-
BMJ Case Reports Dec 2023Congenital pulmonary airway malformation (CPAM) is the most common among a rare group of congenital anomalies of the lower respiratory tract. It has variable...
Congenital pulmonary airway malformation (CPAM) is the most common among a rare group of congenital anomalies of the lower respiratory tract. It has variable presentation depending on its subtype and the patient's age. It may lead to respiratory distress in neonates. It can be a particularly challenging diagnosis in children born asymptomatic but present with complications later in life such as haemoptysis, recurrent chest infections, breathlessness and pneumothorax. Prenatal ultrasound, chest X-ray, CT scan and MRI are helpful in making a radiological diagnosis.A woman in her late teens presented with shortness of breath and right pleuritic chest pain. CT's chest showed a number of bullae of varying sizes on the right, including one huge bulla compressing all three lobes. She underwent lung volume reduction surgery via video-assisted thoracoscopy, and the histology specimen confirmed the diagnosis of CPAM type 1.
Topics: Infant, Newborn; Child; Pregnancy; Female; Adolescent; Humans; Pneumothorax; Cystic Adenomatoid Malformation of Lung, Congenital; Tomography, X-Ray Computed; Radiography; Pneumonectomy; Dyspnea
PubMed: 38050398
DOI: 10.1136/bcr-2022-254294 -
JACC. Clinical Electrophysiology Feb 2024Catheter ablation is a mainstay of atrial fibrillation (AF) treatment. Acute pericarditis after ablation is 1 of the frequently observed complications. There is a...
BACKGROUND
Catheter ablation is a mainstay of atrial fibrillation (AF) treatment. Acute pericarditis after ablation is 1 of the frequently observed complications. There is a significant lack of data on the incidence and predictors of postablation pericarditis.
OBJECTIVES
This study examines the incidence, characteristics, and predictors of pericarditis after AF ablation.
METHODS
Patients undergoing AF ablation from January 1, 2016, to March 31, 2022, at Johns Hopkins were prospectively enrolled in an AF ablation registry. A clinical diagnosis of acute pericarditis was established in accordance with 2015 European Society of Cardiology guidelines by the presence of at least 2 of the following characteristics: pleuritic chest pain, friction rub, typical electrocardiographic changes, or pericardial effusion within 3 months after the ablation procedure.
RESULTS
Of 1,540 patients who underwent AF ablation, 57 patients (3.7%) developed acute pericarditis. Baseline clinical characteristics including age, sex, and body mass index were comparable between the pericarditis and nonpericarditis groups. The median time to symptom onset was 1 day. Electrocardiographic changes were observed in 34 (59.6%) patients, pericardial effusion developed in 7 (12%) patients, and the mean duration of medical treatment was 7 days (25th-75th percentile: 3-14 days). Most pericarditis cases were treated medically with disease-specific nonsteroidal anti-inflammatory drugs (100%) and colchicine (81%). Effusion with tamponade necessitating pericardiocentesis was observed in 4 (7%) patients. Radiofrequency (RF) ablation was performed in 869 (58.6%) patients in the nonpericarditis group and 39 (68.4%) patients with pericarditis; cryoballoon ablation was performed in 486 (32.8%) patients in the nonpericarditis group and 11 (19.3%) patients with pericarditis. Multivariable logistic regression analysis identified RF ablation (OR: 2.09; 95% CI: 1.07-4.08; P = 0.03) as an independent predictor of acute pericarditis after AF ablation, whereas age per unit increase was associated with a decreased risk (OR: 0.97; 95% CI: 0.95-0.995; P = 0.02).
CONCLUSIONS
The incidence of acute pericarditis after catheter ablation in our study population was 3.7%. RF ablation and younger age were independent risk factors for postablation acute pericarditis.
Topics: Humans; Atrial Fibrillation; Pericardial Effusion; Treatment Outcome; Cryosurgery; Catheter Ablation; Pericarditis
PubMed: 38032577
DOI: 10.1016/j.jacep.2023.09.026 -
American Journal of Industrial Medicine Jan 2024Pleural thickening (PT) is a major consequence of exposure to all fiber types of asbestos. In recent decades, it is more prevalent than parenchymal asbestosis. Its...
Pleural thickening (PT) is a major consequence of exposure to all fiber types of asbestos. In recent decades, it is more prevalent than parenchymal asbestosis. Its manifestations occupy a full clinical and radiographic spectrum. Six major manifestations can be identified: (a) acute pleuritis generally with effusion; (b) diffuse PT or fibrous pleuritis; (c) rounded atelectasis; (d) circumscribed PT or plaques; (e) chronic pleuritic pain; and (f) mesothelioma. Review of the experience of workers and community members in Libby, MT to asbestiform fibers in vermiculite has confirmed the appearance of these previously known benign and malignant asbestos-related diseases as well as a unique pleuropulmonary disease characterized as lamellar PT and associated with progressive decline in pulmonary function and pleuritic pain. Despite previous literature asserting that PT represents a marker for asbestos exposure without significant effect on pulmonary function and physiology, the experience of Libby amphibole (LA) disease, along with other studies, indicates that PT plays a role in declining vital capacity in those with prolonged or unusual exposures such as those arising from LA.
