Acute Pleuritis Research Articles

Thymic MALT lymphoma associated with Sjögren’s syndrome with postoperative cardiac tamponade and acute pleuritis: a case report

BackgroundThymic mucosa-associated lymphoid tissue (MALT) lymphoma is rare and is known to be associated with Sjögren’s syndrome (SjS). SjS is rarely accompanied by serositis. Here, we describe the first case of postoperative cardiac tamponade and acute pleuritis in a patient with thymic MALT lymphoma associated with SjS.Case presentationA 33-year-old woman with SjS presented with an anterior mediastinal mass on chest computed tomography, which was performed for further examination of the condition. Suspecting a thymic MALT lymphoma or thymic epithelial tumor, total thymectomy was performed. The mediastinal mass was histopathologically diagnosed as a thymic MALT lymphoma. The patient was discharged with a good postoperative course but visited the hospital 30 days after surgery for dyspnea. Cardiac tamponade was observed and drainage was performed. Four days after pericardial drainage, chest radiography revealed massive left pleural effusion, and thoracic drainage was performed. The patient was diagnosed with serositis associated with SjS and treated with methylprednisolone, which relieved cardiac tamponade and pleuritis.ConclusionsSurgical invasion of thymic MALT lymphomas associated with SjS may cause serositis. Postoperative follow-up should be conducted, considering the possibility of cardiac tamponade or acute pleuritis due to serositis as postoperative complications.

Recognizing the pleura in asbestos-related pleuropulmonary disease: Known and new manifestations of pleural fibrosis.

Pleural thickening (PT) is a major consequence of exposure to all fiber types of asbestos. In recent decades, it is more prevalent than parenchymal asbestosis. Its manifestations occupy a full clinical and radiographic spectrum. Six major manifestations can be identified: (a) acute pleuritis generally with effusion; (b) diffuse PT or fibrous pleuritis; (c) rounded atelectasis; (d) circumscribed PT or plaques; (e) chronic pleuritic pain; and (f) mesothelioma. Review of the experience of workers and community members in Libby, MT to asbestiform fibers in vermiculite has confirmed the appearance of these previously known benign and malignant asbestos-related diseases as well as a unique pleuropulmonary disease characterized as lamellar PT and associated with progressive decline in pulmonary function and pleuritic pain. Despite previous literature asserting that PT represents a marker for asbestos exposure without significant effect on pulmonary function and physiology, the experience of Libby amphibole (LA) disease, along with other studies, indicates that PT plays a role in declining vital capacity in those with prolonged or unusual exposures such as those arising from LA.

COVID - 19 - a New Challenging Disease for Intensivists and Cardiologists. From Basic Science to the Clinical Setting

A novel coronavirus causing Acute Respiratory Distress Syndrome (SARS-CoV-2) has been considered the cause of a large number of lower respiratory tract infections leading to severe respiratory failure in many cases. However, the evidence-based hospital reports show that the COVID -19 infestation may range from an asymptomatic or minimally symptomatic course with an almost bizarre deterioration of life parameters (“silent hypoxia”) through to critically ill patients with multiple organ failure including that of the lungs, kidneys, nervous system and other organs. Moreover, this coronavirus disease may cause significant lung damage in asymptomatic COVID-19 positive patients who recover at home.The virus enters through the angiotensin-converting enzyme 2 receptor (ACE2) widely expressed in the cardiovascular system and other organs and tissues, which can result in myocardial injury, myocarditis, acute myocardial infarction, heart failure, arrhythmias, brain stroke, acute pleuritis, pneumonia and venous thromboembolic events. COVID -19 - induced failure of some central mechanisms controlling breathing and the circulation may explain the mismatch between the clinical symptoms and the objective physiologic life parameters in many patients treated by intensivists or cardiologists. The severity of coronavirus disease is dependent on numerous factors including the magnitude of the host immune response, the impairment of central and peripheral nervous system, age, co-morbidities (e.g. diabetes, arterial hypertension, obesity, chronic heart failure) and presumably genetic proclivity. A brand-new treatment approach with use of alternative or experimental therapies such us Extracorporeal Membrane Oxygenation (ECMO), plasmapheresis, proinflammatory interleukins - targeted drugs, covalescent plasma transfusion, virus replication inhibitors is obviously needed in some COVID-19 patients.

Acute Pleuritis Caused by Mesalamine

Acute Pleuritis Caused by Mesalamine

New-onset systemic lupus erythematosus in a long-term hemodialysis patient with acute pleuritis and pneumonitis.

