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Canadian Respiratory Journal 2013Diffuse pulmonary lymphangiomatosis (DPL) is a rare disease characterized by infiltration of the lung, pleura and mediastinum with thin-walled lymphangiomas. DPL can...
Diffuse pulmonary lymphangiomatosis (DPL) is a rare disease characterized by infiltration of the lung, pleura and mediastinum with thin-walled lymphangiomas. DPL can result in mass effect from infiltrative disease, restrictive and obstructive pulmonary physiology, chylous effusions and respiratory failure. The present article discusses clinical, radiographic and pathological features, and treatment options for DPL.
Topics: Female; Humans; Lung Diseases; Lymphangiectasis; Middle Aged
PubMed: 23457676
DOI: 10.1155/2013/971350 -
Journal of Thoracic Disease Jul 2017Since 1995, video-assisted thoracoscopic oesophagectomy (VATS), according the same surgical principles as the Japanese open surgery, has been completed in 700 patients... (Review)
Review
Since 1995, video-assisted thoracoscopic oesophagectomy (VATS), according the same surgical principles as the Japanese open surgery, has been completed in 700 patients with oesophageal cancer. Our indication for VATS is (I) no extensive pleural adhesion; (II) no contiguous tumor spread; (III) pulmonary function capable of sustaining single-lung ventilation, and (IV) non radiated patients. We use 4 ports around a 5 cm mini-thoracotomy on 5th intercostal space. We laid emphasis on utilizing magnifying effect of video (5 to 20 magnifications), obtained by positioning the camera at close vicinity to the dissection. Magnified view facilitates recognizing the fine layer structure of the mediastinum. The dissection should be performed following this layer structure just like open the page of a book. Tearing the layer makes the dissection irrational and cause unnecessary bleeding and invasiveness. The microanatomies we recognize during upper mediastinal dissection are (I) the most outer layer below the mediastinal pleura are branches from the vagus nerve and thoracic sympathetic trunk; (II) there is no vessel flow in the nerves or out, in the field of dissection; (III) the ideal layer of dissection along the nerve is exposing the epineurium; (IV) the strongest fixing structures in the mediastinum are the vagal nerves and nerves form thoracic sympathetic trunk; (V) the stump of thoracic duct shows particular appearance because of the intramural smooth muscle; (VI) the lymphonodes in the mediastinum are fixed strongly with nerves and gently with vessels; (VII) the aorta is covered with fine fibrous membrane consisting of branches form thoracic sympathetic trunk, etc. Magnified view shows the microstructure of the lymph node such as the afferent lymphatics penetrating the capsule and the hilum structure consisting the efferent lymphatics, artery, vein and nerve. The direction of the hilum of nodes is defined in each region. Therefore, understanding the hilum direction facilitates rational dissection. The hospital mortality was four patients (0.6%). The rate of regional control was 95%. The 5-year survival rates of the patients with pStage 0, 1, 2, 3, 4 were 92%, 88%, 69%, 52% and 24%, respectively, which were favorably compared with open surgery.
PubMed: 28815070
DOI: 10.21037/jtd.2017.05.25 -
The Journal of Thoracic and... Jul 2017Thymectomy is part of the therapeutic armamentarium for myasthenia gravis (MG). During the past 80 years, multiple observational studies have shown that thymectomy can...
Thymectomy is part of the therapeutic armamentarium for myasthenia gravis (MG). During the past 80 years, multiple observational studies have shown that thymectomy can potentially fasten stabilization of the disease, reduce the need for corticosteroids, and in some patients lead to complete remission. The benefit from thymectomy in MG is supported by propensity score analysis. A randomized control trial looking at the role of thymectomy in nonthymomatous MG patients was recently completed, but the results are not yet available. The approach and extent of thymectomy remain a topic of intense discussion, particularly with the development of minimally invasive surgery. Although the presence of extracapsular thymic tissue is frequent and well described, the accessibility of these ectopic thymic foci as well as their function and impact on outcome after surgery have been unclear, leading to divergent views between proponents of a maximal cervicomediastinal thymectomy with en bloc resection of all fatty tissue between the thyroid grand and the diaphragm and those of a less extensive approach. In the future, better definition of the type of thymectomy will be important, particularly if prospective studies and randomized trials are performed to compare different surgical approaches. One possibility would be to reserve the term "extended thymectomy" to resection of the thymus with the anterior mediastinal fat between both pleura, the pericardium and diaphragm. More extensive surgery should be specified when it encompasses sites such as the right and left pericardiophrenic angles, the aortopulmonary window, the aortocaval groove and retroinnominate space, and the perithyroid area.
