Primary thoracic muscle tuberculosis: two case reports.

BACKGROUND: The aim of this case report is to present our experience with two very rare cases of thoracic muscle tuberculosis. Muscle tuberculosis, as a primary disease, can only be detected in cases in which mycobacteria have been transplanted to a muscle through an infected needle. CASE PRESENTATIONS: Case 1 is a 38-year-old immigrant man and Case 2 is a 24-year-old immigrant man, both originating from Sub-Saharan African Countries; they presented in the past two years to our hospital with swellings at the base of the hemithorax and were diagnosed as having muscle tuberculosis. Administration of anti-tuberculosis chemotherapy caused: (a) diminution of inflammation, (b) diminution of the size of local fusiform injury, and (c) clinical improvement. CONCLUSIONS: Thoracic muscle tuberculosis should be considered to be one of the etiologies of muscular disease in European countries with a high incidence of immigrants originating from endemic geographical areas.

A massive haemothorax as an unusual complication of infective endocarditis caused by Streptococcus sanguinis.

OBJECTIVE AND IMPORTANCE: Infective endocarditis involving the tricuspid valve is an uncommon condition, and a consequent haemothorax associated with pulmonary embolism is extremely rare. Particularly, there are no guidelines for the management of this complication. We describe a rare case of pulmonary embolism and infarction followed by a haemothorax due to infective endocarditis of the tricuspid valve caused by Streptococcus sanguinis. CLINICAL PRESENTATION: A 25-year-old man with a ventricular septal defect (VSD) presented with fever. On physical examination, his body temperature was 38.8 °C, and a grade III holosystolic murmur was heard. A chest X-ray did not reveal any specific findings. A transoesophageal echocardiogram showed a perimembranous VSD and echogenic material attached to the tricuspid valve. All blood samples drawn from three different sites yielded growth of pan-susceptible S. sanguinis in culture bottles. On day 12 of hospitalization, the patient complained of pleuritic chest pain without fever. Physical examination revealed reduced breathing sounds and dullness in the lower left thorax. On his chest computed tomography scan, pleural effusion with focal infarction and pulmonary embolism were noted on the left lower lung. Thoracentesis indicated the presence of a haemothorax. INTERVENTION: Our case was successfully treated using antibiotic therapy alone with adjunctive chest tube insertion, rather than with anticoagulation therapy for pulmonary embolism or cardiac surgery. CONCLUSION: When treating infective endocarditis caused by S. sanguinis, clinicians should include haemothorax in the differential diagnosis of patients complaining of sudden chest pain.

[Application of early videothoracoscopic pulmonary decortication in the treatment of an acute pleural empyema and suppurated clotted hemothorax].

There was presented the experience of performance of videothoracoscopic pulmonary decortications in 22 patients, suffering suppurated clotted hemothorax, and in 188--an acute pleural empyema. In 97.3% patients the cessation of purulent process and pulmonary volume restoration were achieved. Residual cavities with the pulmonary nonairtightness signs were revealed in 3 (1.4%) patients, the empyema recurrence--in 1 (0.5%), suppuration of the wound, made by thoracic port--in 1 (0.5%), all the patients are alive.

Open thoracic window: a useful alternative for retained infected pleural collections in critically ill trauma patients.

Historically, tube thoracostomy, image-guided drainage, or an open thoracotomy has been indicated as the standard procedure for the management of patients with retained infected pleural collections (RIPC). These infections can be a debilitating and potentially lethal complication in already critically ill trauma patients. The purpose of this review was to evaluate the usefulness of an open thoracic window (OTW) as definitive therapy for the management of RIPC refractory to conventional therapies. The medical records of patients who underwent an OTW for RIPC were reviewed for the following: demographic data, primary diagnosis, clinical findings that explained the failure of the conventional management, bacteriology of the retained collection, and final outcome. Over a 3-year period, eight critically ill trauma patients who had sustained multiple system trauma and developed a RIPC were identified (six males and two females; average age, 47 years). Of the eight patients identified, six collections were in the right and two in the left pleural cavity. Staphylococcus aureus and Acinetobacter were the two most common bacterial isolates from these collections. All patients had undergone multiple and unsuccessful drainage attempts by thoracostomy tubes. Additionally, two of the patients also underwent image-guided drainage procedures, which proved to be unsuccessful. After creation of the OTW, all patients had complete resolution of the RIPC, and all were discharged alive from the hospital. During outpatient follow up, the OTW was found to have completely healed and required no further surgical intervention. The creation of long-term pleural drainage, with an OTW, facilitates and expedites the resolution of persistent infected pleural collections by providing more efficient surgical drainage and mechanical débridement. Our experience also shows this uncommon operation to be an effective alternative when conventional measures have failed.

Experimental aerobic-anaerobic thoracic empyema in the guinea pig.

The clinical and pathological features of experimental aerobic-anaerobic thoracic empyema in the Duncan-Harley guinea pig are described. Thoracic empyema development and early death (less than 14 days after bacterial inoculation) were noted after various concentrations and species were inoculated into the pleural space with a piece of umbilical tape, which was used as a cofactor. The effect of concomitant hemothorax was also tested. Gram-negative infection was found to have a more virulent course than Gram-positive infection in the thoracic cavity. Moreover, these findings support the thesis that intrathoracic inoculation of anaerobic bacteria, even in combination with other anaerobic species, fails to produce clinical empyemas. However, anaerobic bacteria appear to enhance synergistically the virulence of sublethal and subempyema-forming concentrations of aerobic bacteria such as Staphylococcus aureus and Escherichia coli.