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Consunji-Araneta R, Higgins R, Qing G, Bouhasan L. Tuberculous damaged lung in a child. Pediatr Pulmonol 2011; 46:1247-50. [PMID: 21815276 DOI: 10.1002/ppul.21503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Accepted: 06/23/2011] [Indexed: 11/07/2022]
Abstract
Tuberculosis (TB) remains the "great pretender." We report the case of a 10-year-old female, who presented with a mass in the left chest that was suspected initially to be a tumor. This was later confirmed to be tuberculous in nature, with dissemination to the liver. A large granuloma eventually replaced the left lung, leaving her with "tuberculous destroyed lung" (TDL), an extremely rare, life-threatening sequela of the disease. We review the pathophysiology, radiologic findings, and management options, which includes pneumonectomy, for this seldom seen but preventable condition.
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Affiliation(s)
- Raquel Consunji-Araneta
- Department of Pediatrics and Child Health, Pediatric Respirology, University of Manitoba, Winnipeg, Manitoba, Canada.
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Pande A, Nasir S, Rueda AM, Matejowsky R, Ramos J, Doshi S, Kulkarni P, Musher DM. The incidence of necrotizing changes in adults with pneumococcal pneumonia. Clin Infect Dis 2011; 54:10-6. [PMID: 22042878 DOI: 10.1093/cid/cir749] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Necrotizing pneumonia is generally considered a rare complication of pneumococcal infection in adults. We systematically studied the incidence of necrotizing changes in adult patients with pneumococcal pneumonia and examined the severity of infection, role of causative serotypes, and association with bacteremia. METHODS We used a database of all pneumococcal infections identified at our medical center between 2000 and 2010. Original readings of chest X-rays (CXR) and computerized tomography (CT) were noted. Images were then independently reevaluated by 2 radiologists. The severity of disease at admission was assessed using SMART-COP and Pneumonia Outcomes Research Team (PORT) scoring systems. RESULTS In 351 cases of pneumococcal pneumonia, necrosis was reported in no (0%) original CXR readings and in 6 of 136 (4.4%) CTs. With rereading, 8 of 351 (2.3%) CXR and 15 of 136 (11.0%) CT had necrotizing changes. Overall, these changes were identified in 23 of 351 (6.6%) patients. The incidence of bacteremia and the admitting SMART-COP and PORT scores were similar in patients with and without necrosis (P = 1.00, P = .32, and P = .54, respectively). Type 3 pneumococcus was more commonly isolated from patients with necrosis than from patients without necrosis (P = .05), but 10 other serotypes were also implicated in 16 cases for which the organism was available for typing. CONCLUSIONS Necrotizing changes in the lungs were seen in 6.6% of a large series of adults with pneumococcal pneumonia but were often overlooked on initial readings. Patients with necrosis were not more likely to have bacteremia or more severe disease. Type 3 pneumococcus was the most commonly identified serotype.
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Affiliation(s)
- Anupam Pande
- School of Public Health, University of Texas Health Science Center, Houston, Texas, USA
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Tsai YF, Tsai YT, Ku YH. Surgical Treatment of 26 Patients with Necrotizing Pneumonia. Eur Surg Res 2011; 47:13-8. [DOI: 10.1159/000327684] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Accepted: 03/18/2011] [Indexed: 11/19/2022]
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Le Falher G, Makinson A, Eden A, Lesnik A, Le Moing V, Reynes J. [Two cases of pulmonary gangrene in HIV-infected patients: favorable outcome without surgery]. Med Mal Infect 2010; 41:102-4. [PMID: 21145679 DOI: 10.1016/j.medmal.2009.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2009] [Revised: 10/22/2009] [Accepted: 11/13/2009] [Indexed: 11/29/2022]
Affiliation(s)
- G Le Falher
- Service des Maladies Infectieuses et Tropicales, Hôpital Gui-de-Chauliac, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France.
