Spontaneous Chylothorax Following Septic Pulmonary Embolization
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Pleural Effusion and Ventilation/Perfusion Scan Interpretation for Acute Pulmonary Embolus
ventricular function by radionuclide angiography during exercise in normal subjects 33. Verani MS. Myocardial perfusion imaging versus two-dimensional echocardiography: and patients with chronic coronary heart disease. J Am Coll Cardiol 1983;1:1518- comparative value in the diagnosis of coronary artery disease. J NucÃCardiol 1529. 1994;1:399-414. 29. Adam WE. Tarkowska A, Bitter F, Stauch M, Geffers H. Equilibrium (gated) 34. Foster T, McNeill AJ, Salustri A, et al. Simultaneous dobutamine stress echocardiog radionuclide ventriculography. Cardiovasc Radial 1979;2:161-173. raphy and technetium-99m SPECT in patients with suspected coronary artery disease. 30. Hurwitz RA, TrêvesS, Kuroc A. Right ventricular and left ventricular ejection fraction J Am Coll Cardiol I993;21:1591-I596. in pediatrie patients with normal hearts: first pass radionuclide angiography. Am 35. Marwick TH, D'Hondt AM, Mairesse GH, Baudhuin T, Wijins W, Detry JM, Meiin Heart J 1984;107:726-732. 31. Freeman ML, Palac R, Mason J, et al. A comparison of dobutamine infusion and JA. Comparative ability of dobutamine and exercise stress in inducing myocardial ischemia in active patients. Br Heart J 1994:72:31-38. supine bicycle exercise for radionuclide cardiac stress testing. Clin NucÃMed 1984:9:251-255. 36. Senior R, Sridhara BS, Anagnostou E, Handler C, Raftery EB, Lahiri A. Synergistic 32. Cohen JL, Greene TO, Ottenweller J, Binebaum SZ, Wilchfort SD, Kim CS. value of simultaneous stress dobutamine sestamibi single-photon-emission computer Dobutamine digital echocardiography for detecting coronary artery disease. Am J ized tomography and echocardiography in the detection of coronary artery disease. -
Chylothorax After Left Side Pneumothorax Surgery Managed by OK-432 Pleurodesis: an Effective Alternative
View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Elsevier - Publisher Connector Available online at www.sciencedirect.com ScienceDirect Journal of the Chinese Medical Association 77 (2014) 653e655 www.jcma-online.com Case Report Chylothorax after left side pneumothorax surgery managed by OK-432 pleurodesis: An effective alternative Sheng-Yang Huang a, Chou-Ming Yeh b, Chia-Man Chou a,c,*, Hou-Chuan Chen a a Division of Pediatric Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, ROC b Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan, ROC c National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC Received June 13, 2013; accepted September 23, 2013 Abstract Chylothorax, a relatively rare complication of thoracic surgery, mostly occurs on the right side. We present a 16-year-old male who received thoracoscopic surgery for left spontaneous pneumothorax. Chylothorax developed on the postoperative 2nd day and resolved after diet control on the 4th day. Unfortunately, chylothorax recurred 2 weeks later. Chest drainage and nil per os with total parental nutrition were given but in vain. Thereafter, chemical pleurodesis with OK-432 was performed. Chylothorax resolved on the next day. The relevant literature is reviewed and possible pathogenesis clarified. Copyright © 2014 Elsevier Taiwan LLC and the Chinese Medical Association. All rights reserved. Keywords: chylothorax; pleurodesis; pneumothorax 1. Introduction 2. Case Report Postoperative chylothorax is infrequent but potentially A 16-year-old male patient had the history of left chest pain life-threatening and time-consuming to manage. Associated for 5 days. -
Section 8 Pulmonary Medicine
