1/17. pleural effusion during interferon treatment for chronic hepatitis c.A 54-year-old male patient was admitted to Osaka University Medical School Hospital for interferon treatment for chronic hepatitis c and the daily administration of recombinant interferon-alpha 2a started at the dose of 9 megaunits per day. Fourteen days later, moderate right pleural effusion was detected by abdominal magnetic resonance imaging study. He had experienced no symptom to suggest pleural effusion or any pulmonary lesions during interferon treatment. The pleural fluid was serous, showing the character of slightly bloody, turbid and positive Rivalta test, and the levels of lactic dehydrogenase and adenosine deaminase were not elevated. His serum titer of anti-nuclear antibody increased to 80 in homogenous staining, but anti-dna antibody and anti-liver kidney microsome-1 antibody remained negative. Other laboratory tests or physical findings could not satisfy the criteria of any autoimmune diseases, such as systemic lupus erythematosus. After discontinuation of interferon administration, his pleural effusion resolved gradually and disappeared completely by use of no specific drugs. This is the first case that pleural effusion developed during interferon administration without any other clinical signs indicating autoimmune diseases. The increase of serum titer of anti-nuclear antibody prompted us to elucidate that pleuritis might be induced by immunological activation of interferon.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/17. chylothorax fluid autoinfusion in a chronic hemodialysis patient.A large left-sided pleural effusion occurred in a 12-year-old end-stage renal disease patient undergoing chronic hemodialysis (HD). The fluid had physical and laboratory characteristics of chylothorax (CHTX) and was probably related to the multiple HD accesses placed in the neck area. Initially, thoracenteses were performed and the fluid discarded. Subsequently, a permanent drainage catheter placed in the left hemithorax was connected to a syringe with a stopcock, and from here to the arterial port of the HD catheter. One liter of CHTX fluid was removed on dialysis days three times weekly, for 7.5 weeks, and directly re-infused into the patient in a closed sterile circuit. A total of about 20 l was safely returned to the patient. The procedure was well tolerated and provided time until the CHTX resolved spontaneously. It is recommended that in similar clinical settings re-infusion of CHTX fluid should be performed to prevent the loss of protein-/T-cell-rich fluid.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/17. pleural effusion in temporal arteritis.A 73-year-old woman was admitted to hospital with a one-month history of temporal headache, low-grade fever, fatigue, nocturnal sweats and pleural pain. On the fifth day after admission she developed chest pain at the left site of the thorax, productive cough and progressive dyspnea. A pleural effusion was revealed on physical examination, as well as a bilateral temporal artery thickening. An erythrocyte sedimentation rate of 135 mm in the 1st hour was found. Chest X-ray showed left pleural effusion. Thoracocentesis revealed serous fluid exudate. A percutaneous pleural biopsy showed only minimal inflammatory changes. Temporal artery biopsy showed giant cell arteritis. The patient received prednisone 60 mg/daily with a dramatic clinical response. pleural effusion is a rare manifestation of temporal arteritis; only seven cases have been reported worldwide. We present a new case of temporal arteritis with pleurisy.- - - - - - - - - - ranking = 5.5079733450157keywords = physical examination, physical (Clic here for more details about this article) |
4/17. hydrothorax without ascites in liver cirrhosis.pleural effusion in patients with liver cirrhosis and intractable ascites is well known, but hepatic hydrothorax in the absence of ascites is a rare complication. We present the case of a 43-year old male, with a medical history of liver cirrhosis due to hepatitis c virus, who was admitted to the Pneumology Clinic for dyspnoea, worsening of general status and chronic asthenia. The pleural effusion, revealed on physical and laboratory examinations, persisted despite the therapy with diuretics and the frequent thoracocentesis. The thoracostomy followed by pleurodesis also failed. The pecularity of this case was the presence of refractory hydrothorax in the absence of ascites.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/17. Pseudo-meigs syndrome secondary to ovarian germ cell tumor.An 11-year-old white girl presenting with fever, dyspnea, and cough demonstrated a left pleural effusion, ascites, and a suprapubic mass on physical and radiologic examinations. Surgical resection of the mass found a stage Ic malignant mixed germ cell tumor of the ovary. The pleural effusion and ascites were benign and resolved spontaneously after complete resection of the tumor, which is characteristic of a pseudo-meigs syndrome.