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Radiology Case Reports Aug 2024Pulmonary arteries may rarely be involved by primary and secondary tumors. Clinical and imaging features mimic those of PE making it challenging to diagnose....
Pulmonary arteries may rarely be involved by primary and secondary tumors. Clinical and imaging features mimic those of PE making it challenging to diagnose. Choriocarcinoma is a malignant germ cell tumor, typically in the female genital tract. Rarely, they can present as PA thrombus. Female patients with a history of a molar pregnancy, ectopic pregnancy, abortion or in this case a miscarriage, are at a higher risk of gestational trophoblastic disease which can manifest in this way, albeit this is rare. In this report we describe the case of a 52-year-old female who presented with a 1 month history of worsening dyspnea and pleuritic lower thoracic pain. A diagnosis of pulmonary embolism (PE) was confirmed on CT pulmonary angiogram, with a large volume thrombus in the left pulmonary artery (PA). She failed to improve on standard anticoagulation therapy and was found to have a raised beta-human chorionic gonadotropin of >100,000. This leads to an extensive malignancy work-up. The only pertinent finding was that of increased fluorodeoxyglucose (FDG) accumulation in the PA thrombus. Endovascular biopsy of the thrombus was performed, and the patient was diagnosed with choriocarcinoma of the PA. This case highlights the importance of further investigation in patients failing to respond to anticoagulation therapy for PE. It also illustrates the role of interventional radiology in obtaining histological diagnosis in patient's presenting with PA tumor thrombus.
PubMed: 38881620
DOI: 10.1016/j.radcr.2024.05.020 -
Cureus Apr 2024Valley fever is a fungal infection, commonly of the lungs, caused by Coccidioides immitis or Coccidioides posadasii. This disease is endemic to the southwestern United...
Valley fever is a fungal infection, commonly of the lungs, caused by Coccidioides immitis or Coccidioides posadasii. This disease is endemic to the southwestern United States, Central America, and South America. Infected individuals are typically asymptomatic but may develop community-acquired pneumonia. On rare occasions, coccidioidomycosis can present with severe complications in addition to the pulmonary manifestation. In this study, a 58-year-old immunocompetent male presented to the Emergency Department with a cough, night sweats, and pleuritic chest pain. Despite the administration of broad-spectrum antimicrobials, he developed a large right pleural effusion that did not resolve following thoracentesis. Serology was positive for Coccidioides, and the patient was referred to a thoracic surgeon due to persistent effusion. It is rare for patients with coccidiomycosis to develop a large pleural effusion requiring surgical intervention, especially in immunocompetent individuals. This case highlights the importance of monitoring patients with unresolved acute pneumonia in endemic areas and considering Coccidioides as a possible etiology.
PubMed: 38738118
DOI: 10.7759/cureus.57983 -
Radiology Case Reports Aug 2024Epipericardial fat necrosis is a rare cause of acute pleuritic chest pain and is a benign and self-limiting condition. It is important to distinguish epipericardial fat...
Epipericardial fat necrosis is a rare cause of acute pleuritic chest pain and is a benign and self-limiting condition. It is important to distinguish epipericardial fat necrosis from other diseases that cause acute chest pain, such as acute myocardial infarction, pulmonary embolism, and acute pericarditis, because conservative treatment is recommended for epipericardial fat necrosis. This report presents the case of a 25-year-old man with severe pleuritic chest pain located on the left anterior side that was associated with dyspnea. Electrocardiogram and laboratory data were normal, except for a slight elevation of C-reactive protein level. Contrast-enhanced chest computed tomography revealed a fatty ovoid lesion surrounded by a thick rim on the left side of the pericardial fat. Fat stranding was observed both inside and adjacent to the fatty ovoid lesion. A slight contrast enhancement of the thick rim and a slight linear enhancement inside the lesion were observed. Furthermore, a small amount of left pleural effusion was observed. The patient was diagnosed with epipericardial fat necrosis and treated with analgesics, and the symptoms improved 1 week after the emergency department visit. Radiologists should be familiar with epipericardial fat necrosis to prevent overlooking and misdiagnosing the condition.
PubMed: 38737185
DOI: 10.1016/j.radcr.2024.04.022 -
Cureus May 2024A 29-year-old male, otherwise healthy with no past medical history, presented to the hospital after a two-day history of pleuritic chest pain with a fever. He had...
