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PubMed1992

Virilizing adrenal cortical neoplasm arising ectopically in the thorax.

We describe a 44-yr-old woman with a 12-yr history of clinical virilization and serum testosterone levels up to 28.1 nmol/L (normal range, 1-3.3 nmol/L) in whom repeated clinical evaluation and surgical procedures failed to reveal the source of androgen production. At the time the patient was referred to the Clinical Center of the NIH, an intrathoracic mass was seen on upper cuts of an abdominal computer-aided tomography scan, confirmed by computer-aided tomography scan and magnetic resonance imaging of the chest. A 6 x 5 x 3.5-cm mass, attached to the posterior pericardium, was removed by thoracotomy. Pathological examination revealed an adrenal cortical neoplasm of uncertain malignant potential that contained testosterone, 11-deoxycortisol, progesterone, and 17-hydroxyprogesterone. After the operation, the patient's serum testosterone levels decreased to the normal range. Ectopic adrenal cortical rests in the thorax and neoplasms arising from these rests are extremely rare, and we are not aware of a similar case previously reported. In women with virilization, radiological studies of the thorax as well as other reported sites of ectopic adrenal cortex should be performed if radiological studies of the abdomen and pelvis fail to locate the source of the neoplasm.

Adrenal Cortex Neoplasms↗
PubMed1975

111-In-labelled bleomycin; clinical experience as a diagnostic agent in tumours of the thorax and abdomen.

The potential value of indium-labelled bleomycin as a diagnostic scanning agent has been investigated in patients with a variety of malignant neoplasms involving the thorax, abdomen or pelvis. Sixty-five patients were scanned on 72 occasions, the optimum time to perform the examination being 72 hours after the intravenous injection of 2 mCi 111-In chelated to 2 mg bleomycin. Tumour uptake was visualized in 53 out of 62 scans in which tumour was present, but the extent of tumour was underestimated in seven cases, and over-estimated in five others. The latter were mostly due to uptake in infective lesions. These results indicate that the situations in which indium bleomycin is most likely to provide clinically relevant information are the distinction between recurrent tumour and post-radiotherapy changes in the thorax and pelvis, the diagnosis of recurrent carcinoma within the pelvis, and the distinction between bony metastases from carcinoma of the prostate and Paget's disease. Further clinical trials are necessary to assess these situations.

Abdominal Neoplasms↗
PubMed1981

Computed tomography of the thorax: a status report.

Computed tomography (CT) of the thorax shows early promise of important diagnostic advances. We believe that CT often provides information superior to that provided by standard roentgenographic techniques, is capable of significantly influencing patient management, and in selected instances, offers unique information not available by other methods. Computed tomography permits the imaging of mediastinal structures not possible with conventional roentgenographic methods and can diagnose with certainty benign mediastinal conditions such as pericardial cysts and focal or diffuse accumulations of fat. It is ideal for detecting pleural abnormalities and for displaying underlying parenchymal disease in patients with complex pleuroparenchymal shadows on conventional films. Pulmonary metastases unseen on the plain chest film can be detected with greater sensitivity than by any other method. Future applications of CT include the staging of mediastinal lymph nodes in bronchogenic carcinoma, the differentiation of benign from malignant solitary pulmonary nodules, and the detection of diffuse diseases involving the lung parenchyma before they are visible on conventional roentgenograms. Additional clinical experience and careful studies will determine CTs final role as a diagnostic aid for disorders of the thorax.

Costs and Cost Analysis↗
PubMed2003

Value of the radiological study of the thorax for diagnosing left ventricular dysfunction in Chagas' disease.

