scholarly journals Mixed Actinomyces israelii and Aggregatibacter actinomycetemcomitans infection causing empyema necessitatis and multiple skin abscesses in an immunocompetent patient

2019 ◽  
Vol 12 (9) ◽  
pp. e230287 ◽  
Author(s):  
Takaaki Kobayashi ◽  
Evgeny Arshava ◽  
Bradley Ford ◽  
Poorani Sekar
Keyword(s):  
Chest Wall ◽  
Thoracoscopic Surgery ◽  
Aggregatibacter Actinomycetemcomitans ◽  
Immunocompetent Patient ◽  
Silver Stain ◽  
Left Chest ◽  
Chest Wall Abscess ◽  
Pathological Evaluation ◽  
Methenamine Silver Stain ◽  
The Right

A 45-year-old- man presented with left chest wall pain, swelling and cough. Over a 2-month period he developed abscesses in the right foot, right anterior thigh, left buttock and left chest. Incision and drainage of the soft tissue abscesses and video-assisted thoracoscopic surgery to drain the loculated empyema contiguous with the chest wall abscess were performed as surgical management. Gram stain showed beaded Gram-positive rods and the culture initially grew Aggregatibacter actinomycetemcomitans and Eikenella corrodens. Pathological evaluation of the pleura showed sulfur granules and organisms consistent with Actinomyces spp. on Gomori methenamine silver stain; Actinomyces israelii was recovered in culture with extended incubation. The patient was treated for 3 weeks with ceftriaxone and oral metronidazole, followed by oral amoxicillin. Culture of A. actinomycetemcomitans with other findings consistent with actinomycosis warrants 6–12 months of antibiotic therapy.

scholarly journals Primary Tubercular Chest Wall Abscess in a Young Immunocompetent Male

2014 ◽  
Vol 2014 ◽  
pp. 1-4
Author(s):  
Shweta Sharma ◽  
R. K. Mahajan ◽  
V. P. Myneedu ◽  
B. B. Sharma ◽  
Nandini Duggal
Keyword(s):  
Chest Wall ◽  
Immunocompetent Patient ◽  
Rare Entity ◽  
Hematogenous Spread ◽  
Clinical Challenge ◽  
Chest Wall Abscess ◽  
Direct Inoculation ◽  
Underlying Pathology ◽  
Patient Infection ◽  
Rule Out

Chest wall tuberculosis is a rare entity especially in an immunocompetent patient. Infection may result from direct inoculation of the organisms or hematogenous spread from some underlying pathology. Infected lymph nodes may also transfer the bacilli through lymphatic route. Chest wall tuberculosis may resemble a pyogenic abscess or tumour and entertaining the possibility of tubercular etiology remains a clinical challenge unless there are compelling reasons of suspicion. In tuberculosis endemic countries like India, all the abscesses indolent to routine treatment need investigation to rule out mycobacterial causes. We present here a case of chest wall tuberculosis where infection was localized to skin only and, in the absence of any evidence of specific site, it appears to be a case of primary involvement.

scholarly journals Axillary uniportal video-assisted thoracoscopic surgery for bullae is a cosmetically superior approach to primary spontaneous pneumothorax: a case report

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Weijiang Ma ◽  
Xiuping Deng ◽  
Ming Wen ◽  
Limin Yang ◽  
Xun Ouyang ◽  
...  
Keyword(s):  
Chest Wall ◽  
Spontaneous Pneumothorax ◽  
Thoracoscopic Surgery ◽  
Primary Spontaneous Pneumothorax ◽  
Natural State ◽  
Axillary Approach ◽  
Video Assisted ◽  
Good Cosmetic ◽  
The Right ◽  
Video Assisted Thoracoscopic Surgery

Abstract Background Bulla is a common cause of primary spontaneous pneumothorax. Video-assisted thoracoscopic surgery (VATS) through the lateral chest wall is a common surgical approach and an effective treatment for this condition, but postoperative incision scars affect the aesthetic outcome. VATS via axillary approach can hide the scar in the axilla, and the wound in its natural state is invisible; this greatly improves the cosmetic appearance. To our knowledge, this is the first report of VATS-based bullectomy via the axillary approach in a patient with spontaneous pneumothorax. Case presentation A 20-year-old female patient was admitted to the hospital with a 2-day history of chest tightness and chest pain. Plain chest computed tomography showed right spontaneous pneumothorax, lung compression of 75%, and right pulmonary bulla. After complete preoperative examination, VATS bullectomy via right axillary approach was performed. During the operation, a bulla measuring about 4 × 4 cm was found at the apex of the right lung and resected. The incision healed well, and the patient was discharged after surgery. Conclusions VATS bullectomy via axillary approach is safe and feasible, with the incision hidden in the axilla and not visible in the natural state. This method leaves no scar on the chest wall and has good cosmetic outcome.

