scholarly journals Management of Pleural Brucellosis: Case Report

2009 ◽  
Vol 2 ◽  
pp. IDRT.S2235 ◽  
Author(s):  
Adel Alothman ◽  
Salih Bin Salih ◽  
Salwa Alothman ◽  
Ghassan Al Johani
Keyword(s):  
Case Report ◽  
Pleural Effusion ◽  
Incidence Rate ◽  
Pleural Fluid ◽  
Middle Eastern ◽  
Developed Countries ◽  
History Of ◽  
Chest X Ray ◽  
Low Incidence ◽  
The Right

Background Brucellosis is a zoonotic disease, with low incidence rate in developed countries, however the incidence rate in Middle Eastern countries remains high. Chest symptoms in brucellosis cases account for about 15% of the cases, but dealing with respiratory system involvement is rare particularly pleural involvement. Case Report We report a case of a 60-year-old Saudi woman who was admitted with two months history of fever, productive cough anorexia and weight loss, contact with sheep. She was ill looking, underweight and febrile while she was on treatment. Examination of the chest showed signs of pleural effusion on the right side with right infrascapular crepitations. Chest X-ray: showed pleural effusion and right LL infiltrates. CT chest: showed right loculated, pleural effusion. Pleural fluid examination showed exudative changes, on culture of pleural fluid, Brucella species grew. AFB in pleural fluid was negative. She was treated with Streptomycin, Doxycyclin and Ciprofloxacin. She improved within one week of treatment and was discharged, after 14 days on antibrucella therapy. Discussion Pulmonary brucellosis is reported in medical literature occasionally but only few reports are available about pleural brucellosis. The challenge with pleural brucellosis and the association of loculated abscesses lies in therapy. Due to lack of previous information with such cases, we suggest that a period of more than six weeks is needed to treat this condition. We recommend that pleural brucellosis needs to be treated with at least two therapeutic agents for nine weeks.

scholarly journals Untreated Active Tuberculosis in Pregnancy with Intraocular Dissemination: A Case Report and Review of the Literature

2015 ◽  
Vol 2015 ◽  
pp. 1-6
Author(s):  
Shadi Rezai ◽  
Stephen LoBue ◽  
Daniel Adams ◽  
Yewande Oladipo ◽  
Ramses Posso ◽  
...  
Keyword(s):  
Case Report ◽  
Developed Countries ◽  
Physiological Changes ◽  
Review Of The Literature ◽  
X Ray ◽  
Delay In Diagnosis ◽  
The Past ◽  
History Of ◽  
Chest X Ray ◽  
Patient Refusal

Background.Tuberculosis (TB) is a disease that affects hundreds of millions of people across the world. However, the incidence in developed countries has decreased over the past decades causing physicians to become unfamiliar with its unspecific symptoms. Pregnant individuals are especially difficult because many symptoms of active TB can mimic normal physiological changes of pregnancy. We present a case report of a 26-year-old multiparous woman, G4P3003, at 38-week gestation with a history of positive PPD who emigrated from Ghana 6 years ago. She came to the hospital with an initial complaint of suprapubic pain, pressure, and possible leakage of amniotic fluid for the past week. Patient also complained of a productive cough for the past 3 to 4 months with a decrease in vision occurring with the start of pregnancy. Visual acuity was worse than 20/200 in both eyes. Definitive diagnosis of active TB was delayed due to patient refusal of chest X-ray. Fortunately, delay in diagnosis was minimized since patient delivered within 24 hours of admission. Active TB was confirmed with intraocular dissemination. Patient had optic atrophy OS (left eye) and papillitis, choroiditis, and uveitis OD (right eye) due to TB infiltration. Fetus was asymptomatic and anti-TB therapy was started for both patients.