OBJECTIVE: To determine the value of the radiological study of the thorax for diagnosing left ventricular dilation and left ventricular systolic dysfunction in patients with Chagas' disease. METHODS: A cross-sectional study of 166 consecutive patients with Chagas' disease and no other associated diseases. The patients underwent cardiac assessment with chest radiography and Doppler echocardiography. Sensitivity, specificity, and positive and negative predictive values of chest radiography were calculated to detect left ventricular dysfunction and the accuracy of the cardiothoracic ratio in the diagnosis of left ventricular dysfunction with the area below the ROC curve. The cardiothoracic ratio was correlated with the left ventricular ejection fraction and the left ventricular diastolic diameter. RESULTS: The abnormal chest radiogram had a sensitivity of 50%, specificity of 80.5%, and positive and negative predictive values of 51.2% and 79.8%, respectively, in the diagnosis of left ventricular dysfunction. The cardiothoracic ratio showed a weak correlation with left ventricular ejection fraction (r=-0.23) and left ventricular diastolic diameter (r=0.30). The area calculated under the ROC curve was 0.734. CONCLUSION: The radiological study of the thorax is not an accurate indicator of left ventricular dysfunction; its use as a screening method to initially approach the patient with Chagas' disease should be reevaluated.

Adult↗
PubMed1979

Fatty tumors of the thorax demonstrated by CT.

The radiographic signs previously described for fatty tumors of the thorax although helpful are nonspecific. In the past, the diagnosis of benign fatty tumors of the chest in asymptomatic patients required surgical intervention. This report illustrates the gamut of fat-containing tumors of the thorax encountered over a recent 1 year period. CT proved to be helpful in the diagnosis and management on these cases. When the CT numbers of the fatty lesion was around -55 EMI units, intervention was felt to be unnecessary. However, when the CT number of the mass ranged from --10 to--20 EMI units, intervention was felt to be necessary since a malignancy could not be excluded on the basis of the CT findings alone.

Adult↗
PubMedDate not supplied

Omentalization of the thorax for treatment of idiopathic chylothorax with constrictive pleuritis in a cat.

A 6-year-old, spayed female Himalayan cat with idiopathic chylothorax, which failed to respond to medical management, was successfully treated by advancement of the omentum into the thorax. Exploratory thoracotomy revealed severe, constrictive pleuritis as a sequela to chylothorax. Because of the poor prognosis for recovery from chylothorax in cats with thoracic duct ligation alone, and the lack of success in performing thoracic duct ligation in this cat, the omentum was advanced into the thorax through a hole created in the diaphragm and sutured within the thoracic cavity. The cat recovered from surgery and is clinically normal 13 months postoperatively. Omental advancement may be an effective surgical management technique for this challenging disease in cats.

Animals↗
PubMed2005

[A modified retroperitoneal approach to the kidney in patients with a highly deformed thorax: obtaining a wide operative field through subperiosteal resection of the 10th, 11th and 12th ribs].

We herein report a technique which facilitates a retroperitoneal approach to the kidney in cases of highly deformed thorax due to kyphoscoliosis. The operation consists of a lumbar oblique incision with removal of the 11th rib, combined with the additional removal of the 12th and 10th ribs. Resection of the upper two ribs was performed subperiosteally, leaving the periosteum of the deep side untouched. However, the deep side periosteum of the 12th rib was incised caudal from the pleural margin in order to facilitate exposure of the diaphragm. The retroperitoneal space was entered through the tip of the 11th rib bed. The diaphragm was incised dorso-medially at a level 1 cm caudal from the lower margin of the pleura, to an extent necessary to enable the pleura together with the cranial diaphragm to be manoeuvred in an upward direction. Two cases with renal tuberculosis associated with high-grade kyphosis and one case with staghorn calculi accompanied with lordosis were operated on utilizing this technique. In the former two cases, the thoracic cage was in direct contact with the iliac bone and there was practically no space between the rib border and the iliac crest. This was also true of the third case, but the grade of deformity was not as extensive as in the former two cases. Removal of the 10th, 11th and 12th ribs could be achieved without injuring the pleura and a satisfactorily large operating field could thus be developed which enabled a simple nephrectomy to be performed without difficulty. The characteristic feature of the described approach is that resection of the 10th and 11th ribs is simply to facilitate manoevrability of the wound margin, without going through the rib bed. The technique could be advantageous in selected cases where there is a highly deformed thorax.

