1/56. Treatment for empyema with bronchopleural fistulas using endobronchial occlusion coils: report of a case.We report herein the case of a woman with bronchopleural fistulas treated with the endobronchial placement of vascular embolization coils. She was referred to our hospital to undergo lavage of a postoperative empyema. She had undergone an air plombage operation for pulmonary tuberculosis 9 years previously. However, bronchopleural fistulas occurred postoperatively and she had to continue the use of a chest drainage tube since then. Lavage of her empyema space with 5kE of OK-432 (picibanil: Chugai) plus 100 mg minocycline was performed once every 2 weeks for 3 months, and the purulent discharge from the empyema remarkably decreased. Thereafter, the bronchopleural fistulas were occluded endobronchially by the placement of vascular embolization coils. Soon after the procedure, air leakage from the fistulas was stopped and the drainage tube was removed 2 days later. The patient remains well without any additional treatment at 20 months after this treatment. As treatment for empyema with bronchopleural fistulas, it would be worth trying to lavage the empyema space with OK-432 until it is cleaned out and to plug the fistulas by the endobronchial placement of embolization coils, before such radical operations as thoracoplasty and space-filling of the empyema are considered.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
2/56. Pleural empyema: An unusual presentation of esophageal perforation.A 67-year-old patient presented with pleural empyema as the sole manifestation of thoracic esophageal perforation, 2 weeks after accidental fish bone ingestion. Nonspecific chest pain and general deterioration, unusual presenting symptoms in themselves, accounted for the extreme delay in the diagnosis. The empyema was treated surgically, and the esophageal perforation conservatively. Despite the poor prognostic factors, the patient recovered completely after 50 days in hospital.- - - - - - - - - - ranking = 2.2861453846145keywords = chest pain, chest (Clic here for more details about this article) |
3/56. Lack of mediastinal shift as a clue to delayed postpneumonectomy empyema.Delayed postpneumonectomy empyema is uncommon. The condition is usually elusive and diagnosed late in the course of the disease, leading to increased morbidity. New air-fluid level on chest x-ray film or appearance of empyema necessitatis may enhance the index of suspicion and lead to early diagnosis, but in many cases no clinical or laboratory clues are apparent. We describe the case of a 60-year-old man with high fever and dyspnea 3(1/2) years after pneumonectomy. Diagnosis of postpneumonectomy empyema was delayed and finally suggested by the lack of expected mediastinal shift on chest film. Computed tomography (CT) of the chest showed a large quantity of fluid, which later proved to be empyema. The patient was treated successfully by continuous cavity irrigation with neomycin and systemic antibiotics. We conclude that in postpneumonectomy patients with septic fever, the only clue to diagnosis of delayed postpneumonectomy empyema may be hemithorax opacification without mediastinal shift, confirmed by CT-guided thoracocentesis. Therapy with cavity irrigation and systemic antibiotics seems appropriate.- - - - - - - - - - ranking = 3keywords = chest (Clic here for more details about this article) |
4/56. Managing the nonsurgical candidate with an empyema related to community-acquired lobar pneumonia.This case study reviews the medical management for a 76-year-old patient with a cardiac history and recurrent admissions for a persistent pneumonia. Computed tomography showed evidence of an empyema in the right middle and lower lobes of his lung. The standard treatment for an empyema is a thoracotomy and long-term antibiotics. However, the patient's cardiac history disqualified surgery as an option. Therefore the management plan was composed of antibiotics and treatment of his symptoms. The patient's symptoms improved after a week of levofloxacin (Levaquin), prednisone, bilevel positive airway pressure mask as required, and oxygen. He was discharged with home care, oxygen, Levaquin, tapering doses of prednisone, and previous medications. At a 6-week follow-up examination, the patient was asymptomatic and had marked improvement noted on chest radiograph. The advanced practice nurse played an important role in this patient's recovery by conducting patient education and coordinating follow-up after his release.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