scholarly journals URINOTHORAX: AN UNUSUAL CAUSE OF MASSIVE PLEURAL EFFUSION

2019 ◽  
Vol 2 (1) ◽  
pp. 18-19
Author(s):  
Jose Luis Bauza Quetglas ◽  
Maria Isabel Fullana ◽  
Javier Asensio ◽  
Manuel Díaz ◽  
A.M. Pinheiro ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Pleural Effusion ◽  
Pleural Fluid ◽  
Diffuse Abdominal Pain ◽  
Thoracic Drainage ◽  
History Of ◽  
Chest X Ray ◽  
Blood Leukocyte ◽  
Diagnostic Criterion ◽  
Serum Ratio

A 74 year-old male with a history of high blood pressure and hyperuricemia was admitted to the hospital with asthenia, unquantified weight loss, dyspnea on moderate exertion for 2 weeks, and diffuse abdominal pain. Blood leukocyte count was 12400/uL, creatinine 0.98 mg/dL, CRP 19 mg/dL, and LDH 318 U/L. The chest X-ray showed a right pleural effusion and the pleural fluid was suggestive of an exudate. Thorax and abdominal CT scan revealed a polycystic right kidney with grade IV hydronephrosis and suggested the presence of a nephropleural fistula. The thoracocentesis was repeated and the pleural fluid / serum ratio of creatinine obtained was higher than 1 (1.35 mg/dL), which is a diagnostic criterion for urinothorax. Finally, a retrograde pyelography was carried out, and confirmed the passage of urinary tract fluid into the pleural cavity. A thoracic drainage tube and a nephrostomy through the superior calyx were placed, both draining purulent material. One month later, the control CT shows a right atrophic kidney and a reduction of the size of the fistulous path. Urinothorax is an infrequent and underdiagnosed pathology, with few cases reported. It is usually presented as a transudative pleural effusion. Currently, no test is available to confirm the diagnosis, although the ratio of serum creatinine/pleural creatinine could suggest the presence of urinothorax. Radiographic imaging is useful to support the diagnosis. Management of a urinothorax requires a multidisciplinary approach with an emphasis on the correction of the underlying urinary tract pathology, and once corrected, this often leads to a rapid resolution of the pleural effusion.

scholarly journals URINOTHORAX: AN UNUSUAL CAUSE OF MASSIVE PLEURAL EFFUSION

2019 ◽  
Vol 2 (1) ◽  
pp. 18-19
Author(s):  
Jose Luis Bauza Quetglas ◽  
Maria Isabel Fullana ◽  
Javier Asensio ◽  
Manuel Díaz ◽  
A.M. Pinheiro ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Pleural Effusion ◽  
Pleural Fluid ◽  
Diffuse Abdominal Pain ◽  
Thoracic Drainage ◽  
History Of ◽  
Chest X Ray ◽  
Blood Leukocyte ◽  
Diagnostic Criterion ◽  
Serum Ratio

A 74 year-old male with a history of high blood pressure and hyperuricemia was admitted to the hospital with asthenia, unquantified weight loss, dyspnea on moderate exertion for 2 weeks, and diffuse abdominal pain. Blood leukocyte count was 12400/uL, creatinine 0.98 mg/dL, CRP 19 mg/dL, and LDH 318 U/L. The chest X-ray showed a right pleural effusion and the pleural fluid was suggestive of an exudate. Thorax and abdominal CT scan revealed a polycystic right kidney with grade IV hydronephrosis and suggested the presence of a nephropleural fistula. The thoracocentesis was repeated and the pleural fluid / serum ratio of creatinine obtained was higher than 1 (1.35 mg/dL), which is a diagnostic criterion for urinothorax. Finally, a retrograde pyelography was carried out, and confirmed the passage of urinary tract fluid into the pleural cavity. A thoracic drainage tube and a nephrostomy through the superior calyx were placed, both draining purulent material. One month later, the control CT shows a right atrophic kidney and a reduction of the size of the fistulous path. Urinothorax is an infrequent and underdiagnosed pathology, with few cases reported. It is usually presented as a transudative pleural effusion. Currently, no test is available to confirm the diagnosis, although the ratio of serum creatinine/pleural creatinine could suggest the presence of urinothorax. Radiographic imaging is useful to support the diagnosis. Management of a urinothorax requires a multidisciplinary approach with an emphasis on the correction of the underlying urinary tract pathology, and once corrected, this often leads to a rapid resolution of the pleural effusion.

