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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 -
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 -
Journal of Clinical Medicine May 2023A congenital intrathoracic kidney (ITK) is a rare anomaly that is recognized to have four causes: renal ectopia with an intact diaphragm, diaphragmatic eventration,... (Review)
Review
INTRODUCTION
A congenital intrathoracic kidney (ITK) is a rare anomaly that is recognized to have four causes: renal ectopia with an intact diaphragm, diaphragmatic eventration, diaphragmatic hernia, and traumatic diaphragmatic rupture. We report a case of a prenatal-diagnosed ITK related to a congenital diaphragmatic hernia (CDH) and conducted a systematic review of all cases of the prenatal diagnosis of this association.
CASE PRESENTATION
A fetal ultrasound scan at 22 gestational weeks showed left CDH and ITK, hyperechoic left lung parenchyma, and mediastinal shift. The fetal echocardiography and karyotype were normal. Magnetic resonance imaging at 30 gestational weeks confirmed the ultrasound suspicion of left CDH in association with bowel and left kidney herniation. The fetal growth, amniotic fluid, and Doppler indices remained within the normal range over time. The woman delivered the newborn via an at-term spontaneous vaginal delivery. The newborn was stabilized and underwent non-urgent surgical correction; the postoperative course was uneventful.
CONCLUSIONS
CDH is the rarest cause of ITK; we found only eleven cases describing this association. The mean gestational age at diagnosis was 29 ± 4 weeks and 4 days. There were seven cases of right and four cases of left CDH. There were associated anomalies in only three fetuses. All women delivered live babies, the herniated kidneys showed no functional damage after their surgical correction, and the prognosis was favorable after surgical repair. The prenatal diagnosis and counseling of this condition are important in planning adequate prenatal and postnatal management in order to improve neonatal outcomes.
PubMed: 37297803
DOI: 10.3390/jcm12113608 -
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 -
World Journal of Clinical Cases Sep 2023Diaphragmatic hernia (DH) is extremely rarely described during pregnancy. Due to the rarity, there is no diagnostic or treatment algorithm for DH in pregnancy.
BACKGROUND
Diaphragmatic hernia (DH) is extremely rarely described during pregnancy. Due to the rarity, there is no diagnostic or treatment algorithm for DH in pregnancy.
AIM
To summarize and define the most appropriate diagnostic methods and therapeutic options for DH in pregnancy based on scarce literature.
METHODS
Literature search of English-, German-, Spanish-, and Italian-language articles were performed using PubMed (1946-2021), PubMed Central (1900-2021), and Google Scholar. The PRISMA protocol was followed. The search terms included: Maternal diaphragmatic hernia, congenital hernia, pregnancy, cardiovascular collapse, mediastinal shift, abdominal pain in pregnancy, hyperemesis, diaphragmatic rupture during labor, puerperium, hernie diaphragmatique maternelle, hernia diafragmática congenital. Additional studies were identified by reviewing reference lists of retrieved studies. Demographic, imaging, surgical, and obstetric data were obtained.
RESULTS
One hundred and fifty-eight cases were collected. The average maternal age increased across observed periods. The proportion of congenital hernias increased, while the other types appeared stationary. Most DHs were left-sided (83.8%). The median number of herniated organs declined across observed periods. A working diagnosis was correct in 50%. DH type did not correlate to maternal or neonatal outcomes. Laparoscopic access increased while thoracotomy varied across periods. Presentation of less than 3 days carried a significant risk of strangulation in pregnancy.
CONCLUSION
The clinical presentation of DH is easily confused with common chest conditions, delaying the diagnosis, and increasing maternal and fetal mortality. Symptomatic DH should be included in the differential diagnosis of pregnant women with abdominal pain associated with dyspnea and chest pain, especially when followed by collapse. Early diagnosis and immediate intervention lead to excellent maternal and fetal outcomes. A proposed algorithm helps manage pregnant women with maternal DH. Strangulated DH requires an emergent operation, while delivery should be based on obstetric indications.
PubMed: 37900237
DOI: 10.12998/wjcc.v11.i27.6440 -
Late presentation of congenital type IV esophageal hiatus hernia in a 9-year-old boy: a case report.Journal of Medical Case Reports Mar 2022Congenital diaphragmatic hernia affects 1 in every 2000-5000 live births. The mediastinum shifts to the opposite side, the lungs are hypoplastic, and the arterioles are...
