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Interactive Cardiovascular and Thoracic... Jun 2022Isolated Chylopericardium (without chylothorax) is a rare clinical disorder that may happen idiopathically or secondary to trauma, radiotherapy, lymphatic anomalies,...
Isolated Chylopericardium (without chylothorax) is a rare clinical disorder that may happen idiopathically or secondary to trauma, radiotherapy, lymphatic anomalies, infections or mediastinal neoplasm. We present a case of middle-aged male with no past medical history of note prior to developing heavy sweating, loss of weight and cough. A series of investigations were done including chest computed tomography which showed enlarged mediastinal lymph nodes leading to uncomplicated mediastinoscopy and lymph node biopsy. Six days after being discharged, he developed dyspnoea and chest pain. Echocardiography revealed massive pericardial effusion. Pericardiocentesis was done and surprisingly revealed milky white chylous fluid. The patient was then successfully managed without the need for further intervention.
Topics: Chylothorax; Humans; Lymph Nodes; Male; Mediastinum; Middle Aged; Pericardial Effusion; Pericardiocentesis
PubMed: 34964452
DOI: 10.1093/icvts/ivab365 -
Journal of Clinical Oncology : Official... Aug 2023Journal of Clinical Oncology, Accurate staging of the mediastinal lymph nodes in resectable non-small-cell lung cancer (NSCLC) is critically important to determine the... (Review)
Review
Journal of Clinical Oncology, Accurate staging of the mediastinal lymph nodes in resectable non-small-cell lung cancer (NSCLC) is critically important to determine the overall stage of the tumor and guide subsequent management. The staging process typically begins with positron emission tomography (PET) or computed tomography imaging; however, imaging alone is inadequate, and tissue acquisition is required for confirmation of nodal disease. Mediastinoscopy was long considered the gold standard for staging of mediastinal lymph nodes, but, recently, endobronchial ultrasound-guided (EBUS) fine-needle aspiration (FNA) has become the standard of care. EBUS-FNA, in combination with supplementary technologies, such as intranodal forceps biopsy and esophageal ultrasonography, has a high sensitivity and specificity for the diagnosis of nodal metastases. EBUS-FNA is also capable of assessing N1 disease and obtaining adequate tissue for tumor genomic analysis to help guide treatment. In the case of negative findings on EBUS, a confirmatory video mediastinoscopy is still recommended by the European Society of Thoracic Surgeons guidelines. However, whether confirmatory mediastinoscopy is necessary is a matter of debate, and it is not commonly performed in North America. To address this question, Bousema and colleagues performed a randomized noninferiority trial to determine rates of unforeseen nodal metastases after EBUS alone versus EBUS with confirmatory mediastinoscopy in patients with resectable NSCLC. The authors concluded that EBUS alone is noninferior to EBUS with confirmatory mediastinoscopy. These findings affirm our current practice to forgo confirmatory mediastinoscopy after negative findings on EBUS.
Topics: Humans; Carcinoma, Non-Small-Cell Lung; Mediastinoscopy; Lung Neoplasms; Neoplasm Staging; Mediastinum; Endosonography; Lymph Nodes
PubMed: 37267507
DOI: 10.1200/JCO.23.00867 -
Turk Gogus Kalp Damar Cerrahisi Dergisi Jan 2024Mediastinal tumors are the most common thoracic tumor in the pediatric population. They include a spectrum of tumors, and most are malignant. These lesions can be... (Review)
Review
Mediastinal tumors are the most common thoracic tumor in the pediatric population. They include a spectrum of tumors, and most are malignant. These lesions can be anatomically and radiologically classified by means of compartments; anterior, middle, and posterior. Symptoms, signs, localization of the tumor, age of the child, and tumor markers are key points of diagnosis. Surgical approaches are typically needed for diagnosis, but sometimes tru-cut needle biopsies may be sufficient. Mediastinoscopy, mediastinotomy, and video-assisted thoracoscopic surgery may be used in the diagnostic workup of mediastinal tumors in children as they are used in adults. Frequently, diagnosis and treatment are both established by means of surgery. Surgery remains the mainstay of treatment of most benign and malignant nonlymphoid tumors. Combined modality of treatment incorporating chemotherapy and radiotherapy is often required in malignant tumors and is associated with high survival rates in these patients.
PubMed: 38584788
DOI: 10.5606/tgkdc.dergisi.2024.25799 -
Abdominal Radiology (New York) Aug 2022Percutaneous image-guided biopsy is an invaluable technique in the management of a myriad of different conditions; however, percutaneous access to some targets remains... (Review)
Review
Percutaneous image-guided biopsy is an invaluable technique in the management of a myriad of different conditions; however, percutaneous access to some targets remains challenging. Trans-osseous biopsy provides safe, high-yield access to many challenging lesions in the chest, abdomen, and pelvis which might otherwise require more invasive procedures, such as mediastinoscopy or surgery to establish a histological diagnosis. Additionally, trans-osseous biopsy is well tolerated and may reduce the risk of injury to intervening vital structures as compared to other percutaneous techniques. In this article we review the indications, technical challenges, alternative techniques, and potential complications of trans-sternal, trans-costal, trans-scapular, trans-vertebral, trans-iliac, and trans-sacral biopsies.
