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Thoracic Surgery Clinics May 2011
Topics: Diaphragm; Esophagus; Humans; Mediastinum; Pleura; Thoracic Cavity
PubMed: 21477762
DOI: 10.1016/j.thorsurg.2011.01.008 -
Henry Ford Hospital Medical Bulletin Sep 1962
Topics: Diverticulum; Diverticulum, Esophageal; Esophagus; Humans; Mediastinum
PubMed: 13946114
DOI: No ID Found -
American Journal of Surgery Jul 1947
Topics: Esophagus; Humans; Mediastinum
PubMed: 20249212
DOI: 10.1016/0002-9610(47)90097-4 -
Journal of Clinical Ultrasound : JCU Jan 2005Although conventional sonography has been used widely in evaluation of the abdominal and cervical esophagus, its use in the thoracic esophagus is seldom mentioned. The... (Clinical Trial)
Clinical Trial
PURPOSE
Although conventional sonography has been used widely in evaluation of the abdominal and cervical esophagus, its use in the thoracic esophagus is seldom mentioned. The aim of this study was to assess whether conventional sonography could demonstrate the thoracic esophagus and to determine this structure's normal sonographic appearance and measurements.
METHODS
Transthoracic sonography was performed in 253 healthy volunteers ranging in age from 12 to 72 years (mean, 41 +/- 15 years). The subjects were examined while supine with their hands raised over their heads; the transducer was placed along the left side of the sternum sequentially from the first to the fifth intercostal spaces. The ultrasound beam was directed to the thoracic aorta using the heart as an acoustic window. The detectable length of the thoracic esophagus was measured in the longitudinal scan from the upper most part visualized to the point at which it penetrated the diaphragm. The esophageal thickness was measured on the anterior wall at the level of the left atrium.
RESULTS
In 188 (74%) of the 253 subjects, the thoracic esophagus could be demonstrated by sonography, except for the portion under the first and second intercostal spaces. In 3 of these 188 subjects, the esophagus also was not visualized at the third intercostal space. In these 188 subjects, the esophageal wall was shown as 3 layers. The esophageal lumen appeared as 1 or 2 hyperechoic bands in longitudinal sonograms. In 163 subjects, gas artifact and the comet-tail sign, with downward movement, were seen in the esophageal lumen after swallowing. The mean demonstrable length of the thoracic esophagus was 10.2 +/- 1.9 cm and the mean thickness 3.2 +/- 0.3 mm.
CONCLUSIONS
Most of the thoracic esophagus can be visualized by sonography, except for a short portion at the back of the left main bronchus. The heart and the thoracic aorta are 2 important landmarks in scanning.
Topics: Adolescent; Adult; Aged; Child; Esophagus; Female; Humans; Male; Middle Aged; Prospective Studies; Sensitivity and Specificity; Thorax; Ultrasonography
PubMed: 15690445
DOI: 10.1002/jcu.20083 -
Clinical Lung Cancer Jul 2016Thoracic radiotherapy (TRT) has been evaluated as a means of improving overall survival and progression-free survival in patients with extensive stage small-cell lung... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Thoracic radiotherapy (TRT) has been evaluated as a means of improving overall survival and progression-free survival in patients with extensive stage small-cell lung cancer (ES-SCLC).
METHODS
A systematic review of Medline and Embase (inception to January 2015) was undertaken to identify studies of extensive stage SCLC patients receiving platinum-based chemotherapy and randomized to receive TRT versus no TRT. Studies were screened by title (n = 2343) and then abstract (n = 72), with subsequent full-text review (n = 16). Effect estimates (hazard ratios [HR] and confidence intervals) were abstracted, with a random-effects model created to estimate treatment effects. Cochrane's Q and I(2) statistics were used to assess study heterogeneity.
RESULTS
Two randomized studies were identified, including a total of 604 patients (302 TRT; 302 non-TRT). All patients received prophylactic cranial irradiation. The weighted median age was 62 years, and 56% were male. TRT was delivered as 30 Gy/10 fractions (n = 247) or 54 Gy twice daily/36 fractions (n = 55). Overall, the delivery of TRT was associated with improved overall survival (HR, 0.81; 95% confidence interval, 0.69-0.96; P = .014) and progression-free survival (HR, 0.74; 95% confidence interval, 0.64-0.87, P < .001). For both end points, the studies were not found to be heterogeneous (P = .439 and P = .638 respectively, I(2) = 0). Bronchopulmonary toxicity (grade 3 or higher) was similar in both groups (≤ 2%). Esophageal toxicity (grade 3 or higher) was 6.6% in the TRT arm and 0% in the non-TRT arm (P < .001).
