Background and Aims While chest X-ray (CXR) has been a conventional tool in intensive care units (ICUs) to identify lung pathologies, computed tomography (CT) scan remains the gold standard. Use of lung ultrasound (LU...Background and Aims While chest X-ray (CXR) has been a conventional tool in intensive care units (ICUs) to identify lung pathologies, computed tomography (CT) scan remains the gold standard. Use of lung ultrasound (LUS) in resource-rich ICUs is still under investigation. The present study compares the utility of LUS to that of CXR in identifying pulmonary edema and pleural effusion in ICU patients. In addition, consolidation and pneumothorax were analyzed as secondary outcome measures. Material and Methods This is a prospective, single centric, observational study. Patients admitted in ICU were examined for lung pathologies, using LUS by a trained intensivist;and CXR done within 4 hours of each other. The final diagnosis was ascertained by an independent senior radiologist, based on the complete medical chart including clinical findings and the results of thoracic CT, if available. The results were compared and analyzed. Results Sensitivity, specificity and diagnostic accuracy of LUS was 95%, 94.4%, 94.67% for pleural effusion;and 98.33%, 97.78%, 98.00% for pulmonary edema respectively. Corresponding values with CXR were 48.33%, 76.67%, 65.33% for pleural effusion;and 36.67%, 82.22% and 64.00% for pulmonary edema respectively. Sensitivity, specificity and diagnostic accuracy of LUS was 91.30%, 96.85%, 96.00% for consolidation;and 100.00%, 79.02%, 80.00% for pneumothorax respectively. Corresponding values with CXR were 60.87%, 81.10%, 78.00% for consolidation;and 71.3%, 97.20%, 96.00% for pneumothorax respectively. Conclusion LUS has better diagnostic accuracy in diagnosis of pleural effusion and pulmonary edema when compared with CXR and is thus recommended as an effective alternative for diagnosis of these conditions in acute care settings. Our study recommends that a thoracic CT scan can be avoided in most of such cases.展开更多
Pleural effusion usually causes a diagnostic dilemma with a long list of differential diagnoses.Many studies found a high prevalence of pleural effusions in critically ill and mechanically ventilated patients,with a w...Pleural effusion usually causes a diagnostic dilemma with a long list of differential diagnoses.Many studies found a high prevalence of pleural effusions in critically ill and mechanically ventilated patients,with a wide range of variable prevalence rates of up to 50%-60%in some studies.This review emphasizes the importance of pleural effusion diagnosis and management in patients admitted to the intensive care unit(ICU).The original disease that caused pleural effusion can be the exact cause of ICU admission.There is an impairment in the pleural fluid turnover and cycling in critically ill and mechanically ventilated patients.There are also many difficulties in diagnosing pleural effusion in the ICU,including clinical,radiological,and even laboratory difficulties.These difficulties are due to unusual presentation,inability to undergo some diagnostic procedures,and heterogenous results of some of the performed tests.Pleural effusion can affect the patient’s outcome and prognosis due to the hemodynamics and lung mechanics changes in these patients,who usually have frequent comorbidities.Similarly,pleural effusion drainage can modify the ICUadmitted patient’s outcome.Finally,pleural effusion analysis can change the original diagnosis in some cases and redirect the management toward a different way.展开更多
BACKGROUND Viral pleurisy is a viral infected disease with exudative pleural effusions.It is one of the causes for pleural effusions.Because of the difficult etiology diagnosis,clinically pleural effusions tend to be ...BACKGROUND Viral pleurisy is a viral infected disease with exudative pleural effusions.It is one of the causes for pleural effusions.Because of the difficult etiology diagnosis,clinically pleural effusions tend to be misdiagnosed as tuberculous pleurisy or idiopathic pleural effusion.Here,we report a case of pleural effusion secondary to viral pleurisy which is driven by infection with epstein-barr virus.Viral infection was identified by metagenomic next-generation sequencing(mNGS).CASE SUMMARY A 40-year-old male with a history of dermatomyositis,rheumatoid arthritis,and secondary interstitial pneumonia was administered with long-term oral prednisone.He presented with fever and chest pain after exposure to cold,accompanied by generalized sore and weakness,night sweat,occasional cough,and few sputums.The computed tomography scan showed bilateral pleural effusions and atelectasis of the partial right lower lobe was revealed.The pleural fluids were found to be yellow and slightly turbid after pleural catheterization.Thoracoscopy showed fibrous adhesion and auto-pleurodesis.Combining the results in pleural fluid analysis and mNGS,the patient was diagnosed as viral pleuritis.After receiving Aciclovir,the symptoms and signs of the patient were relieved.CONCLUSION Viral infection should be considered in cases of idiopathic pleural effusion unexplained by routine examination.mNGS is helpful for diagnosis.展开更多
Pleural effusion is a commonly encountered respiratory disorder. In the majority of cases, a single causative agent is responsible. Pleural effusions resulting from simultaneous involvement of the membranes by two dif...Pleural effusion is a commonly encountered respiratory disorder. In the majority of cases, a single causative agent is responsible. Pleural effusions resulting from simultaneous involvement of the membranes by two different pathologic processes are unusual.展开更多
The occurrence of pancreatic pleural effusion,secondary to an internal pancreatic fistula,is a rare clinical syndrome and diagnosis is often missed.The key to the diagnosis is a dramatically elevated pleural fluid amy...The occurrence of pancreatic pleural effusion,secondary to an internal pancreatic fistula,is a rare clinical syndrome and diagnosis is often missed.The key to the diagnosis is a dramatically elevated pleural fluid amylase.This pancreatic pleural effusion is also called a pancreatic pleural fistula.It is characterized by profuse pleural fluid and has a tendency to recur.Here we report a case of delayed internal pancreatic fistula with pancreatic pleural effusion emerging after splenectomy.From the treatment of this case,we conclude that the symptoms and signs of a subphrenic effusion are often obscure;abdominal computed tomography may be required to look for occult,intra-abdominal infection;and active conservative treatment should be carried out in the early period of this complication to reduce the need for endoscopy or surgery.展开更多
BACKGROUND Pleural effusions occur for various reasons,and their diagnosis remains challenging despite the availability of different diagnostic modalities.Medical thoracoscopy(MT)can be used for both diagnostic and th...BACKGROUND Pleural effusions occur for various reasons,and their diagnosis remains challenging despite the availability of different diagnostic modalities.Medical thoracoscopy(MT)can be used for both diagnostic and therapeutic purposes,especially in patients with undiagnosed pleural effusion.AIM To assess the diagnostic efficacy and safety of MT in patients with pleural effusion of different causes.METHODS Between January 1,2012 and April 30,2021,patients with pleural effusion underwent MT in the Department of Respiratory Medicine,The Second Affiliated Hospital of Xi’an Jiaotong University(Shaanxi,China).According to the discharge diagnosis,patients were divided into malignant pleural effusion(MPE),tuberculous pleural effusion(TBPE),and inflammatory pleural effusion(IPE)groups.General information,and tuberculosis-and effusion-related indices of the three groups were analyzed.The diagnostic yield,diagnostic accuracy,performance under thoracoscopy,and complications of patients were compared among the three groups.Then,the significant predictive factors for diagnosis between the MPE and TBPE groups were analyzed.RESULTS Of the 106 patients enrolled in this 10-year study,67 were male and 39 female,with mean age of 57.1±14.184 years.Among the 74 thoracoscopy-confirmed patients,41(38.7%)had MPE,21 had(19.8%)TBPE,and 32(30.2%)were undiagnosed.Overall diagnostic yield of MT was 69.8%(MPE:75.9%,TBPE:48.8%,and IPE:75.0%,with diagnostic accuracies of 100%,87.5%,and 75.0%,respectively).Under thoracoscopy,single or multiple pleural nodules were observed in 81.1%and pleural adhesions in 34.0%with pleural effusions.The most common complication was chest pain(41.5%),followed by chest tightness(11.3%)and fever(10.4%).Multivariate logistic regression analyses showed effusion appearance[odds ratio(OR):0.001,95%CI:0.000-0.204;P=0.010]and carcinoembryonic antigen(OR:0.243,95%CI:0.081-0.728;P=0.011)as significant for differentiating MPE and TBPE,with area under the receiver operating characteristic curve of 0.977(95%CI:0.953-1.000;P<0.001).CONCLUSION MT is an effective,safe,and minimally invasive procedure with high diagnostic yield for pleural effusion of different causes.展开更多
