11/205. Biphasic pulmonary blastoma in a child.pulmonary blastoma (PB) is a rare malignant pulmonary tumor composed of immature mesenchyme and/or epithelium that resembles an embryonic lung at 10-16 weeks gestation. PBs constitute only 0.25 to 0.5 percent of all primary malignant lung tumors. Approximately 20 percent of the reported cases have occurred in pediatric patients. A seven-year-old girl presented with fever, cough, respiratory distress and chest pain on the left side. An x-ray, ultrasonography and a computed tomographic scan of the chest showed a large mass consisting of solid and cystic components almost completely occupying the left hemithorax associated with pleural effusion. The diagnosis of biphasic PB was established by histological examination of thoracotomy material. The patient was considered inoperable due to tumor involvement of the mediastinum, and she died two days after the initiation of chemotherapy. We report this case of PB to raise attention to the clinical, radiological and pathological features of PB in childhood because of its rarity.- - - - - - - - - - ranking = 1keywords = chest, pain (Clic here for more details about this article) |
12/205. Clinical features of patients with acute respiratory illness and rhinovirus in their bronchoalveolar lavages.BACKGROUND: Several reports in selected populations suggest that human rhinovirus (HRV) may be responsible for lower respiratory tract infections or pneumonia. We describe clinical features of all patients with rhinovirus cultured from their bronchoalveolar lavage (BAL) during a 10-yr period in a tertiary care center. methods: Results for viral culture of all lower respiratory specimens performed during a 10-year period at the University of virginia health Sciences Center were reviewed. A case was defined as any patient with a positive culture for HRV in a BAL specimen. A comprehensive review of the patients' medical records was performed. In one case, in situ hybridization (ISH) was performed in order to identify whether rhinoviral rna was present in bronchial biopsy specimens. RESULTS: During the 10-year study period viruses were identified in 431 lower respiratory tract specimens, and were most frequently cytomegalovirus or herpes simplex virus. Twenty patients (ages, 2.5-86 year) had a bronchoalveolar specimen culture positive for HRV. All had an abnormal chest radiograph, 60% were admitted to the intensive care unit, and 25% expired during their hospitalization. In 18 patients (90%) various severe underlying conditions were identified including solid organ transplants in seven, malignancies in four and AIDS in two. An immunosuppressive disease or condition requiring immunosuppressive therapy was present in all cases. In addition to HRV, one or more potential pathogens were identified in respiratory specimens from 14 patients (70%). Histopathological abnormalities, ranging from fibropurulent debris in alveoli to diffuse alveolar damage, were present in 6 of 13 bronchial biopsies. In two cases without any other significant pathogens than HRV, acute inflammations with fibropurulent debris in alveoli were observed. One lung transplant patient showed intermittent recovery of HRV in her respiratory specimens during a 15-week time period, but ISH did not show HRV rna in bronchial epithelial cells. CONCLUSION: Our observations suggest that HRV recovery from BALs or lower respiratory tract samples in highly immunocompromised patients is associated with severe lower respiratory tract illness. Whether HRV directly causes viral pneumonia or predispose to pulmonary injury and/or superinfection remains uncertain.- - - - - - - - - - ranking = 0.45107943219381keywords = chest (Clic here for more details about this article) |
13/205. Aspiration of an avulsed primary incisor. A case report.A 7-year-old girl had injured her maxillary primary incisors in a playground. One of the already-mobile incisors had been avulsed. The child who had a cough and breathing difficulties during sleep was diagnosed as suffering from upper respiratory infection and was treated with antibiotics. A few days later because her body temperature was elevated a chest radiograph was taken. The radiograph revealed an aspirated tooth in her right bronchus with atelectasis of the lower lobe. The tooth was removed by bronchoscopy. dentists should suspect any tooth that has been avulsed and not found as possibly aspirated.- - - - - - - - - - ranking = 1.6643363821732keywords = upper, chest (Clic here for more details about this article) |
14/205. An unusual anterior mediastinal mass in a child with B-thalassemia major.This case report describes the delayed appearance of Morgagni's hernia in a 5 year old child with B-thalassemia major to present as an anterior mediastinal mass. The progressive enlargement of the liver resulted in herniation of the left lobe of the liver through the already congenitally present Morgagni's hernia leading to its enlargement. The report also emphasizes the fact that a previously normal chest x-ray should not preclude the diagnosis of Morgagni's hernia. Morgagni's hernia should also be included in the differential diagnosis of anterior mediastinal masses in children.- - - - - - - - - - ranking = 0.45107943219381keywords = chest (Clic here for more details about this article) |
15/205. Aspergillus laryngotracheobronchial infection in a 6-year-old girl following bone marrow transplantation.Localised fungal infection of the larynx and tracheobronchial tree is extremely uncommon. We report the case of a 6-year-old girl with acute lymphocytic leukaemia, who developed symptoms of upper airways obstruction 6 months after a cord blood transplant. bronchoscopy showed a pale plaque lesion in the larynx and tracheobronchial tree. aspergillus fumigatus was cultured from a biopsy of the lesion. The patient was treated successfully with a prolonged course of amphotericin b and assessed with multiple surveillance bronchoscopies.- - - - - - - - - - ranking = 1.2132569499794keywords = upper (Clic here for more details about this article) |
16/205. Vagal neuropathy after upper respiratory infection: a viral etiology?PURPOSE: To describe a condition that occurs following an upper respiratory illness, which represents injury to various branches of the vagus nerve. patients with this condition may present with breathy dysphonia, vocal fatigue, effortful phonation, odynophonia, cough, globus, and/or dysphagia, lasting long after resolution of the acute viral illness. The patterns of symptoms and findings in this condition are consistent with the hypothesis that viral infection causes or triggers vagal dysfunction. This so-called postviral vagal neuropathy (PVVN) appears to have similarities with other postviral neuropathic disorders, such as glossopharyngeal neuralgia and Bell's palsy. MATERIALS AND methods: Five patients were identified with PVVN. Each patient's chart was reviewed, and elements of the history were recorded. RESULTS: Each of the 5 patients showed different features of PVVN. CONCLUSIONS: Respiratory infection can trigger or cause vocal fold paresis, laryngopharyngeal reflux, and neuropathic pain.- - - - - - - - - - ranking = 6.1641258855092keywords = upper, pain (Clic here for more details about this article) |
