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International Journal of Infectious... Dec 2014Cryptococcosis with thoracic spine involvement is extremely rare, with most cases occurring in immunosuppressed patients. We report a case of cryptococcosis of the...
Cryptococcosis with thoracic spine involvement is extremely rare, with most cases occurring in immunosuppressed patients. We report a case of cryptococcosis of the thoracic vertebrae confirmed by histopathology. The immunocompetence of the patient is a most interesting feature of this case. Laboratory investigations were normal, but the erythrocyte sedimentation rate was raised. A computed tomography scan showed an eccentric lytic lesion with a clear boundary at T2-T3. Magnetic resonance imaging showed the endplates of the T2 and T3 vertebral bodies to be involved, but without significant loss of the intervertebral disk height. A prespinal and large paraspinal soft tissue component was spreading along T1-T4, and the pleura and dural sac at the level of T2-T3 had thickened abnormally. (18)F-fluorodeoxyglucose positron emission tomography/computed tomography showed abnormal uptake in the lesion. The above-mentioned clinical and imaging information will help improve our understanding of this rare disease.
Topics: Aged; Cryptococcosis; Female; Humans; Magnetic Resonance Imaging; Positron-Emission Tomography; Spinal Diseases; Thoracic Vertebrae; Tomography, X-Ray Computed
PubMed: 25449251
DOI: 10.1016/j.ijid.2014.07.013 -
Cureus Apr 2024Pericarditis is an inflammatory process that affects the pericardium, the fibrous sac surrounding the heart. Acute pericarditis accounts for approximately 0.1% of...
Re-enforcing High-Risk Acute Pericarditis Requiring Hospital Admission: An Unusual Case of Critical Idiopathic Acute Pericarditis Presenting As Tamponade and Pleuro-Pericardial Complications in a Patient Presenting With Flu-Like Symptoms.
Pericarditis is an inflammatory process that affects the pericardium, the fibrous sac surrounding the heart. Acute pericarditis accounts for approximately 0.1% of inpatient admissions and 5% of non-ischemic chest pain visits to the emergency departments (EDs). Most patients who present with acute pericarditis have a benign course and good prognosis. However, a rare percent of the patients develop complicated pericarditis. Examples of complications include pericardiac effusion, cardiac tamponade, constrictive pericarditis, effusive and constrictive pericarditis and, even more rarely, large pleural effusion The occurrence of complicated pericarditis can lead to high morbidity and mortality if not urgently managed in most patients. Our case presents a 60-year-old male that presented to the emergency room with flu-like symptoms. However, the viral panel test was negative. He initially got discharged with supportive care but was brought back to the ED by his wife in a critical, life-threatening state due to pericarditis symptoms complicated by tamponade and shock. His condition required urgent intervention and critical level of care. The patient's course was also complicated by myopericarditis and recurrent bilateral pleural effusions, which required therapeutic interventions. This unique case presents the patient group that develop multiple life-threatening complications of acute pericarditis, including cardiac tamponade and shock, affecting several end organs. This case also highlights clues to the predisposing factors to complications of acute pericarditis. Patients who present with high-risk signs and symptoms indicating poorer prognosis warrant further observation and admission. This will also add to the literature reviews regarding the risk factors associated with development of complicated acute pericarditis. This will also serve as a review of pathophysiology, etiology, current diagnosis and available novel treatment for such patients.
PubMed: 38741856
DOI: 10.7759/cureus.58147 -
International Journal of Surgery Case... 2014Bochdalek's diaphragmatic hernia (BDH) rarely developed symptomatic in adulthood but mostly required an operation. In adult BDH cases, long-term residing of the massive...
INTRODUCTION
Bochdalek's diaphragmatic hernia (BDH) rarely developed symptomatic in adulthood but mostly required an operation. In adult BDH cases, long-term residing of the massive intraabdominal organs in the thoracic cavity passively causes loss of domain for abdominal organs (LOD).