CONCLUSION
This systematic review with meta-analysis of 2 randomized trials indicates that TRT improves overall survival and progression-free survival in patients with extensive stage SCLC, with a small incremental risk of esophageal toxicity.
Topics: Animals; Esophagus; Female; Humans; Male; Middle Aged; Neoplasm Staging; Radiography, Thoracic; Randomized Controlled Trials as Topic; Small Cell Lung Carcinoma; Survival Analysis; Thorax
PubMed: 26498503
DOI: 10.1016/j.cllc.2015.09.007 -
Journal of Ultrasound in Medicine :... Sep 2012The purpose of this study was to determine the normal sonographic appearance of the cervical and thoracic esophagus and to provide corresponding measurements in healthy...
OBJECTIVES
The purpose of this study was to determine the normal sonographic appearance of the cervical and thoracic esophagus and to provide corresponding measurements in healthy children.
METHODS
In this prospective study, 93 children (51 girls and 42 boys) 1 to 15 years of age were examined sonographically. With the patient in a supine position for evaluation of the cervical esophagus, the ultrasound transducer was placed on both sides of the trachea. To evaluate the thoracic esophagus, the hands were raised over the head, and the ultrasound transducer was placed along the left side of the sternum. The length of the cervical esophagus was measured longitudinally, and the anteroposterior and transverse diameters of the cervical and thoracic esophagus were measured transversely, as was the thickness of the cervical esophageal wall.
RESULTS
The cervical esophagus was identified in all of the children, whereas the thoracic esophagus was shown in 41 (44%) of the 93 participants. The length of the cervical esophagus and anteroposterior and transverse diameters of the cervical and thoracic esophagus increased with age. The mean thickness of the cervical esophagus was 2.8 mm at all ages. The cervical esophageal wall appeared as 5 layers on the sonograms, and the lumen was distinct.
CONCLUSIONS
Evaluation of the cervical esophagus was readily achievable with sonography in children, whereas visualization of the thoracic esophagus was difficult because of the deep location, small size, and influence of bones and gas in the lungs. Conventional sonography can be easily used in the evaluation of cervical esophageal diseases in children.
Topics: Adolescent; Chi-Square Distribution; Child; Child, Preschool; Esophagus; Female; Humans; Infant; Male; Mediastinum; Neck; Prospective Studies; Reference Values; Transducers; Ultrasonography
PubMed: 22922617
DOI: 10.7863/jum.2012.31.9.1375 -
General Thoracic and Cardiovascular... Jun 2021We previously reported on the thin membranous dense connective tissue around the esophagus in the upper mediastinum. This time, we histologically investigated the...
OBJECTIVE
We previously reported on the thin membranous dense connective tissue around the esophagus in the upper mediastinum. This time, we histologically investigated the existence of similar structures in the middle and lower mediastinum, caudal to the bifurcation of the trachea.
METHODS
Semi-sequential transverse sections of the mediastinum were obtained from two cadavers. Hematoxylin and eosin staining and Elastica van Gieson staining were performed.
RESULTS
In the middle mediastinum, the "visceral sheath" could not be observed completely around the esophagus. In the lower mediastinum, the thin membranous dense connective tissue was observed beneath the pericardium on the ventral side of the esophagus. On the dorsal side of the esophagus, two thin membranous dense connective tissues were similarly observed in two cadavers. One existed between the dorsal side of the esophagus and the three vessels (i.e., the descending aorta, the azygos vein and the thoracic duct) and was integrated with the thin membranous dense connective tissue of the ventral side of the esophagus at the bilateral side of the esophagus. This integrated dense connective tissue reached the left subpleural region and the adventitia of the aorta on the left side and the peripleural and pulmonary hilum on the right side. The other thin membranous dense connective tissue, which represents the "vascular sheath", was observed between the descending aorta and the thoracic duct.
CONCLUSION
These two thin membranous dense connective tissues, which are considered to represent the visceral sheath and vascular sheath, are thought to be available as optimal dissecting layers for radical esophagectomy.