Dosimetric Evaluation of Photons Versus Protons in Postmastectomy Planning for Ultrahypofractionated Breast Radiotherapy

2021 ◽  
Author(s):  
Puntiwa Oonsiri ◽  
Chonnipa Nantavithya ◽  
Chawalit Lertbutsayanukul ◽  
Thanaporn Sarsitthithum ◽  
Mananchaya Vimolnoch ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Chest Wall ◽  
Organs At Risk ◽  
Skin Dose ◽  
Proton Radiation ◽  
Breast Radiotherapy ◽  
Left Chest ◽  
Ipsilateral Lung ◽  
Heart Dose ◽  
The Right

Abstract Background: Ultrahypofractionation can shorten the irradiation period. This study is the first dosimetric investigation comparing ultrahypofractionation using volumetric arc radiation therapy (VMAT) and intensity-modulated proton radiation therapy (IMPT) techniques in postmastectomy treatment planning. Materials and methods: Twenty postmastectomy patients (10-left and 10-right sided) were replanned with both VMAT and IMPT techniques. There were 4 scenarios: left chest wall, left chest wall including regional nodes, right chest wall, and right chest wall including regional nodes. The prescribed dose was 26 Gy (RBE) in 5 fractions. For VMAT, a 1-cm bolus was added for 2 in 5 fractions. For IMPT, robust optimization was performed on the CTV structure with a 3-mm setup uncertainty and a 3.5% range uncertainty. This study aimed to compare the dosimetric parameters of the PTV, ipsilateral lung, contralateral lung, heart, skin, esophageal, and thyroid doses. Results: The PTV-D95 was kept above 24.7 Gy in both VMAT and IMPT plans. The ipsilateral lung mean dose of the IMPT plans was comparable to that of the VMAT plans. In three of four scenarios, the V5 of the ipsilateral lung in IMPT plans was lower than in VMAT plans. The Dmean and V5 of heart dose were reduced by a factor of 4 in the IMPT plans of the left side. For the right side, the Dmean of the heart was less than 1 Gy for IMPT, while the VMAT delivered approximately 3 Gy. The IMPT plans showed a significantly higher skin dose owing to the lack of a skin-sparing effect in the proton beam. The IMPT plans provided lower esophageal and thyroid mean dose. Conclusion: Despite the higher skin dose with the proton plan, IMPT significantly reduced the dose to adjacent organs at risk, which might translate into the reduction of late toxicities when compared with the photon plan. Key words: proton therapy, ultrahypofractionation, postmastectomy, breast irradiation

scholarly journals MALDI-TOF vs. VITEK 2 for identification of Aggregatibacter actinomycetemcomitans chest wall abscess

IDCases ◽  
2020 ◽  
Vol 20 ◽  
pp. e00749
Author(s):  
Mahwish Hussain ◽  
Anne Yang ◽  
Mohamed Yassin ◽  
Ricardo Arbulu ◽  
Tung Phan
Keyword(s):  
Chest Wall ◽  
Aggregatibacter Actinomycetemcomitans ◽  
Maldi Tof ◽  
Chest Wall Abscess ◽  
Vitek 2

scholarly journals Pleuropneumonia with chest wall abscess due to salmonella enteric in immunocompetent patient: a case report

2020 ◽  
Vol 2 (5) ◽  
pp. 01-05
Author(s):  
Youssef Sleiman
Keyword(s):  
Chest Wall ◽  
Gastrointestinal Symptoms ◽  
Rare Condition ◽  
Needle Aspiration ◽  
Immunocompetent Patient ◽  
Bacterial Disease ◽  
Lung Field ◽  
Salmonella Infection ◽  
Chest Wall Abscess ◽  
Lower Lung

Introduction: Pleuropulmonary with bony and cutaneous involvement of salmonella infection is a very rare condition and no case was ever reported in Lebanon. Case presentation: We report a case of 39-year-old immunocompetent man, with no past medical history, presented with a right bulging chest wall mass. The chest radiographs revealed pleural effusion and presence of a hypodense central necrosis at right lower lung field. Salmonella was identified from the cultures of fine needle aspiration (FNA) form the mass. After treating salmonella with adequate antibiotics, the patient was improved. Discussion: salmonella infection is a common bacterial disease that affects the intestinal tract. Infection may spread beyond the intestine causing many complications like in our reported case. Conclusion: we should suspect salmonellosis in any patient presenting with gastrointestinal symptoms followed by pleuropneumonia with chest wall infection.

