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Mitsuishi A, Miura Y, Arakawa Y, Noguchi T. Distinguishing sterile inflammation from graft infection. J Cardiothorac Surg 2024; 19:22. [PMID: 38263206 PMCID: PMC10804788 DOI: 10.1186/s13019-024-02504-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 01/14/2024] [Indexed: 01/25/2024] Open
Abstract
We describe the case of a 68-year-old man who underwent ascending aortic replacement and thoracic endovascular aortic repair. Four years later, the patient developed neck pain on the right side and chest computed tomography showed expansion of fluid in the mediastinum which had extended to the neck. Echocardiography revealed advanced severity of aortic regurgitation and decreased ejection fraction. Given the progression of aortic regurgitation, decreased cardiac function, and rapidly expanding fluid accumulation causing neck pain, reoperation was indicated. All microbiological test including polymerase chain reaction were negative indicating absence of any infection. The patient is being followed-up without antibiotics and CT has not shown peri-graft fluid 2 years postoperatively. Since infection cannot be excluded completely, it is important to assess the condition with selective medium, extended culture periods, genetic testing, and consultations with microbiology laboratories when normal culture tests for general bacteria, and fungi are negative which can help avoid drug-resistant bacteria count, elevated medical costs, and drug side effects due to the improper use of antibiotics through proper diagnosis.
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Affiliation(s)
- Atsuyuki Mitsuishi
- Department of Cardiovascular Surgery, School of Medicine, Kochi University, 185-1, Kohasu, Nankoku-shi, Okohmachi, Kochi Prefecture, 783-8505, Japan.
| | - Yujiro Miura
- Department of Cardiovascular Surgery, Kochi Medical School, 185-1, Kohasu, Nankoku-shi, Okohcho, Kochi Prefecture, 783-8505, Japan
| | - Yu Arakawa
- Department of Clinical Infectious Diseases, Kochi Medical School, 185-1, Kohasu, Nankoku-shi, Okohcho, Kochi Prefecture, 783-8505, Japan
| | - Tatsuya Noguchi
- Department of Cardiology and Geriatrics, Kochi Medical School Hospital, 185-1, Kohasu, Nankoku-shi, Okohcho, Kochi Prefecture, 783-8505, Japan
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Kompel A, Guermazi A. Imaging of MSK infections in the ER. Skeletal Radiol 2023:10.1007/s00256-023-04554-7. [PMID: 38147081 DOI: 10.1007/s00256-023-04554-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 12/10/2023] [Accepted: 12/17/2023] [Indexed: 12/27/2023]
Abstract
Musculoskeletal infections in the ER are not an uncommon presentation. The clinical context is critical in determining the suspicion for infection and degree of tissue involvement which can involve all layers from the skin to bones. The location, extent, and severity of clinically suspected infection directly relate to the type of imaging performed. Uncomplicated cellulitis typically does not require any imaging. Localized and superficial infections can mostly be evaluated with ultrasound. If there is a diffuse site (an entire extremity) or suspected deeper involvement (muscle/deep fascia), then CT is accurate in diagnosing, widely available, and performed quickly. With potential osseous involvement, MRI is the gold standard for diagnosing acute osteomyelitis; however, it has the drawbacks of longer scan times, artifacts including patient motion, and limited availability.
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Affiliation(s)
- Andrew Kompel
- Boston University School of Medicine, Boston, MA, USA.
