Cases reported "Empyema"

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1/36. Intrapericardial benign teratoma with unusual presentation.

    Benign teratoma, also referred as dermoid cyst, do occur in the mediastinum. However, their intrapericardial location has been reported very occasionally. This case of intrapericardial benign solid teratoma is being presented because of its rarity and its unusual presentation as a case of empyema, with features of cardiac compression and pericardial effusion.
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keywords = effusion
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2/36. Intrapleural streptokinase in a two-year-old child with a parapneumonic effusion.

    A two-year-old child was hospitalised with features of parapneumonic effusion. He was initially managed with parenteral antibiotics and chest tube drainage. After three days drainage became insignificant inspite of chest tube being patent and appropriately positioned. CT scan of chest showed multiloculated effusion. In view of multiloculated effusion it was decided to try intrapleural fibrinolysis with streptokinase. streptokinase in a dose of 1,25000 IU dissolved in 50 ml of normal saline was instilled through the chest tube daily. After instilling three doses, there was a significant increase in the drainage followed by almost complete radiological resolution. There were no side effects. Intrapleural streptokinase is a useful adjunctive threapeutic modality in the management of complicated parapneumonic effusion or empyema in paediatric patients.
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ranking = 8
keywords = effusion
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3/36. The problem of empyematous pleural effusion in rheumatoid arthritis: report of two cases and review of the literature.

    Two patients with rheumatoid arthritis and empyematous pleural effusion were treated with repeated drainage and intrapleural corticosteroids. One patient with active joint disease improved within 3 months without sequelae, probably because of the systemic therapy. The other patient, with non-active joint disease, had persistent pleural effusion which resulted in pleural thickening and symptomatic restrictive disturbance. It appears that early intervention intended to prevent the accumulation of empyematous pleural effusion could also prevent pleural thickening and fibrosis. Therapeutic options are discussed.
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ranking = 7
keywords = effusion
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4/36. Community-acquired pseudomonas aeruginosa pneumonia complicated with loculated empyema in an infant with selective iga deficiency.

    pseudomonas aeruginosa is widely prevalent in the hospital environment, especially in intensive care units. Selective iga deficiency is characterized by a serum IgA level less than 5 mg/dl with no deficiency of other immunoglobulins. The occurrence of community-acquired P. aeruginosa pneumonia with empyema is rare in pediatric patients. We present a 10-month-old male infant who was referred due to persistent fever and progressive respiratory distress for 1 week. A chest radiograph revealed a right lobar pneumonia with pleural effusion. P. aeruginosa that was subsequently isolated from both blood and pleural effusion cultures. The patient received treatment with ceftazidime and intrapleural instillation of urokinase to promote drainage of empyema. Subsequent immunological screening revealed a very low serum IgA level (<5 mg/dl). We present our experience in successfully treating a loculated empyema with intrapleural instillation of urokinase in an infant. It is also important for pediatricians to be aware that they should be alert for the patient who present with respiratory infections due to unusual organisms. An advanced immunological study to investigate the underlying disorders in these patients is mandatory.
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ranking = 2
keywords = effusion
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5/36. Video-assisted thoracoscopic surgery under local anesthesia for right empyema secondary to aspiration pneumonia caused by esophageal achalasia: case report.

    A 55-year-old man was admitted to the Department of internal medicine of our hospital with chief complaints of fever, cough, and right-sided chest pain. Plain radiography of the chest revealed widening of the mediastinum (attributed to esophageal achalasia), pneumonia, and right pleural effusion. According to the properties of the pleural fluid, empyema was diagnosed. Because the empyema was resistant to antibiotic treatment and was in the fibrinopurulent stage, it could not be drained effectively. Therefore, after treatment of the esophageal achalasia by balloon dilatation of the lower esophagus, the empyema was treated by video-assisted thoracoscopic surgery, i.e., by video-assisted thoracoscopic drainage and curettage of the empyema cavity, under local anesthesia.
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keywords = effusion
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6/36. Spontaneous bilateral bacterial empyema in a patient with nephrotic syndrome.

