ABSTRACT
Most cases of mediastinal abscess occur as a postoperative complication of a thoracic surgical procedure or following trauma. The most common causative microorganism is Staphylococcus aureus, but it can be rarely caused by unusual microorganisms, such as Gemella species. These are relatively difficult-to-identify commensal microorganisms of the upper respiratory and gastrointestinal tracts and may cause several infections. A 66-year-old man was diagnosed with Gemella bergeri mediastinal abscess by the molecular detection of bacterial genes. He was successfully treated with penicillin antibiotic for eight weeks. To our knowledge, this is the first case report of mediastinal abscess caused by G. bergeri.
Subject(s)
Gemella , Gram-Positive Bacterial Infections , Mediastinal Diseases , Abscess/diagnosis , Abscess/drug therapy , Aged , Gram-Positive Bacterial Infections/diagnosis , Gram-Positive Bacterial Infections/drug therapy , Humans , Male , Mediastinal Diseases/diagnostic imaging , Mediastinal Diseases/drug therapySubject(s)
Epidural Abscess/diagnosis , Mediastinal Diseases/diagnosis , Osteomyelitis/diagnosis , Pneumothorax/diagnosis , Streptococcal Infections/diagnosis , Thoracic Vertebrae , Aged , Anti-Bacterial Agents/therapeutic use , Diabetes Mellitus, Type 2 , Diagnosis, Differential , Echocardiography , Epidural Abscess/complications , Epidural Abscess/diagnostic imaging , Epidural Abscess/drug therapy , Fever/etiology , Humans , Male , Mediastinal Diseases/complications , Mediastinal Diseases/diagnostic imaging , Mediastinal Diseases/drug therapy , Osteomyelitis/complications , Osteomyelitis/diagnostic imaging , Osteomyelitis/drug therapy , Pneumothorax/complications , Pneumothorax/diagnostic imaging , Pneumothorax/drug therapy , Streptococcal Infections/complications , Streptococcal Infections/diagnostic imaging , Streptococcal Infections/drug therapy , Streptococcus intermedius/isolation & purificationSubject(s)
Bone Diseases/diagnostic imaging , Mediastinal Diseases/diagnostic imaging , Osteomyelitis/diagnostic imaging , Spinal Diseases/diagnostic imaging , Tuberculosis/complications , Tuberculosis/diagnostic imaging , Abscess/diagnostic imaging , Abscess/drug therapy , Abscess/etiology , Antitubercular Agents/therapeutic use , Bone Diseases/drug therapy , Bone Diseases/etiology , Child , Diagnosis, Differential , Female , Humans , Magnetic Resonance Imaging , Mediastinal Diseases/drug therapy , Mediastinal Diseases/etiology , Mediastinum/diagnostic imaging , Osteomyelitis/drug therapy , Osteomyelitis/etiology , Spinal Diseases/drug therapy , Spinal Diseases/etiology , Tomography, X-Ray Computed , Tuberculosis/drug therapy , Whole Body ImagingSubject(s)
Dyspnea/etiology , Erythema Nodosum/etiology , Fever/etiology , Hyalohyphomycosis/complications , Lymphadenitis/etiology , Mediastinal Diseases/etiology , Adolescent , Antifungal Agents/therapeutic use , Diagnosis, Differential , Erythema Nodosum/diagnosis , Erythema Nodosum/drug therapy , Glucocorticoids/therapeutic use , Humans , Hyalohyphomycosis/diagnosis , Hyalohyphomycosis/drug therapy , Itraconazole/therapeutic use , Leg , Lung/diagnostic imaging , Lymph Nodes , Lymphadenitis/diagnosis , Male , Mediastinal Diseases/diagnosis , Mediastinal Diseases/drug therapy , Mediastinum , Posture , Prednisone/therapeutic use , Tomography, X-Ray ComputedSubject(s)
Granuloma/microbiology , Histoplasmosis/complications , Mediastinal Diseases/microbiology , Adolescent , Antifungal Agents/therapeutic use , Chest Pain/etiology , Diagnostic Imaging , Dyspnea/etiology , Female , Granuloma/drug therapy , Histoplasma , Histoplasmosis/drug therapy , Histoplasmosis/microbiology , Humans , Mediastinal Diseases/drug therapy , Vomiting/etiologyABSTRACT
Mycobacterium haemophilum is a rare pathogen, predominately present in the immunocompromised population. It is especially studied in HIV and haematological malignancy patients. Given its unique living conditions, it is often difficult to establish its diagnosis, but it is often suspected by its classic association with ulcerating skin findings. Our case is unique in that our patient is immunocompromised by his rheumatoid arthritis treatment, and presented without any skin lesions, but was found to have this rare pathogen causing a constellation of unusual symptoms.
