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Peiffer-Smadja N, Harent S, Messeca C, Lechapt-Zalcman E, Yazdanpanah Y, Joly V. A case of thoracic actinomycosis presenting as sudden paraplegia. Rev Neurol (Paris) 2018; 175:89-92. [PMID: 30309660 DOI: 10.1016/j.neurol.2018.01.380] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 01/15/2018] [Accepted: 01/16/2018] [Indexed: 11/18/2022]
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Lochindarat S, Teeratakulpisarn J, Warachit B, Chanta C, Thapa K, Gilbert GL, Wangroongsarb Y, Pirçon JY, Van Dyke MK, Liu Y, Hausdorff WP. Bacterial etiology of empyema thoracis and parapneumonic pleural effusion in Thai children aged less than 16 years. THE SOUTHEAST ASIAN JOURNAL OF TROPICAL MEDICINE AND PUBLIC HEALTH 2014; 45:442-454. [PMID: 24968687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This study aimed to identify the bacterial etiology of empyema thoracis or parapneumonic pleural effusions in Thai children, with a focus on pneumococcus. This hospital-based, descriptive study included children aged < or = 16 years, diagnosed with empyema thoracis or parapneumonic pleural effusion, from whom a pleural fluid (PF) sample was taken between January 2008 and November 2009. PF and blood samples were cultured and PF samples were also tested by polymerase chain reaction (PCR) to assess whether evidence of an infection might be identified among culture-negative samples. Serotyping of Streptococcus pneumoniae-positive samples was performed by molecular techniques and Quellung reaction. In this study, 29 children with empyema thoracis and 42 children with parapneumonic pleural effusion were enrolled. Potentially pathogenic bacteria were cultured in 13/71 samples at local or central laboratories; the most common bacteria were Staphylococcus aureus (8 children) and S. pneumoniae (2 children). Molecular techniques detected one or more targeted respiratory pathogens in 18/71 PF samples. S. pneumoniae and Haemophilus influenzae were identified by PCR in 13 and 6 children, respectively; PCR for S. aureus was not performed. The pneumococcal serotypes identified were 1, 3, 5, 6A/B, 9A/V, 14, 15A, 19F and 23A. This study shows that among Thai children with empyema thoracis and parapneumonic pleural effusions, S. aureus and S. pneumoniae were the most common pathogens identified by culture and PCR, respectively. These findings confirmed that molecular techniques are more sensitive for identification of S. pneumoniae and H. influenzae and enhance detection of important bacterial causes of empyema.
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Petroianni A, Conti V, Terzano C. A thoracic mass infiltrating the chest wall. EUROPEAN REVIEW FOR MEDICAL AND PHARMACOLOGICAL SCIENCES 2011; 15:345-348. [PMID: 21528783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A case of thoracic mass infiltrating the chest wall mimicking a pulmonary invasive neoplasm is reported. Differential diagnosis and characteristic radiological and histological imaging had a decisive role in the case management. Actinomycosis is caused by a gram-positive, filamentous, microaerophilic bacteria. About 15% of the infections caused by Actinomyces involve the thorax. If not promptly diagnosed and treated thoracic actinomycosis may determine contiguous and systemic involvement. Actinomycosis is an anaerobic-to-microaerophilic bacteria and direct identification and isolation are difficult to obtain. In depth discussion diagnostic and therapeutic features are described in this report.
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Saxena P, Konstantinov IE, Zelei D, Newman MAJ. Spontaneous Subscapular Abscess: A Rare Surgical Condition. Heart Lung Circ 2008; 17:517-8. [PMID: 17419099 DOI: 10.1016/j.hlc.2007.02.095] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2007] [Revised: 02/16/2007] [Accepted: 02/19/2007] [Indexed: 11/28/2022]
Abstract
Subscapular abscess is a rare clinical problem. Herein we describe a young male patient who presented with a subscapular abscess and was managed successfully with surgical drainage and debridement of the cavity.
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Parvin R, Haque MA, Islam MN, Shaha CK, Uddin SN, Sarkar S, Hossain MB. Pott's disease in a young child. Mymensingh Med J 2008; 17:206-209. [PMID: 18626460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
A 16-month-old emaciated, immunized child presented with low-grade fever and progressive kyphosis with a right sided para-vertebral abscess for 9 months. During this period of illness the child had marked loss of appetite and progressive weight loss. There was history of contact with sputum smear positive father. A gibbus was present at thoraco-lumbar region with a cold abscess at the right side of the gibbus and signs of upper motor neuron lesion were found on lower limb examination. Diagnosis was supported by relevant investigations including MRI of dorsolumbar spine and treatment was started beforehand with anti-tubercular drugs. The paravertebral abscess was drained several times and antibiotics were used depending upon the results of microbiological study. At the same time the patient was advised to wear a modified chest brace for immobilization and the management for severe malnutrition was also started accordingly. There was significant clinical improvement observed within one month of starting treatment.