| | - Ali Guermazi
- Boston University School of Medicine, Boston, MA, USA
- Boston VA Healthcare System, West Roxbury, MA, USA
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Wakonig KM, Dommerich S, Fischer T, Arens P, Hamm B, Olze H, Lerchbaumer MH. The Diagnostic Performance of Multiparametric Ultrasound in the Qualitative Assessment of Inconclusive Cervical Lymph Nodes. Cancers (Basel) 2023; 15:5035. [PMID: 37894402 PMCID: PMC10605624 DOI: 10.3390/cancers15205035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/27/2023] [Accepted: 10/04/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Enlarged cervical lymph nodes (CLNs) can result from infection or malignancies, and a definitive diagnosis requires histological examination. Ultrasound (US) remains the first-line imaging modality for detection, and new US techniques may improve characterization. The aim of our study was to investigate whether the qualitative assessment of multiparametric US (mpUS) can improve diagnostic performance in the differentiation of benign and malignant CLNs. METHODS 107 CLNs in 105 patients were examined by preoperative mpUS consisting of B-mode US, color-coded duplex sonography (CCDS), shear wave elastography (SWE) and contrast-enhanced US (CEUS). US images were evaluated in consensus by two experienced US operators. Histopathological examination was used as reference standard. RESULTS SWE and CEUS combined showed the highest overall diagnostic performance (91% sensitivity, 77% specificity, 87% positive predictive value (PPV), 83% negative predictive value (NPV), 90% accuracy, χ2 (1) = 51.485, p < 0.001) compared to B-mode US and CCDS (87% sensitivity, 44% specificity, 73% PPV, 65% NPV, 73% accuracy χ2 (1) = 12.415, p < 0.001). In terms of individual techniques, SWE had higher specificity than B-mode and CCDS (71% sensitivity, 90% specificity, 92% PPV, 64% NPV, 78% accuracy, χ2 (1) = 36.115, p < 0.001), while qualitative CEUS showed the best diagnostic performance of all investigated US techniques (93% sensitivity, 85% specificity, 91% PPV, 87% NPV, 90% accuracy, χ2 (1) = 13.219, p < 0.001). Perfusion patterns, homogeneity, presence of necrosis, and malignancy differed significantly between malignant and benign CLNs (p < 0.001). CONCLUSIONS SWE and CEUS can facilitate the differentiation of inconclusive CLNs when performed to supplement B-mode US and CCDS. MpUS may thus aid the decision between surgery and a watch-and-scan strategy in enlarged CLNs.
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Affiliation(s)
- Katharina Margherita Wakonig
- Department of Otorhinolaryngology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum and Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany; (S.D.); (P.A.); (H.O.)
| | - Steffen Dommerich
- Department of Otorhinolaryngology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum and Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany; (S.D.); (P.A.); (H.O.)
| | - Thomas Fischer
- Department of Radiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (T.F.); (B.H.); (M.H.L.)
| | - Philipp Arens
- Department of Otorhinolaryngology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum and Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany; (S.D.); (P.A.); (H.O.)
| | - Bernd Hamm
- Department of Radiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (T.F.); (B.H.); (M.H.L.)
| | - Heidi Olze
- Department of Otorhinolaryngology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum and Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany; (S.D.); (P.A.); (H.O.)
| | - Markus Herbert Lerchbaumer
- Department of Radiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (T.F.); (B.H.); (M.H.L.)
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Young K, Tang DM, Wu AW. Infratemporal Fossa Abscesses: A Systematic Review of Cases. EAR, NOSE & THROAT JOURNAL 2022:1455613221121040. [PMID: 35961934 DOI: 10.1177/01455613221121040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES We have attempted to characterize the clinical presentations and management of infratemporal fossa abscesses with the goal of improving awareness and promoting earlier diagnosis and treatment for this rare condition. METHODS an extensive systematic search was performed through Pubmed/Medline, CINAHL (EBSCOhost), and Web of Science. Two authors screened out studies by abstracts, and a third resolved any conflicts. The remaining studies were assessed by full-text assessment, leaving 43 studies for data extraction. RESULTS sixty-seven patients were included from the final 43 studies. The patients were predominantly male (56.7%), and the average age of patients was 44.3 years (standard deviation (SD) 19.8 years). Risk factors most commonly odontogenic, whether the etiology was through tooth extraction (n = 30, 44.8%) or infection (n = 17, 25.4%). Symptoms on presentation included pain (n = 40, 83.3%), swelling (n = 39, 81.3%), and trismus (n = 36, 75.0%). Twenty-two (32.8%) patients were managed with intraoral incision and drainage (I&D), 18 (26.9%) with extraoral I&D. After treatment, 45 of the 48 (93.8%) patients from the case reports and series were deemed to have achieved complete resolution. CONCLUSIONS Infratemporal fossa abscesses are rare, but they may be associated with serious neurologic and systemic complications. Although prompt diagnosis paramount in avoiding these sequelae, patients often experienced delays in diagnosis. Surgical drainage and extended antibiotic therapy is recommended.