BACKGROUND
Congenital diaphragmatic hernia affects 1 in every 2000-5000 live births. The mediastinum shifts to the opposite side, the lungs are hypoplastic, and the arterioles are abnormal, resulting in pulmonary hypertension. Respiratory and cardiovascular functions are severely impaired at birth, resulting in significant mortality and morbidity as a result of the associated malformations.
CASE PRESENTATION
A 9-year-old persian boy was referred with complaint of intermittent abdominal pain in the left lower quadrant and an episode of vomiting. The patient was tachypneic, and the abdomen was nontender on examination. Lung sounds on the left side were considerably decreased, whereas heart sounds on the right side were louder. There was no history of underlying disease in the patient. Initial laboratory blood tests, chest x-ray, spiral computed tomography scan, and chest sonography were requested. Blood tests were normal, and chest x-ray revealed a round-shaped lesion with relatively clear boundaries containing air-fluid level and shift of the heart and mediastinum to the right. A spiral computed tomography scan of the lungs demonstrated the shift of the heart and mediastinum to the right side was due to dilated stomach and colon pressure, and chest sonography revealed that half of the stomach was inside the thorax. Laparotomy surgery was performed. The patient had no complications following surgery.
CONCLUSIONS
Herniation of abdominal contents through the diaphragmatic hiatus should be suspected in patients with tachypnea and mediastinal shift to the right side. Rapid diagnosis and early surgical treatment are necessary to avert any potentially life-threatening complications.
Topics: Abdominal Pain; Child; Diaphragm; Hernia, Hiatal; Hernias, Diaphragmatic, Congenital; Humans; Infant, Newborn; Male; Thorax
PubMed: 35287701
DOI: 10.1186/s13256-022-03331-9 -
Frontiers in Oncology 2021This article retrospectively characterized the geometric and dosimetric changes in target and normal tissues during radiotherapy for lung cancer patients with...
BACKGROUND AND PURPOSE
This article retrospectively characterized the geometric and dosimetric changes in target and normal tissues during radiotherapy for lung cancer patients with atelectasis.
MATERIALS AND METHODS
A total of 270 cone beam computed tomography (CBCT) scans of 18 lung patients with atelectasis were collected. The degree and time of resolution or expansion of the atelectasis were recorded. The geometric, dosimetric, and biological changes in the target and lung tissue were also quantified.
RESULTS
There were two patients with expansion, four patients with complete regression, six patients with partial regression, and six patients with no change. The time of resolution or expansion varied. The tumor volume increased by 3.8% in the first seven fractions, then decreased from the 9th fraction, and by 33.4% at the last CBCT. In the LR direction, the average center of mass (COM), boundaries of the tumors gradually shifted mediastinally. In the AP direction, the COM of the tumors was shifted slightly in the posterior direction and then gradually shifted to the anterior direction; the boundaries of the tumors all moved mediastinally. In the SI direction, the COM of the tumors on the right side of the body was substantially shifted toward the head direction. The boundaries of the tumors varied greatly. D, D, D, V, V, and TCP of the PTV were reduced during radiotherapy and were reduced to their lowest values during the last two fractions. The volume of the ipsilateral lung tended to increase gradually. The V, V, V, V, V, and NTCP of the total lung gradually increased with the fraction.
CONCLUSIONS
For most patients, regression of the atelectasis occurred, and the volume of the ipsilateral lung tended to increase while the tumor volume decreased, and the COM and boundary of the tumors shifted toward mediastinum, which caused an insufficient dose to the target and an overdose to the lungs. Regression or expansion may occur for any fraction, and it is therefore recommended that CBCT be performed at least every other day.
PubMed: 34367970
DOI: 10.3389/fonc.2021.690278 -
Cureus Jun 2023Pulmonary tuberculosis is associated with long-term complications that affect both the respiratory and cardiovascular systems. We present the case of a 65-year-old male...
Pulmonary tuberculosis is associated with long-term complications that affect both the respiratory and cardiovascular systems. We present the case of a 65-year-old male patient who presented with chief complaints of productive cough and breathlessness for the last four years. Further radiological investigations revealed a left-sided destroyed lung with left lung collapse and deviation of the mediastinum towards the left side. The patient responded well to treatment with broad-spectrum antimicrobial drugs and mucolytics.
