Monday, March 21, 2016

Most Common Diseases of elder: Respiratory Pleural disease: Pleural effusion - The Misdiagnosis

Kyle J. Norton(Scholar and Master of Nutrients, all right reserved)
Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

                                          Respiratory Disease

Respiratory Disease is defined as medical conditions, affecting the breathing organ and tissues including Inflammatory lung disease, Obstructive lung diseases, Restrictive lung diseases, Respiratory tract infections, trachea, bronchi, bronchioles, alveoli, the nerves and muscles breathing , etc,.

                   Pleural disease: Pleural effusion

The pleura is a thin tissue covered by a layer of cells (mesothelial cells) that surrounds the lungs and lines the inside of the chest wall.
Pleural effusion is a condition of collection of fluid within the pleural cavity as a result of heart failure, bleeding (hemothorax), infections, excessive or decreased fluid volume, etc.

                                         The Misdiagnosis

1. Giant bronchogenic cyst
There is a report of a case of giant pulmonary bronchogenic cyst (18 cm × 15 cm × 10 cm) misdiagnosed with loculated pleural effusion. Later Histopathology studies revealed a giant bronchogenic cyst with abscess formation(49).

2. Amoebic liver abscess
There is a report of a 3 year old who had amoebic liver abscess but was wrongly diagnosed and treated for lobar Pneumonia with pleural effusion(50).

3. Extrapleural empyema
there is a report of 49-year-old man with diabetes mellitus and alcoholic liver cirrhosis presented with dyspnoea and fever. A chest computed tomography scan revealed three areas of loculated pleural effusion. Initially, the patient was thought to have an intrapleural empyema and during open drainage, the patient was diagnosed to have an extrapleural empyema(51).

4. False positive for malignancy
there is a report of a 23-year-old female with systemic lupus erythematosus is reported. The clinical features included fever, shortness of breath, lymphadenopathies, hepatosplenomegaly, pleural and pericardial fluids, ANA and Anti-DNA positivity. Pleural biopsy was false positive for malignancy on two occasions. High CA125 levels were detected in both serum and pleural fluid. Following prednisolone treatment, clinical and laboratory findings returned to normal(52). Other study report of a case of a patient with traumatic hemothorax, showing high pleural fluid concentrations of ferritin, tissue polypeptide antigen, and cancer antigen 125. This patient’s pleural fluid also contained high levels of bilirubin and many macrophages containing phagocytized red blood cells, suggesting a local metabolism of hemoglobin. Our case confirms that some tumoral markers can give false positive results and suggests that their significance must be evaluated differently in bloody pleural effusions as compared with non-bloody pleural effusions(53).

5. Boerhaave’s Syndrome
There is a report of a case of an atypical presentation of Boerhaave’s Syndrome in an elderly female who presented to the Emergency Department with dyspnea, right sided chest pain, right pleural effusion, and hypovolemic shock without an identifiable antecedent event. A chest radiograph revealed massive right hydropneumothorax. After placement of a chest tube, the patient was admitted to the intensive care unit. Only 36 hours after admission did the diagnosis of Boerhaave’s Syndrome become evident(54).

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