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World Journal of Clinical Cases Jul 2022Tension pneumothorax of the contralateral lung during single-lung ventilation (SLV) combined with artificial pneumothorax can cause cardiac arrest due to bilateral...
BACKGROUND
Tension pneumothorax of the contralateral lung during single-lung ventilation (SLV) combined with artificial pneumothorax can cause cardiac arrest due to bilateral pneumothorax. If not rapidly diagnosed and managed, this condition can lead to sudden death. We describe the emergency handling procedures and rapid diagnostic methods for this critical emergency situation.
CASE SUMMARY
We report a case of bilateral pneumothorax in a neonatal patient who underwent thoracoscopic esophageal atresia and tracheoesophageal fistula repair under the combined application of SLV and artificial pneumothorax. The patient suffered sudden cardiac arrest and received emergency treatment to revive her. The recognition of dangerous vital sign parameters, rapid evacuation of the artificial pneumothorax, and initiation of lateral position cardiopulmonary resuscitation while simultaneously removing the endotracheal tube to the main airway are critically important. Moreover, even though the sinus rhythm was restored, the patient's continued tachycardia, reduced pulse pressure, and depressed pulse oximeter waveform were worrisome. We should highly suspect the possibility of pneumothorax and use rapid diagnostic methods to make judgment calls. Sometimes thoracoscopy can be used for rapid examination; if the mediastinum is observed to be shifted to the right, it may indicate tension pneumothorax. This condition can be immediately relieved by needle thoracentesis, ultimately allowing the safe completion of the surgical procedure.
CONCLUSION
Bilateral pneumothorax during SLV combined with artificial pneumothorax is rare but can occur at any time in neonatal thoracoscopic surgery. Therefore, anesthesiologists should consider this possibility, be alert, and address this rare but critical complication in a timely manner.
PubMed: 36158024
DOI: 10.12998/wjcc.v10.i21.7592 -
International Journal of Surgery Case... Oct 2022Diaphragmatic injuries are a consequence of penetrating or blunt thoracoabdominal trauma. Minor injuries are often masked. However, they are easily picked in the...
INTRODUCTION
Diaphragmatic injuries are a consequence of penetrating or blunt thoracoabdominal trauma. Minor injuries are often masked. However, they are easily picked in the presence of diaphragmatic herniations. Delayed presentation is associated with the influx of visceral contents into the thoracic cavity, which may cause strangulation and obstruction. Viscerothorax is a rare complication of diaphragmatic injuries.
PRESENTATION OF CASE
A case report of a 25-year-old male patient with a history of penetrating chest injury. He presented to our setting with a sharp abdominal pain and episodes of vomiting that were later accompanied by chest pains and difficulty breathing. A CT scan revealed the presence of a left hemidiaphragmatic injury with a viscerothorax and mediastinal shift to the right side. Surgery was immediately done and with a good postoperative outcome.
DISCUSSION
Diaphragmatic injuries are still uncommon and are often overlooked in initial presentations. The presence of herniation through the defect prompts early diagnosis. Delayed presentations of these injuries are often affiliated with herniations that may be strangulating or obstructing with more severe complications such as viscerothorax causing tension into the thoracic cavity.
CONCLUSION
The approach to diaphragmatic injuries at their initial presentation must be handled with an excellent index of suspicion in the evaluation of trauma victims to reduce management delay and avoid detrimental complications in contrast to the involvement of other associated injuries such as haemothorax, rib fractures, and visceral injuries. Early defect diagnosis followed by definitive surgical repair is the most favoured approach.
PubMed: 36148753
DOI: 10.1016/j.ijscr.2022.107688 -
The British Journal of Radiology Dec 2022Intrathoracic fat-containing lesions may arise in the mediastinum, lungs, pleura, or chest wall. While CT can be helpful in the detection and diagnosis of these lesions,... (Review)
Review
Intrathoracic fat-containing lesions may arise in the mediastinum, lungs, pleura, or chest wall. While CT can be helpful in the detection and diagnosis of these lesions, it can only do so if the lesions contain scopic fat. Furthermore, because CT cannot demonstrate microscopic or intravoxel fat, it can fail to identify and diagnose microscopic fat-containing lesions. MRI, employing spectral and chemical shift fat suppression techniques, can identify both macroscopic and microscopic fat, with resultant enhanced capability to diagnose these intrathoracic lesions non-invasively and without ionizing radiation. This paper aims to review the CT and MRI findings of fat-containing lesions of the chest and describes the fat-suppression techniques utilized in their assessment.
