scholarly journals Pancreaticopleural fistula: An insidious cause of pleural effusion –case report

2021 ◽  
Author(s):  
Fábio Murteira ◽  
Tiago Costa ◽  
Sara Barbosa Pinto ◽  
Elsa Francisco ◽  
Ana Catarina Gomes
Keyword(s):  
Computed Tomography ◽  
Acute Pancreatitis ◽  
Case Report ◽  
Pleural Effusion ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Pancreatic Amylase ◽  
Pleural Effusions ◽  
Primary Event ◽  
Endoscopic Retrograde ◽  
Left Chest

Pancreaticopleural fistulas (PPF) are a rare etiology of pleural effusions. We describe a case of a 61-year-old man, with left chest pain with six months of progression who presented with a large volume unilateral pleural effusion. A thoracentesis was performed, which showed a dark reddish fluid(exudate) and high content of pancreatic amylase. After that an abdominal computed tomography (CT)and magnetic resonance cholangiopancreatography (MRCP) was done, revealing fistulous pathways that originated in the pancreas. The patient was admitted for conservative and endoscopic treatment by Endoscopic Retrograde Cholangiopancreatography (ERCP) and a prosthesis was placed on a fistulous path. He was discharged without complications, with the resolution of the pleural effusion and fistula.The interest of this case lies in the rarity of the event and absence of symptoms of the probable primary event (acute pancreatitis). The possible iatrogenic association with several drugs of his usual medication makes it even more complex.

scholarly journals Pancreaticopleural fistula: a case report

2018 ◽  
Vol 8 (3) ◽  
pp. 73-75
Author(s):  
Bikas Thapa ◽  
Nirajan Subedi ◽  
Ramesh S. Bhandari
Keyword(s):  
Computed Tomography ◽  
Case Report ◽  
Chronic Pancreatitis ◽  
Fistulous Tract ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Pleural Space ◽  
Diagnostic Challenge ◽  
Endoscopic Retrograde ◽  
Chronic Alcoholic ◽  
Surgical Interventions

Pancreaticopleural fistula is a diagnostic challenge to physicians. The diagnosis should be suspected if a patient presents with pleural effusion in a setting of chronic pancreatitis. The significantly raised amylase in the pleural fluid offers an important clue to the diagnosis. Computed Tomography (CT), Endoscopic retrograde cholangiopancreatography (ERCP) and Magnetic resonance cholangiopancreatography (MRCP) can reveal the fistulous tract between the pancreas and the pleural space. The therapeutic options include medical, endoscopic, as well as surgical interventions. Here we report a case of pancreaticopleural fistula in a chronic alcoholic that was treated successfully by medical management.

Yellow Nail Syndrome Presenting With a Pericardial Effusion: A Case Report and Review of the Literature

2017 ◽  
Vol 22 (2) ◽  
pp. 190-193 ◽  
Author(s):  
Laura C. Soong ◽  
Richard M. Haber
Keyword(s):  
Computed Tomography ◽  
Case Report ◽  
Pleural Effusion ◽  
Pericardial Effusion ◽  
Respiratory Tract ◽  
Clinical Findings ◽  
Review Of The Literature ◽  
Pleural Effusions ◽  
Yellow Nail Syndrome ◽  
Tract Involvement

Yellow nail syndrome (YNS) is a constellation of clinical findings including at least 2 of the 3 features of thickened yellow nails, respiratory tract involvement, and lymphedema. We report the case of a middle-aged man presenting with dystrophic, thickened yellow nails; an idiopathic pericardial effusion in the absence of pleural effusion(s); and unilateral apical bronchiectasis found on computed tomography of the chest. This represents a unique presentation of YNS as the first report of a patient with YNS and a pericardial effusion in the absence of pleural effusions and lymphedema and is the 11th case report of YNS with pericardial effusion.

scholarly journals Rapidly Progressive Lung Cysts and Pleural Effusion: A Case Report

