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The Annals of Thoracic Surgery Dec 2021
Topics: Aged; Calcinosis; Hemorrhage; Humans; Male; Mediastinal Cyst; Mediastinum; Thoracotomy; Tomography, X-Ray Computed
PubMed: 34419439
DOI: 10.1016/j.athoracsur.2021.07.049 -
Frontiers in Immunology 2023CD8 T cells drive anti-cancer immunity in response to antigen-presenting cells such as dendritic cells and subpopulations of monocytes and macrophages. While CD14...
CD8 T cells drive anti-cancer immunity in response to antigen-presenting cells such as dendritic cells and subpopulations of monocytes and macrophages. While CD14 classical monocytes modulate CD8 T cell responses, the contributions of CD16 nonclassical monocytes to this process remain unclear. Herein we explored the role of nonclassical monocytes in CD8 T cell activation by utilizing E2-deficient (E2) mice that lack nonclassical monocytes. During early metastatic seeding, modeled by B16F10-OVA cancer cells injected into E2 mice, we noted lower CD8 effector memory and effector T cell frequencies within the lungs as well as in lung-draining mediastinal lymph nodes in the E2 mice. Analysis of the myeloid compartment revealed that these changes were associated with depletion of MHC-IILy6C nonclassical monocytes within these tissues, with little change in other monocyte or macrophage populations. Additionally, nonclassical monocytes preferentially trafficked to primary tumor sites in the lungs, rather than to the lung-draining lymph nodes, and did not cross-present antigen to CD8 T cells. Examination of the lung microenvironment in E2 mice revealed reduced CCL21 expression in endothelial cells, which is chemokine involved in T cell trafficking. Our results highlight the previously unappreciated importance of nonclassical monocytes in shaping the tumor microenvironment via CCL21 production and CD8 T cell recruitment.
Topics: Mice; Animals; Monocytes; CD8-Positive T-Lymphocytes; Endothelial Cells; Lung; Neoplasms; Tumor Microenvironment
PubMed: 37426658
DOI: 10.3389/fimmu.2023.1101497 -
Korean Journal of Radiology Jan 2023As the majority of incidentally detected lesions in the anterior mediastinum is small nodules with soft tissue appearance, the differential diagnosis has typically... (Review)
Review
As the majority of incidentally detected lesions in the anterior mediastinum is small nodules with soft tissue appearance, the differential diagnosis has typically included thymic neoplasm and prevascular lymph node, with benign cyst. Overestimation or misinterpretation of these lesions can lead to unnecessary surgery for ultimately benign conditions. nonsurgical anterior mediastinal lesions. The pitfalls of MRI evaluation for anterior mediastinal cystic lesions are as follows: first, we acknowledge the limitation of T2-weighted images for evaluating benign cystic lesions. Due to variable contents within benign cystic lesions, such as hemorrhage, T2 signal intensity may be variable. Second, owing to extensive necrosis and cystic changes, the T2 shine-through effect may be seen on diffusion-weighted images (DWI), and small solid portions might be missed on enhanced images. Therefore, both enhancement and DWI with apparent diffusion coefficient values should be considered. An algorithm will be suggested for the diagnostic evaluation of anterior mediastinal cystic lesions, and finally, a management strategy based on MRI features will be suggested.
Topics: Humans; Mediastinum; Magnetic Resonance Imaging; Thymus Neoplasms; Diffusion Magnetic Resonance Imaging; Diagnosis, Differential; Mediastinal Neoplasms
PubMed: 36606621
DOI: 10.3348/kjr.2022.0606 -
Resuscitation Aug 2023Determine the frequency with which computed tomography (CT) after out-of-hospital cardiac arrest (OHCA) identifies clinically important findings.
AIM
Determine the frequency with which computed tomography (CT) after out-of-hospital cardiac arrest (OHCA) identifies clinically important findings.
METHODS
We included non-traumatic OHCA patients treated at a single center from February 2019 to February 2021. Clinical practice was to obtain CT head in comatose patients. Additionally, CT of the cervical spine, chest, abdomen, and pelvis were obtained if clinically indicated. We identified CT imaging obtained within 24 hours of emergency department (ED) arrival and summarized radiology findings. We used descriptive statistics to summarize population characteristics and imaging results, report their frequencies and, post hoc, compared time from ED arrival to catheterization between patients who did and did not undergo CT.
