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Physical Examination

Physical examination findings suggestive of peritonsillar abscess include the following:[1][2][3][4]

Appearance of the Patient

  • They are usually acutely-ill looking.

Vital Signs

HEENT

Neck

Lungs

  • May be in obvious respiratory distress with flaring of ala nasi, subcostal and intercostal recessions.
  • Increased respiratory rate in both children and adults
  • Decreased air-entry depending of degree of airway obstruction

Extremities

  • Cyanosis












Variable Croup Epiglottitis Pharyngitis Tonsilitis Retropharyngeal abscess
Presentation Cough ✔ — Sore throat, pain on swallowing, fever, headache, abdominal pain, nausea and vomiting Sore throat, pain on swallowing, fever, headache, cough Neck pain, stiff neck, torticollis

fever, malaise, stridor, and barking cough

Stridor ✔ ✔
Drooling — ✔
Others are Hoarseness, Difficulty breathing, symptoms of the common cold, Runny nose, Fever Other symptoms include difficulty breathing, fever, chills, difficulty swallowing, hoarseness of voice
Causes Parainfluenza virus H. influenza type b, beta-hemolytic streptococci, Staphylococcus aureus, fungi and viruses. Group A beta-hemolytic streptococcus. Most common cause is viral including adenovirus, rhinovirus, influenza, coronavirus, and respiratory syncytial virus. Second most common causes are bacterial; Group A streptococcal bacteria,[5]  Polymicrobial infection. Mostly; Streptococcus pyogenes, Staphylococcus aureus and respiratory anaerobes (example; Fusobacteria, Prevotella, and Veillonella species)[6][7][8][9][10][11]
Physical exams findings Suprasternal and intercostal indrawing,[12] Inspiratory stridor[13], expiratory wheezing,[13] Sternal wall retractions[14] Cyanosis, Cervical lymphadenopathy, Inflammed epiglottis Inflammed pharynx with or without exudate Fever, especially 100°F or higher.[15][16]Erythema, edema and Exudate of the tonsils.[17] cervical lymphadenopathy, Dysphonia.[18] Child may be unable to open the mouth widely. May have enlarged

cervical lymph nodes and neck mass.

Age commonly affected Mainly 6 months and 3 years old

rarely, adolescents and adults[19]

Used to be mostly found in

pediatric age group between 3 to 5 years,

however, recent trend favors adults

as most commonly affected individuals[20]

with a mean age of 44.94 years.

Mostly in children and young adults,

with 50% of cases identified

between the ages of 5 to 24 years.[21]

Primarily affects children

between 5 and 15 years old.[22]

Mostly between 2-4 years, but can occur in other age groups.[23][24]
Imaging finding Steeple sign on neck X-ray Thumbprint sign on neck x-ray — Intraoral or transcutaneous USG may show an abscess making CT scan unnecessary.[25][26][27] On CT scan, a mass impinging on the posterior pharyngeal wall with rim enhancement is seen[28][29]
Treatment Dexamethasone and nebulised epinephrine Airway maintenance, parenteral Cefotaxime or Ceftriaxone in combination with Vancomycin. Adjuvant therapy includes corticosteroids and racemic Epinephrine.[30][31] Antimicrobial therapy mainly penicillin-based and analgesics. Antimicrobial therapy mainly penicillin-based and analgesics with tonsilectomy in selected cases. Immediate surgical drainage and antimicrobial therapy. emperic therapy involves; ampicillin-sulbactam or clindamycin.












  • Peritonsillar abscess Image courtesy of RadsWiki and copylefted
    Peritonsillar abscess Image courtesy of RadsWiki and copylefted
  • Peritonsillar abscess Image courtesy of RadsWiki and copylefted
    Peritonsillar abscess Image courtesy of RadsWiki and copylefted
  • Peritonsillar abscess Image courtesy of RadsWiki and copylefted
    Peritonsillar abscess Image courtesy of RadsWiki and copylefted
  • Peritonsillar abscess Image courtesy of RadsWiki and copylefted
    Peritonsillar abscess Image courtesy of RadsWiki and copylefted

Treatment

Treatment is, as for all abscesses, through surgical incision and drainage of the pus, thereby relieving the pain of the stretched tissues. The drainage can often be achieved in the Outpatient Department using a guarded No. 11 blade in an awake and co-operative patient. Sometimes, a needle aspiration can suffice. Antibiotics are also given to treat the infection.

