-
Respiratory Medicine Case Reports 2023The incidence of critical leptospirosis manifested as massive pulmonary hemorrhage has been significantly reduced, which has been rarely reported in recent years, while...
BACKGROUND
The incidence of critical leptospirosis manifested as massive pulmonary hemorrhage has been significantly reduced, which has been rarely reported in recent years, while the mortality rate is extremely high once it occurs.
CASE PRESENTATION
A 54-year-old man with no HIV infection was admitted to the local county hospital due to high-grade continuous fever lasting four days (38.5-40.5C), upper limb and shoulder-back muscle pain, and general fatigue. The chest CT (Aug 26, 2021) showed "multiple patchy, cloudy, and fuzzy shadows in both lungs, mainly under the pleura of the upper and lower lobes of both lungs; some lymph nodes in the mediastinum are enlarged". Despite being diagnosed with "common community-acquired pneumonia" and starting injectable levofloxacin, the symptoms worsened, and massive hemoptysis occurred. However, after being transferred to our hospital, the patient was diagnosed with the "pulmonary hemorrhage type of leptospirosis" through comprehensive dynamic analysis. The patient recovered very well after undergoing "penicillin 3MIU q6h" alone for two weeks to fight the infection.
CONCLUSIONS
Leptospirosis has a high mortality rate when it becomes critical or severe. Diagnosis typically relies on factors such as epidemiology, clinical symptoms, and pathogenetic testing. Metagenomic next-generation sequencing (mNGS) is more effective in sensitivity and speed than traditional detection methods, making it an excellent option for diagnosing challenging and severe infections in emergencies. Additionally, when experiencing sudden coughing up of blood, it's important to consider the possibility of pulmonary hemorrhage as a type of leptospirosis.
PubMed: 38094659
DOI: 10.1016/j.rmcr.2023.101954 -
Surgical Laparoscopy, Endoscopy &... Feb 2024Intrathoracic esophagogastric anastomosis following minimally invasive Ivor-Lewis esophagectomy is a technically demanding surgical technique that can result in serious...
A Novel Method for Thoracoscopic Overlap Esophagogastric Reconstruction With Pleural Closure following Minimally Invasive Ivor-Lewis Esophagectomy for Esophagogastric Junction Cancer.
BACKGROUND
Intrathoracic esophagogastric anastomosis following minimally invasive Ivor-Lewis esophagectomy is a technically demanding surgical technique that can result in serious intrathoracic infections when anastomotic leakage occurs. Herein, we report a novel side-overlap esophagogastric anastomosis with pleural closure for esophagogastric junction cancer.
METHODS
The 3 key points of our novel technique were the following: (1) overlap esophagogastric anastomosis and closure of the entry hole were all performed using a linear stapler; (2) the pleura was closed to separate the anastomotic site from the thoracic cavity; and (3) the mediastinal drain was inserted transhiatally from the abdominal cavity.
RESULTS
This modified anastomosis procedure was performed on 8 consecutive patients at our institution. The median overall/thoracoscopic operating time and estimated blood loss were 652.5/241.5 min and 89 mL, respectively. No mortality or serious postoperative complications occurred, and the median postoperative hospital stay was 22 days (range, 17 to 37 d).
CONCLUSION
This novel thoracoscopic overlap esophagogastric reconstruction procedure with pleural closure is safe and feasible.
Topics: Humans; Esophagectomy; Pleura; Esophageal Neoplasms; Esophagogastric Junction; Anastomotic Leak; Anastomosis, Surgical; Postoperative Complications; Retrospective Studies
PubMed: 38091490
DOI: 10.1097/SLE.0000000000001250 -
Journal of Thoracic Disease Nov 2023Systemic artery to pulmonary artery fistula (SA-PAF) is an uncommon disease which is often incidentally diagnosed during evaluation of hemoptysis patients. The aim of...
BACKGROUND
Systemic artery to pulmonary artery fistula (SA-PAF) is an uncommon disease which is often incidentally diagnosed during evaluation of hemoptysis patients. The aim of our study was to describe the cases of SA-PAF in our institution and to report the correlating clinical and radiological findings.
