RESUMO
Differentiating between giant pulmonary bullae and pneumothorax can pose a challenge in clinical settings. A chest CT scan during the patient's health assessment revealed that approximately 40% of the right chest cavity was filled with air, leading to incomplete expansion of the right lung. The patient was initially misdiagnosed with pneumothorax in the emergency department and subsequently underwent closed thoracic drainage without experiencing any improvement in symptoms. Upon further examination through thoracoscopy, the patient was correctly diagnosed with a giant pulmonary bulla. Upon reviewing the patient's chest CT scan, we were able to identify key distinguishing features between giant pulmonary bullae and pneumothorax.
Assuntos
Vesícula , Erros de Diagnóstico , Pneumotórax , Tomografia Computadorizada por Raios X , Humanos , Pneumotórax/diagnóstico por imagem , Pneumotórax/diagnóstico , Pneumotórax/etiologia , Vesícula/diagnóstico por imagem , Masculino , Diagnóstico Diferencial , Pneumopatias/diagnóstico por imagem , Pneumopatias/diagnóstico , Serviço Hospitalar de EmergênciaRESUMO
For herpes zoster (HZ) infection, early diagnosis and treatment are important in order to shorten the course of the disease and reduce sequelae, however, there is a lack of non-invasive diagnostic methods. Reflectance confocal microscopy (RCM) is a non-invasive technique often used to diagnose dyspigmented dermatosis, skin tumours, human papillomavirus infectious dermatosis, etc. To evaluate the clinical value of RCM for the early diagnosis of HZ. We collected RCM images from 30 HZ patients with typical vesicles in order to analyse their features. We then utilized RCM to analyse early lesions of another 12 HZ patients, who presented with localized erythema or papules, but not typical vesicles. In addition, we recruited one patient with HZ and observed the lesions over 14 days also using RCM. RCM images showed that the typical lesions of HZ mainly involved oedema of the spinous layer, intraepidermal blister formation, ballooning multinucleated giant (BMG) cells, and dermal papillary oedema. Among them, BMG cells were of specific diagnostic value. Early lesions of HZ patients without typical vesicles showed BMG cells under RCM. A few BMG cells were observed during the early stage of HZ. However, the number of BMG cells increased significantly as typical clustered blisters gradually appeared in the lesions. With the regression of the lesions, the number of BMG cells decreased gradually. RCM, with the advantages of being non-invasive, rapid, and convenient, has an important role in monitoring the evolution of HZ.
Assuntos
Diagnóstico Precoce , Herpes Zoster , Microscopia Confocal , Humanos , Microscopia Confocal/métodos , Herpes Zoster/patologia , Herpes Zoster/diagnóstico , Feminino , Masculino , Pessoa de Meia-Idade , Idoso , Adulto , Células Gigantes/patologia , Vesícula/diagnóstico por imagem , Vesícula/patologia , Vesícula/virologia , Edema/diagnóstico por imagem , Edema/patologia , Idoso de 80 Anos ou maisRESUMO
PURPOSE: Details of the neogenesis of bullae (NOB), which causes recurrent primary spontaneous pneumothorax (PSP) following bullectomy, have not been reported and risk factors for NOB remain unclear. We aimed to clarify the details of NOB. METHODS: We conducted a prospective study using three computed tomography (CT) examinations performed 6, 12, and 24 months after bullectomy to identify the incidence of and risk factors for NOB. We enrolled 50 patients who underwent bullectomy for PSP. RESULTS: After excluding 11 patients who canceled the postoperative CT examination at 6 months after bullectomy, only 39 patients were analyzed. The incidence of NOB at 6, 12, and 24 months after bullectomy was 38.5%, 55.2%, and 71.2%, respectively. The rate of NOB in the operated lung was almost 2 times higher than that in the contralateral nonoperative lung. Male sex, multiple bullae on preoperative CT, long stapling line (≥7 cm), deep stapling depth (≥1.5 cm), and heavier resected sample (≥5 g) were suggested to be risk factors for NOB. CONCLUSIONS: We recognized a high incidence of postoperative NOB in PSP patients. Bullectomy itself seems to promote NOB. Postoperative NOB occurs frequently, especially in patients who require a large-volume lung resection with a long staple line.