scholarly journals Computed tomography-guided thoracoscopic debridement for multiple loculated organizing empyema: a case report

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Masaya Aoki ◽  
Tadashi Umehara ◽  
Shoichiro Morizono ◽  
Yasuhiro Tokuda ◽  
Go Kamimura ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Chest Wall ◽  
Thoracoscopic Surgery ◽  
Treatment Options ◽  
Fluid Collection ◽  
Skin Incision ◽  
The Body ◽  
Accidental Injury ◽  
Anatomical Structures ◽  
The Right

Abstract Background Video-assisted thoracoscopic surgery (VATS) for organizing empyema is challenging because fibrous septa and peel within the cavity are thickened and hardened. Some patients have multiple isolated empyema cavities that require debridement individually because firm intrathoracic adhesion was developed during this phase. If the debridement was incomplete as a result of worrying about an accidental injury of the surrounding organ, additional interventions may be required due to the persistent empyema cavity or insufficient expansion of the ipsilateral lung. We here describe a representative case with multiple loculated organizing empyema that could safely and reliably perform VATS debridement under C-arm cone-beam computed tomography (CBCT). Case presentation A 67-year-old woman was admitted to our department for the treatment of right empyema. Chest computed tomography showed fluid collection in three independent spaces within the right thoracic cavity. It was assumed that a firm adhesion between the lung and chest wall was developed because about 7 weeks passed since the onset. Therefore, we decided to use CBCT to completely debride three empyema cavities separately by VATS. One cavity was only in a narrow range with the chest wall, and it was located on the back of cost rib cartilage. By clicking any intended anatomical structures on CBCT images, the position was readily depicted by lase projection on the body surface, which helped to place the best skin incision. Moreover, in other cavities, CBCT after initial debridement showed insufficiently dissected cavity. Additional debridement resulted in a successful shrinkage of the empyema cavity. Conclusion We believe that VATS debridement under CBCT guidance is one of the useful treatment options for multiple loculated organizing empyema.

scholarly journals Kimura’s disease affecting multiple body parts in a 57-year-old female patient: a case report

2019 ◽  
Vol 15 (1) ◽  
Author(s):  
Bo Yu ◽  
Guoxing Xu ◽  
Xiaofan Liu ◽  
Wen Yin ◽  
Hao Chen ◽  
...  
Keyword(s):  
Lymph Nodes ◽  
Chest Wall ◽  
Immunoglobulin E ◽  
The Body ◽  
Unknown Etiology ◽  
Kimura’S Disease ◽  
Body Parts ◽  
Tissue Mass ◽  
Left Chest ◽  
The Right

Abstract Background Kimura’s disease (KD) is a rare chronic inflammatory disease with unknown etiology. It usually manifests as a painless soft tissue mass or subcutaneous nodule on one side of the patient’s head and/or neck and rarely affects multiple parts of the body. The disease is more common among young Asian males. Case presentation A 57-year-old Chinese woman complained of multiple masses on her body surface. Ultrasonography was used to examine the retroperitoneal, bilateral neck, bilateral supraclavicular, bilateral axillary, and bilateral inguinal superficial lymph nodes. Enlargement of multiple lymph nodes was found in all areas. Many solid nodules were also found in the right parotid gland and right posterior neck area, respectively. Numerous solid nodules were seen on the left chest wall. Laboratory tests showed that the percentage of eosinophils in the whole blood was 39.40%, total immunoglobulin E (IgE) level was > 5000 kU/L, and serum special IgE to Phadiatop (inhaled allergens) and fx5 (food allergens) were 1.01 and 1.04 kUA/L, respectively. After a complete examination, the masses located in the right neck, retroauricular and left axillary regions, and left chest wall were resected directly. Postoperative pathological findings revealed KD. Conclusions The case discussed in this study is extremely rare and did not meet the common affected areas and age characteristics of KD. This presentation can be used to improve disease awareness among physicians.

scholarly journals Erosion of a right ventricular pacer lead into the left chest wall

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Michael J. Herr ◽  
J. Macy Cottrell ◽  
H. Edward Garrett ◽  
Darryl S. Weiman
Keyword(s):  
Cardiac Arrest ◽  
Right Ventricular ◽  
Chest Wall ◽  
Unique Case ◽  
Case Presentation ◽  
Left Chest ◽  
Pacing Lead ◽  
The Right ◽  
Wall Mass ◽  
Chest Wall Mass

