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At least 199 records · Page 11Linked to original sources
PubMedDate not supplied

Imaging features of atypical thoracic Castleman disease.

The imaging features of 16 cases of pathologically proven atypical thoracic Castleman disease (CD) were retrospectively reviewed. Thirteen out of 16 tumors originated from atypical locations, including eight from the pleura and one each from the axilla, supraclavicular fossa, intercostal space, pericardium, and lung. Six out of 16 tumors revealed atypical enhancement, including poor CT enhancement in three tumors, target-like CT enhancement in two tumors, and concentric MR enhancement pattern in one tumor. These atypical enhancement patterns were histopathologically corresponded to various degrees of degeneration, necrosis, and fibrosis.

Adult↗
PubMed1996

Unusual thoracic collaterals of gastro-oesophageal varices in a patient with end-stage liver disease.

Thoracic varices are rare anomalies in patients with liver cirrhosis and portal hypertension. Gastro-oesophageal varices usually drain into the azygos or hemiazygos vein. The case is reported here of an unusual collateral pathway of gastro-oesophageal varices with drainage to the vena anonyma system presenting as lung masses on chest X-ray, which completely resolved after successful liver transplantation.

Collateral Circulation↗
PubMedDate not supplied

Thoracic disk disease: diagnosis and treatment.

Symptomatic degenerative disk disease is much less common in the thoracic spine than in the cervical and lumbar regions. Accurate diagnosis relies on a strong clinical suspicion that is confirmed with appropriate diagnostic imaging. Presenting symptoms vary tremendously, from atypical pain patterns to myelopathy. The use of computed tomography in combination with myelography and magnetic resonance imaging have greatly increased the ability to accurately visualize thoracic spine disorders. The superior resolution of available imaging modalities has made the incidental detection of asymptomatic thoracic disk abnormalities more frequent. Most patients with symptomatic thoracic disk disease will respond favorably to nonoperative management. Surgery is indicated for the rare patient with an acute thoracic disk herniation with progressive neurologic deficit (i.e., signs or symptoms of thoracic spinal cord myelopathy). Once surgical intervention has been chosen, careful preoperative planning is necessary. The level, anatomic location, and morphology of the herniation must be precisely determined to select the optimal approach. Posterior laminectomy has largely been abandoned for the treatment of symptomatic thoracic disk protrusions. Surgeons still may choose among anterior, lateral, and posterior approaches when surgically addressing the thoracic intervertebral disk.

Adult↗
PubMed2006

The short-to-midterm results of endovascular stent grafting for acute thoracic aortic diseases in Chinese patients.

OBJECTIVE: To review the results of endovascular treatment of acute thoracic aortic diseases in a group of Chinese patients. DESIGN: Retrospective study. SETTING: A tertiary referral hospital with a cardiothoracic surgery service. PATIENTS: All 15 patients presenting with acute thoracic aortic diseases between September 2001 and October 2005 inclusive, of whom eight had traumatic rupture, four had complicated acute dissections, two had mycotic aneurysms, and one an aneurysm with an aortobronchial fistula. INTERVENTIONS: Thoracic aortic stent grafting. MAIN OUTCOME MEASURES: Immediate success, 6-month and 1-year survival rates. RESULTS: The median follow-up period was 20.6 months (range, 0-50.1 months). Stent grafts were deployed with immediate success in all patients. Two patients had ancillary bypass surgery for the supra-aortic branches. There were two in-hospital deaths. Four sustained access artery injury and needed graft repair. Computed tomography at 1 month showed complete thrombosis of the aneurysmal lumen or the thoracic aortic false lumen in 12 of 13 survivors. Computed tomography at 6 months showed complete thrombosis of the aneurysmal lumen or the false lumen in nine of 10 patients due for follow-up. Both 6-month and 1-year survival rates were 87%. CONCLUSIONS: Thoracic aortic stent grafting for acute thoracic aortic disease is feasible and has a high success rate, with good short-to-midterm results. However, the large size of the stent graft introducer set imposes a high risk of access artery injury, for which further improvements are necessary.

Aortic Dissection↗
PubMed1991

[Usefulness of transesophageal echocardiography in thoracic aortic disease: comparison with computed tomography and angiography].

