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2761. Cardiac tamponade due to primary pericardial lymphoma in a patient with AIDS.
Cardiac tamponade due to lymphomatous involvement of the heart is a dramatic and unusual complication. Because of their nonspecific clinical presentation, these tumors are seldom diagnosed antemortem. We report the case of a patient with AIDS who presented with signs and symptoms of cardiac tamponade. Emergency pericardiocentesis followed by staging studies revealed large cell B-lymphocyte lymphoma confined to the pericardial space. With combination chemotherapy, a durable complete response was obtained. This case illustrates the potential benefit of aggressive treatment of extranodal non-Hodgkin's lymphoma in a patient with AIDS. The case is of particular interest because of the unusual development of isolated pericardial involvement as the sentinel sign of lymphoma.
2762. Peripheral intrapulmonary hamartoma accompanied by a similar endotracheal lesion.
We describe a case of peripheral intrapulmonary hamartoma accompanied by a similar endotracheal lesion. A 70-year-old asymptomatic man had a polypoid lesion in the trachea and a nodular shadow in a peripheral lung area. A biopsy specimen from the trachea revealed a chondroid hamartoma, and the surgically resected tissue of the intrapulmonary tumor showed the same histologic findings. This is the second case of multiple hamartomas showing coexistence of tracheobronchial and parenchymal tumors.
2763. Liposarcoma of the posterior mediastinum in a child.
Liposarcoma is rare in children and rarely occurs in the posterior mediastinum in any age group. A massive intrathoracic tumor in a 17-year-old young man was a diagnostic dilemma; preoperative radiographic evaluation and biopsy led us to believe it was a teratoma. At operation, a poorly differentiated myxoid liposarcoma originating from the posterior mediastinum was found and excised. To our knowledge, this is the first liposarcoma of the posterior mediastinum reported in a patient less than 18 years old.
2764. Atrial-esophageal fistula shown by transthoracic echocardiogram.
Nontraumatic atrial-esophageal fistula is a catastrophic problem usually diagnosed postmortem and almost invariably fatal. We report the first case of a patient in whom the diagnosis of atrial-esophageal fistula was made from a transthoracic echocardiography antemortem. Echocardiography showed multiple microbubbles in the left atrium and ventricle emanating from the posterior aspect of the left atrium adjacent to the pulmonary veins. The literature is reviewed and the significance of the case and the echocardiogram is discussed.
2769. Environmental airborne tremolite asbestos pollution and pleural plaques in Afghanistan.
A 51-year-old man underwent pleuroscopy for radiologic pleural abnormalities. Pathologic examination of pleural and lung biopsy specimens concluded on hyalinized pleural plaques associated with mild asbestosis. Transmission electron microscopy analysis showed significant retention of tremolite asbestos fibers. The absence of any occupational exposure to asbestos and the existence of geologic deposits of tremolite in the Kabul area of Afghanistan suggest an environmental exposure during the patient's childhood spent in this region.
2770. Three-dimensional reconstruction of ultrafast chest CT for diagnosis and operative planning in a child with right pneumonectomy syndrome.
After receiving a neonatal right pneumonectomy for septic complications of unilateral pulmonary artery agenesis, a 2 1/2-year-old girl was referred to the Cardiothoracic Surgery Service for evaluation of increasing symptoms of wheezing and stridor. Extensive workup included a three-dimensional ultrafast CT image reconstruction that aided in the diagnosis and operative planning. Successful relief of the airway obstruction was achieved by aortic suspension and by placing a Silastic tissue expander prosthesis. Before operation, this child had been admitted to the hospital on 18 different occasions for respiratory symptoms. Six months after surgery, she is not receiving any medications and is symptom-free.
2771. Prolonged survival in a patient with a single ventricle without pulmonary stenosis.
Prolonged survival of the patient with a single ventricle is rare. We report the case of a 57-year-old man who has type A3 of Van Praagh's classification of single ventricle with pulmonary hypertension without pulmonary stenosis. Favorable streaming, a large bulboventricular foramen, and intact atrioventricular valves may have contributed to his long-term survival.
