-
JPMA. the Journal of the Pakistan... Jan 2019Lymphoblastic lymphomas account for 20-30% of all non-Hodgkin lymphomas (NHL) in children, and most cases of childhood lymphoblastic lymphoma are T-cell type (T-LL)....
Lymphoblastic lymphomas account for 20-30% of all non-Hodgkin lymphomas (NHL) in children, and most cases of childhood lymphoblastic lymphoma are T-cell type (T-LL). T-LL occurs most frequently in late childhood and adolescence; with male predominance of 2:1.We present a paediatric case with a right sided mediastinal mass causing mediastinal shift diagnosed as T-LL.
Topics: Antineoplastic Agents; Child; Compartment Syndromes; Humans; Lymphoma, T-Cell; Male; Mediastinal Neoplasms; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Radiography, Thoracic; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 30623931
DOI: No ID Found -
SAGE Open Medical Case Reports 2024We hereby present a 70-year-old male Ethiopian farmer who presented with clinical manifestations suggestive of acute large bowel obstruction, which had persisted for 3...
We hereby present a 70-year-old male Ethiopian farmer who presented with clinical manifestations suggestive of acute large bowel obstruction, which had persisted for 3 days. Over the past 3 years, he has experienced three similar recurring episodes, which were alleviated by decompression using a rectal tube. Upon initial examination, the patient displayed signs of cardiopulmonary distress, although no indications of peritonitis were observed. Further evaluation through plain abdominal and chest X-rays revealed findings consistent with sigmoid volvulus, as well as mediastinal shift, elevated diaphragm, and a right-positioned heart. Consequently, a sigmoid resection and an end colostomy were done. The patient showed improvement and was discharged from the hospital on the 14th day following the surgery. It is atypical for an individual to present with acute sigmoid volvulus accompanied by a mediastinal shift resulting from mass action on the hemidiaphragm. Therefore, it may be imperative to involve a pulmonologist in managing this rare situation. By ensuring that the surgical team is well-informed in such circumstances, patients can receive enhanced care and treatment.
PubMed: 38606032
DOI: 10.1177/2050313X241246658 -
European Journal of Pediatrics Sep 2022In recent years, magnetic resonance imaging (MRI) has largely increased our knowledge and predictive accuracy of congenital diaphragmatic hernia (CDH) in the fetus.... (Review)
Review
UNLABELLED
In recent years, magnetic resonance imaging (MRI) has largely increased our knowledge and predictive accuracy of congenital diaphragmatic hernia (CDH) in the fetus. Thanks to its technical advantages, better anatomical definition, and superiority in fetal lung volume estimation, fetal MRI has been demonstrated to be superior to 2D and 3D ultrasound alone in CDH diagnosis and outcome prediction. This is of crucial importance for prenatal counseling, risk stratification, and decision-making approach. Furthermore, several quantitative and qualitative parameters can be evaluated simultaneously, which have been associated with survival, postnatal course severity, and long-term morbidity.
CONCLUSION
Fetal MRI will further strengthen its role in the near future, but it is necessary to reach a consensus on indications, methodology, and data interpretation. In addition, it is required data integration from different imaging modalities and clinical courses, especially for predicting postnatal pulmonary hypertension. This would lead to a comprehensive prognostic assessment.
WHAT IS KNOWN
• MRI plays a key role in evaluating the fetal lung in patients with CDH. • Prognostic assessment of CDH is challenging, and advanced imaging is crucial for a complete prenatal assessment and counseling.
WHAT IS NEW
• Fetal MRI has strengthened its role over ultrasound due to its technical advantages, better anatomical definition, superior fetal lung volume estimation, and outcome prediction. • Imaging and clinical data integration is the most desirable strategy and may provide new MRI applications and future research opportunities.
Topics: Female; Fetus; Hernias, Diaphragmatic, Congenital; Humans; Lung; Lung Volume Measurements; Magnetic Resonance Imaging; Pregnancy; Prognosis; Retrospective Studies; Ultrasonography, Prenatal
PubMed: 35794403
DOI: 10.1007/s00431-022-04540-6 -
Cureus Jul 2021On radiographic imaging, the finding of a right-sided heart location can be due to multiple etiologies and may be congenital or acquired. We present the case of a...
On radiographic imaging, the finding of a right-sided heart location can be due to multiple etiologies and may be congenital or acquired. We present the case of a 71-year-old male with a self-reported past medical history of hiatal hernia and previously diagnosed dextrocardia. The patient experienced cardiovascular intervention following an ST-elevation myocardial infarction. In the cardiac workup, a low-voltage normal electrocardiogram confirmed dextroposition of the heart due to significant herniation of gastric contents into the thoracic cavity. This gentleman had presumably been diagnosed with dextrocardia, a right-left reversal of heart anatomy and electrophysiology, based on imaging and incomplete workup. Dextroposition refers to a rightward shift of the mediastinum with no changes in orientation of cardiac anatomy, and therefore unchanged directional orientation of conduction. This is an important distinction from dextrocardia, a mirror-image reversal of the cardiac chambers and heart location in the chest wall, such as that due to congenital ciliary dysfunction. A sliding hernia is an uncommon cause of the rightward mediastinal shift, with few such cases documented in the literature, and cardiovascular manifestations of hiatal hernias are discussed. This case exemplifies the role of an electrocardiogram in distinguishing between dextrocardia and dextroposition for accurate diagnosis and management.
