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BMC Pediatrics Oct 2023The etiology of Plastic bronchitis (PB) is unknown. The incidence of pulmonary infection associated with PB has increased year by year, but respiratory syncytial virus...
BACKGROUND
The etiology of Plastic bronchitis (PB) is unknown. The incidence of pulmonary infection associated with PB has increased year by year, but respiratory syncytial virus (RSV) as a pathogen causes PB has rarely been reported.
CASE PRESENTATION
A 2-year-old immunocompromised girl was admitted to the hospital with cough, fever for 5 days, and aggravated with shortness of breath for 1 day. With mechanical ventilation, her respiratory failure was not relieved, and subcutaneous emphysema and mediastinal pneumatosis appeared. Extracorporeal membrane oxygenation (ECMO) was administrated, but the tidal volume was low. Therefore, a bronchoscopy was performed, by which plastic secretions were found and removed. Pathology of the plastic secretions confirmed the diagnosis of type I PB. RSV was the only positive pathogen in the alveolar lavage fluid by the next-generation sequencing test. After the bronchoscopic procedure, her dyspnea improved. The patient was discharged with a high-flow nasal cannula, with a pulse oxygen saturation above 95%. Half a year after discharge, she developed sequelae of bronchitis obliterans.
CONCLUSION
RSV could be an etiology of PB, especially in an immunocompromised child. In a patient with pulmonary infection, if hypoxemia is presented and unresponded to mechanical ventilation, even ECMO, PB should be considered, and bronchoscopy should be performed as soon as possible to confirm the diagnosis and to treat.
Topics: Child, Preschool; Female; Humans; Bronchitis; Bronchoalveolar Lavage Fluid; Dyspnea; Respiratory Insufficiency; Respiratory Syncytial Virus Infections; Respiratory Syncytial Virus, Human
PubMed: 37848827
DOI: 10.1186/s12887-023-04351-0 -
Therapeutic Advances in Pulmonary and... 2023Spontaneous pneumomediastinum (SPM) is the presence of air in the mediastinal interstices in the absence of any surgical or medical procedure, chest trauma, or...
Spontaneous pneumomediastinum (SPM) is the presence of air in the mediastinal interstices in the absence of any surgical or medical procedure, chest trauma, or mechanical ventilation. SPM can occur during vigorous Valsalva maneuvers, such as weight lifting, coughing fits, hyperemesis gravidarum, and so on, or during inhalation of illicit substances or toxic agents, as a result of an abrupt increase in pressure in the tracheal tree. Preexisting underlying lung disease may be a contributing factor. In the present case, we report for the first time an SPM due to accidental overexposure to paint thinner in a 15-year-old male from a low-income rural family. He was offered a job painting the inside of a house, which he accepted to earn some money for the family household. However, due to his inexperience, he overdosed on a can of paint with thinner. About 2 h after starting work, he began to feel increasingly severe chest pain and had to be rushed to the local level one basic hospital by his parents. Physical examination revealed subcutaneous emphysema over the supraclavicular area and crackles in the precordial area. Chest radiographs showed a pneumomediastinum. In retrospect, the patient denied coughing or sneezing attacks after exposure. He was transferred to a regional tertiary hospital for further diagnostic evaluation to rule out airway/esophageal perforation. Chest computed tomography confirmed underlying SPM and subcutaneous emphysema. The oesophagogram and bronchoscopy were unremarkable. SPM, possibly secondary to overexposure to thinner vapors, a hydrocarbon-based compound, was the final diagnosis. The patient was discharged asymptomatic on day 5.
PubMed: 37822328
DOI: 10.1177/11795484231201751 -
Cureus Sep 2023Background Chest X-rays (CXRs) are widely used for cost-effective screening of active pulmonary tuberculosis despite their limitations in sensitivity and specificity...