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Westphal FL, Lima LCD, Netto JCL, Tavares E, Andrade EDO, Silva MDSD. Tratamento cirúrgico de crianças com pneumonia necrosante. J Bras Pneumol 2010. [DOI: 10.1590/s1806-37132010000600008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Descrever os resultados do tratamento cirúrgico de crianças com pneumonia necrosante. MÉTODOS: Análise retrospectiva dos prontuários de 20 crianças diagnosticadas com pneumonia necrosante e submetidas ao tratamento cirúrgico nos serviços de cirurgia torácica de dois hospitais na cidade de Manaus (AM) entre março de 1997 e setembro de 2008. Dados referentes a idade, sexo, agente etiológico, motivos da indicação cirúrgica, tipo de ressecção cirúrgica realizada e complicações pós-operatórias foram compilados. RESULTADOS: Dos 20 pacientes analisados, 12 (60%) eram do sexo feminino. A média de idade dos pacientes foi de 30 meses. Os agentes etiológicos mais encontrados foram Staphylococcus aureus, em 5 pacientes (25%), e Klebsiella sp., em 2 (10%). Os motivos de indicação cirúrgica foram sepse, em 16 pacientes (80%), e fístula broncopleural, em 4 (20%). Os tipos de procedimentos cirúrgicos realizados foram lobectomia, em 12 pacientes (60%), segmentectomia, em 7 (35%), e bilobectomia, em 1 (5%). Além desses procedimentos, 8 pacientes (40%) foram submetidos à descorticação pulmonar. As complicações pós-operatórias foram as seguintes: fístula broncopleural, em 4 pacientes (20%); empiema, em 1 (5%); pneumatocele, em 1 (5%); e flebite em membro superior esquerdo, em 1 (5%). Quatro pacientes (20%) morreram. CONCLUSÕES: Pacientes com evidências de necrose pulmonar devem ser considerados para a ressecção cirúrgica, que está indicada em casos graves de sepse, fístula broncopleural de alto débito ou insuficiência respiratória aguda que não respondem ao tratamento clínico.
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Abstract
A pulmonary cavity is a gas-filled area of the lung in the center of a nodule or area of consolidation and may be clinically observed by use of plain chest radiography or computed tomography. Cavities are present in a wide variety of infectious and noninfectious processes. This review discusses the differential diagnosis of pathological processes associated with lung cavities, focusing on infections associated with lung cavities. The goal is to provide the clinician and clinical microbiologist with an overview of the diseases most commonly associated with lung cavities, with attention to the epidemiology and clinical characteristics of the host.
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Abstract
This article discusses the common clinical scenarios regarding otherwise healthy children who develop suspected pneumonia in which imaging becomes an issue. The following topics are covered concerning the roles of imaging in the management of pneumonia: evaluation for possible pneumonia, determination of a specific etiologic agent, exclusion of other pathology, evaluation of the child with failure of pneumonia to clear, and evaluation of complications related to pneumonia.
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Affiliation(s)
- Lane F Donnelly
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, USA.
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Abstract
Les pneumonies infectieuses aiguës constituent un problème de santé publique important, car elles sont une cause majeure de morbidité et de mortalité chez l’adulte. Si les données cliniques et radiographiques permettent le plus souvent de faire le diagnostic de pneumonie infectieuse, le diagnostic étiologique est plus difficile. En effet, de nombreux agents pathogènes peuvent être responsables de pneumonie et la réaction du parenchyme pulmonaire est peu variée, d’où la faible spécificité des lésions radiologiques observées en dehors de quelques cas particuliers. C’est pourquoi la compréhension des mécanismes physiopathologiques permet d’expliquer certains aspects radiologiques. De même, la connaissance des bases anatomocliniques et radiologiques autorise la reconnaissance de trois aspects radiographiques principaux. Quant à l’appréciation des contextes épidémiologique et immunitaire, ils peuvent permettre également d’approcher le germe en cause.
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Affiliation(s)
- L F Donnelly
- Department of Radiology, Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA.
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WESTPHAL FERNANDOLUIZ, LIMA LUIZCARLOSDE, FERREIRA CYNTIAALMEIDA, CARVALHO MARIAAUXILIADORADE. Tratamento cirúrgico de pneumonia necrosante: análise de quatro casos. ACTA ACUST UNITED AC 2000. [DOI: 10.1590/s0102-35862000000100002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A pneumonia necrosante é uma patologia grave que surge como complicação rara de pneumonia lobar. Quatro crianças na faixa etária entre dez e 28 meses foram hospitalizadas com pneumonia bacteriana aguda, evoluindo com toxemia, derrame pleural e insuficiência respiratória, respondendo insatisfatoriamente a antibioticoterapia e drenagem pleural. Todos os pacientes foram submetidos a tratamento cirúrgico para descorticação pulmonar e ressecção de tecido pulmonar necrosado. Complicações como fístulas broncopleurais ocorreram em dois pacientes, havendo óbito em um dos casos. Os autores concluem que a ressecção pulmonar de emergência é indicada quando a necrose pulmonar é diagnosticada em pacientes septicêmicos ou com fístula broncopleural de alto débito, visando a melhora do prognóstico dessas crianças, mesmo cientes de que o índice de morbimortalidade nesses casos é alto.