METHODS
We reviewed 231 chest computed tomography (CT) scans performed in our institution due to hemoptysis from January 2020 to February 2023. In patients diagnosed with SA-PAF had their electronic medical records and CT images analyzed.
RESULTS
In 231 patients, 19 (8.2%) of them had SA-PAF findings which was characterized by a peripheral nodular soft tissue opacity in the subpleural lung and traceable vascular structure in continuity with one or more peripheral pulmonary artery branches in CT. Etiology of each patient was categorized as either congenital (7, 36.8%), and acquired (12, 63.2%). The origins of SA-PAFs were 16 intercostal, two anterior mediastinal, and one costocervical artery. Eight of 19 patients did not show any associated intralobar imaging abnormalities, while bronchiectasis, cellular bronchiolitis, centrilobular emphysema, and pleura effusion were observed in 11 patients.
CONCLUSIONS
SA-PAF is a benign vascular anomaly which is frequently overlooked when evaluating hemoptysis by either clinician or radiologists but is an important factor in the differential diagnosis of patients with hemoptysis.
PubMed: 38090324
DOI: 10.21037/jtd-23-861 -
Zhonghua Jie He He Hu Xi Za Zhi =... Dec 2023Malignant pleural effusion (MPE) is a pleural effusion that is caused by a malignant tumor originating in the pleura or by a metastatic malignant tumor from another site...
Malignant pleural effusion (MPE) is a pleural effusion that is caused by a malignant tumor originating in the pleura or by a metastatic malignant tumor from another site that has invaded the pleura. MPE is associated with poor prognosis. Members of the Pleural and Mediastinal Diseases Working Group (preparatory) of Chinese Thoracic Society and some external experts selected clinical issues related to the management of MPE and conducted rigorous evidence retrieval and evaluation. After several meetings and revisions of the manuscript, recommendations were made. This consensus applies to patients aged≥18 years old with MPE caused by various malignancies except for pleural mesothelioma. It included four chapters: pathogenesis of MPE, prognostic evaluation of MPE, local thoracic treatment, and systemic anticancer therapy for MPE.The main recommendations of this consensus are as follows:1. Prognosis evaluation of MPE was valuable in formulating treatment options. It is suggested to comprehensively evaluate the patient's prognosis by combining the patient's performance status, tumor type, and laboratory examination.2. It is recommended that in patients with symptomatic MPE, therapeutic thoracentesis could be used as the initial therapeutic option. Evaluate whether the lung is expandable after thoracentesis and drainage, and then develop a therapeutic regimen.3. In patients with MPE and known expandable or nonexpandable lung, an indwelling pleural catheter (IPC) is recommended as a first-line pleural management. Daily IPC drainages are recommended. In patients with MPE and expandable lung, talc pleurodesis by talc poudrage or talc slurry is recommended if the drug is accessible. Other pleurodesis agents include povidone iodine, bleomycin, and doxycycline.4. After drainage, it is suggested to consider the option of intrapleural use of recombinant human endostatin or bevacizumab alone or in combination with intrapleural chemotherapy. Intrapleural intervention including electrocautery, argon knife, cryotherapy, laser and radiofrequency ablation, is recommended for use in patients who have undergone rigorous evaluation in eligible hospitals. The use of intrapleural urokinase or streptokinase via pleural catheter is recommended for patients with symptomatic MPE and loculated effusion.5. For patients with good performance status and metastatic malignancies, systemic anti-cancer treatment is recommended as standard of care.
Topics: Adolescent; Humans; Catheters, Indwelling; Consensus; Drainage; East Asian People; Pleural Effusion, Malignant; Pleurodesis; Prognosis; Talc
PubMed: 38044047
DOI: 10.3760/cma.j.cn112147-20230902-00126 -
Radiotherapy and Oncology : Journal of... Jan 2024Central/ultra-central thoracic tumors are challenging to treat with stereotactic radiotherapy due potential high-grade toxicity. Stereotactic MR-guided adaptive...
