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Surgery Journal (New York, N.Y.) Jan 2018While colonoscopy is generally regarded as a safe procedure, colonic perforation can occur and the risk of this is higher when interventional procedures are undertaken.... (Review)
Review
While colonoscopy is generally regarded as a safe procedure, colonic perforation can occur and the risk of this is higher when interventional procedures are undertaken. The presentation may be acute or delayed depending on the extent of the perforation. Extracolonic gas following colonic perforation can migrate to several body compartments that are embryologically related and it has previously been reported in the thorax, mediastinum, neck, scrotum, and lower limbs. This review discusses in detail the anatomical pathways that led to a rare case of widespread subcutaneous emphysema, bilateral pneumothoraces, pneumomediastinum, and mediastinal shift from colonic perforation during a diagnostic colonoscopy. This is further supported by a description of the radiological images.
PubMed: 29479562
DOI: 10.1055/s-0038-1624563 -
Magnetic Resonance in Medical Sciences... Oct 2023The anterior mediastinum is the most common location of mediastinal tumors, and thymic epithelial tumors are the most common mediastinal tumors. It is important to...
The anterior mediastinum is the most common location of mediastinal tumors, and thymic epithelial tumors are the most common mediastinal tumors. It is important to differentiate thymic epithelial tumors from malignant lymphomas and malignant germ cell tumors because of the different treatment strategies. Dynamic contrast-enhanced MRI and diffusion-weighted imaging can provide additional information on the differential diagnosis. Chemical shift imaging can detect tiny fat tissues in the lesion and is useful in differentiating thymic hyperplasia from other solid tumors such as thymomas. MRI findings reflect histopathological features of mediastinal tumors, and a comprehensive evaluation of MRI sequences is important for estimation of the histopathological features of the tumor. In this manuscript, we describe the MRI findings of anterior mediastinal solid tumors and the role of MRI in the differential diagnosis.
Topics: Humans; Mediastinum; Mediastinal Neoplasms; Diagnosis, Differential; Thymus Neoplasms; Magnetic Resonance Imaging; Neoplasms, Glandular and Epithelial
PubMed: 35296589
DOI: 10.2463/mrms.rev.2021-0098 -
Cureus Nov 2022Emphysema is a progressive and degenerative lung disease that most commonly occurs due to many years of smoking or exposure to smoke and irritants. It is also seen in...
Emphysema is a progressive and degenerative lung disease that most commonly occurs due to many years of smoking or exposure to smoke and irritants. It is also seen in the congenital absence of the alpha-1-antitrypsin enzyme. Bullous emphysema is an advanced stage of the disease where strictures of the bronchi permit the inspired air to enter the bronchi but close on expiration, causing air retention and alveolar dilation, destruction, and atrophy. Multiple small bullae coalesce to form a giant bulla (defined as occupying more than one-third of the hemithorax), which causes respiratory symptoms and mediastinal shifting and leads to a poor general condition of the patient. Here, we present the cases of two patients diagnosed with bullous emphysema who presented within three months of each other. This article details the similarities and differences in the approach to both cases and the learning experience from these presentations, especially in acute symptomatology. Bullous emphysema is usually confused with a pneumothorax on a simple chest X-ray; hence, it is imperative to look for the lung margins and confirm the diagnosis using computed tomography of the thorax.
PubMed: 36505170
DOI: 10.7759/cureus.31182 -
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 -
Paediatric Respiratory Reviews Mar 2021To develop a clinical guideline for structured assessment and uniform reporting of congenital lung abnormalities (CLA) on Computed Tomography (CT)-scans. (Review)
Review
OBJECTIVES
To develop a clinical guideline for structured assessment and uniform reporting of congenital lung abnormalities (CLA) on Computed Tomography (CT)-scans.
MATERIALS AND METHODS
A systematic literature search was conducted for articles describing CT-scan abnormalities of congenital pulmonary airway malformation (CPAM), bronchopulmonary sequestration (BPS), congenital lobar emphysema (CLE) and bronchogenic cyst (BC). A structured report using objective features of CLA was developed after consensus between a pediatric pulmonologist, radiologist and surgeon.
RESULTS
Of 1581 articles identified, 158 remained after title-abstract screening by two independent reviewers. After assessing full-texts, we included 28 retrospective cohort-studies. Air-containing cysts and soft tissue masses are described in both CPAM and BPS while anomalous arterial blood supply is only found in BPS. Perilesional low-attenuation areas, atelectasis and mediastinal shift may be found in all aforementioned abnormalities and can also be seen in CLE as a cause of a hyperinflated lobe. We have developed a structured report, subdivided into five sections: Location & Extent, Airway, Lesion, Vascularization and Surrounding tissue.
CONCLUSIONS
CT-imaging findings in CLA are broad and nomenclature is variable. Overlap is seen between and within abnormalities, possibly due to definitions often being based on pathological findings, which is an unsuitable approach for CT imaging. We propose a structured assessment of CLA using objective radiological features and uniform nomenclature to improve reporting.
Topics: Child; Cystic Adenomatoid Malformation of Lung, Congenital; Humans; Lung; Pulmonary Atelectasis; Respiratory System Abnormalities; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 32178987
DOI: 10.1016/j.prrv.2019.12.004 -
Journal of Clinical Medicine Jan 2024Fetal magnetic resonance imaging (MRI) is broadly used as a method for assessing prognosis in congenital diaphragmatic hernia (CDH). In addition to the extent of lung...
