Cases reported "Mediastinal Diseases"

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1/30. Spontaneous oesophageal perforation due to mediastinal tuberculous lymphadenitis - atypical presentation of tuberculosis.

    Spontaneous non-traumatic oesophageal perforation secondary to bursting of a mediastinal tuberculous abscess into the oesophagus is rare. The diagnosis is delayed, as perforation remains localised due to mediastinal lymph nodes. Patient can be effectively managed by paraoesophageal drainage of the mediastinal abscess and oesophageal diversion.
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ranking = 1
keywords = esophagus
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2/30. Esophageal laceration and charcoal mediastinum complicating gastric lavage.

    A 19-year-old woman underwent multiple attempts at orogastric lavage before success 5 h after ingesting approximately 24 grams of ibuprofen in a suicide attempt. Activated charcoal was administered via the lavage tube. She vomited charcoal shortly after administration and began experiencing difficulty breathing and an increase in the pitch of her voice. A chest X-ray study showed a widened mediastinum, pneumopericardium, and subcutaneous emphysema consistent with esophageal perforation that was confirmed by computed tomography scan. Surgical exploration revealed a tear in the proximal posterior esophagus with charcoal in the posterior mediastinum. She remained intubated for 7 days and was discharged 14 days after admission. This is a report of esophageal perforation with activated charcoal contamination of the mediastinum after gastric lavage. The risks and benefits of this procedure should be carefully considered in each patient prior to its use. Awake patients should be cooperative with the procedure to minimize any risk of trauma to the oropharynx or esophagus.
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ranking = 2
keywords = esophagus
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3/30. sarcoidosis and giant midesophageal diverticulum.

    traction diverticula of the midesophagus result from granulomatous inflammation of mediastinal lymph nodes. tuberculosis and histoplasmosis are known etiologies of this condition. To the best of our knowledge, this is the first report of a traction diverticulum caused by sarcoidosis.
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ranking = 1
keywords = esophagus
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4/30. Invasive inflammatory pseudo-tumor involving the lung and the mediastinum.

    Inflammatory pseudotumor is a rare clinical entity. We report here the case of a 14-year-old boy who underwent lung resection en bloc with the lower esophagus, the mediastinal pleura and the diaphragm for an inflammatory pseudotumor of the left lower lobe. Postoperative radiotherapy was administered. The patient is well at 9-year follow-up. Inflammatory pseudotumor may present a particularly aggressive behavior. Multimodality approach, including extensive surgical resection, may be necessary in dealing with this disease.
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ranking = 1
keywords = esophagus
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5/30. Extraluminal migration of a coin in the oesophagus of a child misdiagnosed as asthma.

    Ingestion of a foreign body, the commonest being a coin, is a common problem in children. In most cases the coin will pass uneventfully through the gastrointestinal tract. However, on rare occasions it may become lodged in the oesophagus with subsequent extraluminal migration with the potential for serious complications such as vascular fistula or chronic suppurative infection. A case is presented of extraluminal migration of a coin in the oesophageal associated with abscess formation in a 15 month old boy. This case is particularly important because the presenting symptom of wheezing led to the erroneous diagnosis of asthma, which resulted in a three month delay in investigation and treatment. In addition, it raises the issue of whether to perform chest radiography on newly diagnosed asthmatic patients to rule out the presence of a foreign body and thereby prevent serious complications.
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ranking = 5
keywords = esophagus
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6/30. Conservative management of a case of cervical esophagus perforation with mediastinal abscess and bilateral pleural effusion.

    Perforation of the cervical esophagus is a serious circumstance. mediastinitis secondary to esophageal perforations is associated with high mortality. There is a lack of consensus on the optimal treatment for this condition. We present a case of conservative treatment in an 82-year-old woman with cervical esophagus rupture associated with mediastinal abscess and bilateral pleural effusion resulting from dilatation of a malignant esophageal stricture. Conservative treatment consisted on broad-spectrum intravenous antibiotic therapy, antireflux measures and gastrostomy was satisfactory. Treatment of the esophageal perforation should be individualized to the circumstances of each patient. Advances in antibiotic and nutritional therapy, early institution of treatment and observance of the indications, made possible a more frequent use of a conservative therapeutic approach.
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ranking = 6
keywords = esophagus
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7/30. Pyopneumopericardium caused by mediastinal granuloma.

    We report the case of a previously healthy 32-year-old man who was seen with flulike symptoms, dyspnea, and chest pain. The diagnosis was pyopneumopericardium, and pericardial tap revealed 1.3 L of purulent material. Computed tomography of the chest demonstrated a calcified mass inferior to the carina. Urgent exploration through a right thoracotomy revealed that the mass was adherent to the esophagus and pericardium. The subcarinal mass was resected. Pathological study demonstrated granulomatous lymph nodes, which were likely due to histoplasmosis. This is among the first reports of granulomatous erosion into the pericardium causing pyopneumopericardium. The patient made a good recovery, and his case demonstrates the importance of early imaging and mediastinal exploration for pyopneumopericardium.
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ranking = 1
keywords = esophagus
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8/30. A large mediastinal tumor with spontaneous regression 30 years after esophageal bypass surgery.

    We describe the case of an 80-year-old man admitted to the hospital for the first time with chest pain and progressive respiratory difficulty. Radiographic findings of the chest showed a large, cystic mediastinal mass from the jugulum to the diaphragm. The patient's history revealed bypass operation for a benign esophageal stricture 30 years ago. During the hospital stay, clinical symptoms resolved within 48 hours without specific treatment. Seven days after admission a chest roentgenogram showed almost complete regression of the tumor, which was supposed to be a mucocele of the colon bypassing the esophagus.
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ranking = 1
keywords = esophagus
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9/30. Mediastinal mass with Dysphagia in an elderly patient.

    We report the use of endoscopic techniques for successful diagnosis in a case of atypical esophageal tuberculosis. tuberculosis of the esophagus is an unusual presentation of this disease, having been estimated to occur in 0.15% of the people who die of tuberculosis. A few cases of possible primary tuberculous esophagitis have been described. This report describes a patient with dysphagia who appeared to have esophageal tuberculosis without hiv and in the absence of other signs of tuberculosis. The patient responded promptly to treatment with tuberculostatics.
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ranking = 1
keywords = esophagus
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10/30. An unusual presentation of oesophageal tuberculosis.

    Oesophageal tuberculosis secondary to tuberculous mediastinal lymphadenopathy is a very unusual presentation of adult tuberculosis. We report a young patient who presented with anorexia and weight loss. The chest radiograph and CT scan revealed mediastinal lymphadenopathy causing extrinsic oesophageal compression on the barium swallow. This was confirmed by upper gastrointestinal endoscopy. Four weeks later, because of spontaneous partial relief in dysphagia, upper gastrointestinal endoscopy was repeated and revealed an ulcerated lesion with nodular margins at the mid-oesophagus. biopsy from the ulcer margin revealed non-caseating granulomas. The patient had complete relief of dysphagia and other symptoms within 3 weeks of start of antituberculosis therapy.
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ranking = 1
keywords = esophagus
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