Nodular histiocytic/mesothelial hyperplasia as consequence of chronic mesothelium irritation by subphrenic abscess.

PURPOSE: Pleural nodular histiocytic/mesothelial hyperplasia is a nodular histiocytic/mesothelial proliferation, often delimiting cystic cavities, due to irritation by a pulmonary noxa. Case report results: The patient had right pleural parietal and diaphragmatic thickness, with pleural effusion, without lung alterations. He previously underwent left hemicolectomy and liver resection, due to a diverticulitis and a liver histiocytes-rich abscess. Video-assisted thoracoscopy biopsy showed a double population of reactive mesothelial cells and histiocytes. CONCLUSION: Nodular histiocytic/mesothelial hyperplasia represents a potential pitfall for pathologists. Immunohistochemistry is crucial for the differential diagnosis with some malignancies. We suggest that in our patient, a chronic mesothelium inflammation happened by transdiaphragmatic involvement as a consequence of the liver abscess. Some pathogenetic mechanisms are hypothesized.

[Aspergillus peritonitis--a case report]. / Aspergillus peritonitis esete.

The incidence of fungal infections such as Aspergillosis is increasing among immunocompromised patients. Demand for diagnosis of mycotic diseases is steadily raising among clinicians and treatment of these patients represents a continually growing challenge. The authors present a case of a 53-year-old male patient with Aspergillus peritonitis. This case deserves attention because its extreme rarity in the medical literature and complex therapy of coinfections during the hospital stay which was difficult and relatively expensive. The importance of consultation and microbiological sampling is emphasized.

[Fungal liver abscesses in a patient with primary sclerosing cholangitis and Crohn's disease]. / Abscesos hepáticos fúngicos en un paciente con colangitis esclerosante primaria y enfermedad de Crohn.

Liver abscesses are a relatively infrequent complication of inflammatory bowel disease. These abscesses are usually multiple and of polymicrobial origin. The development of primary sclerosing cholangitis in inflammatory bowel disease, although provoking alterations in biliary morphology and a higher incidence of infections, does not predispose patients to the development of liver abscesses. We describe a new case of primary sclerosing cholangitis and Crohn's disease with multiple fungal liver abscesses caused by Candida albicans. The patient had developed a duodenal-biliary fistula. Antibiotic therapy produced clinical response and surgery was performed to repair the fistula.

Transphrenic fistulization of a subphrenic abscess to lung parenchyma.

A 53-year-old woman was admitted with respiratory distress. For several years, she had chronic alcoholic pancreatitis with ductal stones that were treated with a stent and with shockwave lithotripsy. Both treatments were unsuccessful, and the pancreatitis was complicated with an infected pseudocyst. The pancreatic head had to be resected, which was complicated with recurrent subphrenic abscesses. She then was admitted with respiratory distress and initially diagnosed with pneumonia of the right lower lobe. Further investigations showed supradiaphragmatic and subdiaphragmatic air-fluid levels. In both collections Streptococcus milleri was cultured, and subsequently the patient was diagnosed with a fistula connecting the subdiaphragmatic abscess with pulmonary tissue. This was treated with intravenous amoxicillin/clavulanate and drainage of the subdiaphragmatic collection. She did not develop a pulmonary empyema, because multiple adhesions, which were due to recurrent abscesses after pancreatic surgery, prevented breakthrough into the pleural cavity.

Clinical spectrum of septic pulmonary embolism and infarction.

Management of septic pulmonary embolism now suggests a predictability of the clinical course which often allows an early decision regarding the need for definitive thoracotomy. Sixty patients have been treated within the past 5 years. Antibiotics were employed in all patients, administered whenever possible according to cultures. In 12 patients thoracotomy was required. This involved decortication and varying amounts of pulmonary resection from wedge excision to pneumonectomy. Early appreciation of septic pulmonary embolism and prompt thoracotomy can frequently obviate the need for tardy open drainage procedures with consequent prolonged recovery. Sources of emboli must be controlled. Interruption of the inferior vena cava, vein excision, aggressive control of peripheral abscesses, and excision of the tricuspid valve may be required. Reliance on antiocagulants alone to control emboli is dangerous, and proper surgical intervention and antibiotic therapy reduce the need for long-term anticoagulation.

The "elephant man" of Cambridge. a case report of neurofibromatosis.

The case is presented of a 65-year-old man with neurofibromatosis manifesting facial and skeletal features resembling those of the "elephant man" described by Sir Frederick Treves. Autopsy revealed not only a pheochromocytoma (a common accompaniment of neurofibromatosis), but an enlarged infarcted spleen and a subphrenic abscess. These findings have not been described previously in a patient with neurofibromatosis.

Bronchoperitoneal fistula secondary to chronic Klebsiella pneumoniae subphrenic abscess.

We treated a case of bronchoperitoneal fistula secondary to a Klebsiella pneumoniae subphrenic abscess. This fistulous communication and the surgical procedure used to treat it are described.

Exudative pleural effusions secondary to gastrointestinal diseases.