BACKGROUND/PURPOSE
Central/ultra-central thoracic tumors are challenging to treat with stereotactic radiotherapy due potential high-grade toxicity. Stereotactic MR-guided adaptive radiation therapy (SMART) may improve the therapeutic window through motion control with breath-hold gating and real-time MR-imaging as well as the option for daily online adaptive replanning to account for changes in target and/or organ-at-risk (OAR) location.
MATERIALS/METHODS
26 central (19 ultra-central) thoracic oligoprogressive/oligometastatic tumors treated with isotoxic (OAR constraints-driven) 5-fraction SMART (median 50 Gy, range 35-60) between 10/2019-10/2022 were reviewed. Central tumor was defined as tumor within or touching 2 cm around proximal tracheobronchial tree (PBT) or adjacent to mediastinal/pericardial pleura. Ultra-central was defined as tumor abutting the PBT, esophagus, or great vessel. Hard OAR constraints observed were ≤ 0.03 cc for PBT V40, great vessel V52.5, and esophagus V35. Local failure was defined as tumor progression/recurrence within the planning target volume.
RESULTS
Tumor abutted the PBT in 31 %, esophagus in 31 %, great vessel in 65 %, and heart in 42 % of cases. 96 % of fractions were treated with reoptimized plan, necessary to meet OAR constraints (80 %) and/or target coverage (20 %). Median follow-up was 19 months (27 months among surviving patients). Local control (LC) was 96 % at 1-year and 90 % at 2-years (total 2/26 local failure). 23 % had G2 acute toxicities (esophagitis, dysphagia, anorexia, nausea) and one (4 %) had G3 acute radiation dermatitis. There were no G4-5 acute toxicities. There was no symptomatic pneumonitis and no G2 + late toxicities.
CONCLUSION
Isotoxic 5-fraction SMART resulted in high rates of LC and minimal toxicity. This approach may widen the therapeutic window for high-risk oligoprogressive/oligometastatic thoracic tumors.
Topics: Humans; Radiotherapy Planning, Computer-Assisted; Neoplasm Recurrence, Local; Radiosurgery; Thoracic Neoplasms; Magnetic Resonance Imaging; Radiation Injuries; Lung Neoplasms
PubMed: 38030080
DOI: 10.1016/j.radonc.2023.110034 -
Insights Into Imaging Nov 2023To evaluate the effect of tract embolization (TE) with gelatin sponge slurries during a percutaneous lung biopsy on chest tube placement and to evaluate the predictive...
BACKGROUND
To evaluate the effect of tract embolization (TE) with gelatin sponge slurries during a percutaneous lung biopsy on chest tube placement and to evaluate the predictive factors of chest tube placement.
METHODS
Percutaneous CT-guided lung biopsies performed with (TE) or without (non-TE) tract embolization or between June 2012 and December 2021 at three referral tertiary centers were retrospectively analyzed. The exclusion criteria were mediastinal biopsies, pleural tumors, and tumors adjacent to the pleura without pleural crossing. Variables related to patients, tumors, and procedures were collected. Univariable and multivariable analyses were performed to determine risk factors for chest tube placement. Furthermore, the propensity score matching analysis was adopted to yield a matched cohort.
RESULTS
A total of 1157 procedures in 1157 patients were analyzed, among which 560 (48.4%) were with TE (mean age 66.5 ± 9.2, 584 men). The rates of pneumothorax (44.9% vs. 26.1%, respectively; p < 0.001) and chest tube placement (4.8% vs. 2.3%, respectively; p < 0.001) were significantly higher in the non-TE group than in the TE group. No non-targeted embolization or systemic air embolism occurred. In the whole population, two protective factors for chest tube placement were found in univariate analysis: TE (OR 0.465 [0.239-0.904], p < 0.05) and prone position (OR 0.212 [0.094-0.482], p < 0.001). These data were confirmed in multivariate analysis (p < 0.001 and p < 0.0001 respectively). In the propensity matched cohort, TE reduces significatively the risk of chest tube insertion (OR = 0.44 [0.21-0.87], p < 0.05).