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Abstract
Unusual pneumococcal infections occurred frequently in the preantibiotic age but rapidly declined with the advent of the antibiotic era. Unfortunately, the morbidity and mortality associated with invasive pneumococcal disease remain high despite antibiotic therapy and monumental advances in medical technology. The incidence of invasive pneumococcal disease has increased recently because of the onset of the human immunodeficiency virus (HIV) epidemic and the emergence of antibiotic-resistant pneumococcus. Robert Austrian described the clinical triad of pneumococcal pneumonia, meningitis, and endocarditis, a syndrome that now bears his name. Although seen infrequently today, unusual manifestations of pneumococcal infection such as those Austrian reported still occur. A review of these cases is warranted because, as drug-resistant organisms continue to emerge worldwide, more unusual pneumococcal infections will be seen. Streptococcus pneumoniae is responsible for a remarkable array of disease processes; our literature review uncovered 95 different types of unusual pneumococcal infections representing 2,064 cases. Examples of these infections included pancreatic and liver abscesses, aortitis, gingival lesions, phlegmonous gastritis, inguinal adenitis, testicular and tubo-ovarian abscesses, and necrotizing fasciitis. We also reviewed predisposing underlying illnesses and conditions. Alcoholism, HIV infection, splenectomy, connective tissue disease, steroid use, diabetes mellitus, and intravenous drug use remain common risk factors for invasive pneumococcal infections. Currently, multidrug-resistant S. pneumoniae remains susceptible to vancomycin and several new third-generation fluoroquinolones. As what some fear will be a possible postantibiotic era approaches, clinicians must be able to recognize and manage unusual pneumococcal infections.
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Affiliation(s)
- S N Taylor
- Louisiana State University Medical Center, Department of Medicine, New Orleans 70112, USA
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Donnelly LF, Klosterman LA. Cavitary necrosis complicating pneumonia in children: sequential findings on chest radiography. AJR Am J Roentgenol 1998; 171:253-6. [PMID: 9648799 DOI: 10.2214/ajr.171.1.9648799] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The objective of this study was to describe the sequential clinical and radiographic findings of cavitary necrosis complicating pneumonia in childhood. MATERIALS AND METHODS A study group of 17 children (mean age, 6 years) was identified by reviewing CT examinations of all patients who underwent CT of the chest to evaluate possible complications of pneumonia over a 3-year period. Children included in the study group were those who met the criteria for cavitary necrosis: loss of lung architecture, decreased enhancement, and multiple cavities with thin, nonenhancing walls. In the 17 identified cases, sequential chest radiographs were reviewed for visibility of a lung cavity. Long-term follow-up radiographs were evaluated for persistent abnormalities. RESULTS Ten of the 17 cases of cavitary necrosis seen on CT showed cavities at some time on radiography: one cavity was visible at the time of diagnosis on CT and nine were visible only later. All three cavities that were predominantly air-filled on CT were revealed by radiography, whereas 50% (7/14) of predominantly fluid-filled cavities were revealed by radiography. Eleven children underwent follow-up radiography more than 40 days after the diagnosis of cavitary necrosis. Radiographs of those 11 children showed clear lungs without pulmonary sequelae. CONCLUSION In children, cavitary necrosis is associated with severe illness; however, cases usually resolve without surgical intervention, and long-term follow-up radiography shows clear lungs without pulmonary sequelae. Evidence of cavitary necrosis complicating pneumonia is often seen on CT before or in the absence of findings on chest radiography.
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Affiliation(s)
- L F Donnelly
- Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA
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Abstract
BACKGROUND Pulmonary gangrene is a rare complication of severe lung infection with devitalization of lung parenchyma and secondary infection. If untreated, gangrene of the lung leads to sepsis, multiple-organ failure, and death. Resection of all gangrenous tissue is mandatory and is lifesaving. Pleural empyema commonly accompanies gangrene of the lung; in its presence, dissection of hilar structures for resection can lead to mediastinitis or bronchopleural fistula and should be avoided. METHODS Three patients with pulmonary gangrene were treated in two stages: immediate fenestration first and then delayed resection of gangrenous lung in a clean field and immediate closure of the pleural window. RESULTS Two patients underwent pneumonectomy and 1 patient, lobectomy. All patients recovered without complications. CONCLUSIONS Creation of a pleural window (fenestration) for 1 week enables safe and curative resection of a gangrenous lung or lobe in a clean field and in a patient in stable condition.
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Affiliation(s)
- Y Refaely
- Department of Thoracic Surgery, Tel Aviv University Sackler School of Medicine, Israel
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Abstract
Illicit drug users comprise a substantial and growing proportion of the HIV-infected population. Although they develop pulmonary complications common to all HIV transmission groups, they also have unique respiratory illnesses due to the direct effect of the illicit drugs on the lung. Bacterial infections, tuberculosis, and noninfectious complications all have a major effect on morbidity and mortality in this portion of the HIV-infected population.