SECTION 8 PULMONARY MEDICINE 336425_ST08_286-311.indd6425_ST08_286-311.indd 228686 111/7/121/7/12 111:411:41 AAMM CHAPTER 66 EVALUATION OF CHRONIC COUGH 1. EPIDEMIOLOGY • Nearly all adult cases of chronic cough in nonsmokers who are not taking an ACEI can be attributed to the “Pathologic Triad of Chronic Cough” (asthma, GERD, upper airway cough syndrome [UACS; previously known as postnasal drip syndrome]). • ACEI cough is idiosyncratic, occurrence is higher in female than males 2. PATHOPHYSIOLOGY • Afferent (sensory) limb: chemical or mechanical stimulation of receptors on pharynx, larynx, airways, external auditory meatus, esophagus stimulates vagus and superior laryngeal nerves • Receptors upregulated in chronic cough • CNS: cough center in nucleus tractus solitarius • Efferent (motor) limb: expiratory and bronchial muscle contraction against adducted vocal cords increases positive intrathoracic pressure 3. DEFINITION • Subacute cough lasts between 3 and 8 weeks • Chronic cough duration is at least 8 weeks 4. DIFFERENTIAL DIAGNOSIS • Respiratory tract infection (viral or bacterial) • Asthma • Upper airway cough syndrome (postnasal drip syndrome) • CHF • Pertussis • COPD • GERD • Bronchiectasis • Eosinophilic bronchitis • Pulmonary tuberculosis • Interstitial lung disease • Bronchogenic carcinoma • Medication-induced cough 5. EVALUATION AND TREATMENT OF THE COMMON CAUSES OF CHRONIC COUGH • Upper airway cough syndrome: rhinitis, sinusitis, or postnasal drip syndrome • Presentation: symptoms of rhinitis, frequent throat clearing, itchy -
Diagnosing Pulmonary Embolism M Riedel
309 Postgrad Med J: first published as 10.1136/pgmj.2003.007955 on 10 June 2004. Downloaded from REVIEW Diagnosing pulmonary embolism M Riedel ............................................................................................................................... Postgrad Med J 2004;80:309–319. doi: 10.1136/pgmj.2003.007955 Objective testing for pulmonary embolism is necessary, embolism have a low long term risk of subse- quent VTE.2 5–7 because clinical assessment alone is unreliable and the consequences of misdiagnosis are serious. No single test RISK FACTORS AND RISK has ideal properties (100% sensitivity and specificity, no STRATIFICATION risk, low cost). Pulmonary angiography is regarded as the The factors predisposing to VTE broadly fit Virchow’s triad of venous stasis, injury to the final arbiter but is ill suited for diagnosing a disease vein wall, and enhanced coagulability of the present in only a third of patients in whom it is suspected. blood (box 1). The identification of risk factors Some tests are good for confirmation and some for aids clinical diagnosis of VTE and guides decisions about repeat testing in borderline exclusion of embolism; others are able to do both but are cases. Primary ‘‘thrombophilic’’ abnormalities often non-diagnostic. For optimal efficiency, choice of the need to interact with acquired risk factors before initial test should be guided by clinical assessment of the thrombosis occurs; they are usually discovered after the thromboembolic event. Therefore, the likelihood of embolism and by patient characteristics that risk of VTE is best assessed by recognising the may influence test accuracy. Standardised clinical presence of known ‘‘clinical’’ risk factors. estimates can be used to give a pre-test probability to However, investigations for thrombophilic dis- orders at follow up should be considered in those assess, after appropriate objective testing, the post-test without another apparent explanation. -
Venous Air Embolism, Result- Retrospective Study of Patients with Venous Or Arterial Ing in Prompt Hemodynamic Improvement
Ⅵ REVIEW ARTICLE David C. Warltier, M.D., Ph.D., Editor Anesthesiology 2007; 106:164–77 Copyright © 2006, the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins, Inc. Diagnosis and Treatment of Vascular Air Embolism Marek A. Mirski, M.D., Ph.D.,* Abhijit Vijay Lele, M.D.,† Lunei Fitzsimmons, M.D.,† Thomas J. K. Toung, M.D.‡ exogenously delivered gas) from the operative field or This article has been selected for the Anesthesiology CME Program. After reading the article, go to http://www. other communication with the environment into the asahq.org/journal-cme to take the test and apply for Cate- venous or arterial vasculature, producing systemic ef- gory 1 credit. Complete instructions may be found in the fects. The true incidence of VAE may be never known, CME section at the back of this issue. much depending on the sensitivity of detection methods used during the procedure. In addition, many cases of Vascular air embolism is a potentially life-threatening event VAE are subclinical, resulting in no untoward outcome, that is now encountered routinely in the operating room and and thus go unreported. Historically, VAE