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Jiménez-Castillo RA, Aguilar-Rivera LR, Carrizales-Sepúlveda EF, Gómez-Quiroz RA, Llantada-López AR, González-Aguirre JE, Náñez-Terreros H, Rendón-Ramírez EJ. A case of round pneumonia due to Enterobacter hormaechei: the need for a standardized diagnosis and treatment approach in adults. Rev Inst Med Trop Sao Paulo 2021; 63:e3. [PMID: 33503151 PMCID: PMC7816868 DOI: 10.1590/s1678-9946202163003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 11/23/2020] [Indexed: 01/13/2023] Open
Abstract
Round pneumonia is an unusual radiological manifestation of a bacterial lung infection. We present the case of an elderly male patient who arrived at the emergency room with a productive cough and exertional dyspnea. His chest x-ray and CT showed a round opacity and air bronchograms in the right upper lobe. Taken together, the patient's symptoms and images strongly suggest a pulmonary infection. Empirical antibiotic therapy with ceftriaxone and clarithromycin was started. The sputum culture was positive for Enterobacter hormaechei and the bacterium was sensitive to levofloxacin; therefore, the antibiotic therapy was changed. Despite the treatment, the patient progressed to respiratory failure and septic shock, dying six days after admission. Although round pneumonia is uncommon, it is a potentially curable disease and clinicians should always consider it in their differential diagnosis.
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Affiliation(s)
- Raúl Alberto Jiménez-Castillo
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Departamento de Medicina Interna, Monterrey, México
| | - Leonardo René Aguilar-Rivera
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Departamento de Medicina Interna, Monterrey, México
| | - Edgar Francisco Carrizales-Sepúlveda
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Departamento de Cardiología, Monterrey, México
| | - Ricardo Andrés Gómez-Quiroz
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Departamento de Medicina Interna, Monterrey, México
| | - Anabella Rosalía Llantada-López
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Departamento de Medicina Interna, Monterrey, México
| | - Julio Edgardo González-Aguirre
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Departamento de Medicina Interna, Monterrey, México
| | - Homero Náñez-Terreros
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Departamento de Medicina Interna, Monterrey, México
| | - Erick Joel Rendón-Ramírez
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Departamento de Medicina Interna, Monterrey, México
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Violante-Cumpa JR, Violante-Cumpa KA, Carrizales-Sepúlveda EF. Unusual radiographic presentation of pneumonia in adults with chronic kidney disease. Intern Emerg Med 2019; 14:811-812. [PMID: 30603859 DOI: 10.1007/s11739-018-02022-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 12/27/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Jorge Rafael Violante-Cumpa
- Internal Medicine Department, Hospital Universitario, Universidad Autónoma de Nuevo León, Madero and Gonzalitos Av, N/N Col. Mitras Centro, 64460, Monterrey, Nuevo León, Mexico.
| | | | - Edgar Francisco Carrizales-Sepúlveda
- Internal Medicine Department, Hospital Universitario, Universidad Autónoma de Nuevo León, Madero and Gonzalitos Av, N/N Col. Mitras Centro, 64460, Monterrey, Nuevo León, Mexico
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Rodríguez E. [Pneumonia ward round: A case presentation]. Semergen 2018; 44:515-516. [PMID: 30206036 PMCID: PMC7110597 DOI: 10.1016/j.semerg.2018.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 02/27/2018] [Accepted: 03/10/2018] [Indexed: 11/28/2022]
Affiliation(s)
- E Rodríguez
- Atención Primaria, Consultorio Auxiliar Cervera del Maestre, Consellería de Sanidad Universal de la Comunidad Valenciana, Cervera del Maestre, Castellón, España.
