Role of diffusion-weighted magnetic resonance imaging in the differentiation of benign and malignant pulmonary lesions.

PURPOSE: To evaluate the role of magnetic resonance (MRI) diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) measurement of solid and cystic pulmonary masses in differentiating benign from malignant lesions. MATERIAL AND METHODS: The study included 41 patients with pulmonary masses, who underwent conventional MRI and DWI (b value 0, 500, and 1000 s/mm²) examinations with 1.5-T MRI. The diffusion signal and the mean ADC values of the solid and cystic lesions were obtained. Statistical analyses were performed with the Mann-Whitney U test (z), Pearson's chi-square test, and receiver operating characteristic (ROC) analysis. RESULTS: Thirty-three lesions were malignant, and eight lesions were benign. The malignant masses showed significantly higher signal intensity on DWI than benign masses (p = 0.006), and the mean ADC value of malignant solid lesions was significantly lower than that of benign lesions (p = 0.02). By ROC analysis, an ADC cut-off value of 1.4 × 10-3 mm2/s was considered the threshold value, and the sensitivity and specificity were 93.8% and 75%, respectively. There was no significant difference between the ADC value of the cystic parts inside the benign and the malignant lesions. CONCLUSIONS: Diffusion-weighted MRI and measurement of ADC value can significantly differentiate between solid benign and malignant pulmonary masses.

Outcome of blunt diaphragmatic rupture. Analysis of 44 cases.

To determine the predictors of outcome after blunt diaphragmatic rupture, the records of 44 patients aged 15-70 years (84.1% male) who underwent diaphragm repair between 1998 and 2007 were reviewed. There were 38 (86.4%) cases of acute diaphragmatic rupture and 6 (13.6%) of post-traumatic diaphragmatic hernia. The injury was left-sided in 30 (68.2%) patients, right-sided in 12 (27.3%), and bilateral in 2 (4.5%). The diagnosis of acute diaphragmatic rupture was made preoperatively in 28 (73.7%) patients and intraoperatively in 10 (26.3%). Repair was carried out through a thoracotomy in 31 cases, laparotomy in 4, and thoracolaparotomy in 3. The mortality rate after diaphragmatic rupture was 13.2% (5/38). The 33 survivors had a significantly younger mean age (37 vs. 57 years) and lower incidences of multiple injuries (36.4% vs. 100%) and shock (24.2% vs. 100%). Repair of diaphragmatic hernia was performed through a thoracotomy in all cases, with no mortality. It was concluded that age, associated severe multiple injuries, and clinical status were predictors of mortality after blunt diaphragmatic rupture.

Blunt traumatic bronchial rupture in patients younger than 18 years.

The aim of this study was to evaluate our results of management of bronchial rupture after blunt chest trauma in young patients. Between January 2000 and December 2007, 34 patients aged 6-18-years old were treated for bronchial rupture; 25 presented early and 9 presented late. The 21 (62%) boys and 13 (38%) girls had a mean age of 11.58 +/- 2.51 years. Radiography, computed tomography, and rigid bronchoscopy were performed in stable acute cases and late-presenting cases, with rapid bronchoscopy followed by thoracotomy in urgent cases. In the patients who presented early, repair was undertaken through a right thoracotomy in 21 (84%) and via a left thoracotomy in 4 (16%). Direct suturing was carried out in all except 3 patients who needed lobectomy. Reimplantation of the main bronchus after debridement of the edges was possible in 4 (44%) of the chronic cases, and pulmonary resection was required in 5 (56%). Four (11.8%) patients died due to perioperative cardiac arrest and cerebral hypoxia with failure of resuscitation. Meticulous collaboration between the surgeon and anesthetist is important to ensure survival.

Pediatric traumatic bronchial rupture; results of early and late presentation.

The aim of this study is to evaluate our results in management of bronchial rupture after blunt chest trauma in children either presented early or late and their prognosis. Between January 2000 and December 2007, 25 cases <18 years presented early with blunt chest trauma and underwent surgical treatment of bronchial rupture, and 9 cases presented late. This study included 34 cases with age ranging from 6 to 18 years (mean 11.58+/-2.51 years). Twenty-one of them were males (61.76%) and 13 (38.24%) were females. In early cases, we approached 21 patients (84%) through right thoracotomy and 4 cases (16%) via left thoracotomy, direct sutures of the all early cases (except 3 cases needed lobectomies) were done. Reimplantation after debridment of the edges was done in 4 cases (44.44%) in the late cases, while pulmonary resections were done in 5 cases (55.56%). Mortalities from perioperative cardiac arrest and cerebral hypoxia with failure of resuscitation occurred in 4 patients (11.76%) from all cases. We conclude that early diagnosis and repair of the bronchial rupture gives good results before suppuration of the parenchyma, which leads to pulmonary resection. Meticulous coordination between the surgeon and anaesthiologist is important to prevent mortalities. Keywords: Bronchial rupture; Children; Blunt chest trauma.