A 29-year-old male, otherwise healthy with no past medical history, presented to the hospital after a two-day history of pleuritic chest pain with a fever. He had received his first dose of the mRNA-1273 coronavirus disease (COVID-19) vaccine (Moderna) two months prior without any adverse reactions. He received his second dose approximately 24 hours before symptom onset and hospital presentation. Work-up was unremarkable for respiratory, autoimmune, and rheumatological etiologies. The patient was found to have electrocardiogram features and symptoms in keeping with pericarditis, C-reactive protein elevation, and a peak high-sensitivity troponin level of 9,992 ng/L suggestive of a component of myocarditis. A dilemma arose regarding whether this patient should be diagnosed with perimyocarditis or myopericarditis, terms often used interchangeably without proper reference to the primary pathology, which can ultimately affect management. A subsequent echocardiogram was unremarkable, with a normal left ventricular systolic function, but cardiac resonance imaging revealed myocardial edema suggestive of myocarditis. Without convincing evidence for an alternative explanation after an extensive work-up of ischemic, autoimmune, rheumatological, and infectious etiologies, this patient was diagnosed with COVID-19 mRNA vaccine-induced myopericarditis. The patient fully recovered after receiving a treatment course of ibuprofen and colchicine. This case explores how the diagnosis of COVID-19 vaccine-induced myopericarditis was made and treated using an evidence-based approach, highlighting its differentiation from perimyocarditis.
PubMed: 38736762
DOI: 10.7759/cureus.59999 -
International Journal of Surgery Case... Jun 2024Pulmonary sarcomatoid carcinoma is a very rare primary tumor of the lung. Although usually aggressive, these tumors have not been described previously to invade through...
INTRODUCTION
Pulmonary sarcomatoid carcinoma is a very rare primary tumor of the lung. Although usually aggressive, these tumors have not been described previously to invade through the diaphragm into the liver. We present a patient with a pulmonary sarcomatoid carcinoma with transdiaphragmatic spread into the dome of the liver.
PRESENTATION OF CASE
An 82-year-old female with a lifetime non-smoking history presented with generalized fatigue, fever, night sweats, cough, and pleuritic chest pain. She had recently traveled to the western United States. Additionally, she had recently undergone periodontal deep cleaning with no peri-procedural antibiotics. Laboratory testing was significant for a leukocytosis of 13.5 white blood cells per microliter and a negative viral panel. Computed tomography and magnetic resonance imaging revealed a large heterogeneous mass extending from the right pulmonary hilum through the diaphragm. Although initial radiology reports suggested hepatic abscess, percutaneous fine needle aspiration was performed. Biopsy revealed pulmonary sarcomatoid carcinoma. She was begun on systemic treatment.
DISCUSSION
Pulmonary sarcomatoid carcinoma can exhibit transdiaphragmatic invasion into the liver. This clinical situation can easily be confused with a hepatic abscess, but suspicion should remain for abscess. Clinical suspicion for neoplasm should warrant biopsy when technically possible.
CONCLUSION
Although hepatic abscesses can exhibit transdiaphragmatic spread into the chest, pulmonary sarcomatoid carcinoma can also invade the abdomen. Biopsy should be performed during the evaluation and workup of the patient.
PubMed: 38718493
DOI: 10.1016/j.ijscr.2024.109675 -
Cureus Mar 2024Pericardial effusion is a collection of fluid in the pericardial sac that can result in symptoms such as shortness of breath, pleuritic chest pain, and/or hemodynamic...
Pericardial effusion is a collection of fluid in the pericardial sac that can result in symptoms such as shortness of breath, pleuritic chest pain, and/or hemodynamic instability. Malignant pleural effusions are seen in a few cancer patients and are associated with poor prognosis. Here, we present the case of a 65-year-old female with a large malignant pericardial effusion in the setting of advanced-stage lung adenocarcinoma.
PubMed: 38690490
DOI: 10.7759/cureus.57287 -
SAGE Open Medical Case Reports 2024Tuberculosis, being an airborne disease with a broad spectrum of symptoms and signs, is a rare cause of chylothorax. Mortality due to tuberculous chylothorax is 6%, and...
Tuberculosis, being an airborne disease with a broad spectrum of symptoms and signs, is a rare cause of chylothorax. Mortality due to tuberculous chylothorax is 6%, and bilateral chylothorax has a higher mortality with a poor prognosis. A previously well 28-year-old male with a household contact history of tuberculosis exposure presented with a 1-month history of shortness of breath, fever, pleuritic chest pain, and constitutional symptoms. He was found to have bilateral chylothorax, generalized lymphadenopathy, hepatosplenomegaly, and miliary nodules in chest x-ray. Sputum acid-fast bacilli, pleural fluid TB PCR (Tuberculosis polymerase chain reaction) and culture became negative. Sputum culture became positive for at 6 weeks. He had marked clinical and radiological improvement within 2 months of starting anti-tuberculosis treatment. Diagnosis of pleural tuberculosis is difficult as pleural fluid acid-fast bacilli detection has poor sensitivity. It is important to consider tuberculosis in patients with chylothorax and initiate prompt treatment.