A 61-year-old woman, with a 25-year history of maintenance hemodialysis due to end-stage renal disease of unknown causes, was admitted because of systemic joint pain and inflammatory response of unknown etiology that persisted for 1month. Laboratory data on admission revealed leukocytopenia, lymphocytopenia, high serum C-reactive protein, and positivity for antinuclear antibody (ANA) and anti-double strand DNA. After admission, she progressively developed cough and dyspnea. A chest radiograph revealed bilateral ground glass opacity and pleural effusion. A thoracentesis revealed lupus erythematosus cells, suggesting lupus pleuritis. A chest computed tomography showed a pattern of diffuse alveolar damage compatible with acute lupus pneumonitis. She fulfilled the American Rheumatism Association diagnostic criteria for systemic lupus erythematosus (SLE). Methylprednisolone pulse therapy followed by oral prednisone treatment improved the clinical symptoms and laboratory abnormalities. ANA was negative 25years earlier when she first started hemodialysis and she had neither clinical nor serological abnormalities related to SLE during the last 25years. Further, she had neither received drugs that can cause drug-induced SLE, nor had a history of ultraviolet ray exposure, pregnancy, blood transfusion, trauma and smoking. This report suggests that new-onset SLE can develop in patients undergoing long-term dialysis. Hence, when we encounter dialysis patients with arthralgia and/or respiratory disorders, we should consider the possibility of new-onset SLE.

Successful resection of large mediastinal mature cystic teratoma immediately after evacuation of fluid content

Successful resection of large mediastinal mature cystic teratoma immediately after evacuation of fluid content Ryo Miyahara, Shinjiro Nagai, Toshihiko Sato, Chen Fengshi, Toru Bando, Kenichi Okubo, Hiroshi DateDepartment of Thoracic Surgery, Kyoto University, Kyoto, JapanAbstract: In this report, we presented a case of urgent resection of mature giant mediastinal teratoma. Its characteristic radiologic findings allowed us to plan evacuation of intratumoral fluid in order to make the surgical procedure safe and less invasive. In addition, a hybrid thoracoscopic-open approach also provided safety and allowed a somewhat less invasive tumor resection than otherwise would have been required. The patient recovered well without recurrence at nine months’ follow-up, with full expansion of the right middle and lower lobes. Here we discuss the diagnosis and surgical procedure with reference to the literature.Keywords: mediastinal mature teratoma, rupture, acute pleuritis

Efficacy and safety of pleural biopsy in aetiological diagnosis of pleural effusion

Study Objective: To find out the efficacy and safety of pleural biopsy in aetiological diagnosis of pleural effusion Design: A prospective study. The efficacy and safety of pleural biopsy was studied in 50 patients of pleural effusion. Setting: Out and In patients service of department of Tuberculosis & Chest Diseases, MLN Medical college Allahabad. Patients: 50 patients who were above the age of 12 years were studied. Total no. of male patients was 34 and female were 16. Results: Pleural biopsy made diagnosis of TB in 19 patients (out of 41 patients of tuberculosis), malignancy in 4 (out of 8), chronic non specific pleuritis in20, inadequate pleura in 5, acute pleuritis in 1 and no pleura in 1 patient. None of the patient developed any major complication. Conclusion: Pleural biopsy is 46% sensitive and 100% specific for tuberculosis in one bite. Yield can be increased if more bites are obtained. Similarly sensitivity and specificity for malignancy is 50% and100%. And pleural biopsy is 100% safe procedure.

Empyema Necessitatis Due to Methicillin-Resistant Staphylococcus aureus : Case Report and Review of the Literature

Empyema necessitatis is a rare complication of empyema in which the pleural infection spreads outside of the pleural space to involve the soft tissues of the chest wall. Most cases of empyema necessitatis are related to Mycobacterium tuberculosis and, less commonly, to Actinomyces spp. and Streptococcus spp. Staphylococcus aureus has rarely been reported as the causative agent of empyema necessitatis, with the majority of S. aureus isolates being methicillin sensitive. Only two cases of empyema necessitatis due to methicillin-resistant S. aureus (MRSA) have been reported in the medical literature. We report the case of a 59-year-old Caucasian male who presented to our institution with complaints of pain in and swelling of his left upper chest of 2-months duration. A computed tomography scan of the chest showed an 8.1- by 6.5-cm lesion which extended from the left upper lobe of the lung into the extrathoracic soft tissues beneath the left upper pectoralis muscle. A wedge resection of the left upper lung lobe revealed lung tissue with an organized pneumonia-like pattern associated with marked acute pleuritis. Blood and urine cultures and cultures of the left chest soft tissue mass grew MRSA. The patient was successfully treated with vancomycin followed by a 10-day outpatient course of ciprofloxacin and trimethoprim-sulfamethoxazole. This case represents an extremely rare manifestation of an increasingly dangerous bacterial pathogen.

