ABSTRACT
Combined pulmonary fi brosis and emphysema (CPFE) is a recently recognized radiologically defi ned syndrome characterized by simultaneous coexistence of both upper lobe emphysema and lower lobe pulmonary fi brosis. We present a case of CPFE in a 57-year-old male smoker who presented with dry cough, progressive breathlessness, and swelling of feet. His chest X-ray revealed bilateral lower Zone reticulonodular opacities with hyperlucent upper Zones. Pulmonary function tests showed wellpreserved lung volumes and reduced diff using capacity of the lung for carbon monoxide. High-resolution computed tomogram showed bilateral lower lobe subpleural honeycombing along with fi brosis and traction bronchiectasis with bilateral upper lobe emphysema predominantly paraseptal type. His 2D echo was suggestive of moderate pulmonary arterial hypertension.
Subject(s)
Carbon Monoxide/analysis , Emphysema/diagnosis , Emphysema/epidemiology , Humans , Hypertension, Pulmonary/complications , Hypertension, Pulmonary/epidemiology , Male , Middle Aged , Pulmonary Artery , Pulmonary Diffusing Capacity/methods , Pulmonary Fibrosis/diagnosis , Pulmonary Fibrosis/epidemiology , Tomography, X-Ray Computed/methodsABSTRACT
Emphysematous cystitis is found in diabetic patients and in individuals with urinary stasis and immunosuppression. We report a 58-year-old male with hypertension, type 2 Diabetes on insulin treatment and central nervous system vasculitis on immunosuppressive therapy. He was admitted with weight loss and gait instability. A PET-CT showed a circumscribed image of air in the bladder contour without involving the upper urinary tract, suggesting emphysematous cystitis. Re-interrogated, the patient referred pneumaturia, dysuria and febrile sensation one week before admission. Urine culture showed Enterobacter aerogenes. He was treated with a urinary catheter, metabolic control and parenteral antimicrobials. The patient was discharged without symptoms 21 days after admission, with the bladder catheter.
Subject(s)
Humans , Male , Middle Aged , Cystitis/diagnosis , Emphysema/diagnosis , Enterobacter aerogenes/isolation & purification , Enterobacteriaceae Infections/drug therapy , Cystitis/complications , Dysuria/etiology , Emphysema/complications , Imipenem/therapeutic use , Treatment Outcome , Urinary Incontinence, Urge/etiologyABSTRACT
We report a 53 year-old woman with type 2 diabetes mellitus and hypertension, presenting with progressive abdominal pain lasting three weeks, associated with lower abdominal swelling and fever. Clinical examination showed a large increase in abdominal volume, contraction of extracellular compartment, and signs of severe sepsis. Computed tomography showed an over-distended bladder with severe wall and luminal pneumatosis and bilateral hydronephrosis. The diagnosis was of emphysematous cystitis associated to hydronephrosis. Urine and blood cultures were positive for multi-susceptible Escherichia coli. Clinical evolution was favorable after 6 weeks of ceftriaxone and urinary catheter use. Emphysematous cystitis is a rare clinical entity, with an associated mortality of 7%. Known predisposing factors are older age, female gender and presence of diabetes. Microbiological agents most frequently involved are Escherichia coli and Klebsiella pneumoniae (80% of cases). Medical treatment is preferred and is based on urinary tract decompression with a bladder catheter, and prolonged broad spectrum antimicrobial therapy.
Subject(s)
Female , Humans , Middle Aged , Cystitis/diagnosis , Emphysema/diagnosis , Cystitis/etiology , /complications , Emphysema/etiology , Tomography, X-Ray ComputedABSTRACT
No abstract available.
Subject(s)
Female , Humans , Middle Aged , Anti-Bacterial Agents/therapeutic use , Emphysema/diagnosis , Escherichia coli/isolation & purification , Escherichia coli Infections/diagnosis , Kidney/pathology , Necrosis , Nephrectomy , Pyelonephritis/diagnosis , Renal Dialysis , Tomography, X-Ray Computed , Treatment OutcomeSubject(s)
Female , Humans , Middle Aged , Emphysema/diagnosis , Parotitis/diagnosis , Emphysema/drug therapy , Parotitis/drug therapyABSTRACT
Pyelonephritis is a pyogenic infection of renal parenchyma that involves the renal pelvis. It is generally of easy diagnosis. The present case report aims to describe two different manifestations of this infection: xanthogranulomatous pyelonephritis and emphysematous pyelonephritis, which have poor prognosis and require a more effective treatment. The two cases were women in the fiftieth and sixtieth decade of life, with diabetes mellitus and history of weight loss. The diagnosis of the renal infection was established through computed tomography and the treatment was based in surgical procedure, with favorable outcome.
Subject(s)
Female , Humans , Middle Aged , Emphysema/diagnosis , Kidney Diseases/diagnosis , Pyelonephritis, Xanthogranulomatous/diagnosis , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Childhood parotid swelling has a number of differential diagnosis mostly of inflammatory origin. Pneumoparotitis is an uncommon cause of parotid inflammation. It is caused by an excessive increase of intraoral pressure and secondary passage of air into the Stensen or Stenon duct and its glandular branches. Diagnostic clues can usually be obtained by a directed anamnesis. Ultrasonography (US) and computed tomography are essential diagnostic tools for this condition that has a benign course with spontaneous resolution in most cases. We present four cases of pneumoparotitis diagnosed by US in children 5 to 13 years of age. One of the cases occurred after the child chewed gum and made bubbles for a prolonged timeperiod and the other three after inflating baloons, making bubbles inside a pool and after playing the flute. All cases resolved spontaneously after two days. We suggest to consider pneumoparotitis in the differential diagnosis of parotid swellig in children.
Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Male , Emphysema/diagnosis , Parotid Diseases/diagnosis , Diagnosis, Differential , Emphysema/etiology , Emphysema/physiopathology , Parotid Diseases/etiology , Parotid Diseases/physiopathology , Remission, SpontaneousABSTRACT
Emphysematous Cystitis is a primary infection of the bladder with production of gas by bacteria. The infection is uncommon, still has obvious clinical importance due to its morbidity and mortality potential, as the following case enlightens. We report a clinical case of a patient admitted with acute myocardial infarction who developed an acute emphysematous cystitis, a further complication in his long and complex period of hospitalization.
Subject(s)
Aged, 80 and over , Humans , Male , Cystitis/diagnosis , Emphysema/diagnosis , Cystitis/complications , Emphysema/complications , Fatal Outcome , Length of Stay , Myocardial Infarction/complications , Tomography, X-Ray ComputedABSTRACT
Emphysematous pyelonephritis is a rare, life endangering suppurative infection of the renal parenchyma and perirenal spaces. The disease is encountered mainly in patients with diabetes mellitus and is characterized by the production of intrarenal and, occasionally, perirenal gas. We present 4 cases of emphysematous pyelonephritis encountered in our hospital with review of the literature.
Subject(s)
Aged , Diabetes Mellitus, Type 2/complications , Emphysema/diagnosis , Female , Humans , Kidney/pathology , Male , Middle Aged , Pyelonephritis/diagnosisABSTRACT
We present an interesting and rare case of a diabetic patient who developed extensive unilateral emphysematous pyelonephritis (EPN) which was caused by fungal infection. The diagnosis was confirmed on computed tomography (CT) scan of the abdomen. Repeated urine cultures grew Candida albicans but no other organisms were isolated. The patient remained febrile and unwell despite parenteral broad spectrum antibiotics and antifungal treatment. She underwent nephrectomy and then made a good clinical recovery.
Subject(s)
Adult , Anti-Bacterial Agents/therapeutic use , Antifungal Agents/therapeutic use , Candida albicans/drug effects , Candidiasis/complications , Diabetes Mellitus, Type 2/complications , Emphysema/diagnosis , Female , Fluconazole/therapeutic use , Humans , Insulin/therapeutic use , Malaysia , Nephrectomy , Pyelonephritis/diagnosis , Risk Factors , Treatment OutcomeSubject(s)
Humans , Female , Emphysema/diagnosis , /pathogenicity , Urologic Diseases , Tomography, X-Ray Computed , Nephrectomy , Treatment OutcomeABSTRACT
Emphysematous prostatic abscess is a very rare form of prostatitis. Emphysematous prostatic abscess due to Klebsiella pneumoniae may have a poor prognosis according to a few previous reports. We report a rare case of successfully treated emphysematous prostatic abscess with cystitis due to Klebsiella pneumoniae in a 50-yr-old man with 15-yr history of diabetes mellitus. The patient was referred to the emergency room of our hospital. The KUB film revealed gas shadows in the lower pelvic area suggestive of emphysematous cystitis or emphysematous prostatic abscess. The gas was mainly occupying the prostate and was also seen in the bladder on pelvic CT. The patient was successfully treated with long-term antibiotic use and additional percutaneous drainage of the abscess. Emphysematous prostatic abscess may be misdiagnosed as emphysematous cystitis due to the similar location of gas shadows on radiography. Computerized tomography and transrectal ultrasonography are helpful in making the diagnosis of emphysematous prostatic abscess. Appropriate use of effective antibiotics with drainage of pus is the best treatment. This case emphasizes the importance of timely and accurate diagnosis followed by appropriate treatment in emphysematous prostatic abscess in diabetic patients.
Subject(s)
Humans , Male , Middle Aged , Abscess , Anti-Bacterial Agents/therapeutic use , Cystitis/diagnosis , Diabetes Mellitus/complications , Drainage , Emphysema/diagnosis , Klebsiella Infections/diagnosis , Klebsiella pneumoniae/metabolism , Prostate/microbiology , Prostatic Diseases/diagnosisABSTRACT
Emphysematous pyelonephritis is a rare life-threatening suppurative necrotising infection of the renal parenchyma and perirenal tissue producing abscess formation and intrarenal gas. It is almost always seen in diabetics, making it a concern of the physician. A high index of suspicion is required for diagnosis and a combined approach has significantly reduced the mortality.
Subject(s)
Diabetes Complications , Emphysema/diagnosis , Humans , Kidney Papillary Necrosis/diagnosis , PrognosisABSTRACT
Emphysematous pyelonephritis is a rare life threatening infection in diabetes characterised by suppurative infection of renal parenchyma and perirenal tissues. It usually presents with fever, nausea, vomiting, abdominal pain, shock, lethargy, and confusion. Diabetic ketoacidosis is an uncommon presentation. In the present case, an elderly female presented with abdominal pain, fever, vomiting, and altered sensorium. She was diagnosed to have diabetic ketoacidosis with metabolic encephalopathy with right emphysematous pyelonephritis. She had an excellent response to medical treatment alone and was later discharged on oral hypoglycaemic agents.