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The Neuroradiology Journal Oct 2022The use of mechanical thrombectomy (MT) for treatment of acute large vessel occlusion has recently increased. Prompt and timely guiding catheter (GC) induction is...
BACKGROUND
The use of mechanical thrombectomy (MT) for treatment of acute large vessel occlusion has recently increased. Prompt and timely guiding catheter (GC) induction is necessary to improve prognosis of MT and reduce the time for recanalization. However, difficulties in GC induction are encountered in some patients. This GC induction depends mainly on the aortic arch structure. Therefore, this study focused on assessing presence of tracheal shift on chest X-ray images as pre-treatment evaluation method for GC induction due to its wide availability as an indicator for status of the mediastinum.
METHODS
We retrospectively examined 33 patients who underwent MT at our facilities between April 2017 and March 2021. The patients were divided into two groups according to presence or absence of tracheal shift on chest X-ray images. Background characteristics and treatment courses in these two groups were compared.
RESULTS
Among 33 patients, tracheal shift was observed on the chest X-ray images of 14 patients. Furthermore, tracheal shift was positively correlated with the time of GC induction (32.9 min vs. 11.6 min, [ < 0.05]) and the female sex ( = 0.03). Additionally, tracheal shift exhibited correlations with multiple risk factors of atherosclerosis ( = 0.04).
CONCLUSIONS
In patients with tracheal shift, GC induction could be expectedly difficult. Therefore, advanced disinfection of the right upper arm and affected side of the neck during MT in preparation for changing an approach route is required.
Topics: Brain Ischemia; Female; Humans; Retrospective Studies; Stroke; Thrombectomy; Treatment Outcome; X-Rays
PubMed: 35581955
DOI: 10.1177/19714009221084237 -
The American Journal of Case Reports Jul 2022BACKGROUND Radical esophagectomy for cancer is a potentially curative treatment that requires two/three-field lymphadenectomy. Serious complications can occur, including...
BACKGROUND Radical esophagectomy for cancer is a potentially curative treatment that requires two/three-field lymphadenectomy. Serious complications can occur, including chyle leak (CL). CL has an incidence rate of 1-9% and is associated with a higher rate of postsurgical morbidity and mortality. It usually occurs in the early postoperative period; delayed CL is less common and is thought to be due to an occult leak or late diagnosis. CASE REPORT A 54-year-old man with adenocarcinoma of the esophagus underwent Lewis-Tanner esophagectomy after neoadjuvant chemotherapy with FLOT. During en bloc lymphadenectomy, the main thoracic duct was identified, clipped, and divided. The postoperative course was uneventful. One month after hospital discharge, he was readmitted with severe abdominal, scrotal, and lower-limb edema. A chest-abdomen CT scan revealed massive pleural effusion with left shift and compression of the mediastinum. The patient was initially treated with fasting and fat-free total parenteral nutrition, and the drain output was 2800-3000 mL/dL. Lymphoscintigraphy with ethiodized oil eventually revealed a thoracic duct leak, and lymphatic embolization was successfully performed with a 4-mm metallic spiral and glue. Drain output dramatically reduced, and after 11 days the thoracic drain was removed and the patient was safely discharged. CONCLUSIONS Thoracic duct embolization seems be an effective therapy in treating high-output (>1000 mL/dL) CL that has occurred more than 2 weeks after esophagectomy. It can be considered as a first-line treatment due to its simplicity and effectiveness.
Topics: Chest Tubes; Chyle; Esophageal Neoplasms; Esophagectomy; Humans; Male; Middle Aged; Postoperative Complications; Thoracic Duct
PubMed: 35867626
DOI: 10.12659/AJCR.936590 -
Prenatal Diagnosis Jan 2020To quantify the mediastinal shift angle (MSA) in fetuses with isolated left congenital diaphragmatic hernia (CDH) by magnetic resonance imaging and evaluate survival. (Observational Study)
Observational Study
OBJECTIVE
To quantify the mediastinal shift angle (MSA) in fetuses with isolated left congenital diaphragmatic hernia (CDH) by magnetic resonance imaging and evaluate survival.
METHOD
Fetuses from singleton pregnancies with isolated left CDH were matched for gestational age with controls without thoracic malformations. For all fetuses the MSA was determined by two operators and inter-operator variability and differences between cases and controls were investigated. For all cases total fetal lung volume (TFLV) was calculated and the correlation between MSA and TFLV was assessed, and its predictive value towards survival was determined.
