ABSTRACT
Empyema necessitans should be suspected in any patient presenting with constitutional symptoms, pleural effusion, and a subcutaneous chest wall mass. Thoracic sonography is a readily available tool, which can expedite diagnosis and timely management.
ABSTRACT
Introduction: This study aims to answer the question of whether adding mobile cone-beam computed tomography (mCBCT) imaging to shape-sensing robotic-assisted bronchoscopy (ssRAB) translates into a quantifiable improvement in the tool-lesion relationship. Methods: Data from 102 peripheral lung lesions with ≥2 sequential mCBCT orbital spins and from 436 lesions with 0-1 spins were prospectively captured and retrospectively analysed. The primary outcome was the tool-lesion relationship status across the first and the last mCBCT spins. Secondary outcomes included 1) the change in distance between the tip of the sampling tool and the centre of the lesion between the first and the last spins and 2) the per-lesion diagnostic yield. Results: Compared to lesions requiring 0-1 spins, lesions requiring ≥2 spins were smaller and had unfavourable bronchus sign and intra-operative sonographic view. On the first spin, 54 lesions (53%) were designated as non-tool-in-lesion (non-TIL) while 48 lesions (47%) were designated as TIL. Of the 54 initially non-TIL cases, 49 (90%) were converted to TIL status by the last spin. Overall, on the last spin, 96 out of 102 lesions (94%) were defined as TIL and six out of 102 lesions (6%) were defined as non-TIL (p<0.0001). The mean distance between the tool and the centre of the lesion decreased from 10.4 to 6.6â mm between the first and last spins (p<0.0001). The overall diagnostic yield was 77%. Conclusion: Targeting traditionally challenging lung lesions, intra-operative volumetric imaging allowed for the conversion of 90% of non-TIL status to TIL. Guidance with mCBCT resulted in a significant decrease in the distance between the tip of the needle to lesion centre.
ABSTRACT
CASE PRESENTATION: A 51-year-old nonsmoking man presented to his general practitioner with a primary complaint of 4 months of progressive hoarseness, and was subsequently referred to an otolaryngologist. He had no relevant medical or surgical history. He did not take any chronic medications or supplements. He was born in the Dominican Republic and moved to New York City when he was 36 years old. He worked in construction. In his spare time, he would return to his home country. The patient was a lifelong nonsmoker and reported no alcohol consumption. He denied shortness of breath, cough, sputum expectoration, fevers, chills, and night sweats.