ABSTRACT
Chest X-ray (CXR) is an extensively utilized radiological modality for supporting the diagnosis of chest diseases. However, existing research approaches suffer from limitations in effectively integrating multi-scale CXR image features and are also hindered by imbalanced datasets. Therefore, there is a pressing need for further advancement in computer-aided diagnosis (CAD) of thoracic diseases. To tackle these challenges, we propose a multi-branch residual attention network (MBRANet) for thoracic disease diagnosis. MBRANet comprises three components. Firstly, to address the issue of inadequate extraction of spatial and positional information by the convolutional layer, a novel residual structure incorporating a coordinate attention (CA) module is proposed to extract features at multiple scales. Next, based on the concept of a Feature Pyramid Network (FPN), we perform multi-scale feature fusion in the following manner. Thirdly, we propose a novel Multi-Branch Feature Classifier (MFC) approach, which leverages the class-specific residual attention (CSRA) module for classification instead of relying solely on the fully connected layer. In addition, the designed BCEWithLabelSmoothing loss function improves the generalization ability and mitigates the problem of class imbalance by introducing a smoothing factor. We evaluated MBRANet on the ChestX-Ray14, CheXpert, MIMIC-CXR, and IU X-Ray datasets and achieved average AUCs of 0.841, 0.895, 0.805, and 0.745, respectively. Our method outperformed state-of-the-art baselines on these benchmark datasets.
Subject(s)
Radiography, Thoracic , Humans , Radiography, Thoracic/methods , Neural Networks, Computer , Thoracic Diseases/diagnostic imaging , Thoracic Diseases/diagnosis , Algorithms , Diagnosis, Computer-Assisted/methodsABSTRACT
Brucellosis remains a major public health problem worldwide. It is commonly found in most developed and developing countries, such as the Mediterranean region, the Middle East, and Latin America. In China, brucellosis is mainly distributed in some of the northern provinces and is relatively rare in Shandong province. Brucellosis has a variety of clinical manifestations, with fever, sweating, fatigue, and migratory joint pain being the most common. Because of the non-specific clinical symptoms, brucellosis is often misdiagnosed as other diseases. Here, we report a rare case of brucellosis of thoracic vertebrae misdiagnosed as thoracic malignant tumor and present a review of related literature.
Subject(s)
Brucellosis/diagnosis , Diagnostic Errors , Neoplasms/diagnosis , Spondylitis/diagnosis , Thoracic Vertebrae/pathology , Anti-Bacterial Agents/therapeutic use , Brucellosis/drug therapy , Brucellosis/pathology , China , Doxycycline/therapeutic use , Female , Humans , Middle Aged , Positron Emission Tomography Computed Tomography , Rifampin/therapeutic use , Spondylitis/microbiology , Spondylitis/pathology , Streptomycin/therapeutic use , Thoracic Diseases/diagnosis , Thoracic Diseases/microbiology , Thoracic Diseases/pathology , Thoracic Vertebrae/microbiologyABSTRACT
The existing coverage criteria for noninvasive ventilation (NIV) do not recognize the benefits of early initiation of NIV for those with thoracic restrictive disorders and do not address the unique needs for daytime support as the patients progress to ventilator dependence. This document summarizes the work of the thoracic restrictive disorder Technical Expert Panel working group. The most pressing current coverage barriers identified were: (1) delays in implementing NIV treatment; (2) lack of coverage for many nonprogressive neuromuscular diseases; and (3) lack of clear policy indications for home mechanical ventilation (HMV) support in thoracic restrictive disorders. To best address these issues, we make the following key recommendations: (1) given the need to encourage early initiation of NIV with bilevel positive airway pressure devices, we recommend that symptoms be considered as a reason to initiate therapy even at mildly reduced FVCs; (2) broaden CO2 measurements to include surrogates such as transcutaneous, end-tidal, or venous blood gas; (3) expand the diagnostic category to include phrenic nerve injuries and disorders of central drive; (4) allow a bilevel positive airway pressure device to be advanced to an HMV when the vital capacity is < 30% or to address severe daytime respiratory symptoms; and (5) provide additional HMV when the patient is ventilator dependent with use > 18 h per day. Adoption of these proposed recommendations would result in the right device, at the right time, for the right type of patients with thoracic restrictive disorders.
