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1.
Kyobu Geka ; 74(4): 304-307, 2021 Apr.
Artigo em Japonês | MEDLINE | ID: mdl-33831891

RESUMO

A 15-year-old boy who presented recurrent bilateral pneumothoraces after allogenic bone marrow transplantation for the treatment of myelodysplastic syndrome is presented. We performed bulla resection under the thoracoscopic surgery for three times. Pathological examination revealed irregular fibrous thickening of the visceral pleura and alveolar fibrosis, consistent with a diagnosis of pleuroparenchymal fibroelastosis (PPFE). Also the findings of bronchiolitis obliterans (BO) was noted and chronic graftversus-host disease( GVHD) was strongly suggested. Twenty-five months after the operation, bilateral living-donor lobar lung transplantation was performed and the diagnosis of GVHD was established.


Assuntos
Bronquiolite Obliterante , Doença Enxerto-Hospedeiro , Transplante de Pulmão , Pneumotórax , Adolescente , Transplante de Medula Óssea/efeitos adversos , Doença Enxerto-Hospedeiro/complicações , Humanos , Masculino , Pneumotórax/diagnóstico por imagem , Pneumotórax/etiologia , Pneumotórax/cirurgia
2.
Rev Fac Cien Med Univ Nac Cordoba ; 78(1): 37-40, 2021 03 18.
Artigo em Inglês | MEDLINE | ID: mdl-33787024

RESUMO

BACKGROUND: Image-guided percutaneous transthoracic lung biopsy has become a widely used and less invasive diagnostic method. Pneumothorax is the most frequent complication after lung biopsy. The aim of the present study is to describe the experience with expectant management of asymptomatic small post-biopsy pneumothorax in order to reduce unnecessary hospital admissions. METHODS: A retrospective review was performed analyzing the results of subjects who underwent expectant and conservative treatment after presenting pneumothorax following  percutaneous lung biopsy, in a period of 6 years (January 2013 - December 2019) RESULTS: 160 subjects who underwent diagnostic percutaneous lung biopsy of lung nodules were evaluated. Of these, 46 subjects (29%) presented pneumothorax, of which 36 were small. This group of subjects was managed expectantly, with a therapeutic success of 81% (7 subjects had to undergo percutaneous pleural drainage). CONCLUSIONS: Expectant management in subjects with pneumothorax following percutaneous lung biopsy is a useful tool and should be applied by surgeons in order to avoid hospitalizations and / or unnecessary  and expensive procedures.


Assuntos
Pneumotórax , Hospitalização , Humanos , Pulmão/diagnóstico por imagem , Pneumotórax/diagnóstico por imagem , Pneumotórax/etiologia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
3.
J Coll Physicians Surg Pak ; 31(2): 132-137, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33645177

RESUMO

OBJECTIVE: To determine the risk factors for spontaneous pneumomediastinum (SPM), its clinical course and effect on prognosis in patients with Coronavirus disease-19 (COVID-19) pneumonia. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Kayseri City Training and Research Hospital, Turkey, from April  to September 2020. METHODOLOGY: All COVID-19 patients' clinical, laboratory, and radiologic characteristics, as well as treatment outcome data, were obtained through medical record extraction. Group A had 50 patients (22 men and 28 women) without SPM, and Group B had 20 patients (10 men and 10 women) with SPM. RESULTS: Considering the accompanying comorbidities, the frequencies of asthma and inhaler-use was significantly higher in Group B than in Group A (p <0.05). In the CT evaluation at presentation, the rate of involvement of all five lobes of the lung in Group B was significantly higher than in Group A. Rates of tube thoracostomy, mechanical ventilator requirement, length of stay in hospital, and exitus were significantly higher in Group B than in Group A (p <0.05). CONCLUSION: SPM development in a patient with COVID-19 pneumonia is a sign that the prognosis will not be good, and these patients need a more aggressive treatment. Key Words: Spontaneous pneumomediastinum, COVID-19, Pneumothorax, Real-time polymerase chain reaction, Subcutaneous emphysema.


