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European Journal of Case Reports in... 2021The aetiology of pulmonary nodules is varied, with malignant lesions being the most important and requiring rapid diagnosis and treatment. However, although clinical...
UNLABELLED
The aetiology of pulmonary nodules is varied, with malignant lesions being the most important and requiring rapid diagnosis and treatment. However, although clinical presentation and imaging may suggest a specific diagnosis, it should be kept in mind that some benign pathologies mimic more serious disease. A 50-year-old man presented with left pleuritic chest pain. A CT scan showed an ipsilateral pulmonary spiculated nodule. Pneumonia was assumed and the patient was started on antibiotic therapy. In the absence of improvement, positron emission tomography and a transthoracic aspiration biopsy were performed. Lung cancer was diagnosed and the patient underwent an upper lobectomy. However, examination of the surgical specimen showed no malignancy.
LEARNING POINTS
Although complementary diagnostic exams are increasingly available and widely used, they may produce false positive or false negative results.A correct diagnostic approach can lead to an incorrect diagnosis.The preoperative diagnosis of pulmonary nodules can be a challenge.
PubMed: 33987120
DOI: 10.12890/2021_002422 -
The American Journal of Case Reports Jul 2020BACKGROUND Severe acute respiratory syndrome coronavirus 2, the virus responsible for Coronavirus Disease 2019 (COVID-19), has infected more than 8 million people...
BACKGROUND Severe acute respiratory syndrome coronavirus 2, the virus responsible for Coronavirus Disease 2019 (COVID-19), has infected more than 8 million people worldwide and placed massive strains on healthcare systems around the world. Although classically causing cough, fever, and shortness of breath, increasing evidence suggests that manifestations of COVID-19 can be more subtle or masquerade as other clinical entities. CASE REPORT A 48-year-old man with hypertension and type 2 diabetes mellitus presented to the Emergency Department with acute-onset pleuritic chest pain that had developed 1 day earlier and was found to be hypoxemic, requiring supplemental oxygen. He was admitted under the internal medicine service and underwent an extensive workup for his chest pain and hypoxemia, including a negative computed tomography scan with pulmonary embolism protocol, negative nuclear medicine ventilation/perfusion scan, normal electrocardiogram, and normal echocardiography. In the end, he was diagnosed with viral pleuritis as the diagnosis of exclusion. Our patient subsequently developed a fever and shortness of breath and his nasopharyngeal swab performed on admission to hospital returned positive for COVID-19. The patient's pleuritic pain and oxygen requirements improved with supportive management over the next several days. CONCLUSIONS I report a patient who experienced pleuritic chest pain from viral pleurisy that was the initial manifestation of COVID-19 which, to the best of my knowledge, has not yet been reported in the literature. This case report further emphasizes that COVID-19 may present with atypical symptoms. It is crucial to be aware of these atypical presentations of COVID-19 so that patients are appropriately identified, isolated, and treated, while protecting health care workers from exposure.
Topics: Betacoronavirus; COVID-19; Coronavirus Infections; Diabetes Mellitus, Type 2; Emergency Service, Hospital; Humans; Hypertension; Male; Middle Aged; Pandemics; Pleurisy; Pneumonia, Viral; SARS-CoV-2; Tomography, X-Ray Computed
PubMed: 32706769
DOI: 10.12659/AJCR.925775 -
Journal of Education & Teaching in... Oct 2021An empyema is a pus-filled collection within the pleural space of the thorax that most commonly results from an untreated pneumonia. Additional risk factors include poor...
UNLABELLED
An empyema is a pus-filled collection within the pleural space of the thorax that most commonly results from an untreated pneumonia. Additional risk factors include poor dental hygiene, malnutrition, immunosuppression, alcohol or IV drug use, and gastroesophageal reflux. Symptoms typically include a productive cough, fever, and pleuritic chest pain, and radiographic imaging is necessary for diagnosis.1 In this case report, an adult male presented to the emergency department (ED) with a productive cough and shortness of breath. Ultrasound and computed tomography (CT) imaging confirmed the diagnosis of a left-sided empyema. The patient was successfully treated with a chest tube and antibiotics and was subsequently discharged eight days after admission. This case demonstrates the effectiveness of ultrasound and CT in diagnosing an empyema from other lung conditions. Ultrasound has the potential to visualize additional features not always seen on CT alone, which suggests the possibility of lung ultrasound as an alternative to a chest CT when diagnosing patients in at-risk radiation exposure groups, including children and pregnant women.
TOPICS
Empyema, lung ultrasound, chest tube.
