Cases reported "Pneumonia"

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1/21. 3: Community-acquired pneumonia.

    Community-acquired pneumonia is caused by a range of organisms, most commonly streptococcus pneumoniae, mycoplasma pneumoniae, chlamydia pneumoniae and respiratory viruses. Chest x-ray is required for diagnosis. A risk score based on patient age, coexisting illness, physical signs and results of investigations can aid management decisions. patients at low risk can usually be managed with oral antibiotics at home, while those at higher risk should be further assessed, and may need admission to hospital and intravenous therapy. For S. pneumoniae infection, amoxycillin is the recommended oral drug, while benzylpenicillin is recommended for intravenous use; all patients should also receive a tetracycline (eg, doxycycline) or macrolide (eg, roxithromycin) as part of initial therapy. Flucloxacillin or dicloxacillin should be added if staphylococcal pneumonia is suspected, and gentamicin or other specific therapy if gram-negative pneumonia is suspected; a third-generation cephalosporin plus intravenous erythromycin is recommended as initial therapy for severe cases. Infections that require special therapy should be considered (eg, tuberculosis, melioidosis, legionella, acinetobacter baumanii and pneumocystis carinii infection).
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2/21. Fire breathing pneumonia.

    Rounded lesions on chest x-ray can often be difficult both to diagnose and to treat. We report a case of a right middle lobe lesion in a young, previously healthy patient who presented with pleurtic chest pain and haemoptysis. His symptoms and chest x-ray appearance were caused by exposure to paraffin oil (kerosene), a substance commonly used for medical as well as domestic purposes.
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3/21. An extremely basic monoclonal IgG in an aged apoplectic patient with prolonged bacterial infection.

    A case with prolonged bacterial infection accompanied by an abnormal serum protein which migrated in the post-gamma region on electrophoresis is presented. The abnormal protein was identified as IgG with gamma-type light chain moiety. The patient suffered from prolonged pneumonia and cholecystitis, bone marrow aspiration and skeletal x-rays did not indicate multiple myeloma.
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4/21. Right-sided diaphragmatic hernia following group B streptococcal pneumonia and sepsis.

    A case of right-sided diaphragmatic hernia following group B streptococcal pneumonia and sepsis is reported herein. The clinical course was characteristic. The position of the right hemidiaphragm was initially normal. After an antecedent group B streptococcal infection, an abnormal shadow indicating either pneumonia or a pleural effusion on the chest x-ray was recognized and an elevation of the bowel and liver into the right hemithorax gradually appeared. Repair of the hernia was indicated and the postoperative result was excellent. The relationship between a delayed-onset diaphragmatic hernia and a group B streptococcal infection is still unknown. Increased intrathoracic pressure caused by mechanical ventilation coupled with an abnormal lung compliance due to inflammation may have resulted in the delayed herniation. Among various methods for diagnosis applied, chest x-ray and ultrasonography were noninvasive and useful.
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5/21. Polymer fume fever-like syndrome due to hairspray inhalation.

    inhalation of fluoropolymer pyrolysis products causes a self-limited illness termed polymer fume fever; symptoms include fever, chills, myalgias and non-productive cough, and are easily mistaken for an acute viral illness. We report a 29-y-old male who developed fever and pneumonitis shortly after the inhalation of pyrolyzed hairspray. Chest x-rays showed pictures consistent with pneumonitis. The patient was treated solely with supplemental oxgen, and his symptoms resolved over 24 h. inhalation of pyrolyzed hairspray may cause a syndrome resembling polymer fume fever.
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6/21. Bronchoscopic diagnosis of ruptured pulmonary hydatid cyst presenting as nonresolving pneumonia: report of two patients.

    The diagnosis and management of pulmonary hydatid disease represents an important clinical problem in areas of the world endemic to echinococcal infection. We report two patients, ages 14 and 34, respectively, who were admitted to our clinic for investigation of nonresolving pneumonia. Neither had responded to antibiotics prior to admission. Chest x-rays demonstrated lobar collapse and consolidation in both patients. Fiberoptic bronchoscopy revealed laminated membrane of hydatid cyst occluding the bronchus of apicoposterior and anterior segmental bronchi of the left upper lobe in the first patient and the anterior segment of the right upper lobe in the second patient. The diagnoses were confirmed at the time of surgery.
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7/21. Pneumonitis and pneumatoceles following accidental hydrocarbon aspiration in children.

