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Sample records for pulmonar pleural relato

  1. Pulmonary and pleural cysticercosis: a case report; Cisticercose pulmonar pleural: relato de um caso

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    Rodacki, Marco Antonio; Toni, Xisto A. de; Meira, Lisiane A.; Goncalves, Nelson L.; Oliveira, Godofredo G. [Hospital Santa Isabel, Blumenau, SC (Brazil); Toni, Guilherme de [Parana Univ., Curitiba, PR (Brazil). Faculdade de Medicina

    1995-07-01

    The authors report a case of disseminated cysticercosis involving the lungs, pleura, brain and subcutaneous tissues. Plain chest X-rays and chest computed tomography showed multiple round ill defined nodular lesions scattered through the lungs and pleural surface, identified as cystic lesions by ultrasound. Calcified cysticerci were visualized in the subcutaneous tissues of the arms and thorax at the plain chest X-rays. Biopsy of subcutaneous nodes was performed, which results revealed cysticercosis. Brain CT demonstrated multiple calcified intraparenchymatous lesions, associated with cystic lesions, compatible with cysticercosis. Due to the rarity of the lung involvement by cysticercosis, an open lung biopsy was performed with partial resection of the lingula and two cystic lesions, which anatomo-pathological results revealed pleural and pulmonary cysticercosis. The pleural and pulmonary involvement is extremely rare manifestation of a rather common disease, usually due to heavy infestation of Taenia solium larvae. As a far as we know, we did not see clear illustration of proved lung and pleural cysticercosis fully documented in the world literature. (author). 5 refs., 7 figs.

  2. Failure to wean caused by cryptogenic fibrosing pleuritis and bilateral lung trapping: case report Falência do desmame em paciente com fibrose pleural idiopática e trapping pulmonar bilateral: relato de caso

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    Elsemiek Verweel

    2007-12-01

    Full Text Available BACKGROUND AND OBJECTIVES: Cryptogenic fibrosing pleuritis is an extremely rare disease, which can affect both lungs from a very young age. The most common finding is severe lung restriction resulting in both hypoxemic and ventilatory failure. CASE REPORT: Male patient, 26 year old with acute deterioration of chronic respiratory failure. Following admission prolonged mechanical ventilation was necessary. An atypical clinical presentation made the diagnosis difficult, but eventually cryptogenic fibrosing pleuritis and lung fibrosis were established. CONCLUSIONS: The prognostic outcome of patients with the final diagnosis of cryptogenic fibrosing pleuritis is extremely poor, especially in an advanced phase of this disease. We recommend early treatment with corticosteroids or surgical pleural decortication.JUSTIFICATIVA E OBJETIVOS: Fibrose pleural idiopática é uma doença rara e pode afetar ambos pulmões já desde uma idade precoce. O achado mais comum na fibrose pleural idiopática é uma restrição pulmonar grave que pode levar a um quadro de falência respiratória e hipoxemia. RELATO DO CASO: Paciente do sexo masculino, 26 anos, internado com reagudização de insuficiência respiratória crônica e submetido à ventilação mecânica prolongada. Após intensa investigação e uma apresentação clínica atípica, foi estabelecido o diagnóstico de fibrose pleural idiopática associado à fibrose pulmonar. CONCLUSÕES: O prognóstico de pacientes com fibrose pleural idiopática é extremamente ruim, particularmente em fase avançada da doença. Recomenda-se o tratamento precoce com corticosteróides ou decorticação pleural cirúrgica.

  3. Edema pulmonar agudo neurogênico: relato de caso

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    Brito,José Correia De Farias; Diniz,Maria Cerly Almeida; Rosas,Roberto Ramalho; Silva,José Alberto Gonçalves Da

    1995-01-01

    Os autores apresentam um caso de edema pulmonar agudo numa paciente de 28 anos de idade acometida de hemorragia subaracnóidea secundária à rotura de aneurisma intracraniano. A sintomatologia respiratória ocorreu durante o agravamento do quadro neurológico. Alguns aspectos etiológicos e fisiopatogênicos do edema pulmonar agudo neurogênico são analisados.

  4. Embolia pulmonar na sala de cirurgia: relato de caso Embolia pulmonar en sala operatoria: relato de caso Pulmonary embolism in the operating room: case report

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    Karina Bernardi Pimenta

    2002-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Embolia pulmonar é uma complicação freqüente no período pós-operatório. O objetivo deste relato é apresentar um caso de embolia pulmonar ocorrida na sala de operação e chamar a atenção para a importância da profilaxia de trombose venosa em pacientes cirúrgicos. RELATO DO CASO: Trata-se de um paciente do sexo masculino, 55 anos e 83 kg com diagnóstico de câncer de próstata, submetido a prostatectomia supra-púbica sob anestesia geral. Ao final da cirurgia, o paciente já extubado e logo após sua passagem para a maca de transporte apresentou instabilidade hemodinâmica e diminuição da SpO2 para 80%. Foi reintubado e encaminhado para a UTI. A tomografia computadorizada mostrou imagens com aspecto de embolia pulmonar. O paciente evoluiu para óbito no 5º dia de pós-operatório. CONCLUSÕES: O elevado índice de suspeita não é suficiente para firmar o diagnóstico pois a embolia pulmonar é uma doença silenciosa e a rotina de investigação não possui elevada sensibilidade. A profilaxia precoce e adequada é a melhor estratégia.JUSTIFICATIVA Y OBJETIVOS: Embolia pulmonar es una complicación frecuente en el período pós-operatorio. El objetivo de este relato es presentar un caso de embolia pulmonar ocurrida en la sala de operación y llamar la atención para la importancia de la profilaxis de trombosis venosa en pacientes cirúrgicos. RELATO DE CASO: Se trata de un paciente del sexo masculino, 55 años y 83 kg con diagnóstico de cáncer de próstata, sometido a prostatectomia supra-púbica bajo anestesia general. Al final de la cirugía, el paciente ya entubado y luego después de pasar para la camilla de transporte presentó inestabilidad hemodinámica y diminución de la SpO2 para 80%. Fue reintubado y encaminado para la UTI. La tomografía computadorizada mostró imágenes con aspecto de embolia pulmonar. El paciente evolucionó para óbito en el 5º día de pós-operatorio. CONCLUSIONES: El

  5. Linfonodo pulmonar na paracoccidioidomicose aguda infantil (relato de um caso

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    Evanil Pires de Campos

    1992-09-01

    Full Text Available Observou-se a evolução de um linfonodo pulmonar na paracoccidioidomicose (PCM aguda infantil. Doente, masculino, 6 anos, branco, natural de Curitiba (PR, procedente de Guaratinguetá (SP, que há 3 meses desenvolveu quadro gripal, febre diária, bimodal, prolongada, precedida de calafrio, acompanhada de sudorese inodora, cefaléia frontal e anorexia. Diagnosticado e tratado como pneumonia por cinco dias, sem melhora do quadro. Há 2 meses, apresentou dor óssea nos braços e articulações do pé, com edema inflamatório e emagrecimento de 6 kg em 3 meses. Exame físico revelou: peso 20 kg; estatura 120 cm; P. A. 90/60 mmHg; facies atípica, hipoativo, palidez cutâneo-mucosa (+ +, hipotrofia muscular, adenopatiageneralizada, sopro sistólico suave em foco aórtico acessório e hepatesplenomegalia. Imunodifusão com exoantígeno glicoprotéico 43 kdpositiva (1/32. A biópsia de gânglio revelou Paracoccidioides brasiliensis. A radiologia demonstrou na primeira consulta, discreto infiltrado intersticial bilateral com linfoadenomegaliapara-hilar que desaparecu em 30 dias. Observou- se, ainda, massa tumoral mediastínica superior, hiperplasia do sistema fagocítico mononuclear e lesões osteolíticas nos 60 dias iniciais da evolução.

  6. Linfonodo pulmonar na paracoccidioidomicose aguda infantil (relato de um caso

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    Evanil Pires de Campos

    1992-09-01

    Full Text Available Observou-se a evolução de um linfonodo pulmonar na paracoccidioidomicose (PCM aguda infantil. Doente, masculino, 6 anos, branco, natural de Curitiba (PR, procedente de Guaratinguetá (SP, que há 3 meses desenvolveu quadro gripal, febre diária, bimodal, prolongada, precedida de calafrio, acompanhada de sudorese inodora, cefaléia frontal e anorexia. Diagnosticado e tratado como pneumonia por cinco dias, sem melhora do quadro. Há 2 meses, apresentou dor óssea nos braços e articulações do pé, com edema inflamatório e emagrecimento de 6 kg em 3 meses. Exame físico revelou: peso 20 kg; estatura 120 cm; P. A. 90/60 mmHg; facies atípica, hipoativo, palidez cutâneo-mucosa (+ +, hipotrofia muscular, adenopatiageneralizada, sopro sistólico suave em foco aórtico acessório e hepatesplenomegalia. Imunodifusão com exoantígeno glicoprotéico 43 kdpositiva (1/32. A biópsia de gânglio revelou Paracoccidioides brasiliensis. A radiologia demonstrou na primeira consulta, discreto infiltrado intersticial bilateral com linfoadenomegaliapara-hilar que desaparecu em 30 dias. Observou- se, ainda, massa tumoral mediastínica superior, hiperplasia do sistema fagocítico mononuclear e lesões osteolíticas nos 60 dias iniciais da evolução.The primary complex like Ghon was observed in a child's clinical roentgenographic study. C.S., white, male, 6 years old, was born in Curitiba (PR, Brazil and living in Guaratingueta (SP, Brazil, developed "common cold", bimodal diary fever, chills, shake and sweats. Dyspnea, cough with general fymphadenopathy. Foot and right shoulder artralgies. Six months ago visited a cave, equitation practice, dog and cat contacts and notransfusion, frontal sweats, fever (38.4°C. T.A. was 8/6, tachicardia in generalizated fymphadenopathy. Cardiopulmonary system was normal, mesogastric tumoral mass, hepatesplenomegaly and no ascitis. Bone marrow with eosinophilia; nodule demonstred presence of P. brasiliensis; hypoalbuminemia

  7. Malária pulmonar: aspectos na tomografia computadorizada de alta resolução - relato de caso

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    Rodrigues Rosana

    2004-01-01

    Full Text Available Neste trabalho é relatado o caso de paciente do sexo masculino, de 38 anos de idade, que desenvolveu quadro de malária com comprometimento pulmonar. A tomografia computadorizada de alta resolução evidenciou espessamento de septos interlobulares e de bainhas peribroncovasculares, com áreas esparsas de atenuação em vidro fosco e de consolidações, além de derrame pleural bilateral, aspectos compatíveis com edema pulmonar. O paciente recebeu tratamento específico, evoluindo bem e tendo alta 11 dias após a internação.

  8. Procedimento e complicações anestésicas no manejo de lavagem pulmonar total em paciente obeso com proteinose alveolar pulmonar: relato de caso

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    Helena Marta Rebelo

    2012-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O primeiro caso de proteinose alveolar pulmonar (PAP foi descrito por Rose em 1958, mas ainda é um distúrbio raro. PAP é caracterizada pela deposição de material lipoproteico secundário ao processamento anormal de surfactantes pelos macrófagos. Os pacientes podem ter dispneia progressiva e tosse, às vezes acompanhadas pelo agravamento da hipóxia, e seu curso pode variar de deterioração progressiva a melhora espontânea. Muitas terapias foram usadas, incluindo antibióticos, drenagem postural e ventilação com pressão positiva intermitente com acetilcisteína, heparina e soro fisiológico em aerossol. Atualmente, a base do tratamento é a lavagem pulmonar total (LPT. A LPT, embora seja geralmente bem-tolerada, pode estar associada a algumas complicações. RELATO DE CASO: Relatamos um caso de PAP grave durante o procedimento anestésico e as complicações no manejo da proteinose alveolar pulmonar em um paciente que havia sido submetido a múltiplas e alternadas lavagens de um dos pulmões ao longo de sete anos (os últimos três em nosso hospital, com melhora dos sintomas depois de cada tratamento.

  9. Pseudocisto pulmonar pós-traumático em jogador de futebol: relato de caso

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    Andre Nathan Costa

    2013-04-01

    Full Text Available Pseudocistos pulmonares são lesões raras que se desenvolvem no parênquima pulmonar após traumas fechados e de grande energia, cujo diagnóstico se baseia na associação da história clínica com exames de imagem. Relata-se a seguir um pseudocisto pulmonar ocorrido no parênquima contralateral ao trauma em um homem de 31 anos que apresentou episódio de hemoptise após queda durante partida de futebol.

  10. Edema pulmonar por pressão negativa após hipofisectomia transesfenoidal: relato de caso

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    Viviane Ferreira Albergaria

    2008-08-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O edema pulmonar por pressão negativa (EPPN é uma complicação incomum que evolui rapidamente após quadro agudo ou crônico de obstrução de vias aéreas. O objetivo deste relato foi apresentar um caso de EPPN após obstrução de vias aéreas superiores em paciente com acromegalia que foi submetido à hipofisectomia transesfenoidal. RELATO DO CASO: Paciente do sexo masculino, 48 anos, 80 kg, estado físico ASA III, portador de tumor de hipófise, hipertensão arterial e acromegalia, foi submetido à hipofisectomia transesfenoidal sob anestesia geral balanceada. O procedimento cirúrgico evoluiu sem intercorrências. A extubação traqueal foi realizada com o paciente em plano anestésico superficial. Evoluiu com esforço ventilatório, retração da parede abdominal, hipoxemia grave (SpO2 30%, inconsciência e disritmia cardíaca (extra-sístole ventricular e bradicardia. A ventilação com pressão positiva sob máscara facial e cânula orofaríngea foi ineficaz. O paciente foi intubado e, nesse momento, havia estertores pulmonares bilaterais com a presença de secreção rósea aerada dentro da cânula traqueal compatível com quadro de EPPN. O paciente foi encaminhado ao CTI, onde permaneceu sob ventilação mecânica por 96 horas. Recebeu alta para a enfermaria no quinto dia pós-operatório sem seqüela neurológica. CONCLUSÃO: O EPPN pode ocorrer no período pós-anestésico imediato de hipofisectomia transesfenoidal. O diagnóstico e tratamento rápidos são essenciais para uma resolução precoce e diminuição da morbidade.

  11. Edema pulmonar neurogênico: relato de dois casos Neurogenic pulmonary edema: report of two cases

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    Desanka Dragosavac

    1997-06-01

    Full Text Available O edema pulmonar neurogênico é rara e grave complicação de pacientes com traumatismo craniencefálico (TCE. Pode ocorrer também em outras patologias do sistema nervoso central, tais como acidentes vasculares cerebrais (AVC, tumores ou após crises epilépticas, entre outras. Foram avaliados 36 casos com TCE grave e quatro pacientes com AVC, internados na UTI geral, no período de janeiro a setembro 1995. Nesse intervalo de tempo foram diagnosticados dois casos de edema pulmonar neurogênico, um ocorrendo em paciente com TCE grave e outro em paciente com AVC hemorrágico. O diagnóstico foi estabelecido pelo rápido desenvolvimento de edema pulmonar, com hipoxemia grave, queda da complacência pulmonar e infiltrados difusos bilaterais sem história prévia de aspiração traqueal ou outro fator de risco para o desenvolvimento de síndrome de angústia respiratória aguda. No primeiro paciente com trauma craniencefálico, o edema neurogênico foi diagnosticado na internação, uma hora após o trauma, com concomitante reação inflamatória grave e boa evolução em três dias. O outro caso, com AVC hemorrágico, desenvolveu edema neurogênico no quarto dia após drenagem de hematoma intraparenquimatoso, evoluindo para o óbito.Neurogenic pulmonary edema is a rare and serious complication in patients with head injury. It also may develop after a variety of cerebral insults such as subarachnoid hemorrhage, brain tumors and after epileptic seizures. Thirty six patients with severe head injury and four patients with cerebrovascular insults treated in Intensive Care Unit of HC-UNICAMP from January to September 1995 were evaluated. In this period there were two patients with neurogenic pulmonary edema, one with head injury and other with intracerebral hemorrhage. Diagnosis was made by rapid onset of pulmonary edema, severe hypoxemia, decrease of pulmonary complacence and diffuse pulmonary infiltrations, without previous history of tracheal

  12. Infecção pulmonar tripla em paciente gravemente imunocomprometido por AIDS: relato de caso

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    Faucz Rafael Artigas

    2006-01-01

    Full Text Available Os autores relatam um caso de paciente do sexo masculino, 38 anos de idade, motorista, soropositivo para HIV há oito anos, sem acompanhamento, com quadro de tosse produtiva com secreção acinzentada e episódios intermitentes de dispnéia há 15 dias. Informava dois episódios pregressos de tuberculose pulmonar (1983 e 2001 tratados. A radiografia de tórax evidenciou áreas de hipotransparência nodular e broncogramas aéreos bilateralmente. A tomografia computadorizada de tórax evidenciou vários achados inespecíficos, dentre eles áreas esparsas de consolidação, cavitação, bronquiectasia, opacidade em vidro fosco, espessamento intersticial e broncogramas aéreos. A lavagem broncoalveolar evidenciou numerosas hifas com raros septos bifurcados sugestivos de Aspergillus sp. e a cultura foi positiva para Nocardia sp. e Mycobacterium tuberculosis. Foi instituída terapia com anfotericina B, sulfametoxazol-trimetoprim e anti-retrovirais. Após 20 dias, recebeu alta sem queixas pulmonares. Decorridos 15 dias, retornou com diarréia, febre, disfagia e emagrecimento importante. Foi a óbito após cinco dias, por sepse estafilocócica.

  13. Bloqueio pleural bilateral: analgesia e funções pulmonares em pós-operatório de laparotomias medianas Bloqueo pleural bilateral: analgesia y funciones pulmonares en pós-operatorio de laparotomias medianas Bilateral pleural block: analgesia and pulmonary functions in postoperative of median laparotomies

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    Karl Otto Geier

    2004-08-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Não obstante o bloqueio pleural ter sido convertido quase numa panacéia analgésica, resultados contraditórios foram publicados. O objetivo deste estudo foi observar o desempenho analgésico e espirométrico das funções pulmonares no pós-operatório imediato de 21 pacientes com o bloqueio pleural bilateral em laparotomias medianas de urgência. MÉTODO: Bloqueio pleural bilateral foi realizado em decúbito dorsal horizontal em 21 pacientes com 20 ml de bupivacaína a 0,375% com adrenalina a 1:400.000 administrados por cateter em cada hemitórax durante o pós-operatório imediato. Soluções aleatórias de bupivacaína e de solução fisiológica foram administradas por residentes ou enfermeiras que desconheciam o conteúdo das seringas, e seus desfechos analgésicos avaliados de acordo com a escala de dor Prince Henry ao comparar os valores pré e pós-bloqueio pleural bilateral. Em função da dor pós-operatória, testes espirométricos das funções pulmonares também foram determinados mediante espirômetro portátil. RESULTADOS: Analgesia pós-operatória, com duração média de 247,75 ± 75 minutos foi constatada em todos os pacientes com a bupivacaína, embora tenha persistido dor residual de menor intensidade na região suprapúbica em cinco pacientes (8% e em dois pacientes na apófise xifóide (3,2%. Nenhum efeito analgésico foi obtido com solução fisiológica. Face à dor pós-operatória, as funções pulmonares, avaliadas antes e após os bloqueios, registraram melhora com a bupivacaína na CVF (p JUSTIFICATIVA Y OBJETIVOS: No obstante el bloqueo pleural haber sido convertido casi en una panacea analgésica, fueron publicados resultados contradictorios. El objetivo de este estudio fue observar el desempeño analgésico y espirométrico de las funciones pulmonares en el pós-operatorio inmediato de 21 pacientes con el bloqueo pleural bilateral en laparotomias medianas de urgencia. M

  14. Dispneia expiratória restritiva em um gato com fibrose pulmonar idiopática: relato de caso

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    Pereira, C.O.; Costa, F.V.A.; Gomes, D.C.; Kasper, P.N.; Vieira, A.B.; Driemeier, D.

    2017-01-01

    RESUMO As doenças pulmonares intersticiais constituem um grupo de doenças difusas do parênquima pulmonar, no qual a fibrose pulmonar intersticial está incluída. Histologicamente, esta se caracteriza por hiperplasia de pneumócitos tipo II, hiperplasia ou hipertrofia de músculo liso e fibrose. Embora a patogenia da fibrose pulmonar intersticial não esteja bem elucidada, devido às semelhanças microscópicas encontradas nos pneumócitos tipo II em felinos e na forma familiar da doença em humanos, a...

  15. Manobra de recrutamento alveolar na contusão pulmonar: relato de caso e revisão da literatura Alveolar recruitment in pulmonary contusion: case report and literature review

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    Lívia Maria Vitório Trindade

    2009-03-01

    Full Text Available O tratamento da contusão pulmonar quando instituído de forma correta é bastante simples na maioria das vezes. As alterações fisiopatológicas acontecem como decorrência dos efeitos produzidos pela perda da integridade da parede torácica, acúmulo de líquidos na cavidade pleural, obstrução da via aérea e disfunção pulmonar. A manobra de recrutamento alveolar consiste na reabertura de áreas pulmonares colapsadas através do aumento da pressão inspiratória na via aérea. O objetivo deste relato foi apresentar um caso de contusão pulmonar, avaliando a efetividade da manobra de recrutamento alveolar e revisão da literatura. Paciente do sexo masculino, 33 anos, com quadro clínico de trauma de tórax bilateral e trauma crânio-encefálico, evoluiu com rebaixamento do nível de consciência, insuficiência respiratória aguda, choque hipovolêmico, hemoptise. Foi submetido a toracocentese, drenagem torácica bilateral e submetido a ventilação mecânica invasiva. Após 48 horas de ventilação mecânica invasiva, segundo os preceitos da estratégia protetora, iniciou-se manobras de recrutamento alveolar modo, Pressão controlada 10 cmH2O, freqüência respiratória 10rpm, tempo inspiratório 3.0, pressão positiva no final da expiração 30 cmH2O, FIO2 100%, durante dois minutos. Após a aplicação da manobra de recrutamento alveolar O paciente apresentou melhora pulmonar significativa da oxigenação, caracterizada por aumento da relação PaO2/FiO2, porém houve variação da mesma entre 185 a 322. Obteve alta da unidade na terapia intensiva após 22 dias e hospitalar após 32 dias da admissão. A manobra de recrutamento alveolar neste paciente apresentou resultados significativos no tratamento da contusão pulmonar, melhorando a oxigenação arterial, prevenindo o colapso alveolar e revertendo quadros de atelectasias.Treatment of pulmonary contusion when adequately established is very simple in most cases. Pathophysiological

  16. Tratamento de tromboembolismo pulmonar por aspiração percutânea do trombo: relato de caso

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    Góes Junior,Adenauer Marinho de Oliveira; Mascarenhas,Fabricio; Mourão,Guilherme de Souza; Elkis,Henrique; Pieruccetti,Marco Antônio

    2010-01-01

    O tromboembolismo pulmonar (TEP) maciço é uma importante causa de mortalidade. A principal causa de óbito é a disfunção do ventrículo direito, provocada pela alta resistência ao seu fluxo de ejeção, e a sobrevida do paciente, nessas situações, depende da pronta desobstrução das artérias pulmonares. A anticoagulação, o uso de trombolíticos e a embolectomia pulmonar representam opções terapêuticas consolidadas para diferentes cenários clínicos de TEP. A Radiologia Intervencionista representa ho...

  17. Aorticopulmonary septal defect in a dog: case report Defeito do septo aórtico-pulmonar em um cão: relato de caso

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    J.P.E. Pascon

    2010-06-01

    Full Text Available A 10-month-old intact female mixed breed dog was referred for evaluation of exercise-induced dyspnea and a low grade II/VI systolic murmur was detected. The communication between ascending aortic and pulmonary trunk was observed by detecting a continuous flow just above the semilunar valves on echoDopplercardiography and attested by surgery. After the surgical procedure, the dog was presented in good clinical conditions without exercise-induced dyspnea, reflecting the importance of an early and accurate diagnostic for the therapeutic success. This is the first Brazilian report of this rare congenital disease and the unique well succeed surgery in the veterinary literature.Na avaliação da dispneia pós-exercício em uma cadela de 10 meses de idade, não castrada e sem raça definida, foi detectado sopro sistólico leve grau II/VI. A comunicação entre a aorta ascendente e o tronco pulmonar, observada pela presença de fluxo contínuo logo abaixo das valvas semilunares, à ecoDopplercardiografia, foi confirmada pela cirurgia. Após o procedimento cirúrgico, a cadela apresentou boa condição clínica e ausência de dispneia mesmo ao exercício. Ressalta-se a importância do diagnóstico precoce e preciso para o sucesso terapêutico. Este é o primeiro relato brasileiro dessa rara doença e a única cirurgia, bem sucedida, descrita na literatura veterinária consultada.

  18. Edema pulmonar assimétrico por pressão negativa pós-obstrução de via aérea superior: relato de caso Edema pulmonar asimétrico por presión negativa pós-obstrucción aguda de vía aérea superior: relato de caso Asymmetric negative pressure pulmonary edema after acute upper airway obstruction: case report

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    Aldo José Peixoto

    2002-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Edema pulmonar por pressão negativa pós-obstrução de via aérea é atualmente uma entidade bem descrita, porém, provavelmente pouco diagnosticada e os casos pouco publicados. O objetivo deste relato é apresentar um caso de edema pulmonar por pressão negativa pós-obstrução de via aérea superior, cuja principal característica foi a assimetria do edema pulmonar, sendo muito mais acentuado no pulmão direito. RELATO DO CASO: Menino de 4 anos, 17 kg, estado físico ASA I, foi submetido a adenoamigdalectomia e cauterização de cornetos, sob anestesia geral com sevoflurano/óxido nitroso/O2. A cirurgia durou 1 hora e 30 minutos sem qualquer intercorrência. Com a superficialização da anestesia o paciente, ventilando espontaneamente, reagiu ao tubo traqueal, que foi retirado. Após isto, os esforços ventilatórios resultaram em retração da parede torácica, sem aparente movimento de ar, sendo impossível ventilá-lo com máscara facial, ocorrendo hipoxemia grave (SpO2 de 50%, necessitando ser reintubado. Neste momento foi verificado que o pulmão se encontrava mais duro e havia estertores bilateralmente, caracterizando edema pulmonar. Uma radiografia de tórax mostrou infiltrado pulmonar difuso bilateralmente, porém, com atelectasia do lobo superior direito, mostrando acentuada assimetria do edema pulmonar. O paciente teve que ser ventilado mecanicamente com PEEP durante 20 horas, quando foi extubado. Houve melhora progressiva do edema pulmonar, recebendo alta em 48 horas. CONCLUSÕES: O edema pulmonar por pressão negativa é uma entidade rara com alto grau de morbidade, pouco diagnosticada e exige do anestesiologista conhecimento atualizado e tratamento adequado. Costuma ser bilateral, raramente unilateral e excepcionalmente com expressiva assimetria como no nosso relato. A maioria dos casos é tratada com suporte ventilatório com PEEP ou CPAP, não necessitando de qualquer outra terapia. O prognóstico

  19. Edema agudo pulmonar associado à obstrução das vias aéreas: relato de caso Edema agudo pulmonar asociado a la obstrucción de las vías aéreas: relato de caso Acute pulmonary edema associated with obstruction of the airways: case report

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    Flora Margarida Barra Bisinotto

    2008-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O edema pulmonar por pressão negativa tem sido definido como edema não-cardiogênico, com transudação de líquido para o interstício pulmonar, por aumento na pressão negativa intratorácica, ocasionado pela obstrução das vias aéreas superiores. Descreveu-se o caso de paciente hígida, submetida à anestesia geral, que apresentou edema agudo pulmonar após a extubação traqueal. RELATO DO CASO: Paciente de 23 anos, sexo feminino, estado físico ASA II, submetida à anestesia geral para videolaparoscopia ginecológica. O procedimento durou 3 horas, sem intercorrências. Após a extubação, a paciente apresentou laringoespasmo e diminuição da saturação de oxigênio. Houve melhora após colocação de cânula oral e administração de oxigênio, sob pressão positiva, com máscara facial. Estabilizado o quadro, foi encaminhada à sala de recuperação pós-anestésica, onde, logo após a admissão, apresentou edema agudo de pulmão com eliminação de secreção serossanguinolenta. O tratamento constou de elevação do dorso, oxigênio sob máscara, furosemida e restrição hídrica. A radiografia torácica mostrou imagem compatível com edema agudo pulmonar e área cardíaca normal. O eletrocardiograma (ECG, ecocardiografia e enzimas cardíacas estavam normais. A paciente apresentou boa evolução, recebendo alta hospitalar no dia seguinte, assintomática. CONCLUSÕES: O edema agudo de pulmão associado à obstrução das vias aéreas superiores é condição clínica que pode agravar procedimentos cirúrgicos de baixa morbidade e que aparece sobretudo em pacientes jovens. O tratamento deve ser instituído precocemente, pois a resolução também é rápida e, na maioria das vezes, sem seqüelas.JUSTIFICATIVA Y OBJETIVOS: El edema pulmonar por presión negativa ha sido definido como edema no cardiogénico, con transudación de líquido para el intersticio pulmonar, por aumento en la presión negativa

  20. Bloqueio do plexo braquial, por via infraclavicular vertical, em paciente com doença pulmonar obstrutiva crônica: relato de caso Bloqueo del plexo braquial, por vía infraclavicular vertical, en paciente con enfermedad pulmonar obstructiva crónica: relato de caso Infraclavicular vertical brachial plexus blockade in patients with chronic obstructive pulmonary disease: case report

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    Diogo Brüggemann da Conceição

    2006-10-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Os pacientes com doença pulmonar obstrutiva crônica (DPOC têm risco aumentado de complicações pós-operatórias, sobretudo quando submetidos à anestesia geral. O bloqueio do plexo braquial representa uma alternativa para estes pacientes em intervenções cirúrgicas de membros superiores. O objetivo deste relato foi apresentar um caso de bloqueio do plexo braquial, por via infraclavicular vertical em paciente com DPOC com fratura de cotovelo. RELATO DO CASO: Paciente do sexo feminino, 67 anos, 52 kg, estado físico ASA III, com indicação de osteossíntese de cotovelo, portadora de bronquiectasias desde nove anos de idade após uma pneumonia. Apresentava tosse produtiva habitualmente, e fora submetida à avaliação de seu pneumologista que a liberou para o procedimento. Após instalação de monitorização com pressão arterial não-invasiva, ECG e oxímetro de pulso, foi realizado bloqueio do plexo braquial por via infraclavicular vertical com 30 mL de ropivacaína a 0,5%. A intervenção cirúrgica foi realizada sem intercorrências. A paciente recebeu alta hospitalar no dia seguinte ao procedimento cirúrgico. CONCLUSÕES: O bloqueio do plexo braquial por via infraclavicular vertical é uma técnica alternativa para portadores de DPOC e fratura de cotovelo, por sua menor morbidade quando comparado com a anestesia geral e com a via supraclavicular.JUSTIFICATIVA Y OBJETIVOS: Los pacientes con enfermedad pulmonar obstructiva crónica (DPOC presentan riesgo mayor de complicaciones postoperatorias especialmente cuando se les someten a la anestesia general. El bloqueo del plexo braquial representa una alternativa para esos pacientes en intervenciones quirúrgicas de miembros superiores. El objetivo de este relato fue el de presentar un caso de bloqueo del plexo braquial, por vía infraclavicular vertical en paciente con DPOC con fractura de codo. RELATO DEL CASO: Paciente del sexo femenino, 67 años, 52 kg

  1. Barotrauma pulmonar no intra-operatório de procedimento cirúrgico oftalmológico: relato de caso Barotrauma pulmonar en el intraoperatorio de procedimiento quirúrgico oftalmológico: relato de caso Intraoperative pulmonary barotrauma during ophthalmologic surgery: case report

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    Affonso Henrique Zugliani

    2008-02-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Acidentes anestésicos graves por mau funcionamento de ventiladores mecânicos tornaram-se raros nos tempos atuais. Porém, detalhes técnicos, mesmo em aparelhos de fabricação recente, podem resultar em armadilhas para o anestesiologista e ameaçar a segurança do paciente. O objetivo deste relato de caso foi enfatizar a necessidade de análise criteriosa do material em uso, assim como de detectar e tratar o pneumotórax hipertensivo intra-operatório. RELATO DO CASO: Paciente do sexo feminino, 16 anos, estado físico ASA I, submetida a recobrimento conjuntival de córnea sob anestesia geral. A manutenção foi feita com isoflurano e ventilação controlada mecânica. A anestesia transcorreu sem anormalidades. Na fase final do procedimento cirúrgico, após mobilização do aparelho de anestesia para o início do procedimento de despertar, observou-se quadro de hipóxia, hipotensão arterial e dificuldade ventilatória. Retirados os campos cirúrgicos, evidenciou-se importante enfisema subcutâneo, envolvendo a face, o pescoço e o membro superior. Procedeu-se à troca da cânula traqueal, observando-se a presença de sangue em seu interior. A radiografia de tórax confirmou o diagnóstico de pneumotórax, que foi prontamente drenado. A inspeção no equipamento revelou acotovelamento da mangueira que liga a região inferior do canister ao corpo do aparelho, em função da mobilização do braço articulado, bloqueando o fluxo normal de gases e levando a barotrauma pulmonar. CONCLUSÕES: O pneumotórax hipertensivo durante anestesia geral com ventilação com pressão positiva deve ser sempre um acidente a ser considerado. Múltiplos fatores podem precipitá-lo, o que exige alto grau de suspeição sempre que estiverem envolvidos no ato anestésico-cirúrgico. O equipamento de anestesia deve ser cuidadosamente examinado para que sejam detectadas potenciais causas de acidentes anestésicos.JUSTIFICATIVA Y OBJETIVOS

  2. Hipoxemia por fístulas artério-venosas pulmonares em criança: relato de caso Hipoxemia por fístulas artério-venosas pulmonares en niño: relato de caso Hypoxemia by pulmonary arteriovenous fistulae in childhood: case report

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    Aleksandra Paula Lima

    2004-08-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A presença de fístulas artério-venosas pulmonares (FAVP deve ser investigada em pacientes com cianose sem causa esclarecida. O objetivo é relatar um caso de lobectomia pulmonar em criança portadora de FAVP. RELATO DO CASO: Paciente do sexo masculino, 3 anos, com história de cianose sem dispnéia desde 8 meses, com baqueteamento digital e ausculta cardíaca normal. ECG e ecocardiografia eram normais e a radiografia de tórax mostrou condensação na metade superior do pulmão esquerdo. A gasometria arterial mostrou PaO2 de 28 mmHg, em ar ambiente, e PaO2 de 31,5 mmHg com cateter nasal de O2. Foi feito diagnóstico de FAVP através de ressonância nuclear magnética, sem possibilidade de embolização. O paciente foi submetido a lobectomia superior esquerda sob anestesia geral associada à anestesia subaracnóidea com morfina e bupivacaína. Foi realizada ventilação monopulmonar com introdução do tubo traqueal seletivo para o pulmão direito. A SaO2 era: em ar ambiente de 59%; à admissão à sala de operações, 69% (FiO2 = 1,0; após indução da anestesia geral, 65% (FiO2 = 1,0; durante a ventilação monopulmonar, 58% (FiO2 = 1,0; após a lobectomia e 98% (FiO2 = 0,6 ao final da cirurgia, com extubação traqueal uma hora após o final do procedimento. A partir do 5º dia de pós-operatório, começou a apresentar progressiva diminuição da SpO2 (até 83% devido aumento de outra FAVP, tratada com embolização sob anestesia geral. A alta hospitalar ocorreu no 15º do pós-operatório. CONCLUSÕES: Neste caso, havia refratariedade à suplementação com O2 e houve melhora imediata com o tratamento cirúrgico. Entretanto, após ressecção da FAVP de maior tamanho ocorreu aumento de outra fístula, que contribuiu para a diminuição da SpO2 no pós-operatório, revertida com a embolização. Com o crescimento da criança, outras fístulas pulmonares ou em outros órgãos poderão surgir, caracterizando a s

  3. Esclerose sistêmica difusa com hipertensão pulmonar isolada: relato de caso Diffuse systemic sclerosis with isolated pulmonary hypertension: a case report

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    SILMÉIA GARCIA ZANATI

    2000-12-01

    Full Text Available A esclerose sistêmica (ES é uma doença incomum, caracterizada por alterações vasculares e fibrose em pele e vários órgãos. O envolvimento pulmonar é freqüente na ES; entretanto, hipertensão pulmonar (HP na ausência de fibrose intersticial é raramente observada. Os autores descrevem um caso de ES difusa com HP isolada em paciente do sexo feminino, de 49 anos. O diagnóstico de HP pôde ser sugerido pelo exame físico e confirmado por ecodopplercardiograma, que permitiu estimar a pressão sistólica em artéria pulmonar em 80mmHg. Tratamento foi iniciado com nifedipina; entretanto, devido a efeitos colaterais da droga, não foi possível o aumento da dose além de 30mg ao dia; nesta dosagem, a nifedipina não acarretou redução da pressão arterial pulmonar.Systemic sclerosis (SS is an uncommon disease characterized by small blood vessel vasculopathy and increased connective tissue in the skin and in other organs. The pulmonary involvement is common in SS; however, pulmonary hypertension without interstitial fibrosis is rare. The authors present a case of the diffuse form of SS with isolated pulmonary hypertension. The diagnosis of pulmonary hypertension was suggested by physical examination and confirmed by doppler-echocardiography which allowed for the estimation of the pulmonary artery systolic pressure in 80 mmHg. The authors started treatment with nifedipine; however, as the patient presented side effects, it was not possible to increase the dose beyond 30 mg/day. In this dosage, nifedipine did not decrease the pulmonary arterial pressure.

  4. Pseudocisto pulmonar pós-traumático em jogador de futebol: relato de caso Post-traumatic pulmonary pseudocyst in a soccer player: a case report

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    Andre Nathan Costa

    2013-04-01

    Full Text Available Pseudocistos pulmonares são lesões raras que se desenvolvem no parênquima pulmonar após traumas fechados e de grande energia, cujo diagnóstico se baseia na associação da história clínica com exames de imagem. Relata-se a seguir um pseudocisto pulmonar ocorrido no parênquima contralateral ao trauma em um homem de 31 anos que apresentou episódio de hemoptise após queda durante partida de futebol.Pulmonary pseudocysts are uncommon cavitary lesions that develop in the lung parenchyma as a consequence of blunt thoracic trauma, whose diagnosis is based on an association of clinical history and imaging findings. The present report describes the case of a pulmonary pseudocyst observed in the parenchyma contralateral to the trauma site in a 31-year-old man presenting with hemoptysis after falling during a soccer match.

  5. Infecção pulmonar por "Rhodococcus equi": relato dos dois primeiros casos brasileiros Pulmonary Rhodococcus equi infection: report of the first two Brazilian cases

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    LUIZ CARLOS SEVERO

    2001-05-01

    Full Text Available O Rhodococcus equi, principal agente da rodococose, é um cocobacilo pleomórfico, gram-positivo e aeróbio, que infecta humanos por via inalatória ou transcutânea e se manifesta clinicamente como abscesso pulmonar. Relatam-se os dois primeiros casos brasileiros da doença. Ambos os pacientes eram imunocomprometidos e apresentavam quadro infeccioso pulmonar. O primeiro tinha AIDS e apresentava pneumonia cavitada em lobo superior esquerdo, que teve evolução fatal. O segundo tinha doença de Goodpasture, insuficiência renal crônica e fazia uso de corticosteróides. Apresentava uma lesão pulmonar escavada no lobo superior direito, que foi tratada com sulfametoxazol-trimetoprim, com resolução do processo.Rhodococcus equi, the principal agent of rhodococcosis, is a pleomorphic, gram-positive, aerobic coccus bacillus that infects humans by inhalation or through a transcutaneous route. It is clinically manifested as a pulmonary abscess. The first two Brazilian cases of rhodococcosis are reported on. Both patients were immunocompromised and showed pulmonary infection. The first patient had AIDS and cavitating pneumonia in the left upper lobe, that was fatal. The second case presented Goodpasture syndrome and was under chronic corticotherapy. He displayed a cavitating nodular lesion in the right upper lobe, that was successfully treated with sulfametoxazol-trimethoprim.

  6. Pulmonary malaria: high-resolution computed tomography findings - a case report; Malaria pulmonar: aspectos na tomografia computadorizada de alta resolucao - relato de caso

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    Rodrigues, Rosana; Souza, Daniel Andrade Tinoco de [Universidade Federal, Rio de Janeiro, RJ (Brazil). Hospital Universitario Clementino Fraga Filho. Servico de Radiodiagnostico; Hospital Copa D' Or, Rio de Janeiro, RJ (Brazil); Marchiori, Edson [Universidade Federal Fluminense, Niteroi, RJ (Brazil). Dept. de Radiologia]. E-mail: edmarchiori@bol.com.br

    2004-04-01

    We report the case of a 38-year-old man with pulmonary malaria. High-resolution computed tomography showed thickening of the peribronchovascular interstitium and interlobular septa, areas of consolidation and ground glass attenuation and bilateral pleural effusion suggesting pulmonary edema. The patient recovered well after receiving specific treatment and was discharged after 11 days of hospitalization. (author)

  7. Comunicação direta entre artéria pulmonar direita e átrio esquerdo: relato de dois casos

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    SCHIMIN Luiz Carlos

    2000-01-01

    Full Text Available A comunicação direta entre a artéria pulmonar direita e o átrio esquerdo é uma condição rara, tendo sido relatados menos de 40 casos em toda a literatura. Apresentação clínica é variável, podendo o paciente mostrar-se com quadro de cianose, dispnéia ou insuficiência cardíaca. No entanto, o diagnóstico pode ser facilmente feito com métodos de imagem. O tratamento cirúrgico oferece a cura completa com baixa morbi-mortalidade. Sem o mesmo, sérias complicações podem advir como embolia ou abscesso cerebral. Os autores apresentam dois casos de comunicação direta entre artéria pulmonar direita e átrio esquerdo. São discutidas as teorias embriogênicas e as variantes anatômicas desta anomalia congênita.

  8. Edema pulmonar após absorção sistêmica de fenilefrina tópica durante cirurgia oftalmológica em criança: relato de caso Edema pulmonar después de absorción de fenilefrina tópica durante cirugía oftalmológica en niño: relato de caso Pulmonary edema after topic phenylephrine absorption during pediatric eye surgery: case report

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    Maria de Fátima Savioli Fischer

    2004-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Soluções tópicas de fenilefrina são empregadas freqüentemente em cirurgia oftalmológica com o objetivo de promover descongestionamento capilar ou dilatação pupilar. Este artigo descreve um caso de hipertensão arterial grave seguida de edema pulmonar durante cirurgia para correção de estrabismo. A provável causa desta complicação foi a absorção sistêmica de fenilefrina administrada por via tópica ocular. O objetivo do relato é a discussão de meios de prevenção desta complicação, assim como do tratamento mais adequado. RELATO DO CASO: Paciente do sexo masculino, 12 anos, 50 kg, estado físico ASA I, admitido no centro cirúrgico para realização de correção de estrabismo convergente bilateral em regime ambulatorial. Foi submetido à anestesia geral venosa e a manutenção, realizada com infusão contínua de remifentanil e propofol. Após colocação do bléfaro, 6 gotas de fenilefrina a 10% foram aplicadas por via tópica. Decorridos 5 minutos do início da cirurgia, o paciente desenvolveu hipertensão arterial e taquicardia, refratárias à elevação da dose administrada de remifentanil e propofol, bem como à administração de droperidol. O controle da pressão arterial e da freqüência cardíaca foi possível após o emprego do sevoflurano, mas houve diminuição da saturação de oxigênio e o aparecimento de crepitações pulmonares difusas por provável desenvolvimento de edema pulmonar agudo. A furosemida foi administrada e os anestésicos foram suspensos. O paciente apresentou melhora progressiva do quadro pulmonar, enquanto os valores de pressão arterial permaneciam dentro da normalidade. Recebeu alta da sala de recuperação pós-anestésica 6 horas após a cirurgia, quando se apresentava em ventilação espontânea em ar ambiente, com saturação de O2, ausculta pulmonar e pressão arterial normais. CONCLUSÕES: A administração de fenilefrina tópica deve ser realizada com

  9. Efeitos do local de inserção do dreno pleural na função pulmonar no pós-operatório de cirurgia de revascularização do miocárdio Effects of the pleural drain site on the pulmonary function after coronary artery bypass graf

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    Solange Guizilini

    2004-03-01

    Full Text Available OBJETIVO: Analisar a alteração da função pulmonar e dor em pacientes submetidos à cirurgia de revascularização do miocárdio (RM com enxerto da artéria torácica interna esquerda (ATIE, sem circulação extracorpórea (CEC, comparando a inserção do dreno pleural nas regiões intercostal e subxifóide. MÉTODO: Vinte e oito pacientes (média de idade 57,4 ± 8,4 anos foram alocados em dois grupos, de acordo com a posição do dreno pleural. Grupo IL (n=15 com inserção do dreno no sexto espaço intercostal esquerdo na linha axilar média; e grupo IM (n =13 inserção do dreno na região subxifóide. Todos os pacientes foram submetidos à avaliação da função pulmonar. Registros espirométricos da capacidade vital forçada (CVF e do volume expiratório forçado no primeiro segundo (VEF1 foram obtidos no pré, primeiro, terceiro e quinto dia dias pós-operatório (PO e a gasometria arterial em ar ambiente no pré e primeiro dia de pós-operatório. A sensação de dor foi quantificada por um escore padrão (0 a 10 no primeiro dia de pós-operatório. RESULTADOS: Em ambos os grupos houve queda significativa da CVF e do VEF1 até o quinto pós-operatório (pOBJECTIVE: To analyze the pulmonary function changes and pain in patients undergoing off-pump coronary artery bypass grafting utilizing a left internal thoracic artery graft, comparing the pleural drain insertion through the intercostal space and subxyphoid approach. METHODS: Twenty eight patients (mean age 57.4 ± 8.4 years were divided into two groups, according to the pleural drain site. Group IL (n=15 had the pleural drain inserted through the sixth left intercostal space at the mid-axillary line and in the IM group (n=13 the drain was placed through the subxyphoid region. All the patients underwent pre- and post-operative evaluation of pulmonary function tests as well as arterial blood gas analysis. Forced vital capacity (FVC and forced expiratory volume in 1 second (FEV1 were

  10. Hemossiderose pulmonar idiopática tratada com azatioprina: relato de caso em criança Idiopathic pulmonary hemosiderosis treated with azathioprine in a child

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    Clemax Couto Sant`Anna

    2007-12-01

    Full Text Available A hemossiderose pulmonar idiopática (HPI, principal causa de hemossiderose pulmonar em crianças, cursa com sangramento alveolar intermitente e presença de hemossiderófagos no escarro ou no lavado gástrico. O tratamento é baseado nos corticoesteróides e citostáticos, em condições especiais. Descreve-se o caso de uma menina de sete anos com HPI, que conseguiu controle parcial da doença mediante altas doses de corticoesteróide. O tratamento, no entanto, necessitou ser suspenso gradualmente visto a paciente ter desenvolvido fácies cushingóide. Foi iniciada a associação da azatioprina ao corticóide até a substituição total por azatioprina isolada, cujo uso foi mantido por quatro anos, com ótimo resultado.Idiopathic pulmonary hemosiderosis (IPH, the main cause of pulmonary hemosiderosis in children, is characterized by intermittent alveolar bleeding and hemosiderin-laden macrophages in sputum and in gastric lavage. The treatment is based on corticosteroids and cytotoxic drugs, under special conditions. We describe the case of a 7-year-old girl with IPH who achieved partial clinical remission with high doses of corticosteroids. However, the treatment had to be discontinued because the patient developed Cushing's syndrome. Treatment was started with an azathioprine-corticosteroid combination and then changed to azathioprine alone, which was maintained for four years, with excellent results.

  11. Paracoccidioidomicose pulmonar: relato de caso clínico com aspetos em tomografia computorizada de alta resolução

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    M. Armas

    2012-07-01

    Full Text Available Resumo: A Paracoccidioidomicose é uma micose sistémica endémica nas áreas rurais da América Latina, uma fonte importante de imigrantes e destino de emigração e turismo europeu, a maioria dos casos ocorrendo no Brasil, Argentina, Venezuela e Colômbia. Os autores descrevem o caso clínico de um paciente com 43 anos, anteriormente emigrado na Venezuela e residente em Portugal há 8 anos, que se apresenta com lesão cutânea isolada. Embora sem queixas relevantes do foro respiratório, apresentava extensas lesões do parênquima pulmonar caracterizadas por tomografia computorizada de alta resolução (TCAR. Foi realizada biópsia da lesão cutânea e exame micológico da expetoração que revelaram infeção por Paracoccidioides brasiliensis (PB. Abstract: Paracoccidioidomycosis is a systemic mycosis which is endemic in rural areas of Latin America, an important European source of immigrants and a growing European touristic destination as well, with most cases occurring in Brazil, Argentina, Venezuela and Colombia. The authors report a case of a 43 year old man who previously worked in Venezuela and is living in Portugal for 8 years, presenting with a single cutaneous lesion. Despite the absence of valuable respiratory complaints, severe lung damage was found with high-resolution computed tomography (HRCT. Biopsy of the cutaneous lesion and mycologic sputum examination were performed revealing Paracoccidioides brasiliensis infection. Palavras-chave: Paracoccidioidomicose, Paracoccidioides brasiliensis, Fibrose pulmonar, Tomografia computorizada de alta resolução, Keywords: Paracoccidioidomycosis, Paracoccidioides brasiliensis, Pulmonary fibrosis, High-resolution computed tomography

  12. Nocardiose pulmonar em paciente com síndrome da imunodeficiência adquirida: relato de caso Pulmonary nocardiosis in a patient with acquired immunodeficiency syndrome: case report

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    Ana Carina Gamboa da Silva

    2002-07-01

    Full Text Available Os autores descrevem um caso de nocardiose pulmonar em um homem de 37 anos de idade com a síndrome da imunodeficiência adquirida, em tratamento com anti-retrovirais, cujos sintomas de apresentação foram tosse com expectoração, hemoptóicos e emagrecimento progressivo. Foi realizada radiografia do tórax, que demonstrou consolidação no lobo superior do pulmão direito, e tomografia computadorizada do tórax, que evidenciou consolidação pulmonar com áreas escavadas. Diante dos achados radiológicos inespecíficos, foi realizada broncoscopia com lavado broncoalveolar, evidenciando estruturas filamentosas Gram-positivas compatíveis com Nocardia sp. O tratamento utilizado foi sulfametoxazol-trimetoprim, com remissão completa do quadro respiratório. Após revisão da literatura, foram discutidos os principais aspectos radiológicos desta doença.The authors describe a case of pulmonary nocardiosis in a 37-year-old man with acquired immunodeficiency syndrome in treatment with antiretroviral drugs. Clinical symptoms were productive cough, hemoptysis and progressive weight loss. A chest x-ray film showed a right upper lobe consolidation while the computed tomography demonstrated consolidation and areas of cavitation. The radiologic findings were unspecific. Consequently, a bronchoscopy with bronchoalveolar lavage was performed, revealing filamentous Gram-positive bacteria (Nocardia sp. Treatment with trimethoprim-sulfamethoxazole resulted in complete remission of the respiratory symptoms. The authors review the literature and discuss the main radiological features of this disease.

  13. Reoperação de tromboendarterectomia pulmonar em recidiva de tromboembolismo pulmonar crônico hipertensivo

    OpenAIRE

    Gomes,Walter José; Imaeda,Carlos Jogi; Perfeito,João Alessio; Sarmento,Petrúcio Abrantes; Souza,Rodrigo Caetano; Forte,Vicente

    2009-01-01

    A cirurgia de tromboendarterectomia tem se estabelecido como método padrão de tratamento do tromboembolismo pulmonar crônico hipertensivo, com excelentes resultados. Entretanto, a reoperação na recidiva do embolismo pulmonar não tem relato na literatura nacional, permanecendo obscuras a sua segurança e efetividade. Relatamos o caso de uma paciente com recorrência de tromboembolismo pulmonar crônico hipertensivo ocorrido cinco anos após a primeira cirurgia de tromboendarterectomia pulmonar, e ...

  14. Edema pulmonar por pressão negativa após extubação traqueal: relato de caso Negative pressure pulmonary edema after tracheal extubation: case report

    Directory of Open Access Journals (Sweden)

    Fabiano Timbó Barbosa

    2007-03-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O edema pulmonar por pressão negativa após obstrução de via aérea é atualmente uma entidade bem descrita, porém pouco diagnosticada e com poucos casos relatados. O objetivo deste artigo foi relatar um caso de edema pulmonar por pressão negativa (EPPN após extubação traqueal com sucesso terapêutico, após uso de ventilação mecânica não-invasiva com pressão positiva. RELATO DO CASO: Paciente do sexo feminino, 22 anos, foi submetida à colecistectomia aberta. Os exames pré-operatórios encontravam-se sem alterações. Imediatamente após extubação a paciente apresentou dispnéia súbita e crepitações pulmonares. Foi iniciado tratamento para edema agudo de pulmão com oxigenoterapia sob máscara de Venturi, elevação do tórax e diurético. A paciente foi encaminhada a UTI devido a falha no tratamento. Ao chegar a UTI foi iniciada ventilação mecânica não-invasiva (VMNI com pressão de suporte (15 cmH2O e pressão expiratória final positiva (5 cmH2O com resolução dos sintomas. A paciente foi mantida em observação por mais 24 horas depois do evento com boas condições e recebeu alta para o quarto sem sintomas. CONCLUSÕES: O EPPN é uma entidade de difícil diagnóstico e deverá ser observada sempre que os pacientes evoluem com sinais e sintomas de insuficiência respiratória pós-extubação. Esta paciente se beneficiou de VMNI, mas caso haja falha terapêutica, a intubação traqueal e o suporte ventilatório mecânico invasivo deverão ser instituídos para melhor oxigenação dos pacientes.BACKGROUND AND OBJECTIVES: Negative pressure pulmonary edema after acute upper airway obstruction is a well-described event, thought infrequently diagnosed and reported. This report aimed at presenting a case of postextubation negative pressure pulmonary edema refractory to use of diuretics and with successful therapeutic after using positive pressure noninvasive mechanic ventilation. CASE REPORT: A

  15. Embolia pulmonar por líquido amniótico: relato de caso e revisão da literatura Pulmonary amniotic fluid embolism syndrome: case report and literature review

    Directory of Open Access Journals (Sweden)

    Edmilton Pereira de Almeida

    2007-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A embolia pulmonar por líquido amniótico é uma complicação obstétrica rara, freqüentemente fatal, de fisiopatologia ainda não totalmente esclarecida e pouco conhecida pelo intensivista e obstetra. O objetivo deste relato foi enfatizar a necessidade de conhecimento desta entidade clínica e discutir a literatura pertinente de maior relevância. RELATO DO CASO: Paciente com 15 anos, primigesta, 34 semanas de gestação, foi admitida no serviço de emergência para tratamento de início de parto prematuro. Queixava-se de tosse e dispnéia. Ao exame clínico apresentava-se taquipneica (28 irm, ausculta pulmonar normal, sem outras anormalidades. Permaneceu em observação com uso de oxigênio através de máscara facial. Houve agravamento progressivo sendo transferida para a UTI. À admissão na UTI apresentava taquipnéia (28 irm, lúcida, pressão arterial (PA de 104 x 56 mmHg e pressão arterial média (PAM de 65 mmHg, SpO2 de 87% com fluxo de oxigênio de 5 L/min. Devido à piora progressiva da mecânica ventilatória foi realizada intubação traqueal e instituída ventilação mecânica com pressão controlada e volume garantido. Radiograma de tórax evidenciou infiltrado pulmonar extenso e bilateral. O painel de coagulação evidenciou importante alargamento do tempo de tromboplastina parcial ativado de 34,7 seg na admissão para 57,4 seg, 10 horas após, com redução progressiva nos dias subsequentes. Foi submetida à cesariana na manhã seguinte. Apresentou importante hipotensão arterial no intra-operatório, apesar de utilização de cristalóides em volume aparentemente adequado, sendo iniciado administração de noradrenalina. Foi extubada no 3º dia, recebendo alta hospitalar 13 dias após a admissão, assintomática. CONCLUSÕES: A embolia por líquido amniótico é uma rara e catastrófica complicação da gestação. A síndrome se caracteriza por um quadro súbito de desconforto ventilat

  16. Cryptococcus gattii fungemia: report of a case with lung and brain lesions mimicking radiological features of malignancy Fungemia por Cryptococcus gattii: relato de um caso com lesões cerebrais e pulmonares nos achados radiológicos mimetizando câncer

    Directory of Open Access Journals (Sweden)

    Flávio de Mattos Oliveira

    2007-08-01

    Full Text Available A 64-year-old apparently immunocompetent white man developed lung and brain lesions of disseminated cryptococcosis. The radiologic features mimicked those of lung cancer metastatic to the central nervous system. C. gattii was recovered from cultures of bronchoalveolar lavage fluid, brain biopsy, and blood. The same fungus was recovered from pulmonary and brain specimens at autopsy. Serum and cerebrospinal fluid cryptococcal antigen tests were diagnostic in our case and should be included in the diagnostic evaluation of unexplained pulmonary and cerebral lesions. A literature search showed few reports of fungemia by this species of Cryptococcus, contrasting to C. neoformans.Homem branco de 64 anos, aparentemente imunocompetente, desenvolveu lesões pulmonares e cerebrais por criptococose disseminada. Os achados radiológicos foram similares àqueles encontrados em pacientes com câncer de pulmão e metástase no sistema nervoso central. C. gattii foi isolado de cultivos de lavado broncoalveolar, biópsia cerebral e sangue. O mesmo fungo foi encontrado em fragmentos pulmonares e cerebrais obtidos da autópsia. Testes de antígeno no soro e no líquido cefalorraquidiano foram diagnóstico no nosso caso e devem ser incluídos na avaliação diagnóstica de lesões pulmonares e cerebrais indefinidas. Pesquisa na literatura mostrou poucos relatos de fungemia por esta espécie de Cryptococcus, contrastando com C. neoformans.

  17. Síndrome pulmonar por hantavírus com disfunção de múltiplos órgãos: relato de caso Hantavirus pulmonary syndrome with multiple organ dysfunctions: case report

    Directory of Open Access Journals (Sweden)

    Marcelo Spegiorin Moreno

    2007-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A hantavirose é uma zoonose que apresenta distribuição mundial e sua transmissão está relacionada com o íntimo contato com roedores. Causa dois tipos de doença: a febre hemorrágica com síndrome renal (FHSR, endêmica na Ásia e Europa e a síndrome pulmonar por hantavírus (SPH, encontrada no continente americano, inclusive no Brasil, com elevadas taxas de mortalidade. O objetivo deste estudo foi relatar um caso de SPH com disfunção de múltiplos órgãos, que recebeu tratamento intensivo precoce e reanimação guiada por parâmetros de fluxo e de perfusão tecidual. RELATO DO CASO: Paciente do sexo masculino, 36 anos, iniciou quadro febril inespecífico, dispnéia progressiva, hipóxia grave e insuficiência respiratória aguda. Apresentava infiltrado interstício-alveolar difuso na radiografia de tórax. Evoluiu com disfunção de múltiplos órgãos (pulmonar, renal, hematológica, cardiovascular e metabólica. Recebeu tratamento e monitorização hemodinâmica invasiva precoces. As alterações laboratoriais mais importantes foram plaquetopenia, elevação dos níveis de hematócrito e hemoglobina, leucocitose, elevação de transaminases, de lactado desidrogenase e sorologia positiva para hantavírus (ELISA IgM positivo. O paciente apresentou reversão das disfunções orgânicas, recebendo alta hospitalar após 21 dias de hospitalização. CONCLUSÕES: A reanimação precoce e agressiva dirigida por metas levou à reversão da síndrome de falência de múltiplos órgãos e a um desfecho clínico favorável, apesar da gravidade da doença.BACKGROUND AND OBJECTIVES: Hantavirus infection is a zoonose with worldwide distribution. The transmission is related to the intimal contact with rodents. It causes two syndromes: hemorrhagic fever with renal syndrome (HFRS, endemic in Asia and Europe and the Hantavirus pulmonary syndrome (HPS, found in the American continent, including Brazil, with high mortality

  18. Linfangioleiomiomatosis pulmonar

    OpenAIRE

    Carlos Salazar-Vargas; Victoria Monterroso-Azofeifa; Gloria Arauz-Pacheco; Bayardo Robelo-Pentzke

    2000-01-01

    La Linfangioleiomiomatosis pulmonar es una enfermedad muy rara, que afecta sólo mujeres en edad reproductiva. Se presenta con disnea progresiva, pneumotórax a repetición y, ocasionalmente, con hemoptisis y quilotórax. El TAC de alta resolución muestra quistes pulmonares bilaterales de tamaño variable hasta bulas francas. Histológicamente, se aprecian múltiples cavidades de paredes finas, dilatación de vasos linfáticos, venas, arterias, bronquiolos y sacos alveolares, por proliferación de hace...

  19. Blastoma pulmonar

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    Mauro Zamboni

    2007-05-01

    Full Text Available Resumo: O blastoma pulmonar é um tumor primário do pulmão, raro, de mau prognóstico e que acomete doentes mais jovens do que os portadores do carcinoma de células não pequenas do pulmão. Geralmente, são vistos sob a forma de grandes massas pulmonares, sintomáticas e com metástases para linfonodos mediastinais. Do ponto de vista anátomo-patológico, estes tumores são bifásicos, englobando na sua estrutura componentes mesenquimal e epitelial. Embora infrequente, este tipo de tumor deve fazer parte do diagnóstico diferencial das neoplasias pulmonares. Os autores apresentam um caso de blastoma pulmonar e fazem revisão da literatura.Rev Port Pneumol 2007; XIII (3: 391-395 Abstract: Pulmonary blastoma is a rare primary lung tumor with poor prognosis that commonly presents at a younger age than the non-small cell lung cancer. Classicaly they are large, symptomatic tumors with lymph nodal metastasis and carry poor prognosis. Pathological examination revealed features suggesting a biphasic tumor with mesenchymal and epithelial components. Over 200 cases have been reported so far worldwide since the first description of the tumor in 1945. Authors present a case of pulmary blastoma with literature revision.Rev Port Pneumol 2007; XIII (3: 391-395 Palavras-chave: Cancro do pulmão, blastoma, blas-toma pulmonar, tumor primário do pulmão, Keywords: Lung cancer, blastoma, pulmonary blastoma, primary tumors of lung

  20. Quistes pulmonares congénitos

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    Nuvia Suárez García

    2014-06-01

    Full Text Available Introducción: las malformaciones pulmonares congénitas constituyen una alteración en el desarrollo embriológico y fetal de las distintas estructuras pulmonares y una rara expresión de estas son los quistes pulmonares congénitos. Caso clínico: se presenta un recién nacido a término, de buen peso, asintomático y estable hasta el tercer día de vida al debutar con un estado de shock séptico secundario, de bronconeumonía complicada con derrame pleural derecho. En los estudios evolutivos hacia el cuarto de día de vida se le diagnostica como hallazgo radiológico la presencia de quistes pulmonares que evolucionan de forma asintomática. Después de una valoración multidisciplinaria es egresado con un seguimiento por su condición de alto riesgo. Actualmente saludable y con buen desarrollo psicomotor. Conclusiones: la importancia del tema que se presenta es que se describe una presentación rara de quistes pulmonares congénitos en un recién nacido que desarrolló un estadio avanzado de sepsis.

  1. Pleural effusion

    Science.gov (United States)

    Complications of pleural effusion may include: Lung damage Infection that turns into an abscess, called an empyema Air in the chest cavity ( pneumothorax ) after drainage of the effusion Pleural thickening (scarring of the lining of the ...

  2. Amiloidose pulmonar: relato de caso de achado radiológico da apresentação nodular em grande fumante Pulmonary amyloidosis: radiographic finding of nodular opacities in a heavy smoker

    Directory of Open Access Journals (Sweden)

    Jorge Montessi

    2007-06-01

    Full Text Available A amiloidose pulmonar é uma doença rara, caracterizada pelo depósito extracelular de proteínas fibrilares no pulmão. Amiloidose é um termo genérico para grupos heterogêneos de doenças, incluindo doença de Alzheimer e diabetes mellitus tipo II. Apresenta-se no aparelho respiratório sob as formas traqueobrônquica, nodular pulmonar e septal alveolar (parenquimatosa difusa. Relata-se o caso de uma mulher, tabagista (20 anos/maço, portadora de amiloidose nodular pulmonar, diagnosticada através de exames pré-operatórios à realização de colecistectomia videolaparoscópica.Pulmonary amyloidosis is a rare disease, characterized by extracellular deposition of fibrillary protein in the lungs. Amyloidosis is a generic term for a heterogeneous group of diseases, including Alzheimer's disease and type 2 diabetes mellitus. In the respiratory system, it appears in various forms: tracheobronchial; nodular pulmonary; and alveolar septal (diffuse parenchymal. We present the case of a woman who was a 20 pack-year smoker and had nodular pulmonary amyloidosis, as diagnosed through tests performed prior to laparoscopic cholecystectomy.

  3. Drenagem anômala parcial de quatro veias pulmonares com septo interatrial íntegro: relato de um caso raro Partial anomalous return of four pulmonary veins with intact interatrial septum defect: a rare case report

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    Edmar Atik

    2008-07-01

    Full Text Available É relatado caso raro de drenagem anômala parcial de quatro veias pulmonares no átrio direito e veia cava superior, com septo interatrial íntegro em criança de cinco anos de idade. Havia poucos sintomas, em contraste com débito ventricular esquerdo dependente do fluxo da veia lobar superior esquerda e da língula. Complacência diminuída à esquerda motivou quadro acentuado de hipertensão venocapilar pulmonar no pós-operatório imediato, aliviado por feitura de comunicação interatrial de 8 mm. A evolução posterior foi boa.We report on the rare case of partial anomalous return of four pulmonary veins in the right atrium and superior vena cava with intact interatrial septum in a five-year-old child. There were few symptoms in contrast with the left ventricular output dependent on the flow of the left upper lobe vein and from the lingula. Reduced compliance to the left led to a severe picture of pulmonary venocapillary hypertension in the immediate postoperative period, mitigated by an 8-mm interatrial septal defect. The patient progressed well after the intervention.

  4. Efeitos de exercícios físicos em piscina sobre a função pulmonar do portador de distrofia muscular de duchenne. Um relato de caso

    OpenAIRE

    Sales, Israel; Clebis, Naianne Kelly; Stabille, Sandra Regina

    2008-01-01

    A distrofi a muscular de Duchenne (DMD) leva a degeneração lenta do tecido muscular gerando fraquezamuscular, e insufi ciência respiratória. Na maioria dos casos, é uma doença hereditária para a qual ainda não se obteve cura.O tratamento disponível é paliativo e tem como fi nalidade retardar e minimizar as complicações que levam a incapacitaçãoe ao óbito. O presente relato objetivou a verif...

  5. Computed tomography prospective study of pleural-pulmonary changes after abdominal surgery : assessment of associated risk factors; Estudo prospectivo por tomografia computadorizada das alteracoes pleuro-pulmonares apos cirurgia abdominal: avaliacao dos fatores de risco associados

    Energy Technology Data Exchange (ETDEWEB)

    Rossi, Luis Antonio [Pontificia Univ. Catolica de Sao Paulo, SP (Brazil). Centro de Ciencias Medicas e Biologicas]. E-mail: luizrossimd@uol.com.br; Bromberg, Sansom Henrique [Instituto de Assistencia Medica ao Servidor Publico Estadual de Sao Paulo (IAMSPE), Sao Paulo, SP (Brazil). Curso de Pos-graduacao em Gastroenterologia Cirurgica

    2005-07-01

    Postoperative pleural-pulmonary changes (PPC) are very common following elective abdominal surgery, resolving without clinical manifestations in most patients. The incidence and risk factors associated are unknown. Objective: to determine the incidence of PPC and possible association with risk factors using computerized tomography (CT). Material and method: thirty seven patients submitted to elective abdominal surgery were prospectively analyzed using CT performed in the preoperative period and 48 hours after surgery. The PPC was scored from 0 to III. The risk factors evaluated were: age, sex, obesity, smoking history, alcoholism, comorbid conditions, cancer, ASA classification, duration of surgery, surgical incision type and number of days of hospitalization. Results: Pleura effusion was detected by CT in 70.3% (26/37) of the patients and pulmonary atelectasis in 75.5% (28/37). Grade I and II PPC was found in 59.5% (22/37) of the patients and grade III in 21.6% (8/37). Two (5.4%) of these patients developed serious pulmonary complications whereas one patient died. Surgery due to cancer, class ASA >2, longitudinal incision and > 15 cm showed statistical significance and were associated with pleural effusion. The hospitalization was over 2.4 longer for patients with PPC. Conclusion: PPC is frequently seen in patients submitted to abdominal surgery. The use of the CT for the detection of pulmonary atelectasis and pleural effusion proved to be effective. Most cases of PPC are self-limited, resolving without symptoms. (author)

  6. Pleural effusion

    International Nuclear Information System (INIS)

    Jimenez Q, Andres; Camacho D, Fidel

    2009-01-01

    The pleural effusion is defined as the abnormal accumulation of liquid in the pleural space that produces to itself for increase in the production or decrease of the drainage, common reasons in clinics disorders. Inside the reasons of the increase of the production we can enunciate an increase of the capillary pleural permeability, decrease of the oncotic pressure capillary and increase of the hydrostatic capillary pressure, there are less clear the reasons of the decrease of the drainage but are outlined the alteration of the lymphatic pleural contractibility , infiltration of vessels and lymphatic nodules for neoplasia diseases and alterations to pleural level that they should prevent that the this liquid touch the lymphatic pores. The objective of this review is the analysis of the physiological bases of the pleura and the production of the pleural liquid, the physiological aspects of the pleural effusion, the approach of the diagnose and the medical and surgical managing of the same one for the different reasons that produce it.

  7. Pulmonary thromboembolism in AIDS patient with chronic venous insufficiency, pulmonary tuberculosis and breast cancer: a case report and pathophysiology review Tromboembolismo pulmonar em uma paciente com AIDS com insuficiência venosa profunda, tuberculose pulmonar e câncer de mama: relato de um caso e revisão da fisiopatologia

    Directory of Open Access Journals (Sweden)

    Juan José Cortez-Escalante

    2006-04-01

    Full Text Available Recent literature reports thrombotic episodes occurring in patients with HIV infection associated with other abnormalities including neoplasms and infections predisposing to a hypercoagulable state. We report a 47-year-old woman who developed pulmonary thromboembolism in association with HIV infection, pulmonary tuberculosis and breast cancer. She was treated with rifampin, isoniazid, pyrazinamide; heparin, phenprocoumon, zidovudine, lamivudine and efavirenz. Acid fast bacilli were visualized in a sputum smear and three months after, Mycobacterium tuberculosis was isolated from lymph node biopsy during a episode of immune reconstitution. The isolated mycobacteria showed sensitivity to all first-line drugs. HIV infection, breast cancer and pulmonary tuberculosis have several mechanisms that induce hypercoagulable state and can lead to thromboembolic complications. Pulmonary thromboembolism in this patient was a diagnostic challenge because of all the other severe diseases that she experienced at the same time.Publicações recentes relatam episódios trombóticos em pacientes infectados pelo HIV associados a outras condições que incluem neoplasias e infecções que predispõem para um estado de hipercoagulabilidade. Relata-se o caso de uma paciente de 47 anos portadora do HIV que desenvolveu tromboembolismo pulmonar, tuberculose pulmonar e câncer de mama. Foi tratada com rifampicina, isoniazida, pirazinamida, heparina, femprocumona, zidovudina, lamivudina e efavirenz. Bacilos ácido-álcool-resistentes foram observados no exame de escarro e três meses depois foi isolado o Mycobacterium tuberculosis da biópsia de linfonodo durante um episódio de reconstituição imune. A micobactéria isolada demonstrou sensibilidade a todas as drogas anti-tuberculosas de primeira linha. A infecção pelo HIV, o câncer de mama e a tuberculose pulmonar possuem vários mecanismos que induzem um estado de hipercoagulabilidade e que podem produzir complica

  8. Agenesia pulmonar unilateral

    OpenAIRE

    Malcon,Maura Cavada; Malcon,Claudio Mattar; Cavada,Marina Neves; Caruso,Paulo Eduardo Macedo; Real,Lara Flório

    2012-01-01

    A agenesia pulmonar é uma anomalia congênita rara. Relatamos um caso de um menino de 8 anos de idade com agenesia pulmonar à esquerda sem associação com outras malformações. O diagnóstico foi realizado por achados de imagem quando o paciente apresentou sintomas como tosse, sibilância e dispneia sem melhora do quadro clínico após evolução de 30 dias.

  9. Pleural empyema

    International Nuclear Information System (INIS)

    Posada Saldarriaga, Ricardo

    2000-01-01

    Empyema is the collection of liquid infected pleural. The exuded associated to bacterial infectious processes are divided in spill para-pneumonic non-complicated and complicated or properly empyema. The paper includes the history, pathogenesis, etiology and diagnostic among other topics

  10. El tromboembolismo pulmonar (TEP)

    OpenAIRE

    Álvarez Alonso, Elena

    2015-01-01

    El trombo-embolismo pulmonar (TEP) consiste en la obstrucción de la arteria pulmonar o de una de sus ramas, normalmente por un trombo, aunque también puede existir una obstrucción por otras sustancias que impiden la circulación. El objetivo principal de este trabajo es dar conocer los síntomas del TEP para poder prevenir posibles complicaciones, comenzar a tratarlo desde sus inicios e informar a la población de cuáles son los principales factores de riesgo que pueden causar esta enfermed...

  11. Absceso y tuberculosis pulmonar

    OpenAIRE

    Hercelles García, Oswaldo

    2014-01-01

    Si la tuberculosis pulmonar es conocida desde los tiempos más remotos y el absceso del pulmón es considerado, desde el siglo XIX, como una entidad patológica perfectamente definida, es evidente que la asociación absceso y tuberculosis pulmonar no tiene su verdadera expresión de estudio, sino en los últimos años. If pulmonary tuberculosis has been known since ancient times and lung abscess is considered, since the nineteenth century as a well-defined disease entity, it is clear that the abs...

  12. Parapneumonic pleural effusion

    Science.gov (United States)

    Pleural effusion - pneumonia ... Pneumonia, most commonly from bacteria, causes parapneumonic pleural effusion. ... Call your provider if you have symptoms of pleural effusion. Call your provider or go to the emergency ...

  13. La tuberculosis pulmonar

    OpenAIRE

    Suñé Ysamat, Bertila

    1982-01-01

    La tuberculosis pulmonar todavía no es una enfermedad erradicada, aunque su incidencia ha disminuido considerablemente. El tratamiento y el pronóstico de esta enfermedad han dado un cambio profundo durante estos últimos 30 años con el descubrimiento de nuevos medicamentos antituberculosos.

  14. Endometriose pleural: achados na ressonância magnética Pleural endometriosis: findings on magnetic resonance imaging

    Directory of Open Access Journals (Sweden)

    Edson Marchiori

    2012-12-01

    Full Text Available A endometriose é uma doença ginecológica benigna associada à dor pélvica e infertilidade que afeta principalmente mulheres em idade reprodutiva. A endometriose torácica afeta o parênquima pulmonar ou a pleura. Relatamos os casos de duas pacientes com endometriose pleural que apresentaram pneumotórax recorrente. Em ambos os casos, a ressonância magnética de tórax mostrou hidropneumotórax à direita e nódulos redondos, bem definidos, na superfície pleural à direita. A ressonância magnética é uma boa opção para a caracterização dos nódulos de endometriose pleural e de derrame pleural hemorrágico.Endometriosis is a benign gynecological disorder associated with pelvic pain and infertility, primarily affecting women of reproductive age. Thoracic endometriosis affects the pulmonary parenchyma or pleura. We report the cases of two patients with pleural endometriosis who presented with recurrent pneumothorax. In both cases, magnetic resonance imaging (MRI of the chest showed right hydropneumothorax and well-defined, rounded nodules on the pleural surface in the right hemithorax. We conclude that MRI is a good option for the characterization of pleural endometriotic nodules and hemorrhagic pleural effusion.