Assuntos
Pneumopatias , Pneumotórax , Feminino , Humanos , Masculino , Vesícula/diagnóstico por imagem , Vesícula/epidemiologia , Vesícula/cirurgia , Incidência , Pneumotórax/diagnóstico por imagem , Pneumotórax/epidemiologia , Pneumotórax/cirurgia , Estudos Prospectivos , Recidiva , Fatores de Risco , Resultado do TratamentoAssuntos
Dissecção Aórtica , Aneurisma Intracraniano , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Aneurisma Intracraniano/complicações , Dissecção Aórtica/diagnóstico por imagem , Dissecção Aórtica/cirurgia , Dissecção Aórtica/complicações , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Vesícula/etiologia , Vesícula/diagnóstico por imagemRESUMO
A 38-year-old male, he was diagnosed with a giant pulmonary bulla occupying 2/3 of the right thoracic cavity on chest computed tomography( CT). The preoperative pulmonary function was unfavorable, so bullectomy of right upper lobe with video-assisted thoracoscopic surgery( VATS) was performed. The outpatient follow-up was completed at 6 months after surgery. However, one year and eleven months postoperatively, the patient returned to the clinic complaining of dyspnea. Chest X-ray and CT showed a recurrence of a giant emphysematous bulla in the right upper lobe. Two years and three months after the initial surgery, the recurrent giant bulla was resected by right upper lobectomy with VATS. About four years after the reoperation, no recurrence of giant pulmonary bulla has been seen. Although there are some reports on surgical treatment and results of giant pulmonary bulla, there are few reports on recurrent cases, so we report this case.
Assuntos
Pneumopatias , Enfisema Pulmonar , Masculino , Humanos , Adulto , Vesícula/diagnóstico por imagem , Vesícula/cirurgia , Enfisema Pulmonar/diagnóstico por imagem , Enfisema Pulmonar/cirurgia , Pulmão/cirurgiaAssuntos
Vesícula , Extremidade Inferior , Humanos , Vesícula/diagnóstico por imagem , Vesícula/etiologiaRESUMO
A 46-year-old man was taken to a hospital by ambulance because of sudden onset of dyspnea, and was inserted chest drainage tube with a diagnosis of right-sided tension pneumothorax on chest X-ray. Since the chest drainage was not effective, he was transferred to our institute. Based on chest computed tomography (CT) findings, a diagnosis of giant bullae of the right lung was made, and surgical treatment was performed. Postoperatively, the improvement of respiratory function was confirmed.
Assuntos
Pneumotórax , Masculino , Humanos , Pessoa de Meia-Idade , Pneumotórax/diagnóstico por imagem , Pneumotórax/cirurgia , Vesícula/diagnóstico por imagem , Vesícula/cirurgia , Pulmão , Erros de Diagnóstico/efeitos adversosRESUMO
Ruptures of pulmonary blebs and bullae are the most common cause of spontaneous pneumothorax in dogs. Incidental bullae/blebs have been documented in otherwise healthy people, however information for veterinary patients is currently lacking. Objectives of this retrospective, observer agreement, analytical study were to characterize incidental bullae in thoracic CT studies of dogs, assess interobserver variability for characterizing the bullae, and assess anesthesia risks. Inclusion criteria were dogs presenting for non-pneumothorax related reasons that had a thoracic CT at a single specialty and emergency hospital from 2012 to 2021 and had a bulla listed in the CT report. Medical records for dogs meeting inclusion criteria were reviewed to collect data on signalment, weight, total number of general anesthesia procedures 2 years prior and 2 years following the CT scan, and adverse anesthesia events. In addition, the CT images were reviewed by three American College of Veterinary Radiology-certified veterinary radiologists to collect data on the location, size, number of bullae and thickness of the bulla wall. A total of 1119 dogs met initial inclusion criteria and 74 dogs were included in analyses. There was no sex predilection for incidental pulmonary bullae. Bullae were more commonly found in older (median age 11.3 years), large breed dogs (median weight 20.7 kg). A solitary bulla of less than 1 cm was the most common finding with no apparent predilection for a particular lung lobe. There was strong correlation among the three radiologists for bulla location, size, and number, but weak correlations for bulla wall thickness. No adverse anesthesia events were found following CT anesthesia or following repetitive anesthesia procedures.
