Pulmonary infarction, pleural effusion in [keywords]
- Spontaneous right whole-lung torsion secondary to bronchial carcinoma: a case report. [Journal Article]
- J Cardiothorac Surg 2016; 11(1):107.
Spontaneous whole lung torsion is an absolut rarity and most cases occur after previous surgery.We present the case of a spontaneous whole-lung torsion in a 82-year old man. The patient was referred to our thoracic surgery department from the emergency department of a referring hospital with rapidly progressive dyspnea. CT-scan revealed a 180° degree counterclockwise torsion of the entire right lung with complete atelectasis and congestion of the upper lobe as well as pleural effusion. Thoracoscopy confirmed lung torsion and revealed hemorrhagic infarction of the upper lobe. Subsequently thoracotomy and upper lobectomy were performed. Most likely the lung torsion occurred due to a combination of pleural effusion and venous congestion with complete atelectasis of the upper lobe as a result of adenocarcinoma of the upper lobe.To our knowledge this is the first reported case of a patient presenting with lung torsion as the first symptom of lung cancer. When lung torsion is suspected rapid diagnosis is crucial in order to prevent hemorrhagic lung infarction.
- Left ventricular pseudoaneurysm - a challenging diagnosis. [JOURNAL ARTICLE]
- Rev Port Cardiol 2016 Jun; 35(6):373.e1-373.e6.
Left ventricular pseudoaneurysm is a rare complication of acute myocardial infarction, associated with high mortality. However, it can present in a non-specific manner, complicating and delaying the diagnosis. The authors present the case of a 65-year-old patient, hypertensive, with no other known relevant medical history, who presented with chest pain, cough and left pleural effusion, initially attributed to a pulmonary process. However, these were in fact the result of a left ventricular pseudoaneurysm following silent acute myocardial infarction. The diagnosis was suspected on echocardiography and confirmed by cardiac magnetic resonance imaging, and the patient underwent successful surgical pseudoaneurysm repair. This case illustrates an atypical presentation of a left ventricular pseudoaneurysm, in which the manifestations resulted from pericardial and pleural extension of the inflammatory process associated with contained myocardial rupture. The case demonstrates the need for a high index of suspicion, and the value of imaging techniques to confirm it, in order to proceed with appropriate surgical treatment, and thus modify the course of the disease.
- A massive haemothorax as an unusual complication of infective endocarditis caused by Streptococcus sanguinis. [Journal Article]
- Acta Clin Belg 2016 Aug; 71(4):253-7.
Infective endocarditis involving the tricuspid valve is an uncommon condition, and a consequent haemothorax associated with pulmonary embolism is extremely rare. Particularly, there are no guidelines for the management of this complication. We describe a rare case of pulmonary embolism and infarction followed by a haemothorax due to infective endocarditis of the tricuspid valve caused by Streptococcus sanguinis.A 25-year-old man with a ventricular septal defect (VSD) presented with fever. On physical examination, his body temperature was 38.8 °C, and a grade III holosystolic murmur was heard. A chest X-ray did not reveal any specific findings. A transoesophageal echocardiogram showed a perimembranous VSD and echogenic material attached to the tricuspid valve. All blood samples drawn from three different sites yielded growth of pan-susceptible S. sanguinis in culture bottles. On day 12 of hospitalization, the patient complained of pleuritic chest pain without fever. Physical examination revealed reduced breathing sounds and dullness in the lower left thorax. On his chest computed tomography scan, pleural effusion with focal infarction and pulmonary embolism were noted on the left lower lung. Thoracentesis indicated the presence of a haemothorax.Our case was successfully treated using antibiotic therapy alone with adjunctive chest tube insertion, rather than with anticoagulation therapy for pulmonary embolism or cardiac surgery.When treating infective endocarditis caused by S. sanguinis, clinicians should include haemothorax in the differential diagnosis of patients complaining of sudden chest pain.
- Respiratory System Function in Patients after Aortic Valve Replacement through Right Anterior Minithoracotomy. [JOURNAL ARTICLE]
- Thorac Cardiovasc Surg 2016 Feb 23.
Objective The aim of the study was to analyze respiratory system function after minimally invasive aortic valve replacement through right anterior minithoracotomy (RAT-AVR). Methods An observational study of 187 patients electively scheduled for RAT-AVR between January 2010 and December 2013. Pulmonary complications were analyzed and spirometry examinations were performed preoperatively, 1 week, 1 month, and 3 months after surgery. Results Hospital mortality was 1.1%. A double-lumen intratracheal tube was used in 88.2% and single-lumen intratracheal tube was used in 11.8% of patients. Pulmonary complications occurred in 10.8% of the patients. Prolonged (>24 hours) mechanical ventilation time was present in five patients (2.7%). The reasons were stroke (n = 1), perioperative myocardial infarction (n = 2), and pneumothorax (n = 2). Right pleural effusion, which occurred in 7.7% (n = 14) of patients, was the most frequent respiratory system complication. One week after surgery, the spirometry parameters decreased in comparison to the preoperative period, then after 3 months statistically significant improvement occurred; however, the spirometry parameters still had not returned to preoperative values. Multivariable median regression analysis shows that the presence of chronic obstructive pulmonary disease and pulmonary complications were associated with lower values of forced expiratory volume in 1 second after surgery. There was no statistically significant difference regarding spirometry values or incidence of pulmonary complications after surgery between patients in whom single-lung or double-lung ventilation was applied. Conclusion Pulmonary functional status measured with spirometry parameters was diminished after RAT-AVR surgery. Single-lung ventilation did not result in a higher rate of respiratory complications after RAT-AVR surgery.