  15. Eosinofilia pulmonar Pulmonary eosinophilia

    Directory of Open Access Journals (Sweden)

    Luiz Eduardo Mendes Campos

    2009-06-01

    Full Text Available As formas de eosinofilia pulmonar constituem um grupo heterogêneo definido pela presença de um ou dois critérios: infiltrado pulmonar com eosinofilia sanguínea e/ou eosinofilia tissular caracterizada por eosinófilos demonstrados na biópsia pulmonar ou no lavado broncoalveolar. Embora o infiltrado inflamatório seja composto de macrófagos, linfócitos, neutrófilos e eosinófilos, a presença de eosinofilia é um marcador importante para o diagnóstico e tratamento. A apresentação clínica e radiológica pode revelar eosinofilia pulmonar simples, pneumonia eosinofílica crônica, pneumonia eosinofílica aguda, aspergilose broncopulmonar alérgica e eosinofilia pulmonar associada à doença sistêmica, como na síndrome de Churg-Strauss e na síndrome hipereosinofílica. A asma está frequentemente associada, podendo ser um pré-requisito, como na aspergilose broncopulmonar alérgica e na síndrome de Churg-Strauss. Nas doenças com acometimento sistêmico, a pele, o coração e o sistema nervoso são os órgãos mais comprometidos. A apresentação radiológica pode ser considerada como típica, ou pelo menos sugestiva, para três formas de eosinofilia pulmonar: pneumonia eosinofílica crônica, aspergilose broncopulmonar alérgica e pneumonia eosinofílica aguda. A etiologia da eosinofilia pulmonar pode ser de causa primária (idiopática ou secundária, compreendendo causas conhecidas, como drogas, parasitas, infecções por fungos e micobactérias, irradiação e toxinas. A eosinofilia pulmonar pode também estar associada a doenças pulmonares difusas, doenças do tecido conectivo e neoplasias.Pulmonary eosinophilia comprises a heterogeneous group of diseases defined by eosinophilia in pulmonary infiltrates (bronchoalveolar lavage fluid or in tissue (lung biopsy specimens. Although the inflammatory infiltrate is composed of macrophages, lymphocytes, neutrophils and eosinophils, eosinophilia is an important marker for the diagnosis

  16. CT of pleural abnormalities

    International Nuclear Information System (INIS)

    Webb, W.R.

    1995-01-01

    Briefly discussed were CT diagnosis of pleural thickening, CT technique for examining the pleura or pleuro-pulmonary disease, diagnosis of pleural collections, diagnosis of pleural fluid abnormalities in patients with pneumonia, pleural neoplasms, malignant (diffuse) mesothelioma, metastases, local fibrous tumor of the pleura (benign mesothelioma) (21 refs.)

  17. CT of pleural abnormalities

    Energy Technology Data Exchange (ETDEWEB)

    Webb, W R [California Univ., San Francisco, CA (United States). Dept. of Radiology

    1996-12-31

    Briefly discussed were CT diagnosis of pleural thickening, CT technique for examining the pleura or pleuro-pulmonary disease, diagnosis of pleural collections, diagnosis of pleural fluid abnormalities in patients with pneumonia, pleural neoplasms, malignant (diffuse) mesothelioma, metastases, local fibrous tumor of the pleura (benign mesothelioma) (21 refs.).

  18. Pleural Lubrication

    Directory of Open Access Journals (Sweden)

    Cristina Porta

    2016-05-01

    Full Text Available During breathing, the pleural surfaces slide against each other continuously without damage. Pleural liquid and lubricating molecules should provide the lubrication of the sliding surfaces, thus protecting the mesothelium from shear-induced abrasion. D’Angelo et al. (Respir. Physiol. Neurobiol. 2004 measured the coefficient of kinetic friction (μ of rabbit parietal pleura sliding against visceral pleura in vitro at physiological velocities and under physiological loads; it was ~0.02 and did not change with sliding velocity, consistent with boundary lubrication. μ in boundary lubrication can be influenced by surface molecules like hyaluronan, sialomucin or surface active phospholipidis. Hyaluronan or sialomucin is able to restore good boundary lubrication in damaged mesothelium. Nevertheless, hyaluronidase and neuraminidase treatment of the mesothelium does not increase μ, though neuraminidase cleaves sialic acid from the mesothelium. Short pronase or phospholipase treatment, so as to affect only the mesothelial glycocalyx, increases μ, and this increase is removed by hyaluronan or sialomucin. On the other hand, addition of phospholipids after phospholipase treatment produces a small effect relative to that of hyaluronan or sialomucin, and this effect is similar with unsaturated or saturated phospholipids. In damaged mesothelium, the lubrication regimen becomes mixed, but addition of hyaluronan or sialomucin restores boundary lubrication.

  19. Leptospirose pulmonar Pulmonary leptospirosis

    Directory of Open Access Journals (Sweden)

    João Cláudio Barroso Pereira

    2007-12-01

    Full Text Available No presente artigo, os autores discutem brevemente sobre a leptospirose, realçando a forma pulmonar da doença. Revê-se a patologia, achados clínicos, diagnóstico por métodos de imagem e broncoscopia e tratamento da leptospirose pulmonar. É também lembrado o diagnóstico clínico e radiológico precoces, para que se possa iniciar terapêutica adequada. Os autores concluem que a forma pulmonar da leptospirose deve ser sempre considerada como causa e diagnóstico diferencial da hemorragia alveolar difusa e síndroma de dificuldade respiratória do adulto.In this article, the authors discuss briefly the leptospirosis, emphasizing mainly the pulmonary form of disease. The authors review pathology, clinical findings, imaging and broncoscopy diagnosis, treatment of pulmonary leptospirosis. It is also remembered about early clinics and radiology diagnosis to start therapeutics. The authors conclude that pulmonary form of disease must always be remembered and considered as cause and differential diagnosis of Diffuse Alveolar Hemorrhage and Adult Respiratory Distress Syndrome.

  20. Proteinosis alveolar pulmonar

    Directory of Open Access Journals (Sweden)

    Concepción Sánchez Infante

    2011-12-01

    Full Text Available La proteinosis alveolar pulmonar es una enfermedad respiratoria crónica, caracterizada por alteración en el metabolismo del surfactante, lo que determina su acumulación anormal en el espacio alveolar. Es una enfermedad extremadamente rara. Se han reportado solamente 500 casos en la literatura. Se describió por primera vez en 1958. Se presenta un caso de proteinosis alveolar pulmonar en un lactante de 2 meses, con desnutrición proteico energética, que ingresa por dificultad respiratoria e hipoxemia, y, con imágenes radiológicas de tipo retículo-nodulillar, en vidrio deslustrado, en el cual se plantea inicialmente el diagnóstico de bronconeumonía. Ante la evolución desfavorable y no respuesta al tratamiento, se realizó un estudio para descartar enfermedades pulmonares crónicas. El paciente fallece y se confirma el diagnóstico por anatomía patológica. Se realiza una revisión del tema.

  1. CRIPTOCOCOSE: RELATO DE CASO

    Directory of Open Access Journals (Sweden)

    Fernanda Alvarez GENTIL

    2016-12-01

    Full Text Available Criptococose, doença infecciosa fúngica, oportunista, potencialmente fatal, que acomete animais silvestres e domésticos, principalmente cachorro e gato e o homem. Causada pela levedura, Cryptococcus neoformans. Mais frequente em adultos, comumente diagnosticada em pacientes imunodeprimidos, como os soropositivos, fator predisponente mais frequente. Outros fatores são: uso prolongado de medicações imunossupressoras, doenças como diabetes, sarcoidose, doença de Hodgkin e outras neoplasias hematológicas, lúpus eritematoso, artrite reumatoide, doença de Behçet, e transplante de vísceras sólidas. Geralmente adquirida pela inalação do agente etiológico. Objetivo: este estudo objetiva relatar o caso de um paciente portador de criptococose, que esteve invernado no Hospital São José do Avaí (HSJA de Itaperuna, no mês de setembro de 2016, corroborando na literatura descrita sobre o tema, justifica-se o tema pela raridade do caso. Metodologia: inicialmente realizou-se pesquisa bibliográfica através da seleção de autores que asseguraram uma fundamentação teórico-metodológica que serviu de arcabouço para o desenvolvimento do estudo. A metodologia apresentada refere-se a um relato de caso, realizado a partir do prontuário do paciente e dos exames disponíveis. Resultados: a Radiografia de tórax evidenciou massa pulmonar em lobo inferior direito e a Tomografia de tórax também demonstrou esse acometimento; sendo realizada biópsia desse fragmento, que consolidou o diagnóstico de criptococose. A lâmina do paciente, corada com hematoxilina-eosina demonstrou aspectos característicos do acometimento por esse fungo. Conclusão: para o tratamento, pode-se utilizar antifúngicos como a anfotericina B associado com 5-flucitosina, em infecções disseminadas; ou fluconazol e itraconazol, para infecções cutâneas. 

  2. Late outcome of right ventricular outflow tract repair using bicuspid pulmonary prosthesis in tetralogy of Fallot surgery repair: case report Resultado tardio da reconstrução da via de saída do ventrículo direito com prótese pulmonar bicúspide na correção da tetralogia de Fallot: relato de caso

    Directory of Open Access Journals (Sweden)

    Miguel Angel Maluf

    2009-12-01

    Full Text Available We present a case of a 19 year-old female patient, with tetralogy of Fallot and hypoplastic pulmonary ring. Diagnosis was performed by echocardiography and cardiac catheterization. The surgical repair was performed at the age of 2 years old. A right ventricular outflow tract remodeling was performed using a porcine pulmonary bicuspid prosthesis. The patient presented a uneventful follow-up during 17 years. Postoperative assessment has shown: mild pulmonary insufficiency and mild pulmonary ventricle gradient, satisfactory right ventricular performance and prosthesis not presenting calcification. This is an option to correct the tetralogy of Fallot adopted by our Institution in the last two decades.É apresentado o caso de uma paciente de 19 anos de idade, sexo feminino, portadora de tetralogia de Fallot com anel pulmonar hipoplásico. O diagnóstico foi feito com ecoDopplercardiograma e cateterismo cardíaco. A correção cirúrgica foi realizada com 2 anos de idade. Para a reconstrução da valva pulmonar e via de saída do ventrículo foi utilizada prótese bivalvular pulmonar porcina. A paciente teve boa evolução clínica durante 17 anos. A avaliação pós-operatória demonstrou: discreta insuficiência pulmonar, discreto gradiente transvalvar pulmonar, desempenho do ventrículo direito preservado e prótese pulmonar sem calcificação. Esse é o procedimento adotado pela nossa Instituição para a correção da tetralogia de Fallot, nos últimos 20 anos.

  3. Linfangioleiomiomatosis y trasplante pulmonar

    OpenAIRE

    Ansótegui Barrera, Emilio

    2012-01-01

    La linfangioleiomiomatosis (LAM) es una enfermedad rara que afecta predominantemente a la mujer, sobre todo en edad fértil. Se caracteriza por una proliferación anormal de células musculares lisas inmaduras, células LAM, que crecen de una manera aberrante en la vía aérea, parénquima, linfáticos y vasos sanguíneos pulmonares, lo que determina una evolución progresiva hacia la insuficiencia respiratoria que condiciona el fallecimiento de las pacientes. Tiene carácter multisistémico afectando as...

  4. Disseminated Pleural Siliconoma Mimicking Malignant Pleural Mesothelioma.

    Science.gov (United States)

    Tanaka, Toshiki; Tao, Hiroyuki; Hayashi, Tatsuro; Yoshiyama, Koichi; Furukawa, Masashi; Yoshida, Kumiko; Okabe, Kazunori

    2015-12-01

    A 48-year-old woman with a 3-month history of back pain was admitted for further examination of multiple left pleural nodules. She had undergone bilateral breast augmentation with silicone implants 10 years previously. Nine years after the operation, both ruptured implants were removed, and autologous fat was injected. Computed tomography revealed multiple pleural nodules suggestive of malignant pleural mesothelioma. Thoracoscopic exploration revealed multiple pleural nodules with massive pleural adhesions. The nodules were filled with viscous liquid and were histologically determined to be siliconomas. Disseminated pleural siliconoma should be recognized as a late adverse event of silicone breast implantation. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  5. Complicações pulmonares de endocardite tricúspide num doente toxicómano

    Directory of Open Access Journals (Sweden)

    Carlos Lousada

    1997-01-01

    Full Text Available RESUMO: Os autore apresentam o caso clínico de um doente toxicodependente com embolias pulmonares sépticas, pneumotórax e derrame pleural secundários a endocardite tricúspide e sindrome nefrótico.Discutese o diagnóstico, mecanismos etiopatogénicos, terapêutica médica, indicações cirúrgicas e prognóstico destas situações. SUMMARY: The authors present a case of an intravenous drug addict with septic pulmonary embolism, pneumothorax and pleural effusion secondary to tricuspid infectious endocarditis and nephrotic syndrome.The diagnosis, etiopathogenic mechanisms, treatment implications, the role of surgery and the prognosis are discussed. Palavras-chave: embolia pulmonar séptica, pneumotórax, endocardite tricúspide, Key-Word: septic pulmonary emboli, pneumothorax, tricuspid endocarditis

  6. Malignant pleural mesothelioma

    International Nuclear Information System (INIS)

    Wentz, K.U.; Irngartinger, G.; Georgi, P.; Kaick, G. van; Kleckow, M.; Vollhaber, H.H.; Deutsches Krebsforschungszentrum, Heidelberg; Krankenhaus Rohrbach

    1986-01-01

    In 34 patients with suspected malignant pleural mesothelioma the results of computed tomography are compared with the findings of 67 Ga-scintigraphy. The differential diagnosis of 14 pleural mesotheliomas, 7 pleural carcinoses, 10 inflammatory and 3 other pleural diseases is performed more accurately by CT than by scintigraphy. 67 Ga uptake depends on the thickness of inflammatory as well as malignant lesions. Thus, numerous pleural processes that can be localised by CT escape scintigraphic detection, CT is indicated if there is clinical and radiological suspicion of pleural mesothelioma; in that case, there is hardly any indication for 67 Ga scintigraphy. (orig.)

  7. Envolvimento pulmonar na polimiosite

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    Direndra Hasmucrai

    2010-07-01

    Full Text Available Resumo: Introdução: A polimiosite (PM e a dermatomiosite são classificadas como miopatias inflamatórias idiopáticas. O envolvimento pulmonar por PM é pouco frequente, estando descrito na literatura em cerca de 10% de casos.Os autores apresentam um caso de uma mulher de 75 anos, com queixas de febre, perda ponderal, artralgias, mialgias e diminuição simétrica e proximal da força muscular com impotência funcional dos membros superiores e inferiores, com início um mês antes do internamento. Apresentava infiltrados pulmonares na telerradiografia de tórax. Após estudo exaustivo estabeleceu-se o diagnóstico de envolvimento pulmonar na forma de pneumonia organizativa por PM. Efectuou-se corticoterapia e terapêutica com micofenolato com melhoria clínica, analítica e radiológica. Conclusão: Neste caso, foi a alteração na telerradiografia de tórax numa doente sem sintomatologia respiratória que levou ao estudo exaustivo até ao diagnóstico de PM, realçando mais uma vez a importância da telerradiografia no rastreio de patologias de outros foros. Abstract: Introduction: Polymyositis and dermatomyositis are classified as idiopathic inflammatory myopathies. Interstitial lung disease is rare and is described in the literature in about 10% of cases.The authors describes a case of 75 year old woman presenting with one month evolution of fever, weight loss, arthralgia, myalgia and symmetric and proximal muscle weakness of upper and lower limbs. Nonspecific interstitial changes was found in chest X-ray. After exhaustive study, the diagnosis of pulmonary envolvement in the form of organizing pneumonia by polymyositis, was established. Glucocorticoids and mycophenolate were prescribed with good clinical, analytical and radiological outcome. Conclusion: In this case, it was the changes in the chest X-ray in a patient without respiratory symptomatology, that conducted to exhaustive study to polymyositis diagnosis, enhancing once again the

  8. Reoperação de tromboendarterectomia pulmonar em recidiva de tromboembolismo pulmonar crônico hipertensivo Repeat pulmonary thromboendarterectomy after recurrence of chronic thromboembolic pulmonary hypertension

    Directory of Open Access Journals (Sweden)

    Walter José Gomes

    2009-01-01

    Full Text Available A cirurgia de tromboendarterectomia tem se estabelecido como método padrão de tratamento do tromboembolismo pulmonar crônico hipertensivo, com excelentes resultados. Entretanto, a reoperação na recidiva do embolismo pulmonar não tem relato na literatura nacional, permanecendo obscuras a sua segurança e efetividade. Relatamos o caso de uma paciente com recorrência de tromboembolismo pulmonar crônico hipertensivo ocorrido cinco anos após a primeira cirurgia de tromboendarterectomia pulmonar, e que necessitou de reoperação para resolução dos sintomas.Pulmonary thromboendarterectomy has been established as the standard method for the treatment of chronic thromboembolic pulmonary hypertension, with excellent results. However, repeat pulmonary thromboendarterectomy due to recurrence of pulmonary embolism has never been reported in the Brazilian literature. Its safety and effectiveness remain obscure. We report the case of a patient presenting recurrence of chronic thromboembolic pulmonary hypertension five years after the first pulmonary thromboendarterectomy and requiring a second operation for resolution of the symptoms.

  9. Diagnostic Tools of Pleural Effusion

    OpenAIRE

    Na, Moon Jun

    2014-01-01

    Pleural effusion is not a rare disease in Korea. The diagnosis of pleural effusion is very difficult, even though the patients often complain of typical symptoms indicating of pleural diseases. Pleural effusion is characterized by the pleural cavity filled with transudative or exudative pleural fluids, and it is developed by various etiologies. The presence of pleural effusion can be confirmed by radiological studies including simple chest radiography, ultrasonography, or computed tomography....

  10. Pulmonary artery catheter complications: report on a case of a knot accident and literature review Complicações do cateter de artéria pulmonar: relato de caso de formação de nó verdadeiro revisão da literatura

    Directory of Open Access Journals (Sweden)

    Marcelo Cruz Lopes

    2004-01-01

    Full Text Available A particular event concerning a Swan-Ganz catheter complication is reported. A 41-year-old woman was admitted at the emergency room of our hospital with massive gastrointestinal bleeding. A total gastrectomy was performed. During the postoperative period in the intensive care unit , the patient maintained hemodynamic instability. Invasive hemodynamic monitoring with a pulmonary artery catheter was then indicated. During the maneuvers to insert the catheter, a true knot formation was identified at the level of the superior vena cava. Several maneuvers by radiological endovascular invasive techniques allowed removal of the catheter. The authors describe the details of this procedure and provide comments regarding the various techniques that were employed in overcoming this event. A comprehensive review of evidence regarding the benefits and risks of pulmonary artery catheterization was performed. The consensus statement regarding the indications, utilization, and management of the pulmonary artery catheterization that were issued by a consensus conference held in 1996 are also discussed in detail.É relatada uma complicação infreqüente , associada ao uso do Cateter de Artéria Pulmonar. Uma paciente de 41 anos foi admitida no Pronto Socorro do nosso hospital com hemorragia digestiva alta grave. A doente foi submetida à gastrectomia total. Na Unidade de Terapia Intensiva, evoluiu com instabilidade hemodinâmica, sendo indicada a monitorização hemodinâmica invasiva com cateter de artéria pulmonar. Durante as manobras para o correto posicionamento do cateter na artéria pulmonar, foi diagnosticado formação de nó verdadeiro, ao nível da veia cava superior. Os autores discutem as várias opções técnicas empregadas para a resolução desta complicação, através do emprego da radiologia intervencionista endovascular. Extensa revisão da literatura procurando discutir os benefícios e riscos envolvidos na monitorização hemodin

  11. Ultrasound guided pleural biopsy in undiagnosed exudative pleural effusion patients

    Directory of Open Access Journals (Sweden)

    Adel S. Ahmed

    2016-04-01

    In conclusion: Thoracic ultrasound (TUS guided pleural biopsy had a diagnostic yield which was slightly lower but comparable to both CT guided pleural biopsy and medical thoracoscopic pleural biopsy (MT.

  12. Ultrasound guided pleural biopsy in undiagnosed exudative pleural effusion patients

    OpenAIRE

    Adel S. Ahmed; Mostafa I. Ragab; Alaa eldin M. Elgazaar; Nagwan A. Ismail

    2016-01-01

    Introduction: Pleural biopsy for pathological confirmation is the standard diagnostic procedure for pleural diseases, transthoracic ultrasonography (TUS) has evolved as an important imaging tool for diagnosing pleural and pulmonary conditions. Aim of the study: To assess the diagnostic yield of TUS guided pleural biopsy versus both CT guided and thoracoscopic pleural biopsy in the diagnosis of undiagnosed exudative pleural effusion. Patients and methods: The study was conducted at chest...

  13. Comprometimento pulmonar na leptospirose

    Directory of Open Access Journals (Sweden)

    Jorge Eduardo Manhães de Carvalho

    1992-03-01

    Full Text Available Em 23 pacientes com leptospirose apresentando comprometimento pulmonar, internados no Hospital Universitário Antônio Pedro da XJFF, Niterói, hemoptise e hemoptóicos foram observados em 21,7% e 30,4%, respectivajnente. Gasometria arterial revelou hipoxemia e hipocapnia na maioria dos casos. Radiografia de tórax em 15 pacientes mostrou comprometimento alveolar em 60%, comprometimento intersticial-reticular em 6%, padrão misto (alveolar e intersticial em20%e ausência de alterações radiológicas em 14%. A necrópsiade 13 pacientes mostrou edema, congestão e hemorragia nos pulmões em 100% dos casos. A hemorragia foi focal em 46% e difusa em 54% dos casos. Houve formação de membrana hialina em 30% e trombos de fibrina em 46% dos pulmões estudados, o que estabelece o diagnóstico da coagulação intravascular disseminada e a ocorrência da síndrome de angústia respiratória na leptospirose.

  14. Pleural effusion in the dog and cat

    International Nuclear Information System (INIS)

    Forrester, S.D.

    1990-01-01

    The most common causes of pleural effusion and their management are discussed under the headings: pleural anatomy; pleural fluid movement; mechanisms of pleural effusion; diagnosis; patterns of pleural effusion

  15. Pleural function and lymphatics.

    Science.gov (United States)

    Negrini, D; Moriondo, A

    2013-02-01

    The pleural space plays an important role in respiratory function as the negative intrapleural pressure regimen ensures lung expansion and in the mean time maintains the tight mechanical coupling between the lung and the chest wall. The efficiency of the lung-chest wall coupling depends upon pleural liquid volume, which in turn reflects the balance between the filtration of fluid into and its egress out of the cavity. While filtration occurs through a single mechanism passively driving fluid from the interstitium of the parietal pleura into the cavity, several mechanisms may co-operate to remove pleural fluid. Among these, the pleural lymphatic system emerges as the most important one in quantitative terms and the only one able to cope with variable pleural fluid volume and drainage requirements. In this review, we present a detailed account of the actual knowledge on: (a) the complex morphology of the pleural lymphatic system, (b) the mechanism supporting pleural lymph formation and propulsion, (c) the dependence of pleural lymphatic function upon local tissue mechanics and (d) the effect of lymphatic inefficiency in the development of clinically severe pleural and, more in general, respiratory pathologies. © 2012 The Authors Acta Physiologica © 2012 Scandinavian Physiological Society.

  16. Pleural spill malign

    International Nuclear Information System (INIS)

    Camacho Duran, Fidel; Zamarriego, Roman; Gonzalez, Mauricio

    2002-01-01

    The pleural spills are developed because of an alteration in the mechanisms that usually move between 5 and 10 liters of liquid through the space pleural every 24 hours and this is reabsorbed, only leaving 5 to 20 ml present. The causes more common of spill pleural they are: congestive heart failure, bacterial pneumonia, malign neoplasia and pulmonary clot. The causes more common of pleural spill malign in general are: cancer of the lung, cancer of the breast and lymphomas. In the man, cancer of the lung, lymphomas and gastrointestinal cancer. In the woman, cancer of the breast, gynecological cancer and lung cancer. The paper, includes their characteristics, treatments and medicines

  17. Pleural biopsy for indeterminate cases of pleural effusion | Ukadike ...

    African Journals Online (AJOL)

    Materials and Methods: This is a retrospective study of all consecutive cases of pleural biopsies done for indeterminate cause of pleural effusion in the University of Benin Teaching Hospital from December 2008 to May 2010, a total of 18months. Blind pleural biopsy was carried out using the Abram's Pleural Biopsy Needle.

  18. Pleural mesothelioma - case report.

    Science.gov (United States)

    Klawiter, Anna; Damaszke, Tomasz

    2010-10-01

    Pleural mesothelioma is a very rare neoplasm; especially the local form. The diagnostics is difficult and the prognosis unfavourable. We presented a case of a man with dyspnoea and cough. His chest radiogram showed hydrothorax on the left side. Neither the examinations of the pleural liquid, nor the CT-guided fine needle biopsy established the diagnosis. CT showed features suggestive of pleural mesothelioma. The diagnosis was confirmed by thoracoscopy. Although no neoplastic cells were found in the thoracoscopic specimen from the supradiaphragmatic tumor, we assumed that to be a case of a diffuse, primarily local form of mesothelioma. Diagnostics of pleural mesothelioma is very difficult. CT and thoracoscopy seem to be very valuable diagnostic methods. It is worth remembering that pleural mesothelioma can have a local form which may transform into a diffuse one.

  19. Atypical pleural tuberculosis presenting as an isolated pleural tuberculoma

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, Sook Min; Rho, Ji Young; Yoo, Seung Min; Jung, Hae Kyoung (Department of Radiology, CHA Bundang Medical Center, CHA University, Gyeonggi-do (Korea, Republic of)), Email: rhoji@naver.com; Cho, Sang Ho (Department of Pathology, CHA Bundang Medical Center, CHA University, Gyeonggi-do (Korea, Republic of))

    2012-02-15

    Pleural tuberculosis is the most common extrapulmonary manifestation of tuberculosis, and is generally characterized by an effusion. The effusion is usually unilateral and residual pleural thickening or calcification is also observed in some cases. Manifestations of multiple pleural tuberculomas without associated effusion and history of tuberculosis or antituberculous therapy are rare and an isolated pleural tuberculoma is exceedingly rare. Herein, we report the first documented case of an isolated pleural tuberculoma, diagnosed by chest CT and pathological findings. Although rare, an isolated pleural tuberculoma should be added to the differential diagnosis of focal nodular pleural tumors, particularly in areas of high tuberculosis prevalence

  20. Pleural mechanics and fluid exchange.

    Science.gov (United States)

    Lai-Fook, Stephen J

    2004-04-01

    The pleural space separating the lung and chest wall of mammals contains a small amount of liquid that lubricates the pleural surfaces during breathing. Recent studies have pointed to a conceptual understanding of the pleural space that is different from the one advocated some 30 years ago in this journal. The fundamental concept is that pleural surface pressure, the result of the opposing recoils of the lung and chest wall, is the major determinant of the pressure in the pleural liquid. Pleural liquid is not in hydrostatic equilibrium because the vertical gradient in pleural liquid pressure, determined by the vertical gradient in pleural surface pressure, does not equal the hydrostatic gradient. As a result, a viscous flow of pleural liquid occurs in the pleural space. Ventilatory and cardiogenic motions serve to redistribute pleural liquid and minimize contact between the pleural surfaces. Pleural liquid is a microvascular filtrate from parietal pleural capillaries in the chest wall. Homeostasis in pleural liquid volume is achieved by an adjustment of the pleural liquid thickness to the filtration rate that is matched by an outflow via lymphatic stomata.

  1. Diagnostic Tools of Pleural Effusion

    Science.gov (United States)

    2014-01-01

    Pleural effusion is not a rare disease in Korea. The diagnosis of pleural effusion is very difficult, even though the patients often complain of typical symptoms indicating of pleural diseases. Pleural effusion is characterized by the pleural cavity filled with transudative or exudative pleural fluids, and it is developed by various etiologies. The presence of pleural effusion can be confirmed by radiological studies including simple chest radiography, ultrasonography, or computed tomography. Identifying the causes of pleural effusions by pleural fluid analysis is essential for proper treatments. This review article provides information on the diagnostic approaches of pleural effusions and further suggested ways to confirm their various etiologies, by using the most recent journals for references. PMID:24920946

  2. Pleural needle biopsy

    Science.gov (United States)

    ... own. Sometimes, a chest tube is needed to drain the air and expand the lung. There is also a chance of excessive blood loss. Considerations If a closed pleural biopsy is not enough to make a diagnosis, ...

  3. Tuberculous Pleural Effusion

    Science.gov (United States)

    Cohen, Leah A.; Light, Richard W.

    2015-01-01

    When a patient presents with new pleural effusion, the diagnosis of tuberculous (TB) pleuritis should be considered. The patient is at risk for developing pulmonary or extrapulmonary TB if the diagnosis is not made. Between 3% and 25% of patients with TB will have TB pleuritis. The incidence of TB pleuritis is higher in patients who are human immunodeficiency virus (HIV)-positive. Pleural fluid is an exudate that usually has a predominance of lymphocytes. The easiest way to diagnose TB pleuritis in a patient with lymphocytic pleural effusion is to demonstrate a pleural fluid adenosine deaminase level above 40 IU/L. The treatment for TB pleuritis is the same as that for pulmonary TB. Tuberculous empyema is a rare occurrence, and the treatment is difficult. PMID:29404070

  4. Tuberculosis pulmonar de campos inferiores

    Directory of Open Access Journals (Sweden)

    Alejandra González

    2010-10-01

    Full Text Available La tuberculosis (TB que compromete sólo los campos pulmonares inferiores (TBCI es poco frecuente en el adulto y en general está asociada a alguna causa de inmunodepresión. El objetivo de nuestro trabajo fue determinar la incidencia de TBCI en nuestra población y comparar sus características respecto de la TB pulmonar de localización habitual. Se estudiaron en forma retrospectiva en el período de 2004 a 2008, 42 pacientes con TBCI que fueron comparados con 84 pacientes con TB pulmonar de localización habitual (grupo control. Se excluyeron pacientes con HIV. La TBCI representó el 6% del total de TB pulmonar. No se encontraron diferencias significativas en cuanto a edad, sexo, presencia de cavidades en la radiografía, días de evolución y nivel de albúmina. La TBCI tuvo significativamente mayor proporción de comorbilidades (p < 0.001, presencia de condensación (p < 0.001 y compromiso unilateral (p < 0.001 en la radiografía de tórax, junto con mayor número de internaciones (p = 0.02. Cabe destacar que sólo16 de los 42 pacientes con TBCI (38% tenían alguna comorbilidad demostrada. La TBCI puede presentarse aun sin comorbilidades asociadas y debe sospecharse en neumonías de evolución tórpida independientemente de su localización.

  5. [Pleural effusion: diagnosis and management].

    Science.gov (United States)

    Pastré, J; Roussel, S; Israël Biet, D; Sanchez, O

    2015-04-01

    Pleural effusion management is a common clinical situation associated with numerous pulmonary, pleural or extra-pulmonary diseases. A systematic approach is needed to enable a rapid diagnosis and an appropriate treatment. Pleural fluid analysis is the first step to perform which allows a presumptive diagnosis in most cases. Otherwise, further analysis of the pleural fluid or thoracic imaging or pleural biopsy may be necessary. This review aims at highlighting the important elements of the work-up required by a pleural effusion. Copyright © 2014 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.

  6. Histoplasma com derrame pleural: relato de um caso Histoplasmoma and pleural effusion: a case report

    Directory of Open Access Journals (Sweden)

    Marcos C. de Almeida

    1990-10-01

    Full Text Available Efusões pleurais surgem raramente em associação com a histoplasmose capsu-lata, ocorrendo em geral nas formas agudas da doença. Relatamos e discutimos um caso clínico em que um histoplasmoma subpleural acompanhou-se de dor pleurítica, hidrotórax e pleurite fibrosante.

  7. [Pleural lymphatics and effusions].

    Science.gov (United States)

    Mordant, P; Arame, A; Legras, A; Le Pimpec Barthes, F; Riquet, M

    2013-06-01

    The pleural lymphatic system has a great absorption capacity. Its most known function is fluid resorption. The pleura which cover the lungs (visceral pleura), the mediastinum, diaphragm and thoracic wall (parietal pleura) are formed by a mesothelial cell layer (mesothelium). This permeable layer is in direct contact with the vascular endothelium. The mesothelium is based over a connective tissue (interstitium) containing the blood and lymphatic vessels. The primary lymphatic vessels drain interstitium but are also in direct contact with pleural space by the stoma or openings, situated in the lower parts of parietal pleura, i.e: diaphragm, over lower ribs and mediastinum but not existing in the adjacent visceral pleura. In addition, a part of interstitial pulmonary fluid entered in the pleural cavity by passing the visceral pleura would be absorbed by these openings. The resorption process is active and directly related to the function of smooth muscles of lymphatic vessels. Besides resorption, we must emphasize that this "pumping" activity is permanent and the origin of negative pressure (the pleural void) in pleural cavity, a unique property. The other resorbed elements are molecules, bacterial and cellular debris, cells, red blood and cancer cells. Copyright © 2013. Published by Elsevier Masson SAS.

  8. Diagnostic imaging of small amounts of pleural fluid: pleural effusion vs. physiologic pleural fluid.

    Science.gov (United States)

    Kocijancic, Igor

    2007-12-01

    The aim of this article is to present an overview of our 10 years clinical research work and early clinical experience with small pleural effusions. Small amounts of pleural fluid are severely difficult to identify with imaging methods (chest x-rays and ultrasound). Nevertheless, it may be an important finding, sometimes leading to a definitive diagnosis of pleural carcinomatosis, infection or other pathologic condition. Chest x-rays were used for many years for the diagnosis of small pleural effusions. Lateral decubitus chest radiographs represented a gold standard for imaging of small amounts of plural fluid for more than 80 years. In the last two decades, ultrasonography of pleural space became a leading real-time method for demonstrating small pleural effusions. Furthermore, the advent of sonographic technology actually enables detection of physiologic pleural fluid in some otherwise healthy individuals. In conclusion, new definitions of the key terms in the field of diagnostic imaging of small amounts of pleural fluid seem to be justified. We suggest that the term pleural fluid should determine physiologic pleural space condition while the term pleural effusion should only be used in the cases of pleural involvement or pleural illness.

  9. FIBROSIS PULMONAR IDIOPÁTICA

    Directory of Open Access Journals (Sweden)

    Álvaro Undurraga P., DR.

    2015-05-01

    Diversas comorbilidades se han descrito como la hipertensión pulmonar, la asociación con enfisema y el reflujo gastroesofágico. Sólo recientemente aparecen fármacos útiles, que son la Pirfenidona y el Nintedanib. El clásico esquema de prednisona, azatriopina y N-acetil cisteina, se ha demostrado ineficaz. Otros recursos que pueden utilizarse como complementos útiles en la enfermedad son el oxígeno, la rehabilitación, las terapias antirreflujo y el manejo sintomático de la tos.

  10. Árgon-plasma no tratamento de leiomioma benigno metastizante pulmonar: um caso clínico

    Directory of Open Access Journals (Sweden)

    A. Bugalho

    2010-11-01

    Full Text Available Resumo: Os leiomiomas benignos metastizantes pulmonares são tumores raros de células musculares lisas. Uma doente de 48 anos foi avaliada devido a tosse persistente, dispneia progressiva e sintomas constitucionais. A tomografi a computorizada do tórax revelou uma massa endobrônquica à esquerda, múltiplos nódulos do parênquima pulmonar e derrame pleural. As características histológicas da biopsia brônquica foram consistentes com o diagnóstico de leiomioma benigno metastizante. A doente foi submetida a árgon-plasma e desobstrução mecânica com efi cácia terapêutica. Verifi cou-se estabilidade clínica nos últimos quatro anos. Abstract: Benign metastasizing leiomyomas of the lung are rare smooth muscle cells tumours. We report the case of a 48 year-old female who was evaluated due to persistent cough, progressive dyspnoea and constitutional symptoms. Chest computed tomography revealed a left endobronchial mass, multiple parenchyma nodules and a pleural effusion. Bronchial biopsy histological features were consistent with benign metastasizing leiomyoma. The patient was successfully treated with argon-plasma and mechanical debulking. There was no disease relapse in the last four years. : PALAVRAS-CHAVE, Leiomioma benigno, metastizante, Neoplasias pulmonares, Diagnóstico, Broncoscopia, Tratamento, Tratamento árgon-plasma, KEYWORDS: Benign metastasizing, leiomyoma, Lung neoplasms, Diagnosis, Bronchoscopy, Management, Argon-plasma Treatment

  11. [Malignant pleural mesothelioma].

    Science.gov (United States)

    Sritharan, Sajitha Sophia; Frandsen, Jens Lundby; Omland, Øyvind; Bruun, Jens Meldgaard

    2018-04-09

    Malignant pleural mesothelioma (MPM) is a rare cancer with a poor prognosis. The disease is of importance, since the incidence in Denmark is increasing despite cessation of the use of asbestos in the 1980s. MPM has a long latency period, and the first symptom is often dyspnoea, typically caused by pleural effusion. The diagnosis is a challenge, because cytology often is non-conclusive, and thoracoscopy is needed to obtain biopsies for immunohistochemistry. The occupational history is important, since the patients are entitled to compensation. The treatment is often limited to palliation.

  12. Enfermedad pulmonar intersticial asociada a rituximab

    Directory of Open Access Journals (Sweden)

    Marcelo Fernández Casares

    2013-08-01

    Full Text Available La introducción en la práctica clínica del anticuerpo anti-CD20 rituximab ha mejorado sustancialmente el pronóstico de diversas enfermedades autoinmunes y hematológicas. Con el incremento de su uso ha aumentado el registro de efectos adversos, entre ellos la toxicidad pulmonar. Una de sus complicaciones más serias es la enfermedad pulmonar intersticial, entidad potencialmente fatal que debe ser considerada en pacientes que han recibido rituximab y presentan disnea, fiebre y tos sin clara evidencia de infección. Presentamos un caso de enfermedad pulmonar intersticial asociada a rituximab.

  13. Pleural fluid smear

    Science.gov (United States)

    ... into the space around the lungs, called the pleural space. As fluid drains into a collection bottle, you may cough a bit. This is because your lung re-expands to fill the space where fluid had been. This sensation lasts for a few hours after the test.

  14. Evaluation of lymphocytic exudative pleural effusion with pleural biopsy

    International Nuclear Information System (INIS)

    Khurram, M.; Jaffery, A.H.; Khar, Hamama-tul-Bushra; Malik, M.F.; Javed, S.; Burki, U.F.; Khan, B.A.; Ali, A.

    2002-01-01

    Objective: Evaluation of lymphocytic exudative pleural effusion by histopathological examination of pleural biopsy in patients with suspected tuberculous or malignant pleural effusion. Place and Duration of Study: The study was conducted at Pulmonology Department, Pakistan Institute of Medical Sciences, Islamabad and DHQ Teaching Hospital, Rawalpindi for two years 1999-2000. Subjects and Methods: A total of 120 patients with exudative pleural effusion underwent closed pleural biopsy with Abram's needle in standard way. Average 4 biopsy specimens were obtained in each patient which were examined histopathologically. Patients in whom a definite diagnosis was not possible were further investigated with repeat pleural biopsy, sputum examinations, bronchoscopy etc. Results definite histopathological diagnosis with pleural biopsy was possible in 59 (49.16% patients, including 13 diagnosed on repeat pleural biopsy. Two commonest diagnoses made were tuberculosis and adenocarcinoma, 64.40% and 13.55% respectively. Conclusion: Histopathological evaluation of pleural biopsy specimens can lead to diagnosis in 49.16% patients with exudative lymphocytic pleural effusion. (author)

  15. [Sarcoid pleural effusion].

    Science.gov (United States)

    Rodríguez-Núñez, Nuria; Rábade, Carlos; Valdés, Luis

    2014-12-09

    Pleural effusion (PE) is a very uncommon manifestation of sarcoidosis. It is equally observed in men and women, can appear at any age and in all radiologic stages, though it is more common in stages i and ii. Effusions have usually a mild or medium size and mainly involve the right side. Various mechanisms can be implicated. PE will be a serous exudate if there is an increase in the capillary permeability due to direct involvement of the pleural membrane, a chylothorax if mediastinum lymph nodes compress the thoracic duct and/or the lymphatic drainage from the pleural cavity, an hemothorax if granuloma compress or invade pleural small vessels or capillaries, and even a transudate if there is compression of the inferior vena cava, atelectasis due to complete bronchial obstruction or when the resolution of the PE is incomplete with chronic thickening of visceral pleura (trapped lung). It manifests biochemically as a pauci-cellular exudate with a predominance of lymphocytes, though there can be a preponderance of eosinophils or neutrophils. Protein concentrations are usually proportionately higher than lactate dehidrogenase, adenosine deaminase is normally low and it is possible to find increased levels of CA-125 in women. The tuberculin test is negative and pleural or lung biopsies yield the diagnosis by confirming the presence of non-caseating granulomata. These PE can have a favorable self-limited outcome, even though in most cases treatment with corticosteroids is needed, while surgery is required in a few cases. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

  16. Reabilitação pulmonar em longo prazo na doença pulmonar obstrutiva crônica (DPOC

    Directory of Open Access Journals (Sweden)

    Cintia Laura Pereira de Araújo

    2014-04-01

    Full Text Available Introdução: A Doença Pulmonar Obstrutiva Crônica (DPOC prejudica o estado funcional, com consequente limitação das Atividades de Vida Diária (AVD. Este estudo teve como objetivo investigar o efeito de um programa de Reabilitação Pulmonar (RP, em longo prazo, no estado funcional, na dispneia e no índice BODE em pacientes com DPOC. Relato de caso: Trata-se de um estudo retrospectivo e documental, com análise dos prontuários de cinco pacientes participantes de um programa de RP por um ano. Destes prontuários foram coletados dados referentes às avaliações: espirometria, Índice de Massa Corporal (IMC, escalas London Chest Activity of Daily Living (LCADL e Medical Research Council e (MRC teste de caminhada de seis minutos. Após um ano participando do programa de exercício físico, a maioria dos pacientes apresentou maior capacidade funcional, menor dispneia e redução no risco de mortalidade. Conclusão: Um ano de RP parece ter função de manutenção da melhora da capacidade funcional de pacientes com DPOC, após 24 sessões de treinamento.

  17. [Dynamics of pleural liquid in hydrothorax].

    Science.gov (United States)

    Nakamura, T; Iwaskai, Y; Gotoh, T; Hiramori, N; Fujii, T; Sakai, M; Nakagaki, Y; Arimoto, T; Mizobuchi, K; Hashikura, H

    1994-12-01

    The basics of pleural liquid dynamics are summarized. The normal pleural cavity contains a small amount of pleural liquid (0.1-0.3 ml/kg). Its protein concentration is about 1.0 g/dl and its pH is 7.6. The normal flow of pleural liquid is gravity dependent, and pleural liquid flows from the costal to the mediastinal region. In experimental hydrothorax, the pleural liquid was removed mainly via lymphatics. The turnover of the pleural liquid is rapid, and it depends on the area of contact between pleural liquid and pleural and on the blood flow to the pleura.

  18. Calcified pleural scars and pleural empyema with mural calcification

    Energy Technology Data Exchange (ETDEWEB)

    Schmitt, W.G.H.; Huebener, K.H.

    1981-06-01

    The differential diagnosis between calcified pleural scars and pleural empyemas with mural calcification was studied by computer tomography, bearing in mind the patient's history. In view of the high complication rate of pleural empyemas, such as internal or external fistulae, it is desirable to elucidate every form of pleural shadowing which is more than 20 mm thick. Criteria are offered, which permit the differentiation of the pleural changes by means of conventional radiological examinations. Valuable additional information can be obtained by computer tomography. Forty-nine patients with calcification in the pleura were found among 1.900 chest x-rays which had been examined. Out of these, seven had a pleural empyema. In one case an echinococcus cyst with mural calcification was punctured under X-ray control.

  19. Calcified pleural scars and pleural empyema with mural calcification

    International Nuclear Information System (INIS)

    Schmitt, W.G.H.; Huebener, K.H.

    1981-01-01

    The differential diagnosis between calcified pleural scars and pleural empyemas with mural calcification was studied by computer tomography, bearing in mind the patient's history. In view of the high complication rate of pleural empyemas, such as internal or external fistulae, it is desirable to elucidate every form of pleural shadowing which is more than 20 mm thick. Criteria are offered, which permit the differentiation of the pleural changes by means of conventional radiological examinations. Valuable additional information can be obtained by computer tomography. Forty-nine patients with calcification in the pleura were found among 1.900 chest x-rays which had been examined. Out of these, seven had a pleural empyema. In one case an echinococcus cyst with mural calcification was punctured under X-ray control. (orig.) [de

  20. Criptococose pulmonar: aspectos na tomografia computadorizada

    Directory of Open Access Journals (Sweden)

    Silva Ana Carina Gamboa da

    2003-01-01

    Full Text Available A criptococose pulmonar é uma doença causada pelo Criptococcus neoformans, um fungo unimórfico que possui distribuição mundial, existindo na mesma forma tanto no seu habitat natural quanto em animais e humanos. A doença possui apresentações clínica e patológica variáveis e pode manifestar-se tanto em pacientes com a imunidade normal como em imunocomprometidos, que representam a maioria dos casos. Neste trabalho são analisados os aspectos encontrados nas tomografias computadorizadas do tórax de 14 pacientes com criptococose pulmonar confirmada. Os achados mais freqüentes na tomografia do tórax foram as massas e os nódulos pulmonares. Outros aspectos observados foram as áreas de escavação, as consolidações, o espessamento do interstício peribroncovascular e o reticulado difuso. Massa pulmonar foi o achado isolado mais comum (64,2%, seguido dos nódulos isolados ou múltiplos (35,7%. Doença pulmonar difusa foi vista em apenas 14,2% dos casos. Os lobos superiores foram os mais comprometidos, sendo a doença mais comum nas regiões anteriores. A tomografia do tórax permitiu avaliar com precisão o grau de comprometimento do parênquima pulmonar.

  1. Uso de neumocitos de tipo II en el tratamiento de enfermedades pulmonares asociadas con fibrosis pulmonar

    OpenAIRE

    Serrano-Mollar, Anna; Closa, Daniel; Bulbena, Oriol

    2005-01-01

    Se describe el empleo de neumocitos tipo II como agentes inhibidores de la proliferación de fibroblastos, por lo que pueden ser utilizados en la elaboración de un medicamento para el tratamientode enfermedades pulmonares que cursan con fibrosis pulmonar.

  2. Pleural mesothelioma – case report

    OpenAIRE

    Klawiter, Anna; Damaszke, Tomasz

    2010-01-01

    Summary Background: Pleural mesothelioma is a very rare neoplasm; especially the local form. The diagnostics is difficult and the prognosis unfavourable. Case Report: We presented a case of a man with dyspnoea and cough. His chest radiogram showed hydrothorax on the left side. Neither the examinations of the pleural liquid, nor the CT-guided fine needle biopsy established the diagnosis. CT showed features suggestive of pleural mesothelioma. The diagnosis was confirmed by thoracoscopy. Althoug...

  3. Neumotórax bilateral como complicación de metástasis pulmonar cavitaria de un angiosarcoma

    Directory of Open Access Journals (Sweden)

    Lorena V. Maldonado

    2014-06-01

    Full Text Available Las metástasis pulmonares de angiosarcoma constituyen una complicación común de una neoplasia maligna poco frecuente. Habitualmente se presentan como nódulos solidos periféricos y derrame pleural. Presentamos el caso de un hombre de 65 años de edad con neumotórax bilateral recurrente, secundario a metástasis cavitadas de un angiosarcoma primitivo de cuero cabelludo. La videotoracoscopia permitió la inspección, la resección de las metástasis y la pleurodesis. No ocurrieron complicaciones ni recurrencia tumoral a los seis meses de seguimiento.

  4. Pleural irregularities and mediastinal pleural involvement in early stages of malignant pleural mesothelioma and benign asbestos pleural effusion.

    Science.gov (United States)

    Kato, Katsuya; Gemba, Kenichi; Fujimoto, Nobukazu; Aoe, Keisuke; Takeshima, Yukio; Inai, Kouki; Kishimoto, Takumi

    2016-09-01

    To elucidate differences in the level and localization of pleural irregularities in early malignant pleural mesothelioma (eMPM) and benign asbestos pleural effusion (BAPE) using CT. Retrospective assessment of CT findings of consecutive patients with BAPE at a single centre and patients with eMPM reported in Japanese vital statistics. Thirty-six patients with confirmed diagnoses of BAPE and sixty-six patients with confirmed diagnoses of eMPM (mesothelioma stages T1 or T2) were included. Informed consent, CT scans, and clinical and pathologic details were obtained for all patients and were reviewed by one radiologist, two pathologists, and two pulmonologists. Asbestosis, pleural plaque, rounded atelectasis, and diffuse pleural thickening were assessed in all patients. Prevalence of asbestosis, pleural plaque, rounded atelectasis, and diffuse pleural thickening was significantly higher in the BAPE group. Low-level irregularity was more common in the BAPE group (ppleural irregularity was not observed in any patients in the BAPE group, although 55% of patients in the eMPM group showed interlobar pleural irregularity. Mediastinal pleural involvement was observed in 74% of patients in the eMPM group and had a positive predictive value of 89%. This study demonstrates that the level and localization of plural irregularities significantly differed between patients with BAPE and eMPM. Large-scale prospective studies are needed to fully establish the diagnostic utility of such differences. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  5. Manejo escalonado en la supuración pleural

    Directory of Open Access Journals (Sweden)

    Bruk Bekele Jembere

    2002-12-01

    Full Text Available Se realizó un estudio de 36 enfermos con empiema pleural, atendidos por el grupo de Cirugía Torácica del Hospital Universitario "Comandante Manuel Fajardo" entre enero de 1995 y diciembre del 2000. Los enfermos se clasificaron en 3 estadios evolutivos: exudativo, fibrinopurulento y organizado, los que sirvieron de guías para establecer el proceder quirúrgico que se debía realizar. La principal causa fue la neumopatía inflamatoria seguida por las posquirúrgicas. Los gérmenes hallados con mayor frecuencia en los cultivos fueron: el estafilococo, las bacterias gran negativas y el estreptococo. Las intervenciones más realizadas fueron: la pleurotomía mínima con lavado pleural y sin él y la decorticación pleural en sus diferentes variantes. A 3 pacientes se les realizó algún tipo de resección pulmonar. En la fase fibrinopurulenta el 50 % requirió decorticación precoz con el 100 % de curación. En la fase organizada el tratamiento de elección fue la decorticación clásica (62,5 % o la tardía (18,8 %; los 2 fallecidos fueron de esta fase. Las complicaciones fueron escasas, infecciosas en su gran mayoría; el índice de mortalidad quirúrgica fue 5,6 %A study of 36 patients with pleural empyema that were attended by the Group of Thoracic Surgery from Comandante Manuel Fajardo Teaching Hospital from January, 1995, to December, 2000, was conducted. Patients were classified into 3 evolutive stages:exudative, fibrinopurulent and organized, which were used as guides to determine the surgical procedure to be performed. The main cause was inflammatory pneumopathy followed by the postsurgical ones. The germs most commonly found in cultures were: staphylococcus, Gram-negative bacteria and streptococcus. The most used operations were: minimum pleurotomy with and without pleural lavage and pleural decortication in its different variants. 3 patients underwent some type of lung resection. In the fibrinopurulent stage, 50 % required early

  6. Management of malignant pleural effusions.

    LENUS (Irish Health Repository)

    Uzbeck, Mateen H

    2010-06-01

    Malignant pleural effusions are a common clinical problem in patients with primary thoracic malignancy and metastatic malignancy to the thorax. Symptoms can be debilitating and can impair tolerance of anticancer therapy. This article presents a comprehensive review of pharmaceutical and nonpharmaceutical approaches to the management of malignant pleural effusion, and a novel algorithm for management based on patients\\' performance status.

  7. Management of malignant pleural effusion

    NARCIS (Netherlands)

    Boshuizen, R.C.

    2017-01-01

    The first part of this thesis focuses on IPCs (indwelling pleural catheters) in malignant pleural effusion (MPE) management. In an invited review, the (dis)advantages and prejudices of IPCs are described (Chapter1.1). Since costs and reimbursement issues are the main reasons in the Netherlands to

  8. Large Right Pleural Effusion

    Directory of Open Access Journals (Sweden)

    Robert Rowe

    2016-09-01

    Full Text Available History of present illness: An 83-year-old male with a distant history of tuberculosis status post treatment and resection approximately fifty years prior presented with two days of worsening shortness of breath. He denied any chest pain, and reported his shortness of breath was worse with exertion and lying flat. Significant findings: Chest x-ray and bedside ultrasound revealed a large right pleural effusion, estimated to be greater than two and a half liters in size. Discussion: The incidence of pleural effusion is estimated to be at least 1.5 million cases annually in the United States.1 Erect posteroanterior and lateral chest radiography remains the mainstay for diagnosis of a pleural effusion; on upright chest radiography small effusions (>400cc will blunt the costophrenic angles, and as the size of an effusion grows it will begin to obscure the hemidiphragm.1 Large effusions will cause mediastinal shift away from the affected side (seen in effusions >1000cc.1 Lateral decubitus chest radiography can detect effusions greater than 50cc.1 Ultrasonography can help differentiate large pulmonary masses from effusions and can be instrumental in guiding thoracentesis.1 The patient above was comfortable at rest and was admitted for a non-emergent thoracentesis. The pulmonology team removed 2500cc of fluid, and unfortunately the patient subsequently developed re-expansion pulmonary edema and pneumothorax ex-vacuo. It is generally recommended that no more than 1500cc be removed to minimize the risk of re-expansion pulmonary edema.2

  9. Pleural Effusion in Multiple Myeloma.

    Science.gov (United States)

    Wang, Zhuo; Xia, Guoguang; Lan, Ling; Liu, Fayong; Wang, Yanxun; Liu, Baoyue; Ding, Yi; Dai, Li; Zhang, Yunjian

    2016-01-01

    Pleural effusion is rarely observed in patients with multiple myeloma (MM). Myeloma cell infiltration or invasion to the pleura is very rare. This study aimed to investigate the clinical characteristics of pleural effusion in patients with MM. We retrospectively reviewed the medical records of patients diagnosed with pleural effusion, MM, and pleural effusion with MM between 2004 and 2014 at Beijing Jishuitan Hospital. The present study included patients with pleural effusion who underwent cytological, bacteriological, biochemical and other testing. The cytopathology of abnormal pleural effusion cells was not diagnostic, thus flow cytometry was performed. MM was defined using the diagnosis standard of NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) 2014 for MM. This study included 3,480 pleural effusion patients and 319 MM patients. There were 34 patients with both MM and pleural effusion (17 men and 17 women). The average age was 63 years (range, 48-84 years). Pleural effusion with MM was caused by congestive heart disease, chronic renal failure, hypoalbuminemia, pulmonary infarctions, cirrhosis, pulmonary arterial hypertension, parapneumonic effusion, tuberculous pleural effusion, and myelomatous pleural effusion (MPE). The diagnosis of MPE was confirmed by the detection of myeloma cells in the pleural fluid using flow cytometric analyses. There were only 2 MPE cases in our study. The first MPE case was a woman. The first clinical manifestation was pleural effusion, and the diagnosis was non-secretory MM, DSS stage IIIA (Durie-Salmon staging system); ISS stage I (the International Staging System). The second MPE case was a man who was diagnosed with MM IgA-κ, DSS stage IIIA; ISS stage II. The detection rate of MPE was very low. MPE tended to present with yellow exudates and the lack of physical and chemical characteristics. Furthermore, patients with MPE exhibited many yellow nodules on the pleura. These nodules were lobulated and had abundant

  10. Ultrasound-guided intrapleural positioning of pleural catheters: influence on immediate lung expansion and pleurodesis in patients with recurrent malignant pleural effusion.

    Science.gov (United States)

    Araujo, Pedro Henrique Xavier Nabuco de; Terra, Ricardo Mingarini; Santos, Thiago da Silva; Chate, Rodrigo Caruso; Paiva, Antonio Fernando Lins de; Pêgo-Fernandes, Paulo Manuel

    2017-01-01

    To evaluate the role of intrapleural positioning of a pleural catheter in early lung expansion and pleurodesis success in patients with recurrent malignant pleural effusion (RMPE). This was a retrospective study nested into a larger prospective cohort study including patients with RMPE recruited from a tertiary university teaching hospital between June of 2009 and September of 2014. The patients underwent pleural catheter insertion followed by bedside pleurodesis. Chest CT scans were performed twice: immediately before pleurodesis (iCT) and 30 days after pleurodesis (CT30). Catheter positioning was categorized based on iCT scans as posterolateral, anterior, fissural, and subpulmonary. We used the pleural volume on iCT scans to estimate early lung expansion and the difference between the pleural volumes on CT30 and iCT scans to evaluate radiological success of pleurodesis. Clinical pleurodesis success was defined as no need for any other pleural procedure. Of the 131 eligible patients from the original study, 85 were included in this nested study (64 women; mean age: 60.74 years). Catheter tip positioning was subpulmonary in 35 patients (41%), anterior in 23 (27%), posterolateral in 17 (20%), and fissural in 10 (12%). No significant differences were found among the groups regarding early lung expansion (median residual pleural cavity = 377 mL; interquartile range: 171-722 mL; p = 0.645), radiological success of pleurodesis (median volume = 33 mL; interquartile range: -225 to 257 mL; p = 0.923), and clinical success of pleurodesis (85.8%; p = 0.676). Our results suggest that the position of the tip of the pleural catheter influences neither early lung expansion nor bedside pleurodesis success in patients with RMPE. Avaliar o papel do posicionamento intrapleural do cateter pleural na expansão pulmonar precoce e no sucesso da pleurodese em pacientes com derrame pleural maligno recorrente (DPMR). Trata-se de um estudo retrospectivo aninhado em um estudo prospectivo de

  11. Pleural mesothelioma – case report

    International Nuclear Information System (INIS)

    Klawiter, Anna; Damaszke, Tomasz

    2010-01-01

    Pleural mesothelioma is a very rare neoplasm; especially the local form. The diagnostics is difficult and the prognosis unfavourable. We presented a case of a man with dyspnoea and cough. His chest radiogram showed hydrothorax on the left side. Neither the examinations of the pleural liquid, nor the CT-guided fine needle biopsy established the diagnosis. CT showed features suggestive of pleural mesothelioma. The diagnosis was confirmed by thoracoscopy. Although no neoplastic cells were found in the thoracoscopic specimen from the supradiaphragmatic tumor, we assumed that to be a case of a diffuse, primarily local form of mesothelioma. Diagnostics of pleural mesothelioma is very difficult. CT and thoracoscopy seem to be very valuable diagnostic methods. It is worth remembering that pleural mesothelioma can have a local form which may transform into a diffuse one

  12. [Non-tuberculous pleural infections versus tuberculous pleural infections].

    Science.gov (United States)

    Horo, K; N'Gom, A; Ahui, B; Brou-Gode, C; Anon, J-C; Diaw, A; Bemba, P; Foutoupouo, K; Djè Bi, H; Ouattara, P; Kouassi, B; Koffi, N; Aka-Danguy, E

    2012-03-01

    In countries where tuberculosis is endemic, the main differential diagnosis for pleural infection by common bacteria is pleural tuberculosis. The purpose of our study was to determine the differences between pleural infection by common bacteria and that caused by pleural tuberculosis. Our study was a retrospective analysis and compared the characteristics of confirmed pleural infection by common bacteria (PIB) and that due to pleural tuberculosis (PT). For the PIB, the signs evolved for 2.4 ± 1.4 weeks versus 5.6 ± 2.2 weeks for the PT (P=0.01). In multivariate analysis, for PIB the onset of symptoms was more abrupt (OR=3.8 [1.5; 9.9]; P=0.01), asthenia was less frequent (OR=0.3 [0.1; 0.9]; P=0.03), pleural liquid was more purulent (OR=40.0 [15.0; 106.7]; Ppleural effusions caused by tuberculosis (TB) and those due to other bacterial infections. However, they are not sufficiently sensitive and therefore the search for the tuberculous bacillus must be systematic while waiting for implementation of new diagnostic tests for the organism. Copyright © 2012 SPLF. Published by Elsevier Masson SAS. All rights reserved.

  13. Yield of abrams needle pleural biopsy in exudative pleural effusion

    International Nuclear Information System (INIS)

    Khan, I.N.; Zaman, M.; Khan, N.; Jadoon, H.; Ahmed, A.

    2009-01-01

    Pleural effusion is the abnormal collection of fluid in the pleural space resulting from excessive fluid production or decreased absorption and it is one of the most common clinical conditions that we come across in pulmonology clinics and in hospitals. The objective of prospective study was to evaluate the diagnostic role of Abrams Needle Biopsy in Exudative Pleural Effusion The study was performed at the Department of Pulmonology, Ayub Teaching Hospital, Abbottabad over a period of 1 year, i.e., January 2008 to December 2008. Sixty-three patients of either sex and all ages with exudative pleural effusion, on whom Abrams Needle Biopsy was performed were included in the study. Minimum of four specimens from each patient were taken and histopathology done. Out of 63 patients, histopathology revealed the cause in 60 (95%) cases. Tuberculosis, malignancy and rheumatoid pleurisy were confirmed in 34, 24, and 2 cases respectively. Specimens of 3 patients did not reveal any result and showed non-specific inflammation and were further investigated accordingly. The diagnostic yield of Biopsy was 95%. Pleural biopsy is still a reliable and valuable investigation in diagnosing pleural effusion, provided that adequate pleural specimen is taken. (author)

  14. Agenesia pulmonar unilateral Unilateral pulmonary agenesis

    OpenAIRE

    Maura Cavada Malcon; Claudio Mattar Malcon; Marina Neves Cavada; Paulo Eduardo Macedo Caruso; Lara Flório Real

    2012-01-01

    A agenesia pulmonar é uma anomalia congênita rara. Relatamos um caso de um menino de 8 anos de idade com agenesia pulmonar à esquerda sem associação com outras malformações. O diagnóstico foi realizado por achados de imagem quando o paciente apresentou sintomas como tosse, sibilância e dispneia sem melhora do quadro clínico após evolução de 30 dias.Pulmonary agenesis is a rare congenital anomaly. We report the case of an 8-year-old boy with left lung agenesis, without any other congenital mal...

  15. Update on pleural diseases - 2007

    Directory of Open Access Journals (Sweden)

    Bishay Ayman

    2007-01-01

    Full Text Available Background : New information is available on pleural diseases. The authors selected articles to make recommendations on diagnostic and treatment aspects of pleural diseases. Materials and Methods: Eleven articles published in the English language between 2004 and 2007 were chosen. The basis of selection of the articles was the impact on daily practice, change in prior thinking of a disease process or specific treatment modality, as well as proper design and execution of the study. 5-amino-laevulinic acid with fluorescent light combined with white light may allow further diagnostic yield in undiagnosed pleural disease. FDG-PET may allow prognostication of patients with pleural tumors. Utilizing ultrasound by trained Emergency Department physicians is a rapid and effective technique to evaluate non-traumatic pleural effusions in symptomatic patients. Serum osteopontin levels may distinguish patients exposed to asbestos with benign disease from those with pleural mesothelioma. Administration of streptokinase in patients with empyema does not need for surgical drainage, length of hospital stay, or mortality as compared to conventional treatment with chest tube drainage and intravenous antibiotics. Silver nitrate may be an alternative agent to talc for producing pleurodesis. Routine use of graded talc (50% particles greater than 25 microns is recommended to reduce the morbidity associated with talc pleurodesis. Study design does not permit us to conclude that aspiration of spontaneous pneumothorax is as effective as chest tube drainage. Pleural catheter may prove to be an important palliative modality in treating debilitated patients or patients with trapped lung who show symptomatic improvement with drainage; however, at the present time, these catheters cannot be considered a first line treatment option for patients with malignant pleural effusion. One of the studies reviewed showed no significant difference in tract metastasis in patients with

  16. Pleural liquid during hemorrhagic hypotension.

    Science.gov (United States)

    Tresoldi, Claudio; Porta, Cristina; Zocchi, Luciano; Agostoni, Emilio

    2007-02-15

    The effect of approximately 25% or 35% blood loss (b.l.) on volume, pressure, and protein concentration of pleural liquid has been determined in anesthetized rabbits in lateral or supine posture. Volume and pressure of pleural liquid did not change with 25% b.l. 30 and 60 min after beginning of hemorrhage, and with 35% b.l. at 30 min (bleeding time approximately 10 and 12 min, respectively). With 35% b.l. protein concentration of pleural liquid was 85% greater (PPleural liquid seems protected against derangements from hemorrhage up to 25% b.l. for periods shorter than 1 h.

  17. Enfermedad pulmonar por amianto en trabajadores de acería

    Directory of Open Access Journals (Sweden)

    Rita Zurbriggen

    2013-06-01

    Full Text Available Las enfermedades relacionadas al amianto se producen por la inhalación de fibras de asbestos en su variedad crisotilo o amianto blanco. A pesar de que en la Argentina la prohibición data del año 2003, existen numerosas industrias donde se sigue trabajando con este mineral, entre ellas las metalúrgicas y acerías. Actualmente se conoce la alta patogenicidad de este material, por lo que en muchos países existen programas de seguimiento de los trabajadores expuestos. Se describen las características generales y manifestaciones clínicas pulmonares de 27 pacientes que trabajaron en una gran acería de América del Sur. El diagnóstico de amiantopatías se realizó mediante historia clínica laboral, antecedente de exposición al amianto, estudios complementarios de función pulmonar e imágenes del tórax. Se analizaron la fuente de exposición (laboral, doméstica y ambiental, tiempo de exposición y período de latencia en los pacientes de los cuales se detectó enfermedad relacionada. Los antecedentes de tabaquismo fueron tenidos en cuenta para el análisis. En 22 pacientes se presentaron patologías benignas (81.4%, 16 de ellos tenían lesiones exclusivamente pleurales y otros 6 asbestosis. Las patologías malignas se presentaron en 5 pacientes (18.5%, en 4 fueron mesoteliomas y en uno carcinoma pulmonar. El problema de la exposición al amianto tiene vigencia actual. De ahí la necesidad de un programa de vigilancia en trabajadores expuestos al amianto actualmente o en el pasado, para detectar, notificar, registrar e investigar las características de estas patologías.

  18. Diagnostic yield of pleural biopsy in exudative pleural effusion.

    Science.gov (United States)

    Devkota, K C; Chokhani, R; Gautam, S

    2014-09-01

    To know the diagnostic role of pleural biopsy in determining underlying etiological causes of exudative pleural effusion. A total of 47 patients, aged 16-104 years with mean age of 47.36 years, of either sex, with exudative pleural effusion underwent closed pleural biopsy with Abram's needle in standard way. Average 4-6 biopsy specimens were obtained from each patient, which were sent for histopathological examination. In this study, 47 cases of exudative pleural effusion were included, among them 26 (55.31%) cases were male and 21 (44.69%) were female with mean age 47.36 years. Cough was reported by 42 (89.36%) cases, expectoration 28 (59.57%), hemoptysis 3 (6.38%), breathlessness 27 (57.44%), wheezing 3 (6.38%), chest pain 38 (80.85%) and fever by 30 (63.82%) cases. Out of 47 cases, 28 (59.57%) cases had a positive yield, whereas in 19 (40.43%) cases the result was nonspecific inflammation. Out of 28 (59.57%) cases with positive yield 21 (44.68%) were found to have granulomatous inflammation and 10 (21.28%) cases were malignant. Among malignant pleural effusion, 4 cases were squamous cell carcinoma; 3 small cell carcinoma; 1 case adenocarcinoma and 1 case found to have mesothelioma. Tuberculosis and malignancy are the two most common causes of exudative pleural effusion in our set up. Pleural biopsy is a safe, simple and well validated diagnostic tool that helps us to differentiate between malignancy and tuberculosis.

  19. Pleural effusion: Role of pleural fluid cytology, adenosine deaminase level, and pleural biopsy in diagnosis

    Directory of Open Access Journals (Sweden)

    Biswajit Biswas

    2016-01-01

    Full Text Available Objective: The present study is designed to evaluate the role of pleural fluid analysis in diagnosing pleural diseases and to study the advantages and disadvantages of thoracocentasis and pleural biopsy. Materials and Methods: We prospectively included 66 consecutive indoor patients over a duration of 1 year. Pleural fluid was collected and cytological smears were made from the fluid. Plural biopsy was done in the same patient by Cope needle. Adequate pleural biopsy tissue yielding specific diagnosis was obtained in 47 (71.2% cases. Results: Tuberculosis was the commonest nonneoplastic lesion followed by chronic nonspecific pleuritis comprising 60% and 33.3% of the nonneoplastic cases respectively and tuberculosis was predominantly diagnosed in the younger age group. Majority (70.8% of malignancy cases were in the age group of >50-70. Adenocarcinoma was found to be the commonest (66.7% malignant neoplasm in the pleurae followed by small-cell carcinoma (20.8%. Conclusion: Pleural biopsy is a useful and minimally invasive procedure. It is more sensitive and specific than pleural fluid smears.

  20. Pleurisy and Other Pleural Disorders

    Science.gov (United States)

    ... scan also may show signs of pneumonia, a lung abscess, a tumor, or other possible causes of pleural disorders. Ultrasound This test uses sound waves to create pictures of your lungs. An ultrasound may show where fluid is located ...

  1. The CT diagnose of pleural metastasis tumour

    International Nuclear Information System (INIS)

    Chen Liqun; Han Kaibin; Pan Heng; Huang Xiaoru; Zhou Bingcao; Huang Yuehua

    2007-01-01

    Objective: To discuss the CT characteristic of pleural metastasis tumour,enhance the diagnostic level of pleural metastasis tumour. Methods: Review 30 cases which have been performed CT scan in our hospital during March 2002 to June 2003, which have been approved to pleural metastasis tumour by pathology and clinic. Make use of GE Hispeed.zx/i spiral CT,10mm thickness,10mm increment, l.5 pitch, some of them use 10mm or high resolution mode. All cases have been performed normal scan, 25 cases with contrast scan. Results: The CT representation of pleural metastasis tumour are encapsulated pleural effusion with irregular pleural thickening(56.6%), nodular pleural thickening(46.6%), pleural masses (13.3%), pneumothorax (3.3%), etc. Encapsulated pleural effusion and nodular pleural thickening are 76.6%, use contrast mode to scan pleural pathological changes enhance upon middle level, CT value increment > 20HU, there are 66.6% cases with other chest metastasis symptom, 73.3% primary lesion are pulmonary cancer, and 20% no primary lesion are found. Conclusion: Combine primary lesion history and other chest metastasis symptom, Spiral CT examination can differentiate most of pleural metastasis tumour, but it is difficult to differentiate the cases between with a little pleural effusion or light band pleural thickening and reactive alteration. (authors)

  2. A utilidade da TC de tórax no diagnóstico do sequestro pulmonar Usefulness of chest CT in the diagnosis of pulmonary sequestration

    Directory of Open Access Journals (Sweden)

    José Gustavo Pugliese

    2010-04-01

    Full Text Available O sequestro pulmonar é uma rara anomalia congênita, caracterizada por tecido pulmonar embrionário não funcionante, perfazendo 0,15-6,40% de todas as malformações pulmonares congênitas. Essa anomalia envolve o parênquima e a vascularização pulmonar, sendo classificado como intralobar ou extralobar. Neste relato, descrevemos o caso de um paciente de 56 anos com hemoptise e imagem hipotransparente retrocardíaca em base de hemitórax esquerdo na radiografia de tórax. Após a realização de TC com contraste endovenoso, foi evidenciada a presença de sequestro pulmonar. O paciente foi submetido à cirurgia para a retirada do tecido anômalo, que foi realizada com sucesso. Apresentou boa evolução pós-operatória e recebeu alta com acompanhamento ambulatorial.Pulmonary sequestration is a rare congenital anomaly, characterized by nonfunctional embryonic pulmonary tissue. Pulmonary sequestration accounts for 0.15-6.40% of all congenital pulmonary malformations. This anomaly, which is classified as intralobar or extralobar, involves the lung parenchyma and its vascularization. We report the case of a 56-year-old male presenting with hemoptysis. A chest X-ray showed an area of opacity behind the cardiac silhouette in the base of the left hemithorax. Chest CT scans with intravenous contrast revealed pulmonary sequestration. The patient underwent surgery, in which the anomalous tissue was successful resected. The postoperative evolution was favorable, and the patient was discharged to outpatient treatment.

  3. Síndrome de Claude Bernard-Horner associada ao empiema pleural Claude Bernard-Horner syndrome resulting from pleural empyema

    Directory of Open Access Journals (Sweden)

    Fernando Luiz Westphal

    2006-04-01

    Full Text Available A síndrome de Claude Bernard-Horner apresenta várias etiologias, ocorre por interrupção do estímulo nervoso em qualquer ponto do trajeto do nervo e pode ser intra ou extratorácica. É relatado um caso dessa síndrome causado por empiema pleural septado, localizado em região paravertebral, no terço superior do hemitórax direito. O paciente foi submetido à toracotomia para drenagem da cavidade pleural. A evolução foi satisfatória, com regressão do quadro infeccioso, expansão pulmonar e remissão da síndrome.Claude Bernard-Horner syndrome presents various etiologies and occurs as the direct result of interrupted nerve signaling at any point along the nerve trajectory, be it intrathoracic or extrathoracic. Herein, we report a case of Claude Bernard-Horner syndrome caused by loculated pleural empyema located in the paravertebral region of the upper third of the right hemithorax. The patient was submitted to thoracotomy in order to drain the infected fluids. The end result was satisfactory, including resolution of the infection, pulmonary expansion, and remission of the syndrome.

  4. STUDY OF 200 CASES OF PLEURAL FLUID

    Directory of Open Access Journals (Sweden)

    Ramakrishna R

    2016-09-01

    Full Text Available BACKGROUND We have studied 200 patients of pleural fluid presenting to our tertiary care centre. Presence of cases of pleural fluid is a common presentation both in pulmonary and extrapulmonary diseases. We analysed the patients having both exudates and transudates and studied the results. MATERIALS AND METHODS We selected patients above 20 years of age and classified the patients with pleural fluid as having transudates and exudates. We studied the causes of transudates and exudates. A total of 200 patients are studied in this prospective study. Diagnosis of pleural exudates is made on the basis of Light’s criteria, chest x-ray, pleural fluid analysis, CT scan in selected patients, sputum examination, bronchoscopy and bronchial washings. Moribund and non-cooperative patients and HIV positives were excluded from the study. RESULTS Among the 200 patients, 91% have exudates. 9% have transudates by Light’s criteria. Tuberculosis is the commonest cause of effusions (64.83% followed by malignancy (13.73% and sympneumonic or parapneumonic effusions (9.89%. Pleural effusions occurred predominantly in males. Prevalence of diabetes Mellitus among cases of tuberculous pleural effusions is 13.56%. Tuberculous effusions are predominantly right-sided. CONCLUSION Predominant cases of pleural fluid are exudates. Commonest cause of pleural effusion is Tuberculosis followed by malignancy both pulmonary and extrapulmonary and sym. and parapneumonic effusions. Prevalence of Diabetes among Tuberculous pleural effusion cases is more or less same as in general population. Cough, expectoration fever, chest pain and breathlessness are the common symptoms occurring in three fourths of the patients of tuberculous pleural effusion. Most of the cases of Tuberculous effusion are above 30 years of age. In the diagnosis of tuberculous pleural effusion, Pleural fluid ADA is very important. Pleural fluid cytology, pleural biopsy, bronchoscopy, bronchial washings and sputum

  5. Endocarditis infecciosa de válvula pulmonar nativa

    OpenAIRE

    Franco Romaní R; Fernando Atencia M; José Cuadra A

    2007-01-01

    La endocarditis infecciosa en válvulas derechas es predominantemente en la válvula tricuspídea, mientras la válvula pulmonar es excepcionalmente afectada (menos de 1,5%), por lo que son pocos los casos reportados en la literatura mundial. Las manifestaciones clínicas de endocarditis en válvula pulmonar no son las clásicas de endocarditis infecciosa, como son los síntomas de embolismo séptico pulmonar. La endocarditis aislada de válvula pulmonar nativa es inusual en personas que no consumen dr...

