ABSTRACT
OBJECTIVES: This study was conducted to investigate the risk factors for pulmonary abscess-related empyema by investigating the clinical characteristics and chest computed tomography imaging features of patients with pulmonary abscesses. METHODS: We retrospectively analyzed the chest computed tomography findings and clinical features of 101 cases of pulmonary abscess, including 25 cases with empyema (the experimental group) and 76 cases with no empyema (the control group). The potential risk factors for pulmonary abscess-related empyema were compared between the groups by using univariate and multivariate logistic regression analyses. RESULTS: The incidence of pulmonary abscess-related empyema was 24.8% (25/101). Univariate analysis showed that male gender, diabetes, pleuritic symptoms, white blood cells >10×109/L, albumin level <25 g/L, and positive sputum cultures were potential clinical-related risk factors and that an abscess >5 cm in diameter and transpulmonary fissure abscesses were potential computed tomography imaging-related risk factors for pulmonary abscess-related empyema. Multivariate logistic regression analysis showed that transpulmonary fissure abscesses (odds ratio=9.102, p=0.003), diabetes (odds ratio=9.066, p=0.003), an abscess >5 cm in diameter (odds ratio=8.998, p=0.002), and pleuritic symptoms (odds ratio=5.395, p=0.015) were independent risk factors for pulmonary abscess-related empyema. CONCLUSIONS: Transpulmonary fissure abscesses, diabetes, giant pulmonary abscesses, and pleuritic symptoms increased the risk of empyema among patients with pulmonary abscesses.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Tomography, X-Ray Computed/methods , Empyema, Pleural/diagnostic imaging , Lung Abscess/diagnostic imaging , Pleural Diseases/complications , Sex Factors , Regression Analysis , Risk Factors , Empyema, Pleural/complications , Empyema, Pleural/blood , Diabetes Complications/complications , Serum Albumin, Human/analysis , Leukocyte Count , Lung Abscess/complications , Lung Abscess/bloodSubject(s)
Humans , Male , Adult , Pericarditis, Constrictive/diagnosis , Pleural Diseases/diagnosis , Cardiomyopathy, Restrictive/diagnosis , Edema/diagnosis , Pericarditis, Constrictive/complications , Pleural Diseases/complications , Pleural Effusion , Autopsy , Cardiomyopathy, Restrictive/complications , Fatal Outcome , Edema/complicationsABSTRACT
OBJECTIVE: To determine the patho-mechanism of pleural effusion or hydropneumothorax in Mycobacterium avium complex (MAC) lung disease through the computed tomographic (CT) findings. MATERIALS AND METHODS: 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. RESULTS: 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/microL). 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. CONCLUSION: 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.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Fistula/complications , Hydropneumothorax/complications , Lung/diagnostic imaging , Mycobacterium avium/isolation & purification , Mycobacterium avium Complex/isolation & purification , Mycobacterium avium-intracellulare Infection/diagnosis , Pleural Diseases/complications , Pleural Effusion/complications , Retrospective Studies , Tomography, X-Ray ComputedABSTRACT
Objective. We aimed to assess the role of medical thoracoscopy in patients with undiagnosed pleural effusion. Methods. 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. Results. 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). Conclusion. Medical thoracoscopy is a useful tool for the diagnosis of pleural diseases. The procedure is safe with minimal complications.
Subject(s)
Adult , Biopsy, Needle , Diagnostic Errors/prevention & control , Female , Humans , Image-Guided Biopsy/methods , Male , Middle Aged , Pleura/pathology , Pleural Diseases/classification , Pleural Diseases/complications , Pleural Diseases/diagnosis , Pleural Effusion/diagnosis , Pleural Effusion/etiology , Prospective Studies , Reproducibility of Results , Thoracoscopy/methodsABSTRACT
Introducción: La fístula broncopleural (FBP) secundaria a cirugía o infección es un reto terapéutico. Su tratamiento puede ser expectante o quirúrgico, describiéndose cada vez más el cierre endoscópico. Objetivo: Descripción de caso clínico de un paciente en quién se logró el cierre de una FBP vía endoscópica mientras evolucionaba con un síndrome de distress respiratorio agudo (SDRA) grave. Caso clínico: Paciente de 14 años de edad con antecedente de lobectomía inferior izquierda por bronquiectasias crónicas, quien desarrolló una FBP central secundaria al drenaje transtorácico de un absceso lingular. Presentó un shock séptico asociado a un SDRA. En su evolución la FBP de alto flujo impidió una ventilación mecánica adecuada, siendo esta cerrada por vía broncoscópica con tetraciclina y Gelfoam®, lo que permitió una disminución significativa de su débito, con cierre definitivo a las tres semanas del procedimiento. Conclusión: La FBP secundaria a un absceso pulmonar, puede ser tratada eficientemente con selle fibrobroncoscópico durante el curso de un fallo respiratorio grave en un paciente críticamente enfermo, evitando alternativas quirúrgicas de mayor riesgo.
