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Query: UMLS:C0034067 (emphysema)
 11,506 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A number of medical disciplines are involved in the diagnosis and therapy of thoracic pain. The origin may be somatic or visceral. Individual diseases are discussed in particular such as myalgia epidemica, intercostal neuralgia, herpes zoster, pleuritis and pneumonia, pulmonary embolism, pneumothorax, mediastinal emphysema, mediastinitis, pulmonary hypertension and the hyperventilation syndrome. Differential diagnosis is also referred to.
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PMID:[Pulmological aspects of diagnosis of thoracic pain (author's transl)]. 677 86

The main objective of the maximal exercise test is to measure a patient's exercise limit and to identify the cause. The test to be interpreted is evaluated first by judging exercise tolerance on the basis of maximal oxygen consumption (VO2max or symptom-limited VO2(VO2 SL). Intolerance is moderate if VO2 is under 85% of the theoretical level and severe when it is under 60%. Interpretation then consists in identifying the cause of the limitation. Ventilatory reserve is the main element for determining whether the limitation is due to ventilatory or cardiac impairment. In case of a ventilatory limitation, ventilatory reserve falls and the ventilatory pattern and gasometric values orient the diagnosis to emphysema, diffuse interstitial lung disease or bronchopneumopathy. If the ventilatory reserve rises, the limitation has cardiac as origin and in this case the oxygen pool is decreased. Persistence of chronotrope reserve can indicate coronary artery disease while the VD/VT ratio is useful for differentiating cardiac and vascular limitations. Peripheral limitations usually produce an early major increase in blood lactate, a high lactate/pyruvate ratio, with lactate or ventilatory thresholds under 40% of theoretical VO2max, especially in case of muscle pain and low watt equivalent. Nevertheless, these parameters cannot be used to confirm a precise diagnosis. The only positive diagnosis given by the exercise test concerns glycogenolysis disorders (por example McArdle's disease) seen as a total absence of increased lactate level. In conclusion, the exercise test is a means of assessing a patient's exercise tolerance and provides arguments for determining the origin of the limitation. However, as no one argument is truly pathognomonic, the diagnosis hypothesis must be based on all the elements available from clinical examination and complementary explorations.
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PMID:[Interpreting exercise tests]. 961 44

We describe a 38-year-old man who presented with proximal muscle weakness, myalgia, polyarthralgia, and skin rash and was diagnosed as having dermatomyositis (DM). The patient's symptoms improved with prednisolone therapy. However, myopathy relapsed and pneumomediastinum with subcutaneous emphysema developed. Pneumomediastinum with subcutaneous emphysema rapidly disappeared by the administration of ciclosporin. We reviewed the present case and previously reported cases regarding the clinical characteristics. All of the reported death cases were accompanied by interstitial lung disease (ILD). Although it has been reported that pneumomediastinum in DM can be fatal, the direct cause of patient's death was due to respiratory failure resulting from progressive ILD. Pneumomediastinum without ILD shows a good prognosis.
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PMID:Pneumomediastinum in dermatomyositis itself is not a poor prognostic factor: report of a case and review of the literature. 1830 89

A 44-year-old male with no previous medical history or comorbidities presented with significantly increasing shortness of breath, myalgia, nausea, and fatigue. He had no diagnosed medical conditions and enjoyed good health prior to the episode of acute respiratory infection. There was no history of smoking, emphysema, or chronic lung diseases. CT revealed bilateral ground-glass opacities in predominantly peripheral distribution. Based on imaging spectrum and global pandemic of the novel coronavirus, typical SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection was suspected. Viral load was confirmed with biochemical data and laboratory results. Interestingly, despite intensive treatment, the patient developed sudden complications during the second week of his hospitalization. The symptoms started to resolve on pharmacological treatment and supplemental noninvasive oxygen supply over the next weeks. We illustrate and discuss the case of spontaneous pneumomediastinum as an uncommon manifestation of novel SARS-CoV2 chest infection. Even though our patient did not develop acute respiratory distress syndrome or further complications, the presented case highlights the importance of basic radiological monitoring of the disease in order to ensure prompt diagnosis of complications and appropriate subsequent management.
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PMID:Spontaneous Pneumomediastinum Associated With SARS-CoV-2: Infrequent Complication of the Novel Disease. 3268 26