Subject(s)
Arthritis, Rheumatoid/immunology , Immunocompromised Host , Mediastinal Diseases/diagnosis , Mycobacterium Infections/diagnosis , Mycobacterium haemophilum , Adalimumab/therapeutic use , Adult , Antirheumatic Agents/therapeutic use , Arthritis, Rheumatoid/complications , Arthritis, Rheumatoid/drug therapy , Diagnosis, Differential , Humans , Lymph Nodes/pathology , Male , Mediastinal Diseases/complications , Mediastinal Diseases/diagnostic imaging , Mediastinal Diseases/drug therapy , Mycobacterium Infections/complications , Mycobacterium Infections/diagnostic imaging , Mycobacterium Infections/drug therapyABSTRACT
SETTING: Endobronchial ultrasound (EBUS) is now the preferred tool to sample malignant mediastinal lesions. Data on its role in tubercular mediastinal adenopathy are limited.OBJECTIVE: To evaluate the efficacy of EBUS in diagnosing tubercular mediastinal lymphadenopathy and correlate the cytological and microbiological results obtained on aspirate with standard methods (radiology and the tuberculin skin test) suggesting tuberculosis (TB).DESIGN: A prospective study of 125 patients with suspected tubercular mediastinal lymphadenopathy who underwent EBUS-transbronchial needle aspiration. Only patients with a microbiologically confirmed diagnosis or unequivocal clinico-radiological response to anti-TB treatment during follow-up were included.RESULTS: A total of 122 patients showed findings suggesting TB on cytopathology (sensitivity 97.6%), 105 (84%) of whom had microbiological evidence of TB (positive smear/culture or both). Performing staining for acid-fast bacilli on slides prepared during the procedure vs. only on samples submitted in saline significantly improved the yield. Only 92 patients (73.6%) were Mantoux-positive. Cytology was more sensitive than computed tomography in picking up necrosis. Granulomas, with or without necrosis, were equally likely to be microbiologically positive. However, presence of only necrosis in a TB-endemic region invariably points towards TB diagnosis.CONCLUSIONS: EBUS was highly sensitive and specific for diagnosis of mediastinal TB and may be considered the investigation of choice for tubercular mediastinal adenopathy.
Subject(s)
Endoscopic Ultrasound-Guided Fine Needle Aspiration/methods , Lymphadenopathy/diagnosis , Mediastinal Diseases/diagnosis , Tuberculosis, Lymph Node/diagnosis , Adolescent , Adult , Aged , Antitubercular Agents/administration & dosage , Child , Female , Follow-Up Studies , Humans , Lymphadenopathy/drug therapy , Male , Mediastinal Diseases/drug therapy , Middle Aged , Prospective Studies , Sensitivity and Specificity , Tuberculosis, Lymph Node/drug therapy , Young AdultSubject(s)
Lymphadenopathy , Mediastinal Diseases , Tularemia , Aged , Anti-Bacterial Agents/therapeutic use , Ciprofloxacin/therapeutic use , Diagnosis, Differential , Humans , Lymphadenopathy/diagnosis , Lymphadenopathy/drug therapy , Lymphadenopathy/microbiology , Male , Mediastinal Diseases/diagnosis , Mediastinal Diseases/drug therapy , Mediastinal Diseases/microbiology , Positron Emission Tomography Computed Tomography , Tularemia/diagnosis , Tularemia/drug therapy , Tularemia/microbiologyABSTRACT
Mediastinal mucormycosis is an uncommon but lethal infection associated with an 83% mortality. We describe a case of fatal Rhizopus microsporus mediastinitis despite three exploratory mediastinal surgeries and complementary systemic and mediastinal irrigation with liposomal amphotericin B. We further review the literature on surgical and antifungal management of mediastinal mucormycosis.
