scholarly journals Pleural Sarcoidosis and Occult Lymphatic Anthracosis: An Unusual Symptomatic Association

2020 ◽  
Author(s):  
Rosa Alves ◽  
Bruno Sousa ◽  
Francisco d'Orey ◽  
Pedro Sequeira ◽  
Ana Oliveira ◽  
...  
Keyword(s):  
Chest Pain ◽  
Pleural Effusion ◽  
Inflammatory Disease ◽  
Clinical Presentation ◽  
Unknown Aetiology ◽  
Pleuritic Chest Pain ◽  
Middle Aged ◽  
Bronchial Disease ◽  
Wide Range ◽  
Granulomatous Diseases

Sarcoidosis is a chronic multisystemic inflammatory disease of unknown aetiology. Virtually any organ or system can be involved, resulting in a wide range of clinical presentation. Pleural sarcoidosis is rare. Pleural effusion can only be attributed to pleural sarcoidosis in the presence of pleural non-caseating epithelioid granulomas and after excluding other granulomatous diseases. Anthracosis is a pneumoconiosis associated with thoracic adenopathies and bronchial disease, and it is usually asymptomatic. The authors present a case of a middle-aged man hospitalized due to cough, right-sided pleuritic chest pain and trepopnoea.

scholarly journals A Rare Case of Cyclical Hemothorax: Thoracic Endometriosis Syndrome

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Muhammad Shabbir Rawala ◽  
Muhammad Farhan Khaliq ◽  
Muhammad Asif Iqbal ◽  
S. Tahira Shah Naqvi ◽  
Kinaan Farhan ◽  
...  
Keyword(s):  
Chest Pain ◽  
Pleural Effusion ◽  
Reproductive Age ◽  
Common Disease ◽  
Pleuritic Chest Pain ◽  
Rare Presentation ◽  
Ct Guided ◽  
Endometrial Cells ◽  
Wide Range ◽  
Thoracic Endometriosis

Endometriosis is a common condition in which endometrial cells and stroma are deposited in extrauterine sites. Its prevalence has been estimated to be 10% of reproductive age females. It is commonly found in the pelvis; however, it may be found in the abdomen, thorax, brain, or skin. Thoracic involvement is a relatively rare presentation of this common disease. Thoracic endometriosis commonly presents as pneumothorax in 73% of patients. A rarer presentation of thoracic endometriosis is hemothorax (<14%) or hemoptysis (7%). Thoracic endometriosis is an uncommon cause of a pleural effusion. We present a case of 28-year-old African American female with no other medical conditions. She presented to the hospital with worsening right-sided pleuritic chest pain, dyspnea, and menorrhagia. She had been complaining of pleuritic chest pain for 5 years, the onset of which corresponds to the start of her menstrual cycle and is relieved with cessation of menses. Initial laboratory studies revealed a severe microcytic anemia with normal coagulation profile. Chest X-ray showed small right pleural effusion and suspicious for airspace disease. A computed tomography (CT) of chest was ordered for further clarification and identified large right pleural effusion. CT-guided thoracentesis removed 500 ml of serosanguinous fluid consisting of blood elements. There can be multiple sites involved with endometriosis and can present with wide range of symptoms that occur periodically with menses in young woman. The history and pleural fluid findings of this case are suggestive of Thoracic Endometriosis Syndrome. The diagnosis of this is often missed or delayed by clinicians, which can result in recurrent hospitalization and other complications. As internists we should be suspicious of atypical presentations of endometriosis and treat them early before complications develop. This case also highlights the importance of suspecting atypical etiologies for pleural effusion.

scholarly journals Adult onset stills disease: Newly diagnosed in pregnancy with rare clinical presentation as pleural effusion

2021 ◽  
Vol 8 (4) ◽  
pp. 582-584
Author(s):  
Garima Shah ◽  
Bikram Shah
Keyword(s):  
Chest Pain ◽  
Pleural Effusion ◽  
Inflammatory Disease ◽  
Adult Onset Still’S Disease ◽  
High Grade ◽  
Adult Onset ◽  
Still’S Disease ◽  
High Grade Fever ◽  
Still's Disease ◽  
Exacerbation Of Symptoms

