1.Broncho-Pleural Fistula with Hydropneumothorax at CT: Diagnostic Implications in Mycobacterium avium Complex Lung Disease with Pleural Involvement.
Hyun Jung YOON ; Myung Jin CHUNG ; Kyung Soo LEE ; Jung Soo KIM ; Hye Yun PARK ; Won Jung KOH
Korean Journal of Radiology 2016;17(2):295-301
OBJECTIVE: To determine the patho-mechanism of pleural effusion or hydropneumothorax in Mycobacterium avium complex (MAC) lung disease through the computed tomographic (CT) findings. MATERIALS AND METHODS: We retrospectively collected data from 5 patients who had pleural fluid samples that were culture-positive for MAC between January 2001 and December 2013. The clinical findings were investigated and the radiological findings on chest CT were reviewed by 2 radiologists. RESULTS: The 5 patients were all male with a median age of 77 and all had underlying comorbid conditions. Pleural fluid analysis revealed a wide range of white blood cell counts (410-100690/microL). The causative microorganisms were determined as Mycobacterium avium and Mycobacterium intracellulare in 1 and 4 patients, respectively. Radiologically, the peripheral portion of the involved lung demonstrated fibro-bullous changes or cavitary lesions causing lung destruction, reflecting the chronic, insidious nature of MAC lung disease. All patients had broncho-pleural fistulas (BPFs) and pneumothorax was accompanied with pleural effusion. CONCLUSION: In patients with underlying MAC lung disease who present with pleural effusion, the presence of BPFs and pleural air on CT imaging are indicative that spread of MAC infection is the cause of the effusion.
Aged
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Aged, 80 and over
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Female
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Fistula/complications
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Humans
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Hydropneumothorax/complications/microbiology/*radiography
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Lung/radiography
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Male
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Middle Aged
;
Mycobacterium avium/*isolation & purification
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Mycobacterium avium Complex/isolation & purification
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Mycobacterium avium-intracellulare Infection/*diagnosis/microbiology
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Pleural Diseases/complications/microbiology/*radiography
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Pleural Effusion/complications
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Retrospective Studies
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*Tomography, X-Ray Computed
2.Clinical Role of Interstitial Pneumonia in Patients with Scrub Typhus: A Possible Marker of Disease Severity.
Sun Wha SONG ; Ki Tae KIM ; Young Mi KU ; Seog Hee PARK ; Young Soo KIM ; Dong Gun LEE ; Sun Ae YOON ; Young Ok KIM
Journal of Korean Medical Science 2004;19(5):668-673
Interstitial pneumonia (IP) frequently occurs in patients with scrub typhus, but its clinical significance is not well known. This study was designed to evaluate interstitial pneumonia as a marker of severity of the disease for patients with scrub typhus. We investigated clinical parameters representing the severity of the disease, and the chest radiographic findings for 101 patients with scrub typhus. We then compared these clinical factors between patients with and without IP. We also studied the relationship between IP and other chest radiographic findings. The chest radiography showed IP (51.4%), pleural effusion (42.6%), cardiomegaly (14.9%), pulmonary alveolar edema (20.8%), hilar lymphadenopathy (13.8%) and focal atelectasis (11.8%), respectively. The patients with IP (n=52) had higher incidences in episode of hypoxia (p=0.030), hypotension (p=0.024), severe thrombocytopenia (p=0.036) and hypoalbuminemia (p=0.013) than the patients without IP (n=49). The patients with IP also had higher incidences of pleural effusion (p<0.001), focal atelectasis (p=0.019), cardiomegaly (p<0.001), pulmonary alveolar edema (p=0.011) and hilar lymphadenopathy (p<0.001) than the patients without IP. Our data suggest that IP frequently occurs for patients with scrub typhus and its presence is closely associated with the disease severity of scrub typhus.
Adult
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Aged
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Aged, 80 and over
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Female
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Fluorescent Antibody Technique, Indirect
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Humans
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Incidence
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Lung/microbiology/radiography
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Lung Diseases, Interstitial/epidemiology/*microbiology/*radiography
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Male
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Middle Aged
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Pleural Effusion/epidemiology/microbiology/radiography
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Predictive Value of Tests
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Prognosis
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Scrub Typhus/*complications/epidemiology/*radiography
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*Severity of Illness Index