Topics: Humans; Tomography, X-Ray Computed; Magnetic Resonance Imaging; Mediastinum; Thoracic Wall; Pleura
PubMed: 36125174
DOI: 10.1259/bjr.20220235 -
Cureus Aug 2022A 32-year-old male presented to the hospital with chief complaints of fever, cough, and breathlessness for the past 4 days and was found to be positive for severe acute...
A 32-year-old male presented to the hospital with chief complaints of fever, cough, and breathlessness for the past 4 days and was found to be positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). On arrival at the hospital, the patient required supplemental oxygen. In addition, injection enoxaparin 80 mg subcutaneous twice a day and injection methylprednisolone 40 mg IV twice a day were administered for 10 days. Following this, the patient reported symptomatic improvement and was shifted to the ward with O2 @ 2 L/min through nasal prongs. However, the same evening he complained of right-sided pleuritic chest pain and developed worsening hypoxemia. CT scan of the thorax confirmed the presence of hydropneumothorax with a mediastinal shift to the left side. An intercostal drain (ICD) was placed after shifting him to the intensive care unit (ICU); pleural fluid sent for analysis confirmed the presence of a secondary bacterial infection for which he was treated with appropriate parenteral antibiotics.
PubMed: 36106207
DOI: 10.7759/cureus.27827 -
Radiotherapy and Oncology : Journal of... Oct 2022Image-guided radiotherapy using cone beam-CT (CBCT) images is used to evaluate patient anatomy and positioning before radiotherapy. In this study we analyzed and...
BACKGROUND AND PURPOSE
Image-guided radiotherapy using cone beam-CT (CBCT) images is used to evaluate patient anatomy and positioning before radiotherapy. In this study we analyzed and optimized a traffic light protocol (TLP) used in lung cancer patients to identify patients requiring treatment adaptation.
MATERIALS AND METHODS
First, CBCT review requests of 243 lung cancer patients were retrospectively analyzed and divided into 6 pre-defined categories. Frequencies and follow-up actions were scored. Based on these results, the TLP was optimized and evaluated in the same way on 230 patients treated in 2018.
RESULTS
In the retrospective study, a total of 543 CBCT review requests were created during treatment in 193/243 patients due to changed anatomy of lung (24%), change of tumor volume (24%), review of match (18%), shift of the mediastinum (15%), shift of tumor (15%) and other (4%). The majority of requests (474, 87%) did not require further action. In 6% an adjustment of the match criteria sufficed; in 7% treatment plan adaptation was required. Plan adaptation was frequently seen in the categories changed anatomy of lung, change of tumor volume and shift of tumor outside the PTV. Shift of mediastinum outside PRV and shift of GTV outside CTV (but inside PTV) never required plan adaptation and were omitted to optimize the TLP, which reduced the CBCT review requests by 23%.
CONCLUSIONS
The original TLP selected patients that required a treatment adaptation, but with a high false positive rate. The optimized TLP reduced the amount of CBCT review requests, while still correctly identifying patients requiring adaptation.
Topics: Humans; Radiotherapy, Image-Guided; Retrospective Studies; Radiotherapy Planning, Computer-Assisted; Workflow; Lung Neoplasms; Cone-Beam Computed Tomography; Radiotherapy Dosage; Radiotherapy, Intensity-Modulated
PubMed: 36067908
DOI: 10.1016/j.radonc.2022.08.030 -
International Journal of Surgery Case... Sep 2022Lipoma is a benign tumor that arises from adipose tissue; subcutaneous fat is the most common site. It is the most common soft tissue tumor in adulthood. They are...
INTRODUCTION AND IMPORTANCE
Lipoma is a benign tumor that arises from adipose tissue; subcutaneous fat is the most common site. It is the most common soft tissue tumor in adulthood. They are usually curable with simple excision. They are slow growing and can rarely become cancerous. Lipomatosis is when there are multiple lipomas with different pedicles. Lipomas arising from the thoracic pleura are rare and intrathoracic lipomatosis is exceptionally rare. Here we report a case of huge lipomatosis removed from the right pleural cavity in a 65 years old man.
CASE PRESENTATION
A 65 years old male from southern region of Ethiopia, presented with shortness of breath associated with chest pain, productive cough, easy fatigability, and dyspnea on exertion. On exams, he had dullness on chest percussion and absent air entry on the right hemichest on auscultation. He had a history of treatment for pulmonary tuberculosis seven years back. Chest CT showed huge lobulated heterogeneous mass in the right pleural space with significant mediastinal shift to the left. All the large and small masses were removed by a thoracotomy and the specimen was subjected to histopathology examination which revealed myxoid lipoma.