is most often other patient care areas. The circumstances under which phy- associated with sitting position craniotomies (posterior sicians and nurses may encounter air embolism are no longer fossa). Although this surgical technique is a high-risk limited to neurosurgical procedures conducted in the “sitting procedure for air embolism, other recently described position” and occur in such diverse areas as the interventional radiology suite or laparoscopic surgical center. Advances in circumstances during both medical and surgical thera- monitoring devices coupled with an understanding of the peutics have further increased concern about this ad- pathophysiology of vascular air embolism will enable the phy- verse event. -
An Interesting Case of Undiagnosed Pleural Effusion Case Report
Amit Panjwani, Thuraya Zaid [email protected] Pulmonary Medicine, Salmaniya Medical Complex, Manama, Bahrain. An interesting case of undiagnosed pleural effusion Case report Pleural effusions are commonly encountered in the Investigations revealed a haemoglobin level Cite as: Panjwani A, Zaid T. clinical practise of both respiratory and nonrespiratory of 16.4 g⋅dL−1, and total leukocyte count of An interesting case of specialists. An estimated 1–1.5 million new cases in 8870 cells⋅mm−3 with a differential count of 62% undiagnosed pleural effusion. the USA and 200 000–250 000 new cases of pleural neutrophils, 28% lymphocytes, 7% monocytes, 2% Breathe 2017; 13: e46–e52. effusions are reported from the UK each year [1]. eosinophils and 1% basophils. The platelet count Analysis of the relevant clinical history, physical was 160 000 cells⋅mm−3. Creatinine, electrolytes examination, chest radiography and diagnostic and liver function tests were normal. The ECG was thoracentesis is useful in identifying the cause of unremarkable and cardiac enzymes were within pleural effusion in majority of the cases [2]. In a few normal limits. Chest radiograph (figure 1) showed a cases, the aetiology may be unclear after the initial mild, right-sided pleural effusion, blunting of the left assessment. The list of diseases that may account for costophrenic angle, no shift of mediastinal position a persistent undiagnosed pleural effusion is long [3]. and no lung parenchymal opacities. We present an interesting case of undiagnosed pleural effusion that was encountered in our hospital. R Case presentation A 33-year-old male presented to our hospital with a history of sudden-onset, pleuritic, right-sided chest pain of 2 days’ duration. -
Diagnosis of Chronic Thromboembolic Pulmonary Hypertension After Acute Pulmonary Embolism
Early View Review Diagnosis of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism Fredrikus A. Klok, Francis Couturaud, Marion Delcroix, Marc Humbert Please cite this article as: Klok FA, Couturaud F, Delcroix M, et al. Diagnosis of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism. Eur Respir J 2020; in press (https://doi.org/10.1183/13993003.00189-2020). This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Copyright ©ERS 2020 Diagnosis of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism Fredrikus A. Klok, Francis Couturaud F2, Marion Delcroix M3, Marc Humbert4-6 1 Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands 2 Département de Médecine Interne et Pneumologie, Centre Hospitalo-Universitaire de Brest, Univ Brest, EA 3878, CIC INSERM1412, Brest, France 3 Department of Respiratory Diseases, University Hospitals and Respiratory Division, Department of Chronic Diseases, Metabolism & Aging, KU Leuven – University of Leuven, Leuven, Belgium 4 Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France 5 Service de Pneumologie et Soins Intensifs Respiratoires, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France 6 INSERM UMR S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France Corresponding author: Frederikus A. Klok, MD, FESC; Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands; Albinusdreef 2, 2300RC, Leiden, the Netherlands; Phone: +31- 715269111; E-mail: [email protected] Abstract Chronic thromboembolic pulmonary hypertension (CTEPH) is the most severe long-term complication of acute pulmonary embolism (PE). -
