Diagnostic Accuracy for Acute Rib Fractures: A Cross-sectional Study Utilizing Automatic Rib Unfolding and 3D Volume-Rendered Reformation.

RATIONALE AND OBJECTIVES: The aim of this study was to compare the use of computed tomography (CT) with automatic rib unfolding and three-dimensional (3D) volume-rendered imaging in the detection and characterization of rib fractures and flail chest. MATERIALS AND METHODS: A total of 130 patients with blunt chest trauma underwent whole-body CT, and five independent readers assessed the presence and characterization of rib fractures using traditional CT images, automatic rib unfolding, and 3D volume-rendered images in separate readout sessions at least 2 weeks apart. A gold standard was established by consensus among the readers based on the combined analysis of conventional and reformatted images. RESULTS: Automatic rib unfolding significantly reduced mean reading time by 47.5%-74.9% (P < 0.0001) while maintaining a comparable diagnostic performance for rib fractures (positive predictive value [PPV] of 82.1%-93.5%, negative predictive value [NPV] of 96.8%-98.2%, and 69.4%-94.2% and 96.9%-99.1% for conventional axial images and 70.4%-85.1% and 95.2%-96.6% for 3D images) and better interobserver agreement (kappa of 0.74-0.87). For flail chest, automatic rib unfolding showed a PPV of 85.7%-100%, NPV of 90.4%-99.0%, and 80.0%-100% and 89.7%-100% for conventional axial images and 76.9%-100% and 89.0%-92.1% for 3D images. CONCLUSION: Automatic rib unfolding demonstrated equivalent diagnostic performance to conventional images in detecting acute rib fractures and flail chest, with good interobserver agreement and time-saving benefits.

Effect of multidisciplinary team care on survival of oesophageal cancer patients: a retrospective nationwide cohort study.

Oesophageal cancer is the sixth leading cause of cancer death worldwide. This nationwide study analyses the survival results of oesophageal cancer under multidisciplinary team (MDT) care. We enrolled oesophageal cancer patients diagnosed between 2010 and 2015 with follow-up for at least 1 year. This study performed propensity score matching with a ratio of 1:1 between MDT participants and non-MDT participants. We performed conditional Cox proportional hazards model to research relative risk of survival and associated factors of survival. The adjusted survival curves were plotted. 8184 newly diagnosed oesophageal cancer patients were included. The favourable survival factors include participant status of MDT, gender, monthly salary, urbanization level, other catastrophic illness, stage of cancer, treatment methods, and service volume of physicians (P < 0.05). MDT participants showed lower risk of death (HR = 0.73; 95% CI 0.67-0.79). Further stratification analysis revealed that the incorporation of an MDT reduced the death risk of patients with stages 2, 3, and 4 cancer, with the greatest reduction observed in patients with stage 3 cancer (HR = 0.72; 95% CI 0.67-0.79). The risk of death was lower for oesophageal cancer patients who enrolled in MDT care.

Effect of diabetes mellitus on risk of latent TB infection in a high TB incidence area: a community-based study in Taiwan.

OBJECTIVE: To investigate the association between diabetes and latent tuberculosis infections (LTBI) in high TB incidence areas. DESIGN: Community-based comparison study. SETTING: Outpatient diabetes clinics at 4 hospitals and 13 health centres in urban and rural townships. A community-based screening programme was used to recruit non-diabetic participants. PARTICIPANTS: A total of 2948 patients with diabetes aged older than 40 years were recruited, and 453 non-diabetic participants from the community were enrolled. PRIMARY AND SECONDARY OUTCOME MEASURES: The interferon-gamma release assay (IGRA) and the tuberculin skin test were used to detect LTBI. The IGRA result was used as a surrogate of LTBI in logistic regression analysis. RESULTS: Diabetes was significantly associated with LTBI (adjusted OR (aOR)=1.59; 95% CI 1.11 to 2.28) and age correlated positively with LTBI. Many subjects with diabetes also had additional risk factors (current smokers (aOR=1.28; 95% CI 0.95 to 1.71), comorbid chronic kidney disease (aOR=1.26; 95% CI 1.03 to 1.55) and history of TB (aOR=2.08; 95% CI 1.19 to 3.63)). The presence of BCG scar was protective (aOR=0.66; 95% CI 0.51 to 0.85). Duration of diabetes and poor glycaemic control were unrelated to the risk of LTBI. CONCLUSION: There was a moderately increased risk of LTBI in patients with diabetes from this high TB incidence area. This finding suggests LTBI screening for the diabetics be combined with other risk factors and comorbidities of TB to better identify high-risk groups and improve the efficacy of targeted screening for LTBI.