Assuntos
/complicações , Pulmão/diagnóstico por imagem , Enfisema Mediastínico/etiologia , Adulto , Idoso , Tubos Torácicos , Feminino , Humanos , Masculino , Enfisema Mediastínico/diagnóstico , Enfisema Mediastínico/diagnóstico por imagem , Pessoa de Meia-Idade , Pandemias , Pneumotórax/diagnóstico por imagem , Pneumotórax/virologia , Prognóstico , Reação em Cadeia da Polimerase em Tempo Real , Enfisema Subcutâneo/diagnóstico por imagem , Enfisema Subcutâneo/etiologia , Toracostomia , Tomografia Computadorizada por Raios X
4.
Ann R Coll Surg Engl ; 103(3): e98-e100, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33645284

RESUMO

Pneumothorax resulting from traumatic thoracic injury is a potentially life-threatening emergency requiring prompt recognition and management with an intercostal drain. A 34-year-old woman was brought into the emergency department after sustaining a stab injury to the right upper outer quadrant of the right breast. She described noticing a jelly-like substance from her wound, on the background of a prior cosmetic breast augmentation. On examination, it was noted that the right breast was significantly swollen. Computed tomography demonstrated a large right sided pneumothorax with associated punctured right breast implant, a 'pneumocapsule' and extensive subcutaneous emphysema of the breast. This case highlights that the fibrous tissue capsule around a breast implant can function as an anatomical space in continuity with the thoracic cavity, masking the diagnosis of pneumothorax in penetrating trauma.


Assuntos
Implantes de Mama , Pneumotórax/diagnóstico por imagem , Traumatismos Torácicos/diagnóstico por imagem , Ferimentos Perfurantes/diagnóstico por imagem , Adulto , Mama/diagnóstico por imagem , Mama/lesões , Tubos Torácicos , Feminino , Humanos , Lacerações , Fígado/diagnóstico por imagem , Fígado/lesões , Pneumotórax/etiologia , Pneumotórax/terapia , Enfisema Subcutâneo , Traumatismos Torácicos/complicações , Toracostomia , Tomografia Computadorizada por Raios X , Ferimentos Perfurantes/complicações
5.
Medicine (Baltimore) ; 100(7): e24815, 2021 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-33607846

RESUMO

RATIONALE: Tension gastrothorax is a serious condition that can cause acute respiratory failure, which is mostly related to congenital diaphragmatic hernia (CDH) in pediatric cases. It is uncommon in late-onset CDH patients, and is difficult to diagnose due to atypical presentation. It is often misdiagnosed as tension pneumothorax or pleural effusion, leading to delayed treatment and potentially fatal outcome. In this study, we are reporting our experience of diagnosis and treatment of tension gastrothorax in a late-onset CDH patient. PATIENT CONCERNS: A 2-year old boy presented to this hospital with severe dyspnea and abdominal pain that suddenly occurred while taking a bath. DIAGNOSIS: Based on radiological findings we diagnosed tension gastrothorax. INTERVENTIONS: Hernia reduction and diaphragmatic defect repair were performed under thoracotomy. OUTCOMES: After the operation, the patient's clinical symptoms and imaging findings improved. At 1-year postoperative follow up, the patient was well with normal chest x-ray findings. LESSONS: Tension gastrothorax in late-onset CDH is a life-threatening condition that requires rapid diagnosis and treatment. When the diagnosis is unclear by chest x-ray, chest computed tomography should be performed to confirm the diagnosis. A nasogastric tube should be inserted whenever possible for diagnosis and gastric decompression. Although laparotomy is the most preferred approach, we recommend that surgeons consider taking a thoracotomy approach in unstable patients that cannot undergo gastric decompression before operation.