PubMed: 38638875
DOI: 10.1177/2050313X241247410 -
Cureus Mar 2024Daptomycin is an antibiotic used for resistant Gram-positive organisms and has the rare side effect of inducing acute eosinophilic pneumonia (AEP). This condition can be...
Daptomycin is an antibiotic used for resistant Gram-positive organisms and has the rare side effect of inducing acute eosinophilic pneumonia (AEP). This condition can be fatal due to respiratory failure if not treated, as eosinophils migrate to the lungs and inflammatory cascades cause epithelial injury. Daptomycin-induced AEP can be misdiagnosed as bacterial pneumonia or malignancy, which may lead to unnecessary testing or treatments. Diagnostic criteria include dyspnea, fever, recent daptomycin exposure, infiltrates on imaging, eosinophils on bronchoalveolar lavage or peripheral eosinophilia, and clinical improvement with medication discontinuation. We present a unique case of daptomycin-induced eosinophilic pneumonia in a 72-year-old male with the chief complaint of dyspnea and initial concerns for lung cancer after a spiculated nodule was seen on imaging. Prior to undergoing a lung biopsy, repeat imaging showed a decrease in the suspicious nodule, reducing the likelihood of malignancy and prompting a re-evaluation of the history of the present illness and medication list. Daptomycin was stopped, and the patient's symptoms and imaging improved. This case illustrates the importance of early recognition and appropriate treatment of AEP, which allows for complete clinical recovery.
PubMed: 38618432
DOI: 10.7759/cureus.56106 -
Cureus Mar 2024We present the case of a 64-year-old female with a past medical history significant for unclassified interstitial lung disease (ILD) from suspected hypersensitivity...
We present the case of a 64-year-old female with a past medical history significant for unclassified interstitial lung disease (ILD) from suspected hypersensitivity pneumonitis secondary to chronic mold exposure with steroid responsiveness and prior pneumothorax. The patient developed shortness of breath and pleuritic chest pain after undergoing routine outpatient pulmonary function tests (PFTs). She was immediately transferred to the emergency department and found to have a moderate left basilar pneumothorax. She underwent emergent surgical chest tube placement followed by doxycycline pleurodesis. Repeat chest imaging showed inadvertent retraction of the chest tube and extensive subcutaneous emphysema. The surgical chest tube was replaced by a pigtail catheter with an improvement of subcutaneous emphysema. This case demonstrates the development of a rare but serious complication of pneumothorax that could occur in patients who have ILD undergoing routine PFTs. Clinicians should be aware of this risk when patients who have ILD present for PFTs and counsel them to seek immediate medical attention if they develop signs of acute onset dyspnea after performing PFTs.
PubMed: 38586742
DOI: 10.7759/cureus.55675 -
Respiratory Medicine Case Reports 2024Behcet's disease (BD) is a chronic and inflammatory vasculitis characterized by recurrent oral and genital aphthous ulcers, uveitis, and skin lesions. Although there is...
Behcet's disease (BD) is a chronic and inflammatory vasculitis characterized by recurrent oral and genital aphthous ulcers, uveitis, and skin lesions. Although there is a high rate of deep vein thrombosis in BD, pulmonary arterial thromboembolism (PTE) is a rare complication. We present a 30-year-old patient who was admitted with pleuritic chest pain, non-massive hemoptysis since 4 days ago and medical history of intermittent genial aphthous lesions, and skin lesions. During our evaluation, he had an S1Q3T3 pattern in the electrocardiogram, a high level of D-dimer, a low level of FDP and fibrinogen along with pulmonary emboli in lobar and segmental branches of the right pulmonary artery and segmental branches of left lower lobe pulmonary artery were detected in his pulmonary CT Angiography. Then, he was positive for HLA-B51. Based on his clinical condition and history of recurrent genital and skin lesions, a positive pathergy test. Therefore, the diagnosis of BD was confirmed for him. Diagnosis of PTE can be difficult due to the rarity of PTE in BD and nonspecific clinical symptoms; therefore, a high degree of suspicion and appropriate radiographic imaging is essential for the diagnosis.
PubMed: 38584762
DOI: 10.1016/j.rmcr.2024.102009