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1.
Rev Port Cir Cardiotorac Vasc ; 28(1): 59-60, 2021 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-33834649

RESUMO

INTRODUCTION: Congenital chest wall deformities are common in children, causing self and parental concern mainly due to cosmesis. These defects rarely cause severe symptoms in patients. CASE REPORT: 11-year-old girl with a complex chest wall deformity and severe scoliosis causing progressive neurological loss of function. When mobilized to prone position for orthopedic surgery, she suffered sudden hypotension immediately followed by a cardiac arrest, that reverted after moving the child back to supine position. The cardiac arrest was interpreted as a result of a decrease in venous blood return secondary to heart and great vessels compression. She was then proposed and submitted to a modified Ravitch procedure with retrosternal metal bar placement in order to allow ventral positioning. This was successfully achieved, and the patient underwent scoliosis correction 3 months later. After more than a year of follow up, she reduced the need for non-invasive ventilation and tolerates prone positioning. CONCLUSION: This case report alerts medical community that beyond cosmesis concerns, severe chest wall deformities can cause life-threatening events if not correctly managed.


Assuntos
Parada Cardíaca , Parede Torácica , Criança , Feminino , Parada Cardíaca/etiologia , Humanos , Parede Torácica/diagnóstico por imagem
2.
Medicine (Baltimore) ; 100(6): e24711, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578611

RESUMO

RATIONALE: Recurrent liposarcoma, previously confirmed as lipoma, has rarely been reported. However, the risk factors for recurrence and the correlation between benign lipoma and malignant liposarcoma remain unclear. In this case study, we suggest a precise diagnostic strategy to minimize recurrence and malignant transformation. PATIENT CONCERNS: A 60-year-old male patient with a history of left chest wall swelling without any symptoms underwent excisional surgery, and the mass was confirmed as a benign lipoma in 2015. In 2019, the patient returned to the hospital with symptoms of a palpable mass on the left chest wall. DIAGNOSIS: The mass was considered a recurrent lipomatous tumor with the possibility of malignant transformation. Magnetic resonance imaging (MRI) revealed a deep-seated, septate, intramuscular, irregular margin, and large lipomatous tumor invading the ribs, pleura, and adjacent muscle, suggestive of malignancy. The MRI findings were similar to those 4 years ago, except for margin irregularity and invasion to adjacent tissue. INTERVENTIONS: Wide en bloc excisions encompassing the 5th to 7th ribs, pleura, and adjacent muscle were followed by reconstruction with a pedicled latissimus dorsi muscle flap. OUTCOMES: The recurrent large lipomatous tumor was confirmed as well-differentiated liposarcomas through histological and MDM2-FISH immunohistochemical staining. Postoperatively, follow-up visits continued for 1.5 years without recurrence. LESSONS: We suggest that deep-seated, septate, and giant lipomatous tumors should be considered as risk factors for recurrence with the possibility of malignancy and misdiagnosis. It is important to inform patients of all these possibilities and plan close and long-term follow-up.


Assuntos
Lipoma/patologia , Lipossarcoma/patologia , Recidiva Local de Neoplasia/patologia , Neoplasias Torácicas/patologia , Parede Torácica/patologia , Humanos , Lipoma/diagnóstico por imagem , Lipoma/cirurgia , Lipossarcoma/diagnóstico por imagem , Lipossarcoma/cirurgia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/cirurgia , Neoplasias Torácicas/diagnóstico por imagem , Neoplasias Torácicas/cirurgia , Parede Torácica/diagnóstico por imagem , Parede Torácica/cirurgia
3.
BMC Infect Dis ; 21(1): 196, 2021 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-33607951

