RESUMEN
INTRODUCTION: We present a clinical case of a patient with neurological sequelae, dementia, gastrostomy and tracheostomy with a metal canula, who developed a lung abscess in an atypical topography, in the anterior segment of the left upper lobe, being attended to in the emergency department. CASE PRESENTATION: A 79-year-old man who was bedridden and with neurological sequelae resulting from a hemorrhagic stroke, with gastrostomy and tracheostomy with a metal canula, was attended for daily fever and increased secretion trough the canula, and a diagnosis of bronchoaspiration pneumonia was made. The chest X-ray was unremarkable with an evaluation impaired by the patient's posture. The chest CT showed a characteristic image of an abscess in the topography of the anterior segment of the upper lobe. Improvement in the patient`s clinical condition was accompanied by an improvement in the CT imaging results. And the other exams carried out did not show any other associated lung disease. DISCUSSION: Chest X-ray is still the initial method for studying infectious lung lesions, and CT is indicated in cases where the appearance of the lesion is not well defined, if doubts persist, whether the patient is immunosuppressed or oncological. CT can provide better definition of abscess imaging findings and is particularly useful for visualizing cavities not well delineated by X-ray, especially when a malignant neoplastic tumor lesion is suspected or when there is an associated pleural collection.
Asunto(s)
Absceso Pulmonar , Neumonía , Masculino , Humanos , Anciano , Absceso Pulmonar/diagnóstico por imagen , Pulmón/diagnóstico por imagen , Tomografía Computarizada por Rayos XAsunto(s)
Fístula Bronquial , Empiema Pleural , Absceso Pulmonar , Enfermedades Pleurales , Ultrasonografía , Humanos , Masculino , Fístula Bronquial/diagnóstico por imagen , Fístula Bronquial/complicaciones , Empiema Pleural/diagnóstico por imagen , Absceso Pulmonar/diagnóstico por imagen , Absceso Pulmonar/complicaciones , Enfermedades Pleurales/diagnóstico por imagen , Enfermedades Pleurales/complicaciones , Sistemas de Atención de Punto , Pruebas en el Punto de Atención , Ultrasonografía/métodos , AdultoAsunto(s)
Aspergilosis , Absceso Pulmonar , Neumonía Neumocócica , Infecciones por Pseudomonas , Humanos , Aspergillus fumigatus , Neumonía Neumocócica/complicaciones , Absceso Pulmonar/complicaciones , Absceso Pulmonar/diagnóstico por imagen , Pseudomonas aeruginosa , Infecciones por Pseudomonas/complicaciones , Infecciones por Pseudomonas/tratamiento farmacológicoRESUMEN
BACKGROUND: Although most stroke patients have underlying vascular risk factors, it is important to consider infectious causes of stroke in young adults without traditional risk factors or patients with cryptogenic stroke. Pulmonary vein thrombosis and air embolism can potentially cause cerebral infarction. However, the association between infection and pulmonary vein thrombosis or air embolism is often overlooked. In this case, we present a rare infectious cause of stroke and air embolism involving a pulmonary abscess and pulmonary vein thrombosis. CASE PRESENTATION: A 37-year-old male patient initially presented with right-sided pneumonia. During treatment at a local hospital, he developed headaches and left limb weakness. Subsequently, he was transferred to our hospital due to septic shock. Neurological evaluations revealed multiple brain foci and thrombosis in the right superior pulmonary vein. Following treatment with broad-spectrum antibiotics and anticoagulants, the patient's clinical symptoms and inflammatory markers showed improvement. However, a computed tomography scan revealed the formation of a pulmonary abscess, and the patient experienced coma and epilepsy after severe coughing with massive hemoptysis. Multiple air embolisms were observed in the brain computed tomography. Eventually, the patient's family chose to discharge him from the hospital. CONCLUSIONS: This case highlights the rare and complex etiologies of stroke associated with infection in a young patient. Early detection, diagnosis, and appropriate treatment of infected systemic embolism in young patients are crucial to prevent serious complications.