Subject(s)
Male , Adolescent , Humans , Bronchoscopy , Pleural Diseases/surgery , Bronchial Fistula/surgery , Optical Fibers , Lung Abscess/complications , Critical Illness , Drainage , Pleural Diseases/complications , Pleural Diseases/therapy , Bronchial Fistula/complications , Bronchial Fistula/therapy , Shock, Septic/complications , Respiratory Distress Syndrome/complications , Treatment OutcomeABSTRACT
Hydatid disease is a parasitic infection that most commonly involves the liver. Imaging plays a vital role in the diagnosis of this disease. Rupture of the cyst can give rise to a wide spectrum of complications. We describe a case of hepatic hydatid cyst with rupture into the biliary tree, right pleural cavity and dissemination into the peritoneal cavity, with associated splenic hydatid cysts. MRI may be a useful non-invasive diagnostic tool in such disseminated cases to define the complete extent of the disease.
Subject(s)
Bile Duct Diseases/complications , Echinococcosis/diagnosis , Echinococcosis, Hepatic/complications , Female , Humans , Middle Aged , Peritoneal Diseases/diagnosis , Pleural Diseases/complications , Splenic Diseases/complicationsABSTRACT
Introducción: En el estudio de algunos derrames pleurales de tipo exudado, la biopsia pleural informa pleuritis inespecífica (PI). No hay criterios que permitan pronosticar cuál será la evolución de estos pacientes ni hay acuerdo acerca de cuál debe ser la conducta ante el informe de PI. Objetivos: Identificar características clínicas, radiológicas o de laboratorio que permitan predecir la evolución de los pacientes con PI y sugieren la enfermedad subyacente. Pacientes y Métodos: Se revisó la historia y la evolución de los pacientes con derrame de tipo exudado que fueron sometidos a una primera biopsia pleural en la cual una muestra de buena calidad informó PI. Se excluyeron aquellos con ADA > 50 U y citología sospechosa o definitiva de malignidad. Se comparó el número de biopsias y procedimientos a que fue sometido cada paciente después de recibir el informe de PI y los diagnósticos finales. Se buscaron diferencias entre grupos de acuerdo con el diagnóstico definitivo (tuberculosis y cáncer, resolución espontánea, otra causa de PI y muerte sin diagnóstico). Resultados: De 430 biopsias tomadas durante el período de estudio (1991-1993), 60 fueron informadas como PI. Se obtuvieron datos completos en 43 casos. Las características clínicas, radiológicas y bioquímicas fueron similares entre los grupos. Solamente la pérdida de peso se asoció con una mayor probabilidad de tuberculosis o cáncer. El uso de toracoscopia se asoció con mayor probabilidad de alcanzar un diagnóstico definitivo. Conclusión: Si se incluye en la definición de PI un nivel de ADA inferior a 50 U (para excluir TBC) y un resultado de la citología que no sugiera cáncer, ningún factro clínico o paraclínico permite pronosticar la presencia de tuberculosis o cáncer en pacientes con PI. Está indicado continuar el proceso diagnóstico, incluyendo métodos invasivos de estudio de la pleura.
Subject(s)
Humans , Exudates and Transudates/microbiology , Exudates and Transudates/physiology , Pleural Diseases/classification , Pleural Diseases/complications , Pleural Diseases/diagnosis , Pleural Diseases/drug therapy , Pleural Diseases/epidemiology , Pleural Diseases/etiology , Pleural Diseases/microbiology , Pleural Diseases/physiopathology , Pleural Diseases/therapy , Pleural Effusion/classification , Pleural Effusion/complications , Pleural Effusion/diagnosis , Pleural Effusion/drug therapy , Pleural Effusion/epidemiology , Pleural Effusion/etiology , Pleural Effusion/microbiology , Pleural Effusion/physiopathology , Pleural Effusion/therapyABSTRACT
A series of 44 cases of staphylococcal pulmonary infection in children is reported. Their clinical features and characteristic roentgenological manifestations have been discussed.
Subject(s)
Child , Child, Preschool , Empyema/etiology , Female , Humans , Infant , Infant, Newborn , Male , Pleural Diseases/complications , Pneumonia, Staphylococcal/complications , Pneumothorax/etiologyABSTRACT
A incidência de manifestaçöes pleuropulmonares é bastante alta, principalmente na forma sistêmica (66%). Embora às vezes näo existam sinais clínicos pulmonares, devemos buscar esse diagnóstico quando existe agudizaçäo de ARJ, com febre, taquicardia, taquipnéia, dor torácica ou abdominal, que geralmente surgem com vômitos. Nessas ocasiöes, é freqüente encontrarmos leucocitose, desvio para esquerda e VHS muito acelerada, sem evidência de processo infeccioso concomitante. Uma revisäo da literatura mundial aponta as diversas manifestaçöes pleuropulmonares já descritas
Subject(s)
Child, Preschool , Child , Humans , Male , Female , Arthritis, Juvenile/complications , Pleural Diseases/complications , Lung Diseases/complications , Arthritis, Juvenile/diagnosisABSTRACT
Historia clínica de una paciente de cinco años internada en el Hospital Infantil de Monterrey, con diagnóstico de absceso hepático amebiano abierto a pleura izquierda. Durante su estancia se corroboró con estudio de esofagograma la presencia de fístulas hacia estómago, esófago y pleura. Primero fue tratada quirúrgicamente en relación con su cuadro abdominal y posteriormente, por transtoracotomía, de su fístulas esofágica. En este estudio se presenta una casuística de diez años en el HIM, comparada con la de otros centros hospitalarios. Se encontró que esta complicación es propia de la edad adulta y que ha sido informada habitualmente como hallazgo de necropsia. En el caso que publicamos se logró tener una evolución, aunque prolongada, favorable para la paciente