    Spontaneous bacterial empyema (SBEM), a rare infectious complication among liver cirrhosis patients, is characterized by infection in the presence of pleural effusion without evidence of pre-existing pneumonia. The prevalence of SBEM in cirrhotic patients with hydrothorax is about 13%. However, it has previously not been reported in medical literature in patients with nephrotic syndrome. The most common microorganism identified is escherichia coli, followed by streptococcus species, enterococcus species, klebsiella pneumoniae, and pseudomonas stutzeri. We present a patient with a history of nephrotic syndrome caused by membranous nephropathy, who received steroids and cyclophosphamide. He developed bilateral SBEM due to aeromonas hydrophila and E. coli, which were isolated from the left- and right-side pleural fluid, respectively. The detailed clinical course, treatment, and outcome are described.
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ranking = 1
keywords = effusion
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7/36. Mediastinal and thoracic complications of necrotizing fasciitis of the head and neck.

    Mediastinal and thoracic extension of head and neck infections are rare but occur even in the modern antibiotic era. Early intervention is paramount to successful clinical outcome. 111Indium-labeled white blood cell (WBC) scan, a new imaging modality, appears to play a role in complementing computed tomographic (CT) findings, demonstrating early extension of disease, and following therapeutic efficacy. Together, the CT scan and WBC scan aid in directing early intervention and extent of surgery in this disease of high-potential mortality. We report 3 cases of deep head and neck infection complicated by mediastinal extension, including mediastinitis, pericardial effusion, and tamponade, empyema, and respiratory failure. Early surgical intervention included neck drainage, tracheostomy, thoracotomy, and pericardiotomy. While usually associated with greater than 50% mortality, all of the patients in this series survived. Based on our experience, we recommend prompt aggressive surgical debridement in treating mediastinal complications resulting from head and neck infections.
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ranking = 1
keywords = effusion
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8/36. Group A beta-hemolytic streptococcal type M11 sepsis and empyema: a case report.

    A case of serious suppurative disease caused by GABHS in a previously well 2-month-old Thai female presenting with clinical features of sepsis and right pleural effusion was reported. Treatment was initially with cloxacillin and a right side intercostal drainage. When subsequent cultures of blood and pleural fluid grew GABHS; intravenous penicillin was substituted. She made an uneventful recovery. Typing of the GABHS revealed non typable T-antigen and M-protein 11 GABHS, although very sensitive to penicillin, can cause severe and rapidly progressive disease in a very young infant. This is the first case of GABHS type M11 causing pleural effusion and sepsis in an infant ever reported in thailand. Epidemiologic study might be indicated if an epidemic should occur.
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ranking = 2
keywords = effusion
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9/36. empyema due to ventriculopleural shunt.

    empyema developing seven weeks after craniotomy in a 62-year-old black woman with an ipsilateral ventriculopleural (V-PL) shunt is described. infection of the pleural space presumably resulted from transfer of organisms from a proximal V-PL shunt infection to the thorax. empyema resulting from V-PL shunt infection has not previously been reported. Pleural effusions in patients with V-PL shunts must be considered as a potential site of infection with possible development of empyema.
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ranking = 1
keywords = effusion
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10/36. Use of intrapleural streptokinase in the treatment of thoracic empyema.

    The incidence of pleural effusions in bacterial pneumonia may exceed 40%, a factor that may be related to increased morbidity and mortality. Options in the treatment of complicated pleural effusions or empyema, when unresponsive to closed tube drainage, include repositioning of the indwelling tube thoracostomy or insertion of additional chest tubes, instillation of intrapleural streptokinase, and surgical intervention. The authors describe the course of three patients wherein the use of intrapleural streptokinase was efficacious in effecting prompt drainage of previously inadequately evacuated empyema, thus eliminating the necessity for further invasive intervention.
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ranking = 2
keywords = effusion
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