Cases reported "Pleural Effusion"

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1/11. Post cardiac injury syndrome--one more cause of false positive IgG, IgM antibodies in pleural fluid against antigen-60 of mycobacterium tuberculosis.

    Post cardiac injury syndrome (PCIS) is known to occur following myocardial infarction, cardiac surgery, blunt chest trauma, percutaneous left ventricular puncture and pace-maker implantation. The diagnosis is one of exclusion. We report a case of PCIS following cardiac surgery who showed false positive IgG, IgM antibodies to antigen A60 of mycobacterium tuberculosis in pleural fluid.
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2/11. The use of recombinant factor viia (NovoSeven) in a patient with a factor xi deficiency and a circulating anticoagulant.

    A 75-year-old female known to have a chronic myelomonocytic leukaemia and an acquired FXI deficiency (FXI level, 5%) related to a FXI inhibitor (38 Bethesda units) was admitted to the hospital for acute pneumonia associated with a bulky pleural effusion. A therapeutic puncture was found to be essential for the patient. But, such a procedure is a haemostatic challenge which requires adequate preparation. A first treatment composed of intravenous immunoglobulins and immunosuppressive therapy failed to eradicate the inhibitor and to restore a normal FXI level. In this context, steroids or FXI concentrates were not recommended. Thus, small doses of recombinant activated factor VII were used to achieve haemostasis. The procedure was successful, the tolerance was good and no adverse events occurred.
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3/11. The diagnosis of pleural effusion by ultrasonic and radiologic techniques.

    The value of the A-mode ultrasonic technique and the radiologic method in the diagnosis of pleural effusion was assessed in 116 patients with diseases of the pleura. Ultrasonic and radiologic examinations, as well as needle punctures, were performed, and the results were compared statistically. The pleural fluid was detected by ultrasound in 93 percent (74) and by radiologic examination in 83 percent (66) of the 80 cases with such fluid. The absence of fluid was established by ultrasound in 89 percent (32/36) and by radiologic examination in 61 percent (22/36). For the first time the superiority of the ultrasonic method over the radiologic one was demonstrated, and the difference was most obvious in cases of small pleural effusion. Ultrasound permitted the detection of very small amounts (even 3 to 5 ml) of loculated pleural fluid. In contrast to the radiologic method, ultrasound permitted easy differentiation between loculated pleural fluid and pleural thickenings. The ultrasonic method appeared especially useful in the accurate localization and precise indicating of the site for needle aspiration of even the smallest fluid collections. It made possible thoracocentesis in 94 percent (154) of 163 instances. The practical value of the ultrasonic method, both in establishing diagnosis and in treatment, is emphasized.
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4/11. Accidental small-bowel puncture, and importance of patient positioning, during isotopic peritoneography: a case report.

    A 47-y-old woman with chronic liver disease, who had previously undergone placement of a peritoneal venous shunt without ascites, presented with a chronic right pleural effusion. The first attempt at radionuclide injection resulted in an accidental small-bowel injection with consequent intraalimentarily induced nuclear small-bowel followthrough. I have not read of this interesting complication in the literature. She did not have a bowel obstruction. A repeated study 2 d later demonstrated an obstructed peritoneal shunt and right hemidiaphragmatic pleural leak best seen with the patient upright.
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5/11. Giant Morgagnian hernia masquerading as pleural effusion.

    Morgagnian hernia is a congenital diaphragmatic hernia which occurs through anteromedial defect in the diaphragm. A 58-year-old lady was referred for surgical management of chronic massive pleural effusion. High-resolution CT scan of the chest demonstrated an anteromedial defect in the diaphragm and with contents being colon and great omentum. She required anterolateral thoracotomy and reduction of hernia with repair of formen of Morgagni with prolene mesh. Blind needle aspiration would have punctured the colon; hence the case is being reported to highlight the necessity of CT scan/ultrasound of chest in investigating a chronic massive pleural effusion much before a needle is put for aspiration blindly.
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6/11. intracranial hypotension and recurrent pleural effusion after snow-boarding injury: a manifestation of cerebrospinal fluid-pleural fistula.