2011 ◽  
Vol 2011 ◽  
pp. 1-3 ◽  
Author(s):  
Diana Olsen ◽  
Charlene Molloy ◽  
P. S. Sriram
Keyword(s):  
Endothelial Cells ◽  
Case Report ◽  
Pleural Effusion ◽  
Vascular Endothelial Cells ◽  
Vascular Endothelial ◽  
Review Of The Literature ◽  
Pleural Effusions ◽  
Lung Cysts ◽  
Pulmonary Cysts ◽  
Thin Walled

Angiosarcoma is a rare but highly malignant tumor arising from vascular endothelial cells. Angiosarcoma commonly arises from the heart, liver, breast, and skin including the scalp. Angiosarcoma metastasizing to the lungs can present as either pneumothorax, hemothorax, or pleural effusions. They can rarely present as rapidly enlarging thin-walled pulmonary cysts. A review of the literature is included.

scholarly journals The clicking chest: what exactly did Hamman hear? A case report of a left-sided pneumothorax

2020 ◽  
Author(s):  
Nadeem Jimidar ◽  
Patrick Lauwers ◽  
Emmanuela Govaerts ◽  
Marc Claeys
Keyword(s):  
Computed Tomography ◽  
Differential Diagnosis ◽  
Case Report ◽  
Case Reports ◽  
Gunshot Wounds ◽  
Computed Tomography Scan ◽  
Imaging Studies ◽  
Left Chest ◽  
Case Summary ◽  
Tomography Scan

Abstract Background Hamman’s sign is a rare phenomenon. Louis Hamman described this pathognomonic clicking chest noise in association with pneumomediastinum in 1937. This typical noise can also be present in left-sided pneumothorax. Clinical cases already mention this pericardial knock in 1918 in gunshot wounds of the left chest and in 1928 in cases of spontaneous left-sided pneumothorax. However, the sound itself has only rarely been recorded. Case summary We describe a case of a young man with no significant medical history who was referred to the hospital with chest pain and audible clicks, documented with his smartphone. Imaging studies including chest radiograph and computed tomography scan revealed a left-sided pneumothorax. The patient underwent semi-urgent insertion of a thorax drain. His clinical outcome was excellent. Discussion In recent years only a few case reports describe Hamman’s sign, as it is rare and happens only transiently. This case report includes the audible clicks recorded by the patient with his smartphone. We stress the importance of thoracic clicking sounds as key symptom in the differential diagnosis of left-sided pneumothorax, pneumomediastinum, and valvular pathology such as mitral valve prolapse.

scholarly journals Application of Computed Tomography (CT) Attenuation Values in Diagnosis of Transudate and Exudate in Patients with Pleural Effusion

2018 ◽  
Vol 11 (02) ◽  
pp. 19-25
Author(s):  
Keshab Sharma ◽  
PS Lamichhane ◽  
BK Sharma
Keyword(s):  
Computed Tomography ◽  
Pleural Effusion ◽  
Ct Scan ◽  
Pleural Fluid ◽  
Pleural Effusions ◽  
Hounsfield Units ◽  
Fluid Analysis ◽  
Ct Attenuation ◽  
The Mean ◽  
Attenuation Values