BACKGROUND Meigs syndrome is a rare neoplastic disease characterized by the triad of benign solid ovarian tumor,ascites,and pleural effusion.In postmenopausal women with pleural effusions,ascites,elevated CA-125 level...BACKGROUND Meigs syndrome is a rare neoplastic disease characterized by the triad of benign solid ovarian tumor,ascites,and pleural effusion.In postmenopausal women with pleural effusions,ascites,elevated CA-125 level,and pelvic masses,the probability of disseminated disease is high.Nevertheless,the final diagnosis is based on its histopathologic features following surgical removal of a mass lesion.Here we describe a case of Meigs syndrome with pleural effusion as the initial manifestation.CASE SUMMARY A 52-year-old woman presented with a 2-mo history of dry cough and oppression in the chest and was admitted to our hospital due to recurrent pleural effusion and gradual worsening of dyspnea that had occurred over the previous month.Two months before admission,the patient underwent repeated chest drainage and empirical anti-tuberculosis treatment.However,the pleural fluid accumulation persisted,and the patient began to experience dyspnea on exertion leading to admission.A computed tomography scan of the chest,abdominal ultrasound,and magnetic resonance imaging confirmed the presence of right-sided pleural effusion and ascites with a right ovarian mass.Serum tumor markers showed raised CA-125.With a suspicion of a malignant tumor,the patient underwent laparoscopic excision of the ovarian mass and the final pathology was consistent with an ovarian fibrothecoma.On the seventh day postoperation,the patient had resolution of the right-sided pleural effusion.CONCLUSION Despite the relatively high risk of malignancy when an ovarian mass associated with hydrothorax is found in a patient with elevated serum levels of CA-125,clinicians should be aware about rare benign syndromes,like Meigs,for which surgery remains the preferred treatment.展开更多
Pleural effusion after hepatectomy is associated with significant morbidity and prolonged hospital stays.Several studies have addressed the risk factors for postoperative pleural effusion.However,there are no research...Pleural effusion after hepatectomy is associated with significant morbidity and prolonged hospital stays.Several studies have addressed the risk factors for postoperative pleural effusion.However,there are no researches concerning the role of the initial 12-h operative fluid volume.The aim of this study was to evaluate whether the initial 12-h operative fluid volume during liver resection is an independent risk factor for pleural effusion after hepatectomy.In this study,we retrospectively analyzed clinical data of 470 patients consecutively undergoing elective hepatectomy between January 2011 and December 2012.We prospectively collected and retrospectively analyzed baseline and clinical data,including preoperative,intraoperative,and postoperative variables.Univariate and multivariate analyses were carried out to identify whether the initial 12-h operative fluid volume was an independent risk factor for pleural effusion after hepatectomy.The multivariate analysis identified 2 independent risk factors for pleural effusion:operative time [odds ratio(OR)=10.2] and initial 12-h operative fluid volume(OR=1.0003).Threshold effect analyses revealed that the initial 12 h operative fluid volume was positively correlated with the incidence of pleural effusion when the initial 12-h operative fluid volume exceeded 4636 m L.We conclude that the initial 12-h operative fluid volume during liver resection and operative time are independent risk factors for pleural effusion after hepatectomy.Perioperative intravenous fluids should be restricted properly.展开更多
Objective: To report a case of Endometriosis associated with Pleural effusion. Design: Case report. Setting: Tertiary care center. Patient(s): A 30-year old woman presented with a right pleural effusion complicated wi...Objective: To report a case of Endometriosis associated with Pleural effusion. Design: Case report. Setting: Tertiary care center. Patient(s): A 30-year old woman presented with a right pleural effusion complicated with pneumothorax-mimicking TB. Intervention(s): Thoracentesis, pleural biopsy by a video-assisted thoracic surgery, pleurodesis, thoracic wedge resection, CT chest, CT Abdomen, and diagnostic Laparoscopy. Main Outcome Measure(s): After taking a GnRH analog, there was no recurrence of pleural effusion nor ascites. Result(s): Thoracentesis and wedge resection of lung ruled out malignancy. An omental mass biopsy obtained from diagnostic laparoscopy after the patient returned with drug-induced hepatitis, and ascites revealed endometriosis. Conclusion(s): Thoracic endometriosis is rare;however, it should be considered in the differential diagnosis by unknown causes of pleural effusion in reproductive age timeframe in women.展开更多
The sieving and enrichment of rare tumor cells from large-volume pleural effusion(PE)samples is a promising technique for cell-based lung tumor diagnosis and drug tests,which features high throughput and recovery,puri...The sieving and enrichment of rare tumor cells from large-volume pleural effusion(PE)samples is a promising technique for cell-based lung tumor diagnosis and drug tests,which features high throughput and recovery,purification,as well as viability rates of rare target cells as the prerequisites for high sensitivity,specificity,and accuracy of tumor cell analysis.In this paper,we propose a three-dimensional(3 D)sieving method for rare tumor cell enrichment,which effectively eliminates the"dead zones"in traditional two-dimensional(2 D)cell filters with a dimension-raising strategy to satisfy the requirements mentioned above.The prototype device was combined with a funnel-shaped holder,a flexible micropore membrane in the middle,and a3 D spiral fluid channel covered on the membrane as a three-layer ice-creaming cone composite structure.Driven by gravity alone,the device performed as follows:(1)20-fold throughput compared with the 2 D commercial planee hich was up to 20 mL/min for a threefold dilution of whole blood sample;(2)high recovery rates of 84.5%±21%,86%±25%,83%±14%for 100,1000,and 10000 cells/mL,respectively,in 30 mL phosphate buffer saline(PBS)sample,and a 100%positive detection rate in the case of≤5 A549 cells in 1 mL PBS;(3)a typical purification rate of 85.5%±9.1%;and(4)a viability rate of>93%.In the demonstration application,this device effectively enriched rare target cells from large volumes(>25 mL)of clinical pleural effusions.The following results indicated that tumor cells were easy-to-discover in the enriched PE samples,and the proliferation capability of purified cells was(>4.6 times)significantly stronger than that of unprocessed cells in the subsequent 6-day culture.The above evaluation indicates that the proposed easily reproducible method for the effective execution of rare cell enrichments and assays is expected to become a practical technique for clinical cell-based tumor diagnosis.展开更多
Takayasu arteritis (TA) is a chronic, nonspecific inflammatory disease of large and medium-sized vessels that primarily involves the aorta and its branches. TA involving the pulmonary arteries has a prevalence ranging...Takayasu arteritis (TA) is a chronic, nonspecific inflammatory disease of large and medium-sized vessels that primarily involves the aorta and its branches. TA involving the pulmonary arteries has a prevalence ranging from 14% to 86%, which can lead to pulmonary hypertension, a progressive increase in pulmonary artery pressure, and eventually death from right heart failure. The presentation of pulmonary arteritis (PA) is very nonspecific, with a reported misdiagnosis rate of up to 60% and a diagnosis time ranging from 1 month to more than 10 years. The clinical manifestation of pleural effusion is very rare in both TA and PA cases. Based on our literature review, this is the 6th reported case of TA with pleural effusion, and the specific mechanism of TA with pleural effusion is still unclear. The characteristics of this case and the previously reported cases are summarized in this article to improve the understanding of TA and PA and reduce the misdiagnosis rate.展开更多
