1/5. A new combined surgical procedure for severe descending necrotizing mediastinitis with bilateral empyema.In this report, we will describe the treatment of a 38-year-old man with severe descending necrotizing mediastinitis (DNM) with bilateral empyema. DNM is a rare disease with a high mortality rate, and when accompanied by bilateral empyema, this is particularly serious and potentially fatal. To improve the prognosis of such patients, the establishment of an adequate surgical procedure for satisfactory debridement and drainage is essential. This is the first report on a new combined surgical procedure consisting of right standard posterolateral thoracotomy and left video-assisted thoracoscopic surgery (VATS) for severe DNM with bilateral empyema.- - - - - - - - - - ranking = 1keywords = prognosis (Clic here for more details about this article) |
2/5. Primary malignant lymphoma arising in the pleura without preceding long-standing pyothorax.We report a very rare case of primary malignant lymphoma arising in the pleura with no history of persistent pyothorax. A 72-year-old male was hospitalized with dyspnea on effort and chest CT demonstrated a mass along the right chest wall. Right thoracotomy with complete en bloc resection of the pleural tumor was performed. Immunohistochemical examination of the pleural tumor showed that the histology was marginal zone B-cell malignant lymphoma. We considered that this tumor had originated from the soft tissue in the chest wall based on radiographical and surgical findings. As diagnosis and treatment of pleural malignant lymphoma seems to have been difficult in most cases reported in the literature, it is thought that early active and accurate biopsy with large-bore needles, or, if possible, surgical incision for early diagnosis and aggressive surgery to achieve complete resection combined with radiation therapy and/or chemotherapy would be very important for a good prognosis.- - - - - - - - - - ranking = 1keywords = prognosis (Clic here for more details about this article) |
3/5. Spinal osteomyelitis presenting with a life-threatening pleural empyema.STUDY DESIGN: This case report illustrates a rare presentation of spinal osteomyelitis that initially manifested as a life-threatening pleural empyema leading to misdiagnosis. OBJECTIVES: A high index of suspicion is required to make the correct diagnosis of spinal osteomyelitis, especially with unusual presentations. Appropriate antibiotic management should be commenced immediately the diagnosis is made. SUMMARY OF BACKGROUND DATA: A review of the literature reveals five previous cases of vertebral osteomyelitis associated with pleural effusions. In three of these, the effusions were reactive and sterile. There is only one previous case of a pleural empyema related to primary spinal osteomyelitis. There also is one case report of vertebral osteomyelitis presenting as a mediastinal abscess. methods: A case is presented of a man thought to have bronchogenic carcinoma with a destructive vertebral metastasis who was sent for palliative radiation therapy. A life-threatening pleural effusion subsequently developed, and after additional investigation, he was found to have spinal osteomyelitis with a pleural empyema. RESULTS: The empyema was drained through an indwelling chest tube, and the patient was administered appropriate antibiotics. He made a complete and uneventful recovery. CONCLUSIONS: The case illustrates a rare presentation of spinal osteomyelitis. It exemplifies the dictum that if a malignant disease is suspected, every effort has to be made to establish a histologic diagnosis to prevent inappropriate management and the potentially devastating consequences of an incorrect diagnosis. It also high-lights the difficulties in diagnosis of vertebral osteomyelitis with empyema. With correct management, the prognosis is excellent.- - - - - - - - - - ranking = 1keywords = prognosis (Clic here for more details about this article) |
4/5. Gastropleural fistula due to gastric lymphoma presenting as tension pneumothorax and empyema.The formation of a gastropleural fistula is an uncommon complication of a number of conditions. The case of a patient with gastropleural fistula, as a complication of gastric lymphoma, is presented. The patient developed a tension pneumothorax and empyema. On cytological examination of the empyematous fluid, the presence of food debris aided diagnosis. The patient died 2 days after a total gastrectomy. The development of this complication in gastric lymphoma appears to have a particularly poor prognosis.- - - - - - - - - - ranking = 1keywords = prognosis (Clic here for more details about this article) |
5/5. Unusual presentation of cervicothoracic actinomycosis complicated by pericardial effusion: a case report.actinomycosis is a chronic-suppurative disease characterized by abscesses and draining sinus tracts, with fibrosis and granulation involving the face and neck and thoracic or pelvic-abdominal regions. Dermatological findings in patients at high risk are the key to the correct diagnosis. actinomycosis is frequently undiagnosed or misdiagnosed until the correct diagnosis is made after surgical resection. Alcoholic, homeless, and disadvantaged individuals and patients with other factors predisposing to infection including poor dentition, alcoholism, seizures, and trauma are common in the emergency department; thus, emergency physicians should be aware of the different presentations and complications of this disease. The treatment of choice is a high dose of penicillin in conjunction with surgical debridement. The prognosis is excellent with correct diagnosis and therapy.- - - - - - - - - - ranking = 1keywords = prognosis (Clic here for more details about this article) |