PubMed: 37465266
DOI: 10.21980/J8SH2N -
BMC Emergency Medicine May 2021Chest pain is one of the commonest presenting complaints in urgent/emergency care, with a lifelong prevalence of up to 25% in the adult population. Pleuritic chest pain...
BACKGROUND
Chest pain is one of the commonest presenting complaints in urgent/emergency care, with a lifelong prevalence of up to 25% in the adult population. Pleuritic chest pain is a subset of high investigation burden because of a diverse range of possible causes varying from simple musculoskeletal conditions to pulmonary embolism.
CASE SERIES
Among otherwise fit and healthy adult patients presenting in our emergency department with sudden onset of unilateral pleuritic chest pain, within 1 month we identified a cohort of five patients with pin-point tenderness in one specific costo-sternal joint often with referred pain to the back. All cases had apparent and, previously undiagnosed mild/moderate scoliosis.
METHODS
To confirm and validate the observed association between scoliosis and pleuritic chest pain, a retrospective audit was designed and performed using the hospital's electronic medical record system to reassess all consecutive adult chest pain patients.
RESULTS
The Odds Ratio for having chest pain with scoliosis was 30.8 [95%CI 1.71-553.37], twenty times higher than suggested by prevalence data.
DISCUSSION
In scoliosis the pathologic lateral curvature of the spine adversely affects the functional anatomy of both the spine and ribcage. In our hypothesis the chest wall asymmetry enables minor slip/subluxation of a rib either in the costo-sternal and/or costovertebral junction exerting direct pressure on the intercostal nerve causing pleuritic pain.
CONCLUSION
Thorough physical examination of the anterior and posterior chest wall is key to identify underlying scoliosis in otherwise fit patients presenting with sudden onset of pleuritic pain. Incorporating assessment for scoliosis in the low-risk chest pain protocols/tools may help reducing the length of stay in the emergency department and, facilitate speedy but safe discharge with increased patient satisfaction.
Topics: Adult; Chest Pain; Emergency Service, Hospital; Humans; Pleurisy; Retrospective Studies; Scoliosis
PubMed: 34001003
DOI: 10.1186/s12873-021-00455-x -
Revista Espanola de Enfermedades... Nov 2022A 35-year-old male with a history of recurrent pleuritic chest pain was referred for evaluation of a mediastinal mass detected on CT. MRI showed a 10.5 x 7 x 3 cm lesion...
A 35-year-old male with a history of recurrent pleuritic chest pain was referred for evaluation of a mediastinal mass detected on CT. MRI showed a 10.5 x 7 x 3 cm lesion in the posterior mediastinum. EUS revealed a multicystic lesion with thin septa and clear anechoic content that extended from the lower posterior mediastinum to the upper retroperitoneum. EUS-FNA was performed using a 22-gauge needle with aspiration of a serosanguineous fluid. Fluid analysis showed low values of amylase, triglycerides, CEA, and CA19-9. Cytology tests identified small mature lymphocytes without malignancy.
Topics: Male; Humans; Adult; Endosonography; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Mediastinum; Mediastinal Diseases; Needles; Surgical Instruments
PubMed: 35187944
DOI: 10.17235/reed.2022.8697/2022 -
Frontiers in Oncology 2022Pericardial effusion is a common finding in advanced-stage lung cancer. The presence of malignant cells or drainage of exudate effusion in the pericardial space may...
Pericardial effusion is a common finding in advanced-stage lung cancer. The presence of malignant cells or drainage of exudate effusion in the pericardial space may cause symptoms of dyspnea, pleuritic chest pain, and syncope. In addition to the difficulty physicians face in the detection and diagnosis of malignant pericardial effusion, treatment may be challenging considering the cancer prognosis and cardiovascular stability of the patient. Despite the availability of several treatment modalities for malignant pericardial effusion, including chemotherapy and surgery, patients with lung cancer historically present with poor prognoses. In addition to lung adenocarcinoma with malignant pericardial effusion, this case was complicated by COVID-19 and malignancy-associated obstructive pneumonia. We present a case of a 64-year-old woman with advanced non-small cell lung carcinoma (NSCLC) with malignant pericardial effusion who, despite testing positive for COVID-19 and having obstructive pneumonia, had favorable outcomes following systemic therapy with combined chemo-immunotherapy.
PubMed: 35600364
DOI: 10.3389/fonc.2022.871132 -
Cureus Oct 2022Dressler syndrome, also known as post-myocardial infarction syndrome, is a condition in which sterile pericarditis develops shortly after myocardial injury. It is...