BACKGROUNDThe renal system has a specific pleural effusion associated with it in the form of“urothorax”, a condition where obstructive uropathy or occlusion of thelymphatic ducts leads to extravasated fluids (urine ...BACKGROUNDThe renal system has a specific pleural effusion associated with it in the form of“urothorax”, a condition where obstructive uropathy or occlusion of thelymphatic ducts leads to extravasated fluids (urine or lymph) crossing thediaphragm via innate perforations or lymphatic channels. As a rare disorder thatmay cause pleural effusion, renal lymphangiectasia is a congenital or acquiredabnormality of the lymphatic system of the kidneys. As vaguely mentioned in areport from the American Journal of Kidney Diseases, this disorder can be causedby extrinsic compression of the kidney secondary to hemorrhage.CASE SUMMARYA 54-year-old man with biopsy-proven acute tubulointerstitial nephropathyexperienced bleeding 3 d post hoc, which, upon clinical detection, manifested as amassive perirenal hematoma on computed tomography (CT) scan withoutconcurrent pleural effusion. His situation was eventually stabilized byexpeditious management, including selective renal arterial embolization. Despite good hemodialysis adequacy and stringent volume control, a CT scan 1 mo laterfound further enlargement of the perirenal hematoma with heterogeneoushypodense fluid, left side pleural effusion and a small amount of ascites. Thesefluid collections showed a CT density of 3 Hounsfield units, and drained fluid ofthe pleural effusion revealed a dubiously light-colored transudate withlymphocytic predominance (> 80%). Similar results were found 3 mo later, duringwhich time the patient was free of pulmonary infection, cardiac dysfunction andovert hypoalbuminemia. After careful consideration and exclusion of otherpossible causative etiologies, we believed that the pleural effusion was due to theocclusion of renal lymphatic ducts by the compression of kidney parenchymaand, in the absence of typical dilation of the related ducts, considered our case asextrarenal lymphangiectasia in a broad sense.CONCLUSIONAs such, our case highlighted a morbific passage between the kidney and thoraxunder an extraordinarily rare condition. Given the paucity of pertinentknowledge, it may further broaden our understanding of this rare disorder.展开更多
BACKGROUND Spontaneous esophageal rupture or Boerhaave’s syndrome is a rare and acute disease with a high incidence of misdiagnosis and mortality.Here,we aimed to explore the clinical characteristics,diagnosis,treatm...BACKGROUND Spontaneous esophageal rupture or Boerhaave’s syndrome is a rare and acute disease with a high incidence of misdiagnosis and mortality.Here,we aimed to explore the clinical characteristics,diagnosis,treatment,and prognosis of spontaneous esophageal rupture,and to analyze the causes of misdiagnosis during the treatment of spontaneous esophageal rupture.CASE SUMMARY The clinical features of the patient with spontaneous esophageal rupture misdiagnosed earlier as pleural effusion were retrospectively analyzed and the reasons for misdiagnosis are discussed based on a current review of the literature.The patient was admitted to a local hospital due to shortness of breath accompanied by vomiting and abdominal distension for five hours.Based on the computed tomography(CT)scan analysis,clinically,right pleural effusion was diagnosed.However,the patient was unwilling to undergo right closed thoracic drainage.The patient also had intermittent fevers against infection,and during the course of treatment,he complained of chest pain,following which,he was transferred to our hospital.Grapefruit-like residue drainage fluid was observed.Re-examination of the chest CT scans suggested the presence of spontaneous perforation in the upper left esophagus.Therefore,the patient underwent an urgent esophageal hiatus repair.Unfortunately,the patient died of infection and respiratory failure due to progressive dyspnea after surgery.CONCLUSION Spontaneous esophageal rupture is a rare disease associated with high fatality.The patients do not present typical clinical symptoms and the disease progresses rapidly.This case report highlights the importance of a dynamic review of chest CT scan,not only for the initial identification of segmental injury but also for prioritizing subsequent treatment strategies.Moreover,we have presented some clues for clinicians to recognize and diagnose spontaneous esophageal rupture at rare sites(upper-esophageal segment)through this case report of spontaneous esophageal rupture that caused the patient’s death.We have also summarized the reasons for the misdiagnosis and lessons learned.展开更多
BACKGROUND Cutaneous myiasis is frequently observed;however,eosinophilic pleural effusion induced by this condition is rare.CASE SUMMARY We report the case of a 65-year-old female Tibetan patient from Qinghai Province...BACKGROUND Cutaneous myiasis is frequently observed;however,eosinophilic pleural effusion induced by this condition is rare.CASE SUMMARY We report the case of a 65-year-old female Tibetan patient from Qinghai Province,who presented to West China Hospital of Sichuan University around mid-November 2011 with a chief complaint of recurrent cough,occasional hemoptysis,and right chest pain.There was no past medical and surgical history of note,except for occasional dietary habit of eating raw meat.Clinical examination revealed a left lung collapse and diminished breathing sounds in her left lung,with moist rales heard in both lungs.Chest X-rays demonstrated a left hydropneumothorax and a right lung infection.Chest computed tomography revealed a left hydropneumothorax with partial compressive atelectasis and patchy consolidation on the right lung.Laboratory data revealed peripheral blood eosinophilia of 37.2%,with a white blood cell count of 10.4×109/L.Serum immunoglobulin E levels were elevated(1650 unit/mL).Serum parasite antibodies were negative except for cysticercosis immunoglobulin G.Bone marrow aspirates were hypercellular,with a marked increase in the number of mature eosinophils and eosinophilic myelocytes.An ultrasound-guided left-sided thoracentesis produced a yellow-cloudy exudative fluid.Failure to respond to antibiotic treatment during hospitalization for her symptoms and persistent blood eosinophilia led the team to start oral albendazole(400 mg/d)for presumed parasitic infestation for three consecutive days after the ninth day of hospitalization.Intermittent migratory stabbing pain and swelling sensation on both her upper arms and shoulders were reported;tender nodules and worm-like live organisms were observed in the responding sites 1 wk later.After the removal of the live organisms,they were subsequently identified as first stage hypodermal larvae by the Sichuan Institute of Parasites.The patient’s symptoms were relieved soon afterwards.Telephonic follow-up 1 mo later indicated that the blood eosinophilia and pleural effusion were resolved.CONCLUSION Eosinophilic pleural fluid can be present in a wide array of disorders.Myiasis should be an important consideration for the differential diagnosis when eosinophilic pleural effusion with blood eosinophilia is observed.展开更多
<strong>Background:</strong> Coincidental pleural effusion has been observed by computed tomography (CT) scans in individual patients with gastric leaks after laparoscopic sleeve gastrectomy;however, the f...<strong>Background:</strong> Coincidental pleural effusion has been observed by computed tomography (CT) scans in individual patients with gastric leaks after laparoscopic sleeve gastrectomy;however, the frequency of this phenomenon has not been investigated in cohort studies. <strong>Objectives:</strong> This study aimed to assess the diagnostic accuracy of left pleural effusion as an indicator of gastric leaks after laparoscopic sleeve gastrectomy. <strong>Setting:</strong> University hospital and bariatric surgery center of excellence. <strong>Methods:</strong> This single-center retrospective analysis included consecutive patients who had undergone laparoscopic sleeve gastrectomy followed by CT scans to investigate suspected gastric leaks from September 2011 to September 2018. The sensitivity, specificity, Youden’s index, and predictive values were estimated using a 2 × 2 cross-tabulation. <strong>Results:</strong> The study involved assessing the CT scans of 148 patients;80 patients (44 men and 36 women, mean age: 34 years, mean body mass index {BMI}: 46 kg/m<sup>2</sup>) had positive findings of gastric leaks after laparoscopic sleeve gastrectomy, such as contrast leak, gas leak, and peri-gastric collection (either singly or in combination). The CT findings were negative for gastric leaks in 68 patients (38 men and 30 women, mean age: 33 years, mean BMI: 45 kg/m<sup>2</sup>). Pleural effusion manifested as a fluid density in the dependent portion of pleural cavity on CT. The sensitivity of left pleural effusion to predict gastric leaks after laparoscopic sleeve gastrectomy was 73.8%, and the specificity was 91.2%. The positive and negative predictive values were 90.8% and 74.7%, respectively, and the Youden’s index was 64.9%. <strong>Conclusion:</strong> Left pleural effusion exhibits good diagnostic accuracy for gastric leaks after laparoscopic sleeve gastrectomy. Notably, the specificity (91.2%) was very high.展开更多