Peritonsillar abscesses are widely considered one of the most painful complications, primarily the surgical draining of the abscess itself. The patient is operated on awake, surgically slicing open the tonsil and draining the abscess.

Complications

  • Parapharyngeal abscess
  • Extension of abscess in other deep neck spaces leading to airway compromise
  • Septicaemia





Alternaria spp[32]

Rhodotorula spp [33]

Acremonium spp.[34] 

Dreschlera spp[35]

Malassezia spp[36]

Scedosporium spp[37]

Arthrographis spp[38]

Blastoschizomyces (11, 12),

Paecilomyces (13, 14),

Aureobasidium (15),

Clavispora (16), Ustilago (17), 

Exophiala (Wangiella) (18),

and Exserohilum (19, 20).

On the other hand, most cases of fungal CNS infections are caused by only a few important species,

The common causes of fungal meningistis may be classified into two subgroups. This inlcudes:


Primary fungal pathogens of humans

All of these may cause CNS infections. This group includes: C. neoformans (22, 23),

Coccidioides immitis (24, 25, 26),

Blastomyces dermatitidis (27, 28),

Paracoccidioides brasiliensis (29, 30),

Sporothrix schenckii (31, 32), 

H. capsulatum (33, 34),

Pseudallescheria boydii (Scedosporium apiospermum) (35, 36),

dematiaceous fungi (37, 38, 39).

The second group is considered opportunists, which take advantage of significant immune defects in the host. This group includes

Candida species (40, 41, 42),

Aspergillus species (43, 44, 45),

mucormycosis (46, 47), and

Trichosporon species (48, 49).



Title:Fungal Meningitis Author / Creator:Horan ; Perfect, Jennifer, John L. R. Language: English Is Part Of: Infections of the Central Nervous System Identifier: ISBN: 978-1-4698-8366-3 Source: Gale Virtual Reference Library (GVRL)


According to severity of the disease
Mild
  • Early diagnosis and treatment
  • Responds to medical treatment
  • Typical clinical presentation
  • Good prognosis
Moderate
  • May present late with typical or atypical symptoms
  • May present with complications
  • Variable response to treatment
Severe
  • Presents with complications or prolonged illness
  • Immunocompromised
  • Common in extremes of age
  • Delayed diagnosis and treatment
  • Surgical treatment may be required in addition to medical treatment
  • Increased morbidity and mortality
According to the duration of disease[39]
Acute
  • Lasts few weeks
  • Patient acutely ill
  • Mostly in HIV-associated patients
  • Impaired consciousness
  • Seeks medical treatment early due to sudden deterioration
Subacute
  • Lasts less than 4 weeks
  • Patient acutely ill
  • Mostly in HIV-associated patients
  • Impaired consciousness
  • Seeks medical treatment early due to sudden deterioration
Chronic
  • Lasts more than 4 weeks
  • Gradual deterioration of patient
  • Prolonged history of atypical symptoms
  • Common in older patients
Recurrent
  • Multiple episodes which lasts less than 4 weeks
  • History of incompliance to medication
  • immunosuppression may be the underlying cause










Variable Empyema Thoracis Lung abscess Pleural effusion Pneumonia Lung cancer
Presentation Variable presentation

but may follow long standing pneumonia

Usually has history of aspiration pneumonia, alcoholics, drug abusers, seizure disorder, have undergone recent general anesthesia, or have a nasogastric or endotracheal tube. Usually follows pneumonia as a complication presents with fever, pleuritc chest pain, cough mostly asymptomatic but may

have cough productive with

hemoptysis and

chronic history of smoking

Causes In general any bacteria

can cause an empyema, however different bacteria are associated

with different rates of empyema formation.[1]  Common causes include bacteroides, fusobacterium, 

