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Pulmonary Therapy Jun 2021End-stage chronic obstructive pulmonary disease (COPD) is the most common indication for single- or double-lung transplantation. Acute native lung hyperinflation (ANLH)... (Review)
Review
End-stage chronic obstructive pulmonary disease (COPD) is the most common indication for single- or double-lung transplantation. Acute native lung hyperinflation (ANLH) is a unique postoperative complication of single-lung transplantation for COPD patients, with incidence varying in the medical literature from 15 to 30%. The diagnosis is made radiographically by contralateral mediastinal shift and ipsilateral diaphragmatic flattening. ANLH can deteriorate into hemodynamic instability, and respiratory impairment can result from compression of the allograft, which can precipitate atelectasis, hypoxemia, and hypercapnia, necessitating specific ventilatory intervention or volume reduction surgery. Currently, there is consensus for a therapeutic role of noninvasive positive pressure ventilation (NIPPV) in acute respiratory failure after lung transplantation as a well-tolerated measure to avoid re-intubation. This manuscript presents a concise review on the diagnosis and treatment of ANLH following unilateral lung transplant, along with a management algorithm created by the authors.
PubMed: 33263926
DOI: 10.1007/s41030-020-00141-6 -
World Journal of Gastrointestinal... Oct 2023Minimally invasive surgery is increasingly indicated in the management of malignant disease. Although oesophagectomy is a difficult operation, with a long learning... (Review)
Review
Minimally invasive surgery is increasingly indicated in the management of malignant disease. Although oesophagectomy is a difficult operation, with a long learning curve, there is actually a shift towards the laparoscopic/thoracoscopic/ robotic approach, due to the advantages of visualization, surgeon comfort (robotic surgery) and the possibility of the whole team to see the operation as well as and the operating surgeon. Although currently there are still many controversial topics, about the surgical treatment of patients with gastro-oesophageal junction (GOJ) adenocarcinoma, such as the type of open or minimally invasive surgical approach, the type of oesophago-gastric resection, the type of lymph node dissection and others, the minimally invasive approach has proven to be a way to reduce postoperative complications of resection, especially by decreasing pulmonary complications. The implementation of new technologies allowed the widening of the range of indications for this type of surgical approach. The short-term and long-term results, as well as the benefits for the patient - reduced surgical trauma, quick and easy recovery - offer this type of surgical treatment the premises for future development. This article reviews the updates and perspectives on the minimally invasive approach for GOJ adenocarcinoma.
PubMed: 37969407
DOI: 10.4251/wjgo.v15.i10.1675 -
Journal of Veterinary Internal Medicine Jul 2021Lobar emphysema in dogs and cats is caused by bronchial collapse during expiration and subsequent air trapping. Congenital causes such as bronchial cartilage defects or...
BACKGROUND
Lobar emphysema in dogs and cats is caused by bronchial collapse during expiration and subsequent air trapping. Congenital causes such as bronchial cartilage defects or acquired causes such as compressive neoplastic lesions have been reported. Morbidity results from hyperinflation of the affected lung lobe and compression of adjacent thoracic structures.
OBJECTIVE
To describe patient characteristics and imaging findings in dogs and cats with lobar emphysema.
ANIMALS
Fourteen dogs and 3 cats with lobar emphysema diagnosed by imaging findings were retrospectively identified from veterinary referral hospital populations over a 10-year period.
METHODS
Cases that included thoracic radiography, thoracic computed tomography (CT), or both were included. All images were reviewed by a European College of Veterinary Diagnostic Imaging diplomate. Relevant case information included signalment, clinical findings, treatment, and histopathology where available.
RESULTS
Ten of 17 (59%) patients were presented for evaluation of dyspnea and 6 (35%) for coughing. Eleven (65%) patients were <3 years of age. The right middle lung lobe was affected in 12 cases (71%) and multiple lobes were affected in 7 cases (41%). Congenital lobar emphysema was suspected in 14 cases (82%).
CONCLUSION AND CLINICAL IMPORTANCE
Lung lobe hyperinflation, atelectasis of nonaffected lung lobes, mediastinal shift, and thoracic wall and diaphragmatic wall deformation were common findings. Lobar or multilobar emphysema should be considered in patients with dyspnea or coughing, particularly younger patients. Although radiography is useful, CT provides better detail. In older patients, acquired causes of bronchial compression should be considered.
Topics: Animals; Cat Diseases; Cats; Dog Diseases; Dogs; Emphysema; Radiography, Thoracic; Retrospective Studies
PubMed: 34145623
DOI: 10.1111/jvim.16183 -
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 -
Diagnostics (Basel, Switzerland) Jan 2023A 41-year-old female underwent a cervical spine CT for the workup of posterior neck pain irradiating to the shoulders for several months. An incidental thyroid nodule...
A 41-year-old female underwent a cervical spine CT for the workup of posterior neck pain irradiating to the shoulders for several months. An incidental thyroid nodule was found and classified as Bethesda III on the Fine-needle aspiration cytology (FNAC) results. Three months later, the patient developed mild shortness of breath, dry cough, and fever. Chest X-ray revealed a mild enlargement in the bilateral hilar regions. CT showed mediastinal and bilateral hilar enlarged lymph nodes and pulmonary micronodules. The workup was further completed with a F-FDG PET/CT, showing intense FDG uptake in the mediastinal and bilateral hilar lymph nodes and increased uptake in the thyroid nodule. Endobronchial Ultrasound-guided Transbronchial needle aspiration (EBUS-TBNA) of a left hilar lymph node showed epithelioid non-necrotizing granulomas. Because of the FNAC results, size of the nodule and tracheal shift, thyroid lobectomy was performed one month later. Histopathological results also revealed multiple non-necrotizing epithelioid granulomas, suggesting systemic sarcoidosis with involvement of the thyroid. To our knowledge, this is the first report of thyroid sarcoidosis detected on F-FDG PET/CT. Although an increased FDG uptake in a thyroid nodule is usually suggestive of thyroid malignancy, toxic nodule, or follicular hyperplasia, our case report shows that it could also suggest thyroid sarcoidosis.