  6. Agenesia pulmonar unilateral Unilateral pulmonary agenesis

    Directory of Open Access Journals (Sweden)

    Maura Cavada Malcon

    2012-08-01

    Full Text Available A agenesia pulmonar é uma anomalia congênita rara. Relatamos um caso de um menino de 8 anos de idade com agenesia pulmonar à esquerda sem associação com outras malformações. O diagnóstico foi realizado por achados de imagem quando o paciente apresentou sintomas como tosse, sibilância e dispneia sem melhora do quadro clínico após evolução de 30 dias.Pulmonary agenesis is a rare congenital anomaly. We report the case of an 8-year-old boy with left lung agenesis, without any other congenital malformations. When the patient presented symptoms, including cough, wheezing, and dyspnea, with no clinical improvement after a period of 30 days, imaging studies were conducted and the diagnosis was made.

  7. A importância da pressão pleural na avaliação da mecânica respiratória

    OpenAIRE

    Fernandes,Cláudia Regina

    2006-01-01

    JUSTIFICATIVA E OBJETIVOS: Para a partição das medidas de mecânica do sistema respiratório em seus componentes pulmão e parede torácica, faz-se necessário o conhecimento da pressão pleural. A finalidade desta revisão foi discutir sobre medidas alternativas à obtenção da pressão pleural para o cálculo da mecânica pulmonar, relatar as peculiaridades do método do balão esofágico para obtenção indireta da pressão pleural, as particularidades da obtenção da medida da pressão esofágica em pacientes...

  8. Diagnostic yield and safety of closed needle pleural biopsy in exudative pleural effusion.

    Science.gov (United States)

    Rajawat, Govind Singh; Batra, Supreet; Takhar, Rajendra Prasad; Rathi, Lalit; Bhandari, Chand; Gupta, Manohar Lal

    2017-01-01

    Closed pleural biopsy was previously considered a procedure of choice in cases of undiagnosed pleural effusion with good efficacy. Currently, the closed pleural biopsy has been replaced by thoracoscopic biopsy but not easily available in resource-limited setups. The objective of this study was to analyze the diagnostic yield and safety of closed needle pleural biopsy in exudative pleural effusion and assessment of patients' characteristics with the yield of pleural biopsy. This was a cross-sectional study. This study was conducted at Institute of Respiratory Diseases, SMS Medical College, Jaipur, a tertiary care center of West India. A total of 250 cases of pleural effusion were evaluated with complete pleural fluid biochemical, microbiological, and cytological examination. Out of these 250 patients, 59 were excluded from the study as the diagnosis could be established on initial pleural fluid examination. The remaining (191) patients were considered for closed pleural biopsy with Abrams pleural biopsy needle. The main outcome measure was diagnostic yield in the form of confirming diagnosis. Out of the 191 patients with exudative lymphocytic pleural effusion, 123 (64.40%) were diagnosed on the first pleural biopsy. Among the remaining 68 patients, 22 patients had repeat pleural biopsy with a diagnostic yield of 59.9%. The overall pleural biopsy could establish the diagnosis in 136 (71.20%) patients with pleural effusion. The most common diagnosis on pleural biopsy was malignancy followed by tuberculosis. Closed pleural biopsy provides diagnostic yield nearly comparative to thoracoscopy in properly selected patients of pleural effusions. In view of good yield, low cost, easy availability, and very low complication rate, it should be used routinely in all cases of undiagnosed exudative lymphocytic pleural effusion. There was no comparison with a similar group undergoing thoracoscopic pleural biopsy.

  9. Diagnóstico do embolismo pulmonar

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    João Castaño

    2003-03-01

    Full Text Available RESUMO: O diagnóstico do Embolismo Pulmonar é considerado por vezes difícil. É importante reconhecer as situações clínicas que podem ser potencialmente desencadeantes. Existe uma série de meios auxiliares de diagnóstico, quer laboratoriais quer imagiológicos, que devem ser adaptados aos meios disponíveis em cada instituição.REV PORT PNEUMOL 2003; IX (2: 129-137 ABSTRACT: Pulmonary Embolism is often considered a difficult diagnosis to establish. It is important to recognise clinical situations that leads to it. There are a few laboratory and imaging tests, that should be tailored to the available facilities in each institution.REV PORT PNEUMOL 2003; IX (2: 129-137 Palavaras-chave: Tromboembolismo Pulmonar, Pulmão, Perfusão Pulmonar, Tomografia Computorizada (TC, Angiografia, Helicoidal, Key-words: Pulmonary Embolism, Lung, Lung Perfusion, Computed Tomography (CT, Angiography, Helical

  10. ENFOQUE ACTUAL DE LAS MALFORMACIONES PULMONARES

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    Dra. Mónica Saavedra

    2017-01-01

    Full Text Available Las malformaciones pulmonares corresponden a distintas anomalías del sistema respiratorio que se presentan con baja incidencia (1 en cada 10.000 a 35.000 embarazos, dentro de las que se incluye a las Malformaciones Pulmonares Congénitas y de la vía aérea (MCPA, antes conocida malformación adenomatosa quística, secuestros pulmonares, lesiones híbridas y enfisema lobar congénito. Durante los últimos años se ha visto un aumento en el diagnóstico antenatal y avances en el conocimiento de la patogénesis e historia natural de esta enfermedad, pero aún existe controversia en cuanto a la clasificación a utilizar y a su tratamiento. La mayoría de los recién nacidos (90% son asintomáticos al nacer, pero hay malformaciones que generan serias complicaciones para el feto o recién nacido. El propósito de esta publicación es hacer un resumen actualizado de la historia natural, diagnóstico y tratamiento de las MCPA.

  11. Massas pulmonares bilaterais. Mesma etiologia?

    Directory of Open Access Journals (Sweden)

    C. Damas

    2007-03-01

    Full Text Available Resumo: Os autores descrevem o caso de uma mulher de 50 anos, fumadora. Assintomática até Setembro de 2003, altura em que refere o aparecimento de tosse seca, cansaço e perda de peso. Na radiografia do tórax eram evidentes duas massas, uma no lobo superior direito e outra no lobo lingular. A doente foi submetida a biópsia aspirativa transtorácica e a citologia obtida foi compatível com carcinoma de pulmão do tipo pequenas células. No estadiamento da doença foram identificadas lesões hepáticas secundárias, motivo porque a doença foi considerada como disseminada, dada a existência de lesões hepáticas e pulmonares contra-laterais. Foi, nesta fase, iniciada quimioterapia com carboplatinum e etoposídeo. Seis meses mais tarde, a lesão direita inha diminuído, mas a lesão esquerda apresentava aumento das suas dimensões. A biópsia desta lesão mos-trou uma citologia compatível com adenocarcinoma do pulmão, motivo porque inicia novo ciclo de quimioterapia com vinorelbina e gencitabina. Aos quatro ciclos e por não se evidenciar nenhuma resposta ao tratamento, foi realizada radioterapia da lesão esquerda. Durante este período (28 meses mantém-se assintomática, mantendo a sua actividade diária habitual.De acordo com o momento do diagnóstico as neo-plasias do pulmão podem ser consideradas síncronas ou metácronas. Estas últimas são mais frequentes, re-presentando cerca de 50-70% dos casos, sendo o pa-drão histológico mais frequente o adenocarcinoma.No caso apresentado, a situação parecia ser uma doença disseminada, o que afastou a hipótese de tumores síncronos. Apesar de a doença se apresentar num estádio avançado aquando do diagnóstico e do mau prognósti-co associado, a evolução dos dois tipos de tumor não pareceu comprometer a actividade diária da doente.Rev Port Pneumol 2007; XIII (2: 287

  12. Evaluation of usefulness of pleural fluid adenosine deaminase in diagnosing tuberculous pleural effusion from empyema

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    Vijetha Shenoy

    2014-02-01

    Full Text Available Objective: To evaluate the utility of adenosine deaminase activity in the pleural fluid for the diagnosis of tuberculous pleural effusion from empyema of non-tubercular origin. Method: A retrospective analysis of data was performed on patients who were diagnosed to have tuberculous pleural effusion and empyema of non tubercular origin. Among 46 patients at Kasturba Hospital, Manipal University, Manipal, Karnataka, India, from November 201 2 to February 2013 who underwent pleural fluid adenosine deaminase estimation, 25 patients with tuberculous pleural effusion and 21 patients with empyema were diagnosed respectively. Adenosine deaminase in pleural fluid is estimated using colorimetric, Galanti and Guisti method. Results: Pleural fluid Adenosine Deaminase levels among tuberculous pleural effusion(109.38依 53.83 , empyema (141.20依71.69 with P=0.27. Conclusion: Pleural fluid adenosine deaminase alone cannot be used as a marker for the diagnosis of tuberculous pleural effusion.

  13. Discrimination between pleural thickening and minimal pleural effusion using color Doppler chest ultrasonography

    OpenAIRE

    Hasan, Ali A.; Makhlouf, Hoda A.; Mohamed, Alaa R.M.

    2013-01-01

    Background: The discrimination of pleural thickening from minimal pleural effusion may be difficult as both lesions appear as anechoic on grayscale ultrasound, hence, free of “echoes” does not confirm the presence of pleural fluid. Aim of this study: To evaluate the value of color Doppler ultrasound in differentiating minimal pleural effusion that could be aspirated from pleural thickening and to compare it with grayscale ultrasound. Patients and methods: This analytic cross-sectional s...

  14. Postoperative pleural effusion following upper abdominal surgery

    DEFF Research Database (Denmark)

    Nielsen, P H; Jepsen, S B; Olsen, A D

    1989-01-01

    amylases, sex, smoking habits, or weight. There was no correlation between the localization of the pleural effusions and that of the abdominal incisions. There was a positive correlation between atelectasis and pleural effusion, but no evidence of a causal relationship. Pleural effusions might be related...

  15. Pleural effusions in the postpartum period

    International Nuclear Information System (INIS)

    Stark, P.; Pollack, M.S.

    1986-01-01

    We report on the high frequency of pleural effusions in the immediate postpartum period. Forty-four out of 45 women who examined within 24-48 h after delivery showed evidence of pleural fluid. Under these circumstances, this pleural abnormality should not be considered an indicator of serious cardiopulmonary disease. (orig.) [de

  16. A very complicated pleural effusion

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    J.P. Gilbert*

    2013-12-01

    Discussion: Re-expansion pulmonary oedema is a recognised complication of large pleural effusion drainage. The mechanism remains unclear, although reduced left ventricular function, in this case from a possible pericardial effusion, may be a precipitant. To prevent this phenomenon the British Thoracic Society recommends draining a maximum of 1.5 litres of fluid. This case was further complicated by a pneumothorax; again a recognised complication, especially if there is underlying poor compliance of the lung parenchyma. Re-expansion pulmonary oedema has an incidence of <1% and pneumothorax <5%. Their occurrence has not previously been reported simultaneously. Large pleural effusions are commonly encountered in clinical practice in South Africa. The existence of multiple co-morbidities including tuberculosis, HIV and impaired cardiac function may complicate their management. This case highlights the need for close monitoring and controlled drainage of pleural effusions in emergency practice.

  17. Radiologic diagnosis of pleural mesothelioma

    International Nuclear Information System (INIS)

    Fujimoto, Toshifumi; Hayashi, Kuniaki; Matsunaga, Naofumi

    1989-01-01

    Five cases of pleural mesothelioma (3 benign and 2 malignant) were evaluated with chest radiograph and CT. A case of benign localized mesothelioma growing within the major fissure, and a case of diffuse malignant mesothelioma encircling the descending thoracic aorta are included among the five cases. Pleural mesotheliomas present a variety of roentgenographic manifestations depending upon the histologic type, the site of origin, and the direction of the extension, and can easily be misdiagnosed as lung tumor, aortic aneurysm, or mediastinal tumor. It is emphasized that pleural mesothelioma should be considered as a differential diagnosis when a mass lesion is found in the mediastinum, hilar region, interlobar fissure, or near the chest wall. (author)

  18. Traumatic subarachnoid-pleural fistula

    International Nuclear Information System (INIS)

    Brown, W.H.; Stothert, J.C. Jr.

    1985-01-01

    Traumatic subarachnoid-pleural fistulas are rare. The authors found nine cases reported since 1959. Seven have been secondary to trauma and two following thoracotomy. One patient's death is thought to be directly related to the fistula. The diagnosis should be suspected in patients with a pleural effusion and associated vertebral trauma. The diagnosis can usually be confirmed with contrast or radioisotopic myelography. Successful closure of the fistula will usually occur spontaneously with closed tube drainage and antibiotics; occasionally, thoracotomy is necessary to close the rent in the dura

  19. Ultrasonographic Observations of the Pleural Effusion

    International Nuclear Information System (INIS)

    Lee, Dong Hoo; Park, Sung Soo; Lee, Chung Hee

    1982-01-01

    Five cases of patients with pleural effusion were evaluated by the grey-scale ultrasonography. Ultrasonography of pleural effusion in each case was represented as fluid accumulation within the pleural cavity with anechoic crescent moon shape or saddle appearance marginated by diaphragm. Ptosis of the liver with demonstrable right diaphragm was assessment in the severe right pleural effusion. it is emphasized that the practical advantages of the ultrasonographic approach were notable both in establishing diagnosis and in treatment of pleural effusion,with special regarding of noninvasiveness particularly in the women of pregnancy, of staging in the patient with malignant lymphoma, and of safety in a subsequent thoracentesis under the ultrasonographic guidance

  20. Ultrasonographic Observations of the Pleural Effusion

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Dong Hoo; Park, Sung Soo; Lee, Chung Hee [Hanyang University School of Medicine, Seoul (Korea, Republic of)

    1982-12-15

    Five cases of patients with pleural effusion were evaluated by the grey-scale ultrasonography. Ultrasonography of pleural effusion in each case was represented as fluid accumulation within the pleural cavity with anechoic crescent moon shape or saddle appearance marginated by diaphragm. Ptosis of the liver with demonstrable right diaphragm was assessment in the severe right pleural effusion. it is emphasized that the practical advantages of the ultrasonographic approach were notable both in establishing diagnosis and in treatment of pleural effusion,with special regarding of noninvasiveness particularly in the women of pregnancy, of staging in the patient with malignant lymphoma, and of safety in a subsequent thoracentesis under the ultrasonographic guidance

  1. Atresia pulmonar con comunicación interventricular

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    Tomasa Centella Hernández

    2014-04-01

    Full Text Available La atresia pulmonar con comunicación interventricular es una cardiopatía congénita cianótica, severa y rara, de alta complejidad, que se caracteriza por la ausencia de conexión entre el ventrículo derecho y las arterias pulmonares. Coexiste con una comunicación interventricular. El flujo hacia el territorio pulmonar puede realizarse a través del ductus arterioso o de colaterales sistémico-pulmonares. La dificultad de esta cardiopatía viene determinada por los diferentes niveles de interrupción desde el ventrículo derecho hasta el territorio pulmonar, y por la diferencia anatómica de las fuentes del flujo hacia dicho territorio, lo que determina diferentes tipos de abordaje quirúrgico.

  2. Radiation therapy for pleural mesothelioma

    International Nuclear Information System (INIS)

    Seydel, H.G.

    1986-01-01

    There is clear evidence that both pleural and peritoneal malignant mesothelioma are increasing in incidence in the United States. There is a recognized long period of latency from asbestos exposure to the emergence and diagnosis of tumor. Considering the levels of asbestos utilization in the mid-20th century, we must expect that the number of cases will continue to increase until the end of this century. Evaluation of treatment options is thus a critical issue in determining treatment approaches for this disease. Recognized only recently, mesothelioma has no effective treatment, and patients are reported only anecdotally as cured. Pleural mesothelioma is the more common presentation, but even here the reports are from small, uncontrolled series. Only one study is available in which a concomitant comparison of treatment methods was carried out. Randomized clinical studies regarding treatment of pleural mesothelioma have only recently been initiated by the clinical cooperative groups. There is thus a paucity of information on treatment in general and radiation therapy specifically for malignant mesothelioma. This chapter reviews the reported experience using radiation therapy alone and combined with other modalities for the treatment of malignant pleural mesothelioma and considers the potential for improvement of the results of current methods of radiation therapy

  3. Proteinosis alveolar pulmonar Pulmonary alveolar proteinosis

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    Concepción Sánchez Infante

    2011-12-01

    Full Text Available La proteinosis alveolar pulmonar es una enfermedad respiratoria crónica, caracterizada por alteración en el metabolismo del surfactante, lo que determina su acumulación anormal en el espacio alveolar. Es una enfermedad extremadamente rara. Se han reportado solamente 500 casos en la literatura. Se describió por primera vez en 1958. Se presenta un caso de proteinosis alveolar pulmonar en un lactante de 2 meses, con desnutrición proteico energética, que ingresa por dificultad respiratoria e hipoxemia, y, con imágenes radiológicas de tipo retículo-nodulillar, en vidrio deslustrado, en el cual se plantea inicialmente el diagnóstico de bronconeumonía. Ante la evolución desfavorable y no respuesta al tratamiento, se realizó un estudio para descartar enfermedades pulmonares crónicas. El paciente fallece y se confirma el diagnóstico por anatomía patológica. Se realiza una revisión del tema.The pulmonary alveolar proteinosis is a chronic respiratory disease characterized by surfactant metabolism alteration determining its abnormal accumulation in the alveolar space. It is a disease very rare and in literature only 500 cases have been reported; it was described for the first time in 1958. This is a case presentation of pulmonary alveolar proteinosis in an infant aged 2 months with energetic protein malnutrition admitted due to respiratory difficulty and hypoxemia and with radiologic images of the reticulonodulillary, in frosting glass, where initially is made the diagnosis of bronchopneumonia. In the face of unfavorable evolution and no response to treatment, a study was conducted to rule out chronic pulmonary diseases. Patient died confirming the diagnosis according to the pathologic anatomy. A review on subject is carried out.

  4. Raquitismo carencial: relato de caso

    OpenAIRE

    Porto, Juliana Antola et al.

    2005-01-01

    Introdução: O raquitismo é uma doença do tecido ósseo em formação, onde há falha na calcificação e conseguinte acúmulo de tecido osteóide. O raquitismo carencial é decorrente da deficiência dos precursores da vitamina D, sendo a causa de raquitismo mais facilmente evitável e tratável. Objetivo: Relatar um caso, revisar a etiopatogenia e o tratamento do raquitismo carencial. Relato de caso: Paciente masculino com 2 anos de idade, previamente hígido, consulta com dificuldade de deambular progre...

  5. Diagnóstico do embolismo pulmonar

    OpenAIRE

    Castaño, João; Alpendre, João; Pisco, João Martins

    2003-01-01

    RESUMO: O diagnóstico do Embolismo Pulmonar é considerado por vezes difícil. É importante reconhecer as situações clínicas que podem ser potencialmente desencadeantes. Existe uma série de meios auxiliares de diagnóstico, quer laboratoriais quer imagiológicos, que devem ser adaptados aos meios disponíveis em cada instituição.REV PORT PNEUMOL 2003; IX (2): 129-137 ABSTRACT: Pulmonary Embolism is often considered a difficult diagnosis to establish. It is important to recognise clinical situation...

  6. Pleural pressure swing and lung expansion after malignant pleural effusion drainage: the benefits of high-temporal resolution pleural manometry.

    Science.gov (United States)

    Boshuizen, Rogier C; Sinaasappel, Michiel; Vincent, Andrew D; Goldfinger, Vicky; Farag, Sheima; van den Heuvel, Michel M

    2013-07-01

    Malignant pleural effusion is a common complication in end-stage cancer patients and can cause severe dyspnea. Therapeutic thoracentesis is often limited to 1 to 1.5 L. Pleural manometry can be used to recognize a not-expanded lung. Interval pleural pressure measurements with a high temporal resolution were performed after each removal of 200 mL of fluid to observe pleural pressure swings. Pleural elastance was defined as the difference in pleural pressure divided by the change in volume. Chest x-rays were performed to evaluate lung expansion, reexpansion pulmonary edema, and fluid residue. Thirty-four procedures in 30 patients were eligible for analysis. Four patients had incomplete lung expansion after drainage. No reexpansion pulmonary edema was observed. Pleural pressure swing after 200 mL drainage was higher when the lung did not expand. Pleural elastance after removal of 500 mL was higher in the not-expanded subgroup. We demonstrated that a high pleural pressure swing after removal of only 200 mL was related to incomplete lung expansion. We confirmed the association between pleural elastance and lung expansion.

  7. Pleural Intensity-Modulated Radiotherapy for Malignant Pleural Mesothelioma

    International Nuclear Information System (INIS)

    Rosenzweig, Kenneth E.; Zauderer, Marjorie G.; Laser, Benjamin; Krug, Lee M.; Yorke, Ellen; Sima, Camelia S.; Rimner, Andreas; Flores, Raja; Rusch, Valerie

    2012-01-01

    Purpose: In patients with malignant pleural mesothelioma who are unable to undergo pneumonectomy, it is difficult to deliver tumoricidal radiation doses to the pleura without significant toxicity. We have implemented a technique of using intensity-modulated radiotherapy (IMRT) to treat these patients, and we report the feasibility and toxicity of this approach. Methods and Materials: Between 2005 and 2010, 36 patients with malignant pleural mesothelioma and two intact lungs (i.e., no previous pneumonectomy) were treated with pleural IMRT to the hemithorax (median dose, 46.8 Gy; range, 41.4–50.4) at Memorial Sloan-Kettering Cancer Center. Results: Of the 36 patients, 56% had right-sided tumors. The histologic type was epithelial in 78%, sarcomatoid in 6%, and mixed in 17%, and 6% had Stage I, 28% had Stage II, 33% had Stage III, and 33% had Stage IV. Thirty-two patients (89%) received induction chemotherapy (mostly cisplatin and pemetrexed); 56% underwent pleurectomy/decortication before IMRT and 44% did not undergo resection. Of the 36 patients evaluable for acute toxicity, 7 (20%) had Grade 3 or worse pneumonitis (including 1 death) and 2 had Grade 3 fatigue. In 30 patients assessable for late toxicity, 5 had continuing Grade 3 pneumonitis. For patients treated with surgery, the 1- and 2-year survival rate was 75% and 53%, and the median survival was 26 months. For patients who did not undergo surgical resection, the 1- and 2-year survival rate was 69% and 28%, and the median survival was 17 months. Conclusions: Treating the intact lung with pleural IMRT in patients with malignant pleural mesothelioma is a safe and feasible treatment option with an acceptable rate of pneumonitis. Additionally, the survival rates were encouraging in our retrospective series, particularly for the patients who underwent pleurectomy/decortication. We have initiated a Phase II trial of induction chemotherapy with pemetrexed and cisplatin with or without pleurectomy

  8. Pleural Intensity-Modulated Radiotherapy for Malignant Pleural Mesothelioma

    Energy Technology Data Exchange (ETDEWEB)

    Rosenzweig, Kenneth E., E-mail: ken.rosenzweig@mountsinai.org [Department of Radiation Oncology, Mount Sinai Medical Center, New York, NY (United States); Zauderer, Marjorie G. [Department of Medicine, Thoracic Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Laser, Benjamin [Department of Radiation Oncology, Henry Ford Hospital, Detroit, MI (United States); Krug, Lee M. [Department of Medicine, Thoracic Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Yorke, Ellen [Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Sima, Camelia S. [Department of Epidemiology/Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Rimner, Andreas [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Flores, Raja [Department of Surgery, Mount Sinai Medical Center, New York, NY (United States); Rusch, Valerie [Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)

    2012-07-15

    Purpose: In patients with malignant pleural mesothelioma who are unable to undergo pneumonectomy, it is difficult to deliver tumoricidal radiation doses to the pleura without significant toxicity. We have implemented a technique of using intensity-modulated radiotherapy (IMRT) to treat these patients, and we report the feasibility and toxicity of this approach. Methods and Materials: Between 2005 and 2010, 36 patients with malignant pleural mesothelioma and two intact lungs (i.e., no previous pneumonectomy) were treated with pleural IMRT to the hemithorax (median dose, 46.8 Gy; range, 41.4-50.4) at Memorial Sloan-Kettering Cancer Center. Results: Of the 36 patients, 56% had right-sided tumors. The histologic type was epithelial in 78%, sarcomatoid in 6%, and mixed in 17%, and 6% had Stage I, 28% had Stage II, 33% had Stage III, and 33% had Stage IV. Thirty-two patients (89%) received induction chemotherapy (mostly cisplatin and pemetrexed); 56% underwent pleurectomy/decortication before IMRT and 44% did not undergo resection. Of the 36 patients evaluable for acute toxicity, 7 (20%) had Grade 3 or worse pneumonitis (including 1 death) and 2 had Grade 3 fatigue. In 30 patients assessable for late toxicity, 5 had continuing Grade 3 pneumonitis. For patients treated with surgery, the 1- and 2-year survival rate was 75% and 53%, and the median survival was 26 months. For patients who did not undergo surgical resection, the 1- and 2-year survival rate was 69% and 28%, and the median survival was 17 months. Conclusions: Treating the intact lung with pleural IMRT in patients with malignant pleural mesothelioma is a safe and feasible treatment option with an acceptable rate of pneumonitis. Additionally, the survival rates were encouraging in our retrospective series, particularly for the patients who underwent pleurectomy/decortication. We have initiated a Phase II trial of induction chemotherapy with pemetrexed and cisplatin with or without pleurectomy

  9. Closed pleural biopsy is still useful in the evaluation of malignant pleural effusion

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    Somnath Bhattacharya

    2012-01-01

    Full Text Available Background: Pleural fluid cytology for malignant cells is the easiest way to diagnose malignant pleural effusion with good sensitivity and specificity. With the introduction of medical thoracoscopy, the use of closed pleural biopsy for the diagnosis of cytology negative malignant pleural effusion is gradually decreasing. However use of thoracoscopy is limited due to its high cost and procedure related complications. Aims: The aim was to assess the usefulness of closed pleural biopsy in the diagnosis of malignant pleural effusion. Materials and Methods: Sixty-six patients of pleural effusion associated with malignancy were selected from the patients admitted in the chest ward of a tertiary care hospital over a period of 1 year. Pleural fluid aspiration for cytology and closed pleural biopsy were done in all the patients. Results: Out of 66 patients, 46 (69% patients showed malignant cells in pleural fluid cytology examination. Cytology was positive in 35 (52%, 10 (15%, and 1 (1.5% patients in the first, second, and third samples respectively. Closed pleural biopsy was positive in 32 (48% patients. Among them, 22 also had positive cytology. Additional 10 cytology negative patients were diagnosed by pleural biopsy. Cytology-histology concordance was seen in 12 patients. Definite histological diagnosis could be achieved in five patients with indeterminate cytology. Pleural biopsy was not associated with any major postoperative complication. Conclusion: Closed pleural biopsy can improve the diagnostic ability in cytology negative malignant pleural effusion. Closed pleural biopsy has still a place in evaluation of malignant pleural effusion especially in a resource-limited country like India.

  10. Complicated pleural tuberculosis in children: CT evaluation

    International Nuclear Information System (INIS)

    Moon, W.K.; Kim, W.S.; Kim, I.O.; Im, J.G.; Kim, J.H.; Yeon, K.M.; Han, M.C.

    1999-01-01

    Purpose. To describe the CT features of complicated pleural tuberculosis in children and to define the use of CT in children with pleural tuberculosis. Materials and methods. The CT findings in 11 children with complicated pleural tuberculosis were retrospectively analysed. CT was performed to evaluate persistent pleural thickening (n = 6) or a mass-like lesion (n = 5) detected on plain radiographs. Chest radiographs and medical records were reviewed to determine whether additional information provided by CT had altered clinical management. Results. On CT, more than one location was involved in five patients (45 %) and in two patients (18 %) the entire pleural spaces were involved. Pleural thickening was seen in all 11 patients and enhancement after administration of contrast medium occurred in ten patients (91 %). Low-density fluid collections were seen in nine patients (82 %) and in two, CT revealed fluid collections within calcified pleural lesions. In five patients with mass-like lesions on plain radiographs, CT showed a low-density pleural mass with peripheral enhancement in four and a calcified pleural mass with fluid collection in one. CT demonstrated parenchymal abnormalities on the same side as pleural lesions in all 11 patients and hilar or mediastinal adenopathy in four. Four patients (36 %) underwent surgery because of fluid within a calcified fibrothorax (n = 3) and chest wall tuberculosis (n = 1) that were seen only on CT. Conclusions. The CT features of complicated pleural tuberculosis in children were pleural thickening, enhancement and fluid collection with associated parenchymal abnormalities and lymphadenopathy. In the evaluation of children with pleural tuberculosis, CT can be useful for demonstrating fluid within a calcified fibrothorax or chest wall involvement, which usually requires surgical intervention. (orig.)

  11. Treatment of complicated parapneumonic pleural effusion and pleural parapneumonic empyema.

    Science.gov (United States)

    Rodríguez Suárez, Pedro; Freixinet Gilart, Jorge; Hernández Pérez, José María; Hussein Serhal, Mohamed; López Artalejo, Antonio

    2012-07-01

    We performed this observational prospective study to evaluate the results of the application of a diagnostic and therapeutic algorithm for complicated parapneumonic pleural effusion (CPPE) and pleural parapneumonic empyema (PPE). From 2001 to 2007, 210 patients with CPPE and PPE were confirmed through thoracocentesis and treated with pleural drainage tubes (PD), fibrinolytic treatment or surgical intervention (videothoracoscopy and posterolateral thoracotomy). Patients were divided into 3 groups: I (PD); II (PD and fibrinolytic treatment); IIIa (surgery after PD and fibrinolysis), and IIIb (direct surgery). The statistical study was done by variance analysis (ANOVA), χ2 and Fisher exact test. The presence of alcohol or drug consumption, smoking and chronic obstructive pulmonary disease (COPD) were strongly associated with a great necessity for surgical treatment. The IIIa group was associated with increased drainage time, length of stay and complications. No mortality was observed. The selective use of PD and intrapleural fibrinolysis makes surgery unnecessary in more than 75% of cases. The selective use of PD and fibrinolysis avoids surgery in more than 75% of cases. However, patients who require surgery have more complications, longer hospital stay, and more days on PD and they are more likely to require admittance to the Intensive Care Unit.

  12. Anastomose cavo-pulmonar total sem uso de material protético

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    Valdester C. PINTO Jr.

    1998-07-01

    Full Text Available Objetivo: Demonstrar a viabilidade na feitura de túnel cava inferior-cava superior com retalho da parede atrial direita, evitando o emprego de material protético. Casuística e Métodos: Foram operados 2 pacientes nos quais se empregou a técnica de anastomose cavo-pulmonar total, sem uso de material protético. O primeiro caso, A.L.M., masc, 4 anos, 15 kg, era portador de atresia tricúspide (EP, com comunicação interventricular (CIV restritiva. O segundo caso, M.E.N.O., fem, 15 anos, 47 kg, tinha doença de Ebstein. O controle pós-operatório dos pacientes foi feito com ecocardiograma e cateterismo cardíaco. As operações foram realizadas com o emprego de circulação extracorpórea (CEC, e cardioplegia sangüínea como método de proteção miocárdica. A canulação das cavas foi o mais distal possível. A tunelização foi realizada com retalho de tecido atrial direito, suturado ao septo interatrial, deixando-se o seio coronariano e a comunicação interatrial (CIA para a esquerda. Resultados: Ambos os pacientes evoluíram, sem complicações, na UTI. O primeiro apresentou derrame pleural discreto à direita, e o segundo mantém-se em estimulação artificial (VVI,R. Conclusões: A tunelização intra-atrial para anastomose cavo-pulmonar total pode ser realizada sem o uso de material protético, evitando-se os riscos advindos do seu emprego (calcificação, retração, embolização.The authors describe two cases (one tricuspid atresia without TGA or pulmonary stenosis, but with a restrictive IVC: the second of an Ebstein disease of total cavo-pulmonary anastomosis using only the tissue of the atrial wall, avoiding any prosthetic material. Both cases were done under cardiopulmonary bypass and cold blood cardioplegia. A flap of the right atrial wall was used to re-direct the blood flow. Pleural effusion in one patient and complete AV block in the other were the complications found. They conclude that right intra-atrial tunneling for

  13. Empiema pleural: Resultados del tratamiento en el Hospital Clinicoquirúrgico Docente "Comandante Manuel Fajardo

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    Jesús Valdés Jiménez

    1999-04-01

    Full Text Available Se realizó un estudio prospectivo de 15 pacientes con empiema pleural, ingresados en el Hospital Clinicoquirúrgico Docente "Comandante Manuel Fajardo", en el período de enero de 1995 a diciembre de 1997. La forma aguda se presentó en 5 enfermos, mientras que la crónica se presentó en 10. La neumopatía inflamatoria fue la causa más frecuente. La mayoría fue tratada con combinaciones de antibióticos betalactámicos y aminoglucósidos, complementada con terapéutica quirúrgica. En la forma aguda resultó útil el lavado pleural, mientras que en la crónica el proceder más utilizado fue la decorticación, seguido de la ventana torácica y la resección pulmonar. Sólo falleció un enfermo con un cáncer de pulmón avanzadoA prospective study of 15 patients with pleural empyema admitted at the "Comandante Manuel Fajardo" Clinical and Surgical Teaching Hospital from January, 1995, to December, 1997, was conducted. The acute form was observed in 3 patients and the chronic form in 10. The inflammatory neumopathy was the most frequent cause. Most of the patients were treated with combinations of lactam and amynoglycoside antibiotics, complemented with surgical therapeutics. In the acute form pleural lavage proved to be useful, whereas in the chronic form the most used procedure was decortication, followed by thoracic window and pulmonary resection. Only one patient died with advanced lung cancer

  14. Combined blood and pleural levels of mesothelin and osteopontin for the diagnosis of malignant pleural mesothelioma

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    Wafaa M. Ashour

    2012-07-01

    Conclusion: The performance of serum and pleural mesothelin in diagnosing MPM was improved when combined with plasma and pleural osteopontin (respectively through logistic regression analysis model. This will be a great advance in screening and management of MPM.

  15. Computed tomography findings of malignant pleural mesothelioma

    Energy Technology Data Exchange (ETDEWEB)

    Shiota, Yutaro; Sato, Toshio; Yamaguchi, Kazuo; Ono, Tetsuya; Kaji, Masaro; Niiya, Harutaka (Kure Kyosai Hospital, Hiroshima (Japan))

    1994-04-01

    Computed tomography (CT) findings were assessed in 7 patients with malignant mesothelioma. CT findings were also reviewed in 9 patients with lung cancer and pleuritis carcinomatosa and in 11 patients with tuberculous pleuritis. Five patients with malignant mesothelioma underwent CT scans twice, on admission and from 1 to 7 months after admission. Tuberculous pleuritis could be distinguished from pleuritis carcinomatosa and malignant mesothelioma by the presence or absence of pleural nodularity and chest wall invasion. Although it was difficult to identify specific CT features clearly distinguishing malignant mesothelioma from pleuritis carcinomatosa, characteristic findings of malignant mesothelioma appeared to include the rapid development and progression of pleural rind and a tendency to spread directly into the chest wall. We divided the pleural into the four regions; upper anterior, upper posterior, lower anterior and lower posterior regions. Pleural changes were more frequently seen in the lower pleural regions than in the upper pleural regions in malignant mesothelioma. (author).

  16. Computed tomography findings of malignant pleural mesothelioma

    International Nuclear Information System (INIS)

    Shiota, Yutaro; Sato, Toshio; Yamaguchi, Kazuo; Ono, Tetsuya; Kaji, Masaro; Niiya, Harutaka

    1994-01-01

    Computed tomography (CT) findings were assessed in 7 patients with malignant mesothelioma. CT findings were also reviewed in 9 patients with lung cancer and pleuritis carcinomatosa and in 11 patients with tuberculous pleuritis. Five patients with malignant mesothelioma underwent CT scans twice, on admission and from 1 to 7 months after admission. Tuberculous pleuritis could be distinguished from pleuritis carcinomatosa and malignant mesothelioma by the presence or absence of pleural nodularity and chest wall invasion. Although it was difficult to identify specific CT features clearly distinguishing malignant mesothelioma from pleuritis carcinomatosa, characteristic findings of malignant mesothelioma appeared to include the rapid development and progression of pleural rind and a tendency to spread directly into the chest wall. We divided the pleural into the four regions; upper anterior, upper posterior, lower anterior and lower posterior regions. Pleural changes were more frequently seen in the lower pleural regions than in the upper pleural regions in malignant mesothelioma. (author)

  17. Mycobacterium intracellulare Pleurisy Identified on Liquid Cultures of the Pleural Fluid and Pleural Biopsy

    OpenAIRE

    Lim, Jong Gu; O, Sei Won; Lee, Ki Dong; Suk, Dong Keun; Jung, Tae Young; Shim, Tae Sun; Chon, Gyu Rak

    2013-01-01

    Pleural effusion is a rare complication in non-tuberculous mycobacterial infection. We report a case of Mycobacterium intracellulare pleuritis with idiopathic pulmonary fibrosis in a 69-year-old man presenting with dyspnea. Pleural effusion revealed lymphocyte dominant exudate. M. intracellulare was identified using a polymerase chain reaction-restriction fragment length polymorphism method and liquid cultures of pleural effusion and pleural biopsy. After combination therapy for M. intracellu...

  18. Managing malignant pleural effusion with an indwelling pleural catheter: factors associated with spontaneous pleurodesis.

    Science.gov (United States)

    Wong, W M; Tam, T Cc; Wong, M Ky; Lui, M Ms; Ip, M Sm; Lam, D Cl

    2016-08-01

    Malignant pleural effusion can be recurrent despite active anti-cancer treatment. Significant malignant pleural effusion leads to debilitating dyspnoea and worsening quality of life in patients with advanced cancer. An indwelling pleural catheter offers a novel means to manage recurrent malignant pleural effusion and may remove the need for repeated thoracocentesis. Spontaneous pleurodesis is another unique advantage of indwelling pleural catheter placement but the factors associated with its occurrence are not clearly established. The aims of this study were to explore the safety of an indwelling pleural catheter in the management of symptomatic recurrent malignant pleural effusion, and to identify the factors associated with spontaneous pleurodesis. This case series with internal comparisons was conducted in the Division of Respiratory Medicine, Department of Medicine, Queen Mary Hospital, Hong Kong. All patients who underwent insertion of an indwelling pleural catheter from the initiation of such service from January 2010 to December 2014 were included for data analysis. Patients were monitored until December 2014, with the last catheter inserted in July 2014. Between 2010 and 2014, a total of 23 indwelling pleural catheters were inserted in 22 consecutive patients with malignant pleural effusion, including 15 (65.2%) cases with malignant pleural effusion as a result of metastatic lung cancer. Ten (43.5%) cases achieved minimal output according to defined criteria, in five of whom the pleural catheter was removed without subsequent re-accumulation of effusion (ie spontaneous pleurodesis). Factors associated with minimal output were the absence of trapped lung (P=0.036), shorter time from first appearance of malignant pleural effusion to catheter insertion (P=0.017), and longer time from catheter insertion till patient's death or end of study (P=0.007). An indwelling pleural catheter provides a safe means to manage symptomatic malignant pleural effusion

  19. Edema pulmonar hidrostático: aspectos na tomografia computadorizada de alta resolução Hydrostatic pulmonary edema: high-resolution computed tomography aspects

    Directory of Open Access Journals (Sweden)

    Cláudia Maria Cunha Ribeiro

    2006-12-01

    Full Text Available OBJETIVO: A proposta deste estudo foi caracterizar por meio de tomografia computadorizada de alta resolução do tórax as principais alterações pulmonares do edema pulmonar hidrostático. MÉTODOS: Foram analisadas, retrospectivamente, as tomografias de quinze pacientes com quadro clínico de edema pulmonar hidrostático, divididos em cinco principais grupos etiológicos: insuficiência cardíaca congestiva, valvulopatia mitral aguda, infarto agudo do miocárdio, miocardite e mediastinite fibrosante, tendo sido sete pacientes classificados no primeiro grupo e dois em cada um dos demais. RESULTADOS: Os principais achados do edema hidrostático foram opacidades em vidro fosco (100%, espessamento dos septos interlobulares (100%, derrame pleural (87% e espessamento do interstício peribroncovascular (80%. Outros achados menos comuns foram aumento do calibre dos vasos, consolidações e nódulos do espaço aéreo. CONCLUSÃO: O padrão predominante encontrado nos pacientes estudados foi o de opacidades em vidro fosco associadas a espessamento dos septos interlobulares (padrão de pavimentação em mosaico, com derrame pleural bilateral, predominante à direita.OBJECTIVE: This study aimed to use high-resolution computed tomography scans of the chest to characterize the principal alterations occurring in cases of hydrostatic pulmonary edema. METHODS: A retrospective analysis was made of the tomography scans of 15 patients presenting clinical profiles of hydrostatic pulmonary edema. The cases were divided into five groups by etiology: congestive heart failure (n = 7; acute mitral valve disease (n = 2; acute myocardial infarction (n = 2; myocarditis (n = 2; and fibrosing mediastinitis (n = 2. RESULTS: The principal findings in the cases of hydrostatic pulmonary edema were ground-glass opacities (in 100%, interlobular septal thickening (in 100%, pleural effusion (in 87% and peribronchovascular interstitial thickening (in 80%. Other, less common

  20. Spontaneous esophageal-pleural fistula

    OpenAIRE

    Vyas, Sameer; Prakash, Mahesh; Kaman, Lileshwar; Bhardwaj, Nidhi; Khandelwal, Niranjan

    2011-01-01

    Spontaneous esophageal-pleural fistula (EPF) is a rare entity. We describe a case in a middle-aged female who presented with severe retrosternal chest pain and shortness of breadth. Chest computed tomography showed right EPF and hydropneumothorax. She was managed conservatively keeping the chest tube drainage and performing feeding jejunostomy. A brief review of the imaging finding and management of EPF is discussed.

  1. Spontaneous esophageal-pleural fistula.

    Science.gov (United States)

    Vyas, Sameer; Prakash, Mahesh; Kaman, Lileshwar; Bhardwaj, Nidhi; Khandelwal, Niranjan

    2011-10-01

    Spontaneous esophageal-pleural fistula (EPF) is a rare entity. We describe a case in a middle-aged female who presented with severe retrosternal chest pain and shortness of breadth. Chest computed tomography showed right EPF and hydropneumothorax. She was managed conservatively keeping the chest tube drainage and performing feeding jejunostomy. A brief review of the imaging finding and management of EPF is discussed.

  2. Pleural mesothelioma in Costa Rica

    International Nuclear Information System (INIS)

    Maineri-Hidalgo, Jose Alberto; Putvinsky, Vladimir; Mainieri-Breedy, Giovanna

    2006-01-01

    The mesothelioma is a neoplasia originated in the serous membranes that drape the cellomic cavities and there cover the visceras that they contain, whose development has related to the exhibition to the asbestos. The present study describes the characteristics of the cases of mesothelioma pleural diagnosed in 3 adults hospitals in Costa Rica. 29 cases of pleural mesothelioma were found between 1972 and 2002 after reviewing the pathology service archives of the 3 national general hospitals of the Costa Rican social security health system. The incidence rate in 2002 was 1 case per 2 million; there were 15 females and 14 males, with a mean age of 54 years. Twenty cases presented with pleural effusion being dyspnea, chest pain, cough, fever and weight loss the most frequent symptoms. The disease was detected in all the cases because of an abnormal chest X-ray. The method used to obtain tissue for histological diagnosis was thoracotomy for 15 cases, pleural biopsy in 8, thoracoscopy in 4 and autopsy in 2. The histological diagnosis in 16 cases was fibrous mesothelioma, 10 malignant and 6 benign, 11 were epithelial (all malignant) and 2 were malignant mixed mesothelioma. The treatment in all the benign cases was surgical resection and none recurred. Two of the malignant lesions were resected, 1 had an extrapleural pneumonectomy along with pericardial and diaphragmatic resection, but the survival was not better than the rest of the malignant cases, with an average survival rate for all of them of only 6 months. Chemotherapy and radiotherapy showed no additional benefit. (author) [es

  3. Spontaneous esophageal-pleural fistula

    Directory of Open Access Journals (Sweden)

    Sameer Vyas

    2011-01-01

    Full Text Available Spontaneous esophageal-pleural fistula (EPF is a rare entity. We describe a case in a middle-aged female who presented with severe retrosternal chest pain and shortness of breadth. Chest computed tomography showed right EPF and hydropneumothorax. She was managed conservatively keeping the chest tube drainage and performing feeding jejunostomy. A brief review of the imaging finding and management of EPF is discussed.

  4. Massive pleural effusion in a young woman

    OpenAIRE

    Ghiringhelli, Paolo; Cattaneo, Roberto; Tiso, Angelo; Cesaro, Claudia

    2012-01-01

    Pleural effusion is a clinical manifestation shared by several underlying pathologies. The differential diagnosis is based on the clinical history, the physical examination, the analysis of the pleural fluid, and the laboratory data (mainly blood tests). There are cases, such as the patient described, where TC is not enough, and unusual imaging techniques are required for the study of pleural effusion, i.e. magnetic resonance cholangiography, cholangiopancreatography (MRCP) and endoscopic ret...

  5. Pleural liquid and its exchanges.

    Science.gov (United States)

    Agostoni, Emilio; Zocchi, Luciano

    2007-12-15

    After an account on morphological features of visceral and parietal pleura, mechanical coupling between lung and chest wall is outlined. Volume of pleural liquid is considered along with its thickness in various regions, and its composition. Pleural liquid pressure (P(liq)) and pressure exerted by lung recoil in various species and postures are then compared, and the vertical gradient of P(liq) considered. Implications of lower P(liq) in the lung zone than in the costo-phrenic sinus at iso-height are pointed out. Mesothelial permeability to H(2)O, Cl(-), Na(+), mannitol, sucrose, inulin, albumin, and various size dextrans is provided, along with paracellular "pore" radius of mesothelium. Pleural liquid is produced by filtration from parietal pleura capillaries according to Starling forces. It is removed by absorption in visceral pleura capillaries according to Starling forces (at least in some species), lymphatic drainage through stomata of parietal mesothelium (essential to remove cells, particles, and large macromolecules), solute-coupled liquid absorption, and transcytosis through mesothelium.

  6. Identifying Malignant Pleural Effusion by A Cancer Ratio (Serum LDH: Pleural Fluid ADA Ratio).

    Science.gov (United States)

    Verma, Akash; Abisheganaden, John; Light, R W

    2016-02-01

    We studied the diagnostic potential of serum lactate dehydrogenase (LDH) in malignant pleural effusion. Retrospective analysis of patients hospitalized with exudative pleural effusion in 2013. Serum LDH and serum LDH: pleural fluid ADA ratio was significantly higher in cancer patients presenting with exudative pleural effusion. In multivariate logistic regression analysis, pleural fluid ADA was negatively correlated 0.62 (0.45-0.85, p = 0.003) with malignancy, whereas serum LDH 1.02 (1.0-1.03, p = 0.004) and serum LDH: pleural fluid ADA ratio 0.94 (0.99-1.0, p = 0.04) was correlated positively with malignant pleural effusion. For serum LDH: pleural fluid ADA ratio, a cut-off level of >20 showed sensitivity, specificity of 0.98 (95 % CI 0.92-0.99) and 0.94 (95 % CI 0.83-0.98), respectively. The positive likelihood ratio was 32.6 (95 % CI 10.7-99.6), while the negative likelihood ratio at this cut-off was 0.03 (95 % CI 0.01-0.15). Higher serum LDH and serum LDH: pleural fluid ADA ratio in patients presenting with exudative pleural effusion can distinguish between malignant and non-malignant effusion on the first day of hospitalization. The cut-off level for serum LDH: pleural fluid ADA ratio of >20 is highly predictive of malignancy in patients with exudative pleural effusion (whether lymphocytic or neutrophilic) with high sensitivity and specificity.

  7. Discrimination between pleural thickening and minimal pleural effusion using color Doppler chest ultrasonography

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    Ali A. Hasan

    2013-07-01

    Conclusions: Application of color Doppler examination increases the accuracy of real time chest ultrasound to discriminate pleural thickening from minimal pleural effusion and hence color Doppler examination proved to be a useful diagnostic tool to real-time gray-scale ultrasound for diagnosis of minimal pleural effusion.

  8. Advanced medical interventions in pleural disease

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    Rahul Bhatnagar

    2016-06-01

    Full Text Available The burden of a number of pleural diseases continues to increase internationally. Although many pleural procedures have historically been the domain of interventional radiologists or thoracic surgeons, in recent years, there has been a marked expansion in the techniques available to the pulmonologist. This has been due in part to both technological advancements and a greater recognition that pleural disease is an important subspecialty of respiratory medicine. This article summarises the important literature relating to a number of advanced pleural interventions, including medical thoracoscopy, the insertion and use of indwelling pleural catheters, pleural manometry, point-of-care thoracic ultrasound, and image-guided closed pleural biopsy. We also aim to inform the reader regarding the latest updates to more established procedures such as chemical pleurodesis, thoracentesis and the management of chest drains, drawing on contemporary data from recent randomised trials. Finally, we shall look to explore the challenges faced by those practicing pleural medicine, especially relating to training, as well as possible future directions for the use and expansion of advanced medical interventions in pleural disease.

  9. Lymphocytic Pleural Effusion in Acute Melioidosis

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    Kuo-Mou Chung

    2007-10-01

    Full Text Available An endemic outbreak of melioidosis developed in southern Taiwan following a flood caused by a typhoon in July 2005. A total of 27 patients were diagnosed with the acute and indigenous form of pulmonary melioidosis. Parapneumonic pleural effusions were noted on chest X-rays in six patients. Thoracentesis was done in three patients and all revealed lymphocyte predominance in differential cell count. Burkholderia pseudomallei was isolated in the pleural effusion in one of them. All three patients survived after antibiotic treatment. Lymphocytic pleural effusion is generally seen in tuberculosis or malignancy. However, our findings suggest that melioidosis should be considered in the differential diagnosis of lymphocytic pleural effusion.

  10. Pancreatico-pleural Fistula: Case Series

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    Manoj Munirathinam

    2018-01-01

    Full Text Available Pancreatico-pleural fistula is a rare but serious complication of acute and chronic pancreatitis. The pleural effusion caused by pancreatico-pleural fistula is usually massive and recurrent. It is predominately left-sided but right-sided and bilateral effusion does occur. We report four cases of pancreatico-pleural fistula admitted to our hospital. Their clinical presentation and management aspects are discussed. Two patients were managed by pancreatic endotherapy and two patients were managed conservatively. All four patients improved symptomatically and were discharged and are on regular follow-up. Most of these patients would be evaluated for their breathlessness and pleural effusion delaying the diagnosis of pancreatic pathology and management. Hence, earlier recognition and prompt treatment would help the patients to recover from their illnesses. Pancreatic pleural fistula diagnosis requires a high index of suspicion in patients presenting with chest symptoms or pleural effusion. Extremely high pleural fluid amylase levels are usual but not universally present. A chest X-ray, pleural fluid analysis, and abdominal imaging (magnetic resonance cholangiopancreatography/magnetic resonance imaging abdomen more useful than contrast-enhanced computed tomography abdomen would clinch the diagnosis. Endoscopic retrograde cholangiopancreatography with stent or sphincterotomy should be considered when pancreatic duct (PD reveals a stricture or when medical management fails in patients with dilated or irregular PD. Surgical intervention may be indicated in patients with complete disruption of PD or multiple strictures.

  11. Microfilaria in pleural effusion: An unusual association

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    Rehena Sarkar

    2016-01-01

    Full Text Available Lymphatic filariasis is a major public health problem in tropical countries and India is endemic for it. However, lymphatic filariasis presenting as pleural effusion is an unusual manifestation and finding microfilaria in pleural effusion without any lung pathology is rare. We report a case of pleural effusion without any underlying lung pathology and normal blood picture. Clinical cure occurred after treatment with diethyl-carbamazepine. Filariasis should be kept in view while considering the differential diagnosis of idiopathic pleural effusion, especially in endemic countries.

  12. Physiology of breathlessness associated with pleural effusions

    Science.gov (United States)

    Thomas, Rajesh; Jenkins, Susan; Eastwood, Peter R.; Lee, Y.C. Gary; Singh, Bhajan

    2015-01-01

    Purpose of review Pleural effusions have a major impact on the cardiorespiratory system. This article reviews the pathophysiological effects of pleural effusions and pleural drainage, their relationship with breathlessness, and highlights key knowledge gaps. Recent findings The basis for breathlessness in pleural effusions and relief following thoracentesis is not well understood. Many existing studies on the pathophysiology of breathlessness in pleural effusions are limited by small sample sizes, heterogeneous design and a lack of direct measurements of respiratory muscle function. Gas exchange worsens with pleural effusions and improves after thoracentesis. Improvements in ventilatory capacity and lung volumes following pleural drainage are small, and correlate poorly with the volume of fluid drained and the severity of breathlessness. Rather than lung compression, expansion of the chest wall, including displacement of the diaphragm, appears to be the principle mechanism by which the effusion is accommodated. Deflation of the thoracic cage and restoration of diaphragmatic function after thoracentesis may improve diaphragm effectiveness and efficiency, and this may be an important mechanism by which breathlessness improves. Effusions do not usually lead to major hemodynamic changes, but large effusions may cause cardiac tamponade and ventricular diastolic collapse. Patients with effusions can have impaired exercise capacity and poor sleep quality and efficiency. Summary Pleural effusions are associated with abnormalities in gas exchange, respiratory mechanics, respiratory muscle function and hemodynamics, but the association between these abnormalities and breathlessness remains unclear. Prospective studies should aim to identify the key mechanisms of effusion-related breathlessness and predictors of improvement following pleural drainage. PMID:25978627

  13. Are the days of closed pleural biopsy over? Yes

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    Dharmesh Patel

    2015-01-01

    Full Text Available In the modern management of pleural diseases, thoracoscopy has a clear advantage over closed pleural biopsy. By way of its high yield, both in malignant pleural disease and pleural Tuberculosis – the two commonest cause of undiagnosed pleural effusion, thoracoscopy has the added advantage of faster symptom relief and offering effective pleurodesis. This makes it an attractive diagnostic and therapeutic procedure of choice and features high in the algorithms of many international guidelines on the approach to pleural diseases.

  14. Sarcoma da Artéria Pulmonar — dificuldades diagnósticas e terapêuticas

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    Sofia Neves

    2003-01-01

    Full Text Available RESUMO: O Sarcoma da Artéria Pulmonar é um tumor raro, apresentando-se com sinais e sintomas inespecíficos, simulando por vezes o Tromboembolismo Pulmonar (TEP, o que torna o seu diagnóstico difícil e tardio.A este propósito os autores apresentam um caso de um homem de 59 anos, ex-fumador, internado por dispneia de esforço, toracalgia e sintomas gerais.Portador de uma radiografia e TAC torácicas, ambas evidenciando imagens sugestivas de Trombose da Artéria Pulmonar Direita.Analiticamente e antes de qualquer terapêutica: Inibidor Lúpico ↑ e anticardiolipina IgM +.Presumido diagnóstico inicial de TEP crónico em doente com provável Síndroma de Hipercoaguabilidade, iniciou terapêutica hipocoagulante, com melhoria.Reinternado 2 meses após alta por agravamento clínico e radiológico. Proposto e aceite para Tromboendarterectomia Pulmonar, sob circulação extracorporal e paragem cardiocirculatória em hipotermia profunda (18 ºC. Durante a cirurgia constatou-se a presença de «mega-artérias pulmonares» preenchidas por massa trombosada que se estendia às ramificações arteriais segmentares. Após a exérese dessa massa houve necessidade de realizar Pneumectomia direita por hemorragia progressiva incontrolável.Veio a falecer ao 7.º dia de pós-operatório, por ARDS em pulmão único.Resultado Anatomopatológico: Sarcoma da Artéria Pulmonar com Metastização Pulmonar e Pleural.REV PORT PNEUMOL IX (1: 41-51 ABSTRACT: Primary Pulmonary Artery Sarcoma is a rare entity, which shares some clinical features with Thromboembolic Pulmonary Disease (TEPD, complicating differential diagnosis.The authors report a Clinical Case of a Primary Pulmonary Artery Sarcoma in a 59 years old man, admitted with a history of dyspnoea on exertion, chest pain and general symptoms. Chest X-ray, Computed Tomography Scan, Angiographies and Magnetic Resonance Imaging

  15. Endocarditis infecciosa de válvula pulmonar nativa

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    Franco Romaní R

    2007-04-01

    Full Text Available La endocarditis infecciosa en válvulas derechas es predominantemente en la válvula tricuspídea, mientras la válvula pulmonar es excepcionalmente afectada (menos de 1,5%, por lo que son pocos los casos reportados en la literatura mundial. Las manifestaciones clínicas de endocarditis en válvula pulmonar no son las clásicas de endocarditis infecciosa, como son los síntomas de embolismo séptico pulmonar. La endocarditis aislada de válvula pulmonar nativa es inusual en personas que no consumen drogas intravenosas. Se presenta el caso de un paciente varón con diabetes mellitus tipo 2 y sin otro factor predisponente.

  16. Embolectomía en una embolia pulmonar aguda masiva

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    Manuel Carnero Alcázar

    2007-07-01

    Full Text Available Presentamos el caso de un varón de 57 años que, en el seno de un meningioma microcítico, padece una tromboembolia pulmonar masiva aguda con inestabilidad hemodinámica. Dado el riesgo de hemorragia por el tumor craneal, se contraindica la terapia fibrinolítica y se procede a practicar embolectomía pulmonar. Ésta se realiza bajo anestesia general, con canulación convencional y bajo hipotermia moderada. Se extrae émbolo en el tronco de la arteria pulmonar y con catéter de Fogarty se extraen émbolos en ramas lobares y segmentarias. Discutimos la asociación de enfermedad tromboembólica con determinadas neoplasias y el tratamiento de la tromboembolia pulmonar

  17. Idade pulmonar em mulheres com obesidade mórbida

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    Fabiana Sobral Peixoto-Souza

    2013-06-01

    Full Text Available OBJETIVO: Verificar a influência da obesidade mórbida na idade pulmonar de mulheres e correlacionar com a massa corporal, índice de massa corporal (IMC e variáveis ventilatórias. MÉTODOS: Estudo longitudinal realizado com 72 obesas mórbidas e grupo controle constituído de mulheres eutróficas. As voluntárias realizaram um teste de função pulmonar para determinação da idade pulmonar e os resultados foram correlacionados com as variáveis antropométricas e volumes pulmonares. RESULTADOS: As obesas mórbidas apresentaram uma idade pulmonar significativamente superior (50,1 ± 6,8 anos às eutróficas (38,8 ± 11,4 anos. Não houve diferença entre a idade cronológica entre os grupos. Houve uma correlação significativa e positiva entre idade cronológica, massa corporal e IMC com a idade pulmonar (r = 0,3647, 0,4182, 0,3743, respectivamente. Houve uma correlação negativa entre a capacidade vital forçada (CVF, volume expiratório forçado no primeiro segundo (VEF1, razão (VEF1/CVF e volume de reserva expiratório (VRE com a idade pulmonar (r = -0.7565, -0.8769, -0.2723, -0.2417, respectivamente. CONCLUSÃO: A idade pulmonar das obesas mórbidas encontra-se aumentada e está associada com o aumento da massa corporal e IMC.

  18. Factores de riesgo de mortalidad precoz del Trasplante Pulmonar

    OpenAIRE

    Kreis Esmendi, Germán

    2006-01-01

    Consultable des del TDX Títol obtingut de la portada digitalitzada A pesar de la experiencia acumulada, la mortalidad postoperatoria temprana del trasplante pulmonar continua siendo elevada. Los factores asociados a este evento permanecen siendo controvertidos. Objetivo: Revisar la serie de trasplantes pulmonares realizados en el Hospital Vall d' Hebron para establecer la supervivencia acumulada e identificar los factores asociados con riesgo de mortalidad postoperatoria precoz. Pacient...

  19. A importância da pressão pleural na avaliação da mecânica respiratória La importancia de la presión pleural en la evaluación de la mecánica respiratoria Importance of pleural pressure for the evaluation of respiratory mechanics

    Directory of Open Access Journals (Sweden)

    Cláudia Regina Fernandes

    2006-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Para a partição das medidas de mecânica do sistema respiratório em seus componentes pulmão e parede torácica, faz-se necessário o conhecimento da pressão pleural. A finalidade desta revisão foi discutir sobre medidas alternativas à obtenção da pressão pleural para o cálculo da mecânica pulmonar, relatar as peculiaridades do método do balão esofágico para obtenção indireta da pressão pleural, as particularidades da obtenção da medida da pressão esofágica em pacientes sedados ou anestesiados, discorrer sobre a medida direta da pressão pleural e sua correlação com a pressão esofágica, assim como relatar sobre o reflexo da PEEP nas pressões pleural e esofágica. CONTEÚDO: A variação da pressão intra-esofágica reflete a variação da pressão intrapleural, podendo ser usada como medida alternativa à pressão pleural direta, no estudo da mecânica dos componentes pulmão e parede do sistema respiratório. A medida da pressão esofágica pode ser realizada por meio de um delicado balão posicionado no interior do esôfago. O método e a técnica foram observados e validados em seres humanos e animais em diferentes condições e posturas corporais. O emprego da PEEP em pacientes sob ventilação controlada mecânica está consolidado; no entanto, existem controvérsias da correlação próxima entre a pressão esofágica e a pressão pleural em pacientes ventilados com PEEP, o que pode resultar em erros de cálculo de mecânica respiratória considerando a pressão esofágica. CONCLUSÕES: O método do balão esofágico é o mais utilizado para a obtenção da medida indireta da pressão pleural. Em pacientes sedados ou anestesiados sem alterações significativas da complacência respiratória, a variação da pressão esofágica corresponde à variação da pressão pleural quando a PEEP é aplicada.JUSTIFICATIVA Y OBJETIVOS: Para la partición de las medidas de mecánica del sistema

  20. [Residual pleural thickening in tuberculous pleuritis. Associated factors

    Science.gov (United States)

    Ruiz, E; Alegre, J; Alemán, C; Vizcaya, S; Armadans, L; Segura, R M; Andreu, J; Iglesias, D; Fernández de Sevilla, T

    2000-10-01

    To study the factors related to the development of residual pleural thickening in pleural tuberculosis. We studied 39 patients with tuberculous pleural effusion. A chest X-ray was taken of each patient at the end of treatment. The patients' medical histories, pleural fluid findings and diagnostic chest films were evaluated. Residual pleural thickening was defined as thickening that was visibly greater than 2 mm in the lower side portion of the chest film. Residual pleural thickening developed in 26% of patients and was found mainly in men (RR = 3.86). In no patients with Löwenstein-Jensen cultures positive for Mycobacterium tuberculosis did pleural complications develop. Residual pleural thickening is a common complication of tuberculous pleural effusion. Residual pleural thickening in tuberculous pleurisy occurs more often in men and older patients, and in cases in which pleural liquid culture is negative for M. tuberculosis.

  1. Metastização pulmonar na apresentação de angiossarcoma cardíaco – Caso clínico e discussão

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    Vítor Fonseca

    2009-11-01

    Full Text Available Resumo: Apresenta-se um caso clínico referente a doente de 35 anos, do sexo masculino sem antecedentes pessoais relevantes, admitido no serviço de urgência por quadro de toracalgia e tosse produtiva com alterações electrocardiográficas sugestivas de pericardite. Inicialmente admitido pelo Serviço de Cardiologia, com melhoria do quadro clínico após terapêutica anti-inflamatória; contudo, no internamento houve como intercorrência pneumonia de provável etiologia bacteriana, complicada por derrame pleural. Após a alta, foi referenciado à consulta de pneumologia, onde se manteve o estudo etiológico do derrame persistente, tendo vindo a complicar-se o seu quadro com alterações das cavidades cardiacas e múltiplos nódulos pulmonares, sugestivos de endocardite subaguda com embolização séptica pulmonar. Internado no serviço de Pneumologia e submetido a videotoracoscopia, foi-lhe diagnosticado angiossarcoma cardíaco com metastização pulmonar. Assistiu-se a uma rápida evolução do quadro clínico, quase fulminante, com falência cardíaca e óbito do doente sem ter iniciado radioterapia ou quimioterapia adjuvante. Abstract: We present a case report of a 35 year-old male without any relevant former pathology admitted to the emergency room with atypical chest pain, cough and sputum with ECG changes suggesting pericarditis. He was initially admitted to the cardiology ward and experienced clinical improvement after initiating anti-inflammatory treatment. As intercurrence he had bacterial origin pneumonia complicated by pleural effusion (PE. After discharge patient was referred to a pulmonology appointment where aetiological investigation of the PE was instigated. Investigation revealed changes in the cardiac cavities and multiple lung nodules, suggesting subacute endocarditis with septic pulmonary embolism. Admitted to the pulmonology unit patient underwent

  2. Pleural effusion: diagnosis, treatment, and management

    Science.gov (United States)

    Karkhanis, Vinaya S; Joshi, Jyotsna M

    2012-01-01

    A pleural effusion is an excessive accumulation of fluid in the pleural space. It can pose a diagnostic dilemma to the treating physician because it may be related to disorders of the lung or pleura, or to a systemic disorder. Patients most commonly present with dyspnea, initially on exertion, predominantly dry cough, and pleuritic chest pain. To treat pleural effusion appropriately, it is important to determine its etiology. However, the etiology of pleural effusion remains unclear in nearly 20% of cases. Thoracocentesis should be performed for new and unexplained pleural effusions. Laboratory testing helps to distinguish pleural fluid transudate from an exudate. The diagnostic evaluation of pleural effusion includes chemical and microbiological studies, as well as cytological analysis, which can provide further information about the etiology of the disease process. Immunohistochemistry provides increased diagnostic accuracy. Transudative effusions are usually managed by treating the underlying medical disorder. However, a large, refractory pleural effusion, whether a transudate or exudate, must be drained to provide symptomatic relief. Management of exudative effusion depends on the underlying etiology of the effusion. Malignant effusions are usually drained to palliate symptoms and may require pleurodesis to prevent recurrence. Pleural biopsy is recommended for evaluation and exclusion of various etiologies, such as tuberculosis or malignant disease. Percutaneous closed pleural biopsy is easiest to perform, the least expensive, with minimal complications, and should be used routinely. Empyemas need to be treated with appropriate antibiotics and intercostal drainage. Surgery may be needed in selected cases where drainage procedure fails to produce improvement or to restore lung function and for closure of bronchopleural fistula. PMID:27147861

  3. Seqüestro pulmonar extralobar: análise anatomopatológica de dois casos em natimortos e revisão da literatura Extralobar pulmonary sequestration: anatomical analysis of two cases in stillbirths and review of literature

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    Ítalo Martins de Oliveira

    2008-06-01

    Full Text Available O seqüestro pulmonar é definido como uma massa anormal de tecido pulmonar sem comunicação com a árvore brônquica. É anomalia rara, responsável por 0,15-6,45% das malformações pulmonares congênitas. Quando possui revestimento pleural próprio, chama-se seqüestro pulmonar extralobar (SPE. Este trabalho descreve dois casos de SPE em natimortos (NM com 32 (1 e 34 (2 semanas de gestação com diagnóstico clínico de hipoxia intra-uterina e adenomatose cística, respectivamente, e faz revisão da literatura. O diagnóstico envolveu análise ultra-sonográfica, sindrômica, macroscópica e microscópica dos NM. Foi observada massa supradiafragmática no hemitórax esquerdo ligada à aorta torácica (1 e ao diafragma (2. As MFs associadas foram agenesia tímica (2, hipoplasia pulmonar (2, pé torto congênito (1 e acondroplasia de membros (2. A microscopia evidenciou, nos dois casos, tecido pulmonar imaturo e pedículo vascularizado e inervado.Pulmonary sequestration represents an abnormal pulmonary mass that does not communicate with the tracheobronchial tree. It is a rare malformation (MF, accountable for 0.15%-6.45% of pulmonary congenital MFs. When it has its own pleural covering, it is called extralobar (EBPS. This work describes two cases of EBPS in stillbirths (SB, at 32 (1 and 34 (2 weeks' gestation, with clinical diagnosis of intrauterine hypoxia and cystic adenomatosis, respectively. It also reviews the literature on the subject. The diagnosis involved ultrasonographic, syndromic, macroscopic and microscopic analysis. The macroscopy showed a supradiaphragmatic mass in the left hemithorax linked to thoracic aorta (1 and diaphragm (2. The associated MFs were: thymic agenesis (2, pulmonary hypoplasia (2, clubfoot (1 and achondroplasia (2. Microscopy demonstrated, in both cases, immature pulmonary tissue and vascularized and innervated pedicle.

  4. Randomized Trial of Pleural Fluid Drainage Frequency in Patients with Malignant Pleural Effusions. The ASAP Trial.

    Science.gov (United States)

    Wahidi, Momen M; Reddy, Chakravarthy; Yarmus, Lonny; Feller-Kopman, David; Musani, Ali; Shepherd, R Wesley; Lee, Hans; Bechara, Rabih; Lamb, Carla; Shofer, Scott; Mahmood, Kamran; Michaud, Gaetane; Puchalski, Jonathan; Rafeq, Samaan; Cattaneo, Stephen M; Mullon, John; Leh, Steven; Mayse, Martin; Thomas, Samantha M; Peterson, Bercedis; Light, Richard W

    2017-04-15

    Patients with malignant pleural effusions have significant dyspnea and shortened life expectancy. Indwelling pleural catheters allow patients to drain pleural fluid at home and can lead to autopleurodesis. The optimal drainage frequency to achieve autopleurodesis and freedom from catheter has not been determined. To determine whether an aggressive daily drainage strategy is superior to the current standard every other day drainage of pleural fluid in achieving autopleurodesis. Patients were randomized to either an aggressive drainage (daily drainage; n = 73) or standard drainage (every other day drainage; n = 76) of pleural fluid via a tunneled pleural catheter. The primary outcome was the incidence of autopleurodesis following the placement of the indwelling pleural catheters. The rate of autopleurodesis, defined as complete or partial response based on symptomatic and radiographic changes, was greater in the aggressive drainage arm than the standard drainage arm (47% vs. 24%, respectively; P = 0.003). Median time to autopleurodesis was shorter in the aggressive arm (54 d; 95% confidence interval, 34-83) as compared with the standard arm (90 d; 95% confidence interval, 70 to nonestimable). Rate of adverse events, quality of life, and patient satisfaction were not significantly different between the two arms. Among patients with malignant pleural effusion, daily drainage of pleural fluid via an indwelling pleural catheter led to a higher rate of autopleurodesis and faster time to liberty from catheter. Clinical trial registered with www.clinicaltrials.gov (NCT 00978939).

  5. Diagnostic Utility of Pleural Fluid Adenosine Deaminase Level in Tuberculousis Pleural Effusion

    International Nuclear Information System (INIS)

    Suleman, A.; Abbasi, M. A.; Anwar, S. A.; Kamal, M.; Khan, H.

    2016-01-01

    Background: Early diagnosis and management of tuberculosis is essential for decreasing the disease burden. Pakistan is one of the few countries of world with a very high burden of tuberculosis. Many diagnostic tests are available for detection of tuberculosis but each is fraught with certain limitations of its own. Methods: This study was a cross sectional validation study that sought to determine the validity of pleural fluid adenosine deaminase levels for diagnosis of tuberculous pleural effusion. Results: A total of 160 patients with exudative lymphocytic pleural effusions were enrolled in this study. The mean pleural fluid ADA level was 52.18±1.98 U/L. The mean pleural fluid ADA level in patients diagnosed to have tuberculosis on pleural biopsy/histopathology was higher as compared to patients who did not have tuberculous pleural effusion 52.16±2.4 U/L vs 38.6±3.14 U/L. The difference was found to be statistically significant between the two groups (p<0.05). The sensitivity, specificity, ppv and npv of pleural fluid ADA level were 88.88 percent, 77.04 percent, 86.28 percent and 81.04 percent respectively. Conclusion: Despite wide variations in the reported sensitivity and specificity of pleural fluid ADA level, it can be used as a surrogate for pleural biopsy when the latter is not feasible. (author)

  6. Pleural Fluid Adenosine Deaminase (ADA) Predicts Survival in Patients with Malignant Pleural Effusion.

    Science.gov (United States)

    Terra, Ricardo Mingarini; Antonangelo, Leila; Mariani, Alessandro Wasum; de Oliveira, Ricardo Lopes Moraes; Teixeira, Lisete Ribeiro; Pego-Fernandes, Paulo Manuel

    2016-08-01

    Systemic and local inflammations have been described as relevant prognostic factors in patients with cancer. However, parameters that stand for immune activity in the pleural space have not been tested as predictors of survival in patients with malignant pleural effusion. The objective of this study was to evaluate pleural lymphocytes and Adenosine Deaminase (ADA) as predictors of survival in patients with recurrent malignant pleural effusion. Retrospective cohort study includes patients who underwent pleurodesis for malignant pleural effusion in a tertiary center. Pleural fluid protein concentration, lactate dehydrogenase, glucose, oncotic cytology, cell count, and ADA were collected before pleurodesis and analyzed. Survival analysis was performed considering pleurodesis as time origin, and death as the event. Backwards stepwise Cox regression was used to find predictors of survival. 156 patients (out of 196 potentially eligible) were included in this study. Most were female (72 %) and breast cancer was the most common underlying malignancy (53 %). Pleural fluid ADA level was stratified as low (Pleural fluid cell count and lymphocytes number and percentage did not correlate with survival. Pleural fluid Adenosine Deaminase levels (pleural effusion who undergo pleurodesis.

  7. Multidetector CT Findings and Differential Diagnoses of Malignant Pleural Mesothelioma and Metastatic Pleural Diseases in Korea

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Yoon Kyung [Department of Radiology, Gachon University Gil Medical Center, Incheon 21565 (Korea, Republic of); Kim, Jeung Sook [Department of Radiology, Dongguk University Ilsan Hospital, Goyang 10326 (Korea, Republic of); Lee, Kyung Won [Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620 (Korea, Republic of); Yi, Chin A [Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351 (Korea, Republic of); Koo, Jin Mo [Department of Radiology, Seoul National University College of Medicine, Seoul 03080 (Korea, Republic of); Jung, Soon-Hee [Department of Pathology, Yonsei University Wonju College of Medicine, Wonju 26426 (Korea, Republic of)

    2016-11-01

    To compare the multidetector CT (MDCT) features of malignant pleural mesothelioma (MPM) and metastatic pleural disease (MPD). The authors reviewed the MDCT images of 167 patients, 103 patients with MPM and 64 patients with MPD. All 167 cases were pathologically confirmed by sonography-guided needle biopsy of pleura, thoracoscopic pleural biopsy, or open thoracotomy. CT features were evaluated with respect to pleural effusion, pleural thickening, invasion of other organs, lung abnormality, lymphadenopathy, mediastinal shifting, thoracic volume decrease, asbestosis, and the presence of pleural plaque. Pleural thickening was the most common CT finding in MPM (96.1%) and MPD (93.8%). Circumferential pleural thickening (31.1% vs. 10.9%, odds ratio [OR] 3.670), thickening of fissural pleura (83.5% vs. 67.2%, OR 2.471), thickening of diaphragmatic pleura (90.3% vs. 73.4%, OR 3.364), pleural mass (38.8% vs. 23.4%, OR 2.074), pericardial involvement (56.3% vs. 20.3%, OR 5.056), and pleural plaque (66.0% vs. 21.9%, OR 6.939) were more frequently seen in MPM than in MPD. On the other hand, nodular pleural thickening (59.2% vs. 76.6%, OR 0.445), hilar lymph node metastasis (5.8% vs. 20.3%, OR 0.243), mediastinal lymph node metastasis (10.7% vs. 37.5%, OR 0.199), and hematogenous lung metastasis (9.7% vs. 29.2%, OR 0.261) were less frequent in MPM than in MPD. When we analyzed MPD from extrathoracic malignancy (EMPD) separately and compared them to MPM, circumferential pleural thickening, thickening of interlobar fissure, pericardial involvement and presence of pleural plaque were significant findings indicating MPM than EMPD. MPM had significantly lower occurrence of hematogenous lung metastasis, as compared with EMPD. Awareness of frequent and infrequent CT findings could aid in distinguishing MPM from MPD.

