fixed gas-bubble. The cause of a pleural effusion ...

The cause of a pleural effusion diagnosed by a fixed gas-bubble. J M Nijhuis-Heddes and B J Pannekoek Chest 1988;94;851-852 DOI 10.1378/chest.94.4.851 The online version of this article, along with updated information and services can be found online on the World Wide Web at: http://chestjournal.chestpubs.org/content/94/4/851.citation

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[:

roentenoram of the month

:i

-

The Cause of a Pleural Effusion

.-

Diagnosed

by a Fixed

Gas.Bubble* J. MA.

A

14-year-old

girl

dyspnea the

chest.

She

nausea,

vomiting,

for

four

days.

not

abroad

was

Beside

was

suffering

film

to the

in

had

never

and

high and

B

for

pain

recurrent

epigastrium,

been

;

hospital

right-sided

from

pain

in

seriously

ill.

hour

and

taken

of 40.8#{176}C rectally,

physical

examination showed

WBC

on

Pannekoek,

was

of 12.8

admission

ESR

x 1O/cu

was

no

She

ated.

film

of

mm

mm.

interpreted

taken in

decrease

detected

milliliters

of

protein

content

were

negative, cells

after

the

of the

pleural

finding

including

The

a right-sided

was confirmed by a chest a lateral view (Fig 1 and 2). Five

This

inflammatory

further found.

and

only.

hundred

were 70

M.D.

performed

effusion

cultures

fever on

.J. M.

x-ray

fever,

diarrhea

recently.

investigations

first

x-ray

M. D.

referred

an intermittent

She

abnormalities

the

was

and

a high

Laboratory

Nijhuis-Heddes,

were

hemorrhagic and

45

gIL,

at cytologic

seen.

The

evacuation pleural

fluid

was

chest

showed

fluid

was

evacu-

bacteriologic examination, x-ray

only

pictures

a

minor

level.

A chest as being

normal. Because ment

was

a bacterial started

However,

the

following abdominal

six days. abscess,

*Fmm

clinical

was

infection with

broad

suspected,

spectrum

picture

did

not

Considering the an ultrasonographic

improve

in the

possibility of an examination

Department of Pulmonary Diseases, Reinier The Netherlands. Reprint requests: Dr Pannekoek, Reinier de GraafcarthuLs 5012, 2600 GA Deift, the Netherlands Hospital,

the

treatantibiotics.

de Graaf

Deift,

Postbus

,.

FIGURE

1

2

FIGURE

CHEST

I

94


I 4 I OCTOBER,

1988

851

Diagnosis:

Retroperitoneal

The

chest

x-ray

x-ray

picture

showed

abscess

film

on

on

the

taken

a pleural

admission

effusion

is normal.

day

of hospital

(Fig

1 and

2) and

subdiaphragm gas bubble the posteroanterior view

with a fluid in the liver

the

retroperitoneal

lateral

presence

view

in

the

of retroperitoneal roentgenographic

specific

The

sixth

gas finding

stay also

level located shadow and space.

a on on

.‘

The

bubbles is the most of a retroperitoneal

abscess. the

To verify excretory

diagnosis,

a plain

urography,

barium

ofthe

study

diagnosis

film

ultrasound

large

bowel

of retroperitoneal

of the

abdomen, and a performed. The

examination,

were

abscess

was

strated on the x-ray films of the large leakage of contrast (Fig 3). The appendix Retroperitoneal abscesses usually pyelonephritis

and

tuberculosis, cause

and

in

our

appendix.

pancreatitis bowel

patient

The

was

cific, nonlocalized testinal complaints as chills, sweating, studies are roentgenographic the

diagnosis.

in some the

two the

diagnosis

weeks.3 patients

Just the retroperitoneal

The is often

rather

the

long

is usually spontaneously

mortality

rate

value

admission

with

a mean

operative. as did

is about

large bowel.

Note the leakage

of contrast

and of about

Some our

of

patient.

30 percent.

finding of fixed gas bubbles space on plain chest x-ray films

immediately

to

retroperitoneal

the

cause

of

pleural

effusion,

ie,

abscess. REFERENCES

several establish

is ofgreat

between

3. X-ray film ofthe

FIGURE

nonspe-

In general, necessary to

tomography interval

Treatment

specific

include

abdominal pain and other gastroinand constitutional symptoms such fever, or malaise.3 Laboratory

Computed

recover

probable

of a retrocecal

typically

.

trauma,

The

‘

perforation

very helpful. studies are

cases.35

Nevertheless

852

not

or following

perforations.

symptoms

best demonbowel showing did not fill. originate from

‘

in the points

1 Altemeier WA, Alexander JW Retroperitoneal abscess. Arch Surg 1961; 83:512-24 2 Kleinschmidt F, Jacobs C, Petersen H. Die Infektion im retroperitonealen Raum. Akt Chir 1978; 13:153-62 3 Crepps JT, Welch JP Orlando R. Management and outcome of retroperitoneal

abscesses.

4 Van Den

Wildenberg

in the

Neth

grass.

5 Krestin

GP Beyer

Diagnostik ren.

Fortschr

Am

Surg

1987;

205:276-81

FAJM. The retrocoecal J Surg 1982; 34:133-35 D, Steinbrich W Rationelles

abdomineller Rontgenstr

Roentgenogram

Abszesse

1984;

mit

Hilfe

appendix:

a snake

Vorgehen bildgebender

bei der Verfah-

141.6:673-77

of the Month


(Nijhuis-Heddes

Pannekoek)

The cause of a pleural effusion diagnosed by a fixed gas-bubble. J M Nijhuis-Heddes and B J Pannekoek Chest 1988;94; 851-852 DOI 10.1378/chest.94.4.851 This information is current as of January 5, 2012 Updated Information & Services Updated Information and services can be found at: http://chestjournal.chestpubs.org/content/94/4/851.citation Permissions & Licensing Information about reproducing this article in parts (figures, tables) or in its entirety can be found online at: http://www.chestpubs.org/site/misc/reprints.xhtml Reprints Information about ordering reprints can be found online: http://www.chestpubs.org/site/misc/reprints.xhtml Citation Alerts Receive free e-mail alerts when new articles cite this article. To sign up, select the "Services" link to the right of the online article. Images in PowerPoint format Figures that appear in CHEST articles can be downloaded for teaching purposes in PowerPoint slide format. See any online figure for directions.