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Affiliation(s)
- Kurtis Young
- Division of Otolaryngology, University of California Davis Medical Center, Sacramento, CA, USA
- John A. Burns School of Medicine, University of Hawaii at Manoa
| | - Dennis M Tang
- Cedars-Sinai Division of Otolaryngology, Los Angeles, CA, USA
| | - Arthur W Wu
- Cedars-Sinai Division of Otolaryngology, Los Angeles, CA, USA
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A Systematic Review of Cases with Bezold's Abscess. Otol Neurotol 2022; 43:727-733. [PMID: 35763491 DOI: 10.1097/mao.0000000000003569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective for this systematic review is to characterize clinical presentations of Bezold's abscesses to improve awareness and promote earlier diagnoses and prompt intervention in this increasingly rare otologic infection. DATA SOURCES Pubmed/Medline, CINAHL (EBSCOhost), and Web of Science articles in all languages were searched. STUDY SELECTION Inclusion criteria were that the article was either a case report, case series, or retrospective review with individual case data available. Non-English articles were excluded if they lacked an English language abstract and if that abstract lacked information on baseline demographics, clinical presentation, and management. DATA EXTRACTION Included studies were evaluated using fulltext review and demographics, etiology, microbiology, antibiotic usage, and surgical variables were collected. DATA SYNTHESIS Data were qualitatively synthesized, with means and averages obtained for all continuous variables. CONCLUSIONS Bezold's abscess remains a rare otologic infection, but they are relatively commonly associated with serious neurologic and systemic complications. Delay in diagnosis was a frequent commonality and diagnostic vigilance is tantamount in avoiding this sequelae. Aggressive surgical extirpation and long-term antibiotic treatment is recommended.
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Aliabadi E, Farshad MM, Kheirkhah M, Jafari SH. Clinical, CT scan, and laboratory changes of abscess patients with odontogenic origin admitted to Shiraz acute surgical care center, Iran. J Family Med Prim Care 2021; 10:3314-3318. [PMID: 34760750 PMCID: PMC8565145 DOI: 10.4103/jfmpc.jfmpc_1047_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 07/10/2021] [Accepted: 07/29/2021] [Indexed: 11/04/2022] Open
Abstract
Introduction Rapid diagnosis of maxillofacial abscess with the odontogenic origin is effective in the treatment of patients. This study aimed to check the clinical evaluation, head, and neck computed tomography (CT) scan, and microbial sensitivity of hospitalized patients diagnosed with maxillofacial abscess admitted to the Maxillofacial Surgery Ward Shaheed Rajaie Surgical Acute Care Center of Shiraz, Iran from 2019-2021. Method A cross-sectional study was conducted. The sample included patients diagnosed with the abscess of odontogenic origin. Data collection tools included personal profile registration form, chief complainant and clinical evaluation, laboratory test results, pus culture, antibiogram results, and head and neck CT scan changes form. Data was reported with descriptive statistics by SPSS-16 software. Results The majority of patients were male; infection duration was 10 days; maximum mouth opening size was less than 20 mm in more than half of patients. The scan revealed 41.8% abscess, 36.4% cellulite, and 21.8% mixed abscess and cellulitis. There was 29.1% involvement of salivary glands. The majority of abscesses were unifocal involved in the submandibular space, and the least involvement was in peri mandibular space and carotid sheath. The most common organism causing was staphylococcal abscess coagulase-negative. Conclusion In patients with maxillofacial abscess requiring hospitalization, the most common clinical features were trismus, toxic appearance, and dysphagia, and the most common source of abscess in scanning patients with mandibular molars was the most involved submandibular space and pterygomandibular space. Vancomycin, cotrimoxazole, and cefazolin had the greatest effect in the treatment of odontogenic infections in terms of antibiogram results and microbial culture.
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Affiliation(s)
- Ehsan Aliabadi
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Mahdi Farshad
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masoomeh Kheirkhah
- Nursing Care Research Center (NCRC), Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Hamed Jafari
- Medical Imaging Research Center, Department of Radiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Jung J, Choi M. Nonsurgical resolution of caudal mediastinal paraesophageal abscess in a cat. J Vet Med Sci 2014; 77:499-502. [PMID: 25648207 PMCID: PMC4427755 DOI: 10.1292/jvms.14-0518] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A one-year-old, castrated male domestic short hair cat was admitted with a history of anorexia, regurgitation and pyrexia for two days. Fever and leukocytosis were identified. There were a large soft tissue density oval mass in the caudal mediastinum on thoracic radiographs, a fluid-filled oval mass in the caudal mediastinum on ultrasonography, and left-sided and ventrally displaced and compressed esophagus on esophagram. On esophageal endoscopy, there were no esophageal abnormalities. CT findings with a fluid filled mass with rim enhancement indicated a caudal mediastinal paraesophageal abscess. The patient was treated with oral antibiotics, because the owner declined percutaneous drainage and surgery. The patient was admitted on emergency with severe respiratory distress; and ruptured abscess and deteriorated pleuropneumonia were suspected. With intensive hospitalization care and additional antibiotic therapy, the patient had full recovery.
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Affiliation(s)
- Joohyun Jung
- Ilsan Animal Medical Center, Daehwa-dong 2030, Ilsanseo-gu, Goyang-si, Gyeonggi-do, 411-803, South Korea
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