Topics: Humans; Asbestos; Asbestos, Amphibole; Asbestosis; Fibrosis; Pain; Pleura; Pleural Diseases; Pleurisy
PubMed: 38030592
DOI: 10.1002/ajim.23553 -
European Heart Journal. Case Reports Nov 2023COVID-19 infection and the COVID-19 vaccines have been associated with rare cases of pericarditis. We present a case of constrictive pericarditis (CP) following the...
BACKGROUND
COVID-19 infection and the COVID-19 vaccines have been associated with rare cases of pericarditis. We present a case of constrictive pericarditis (CP) following the vaccine.
CASE SUMMARY
A 19-year-old healthy male started having progressive abdominal pain, emesis, dyspnoea, and pleuritic chest pain 2 weeks after the second dose of Pfizer vaccine. Computed tomography angiography chest revealed bilateral pleural effusions and pericardial thickening with effusion. Cardiac catheterization showed ventricular interdependence. Cardiac magnetic resonance (CMR) showed septal bounce and left ventricular tethering suggestive of CP. A total pericardiectomy was performed with significant symptom improvement. Pathology showed chronic fibrosis without amyloid, iron deposits, or opportunistic infections. Patient had Epstein-Barr Virus (EBV) viraemia 825 IU/mL and histoplasmosis complement-fixation positive with negative serum and urine antigen. Hypercoagulable panel and infectious workup were otherwise negative. The patient had resolution of cardiac symptoms at 3 months of follow-up.
DISCUSSION
The patient developed progressive symptoms within 2 weeks of his second Pfizer vaccine. Echocardiogram and CMR had classic signs of CP, and pericardial pathology confirmed fibrotic pericardium. The patient had no prior surgery, thoracic radiation, or bacterial infection. Epstein-Barr Virus viraemia was thought to be reactionary, and histoplasmosis complement likely represented chronic exposure. The timing of symptoms and negative multidisciplinary workup raises the suspicion for COVID vaccine-induced CP. The COVID vaccines benefits far exceed the risks, but complications still can occur. Practitioners should have a high index of suspicion to allow prompt diagnosis of CP.
PubMed: 38025132
DOI: 10.1093/ehjcr/ytad540 -
Lupus Jan 2024Lymphoid interstitial pneumonia (LIP) is a rare form of interstitial pulmonary disease, which has been described in association with a wide range of autoimmune... (Review)
Review
Lymphoid interstitial pneumonia (LIP) is a rare form of interstitial pulmonary disease, which has been described in association with a wide range of autoimmune disorders. Although the association of this entity with Sjogren's syndrome is well known, only a few cases are reported in relation to systemic lupus erythematosus (SLE). The aim of this paper is to review the cases reported in literature to date, as well as to describe the characteristics of these patients including the new case presented herein. We will be focusing on the case of a 36-year-old female patient diagnosed with SLE on hydroxychloroquine treatment who develops pleuritic chest pain and progressive dyspnea after 3 years of follow-up. The chest CT scan showed pleural thickening and both multiple and bilateral micronodules. A lung biopsy was also performed, revealing an infiltration of lymphocytes, plasma cells, and histiocytes in the alveolar septa suggestive of LIP. After conducting a review of the literature, we identified seven other cases describing SLE in association with LIP. The majority of them were young women, and LIP tends to appear early in the course of the disease, even as a form of initial presentation in some cases. Symptoms included cough, dyspnea, and pleuritic pain, with the exception of one case which was asymptomatic. It is noteworthy that half of the patients were positive for anti-SSA/anti-SSB autoantibodies, and some of them also met criteria for Sjogren's syndrome. Treatment with steroids and other immunosuppressive agents improved symptoms in all of them.
Topics: Humans; Female; Adult; Lupus Erythematosus, Systemic; Sjogren's Syndrome; Lung Diseases, Interstitial; Pleurisy; Dyspnea
PubMed: 38018810
DOI: 10.1177/09612033231218957 -
Indian Journal of Otolaryngology and... Dec 2023Cough is a whole-sole dynamic housekeeper of the airways. Although a run-of-the-mill symptom, chronic cough frequently forces the patient to seek medical help. It can...
Cough is a whole-sole dynamic housekeeper of the airways. Although a run-of-the-mill symptom, chronic cough frequently forces the patient to seek medical help. It can persist for years end on, and not only makes the patient anxious about underlying illness, but may cause vomiting, exhaustion, impaired sleep, urinary incontinence, and social embarrassment. The propulsive effort made by the patient to clear the noxious stimuli irritating the airways can at times disrupt the integrity of the chest wall and result in rib fractures. We present a case who was detected to have cough fracture during the evaluation of symptoms of chronic cough with pleuritic chest pain. He was evaluated for the aetiology of chronic cough and was diagnosed to have laryngopharyngeal reflux which even though a common aetiology for chronic cough is a very uncommon cause of cough rib fracture. The importance of small innocuous diseases causing severe debility, even in patients with no comorbid illness or contributing risk factors is emphasized by this case report.
