Cases reported "Pleural Effusion"

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1/83. Pancreaticopleural fistula: diagnosis with magnetic resonance pancreatography.

    Pancreaticopleural fistula secondary to chronic pancreatitis is a rare cause of recurrent pleural effusion. The demonstration of the fistula with endoscopic retrograde pancreatography and CT is invasive or limited. We report in two patients the use of magnetic resonance pancreatography as a noninvasive alternative to endoscopic retrograde pancreatography for the diagnosis of pancreaticopleural fistula.
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ranking = 1
keywords = fistula
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2/83. A case of eosinophilic pleural effusion induced by pancreatothoracic fistula.

    A 49-year-old man was admitted for evaluation of a left pleural effusion. Thoracenthesis yielded a hemorrhagic pleural effusion with a high percentage of eosinophils (15.9%). Although there were no significant abdominal signs, serological examinations demonstrated a marked increase of pancreatic enzyme activity. Moreover, abdominal CT demonstrated cystic changes between the tail of the pancreas and the spleen. Accordingly ERP was performed under pressure, and contrast medium draining from the pancreas was observed. Pancreatic pleural effusion in this patient consisted of pancreatic juice retained in the thoracic cavity, which resulted from intrapancreatic fistulation connecting to the thoracic cavity due to a pancreatic cyst caused by chronic pancreatitis. The present report indicates that we should investigate the retention of eosinophilic pleural effusion considering not only the possibility of thoracic disease, but also the possibility of a pleural effusion derived from abdominal diseases.
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ranking = 13.538845495359
keywords = pancreatic fistula, fistula
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3/83. Granulomatous pneumonitis. A result of intrapleural instillation of quinacrine and talcum powder.

    A 73-year-old man with bilateral recurrent pleural effusions had relief of symptoms with intrapleural instillation of quinacrine hydrochloride and talcum powder. At postmortem, examination of the lungs showed granulomatous consolidation of a portion of the lower lobe of the left lung. The granulomatous reaction was in response to large numbers of talc and quinacrine crystals within the pulmonary parenchyma. A review of the literature disclosed no reports of pulmonary damage following the intrapleural administration of these two agents. This unusual complication of therapy may have resulted from the aspiration of crystals through a small, undetected bronchopleural fistula.
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ranking = 0.14285714285714
keywords = fistula
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4/83. Marked effect of octreotide acetate in a case of pancreatic pleural effusion.

    A pancreaticopleural effusion is a rare complication of chronic pancreatitis. fasting, a protease inhibitor, and/or a surgical intervention are generally selected for the treatment of the pancreatic effusion. We reported here the case, in which octreotide acetate was effective for resolving pancreatic effusion. A 67-year-old man was admitted with a massive pleural effusion. This effusion contained a high level of amylase. Endoscopic retrograde pancreatography followed by computed tomography revealed a pancreaticopleural fistula. The pleural effusion was not improved by the treatment of the protease inhibitor with total parenteral nutrition and fasting. A pancreatic stent could not be emplaced because the major pancreatic duct was coiled. Administration of octreotide acetate, a long-acting somatostatin analogue, markedly diminished the effusion and closed the pancreaticopleural fistula. Transient eosinophilia of peripheral blood was seen on admission, but the number of eosinophils decreased after the octreotide therapy and normalised when pleural effusion disappeared. octreotide is one of the effective options for the treatment of pancreatic pleural effusion.
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ranking = 0.28571428571429
keywords = fistula
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5/83. subcutaneous emphysema associated with chest tube drainage.

    BACKGROUND: subcutaneous emphysema may complicate a pneumothorax, but may also occur as a consequence of its treatment by chest tube drainage. The aim of this study was to evaluate the factors involved in the association between subcutaneous emphysema and chest tube drainage, and the clinical outcomes in these cases. METHODOLOGY: One hundred and sixty-seven patients undergoing chest tube drainage within a 12-month period were evaluated retrospectively. There were 30 reported cases of subcutaneous emphysema (SE). Comparisons were made between those with subcutaneous emphysema and those who did not develop this complication. RESULTS: A total of 134 patient notes were evaluated (25 SE and 109 non-SE). subcutaneous emphysema was more commonly associated with trauma, bronchopleural fistulae, large and bilateral pneumothoraces, and mechanical ventilation. subcutaneous emphysema was also associated with prolonged drainage, poor tube placement, tube blockage, side-port migration, and a greater number of chest tubes. Importantly, those with SE had a longer length of stay and increased mortality. CONCLUSION: subcutaneous emphysema can be spontaneous or traumatic, but is associated with avoidable causes such as inadequate chest tube drainage, particularly due to poor tube placement, anchorage and blockage, and also with side-port migration into the subcutaneous tissue. It is associated with an increased morbidity and mortality, and may indicate the need for urgent chest tube replacement.
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ranking = 0.14285714285714
keywords = fistula
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6/83. Allergic bronchopulmonary aspergillosis: a rare cause of pleural effusion.