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Chernihovski A, Loberant N, Cohen I, Nassar F, Lemer J, Altman E. Chest wall actinomycosis. THE ISRAEL MEDICAL ASSOCIATION JOURNAL : IMAJ 2007; 9:686-687. [PMID: 17939638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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Stelzmueller I, Biebl M, Berger N, Eller M, Mendez J, Fille M, Angerer K, Schmid T, Lorenz I, Margreiter R, Bonatti H. Relevance of group Milleri streptococci in thoracic surgery: a clinical update. Am Surg 2007; 73:492-7. [PMID: 17521006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Group Milleri streptococci (GMS), a heterogeneous group of streptococci, are associated with purulent infections. This study was a retrospective analysis of all consecutive thoracic infections of GMS between 2001 and 2004. Of 246 surgical GMS infections, thoracic infections accounted for 4.5 per cent, including 10 pleural infections (eight empyemas and two infected pleural effusions) and one mediastinal infection. The etiology of pleural infection was parapneumonic (7), second to esophageal perforation (1), liver transplantation (1), and liver resection (1). Polymicrobial infections were present in 64 per cent. All patients underwent removal of the infected masses, including drainage (3), thoracoscopic decortication (5), thoracotomy with debridement (2), and incision with drainage (1). The case fatality rate was 9 per cent (there was one patient with congestive heart disease unfit to undergo surgical empyema evacuation) and the recurrence rate was 27.3 per cent (three patients). Combined antibiotic/surgical treatment was successful in all other cases. GMS isolates were susceptible to clindamycin and all beta-lactam antibiotics except ceftazidime, but were resistant to aminoglycosides. If found intrathoracically, GMS frequently progress to severe empyema. Therefore, timely removal of pleural collection by percutaneous drainage or surgical intervention seems indicated. If surgery is required, thoracoscopic decortication may be the preferred approach.
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Aviram G, Fishman JE, Boiselle PM. Thoracic Infections in Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome. Semin Roentgenol 2007; 42:23-36. [PMID: 17174172 DOI: 10.1053/j.ro.2006.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Ka AS, Brousse V, Diakhaté I, Sermet-Gaudelus I, Lenoir G, Imbert P. [Tuberculous cold abscess of the chest wall in children: A report of 3 cases]. Arch Pediatr 2006; 13:1265-6. [PMID: 16860543 DOI: 10.1016/j.arcped.2006.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2006] [Accepted: 06/21/2006] [Indexed: 11/28/2022]
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Bark B, Perlick E, Stöver B. Thoraxwandüberschreitender (Pseudo-?) Tumor beim Kind - Abszedierende thorakale Aktinomykose durch Aktinomyces meyeri et israeli. ROFO-FORTSCHR RONTG 2004; 176:125-7. [PMID: 14712418 DOI: 10.1055/s-2004-814658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Biswas S, Saha AK, Bhar B. A case of chronic chest wall sinus. JOURNAL OF THE INDIAN MEDICAL ASSOCIATION 2004; 102:44-5, 52. [PMID: 15195862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
A 17-year-old Muslim female presented with a swelling over the chest wall underneath her left breast. The swelling was aspirated and the cytology report of the aspirated material showed it to be of pyogenic origin. An incision and drainage was done, after which the patient presented with a non-healing discharging sinus at the same site. The exact nature of the disease was known only after excising the sinus tract with the affected rib.
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Fenniche S, Fekih L, Hassene H, Hantous S, Belhabib D, Megdiche ML. [Tuberculous thoracic parietal abcess. Report of 4 cases]. LA TUNISIE MEDICALE 2003; 81:738-42. [PMID: 17722787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Cold abcess of the chest wall is a rare extra-pulmonary tuberculous location, usually described in cases of severe or disseminated form of tuberculous. His frequency is estimated for 1 to 5% of osteoarticular tuberculous. Four cases of cold abcess of the chest wall are reported. Three of the patients are more than 65- year- old and a 30-year-old woman. In three cases, abcess is developped in the posterior chest wall and it is sternal in the fourth case . Neither immunodepression nor previous tuberculous history or other location of the tuberculosis were noted. Diagnosis is based on demonstrating mycobacterium tuberculosis in pus culture in three cases and on histologic pattern in the last one. Classic anti-tuberculosis treatement was prolonged at 12 and 15 months in 2 patients because of respectively general and local prolonged evolution.