RESULTS
We included 597 subjects, of which 491 (82.2%) had a CT obtained. Time to CT was 4.1 hours [2.8-5.7]. Most (n = 480, 80.4%) underwent CT head, of which 36 (7.5%) had intracranial hemorrhage and 161 (33.5%) had cerebral edema. Fewer subjects (230, 38.5%) underwent a cervical spine CT, and 4 (1.7%) had acute vertebral fractures. Most subjects (410, 68.7%) underwent a chest CT, and abdomen and pelvis CT (363, 60.8%). Chest CT abnormalities included rib or sternal fractures (227, 55.4%), pneumothorax (27, 6.6%), aspiration or pneumonia (309, 75.4%), mediastinal hematoma (18, 4.4%) and pulmonary embolism (6, 3.7%). Significant abdomen and pelvis findings were bowel ischemia (24, 6.6%) and solid organ laceration (7, 1.9%). Most subjects that had CT imaging deferred were awake and had shorter time to catheterization.
CONCLUSIONS
CT identifies clinically important pathology after OHCA.
Topics: Humans; Out-of-Hospital Cardiac Arrest; Tomography, X-Ray Computed; Thoracic Injuries; Intracranial Hemorrhages; Emergency Service, Hospital; Retrospective Studies
PubMed: 37422167
DOI: 10.1016/j.resuscitation.2023.109898 -
Multimedia Manual of Cardiothoracic... May 2023Paragangliomas are tumours originating from the autonomic nervous system and rarely occur in the chest. They may manifest through symptoms of excess catecholamine...
Paragangliomas are tumours originating from the autonomic nervous system and rarely occur in the chest. They may manifest through symptoms of excess catecholamine release or due to local compression, can be an incidental finding on a computed tomography/magnetic resonance imaging examination or can be found when screening patients with specific gene mutations. Surgical removal is indicated in case of symptoms, (imminent) compression of vital structures or to prevent progression to malignancy. Resection of a paraganglioma in the middle mediastinum can be challenging. The relationship of the tumour to vital structures and its blood supply determine the surgical access route. In this case report, a large paraganglioma situated in the middle mediastinum is resected. Because of the close relationship to vital structures and the presence of feeding arteries from the aortic arch, a transsternal transpericardial approach is chosen. After a median sternotomy, stepwise dissection between the aorta, superior caval vein and right pulmonary artery and the opening of the posterior pericardium gives access to the middle mediastinum and the area between the tracheal bifurcation and the left atrial roof. These steps can be done without cardiopulmonary bypass. After identification and division of the feeding aortic arch arteries, the highly vascularized tumour can be further dissected and removed.
Topics: Humans; Vena Cava, Superior; Mediastinal Neoplasms; Paraganglioma; Mediastinum; Aorta, Thoracic
PubMed: 37212249
DOI: 10.1510/mmcts.2023.010 -
Mediastinum (Hong Kong, China) 2023The propensity of thymic cysts to mimic solid thymic epithelial tumors (TETs) on computed tomography (CT), on account of attenuation values greater than water and...
BACKGROUND
The propensity of thymic cysts to mimic solid thymic epithelial tumors (TETs) on computed tomography (CT), on account of attenuation values greater than water and thickened or calcified walls, can lead to non-therapeutic thymectomy. These lesions can fluctuate in volume, CT attenuation, and magnetic resonance imaging (MRI) signal over time. We hypothesized that spontaneous hemorrhage and resorption may contribute to their variable appearance over time.
METHODS
Completely excised thymic cysts were identified retrospectively over a 20-year period by their pathologic diagnosis. Cysts were excluded if they did not have available presurgical imaging, were not prevascular, were located within or contained an enhancing mass by imaging, or were of non-thymic origin upon microscopic review. Histopathological analysis of all available resected thymic cyst material and radiologic analysis of the cysts on pre-operative imaging were performed.
RESULTS
Upon application of exclusion criteria, we identified 18 thymic cysts from the initial 85 mediastinal cystic specimens. Most cysts were unilocular (11/15, 73%), showed turbid-to-semisolid, hemorrhagic fluid (10/12, 83%) and showed histopathological findings suggestive of intralesional microbleeding (14/18, 78%), remodeling (8/18, 44%), pathological wound healing/scarring of the capsule (16/18, 89%), and fat necrosis in the surrounding thymic tissue (12/18, 67%). On CT, 6/17 (35%) cysts demonstrated wall calcification. Sixty-five percent (11/17) had attenuation values ≥20 Hounsfield units (HU). Two of the 4 cysts imaged by MRI were T1-isointense, one was mixed hyper- and isointense, and one T1-hypointense to muscle, with iso- and hyperintensity indicating hemorrhagic or proteinaceous content. Twenty-five percent (1/4) of cyst walls imaged by MRI were T1/T2-hypointense, indicating presence of calcification, hemosiderin, and/or fibrosis.
CONCLUSIONS
Resected thymic cysts in this cohort often showed features suggestive of intralesional microbleeding, inflammation, and fibrosis, which may explain their appearance and behavior over time on CT and MRI.
PubMed: 37261095
DOI: 10.21037/med-22-42 -
Pneumologie (Stuttgart, Germany) Jun 2020An 80-year old female was referred to our hospital with left internal carotid artery stenosis and a childhood history of hemoptysis.