CONCLUSIONS
The TE technique using standardized gelatin sponge slurry reduces the need for chest tube placement after percutaneous CT-guided lung biopsy.
CRITICAL RELEVANCE STATEMENT
The tract embolization technique using standardized gelatin sponge slurry reduces the need for chest tube placement after percutaneous CT-guided lung biopsy.
KEY POINTS
1. Use of tract embolization with gelatine sponge slurry during percutaneous lung biopsy is safe. 2. Use of tract embolization significantly reduces the risk of chest tube insertion. 3. This is the first multicenter study to show the protective effect of tract embolization on chest tube insertion.
PubMed: 38015340
DOI: 10.1186/s13244-023-01566-8 -
Archivos de Bronconeumologia Jan 2024Thoracic ultrasound (TU) has rapidly gained popularity over the past 10 years. This is in part because ultrasound equipment is available in many settings, more training... (Review)
Review
Thoracic ultrasound (TU) has rapidly gained popularity over the past 10 years. This is in part because ultrasound equipment is available in many settings, more training programmes are educating trainees in this technique, and ultrasound can be done rapidly without exposure to radiation. The aim of this review is to present the most interesting and innovative aspects of the use of TU in the study of thoracic diseases. In pleural diseases, TU has been a real revolution. It helps to differentiate between different types of pleural effusions, guides the performance of pleural biopsies when necessary and is more cost-effective under these conditions, and assists in the decision to remove thoracic drainage after talc pleurodesis. With the advent of COVID19, the use of TU has increased for the study of lung involvement. Nowadays it helps in the diagnosis of pneumonias, tumours and interstitial diseases, and its use is becoming more and more widespread in the Pneumology ward. In recent years, TU guided biopsies have been shown to be highly cost-effective, with other advantages such as the absence of radiation and the possibility of being performed at bedside. The use of contrast in ultrasound to increase the cost-effectiveness of these biopsies is very promising. In the study of the mediastinum and peripheral pulmonary nodules, the introduction of echobronchoscopy has brought about a radical change. It is a fully established technique in the study of lung cancer patients. The introduction of elastography may help to further improve its cost-effectiveness. In critically-ill patients, diaphragmatic ultrasound helps in the assessment of withdrawal of mechanical ventilation, and is now an indispensable tool in the management of these patients. In neuromuscular patients, ultrasound is a good predictor of impaired lung function. Currently, in Neuromuscular Disease Units, TU is an indispensable tool. Ultrasound study of the intercostal musculature is also effective in the study of respiratory function, and is widely used in Respiratory Rehabilitation. In Intermediate Care Units, thoracic ultrasound is indispensable for patient management. In these units there are ultrasound protocols for the management of patients with acute dyspnoea that have proven to be very effective.
Topics: Humans; Pleural Effusion, Malignant; Pleurodesis; Pleural Diseases; Thoracic Diseases; Pleura
PubMed: 37996336
DOI: 10.1016/j.arbres.2023.10.009 -
Revista Do Colegio Brasileiro de... 2023thoracic trauma is defined as anything that involves the rib cage, the musculoskeletal framework that houses the heart, lungs, pleurae and mediastinal structures. It can... (Observational Study)
Observational Study
INTRODUCTION
thoracic trauma is defined as anything that involves the rib cage, the musculoskeletal framework that houses the heart, lungs, pleurae and mediastinal structures. It can be superficial or immediately lifethreatening for victims. In Brazil, most assistance is due to urban violence.
OBJECTIVE
evaluate the clinical and epidemiological aspect of patients who are victims of thoracic trauma treated at Hospital de Urgência de Sergipe, Aracaju/SE, Brazil.
