Antemortem diagnosis of asbestosis by screening chest radiograph correlated with postmortem histologic features of asbestosis: a study of 273 cases.

BACKGROUND: Accuracy in the clinical diagnosis of asbestosis has significant implications for the future health of affected patients as well as serious medicolegal implications for both patients and asbestos-associated industries. The radiographic gold-standard for diagnosis of asbestosis has been the plain chest radiograph, and in many asbestosis-screening clinics, chest radiograph abnormalities in conjunction with a history of asbestos exposure have been the mainstay of diagnosis. No studies have yet compared the antemortem chest radiographic diagnosis of asbestosis with the subsequent presence of pulmonary fibrosis and lung tissue ferruginous bodies at autopsy. METHODS: Records were reviewed from 273 autopsies performed to investigate asbestosis over an 11-year period. Accrued data included age and gender as well as the presence or absence of the following: occupational exposure to asbestos, antemortem clinical diagnosis of asbestosis by chest radiograph, fibrous pleural plaques, peribronchiolar or interstitial pulmonary fibrosis, ferruginous bodies in histologic sections of lung tissue, and ferruginous bodies in digested lung tissue. RESULTS: 242 cases with the antemortem radiographic diagnosis of asbestosis (study group) were identified. 31 additional autopsies had been requested based on history of asbestos exposure without radiographic documentation of asbestosis (control group). Comparison of the two groups showed a statistically significant increase in the association of chest radiograph-diagnosed asbestosis and the presence at autopsy of pleural plaques (p = 0.0109), peribronchiolar or interstitial pulmonary fibrosis (p = 0.0472), and histologically-diagnostic asbestosis (p = 0.0021). At autopsy, histologically-diagnostic asbestosis was confirmed in only 90 of the 243 study group cases. Comparison of individual parameters within the 242 study group cases showed a statistically significant correlation between the presence of fibrous pleural plaques and histologically-proven pulmonary fibrosis (p = 0.0025) as well as the subsequent histologic diagnosis of asbestosis (p < 0.0001). CONCLUSION: Clinical diagnosis of asbestosis by screening chest radiograph is more predictive of the postmortem presence of fibrous pleural plaques, pulmonary fibrosis, and histologically-proven asbestosis than is occupational exposure history alone. However, chest radiograph-based diagnosis of asbestosis significantly overpredicts the subsequent histologic diagnosis of asbestosis.

Empyema necessitatis due to methicillin-resistant Staphylococcus aureus: case report and review of the literature.

Empyema necessitatis is a rare complication of empyema in which the pleural infection spreads outside of the pleural space to involve the soft tissues of the chest wall. Most cases of empyema necessitatis are related to Mycobacterium tuberculosis and, less commonly, to Actinomyces spp. and Streptococcus spp. Staphylococcus aureus has rarely been reported as the causative agent of empyema necessitatis, with the majority of S. aureus isolates being methicillin sensitive. Only two cases of empyema necessitatis due to methicillin-resistant S. aureus (MRSA) have been reported in the medical literature. We report the case of a 59-year-old Caucasian male who presented to our institution with complaints of pain in and swelling of his left upper chest of 2-months duration. A computed tomography scan of the chest showed an 8.1- by 6.5-cm lesion which extended from the left upper lobe of the lung into the extrathoracic soft tissues beneath the left upper pectoralis muscle. A wedge resection of the left upper lung lobe revealed lung tissue with an organized pneumonia-like pattern associated with marked acute pleuritis. Blood and urine cultures and cultures of the left chest soft tissue mass grew MRSA. The patient was successfully treated with vancomycin followed by a 10-day outpatient course of ciprofloxacin and trimethoprim-sulfamethoxazole. This case represents an extremely rare manifestation of an increasingly dangerous bacterial pathogen.

Kluyvera infections in the pediatric population.

In pediatric patients, Kluyvera spp. has emerged as a cause of disease ranging from soft tissue infections to sepsis with multiorgan failure. Successful treatment options include third-generation cephalosporins, tetracycline, aminoglycosides, and fluoroquinolones, but resistance to first- and second-generation cephalosporins persists. Clinicians should be aware of the spectrum of disease and increasing clinical importance associated with this emerging pathogen.

Mammary-type fibroepithelial neoplasms of the vulva: a case report and review of the literature.

Mammary-type fibroepithelial neoplasms of the vulva are rare lesions of uncertain histogenesis. Origin from ectopic breast tissue and from anogenital glandular tissue that shares similar histologic homology with breast tissue has been postulated. We report the case of a 45-year-old woman who presented with a vulvar mass of several years duration. Excision of the lesion and subsequent histologic examination showed a mammary-type fibroadenoma with apocrine change. No ectopic breast tissue was identified outside the lesion. The theories of histogenesis of these neoplasms and additional cases of mammary-type lesions of the vulva reported in the medical literature are reviewed.

Neisseria sicca meningitis following intracranial hemorrhage and ventriculostomy tube placement.

A normal component of the flora of the oropharynx, Neisseria sicca was first isolated in 1906 and has since been reported as a rare cause of various human infections including endocarditis, pneumonia, sinusitis, sepsis, and urethritis. We report the case of a 44-year-old African-American female with a history of hypertension who presented with complaints of right frontal headache, nausea, photophobia, and vomiting. A computed tomography scan of the patient's brain showed a large subarachnoid hemorrhage, and an arteriogram confirmed a large posterior communicating artery aneurysm. A ventriculostomy tube was placed, and the patient subsequently developed an elevated temperature and elevated white blood cell count. Cerebrospinal fluid studies showed elevated protein and glucose levels and cultures positive for N. sicca. This is only the seventh reported case of culture-proven meningitis related to N. sicca, and the first reported case associated with intracranial hemorrhage and ventriculostomy tube placement.