-
Frontiers in Cellular and Infection... 2024Mucormycosis is an uncommon invasive fungal infection that has a high mortality rate in patients with severe underlying diseases, which leads to immunosuppression. Due...
BACKGROUND
Mucormycosis is an uncommon invasive fungal infection that has a high mortality rate in patients with severe underlying diseases, which leads to immunosuppression. Due to its rarity, determining the incidence and optimal treatment methods for mucormycosis in children is challenging. Metagenomic next-generation sequencing (mNGS) is a rapid, precise and sensitive method for pathogen detection, which helps in the early diagnosis and intervention of mucormycosis in children. In order to increase pediatricians' understanding of this disease, we conducted a study on the clinical features of mucormycosis in children and assessed the role of mNGS in its diagnosis.
METHODS
We retrospectively summarized the clinical data of 14 children with mucormycosis treated at the First Affiliated Hospital of Zhengzhou University from January 2020 to September 2023.
RESULTS
Of the 14 cases, 11 case of mucormycosis were classified as probable, and 3 cases were proven as mucormycosis. Most children (85.71%) had high-risk factors for mucormycosis. All 14 children had lung involvement, with 5 cases of extrapulmonary dissemination. Among the 14 cases, 4 cases underwent histopathological examination of mediastinum, lung tissue or kidney tissue, in which fungal pathogens were identified in 3 patients. Fungal hyphae was identified in 3 cases of mucormycosis, but only 1 case yielded a positive culture result. All patients underwent mNGS testing with samples from blood (8/14), bronchoalveolar lavage fluid (6/14), and tissue (1/14). mNGS detected fungi in all cases: 7 cases had , 4 cases had , 3 cases had , 1 case had , and 1 case had . Coinfections were found with in 3 cases, bacteria in 3 cases, and viruses in 5 cases.
CONCLUSION
Children with mucormycosis commonly exhibit non-specific symptoms like fever and cough during the initial stages. Early diagnosis based on clinical symptoms and imaging is crucial in children suspected of having mucormycosis. mNGS, as a supplementary diagnostic method, offers greater sensitivity and shorter detection time compared to traditional mucormycosis culture or histopathological testing. Additionally, mNGS enables simultaneous detection of bacteria and viruses, facilitating timely and appropriate administration of antibiotics and thereby enhancing patient outcomes.
Topics: Humans; Mucormycosis; High-Throughput Nucleotide Sequencing; Male; Female; Child; Child, Preschool; Metagenomics; Retrospective Studies; Infant; Adolescent; Invasive Fungal Infections; China
PubMed: 38915923
DOI: 10.3389/fcimb.2024.1368165 -
ACG Case Reports Journal Jun 2024Pancreatitis is an inflammatory pancreatic disease; common etiologies include infection, anatomic abnormalities, biliary, inborn errors of metabolism, trauma, and rarely...
Pancreatitis is an inflammatory pancreatic disease; common etiologies include infection, anatomic abnormalities, biliary, inborn errors of metabolism, trauma, and rarely malignancy. Primary mediastinal large B-cell lymphoma commonly presents in younger women with principally mediastinal involvement. We report the first documented case of a pediatric patient presenting with acute pancreatitis secondary to metastatic primary mediastinal large B-cell lymphoma. Since diagnosis, the patient underwent a combination of chemotherapy and immunotherapy treatments, and the tumor burden had decreased significantly. Malignancy is a rare documented presentation of acute pancreatitis in the pediatric population, and it should be included in a broad differential diagnosis.
PubMed: 38912377
DOI: 10.14309/crj.0000000000001394 -
ACG Case Reports Journal Jun 2024Inferior phrenic artery (IPA) aneurysms are the rarest type of visceral aneurysms. It usually occurs secondary to trauma, surgery, or as a complication of pancreatitis....
