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Query: UMLS:C0231807 (exertional dyspnea)
 3,402 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The clinical course of chronic diffuse interstitial lung disease (ILD) was studied in 14 patients with SLE. The mean duration of follow-up was 7.3 years. All patients had dyspnea on exertion, pleuritic chest pain, chronic cough, and basilar rales. Chest roentgenogram showed diffuse or basilar infiltrates, pleural disease, and elevation of both diaphragms. Systemic corticosteroids were given early in the course of the illness for lung involvement and multisystem disease. Diffusing capacity for carbon monoxide (DLCO) and inspiratory vital capacity (IVC) improved or remained unchanged in the majority of patients. Respiratory complaints improved in all patients; however, two patients died of pulmonary fibrosis and another died of bacterial pneumonia. Alveolar septal deposits of immunoglobulins and complement were found. This study showed that while variability existed among individual subjects, the clinical progression of ILD was slow and tended to improve or stabilize with time.
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PMID:A long-term study of interstitial lung disease in systemic lupus erythematosus. 221 53

This is a case report of pulmonary hypertension in a woman with systemic lupus erythematosus who had taken an oral contraceptive. She was 16 yr old when diagnosed with SLE in July 1984, based on many clinical features and high DNA antibodies, RNP antibodies and CPK, and low complement. She improved slowly with prenisolone. She remained in remission for 7 months except for mild flare-ups involving synovitis, pleuritic chest pain and Raynaud's phenomenon. She began taking oral contraceptives 5 months later (30 mcg ethinyl estradiol and 150 mcg levonorgestrel). 7 months later she was readmitted with the same severe clinical and laboratory findings, but in addition exertional dyspnea. Pulmonary hypertension was evident, by x-ray, EKG, echocardiogram and right heart catheterization. Lupus anticoagulant and anticardiolipin antibodies were negative. She was treated with predniosolone, warfarin and nifedipine and remained stable for 6 months. She died of cardiac arrest after emergency surgery for ovarian cyst, complicated by shock and siezures. The author discussed the relationship between pulmonary hypertension and both oral contraception and SLE, since it is rare in either of these situations.
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PMID:Pulmonary hypertension, systemic lupus erythematosus, and the contraceptive pill: another report. 382 39

A 25-year old HIV-1-positive hemophiliac was admitted with fever, cough, exertional dyspnea and pleuritic chest pain. Chest x-ray showed diffuse bilateral infiltrates with a left sided nodular consolidation. Pneumocystis-carinii-pneumonia was suspected and diagnosed by broncho-alveolar lavage. With therapy the diffuse infiltrates improved, but the nodule and the symptoms failed to resolve. A fine-needle aspiration of the nodule revealed concurrent cryptococcosis. Treatment with fluconazole resulted in complete resolution of symptoms. Details of the case are presented and clinical implications are discussed.
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PMID:[Double infection of the lung with Pneumocystis carinii and Cryptococcus neoformans in an AIDS patient]. 830 25

A 52-year-old man presented with a four-month history of malaise, low-grade fever, decreased appetite, and a 20-pound weight loss. He complained of joint pain and swelling, proximal muscle weakness, exertional dyspnea, and a dry cough. He also noted that his fingers had turned white and then blue when chilled and red when rewarmed. He had not had pleuritic chest pain, dysphagia, dry eyes or mouth, rash, or skin photosensitivity.
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PMID:A man with vague rheumatic complaints. 975 May 51

A 54-year-old woman with myoepithelioma, a very rare tumor of the lung, is reported. The patient presented with exertional dyspnea, cough and intermittent pleuritic chest pain. Her chest X-ray revealed a peripheral 2 cm mass in the left lower lung zone. Bronchoscopy was normal. She underwent thoracotomy in which a wedge-resection was performed. Histological examination of the specimen demonstrated myoepithelioma of the lung.
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PMID:Myoepithelioma of the lung. 1073 57

We describe the case of a 21-year-old black female who was readmitted postpartum because of increasing exertional dyspnea, orthopnea, pleuritic chest pain, and pedal edema. The patient underwent a successful course of clinical treatment for peripartum cardiomyopathy consisting of a regimen of digoxin, diuretics, captopril, and heparin. The results of an endomyocardial biopsy done at readmission were normal: there was no evidence of inflammation, necrosis, or fibrosis; the endocardium, intramural arterioles, mitochondria, and ultrastructure were normal, as was the amount of glycogen; nuclear chromatin were evenly dispersed; and no antibodies were found. Previous studies have shown that approximately half of patients who suffer from peripartum cardiomyopathy recover, while half develop a more severe form of dilated cardiomyopathy. We venture to speculate that normal endomyocardial biopsy findings during the acute stage of the disease may be predictive of recovery. With more certainty, we propose that histologic findings from material taken during an acute episode can and should guide the course of therapy.
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PMID:Peripartum cardiomyopathy: the value of endomyocardial biopsy in diagnosis, prognostication, and therapy. 1522 81

