3-month history of worsening dyspnoea, haemoptysis and cough, with no orthopnoea, paroxysmal nocturnal dyspnoea or weight loss. The patients’ past medical history included resection of an amyloid tumour from the left lower lobe of the lung in 2004, ex-smoker with a 30-pack year history, significant occupational asbestos exposure through work as a diesel mechanic, and hypercholesterolaemia. The patient lives at home with his partner and is independent with the activities of daily living. On examination, the patient appeared well, in no respiratory distress. Observations were within normal limits, with oxygen saturations of 94% on room air, respiration rate of 18. On auscultation, there were late inspiratory crackles, as well as decreased hepatic dullness to percussion. There was a central trachea and no palpable cervical lymphadenopathy. Cardiovascular examination was unremarkable, and the patient was euvolaemic. Abdominal examination was unremarkable with no palpable organomegaly, and he did not have a rash or skin abnormalities seen. The initial investigations were conducted to investigate a potential lung malignancy underlying malignancy, based on the appearance on CT scan. The patient advised us that he had a previous diagnosis of primary pulmonary amyloidosis, first diagnosed 14 years ago. The diagnosis was made after a chest x-ray and CT showed a nodule, suspicious for cancer. Pulmonary function tests were performed and he was referred to a Cardiothoracic surgeon for consideration of a left lower lobectomy. He was treated with a wedge resection. Histopathology from this specimen showed primary pulmonary amyloidosis. There was a delay in the understanding of how the patient came to have this rare diagnosis, as it took five days for the medical records to be sourced from the archive.

Cryptogenic organising pneumonia: an unusual cause of pleuritic chest pain

2021 ◽  
Vol 14 (1) ◽  
pp. e238514
Author(s):  
Rebecca Ceci Bonello ◽  
Etienne Ceci Bonello ◽  
Christian Vassallo ◽  
Edward Giles Bellia
Keyword(s):  
Chest Pain ◽  
Inflammatory Markers ◽  
White Cell Count ◽  
Clinical Status ◽  
Lower Lobe ◽  
Pleuritic Chest Pain ◽  
Ct Guided ◽  
Atypical Pathogens ◽  
Ct Guided Biopsy ◽  
The Right

A 76-year-old woman presented with a 2-hour history of pleuritic chest pain with no other associated symptoms. Blood investigations revealed raised inflammatory markers and an elevated white cell count. On chest radiograph, an airspace shadow indicative of a consolidation was prominent. This was followed by a CT scan of her thorax which showed a spiculated lesion in the right upper lobe, a lesion in the posterior segment of the left lower lobe and mildly enlarged right hilar lymph nodes. She was started on dual antibiotic therapy; however, the patient’s clinical status and inflammatory markers did not improve. A bronchoscopy was performed which excluded malignancy and atypical pathogens. CT-guided biopsy confirmed the presence of cryptogenic organising pneumonia. Prednisolone 50 mg daily was prescribed with quick resolution of symptoms.

A rare case of spontaneous haemothorax in patient with haemophilia A

2021 ◽  
Vol 14 (4) ◽  
pp. e242412
Author(s):  
Suthaphong Tripoppoom ◽  
Nophol Leelayuwatanakul
Keyword(s):  
Chest Pain ◽  
Rare Case ◽  
Rare Event ◽  
Haemophilia A ◽  
Minor Trauma ◽  
Conservative Approach ◽  
Pleuritic Chest Pain ◽  
Good Clinical Outcome ◽  
History Of

Haemorrhage in patients with haemophilia is common after minor trauma but may occur spontaneously. Despite the diversity of bleeding sites, spontaneous haemothorax, on a non-traumatic basis, is an exceedingly rare event and only a few cases had been reported. We present a case of a 43-year-old man with a history of haemophilia A who had pleuritic chest pain for 1 day without significant history of trauma. Diagnostic thoracentesis showed bloody pleural fluid in which neither abnormal cell nor organism was found. He was treated by cryoprecipitate replacement and therapeutic thoracentesis for releasing haemothorax. After discharge, the patient returned for follow-up with complete radiological resolution. Regarding the consequences of retained haemothorax from conservative approach and the procedure-related bleeding of given therapeutic intervention in haemothorax making its management in patients with haemophilia to be more challenging. Our case illustrates a conservative treatment of spontaneous haemothorax in patient with haemophilia resulting in a good clinical outcome.

scholarly journals Development of a Large Pneumatocele in a Patient Recovering from COVID-19 Pneumonitis