Asunto(s)
Embolia Aérea , Absceso Pulmonar , Embolia Pulmonar , Venas Pulmonares , Accidente Cerebrovascular , Trombosis de la Vena , Humanos , Masculino , Adulto Joven , Adulto , Absceso Pulmonar/complicaciones , Absceso Pulmonar/diagnóstico por imagen , Absceso Pulmonar/terapia , Venas Pulmonares/diagnóstico por imagen , Trombosis de la Vena/complicaciones , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/tratamiento farmacológico , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/diagnóstico por imagen , Embolia Pulmonar/diagnósticoRESUMEN
Surgical resection of the infected lung with curative intent is the treatment of choice for lung abscesses that are difficult to control with medical treatment alone. However, lung resection is considered difficult in some cases. Herein, we report two cases of destroyed lungs with severe symptoms, for which palliative cavernostomy was performed instead of infected lung resection. Case 1 was a 45-year-old man who had granulomatosis with polyangiitis in both lungs. Steroid pulse and immunosuppression therapies were repeated, resulting in a huge, destroyed lung on the right side with chronic necrotizing bilateral aspergillosis, causing severe symptoms. Considering the bilateral spread and extension of the cavity lesions, cavernostomy was performed for the destroyed right lung. Case 2 was a 73-year-old woman who had undergone a left lower lobectomy for a metastatic lung tumor and developed a destroyed lung with severe symptoms in the residual left upper lobe caused by a non-tuberculous mycobacterial infection. Since a completion pneumonectomy with curative intent was considered too invasive for her poor general condition, cavernostomy was performed for the destroyed lung. Palliative operations significantly relieved the severe symptoms and improved the general conditions of these patients, enabling outpatient follow up.
Asunto(s)
Aspergilosis , Absceso Pulmonar , Neoplasias Pulmonares , Humanos , Masculino , Femenino , Anciano , Persona de Mediana Edad , Pulmón/cirugía , Aspergilosis/cirugía , Neumonectomía/métodos , Absceso Pulmonar/diagnóstico por imagen , Absceso Pulmonar/cirugía , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/cirugíaRESUMEN
We present a case of a 24-year-old female who presented with a history of fever and back pain. She had no particular medical history and was not taking any medication. Transthoracic echocardiology and computed tomography showed a patent ductus arteriosus with vegetation in the pulmonary artery. She was treated with penicillin G;however, the vegetation embolized into the left pulmonary artery. After the antibiotics was changed to clindamycin and ceftriaxone, the resolution of the lung abscess was shown by computed tomography( CT). Two months later, a surgical repair of the patent ductus arteriosus was successfully performed. Patent ductus arteriosus-associated infectious endocarditis is relatively rare in adulthood.
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Conducto Arterioso Permeable , Absceso Pulmonar , Femenino , Humanos , Adulto Joven , Adulto , Conducto Arterioso Permeable/complicaciones , Conducto Arterioso Permeable/diagnóstico por imagen , Conducto Arterioso Permeable/tratamiento farmacológico , Antibacterianos/uso terapéutico , Arteria Pulmonar , Ceftriaxona , Absceso Pulmonar/complicaciones , Absceso Pulmonar/diagnóstico por imagen , Absceso Pulmonar/tratamiento farmacológicoRESUMEN
Chronic granulomatous disease (CGD) is a rare, primary immunodeficiency disorder that occurs due to a defective NADPH (Nicotinamide Adenine Dinucleotide Phosphate) oxidase system. Due to the varying clinical presentation and symptom overlap with other conditions, CGD can often pose as a challenge for paediatricians. This case report describes the approach to diagnosis and management of an infant affected by CGD, with liver abscess.