PubMed: 34306902
DOI: 10.7759/cureus.16521 -
BMJ Case Reports May 2024Postpneumonectomy changes, including ipsilateral diaphragmatic elevation and rib crowding, mediastinal shifting of the heart and reduction of respiratory functional...
Postpneumonectomy changes, including ipsilateral diaphragmatic elevation and rib crowding, mediastinal shifting of the heart and reduction of respiratory functional reserve by 45%-55%, make cardiac surgery challenging in terms of access to the heart and great vessels. There is a paucity of literature on coronary artery bypass graft (CABG) surgery in patients with a history of pneumonectomy. We report a case of a male in his 70s with a history of left pneumonectomy who underwent a successful on-pump CABG surgery using the left internal mammary artery graft and great saphenous vein graft. The patient was extubated postoperatively and discharged in a stable condition. With no consensus available for optimal preoperative, intraoperative and postoperative management for these high-risk patients, our case report adds to the rare literature regarding successful on-pump CABG after pneumonectomy.
Topics: Humans; Male; Pneumonectomy; Coronary Artery Bypass; Aged; Mammary Arteries; Lung Neoplasms; Treatment Outcome
PubMed: 38802260
DOI: 10.1136/bcr-2024-260815 -
Collegium Antropologicum Dec 2014The incarceration of diaphragmatic hernia is very rare. We present a case of a four-year-old girl who developed the incarceration of left-sided diaphragmatic hernia,...
The incarceration of diaphragmatic hernia is very rare. We present a case of a four-year-old girl who developed the incarceration of left-sided diaphragmatic hernia, who, until then, was completely asymptomatic. This incarceration of the hernia represented a surgical emergency presenting as obstructive ileus and a severe respiratory distress which developed from what appeared to be full health. During a brief pre-operative examination a number of differential diagnoses were suggested. Along with the laboratory blood analysis (complete blood count and acid-base balance) a plain thoracic and abdominal radiography was done (babygram). After that, through an inserted nasal-gastric tube, barium meal of the upper gastrointestinal tract was done, showing abdominal organs in the left half of the thorax and a significant shift of the mediastinum to the right. With an urgent upper medial laparotomy we accessed the abdominal cavity and made the correct diagnosis. An opening was shown in the rear part of the left hemi-diaphragm with thickened and edematous edges, approx. 6 cm in diameter with incarcerated content. The incarcerated abdominal organs (stomach, transversal colon, small intestine and spleen) gradually moved into the abdominal cavity. The opening was closed with nonresorptive sutures (TiCron) size 2-0 with aprevious control and ventilated expansion of the well-developed left lung. In postoperative course the acid-base balance quickly recovered, as well as the general state of the patient and radiography showed a good expansion and lucency of the lung parenchyma and a return of the mediastinum into the middle part of the thorax.
Topics: Child, Preschool; Diagnosis, Differential; Female; Hernia, Diaphragmatic; Humans; Radiography
PubMed: 25842758
DOI: No ID Found -
Journal of Radiology Case Reports Aug 2021Tension gastrothorax is a rare, life-threatening clinical condition caused by intrathoracic herniation of the stomach through a diaphragmatic defect which becomes... (Review)
Review
Tension gastrothorax is a rare, life-threatening clinical condition caused by intrathoracic herniation of the stomach through a diaphragmatic defect which becomes increasingly distended over time. If not recognized promptly, this can rapidly progress to respiratory distress, mediastinal shift, and hemodynamic compromise. Initial clinical presentation and imaging findings closely mirror those of tension pneumothorax, confounding diagnosis and potentially leading to unnecessary interventions with increased risk of morbidity and mortality. Here, we present a case of an elderly female who presented with a non-traumatic tension gastrothorax and a review of key imaging features and strategies to aid in recognition and accurate diagnosis of this emergent clinical entity.
Topics: Aged; Dyspnea; Female; Hernias, Diaphragmatic, Congenital; Humans; Pneumothorax; Stomach
PubMed: 35586797
DOI: 10.3941/jrcr.v15i8.4144 -
JTCVS Techniques Dec 2023Branch-first total aortic arch repair is a paradigm shift in the technical approach for uninterrupted neuroprotection during open aortic surgery. This technique is...
BACKGROUND
Branch-first total aortic arch repair is a paradigm shift in the technical approach for uninterrupted neuroprotection during open aortic surgery. This technique is further modified to instigate hazardous sternal reentry in patients with hostile mediastinal anatomy at risk of aortic injury.
METHODS
Intraoperative preparation and the illustrated operative technique of the cervical branch-first technique are described. The accompanying case series narrates the experiences and outcomes of 4 patients who underwent successful complex reoperative aortic surgery utilizing this technique.
