Pulmonary dirofilariasis with cavity formation and pleural effusion]

A 61-year-old man visited a community hospital because of hemosputum. A solitary nodule in the left lower lung field was pointed out on a chest roentgenogram. The patient was treated with antibiotics, but the solitary nodule increased in size. He was referred to our hospital because of high fever and observations of cavity formation and pleural effusion on a chest roentgenogram. The pleural effusion showed no cytologic evidence of malignancy, and cultures were also negative for bacteria. An increased percentage of lymphocytes was detected in the pleural effusion, but slight eosinophilia was found in blood samples. Dot enzyme-linked immunosorbent assay and Ouchterlony's double-diffusion test yielded a diagnosis of pulmonary dirofilariasis. After drainage of the pleural effusion by thoracentesis, spontaneous regression was observed. Cavity formation, pleural effusion, and spontaneous regression are in general rare in patients with pulmonary dirofilariasis.     

Cardiac involvement in hypereosinophilic syndrome

Hypereosinophilic syndrome is a heterogeneous group of disorders characterised by hypereosinophilia and organ involvement of varying intensity. We describe involvement of the heart in patients with hypereosinophilic syndrome,and the diagnostic and therapeutic clinical management of these patients.     

以胸腔积液为首发症状的特发性嗜酸粒细胞增多综合征1例并文献复习

目的 探讨以胸腔积液为首发症状的特发性嗜酸粒细胞增多综合征(idiopathichypereosinophilic syndrome,IHES)的临床特点及诊治经验,提高广大临床工作者对该病的认识.方法 回顾性分析重庆医科大学附属第一医院呼吸内科收治的1例IHES患者的病例资料,并结合国内外文献进行文献复习.以“特发性嗜酸粒细胞增多综合征”为检索词检索中国期刊全文数据库(CNKI)、中文科技期刊数据库(维普)、万方数据库,以“idiopathichypereosinophilic syndrome”、“eosinophilia”、“hypereosinophilia”为检索词检索Embase数据库、MEDLINE数据库(PubMed),检索时间为1990年1月到2015年12月.结果 患者为青年男性,2015年10月10日因“反复咳嗽、胸闷、气促2个月,加重半个月”入院,血常规提示嗜酸粒细胞绝对值17.28×109/L,胸部CT提示左侧胸腔中量积液,右侧胸腔少量积液,最终被诊断为IHES,糖皮质激素治疗2个月后,患者临床症状好转,胸腔积液明显吸收.文献经检索、去重后,共筛选诊断为IHES的国内外病例报道74篇,其中合并胸腔积液的病例报道共25篇.国内已公开报道IHES患者共103例,最常受累的部位包括皮肤(约34.0％),其次为呼吸系统、消化系统,14.6％伴有胸腔积液.结论 IHES的临床症状常不典型,易与其他疾病相混淆,诊断较为复杂,只有提高临床工作者对于该病的认识及其临床资料的掌握,才能真正减少误诊误治.     

Lymphocytic pleural effusion in postpericardiotomy syndrome

Postpericardiotomy syndrome has been recognized as a frequent complication following coronary artery bypass graft (CABG) surgery. We observed five cases of postpericardiotomy syndrome resulting in exudative pleural effusions with white blood cell differential counts greater than 80% lymphocytes. Tuberculosis, lymphoma, and other neoplasma have been major diseases associated with lymphocytic exudative pleural effusions. We feel postpericardiotomy syndrome is another important etiology that should be considered in post-CABG patients with lymphocytic pleural effusion.     

Pulmonary atelectasis and massive pleural effusion. Echocardiography

Pulmonary atelectasis can be detected by Two Dimensional Echocardiography (2D-E) when massive pleural effusion is present. A triangular mass, base toward the mediastinum and apex moving freely in the pleural cavity, is shown by 2D-E either in an apical modified view in left pleural effusions or in a subcostal modified view in right pleural effusions. The texture of the mass is liver-like. Three cases are reported by way of example. Differential diagnosis with other masses, such as pleural or pericardial metastasis, is discussed.     

Pulmonary anisakiasis presenting as eosinophilic pleural effusion

A 63-year-old man developed a pleural effusion with marked eosinophilia, which was more prominent in the pleural fluid than in the peripheral blood. The pleural effusion spontaneously disappeared 7 days after admission. A multiple dot enzyme-linked immunosorbent assay for anisakiasis was strongly positive for both the serum and pleural fluid. The serum IgG titre for Anisakis simplex gradually decreased over 7 months. It is suspected that Anisakis larvae can penetrate the alimentary canal, and then migrate into the pleural cavity through the diaphragm. Screening with a serological test is useful in the diagnosis of this condition; human pulmonary anisakiasis.     

