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At least 757 records · Page 42Linked to original sources
PubMed1978

Intrathoracic manifestations of Degos' disease (malignant atrophic papulosis).

Degos' disease (malignant atrophic papulosis) is a rare multisystemic disease with characteristic cutaneous lesions, abdominal symptoms and often rapidly fatal course. Our review of the reported intrathoracic involvement in the more than 60 reported cases of Degos' disease suggests that pleuritis and pericarditis are manifestations of the underlying pathophysiologic process. Seventeen of these reported cases were said to have intrathoracic lesions, which were, in most cases, incidental findings at autopsy. We present an illustrative report of a case in which chronic pleuritis and pericarditis were the major causes of morbidity in a 32-year-old woman with Degos' disease.

Adult↗
PubMed1979

Thoracoscopy. A safe, accurate diagnostic procedure using the rigid thoracoscope and local anesthesia.

A thoracoscopic examination was performed in 41 patients under local anesthesia in the lateral decubitus position. Prior thoracocentesis (38 patients) and blind biopsy with an Abrams' needle (32 patients) had been nondiagnostic. The initial nine patients were examined with the flexible fiberoptic bronchoscope, yielding a diagnostic accuracy of 56 percent (five cases). This technique was discontinued when two patients had normal findings on biopsies, despite the visual observation of later diagnosed carcinoma. Subsequent thoracoscopic procedures were performed with a rigid 11-mm single-puncture thoracoscope (Storz), which was diagnostic in 28 (88 percent) of the remaining 32 patients. A hemothorax (400 ml) was the only potentially serious complication. Twelve patients were prospectively monitored during the thoracoscopic procedure for changes in cardiac rhythm and oxygen saturation. Sinus tachycardia was the only arrhythmia observed. The mean fall in oxygen saturation was 1.4 percent. We conclude that thoracoscopic examination with the rigid thoracoscope is diagnostically superior to the fiberoptic bronchoscope and is a safe procedure which can be performed under local anesthesia.

Anesthesia, Local↗
PubMed1987

Familial bilateral paralysis of diaphragm. Adult onset.

At age 50 two homozygote twin brothers developed bilateral paralysis of the diaphragm. No infectious, metabolic, degenerative or proliferative disorders of the neuromuscular system and no thoracic diseases which could explain this lesion were detected during four years of follow-up. It appears thus to be an isolated lesion of genetic origin. To the best of our knowledge, no similar cases have been reported in literature.

Diaphragm↗
PubMed2006

Video assisted thoracoscopic surgery at the Queen Elizabeth Hospital Barbados.

Video assisted thoracoscopic surgery (VATS) is now an established technique for diagnostic and therapeutic intervention in patients with thoracic pathology at the Queen Elizabeth Hospital (QEH). This article reviews the experience with 50 patients over the period May 1996 to February 2003, looking at various factors and outcomes in an attempt to ascertain the viability of this procedure at this institution. It serves as a follow-up article to the publication of the initial experience in 1999 (1). There were 24 males and 26 females included in the study. Video assisted thoracoscopic surgery was used for diagnosis in 27 cases (54%), therapeutic indication in 17 cases (34%) and as both a diagnostic and therapeutic modality in six cases (12%). In 92% of cases, the operations were completed thoracoscopically with a conversion rate of 8%. The morbidity and mortality rates were 18% and 2% respectively. Video assisted thoracoscopic surgery is an effective tool for the treatment and investigation of selected thoracic pathology at the QEH with complications and mortality rates comparable to other institutions (2, 3).

Adult↗
PubMed1984

Sonographically guided needle biopsy for diagnosis of thoracic lesions.