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/17. Meigs' syndrome in a young woman with a normal serum CA-125 level.We report on a 27-year-old woman who presented with an ovarian solid tumor (20 x 15 cm) and massive ascites. A physical examination and chest X-ray revealed a moderate amount of pleural effusion on the right side. Cytologic study of the pleural effusion showed reactive mesothelial cells without evidence of malignancy. Gram's stain was negative. The blood chemistry was within normal limits. The serum CA-125 level was 22 (normal, < 35) U/ml, the alpha-fetoprotein (AFP) level was 8 (normal, < 20) ng/ml, and the carcinoembryonic antigen (CEA) was 0.5 (normal, < 5) ng/ml. An explorative laparotomy revealed approximately 1500 ml of serous ascites and a very large multilobulated left adnexal mass (20 x 15 cm) with no malignant cytology in the ascitic fluid. Postoperatively, the pleural effusion spontaneously resolved, and the microscopic examination revealed a benign fibroma-thecoma, confirming the diagnosis of Meigs' syndrome. The symptoms resolved after removal of this pelvic tumor. This is an unusual case of a young female with Meigs' syndrome and a normal serum CA-125 level.- - - - - - - - - - ranking = 5.5079733450157keywords = physical examination, physical (Clic here for more details about this article) |
7/17. Ovarian sclerosing stromal tumor presenting as Meigs' syndrome with elevated CA-125.Meigs' syndrome caused by sclerosing stromal tumor is extremely rare and only two cases have been reported to date. An elevated serum level of CA-125 is also unusual and it has been thought that it is the consequence of physical irritation and inflammation. In this report, we present the case of a 50-year-old postmenopausal woman with a sclerosing stromal tumor presenting with Meigs' syndrome and an elevated CA-125 level (1476.8 IU/mL). This case highlights the difficulty in discerning the diagnosis of Meigs' syndrome from that of an ovarian malignancy and it should be considered in the differential diagnosis in postmenopausal patients with pelvic mass, ascites, pleural effusions and elevated serum CA-125.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/17. yellow nail syndrome: a perspective.The yellow nail syndrome is an unusual lymphangitic disorder classically characterized by the presence of nail discoloration, lymphedema and pleural effusion. Since the recognition of the significance of these associated physical findings, four cases have been diagnosed at our institution in the last six years. This suggests that the syndrome may not be as rare as previously reported in medical literature. More often it may remain unrecognized in the absence of the classic triad of physical findings. To heighten awareness of this disorder, we describe our most recent patient diagnosed with YNS and provide a review of the current medical literature.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
9/17. Massive primary chylopericardium: a case report.A large pericardial effusion was discovered in an asymptomatic 12-year-old boy admitted for an elective orthopedic procedure. On physical examination, heart rate was 96 and blood pressure was 130/70 without paradox. The neck veins were not distended, but heart tones were distant. Chest roentgenogram (CXR) showed an enlarged cardiac silhouette. Echocardiogram showed a massive pericardial effusion compressing the right atrium, with depressed ventricular contractility. pericardiocentesis yielded 450 mL of chylous fluid. A percutaneous pericardial drain was placed and drained another 400 mL of chyle. Pericardial fluid reaccumulated even though the patient was on a low-fat diet, and 1 week after admission left thoracotomy was performed with partial pericardiectomy and pericardial window. There was 1 L of chyle in the pericardial sac; frozen section of the pericardium showed lymphangiectasia. Chest tube drainage diminished rapidly and the patient was discharged. Follow-up CXR at 1 week showed fluid in both pleural spaces requiring bilateral tube thoracostomies again draining chyle. Even with total parenteral nutrition (TPN), 500 mL/d of chyle drained from the pleural tubes. Right thoracotomy with ligation of the thoracic duct was performed after 1 week of TPN. Pleural drainage abruptly dropped, and there has been no reaccumulation in either the pleural spaces or pericardium at 6-month follow-up. This case dramatically supports early thoracic duct ligation and partial pericardiectomy as the treatment of choice for primary massive chylopericardium.- - - - - - - - - - ranking = 5.5079733450157keywords = physical examination, physical (Clic here for more details about this article) |
10/17. empyema of the gallbladder: a case with unusual presentation.A case of gallbladder empyema associated with multiple complications caused by a delay in diagnosis is presented. Recent literature is reviewed especially emphasizing the clinical presentation with scanty physical signs. Greater awareness of the indolent and chronic presentation might reduce the considerable morbidity and mortality that are associated with delayed operative intervention.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
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