Abstract Background Erosion of a pacer lead into the chest wall may result in pericardial effusion with cardiac tamponade. Free rupture into the pleura or mediastinum can result in hypotension and cardiac arrest. Case presentation We report a unique case of a right ventricular pacer lead which eroded through the right ventricle into the left chest wall and penetrated a rib. The patient presented with a tender chest wall mass without pericardial or pleural effusion. The segment of rib which the pacing lead had penetrated was removed. Conclusions The patient tolerated the procedure well and was discharged 1 week after the operation. This case adds to the current literature the justification of removal of temporary and non-functional pacing leads.

scholarly journals Septic shock due to Yersinia pseudotuberculosis infection in an adult immunocompetent patient: a case report and literature review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Takehiro Hashimoto ◽  
Ryuichi Takenaka ◽  
Haruka Fukuda ◽  
Kazuhiko Hashinaga ◽  
Shin-ichi Nureki ◽  
...  
Keyword(s):  
Septic Shock ◽  
Therapeutic Strategy ◽  
Yersinia Pseudotuberculosis ◽  
Immunocompromised Host ◽  
Immunocompetent Patient ◽  
Case Presentation ◽  
Gram Negative ◽  
Old Japanese ◽  
The Right ◽  
Immunocompetent Patients

Abstract Background Yersinia pseudotuberculosis infection can occur in an immunocompromised host. Although rare, bacteremia due to Y. pseudotuberculosis may also occur in immunocompetent hosts. The prognosis and therapeutic strategy, especially for immunocompetent patients with Y. pseudotuberculosis bacteremia, however, remains unknown. Case presentation A 38-year-old Japanese man with a mood disorder presented to our hospital with fever and diarrhea. Chest computed tomography revealed consolidation in the right upper lobe with air bronchograms. He was diagnosed with pneumonia, and treatment with intravenous ceftriaxone and azithromycin was initiated. The ceftriaxone was replaced with doripenem and the azithromycin was discontinued following the detection of Gram-negative rod bacteria in 2 sets of blood culture tests. The isolated Gram-negative rod bacteria were confirmed to be Y. pseudotuberculosis. Thereafter, he developed septic shock. Doripenem was switched to cefmetazole, which was continued for 14 days. He recovered without relapse. Conclusions We herein report a case of septic shock due to Y. pseudotuberculosis infection in an adult immunocompetent patient. The appropriate microorganism tests and antibiotic therapy are necessary to treat patients with Y. pseudotuberculosis bacteremia.

scholarly journals Catamenial pneumothorax with bubbling up on the diaphragmatic defects: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Bo Dong ◽  
Chun-Li Wu ◽  
Yin-liang Sheng ◽  
Bin Wu ◽  
Guan-Chao Ye ◽  
...  
Keyword(s):  
Thoracoscopic Surgery ◽  
Lung Lesion ◽  
Parietal Pleura ◽  
Catamenial Pneumothorax ◽  
Endometrial Cells ◽  
Retrograde Menstruation ◽  
History Of ◽  
The Right ◽  
Thoracic Endometriosis

Abstract Background Catamenial pneumothorax is characterized by spontaneous recurring pneumothorax during menstruation, which is a common clinical manifestation of thoracic endometriosis syndrome. There are still controversies about its pathogenesis. Case presentation A 43-year-old woman with a history of endometriosis came to our hospital due to recurring pneumothorax during menstruation. Uniportal Video-assisted Thoracoscopic Surgery (VATS) exploration was performed on the eve of menstruating. We thoroughly explored the diaphragm, visceral and parietal pleura: The lung surface was scattered with yellowish-brown implants; no bullae were found; multiple diaphragmatic defects were found on the dome. And surprisingly, we caught a fascinating phenomenon: Bubbles were slipping into pleural cavity through diaphragmatic defects. We excised the diaphragmatic lesions and wedge resected the right upper lung lesion; cleared the deposits and flushed the thoracic cavity with pure iodophor. Diaphragmatic lesions confirmed the presence of endometriosis, and interestingly enough, microscopically, endometrial cells were shedding with impending menses. After a series of intraoperative operations and postoperative endocrine therapy, the disease did not recur after a period of follow-up. Conclusion We have witnessed the typical signs of catamenial pneumothorax at the accurate timing: Not only observed the process of gas migration macroscopically, but also obtained pathological evidence of diaphragmatic periodic perforation microscopically, which is especially precious and confirms the existing theory that retrograde menstruation leads to diaphragmatic endometriosis, and the diaphragmatic fenestration is obtained due to the periodic activities of ectopic endometrium.

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