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Nodular or Round Pneumonia With Highly Elevated Rheumatoid Factors. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2015. [DOI: 10.1097/ipc.0000000000000233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Çimen D, Bulcun E, Ekici A, Güngör Ö, Ekici M. Case of round pneumonia: pulmonary infarct and a rare situation that is similar with the lung cancer. CLINICAL RESPIRATORY JOURNAL 2014; 9:512-5. [PMID: 24725533 DOI: 10.1111/crj.12137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 03/05/2014] [Accepted: 04/04/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Round pneumonia (RP) is a rare radiological presentation of a subtype of lobar pneumonia that arises because of a developmental defect in connective tissues (pores of Köhn and channels of Lambert). The round appearance on chest X-ray (CXR) is thought to occur from an infectious process that spreads from small peripheral alveoli centrifugally through interalveolar channels via the pores of Kohn and the canals of Lambert. This explains the nonsegmental distribution and shape of RP. The pathogenesis of RP is unknown. An alternative theory holds that RP in children occurs because of underdeveloped pores of Kohn and the absence of canals of Lambert, limiting the spread of the organism and resulting in a focal, round mass seen on radiographs. As a result of this developmental defect, dissemination of infection remains in a limited area. While this is a well-known entity in childhood, it has been described infrequently in adults. Lesions of RP are not necessarily round; oval lesions can also be seen. It is a radiological subtype of the pneumonia subtype and presents as a solitary nodule or a mass lesion in CXR. METHODS We presented two cases of RP. One mimicked and was mistaken for pulmonary infarction because of triangular pleural-based density and the other mimicked pulmonary malignancy because of a homogeneous triangular opacity based on the pleura on the posteroanterior radiography and computed tomography. CONCLUSION These cases were presented because of RP's importance, and RP should be considered a part of differential diagnosis of pulmonary infarct and lung tumor.
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Affiliation(s)
- Dilay Çimen
- Faculty of Medicine, Department of Pulmonary Medicine, University of Kirikkale, Kirikkale, Turkey
| | - Emel Bulcun
- Faculty of Medicine, Department of Pulmonary Medicine, University of Kirikkale, Kirikkale, Turkey
| | - Aydanur Ekici
- Faculty of Medicine, Department of Pulmonary Medicine, University of Kirikkale, Kirikkale, Turkey
| | - Ömür Güngör
- Faculty of Medicine, Department of Pulmonary Medicine, University of Kirikkale, Kirikkale, Turkey
| | - Mehmet Ekici
- Faculty of Medicine, Department of Pulmonary Medicine, University of Kirikkale, Kirikkale, Turkey
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Velasco-Tirado V, Hernández-Cabrera M, Pisos-Álamo E, Pérez-Arellano JL. Rickettsia typhi. A new causative agent of round pneumonia in adults. Enferm Infecc Microbiol Clin 2012; 30:427-8. [PMID: 22503113 DOI: 10.1016/j.eimc.2012.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Revised: 02/16/2012] [Accepted: 02/18/2012] [Indexed: 12/01/2022]
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Anton E, Larrañaga O. An Unusual Presentation of Adult Pneumonia to the Emergency Department. J Emerg Med 2011; 40:214-5. [DOI: 10.1016/j.jemermed.2009.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2008] [Accepted: 01/06/2009] [Indexed: 11/29/2022]
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Neumonía redonda: una causa poco habitual de nódulos pulmonares múltiples. Arch Bronconeumol 2010; 46:211-2. [DOI: 10.1016/j.arbres.2009.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Revised: 11/08/2009] [Accepted: 11/15/2009] [Indexed: 10/20/2022]
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Abstract
Various diseases in the pediatric age group can present as an intrathoracic rounded opacity on a chest radiograph. The purpose of this pictorial essay is to emphasize the imaging appearance of round pneumonia, an entity that occurs especially in the pediatric population. Additional pathologies with similar chest radiographic appearances are also presented. The diagnosis of round pneumonia should be made in children who have the typical clinical presentation along with chest radiographs demonstrating the characteristic findings.