- The prognostic significance of serum troponin T levels in Crimean-Congo Hemorrhagic Fever patients. [JOURNAL ARTICLE]
- J Med Virol 2015 Dec 22.
Crimean-Congo Hemorrhagic Fever (CCHF) is a disease transmitted by the Crimean-Congo hemorrhagic fever virus (CCHFV), characterized by severe fever and hemorrhage and with a reported fatality level of 3-30%. Cerebral hemorrhage, gastrointestinal hemorrhage, severe anemia, shock, myocardial infarction, pulmonary edema and pleural effusion may be seen as causes of death. Cardiac troponin T (cTn-T) is a biochemical marker with high sensitivity and specificity in myocardial injury. The purpose of this study was to determine the prognostic significance of serum troponin T levels in CCHF patients.Patients hospitalized with a diagnosis of CCHF and whose serum cTn-T was investigated were examined retrospectively. Patients were divided into two groups on the basis of presence or absence of hemorrhage. Data were subjected to statistical analysis.One hundred thirty-five CCHF patients and 72 control subjects were included. Hemorrhage was present in 48 (35.6%) patients. Mean serum cTn-T level was 17.3 ± 28.0 ng/L in the patients with hemorrhage, 9.98 ± 5.97 ng/L in the non-hemorrhage patients (P = 0.001) and 6.6 ± 2.6 ng/L in the control samples (p < 0.001). At a cTn-T level cut-off point of 9 ng/L, area under the ROC curve was 0.797 (95% CI: 0.730-0.854), sensitivity 83.0%, specificity 87.5%, PPD 95.7% and NPV 60.3%. At logistic regression analysis, a rise in cTn-T level above 14 ng/L increased the probability of hemorrhage in CCHF patients approximately three-fold.An increased troponin T level may be a prognostic risk factor for hemorrhage in CCHF patients. This marker should therefore be borne in mind in determining treatment strategy in these patients. This article is protected by copyright. All rights reserved.
- A Young Man Presenting with Pleuritic Chest Pain and Fever after Electrophysiological Study and Implantable Cardioverter-Defibrillator Placement: Diagnostic Difficulties and Value of Bedside Thoracic Sonography. [Journal Article]
- Case Rep Med 2015.:801328.
We describe the case of a 23-year-old man presenting with recurrent pleuritic chest pain and prolonged fever after electrophysiology testing and placement of an implantable cardioverter-defibrillator because of a suspected arrhythmogenic right ventricular dysplasia. The clinical suspicion was initially directed toward pneumonia with pleural effusion and later toward an infection of the cardiac device complicated by septic pulmonary embolism. The definitive diagnosis of pulmonary embolism and infarction was suggested by a point-of-care thoracic sonography, performed at the bedside by a clinician caring for the patient, and then confirmed by contrast enhanced computed tomography, which also showed thrombosis of the left iliofemoral vein, site of percutaneous puncture for cardiac catheterization. Prolonged fever was attributable to a concomitant Epstein-Barr virus primary infection that acted as confounding factor. The present report confirms the value of bedside thoracic sonography in the diagnostic evaluation of patients with nonspecific respiratory symptoms.
- Pulmonary manifestations in a group of patients with Behcet's disease. [JOURNAL ARTICLE]
- Int J Rheum Dis 2015 Sep 9.
In this study we investigated the frequency and characteristics of pulmonary manifestations in a group of patients with Behcet's disease (BD) who were admitted to Cairo University Hospital.Fifteen patients were included in our study, 14 men (93.3%) and one woman (6.66%).Their mean age was 30.06 ± 9.8 years and the mean age of onset of BD was 23.7 ± 5.54 years. All patients were subjected to full history taking, clinical examination, plain chest X-ray and helical computed tomography (CT) study of the chest.Pulmonary involvements were detected in 11 patients with BD, 73.3% of cases: 10 men (90.9%) and one woman (9.09%).Their mean age was 28.8 ± 8.07, the mean age of onset of BD was 23.2 ± 5.59 years and the mean disease duration until lung manifestations appear was 3.7 ± 4.8 years. The main pulmonary and constitutional symptoms in these 11 patients were as follows: dyspnea 81.8%, cough 63.6%, weight loss 63.6%, chest tightness 54.5%, hemoptysis 45%, massive hemoptysis 27.2%, fever 36.3% and expectoration 36.3. Analysis of both vascular and parenchymal lung lesions in helical CT scan in the 11 patients with BD were as follows: pulmonary artery aneurysm (PAA) occurred in 5/11 patients (45.4%), pulmonary nodules occurred in 3/11 patients (27.2%), pleural effusion occurred in 3/11 patients (27.2%), pulmonary embolism and infarction occurred in 1/11 patients (9.09%) and pneumonitis occurred in 1/11 patients (9.09%).The higher frequency of pulmonary manifestations in our patients (73.3%) and the higher frequency of PAA (33.3%) could be related to the fact that this study was conducted on a group of patients who were admitted to the hospital with more severe illnesses.