Several different diseases of the gastrointestinal tract may have an associated exudative pleural effusion. In the acutely ill patient with a pleural effusion, the possibility of esophageal perforation should always be considered. It is important to establish this diagnosis as soon as possible since the mortality rate increases markedly if drainage of the mediastinum is delayed for even 12 or 24 hours. The best screening test for esophageal rupture is the level of amylase in the pleural fluid. All patients with undiagnosed exudative pleural effusions should have the amylase level in their pleural fluid measured to rule out a pancreatic etiology for their pleural effusion. In patients with acute pancreatitis, the clinical presentation may be dominated by chest symptoms. Such patients have small to moderately sized pleural effusions that resolve rapidly once appropriate therapy is instituted. If symptoms persist, the possibility of a pancreatic abscess or a pancreatic pseudocyst should be considered. Patients with pancreatic pseudocysts may develop a sinus tract between the pseudocyst and the pleural space. In this situation a large pleural effusion develops. Frequently there are no abdominal symptoms and the diagnosis will not be made unless a pleural fluid amylase is obtained. Patients with exudative pleural effusions that contain predominantly polymorphonuclear leukocytes should be suspected of having an intra-abdominal abscess, particularly when there is no associated parenchymal infiltrate. Subphrenic, intrahepatic, and splenic abscesses all have a high incidence of accompanying pleural effusion. Abdominal CT scanning is the method of choice to establish each of these diagnoses.

Cranial asymmetry secondary to unilateral hemispheric damage during late childhood. Case report.

Skull abnormalities such as unilateral hypertrophy of skull thickness, enlarged sinuses, and elevated petrous ridge with contralateral body hemiatrophy are commonly associated with hemispheric damage that occurs during infancy. The present case emphasizes that such changes may be associated with cortical damage during late childhood.

Intraabdominal abscess after penetrating abdominal trauma.

In 57 (2.4 percent) of 2,416 patients undergoing laparotomy for penetrating abdominal trauma from 1977 to 1980, an intraabdominal abscess developed in the postoperative period. Preoperative antibiotic administration, careful closure of gastrointestinal tract perforation with diversion as necessary, and copious irrigation of the peritoneal cavity at the completion of surgery were common factors in all operations. Over 80 percent of penetrating wounds leading to abscesses occurred in the upper quadrants, and common risk factors included multiple intraabdominal solid organ injuries requiring open drainage, coupled with gastrointestinal tract perforation. Physician delay in the recognition of patients with intraabdominal abscess and in reoperation was a common problem.

CT findings in post-operative subphrenic abscess with teratomatous inclusions.

A 39-year-old woman presented with abdominal pain after tubal sterilization. CT showed a subphrenic abscess with fatty inclusions owing to laceration or rupture of a mature ovarian teratoma. Although subphrenic abscess is a well recognized post-operative complication, and ovarian teratomas are frequent, a teratomatous inclusion within a subphrenic abscess is a unique finding.

Rupture of splenic artery pseudoaneurysm.

Pseudoaneurysms of the splenic artery have been well described in association with pancreatic pseudocysts secondary to pancreatitis. We present a case of a ruptured splenic artery pseudoaneurysm 14 years after splenectomy for trauma which, at that time, was complicated by a subphrenic abscess.

Centrocytic lymphoma presenting as a subphrenic abscess and a solitary liver nodule.

Non Hodgkin's lymphoma revealed by hepatic manifestations is extremely rare. We describe here a 82-year old male patient who presented with a right subphrenic abscess and a solitary liver tumour that was shown to be a centrocytic lymphoma. Furthermore, asymptomatic cryptogenic liver cirrhosis was diagnosed. This previously unreported form of clinical presentation of a non Hodgkin's lymphoma as well as the association with liver cirrhosis are discussed in the context of the recent literature.

Extraction of retained gallstones from an abscess cavity: a percutaneous endoscopic technique.

A novel technique to retrieve spilled gallstones in an abscess cavity with the use of minimally invasive techniques is described.

Left pleural effusion: masking subphrenic abscess--caused by Salmonella enteritidis serotype Heidelberg.

The authors describe a young girl presenting with fever and respiratory distress and a chest x-ray showing a left lower lobe infiltrate and an effusion. She also had splenomegaly. Salmonella enteritidis serotype Heidelberg was isolated by thoracentesis. Further evaluation disclosed an occult but large left subphrenic abscess, explaining the misleading presentation and radiograph. A review of salmonella infections associated with subphrenic abscess is discussed.

Hepatobiliary-lung imaging. A case report.

The use of combined hepatobiliary-lung imaging in the diagnosis and evaluation of a subphrenic process is described.

An unusual paratyphoid fever.

Salmonella typhi is known to produce acalculous cholecystitis and related gall bladder perforation. Following is a documentation of a patient of sub-phrenic abscess and gall bladder perforation which was possibly a result of Salmonella paratyphi A.

[Late sequellae of a splenectomy (author's transl)]. / Late verwikkelingen van een splenectomie

This is the case of a patient who underwent splenectomy after traumatic rupture of the spleen. After the operation, while on parenteral feeding, the patient presented with fever and septicemia during approximately 2 months; no origin to this could be found. Two months after the accident the patient died of perforation of a subdiaphragmatic abscess into the stomach and the lung. The authors discuss the possibilities of coming to an earlier diagnosis. They recognize the necessity of a more aggressive attitude to establish the diagnosis.