BACKGROUND Infected aortic aneurysms are uncommon and difficult to treat.We present a case of infected aortic aneurysm with recurrent nontyphoidal Salmonella bacteremia.CASE SUMMARY A 68-year-old gentleman presented w...BACKGROUND Infected aortic aneurysms are uncommon and difficult to treat.We present a case of infected aortic aneurysm with recurrent nontyphoidal Salmonella bacteremia.CASE SUMMARY A 68-year-old gentleman presented with non-specific symptoms and was found to have nontyphoidal Salmonella bacteremia and was treated with intravenous ceftriaxone.However his condition did not improve,and he developed a multiloculated right pleural effusion.Thoracocentesis was done to drain hemorrhagic pleural fluid.Chest computed tomography demonstrated descending thoracic aorta saccular aneurysm with periaortic hematoma likely due to recent bleed and extending to the right pleural cavity.He was referred to cardiothoracic surgery team and was planned for medical therapy in view of hemodynamic stability and no evidence of active leakage.He completed intravenous antibiotic for 5 wk and refused surgical intervention.Unfortunately,he was admitted twice for recurrent nontyphoidal Salmonella bacteremia.Finally,he agreed for surgical intervention and underwent endovascular aortic repair 3 mo later.Postoperatively,his condition remained stable with no recurrence of infection.CONCLUSION Our case highlights the importance of high index of suspicion of infected aortic aneurysm in patients with Salmonella bacteremia with high-risk factors such as atherosclerosis.展开更多
<strong>Background:</strong> Kikuchi-Fujimoto disease (KFD), also named Histiocytic necrotizing lymphadenitis (HNL), is a rare and self-limited necrotizing lymphadenitis, most commonly affects young Asian ...<strong>Background:</strong> Kikuchi-Fujimoto disease (KFD), also named Histiocytic necrotizing lymphadenitis (HNL), is a rare and self-limited necrotizing lymphadenitis, most commonly affects young Asian female. KFD is characterized by lymphadenopathy, cytopenia, fever, rashes, and weight loss, however, hemophagocytic syndrome and pleural effusion are rarely reported. <strong>Case Presentation:</strong> We present the case of a 61-year-old man with clinical features including fever, lymphadenopathy, purpura, arthralgia, pleural effusion and pulmonary infection. He had cervical lymphnodebiopsy and the pathology is consistent with KFD, laboratory tests and clinical manifestations were consistent with hemophagocytic syndrome (HLH). After initial treatment including corticosteroid and anti-infection drugs, the patient showed improvement but soon deteriorated. <strong>Conclusion:</strong> KFD is a self-limited disease with spontaneous resolution. However, the cases of KFD with HLH may have a fatal course. Early appropriate intensive immunosuppressive therapy and strong anti-infection therapy could be beneficial for the treatment outcome.展开更多
A 32-year-old patient with no previous history was admitted for chest pain, dyspnea, <span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-fami...A 32-year-old patient with no previous history was admitted for chest pain, dyspnea, <span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">appetite and weight loss</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">.</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Chest X-ray revealed an</span></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;"> opacity involving the lower two-thirds of the right hemithorax, suggestive of a pleural effusion. </span><span style="font-family:Verdana;">Because of the absence of fluid return even after ultrasound-guided </span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">thoracentesis,</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> a </span></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;">Chest Computed tomography was required showing a heterogeneous anterior mediastinal mass with soft tissue, fat, fluid and calcifications associated </span><span style="font-family:Verdana;">with extensive encysted fluid collection in the right hemithorax. A</span><span style="font-family:Verdana;"> video-assisted mini-thoracotomy revealed a mediastinal tumor firmly attached to the thy</span><span style="font-family:Verdana;">mus with a cystic wall lined by squamous epithelium and sebaceous gland</span><span style="font-family:Verdana;"> composed of respiratory tissue, adipose tissue, cartilage,</span></span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">smooth muscle fibers, and well-differentiated pancreatic tissue. These findings led to the diagnosis of a mature thymic teratoma.</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">The patient was discharged 7 days after surgery, with no recurrence on follow-up.</span></span></span>展开更多
Objective:Guided by the theory of syndrome differentiation of yin and yang in traditional Chinese medicine surgery,through visual observation of internal medicine thoracoscope,comprehensive observation of pleural cavi...Objective:Guided by the theory of syndrome differentiation of yin and yang in traditional Chinese medicine surgery,through visual observation of internal medicine thoracoscope,comprehensive observation of pleural cavity and immunohistochemistry of biopsy tissue,to classify malignant pleural effusion according to syndrome differentiation,and to explore the scientific nature of its theory.Methods:From March 1,2014 to February 28,2015,40 cases of malignant pleural effusion were treated in Beijing Chaoyang Hospital affiliated to Capital Medical University.According to the proposed TCM diagnostic criteria for yin and yang syndrome differentiation,and collect age,gender,course of disease,clinical symptoms,tumor primary focus,histomorphological manifestations and immunohistochemical results and other related information,and carry out statistical data processing.Results:The positive syndrome was mainly metastatic lung adenocarcinoma,which accounted for the majority of all MPE cases,up to 75%.The immunohistochemical results of biopsy tissues were mainly CEA and TTF-1 positive;While pleural effusion caused by pleural mesothelioma was the main type of yin syndrome,and the results of immunohistochemistry combined with biopsy were mainly positive for D2-40,Calretinin,WT-1 and CK5/6.Conclusion:TCM syndrome differentiation of MPE based on internal thoracoscopy combined with biopsy immunohistochemical results has sufficient theoretical basis and certain scientific nature,and further clinical research is needed to verify its effectiveness and practicability in the future.展开更多
Background:Non-small cell lung cancer(NSCLC)patients with epidermal growth factor receptor(EGFR)mutations or anaplastic lymphoma kinase(ALK)fusions show dramatic responses to specific tyrosine kinase inhibitors(TKIs);...Background:Non-small cell lung cancer(NSCLC)patients with epidermal growth factor receptor(EGFR)mutations or anaplastic lymphoma kinase(ALK)fusions show dramatic responses to specific tyrosine kinase inhibitors(TKIs);however,after 10-12 months,secondary mutations arise that confer resistance.We generated a murine xenograft model using patient-derived NSCLC cells isolated from the pleural fluid of two patients with NSCLC to investigate the mechanisms of resistance against the ALK-and EGFR-targeted TKIs crizotinib and osimertinib,respectively.Methods:Genotypes of patient biopsies and xenograft tumors were determined by whole exome sequencing(WES),and patients and xenograft-bearing mice received targeted treatment(crizotinib or osimertinib)accordingly.Xenograft mice were also treated for prolonged periods to identify whether the development of drug resistance and/or treatment responses were associated with tumor size.Finally,the pathology of patients biopsies and xenograft tumors were compared histologically.Results:The histological characteristics and chemotherapy responses of xenograft tumors were similar to the actual patients.WES showed that the genotypes of the xenograft and patient tumors were similar(an echinoderm microtu-bule-associated protein-like 4-ALK(EML4-ALK)gene fusion(patient/xenograft:CTC15035EML4-ALK)and EGFR L858R and T790M mutations(patient/xenograft:CTC15063EGFR L858R,T790M)).After continuous crizotinib or osimertinib treatment,WES data suggested that acquired ALK E1210K mutation conferred crizotinib resistance in the CTC15035EML4-ALK xenograft,while decreased frequencies of EGFR L858R and T790M mutations plus the appearance of v-RAF murine sarcoma viral oncogene homolog B(BRAF)G7V mutations and phosphatidylinositol-4-phosphate 3-kinase catalytic subunit type 2 alpha(PIK3C2A)A86fs frame shift mutations led to osimertinib resistance in the CTC15063EGFR L858R,T790M xenografts.Conclusions:We successfully developed a new method of generating drug resistance xenograft models from liquid biopsies using microfluidic technology,which might be a useful tool to investigate the mechanisms of drug resist-ance in NSCLC.展开更多
