Accuracy of the physical examination in evaluating pleural effusion

2008 ◽  
Vol 75 (4) ◽  
pp. 297-303 ◽  
Author(s):  
D. ROLSTON ◽  
E. DIAZ-GUZMAN ◽  
M. M. BUDEV
Keyword(s):  
Pleural Effusion ◽  
Physical Examination

scholarly journals Diagnostic challenge and surgical management of Boerhaave’s syndrome: three diagnosed cases of spontaneous esophageal rupture

2020 ◽  
Author(s):  
Jiayue Wang ◽  
Degang Wang ◽  
Jianjiao Chen
Keyword(s):  
Pleural Effusion ◽  
Early Diagnosis ◽  
Physical Examination ◽  
Ct Scan ◽  
Medical History ◽  
Subcutaneous Emphysema ◽  
Esophageal Perforation ◽  
Esophageal Rupture ◽  
Boerhaave’S Syndrome ◽  
Boerhaave's Syndrome

Abstract BACKGROUND: Boerhaave’s syndrome is the spontaneous rupture of the esophagus, caused by an increase of intraluminal pressure that is produced in the context of negative intrathoracic pressure. It has a high index of morbimortality, which is why it requires early diagnosis and treatment. Symptoms may vary, and diagnosis can be challenging.CASE PRESENTATION: Case one: A 54-year-old man presented to us with sudden-onset epigastric pain radiating to the back following hematemes. His previous medical history included gastric ulcer. His physical signs suggested early shock. Combined with his medical history and physical signs, emergency doctor suspected a diagnosis of peptic ulcer with hematemesis, and esophagegastroscopy was performed. However, upper gastrointestinal endoscopy revealed a full-thickness rupture of the esophageal wall. The subsequent computed tomography (CT) showed frank pneumomediastinum and heterogeneous pleural effusion. He was subsequently referred to us in view of suspected Boerhaave’s syndrome and clinical worsening. In view of hemodynamic instability with uncontrolled sepsis, he was planned for surgery. Esophageal perforation repair operation and jejunostomy was performed for him. The postoperative period was uneventful, and he was discharged.Case two: A 62-year-old man was admitted to the emergency department with thoracic dull pain and chest distress that started after he had been vomiting several hours before presentation. On physical examination, he presented rough bronchovesicular breathing sound, and crepitant rales in lungs prompting subcutaneous emphysema. Chest CT scan showed pneumomediastinum and large left-sided pleural effusion. Esophagus fistula was confirmed by contrast esophagography. Therefore, spontaneous esophageal perforation was suspected. Then, we performed thoracotomy to repair the esophageal tear as well as to debride and irrigate the left pleural space. His vital signs remained stable intraoperatively, and his postoperative periods were uneventful with no leakage or stricture. Case three: The patient was a 69-year old male presenting with a severe retrosternal and upper abdominal pain followed an episode of forceful vomiting. At admission, he was diaphoretic and in respiratory distress. Physical examination revealed extensive cervical and thoracic subcutaneous emphysema but was otherwise unremarkable. A thoracic CT scan revealed a rupture in the left distal part of the oesophagus, a pneumomediastinum and left-sided pleural effusions. Conservative treatment, with cessation of oral intake, nasogastric suction, administration of intravenous fluids and parenteral nutrition, intravenous broad-spectrum anti-biotics, proton pump inhibitors and drainage of the pleural effusion by left-sided thoracostomy, failed to improve disease conditions. Open thoracic surgery was performed with debridement and drainage of the mediastinum and the pleural cavity, after which he made a slow but full recovery.CONCLUSIONS: We highlight that early diagnosis and appropriate surgical treatment are essential for optimum outcome in patients with esophageal rupture. We emphasize the importance of critical care support, particularly in the early stages of management.

scholarly journals ADULT BOCHDALEK HERNIA: AN UNUSUAL PRESENTATION AND DIAGNOSTIC DILEMMA.

