Cause Of Pleuritis Research Articles

Thoracic empyema due to nontuberculous mycobacteria in an immunocompetent patient without pulmonary disease: a case report

BackgroundPleural involvement by non-tuberculous mycobacteria (NTM), especially NTM empyema in the immunocompetent patient without pulmonary diseases is a rare disease. It is difficult to diagnose with only a few cases of immunodeficient patients in the literature.Case presentationWe describe a 63-year-old male with empyema due to NTM and highlight the challenges of diagnosis.ConclusionsNon-tuberculous mycobacterial infection should be considered as a cause of pleuritis or empyema without pulmonary disease, however it is a real diagnostic dilemma.

A solitary pulmonary nodule caused by Mycobacterium avium with pleural effusion and pleuritis after transbronchial biopsy: a case report

BackgroundPleural effusion and pleuritis are uncommon manifestations of Mycobacterium avium complex pulmonary disease. Pleuritis caused by Mycobacterium avium complex pulmonary disease presenting as a solitary pulmonary nodule is extremely rare. The pathogenesis of Mycobacterium avium complex pleuritis has not been elucidated. However, it has been suggested that secondary spontaneous pneumothorax from Mycobacterium avium complex pulmonary disease is one of the causes of Mycobacterium avium complex pleuritis.Case presentationA 67-year-old Japanese woman who presented with a solitary pulmonary nodule developed a transient pneumothorax after transbronchial biopsy. A definitive diagnosis of solitary pulmonary nodule could not be made on bronchoscopy, so video-assisted thoracoscopic surgery was performed 1 month after bronchoscopy. On the day of hospitalization for the procedure, a left-sided pleural effusion appeared on a chest radiograph. Thickening of the parietal and visceral pleura and numerous scattered white small granules were seen on thoracoscopy. Histologic examination of the resected left lower lobe and a biopsy of the parietal pleura showed Mycobacterium avium complex solitary pulmonary nodule and Mycobacterium avium complex pleuritis.ConclusionIatrogenic pneumothorax can be a cause of pleuritis in a patient with Mycobacterium avium complex pulmonary disease. Clinicians should watch for the appearance of secondary pleuritis after transbronchial biopsy even in a patient with localized disease such as Mycobacterium avium complex solitary pulmonary nodule.

Mycobacterium abscessus ssp. abscessus infection progressing to empyema from vertebral osteomyelitis in an immunocompetent patient without pulmonary disease: a case report

BackgroundPleural involvement by non-tuberculous mycobacteria (NTM) in patients without distinct pulmonary disease is extremely rare. Vertebral osteomyelitis (VO) with or without pulmonary disease is also a rare clinical presentation of NTM infection, and pleural spread of NTM from VO has not been reported.Case presentationA 63-year-old woman was admitted to our hospital with back pain persisting for 4 months and a 2-day history of fever and right chest pain. The patient was initially treated as right-sided empyema due to general bacteria. However, after removal of the chest tube, a previously overlooked paravertebral lesion was observed on CT. MRI confirmed VO at T7/8. Mycobacterium abscessus ssp. abscessus was detected in both the thoracic cavity and the paravertebral lesion. Both VO and the paravertebral abscess were improved by antimycobacterial treatment.ConclusionVO of the thoracic spine due to non-tuberculous mycobacterial infection should be considered as a cause of pleuritis or empyema without pulmonary disease, especially in patients with back pain.

Pulmonary-pleural complications of pancreatitis

OBJECTIVE. The authors investigated pulmonary-pleural complications of pancreatitis and evaluated results of CT examination in diagnostics and possibility of low invasive surgery in treatment of pancreaticogenic pleurisy. MATERIAL AND METHODS. A retrospective analysis was made of 156 medical histories of patients with acute pancreatitis and their results. An ultrasound examinations of the chest and CT scan were applied in order to determine lung tissue condition and presence of fluid in pleural cavities. RESULTS. The application of CT in diagnostics of pulmonary-pleural complications allowed doctors to identify an effusion in pleural cavities in 3,5-50 % patients with acute pancreatitis. The number and localization of effusions were defined more precisely. CONCLUSIONS. Mini-invasive procedures (puncture, videothoracoscopy) with examination of exudate on amylase activity and biopsy of pleura determined the causes of pleuritis. This was effective in pleritis elimination against a background of different methods of treatment of pancreatitis.

Pleuritis in slaughter pigs: Relations between lung lesions and bacteriology in 10 herds with high pleuritis

Pleuritis in slaughter pigs has increased in recent years in the Netherlands. The aim of the present study was to determine what respiratory pathogens were involved in pleuritis. In total, lungs of 968 slaughter pigs from 10 herds with high prevalence of pleuritis were morphologically examined for size, location, and type of lesions. Moreover, histology and bacteriology were performed. Examination of gross lung lesions showed 45% pleuritis, 14% pleuropneumonia and 38% catarrhal pneumonia. Peribronchiolar cuffing was found in 61 of 142 samples. Actinobacillus pleuropneumoniae was cultured from 22 lung samples from four herds. Pasteurella multocida was cultured from 55 lung samples in eight herds. No specific pattern with respect to the causal pathogens was found. In conclusion, no single infectious cause of pleuritis was found. A variety of infectious agents combined with environmental factors should be considered as a cause of pleuritis.