    Accidental ingestion and aspiration of hydrocarbons in children are common. Among the various clinical and pathological manifestations of hydrocarbon (HC) poisoning, pneumonitis is the most significant and occurs in up to 40% of children, whereas formation of pneumatoceles is believed to be a rare event. We report two children with HC pneumonitis and pneumatoceles as a reversible complication after ingestion and aspiration of lamp oil with very low viscosity. Patient 1, a 21-month-old boy, started to cough and developed tachypnea, sternal retractions and mild cyanosis immediately after aspiration. Patient 2, a 24-month-old girl, was asymptomatic during the first days after the accident; subsequently, she started to cough and developed fever, dyspnea and chest pain. Chest x-ray and computed tomography revealed multiple patchy infiltrates in both cases; after several days, these confluent infiltrates developed into pneumatoceles. Both children were treated with antibiotics and steroids. They recovered within three and four weeks, respectively, with complete remission of the radiologic abnormalities and had an uneventful follow-up after discharge.
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8/21. Bronchocutaneous fistula after chest-tube placement: A rare complication of tube thoracostomy.

    Bronchocutaneous fistula is a pathologic communication between the bronchus, pleural space, and subcutaneous tissue. It can occur as a complication of positive pressure ventilation and pneumonectomy. diagnosis is made by imaging studies. Treatment options are endoscopic repair, parietal pleurectomy, and pleurodesis. Our patient is a 53-year-old woman who had a difficult chest-tube placement for complicated parapneumonic effusion. Computed tomography scan revealed a fistulous tract from the bronchus to the skin at the site of the original chest tube, and chest x-ray film revealed a subcutaneous fistulous air tract in the lateral chest. It is usually an acquired condition; congenital bronchocutaneous fistula is rare. We report a case of bronchocutaneous fistula after chest-tube placement.
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9/21. Congenital paraesophageal hiatal hernia: pitfalls in the diagnosis and treatment.

    PURPOSE: The aim of this study was to analyze pitfalls in the diagnosis and treatment of congenital paraesophageal hiatal hernia (PEHH). methods: Between 1992 and 2004, the records of 5 infants with PEHH were retrospectively reviewed for age, sex, presenting symptoms, radiological studies, operative findings and approaches, and outcomes. RESULTS: All cases (3 male, 2 female) had right-sided hernias. They had clinical features of recurrent chest infections and intermittent vomiting that were present since birth in 3. Three presented acutely ill with findings of respiratory distress and vomiting. Three were referred with misdiagnoses of reflux disease, thoracic mass, and bronchopneumonia. On the chest x-rays of 3 cases, there were paracardiac opacities suggesting a mass lesion. According to the upper gastrointestinal series and/or computed tomography findings, 4 cases had a combination of sliding and paraesophageal hernia, and the remainder one had pure rolling hiatus hernia. Three had obstruction owing to organoaxial volvulus and required an emergency operation. All cases had a large hernia orifice. Four had gastroesophageal junction (GEJ) displaced into the thorax, and in 3, the stomach was found to be twisted, and transverse colon with omentum was also in the thorax in 2. In the remainder, the GEJ was in its normal position with herniated stomach. None of the cases had normal gastrosplenic and gastrocolic ligaments. Surgical repair included resection of the sac, closure of the hiatal defect, and Thal procedure. Two had intestinal malrotation, with right ovarian torsion and ventricular septal defect, respectively. Postoperative ventilation was required in one who later died. At a mean follow-up of 2 years, the other 4 had no symptoms related to the disease, and no evidence of recurrence or reflux was noted on control upper gastrointestinal series. CONCLUSION: Congenital PEHH may be difficult to diagnose. It is frequently complicated and associated with morbidity and even mortality. If the defect is large and associated with displacement of GEJ into the thorax, adding an antireflux procedure to the repair is appropriate.
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10/21. Non-resolving pneumonia in a young boy--beware of foreign body aspiration.

    A 4 1/2-year-old boy presented with recurrent cough and cold of 2 years duration. Chest x-ray revealed collapse consolidation of right lower lobe. Rigid bronchoscopy was done and the nozzle of a pen was extracted from right main bronchus. The radiological improvement took three months after extraction of the foreign body. Undetected foreign body aspiration is one of the causes of nonresolving pneumonia in children.
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