文摘Background and Aims While chest X-ray (CXR) has been a conventional tool in intensive care units (ICUs) to identify lung pathologies, computed tomography (CT) scan remains the gold standard. Use of lung ultrasound (LUS) in resource-rich ICUs is still under investigation. The present study compares the utility of LUS to that of CXR in identifying pulmonary edema and pleural effusion in ICU patients. In addition, consolidation and pneumothorax were analyzed as secondary outcome measures. Material and Methods This is a prospective, single centric, observational study. Patients admitted in ICU were examined for lung pathologies, using LUS by a trained intensivist;and CXR done within 4 hours of each other. The final diagnosis was ascertained by an independent senior radiologist, based on the complete medical chart including clinical findings and the results of thoracic CT, if available. The results were compared and analyzed. Results Sensitivity, specificity and diagnostic accuracy of LUS was 95%, 94.4%, 94.67% for pleural effusion;and 98.33%, 97.78%, 98.00% for pulmonary edema respectively. Corresponding values with CXR were 48.33%, 76.67%, 65.33% for pleural effusion;and 36.67%, 82.22% and 64.00% for pulmonary edema respectively. Sensitivity, specificity and diagnostic accuracy of LUS was 91.30%, 96.85%, 96.00% for consolidation;and 100.00%, 79.02%, 80.00% for pneumothorax respectively. Corresponding values with CXR were 60.87%, 81.10%, 78.00% for consolidation;and 71.3%, 97.20%, 96.00% for pneumothorax respectively. Conclusion LUS has better diagnostic accuracy in diagnosis of pleural effusion and pulmonary edema when compared with CXR and is thus recommended as an effective alternative for diagnosis of these conditions in acute care settings. Our study recommends that a thoracic CT scan can be avoided in most of such cases.
文摘Pleural effusion usually causes a diagnostic dilemma with a long list of differential diagnoses.Many studies found a high prevalence of pleural effusions in critically ill and mechanically ventilated patients,with a wide range of variable prevalence rates of up to 50%-60%in some studies.This review emphasizes the importance of pleural effusion diagnosis and management in patients admitted to the intensive care unit(ICU).The original disease that caused pleural effusion can be the exact cause of ICU admission.There is an impairment in the pleural fluid turnover and cycling in critically ill and mechanically ventilated patients.There are also many difficulties in diagnosing pleural effusion in the ICU,including clinical,radiological,and even laboratory difficulties.These difficulties are due to unusual presentation,inability to undergo some diagnostic procedures,and heterogenous results of some of the performed tests.Pleural effusion can affect the patient’s outcome and prognosis due to the hemodynamics and lung mechanics changes in these patients,who usually have frequent comorbidities.Similarly,pleural effusion drainage can modify the ICUadmitted patient’s outcome.Finally,pleural effusion analysis can change the original diagnosis in some cases and redirect the management toward a different way.
文摘BACKGROUND Viral pleurisy is a viral infected disease with exudative pleural effusions.It is one of the causes for pleural effusions.Because of the difficult etiology diagnosis,clinically pleural effusions tend to be misdiagnosed as tuberculous pleurisy or idiopathic pleural effusion.Here,we report a case of pleural effusion secondary to viral pleurisy which is driven by infection with epstein-barr virus.Viral infection was identified by metagenomic next-generation sequencing(mNGS).CASE SUMMARY A 40-year-old male with a history of dermatomyositis,rheumatoid arthritis,and secondary interstitial pneumonia was administered with long-term oral prednisone.He presented with fever and chest pain after exposure to cold,accompanied by generalized sore and weakness,night sweat,occasional cough,and few sputums.The computed tomography scan showed bilateral pleural effusions and atelectasis of the partial right lower lobe was revealed.The pleural fluids were found to be yellow and slightly turbid after pleural catheterization.Thoracoscopy showed fibrous adhesion and auto-pleurodesis.Combining the results in pleural fluid analysis and mNGS,the patient was diagnosed as viral pleuritis.After receiving Aciclovir,the symptoms and signs of the patient were relieved.CONCLUSION Viral infection should be considered in cases of idiopathic pleural effusion unexplained by routine examination.mNGS is helpful for diagnosis.
文摘Pleural effusion is a commonly encountered respiratory disorder. In the majority of cases, a single causative agent is responsible. Pleural effusions resulting from simultaneous involvement of the membranes by two different pathologic processes are unusual.
文摘The occurrence of pancreatic pleural effusion,secondary to an internal pancreatic fistula,is a rare clinical syndrome and diagnosis is often missed.The key to the diagnosis is a dramatically elevated pleural fluid amylase.This pancreatic pleural effusion is also called a pancreatic pleural fistula.It is characterized by profuse pleural fluid and has a tendency to recur.Here we report a case of delayed internal pancreatic fistula with pancreatic pleural effusion emerging after splenectomy.From the treatment of this case,we conclude that the symptoms and signs of a subphrenic effusion are often obscure;abdominal computed tomography may be required to look for occult,intra-abdominal infection;and active conservative treatment should be carried out in the early period of this complication to reduce the need for endoscopy or surgery.
基金Supported by Shaanxi Science and Technology Research Plan Program,Shaanxi,China,No. 2020SF-106
文摘BACKGROUND Pleural effusions occur for various reasons,and their diagnosis remains challenging despite the availability of different diagnostic modalities.Medical thoracoscopy(MT)can be used for both diagnostic and therapeutic purposes,especially in patients with undiagnosed pleural effusion.AIM To assess the diagnostic efficacy and safety of MT in patients with pleural effusion of different causes.METHODS Between January 1,2012 and April 30,2021,patients with pleural effusion underwent MT in the Department of Respiratory Medicine,The Second Affiliated Hospital of Xi’an Jiaotong University(Shaanxi,China).According to the discharge diagnosis,patients were divided into malignant pleural effusion(MPE),tuberculous pleural effusion(TBPE),and inflammatory pleural effusion(IPE)groups.General information,and tuberculosis-and effusion-related indices of the three groups were analyzed.The diagnostic yield,diagnostic accuracy,performance under thoracoscopy,and complications of patients were compared among the three groups.Then,the significant predictive factors for diagnosis between the MPE and TBPE groups were analyzed.RESULTS Of the 106 patients enrolled in this 10-year study,67 were male and 39 female,with mean age of 57.1±14.184 years.Among the 74 thoracoscopy-confirmed patients,41(38.7%)had MPE,21 had(19.8%)TBPE,and 32(30.2%)were undiagnosed.Overall diagnostic yield of MT was 69.8%(MPE:75.9%,TBPE:48.8%,and IPE:75.0%,with diagnostic accuracies of 100%,87.5%,and 75.0%,respectively).Under thoracoscopy,single or multiple pleural nodules were observed in 81.1%and pleural adhesions in 34.0%with pleural effusions.The most common complication was chest pain(41.5%),followed by chest tightness(11.3%)and fever(10.4%).Multivariate logistic regression analyses showed effusion appearance[odds ratio(OR):0.001,95%CI:0.000-0.204;P=0.010]and carcinoembryonic antigen(OR:0.243,95%CI:0.081-0.728;P=0.011)as significant for differentiating MPE and TBPE,with area under the receiver operating characteristic curve of 0.977(95%CI:0.953-1.000;P<0.001).CONCLUSION MT is an effective,safe,and minimally invasive procedure with high diagnostic yield for pleural effusion of different causes.