haemophilus influenzae, pneumococcal infections,

staphylococcus aureus,

streptococcus, TB

Lung abscess is commonly caused by bacterial infections and these include bacteroides, peptostreptococcus and prevotella mostly after aspiration Common causes of transudative pleural effusion include;[1][2][3][4][5] left ventricular failure, Nephrotic syndrome, and cirrhosis, while common causes of exudative pleural effusions[6] are bacterial pneumonia and malignancy Pneumonia can result from a variety of causes, including infection with bacteria, viruses, fungi, parasites, and chemical injury to the lungs Direct cause of lung cancers

is DNA mutations that often

result in either activation

of proto-oncogenes

(e.g. K-RAS) or the inactivation of tumors suppressor genes

(e.g. TP53) or both. The risk of these genetic mutations may be increased following exposure to environmental components example smoking

Laboratory findings The pleural fluid typically has a low pH (<7.20),

low glucose (<60 mg/dL), and contains infectious organisms.

Therefore, the diagnosis relies on the presence of pus or organisms on gram stain. A positive bacteria culture from pleural fluid is not needed to make diagnosis of empyema.[40][41]

Raised inflammatory markers ( eg high ESR, CRP) are usual but not specific The most widely used criteria is to differentiate between exudate and transudate using the light's criteria. Fluid is exudate when:
  • Pleural fluid protein/serum protein ratio >0.5
  • Fluid/serum lactic dehydrogenase (LDH) ratio >0.6
  • Fluid LDH greater than 2/3 the upper limits of normal of the serum LDH
 Laboratory findings are non specific example leukocytosis, sputum samples for gram staining and culture. Other tests include urine antigen test, PCR, C-reactive protein and procalcitonin The laboratory findings are 

non specific including:

neutropenia, hyponatremia,

hypokalemia, hypercalcemia,

respiratory acidosis,

hypercarbia, hypoxia, and

tumor cells in sputum and

pleural effusion cytology.

Physical examination On examination, the following

findings may be seen:[42][43][44]

Lateral chest wall swelling

and tenderness, clubbing of the fingernails, dull percussion note, r

educed breath sounds on the affected side of the chest, egophony, coarse crackles, increased tactile fremitus,

mediastinal shift to opposite side with large empyema

Chest examination shows features of consolidation such as localised dullness on percussion, bronchial breath sound etc.

Dental decay is common especially in alcoholics and children. Clubbing is present in one third of patients.

Bulging of the intercostal spaces,

decreased chest expansion

bronchovesicular breath sounds

of decreased intensity, egophony,

dullness to percussion,

decreased or absent fremitus.

Physical examination increased respiratory rate, low oxygen saturation, difficulty breathing, bronchial breathe sounds, increased tactile fremitus crackling sounds, or increased whispered pectoriloquy.  Physical examination findings are non specific and may include decreased/absent breath sounds, pallor, low-grade fever, tachypnea and cachezia.
CXR Chest X ray of empyema shows air-fluid level continuos homogenous pattern from the mediastinum to the chest wall forming obtuse angle with the lung parenchyma.[45]

Chest xray shows often unilateral cavity containing an air-fluid level and consolidation of lung parenchyema.

A homogenous opacification is noted at the affected side. The costophrenic angle is obliterated with a meniscus. CXR shows areas of diffused opacities. CXR may show lung mass, widening of the mediastinum, atelectasis, or pleural effusion.
Chest ultrasound Ultrasound in empyema is positive

for suspended microbubble sign,

air fluid level, curtains sign

and loss of gliding sign.[46]

Ultrasound in lung abscess is negative for suspended microbubble sign, curtains sign and loss of gliding sign but air fluid level may be seen,.[47] Ultrasonography is helpful in making diagnosis of pleural effusion particularly in differentiating effusion from masses.[48] The extended thoracic spine sign on sonography has high sensitivity and specificity for diagnosing pleural effusion.[49] Chest or upper abdominal ultrasound may show subpulmonic effusion as shown below.[50][51][52] Not reqiured unless complicated with empyema USG is helpful in guiding biopsy, staging and estimating prognosis. It may show hypo- and hyperechogenic masses.[53][54][55]
CT scan Seen as a lung mass whose cavity

is regular with smooth

and regular lumen, well-defined

boundary and shape changes

with change in patient's position.[56]