Chylothorax As Rare Manifestation of Pleural Involvement in Waldenström Macroglobulinemia: Mechanisms and Management
210 Lymphology 49 (2016) 210-217 CHYLOTHORAX AS RARE MANIFESTATION OF PLEURAL INVOLVEMENT IN WALDENSTRÖM MACROGLOBULINEMIA: MECHANISMS AND MANAGEMENT G. Leoncini, C.C. Campisi, G. Fraternali Orcioni, F. Patrone, F. Ferrando, C. Campisi Unit of Thoracic Surgery (GL), Unit of General & Lymphatic Surgery - Microsurgery and Department of Surgical Sciences and Integrated Diagnostics (DISC) (CCC,CC), Unit of Pathology (GFO), Unit of Internal Medicine and Medical Oncology and Department of Internal Medicine (DIMI) (FP,FF), IRCCS San Martino University Hospital - National Institute for Cancer Research, and University School of Medicine and Pharmaceutics, Genoa, Italy ABSTRACT increase of IgM level. Pleuropulmonary involvement is reported to be rare (from 0 Here we report the clinical, pathological, to 5% of cases), and it usually occurs during and immunological features of a rare case of the late phase of the disease (3,4). In such a Waldenström macroglobulinemia (WM) with scenario, chylothorax is rarely observed in pleural infiltrations. An atypical chylothorax, WM patients; indeed only seven cases have successfully treated by videothoracoscopy, been reported in the literature (5-11). We represented the main clinical feature of this report the case of a 66-year old man with the case of low-grade lymphoplasmacytic main clinical presentation of pleural lymphoma. Pleuropulmonary manifestations infiltrations with right chylothorax following are rare (from 0 to 5% of cases) in WM, with immunochemotherapy. An extra-bone chylothorax observed in just seven patients marrow involvement was suggested by both worldwide. In addition to describing this pleural fluid examination and multiple uncommon clinical presentation, we investi- pleural biopsies in parallel with a marked gate hypothetical pathogenetic mechanisms decrease of bone marrow (BM) participation causing chylothorax and through an up-to- (tumor cells in BM from 70% to 8%). -
Pulmonary Embolism a Pulmonary Embolism Occurs When a Blood Clot Moves Through the Bloodstream and Becomes Lodged in a Blood Vessel in the Lungs
Pulmonary Embolism A pulmonary embolism occurs when a blood clot moves through the bloodstream and becomes lodged in a blood vessel in the lungs. This can make it hard for blood to pass through the lungs to get oxygen. Diagnosing a pulmonary embolism can be difficult because half of patients with a clot in the lungs have no symptoms. Others may experience shortness of breath, chest pain, dizziness, and possibly swelling in the legs. If you have a pulmonary embolism, you need medical treatment right away to prevent a blood clot from blocking blood flow to the lungs and heart. Your doctor can confirm the presence of a pulmonary embolism with CT angiography, or a ventilation perfusion (V/Q) lung scan. Treatment typically includes medications to thin the blood or placement of a filter to prevent the movement of additional blood clots to the lungs. Rarely, drugs are used to dissolve the clot or a catheter-based procedure is done to remove or treat the clot directly. What is a pulmonary embolism? Blood can change from a free flowing fluid to a semi-solid gel (called a blood clot or thrombus) in a process known as coagulation. Coagulation is a normal process and necessary to stop bleeding and retain blood within the body's vessels if they are cut or injured. However, in some situations blood can abnormally clot (called a thrombosis) within the vessels of the body. In a condition called deep vein thrombosis, clots form in the deep veins of the body, usually in the legs. A blood clot that breaks free and travels through a blood vessel is called an embolism. -
Pulmonary Embolism in the First Trimester of Pregnancy