RESULTS
The indications for resternotomy included a sixth reoperation for recurrent mycotic aortic pseudoaneurysm, a third reoperation for extensive infective endocarditis, a reoperation for complete Bentall graft dehiscence with contained aortic rupture, and a third reoperation for residual type A dissection. All patients survived their proposed surgery. Two patients were operated on in an emergency setting. Two patients separated from cardiopulmonary bypass with extracorporeal support. None experienced permanent neurological sequelae, gut ischemia, peripheral arterial complications, or in-hospital mortality. One mortality due to decompensated heart failure was reported at 6 months postoperatively.
CONCLUSIONS
The cervical branch-first technique offers unparalleled advantage in neuroprotection from an early stage of complex reoperative aortic surgery. It provides an independent circuit for complete antegrade cerebral perfusion, irrespective of suspension to circulatory flows to the rest of the body during complex reentry into hostile chests. Our experience to date has demonstrated promising outcomes and further refinements will guide patient selection best suited for this technique.
PubMed: 38152225
DOI: 10.1016/j.xjtc.2023.08.030 -
Virology Journal Nov 2018Porcine circovirus type 2 (PCV2), a highly prevalent, economically important swine pathogen is classified into different genotypes (PCV2a-f) based on phylogenetic...
Porcine circovirus type 2 (PCV2), a highly prevalent, economically important swine pathogen is classified into different genotypes (PCV2a-f) based on phylogenetic analysis. Since the introduction of extensive vaccination programs, at least two major shifts have been observed in the prevalence of PCV2 genotypes. The first genotype shift from 2a towards 2b occurred around 2003, while in recent years, we are witnessing the second change in genotype prevalence from the predominant 2b towards 2d.In this study, a PCV2d-2 isolate was characterized as a potential challenge virus for the evaluation of PCV2 vaccine efficacy. Ten-week-old pigs carrying low to moderate levels of maternally derived antibodies to PCV2 were infected with the isolate by the nasal route. Over the next 4 weeks post-infection, the pigs were monitored for the presence of viremia, fecal virus excretion, and humoral immune responses. At the end of the post-infection observation period, samples were taken from the mediastinal and mesenteric lymph nodes of the animals and tested for viral load. The gradual depletion of maternally derived antibodies in the sera of piglets was demonstrated by ELISA and virus neutralization tests. Following experimental infection by PCV2d-2, specific IgM antibodies were first detected at 14 days post challenge (dpch), while IgG class antibodies were first detected at 21 dpch. Both viremia and virus shedding could be detected at 7 dpch, in 36 and 50% of the pigs, respectively. The proportion of shedders reached 100% by 14 dpch and remained at this level, while viremia was demonstrated in 86, 100, and 100% of the pigs at 14, 21, and 28 dpch, respectively. Both the mediastinal and mesenteric lymph nodes contained high levels of virus (7.6 and 8.5 log copies/mg tissue, respectively).
Topics: Animals; Antibodies, Viral; Circoviridae Infections; Circovirus; Female; Immunoglobulin G; Immunoglobulin M; Lymph Nodes; Male; Phylogeny; Swine; Swine Diseases; Vaccination; Viral Load; Viral Vaccines; Viremia; Virus Shedding
PubMed: 30482219
DOI: 10.1186/s12985-018-1098-0 -
Journal of Thoracic Imaging Jul 2016Lung cancer remains the leading cause of cancer-related mortality in the United States, and accurate staging of disease plays an important role in the formulation of... (Review)
Review
Lung cancer remains the leading cause of cancer-related mortality in the United States, and accurate staging of disease plays an important role in the formulation of treatment strategies and optimization of patient outcomes. The International Association for the Study of Lung Cancer has recently proposed changes to the upcoming eighth edition of the tumor, node, and metastasis (TNM-8) staging system used for lung cancer. This revised classification is based on significant differences in patient survival identified on analysis of a new large international database of lung cancer cases. Key changes include: further modifications to the T descriptors based on 1 cm increments in tumor size; grouping of tumors resulting in partial or complete lung atelectasis/pneumonitis; grouping of tumors involving a main bronchus with respect to distance from the carina; reassignment of diaphragmatic invasion; elimination of mediastinal pleural invasion as a descriptor; and further subdivision of metastatic disease into distinct descriptors based on the number of extrathoracic metastases and involved organs. Because of these changes, several new stage groups have been developed, and others have shifted. Although TNM-8 represents continued improvement upon modifications previously made to the staging system, reflecting an evolving understanding of tumor behavior and patient management, several limitations and unaddressed issues persist. Understanding the proposed revisions to TNM-8 and awareness of key limitations and potential controversial issues still unaddressed will allow radiologists to accurately stage patients with lung cancer and optimize treatment decisions.
Topics: Humans; Lung; Lung Neoplasms; Neoplasm Staging; Positron-Emission Tomography; Tomography, X-Ray Computed
PubMed: 27306388
DOI: 10.1097/RTI.0000000000000213