Assuntos
Hérnias Diafragmáticas Congênitas/complicações , Hérnias Diafragmáticas Congênitas/cirurgia , Toracotomia/métodos , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Assistência ao Convalescente , Pré-Escolar , Diagnóstico Diferencial , Dispneia/diagnóstico , Dispneia/etiologia , Hérnias Diafragmáticas Congênitas/diagnóstico por imagem , Humanos , Masculino , Pneumotórax/diagnóstico por imagem , Radiografia Torácica/métodos , Estômago/diagnóstico por imagem , Estômago/fisiopatologia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
6.
J Infect Public Health ; 14(3): 290-292, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33610937

RESUMO

Real-Time-reverse-transcription-Polymerase-Chain-Reaction from nasopharyngeal swabs and chest computed tomography (CT) depicting typically bilateral ground-glass opacities with a peripheral and/or posterior distribution are mandatory in the diagnosis of COVID-19. COVID-19 pneumonia may present though with atypical features such as pleural and pericardial effusions, lymphadenopathy, cavitations, and CT halo sign. In these two case-reports, COVID-19 presented as pneumothorax, pneumomediastinum and subcutaneous emphysema in critically ill patients. These disorders may require treatment or can be even self-limiting. Clinicians should be aware of their potential effects on the cardiorespiratory status of critically ill COVID-19 patients. Finally, pneumothorax can be promptly diagnosed by means of lung ultrasound. Although operator dependent, lung ultrasound is a useful bedside diagnostic tool that could alleviate the risk of cross-infection related to COVID-19 patient transport.


Assuntos
/complicações , Enfisema Mediastínico , Pneumotórax , Enfisema Subcutâneo , Humanos , Unidades de Terapia Intensiva , Masculino , Enfisema Mediastínico/diagnóstico por imagem , Enfisema Mediastínico/virologia , Pessoa de Meia-Idade , Pneumotórax/diagnóstico por imagem , Pneumotórax/virologia , Enfisema Subcutâneo/diagnóstico por imagem , Enfisema Subcutâneo/virologia
7.
J Small Anim Pract ; 62(3): 178-186, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33496045

RESUMO

OBJECTIVES: To assess the accuracy of the lung ultrasound protocol Vet BLUE, using thoracic CT as the reference standard, for the detection of thoracic pathology in dogs and cats. MATERIALS AND METHODS: Animals that had thoracic ultrasound and thoracic CT were prospectively recruited between May 2017 and September 2018. The Vet BLUE protocol was performed on animals at the time of admission by veterinarians with basic training in emergency ultrasound. A board-certified radiologist, blinded to the Vet BLUE findings, reviewed the CT images. RESULTS: CT was abnormal in 64.5% (20/31) animals. The number of CT sites positive for alveolar-interstitial syndrome was 24.2% (60/248). When using CT as the reference standard, detection of ≥3 B lines with thoracic ultrasound had a sensitivity of 18.33% and specificity of 98.4% for detection of site specific alveolar-interstitial syndrome. The sensitivity of Vet BLUE to detect alveolar-interstitial syndrome increased to 56.9% when including the presence of any B line as abnormal. Overall accuracy for detection of alveolar-interstitial syndrome based on these two criteria was 79% and 73%, respectively. Vet BLUE correctly identified consolidation in 58.3% (14/24) sites, pleural effusion in 66.6% (2/3) cases, pneumothorax in 33.3% (1/3) cases and intrathoracic mass in 25% (1/4) cases. CLINICAL SIGNIFICANCE: The Vet BLUE protocol is a useful technique to detect alveolar-interstitial syndrome and other thoracic pathology but should not be used as a sole imaging method. Detection of ≥3 B lines is highly suggestive of alveolar-interstitial syndrome and warrants further diagnostics.