scholarly journals Explosive Pleuritis

2001 ◽  
Vol 12 (2) ◽  
pp. 104-107 ◽  
Author(s):  
Jasdeep K Sharma ◽  
Thomas J Marrie
Keyword(s):  
Computed Tomography ◽  
Pleural Effusion ◽  
Respiratory Distress ◽  
Pleural Fluid ◽  
Case Definition ◽  
Pulmonary Tissue ◽  
X Ray ◽  
Mediastinal Shift ◽  
Chest X Ray ◽  
The Right

The objective of the present paper is to describe the clinical and computed tomography features of 'explosive pleuritis', an entity first named by Braman and Donat in 1986, and to propose a case definition. A case report of a previously healthy, 45-year-old man admitted to hospital with acute onset pleuritic chest pain is presented. The patient arrived at the emergency room at 15:00 in mild respiratory distress; the initial chest x-ray revealed a small right lower lobe effusion. The subsequent clinical course in hospital was dramatic. Within 18 h of admission, he developed severe respiratory distress with oxygen desaturation to 83% on room air and dullness of the right lung field. A repeat chest x-ray, taken the morning after admission, revealed complete opacification of the right hemithorax. A computed tomography scan of the thorax demonstrated a massive pleural effusion with compression of pulmonary tissue and mediastinal shift. Pleural fluid biochemical analysis revealed the following concentrations: glucose 3.5 mmol/L, lactate dehydrogenase 1550 U/L, protein 56.98 g/L, amylase 68 U/L and white blood cell count 600 cells/mL. The pleural fluid cultures demonstrated light growth of coagulase-negative staphylococcus and viridans streptococcus, and very light growth ofCandida albicans. Cytology was negative for malignant cells. Thoracotomy was performed, which demonstrated a loculated parapneumonic effusion that required decortication. The patient responded favourably to the empirical administration of intravenous levofloxacin and ceftriaxone, and conservative surgical methods in the management of the empyema. This report also discusses the patient's rapidly progressing pleural effusion and offers a potential case definition for explosive pleuritis. Explosive pleuritis is a medical emergency defined by the rapid development of a pleural effusion involving more than 90% of the hemithorax over 24 h, which causes compression of pulmonary tissue and mediastinal shift to the contralateral side.

scholarly journals Metastasis of colorectal carcinoma in the testis: first sign of peritoneal disease

2019 ◽  
Vol 2019 (10) ◽  
Author(s):  
Johannes A Smit ◽  
Jara M Baas ◽  
Paul M Verheijen
Keyword(s):  
Case Report ◽  
Colorectal Carcinoma ◽  
Incidence Rate ◽  
Peritoneal Metastasis ◽  
Poor Prognosis ◽  
Advanced Stage ◽  
Peritoneal Disease ◽  
Testicular Metastasis ◽  
Low Incidence ◽  
The Right

Abstract Metastases of colorectal carcinoma (CRC) in the testis are very rare and indicate an advanced stage of disease. In this case report, we present a patient with adenocarcinoma in the sigmoid colon with metastasis in the right testis. Testicular metastasis of CRC is mostly diagnosed late because of their low incidence rate. Patients with CRC and testicular metastasis have a poor prognosis. In this case, the patient turned out to have peritoneal metastasis and one should be aware that testicular metastasis could be the first sign of widespread disease.

scholarly journals Thoracoscopic Diagnosis of Follicular Lymphoma Relapsing after 13 Years

2019 ◽  
Vol 05 (01) ◽  
pp. e5-e7
Author(s):  
Serda Kanbur ◽  
Onur Derdiyok ◽  
Hakan Kiral ◽  
Hakan Yilmaz ◽  
Mine Demir ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Follicular Lymphoma ◽  
Thoracoscopic Surgery ◽  
Primary Treatment ◽  
Lymph Node Biopsy ◽  
Pleural Thickening ◽  
Lymphoma Treatment ◽  
History Of ◽  
Chest X Ray ◽  
The Right