Background Chest X-rays (CXRs) are widely used for cost-effective screening of active pulmonary tuberculosis despite their limitations in sensitivity and specificity when interpreted by clinicians or radiologists. To address this issue, computer-aided detection (CAD) algorithms, particularly deep learning architectures based on convolution, have been developed to automate the analysis of radiography imaging. Deep learning algorithms have shown promise in accurately classifying lung abnormalities using chest X-ray images. In this study, we utilized the EfficientNet B4 model, which was pre-trained on ImageNet with 380x380 input dimensions, using its weights for transfer learning, and was modified with a series of components including global average pooling, batch normalization, dropout, and a classifier with 12 image-wise and 44 segment-wise lung zone evaluation classes using sigmoid activation. Objectives Assess the clinical usefulness of our previously created EfficientNet B4 model in identifying lung zone-specific abnormalities related to active tuberculosis through an observer performance test involving a skilled clinician operating in tuberculosis-specific environments. Methods The ground truth was established by a radiologist who examined all sample CXRs to identify lung zone-wise abnormalities. An expert clinician working in tuberculosis-specific settings independently reviewed the same CXR with blinded access to the ground truth. Simultaneously, the CXRs were classified using the EfficientNet B4 model. The clinician's assessments were then compared with the model's predictions, and the agreement between the two was measured using the kappa coefficient, evaluating the model's performance in classifying active tuberculosis manifestations across lung zones. Results The results show a strong agreement (Kappa ≥0.81) seen for lung zone-wise abnormalities of pneumothorax, mediastinal shift, emphysema, fibrosis, calcifications, pleural effusion, and cavity. Substantial agreement (Kappa = 0.61-0.80) for cavity, mediastinal shift, volume loss, and collapsed lungs. The Kappa score for lung zone-wise abnormalities is moderate (0.41-0.60) for 39% of cases. In image-wise agreement, the EfficientNet B4 model's performance ranges from moderate to almost perfect across categories, while in lung zone-wise agreement, it varies from fair to almost perfect. The results show strong agreement between the EfficientNet B4 model and the human reader in detecting lung zone-wise and image-wise manifestations. Conclusion The clinical utility of the EfficientNet B4 models to detect the abnormalities can aid clinicians in primary care settings for screening and triaging tuberculosis where resources are constrained or overburdened.
PubMed: 37818499
DOI: 10.7759/cureus.44954 -
European Journal of Cardio-thoracic... Oct 2023Screening for lung cancer with low radiation dose computed tomography has a strong evidence base, is being introduced in several European countries and is recommended as... (Review)
Review
BACKGROUND
Screening for lung cancer with low radiation dose computed tomography has a strong evidence base, is being introduced in several European countries and is recommended as a new targeted cancer screening programme. The imperative now is to ensure that implementation follows an evidence-based process that will ensure clinical and cost effectiveness. This European Respiratory Society (ERS) task force was formed to provide an expert consensus for the management of incidental findings which can be adapted and followed during implementation.
METHODS
A multi-European society collaborative group was convened. 23 topics were identified, primarily from an ERS statement on lung cancer screening, and a systematic review of the literature was conducted according to ERS standards. Initial review of abstracts was completed and full text was provided to members of the group for each topic. Sections were edited and the final document approved by all members and the ERS Science Council.
RESULTS
Nine topics considered most important and frequent were reviewed as standalone topics (interstitial lung abnormalities, emphysema, bronchiectasis, consolidation, coronary calcification, aortic valve disease, mediastinal mass, mediastinal lymph nodes and thyroid abnormalities). Other topics considered of lower importance or infrequent were grouped into generic categories, suitable for general statements.
CONCLUSIONS
This European collaborative group has produced an incidental findings statement that can be followed during lung cancer screening. It will ensure that an evidence-based approach is used for reporting and managing incidental findings, which will mean that harms are minimised and any programme is as cost-effective as possible.
Topics: Humans; Lung Neoplasms; Early Detection of Cancer; Expressed Sequence Tags; Incidental Findings; Tomography, X-Ray Computed
PubMed: 37804174
DOI: 10.1093/ejcts/ezad302 -
Case Reports in Anesthesiology 2023Tracheal diverticulum (TD) is a rare disease. Due to the worldwide pandemic of COVID-19, the increase of routine preoperative chest CT examination has led to a higher...
Tracheal diverticulum (TD) is a rare disease. Due to the worldwide pandemic of COVID-19, the increase of routine preoperative chest CT examination has led to a higher detection rate of TD. Although TD is very rare, it is one of the reasons for difficult intubation and difficult ventilation. Improper treatment can cause severe airway emergencies such as diverticulum tearing, tracheal rupture, and subcutaneous or mediastinal emphysema. Unfortunately, there are few studies on TD, especially in perioperative airway and anesthesia management. This paper reports a case of TD found by preoperative chest CT examination who required tracheal intubation under general anesthesia. For the first time, ultrasound was used to confirm the position of tracheal tube and TD, and good results were achieved. This attempt provides a new idea and method for airway management in patients with TD.
PubMed: 37767048
DOI: 10.1155/2023/5586490 -
The Journal of International Medical... Sep 2023Hamman's syndrome is a rare clinical entity that presents with spontaneous pneumomediastinum and subcutaneous emphysema. It is most commonly diagnosed in young men and...
Hamman's syndrome is a rare clinical entity that presents with spontaneous pneumomediastinum and subcutaneous emphysema. It is most commonly diagnosed in young men and pregnant women, and is rare in children. We report the case of a female toddler who presented to an emergency department with fever, cough and shortness of breath. Imaging studies revealed subcutaneous emphysema and pneumomediastinum. The patient was diagnosed with Hamman's syndrome after ruling out other possibilities. We discuss the underlying mechanisms of the disease, the diagnostic criteria and the treatment options. The purpose of this case report is to improve clinicians' awareness of the existence of this rare clinical entity in paediatric patients.