文摘BACKGROUND Meigs syndrome is a rare neoplastic disease characterized by the triad of benign solid ovarian tumor,ascites,and pleural effusion.In postmenopausal women with pleural effusions,ascites,elevated CA-125 level,and pelvic masses,the probability of disseminated disease is high.Nevertheless,the final diagnosis is based on its histopathologic features following surgical removal of a mass lesion.Here we describe a case of Meigs syndrome with pleural effusion as the initial manifestation.CASE SUMMARY A 52-year-old woman presented with a 2-mo history of dry cough and oppression in the chest and was admitted to our hospital due to recurrent pleural effusion and gradual worsening of dyspnea that had occurred over the previous month.Two months before admission,the patient underwent repeated chest drainage and empirical anti-tuberculosis treatment.However,the pleural fluid accumulation persisted,and the patient began to experience dyspnea on exertion leading to admission.A computed tomography scan of the chest,abdominal ultrasound,and magnetic resonance imaging confirmed the presence of right-sided pleural effusion and ascites with a right ovarian mass.Serum tumor markers showed raised CA-125.With a suspicion of a malignant tumor,the patient underwent laparoscopic excision of the ovarian mass and the final pathology was consistent with an ovarian fibrothecoma.On the seventh day postoperation,the patient had resolution of the right-sided pleural effusion.CONCLUSION Despite the relatively high risk of malignancy when an ovarian mass associated with hydrothorax is found in a patient with elevated serum levels of CA-125,clinicians should be aware about rare benign syndromes,like Meigs,for which surgery remains the preferred treatment.
文摘Pleural effusion after hepatectomy is associated with significant morbidity and prolonged hospital stays.Several studies have addressed the risk factors for postoperative pleural effusion.However,there are no researches concerning the role of the initial 12-h operative fluid volume.The aim of this study was to evaluate whether the initial 12-h operative fluid volume during liver resection is an independent risk factor for pleural effusion after hepatectomy.In this study,we retrospectively analyzed clinical data of 470 patients consecutively undergoing elective hepatectomy between January 2011 and December 2012.We prospectively collected and retrospectively analyzed baseline and clinical data,including preoperative,intraoperative,and postoperative variables.Univariate and multivariate analyses were carried out to identify whether the initial 12-h operative fluid volume was an independent risk factor for pleural effusion after hepatectomy.The multivariate analysis identified 2 independent risk factors for pleural effusion:operative time [odds ratio(OR)=10.2] and initial 12-h operative fluid volume(OR=1.0003).Threshold effect analyses revealed that the initial 12 h operative fluid volume was positively correlated with the incidence of pleural effusion when the initial 12-h operative fluid volume exceeded 4636 m L.We conclude that the initial 12-h operative fluid volume during liver resection and operative time are independent risk factors for pleural effusion after hepatectomy.Perioperative intravenous fluids should be restricted properly.
文摘Objective: To report a case of Endometriosis associated with Pleural effusion. Design: Case report. Setting: Tertiary care center. Patient(s): A 30-year old woman presented with a right pleural effusion complicated with pneumothorax-mimicking TB. Intervention(s): Thoracentesis, pleural biopsy by a video-assisted thoracic surgery, pleurodesis, thoracic wedge resection, CT chest, CT Abdomen, and diagnostic Laparoscopy. Main Outcome Measure(s): After taking a GnRH analog, there was no recurrence of pleural effusion nor ascites. Result(s): Thoracentesis and wedge resection of lung ruled out malignancy. An omental mass biopsy obtained from diagnostic laparoscopy after the patient returned with drug-induced hepatitis, and ascites revealed endometriosis. Conclusion(s): Thoracic endometriosis is rare;however, it should be considered in the differential diagnosis by unknown causes of pleural effusion in reproductive age timeframe in women.
基金supported by the National Key Research and Development Program of China(No.2018YFC2001100)the National Natural Science Foundation of China(Nos.61774167 and 61801477)+2 种基金the Instrument Development Program of the Chinese Academy of Sciences,Beijing Municipal Natural Science Foundation(Nos.4192062 and 4182072)Beijing Municipal Administration of Hospitals Incubating Program(No.PX2017050)Youth Innovation Promotion Association of Chinese Academy of Sciences。
文摘The sieving and enrichment of rare tumor cells from large-volume pleural effusion(PE)samples is a promising technique for cell-based lung tumor diagnosis and drug tests,which features high throughput and recovery,purification,as well as viability rates of rare target cells as the prerequisites for high sensitivity,specificity,and accuracy of tumor cell analysis.In this paper,we propose a three-dimensional(3 D)sieving method for rare tumor cell enrichment,which effectively eliminates the"dead zones"in traditional two-dimensional(2 D)cell filters with a dimension-raising strategy to satisfy the requirements mentioned above.The prototype device was combined with a funnel-shaped holder,a flexible micropore membrane in the middle,and a3 D spiral fluid channel covered on the membrane as a three-layer ice-creaming cone composite structure.Driven by gravity alone,the device performed as follows:(1)20-fold throughput compared with the 2 D commercial planee hich was up to 20 mL/min for a threefold dilution of whole blood sample;(2)high recovery rates of 84.5%±21%,86%±25%,83%±14%for 100,1000,and 10000 cells/mL,respectively,in 30 mL phosphate buffer saline(PBS)sample,and a 100%positive detection rate in the case of≤5 A549 cells in 1 mL PBS;(3)a typical purification rate of 85.5%±9.1%;and(4)a viability rate of>93%.In the demonstration application,this device effectively enriched rare target cells from large volumes(>25 mL)of clinical pleural effusions.The following results indicated that tumor cells were easy-to-discover in the enriched PE samples,and the proliferation capability of purified cells was(>4.6 times)significantly stronger than that of unprocessed cells in the subsequent 6-day culture.The above evaluation indicates that the proposed easily reproducible method for the effective execution of rare cell enrichments and assays is expected to become a practical technique for clinical cell-based tumor diagnosis.
文摘Takayasu arteritis (TA) is a chronic, nonspecific inflammatory disease of large and medium-sized vessels that primarily involves the aorta and its branches. TA involving the pulmonary arteries has a prevalence ranging from 14% to 86%, which can lead to pulmonary hypertension, a progressive increase in pulmonary artery pressure, and eventually death from right heart failure. The presentation of pulmonary arteritis (PA) is very nonspecific, with a reported misdiagnosis rate of up to 60% and a diagnosis time ranging from 1 month to more than 10 years. The clinical manifestation of pleural effusion is very rare in both TA and PA cases. Based on our literature review, this is the 6th reported case of TA with pleural effusion, and the specific mechanism of TA with pleural effusion is still unclear. The characteristics of this case and the previously reported cases are summarized in this article to improve the understanding of TA and PA and reduce the misdiagnosis rate.