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Zito I, Downes SM, Patel RJ, Cheetham ME, Ebenezer ND, Jenkins SA, Bhattacharya SS, Webster AR, Holder GE, Bird AC, Bamiou DE, Hardcastle AJ. RPGR mutation associated with retinitis pigmentosa, impaired hearing, and sinorespiratory infections. J Med Genet 2003; 40:609-15. [PMID: 12920075 PMCID: PMC1735548 DOI: 10.1136/jmg.40.8.609] [Citation(s) in RCA: 98] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Smith MB, Molina CP, Schnadig VJ, Boyars MC, Aronson JF. Pathologic features of Mycobacterium kansasii infection in patients with acquired immunodeficiency syndrome. Arch Pathol Lab Med 2003; 127:554-60. [PMID: 12708897 DOI: 10.5858/2003-127-0554-pfomki] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Mycobacterium kansasii is a slow-growing photochromogenic mycobacterium that may infect patients with human immunodeficiency virus (HIV) late in the course of acquired immunodeficiency syndrome (AIDS). The clinical features of pulmonary and extrapulmonary infections have been described in the literature; however, the pathology of infection has not been adequately addressed. OBJECTIVE This report describes the pathologic features of 12 cases of M kansasii infection in patients with AIDS. DESIGN The medical records, autopsy protocols, cytologic material, and histologic material from patients with AIDS and concomitant M kansasii infection at a tertiary-care medical center during 1990-2001 were reviewed. RESULTS Twelve cases were identified, 6 by autopsy, 5 of which were diagnosed postmortem. Four of the 12 cases had cytologic material and 4 cases had histologic biopsies available for review. Pulmonary infection was most common (9/12), and all patients in whom thoracic lymph nodes were assessed showed involvement (7/7). Abdominal infection was less frequent, with only 1 of 6, 2 of 6, and 2 of 6, demonstrating liver, spleen, and abdominal lymph node infection, respectively. Isolated infections without documented pulmonary infection included brain abscess (n = 1), ulnar osteomyelitis (n = 1), and paratracheal mass (n = 1). Cytologic and histologic material showed a wide range of inflammatory reactions, including granulomas with and without necrosis, neutrophilic abscesses, spindle-cell proliferations, and foci of granular eosinophilic necrosis. The M kansasii bacillus was characteristically long, coarsely beaded, and frequently showed folded, bent, or curved ends. Intracellular bacilli were randomly or haphazardly distributed within histiocytes. CONCLUSION Mycobacterium kansasii infection produces predominantly pulmonary infection in late-stage AIDS with a high incidence of thoracic lymph node involvement and a much lower incidence of dissemination to other sites. Infection is manifest as a wide variety of inflammatory reactions on cytology and histology; however, the characteristic appearance of the bacillus on acid-fast bacilli stain and its intracellular arrangement in histiocytes can allow a presumptive identification.
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Gupta SK, BarrosD'sa S, Evans PD, White DG. Anterior chest wall abscess caused by Salmonella enteritidis in a healthy adult. J Infect 2003; 46:142-3. [PMID: 12634079 DOI: 10.1053/jinf.2002.1083] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We report a case of anterior chest wall abscess in an immunocompetent adult by Salmonella enteritidis, whose food was contaminated by bird droppings. The patient did not have any gastrointestinal symptoms. Surgical excision followed by antibiotics (cefuroxime and ciprofloxacin) successfully treated the condition. To our knowledge, this is the first reported case of anterior chest wall abscess caused by S. enteritidis in an immunocompetent adult without any preceding gastrointestinal symptoms. We feel that the contamination of his food with the bird droppings was a risk factor.