2015 ◽  
Vol 1 (2) ◽  
pp. 111
Author(s):  
Nikhil S Shetty ◽  
Vijay P Agrawal ◽  
Ashwin Narasimhaprasad
Keyword(s):  
Pleural Effusion ◽  
Physical Examination ◽  
Rare Condition ◽  
Chest Ct ◽  
Delayed Presentation ◽  
Bochdalek Hernia ◽  
Diagnostic Dilemma ◽  
X Ray ◽  
Chest X Ray ◽  
Chest Ct Scan

Bochdalek hernia is a rare condition in adult and usually diagnosis is missed. It is usually mistakenly diagnosed as TB, pleural effusion, empyema, lung cyst and pneumothorax. Delayed presentation is not uncommon. We present a case of 18 year old male patient who was misdiagnosed as having left sided pleural effusion with TB and associated gastritis for three days and later referred to our institution. Diagnosis was established by physical examination, chest x-ray and chest CT- scan. Per operatively a gangrenous ileal segment was seen of about 10 cms which was later resected. The Hernia was later closed with Prolene sutures.

Infectious Endocarditis and Chylothorax in a Cat

2011 ◽  
Vol 47 (6) ◽  
pp. e121-e126 ◽  
Author(s):  
Amy Dixon-Jimenez ◽  
Marco L. Margiocco
Keyword(s):  
Heart Failure ◽  
Weight Loss ◽  
Pleural Effusion ◽  
Aortic Valve ◽  
Physical Examination ◽  
Cardiac Disease ◽  
Aortic Insufficiency ◽  
Bacterial Endocarditis ◽  
Oral Antibiotics ◽  
Progressive Weight Loss

A 6 yr old domestic longhair cat was evaluated for progressive weight loss, weakness, and dyspnea. Results of a physical examination and electrocardiogram were suggestive of cardiac disease. Thoracic radiographs revealed pleural effusion, which thoracocentesis revealed was consistent with chyle. An echocardiogram was performed, and aortic valve endocarditis with secondary aortic insufficiency was presumptively diagnosed. The cat was treated with broad-spectrum oral antibiotics and palliative cardiac medications. Two days after discharge, the cat's dyspnea returned, and it died suddenly. Histopathology and culture confirmed Pseudomonas bacterial endocarditis of the aortic valve. Bacterial endocarditis in the cat has rarely been reported in the literature. This case described heart failure and chylothorax resulting from bacterial endocarditis.

scholarly journals Massive pleural effusion in a young woman

2012 ◽  
Vol 6 (4) ◽  
pp. 141-147
Author(s):  
Paolo Ghiringhelli ◽  
Roberto Cattaneo ◽  
Angelo Tiso ◽  
Claudia Cesaro
Keyword(s):  
Pleural Effusion ◽  
Physical Examination ◽  
Imaging Techniques ◽  
Laboratory Data ◽  
Clinical History ◽  
Complete Healing ◽  
Progressive Dyspnoea ◽  
Endoscopic Retrograde ◽  
Massive Pleural Effusion ◽  
History Of

Pleural effusion is a clinical manifestation shared by several underlying pathologies. The differential diagnosis is based on the clinical history, the physical examination, the analysis of the pleural fluid, and the laboratory data (mainly blood tests). There are cases, such as the patient described, where TC is not enough, and unusual imaging techniques are required for the study of pleural effusion, i.e. magnetic resonance cholangiography, cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP).This case analyses a 42-year-old female patient who arrived with progressive dyspnoea, chest pain, cough, a history of alcohol abuse, and a recent episode of acute pancreatitis. The physical examination revealed signs of right-sided pleural effusion. These features, together with laboratory data, made it possible to pose the diagnosis of pancreaticopleural fistula, to treat it, and to obtain a complete healing in a two-month period.

scholarly journals Comparing accuracy of bedside ultrasound examination with physical examination for detection of pleural effusion

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Michael H. Walsh ◽  
Kang X. Zhang ◽  
Emily J. Cox ◽  
Justin M. Chen ◽  
Nicholas G. Cowley ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Confidence Interval ◽  
Physical Examination ◽  
Ultrasound Examination ◽  
Bedside Ultrasound ◽  
Chest Imaging ◽  
Reference Standard ◽  
Convenience Sample ◽  
Imaging Results ◽  
Medical Inpatients

