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Radiology of Infectious Diseases and Their Potential Mimics in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Jocelyn A. Luongo, Boris Shapiro, Orlando A. Ortiz, Douglas S. Katz
Although many chest radiographs in patients with pulmonary embolus (PE) are not entirely normal, the findings are usually not specific for PE, and confirmation or exclusion with additional imaging, particularly with pulmonary CT angiography (the current imaging reference standard), ventilation/perfusion (V/Q) scan, and lower extremity venous Doppler, are required for diagnosis. Radiographic findings include right heart enlargement, central pulmonary artery enlargement (usually when chronic, but occasionally when acute with a large clot burden), localized peripheral oligemia with or without distention of more proximal vessels (“Westermark sign”), and peripheral air-space opacification due to localized pulmonary hemorrhage. When lung infarction occurs, in a minority of patients, a pleural-based, wedge-shaped opacity can be identified, the “Hampton’s hump.” Lung infarction can have a similar appearance to segmental pneumonia, and correlation with CT angiography is usually needed to differentiate the two entities (Figure 5.21a and b). The utility of chest radiography is more for identifying between alternate diagnoses and for interpretation of V/Q scans, to correlate with abnormal areas of perfusion or ventilation [77].
The blood
Published in Brian J Pollard, Gareth Kitchen, Handbook of Clinical Anaesthesia, 2017
Alastair Duncan, Santosh Patel
During prolonged periods of deoxygenation, irreversible sickling may occur. In this situation, the cells aggregate and occlude small blood vessels and this leads to tissue infarction and further hypoxia. Hypoxia is aggravated by lung infarction, which is a common cause of death. The major features of sickle cell disease are therefore chronic anaemia and the occurrence of sickle cell ‘crises’ in which multiple episodes of tissue infarction occur.
Test Paper 4
Published in Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike, Get Through, 2017
Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike
With regard to the progression of pulmonary consolidation on CXR, all of the following options are true except Lung contusion appears in 6 hours and clears in 3–7 days.Aspiration appears in minutes and clears in 24–48 hours unless infected.Lung infarction due to pulmonary embolism manifests after 3–5 days and clears in approximately 3 weeks.Fat embolism appears in 6 hours and clears in 7–10 days.ARDS with diffuse alveolar damage appears after 24–48 hours and clears in 4–6 weeks.
Procalcitonin Measurement in Pleural Fluid to Predict Infectious Complications of the Chest Post Lung Resection
Published in Journal of Investigative Surgery, 2021
Vasileios Kouritas, Charalambos Zissis, Ionas Bellenis
Chest infectious complications (complicated group) included atelectasis/pneumonia (mainly new and persisting consolidation with elevated WBC > 12,000/103 mm and clinical signs of respiratory involvement; that is, temperature >38 °C, new cough or/and suggestive sputum, tachypnea, etc.), postoperative infected pleural effusion/empyema/infected space, prolonged air leak (>5 days postoperatively) with evidence of infection (change in drainage consistency including pus or turbulent effusion with no other obvious site of infection needing treatment such as antibiotics), lung torsion, and lung infarction. Patients with simple prolonged air leak; that is, without findings of infection, were categorized into the non-complication group. In addition to the above, diagnosis was further based on blood test(raised WBC and CRP levels as previously described), clinical (fever, tachypnea, treatment escalation, change in drainage fluid consistency), and imaging findings, in accordance with the European Society of Thoracic Surgeons/Society of Thoracic Surgeons(ESTS/STS) standard definitions [11].
The relevance of bronchoalveolar lavage fluid analysis for lung cancer patients
Published in Expert Review of Respiratory Medicine, 2020
Macrophages are the main cellular compound in BALF and these cells are visible in various forms from young cells resembling monocytes to large adult forms with reactive changes in the cytoplasm [8]. Macrophages may form groups resembling clusters of malignant cells. These cells are similar in size to cancer cells, which creates additional difficulties. Bronchial epithelial cells, particularly ciliated cells are occasionally visible in normal BALF smears but, in the case of ‘bronchial’ admixture, they are more numerous and confusing for the untrained eye. It happens in the condition of airway obturation. The alveolar epithelial cells (AE) are highly reactive in response to many lung pathologies. Small clusters of AEII are very similar to the forms of adenocarcinoma [39]. Such conditions as interstitial pneumonitis, diffuse alveolar damage, viral infections, lung infarction or radiation therapy are known to cause the reactivity of the airway epithelial cells [10,40].
Dilemmas in Dual Disease: Complexity and Futility in Prosthetic Valve Endocarditis and Substance Use Disorder
Published in The American Journal of Bioethics, 2018
James N. Kirkpatrick, Jason W. Smith
Which cardiac structure is involved plays a significant role in morbidity and the mode of death. Right-sided heart valve (tricuspid and pulmonic) lesions can lead to liver and kidney failure and lower extremity swelling. Left-sided heart valve (mitral and aortic) dysfunction can produce shortness of breath from pulmonary congestion. Endocarditis vegetations can break off and travel. John's tricuspid valve vegetations may have traveled to his lungs, causing a pulmonary embolism and lung infarction (given his presentation with chest pain and shortness of breath). These lung problems can worsen during cardiac surgery, consigning patients to mechanical ventilation for long stretches and not infrequently contributing to death. If his mitral or aortic valves were affected, vegetations could embolize to the brain, the extremities, or other organs. Embolism of infected material to the brain creates a major problem when surgery is otherwise indicated, as these pockets of infection tend to bleed, especially when aided by the large amounts of blood thinner necessary for intraoperative cardiopulmonary bypass. Cerebral embolism presents another particularly vexing dilemma: The risk of repeat embolism is often high without surgery, but operations are safer the longer one waits after embolism, especially if the embolism has bled. Surgery can be like attempts to diffuse a ticking time bomb without knowing whether cutting the wire will cause a premature explosion.