Humans↗
PubMedDate not supplied

[Helical computerized tomography of the thorax in the diagnosis of unresolved chronic pulmonary thromboembolism].

We assessed the diagnostic usefulness of helical CT scan of the thorax in the setting of chronic thromboembolic pulmonary hypertension by prospectively comparing the results of helical CT scan to those of the pulmonary angiogram (gold standard). We studied 40 patients with diagnosis of pulmonary hypertension of diverse etiology (mean age: 40.7 +/- 12 y.o.; mean systolic pulmonary artery pressure: 91 +/- 33 mmHg)). Thirty of these patients fulfilled the diagnostic criteria of chronic thromboembolic pulmonary hypertension and the other ten were used as controls. Diagnosis in control patients included: primary pulmonary hypertension (4); patent ductus arteriosus (2); atrial septal defect (1); rheumatic valve disease (1); ischemic heart disease (1); and acute pulmonary embolism (1). Both helical CT scan and pulmonary angiogram were part of the routine diagnostic work up of these patients, and were, performed and interpreted almost simultaneously (within one week) by a different group of investigators in a blind manner. Only the diagnostic accuracy of the method regarding central (major arteries) vascular lesions was evaluated. Helical CT scan had an overall sensitivity of 100% (29/29), and a specificity of 91% (10/11). Positive predictive and negative predictive values were 96.6% (29/30) and 100% (10/10), respectively. Overall diagnostic accuracy was 97.5% (39/40). We conclude that helical CT scan of the thorax is an excellent alternative approach for the diagnosis of major arteries lesions in the setting of chronic thromboembolic pulmonary hypertension.

Adolescent↗
PubMedDate not supplied

[Computerized tomography of the thorax in evaluation of resectability of pulmonary carcinoma].

A group of 49 patients with non-small cell lung carcinoma was investigated at the Clinic of Pulmonary Diseases of the Military Medical Academy in the period 01.01.1995.-01.03.1999. In all patients were performed bronchoscopy, ultrasound of the abdomen and computed tomography (CT) of the thorax. The patients suspected to have locoregionally disseminated disease were selected. The aim of the investigation was to estimate the reliability of CT of the thorax in the evaluation of the possibility for lung carcinoma resection. The findings were confirmed either by invasive diagnostic procedures and/or during thoracotomy. During the evaluation of the direct invasion of mediastinal organs, sensitivity of the method was 48% and specificity was 89%. In the evaluation of the mediastinal lymph node metastases by CT scan, sensitivity of the method was 68.4% and specificity was 81.3%. Reliability of CT of the mediastinum was significantly higher in the detection of lymph nodes suspected to be metastatically altered than in the evaluation of the direct carcinoma invasion into mediastinal organs.

Adult↗
PubMed2003

Prediction of anemia on unenhanced computed tomography of the thorax.

OBJECTIVE: To determine if anemia can be predicted on unenhanced computed tomography (CT) of the thorax. METHODS: Hemoglobin and hematocrit levels were obtained within 24 hours of the unenhanced CT scan of the thorax of 200 patients. Anemia was defined as a hemoglobin level less than 140 g/L for men and less than 120 g/L for women. Regions of interest were placed on the left ventricular cavity, aorta and the interventricular septum if visualized. The attenuation of the interventricular septum and left ventricular cavity were correlated with the presence or absence of anemia. RESULTS: When the interventricular septum was not visualized, for every 1 Hounsfield unit (HU) increase in left ventricular attenuation, hemoglobin increased by 0.435 g/L (SE = 0.253, p < 0.001). Failure to visualize the interventricular septum did not exclude the presence of anemia in either sex. When the interventricular septum was visualized, 100% of males and 89% of females met the criteria for the diagnosis of anemia. The prediction of anemia by visualization of the interventricular septum alone yielded a sensitivity of 75.4% and a specificity of 90.3%, with 80% of patients correctly predicted. The multiple regression analysis model yielded a sensitivity of 94.2% and a specificity of 67.7%, with 86% of patients correctly predicted. CONCLUSION: The diagnosis of anemia should be suggested whenever the interventricular septum is visualized on unenhanced CT.