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Price S, Via G, Sloth E, Guarracino F, Breitkreutz R, Catena E, Talmor D. Echocardiography practice, training and accreditation in the intensive care: document for the World Interactive Network Focused on Critical Ultrasound (WINFOCUS). Cardiovasc Ultrasound 2008; 6:49. [PMID: 18837986 PMCID: PMC2586628 DOI: 10.1186/1476-7120-6-49] [Citation(s) in RCA: 163] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2008] [Accepted: 10/06/2008] [Indexed: 03/06/2023] Open
Abstract
Echocardiography is increasingly used in the management of the critically ill patient as a non-invasive diagnostic and monitoring tool. Whilst in few countries specialized national training schemes for intensive care unit (ICU) echocardiography have been developed, specific guidelines for ICU physicians wishing to incorporate echocardiography into their clinical practice are lacking. Further, existing echocardiography accreditation does not reflect the requirements of the ICU practitioner. The WINFOCUS (World Interactive Network Focused On Critical UltraSound) ECHO-ICU Group drew up a document aimed at providing guidance to individual physicians, trainers and the relevant societies of the requirements for the development of skills in echocardiography in the ICU setting. The document is based on recommendations published by the Royal College of Radiologists, British Society of Echocardiography, European Association of Echocardiography and American Society of Echocardiography, together with international input from established practitioners of ICU echocardiography. The recommendations contained in this document are concerned with theoretical basis of ultrasonography, the practical aspects of building an ICU-based echocardiography service as well as the key components of standard adult TTE and TEE studies to be performed on the ICU. Specific issues regarding echocardiography in different ICU clinical scenarios are then described. Obtaining competence in ICU echocardiography may be achieved in different ways - either through completion of an appropriate fellowship/training scheme, or, where not available, via a staged approach designed to train the practitioner to a level at which they can achieve accreditation. Here, peri-resuscitation focused echocardiography represents the entry level--obtainable through established courses followed by mentored practice. Next, a competence-based modular training programme is proposed: theoretical elements delivered through blended-learning and practical elements acquired in parallel through proctored practice. These all linked with existing national/international echocardiography courses. When completed, it is anticipated that the practitioner will have performed the prerequisite number of studies, and achieved the competency to undertake accreditation (leading to Level 2 competence) via a recognized National or European examination and provide the appropriate required evidence of competency (logbook). Thus, even where appropriate fellowships are not available, with support from the relevant echocardiography bodies, training and subsequently accreditation in ICU echocardiography becomes achievable within the existing framework of current critical care and cardiological practice, and is adaptable to each countrie's needs.
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Affiliation(s)
- Susanna Price
- Adult Intensive Care Unit, Royal Brompton Hospital, Sydney Street, SW3 6NP London, UK
| | - Gabriele Via
- 1st Department of Anesthesia and Intensive Care, Fondazione IRCCS Policlinico San Matteo, P.zzale Golgi 2, 27100 Pavia, Italy
| | - Erik Sloth
- Department of Anaesthesiology, Skejby Sygehus, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Fabio Guarracino
- Cardiothoracic Anaesthesia and ICU, Azienda Ospedaliera Pisana, via Paradisa 2, 56124 Pisa, Italy
| | - Raoul Breitkreutz
- Department of Anesthesiology, Intensive Care, and Pain therapy, Hospital of the Johann-Wolfgang-Goethe University, Theodor Stern Kai 7, 60590 Frankfurt am Main, Germany
| | - Emanuele Catena
- Department of Cardiothoracic Anesthesia, Azienda Ospedaliera Niguarda Ca'Granda, P.za Osp. Maggiore 3, 20100, Milan, Italy
| | - Daniel Talmor
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA 02215, USA
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Atypical pneumonias: current clinical concepts focusing on Legionnaires' disease. Curr Opin Pulm Med 2008; 14:183-94. [PMID: 18427241 DOI: 10.1097/mcp.0b013e3282f79678] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This review provides clinicians with an overview of the clinical features of the atypical pneumonias. Atypical community-acquired pneumonia pathogens cause systemic infections with pneumonia. The key to the clinical diagnosis of atypical pneumonias depends on recognizing the characteristic pattern of extrapulmonary organ involvement different for each pathogen. As Legionella is likely to present as severe pneumonia and does not respond to beta-lactams, it is important to presumptively diagnose Legionnaires' disease clinically so that Legionella coverage is included in empiric therapy. This study reviews the clinical features and nonspecific laboratory markers of atypical pathogens, focusing on Legionnaires' disease. RECENT FINDINGS Case reports/outbreaks increase our understanding of Legionnaires' disease transmission. Both Mycoplasma pneumoniae and Chlamydophilia pneumoniae may cause asthma. Antimicrobial therapy of Chlamydophilia pneumoniae/Mycoplasma pneumoniae is important to decrease person-to-person spread and to decrease potential long-term sequelae. SUMMARY Atypical pulmonary pathogens cause systemic infections accompanied by a variety of characteristic extrapulmonary features. Clinically, it is possible to differentiate Legionnaires' disease from the other typical/atypical pneumonias. Rapid clinical diagnosis of atypical pathogens, particularly Legionnaires' disease, is important in selecting effective empiric therapy and prompting definitive laboratory testing.