PRESENTATION OF CASE
A 63-year-old man presented at our institution complaining of sudden left upper quadrant abdominal pain. Chest radiography showed a hyperdense lesion containing bowel gas in the left pleural space. Computed tomography revealed a dilated bowel above the diaphragm and intestinal obstruction suggestive of gangrenous changes. These findings were consistent with the diagnosis of incarcerated BDH and an emergency laparotomy was performed. Operative findings revealed the hypoplastic lung, lack of hernia sac, and location of the diaphragmatic defect, which indicated that his hernia was true congenital. Organs were reduced into the abdominal cavity, and large defect of the diaphragm was repaired with combination of direct vascular closure and intraperitoneal onlay mesh reinforcement using with expanded polytetrafluoroethylene (ePTFE) mesh. On the postoperative day 1, the patient fell into the shock and was diagnosed to have abdominal compartment syndrome (ACS). Conservative therapies were administered, but resulted in gastropleural fistula and pleural empyema, which required an emergency surgery. Mesh extraction and fistulectomy were performed.
DISCUSSION
A PubMed search for the case of ACS after repair of the adult BDH revealed only three cases, making this very rare condition.
CONCLUSION
In dealing with adult BDH, possible post-repair ACS should be considered.
PubMed: 24441713
DOI: 10.1016/j.ijscr.2013.12.018 -
Cell Sep 1996Emergence of hemopoietic stem cells in the mammalian embryo has yet to be definitively allocated. Previously, we detected multipotent hemopoietic precursors in the...
Emergence of hemopoietic stem cells in the mammalian embryo has yet to be definitively allocated. Previously, we detected multipotent hemopoietic precursors in the region surrounding the dorsal aorta (paraaortic splanchnopleura) beginning at 8.5 days postcoitum (dpc). However, as circulation is already established, it remained unclear whether hemopoietic precursors arise in situ or are blood-delivered. By adding an organotypic step to our former culture system, we now detect lymphocyte and multipotent myeloid precursors from the intraembryonic splanchnopleura as early as 7.5 dpc. Under identical conditions, yolk sacs from the same embryos are unable to generate lymphoid progeny and have a reduced potential for myeloid differentiation and maintenance. Thus, if isolated before circulation, the yolk sac does not produce multipotent precursors and therefore does not contribute to definitive hemopoiesis in the mouse.
Topics: Animals; Aorta; Base Sequence; Culture Techniques; DNA Primers; Embryonic and Fetal Development; Female; Gene Expression Regulation, Developmental; Gestational Age; Hematopoiesis; Hematopoietic Stem Cells; Lymphocytes; Male; Mice; Mice, Inbred BALB C; Mice, Inbred C57BL; Pleura; Pregnancy; Yolk Sac
PubMed: 8808626
DOI: 10.1016/s0092-8674(00)80166-x -
Clinical Pathology (Thousand Oaks,... 2020Calcifying fibrous tumor (CFT) is a rare entity, with a distinctive histological presentation, initially reported as childhood fibrous tumor with psammoma bodies. It is...
BACKGROUND
Calcifying fibrous tumor (CFT) is a rare entity, with a distinctive histological presentation, initially reported as childhood fibrous tumor with psammoma bodies. It is a benign hypocellular fibrous neoplasm calcifications and lymphoplasmacytic infiltrate. The CFTs may involve many sites, including gastrointestinal tract, pleura, abdominal cavity, and neck. The diagnosis might be challenging due to histological overlaps with other mesenchymal tumors. The prognosis is good. We describe herein the case of a 53-year-old woman with an incidentally diagnosed CFT of the mesentery.
CASE PRESENTATION
A 53-year-old woman presented to the surgery department with a 2-year history of an anterior abdominal hernia. A computed tomographic scan of the abdomen failed to demonstrate any evidence of a mesenteric nodule. The patient underwent surgical treatment. Careful exploration during the excision of herniated sac revealed a solitary nodule of the mesentery. Local excision was performed. On gross, it was a well-demarcated nodule. Microscopically, the tumor consisted of an abundant paucicellular hyalinized collagen with calcifications; associated to a sparse mononuclear inflammatory infiltrate.
