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Interactive Cardiovascular and Thoracic... Jun 2022Isolated Chylopericardium (without chylothorax) is a rare clinical disorder that may happen idiopathically or secondary to trauma, radiotherapy, lymphatic anomalies,...
Isolated Chylopericardium (without chylothorax) is a rare clinical disorder that may happen idiopathically or secondary to trauma, radiotherapy, lymphatic anomalies, infections or mediastinal neoplasm. We present a case of middle-aged male with no past medical history of note prior to developing heavy sweating, loss of weight and cough. A series of investigations were done including chest computed tomography which showed enlarged mediastinal lymph nodes leading to uncomplicated mediastinoscopy and lymph node biopsy. Six days after being discharged, he developed dyspnoea and chest pain. Echocardiography revealed massive pericardial effusion. Pericardiocentesis was done and surprisingly revealed milky white chylous fluid. The patient was then successfully managed without the need for further intervention.
Topics: Chylothorax; Humans; Lymph Nodes; Male; Mediastinum; Middle Aged; Pericardial Effusion; Pericardiocentesis
PubMed: 34964452
DOI: 10.1093/icvts/ivab365 -
European Journal of Cardio-thoracic... May 2014Accurate preoperative staging and restaging of mediastinal lymph nodes in patients with potentially resectable non-small-cell lung cancer (NSCLC) is of paramount...
Accurate preoperative staging and restaging of mediastinal lymph nodes in patients with potentially resectable non-small-cell lung cancer (NSCLC) is of paramount importance. In 2007, the European Society of Thoracic Surgeons (ESTS) published an algorithm on preoperative mediastinal staging integrating imaging, endoscopic and surgical techniques. In 2009, the International Association for the Study of Lung Cancer (IASLC) introduced a new lymph node map. Some changes in this map have an important impact on mediastinal staging. Moreover, more evidence of the different mediastinal staging technique has become available. Therefore, a revision of the ESTS guidelines was needed. In case of computed tomography (CT)-enlarged or positron emission tomography (PET)-positive mediastinal lymph nodes, tissue confirmation is indicated. Endosonography [endobronchial ultrasonography (EBUS)/esophageal ultrasonography (EUS)] with fine-needle aspiration (FNA) is the first choice (when available), since it is minimally invasive and has a high sensitivity to rule in mediastinal nodal disease. If negative, surgical staging with nodal dissection or biopsy is indicated. Video-assisted mediastinoscopy is preferred to mediastinoscopy. The combined use of endoscopic staging and surgical staging results in the highest accuracy. When there are no enlarged lymph nodes on CT and when there is no uptake in lymph nodes on PET or PET-CT, direct surgical resection with systematic nodal dissection is indicated for tumours ≤ 3 cm located in the outer third of the lung. In central tumours or N1 nodes, preoperative mediastinal staging is indicated. The choice between endoscopic staging with EBUS/EUS and FNA or video-assisted mediastinoscopy depends on local expertise to adhere to minimal requirements for staging. For tumours >3 cm, preoperative mediastinal staging is advised, mainly in adenocarcinoma with high standardized uptake value. For restaging, invasive techniques providing histological information are advisable. Both endoscopic techniques and surgical procedures are available, but their negative predictive value is lower compared with the results obtained in baseline staging. An integrated strategy using endoscopic staging techniques to prove mediastinal nodal disease and mediastinoscopy to assess nodal response after induction therapy needs further study.
Topics: Algorithms; Carcinoma, Non-Small-Cell Lung; Humans; Lung Neoplasms; Lymph Nodes; Mediastinal Neoplasms; Neoplasm Staging; Thoracoscopy
PubMed: 24578407
DOI: 10.1093/ejcts/ezu028 -
Turk Gogus Kalp Damar Cerrahisi Dergisi Jan 2024Mediastinal tumors are the most common thoracic tumor in the pediatric population. They include a spectrum of tumors, and most are malignant. These lesions can be... (Review)
Review
Mediastinal tumors are the most common thoracic tumor in the pediatric population. They include a spectrum of tumors, and most are malignant. These lesions can be anatomically and radiologically classified by means of compartments; anterior, middle, and posterior. Symptoms, signs, localization of the tumor, age of the child, and tumor markers are key points of diagnosis. Surgical approaches are typically needed for diagnosis, but sometimes tru-cut needle biopsies may be sufficient. Mediastinoscopy, mediastinotomy, and video-assisted thoracoscopic surgery may be used in the diagnostic workup of mediastinal tumors in children as they are used in adults. Frequently, diagnosis and treatment are both established by means of surgery. Surgery remains the mainstay of treatment of most benign and malignant nonlymphoid tumors. Combined modality of treatment incorporating chemotherapy and radiotherapy is often required in malignant tumors and is associated with high survival rates in these patients.