Adult onset Still’ disease (AOSD) is a rare inflammatory disease which involves multiple systems and is of unknown etiology first described in 1971.It has more prevalence among young females and few studies show the exacerbation of symptoms during pregnancy. Patients usually presents with high grade fever, arthritis, arthralgia, salmon pink rash, organomegaly, lymphadenopathy but rarely can present with pleural symptoms, cardiac symptoms. Several criteria’s are used for diagnosis but Yamaguchi’s has the highest sensitivity of 93.5%. Yamaguchi’s classification criteria includes major and minor criteria’s and exclusion criteria’s. Although diagnostic criteria are there but AOSD till date is a diagnosis of exclusion. All the causes of clinical symptoms should be excluded which involves malignancies, infections, inflammatory conditions, autoimmune diseases before the diagnosis of AOSD is made. A 26-year-old female with G2P0010 and POG 6 weeks presented to medicine OPD with high grade fever associated with chills and rigors from 1 week. She was also complaining of stiffness and pain in multiple joints with chest pain, easy fatigability. She was having rashes on upper back below nape of neck. All the necessary investigations were carried out. It was found that she was also having right sided pleural effusion and severe microcytic hypochromic anemia. After batteries of investigations and consultation by obstetrician, rheumatologist, dermatologist diagnosis of Adult Onset Still’s disease was made. It was a diagnosis of exclusion. Patient was started on steroids and she responded well. All the symptoms including pleural effusion was subsided. Adult onset still’s disease is a form of still’s disease. It is a rare systemic auto-inflammatory disease. Yamaguchi is the most sensitive criteria but till date it is diagnosed after excluding possible causes of malignancies, infections and autoimmune conditions. Sometimes patients do present with rare symptoms like pleural effusion, pericarditis some may present as acute respiratory distress syndrome or mild symptoms like cough, pleuritic chest pain. In our case also all the possible causes were excluded as patient presented with pleural effusion for the first time during pregnancy, so the impact of the disease on the fetal outcome was also considered. AOSD has always been a diagnosis of exclusion but as in our case and cases with similar presentation AOSD should be consider as a differential diagnosis. Although there are only few studies which shows that there is fatal outcome of pregnancy in AOSD however there are studies showing exacerbation of symptoms of AOSD during pregnancy. Its early diagnosis and prompt treatment can be helpful in the better outcome of pregnancy as well as better prognosis of disease.

scholarly journals A Rapidly Progressing Pleural Effusion within 24 Hours: A Case Report

2021 ◽  
Author(s):  
Bassem Alhariri ◽  
Ayisha Ameen ◽  
Abdulqadir Nashwan
Keyword(s):  
Case Report ◽  
Chest Pain ◽  
Pleural Effusion ◽  
Shoulder Pain ◽  
Left Shoulder ◽  
Shortness Of Breath ◽  
Pleuritic Chest Pain

Patients with pleural effusion are mostly presenting with shortness of breath and pleuritic chest pain. This report describes a case of PE who presented with left shoulder pain and was found to have rapidly accumulating massive effusion within 24 hours of presentation. Thoracocentesis was performed a showed an exudative picture

The clinical presentation of respiratory disease

2020 ◽  
pp. 3947-3955
Author(s):  
Samuel Kemp ◽  
Julian Hopkin
Keyword(s):  
Chest Pain ◽  
Family History ◽  
Pulse Oximetry ◽  
Respiratory Disease ◽  
Exercise Tolerance ◽  
Clinical Presentation ◽  
Chronic Respiratory Disease ◽  
Pleuritic Chest Pain ◽  
Detailed History ◽  
Diagnostic Hypothesis

Respiratory disease can present in many ways, with variations attributable to many factors. The clinical presentation directs diagnostic hypothesis making, the choice of diagnostically discriminating investigations, and the most appropriate management. If a detailed history is not taken, the patient not observed carefully and examined diligently, and the information from these sources is not analysed correctly, then inappropriate investigation and management is likely. Common symptoms of respiratory disease are breathlessness, cough, haemoptysis, and pleuritic chest pain, details of which can point to particular diagnoses. An account of environmental exposures at work and home, and of family history, is critically important in some cases. In chronic respiratory disease, where breathlessness and disability are to be assessed, walking with the patient and observing exercise tolerance and distress (and pulse oximetry) can provide valuable information.

scholarly journals Pulmonary thromboembolism in an emergency hospital: Are our patients different?