RESULTS
Thirty-four fetuses were included as cases and 42 as controls. The mean gestational age for assessment of CDH fetuses was 32 weeks (range 27-38). Twenty-four fetuses survived until discharge and 10 did not. There was an excellent inter-operator reliability for measuring the MSA and a significant difference between MSA in cases and controls. There was an inverse correlation between MSA values and survival, a correlation between TFLV and survival and an inverse correlation between MSA and TFLV. The area under the ROC curve for MSA in predicting survival was 0.931 (95% CI 0.851-1.000).
CONCLUSION
The MSA measured late in gestation correlates with postnatal survival in patients with isolated left CDH.
Topics: Case-Control Studies; Female; Fetus; Gestational Age; Hernias, Diaphragmatic, Congenital; Humans; Infant, Newborn; Lung; Magnetic Resonance Imaging; Mediastinum; Organ Size; Pregnancy; Prognosis; Retrospective Studies; Survival Rate
PubMed: 31883153
DOI: 10.1002/pd.5619 -
BMC Pulmonary Medicine Dec 2021Congenital lobal emphysema (CLE) is a developmental lung abnormality usually diagnosed in the neonatal period and is rarely observed in adults. Adults with CLE are... (Review)
Review
BACKGROUND
Congenital lobal emphysema (CLE) is a developmental lung abnormality usually diagnosed in the neonatal period and is rarely observed in adults. Adults with CLE are usually asymptomatic and only a small fraction may present with coughing, recurrent pneumonia and respiratory distress. In imaging studies, the most frequently affected lobe of CLE is the left upper lobe, followed by the right middle lobe. However, multilobar involvement with severe mediastinal shift is extremely rare.
CASE PRESENTATION
We report a case of fatal CLE in a 28-year-old puerpera with postpartum respiratory failure. Chest computed tomography (CT) revealed emphysema of the right upper, middle and lower lobes resulting in adjacent atelectasis. Hyperinflation of the right upper lobe crossed the midline, leading to a deviation of the mediastinal structure to the left hemithorax and severe compression of the left lung.
CONCLUSIONS
Early and timely diagnosis of CLE with routine follow-up is necessary for patients. CLE, especially with multilobar involvement or mediastinal shift, could be life-threatening and should be promptly and aggressively treated to prevent severe complications.
Topics: Adult; Fatal Outcome; Female; Humans; Puerperal Disorders; Pulmonary Emphysema; Respiratory Insufficiency; Tomography, X-Ray Computed
PubMed: 34930207
DOI: 10.1186/s12890-021-01787-x -
Pediatric Emergency Care Jul 2021Acute late-presenting congenital diaphragmatic hernia (CDH) might result in mediastinal shift away from the lesion and even sudden cardiopulmonary arrest. This study...
OBJECTIVES
Acute late-presenting congenital diaphragmatic hernia (CDH) might result in mediastinal shift away from the lesion and even sudden cardiopulmonary arrest. This study aimed to discuss the prompt and effective emergency management of acute late-presenting CDH.
METHODS
A retrospective review of acute late-presenting CDH cases in West China Hospital of Sichuan University and Guizhou Provincial People's Hospital from October 2010 to June 2016 was conducted.
RESULTS
A total of 22 patients were included in this study. All the patients presented with respiratory symptoms. Chest x-ray revealed swollen stomach and mediastinal shift. After nasogastric tube placement, fluid infusion, and nasal oxygen breathing, the symptoms in 8 patients ameliorated, and 14 patients had no signs of obvious relief. Three patients underwent the bedside percutaneous puncture of distensible stomach, and 1 patient died in the process of emergent management for critical condition. The remaining 21 patients underwent emergency surgery. Five thoracotomies and 16 thoracoscopies were performed. Five thoracoscopies that were converted to thoracotomies were required for the difficult reduction of herniated stomach. At follow-up, all patients improved their condition.
CONCLUSIONS
Acute late-presenting CDH is a clinical emergency that can be fatal. The sudden and progressive expansion of the stomach is mainly responsible for this emergent condition. The prompt and effective management is key to decrease the mortality and achieve favorable prognosis.
Topics: Child; Heart Arrest; Hernias, Diaphragmatic, Congenital; Humans; Infant; Retrospective Studies; Thoracoscopy; Thoracotomy
PubMed: 31219969
DOI: 10.1097/PEC.0000000000001860 -
European Journal of Case Reports in... 2021Acute gastric volvulus is a rare complication affecting 4% of hiatal hernias. It is described as an abnormal rotation of the stomach around a transverse or longitudinal...
