scholarly journals A tüdő nekrotizáló sarcoid granulomatosisa

2021 ◽  
Vol 162 (38) ◽  
pp. 1541-1547
Author(s):  
Noémi Zombori-Tóth ◽  
Katalin Ugocsai ◽  
Árpád Vincze ◽  
József Furák ◽  
László Tiszlavicz ◽  
...  
Keyword(s):  
Standard Form ◽  
Spontaneous Remission ◽  
Rare Entity ◽  
Soft Tissue Density ◽  
Thoracoscopic Resection ◽  
Granulomatous Angiitis ◽  
X Ray ◽  
Bilateral Hilar Lymphadenopathy ◽  
Function Test ◽  
Chest X Ray

Összefoglaló. A nekrotizáló sarcoid granulomatosis a granulomatosus pulmonalis angitisek közé tartozó, ritka kórkép. Egyesek a sarcoidosis variánsának, mások primer pulmonalis vasculitisnek tartják. A kórkép klinikai és patológiai jellegzetességeit két eset bemutatásával ismertetjük. A 20 éves nőbeteg sürgősséggel került pulmonológiai osztályra száraz köhögés, jobb oldali, mély belégzéssel összefüggő mellkasi fájdalom és láz miatt, a 63 éves férfi beteget pedig pneumoniát követő kontroll-mellkasröntgenfelvételen látott elváltozás kivizsgálása során észlelték. Az autoimmun panel vizsgálata, a mikrobiológiai tesztek mindkét betegnél negatívnak bizonyultak, a légzésfunkciós vizsgálat és a bronchoszkópos vizsgálat nem talált eltérést. A mellkas-CT-felvételen lágyrész-denzitású nodulusok látszottak egyoldali dominanciával, a folyamatot nem kísérte a hilusi nyirokcsomók szimmetrikus megnagyobbodása. A nodulusok szövettani vizsgálata vált indokolttá, melyet videoasszisztált torakoszkópos tüdőreszekciós mintavétellel biztosítottak. Mikroszkóposan a tüdőparenchymában gócos nekrózisokat, a környezetükben el nem sajtosodó epitheloid sejtes granulomatosus gócokat, az átfutó artériákban pedig granulomatosus arteritist láttak; a klinikai adatok figyelembevételével a tüdő nekrotizáló sarcoid granulomatosisa diagnózisát állították fel. A tüdőbetegség mindkét betegnél egy év alatt spontán regrediált. Az irodalom adatait és az eseteket összegezve, a tüdő nekrotizáló sarcoid granulomatosisában mikrobiológiai vizsgálatokkal nem igazolható tüdőfertőzés, és az immunológiai kivizsgálás sem tár fel szisztémás autoimmun betegséget; a diagnózis a klinikai kép és a képalkotó vizsgálatok alapján indikált szövettani vizsgálattal állítható fel. A betegség szteroidkezelésre jól reagál, de előfordul spontán regresszió is, az utóbbira láttunk példát. Bár az entitás átmenetet képez a nekrotizáló vasculitisek és a sarcoidosis között, egyre több érv szól amellett, hogy a sarcoidosis spektrumába tartozik. Orv Hetil. 2021; 162(38): 1541–1547. Summary. Necrotizing sarcoid granulomatosis is a rare entity currently classified as a subtype of granulomatous pulmonary angiitis. It is considered to be either a variant of sarcoidosis or a primary pulmonary angiitis. Two cases are demonstrated to present its clinical and pathological features. A 20-year-old female patient was admitted to the department of pulmonology with dry cough, right-sided chest pain during hyperventilation and fever. A 63-year-old male patient was observed with a right-sided lesion on chest X-ray after pneumonia. In both cases, autoimmune panel examination, microbiology tests, spirometry function test and bronchoscopy were unremarkable. Chest CT scans have revealed nodules with soft-tissue density without bilateral hilar lymphadenopathy. In order to clarify the diagnosis, video-assisted thoracoscopic resection (biopsy) was performed. Microscopically, parenchymal focal necrosis with adjacent to non-caseating granulomas and granulomatous angiitis were detected. In both cases, spontaneous remission occurred within a year. Histological examination – integrated with clinical data and radiological tests’ results – is the gold standard form of evaluation to confirm necrotizing sarcoid granulomatosis; furthermore, exclusion of pneumonia and autoimmune diseases are also required. The disease responds well to corticosteroids; moreover, spontaneous remission is often reported, as it happened in both cases. Necrotizing sarcoid granulomatosis is a transition between necrotizing vasculitides and sarcoidosis; although more and more evidence appears supporting the fact that necrotizing sarcoid granulomatosis may belong to the spectrum of sarcoidosis. Orv Hetil. 2021; 162(38): 1541–1547.