2017 ◽  
Vol 55 (4) ◽  
pp. 237-244 ◽  
Author(s):  
Ana Maria Balahura ◽  
Andrada Guţă ◽  
Vlad Mihalcea ◽  
Emma Weiss ◽  
Maria Dorobanţu ◽  
...  
Keyword(s):  
Chest Pain ◽  
Hospital Stay ◽  
Older Patients ◽  
Clinical Presentation ◽  
Pulmonary Thromboembolism ◽  
Clinical Severity ◽  
Pleuritic Chest Pain ◽  
Younger Patients ◽  
Emergency Hospital ◽  
History Of

Abstract Introduction. Pulmonary thromboembolism (PTE) represents a medical emergency and is the third most common cause of mortality after myocardial infarction and stroke. The purpose of this study was to describe the characteristics and management of patients with PTE admitted in a referral emergency hospital in Romania. Material and methods. We retrospectively reviewed all cases of PTE diagnosed in one of the largest emergency hospitals in Bucharest during a 2-year period (January 2014 – December 2016). Patients with acute PTE were identified by a database search of the diagnostic codes of all discharge diagnoses. Demographic, clinical and paraclinical tests data was retrieved from medical records. Results. 221 patients (48.87% male, mean age 61.76 years (range 21-94 years)) were diagnosed with PTE in our hospital (0.31% of all hospitalizations). Dyspnea was the most frequent symptom reported (78.9%), followed by pleuritic chest pain (23.9%) and unilateral leg pain (15.8%). Upon presentation, 12.6% of patients had high-risk PTE. Up to 72.8% of patients had at least one thrombotic risk factor, while cancer (14%) was the most frequent amongst them. The mean length of hospitalization was 10.3 ± 4.6 days. Unfractioned heparin (UFH) was the preferred anticoagulant during hospital stay (73.7%, p < 0.001). Vitamin K antagonists (AVK) were the preferred anticoagulant (71.7%, p < 0.001) after discharge, whereas non-antivitamin K oral anticoagulants (NOAC) were recommended in 26.3% of patients. Thrombolysis was used in 18 (8.4%) cases. Mortality was 0.9%. Younger patients more frequently associated thrombophilia or a previous thromboembolic event and clinical signs of DVT at presentation. Older patients associated more frequently a history of hospitalization for heart failure or atrial fibrillation during the previous 3 months and a history of cancer. The clinical presentation in older patients was more severe, with higher PESI scores (103.6 ± 33.4 vs. 55.5 ± 17.9, p<0.001) and a longer hospital stay (10.7 ± 4.7 vs. 9.2 ± 3.9, p = 0.03). The type of anticoagulant treatment did not differ depending on age. Conclusion. In our emergency hospital, PTE is a relatively rare cause of hospitalization; the rate is, however, comparable with other major hospitals. Dyspnea and pleuritic chest pain was the clinical presentation dyad. UFH was the preferred anticoagulant for in-hospital treatment while AVK was the preferred option for long term treatment and recurrence prophylaxis; however an increasing number of patients are prescribed NOAC. In older patients clinical severity was higher upon presentation, hospitalization duration was increased and cancer was more frequently associated. Younger patients associated more frequently a primary hypercoagulable state and recurrent thromboembolism. Mortality rate was low during hospitalization, comparable with that seen in other studied populations.

scholarly journals A Very Rare Cause of Pleuritic Chest Pain: Bilateral Pleuritis as a First Sign of Familial Mediterranean Fever