Adolescent↗
PubMed2003

Left ventricular end-diastolic pressure-volume relationship in septic rats with open thorax.

To estimate changes in compliance, we evaluated the effects of sepsis on the end-diastolic pressure-volume relationship (EDPVR) in the left ventricle of rats that had undergone an open thorax procedure. Sepsis was induced in male Wistar Hannover rats (n = 7; 240 to 270 g) by intraperitoneal administration of a slurry of cecal contents; control rats (n = 7) were given 5% dextrose only. On the third day after induction of sepsis, left ventricular (LV) pressure and LV dimensions were recorded simultaneously in animals of both groups. Using a micromanometer and ultrasonic crystals, measurements were obtained at baseline and during the increase of afterload. Blood samples were taken for determination of complete blood count, white blood cell differential count, and lactate concentration, and for bacteriologic examination. Septic rats lost weight, and developed changes in body temperature, ascites, and abscesses in the abdominal and thoracic cavities, gram-negative bacteremia, and increase in heart rate. On the third day after induction of sepsis, LV EDPVR decreased, compared with that in the control rats (regression coefficients: control group, 8.41 to 23.95; sepsis group, 3.94 to 7.92). Myocardial compliance in the left ventricle increased on the third day of sepsis in the open-thorax rat model, as evidenced by the downward shift of LV EDPVR in rats with sepsis, compared with controls.

Animals↗
PubMed2004

[Case of positive identification by digital superimposed comparison between photograph of the thoracic vertebrae front and thorax roentgenograph].

We reported an autopsy case in which an antemortem thorax roentgenograph and a postmortem photograph of thoracic vertebrae front were available for digital superimposed comparison of contour of the vertebral column and provided a positive identification by the characteristic osteophyte formation. In the elderly, the thorax roentgenograph is often stored in medical institution. Osteophyte formation of the vertebral column has individual features with the aging and formed characteristic profiles of the vertebral column. Photographing of a cadaver's thoracic vertebrae front after removing of the thoracic and abdominal organ should be carried out to make a material for future comparison examination in personal identification.

Aging↗
PubMed1989

[Radiation dosage of premature infants caused by roentgen imaging of the thorax].

The X-ray pictures of the thorax from premature infants must be prepared by conditions of neonatal intensive care. For this X-ray pictures are available very often single-puls generators only. The radiation exposure is dependent prominently on the type of the generator. The radiation exposure was compared between single-puls generators and 6-puls generators. The dosimetry was performed with CaF2-thermoluminescent dosimeters. The results of measurement demonstrated: In the radiation fields the radiation exposure is considerable higher by the single-puls generators than by the 6-puls generators. The indication to X-ray pictures of the thorax from premature infants under conditions of bed-side with single-puls generators must be very accuratly.

Humans↗
PubMed1986

Changes in lung volume and lung-thorax compliance during cardiac surgery in children 11 days to 4 years of age.