Inferior phrenic artery (IPA) aneurysms are the rarest type of visceral aneurysms. It usually occurs secondary to trauma, surgery, or as a complication of pancreatitis. In addition, it can be a manifestation of underlying systemic pathology such as vasculitis, collagen vascular disorders, sepsis, or segmental arterial mediolysis. It can be associated with hypertension in 43% of cases. The presentation of IPA aneurysm is nonspecific with abdominal pain, melena, hematochezia, and anemia. The ruptured and actively bleeding aneurysm can lead to hemorrhagic shock, and immediate management is required with angiography and endovascular embolization with coil or gel foam or stent etc. Inaccessible locations are reached with surgical intervention, but it is associated with high morbidity and mortality. We here report a rare case of spontaneously ruptured IPA pseudoaneurysm extending from the posterior mediastinum to the subdiaphragmatic area and managed with coil and gel foam embolization.
PubMed: 38912373
DOI: 10.14309/crj.0000000000001395 -
Frontiers in Oncology 2024SMARCA4-deficient undifferentiated thoracic tumor (SMARCA4-UT) is a rare malignant tumor characterized by inactivation of the gene and the presence of undifferentiated...
SMARCA4-deficient undifferentiated thoracic tumor (SMARCA4-UT) is a rare malignant tumor characterized by inactivation of the gene and the presence of undifferentiated or rhabdoid morphology in the tissue. This tumor is highly invasive, typically diagnosed at advanced stages III or IV, and commonly involves thoracic structures, such as the mediastinum and chest wall. Reported cases are limited and treatment guidelines have not yet been established. Here, we present a rare case of surgically treated non-metastatic SMARCA4-UT. The patient presented with blood-tinged sputum, dyspnea, and a history of heavy smoking, and underwent surgery after preoperative evaluation ruled out contraindications. The tumor was successfully removed along with the relevant lymph nodes; analysis determined it to be stage IIB T3N0M0. No recurrence was detected at two months post-surgery. However, four months after surgery, the tumor recurred and invaded the adjacent ribs. The diagnosis, differential diagnosis, and treatment of SMARCA4-deficient undifferentiated lung tumors is considered. The combination of chemotherapy and immunotherapy has shown efficacy, and other treatments such as anti-angiogenic drugs, histone deacetylase inhibitors (HDACi), enhancer of zeste 2 polycomb repressive complex 2 subunit (EZH2) inhibitors, and oxidative phosphorylation (OXPHOS) inhibitors may also be beneficial in treating SMARCA4-UT.
PubMed: 38903719
DOI: 10.3389/fonc.2024.1399868 -
Cureus May 2024Celiac artery compression syndrome is not frequent in the pediatric population. The syndrome may entail long-standing abdominal pain, recurrent vomiting,...
Celiac artery compression syndrome is not frequent in the pediatric population. The syndrome may entail long-standing abdominal pain, recurrent vomiting, bloating, weight loss, and an abdominal bruit, which in the case of our patient, was an incidental finding. Notably, patients may be asymptomatic. Our patient is a 16-year-old male who presented with concerns about multiple, non-tender chest lymph nodes lasting for two weeks. He had also lost 80 lbs. over one year. On examination, however, an abdominal bruit was discovered, and a diagnostic workup was significant for celiac artery compression following a magnetic resonance angiography of the abdomen. Due to his significant weight loss and mediastinal lymphadenopathy, a chest computed tomography (CT) scan was done to rule out malignancy. The chest CT scan was reported as normal. Additionally, a renal duplex ultrasound was done to rule out renal artery stenosis, considering he had presented with elevated blood pressure; this was also unremarkable. Although this patient had a history of marijuana use, his assessment did not show marked dependence. Substance abuse and atherosclerotic vascular disease can be predisposing factors for celiac artery compression syndrome in older individuals. However, compression of the celiac trunk by the median arcuate ligament is a congenital anomaly more appreciated in younger age groups. The patient was referred to vascular surgery for possible median arcuate ligament release.
PubMed: 38894788
DOI: 10.7759/cureus.60580 -
Journal of Thoracic Disease May 2024Pulmonary artery periadventitial hematoma (PAPH) with aortic dissection (AD) is a rare condition but has been reported to correlate with prognosis. However, there are...
BACKGROUND
Pulmonary artery periadventitial hematoma (PAPH) with aortic dissection (AD) is a rare condition but has been reported to correlate with prognosis. However, there are few cases of PAPH, and the relationship with computed tomography (CT) findings of AD are unknown. This study aimed to evaluate CT findings and early prognosis in patients with PAPH in AD.