A case of Sj?gren's syndrome with pleural effusion]

A 45-year-old woman was admitted to our hospital because of a fever. A round erythema was noted on the skin, suggesting collagen disease. Bilateral pleural effusion developed during hospitalization, and serum and pleural effusion were positive for antinuclear antibody, RA factor, anti-SS-A antibody, and anti-SS-B antibody. A diagnosis of Sj?gren's syndrome was made on the basis of reduced lacrimation and the histological findings in a biopsy specimen from the lip. The cells in the pleural effusion were predominantly lymphocytes, and so a pleural lesion associated with Sj?gren's syndrome was suspected, but reports of this condition have been scarce. Good therapeutic results were obtained by corticosteroid administration. Sj?gren's syndrome should be considered in the differential diagnosis of pleural effusion associated with collagen disease.     

Paragonimiasis westermani with repeated pleural effusion and diagnosed by detecting parasite eggs in pleural effusion]

A 73-year-old man was referred to our hospital because of left chest pain, left pleural effusion and peripheral blood eosinophilia. After three months, left pleural effusion resolved without treatment and the etiology remained unclarified. Three years later, he was admitted for evaluation of right pleural effusion. Peripheral blood eosinophil count and serum IgE value were elevated. Eosinophilia was also observed in the pleural effusion. The diagnosis of paragonimiasis westermani was confirmed by immunoserological examination of the serum and by detection of Paragonimius eggs in the pleural effusion. Two cycles of treatment with praziquantel were effective in this case. When a patient has repeated pleural effusion, paragonimiasis should be considered in the differential diagnosis.     

Eosinophilic pleural effusion by dirofilariasis]

A 44-year-old man visited our hospital because of right chest pain. Pleural effusion in the right lung was detected on a chest radiograph. A chest CT scan demonstrated no abnormal lesions in either lung field, but passive atelectasis due to the pleural effusion was present. Since many eosinophils were found in the exudative pleural effusion, a parasitic infection was suspected. An enzyme-linked immunosorbent assay test led to a diagnosis of eosinophilic pleural effusion by dirofilariasis. Pleural effusion disappeared spontaneously and the level of anti-Dirofilaria immitis antibody decreased. Continued careful observation is necessary in such cases.     

Therapy of a hypereosinophilic syndrome with cardiac involvement

The case of a young patient suffering from a hypereosinophilic syndrome (HES), complicated by restrictive cardiomyopathy and severe mitral regurgitation is analyzed, according to clinical, echocardiographic, haemodynamic, and bioptic histological findings. Seven days after mitral valve replacement (St. Jude Medical valve), the patient died in cardiogenic shock. The present state of treatment of this disease is discussed.     

Pulmonary thromboembolism in a patient with idiopathic hypereosinophilic syndrome

We report a successful treatment in a patient with idiopathic hypereosinophilic syndrome (HES) presenting with left pulmonary truncal thromboembolism and right pleural effusion. A treatment with urokinase infusion by a Swan-Gants catheter near a left pulmonary thrombus was performed and left pulmonary arterial occlusions were recanalized completely. After corticosteroid therapy was started, right pleural effusion disappeared. Both anticoagulant and corticosteroid therapy was necessary for treatment in HES patients who had thromboembolic episodes.     

Pulmonary thromboembolism in a patient with idiopathic hypereosinophilic syndrome

Abstract

We report a successful treatment in a patient with idiopathic hypereosinophilic syndrome (HES) presenting with left pulmonary truncal thromboembolism and right pleural effusion. A treatment with urokinase infusion by a Swan-Gants catheter near a left pulmonary thrombus was performed and left pulmonary arterial occlusions were recanalized completely. After corticosteroid therapy was started, right pleural effusion disappeared. Both anticoagulant and corticosteroid therapy was necessary for treatment in HES patients who had thromboembolic episodes.     

A case of sarcoidosis presenting with Heerfordt's syndrome, associated with hepatosplenomegaly, pleural effusion, and ascites]

A 30-year-old female developed symptoms consistent with Heerfordt's syndrome (complete type) and was effectively treated with steroid. However, she developed hepatosplenomegaly, bloody pleural effusion, and ascites one year after discontinuation of steroid therapy. The symptoms were considered to be due to sarcoidosis since serum ACE level, and ACE level and OKT4/8 ratio in pleural and peritoneal effusions were significantly elevated, and readministration of steroid normalized these changes. Bloody pleural and peritoneal effusions are very rare complications of sarcoidosis.     

IFN-γ、 CRP与结核性胸膜炎胸膜黏连的相关性

结核性渗出性胸膜炎的常见并发症为胸膜黏连,近年来有关结核性胸膜炎所致胸膜黏连的影响因素报道较多,胸腔积液存在的时间,胸水白蛋白及纤维蛋白原含量,胸腔积液是否抽液治疗等均与胸膜黏连有相关性,但免疫因素及炎症反应在结核性胸腔积液发生胸膜黏连,研究报道较少.临床证实以辅助性T淋巴细胞（Th细胞）免疫为代表的机体免疫功能与结核病的发病、病情转归等关系密切.Thl免疫在外周血减弱而在病灶处增强,且随病程动态变化,这是结核病的基本免疫学特征.