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Cureus Apr 2024Tuberculosis is rampant in endemic countries. Extrapulmonary tuberculosis, like pleural effusion, is infrequently reported in outpatient departments. However,...
Tuberculosis is rampant in endemic countries. Extrapulmonary tuberculosis, like pleural effusion, is infrequently reported in outpatient departments. However, diaphragmatic eventration is rare and is not reported in active tuberculosis. Herein, the first-of-its-type case of a diaphragmatic eventration with tuberculous right pleural effusion in an Indian male is presented. The diagnosis was challenging and achieved through radiometric investigations and diagnostic pleural tapping. He was put on an anti-tuberculous treatment based on his weight.
PubMed: 38741827
DOI: 10.7759/cureus.58163 -
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 -
Cureus Apr 2024Pleural effusions can be secondary to several different etiologies. Sometimes, they can be related to hypothyroidism. We present a case of massive pleural effusion...
Pleural effusions can be secondary to several different etiologies. Sometimes, they can be related to hypothyroidism. We present a case of massive pleural effusion resulting from hypothyroidism. A 75-year-old male with a history of liver cirrhosis, hypothyroidism, and medication non-adherence presented to the emergency department (ED) with shortness of breath and altered mental status. Physical exam and chest imaging were consistent with right-sided pleural effusion. Effusion was exudative. Multiple recurrences complicated the hospitalization despite thoracentesis and pleurodesis. Labs revealed hypothyroidism, and finally, the patient was started on hormone replacement, resulting in the resolution of the effusion. Pleural effusion is a rare manifestation of hypothyroidism, thought to be mediated by vascular endothelial factors. Pleural fluid analysis shows both exudative and transudative patterns. Hormonal replacement is the mainstay of treatment. Clinicians need to be aware of the rare etiologies of pleural effusion. Depending on the patient's presentation, due work-up should be done to ensure a timely diagnosis and management.
PubMed: 38738057
DOI: 10.7759/cureus.58072 -
European Clinical Respiratory Journal 2024In patients with recurrent pleural effusion, therapeutic thoracentesis is one way of relief. Correct prediction of which patients will experience relief following...
BACKGROUND
In patients with recurrent pleural effusion, therapeutic thoracentesis is one way of relief. Correct prediction of which patients will experience relief following drainage may support the management of these patients. This study aimed to assess the association between ultrasound (US) characteristics and a relevant improvement in dyspnoea immediately following drainage.
METHODS
In a prospective, observational study, patients with recurrent unilateral pleural effusion underwent US evaluation of effusion characteristics and diaphragm movement measured by M-mode and the Area method before and right after drainage. The level of dyspnoea was assessed using the modified Borg scale (MBS). A minimal important improvement in dyspnoea was defined as delta MBS ≥ 1.
RESULTS
In the 104 patients included, 53% had a minimal important improvement in dyspnoea following thoracentesis. We found no association between US-characteristics, including diaphragm shape or movement (M-mode or the Area method), and a decrease in dyspnoea following drainage. Baseline MBS score ≥ 4 and a fully drained effusion were significant correlated with a minimal important improvement in dyspnoea (OR 3.86 (1.42-10.50), = 0.01 and 2.86 (1.03-7.93), = 0.04, respectively).
CONCLUSIONS
In our study population, US-characteristics including assessment of diaphragm movement or shape was not associated with a minimal important improvement in dyspnoea immediately following thoracentesis.
PubMed: 38711600
DOI: 10.1080/20018525.2024.2337446 -
Cureus Mar 2024We present a clinical case of a 79-year-old male admitted to inpatient care for longstanding asthenia and respiratory symptoms. Associated features were polyserositis,...
We present a clinical case of a 79-year-old male admitted to inpatient care for longstanding asthenia and respiratory symptoms. Associated features were polyserositis, multiple enlarged lymphatic nodules, acute kidney injury, and heart failure. The patient's recent medical history revealed SARS-CoV-2 vaccination a week prior and an upper respiratory tract infection. The laboratory results from thoracentesis were compatible with a transudate, with no immunological stain. Epstein-Barr virus polymerase chain reaction (PCR) was positive. The thoracic, abdominal, and pelvic CT scans revealed multiple enlarged lymphatic nodules, worsening the pre-existent polyserositis and hepatosplenomegaly. The patient began to show signs of neurologic symptoms and deterioration of the global health status. An enlarged lymphatic nodule was excised and the pathology showed human herpesvirus 8 multicentric Castleman disease. The disease evolved rapidly into hematological dysfunction and blood transfusions were necessary. Even though the patient was started on high-dose rituximab therapy combined with etoposide, the disease evolved into multiorgan dysfunction with a fatal outcome.
PubMed: 38646242
DOI: 10.7759/cureus.56534 -
Case Reports in Pulmonology 2024. causes a helminthic infection that occurs via penetration of the skin with migration to the bloodstream, tracheobronchial tree, and gastrointestinal system. Pulmonary...
. causes a helminthic infection that occurs via penetration of the skin with migration to the bloodstream, tracheobronchial tree, and gastrointestinal system. Pulmonary manifestations are rare and are typically seen in immunosuppressed patients who have hyperinfection syndrome. Eosinophilic pleural effusions are rare in strongyloidiasis and only cited in a few case reports. . A 45-year-old male with a past medical history of diabetes mellitus, alcoholic cirrhosis, and end-stage renal disease presented to the emergency department with abdominal pain and dyspnea. Imaging studies demonstrated large bilateral pleural effusions, and he subsequently underwent an ultrasound-guided thoracentesis on the right hemithorax, yielding an exudative eosinophilic pleural effusion. An extensive hematology, gastroenterology, and infectious work-up was pursued. Strongyloides immunoglobulin G was positive, and he was successfully treated with ivermectin. . Eosinophilic pleural effusions related to strongyloidiasis are exceedingly rare. Clinicians should consider infection as a part of the differential diagnosis when evaluating immunosuppressed patients with eosinophilic pleural effusions. Loculated abdominal fluid may also be a rare manifestation of hyperinfection syndrome.