  8. Multidetector CT findings and differential diagnoses of malignant pleural mesothelioma and metastatic pleural diseases in Korea

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Yoon Kyung [Dept. of Radiology, Gachon University Gil Medical Center, Incheon (Korea, Republic of); Kim, Jeung Sook [Dept. of Radiology, Dongguk University Ilsan Hospital, Goyang (Korea, Republic of); Lee, Kyung Won [Dept. of Radiology, Seoul National University Bundang Hospital, Seongnam (Korea, Republic of); Yi, Chin A [Dept. of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Koo, Jin Mo [Dept. of Radiology, Seoul National University College of Medicine, Seoul (Korea, Republic of); Jung, Soon Hee [Dept. of Pathology, Yonsei University Wonju College of Medicine, Wonju (Korea, Republic of)

    2016-07-15

    To compare the multidetector CT (MDCT) features of malignant pleural mesothelioma (MPM) and metastatic pleural disease (MPD). The authors reviewed the MDCT images of 167 patients, 103 patients with MPM and 64 patients with MPD. All 167 cases were pathologically confirmed by sonography-guided needle biopsy of pleura, thoracoscopic pleural biopsy, or open thoracotomy. CT features were evaluated with respect to pleural effusion, pleural thickening, invasion of other organs, lung abnormality, lymphadenopathy, mediastinal shifting, thoracic volume decrease, asbestosis, and the presence of pleural plaque. Pleural thickening was the most common CT finding in MPM (96.1%) and MPD (93.8%). Circumferential pleural thickening (31.1% vs. 10.9%, odds ratio [OR] 3.670), thickening of fissural pleura (83.5% vs. 67.2%, OR 2.471), thickening of diaphragmatic pleura (90.3% vs. 73.4%, OR 3.364), pleural mass (38.8% vs. 23.4%, OR 2.074), pericardial involvement (56.3% vs. 20.3%, OR 5.056), and pleural plaque (66.0% vs. 21.9%, OR 6.939) were more frequently seen in MPM than in MPD. On the other hand, nodular pleural thickening (59.2% vs. 76.6%, OR 0.445), hilar lymph node metastasis (5.8% vs. 20.3%, OR 0.243), mediastinal lymph node metastasis (10.7% vs. 37.5%, OR 0.199), and hematogenous lung metastasis (9.7% vs. 29.2%, OR 0.261) were less frequent in MPM than in MPD. When we analyzed MPD from extrathoracic malignancy (EMPD) separately and compared them to MPM, circumferential pleural thickening, thickening of interlobar fissure, pericardial involvement and presence of pleural plaque were significant findings indicating MPM than EMPD. MPM had significantly lower occurrence of hematogenous lung metastasis, as compared with EMPD. Awareness of frequent and infrequent CT findings could aid in distinguishing MPM from MPD.

  9. Pleural fluid exchange in rabbits.

    Science.gov (United States)

    Stashenko, Gregg J; Robichaux, Amy; Lee, Y C Gary; Sanders, Jonathan R; Roselli, Robert J; Light, Richard W

    2007-07-01

    The study was designed to better characterize pleural fluid absorption in rabbits with the following two objectives: to determine the relative absorption of saline versus high-protein solutions, and to identify the relative rates of absorption of dextran molecules of varying sizes. Twenty New Zealand white rabbits received a 12-mL intrapleural injection of saline solution and a 10% protein solution on opposite sides, each solution containing dextran molecules with varying MWs. At sacrifice at 1, 4, 8, 18 and 24 h, the volume of pleural fluid and the concentrations of the dextran molecules were determined. Saline was absorbed faster than the high-protein fluid (P higher than those in the protein solution at all times after injection (P = 0.005; P higher-MW dextrans were cleared more slowly than the lower-MW dextrans in a continuously graded manner. Saline was absorbed faster than a solution with a high protein content. There was a continuous spectrum in the rate of absorption of the dextran molecules, with the larger molecules being absorbed more slowly.

  10. Perturbação respiratória durante o sono em doença pulmonar obstrutiva crônica Respiratory disturbance during sleep in chronic obstructive pulmonary disease

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    Ana C. Krieger

    2005-04-01

    Full Text Available A doença pulmonar obstrutiva crônica é uma condição freqüente e é hoje a quarta principal causa de mortes nos Estados Unidos. A prevalência de perturbação respiratória durante o sono, ou síndrome de superposição, como anteriormente denominada, ainda não foi determinada devido à publicação de relatos conflitantes. Esta condição deve continuar sendo investigada devido aos efeitos adversos causados por transtornos respiratórios relacionados ao sono em pacientes com doença pulmonar de base. Neste relato, discutiremos brevemente os mecanismos envolvidos na origem da perturbação respiratória durante o sono em doença pulmonar obstrutiva crônica e auxiliaremos o leitor a distinguir àqueles pacientes que se beneficiariam de uma avaliação do padrão do sono mais detalhada, com a discussão de tópicos de gerenciamento e opções de tratamento.Chronic obstructive pulmonary disease is a prevalent condition and is currently the forth leading cause of mortality in the US. The prevalence of respiratory disturbance during sleep, or overlap syndrome as it was commonly known in the past, is still undetermined as conflicting reports have been published. Because of the adverse effects of sleep-related respiratory impairment in patients with underlying pulmonary disease, this condition deserves further investigation. In this report, we will briefly discuss the mechanisms involved in generating respiratory disturbance during sleep in Chronic Obstructive Pulmonary Disease and will guide the reader into distinguishing those patients who would benefit from a more detailed sleep evaluation, discussing management issues and treatment options.

  11. CT diagnosis and differential diagnosis of malignant pleural mesothelioma

    International Nuclear Information System (INIS)

    Xiong Juxin; Yang Zenian; Luo Zhongyao

    2008-01-01

    Objective: To study the CT features of malignant pleural mesothelioma and improve diagnostic accuracy. Methods: The CT findings of 14 patients with malignant pleural mesothelioma proven by surgery or histopathology were analyzed retrospectively. CT plain scan was performed in all cases, 9 cases received both CT plain scan and contrast CT scan. Results: All the cases demonstrated various pleural thickening including diffuse pleural thickening (n=10). Among all the cases, there were nodular pleural thickening (n=4), lumpy pleural thickening (n=7), ring-like pleural thickening (n=3). Pleural thickness which was more than 1.0 cm was found in 12 cases. Pleural effusion (n=10), mediastinum immobilization (n=10) and thoracic cavity stricture in the trouble side (n=10) were also revealed. Conclusion: Obvious characteristics in cases with malignant pleural mesothelioma was showed in CT examination, which plays an important role in the diagnosis and differential diagnosis of this disease. (authors)

  12. Mast cells mediate malignant pleural effusion formation.

    Science.gov (United States)

    Giannou, Anastasios D; Marazioti, Antonia; Spella, Magda; Kanellakis, Nikolaos I; Apostolopoulou, Hara; Psallidas, Ioannis; Prijovich, Zeljko M; Vreka, Malamati; Zazara, Dimitra E; Lilis, Ioannis; Papaleonidopoulos, Vassilios; Kairi, Chrysoula A; Patmanidi, Alexandra L; Giopanou, Ioanna; Spiropoulou, Nikolitsa; Harokopos, Vaggelis; Aidinis, Vassilis; Spyratos, Dionisios; Teliousi, Stamatia; Papadaki, Helen; Taraviras, Stavros; Snyder, Linda A; Eickelberg, Oliver; Kardamakis, Dimitrios; Iwakura, Yoichiro; Feyerabend, Thorsten B; Rodewald, Hans-Reimer; Kalomenidis, Ioannis; Blackwell, Timothy S; Agalioti, Theodora; Stathopoulos, Georgios T

    2015-06-01

    Mast cells (MCs) have been identified in various tumors; however, the role of these cells in tumorigenesis remains controversial. Here, we quantified MCs in human and murine malignant pleural effusions (MPEs) and evaluated the fate and function of these cells in MPE development. Evaluation of murine MPE-competent lung and colon adenocarcinomas revealed that these tumors actively attract and subsequently degranulate MCs in the pleural space by elaborating CCL2 and osteopontin. MCs were required for effusion development, as MPEs did not form in mice lacking MCs, and pleural infusion of MCs with MPE-incompetent cells promoted MPE formation. Once homed to the pleural space, MCs released tryptase AB1 and IL-1β, which in turn induced pleural vasculature leakiness and triggered NF-κB activation in pleural tumor cells, thereby fostering pleural fluid accumulation and tumor growth. Evaluation of human effusions revealed that MCs are elevated in MPEs compared with benign effusions. Moreover, MC abundance correlated with MPE formation in a human cancer cell-induced effusion model. Treatment of mice with the c-KIT inhibitor imatinib mesylate limited effusion precipitation by mouse and human adenocarcinoma cells. Together, the results of this study indicate that MCs are required for MPE formation and suggest that MC-dependent effusion formation is therapeutically addressable.

  13. Relatos de pesquisas científicas

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    Congresso Internacional de Dislexia

    2011-05-01

    Full Text Available Relatos de pesquisas científicas apresentadas na terceira edição do Congresso Internacional de Dislexia (CID, realizado nas dependências do Centro Universitário Metodista Izabela Hendrix, em maio de 2011. Tratam-se de relatos de resultados de pesquisas científicas, descritivas ou experimentais das áreas da Psicologia, Fonoaudiologia, Piscopedagogia, Pedagogia e Neurociências realizadas no contexto nacional e internacional em torno da temática dislexia. 

  14. Actualizacin en el diagnstico y tratamiento de la hipertensin pulmonar

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    Juan A. Mazzei

    2011-05-01

    Full Text Available El trmino hipertensin pulmonar agrupa a un conjunto heterogneo de enfermedades que tienen en comn una remodelacin obstructiva del lecho vascular pulmonar. Esta alteracin provoca un estado hemodinmico caracterizado por una elevacin sostenida de la presin del circuito arterial pulmonar. La morbilidad y mortalidad de esta enfermedad son la consecuencia del fracaso de la compensacin del ventrculo derecho a este aumento de la poscarga. La presuncin clnica y el diagnstico precoz, una estratificacin adecuada basada en las causas subyacentes y los diferentes territorios vasculares comprometidos, la respuesta a los frmacos y el grado de gravedad, la seleccin de las diferentes alternativas teraputicas y su indicacin oportuna son los objetivos para el tratamiento contemporneo ptimo de los enfermos con hipertensin pulmonar y ser una importante tarea en el futuro. Estas recomendaciones estn destinadas al mdico general y tienen por objeto facilitar la deteccin precoz, el diagnstico y el tratamiento de los pacientes con hipertensin pulmonar, y pueden representar una diferencia significativa en el pronstico. Adems, como la evaluacin diagnstica requiere exmenes complementarios que habitualmente no estn disponibles en todas las instituciones asistenciales, tambin pueden ser utilizadas como fundamento para solicitar la derivacin oportuna a centros asistenciales de referencia.

  15. Diagnóstico precoz de enfermedades pulmonares por tabaquismo

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    Dr. D. Rodrigo Gil

    2010-09-01

    Full Text Available El tabaquismo es una epidemia y en Chile la prevalencia no ha disminuido. Entre las causas más importantes de muerte por tabaquismo están el cáncer pulmonar y la enfermedad pulmonar obstructiva crónica (EPOC. La erradicación del tabaquismo es la mejor estrategia de prevención de estas enfermedades. La segunda estrategia es la detección precoz de ellas. Sin embargo la EPOC está sub diagnosticada en todo el mundo. No está claro si la solución es hacer más espirometrías en población de riesgo. Es posible que otros métodos diagnósticos como la tomografía axial computada de tórax (TAC y la difusión pulmonar, puedan mejorar la capacidad de diagnóstico precoz de esta enfermedad. El cáncer pulmonar es el más mortal de los cánceres. El diagnóstico en etapas tempranas mejora significativamente su pronóstico. Hay varios estudios en curso que evalúan el beneficio de hacer pesquisa de cáncer pulmonar con TAC.

  16. Ossificação pulmonar dendriforme Dendriform pulmonary ossification

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    Andrezza Araújo de Oliveira Duarte

    2006-06-01

    Full Text Available A ossificação pulmonar difusa é uma condição rara, de etiologia desconhecida, na qual osso maduro é encontrado no parênquima pulmonar. É quase sempre descoberta como um achado incidental de autópsias. Freqüentemente afeta homens de meia-idade e é assintomática. Relata-se o caso de um paciente de 75 anos, que apresentou uma radiografia torácica com comprometimento pulmonar difuso e cujo diagnóstico foi baseado no exame histopatológico de fragmento pulmonar obtido através da biópsia a céu aberto, o qual demonstrou fibrose intersticial acentuada com ossificação do parênquima pulmonar.Diffuse pulmonary ossification is a rare condition of unknown pathogenesis in which mature bone is found in the pulmonary parenchyma. It is almost invariably discovered as an incidental finding at autopsy. Most commonly, it affects middle-aged men and is asymptomatic. We present the case of a 75-year-old man in which the chest X-ray showed diffuse interstitial infiltrate. Diagnosis was based on histopathological examination by open-lung biopsy, which revealed interstitial fibrosis with pulmonary ossification.

  17. Situações vivenciadas pelos trabalhadores de enfermagem na assistência ao portador de tuberculose pulmonar La asistencia al portador de tuberculosis pulmonar bajo la óptica de los trabajadores de enfermería Nursing workers' experiences in care for pulmonary tuberculosis patients

    Directory of Open Access Journals (Sweden)

    Érika do Carmo Bertazone

    2005-06-01

    Full Text Available Este estudo teve como objetivo identificar os aspectos positivos e negativos relacionados à assistência prestada ao portador de tuberculose pulmonar, com base nos relatos dos trabalhadores de enfermagem de uma unidade de isolamento. Categorizamos os relatos de 26 trabalhadores de enfermagem (enfermeiros, auxiliares, técnicos e atendentes de enfermagem, com referências positivas e negativas. Obtivemos 24 relatos, dos quais extraímos um total de 94 (100% situações, sendo 38 (40,5% consideradas positivas e 56 (59,5% negativas. As categorias de situações que apresentaram maior frequência foram relacionadas às orientações sobre o tratamento, aos sentimentos vivenciados pelo paciente em relação à sua doença e ao despreparo da equipe de enfermagem.La finalidad de este estudio fue identificar los aspectos positivos y negativos relacionados a la atención prestada al portador de tuberculosis pulmonar, con base en los informes de los trabajadores de enfermería de una unidad de aislamiento. Categorizamos los informes de 26 trabajadores de enfermería (enfermeros, auxiliares, técnicos y asistentes de enfermería. Obtuvimos 24 relatos, con un total de 94 (100% situaciones, de las cuales 38 (40,5% fueron considerados positivos y 56 (59,5% negativos. Las categorías de situaciones con mayor frecuencia estaban relacionadas a las orientaciones sobre el tratamiento, a los sentimientos vividos por el paciente respecto a su enfermedad y a la falta de preparación del equipo de enfermería.This descriptive study aimed to identify the positive and negative aspects related to nursing care for pulmonary tuberculosis patients, based on the reports of nursing workers at an isolation unit. We categorized the reports of 26 nursing workers (nurses, auxiliaries, technicians and nursing attendants in terms of positive and negative references. We obtained 24 reports, resulting in 94 (100% situations, 38 (40.5% of which were seen as positive and 56 (59.5% as

  18. Incidência de complicações pulmonares na cirurgia de revascularização do miocárdio Incidencia de complicaciones pulmonares en la cirugía de revascularización del miocardio Incidence of pulmonary complications in myocardial revascularization

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    Leila D. N Ortiz

    2010-10-01

    Full Text Available FUNDAMENTO: No período do peri-operatório, os cuidados têm sido cada vez mais criteriosos, entretanto, as complicações pulmonares após a abordagem cirúrgica ainda são frequentes, predispondo o paciente a um maior tempo de internação ou ao óbito. OBJETIVO: Descrever a incidência de complicações pulmonares e identificar a sua associação com tempos de circulação extracorpórea (CEC; cirurgia e isquemia; número de enxertos; localização e tempo de drenos após cirurgia de revascularização do miocárdio (CRM. MÉTODOS: Nesta coorte contemporânea, foram estudados 202 pacientes em hospital universitário de referência para cardiologia no sul do Brasil, submetidos à CRM eletiva com ponte safena e artéria mamária interna com CEC, no período de abril/2006 a novembro/2007. Os desfechos considerados foram: tempo de ventilação mecânica; surgimento de pneumonia; atelectasia; derrame pleural; hora da retirada e localização dos drenos; e tempo de internação. RESULTADOS: Observou-se algum tipo de complicação pulmonar em 90 dos 202 pacientes. A frequência de derrame pleural foi de 84% e a de atelectasia foi de 65%. Apresentaram associação com complicações pulmonares os tempos de CEC (p = 0,003, cirúrgico (p = 0,040 e isquemia (p = 0,001; o tempo de permanência de drenos (p = 0,050 e a localização pleural dos drenos (p = 0,033, além de idade (p = 0,001, fração de ejeção (p = 0,010, diagnóstico de asma (p = 0,047 e exame radiológico de tórax pré-operatório anormal (p = 0,029. CONCLUSÃO: Variáveis relacionadas à complexidade do ato cirúrgico e comorbidades pré-existentes estão associadas a uma alta incidência de complicações pulmonares no pós-operatório. Esses dados reforçam a importância da avaliação clínica peri-operatória para detecção precoce de complicação respiratória após CRM.FUNDAMENTO: En el período del peri-operatorio, los cuidados han sido cada vez más criteriosos, entre

  19. Hipertensión pulmonar postparto

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    Juan Pablo Escalante

    2015-02-01

    Full Text Available La presencia de hipertensión pulmonar (HP en el embarazo es poco frecuente y conlleva un alto riesgo para madres e hijos. Existe escasa bibliografía relacionada al diagnóstico de la misma luego del parto. Se describen tres pacientes a quienes se diagnostica HP luego de cursar sus embarazos y partos libres de eventos. A pesar de desconocerse las causas, son varios los mecanismos propuestos, como la hipercoagulabilidad, la hipoxia placentaria o la embolia de líquido amniótico. Resulta difícil definir si la HP diagnosticada en el puerperio, corresponde a una HP en período asintomático que fue desenmascarada por el estrés fisiológico del parto o es una condición de reciente comienzo. A pesar de la falta de datos que avalen la ausencia de HP previa al embarazo en nuestras tres casos, el curso libre de eventos en sus embarazos, sin síntomas y con partos normales, indican que no padecían esta enfermedad hasta el momento del parto, y que la desarrollaron posteriormente. De haberla padecido antes se hubieran presentado síntomas previos al parto o en el puerperio inmediato, ya que las demandas hemodinámicas deterioran gravemente a un ventrículo con poca reserva.

  20. Coriocarcinoma con metástasis pulmonar

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    Vicia Sánchez Abalos

    2014-05-01

    Full Text Available Se presenta el caso clínico de una fémina de 44 años de edad, con 32 semanas de embarazo, la cual fuera ingresada en la Unidad de Cuidados Intensivos del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba, por presentar insuficiencia respiratoria aguda como consecuencia de una sepsis. La paciente fue tratada con cefalosporina de tercera generación y ventilación mecánica no invasiva, pero se mantuvieron las características gasométricas de hipoxemia y una mala reacción terapéutica, por lo que se requirió instrumentación de las vías respiratorias y soporte hemodinámico, sin lograr regresión del cuadro clínico, lo cual condujo a un paro cardiorrespiratorio y, con ello, a la muerte. La necropsia mostró un coriocarcinoma del endometrio con metástasis pulmonar

  1. Tratamiento acortado estrictamente supervisado para tuberculosis pulmonar

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    Alvarez-Gordillo Guadalupe del Carmen

    1998-01-01

    Full Text Available Objetivo. Evaluar la posibilidad de aplicar el tratamiento acortado estrictamente supervisado (TAES en el Programa de Control de la Tuberculosis en Chiapas, México. Material y métodos. Se evaluó la eficacia y la eficiencia del tratamiento en una cohorte de pacientes con tuberculosis pulmonar confirmada por baciloscopía, que ingresaron a tratamiento con esquemas de autoadministración semisupervisión y estricta supervisión, de enero a junio de 1996. Resultados. La eficacia fue de 90.9. 97.7 y 100% para los esquemas de tratamiento autoadministrado, semisupervisado y TAES, respectivamente, mientras que la eficiencia fue de 68.1. 77.6 y 88.5% en el mismo orden. Conclusiones. Para la salud pública el TAES demostró ser la actividad más importante en el control de la tuberculosis, al elevar las tasas de curación y disminuir, por lo tanto, las fuentes de transmisión de la enfermedad.

  2. Imaging of small amounts of pleural fluid. Part one - small pleural effusions

    International Nuclear Information System (INIS)

    Kocijancic, I.

    2005-01-01

    Background. Small pleural effusions are not readily identified on conventional radiographic views of the chest, but may be an important finding, sometimes leading, via thoracocentesis, to a definitive diagnosis of pleural carcinomatosis, infection or transudate. A small meniscus sign and a medial displacement of the costophrenic angle are the only subtle signs of small accumulations of fluid on posteroanterior chest X-rays. On lateral views the finding of a small meniscus sign in the posterior costophrenic angle is the sign of small pleural effusion. Conclusions. Lateral decubitus chest radiographs were used for many years for the diagnosis of small pleural effusions. In last decades ultrasonography of pleural space becomes a leading real-time method for demonstrating small pleural effusions. (author)

  3. Identification of pleural effusion with low levels of adenosine deaminase but without signs of acute inflammation or pleural thickening to diagnose early malignant pleural mesothelioma

    International Nuclear Information System (INIS)

    Moriyama, Satoru; Tanahashi, Masayuki; Suzuki, Eriko

    2012-01-01

    We reviewed the clinical findings and diagnostic methods used in the diagnosis of malignant pleural mesothelioma (MPM) in patients with pleural effusion with low levels of adenosine deaminase (ADA), but without signs of acute inflammation or pleural thickening. The hospital records of 40 patients with pleural effusion of unknown origin or pleural thickening were retrospectively investigated. In all of those studies, pleural effusion was exudative, lymphocyte-dominant, no mycobacteria or other bacteria, and low levels of ADA. There were 30 men and 10 women with an average age of 62.8 years old. The diagnosis of MPM was obtained by cytology of the pleural effusion in 3 patients and by core-needle biopsy of the thickened pleura in 3. Thoracoscopic pleural biopsy under general anesthesia was performed for the other 34 patients. The pathologic diagnosis of pleural biopsy was MPM in 20 patients, inflammatory change in 12, and pleural dissemination of cancer in 2. All of the 7 patients with more than 100 μg/ml of hyaluronic acid in their pleural effusion received a diagnosis of MPM. A total of 20 of 23 patients with irregular or nodular pleural thickening on computed tomography findings were confirmed to have MPM. Moreover, 6 of 17 patients with smooth pleural thickening were confirmed to have MPM. In patients with nodular pleural thickening it was easy to make the diagnosis. However, in those with smooth thickening, careful observation was required to select the appropriate biopsy site and resection margins of full-thickness pleura. As the rate of MPM in the patients with pleural effusion with low levels of ADA, but without signs of acute inflammation or pleural thickening is high (65%), an early thoracoscopic pleural biopsy is strongly recommended. (author)

  4. Mycobacterium intracellulare Pleurisy Identified on Liquid Cultures of the Pleural Fluid and Pleural Biopsy.

    Science.gov (United States)

    Lim, Jong Gu; O, Sei Won; Lee, Ki Dong; Suk, Dong Keun; Jung, Tae Young; Shim, Tae Sun; Chon, Gyu Rak

    2013-03-01

    Pleural effusion is a rare complication in non-tuberculous mycobacterial infection. We report a case of Mycobacterium intracellulare pleuritis with idiopathic pulmonary fibrosis in a 69-year-old man presenting with dyspnea. Pleural effusion revealed lymphocyte dominant exudate. M. intracellulare was identified using a polymerase chain reaction-restriction fragment length polymorphism method and liquid cultures of pleural effusion and pleural biopsy. After combination therapy for M. intracellulare pulmonary disease, the patient was clinically well at a 1-month follow-up.

  5. [Determination of isoniazide concentration in pleural effusion and its pleural permeability in patients with tuberculous pleurisy].

    Science.gov (United States)

    Liu, Yuan; Zhang, Qing; Zhang, Junfeng; Huang, Guohua; Zhu, Shunfang; Liu, Sijia; Li, Guofeng

    2012-05-01

    To establish a high-performance liquid chromatography (HPLC)-based method for determining isoniazide concentration in pleural effusion and plasma of patients with tuberculous pleurisy, and evaluate the permeability of isoniazide from blood into pleural effusion. We collected pleural effusion from 15 patients with tuberculous pleurisy 2 h after administration 300 mg isoniazide in the morning of day 1. Pleural effusion and plasma were obtained 2 h after isoniazide administration on day 3. Isoniazide concentration was measured using HPLC, and the penetration rate of isoniazide in pleural effusion was calculated. Isoniazide concentration in the pleural effusion averaged 1.156∓1.190 µg/ml in the 15 patients at 2 h after isoniazide administration on day 1. On day 3, isoniazide concentration was 1.920∓1.294 µg/ml in the pleural effusion and 2.445∓1.463 µg/ml in the plasma, and the mean penetration rate of isoniazide from blood into the pleural effusion was 86.0%. As isoniazide has a high penetration rate into the pleural effusion in most patients, continuous oral administration of isoniazid has been sufficient to achieve an effective treatment concentration, and intrapleural injection of isoniazide may seem unnecessary for non-drug-resistant tuberculosis pleurisy.

  6. The use of Jackson-Pratt silicone flat drains as prolonged pleural catheters for the management of pleural effusions

    OpenAIRE

    Demirhan, Ozkan; Kasapoglu, Tugce; Ece, Ferah; Toker, Alper

    2013-01-01

    Introduction: Imbalance between secretion and absorbtion of pleural fluid results in pleural effusion. Emergence of pleural effusion ipsilateral or contralateral to the side drained previously is named recurrent effusion. There is currently no standart approach for the management of recurrent pleural effusions. Materials and methods: Eighteen patients, treated between 2011 and 2012 for recurrent pleural effusions due to various etiologies, not considered for surgical or other treatments, ...

  7. Micetoma pulmonar por Scedosporium sp, reporte de dos casos

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    José G. Somocurcio

    2009-07-01

    Full Text Available Se reporta los dos primeros casos de micetoma pulmonar por Scedosporium sp, en el Perú, tratados quirúrgicamente en el Hospital Nacional Hipólito Unanue. Se practicó resección pulmonar debido a micetoma pulmonar de donde se tomó muestras que fueron enviadas a microbiología y anatomía patológica para cultivo y estudio histopatológico. Se identificó el moho Scedosporium sp en dos pacientes con secuelas cavitarias por tuberculosis, quienes presentaron tos y hemoptisis de dos meses y tres años de evolución, respectivamente. Radiológicamente las cavidades estaban ocupadas por una "bola fúngica". La histopatología indicó presencia de abundantes hifas, indistinguibles de las de Aspergillus sp, mientras que la inmunodifusión para Aspergillus fue negativa.

  8. Tromboendarterectomía pulmonar en el tratamiento de la hipertensión pulmonar tromboembólica crónica

    OpenAIRE

    José Antonio Blázquez; José María Cortina; Enrique Pérez; Alberto Forteza; María Jesús López; Jorge Centeno; Enrique Ruiz; Carlos Esteban Martín; Javier de Diego; Juan José Rufilanchas

    2007-01-01

    La tromboendarterectomía pulmonar representa el tratamiento potencialmente curativo de la hipertensión pulmonar tromboembólica crónica. Material y método: Entre febrero de 1996 y mayo de 2006, 20 pacientes con hipertensión pulmonar tromboembólica crónica fueron sometidos a tromboendarterectomía pulmonar. El 90% (18/20) presentaba clase funcional III-IV. Los datos hemodinámicos preoperatorios son: presión sistólica pulmonar 86 ± 17 mmHg, presión arterial pulmonar media 49 ± 9 mmHg, resisten...

  9. Massive pleural effusion in a young woman

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    Paolo Ghiringhelli

    2012-12-01

    Full Text Available Pleural effusion is a clinical manifestation shared by several underlying pathologies. The differential diagnosis is based on the clinical history, the physical examination, the analysis of the pleural fluid, and the laboratory data (mainly blood tests. There are cases, such as the patient described, where TC is not enough, and unusual imaging techniques are required for the study of pleural effusion, i.e. magnetic resonance cholangiography, cholangiopancreatography (MRCP and endoscopic retrograde cholangiopancreatography (ERCP.This case analyses a 42-year-old female patient who arrived with progressive dyspnoea, chest pain, cough, a history of alcohol abuse, and a recent episode of acute pancreatitis. The physical examination revealed signs of right-sided pleural effusion. These features, together with laboratory data, made it possible to pose the diagnosis of pancreaticopleural fistula, to treat it, and to obtain a complete healing in a two-month period.

  10. Role of Bronchoscopy in Malignant Pleural effusion

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    Gomathi. R. G.

    2016-04-01

    Full Text Available The aim of this study was to assess the role of Bronchoscopy in plural effusion in cancer condition. Pleural effusion is one of the commonest problems with which patients present to the hospital. Around a million patients worldwide develop pleural effusion each year. This is a Prospective and Observational Study. All patients diagnosed to have pleural effusion by xray, clinical examination and ultrasound examination of pleura if needed will undergo informed. All 32 patients underwent bronchoscopy procedure, 30 patients had endobronchial mass and biopsy was done which was positive for malignancy and 2 patients had bronchial wash cytology positive for malignancy We conclude that bronchoscopy has a definite role in the etiological diagnosis of pleural effusion.

  11. Investigating a Case of Recurrent Pleural Effusion

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    Patrícia Rodrigues

    2011-01-01

    Full Text Available We describe the case of a patient with long-standing Parkinson's disease and recurrent bilateral pleural effusions. The pleural fluid was an exudate, rich in normal lymphocytes, and the echocardiogram, chest computerized axial tomography, and immunological, microbiological and cytological studies were negative. The patient had been taking bromocriptine, which can be related to chronic pleural effusions. Using Pubmed, we found about 40 cases of pleuropulmonary changes or constrictive pericarditis that were related to bromocriptine. We decided to suspend this drug, with resolution of the pleural effusion and respiratory complaints for more than a year now. We discuss possible underlining mechanisms for this and emphasize the importance of collecting the past medical history and medication and of considering possible iatrogenic effects.

  12. Pancreatic Pseudocyst Pleural Fistula in Gallstone Pancreatitis

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    Sala Abdalla

    2016-01-01

    Full Text Available Extra-abdominal complications of pancreatitis such as pancreaticopleural fistulae are rare. A pancreaticopleural fistula occurs when inflammation of the pancreas and pancreatic ductal disruption lead to leakage of secretions through a fistulous tract into the thorax. The underlying aetiology in the majority of cases is alcohol-induced chronic pancreatitis. The diagnosis is often delayed given that the majority of patients present with pulmonary symptoms and frequently have large, persistent pleural effusions. The diagnosis is confirmed through imaging and the detection of significantly elevated amylase levels in the pleural exudate. Treatment options include somatostatin analogues, thoracocentesis, endoscopic retrograde cholangiopancreatography (ERCP with pancreatic duct stenting, and surgery. The authors present a case of pancreatic pseudocyst pleural fistula in a woman with gallstone pancreatitis presenting with recurrent pneumonias and bilateral pleural effusions.

  13. Enfermedad pulmonar intersticial difusa en trabajadores de la limpieza

    OpenAIRE

    Bravo Graterol, Ricardo Alejandro

    2011-01-01

    En este trabajo se describen las características de 5 trabajadores de la limpieza que fueron diagnosticados de enfermedad pulmonar intersticial difusa no aguda de causa desconocida mediante biopsia pulmonar quirúrgica. La edad media fue de 64 años y 4 fueron mujeres. Las exposiciones más frecuentes fueron el salfumán y lejía, y ninguno de los pacientes utilizó protección adecuada. Las características más llamativas de estos pacientes se observaron en la TACAR y la histopatología que mostraron...

  14. Management of Septated Malignant Pleural Effusions

    OpenAIRE

    Banka, Radhika; Terrington, Dayle; Mishra, Eleanor K.

    2018-01-01

    Purpose of Review: We review recent studies of patients with septated malignant pleural effusions, to understand what the clinical implications for patients are and what evidence-based methods should be used to manage these effusions. Recent Findings: Fibrinolytics improve effusion size assessed radiologically in patients with a chest drain inserted for septated malignant pleural effusions but this does not translate into an improvement in breathlessness relief or pleurodesis success. Fibrino...

  15. An undiagnosed pleural effusion with surprising consequences

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    A.G. Casalini

    2017-01-01

    With this case report, we would like to underline the importance of making a correct diagnosis of any pleural effusion as soon as possible by at least a thoracocentesis. If untreated, tuberculosis may easily disseminate to other organs. Some considerations and suggestions for antibiotic treatment of pleural effusion will also be given, since many antibiotics have some anti-tuberculosis effect and may delay the diagnosis of this infectious disease.

  16. Crise tireotóxica - um relato de caso

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    Mariana Fidelis Solla

    2015-10-01

    Full Text Available A crise tireotóxica (CT é a complicação mais grave dohipertireoidismo, caracterizada por um conjunto de sinais e sintomassecundários à hipersecreção aguda de hormônios tireoidianos. Contudo, adescompensação da tireoide até o estado de CT ainda não está bemestabelecida. Os fatores desencadeantes incluem: infecções, cirurgias,traumas, extrações dentárias, alterações glicêmicas, suspensão da medicaçãoanti-tireoidiana, parto e palpação vigorosa da tireóide . A CT é uma emergênciamédica que exige cuidados em unidade de tratamento intensivo (UTI. Odiagnóstico precoce é imprescindível para o êxito terapêutico e influidiretamente no prognóstico e sobrevida do paciente. Objetivos: Relatar o casoda paciente do Conjunto Hospitalar de Sorocaba (CHS que ficou sobrecuidados na UTI devido à CT que evolui para fibrilação atrial (FA etromboembolismo pulmonar (TEP, contribuindo para o meio acadêmico ecientífico. Metodologia: As informações contidas nesse trabalho foram obtidaspor meio de análise de prontuário e revisão de literatura. Relato de caso:Paciente de 25 anos, sexo feminino, deu entrada ao pronto atendimento doCHS com quadro de dispneia, palpitações intensas, ansiosa e com tremores deextremidades. A ectoscopia revelou paciente corada, hidratada, anictérica,acianótica, febril e anasarca evidente. O exame específico da tireóidedemonstrou glândula aumentada de tamanho, bócio difuso, sem nodulações àpalpação. Observou-se veias jugulares ingurgitadas e hepatomegalia. Àausculta verificou-se bulhas arrítimicas com hiperfonese de P2 e FC:214bpm.O ECG padrão de FA e sobrecarga de VE. Conclusão: O hipertiroidismo semtratamento clínico pode evoluir ,culminando com sinais e sintomas compatíveiscom crise tireotóxica. sendo necessários diagnóstico e tratamento precoces.

  17. Lung volume reduction surgery: an overview Cirurgia redutora de volume pulmonar: uma revisão

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    Rodrigo Afonso da Silva Sardenberg

    2010-01-01

    úrgica. Os estudos analisados consistiram de randomizados controlados, estudos clínicos controlados, (randomizados e não randomizados, revisões e séries de casos. As questões acerca da validade através dos relatos iniciais, seguimentos incompletos, critérios de seleção indefinidos e análises de sobrevida confundiram a interpretação dos dados clínicos provenientes da CRVP. Pacientes com enfisema de predomínio em lobos superiores, inferiores e difuso, foram incluídos; também analisamos pontos chave, tais como morbidade e mortalidade peri-operatórias, assim como a medida da função pulmonar através do VEF 1. Enfisema do tipo bolhoso foi excluído desta revisão. Foram incluídas para análise também vias de acesso cirúrgico como esternotomia mediana, toracotomias unilateral ou bilateral e videotoracoscopia unilateral ou bilateral com grampeamento ou ablação por laser. Os resultados dos estudos prospectivos randomizados entre o tratamento clínico e a CRVP são essenciais para que alguma conclusão possa ser definitiva.

  18. Incidência de complicações pulmonares na cirurgia de revascularização do miocárdio

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    Leila D. N Ortiz

    2010-10-01

    Full Text Available FUNDAMENTO: No período do peri-operatório, os cuidados têm sido cada vez mais criteriosos, entretanto, as complicações pulmonares após a abordagem cirúrgica ainda são frequentes, predispondo o paciente a um maior tempo de internação ou ao óbito. OBJETIVO: Descrever a incidência de complicações pulmonares e identificar a sua associação com tempos de circulação extracorpórea (CEC; cirurgia e isquemia; número de enxertos; localização e tempo de drenos após cirurgia de revascularização do miocárdio (CRM. MÉTODOS: Nesta coorte contemporânea, foram estudados 202 pacientes em hospital universitário de referência para cardiologia no sul do Brasil, submetidos à CRM eletiva com ponte safena e artéria mamária interna com CEC, no período de abril/2006 a novembro/2007. Os desfechos considerados foram: tempo de ventilação mecânica; surgimento de pneumonia; atelectasia; derrame pleural; hora da retirada e localização dos drenos; e tempo de internação. RESULTADOS: Observou-se algum tipo de complicação pulmonar em 90 dos 202 pacientes. A frequência de derrame pleural foi de 84% e a de atelectasia foi de 65%. Apresentaram associação com complicações pulmonares os tempos de CEC (p = 0,003, cirúrgico (p = 0,040 e isquemia (p = 0,001; o tempo de permanência de drenos (p = 0,050 e a localização pleural dos drenos (p = 0,033, além de idade (p = 0,001, fração de ejeção (p = 0,010, diagnóstico de asma (p = 0,047 e exame radiológico de tórax pré-operatório anormal (p = 0,029. CONCLUSÃO: Variáveis relacionadas à complexidade do ato cirúrgico e comorbidades pré-existentes estão associadas a uma alta incidência de complicações pulmonares no pós-operatório. Esses dados reforçam a importância da avaliação clínica peri-operatória para detecção precoce de complicação respiratória após CRM.

  19. La tuberculosis pulmonar, enfermedad reemergente en Cuba

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    Margarita González Tapia

    2014-08-01

    Full Text Available Sr. Editor: La tuberculosis es una de las enfermedades remergentes en Cuba; por ello en todas las provincias cubanas se trabaja con mucha fuerza, dedicación y profesionalidad con respecto a esta problemática. En este contexto, resulta muy acertada la publicación del artículo “Algunas variables clínico-epidemiológicas de la tuberculosis pulmonar. Puerto Padre, 2008-2012”, que salió en el Vol.38 No.6.01 del mes de junio de 2013 de la Revista Electrónica Dr. Zoilo E. Marinello Vidaurreta; tanto por el significado social que reviste la divulgación de este tema, como por el propio resultado de la investigación realizada. La historia de la tuberculosis es un tema apasionante. En pocas enfermedades es posible documentar su estrecha relación con la historia de la propia humanidad como en la que nos ocupa. Existen evidencias paleológicas de tuberculosis vertebral en momias egipcias que datan aproximadamente del año 2400 a.C. La tuberculosis se ha conocido a través de la historia, con los nombres de: tisis, consunción, escrófula, mal de Pott, plaga blanca y mal del rey.1 En el artículo se plantea como conclusión que la tendencia de la tuberculosis en el quinquenio de estudio es estacionaria, pero en los últimos cuatro años tiende al ascenso. En los casos diagnosticados de tuberculosis en este quinquenio más de dos tercios correspondieron al sexo masculino y mayores de 45 años, las ocupaciones que más prevalecieron fueron recluso, desocupado, ama de casa y jubilado. Los factores de riesgo que más se relacionaron fueron el albergamiento prolongado en instituciones cerradas, el alcoholismo, y la edad mayor de 65 años; la forma clínica de mayor incidencia en casi la totalidad de los pacientes fue la pulmonar y, dentro de ella, los casos con baciloscopia positiva. Hubo fallas en el diagnóstico, ya que alrededor de la mitad de los casos se diagnosticaron en la atención secundaria y con un tiempo de demora de más de dos meses de

  20. MASSIVE PLEURAL EFFUSION: A CASE REPORT

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    Putu Bayu Dian Tresna Dewi

    2013-03-01

    Full Text Available Pleural effusion is abnormal fluid accumulation within pleural cavity between the parietal pleura and visceralis pleura, either transudation or exudates. A 47 year-old female presented with dyspneu, cough, and decreased of appetite. She had history of right lung tumor. Physical examination revealed asymmetric chest movement where right part of lung was lagged during breathing, vocal fremitus on the right chest was decreased, dullness at the right chest, decreased vesicular sound in the right chest, enlargement of supraclavicular and colli dextra lymph nodes, and hepatomegali. Complete blood count showed leukocytosis. Clinical chemistry analysis showed hipoalbumin and decreased liver function. Blood gas analysis showed hypoxemia. Pleural fluid analysis showed an exudates, murky red liquid color filled with erythrocytes, number of cells. Cytological examination showed existence of a non-small cell carcinoma tends adeno type. From chest X-ray showed massive right pleural effusion. Based on history, physical examination and investigations, she was diagnosed with massive pleural effusion et causa suspected malignancy. She had underwent pleural fluid evacuation and treated with analgesics and antibiotics.

  1. Clinical Investigation of Benign Asbestos Pleural Effusion

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    Nobukazu Fujimoto

    2015-01-01

    Full Text Available There is no detailed information about benign asbestos pleural effusion (BAPE. The aim of the study was to clarify the clinical features of BAPE. The criteria of enrolled patients were as follows: (1 history of asbestos exposure; (2 presence of pleural effusion determined by chest X-ray, CT, and thoracentesis; and (3 the absence of other causes of effusion. Clinical information was retrospectively analysed and the radiological images were reviewed. There were 110 BAPE patients between 1991 and 2012. All were males and the median age at diagnosis was 74 years. The median duration of asbestos exposure and period of latency for disease onset of BAPE were 31 and 48 years, respectively. Mean values of hyaluronic acid, adenosine deaminase, and carcinoembryonic antigen in the pleural fluid were 39,840 ng/mL, 23.9 IU/L, and 1.8 ng/mL, respectively. Pleural plaques were detected in 98 cases (89.1%. Asbestosis was present in 6 (5.5% cases, rounded atelectasis was detected in 41 (37.3% cases, and diffuse pleural thickening (DPT was detected in 30 (27.3% cases. One case developed lung cancer (LC before and after BAPE. None of the cases developed malignant pleural mesothelioma (MPM during the follow-up.

  2. Clinical diagnosis of malignant pleural mesothelioma

    International Nuclear Information System (INIS)

    Nishi, Hideyuki; Washio, Kazuhiro; Mano, Masayuki

    2008-01-01

    We evaluated clinical and thoracoscopic findings of cases that underwent thoracoscopic biopsy for the diagnosis of malignant pleural mesothelioma. We reviewed 32 cases suspected of having malignant pleural mesothelioma from 2003 to 2006. We made a diagnosis of malignant pleural mesothelioma via thoracoscopic biopsy (19 cases). The cut-off level of hyaluronic acid in malignant effusions, selected on the basis of the best diagnostic efficacy, was 100 μg/ml. We can decrease the incidence of false negative cases by the combination of CT findings and the presence of hyaluronic acid in pleural effusion. In the pleural thickening type of thoracoscopic appearance, the parietal pleurae were thickened, and small nodules were rare. As for this type, tumor cells were histologically absent or confined to the submesothelial tissue. We considered that determinations of specific sites were difficult. Adequate tissue samples obtained via video-assisted thoracoscopy were necessary for diagnosis. We can decrease the incidence of false negative cases by the combination of the presence of hyaluronic acid in pleural effusion and thoracoscopic biopsy. (author)

  3. Relato de caso: esclerose tuberosa

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    Samuel Simis

    2016-10-01

    Full Text Available Introdução: O Complexo de Esclerose Tuberosa (CET é uma síndrome neurocutânea transmitida hereditariamente, de traço autossômico dominante e que se manifesta por uma tríade clássica: deficiência mental, convulsões e adenoma sebáceo. A mutação responsável pela síndrome está presente em até 85% dos portadores de CET e.ocorre nos genes supressores tumorais TSC1 e TSC2, que produzem hamartina e tuberina, respectivamente.A prevalência do CET é de 1:10.000 a 1:170.000, atinge mais indivíduos do sexo masculina e é rara em negros. Relato de Caso: R.C.S.B., paciente do sexo feminino, 16 anos, vem encaminhada ao ambulatório de neurologia devido a quadro de convulsões tônico-clônicas generalizadas e crises de ausência diárias há 1 ano, mas com história de convulsões aos 2 anos que cessaram espontaneamente. Está em tratamento com fenitoína 200mg/dia e carbamazepina 800mg/dia, mas ainda apresenta crises de ausência. A paciente apresenta as lesões cutâneas típicas do CET: adenomas sebáceos (angiofibroma em face distribuídos simetricamente entre nariz e bochechas, envolvendo ainda fronte e queixo. Não há sinais de retardo mental. A ressonância nuclear magnética revelou imagens com padrão compatível com áreas de desmielinização. O eletroencefalograma encontrava-se normal. Conclusão: O tratamento do CET ainda é um desafio para muitos neurologistas, uma vez que não há tratamento específico para doença. A paciente deve contar com equipe multidisciplinar, por vezes é necessário acompanhamento com neurologista, dermatologista, geneticista, psicólogos e outros, dependendo das manifestações do CET. A finalidade terapêutica é a qualidade de vida da paciente, que pode ser prejudicada pelas várias convulsões ou alterações estéticas da doença.

  4. Ascite meconial - relato de caso

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    Celeste Gomez Sardinha Oshiro

    2016-10-01

    Full Text Available INTRODUÇÃO: A ascite meconial resultante da perfuração intestinal fetal tem baixa incidência (1:30.000 nascimentos e elevada mortalidade (50%. Os achados ecográficos fetais incluem ascite e calcificações intra-abdominais. OBJETIVO: Relatar um caso de ascite meconial neonatal no Conjunto Hospitalar de Sorocaba. METODOLOGIA: Descrição do referido caso e revisão de literatura. RELATO DE CASO: Recém-nascido de J.A.P., masculino, de parto cesáreo por iteratividade em 12/05/2016, cuja mãe com 44 anos, sem intercorrências no pré-natal, negou consanguinidade, vícios e infecções; ultrassonografia obstétrica evidenciou ascite moderada, circunferência abdominal >p95, hepatomegalia e hidrocele. Ao nascimento, idade gestacional 3 8 2 /7 semanas, peso=3630g, comprimento=49 cm, Apgar 8/9. Apresentava abdome globoso, fígado a 4 cm do rebordo costal direito e hidrocele volumosa. Realizada paracentese com saída de 310 ml de líquido esverdeado (meconial. No 5o dia de vida, durante laparotomia, observou-se aderência de alças intestinais, perfuração de íleo terminal a 8 cm da vávula íleo-cecal, sendo realizada ileostomia. O anátomo-patológico de apêndice cecal evidenciou processo inflamatório crônico, neovascularização e fibrose. Paciente recebeu nutrição parenteral por 14 dias; houve progressão da dieta do 6o ao 36o dia de vida, recebendo alta em aleitamento materno e boa recuperação clínica. CONCLUSÃO: A ascite meconial por perfuração intestinal deve ser considerada no diagnóstico diferencial de ascite fetal. O diagnóstico ecográfico pré-natal é fundamental para o prognóstico pós-natal.

  5. Rehabilitación pulmonar en hipertensión pulmonar

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    Vilma Gómez

    2017-09-01

    Full Text Available El manejo del paciente con hipertensión pulmonar es complejo y requiere de un equipo interdisciplinario. Es trascendental que los programas de rehabilitación cuenten con neumólogo, fisioterapeutas entrenados, psicólogos, profesionales en trabajo social, nutrición y enfermería. Para el ingreso al programa los pacientes deben contar con manejo farmacológico óptimo y prueba de ejercicio cardiopulmonar integrada o prueba de caminata de seis minutos para determinar la condición basal, las causas de limitación al ejercicio y la intensidad del ejercicio, y prever riesgos. Se indican al menos dos a tres sesiones a la semana supervisadas durante 10 a 12 semanas para lograr mejoría en cuanto a capacidad de ejercicio, calidad de vida y niveles de actividad física. Se puede hacer entrenamiento en ambiente hospitalario, ambulatorio o mixto aunque siempre con comienzo en un ámbito supervisado y con el equipo de monitorización necesario. En cuanto al riesgo, en pacientes con hipertensión pulmonar clase funcional IV, la frecuencia de eventos adversos no fue mayor al compararse con pacientes en clase funcional II y III; los efectos del entrenamiento en estos pacientes son similares a los obtenidos en aquellos con mejor clase funcional con necesidad de reducir la intensidad del ejercicio para que sea tolerado y seguro. Es vital educar tanto al paciente como a su cuidador en cuanto a la enfermedad, y adicionalmente brindar soporte psicosocial y nutricional.

  6. Idiopathic pleural panniculitis with recurrent pleural effusion not associated with Weber-Christian disease

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    Laperuta Paolo

    2016-01-01

    Full Text Available A 82-year-old patient with dyspnea and a recurrent history of pleural effusion was admitted into our unit. He performed a Chest computed tomography showing right pleural effusion. Video-assisted thoracoscopy (VATS exploratory showed parietal pleural thickening of adipose tissue. The surgical procedure consisted, therefore, in the execution of multiple biopsies of the parietal pleura which appeared covered, on the whole surface, by islands of adipose tissue, without macroscopic pathological aspects. After the procedure was performed pleurodesis with talc. The definitive histological examination consisted of normal mesothelial cells surrounded by fatty tissue infiltrated by small lymphocytes in a patient without skin lesions or visceral or systemic signs of inflammatory involvement of the adipose tissue. We reported a rare case of idiopathic pleural panniculitis with recurrent pleural effusion not associated with Weber-Christian disease.

  7. Enfermedades pulmonares intersticiales en el niño

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    Roberto Razón Behar

    Full Text Available Las enfermedades pulmonares intersticiales en el niño, comprenden un gran y heterogéneo grupo de raras enfermedades difusas pulmonares de morbilidad variada. Se caracterizan por cambios inflamatorios y fibróticos que causan remodelación de las paredes alveolares y de las vías respiratorias distales, y ocasionan un defecto restrictivo funcional y una alteración en el intercambio gaseoso, con hipoxemia progresiva. Son muchas las enfermedades que pueden afectar al intersticio pulmonar y múltiples las formas etiológicas causadas por una variedad de procesos patológicos, que incluyen, factores genéticos, asociación a enfermedades sistémicas, así como a respuestas inflamatorias o fibróticas a diferentes estímulos. Sin embargo, algunas veces su origen es desconocido, y se catalogan entonces como idiopáticas. Los neumólogos pediátricos han tratado de clasificar los casos de las enfermedades pulmonares intersticiales en las diferentes categorías descritas originalmente en adultos, pero, en realidad, existen formas del adulto que no se observan en la infancia, y formas únicas de presentación pediátrica. Se señala la importancia del conocimiento de estas entidades, particularmente las de origen desconocido o idiopáticas.

  8. Estado actual del tratamiento del cáncer pulmonar

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    Dr. Clavero R. José Miguel

    2013-07-01

    Pese a la letalidad de esta neoplasia y el aumento de su incidencia a nivel mundial, los avances que se describen en el presente artículo permiten vislumbrar un mejor futuro para los pacientes con cáncer pulmonar.

  9. Pleural tuberculosis: A concise clinical review.

    Science.gov (United States)

    Shaw, Jane A; Irusen, Elvis M; Diacon, Andreas H; Koegelenberg, Coenraad F

    2018-05-01

    Tuberculosis (TB) is the leading infectious cause of death worldwide, and the commonest cause of death in people living with HIV. Globally, pleural TB remains one of the most frequent causes of pleural exudates, particularly in TB-endemic areas and in the HIV positive population. Most TB pleural effusions are exudates with high adenosine deaminase (ADA), lymphocyte-rich, straw-coloured and free flowing, with a low yield on mycobacterial culture. TB pleurisy can also present as loculated neutrophil-predominant effusions which mimic parapneumonic effusions. Rarely, they can present as frank TB empyema, containing an abundance of mycobacteria. Up to 80% of patients have parenchymal involvement on chest imaging. The diagnosis is simple if M. tuberculosis is detected in sputum, pleural fluid or biopsy specimens, and the recent advent of liquid medium culture techniques has increased the microbiological yield dramatically. Where the prevalence of TB is high the presence of a lymphocyte-predominant exudate with a high ADA has a positive predictive value of 98%. In low prevalence areas, the absence of an elevated ADA and lymphocyte predominance makes TB very unlikely, and pleural biopsy should be performed to confirm the diagnosis. Pleural biopsy for liquid culture and susceptibility testing must also be considered where the prevalence of drug resistant TB is high. Treatment regimens are identical to those administered for pulmonary TB. Initial pleural drainage may have a role in symptom relief and in hastening the resolution of the effusion. Surgical intervention may be required in loculated effusions and empyemas. © 2018 John Wiley & Sons Ltd.

  10. Evaluation of CT findings for diagnosis of pleural effusions

    International Nuclear Information System (INIS)

    Arenas-Jimenez, J.; Alonso-Charterina, S.; Fernandez-Latorre, F.; Gil-Sanchez, S.; Sanchez-Paya, J.; Lloret-Llorens, M.

    2000-01-01

    Computed tomography studies are usually used to assess patients with pleural effusions, and radiologists should be aware of the significance of different CT findings for the diagnosis of the effusion. The purpose of this study was to evaluate CT findings for etiological diagnosis of pleural effusions. Contrast-enhanced CT of the chest of 211 patients with pleural effusion of definite diagnosis were evaluated. The CT images were evaluated for the presence and extent of pleural effusion, thickening or nodules, extrapleural fat and other changes in the mediastinum or lung. The CT scans were read by two independent observers and correlation between them was evaluated. Comparison of CT findings between benign and malignant effusions, between exudates and transudates, and between empyemas and the other parapneumonic effusions were carried out. Kappa values for most CT findings were >0.85. Loculation, pleural thickening, pleural nodules, and extrapleural fat of increased density were only present in exudative effusions. Multiple pleural nodules and nodular pleural thickening were the only pleural findings limited to malignant pleural effusions. The signs were also more frequently seen in empyemas than in other parapneumonic effusions. Computed tomography findings can help to distinguish between transudates and exudates. Although there is some overlap between benign and malignant pleural effusions, pleural nodules and nodular pleural thickening were present almost exclusively in the latter. Although differences between CT findings of empyemas and the other parapneumonic effusions exist, there is no finding which can definitely differentiate between them. (orig.)

  11. [Sarcoidosis related pleural effusion: 6 case reports and literatures review].

    Science.gov (United States)

    Wang, Feng; Tong, Zhaohui; Wang, Zhen; Wang, Xiaojuan; Xu, Lili

    2015-02-01

    To summarize the clinical features and the diagnosis-treatment points of sarcoidosis related pleural effusion. Six typical sarcoidosis related pleural effusion cases with pathological evidence were reviewed, and the clinical data of these cases were retrospectively analyzed and the related literatures were reviewed. The literature review was carried out respectively with "sarcoidosis", "pleural disease" and "pleural effusion" as the keywords in CNKI and PubMed database by January 2014. Six cases, including 1 male and 5 females, with sarcoidosis related pleural effusions were reported. 3 cases had bilateral effusions, 2 cases had left effusion and 1 case had right effusion. The pleural effusion routine test had a low specificity, which demonstrated that the fluid was exudate and consisted with large number of lymphocytes. 3 of these cases were diagnosed by medical thoracoscopy. Medical thoracoscopy revealed that pleural involvement was variable with multiple nodulespresent in some cases and subtle change in others. A total of 28 literatures and 92 cases with pleural involvement in sarcoidosis were retrieved from CNKI and PubMed database (time range: 2004.1-2014.1), including 59 cases of pleural effusion, 29 cases of pleural thickening, 3 cases of pneumothorax and 1 case of nodules in pleura. Pleural involvement in sarcoidosis was often misdiagnosed or mistreated as tuberculous pleurisy because the routine tests regarding pleural effusion usually had a low specificity. Medical thoracoscopy could provide clinicians with important clues to assist differentiation of the cause for non-conclusive pleural effusion in this situation.

  12. Treatment of malignant pleural mesothelioma

    International Nuclear Information System (INIS)

    Yusa, Toshikazu

    2007-01-01

    In Japan, it is predicted that mesothelioma will rapidly increase in the future. Malignant pleural mesothelioma that accounts for approximately 90% of mesothelioma as a whole has a median survival time of approximately nine months which is considered a poor prognosis. As for the treatment of this disease, extrapleural pneumonectomy or pleurectomy/decortication are available for those patients who can be surgically operated on. However, since a complete cure rate is low when only surgical treatment is performed, generally a multimodality treatment is performed wherein chemotherapy and/or radiotherapy are combined. For chemotherapy, a large-scale randomized phase III study demonstrated that a treatment using two agents: pemetrexed, which is a new multitargeted antifolate, and cisplatin is effective. Pemetrexed will be the drug of first choice for mesothelioma in the future. As other treatment methods, chemohyperthermia, treatments using various kinds of cytokines and angiogenesis inhibitors, genetic treatment and photodynamic therapy have been attempted. The current treatment results for this disease are very poor, and there has been a strong demand for establishing an effective treatment method. (author)

  13. Coccidioidomicose pulmonar em caçador de tatus Pulmonary coccidioidomycosis in a armadillo hunter

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    FABRÍCIO ANDRÉ MARTINS DA COSTA

    2001-09-01

    Full Text Available A coccidioidomicose, uma doença fúngica adquirida através da inalação do agente Coccidioides immitis sob forma de artroconídio, vem sendo descrita desde 1892. Restringe-se principalmente a áreas de clima árido, solo alcalino e regiões de baixo índice pluviométrico. Não por acaso, a maioria dos casos descritos no Brasil ocorreu na região Nordeste. Relata-se o caso de um homem de 19 anos, imunocompetente, com queixa de dor pleural bilateral, febre, adinamia e tosse seca havia dois meses. A radiografia de tórax evidenciou múltiplos nódulos bilaterais. O paciente participava de caçadas a tatus (Dasypus novemcinctus e a pesquisa direta para fungos no escarro evidenciou Coccidioides sp. Tratado com anfotericina B, apresentou pneumotórax e insuficiência respiratória, indo a óbito. A biópsia pulmonar post mortem evidenciou Coccidioides immitis sob a forma de endósporos.Coccidioidomycosis is a disease caused by inhalation of arthrospores of the fungus Coccidioides immitis. It has been recognized as a clinical entity since 1892. It is related to activities that involves dust exposure. It is found in many regions of the western hemisphere with dry and alkaline soil. In Brazil it has been described almost exclusively in the Northeast region where drought periods may favor its growth in its soil. We report a case of fatal coccidioidomycosis, in an immunocompetent host, associated to the activity of armadillo hunting (Dasypus novemcynctus in a rural area of Ceará state.

  14. Infectious pleural effusion status and treatment progress

    Science.gov (United States)

    Yang, Wei; Zhang, Ze-Ming

    2017-01-01

    Pleural cavity infection continuously seriously threatens human health with continuous medical progress. From the perspective of pathophysiology, it can be divided into three stages: exudative stage, fibrin exudation and pus formation stage, and organization stage. Due to the pathogenic bacteria difference of pleural cavity infection and pulmonary infection, it is very important for disease treatment to analyze the bacteria and biochemical characteristics of the infectious pleural effusion. Most prognoses of patients have been relatively good, while for some patients, the complicated parapneumonic effusion or empyema could be evolved. Antibiotic treatment and sufficient drainage are the foundation for this treatment. No evidence can support the routine use of a fibrin agent. However, it has been reported that the plasminogen activator and deoxyribonuclease can be recommended to be applied in the pleural cavity. In case of failure on conservative medical treatment, operative treatment can be applied such as thoracoscopy and pleural decortication. According to the clinical characteristics of these patients, it is a key to research prognosis, as well as early evaluation and stratification, in the future. PMID:29268539

  15. Hypertrophic osteoarthropathy in association with pulmonary tuberculosis: a case report; Osteoartropatia hipertrofica associada a tuberculose pulmonar: relato de caso

    Energy Technology Data Exchange (ETDEWEB)

    Moreira, Luiza Beatriz Melo; Marchiori, Edson [Universidade Federal Fluminense, Niteroi, RJ (Brazil). Dept. de Radiologia]. E-mail: edmarchiori@zipmail.com.br; Melo, Alessandro Severo Alves de [Hospital Universitario Antonio Pedro, Niteroi, RJ (Brazil). Servico de Radiologia; Pinto, Ana Lucia de Araujo [Hospital Universitario Antonio Pedro, Niteroi, RJ (Brazil). Servico de Pneumologia; Monteiro, Nicolau Pedro [Universidade Federal Fluminense, Niteroi, RJ (Brazil). Dept. de Medicina Clinica

    2002-02-01

    In this article the authors report a case of a patient with hypertrophic osteoarthropathy associated with pulmonary tuberculosis. This disorder is a rare complication of tuberculosis and may be associated with severe and fulminant disease. The imaging methods used in the diagnosis of this disease included lower limbs radiographs that showed bilateral periosteal reaction, and chest radiographs and computed tomography that revealed a mass in the upper lobe of the right lung. Although a fine needle aspiration was suggestive of tuberculosis, the definitive diagnosis was made after thoracotomy and histopathological examination of the mass. The patient presented symptomatic and radiological improvement after treatment of tuberculosis. (author)

  16. Diphyllobothrium latum: relato de caso no Brasil

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    Emmel Vanessa Erichsen

    2006-01-01

    Full Text Available Difilobotriose é causada em humanos pela infecção com vermes adultos do gênero Diphyllobothrium adquiridos pelo consumo de peixe cru ou mal cozido. Diphyllobothrium latum foi confirmado pelo exame dos proglotes grávidos e típicos ovos operculados nas fezes. O paciente havia comido crustáceos e peixes. É o relato do primeiro brasileiro infectado.

  17. Evaluation of pleural disease using MR and CT: With special reference to malignant pleural mesothelioma

    International Nuclear Information System (INIS)

    Knuuttila, A.; Kivisaari, L.; Kivisaari, A.; Palomaeki, M.; Tervahartiala, P.; Mattson, K.

    2001-01-01

    Purpose: To evaluate MR imaging and CT in differentiating malignant pleural mesothelioma from other malignancies or benign pleural disease. Material and Methods: Thirty-four patients (18 pleural mesothelioma, 9 other malignancies, 7 benign pleural diseases) were examined using enhanced CT and MR. Two radiologists reviewed the CT and two others the MR images. Comparisons were made between the diagnostic groups and the imaging methods. Results: The abnormalities commonly found in malignant disease, but significantly less frequently in benign pleural disease, were focal thickening and enhancement of inter lobar fissures. In mesothelioma, enhancement of inter lobar fissures, tumour invasion of the diaphragm, mediastinal soft tissue or chest wall, were significantly more often observed than in other malignancies and MR was the most sensitive method. In other malignancies, invasion of bony structures was a more common finding and was also better shown by MR. The contrast-enhanced T1 fat-suppressed (CET1fs) sequence detected these features better than other MR sequences. Conclusion: MR, especially the CET1fs sequence in three planes, gave more information than enhanced CT. Focal thickening and enhancement of inter lobar fissures were early abnormalities indicating malignant pleural disease. MR could be clinically useful for differentiating mesothelioma from other pleural diseases

  18. Evaluation of pleural disease using MR and CT: With special reference to malignant pleural mesothelioma

    Energy Technology Data Exchange (ETDEWEB)

    Knuuttila, A. [Helsinki Univ. Central Hospital (Finland). Dept. of Medicine; Kivisaari, L.; Kivisaari, A.; Palomaeki, M.; Tervahartiala, P. [Helsinki Univ. Central Hospital (Finland). Dept. of Radiology; Mattson, K. [Helsinki Univ. Central Hospital (Finland). Dept. of Medicine

    2001-09-01

    Purpose: To evaluate MR imaging and CT in differentiating malignant pleural mesothelioma from other malignancies or benign pleural disease. Material and Methods: Thirty-four patients (18 pleural mesothelioma, 9 other malignancies, 7 benign pleural diseases) were examined using enhanced CT and MR. Two radiologists reviewed the CT and two others the MR images. Comparisons were made between the diagnostic groups and the imaging methods. Results: The abnormalities commonly found in malignant disease, but significantly less frequently in benign pleural disease, were focal thickening and enhancement of inter lobar fissures. In mesothelioma, enhancement of inter lobar fissures, tumour invasion of the diaphragm, mediastinal soft tissue or chest wall, were significantly more often observed than in other malignancies and MR was the most sensitive method. In other malignancies, invasion of bony structures was a more common finding and was also better shown by MR. The contrast-enhanced T1 fat-suppressed (CET1fs) sequence detected these features better than other MR sequences. Conclusion: MR, especially the CET1fs sequence in three planes, gave more information than enhanced CT. Focal thickening and enhancement of inter lobar fissures were early abnormalities indicating malignant pleural disease. MR could be clinically useful for differentiating mesothelioma from other pleural diseases.

  19. Secretion of intelectin-1 from malignant pleural mesothelioma into pleural effusion.

    Science.gov (United States)

    Tsuji, S; Tsuura, Y; Morohoshi, T; Shinohara, T; Oshita, F; Yamada, K; Kameda, Y; Ohtsu, T; Nakamura, Y; Miyagi, Y

    2010-08-10

    Malignant pleural mesothelioma (MPM) is a rare but fatal tumour. Although most MPM patients show pleural effusion at even the early stage, it is hard to diagnose as MPM at the early stage because a sensitive and reliable diagnostic marker for MPM has not been found in plasma or pleural effusion. In this study, we investigated whether intelectin-1 was specifically contained in MPM cells and the pleural effusion of MPM patient by immunohistochemistry, western blotting, and enzyme-linked immunosorbent assay. Malignant pleural mesothelioma cell lines, but not lung adenocarcinoma cell lines, secreted intelectin-1. In immunohistochemistry, epithelioid-type MPMs, but neither pleura-invading lung adenocarcinomas nor reactive mesothelial cells near the lung adenocarcinomas, were stained with anti-intelectin antibodies. Pleural effusion of MPM patients contained a higher concentration of intelectin-1 than that of lung cancer patients. These results suggest that detection of intelectin-1 may be useful for a differential diagnosis of epithelioid-type MPM in immunohistochemistry and that a high concentration of intelectin-1 in pleural effusion can be used as a new marker for clinical diagnosis of MPM.

  20. Predictive Factors and Treatment Outcomes of Tuberculous Pleural Effusion in Patients With Cancer and Pleural Effusion.

    Science.gov (United States)

    Lee, Jaehee; Lee, Yong Dae; Lim, Jae Kwang; Lee, Deok Heon; Yoo, Seung Soo; Lee, Shin Yup; Cha, Seung Ick; Park, Jae Yong; Kim, Chang Ho

    2017-08-01

    Patients with cancer are at an increased risk of tuberculosis. As pleural effusion has great clinical significance in patients with cancer, the differential diagnosis between tuberculous pleural effusion (TPE) and malignant pleural effusion (MPE) is important. However, the predictive factors and treatment outcomes of TPE in patients with cancer have rarely been studied. Confirmed TPE cases identified at cancer diagnosis and during anticancer management from 2008-2015 were retrospectively investigated. Patients in the study included coexisting TPE and cancer (n = 20), MPE (n = 40) and TPE without cancer (n = 40). Control groups were patients with MPE, and patients with TPE without cancer. Clinical, laboratory and pleural fluid characteristics were compared among groups. Treatment outcomes were compared between patients with TPE with and without cancer. In the final analysis, serum C-reactive protein (S-CRP) ≥3.0mg/dL and pleural fluid adenosine deaminase (ADA) ≥40U/L were independent predictors for identifying TPE in patients with cancer having pleural effusion. The combination of S-CRP with pleural fluid ADA using an "or" rule achieved a sensitivity of 100%, whereas both parameters combined in an "and" rule had a specificity of 98%. Treatment outcomes were not different between the TPE groups with and without cancer. S-CRP and pleural fluid ADA levels may be helpful for predicting TPE in patients with cancer with pleural effusion. The combination of these biomarkers provides better information for distinguishing between TPE and MPE in these patients. Treatment outcomes of TPE in patients with cancer are comparable to those in patients without cancer. Copyright © 2017 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.

  1. Ultrassom pulmonar em pacientes críticos: uma nova ferramenta diagnóstica Lung ultrasound in critically ill patients: a new diagnostic tool

    Directory of Open Access Journals (Sweden)

    Felippe Leopoldo Dexheimer Neto

    2012-04-01

    Full Text Available A avaliação pulmonar através do ultrassom é um tema de crescente interesse na avaliação de pacientes críticos, muitas vezes aplicado por não radiologistas. Como essa técnica baseia-se no fato de que todas as agressões agudas reduzem a aeração pulmonar, o ultrassom pulmonar pode fornecer informações complementares ao exame físico e à impressão clínica, com a principal vantagem de ser realizado à beira do leito. O objetivo dessa revisão foi avaliar as aplicações clínicas do ultrassom pulmonar, através da pesquisa das bases de dados PubMed e Biblioteca Virtual em Saúde dos seguintes termos, em português e em inglês: ultrassom, pulmão e cuidados críticos. Além dos artigos mais relevantes, estendeu-se a busca a livros especializados. Dados da literatura mostram que o ultrassom pulmonar é útil na interpretação de infiltrados pulmonares, tendo boa acurácia na identificação de consolidações e de síndrome intersticial. Além disso, ultrassom pulmonar tem sido amplamente utilizado na avaliação e abordagem de derrames pleurais, assim como na identificação de pneumotórax. Essa técnica pode também ser útil na avaliação imediata de pacientes com dispneia ou insuficiência respiratória aguda. Outras aplicações descritas são a monitorização da resposta ao tratamento e o aumento da segurança na realização de procedimentos invasivos. Embora ainda haja a necessidade de uma padronização dos critérios de treinamento e certificação, esse é um método rápido, barato e amplamente disponível, e a incorporação dessa nova tecnologia deve tornar-se progressivamente maior no cuidado de doentes críticos.The evaluation of critically ill patients using lung ultrasound, even if performed by nonspecialists, has recently garnered greater interest. Because lung ultrasound is based on the fact that every acute illness reduces lung aeration, it can provide information that complements the physical examination and

  2. Radionuclide Peritoneal Scintigraphy in Patients with Ascites and Pleural Effusion

    International Nuclear Information System (INIS)

    Lee, Jae Tae; Lee, Kyu Bo; Whang, Kee Suk; Kim, Gwang Won; Chung, Byung Chun; Cho, Dong Kyu; Chung, Joon Mo

    1990-01-01

    Simultaneous presence of ascites and pleural effusion has been documented in patients with cirrhosis of the liver, renal disease, Meigs' syndrome and in patients undergoing peritoneal dialysis. Mechanisms proposed in the formation of pleural effusion in most of the above diseases are lymphatic drainage and diaphragmatic defect. But sometimes, hepatic hydrothoraxes in the absence of clinical ascites and pleural effusion secondary to pulmonary or cardiac disease are noted. It is not always possible to differentiate between pleural effusion caused by transdiaphragmatic migration of ascites and by other causes based solely on biochemical analysis. Authors performed radionuclide scintigraphy after intraperitoneal administration of 99m Tc-labeled colloid in 23 patients with both ascites and pleural effusion in order to discriminate causative mechanisms responsible for pleural effusion. Scintigraphy demonstrated the transdiaphtagmatic flow of fluid from the peritoneum to pleural cavities in 13 patients correctly. In contrast, in 5 patients with pleural effusion secondary to pulmonary, pleural and cardiac diseases, radiotracers fail to traverse the diaphragm and localize in the pleural space. Ascites draining to mediastinal lymph nodes and blocked passage of lymphatic drainage were also clarified, additionally. Conclusively, radionuclide peritoneal scintigraphy is an accurate, rapid and easy diagnostic tool in patients with both ascites and pleural effusion. It enables the causes of pleural effusion to be elucidated, as well as providing valuable information required when determining the appropriate therapy.

  3. A case of young woman with recurrent right pleural effusion

    OpenAIRE

    Mehta, Asmita A; Gupta, Amit; Venkitakrishnan, Rajesh

    2015-01-01

    Endomterisois is usually found in women of child-bearing age. A case is presented of massive right-sided pleural effusion caused by endometriosis. The final diagnosis was made by thoracoscopic pleural biopsy. Physicians should be aware of this potentially treatable cause of pleural effusion having excluded other possibilities such as malignancy and tuberculosis.

  4. A case of young woman with recurrent right pleural effusion

    Directory of Open Access Journals (Sweden)

    Asmita A Mehta

    2015-01-01

    Full Text Available Endomterisois is usually found in women of child-bearing age. A case is presented of massive right-sided pleural effusion caused by endometriosis. The final diagnosis was made by thoracoscopic pleural biopsy. Physicians should be aware of this potentially treatable cause of pleural effusion having excluded other possibilities such as malignancy and tuberculosis.

  5. A case of young woman with recurrent right pleural effusion.

    Science.gov (United States)

    Mehta, Asmita A; Gupta, Amit; Venkitakrishnan, Rajesh

    2015-01-01

    Endomterisois is usually found in women of child-bearing age. A case is presented of massive right-sided pleural effusion caused by endometriosis. The final diagnosis was made by thoracoscopic pleural biopsy. Physicians should be aware of this potentially treatable cause of pleural effusion having excluded other possibilities such as malignancy and tuberculosis.

  6. Thoracic computed tomography in patients with suspected malignant pleural effusions

    International Nuclear Information System (INIS)

    Traill, Zoee C.; Davies, Robert J.O.; Gleeson, Fergus V.

    2001-01-01

    AIM: To assess the role of contrast-enhanced computed tomography (CT) prospectively in patients with suspected malignant pleural effusions. MATERIALS AND METHODS: Forty consecutive patients referred for the investigation of a suspected malignant pleural effusion had contrast-enhanced thoracic CT, thoracoscopy, thoraco-centesis and pleural biopsy, either percutaneously or at thoracoscopy. Final diagnoses were based on histopathological or cytological analysis (n = 30), autopsy findings (n = 3) or clinical follow-up (n = 7). The pleural surfaces were classified at contrast-enhanced CT as normal or abnormal and, if abnormal, as benign or malignant in appearance using previously established CT criteria for malignant pleural thickening by two observers unaware of the pathological diagnosis. RESULTS: Pleural effusions were malignant in 32 patients and benign in eight patients. Pleural surfaces assessed at CT showed features of malignancy in 27 out of 32 patients with a malignant effusion (sensitivity 84%, specificity 100%). Overall, CT appearances indicated the presence of malignancy in 28 of 32 (87%) patients. All eight patients with benign pleural disease were correctly diagnosed by CT. CONCLUSION: Contrast-enhanced CT is of value in patients with suspected malignant pleural effusions. The previously established criteria for malignant pleural thickening of nodularity, irregularity and pleural thickness >1 cm are reliable in the presence of a pleural effusion. Traill, Z.C. et al. (2001)

  7. External radiotherapy in a pleural mesothelioma tumor

    International Nuclear Information System (INIS)

    Fernandez, M.C.; Garcia, J.L.; Gomez, A.; Simon, J.L.; Maillo, M.; Jimenez Torres, M. J.

    1994-01-01

    Pleural mesothelioma is an uncommon tumor compared with other thoracic malignancies and a 80% of the cases have asbestos exposure. From 1983 to 1992 we have examined patients suffering from malignant pleural mesothelioma treated with external radiotherapy. We treated 11 patients of which 9 were males and 2 were females. The most frequent symptom was the chest pain and all these patients underwent a torascoscopy followed by a pleasured. Of the 11 cases: 10 were malignant epithelial mesothelioma and 1 was a mixed pleural case. Afterwards, they were treated with external radiotherapy between 30 and 55 Gy, with few complications. At the moment, 5 patients are still alive and there is a survival rate of 50% at 24 and 60 months and of 25% at 120 months. We think that external radiotherapy is a good palliative treatment with few complications. (Author) 28 refs

  8. Novel therapies for malignant pleural mesothelioma.

    Science.gov (United States)

    Scherpereel, Arnaud; Wallyn, Frederic; Albelda, Steven M; Munck, Camille

    2018-03-01

    Malignant pleural mesothelioma is a rare cancer that is typically associated with exposure to asbestos. Patients with malignant pleural mesothelioma have poor outcomes with suboptimal therapeutic options and currently no treatment is curative. The standard frontline treatment, cisplatin plus pemetrexed chemotherapy, has only short and insufficient efficacy, and no validated treatment beyond first-line therapy is available. New therapeutic strategies are therefore needed. The addition of bevacizumab (an anti-VEGF antibody) combined with cisplatin plus pemetrexed has shown some promise. However, immunotherapy, especially immune checkpoint inhibitors, has generated a lot of excitement because of data suggesting the potential value of immune checkpoint inhibitors for patients who have failed chemotherapy. In this Review, we describe immune checkpoint inhibitors, other immunotherapies, targeted therapies, or combinations of novel drugs being investigated in malignant pleural mesothelioma, as well as the issues surrounding the selection of the best candidates for these treatments. Copyright © 2018 Elsevier Ltd. All rights reserved.