17/205. A case of surgically treated acute cerebellitis with hydrocephalus.We report a pediatric case of acute cerebellitis with hydrocephalus requiring emergency placement of external ventricular drainage. A 7-year-old boy presented with acute development of headache, nausea and vomiting. Magnetic resonance (MR) examination revealed obstructive hydrocephalus and marked bilateral cerebellar swelling on T2-weighted imaging. After the placement of external ventricular drainage, symptoms of intracranial hypertension promptly improved, and other clinical and radiological abnormalities gradually resolved following intravenous injection of corticosteroids. Surgical treatment and timing in the treatment of acute cerebellitis are discussed.- - - - - - - - - - ranking = 0.035088918275441keywords = headache (Clic here for more details about this article) |
18/205. Clinical presentation of inhalational anthrax following bioterrorism exposure: report of 2 surviving patients.The use of anthrax as a weapon of biological terrorism has moved from theory to reality in recent weeks. Following processing of a letter containing anthrax spores that had been mailed to a US senator, 5 cases of inhalational anthrax have occurred among postal workers employed at a major postal facility in washington, DC. This report details the clinical presentation, diagnostic workup, and initial therapy of 2 of these patients. The clinical course is in some ways different from what has been described as the classic pattern for inhalational anthrax. One patient developed low-grade fever, chills, cough, and malaise 3 days prior to admission, and then progressive dyspnea and cough productive of blood-tinged sputum on the day of admission. The other patient developed progressively worsening headache of 3 days' duration, along with nausea, chills, and night sweats, but no respiratory symptoms, on the day of admission. Both patients had abnormal findings on chest radiographs. Non-contrast-enhanced computed tomography of the chest showing mediastinal adenopathy led to a presumptive diagnosis of inhalational anthrax in both cases. The diagnoses were confirmed by blood cultures and polymerase chain reaction testing. Treatment with antibiotics, including intravenous ciprofloxacin, rifampin, and clindamycin, and supportive therapy appears to have slowed the progression of inhalational anthrax and has resulted to date in survival.- - - - - - - - - - ranking = 0.93724778266305keywords = chest, headache (Clic here for more details about this article) |
19/205. death due to bioterrorism-related inhalational anthrax: report of 2 patients.On October 9, 2001, a letter containing anthrax spores was mailed from new jersey to washington, DC. The letter was processed at a major postal facility in washington, DC, and opened in the Senate's Hart Office Building on October 15. Between October 19 and October 26, there were 5 cases of inhalational anthrax among postal workers who were employed at that major facility or who handled bulk mail originating from that facility. The cases of 2 postal workers who died of inhalational anthrax are reported here. Both patients had nonspecific prodromal illnesses. One patient developed predominantly gastrointestinal symptoms, including nausea, vomiting, and abdominal pain. The other patient had a "flulike" illness associated with myalgias and malaise. Both patients ultimately developed dyspnea, retrosternal chest pressure, and respiratory failure requiring mechanical ventilation. leukocytosis and hemoconcentration were noted in both cases prior to death. Both patients had evidence of mediastinitis and extensive pulmonary infiltrates late in their course of illness. The durations of illness were 7 days and 5 days from onset of symptoms to death; both patients died within 24 hours of hospitalization. Without a clinician's high index of suspicion, the diagnosis of inhalational anthrax is difficult during nonspecific prodromal illness. Clinicians have an urgent need for prompt communication of vital epidemiologic information that could focus their diagnostic evaluation. Rapid diagnostic assays to distinguish more common infectious processes from agents of bioterrorism also could improve management strategies.- - - - - - - - - - ranking = 0.54892056780619keywords = chest, pain (Clic here for more details about this article) |
20/205. Bag-mask ventilation as a temporizing measure in acute infectious upper-airway obstruction: does it really work?jaw-thrust and bag-mask ventilation usually provide adequate oxygenation in patients with acute infectious upper-airway obstruction (AIUAO). It is the treatment of choice for patients on the way to hospital or in an emergency department until definitive stabilization is achieved with available resources. We report three fatal case studies showing ineffective bag-mask ventilation in AIUAO that raise concerns over this treatment. Case 1 is a 4-year-old patient with epiglottitis who suffered complete obstruction during transport to the hospital. Case 2 is a 3-year-old patient with epiglottitis who suffered complete obstruction during transport to the hospital. Case 3 is a 3-year-old child with viral laryngotracheitis and respiratory arrest just after the admission. Should the approach of bag-mask ventilation in AIUAO change to ventilate patients in the prone position? This approach offers two advantages. First, gravity helps the epiglottis fall forward, reducing the airway obstructions. Second, if the patient vomits during ventilation, the vomit will fall to the floor. During bag-mask ventilation in patients with severe partial airway obstruction, ventilation pressure is high. Gastric inflation may occur and rapidly distend the stomach. This gastric distension interferes with ventilation by elevating the diaphragm, resulting in a decreased lung volume. Cricoid pressure could prevent gastric distension in these instances and should be recommended.- - - - - - - - - - ranking = 6.0662847498968keywords = upper (Clic here for more details about this article) |
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