Mass may resolve on antibiotics The split pleura sign is present[57]

(most reliable sign to differentiate

empyema from lung abscess)[58]

Lung mass whose cavity is rregular with undulated lumen, irregular-poorly defined boundary and shape does not change with change in patient's position.[59] Mass may resolve on antibiotics In most cases CT imaging may not provide additional information that would influence the clinical decision-making process.[60][61] [62] CT scan shows heterogeneous opacification of the affected side and cardiomediastinal shift to the opposite site in unilateral effusion.[63]
  • CT findings in pneumonia include:[1]
 Seen as a spiculated irregular solid mass that does not resolve on antibiotics
  1. ↑ Galioto NJ (2008). "Peritonsillar abscess". Am Fam Physician. 77 (2): 199–202. PMID 18246890.
  2. ↑ Ferri, Fred (2015). Ferri's clinical advisor 2015 : 5 books in 1. Philadelphia, PA: Elsevier/Mosby. ISBN 978-0323083751.
  3. ↑ Passy V (1994). "Pathogenesis of peritonsillar abscess". Laryngoscope. 104 (2): 185–90. doi:10.1288/00005537-199402000-00011. PMID 8302122.
  4. ↑ Nwe TT, Singh B (2000). "Management of pain in peritonsillar abscess". J Laryngol Otol. 114 (10): 765–7. PMID 11127146.
  5. ↑ Putto A (1987). "Febrile exudative tonsillitis: viral or streptococcal?". Pediatrics. 80 (1): 6–12. PMID 3601520.
  6. ↑ Cheng J, Elden L (2013). "Children with deep space neck infections: our experience with 178 children". Otolaryngol Head Neck Surg. 148 (6): 1037–42. doi:10.1177/0194599813482292. PMID 23520072.
  7. ↑ Abdel-Haq N, Quezada M, Asmar BI (2012). "Retropharyngeal abscess in children: the rising incidence of methicillin-resistant Staphylococcus aureus". Pediatr Infect Dis J. 31 (7): 696–9. doi:10.1097/INF.0b013e318256fff0. PMID 22481424.
  8. ↑ Inman JC, Rowe M, Ghostine M, Fleck T (2008). "Pediatric neck abscesses: changing organisms and empiric therapies". Laryngoscope. 118 (12): 2111–4. doi:10.1097/MLG.0b013e318182a4fb. PMID 18948832.
  9. ↑ Brook I (2004). "Microbiology and management of peritonsillar, retropharyngeal, and parapharyngeal abscesses". J Oral Maxillofac Surg. 62 (12): 1545–50. PMID 15573356.
  10. ↑ Wright CT, Stocks RM, Armstrong DL, Arnold SR, Gould HJ (2008). "Pediatric mediastinitis as a complication of methicillin-resistant Staphylococcus aureus retropharyngeal abscess". Arch Otolaryngol Head Neck Surg. 134 (4): 408–13. doi:10.1001/archotol.134.4.408. PMID 18427007.
  11. ↑ Asmar BI (1990). "Bacteriology of retropharyngeal abscess in children". Pediatr Infect Dis J. 9 (8): 595–7. PMID 2235179.
  12. ↑ Johnson D (2009). "Croup". BMJ Clin Evid. 2009. PMC 2907784. PMID 19445760.
  13. ↑ 13.0 13.1 Cherry, James D. (2008). "Croup". New England Journal of Medicine. 358 (4): 384–391. doi:10.1056/NEJMcp072022. ISSN 0028-4793.
  14. ↑ Johnson D (2009). "Croup". BMJ Clin Evid. 2009. PMC 2907784. PMID 19445760.
  15. ↑ Tonsillitis. Medline Plus. https://www.nlm.nih.gov/medlineplus/ency/article/001043.htm. Accessed May 2nd, 2016.
