Cases of human dirofilariasis have been reported in several countries around the world, including a large number in the Atlantic and Gulf Coast regions of the United States. Most commonly, these cases have subcutaneous or pulmonary involvement; however, there have been few reports of dirofilariasis involving structures such as large vessels, mesentery, the spermatic cord, and liver. We present a case of an unusual presentation of human dirofilariasis presenting as a shoulder abscess and what is presumed to be pulmonary and splenic involvement in a 55-year-old female.
Pulmonary fibrosis has been reported to occur in 25-90% of patients with systemic scleroderma with a lower prevalence of 12-39% in limited scleroderma. The cause of this fibrosis is presumed to be post-inflammatory. However, because of the presence of esophageal dysmotility in scleroderma, there is a possibility of aspiration resulting in fibrosis. If this were the case, the worse the esophageal dilatation, the more extensive would be the fibrosis. The objective of our study was to determine if there is a correlation between esophageal dilatation (measured by the esophageal diameter and extent of pulmonary fibrosis (estimated by fibrosis score from high resolution CT [HRCT] of chest) in patients with scleroderma. METHODS: The records of 74 patients with scleroderma followed at our institution were reviewed. Patient demographics and type of scleroderma (systemic vs. limited) were noted. Esophageal diameter was determined from HRCT by averaging measurements at 3 levels-at the middle of the aortic arch, 2 cm below the carina and just above the diaphragm. Studied variables were expressed as mean AE SD. Patients' chest HRCT scans were graded by a radiologist for ILD by a fibrosis score, calculated by estimating the percentage of parenchymal involvement in three zones (upper, middle, lower) of each lung, with a score of 100 representing normal and a score of 400 representing severe fibrosis. Pearson's correlation test was used to determine the association between esophageal diameter and fibrosis score. p< 0.05 was deemed statistically significant. RESULTS: Mean age was 57.5 AE 12.7 years; 66% were females; majority of the studied patients (76%) had limited disease. Mean esophageal diameter was 13.9 AE 4.4 mm. Mean fibrosis score was: 109 AE 27mm. Using Pearson's test for linear correlation, there was no significant correlation between esophageal diameter and fibrosis score (r ¼ 0.052; p ¼ 0.7) in the studied patients. CONCLUSIONS: There is no significant correlation between esophageal diameter and extent of pulmonary fibrosis in limited scleroderma.
PURPOSE: Pulmonary hypertension (PH) is reported to occur predominantly in patients with limited scleroderma while esophageal dysmotility is more common in diffuse scleroderma. The relation between mean pulmonary artery pressure (mPAP) and esophageal dilatation in scleroderma-associated pulmonary hypertension (Scl-PH) has not been studied. The objective of the study was to determine the relation between esophageal diameter with mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance (PVR) respectively in Scl-PAH patients. METHODS: We reviewed the records of 26 patients with Scl-PAH followed at the PH center at our institution. Patient demographics, mPAPA and PVR were noted. Esophageal diameter was determined from CT imaging by averaging measurements at 3 levels-at the middle of the aortic arch, 2cm below the carina and just above the diaphragm. Studied variables were expressed as mean + SD. Pearson's test for linear correlation was used to determine the association between mPAP and PVR respectively with esophageal diameter in Scl-PAH patients. p< 0.05 was deemed statistically significant. RESULTS: Mean age was 67+ 15 years; 77% were females; 70% had limited disease. Mean PAP was 36.5 + 10 mm Hg; mean PVR was 553 + 360 dynes.sec/cm 5. Mean esophageal diameter was 20.4 + 5.7 mm. There was significant correlation between mean PAP and esophageal diameter (r ¼-0.436; p¼0.05) but no significant correlation between PVR and esophageal diameter (r ¼-0.004; p¼0.09). CONCLUSIONS: There appears to be a significant correlation between esophageal dilatation and mPAP in patients with Scl-PAH. CLINICAL IMPLICATIONS: Esophageal involvement is less common in patients with scleroderma-associated pulmonary hypertension which is likely related to their limited disease.
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