Subject(s)
Home Care Services , Medicare , Neuromuscular Diseases , Noninvasive Ventilation , Respiratory Insufficiency , Thoracic Diseases , Blood Gas Analysis/methods , Continuous Positive Airway Pressure/instrumentation , Continuous Positive Airway Pressure/methods , Home Care Services/organization & administration , Home Care Services/standards , Humans , Medicare/organization & administration , Medicare/standards , Neuromuscular Diseases/complications , Neuromuscular Diseases/diagnosis , Neuromuscular Diseases/physiopathology , Noninvasive Ventilation/instrumentation , Noninvasive Ventilation/methods , Patient Selection , Respiratory Insufficiency/blood , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapy , Thoracic Diseases/complications , Thoracic Diseases/diagnosis , United StatesABSTRACT
The diagnosis of thoracic endometriosis (TE) is challenging, hence resulting in under-diagnosis as well as long delays before arriving at a correct definitive diagnosis. Our aim is to review the histopathological findings in TE, summarise the diagnostic features, identify any major histo-morphological indicator(s) hitherto unrecognised as such, suggest diagnostic criteria; all with the aim of improving the diagnostic capacity and reducing observer error even where the clinical suspicion is low. A case-control study in which a search in the pathology archives of a referral hospital over a 10-year period was conducted. Twenty-six cases of TE were identified, reviewed, and compared with a control population of 48 cases taken from common benign thoracic diseases. Nine notable histological features were identified in varying permutations in the test group, namely: endometrioid glands, lymphoid clusters, ceroid macrophages, siderophages, cholesterol crystals, capillary congestion, multinucleated giant cells, smooth muscle bundles and fibrosis. The first 6 features were frequent; each being present in over 13 (13/26; 50%) test cases. The first 8 features showed significant association with TE by the Chi-squared test (P<0.05). In this group, the strength of association is high for the first 4 features (Cramér's V≥0.5). The presence of ceroid macrophages is shown to be a novel key feature, previously unrecognised as such, for the identification of TE. The presence of any three of four features including endometrioid glands, lymphoid clusters, ceroid macrophages and siderophages is a suggested criterion for the definitive diagnosis of TE.
Subject(s)
Endometriosis/diagnosis , Staining and Labeling/methods , Thoracic Diseases/diagnosis , Adult , Case-Control Studies , Endometriosis/physiopathology , Endometrium/pathology , Female , Humans , Lymphocytes/pathology , Middle Aged , Nigeria/epidemiology , Retrospective Studies , Thoracic Diseases/physiopathology , Thorax/anatomy & histology , Thorax/pathology , Uterus/anatomy & histology , Uterus/pathologyABSTRACT
This Review depicts the evolving role of MRI in the diagnosis and prognostication of anomalies of the fetal body, here including head and neck, thorax, abdomen and spine. A review of the current literature on the latest developments in antenatal imaging for diagnosis and prognostication of congenital anomalies is coupled with illustrative cases in true radiological planes with viewable three-dimensional video models that show the potential of post-acquisition reconstruction protocols. We discuss the benefits and limitations of fetal MRI, from anomaly detection, to classification and prognostication, and defines the role of imaging in the decision to proceed to fetal intervention, across the breadth of included conditions. We also consider the current capabilities of ultrasound and explore how MRI and ultrasound can complement each other in the future of fetal imaging.