A Rare Case of Acute Phlegmonous Esophagogastritis Complicated with Hypopharyngeal Abscess and Esophageal Perforation.

BACKGROUND Acute phlegmonous esophagogastritis is a life-threatening disease that may be combined with serious complications. We present the classical radiological and endoscopic features and treatment strategy of a middle-aged female patient suffering from acute phlegmonous esophagogastritis complicated with hypopharyngeal abscess, esophageal perforation, mediastinitis, and empyema. CASE REPORT A 60-year-old Taiwanese female presented at our hospital due to fever, fatigue, painful swallowing, and vague chest pain for 5 days. She had a past history of uncontrolled type 2 diabetes mellitus. On physical examination, general weakness, chest pain, odynophagia, and a fever up to 38.9°C were found. Positive laboratory findings included leukocytosis (leukocyte count of 14.58×10³/µL, neutrophils 76.8%) and serum glucose 348 mg/dL (HbA1c 11.3%). A diagnosis of acute phlegmonous esophagogastritis with hypopharyngeal abscess was made based on typical computed tomography image features and clinical signs of infection. The patient received empirical antibiotic therapy initially; however, esophageal perforation with mediastinitis and empyema developed after admission. Emergency surgery with drainage and debridement was performed and antibiotics were administered. She was discharged in a stable condition on the 56th day of hospitalization. Six months later, a delayed esophageal reconstruction was performed. The patient has performed well for 9 months to date since the initial diagnosis. CONCLUSIONS Acute phlegmonous esophagogastritis complicated with hypopharyngeal abscess and esophageal perforation is extremely rare, and requires immediate medical attention. This report serves to remind physicians of this rare entity and the potential complications that may manifest with acute phlegmonous esophagogastritis.

A Huge Subcutaneous Hematoma in an Adult with Kasabach-Merritt Syndrome.

BACKGROUND Kasabach-Merritt syndrome is a potentially fatal disease that consists of hemangioma(s) with thrombocytopenia, microangiopathic hemolytic anemia, and coagulopathy. Extensive hemangiomatosis is rare. We present the radiological features and treatment strategy of a young adult suffering from Kasabach-Merritt syndrome with widespread hemangiomas and an infected huge hematoma in the right thigh. CASE REPORT A 33-year-old Taiwanese male presented with a painful 20-cm mass over his right thigh and gross hematuria for 2 days. Hemangiomatosis was bioptically proven in infancy and the patient was under regular follow-up. Physical examination revealed normal heart rate, respiratory rate, and body temperature. Multiple palpable lumps with brown and purple areas of skin over the neck, trunk, and right thigh were noted. Laboratory examinations revealed thrombocytopenia anemia and elevated fibrin degradation products. There were no signs of sepsis. Blood transfusion and steroid therapy were executed. Computed tomography showed a huge complicated subcutaneous hematoma in the right thigh. Drainage of the huge hematoma was performed and antibiotics were prescribed. After the local infection in the right thigh and the bleeding tendency were controlled, the patient was discharged in a stable condition two weeks later. CONCLUSIONS A huge infected hematoma and widespread hemangiomas are extremely rare complications of Kasabach-Merritt syndrome. There are no known treatment guidelines currently available. Our patient was successfully treated with steroids, drainage, and antibiotics.

Primary Pulmonary Meningioma Simulating a Pulmonary Metastasis.

Primary pulmonary meningiomas represent a rare tumor entity. Few cases have been reported in the English medical literature, and they have almost all been solitary and benign in nature, with the exception of several extremely rare cases. We report herein a case of PPM that raised suspicion of a pulmonary metastatic tumor initially, as it was depicted as a single, round, small, ground-glass opacity pulmonary nodule on a chest computed tomography scan, in a 55-year-old man with a history of buccal cancer. Increased awareness of the clinical and radiologic characteristics of this rare category can assist a multidisciplinary team to perform adequate management.