  16. ↑ "Tonsillitis - NHS Choices".
  17. ↑ Stelter K (2014). "Tonsillitis and sore throat in children". GMS Curr Top Otorhinolaryngol Head Neck Surg. 13: Doc07. doi:10.3205/cto000110. PMC 4273168. PMID 25587367.
  18. ↑ "Tonsillitis - Symptoms - NHS Choices".
  19. ↑ Tong MC, Chu MC, Leighton SE, van Hasselt CA (1996). "Adult croup". Chest. 109 (6): 1659–62. PMID 8769531.
  20. ↑ Lichtor JL, Roche Rodriguez M, Aaronson NL, Spock T, Goodman TR, Baum ED (2016). "Epiglottitis: It Hasn't Gone Away". Anesthesiology. 124 (6): 1404–7. doi:10.1097/ALN.0000000000001125. PMID 27031010.
  21. ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
  22. ↑ Sharav, Yair; Benoliel, Rafael (2008). Orofacial Pain and Headache. Elsevier. ISBN 0723434123.
  23. ↑ Craig FW, Schunk JE (2003). "Retropharyngeal abscess in children: clinical presentation, utility of imaging, and current management". Pediatrics. 111 (6 Pt 1): 1394–8. PMID 12777558.
  24. ↑ Coulthard M, Isaacs D (1991). "Neonatal retropharyngeal abscess". Pediatr Infect Dis J. 10 (7): 547–9. PMID 1876473.
  25. ↑ Kawabata M, Umakoshi M, Makise T, Miyashita K, Harada M, Nagano H; et al. (2016). "Clinical classification of peritonsillar abscess based on CT and indications for immediate abscess tonsillectomy". Auris Nasus Larynx. 43 (2): 182–6. doi:10.1016/j.anl.2015.09.014. PMID 26527518.
  26. ↑ Nogan S, Jandali D, Cipolla M, DeSilva B (2015). "The use of ultrasound imaging in evaluation of peritonsillar infections". Laryngoscope. 125 (11): 2604–7. doi:10.1002/lary.25313. PMID 25946659.
  27. ↑ Fordham MT, Rock AN, Bandarkar A, Preciado D, Levy M, Cohen J; et al. (2015). "Transcervical ultrasonography in the diagnosis of pediatric peritonsillar abscess". Laryngoscope. 125 (12): 2799–804. doi:10.1002/lary.25354. PMID 25945805.
  28. ↑ Philpott CM, Selvadurai D, Banerjee AR (2004). "Paediatric retropharyngeal abscess". J Laryngol Otol. 118 (12): 919–26. PMID 15667676.
  29. ↑ Vural C, Gungor A, Comerci S (2003). "Accuracy of computerized tomography in deep neck infections in the pediatric population". Am J Otolaryngol. 24 (3): 143–8. PMID 12761699.
  30. ↑ Nickas BJ (2005). "A 60-year-old man with stridor, drooling, and "tripoding" following a nasal polypectomy". J Emerg Nurs. 31 (3): 234–5, quiz 321. doi:10.1016/j.jen.2004.10.015. PMID 15983574.
  31. ↑ Wick F, Ballmer PE, Haller A (2002). "Acute epiglottis in adults". Swiss Med Wkly. 132 (37–38): 541–7. PMID 12557859.
  32. ↑ OHASHI Y (1960). "On a rare disease due to Alternaria tenuis Nees (alternariasis)". Tohoku J Exp Med. 72: 78–82. PMID 13730495.
  33. ↑ Shinde RS, Mantur BG, Patil G, Parande MV, Parande AM (2008). "Meningitis due to Rhodotorula glutinis in an HIV infected patient". Indian J Med Microbiol. 26 (4): 375–7. PMID 18974495.
  34. ↑ Fincher RM, Fisher JF, Lovell RD, Newman CL, Espinel-Ingroff A, Shadomy HJ (1991). "Infection due to the fungus Acremonium (cephalosporium)". Medicine (Baltimore). 70 (6): 398–409. PMID 1956281.