15-epi-lipoxin A4-mediated induction of nitric oxide explains how aspirin inhibits acute inflammation.

The established model for the mechanism of action of aspirin is the inhibition of prostaglandin synthesis. However, this has never fully explained aspirin's repertoire of antiinflammatory properties. We found in acute pleuritis that aspirin, but not salicylate, indomethacin, or piroxicam, increased plasma nitric oxide (NO), which correlated with a reduction in inflammation. Inhibiting aspirin-elicited NO pharmacologically in this model nullified the antiinflammatory effects of aspirin. Moreover, aspirin was not antiinflammatory in either constitutive (eNOS) or inducible NO synthase (iNOS) knockout mice with IL-1β–induced peritonitis. It transpires that aspirin generates NO through its unique ability to trigger the synthesis of 15-epi-lipoxin A4. Aspirin and 15-epi-lipoxin A4 were shown to inhibit leukocyte trafficking in an NO-dependent manner using intravital microscopy on IL-1β–stimulated mouse mesentery. Not only did aspirin inhibit leukocyte–endothelial interaction in a manner similar to NO in wild-type mice but both aspirin and 15-epi-lipoxin A4 had markedly reduced effects on leukocyte–endothelial cell adherence in eNOS- and iNOS-deficient mice compared with wild type. Collectively, these data suggest that aspirin triggers the synthesis of 15-epi-lipoxin A4, which increases NO synthesis through eNOS and iNOS. This aspirin-elicited NO exerts antiinflammatory effects in the microcirculation by inhibiting leukocyte–endothelium interactions.

Pleural effusion associated with acute and chronic pleuropneumonia and pleuritis secondary to thoracic wounds in horses: 43 cases (1982–1992)

Summary Case records of 43 horses with pleural effusion associated with acute pleuropneumonia, chronic pleuropneumonia, or pleuritis secondary to a penetrating thoracic wound were reviewed to determine the predisposing factors, diagnosis, and treatment of this condition. Acute pleuropneumonia was diagnosed in 36 horses, the majority of which were Thoroughbreds (89%). Of 22 (61%) horses that were in race training at the onset of illness, 11 (31%) had been recently transported a long distance and 4 (11%) had evidence of exercise-induced pulmonary hemorrhage. Physical examination findings and hematologic data were nonspecific. The most consistent abnormality was hyperfibrino-genemia. Affected horses were treated with antibiotics, thoracic drainage, nonsteroidal anti-inflammatory drugs, and supportive care. Twenty-two (61%) horses were discharged from the hospital, with the mean duration of hospitalization for those discharged being 23 days. Nine (25%) horses were euthanatized and 5 (14%) died. Bacterial culturing of thoracic fluid resulted in growth in 30 of the 36 (83%) horses. The finding of anaerobic bacteria in thoracic fluid was not associated with a lower survival rate (62%) than the overall survival rate (61%). Four horses with chronic pleuropneumonia had a history of lethargy and inappetence for > 2 weeks. Actinobacillus equuli was isolated, either alone or in combination with other bacteria, from thoracic fluid of these 4 horses. Each horse was treated with broad spectrum antibiotics and made a rapid recovery. Three horses with acute pleuritis secondary to penetrating thoracic wounds also had nonspecific clinical signs, apart from the wound and a large volume of pleural effusion. Bacteriologic isolates from these horses differed slightly from those of horses with acute pleuropneumonia.

Acute phase protein response, food intake, liveweight change and lesions following intrathoracic injection of yeast in sheep

Acute phase protein concentrations in blood, food intake and liveweight changes were compared in 10 sheep given intrathoracic injections of yeast and 10 control sheep over a period of 61 days. The yeast injections caused acute pleuritis and limited necrotising lung lesions which progressed to fibrous pleural adhesions and walled-off abscesses. The responses of ceruloplasmin, fibrinogen and haptoglobin were closely correlated (r = 0·87 to 0·91) in the yeast-injected sheep with peaks on days 5 or 7 after treatment (4, 4·6 and over 130 times control, respectively). Albumin concentration fell to a nadir of 89 per cent of control on day 12 after treatment. Depression of food intake was temporally related to the ‘positive’ acute phase protein responses with a nadir on day 5 after treatment (30 per cent of control). Liveweight showed a pronounced fall to five days after treatment and thereafter remained depressed relative to the controls for most of the experimental period. The data suggest that the ‘positive’ acute phase proteins may be useful indicators of production losses due to inflammatory diseases in sheep.