PubMed: 36673106
DOI: 10.3390/diagnostics13020296 -
Clinical Case Reports Mar 2022Mediastinal shift and chest wall retraction limit the indication of a double lung transplant in patients with complete destruction of lung parenchyma. We report outcomes...
Mediastinal shift and chest wall retraction limit the indication of a double lung transplant in patients with complete destruction of lung parenchyma. We report outcomes as well as preoperative and operative management in two patients with significant lung volume reduction and mediastinal shift due to bronchiectasis of the right lung.
PubMed: 35990927
DOI: 10.1002/ccr3.5515 -
Clinical Case Reports Oct 2021Primary pulmonary Ewing sarcoma can present as a massive mass in the left hemithorax covering the entire lung and can press the pulmonary artery and cause a significant...
Primary pulmonary Ewing sarcoma can present as a massive mass in the left hemithorax covering the entire lung and can press the pulmonary artery and cause a significant mediastinal shift.
PubMed: 34659754
DOI: 10.1002/ccr3.4857 -
Frontiers in Veterinary Science 2022A 5-year-old female spayed French Bulldog presented for anorexia and increased respiratory rate. On presentation, she was dyspneic with stridor and increased...
A 5-year-old female spayed French Bulldog presented for anorexia and increased respiratory rate. On presentation, she was dyspneic with stridor and increased bronchovesicular sounds. Point-of-care ultrasound identified pericardial effusion. Thoracic radiographs identified pleural effusion, a wide cranial mediastinum, and multifocal unstructured interstitial pulmonary opacities. Bloodwork revealed a moderate leukocytosis characterized by a mature neutrophilia with a left shift, hypoalbuminemia, mildly increased alkaline phosphatase activity, and moderate hypokalemia. Thoracic CT findings revealed moderate pericardial and bilateral pleural effusion, mediastinal effusion, and moderate cranial mediastinal lymphadenopathy. Diagnostic thoracocentesis and pericardiocentesis revealed septic exudates with bacilli. Two days later, a median sternotomy and pericardiectomy were performed. Aerobic cultures of the effusions grew ss . The patient was treated with Amoxicillin-clavulanate and enrofloxacin for 12 weeks and clinically fully recovered. has not been reported as a cause of purulent pericarditis and pyothorax in a dog. Uniquely, this patient is suspected of developing this infection secondary to immunosuppression.
PubMed: 35664856
DOI: 10.3389/fvets.2022.884654 -
Mediastinum (Hong Kong, China) 2024Locally invasive thymic neoplasms are challenging clinical scenarios and typically require a multidisciplinary approach. The involvement of major mediastinal veins such... (Review)
Review
Locally invasive thymic neoplasms are challenging clinical scenarios and typically require a multidisciplinary approach. The involvement of major mediastinal veins such as the superior vena cava (SVC) used to be a contraindication to surgery, but with improved surgical technique and outcomes, this paradigm has shifted. In some situations, complex resections and reconstructions may be indicated and required to improve the long-term outcome of these patients. We report two of our cases along with a current review of literature. We also describe the preoperative workup, operative techniques, postoperative management, complications, and outcomes of patients with invasive thymic neoplasms that involve the mediastinal veins. Our first case describes a patient who was diagnosed with a thymoma extending from the diaphragm to the base of the neck that was also encasing major vascular structures including the SVC and left innominate vein. Our second case describes a patient who was also diagnosed with a large anterior mediastinal mass encasing the great veins and invading the chest wall. We describe the management of these patients and then delve deeper into operative techniques including SVC resection and reconstruction. We describe the types of conduits that can be used and complications to be mindful of when clamping the great veins, such as the SVC. Improvements in conduit materials and neoadjuvant and adjuvant therapies over the years have made it more feasible for patients with invasive thymic neoplasms to undergo surgery.
PubMed: 38322190
DOI: 10.21037/med-20-69 -
BMJ Case Reports Aug 2019Horseshoe lung is a rare congenital anomaly and mostly accompanied by scimitar syndrome. Most aspects of this complex anomaly can be demonstrated via multidetector CT...
Horseshoe lung is a rare congenital anomaly and mostly accompanied by scimitar syndrome. Most aspects of this complex anomaly can be demonstrated via multidetector CT (MDCT). We present two baby girls who had horseshoe lung associated with right lung hypoplasia and scimitar vein. The chest roentgenograms showed displacement of the heart and mediastinum to the right with smaller right lung. Echocardiography revealed dextroposition, secundum atrial septal defect and bilateral slight peripheral pulmonary stenosis in the first case and dextroposition, severe pulmonary hypertension, secundum atrial septal defect and tricuspid regurgitation in the other one. On thoracic MDCT, the right lung and pulmonary artery were hypoplastic with cardiomediastinal shift to the right. There was an abnormal right pulmonary vein draining into the inferior vena cava on the lower zone of the right lung (scimitar vein). The posterobasal portions of the both lungs were fused through a midline isthmus behind the heart.
Topics: Echocardiography; Female; Humans; Infant; Lung; Multidetector Computed Tomography; Scimitar Syndrome
PubMed: 31420418
DOI: 10.1136/bcr-2014-204389