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Focal mass-like opacity on chest radiography: round pneumonia. J Emerg Med 2008; 39:e89-90. [PMID: 18650049 PMCID: PMC7126507 DOI: 10.1016/j.jemermed.2007.11.106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2006] [Revised: 01/12/2007] [Accepted: 11/15/2007] [Indexed: 11/23/2022]
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Camargo JJDP, Camargo SM, Machuca TN, Perin FA. Round pneumonia: a rare condition mimicking bronchogenic carcinoma. Case report and review of the literature. SAO PAULO MED J 2008; 126:236-8. [PMID: 18853036 PMCID: PMC11025979 DOI: 10.1590/s1516-31802008000400010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2007] [Revised: 05/16/2007] [Accepted: 06/17/2008] [Indexed: 11/22/2022] Open
Abstract
CONTEXT Round pneumonia is a condition usually described in children, with few reports addressing adult patients. It is an oval-shaped consolidation that, due to its radiological appearance, simulates bronchogenic carcinoma. Its evolution tends to be benign, although diagnostic dilemmas have sometimes required exploratory thoracotomy. Deaths caused by this condition have even been reported. To the best of our knowledge, there have been 31 previous cases of round pneumonia in adults reported in the English and Portuguese-language literature, of which only one was completely asymptomatic. CASE REPORT The case of a 54-year-old female patient presenting a lung mass found on routine imaging evaluation is reported. Respiratory symptoms and signs were absent, but the patient had a significant history of smoking. Her physical examination gave normal results. On chest radiographs, a mass located in the middle third of the right lung was observed. Three weeks after the initial evaluation, the patient was admitted for a complete evaluation and for staging of a pulmonary malignancy, but repeated chest radiographs showed complete resolution.
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Gianvecchio RP, Munõz D, Gianvecchio VAP, Albieri L. Pneumonia redonda, uma apresentação radiológica rara. REVISTA PAULISTA DE PEDIATRIA 2007. [DOI: 10.1590/s0103-05822007000200015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVO: Descrição de caso de pneumonia redonda em criança. DESCRIÇÃO DO CASO: Criança do gênero feminino, quatro anos e 11 meses, com dor no corpo, cefaléia e febre sem sinais localizatórios há dois dias. Apresentou radiografia de tórax com imagem redonda em lobo superior do pulmão direito e lobo médio do pulmão esquerdo. O hemograma mostrou leucocitose e neutrofilia. Com a antibioticoterapia, houve resolução do quadro clínico e radiológico. COMENTÁRIOS: Considerando outros diagnósticos diferenciais diante desta apresentação radiológica, em crianças com quadro infeccioso, é razoável aguardar a resposta clínica à antibioticoterapia antes de prosseguir com investigação de maior complexidade.
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Shie P, Farukhi I, Hughes RS, Oz OK. Round Pneumonia Mimicking Pulmonary Malignancy on F-18 FDG PET/CT. Clin Nucl Med 2007; 32:55-6. [PMID: 17179809 DOI: 10.1097/01.rlu.0000249628.58514.fd] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Philip Shie
- Division of Nuclear Medicine, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9153, USA
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