To evaluate the usefulness of transesophageal echocardiography in thoracic aortic disease, transesophageal echocardiography was performed in 11 patients with thoracic aortic disease (true aortic aneurysm in two patients, aortic dissection in nine patients). Findings obtained by transesophageal echocardiography were compared with those obtained by computed tomography (nine patients) and angiography (six patients). Results were as follows: 1. True aortic aneurysm: Although transesophageal echocardiography and computed tomography could evaluate the size of the aorta and detect mural thrombus, angiography underestimated degree of aortic dilatation because of the presence of mural thrombus. 2. Aortic dissection: Although computed tomography could not differentiate thrombus in the false lumen from mural thrombus in two patients, transesophageal echocardiography could discriminate those two easily in one patient from properties and motion of the intimal flap, and flow information in the false lumen. Angiography could not evaluate the range of dissection in any patients with thrombus in the false lumen. With transesophageal echocardiography we could detect the entry in all six patients with aortic dissection of DeBakey type III except 1 patient with aortic dissection of DeBakey type I. Transesophageal echocardiography could obtain real-time image of most of the aorta except for a part of the ascending aorta. Therefore, transesophageal echocardiography was useful for diagnosing thoracic aortic disease and distinguishing between true aortic aneurysm and aortic dissection.

Aged↗
PubMed1978

Pattern of thoracic surgical diseases in Nigeria: experience at the University College Hospital, Ibadan.

A prospective study of 595 patients treated by the Thoracic Surgical Unit (TSU) at the University College Hospital (UCH), Ibadan between July 1975 and December 1977 was carried out to determine the pattern of thoracic surgical diseases in Nigeria and to prove or disprove the rarity of certain cardiopulmonary diseases in tropical Africa. This review shows that pyogenic infections of the lung and pleura constitute the largest percentage (38.5) of the thoracic surgical diseases in Nigeria. Although pulmonary tuberculosis accounts for only 23.4 percent of our total inpatient load, it constitutes about 60 percent of our outpatient clinic practice. Cardiovascular diseases form 12.9 percent, notably congenital and acquired valvular heart diseases. An interesting finding was the occasional association of pyomyositis with pyogenic pericarditis and empyema thoracis. This triad is being investigated. Chest trauma was the most common thoracic surgical emergency accounting for 9.2 percent of the total thoracic surgical pathology. The most common causes of dysphagia are strictures from corrosive esophagitis, achalasia, and carcinoma of the esophagus. Present experience confirms the rarity of hiatus hernia, reflux esophagitis, atherosclerotic cardiovascular disease, and, perhaps, carcinoma of the lung among Nigerians.

Adolescent↗
PubMedDate not supplied

Stent-graft placement for the treatment of thoracic aortic diseases.

The recent development of aortic stent-grafts has brought the management of thoracic aortic diseases into the realm of interventional radiology. Stent-graft placement is now an alternative to surgery for the treatment of descending thoracic aortic aneurysms, ulcers, and fistulas and is sometimes indicated in cases of mycotic aneurysm, posttraumatic aortic rupture, or thoracic descending aortic dissection. Pretreatment imaging is crucial for evaluating patient eligibility, selecting the appropriate stent-graft, and planning the intervention. Stent-graft treatment of long atherosclerotic aneurysms, lesions close to aortic branch vessels, and aortic dissections is subject to technical pitfalls, and adverse events such as endoleaks, stent migration or misplacement, aortic perforation, and vascular trauma will require specific interventions, although they occur in only a minority of patients. Thoracic stent-graft placement in good surgical candidates remains controversial because long-term results are unknown. However, short-term morbidity and mortality rates from endovascular treatment compare favorably with those from surgery, and stent-graft placement is proving to be a safe, minimally invasive, and effective treatment for thoracic aortic diseases and is already the best option in many affected patients who are poor surgical candidates.

Aorta, Thoracic↗
PubMed1993

Comparison of CT and MRI in the evaluation of therapeutic response in thoracic Hodgkin disease.

Current imaging modalities are accurate in establishing the diagnosis and extent of thoracic Hodgkin disease. After treatment, however, it is extremely difficult to differentiate potential residual active neoplastic disease from scar tissue, or identify early recurrence. We evaluated the contribution of MRI in the assessment of the response to treatment of thoracic Hodgkin disease in the assumption that scar formation would be characterized by low signal intensity in all pulse sequences, whereas active tumor should maintain a degree of high signal intensity on T2-weighted images. In 47 occasions (23 patients) both CT and MRI were able to identify correctly active disease, but had low specificity in confirming remission because of residual tissues masses. High signal intensity on T2-weighted MR images often persisted despite remission, probably because of edema, necrosis, granulation or other factors. MRI was somewhat more specific than CT and may be quite valuable to confirm remission in patients with residual masses that no longer appear hyperintense on T2 after treatment.