文摘BACKGROUNDThe renal system has a specific pleural effusion associated with it in the form of“urothorax”, a condition where obstructive uropathy or occlusion of thelymphatic ducts leads to extravasated fluids (urine or lymph) crossing thediaphragm via innate perforations or lymphatic channels. As a rare disorder thatmay cause pleural effusion, renal lymphangiectasia is a congenital or acquiredabnormality of the lymphatic system of the kidneys. As vaguely mentioned in areport from the American Journal of Kidney Diseases, this disorder can be causedby extrinsic compression of the kidney secondary to hemorrhage.CASE SUMMARYA 54-year-old man with biopsy-proven acute tubulointerstitial nephropathyexperienced bleeding 3 d post hoc, which, upon clinical detection, manifested as amassive perirenal hematoma on computed tomography (CT) scan withoutconcurrent pleural effusion. His situation was eventually stabilized byexpeditious management, including selective renal arterial embolization. Despite good hemodialysis adequacy and stringent volume control, a CT scan 1 mo laterfound further enlargement of the perirenal hematoma with heterogeneoushypodense fluid, left side pleural effusion and a small amount of ascites. Thesefluid collections showed a CT density of 3 Hounsfield units, and drained fluid ofthe pleural effusion revealed a dubiously light-colored transudate withlymphocytic predominance (> 80%). Similar results were found 3 mo later, duringwhich time the patient was free of pulmonary infection, cardiac dysfunction andovert hypoalbuminemia. After careful consideration and exclusion of otherpossible causative etiologies, we believed that the pleural effusion was due to theocclusion of renal lymphatic ducts by the compression of kidney parenchymaand, in the absence of typical dilation of the related ducts, considered our case asextrarenal lymphangiectasia in a broad sense.CONCLUSIONAs such, our case highlighted a morbific passage between the kidney and thoraxunder an extraordinarily rare condition. Given the paucity of pertinentknowledge, it may further broaden our understanding of this rare disorder.
基金Supported by the Natural Science Foundation of Hubei Province,No.2019CFB798。
文摘BACKGROUND Spontaneous esophageal rupture or Boerhaave’s syndrome is a rare and acute disease with a high incidence of misdiagnosis and mortality.Here,we aimed to explore the clinical characteristics,diagnosis,treatment,and prognosis of spontaneous esophageal rupture,and to analyze the causes of misdiagnosis during the treatment of spontaneous esophageal rupture.CASE SUMMARY The clinical features of the patient with spontaneous esophageal rupture misdiagnosed earlier as pleural effusion were retrospectively analyzed and the reasons for misdiagnosis are discussed based on a current review of the literature.The patient was admitted to a local hospital due to shortness of breath accompanied by vomiting and abdominal distension for five hours.Based on the computed tomography(CT)scan analysis,clinically,right pleural effusion was diagnosed.However,the patient was unwilling to undergo right closed thoracic drainage.The patient also had intermittent fevers against infection,and during the course of treatment,he complained of chest pain,following which,he was transferred to our hospital.Grapefruit-like residue drainage fluid was observed.Re-examination of the chest CT scans suggested the presence of spontaneous perforation in the upper left esophagus.Therefore,the patient underwent an urgent esophageal hiatus repair.Unfortunately,the patient died of infection and respiratory failure due to progressive dyspnea after surgery.CONCLUSION Spontaneous esophageal rupture is a rare disease associated with high fatality.The patients do not present typical clinical symptoms and the disease progresses rapidly.This case report highlights the importance of a dynamic review of chest CT scan,not only for the initial identification of segmental injury but also for prioritizing subsequent treatment strategies.Moreover,we have presented some clues for clinicians to recognize and diagnose spontaneous esophageal rupture at rare sites(upper-esophageal segment)through this case report of spontaneous esophageal rupture that caused the patient’s death.We have also summarized the reasons for the misdiagnosis and lessons learned.
基金Supported by Key Project of Science and Technology Agency of Sichuan Province,China,No.2020YFS0149.
文摘BACKGROUND Cutaneous myiasis is frequently observed;however,eosinophilic pleural effusion induced by this condition is rare.CASE SUMMARY We report the case of a 65-year-old female Tibetan patient from Qinghai Province,who presented to West China Hospital of Sichuan University around mid-November 2011 with a chief complaint of recurrent cough,occasional hemoptysis,and right chest pain.There was no past medical and surgical history of note,except for occasional dietary habit of eating raw meat.Clinical examination revealed a left lung collapse and diminished breathing sounds in her left lung,with moist rales heard in both lungs.Chest X-rays demonstrated a left hydropneumothorax and a right lung infection.Chest computed tomography revealed a left hydropneumothorax with partial compressive atelectasis and patchy consolidation on the right lung.Laboratory data revealed peripheral blood eosinophilia of 37.2%,with a white blood cell count of 10.4×109/L.Serum immunoglobulin E levels were elevated(1650 unit/mL).Serum parasite antibodies were negative except for cysticercosis immunoglobulin G.Bone marrow aspirates were hypercellular,with a marked increase in the number of mature eosinophils and eosinophilic myelocytes.An ultrasound-guided left-sided thoracentesis produced a yellow-cloudy exudative fluid.Failure to respond to antibiotic treatment during hospitalization for her symptoms and persistent blood eosinophilia led the team to start oral albendazole(400 mg/d)for presumed parasitic infestation for three consecutive days after the ninth day of hospitalization.Intermittent migratory stabbing pain and swelling sensation on both her upper arms and shoulders were reported;tender nodules and worm-like live organisms were observed in the responding sites 1 wk later.After the removal of the live organisms,they were subsequently identified as first stage hypodermal larvae by the Sichuan Institute of Parasites.The patient’s symptoms were relieved soon afterwards.Telephonic follow-up 1 mo later indicated that the blood eosinophilia and pleural effusion were resolved.CONCLUSION Eosinophilic pleural fluid can be present in a wide array of disorders.Myiasis should be an important consideration for the differential diagnosis when eosinophilic pleural effusion with blood eosinophilia is observed.
文摘<strong>Background:</strong> Coincidental pleural effusion has been observed by computed tomography (CT) scans in individual patients with gastric leaks after laparoscopic sleeve gastrectomy;however, the frequency of this phenomenon has not been investigated in cohort studies. <strong>Objectives:</strong> This study aimed to assess the diagnostic accuracy of left pleural effusion as an indicator of gastric leaks after laparoscopic sleeve gastrectomy. <strong>Setting:</strong> University hospital and bariatric surgery center of excellence. <strong>Methods:</strong> This single-center retrospective analysis included consecutive patients who had undergone laparoscopic sleeve gastrectomy followed by CT scans to investigate suspected gastric leaks from September 2011 to September 2018. The sensitivity, specificity, Youden’s index, and predictive values were estimated using a 2 × 2 cross-tabulation. <strong>Results:</strong> The study involved assessing the CT scans of 148 patients;80 patients (44 men and 36 women, mean age: 34 years, mean body mass index {BMI}: 46 kg/m<sup>2</sup>) had positive findings of gastric leaks after laparoscopic sleeve gastrectomy, such as contrast leak, gas leak, and peri-gastric collection (either singly or in combination). The CT findings were negative for gastric leaks in 68 patients (38 men and 30 women, mean age: 33 years, mean BMI: 45 kg/m<sup>2</sup>). Pleural effusion manifested as a fluid density in the dependent portion of pleural cavity on CT. The sensitivity of left pleural effusion to predict gastric leaks after laparoscopic sleeve gastrectomy was 73.8%, and the specificity was 91.2%. The positive and negative predictive values were 90.8% and 74.7%, respectively, and the Youden’s index was 64.9%. <strong>Conclusion:</strong> Left pleural effusion exhibits good diagnostic accuracy for gastric leaks after laparoscopic sleeve gastrectomy. Notably, the specificity (91.2%) was very high.