OBJECTIVE
Fetal magnetic resonance imaging (MRI) is broadly used as a method for assessing prognosis in congenital diaphragmatic hernia (CDH). In addition to the extent of lung hypoplasia, determined by measuring the lung volume, cardiac impairment due to pulmonary hypertension and left cardiac hypoplasia is decisive for the prognosis. The percentage area of left ventricle (pALV) describes the percentage of the inner area of the left ventricle in relation to the total area, whereas the mediastinal shift angle (MSA) quantifies the extent of cardiac displacement. The prognostic value of pALV and MSA should be evaluated in terms of survival, the need for extracorporeal membrane oxygenation (ECMO) therapy, and the development of chronic lung disease (CLD).
METHODS
In a total of 122 fetal MRIs, the MSA and pALV were measured retrospectively and complete outcome parameters were determined regarding survival for all 122 subjects, regarding ECMO therapy in 109 cases and about the development of CLD in 78 cases. The prognostic value regarding the endpoints was evaluated using logistic regression and ROC analysis.
RESULTS
The MSA was significantly higher in children who received ECMO therapy ( = 0.0054), as well as in children who developed CLD ( = 0.0018). ROC analysis showed an AUC of 0.68 for ECMO requirement and 0.77 with respect to CLD development. The pALV showed a tendency towards higher levels in children who received ECMO therapy ( = 0.0824). The MSA and the pALV had no significant effect on survival (MSA: = 0.4293, AUC = 0.56; pALV: = 0.1134, AUC = 0.57).
CONCLUSIONS
The MSA determined in fetal MRI is a suitable prognostic parameter for ECMO requirement and CLD development in CDH patients and can possibly be used as a supplement to the established parameters.
PubMed: 38202274
DOI: 10.3390/jcm13010268 -
Journal of Thoracic Disease Jan 2023
PubMed: 36794129
DOI: 10.21037/jtd-22-1420 -
Journal of Thoracic Disease Aug 2018The role of radiation therapy (RT) in thymic malignancies has long been subject to considerable controversy. The main role for RT is in the setting of adjuvant therapy... (Review)
Review
The role of radiation therapy (RT) in thymic malignancies has long been subject to considerable controversy. The main role for RT is in the setting of adjuvant therapy after surgical tumor resection, especially in advanced or incompletely resected cases. However, recent studies with larger patient numbers and cleaner study populations than previous studies have indicated a potentially clearer than previously assumed benefit after post-operative RT (PORT) even for completely resected patients with earlier stages of thymoma. In marginally resectable patients RT may be used in combination with neoadjuvant chemotherapy to shrink tumors and thereby potentially enable resection. In unresectable patients concurrent or sequential chemotherapy and RT can be employed as the definitive nonsurgical approach. The tendency of thymic tumors to recur in the pleural space highlights the necessity for more effective approaches to identify and treat high risk patients. Experiences in other pleural malignancies may pave the way to novel treatment modalities, for example pleural IMRT. The role of these techniques in thymic malignancies has yet to be determined and is not advisable at the current time outside of a clinical study. As the disease often takes an indolent course with excellent long-term local control (LC) and survival, late toxicities related to radiation of the mediastinum and adjacent organs at risk (OARs) have to be taken into consideration and may jeopardize the benefit patients experience from RT, especially in younger patients with a long-anticipated life expectancy. Radiation techniques, such as intensity modulated RT (IMRT) and proton beam therapy (PBT), have substantially reduced the exposure of OARs to ionizing radiation which is expected to translate into reduced long-term toxicities. Hence, the risk-benefit ratio of RT in early stage thymoma patients may be shifted favorably.
PubMed: 30206499
DOI: 10.21037/jtd.2018.01.154 -
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 -
Pneumologie (Stuttgart, Germany) Jun 2020An 80-year old female was referred to our hospital with left internal carotid artery stenosis and a childhood history of hemoptysis.
HISTORY
An 80-year old female was referred to our hospital with left internal carotid artery stenosis and a childhood history of hemoptysis.
INVESTIGATIONS AND DIAGNOSIS
The ECG showed 2nd degree Mobitz atrio-ventricular block. The chest x-ray and computerized tomography identified a shift of the mediastinum and the heart to the left. The left lung was completely destroyed whilst the right lung was enlarged and crossed the midline. Pulmonary function tests revealed a moderate restrictive ventilation disorder. The diagnosis of autopneumonectomy was based on patient history together with radiological findings.
TREATMENT AND COURSE
A pacemaker was implanted with two stimulation electrodes via a left cephalic venous cutdown. A carotid endarterectomy was also performed without any complication.
CONCLUSION
After autopneumonectomy, postpneumonectomy like syndrome may occur in very rare cases, whereupon operative treatment is mandatory. Any respiratory infections should be treated with antibiotics. Pacemaker electrode placement via the subclavian vein is contraindicated due to the risk of a catastrophic pneumothorax.
Topics: Aged, 80 and over; Carotid Stenosis; Endarterectomy, Carotid; Female; Hemoptysis; Humans; Lung; Lung Diseases; Pacemaker, Artificial; Pneumonectomy; Respiratory Function Tests; Subclavian Vein; Treatment Outcome; Venous Cutdown
PubMed: 32557508
DOI: 10.1055/a-1148-8770