2013 ◽  
Vol 2013 ◽  
pp. 1-3
Author(s):  
Sevket Ozkaya ◽  
Saliha E. Butun ◽  
Serhat Findik ◽  
Atilla Atici ◽  
Adem Dirican
Keyword(s):  
Abdominal Pain ◽  
Chest Pain ◽  
Pleural Effusion ◽  
Familial Mediterranean Fever ◽  
Gene Mutation ◽  
Colchicine Treatment ◽  
Pleuritic Chest Pain ◽  
Mediterranean Fever ◽  
Recurrent Pleural Effusion ◽  
Gene Mutation Analysis

The familial Mediterranean fever (FMF), also called recurrent polyserositis, is characterized by reccurrent episodes of serositis at pleura, peritoneum, and synovial membrane and fever. We present a patient with recurrent bilateral pleural effusion due to serositis attacks as a first sign of FMF. A 59-year-old Turkish man suffered from recurrent pleuritic chest pain due to pleural effusion and atelectasis. The etiology was not found, and his symptoms were spontaneously recovered during several weeks. The pleuritic chest pain was associated with abdominal pain in the last attack. The gene mutation analysis revealed the homozygosity of FMF (F479L) gene mutation in both our patient and his grandchild. After the colchicine treatment, the attack has not developed. In conclusion, recurrent pleural effusion and pleuritic chest pain may be the first signs of the FMF.

Case 13.14

2014 ◽  
pp. 639-640
Author(s):  
Christine U. Lee ◽  
James F. Glockner
Keyword(s):  
Chest Pain ◽  
Pleural Effusion ◽  
Pericardial Effusion ◽  
Inversion Recovery ◽  
Short Axis ◽  
Pleuritic Chest Pain ◽  
Ssfp Image ◽  
Left Pleural Effusion ◽  
Left Base ◽  
Multiple Episodes

25-year-old man with multiple episodes of pleuritic chest pain Short-axis SSFP image (Figure 13.14.1) reveals a small, predominantly inferior pericardial effusion, a small left pleural effusion, and left base atelectasis. Short-axis and horizontal long-axis LGE inversion recovery T1-weighted images (Figure 13.14.2...

scholarly journals Cerebral embolism due to left atrial myxoma in a patient presenting with chest pain and ST-segment elevation: a case report

2020 ◽  
Author(s):  
António Fontes ◽  
Nuno Dias-Ferreira ◽  
Anabela Tavares ◽  
Fátima Neves
Keyword(s):  
Myocardial Infarction ◽  
Chest Pain ◽  
Magnetic Resonance ◽  
Left Atrial ◽  
Left Ventricular ◽  
Atrial Myxoma ◽  
Left Atrial Myxoma ◽  
St Segment ◽  
Wide Range ◽  
St Elevation

Abstract Background Myocarditis is an uncommon, potentially life-threatening disease that presents with a wide range of symptoms. In acute myocarditis, chest pain (CP) may mimic typical angina and also be associated with electrocardiographic changes, including an elevation of the ST-segment. A large percentage (20–56%) of myxomas are found incidentally. Case summary A 62-year-old female presenting with sudden onset CP and infero-lateral ST-elevation in the electrocardiogram. The diagnosis of ST-elevation myocardial infarction was presumed and administered tenecteplase. The patient was immediately transported to a percutaneous coronary intervention centre. She complained of intermittent diplopia during transport and referred constitutional symptoms for the past 2 weeks. Coronary angiography showed normal arteries. The echocardiogram revealed moderate to severe left ventricular systolic dysfunction due to large areas of akinesia sparing most of the basal segments, and a mobile mass inside the left atrium attached to the septum. The cardiac magnetic resonance (CMR) suggested the diagnosis of myocarditis with concomitant left atrial myxoma. The patient underwent resection of the myxoma. Neurological evaluation was performed due to mild vertigo while walking and diplopia in extreme eye movements. The head magnetic resonance imaging identified multiple infracentimetric lesions throughout the cerebral parenchyma compatible with an embolization process caused by fragments of the tumour. Discussion Myocarditis can have various presentations may mimic acute myocardial infarction and CMR is critical to establish the diagnosis. Myxoma with embolic complications requires emergent surgery. To the best of our knowledge, this is the first case reported in the applicable literature of a myxoma diagnosed during a myocarditis episode.

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