CT SIGNS AND PATTERNS OF LUNG DISEASE

The ground-glass pattern is a common but nonspecific finding on CT. In certain clinical circumstances, it can suggest a specific diagnosis, indicate a potentially treatable disease, and guide a clinician to an appropriate area for biopsy. A pattern of centrilobular ground-glass nodules is fairly specific for the diagnosis of hypersensitivity pneumonitis with the appropriate clinical history. The tree-in-bud pattern indicates disease affecting the small airways. The differential diagnosis is lengthy; however, the most common process leading to this CT appearance is infection. Although commonly associated with M. tuberculosis, many infectious organisms can produce this pattern. When honeycombing is seen on HRCT, a confident diagnosis of lung fibrosis can be made. The most common causes of interlobular septal thickening on HRCT are pulmonary edema, pulmonary hemorrhage, and lymphangitic spread of cancer, and smooth thickening is characteristic of all three. Diffuse lung cysts in patients who are not immunocompromised generally signify Langerhans' cell histiocytosis, lymphangioleiomyomatosis, or centrilobular emphysema. Centrilobular emphysema can be diagnosed when the centrilobular artery is seen as a small nodular opacity in the center of the cyst. Langerhans' cell histiocytosis is often associated with parenchymal nodules, helping to distinguish it from lymphangioleiomyomatosis. When a nodular pattern is seen on HRCT, the differential diagnosis is very long, but can be narrowed by noting whether the nodules are random, centrilobular, or perilymphatic in distribution. A mosaic pattern of lung attenuation can represent an infiltrative, small airway, or vascular process. The distinction can often be made by noting the size of the pulmonary vessels in the abnormal areas of lung, and whether air trapping is present on expiratory scanning. Computed tomographic signs can be useful indicators of a specific disease process. For instance, the air bronchogram sign indicates that an opacity is intrapulmonary in location, and signals the possibility of two types of neoplasm: lymphoma and bronchioloalveolar cell carcinoma. An air crescent sign indicates recovery of the immune system in an immunocompromised patient with invasive pulmonary aspergillosis. The fallen lung sign is diagnostic of a bronchial transection in the correct clinical setting. The gloved finger sign is very suggestive of allergic bronchopulmonary aspergillosis. The halo sign is highly suggestive of early angioinvasive pulmonary aspergillosis in patients with acute leukemia. When a split pleura sign is seen, the diagnosis is often empyema, although other causes of pleuritis can lead to a similar CT appearance.

Clinical significance of (1-->3)-beta-D-glucan in pleural effusion and liquor

The Measurement of serum (1-->3)-beta-D-glucan (beta-glucan) has been considered to be useful in the early diagnosis of deep mycosis. In this study, we investigated the clinical significance of beta-glucan in pleural effusion or liquor from patients with various conditions. beta-glucan was measured in 29 samples of pleural effusion from 27 patients (male: 17, female: 10 median age: 62.1). Two patients undergoing hemodialysis treatment were excluded from the study of normal range of beta-glucan in these samples. beta-glucan was also measured in 39 samples of liquor from 23 inpatients (male: 15, female: 8 median age: 48.4) with certain neurological disorders. In these cases, only two patients had deep mycosis. beta-glucan in the pleural effusion from a patient with Aspergillus pyothorax showed an extremely high value of more than 1100 pg/ml. Slight elevation of beta-glucan was observed in the spinal fluid from a patient with cryptococal, meningitis. In the other cases with no mycotic infection or any factor influencing the value of beta-glucan, beta-glucan in pleural effusion and spinal fluid were generally lower than the normal range of serum samples. However, there is false positive elevation of beta-glucan in pleural effusion. The above results indicated that measurement of beta-glucan in pleural effusion or spinal fluid may be useful for the diagnosis of mycotic infection as the cause of pleuritis or meningitis.

Radiographie, epidemiologie, and clinical aspects of simultaneous pleural and peritoneal effusions in dogs and cats: 48 cases (1982-1991)

Summary: In this study, we found that the rate at which radiographically diagnosed simultaneous pleural and peritoneal effusions (double effusions [de]) developed was highest in dogs and cats with infectious causes of pleuritis and/or peritonitis and in those with pancreatitis. However, de were observed more frequently in dogs and cats with neoplastic and cardiovascular diseases. Nonneoplastic liver disease was also documented as a cause of de in the population of this study. Frequency of de was increased in males and in animals > 6 years old. The finding of simultaneous pleural and peritoneal effusions can be considered an indicator of disease severity, and warrants a poor to grave prognosis.

Rheumatoid Pleuritis: Observations in Eight Cases and Suggestions for Making the Diagnosis in Patients without the “Typical Findings”

Eight patients with rheumatoid disease and associated pleuritis have been described. The majority of cases previously reported have had a nonspecific inflammatory pleural reaction. The possibility of coexisting disease as a cause of pleuritis is difficult to dispel; however, the diagnosis can be suspected by appreciation of the clinical setting. The age and sex of the patient (middle-aged men, primarily), the stage of the disease (flare-ups), the duration of existence of the disease (usually of long duration), high incidence of allergies, and the presence of rheumatoid nodules should receive careful consideration. Many of these criteria are applicable to younger patients. The definitive pathology of the rheumatoid nodule is much less likely to be noted in the lung than in affected joints. However, the presence in pleural fluid of “RA” cells, high lactic dehydrogenase levels, and positive rheumatoid factor, with positive rheumatoid factor test but negative lupus cells in the blood, substantiate the rheumatoid etiology. Circulating eosinophilia may be of additional value in the diagnosis.