Subject(s)
Congenital Abnormalities/diagnosis , Magnetic Resonance Imaging/methods , Prenatal Care/statistics & numerical data , Prenatal Diagnosis/methods , Ultrasonography, Prenatal/methods , Abdominal Cavity/abnormalities , Abdominal Cavity/diagnostic imaging , Abdominal Cavity/pathology , Clinical Decision-Making/methods , Congenital Abnormalities/epidemiology , Congenital Abnormalities/pathology , Female , Gestational Age , Head and Neck Neoplasms/congenital , Head and Neck Neoplasms/diagnosis , Head and Neck Neoplasms/epidemiology , Head and Neck Neoplasms/pathology , Humans , Imaging, Three-Dimensional/methods , Infant , Infant, Newborn , Magnetic Resonance Imaging/statistics & numerical data , Pregnancy , Prenatal Care/trends , Prenatal Diagnosis/statistics & numerical data , Prognosis , Radiology/methods , Spinal Diseases/congenital , Spinal Diseases/diagnosis , Spinal Diseases/epidemiology , Spinal Diseases/pathology , Thoracic Diseases/congenital , Thoracic Diseases/diagnosis , Thoracic Diseases/epidemiology , Thoracic Diseases/pathology , Ultrasonography, Prenatal/statistics & numerical data , Urologic Diseases/congenital , Urologic Diseases/diagnosis , Urologic Diseases/epidemiology , Urologic Diseases/pathology , Video Recording/instrumentationABSTRACT
INTRODUCTION: As ultrasound becomes more accessible, the use of point-of-care ultrasound examinations performed by clinicians has increased. Sufficient theoretical and practical skills are prerequisites to integrate thoracic ultrasound into a clinical setting and to use it as supplement in the clinical decision-making. Recommendations on how to educate and train clinicians for these ultrasound examinations are debated, and simulation-based training may improve clinical performance. OBJECTIVES: The aim of this study was to explore the effect of simulation-based training in thoracic ultrasound compared to training on healthy volunteers. METHOD: A total of 66 physicians with no previous experience in thoracic ultrasound completed a training program and assessment of competences from November 2018 to May 2019. After a theoretical session in ultrasound physics, sonoanatomy, and thoracic ultrasound, the physicians were randomized into one of three groups for practical training: (1) simulation-based training, (2) training on a healthy volunteer, or (3) no training (control group). Primary outcome was difference in the clinical performance score after the training period. RESULTS: Using a multiple comparison, ANOVA with Bonferroni correction for multiplicity, there was no statistical significant difference between the two trained groups' performance score: 45.1 points versus 41.9 points (minimum 17 points, maximum 68 points; p = 0.38). The simulation-based training group scored significantly higher than the control group without hands-on training, 36.7 points (p = 0.009). CONCLUSIONS: The use of simulation-based training in thoracic ultrasound does not improve the clinical performance score compared to conventional training on healthy volunteers. As focused, thoracic ultrasound is a relatively uncomplicated practical procedure when taught; focus should mainly be on the theoretical part and the supervised clinical training in a curriculum. However, simulation can be used instead or as an add-on to training on simulated patients.
Subject(s)
Computer Simulation , Education, Medical, Continuing , Education , Respiratory Tract Diseases/diagnosis , Simulation Training/methods , Ultrasonography , Clinical Competence , Curriculum , Education/methods , Education/standards , Education, Medical, Continuing/methods , Education, Medical, Continuing/standards , Educational Measurement , Healthy Volunteers , Humans , Outcome Assessment, Health Care , Point-of-Care Testing , Program Evaluation , Thoracic Diseases/diagnosis , Ultrasonography/methods , Ultrasonography/standardsABSTRACT
BACKGROUND: This study evaluated the consequences in Europe of the COVID-19 outbreak on pathology laboratories orientated toward the diagnosis of thoracic diseases. MATERIALS AND METHODS: A survey was sent to 71 pathology laboratories from 21 European countries. The questionnaire requested information concerning the organization of biosafety, the clinical and molecular pathology, the biobanking, the workload, the associated research into COVID-19, and the organization of education and training during the COVID-19 crisis, from 15 March to 31 May 2020, compared with the same period in 2019. RESULTS: Questionnaires were returned from 53/71 (75%) laboratories from 18 European countries. The biosafety procedures were heterogeneous. The workload in clinical and molecular pathology decreased dramatically by 31% (range, 3%-55%) and 26% (range, 7%-62%), respectively. According to the professional category, between 28% and 41% of the staff members were not present in the laboratories but did teleworking. A total of 70% of the laboratories developed virtual meetings for the training of residents and junior pathologists. During the period of study, none of the staff members with confirmed COVID-19 became infected as a result of handling samples. CONCLUSIONS: The COVID-19 pandemic has had a strong impact on most of the European pathology laboratories included in this study. Urgent implementation of several changes to the organization of most of these laboratories, notably to better harmonize biosafety procedures, was noted at the onset of the pandemic and maintained in the event of a new wave of infection occurring in Europe.