AB0796 THE EVALUATION OF LUNG DIAGNOSTIC PROCEDURE AT THE ONSET OF INFLAMMATORY RHEUMATIC DISEASES WITH INTERSTITIAL LUNG DISEASE

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1422.3-1423
Author(s):  
T. Hoffmann ◽  
P. Oelzner ◽  
F. Marcus ◽  
M. Förster ◽  
J. Böttcher ◽  
...  
Keyword(s):  
Carbon Monoxide ◽  
Interstitial Lung Disease ◽  
Lung Function ◽  
Lung Disease ◽  
Sensitivity And Specificity ◽  
Lung Function Test ◽  
Inflammatory Rheumatic Diseases ◽  
X Ray ◽  
Function Test ◽  
Chest X Ray

Background:Interstitial lung disease (ILD) in inflammatory rheumatic diseases (IRD) is associated with increased mortality. Moreover, the lung is one of the most effected organs on IRD. Consequently, screening methods were required to the detect ILD in IRD.Objectives:The objective of the following study is to evaluate the diagnostic value of lung function test, chest x-ray and HR-CT of the lung in the detection of ILD at the onset of IRD.Methods:The study is designed as a case-control study and includes 126 patients with a newly diagnosed IRD. It was matched by gender, age and the performance of lung function test and chest x-ray. The sensitivity and specificity were verified by crosstabs and receiver operating characteristic (ROC) curve analysis. The study cohort was divided in two groups (ILD group: n = 63 and control group: n = 63). If possible, all patients received a lung function test and optional a chest x-ray. Patients with pathological findings in the screening tests (chest x-ray or reduced diffusing capacity for carbon monoxide (DLCO) < 80 %) maintained a high-resolution computer tomography (HR-CT) of the lung. Additionally, an immunological bronchioalveolar lavage was performed in the ILD group as gold standard for the detection of ILD.Results:The DLCO (< 80 %) revealed a sensitivity of 83.6 % and specificity of 45.8 % for the detection of ILD. Other examined parameter of lung function test showed no sufficient sensitivity as screening test (FVC = Forced Vital Capacity, FEV1 = Forced Expiratory Volume in 1 second, TLC = Total Lung Capacity, TLCO = Transfer factor of the Lung for carbon monoxide). Also, a combination of different parameter did not increase the sensitivity. The sensitivity and specificity of chest x-ray for the verification of ILD was 64.2 % versus 73.6 %. The combination of DLCO (< 80 %) and chest x-ray showed a sensitivity with 95.2 % and specificity with 38.7 %. The highest sensitivity (95.2 %) and specificity (77.4 %) was observed for the combination of DLCO (< 80 %) and HR-CT of the lung.Conclusion:The study highlighted that a reduced DLCO in lung function test is associated with a lung involvement in IRD. DLCO represented a potential screening parameter for lung manifestation in IRD. Especially patients with suspected vasculitis should receive an additional chest x-ray. Based on the high sensitivity of DLCO in combination with chest x-ray or HR-CT for the detection of ILD in IRD, all patients with a reduced DLCO (< 80%) should obtained an imaging of the lung.Disclosure of Interests:None declared

scholarly journals Spontaneous pneumomediastinum and subcutaneous emphysema in a child with unknown aetiology