Variations of binding of labelled tumor necrosis factor α, epidermal growth factor, ganglioside GM-1 and N-acetylglucosamine, galactoside-specific mistletoe lectin and lectin-specific antibodies in mesothelioma and metastatic adenocarcinoma of the pleura

Cytokines, growth factors, biologically active carbohydrate ligands and growth-related lectins like calcyclin or the heparin-binding lectin are monitored for their potential in differential diagnosis. Since the galactoside-specific misletoe lectin enhances cytokine secretion in vitro and in vivo, presence of its ligands on tumor and inflammatory cells is monotired. Tumor necrosis factor α (TNF-α), epidermal growth factor (EGF), and mistletoe lectin (ML-1) as well as carrier-immobilized ganglioside GM 1 (GM-1), and N-acetyl- d-glucosamine (GlcNAc) were biotinylated, and applied to formalin-fixed, paraffin-embedded surgical specimens of 30 cases with epithelial mesothelioma of the pleura, 20 cases with nonspecific acute pleuritis, and 22 cases with metastatic adnocarcinoma into the pleura. In addition, polyclonal antibodies that are specific for calcyclin and the heparin-binding lectin, respectively, were applied to the same cohorts. Statistically significant differences ( p < 0.05) were obtained in the percentage of positive cases for the probes GM-1 and GlcNAc between mesothelioma and metastatic adenocarcinoma: 67% of mesothelioma cases stained positively to GM-1, but only 32% of the adenocarcinoma cases, whereas only 13% of mesothelioma cases stained positively to GlcNAc in contrast to 73% of metastatic adenocarcinoma cases. About 80% of the mesothelioma cases showed binding capacities to TNF-α (45% of metastatic adenocarcinoma cases) and EGF (59% of metastatic adenocarcinoma cases). The ML-1-specific ligands could be detected in a similar percentage (23–32%) in the different cohorts. Using antibodies to certain carbohydrate-binding proteins, the expression of calcyclin was relatively more abundant in the mesothelioma than in the adenocarcinoma cases. The heparin-specific lectin was seen most frequently in mesothelioma (40%) and only in 9% of metastatic adenocarcinoma. ML-1-specific ligands of intra-tumorous mononuclear inflammatory cells were present in 22 25 mesothelioma and in 9 10 of adenocarcinoma with histochemically observed presence of TNF-α-specific binding sites. Since non-specific immunostimulatory therapy with mistletoe lectin has yielded antimetastatic effects in mice and is under investigation in clinical trials, it is noteworthy that the expression of mistletoe-specific receptors of intra-tumorous inflammatory cells coincides with the presence of TNF-α-specific binding sites of tumor cells.

Mortality in Syrian Hamsters Infected with Paragonimus kellicotti

In an attempt to find a small animal model for paragonimiasis, Syrian hamsters were infected with between 1 and 16 metacercariae of Paragonimus kellicotti. A definitive mortality dose-response was observed with 90% of all hamsters given 3 or more parasites succumbing to the infection within 35 days. Hamsters demonstrated acute pleuritis, reactive mesothelial hyperplasia, subpleural accumulations of reactive and mature plasma cells, neovascularization, fibrohistiocytic thickening with and without giant cells, raised fibroconnective tissue lesions, and granulomatous inflammation with hemorrhage. Perivascular plasmacytic (lymphocytic) infiltrate, multifocal bronchopneumonia, and parenchymal necrotizing suppurative granulomatous inflammation, hemorrhagic pneumonia, and diffuse sprinkling of eosinophils, neutrophils, and intraalveolar macrophages also were observed. The response observed here may represent a new small animal mortality model useful in the search for new compounds to treat early trematode infections.

Chronic pleuritic pain in four patients with asbestos induced pleural fibrosis.

Four patients occupationally exposed to asbestos, each suffering at least eight years of disabling, persistent, and often bilateral pleuritic pain are described. Radiographic evidence of pleural disease ranged from plaques seen only on computed tomography to typical bilateral plaques or diffuse thickening to extensive diffuse and circumscribed pleural fibrosis and calcification. There was no history or evidence of acute pleuritis or pleural effusion in three patients. Intermittent pleural friction rubs have been present in all four; one patient showed pleural uptake of gallium-67. Extensive workups including repeated pulmonary ventilation-perfusion scans and cardiac catheterisation have not yielded other diagnoses to explain the pain. It is proposed that persistent pleuritic pain be added to the manifestations of benign asbestos induced pleural disease.