AbstractRelapse in lymphoproliferative malignancies is not an exceptional entity and generally occurs within the first 2 or 3 years following the primary treatment. Lymph node biopsy is essential for the diagnosis of relapse and treatment. A 64-years-old woman was referred to our clinic for back pain and dyspnea. Chest X-ray and computed tomography (CT) showed pleural thickening in the right hemithorax and pleural effusion. Hereby, we report a patient with a history of follicular lymphoma treatment 13 years ago, presenting with unilateral pleural effusion and being diagnosed, unpredictably, with relapsing lymphoma by video-assisted thoracoscopic surgery pleural biopsy.

Mesalamine-induced eosinophilic pleural effusion

2020 ◽  
Vol 13 (4) ◽  
pp. e233886 ◽  
Author(s):  
Abdullah Al-abcha ◽  
Fazal Raziq ◽  
Shouq Kherallah ◽  
Ahmad Alratroot
Keyword(s):  
Pleural Effusion ◽  
Pleural Fluid ◽  
Symptomatic Improvement ◽  
X Ray ◽  
Fluid Analysis ◽  
Ct Angiogram ◽  
History Of ◽  
Chest X Ray ◽  
Eosinophilic Pleural Effusion

A 45-year-old woman with a medical history of ulcerative colitis (UC) presented with difficulty in breathing. The patient was diagnosed with UC a month prior to presentation and was started on mesalamine suppository. Chest x-ray (CXR) on presentation showed bilateral pleural effusion, which was confirmed on CT angiogram of the chest. Diagnostic and therapeutic thoracentesis was performed and 0.7 L of pleural fluid was removed from the left side. The pleural fluid analysis was consistent with exudative pleural effusion with eosinophilia. Symptomatic improvement was noted after thoracentesis. Mesalamine was stopped and repeat CXR was obtained on the follow-up visit, which showed no pleural effusion. The Naranjo score was calculated to be 7, indicating that the eosinophilic pleural effusion was most probably secondary to adverse reaction from mesalamine.

Popliteal artery thrombosis secondary to a tibial osteochondroma

VASA ◽  
2011 ◽  
Vol 40 (3) ◽  
pp. 251-255 ◽  
Author(s):  
Gruber-Szydlo ◽  
Poreba ◽  
Belowska-Bien ◽  
Derkacz ◽  
Badowski ◽  
...  
Keyword(s):  
Case Report ◽  
Magnetic Resonance Angiography ◽  
Popliteal Artery ◽  
Doppler Ultrasonography ◽  
Histopathological Examination ◽  
Previous History ◽  
Plain Radiography ◽  
Artery Thrombosis ◽  
History Of ◽  
The Right

Popliteal artery thrombosis may present as a complication of an osteochondroma located in the vicinity of the knee joint. This is a case report of a 26-year-old man with symptoms of the right lower extremity ischaemia without a previous history of vascular disease or trauma. Plain radiography, magnetic resonance angiography and Doppler ultrasonography documented the presence of an osteochondrous structure of the proximal tibial metaphysis, which displaced and compressed the popliteal artery, causing its occlusion due to intraluminal thrombosis..The patient was operated and histopathological examination confirmed the diagnosis of osteochondroma.

scholarly journals P046 Pointing the finger: an unusual presentation of dactylitis

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Natalia Cernovschi - Feasey ◽  
Julekha Wajed
Keyword(s):  
Pleural Effusion ◽  
Soft Tissue ◽  
Middle Finger ◽  
Joint Involvement ◽  
Long Bones ◽  
History Of ◽  
Systemic Symptoms ◽  
The Right ◽  
Hands And Feet ◽  
Radiographic Changes

