Unusual cause of sudden-onset pleuritic chest pain: Torsion of extralobar pulmonary sequestration

Yuji Okazaki , Toshihisa Ichiba , Yuho Maki
{"title":"Unusual cause of sudden-onset pleuritic chest pain: Torsion of extralobar pulmonary sequestration","authors":"Yuji Okazaki ,&nbsp;Toshihisa Ichiba ,&nbsp;Yuho Maki","doi":"10.1016/j.jemrpt.2023.100043","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Extralobar pulmonary sequestration (EPS) is often diagnosed in neonates due to accompanying congenital anomalies. However, even in adulthood, this condition can, in rare cases, be complicated with torsion and may present with pleuritic chest pain at an emergency department in an undiagnosed state. We describe a case with torsion of ELS in a healthy adult female.</p></div><div><h3>Case report</h3><p>A 21-year-old woman presented with acute-onset back pain and pleuritic chest pain at our emergency department and was initially diagnosed with pleurisy based on normal results of investigations. However, she revisited our department due to flare-ups of pain, and a subsequent CT scan revealed an expanding homogeneous opacity in the left lower lobe of the lung. Magnetic resonance imaging (MRI) confirmed the presence of an encapsulated mass with a hypointense signal on T2-weighted imaging and a feeding artery from the aorta to the mass, leading to a preoperative diagnosis of EPS with hemorrhagic infarction. Video-assisted thoracoscopic surgery was performed, and the cause of hemorrhagic infarction was found to be a torsion. The diagnosis was confirmed histologically.</p></div><div><h3>Why should an emergency physician be aware of this?</h3><p>This case highlights the importance of recognizing torsion of EPS as an unusual cause of pleuritic chest pain and emphasizes the need for early diagnosis in order to perform surgery as soon as possible. Changes in CT findings of torsion of EPS over time can help physicians understand this rare condition. MRI may also be useful for the perioperative diagnosis.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"2 3","pages":"Article 100043"},"PeriodicalIF":0.0000,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"JEM reports","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2773232023000391","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

Abstract

Background

Extralobar pulmonary sequestration (EPS) is often diagnosed in neonates due to accompanying congenital anomalies. However, even in adulthood, this condition can, in rare cases, be complicated with torsion and may present with pleuritic chest pain at an emergency department in an undiagnosed state. We describe a case with torsion of ELS in a healthy adult female.

Case report

A 21-year-old woman presented with acute-onset back pain and pleuritic chest pain at our emergency department and was initially diagnosed with pleurisy based on normal results of investigations. However, she revisited our department due to flare-ups of pain, and a subsequent CT scan revealed an expanding homogeneous opacity in the left lower lobe of the lung. Magnetic resonance imaging (MRI) confirmed the presence of an encapsulated mass with a hypointense signal on T2-weighted imaging and a feeding artery from the aorta to the mass, leading to a preoperative diagnosis of EPS with hemorrhagic infarction. Video-assisted thoracoscopic surgery was performed, and the cause of hemorrhagic infarction was found to be a torsion. The diagnosis was confirmed histologically.

Why should an emergency physician be aware of this?

This case highlights the importance of recognizing torsion of EPS as an unusual cause of pleuritic chest pain and emphasizes the need for early diagnosis in order to perform surgery as soon as possible. Changes in CT findings of torsion of EPS over time can help physicians understand this rare condition. MRI may also be useful for the perioperative diagnosis.

查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
突发性胸膜炎性胸痛的不寻常原因:叶外肺隔离扭转
背景右浅叶肺隔离(EPS)常因新生儿先天性异常而被诊断。然而,即使在成年期,这种情况在极少数情况下也可能并发扭转,并可能在未确诊的情况下在急诊科出现胸膜炎性胸痛。我们描述了一个健康成年女性ELS扭转的病例。病例报告一名21岁女性在急诊科表现为急性背痛和胸膜炎性胸痛,最初根据正常检查结果诊断为胸膜炎。然而,由于疼痛的突然发作,她再次来到我科,随后的CT扫描显示左肺下叶扩大均匀性混浊。磁共振成像(MRI)证实了包裹性肿块的存在,在t2加权成像上显示低信号,并且有一条从主动脉到肿块的供血动脉,因此术前诊断为EPS合并出血性梗死。经电视胸腔镜手术,发现出血性梗塞的原因是扭转。经组织学检查确诊。急诊医生为什么要意识到这一点?本病例强调了认识外系肌扭转是胸膜性胸痛的一种不寻常原因的重要性,并强调了早期诊断的必要性,以便尽快进行手术治疗。随着时间的推移,EPS扭转的CT表现的变化可以帮助医生了解这种罕见的疾病。MRI也可用于围手术期诊断。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 去求助
来源期刊
JEM reports
JEM reports Emergency Medicine
自引率
0.00%
发文量
0
审稿时长
54 days
期刊最新文献
A rare case of yellow nail syndrome in the emergency room setting: A case report Spontaneous perinephric hematoma in an emergency department patient with flank pain: A case report Symptomatic complete heart block: A rare complication of anterior myocardial infarction in a young, fit male: A case report Case of monocular visual impairment Upper gastrointestinal bleeding: A rare presenting sign of pediatric hypothyroidism
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1