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Losanoff JE, Metzler MH, Richman BW, Cotton BA, Jones JW. Necrotizing chest wall infection after blunt trauma: case report and review of the literature. THE JOURNAL OF TRAUMA 2002; 53:787-9. [PMID: 12394886 DOI: 10.1097/00005373-200210000-00030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kim HY, Song KS, Goo JM, Lee JS, Lee KS, Lim TH. Thoracic sequelae and complications of tuberculosis. Radiographics 2001; 21:839-58; discussion 859-60. [PMID: 11452057 DOI: 10.1148/radiographics.21.4.g01jl06839] [Citation(s) in RCA: 171] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Pulmonary tuberculosis is caused by Mycobacterium tuberculosis when droplet nuclei laden with bacilli are inhaled. In accordance with the virulence of the organism and the defenses of the host, tuberculosis can occur in the lungs and in extrapulmonary organs. A variety of sequelae and complications can occur in the pulmonary and extrapulmonary portions of the thorax in treated or untreated patients. These can be categorized as follows: (a) parenchymal lesions, which include tuberculoma, thin-walled cavity, cicatrization, end-stage lung destruction, aspergilloma, and bronchogenic carcinoma; (b) airway lesions, which include bronchiectasis, tracheobronchial stenosis, and broncholithiasis; (c) vascular lesions, which include pulmonary or bronchial arteritis and thrombosis, bronchial artery dilatation, and Rasmussen aneurysm; (d) mediastinal lesions, which include lymph node calcification and extranodal extension, esophagomediastinal or esophagobronchial fistula, constrictive pericarditis, and fibrosing mediastinitis; (e) pleural lesions, which include chronic empyema, fibrothorax, bronchopleural fistula, and pneumothorax; and (f) chest wall lesions, which include rib tuberculosis, tuberculous spondylitis, and malignancy associated with chronic empyema. These varieties of radiologic manifestations can mimic other disease entities. Therefore, recognition and understanding of the radiologic manifestations of the thoracic sequelae and complications of tuberculosis are important to facilitate diagnosis.
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Tangthangtham A, Subhannachart P, Tungsagunwattana S. Transthoracic aspiration cytology for the diagnosis of thoracic infection. JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND = CHOTMAIHET THANGPHAET 2001; 84:688-92. [PMID: 11560219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
The article describes the use and results of transthoracic aspiration cytology for diagnosis of thoracic infection in a Thai referral chest center. We reviewed 60 cytologic samples, initially diagnosed as thoracic infection or inflammation among a total of 532 percutaneous transthoracic needle aspirations obtained from patients with clinical suspicion of malignancy in a period of 6 years. Follow-up clinical data were collected and correlated with cytologic diagnosis. We found specific microorganisms in 8 samples (13.33%). These included 4 cases of actinomycosis, 3 cases of cryptococcosis and a case of aspergillosis. Granulomatous inflammation was found in 12 samples (20.00%). Among these patients, 10 cases were verified as having tuberculosis. The remaining 40 samples (66.67%) revealed acute inflammatory exudate with no specific microorganism. Follow-up clinical data confirmed or assumed infection in 27 cases. Therefore, in patients with thoracic infection who presented with clinical suspicion of malignancy, from our experience, aspiration cytology revealed adequate morphology for accurate diagnosis which resulted in prompt specific treatment and better prognosis.
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Gorelov FI, Khod'ko EI, Kuz'mina EV, Poliakova GA, Golod RA, Martysheva NG. [A method for the surgical treatment of patients with chronic postoperative osteomyelitis of the sternum]. VESTNIK KHIRURGII IMENI I. I. GREKOVA 2000; 159:48-50. [PMID: 10890069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
The authors share their experiences with diagnosing and surgical treatment of chronic postoperative osteomyelitis of sternum developed in 36 patients after operations on the heart, lungs and organs of mediastinum. The purulent process can be liquidated in all the patients due to performing saving resection of the sternum and plasty of the bone defect with local tissues, application of a gauze-cotton roll pressing the subcutaneous fat into the bone defects formed after treatment of the affected portions of the sternum, administration of antibiotics according to sensitivity of the microflora.
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Gendron R, Grenier D, Maheu-Robert L. The oral cavity as a reservoir of bacterial pathogens for focal infections. Microbes Infect 2000; 2:897-906. [PMID: 10962273 DOI: 10.1016/s1286-4579(00)00391-9] [Citation(s) in RCA: 144] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Dental procedures, but more importantly, oral infections and poor oral health can provoke the introduction of oral microorganisms into the bloodstream or the lymphatic system. The subsequent attachment and multiplication of these bacteria on tissues or organs can lead to focal oral infections. Pathogenic agents may also remain at their primary oral site but the toxins liberated can reach an organ or tissue via the bloodstream and cause metastatic injury. Finally, metastatic inflammation may result from an immunological injury caused by oral bacteria or their soluble products that enter the bloodstream and react with circulating specific antibodies to form macromolecular complexes.