Abstract Background/Aims  Dactylitis is commonly associated with psoriatic arthritis, and regularly presents at Rheumatology clinics. We discuss a case where progressive systemic symptoms lead to the consideration of alternate diagnoses. Methods  A 46-year-old Nepalese woman presented to the Rheumatology department with a 3 month history of diffuse swelling of the right middle finger proximal interphalangeal joint, with the appearance of dactylitis. There was pain on movement, but no other joint involvement. Simultaneously she noticed blurred and decreased vision, which on review by the ophthalmologists, was diagnosed with bilateral uveitis. There was no history of psoriasis, inflammatory bowel disease, or other past medical history of note. There was no travel history in the past 12 months. A diagnosis of a presumed inflammatory arthritis was made. Results  Blood tests showed elevated c-reactive protein 55 (normal <4 mg/l), erythrocyte sedimentation rate 138 (normal 0-22 mm/hr) and an iron deficiency anaemia. Rheumatoid factor and Anti-CCP antibody were negative. Hand radiographs were reported as normal. MRI of the third digit confirmed an enhancing soft tissue collection at the proximal phalanx of the right middle finger. She was referred for a biopsy of this lesion. Interestingly over the subsequent few months, she developed progressive breathlessness. Chest radiograph showed a left pleural effusion. Further tests showed negative serum ACE, Lyme and Toxoplasma screen. Quantiferon test was negative. Pleural aspirate showed a transudate with negative Acid-fast bacillus (AFB) test and culture. CT chest and abdomen showed a persistent pleural effusion, inflammatory changes in the small bowel and thickening of the peritoneum and omentum. In view of the systemic involvement, a peritoneal tissue biopsy was performed. This confirmed chronic granulomatous inflammation with positive AFB stain for mycobacterium tuberculosis. Our patient was started on quadruple anti- TB antibiotics for 6 months. Her systemic symptoms and dactylitis have improved, although there is on-going treatment for her ocular involvement. Conclusion  Approximately 10% of all cases of extrapulmonary TB have osteoarticular involvement. Dactylitis is a variant of tuberculous osteomyelitis affecting the long bones of the hands and feet. It occurs mainly in young children; however adults may be affected also. The first manifestation is usually painless swelling of the diaphysis of the affected bone followed by trophic changes in the skin. The radiographic changes are known as spina ventosa, because of the ballooned out appearance of the bone, although this was not seen in our case. Fibrous dysplasia, congenital syphilis, sarcoidosis and sickle cell anaemia may induce similar radiographic changes in the metaphysis of long bones of hands and feet, but do not cause soft tissue swelling or periosteal reaction. This case highlights the importance of testing for TB, especially in atypical cases of dactylitis, with other systemic features. Disclosure  N. Cernovschi - Feasey: None. J. Wajed: None.

scholarly journals Actinomyces meyeriEmpyema: A Case Report and Review of the Literature

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Hae Won Jung ◽  
Chong Rae Cho ◽  
Ji Yoon Ryoo ◽  
Hyun Kyo Lee ◽  
So Young Ha ◽  
...  
Keyword(s):  
Pleural Fluid ◽  
Response To Treatment ◽  
Penicillin G ◽  
Review Of The Literature ◽  
Short Term ◽  
Oral Amoxicillin ◽  
History Of ◽  
Multiple Lung Nodules ◽  
The Right ◽  
Radiological Studies

Actinomyces meyeriis an uncommon cause of human actinomycosis. Here, we report a rare case of empyema caused byA. meyeri. A 49-year-old male presented with a history of 10 days of dyspnea and chest pain. A large amount of loculated pleural effusion was present on the right side and multiple lung nodules were documented on radiological studies. A chest tube was inserted and purulent pleural fluid was drained.A. meyeriwas isolated in anaerobic cultures of the pleural fluid. The infection was alleviated in response to treatment with intravenous penicillin G (20 million IU daily) and oral amoxicillin (500 mg every 8 hours) for 4 months, demonstrating that short-term antibiotic treatment was effective.

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