Assuntos
Vesícula , Doenças do Cão , Cães , Animais , Vesícula/diagnóstico por imagem , Vesícula/etiologia , Vesícula/veterinária , Estudos Retrospectivos , Variações Dependentes do Observador , Tomografia Computadorizada por Raios X/efeitos adversos , Tomografia Computadorizada por Raios X/veterinária , Anestesia Geral/efeitos adversos , Anestesia Geral/veterinária , Doenças do Cão/diagnóstico por imagem , Doenças do Cão/epidemiologia , Doenças do Cão/etiologiaRESUMO
Large lung bullae are rare in children. We report a rare case of a large bulla in the right lung causing compression of the underlying lung with a shift of the mediastinum to the contralateral side. Excision of the bulla was done and a novel technique was used in the repair of bronchial air leakage sites with part of the bullous wall/membrane. The patient recovered well with re-expansion of the underlying collapsed lung.
Assuntos
Atelectasia Pulmonar , Enfisema Pulmonar , Humanos , Criança , Enfisema Pulmonar/diagnóstico por imagem , Enfisema Pulmonar/cirurgia , Vesícula/complicações , Vesícula/diagnóstico por imagem , Vesícula/cirurgia , Pulmão/diagnóstico por imagem , Pulmão/cirurgiaRESUMO
Endoscopic lung volume reduction using unidirectional endobronchial valves is a new technique in the treatment of patients with severe emphysema. However, the movements of the thoracic structures after endobronchial valves insertion are still unpredictable We report the unusual outcome of six patients after valves insertion in the left upper lobe. They all developed a complete atelectasis of the target lobe, a pneumothorax and sequential genuine bullae in the treated left lung of unknown etiology. The chest CT scan prior to the valves insertion was unremarkable. Three patients developed an air-liquid level in the bullae the day before a bacterial infection of their left lower lobe. The three other patients had an uneventful spontaneous resolution of their bullae at long-term follow-up. Therefore, a conservative attitude should be followed in this particular setting.
Assuntos
Enfisema , Pneumotórax , Doença Pulmonar Obstrutiva Crônica , Enfisema Pulmonar , Vesícula/diagnóstico por imagem , Vesícula/etiologia , Vesícula/cirurgia , Broncoscopia/efeitos adversos , Enfisema/complicações , Seguimentos , Humanos , Pneumonectomia/efeitos adversos , Pneumonectomia/métodos , Pneumotórax/diagnóstico por imagem , Pneumotórax/etiologia , Pneumotórax/cirurgia , Doença Pulmonar Obstrutiva Crônica/complicações , Enfisema Pulmonar/diagnóstico por imagem , Enfisema Pulmonar/etiologia , Enfisema Pulmonar/cirurgia , Resultado do TratamentoRESUMO
Purpose: Surgical bullectomy is the standard treatment of giant emphysematous bulla (GEB). However, bronchoscopic treatment should be considered as an alternative approach for patients who are unfit for surgical treatment. The study aimed to evaluate the clinical efficacy of endobronchial occlusion for the treatment of GEB using silicone plugs. Methods: This retrospective study recruited four patients with GEB who were unsuitable for surgery. Preoperative planning was performed using high-resolution computed tomography and a virtual bronchoscopic navigation system. Customized silicone plugs were then placed in the target airway via bronchoscopy to cause GEB regression and atelectasis. Results: All procedures were completed successfully in four patients. Three months after the procedures, compared with baseline, increases in the mean forced expiratory volume in 1 s (from 1.20 L/s to 1.33 L/s), forced vital capacity (from 2.63 L to 2.90 L), diffusion lung capacity for carbon monoxide (from 29% to 41% of the predicted value) and 6-minute walking test (from 412 m to 474 m) were observed. Additionally, the mean total lung capacity (from 6.80 L to 6.35 L), residual volume (from 3.97 L to 3.52 L), and St. George's Respiratory Questionnaire scores (from 67 to 45) were all lower than baseline data. Conclusion: Our preliminary results demonstrated that the endobronchial placement of silicone plugs could be a low-cost, safe, and effective choice for the treatment of GEB in surgically unfit patients.