    aspergillus fumigatus is one of the most ubiquitous of the airborne saprophytic fungi. Allergic bronchopulmonary aspergillosis (ABPA) is a syndrome seen in patients with asthma and cystic fibrosis, and is characterized by hypersensitivity to chronic colonization of the airways with A. fumigatus. We report the case of a patient with ABPA presenting with pleural effusion. A 27-year-old male was referred with recurrent right pleural effusion. Past medical history was remarkable for asthma, allergic sinusitis, and recurrent pleurisy. Investigations revealed peripheral eosinophilia with elevated serum immunoglobulin e and bilateral pleural effusions with bilateral upper lobe proximal bronchiectasis. Precipitating serum antibodies to A. fumigatus were positive and the A. fumigatus immediate skin test yielded a positive reaction. A diagnosis of ABPA associated with bilateral pleural effusions was made and the patient was commenced on prednisolone. At review, the patient's symptoms had considerably improved and his pleural effusions had resolved. ABPA may present with diverse atypical syndromes, including paratracheal and hilar adenopathy, obstructive lung collapse, pneumothorax and bronchopleural fistula, and allergic sinusitis. Allergic bronchopulmonary aspergillosis is a rare cause of pleural effusion and must be considered in the differential diagnosis of patients presenting with a pleural effusion, in particular those with a history of asthma.
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ranking = 0.14285714285714
keywords = fistula
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7/83. Massive pleural effusion as the presenting feature of a subarachnoid-pleural fistula.

    A 14-year-old boy presented with a large symptomatic transudative pleural effusion 4 months after spinal surgery for kyphoscoliosis. Computed tomography myelography confirmed a subarachnoid-pleural fistula (SPF) with a pseudo-meningocele communicating with the left pleural space. A review of the literature indicates this to be a rare finding. The possibility of SPF should be entertained in patients who present with a pleural effusion following transthoracic spinal surgeries.
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ranking = 0.71428571428571
keywords = fistula
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8/83. Sonographic demonstration of a pancreatopleural fistula.

    Pancreatopleural fistula is an uncommon complication of pancreatitis. The presence of a fistulous tract, although not mandatory for diagnosis of pancreatopleural fistula, has been documented previously with contrast-enhanced radiography and endoscopic retrograde cholangiopancreatography. We report the case of a pancreatopleural fistula with right pleural effusion demonstrated sonographically in a 13-year-old girl with a history of chronic pancreatitis and upper abdominal pain. Sonography also showed a pseudocyst of the pancreas with pleural effusion. The patient was treated conservatively with nutritional support and intercostal drainage of the pleural fluid. Her symptoms resolved and the pleural effusion gradually disappeared. Sonography is useful in confirming the presence of a suggested pancreatopleural fistula and can avoid the need for other, more technically challenging imaging modalities.
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ranking = 1.1428571428571
keywords = fistula
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9/83. Urinothorax: a rare pleural effusion.

    A 68-year old man suffered severe respiratory distress, secondary to massive pleural effusion on the right side several hours after removing the nephrostomy tube from both right and left kidneys. A chest tube was placed and a yellowish fluid was evacuated. This was found to be urine from a fistula between the right pelvis and the chest cavity. diagnosis and management of urinothorax are discussed.
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ranking = 0.14285714285714
keywords = fistula
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10/83. Two cases of thoracopancreatic fistula in alcoholic pancreatitis: clinical and CT findings.

    We report two patients who were long-time habitual consumers of alcohol and suffered from thoracopancreatic fistula. The first patient, a 52-year-old man with no symptoms, underwent chest CT scan for a medical check-up and was revealed to have left small pleural effusion. A month later, he suddenly experienced severe cough and back pain. The immediate CT scan showed massive pleural effusion and mediastinal pseudocyst, and the amylase level in the aspirated pleural effusion proved to be elevated. He was successfully treated with medication and drainage of the effusion. The second patient, a 39-year-old woman, underwent CT scan for a medical check-up, and it disclosed that she had a small pleural effusion in the left lower thorax. Follow-up CT two months later revealed the pleural effusion to be resolved, however, it demonstrated that a narrow tract derived from the pancreatic secretion located just posterior to the pancreatic tail extended to the mediastinum along the left hemidiaphragmatic crus. She experienced severe cough and sputum four months later. CT scan showed massive pleural effusion in the left thorax and revealed that the pancreaticopleural fistula was located in the same position as the small tract that had been detected by the previous CT scan. The patient received conservative treatment and eventually recovered from the severe chest complications. We consider that asymptomatic left small pleural effusion in these patients who were habitual drinkers is a potential precursor to symptomatic pancreatitis. The patients developed mediastinal pseudocyst and pancreaticopleural fistula in association with chronic pancreatitis within a few months, and therefore intensive follow-up should be undertaken to minimize or prevent chest complications in association with the subsequent symptomatic pancreatitis.
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ranking = 65.122798905366
keywords = pancreatic fistula, fistula
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