Assuntos
Doenças do Gato , Doenças do Cão , Pneumotórax , Médicos Veterinários , Animais , Doenças do Gato/diagnóstico por imagem , Gatos , Doenças do Cão/diagnóstico por imagem , Cães , Humanos , Pulmão/diagnóstico por imagem , Pneumotórax/diagnóstico por imagem , Pneumotórax/veterinária , Ultrassonografia/veterinária
8.
Medicina (Kaunas) ; 57(1)2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33430107

RESUMO

Foreign body (FB) aspiration occurs less frequently in adults than in children. Among the complications related to FB aspiration, pneumothorax is rarely reported in adults. Although the majority of FB aspiration cases can be diagnosed easily and accurately by using radiographs and bronchoscopy, some patients are misdiagnosed with endobronchial tumors. We describe a case of airway FB that mimicked an endobronchial tumor presenting with pneumothorax in an adult. A 77-year-old man was referred to our hospital due to pneumothorax and atelectasis of the right upper lobe caused by an endobronchial nodule. A chest tube was immediately inserted to decompress the pneumothorax. Chest computed tomography with contrast revealed an endobronchial nodule that was seen as contrast-enhanced. Flexible bronchoscopy was performed to biopsy the nodule. The bronchoscopy showed a yellow spherical nodule in the right upper lobar bronchus. Rat tooth forceps were used, because the lesion was too slippery to grasp with ellipsoid cup biopsy forceps. The whole nodule was extracted and was confirmed to be a FB, which was determined to be a green pea vegetable. After the procedure, the chest tube was removed, and the patient was discharged without any complications. This case highlights the importance of suspecting a FB as a cause of pneumothorax and presents the possibility of misdiagnosing an aspirated FB as an endobronchial tumor and selecting the appropriate instrument for removing an endobronchial FB.


Assuntos
Brônquios , Neoplasias Brônquicas/diagnóstico , Diagnóstico Diferencial , Corpos Estranhos/diagnóstico por imagem , Ervilhas , Derrame Pleural/diagnóstico por imagem , Pneumotórax/diagnóstico por imagem , Idoso , Broncoscopia , Corpos Estranhos/complicações , Corpos Estranhos/cirurgia , Humanos , Masculino , Derrame Pleural/etiologia , Derrame Pleural/terapia , Pneumotórax/etiologia , Pneumotórax/terapia , Aspiração Respiratória
9.
BMJ Case Rep ; 14(1)2021 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-33462033

RESUMO

A previously healthy 37-year-old man presented with fevers and myalgias for a week with a minimal dry cough. Initial SARS-CoV-2 nasopharyngeal testing was negative, but in light of high community prevalence, he was diagnosed with COVID-19, treated with supportive care and self-quarantined at home. Three days after resolution of all symptoms, he developed sudden onset chest pain. Chest imaging revealed a large right-sided pneumothorax and patchy subpleural ground glass opacities. IgM and IgG antibodies for SARS-CoV-2 were positive. His pneumothorax resolved after placement of a small-bore chest tube, which was removed after 2 days.This case demonstrates that patients with COVID-19 can develop a significant pulmonary complication, a large pneumothorax, despite only minimal lower respiratory tract symptoms and after resolution of the original illness. Medical professionals should consider development of a pneumothorax in patients who have recovered from COVID-19 and present with new respiratory symptoms.


Assuntos
/complicações , Convalescença , Pneumotórax/etiologia , Adulto , Dor no Peito/fisiopatologia , Tubos Torácicos , Tosse/fisiopatologia , Dispneia/fisiopatologia , Febre/fisiopatologia , Humanos , Masculino , Mialgia/fisiopatologia , Pneumotórax/diagnóstico por imagem , Pneumotórax/fisiopatologia , Pneumotórax/terapia , Radiografia Torácica , Índice de Gravidade de Doença , Toracostomia , Tomografia Computadorizada por Raios X
10.
Z Geburtshilfe Neonatol ; 225(1): 15-18, 2021 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-33412598

RESUMO

Lung ultrasound is a well-studied diagnostic procedure in emergency medicine. Over the last several years, international research groups have investigated the role of lung ultrasound to evaluate neonatal respiratory diseases. Specific diagnostic algorithms and key features of a neonatal pneumothorax have been released. Compared to X-ray examination, lung ultrasound has many advantages, such as faster diagnostic time, lack of exposure to ionizing radiation, and excellent sensitivity and specificity. Thus, lung ultrasound contributes to the improvement of medical healthcare in the neonatal intensive care unit. We consider the use of lung ultrasound as a new standard procedure to diagnose a pneumothorax in neonatology.