  9. Polycystic liver disease with right pleural effusion

    Science.gov (United States)

    Anggreini, A. Y.; Dairi, L. B.

    2018-03-01

    Polycystic liver disease (PCLD) is a condition in which multiple cysts form in the hepatic parenchyma. The polycystic liver disease is also an autosomal dominant disorder (ADPLD) caused by a mutation in a gene that encodes a protein hepatocystin. PCLD has a prevalence count of 1:200,000 people in the people of America. PCLD occurs ± 24% of patients in the third decade of age to 80% by the sixth decade. Women tend to get larger cysts and more and correlated with the number of pregnancies. The following case report of a woman, 51-years-old who was treated at Haji Adam Malik hospital Medan with a diagnosis of polycystic liver disease with right pleural effusion. Some literature has reported complications of the polycystic liver disease but rarely reported with pleural effusion presentation. The patient had already undergone a puncture of pleural fluid and after three weeks of treatment condition of the patient improved and permitted to be outgoing patient.

  10. Imaging of small amounts of pleural fluid. Part two - physiologic pleural fluid

    International Nuclear Information System (INIS)

    Kocijancic, I.

    2006-01-01

    Background. There are only a few articles reporting the possibility of radiographic and sonographic detection of physiologic pleural fluid in healthy individuals. In the last decade the advent of sonographic equipments enables the detection of small amounts of physiologic pleural fluid in about 20% of healthy individuals. In certain physiologic conditions (i.e. pregnancy) the physiologic pleural fluid could be detected more frequently by chest ultrasonography. Conclusions. A positive result, if detected, should not be taken as a sign of the occult thoracic disease. (author)

  11. A rare cause of pleural effusion: ruptured primary pleural hydatid cyst.

    Science.gov (United States)

    Erkoç, Mustafa Fatih; Öztoprak, Bilge; Alkan, Sevil; Okur, Aylin

    2014-03-06

    Hydatidosis is an endemic parasitic disease in Mediterranean countries, often caused by the dog tapeworm Echinococcus granulosus. The disease predominantly affects the liver (60-70%) and lungs (30%), and the surgical management is considered as the gold standard for treatment. Besides anaphylactic reactions, the most frequent complication of the hydatid disease is rupture into neighbouring structures, often affecting the bronchi, gastrointestinal tract and peritoneal/pleural cavities, according to its location. Primary pleural hydatidosis is an extremely rare entity and we present a ruptured pleural hydatid cyst with unusual location.

  12. [Molecular heterogeneity of malignant pleural mesotheliomas].

    Science.gov (United States)

    Tranchant, Robin; Montagne, François; Jaurand, Marie-Claude; Jean, Didier

    2018-01-01

    Malignant pleural mesothelioma (MPM) is predominantly an occupational cancer, most often linked to asbestos exposure. Malignant pleural mesothelioma prognosis is poor with a short survival median, due to the aggressiveness of tumor cells and the weak efficiency of conventional anti-cancer therapies. Clinical, histological, and molecular data suggest tumor heterogeneity between patients as it was also shown for other cancer types. Consequently, there is an urgent need to develop new therapies that take into account this heterogeneity and the molecular characteristics of malignant pleural mesothelioma, in particular by identifying new anti-cancer drugs targeting the molecular specificities of each malignant pleural mesothelioma. Malignant pleural mesothelioma is characterized by numerous molecular alterations at the chromosomal, genetic and epigenetic levels. Molecular classification based on gene expression profile has firstly defined two tumor groups, C1 and C2, and more recently, four groups. By integrating genetic and transcriptomic analysis, a C2 LN tumor subgroup of the C2 group has been identified and characterized. In addition to tumor heterogeneity between patients, intra-tumor heterogeneity is supported by several evidences. Most therapeutic strategies that take into account the tumor molecular characteristics have focused on targeted therapies based on mutated genes. A more appropriate strategy would be to consider better-defined tumor groups on the basis of several molecular alterations types as it has been proposed for the C2 LN subgroup. A robust definition of homogeneous tumor groups sharing common molecular characteristics is necessary for the development of effective precision medicine for malignant pleural mesothelioma. Copyright © 2017 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

  13. Tuberculous pleural effusions: advances and controversies

    Science.gov (United States)

    Allwood, Brian W.; Diacon, Andreas H.; Koegelenberg, Coenraad F. N.

    2015-01-01

    On a global scale, tuberculosis (TB) remains one of the most frequent causes of pleural effusions. Our understanding of the pathogenesis of the disease has evolved and what was once thought to be an effusion as a result of a pure delayed hypersensitivity reaction is now believed to be the consequence of direct infection of the pleural space with a cascade of events including an immunological response. Pulmonary involvement is more common than previously believed and induced sputum, which is grossly underutilised, can be diagnostic in approximately 50%. The gold standard for the diagnosis of tuberculous pleuritis remains the detection of Mycobacterium tuberculosis in pleural fluid, or pleural biopsy specimens, either by microscopy and/or culture, or the histological demonstration of caseating granulomas in the pleura along with acid fast bacilli (AFB). In high burden settings, however, the diagnosis is frequently inferred in patients who present with a lymphocytic predominant exudate and a high adenosine deaminase (ADA) level, which is a valuable adjunct in the diagnostic evaluation. ADA is generally readily accessible, and together with lymphocyte predominance justifies treatment initiation in patients with a high pre-test probability. Still, false-negative and false-positive results remain an issue. When adding closed pleural biopsy to ADA and lymphocyte count, diagnostic accuracy approaches that of thoracoscopy. The role of other biomarkers is less well described. Early pleural drainage may have a role in selected cases, but more research is required to validate its use and to define the subpopulation that may benefit from such interventions. PMID:26150911

  14. Pleural Empyema due to Group D Salmonella

    Directory of Open Access Journals (Sweden)

    Jennifer C. Kam

    2012-01-01

    Full Text Available Non-typhi Salmonella normally presents as a bacteremia, enterocolitis, and endovascular infection but rarely manifests as pleuropulmonary disease. We present a case of a 66-year-old female with underlying pulmonary pathology, secondary to an extensive smoking history, who presented with a left-sided pleural effusion. The causative agent was identified as being group D Salmonella. Decortication of the lung was performed and the patient was discharged on antibiotics with resolution of her symptoms. This case helps to support the inclusion of Salmonella group D as a possible etiological agent of infection in the differential causes of exudative pleural effusions.

  15. Malignant pleural mesothelioma in a nuclear engineer

    International Nuclear Information System (INIS)

    Huncharek, M.

    1988-01-01

    Malignant pleural mesothelioma accounts for a large proportion of deaths among occupational cohorts exposed to asbestos. Of particular interest are recent reports of a high risk of mesothelioma among occupational groups previously thought to be at low risk for developing this neoplasm. In the present report we present a case of pleural mesothelioma associated with bystander exposure to asbestos in a nuclear engineer. To our knowledge, this is the first report of the disease occurring in a member of this occupational group after work related exposure to asbestos. (author)

  16. CT Scan-Guided Abrams' Needle Pleural Biopsy versus Ultrasound-Assisted Cutting Needle Pleural Biopsy for Diagnosis in Patients with Pleural Effusion: A Randomized, Controlled Trial.

    Science.gov (United States)

    Metintas, Muzaffer; Yildirim, Huseyin; Kaya, Tamer; Ak, Guntulu; Dundar, Emine; Ozkan, Ragip; Metintas, Selma

    2016-01-01

    Image-guided pleural biopsies, both using ultrasound (US) or computed tomography (CT), are important in the diagnosis of pleural disease. However, no consensus exists regarding which biopsy needles are appropriate for specific procedures. In this randomized, prospective study, we aimed to compare CT scan-guided pleural biopsy using an Abrams' needle (CT-ANPB) with US-assisted pleural biopsy using a cutting needle (US-CNPB) with respect to both diagnostic yield and safety. Between February 2009 and April 2013, 150 patients with exudative pleural effusion who could not be diagnosed by cytological analysis were included in the study. The patients were randomized into either the US-CNPB group or the CT-ANPB group. The two groups were compared in terms of diagnostic sensitivity and complications. Of the 150 patients enrolled in this study, 45 were diagnosed with malignant mesothelioma, 46 were diagnosed with metastatic pleural disease, 18 were diagnosed with pleural tuberculosis, 34 were diagnosed with benign pleural disease, and 7 were lost to follow-up. In the US-CNPB group, the diagnostic sensitivity was 66.7%, compared with 82.4% in the CT-ANPB group; the difference between the two groups was statistically significant (p = 0.029). The sensitivity of CT-ANPB increased to 93.7% for patients with a pleural thickness ≥1 cm. The complication rates were low and acceptable. The first diagnostic intervention that should be preferred in patients with pleural effusion and associated pleural thickening on a CT scan is CT-ANPB. US-CNPB should be used primarily in cases for which only pleural thickening but no pleural effusion is noted. © 2016 S. Karger AG, Basel.

  17. Estado del arte en hipertensión pulmonar y cateterismo cardiaco derecho

    Directory of Open Access Journals (Sweden)

    Rubén Dueñas V.

    2017-09-01

    Full Text Available La definición universalmente aceptada de hipertensión pulmonar corresponde a todos los pacientes con presión arterial pulmonar media igual o mayor a 25 mm Hg en reposo, medida por cateterismo cardíaco derecho, sin olvidar que la presión promedio normal de la arteria pulmonar es de máximo 20 mm Hg, lo cual obliga a seguir a los pacientes con presión arterial pulmonar media entre 20 y 24 mm Hg. También cabe recordar ser claros al diferenciar entre hipertensión pulmonar e hipertensión arterial pulmonar. La hipertensión pulmonar incluye cinco grupos, entre los cuales la hipertensión arterial pulmonar constituye el grupo 1. El concepto de hipertensión arterial pulmonar inducida por el ejercicio puede definirse como todos los pacientes con presión arterial pulmonar por encima de los 30 mm Hg a un gasto cardíaco menor de 10 l, o una resistencia pulmonar total de más de 3 unidades Wood. La hipertensión pulmonar inducida por el ejercicio es un campo de investigación hasta ahora poco explorado. La clasificación continúa con los cinco grupos, y es dinámica de acuerdo con el progreso en entender la fisiopatología de cada enfermedad.

  18. Evaluation of pleural and pericardial effusions by magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Tscholakoff, D.; Sechtem, U.; De Geer, G.; Schmidt, H.; Higgins, C.B.

    1987-08-01

    MR examinations of 36 patients with pleural and/or pericardial effusions were retrospectively evaluated. The purpose of this study was to determine of MR imaging is capable of differentiating between pleural and pericardial effusions of different compositions using standard electrocardiogram (ECG)-gated and nongated spin echo pulse sequences. Additional data was obtained from experimental pleural effusions in 10 dogs. The results of this study indicate that old haemorhages into the pleural or pericardial space can be differentiated from other pleural or pericardial effusions. However, further differentiation between transudates, exudates and sanguinous effusions is not possible on MR images acquired with standard spin echo pulse sequences. (orig./MG)

  19. ACTOS DE HABLA EN RELATOS DE TRADICION ORAL*: Notas sobre un relato oral cusqueño

    OpenAIRE

    Espino Relucé, Gonzalo

    2014-01-01

    En este artículo se explora el comportamiento de los hablantes dela construcción de relatos orales a partir del texto Saqsaywaman, recogido por el autor en Cusco. Se propone una categoría operativa sobrelos actos del habla haciéndose lo propio con relatos orales. Se transcribe Saqsaywaman y se analiza el texto.

  20. Metastização pulmonar de neoplasia da mama

    Directory of Open Access Journals (Sweden)

    Jorge Dionísio

    2002-03-01

    Full Text Available RESUMO: Para caracterizar os doentes com metastização pulmonar de neoplasia da mama, procedemos a um estudo retrospectivo dos processos de 129 doentes referenciados à Unidade de Pneumologia entre Julho de 1990 e Janeiro de 2000.Foi considerada a existência de metastização pulmonar em 89 casos.Avaliámos as manifestações clínicas apresentadas, o intervalo de tempo até ao diagnóstico de metastização pulmonar, os aspectos radiológicos, endoscópicos, as terapêuticas efectuadas e a sobrevida.O intervalo médio entre o diagnóstico da neoplasia da mama e o diagnóstico de metastização pulmonar foi de 81,9±5,7 meses. Os sintomas respiratórios foram referidos em 83,1% dos doentes. O padrão radiológico mais comum foi a presença de massas ou nódulos pulmonares (66,3%. Foram observadas 49 com sinais directos de neoplasia na broncofibroscopia. Em 47 os aspectos anatomopatológicos encontrados foram compatíveis com metastização endobrônquica de tumor da mamaO tratamento mais frequentemente utilizado após o diagnóstico de metástase pulmonar foi a quimioterapia, em 60,2% dos casos.Após o diagnóstico de metastização, a sobrevida mediana foi de 20,1 meses, com 63,4% dos doentes vivos ao fim de 1 ano.Nos doentes com carcinoma da mama e suspeita de metastização verificámos um grande intervalo livre entre o diagnóstico do tumor da mama e o aparecimento de metastização. Os sintomas respiratórios tra-duziram a grande frequência de envolvimento endobrônquico. O diagnóstico anatomopatológico de metastização pulmonar foi obtido em 52,8% dos doentes. A terapêutica mais utilizada após diagnóstico de metastização foi a quimioterapia e a sobrevida ao ano foi de 63,4%.REV PORT PNEUMOL 2002; VIII (2: ABSTRACT: We performed a retrospective study of 129 patients observed in Pneumology unit between July 1990 and January 2000 to evaluate the clinical, radiological and endoscopic patterns as well as the clinical evolution of

  1. CT diagnosis of pleural dissemination without pleural effusion in primary lung cancer

    International Nuclear Information System (INIS)

    Murayama, Sadayuki; Murakami, Junji; Yoshimitsu, Kengo; Torii, Yoshikuni; Masuda, Kouji; Ishida, Teruyoshi.

    1996-01-01

    We retrospectively reviewed the CT scans of 25 primary lung cancers with disseminated pleural nodules or minimal malignant pleural effusion that were not recognized preparatively. Special attention was devoted to abutting interlobar fissures, thick major fissures, and disseminated nodules on the chest wall, the diaphragm, and in the interlobar fissures. Among 10 primary tumors abutting interlobar fissures, nine (90%) had at least one of these findings. Among 15 primary lung tumors which did not abut interlobar fissures, four (27%) had at least one of these findings. We conclude that CT is a useful modality for detecting the pleural dissemination of primary lung cancers when primary lung cancers abut interlobar fissures even if no pleural effusion is detectable on CT. (author)

  2. Trasplante pulmonar: experiencia en clínica las condes

    Directory of Open Access Journals (Sweden)

    C. María Teresa Parada, Dra

    2010-03-01

    Hace 10 años Clínica Las Condes inicia su programa de trasplante pulmonar el que ha sido pionero nacional en número de injertos realizados y resultados obtenidos a largo plazo. Se realiza una revisión de las indicaciones, complicaciones precoces y tardías, capacidad física posterior al trasplante y sobrevida alejada de los pacientes trasplantados de pulmón en nuestro programa.

  3. Patología de la tuberculosis pulmonar.

    OpenAIRE

    FERRUFINO, JC

    2013-01-01

    Este artículo trata sobre la patología de la tuberculosis pulmonar desde el momento del ingreso del bacilo de Koch a los pulmones del paciente. Para ello se ha dividido en dos partes. La primera se ocupa de algunos aspectos de la inmunopatología de esta enfermedad y en la segunda se desarrolla los diferentes periodos en la evolución natural de este mal.

  4. Detection, modeling and matching of pleural thickenings from CT data towards an early diagnosis of malignant pleural mesothelioma

    Science.gov (United States)

    Chaisaowong, Kraisorn; Kraus, Thomas

    2014-03-01

    Pleural thickenings can be caused by asbestos exposure and may evolve into malignant pleural mesothelioma. While an early diagnosis plays the key role to an early treatment, and therefore helping to reduce morbidity, the growth rate of a pleural thickening can be in turn essential evidence to an early diagnosis of the pleural mesothelioma. The detection of pleural thickenings is today done by a visual inspection of CT data, which is time-consuming and underlies the physician's subjective judgment. Computer-assisted diagnosis systems to automatically assess pleural mesothelioma have been reported worldwide. But in this paper, an image analysis pipeline to automatically detect pleural thickenings and measure their volume is described. We first delineate automatically the pleural contour in the CT images. An adaptive surface-base smoothing technique is then applied to the pleural contours to identify all potential thickenings. A following tissue-specific topology-oriented detection based on a probabilistic Hounsfield Unit model of pleural plaques specify then the genuine pleural thickenings among them. The assessment of the detected pleural thickenings is based on the volumetry of the 3D model, created by mesh construction algorithm followed by Laplace-Beltrami eigenfunction expansion surface smoothing technique. Finally, the spatiotemporal matching of pleural thickenings from consecutive CT data is carried out based on the semi-automatic lung registration towards the assessment of its growth rate. With these methods, a new computer-assisted diagnosis system is presented in order to assure a precise and reproducible assessment of pleural thickenings towards the diagnosis of the pleural mesothelioma in its early stage.

  5. Indwelling pleural drain for mobile management of malignant pleural effusion-combining benefits of both methods

    OpenAIRE

    Dinesh Mehta; Anshu Gupta; Sameer Singhal; Sachin Bansal

    2015-01-01

    Malignant pleural effusion is a leading cause of morbidity in lung cancer patients requiring repeated pleural aspirations or persistent intercostal drainage tube. Using an indigenous method of putting icd tube of smaller size with subcutaneous tunneling would allow draining fluid from lungs easily and painlessly when needed and avoid the need for repeated injections and chest tube insertion every time the fluid is to be drained.

  6. Indwelling pleural drain for mobile management of malignant pleural effusion-combining benefits of both methods

    Directory of Open Access Journals (Sweden)

    Dinesh Mehta

    2015-01-01

    Full Text Available Malignant pleural effusion is a leading cause of morbidity in lung cancer patients requiring repeated pleural aspirations or persistent intercostal drainage tube. Using an indigenous method of putting icd tube of smaller size with subcutaneous tunneling would allow draining fluid from lungs easily and painlessly when needed and avoid the need for repeated injections and chest tube insertion every time the fluid is to be drained.

  7. RADIODIAGNOSIS OF PLEURAL LESIONS WITH USG AND CT SCAN

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    Bheemashanker

    2017-09-01

    Full Text Available BACKGROUND Ultrasound is easy available, less expensive study. It differentiates pleural effusion, consolidation and masses. CT scores in diagnosing early pleural lesions and helps in localising lesions differentiating benign and malignant. The aim of the study is to- 1. Assess the value of ultrasonography and computed tomography in evaluation of pleural lesions. 2. Determine the sensitivity and specificity of ultrasound and CT in pleural lesions. MATERIALS AND METHODS The present study was aimed at assessing the value of ultrasonography and CT in evaluating the pleural lesions. In our study, during the period of 12 months, 100 patients with pleural effusions were evaluated. The most common cause was transudate. Exudates consist of malignant and non-malignant causes. RESULTS The study group was defined into two groups- Malignant and non-malignant group based on pleural effusion of transudate and exudate types. CT and ultrasound has success rate of 100% and 85% respectively to identify neoplastic and non-neoplastic disease. Diagnostic accuracy of CT and ultrasound are comparable while CT scores over ultrasound in failed cases. CT has 100% sensitivity and 100% specificity in pleural lesions. CT has more therapeutic value compared to ultrasound. CONCLUSION The role of ultrasound and CT are complimentary, give high yield of positive results for pleural mass differentiation; useful for guided procedures like pleural biopsy and pleural drainage. Combined study not only useful for localisation of lesion, but also gives information about the extent of disease and characterising the tissue density by analysis of attenuation coefficient.

  8. Distribution of pleural effusion associated with ascites on abdominal CT

    Energy Technology Data Exchange (ETDEWEB)

    Bae, In Young; Park, Chan Sup; Yeon, Jae Woo; Jeon, Yong Sun; Choi, Sung Kyu; Chung, Won Kyun [Inha Univ. Hospital, Songnam (Korea, Republic of)

    1997-04-01

    To determine through an analysis of the location of pleural effusion associated with ascites, as seen on abdominal CT scan, differences in the distribution of pleural effusion according to the etiology and distribution of ascites. We retrospectively evaluated 77 consecutive patients in whom abdominal CT scan revealed pleural effusion associated with ascites. Patients with history of surgery or trauma and those with clinically and radiologically diagnosed lung or pleural diseases were excluded. We compared the location of pleural effusion with the etiology and distribution of ascites. Forty-two patients were suffering from hepatobiliary diseases, mainly right dominant pleural effusion (26/42, 62%). Fourteen had intraperitoneal carcinomatosis with no significant difference between the frequency of right dominant (5/14, 36%) and of left dominant (6/14, 43%) pleural effusion. Eleven patients had pancreatic diseases, with mainly left dominant pleural effusion (6/11, 55%). Patients with right dominant ascites usually had right dominant pleural effusion (22/24, 92%) and those with left dominant ascites had left dominant pleural effusion (9/10, 90%). Ascites-associated pleural effusion correlated with the anatomical location of the etiology of ascites; its laterality was, in addition, usually the same as that of ascites.

  9. Distribution of pleural effusion associated with ascites on abdominal CT

    International Nuclear Information System (INIS)

    Bae, In Young; Park, Chan Sup; Yeon, Jae Woo; Jeon, Yong Sun; Choi, Sung Kyu; Chung, Won Kyun

    1997-01-01

    To determine through an analysis of the location of pleural effusion associated with ascites, as seen on abdominal CT scan, differences in the distribution of pleural effusion according to the etiology and distribution of ascites. We retrospectively evaluated 77 consecutive patients in whom abdominal CT scan revealed pleural effusion associated with ascites. Patients with history of surgery or trauma and those with clinically and radiologically diagnosed lung or pleural diseases were excluded. We compared the location of pleural effusion with the etiology and distribution of ascites. Forty-two patients were suffering from hepatobiliary diseases, mainly right dominant pleural effusion (26/42, 62%). Fourteen had intraperitoneal carcinomatosis with no significant difference between the frequency of right dominant (5/14, 36%) and of left dominant (6/14, 43%) pleural effusion. Eleven patients had pancreatic diseases, with mainly left dominant pleural effusion (6/11, 55%). Patients with right dominant ascites usually had right dominant pleural effusion (22/24, 92%) and those with left dominant ascites had left dominant pleural effusion (9/10, 90%). Ascites-associated pleural effusion correlated with the anatomical location of the etiology of ascites; its laterality was, in addition, usually the same as that of ascites

  10. [The diagnostic value of medical thoracoscopy for unexplained pleural effusion].

    Science.gov (United States)

    Jiang, Shu-juan; Mu, Xiao-yan; Zhang, Song; Su, Li-li; Ma, Wei-xia

    2013-05-01

    To explore the endoscopic features of patients with unexplained pleural effusion, and to evaluate the diagnostic value of medical thoracoscopy. A retrospective analysis of 2380 patients with unexplained pleural effusion (1320 males and 1060 females; age 15-94 years) in Shandong Provincial Hospital from 1992 to 2011 were performed .The diagnosis was confirmed by medical thoracoscopy. The endoscopic findings of malignant pleural effusion mostly showed nodules of varying sizes. The nodules could be grape-like, cauliflower-like, fused into masses, or diffused small nodules . The appearance of cancerous nodules was more diversified compared to tuberculous nodules. Tuberculous pleurisy was manifested as diffuse pleural congestion and miliary changes, multiple small gray-white nodules, fibrin deposition and adhesion in the pleural cavity, pleural thickening and loculation . The pathological diagnosis was as follows: pleural metastases in 899 (37.8%), primary pleural mesothelioma in 439 (18.4%), tuberculous pleurisy in 514 (21.6%), non-specific inflammation in 226 (9.5%), empyema in 190 (8.0%), hepatic pleural effusion in 36 (1.5%) and pleural effusion of unknown causes in 76 (3.2%) cases. The diagnostic positive rate of medical thoracoscopy was 96.8%. No serious complications were observed. Medical thoracoscopy is a relatively safe procedure and has an important application value in the diagnosis of unexplained pleural effusion.

  11. Medical thoracoscopy: a useful diagnostic tool for undiagnosed pleural effusion.

    Science.gov (United States)

    Agarwal, Abhishek; Prasad, Rajendra; Garg, Rajiv; Verma, S K; Singh, Abhijeet; Husain, N

    2014-01-01

    We aimed to assess the role of medical thoracoscopy in patients with undiagnosed pleural effusion. Patiens presenting with pleural effusion underwent three pleural aspirations. Patients in whom pleural fluid analysis was inconclusive underwent closed pleural biopsy for diagnostic confirmation. Patients in whom closed pleural biopsy was incolcusive underwent medical thoracoscopy using a rigid thoracoscope with a viewing angle of zero degrees was done under local anaesthesia and sedation with the patient lying in lateral decubitus position with the affected side up. Biopsy specimens from parietal pleura were obtained under direct vision and were sent for histopathological examination. Of the 128 patients with pleural effusion who were studied, pleural fluid examination established the diagnosis in 81 (malignancy 33, tuberculosis 33, pyogenic 14 and fungal 1); 47 patients underwent closed pleural biopsy and a diagnosis was made in 28 patients (malignancy 24, tuberculosis 4). The remaining 19 patients underwent medical thoracoscopy and pleural biopsy and the aetiological diagnosis could be confirmed in 13 of the 19 patients (69%) (adenocarcinoma 10, poorly differentiated carcinoma 2 and mesothelioma 1). Medical thoracoscopy is a useful tool for the diagnosis of pleural diseases. The procedure is safe with minimal complications.

  12. Nuevas intervenciones en hipertensión arterial pulmonar

    Directory of Open Access Journals (Sweden)

    Juan Esteban Gómez Mesa

    2017-09-01

    Full Text Available El manejo farmacológico de la hipertensión arterial pulmonar se basa en agentes que actúan en tres vías principales: endotelina 1, prostaglandina I2 y óxido nítrico. La mayoría de estudios clínicos para aprobación de medicamentos desarrollados para tratar esta condición, han sido cortos y enfocados en el cambio en la caminata de 6 minutos. Al tener en cuenta que las diferentes formas de hipertensión arterial pulmonar tienen como denominador común para las alteraciones moleculares y celulares el entrecruzamiento celular con la pared vascular asociado a procesos inflamatorios e inmunes inapropiados, disbalance entre la síntesis y degradación de matriz extracelular, alteraciones genéticas (gen BMPR2 en hipertensión arterial pulmonar hereditaria y epigenéticas, se requiere un mejor entendimiento de la fisiopatología de la enfermedad, lo cual permitirá desarrollar nuevos tratamientos o intervenciones en estos pacientes en cada uno de estos niveles.

  13. Role of blind closed pleural biopsy in the managment of pleural exudates.

    Science.gov (United States)

    Pereyra, Marco F; San-José, Esther; Ferreiro, Lucía; Golpe, Antonio; Antúnez, José; González-Barcala, Francisco-Javier; Abdulkader, Ihab; Álvarez-Dobaño, José M; Rodríguez-Núñez, Nuria; Valdés, Luis

    2013-01-01

    The performance of blind closed pleural biopsy (BCPB) in the study of pleural exudates is controversial. To assess the diagnostic yield of BCPB in clinical practice and its role in the study of pleural exudates. Data were retrospectively collected on all patients who underwent BCPB performed between January 1999 and December 2011. A total of 658 BCPBs were performed on 575 patients. Pleural tissue was obtained in 590 (89.7%) of the biopsies. A malignant pleural effusion was found in 35% of patients. The cytology and the BCPB were positive in 69.2% and 59.2% of the patients, respectively. Of the patients with negative cytology, 21 had a positive BCPB (diagnostic improvement, 15%), which would have avoided one pleuroscopy for every seven BCPBs that were performed. Of the 113 patients with a tuberculous effusion, granulomas were observed in 87 and the Lowenstein culture was positive in an additional 17 (sensitivity 92%). The overall sensitivity was 33.9%, with a specificity and positive predictive value of 100%, and a negative predictive value of 71%. Complications were recorded in 14.4% of patients (pneumothorax 9.4%; chest pain 5.6%; vasovagal reaction, 4.1%; biopsy of another organ 0.5%). BCPB still has a significant role in the study of a pleural exudate. If an image-guided technique is unavailable, it seems reasonable to perform BCPB before resorting to a pleuroscopy. These results support BCPB as a relatively safe technique.

  14. Palliative Treatment of Malignant Pleural Effusion

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    Chenyang Liu

    2015-01-01

    Full Text Available Malignant pleural effusion (MPE is a common clinical problem caused by cancers. Pleural effusion can be the first sign of cancer in more than 25% of patients. Lung cancer and breast cancer are the most common cancers that metastasize to the pleura in men and women, respectively. Other cancers, including, but not limited to, lymphomas, ovarian cancer, stomach cancer, and several unknown primary cancers can also lead to MPE. Dyspnea and chest pain are the most common symptoms of MPE along with other symptoms such as a cough, weight loss, anorexia, fatigue, and weakness. Aggravation of these symptoms is closely related to the rate of accumulation of pleural effusion. Treatment options to MPE are determined by the type and extent of the underlying malignancy. The major goals of the treatment are to relieve symptoms, restore functions, improve the quality of life, and minimize the duration of hospital stay and costs. Although some patients can be treated with systemic therapies, most of these treatments are temporary, and MPE would recur soon. Hence, further palliative treatments to effectively control pleural effusions and relieve symptoms are necessary. This review addresses the pathophysiology of MPE and the treatment options for patients with MPE.

  15. Ultrasound-guided forceps for pleural biopsy

    Directory of Open Access Journals (Sweden)

    Gamal Agmy

    2014-04-01

    Clinical implications: Ultrasound-guided forceps for pleural biopsy can overcome many of the limitations of the conventional needle biopsy procedures, provides multiple biopsy specimens of the parietal pleura that are inaccessible to the biopsy needle, and can be carried out easily and safely even in sick and obese patients. The diagnostic yield is nearly similar to thoracoscopy.

  16. Pleural Tuberculosis and its Treatment Outcomes

    African Journals Online (AJOL)

    Sciences, University Sains Malaysia, 11800 Penang, Malaysia, 4Discipline of ... 37.7 %) of cases among tuberculosis pleuritis patients were Chinese, followed by Malay (31.2 %). Out ... combined with culture, diagnosis can be made in ... Chinese (46.5 %), Indian (10.6 %) and ... left pleural effusion (48.6 % compared to 27.5.

  17. The Heimlich Valve for Pleural Cavity Drainage

    African Journals Online (AJOL)

    The ANNALS of AFRICAN SURGERY | www.annalsofafricansurgery.com. The ANNALS of AFRICAN SURGERY. July 2016 Volume 13 Issue 2 45. The Heimlich Valve for Pleural Cavity Drainage. Winston Ominde Makanga1, Andrew Nyaoncha Nyangau2 , Benjamin Njoga Njihia3. 1. St Mary's Mission Hospital, Elementaita.

  18. Pleural Mass Lesion Containing Calcium Sludge

    Directory of Open Access Journals (Sweden)

    Can Kurkcuoglu

    2012-01-01

    Full Text Available   A 30 year-old man was admitted with of chest pain. Had a x-ray and computed tomography showed calcified pleural mass . Lesions in the white-colored, dense mud was the consistency of the material.

  19. Diaphragmatic Hernia Masquerading as Pleural Effusion | Nalladaru ...

    African Journals Online (AJOL)

    Rupture of the diaphragm is almost always due to major trauma. We present here an unusual and rare case of late presentation of diaphragmatic hernia after an innocuous injury. The patient was initially misdiagnosed as a left pleural effusion on the basis of chest X.ray and ultrasound findings. Finally, the diagnosis was ...

  20. Diaphragmatic Hernia Masquerading as Pleural Effusion

    African Journals Online (AJOL)

    As many as 30% of diaphragmatic hernias present late.[1] We present an unusual case report of a late presentation of isolated diaphragmatic injury, after apparently minor blunt trauma, which was initially misdiagnosed as pleural effusion. CASE REPORT. A 40-year-old man slipped and fell against the edge of his bath tub.

  1. Optimising the utility of pleural fluid adenosine deaminase for the diagnosis of adult tuberculous pleural effusion in Hong Kong.

    Science.gov (United States)

    Chang, K C; Chan, M C; Leung, W M; Kong, F Y; Mak, C M; Chen, S Pl; Yu, W C

    2018-02-01

    Pleural fluid adenosine deaminase level can be applied to rapidly detect tuberculous pleural effusion. We aimed to establish a local diagnostic cut-off value for pleural fluid adenosine deaminase to identify patients with tuberculous pleural effusion, and optimise its utility. We retrospectively reviewed the medical records of consecutive adults with pleural fluid adenosine deaminase level measured by the Diazyme commercial kit (Diazyme Laboratories, San Diego [CA], United States) during 1 January to 31 December 2011 in a cluster of public hospitals in Hong Kong. We considered its level alongside early (within 2 weeks) findings in pleural fluid and pleural biopsy, with and without applying Light's criteria in multiple scenarios. For each scenario, we used the receiver operating characteristic curve to identify a diagnostic cut-off value for pleural fluid adenosine deaminase, and estimated its positive and negative predictive values. A total of 860 medical records were reviewed. Pleural effusion was caused by congestive heart failure, chronic renal failure, or hypoalbuminaemia caused by liver or kidney diseases in 246 (28.6%) patients, malignancy in 198 (23.0%), non-tuberculous infection in 168 (19.5%), tuberculous pleural effusion in 157 (18.3%), and miscellaneous causes in 91 (10.6%). All those with tuberculous pleural effusion had a pleural fluid adenosine deaminase level of ≤100 U/L. When analysis was restricted to 689 patients with pleural fluid adenosine deaminase level of ≤100 U/L and early negative findings for malignancy and non-tuberculous infection in pleural fluid, the positive predictive value was significantly increased and the negative predictive value non-significantly reduced. Using this approach, neither additionally restricting analysis to exudates by Light's criteria nor adding closed pleural biopsy would further enhance predictive values. As such, the diagnostic cut-off value for pleural fluid adenosine deaminase is 26.5 U/L, with a

  2. Posible papel del grado de vascularización pulmonar en la resistencia/susceptibilidad a la hipertensión arterial pulmonar en una estirpe comercial de pollos de engorde

    OpenAIRE

    Areiza Rojas, Rafael Alfonso

    2010-01-01

    Desde hace varias decadas se conoce la baja capacidad de adaptacion de los pollos de engorde a la hipoxia hipobarica. Si bien el sistema parabronquial pulmonar de las aves permite una mayor eficiencia para el intercambio gaseoso pulmonar, los programas de mejoramiento genetico de los pollos de engorde han resultado colateralmente en una disminucion en la capacidad pulmonar de intercambio gaseoso. La respuesta angiogenica del lecho vascular pulmonar como consecuencia de la ex...

  3. Terapia com surfactante pulmonar exógeno em pediatria Exogenous surfactant therapy in pediatrics

    Directory of Open Access Journals (Sweden)

    Norberto A. Freddi

    2003-11-01

    Full Text Available OBJETIVO: Revisar o estágio atual do conhecimento sobre a utilização do surfactante exógeno nas diferentes doenças pulmonares que levam à insuficiência respiratória aguda em crianças. FONTES DOS DADOS: Este manuscrito baseia-se na experiência clínica dos autores sobre o assunto e na revisão da literatura recente através de consulta aos bancos de dados ONIA, Mdconsult, Medline e Cochrane Database Library. SÍNTESE DOS DADOS: Apesar do sucesso obtido com a utilização do surfactante exógeno na síndrome de desconforto respiratório do recém-nascido, questões permanecem indefinidas, como o momento do seu emprego, muito precoce (profilático, baseado na idade gestacional ou em testes rápidos de maturidade pulmonar, ou então mais tardiamente, após o quadro clínico instalado. Em outras patologias graves que levam à insuficiência respiratória grave com necessidade de suporte ventilatório, o seu uso ainda é controverso, e os dados da literatura são limitados e conflitantes. Porém, relatos de uso clínico em várias destas situações, com sucesso, têm sido freqüentes. A pesquisa em surfactante tem-se centrado ultimamente na sua inativação por várias substâncias que podem estar presentes na via aérea. Nas patologias em que a inativação parece ser um fator importante, novos surfactantes com adição de adjuvantes para reverter a tendência à inativação (por exemplo: polietilenoglicol estão atualmente em fase de testes. CONCLUSÕES: A terapia com surfactante exógeno ainda não é um tema esgotado, nem mesmo na SDR. Os surfactantes podem ser ainda aperfeiçoados, sobretudo para resistir à inibição, e as formas de utilização em outras doenças que não a SDR deverão ser aperfeiçoadas.OBJECTIVE: To review current knowledge about the use of exogenous surfactants in the treatment of different lung diseases causing acute respiratory failure in children. SOURCE OF DATA: This review is based on the authors

  4. Secuestro pulmonar una infrecuente causa de hipertension pulmonar persistente en el recién nacido reporte de un caso

    Directory of Open Access Journals (Sweden)

    Lupo Méndez

    2017-01-01

    Full Text Available La hipertensión pulmonar persistente del recién nacido ( HPPRN es una entidad frecuente en las unidades de cuidados intensivos neonatales ( UCIN , sin embargo, algunas de sus causas pasan desapercibidas, debido a su baja frecuencia y poca asociación con esta patología. A propósito de un caso en nuestra UCIN , en un neonato a término que presentó HPPRN secundario a una malformación pulmonar, raramente asociada con esta patología en este grupo etareo, ya que se encontró mayor disposición a factores propios del nacimiento, y noxas maternas. El paciente presentó dificultad respiratoria horas después de su nacimiento, con evolución y persistencia de su sintomatología, por lo que se necesitó de diversos medios diagnósticos para establecer su etiología. Es importante destacar que el primer ecocardiograma doppler no mostró ninguna alteración anatómica o funcional, reportado normal; con posterior empeoramiento clínico del neonato, por lo que se ordenó un control ecocardiografico, y se evidenció una presión pulmonar estimada de 71 mmHg; se continuó el estudio etiológico con imágenes complemen - tarias, en esta caso una tomografía de tórax contrastada, y finalmente fue corroborado con un cateterismo cardiaco, lo cual permitió a su vez, manejo terapéutico y corrección de anomalía estructural de vasos pulmonares.

  5. Segurança e efetividade da fisioterapia respiratória em abscesso pulmonar: estudo de casos Safety and effectiveness of chest physiotherapy in lung abscess: a two-case study

    Directory of Open Access Journals (Sweden)

    Josy Davidson

    2010-12-01

    Full Text Available O abscesso pulmonar é uma lesão necrótica geralmente devida a germes piogênicos. A fisioterapia respiratória (FR é indicada, porém há poucos relatos na literatura, não havendo consenso quanto ao uso e às técnicas de FR para esse caso. O objetivo deste estudo de dois casos foi verificar a segurança e efetividade da FR no tratamento do abcesso pulmonar. O caso 1 foi um paciente de 30 anos, internado; a terapia consistiu em posicioná-lo em Trendelenburg semi-lateral direito para ventral por 30 minutos, três vezes ao dia, com saída de grande quantidade de secreção. Após 5 dias, o radiograma de tórax demonstrou redução de 90% do nível hidroaéreo, verificando-se o esvaziamento completo do abscesso após 14 dias de internação. O caso 2 foi uma paciente de 28 anos igualmente com diagnóstico de abscesso pulmonar, também tratada com drenagem postural, nos mesmos posicionamento e freqüência que o caso 1, sendo drenada grande quantidade de secreção amarelada e fluida. Após 7 dias de tratamento evidenciou-se redução importante do nível líquido do abscesso pulmonar. Conclui-se que a drenagem postural isoladamente é uma técnica de fisioterapia efetiva e segura no tratamento do abcesso pulmonar.Lung abscess is a necrotic lesion mostly caused by pyogenic germs. Chest physical therapy (CPT is indicated, but there are few studies available and no consensus on CPT use and techniques for theses cases. The purpose of this study was to assess safety and effectiveness of postural drainage in treating lung abscess in two cases. Patient 1, male, 30 years old, was laid in Trendelenburg, in semi-lateral to ventral decubitus for 30 minutes, three times a day. After five days of therapy, X-ray showed a 90% decrease of sputum, and on the 14th day full drainage was achieved. Case 2 was a female patient, 28 years old, treated at the same position and frequency as case 1. After seven days of therapy, exams showed a great decrease of pus from

  6. Os abcessos pulmonares em revisão

    Directory of Open Access Journals (Sweden)

    Ana Moura Gonçalves

    2008-01-01

    Full Text Available Resumo: Os abcessos pulmonares são cavidades que surgem no parênquima pulmonar, apresentando maior ou menor quantidade de tecido necrosado no seu interior. Surgem em indivíduos predispostos, como sejam os doentes com doença pulmonar crónica ou obstrução secundária a neoplasia e os doentes com maior risco de aspiração, estando incluidos os doentes com alteração do estado neurológico, os utilizadores de drogas endovenosas, os doentes com alcoolismo, patologia da faringe e esofágica, doença neuromuscular, entre outras. É feita a revisão dos principais agentes causais, da metodologia diagnóstica, da abordagem terapêutica na actualidade e do prognóstico destas situações.Os abcessos pulmonares, para além de relativamente pouco frequentes, são difíceis de caracterizar, sendo a resistência aos antibióticos um problema a ter presente, na sua abordagem terapêutica. Abstract: Lung abscesses are cavitating lesions containing necrotic debris caused by microbial infection. Patients with chronic lung disease, bronchial obstruction secondary to cancer, a history of aspiration or risk of aspiration caused by alcoholism, altered mental status, structural or physiologic alterations of the pharynx and esophagus, neuromuscular disorders, anesthesia, are among others at higher risk of developing lung abcess.The main bacteriological characteristics, the diagnosis, therapy and prognosis are considered. The problem of antimicrobial resistance is also referred. Palavras-chave: Abcesso pulmonar, pneumonia de aspiração, resistência antimicrobiana, anaeróbios, Key-words: Lung abscesses, aspiration pneumonia, antimicrobial resistance, anaerobes

  7. Hemangioma de úvula: relato de um caso

    Directory of Open Access Journals (Sweden)

    G. Sobrinho Fernando P.

    2003-01-01

    Full Text Available O hemangioma é o mais comum tumor de origem vascular, benigno, freqüentemente diagnosticado em crianças, e com predileção pela cabeça e pescoço, mas que raramente tem origem na úvula. Neste órgão, apresenta risco de traumatismo local e sangramento. Este artigo relato um caso de hemangioma de úvula num adulto jovem com disfagia orofaríngea progressiva e sensação de corpo estranho na garganta, tratado com sucesso por ressecção cirúrgica do tumor com bisturi de radiofreqüência.

  8. Relatos de vivências educacionais

    Directory of Open Access Journals (Sweden)

    Congresso Internacional de Dislexia

    2011-05-01

    Full Text Available Relatos de experiências em educação, abrangendo a descrição de projeto ou vivência específica em sala de aula ou outro ambiente educacional, que envolva o trabalho com escolares com dislexia e outros transtornos da aprendizagem da leitura e escrita.Os trabalhos foram apresentados na terceira edição do Congresso Internacional de Dislexia (CID, realizado nas dependências do Centro Universitário Metodista Izabela Hendrix, em maio de 2011. 

  9. Doença pleural e síndroma de imunodeficiência adquirida

    Directory of Open Access Journals (Sweden)

    Adelina Amorim

    2004-05-01

    Full Text Available RESUMO: As infecções respiratórias estão entre as infecções mais comuns nos doentes infectados pelo vírus da imunodeficiência humana (VIH, podendo ocorrer com qualquer valor de CD4. As complicações pleurais não são frequentes, mas têm algumas características distintas das dos doentes VIH negativos.A ocorrência de pneumotórax (PTX em doentes com infecção VIH foi descrito pela primeira vez em 1984. A incidência total de PTX nos doentes com síndroma da imunodeficiência adquirida (SIDA varia entre os 2,7% e 4,9%. A maioria dos casos ocorre em doentes com infecção por Pneumocystis carinii prévia ou actual, que apresentam cavidades pulmonares subpleurais, associadas a necrose. O tratamento do PTX nos doentes com SIDA é difícil, verificando-se uma maior tendência para a persistência de fístulas broncopleurais. O uso de drenagem por toracostomia, com ou sem esclerose pleural, pode não ser suficiente para resolver o PTX. Outras opções terapêuticas são a colocação de uma válvula de Heimlich ou o recurso à cirurgia.A prevalência e a etiologia do derrame pleural (DP em doentes hospitalizados com SIDA é muito variável. Uma das causas que pode contribuir para esta variabilidade é a diferença nos factores de risco associados à infecção VIH na população estudada. Os derrames parapneumónicos, a tuberculose e o sarcoma de Kaposi são as causas mais comuns. Os empiemas são uma complicação pleural rara. Apesar de a pneumonia por Pneumocystis carinii ser uma causa comum de pneumonia nos doentes com SIDA, raramente é causa de derrame pleural. Outras causas possíveis de derrame pleural são os linfomas não-Hodgkin, nomeadamente o linfoma das cavidades corporais.REV PORT PNEUMOL 2004; X (3: 217-225 ABSTRACT: Respiratory infections are among the most common complications in patients infected with human

  10. Does selective pleural irradiation of malignant pleural mesothelioma allow radiation dose escalation. A planning study

    International Nuclear Information System (INIS)

    Botticella, A.; Defraene, G.; Nackaerts, K.; Deroose, C.; Coolen, J.; Nafteux, P.; Vanstraelen, B.; Joosten, S.; Michiels, L.A.W.; Peeters, S.; Ruysscher, D. de

    2017-01-01

    After lung-sparing radiotherapy for malignant pleural mesothelioma (MPM), local failure at sites of previous gross disease represents the dominant form of failure. Our aim is to investigate if selective irradiation of the gross pleural disease only can allow dose escalation. In all, 12 consecutive stage I-IV MPM patients (6 left-sided and 6 right-sided) were retrospectively identified and included. A magnetic resonance imaging-based pleural gross tumor volume (GTV) was contoured. Two sets of planning target volumes (PTV) were generated for each patient: (1) a ''selective'' PTV (S-PTV), originating from a 5-mm isotropic expansion from the GTV and (2) an ''elective'' PTV (E-PTV), originating from a 5-mm isotropic expansion from the whole ipsilateral pleural space. Two sets of volumetric modulated arc therapy (VMAT) treatment plans were generated: a ''selective'' pleural irradiation plan (SPI plan) and an ''elective'' pleural irradiation plan (EPI plan, planned with a simultaneous integrated boost technique [SIB]). In the SPI plans, the average median dose to the S-PTV was 53.6 Gy (range 41-63.6 Gy). In 4 of 12 patients, it was possible to escalate the dose to the S-PTV to >58 Gy. In the EPI plans, the average median doses to the E-PTV and to the S-PTV were 48.6 Gy (range 38.5-58.7) and 49 Gy (range 38.6-59.5 Gy), respectively. No significant dose escalation was achievable. The omission of the elective irradiation of the whole ipsilateral pleural space allowed dose escalation from 49 Gy to more than 58 Gy in 4 of 12 chemonaive MPM patients. This strategy may form the basis for nonsurgical radical combined modality treatment of MPM. (orig.) [de

  11. Pleural tissue hyaluronan produced by postmortem ventilation in rabbits.

    Science.gov (United States)

    Wang, P M; Lai-Fook, S J

    2000-01-01

    We developed a method that used Alcian blue bound to hyaluronan to measure pleural hyaluronan in rabbits postmortem. Rabbits were killed, then ventilated with 21% O2--5% CO2--74% N2 for 3 h. The pleural liquid was removed by suction and 5 ml Alcian blue stock solution (0.33 mg/ml, 3.3 pH) was injected into each chest cavity. After 10 min, the Alcian blue solution was removed and the unbound Alcian blue solution (supernatant) separated by centrifugation and filtration. The supernatant transmissibility (T) was measured spectrophotometrically at 613 nm. Supernatant Alcian blue concentration (Cab) was obtained from a calibration curve of T versus dilutions of stock solution Cab. Alcian blue bound to pleural tissue hyaluronan was obtained by subtracting supernatant Cab from stock solution Cab. Pleural tissue hyaluronan was obtained from a calibration curve of hyaluronan versus Alcian blue bound to hyaluronan. Compared with control rabbits, pleural tissue hyaluronan (0.21 +/- 0.04 mg/kg) increased twofold, whereas pleural liquid volume decreased by 30% after 3 h of ventilation. Pleural effusions present 3 h postmortem without ventilation did not change pleural tissue hyaluronan from control values. Thus ventilation-induced pleural liquid shear stress, not increased filtration, was the stimulus for the increased hyaluronan produced from pleural mesothelial cells.

  12. Incidence and significance of pleural effusion after hepatoma surgery

    International Nuclear Information System (INIS)

    Song, Jae Uoo; Im, Jung Gi; Ahn, Joong Mo; Kim, Seung Cheol; Kim, Sam Soo; Kim, Seung Hoon; Yeon, Kyung Mo

    1994-01-01

    We performed this study to evaluate the clinical significance and temporal changes of pleural effusion developed after the resection of hepatoma. We reviewed retrospectively follow-up chest radiographs of 97 patients who had undergone operation for hepatoma and had no radiologically demonstrable postoperative complications. The duration of pleural effusion was classified into five groups and the amount of pleural effusion at one week after operation was graded into four groups. Statistical significance of the relationship between the duration, amount of pleural effusion and five factors, which are location and size of tumor, age of the patients, methods of operation, and preoperative liver function, was studied respectively. Pleural effusion was developed in 63.9% (62/97) and the mean duration was 2.5 weeks. In 92% (52/56), pleural effusion disappeared spontaneously within four weeks. Patients who had hepatoma in upper portion of the right lobe developed more frequent pleural effusion which persisted longer, and was larger in amount at one week after operation(p<0.05). There were no statistically significant differences between pleural effusion and the other four factors. Pleural effusion following hepatoma surgery should not be regarded as a sign of post-operative complication, as it invariably disappears spontaneously within four weeks. Development of pleural effusion is considered to be caused by local irritation and disturbance of lymphatic flow at the diaphragm

  13. Angioceratoma conjuntival canino: relato de caso

    Directory of Open Access Journals (Sweden)

    J.O.T. Souza

    Full Text Available RESUMO O angioceratoma é um tumor de origem vascular, semelhante ao hemangioma, que se diferencia deste por alterações histológicas epiteliais. A apresentação ocular do angioceratoma é pouco frequente em cães, sendo mais comum a ocorrência de hemangioma e hemangiossarcoma. Neste relato, é descrito o caso de um cão, macho, da raça Border Collie, que apresentava uma massa localizada, hiperêmica, bem vascularizada e protrusa, na região temporal da conjuntiva bulbar do olho direito (OD. Foi realizado exame oftalmológico completo e ultrassonografia ocular, tendo sido possível observar que a massa não envolvia outras estruturas oculares além da conjuntiva. Dessa forma, foi realizada a conjuntivectomia parcial, e o material foi encaminhado para análise histológica. O exame histopatológico foi conclusivo para um angioceratoma e mostrou que as margens da amostra estavam livres. O procedimento cirúrgico com margem de segurança foi eficiente no tratamento da neoplasia, sem recorrência até o momento do presente relato.

  14. Pleural fluid cell-free DNA integrity index to identify cytologically negative malignant pleural effusions including mesotheliomas

    International Nuclear Information System (INIS)

    Sriram, Krishna B; Courtney, Deborah; Yang, Ian A; Bowman, Rayleen V; Fong, Kwun M; Relan, Vandana; Clarke, Belinda E; Duhig, Edwina E; Windsor, Morgan N; Matar, Kevin S; Naidoo, Rishendran; Passmore, Linda; McCaul, Elizabeth

    2012-01-01

    The diagnosis of malignant pleural effusions (MPE) is often clinically challenging, especially if the cytology is negative for malignancy. DNA integrity index has been reported to be a marker of malignancy. The aim of this study was to evaluate the utility of pleural fluid DNA integrity index in the diagnosis of MPE. We studied 75 pleural fluid and matched serum samples from consecutive subjects. Pleural fluid and serum ALU DNA repeats [115bp, 247bp and 247bp/115bp ratio (DNA integrity index)] were assessed by real-time quantitative PCR. Pleural fluid and serum mesothelin levels were quantified using ELISA. Based on clinico-pathological evaluation, 52 subjects had MPE (including 16 mesotheliomas) and 23 had benign effusions. Pleural fluid DNA integrity index was higher in MPE compared with benign effusions (1.2 vs. 0.8; p<0.001). Cytology had a sensitivity of 55% in diagnosing MPE. If cytology and pleural fluid DNA integrity index were considered together, they exhibited 81% sensitivity and 87% specificity in distinguishing benign and malignant effusions. In cytology-negative pleural effusions (35 MPE and 28 benign effusions), elevated pleural fluid DNA integrity index had an 81% positive predictive value in detecting MPEs. In the detection of mesothelioma, at a specificity of 90%, pleural fluid DNA integrity index had similar sensitivity to pleural fluid and serum mesothelin (75% each respectively). Pleural fluid DNA integrity index is a promising diagnostic biomarker for identification of MPEs, including mesothelioma. This biomarker may be particularly useful in cases of MPE where pleural aspirate cytology is negative, and could guide the decision to undertake more invasive definitive testing. A prospective validation study is being undertaken to validate our findings and test the clinical utility of this biomarker for altering clinical practice

  15. Relato literario, relato periodístico: el caso Elián González

    OpenAIRE

    Lic. María Inés Loyola; Lic. Miriam Eugenia Villa

    2000-01-01

    Nos proponemos estudiar las relaciones entre relato literario y relato periodístico a partir del caso del niño balsero cubano, Elián González, que estuvo retenido en Estados Unidos durante siete meses. En este análisis, el principal objetivo es describir las diferencias y similitudes respecto a la construcción discursiva de la historia narrada, sus personajes y escenarios. La finalidad de la comparación es demostrar cómo los relatos "no ficcionales" que los medios imponen como verdaderos y ac...

  16. CT findings of diffuse pleural diseases: differentiation of malignant disease from tuberculosis

    International Nuclear Information System (INIS)

    Roh, In Gye; Kook, Shin Ho; Lee, Young Rae; Chin, Seung Bum; Park, Yoon Ok; Park, Hae Won

    1997-01-01

    To evaluate whether or not previously known CT criteria for differentiating malignant and benign pleural diseases are useful in the differentiation of diffuse malignant pleural diseases and tuberculosis. We retrospectively analyzed CT scans of 42 patients comprising 20 cases of malignant pleural diseases and 22 cases of tuberculous pleural diseases, according to previously known CT criteria for differentiating malignant and benign pleural diseases. The most common shape of pleural effusion was crescentic in malignant pleural diseases and loculated in tuberculosis. The aggressive nature of pleural effusion, pleural rind, and pleura thickening was 1.5 times more frequently observed in malignant pleural diseases than in tuberculosis. Smooth thickening or smooth nodular pleural thickening and extrapleural deposition of fat were 1.5 times more frequently found in tuberculous than in malignant pleural diseases. Interruption of pleural thickening was found twice as frequently in malignant pleural diseases as in tuberculosis. Decreased lung volume was found twice as frequently in tuberculous as in malignant pleural diseases. Anatomical mediastinal pleural involvement was three times, and irregular nodular pleural thickening nine times more frequent in malignant pleural diseases than in tuberculosis. The sensitivity and specificity of CT findings above 70%, and thus suggesting malignant pleural diseases, were as follows : 1) aggressive nature of pleural fluid collection extending to the azygoesophageal recess or tongue of the lung (51.5%, 75%); 2) involvement of anatomical mediastinal pleura (69.2%, 73.7%); 3) irregular nodular pleural thickening (87.5%, 69%). Although there in overlap between previously known CT criteria for the differentiation of benign and malignant pleural diseases, the aggressive nature of pleural fluid collection extending to the azygoesophageal recess or tongue of the lung, the involvement of anatomical mediastinal pleura and irregular nodular

  17. Eosinophilic Pleural Effusion: A Rare Manifestation of Hypereosinophilic Syndrome

    Directory of Open Access Journals (Sweden)

    Ndubuisi C. Okafor

    2009-01-01

    Full Text Available Several causes of eosinophilic pleural effusions have been described with malignancy being the commonest cause. Hypereosinophilic syndrome (HES is a rare disease and very few cases have been reported of HES presenting as eosinophilic pleural effusion (EPE. We report a case of a 26-year-old male who presented with shortness of breath. He had bilateral pleural effusions, generalized lymphadenopathy, splenomegaly, and leukocytosis with marked peripheral blood eosinophilia. The pleural fluid was exudative, with 25%–30% eosinophilis, and absence of neoplastic cells. Hypereosinophilic syndrome was diagnosed after other causes of eosinophilia were excluded. He continued to be dyspneic with persistent accumulation of eosinophilic pleural fluid, even after his peripheral eosinophil count had normalized in response to treatment. This patient represents a very unusual presentation of HES with dyspnea and pleural effusions and demonstrates that treatment based on response of peripheral eosinophil counts, as is currently recommended, may not always be clinically adequate.

  18. Terapia celular em doenças pulmonares: existem perspectivas? Cell therapy in pulmonary diseases: are there perspectives?

    Directory of Open Access Journals (Sweden)

    João T. Ribeiro-Paes

    2009-05-01

    Full Text Available A terapia celular poderia ser conceituada de forma ampla e genérica como o emprego de células para tratamento de doenças. Apesar de um número não tão expressivo de relatos tendo o pulmão como objeto de estudo na terapia celular em pacientes humanos, há dados consistentes da literatura, tanto em humanos, quanto em modelos animais,que evidenciam a migração de células-tronco da medula óssea para o pulmão,em diferentes situações experimentais. Esses resultados forneceram o embasamento experimental para o emprego de células-tronco na regeneração do tecido pulmonar em modelos animais. Em nosso laboratório, vários projetos de pesquisa têm sido conduzidos com a finalidade de avaliar a resposta pulmonar (morfológica e funcional ao tratamento com células-tronco adultas em camundongos com doença pulmonar obstrutiva crônica (DPOC induzida experimentalmente. Os resultados obtidos, aliados àqueles de outros grupos de pesquisa, permitem aventar a possibilidade de aplicação, a curto prazo, da terapia celular em pacientes com DPOC. Em outra patologia pulmonar, fibrose cística (FC, cuja abordagem terapêutica com células-tronco apresenta aspectos particulares em relação às patologias pulmonares crônico-degenerativas, há avanços promissores e potencialmente interessantes; no entanto, os resultados podem ser considerados incipientes e deve-se assinalar, portanto, que a associação da terapia gênica e celular apresenta-se como uma alternativa possível, mas ainda muito distante quanto à sua consolidação e incorporação como opção terapêutica segura e eficaz em FC. Por outro lado, tendo por embasamento os resultados obtidos em modelos experimentais, é possível postular que a terapia celular com células-tronco hematopoéticas (ou de outras fontes encerra perspectivas consistentes de aplicação em diversas outras patologias pulmonares humanas, especialmente em DPOC.Cell therapy can be briefly described as the use of

  19. Visualization of normal pleural sinuses with AMBER

    International Nuclear Information System (INIS)

    Aarts, N.J.; Kool, L.J.S.; Oestmann, J.W.

    1991-01-01

    This paper reports that ventral and dorsal pleural sinuses are frequently better appreciated with advanced modulated beam equalization radiography (AMBER) than with standard chest radiography. The visualization of the sinuses with both techniques was compared and their typical configuration studied. Four hundred patients without known chest disease were evaluated. Two groups of 200 patients were studied with either AMBER or standard chest radiography. Visualization was evaluated by three radiologists using a four-point scale. The shape of the sinus was traced if sufficiently visible. A significantly larger segment of the respective sinuses was seen with the AMBER technique. The dorsal sinus was significantly easier to trace than the ventral. Various sinus configurations were noted. AMBER improves the visibility of the pleural sinuses. Knowledge of their normal configuration is the precondition for correctly diagnosing lesions hitherto frequently overlooked

  20. MR imaging of pleural and peritoneal effusion

    International Nuclear Information System (INIS)

    Shiono, Takahiro; Yoshikawa, Kohki; Takenaka, Eiichi; Hisamatsu, Katsuji

    1993-01-01

    The purpose of this study was to assess the efficacy of MR imaging in predicting the quality of ascites and pleural effusion. MR examinations of 20 patients with different benign or malignant diseases accompanied with ascites or pleural effusion were retrospectively studied. Results were compared with histopathological findings. On T 1 - and T 2 -weighted images, the MR intensity of the effusion depended mainly on the concentration of protein, whereas on gradient echo images, it depended mainly on the concentration of blood. MR examination was useful in non-invasively differentiating exudative or hemorrhagic effusion from serous effusion. Knowledge or inference of the quality of effusion can direct MR interpretation and may improve diagnostic accuracy. (author)

  1. Proteomic study of benign and malignant pleural effusion.

    Science.gov (United States)

    Li, Hongqing; Tang, Zhonghao; Zhu, Huili; Ge, Haiyan; Cui, Shilei; Jiang, Weiping

    2016-06-01

    Lung adenocarcinoma can easily cause malignant pleural effusion which was difficult to discriminate from benign pleural effusion. Now there was no biomarker with high sensitivity and specificity for the malignant pleural effusion. This study used proteomics technology to acquire and analyze the protein profiles of the benign and malignant pleural effusion, to seek useful protein biomarkers with diagnostic value and to establish the diagnostic model. We chose the weak cationic-exchanger magnetic bead (WCX-MB) to purify peptides in the pleural effusion, used matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS) to obtain peptide expression profiles from the benign and malignant pleural effusion samples, established and validated the diagnostic model through a genetic algorithm (GA) and finally identified the most promising protein biomarker. A GA diagnostic model was established with spectra of 3930.9 and 2942.8 m/z in the training set including 25 malignant pleural effusion and 26 benign pleural effusion samples, yielding both 100 % sensitivity and 100 % specificity. The accuracy of diagnostic prediction was validated in the independent testing set with 58 malignant pleural effusion and 34 benign pleural effusion samples. Blind evaluation was as follows: the sensitivity was 89.6 %, specificity 88.2 %, PPV 92.8 %, NPV 83.3 % and accuracy 89.1 % in the independent testing set. The most promising peptide biomarker was identified successfully: Isoform 1 of caspase recruitment domain-containing protein 9 (CARD9), with 3930.9 m/z, was decreased in the malignant pleural effusion. This model is suitable to discriminate benign and malignant pleural effusion and CARD9 can be used as a new peptide biomarker.

  2. Diagnosis of malignant pleural effusion and lung cancer with CT

    International Nuclear Information System (INIS)

    Jakimovska, S.; Jakimovska, M.; Jovanovska, S.; Ilieva, S.

    2012-01-01

    Full text: Introduction: A pleural effusion is defined as an abnormal amount of fluid in the space between the layers of tissue (the pleura) that line the lungs. If cancer cells are present in this fluid (pleural cavity) it is called a malignant cancerous pleural effusion. Many benign and malignant disease can cause pleural effusion.The new onset of pleural effusion may herald the presence of a previously undiagnosed malignancy, or more typically, complicate the course of a known lung tumor. Malignant pleural effusions can lead lead to an initial diagnosis of lung cancer in patients.and it was the first symptom of lung cancer. Pleural deposits of tumor cause pleuritic pain. Purpose of this presentation is to show the role of CT in diagnosis of malignant pleural effusion and lung cancer. Material and methods: CT examinations of chest were made to 138 patients for 1 year (1/6/2011- 1/6/2012) with Siemens Somatom Emotion 16 CT Scanner. Patients were at age of 30 -81 years, 93 of them are male and 45 are female. Results: 56 (40.5%) of the patients had pleural effusion. From this group 21 37.5% had malignant pleural effusion and lung cancer. 17 (81%) of them are male, and 4 (19%) are female. 9 (43%) diagnosed lung cancer for first time. Conclusion: Pleural effusion more commonly occur in patient with advanced-stage tumor who frequently have metastases to other organs and long-term survival is uncommon in this group. CT diagnosed malignant pleural effusion and lung cancer and help to choice treatment for these patients

  3. A Case of Massive Pleural Effusion: Pleurodesis by Bleomycin.

    Science.gov (United States)

    Hasan, R; Khan, O S; Aftabuddin, M; Razzaque, A M; Chowdhury, G A

    2016-04-01

    Malignant pleural effusion is a common complication of primary and metastatic pleural malignancies. Pleurodesis for the management of malignant pleural effusion is intended to achieve symphysis between parietal and visceral pleura, and to prevent relapse of pleural effusion. Many chemical agents are tried to induce inflammation and damage of the pleural mesothelial layer to achieve this symphysis. Hemorrhagic pleural effusion, especially in the right hemithorax commonly occurs as presentation of primary and metastatic pleural malignancies. This case reports massive right-sided hemorrhagic pleural effusion as the sole manifestation of primary lung cancer in a 45 year old man. Patient attended our department of thoracic surgery complaining of cough, shortness of breath and right sided chest pain. A chest X-ray and chest computer tomography (CT) radiograph shows right sided massive pleural effusion. Right sided tube thoracotomy done. Pleural fluid study was done. Fluid for cytopathology was positive for malignant cell. Computed tomography guided fine needle aspiration cytology from right lung lesion was also done. Diagnosis was as small cell carcinoma. Pleural effusion resolved after 9(th) post operative day of chest tube insertion. Bleomycin pleurodesis was done. Day after pleurodesis intra thoracic tube was removed and patient was discharged from hospital on 10(th) Post operative day with an advice to attend the oncology department for further treatment. The protocol of tube thoracostomy and chemical pleurodesis was almost always successful in giving symptomatic relief of respiratory distress for a considerable period of time. However, chemical pleurodesis is not possible in all cases of malignant pleural effusion because it has got potential complication including death.

  4. Micro-pleural Metastasis Without Effusion: CT and US Findings

    International Nuclear Information System (INIS)

    Na, Hyoung Il; Yoo, Seung Min; Kim, Yang Soo; Lee, Hwa Yeon; Song, In Sup; Shim, Hyung Jin; Kwak, Byung Kook; Shin, Jong Wook

    2004-01-01

    Pleural metastasis from malignancy is commonly combined with effusion. We report the ultrasonographic and CT findings in a rare case of micro-pleural metastasis without effusion. A 34-year-old male patient with lung cancer underwent video-assisted thoracoscopic surgery (VATS), prior to open thoracotomy. VATS revealed multiple metastatic micronodules on the pleura, which were overlooked on the preoperative CT scan. The HRCT images and chest ultrasonograms showed clear evidence of pleural micro-nodules

  5. Characteristics of Patients with Tuberculous Pleural Effusion in Rural Nepal

    OpenAIRE

    M S Paudel; Anjana Kafle; Bishal Khatri Chhetri; Sahadev Prasad Dhungana; Anuj Poudel; Shamsuddhin .

    2013-01-01

      Introduction: Tuberculosis (TB) is a major cause of mortality and morbidity in developing countries. Tubercular Pleural effusion is the second most common form of extra pulmonary tuberculosis (EPTB), superseded in Prevalence only by lymph node tuberculosis. Pleural effusion occurs in approximately 5% of patients with TB. The purpose of this study was to assess the demographic characteristics of patients presenting with pleural effusion in rural Nepal.   Methods: A retrospe...

  6. Micro-pleural Metastasis Without Effusion: CT and US Findings

    Energy Technology Data Exchange (ETDEWEB)

    Na, Hyoung Il; Yoo, Seung Min; Kim, Yang Soo; Lee, Hwa Yeon; Song, In Sup; Shim, Hyung Jin; Kwak, Byung Kook; Shin, Jong Wook [Chung-Ang University College of Medicine, Seoul (Korea, Republic of)

    2004-09-15

    Pleural metastasis from malignancy is commonly combined with effusion. We report the ultrasonographic and CT findings in a rare case of micro-pleural metastasis without effusion. A 34-year-old male patient with lung cancer underwent video-assisted thoracoscopic surgery (VATS), prior to open thoracotomy. VATS revealed multiple metastatic micronodules on the pleura, which were overlooked on the preoperative CT scan. The HRCT images and chest ultrasonograms showed clear evidence of pleural micro-nodules

  7. Ventriculo-pleural shunt patency study

    International Nuclear Information System (INIS)

    Yeates, K.

    2000-01-01

    Full text: A twenty-four year old male was admitted to hospital complaining of headaches, drowsiness and blurred vision. He suffered from congenital hydrocephalus and had had a ventriculo-peritoneal shunt inserted in infancy. This had undergone many revisions due to persistent peritoneal infections and had recently been replaced with a ventriculo-pleural shunt. The symptoms described suggested shunt blockage and he was referred for a Shunt Patency Study. The current shunt is a HAKIM Programmable Valve Shunt System and the opening pressure was 12cm of CSF (within the normal range). Forty megabecquerels of filtered 99 Tc m O 4 was injected into the pre-chamber of the shunt. Serial images and counts were obtained for twenty-five minutes after the injection. The images showed the tracer flowing from the shunt within the first ten minutes. At twenty minutes almost all of the tracer had drained from the shunt and was present in the right pleural cavity, indicating shunt patency. This study is presented to demonstrate the appearances of a normally functioning, but rarely seen Ventriculo-Pleural CSF Shunt. Copyright (2000) The Australian and New Zealand Society of Nuclear Medicine Inc

  8. The Pleural Mesothelium in Development and Disease

    Directory of Open Access Journals (Sweden)

    Hitesh eBatra

    2014-08-01

    Full Text Available The pleural mesothelium, derived from the embryonic mesoderm, is formed by a metabolically active monolayer of cells that blanket the chest wall and lungs on the parietal and visceral surfaces, respectively. The pleura and lungs are formed as a result of an intricate relationship between the mesoderm and the endoderm during development. Pleural Mesothelial Cells (PMCs are known to express Wilms tumor-1 (Wt1 gene and in lineage labeling studies of the developing embryo, PMCs were found to track into the lung parenchyma and undergo mesothelial-mesenchymal transition (MMT to form α-smooth muscle actin (α-SMA-positive cells of the mesenchyme and vasculature. There is definite evidence that mesothelial cells can differentiate and this seems to play an important role in pleural and parenchymal pathologies. Mesothelial cells can differentiate into adipocytes, chondrocytes and osteoblasts; and have been shown to clonally generate fibroblasts and smooth muscle cells in murine models. This supports the possibility that they may also modulate lung injury-repair by re-activation of developmental programs in the adult reflecting an altered recapitulation of development, with implications for regenerative biology of the lung.

  9. Pregnancy with bilateral tubercular pleural effusion: challenges.

    Science.gov (United States)

    Ahuja, Vanita; Gombar, Satinder; Kumar, Navneet; Goyal, Nitika; Gupta, Kanika

    2014-04-01

    Pulmonary tuberculosis (TB) during pregnancy mimics some of the physiological changes that occur during pregnancy. Diagnosis is challenging, especially when the patient presents with acute respiratory distress. The incidence of pleural effusion in TB is 3-25% and in the majority of patients, is unilateral. We describe the intensive care management of a 27-year-old pregnant woman admitted to our hospital with life threatening respiratory distress and circulatory shock. She continued to have severe metabolic and respiratory acidosis with shock in spite of the resuscitative measures undertaken. At that point, a bedside lung ultrasonography showed bilateral pleural effusion which was followed with therapeutic thoracocentesis of the right side. This resulted in the stabilization of the respiratory mechanics and haemodynamics of the patient. The pleural fluid culture tested positive for acid fast bacilli after 4 weeks in the intensive care unit. Anti-TB therapy was started and she made a rapid recovery with liberation from mechanical ventilation. The early use of bedside lung ultrasonography was instrumental in the successful management of this patient.

  10. Enfermedades con alteraciones de la circulación pulmonar

    OpenAIRE

    Suñé Ysamat, Bertila

    1982-01-01

    El edema pulmonar es el acúmulo de líquido seroso o serohemático en el exterior de los vasos. Cualquiera que sea su etiología, el mecanismo de producción es siempre el mismo: en primer lugar es intersticial; es decir, alrededor de los alveolos. Se traduce clínicamente por una aceleración de la frecuencia respiratoria. A medida que la extravasación de líquido aumenta, los alveolos se ven afectados por el edema. Al edema intersticial se le ha añadido el edema alveolar...

  11. Tabaco e morfologia: Doenças pulmonares

    Directory of Open Access Journals (Sweden)

    Lina Carvalho

    2007-05-01

    Full Text Available Resumo: O tabaco está implicado na carcinogénese multiorgâni-ca, com identificação de mais de cinquenta substâncias carcinogénicas que induzem mutações, alterando o ciclo celular, a resposta auto-imune e a regulação endócrina. É um dos nove factores identificados responsáveis por um terço de mortes por neoplasias malignas juntamente com erros dietéticos, obesidade, sedentarismo, consumo de álcool, promiscuidade sexual, toxicodependência e po-luição ambiental geral e limitada. Está implicado nas doenças cardiovasculares que representam a primeira causa de morte nos países civilizados e, no aparelho respiratório, é o factor principal para o desenvolvimento de DPOC (doença pulmonar obstrutiva crónica, RB-ILD (bron-quiolite respiratória e doença pulmonar intersticial, DIP (pneumonia intersticial descamativa, bronquiolite e fi-brose intersticial bronquiolocêntrica, histiocitose de células de Langerhans, pneumonia eosinofílica, sarcoidose, metaplasia epidermóide do epitélio respiratório e carcinoma bronco-pulmonar. O estado inflamatório crónico sistémico induzido pelo tabaco constitui a base de desenvolvimento de alterações genéticas também dependentes dos contaminantes do tabaco.Rev Port Pneumol 2007; XIII (3: 383-389 Abstract: Tobacco is implicated in multisystemic carcinogenesis through more than fifty identified carcinogenic metabolites that produce mutations responsible for alterations in cell cycle, immune response and endocrine regulation. Is one of nine risk factors identified in one third of cancer deaths together with obesity, sedentary, alcohol consumption, sexual promiscuity, drug addiction, and open and closed air contamination. Answering for cardiovascular diseases as the first cause of death in civilized world, tobacco is also pointed as the major factor implicated in the development of COPD (chronic obstructive pulmonary disease, RB-ILD (respira-tory bronchiolitis and interstitial lung disease

  12. Tabaco e morfologia: Doenças pulmonares

    Directory of Open Access Journals (Sweden)

    Lina Carvalho

    2007-05-01

    Full Text Available Resumo: O tabaco está implicado na carcinogénese multiorgânica, com identificação de mais de cinquenta substâncias carcinogénicas que induzem mutações, alterando o ciclo celular, a resposta auto-imune e a regulação endócrina. É um dos nove factores identificados responsáveis por um terço de mortes por neoplasias malignas juntamente com erros dietéticos, obesidade, sedentarismo, consumo de álcool, promiscuidade sexual, toxicodependência e poluição ambiental geral e limitada. Está implicado nas doenças cardiovasculares que representam a primeira causa de morte nos países civilizados e, no aparelho respiratório, é o factor principal para o desenvolvimento de DPOC (doença pulmonar obstrutiva crónica, RB-ILD (bronquiolite respiratória e doença pulmonar intersticial, DIP (pneumonia intersticial descamativa, bronquiolite e fibrose intersticial bronquiolocêntrica, histiocitose de células de Langerhans, pneumonia eosinofílica, sarcoidose, metaplasia epidermóide do epitélio respiratório e carcinoma bronco-pulmonar. O estado inflamatório crónico sistémico induzido pelo tabaco constitui a base de desenvolvimento de alterações genéticas também dependentes dos contaminantes do tabaco. Abstract: Tobacco is implicated in multisystemic carcinogenesis through more than fifty identified carcinogenic metabolites that produce mutations responsible for alterations in cell cycle, immune response and endocrine regulation. Is one of nine risk factors identified in one third of cancer deaths together with obesity, sedentary, alcohol consumption, sexual promiscuity, drug addiction, and open and closed air contamination. Answering for cardiovascular diseases as the first cause of death in civilized world, tobacco is also pointed as the major factor implicated in the development of COPD (chronic obstructive pulmonary disease, RB-ILD (respiratory bronchiolitis and interstitial lung disease, DIP (desquamative interstitial pneumonia

  13. Toracocentese e biópsia pleural Thoracentesis and pleural biopsy

    Directory of Open Access Journals (Sweden)

    Roberta Sales

    2006-08-01

    Full Text Available A toracocentese é o método de escolha para a obtenção de amostras de líquido pleural. Embora seja considerado um procedimento pouco invasivo, é fundamental que a toracocentese obedeça a uma técnica padronizada com a finalidade de aprimorar a chance de diagnóstico e minimizar riscos. A biópsia de pleura tem por objetivo ampliar e complementar a chance de diagnóstico das doenças pleurais, sendo indicada em casos selecionados.Thoracentesis is the method of choice for obtaining samples of pleural fluid. Although it is considered a minimum invasive procedure, it is crucial to follow a standardized technique with the purpose of optimizing the chance of diagnosis and minimizing risks. The pleura biopsy may enlarge and complement the chance of diagnosis of the pleural diseases and is indicated in selected cases.