2772. Pericardial tamponade in chronic myelomonocytic leukemia.
We report four cases of malignant pleuropericardial effusions in patients with chronic phase myelomonocytic leukemia (CMML). Based on current literature, this event is rare and very poorly understood. Our cases shed light on three important clinical characteristics: (1) patients with CMML develop effusions during uncontrolled leukocytosis; (2) these effusions are very responsive to conventional chemotherapy; and (3) effusions may develop without clinical forms of disease in other sites of extramedullary hematopoiesis.
2773. Localized pleural mesothelioma with elevation of high molecular weight insulin-like growth factor II and hypoglycemia.
Recurrent hypoglycemia occurred in a 48-year-old woman with a localized pleural mesothelioma. During hypoglycemia, serum high molecular weight insulin-like growth factor II (IGF-II) was elevated. The tumor also contained a high level of high molecular weight IGF-II. We propose that the primary cause of the hypoglycemia in this patient was the high molecular weight IGF-II produced by the tumor.
2774. Spontaneous biliothorax (thoracobilia) following cholecystopleural fistula presenting as an acute respiratory insufficiency. Successful removal of gallstones from the pleural space.
A patient presented to the emergency department with tachypnea, fever, a right pleural effusion, and lung consolidation. The computed tomographic guided thoracentesis yielded a greenish fluid with bilirubin. The ultrasound examination demonstrated a distended gallbladder with stones, positioned on the ventral face of the liver and a free communication between the fundus and the pleural cavity. The cholecystopleural fistula was confirmed at operation.
2775. Compression of the left main bronchus between a descending thoracic aortic aneurysm and an enlarged right pulmonary artery.
A man with chronic obstructive lung disease presented to the hospital with respiratory failure and a chest x-ray indicated complete radiopacity of the left hemithorax. An endobronchial malignancy was suspected, but unexpectedly left-main bronchial occlusion was found secondary to compression between a descending thoracic aortic aneurysm and an enlarged right pulmonary artery.
2776. Greenfield inferior vena cava filter dislodged during central venous catheter placement.
Two cases of a Greenfield inferior vena cava (IVC) filter being dislodged during central venous catheter placement are described. This event appears to be related to J-tip guidewire use during venous catheterization. To our knowledge, this occurrence previously has not been reported. One of the two filters was dislodged from the IVC to a new position in the right atrium. Dislodging of the filter in these two particular cases did not give rise to clinical signs or symptoms.
2777. Runaway pacemaker during high-energy neutron radiation therapy.
作者: M H Raitt.;K J Stelzer.;G E Laramore.;G H Bardy.;G L Dolack.;J E Poole.;P J Kudenchuk.
来源: Chest. 1994年106卷3期955-7页
Runaway pacemaker occurred in a patient undergoing high-energy neutron radiation therapy despite adherence to published safety guidelines. The very low estimated dose of 0.9 Gy received by the pacemaker demonstrates the extreme sensitivity of integrated circuits to this new modality of radiation therapy.
2778. Fatal massive hemoptysis secondary to intralobar sequestration.
We report the case of a 29-year-old woman who died of massive hemoptysis due to hemorrhage from an intralobar pulmonary sequestration into the tracheobronchial tree. The sequestration had been diagnosed in childhood but had been managed nonoperatively. This case emphasizes the need for early surgical treatment of pulmonary sequestration.
2779. Pleural effusion associated with ipsilateral breast and arm edema as a complication of subclavian vein catheterization and arteriovenous fistula formation for hemodialysis.
A 38-year-old woman with end-stage kidney disease presented with a pleural effusion and profound edema of the ipsilateral arm and breast. A patent hemodialysis arteriovenous fistula access was present in the involved extremity. Brachiocephalic vein stenosis, as a result of previous dialysis catheter placement in the subclavian vein, was demonstrated by ultrasound imaging and Doppler analysis. Takedown of the arteriovenous fistula in the edematous arm along with living-related kidney transplantation caused immediate resolution of the breast and arm edema and rapid clearing of the effusion. An anatomic explantation for the findings is offered.
2780. Pulmonary sequestration receiving arterial supply from the left circumflex coronary artery.
Pulmonary sequestration is an uncommon anomaly for which the arterial supply is usually derived from the aorta or its major branches. A 66-year-old man is described with a pulmonary sequestration that received its arterial supply from a coronary artery.
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