Obstetrics & Gynecology International Journal Case Report Open Access Pulmonary embolism in the first trimester of pregnancy Summary Volume 11 Issue 1 - 2020 Pulmonary embolism in the first trimester of pregnancy without a known medical history Orfanoudaki Irene M is a very rare complication, which if it is misdiagnosed and left untreated leads to sudden Obstetric Gynecology, University of Crete, Greece pregnancy-related death. The sings and symptoms in this trimester are no specific. The causes for pulmonary embolism are multifactorial but in the first trimester of pregnancy, Correspondence: Orfanoudaki Irene M, Obstetric the most important causes are hereditary factors. Many times the pregnant woman ignores Gynecology, University of Crete, Greece, 22 Archiepiskopou her familiar hereditary history and her hemostatic system is progressively activated for the Makariou Str, 71202, Heraklion, Crete, Greece, Tel +30 hemostatic challenge of pregnancy and delivery. The hemostatic changes produce enhance 6945268822, +302810268822, Email coagulation and formation of micro-thrombi or thrombi and prompt diagnosis is crucial to prevent and treat pulmonary embolism saving the lives of a pregnant woman and her fetus. Received: January 19, 2020 | Published: January 28, 2020 Keywords: pregnancy, pulmonary embolism, mortality, diagnosis, risk factors, arterial blood gases, electrocardiogram, ventilation perfusion scan, computed tomography pulmonary angiogram, magnetic resonanance, compression ultrasonography, echocardiogram, D-dimers, troponin, brain -
Acute Pulmonary Embolism in Patients with and Without COVID-19
Journal of Clinical Medicine Article Acute Pulmonary Embolism in Patients with and without COVID-19 Antonin Trimaille 1,2 , Anaïs Curtiaud 1, Kensuke Matsushita 1,2 , Benjamin Marchandot 1 , Jean-Jacques Von Hunolstein 1 , Chisato Sato 1,2, Ian Leonard-Lorant 3, Laurent Sattler 4 , Lelia Grunebaum 4, Mickaël Ohana 3 , Patrick Ohlmann 1 , Laurence Jesel 1,2 and Olivier Morel 1,2,* 1 Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, 67000 Strasbourg, France; [email protected] (A.T.); [email protected] (A.C.); [email protected] (K.M.); [email protected] (B.M.); [email protected] (J.-J.V.H.); [email protected] (C.S.); [email protected] (P.O.); [email protected] (L.J.) 2 INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, FMTS, 67000 Strasbourg, France 3 Radiology Department, Nouvel Hôpital Civil, Strasbourg University Hospital, 67000 Strasbourg, France; [email protected] (I.L.-L.); [email protected] (M.O.) 4 Haematology and Haemostasis Laboratory, Centre for Thrombosis and Haemostasis, Nouvel Hôpital Civil, Strasbourg University Hospital, 67000 Strasbourg, France; [email protected] (L.S.); [email protected] (L.G.) * Correspondence: [email protected] Abstract: Introduction. Acute pulmonary embolism (APE) is a frequent condition in patients with Citation: Trimaille, A.; Curtiaud, A.; COVID-19 and is associated with worse outcomes. Previous studies suggested an immunothrombosis Matsushita, K.; Marchandot, B.; instead of a thrombus embolism, but the precise mechanisms remain unknown. -
COVID-19 Associated Pulmonary Embolism in Pediatric Patients
Prepublication Release A N O F F I C I A L J O U R N A L O F T H E A M E R I C A N A C A D E M Y O F P E D I A T R I C S COVID-19 Associated Pulmonary Embolism in Pediatric Patients Melissa Chima, Duane Williams, Neal J. Thomas, Conrad Krawiec DOI: 10.1542/hpeds.2021-005866 Journal: Hospital Pediatrics Article Type: Original Article Citation: Chima M, et al. COVID-19 Associated Pulmonary Embolism in Pediatric Patients. Hosp Pediatr. 2021; doi: 10.1542/hpeds.2021-005866 This is a prepublication version of an article that has undergone peer review and been accepted for publication but is not the final version of record. This paper may be cited using the DOI and date of access. This paper may contain information that has errors in facts, figures, and statements, and will be corrected in the final published version. The journal is providing an early version of this article to expedite access to this information. The American Academy of Pediatrics, the editors, and authors are not responsible for inaccurate information and data described in this version. Downloaded©202 from1 www.aappublications.org/news American Academy byof guest Pediatrics on October 1, 2021 Prepublication Release COVID-19 Associated Pulmonary Embolism in Pediatric Patients Melissa Chima, BS1, Duane Williams, MD2, Neal J. Thomas, MD2,3, Conrad Krawiec, MD2 Authors’ Affiliations and Addresses: 1Penn State College of Medicine, 500 University Drive, P.O. Box 850, Hershey, PA, USA 17033-0850, Tel: (717)-531-5337, Fax: (717)-531-8985.