Asunto(s)
Enfermedad Granulomatosa Crónica , Absceso Pulmonar , Lactante , Humanos , Niño , Absceso Pulmonar/diagnóstico por imagen , Absceso Pulmonar/terapia , Pakistán , Enfermedad Granulomatosa Crónica/complicaciones , Enfermedad Granulomatosa Crónica/diagnóstico , NADPH Oxidasas , HígadoAsunto(s)
Fístula Bronquial , Absceso Pulmonar , Enfermedades Pleurales , Humanos , Absceso Pulmonar/complicaciones , Absceso Pulmonar/diagnóstico por imagen , Absceso Pulmonar/cirugía , Fístula Bronquial/diagnóstico por imagen , Fístula Bronquial/etiología , Fístula Bronquial/cirugía , Enfermedades Pleurales/complicaciones , Enfermedades Pleurales/diagnóstico por imagen , Enfermedades Pleurales/cirugía , Pulmón , NeumonectomíaAsunto(s)
Empiema , Absceso Pulmonar , Neumonía , Teratoma , Humanos , Absceso Pulmonar/complicaciones , Absceso Pulmonar/diagnóstico por imagen , Empiema/complicaciones , Neumonía/complicaciones , Neumonía/diagnóstico por imagen , Teratoma/complicaciones , Teratoma/diagnóstico por imagen , Teratoma/cirugíaAsunto(s)
Fístula Bronquial , Absceso Pulmonar , Enfermedades Pleurales , Humanos , Absceso Pulmonar/diagnóstico por imagen , Absceso Pulmonar/terapia , Siliconas , Enfermedades Pleurales/complicaciones , Enfermedades Pleurales/terapia , Fístula Bronquial/diagnóstico por imagen , Fístula Bronquial/terapia , Fístula Bronquial/complicaciones , Tórax , Neumonectomía/efectos adversosRESUMEN
Lung abscesses and empyemas are 2 forms of pulmonary infection that can present with similar clinical features. However, empyemas are associated with higher morbidity and mortality, necessitating the need to distinguish one from the other. Plain radiographs can sometimes provide clues to help differentiate the 2 pathologies but more often than not, a computed tomography scan is required to confirm the diagnosis. Correct diagnosis is essential, as the goal standard therapeutic intervention for empyemas may be contraindicated in patients with lung abscesses. Empyemas require percutaneous or surgical drainage in combination with antibiotics, while lung abscesses are generally treated with antibiotics alone as drainage can be associated with various complications. We present a case of a 65-year-old man with parapneumonic empyema diagnosed with characteristic findings on chest computed tomography and treated with surgical drainage and antibiotics. We hope to improve patient outcomes by highlighting the classical radiographic findings that help distinguish empyema and abscess.
Asunto(s)
Empiema , Absceso Pulmonar , Masculino , Humanos , Anciano , Absceso Pulmonar/diagnóstico por imagen , Absceso Pulmonar/terapia , Empiema/diagnóstico , Empiema/terapia , Empiema/complicaciones , Drenaje/métodos , Tomografía Computarizada por Rayos X/métodos , Antibacterianos/uso terapéuticoRESUMEN
The purpose of this study was to establish a clinical prediction model for the differential diagnosis of pulmonary cystic echinococcosis (CE) and pulmonary abscess according to computed tomography (CT)-based radiomics signatures and clinical indicators. This is a retrospective single-centre study. A total of 117 patients, including 53 with pulmonary CE and 64 with pulmonary abscess, were included in our study and were randomly divided into a training set (n = 95) and validation set (n = 22). Radiomics features were extracted from CT images, a radiomics signature was constructed, and clinical indicators were evaluated to establish a clinical prediction model. Finally, a model combining imaging radiomics features and clinical indicators was constructed. The performance of the nomogram, radiomics signature and clinical prediction model was evaluated and validated with the training and test datasets, and then the three models were compared. The radiomics signature of this study was established by 25 features, and the radiomics nomogram was constructed by using clinical factors and the radiomics signature. Finally, the areas under the receiver operating characteristic curve (AUCs) for the training set and test set were 0.970 and 0.983, respectively. Decision curve analysis showed that the radiologic nomogram was better than the clinical prediction model and individual radiologic characteristic model in differentiating pulmonary CE from pulmonary abscess. The radiological nomogram and models based on clinical factors and individual radiomics features can distinguish pulmonary CE from pulmonary abscess and will be of great help to clinical diagnoses in the future.