PubMed: 37425496
DOI: 10.7759/cureus.40035 -
Journal of the American Heart... Jun 2021Background Tetralogy of Fallot with absent pulmonary valve is associated with high mortality, but it remains difficult to predict outcomes prenatally. We aimed to...
Background Tetralogy of Fallot with absent pulmonary valve is associated with high mortality, but it remains difficult to predict outcomes prenatally. We aimed to identify risk factors for mortality in a large multicenter cohort. Methods and Results Fetal echocardiograms and clinical data from 19 centers over a 10-year period were collected. Primary outcome measures included fetal demise and overall mortality. Of 100 fetuses, pregnancy termination/postnatal nonintervention was elected in 22. Of 78 with intention to treat, 7 (9%) died in utero and 21 (27%) died postnatally. With median follow-up of 32.9 months, no deaths occurred after 13 months. Of 80 fetuses with genetic testing, 46% had chromosomal abnormalities, with 22q11.2 deletion in 35%. On last fetal echocardiogram, at a median of 34.6 weeks, left ventricular dysfunction independently predicted fetal demise (odds ratio [OR], 7.4; 95% CI 1.3, 43.0; =0.026). Right ventricular dysfunction independently predicted overall mortality in multivariate analysis (OR, 7.9; 95% CI 2.1-30.0; =0.002). Earlier gestational age at delivery, mediastinal shift, left ventricular/right ventricular dilation, left ventricular dysfunction, tricuspid regurgitation, and Doppler abnormalities were associated with fetal and postnatal mortality, although few tended to progress throughout gestation on serial evaluation. Pulmonary artery diameters did not correlate with outcomes. Conclusions Perinatal mortality in tetralogy of Fallot with absent pulmonary valve remains high, with overall survival of 64% in fetuses with intention to treat. Right ventricular dysfunction independently predicts overall mortality. Left ventricular dysfunction predicts fetal mortality and may influence prenatal management and delivery planning. Mediastinal shift may reflect secondary effects of airway obstruction and abnormal lung development and is associated with increased mortality.
Topics: Canada; Echocardiography, Doppler, Color; Fetal Death; Fetal Heart; Humans; Predictive Value of Tests; Prognosis; Pulmonary Valve; Retrospective Studies; Risk Assessment; Risk Factors; Tetralogy of Fallot; Ultrasonography, Prenatal; United States; Ventricular Dysfunction, Left; Ventricular Dysfunction, Right
PubMed: 34098741
DOI: 10.1161/JAHA.120.019713 -
Case Reports in Infectious Diseases 2020Community-Acquired Pneumonia (CAP) is a common reason for hospitalization of a pediatric patient. We report a 20-month-old female admitted for suspected CAP. History...
Community-Acquired Pneumonia (CAP) is a common reason for hospitalization of a pediatric patient. We report a 20-month-old female admitted for suspected CAP. History included a week-long cough, fever, dyspnea, single occurrence of seizure-like activity, and a sick contact. Initial chest X-ray (CXR) showed left lower lobe pneumonia and parapneumonic effusion with a complex left pleural effusion. Ultrasound findings prompted the need for contrast-enhanced computed tomography (CT) of the chest. Contrast-enhanced CT of the chest confirmed a large pleural effusion with major atelectasis and mediastinal shift. The patient was treated with empiric antibiotics, video-assisted thoracoscopic surgical (VATS) decortication of empyema, and chest tube placement. Due to intraoperative complications, the VATS decortication was aborted and patient was transferred to the pediatric intensive care unit (PICU). A thoracentesis with culture failed to isolate a bacterial organism. Dexamethasone was started after repeat CXR showed persistent infiltrate. Subsequent contrast-enhanced CT of the chest showed a large collection of air and persistent consolidation. The patient received repeat VATS decortication and reinsertion of a chest tube. Repeat pleural fluid cultures failed to isolate a bacterial organism. Infectious disease (ID) consult recommended linezolid 140 mg Q8H for 4 weeks. Seven days after second VATS, a respiratory pathogen panel was positive for rhinovirus/enterovirus. With resolution of leukocytosis and clinical improvement, the patient was discharged with the chest tube in place and pediatric surgery outpatient follow-up. After three months, sequalae from both the infection and interventions presented .
PubMed: 32099701
DOI: 10.1155/2020/7301617