急性感染症の指標としての末しょう白血球のルミノール依存性化学発光測定を意義

We have tested whether or not luminol-dependent chemiluminescence (CL) of whole blood can be used for monitoring an acute bacterial infection or acute episode of bacterial infection of patients with chronic infectious diseases. This assay has several serious problems to get a reliable and reproducible measurement, for example, diurnal and daily variation, changeable measurement by time after bleeding and contamination of red blood cells and plasma constituents. These shortcomings could be overcome by using 10μl of whole blood instead of 100μl of it and by measuring it within 30 minutes after bleeding at a certain fixed time for a patient. Acute bacterial infections, such as acute pneumonia or acute pleuritis induced a great increased CL response which turned to the normal level immediately after its recovery. The similar kinetics of CL response was observed at acute episode of patients with chronic infectious diseases. A very good correlation existed between CL response and clinical signs of acute bacterial infections, such as fever, increased erythrocyte sedimentation rate, leukocytosis (r=0.73), increased CRP (r=0.88) . This assay can be used as one of the rapid and simple function tests of leukocytes for monitoring acute bacterial infections.

Wissler's Syndrome Associated with Parainfluenza 2 Infection.

Abstract A 9-year-old boy fell ill with respiratory symptoms and high fever, followed after a day or so by acute pleuritis. A classical Wissler's syndrome developed with altogether 3 attacks of high fever within the course of a month, various forms of exanthema on 2 occasions, arthritis in knee-joint, leucocytosis with eosinophilia attaining an extreme degree, and a high erythrocyte sedimentation rate. Blood cultures were negative; and, through extensive bacteriological tests and serological reactions, infections with various bacteria, mycoplasma, psittacosis agent and ordinary respiratory virus could be excluded with the exception of parainfluenza 2, for which infection there was clear serological evidence. Urinary findings with abundance of inclusion-bearing cells and occurrence of multinuclear giant cells may be considered to confirm this diagnosis. Pulmonary infiltrates, appearing after the acute pleuritis had receded, were probably due to small primary bronchopneumonias caused by parainfluenza 2. Infiltrates appearing in the subsequent course without clinical symptoms are classified, on the other hand, as eosinophil pulmonary infiltrates. These, as well as the primary pleuritis, must be regarded as subsymptoms of Wissler's syndrome. Aetiologically, a bacterial cause has been sought for earlier. The present case, however, shows that Wissler's syndrome may be brought on by a virus infection. The clinical picture may possibly reflect an individual reaction of an allergic nature to various infections, both bacteriological and virological.

Combined Abscess and Carcinoma of the Stomach

Circumscribed or diffuse acute inflammation of the stomach is an uncommon disease and is never diagnosed before operation or necropsy. It is rare for either abscess or cancer of the stomach to be found in the incipient stages, the lesions usually being well developed when seen by the pathologist. The following account, therefore, is of interest as recording the co-existence of two infrequently observed pathologic changes. Case Report The clinical record is brief. The patient, a married woman of fifty-six years, complained of vague abdominal distress for several months, with occasional attacks of nausea and vomiting. She did not lose weight nor could she recollect any other symptoms. There was apparent tenderness of the lower right side of the abdomen but no rigidity. Nothing of diagnostic importance was observed in the vomitus, urine, or stools. The symptoms became more severe and were associated with slight elevation of temperature. Gastric analyses were not made. Further preoperative data were not significant. A laparotomy was performed and the appendix removed, but the patient died at the end of the first week. In the appendix only moderate chronic inflammatory changes were found on histologic examination. At the necropsy, which was performed twenty-four hours after the body had been embalmed, there were observed localized peritonitis about the cecum and evidence of septicemia, such as enlarged spleen, acute pleuritis, and pneumonitis.

ABDOMINAL SYMPTOMS OF THORACIC DISEASE.

Acute pleuritis is sometimes accompanied by pain referred to the hypochondriac region of the affected side, and a peculiarity of the pain is its constancy. It is not felt merely on deep breathing, nor more severely on inspiration, as is so commonly the case with pleuritic pain in the nipple region. Exertion and cough, however, are prone to accentuate it, and it may cause more or less grunting respiration. I recall one case of severe epigastric pain caused by diaphragmatic pleuritis in which cough was absent, and in such a case it is difficult to arrive at a diagnosis at the onset of the disease, time and developments being necessary to determine the real nature of the affection. The abdominal pain that is present in some cases of lobar penumonia, however, is particularly striking in its deceptive characteristics. Last autumn I observed two cases in which the onset of the

On Strapping the Affected Side in Cases of Acute Pleuritis

On Strapping the Affected Side in Cases of Acute Pleuritis