CONCLUSIONS
Calcifying fibrous tumor is a benign lesion. The diagnosis is based on histology, because clinical and radiological features are nonspecific. Awareness of this entity is crucial to distinguish it from other mesenchymal tumors especially in the gastrointestinal tract.
PubMed: 32637936
DOI: 10.1177/2632010X20930689 -
Canadian Medical Association Journal Apr 1977An unusual penetrating chest injury was caused by a ball-point pen. Because of apparent penetration of the heart, preparations were made for an emergency open-heart...
An unusual penetrating chest injury was caused by a ball-point pen. Because of apparent penetration of the heart, preparations were made for an emergency open-heart procedure before emergency thoracotomy was undertaken, with the pen still in situ. The pen had bruised the epicardium but had not penetrated the pericardial sac. After removal of the pen, the wound was closed and a chest tube left in place. Recovery, apart from minor degrees of basal atelectasis, pleural effusion and wound infection, was uneventful. The outcome was consistent with that associated with current aggressive management of penetrating chest injuries. Management is based on three approaches. The primary one is intercostal thoracostomy tube drainage and fluid and blood replacement. In cases of massive hemorrhage or air leak, thoracotomy is necessary. The third approach is to prevent post-traumatic pulmonary insufficiency by using fine, high-efficiency filters during blood transfusion, avoiding excessive administration of intravenous fluids, performing tracheostomy after prolonged endotracheal intubation, and using a volume respirator with positive end-expiratory pressure. The average mortality for penetrating wounds of the heart is 25%.
Topics: Drainage; Humans; Male; Middle Aged; Pericardium; Pleural Effusion; Pulmonary Atelectasis; Thoracic Injuries; Wound Infection; Wounds, Penetrating
PubMed: 856432
DOI: No ID Found -
Journal of Clinical Imaging Science 2018Pancreatic pseudocyst develops as a complication of both acute and chronic pancreatitis. Although the common location of pseudocyst is lesser sac, extension of...
Pancreatic pseudocyst develops as a complication of both acute and chronic pancreatitis. Although the common location of pseudocyst is lesser sac, extension of pseudocyst can occur into mesentery, retroperitoneum, inguinal region, scrotum, liver, spleen, mediastinum, pleura, and lung. Extension of pseudocyst into psoas muscle and lumbar triangle is extremely rare. The development of pseudocyst in lumbar triangle is radiologically equivalent and further extension of Grey Turner's sign seen clinically in acute pancreatitis. This extension occurs due to the destructive nature of pancreatic enzymes. The lumbar triangle is the site of anatomic weakness in the lateral abdominal wall in the lumbar region. We report the case of a 35-year-old alcoholic male patient who presented with abdominal pain followed by distension and swelling in the right lumbar region for 1 week. On computed tomography scan of the abdomen, acute-on-chronic pancreatitis with multiple pseudocysts in the right posterior pararenal space, extending through the right lumbar triangle in the right lateral abdominal wall, right posterior paraspinal muscles, right iliopsoas, right obturator externus, and medial aspect of the right upper thigh, beneath anterior abdominal wall in the upper abdomen and in the right lateral thoracic wall through the right 11 intercostal space, was detected.
PubMed: 30197824
DOI: 10.4103/jcis.JCIS_29_18 -
Journal of Cardiothoracic Surgery Jun 2012The tumorous infiltration or carcinosis of the pericardium could cause pericardial effusion in up to one-third of cases of malignancy, thus potentially interfere with...
BACKGROUND
The tumorous infiltration or carcinosis of the pericardium could cause pericardial effusion in up to one-third of cases of malignancy, thus potentially interfere with the otherwise desirable oncological treatment. The existing surgical methods for the management of pericardial fluid are well-established but are not without limitations in the symptomatic relief of malignant pericardial effusion (MPE). The recurrence rate ranges between 43 and 69% after pericardiocentesis and 9 to 16% after pericardial drainage. The desire to overcome relative limitations of the existing methods led us to explore an alternative approach.