  35. ↑ Fuste FJ, Ajello L, Threlkeld R, Henry JE (1973). "Drechslera hawaiiensis: causative agent of a fatal fungal meningo-encephalitis". Sabouraudia. 11 (1): 59–63. PMID 4739938.
  36. ↑ Rosales CM, Jackson MA, Zwick D (2004). "Malassezia furfur meningitis associated with total parenteral nutrition subdural effusion". Pediatr Dev Pathol. 7 (1): 86–90. doi:10.1007/s10024-003-4030-5. PMID 15255040.
  37. ↑ Symoens F, Knoop C, Schrooyen M, Denis O, Estenne M, Nolard N; et al. (2006). "Disseminated Scedosporium apiospermum infection in a cystic fibrosis patient after double-lung transplantation". J Heart Lung Transplant. 25 (5): 603–7. doi:10.1016/j.healun.2005.12.011. PMID 16678041.
  38. ↑ Chin-Hong PV, Sutton DA, Roemer M, Jacobson MA, Aberg JA (2001). "Invasive fungal sinusitis and meningitis due to Arthrographis kalrae in a patient with AIDS". J Clin Microbiol. 39 (2): 804–7. doi:10.1128/JCM.39.2.804-807.2001. PMC 87827. PMID 11158158.
  39. ↑ Zheng H, Chen Q, Xie Z, Wang D, Li M, Zhang X; et al. (2016). "A retrospective research of HIV-negative cryptococcal meningoencephalitis patients with acute/subacute onset". Eur J Clin Microbiol Infect Dis. 35 (2): 299–303. doi:10.1007/s10096-015-2545-0. PMID 26792138.
  40. ↑ Mavroudis C, Ganzel BL, Cox SK, Polk HC (1987). "Experimental aerobic-anaerobic thoracic empyema in the guinea pig". Ann Thorac Surg. 43 (3): 298–302. PMID 3548615.
  41. ↑ Perez VP, Caierão J, Fischer GB, Dias CA, d'Azevedo PA (2016). "Pleural effusion with negative culture: a challenge for pneumococcal diagnosis in children". Diagn Microbiol Infect Dis. 86 (2): 200–4. doi:10.1016/j.diagmicrobio.2016.07.022. PMID 27527890.
  42. ↑ Atay S, Banki F, Floyd C (2016). "Empyema necessitans caused by actinomycosis: A case report". Int J Surg Case Rep. 23: 182–5. doi:10.1016/j.ijscr.2016.04.005. PMC 5022073. PMID 27180228.
  43. ↑ Gomes MM, Alves M, Correia JB, Santos L (2013). "Empyema necessitans: very late complication of pulmonary tuberculosis". BMJ Case Rep. 2013. doi:10.1136/bcr-2013-202072. PMC 3863066. PMID 24326441.
  44. ↑ Kuan YC, How SH, Yeen WC, Ng TH, Fauzi AR (2011). "Empyema thoracis complicated by pneumothorax necessitans manifesting as lobulated, localized subcutaneous emphysematous swellings". Ann Thorac Surg. 91 (6): 1969–71. doi:10.1016/j.athoracsur.2010.11.075. PMID 21619994.
  45. ↑ Moffett BK, Panchabhai TS, Nakamatsu R, Arnold FW, Peyrani P, Wiemken T; et al. (2016). "Comparing posteroanterior with lateral and anteroposterior chest radiography in the initial detection of parapneumonic effusions". Am J Emerg Med. 34 (12): 2402–2407. doi:10.1016/j.ajem.2016.09.021. PMID 27793503.
  46. ↑ Lin FC, Chou CW, Chang SC (2004). "Differentiating pyopneumothorax and peripheral lung abscess: chest ultrasonography". Am J Med Sci. 327 (6): 330–5. PMID 15201646.
  47. ↑ Lin FC, Chou CW, Chang SC (2004). "Differentiating pyopneumothorax and peripheral lung abscess: chest ultrasonography". Am J Med Sci. 327 (6): 330–5. PMID 15201646.
  48. ↑ Invalid <ref> tag; no text was provided for refs named pmid21345104