- Frequency of nonthromboembolic imaging abnormalities in pregnant women referred for computed tomography pulmonary arteriography. [Journal Article]
- Can Assoc Radiol J 2015 Feb; 66(1):24-9.
The study sought to determine the frequency of nonthromboembolic imaging abnormalities in pregnant women referred for computed tomography pulmonary arteriography (CTPA).CTPA studies on 100 consecutive pregnant women performed over a 5-year period were reviewed independently by 2 radiologists, with conflicts resolved by consensus. Age range was 18-43 years (mean 28 years). The presence or absence of pulmonary embolism and of nonthromboembolic imaging abnormalities was recorded. These were graded as A if the abnormalities were thought to provide potential alternative explanations for acute symptoms, B if findings were incidental that required clinical or radiologic follow-up, and C if the findings did not require further action.Pulmonary embolism was seen in 5 women. In 2 of these additional findings of consolidation and infarction were seen. Ninety-five women did not have pulmonary embolism. Eleven women (12%) had grade A abnormalities; 6 cases of consolidation, 2 cases of lobar collapse, and 3 cases of heart failure with pleural effusions. One woman had a grade B abnormality due to the presence of pulmonary nodules. Ten women had incidental grade C abnormalities.Pulmonary embolism occurs in 5% of pregnant women referred for CTPA. In pregnant women without embolism on CTPA, potential alternative causes for patient symptoms are seen on CT in 12% of cases.
- Detailed statistical analysis plan for the pulmonary protection trial. [Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't]
- Trials 2014.:510.
Pulmonary dysfunction complicates cardiac surgery that includes cardiopulmonary bypass. The pulmonary protection trial evaluates effect of pulmonary perfusion on pulmonary function in patients suffering from chronic obstructive pulmonary disease. This paper presents the statistical plan for the main publication to avoid risk of outcome reporting bias, selective reporting, and data-driven results as an update to the published design and method for the trial.The pulmonary protection trial is a randomized, parallel group clinical trial that assesses the effect of pulmonary perfusion with oxygenated blood or Custodiol™ HTK (histidine-tryptophan-ketoglutarate) solution versus no pulmonary perfusion in 90 chronic obstructive pulmonary disease patients. Patients, the statistician, and the conclusion drawers are blinded to intervention allocation. The primary outcome is the oxygenation index from 10 to 15 minutes after the end of cardiopulmonary bypass until 24 hours thereafter. Secondary outcome measures are oral tracheal intubation time, days alive outside the intensive care unit, days alive outside the hospital, and 30- and 90-day mortality, and one or more of the following selected serious adverse events: pneumothorax or pleural effusion requiring drainage, major bleeding, reoperation, severe infection, cerebral event, hyperkaliemia, acute myocardial infarction, cardiac arrhythmia, renal replacement therapy, and readmission for a respiratory-related problem.The pulmonary protection trial investigates the effect of pulmonary perfusion during cardiopulmonary bypass in chronic obstructive pulmonary disease patients. A preserved oxygenation index following pulmonary perfusion may indicate an effect and inspire to a multicenter confirmatory trial to assess a more clinically relevant outcome.ClinicalTrials.gov identifier: NCT01614951, registered on 6 June 2012.
- Incidence, outcome, and attributable resource use associated with pulmonary and cardiac complications after major small and large bowel procedures. [Journal Article]
- Perioper Med (Lond) 2014.:7.
Complications increase the costs of care of surgical patients. We studied the Premier database to determine the incidence and direct medical costs related to pulmonary complications and compared it to cardiac complications in the same cohort.We identified 45,969 discharges in patients undergoing major bowel procedures. Postoperative pulmonary and cardiac complications were identified through the use of International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) codes and through the use of daily resource use data. Pulmonary complications included pneumonia, tracheobronchitis, pleural effusion, pulmonary failure, and mechanical ventilation more than 48 h after surgery. Cardiac complications included ventricular fibrillation, acute myocardial infarction, cardiogenic shock, cardiopulmonary arrest, transient ischemia, premature ventricular contraction, and acute congestive heart failure.Postoperative pulmonary complications (PPC) or postoperative cardiac complications (PCC) were present in 22% of cases; PPC alone was most common (19.0%), followed by PPC and PCC (1.8%) and PCC alone (1.2%). The incremental cost of PPC is large ($25,498). In comparison, PCC alone only added $7,307 to the total cost.The current study demonstrates that postoperative pulmonary complications represent a significant source of morbidity and incremental cost after major small intestinal and colon surgery and have greater incidence and costs than cardiac complications alone. Therefore, strategies to reduce the incidence of these complications should be targeted as means of improving health and bending the cost curve in health care.