UNLABELLED
Acute gastric volvulus is a rare complication affecting 4% of hiatal hernias. It is described as an abnormal rotation of the stomach around a transverse or longitudinal axis and can be intra-abdominal or intrathoracic. Intrathoracic gastric volvulus can lead to tension gastrothorax, which is defined as the presence of a massive gastric distension in the chest cavity causing a mediastinal shift with haemodynamic instability and a risk of cardiorespiratory arrest. We report a case of intrathoracic gastric volvulus with probable tension gastrothorax. Early diagnosis of gastrothorax with computed tomography and immediate insertion of a nasogastric tube resulted in rapid clinical improvement. Surgical intervention is the treatment of choice.
LEARNING POINTS
Tension gastrothorax should be suspected in the presence of abdominal and chest pain, vomiting and haemodynamic instability.Prompt diagnosis and treatment are necessary to reduce morbidity and mortality.
PubMed: 34790622
DOI: 10.12890/2021_002818 -
Cureus Apr 2022Primary pulmonary leiomyosarcomas (PPLs) are extremely rare tumors of the lungs. They can present with non-specific symptoms or can also be asymptomatic with clues...
Primary pulmonary leiomyosarcomas (PPLs) are extremely rare tumors of the lungs. They can present with non-specific symptoms or can also be asymptomatic with clues towards diagnosis being found on routine examination or radiographs. We present a case of a 54-year-old woman who presented with worsening shortness of breath and spells of dizziness. Her chest radiographs showed right-sided pleural effusion and CT revealed a large enhancing pleural mass with compression atelectasis and mediastinal shift. She underwent a thoracoscopy and right pleural biopsy. Histopathology and immunohistochemistry were most consistent with leiomyosarcoma. An extensive search for a possible primary in other sites was unrevealing, thus diagnosing the patient with PPL. She was managed with surgery and radiotherapy.
PubMed: 35392278
DOI: 10.7759/cureus.23821 -
Molecular and Clinical Oncology Dec 2019Gorham-Stout disease (GSD) is a rare bone condition that is characterized by the spontaneous, idiopathic and progressive proliferation of blood or lymphatic vessels,...
Gorham-Stout disease in the rib and thoracic spine with spinal injury treated with radiotherapy, zoledronic acid, vitamin D, and propranolol: A case report and literature review.
Gorham-Stout disease (GSD) is a rare bone condition that is characterized by the spontaneous, idiopathic and progressive proliferation of blood or lymphatic vessels, which replace the bone and marrow space. The precise etiology and pathophysiology of GSD remain poorly understood. Therefore, there is no consensus on the treatment of this disease. In the current study, a rare case of GSD in the rib and thoracic spine with spinal injury that was treated with radiotherapy, zoledronic acid, vitamin D and propranolol, is reported. A 77-year-old man visited the hospital complaining of constipation for 10 days. Within a few days, the patient had recognized complete paralysis of the bilateral lower legs. Radiologically, large osteolytic lesions were confirmed in the 6, 7 and 8th right ribs, the 6 and 7th thoracic vertebrae and in the liver and spleen. The lesions were diagnosed as GSD based on clinical findings, imaging characteristics and needle biopsy results. The patient was treated with zoledronic acid, activated vitamin D, propranolol and radiotherapy to the thoracic vertebrae. However, approximately 5 months after the first treatment, the rapidly increasing hemorrhagic pleural effusion compressed the left lung and caused a mediastinal shift to the right thorax. Unfortunately, the patient succumbed to the disease 7 months after first admission. To the best of our knowledge, this is the first reported case of GSD in the rib and thoracic spine with spinal injury to be treated with radiotherapy, propranolol, vitamin D and zoledronic acid. Furthermore, there have been no previous reports of a mediastinal shift caused by intralesional hemorrhage in GSD. For future reference, it should be noted that such processes may occur in GSD lesions of the thoracic spine and/or thorax. The present case will therefore contribute to a deeper understanding of GSD, a rare clinical entity.
PubMed: 31798875
DOI: 10.3892/mco.2019.1934 -
Mediastinum (Hong Kong, China) 2021Masaoka-Koga staging system remains the most frequently applied clinical staging system for thymic malignancy. However, the International Association for the Study of...