Assuntos
Pneumopatias/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Neonatologia/normas , Pneumotórax/diagnóstico por imagem , Ultrassonografia/métodos , Humanos , Recém-Nascido , Guias de Prática Clínica como Assunto , Padrões de Referência
11.
Br J Radiol ; 94(1117): 20200633, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33125260

RESUMO

OBJECTIVE: To develop and validate a CT-based nomogram to predict the occurrence of loculated pneumothorax due to hook wire placement. METHODS: Patients (n = 177) were divided into pneumothorax (n = 72) and non-pneumothorax (n = 105) groups. Multivariable logistic regression analysis was applied to build a clinical prediction model using significant predictors identified by univariate analysis of imaging features and clinical factors. Receiver operating characteristic (ROC) was applied to evaluate the discrimination of the nomogram, which was calibrated using calibration curve. RESULTS: Based on the results of multivariable regression analysis, transfissure approach [odds ratio (OR): 757.94; 95% confidence interval CI (21.20-27099.30) p < 0.0001], transemphysema [OR: 116.73; 95% CI (12.34-1104.04) p < 0.0001], localization of multiple nodules [OR: 8.04; 95% CI (2.09-30.89) p = 0.002], and depth of nodule [OR: 0.77; 95% CI (0.71-0.85) p < 0.0001] were independent risk factors for pneumothorax and were included in the predictive model (p < 0.05). The area under the ROC curve value for the nomogram was 0.95 [95% CI (0.92-0.98)] and the calibration curve indicated good consistency between risk predicted using the model and actual risk. CONCLUSION: A CT-based nomogram combining imaging features and clinical factors can predict the probability of pneumothorax before localization of ground-glass nodules. The nomogram is a decision-making tool to prevent pneumothorax and determine whether to proceed with further treatment. ADVANCES IN KNOWLEDGE: A nomogram composed of transfissure, transemphysema, multiple nodule localization, and depth of nodule has been developed to predict the probability of pneumothorax before localization of GGNs.


Assuntos
Neoplasias Pulmonares/diagnóstico por imagem , Pneumotórax/diagnóstico por imagem , Cuidados Pré-Operatórios/métodos , Nódulo Pulmonar Solitário/diagnóstico por imagem , Cirurgia Torácica Vídeoassistida/instrumentação , Tomografia Computadorizada por Raios X/métodos , Feminino , Humanos , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Nomogramas , Pneumotórax/etiologia , Valor Preditivo dos Testes , Cuidados Pré-Operatórios/instrumentação , Radiografia Intervencionista , Reprodutibilidade dos Testes , Cirurgia Torácica Vídeoassistida/efeitos adversos , Cirurgia Torácica Vídeoassistida/métodos
12.
Radiología (Madr., Ed. impr.) ; 63: 0-0, 2021. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-196553

RESUMO

Los pacientes con COVID-19 presentan una evolución muy variable: desde enfermos con síntomas leves de corta duración a pacientes con enfermedad grave que desarrollan un síndrome de distrés respiratorio agudo, con ingresos prolongados en unidades de críticos. Desde el punto de vista radiológico, la etapa inicial se caracteriza por una neumonía viral poco expresiva. No obstante, en algunos pacientes, con el inicio de la respuesta inmunitaria se produce un daño pulmonar agudo con patrones radiológicos de neumonía organizada y daño alveolar difuso. La enfermedad moderada-grave se asocia con una incidencia alta de tromboembolismo pulmonar, generalmente de distribución periférica y asociado al daño endotelial, encamamiento prolongado y coagulopatía de la enfermedad. Otras complicaciones relativamente frecuentes son: el neumotórax y el neumomediastino espontáneos por rotura de paredes alveolares, y el barotrauma en pacientes con ventilación mecánica. La sobreinfección es más frecuente en pacientes graves, generalmente de origen bacteriano y menos frecuente fúngico