METHOD
cross-sectional, observational and prospective study, carried out for eleven months, with 100 polytraumatized patients. A semi-structured form was applied, and the data were systematized, analyzed and statistically tested considering a 5% margin of error. Results: 85% of the patients were male, with a mean age of 39.3 and an age range of 30 to 49 years; 57% of them had incomplete primary education, 70% had a family income of up to 2 minimum wages and 41% were from Greater Aracaju. As for the mechanism of trauma, 33% were car-related, with blunt trauma as the main mechanism, and rib fractures as the main consequence. Among penetrating injuries, CWI (26%) and GSW (21%) were the most prevalent, with hemothorax being the main consequence. Most patients underwent thoracostomy (59%).
CONCLUSION
the profile found was of young men, victims of urban violence. The thoracostomy was resolving in most cases and should be instituted promptly when necessary. A smaller number of patients may require thoracotomy, especially in the presence of hemodynamic instability.
Topics: Adult; Female; Humans; Male; Middle Aged; Cross-Sectional Studies; Fractures, Bone; Hemothorax; Hospitals; Prospective Studies; Retrospective Studies; Thoracic Injuries; Wounds, Nonpenetrating
PubMed: 37971115
DOI: 10.1590/0100-6991e-20233542-en -
Lung India : Official Organ of Indian... 2023Computed tomography (CT)-guided biopsy is emerging as a preferred and safe method for obtaining tissue samples in pleural diseases.
BACKGROUND
Computed tomography (CT)-guided biopsy is emerging as a preferred and safe method for obtaining tissue samples in pleural diseases.
OBJECTIVE
This study aimed to evaluate the diagnostic yield and safety of percutaneous CT-guided biopsy in pleural diseases and to find CT findings predictive of malignant neoplastic pleural disease.
MATERIAL AND METHODS
This retrospective study included 77 patients with pleural disease who underwent CT-guided pleural biopsies from July 2013 to May 2020. All procedures were performed with a coaxial semi-automatic biopsy device. Histopathology was performed in all cases, and additional tests such as immunohistochemistry (IHC) or microbiological analysis were carried out depending on clinical suspicion. The correlation of CT findings with final diagnosis was performed by Chi-square, Fisher's exact test and logistic regression analysis.
RESULTS
The overall technical success rate of CT-guided pleural biopsy was 100% with a diagnostic yield of 96.1%. No major complication was encountered, with minor complications encountered in the form of minimal pneumothorax and chest pain. Malignant pleural conditions constituted the largest group including metastatic adenocarcinoma as the most common (31.2%), followed by metastatic squamous cell carcinoma and mesothelioma. Tubercular pleural involvement was the second most common category (16.9%). The cartridge-based nucleic acid amplification test (CB-NAAT) assay had 90% sensitivity on pleural tissue in tubercular cases. CT features predictive of malignancy were irregular and nodular pleural thickening, mediastinal and diaphragmatic pleural involvement and mediastinal/chest wall invasion. There was a good correlation between higher pleural thicknesses with malignant outcome.
CONCLUSION
Percutaneous CT-guided biopsy is a safe method for obtaining pleural tissue samples with high diagnostic yield. CT findings provide clues, which favour malignant pleural involvement.
PubMed: 37961959
DOI: 10.4103/lungindia.lungindia_164_23 -
Cureus Sep 2023Tuberculosis is mainly known to affect the lungs, but it can manifest at various extrapulmonary sites. Disseminated tuberculosis is a relatively rare clinical condition,...
Tuberculosis is mainly known to affect the lungs, but it can manifest at various extrapulmonary sites. Disseminated tuberculosis is a relatively rare clinical condition, and cases with no history of the disease are sparse. A case of an 18-year-old Indian male is presented. He came with complaints of chest pain, coughing with expectoration, and loss of appetite. The diagnostic workup led to a definite diagnosis of disseminated tuberculosis with involvement of the lungs, pleura, mediastinal lymph nodes, and pericardium. He was initiated on a fixed-dose anti-tubercular treatment per the national guidelines.
PubMed: 37868442
DOI: 10.7759/cureus.45562