PubMed: 38628651
DOI: 10.1155/2024/6652207 -
Cureus Mar 2024Biliothorax is the presence of bile in the pleural cavity. This condition is rare, and it usually results as a complication of hepatobiliary procedures. The authors...
Biliothorax is the presence of bile in the pleural cavity. This condition is rare, and it usually results as a complication of hepatobiliary procedures. The authors present a case of an 87-year-old female who was admitted to the emergency department with the acute onset of severe dyspnea. A chest X-ray and CT revealed a large right-lung pleural effusion that, after thoracentesis, confirmed the presence of biliothorax. It is important to consider this entity when confronted with an effusion liquid of a dark greenish color, as a delay in diagnosis and management may be life-threatening.
PubMed: 38590492
DOI: 10.7759/cureus.55838 -
Cureus Mar 2024Chylothorax is defined as a pleural effusion with triglyceride levels greater than 110 mg/dL and/or chylomicrons present in the pleural fluid. A chylothorax may be...
Chylothorax is defined as a pleural effusion with triglyceride levels greater than 110 mg/dL and/or chylomicrons present in the pleural fluid. A chylothorax may be classified as traumatic or nontraumatic, with malignancy being the most common cause of atraumatic chylothoraces. Herein, we present the case of a 63-year-old woman with a past medical history of a mediastinal teratoma and stage III colon adenocarcinoma who presented to the emergency room with new-onset shortness of breath. A week prior to presentation, she was diagnosed with metastatic renal cell carcinoma after a retrocrural lymph node was biopsied. In the emergency department, a chest X-ray revealed a large right-sided pleural effusion, which was later diagnosed as a chylothorax based on pleural fluid analysis. Thoracentesis was performed and the patient was sent home. Three days later, the patient returned after experiencing palpitations and shortness of breath. The patient was diagnosed with recurrent chylothorax after a repeat chest X-ray and thoracentesis. The patient was ultimately treated with chemical pleurodesis. To the best of our knowledge, this case is the only reported chylothorax due to renal cell carcinoma metastasis reported in the literature. It describes the presentation and subsequent successful treatment of this rare condition with chemical pleurodesis.
PubMed: 38562359
DOI: 10.7759/cureus.55363 -
The Clinical Respiratory Journal Mar 2024Pleural effusions are known to occur in many cases of COVID-19. Data on typical characteristics of COVID-19-associated pleural effusions are limited. The goal of this...
INTRODUCTION
Pleural effusions are known to occur in many cases of COVID-19. Data on typical characteristics of COVID-19-associated pleural effusions are limited. The goal of this project was to characterize the pleural fluid from patients with COVID-19.
METHODS
We retrospectively collected electronic medical record data from adults hospitalized at a large metropolitan hospital system with COVID-19 infection who had a pleural effusion and a thoracentesis performed. We assessed pleural fluid characteristics and applied Light's criteria.
RESULTS
We identified 128 effusions from 106 unique patients; 45.4% of the effusions had fluid/serum protein ratio greater than 0.5, 33.9% had fluid/serum lactate dehydrogenase (LDH) greater than 0.6, and 56.2% had fluid LDH greater than 2/3 of the serum upper limit of normal. Altogether, 68.5% of effusions met at least one of these three characteristics and therefore were exudative by Light's criteria. The white blood cell (WBC) differential was predominantly lymphocytic (mean 42.8%) or neutrophilic (mean 28.7%); monocytes (mean 12.7%) and eosinophils (mean 2.5%) were less common.
CONCLUSION
We demonstrate that 68.5% of pleural effusions in patients with COVID-19 infection were exudative and hypothesize that COVID-19-associated pleural effusions are likely to be exudative with WBC differential more likely to be predominantly lymphocytic.
Topics: Adult; Humans; Retrospective Studies; COVID-19; Exudates and Transudates; Pleural Effusion; Thoracentesis
PubMed: 38529671
DOI: 10.1111/crj.13744 -
Journal of Ultrasonography Feb 2024This study aimed to examine the feasibility and potential benefits of an optical see-through head-mounted display (OST-HMD) during real-time ultrasound-guided...
AIM
This study aimed to examine the feasibility and potential benefits of an optical see-through head-mounted display (OST-HMD) during real-time ultrasound-guided thoracentesis simulations.
MATERIAL AND METHODS
Six physicians performed a thoracentesis simulation using an OST-HMD and a wireless image transmission system. The time required, puncture needle visibility, pleural fluid collection success rate, and head movement during the procedure using a smart glass equipped with an inertial measurement unit were all recorded and compared with and without the HMD.
RESULTS
Study participants successfully extracted effusions in all procedures. The use of OST-HMD did not significantly affect the time of the procedure, but notably decreased the horizontal and vertical head movements during the procedure.
CONCLUSIONS
The study demonstrated the feasibility of using an OST-HMD in a simulated real-time ultrasound-guided thoracentesis procedure and showed the potential of HMD in thoracentesis to improve ergonomics and accuracy. Further research is necessary to confirm these findings.
PubMed: 38528938
DOI: 10.15557/jou.2024.0012