PubMed: 38584788
DOI: 10.5606/tgkdc.dergisi.2024.25799 -
Continuum (Minneapolis, Minn.) Jun 2014This article provides an update on the evaluation and treatment of neurosarcoidosis. (Review)
Review
PURPOSE OF REVIEW
This article provides an update on the evaluation and treatment of neurosarcoidosis.
RECENT FINDINGS
The broad range of clinical manifestations of neurosarcoidosis has recently expanded to include painful small fiber neuropathy. Although definitive diagnosis remains a challenge, fluorodeoxyglucose positron emission tomographic (FDG-PET) scan and high-resolution CT allow for improved detection of systemic sarcoidosis. In addition, endobronchial ultrasound-guided transbronchial needle aspiration provides a less invasive means of tissue confirmation of systemic sarcoidosis than mediastinoscopy. Although not standardized, treatment strategies for neurosarcoidosis now commonly include tumor necrosis factor-α antagonists in combination with corticosteroids and other cytotoxic agents for patients with severe disease.
SUMMARY
Advances in the diagnosis and management of neurosarcoidosis may benefit the patient and clinician faced with this multifaceted disease.
Topics: Central Nervous System Diseases; Humans; Sarcoidosis
PubMed: 24893233
DOI: 10.1212/01.CON.0000450965.30710.e9 -
Multimedia Manual of Cardiothoracic... Jan 2005The use of videotechniques in mediastinoscopy has increased the quality of mediastinal lymph node staging due to improved visualisation and magnification on the screen....
The use of videotechniques in mediastinoscopy has increased the quality of mediastinal lymph node staging due to improved visualisation and magnification on the screen. The anatomical landmarks are much more easily identified. Teaching with standard mediastinoscopy is difficult as the working channel is small. Videomediastinoscopy has made teaching much easier. It is hoped that videotaping accompanying this article may contribute to standardisation and refinement of this very important and frequently performed procedure. Indications, technique, results and complications are discussed in more detail in the procedure on conventional mediastinoscopy.
PubMed: 24413769
DOI: 10.1510/MMCTS.2004.000166 -
Chest Mar 2020There remains debate over the best invasive diagnostic modality for mediastinal nodal evaluation. Prior studies have limited generalizability and insufficient power to...
BACKGROUND
There remains debate over the best invasive diagnostic modality for mediastinal nodal evaluation. Prior studies have limited generalizability and insufficient power to detect differences in rare adverse events. We compared the risks and costs of endobronchial ultrasound (EBUS)-guided nodal aspiration and mediastinoscopy performed for any indication in a large national cohort.
METHODS
We conducted a retrospective study (2007-2015) with MarketScan, a claims database of individuals with employer-provided insurance in the United States. Patients who underwent multimodality mediastinal evaluation (n = 1,396) or same-day pulmonary resection (n = 2,130) were excluded. Regression models were used to evaluate associations between diagnostic modalities and risks and costs while adjusting for patient characteristics, year, concomitant bronchoscopic procedures, and lung cancer diagnosis.
RESULTS
Among 30,570 patients, 49% underwent EBUS. Severe adverse events-pneumothorax, hemothorax, airway/vascular injuries, or death-were rare and invariant between EBUS and mediastinoscopy (0.3% vs 0.4%; P = .189). The rate of vocal cord paralysis was lower for EBUS (1.4% vs 2.2%; P < .001). EBUS was associated with a lower adjusted risk of severe adverse events (OR, 0.42; 95% CI, 0.32-0.55) and vocal cord paralysis (OR, 0.57; 95% CI, 0.54-0.60). The mean cost of EBUS was $2,211 less than mediastinoscopy ($6,816 vs $9,023; P < .001). After adjustment this difference decreased to $1,650 (95% CI, $1,525-$1,776).