  14. Vascular endothelial growth factor in diagnosis of pleural effusion

    Directory of Open Access Journals (Sweden)

    Nasr H. Khalil

    2017-01-01

    Conclusion: VEGF pleural fluid level could differentiate between malignant and non malignant effusion, while could not differentiate between tuberculous and nontuberculous, or between parapneumonic and nonparapneumonic exudative effusions.

  15. [Parapneumonic pleural effusion: difficulties in making therapeutic decisions].

    Science.gov (United States)

    Chudzicka, Aleksandra; Chciałowski, Andrzej

    2007-01-01

    Pneumonia is the second most common cause of pleural effusion. The presence of pleural fluid makes the prognosis in patients with pneumonia worse and causes a higher mortality rate. This is why it is very important to undertake suitable treatment as soon as possible. Most parapneumonic pleural effusions resolve with antibiotic alone, but sometimes more invasive treatment is necessary. Therapeutic decisions are based on different criteria. For many years determining biochemical fluid characteristics has been used for this purpose. Presentlythe usefullness of new parameters is being evaluated. Their application in diagnostics was possible thanks to better knowledge of mechanisms that participate in the development of parapneumonic pleural effusion.

  16. Contribution of positron emission tomography in pleural disease.

    Science.gov (United States)

    Duysinx, B; Corhay, J-L; Larock, M-P; Withofs, N; Bury, T; Hustinx, R; Louis, R

    2010-10-01

    Positron emission tomography (PET) now plays a clear role in oncology, especially in chest tumours. We discuss the value of metabolic imaging in characterising pleural pathology in the light of our own experience and review the literature. PET is particularly useful in characterising malignant pleural pathologies and is a factor of prognosis in mesothelioma. Metabolic imaging also provides clinical information for staging lung cancer, in researching the primary tumour in metastatic pleurisy and in monitoring chronic or recurrent pleural pathologies. PET should therefore be considered as a useful tool in the diagnosis of liquid or solid pleural pathologies. Copyright © 2010 SPLF. Published by Elsevier Masson SAS. All rights reserved.

  17. Mechanical coupling and liquid exchanges in the pleural space.

    Science.gov (United States)

    Agostoni, E; Zocchi, L

    1998-06-01

    The pleural space provides the mechanical coupling between lung and chest wall: two views about this coupling are reported and discussed. Information on volume, composition, thickness, and pressure of the pleural liquid under physiologic conditions in a few species is provided. The Starling pressures of the parietal pleura filtering liquid into pleural space, and those of the visceral pleura absorbing liquid from the space are considered along with the permeability of the mesothelium. Information on the lymphatic drainage through the parietal pleura and on the solute-coupled liquid absorption from the pleural space under physiologic conditions and with various kinds of hydrothorax are provided.

  18. Malignant pleural mesothelioma in a 13-year-old girl

    Energy Technology Data Exchange (ETDEWEB)

    Goyal, M.; Konez, O.; Patel, D. [Department of Radiology, Children' s Hospital Medical Center of Akron, OH (United States); Department of Radiology, Aultman Hospital, Canton, OH (United States); Swanson, K.F.; Vyas, P.K. [Department of Radiology, Children' s Hospital Medical Center of Akron, OH (United States)

    2000-11-01

    Pleural mesothelioma is an uncommon tumor in all age groups, but is especially rare in childhood. We describe the clinical and radiological features of malignant pleural mesothelioma in a 13-year-old girl. The chest radiograph showed nearly complete opacification and loss of volume in the left hemithorax. Computed tomography demonstrated a large pleural effusion centrally surrounded by a thick enhancing rind of soft tissue. The radiological features of childhood pleural mesothelioma in our case were similar to those described in adults with this disease. (orig.)

  19. Malignant pleural mesothelioma in a 13-year-old girl

    International Nuclear Information System (INIS)

    Goyal, M.; Konez, O.; Patel, D.; Swanson, K.F.; Vyas, P.K.

    2000-01-01

    Pleural mesothelioma is an uncommon tumor in all age groups, but is especially rare in childhood. We describe the clinical and radiological features of malignant pleural mesothelioma in a 13-year-old girl. The chest radiograph showed nearly complete opacification and loss of volume in the left hemithorax. Computed tomography demonstrated a large pleural effusion centrally surrounded by a thick enhancing rind of soft tissue. The radiological features of childhood pleural mesothelioma in our case were similar to those described in adults with this disease. (orig.)

  20. The effect of changing the contact surface area between pleural liquid and pleura on the turnover of pleural liquid.

    Science.gov (United States)

    Nakamura, T; Hara, H; Ijima, F; Arai, T; Kira, S

    1984-03-01

    To study the dynamics of pleural liquid, 250 ml of saline labeled with markers were injected into the pleural cavity of anesthetized dogs. For 3 h, liquid volume and concentration of these markers were measured. In a control group of dogs, the turnover rate of pleural liquid was 19.6 +/- 5.6 ml/min and lymphatic flow was 0.58 +/- 0.07 ml/min. In a group of pneumonectomized dogs, the turnover rate and lymphatic flow fell to about one fourth of those in the control group. When the left pulmonary artery was occluded, the turnover rate was halved, but lymphatic flow was not significantly different from that in the control group. These results suggest that the turnover rate of pleural liquid is dependent on the area of contact between pleural liquid and pleura and on the blood flow of the pleura. In addition, it appears that changes in pleural liquid volume are dependent on lymphatic flow.

  1. Diffusion-weighted MR imaging of pleural fluid: differentiation of transudative vs exudative pleural effusions

    International Nuclear Information System (INIS)

    Baysal, T.; Bulut, T.; Dusak, A.; Dogan, M.; Goekirmak, M.; Kalkan, S.

    2004-01-01

    The aim of this study was to evaluate the ability of diffusion-weighted MRI in differentiating transudative from exudative pleural effusions. Fifty-seven patients with pleural effusion were studied. Diffusion-weighted imaging (DWI) was performed with an echo-planar imaging (EPI) sequence (b values 0, 1000 s/mm 2 ) in 52 patients. The apparent diffusion coefficient (ADC) values were reconstructed from three different regions. Subsequently, thoracentesis was performed and the pleural fluid was analyzed. Laboratory results revealed 20 transudative and 32 exudative effusions. Transudates had a mean ADC value of 3.42±0.76 x 10 -3 mm 2 /s. Exudates had a mean ADC value of 3.18±1.82 x 10 -3 mm 2 /s. The optimum cutoff point for ADC values was 3.38 x 10 -3 mm 2 /s with a sensitivity of 90.6% and specificity of 85%. A significant negative correlation was seen between ADC values and pleural fluid protein, albumin concentrations and lactate dehydrogenase (LDH) measurements (r=-0.69, -0.66, and -0.46, respectively; p<0.01). The positive predictive value, negative predictive value, and diagnostic accuracy of ADC values were determined to be 90.6, 85, and 88.5%, respectively. The application of diffusion gradients to analyze pleural fluid may be an alternative to the thoracentesis. Non-invasive characterization of a pleural effusion by means of DWI with single-shot EPI technique may obviate the need for thoracentesis with its associated patient morbidity. (orig.)

  2. The Management of Delayed Post-Pneumonectomy Broncho-Pleural Fistula and Esophago-Pleural Fistula

    Directory of Open Access Journals (Sweden)

    Dongsub Noh

    2016-04-01

    Full Text Available Broncho-pleural fistula (BPF and esophago-pleural fistula (EPF after pulmonary resection are challenging to manage. BPF is controlled by irrigation and sterilization, but such therapy is not sufficient to promote closure of EPF, which usually requires surgical management. However, it is generally difficult to select an appropriate surgical method for closure of BPF and EPF. Here, we report a case of concomitant BPF and EPF after left completion pneumonectomy, in which both fistulas were closed through a right thoracotomy.

  3. Metastização pulmonar na apresentação de angiossarcoma cardíaco – Caso clínico e discussão

    Directory of Open Access Journals (Sweden)

    Vítor Fonseca

    2009-11-01

    Full Text Available Resumo: Apresenta-se um caso clínico referente a doente de 35 anos, do sexo masculino sem antecedentes pessoais relevantes, admitido no serviço de urgência por quadro de toracalgia e tosse produtiva com alterações electrocardiográficas sugestivas de pericardite. Inicialmente admitido pelo Serviço de Cardiologia, com melhoria do quadro clínico após terapêutica anti-inflamatória; contudo, no internamento houve como intercorrência pneumonia de provável etiologia bacteriana, complicada por derrame pleural. Após a alta, foi referenciado à consulta de pneumologia, onde se manteve o estudo etiológico do derrame persistente, tendo vindo a complicar-se o seu quadro com alterações das cavidades cardiacas e múltiplos nódulos pulmonares, sugestivos de endocardite subaguda com embolização séptica pulmonar. Internado no serviço de Pneumologia e submetido a videotoracoscopia, foi-lhe diagnosticado angiossarcoma cardíaco com metastização pulmonar. Assistiu-se a uma rápida evolução do quadro clínico, quase fulminante, com falência cardíaca e óbito do doente sem ter iniciado radioterapia ou quimioterapia adjuvante.Rev Port Pneumol 2009; XV (6: 1175-1184 Abstract: We present a case report of a 35 year-old male without any relevant former pathology admitted to the emergency room with atypical chest pain, cough and sputum with ECG changes suggesting pericarditis. He was initially admitted to the cardiology ward and experienced clinical improvement after initiating anti-inflammatory treatment. As intercurrence he had bacterial origin pneumonia complicated by pleural effusion (PE. After discharge patient was referred to a pulmonology appointment where aetiological investigation of the PE was instigated. Investigation revealed changes in the cardiac cavities and multiple lung nodules, suggesting subacute endocarditis with septic pulmonary embolism. Admitted to the

  4. Cell origins and diagnostic accuracy of interleukin 27 in pleural effusions.

    Directory of Open Access Journals (Sweden)

    Wei-Bing Yang

    Full Text Available The objective of the present study was to investigate the presence of interleukin (IL-27 in pleural effusions and to evaluate the diagnostic significance of pleural IL-27. The concentrations of IL-27 were determined in pleural fluids and sera from 68 patients with tuberculous pleural effusion, 63 malignant pleural effusion, 22 infectious pleural effusion, and 21 transudative pleural effusion. Flow cytometry was used to identify which pleural cell types expressed IL-27. It was found that the concentrations of pleural IL-27 in tuberculous group were significantly higher than those in malignant, infectious, and transudative groups, respectively. Pleural CD4(+ T cells, CD8(+ T cells, NK cells, NKT cells, B cells, monocytes, macrophages, and mesothelial cells might be the cell sources for IL-27. IL-27 levels could be used for diagnostic purpose for tuberculous pleural effusion, with the cut off value of 1,007 ng/L, IL-27 had a sensitivity of 92.7% and specificity of 99.1% for differential diagnosing tuberculous pleural effusion from non-tuberculous pleural effusions. Therefore, compared to non-tuberculous pleural effusions, IL-27 appeared to be increased in tuberculous pleural effusion. IL-27 in pleural fluid is a sensitive and specific biomarker for the differential diagnosing tuberculous pleural effusion from pleural effusions with the other causes.

  5. Osteocondromatose em gato: relato de caso

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    S. Winter

    Full Text Available RESUMO A osteocondromatose é caracterizada por nódulos únicos ou múltiplos decorrentes de um crescimento ósseo excessivo benigno. É encontrada em cães, gatos, equinos e humanos. Em felinos, tem maior incidência dos dois aos quatro anos de idade. A etiologia em gatos está relacionada ao vírus da leucemia felina, e também já foi encontrada relação com o fibrossarcoma. A manifestação clínica depende do local acometido e do tamanho da lesão. O diagnóstico definitivo é por meio de histopatologia e o prognóstico é desfavorável, pois ocorrem muitas recidivas. Este relato de caso objetiva descrever a apresentação dessa enfermidade em um felino jovem.

  6. Hipomelanose de Ito - relato de um caso

    Directory of Open Access Journals (Sweden)

    Adriana S. de Almeida

    2001-02-01

    Full Text Available Objetivo: Os autores têm como objetivo relatar um caso de hipomelanose de Ito (HI, uma síndrome neurocutânea rara, com alterações neurológicas e cromossômicas associadas ao comprometimento cutâneo e pneumonias de repetição. Relato do caso: Este relato é referente a um paciente masculino, 1 ano e 11 meses, internado no Hospital Universitário São Vicente de Paulo por broncopneumonia bilateral. Ao exame foram observadas máculas hipocrômicas na pele compatíveis com HI, além de atraso do desenvolvimento neuropsicomotor. O paciente foi submetido à biópsia incisional de pele das lesões do abdômen, eletroencefalograma, ressonância magnética e estudo citogenético. Resultados: Os exames histológico e imunoistoquímico evidenciaram ausência de melanina e diminuição de melanócitos em áreas focais da epiderme, respectivamente. O eletroencefalograma apresentou disfunção córtico-subcortical difusa. A ressonância magnética do encéfalo foi compatível com cisto aracnoídeo em região temporal. O cariótipo evidenciou mosaicismo cromossômico com uma linhagem normal (46,XY e uma linhagem celular que apresentava deleção intersticial nas bandas 22.2 - 24.2 do braço longo do cromossomo 10 (25%. Conclusões: Os autores, com o presente estudo, destacam a importância das lesões de pele na definição etiológica das desordens neuropediátricas.

  7. A new diagnostic approach for bilious pleural effusion.

    Science.gov (United States)

    Saraya, Takeshi; Light, Richard W; Sakuma, Sho; Nakamoto, Yasuo; Wada, Shoko; Ishida, Manabu; Inui, Toshiya; Koide, Takashi; Ishii, Haruyuki; Takizawa, Hajime

    2016-09-01

    Bilious pleural effusion is an extremely rare condition associated with liver diseases, subphrenic or subhepatic abscess formation, biliary peritonitis, and invasive procedures (i.e., percutaneous biliary drainage or liver biopsy). The current diagnostic test is based on the measurement of the ratio of pleural total bilirubin to serum total bilirubin, which is greater than 1 in patients with bilious pleural effusion. Given the low incidence of bilious pleural effusion, the precise diagnostic yield of this ratio based test has not been evaluated. We retrospectively reviewed the medical records of our institution and searched the PubMed database for reports of bilious pleural effusion. We identified a total of 12 cases of bilious pleural effusion (9 from 8 Pubmed reports and 3 from our institutional records). The factors causing this condition were broadly classified into three categories based on the pathophysiology: 1) liver diseases (echinococcosis, tuberculosis and amebiasis); 2) subhepatic/subphrenic abscess or biliary peritonitis, with or without biliary tract obstruction; and 3) iatrogenic disease after percutaneous biliary drainage and/or liver biopsy. The sensitivity of detection was 76.9% when the ratio of pleural total bilirubin to serum total bilirubin was greater than 1. The sensitivity increased to 100% when a combination test including pleural glycoholic acid was adopted. This study demonstrates the high diagnostic yield for bilious pleural effusion using a combination of two test criteria; a ratio of pleural total bilirubin to serum total bilirubin greater than 1 and the presence of pleural glycoholic acid. Copyright © 2016 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.

  8. Biomarcadores de lesión miocárdica y edema pulmonar de las alturas

    OpenAIRE

    Uribe, Hellen C.; Linares, Gerardo; Cortés, Luis A.

    2014-01-01

    El edema pulmonar de las alturas es una entidad potencialmente fatal que se presenta en individuos que ascienden rápidamente por encima de 2.500 msnm. La hipoxia, el deterioro de la clase funcional y la dificultad respiratoria son el resultado de un edema pulmonar no cardiogénico. En este caso clínico de edema pulmonar de las alturas se encontró elevación de biomarcadores de lesión miocárdica y de sobrecarga de presión, sin compromiso estructural cardiaco o coronario, hallazgo que no ha sido ...

  9. Doença de Castleman associada a derrame pleural Castleman's disease accompanied by pleural effusion

    Directory of Open Access Journals (Sweden)

    Valéria Góes Ferreira Pinheiro

    2008-08-01

    Full Text Available A doença de Castleman é uma rara afecção do tecido linfóide. Relatamos o caso de uma paciente do sexo feminino com otosclerose bilateral, sem sintomas respiratórios e com achado incidental de derrame pleural esquerdo em uma radiografia de tórax. A tomografia computadorizada de tórax revelou uma massa mediastinal. A biópsia demonstrou tratar-se de variante plasmocitária da doença de Castleman. A paciente foi submetida à ressecção da massa mediastinal. Houve regressão do derrame, o qual persistiu como pequena loculação no espaço pleural esquerdo.Castleman's disease is a rare disorder of the lymphoid tissue. We report the case of a female patient with bilateral otosclerosis, no respiratory symptoms, and pleural effusion discovered as an incidental finding on a chest X-ray. Computed tomography of the chest revealed a mediastinal mass. The biopsy findings demonstrated that it was a plasmacytic variant of Castleman's disease. The patient underwent mediastinal mass resection. This resulted in near-total resolution of the effusion, which remained as a small loculation within the left pleural space.

  10. High IL-35 pleural expression in patients with tuberculous pleural effusion.

    Science.gov (United States)

    Dong, Xuan; Yang, Jiong

    2015-05-03

    IL-35 is a novel anti-inflammatory and immunosuppressive cytokine primarily produced by Treg cells, and is involved in inflammatory diseases and autoimmune diseases. However, its roles in tuberculous pleural effusion (TPE) remain unknown. We aimed to investigate the potential involvement of IL-35 in TPE. Thirty TPE patients and 20 lung cancer patients with malignant pleural effusion (MPE) were recruited. Samples of pleural effusion (100 mL) were collected after traditional pleurocentesis. Blood was sampled from TPE patients. Mononuclear cells were isolated by Ficoll-Hypaque gradient. Proportions of Th1, Th17, and IL-35-producing cells were analyzed by flow cytometry. IL-35 was assessed by real-time RT-PCR, ELISA, and immunofluorescence. An ELISPOT assay was used to assess the effect of IL-35 on pleural effusion mononuclear cells (PEMCs). Proportions of IL-35-producing cells were higher in TPE compared with MPE (49.4±6.0 vs. 15.8±5.4%, Ppleural tissues from TPE patients. Results suggest that there is an imbalance in IL-35 metabolism in TPE. However, further studies are required to assess the exact relationship with the immune system response to tuberculosis. IL-35 might play a role in TPE and might be targeted as a treatment for TPE.

  11. Malignant pleural effusion from papillary thyroid carcinoma diagnosed by pleural effusion cytology: A case report.

    Science.gov (United States)

    Kosmas, Konstantinos; Tsonou, Anna; Mitropoulou, Georgia; Salemi, Eufrosyni; Kazi, Danai; Theofanopoulou, Ageliki

    2018-02-01

    Papillary thyroid carcinoma (PTC) is by far the most common thyroid malignancy (over 85%) of all the thyroid cancers. It has excellent prognosis and 10-year survival rate in most of the cases (95%). Most of the tumors are indolent and do not recur or metastasize after removal. However, widespread metastases to lung, skeleton, central nervous system and, occasionally, other organs may be observed. In rare instances, this disease may metastasize to the pleura and manifest as a malignant pleural effusion (MPE) and portend poor prognosis. This article reports the cytomorphologic and immunocytochemical findings of a female patient with a symptomatic pleural effusion resulting from PTC metastatic to the pleura. Pleural fluid cytology revealed abundant papillary clusters with relatively nuclear pleomorphism, intranuclear cytoplasmic inclusions and nuclear grooves, small and distinct nucleoli as well as small discrete vacuoles. Psammoma bodies were not seen. Immunocytochemical staining was positive for TGB, EMA, Ber-EP4, CK19, and negative for TTF-1. Metastasis of PTC to pleural fluid is extremely rare and diagnosing the disease by cytology is challenging and requires medical expertise as well as knowledge of clinical context and immunocytochemical staining. Additionally, a cytologic diagnosis of MPE due to PTC provides important treatment information and plays an important role in prognosis. © 2017 Wiley Periodicals, Inc.

  12. The accuracy of pleural ultrasonography in diagnosing complicated parapneumonic pleural effusions.

    Science.gov (United States)

    Svigals, Philip Z; Chopra, Amit; Ravenel, James G; Nietert, Paul J; Huggins, John T

    2017-01-01

    We compared the accuracy of pleural ultrasound versus chest CT versus chest radiograph (CXR) to determine radiographic complexity in predicting a complicated parapneumonic effusion (CPPE) defined by pleural fluid analysis. 66 patients with parapneumonic effusions were identified with complete data. Pleural ultrasound had a sensitivity of 69.2% (95% CI 48.2% to 85.7%) and specificity of 90.0% (95% CI 76.3% to 97.2%). Chest CT had a sensitivity of 76.9% (95% CI 56.3% to 91.0%) and specificity of 65.0% (95% CI 48.3% to 79.4%). CXR had a sensitivity of 61.5% (95% CI 40.6% to 79.8%) and specificity of 60.0% (95% CI 43.3% to 75.1%). Pleural ultrasound appears to be a superior modality to rule in a CPPE when compared with chest CT and CXR. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  13. DIAGNOSTIC VALUE OF CYTOLOGICAL EXAMINATION OF PLEURAL FLUID IN TUBERCULOSIS

    Directory of Open Access Journals (Sweden)

    Iffat Jamal

    2018-01-01

    Full Text Available BACKGROUND Tuberculosis is a worldwide health problem with highest incidence in developing countries like India. It involves a large number of organs including lungs, pleural lymph nodes, genital sytem, gastrointestinal tract, etc. In resource poor countries, cytological examination of pleural fluid serves as a rapid, effective, economical and easy method of diagnosing tubercuolus pleural effusions, which can be correlated with other newer ancillary techniques. MATERIALS AND METHODS The present study was conducted on 100 patients coming to Patna Medical College and Hospital, Patna, over a period of two years from August 2012 to September 2014 with clinical complaints of cough, fever and chest pain with a clinical diagnosis of tuberculous pleural effusion. RESULTS Pleural tapping was done and detailed cytological examination of pleural fluid was done and its findings were correlated with gross, biochemical and microbiological findings. Both wet fixed (Giemsa stained and air-dried slides (Papanicolaou stained were prepared and microscopic examination was done. Special stains like Ziehl-Neelsen stain (ZN stain for acid-fast bacilli was also performed for confirmation. CONCLUSION Cytological smears revealed predominance of lymphocytes. Mesothelial cells were absent or nearly absent. Eosinophils followed mesothelial cell pattern and were absent in a relatively large number of cases. This technique is safe, reliable, cost-effective and can be used for diagnostic purposes. It is also less traumatic as compared to pleural biopsy. Cytological examination when combined with other newer diagnostic test increases the chances of accurate diagnosis of tuberculous pleural effusion.

  14. High pleural fluid adenosine deaminase levels: A valuable tool for ...

    African Journals Online (AJOL)

    To determine the positive predictive value (PPV) of FADA, the frequent causes of FPs in our laboratory and the demographic characteristics of tuberculous pleural effusions (TPEs) and non-tuberculous pleural effusions (NTPEs). Methods. High FADA results generated in the past year were extracted with corresponding TB ...

  15. Pleural drainage and pleurodesis: implementation of guidelines in four hospitals.

    NARCIS (Netherlands)

    Burgers, J.A.; Kunst, P.W.; Koolen, M.G.; Willems, L.N.; Burgers, J.S.

    2008-01-01

    The aim of the present study was to evaluate the implementation of the 2003 Dutch guideline on the diagnosis and treatment of malignant pleural effusions, and the potential effect of the implementation on the clinical outcome of pleurodesis. All patients with malignant pleural effusion who had a

  16. Pleural drainage and pleurodesis: implementation of guidelines in four hospitals

    NARCIS (Netherlands)

    Burgers, J. A.; Kunst, P. W. A.; Koolen, M. G. J.; Willems, L. N. A.; Burgers, J. S.; van den Heuvel, M.

    2008-01-01

    The aim of the present study was to evaluate the implementation of the 2003 Dutch guideline on the diagnosis and treatment of malignant pleural effusions, and the potential effect of the implementation on the clinical outcome of pleurodesis. All patients with malignant pleural effusion who had a

  17. Recurrent Exudative Pleural Effusion with Flare up of Chronic ...

    African Journals Online (AJOL)

    We describe herein a young male patient who presented with exudative pleural effusion that appeared with flare up of chronic HBV infection and spontaneously recovered with the clinical and biochemical improvement of the hepatitis on two occasions five months apart. Other causes of hepatitis and exudative pleural ...

  18. Asbestos-related diffuse pleural thickening.

    Science.gov (United States)

    Fujimoto, Nobukazu; Kato, Katsuya; Usami, Ikuji; Sakai, Fumikazu; Tokuyama, Takeshi; Hayashi, Seiji; Miyamoto, Kenji; Kishimoto, Takumi

    2014-01-01

    The clinical features of asbestos-related diffuse pleural thickening (DPT) remain unclear. To clarify the association between radiological findings of DPT and respiratory function. Medical data from patients with asbestos-related DPT were collected, including their history of occupational or neighborhood asbestos exposure, initial symptoms, modified Medical Research Council dyspnea grade, smoking history, radiological findings, and respiratory function test results. There were 106 DPT patients between 2005 and 2010 [i.e. 103 men (97.2%) and 3 women (2.8%)]. The median age at diagnosis was 69 years (range 46-88). Patient occupations related to asbestos exposure included: asbestos product manufacturing (n = 17); the shipbuilding industry (n = 14); the construction industry (n = 13); heat insulation work (n = 12); plumbing, asbestos spraying, and electrical work (n = 7 each), and transportation and demolition work (n = 4 each). The median duration of asbestos exposure was 25 years (range 2-54), and the median latency period before the onset of DPT was 46 years (range 25-66). Involvement of the costophrenic angle (CPA) was also negatively correlated with the percent vital capacity (%VC; r = -0.448, p < 0.01). Pleural thickness and the craniocaudal and horizontal extension of pleural thickening, as determined by chest computed tomography (CT), were also negatively correlated with %VC (r = -0.226, p < 0.05; r = -0.409, p < 0.01, and r = -0.408, p < 0.01, respectively). DPT develops after a long latency period following occupational asbestos exposure and causes marked respiratory dysfunction. The extension of DPT should be evaluated by chest CT, and chest X-ray would be important for the evaluation of the involvement of the CPA.

  19. Volúmenes pulmonares normales en pacientes con fibrosis pulmonar idiopática y enfisema Normal lung volumes in patients with idiopathic pulmonary fibrosis and emphysema

    Directory of Open Access Journals (Sweden)

    Juan Pablo Casas

    2008-08-01

    Full Text Available La fibrosis pulmonar idiopática (FPI es una enfermedad que se caracteriza por presentar un compromiso pulmonar de tipo restrictivo, resultante de una reducción en la complacencia pulmonar secundaria a fibrosis difusa. En el enfisema, la pérdida de elasticidad pulmonar y el colapso de las vías aéreas periféricas generan obstrucción e hiperinflación. El efecto simultáneo que ambas enfermedades producen sobre la fisiología pulmonar no es del todo claro y se han descripto volúmenes pulmonares normales o casi normales. Presentamos 4 pacientes de sexo masculino de 64, 60, 73 y 70 años, con antecedentes de tabaquismo e historia de disnea progresiva, tres de ellos con grave limitación en su calidad de vida al momento de la consulta. En la tomografía de tórax de alta resolución todos los pacientes presentaban signos de enfermedad intersticial pulmonar avanzada, con cambios de tipo fibrótico con predominio basal y subpleural, que coexistían con enfisema centroacinar con predominio en lóbulos superiores. Uno de ellos tuvo confirmación diagnóstica de ambas condicioes por biopsia pulmonar a cielo abierto. En los cuatro pacientes la espirometría y volúmenes pulmonares fueron normales, pero tenían importante compromiso del intercambio gaseoso evaluado mediante el test de caminata de 6 minutos. Tres de los pacientes tenían hipertensión pulmonar grave diagnosticado por ecocardiograma. La presencia de volúmenes pulmonares normales no excluye un diagnóstico de fibrosis pulmonar idiopática en pacientes fumadores si coexisten evidencias tomográficas de enfisema. En estos pacientes el grado de compromiso funcional, determinado por la reducción de los volúmenes pulmonares, no debería ser considerado en la evaluación de la gravedad.Pulmonary function tests in idiopathic pulmonary fibrosis characteristically show a restrictive pattern, resulting from reduction of pulmonary compliance due to diffuse fibrosis. Conversely, an obstructive

  20. Anestesia para paciente portador da equência de moebius: relato de caso Anestesia para Paciente Portador de la Secuencia de Moebius: relato de Caso Anesthesia in a patient with moebius sequence: case report

    Directory of Open Access Journals (Sweden)

    Adriano Bechara de Souza Hobaika

    2009-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A sequência de Moebius (SM é uma rara paralisia do VI e VII nervos cranianos. Alterações craniofaciais estão presentes em aproximadamente 90% destes pacientes, o que pode tornar a intubação traqueal muito difícil. RELATO DO CASO: Paciente do sexo masculino, 2 anos e 5 meses, portador de SM, submetido à broncoscopia flexível para avaliação de laringotraqueomalácia. Comorbidades: crises de broncoespasmo e comunicação interventricular. Realizou-se indução anestésica com sevoflurano em O2 a 100% e venóclise. Introduziu-se máscara laríngea AMBU® número 2,5 e o fibrobroncoscópio foi introduzido através da mesma. O procedimento foi realizado sem complicações e a broncoscopia revelou-se normal. O paciente recebeu alta para casa após duas horas. CONCLUSÕES: O controle das vias aéreas é o grande desafio nestes pacientes, havendo relato de falha ou dificuldade de intubação em 13 pacientes de uma série de 41 casos analisados. Micrognatia, retrognatia, hipoplasia mandibular e fenda palatina são algumas características destes pacientes. Em outra grande série com 106 anestesias em pacientes com SM há descrição do uso da máscara laríngea em um caso. Parece não haver contra-indicação a realizar o procedimento em regime ambulatorial. Há relato de aspiração pulmonar e obstrução respiratória na sala de recuperação devido à dificuldade em deglutir e eliminar as secreções da boca e recomenda-se administrar antisialogogos.JUSTIFICATIVA Y OBJETIVOS: La secuencia de Moebius (SM es una rara parálisis del VI y VII nervios cranianos. Las alteraciones craneofaciales están presentes en aproximadamente un 90% de esos pacientes, lo que puede hacer con que la intubación traqueal sea muy difícil. RELATO DEL CASO: Paciente del sexo masculino, 2 años y 5 meses, portador de SM, sometido a la broncoscopia flexible para la evaluación de laringotraqueomalacia. Comorbidades: crisis de broncoespasmo

  1. Localized malignant pleural mesothelioma: report of two cases.

    Science.gov (United States)

    Tanzi, Silvia; Tiseo, Marcello; Internullo, Eveline; Cacciani, Giancarlo; Capra, Roberto; Carbognani, Paolo; Rusca, Michele; Rindi, Guido; Ardizzoni, Andrea

    2009-08-01

    Localized malignant pleural mesothelioma is very rare tumor disease. There are sporadic reports in the literature showing that this entity has a different biologic behavior compared with diffuse pleural mesothelioma. We report two cases of radically resected localized pleural malignant mesothelioma, with a previous history of asbestos exposure. Both cases showed a microscopic and immunohistochemical findings of malignant mesothelioma, biphasic and sarcomatoid lympho-histiocitoid variant type, respectively, without evidence of diffuse pleural spread. The first is very peculiar case of bilateral localized malignant pleural mesothelioma with complete response to chemotherapy and localized late recurrence, radically resected and treated with adjuvant radiotherapy. The second case revealed as a solitary localized mass, underwent a complete en bloc resection and adjuvant radiotherapy. Both cases demonstrate that the localized malignant mesothelioma should be distinguished from diffuse form and that complete resection is associated with good prognosis.

  2. Management of Pleural Effusion, Empyema, and Lung Abscess

    Science.gov (United States)

    Yu, Hyeon

    2011-01-01

    Pleural effusion is an accumulation of fluid in the pleural space that is classified as transudate or exudate according to its composition and underlying pathophysiology. Empyema is defined by purulent fluid collection in the pleural space, which is most commonly caused by pneumonia. A lung abscess, on the other hand, is a parenchymal necrosis with confined cavitation that results from a pulmonary infection. Pleural effusion, empyema, and lung abscess are commonly encountered clinical problems that increase mortality. These conditions have traditionally been managed by antibiotics or surgical placement of a large drainage tube. However, as the efficacy of minimally invasive interventional procedures has been well established, image-guided small percutaneous drainage tubes have been considered as the mainstay of treatment for patients with pleural fluid collections or a lung abscess. In this article, the technical aspects of image-guided interventions, indications, expected benefits, and complications are discussed and the published literature is reviewed. PMID:22379278

  3. [Eosinophilic pleural effusion possibly induced by fibrin sealant].

    Science.gov (United States)

    Kambayashi, Takatoyo; Suzuki, Takashi

    2012-02-01

    A 74-year-old man underwent right upper lobectomy for the lung cancer and bullectomy of right lower lobe. Fibrin sealant was used for sealing the excision line. The increase of the pleural effusion with increasing C-reactive protein( CRP) and eosinophilia was noted at the 17th day after the operation. The pleural effusion was transparent and yellowish colored suggesting transudatory liquid. The eosinophil in the pleural effusion was as high as 14%. The drainage of the pleural effusion was performed for 2 days resulting in disappearing the abnormal accumulation without any additional treatment. The cause of pleural effusion was supposed to be fibrin sealant by a positive result of the drug lymphocyte stimulation test.

  4. Endometrial carcinoma with pleural metastasis: A case report.

    Science.gov (United States)

    Semczuk, Andrzej; Skomra, Danuta; Rybojad, Pawel; Jeczeń, Ryszard; Rechberger, Tomasz

    2006-01-01

    There have been a limited number of studies giving the incidence of pleural metastasis from female genital tract tumors. An unusual case occurred of recurrent pleural malignant effusion associated with disseminated serous papillary endometrial adenocarcinoma (EC). A total abdominal hysterectomy with bilateral salpingo-oophorectomy, pelvic lymphadenectomy, appendectomy and omentectomy was performed. Treatment of the pleural malignant effusion consisted of thoracotomy with partial decortication, systemic chemotherapy and radiotherapy. The patient died of circulatory failure 8 months after the primary diagnosis. Although the pleura is a rare site of widespread EC, one should recognize the possibility of pleural spread from female genital tract neoplasms presenting with associated symptoms. Cytopathologic examination of the pleural effusion and the finding ofcarcinoma cells mandate an investigation for the primary site of the neoplasm by a multidisciplinary group.

  5. Recommendations of diagnosis and treatment of pleural effusion. Update.

    Science.gov (United States)

    Villena Garrido, Victoria; Cases Viedma, Enrique; Fernández Villar, Alberto; de Pablo Gafas, Alicia; Pérez Rodríguez, Esteban; Porcel Pérez, José Manuel; Rodríguez Panadero, Francisco; Ruiz Martínez, Carlos; Salvatierra Velázquez, Angel; Valdés Cuadrado, Luis

    2014-06-01

    Although during the last few years there have been several important changes in the diagnostic or therapeutic methods, pleural effusion is still one of the diseases that the respiratory specialist have to evaluate frequently. The aim of this paper is to update the knowledge about pleural effusions, rather than to review the causes of pleural diseases exhaustively. These recommendations have a longer extension for the subjects with a direct clinical usefulness, but a slight update of other pleural diseases has been also included. Among the main scientific advantages are included the thoracic ultrasonography, the intrapleural fibrinolytics, the pleurodesis agents, or the new pleural drainages techniques. Copyright © 2013 SEPAR. Published by Elsevier Espana. All rights reserved.

  6. Duodenal Metastasis of Malignant Pleural Mesothelioma

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    Huang-Chi Chen

    2008-12-01

    Full Text Available Metastatic malignant mesothelioma of the pleura is uncommon at the time of initial diagnosis. The gastrointestinal lumen is rarely found at autopsy in patients with widespread disease. Here, we describe an extremely rare case of isolated duodenal metastasis of sarcomatoid mesothelioma of the pleura in a 73-year-old man, without memory of any direct exposure to asbestos. The possibility of gastrointestinal tract metastasis should be considered in the presence of anemia or positive occult blood test in patients with malignant pleural mesothelioma.

  7. Image-guided pleural biopsy: diagnostic yield and complications

    International Nuclear Information System (INIS)

    Benamore, R.E.; Scott, K.; Richards, C.J.; Entwisle, J.J.

    2006-01-01

    Background: Pleural biopsy and cytology are standard procedures for the investigation of pleural disease. Recent medical literature has suggested that image-guided pleural biopsy shows improved sensitivity for the diagnosis of pleural malignancy, when compared with the more commonly performed reverse bevel needle biopsy such as Abrams' needle. In our centre there has been an increasing trend towards performing image-guided pleural biopsies, and to our knowledge there is no large published series documenting the complication rate and diagnostic yield. Methods: The radiology and pathology databases were searched for all image-guided [computed tomography (CT) and ultrasound (US)] pleural biopsies from January 2001 to December 2004. All imaging and histology were reviewed, and final diagnostic information about patients was obtained from the respiratory multidisciplinary team database and patient notes. A record was made of complications following biopsy, presence of pleura in the biopsy, and adequacy of tissue for histological diagnosis. Results: A total of 82 patients underwent 85 image-guided pleural biopsies over a 4-year period. 80 cases were performed under CT and five under US guidance. The rate of new pneumothorax detected by chest radiography was 4.7%. No patient required a chest drain or blood transfusion to treat complications. In 10 (12%) cases, there was inadequate tissue to reach a confident histological diagnosis and in eight (9%) of these, no pleura was present. Assuming all suspicious and inadequate biopsies are treated as benign, which is the worst case scenario, image-guided pleural biopsy has a sensitivity and specificity of 76% and 100%, respectively, for the diagnosis of malignant disease. Conclusions: Image-guided pleural biopsy is a safe procedure with few associated complications and has a higher sensitivity than previously published series for reverse cutting needle biopsy in the diagnosis of malignant pleural disease

  8. Image-guided pleural biopsy: diagnostic yield and complications

    Energy Technology Data Exchange (ETDEWEB)

    Benamore, R.E. [Department of Radiology and Department of Histopathology, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester (United Kingdom)]. E-mail: rachelbenamore@doctors.org.uk; Scott, K. [Department of Radiology and Department of Histopathology, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester (United Kingdom); Richards, C.J. [Department of Radiology and Department of Histopathology, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester (United Kingdom); Entwisle, J.J. [Department of Radiology and Department of Histopathology, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester (United Kingdom)

    2006-08-15

    Background: Pleural biopsy and cytology are standard procedures for the investigation of pleural disease. Recent medical literature has suggested that image-guided pleural biopsy shows improved sensitivity for the diagnosis of pleural malignancy, when compared with the more commonly performed reverse bevel needle biopsy such as Abrams' needle. In our centre there has been an increasing trend towards performing image-guided pleural biopsies, and to our knowledge there is no large published series documenting the complication rate and diagnostic yield. Methods: The radiology and pathology databases were searched for all image-guided [computed tomography (CT) and ultrasound (US)] pleural biopsies from January 2001 to December 2004. All imaging and histology were reviewed, and final diagnostic information about patients was obtained from the respiratory multidisciplinary team database and patient notes. A record was made of complications following biopsy, presence of pleura in the biopsy, and adequacy of tissue for histological diagnosis. Results: A total of 82 patients underwent 85 image-guided pleural biopsies over a 4-year period. 80 cases were performed under CT and five under US guidance. The rate of new pneumothorax detected by chest radiography was 4.7%. No patient required a chest drain or blood transfusion to treat complications. In 10 (12%) cases, there was inadequate tissue to reach a confident histological diagnosis and in eight (9%) of these, no pleura was present. Assuming all suspicious and inadequate biopsies are treated as benign, which is the worst case scenario, image-guided pleural biopsy has a sensitivity and specificity of 76% and 100%, respectively, for the diagnosis of malignant disease. Conclusions: Image-guided pleural biopsy is a safe procedure with few associated complications and has a higher sensitivity than previously published series for reverse cutting needle biopsy in the diagnosis of malignant pleural disease.

  9. Prognostic impact of pleural effusion in acute pulmonary embolism.

    Science.gov (United States)

    Kiris, Tuncay; Yazıcı, Selçuk; Koc, Ali; Köprülü, Cinar; Ilke Akyildiz, Zehra; Karaca, Mustafa; Nazli, Cem; Dogan, Abdullah

    2017-07-01

    Background Pulmonary embolism (PE) is a common and life-threatening condition associated with considerable morbidity and mortality. Pleural effusion occurs in about one in three cases; however, data on its prognostic value are scarce. Purpose To investigate the association between pleural effusion and both 30-day and long-term mortality in patients with acute PE. Material and Methods We retrospectively evaluated 463 patients diagnosed with acute PE using computed tomography pulmonary angiography (CTPA). Echocardiographic, demographic, and laboratory data were collected. The study population was divided into two groups: patients with and without pleural effusions. Pleural effusion detected on CT was graded as small, moderate, and large according to the amount of effusion. The predictors of 30-day and long-term total mortality were analyzed. Results Pleural effusions were found in 120 patients (25.9%). After the 30-day follow-up, all-cause mortality was higher in acute PE patients with pleural effusions than in those without (23% versus 9%, P pleural effusions had significantly higher incidence of long-term total mortality than those without pleural effusions (55% versus 23%, P pleural effusion was an independent predictor of 30-day and long-term mortality (odds ratio [OR], 2.154; 95% confidence interval [CI], 1.186-3.913; P = 0.012 and OR, 1.591; 95% CI, 1.129-2.243; P = 0.008, respectively). Conclusion Pleural effusion can be independently associated with both 30-day and long-term mortality in patients with acute PE.

  10. Envolvimento pulmonar na polimiosite Pulmonary disease in polymyositis

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    Direndra Hasmucrai

    2010-08-01

    Full Text Available Introdução: A polimiosite (PM e a dermatomiosite são classificadas como miopatias inflamatórias idiopáticas. O envolvimento pulmonar por PM é pouco frequente, estando descrito na literatura em cerca de 10% de casos. Os autores apresentam um caso de uma mulher de 75 anos, com queixas de febre, perda ponderal, artralgias, mialgias e diminuição simétrica e proximal da força muscular com impotência funcional dos membros superiores e inferiores, com início um mês antes do internamento. Apresentava infiltrados pulmonares na telerradiografia de tórax. Após estudo exaustivo estabeleceu -se o diagnóstico de envolvimento pulmonar na forma de pneumonia organizativa por PM. Efectuou-se corticoterapia e terapêutica com micofenolato com melhoria clínica, analítica e radiológica. Conclusão: Neste caso, foi a alteração na telerradiografia de tórax numa doente sem sintomatologia respiratória que levou ao estudo exaustivo até ao diagnóstico de PM, realçando mais uma vez a importância da telerradiografia no rastreio de patologias de outros foros.Introduction: Polymyositis and dermatomyositis are classified as idiopathic inflammatory myopathies. Interstitial lung disease is rare and is described in the literature in about 10% of cases. The authors describes a case of 75 year old woman presenting with one month evolution of fever, weight loss, arthralgia, myalgia and symmetric and proximal muscle weakness of upper and lower limbs. Nonspecific interstitial changes was found in chest X -ray. After exhaustive study, the diagnosis of pulmonary envolvement in the form of organizing pneumonia by polymyositis, was established. Glucocorticoids and mycophenolate were prescribed with good clinical, analytical and radiological outcome. Conclusion: In this case, it was the changes in the chest X -ray in a patient without respiratory symptomatology, that conducted to exhaustive study to polymyositis diagnosis, enhancing once again the importance of X

  11. Capacidad del diagnostico clínico presuntivo y validez del estudio del exudado pleural en pacientes con derrame pleural inespecífico

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    Edgar Antonio Flórez

    1998-07-01

    Full Text Available To identify the validity of clinical diagnostic and the analysis of pleural exudate in the diagnosis of inespecific pleural effusion, we reviewed the clinical records of 40 adults, 61% (24 male and 16 female with an average age of 45 ± 17 years. Pleural biopsy was the gold standard. The clinical diagnosis were: pleural metastatic cancer (34% and pleural tuberculosis (TBC (27%. Pleural effusions where: lymphocitic (68%, neutrofilic (27% and eosinofilic (5%. Histologic types  inespecific cronic pleuritis (56.1% pleural TBC (22% and pleural metastatic cancer (12.2%. The comparision test show for pleural TBC a Kappa: 0.47, for pleural cancer was (Kappa low: 0.18. The validity tests show for pleural The the greater sensitivity for the Iymphocitic count (44% and the greater specificity was for the eosinotilic count (97% for pleural metastatic cancer the best sensitivity was for neutrofilic exudate (60% and the greater percentage of specificity (97% was for eosinofilic predominium. The predictive positive value for metastatic cancer and THC was (50% and (60% respectively the odds ratio between the pleural exudate and pleural biopsy for metastatic cancer and THC was probably casual.

  12. Empiema pleural no tuberculoso: resultados en el Hospital «Abel Santamaría Cuadrado» (2000 a 2004 Non-tuberculous pleural empyema: results in “Abel Santamaría Cuadrado” Hospital (2000-2004

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    Ivanis Ruizcalderón Cabrera

    2007-03-01

    Full Text Available El empiema pleural es una enfermedad infecciosa de incidencia moderada en nuestro medio, de diagnóstico fácil y de tratamiento exitoso cuando se logra descubrir a tiempo. Sin embargo, su persistencia determina la aparición de secuelas con impacto importante en la morbilidad y mortalidad del paciente. Realizamos un estudio retrospectivo, transversal y descriptivo en el que se hace una evaluación del tratamiento de los pacientes con empiema pleural no tuberculoso tratados en el Servicio de Cirugía General del Hospital «Abel Santamaría Cuadrado» entre enero de 2000 y diciembre de 2004. En una muestra de 34 pacientes fueron estudiadas las variables: edad, sexo, causa, gérmenes, tratamiento adoptado. Se observó que el grupo de edad más afectado fue el de 41 a 60 años (17 pacientes; 50 % y sobre todo, los pacientes del sexo masculino (82,4 %, con una relación de 3,8:1. En el 61,8 % de los pacientes se encontraron enfermedades pulmonares asociadas y los gérmenes patógenos más frecuentes fueron el Staphylococcus aureus (29,4 % y el Streptococcus pneumoniae(20,6 %. El mayor porcentaje de los casos fue resuelto mediante cirugía torácica videoasistida (32,4 %. La mayoría de los pacientes llegó a los servicios quirúrgicos en las fases avanzadas de la afección y se apreció un incremento de los cultivos mixtos de gérmenes patógenos. El tratamiento más agresivo de las colecciones purulentas fue el de mejor resultado

  13. RAQUITISMO HIPOFOSFATÊMICO: RELATO DE CASO

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    Marta Liliane de Almeida Maia

    2018-03-01

    Full Text Available RESUMO Objetivo: O raquitismo hipofosfatêmico precisa ser precocemente diagnosticado porque seu tratamento previne sequelas incapacitantes. Este relato alerta para a doença. Relato de caso: Relato de perfil metabólico, depuração de creatinina, estado nutricional e desenvolvimento pôndero-estatural de paciente com características clínico-laboratoriais de raquitismo hipofosfatêmico, atendido em ambulatório de tubulopatias por período de 12 meses. Chegou ao serviço após tempo prolongado acamado, dependente de ventilação mecânica e com perfil metabólico ósseo alterado. Terapêutica consistiu na administração de fósforo (inicial: 65 mg/kg/dia, final: 24,2 mg/kg/dia, cálcio (inicial: 127 mg/kg/dia, final: 48,4 mg/kg/dia e calcitriol (inicial: 0,06 mcg/kg/dia, final: 0,03 mcg/kg/dia, e a análise constou da descrição das consultas, utilizando-se mediana de exames laboratoriais e dados antropométricos. Observou-se nítida melhora inicial do padrão respiratório do paciente, que evoluiu com ventilação espontânea e deambulação autônoma; com exames laboratoriais: cálcio (mg/dL inicial 7,1, final 10,1; fósforo (mg/dL inicial 1,7, final 3,2; magnésio (mg/dL inicial 1,5, final 2,1; paratormônio (pg/L inicial 85,8, final 52,7; fosfatase alcalina (UI/L inicial 12660, final 938; e melhora do desenvolvimento pôndero-estatural (escore Z: E/I inicial: -6,05, final -3,64; P/I: inicial -2,92, final -1,57 com presença de litíase transitória. A depuração de creatinina (mL/min/1,73 m2sc foi constante durante o seguimento. O tratamento propiciou benefícios clínicos, bioquímicos e nutricionais, mas, apesar da boa resposta inicial, a família abandonou o seguimento por dois anos, apresentando o paciente piora da deambulação e das deformidades esqueléticas. Comentários: Não apenas diagnóstico precoce é necessário, como também a adesão ao tratamento é fundamental para o sucesso na condução dessa patologia.

  14. Does selective pleural irradiation of malignant pleural mesothelioma allow radiation dose escalation. A planning study

    Energy Technology Data Exchange (ETDEWEB)

    Botticella, A.; Defraene, G. [KU Leuven - University of Leuven, Department of Oncology, Experimental Radiation Oncology, Leuven (Belgium); Nackaerts, K. [KU Leuven - University of Leuven, University Hospitals Leuven, Department of Respiratory Medicine, Leuven (Belgium); Deroose, C. [KU Leuven - University of Leuven, University Hospitals Leuven, Nuclear Medicine, Leuven (Belgium); Coolen, J. [KU Leuven - University of Leuven, University Hospitals Leuven, Radiology Department, Leuven (Belgium); Nafteux, P. [University Hospitals Leuven, Department of Thoracic Surgery, Leuven (Belgium); Vanstraelen, B. [University Hospitals Leuven, Department of Radiation Oncology, Leuven (Belgium); Joosten, S.; Michiels, L.A.W. [Fontys University of Applied Science, Institute Paramedical Studies, Medical Imaging and Radiotherapeutic Techniques, Eindhoven (Netherlands); Peeters, S. [KU Leuven - University of Leuven, Department of Oncology, Experimental Radiation Oncology, Leuven (Belgium); University Hospitals Leuven, Department of Radiation Oncology, Leuven (Belgium); Ruysscher, D. de [KU Leuven - University of Leuven, Department of Oncology, Experimental Radiation Oncology, Leuven (Belgium); Maastricht University Medical Center, GROW - School for Oncology and Developmental Biology, Department of Radiation Oncology (MAASTRO Clinic), Maastricht (Netherlands)

    2017-04-15

    After lung-sparing radiotherapy for malignant pleural mesothelioma (MPM), local failure at sites of previous gross disease represents the dominant form of failure. Our aim is to investigate if selective irradiation of the gross pleural disease only can allow dose escalation. In all, 12 consecutive stage I-IV MPM patients (6 left-sided and 6 right-sided) were retrospectively identified and included. A magnetic resonance imaging-based pleural gross tumor volume (GTV) was contoured. Two sets of planning target volumes (PTV) were generated for each patient: (1) a ''selective'' PTV (S-PTV), originating from a 5-mm isotropic expansion from the GTV and (2) an ''elective'' PTV (E-PTV), originating from a 5-mm isotropic expansion from the whole ipsilateral pleural space. Two sets of volumetric modulated arc therapy (VMAT) treatment plans were generated: a ''selective'' pleural irradiation plan (SPI plan) and an ''elective'' pleural irradiation plan (EPI plan, planned with a simultaneous integrated boost technique [SIB]). In the SPI plans, the average median dose to the S-PTV was 53.6 Gy (range 41-63.6 Gy). In 4 of 12 patients, it was possible to escalate the dose to the S-PTV to >58 Gy. In the EPI plans, the average median doses to the E-PTV and to the S-PTV were 48.6 Gy (range 38.5-58.7) and 49 Gy (range 38.6-59.5 Gy), respectively. No significant dose escalation was achievable. The omission of the elective irradiation of the whole ipsilateral pleural space allowed dose escalation from 49 Gy to more than 58 Gy in 4 of 12 chemonaive MPM patients. This strategy may form the basis for nonsurgical radical combined modality treatment of MPM. (orig.) [German] Beim malignen Pleuramesotheliom (MPM) ist nach lungenschonender Radiotherapie das lokale Scheitern an Stellen eines frueheren, sichtbaren Tumors die dominierende Form des Scheiterns. Unser Ziel ist es, zu untersuchen, ob die selektive

  15. Cierre percutáneo de fístulas coronario-pulmonares en el adulto

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    Pedro Trujillo, MD

    2014-01-01

    Full Text Available El cierre percutáneo de las fístulas coronario-pulmonares con implante de “coils” es eficaz y pueden realizarlo los cardiólogos intervencionistas de adultos. Se presentan tres casos clínicos de cierre percutáneo exitoso de fístulas coronario-pulmonares con implante de “coils”.

  16. Fusariosis como nódulo pulmonar solitario.

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    Nelson Moreno

    2008-07-01

    Full Text Available Las micosis invasivas son causa común de morbilidad y mortalidad en pacientes inmunosuprimidos. De éstas las más importantes en frecuencia son la Aspergilosis y la Fusariosis, ambas agrupadas bajo el término de Hialohifomicosis. Uno de los órganos afectados con mayor frecuencia es el pulmón. Desafortunadamente las manifestaciones clínicas son inespecíficas como la tos, el dolor pleurítico y la hemoptisis. Radiológicamente puede presentar desde infiltrados difusos, hasta lesiones nodulares o cavitaciones. Este es el primer informe en Colombia de un nódulo pulmonar único por hongos del género Fusarium en una paciente inmunocompetente.

  17. Una mirada general a las enfermedades pulmonares intersticiales y una específica a la fibrosis pulmonar idiopática

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    Pedro J. Marcos

    2013-03-01

    Full Text Available Las enfermedades pulmonares intersticiales difusas (EPID engloban un conjunto heterogéneo de patologías caracterizadas por afectar predominantemente al intersticio pulmonar, que es el espacio anatómico comprendido entre lasmembranas basales del epitelio alveolar y el endotelio capilar. Con frecuencia se observa un retraso en el diagnósticode las EPID. La falta de especificidad de los síntomas y el escaso uso de técnicas diagnósticas como es la espirometría en los primeros niveles asistenciales, hacen que sea bastante frecuente que los clínicos achaquen los síntomasrespiratorios del paciente a entidades más prevalentes comoes la enfermedad pulmonar obstructiva crónica (EPOC

  18. Failure Patterns After Hemithoracic Pleural Intensity Modulated Radiation Therapy for Malignant Pleural Mesothelioma

    Energy Technology Data Exchange (ETDEWEB)

    Rimner, Andreas, E-mail: rimnera@mskcc.org [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Spratt, Daniel E. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Zauderer, Marjorie G. [Department of Medicine, Thoracic Oncology Service, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, New York, New York (United States); Rosenzweig, Kenneth E. [Department of Radiation Oncology, Mount Sinai Medical Center, New York, New York (United States); Wu, Abraham J.; Foster, Amanda [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Yorke, Ellen D. [Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Adusumilli, Prasad; Rusch, Valerie W. [Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Krug, Lee M. [Department of Medicine, Thoracic Oncology Service, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, New York, New York (United States)

    2014-10-01

    Purpose: We previously reported our technique for delivering intensity modulated radiation therapy (IMRT) to the entire pleura while attempting to spare the lung in patients with malignant pleural mesothelioma (MPM). Herein, we report a detailed pattern-of-failure analysis in patients with MPM who were unresectable or underwent pleurectomy/decortication (P/D), uniformly treated with hemithoracic pleural IMRT. Methods and Materials: Sixty-seven patients with MPM were treated with definitive or adjuvant hemithoracic pleural IMRT between November 2004 and May 2013. Pretreatment imaging, treatment plans, and posttreatment imaging were retrospectively reviewed to determine failure location(s). Failures were categorized as in-field (within the 90% isodose line), marginal (<90% and ≥50% isodose lines), out-of-field (outside the 50% isodose line), or distant. Results: The median follow-up was 24 months from diagnosis and the median time to in-field local failure from the end of RT was 10 months. Forty-three in-field local failures (64%) were found with a 1- and 2-year actuarial failure rate of 56% and 74%, respectively. For patients who underwent P/D versus those who received a partial pleurectomy or were deemed unresectable, the median time to in-field local failure was 14 months versus 6 months, respectively, with 1- and 2-year actuarial in-field local failure rates of 43% and 60% versus 66% and 83%, respectively (P=.03). There were 13 marginal failures (19%). Five of the marginal failures (38%) were located within the costomediastinal recess. Marginal failures decreased with increasing institutional experience (P=.04). Twenty-five patients (37%) had out-of-field failures. Distant failures occurred in 32 patients (48%). Conclusions: After hemithoracic pleural IMRT, local failure remains the dominant form of failure pattern. Patients treated with adjuvant hemithoracic pleural IMRT after P/D experience a significantly longer time to local and distant failure than

  19. Ventana torácica en el tratamiento del empiema pleural crónico en el Hospital Nacional Cayetano Heredia, 1990-1998

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    Rosalba Lupe Maekawa Ykehara

    2002-07-01

    Full Text Available Objetivo: Describir los resultados de la ventana torácica en el manejo del empiema pleural. Pacientes y métodos: Estudio descriptivo, retrospectivo y transversal. Se incluyeron pacientes sometidos a ventana torácica (toracostomía entre 1990-1998, en el Hospital Nacional Cayetano Heredia. Se estudió el tratamiento quirúrgico (técnica, hallazgos y complicaciones, morbilidad y mortalidad. De los 59 casos estudiados 39 (66.1% fueron varones y 20 (33.9% mujeres. La edad promedio fue 30.9 ± 14 años. Resultados: Según la etiología, 55.93% tuvieron empiema pleural tuberculoso, 28.81% empiema post cirugía pulmonar, 11.86% empiema post neumónico y 3.39% empiema por traumatismo. El 95% de los casos fueron previamente drenados con tubo de toracostomía. El patrón radiológico predominante fue el hidroneumotórax (58%. El 64.4% fueron intervenidos bajo anestesia regional. El tiempo promedio operatorio fue de 57.3 ± 28 minutos. Los arcos costales resecados con más frecuencia fueron el 6°-7° (25%. El tiempo promedio de hospitalización fue 38.6 ± 26.9 días, el tiempo promedio postoperatorio fue 8.5 ± 8.3 días. De los pacientes que tuvieron un seguimiento mayor a 3 meses (33 pacientes, se pudo confirmar el cierre de la ventana torácica en 13 casos y reexpansión pulmonar en 21 casos. Conclusiones: La indicación principal fue la falta de respuesta al tubo de toracostomía de drenaje (40%. La etiología principal es el empiema pleural tuberculoso. Es un procedimiento ideal para pacientes severamente comprometidos e inmunosuprimidos. Las complicaciones postoperatorias fueron 11.86%. El porcentaje de reoperaciones fue de 3.4%. No se encontró mortalidad asociada al procedimiento. (Rev Med Hered 2002; 13: 90-98.

  20. Variáveis capnográficas pré e pós-tromboendarterectomias pulmonares Pre and post-pulmonary thromboendarterectomies campnographic variables

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    Marcos Mello Moreira

    2007-12-01

    Full Text Available Este relato de dois casos com os resultados da fração tardia de espaço morto (fDlate, fração do espaço morto alveolar end-tidal (AVDSf, gradiente artério-alveolar de CO2 [P(a-etCO2] e slope da fase 3 do espirograma, submetidos à tromboendarterectomia pulmonar por tromboembolismo pulmonar (TEP. O TEP foi diagnosticado pela cintilografia pulmonar, tomografia helicoidal computadorizada e por arteriografia pulmonar. O cálculo da fDlate, AVDSf e P(a-etCO2 baseou-se na capnografia volumétrica associada à gasometria arterial. A fDlate préoperatória do primeiro paciente foi de 0,16 (cutoff de 0,12 e a AVDSf = 0,30 (cutoff de 0,15. Já a fDlate do segundo paciente resultou falso-negativa (0,01, embora a AVDSf resultasse positiva (0,28. A fDlate pós-operatória do primeiro paciente foi de -0,04 e a AVDSf de 0,16; a fDlate do segundo paciente foi de 0,07 e a AVDSf = 0,28. A associação destas variáveis com os exames por imagem reforça a importância deste método como ferramenta diagnóstica não-invasiva no diagnóstico de TEP.In these case report, the results of late dead space fraction (fDlate, end-tidal alveolar dead space fraction (AVDSf, arterial-alveolar gradient CO2 [P(a-etCO2], and slope phase 3 of spirogram of two patients who underwent thromboendarterectomy for pulmonary embolism (PE are shown. PE was diagnosed by pulmonary scintigraphy, helical tomography, and pulmonary angiography. The calculation of fDlate, AVDSf and P(a-etCO2 was based on volumetric capnography associated with arterial blood gas analysis. The pre-operative fDlate of the first patient was 0.16 (cutoff 0.12 and AVDSf was 0.30 (cutoff 0.15. However, the fDlate of the second patient was false-negative (0.01 but, the AVDSf was positive (0.28. Postoperative fDlate of the first patient was -0.04 and AVDSf was 0.16; for the second patient, the values were 0.07 and 0.28, respectively. The association of these capnographic variables with image exams reinforces the

  1. Findings and use of CT for pleural empyemas

    International Nuclear Information System (INIS)

    Kirsch, E.; Gueckel, C.; Kaim, A.; Steinbrich, W.

    1994-01-01

    Chest radiographs and CT images of 25 patients with pleural empyemas were compared retrospectively with those of 20 patients with pleural exudates and transdudates in order to determine criteria for differential diagnosis and to define the place of CT in the diagnosis of pleural empyemas. The sign which was most suggestive of an empyema on a chest radiograph was an encapsulated effusion in an atypical position (18/25); this was found in only 4 out of 20 exudates and in none of the transudates. On CT, changes in the pleura, the subcostal tissues and the configuration and position of the fluid were suggestive of an empyema. In nearly all patients with a pleural empyema there was thickening and increased contrast uptake of the parietal pleura (22/25) and thickening and increased density oft the subcostal tissues (23/25). Usually, empyemas were encapsulated and biconvex (20/25). None of the patients with pleural transudates showed any of these changes. In the presence of some pleural exudates, pleural (14/20) or thoracic (11/20) changes were noted. In part, these changes were due to previous treatment (sclerotherapy) or tumour infiltration (7/20). An attempt to correlate the CT findings with changes in the pleura and subcostal tissues with the clinical empyema stages I-III, according to Light, showed that CT was unable to distinguish between early and late empyemas. Consequently, diagnostic aspiration remains necessary for correct treatment. (orig.) [de

  2. Role of aquaporin and sodium channel in pleural water movement.

    Science.gov (United States)

    Jiang, Jinjun; Hu, Jie; Bai, Chunxue

    2003-12-16

    The role of the ENaC sodium channel and aquaporin-1 (AQP1) water channel on pleural fluid dynamics in mice was investigated. 0.25 ml of hypertonic or isosmolar fluid was infused into the pleural space in anesthetized wildtype and AQP1 null mice. Pleural fluid was sampled at specified times to quantify the osmolality and volume. The sodium channel activator terbutaline increased isosmolar fluid clearance by 90% while the sodium channel inhibitor amiloride decreased it by 15%, but had no effect on osmotically driven water transport. AQP1 deletion significantly decreased osmotic water transport in pleural space by twofold, but it had no effect on isosmolar fluid clearance. Pretreatment with dexamethasone increased pleural osmotic fluid entry by 25%, while intravenous injection of HgCl2 decreased osmotic pleural water movement by 43%. These results provided evidence for a role of a sodium channel in pleural fluid absorption; AQP1 plays a major role in osmotic liquid transport but it does not affect isosmolar fluid clearance.

  3. Allergic bronchopulmonary aspergillosis: a rare cause of pleural effusion.

    LENUS (Irish Health Repository)

    O'Connor, T M

    2012-02-03

    Aspergillus fumigatus is one of the most ubiquitous of the airborne saprophytic fungi. Allergic bronchopulmonary aspergillosis (ABPA) is a syndrome seen in patients with asthma and cystic fibrosis, and is characterized by hypersensitivity to chronic colonization of the airways with A. fumigatus. We report the case of a patient with ABPA presenting with pleural effusion. A 27-year-old male was referred with recurrent right pleural effusion. Past medical history was remarkable for asthma, allergic sinusitis, and recurrent pleurisy. Investigations revealed peripheral eosinophilia with elevated serum immunoglobulin E and bilateral pleural effusions with bilateral upper lobe proximal bronchiectasis. Precipitating serum antibodies to A. fumigatus were positive and the A. fumigatus immediate skin test yielded a positive reaction. A diagnosis of ABPA associated with bilateral pleural effusions was made and the patient was commenced on prednisolone. At review, the patient\\'s symptoms had considerably improved and his pleural effusions had resolved. ABPA may present with diverse atypical syndromes, including paratracheal and hilar adenopathy, obstructive lung collapse, pneumothorax and bronchopleural fistula, and allergic sinusitis. Allergic bronchopulmonary aspergillosis is a rare cause of pleural effusion and must be considered in the differential diagnosis of patients presenting with a pleural effusion, in particular those with a history of asthma.

  4. Differential diagnosis of tuberculous pleural effusion and malignant

    International Nuclear Information System (INIS)

    Na, Eui Sung; Kim, Young Nam; Lee, Mee Ran; Oh, Yu Whan; Kang, Eun Young

    1997-01-01

    The purpose of this study is to evaluate the diagnostic accuracy of CT in the differential diagnosis of tuberculous and malignant pleural effusion whether or not lung lesions are present, and to investigate the CT findings used for this differential diagnosis. This study involved 30 patients with tuberculous pleural effusion (mean age, 44.6 years; M : F = 19:11) and 20 with malignant pleural effusion (mean age, 57.2 years; M: F=10:10). All 50 patients underwent enhanced CT chest scans, and the respective conditions were pathologically confirmed. Two radiologists unaware of the pathologic results and distributions of patients reviewed these scans, CT findings of pleural effusions, their diagnoses, and the degree of confidence of their diagnoses. In most cases, CT provided correct differential diagnosis between tuberculous and malignant pleural effusion. It can help determine the nature of associated lung and pleural lesions, and specific findings of the latter, and can accurately differentiate tuberculous and malignant pleural effusion. (author). 20 refs., 3 tabs., 5 figs

  5. Comunicación de un caso de malformación arteriovenosa pulmonar en la adolescencia

    OpenAIRE

    Flores Hernández, Salomón Sergio; González Zamora, José Francisco; Carrasco Daza, Daniel; González Flores, María de Lourdes

    2006-01-01

    Las malformaciones arteriovenosas pulmonares (MA VP) son comunicaciones anormales entre las arterias y las venas pulmonares. Las MAVP, están caracterizadas por cortocircuitos de derecha a izquierda de grado variable y el efecto de estas comunicaciones depende del tamaño de los vasos involucrados. Puede presentarse hipoxemia, hipocratismo digital y poliglobulia secundario al cortocircuito intrapulmonar. Presentamos el caso de un paciente femenino de 14 años de edad con MA VP pulmonar, cuyos ha...

  6. Clinical value of jointly detection serum lactate dehydrogenase/pleural fluid adenosine deaminase and pleural fluid carcinoembryonic antigen in the identification of malignant pleural effusion.

    Science.gov (United States)

    Zhang, Fan; Hu, Lijuan; Wang, Junjun; Chen, Jian; Chen, Jie; Wang, Yumin

    2017-09-01

    Limited data are available for the diagnostic value, and for the diagnostic sensitivity and specificity of joint detection of serum lactate dehydrogenase (sLDH)/pleural fluid adenosine deaminase (pADA) and pleural fluid carcinoembryonic antigen (pCEA) in malignant pleural effusion (MPE). We collected 987 pleural effusion specimens (of which 318 were malignant pleural effusion, 374 were tubercular pleural effusion, and 295 were parapneumonic effusion specimens) from the First Affiliated Hospital of Wenzhou Medical University from July 2012 to March 2016. The pADA, sLDH, pleural fluid LDH (pLDH), serum C-reactive protein (sCRP), pleural fluid protein, pCEA, white blood cell (WBC), and red blood cell (RBC) were analyzed, and the clinical data of each group were collected for statistical analysis. The level of sLDH/pADA, pCEA, and RBC from the MPE group was markedly higher than the tuberculosis pleural effusion (TB) group (Mann-Whitney U=28422.000, 9278.000, 30518, P=.000, .000, .000) and the parapneumonic pleural fluid group (Mann-Whitney U=5972.500, 7113.000, 36750.500, P=.000, .000, .000). The receiver operating characteristic curve ROC showed that the area under the ROC curve (AUC) (=0.924, 0.841) of pCEA and sLDH/pADA (cutoff=4.9, 10.6) were significantly higher than other markers for the diagnosis of MPE. Thus, joint detection of pCEA and sLDH/pADA suggested that the sensitivity, specificity, and AUC was 0.94, 81.70, and 94.32 at the cutoff 0.16 and diagnostic performance was higher than pCEA or sLDH/pADA. Joint detection of sLDH/pADA and pCEA can be used as a good indicator for the identification of benign and MPE with higher sensitivity and specificity than pCEA or sLDH/pADA. © 2016 Wiley Periodicals, Inc.

  7. Intrapleural agents for pleural infection: fibrinolytics and beyond.

    Science.gov (United States)

    Rahman, Najib M

    2012-07-01

    Pleural infection is a common, increasing clinical problem with a high morbidity and mortality. Medical management of pleural infection often fails, requiring invasive thoracic surgery to drain infected pleural collections, and for many years intrapleural agents have been assessed to reduce the need for surgical drainage and improve clinical outcomes. Randomized trials assessing intrapleural fibrinolytic agents have given conflicting results, and recent evidence provides important information on the role of intrapleural agents in the treatment of pleural infection, and the possible biology associated with infection progression in these patients. Pleural infection is increasing in both the adult and paediatric populations. The combined previous evidence assessing intrapleural fibrinolytics alone in pleural infection suggests lack of efficacy for clinically important outcomes. The Multi-Centre Intrapleural Sepsis Trial 2 (MIST2) study provides the first evidence of a novel treatment combination [intrapleural tissue plasminogen activator (tPA) combined with intrapleural deoxyribonuclease (DNase)], which significantly improves the chest radiograph compared with either agent alone or placebo, and has potentially important benefits to important clinical outcomes (need for surgery and hospital stay). The precise mechanism of action of combination fibrinolytic and DNase in pleural infection is speculative. Fibrinolytic therapy alone has not been proven to be of use in the treatment of pleural infection. The MIST2 study provides clear-cut evidence demonstrating improved chest radiographs, and highly suggestive secondary outcomes suggesting improved clinically important outcomes, using a combination of intrapleural tPA and DNase. This novel treatment combination may represent an important step in our understanding and treatment of pleural infection; however, larger clinical studies specifically addressing important clinical outcomes and further laboratory research describing

  8. NEUMOTÓRAX ESPONTÁNEO ASOCIADO A FIBROSIS PULMONAR EN UN PACIENTE CON NEUROFIBROMATOSIS TIPO 2

    Directory of Open Access Journals (Sweden)

    Gabriel Alcalá Cerra

    2010-04-01

    Full Text Available El compromiso pulmonar en pacientes con neurofibromatosis ha sido reiteradamente descrito como una complicación muy rara en la variedad tipo 1. Se caracteriza por enfermedad pulmonar intersticial difusa, fibrosis pulmonar, neoplasias torácicas y formación de bulas, estas últimas, con alto riesgo de ruptura. Describimos un caso de neumotórax espontáneo en una paciente con neurofibromatosis tipo 2, como consecuencia de cambios fibróticos pulmonares. A nuestro conocimiento, esta asociación no había sido reportada.

  9. Value of the lateral view in diagnosing pleural plaques

    International Nuclear Information System (INIS)

    Hillerdal, G.

    1986-01-01

    To assess the value of the lateral view in the diagnosis of pleural plaques, 2018 chest roentgenograms from the general population were scrutinized for such plaques. The lateral and posterior-anterior (PA) views were read separately and without knowledge of the occupational history or other clinical data. Of the males, 4.8% had pleural plaques in the PA view and 2% had dorsal pleural plaques in the lateral view. A total of 54% of the positive cases in the PA view also showed typical plaques in the PA view. Thus, there remained a number of cases which were diagnosed only in the lateral view; in all, these constituted 18.8%

  10. Development of a Novel Alginate-Based Pleural Sealant

    Science.gov (United States)

    2016-07-01

    thoracotomy is performed on a anesthetized ventilated live rat (a), an incision is made to induce pleural air leak (b), and sealant material [ liquid ...AWARD NUMBER: W81XWH-15-1-0107 TITLE: Development of a Novel Alginate-Based Pleural Sealant PRINCIPAL INVESTIGATOR: Daniel J. Weiss MD PhD...SUBTITLE Development of a Novel Alginate-Based Pleural Sealant 5a. CONTRACT NUMBER 5b. GRANT NUMBER W81XWH-15-1-0107 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR

  11. X-ray appearance of anaerobic pulmonary and pleural lesions

    International Nuclear Information System (INIS)

    Ishchenko, B.I.; Kochetkov, A.V.; Stolbovoj, A.V.

    1984-01-01

    The authors describe a clinical and X-ray appearance of the suppurative affections of the lungs and pleural empyemas in 57 patients. Extensive one- or two-lobar affections, massive necrosis of the pulmonary tissue in the form of single focal destructions or multiple cavities of different sizes in the presence of extensive pneumonic infiltration, frequent development of pyopneumothorax as a complication are typical of anaerobic pulmonary processes. The signs of the anaerobic nature of pleural empyemas are fast division of the pleural cavity into separate chambers, gas formation with the presence of several horizontal levels of liquid

  12. Limbic Encephalitis Driven by a Pleural Mesothelioma: A Paraneoplastic Complication

    Directory of Open Access Journals (Sweden)

    Jacob O. Day

    2016-10-01

    Full Text Available Paraneoplastic neurological syndromes have only been described with pleural mesothelioma in five cases. We have described a 72-year-old man who developed anterograde amnesia 27 months after diagnosis of epithelioid pleural mesothelioma. Investigations revealed a limbic encephalitis with no alternative causes identified. Limbic encephalitis is a classical paraneoplastic syndrome and presentation within five years of a cancer with no other causes identified is sufficient to diagnose a paraneoplastic etiology. This is the first case of isolated paraneoplastic limbic encephalitis driven by a pleural mesothelioma.

  13. Derrame pleural como debut de síndrome linfoproliferativo

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    Ochoa Ramírez Á

    2017-07-01

    Full Text Available Extranodal MALT lymphomas are a type of lymphoproliferative syndrome belonging to non-Hodgkin's lymphomas. The most common affectation of these types of lymphomas is the digestive tract (80%, the lung being only 14% of cases. We present the case of a 73 years old woman who goes to progressive dyspnea, with a large right pleural effusion on the chest x-ray. After screening and differential diagnosis of the different types of pleural effusion and the clinical etiological processes involved in its production, the diagnosis of lymphoproliferative process was reached, starting chemotherapy treatment with good evolution of both the pleural effusion and the patient's clinic.

  14. Pathogenesis of pleural effusion in carcinoma of the breast

    International Nuclear Information System (INIS)

    Weichselbaum, R.; Marck, A.; Hellman, S.

    1977-01-01

    Three hundred and fifty-two patients with carcinoma of the breast treated postoperatively with radiotherapy were analyzed for laterality and incidence of pleural effusion. A statistically significant increase in ipsilateral pleural effusions was noted in the entire group (p less than 0.0001). Thirty-three percent of the patients with chest wall recurrences developed ipsilateral effusions while only 4.5 percent of those who did not develop chest wall recurrences suffered ipsilateral effusions (p less than 0.001). The role of the chest wall lymphatics in the development of malignant pleural effusions is discussed

  15. Pleural effusion segmentation in thin-slice CT

    Science.gov (United States)

    Donohue, Rory; Shearer, Andrew; Bruzzi, John; Khosa, Huma

    2009-02-01

    A pleural effusion is excess fluid that collects in the pleural cavity, the fluid-filled space that surrounds the lungs. Surplus amounts of such fluid can impair breathing by limiting the expansion of the lungs during inhalation. Measuring the fluid volume is indicative of the effectiveness of any treatment but, due to the similarity to surround regions, fragments of collapsed lung present and topological changes; accurate quantification of the effusion volume is a difficult imaging problem. A novel code is presented which performs conditional region growth to accurately segment the effusion shape across a dataset. We demonstrate the applicability of our technique in the segmentation of pleural effusion and pulmonary masses.