2019 ◽  
Vol 12 (2) ◽  
pp. e226805
Author(s):  
Anoopkishore Chidambaram ◽  
Sirisha Donekal
Keyword(s):  
Subcutaneous Emphysema ◽  
Rare Entity ◽  
X Ray ◽  
Spontaneous Pneumomediastinum ◽  
Expert Opinions ◽  
Repeat Chest ◽  
Chest X Ray ◽  
Red Flag ◽  
Surgical Emphysema ◽  
Safety Netting

Spontaneous subcutaneous emphysema and pneumomediastinum in children without any predisposing factors is a rare entity. We present a case of an adolescent boy with spontaneous pneumomediastinum. He is a 14-year-old boy brought to the hospital with an odd feeling in the neck and chest. Initial chest X-ray revealed subcutaneous emphysema and pneumomediastinum. He was further evaluated with CT thorax and abdomen with contrast which revealed extensive pneumomediastinum with associated surgical emphysema in the chest wall and neck. Expert opinions from the cardiothoracic and respiratory teams were obtained. The child was discharged with safety netting and description of red flag signs. Repeat chest X-ray in 2 weeks showed complete resolution of the pneumomediastinum and subcutaneous emphysema. We will briefly discuss about the diagnosis and treatment of spontaneous pneumomediastinum and subcutaneous emphysema.

scholarly journals Absence of major fibrotic adverse events in hyperprolactinemic patients treated with cabergoline

2010 ◽  
Vol 162 (4) ◽  
pp. 667-675 ◽  
Author(s):  
M Lafeber ◽  
A M E Stades ◽  
G D Valk ◽  
M J Cramer ◽  
F Teding van Berkhout ◽  
...  
Keyword(s):  
Adverse Events ◽  
Pulmonary Function ◽  
Pulmonary Function Test ◽  
Adverse Reactions ◽  
Valvular Regurgitation ◽  
X Ray ◽  
Increased Risk ◽  
Function Test ◽  
Additional Imaging ◽  
Chest X Ray

BackgroundCabergoline, a dopamine agonist used to treat hyperprolactinemia, is associated with an increased risk of fibrotic adverse reactions, e.g. cardiac valvular fibrosis, pleuropulmonary, and retroperitoneal fibrosis.ObjectiveThis study evaluated the prevalence and risk of fibrotic adverse reactions during cabergoline therapy in hyperprolactinemic and acromegalic patients.DesignA cross-sectional study was conducted in a University Hospital.PatientsA total of 119 patients with hyperprolactinemia and acromegaly who were on cabergoline therapy participated in the study.MethodsAll patients were requested to undergo a cardiac assessment, pulmonary function test, chest X-ray, and blood tests as recommended by the European Medicine Agency. Matched controls were recruited to compare the prevalence of valvular regurgitation. Cardiac valvular fibrosis was evaluated by assessing valvular regurgitation and the mitral valve tenting area (MVTa). The risk of pleuropulmonary fibrosis was assessed by a pulmonary function test, a chest X-ray, and if indicated, by additional imaging studies.ResultsThe prevalence of clinically relevant valvular regurgitation was not significantly different between cases (11.3%) and controls (6.1%; P=0.16). The mean MVTa was 1.27±0.17 and 1.24±0.21 cm2 respectively (P=0.54). Both valvular regurgitation and the MVTa were not related to the cumulative dose of cabergoline. A significantly decreased pulmonary function required additional imaging in seven patients. In one patient, possible early interstitial fibrotic changes were seen. Lung function impairment was not related to the cumulative cabergoline dose.ConclusionCabergoline, typically dosed for the long-term treatment of hyperprolactinemia or acromegaly, appears not to be associated with an increased risk of fibrotic adverse events.

scholarly journals Low QRS Voltage in Limb Leads Indicates Accompanying Precordial Voltage Attenuation Resulting in Underestimation of Left Ventricular Hypertrophy