Topics: Abdomen; Humans; Image-Guided Biopsy; Pelvis; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 34132879
DOI: 10.1007/s00261-021-03167-9 -
Journal of Clinical Oncology : Official... Aug 2023Resectable non-small-cell lung cancer (NSCLC) with a high probability of mediastinal nodal involvement requires mediastinal staging by endosonography and, in the absence... (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
Resectable non-small-cell lung cancer (NSCLC) with a high probability of mediastinal nodal involvement requires mediastinal staging by endosonography and, in the absence of nodal metastases, confirmatory mediastinoscopy according to current guidelines. However, randomized data regarding immediate lung tumor resection after systematic endosonography versus additional confirmatory mediastinoscopy before resection are lacking.
METHODS
Patients with (suspected) resectable NSCLC and an indication for mediastinal staging after negative systematic endosonography were randomly assigned to immediate lung tumor resection or confirmatory mediastinoscopy followed by tumor resection. The primary outcome in this noninferiority trial (noninferiority margin of 8% that previously showed to not compromise survival, < .0250) was the presence of unforeseen N2 disease after tumor resection with lymph node dissection. Secondary outcomes were 30-day major morbidity and mortality.
RESULTS
Between July 17, 2017, and October 5, 2020, 360 patients were randomly assigned, 178 to immediate lung tumor resection (seven dropouts) and 182 to confirmatory mediastinoscopy first (seven dropouts before and six after mediastinoscopy). Mediastinoscopy detected metastases in 8.0% (14/175; 95% CI, 4.8 to 13.0) of patients. Unforeseen N2 rate after immediate resection (8.8%) was noninferior compared with mediastinoscopy first (7.7%) in both intention-to-treat (Δ, 1.03%; UL 95% CIΔ, 7.2%; = .0144) and per-protocol analyses (Δ, 0.83%; UL 95% CIΔ, 7.3%; = .0157). Major morbidity and 30-day mortality was 12.9% after immediate resection versus 15.4% after mediastinoscopy first ( = .4940).
CONCLUSION
On the basis of our chosen noninferiority margin in the rate of unforeseen N2, confirmatory mediastinoscopy after negative systematic endosonography can be omitted in patients with resectable NSCLC and an indication for mediastinal staging.
Topics: Humans; Lung Neoplasms; Carcinoma, Non-Small-Cell Lung; Mediastinoscopy; Endosonography; Neoplasm Staging; Lymph Nodes
PubMed: 37018653
DOI: 10.1200/JCO.22.01728 -
Polish Archives of Internal Medicine Aug 2021Tuberculosis is frequently omitted in the diagnostic workup and may be identified accidentally following thoracic surgeries, mostly those targeting lung cancer.
INTRODUCTION
Tuberculosis is frequently omitted in the diagnostic workup and may be identified accidentally following thoracic surgeries, mostly those targeting lung cancer.
OBJECTIVES
This study aimed to assess the clinical characteristics of patients who underwent thoracic surgery that resulted in the diagnosis of tuberculosis and to review lesions initially found on chest imaging in the context of the potential presence of tuberculosis.
PATIENTS AND METHODS
We analyzed medical records of all patients hospitalized at the Department of Thoracic Surgery of the National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland, between the years 2014 and 2018 (n = 57) in whom tuberculosis was diagnosed. Two radiologists who knew the diagnosis retrospectively analyzed preprocedural chest computed tomography scans of the study patients.
RESULTS
Tuberculosis was diagnosed by culture of specimens obtained during video‑ assisted thoracoscopy (21 patients), thoracotomy (24 patients), mediastinoscopy (6 patients), transthoracic fine‑ needle biopsy (3 patients), and transbronchial biopsy (1 patient). In the remaining 2 individuals, the diagnosis was established based on the microbiological examination of drained pleural fluid. In 42 patients (73.7%), the diagnosis of tuberculosis was unexpected to thoracic surgeons. Radiological findings suggestive of tuberculosis were present in 38 patients (66.7%). The radiologists who retrospectively analyzed the imaging records suggested tuberculosis in 31 persons (54.3%), whereas those who carried out the initial preprocedural evaluation, in 11 (19.3%).
CONCLUSIONS
The majority of the study patients presented with radiological findings encountered in tuberculosis, which should have led to a less invasive diagnostic workup. This highlights the role of radiologists in the identification of the disease.
Topics: Humans; Lung Neoplasms; Retrospective Studies; Surgeons; Thoracoscopy; Thoracotomy; Tuberculosis
PubMed: 34057343
DOI: 10.20452/pamw.16020 -
The Annals of Thoracic Surgery May 2017Paragangliomas of the mediastinum are rare, with only approximately 150 cases reported in the literature. Surgical excision is the treatment of choice; however, these...
Paragangliomas of the mediastinum are rare, with only approximately 150 cases reported in the literature. Surgical excision is the treatment of choice; however, these tumors often lie near critical vascular structures. Here we present the case of a patient with a mediastinal paraganglioma discovered during a diagnostic procedure.
Topics: Aged; Biopsy; Female; Humans; Mediastinal Neoplasms; Mediastinoscopy; Paraganglioma, Extra-Adrenal; Tomography, X-Ray Computed
PubMed: 28431713
DOI: 10.1016/j.athoracsur.2016.10.031 -
The Journal of Thoracic and... Jun 2018
Topics: Humans; Lung Neoplasms; Mediastinum
PubMed: 29455955
DOI: 10.1016/j.jtcvs.2018.01.039