  16. Thoracoscopic modified pleural tent for spontaneous pneumothorax.

    Science.gov (United States)

    Kawachi, Riken; Matsuwaki, Rie; Tachibana, Keisei; Karita, Shin; Nakazato, Yoko; Tanaka, Ryota; Nagashima, Yasushi; Takei, Hidefumi; Kondo, Haruhiko

    2016-08-01

    We developed a modified pleural tent (m-tent) procedure and used it in our hospital in almost 30 consecutive patients with spontaneous pneumothorax. The objective of this study was to clarify the feasibility and effectiveness of a thoracoscopic m-tent for the treatment of spontaneous pneumothorax. From July 2013 to November 2014, 107 patients with spontaneous pneumothorax were treated in our institution. Eighty-nine of these patients were analysed retrospectively. The inclusion criteria for thoracoscopic m-tent for spontaneous pneumothorax were multiple and widespread bullae, postoperative relapse and secondary spontaneous pneumothorax. The surgical procedures were usually performed through three ports. After bullectomy, an m-tent is made to strip the parietal pleura off the chest wall from about the level of the fourth or fifth rib to the apex, and two or three ligations are then applied to fix the pleural tent and lung parenchyma. Patients in whom an m-tent was not indicated underwent bullectomy plus coverage using absorbable materials. Twenty-seven patients underwent bullectomy plus m-tent (m-tent group) and 62 underwent bullectomy plus coverage over a staple line using an absorbable material such as a polyglycolic acid sheet or nitrocellulose sheet (coverage group). No severe postoperative complications were observed in either group. The m-tent and coverage groups showed significant differences in operation time (129 vs 86 min, mean), haemorrhage (12.8 vs 7.2 ml), postoperative hospital stay (3.7 vs 2.9 days) and postoperative painkiller intake (8.6 vs 6.8 days). Recurrence was observed in 1 (3.7%) and 2 patients (3.2%), respectively. The thoracoscopic m-tent procedure requires a longer operation, a longer hospital stay and greater painkiller intake. However, these differences are acceptable, and an m-tent should be considered as an option for pleural reinforcement in spontaneous pneumothorax, especially in patients who are complicated with severe pulmonary

  17. Moxifloxacin pharmacokinetics and pleural fluid penetration in patients with pleural effusion.

    Science.gov (United States)

    Chatzika, Kalliopi; Manika, Katerina; Kontou, Paschalina; Pitsiou, Georgia; Papakosta, Despina; Zarogoulidis, Konstantinos; Kioumis, Ioannis

    2014-01-01

    The aim of this study was to evaluate the pharmacokinetics and penetration of moxifloxacin (MXF) in patients with various types of pleural effusion. Twelve patients with empyema/parapneumonic effusion (PPE) and 12 patients with malignant pleural effusion were enrolled in the study. A single-dose pharmacokinetic study was performed after intravenous administration of 400 mg MXF. Serial plasma (PL) and pleural fluid (PF) samples were collected during a 24-h time interval after drug administration. The MXF concentration in PL and PF was determined by high-performance liquid chromatography, and main pharmacokinetic parameters were estimated. Penetration of MXF in PF was determined by the ratio of the area under the concentration-time curve from time zero to 24 h (AUC24) in PF (AUC24PF) to the AUC24 in PL. No statistically significant differences in the pharmacokinetics in PL were observed between the two groups, despite the large interindividual variability in the volume of distribution, clearance, and elimination half-life. The maximum concentration in PF (CmaxPF) in patients with empyema/PPE was 2.23±1.31 mg/liter, and it was detected 7.50±2.39 h after the initiation of the infusion. In patients with malignant effusion, CmaxPF was 2.96±1.45 mg/liter, but it was observed significantly earlier, at 3.58±1.38 h (Ppleural effusion.

  18. Cost-effectiveness of indwelling pleural catheter compared with talc in malignant pleural effusion.

    Science.gov (United States)

    Olfert, Jordan A P; Penz, Erika D; Manns, Braden J; Mishra, Eleanor K; Davies, Helen E; Miller, Robert F; Luengo-Fernandez, Ramon; Gao, Song; Rahman, Najib M

    2017-05-01

    Malignant pleural effusion is associated with morbidity and mortality. A randomized controlled trial previously compared clinical outcomes and resource use with indwelling pleural catheter (IPC) and talc pleurodesis in this population. Using unpublished quality of life data, we estimate the cost-effectiveness of IPC compared with talc pleurodesis. Healthcare utilization and costs were captured during the trial. Utility weights produced by the EuroQol Group five-dimensional three-level questionnaire and survival were used to determine quality-adjusted life-years (QALYs) gained. The incremental cost-effectiveness ratio (ICER) was calculated over the 1-year trial period. Sensitivity analysis used patient survival data and modelled additional nursing time required per week for catheter drainage. Utility scores, cost and QALYs gained did not differ significantly between groups. The ICER for IPC compared with talc was favorable at $US10 870 per QALY gained. IPC was less costly with a probability exceeding 95% of being cost-effective when survival was pleural effusion in patients without history of prior pleurodesis, with consideration for patient survival, support and preferences. © 2016 The Authors. Respirology published by John Wiley & Sons Australia, Ltd on behalf of Asian Pacific Society of Respirology.

  19. Broncho-pleural fistula with hydropneumothorax at CT: Diagnostic implications in mycobacterium avium complex lung disease with pleural involvement

    International Nuclear Information System (INIS)

    Yoon, Hyun Jung; Chung, Myung Jin; Lee, Kyung Soo; Park, Hye Yun; Koh, Won Jung; Kim, Jung Soo

    2016-01-01

    To determine the patho-mechanism of pleural effusion or hydropneumothorax in Mycobacterium avium complex (MAC) lung disease through the computed tomographic (CT) findings. We retrospectively collected data from 5 patients who had pleural fluid samples that were culture-positive for MAC between January 2001 and December 2013. The clinical findings were investigated and the radiological findings on chest CT were reviewed by 2 radiologists. The 5 patients were all male with a median age of 77 and all had underlying comorbid conditions. Pleural fluid analysis revealed a wide range of white blood cell counts (410-100690/µL). The causative microorganisms were determined as Mycobacterium avium and Mycobacterium intracellulare in 1 and 4 patients, respectively. Radiologically, the peripheral portion of the involved lung demonstrated fibro-bullous changes or cavitary lesions causing lung destruction, reflecting the chronic, insidious nature of MAC lung disease. All patients had broncho-pleural fistulas (BPFs) and pneumothorax was accompanied with pleural effusion. In patients with underlying MAC lung disease who present with pleural effusion, the presence of BPFs and pleural air on CT imaging are indicative that spread of MAC infection is the cause of the effusion

  20. Broncho-pleural fistula with hydropneumothorax at CT: Diagnostic implications in mycobacterium avium complex lung disease with pleural involvement

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Hyun Jung; Chung, Myung Jin; Lee, Kyung Soo; Park, Hye Yun; Koh, Won Jung [Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Kim, Jung Soo [Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon (Korea, Republic of)

    2016-04-15

    To determine the patho-mechanism of pleural effusion or hydropneumothorax in Mycobacterium avium complex (MAC) lung disease through the computed tomographic (CT) findings. We retrospectively collected data from 5 patients who had pleural fluid samples that were culture-positive for MAC between January 2001 and December 2013. The clinical findings were investigated and the radiological findings on chest CT were reviewed by 2 radiologists. The 5 patients were all male with a median age of 77 and all had underlying comorbid conditions. Pleural fluid analysis revealed a wide range of white blood cell counts (410-100690/µL). The causative microorganisms were determined as Mycobacterium avium and Mycobacterium intracellulare in 1 and 4 patients, respectively. Radiologically, the peripheral portion of the involved lung demonstrated fibro-bullous changes or cavitary lesions causing lung destruction, reflecting the chronic, insidious nature of MAC lung disease. All patients had broncho-pleural fistulas (BPFs) and pneumothorax was accompanied with pleural effusion. In patients with underlying MAC lung disease who present with pleural effusion, the presence of BPFs and pleural air on CT imaging are indicative that spread of MAC infection is the cause of the effusion.

  1. The role of CT in the differential diagnosis of malignant pleural mesothelioma and diffuse metastatic pleural involvement

    International Nuclear Information System (INIS)

    Kirova, G.; Beeva, M.; Sergieva, S.; Tsenkov, Kh.; Tsonev, P.

    1997-01-01

    The purpose of the study was to establish the presence of similarities and differences in the CT finding of patients presenting histologically proved diffuse pleural metastases and malignant pleural mesothelioma. Twenty-six patients with diffuse metastatic involvement of the pleura divided in two groups according to histological diagnosis, made on basis of findings at examination of the specimens obtained by pneumonectomy and pleural biopsy, are subjected to retrospective investigation. Group one is of ten patients with malignant pleural mesothelioma, and group two - sixteen patients presenting diffuse metastatic changes in the pleural membranes. All scanograms are separately evaluated in terms of state of the pulmonary parenchyma and that of of the pleurae, chest wall and mediastinum. As shown by the summed up data, the CT image of the pleura in malignant pleural mesothelioma and diffuse metastatic pleural disease lacks clearcut distinction, and its roentgenological characterization does not warrant a specific morphological diagnosis. There is difference in the degree of manifestation of so-called additional signs such as enlarged hilum and mediastinal lymph nodes, metastatic lesions to the pulmonary parenchyma and destruction of adjacent bone structures

  2. Status of Exudative Pleural Effusion in Adults of South Khorasan Province, Northeast Iran: Pleural Tuberculosis Tending toward Elderly

    Directory of Open Access Journals (Sweden)

    Sayyed Gholam Reza Mortazavi-Moghaddam

    2016-07-01

    Full Text Available The causes and situation of exudative pleural effusion vary from one area to another. A cross-sectional study was conducted on 327 patients with exudative pleural effusion in South Khorasan province (Iran. The patients were older than 12 years and comprised 172 (52.6% males and 155 (47.4% females. The study commenced in 2007 with seven years duration. The Light’s criteria were used to define exudative effusion. Procedures including pleural fluid analysis, microbiological study, pleural biopsy, and systemic investigations were conducted to determine the special cause of pleural effusion. The mean age of the patients was 63.4±18.4 years. Malignancies, tuberculosis, and parapneumonia pleural exudation were diagnosed in 125 (38.2%, 48 (14.7%, and 45 (13.8% cases, respectively. Among malignant effusions, metastasis from lung cancer made 48 (38.4% of the cases. The origin of metastasis was not determined in 44 (35.2% patients. The mean age of patients was not significantly different between malignant (66.9±14.3 years and tuberculosis (63.9±19.7 years cases (P=0.16. The older age of tuberculosis patients could be a new discussion point on the overall impression created on the subject of tuberculosis pleural exudation (TB-PLE occurring in young people.

  3. Relato de caso: anestesia em paciente portador de distrofia torácica asfixiante: Síndrome de Jeune

    Directory of Open Access Journals (Sweden)

    Deise Saletti

    2012-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Síndrome de Jeune, ou Distrofia Torácica Asfixiante, é uma doença autossômica recessiva. Esta síndrome é caracterizada por uma displasia óssea com variadas anormalidades: torácica, pancreática, cardíaca, hepática, renal e da retina. A idade em que o quadro clínico dos pacientes se apresenta está correlacionada com a gravidade da doença. Esses pacientes apresentam policondrodistrofia com costelas largas, curtas, horizontais e junções costocondrais irregulares levando a uma caixa torácica rígida e reduzida com grau de injúria respiratória variado. RELATO DO CASO: Paciente do sexo masculino, 4 meses, 7 kg, portador de Distrofia Torácica Asfixiante. Apresentava-se intubado e com caixa torácica reduzida. Ecocardiograma: hipertensão pulmonar leve. Tomografia de tórax: hipoplasia pulmonar. Submetido à toracoplastia bilateral e toracotomia sob anestesia geral. Manutenção da anestesia: infusão contínua de sufentanil e sevoflurano. Parâmetros ventilatórios: ventilação mecânica ciclada à pressão. Com a abertura do tórax, houve melhora dos parâmetros ventilatórios e, após o posicionamento da prótese torácica, observou-se limitação ventilatória. Decidiu-se pela diminuição da prótese torácica com consequente melhora da ventilação. CONCLUSÕES: É imprescindível o diagnóstico de todas as anormalidades presentes para o correto manejo anestésico. Foi necessária observação para adequar ventilação pré- e pós-toracotomia/toracoplastia e para manter o paciente hemodinamicamente estável. A forma mais adequada para ventilação mecânica é a ciclada à pressão para vencer a barreira mecânica. No intraoperatório, é desejável manter o pico de pressão inspiratória o mais baixo possível para minimizar o risco de barotrauma, de impedimento do retorno venoso e diminuição do débito cardíaco.

  4. Malignant pleural mesothelioma in a child

    Directory of Open Access Journals (Sweden)

    Jed Brendan Scharf

    2015-10-01

    Full Text Available Malignant pleural mesothelioma (MPM is an aggressive malignancy that occurs extremely rarely in the pediatric population. It carries a dismal prognosis. Adult studies are often used to guide therapy in the pediatric population, as a limited number of case reports form the body of pediatric literature. Herein, we document the course and treatment of an 8-year old male diagnosed with MPM. The diagnosis came after he presented to his family physician with dyspnea and was found to have a large right-sided chest mass on subsequent imaging. Through an initial right pneumonectomy and subsequent chest wall excision, followed by chemotherapy with Pemetrexed and Cisplatin he remains virtually disease free today, almost 2 years following surgery.

  5. Comprehensive immunoproteogenomic analyses of malignant pleural mesothelioma.

    Science.gov (United States)

    Lee, Hyun-Sung; Jang, Hee-Jin; Choi, Jong Min; Zhang, Jun; de Rosen, Veronica Lenge; Wheeler, Thomas M; Lee, Ju-Seog; Tu, Thuydung; Jindra, Peter T; Kerman, Ronald H; Jung, Sung Yun; Kheradmand, Farrah; Sugarbaker, David J; Burt, Bryan M

    2018-04-05

    We generated a comprehensive atlas of the immunologic cellular networks within human malignant pleural mesothelioma (MPM) using mass cytometry. Data-driven analyses of these high-resolution single-cell data identified 2 distinct immunologic subtypes of MPM with vastly different cellular composition, activation states, and immunologic function; mass spectrometry demonstrated differential abundance of MHC-I and -II neopeptides directly identified between these subtypes. The clinical relevance of this immunologic subtyping was investigated with a discriminatory molecular signature derived through comparison of the proteomes and transcriptomes of these 2 immunologic MPM subtypes. This molecular signature, representative of a favorable intratumoral cell network, was independently associated with improved survival in MPM and predicted response to immune checkpoint inhibitors in patients with MPM and melanoma. These data additionally suggest a potentially novel mechanism of response to checkpoint blockade: requirement for high measured abundance of neopeptides in the presence of high expression of MHC proteins specific for these neopeptides.

  6. Parapneumonic pleural effusion: early versus late thoracoscopy

    Directory of Open Access Journals (Sweden)

    Rodrigo Romualdo Pereira

    2017-07-01

    Full Text Available ABSTRACT Objective: To evaluate the best time to perform thoracoscopy for the treatment of complicated parapneumonic pleural effusion in the fibrinopurulent phase in patients ≤ 14 years of age, regarding the postoperative evolution and occurrence of complications. Methods: This was a retrospective comparative study involving patients with parapneumonic pleural effusion presenting with septations or loculations on chest ultrasound who underwent thoracoscopy between January of 2000 and January of 2013. The patients were divided into two groups: early thoracoscopy (ET, performed by day 5 of hospitalization; and late thoracoscopy (LT, performed after day 5 of hospitalization. Results: We included 60 patients, 30 in each group. The mean age was 3.4 years; 28 patients (46.7% were male; and 47 (78.3% underwent primary thoracoscopy (no previous simple drainage. The two groups were similar regarding gender, age, weight, and type of thoracoscopy (p > 0.05 for all. There was a significant difference between the ET and the LT groups regarding the length of the hospital stay (14.5 days vs. 21.7 days; p < 0.001. There were also significant differences between the groups regarding the duration of fever in days; the total number of days from admission to the initiation of drainage; and the total number of days with the drain in place. Eight patients (13.6% had at least one post-thoracoscopy complication, there being no difference between the groups. There were no deaths. Conclusions: Performing ET by day 5 of hospitalization was associated with shorter hospital stays, shorter duration of drainage, and shorter duration of fever, although not with a higher frequency of complications, requiring ICU admission, or requiring blood transfusion.

  7. Detection of EpCAM-positive microparticles in pleural fluid: A new approach to mini-invasively identify patients with malignant pleural effusions

    OpenAIRE

    Roca, Elisa; Lacroix, Romaric; Judicone, Coralie; Laroumagne, Sophie; Robert, St?phane; Cointe, Sylvie; Muller, Alexandre; Kaspi, Elise; Roll, Patrice; Brisson, Alain R.; Tantucci, Claudio; Astoul, Philippe; Dignat-George, Fran?oise

    2015-01-01

    Pleural biomarkers allowing to mini-invasively discriminate benign from malignant pleural effusions are needed. Among potential candidates, microparticles (MPs) are extracellular vesicles that vectorize antigen derived from the parent cell. We hypothesized that tumor-derived MPs could be present in the pleural liquid and help to identify patients with malignant pleural effusions. Using highly sensitive flow cytometry and cryo-electron microscopy, we showed that large amounts of MPs from hemat...

  8. Dysphagia as an unusual complication of pleural mesothelioma

    International Nuclear Information System (INIS)

    Khan, S.; But, N.; Bajwa, F.

    2008-01-01

    Dysphagia is an unusual presentation of pleural mesothelioma and carries a grim prognosis. A case of an elderly patient is presented herein, in whom the diagnosis was confirmed histologically, and the patient was still surviving 6 months after palliation. (author)

  9. A practical approach to diagnosing pleural effusion in southern Africa

    African Journals Online (AJOL)

    pleural space is a common medical a iction and invariably ... rheumatic arthritis or pulmonary embolisms. Differentiating the ... Patients often present with a cough, dyspnoea ... Peritoneal dialysis .... infection can guide antibiotic choice.[1] e.

  10. Management of malignant pleural effusion: challenges and solutions

    Science.gov (United States)

    Penz, Erika; Watt, Kristina N; Hergott, Christopher A; Rahman, Najib M; Psallidas, Ioannis

    2017-01-01

    Malignant pleural effusion (MPE) is a sign of advanced cancer and is associated with significant symptom burden and mortality. To date, management has been palliative in nature with a focus on draining the pleural space, with therapies aimed at preventing recurrence or providing intermittent drainage through indwelling catheters. Given that patients with MPEs are heterogeneous with respect to their cancer type and response to systemic therapy, functional status, and pleural milieu, response to MPE therapy is also heterogeneous and difficult to predict. Furthermore, the impact of therapies on important patient outcomes has only recently been evaluated consistently in clinical trials and cohort studies. In this review, we examine patient outcomes that have been studied to date, address the question of which are most important for managing patients, and review the literature related to the expected value for money (cost-effectiveness) of indwelling pleural catheters relative to traditionally recommended approaches. PMID:28694705

  11. Gravidez em paciente com microlitíase alveolar pulmonar grave Pregnancy in a patient with severe pulmonary alveolar microlithiasis

    Directory of Open Access Journals (Sweden)

    José Osmar Bezerra de Souza Filho

    2008-10-01

    Full Text Available A microlitíase alveolar pulmonar (MAP é uma doença rara que atinge ambos os pulmões, caracterizada pela presença de pequenos cálculos (fosfato de cálcio nos espaços alveolares. Relatamos o caso de uma paciente do sexo feminino, de 26 anos, cujo diagnóstico foi confirmado com base nos achados marcantes na radiografia de tórax e tomografia computadorizada de alta resolução. A paciente, gestante de 28 semanas, retornou ao hospital 10 meses após o diagnóstico apresentando insuficiência respiratória hipoxêmica e com distúrbio ventilatório restritivo grave à espirometria. Após completadas 32 semanas e 4 dias de gestação, foi submetida aparto cesariano, com sucesso para mãe e filha. A MAP tem evolução clínica variável. Tem provável caráter autossômico recessivo e associação com história familiar positiva. A etiologia é incerta, e muitos autores especulam que haja um defeito enzimático local responsável pelo acúmulo intra-alveolar de cálcio. Relatos de pacientes com MAP que engravidaram são excepcionais, sendo o presente caso o primeiro descrito no Brasil. O curso dessa doença costuma ser lentamente progressivo, e os pacientes geralmente falecem devido à insuficiência cardiorrespiratória. O presente caso ilustra a necessidade de se oferecer aconselhamento genético e orientações sobre o risco de gravidez às pacientes, especialmente em casos de doença avançada. Atualmente, a única terapia efetiva é o transplante pulmonar.Pulmonary alveolar microlithiasis (PAM is a rare disease that affects both lungs. It is characterized by the presence of small calculi (calcium phosphate within the alveolar spaces. We report the case of a 26-year-old female whose diagnosis was based on characteristic findings on chest X-rays and high-resolution computed tomography scans. The patient, 28 weeks pregnant, was rehospitalized 10 months after the diagnosis, presenting hypoxemic acute respiratory failure and severe restrictive

  12. Toxicidade pulmonar induzida pela rapamicina Lung toxicity induced by rapamycin

    Directory of Open Access Journals (Sweden)

    C Damas

    2006-11-01

    Full Text Available As doenças pulmonares induzidas por fármacos constituem uma causa crescente de morbilidade, tendo sido descritas diferentes formas de toxicidade associadas a inúmeras substâncias. O sirolimus (rapamicina é um fármaco imunossupressor usado de forma crescente no contexto do transplante de órgãos sólidos, nomeadamente no transplante renal. A toxicidade pulmonar tem sido descrita como um dos potenciais efeitos laterais, nomeadamente causando formas de pneumonite intersticial ou, mais raramente, hemorragia alveolar. Os autores descrevem os casos de quatro doentes (3 do sexo masculino, 1 do sexo feminino com idades compreendidas entre os 46-71 anos, recipientes de transplante renal (rim cadáver há 3 anos (1 doente e 7 anos (3 doentes. A imunosupressão consistia em micofenolato mofetil, prednisolona e rapamicina. Os quatro doentes foram admitidos por febre, tosse produtiva (2 e dispneia (3. Apresentavam imagem radiológica de infiltrados pulmonares bilaterais de predomínio basal. O LBA mostrou alveolite linfocítica em 3 doentes, tendo-se observado no entanto diferentes relações CD4/CD8., para além de neutrofilia em 2 deles. No restante doente, observou-se hemorragia alveolar grave. Não houve em nenhum dos casos qualquer isolamento de micro organismos patogénicos no LBA. As queixas apresentadas, bem como as alterações radiológicas regrediram com a suspensão do fármaco. Estes quatro casos revelaram alguma variedade, quer na apresentação clínica, quer nos achados dos exames subsidiários efectuados, nomeadamente no LBA. Este facto pode ter como causa diferentes mecanismos fisiopatológicos a nível do pulmão induzidos pelo sirolimus.Drug induced lung diseases (DILD are an increasingly cause of morbidity. Many drugs have been described, causing several patterns of injury. Sirolimus is an immunosuppressive agent increasingly used in renal and other solid organ transplantation. Pulmonary toxicity has been recognised as a potential

  13. Contribution of positron emission tomography in pleural disease.

    OpenAIRE

    Duysinx, Bernard; Corhay, Jean-Louis; Larock, Marie-Paule; Withofs, Nadia; Bury, Thierry; Hustinx, Roland; Louis, Renaud

    2010-01-01

    INTRODUCTION: Positron emission tomography (PET) now plays a clear role in oncology, especially in chest tumours. We discuss the value of metabolic imaging in characterising pleural pathology in the light of our own experience and review the literature. BACKGROUND: PET is particularly useful in characterising malignant pleural pathologies and is a factor of prognosis in mesothelioma. Metabolic imaging also provides clinical information for staging lung cancer, in researching the primary tumou...

  14. A PRACTICAL METHOD FOR QUANTIFICATION OF PLEURAL EFFUSION BY USG

    OpenAIRE

    Swish Kumar; Dinesh Kumar; Suganita; Singh; Vijay Shankar; Rajeev; Ajay; Anjali

    2016-01-01

    OBJECTIVE The aim of this study is to find a correlation between pleural separation and amount of aspirated effusion. METHODS Total 20 adult patients with 25 effusions were taken into the study with chest x-ray showing homogeneous opacity in either one or both of the lung field, which was confirmed on USG. Only uncomplicated pleural effusion were taken into study. Effusion with septations or encysted effusion or pyothorax were excluded from the study. RESULTS...

  15. Pleural Mesothelioma Surveillance: Validity of Cases from a Tumour Registry

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    France Labrèche

    2012-01-01

    Full Text Available BACKGROUND: Pleural mesothelioma is a rare tumour associated with exposure to asbestos fibres. Fewer than than one-quarter of cases registered in the Quebec Tumour Registry (QTR have been compensated as work-related. While establishing a surveillance system, this led to questioning as to whether there has been over-registration of cases that are not authentic pleural mesotheliomas in the QTR.

  16. Lesao pulmonar induzida pela ventilacao em recem-nascidos prematuros

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    Clarissa Gutierrez Carvalho

    2013-12-01

    Full Text Available A necessidade de intubação e do uso de ventilação mecânica na prematuridade está relacionada à chamada lesão pulmonar induzida pela ventilação e à consequente displasia broncopulmonar. Busca-se a melhor compreensão dos mecanismos de lesão envolvendo resposta inflamatória mediada pelas citocinas para o desenvolvimento de novas estratégias protetoras. Pesquisou-se na base de dados PubMed, incluindo artigos relevantes, os unitermos "ventilator induced lung injury preterm", "continuous positive airway pressure", "preterm" e "bronchopulmonary dysplasia". Dados e informações significativas foram compilados em tópicos, com o objetivo de formar uma visão crítica e plena acerca da lesão induzida pela ventilação e de suas consequências ao prematuro. Foi revisado o papel das citocinas pró-inflamatórias como mediadores da lesão, especialmente interleucinas 6 e 8, e fator de necrose tumoral alfa. Foram apresentadas evidências em estudos com animais e também em humanos, mostrando que breves períodos de ventilação mecânica são suficientes para a liberação dessas interleucinas inflamatórias. Também foram revisadas outras formas de ventilação mecânica e de ventilação não invasiva, como alternativas protetoras aos modos convencionais. Concluiu-se que o uso de ventilação não invasiva, a intubação com administração precoce de surfactante e a extubação rápida para CPAP nasal, além de estratégias que regulam o volume corrente evitando o volutrauma (como a ventilação com volume garantido, são medidas protetoras da lesão pulmonar induzida pela ventilação mecânica no prematuro.

  17. Comportamiento del Programa Nacional de Tuberculosis pulmonar, en un municipio

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    René F. Espinosa Alvarez

    1998-10-01

    Full Text Available Se conoce que la tuberculosis pulmonar constituye un serio problema de salud en la mayor parte de los países del mundo. En el nuestro existe un programa de control de dicha entidad y su conocimiento y objetivos son de vital importancia para el médico de la familia. Se analizó el comportamiento del programa nacional de tuberculosis pulmonar en el policlínico docente Lawton en el trienio 1995-1997, a cuyo efecto se revisaron desde el 1-1-95 al 31-12-97 los esputos indicados por los médicos de la familia de los 49 consultorios que existen en dicha unidad y se extrajeron los datos de las hojas de cargo de los médicos del departamento de estadísticas y del laboratorio clínico que controla esta actividad. Los resultados demuestran algunas dificultades que subsisten en el control de la enfermedad que pudieran solucionarse con una mayor dedicación a esta actividad por parte de los médicos de la familia como responsables directos de sus diferentes áreas de salud, así como de las autoridades sanitarias que tienen que ver con el problemaIt is known that pulmonary tuberculosis is a serious health problem in most of the countries. In our country, there is a tuberculosis control program whose knowledge and objectives are of vital importance for the family physician. The behavior of the national program to control pulmonary tuberculosis was analyzed at "Lawton" Teaching Polyclinic from 1995 to 1997. To this end the sputa ordered from 1-1-95 to 31-12-97 by the family physicians from the 49 physicians’ offices existing in this unit were reviewed. Data were given by the Statistics Department and by the Clinical Laboratory controlling this activity. The results show that there are still some difficulties to control this disease that may be solved through a greater dedication to this activity on the part of the family physicians as direct responsible of their different health areas, and of the health authorities having to do with this problem

  18. Enfermedad pulmonar obstructiva: diferencias entre hombres y mujeres

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    María Soledad Rodríguez-Pecci

    2012-06-01

    Full Text Available La enfermedad pulmonar obstructiva crónica (EPOC ha aumentado su prevalencia en el sexo femenino. Los casos de mujeres se describen como más sintomáticas. A pesar de que la EPOC se ha vinculado a elevado riesgo cardiovascular, hay pocos estudios sobre diferencias por sexo. El objetivo de nuestro estudio fue determinar la influencia del sexo sobre calidad de vida y síntomas, tratamiento, factores de riesgo y enfermedad cardiovascular (ECV en una población de pacientes con EPOC. En este estudio prospectivo observacional de corte transversal, se incluyeron pacientes con EPOC ingresados consecutivamente entre el 1 de septiembre de 2008 al 1 de marzo de 2010. Se registraron edad, sexo, habito tabáquico, factores de riesgo y enfermedad cardiovascular, tratamiento y gravedad de la EPOC. Se midió índice tobillo-brazo (ITB y se realizó Euroqol-5D. Se incluyeron 246 pacientes (195 hombres. Los hombres fueron más ex fumadores (68.7% vs. 15.7%, p < 0.001, tuvieron un VEF1 menor (48.7% ± 15.7 vs. 58.2% ± 10.9 de teórico, p < 0.001 y mayor frecuencia de cardiopatía isquémica (16.4% vs. 5.9%, p = 0.04. Las mujeres presentaron más prevalencia de EPOC sin exposición al tabaco (64.7% vs. 7.2%, p < 0.001, más síntomas de ansiedad y depresión (p = 0.004 e ITB alterado en menor frecuencia (20% vs. 41.6%, p = 0.01. Concluimos que hubo diferencias en la EPOC en relación al sexo, con compromiso pulmonar y cardiovascular más grave en hombres y más síntomas de ansiedad y depresión en mujeres.

  19. Abcesso Pulmonar – Estudo Retrospectivo

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    M. José Augusto

    1995-11-01

    Full Text Available RESUMO: O abcesso pulmonar é definido como uma supuração colectada numa cavidade neoformada no pulmão, por uma inflamação aguda não tuberculosa. Por esta definição, estão excluídas as supuraçãoes desenvolvidas em cavidades pré existentes (quistos aereos, carcinoma escavado, bronquiectasias e as resultantes de processos bacilares (1,2,4.Os autores apresentam os resultados de uma revisão clínica de 24 casos correspondentes aos doentes internados com aquele diagnóstico desde 1 de Janeiro de 1990 a 31 de Dezembro de 1994 no Serviço de Medicina Interna do Hospital Distrital de Aveiro.O estudo incidiu na análise dos processos clínicos e radiológicos avaliando a distribuição por sexo, faixa etária, factores predisponentes, tempo de internamento, expressão clínica, radiológica, bacteriológica e finalizando com a terapêutica e evolução. SUMMARY: Lung abcess is defined as a collected suppuration in a neoformed cavity in the lung, caused by a non tuberculous inflammation. From this definition, supurations developed in pre-existant cavities (aerial cysts, escavated carcinoma, bronchiectasis and those resulting from bacillary process, are excluded.The authors submit the results of a clinical revision of 24 cases corresponding to resident patients with that diagnosis from 1st. January 1990 to 31st December 1994 in the Internal Medicine at R.D. Aveiro.The study rests on the analysis of the radiologic and clinical processes taking into account distribution by age and sex, predisposing factors, lenght of internment, radiological and clinical expression, bacteriological profile, therapy and evolution. Palavras-chave: Abcesso Pulmonar, terapêutica, radiologia, Key-Words: Lung abcess, therapy, radiology

  20. Long-term Outcome of Patients With Undiagnosed Pleural Effusion.

    Science.gov (United States)

    Gunluoglu, Gulsah; Olcmen, Aysun; Gunluoglu, Mehmet Zeki; Dincer, Ibrahim; Sayar, Adnan; Camsari, Gungor; Yilmaz, Veysel; Altin, Sedat

    2015-12-01

    The cause of exudative pleural effusion cannot be determined in some patients. The longterm outcomes of patients with undiagnosed pleural effusion were analyzed. Patients with exudative pleural effusion whose diagnostic procedures included pleural biopsy using video-assisted thoracoscopic surgery carried out between 2008 and 2012 were evaluated retrospectively. Patients diagnosed with non-specific pleuritis were included. Fifty-three patients with available follow-up data were included in the study. Forty men and 13 women (mean age 53.9±13.9 years) were included. Median follow-up time was 24 months. No diagnosis was given in 27 patients (51%), and a clinical diagnosis was given in 26 patients (49%) during the follow-up period. Malignant disease (malignant mesothelioma) was diagnosed in 2 (3.7%) patients. Other diseases were parapneumonic effusion in 12, congestive heart failure in 8, and miscellaneous in 4 patients. Volume of effusion at the time of initial examination and re-accumulation of fluid after video-assisted thoracoscopic surgery were associated with malignant disease (P=.004 and .0001, respectively). Although the probability is low, some patients with exudative pleural effusion undiagnosed after pleural biopsy via video-assisted thoracoscopic surgery may have malignant disease. Patients with an initially large volume of effusion that re-accumulates after examination should be closely monitored. Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.

  1. The effectiveness of single port thoracoscopic approach in pleural effusions

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    Yasemin Bilgin Büyükkarabacak

    2014-12-01

    Full Text Available Objective: Currently, thoracoscopic procedures have been used frequently in diagnosis and treatment of pleural effusions. It was reported, high diagnosis and treatment success with thoracoscopy in pleural effusion, which was not, diagnosed using cytology and blinding pleural biopsy procedures. In this study, it was aimed to evaluate of the patient was performed video-assisted thoracic surgery (VATS due to pleural effusion. Methods: Between 2011 and 2014 years, it was evaluated 52 patients was performed VATS because of pleural effusion. The procedure was performed under general anesthesia and single lung ventilation in 50 patients, and local anesthesia in 2 patients. Results: Histopathological results were reported as carcinoma infiltration in 29 patients, benign disease in 23 patients. Cytological examination of liquid was executed before thoracoscopy in all of the patients with malignity positive. In addition, in eight patients pleura biopsy, on which blinding was executed, evaluated as malignity negative. The diagnostic value of our procedure has 100% in malign group and 98% in benign group. In patients with malignant disease, pleurodesis was performed peroperatively. Mean hospital stay was 5 days (3-15. Mean duration of terminating chest tube was 3 days (3-15. There were no morbidity and mortality due to procedure. Conclusion: Single port VATS is an effective and safe procedure in diagnosis and palliative treatment of patient with pleural effusion, and it has high success rate and reduces hospital stay.

  2. Minimally invasive surgical treatment of malignant pleural effusions.

    Science.gov (United States)

    Ciuche, Adrian; Nistor, Claudiu; Pantile, Daniel; Prof Horvat, Teodor

    2011-10-01

    Usually the pleural cavity contains a small amount of liquid (approximately 10 ml). Pleural effusions appear when the liquid production rate overpasses the absorption rate with a greater amount of liquid inside the pleural cavity. Between January 1998 to December 2008 we conducted a study in order to establish the adequate surgical treatment for MPEs. Effective control of a recurrent malignant pleural effusion can greatly improve the quality of life of the cancer patient. The present review collects and examines the clinical results of minimally invasive techniques designed to treat this problem. Patients with MPEs were studied according to several criteria. In our study we observed the superiority of intraoperative talc poudrage, probably due to a more uniform distribution of talc particles over the pleural surface. Minimal pleurotomy with thoracic drainage and instillation of a talc suspension is also a safe and effective technique and should be employed when there are contraindications for the thoracoscopic minimally invasive procedure. On the basis of comparisons involving effectiveness, morbidity, and convenience, we recommend the thoracoscopic insufflations of talc as a fine powder with pleural drainage as the procedure of choice.

  3. Reabsorption kinetics of albumin from pleural space of dogs

    International Nuclear Information System (INIS)

    Miniati, M.; Parker, J.C.; Pistolesi, M.; Cartledge, J.T.; Martin, D.J.; Giuntini, C.; Taylor, A.E.

    1988-01-01

    The reabsorption of albumin from the pleural space was measured in eight dogs receiving 0.5 ml intrapleural injection of 131 I-labeled albumin and a simultaneous intravenous injection of 125 I-labeled albumin. Plasma curves for both tracers were obtained over 24 h. The 125 I-albumin curve served as input function of albumin for interstitial spaces, including pleura, whereas the 131 I-albumin curve represented the output function from pleural space. The frequency function of albumin transit times from pleural space to plasma was obtained by deconvolution of input-output plasma curves. Plasma recovery of 131 I-albumin was complete by 24 h, and the mean transit time from pleura to plasma averaged 7.95 +/- 1.57 (SD) h. Albumin reabsorption occurred mainly via lymphatics as indicated by experiments in 16 additional dogs in which their right lymph ducts or thoracic ducts were ligated before intrapleural injection. A pleural lymph flow of 0.020 +/- 0.003 (SD) ml.kg-1.h-1 was estimated, which is balanced by a comparable filtration of fluid into the pleural space. This suggests that, under physiological conditions, the subpleural lymphatics represent an important control mechanism of pleural liquid pressure

  4. Switching off malignant pleural effusion formation—fantasy or future?

    Science.gov (United States)

    Giannou, Anastasios D.; Stathopoulos, Georgios T.

    2015-01-01

    Malignant pleural effusion (MPE) is common and difficult to treat. In the vast majority of patients the presence of MPE heralds incurable disease, associated with poor quality of life, morbidity and mortality. Current therapeutic approaches are inefficient and merely offer palliation of associated symptoms. Recent scientific progress has shed light in the biologic processes governing the mechanisms behind the pathobiology of MPE. Pleural based tumors interfere with pleural fluid drainage, as well as the host vasculature and immune system, resulting in decreased fluid absorption and increased pleural fluid production via enhanced plasma extravasation into the pleural space. In order to achieve this feat, pleural based tumors must elicit critical vasoactive events in the pleura, thus forming a favorable microenvironment for tumor dissemination and MPE development. Such properties involve specific transcriptional signaling cascades in addition to secretion of important mediators which attract and activate host cell populations which, in turn, impact tumor cell functions. The dissection of the biologic steps leading to MPE formation provides novel therapeutic targets and recent research findings provide encouraging results towards future therapeutic innovations in MPE management. PMID:26150914

  5. Methimazole associated eosinophilic pleural effusion: a case report.

    Science.gov (United States)

    Gaspar-da-Costa, Pedro; Duarte Silva, Filipa; Henriques, Júlia; do Vale, Sónia; Braz, Sandra; Meneses Santos, João; M M Victorino, Rui

    2017-03-21

    Adverse reactions associated to anti-thyroid drugs include fever, rash, arthralgia, agranulocytosis and hepatitis that are thought to be hypersensitivity reactions. Five cases of pleural effusion associated to thionamides have also been reported, two with propylthiouracil and three with carbimazole. We report here a case of a 75-year-old man admitted because of unilateral pleural effusion. The patient had a recent diagnosis of hyperthyroidism and 6 days after starting methimazole complained of pleuritic chest pain. He had elevated C-reactive protein and erythrocyte sedimentation rate and normal white blood cell count and liver enzymes. Chest radiography showed a moderate right pleural effusion and the ultrasound revealed a loculated effusion that was shown to be an eosinophilic exudate. The temporal relationship between methimazole intake and the development of pleural effusion combined with the extensive exclusion of alternative causes, namely infectious, neoplastic and primary auto-immune diseases, led to the diagnosis of hypersensitivity reaction to methimazole. The thionamide was stopped and corticosteroid was started with complete resolution of the pleural effusion in 3 months. Awareness of this rare adverse reaction of anti-thyroid drugs is important and methimazole can be added to the list of possible etiologies of drug-induced eosinophilic pleural effusion.

  6. Evaluation of serum and pleural levels of endostatin and vascular epithelial growth factor in lung cancer patients with pleural effusion.

    Science.gov (United States)

    Zhang, Yu; Yu, Li-Ke; Xia, Ning

    2012-03-01

    To evaluate the diagnostic value of endostatin (ES), vascular endothelial growth factor (VEGF) and carcinoembryonic antigen (CEA) in both serum and pleural effusion of lung cancer patients. Levels of ES, VEGF and CEA in 52 malignant pleural effusion due to lung cancer and 50 patients with non-malignant disease were measured by using sandwich enzyme-linked immunosorbent assay and microparticle enzyme immunoassay. The ES, VEGF and CEA levels in pleural effusion and serum, and their ratio (F/S) were higher in lung cancer group than that in benign group, and the differences were statistically significant (Ppleural effusion due to lung cancer. In comparison with either single determination of concentration in serum or pleural fluid, the combined detection of two or three markers is of important clinical significance in the diagnosis of lung cancer. Copyright © 2012 Hainan Medical College. Published by Elsevier B.V. All rights reserved.

  7. Persistência da imagem metastática pulmonary após tratamento de doença trofoblástica gestacional Persisting metastatic pulmonar imaging after treatment of gestational trophoblastic disease

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    Eddie Fernando Candido Murta

    1999-01-01

    Full Text Available O objetivo deste relato é a apresentação de um caso de doença trofoblástica gestacional com metástases pulmonares, cujas imagens persistiram após a normalização dos títulos de fração beta do hormônio da gonadotrofina coriônica (beta-hCG após cinco ciclos de quimioterapia (metotrexato, 20 mg/dia por 5 dias a cada 14 dias. A paciente foi submetida a ressecção das lesões por toracoscopia vídeo-assistida. O exame histológico demonstrou necrose sem evidência de tumor residual. É importante reconhecer que a persistência de nódulos pulmonares em pacientes com doença trofoblástica gestacional metastática após tratamento e normalização do beta-hCG pode não representar tumor viável mas somente necrose e/ou fibrose.The aim of this report is to present one case of gestational trophoblastic disease with pulmonary metastases apparently persisting despite the return of beta-human chorionic gonadotropin (beta-hCG to normal levels after five cycles of chemotherapy (20 mg methotrexate/day for 5 days. The patient was submitted to a video-assisted thoracoscopy and the nodules were excised. Histological examination showed tissue necrosis without evidence of residual tumor. It is important to recognize that persistent nodules in the lungs of patients with metastatic gestational disease after treatment and normal beta-hCG titers may not represent viable tumor but rather necrosis and/or fibrosis.

  8. Selección de donantes y receptores en trasplante pulmonar: procedimientos generales

    Directory of Open Access Journals (Sweden)

    C. María Teresa Parada, Dra.

    2010-03-01

    Full Text Available El trasplante pulmonar es una alternativa terapéutica que se ha validado en lo últimos 30 años para aquellos pacientes portadores de una enfermedad pulmonar terminal. Las características propias del trasplante pulmonar dadas por su conexión al ambiente a través de la vía aérea y la isquemia presente en las suturas durante el primer mes han constituído por mucho tiempo la principal causa de morbilidad y mortalidad de los pacientes trasplantados pulmonares. Los nuevos medicamentos inmunosupresores, la mejoría de las soluciones de preservación y de las técnicas quirúrgicas han disminuido las complicaciones y mortalidad precoz, siendo el gran desafío aún, el rechazo crónico conocido como el Sindrome de Bronquiolitis Obliterante (SBO. La selección del receptor de acuerdo a la patología de base se ha modificado, promoviendo la derivación precoz en patologías como la fibrosis pulmonar y la fibrosis quística disminuyendo así la mortalidad en la lista de espera.

  9. Hipertensión pulmonar a moderada altura en niños

    Directory of Open Access Journals (Sweden)

    Gabriel F. Díaz, MD

    2012-07-01

    Full Text Available Se reporta la carencia de estudios sobre la relación entre hipertensión pulmonar y altura en niños y, con base en la fisiología de esta última, se hace énfasis en la importancia de la hipoxia hipobárica, que desempeña un papel determinante en la etio y biopatogénesis de la hipertensión pulmonar del habitante de la altura. En cuanto a la biopatogénesis, se señala la importancia de la hiperreactividad del lecho vascular pulmonar y su correcta evaluación. De igual forma, se resumen las patologías relacionadas con hipertensión pulmonar en el niño habitante de la altura y, finalmente, en lo que respecta al tratamiento de la hipertensión pulmonar del habitante de la altura, se resalta, a través de la evolución de casos clínicos, la importancia de vivir a baja altura sobre el nivel del mar.

  10. Advances in lung ultrasound; Avancos na ultrassonografia pulmonar

    Energy Technology Data Exchange (ETDEWEB)

    Francisco Neto, Miguel Jose; Rahal Junior, Antonio; Vieira, Fabio Augusto Cardillo; Silva, Paulo Savoia Dias da; Funari, Marcelo Buarque de Gusmao, E-mail: miguelneto@einstein.br [Hospital Israelita Albert Einstein, Sao Paulo, SP (Brazil)

    2016-11-01

    Ultrasound examination of the chest has advanced in recent decades. This imaging modality is currently used to diagnose several pathological conditions and provides qualitative and quantitative information. Acoustic barriers represented by the aerated lungs and the bony framework of the chest generate well-described sonographic artifacts that can be used as diagnostic aids. The normal pleural line and A, B, C, E and Z lines (also known as false B lines) are artifacts with specific characteristics. Lung consolidation and pneumothorax sonographic patterns are also well established. Some scanning protocols have been used in patient management. The Blue, FALLS and C.A.U.S.E. protocols are examples of algorithms using artifact combinations to achieve accurate diagnoses. Combined chest ultrasonography and radiography are often sufficient to diagnose and manage lung and chest wall conditions. Chest ultrasonography is a highly valuable diagnostic tool for radiologists, emergency and intensive care physicians. (author)

  11. C-reactive protein and serum amyloid A levels in discriminating malignant from non-malignant pleural effusion

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    Hala Mohamed Shalaby Samaha

    2015-10-01

    Conclusion: Measurement of SAA and CRP levels in pleural fluid has good diagnostic utility in differentiation between malignant and non-malignant pleural effusion and pleural SAA has a better diagnostic performance than CRP.

  12. Vascular endothelial growth factor and protein level in pleural effusion for differentiating malignant from benign pleural effusion.

    Science.gov (United States)

    Wu, Da-Wei; Chang, Wei-An; Liu, Kuan-Ting; Yen, Meng-Chi; Kuo, Po-Lin

    2017-09-01

    Pleural effusion is associated with multiple benign and malignant conditions. Currently no biomarkers differentiate malignant pleural effusion (MPE) and benign pleural effusion (BPE) sensitively and specifically. The present study identified a novel combination of biomarkers in pleural effusion for differentiating MPE from BPE by enrolling 75 patients, 34 with BPE and 41 with MPE. The levels of lactate dehydrogenase, glucose, protein, and total cell, neutrophil, monocyte and lymphocyte counts in the pleural effusion were measured. The concentrations of interleukin (IL)-1β, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12, tumor necrosis factor-α, interferon γ, transforming growth factor-β1, colony stimulating factor 2, monocyte chemoattractant protein-1 and vascular endothelial growth factor (VEGF) were detected using cytometric bead arrays. Protein and VEGF levels differed significantly between patients with BPE and those with MPE. The optimal cutoff value of VEGF and protein was 214 pg/ml and 3.35 g/dl respectively, according to the receiver operating characteristic curve. A combination of VEGF >214 pg/ml and protein >3.35 g/dl in pleural effusion presented a sensitivity of 92.6% and an accuracy of 78.6% for MPE, but was not associated with a decreased survival rate. These results suggested that this novel combination strategy may provide useful biomarkers for predicting MPE and facilitating early diagnosis.

  13. Relato de caso: transtorno afetivo bipolar

    Directory of Open Access Journals (Sweden)

    Carlos Von Krakauer Hübner

    2016-10-01

    Full Text Available Introdução: O transtorno afetivo bipolar (TAB é uma doença crônica e grave, marcada pela variância de episódios depressivos com episódios de mania ou hipomania, podendo haver sintomas psicóticos. É classificado em dois tipos, I e II. Sua etiologia é desconhecida, mas supõe-se que envolva influências genéticas e ambientais, variando a cada indivíduo afetado. As apresentações clínicas do TAB podem variar de episódios leves de depressão ou hipomania até episódios depressivos graves ou mania acompanhados ou não de sintomas psicóticos. Objetivos: Relatar o caso de um paciente internado na enfermaria da psiquiatria do Conjunto Hospitalar de Sorocaba que foi diagnosticado com TAB. Metodologia: As informações foram obtidas por meio de revisão do prontuário, entrevista com o paciente e revisão da literatura. Relato de Caso: Homem de 20 anos encaminhado do serviço hospitalar de Itapetininga após alteração de comportamento, heteroagressividade e alucinações auditivas. Conclusões: Transtorno depressivo maior, de ansiedade generalizada, de estresse pós-traumático e esquizofrenia são diagnósticos diferenciais. O episódio maníaco provoca prejuízo no funcionamento social, profissional e até necessidade de hospitalização. O risco de suicídio em pessoas com TAB é estimado em pelo menos 15 vezes o da população em geral. A taxa de não adesão ao tratamento no TAB é de 47%. A conduta terapêutica medicamentosa mais eficaz para a mania é a associação do carbonato de lítio com risperidona, já para a depressão bipolar o carbonato de lítio é a primeira escolha.

  14. Eritema polimorfo farmacoinduzido: relato de caso

    Directory of Open Access Journals (Sweden)

    Lais Orosco Bialon Santana

    2014-10-01

    Full Text Available Introdução: Farmacodermias são queixas comuns devendo ser diferenciadas para o tratamento e a investigação precoce de complicações. O eritema polimorfo é uma doença inflamatória caracterizada por lesões em alvo que permanecem fixas por mais de 6 dias. As etiologias são medicamentosa (anticonvulsivantes, antibióticos e anti- inflamatórios e infecções, sendo o vírus herpes o mais relacionado. Classificado na forma minor, associado a infecções, sem sintomas sistêmicos ou lesões mucosas, e major, com padrão inflamatório e mucoso, considerado forma leve da síndrome de Stevens-Johnson. O diagnóstico é clínico e histopatológico. Relato de Caso: Paciente epilética, com diagnóstico de infecção de via aérea há 12 dias tratada com amoxicilina, ibuprofeno, ácido acetil salicílico e loratadina. Após 10 dias, apresentou edema, prurido, eritema, e bolhas por todo corpo, acompanhadas de febre, dispnéia e odinofagia, além de uma convulsão tônico clônica com perda da consciência. Devido à epilepsia, fazia uso de fenobarbital, o qual foi ajustado há 3 dias (50mg para 100mg/dia. Feito diagnóstico, feito hidrocortisona IV, dipirona e cuidados de suporte. Evoluiu com leucocitose e aumento de PCR, introduziu-se ceftriaxona e aciclovir. Houve em uma semana, melhora das lesões cutâneas e estado geral da paciente. Conclusão: As principais causas de farmacodermias são anticonvulsivantes e anti- inflamatórios, usados pela paciente. Alguns medicamentos estão mais associados à certos padrões de lesão, colaborando para o diagnóstico, confirmado através da biopsia cutânea. Frente aos quadros de eritema, as farmacodermias devem ser aventadas como importante diagnóstico diferencial. O fator causal deve ser identificado a fim do tratamento adequado e diminuição da morbidade.

  15. Combined detection of AM, CYFRA21-1, NSE and CEA levels in pleural effusion for differentiation of malignant from tuberculous pleural effusion

    International Nuclear Information System (INIS)

    Yu Hua; Zhu Wenru; Sun Shuhong; Xu Shuhua; Yu Hui

    2005-01-01

    The level s of four tumor markers (AM, CYFRA21-1, NSE and CEA) pleural effusion in plearal effusion were determined by RIA in 52 patients with tuberculous pleural effusion and 74 patients with malignant pleural effusion. The results showed that the levels of the four tumor markers in malignant pleural effusion were significantly higher than those in tuberculous pleural effusion. Combined detection of the four tumor markers could improve the diagnostic sensitivity and the accuracy to 90.5% and 92.9%, respectively (P<0.01). Detection of AM, CYFRA21-1, NSE and CEA levels in pleural effusion is very useful for the differentiation of malignant from tuberculous pleural effusion. Combined detection of the four markers may greatly improve the diagnostic accuracy. (authors)

  16. Tromboembolismo pulmonar masivo de alto riesgo asociado a foramen oval permeable

    Directory of Open Access Journals (Sweden)

    Antonio Miranda

    2012-04-01

    Full Text Available La alta mortalidad de los pacientes con tromboembolismo pulmonar masivo de alto riesgo amerita un enfoque terapéutico enérgico e invasivo que incluya la embolectomía pulmonar quirúrgica en aquellos pacientes con contraindicación para trombolisis o trombolisis fallida. Describimos un caso de tromboembolismo pulmonar masivo de alto riesgo que recibió tratamiento quirúrgico en vez de trombolisis debido a que al momento del diagnóstico presentaba un trombo móvil a través de un foramen oval permeable con altísima posibilidad de embolismo paradójico arterial.

  17. Tratamento da hipertensão pulmonar persistente do recém-nascido

    OpenAIRE

    Rodrigues, Marisa Isabel Garcia

    2008-01-01

    A hipertensão pulmonar persistente do recém-nascido (HPPRN) é um síndrome clínico complexo com múltiplas causas que resulta da incapacidade da circulação pulmonar fetal fazer a transição para a vida extra-uterina. Define-se como uma resistência vascular pulmonar aumentada e shunt direito-esquerdo através do foramen ovale e/ou do ductus arteriosus, causando hipoxémia arterial refractária à suplementação de oxigénio. Com o aparecimento de novas modalidades terapêuticas, fruto ...

  18. Trombolisis farmacológica y mecánica en tromboembolismo pulmonar submasivo

    Directory of Open Access Journals (Sweden)

    Jorge O. Cáneva

    2014-04-01

    Full Text Available La enfermedad tromboembólica pulmonar, en sus formas aguda, subaguda o crónica, presenta dificultades para su tratamiento y tiene elevada morbimortalidad. La gravedad del evento agudo y su potencial compromiso sobre la función del ventrículo derecho necesitan estrategias terapéuticas, a veces combinadas, para cambiar el curso de la enfermedad a favor de la supervivencia del paciente. Las trombolisis farmacológica y mecánica son instrumentos útiles para tratar un evento embólico pulmonar agudo grave. Se presenta el caso de una joven que desarrolló una embolia pulmonar submasiva de instalación subaguda en quien la terapia combinada y secuencial trombolítica, farmacológica y mecánica, fue exitosa.

  19. The clinical characteristics of pleural effusion in scrub typhus.

    Science.gov (United States)

    Kim, Hyung Ho; Chung, Jong-Hoon; Kim, Dong-Min; Yun, Na Ra; Lee, Jun; Kwon, Yong Eun; Yoon, Sung Ho; Lee, Seung Il; Han, Mi Ah

    2016-06-11

    The aim of this study is to identify the factors associated with the occurrence of pleural effusion and to investigate the characteristics of pleural effusion in scrub typhus. We conducted a retrospective analysis of the medical records of scrub typhus patients between January 2004 and December 2011 at Chosun University Hospital in South Korea. A total of 445 scrub typhus patients were divided into the following two groups: without (n = 352) or with pleural effusion (n = 93). The data of 18 scrub typhus patients who underwent thoracentesis were summarized. Multivariate analysis demonstrated that the following factors were associated with the occurrence of pleural effusion in scrub typhus: older age (odds ratio [OR] = 1.029, P = 0.037, confidence interval [CI] = 1.002-1.056); male gender (OR = 1.924, P = 0.020, CI = 1.109-3.340); presence of heart failure (OR = 2.628, P = 0.039, CI = 1.052-6.565); and lower albumin (OR = 0.107, P ≤ 0.001, CI = 0.058-0.196). Most pleural effusion presentations were bilateral (88 %) and small (91 %). The effusion had transudate characteristics in 7 patients and exudate characteristics in 11 patients based on Light's criteria. This study provided the first data regarding the following four independent risk factors associated with the occurrence of pleural effusion: older age; male gender; the presence of heart failure; and lower albumin. The pleural effusion presentations in scrub typhus patients were bilateral and small in most cases, with transudate and/or exudate characteristics.

  20. A Study of Hypoalbuminemia and Pleural Effusionin Pediatric Nephrotic Syndrome

    Directory of Open Access Journals (Sweden)

    Tovan Perinandika

    2017-06-01

    Full Text Available Background: Nephrotic syndrome (NS is a kidney disease that is most often found in children. Hypoalbuminemia in NS can cause a decrease in oncotic pressure causing extravasation of fluid into the interstitial space. In conditions of severe hypoalbuminemia, fluid extravasation may cause occurrence of pleural effusion. The objectives of this study was to analyze the correlation between hypoalbuminemia and pleural effusion in children with NS. Methods: An analytical study was conducted on 69 medical records of pediatric nephrotic syndrome from 1 January 2008–31 December 2013 in dr. Hasan Sadikin General Hospital. Inclusion criteria were pediatric patients between 1-14 years old with NS. Exclusion criteria were patients who already had albumin transfusion, malnutrition, patients with chronic disease, and incomplete medical record information. Contingency coefficient test was carried out to discover the correlation between variables. Results: Out of 89 samples, 69 samples were included. Characteristics of the included patients are male (n=48, female (n=21, age 1–5 (n=24, 6–10 (n=22, 11–14 (n=23, mild hypoalbuminemia (n=3, moderate hypoalbuminemia (n=27, severe hypoalbuminemia (n=39, patients with pleural effusion (n=23, and non-pleural effusion (n=46. There was a significant correlation between  hypoalbuminemia and pleural effusion with p=0.000 (p<0.05 and moderate correlation (r=0.437. Conclusions: Hypoalbuminemia has correlation with pleural effusion in pediatric nephrotic syndrome. Keywords: Hypoalbuminemia, pediatric nephrotic syndrome, pleural effusion DOI: 10.15850/amj.v4n2.1075

  1. Pleurectomy versus pleural abrasion for primary spontaneous pneumothorax in children.

    Science.gov (United States)

    Joharifard, Shahrzad; Coakley, Brian A; Butterworth, Sonia A

    2017-05-01

    Primary spontaneous pneumothorax (PSP) represents a common indication for urgent surgical intervention in children. First episodes are often managed with thoracostomy tube, whereas recurrent episodes typically prompt surgery involving apical bleb resection and pleurodesis, either via pleurectomy or pleural abrasion. The purpose of this study was to assess whether pleurectomy or pleural abrasion was associated with lower postoperative recurrence. The records of patients undergoing surgery for PSP between February 2005 and December 2015 were retrospectively reviewed. Recurrence was defined as an ipsilateral pneumothorax requiring surgical intervention. Bivariate logistic regressions were used to identify factors associated with recurrence. Fifty-two patients underwent 64 index operations for PSP (12 patients had surgery for contralateral pneumothorax, and each instance was analyzed separately). The mean age was 15.7±1.2years, and 79.7% (n=51) of patients were male. In addition to apical wedge resection, 53.1% (n=34) of patients underwent pleurectomy, 39.1% (n=25) underwent pleural abrasion, and 7.8% (n=5) had no pleural treatment. The overall recurrence rate was 23.4% (n=15). Recurrence was significantly lower in patients who underwent pleurectomy rather than pleural abrasion (8.8% vs. 40%, p<0.01). In patients who underwent pleural abrasion without pleurectomy, the relative risk of recurrence was 2.36 [1.41-3.92, p<0.01]. Recurrence of PSP is significantly reduced in patients undergoing pleurectomy compared to pleural abrasion. Level III, retrospective comparative therapeutic study. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. New therapy of pleural empyema by deoxyribonuclease

    Directory of Open Access Journals (Sweden)

    Grzegorz Kacprzak

    Full Text Available Empyema is a severe complication of different diseases and traumas. Management of this complication is difficult and should comprise general and local procedures. The general procedure is mainly based on administering wide-spectrum antibiotics. Local management depends on patient general condition, but in all cases the essential procedure is to insert a drain into the pleural cavity and to evacuate the pus. Sometimes pus is very thick and its evacuation and following re-expansion of the lung is rather impossible. In these patients surgical intervention is needed. The use of intrapleural enzymes to support the drainage was first described in 1949 by Tillett and Sherry using a mixture of streptokinase and streptococcal deoxyribonuclease. Nowadays, purified streptokinase has come into widespread use, but recent studies reported no streptokinase effect on pus viscosity. On the other side, deoxyribonuclease reduces pus viscosity and may be more useful in treatment. We report two cases of intrapleural administration of Pulmozyme (alfa dornase - deoxyribonuclease (HOFFMANN-LA ROCHE AG in dosage 2 × 2.5 mg with a significant improvement caused by changes in pus viscosity.

  3. New therapy of pleural empyema by deoxyribonuclease

    Directory of Open Access Journals (Sweden)

    Grzegorz Kacprzak

    2013-02-01

    Full Text Available Empyema is a severe complication of different diseases and traumas. Management of this complication is difficult and should comprise general and local procedures. The general procedure is mainly based on administering wide-spectrum antibiotics. Local management depends on patient general condition, but in all cases the essential procedure is to insert a drain into the pleural cavity and to evacuate the pus. Sometimes pus is very thick and its evacuation and following re-expansion of the lung is rather impossible. In these patients surgical intervention is needed. The use of intrapleural enzymes to support the drainage was first described in 1949 by Tillett and Sherry using a mixture of streptokinase and streptococcal deoxyribonuclease. Nowadays, purified streptokinase has come into widespread use, but recent studies reported no streptokinase effect on pus viscosity. On the other side, deoxyribonuclease reduces pus viscosity and may be more useful in treatment. We report two cases of intrapleural administration of Pulmozyme (alfa dornase - deoxyribonuclease (HOFFMANN-LA ROCHE AG in dosage 2 × 2.5 mg with a significant improvement caused by changes in pus viscosity.

  4. Lesões pulmonares em caninos (achados de necrópsias)

    OpenAIRE

    Souza, V. T. F. de; Paraguassu, A. A.; Moreira, E. L. T.

    2001-01-01

    p. 43-47 O estudo macroscópico dos pulmões de 381 caninos necropsiados no Setor de Anatomia Patológica do HOSPMEV/UFBA, revelou alta incidência de lesões pulmonares ( 499 ). Das alterações diagnosticadas, os distúrbios circulatórios compareceram com maior frequência (284) casos, seguidos das alterações da expansão pulmonar (121 ), das inflamatórias ( 69 ), das pigmentares (16 ), das neoplásicas ( metástases) (08) e das parasitárias ( 01 caso ).

  5. Enfermedad periodontal inflamatoria asociada a un absceso pulmonar. Presentación de un caso

    OpenAIRE

    López Rodríguez, Vania Julexis; Garcías Rodríguez, Marisel; Gómez Martínez, Ana Iris; Díaz Gonzáles, Gabriela

    2015-01-01

    Fundamento: A pesar, de que hay reportes de casos en la literatura internacional, que asocian la enfermedad periodontal con enfermedades respiratorias y medidas para la prevención de la enfermedad periodontal inflamatoria, sino se establece un adecuado manejo de esta última, puede evolucionar con una complicación sistémica como es el absceso pulmonar. Objetivo: Ilustrar cómo la enfermedad periodontal inflamatoria puede asociarse a un absceso pulmonar como complicación sistémica en su evolució...

  6. Tratamiento de la enfermedad pulmonar obstructiva crónica: Conceptos actuales

    OpenAIRE

    Pino Alfonso, Pedro Pablo; Rodríguez Vázquez, Juan Carlos; Gassiot Nuño, Carlos; Rodríguez Fernández, Rolando

    1997-01-01

    Se revisan los conceptos actuales en el tratamiento de la enfermedad pulmonar obstructiva crónica, incluidos la bronquitis crónica y el enfisema pulmonar. Se hace hincapié en el abandono del hábito de firmar como paso más importante en el tratamiento. Se dan recomendaciones para el uso de la terapia preventiva, así como la mejor manera de establecer el tratamiento broncodilatador, por pasos, a base de bromuro de ipratropiun, en dosis regulares y beta 2 agonistas, a demanda, así como el uso de...

  7. Artritis reumatoidea y síndrome combinado de fibrosis pulmonar y enfisema

    OpenAIRE

    Fernández Casares, Marcelo; Fielli, Mariano; Cristaldo, Laura; Zárate, Lucía; Capozzi, María Nieves

    2015-01-01

    La combinación de fibrosis pulmonar y enfisema es un síndrome descripto en los últimos años que tiene características propias y no es la casual asociación de dos entidades. El componente de fibrosis más común corresponde a la fibrosis pulmonar idiopática. Sin embargo, otras enfermedades intersticiales pueden formar parte de este síndrome, entre ellas las asociadas a enfermedades del tejido conectivo. Se presenta un caso de este síndrome asociado a artritis reumatoidea con la particularidad qu...

  8. Breve Apontamento da Recente Unidade de Oncologia Pulmonar do Hospital CUF Porto

    Directory of Open Access Journals (Sweden)

    Bárbara Parente

    2017-09-01

    Full Text Available A Unidade de Oncologia Pulmonar do Hospital CUF Porto, iniciou a sua atividade no tratamento de doentes com patologia do foro torácico em janeiro de 2014. Tendo em conta toda a infraestrutura pré-existente no Hospital na área do diagnóstico e estadiamento, deu-se início à consulta Especializada em Oncologia Pulmonar com referenciação de doentes, quer interna, quer externamente, organizando o serviço centrado na doença e no doente.

  9. Edema pulmonar neurogênico: uma revisão atualizada da literatura

    OpenAIRE

    Flávio Antônio Siqueira Ridenti

    2012-01-01

    O edema pulmonar neurogênico ainda é um fenômeno pouco compreendido no contexto da assistência ao paciente neurológico grave. Trata-se de uma situação clínica relativamente rara. Situações de importante dano cerebral como hemorragia subaracnóidea, traumatismos encefálicos severos, hemorragias cerebrais intra-parenquimatosas, crises convulsivas ou outras condições específicas fazem o perfil do paciente com risco de desenvolver edema pulmonar neurogênico. A falta de reconhecimento desta condiçã...

  10. Fibrosis pulmonar asociada a vasculitis con anticuerpos anticitoplasmáticos positivos

    OpenAIRE

    Marcelo Fernández Casares; Alejandra González; Flavia Caputo; Yanina Bottinelli; Patricia Nastavi; Marcelo Zamboni

    2012-01-01

    Las complicaciones pulmonares más conocidas de las vasculitis con anticuerpos anticitoplasmáticos de los neutrófilos (ANCA) positivos (VAA), son la hemorragia alveolar, los granulomas y la estenosis de la vía aérea. En los últimos años han aparecido algunos informes aislados que muestran la asociación con fibrosis pulmonar (FP), sugiriendo que ésta sería otra complicación de las VAA. En este trabajo informamos dos casos con dicha asociación describiendo sus características clínicas, tomográfi...

  11. Hipertensión arterial pulmonar primaria o idiopática

    OpenAIRE

    Yazmín Ravelo-Calzado; Vivian Molina-Cuevas; María de Lourdes Arruzazabala-Valmaña; Daisy Carbajal-Quintana

    2010-01-01

    La hipertensión arterial pulmonar primaria (HAPP) es una enfermedad crónica de causa desconocida que se caracteriza por un incremento de la presión sanguínea media en la arteria pulmonar, mayor de 25 mmHg en reposo o más de 30 mmHg durante el ejercicio. Es una enfermedad que afecta a ambos sexos y no tiene predilección racial. La HAPP sin tratar puede conducir a una insuficiencia ventricular derecha y por consiguiente, a la muerte. La HAPP involucra varios mecanismos subyacentes, dentro de lo...

  12. Protocol of the Australasian Malignant Pleural Effusion (AMPLE) trial: a multicentre randomised study comparing indwelling pleural catheter versus talc pleurodesis

    Science.gov (United States)

    Fysh, Edward T H; Thomas, Rajesh; Read, Catherine A; Lam, Ben C H; Yap, Elaine; Horwood, Fiona C; Lee, Pyng; Piccolo, Francesco; Shrestha, Ranjan; Garske, Luke A; Lam, David C L; Rosenstengel, Andrew; Bint, Michael; Murray, Kevin; Smith, Nicola A; Lee, Y C Gary

    2014-01-01

    Introduction Malignant pleural effusion can complicate most cancers. It causes breathlessness and requires hospitalisation for invasive pleural drainages. Malignant effusions often herald advanced cancers and limited prognosis. Minimising time spent in hospital is of high priority to patients and their families. Various treatment strategies exist for the management of malignant effusions, though there is no consensus governing the best choice. Talc pleurodesis is the conventional management but requires hospitalisation (and substantial healthcare resources), can cause significant side effects, and has a suboptimal success rate. Indwelling pleural catheters (IPCs) allow ambulatory fluid drainage without hospitalisation, and are increasingly employed for management of malignant effusions. Previous studies have only investigated the length of hospital care immediately related to IPC insertion. Whether IPC management reduces time spent in hospital in the patients’ remaining lifespan is unknown. A strategy of malignant effusion management that reduces hospital admission days will allow patients to spend more time outside hospital, reduce costs and save healthcare resources. Methods and analysis The Australasian Malignant Pleural Effusion (AMPLE) trial is a multicentred, randomised trial designed to compare IPC with talc pleurodesis for the management of malignant pleural effusion. This study will randomise 146 adults with malignant pleural effusions (1:1) to IPC management or talc slurry pleurodesis. The primary end point is the total number of days spent in hospital (for any admissions) from treatment procedure to death or end of study follow-up. Secondary end points include hospital days specific to pleural effusion management, adverse events, self-reported symptom and quality-of-life scores. Ethics and dissemination The Sir Charles Gairdner Group Human Research Ethics Committee has approved the study as have the ethics boards of all the participating hospitals. The

  13. The role of pleural fluid MAGE RT-nested PCR in the diagnosis of malignant pleural effusion.

    Science.gov (United States)

    Jeon, Eun Ju; Park, Hye Kyeong; Jeon, Kyeongman; Koh, Won-Jung; Suh, Gee Young; Chung, Man Pyo; Kim, Hojoong; Kwon, O Jung; Ki, Chang-Seok; Kim, Jong-Won; Shim, Young Mog; Um, Sang-Won

    2012-11-01

      Melanoma antigen (MAGE) genes are expressed in tumor cells, the testis and the placenta. The purpose of this prospective study was to investigate the sensitivity, specificity, and accuracy of the carcinoembryonic antigen (CEA), MAGE reverse transcriptase-nested polymerase chain reaction (RT-nested PCR), and cytology of pleural fluid in the diagnosis of malignant pleural effusion.   Patients in whom unilateral pleural effusion was identified on chest radiography from January to December 2009 were included in the study. MAGE genes were analyzed by RT-nested PCR using MAGE A1-6 common primers.   Of 81 enrolled patients, 46 were diagnosed as malignant pleural effusion, and 24 were diagnosed as benign pleural effusion. The diagnoses of 11 patients were not confirmed in this study. The diagnostic sensitivity, specificity, and accuracy of MAGE RT-nested PCR were 61.4%, 95.7%, and 73.1%, respectively. The diagnostic sensitivities of cytology and CEA (>5 ng/mL) were 61.4% and 75.0%, respectively. Among 17 patients with negative cytology who had malignant pleural effusion, 12 and 10 patients were positive for CEA (>5.0 ng/mL) and MAGE RT-nested PCR, respectively. However, of five patients with malignant pleural effusion that was not recognized by cytology and CEA, MAGE RT-nested PCR correctly predicted a malignant etiology in only one additional patient (20%).   MAGE RT-nested PCR seems to add little on the combination of conventional methods in the diagnosis of malignant effusion. © 2012 Tianjin Lung Cancer Institute and Wiley Publishing Asia Pty. Ltd.

  14. Edema pulmonar pós-pneumonectomia Postpneumonectomy pulmonary edema

    Directory of Open Access Journals (Sweden)

    Marcos Naoyuki Samano

    2005-02-01

    Full Text Available A pneumonectomia, embora seja tecnicamente simples, está associada a alta incidência de complicações (cerca de 60%. As complicações respiratórias correspondem a aproximadamente 15% deste total. A mortalidade global dessa cirurgia é de 8,6%, mas em presença de complicações respiratórias, a taxa de mortalidade chega a 30%. O edema pulmonar pós-pneumonectomia é uma complicação rara (3% a 5%, mas muito grave, sendo fatal na maioria dos casos. Foi descrito pela primeira vez há pouco mais de vinte anos mas, apesar da gravidade alarmante, pouco sabemos acerca de sua fisiopatologia, embora muitas hipóteses tenham sido levantadas. Uma vez instalado, nenhuma medida é comprovadamente eficaz no seu tratamento. Vários fatores de risco estão associados ao aparecimento do edema pulmonar pós-pneumonectomia, dentre os quais a sobrecarga hídrica, que foi o primeiro fator evitado. Entretanto, muitos trabalhos mostram não haver relação direta entre o volume recebido e o desenvolvimento do edema. A prevenção é a melhor forma de evitá-lo e deve ser realizada de maneira multifatorial, envolvendo toda a equipe médica, desde o momento da anestesia até os cuidados cirúrgicos e na terapia intensiva. No entanto, tão importante quanto a prevenção, é a suspeita clínica precoce, identificando os pacientes em risco para essa grave complicação.Although pneumonectomy is a technically simple procedure, it has been associated with a high (60% incidence of complications. Respiratory complications account for approximately 15% of such complications. Worldwide, the mortality rate among patients subjected to pneumonectomy is 8.6%. However, the rate among patients developing respiratory complications is 30%. Although postpneumonectomy pulmonary edema is rare (occurring in 3% to 5% of cases, it is a serious complication and is almost always fatal. It was first described twenty years ago and, despite these alarming statistics, little is known

  15. Mechanics of the canine diaphragm in pleural effusion.

    Science.gov (United States)

    De Troyer, André; Leduc, Dimitri; Cappello, Matteo; Gevenois, Pierre Alain

    2012-09-01

    Pleural effusion is a complicating feature of many diseases of the lung and pleura, but its effects on the mechanics of the diaphragm have not been assessed. In the present study, radiopaque markers were attached along muscle bundles in the midcostal region of the diaphragm in anesthetized dogs, and the three-dimensional location of the markers during relaxation before and after the stepwise introduction of liquid into the left or right pleural space and during phrenic nerve stimulation in the same conditions was determined using computed tomography. From these data, accurate measurements of diaphragm muscle length and displacement were obtained, and the changes in pleural and abdominal pressure were analyzed as functions of these parameters. The effect of liquid instillation on the axial position of rib 5 was also measured. The data showed that 1) liquid leaked through the dorsal mediastinal sheet behind the pericardium so that effusion was bilateral; 2) effusion caused a caudal displacement of the relaxed diaphragm; 3) this displacement was, compared with passive lung inflation, much larger than the cranial displacement of the ribs; and 4) the capacity of the diaphragm to generate pressure, in particular pleural pressure, decreased markedly as effusion increased, and this decrease was well explained by the decrease in active muscle length. It is concluded that pleural effusion has a major adverse effect on the pressure-generating capacity of the diaphragm and that this is the result of the action of hydrostatic forces on the muscle.

  16. Radiographic features of pleural effusions in pulmonary embolism

    International Nuclear Information System (INIS)

    Bynum, L.J.; Wilson, J.E.