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Abstract
The emergence of the human immunodeficiency virus (HIV) and the onset of the AIDS epidemic has been associated with the frequent presentation of otherwise rare opportunistic infections and neoplasms. Despite the impairments of cellular and humoral immunity that accompany HIV infection, the prevalence of actinomycosis in the HIV-infected population has remained low. This article reviews previously reported cases of actinomycosis in HIV-positive and AIDS patients. Microbiological, pathological, diagnostic, clinical and therapeutic aspects of actinomycosis in this population are discussed. Clinicians should be aware of the possibility of actinomycosis as the cause of a persistent inflammatory lesion in these patients and know the correct techniques for collecting and submitting tissue specimens for anaerobic culture.
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Khalil A, Le Breton C, Tassart M, Korzec J, Bigot J, Carette M. Utility of CT scan for the diagnosis of chest wall tuberculosis. Eur Radiol 1999; 9:1638-42. [PMID: 10525881 DOI: 10.1007/s003300050900] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The objective of this study was to determine the utility of CT scan findings for the diagnosis of chest wall tuberculosis, excluding the spine. We reviewed 15 patients (13 Africans and 2 Indians) with chest wall tuberculosis, retrospectively. The radiologic examination consisted of a plain X-ray and a CT scan of the chest for each patient. The site of disease was the rib in 13 patients or the body of the sternum in 2 patients. One rib was involved in 11 patients, 2 contiguous ribs (one site) in 2 patients, and bilateral disease (two sites) was observed in the remaining patient. The 14 rib sites involved the posterior arc or costovertebral joint in 11 cases, the anterior arc in 2 cases, and the anterior and middle arc in 1 case. The CT scan findings were an abscess (n = 14) or a soft tissue mass (n = 2), osteolytic lesions (n = 13), periosteal reaction (n = 10), and sequestrum (n = 14). Bone sclerosis was observed only in 3 cases of rib involvement. The association of a soft tissue abscess, an osteolytic lesion, and sequestrum, especially in immigrants to France, suggests chest wall tuberculosis on CT scan.
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Toribio RE, Kohn CW, Lawrence AE, Hardy J, Hutt JA. Thoracic and abdominal blastomycosis in a horse. J Am Vet Med Assoc 1999; 214:1357-60, 1335. [PMID: 10319179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
A 5-year-old Quarter Horse mare was examined because of lethargy, fever, and weight loss of 1 month's duration. Thoracic auscultation revealed decreased lung sounds cranioventrally. Thoracic ultrasonography revealed bilateral anechoic areas with hyperechoic strands, consistent with pleural effusion and fibrin tags. A large amount of free fluid was evident during abdominal ultrasonography. Abnormalities included anemia, hyperproteinemia, hyperglobulinemia, hyperfibrinogenemia, and hypoalbuminemia. Thoracic radiography revealed alveolar infiltrates in the cranial and caudoventral lung fields. A cavitary mass, consistent with an abscess, could be seen caudodorsal to the crura of the diaphragm. Ultrasonographic evaluation of this area revealed a hypoechoic mass with septations. Bilateral thoracocentesis was performed. Bacterial culture of the pleural fluid did not yield growth, but Blastomyces dermatitidis was isolated from pleural fluid, abdominal fluid, and an aspirate of the abscess. The mare was euthanatized, and a diagnosis of thoracic and abdominal blastomycosis was confirmed at necropsy.
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Goh SH, Low BY. Drowning and near-drowning--some lessons learnt. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 1999; 28:183-8. [PMID: 10497663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Over a period of sixteen months, 17 cases of submersion injury (encompassing victims of drowning and near-drowning) were attended to at our Accident and Emergency Department at Changi General Hospital. Most of the victims were inexperienced recreational swimmers, and in 6 of them, early bystander cardiopulmonary resuscitation enabled them to recover without severe morbidity. Non-cardiogenic pulmonary oedema with resulting chest infection was the commonest complication in survivors. Most of the episodes occurred in an urban setting in swimming pools without supervision by lifeguards. About two-thirds of the cases were adults over the age of fifteen years. In addition, there were patients in whom submersion injury was associated with more sinister conditions (fits, traumatic cervical spine injury, dysbarism, intoxication from alcohol or drugs), some of which were unsuspected by the doctors initially. Apart from the immediate threats of hypoxia and pulmonary injury, active search for any possible precipitating causes and associated occult injury should be made. In this study, the determinants of survival from near-drowning were early institution of cardiopulmonary resuscitation, presence of pupil reactivity, and presence of a palpable pulse and cardiac sinus rhythm.
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