HISTORY
An 80-year old female was referred to our hospital with left internal carotid artery stenosis and a childhood history of hemoptysis.
INVESTIGATIONS AND DIAGNOSIS
The ECG showed 2nd degree Mobitz atrio-ventricular block. The chest x-ray and computerized tomography identified a shift of the mediastinum and the heart to the left. The left lung was completely destroyed whilst the right lung was enlarged and crossed the midline. Pulmonary function tests revealed a moderate restrictive ventilation disorder. The diagnosis of autopneumonectomy was based on patient history together with radiological findings.
TREATMENT AND COURSE
A pacemaker was implanted with two stimulation electrodes via a left cephalic venous cutdown. A carotid endarterectomy was also performed without any complication.
CONCLUSION
After autopneumonectomy, postpneumonectomy like syndrome may occur in very rare cases, whereupon operative treatment is mandatory. Any respiratory infections should be treated with antibiotics. Pacemaker electrode placement via the subclavian vein is contraindicated due to the risk of a catastrophic pneumothorax.
Topics: Aged, 80 and over; Carotid Stenosis; Endarterectomy, Carotid; Female; Hemoptysis; Humans; Lung; Lung Diseases; Pacemaker, Artificial; Pneumonectomy; Respiratory Function Tests; Subclavian Vein; Treatment Outcome; Venous Cutdown
PubMed: 32557508
DOI: 10.1055/a-1148-8770 -
BMJ Case Reports Jun 2022A woman in her 50s presented to the Emergency Department, following massive haematemesis, having swallowed a single tooth denture 3 years previously. Endoscopy initially...
A woman in her 50s presented to the Emergency Department, following massive haematemesis, having swallowed a single tooth denture 3 years previously. Endoscopy initially revealed profuse bleeding at 20cm from the incisors, initially treated with an oesophageal covered stent. Following ongoing haematemesis, a thoracic and abdominal CT angiogram demonstrated an aorto-oesophageal fistula, which was successfully treated with a thoracic endograft and left tube thoracostomy. The patient remains well to 1 year. This is the first case to demonstrate successful use of covered stents in both the aorta to stop exsanguination, as well as the oesophagus to prevent mediastinitis and avoid the need for thoracotomy and hypothermic circulatory arrest in a critically ill patient.
Topics: Angioplasty; Aortic Diseases; Esophageal Fistula; Female; Gastrointestinal Hemorrhage; Hematemesis; Humans
PubMed: 35649625
DOI: 10.1136/bcr-2021-246539 -
Thorax Oct 2023
Topics: Humans; Hemoptysis; Mediastinitis
PubMed: 37640549
DOI: 10.1136/thorax-2023-220240 -
Der Pathologe Mar 2021A dysregulated immune response is considered one of the major factors leading to severe COVID-19. Previously described mechanisms include the development of a cytokine... (Review)
Review
BACKGROUND
A dysregulated immune response is considered one of the major factors leading to severe COVID-19. Previously described mechanisms include the development of a cytokine storm, missing immunoglobulin class switch, antibody-mediated enhancement, and aberrant antigen presentation.
OBJECTIVES
To understand the heterogeneity of immune response in COVID-19, a thorough investigation of histomorphological patterns in regional lymph nodes was performed.
MATERIALS AND METHODS
Lymph nodes from the cervical, mediastinal, and hilar regions were extracted from autopsies of patients with lethal COVID-19 (n = 20). Histomorphological characteristics, SARS-CoV‑2 qRT-PCR, and gene expression profiling on common genes involved in immunologic response were analyzed.
RESULTS
Lymph nodes displayed moderate to severe capillary stasis and edema, an increased presence of extrafollicular plasmablasts, mild to moderate plasmacytosis, a dominant population of CD8 T‑cells, and CD11c/CD68 histiocytosis with hemophagocytic activity. Out of 20 cases, 18 presented with hypoplastic or missing germinal centers with a decrease of follicular dendritic cells and follicular T‑helper cells. A positive viral load was detected by qRT-PCR in 14 of 20 cases, yet immunohistochemistry for SARS-CoV-2 N-antigen revealed positivity in sinus histiocytes of only one case. Gene expression analysis revealed an increased expression of STAT1, CD163, granzyme B, CD8A, MZB1, and PAK1, as well as CXCL9.
CONCLUSIONS
Taken together, our findings imply a dysregulated immune response in lethal COVID-19. The absence/hypoplasia of germinal centers and increased presence of plasmablasts implies a transient B‑cell response, implying an impaired development of long-term immunity against SARS-CoV‑2 in such occasions.
Topics: CD8-Positive T-Lymphocytes; COVID-19; Humans; Lung; Lymph Nodes; SARS-CoV-2
PubMed: 33575887
DOI: 10.1007/s00292-021-00914-z