2021 ◽  
Author(s):  
Frances Hampson ◽  
Waleed Salih ◽  
Jennifer Helm Jennifer Helm
Keyword(s):  
Chest Pain ◽  
Hospital Admission ◽  
Clinical Significance ◽  
Prone Position ◽  
Rare Case ◽  
Lower Lobe ◽  
Sudden Onset ◽  
Chest Drain ◽  
Ct Guided ◽  
Initial Imaging

A 39-year-old man presented with severe COVID-19 pneumonitis requiring hospital admission. He represented three days following discharge with sudden onset breathlessness and chest pain. Initial imaging suggested the presence of a left pneumothorax. Following further clinical decline a plan was made to insert a CT guided chest drain. However, imaging in the prone position for the procedure unexpectedly revealed a large left lower lobe pneumatocele with only a very small pneumothorax. Events and appearances suggest that this is a rare case of delayed COVID-19 pneumonitis-related pneumatocele formation. We will discuss the clinical significance of this entity.

scholarly journals Unilateral Pulmonary Artery Aplasia in a Pregnant Patient

2011 ◽  
Vol 2011 ◽  
pp. 1-3 ◽  
Author(s):  
Chitra Lal ◽  
Jim Barker ◽  
Charlie Strange
Keyword(s):  
Pulmonary Hypertension ◽  
Chest Pain ◽  
Pulmonary Artery ◽  
Case Reports ◽  
Pregnant Patient ◽  
Pregnant Female ◽  
Prospective Evaluation ◽  
Rare Anomaly ◽  
History Of ◽  
In Pregnancy

Unilateral pulmonary artery aplasia is a rare anomaly. Case reports of this condition in pregnant patients are even more uncommon and the best approach to management of such patients is still unclear. We report a patient who presented with a history of dyspnea, chest pain, and hemoptysis. Imaging established the diagnosis in a newly pregnant female. Management of the pulmonary artery aplasia patient in pregnancy requires prospective evaluation of pulmonary hypertension.

scholarly journals A Rare Case of Cyclical Hemothorax: Thoracic Endometriosis Syndrome

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Muhammad Shabbir Rawala ◽  
Muhammad Farhan Khaliq ◽  
Muhammad Asif Iqbal ◽  
S. Tahira Shah Naqvi ◽  
Kinaan Farhan ◽  
...  
Keyword(s):  
Chest Pain ◽  
Pleural Effusion ◽  
Reproductive Age ◽  
Common Disease ◽  
Pleuritic Chest Pain ◽  
Rare Presentation ◽  
Ct Guided ◽  
Endometrial Cells ◽  
Wide Range ◽  
Thoracic Endometriosis

Endometriosis is a common condition in which endometrial cells and stroma are deposited in extrauterine sites. Its prevalence has been estimated to be 10% of reproductive age females. It is commonly found in the pelvis; however, it may be found in the abdomen, thorax, brain, or skin. Thoracic involvement is a relatively rare presentation of this common disease. Thoracic endometriosis commonly presents as pneumothorax in 73% of patients. A rarer presentation of thoracic endometriosis is hemothorax (<14%) or hemoptysis (7%). Thoracic endometriosis is an uncommon cause of a pleural effusion. We present a case of 28-year-old African American female with no other medical conditions. She presented to the hospital with worsening right-sided pleuritic chest pain, dyspnea, and menorrhagia. She had been complaining of pleuritic chest pain for 5 years, the onset of which corresponds to the start of her menstrual cycle and is relieved with cessation of menses. Initial laboratory studies revealed a severe microcytic anemia with normal coagulation profile. Chest X-ray showed small right pleural effusion and suspicious for airspace disease. A computed tomography (CT) of chest was ordered for further clarification and identified large right pleural effusion. CT-guided thoracentesis removed 500 ml of serosanguinous fluid consisting of blood elements. There can be multiple sites involved with endometriosis and can present with wide range of symptoms that occur periodically with menses in young woman. The history and pleural fluid findings of this case are suggestive of Thoracic Endometriosis Syndrome. The diagnosis of this is often missed or delayed by clinicians, which can result in recurrent hospitalization and other complications. As internists we should be suspicious of atypical presentations of endometriosis and treat them early before complications develop. This case also highlights the importance of suspecting atypical etiologies for pleural effusion.

scholarly journals An unusual cause of ‘pleuritic’ chest pain

2008 ◽  
Vol 7 (2) ◽  
pp. 80-82
Author(s):  
Evelyn S Tan ◽  
◽  
Pierre J Willemse ◽  
Ahmed H Abdelhafiz ◽  
◽  
...  
Keyword(s):  
Chest Pain ◽  
Exercise Tolerance ◽  
Sudden Onset ◽  
Smoking History ◽  
Isosorbide Mononitrate ◽  
Past Medical History ◽  
Pleuritic Chest Pain ◽  
Intravenous Morphine ◽  
Drug History ◽  
History Of