RESUMO

BACKGROUND: Non-tuberculous mycobacterial (NTM) infections are increasing worldwide, making them an international public health problem. Surgical management is often indicated for localized infectious disease; however, most surgeons are unaware of the potential risks of transmission during surgery. CASE PRESENTATION: An 88-year-old Asian female was referred to our hospital for a tumor in the right lateral thoracic region. One month prior, she had a feeling of fullness and complained of localized pain and warmth in the right lateral thoracic wall. Pain and warmth gradually resolved without intervention; however, the fullness was getting worse. Computed tomography (CT) scan showed a mass of approximately 65 × 30 mm with an osteolytic change, involving the right 8th rib. Based on the rapid growth rate and CT findings, we strongly suspected a malignant chest wall tumor, and en bloc tumor resection with the 8th rib was performed. When the specimen was cut, a large amount of viscous pus was drained and its culture showed growth of Mycobacterium avium. Microscopically, the non-caseating epithelioid cell granuloma extended into the rib, infiltrating the bone cortex. On follow-up 1 month after discharge, there were no signs of infection or other adverse events associated with the surgery. CONCLUSIONS: Herein, we report about a patient with a mass diagnosed as an NTM abscess involving the rib cage, which was confused with a malignant tumor and eventually diagnosed following surgical excision. This report emphasizes the need to be aware of the possibility of NTM infection and take appropriate precautions if the patient has a rapidly growing mass in the chest wall.


Assuntos
Infecções por Mycobacterium não Tuberculosas/microbiologia , Infecções por Mycobacterium não Tuberculosas/patologia , Parede Torácica/microbiologia , Parede Torácica/patologia , Abscesso/diagnóstico por imagem , Abscesso/microbiologia , Abscesso/patologia , Abscesso/cirurgia , Idoso de 80 Anos ou mais , Drenagem , Feminino , Granuloma/microbiologia , Granuloma/patologia , Granuloma/cirurgia , Humanos , Infecções por Mycobacterium não Tuberculosas/diagnóstico por imagem , Infecções por Mycobacterium não Tuberculosas/cirurgia , Mycobacterium avium/isolamento & purificação , Parede Torácica/diagnóstico por imagem , Parede Torácica/cirurgia , Resultado do Tratamento
4.
Clin Nucl Med ; 46(1): 76-77, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33065622

RESUMO

F-FDG PET/CT is now an integral part of management of high-grade B-cell lymphoma. It is used for staging, response evaluation, restaging, and surveillance. Although high-grade B-cell lymphoma most commonly presents with involvement of the lymph nodes, spleen, liver, and bone marrow, chest wall involvement is very rare. We present the staging F-FDG PET/CT findings in a case of an 82-year-old woman with double expressor high-grade B-cell lymphoma of isolated presternal anterior chest wall mass.


Assuntos
Fluordesoxiglucose F18 , Linfoma de Células B/diagnóstico por imagem , Linfoma de Células B/patologia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Parede Torácica/patologia , Idoso de 80 Anos ou mais , Feminino , Humanos , Gradação de Tumores , Estadiamento de Neoplasias , Parede Torácica/diagnóstico por imagem
5.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 1132-1135, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018186

RESUMO

CAD systems have shown good potential for improving breast cancer diagnosis and anomaly detection in mammograms. A basic enabling step for the utilization of CAD systems in mammographic analysis is the correct identification of the breast region. Therefore, several methods to segment the pectoral muscle in the medio-lateral oblique (MLO) mammographic view have been proposed in the literature. However, currently it is difficult to perform and objective comparison between different chest wall (CW) detection methods since they are often evaluated with different evaluation procedures, datasets and the implementations of the methods are not publicly available. For this reason, we propose a methodology to evaluate and compare the performance of CW detection methods using a publicly available dataset (INbreast). We also propose a new intensity-based method for automatic CW detection. We then utilize the proposed evaluation methodology to compare the performance of our CW detection algorithm with a state-of-the-art CW detection method. The performance was measured in terms of the Dice's coefficient similarity, the area error and mean contour distance. The proposed method achieves yielded the best results in all the performance measures.


Assuntos
Parede Torácica , Benchmarking , Humanos , Mamografia , Reconhecimento Automatizado de Padrão , Interpretação de Imagem Radiográfica Assistida por Computador , Parede Torácica/diagnóstico por imagem
6.
Medicine (Baltimore) ; 99(35): e21935, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871936

