Utility of artificial intelligence for detection of pneumothorax on chest radiopgraphs done after transthoracic percutaneous transthoracic biopsy guided by computed tomography.

OBJETIVE: To assess the ability of an artificial intelligence software to detect pneumothorax in chest radiographs done after percutaneous transthoracic biopsy. MATERIAL AND METHODS: We included retrospectively in our study adult patients who underwent CT-guided percutaneous transthoracic biopsies from lung, pleural or mediastinal lesions from June 2019 to June 2020, and who had a follow-up chest radiograph after the procedure. These chest radiographs were read to search the presence of pneumothorax independently by an expert thoracic radiologist and a radiodiagnosis resident, whose unified lecture was defined as the gold standard, and the result of each radiograph after interpretation by the artificial intelligence software was documented for posterior comparison with the gold standard. RESULTS: A total of 284 chest radiographs were included in the study and the incidence of pneumothorax was 14.4%. There were no discrepancies between the two readers' interpretation of any of the postbiopsy chest radiographs. The artificial intelligence software was able to detect 41/41 of the present pneumothorax, implying a sensitivity of 100% and a negative predictive value of 100%, with a specificity of 79.4% and a positive predictive value of 45%. The accuracy was 82.4%, indicating that there is a high probability that an individual will be adequately classified by the software. It has also been documented that the presence of Port-a-cath is the cause of 8 of the 50 of false positives by the software. CONCLUSIONS: The software has detected 100% of cases of pneumothorax in the postbiopsy chest radiographs. A potential use of this software could be as a prioritisation tool, allowing radiologists not to read immediately (or even not to read) chest radiographs classified as non-pathological by the software, with the confidence that there are no pathological cases.

Finding the bubble: atypical and unusual extrapulmonary air in the chest.

OBJECTIVE: To describe the radiologic findings of extrapulmonary air in the chest and to review atypical and unusual causes of extrapulmonary air, emphasizing the importance of the diagnosis in managing these patients. CONCLUSION: In this article, we review a series of cases collected at our center that manifest with extrapulmonary air in the thorax, paying special attention to atypical and uncommon causes. We discuss the causes of extrapulmonary according to its location: mediastinum (spontaneous pneumomediastinum with pneumorrhachis, tracheal rupture, dehiscence of the bronchial anastomosis after lung transplantation, intramucosal esophageal dissection, Boerhaave syndrome, tracheoesophageal fistula in patients with esophageal tumors, bronchial perforation and esophagorespiratory fistula due to lymph-node rupture, and acute mediastinitis), pericardium (pneumopericardium in patients with lung tumors), cardiovascular (venous air embolism), pleura (bronchopleural fistulas, spontaneous pneumothorax in patients with malignant pleural mesotheliomas and primary lung tumors, and bilateral pneumothorax after unilateral lung biopsy), and thoracic wall (infections, transdiaphragmatic intercostal hernia, and subcutaneous emphysema after lung biopsy).

Nódulo pleural único: una forma de reacción paradójica tardía al tratamiento antituberculoso / Solitary pleural nodule: a late paradoxical reaction to antituberculosis treatment

Se presenta el caso de una mujer joven con antecedente de tuberculosis pleural y pulmonar previamente tratada, que acudió a nuestro hospital por dolor torácico y nódulo pleural único visualizado en radiografía simple y TC torácicas. Se realizó punción con aguja fina guiada por ecografía torácica de la lesión pleural con la que se obtuvo material de tipo inflamatorio para estudio con cultivo positivo para Mycobacterium tuberculosis complex. El diagnóstico fue de reacción paradójica al tratamiento antituberculoso y fue tratada durante 6 meses más con resolución de la lesión pleural y el dolor torácico

We present the case of a young woman with a history of previously treated pleural and pulmonary tuberculosis referred to our hospital for chest pain and a single pleural nodule seen on plain chest films and chest CT. Cultures of inflammatory-type material obtained by US-guided fine-needle biopsy of the pleural lesion were positive for Mycobacterium tuberculosis complex. The diagnosis was a paradoxical reaction to antituberculosis treatment; after 6 more months of treatment, the pleural lesion and chest pain disappeared

Solitary pleural nodule: a late paradoxical reaction to antituberculosis treatment. / Nódulo pleural único: una forma de reacción paradójica tardía al tratamiento antituberculoso.

We present the case of a young woman with a history of previously treated pleural and pulmonary tuberculosis referred to our hospital for chest pain and a single pleural nodule seen on plain chest films and chest CT. Cultures of inflammatory-type material obtained by US-guided fine-needle biopsy of the pleural lesion were positive for Mycobacterium tuberculosis complex. The diagnosis was a paradoxical reaction to antituberculosis treatment; after 6 more months of treatment, the pleural lesion and chest pain disappeared.

Diagnóstico por imagen de rotura espontánea de quiste mediastínico del conducto torácico / Diagnostic imaging in spontaneous rupture of a thoracic duct cyst in the mediastinum

Los quistes mediastínicos del conducto torácico son extremadamente raros y pueden dar lugar a quilotórax por rotura espontánea o en el postoperatorio de estas lesiones. Se presenta el caso de una mujer de edad adulta con un quiste mediastínico del conducto torácico y quilotórax debido a rotura espontánea, no descrito previamente en la bibliografía de forma específica. Los hallazgos clínico-radiológicos, el manejo terapéutico y la anatomía patológica se describen, revisando la bibliografía respecto a esta entidad (AU)

Thoracic duct cysts in the mediastinum are extremely rare; they can give rise to chylothorax when they spontaneously rupture or after they are operated on. We present the case of an adult woman with a thoracic duct cyst in the mediastinum and chylothorax from its spontaneous rupture; to our knowledge, this phenomenon has not been specifically reported before. We describe the clinical and radiological findings, the therapeutic management, and the pathology findings, reviewing the literature for this entity (AU)

Diagnostic imaging in spontaneous rupture of a thoracic duct cyst in the mediastinum. / Diagnóstico por imagen de rotura espontánea de quiste mediastínico del conducto torácico.