Background: Pleural effusion is the pathologic accumulation of fluid in the pleural space. The fluid analysis yields important diagnostic information, and in certain cases, fluid analysis alone is enough for diagnosis. Analysis of pleural fluid by thoracentesis with imaging guidance helps to determine the cause of pleural effusion. The purpose of this study was to assess the accuracy of computed tomography (CT) in characterizing pleural fluid based on attenuation values and CT appearance. Materials and Methods: This prospective study included 100 patients admitted to Gandaki Medical College and Teaching Hospital, Pokhara, Nepal between January 1, 2017 and February 28, 2018. Patients who were diagnosed with pleural effusion and had a chest CT followed by diagnostic thoracentesis within 48 hours were included in the study. Effusions were classified as exudates or transudates using laboratory biochemistry markers on the basis of Light’s criteria. The mean attenuation values of the pleural effusions were measured in Hounsfield units in all patients using a region of interest with the greatest quantity of fluid. Each CT scan was also reviewed for the presence of additional pleural features. Results: According to Light’s criteria, 26 of 100 patients with pleural effusions had transudates, and the remaining patients had exudates. The mean attenuation of the exudates (16.5 ±1.7 HU; 95% CI, range, -33.4 – 44 HU) was significantly higher than the mean attenuation of the transudates (11.6 ±0.57 HU; 95% CI, range, 5 - 16 HU), (P = 0.0001). None of the additional CT features accurately differentiated exudates from transudates (P = 0.70). Fluid loculation was found in 35.13% of exudates and in 19.23% of transudates. Pleural thickening was found in 29.7% of exudates and in 15.3% of transudates. Pleural nodule was found in 10.8% of exudates which all were related to the malignancy. Conclusion: CT attenuation values may be useful in differentiating exudates from transudates. Exudates had significantly higher Hounsfield units in CT scan. Additional signs, such as fluid loculation, pleural thickness, and pleural nodules were more commonly found in patients with exudative effusions and could be considered and may provide further information for the differentiation.

scholarly journals F-18 fluorodeoxyglucose positron emission computed tomography in the diagnosis of pleural metastases from breast carcinoma

2020 ◽  
Vol 7 (3) ◽  
pp. 764
Author(s):  
Murat Saricam
Keyword(s):  
Breast Cancer ◽  
Computed Tomography ◽  
Pleural Effusion ◽  
Emission Computed Tomography ◽  
Pleural Effusions ◽  
Fdg Uptake ◽  
Positron Emission ◽  
Pet Ct ◽  
Positron Emission Computed Tomography ◽  
Pleural Metastases

Background: This study aimed to investigate the feasibility of F-18 fluorodeoxyglucose (FDG) positron emission computed tomography (PET/CT) in identifying the pleural invasion of metastatic breast cancers.Methods: A retrospective study was conducted to include 75 patients with untreated breast cancer who had undergone thoracoscopy to drain pleural effusions and to perform pleural biopsies. Whole group of patients were evaluated in terms of age, type of primary breast cancer, macroscopic appearance of pleura during thoracoscopy, maximum standardized FDG uptake value (SUV) reported by PET/CT scan in addition to presence of malignancy detected in pleura and/or pleural effusion.Results: All of 75 patients were female and mean age was 56.12±11.70. Metastatic disease was diagnosed in the pleura of 40 (53.3%) and in the pleural effusion of 43 (57.3%) patients. The sensitivity and specificity of PET/CT in detecting pleural metastases of breast carcinoma was calculated as 88.2% and 96.2% whereas PET/CT demonstrated sensitivity of 91.9% and specificity of 91.3% in identifying malignant pleural effusion. Cut-off values of FDG uptake were 4.25 for pleural metastases and 3.85 for malignant pleural effusions. PET/CT also indicated a false negative rate of 12.5%, a false positive rate of 16.28% and an overall accuracy rate of 85.33% in the diagnosis of pleural metastasis of breast carcinoma.Conclusions: PET/CT reporting an FDG uptake over 4 in the pleura or pleural effusion is beneficial in managing the patients with the suspicion of pleural metastases from breast cancer.

scholarly journals Splenic Haematoma as a Rare Cause of Pleural Effusion: A Case Report

2021 ◽  
Author(s):  
Kashish Dutta ◽  
Anuj Kumar ◽  
Surabhi Jaggi ◽  
Mandeep Kaur Sodhi ◽  
Deepak Aggarwal
Keyword(s):  
Computed Tomography ◽  
Case Report ◽  
Pleural Effusion ◽  
Lung Parenchyma ◽  
Malignant Cells ◽  
Contrast Enhanced ◽  
Enhanced Computed Tomography ◽  
Upper Abdomen ◽  
Contrast Enhanced Computed Tomography ◽  
Exudative Pleural Effusion