Assuntos
Doença Pulmonar Obstrutiva Crônica , Enfisema Pulmonar , Vesícula/diagnóstico por imagem , Vesícula/cirurgia , Broncoscopia/métodos , Volume Expiratório Forçado , Humanos , Pneumonectomia/métodos , Doença Pulmonar Obstrutiva Crônica/cirurgia , Enfisema Pulmonar/diagnóstico por imagem , Enfisema Pulmonar/cirurgia , Estudos Retrospectivos , Silicones , Resultado do TratamentoRESUMO
As bullae contribute to decreased lung function in chronic obstructive pulmonary disease (COPD) patients, effective decompression of large bullae is important. Bronchoscopic lung volume reduction via endobronchial one-way valves is less invasive and has a lower mortality rate than lung volume reduction surgery. We report the case of a 48-year-old male who presented with giant bullae that were expeditiously resolved with endobronchial valves and percutaneous catheter insertion. Three days later, imaging revealed marked decreases in the extent of bullae and atelectasis of the contralateral lung without any complications, including air leakage or pneumothorax. Combination of endobronchial valves and percutaneous catheter insertion might be helpful to accelerate the release of large bullae and to achieve improved lung function and higher levels of physical activity in patients with COPD.
Assuntos
Pneumopatias , Doença Pulmonar Obstrutiva Crônica , Enfisema Pulmonar , Vesícula/diagnóstico por imagem , Vesícula/cirurgia , Broncoscopia , Catéteres , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
We report a 33-year-old man who presented with recurrent right pneumothorax. Computed tomography (CT) showed the presence of a large bulla with a maximum diameter of 8 cm in the right middle lobe; he subsequently underwent bullectomy. Histopathology revealed that pulmonary parenchyma adjacent to the bulla represented nodular proliferation of clear cells characterized by a papillary structure resembling placental chorionic villi. Immunohistochemically, clear cells were positive for CD10, suggesting placental transmogrification of the lung (PTL). We reviewed 36 surgical cases of PTL, and only 2 cases (5.6%), including our case, were operated for spontaneous pneumothorax. Bullous lesions secondary to PTL tend to appear as unilateral large cystic masses in non-upper lobes, which is atypical for primary spontaneous pneumothorax (PSP). Although PTL is considered a very rare cause of secondary pneumothorax, we must carefully differentiate this condition.
Assuntos
Pneumotórax , Masculino , Humanos , Feminino , Gravidez , Adulto , Pneumotórax/diagnóstico por imagem , Pneumotórax/etiologia , Pneumotórax/cirurgia , Vesícula/diagnóstico por imagem , Vesícula/etiologia , Vesícula/cirurgia , Placenta/patologia , Resultado do Tratamento , Pulmão/diagnóstico por imagem , Pulmão/cirurgiaRESUMO
BACKGROUND: Bulla is a common cause of primary spontaneous pneumothorax. Video-assisted thoracoscopic surgery (VATS) through the lateral chest wall is a common surgical approach and an effective treatment for this condition, but postoperative incision scars affect the aesthetic outcome. VATS via axillary approach can hide the scar in the axilla, and the wound in its natural state is invisible; this greatly improves the cosmetic appearance. To our knowledge, this is the first report of VATS-based bullectomy via the axillary approach in a patient with spontaneous pneumothorax. CASE PRESENTATION: A 20-year-old female patient was admitted to the hospital with a 2-day history of chest tightness and chest pain. Plain chest computed tomography showed right spontaneous pneumothorax, lung compression of 75%, and right pulmonary bulla. After complete preoperative examination, VATS bullectomy via right axillary approach was performed. During the operation, a bulla measuring about 4 × 4 cm was found at the apex of the right lung and resected. The incision healed well, and the patient was discharged after surgery. CONCLUSIONS: VATS bullectomy via axillary approach is safe and feasible, with the incision hidden in the axilla and not visible in the natural state. This method leaves no scar on the chest wall and has good cosmetic outcome.