METHODS
This was a retrospective analysis of data from patients with Stanford type A AD diagnosed with contrast-enhanced CT in our institution from April 2008 to February 2023; 316 patients were included in the analyses. Patients comprised a PAPH group (n=78) and a non-PAPH group (n=238). The PAPH group was further divided into a group that died within 1 week of onset (death group; n=15) and a group that survived (alive group; n=63). PAPH was classified into three grades on the basis of the CT findings, as follows: Grade 1: PAPH only in the mediastinum; Grade 2: PAPH that extended into the lung field, with/without interlobular septa; and Grade 3: PAPH with pulmonary hemorrhage.
RESULTS
Compared with the non-PAPH group, the PAPH group had higher rates of early death (P=0.001), pericardial (P<0.001) and mediastinal hemorrhage (P<0.001). When comparing the death and alive groups, there was a significant difference in the rates of inoperable case (P<0.001), Grade 3 PAPH (PAPH with pulmonary hemorrhage) (P<0.001), and hemothorax (P=0.02). Multivariable analysis showed a significant association between Grade 3 PAPH (PAPH with pulmonary hemorrhage) and early death (P=0.004).
CONCLUSIONS
Standard type A AD with PAPH is not rare. Mortality was higher in the PAPH group . the non-PAPH group, and Grade 3 PAPH (PAPH with pulmonary hemorrhage) was a significant risk factor for early death.
PubMed: 38883683
DOI: 10.21037/jtd-23-1914 -
Mediastinum (Hong Kong, China) 2024Giant anterior mediastinal tumors sometimes may cause circulatory collapse and respiratory failure, known as mediastinal mass syndrome (MMS). The prediction and... (Review)
Review
BACKGROUND AND OBJECTIVE
Giant anterior mediastinal tumors sometimes may cause circulatory collapse and respiratory failure, known as mediastinal mass syndrome (MMS). The prediction and prevention of MMS is challenging. The aim of this study is to summarize the evaluation methods for MMS and formulate treatment strategies for giant anterior mediastinal tumors.
METHODS
We performed a thorough analysis of recent international literature on giant anterior mediastinal tumors (>10 cm in diameter) and MMS published in the PubMed database. The search spanned the duration of the preceding 10 years from August 19, 2023, and only studies published in English were included.
KEY CONTENT AND FINDINGS
Mature teratomas and liposarcomas are the most common giant anterior mediastinal tumors and MMS develops most frequently in case of malignant lymphomas. Here, we propose a new treatment strategy for giant anterior mediastinal tumors. Based on imaging findings, giant anterior mediastinal tumors can be classified as cystic or solid and further blood investigation data are useful for a definitive diagnosis. When malignant lymphoma or malignant germ cell tumor is highly suspected, the first choice of treatment is not surgery but chemotherapy and radiotherapy. Moreover, image-guided drainage may be effective if giant cystic anterior tumors develop into MMS. The risk classification of MMS is important for treating giant anterior mediastinal tumors. If the MMS risk classification is 'unsafe' or 'uncertain', the intraoperative management deserves special attention. The surgical approach should however be based on tumor localization and invasion of surrounding tissues. Multidisciplinary team coordination is indispensable in the treatment of giant anterior mediastinal tumors.
CONCLUSIONS
When giant anterior mediastinal tumors are encountered, it is important to follow the appropriate treatment strategy, focusing on the development of MMS based on imaging findings and symptoms.
PubMed: 38881815
DOI: 10.21037/med-23-40 -
Mediastinum (Hong Kong, China) 2024Thymectomy with median sternotomy is the gold standard for thymoma and myasthenia gravis, although minimally invasive procedures such as robot-assisted surgery have... (Review)
Review
BACKGROUND AND OBJECTIVE
Thymectomy with median sternotomy is the gold standard for thymoma and myasthenia gravis, although minimally invasive procedures such as robot-assisted surgery have recently become more common. However, the superiority of these approaches has not been established, and they are infrequently recommended for localized lesions. The International Thymic Malignancies Interest Group warned that despite the perceived reduction in length of hospital stay and pain, the benefits of these approaches compared to the open approach have not been fully substantiated and that prospective collaborative data collection is critical in defining the value of these techniques. Whether thymectomy is necessary for stage I thymomas in the absence of myasthenia gravis or anti-acetylcholine receptor antibodies is also unclear. This study reviews and discusses the literature on this subject.