RESUMO

RATIONALE: Follicular dendritic cell sarcoma (FDCS) is a rare malignant tumor that originates from germinal center follicular dendritic cells, and can occur at both nodal and extranodal sites. There are very few described cases of FDCS arising in the chest wall. PATIENT CONCERNS: A 44-year-old male patient presented with a history of right chest wall pain for 5 months. DIAGNOSES: Positron emission tomography/computed tomography showed a significant increase in F-fluorodeoxyglucose uptake and multiple small axillary lymph nodes without hypermetabolic lesions. Immunohistochemistry results of a core-needle biopsy indicated FDCS, which was consistent with the postoperative pathological examination. INTERVENTIONS: The patient underwent tumor resection with lymphadenectomy of level I axillary nodes. No metastasis in the lymph nodes was observed in the postoperative pathological examination. The patient did not accept chemotherapy or radiotherapy. OUTCOMES: After 18 months, the patient remains in good condition with no evidence of disease recurrence. LESSONS: This report highlights a rare case of a FDCS arising in the chest wall. Accurate clinical diagnosis and staging of this rare malignant sarcoma is essential for the developmnt of effective treatment strategies. Preoperative F-fluorodeoxyglucose positron emission tomography/computed tomography scanning combined with core-needle biopsy could provide differentiation between benign and malignant tumors, as well as lymph node involvement and metastatic status.


Assuntos
Sarcoma de Células Dendríticas Foliculares/diagnóstico , Neoplasias Torácicas/diagnóstico , Parede Torácica , Adulto , Biópsia com Agulha de Grande Calibre , Dor no Peito/etiologia , Sarcoma de Células Dendríticas Foliculares/patologia , Sarcoma de Células Dendríticas Foliculares/cirurgia , Fluordesoxiglucose F18 , Humanos , Imuno-Histoquímica , Excisão de Linfonodo , Linfonodos/patologia , Masculino , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Neoplasias Torácicas/patologia , Neoplasias Torácicas/cirurgia , Parede Torácica/diagnóstico por imagem , Parede Torácica/patologia , Parede Torácica/cirurgia
7.
Acta Chir Orthop Traumatol Cech ; 87(3): 155-161, 2020.
Artigo em Tcheco | MEDLINE | ID: mdl-32773015

RESUMO

PURPOSE OF THE STUDY Rib fractures represent one of the most common fractures sustained by 10-40% of all patients with blunt chest trauma, their incidence increases with age. In the current literature, however, new indication criteria continue to emerge. The purpose of this study is to assess the indication criteria, the timing of surgery and the use of individual plates in dependence on fracture location in our patients after the chest wall stabilisation in a retrospective analysis. MATERIAL AND METHODS Our group of patients (n = 349) included the patients who were hospitalised in the Trauma Centre of the University Hospital Olomouc from 1 January 2015 to 31 January 2019, of whom 16 patients were indicated for a surgery. In case of polytrauma, spiral CT was performed, while all patients with a more serious wall chest trauma underwent 3D CT chest wall reconstruction. The surgical approach was chosen based on the fracture location, most frequently posterolateral thoracotomy was opted for. The type of plates was chosen based on the location and type of the fracture. The most common was the lateral type of fracture. RESULTS The most common indication for surgery was multiple rib fractures with major chest wall disfiguration with the risk of injury to intrathoracic organs, present hemothorax or pneumothorax. The age of patients ranged from 44 to 92 years. 8 patients sustained a thoracic monotrauma, the remaining patients suffered multiple injuries, mostly craniocerebral trauma, pelvic or long bone fractures or parenchymal organ injury. The patients were indicated for surgery between 1 hour and 7 days after the hospital admission, on average 3 plates per patient were used and the most commonly used type of plate was the newly modified Judet plate made by Medin. All the patients underwent a surgical revision of pleural cavity, in 3 patients diaphragmatic rupture was found despite a negative preoperative CT scan. The duration of mechanical ventilation in polytrauma patients was 16 days, in thoracic monotrauma patients it was 2 days. CONCLUSIONS Prevailing majority of patients with a blunt chest trauma with rib fractures is still treated non-operatively, which is confirmed also by our group of patients. Nonetheless, correctly and early indicated stabilisation of the chest wall based on accurate indication criteria is of a great benefit to the patients. The aim of each and every trauma centre should be to develop a standardised protocol for the management of blunt chest trauma (the so-called "rib fracture protocol"), which comprises precisely defined criteria for patient admission, multimodal analgesia, indications for surgery, comprehensive perioperative and postoperative care and a subsequent rehabilitation of patients. Key words: rib fracture protocol, chest wall stabilisation, flail chest.