Dressler syndrome, also known as post-myocardial infarction syndrome, is a condition in which sterile pericarditis develops shortly after myocardial injury. It is characterized by pericardial inflammation typically including pericardial effusion, pleuritic chest pain, and elevated inflammatory markers. While its incidence has greatly decreased in the modern era of coronary revascularization, it remains a clinically important entity with the potential for serious morbidity. Here we present a case of presumed Dressler syndrome in a 54-year-old male who presented to the emergency room with a recurrence of chest pain and clinical signs of pericarditis after sustaining an anterior myocardial infarction two weeks previously.
PubMed: 36426326
DOI: 10.7759/cureus.30670 -
The American Journal of Case Reports Feb 2020BACKGROUND Acute bacterial pericarditis is rare, and the incidence numbers have been declining in the modern antibiotic era. Purulent bacterial pericarditis is a fatal...
BACKGROUND Acute bacterial pericarditis is rare, and the incidence numbers have been declining in the modern antibiotic era. Purulent bacterial pericarditis is a fatal disease in which mortality rates can reach 100% if left untreated. CASE REPORT We present a case of primary purulent bacterial pericarditis with polymicrobial growth including Micromonas micro, Prevotella intermedia and Fusobacterium species, all of which are anaerobic flora of the oral cavity. Constant re-accumulation of the purulent pericardial effusion led the patient to have recurrent echocardiographic and clinical cardiac tamponade requiring recurrent pericardiocentesis' and eventually a pericardial window. CONCLUSIONS Although rare, bacterial pericarditis has been noted to lead to clinical and echocardiographic tamponade. Early diagnosis and treatment are necessary for improving clinical outcomes. It is important to have a suspicion for purulent pericarditis, due to its high level of mortality, in patients who present with non-specific symptoms and pleuritic chest pain.
Topics: Adult; Anti-Bacterial Agents; Bacteria, Anaerobic; Cardiac Tamponade; Fusobacterium; Humans; Male; Pericardiocentesis; Pericarditis; Prevotella intermedia; Rare Diseases
PubMed: 32107365
DOI: 10.12659/AJCR.921633 -
The British Journal of Radiology Jun 2014Epipericardial fat necrosis (EFN) is an uncommon benign and self-limited condition that leads patients to the emergency department (ED) owing to the onset of acute...
OBJECTIVE
Epipericardial fat necrosis (EFN) is an uncommon benign and self-limited condition that leads patients to the emergency department (ED) owing to the onset of acute pleuritic chest pain. The aim of this study was to describe the cases of this disease in our institution and to illustrate the associated clinical and radiological findings.
METHODS
We reviewed 3604 chest scans referred by the ED from November 2011 to July 2013. Patients diagnosed with epipericardial necrosis had their medical records and original tomography reports analysed.
RESULTS
Chest pain was the primary complaint in 426 patients; 11 of them had definitive EFN findings characterized by a round soft-tissue attenuation lesion with a varying degree of strands. All patients presented with pleuritic chest pain on the same side as the lesion. Pericardial thickening, pleural effusion and mild atelectasis were the associated tomography findings. Cardiac enzyme and D-dimer tests performed during the episode were normal in all cases. 27% of the cases only were correctly diagnosed with EFN at the time of presentation.
CONCLUSION
EFN is a benign inflammatory condition frequently overlooked in the ED by physicians and radiologists but is an important factor in the differential diagnosis of patients with acute chest pain.
ADVANCES IN KNOWLEDGE
The article adds clinically and radiologically useful information about the condition and displays the importance of making the correct diagnosis to avoid unnecessary examinations.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Chest Pain; Diagnosis, Differential; Emergency Service, Hospital; Fat Necrosis; Female; Fibrin Fibrinogen Degradation Products; Humans; Male; Middle Aged; Pain Measurement; Pericardium; Tomography, X-Ray Computed
PubMed: 24707937
DOI: 10.1259/bjr.20140118 -
Case Reports in Medicine 2016Lung herniation (LH) is a rare clinical entity involving the protrusion of lung outside the thoracic cage. It has a variety of etiologies and clinical presentations,...
Lung herniation (LH) is a rare clinical entity involving the protrusion of lung outside the thoracic cage. It has a variety of etiologies and clinical presentations, making diagnosis difficult. We present a case of a 20-year-old male who reported pleuritic pain after falling from a skateboard. Evaluation through computed tomography (CT) scanning of the chest revealed an anterior lung hernia associated with rib fractures. This case emphasizes the need for clinicians to include lung herniation in the differential diagnosis of patients with trauma and inexplicable or persistent pulmonary issues.
PubMed: 27872645
DOI: 10.1155/2016/9473906