Fluoroscopically guided percutaneous biopsy of thoracic lesions is widely accepted. However, some lesions are not sufficiently visible on fluoroscopy. When this is the case, sonographic guidance may be helpful. Real-time sonographically guided needle biopsy was performed in 38 such cases, including 27 pulmonary nodules adjacent to the chest wall, three mediastial tumors, five chest wall masses, and three pleural lesions. Definitive diagnoses were made in 30 cases (78.9%), including 21 (91.3%) of 23 malignancies and nine (60%) of 15 benign lesions. Sonographically guided needle biopsy could be performed safely and easily, taking advantage of the real-time monitoring of needle position for the pulmonary masses located adjacent to the chest wall, even when fluoroscopic or CT guidance was not effective. It is suitable for biopsying chest wall tumors, pleural lesions, and anterior mediastinal masses. It is particularly suited to biopsying small pulmonary nodules adjacent to the chest wall, nodules in the apical or juxtadiaphragmatic regions, and those obscured by pleural effusion.

Adult↗
PubMed1992

Diagnostic and therapeutic use of chest sonography: value in critically ill patients.

OBJECTIVE: Portable chest radiography, used for critically ill patients, often fails to depict thoracic disease clearly. Chest sonography allows good characterization of pleural diseases, mediastinal lesions, and pulmonary consolidations, and provides accurate and safe guidance for interventional procedures. Accordingly, we evaluated its usefulness in the diagnosis and management of critically ill patients. SUBJECTS AND METHODS: Sonography was used prospectively to evaluate 41 critically ill patients, when portable chest radiographs were difficult to interpret and failed to explain the clinical findings. An initial diagnosis was made on the basis of clinical and radiologic information. The final diagnosis was confirmed by thoracentesis (n = 15), image-guided aspiration biopsy (n = 7), surgery (n = 3), and clinical follow-up (n = 16). All 41 sonographic examinations were performed by a sonographer who had no knowledge of the initial diagnosis. The sonographic findings were recorded and analyzed. The usefulness of sonography in diagnosis and management was then evaluated according to the following criteria: diagnostic value--(1) made diagnosis, (2) changed diagnosis, (3) additional information, (4) no benefit; and management aid--(1) affected decision, (2) affected decision and guided thoracentesis, (3) affected diagnosis and guided aspiration, (4) no benefit. RESULTS: Chest sonography was helpful in diagnosis in 27 (66%) of 41 patients and in treatment in 37 (90%) of 41 patients. A significant influence on treatment planning occurred in 17 (41%) of 41 patients. A diagnostic aspiration biopsy under sonographic detected sonographically. Thoracentesis were attempted in 25 of 29 patients with pleural effusion and were successful in 24 patients (96%); a minimal pneumothorax developed in one patient (4%). CONCLUSION: Chest sonography is a useful diagnostic tool for critically ill patients with chest diseases. This technique can be particularly helpful when CT is not available or when critically ill patients cannot be moved.

Aortic Aneurysm↗
PubMed1999

Abnormalities of the chest wall in pediatric patients.

A variety of focal processes and diffuse abnormalities are found predominantly in children. In addition, thoracic manifestations of trauma differ in children because of increased chest wall compliance. Familiarity with both these abnormalities as well as the common normal variations provides optimal imaging evaluation.

Adolescent↗
PubMed2000

Using thoracic helical CT to assess iodine concentration in a small volume of nonionic contrast medium during vascular opacification: a prospective study.

OBJECTIVE: The goal of the study was to assess whether, using thoracic helical CT, diagnostic mediastinal and hilar vascular enhancement can be obtained with a small amount of nonionic contrast material (80 ml) injected at a relatively slow rate (2 ml/sec). SUBJECTS AND METHODS: One hundred twenty patients (60 in their fourth decade of life and 60 in their seventh decade of life) referred for contrast-enhanced thoracic CT for malignancies or infections prospectively entered the study. They were randomly assigned to be given one of three iodine concentrations of a nonionic contrast material: 250 mg/ml (1250), 300 mg/ml (1300), and 350 mg/ml (1350). Two radiologists independently graded perivenous artifacts and arterial enhancement of mediastinal and hilar vessels on a 4-point scale: 1, poor; 2, fair; 3, good; and 4, excellent. Measurements of arterial attenuation values (quantitative assessment) were obtained on the aorta and pulmonary artery. RESULTS: Mean scores were equal to or greater than 3 for all vessels only using 1350. The higher the iodine concentration was, the higher the mean score, but there was a statistically significant difference only between scores obtained with 1350 and those obtained with 1300 or 1250. Mean scores were higher for the patients in their seventh decade of life than those in their fourth decade; however, there was no statistically significant difference between scores of the two decade groups. We found a highly significant statistical relationship between scores and arterial attenuation values. CONCLUSION: During contrast-enhanced helical CT examinations for general thoracic evaluations, good opacification of central vascular structures is obtained with a low volume of high iodine concentration nonionic contrast medium.