Assuntos
Tórax Fundido , Fraturas das Costelas , Traumatismos Torácicos , Parede Torácica , Ferimentos não Penetrantes , Tórax Fundido/diagnóstico por imagem , Tórax Fundido/etiologia , Tórax Fundido/cirurgia , Humanos , Estudos Retrospectivos , Fraturas das Costelas/diagnóstico por imagem , Fraturas das Costelas/cirurgia , Traumatismos Torácicos/diagnóstico por imagem , Traumatismos Torácicos/cirurgia , Parede Torácica/diagnóstico por imagem , Parede Torácica/cirurgia , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/cirurgia
8.
Scand J Rheumatol ; 49(4): 312-322, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32484386

RESUMO

OBJECTIVE: This is the first randomized double-blinded, placebo-controlled pilot trial to investigate the efficacy of pamidronate in reducing radiological and clinical disease activity in chronic non-bacterial osteomyelitis (CNO). METHOD: Patients received pamidronate or placebo at baseline and weeks 12 and 24. Whole-body magnetic resonance imaging was performed at baseline and weeks 12 and 36, and computed tomography of the anterior chest wall (ACW) at baseline and week 36. Radiological disease activity was systematically scored in the ACW and spine. Patient-reported outcomes [visual analogue scale (VAS) pain, VAS global health, Health Assessment Questionnaire (HAQ), EuroQol-5 Dimensions (EQ-5D), and 36-item Short-Form Health Survey (SF-36)] and biomarkers of bone turnover and inflammation were assessed at baseline and weeks 1, 4, 12, 24, and 36. Data are expressed as median [interquartile range]. RESULTS: Fourteen patients were randomized and 12 were analysed. From baseline to week 36, the radiological disease activity score in the ACW decreased from 5 [4-7] to 2.5 [1-3] in the pamidronate group, but did not change in the placebo group (p = 0.04). From baseline to week 36, VAS pain and VAS global health tended to decrease more in the pamidronate than in the placebo group (p = 0.11, p = 0.08). Physical functioning (HAQ) and health-related quality of life (EQ-5D, SF-36) did not change. Biomarkers of bone turnover decreased only in the pamidronate group (p ≤ 0.02). CONCLUSION: Pamidronate may improve radiological and clinical disease activity in CNO. Methods to score radiological disease activity in adult CNO were suggested. Clinical Trials: NCT02594878.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Osteomielite/tratamento farmacológico , Pamidronato/uso terapêutico , Coluna Vertebral/efeitos dos fármacos , Parede Torácica/efeitos dos fármacos , Adulto , Biomarcadores/sangue , Conservadores da Densidade Óssea/farmacologia , Remodelação Óssea/efeitos dos fármacos , Método Duplo-Cego , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Osteomielite/sangue , Osteomielite/diagnóstico por imagem , Pamidronato/farmacologia , Medidas de Resultados Relatados pelo Paciente , Projetos Piloto , Coluna Vertebral/diagnóstico por imagem , Parede Torácica/diagnóstico por imagem , Imagem Corporal Total , Adulto Jovem
9.
PLoS One ; 15(5): e0232575, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32379835

RESUMO

BACKGROUND: Pectus excavatum is the most common chest wall skeletal deformity. Although commonly evaluated in adolescence, its prevalence in adults is unknown. METHODS AND FINDINGS: Radiographic indices of chest wall shape were analyzed for participants of the first (n = 2687) and second (n = 1780) phases of the population-based Dallas Heart Study and compared to clinical cases of pectus (n = 297). Thoracic computed tomography imaging studies were examined to calculate the Haller index, a measure of thoracic axial shape, and the Correction index, which quantitates the posterior displacement of the sternum relative to the ribs. At the level of the superior xiphoid, 0.5%, 5% and 0.4% of adult Dallas Heart Study subjects have evidence of pectus excavatum using thresholds of Haller index >3.25, Correction index >10%, or both, respectively. Radiographic measures of pectus are more common in females than males and there is a greater prevalence of pectus in women than men. In the general population, the Haller and Correction indices are associated with height and weight, independent of age, gender, and ethnicity. Repeat imaging of a subset of subjects (n = 992) demonstrated decreases in the mean Haller and Correction indices over seven years, suggesting change to a more circular axial thorax, with less sternal depression, over time. CONCLUSIONS: To our knowledge, this is the first study estimating the prevalence of pectus in an unselected adult population. Despite the higher reported prevalence of pectus cases in adolescent boys, this study demonstrates a higher prevalence of radiographic indices of pectus in adult females.


Assuntos
Tórax em Funil/epidemiologia , Parede Torácica/anormalidades , Adolescente , Adulto , Criança , Estudos de Coortes , Feminino , Tórax em Funil/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Radiografia Torácica/métodos , Costelas/anormalidades , Costelas/diagnóstico por imagem , Índice de Gravidade de Doença , Texas/epidemiologia , Parede Torácica/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Processo Xifoide/anormalidades , Processo Xifoide/diagnóstico por imagem , Adulto Jovem
10.
Am J Med ; 133(10): 1135-1142, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32442508

RESUMO

Chest pain is a common presenting complaint in the primary care setting. Imaging plays a key role in the evaluation of the multiple organ systems that can be responsible for chest pain. With numerous imaging modalities available, determination of the most appropriate test and interpretation of the findings can be a challenge for the clinician. In this 2-part series, we offer resources to guide primary care physicians in the selection of imaging studies and present the imaging findings of various causes of nonemergent chest pain. In Part 2, we focus on the radiologic appearance of common noncardiac sources of chest pain, including gastrointestinal, pulmonary, and musculoskeletal etiologies.


Assuntos
Dor no Peito/etiologia , Transtornos da Motilidade Esofágica/diagnóstico por imagem , Hérnia Hiatal/diagnóstico por imagem , Doenças Musculoesqueléticas/diagnóstico por imagem , Atenção Primária à Saúde , Doenças Respiratórias/diagnóstico por imagem , Transtornos da Motilidade Esofágica/complicações , Fraturas por Compressão/complicações , Fraturas por Compressão/diagnóstico por imagem , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/diagnóstico por imagem , Hérnia Hiatal/complicações , Humanos , Imagem por Ressonância Magnética , Doenças Musculoesqueléticas/complicações , Derrame Pleural/complicações , Derrame Pleural/diagnóstico por imagem , Pneumonia/complicações , Pneumonia/diagnóstico por imagem , Pneumotórax/complicações , Pneumotórax/diagnóstico por imagem , Radiografia Torácica , Doenças Respiratórias/complicações , Fraturas das Costelas/complicações , Fraturas das Costelas/diagnóstico por imagem , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/diagnóstico por imagem , Parede Torácica/diagnóstico por imagem , Síndrome de Tietze/complicações , Síndrome de Tietze/diagnóstico por imagem , Tomografia Computadorizada por Raios X
11.
J Clin Ultrasound ; 48(6): 303-306, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32333800

RESUMO

PURPOSE: Identification of tube thoracostomy insertion location is currently performed using a blind, landmark based approach at either the fifth intercostal space (ICS) or inframammary crease in the midaxillary line. A significant percentage of thoracostomies at this site result in complications. This pilot study aimed to assess whether bedside ultrasound could aid in identifying safer tube thoracostomy insertion sites in emergency department patients. METHODS: Fifty emergency department patients were enrolled in this study. Right and left hemidiaphragms were evaluated with ultrasound at the fifth ICS. Observations were made on if the diaphragm was below, above, or crossed the fifth ICS during an entire respiratory cycle. RESULTS: Eighty-one (95% confidence interval 72-82) of the diaphragms were below, 13 (95% confidence interval 8-21) of the diaphragms were at, and 6 (95% confidence interval 3-12) of the diaphragms were above the location marked using traditional landmark techniques. On the right and left hemidiaphragms, 20% (95% confidence interval 19.9%-20.1%) and 18% (95% confidence interval 17.9%-18.1%) of diaphragms were above or crossing the fifth ICS, respectively CONCLUSIONS: Ultrasound identified a significant number of potential chest tube insertion sites at the fifth ICS that would result in subdiaphragmatic insertion or diaphragmatic injury. Based on this data ultrasound can be used to identify safer insertion sites and reduce thoracostomy complications.


Assuntos
Diafragma/diagnóstico por imagem , Parede Torácica/diagnóstico por imagem , Toracostomia/métodos , Adulto , Idoso de 80 Anos ou mais , Tubos Torácicos , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Ultrassonografia , Ultrassonografia de Intervenção/métodos , Adulto Jovem
13.
Anticancer Res ; 40(3): 1519-1526, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32132052

RESUMO

BACKGROUND/AIM: Chondrosarcomas (CS) of the chest wall are rare, but present an aggressive biological behavior compared to CS of the extremities. The aims of the present study were to determine factors associated with oncological outcomes as well as complications. PATIENTS AND METHODS: We retrospectively analyzed 53 patients (42 primary, 11 recurrent tumors). In total, 39 central CS, 10 peripheral CS, 3 dedifferentiated CS and 1 mesenchymal CS were included. The ribs were most commonly affected (68%). Overall survival and disease-free survival were estimated with Kaplan-Meier analyses and compared with log-rank test. RESULTS: Mean follow-up was 7 years. Negative margins were achieved in 87% of patients. Thirty patients (57%) remained continuously disease-free (NED), three (5%) NED after treatment of relapse, seven (13%) were alive with disease, twelve (23%) were dead with disease and one of other cause. The 10-year survival rate was 81% and 45% in primary and recurrent tumors, respectively. Survival was significantly affected by tumor stage (p<0.001), local recurrence (p=0.025) and metastases (p=0.002). Six complications (16%) were observed. CONCLUSION: The outcome is rather poor, especially in patients with local recurrence. Presumably due to a high biological aggressiveness, a stricter definition of surgical margins should be considered for this location.


Assuntos
Condrossarcoma/diagnóstico , Condrossarcoma/cirurgia , Neoplasias Torácicas/diagnóstico , Neoplasias Torácicas/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Condrossarcoma/diagnóstico por imagem , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias Torácicas/diagnóstico por imagem , Parede Torácica/diagnóstico por imagem , Parede Torácica/patologia , Adulto Jovem
14.
J Pediatr Orthop ; 40(4): 183-189, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32132448

RESUMO

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.


Assuntos
Imagem por Ressonância Magnética/métodos , Implantação de Prótese , Insuficiência Respiratória , Costelas/cirurgia , Escoliose , Doenças Torácicas , Adolescente , Criança , Feminino , Humanos , Masculino , Equipamentos Ortopédicos , Implantação de Prótese/efeitos adversos , Implantação de Prótese/instrumentação , Implantação de Prótese/métodos , Insuficiência Respiratória/diagnóstico , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/fisiopatologia , Insuficiência Respiratória/prevenção & controle , Estudos Retrospectivos , Escoliose/complicações , Escoliose/diagnóstico , Escoliose/fisiopatologia , Escoliose/cirurgia , Doenças Torácicas/diagnóstico , Doenças Torácicas/etiologia , Doenças Torácicas/fisiopatologia , Doenças Torácicas/cirurgia , Parede Torácica/diagnóstico por imagem , Parede Torácica/patologia , Resultado do Tratamento
16.
J Thorac Cardiovasc Surg ; 159(6): 2512-2520.e1, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32087959

RESUMO

OBJECTIVE: Diffuse chest wall invasion (DCWI) is a common finding in patients undergoing intended resection for malignant pleural mesothelioma. We sought to determine the incidence and preoperative predictors of this finding, and to test our anecdotal impression that contraction of the ipsilateral hemithorax is associated with DCWI. METHODS: This was a single-institution retrospective study of 170 patients undergoing intended macroscopic complete resection for malignant pleural mesothelioma from 2014-2018. A novel metric of thoracic cage volume was calculated by preoperative chest computed tomography. Univariable analyses were performed to determine associations of preoperative variables with DCWI. RESULTS: Macroscopic complete resection was achieved by pleurectomy/decortication in 104 patients (61%) and by extrapleural pneumonectomy in 39 patients (23%). Unresectable disease was discovered at thoracotomy in 27 (16%) of patients; 24 (14%) by DCWI and 3 (2%) by intrathoracic organ invasion. In univariable analysis, decreased ipsilateral thoracic cage volume demonstrated the strongest association with unresectability by DCWI (P = .009) with >5% decrease in thoracic cage volume representing the optimal cutoff (P = .014; area under the curve, 0.67). Other preoperative variables associated with DCWI included preoperative chest pain requiring opioids (P = .028), prior pleurodesis (P = .036), decreased forced vital capacity (P = .023), decreased ipsilateral lung perfusion by ventilation/perfusion lung scan (P = .007), and magnetic resonance imaging findings of chest wall invasion (P = .035). CONCLUSIONS: Preoperative identification of DCWI will avoid unnecessary thoracotomy and accelerate initiation of nonsurgical therapy in malignant pleural mesothelioma. Our data suggest that contraction of thoracic cage volume has merit in predicting malignant pleural mesothelioma unresectability and should be validated in prospective studies.


Assuntos
Neoplasias Pulmonares/diagnóstico por imagem , Mesotelioma/diagnóstico por imagem , Neoplasias Pleurais/diagnóstico por imagem , Parede Torácica/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Idoso , Idoso de 80 Anos ou mais , Tomada de Decisão Clínica , Feminino , Humanos , Imageamento Tridimensional , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/terapia , Masculino , Mesotelioma/patologia , Mesotelioma/terapia , Pessoa de Meia-Idade , Invasividade Neoplásica , Seleção de Pacientes , Neoplasias Pleurais/patologia , Neoplasias Pleurais/terapia , Valor Preditivo dos Testes , Estudos Retrospectivos , Parede Torácica/patologia , Parede Torácica/cirurgia , Toracotomia , Procedimentos Desnecessários
17.
Einstein (Sao Paulo) ; 18: eMD5223, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32049130

RESUMO

Computed tomography with multiple detectors and the advancement of processors improved rendered images and three-dimensional reconstructions in clinical practice. Traditional axial slices form non-intuitive images because they are seen in only one plane. The three-dimensional reconstructions can show structures details and diseases with complex anatomy in different perspectives. Cinematic rendering is a newly three-dimensional reconstruction technique, already approved for clinical use, which can produce realistic images from traditional computed tomography data. The algorithm used is based on light trajectory methods and the global lighting model, which simulate thousands of images from all possible directions. Thus, the technique shapes the physical propagation of light and generates a realistic three-dimensional image with depth, shadows and more anatomic details. It is a multidimensional rendering acquired through complex lighting effects. The aim of this article was to show the advance of three-dimensional technology with the cinematic rendering in images exams of the thoracic wall.


Assuntos
Carcinoma de Células Escamosas/diagnóstico por imagem , Imageamento Tridimensional/métodos , Sarcoma Sinovial/diagnóstico por imagem , Neoplasias Torácicas/diagnóstico por imagem , Parede Torácica/diagnóstico por imagem , Adulto , Algoritmos , Humanos , Masculino , Pessoa de Meia-Idade , Sarcoma Sinovial/secundário , Tomografia Computadorizada por Raios X/métodos
19.
Radiología (Madr., Ed. impr.) ; 62(1): 46-50, ene.-feb. 2020. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-194145

RESUMO

ANTECEDENTES Y OBJETIVOS: Gracias a los avances en el campo del escaneado tridimensional (3D) existen instrumentos capaces de generar imágenes con utilidad en medicina. Por otra parte, los estudios de satisfacción ganan cada vez más importancia para evaluar la calidad en la asistencia. Nuestro objetivo es valorar la satisfacción de los pacientes con el uso de un escáner 3D aplicado a las malformaciones de la pared torácica, así como de los profesionales implicados en su uso. MATERIAL Y MÉTODOS: Se han desarrollado encuestas de satisfacción para pacientes y profesionales que han completado pacientes sometidos a escáner 3D en el contexto de un estudio para validar los resultados obtenidos con esta nueva tecnología. Se han obtenido los estadísticos descriptivos de los resultados obtenidos. RESULTADOS: Se han incluido 42 pacientes y 10 profesionales. Los pacientes evalúan de manera positiva la velocidad y la inocuidad. La media de satisfacción global es de 4,71 en una escala del 1 al 5. Entre los profesionales, la satisfacción es inferior, sobre todo en lo que respecta al tratamiento de la imagen. La media de satisfacción global es de 3,1. CONCLUSIONES: Los pacientes evaluados tienen una buena aceptación y satisfacción con la tecnología de escaneado 3D. No ocurre lo mismo con los profesionales, ya que debido a la dificultad de tratamiento de la imagen y a la falta de familiaridad con el sistema presentan una satisfacción menor. Son necesarios avances en la difusión y simplificación de esta tecnología para aprovechar al máximo su potencial


