1/7. Purulent pericarditis presenting as an extracardiac mass in a patient with untreated diabetes.A 50-year-old man with symptoms of bi-ventricular heart failure was transferred to our hospital with a diagnosis of extracardiac tumor. He had a 10 year history of untreated diabetes. Chest computed tomography (CT) revealed an extracardiac mass in the right atrio-ventricular groove. cardiac catheterization revealed an elevated mean right atrial pressure of 18 mmHg, mean pulmonary wedge pressure of 16 mmHg, and the right ventricular pressure curve demonstrated typical dips and plateaus. At surgery, there was severe adhesion between the pericardium and epicardium, and the pericardium was severely thickened and contained turbid pus. In the left thoracic cavity, there was large amount of pleural effusion and pus. Therefore, the patient was diagnosed with purulent pericarditis caused by left empyema. The thickened pericardium at the anterior portion of the heart was resected, however resection of the remaining portion was abandoned because the adhesion was so tight. After surgery, the patient underwent irrigation of the heart and left thoracic cavity by 1% povidone iodine solution and 0.5 mg/ml of imipenem for 7 days. Bacteriologic culture of the pus from the pericardium revealed anaerobic gram negative bacteria. After 4 months of antibiotics infusion, his C reactive protein became negative and the patient was subsequently discharged from our hospital.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
2/7. Pulmonary nocardiosis associated with idiopathic thrombocytopenic purpura.A 69-year-old woman with idiopathic thrombocytopenic purpura, who was regularly followed and treated with prednisolone and danazol, was admitted to our hospital because of shortness of breath. Chest roentgenogram showed a large amount of left-sided pleural effusion. Gram-positive branching rods, subsequently identified as nocardia farcinica, were isolated from the fluid. Antibiotic treatment together with pleural drainage with an intercostal catheter resulted in complete remission of pyothorax. Pulmonary nocardiosis is a rare disease, but recognition of the disease in immunocompromised patients and the prompt initiation of appropriate treatments based on isolation of the pathogen can lead to a successful outcome.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
3/7. Combined systemic and intrapleural treatment of aspergillus pulmonary empyema after invasive aspergillosis.A 12-year-old immunocompromised boy was hospitalized because of invasive aspergillosis with lung and central nervous system involvement. He was treated with surgery and liposomal amphotericin b, but he developed a pulmonary empyema and a bronchopleural-cutaneous fistula. A catheter was placed through the fistula, and amphotericin b (up to 50 mg in 10 ml of 5% dextrose) was instilled daily into the pleural cavity for 45 days. Treatment was well-tolerated, and the empyema resolved completely, with no evidence of recurrence after 2 years of follow-up.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
4/7. empyema following percutaneous catheter drainage of upper abdominal abscess.Percutaneous catheter drainage is a standard therapy for management of selected intra-abdominal abscesses. We describe three patients in whom this technique caused complicated thoracic empyemas. All patients required thoracotomy for decortication despite initial thoracostomy tube drainage. In each case, the percutaneously placed drainage catheter was found traversing the costophrenic angle, leading to direct communication between the pleural space and the abscess cavity. review of the anatomic relationships of the inferior pleural margin to the lower ribs may help prevent this technical error.- - - - - - - - - - ranking = 6keywords = catheter (Clic here for more details about this article) |
5/7. Successful treatment of massive bleeding into the open thoracotomy space by pulmonary artery occlusion: report of a case.A 69-year-old man underwent decortication and latissimus dorsi muscle transposition for the treatment of chronic empyema in January 2001. The empyema recurred in March 2002, and open drainage was thus started in July 2002. In February 2003, massive hemorrhaging from the thoracic cavity occurred. Tamponade and hemostasis were performed immediately, and angiography revealed bleeding from the pulmonary artery (PA). After identification of the bleeding point, surgical hemostasis was successfully achieved following PA occlusion with a Swan-Ganz thermodilution catheter.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
6/7. Recurrent massive bleeding from an intercostal artery aneurysm through an empyema chest tube.Intercostal artery aneurysms can be of congenital, posttraumatic, or mycotic type. Intercostal arterial aneurysmal bleeding can be brisk enough to lead into shock or sudden death. Bleeding through chest tubes has been reported due to various causes; it is commonly due to injury to intercostal or pulmonary vessels and is occasionally due to leaking aortic aneurysms. We describe a patient who had development of repeated episodes of brisk bleeding through an empyema chest tube leading to shock episodes requiring resuscitations. After extensive search, the bleeding source was found to be an intercostal artery aneurysm. Transcatheter embolization of that intercostal artery with absorbable gelatin sponge (Gelfoam) was successful in obliterating the blood flow to the aneurysm and in preventing further bleeding.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
7/7. Percutaneous drainage of pleural collections.pneumothorax is a frequent complication of interventional pulmonary procedures. Percutaneous catheter placement enables safe and effective drainage of pneumothoraces with rapid restoration of vital capacity, oxygenation, and lung reexpansion.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |