Giant lymph node hyperplasia (Castleman's disease) presenting with chylous pleural effusion

A case of giant lymph node hyperplasia (Castleman's disease) with an original presentation of a chylous pleural effusion occurred in a female adolescent. CT scans showed mediastinal lymphadenopathy. Lymph node biopsy was consistent with the plasmacytic variant of Castleman's disease.     

Constrictive pericarditis presenting as unexplained recurrent pleural effusion: a case report

We describe herein the case of a patient who presented with total occlusion of all the major arteries in the unilateral iliofemoral region, including the distal deep femoral artery, on whom an aortolateral circumflex femoral-popliteal artery sequential bypass was successfully performed. This case report serves to demonstrate that the lateral circumflex femoral artery can provide a suitable midway outflow for aortopopliteal bypass in patients with extensive thrombosis of the iliofemoral arteries.     

Acquired immunodeficiency syndrome-related visceral leishmaniasis presenting in a pleural effusion

Visceral leishmaniasis is increasingly reported in immunocompromised patients, including patients with AIDS. We report a case of visceral leishmaniasis in an AIDS patient who presented with pulmonary symptoms and bilateral pleural effusions. Histologic evaluation of pleural fluid and bone marrow revealed histiocytes with intracellular Leishmania amastigotes. Visceral leishmaniasis should be considered in AIDS patients with a significant travel history who present with unexplained pulmonary symptoms.     

Hemorrhagic pleural effusion and pleural thickening as a complication of chronic lymphocytic leukemia

In the Upper Rhine Valley (Germany), Bacillus thuringiensis var. israelensis has been widely used against floodwater mosquitoes over an area of approximately 500 km2 for more than 10 years. The susceptibility of larvae of Aedes vexans field populations in 3 untreated (Lake Constance) and 3 treated areas (Upper Rhine Valley) was assessed by means of bioassays with B.t.i. (Bactimos WP, 6,000 AAU/mg), following WHO guidelines. Log-probit analyses and statistical evaluations of the data showed that the LC50 values as well as slopes of bioassays of the larvae deriving from the different areas showed no significant differences. Two populations in the treated area were even more susceptible than populations from the untreated areas. These results have been confirmed by resistance ratios, which were less than one in all tests carried out.     

Intestinal strongyloidiasis manifesting as eosinophilic pleural effusion

Strongyloidiasis caused by the helminth Strongyloides stercoralis is usually asymptomatic or causes mild dermatologic or gastrointestinal symptoms. In immunocompromised hosts, hyperinfection and dissemination can occur. In this case, I describe a nonimmunocompromised Southeast Asian man who had an eosinophilic pleural effusion, peripheral eosinophilia, and rhabditiform larvae of S stercoralis in the stools. There was complete resolution of the pleural effusion after thiabendazole therapy, thus suggesting strongyloidiasis as the cause of the effusion. Helminthic infections like strongyloidiasis should be considered in the differential diagnosis of an eosinophilic pleural effusion, especially in individuals from endemic areas.     

Rapid development of massive pleural effusion in Legionnaires' disease

The rapid development of a massive exudative pleural effusion was documented in a case of Legionnaires' disease. This clinical event can be considered an established though unusual feature of the widening clinical spectrum of infection by Legionella pneumophila.     

Plasma cell interstitial pneumonia as a manifestation of multicentric Castleman's disease

A 12-year-old boy was admitted to our hospital because of abnormal shadows on a chest radiograph, slight fever, and superficial lymphadenopathy. Laboratory examination showed anemia (Hb 9.9 g/dl) and hyperimmunoglobulinemia (IgG 5469 mg/dl) without M protein. A chest CT scan showed bilateral diffuse shadows and bilateral hilar lymphadenopathy. Biopsy specimens of an inguinal lymph node and a lung showed many lymphoid follicles with germinal centers, and marked infiltration of mature plasma cells in the interfollicular area without destruction of follicular structures. The polyclonality of the plasma cells was confirmed by immunohistochemistry. The patient was not treated because these results excluded malignant disease and he was asymptomatic. At the age of 17 years, he was admitted to our hospital again because of dyspnea and a tendency to bleed. Interstitial pneumonia, hyperimmunoglobulinemia (IgG 13900 mg/dl), and anemia (Hb 6.6 g/dl) were found, along with thrombocytopenia (2.5 x 10(4)/mm3) and proteinuria. The serum interleukin-6 level was high: 177 pg/ml. Bronchoalveolar lavage fluid contained many plasma cells. Therapy with corticosteroids and immunosuppressant medication was effective. Our diagnosis was plasma cell interstitial pneumonia as a manifestation of multicentric Castleman's disease.     

Rosai-Dorfman disease presenting as a meningioma

This report documents an unusal case of extranodal sinus histiocytosis (Rosai-Dorfman disease) which produced a solitary intracranial mass lesion that was diagnosed clinically and radiologically as a meningioma. Morphological features have been described and literature extensively reviewed.     

Sonography of malignant pleural effusion

Two hundred and ten patients with exudative pleural effusion were studied by ultrasound for sonographic signs of pleural carcinomatosis. Images were evaluated for echoes within the fluid, septations, sheet-like or nodular pleural masses, and associated lesions of the lung. Our results showed that sonographic findings of echogenic or septated fluid were unspecific for malignancy. Only the evidence of pleural masses was characteristic of malignant effusion. Ultrasound of the chest should therefore be carried out before invasive diagnostic procedures are planned.     

Castleman's disease. A case report

Angiofollicular lymph node hyperplasia or Castleman's Disease (CD) is a rare lymphoproliferative disorder that manifests itself as a local or generalized tumor-like condition affecting both lymph nodes and non-nodal tissues, usually in the chest and abdomen. Hyaline vascular and plasma cell types have been identified histologically. A new clinical form of CD with multisystemic involvement has been defined as multicentric Castleman's disease. It is very rare in childhood. In this paper we present an eight-year-old boy with multicentric Castleman's disease.     

Management of malignant pleural effusion

Malignant pleural effusion is a frequent cause of morbidity in cancer patients. Pleural aspiration relieves dyspnoea usually only for a matter of days, and if the tumour type is not chemosensitive, some form of pleurodesis is commonly required. Tube thoracostomy is widely used to achieve pleural drainage prior to attempting pleurodesis by instillation of a variety of 'sclerosants'. Recently thoracoscopic instillation of talc has been advocated and some authors report high rates of fluid control. Randomised trials comparing this approach compared to tube thoracostomy and chemical pleurodesis are required.     

Differential diagnosis of pleural effusion

The results of following up 598 patients diagnosed as having pleural exudate were used to analyze the potentialities of complex radiation and clinical differential diagnoses of this abnormality. The authors identified 4 most common nosological entities (tuberculosis, pleuropneumonia, cancer, mesothelioma) among patients of diagnostic hospitals. The diagnostic algorithm should be derived by taking into account the current techniques applicable to each disease form. With this, valid diagnosis may be made in 98.5% of cases.     

Hodgkin's disease presenting as pericarditis

Two patients presented with initial symptoms of pericarditis. Palpable lymph nodes developed a few weeks later and a diagnosis of Hodgkin's disease was made. Although rare, this mode of presentation of Hodgkin's disease has been reported previously, and it should be considered in the differential diagnosis of any patient with pericarditis with severe general symptoms or a prolonged course.