BACKGROUND AND OBJECTIVES: Advances in the field of three-dimensional scanning have enabled the development of instruments that can generate images that are useful in medicine. On the other hand, satisfaction studies are becoming increasingly important in the evaluation of quality in healthcare. We aimed to evaluate patients' and professionals' satisfaction with the use of a three-dimensional scanner applied to chest wall malformations. MATERIAL AND METHODS: In the framework of a study to validate the results of three-dimensional scanning technology, we developed questionnaires to measure satisfaction among patients and professionals. We analyzed the results with descriptive statistics. RESULTS: We included 42 patients and 10 professionals. Patients rated the speed and harmlessness positively; the mean overall level of satisfaction was 4.71 on a scale from 1 to 5. Among professionals, the level of satisfaction was lower, especially with regards to the treatment of the image; the mean overall level of satisfaction was 3.1. CONCLUSIONS: Patients rated 3D scanning technology highly, but professionals were less satisfied due to the difficulty of treating the images and lack of familiarity with the system. For this technology to reach its maximum potential, it must be simplified and more widely disseminated


Assuntos
Humanos , Satisfação do Paciente , Imageamento Tridimensional/métodos , Parede Torácica/anormalidades , Parede Torácica/diagnóstico por imagem , Tórax em Funil/diagnóstico por imagem , Pectus Carinatum/diagnóstico por imagem
20.
J Vasc Interv Radiol ; 31(2): 294-300, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31899108

RESUMO

PURPOSE: To assess safety and efficacy of percutaneous cryoablation for pain palliation of metastases to pleura and chest wall. MATERIALS AND METHODS: This retrospective single-center cohort study included 22 patients (27% female, mean age 63 y ± 11.4) who underwent 25 cryoablation procedures for pain palliation of 39 symptomatic metastases measuring 5.1 cm ± 1.9 (range, 2.0-8.0 cm) in pleura and chest wall between June 2012 and December 2017. Pain intensity was assessed using a numerical scale (0-10 points). Statistical tests t test, χ2, and Wilcoxon signed rank were performed. RESULTS: Patients were followed for a median of 4.1 months (interquartile range [IQR], 2.3-10.1; range, 0.1-36.7 mo) before death or loss to follow-up. Following cryoablation, pain intensity decreased significantly by a median of 4.5 points (IQR, 2.8-6; range, 0-10 points; P = .0002 points, Wilcoxon signed rank). Pain relief of at least 3 points was documented following 18 of 20 procedures. Pain relief occurred within a median of 1 day following cryoablation (IQR, 1-2; range, 1-4 d) and lasted for a median of 5 weeks (IQR, 3-17; range, 1-34 wk). Systemic opioid requirements decreased in 11 of 22 patients (50%) by an average of 56% ± 34. Difference in morphine milligram equivalents was not significant (P = .73, Wilcoxon signed rank). No procedure-related complications occurred despite previous radiation of 7 tumors. Of 25 procedures, 22 (88%) were performed on an outpatient basis. CONCLUSIONS: Percutaneous cryoablation for metastases to pleura and chest wall can safely provide significant pain relief within days following a single session.


Assuntos
Neoplasias Ósseas/cirurgia , Criocirurgia , Manejo da Dor , Dor/prevenção & controle , Cuidados Paliativos , Neoplasias Pleurais/cirurgia , Parede Torácica/cirurgia , Idoso , Analgésicos Opioides/administração & dosagem , Neoplasias Ósseas/complicações , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/secundário , Criocirurgia/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/diagnóstico , Dor/etiologia , Manejo da Dor/efeitos adversos , Medição da Dor , Neoplasias Pleurais/complicações , Neoplasias Pleurais/diagnóstico por imagem , Neoplasias Pleurais/secundário , Estudos Retrospectivos , Parede Torácica/diagnóstico por imagem , Parede Torácica/patologia , Fatores de Tempo , Resultado do Tratamento
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