Vertebral osteomyelitis presenting with pleuritic chest pain and bilateral pleural effusions

The presence of fluid in the pleural space can be seen in a variety of disorders. Presenting symptoms include dyspnea, pleuritic chest pain, and ipsilateral shoulder pain if pleural involvement occurs at the central portion of the diaphragm. Physical examination findings include chest asymmetry, diminished breath sounds, dullness to percussion, and decreased tactile fremitus. In an upright patient, the radiographic appearance of pleural fluid includes blunting of the costophrenic angle, straightening or a more lateral peak of the hemidiaphragm contour, simulation of an elevated hemidiaphragm, or a distance of greater than 2 cm between the gastric air bubble and the lung.

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Twenty-three year-old with pleuritic chest pain

Heart ◽

10.1136/heartjnl-2017-312718 ◽

2018 ◽

Vol 105 (6) ◽

pp. 464-469

Author(s):

Karina P Gopaul ◽

Helen M Parry ◽

Damien Cullington

Keyword(s):

Chest Pain ◽

Congenital Heart ◽

White Cell Count ◽

Coarctation Of The Aorta ◽

List Type ◽

Pleuritic Chest Pain ◽

Reactive Protein ◽

Pulmonary Angiogram ◽

Night Sweats ◽

Ct Pulmonary Angiogram

Clinical introductionA 23-year-old woman followed at another medical centre for congenital heart disease (CHD) presented to our emergency clinic with 3 weeks of bilateral pleuritic chest pain. She returned from holiday in Greece 6 weeks earlier where a tattoo and nasal piercing had been performed. There was no history of night sweats or fever.Her temperature was 37.5°C, heart rate 120 beats/min, oxygen saturations 94% on room air and blood pressure 110/74. Her chest was clear and there was systolic murmur on auscultation. The chest radiograph showed peripheral bilateral lower zone atelectasis. The ECG demonstrated sinus tachycardia. The haemoglobin was 11.2 g/dL, white cell count 10.18×109/L, C-reactive protein 67 mg/L (normal <5 mg/L) and D dimer=430 ng/mL (normal <230 ng/mL).A pulmonary embolus was suspected and a CT pulmonary angiogram was performed (figure 1).QuestionBased on the CT findings, what is the most likely underlying congenital heart lesion in this patient?Bicuspid aortic valveCoarctation of the aortaFontan circulationParachute mitral valveVentricular septal defectFigure 1CT pulmonary angiogram (coronal views).

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Acute Pleuritic Chest Pain and Lung Mass in an Elderly Woman

CHEST Journal ◽

10.1378/chest.97.6.1473 ◽

1990 ◽

Vol 97 (6) ◽

pp. 1473-1474 ◽

Cited By ~ 9

Author(s):

Denis D. Bensard ◽

John A. St. Cyr ◽

Michael R. Johnston

Keyword(s):

Chest Pain ◽

Elderly Woman ◽

Lung Mass ◽

Pleuritic Chest Pain

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A rare case of spontaneous haemothorax in patient with haemophilia A

BMJ Case Reports ◽

10.1136/bcr-2021-242412 ◽

2021 ◽

Vol 14 (4) ◽

pp. e242412

Author(s):

Suthaphong Tripoppoom ◽

Nophol Leelayuwatanakul

Keyword(s):

Chest Pain ◽

Rare Case ◽

Rare Event ◽

Haemophilia A ◽

Minor Trauma ◽

Conservative Approach ◽

Pleuritic Chest Pain ◽

Good Clinical Outcome ◽

History Of

Haemorrhage in patients with haemophilia is common after minor trauma but may occur spontaneously. Despite the diversity of bleeding sites, spontaneous haemothorax, on a non-traumatic basis, is an exceedingly rare event and only a few cases had been reported. We present a case of a 43-year-old man with a history of haemophilia A who had pleuritic chest pain for 1 day without significant history of trauma. Diagnostic thoracentesis showed bloody pleural fluid in which neither abnormal cell nor organism was found. He was treated by cryoprecipitate replacement and therapeutic thoracentesis for releasing haemothorax. After discharge, the patient returned for follow-up with complete radiological resolution. Regarding the consequences of retained haemothorax from conservative approach and the procedure-related bleeding of given therapeutic intervention in haemothorax making its management in patients with haemophilia to be more challenging. Our case illustrates a conservative treatment of spontaneous haemothorax in patient with haemophilia resulting in a good clinical outcome.

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Suspected acute rheumatic fever in a young man in England

BMJ Case Reports ◽

10.1136/bcr-2021-244469 ◽

2021 ◽

Vol 14 (11) ◽

pp. e244469

Author(s):

Zak Michael Wilson ◽

Katie Craster

Keyword(s):

Chest Pain ◽

General Practitioner ◽

Mitral Regurgitation ◽

Rheumatic Fever ◽

Acute Rheumatic Fever ◽

Supportive Therapy ◽

Acute Hospital ◽

Shortness Of Breath ◽

Pleural Effusions ◽

Pericardial Thickening

A 24-year-old fit and well Caucasian man was referred to acute hospital via his General Practitioner with chest pain, palpitations, shortness of breath and an antecedent sore throat. Investigations revealed pericardial and pleural effusions, pericardial thickening on MRI, mild mitral regurgitation on echocardiogram and a raised Antistreptolysin O (ASO) titre.He was treated as acute rheumatic fever (ARF) with a prolonged course of penicillin, supportive therapy with bisoprolol and colchicine with lansoprazole cover. The patient made a full recovery and subsequent cardiac MRI showed resolution of all changes.

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A 39-Year-Old Man With Diabetes, Pleuritic Chest Pain, and Multiple Cavitary Lung Nodules

CHEST Journal ◽

10.1016/j.chest.2018.03.035 ◽

2018 ◽

Vol 154 (3) ◽

pp. e69-e72

Author(s):

Jaividhya Dasarathy ◽

Simranjit Gill ◽

Joel Willis ◽

Christine Alexander

Keyword(s):

Chest Pain ◽

Lung Nodules ◽

Pleuritic Chest Pain

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An unusual case of chest pain

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20203131 ◽

2020 ◽

Vol 7 (8) ◽

pp. 1290

Author(s):

Saswat Subhankar ◽

K. Madhuri ◽

Vivek D. Alone

Keyword(s):

Staphylococcus Aureus ◽

Developing Countries ◽

Chest Pain ◽

Unusual Case ◽

Gram Negative Bacteria ◽

Pleural Effusions ◽

Gram Negative ◽

Competent Patient ◽

E Coli ◽

Gram Positive Bacteria

Osteomyelitis is an infection of the bones caused by pyogenic organisms. The ribs are an extremely uncommon site for osteomyelitis, occurring in less than 1% cases. The main causative organisms are Gram-positive bacteria, such as Staphylococcus aureus and Hemophilus influenzae. Gram-negative bacteria like E. coli have been rarely reported. Authors hereby present a case of an immune-competent patient who presented with an osteomyelitis of the ribs caused by the latter. In developing countries, tuberculosis is considered as the primary cause of osteomyelitis and pleural effusions. However, other organisms should also be considered in patients who present with fulminant infections.

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