Subject(s)
COVID-19/prevention & control , Clinical Laboratory Services/statistics & numerical data , Pathology, Clinical/statistics & numerical data , Pathology, Molecular/statistics & numerical data , Surveys and Questionnaires , Thoracic Diseases/diagnosis , Biological Specimen Banks/organization & administration , Biological Specimen Banks/statistics & numerical data , COVID-19/epidemiology , COVID-19/virology , Clinical Laboratory Services/trends , Containment of Biohazards/statistics & numerical data , Disease Outbreaks , Europe/epidemiology , Forecasting , Humans , Pandemics , Pathology, Clinical/methods , Pathology, Clinical/trends , Pathology, Molecular/methods , Pathology, Molecular/trends , SARS-CoV-2/isolation & purification , SARS-CoV-2/physiology , Specimen Handling/methods , Specimen Handling/statistics & numerical data , Thoracic Diseases/therapyABSTRACT
BACKGROUND: Previous work has identified that inpatient post-thoracic surgery chest x-ray films (CXR) are overutilized. METHODS: A three-phase rapid cycle quality improvement initiative was performed to reduce empiric post-thoracic surgery CXR use by 25% over 1 year. We adapted evidence-based guidelines and implemented "plan-do-study-act" (PDSA) cycle methodology. The PDSA cycles included (1) education with literature and preintervention statistics; (2) electronic medical record order-set modification; and (3) audit and feedback with monthly status reports. Each cycle lasted 3 months. Use of CXR was tracked in the post-anesthesia care unit and as a daily rate of non-post-anesthesia care unit CXRs. Cost data were estimated from Centers for Medicare & Medicaid Services fees. RESULTS: During the initiative, 292 thoracic surgery inpatients were monitored. Before intervention, 99% of patients (69 of 70) received a post-anesthesia care unit CXR, and the daily rate of other CXRs was 1.6. Overall, there was a significant reduction in CXR utilization (P < .001). Post-anesthesia care unit CXRs decreased by 42%, lowering to 89% (68 of 76) to 68% (50 of 74) to 57% (41 of 72) in PDSA cycles 1 through 3, respectively. The daily rate of other CXRs decreased by 38%, lowering to 1.4 to 1.3 to 1.0. Patient perioperative characteristics and health care quality measures were not different between cycles. After quality improvement implementation, cost savings were estimated to be at least $73,292 per year. CONCLUSIONS: Implementation of our quality improvement initiative safely and systematically reduced empiric CXR use after inpatient thoracic surgery. Results will be used in future quality improvement initiatives to reduce unnecessary postoperative testing.
Subject(s)
Quality Improvement , Radiography, Thoracic/statistics & numerical data , Thoracic Diseases/surgery , Thoracic Surgical Procedures , Unnecessary Procedures/statistics & numerical data , Aged , Female , Humans , Inpatients , Male , Postoperative Period , Retrospective Studies , Thoracic Diseases/diagnosisABSTRACT
Heterotopic salivary tissue (HST) is a normal salivary tissue located outsides the major and minor salivary glands. Multiple sites of localisation of heterotopias have been described, the occurrence of HST in the neck is rare and it may have several clinical manifestation. We report the case of 72-year-old Caucasian man presenting a suspect mass on the left-sided supraclavicular region. He is known for melanoma of the right elbow, surgically treated 11 years ago. The final diagnosis of pleomorphic adenoma of HST was retained. Methods of diagnosis and management are documented. Neoplasms arising from HST are uncommon with approximately 80% of benign tumours. Warthin's tumour is the most frequent. The localisation of these neoplasms in the lower neck is very rare and often causes a diagnostic pitfall. Histological analysis provides certainty of diagnosis, defines management and follow-up.