    1978-01-01

    A prospective analysis of 155 patients with pulmonary embolism was undertaken to describe the radiographic characteristics of associated pleural effusions and related abnormalities. Approximately one half of these patients had pleural effusions. Patients with other potential causes of effusion, such as heart failure, pneumonia, or cancer, were eliminated from further analysis. In the remaining 62 patients, radiographic evidence of pulmonary infarction accompanied pleural effusions in one half of the cases. One third of patients with parenchymal consolidation had no evidence of effusion. Atelectasis and other nonspecific radiographic abnormalities occurred in less than one fifth of the cases. Typically, pleural effusions were small and unilateral, appeared soon after symptoms of thromboembolism began, and tended to reach their maximal size very early in the course of the disorder. Pulmonary infarction was associated with larger effusions that cleared more slowly and were more often bloody in appearance on thoracentesis. Chest pain occurred in all but one patient and was a valuable diagnostic clue. Pain and pleural effusions were always ipsilateral and almost always unilateral, but neither correlated well with the presence or time course of infarction. Effusions that were delayed in onset or that enlarged late in the course were associated with recurrent pulmonary embolism or superinfection. These radiographic features may be helpful in the diagnosis and management of pulmonary embolism

  17. Mortality Among Patients with Pleural Effusion Undergoing Thoracentesis

    Science.gov (United States)

    DeBiasi, Erin M.; Pisani, Margaret A.; Murphy, Terrence E.; Araujo, Katy; Kookoolis, Anna; Argento, A Christine; Puchalski, Jonathan

    2016-01-01

    Background Of the 1.5 million people diagnosed with pleural effusion annually in the U.S., approximately 178,000 undergo thoracentesis. While it is known that malignant pleural effusion portends a poor prognosis, mortality of patients with nonmalignant effusions has not been well studied. Methods This prospective cohort study evaluated 308 patients undergoing thoracentesis. Chart review was performed to obtain baseline characteristics. The etiology of the effusions was determined using standardized criteria. Mortality was determined at 30-days and 1-year. Results 247 unilateral and 61 bilateral thoracenteses were performed. Malignant effusion had the highest 30-day (37%) and 1 year (77%) mortality. There was substantial patient 30-day and 1-year mortality with effusions due to multiple benign etiologies (29% and 55%), CHF (22% and 53%), and renal failure (14% and 57%). Patients with bilateral pleural effusion, relative to unilateral, were associated with higher risk of death at 30 days and 1 year (17% versus 47%; HR 2.58 CI [1.44–4.63] and 36% versus 69%; HR 2.32 CI [1.55–3.48]). Conclusions Patients undergoing thoracentesis for pleural effusion have high short and long-term mortality. Patients with malignant effusion had the highest mortality followed by multiple benign etiologies, CHF and renal failure. Bilateral pleural effusion is distinctly associated with high mortality. PMID:25837039

  18. Identification of 10 Candidate Biomarkers Distinguishing Tuberculous and Malignant Pleural Fluid by Proteomic Methods

    OpenAIRE

    Lee, Chang Youl; Hong, Ji Young; Lee, Myung-Goo; Suh, In-Bum

    2017-01-01

    Purpose Pleural effusion, an accumulation of fluid in the pleural space, usually occurs in patients when the rate of fluid formation exceeds the rate of fluid removal. The differential diagnosis of tuberculous pleurisy and malignant pleural effusion is a difficult task in high tuberculous prevalence areas. The aim of the present study was to identify novel biomarkers for the diagnosis of pleural fluid using proteomics technology. Materials and Methods We used samples from five patients with t...

  19. Pleural manometry-historical background, rationale for use and methods of measurement.

    Science.gov (United States)

    Zielinska-Krawczyk, Monika; Krenke, Rafal; Grabczak, Elzbieta M; Light, Richard W

    2018-03-01

    Subatmospheric pleural pressure (Ppl), which is approximately -3 to -5 cmH 2 O at functional residual capacity (FRC) makes pleura a unique organ in the human body. The negative Ppl is critical for maintaining the lungs in a properly inflated state and for proper blood circulation within the thorax. Significant and sudden pleural pressure changes associated with major pleural pathologies, as well as therapeutic interventions may be associated with life-threatening complications. The pleural pressure may show two different values depending on the measurement method applied. These are called pleural liquid pressure and pleural surface pressure. It should also be realized that there are significant differences in pleural pressure distribution in pneumothorax and pleural effusion. In pneumothorax, the pressure is the same throughout the pleural space, while in pleural effusion there is a vertical gradient of approximately 1 cm H 2 O/cm in the pleural pressure associated with the hydrostatic pressure of the fluid column. Currently, two main methods of pleural pressure measurement are used: simple water manometers and electronic systems. The water manometers are conceptually simple, cheap and user-friendly but they only allow the estimation of the mean values of pleural pressure. The electronic systems for pleural pressure measurement are based on pressure transducers. Their major advantages include precise measurements of instantaneous pleural pressure and the ability to display and to store a large amount of data. The paper presents principles and details of pleural pressure measurement as well as the rationale for its use. Copyright © 2018 Elsevier Ltd. All rights reserved.

  20. Detection of EpCAM-positive microparticles in pleural fluid: A new approach to mini-invasively identify patients with malignant pleural effusions.

    Science.gov (United States)

    Roca, Elisa; Lacroix, Romaric; Judicone, Coralie; Laroumagne, Sophie; Robert, Stéphane; Cointe, Sylvie; Muller, Alexandre; Kaspi, Elise; Roll, Patrice; Brisson, Alain R; Tantucci, Claudio; Astoul, Philippe; Dignat-George, Françoise

    2016-01-19

    Pleural biomarkers allowing to mini-invasively discriminate benign from malignant pleural effusions are needed. Among potential candidates, microparticles (MPs) are extracellular vesicles that vectorize antigen derived from the parent cell. We hypothesized that tumor-derived MPs could be present in the pleural liquid and help to identify patients with malignant pleural effusions. Using highly sensitive flow cytometry and cryo-electron microscopy, we showed that large amounts of MPs from hematopoïetic and vascular origin could be detectable in pleural fluids. Their level did not differ between benign (n = 14) and malignant (n = 71) pleural effusions. Analysis of selected tumoral associated antigens (podoplanin, mucin 1 and EpCAM, epithelial-cell-adhesion-molecule) evidenced for the first time the presence of tumor-derived MPs expressing EpCAM in malignant pleural fluids only (Specificity = 93%, Sensitivity = 49% and 45% for flow cytometry and ELISA, respectively). The detection of EpCAM-positive-MPs (EpCAM + MPs) by flow cytometry showed a better specificity and sensitivity than ELISA to distinguish between pleural carcinoma and the others malignant pleural effusions (MPE; Sp: 96% vs 89%; Se: 79% vs 66%). Combining EpCAM+ MPs and cytology improved the diagnosis of MPE compared to cytology alone. This study establishes the basis for using EpCAM+ MPs as a promising new biomarker that could be added to the armamentarium to mini-invasively identify patients with malignant pleural effusions.

  1. Pleural sarcoidosis diagnosed on the basis of an increased CD4/CD8 lymphocyte ratio in pleural effusion fluid: a case report.

    Science.gov (United States)

    Kumagai, Toru; Tomita, Yasuhiko; Inoue, Takako; Uchida, Junji; Nishino, Kazumi; Imamura, Fumio

    2015-08-14

    Pleural effusion induced by sarcoidosis is rare, and pleural sarcoidosis is often diagnosed by thoracoscopic surgery. The diagnosis of pleural sarcoidosis using thoracentesis may be less invasive when sarcoidosis is already diagnosed histologically in more than one organ specimen. Here we report the case of a 64-year-old woman with pleural sarcoidosis diagnosed on the basis of an increased CD4/CD8 lymphocyte ratio in pleural effusion fluid obtained by thoracentesis. This case report is important because it highlights the usefulness of the CD4/CD8 lymphocyte ratio in pleural effusion as an indicator of pleural involvement of sarcoidosis. A 64-year-old Japanese woman visited our hospital with an initial symptom of dyspnea on exertion for a period of 4 months. Chest computed tomography showed bilateral hilar and multiple mediastinal lymphadenopathy, multiple small nodular shadows in her bilateral lungs, small nodular shadows along the interlobar pleura, and bilateral pleural effusion. Her serum angiotensin-converting enzyme and soluble interleukin-2 receptor levels were elevated. Histological analysis of a resected subcutaneous nodule, and biopsy specimens from a right mediastinal lymph node and from her right lung revealed non-caseous epithelioid granulomas. Her bronchoalveolar lavage fluid exhibited a predominance of lymphocytes together with an increase in the CD4/CD8 lymphocyte ratio. The lymphocytic predominance and the increased CD4/CD8 lymphocyte ratio were also detected in the right-sided pleural effusion fluid obtained by thoracentesis. We diagnosed sarcoidosis with pleural involvement. Because pleural effusion did not resolve spontaneously and her symptom of dyspnea on exertion worsened, corticosteroid therapy was initiated, which ameliorated the sarcoidosis and the pleuritis. Analysis of the CD4/CD8 lymphocyte ratio in pleural effusion fluid obtained by thoracentesis may be helpful for the diagnosis of pleural sarcoidosis when the diagnosis is already made

  2. An Unusual Case of Recurrent Pleural Effusion in a Child | Harjai ...

    African Journals Online (AJOL)

    Traumatic pancreatitis in children rarely results in the development of a recalcitrant pleural effusion, secondary to a connection between the pleural cavity and the pancreas. This child presented with predominantly respiratory symptoms of an underlying abdominal condition. Patients with large, recurring pleural effusions ...

  3. Pleural space elastance and changes in oxygenation after therapeutic thoracentesis in ventilated patients with heart failure and transudative pleural effusions.

    Science.gov (United States)

    Chen, Wei-Lin; Chung, Chi-Li; Hsiao, Shih-Hsin; Chang, Shi-Chuan

    2010-08-01

    Therapeutic thoracentesis (TT) is required in patients with refractory pleural effusions and impaired oxygenation. In this study, the relationship between pleural space elastance (PE) and changes in oxygenation after TT was investigated in ventilated patients with heart failure and transudative pleural effusions. Twenty-six mechanically ventilated patients with heart failure and significant transudative effusions, who were undergoing TT, were studied. The effusion was drained as completely as possible, with monitoring of pleural liquid pressure (Pliq) and chest symptoms. The volume of effusion removed, the changes in Pliq during TT, PE and arterial blood gases before and after TT were recorded. The mean volume of effusion removed was 1011.9 +/- 58.2 mL. The mean Pliq decreased from 14.5 +/- 1.0 to 0.1 +/- 1.5 cm H(2)O after TT, and the mean PE was 15.3 +/- 1.8 cm H(2)O/L. TT significantly increased the mean ratio of PaO(2)/fraction of inspired oxygen (FiO(2)) from 243.2 +/- 19.9 to 336.0 +/- 17.8 mm Hg (P 14.5 cm H(2)O/L). Measurement of PE during TT may be valuable for predicting improvement in oxygenation in ventilated patients with heart failure and pleural effusions. Patients with lower PE showed greater improvement in oxygenation after TT.

  4. ENFOQUE DIAGNÓSTICO EN EL PACIENTE CON DERRAME PLEURAL

    Directory of Open Access Journals (Sweden)

    Maite Oyonarte W., DRA.

    2015-05-01

    Full Text Available En el estudio diagnóstico del paciente con derrame pleural se deben considerar la historia clínica y el análisis de las imágenes para acotar el diagnóstico diferencial. El uso adecuado de las técnicas de imágenes contribuye a realizar procedimientos en forma segura. Se debe realizar una toracocentesis diagnóstica y/o evacuadora y se debe analizar completamente el líquido pleural. A veces es necesario realizar biopsia pleural para lo cual existen diversas técnicas disponibles. En los pacientes con pleuritis crónica inespecífica se debe hacer seguimiento por dos años para evaluar el desarrollo de malignidad.

  5. Use of imaging in the management of malignant pleural mesothelioma

    Energy Technology Data Exchange (ETDEWEB)

    Benamore, R.E. [Department of Radiology, University Hospitals of Leicester, Leicester (United Kingdom); O' Doherty, M.J. [Clinical PET Centre, Guy' s and St Thomas' Hospital, London (United Kingdom); Entwisle, J.J. [Department of Radiology, University Hospitals of Leicester, Leicester (United Kingdom)]. E-mail: james.entwisle@uhl-tr.nhs.uk

    2005-12-15

    Malignant pleural mesothelioma (MPM) is an increasingly prevalent tumour. The death rate associated with MPM is predicted to peak in the next 10 years, although radiologists and clinicians will be encountering cases for the next few decades. Contrast-enhanced CT is an established technique for evaluating suspected malignant pleural disease, but MPM can be reliably diagnosed only by histological sampling. However, even with adequate sampling and the use of immunocytochemistry, histological diagnosis is known to be difficult; definitive diagnosis may involve a combination of clinical presentation, radiological and histological appearances. Percutaneous biopsy is a promising technique for sampling the pleura. In view of its pattern of growth, MPM is a challenging disease to image by any method, and it behaves quite differently from lung cancer. This review aims to highlight the practical aspects of assessing malignant pleural mesothelioma.

  6. Multimodal treatment for resectable epithelial type malignant pleural mesothelioma

    Directory of Open Access Journals (Sweden)

    Fukuyama Yasuro

    2004-05-01

    Full Text Available Abstract Background Malignant pleural mesothelioma is a rare malignancy. The outcome remains poor despite complete surgical resection. Patients and methods Eleven patients with histologicaly proven epithelial type malignant pleural mesothelioma undergoing extrapleural pneumonectomy with systemic chemotherapy and/or radiotherapy before and after surgical resection were retrospectively reviewed. Results Ten out of 11 patients underwent complete surgical resection, of these 7 patients had stage I disease. Of these 7 patients, 5 are alive without any recurrence, a 2-year survival rate of 80% was observed in this group. There was no operative mortality or morbidity. Conclusion Extrapleural pneumonectomy with perioperative adjuvant treatment is safe and effective procedure for epithelial type malignant pleural mesothelioma.

  7. Radiologically guided percutaneous pleurodesis of malignant pleural effusion

    International Nuclear Information System (INIS)

    Morrison, M.C.; Mueller, P.R.; Saini, S.; Hahn, P.F.; Lee, M.J.; Cortell, E.; Girard, M.; Goldberg, M.; Simeone, J.F.

    1990-01-01

    This paper reports that in patients with symptomatic malignant pleural effusion. US-guided placement of small-bore catheters for pleurodesis presents an alternative to traditional surgical management. Catheters ranging in size from 7-F to 16-F (n = 17), or greater than 16-F (n = 5), were placed intrapleurally under US guidance in 22 patients with symptomatic malignant pleural effusion. Pleur-E-Vac suction was applied until tube drainage was less than 100 mL/d. Tetracycline (1--2 g/100 mL of normal saline solution) or bleomycin (45--100 U/50 mL of 5% dextrose) was then instilled and left in the pleural space for 1--3 hours. The chest tube was removed when output was less than 20 mL/d

  8. Estudo angiográfico da circulação pulmonar na tetralogia de Fallot com atresia pulmonar Angiographic study of pulmonary circulation in tetralogy of Fallot with pulmonary atresia

    Directory of Open Access Journals (Sweden)

    Marco Aurélio Santos

    2005-02-01

    Full Text Available OBJETIVO: Identificar os tipos de suprimento sangüíneo vascular pulmonar na tetralogia de Fallot com atresia pulmonar por meio de estudo hemodinâmico. MÉTODOS: Foram submetidos a estudo cineangiocardiográfico 56 pacientes portadores de tetralogia de Fallot com atresia pulmonar com idade de 20 dias a 4 anos e efetuadas injeções de contraste nas seguintes estruturas vasculares: 1 veia pulmonar encunhada, 2 colaterais aortopulmonares, 3 aorta torácica e 4 ductus arteriosus e/ou shunt sistêmico pulmonar. RESULTADOS: Dos 56 pacientes, 15 tinham o suprimento sangüíneo pulmonar através de colaterais aortopulmonares, em 36 o suprimento sangüíneo pulmonar era feito isoladamente pelo ductus arteriosus e em 5 pelo ductus arteriosus e colaterais aortopulmonares. Conforme a presença ou ausência de estruturas vasculares que compõem a circulação pulmonar na tetralogia de Fallot com atresia pulmonar e do tipo de perfusão vascular pulmonar, os doentes foram classificados em 6 tipos. CONCLUSÃO: Em função da grande complexidade e extrema variabilidade do suprimento sangüíneo pulmonar na tetralogia de Fallot com atresia pulmonar torna-se possível, com este tipo de abordagem, a obtenção de informações, suficientemente necessárias, para o correto manuseio clínico-cirúrgico.OBJECTIVE: To identify the types of pulmonary vascular blood supply in tetralogy of Fallot with pulmonary atresia by use of hemodynamic study. METHODS: Fifty-six patients with tetralogy of Fallot and pulmonary atresia, and ages ranging from 20 days to 4 years, underwent cineangiocardiographic study with contrast medium injections in the following vascular structures: 1 wedged pulmonary vein; 2 aortopulmonary collaterals; 3 thoracic aorta; and 4 ductus arteriosus or systemic-pulmonary shunt. RESULTS: In the 56 patients studied, pulmonary blood was supplied as follows: in 15, by aortopulmonary collaterals; in 36, only by the ductus arteriosus; and in 5, by the ductus

  9. Análisis in vivo de la vasculopatía arterial pulmonar mediante ultrasonido intravascular (IVUS) en pacientes con insuficiencia respiratoria crónica evaluados para trasplante pulmonar

    OpenAIRE

    Acosta Vélez, Juan Gabriel

    2013-01-01

    El objetivo del estudio es evaluar el remodelado estructural y funcional de las arterias pulmonares asociado a insuficiencia respiratoria crónica severa, mediante ecografía intravascular (IVUS). Se incluyeron 80 pacientes en estudio pretrasplante pulmonar a los que se les realizó cateterismo cardiaco derecho e IVUS de una arteria pulmonar de mediano calibre. A través del IVUS se determinó el módulo elástico, pulsatilidad y porcentaje de fibrosis arterial. La insuficiencia respiratoria crónica...

  10. Biomarkers in routine diagnosis of pleural effusions

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    Tiva Nemanič

    2018-03-01

    Full Text Available Background: Pleural fluid biochemical analysis is the first step in pleural effusion (PE diagnostics. Our purpose was to analyse the utility of the biomarkers used at our clinic in the routine diagnosis of PE. Methods: We retrospectively reviewed the PE levels of proteins, lactate dehydrogenase (LDH, alpha amylase (AA, pH and glucose in 433 patients who were treated at the University Clinic Golnik in a one-year period and compared these values with the final identified aetiology of the effusions. Results: The majority of the effusions were determined to be a consequence of malignancy (n = 154 or infection (n = 108. In 94 cases the aetiology of the effusions was heart failure and in 54 cases other diseases, while 23 effusions remained aetiologically undetermined. Considering Light’s criteria, the vast majority of the effusions were correctly classified as exudates or transudates (97.1 %. Comparing paramalignant and malignant effusions, we detected significantly lower values of pleural fluid LDH (p < 0.0005 and proteins (p < 0.0005, and higher pH (p < 0.0005 values in the paramalignant effusions. Conclusion: We have found that pleural LDH and proteins are the most helpful biochemical parameters in our routine diagnosis of pleural effusions and helped us to correctly narrow the aetiological spectrum. Furthermore, significantly higher pleural LDH and protein values and a pH below 7.32 additionally facilitated distinguishing between malignant and paramalignant effusions. Parameters such as glucose and AA are useful in selected cases and have a limited role in routine diagnostics.

  11. Differentiation of exudative and transudative pleural effusion : MR appearances

    International Nuclear Information System (INIS)

    Kim, Tae Hoon; Lee, Sang Yoon; Kang, Ho Yeong; Kim, Soo Rhan; Yang, Sang Kyu; Shin, So Young; Lee, Shin Hyung; Lee, Chang Joon

    1996-01-01

    The purpose of this study is to determine whether MR images after intravenous administration of Gd-DTPA can differentiate exudative and transudative pleural effusion. We studied 18 patients with ten exudative and eight transudative pleural effusions diagnosed clinically and by thoracentesis. We analysed the relationship between T1 value(normalized to fat) and the ratio of effusion/serum protein of pleural effusion. We also assessed the contrast enhancement of exudative and transudative pleural effusion on T1 weighted SE images taken at 15 and 30minutes after administration of Gd-DTPA. The relationship between the effusion/serum protein ratio and T1 value(normalized to fat) was statistically not significant(r=0.27, P=0.381). On precontrast spin-echo T1WI, mean signal intensity of the transudate was 0.18(±0.04) and that of the exudate was 0.24(±0.07), values which were not significant differences(P>0.05). Postcontrast mean signal intensities of transudates at 15 and 30 were 0.20±0.06 and 0.26±0.08, respectively, values which were not significantly higher than that of precontrast mean signal intensity(P<0.05). Postcontrast mean signal intensity values of exudative pleural effusions at 15 and 30 minutes(0.32±0.06 and 0.39±0.06, respectively) were, on the other hand, significantly higher than that of precontrast mean signal intensity(P<0.05). Postcontrast T1-weighted SE images at 15 and 30 minutes can be helpful in the differentiation of transudative and exudative pleural effusion

  12. Biphasic Malignant Pleural Mesothelioma Masquerading as a Primary Skeletal Tumor

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    James Benjamin Gleason

    2016-01-01

    Full Text Available Biphasic malignant pleural mesothelioma is a rare malignant tumor, usually presenting as a pleural-based mass in a patient with history of chronic asbestos exposure. We herein report a case of a 41-year-old man who presented with chest pain and had a chest computed tomography (CT scan suggestive of a primary skeletal tumor originating from the ribs (chondrosarcoma or osteosarcoma, with no history of asbestos exposure. CT-guided core needle biopsies were diagnosed as malignant sarcomatoid mesothelioma. Surgical resection and chest wall reconstruction were performed, confirming the diagnosis and revealing a secondary histologic component (epithelioid, supporting the diagnosis of biphasic malignant mesothelioma.

  13. A rare pleural effusion in a young male

    Directory of Open Access Journals (Sweden)

    Shabana Begum

    2015-01-01

    Full Text Available A 28-year-old male presented with fever with right-sided chest pain for 2 weeks. Clinicoradiological picture was suggestive of right-sided pleural effusion. He had history of polytrauma following a road traffic accident and had to undergo emergency laparotomy a month ago. Microscopic and culture examination of the pleural fluid showed neutrophilia, high bilirubin content and presence of gram-negative bacilli. Ultrasound of the abdomen showed the presence of biloma in the liver and right subdiaphragmatic space with fistulous communication into the right thoracic cavity. The patient was managed successfully with complete recovery.

  14. CT differentiation of subphrenic abscess and pleural effusion

    International Nuclear Information System (INIS)

    Alexander, E.S.; Proto, A.V.; Clark, R.A.

    1983-01-01

    The computed tomographic scans of 38 patients with proven subphrenic abscesses and 28 patients with proven pleural effusions were reviewed without knowledge of the final diagnosis. In 26% of cases the hemidiaphragm could be identified directly as a stripe, while in 71% of cases only the hemidiaphragmatic contour could be seen. In 3% of cases the hemidiaphragm position was indeterminate because insufficient scans of the chest or abdomen were obtained. In the cases where the hemidiaphragm position could be established, the computed tomographic diagnosis was correct in 100% of subphrenic abscesses and in 96% of pleural effusions. Methods of identifying the hemidiaphragm on computed tomography and the possible pitfalls are discussed

  15. An emerging indication of FDG-PET: pleural tumours

    International Nuclear Information System (INIS)

    Balogova, S.; Kerrou, K.; Montravers, F.; Grahek, D.; Aide, N.; Jacob, T.; Younsi, N.; Cailleux, N.; Talbot, J.N.

    2003-01-01

    The diagnosis and staging of malignant pleural tumours is difficult by means of radiology and also histology. Nevertheless an early diagnose, in particular in those people exposed to asbestos, and an accurate staging are key factors for a better survival. There is thus a potential role for FD G imaging in these relatively rare cancers. In our series, were are currently able to evaluate 22 FD G examinations performed in 16 patients referred for apparently isolated pleural lesions. Twelve FD G examinations were performed with a dedicated PET machine (C-PET, Adac) and ten with a coincidence detection gamma camera (Irix, Picker). The precise clinical settings were the following: characterisation of pleural masses or search for the unknown primary tumour in case of adenocarcinoma (6 cases), staging of a mesothelioma (5 cases), suspicion of recurrence and/or residual lesions (11 cases). The pleural lesions took-up FD G in all cases. By adding our results to data of the five previously published studies, the sensitivity for detecting malignant pleural lesions that are not yet characterised as primary pleural cancer is 99% and the specificity 79%. There was in our series one false positive result due to an inflammatory lesion. False negative results for the detection of lymph node invasion occurred in three patients and were in relation with an infra-centimetric size and the difficulty to distinguish, on FD G images, mediastinal lymph nodes from a widespread pleural and pulmonary extension of cancer. A change in patient management was induced by the FD G examination in 4 patients (25%) and the evolution confirmed that the choice was appropriate. Unknown lesions that could have modified the management were discovered in two other patients. This study highlights the fact that FD G imaging has an impact on the management of patients with solitary pleural lesions and can detect recurrences, in some cases even more accurately than invasive procedures with histology. From our

  16. Imatinib-induced pleural effusion: A case report

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    R Banka

    2017-01-01

    Full Text Available Imatinib is a tyrosine kinase inhibitor and has rarely been reported to cause pleural effusion. We report the case of an 88-year-old male, known case of gastrointestinal stromal tumor on treatment with imatinib, who presented with a 2-week history of cough and dyspnea. He was diagnosed to have a right-sided pleural effusion and thoracentesis of the fluid revealed an exudate with low adenosine deaminase and negative cytology. Withdrawal of the drug lead to resolution of symptoms. We report this case to highlight the side effect profile of imatinib and warn physicians regarding this potential adverse effect which may be mistaken for metastasis or infection.

  17. Drenaje venosa pulmonar anómalo total. Técnicas y resultados

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    Ángel Aroca

    2014-04-01

    Se citan recomendaciones para el a veces complejo manejo postoperatorio y se revisa la literatura más reciente que aporta datos sobre el tratamiento y resultados de la complicación tardía más letal: la obstrucción anastomótica y/o de venas pulmonares.

  18. O problema da hemossiderose pulmonar na doença de Chagas

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    Leila Andrade Siqueira

    1972-10-01

    Full Text Available Os autores estudaram a existência de hemosiderose pulmonar em 60 casou de autopsia, 20 dos quais chagásicos crônicos com cardiopatia, 20 pacientes com cardiopatia não chagásica e 20 casos sem nenhuma manifestação de doença cardíaca. A incidência de hemossiderose pulmonar foi de 75% entre os chagásicos e de 80% entre os pacientes de cardiopatia não chagásica. Nos casos controle sem cardiopatia a incidência foi relativamente baixa (45% e, guando presente, o grau de intensidade era mínimo. Com esses achados, conclui-se que a hemossiderose pulmonar na Doença de Chagas é uma conseqüência da congestão crônica passiva, resultante da insuficiência cardíaca congestiva, do mesmo modo que ocorre em outras condições mórbidas tais como Estenose mitral e Cor-pulmonar crônico, não havendo evidências de uma pneumopatia peculiar em chagásicos.

  19. Linfangioleiomiomatose pulmonar inicial provável e linfangioleiomioma mediastínico

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    M. Pontes

    2014-03-01

    Full Text Available Resumo: Uma mulher de 68 anos foi submetida a uma ressecção de um linfoangioendotelioma mediastinal observado na monitorização de uma lobectomia inferior esquerda devido a bronquiectasia, complicada por quilotórax. Isto levou a uma reavaliação do espécime pulmonar que revelou, além da bronquiectasia inflamatória, nódulos de pequenas células fusiformes no parênquima pulmonar, semelhantes a nódulos pulmonares de tipo meningotelial, mas com positividade imunohistoquímica para actina do músculo liso. A hipótese de desenvolvimento inicial de linfangioleiomiomatose pulmonar é discutida. Abstract: A 68 year old woman was submitted to a mediastinal lymphangioleiomyoma resection found in a follow-up study of lower left lung resection due to bronchiectasis complicated by chylothorax. This led to a revaluation of the pulmonary specimen that revealed, in addition to inflammatory bronchiectasis, small spindle cell nodules in the lung parenchyma, similar to minute pulmonary meningothelial-like nodules, but with smooth muscle actin immunohistochemical positivity. The possibility of initial pulmonary development of lymphangioleiomyomatosis is discussed. Palavras-chave: Mediastinal, Linfangioleiomioma, Linfangioleiomiomatose, Keywords: Mediastinal, Lymphangioleiomyoma, Lymphangioleiomyomatosis

  20. 58. Actitud frente al flujo sanguíneo pulmonar adicional en la operación de glenn

    Directory of Open Access Journals (Sweden)

    F. Serrano Martínez

    2010-01-01

    Conclusiones: El mantenimiento de FPAC no incrementa la morbimortalidad post-Glenn ni altera la conservación funcional del ventrículo único, permitiendo llegar a la fase pre-Fontan con mayor SaO2 y mejor tamaño de ramas pulmonares. La existencia o ausencia de FPAC no influyó en los resultados del Fontan posterior, aunque consideramos interesante mantenerlo, especialmente en casos con ramas pulmonares pequeñas. La paliación pre-Glenn tipo banding pulmonar se asoció a mayor imposibilidad de conservar un FPAC.

  1. Lesiones pulmonares relacionadas con el tabaquismo. Hallazgos y diagnósticos diferenciales por tomografía computada multidetector

    OpenAIRE

    N.E. Bernard; V. Pardo; A.C. Benítez Mendes; A. Seehaus

    2017-01-01

    Resumen: Desde hace tiempo se ha establecido la relación entre el hábito tabáquico y diferentes enfermedades pulmonares, particularmente el cáncer y el enfisema pulmonar. Sin embargo, es menos conocida la asociación del tabaquismo con otras entidades, como la bronquiolitis respiratoria asociada a la enfermedad intersticial (BREI), la neumonitis descamativa (ND), la histiocitosis de Langerhans (HL), la neumonía eosinofílica aguda (NEA), la fibrosis pulmonar (FP) y la combinación de esta última...

  2. Lesiones pulmonares relacionadas con el tabaquismo: Hallazgos y diagnósticos diferenciales por tomografía computada multidetector

    OpenAIRE

    Bernard, N.E; Pardo, V; Benítez Mendes, A.C; Seehaus, A

    2017-01-01

    Desde hace tiempo se ha establecido la relación entre el hábito tabáquico y diferentes enfermedades pulmonares, particularmente el cáncer y el enfisema pulmonar. Sin embargo, es menos conocida la asociación del tabaquismo con otras entidades, como la bronquiolitis respiratoria asociada a la enfermedad intersticial (BREI), la neumonitis descamativa (ND), la histiocitosis de Langerhans (HL), la neumonía eosinofílica aguda (NEA), la fibrosis pulmonar (FP) y la combinación de esta última con el e...

  3. Derrame pleural secundário à hiperestimulação ovariana Pleural effusion following ovarian hyperstimulation

    Directory of Open Access Journals (Sweden)

    Jader Joel Machado Junqueira

    2012-06-01

    Full Text Available A síndrome de hiperestimulação ovariana (SHEO é uma complicação iatrogênica que ocorre na fase lútea de um ciclo hormonal induzido. Na maioria dos casos, os sintomas são autolimitados e regridem espontaneamente. Entretanto, casos graves comumente cursam com desconforto respiratório agudo. O objetivo deste estudo foi descrever a apresentação clínica, o tratamento e os desfechos de derrame pleural associado a SHEO em três pacientes submetidas a fertilização in vitro. A idade das pacientes variou de 27 a 33 anos, e o aparecimento do derrame pleural sintomático (bilateral em todos os casos ocorreu, em média, 43 dias (variação: 27-60 dias após o início da terapia hormonal para a indução da ovulação. Todas as pacientes necessitaram de internação hospitalar para reposição volêmica maciça, e duas delas necessitaram de ventilação mecânica não invasiva. Embora todas as pacientes tenham sido inicialmente submetidas à toracocentese, a recidiva precoce dos sintomas e do derrame pleural fez com que se optasse pela drenagem pleural com cateter do tipo pigtail. Apesar do alto débito de drenagem (média de 1.000 mL/dia na primeira semana e do tempo de drenagem prolongado (9-22 dias, os desfechos foram excelentes (alta hospitalar. Embora o derrame pleural secundário a SHEO seja provavelmente subdiagnosticado, a morbidade associada não deve ser subestimada, principalmente devido a seus efeitos em pacientes potencialmente gestantes. Nesta série de casos, o diagnóstico precoce e as medidas de suporte clínico adequadas permitiram uma evolução favorável, limitando a abordagem cirúrgica a uma drenagem pleural adequada.Ovarian hyperstimulation syndrome (OHSS is an iatrogenic complication that occurs in the luteal phase of an induced hormonal cycle. In most cases, the symptoms are self-limited and spontaneous regression occurs. However, severe cases are typically accompanied by acute respiratory distress. The objective of

  4. Diagnóstico por imagem do tromboembolismo pulmonar agudo Imaging of acute pulmonary thromboembolism

    Directory of Open Access Journals (Sweden)

    C. Isabela S. Silva

    2004-10-01

    Full Text Available O diagnóstico do tromboembolismo pulmonar agudo é baseado na probabilidade clínica, uso do dímero D (quando disponível e na avaliação por imagem. Os principais métodos de imagem utilizados no diagnóstico são representados por cintilografia ventilação-perfusão, angiografia pulmonar e tomografia computadorizada (TC. Na última década vários estudos têm demonstrado que a TC espiral apresenta elevada sensibilidade e especificidade no diagnóstico de tromboembolismo pulmonar agudo. Uma melhor avaliação das artérias pulmonares tornou-se possível com a recente introdução dos equipamentos de TC espirais com multidetectores. Vários pesquisadores têm sugerido que a angiografia pulmonar por TC espiral deve substituir a cintilografia na avaliação de pacientes com suspeita clinica de tromboembolismo pulmonar agudo. Os autores discutem os principais métodos de imagem utilizados no diagnóstico de tromboembolismo pulmonar agudo enfatizando o papel da TC espiral.The diagnosis of acute pulmonary thromboembolism is based on the clinical probability, use of D-dimer (when available and imaging. The main imaging modalities used in the diagnosis are ventilation-perfusion (V/Q, scintigraphy, angiography, and computed tomography (CT. In the last decade several studies have demonstrated that spiral CT has a high sensitivity and specificity in the diagnosis of acute pulmonary thromboembolism. The evaluation of the pulmonary arteries has further improved with the recent introduction of multidetector spiral CT scanners. Various investigators have suggested that spiral CT pulmonary angiography should replace scintigraphy in the assessment of patients whose symptoms are suggestive of acute PE. This article discusses the role of the various imaging modalities in the diagnosis of acute pulmonary thromboembolism with emphasis on the role of spiral CT.

  5. Recurrent respiratory papillomatosis with pulmonary parenchymal spread - report of two cases; Papilomatose respiratoria recorrente com disseminacao pulmonar - relato de dois casos

    Energy Technology Data Exchange (ETDEWEB)

    Araujo Neto, Cesar Augusto de; Campos, Rubia Mara Correia [Bahia Univ., Salvador, BA (Brazil). Dept. de Radiologia]. E-mail: rubiacampos@ig.com.br; Bastos, Maria de Lourdes Santos [Bahia Univ., Salvador, BA (Brazil). Dept. de Pneumologia

    2002-04-01

    The authors report the cases of two adolescent patients with recurrent respiratory papillomatosis with pulmonary parenchymal spread. Both patients presented very similar initial symptoms and clinical evolution. The patients developed larynx papillomas in childhood causing obstruction to airflow and required permanent tracheostomy after several resection and recurrence episodes. Long time after they developed recurrent pulmonary infections. In both cases the disease was diagnosed through clinical history and high resolution computed tomography that revealed papillomas in the trachea and solid or cavitary nodules in the lungs. (author)

  6. A pleural vacuum relief device for pleural drain unit use in the hyperbaric environment.

    Science.gov (United States)

    Gelsomino, Marco; Tsouras, Theo; Millar, Ian; Fock, Andrew

    2017-09-01

    When a standard water-seal pleural drain unit (PDU) is used under hyperbaric conditions there are scenarios where excessive negative intrapleural pressure (IPP) and/or fluid reflux can be induced, risking significant morbidity. We developed and tested a pleural vacuum relief (PVR) device which automatically manages these risks, whilst allowing more rapid hyperbaric pressure change rates. The custom-made PVR device consists of a one-way pressure relief valve connected in line with a sterile micro filter selected for its specific flow capacity. The PVR device is designed for connection to the patient side sampling port of a PDU system, allowing inflow of ambient air whenever negative pressure is present, creating a small, controlled air leak which prevents excessive negative pressure. The hyperbaric performance of a Pleur-Evac A-6000 intercostal drain was assessed with and without this added device by measuring simulated IPP with an electronic pressure monitor connected at the patient end of the PDU. IPP readings were taken at 10, 15, 20 and 30 cmH₂O of suction (set on the drain unit) at compression rates of 10, 30, 60, 80, 90 and 180 kPa·min⁻¹ to a pressure of 280 kPa. At any compression rate of > 10 kPa·min⁻¹, the negative IPP generated by the Pleur-Evac A-6000 alone was excessive and resulted in back flow through the PDU water seal. By adding the PVR device, the generated negative IPP remains within a clinically acceptable range, allowing compression rates of at least 30 kPa·min⁻¹ with suction settings up to -20 cmH₂O during all phases of hyperbaric treatment. The PDU PVR device we have developed works well, minimising attendant workload and automatically avoiding the excessive negative IPPs that can otherwise occur. This device should only be used with suction.

  7. Classificação ultra-sonográfica do derrame pleural e do empiema parapneumônico Ultrasound classification of pleural effusion and parapneumonic empyema

    Directory of Open Access Journals (Sweden)

    Luís Marcelo Inaco Cirino

    2002-03-01

    Full Text Available Os autores correlacionam as alterações anatomopatológicas da cavidade pleural com os achados ultra-sonográficos no derrame pleural e no empiema parapneumônico e apresentam uma classificação baseada nestes dados. Concluem que a ultra-sonografia é método diagnóstico fidedigno para inferir a fase anatomopatológica da doença pleural, bem como auxiliar na escolha da alternativa de tratamento.We correlated the anatomopathological abnormalities of the pleural space with the ultrasound findings in patients with pleural effusion and/or parapneumonic empyema and proposed a classification based on these results. Ultrasonography is a reliable method to infer the anatomopathological phase of pleural disease and consequently may be of help in the choice of the most suitable treatment.

  8. ¿(Anti-TNF-¿ y tuberculosis pulmonar

    Directory of Open Access Journals (Sweden)

    Carlo Vinicio Caballero Uribe

    2006-01-01

    Full Text Available Presentación de una paciente con artritis reumatoide severa en tratamiento con inhibidores del Factor de Necrosis Tumoral (Anti-TNF, quien presenta además un cuadro de tuberculosis pulmonar. La artritis reumatoide es una enfermedad inflamatoria crónica de las articulaciones, que afecta en un inicio la membrana sinovial, pero que si no es tratada oportunamente lleva a daño estructural irreversible del sistema músculo-esquelético y eventualmente de otros sistemas orgánicos. Dentro de los criterios de la American College of Rheumatology se incluyen la Rigidez Matutina, Artritis de 3 o más articulaciones, Artritis simétrica, Nódulos reumáticos, Factor Reumatoideo y hallazgos radiográficos. Dentro de la patogenia de esta enfermedad, el Factor de Necrosis Tumoral es una citocina que juega un papel importante, una producción elevada de TNF-α se ha encontrado en la sinovial de estos pacientes, y por su capacidad de inducir la producción de otras citocinas, como IL-6, IL-17, GM-CSF, M-CSF, e incluso IL-1 y TNF-α (función autócrina, parecería que el TNF-α ejerce una acción “jerárquica” dentro de la llamada red de citocinas y una inhibición de su acción da como resultado un beneficio terapéutico en los pacientes con AR. Sin embargo, es conocido que la infección concurrente más frecuentemente informada con el uso de agentes biológicos (Anti-TNF es la TB, y la incidencia de ésta se ha incrementado desde el advenimiento de la terapia biológica. Por tanto, la descripción de este caso no corresponde a un hecho médico aislado, sino a una problemática actual y real. Este es el primer caso que se reporta en la Costa Caribe.

  9. Compromiso pulmonar en pacientes hospitalizados con infección por el virus de inmunodeficiencia humana en el Hospital Pablo Tobón Uribe (Medellín, Colombia

    Directory of Open Access Journals (Sweden)

    Franco E. Montúfar-Andrade

    Full Text Available Resumen Más de la mitad de los pacientes con infección por virus de inmunodeficiencia humana (VIH pueden tener compromiso pulmonar en el transcurso de su vida. Este puede ser multicausal y las infecciones oportunistas son las principales, sin embargo, las causas no infecciosas no son menos importantes. Objetivo: Describir las características del compromiso pulmonar en pacientes hospitalizados con infección por VIH. Metodología: Estudio descriptivo observacional. Resultados: Se incluyó a 63 pacientes, el 85,7% fueron hombres. La edad promedio fue 40,6 ± 12 años. El 21,4% tuvieron antecedente de promiscuidad sexual y 28,6% fueron hombres con sexo con hombres. Se identificó tabaquismo en 60,3%, alcoholismo en 52,4% y consumo de drogas en 20,6%. El 23,8% tuvo historia de tuberculosis. Al ingreso, el 79,4% tenía sida, el recuento promedio de CD4 fue 138,5 ± 17,7 células/mm3 y el 49,2% tenía CD4 < 100 células/mm3. Las principales comorbilidades fueron: enfermedad neoplásica 20,6%, diarrea crónica 19%, EPOC 6,3% y diabetes mellitus 3,2%. Los principales síntomas al ingreso fueron: respiratorios 66,7%, gastrointestinales 47,6% y neurológicos 34,9%. Los principales oportunistas documentados fueron Mycobacterium spp, H. capsulatum y P. jirovecii. El sarcoma de Kaposi, la enfermedad lifoproliferativa y la EPOC fueron causas de compromiso no infeccioso. Los principales hallazgos radiográficos fueron: infiltrados intersticiales (42,9%, compromiso pleural (23,8% y lesiones cavitarias (7,9%. El compromiso multilobar fue evidente en el 15,9%. Las principales complicaciones fueron falla respiratoria, disfunción orgánica múltiple y falla renal aguda. El 19% requirió ingreso a UCI y, de estos, el 83,3% necesitó ventilación mecánica. La estancia hospitalariapromedio fue de 18 ± 20 días y la mortalidad del 17,5%. Discusión: Las infecciones por oportunistas son las principales causas de compromiso pulmonar y, dentro de estas, las causadas

  10. Sarcoma de alto grado pulmonar en paciente con síndrome constitucional e infil- trado pulmonar persistente

    Directory of Open Access Journals (Sweden)

    Peña Durán A

    2017-07-01

    Full Text Available Patient of 76 years smoker of 40 cigarettes per day until 12 years ago, with constitutional syndrome and pneumological antecedents and criteria of bronchial hyperreactivity, follow up in consultation of routine Pneumology finding in chest X-ray, an infiltrate in the right upper lobe. A thoracoabdominopelvic CT scan is requested, with a mass of almost 4 cm superior in an axillar subsegment of the right upper lobe with underlying pleural thickening, perinodular cystic lesions and doubtful anterior satellite nodule , Right and mediastinal hilar lymphadenopathy stage IIaN1M0 (stage IIA. Fibe- roptic bronchoscopy is performed with a suggestive study of chronic bronchitis. Negative bronchoalveolar and bron- choaspolar lavage samples are collected for malignant tumor cells. We conducted a guided BAG with CT scan and biopsy results showed high grade sarcoma with intense positive vimentin, moderate weak positive actin, caldesmon, S100, Melan A negative, AE1: AE3. CK7 and CK20 negative. In PET CT results, right lung neoplasm with ipsilateral hilar adenopathy is confirmed. VATS thoracic surgery is performed later, lobectomy of upper right lobes and lympha- denectomy are performed. The patient is discharged pending cáncer treatment.

  11. Measurement of Pleural Temperature During Radiofrequency Ablation of Lung Tumors to Investigate Its Relationship to Occurrence of Pneumothorax or Pleural Effusion

    International Nuclear Information System (INIS)

    Tajiri, Nobuhisa; Hiraki, Takao; Mimura, Hidefumi; Gobara, Hideo; Mukai, Takashi; Hase, Soichiro; Fujiwara, Hiroyasu; Iguchi, Toshihiro; Sakurai, Jun; Aoe, Motoi; Sano, Yoshifumi; Date, Hiroshi; Kanazawa, Susumu

    2008-01-01

    The purpose of this study was to investigate the relationship between pleural temperature and pneumothorax or pleural effusion after radiofrequency (RF) ablation of lung tumors. The pleural temperature was measured immediately outside the lung surface nearest to the tumor with a fiber-type thermocouple during 25 ablation procedures for 34 tumors in 22 patients. The procedures were divided into two groups depending on the highest pleural temperature: P-group I and P-group II, with highest pleural temperatures of <40 deg. C and ≥40 deg. C, respectively. The incidence of pneumothorax or pleural effusion was compared between the groups. Multiple variables were compared between the groups to determine the factors that affect the pleural temperature. The overall incidence of pneumothorax and pleural effusion was 56% (14/25) and 20% (5/25), respectively. Temperature data in five ablation procedures were excluded from the analyses because these were affected by the pneumothorax. P-group I and P-group II comprised 10 procedures and 10 procedures, respectively. The incidence of pleural effusion was significantly higher in P-group II (4/10) than in P-group I (0/10) (p = 0.043). However, the incidence of pneumothorax did not differ significantly (p = 0.50) between P-group I (4/10) and P-group II (5/10). Factors significantly affecting the pleural temperature were distance between the electrode and the pleura (p < 0.001) and length of the lung parenchyma between the electrode and the pleura (p < 0.001). We conclude that higher pleural temperature appeared to be associated with the occurrence of pleural effusion and not with that of pneumothorax

  12. The diagnostic value of procalcitonin, adenosine deaminase for tuberculous pleural effusions

    International Nuclear Information System (INIS)

    Sun Jia; Jing Xiufeng; Hui Fuxin

    2010-01-01

    Objective: To explore differential diagnostic value of procalcitonin (PCT), adenosine deaminase (ADA) in pleural fluid and serum for tuberculous pleural effusions. Methods: The concentrations of PCT and ADA both in serum and pleural fluid in one hundred and twenty-eight patients with pleural effusion were detected. These patients were divided into three groups. Fifty-two patients with tuberculous plueral effusion were composed of the tuberculous group. Twenty-two patients with parapneumonic effusion composed the pneumonic group and forty patients with malignant pleural effusion and fourteen patients with heart faliure composed of the control group. Results: There were no statistically significant differences in serum PCT among the three groups (P > 0.05). PCT of pleural fluid was significantly increased in tuberculous and parapneumonic groups compared to the control group (P < 0.05). ADA activities in tuberculous serum and pleural fluid were both higher than those in the parapneumonic and the control groups (P < 0.01). The ratio of ADA in pleural fluid and serum (P /S) was calculated. The diagnostic sensitivity and specificity of P /S (cut-off value 1.27) were 92.3% and 100% respectively for tuberculous pleural effusions calcuted by receiver operating curve. Conclusion: Combined measurements of PCT and ADA in pleural fluid are useful in diagnosing tuberculous pleural effusions. (authors)

  13. Identification of 10 Candidate Biomarkers Distinguishing Tuberculous and Malignant Pleural Fluid by Proteomic Methods.

    Science.gov (United States)

    Lee, Chang Youl; Hong, Ji Young; Lee, Myung Goo; Suh, In Bum

    2017-11-01

    Pleural effusion, an accumulation of fluid in the pleural space, usually occurs in patients when the rate of fluid formation exceeds the rate of fluid removal. The differential diagnosis of tuberculous pleurisy and malignant pleural effusion is a difficult task in high tuberculous prevalence areas. The aim of the present study was to identify novel biomarkers for the diagnosis of pleural fluid using proteomics technology. We used samples from five patients with transudative pleural effusions for internal standard, five patients with tuberculous pleurisy, and the same numbers of patients having malignant effusions were enrolled in the study. We analyzed the proteins in pleural fluid from patients using a technique that combined two-dimensional liquid-phase electrophoresis and matrix assisted laser desorption/ionization-time of flight-mass spectrometry. We identified a total of 10 proteins with statistical significance. Among 10 proteins, trasthyretin, haptoglobin, metastasis-associated protein 1, t-complex protein 1, and fibroblast growth factor-binding protein 1 were related with malignant pleural effusions and human ceruloplasmin, lysozyme precursor, gelsolin, clusterin C complement lysis inhibitor, and peroxirexdoxin 3 were expressed several times or more in tuberculous pleural effusions. Highly expressed proteins in malignant pleural effusion were associated with carcinogenesis and cell growth, and proteins associated with tuberculous pleural effusion played a role in the response to inflammation and fibrosis. These findings will aid in the development of novel diagnostic tools for tuberculous pleurisy and malignant pleural effusion of lung cancer. © Copyright: Yonsei University College of Medicine 2017

  14. Effects of ventilation on hyaluronan and protein concentration in pleural liquid of anesthetized and conscious rabbits.

    Science.gov (United States)

    Wang, P M; Lai-Fook, S J

    1998-01-01

    The hypothesis of this study is that pleural lubrication is enhanced by hyaluronan acting as a boundary lubricant in pleural liquid and by pleural filtration as reflected in changes in protein concentration with ventilation. Anesthetized rabbits were injected intravenously with Evans blue dye and ventilated with 100% O2 at either of two levels of ventilation for 6 h. Postmortem values of hyaluronan, total protein, and Evans blue-dyed albumin (EBA) concentrations in pleural liquid were greater at the higher ventilation, consistent with increases in boundary lubrication, pleural membrane permeability, and pleural filtration. To determine whether these effects were caused by hyperoxia or anesthesia, conscious rabbits were ventilated with either 3% CO2 or room air in a box for 6, 12, or 24 h. Similar to the anesthetized rabbits, pleural liquid hyaluronan concentration after 24 h was higher in the conscious rabbits with the hypercapnic-induced greater ventilation. By contrast, the time course of total protein and EBA in pleural liquid was similar in both groups of conscious rabbits, indicating no effect of ventilation on pleural permeability. The increase in pleural liquid hyaluronan concentration might be the result of mesothelial cell stimulation by a ventilation-induced increase in pleural liquid shear stress.

  15. Computed tomography (CT) findings of the pleural metastasis effusion: the examination of 100 patients

    International Nuclear Information System (INIS)

    Arenas, J. J.; Alonso, S.; Gil, S.; Fernandez, F.; Lloret, M.

    1999-01-01

    To evaluate the computed tomography (CT) findings in a series of 100 pleural metastasis effusions. A retrospective study was carried out that consisted of assessing the CT images of 100 malignant pleural metastasis effusions, evaluating the amount of the effusion, its distribution, the presence of swelling or nodules in the different pleural surfaces, the existence and the characteristics of the extrapleural fat and the changes in other locations different to the pleural cavity, mainly the mediastinum and the pulmonary parenchyma. The effusion was located in 12 patients. The amount of the effusion was slight in 14% and massive in 10% of the sick patients. Pleural nodules were detected in 19% of the studies, in all those that affected the costal parental pleura, being less frequent in the other pleural surfaces. The costal parental pleura was swollen in 43% of the sick patients. 52 sick patients did not have any swelling nor pleural nodules, with the pleural effusion being the only sign of pleural metastasis. Changes in the rest of the thorax were frequent in relation to the malignant illness that causes the effusion and appeared in 67% of the sick patients. The patients with pleural effusions of malignant etiology showed variable CT findings, that in general were non-specific, and in almost half the cases no pleural changes can be seen apart from the effusion. (Author) 13 refs

  16. Diagnostic value and safety of medical thoracoscopy in tuberculous pleural effusion.

    Science.gov (United States)

    Wang, Zhen; Xu, Li-Li; Wu, Yan-Bing; Wang, Xiao-Juan; Yang, Yuan; Zhang, Jun; Tong, Zhao-Hui; Shi, Huan-Zhong

    2015-09-01

    Differentiating tuberculous pleural effusion from other lymphocytic pleural effusions is often challenging. This retrospective study aimed to assess the efficacy and safety of medical thoracoscopy in patients with suspected tuberculous pleural effusion. Between July 2005 and June 2014, patients with pleural effusions of unknown etiologies underwent medical thoracoscopy in our institute after less invasive means of diagnosis had failed. Demographic, radiographic, procedural, and histological data of patients with tuberculous pleural effusion were analyzed. During this 9-year study, 333 of 833 patients with pleural effusion were confirmed to have tuberculous pleurisy. Under thoracoscopy, we observed pleural nodules in 69.4%, pleural adhesion in 66.7%, hyperemia in 60.7%, plaque-like lesions in 6.0%, ulceration in 1.5% of patients with tuberculous pleurisy. Pleural biopsy revealed the presence of Mycobacterium tuberculosis in the pleural tissue or/and demonstration of caseating granulomas in 330 (99.1%) patients. No serious adverse events were recorded, and the most common minor complication was transient chest pain (43.2%) from the indwelling chest tube. Our data showed that medical thoracoscopy is a simple procedure with high diagnostic yield and excellent safety for the diagnosis of tuberculous pleural effusion. Copyright © 2015 Elsevier Ltd. All rights reserved.

  17. Spatial context learning approach to automatic segmentation of pleural effusion in chest computed tomography images

    Science.gov (United States)

    Mansoor, Awais; Casas, Rafael; Linguraru, Marius G.

    2016-03-01

    Pleural effusion is an abnormal collection of fluid within the pleural cavity. Excessive accumulation of pleural fluid is an important bio-marker for various illnesses, including congestive heart failure, pneumonia, metastatic cancer, and pulmonary embolism. Quantification of pleural effusion can be indicative of the progression of disease as well as the effectiveness of any treatment being administered. Quantification, however, is challenging due to unpredictable amounts and density of fluid, complex topology of the pleural cavity, and the similarity in texture and intensity of pleural fluid to the surrounding tissues in computed tomography (CT) scans. Herein, we present an automated method for the segmentation of pleural effusion in CT scans based on spatial context information. The method consists of two stages: first, a probabilistic pleural effusion map is created using multi-atlas segmentation. The probabilistic map assigns a priori probabilities to the presence of pleural uid at every location in the CT scan. Second, a statistical pattern classification approach is designed to annotate pleural regions using local descriptors based on a priori probabilities, geometrical, and spatial features. Thirty seven CT scans from a diverse patient population containing confirmed cases of minimal to severe amounts of pleural effusion were used to validate the proposed segmentation method. An average Dice coefficient of 0.82685 and Hausdorff distance of 16.2155 mm was obtained.

  18. [Imaging of pleural diseases: evaluation of imaging methods based on chest radiography].

    Science.gov (United States)

    Poyraz, Necdet; Kalkan, Havva; Ödev, Kemal; Ceran, Sami

    2017-03-01

    The most commonly employed radiologic method in diagnosis of pleural diseases is conventional chest radiograph. The commonest chest- X-Ray findings are the presence of pleural effusion and thickening. Small pleural effusions are not readily identified on posteroanterior chest radiograph. However, lateral decubitus chest radiograph and chest ultrasonography may show small pleural effusions. These are more efficient methods than posteroanterior chest radiograph in the erect position for demonstrating small amounts of free pleural effusions. Chest ultrasonograph may be able to help in distinguishing the pleural pathologies from parenchymal lesions. On chest radiograph pleural effusions or pleural thickening may obscure the visibility of the underlying disease or parenchymal abnormality. Thus, computed tomography (CT) may provide additional information of determining the extent and severity of pleural disease and may help to differentiate malign pleural lesions from the benign ones. Moreover, CT may provide the differentiation of parenchmal abnormalities from pleural pathologies. CT (coronal and sagittal reformatted images) that also show invasion of chest wall, mediastinum and diaphragm, as well as enlarged hilar or mediastinal lymph nodes. Standart non-invasive imaging techniques may be supplemented with magnetic resonans imaging (MRI).

  19. Hemostatic findings of pleural fluid in dogs and the association between pleural effusions and primary hyperfibrino(geno)lysis: A cohort study of 99 dogs.

    Science.gov (United States)

    Zoia, Andrea; Drigo, Michele; Piek, Christine J; Simioni, Paolo; Caldin, Marco

    2018-01-01

    The primary objective of this study was to determine if activation of coagulation and fibrinolysis occurs in canine pleural effusions. Thirty-three dogs with pleural effusions of different origin were studied. Pleural effusion fibrinogen concentrations were significantly lower, while pleural fibrin-fibrinogen degradation products (FDPs) and D-dimer concentrations were significantly higher than those in plasma (P dogs with pleural effusion, and whether the presence of a concurrent inflammatory process may have activated the hemostatic cascade, with its intrinsically linked secondary hyperfibrinolysis, masking the concurrent PHF. The previously 33 selected dogs with pleural effusion (group 1) were compared to two control groups of 33 healthy (group 2) and 33 sick dogs without pleural effusion (group 3). Serum fibrinogen, FDPs, D-dimer, C-reactive protein (CRP), fibrinogen/CRP ratio, and frequency of PHF were determined. Fibrinogen, FDPs, D-dimer and CRP concentrations in group 1 were significantly increased compared to group 2 (P dogs with pleural effusion compared to healthy dogs. Nevertheless, the decrease in the fibrinogen/CRP ratio in group 1 compared to group 3, considering the higher FDPs and similar D-dimer concentrations, would suggest that PHF is also more frequent in dogs with pleural effusion compared to sick control dogs, and that this phenomenon is hidden due to concurrent secondary hyperfibrinolysis.

  20. Classificação ultra-sonográfica do derrame pleural e do empiema parapneumônico Ultrasound classification of pleural effusion and parapneumonic empyema

    OpenAIRE

    Luís Marcelo Inaco Cirino; Miguel José Francisco Neto; Erasmo Magalhães Castro de Tolosa

    2002-01-01

    Os autores correlacionam as alterações anatomopatológicas da cavidade pleural com os achados ultra-sonográficos no derrame pleural e no empiema parapneumônico e apresentam uma classificação baseada nestes dados. Concluem que a ultra-sonografia é método diagnóstico fidedigno para inferir a fase anatomopatológica da doença pleural, bem como auxiliar na escolha da alternativa de tratamento.We correlated the anatomopathological abnormalities of the pleural space with the ultrasound findings in pa...

  1. A case of recurrent pleural effusion: Can we think beyond tuberculosis and malignancy?

    Directory of Open Access Journals (Sweden)

    Bhumika Vaishnav

    2014-01-01

    Full Text Available Pleural effusion can occur due to a variety of causes such as infectious, neoplastic, inflammatory, autoimmune, traumatic, etc. Recurrent pleural effusions have always been a diagnostic challenge. Here, we present a case of recurrent exudative pleural effusion in a male patient, which was the first clinical manifestation of rheumatoid arthritis. Of note was the absence of articular involvement at the onset of the disease. The low glucose concentration, low pH and low C4 level in the pleural fluid were the most valuable findings to distinguish it from tuberculous and malignant pleural effusions. Pleural biopsy also helped in making such a distinction. Thus, in a patient with recurrent pleural effusion, rheumatoid etiology should also be kept in mind as a differential diagnosis.

  2. Endoscopic ultrasound-guided evaluation of the pleura and cases of pleural effusion.

    Science.gov (United States)

    Sharma, Malay; Rameshbabu, Chittapuram Srinivasan

    2017-01-01

    The most efficient and cost-effective approach for the diagnosis of pleural exudates remains uncertain and is a subject of controversy. Essential factors to be considered include the respective diagnostic yields of thoracocentesis, closed pleural biopsy, and thoracoscopy. The role of endoscopic ultrasound (EUS) of the esophagus as a modality for the evaluation of pleural exudates has not yet been evaluated. The applied anatomy of the pleura has been discussed. The techniques involved in the EUS imaging of different aspects of the pleura in normal cases and in cases with pleural effusion are elaborated. The practical application of this knowledge can be useful in EUS-guided sampling of the pleural wall, pleural nodules, and in cases of pleural effusion.

  3. PET for the evaluation of pleural thickening observed on CT

    NARCIS (Netherlands)

    Kramer, H; Pieterman, RM; Slebos, DJ; Timens, W; Vaalburg, W; Koeter, GH; Groen, HJM

    Early discrimination between benign and malignant pleural diseases is vital for the treatment and prognosis of a patient. Imaging is traditionally performed with CT or MRI, with an accuracy of 50%-75%. PET has proven to be superior as a diagnostic tool in several malignancies. In this prospective

  4. Pyogenic liver abscess mimicking pleural effusion | Abiodun | South ...

    African Journals Online (AJOL)

    Hence, in this unusual setting, pyogenic liver abscess was not considered at the initial assessment, until closer evaluation and futile efforts to drain a seemingly large “pleural effusion” eventually revealed the diagnosis, which was confirmed by imaging. She underwent ultrasound-guided percutaneous drainage of the ...

  5. Recurrence of Malignant Pleural Effusion Following Pleurodesis: Is ...

    African Journals Online (AJOL)

    diluted with 60mls of isotonic saline after which the chest tube was clamped for 4 hours. The thoracostomy tube was removed as soon as the drainage decreased to less than 100ml/day and the chest xray confirmed lung re-expansion and no residual pleural effusion. Pleurodesis was repeated after 7 days if the drainage.

  6. Risk factors influencing the pleural drainage volume after transthoracic oesophagectomy.

    Science.gov (United States)

    Kosugi, Shin-ichi; Kanda, Tatsuo; Yajima, Kazuhito; Ishikawa, Takashi; Sakamoto, Kaoru

    2013-06-01

    The objective of this study was to clarify the factors influencing pleural drainage volume after transthoracic oesophagectomy and to determine criteria for the selection of patients who would benefit from the early removal of chest drains. Clinicopathological characteristics of 155 patients who underwent transthoracic oesophagectomy were prospectively collected, and the daily drainage volume of each patient was retrospectively reviewed. Potential risk factors were compared between the high-output group (n = 39) and low-output group (n = 116), which were dichotomized using the 75th percentile of total pleural drainage volume of the total study population. Multivariate logistic regression analyses were used to identify independent risk factors. The median duration of drainage was 10 days, with a median total drainage volume of 2258 ml. Of 27 potential risk factors influencing the drainage volume, creatinine clearance (P = 0.04), operative approach (P = 0.03) and thoracic duct removal (P = 0.01) were significantly associated with the total pleural drainage volume. The removal of the thoracic duct (P = 0.02; odds ratio, 4.02; 95% confidence interval 1.20-13.41) and lower creatinine clearance (P = 0.04; odds ratio, 1.02; 95% confidence interval 1.00-1.04) was independent risk factors for increased pleural drainage volume after transthoracic oesophagectomy. The early removal of chest drains may be possible in patients without these risk factors.

  7. Pleural drainage and pleurodesis: implementation of guidelines in four hospitals.

    Science.gov (United States)

    Burgers, J A; Kunst, P W A; Koolen, M G J; Willems, L N A; Burgers, J S; van den Heuvel, M

    2008-11-01

    The aim of the present study was to evaluate the implementation of the 2003 Dutch guideline on the diagnosis and treatment of malignant pleural effusions, and the potential effect of the implementation on the clinical outcome of pleurodesis. All patients with malignant pleural effusion who had a pleural drain placed with the intention of performing pleurodesis were registered prospectively in four centres. Details of the procedure and fluid recurrence and survival data were noted. Patients with a proven malignancy (n = 100) were entered into the registration database. Diagnostic guideline recommendations were followed in 60-70% of the patients. Surprisingly, pleurodesis was performed in only 75% of the patients, mainly due to the presence of a trapped lung. All pleurodeses were performed using talc, according to the guideline. Follow-up revealed fluid recurrence in 27 (36%) patients after a mean follow-up of 17 days (range 2-285 days); 14 patients with successful pleurodesis died with a median survival of 61 days (range 13-174 days). Systemic treatment following pleurodesis and good apposition of the pleural surfaces during drainage were good prognostic factors. Despite reasonable-to-good adherence to the guideline, the number of successful pleurodeses was low. Better predictors of a good pleurodesis outcome are needed.

  8. Cytokines in pleural liquid for diagnosis of tuberculous pleurisy.

    Science.gov (United States)

    Yamada, Y; Nakamura, A; Hosoda, M; Kato, T; Asano, T; Tonegawa, K; Itoh, M

    2001-07-01

    An elevated level of adenosine deaminase (ADA) in pleural liquid has been considered as a supplemental diagnostic marker for tuberculous pleurisy. However, this is complicated by false-positives and -negatives. Recently, it has been revealed that various cytokines are intimately involved in the pathognomonic physiology of tuberculosis. In this study, interleukin-8 (IL-8), tumour necrosis factor alpha (TNFalpha) and interferon gamma (IFNgamma) were compared with ADA in pleural liquid of patients with inflammatory (21 cases), malignant (28 cases) and tuberculous (21 cases) disease. The pleural ADA, IL-8, TNFalpha and IFNgamma levels in the tuberculous group were higher than in the other three groups. Analysis of receiver operating characteristic (ROC) curves, to evaluate the utility of the various parameters, demonstrates values for the area under the curve (AUC) of 0.770, 0.875, 0.892 and 0.987, respectively for IL-8, TNFalpha, ADA and IFNgamma. No false-positives were encountered with IFNgamma and only one case with a small volume of pleural liquid was a false-negative. This indicates that IFNgamma is a very reliable marker of tuberculous pleurisy.

  9. Distribution and mixing of a liquid bolus in pleural space.

    Science.gov (United States)

    Bodega, Francesca; Tresoldi, Claudio; Porta, Cristina; Zocchi, Luciano; Agostoni, Emilio

    2006-02-28

    Distribution and mixing time of boluses with labeled albumin in pleural space of anesthetized, supine rabbits were determined by sampling pleural liquid at different times in various intercostal spaces (ics), and in cranial and caudal mediastinum. During sampling, lung and chest wall were kept apposed by lung inflation. This was not necessary in costo-phrenic sinus. Here, 10 min after injection, lung inflation increased concentration of labeled albumin by 50%. Lung inflation probably displaces some pleural liquid cranio-caudally, increasing labeled albumin concentration caudally to injection point (6th ics), and decreasing it cranially. Boluses of 0.1-1 ml did not preferentially reach mediastinal regions, as maintained by others. Time for an approximate mixing was approximately 1 h for 0.1 ml, and approximately 30 min for 1 ml. This relatively long mixing time does not substantially affect determination of contribution of lymphatic drainage through stomata to overall removal of labeled albumin from 0.3 ml hydrothoraces lasting 3 h [Bodega, F., Agostoni, E., 2004. Contribution of lymphatic drainage through stomata to albumin removal from pleural space. Respir. Physiol. Neurobiol. 142, 251-263].

  10. Vascular Endothelial Growth Factor in Pleural Effusions and ...

    African Journals Online (AJOL)

    2018-02-07

    Feb 7, 2018 ... was inversely correlated with pleural fluid glucose and pH levels and had positive correlation with ... Correlation with Radiologic and Biochemical Parameters. N Bayram, Y Karakan, ..... [11,21] Anti-VEGF antibodies have been ...

  11. Distribution side of pleural effusion in heart failure

    International Nuclear Information System (INIS)

    Park, Cheol Kyu; Park, Young Ha; Jung, Se Young; Park, Seog Hee; Bahk, Yong Whee

    1988-01-01

    The interrelationship between the etiology of pleural effusion and the side of its occurrence has been a subject of clinical interest for many years. It has often been stated that pleural effusion caused by congestive heart failure tends to occur on the right side. However, some authors contended that such a side proclivity is not reliable. In the present study, the authors investigated the laterally of effusion caused by various cardiovascular diseases complicated by heart failure. We reviewed the chest X-ray films and clinical records of 68 patients with proven pleural effusion resulted from heart failure. 1. There were 34 men and 34 women with the age ranging from 10 to 84 years with the mean of 59. 2. The diagnoses were rheumatic heart disease (2 patients), coronary heart disease (10 patients), hypertensive heart disease (8 patients), mitral valvular disease (18 patients), aortic valvular disease (3 patients), and miscellaneous (27 patients). 3. 34 patients had unilateral pleural effusion, 25 and 9, right and left, respectively. Of the 34 patients with bilateral effusion, 13 patients had predominantly right-sided effusion, 5 patients had predominantly left-sided effusion and 16 patients had evenly distributed bilateral effusion. Thus, 55.8% of effusion was right-sided

  12. Diagnostic significance of adenosine deaminase in pleural tuberculosis

    International Nuclear Information System (INIS)

    Khurshid, R.; Shore, N.; Saleem, M.; Zameer, N.

    2009-01-01

    Tuberculosis (TB) is a major cause of pleural effusion, which in TB usually has lymphocytic and exudative characteristics. Analysis of adenosine deaminase (ADA) activity is a very useful diagnostic approach to achieve a more rapid and precise diagnosis in cases of Pleural TB (pTB). Fifty male and fifty female patients presenting with tuberculosis pleural effusion was included in the study. The patients were taken from the medical ward of Sir Ganga Ram Hospital between September 2001 and September 2002. Activity of Adenosine Deaminase (ADA) was estimated by the technique of Sodium dodecyl sulphate electrophoresis (SDS-EF) using 10% polyacrylamide gel. Mean age of males was 45.72+-19.22 years and of female was 43.74+-16.09 years. Mean protein level was 3.39+-0.24 g/dl in males, and it was 3.02+-0.26 g/dl in females. Mean specific gravity both in males and females was 1.020+-0.01. The results show an increased level of enzyme ADA in patients as compared to normal subjects. Estimation of ADA activity may provide basis for rapid and efficient diagnosis of pleural TB in different clinical settings. However study should be extended to larger number of patients to reach a better conclusion. (author)

  13. The mysterious pleural effusion | Simao | Annals of Pediatric Surgery

    African Journals Online (AJOL)

    We report the case of a 6-month-old infant on total parenteral nutrition since neonatal period, as a consequence of severe intestinal insufficiency secondary to extensive intestinal resection for necrotizing enterocolitis. The child was admitted to the ICU with respiratory failure due to bilateral milky pleural effusion 17 days after ...

  14. Thoracoscopy in undiagnosed pleural effusions | de Groot | South ...

    African Journals Online (AJOL)

    Objective. To review the indications and accuracy of diagnostic thoracoscopy for pleural effusions of unknown origin. Design. Retrospective review of consecutive patients referred for diagnostic thoracoscopy over a 5-year period from 1 January 1989 to 31 December 1993. Setting. Tertiary referral cardiothoracic unit.

  15. Multiple skeletal lesions and pleural effusion owing to Histoplasma ...

    African Journals Online (AJOL)

    We describe a rare case of multiple skeletal lesions and a pleural effusion owing to Histoplasma capsulatum infection in a 16-year-old immunocompetent girl residing in a non-endemic region. Of note is that she had a lesion within a thoracic vertebra. Following an extensive literature search, we found that vertebral ...

  16. VEGF Correlates with Inflammation and Fibrosis in Tuberculous Pleural Effusion

    Science.gov (United States)

    Bien, Mauo-Ying; Wu, Ming-Ping; Chen, Wei-Lin; Chung, Chi-Li

    2015-01-01

    Objective. To investigate the relationship among angiogenic cytokines, inflammatory markers, and fibrinolytic activity in tuberculous pleural effusion (TBPE) and their clinical importance. Methods. Forty-two patients diagnosed with TBPE were studied. Based on chest ultrasonography, there were 26 loculated and 16 nonloculated TBPE patients. The effusion size radiological scores and effusion vascular endothelial growth factor (VEGF), interleukin- (IL-) 8, plasminogen activator inhibitor type-1 (PAI-1), and tissue type plasminogen activator (tPA) were measured. Treatment outcome and pleural fibrosis, defined as radiological residual pleural thickening (RPT), were assessed at 6-month follow-up. Results. The effusion size and effusion lactate dehydrogenase (LDH), VEGF, IL-8, PAI-1, and PAI-1/tPA ratio were significantly higher, while effusion glucose, pH value, and tPA were significantly lower, in loculated than in nonloculated TBPE. VEGF and IL-8 correlated positively with LDH and PAI-1/tPA ratio and negatively with tPA in both loculated and nonloculated TBPE. Patients with higher VEGF or greater effusion size were prone to develop RPT (n = 14; VEGF, odds ratio 1.28, P = 0.01; effusion size, odds ratio 1.01, P = 0.02), and VEGF was an independent predictor of RPT in TBPE (receiver operating characteristic curve AUC = 0.985, P Effusion VEGF correlates with pleural inflammation and fibrosis and may be targeted for adjunct therapy for TBPE. PMID:25884029

  17. Malignant Pleural Mesothelioma Prognostic Marker: A Review of ...

    African Journals Online (AJOL)

    This article is a review of a series of three studies that proved the involvement of osteopontin as a prognostic marker in malignant pleural mesothelioma (MPM) cancers. The approach used involved synthesizing and analysing the three articles. The first proves the utilization of osteopontin and mesothelin for diagnostic and ...

  18. Diagnosis and management options in malignant pleural effusions

    Science.gov (United States)

    Dixit, Ramakant; Agarwal, KC; Gokhroo, Archana; Patil, Chetan B; Meena, Manoj; Shah, Narender S; Arora, Piyush

    2017-01-01

    Malignant pleural effusion (MPE) denotes an advanced malignant disease process. Most of the MPE are metastatic involvement of the pleura from primary malignancy at lung, breast, and other body sites apart from lymphomas. The diagnosis of MPE has been traditionally made on cytological examination of pleural fluid and/or histological examination of pleural biopsy tissue that still remains the initial approach in these cases. There has been tremendous advancement in the diagnosis of MPE now a day with techniques i.e. characteristic Ultrasound and computed tomography features, image guided biopsies, fluorodeoxyglucose-positron emission tomography imaging, thoracoscopy with direct biopsy under vision, tumor marker studies and immunocytochemical analysis etc., that have made possible an early diagnosis of MPE. The management of MPE still remains a challenge to pulmonologist and oncologist. Despite having various modalities with better tolerance such as pleurodesis and indwelling pleural catheters etc., for long-term control, all the management approaches remain palliative to improve the quality of life and reduce symptoms. While choosing an appropriate management intervention, one should consider the clinical status of the patient, life expectancy, overall cost, availability and comparative institutional outcomes, etc. PMID:28360465

  19. Diagnosis and management options in malignant pleural effusions

    Directory of Open Access Journals (Sweden)

    Ramakant Dixit

    2017-01-01

    Full Text Available Malignant pleural effusion (MPE denotes an advanced malignant disease process. Most of the MPE are metastatic involvement of the pleura from primary malignancy at lung, breast, and other body sites apart from lymphomas. The diagnosis of MPE has been traditionally made on cytological examination of pleural fluid and/or histological examination of pleural biopsy tissue that still remains the initial approach in these cases. There has been tremendous advancement in the diagnosis of MPE now a day with techniques i.e. characteristic Ultrasound and computed tomography features, image guided biopsies, fluorodeoxyglucose-positron emission tomography imaging, thoracoscopy with direct biopsy under vision, tumor marker studies and immunocytochemical analysis etc., that have made possible an early diagnosis of MPE. The management of MPE still remains a challenge to pulmonologist and oncologist. Despite having various modalities with better tolerance such as pleurodesis and indwelling pleural catheters etc., for long-term control, all the management approaches remain palliative to improve the quality of life and reduce symptoms. While choosing an appropriate management intervention, one should consider the clinical status of the patient, life expectancy, overall cost, availability and comparative institutional outcomes, etc.

  20. Prognostic factors of hydrops fetalis with pleural effusion.

    Science.gov (United States)

    Nakayama, Atsushi; Oshiro, Makoto; Yamada, Yasumasa; Hattori, Tetsuo; Wakano, Yasuhiro; Hayashi, Seiji; Kokubo, Minoru; Takemoto, Koji; Honda, Shigeru; Ieda, Kuniko; Yamamoto, Hikaru; Kouwaki, Masanori; Yokoi, Kyoko; Shinohara, Osamu; Kato, Takenori; Miyata, Masafumi; Tanaka, Taihei; Hayakawa, Masahiro

    2017-10-01

    Hydrops fetalis (HF) has a low survival rate, particularly in the case of preterm birth. In addition, the severity index of HF has not been fully investigated yet. The aim of this study was to clarify the prognostic factors of HF with pleural effusion. All live-born HF patients with pleural effusion, except for chromosomal abnormality or complex congenital heart disease, born from 2009 to 2013 in Aichi Prefecture in Japan were included. Prenatal, perinatal, and postnatal information was obtained from the medical records and was retrospectively analyzed. Forty-one HF patients with pleural effusion were included, and 28 patients (68%) survived. On multivariate logistic stepwise analysis, gestational birth week (OR, 0.71; 95% CI: 0.52-0.96, P = 0.027) and standard deviation (SD) score of the birthweight (OR, 1.74; 95% CI: 1.01-2.99, P = 0.045) were significant factors for postnatal death. All patients with both ≥32 gestational weeks and pleural effusion. © 2017 Japan Pediatric Society.