Topics: Humans; Myasthenia Gravis; Thymectomy
PubMed: 26880052
DOI: 10.1016/j.jtcvs.2016.01.006 -
Mediastinum (Hong Kong, China) 2019Thymic malignancies may exhibit aggressive behavior such as invasion of adjacent structures and involvement of the pleura and pericardium. The role of imaging in the... (Review)
Review
Thymic malignancies may exhibit aggressive behavior such as invasion of adjacent structures and involvement of the pleura and pericardium. The role of imaging in the evaluation of primary thymic neoplasms is to properly assess tumor staging, with emphasis on the detection of local invasion and distant spread of disease, correctly identifying candidates for preoperative neoadjuvant therapy. Different imaging modalities are used in the initial investigation of thymic malignancies including chest radiography, computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET), in particular with [18F] fluorodeoxyglucose (FDG). At this moment, CT is the most common imaging modality on the assessment of thymic malignancies. MRI has the benefit of no emission of damaging ionizing radiation reducing the radiation dose to the patient when compared with CT. For this reason, MRI has been playing an important role in the evaluation of tumor invasion and follow up imaging studies which becomes even more relevant in young patients or those patients with prior history of radiation therapy.
PubMed: 35118257
DOI: 10.21037/med.2019.06.05 -
Virchows Archiv : An International... Nov 2015The mediastinum is an anatomically defined space in which organs and major blood vessels reside with surrounding soft tissue elements. The thymus is an important organ... (Review)
Review
The mediastinum is an anatomically defined space in which organs and major blood vessels reside with surrounding soft tissue elements. The thymus is an important organ in the mediastinum, and many of the masses encountered in the mediastinum are related to this organ. Most neoplasms diagnosed in the mediastinum are epithelial tumours (thymomas and thymic carcinomas), lymphomas or germ cell tumours. In contrast, soft tissue tumours of the mediastinum are rare. In 1963, Pachter and Lattes systematically reviewed soft tissue pathology of the mediastinum, covering the hitherto described [2, 226, 227] In this review, based on the 2013 WHO classification of soft tissue tumours and the 2015 WHO classification of tumours of the lung, pleura, thymus and heart, we provide an updated overview of mesenchymal tumours that may be encountered in the mediastinum.
Topics: Diagnosis, Differential; Humans; Mediastinum; Mesoderm; Neoplasm Grading; Thymoma; Thymus Neoplasms
PubMed: 26358059
DOI: 10.1007/s00428-015-1830-8 -
Medical Ultrasonography Feb 2022Ultrasound (US) is an ideal diagnostic tool for paediatric patients owning to its high spatial and temporal resolution, realtime imaging, and lack of ionizing radiation... (Review)
Review
Ultrasound (US) is an ideal diagnostic tool for paediatric patients owning to its high spatial and temporal resolution, realtime imaging, and lack of ionizing radiation and bedside availability. The lack of superficial adipose tissue and favourable acoustic windows in children makes US the first line of investigation for evaluation of pleural and chest wall abnormalities.In the first part of the topic the technical requirements were explained and the use of ultrasound in the lung and pleura in paediatric patients were discussed. In the second part lung parenchymal diseases with their subpleural consolidations are reflected. In the third part, the use of ultrasound for chest wall, mediastinum, diaphragmatic diseases, trachea, interventions and artifacts in paediatric patients are summarized.