CONCLUSIONS
When performed as isolated procedures, EBUS is associated with lower risks and costs compared with mediastinoscopy. Future studies comparing the effectiveness of EBUS vs mediastinoscopy in the community at large will help determine which procedure is superior or if trade-offs exist.
Topics: Bronchoscopy; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Female; Health Care Costs; Health Expenditures; Hemothorax; Humans; Lung Neoplasms; Lymph Nodes; Male; Mediastinoscopy; Middle Aged; Mortality; Neoplasm Staging; Pneumothorax; Postoperative Complications; Respiratory System; Retrospective Studies; Vascular System Injuries; Vocal Cord Paralysis
PubMed: 31605700
DOI: 10.1016/j.chest.2019.09.021 -
Thorax Feb 1978Biopsy of lymph nodes at mediastinoscopy has been the method of diagnosis of tuberculosis in 14 patients; Mycobacterium tuberculosis was cultured from the nodes in nine...
Biopsy of lymph nodes at mediastinoscopy has been the method of diagnosis of tuberculosis in 14 patients; Mycobacterium tuberculosis was cultured from the nodes in nine cases, and in five there was histological evidence of the disease but cultural confirmation was lacking. All patients had radiographic abnormality of the superior mediastinum, and a frequent finding at mediastinoscopy was mediastinal fibrosis involving the fascia and lymph nodes. No cause other than tuberculosis could be demonstrated to account for the mediastinal fibrosis, and the patients made clinical recoveries in response to standard courses of antituberculosis chemotherapy. The development of superior vena caval compression was not observed.
Topics: Adult; Aged; Female; Follow-Up Studies; Humans; Lung; Lymph Nodes; Male; Mediastinoscopy; Mediastinum; Middle Aged; Mycobacterium tuberculosis; Radiography; Tuberculosis, Lymph Node; Tuberculosis, Pulmonary
PubMed: 417418
DOI: 10.1136/thx.33.1.117 -
World Journal of Surgical Oncology Aug 2021To avoid the inconvenience of triangulation among various rigid operating instruments in mediastinoscopy-assisted esophagectomy, we invented a new technique: used a...
BACKGROUND
To avoid the inconvenience of triangulation among various rigid operating instruments in mediastinoscopy-assisted esophagectomy, we invented a new technique: used a flexible endoscope to mobilize thoracic esophagus and dissected mediastinal lymph nodes through the left cervical incision. This technology has not been reported so far. In this study, we introduce our long-term experience and demonstrate this new technique.
METHODS
Twenty-nine patients with early esophageal cancer underwent mediastinoscopy-assisted esophagectomy in our hospital from June 2018 to September 2020. Among them, 12 patients used flexible mediastinoscopy, and 17 patients used conventional rigid mediastinoscopy and instruments to observe their therapeutic effect.
RESULTS
There were no significant differences between the two groups in gender, average age, body mass index, incidence of adverse reactions, bleeding volume, and postoperative hospital stay. The operation time of flexible mediastinoscopy group was significantly shorter than that of rigid mediastinoscopy group (192.9 ± 13.0 vs 246.8 ± 6.9 min, p < 0.01). The number of lymph nodes removed by flexible endoscopy was significantly more than that of rigid endoscopy (8.5 ± 0.6 vs 6.0 ± 0.3, P < 0.01). Postoperative follow-up was completed for all patients, and the average follow-up time was 11.6 ± 7.2 months. During the follow-up period, no recurrence or death was observed.
CONCLUSIONS
Mediastinoscopy-assisted esophagectomy is an effective way to treat early esophageal cancer. The application of flexible mediastinoscopy provides more convenience and better stability. It can facilitate the operation of the surgeon and lymph node dissection, which proved to be a feasible technology.
Topics: Esophageal Neoplasms; Esophagectomy; Humans; Lymph Node Excision; Mediastinoscopy; Neoplasm Recurrence, Local; Prognosis; Technology
PubMed: 34364369
DOI: 10.1186/s12957-021-02352-w