Assuntos
Pneumotórax , Adulto , Axila/cirurgia , Vesícula/diagnóstico por imagem , Vesícula/cirurgia , Feminino , Humanos , Pulmão , Pneumotórax/diagnóstico por imagem , Pneumotórax/cirurgia , Cirurgia Torácica Vídeoassistida , Adulto JovemRESUMO
BACKGROUND: There are few reports on the chest computed tomography (CT) imaging features of children with coronavirus disease 2019 (COVID-19), and most reports involve small sample sizes. OBJECTIVES: To systematically analyze the chest CT imaging features of children with COVID-19 and provide references for clinical practice. DATA SOURCES: We searched PubMed, Web of Science, and Embase; data published by Johns Hopkins University; and Chinese databases CNKI, Wanfang, and Chongqing Weipu. METHODS: Reports on chest CT imaging features of children with COVID-19 from January 1, 2020 to August 10, 2020, were analyzed retrospectively and a meta-analysis carried out using Stata12.0 software. RESULTS: Thirty-seven articles (1747 children) were included in this study. The heterogeneity of meta-analysis results ranged from 0% to 90.5%. The overall rate of abnormal lung CT findings was 63.2% (95% confidence interval [CI]: 55.8%-70.6%), with a rate of 61.0% (95% CI: 50.8%-71.2%) in China and 67.8% (95% CI: 57.1%-78.4%) in the rest of the world in the subgroup analysis. The incidence of ground-glass opacities was 39.5% (95% CI: 30.7%-48.3%), multiple lung lobe lesions was 65.1% (95% CI: 55.1%-67.9%), and bilateral lung lesions was 61.5% (95% CI: 58.8%-72.2%). Other imaging features included nodules (25.7%), patchy shadows (36.8%), halo sign (24.8%), consolidation (24.1%), air bronchogram signs (11.2%), cord-like shadows (9.7%), crazy-paving pattern (6.1%), and pleural effusion (9.1%). Two articles reported 3 cases of white lung, another reported 2 cases of pneumothorax, and another 1 case of bullae. CONCLUSIONS: The lung CT results of children with COVID-19 are usually normal or slightly atypical. The lung lesions of COVID-19 pediatric patients mostly involve both lungs or multiple lobes, and the common manifestations are patchy shadows, ground-glass opacities, consolidation, partial air bronchogram signs, nodules, and halo signs; white lung, pleural effusion, and paving stone signs are rare. Therefore, chest CT has limited value as a screening tool for children with COVID-19 and can only be used as an auxiliary assessment tool.
Assuntos
COVID-19/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Tórax/diagnóstico por imagem , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Adolescente , Vesícula/diagnóstico por imagem , Vesícula/epidemiologia , Vesícula/virologia , COVID-19/diagnóstico , COVID-19/epidemiologia , COVID-19/virologia , Criança , Pré-Escolar , Gerenciamento de Dados , Feminino , Humanos , Incidência , Lactente , Pulmão/patologia , Pulmão/virologia , Masculino , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/epidemiologia , Derrame Pleural/virologia , Pneumotórax/diagnóstico por imagem , Pneumotórax/epidemiologia , Estudos Retrospectivos , SARS-CoV-2/genética , Nódulo Pulmonar Solitário/diagnóstico por imagem , Nódulo Pulmonar Solitário/epidemiologia , Nódulo Pulmonar Solitário/virologia , Tomografia Computadorizada por Raios X/métodos , Tomografia Computadorizada por Raios X/tendênciasRESUMO
Giant lung bullae are usually seen in patients with severe chronic obstructive pulmonary disease. Over time, air trapping leads to severe dyspnea and CO2 accumulation. In severe cases, overinflation and rupture of the bulla can cause secondary life-threatening tension pneumothorax. Since positive pressure ventilation exerts deleterious effects on the bulla, general anesthesia is always challenging in patients with giant bullae. We encountered remarkable intraoperative hypercapnia and decreased tidal volume in a 58-year-old male patient with bilateral bullae who underwent right upper bullectomy, due to overinflation of a bulla located in the upper lobe of the ventilated side. Through this experience, to avoid further overinflation, we devised an original, unique and simple airway management strategy using a standard double lumen tube (DLT), which only requires slightly deeper advancement of the DLT to achieve selective lobar blockade during one lung ventilation (OLV). Following the first case, we used this strategy in a 48-year-old male patient who underwent left giant bullectomy, resulting in successful airway management without overinflation during OLV. We recommend our strategy as an option for successful intraoperative airway management during OLV in select bullectomy patients with bilateral giant bullae.