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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. -
Unusual Case of Primary Spontaneous Hemopneumothorax in a Young Man with Atypical Tension Pneumothorax: a Case Report Youwen Chen* and Zhijian Guo
Chen and Guo Journal of Medical Case Reports (2018) 12:188 https://doi.org/10.1186/s13256-018-1732-x CASE REPORT Open Access Unusual case of primary spontaneous hemopneumothorax in a young man with atypical tension pneumothorax: a case report Youwen Chen* and Zhijian Guo Abstract Background: Spontaneous life-threatening hemopneumothorax is an atypical but treatable entity of unexpected circulatory collapse in young patients, affecting 0.5–11.6% of patients with primary spontaneous pneumothorax. Spontaneous pneumothorax is a well-documented disorder with a classic clinical presentation of acute onset chest pain and shortness of breath. This disorder might be complicated by the development of hemopneumothorax or tension pneumothorax. Case presentation: A 23-year-old Asian man was referred to the emergency room of Xiamen Chang Gung Memorial Hospital with a 1-day history of right-sided chest pain that had been aggravated for 1 hour. A physical examination revealed a young man who was awake and alert but in mild to moderate painful distress. His vital parameters were relatively stable at first. The examining physician noted slight tenderness along the right posterolateral chest wall along the eighth and tenth ribs. Primary spontaneous pneumothorax was considered, and a standing chest X-ray confirmed the diagnosis. A right thoracostomy tube was immediately placed under sterile conditions, and he was referred to the respiratory service. While in the respiratory department, approximately 420 mL of blood was drained from the thoracostomy tube over 15 minutes. Our patient developed obvious hemodynamic instability with hypovolemic shock and was subsequently admitted to the cardiothoracic surgical ward after fluid resuscitation. -
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 -
A Comparative Study of Pneumomediastinums Based on Clinical Experience
ORIGINAL ARTICLE A comparative study of pneumomediastinums based on clinical experience Ersin Sapmaz, M.D.,1 Hakan Işık, M.D.,1 Deniz Doğan, M.D.,2 Kuthan Kavaklı, M.D.,1 Hasan Çaylak, M.D.1 1Department of Thoracic Surgery, Gülhane Training and Research Hospital, Ankara-Turkey 2Department of Pulmonology, Gülhane Training and Research Hospital, Ankara-Turkey ABSTRACT BACKGROUND: Pneumomediastinum (PM) is the term which defines the presence of air in the mediastinum. PM has also been described as mediastinal emphysema. PM is divided into two subgroups called as Spontaneous PM (SPM) and Secondary PM (ScPM). METHODS: A retrospective comparative study of the PM diagnosed between February 2010 and July 2018 is presented. Forty patients were compared. Clinical data on patient history, physical characteristics, symptoms, findings of examinations, length of the hospital stay, treatments, clinical time course, recurrence and complications were investigated carefully. Patients with SPM, Traumatic PM (TPM) and Iatrogenic PM (IPM) were compared. RESULTS: SPM was identified in 14 patients (35%). In ScPM group, TPM was identified in 16 patients (40%), and IPM was identified in 10 patients (25%). On the SPM group, the most frequently reported symptoms were chest pain, dyspnea, subcutaneous emphysema and cough. CT was performed to all patients to confirm the diagnosis and to assess the possible findings. All patients prescribed pro- phylactic antibiotics to prevent mediastinitis. CONCLUSION: The present study aimed to evaluate the clinical differences and managements of PMs in trauma and non-trauma patients. The clinical spectrum of pneumomediastinum may vary from benign mediastinal emphysema to a fatal mediastinitis due to perforation of mediastinal structures. -
Tuberculosis Mediastinal Fibrosis Misdiagnosed As Chronic Bronchitis for 10 Years: a Case Report