Topics: Pregnancy; Male; Humans; Child; Female; Mediastinal Emphysema; Subcutaneous Emphysema; Cough; Dyspnea; Emergency Service, Hospital; Syndrome
PubMed: 37747498
DOI: 10.1177/03000605231200269 -
Ear, Nose, & Throat Journal Sep 2023Foreign body aspiration into the trachea is a common occurrence in children. While most foreign bodies in the airways can be removed using rigid tracheoscopy, there are...
BACKGROUND
Foreign body aspiration into the trachea is a common occurrence in children. While most foreign bodies in the airways can be removed using rigid tracheoscopy, there are instances where tracheostomy or tracheotomy is needed. This article presents a series of cases in which tracheostomy was necessary to remove foreign bodies, and summarizes the relevant experiences and lessons learned.
METHODS
We reviewed a total of 7 cases in which tracheostomy and rigid tracheoscopy were combined for foreign body removal out of a larger cohort of 1559 cases at Shenzhen Children's Hospital in Guangdong, China over a 20-year period.
RESULTS
The combined use of tracheostomy and rigid tracheoscopy resulted in successful removal of foreign bodies in all 7 patients reviewed in this study. Six patients developed complications of tracheotomy, mainly including mediastinal emphysema (5/7), subcutaneous emphysema (3/7), and pneumothorax (1/7). Tracheotomy was temporary in all patients.
CONCLUSION
In cases where a foreign body in the trachea is too large or has irregular, sharp edges, is embedded in submucosal tissues with edema, cannot be passed smoothly through the vocal cords, or local endoscopic facilities are inadequate, a tracheotomy may be necessary. However, this approach should be used with caution, and close collaboration with anesthesiologists and careful management of intraoperative emergencies are crucial for improving the success rate of the procedure. Additionally, the complications should be noted, paying particular attention to early complications such as pneumothorax, pneumomediastinum, and bleeding.
PubMed: 37743805
DOI: 10.1177/01455613231201015 -
Deutsches Arzteblatt International Aug 2023
Topics: Humans; Mediastinal Emphysema
PubMed: 37721139
DOI: 10.3238/arztebl.m2022.0394 -
BMC Veterinary Research Sep 2023Subcutaneous emphysema and pneumomediastinum are rare complications associated with orbital blowout pathological fracture.
BACKGROUND
Subcutaneous emphysema and pneumomediastinum are rare complications associated with orbital blowout pathological fracture.
CASE PRESENTATION
A 7-year old, castrated male Abbysinian cat presented with anorexia, lethargy, nausea, eyelid swelling, nasal discharge, and sneezing. Based on the clinical and diagnostic work-up, the cat was diagnosed with T cell high-grade nasal lymphoma associated with orbital pathological fracture due to the tumour invasion. After chemotherapy, the cat showed massive subcutaneous emphysema from frontal region to abdomen and pneumomediastinum due to orbital blowout pathological fracture. As the nasal mass decreased in volume; the air had moved from the maxillary sinus to the subcutaneous region and the mediastinum through fascial planes in the head and neck region.
CONCLUSIONS
This is a first case report of a massive subcutaneous emphysema and pneumomediastinum due to an orbital blowout pathological fracture following chemotherapy in feline nasal lymphoma in veterinary medicine.
Topics: Male; Cats; Animals; Mediastinal Emphysema; Fractures, Spontaneous; Nose; Subcutaneous Emphysema; Lymphoma, T-Cell; Lymphoma, T-Cell, Peripheral; Cat Diseases
PubMed: 37715215
DOI: 10.1186/s12917-023-03722-0 -
Cureus Aug 2023Subcutaneous emphysema (SE) and pneumomediastinum can be spontaneous or traumatic in origin. Spontaneous SE involving cervical, parapharyngeal, mediastinal,...
Spontaneous Subcutaneous Emphysema in a Teenage Male Extending As Pneumomediastinum, Pneumothorax, Pneumopericardium, and Epidural Pneumatosis: A Rare Combination of Anatomical Locations.
Subcutaneous emphysema (SE) and pneumomediastinum can be spontaneous or traumatic in origin. Spontaneous SE involving cervical, parapharyngeal, mediastinal, pericardial, and pleural space together is rare, while epidural pneumatosis is an even rarer entity. We report a previously healthy teenage male with sudden onset chest pain whose plain radiographs and high-resolution computed tomography (HRCT) showed extensive spread of air in the mediastinum, pericardial space, pleural space, and epidural space. He was hemodynamically stable and had a spontaneous recovery after one week. Follow-up radiological imaging showed complete radiological resolution of gas lucencies. It is quite important for clinicians to be aware of this condition, common and rare routes of extension, and possible complications. Clinical suspicion is vital to plan appropriate investigations especially radiological modalities such as chest X-ray and HRCT. This will help in evaluating the severity of the condition, exclude possible etiologies, and look for potential complications so that proper management and follow-up can be planned.
PubMed: 37711916
DOI: 10.7759/cureus.43462