To examine the effects of cardiac surgery and cardiopulmonary bypass (CPB) on the lung, functional residual capacity (FRC) and lung-thorax compliance were measured at four stages during open heart surgery in 15 children. The patients were anesthetized with fentanyl/droperidol and N2O/O2, paralyzed, and ventilated with volume-controlled mechanical ventilation at 20-30 breaths/min. FRC was measured by tracer gas washout. Static lung-thorax compliance (CLT) was calculated as tidal volume divided by the airway pressure difference between the end of the postinspiratory pause and the end of the expiration, and also from the increase in FRC caused by adding 5 cmH2O of PEEP (CLT[FRC]). Before skin incision, both FRC and compliance were closely correlated with weight and length. During this stage, FRC was 21 +/- 5 ml/kg, CLT 0.90 +/- 0.21, and CLT(FRC) 1.28 +/- 0.35 ml X cmH2O-1 X kg-1 X PEEP 5 increased FRC by 34 +/- 9%. In patients with intact pleural cavities throughout the operation (n = 10), FRC increased by 4 +/- 2 ml/kg when the sternum was retracted (P less than 0.01). During CPB, FRC decreased by 4 +/- 3 ml/kg (P less than 0.01), and FRC at the end of surgery was 5 +/- 4 ml/kg less than before skin incision (P less than 0.01). In these ten children, there was a 13% and 6% decrease in mean CLT and CLT(FRC), respectively, during the operation (P less than 0.05) and mean CLT(FRC) was at least 40% greater than CLT during all four stages (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia↗
PubMed1979

[Indications and methods for the surgical stabilization of an unstable thorax caused by multiple fractures of the ribs (author's transl)].

Every year 8,000 persons involved in road accidents die of irreversible respiratory insufficiency caused by chest injuries. Fractures of the ribs extendig over a number of ribs are present in 70% of the cases and in 15% of them they are accompanied by instability of the thorax and "paradoxical" respiration. Treatment of the instability by "internal pneumatic splinting" (Avery) and by surgical measures is reviewed. Indications for the latter are: (1) open fractures of the chest wall; (2) instability of the thorax combined with intrathoracic injuries; (3) instability of the chest wall with severe therapy-resistant respiratory insufficiency. In a series of animal experiments unilateral instability of the chest wall was induced by multiple rib fractures. By measuring oscillatory resistance before and after stabilization of chest wall the effects of the latter on the impaired lung function could be demonstrated. The results of the experiments indicate that with this type of surgical treatment mortality from combined thoracic injuries with paradoxical breathing can be reduced.

Contusions↗
PubMed1983

Computed multiplanar reconstructions of the thorax using thin transverse-axial slices. A preliminary study.

By reducing cut thickness to 3 mm, spatial resolution of transverse axial and reformatted images of the thorax is markedly improved at the cost of slightly decreased contrast resolution as compared to standard 9 mm CT pictures when using the same dose. Reformatte4d CT pictures of the thorax in coronal sagittal and oblique planes made from thin slices offer a unique way of studying normal and pathological anatomy in vivo. It is further concluded that, although with present reconstruction times this method is as yet not suited for routine use, it might prove to be useful in investigations where high spatial resolution is of prime importance.

Bronchography↗
PubMed1983

Experience with the Artronix Torso-Cat-Scanner in the examination of the thorax, particularly the mediastinum: comparison with mediastinoscopy and operation.

In order to ascertain the diagnostic value of computed tomography (CT) of the thorax, the reports of the CT investigations of the thorax, carried out over a 2-year period, were compared with the actual final diagnosis. This study was narrowed down to those patients on whom a mediastinoscopy and/or an operation was performed. There appears to be a good correlation between the CT findings and the mediastinoscopy if no tumor or metastases are present in the mediastinum. This means that, where the CT scan shows a patient to have a normal mediastinum, it is not necessary to perform mediastinoscopy as a preoperative diagnostic aid.

Humans↗
PubMed1982

High-velocity missile injuries of the thorax.

Nine patients who sustained high-velocity missile injuries to the thorax are reported. Two types of injury were seen: a 'through-and-through' injury (6 patients), and a 'tangential' injury (3 patients). Six patients underwent thoracotomy: 3 had pulmonary resections and 2 had closure of bronchopleural fistulas, while 1 had repair of the diaphragm and liver, which were lacerated, and a pleural toilet. A further patient had a rib resection for empyema at a later stage. All patients had intercostal drains inserted as initial treatment. There were no deaths, and those patients who underwent pulmonary resection recovered fully and rapidly after operation. Extensive pulmonary damage and lobar infarction occurred with 'tangential' high-velocity missile injuries to the thorax.

Humans↗