Abstract Background In detecting pleural effusion, bedside ultrasound (US) has been shown to be more accurate than auscultation. However, US has not been previously compared to the comprehensive physical examination. This study seeks to compare the accuracy of physical examination with bedside US in detecting pleural effusion. Methods This study included a convenience sample of 34 medical inpatients from Calgary, Canada and Spokane, USA, with chest imaging performed within 24 h of recruitment. Imaging results served as the reference standard for pleural effusion. All patients underwent a comprehensive lung physical examination and a bedside US examination by two researchers blinded to the imaging results. Results Physical examination was less accurate than US (sensitivity of 44.0% [95% confidence interval (CI) 30.0–58.8%], specificity 88.9% (95% CI 65.3–98.6%), positive likelihood (LR) 3.96 (95% CI 1.03–15.18), negative LR 0.63 (95% CI 0.47–0.85) for physical examination; sensitivity 98% (95% CI 89.4–100%), specificity 94.4% (95% CI 72.7–99.9%), positive LR 17.6 (95% CI 2.6–118.6), negative LR 0.02 (95% CI 0.00–0.15) for US). The percentage of examinations rated with a confidence level of 4 or higher (out of 5) was higher for US (85% of the seated US examination and 94% of the supine US examination, compared to 35% of the PE, P < 0.001), and took less time to perform (P < 0.0001). Conclusions US examination for pleural effusion was more accurate than the physical examination, conferred higher confidence, and required less time to complete.

Predictors of inflammatory lower airway disease in cats presented to the emergency room in respiratory distress: a case-control study

2021 ◽  
pp. 1098612X2199614
Author(s):  
Nolan V Chalifoux ◽  
Kenneth J Drobatz ◽  
Erica L Reineke
Keyword(s):  
Pleural Effusion ◽  
Physical Examination ◽  
Respiratory Distress ◽  
Respiratory Rate ◽  
Venous Blood ◽  
Multivariable Analysis ◽  
Airway Disease ◽  
Final Diagnosis ◽  
Lower Airway ◽  
History Of

Objectives The objective of the study was to identify whether venous blood gas (VBG) variables may serve as a predictor of inflammatory lower airway disease (ILAD) in cats presenting with respiratory distress. A secondary objective of this study was to compare the diagnostic utility of patient signalment, history and physical examination findings, as compared with VBG variables. Methods The medical records of cats presenting with respiratory distress secondary to ILAD (54 cases) and non-ILAD (121 controls) were retrospectively reviewed. Results No admission VBG variables were predictive of a final diagnosis of ILAD. Comparatively, multivariable analysis identified a history of a cough ( P <0.001), increased respiratory rate ( P = 0.001), the presence of an abdominal component to respiration ( P = 0.007) and the absence of pleural effusion ( P <0.01) to be independently associated with a final diagnosis of ILAD. Cats with a history of a cough and an abdominal component to respiration had 7.86 and 5.81 greater odds of being diagnosed with ILAD, respectively. Cats with pleural effusion had 7.43 lower odds of having this final diagnosis. For every 10 breaths/min increase in respiratory rate, cats had 1.48 greater odds of being diagnosed with ILAD. Cats diagnosed with ILAD had a survival rate of 94% (95% CI 84–99%) vs 61% (95% CI 51–70%) for non-ILAD controls ( P <0.001). Conclusions and relevance The results of this study found patient history and physical examination findings to be more useful predictors of a final diagnosis of ILAD in comparison with VBG variables at presentation. A history of a cough, an abdominal component to respiration and a lack of pleural effusion were found to be significant predictors of this diagnosis. Further investigation into the role of respiratory rate in ILAD is warranted.

scholarly journals Egophony: is this classic semeiological sign still helpful?

2013 ◽  
pp. 80-81
Author(s):  
Domenico Viviani ◽  
Giovanni Gasbarrini
Keyword(s):  
Pleural Effusion ◽  
Physical Examination ◽  
Clinical Sign ◽  
Pathological Conditions ◽  
Chest Auscultation

BACKGROUND Egophony, also known as “E to A change”, is a classical, clinical sign detected by chest auscultation, consisting into a change in timbre, but not pitch or volume, produced by solid interposed between the resonator and the stethoscope head. Egophony was first described in 1916 by R.T.H. Laënnec, but today it is almost unknown. Yet it is a powerful tool to detect pleural effusion as well as other pathological conditions associated with lung compression or consolidation, such as hemothorax or atelectasis of the lung. AIM OF THE STUDY The aim of this paper is to remember the value of this frequently neglected clinical sign and to stress the importance of physical examination, that should always precede – and could often replace – instrumental tests, which are quite expensive and sometimes unnecessary.

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