PubMed: 37974834
DOI: 10.1007/s12070-023-03985-x -
BMJ Case Reports Nov 2023A woman in her late 40s presented with complaints of shortness of breath, right-sided pleuritic chest pain and diffuse myalgias. She was diagnosed with deep vein...
A woman in her late 40s presented with complaints of shortness of breath, right-sided pleuritic chest pain and diffuse myalgias. She was diagnosed with deep vein thrombosis (DVT) 3 weeks earlier and had been compliant with her oral anticoagulation therapy. Investigations revealed a pulmonary embolism (PE) involving the right distal pulmonary artery on a CT angiogram of the chest. She was also found to have an incidental SARS-CoV-2 (COVID-19) infection and an elevated creatine kinase value. Anticoagulation with intravenous heparin was initiated according to the DVT/PE protocol. The following morning, a medium-sized mobile mass was identified in her right atrium on performing a transthoracic echocardiogram. Due to concerns of embolisation of the mass which could result in obstruction, right ventricular strain and ultimately haemodynamic instability, a thrombectomy was performed using the FlowTriever device under transthoracic echocardiography guidance. The right atrial mass was successfully removed and the patient was transitioned to another oral anticoagulant agent. On discharge, a muscle biopsy was performed and aided in the diagnosis of dermatomyositis and the patient received intravenous Ig, steroids and methotrexate.
Topics: Female; Humans; Atrial Fibrillation; COVID-19; Dermatomyositis; Pulmonary Embolism; SARS-CoV-2; Thrombectomy; Thrombosis; Middle Aged
PubMed: 37945279
DOI: 10.1136/bcr-2023-255385 -
Cureus Oct 2023Pericarditis is the inflammation of the pericardial layers. Myopericarditis is diagnosed when this inflammation involves the myocardium, which is marked by elevated...
Pericarditis is the inflammation of the pericardial layers. Myopericarditis is diagnosed when this inflammation involves the myocardium, which is marked by elevated serum cardiac enzymes. With these two pathologies sharing overlaps in etiology, we present a case of a young patient with a recent history of COVID-19 infection who presented with pleuritic and positional chest pain with troponin I elevation and serial ECG changes attributed to myopericarditis as a post-viral sequela of severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) infection. This case demonstrates the importance of identifying and managing the potential cardiac complications in coronavirus disease 2019 (COVID-19) patients, regardless of age or symptom onset.
PubMed: 37942379
DOI: 10.7759/cureus.46655 -
Advanced Emergency Nursing JournalRe-expansion pulmonary edema (RPE) after chest drain insertion is rare. The objective of this clinical case report is to highlight the importance of this chest drain...
Re-expansion pulmonary edema (RPE) after chest drain insertion is rare. The objective of this clinical case report is to highlight the importance of this chest drain insertion complication. A 35-year-old man presented to the emergency department with a chief complaint of shortness of breath and pleuritic chest pain. Further physical examination and radiographic investigations showed a left-sided hemipneumothorax. A chest drain was inserted, but subsequently the patient developed worsening shortness of breath, desaturation, and coughed out pink frothy sputum. Repeated chest radiographic and computed tomographic thorax findings suggested RPE. A nonrebreathable mask with high-flow oxygen was given to the patient to maintain his oxygen saturation. The patient was referred to the cardiothoracic team and was admitted to the hospital. Despite conservative management in the ward, the patient underwent lung decortication. Postdecortication, the left-sided lung re-expanded well, and the patient was discharged home. This case highlighted this rare, potentially fatal complication of chest drain insertion for spontaneous pneumothorax.
Topics: Male; Humans; Adult; Pneumothorax; Pulmonary Edema; Chest Tubes; Tomography, X-Ray Computed; Dyspnea
PubMed: 37885079
DOI: 10.1097/TME.0000000000000481 -
JPMA. the Journal of the Pakistan... Oct 2023Post-Cardiac Injury Syndrome (PCIS) akin to Dressler's syndrome is late-onset pericarditis that is triggered by the body's immune system and presents commonly as pleuro-...
Post-Cardiac Injury Syndrome (PCIS) akin to Dressler's syndrome is late-onset pericarditis that is triggered by the body's immune system and presents commonly as pleuro- pericardial symptoms and raised inflammatory markers. Its occurrence following the insertion of a pacemaker has been reported infrequently and varies in different studies with an estimated prevalence of 1-2%. Our case reports a unique incidence of isolated pleural effusion following the implantation of a pacemaker in a 62-year-old female with complete heart block with no evidence of pericardial effusion on imaging. She developed dyspnoea, pleuritic chest pain, and lethargy. She successfully responded to treatment with NSAIDs and colchicine with no recurrence. This report demonstrates the uncommon course of the disease and highlights the need to consider PCIS as a possible diagnosis in patients presenting with predominant pulmonary findings and suspect it early so that timely treatment can be started, thereby preventing complications.
Topics: Female; Humans; Middle Aged; Pacemaker, Artificial; Pericardial Effusion; Pleural Effusion; Anti-Inflammatory Agents, Non-Steroidal; Syndrome; Heart Injuries
PubMed: 37876079
DOI: 10.47391/JPMA.8237