1183 Letter to the Editor Tuberculosis mediastinal fibrosis misdiagnosed as chronic bronchitis for 10 years: a case report Wei-Wei Gao, Xia Zhang, Zhi-Hao Fu,Wei-Yi Hu, Xiang-Rong Zhang, Guang-Chuan Dai, Yi Zeng Department of Tuberculosis of Three, Nanjing Public Health Medical Center, Nanjing Second Hospital, Nanjing Hospital Affiliated to Nanjing University of Traditional Chinese Medicine, Nanjing 211132, China Correspondence to: Dr. Yi Zeng. Department of Tuberculosis of Three, Nanjing Public Health Medical Center, Nanjing Second Hospital, Nanjing Hospital Affiliated to Nanjing University of Traditional Chinese Medicine, No. 1, Kangfu Road, Nanjing 211132, China. Email: [email protected]. Submitted Feb 27, 2019. Accepted for publication Jun 19, 2019. doi: 10.21037/qims.2019.06.13 View this article at: http://dx.doi.org/10.21037/qims.2019.06.13 Background over previous 2 months. All vital signs at presentation were normal (temperature: 37.6 , heart rate: 97/min, blood Mediastinal fibrosis (MF, or fibrosing mediastinitis) is a rare pressure: 155/95 mmHg, saturation: 95%). Clinical physical condition characterized by rapid increase of fibrous tissues in ℃ examination revealed a lip purpura and reduced breath the mediastinum and is often associated with granulomatous sound in the right lung. diseases such as histoplasmosis, tuberculosis, sarcoidosis, and other fibroinflammatory and autoimmune diseases (1-3). It can cause compression and obliteration of vital mediastinal Laboratory tests structures, e.g., trachea, esophagus, and great vessels (4,5). Blood test results were as follows: blood cell count and Given that the disease is rare and its clinical symptoms liver and kidney function normal. -
Mediastinitis and Bilateral Pleural Empyema Caused by an Odontogenic Infection
Radiol Oncol 2007; 41(2): 57-62. doi:10.2478/v10019-007-0010-0 case report Mediastinitis and bilateral pleural empyema caused by an odontogenic infection Mirna Juretic1, Margita Belusic-Gobic1, Melita Kukuljan3, Robert Cerovic1, Vesna Golubovic2, David Gobic4 1Clinic for Oral and Maxillofacial Surgery, 2Clinic for Anaesthesiology and Reanimatology, 3Department of Radiology, 4Clinic for Internal Medicine, Clinical hospital, Rijeka, Croatia Background. Although odontogenic infections are relatively frequent in the general population, intrathoracic dissemination is a rare complication. Acute purulent mediastinitis, known as descending necrotizing mediastin- itis (DNM), causes high mortality rate, even up to 40%, despite high efficacy of antibiotic therapy and surgical interventions. In rare cases, unilateral or bilateral pleural empyema develops as a complication of DNM. Case report. This case report presents the treatment of a young, previously healthy patient with medias- tinitis and bilateral pleural empyema caused by an odontogenic infection. After a neck and pharynx re-inci- sion, and as CT confirmed propagation of the abscess to the thorax, thoracotomy was performed followed by CT-controlled thoracic drainage with continued antibiotic therapy. The patient was cured, although the recognition of these complications was relatively delayed. Conclusions. Early diagnosis of DNM can save the patient, so if this severe complication is suspected, thoracic CT should be performed. Key words: mediastinitis; empyema, pleural; periapical abscess – complications Introduction rare complication of acute mediastinitis.1-6 Clinical manifestations of mediastinitis are Acute suppurative mediastinitis is a life- frequently nonspecific. If the diagnosis of threatening infection infrequently occur- mediastinitis is suspected, thoracic CT is ring as a result of the propagation of required regardless of negative chest X-ray. -
Catamenial Hemoptysis: a Case Report
Henry Ford Hospital Medical Journal Volume 34 Number 1 Article 14 3-1986 Catamenial Hemoptysis: A Case Report Paul S. Harkaway Michael S. Eichenhorn Follow this and additional works at: https://scholarlycommons.henryford.com/hfhmedjournal Part of the Life Sciences Commons, Medical Specialties Commons, and the Public Health Commons Recommended Citation Harkaway, Paul S. and Eichenhorn, Michael S. (1986) "Catamenial Hemoptysis: A Case Report," Henry Ford Hospital Medical Journal : Vol. 34 : No. 1 , 68-69. Available at: https://scholarlycommons.henryford.com/hfhmedjournal/vol34/iss1/14 This Article is brought to you for free and open access by Henry Ford Health System Scholarly Commons. It has been accepted for inclusion in Henry Ford Hospital Medical Journal by an authorized