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Query: UMLS:C0032285 (pneumonia)
 54,520 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Three childhood cases of beta-hemolytic streptococcal pneumonia are presented with a review of the literature. The disease, though uncommon in childhood, results in severe local and systemic effects. Hematologic fluid and electrolyte problems are frequent. Pericardial disease and secondary bacterial invasion are added dangers encountered in management. Early and vigorous drainage of the pleural cavity is essential to successful outcome. It appears that predisposing viral disease, including influenza, is essential for acquisition of this form of bacterial pneumonia.
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PMID:Group a beta-hemolytic streptococcal pneumonia: clinical course and complications of management. 33 94

The optimal management of effusive pericardial disease remains controversial. Subxiphoid drainage has been criticized for a high recurrence rate while transthoracic procedures (window or pericardiectomy) are more invasive operations with greater potential for morbidity. We compared subxiphoid (SX group) and transthoracic (TT group) drainage in 131 patients (age range from 1 month to 81 years) treated from 1979 to the present. The etiology of effusion included cancer (38), uremia (24), infection (27), radiation (9), and other (33) causes. The two groups had similar age and sex distribution, etiology, and fluid volume. There was no difference in the operative mortality between the two groups (SX 15%, TT 13%, p = NS). Patients undergoing thoracotomy for treatment of effusive pericardial disease had a higher incidence of respiratory complications as defined by the presence of pneumonia, pleural effusion, prolonged ventilation, and need for reintubation (SX 11%, TT 35%, p less than 0.005). This may account, in part, for the longer mean hospital stay in transthoracic group (14.4 vs. 11.4 days). Nine patients were lost to follow-up after hospital discharge. The remaining 104 hospital survivors were followed for between 1 month and 11 years (mean 34 months, cumulative of 297 patient years). Three patients in each group experienced fluid recurrence and all but one were successfully treated by needle aspiration or percutaneous catheter placement. Following discharge, no patient required reoperation for effusive or constrictive pericardial disease or died from tamponade. There were no significant differences in 5-year actuarial survival (SX 54%, TT 49%) or actuarial freedom from recurrence (SX 89%, TT 93%).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Pericardial drainage: subxiphoid vs. transthoracic approach. 201 61

Pericardial involvement with legionnaires' disease is rare. Pericarditis with legionnaires' pneumonia developed in a patient with previous mediastinal irradiation for Hodgkin's disease. Subsequently, the patient had progressive symptoms of pericardial constriction that required pericardiectomy. Acute infection with agents such as legionnaires' bacillus may precipitate the late appearance of pericardial disease in patients with previous mediastinal irradiation.
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PMID:Pericarditis in a patient with Legionnaires' disease. 709 33

The rare case of pericardial effusion with starting tamponade in post-myocardial infarction syndrome (Dressler's Syndrome) is described. Diagnosis and comment: The consequential steroid therapy improves the cardial situation dramatically. There is no echocardiographic differential diagnostic criteria, but in the case of the symptoms of Dressler's Syndrome (fever, pleuritis, pneumonia, serologic changes and pericarditis) allows the diagnosis of this pericardial disease. A latent period of several weeks to some months after myocardial infarction is possible.
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PMID:[Echocardiographic diagnosis in post-myocardial-infarction syndrome (Dressler's syndrome) (author's transl)]. 745 87

Thoracoscopic techniques were used to perform a pericardiectomy in 35 patients with purely effusive pericardial disease after medical management and pericardiocentesis had failed to be effective. There were no intraoperative complications and postoperative complications were few. Two cases of dysrhythmia and 2 cases of pneumonia occurred postoperatively. Malignancy was identified as the cause in 18 patients and there were benign causes in the remaining 17. The hospital stay in the group with benign effusions was 4.6 days. There were no recurrences of pericardial effusions and no constrictive changes developed during a mean follow-up of 9 months. Fourteen (40%) patients had pleural or pulmonary abnormalities that were managed simultaneously thoracoscopically. These abnormalities included 2 pleural masses, 2 pulmonary nodules, and 12 pleural effusions. In 8 instances, the pericardiectomy was performed from the right pleural cavity in order to address the pleural or pulmonary problem. Thoracoscopic pericardial resection has proved safe and effective. It allows a wider pericardial resection than that usually permitted by the subxiphoid route, and should lessen the pain and the number of pulmonary complications, compared with open thoracotomy. An additional advantage is that it allows the visualization and management of simultaneous pleural and pulmonary abnormalities.
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PMID:Thoracoscopic pericardiectomy for effusive pericardial disease. 837 95

In patients with cardiomegaly and signs and symptoms compatible with CHF, unilateral right-sided or bilateral pleural effusions of similar size are likely to be due to left-sided CHF. Isolated right ventricular failure or chronic pulmonary hypertension is not usually associated with pleural effusions, and unrecognized or new-onset left ventricular dysfunction and other causes should be considered when a patient with cor pulmonale presents with a pleural effusion. Unilateral left-sided pleural effusions with cardiomegaly may be due to pericardial disease. Current hypotheses do not adequately explain the laterality of effusions in CHF or pericardial disease. Clinical and radiographic correlation is always required; however, the associations described occur often enough to make them useful in day-to-day clinical practice. When ascribing pleural effusions to CHF, clinicians must be sure the clinical signs and history "fit the picture," because pneumonia and pulmonary embolism may also cause pleural effusions in patients with heart failure. Typical pleural effusions in patients with uncomplicated CHF (demonstrated by small to medium-sized effusions and the absence of fever, leukocytosis, pleuritic chest pain, or marked asymmetry in bilateral effusions) do not require routine diagnostic thoracentesis for evaluation. A reasonable approach in such cases is treatment of the underlying CHF and follow-up radiography to monitor for resolution of the effusions. Prompt diagnostic thoracentesis is indicated whenever atypical features are present and other diagnoses are under consideration.
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PMID:Pleural effusions in cardiovascular disease. Pearls for correlating the evidence with the cause. 1088 42