Topics: Connective Tissue; Esophagectomy; Esophagus; Humans; Mediastinum; Trachea
PubMed: 33713025
DOI: 10.1007/s11748-021-01615-3 -
Radiologie (Heidelberg, Germany) Mar 2023The visceral or middle mediastinum contains nonvascular (trachea, carina, esophagus, and lymph nodes) and vascular structures (heart, ascending aorta, aortic arch,... (Review)
Review
BACKGROUND
The visceral or middle mediastinum contains nonvascular (trachea, carina, esophagus, and lymph nodes) and vascular structures (heart, ascending aorta, aortic arch, descending aorta, superior vena cava, intrapericardial pulmonary arteries, thoracic duct).
OBJECTIVES
The various pathologies of the visceral mediastinum and imaging features are presented.
MATERIALS AND METHODS
Plain film radiography shows the gross anatomy and allows visualization of larger pathologies. However, for detailed anatomic and structural classification more sophisticated imaging techniques are required. Especially computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) are well suited for structural and functional assessment of mediastinal lesions.
CONCLUSION
This article summarizes the major pathologies of the visceral mediastinum.
Topics: Mediastinum; Vena Cava, Superior; Thoracic Duct; Trachea; Esophagus
PubMed: 36715716
DOI: 10.1007/s00117-023-01116-9 -
Surgical and Radiologic Anatomy : SRA 1991The relationships of a tumor of the thoracic esophagus to the adjacent mediastinal structures are currently studied by means of computed tomography (CT), magnetic...
The relationships of a tumor of the thoracic esophagus to the adjacent mediastinal structures are currently studied by means of computed tomography (CT), magnetic resonance imaging (MRI) and, more recently, by echoendoscopy. However, the assessment of axial mediastinal CT and of MRI in the coronal and sagittal planes calls for some degree of experience. To further this training a sectional anatomy is proposed in correlation with imaging of the thoracic esophagus and the posterior mediastinum. Ten fresh subjects whose vascular networks had been previously injected with colored resin were sectioned along the three planes of space after positioning under CT monitoring. The axial sections were compared with the CT images made with a GE 9800 Quick scanner. Three frontal and sagittal sections were compared with the MRI images made with a GE Signa apparatus using a high magnetic field. The relations of the esophagus were studied at three levels: the supra-azygo-aortic segment, where it is related to the left subclavian artery; the inter-azygo-aortic segment, where access to the esophagus is barred on the left by the aortic arch and on the right by the arch of the azygos vein, section of which provides ample access; and the sub-azygo-aortic segment, where the esophagus passes behind the left main bronchus and to the right of the descending aorta, two organs whose invasion contraindicates excision of a tumor of the esophagus but is difficult to assess by current thoracic imaging techniques. The esophagus then descends behind the left atrium; the investigation of the kinetics of the heart cavities by transesophageal echocardiography is an application of this anatomic relationship.(ABSTRACT TRUNCATED AT 250 WORDS)
Topics: Esophagus; Humans; Magnetic Resonance Imaging; Mediastinum; Tomography, X-Ray Computed
PubMed: 1803543
DOI: 10.1007/BF01627765 -
Asian Journal of Endoscopic Surgery Jul 2022A 60-year-old woman with an abnormality discovered during a chest X-ray was referred to the authors' hospital for diagnosis and treatment. Upon enhanced computed...
A 60-year-old woman with an abnormality discovered during a chest X-ray was referred to the authors' hospital for diagnosis and treatment. Upon enhanced computed tomography (CT), endoscopic ultrasonography, and magnetic resonance imaging, a tumor on the left side of the lower thoracic esophagus was detected. We diagnosed mediastinum cyst. One year after the first visit, a CT examination confirmed an increase in lesion size. Therefore, surgery was performed using a left thoracoscopic approach in the prone position. Before surgery, 3D models were used for simulation. Excision was performed without leakage of the contents. The histopathological diagnosis was a bronchogenic cyst. The left thoracoscopic surgery in the prone position is an uncommon approach but is useful for resecting tumors in the left side of the lower mediastinum. The authors were well-prepared and able to perform safe and reliable surgery.
Topics: Bronchogenic Cyst; Esophagus; Female; Humans; Mediastinum; Middle Aged; Prone Position; Thoracoscopy
PubMed: 35322560
DOI: 10.1111/ases.13062