2021 ◽  
Vol 18 (24) ◽  
pp. 12867
Author(s):  
Hye-Bin Gwag ◽  
Su-Hyun Lee ◽  
Hyeon-Jun Kim ◽  
June-Soo Kim ◽  
Young-Keun On ◽  
...  
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Ventricular Hypertrophy ◽  
Structural Heart Disease ◽  
Left Ventricular ◽  
Healthy Population ◽  
Primary Analysis ◽  
X Ray ◽  
Function Test ◽  
Chest X Ray ◽  
Voltage Attenuation

Low QRS voltage (LQRSV) in electrocardiography (ECG) often occurs in limb leads without apparent cause. However, its clinical significance is obscure in healthy populations. We reviewed patients aged over 60 who were scheduled for non-cardiac surgery in two hospitals. Patients underwent pre-operative ECG, echocardiography, pulmonary function test, and chest X-ray. Patients with LQRSV isolated to limb leads and patients without LQRSV were selected from separate hospitals. Among the 9832 patients screened in one hospital, 292 (3.0%) showed LQRSV in limb leads. One-hundred and ninety-four without LQRSV were selected as the control from the 216 patients screened at the other hospital. For primary analysis, patients with structural heart disease or classic etiologies of LQRSV were excluded. Patients with LQRSV had a higher proportion of male and a greater body mass index. Precordial QRS voltages were smaller, whereas left ventricular mass index and the prevalence of echocardiographic left ventricular hypertrophy (LVH) was higher in patients with LQRSV than in those without. Consequentially, diagnostic performance of precordial voltage criteria for LVH was particularly poor in patients with LQRSV in limb leads. LQRSV in limb leads frequently occurs without apparent etiologies. ECG voltage criteria may underestimate LVH in a relatively healthy population with LQRSV in limb leads.

scholarly journals Adherence to Monitoring Guidelines of Amiodarone Adverse Reactions

2019 ◽  
Vol 6 ◽  
pp. 233339281984463 ◽  
Author(s):  
Ophir Lavon ◽  
Ron Goldman
Keyword(s):  
Clinical Guidelines ◽  
Chart Review ◽  
Adverse Reactions ◽  
Retrospective Chart Review ◽  
X Ray ◽  
Liver Functions ◽  
Function Test ◽  
Improve Compliance ◽  
Amiodarone Treatment ◽  
Chest X Ray

Background: Amiodarone treatment frequently causes adverse reactions. Clinical guidelines warrant a comprehensive assessment prior to chronic treatment with amiodarone and repeated monitoring for the appearance of adverse reactions. Objective: To evaluate adherence to these guidelines. Methods: A retrospective chart review of electronic medical records of adult patients treated with oral amiodarone for at least 12 months. Results: One hundred patient records were analyzed; 97% of patients were evaluated for thyroid and liver functions prior to treatment. Liver functions were properly monitored every 6 months in 96% of patients and thyroid function in only 59%. Most (84%) patients completed a chest X-ray before treatment; only 2% completed a respiratory function test. None have performed a chest X-ray annually. Sixty-four percent of the patients were examined by an ophthalmologist prior to treatment; periodic ophthalmic surveillance was not consistent. Neurological and dermatological evaluations were not recorded for any of the patients, unless symptoms appeared. Only 50% were adherent to annual cardiac reassessment. Conclusions: Adherence to recommended clinical guidelines for monitoring amiodarone adverse reactions is poor. Interventions to improve compliance with these guidelines are needed.

scholarly journals An Orbital Mass Partially Responsive to Steroid

2021 ◽  
Vol 5 (2) ◽  
Keyword(s):  
Lower Extremity ◽  
Granulomatous Inflammation ◽  
Orbital Pseudotumor ◽  
Orbital Mass ◽  
Hilar Lymphadenopathy ◽  
X Ray ◽  
Bilateral Hilar Lymphadenopathy ◽  
Chest X Ray