DISCUSSION
Lipoma is a benign tumor with no risk of malignant transformation. Intrathoracic lipoma is quite rare that we don't really find much reported cases.
CONCLUSION
Intrathoracic lipomatosis is a rare condition that progresses without symptoms until it reaches a big size, at which point compressive symptoms appear. The primary approach for both diagnostic and therapeutic purposes continues to be surgical resection.
PubMed: 36067533
DOI: 10.1016/j.ijscr.2022.107565 -
Case Reports in Pulmonology 2022A 50-year-old woman with a history of systemic lupus erythematosus and a recent infection with COVID-19 presented to the emergency department with acute shortness of...
A 50-year-old woman with a history of systemic lupus erythematosus and a recent infection with COVID-19 presented to the emergency department with acute shortness of breath twice in 10 days. She was diagnosed with myopericarditis attributed to COVID-19 infection (first admission), and chest X-ray revealed a small left-sided pneumothorax, pericardial effusion (second admission), with no mediastinal shift or other signs of tension. Computed tomography confirmed these results and revealed a few small cysts in the right lung. An echocardiogram demonstrated normal heart anatomy and filling dynamics. The patient was diagnosed with simple pneumothorax and ongoing myopericarditis managed with colchicine, ibuprofen, and low-dose prednisolone. The patient responded to treatment and was discharged. Pneumothorax association with COVID-19 is reported in a small number of publications, but the association is less clear with SLE. Our patient may have been predisposed to developing pneumothorax after COVID-19 infection due to her existing connective tissue disorder.
PubMed: 36046751
DOI: 10.1155/2022/9594063 -
Rhode Island Medical Journal (2013) Sep 2022A 57-year-old man with a history of right pneumonectomy for squamous cell lung cancer who presented with dyspnea and hypotension, was found to have pericardial effusion...
A 57-year-old man with a history of right pneumonectomy for squamous cell lung cancer who presented with dyspnea and hypotension, was found to have pericardial effusion complicated by cardiac tamponade, associated with pembrolizumab therapy. Pericardiocentesis could not be safely attempted due to presence of right-sided mediastinal tissue shift in the setting of previous right pneumonectomy. The patient improved significantly with surgical placement of pericardial window. Analysis of the pericardial fluid was negative for malignancy and was consistent with acute inflammation. Pembrolizumab and other immune checkpoint inhibitors are associated with cardiovascular toxicity, including pericardial effusion and in rare cases, cardiac tamponade. Treatment of cardiac tamponade in post-pneumonectomy patients may be subject to anatomical limitations precluding percutaneous pericardiocentesis and requires early recognition as well as availability of surgical intervention.
Topics: Antibodies, Monoclonal, Humanized; Antineoplastic Agents, Immunological; Cardiac Tamponade; Humans; Immune Checkpoint Inhibitors; Lung Neoplasms; Male; Middle Aged; Pericardial Effusion; Pneumonectomy
PubMed: 36041021
DOI: No ID Found -
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 -
Children (Basel, Switzerland) Jul 2022Consensus on the optimal management of asymptomatic congenital pulmonary airway malformation (CPAM) is lacking, and comparison between studies remains difficult due to a...
Consensus on the optimal management of asymptomatic congenital pulmonary airway malformation (CPAM) is lacking, and comparison between studies remains difficult due to a large variety in outcome measures. We aimed to define a core outcome set (COS) for pediatric patients with an asymptomatic CPAM. An online, three-round Delphi survey was conducted in two stakeholder groups of specialized caregivers (surgeons and non-surgeons) in various European centers. Proposed outcome parameters were scored according to level of importance, and the final COS was established through consensus. A total of 55 participants (33 surgeons, 22 non-surgeons) from 28 centers in 13 European countries completed the three rounds and rated 43 outcome parameters. The final COS comprises seven outcome parameters: respiratory insufficiency, surgical complications, mass effect/mediastinal shift (at three time-points) and multifocal disease (at two time-points) The seven outcome parameters included in the final COS reflect the diversity in priorities among this large group of European participants. However, we recommend the incorporation of these outcome parameters in the design of future studies, as they describe measurable and validated outcomes as well as the accepted age at measurement.
PubMed: 36010044
DOI: 10.3390/children9081153