editor of Henry Ford Health System Scholarly Commons. Catamenial Hemoptysis: A Case Report Paul S. Harkaway, MD,* and Michael S. Eichenhorn, MD* A young woman presented with recurrent hemoptysis temporally associated with menstruation. Catamenial hemoptysis, an extremely uncommon disorder, is usually caused by the presence of ectopic endometrial tissue within the lung. The use of progesterone suppressed menstruation and hemoptysis during four months of treatment. Chest x-ray was normal. (Henry Ford Hosp Med J 1986:34:68-9) he differential diagnosis of hemoptysis is fairly limited. endobronchial lesion was visualized. The patient had no symptoms of TFrequently in the middle-aged and elderly it signals a se pelvic endometriosis and had no prior pregnancy, pelvic infection, or rious underlying process such as bronchogenic neoplasm. In the pelvic procedures. younger patient the differential diagnosis is even shorter but still Hemoptysis recuned with each mensmial period until administration can reflect serious pathology. -
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%). -
Pneumothorax Schema Narration Slide 1
Pneumothorax Schema Narration Slide 1: Welcome back Clinical Problem Solvers! My name is Gurleen Kaur, and I am a fourth year medical student at Albany Medical College in NY. Slide 2: I’m so excited to discuss a schema for pneumothorax with all of you today. A pneumothorax occurs when air enters into the pleural space which can result in partial or complete collapse of the lung. It should be suspected in patients who present with acute dyspnea and classically have pleuritic chest pain. Slide 3: Physical exam findings may not be evident or can be limited, but a large pneumothorax can lead to decreased chest excursion, diminished breath sounds, absent tactile fremitus, and hyper resonance to percussion. Chest radiography is the most common diagnostic imaging modality used for stable patients, with x-ray revealing a visceral pleural line and limited bronchovascular markings beyond the pleural edge. However, remember that air moves to the least dependent portion of the lung, and the radiographic appearance of a pneumothorax can therefore depend on the patient’s position. Let’s start with an initial approach to causes of pneumothorax. Slide 4: Pneumothorax can be classified as traumatic or spontaneous. Any type of pneumothorax can progress to a tension pneumothorax which is life threatening. Tension pneumothorax occurs as air in the pleural space creates a one-way valve, trapping air. The accumulation of air increases intrapleural pressure causing further lung collapse. Tracheal deviation away from the affected side along with hemodynamic compromise suggests a tension pneumothorax. Unstable patients with tension pneumothorax need urgent decompression with needle or tube thoracostomy. -
Clinical Study Outcome of Concurrent Occult Hemothorax and Pneumothorax in Trauma Patients Who Required Assisted Ventilation
Hindawi Publishing Corporation Emergency Medicine International Volume 2015, Article ID 859130, 6 pages http://dx.doi.org/10.1155/2015/859130 Clinical Study Outcome of Concurrent Occult Hemothorax and Pneumothorax in Trauma Patients Who Required Assisted Ventilation Ismail Mahmood,1 Zainab Tawfeek,2 Ayman El-Menyar,3,4,5 Ahmad Zarour,1 Ibrahim Afifi,1 Suresh Kumar,1 Ruben Peralta,1 Rifat Latifi,1 and Hassan Al-Thani1 1 Department of Surgery, Section of Trauma Surgery, Hamad General Hospital, P.O. Box 3050, Doha, Qatar 2Department of Emergency, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar 3Clinical Research, Section of Trauma Surgery, Hamad General Hospital, Doha, Qatar 4ClinicalMedicine,WeillCornellMedicalSchool,P.O.Box24144,Doha,Qatar 5Internal Medicine, Ahmed Maher Teaching Hospital, Cairo, Egypt Correspondence should be addressed to Ismail Mahmood; [email protected] Received 26 October 2014; Accepted 3 February 2015 Academic Editor: Seiji Morita Copyright © 2015 Ismail Mahmood et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. The management and outcomes of occult hemopneumothorax in blunt trauma patients who required mechanical ventilation are not well studied. We aimed to study patients with occult hemopneumothorax on mechanical ventilation who could be carefully managed without tube thoracostomy. Methods. Chest trauma patients with occult hemopneumothorax who were on mechanical ventilation were prospectively evaluated. The presence of hemopneumothorax was confirmed by CT scanning. Hospital length of stay, complications, and outcome were recorded. Results.Atotalof56chesttraumapatientswithoccult hemopneumothorax who were on ventilatory support were included with a mean age of 36 ± 13 years. -
