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PubMed1994

[Renal infarction following pulmonary surgery in a 13-year-old boy].

We report a case of renal polar infarction in a 13-year old boy following surgical excision of contralateral congenital lobar emphysema. Patient history was unremarkable and yielded no data suggestive of any other underlying pathology or systemic disease. The diagnosis was made on the CT, arteriography and DMSA scan findings. The etiology could not be determined. The patient was treated conservatively with prophylactic antibiotic therapy and followed closely. There were no complications; the patient was asymptomatic one month after the episode. The control IVP showed residual segmental atrophy and ultrasound evaluation disclosed cortical atrophy. The most common cause of this condition, the diagnostic algorithm, treatments and their indications are discussed. Renal graft infarction, which may be associated with acute rejection or venous and/or arterial thrombosis, warrants special attention. The treatment and clinical course are significantly different, although the diagnosis is made using the same methods.

Adolescent↗
PubMed2006

Intracardiac thrombus and pulmonary embolism with cavitation and pneumomediastinum in a patient with protein S deficiency.

We present a case of intracardiac thrombus with pulmonary embolism and pulmonary infarction in a patient with protein S deficiency. Secondary infection of the pulmonary infarction resulted in pneumomediastinum. Thrombus in an unusual location in a young patient without known predisposing conditions is a characteristic feature of a hereditary thrombophilic disorder. Cavitation within a lesion adjacent to the mediastinal pleura can result in pneumomediastinum.

Adult↗
PubMed1993

Simultaneous occurrence of rib infarction and pulmonary infiltrates in sickle cell disease patients with acute chest syndrome.

In order to determine if a relationship exists between rib infarction and the acute chest syndrome (ACS) in sickle cell disease patients, bone scans were reviewed in 55 episodes in 38 patients with pain of suspected osseous origin. A bone scan was positive for thoracic bone infarction if abnormally increased or decreased uptake was present in ribs, sternum or thoracic spine. Radiographs were considered to be positive for ACS if there was pulmonary infiltrate or pleural effusion in the absence of laboratory or clinical evidence of bacterial pneumonia. ACS by chest x-ray was present in 22 episodes, 21 of which showed evidence of infarction of the bony thorax on bone scan. Thoracic bone infarction occurred in the absence of chest x-ray changes in only 11 episodes. This association between bone infarction and radiographic ACS was statistically significant (p < 0.001, Fisher's exact test). A strong association exists between ACS and infarction of the bony thorax. It is possible that bone infarction leads to pain, hypoventilation and the clinical picture of ACS.

Acute Disease↗
PubMed2001

Chest radiograph interpretation skills of anesthesiologists.

OBJECTIVE: To assess the skills of anesthesiologists in the interpretation of chest radiographs. DESIGN: Randomized evaluation conducted among anesthesiologists and radiologists. SETTING: Postgraduate Assembly of the New York State Society of Anesthesiologists in 1999, and the Department of Radiology, New York University Medical Center. PARTICIPANTS: A total of 61 anesthesiologists (48 attending physicians; 13 residents); control group of 8 radiology residents (all participants volunteered). INTERVENTIONS: After completing a demographic survey, participants were asked to review a series of 10 chest radiographs. A brief clinical scenario accompanied each radiograph. No time limit was set for these interpretations. MEASUREMENTS AND MAIN RESULTS: The demographic characteristics of the anesthesiology participants included university faculty (46%), private group practitioners (41%), independent practitioners (11%), and 1 participant with an unspecified type of practice. Additional training among the participants included internal medicine (31%), surgery (19%), and pediatrics (3%); 34% did not specify any additional training. Of the participants, 92% were involved in cases requiring general anesthesia; 96% managed patients in the recovery room; and 34% managed patients in the intensive care unit. Of participants, 80% usually order chest radiographs, but only 42% interpret the films themselves. Misdiagnosed radiographs included pneumothorax by 11% of participants, free air under the diaphragm by 41%, bronchial perforation from a nasogastric tube by 28%, right mainstem intubation by 20%, superior vena cava perforation from a central venous catheter by 31%, normal film by 75%, negative pressure pulmonary edema by 16%, left lower lobe collapse by 80%, pulmonary infarction from a pulmonary artery catheter by 29%, and tension pneumothorax by 41%. Overall scores of the attending physicians were not significantly different from that of residents (p > 0.05). The control group of radiology residents scored significantly better (mean, 83.7; p = 0.009) than the anesthesia residents (mean, 62.8) and anesthesia attending physicians (mean, 62.5). CONCLUSION: Anesthesiologists are deficient in skills for the interpretation of chest radiographs. The skill level of university-based physicians is not greater than physicians in private practice, and skill level does not improve with level of training or experience. Most anesthesiologists rely on radiologists for interpretative results. Further training during the residency years may help improve diagnostic skills.

Anesthesiology↗
PubMed1985

Human pulmonary dirofilariasis. Report of three cases and brief review of the literature.

Three patients with human pulmonary dirofilariasis are presented. The clinical, parasitologic, and pathologic features of this entity are discussed, and the literature is briefly reviewed. A condition that generally has been considered to be an innocuous process can manifest with repeated pulmonary infarctions and multiple pulmonary nodules. At present, there are no distinguishing clinical, roentgenographic, or laboratory features that permit its diagnosis preoperatively. The purpose of this article is to add three more cases to the literature and to increase awareness of this clinicopathologic entity.

Aged↗