Adult↗
PubMed2000

Differentiating normal from abnormal inferior thoracic paravertebral soft tissues on chest radiography in children.

OBJECTIVE: The purposes of this investigation were to define the normal appearances, define factors that have the potential to influence appearance, and establish defined criteria to differentiate normal from abnormal appearances of posteroinferior paravertebral soft tissues on chest radiography in children. SUBJECTS AND METHODS: Paravertebral soft tissues were evaluated on frontal chest radiographs in 23 children with documented abnormalities and 275 children without abnormalities in the region. The frequency of visualization, course, width, and factors (patient positioning, age, and sex) potentially influencing the appearance of paravertebral soft tissues were determined. Inferolateral course and width greater than that of the adjacent pedicle were evaluated as criteria for abnormality. RESULTS: Only 28% of the children without abnormalities had paravertebral soft tissues visualized, and the frequency of visualization directly increased with age (p = 0.001). For identification of abnormal cases on the left side, width greater than the adjacent pedicle had a sensitivity of 100% and a specificity of 98%, and inferolateral course had a sensitivity of 86% and a specificity of 95%. Visualization on the right side (n = 5) was always abnormal. Six normal cases had a width greater than that of the adjacent pedicle on the left side on initial radiographs obtained with supine positioning and met normal criteria on repeated radiographs with upright positioning. CONCLUSION: Width greater than the adjacent pedicle is the best radiographic criterion for differentiation of abnormal from normal left-sided paravertebral soft tissues, particularly on radiographs obtained with upright positioning. Identifiable right-sided paravertebral soft tissue is always abnormal. These criteria are useful aids in determining the need for additional imaging, such as CT.

Adolescent↗
PubMed2000

Lung lobe torsion in dogs: 22 cases (1981-1999).

OBJECTIVE: To identify breed disposition, postoperative complications, and outcome in dogs with lung lobe torsion. DESIGN: Retrospective study. ANIMALS: 22 client-owned dogs. PROCEDURE: Information on signalment; history; clinical findings; results of clinicopathologic testing, diagnostic imaging, and pleural fluid analysis; surgical treatment; intra- and postoperative complications; histologic findings; and outcome were obtained from medical records. RESULTS: All 22 dogs had pleural effusion; dyspnea was the most common reason for examination. Fifteen dogs were large deep-chested breeds; 5 were toy breeds. Afghan Hounds were overrepresented, compared with the hospital population. One dog was euthanatized without treatment; the remaining dogs underwent exploratory thoracotomy and lung lobectomy. Eleven dogs recovered from surgery without complications, but 3 of these later died of thoracic disease. Four dogs survived to discharge but had clinically important complications within 2 months, including chylothorax, mediastinal mesothelioma, gastric dilatation, and a second lung lobe torsion. Six dogs died or were euthanatized within 2 weeks after surgery because of acute respiratory distress syndrome, pneumonia, septic shock, pneumothorax, or chylothorax. Chylothorax was diagnosed in 8 of the 22 dogs, including 4 Afghan Hounds. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that lung lobe torsion is rare in dogs and develops most frequently in large deep-chested dogs, particularly Afghan Hounds. Other predisposing causes were not identified, but an association with chylothorax was evident, especially in Afghan Hounds. Prognosis for dogs with lung lobe torsion was fair to guarded.

Animals↗