Pulmonary Hilar Tumor: An Unusual Presentation of Sclerosing Hemangioma.

Pulmonary sclerosing hemangioma is an uncommon benign tumor of the lung; however, on rare occasions it can arise from the pulmonary hilar region. Herein, we report a 53-year-old female patient who presented with a round opacity in the right upper lung field on a radiograph. Chest computed tomography scanning revealed a 3.1 cm mass in the right pulmonary hilum. Thoracoscopic tumor excision was subsequently performed. On pathohistologic study, the tumor was well defined and composed of round stromal cells and surface cells arranged in a papillary, sclerotic, solid, and hemorrhagic pattern. In immunochemical study, the round cells were positive for thyroid transcription factor-1 (TTF-1) and epithelial membrane antigen (EMA) and negative for cytokeratin. The surface cells were positive for TTF-1, EMA, and cytokeratin. Therefore, a final diagnosis of sclerosing hemangioma was confirmed. In conclusion, pulmonary sclerosing hemangioma is uncommon and rare in the pulmonary hilar region. CT scanning is useful to determine its benignity, although imaging features are not specific for a definite differential diagnosis from other pulmonary tumors. Therefore, tissue diagnosis is usually necessary, and pulmonary sclerosing hemangioma should be listed in the differential diagnoses of pulmonary hilar tumors.

Systemic air embolism causing acute stroke and myocardial infarction after percutaneous transthoracic lung biopsy-a case report.

Computed tomography (CT)-guided transthoracic lung biopsy is a common procedure for the diagnosis of pulmonary lesion. Pneumothorax, pulmonary hemorrhage and hemoptysis are the most common complications of the procedure. Air embolism is a rare serious complication. We reported a case with air embolism related acute ischemic stroke and non-ST elevation myocardial infarction (NSTEMI) simultaneously after percutaneous transthoracic lung biopsy.

Lymphoepithelioma-like carcinoma of the lung: an unusual case and literature review.

We described a case of lymphoepithelioma-like carcinoma (LELC) of the lung of a 65-year-old man with initial symptoms of intermittent chest pain and mild shortness of breath for 2 weeks. A right-lung mass was noted on chest computed tomography (CT) scan and was proved histopathologically as LELC of lung after video-assisted thorascopic lobectomy. He was successfully treated with lobectomy with postoperative adjuvant chemotherapy and is alive without signs of recurrence for 36 months after the diagnosis. It is important for clinicians, pathologists, and radiologists to understand the clinical, pathological, and radiological presentations of this neoplasm to avoid improper clinical decision making and misdiagnosis.

Quantitative ultrasound of the calcaneus in hemodialysis patients.

The aim of this study was to investigate the bone status of hemodialysis patients and identify factors that have influence on bone quality. Four hundred eighty-nine subjects (213 males and 276 females) on maintenance hemodialysis and 696 healthy subjects (309 men, 387 women) were enrolled in this study. Speed of sound (SOS), broadband ultrasound attenuation (BUA) and quantitative ultrasound index (QUI) were assessed by quantitative ultrasound (QUS) at the right calcaneus in both groups. Serum levels of intact parathyroid (iPTH), total alkaline phosphatase (ALP), calcium and phosphate were measured to determine their influence on bone status in hemodialysis patients. All QUS parameters were significantly lower in hemodialysis patients than in controls (p < 0.0001). Stepwise multiple linear regression analysis in male patients indicated that age, weight, calcium-phosphate product and ALP were significant predictors of QUS parameters (adjusted R(2) = 0.15 in SOS; adjusted R(2) = 0.17 in BUA and QUI). In female patients, same findings including number of parity were observed in SOS only (adjusted R(2) = 0.25 in SOS). In postmenopausal patients, the duration of menopause was significant negatively correlated with all QUS parameters (p < 0.01). In conclusion, patients on maintenance hemodialysis had additional risk of bone loss. Advanced age, low body weight, high calcium-phosphate product and high ALP level were important risk factors for deterioration of bone quality.