Outcomes vary widely in patients with COVID-19. Whereas some patients have only mild symptoms of short duration, others develop severe disease that leads to acute respiratory distress syndrome requiring prolonged stays in intensive care units. Radiologically, the initial stage is characterized by viral pneumonia with mild expression. In some patients, however, the onset of the immune response results in acute lung damage with organizing pneumonia and diffuse alveolar damage. Moderate-severe disease is associated with a high incidence of pulmonary embolisms, generally peripherally distributed and associated with endothelial damage, prolonged stays in bed, and coagulopathy. Other relatively common complications are spontaneous pneumothorax and pneumomediastinum due to the rupture of alveolar walls and barotrauma in mechanically ventilated patients. Superinfection, generally bacterial and less commonly fungal, is more common in patients with severe disease


Assuntos
Humanos , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Pandemias , Embolia Pulmonar/virologia , Pneumotórax/virologia , Enfisema Mediastínico/virologia , Síndrome do Desconforto Respiratório do Adulto/virologia , Índice de Gravidade de Doença , Embolia Pulmonar/diagnóstico por imagem , Pneumotórax/diagnóstico por imagem , Enfisema Mediastínico/diagnóstico por imagem , Síndrome do Desconforto Respiratório do Adulto/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Radiografia
15.
R I Med J (2013) ; 103(10): 32-33, 2020 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-33353262

RESUMO

Co-occurrence of pneumothorax and pneumomediastinum is rare in COVID-19 patients. Positive airway pressure therapy used to improve oxygenation may sometimes worsen clinical outcomes in some patients with severe COVID-19 pneumonia. In this case report, we describe an individual who was diagnosed with COVID-19 and developed bilateral pneumothorax and pneumomediastinum after initiating non-invasive positive airway pressure therapy.


Assuntos
/terapia , Enfisema Mediastínico/etiologia , Pneumonia Viral/terapia , Pneumotórax/etiologia , Respiração com Pressão Positiva/efeitos adversos , Idoso , Evolução Fatal , Humanos , Doença Iatrogênica , Masculino , Enfisema Mediastínico/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Pneumotórax/diagnóstico por imagem , Radiografia Torácica
16.
Isr Med Assoc J ; 22(12): 747-751, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33381945

RESUMO

BACKGROUND: Primary spontaneous pneumothorax (PSP) tends to occur in young adults without underlying lung diseases and is usually followed by limited symptoms, while secondary spontaneous pneumothorax (SSP) is a complication of a pre-existing lung disease. Surprisingly, for such common conditions, there is a considerable inconsistency regarding management guidelines. OBJECTIVES: To evaluate the risk factors for spontaneous pneumothoraxes and to summarize outcomes and complications based on our clinical experience. METHODS: This retrospective study group was comprised of 250 consecutive patients older than 18 years of age who were diagnosed with spontaneous pneumothorax and hospitalized at the Meir Medical Center (2004-2017). Data on demographic characteristics, indicating symptoms, chest X-rays, and chest computed tomography (CT) results were collected. Our experience and outcomes were then compared to a large multicenter study. RESULTS: Most of the patients were male (85%) and past or current smokers; 69% presented with PSP, while the rest were SSP. No occupational relation was noted. About 55% of the cases presented with a moderate or large pneumothorax (over 1/3 hemithorax). Most patients (56%) required chest tube drainage and 20% undergone surgery. Nearly 10% presented with a recurrent pneumothorax with the mean time to recurrence being 11 ± 20 days. Although the length of hospital stay of patients that underwent surgery was the longest (P < 0.001) for both PSP and SSP, the recurrence rate was actually reduced, suggesting some benefit for the surgical treatment option. CONCLUSIONS: Our experience showed that the traditional approach to the PSP treatment should be further considered, as previously suggested.


