Pleuritis and pleural effusion as the initial presentation of systemic lupus erythematous in a 23-year-old woman

Systemic lupus erythematous (SLE) is a chronic inflammatory autoimmune disorder that primary affects women and may affect any organ system. Pleural inflammation is a common feature of SLE; however, as an initial presentation in SLE is rare. The author report the case of a 23-year-old woman with chest pain, dyspnea and without fever for 1 week. On physical examination, fine crackles were heard and vocal fremitus was decreased at the base of the left-side of lung. Patient had no symptoms/signs that can meet the SLE criteria; however, immunological workup showed positive response of ANA-speckle, anti-dsDNA, and anti-ENA in patient serum and pleural fluid. Lupus pleuritis with effusions was confirmed by the above investigation. A 1-month course of oral prednisolone-combined oral methrotreate was beneficial in relieving the pleuritis and pleural effusions.     

A decision tree for differentiating tuberculous from malignant pleural effusions

OBJECTIVE: To improve physicians' ability to discriminate tuberculous from malignant pleural effusions through a simple clinical algorithm that avoids pleural biopsy. DESIGN: We retrospectively compared the clinical and pleural fluid features of 238 adults with pleural effusion who satisfied diagnostic criteria for tuberculosis (n=64) or malignancy (n=174) at one academic center (derivation cohort). Then, we built a decision tree model to predict tuberculosis using the C4.5 algorithm. The model was validated with an independent sample set from another center that included 74 tuberculous and 293 malignant effusions (validation cohort). RESULTS: Among 12 potential predictor variables, the classification tree analysis selected four discriminant parameters (age>35 years, pleural fluid adenosine deaminase>38U/L, temperature>or=37.8 degrees C, and pleural fluid LDH>320U/L) from the derivation cohort. The generated flowchart had 92.2% sensitivity, 98.3% specificity, and an area under the ROC curve of 0.976 for diagnosing tuberculosis. The corresponding operating characteristics for the validation cohort were 85.1%, 96.9% and 0.958. CONCLUSIONS: Applying a decision tree analysis that contains simple clinical and laboratory data can help in the differential diagnosis of tuberculous and malignant pleural effusions.     

A case report of thoracic endometriosis – A rare cause of haemothorax

IntroductionThe presence of endometrial tissue in airways, pleura and lung parenchyma is called thoracic endometriosis syndrome (TES). It is a rare pathology, and typically consists of catamenial pneumothorax, haemothorax, haemoptysis, and pulmonary nodules. We report a case of a 36-year-old woman with thoracic endometriosis causing catamenial haemothorax.ConclusionsThe diagnosis of thoracic endometriosis is complicated and often delayed. TES should be suspected in a reproductive age woman with exacerbating symptoms during the menstruation.Treatment may be medical and surgical.     

Post-cardiac injury syndrome: an atypical case following percutaneous coronary intervention

Post-cardiac injury syndrome (PCIS) is a syndrome characterized by pericardial and/or pleural effusion, triggered by a cardiac injury, usually a myocardial infarction or cardiac surgery, rarely a minor cardiovascular percutaneous procedure. Nowadays, the post-cardiac injury syndrome, is regaining importance and interest as an emerging cause of pericarditis, especially in developed countries, due to a great and continuous increase in the number and complexity of percutaneous cardiologic procedures. The etiopathogenesis seems mediated by the immunitary system producing immune complexes, which deposit in the pericardium and pleura and trigger an inflammatory response. We present the atypical case of a 76-year-old man presenting with a hydro-pneumothorax, low-grade fever and elevated inflammation markers, after two complex percutaneous coronary interventions, executed 30 and 75 days prior. The clinical features of our case are consistent with the diagnostic criteria of PCIS: prior injury of the pericardium and/or myocardium, fever, leucocytosis, elevated inflammatory markers, remarkable steroid responsiveness and latency period. Only one element does not fit with this diagnosis and does not find any further explanation: the air accompanying the pleural effusion, determining a hydro-pneumothorax and requiring a pleural drainage catheter positioning.     

可调节式床上胸腔穿刺桌的研制与应用

目的 介绍可调节式床上胸腔穿刺桌的研制并观察其临床应用效果.方法 将胸腔穿刺患者100例,随机分为实验组和对照组各50例,实验组采用可调节式床上胸腔穿刺桌行胸腔穿刺术,对照组采用传统方法 行穿刺术,观察2组患者脉搏、呼吸、动脉血氧饱和度的变化,比较2组穿刺效果.结果 穿刺后2组患者脉搏、呼吸均增快,2组比较差异显著;动脉血氧饱和度下降,2组比较差异显著.实验组患者一次穿刺成功率、舒适度、满意度方面优于对照组,差异显著.结论 可调节式床上胸腔穿刺桌能减轻患者不适,提高穿刺成功率及患者满意度.     

联合检测IL-16与CA125在结核性胸膜炎中的表达及意义

目的探讨血清及胸腔积液中IL-16、CA125在结核性胸膜炎患者中的诊断价值。方法应用酶联免疫吸附法(ELISA)及化学免疫放光法检测32例结核性胸膜炎患者(结核组)、28例恶性胸腔积液患者(恶性组)血清及胸腔积液中IL-16、CA125水平。结果结核组血清及胸腔积液中IL-16水平明显高于肿瘤组(P<0.05);结核组胸腔积液中CA125水平显著高于肿瘤组,差异具有统计学意义(P<0.05);二组患者胸腔积液中IL-16、CA125含量显著高于血清,差异有统计学意义(P<0.05)。结论胸腔积液中IL-16有助于结核性和恶性胸腔积液鉴别,且与CA125联合检测价值更大。