Subject(s)
Amphotericin B/therapeutic use , Antifungal Agents/therapeutic use , Mediastinal Diseases/diagnosis , Mediastinal Diseases/microbiology , Mucormycosis/diagnosis , Mucormycosis/drug therapy , Adult , Fatal Outcome , Female , Humans , Mediastinal Diseases/drug therapy , Mediastinal Diseases/surgery , Rhizopus/drug effects , Therapeutic IrrigationABSTRACT
Invasive aspergillosis (IA) is a disease of the immunocompromised with a predilection for the lungs, although dissemination to all organs is possible. Its diagnosis remains a challenge due to the absence of specific clinical manifestations and laboratory findings. In most cases, diagnosis is eventually made via invasive methods. It carries with it a high mortality due to late diagnosis and delayed treatment. Here, we report a fascinating case of a young, otherwise healthy, immunocompetent patient that presented to us with superior vena cava syndrome and a mediastinal mass. It was anticipated that a malignancy would be found on further workup but, in fact, what was eventually discovered was a case of IA. Our report accentuates the significance of including IA as a differential while diagnosing a mediastinal mass in an immunocompetent host as patient outcome is determined by timely diagnosis and treatment.
Subject(s)
Aspergillosis/diagnosis , Mediastinal Diseases/diagnosis , Superior Vena Cava Syndrome/diagnosis , Adult , Antifungal Agents/therapeutic use , Aspergillosis/drug therapy , Aspergillus flavus/isolation & purification , Diagnosis, Differential , Humans , Immunocompetence , Male , Mediastinal Diseases/drug therapy , Mediastinal Diseases/microbiology , MediastinumSubject(s)
Abscess/diagnostic imaging , Anti-Bacterial Agents/therapeutic use , Fasciitis, Necrotizing/diagnostic imaging , Mediastinal Diseases/diagnostic imaging , Neck Pain/diagnostic imaging , Neck/diagnostic imaging , Abscess/drug therapy , Abscess/pathology , Conservative Treatment , Fasciitis, Necrotizing/drug therapy , Fasciitis, Necrotizing/pathology , Female , Humans , Mediastinal Diseases/drug therapy , Mediastinal Diseases/pathology , Neck/pathology , Neck Pain/microbiology , Neck Pain/pathology , Tomography, X-Ray Computed , Treatment Outcome , Young AdultSubject(s)
Gram-Positive Bacterial Infections/microbiology , Lymphadenopathy/microbiology , Mediastinal Diseases/microbiology , Propionibacterium acnes/isolation & purification , Adult , Anti-Bacterial Agents/therapeutic use , Anti-Retroviral Agents/therapeutic use , Antitubercular Agents/therapeutic use , Gram-Positive Bacterial Infections/diagnosis , Gram-Positive Bacterial Infections/drug therapy , HIV Seropositivity/drug therapy , Humans , Lymphadenopathy/diagnosis , Lymphadenopathy/drug therapy , Male , Mediastinal Diseases/diagnosis , Mediastinal Diseases/drug therapy , Recurrence , Tuberculosis, Lymph Node/diagnosis , Tuberculosis, Lymph Node/drug therapySubject(s)
Adenocarcinoma/pathology , Lymphadenopathy/pathology , Mediastinal Diseases/pathology , Neoplasm Recurrence, Local/pathology , Uterine Cervical Neoplasms/pathology , Aged , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Bronchoscopy/methods , Female , Fluorodeoxyglucose F18/administration & dosage , Fluorodeoxyglucose F18/metabolism , Humans , Lymphadenopathy/diagnostic imaging , Mediastinal Diseases/diagnostic imaging , Mediastinal Diseases/drug therapy , Neoplasm Recurrence, Local/diagnostic imaging , Positron Emission Tomography Computed Tomography/methods , Treatment Outcome , Uterine Cervical Neoplasms/complicationsABSTRACT
INTRODUCTION: Mediastinal abscess is a fatal condition, treatment of mediastinal abscess is with antibiotics and sometimes surgery for debridement and drainage. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a safe assessment and candidate treatment method of mediastinal lesions. OBJECTIVES: This study aimed to HYPERLINK "javascript:void(0);" discuss risks and benefits in treatment of mediastinal abscess by EBUS-TBNA. METHODS: We noticed a 56-year-old man with developed bilateral pneumonia and sepsis after puncture of mediastinal abscess by EBUS-TBNA. The patient was successfully treated with a combination of systemic anti-infection treatment and intracavitary administration of antibiotics, antifungal and repeated drainage and lavage via EBUS-TBNA, in 1 year follow-up without recurrence. RESULTS: This study indicated infection spread risk of mediastinal abscess after EBUS-TBNA, and mediastinal abscess was successfully cured by combination of systemic anti-infection and local intervention through EBUS-TBNA. CONCLUSION: EBUS-TBNA is a potential effective minimally invasive treatment for mediastinal abscess, and it is necessary to be aware of clinical complications after puncture of mediastinal infectious lesions by EBUS-TBNA.
Subject(s)
Biopsy, Fine-Needle/methods , Image-Guided Biopsy/methods , Mediastinal Diseases/pathology , Mediastinum/pathology , Ultrasonography, Interventional/methods , Ultrasonography/instrumentation , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/therapeutic use , Antifungal Agents/administration & dosage , Antifungal Agents/therapeutic use , Drainage/methods , Humans , Male , Mediastinal Diseases/drug therapy , Mediastinal Diseases/microbiology , Mediastinal Diseases/surgery , Mediastinum/diagnostic imaging , Mediastinum/microbiology , Mediastinum/surgery , Middle Aged , Pneumonia/complications , Risk Assessment , Sepsis/complications , Tomography Scanners, X-Ray Computed , Treatment Outcome , Ultrasonography, Interventional/adverse effectsABSTRACT
The actinomycosis is a suppurative infection due to an anaerobic and microaerophillic bacteria called actinomyces. Only few case reports are described for the mediastinal locations of this rare entity. We report a new case of inflammatory pseudotumor in the mediastinum due to Aggregatibacte actinomycetemcomitans revealed by hemoptysis. The mediastinoscopy procedure with biopsy was needed to confirm the definitive bacteriological diagnosis by a positive culture. During the postoperative course, a cutaneous fistula was found which had a favourable evolution after appropriate antibiotherapy. Through this case report, the authors insist upon the importance of considering the diagnosis of mediastinal actinomycosis when facing non-specfic mediastinal mass symptoms and also about the interest of systematic bacterioscopic examination and histopathologic examination on nodes' biopsies to avoid to be lost on pathology of mediastinal tumor or tuberculosis. In practise, we caution the non-expert during biopsies because of this lesion's invasive characteristic especially in the confined space of the mediastinum.
Subject(s)
Actinomycosis/microbiology , Aggregatibacter actinomycetemcomitans/isolation & purification , Mediastinal Diseases/microbiology , Actinomycosis/drug therapy , Actinomycosis/pathology , Amoxicillin/therapeutic use , Humans , Male , Mediastinal Diseases/drug therapy , Mediastinal Diseases/pathology , Young AdultABSTRACT
Dysphagia is commonly attributed to disorders arising from dysfunction of the oesophageal mucosa or oesophageal motility. Mediastinal structures causing compression of the oesophagus remain a rare presenting cause of dysphagia. We report a case of a woman presenting with dysphagia to solid foods and associated symptoms of weight loss. Traditional evaluation for dysphagia was unrevealing until cross-sectional imaging suggested a mediastinal obstructive process. The finding of a mediastinal granuloma, distinct from mediastinal fibrosis, as the aetiology of dysphagia is a rare finding, with specific treatment implications. The patient was treated with itraconazole antifungal therapy with an improvement in her symptoms.