    BACKGROUND DATA: intracranial hypotension causing postural headaches has been described after occult and postsurgical cerebrospinal fluid (CSF) leaks and rarely isolated lumbar punctures. The occurrence of a CSF-pleural communication is much rarer, and a high level of suspicion aids in prompt recognition. PURPOSE: Early detection and anatomic delineation of the site of CSF-pleural fistula allows prompt intervention, results in resolution of symptoms and prevents the complication of meningitis. STUDY DESIGN: A case of intracranial hypotension with postural headaches is described after spinal surgery, with demonstration on computed tomography (CT) myelography of a rare CSF-pleural fistula. methods: The clinical presentation, postoperative intervention and imaging as well as laboratory data are presented. RESULTS: Chest X-ray showed recurrent pleural effusion after placement of chest tube, and serial head CT studies revealed decreasing ventricular size with development of severe headaches. Myelogram and CT postmyelogram demonstrate the CSF-pleural communication, allowing appropriate surgical repair. CONCLUSION: Severe headaches with a recurrent pleural effusion after thoracic spinal surgery may indicate presence of a CSF-pleural fistula, an unusual complication of thoracic spinal surgery.
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7/11. Intercostal arteriovenous fistula due to pleural biopsy.

    A 32 year old woman had a pleural biopsy for a left pleural effusion, which showed caseating granuloma typical of tuberculosis. When the fourth biopsy specimen was removed considerable bleeding occurred from the puncture site. Four days later a bruit was audible over the punctured area, radiating to the back. Eight days after the procedure the patient had a massive bleed into the left pleural space. Selective aortic angiography showed an arteriovenous fistula between the 9th intercostal artery and vein and a pseudoaneurysm in the intercostal punctured area. thoracotomy showed bleeding from the site of the pleural biopsy. The intercostal vessels were ligated and pleural decortication was performed, and the patient recovered uneventfully.
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8/11. Pleuritis by radiation: reports of two cases.

    Two cases of pleuritis by radiation, diagnosed by cytology studies of the pleural fluid, are reported. The clinical picture was that of a respiratory infection, with nonproductive cough and pleuritic chest pain. Chest x-ray studies showed a small pleural effusion that was confirmed by a thorax puncture. The aspirated fluid was hemorrhagic, and Papanicolaou studies were negative for tumor cells. However, multiple reactive mesothelial cells with vacuole formation within the cytoplasm and nuclei were seen. The differential diagnosis of pleuritis by radiation should include infectious pleuritis as well as pleural metastasis. A history of previous radiation and the typical findings in cytologic studies are important to confirm the diagnosis.
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9/11. Invasive disease due to nontypable haemophilus influenzae in children.

    Its virulence factors, immune responses, and sites of isolation characterize nontypable haemophilus influenzae as a pathogen of mucosal surfaces which rarely causes invasive disease. We isolated nontypable H influenzae in pure culture from thoracentesis fluid in a child with pneumonia. An extensive review of the literature in which serotyping of H influenzae was reported revealed that nontypable strains have accounted for only six other cases of pneumonia diagnosed by blood culture, lung puncture, or thoracentesis fluid. The only isolate reported to cause disease outside the neonatal age group may have been a typable strain. Because this organism rarely causes invasive disease, its isolation from sputum is of questionable significance and other causes should be sought.
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10/11. Markedly elevated cytokines in pleural effusion during the ovarian hyperstimulation syndrome: transudate or ascites?

    OBJECTIVE: To study levels of proinflammatory cytokines in pleural fluid during the severe ovarian hyperstimulation syndrome (OHSS). DESIGN: Case report. SETTING: Tertiary academic medical center. PATIENT(S): A 35-year-old female with a 6-year history of unexplained infertility on menotropin therapy and 28 healthy normal controls. INTERVENTION(S): Thoracentesis for severe pleural effusion and venipunctures. MAIN OUTCOME MEASURE(S): interleukin-1 beta (IL-beta), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-alpha) levels were measured by ELISA and compared between pleural effusion and serum from normal controls. RESULT(S): pleural effusion IL-1 beta and IL-6 levels were higher than serum. interleukin-6 levels were elevated particularly in pleural effusion (1,961.89 pg/mL) compared with serum (3.9 /- 0.41 pg/mL). CONCLUSION(S): Our results confirm the high cytokine levels observed in OHSS. cytokines have been implicated in capillary permeability, extravasation of fluid, oliguria, and shock. We have postulated that these mediators are released from the corpora lutea into the peritoneum and systemic circulation. Alternatively, the presence of high cytokine levels in pleural fluid maybe the result of diaphragmatic defects, which allow for the migration of ascites into the pleural space.
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