Assuntos
Pneumotórax/patologia , Adulto , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pneumotórax/diagnóstico por imagem , Pneumotórax/terapia , Radiografia Torácica , Recidiva , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X , Resultado do Tratamento
18.
BMC Med Inform Decis Mak ; 20(Suppl 14): 317, 2020 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-33323117

RESUMO

BACKGROUND: Pneumothorax (PTX) may cause a life-threatening medical emergency with cardio-respiratory collapse that requires immediate intervention and rapid treatment. The screening and diagnosis of pneumothorax usually rely on chest radiographs. However, the pneumothoraces in chest X-rays may be very subtle with highly variable in shape and overlapped with the ribs or clavicles, which are often difficult to identify. Our objective was to create a large chest X-ray dataset for pneumothorax with pixel-level annotation and to train an automatic segmentation and diagnosis framework to assist radiologists to identify pneumothorax accurately and timely. METHODS: In this study, an end-to-end deep learning framework is proposed for the segmentation and diagnosis of pneumothorax on chest X-rays, which incorporates a fully convolutional DenseNet (FC-DenseNet) with multi-scale module and spatial and channel squeezes and excitation (scSE) modules. To further improve the precision of boundary segmentation, we propose a spatial weighted cross-entropy loss function to penalize the target, background and contour pixels with different weights. RESULTS: This retrospective study are conducted on a total of eligible 11,051 front-view chest X-ray images (5566 cases of PTX and 5485 cases of Non-PTX). The experimental results show that the proposed algorithm outperforms the five state-of-the-art segmentation algorithms in terms of mean pixel-wise accuracy (MPA) with [Formula: see text] and dice similarity coefficient (DSC) with [Formula: see text], and achieves competitive performance on diagnostic accuracy with 93.45% and [Formula: see text]-score with 92.97%. CONCLUSION: This framework provides substantial improvements for the automatic segmentation and diagnosis of pneumothorax and is expected to become a clinical application tool to help radiologists to identify pneumothorax on chest X-rays.


Assuntos
Pneumotórax , Algoritmos , Humanos , Processamento de Imagem Assistida por Computador , Pneumotórax/diagnóstico por imagem , Estudos Retrospectivos , Raios X
19.
Artigo em Inglês | MEDLINE | ID: mdl-33053145

RESUMO

Coronavirus Disease 2019 (COVID-19) has rapidly spread worldwide. Numerous studies have shown its typical and atypical CT findings. We report one COVID-19 patient who presented with a transient pneumothorax, spontaneous pneumomediastinum (SP), as well as subcutaneous emphysema during hospitalization. Chest CT andclinical findings were discussed, and a literature review is presented. The probable cause of SP in COVID-19 was alveolar damage. Once pneumothorax and SP were present, the patient should be carefully monitored to prevent respiratory deterioration, especially when lung lesions are severe.


Assuntos
Infecções por Coronavirus/diagnóstico , Coronavirus/isolamento & purificação , Enfisema Mediastínico/diagnóstico por imagem , Pandemias , Pneumonia Viral/diagnóstico , Pneumotórax/diagnóstico por imagem , Enfisema Subcutâneo/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Betacoronavirus , Humanos
20.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5818-5821, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019297

RESUMO

Because the lung deforms during surgery because of pneumothorax, it is important to be able to track the location of a tumor. Deformation of the whole lung can be estimated using intraoperative cone-beam CT (CBCT) images. In this study, we used deformable mesh registration methods for paired CBCT images in the inflated and deflated states, and analyzed their deformation. We proposed a deformable mesh registration framework for deformations of partial organ shapes involving large deformation and rotation. Experimental results showed that the proposed methods reduced errors in point-to-point correspondence. As a result of registration using surgical clips placed on the lung surface during imaging, it was confirmed that an average error of 3.9 mm occurred in eight cases. The result of analysis showed that both tissue rotation and contraction had large effects on displacement.


Assuntos
Pneumotórax , Tomografia Computadorizada de Feixe Cônico , Humanos , Pulmão/diagnóstico por imagem , Pneumotórax/diagnóstico por imagem
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