A 68 year old woman presented with a progressively enlarging orbital mass. MRI of her brain and orbits was consistent with an orbital pseudotumor. Although there was some improvement in the patient’s pain and the size of the mass, it did not fully resolve.The patient had a biopsy demonstrate non-caseating granulomatous inflammation. A chest X-ray and CT chest demonstrated bilateral hilar lymphadenopathy. Further examination and interviewing of the patient revealed several months of joint paints and lower extremity nodules. The patient was diagnosed with orbital sarcoidosis and was started on methotrexate by a rheumatologist

scholarly journals An Evaluation of Preoperative Methods of Preventing Postoperative Pulmonary Complications

1977 ◽  
Vol 5 (1) ◽  
pp. 56-59 ◽  
Author(s):  
I. C. Wheatley ◽  
K. J. Hardy ◽  
C. E. Barter
Keyword(s):  
Vital Capacity ◽  
Forced Expiratory Volume ◽  
Pulmonary Complications ◽  
Respiratory Care ◽  
Postoperative Pulmonary Complications ◽  
X Ray ◽  
Function Test ◽  
Postoperative Respiratory Complications ◽  
Chest X Ray ◽  
Intensive Physiotherapy

The effectiveness of three current regimes of preoperative respiratory care in reducing postoperative respiratory complications following herniorrhaphy was studied prospectively. No smoking for five days plus intensive physiotherapy, five days no smoking, and routine hospital admission two days preoperatively were the regimes. Clinical, bacteriological, chest X-ray, blood gas and respiratory function test data were the criteria for assessment. The same surgical and anaesthetic team performed each operation. No statistical difference between the groups for pulmonary complications was noted. A significant correlation was found between the preoperative vital capacity and arterial pO2; also between the preoperative forced expiratory volume in one second-vital capacity ratio with the postoperative arterial pO2.

scholarly journals Primary Intestinal Hodgkin’s Lymphoma: An Uncommon Presentation

2013 ◽  
Vol 5 (02) ◽  
pp. 124-126 ◽  
Author(s):  
Shruti Sharma ◽  
Safia Rana ◽  
Sujala Kapur ◽  
Zeeba Shamim Jairajpuri
Keyword(s):  
Small Intestine ◽  
Hodgkin’S Lymphoma ◽  
Hodgkin's Lymphoma ◽  
Rare Entity ◽  
Intestinal Lymphoma ◽  
Common Site ◽  
X Ray ◽  
Uncommon Presentation ◽  
Tumor Involvement ◽  
Chest X Ray

ABSTRACTPrimary intestinal lymphoma is a rare lymphoproliferative neoplasm of the small intestine. The primary nature is established on the basis of lack of evidence of lymphoma on chest X-ray, computerized tomographic scan, peripheral blood or bone marrow puncture. Tumor involvement is limited to the gastrointestinal tract, the criteria for inclusion are that the symptoms related to the small intestine are predominant or the only symptoms at the time of laparotomy. Hodgkin's lymphoma (HL) primarily in the small intestine is a rare entity and an uncommon presentation of the disease. Ileum is the more common site of infliction than the jejunum because of its abundant lymphoid follicles. Here, we present a case of primary intestinal HL, in a 30-year-old male.

Isoniazid-Resistant Cavitary Tuberculosis in a Physician Following Isoniazid Prophylaxis

2002 ◽  
Vol 23 (10) ◽  
pp. 622-625
Author(s):  
Tobi B. Karchmer ◽  
John D. Phipps ◽  
Eve T. Giannetta ◽  
Barry M. Farr
Keyword(s):  
Chest Radiograph ◽  
Soft Tissue Density ◽  
X Ray ◽  
Single Drug ◽  
Resistant Tuberculosis ◽  
Tuberculin Skin Test Conversion ◽  
Chest X Ray ◽  
Drug Prophylaxis ◽  
Isoniazid Prophylaxis ◽  
Active Disease

Abstract Single-drug prophylaxis is recommended after tuberculin skin test conversion, but not when there is active disease on chest radiograph because resistance develops frequently. Isoniazid-resistant tuberculosis developed in a physician receiving prophylaxis despite “faint left upper lobe soft tissue density” on chest radiograph. Ignoring active disease on chest x-ray renders this strategy counterproductive and cost ineffective. '(Infect Control Hosp Epidemiol 2002;23:622-625).

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