| The first case of idiopathic bronchiolitis obliterans with organizing pneumonia (BOOP) presenting as solitary pulmonary nodule with spontaneous hydropneumothorax is reported in a 54-year-old man. A wedge resection of the right lower lobe was performed to show typical histological features of BOOP. This case report demonstrates that BOOP has a very diverse clinical manifestation and stresses the need to include solitary pulmonary nodule with hydropneumothorax in the spectrum of BOOP. ( info) |
2/30. Pulmonary sarcoidosis: presentation as bilateral spontaneous hydropneumothorax and pulmonary infiltrates. Pulmonary manifestations in sarcoidosis vary, ranging from asymptomatic chest radiographic abnormalities to progressive destruction of lung parenchyma with respiratory insufficiency. We describe a case of sarcoidosis in a patient with bilateral hydropneumothorax, parenchyma infiltrates, and respiratory insufficiency. hydropneumothorax is extremely rare, and to our knowledge only two cases have been reported. ( info) |
3/30. Tension pneumothorax associated with hydatid cyst rupture. SUMMARY: Hydatid disease is common in turkey. Tension pneumothorax is rare, but it is an important complication of the hydatid cyst with significant morbidity and mortality. Tension hydropneumothorax secondary to the rupture of a hydatid cyst was detected in 5 of 185 spontaneous pneumothorax cases that were treated in the authors' clinic between 1992 and 1998. All patients were subjected to surgical treatment after urgent tube thoracostomy. No mortality or recurrence was observed at follow-ups of 9 to 24 months. ( info) |
4/30. Reexpansion pulmonary oedema as a complication of pleural drainage. One hundred and one (6%) of 1,678 patient studied had bilateral reexpansion pulmonary oedema(RPO). On the whole, one thousand, seven hundred and seventy nine (1,779) pleural spaces were studied, fifteen pleural spaces (0.8%), with mean age of 23 /- 4.5 years had RPO. Among these 15 patients with RPO, the mean period of lung collapse before pneumothorax (PThx) was evacuated was 31.8 /- 21.8 days and for hydrothorax (HThx) was 31.3 /- 30.1 days; for 15 patients without RPO (controls), matched for age and sex, the mean period of lung collapse before CTTD was 7.5 /- 4.1 days and 5.4 /- 1.3 days respectively for PThx and HThx. The differences in the period of lung collapse among patients with RPO and those without, for each pleural disease was statistically significant (P < 0.03). Volume of pleural fluid drained before RPO was noticed was 2196 /- 1103 mls, for the 15 matched patients without RPO (controls), it was 1060 /- 115 mls (p < 0.05). Volume of pleural fluid drained among the patients with SR (Severe response), MR (mild to moderate response) and RD (radiological diagnosis) did not correlate with severity of response. We conclude that prevention of RPO is the desired goal in the management of pleural effusion or Pneumothorax. RPO is commonest among young patients who have had lung collapse for 7 or more days. In these circumstances RPO is prevented, its incidence and severity reduced by methods of gradual evacuation of PThx or pleural fluid drainage. ( info) |
| Pleural involvement in nocardiosis is rarely reported from india. A case of hydropneumothorax due to nocardia asteroides in a patient with diabetes mellitus is reported. Tube thoracostomy drainage and therapy with trimethoprim-sulphamethoxazole for seven months prevented reaccumulation of pleural fluid and improved the general condition but failed to expand the lung. bronchoscopy may be useful if multiple sputum examinations are negative in diagnosing pulmonary nocardiosis. ( info) |
| A previously healthy Caucasian male developed hydropneumothorax and a pleural peel filled with pleomorphic, septate hyphae. The only organism grown from cultures of the lung and pleural fluid was coccidioides immitis, confirmed by exoantigen testing. Spherule-endospore forms were produced, however, following injection of the arthroconidial tissue isolate into BALB/c mice. The patient had a positive immunodiffusion complement-fixation test and developed a positive coccidioidin skin test during therapy. He recovered following thoracotomy and wedge resection of the ruptured coccidioidal cavity, and therapy with amphotericin b followed by fluconazole. The sole presence of the mycelial form of the dimorphic fungus C. immitis in the pleural space may have been due to a low CO2 partial pressure at that site secondary to a bronchopleural fistula. The case shows a distinctive and uncommon presentation of coccidioidomycosis which demonstrates the specificity of both the immunodiffusion complement-fixation assay in diagnosing this disease and the exoantigen test in confirming culture results. ( info) |
7/30. Large asymptomatic hydropneumothorax after thoracentesis. The interventional radiology Case Corner Series is a new feature that will be presented quarterly in JVIR. The format is uniquely designed for the busy interventional radiology practitioner. Case presentations are short and to the point. Discussions are succinct and pertinent to current practice. Each quarter, a difficult or problem case is presented and the reader is challenged with questions relevant to the case. Short answers are then provided based on referenced sources from the current literature. Cases are drawn from the interventional radiology experience at the University of california san francisco and are edited by Jeanne M. LaBerge, MD, and Robert K. Kerlan, Jr, MD. ( info) |
8/30. A case of Lemierre's syndrome presenting with multiple pulmonary abscesses associated with a tension hydropneumothorax resulting in a mediastinal shift. INTRODUCTION: We report a case of Lemierre's syndrome. CLINICAL PICTURE: A previously healthy 36-year-old woman presented with a 2- to 3-month history of fever, cough, dyspnoea and sore throat, which had worsened in the week prior to presentation. Computed tomography of the thorax showed multiple bilateral cavitating lesions and a right-sided hydropneumothorax with mediastinal shift. blood cultures grew fusobacterium and bacteroides species. TREATMENT: Broad-spectrum antibiotics were commenced, a chest drain was inserted, and the patient was transferred to the intensive care unit due to worsening respiratory failure. OUTCOME: Despite intensive supportive care with broad-spectrum antibiotics, aggressive fluid resuscitation and high-dose inotropic support, the patient developed acute renal failure, disseminated intravascular coagulation and intractable shock, and succumbed 8 days later. CONCLUSIONS: Although this condition is uncommon, it should be considered in the differential diagnosis of patients with pulmonary cavitating lesions, especially in the context of fever and rigors preceded by a sore throat. ( info) |
9/30. Unusual case of pyopneumothorax in tennessee. rupture of a coccidioidal pulmonary cavity with subsequent pyopneumothorax is a rare clinical event, even in areas endemic for coccidioidomycosis. Our encounter with a patient diagnosed with this condition in northeast tennessee serves notice to clinicians that coccidioidomycosis is indeed a traveling fungal disease, and practitioners must be alert to common and uncommon manifestations of infection associated with this fungus. A literature review pertaining to coccidioidal pyopneumothorax revealed that patients usually present with a recent onset of chest pain. Serologic testing and pleural fluid culture are highly useful, and management includes surgical intervention with or without antifungal therapy. ( info) |
10/30. A case of acute pneumonitis following talc pleurodesis: high-resolution CT findings. talc is one of the most effective agents for pleurodesis but it may induce serious pulmonary complication caused by pulmonary talc deposition. We describe a case of acute pneumonitis following talc pleurodesis in a 30-year-old woman who had malignant pleural effusion. air-space consolidation and ground-glass attenuation developed in both lungs, predominantly in the ipsilateral lung, shortly after pleurodesis and were not satisfactorily explained by reexpansion pulmonary edema or pneumonia. She was started on treatment with corticosteroid. Her dyspnea rapidly improved and air-space consolidation resolved over a few months on follow-up radiographs. ( info) |