5/56. Pleural empyema due to salmonella: a case report.Pleuropulmonary involvement of salmonella infection is very rare and only two cases of salmonella empyema have been reported in korea. We report the case of a 70-year-old female diabetic patient who presented with right flank pain and right lower chest pain. The chest radiographs revealed fibrostreaky and hazy density at right lower lung field and blunting of right costophrenic angle. Thoracentesis revealed turbid yellowish fluid. salmonella group B was identified from the cultures of blood and pleural fluid. After antimicrobial therapy and repeated therapeutic thoracentesis, the patient was improved.- - - - - - - - - - ranking = 3.2861453846145keywords = chest pain, chest (Clic here for more details about this article) |
6/56. eikenella corrodens: an unusual cause of severe parapneumonic infection and empyema in immunocompetent patients.Over the past 25 years, eikenella corrodens has increasingly been recognized for its pathogenic potential. Previously identified as an organism most likely to cause opportunistic infection in the immunocompromised host, Eikenella more recently has been implicated in a number of clinical infections in non-immunocompromised patients. We report a case of community-acquired pneumonia, caused by Eikenella, in a patient with diabetes mellitus and a past history of testicular cancer. A review of the literature was conducted in order to review other cases of pulmonary infection with Eikenella, in immunocompetent adults. The condition was diagnosed in 15 patients, occurring most often in men with a mean age of 50. patients most often presented with fever, cough and pleuritic chest pain. Complications often involved parapneumonic effusion, empyema, and necrotic parenchymal disease. mortality rates appear to be low. Eikenella is most often susceptible to ampicillin and has variable susceptibility to aminoglycosides. The addition of clindamycin in non-immunocompromised patients with Eikenella infection, co-infected with other pathogens, also appears to be useful. Surgical intervention plays an important role in the recovery of these patients.- - - - - - - - - - ranking = 2.2861453846145keywords = chest pain, chest (Clic here for more details about this article) |
7/56. Management of postpneumonectomy bronchopleural-cutaneous fistula with a single free flap.A variety of local flaps have been described for chest wall and bronchopleural fistula reconstruction. When local options cannot be used because of previous surgery, trauma, radiation, or body habitus, free flaps become an acceptable option. The authors report a case of persistent bronchopleural-cutaneous fistula treated with a free latissimus dorsi musculocutaneous flap that obliterated the right chest cavity, closed the site of empyema drainage, and aided healing of a bronchopleural fistula. Surgical technique including anastomosis to the innominate vein is described.- - - - - - - - - - ranking = 2keywords = chest (Clic here for more details about this article) |
8/56. An unusual intrapleural foreign body: ignored aspiration.A 54-year-old male patient was admitted to our department with fever, dyspnea and chest pain. Left pleural effusion and destroyed left lower lobe was noticed in his computerized chest tomography. After chest tube drainage, massive hemoptysis developed. An emergency thoracotomy was performed. A bronchopleural fistula, destroyed left lower lobe and the head of an oat were detected in the pleural space. Left lower lobectomy and perioperative pneumoperitoneum were performed. The patient had an uneventful postoperative (p.o.) course and was discharged on p.o. day 6. We present this case because of the rarity and to emphasize the clinical presentation. The physicians should be aware of life threatening complications of oat head aspiration.- - - - - - - - - - ranking = 4.2861453846145keywords = chest pain, chest (Clic here for more details about this article) |
9/56. A case of extrapleural empyema.A 49-year-old man with diabetes mellitus and alcoholic liver cirrhosis presented with dyspnoea and fever. A chest computed tomography scan revealed three areas of loculated pleural effusion. Initially, the patient was thought to have an intrapleural empyema and was treated with intravenous antibiotics and closed drainage. However, as he did not improve, he was then treated with open drainage. During open drainage, the patient was diagnosed to have an extrapleural empyema and improved following open drainage treatment.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
10/56. Pleural gas gangrene secondary to esophageal injury by an ingested fish bone.We report a 73-year-old woman with right pleural gas gangrene, treated successfully by thoracoscopic debridement. The clinical course and chest computed radiography and thoracoscopy findings suggested that her condition resulted from a relatively rare esophageal injury after she accidentally ingested a fish bone. Video-assisted thoracoscopic intervention has proved useful in cases involving pleural gas gangrene.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
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