Subject(s)
Deglutition Disorders/etiology , Granuloma/complications , Granuloma/diagnostic imaging , Mediastinal Diseases/complications , Mediastinal Diseases/diagnostic imaging , Adult , Antifungal Agents/administration & dosage , Deglutition Disorders/drug therapy , Diagnosis, Differential , Female , Granuloma/drug therapy , Humans , Itraconazole/administration & dosage , Mediastinal Diseases/drug therapy , Treatment Outcome , Weight LossSubject(s)
Antitubercular Agents/administration & dosage , Mediastinal Diseases/pathology , Mediastinal Neoplasms/pathology , Tomography, X-Ray Computed/methods , Tuberculosis, Pulmonary/diagnostic imaging , Biopsy, Needle , Diagnosis, Differential , Humans , Immunohistochemistry , Infant , Male , Mediastinal Diseases/diagnostic imaging , Mediastinal Diseases/drug therapy , Mediastinal Neoplasms/diagnostic imaging , Mediastinal Neoplasms/drug therapy , Radiography, Thoracic/methods , Treatment Outcome , Tuberculosis, Pulmonary/drug therapy , Tuberculosis, Pulmonary/pathology , TurkeyABSTRACT
BACKGROUND: Thyrotoxicosis after total thyroidectomy is mostly iatrogenic. Rarely, a hyperfunctional thyroid remnant or ectopic tissue may be the cause. There are few cases of Graves' disease arising from thyroid tissue located in the mediastinum and none in which Graves' disease was diagnosed only after surgery. We report the case of a patient with Graves's disease in a mediastinal thyroid mass presenting 7 years after total thyroidectomy for nontoxic goiter. CASE PRESENTATION: A 67-year-old Caucasian woman presented with palpitations, fatigue and weight loss. She had a history of total thyroidectomy for nontoxic multinodular goiter at the age of 60 without any signs of malignancy on microscopic examination. She had been medicated with levothyroxine 100 µg/day since the surgery without follow-up. She was tachycardic, had no cervical mass or eye involvement. Her thyroid-stimulating hormone levels were suppressed (0.000 µU/mL) and her free thyroxine (3.22 ng/dL) and free triiodothyronine (8.46 pg/mL) levels increased. Neither mediastinal enlargement nor trachea deviation was found on chest roentgenogram. Levothyroxine treatment was stopped but our patient showed no improvement on free thyroxine or free triiodothyronine 10 days later. Thyroglobulin was increased to 294 mg/mL. A cervical ultrasound scan revealed no thyroid remnant. Her anti-thyroid-stimulating hormone receptor antibodies were high (19.7 U/L). Corporal scintigraphy demonstrated increased intrathoracic radioiodine uptake. A computed tomography scan confirmed a 60 × 40 mm mediastinal mass. Methimazole 10 mg/day was started. Three months later, her thyroid function was normal and she underwent surgical resection. Microscopic examination showed thyroid tissue with no signs of malignancy. CONCLUSIONS: Although thyrotoxicosis after total thyroidectomy is mostly due to excessive supplementation, true hyperthyroidism may rarely be the cause, which should be kept in mind. The presence of thyroid tissue after total thyroidectomy in our patient may correspond to a remnant or ectopic thyroid tissue that became hyperfunctional in the presence of anti- thyroid-stimulating hormone receptor antibodies.
Subject(s)
Antithyroid Agents/therapeutic use , Goiter/surgery , Graves Disease/surgery , Mediastinal Diseases/pathology , Methimazole/therapeutic use , Thyroidectomy , Thyrotoxicosis/diagnosis , Tomography, Emission-Computed , Aged , Fatigue/etiology , Female , Goiter/pathology , Graves Disease/drug therapy , Graves Disease/pathology , Humans , Mediastinal Diseases/drug therapy , Mediastinal Diseases/surgery , Thyroidectomy/adverse effects , Thyrotoxicosis/drug therapy , Thyroxine , Treatment Outcome , Weight LossABSTRACT
BACKGROUND: The differential diagnosis of a mediastinal mass is a common challenge in clinical practice, with a wide range of differential diagnosis to be considered. One of the rarer causes is tuberculosis. Atypical presentations of tuberculosis are well documented in immunocompromised patients, but should also be considered in the immunocompetent. CASE PRESENTATION: This case outlines a previously healthy 22 year-old immunocompetent male presenting with worsening chest pain, positional dyspnea, dry cough and dysphagia. Chest x-ray showed evidence of an isolated anterior mediastinal mass, which was confirmed on computed tomography. A mediastinoscopy was diagnostic as histology revealed necrotizing granulomatous inflammation and the presence of acid-fast bacilli, indicating mediastinal tuberculosis. CONCLUSION: Typically the underlying presentation of mediastinal tuberculosis is mediastinal lymphadenitis. This case was unusual in that we detected an isolated large anterior mediastinal mass accompanied by a relatively small burden of mediastinal lymphadenitis. Cases similar to this have been documented in immunosuppressed patients however in our case no evidence of immunosuppression was found. This case report emphasizes the importance that a detailed and logical pathway of investigation is pursued when encountering a mediastinal mass.