Adolescent↗
PubMed1989

[Postoperative results and follow-up of thoracic aortic diseases using magnetic resonance tomography].

Operations of the thoracic aorta for aneurysms, dissections, or congenital malformations may lead to early or late complications. Therefore, postoperative control for documentation of the surgical results, for exclusion of early changes and for comparison with later controls is mandatory. To demonstrate that magnetic resonance imaging (MRI), which we already had used with good results for preoperative studies is also able to detect postoperative abnormalities, we examined 30 patients with thoracic aortic disease (20 male, 10 female, mean age 53 +/- 13.7 years) with this diagnostic tool. There were 19 arteriosclerotic aneurysms, 10 dissections, and one aortic tumor. With MRI it was possible in all patients to visualize the results of the surgical treatment postoperatively. Early postoperative complications could be excluded, or demonstrated in one case of a retrograde aortic dissection or a hematopericardium. These pathological findings could also be shown by arterial digital subtraction angiography or echocardiography. Using MRI for follow-up of aortic dissections, the development of an aneurysm of the aortic root in a Marfan-patient could be detected. In all these patients, it was possible to differentiate true and false lumen and to detect the origin of major side branches. The diagnostic advantages of MRI, which we compared with other imaging methods, as echocardiography, computed tomography or angiography are that postoperative complications of thoracic aortic aneurysm surgery can be reliably detected and visualized in 3 different planes. Non-invasiveness, the omission of ionizing radiation and no risk of contrast media application underline that magnetical resonance imaging is an ideal method for follow-up after operation of the thoracic aorta.

Aortic Dissection↗
PubMed1986

The potential of magnetic resonance imaging for the evaluation of thoracic arterial diseases.

Fifty-three patients with a variety of thoracic aortic or pulmonary arterial diseases were evaluated by magnetic resonance imaging to determine the potential of this new technique for the diagnosis of thoracic vascular disease. Direct visualization of the atherosclerotic plaques and demonstration of their precise location and extent was achieved by magnetic resonance imaging. The size and extent of the aneurysms and the presence of mural thrombus were demonstrated by magnetic resonance imaging. Magnetic resonance imaging identified the intimal flap and indicated the proximal extent of thoracic aortic dissection. Magnetic resonance imaging permitted direct visualization of thrombi and aneurysm of the pulmonary arteries. In conclusion, magnetic resonance imaging appears to be a totally noninvasive and reliable technique for demonstration of various pathologic processes involving the thoracic aorta and pulmonary arteries. Vascular imaging is achieved without the need for contrast media.

Adolescent↗
PubMed2006

Prognostic factors for long-term survival in patients with thoracic metastatic disease: a 10-year experience.

OBJECTIVE: To compare survival results after resection in patients with thoracic parenchymal metastatic disease versus non-parenchymal metastatic disease and to identify prognostic factors for survival. METHODS: From 1990 to 2002, we retrospectively studied 134 procedures performed on 93 patients (3-84 years old). There were 73 patients with parenchymal resection and 20 patients with non-parenchymal resection. Tumor histology was epithelial in 62 patients, sarcoma in 21 patients, and teratomas and melanoma in 6 and 4 patients, respectively. Sixty-five patients underwent a metastasectomy once, whereas 28 had their metastatic disease repeatedly resected. RESULTS: Follow-up was 100% complete with a mean time of 43 months (range 1-169). In-hospital mortality was 2.2% (3/134 procedures) and major morbidity 5.5%. Median survival was 39 months (95% CI: 21-56 months). Overall, the actuarial survival at 1, 3, and 5 years were 84%, 55%, and 44%, respectively. For the entire group, by univariate analysis, among the 13 predictor variables selected, only the number of metastases (Hazard Ratio (HR)=3.4 [95% CI: 1.9-6.1]) and completeness of resection (HR=2.3 [95% CI: 1.3-4.2]) were found to be significant for death whereas repeated metastasectomy was found to be a significant predictor for survival (HR=0.25 [95% CI: 0.12-0.55]). In the group of parenchymal metastatic disease, a size greater than 3cm was a predictor for death (HR=2 [95% CI: 1.1-3.7]). In the subgroup of patients with colorectal metastasis, bilateral disease was also found to be a significant predictor for death (HR=3.6, [95% CI: 1.2-11.1]). CONCLUSION: This study supports our current aggressive approach to metastatic thoracic disease. Indeed, patient's survival is improved while a low mortality and morbidity is achieved. The most beneficial impact on long-term survival is correlated to the completeness of the surgery whereas the increasing number and size of the metastasis inversely correlate with survival.