METHODS
The standard armamentarium of the Carlens collar mediastinoscopy procedure was utilized in a Chamberlain parasternal approach of the pericardial sac. The laterality of approach was decided based upon the pleural involvement, as tumor-free pericardiopleural reflection is required. A pericardio-pleural window at least 3 cm in diameter was created. From January 2000 to December 2009, 22 cases were operated on with mediastinoscope-controlled parasternal fenestration (MCPF). Considering the type of the primary tumor, there were 11 lung cancer, 6 breast cancers, 2 haematologic malignancies and in 3 patients the origin of malignancy could not be verified.
RESULTS
There were no operative deaths. We lost one patient (4.5%) in the postoperative hospital period. All of the surviving patients had a minimum of 2 months of symptom-free survival. We detected transient recurrence of MPE in one patient (4.5%) 14 days after the MCPF, which disappeared spontaneously after 24 hours.
CONCLUSION
The MCPF offers a real alternative in certain cases of pericardial effusion. We recommend this method especially for the definitive surgical palliation of MPE.
Topics: Adult; Aged; Female; Heart Neoplasms; Humans; Kaplan-Meier Estimate; Male; Mediastinoscopy; Middle Aged; Neoplasms; Pericardial Effusion; Pericardial Window Techniques
PubMed: 22713743
DOI: 10.1186/1749-8090-7-56 -
Turk Kardiyoloji Dernegi Arsivi : Turk... Dec 2011Pneumopericardium is defined by the presence of air in the pericardial sac. We present a 61-year-old cachectic woman who developed pneumopericardium after...
Pneumopericardium is defined by the presence of air in the pericardial sac. We present a 61-year-old cachectic woman who developed pneumopericardium after pericardiocentesis. She presented with complaints of fatigue and shortness of breath. The chest X-ray showed an increased cardiothoracic ratio, and echocardiographic examination showed a marked pericardial effusion. Pericardiocentesis was performed and a total of 860 ml hemorrhagic pericardial fluid was aspirated. At the end of the first week after removal of the catheter, control chest radiography showed air-fluid levels in the pericardial cavity, and echocardiography revealed dense air bubbles in the decreased pericardial effusion. As the patient was hemodynamically stable, she was monitored on medical treatment. However, five days later, pericardiocentesis was repeated due to a significant increase in the pericardial effusion despite decreased amount of air. As no etiologic factor could be elicited, a connective tissue disease was considered and a corticosteroid was added to her treatment, which resulted in a rapid decline in the pericardial effusion on follow-up chest radiography and echocardiography. She was discharged on steroid therapy.
Topics: Cachexia; Diagnosis, Differential; Dyspnea; Female; Humans; Middle Aged; Pericardiocentesis; Pleural Effusion; Pneumopericardium; Tomography, X-Ray Computed
PubMed: 22257811
DOI: 10.5543/tkda.2011.01699 -
World Journal of Oncology Apr 2018Lung cancer is the number one cause of cancer-related deaths in the United States. Involvement of pericardium occurs once cancer has progressed to stage IV which can...
Lung cancer is the number one cause of cancer-related deaths in the United States. Involvement of pericardium occurs once cancer has progressed to stage IV which can cause massive effusion in the pericardial sac. This can lead to cardiac tamponade which can be fatal very quickly if untreated. The following is a two patient case series in which both patients presented with large pericardial effusion. The first patient sought medical attention due to new onset palpitations and was found to have hemorrhagic pericardial effusion and pulmonary embolism (PE). The second patient presented with shortness of breath. Investigations revealed that she had pericardial and pleural effusions along with multiple metastases throughout the body. Both patients ended up with a diagnosis of non-small cell lung cancer (NSCLC) with mutation. One patient had V600E mutation; other patient had a variant p.D594N mutation. Both patients also had expression of PD-L1.
PubMed: 29760834
DOI: 10.14740/wjon1092w