Subject(s)
Adenoma, Pleomorphic/diagnosis , Choristoma/diagnosis , Salivary Gland Neoplasms/diagnosis , Salivary Glands, Minor , Thoracic Diseases/diagnosis , Aged , Biopsy , Clavicle , Humans , Male , Positron Emission Tomography Computed TomographyABSTRACT
Thoracic endometriosis syndrome (TES) is a rare entity caused by thoracic implantation of endometrial tissue, manifesting as catamenial pneumothorax, pleural effusion and haemoptysis in young female individuals. Its management and long-term prevention of recurrences, can be challenging. We present the case of a young woman who presented with recurrent pneumothorax, haemopneumothorax and pleural effusion. The diagnosis of TES was confirmed based on cytological findings of pleural fluid. She underwent treatment with mechanical pleurodesis twice but continued to have recurrences. Hormonal treatment failed to produce a satisfactory resolution. She underwent chemical pleurodesis, which successfully induced remission of her TES. A review of the literature suggests that chemical pleurodesis produces better results compared with mechanical pleurodesis and that hormonal treatment with gonadotropin-releasing hormone agonists is effective at preventing recurrences.
Subject(s)
Endometriosis/diagnosis , Thoracic Diseases/diagnosis , Adult , Biopsy , Endometriosis/complications , Endometriosis/therapy , Female , Humans , Intubation , Recurrence , Thoracentesis , Thoracic Diseases/complications , Thoracic Diseases/therapy , Thoracic Surgery, Video-AssistedABSTRACT
INTRODUCTION: In this study, made an analysis of the top 100 most-cited articles about respiratory system from Turkey, which was published in Science Citation Index (SCI) and SCI Expanded (SCIE) index. MATERIALS AND METHODS: In Web of Science (WoS) advanced search of the database of "core collection" [v.5.31]; It was written to "CU=TURKEY AND SU=RESPIRATORY SYSTEM" and reached articles from Turkey published in SCI and SCIE indexes until 13.11.2019. The journal in which it was published, the impact factor of the journals, citation counts and the average of the annual citations of the publication of the first 100 articles were found. RESULT: From 1975 to 13 November 2019, the total number of publications in the field of respiratory system by the scientists of our country was 5828. The total number of citations to these articles is 48.708 (with subtracting the self citations it was 46.972). The average of citations per publication in our country is 8.36. The total number of citations for the first 100 articles was 12.374. The most cited article with 309 citations is; "The Arg753Gln Polymorphism of the Human Toll-like Receptor 2 Gene in Tuberculosis Disease" written by Ogus AC, et al. It was published in "European Respiratory Journal". Until 13.11.2019 in WoS database related to respiratory system; It has been published 494.974 articles. Published articles from Turkey is 1.17% of the total articles about respiratory system. CONCLUSIONS: Although there are our studies have been published in journals with high impact factors, our contribution to the literature still seems limited.
Subject(s)
Bibliometrics , Journalism, Medical , Thoracic Diseases/classification , Databases, Factual , Humans , Publications , Review Literature as Topic , Thoracic Diseases/diagnosis , TurkeyABSTRACT
INTRODUCTION: Thoracic endometriosis (TE) is a rare disorder affecting women during their reproductive years. Manifestations of TE include pneumothorax and haemothorax. Treatment is based on surgical and hormonal therapy that aims at eradicating existing endometrial thoracic plaques and to prevent reseeding from pelvic endometriosis. CASE REPORT: We report the case of a 36 year-old young woman presenting thoracic endometriosis revealed by a recurring spontaneous, large and isolated right haemothorax. Diagnosis, pathogeny and treatment are discussed. CONCLUSION: Thoracic endometriosis needs to be considered as a cause of haemothorax in women of childbearing age.
Subject(s)
Endometriosis/diagnosis , Hemothorax/diagnosis , Thoracic Diseases/diagnosis , Adult , Endometriosis/complications , Endometriosis/surgery , Female , Hemothorax/etiology , Hemothorax/surgery , Humans , Pleural Diseases/complications , Pleural Diseases/diagnosis , Pleural Diseases/surgery , Pneumothorax/diagnosis , Pneumothorax/etiology , Pneumothorax/surgery , Recurrence , Thoracic Diseases/complications , Thoracic Diseases/surgeryABSTRACT
BACKGROUND: Castleman's disease (CD) is a rare non-clonal lymphadenopathy. Application of video-assisted thoracoscopic surgery (VATs) in intrathoracic unicentric Castleman's disease (UCD) is rarely reported. This study is aimed to clarify the role of VATs for diagnosis and treatment in intrathoracic UCD. METHODS: The authors reviewed and identified patients who had received a histologic diagnosis of CD through VATs at our hospital from January2010 to June 2018. Clinical and radiologic variables, histopathology, type of approach, complications, and long-term effect were analyzed to evaluate the safety and efficacy of VATs. RESULTS: A total of 10 patients were included in this study, with 8 hyaline vascular type and 2 plasma cell type. The mean maximum diameter of the lesions was 4.66 cm. Nine cases underwent complete surgical excision by VATs, and 1 case was converted to thoracotomy. All patients had no postoperative complications. With a median follow-up of 5 years (range: 1-9 years), no tumor recurrence was found in 9 patients receiving complete tumor resection, and 1 patient with incomplete tumor resection remained symptom free without clinical or radiographic progression. CONCLUSIONS: VATs is an alternative, minimally invasive technique for the diagnosis and treatment in patients with intrathoracic UCD.