Adolescent↗
PubMed1996

Evaluation of thoracic aortic disease with the use of helical CT and multiplanar reconstructions: comparison with surgical findings.

PURPOSE: To assess the accuracy of helical computed tomography (CT) in differentiating different types of thoracic aortic disease, to determine the incremental value of multiplanar reconstructions, and to determine if helical CT could help to reliably predict the need for intraoperative hypothermic circulatory arrest. MATERIALS AND METHODS: Forty-nine patients underwent pre-operative helical CT with multiplanar reconstructions. Images were reviewed for type and location of pathologic lesions and for features that indicated the need for hypothermic circulatory arrest. The incremental yield of multiplanar reconstructions compared with that of axial images was assessed. Imaging findings were compared with surgical findings. RESULTS: The types of lesions present in the patients included 36 aneurysms (three were ruptured), six penetrating ulcers, five dissections, and two pseudoaneurysms. The accuracy of diagnosis was 92% (45 of 49 patients) with the use of CT (both with and without multiplanar reconstruction). The necessity of hypothermic circulatory arrest was successfully predicted in 94% (45 of 48 patients) of cases. CONCLUSION: Helical CT, both with and without the use of multiplanar reconstruction, enabled highly accurate differentiation among diseases of the thoracic aorta and prediction of the need for hypothermic circulatory arrest.

Aorta, Thoracic↗
PubMed2000

[Diagnosis and treatment of thoracic myelopathy due to degenerative thoracic spine disease].

OBJECTIVE: To summarize the experience in the early diagnosis and treatment of chronic thoracic myelopathy due to the compression of degenerative thoracic spine disease. METHODS: 21 patients with thoracic spinal stenosis were operated on from January 1995 to April 2000. Etiologically 16 patients were found to have ossification of the ligamentum flovum, 3 Scheuermann's disease, and 2 DISH. They were confirmed by CT, CTM, MRI and Magnetic MEP. Decompression was performed by en block unroof laminectomy for the posterolateral wall of the thoracic canal. The epstein criteria were used to judge the operative results. RESULTS: In the 21 patients 5 belonged to localized type, 10 continuous type, and 3 skip type in 21 cases. Three patients showed a compression from the anterior side, and 3 were complicated by OPLL of the cervical spine. Results were excellent in 4 patients, good in 8, improved in 2, and poor in 1. One patient was operated on two times because the extent of laminectomy was not enough for the first operation. CONCLUSIONS: Early diagnosis can be made if orthopedists are familiar with the clinical characteristics of thoracic myelopathy, and are alert to thoracic spine stenosis. En block unroof laminectomy is effective and safe to treat thoracic spine stenosis.

Adult↗
PubMed2000

Surgery for thoracic disc disease. Complication avoidance: overview and management.

The operative approach for discectomy in the treatment of thoracic disc disease has changed from standard laminectomy to a variety of dorsolateral and ventral approaches. The procedure-related complications have been reported in numerous clinical studies over the last seven decades: death, neurological deterioration, postoperative vertebral column instability, incomplete disc resection, cerebrospinal fluid leak and fistula, infection, misdiagnosis, pulmonary embolism, pneumonia, and intercostal neuralgia. The authors conducted a Medline search to identify series reporting clinical data related to thoracic discectomy. They analyzed the morbidity and mortality resulting from the various surgical approaches for thoracic disc disease, with special attention to the avoidance and management of surgery-related complications.

Diskectomy↗
PubMed1984

Thoracic disc disease. Clinical manifestations and surgical treatment.

Thoracic disc herniation in an uncommon spinal entity. The authors discuss three variations in the presentation of the disease and point out the importance of being able to recognize both the thoracic prolapsed disc and the symptomatic degenerated nonherniated disc. The seven cases that are reported demonstrate the unique presentations of this disease and the techniques for treatment. Utilization of the anterior transthoracic approach for the excision of the herniated disc is emphasized.

Female↗