Thoracic duct cysts in the mediastinum are extremely rare; they can give rise to chylothorax when they spontaneously rupture or after they are operated on. We present the case of an adult woman with a thoracic duct cyst in the mediastinum and chylothorax from its spontaneous rupture; to our knowledge, this phenomenon has not been specifically reported before. We describe the clinical and radiological findings, the therapeutic management, and the pathology findings, reviewing the literature for this entity.

Tumor fibroso solitario intrapulmonar asociado a hemoptisis: a propósito de un caso / Intrapulmonary solitary fibrous tumor associated with hemoptysis: a case report

El tumor fibroso solitario intrapulmonar es una neoplasia mesenquimal extremadamente rara sobre la que existen muy pocas referencias en la literatura. Presentamos el caso de una mujer joven con hemoptisis que en la radiografía simple de tórax presentó una masa pulmonar, efectuándose a continuación una TCMD con contraste que mostró una tumoración pulmonar sólida, bien definida y con realce heterogéneo. Se realizó resección quirúrgica de dicha lesión y el estudio histológico reveló un tumor fibroso solitario intrapulmonar con un área de degeneración mixoide. A propósito de este caso realizamos una descripción de los hallazgos clínicos, radiológicos e histológicos de esta rara entidad, así como una revisión de la bibliografía (AU)

Intrapulmonary solitary fibrous tumor is an extremely rare mesenchymal neoplasm about which very few references can be found in the literature. We present the case of a young woman with hemoptysis in whom plain-film chest radiographs showed a pulmonary mass. Contrast-enhanced MDCT showed a solid lung tumor with well-defined margins and heterogeneous enhancement. Histological study after surgical resection of the lesion revealed an intrapulmonary solitary fibrous tumor with an area of myxoid degeneration. We describe the clinical, radiological, and histological findings for this rare entity and review the relevant literature (AU)

[Intrapulmonary solitary fibrous tumor associated with hemoptysis: a case report]. / Tumor fibroso solitario intrapulmonar asociado a hemoptisis: a propósito de un caso.

Intrapulmonary solitary fibrous tumor is an extremely rare mesenchymal neoplasm about which very few references can be found in the literature. We present the case of a young woman with hemoptysis in whom plain-film chest radiographs showed a pulmonary mass. Contrast-enhanced MDCT showed a solid lung tumor with well-defined margins and heterogeneous enhancement. Histological study after surgical resection of the lesion revealed an intrapulmonary solitary fibrous tumor with an area of myxoid degeneration. We describe the clinical, radiological, and histological findings for this rare entity and review the relevant literature.

Patología vascular torácica en pacientes oncológicos / Thoracic vascular disease in oncologic patients

La patología oncológica requiere frecuentes controles mediante pruebas de imagen, de forma predominante con tomografía computarizada (TC). En estos pacientes podemos encontrar patología vascular torácica que puede influir en el diagnóstico, el tratamiento y el pronóstico de su enfermedad neoplásica. Los tumores primarios vasculares pueden afectar a los vasos torácicos, como las arterias pulmonares (sarcoma de arteria pulmonar), y la enfermedad neoplásica se puede extender localmente (neoplasia pulmonar) o a distancia hacia los vasos torácicos (embolia pulmonar tumoral y microangiopatía trombótica tumoral pulmonar). El tratamiento oncológico es la causa de múltiples complicaciones sobre los vasos torácicos que en determinados casos llegan a comprometer la vida del paciente. La TC, especialmente con técnica multicorte, permite la evaluación de la enfermedad neoplásica y la patología vascular torácica asociada en el paciente oncológico (AU)

Patients with oncologic disease require frequent imaging tests (predominantly computed tomography) for follow-up. These patients may have thoracic vascular disease that can influence the diagnosis, treatment, and prognosis of their cancer. Primary vascular tumors can involve the thoracic vessels, like the pulmonary arteries (pulmonary artery sarcoma), and the neoplastic disease can extend locally (lung tumor) or remotely to the thoracic vessels (pulmonary tumor embolism and pulmonary tumor thrombotic microangiopathy). Oncologic treatment results in multiple complications that involve the thoracic vessels and can even compromise the patient's life in certain cases. CT, and especially multislice CT, makes it possible to evaluate neoplastic disease and associated thoracic vascular disease in oncologic patients (AU)

[Thoracic vascular disease in oncologic patients]. / Patología vascular torácica en pacientes oncológicos.

Patients with oncologic disease require frequent imaging tests (predominantly computed tomography) for follow-up. These patients may have thoracic vascular disease that can influence the diagnosis, treatment, and prognosis of their cancer. Primary vascular tumors can involve the thoracic vessels, like the pulmonary arteries (pulmonary artery sarcoma), and the neoplastic disease can extend locally (lung tumor) or remotely to the thoracic vessels (pulmonary tumor embolism and pulmonary tumor thrombotic microangiopathy). Oncologic treatment results in multiple complications that involve the thoracic vessels and can even compromise the patient's life in certain cases. CT, and especially multislice CT, makes it possible to evaluate neoplastic disease and associated thoracic vascular disease in oncologic patients.