Purulent pericarditis represents a subset of pericardial disease usually due to a nonviral infectious agent. The presentation is often acute, with rapid progression to tamponade unless a drainage procedure is performed. Although several infectious agents account for the majority of infections, the differential diagnosis is broad. Often, patients with more exotic infectious causes have risk factors for these agents that can be identified by careful history-taking. Distinguishing a bacteremic source from infection acquired by contiguous spread is particularly important. Although most infections spread contiguously are a complication of recent surgery or nearby pneumonia and are, therefore, apparent to the physician, others may be less obvious. For example, head and neck space infections may track to the retropharyngeal space and, from there, posteriorly to the so-called "danger" space, which connects inferiorly to the mediastinum and the pericardium. Failing to identify this source of tracking infection may lead to inadequate drainage as well as inappropriate empiric antibiotic therapy. In acute cases, needle drainage with appropriate staining and culturing of the fluid is adequate for diagnosis and initial management of the complications of fluid collection in the closed space of the pericardial sac. Pericardial biopsy may be the sole method of identifying an etiologic agent, particularly in chronic cases in which granulomatous disease is more commonly seen. In select cases, pericardial window or pericardiectomy procedures are needed to limit complications of reaccumulation of fluid.
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PMID:Purulent Pericarditis. 1109 39

Oncology patients often experience urgent or emergent medical complications that are a direct or indirect result of the underlying malignant condition and are first identified or clarified on radiologic imaging studies. The aim of this review is to identify, discuss, and illustrate some of the major thoracic complications in patients with primary intrathoracic or extrathoracic neoplasms; particular focus is placed on issues in which radiologic imaging may have a significant impact on patient management, including superior vena cava (SVC) syndrome, post-obstructive pneumonia, diaphragmatic paralysis, pleural effusions, pericardial disease, tracheo-esophageal fistula, deep venous thrombosis, and pulmonary embolism.
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PMID:Thoracic complications and emergencies in oncologic patients. 1996 99

Urgent cardiac ultrasound examination in the critical care setting is clinically useful. Application of goal-directed echocardiography in this setting is quite distinct from typical exploratory diagnostic comprehensive echocardiography, because the urgent critical care setting mandates a goal-directed approach. Goal-directed echocardiography most frequently aims to rapidly identify and differentiate the cause(s) of hemodynamic instability and/or the cause(s) of acute respiratory failure. Accordingly, this paper highlights 1) indications, 2) an easily memorized differential diagnostic framework for goal-directed echocardiography, 3) clinical questions that must be asked and answered, 4) practical issues to allow optimal image capture, 5) primary echocardiographic views, 6) key issues addressed in each view, and 7) interpretation of findings within the differential diagnostic framework. The most frequent indications for goal-directed echocardiography include 1) the spectrum of hemodynamic instability, shock, and pulseless electrical activity arrest and 2) acute respiratory failure. The differential diagnostic categories for hemodynamic instability can be remembered using the mnemonic 'SHOCK' (for Septic, Hypovolemic, Obstructive, Cardiogenic, and (K) combinations/other kinds of shock). RESP-F (for exacerbation of chronic Respiratory disease, pulmonary Embolism, ST changes associated with cardiac or pericardial disease, Pneumonia, and heart Failure) can be used for acute respiratory failure. The goals of goal-directed echocardiography in the unstable patient are: assessing global ventricular systolic function, identifying marked right ventricular and left ventricular enlargement, assessing intravascular volume, and the presence of a pericardial effusion. In an urgent or emergent setting, it is recommended to go directly to the best view, which is frequently the subcostal or apical view. The five views are the subcostal four-chamber view, subcostal inferior vena cava view, parasternal long axis view, parasternal short axis view, and the apical four chamber view. Always interpret goal-directed echocardiographic findings in the context of clinically available hemodynamic information. When goal-directed echocardiography is insufficient or when additional abnormalities are appreciated, order a comprehensive echocardiogram. Goal-directed echocardiography and comprehensive echocardiography are not to be used in conflict with each other.
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PMID:A practical approach to goal-directed echocardiography in the critical care setting. 2567 60

Computed tomography pulmonary angiography (CTPA) is the principal means of evaluating dyspnea in the emergency department. As its use has increased, the number of studies positive for pulmonary embolism (PE) has decreased to less than 20%. Many of the negative PE studies provide an alternative explanation for dyspnea, most commonly pneumonia, pulmonary edema, pleural effusion, or atelectasis. Nonthrombotic emboli may also be suggested. Airway and obstructive lung disease may be detected on CTPA. Pleural and pericardial disease may also explain the dyspnea, but more detailed evaluation of the serosal surfaces may be limited on the arterial phase of a CTPA.
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PMID:Negative Computed Tomography for Acute Pulmonary Embolism: Important Differential Diagnosis Considerations for Acute Dyspnea. 2604 11


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