Topics: Artifacts; Child; Humans; Lung; Lung Diseases; Mediastinum; Thoracic Wall; Ultrasonography
PubMed: 34216456
DOI: 10.11152/mu-3323 -
Revista de La Facultad de Ciencias... Mar 2022Chronic eosinophilic pneumonia (CEP) is a rare disease of unknown cause characterized by alveolar and interstitial eosinophilic infiltration. The tomographic pattern is...
Chronic eosinophilic pneumonia (CEP) is a rare disease of unknown cause characterized by alveolar and interstitial eosinophilic infiltration. The tomographic pattern is characterized by consolidations and peripherally distributed ground glass opacities in both upper lobes. Other findings are opacities in bands parallel to the pleura, thickening of the interlobular septa, migratory opacities, and mediastinal lymph nodes. We presented a case of a woman with CEP and described the most relevant clinical and radiological characteristics.
Topics: Female; Humans; Lung; Lymph Nodes; Pulmonary Eosinophilia; Radiography; Tomography, X-Ray Computed
PubMed: 35312249
DOI: 10.31053/1853.0605.v79.n1.33668 -
Tomography (Ann Arbor, Mich.) Jun 2023This review has the purpose of illustrating schematically and comprehensively the key concepts for the beginner who approaches chest radiology for the first time. The... (Review)
Review
This review has the purpose of illustrating schematically and comprehensively the key concepts for the beginner who approaches chest radiology for the first time. The approach to thoracic imaging may be challenging for the beginner due to the wide spectrum of diseases, their overlap, and the complexity of radiological findings. The first step consists of the proper assessment of the basic imaging findings. This review is divided into three main districts (mediastinum, pleura, focal and diffuse diseases of the lung parenchyma): the main findings will be discussed in a clinical scenario. Radiological tips and tricks, and relative clinical background, will be provided to orient the beginner toward the differential diagnoses of the main thoracic diseases.
Topics: Humans; Tomography, X-Ray Computed; Lung; Radiography, Thoracic; Lung Neoplasms; Radiology
PubMed: 37368547
DOI: 10.3390/tomography9030095 -
Thoracic Cancer Jun 2019The study was conducted to assess the safety and efficacy of thermal ablation for the treatment of subpleural lung cancer.
BACKGROUND
The study was conducted to assess the safety and efficacy of thermal ablation for the treatment of subpleural lung cancer.
METHODS
Eighty-nine patients with 101 subpleural lung cancers were identified between January 2012 and July 2018 in our database and included in this study. Tumors were classified as adhering to cervical, costal, diaphragmatic, and mediastinal pleurae. Lesions were categorized based on their relationship to the pleura: close to the pleura, causing pleural indentation, and involving the pleura. The complete ablation rate, local progression-free survival, complications, and associated factors were analyzed.
RESULTS
Subpleural lung cancers included lesions located under costal (n = 69), mediastinal (n = 17), cervical (n = 8), and diaphragmatic (n = 7) pleurae. The rate of complete ablation was 87.1% and the local progression-free survival rates at 3, 6, 12, and 24 months were 86%, 77%, 75%, and 64%, respectively. Tumor size was the most important factor influencing technique efficacy (P < 0.05), with a complete ablation rate of only 55.6% in lung cancers measuring > 30 mm. There were nine (10.11%) major complications, including one chest abscess, five cases of pneumothorax, and three cases of hemothorax. The occurrence of major complications was associated with increased levels of pain within 48 hours post-procedure (P < 0.05).
CONCLUSION
Local thermal ablation is a safe and effective treatment for subpleural lung cancers. Tumor size was the most significant factor affecting technique efficacy. Post-procedure pain indicated the possibility of major complications.
Topics: Abscess; Adult; Aged; Aged, 80 and over; Catheter Ablation; Disease-Free Survival; Female; Hemothorax; Humans; Lung Neoplasms; Male; Middle Aged; Pleural Neoplasms; Pneumothorax; Postoperative Complications; Treatment Outcome; Tumor Burden; Young Adult
PubMed: 31020801
DOI: 10.1111/1759-7714.13068