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Affiliation(s)
- A E O'Donnell
- Department of Medicine, Georgetown University Medical Center, Washington, DC, USA
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Seetharaman ML, Saluja S. Case of the month: iceberg in the pleural space. Br J Radiol 1994; 67:909-10. [PMID: 7953237 DOI: 10.1259/0007-1285-67-801-909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Affiliation(s)
- M L Seetharaman
- Department of Tuberculosis and Chest Diseases, Jawaharlal Institute of Post-Graduate Medical Education and Research, Pondicherry, India
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Affiliation(s)
- C Penner
- Department of Medicine, University of Manitoba, Winnipeg, Canada
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Hammond JM, Lyddell C, Potgieter PD, Odell J. Severe pneumococcal pneumonia complicated by massive pulmonary gangrene. Chest 1993; 104:1610-2. [PMID: 8222837 DOI: 10.1378/chest.104.5.1610] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Massive pulmonary gangrene is a rare complication of pneumonia, particularly in the postantibiotic era. We report two cases of community-acquired Streptococcus pneumoniae pneumonia in young patients with a background of heavy alcohol abuse, but no other preexisting disease, which failed to respond to appropriate antibiotic therapy and intensive care. In both, there was extensive unilateral involvement, with initial dense consolidation followed by cavitation, but the previously reported classic later radiologic feature of coalescence into a large cavity with free-floating slough was not seen. Owing to ongoing sepsis with the development of multiple organ failure and the obvious failure of appropriate medical therapy, both patients underwent pneumonectomy with a successful outcome. These cases serve to emphasize the role of surgery in the management of massive pulmonary gangrene.
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Affiliation(s)
- J M Hammond
- Department of Medicine, Groote Schuur Hospital, Cape Town, South Africa
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Abstract
BACKGROUND A study was carried out to increase familiarity with the aetiology, pathogenesis, and radiographic features that characterise pulmonary gangrene. PATIENTS Four patients with one of the disorders vasoinvasive aspergillosis, infarcted tuberculous cavity, chronic necrotising aspergillosis, and gangrene due to Pseudomonas aeruginosa were selected because they showed the variations of the typical radiographic pattern and illustrated the pathogenesis. A fifth case is also presented, in which pulmonary gangrene was simulated by the invagination of a loculated pleural effusion into the wall of a contiguous lung abscess. CONCLUSIONS Evolution of a crescent or rim of air within a homogeneous shadow is the feature that both heralds the development and facilitates the recognition of pulmonary gangrene. It is most often the result of vascular thrombosis induced by the infecting organism. The outcome of treatment is often unfavourable, principally because of the severity of the predisposing systemic or local underlying disorder, although a delay in diagnosis, possibly due to unfamiliarity with the radiographic pattern, may have contributed to the adverse outcome in some instances.
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Affiliation(s)
- J M Reich
- Division of Pulmonary Medicine, Bess Kaiser Medical Center, Portland, Oregon
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Affiliation(s)
- M D Stein
- Division of General Internal Medicine, Brown University, Rhode Island Hospital, Providence 02903
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Affiliation(s)
- D G Kissner
- Hutzel Hospital, Wayne State University, Detroit, Michigan 48201
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Padmanabhan K, Rajgopalan K, Yeo K, Dhar SR. Intracavitary mass in a patient with Klebsiella pneumonia. Chest 1988; 93:187-8. [PMID: 3335151 DOI: 10.1378/chest.93.1.187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- K Padmanabhan
- Department of Medicine, Coney Island Hospital, Brooklyn, New York
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 3-1984. A 58-year-old man with an enlarging nodule in the left upper lobe. N Engl J Med 1984; 310:178-87. [PMID: 6318109 DOI: 10.1056/nejm198401193100308] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Lloret Perez T, Mitjans Lafont J, Dolores Catala Amoros M, Damia Garcia A. Neumonia aguda gangrenosa y empiema por neumococos. Revision bibliografica. Arch Bronconeumol 1981. [DOI: 10.1016/s0300-2896(15)32450-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Khan FA, Rehman M, Marcus P, Azueta V. Pulmonary gangrene occurring as a complication of pulmonary tuberculosis. Chest 1980; 77:76-80. [PMID: 7351153 DOI: 10.1378/chest.77.1.76] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Eighteen well-documented cases of pulmonary gangrene as a complication of bacterial pulmonary infections have been reported in the literature. These infections were due to Klebsiellapneumoniae, Streptococcus pneumoniae, and Hemophilus influenzae. We describe four patients with pulmonary tuberculosis who developed pulmonary gangrene. Vascular thrombosis and arteritis were found in three of these four patients, and this vascular complication seems to be necessary for the development of pulmonary gangrene.
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Felson B. Letter from the editor: pneumonias. Semin Roentgenol 1980; 15:1-2. [PMID: 7355299 DOI: 10.1016/0037-198x(80)90031-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Choy PP. Right lower lobe lesion with meningitis. Chest 1970; 58:179-80. [PMID: 5455302 DOI: 10.1378/chest.58.2.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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