A 77 year old man presented to A&E with sudden onset left sided chest pain. This chest pain was severe enough to wake him up from sleep in the early hours of the morning. The pain was pleuritic in nature and severe enough to require administration of intravenous morphine. He had a past medical history of ischaemic heart disease (1997), pulmonary embolism (1997), and left sided pnuemothorax (1998). Drug history consisted of lansoprazole 30mg od, isosorbide mononitrate 60mg od, nicorandil 10mg bd, aspirin 75mg od, beclomethasone 100 inhaler 1 puff bd, salbutamol 100 inhaler prn and combivent nebuliser qds. He was a retired miner, having worked for 40 years underground. There was also a 20 pack year smoking history although he had stopped for 20 years. He was independent and had a 100 to 200 yard exercise tolerance on the flat. Observations showed respiratory rate of 18, temperature of 36.5 degrees Celsius, BP 133/69, oxygen saturation of 98% on air and a regular pulse of 70 beats per minute. Clinical examination did not reveal any abnormality, with no abdominal or chest wall tenderness.

scholarly journals Pleurisy Can Cause Chest Wall Tenderness: A Case Report

2020 ◽  
Author(s):  
Shaul Yaari ◽  
Elchanan Juravel ◽  
Murad Daana ◽  
Samuel Noam Heyman
Keyword(s):  
Case Report ◽  
Chest Pain ◽  
Chest Wall ◽  
Musculoskeletal Pain ◽  
Pulmonary Thromboembolism ◽  
Lower Lobe ◽  
Spinal Reflex ◽  
Pleuritic Chest Pain ◽  
Pain Evaluation ◽  
Local Tenderness

Stab-like localized chest pain, aggravated by breathing, is compatible with pleuritic pain or with aching related to chest wall abnormalities. Local tenderness inflicted by palpation helps to differentiate pleuritic from musculoskeletal chest pain and serves as a principal accessory manoeuvre in the algorithm of chest pain evaluation. Herein, we report the case of a 27-year-old patient with pulmonary thromboembolism and right lower lobe consolidation/atelectasis. The patient presented with right-sided chest pain, radiating to the shoulder, related to pleural irritation, yet associated with confounding intense chest wall tenderness and guarding, also involving the costovertebral angle. We propose that spinal reflex-related chest wall tenderness was involved, similar to peritoneal signs evoked by irritation of the parietal peritoneum. This case report illustrates that localized chest wall tenderness and guarding, triggered by palpation, may not serve as unequivocal indicators of musculoskeletal pain, and could be unrecognized features of pleuritic chest pain also.

scholarly journals Woman with dyspnea and history of systemic lupus erythematosus

2021 ◽  
Vol 2 (4) ◽  
Author(s):  
Nicolas Kahl ◽  
◽  
Sukhdeep Singh ◽  
Jessica Oswald ◽  
◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Emergency Department ◽  
Chest Pain ◽  
Lupus Erythematosus ◽  
Lower Leg ◽  
Shortness Of Breath ◽  
Pleuritic Chest Pain ◽  
Systemic Lupus ◽  
Blood Clots ◽  
History Of

32-year-old woman with history of pleurisy and systemic lupus erythematosus presented to the emergency department with shortness of breath and pleuritic chest pain, acutely worse over one day after a six hour flight three days prior. She became dyspneic walking from her hotel bed to the bathroom. She endorsed 3 weeks of right lower leg cramping. She denied history of blood clots. She appeared tachypneic and speaking in short phrases upon arrival. A bedside ultrasound was performed, see Figures. Vitals: T: 98.3 F, HR: 130, BP: 142/88, RR: 24, oxygen saturation 97% on room air.

Ranitidine-Induced Chest Pain

DICP ◽  
1989 ◽  
Vol 23 (3) ◽  
pp. 224-226
Author(s):  
Leslie A. Shimp ◽  
Mindy A. Smith ◽  
Dennis W. Wahr
Keyword(s):  
Heart Disease ◽  
Chest Pain ◽  
Case Reports ◽  
Cardiac Effect ◽  
Cardiovascular Tissues ◽  
History Of ◽  
Cardiac Indices

A 45-year-old woman with no history of heart disease twice experienced chest pain after consuming a dose of ranitidine. The chest pain, which lasted about one hour, was substernal, left of midline, dull, and pounding. H2-receptors are present in cardiovascular tissues. Although several studies have not noted an effect of ranitidine on cardiac indices there have been case reports indicating a cardiac effect. There are no reports of chest pain associated with H2-blocker ingestion; however, both bradycardia and hypotension (reported effects) might cause chest pain. A discussion of the possible mechanisms is presented.

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