  49. ↑ Dickman E, Terentiev V, Likourezos A, Derman A, Haines L (2015). "Extension of the Thoracic Spine Sign: A New Sonographic Marker of Pleural Effusion". J Ultrasound Med. 34 (9): 1555–61. doi:10.7863/ultra.15.14.06013. PMID 26269297.
  50. ↑ Almeida FA, Eiger G (2008). "Subpulmonic effusion". Intern Med J. 38 (3): 216–7. doi:10.1111/j.1445-5994.2007.01619.x. PMID 18290818.
  51. ↑ Connell DG, Crothers G, Cooperberg PL (1982). "The subpulmonic pleural effusion: sonographic aspects". J Can Assoc Radiol. 33 (2): 101–3. PMID 7107669.
  52. ↑ Halvorsen RA, Thompson WM (1986). "Ascites or pleural effusion? CT and ultrasound differentiation". Crit Rev Diagn Imaging. 26 (3): 201–40. PMID 3536306.
  53. ↑ Mroz RM, Korniluk M, Swidzinska E, Dzieciol J, Czaban J, Panek B; et al. (2010). "Lung mass in a 28-year-old male: a case report of a rare tumor". Eur J Med Res. 15 Suppl 2: 95–7. PMC 4360372. PMID 21147631.
  54. ↑ Torun E, Fidan A, Cağlayan B, Salepçi T, Mayadağli A, Salepçi B (2008). "[Prognostic factors in small cell lung cancer]". Tuberk Toraks. 56 (1): 22–9. PMID 18330751.
  55. ↑ Filon E, Kodur E, Cygan M (1989). "[Ultrasonographic examination of the adrenal glands for detection of lung cancer metastasis]". Nowotwory. 39 (3–4): 157–61. PMID 2700089.
  56. ↑ Baber CE, Hedlund LW, Oddson TA, Putman CE (1980). "Differentiating empyemas and peripheral pulmonary abscesses: the value of computed tomography". Radiology. 135 (3): 755–8. doi:10.1148/radiology.135.3.7384467. PMID 7384467.
  57. ↑ Stark DD, Federle MP, Goodman PC, Podrasky AE, Webb WR (1983). "Differentiating lung abscess and empyema: radiography and computed tomography". AJR Am J Roentgenol. 141 (1): 163–7. doi:10.2214/ajr.141.1.163. PMID 6602513.
  58. ↑ Kraus GJ (2007). "The split pleura sign". Radiology. 243 (1): 297–8. doi:10.1148/radiol.2431041658. PMID 17392263.
  59. ↑ Baber CE, Hedlund LW, Oddson TA, Putman CE (1980). "Differentiating empyemas and peripheral pulmonary abscesses: the value of computed tomography". Radiology. 135 (3): 755–8. doi:10.1148/radiology.135.3.7384467. PMID 7384467.
  60. ↑ Corcoran JP, Acton L, Ahmed A, Hallifax RJ, Psallidas I, Wrightson JM; et al. (2016). "Diagnostic value of radiological imaging pre- and post-drainage of pleural effusions". Respirology. 21 (2): 392–5. doi:10.1111/resp.12675. PMID 26545413.
  61. ↑ Federle MP, Mark AS, Guillaumin ES (1986). "CT of subpulmonic pleural effusions and atelectasis: criteria for differentiation from subphrenic fluid". AJR Am J Roentgenol. 146 (4): 685–9. doi:10.2214/ajr.146.4.685. PMID 3485341.
  62. ↑ Halvorsen RA, Thompson WM (1986). "Ascites or pleural effusion? CT and ultrasound differentiation". Crit Rev Diagn Imaging. 26 (3): 201–40. PMID 3536306.
  63. ↑ Wolverson MK, Crepps LF, Sundaram M, Heiberg E, Vas WG, Shields JB (1983). "Hyperdensity of recent hemorrhage at body computed tomography: incidence and morphologic variation". Radiology. 148 (3): 779–84. doi:10.1148/radiology.148.3.6878700. PMID 6878700.
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