METHODS
A narrative review was conducted using PubMed and Scopus databases. Original research articles comparing robotic to video-assisted thoracic surgery or to open thymectomy for thymomas were included. A comparison of partial resection and total thymectomy (thymothymectomy) for thymomas was also conducted.
KEY CONTENT AND FINDINGS
Perioperative outcomes such as blood loss, operative duration, complications, and length of hospital stay were better for robot-assisted resection of early-stage thymomas than for open thymoma surgery. It would be premature to consider partial resection as an appropriate treatment option for thymomas.
CONCLUSIONS
Robotic thymothymectomy is safe with effective and promising long-term results and oncological and surgical outcomes in patients with thymoma. Robotic thymectomy can become the standard procedure in patients with early-stage thymomas.
PubMed: 38881811
DOI: 10.21037/med-23-37 -
Radiology Case Reports Aug 2024A 51-year-old male presented to our tertiary referral hospital with progressive shortness of breath and orthopnea. A computed tomography (CT) of the chest was performed...
A 51-year-old male presented to our tertiary referral hospital with progressive shortness of breath and orthopnea. A computed tomography (CT) of the chest was performed that showed a large cystic middle mediastinal mass. Magnetic resonance imaging (MRI) of the chest demonstrated a large, well-circumscribed, T2-hyperintense cystic middle mediastinal mass resulting in significant compression of the trachea, brachiocephalic artery, superior vena cava, and azygos vein. The patient subsequently developed a right hemispheric stroke due to compression of the brachiocephalic artery and was too clinically unstable to undergo or definitive operative management of the mediastinal cyst. Percutaneous CT-guided aspiration of the cystic middle mediastinal mass was performed, with successful decompression resulting transient improvement in mass-effect on the surrounding mediastinal structures. Six days after successful aspiration of the mass, the patient underwent attempted bronchoscopy for management of tracheobronchial secretions which was complicated by massive pulmonary hemorrhage leading to cardiopulmonary arrest and death. An autospy was conducted, revealing pathological finding consistent with a mature cystic teratoma.
PubMed: 38872748
DOI: 10.1016/j.radcr.2024.05.004 -
Frontiers in Surgery 2024Although the robotic surgical system has accumulated rich experience in the development of thoracic surgery, its application in Tibet area is relatively late. We report...
OBJECTIVE
Although the robotic surgical system has accumulated rich experience in the development of thoracic surgery, its application in Tibet area is relatively late. We report our experience concerning da Vinci Xi system in thoracic surgery and observe its practicability and surgical effect.
METHODS
We retrospectively analyzed 26 patients who underwent robotic thoracic surgery including: twelve lung resection, two esophagectomies, ten mediastinal surgeries and two rib mass resection. The data of patient characteristics, operative time, perioperative complications were collected.
RESULTS
Of the 26 patients, 22 cases were completed with da Vinci system successfully, including 7 segmentectomies, 4 lobectomies, 1 subsegmentectomy, 2 esophagectomies, 10 mediastinal surgeries (6 thymic resections, 3 posterior mediastinal tumor resection, 1 mediastinal cyst resection) and 2 rib mass resection. In which, 3 cases of lung resection begun with robotic technique were converted to thoracoscopic surgery (due to calcification of hilar lymph node), 1 case of bilobectomy was converted to thoracotomy due to thoracic adhesion. All the operations went well and no patients need blood transfusion. All patients had satisfactory postoperative recovery.
CONCLUSION
It is safe, reliable and effective to carry out robotic thoracic surgery on the plateau. On the premise of carefully and seriously discussing the indications of surgery, we should actively carry out the application of da Vinci robotic surgery system in Tibet Plateau.
PubMed: 38872721
DOI: 10.3389/fsurg.2024.1415704