Subject(s)
Castleman Disease , Thoracic Diseases , Thoracic Surgery, Video-Assisted , Adolescent , Adult , Aged , Castleman Disease/diagnosis , Castleman Disease/diagnostic imaging , Castleman Disease/surgery , Female , Humans , Male , Middle Aged , Retrospective Studies , Thoracic Diseases/diagnosis , Thoracic Diseases/diagnostic imaging , Thoracic Diseases/surgery , Thoracotomy , Vena Cava, Superior , Young AdultABSTRACT
Thoracic splenosis is the autotransplantation of splenic tissue in the left thoracic cavity as a result of a splenic injury. This rare pathology is usually asymptomatic and may be discovered on incidental imaging, but the diagnosis often requires invasive procedures such as surgery in order to eliminate a neoplasic origin. We report a rare symptomatic case of a 39-year-old man presenting with chest pain and multiple nodules revealed on a computed tomography scan. The patient underwent a surgical exploration and the pathological studies concluded to a thoracic splenosis. Indeed, the previous medical history of the patient revealed a left thoraco-abdominal traumatism during childhood. The aim of this paper is to emphasize that the diagnosis can now be performed using only imaging techniques such as technetium-99 sulfur colloid or labelled heat-denatured red blood cell scintigraphy to avoid unnecessary invasive procedures including thoracotomy.
Subject(s)
Abdominal Injuries/complications , Asymptomatic Diseases , Spleen/injuries , Splenosis/diagnosis , Splenosis/etiology , Thoracic Diseases/diagnosis , Thoracic Diseases/etiology , Thoracic Injuries/complications , Unnecessary Procedures , Adult , Humans , Male , Splenectomy , Splenosis/pathology , Splenosis/surgery , Thoracic Diseases/pathology , Thoracic Diseases/surgery , ThoracotomySubject(s)
Actinomycosis, Cervicofacial/diagnosis , Edema/diagnosis , Neck/pathology , Pasteurellaceae Infections/diagnosis , Weight Loss , Actinomycosis, Cervicofacial/complications , Aggregatibacter actinomycetemcomitans/isolation & purification , Cocaine-Related Disorders/complications , Diagnosis, Differential , Edema/pathology , Hepatitis C/complications , Heroin Dependence/complications , Humans , Immunoglobulin G4-Related Disease/diagnosis , Male , Middle Aged , Pasteurellaceae Infections/complications , Thoracic Diseases/complications , Thoracic Diseases/diagnosis , Thoracic Diseases/microbiology , Tobacco Use Disorder/complicationsABSTRACT
BACKGROUND: Chondromesenchymal hamartoma of the chest wall is a rare, benign disease that usually presents at birth or in early infancy. It typically involves one or more ribs, forming a unilateral or bilateral extrapleural mass. Patients may be asymptomatic or complain of mild respiratory distress depending on tumor size and location. To the best of our knowledge, only two of the approximately 100 cases reported so far are adults. CASE PRESENTATION: We present two cases of chondromesenchymal hamartoma. The first case involved the left fifth rib in a 24-year-old male, in close proximity to the fifth vertebral body in the left posterior mediastinum, mimicking a posterior mediastinal tumor on imaging. The tumor was excised via thoracoscopy and the patient had an uneventful postoperative course. The second case was that of a 5-month-old boy, who had a tumor involving the left fifth and sixth ribs which caused thoracic cage collapse. Following en bloc resection of the tumor and the involved rib segments, the patient was transferred to the intensive care unit for treatment of pulmonary infection and disseminated intravascular coagulation (DIC). He was discharged from the hospital in stable condition 11 days later. On histopathology, the tumor was found to be a chondromesenchymal hamartoma with immature spindle-shaped mesenchymal cells, plate-like hyaline cartilage, areas of woven bone formation, endochondral ossification and calcification, osteoclastic giant cells, and secondary aneurysmal bone cysts. CONCLUSIONS: Although the presently reported cases have morphological characteristics similar to previously reported ones, they had distinct radiological and clinical characteristics. Patient 1 is only the third report of an adult with chondromesenchymal hamartoma. His case was characterized by its radiological appearance mimicking a posterior mediastinal tumor. Patient 2 represents the first documentation of DIC as a postoperative complication following excision of a chondromesenchymal hamartoma. We present these two cases to provide clinicopathological insights regarding this extremely rare tumor that are relevant to both pathologists and clinicians.