BACKGROUND
Masaoka-Koga staging system remains the most frequently applied clinical staging system for thymic malignancy. However, the International Association for the Study of Lung Cancer (IASLC)/International Thymic Malignancy Interest Group (ITMIG) proposed a tumor-node-metastasis (TNM) staging system in 2014. This study aims to evaluate its impact on stage distribution, clinical implementation, and prognosis for thymomas.
METHODS
We performed a single institution, retrospective analysis of 245 consecutive patients who underwent surgical resection for thymoma. 9 patients with thymic carcinoma were excluded. No patients were lost to follow up. Kaplan-Meier survival analysis was used to calculate overall survival.
RESULTS
Median age was 62 years; 129 patients (53%) were female. The median overall survival was 158 months (range, 108-208 months), and disease-free survival 194 months (range, 170-218 months). At the end of follow up 63 patients were dead. Early Masaoka-Koga stages I (n=74) and II (n=129) shifted to the IASLC/ITMIG stage I (n=203). 8 patients were down staged from Masaoka-Koga stage III to IASLC/ITMIG stage II because of pericardial involvement. Advanced stages III (Masaoka-Koga: n=30; IASLC/ITMIG: n=22) and IV (Masaoka-Koga: n=12; IASLC/ITMIG: n=12) remained similar and were associated with more aggressive WHO thymoma histotypes (B2/B3). Masaoka-Koga (P=0.004), IASLC/ITMIG staging (P<0.0001) and complete surgical resection (P<0.0001) were statistically associated with survival. At multivariate analysis only R status was an independent prognostic factor for survival.
CONCLUSIONS
The proportion of patients with stage I disease increased significantly when IASLC/ITMIG system used, whilst the proportion with stages III and IV were similar in both systems. Completeness of resection, Masaoka-Koga and the IASLC/ITMIG staging system are strong predictors of survival. The TNM staging system is useful in disease management and a strong predictor of overall survival.
PubMed: 35118337
DOI: 10.21037/med-21-24 -
Computational Intelligence and... 2022A single center, retrospective cohort study was conducted to analyze the clinical image features and diagnostic efficiency of pulmonary ultrasound in the diagnosis of...
Clinical Image Feature Analysis and Diagnostic Efficacy Evaluation of Pulmonary Ultrasound in the Diagnosis of Congenital Pulmonary Airway Malformations in Children: Based on a Single Center, Retrospective Cohort Study.
OBJECTIVE
A single center, retrospective cohort study was conducted to analyze the clinical image features and diagnostic efficiency of pulmonary ultrasound in the diagnosis of congenital pulmonary airway malformations (CPAMs) in children.
METHODS
The starting and ending time of this study is from May 2019 to December 2021. This study included 200 children with CPAM diagnosed by prenatal ultrasound and postpartum CT imaging (aged from 1 hour to 3 years), including 103 males and 97 females. All of them were diagnosed by fetal ultrasound and were examined by chest X-ray (CXR), chest CT, and lung ultrasound (LUS). The clinical image characteristics and diagnostic efficiency of CXR, chest CT, and LUS in the diagnosis of CPAM in children were analyzed.
RESULTS
200 lesions were limited to single lung, and the most common were right lower lobe, right lower lobe in 80 cases (40.0%), left lower lobe in 60 cases (30.0%), right upper lobe in 30 cases (15.0%), left upper lobe in 20 cases (10.0%), and right middle lobe in 10 cases (5.0%). Among the 200 cases of preoperative CT examination, 196 cases (98.00%) showed lesions and confirmed diagnosis, and 4 cases were missed. Chest X-ray showed multiple focal circular low-density shadow in the right lung, and the heart shadow and mediastinum moved slightly to the left. CXR showed multiple cystic transparent shadows in the left lower lung and slightly to the right of the mediastinum and heart. CXR showed multiple balloon cavities of different sizes in the right lung field, and the mediastinum and heart shadow shifted to the left. The direct signs of LUS (including single or multiple cystic lesions) were not significantly different from those of CXR, but the indirect signs were significantly higher than those of CXR.
CONCLUSION
The most common CT findings of CPAM in children are cystic lesions, especially polycystic lesions, while LUS images of CPAM in children are various. LUS is a noninvasive and nonradiological examination method, which is easy to operate and repeat. LUS can be used for preliminary qualitative screening of CPAM in children, and the diagnostic value of indirect signs of LUS is better than that of CXR.
Topics: Child; Female; Humans; Lung; Male; Radiography; Retrospective Studies; Tomography, X-Ray Computed; Ultrasonography
PubMed: 36035827
DOI: 10.1155/2022/7490207