Fibrosing Mediastinitis, Severe Pulmonary Hypertension, And
Vascular Diseases and Therapeutics Case Report ISSN: 2399-7400 Troublesome triad: fibrosing mediastinitis, severe pulmonary hypertension, and pulmonary vein stenosis Gregory W Wigger*1 and Jean Elwing2 1Resident Physician, Department of Internal Medicine, University of Cincinnati Medical Center, Cincinnati, OH 45267, USA 2Associate Professor of Medicine, Department of Pulmonary, Critical Care, and Sleep Medicine, University of Cincinnati Medical Center, Cincinnati, OH 45267, USA Abstract Fibrosing mediastinitis is a disorder of invasive and proliferative fibrous tissue growth in the mediastinum. Its occurrence is rare and cause unknown, though it has been associated with several infections. The fibrosis of mediastinal structures, particularly vasculature, results in common symptoms of cough, dyspnea and hemoptysis due to pulmonary hypertension, pulmonary edema, and parenchyma fibrosis. Progression of disease carries a high mortality rate and causes of death are typically due to cor pulmonale,pulmonary infections and respiratory failure. Several medical treatments and surgical procedures have been unsuccessful; however the use of endovascular stenting is showing promising results. Early recognition and diagnosis are essential to provide patients with the best chance of survival and management options.We review the case of a 43 year-old female diagnosed with fibrosing mediastinitis and sequelae of pulmonary vein stenosis and pulmonary hypertension. Unfortunately, she was a poor candidate for pulmonic vein stenting due to her unstable condition. Without treatment of the stenosis, her clinical status and pulmonary hypertension worsened. Pulmonary vasodilators resulted in pulmonary edema and diuresis resulted in hypotension. Ultimately her condition was untreatable. This case illustrates the devastating effects of advanced fibrosing mediastinitis. Clinical presentation/Course The patient’s family elected to withdraw care and the patient passed after extubation. -
Presumptive Antibiotics in Tube Thoracostomy for Traumatic
Trauma Surg Acute Care Open: first published as 10.1136/tsaco-2019-000356 on 4 November 2019. Downloaded from Open access Plenary paper Presumptive antibiotics in tube thoracostomy for traumatic hemopneumothorax: a prospective, Multicenter American Association for the Surgery of Trauma Study Alan Cook ,1 Chengcheng Hu,2 Jeanette Ward,3 Susan Schultz,4 Forrest O’Dell Moore III,5 Geoffrey Funk,6 Jeremy Juern,7 David Turay,8 Salman Ahmad,9 Paola Pieri,10 Steven Allen,11 John Berne,12 for the AAST Antibiotics in Tube Thoracostomy Study Group For numbered affiliations see ABSTRact a hemothorax, pneumothorax, or hemopneu- end of article. Background Thoracic injuries are common in trauma. mothorax (HPTX).1–4 Although no statistics are Approximately one- third will develop a pneumothorax, available for the number of post- traumatic tube Correspondence to hemothorax, or hemopneumothorax (HPTX), usually with thoracostomies (TT) performed in the USA annu- Dr Forrest O’Dell Moore III, John Peter Smith Healthcare Network, concomitant rib fractures. Tube thoracostomy (TT) is the ally, this commonly performed procedure remains Fort Worth, TX 76104, USA; standard of care for these conditions, though TTs expose the first- line treatment for drainage of the pleural fmoore@ jpshealth. org the patient to the risk of infectious complications. The cavity. controversy regarding antibiotic prophylaxis at the time It is well documented that TTs placed in the Presented at the American trauma setting are associated with increased Association for the Surgery of of TT placement remains unresolved. This multicenter 5 6 Trauma 77th Annual Meeting, study sought to reconcile divergent evidence regarding hospital length of stay (LOS), morbidity, and cost.