Subject(s)
Disseminated Intravascular Coagulation/etiology , Hamartoma/pathology , Hamartoma/surgery , Thoracic Diseases/pathology , Thoracic Diseases/surgery , Thoracic Surgical Procedures/adverse effects , Diagnosis, Differential , Hamartoma/diagnosis , Humans , Infant , Male , Mediastinal Neoplasms/diagnosis , Ribs/pathology , Ribs/surgery , Thoracic Diseases/diagnosis , Young AdultABSTRACT
Ultrasound examination of the thorax is superior to chest radiograph or physical examination for diagnosing common conditions such as pneumonia, pulmonary edema, pleural effusion, and pneumothorax. The basic skill set is straightforward to learn, quick to perform, repeatable, and does not involve patient transport, harmful ionizing radiation, or waiting time. This paper outlines the basic building blocks that makeup a thoracic ultrasound examination, regardless of which specific scanning protocol is performed. Narrative videos and illustrative figures demonstrating these techniques are included.
Subject(s)
Emergencies , Thoracic Diseases/diagnosis , Thorax/diagnostic imaging , Ultrasonography/methods , Humans , Reproducibility of ResultsABSTRACT
BACKGROUND: Over the past 100 years, many procedures have been developed for correcting restrictive thoracic deformities which cause thoracic insufficiency syndrome. However, none of them have been assessed by a robust metric incorporating thoracic dynamics. In this paper, we investigate the relationship between radiographic spinal curve and lung volumes derived from thoracic dynamic magnetic resonance imaging (dMRI). Our central hypothesis is that different anteroposterior major spinal curve types induce different restrictions on the left and right lungs and their dynamics. METHODS: Retrospectively, we included 25 consecutive patients with thoracic insufficiency syndrome (14 neuromuscular, 7 congenital, 4 other) who underwent vertical expandable prosthetic titanium rib surgery and received preimplantation and postimplantation thoracic dMRI for clinical care. We measured thoracic and lumbar major curves by the Cobb measurement method from anteroposterior radiographs and classified the curves as per Scoliosis Research Society (SRS)-defined curve types. From 4D dMRI images, we derived static volumes and tidal volumes of left and right lung, along with left and right chest wall and left and right diaphragm tidal volumes (excursions), and analyzed their association with curve type and major curve angles. RESULTS: Thoracic and lumbar major curve angles ranged from 0 to 136 and 0 to 116 degrees, respectively. A dramatic postoperative increase in chest wall and diaphragmatic excursion was seen qualitatively. All components of volume increased postoperatively by up to 533%, with a mean of 70%. As the major curve, main thoracic curve (MTC) was associated with higher tidal volumes (effect size range: 0.7 to 1.0) than thoracolumbar curve (TLC) in preoperative and postoperative situation. Neither MTC nor TLC showed any meaningful correlation between volumes and major curve angles preoperatively or postoperatively. Moderate correlations (0.65) were observed for specific conditions like volumes at end-inspiration or end-expiration. CONCLUSIONS: The relationships between component tidal volumes and the spinal curve type are complex and are beyond intuitive reasoning and guessing. TLC has a much greater influence on restricting chest wall and diaphragm tidal volumes than MTC. Major curve angles are not indicative of passive resting volumes or tidal volumes. LEVEL OF EVIDENCE: Level II-diagnostic.