Thymic cysts (TCs) represent 1-2% of all mediastinal masses. To the best of our knowledge transudative effusion due to rupture of a TC into the pleural cavity, as it happened with our patient, has never been described before. The patient was admitted in 5th Department of Respiratory Medicine of "SOTIRIA" Hospital complaining of pleuritic chest pain in the right hemithorax and dyspnea on exertion. Clinical and laboratory examinations indicated a right pleural effusion. Then, the patient was transferred to the 2nd Department of Propedeutic Surgery of 'LAIKO' Hospital where he underwent surgery. Video-assisted thoracic surgery (VATS) revealed an enormous 25-cm cyst ruptured into the right pleural cavity. The cyst was removed by open thoracotomy due to adhesion to contiguous tissues. Pathological examination indicated thymic origins.
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PMID:A rupture of a huge thymic cyst into the pleural cavity: A case report. 1654 43

Pleural effusion has various causes. In the setting of aortic stenosis, new onset pleural effusion is generally considered as a consequence of heart failure. Here, we describe a 50-year-old male patient who had been followed with aortic stenosis for 30 years. During his admission he presented with exertional dyspnea and pleuritic chest pain. He had no other symptoms or findings of cardiac failure. Complete blood count revealed neutrophilic leukocytosis, a normal hemoglobin level and normal platelet count. Left sided pleural effusion was noted on the posteroanterior chest X-ray. Examination of the pleural fluid revealed myeloid blasts. Bone marrow aspiration smear and flow cytometric analysis of the bone marrow and pleural fluid were consistent with acute myeloid leukemia.
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PMID:An unusual cause of unilateral pleural effusion in the setting of aortic stenosis: acute myeloid leukemia. 1738 3

Coccidioidomycosis is endemic in the southwestern United States, resulting in 100,000 infections annually. The majority of these infections are asymptomatic or manifest as community-acquired pneumonia. In rare cases, patients can present with a mononuclear-cell predominant pyopneumothorax. The presence of spherules in tissue specimens is pathognomonic of this condition. A 72-year-old man born in Arizona with a heavy smoking history, presented with a 1-month history of weakness, night sweats, exertional dyspnea, and left pleuritic chest pain. The physical examination was remarkable for decreased breath sounds and dullness to percussion at the left lung base. His initial laboratory examination showed leukocytosis, eosinophilia, and elevated C-reactive protein. Computed tomography of the chest revealed a left lower lobe infiltrate, a cavity with air-crescent sign and hydropneumothorax. The pleural fluid was sampled and revealed an eosinophilic exudate with normal pH. Bacterial and fungal cultures of the pleural fluid were negative. Biopsy of the cavity wall showed chronic inflammation, fungal hyphae, and rare spherule-like structures. The surgical specimen culture grew Coccidioides immitis. Complement fixation for coccidioidomycosis performed on a serum sample was positive at a titer of 1:2 but a latex agglutinin test was negative. The patient was diagnosed with chronic fibrocavitary pneumonia with pyopneumothorax secondary to C. immitis infection and discharged on itraconazole for 1 year. Coccidioidomycosis can present in a variety of forms and should be part of the differential diagnosis in patients presenting with cavitation, air-crescent sign, eosinophilic pleural effusion, and hyphae and spherules on the tissue specimen. Chronic fibrocavitary pneumonia should be especially considered in patients who lived in endemic areas and have risk factors such as diabetes mellitus or pulmonary fibrosis related to smoking.
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PMID:Spherules, hyphae, and air-crescent sign. 1855 86

Congenital absence of the pericardium is a rare cardiac condition, which can be either isolated or associated with other cardiac and extracardiac anomalies. There are six different types, depending on the severity of the involvement. Most of the patients with this defect are asymptomatic, especially the ones with complete absence of the pericardium. However, some patients are symptomatic, reporting symptoms that include chest pain, palpitations, dyspnea, and syncope. Diagnosis is established by the characteristic features on chest X-ray, echocardiogram, chest computed tomography (CT), and/or cardiac magnetic resonance imging (MRI). We present here a case of a 23 year-old-male, who presented to our hospital with complaints of pleuritic chest pain and exertional dyspnea, of a two-week duration. He was physically active and his past history was otherwise insignificant. His chest CT with contrast was interpreted as showing evidence of multiple emboli, predominantly in the left lung, and he was started on a heparin and warfarin therapy. A repeat chest CT with contrast three weeks later showed no significant change from the previous CT scan. Both scans showed that the heart was abnormally rotated to the left side of the chest. An echocardiogram raised the suspicion of congenital absence of the pericardium, with a posteriorly displaced heart. In retrospect, motion artifact on the left lung, attributed to cardiac pulsations and the lack of pericardium, resulted in a CT chest appearance, mimicking findings of pulmonary embolism. The misdiagnosis of pulmonary embolism was attributed to the artifact caused by excessive cardiac motion artifact on the chest CT scan. In non-gated CT angiograms, excessive motion causes an artifact that blurs the pulmonary vessels, reminiscent of a 'seagull' or a 'boomerang'. Physicians need to be aware of this phenomenon, as well as the characteristic radiological features of this congenital anomaly, to enable them to make a correct diagnosis.
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PMID:Congenital complete absence of pericardium masquerading as pulmonary embolism. 2358 Sep 23


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