Sharma J K, Marrie T J
Department of Medicine, University of Alberta. Edmonton, Alberta.
Can J Infect Dis. 2001 Mar;12(2):104-7. doi: 10.1155/2001/656097.
The objective of the present paper is to describe the clinical and computed tomography features of 'explosive pleuritis', an entity first named by Braman and Donat in 1986, and to propose a case definition. A case report of a previously healthy, 45-year-old man admitted to hospital with acute onset pleuritic chest pain is presented. The patient arrived at the emergency room at 15:00 in mild respiratory distress; the initial chest x-ray revealed a small right lower lobe effusion. The subsequent clinical course in hospital was dramatic. Within 18 h of admission, he developed severe respiratory distress with oxygen desaturation to 83% on room air and dullness of the right lung field. A repeat chest x-ray, taken the morning after admission, revealed complete opacification of the right hemithorax. A computed tomography scan of the thorax demonstrated a massive pleural effusion with compression of pulmonary tissue and mediastinal shift. Pleural fluid biochemical analysis revealed the following concentrations: glucose 3.5 mmol/L, lactate dehydrogenase 1550 U/L, protein 56.98 g/L, amylase 68 U/L and white blood cell count 600 cells/mL. The pleural fluid cultures demonstrated light growth of coagulase-negative staphylococcus and viridans streptococcus, and very light growth of Candida albicans. Cytology was negative for malignant cells. Thoracotomy was performed, which demonstrated a loculated parapneumonic effusion that required decortication. The patient responded favourably to the empirical administration of intravenous levofloxacin and ceftriaxone, and conservative surgical methods in the management of the empyema. This report also discusses the patient's rapidly progressing pleural effusion and offers a potential case definition for explosive pleuritis. Explosive pleuritis is a medical emergency defined by the rapid development of a pleural effusion involving more than 90% of the hemithorax over 24 h, which causes compression of pulmonary tissue and mediastinal shift to the contralateral side.
本文的目的是描述“暴发性胸膜炎”的临床和计算机断层扫描特征，这一病症由布拉曼和多纳特于1986年首次命名，并提出病例定义。本文报告了一名既往健康的45岁男性因急性胸膜炎性胸痛入院的病例。患者于15:00抵达急诊室，有轻度呼吸窘迫；初始胸部X线显示右下叶少量胸腔积液。患者随后在医院的临床病程变化剧烈。入院后18小时内，他出现严重呼吸窘迫，在室内空气中氧饱和度降至83%，右肺野叩诊浊音。入院次日早晨复查胸部X线显示右半侧胸腔完全致密影。胸部计算机断层扫描显示大量胸腔积液，压迫肺组织并导致纵隔向对侧移位。胸腔积液生化分析显示以下浓度：葡萄糖3.5 mmol/L、乳酸脱氢酶1550 U/L、蛋白质56.98 g/L、淀粉酶68 U/L以及白细胞计数600个细胞/mL。胸腔积液培养显示凝固酶阴性葡萄球菌和草绿色链球菌轻度生长，白色念珠菌极轻度生长。细胞学检查未发现恶性细胞。进行了开胸手术，发现为局限性类肺炎性胸腔积液，需要行胸膜剥脱术。患者对经验性静脉使用左氧氟沙星和头孢曲松以及脓胸的保守手术治疗反应良好。本报告还讨论了患者迅速进展的胸腔积液情况，并为暴发性胸膜炎提供了一个潜在的病例定义。暴发性胸膜炎是一种医疗急症，定义为在24小时内胸腔积液迅速发展，累及超过90%的半侧胸腔，导致肺组织受压和纵隔向对侧移位。