文摘BACKGROUND Infected aortic aneurysms are uncommon and difficult to treat.We present a case of infected aortic aneurysm with recurrent nontyphoidal Salmonella bacteremia.CASE SUMMARY A 68-year-old gentleman presented with non-specific symptoms and was found to have nontyphoidal Salmonella bacteremia and was treated with intravenous ceftriaxone.However his condition did not improve,and he developed a multiloculated right pleural effusion.Thoracocentesis was done to drain hemorrhagic pleural fluid.Chest computed tomography demonstrated descending thoracic aorta saccular aneurysm with periaortic hematoma likely due to recent bleed and extending to the right pleural cavity.He was referred to cardiothoracic surgery team and was planned for medical therapy in view of hemodynamic stability and no evidence of active leakage.He completed intravenous antibiotic for 5 wk and refused surgical intervention.Unfortunately,he was admitted twice for recurrent nontyphoidal Salmonella bacteremia.Finally,he agreed for surgical intervention and underwent endovascular aortic repair 3 mo later.Postoperatively,his condition remained stable with no recurrence of infection.CONCLUSION Our case highlights the importance of high index of suspicion of infected aortic aneurysm in patients with Salmonella bacteremia with high-risk factors such as atherosclerosis.
文摘<strong>Background:</strong> Kikuchi-Fujimoto disease (KFD), also named Histiocytic necrotizing lymphadenitis (HNL), is a rare and self-limited necrotizing lymphadenitis, most commonly affects young Asian female. KFD is characterized by lymphadenopathy, cytopenia, fever, rashes, and weight loss, however, hemophagocytic syndrome and pleural effusion are rarely reported. <strong>Case Presentation:</strong> We present the case of a 61-year-old man with clinical features including fever, lymphadenopathy, purpura, arthralgia, pleural effusion and pulmonary infection. He had cervical lymphnodebiopsy and the pathology is consistent with KFD, laboratory tests and clinical manifestations were consistent with hemophagocytic syndrome (HLH). After initial treatment including corticosteroid and anti-infection drugs, the patient showed improvement but soon deteriorated. <strong>Conclusion:</strong> KFD is a self-limited disease with spontaneous resolution. However, the cases of KFD with HLH may have a fatal course. Early appropriate intensive immunosuppressive therapy and strong anti-infection therapy could be beneficial for the treatment outcome.
文摘A 32-year-old patient with no previous history was admitted for chest pain, dyspnea, <span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">appetite and weight loss</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">.</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Chest X-ray revealed an</span></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;"> opacity involving the lower two-thirds of the right hemithorax, suggestive of a pleural effusion. </span><span style="font-family:Verdana;">Because of the absence of fluid return even after ultrasound-guided </span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">thoracentesis,</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> a </span></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;">Chest Computed tomography was required showing a heterogeneous anterior mediastinal mass with soft tissue, fat, fluid and calcifications associated </span><span style="font-family:Verdana;">with extensive encysted fluid collection in the right hemithorax. A</span><span style="font-family:Verdana;"> video-assisted mini-thoracotomy revealed a mediastinal tumor firmly attached to the thy</span><span style="font-family:Verdana;">mus with a cystic wall lined by squamous epithelium and sebaceous gland</span><span style="font-family:Verdana;"> composed of respiratory tissue, adipose tissue, cartilage,</span></span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">smooth muscle fibers, and well-differentiated pancreatic tissue. These findings led to the diagnosis of a mature thymic teratoma.</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">The patient was discharged 7 days after surgery, with no recurrence on follow-up.</span></span></span>
文摘Objective:Guided by the theory of syndrome differentiation of yin and yang in traditional Chinese medicine surgery,through visual observation of internal medicine thoracoscope,comprehensive observation of pleural cavity and immunohistochemistry of biopsy tissue,to classify malignant pleural effusion according to syndrome differentiation,and to explore the scientific nature of its theory.Methods:From March 1,2014 to February 28,2015,40 cases of malignant pleural effusion were treated in Beijing Chaoyang Hospital affiliated to Capital Medical University.According to the proposed TCM diagnostic criteria for yin and yang syndrome differentiation,and collect age,gender,course of disease,clinical symptoms,tumor primary focus,histomorphological manifestations and immunohistochemical results and other related information,and carry out statistical data processing.Results:The positive syndrome was mainly metastatic lung adenocarcinoma,which accounted for the majority of all MPE cases,up to 75%.The immunohistochemical results of biopsy tissues were mainly CEA and TTF-1 positive;While pleural effusion caused by pleural mesothelioma was the main type of yin syndrome,and the results of immunohistochemistry combined with biopsy were mainly positive for D2-40,Calretinin,WT-1 and CK5/6.Conclusion:TCM syndrome differentiation of MPE based on internal thoracoscopy combined with biopsy immunohistochemical results has sufficient theoretical basis and certain scientific nature,and further clinical research is needed to verify its effectiveness and practicability in the future.
基金supported by grants from the Science and Technology Commission of Shanghai Municipality(STCSM)(14140902800 and 16140902800)the National Key R&D Program of China(2016YFC1303300)+1 种基金the National Natural Science Foundation of China(81672272)the Key Project of Shanghai Health&Family Planning Commission(201540365).
文摘Background:Non-small cell lung cancer(NSCLC)patients with epidermal growth factor receptor(EGFR)mutations or anaplastic lymphoma kinase(ALK)fusions show dramatic responses to specific tyrosine kinase inhibitors(TKIs);however,after 10-12 months,secondary mutations arise that confer resistance.We generated a murine xenograft model using patient-derived NSCLC cells isolated from the pleural fluid of two patients with NSCLC to investigate the mechanisms of resistance against the ALK-and EGFR-targeted TKIs crizotinib and osimertinib,respectively.Methods:Genotypes of patient biopsies and xenograft tumors were determined by whole exome sequencing(WES),and patients and xenograft-bearing mice received targeted treatment(crizotinib or osimertinib)accordingly.Xenograft mice were also treated for prolonged periods to identify whether the development of drug resistance and/or treatment responses were associated with tumor size.Finally,the pathology of patients biopsies and xenograft tumors were compared histologically.Results:The histological characteristics and chemotherapy responses of xenograft tumors were similar to the actual patients.WES showed that the genotypes of the xenograft and patient tumors were similar(an echinoderm microtu-bule-associated protein-like 4-ALK(EML4-ALK)gene fusion(patient/xenograft:CTC15035EML4-ALK)and EGFR L858R and T790M mutations(patient/xenograft:CTC15063EGFR L858R,T790M)).After continuous crizotinib or osimertinib treatment,WES data suggested that acquired ALK E1210K mutation conferred crizotinib resistance in the CTC15035EML4-ALK xenograft,while decreased frequencies of EGFR L858R and T790M mutations plus the appearance of v-RAF murine sarcoma viral oncogene homolog B(BRAF)G7V mutations and phosphatidylinositol-4-phosphate 3-kinase catalytic subunit type 2 alpha(PIK3C2A)A86fs frame shift mutations led to osimertinib resistance in the CTC15063EGFR L858R,T790M xenografts.Conclusions:We successfully developed a new method of generating drug resistance xenograft models from liquid biopsies using microfluidic technology,which might be a useful tool to investigate the mechanisms of drug resist-ance in NSCLC.