Pleural effusion has various aetiologies, mostly located either in the lung parenchyma or in the pleura. Subphrenic causes, leading to exudative pleural effusion are uncommon. Authors hereby, presented a case of a 50-year-old female with recurrent left sided pleural effusion. The effusion was haemorrhagic, exudative with low Adenosine Deaminase (ADA), and no malignant cells on cytology. Contrast Enhanced Computed Tomography (CECT) thorax and upper abdomen showed an incidental splenic haematoma. With conservative treatment, splenic haematoma and adjoining pleural effusion resolved completely. Thus, this case highlights splenic haematoma as a rare but important cause of pleural effusion.

scholarly journals COVID-19 Reinfection in a Young Medical Doctor: A Case Report

2021 ◽  
Vol 59 (239) ◽  
Author(s):  
Dhruba Gaire ◽  
Muneshwar Sah ◽  
Bishnu Singh
Keyword(s):  
Computed Tomography ◽  
Case Report ◽  
Pleural Effusion ◽  
Medical Doctor ◽  
Medical Professionals ◽  
Cytokine Storm ◽  
Cost Of Treatment ◽  
Inflammatory Syndrome ◽  
D Dimer ◽  
Monthly Salary

There is hardly any report of reinfection due to coronavirus disease 2019 (COVID-19) in medical professionals from Nepal. We report a case of a 32-year-old doctor with COVID-19 reinfection. Symptoms during the first infection were mild. After one month, he was reinfected and developed diarrhea as well as a continuous high fever. His d-dimer and ferritin were much increased. Computed tomography chest showed bilateral lymph nodes, minimal pleural effusion, and scattered linear fibrosis. After discharge, his depression and myalgia persisted for one month. During reinfection, his symptoms were more severe and cost of treatment was almost eight times his monthly salary and he could not work for six weeks. Possible reasons for severe reinfection and differential diagnoses like cytokine storm, multisystem inflammatory syndrome, reactivation of COVID-19, and infection due to new variants were discussed. Whether infected or vaccinated or not, all should take recommended vaccination and primary-preventive as well as health-promotive measures.

scholarly journals Sonographic Bedside Quantification of Pleural Effusion Compared to Computed Tomography Volumetry in ICU Patients

2018 ◽  
Vol 4 (04) ◽  
pp. E131-E135 ◽  
Author(s):  
Ulf Teichgräber ◽  
Judith Hackbarth
Keyword(s):  
Computed Tomography ◽  
Pleural Effusion ◽  
Ct Scan ◽  
Supine Position ◽  
Cost Effective ◽  
Pleural Effusions ◽  
Icu Patients ◽  
The Us ◽  
Volumetric Estimation ◽  
Scan Data

Abstract To date, the reliability of ultrasound for the quantitative assessment of pleural effusion has been limited. In the following study, an easy and cost-effective bedside ultrasound method was developed and investigated for specific use in the intensive care unit (ICU). 22 patients (median age: 58.5 years, range: 37–88 years, 14 men and 8 women) with a total of 31 pleural effusions were examined in the ICU. The inclusion criterion was complete visualization of the effusion on chest computed tomography (CT). The ultrasound (US) examination was performed less than 6 h after the diagnostic CT scan. The pleural effusion volume was calculated volumetrically from the CT scan data. Within 4.58 +/- 2.87 h after the CT scan, all patients were re-examined with US in the ICU. The fluid crescent's thickness was measured between each intercostal space (ICS) with the patient in a supine position and a 30° inclination of the torso. The US measurements were compared to the calculated CT volumes using regression analysis, resulting in the following formula: V=13.330 x ICS6 (V=volume of the effusion [ml]; ICS6=sonographic measurement of the thickness of the liquid crescent [mm] in the sixth ICS).A significant correlation between the sonographically measured and the CT-calculated volumes was best observed for the sixth ICS (R2=0.589; ICC=0.7469 with p<0.0001 and a 95% CI of 0.5364–0.8705).The sonographic assessment of pleural effusions in a supine position and a 30° inclination of the torso is feasible for the volumetric estimation of pleural effusion. This is especially true for ICU patients with severe primary diseases and orthopnea who are unable to sit upright or lie flat.

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