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At least 1,153 records · Page 64Linked to original sources
PubMed2004

[Interdisciplinary surgery of the thorax-from the general surgeon's point of view].

Interdisciplinary professional management is the most important basic principle for successfully mastering thoracic operations including the thoracic wall and adjacent regions such as neck, axilla, mediastinal vessels, upper limb, and spine. Extended oncological resection in advanced malignant diseases, side-effects of radiotherapy and trauma explain the diversity of possible operative procedures. For technical success, the necessity of vascular grafting, reconstruction of the brachial plexus, spine surgery, cardiac surgery, plastic thoracic wall reconstruction, stabilization of the thoracic wall, modern equipment, and know-how are mandatory. We chose some show-cases which-in our opinion-might be appropriate for demonstrating interdisciplinary therapy management. Functional, oncological, and cosmetic/reconstructive aspects should be considered when approaching these cases.

Humans↗
PubMed2004

[Interdiscplinarity in thorax operations-from the viewpoint of the surgeon].

Occasionally, thoracic interventions may require interdisciplinary teamwork with plastic surgery, heart and vascular surgery, or neurosurgery. Thoracic wall defects following excision of primary wall tumors or recurrent, ulcerating tumors of the breast may require full-thickness myocutaneous flaps, which can best be done with the help of plastic surgeons. In case of infiltration of the heart or thoracic aorta, the en bloc principle of T4 lung tumors occasionally requires the help of heart surgeons, for open atrial resection using the heart-lung machine, or vascular surgeons for aortic graft interposition. Paravertebral dumbbell tumors occasionally may infiltrate to the intraspinal space and therefore need removal by neurosurgeons. When and why other specialists are required for an interdisciplinary approach to diseases of the chest has not been clearly defined. Therefore it is wise to gain informed consent from the patient about the roles of different specialists in interdisciplinary treatment for his disease.

Aged↗
PubMed2006

[Unstable thorax after a coughing fit in a 70-year-old adipose patient].

Lung herniation is uncommon and has been defined as the protrusion of pulmonary tissue and pleural membranes through defects of the thoracic wall. In combination with rib fractures caused by single massive coughing fit, spontaneous lung herniation has previously been reported only three times. To our knowledge, in combination with multiple rib fractures and flail chest, as in the case presented, it has never been reported. Large lung hernias should be treated with prosthetic patches because of unlikely spontaneous recovery and the risk of incarceration. In our case, an anterolateral thoracotomy was performed. After resection of the herniated pleural membrane, a 30 x 30-cm polypropylene mesh was fixed to the diaphragm and with nonresorbable pericostal sutures to the thoracic wall. With this procedure, the loss in stability caused by the ruptured anterior intercostal muscular system could be restored. The postoperative course was uneventful, and the patient was dismissed on day 12.

Aged↗
PubMed2006

[The value of thoracoscopy in thorax trauma].

A hemodynamically stable patient presenting with persistent bleeding through his chest tube (ICD) is a classic indication for early thoracoscopic intervention in trauma. The source of bleeding and air leaks can be identified and often treated: bleeding and perforated pulmonary segments can be resected, and chest wall bleeding may be coagulated or sutured. Injuries to the diaphragm are difficult to diagnose, as they might not be seen in conventional trauma imaging without gross herniation of intra-abdominal contents into the thoracic cavity. Identifying the site of diaphragm perforation can give useful hints in thoracoabdominal trauma, identifying injured cavities and localizing the bullet or stab tract. Most often, diaphragmatic defects may be closed during diagnostic thoracoscopy as well. Non- or partially drainable hemothorax is another indication for thoracoscopy. Coagulated blood can be mechanically mobilised, and aspirated or primary bleeding may be stopped. Effective lavage and a high-performance suction device are required. Correct placement of the drainage is part of optimized therapy, along with inspection of all intrathoracic organs and surfaces. Furthermore, surgical and anaesthesiological teamwork and experience are prerequisites for the fast, professional application of a minimally invasive thoracoscopic approach in chest trauma patients. Diagnostically and theurapeutically, thoracoscopy plays an important role in the trauma setting--in the case of hemodynamically stable patients.

Empyema, Pleural↗
PubMed2003

[Digital thorax radiography: flat-panel detector or storage phosphor plates].

Flat panel detectors are characterized by improved handling and increased dose efficiency. This allows for increasing of work flow efficiency and for reducing the exposure dose by about 50% compared to current systems with a sensitivity of 400. Whether the increased dose efficiency should be used to reduce acquisition dose or to increase image quality in the chest, will be shown by further clinical experience and will be also determined by the subjective preference of the radiologists. The decreased level of image noise opens new perspectives for image processing that way that elaborated multifrequency processing allows for optimizing the display of very small and low contrast structures that was so far limited by overlying image noise. Specialized applications of dual energy subtraction and temporal subtraction will also profit by the new detector technology and will be further driven forward in context with applications such as computed assisted diagnosis even though this is currently not yet broadly applied. Storage phosphor radiography still represents an important alternative technique based on its larger flexibility with respect to equipment configuration, its broader application options in intensive care and emergency radiology and due to economic reasons. These facts are further underlined by the fact that image quality also in storage phosphor radiography could be constantly increased by improving detector technology and image processing and consequently has a high standard.

Artifacts↗
PubMed2005

[Conventional thorax diagnostics in neonates and children].

Advances in neonatal medicine have led to an increasing number of premature infant patients and to an improved survival rate of these children. Chest X-rays of premature infants, newborns, and older children with respiratory difficulties provide information leading to diagnosis and help decide on further clinical management. Diagnostic findings and their appreciation by the radiologist require knowledge of the specific anatomy of the infant chest, and also of common diseases in early and later childhood, congenital or acquired. Radiologic findings in pediatric patients may differ significantly from those in adults. Close collaboration between the neonatologist and radiologist is essential for reaching the right diagnosis.

Child↗
PubMed1996

[Low dose computerized tomography of the thorax. Experimental and clinical studies].

INTRODUCTION: Computed tomography is a significant source of medical radiation exposure for populations in Europe. Reduced radiation exposure may be possible with modern CT scanners with an image quality that while less good than before remains acceptable for clinical purposes. The lung appears particularly well suited to investigation with low-dose CT owing to the high contrast between normal and diseased pulmonary parenchyma. METHODS: We analysed the diagnostic accuracy of different low-dose CT protocols for the detection of pulmonary nodules using inflation-fixed isolated postmortem lung specimens in a chest phantom. In a comparative patient study diagnostic accuracies of standard-dose CT (120 kV, 250 mAs; slice thickness 10 mm, pitch 1) and low-dose CT (120 or 140 kV, 50 mAs; slice thickness 5 or 10 mm, pitch 1 or 2) were assessed. RESULTS: Preliminary results suggest that low-dose CT protocols with radiation exposure of 10-20% of that with standard-dose CT an reliably depict soft tissue density pulmonary nodules with a diameter of more than 5 mm and can also demonstrate smaller nodules equally well is many cases. CONCLUSIONS: Low-dose CT may frequently be an adequate imaging procedure in a given clinical setting, particularly in young patients with benign disease.

Humans↗
PubMed1996

[Radiation exposure in low dose computerized tomography of the thorax].

Computed tomography accounts for a high percentage of the populations exposure to radiation. Every possible means of reducing patient exposure must be considered. Exposure reduction will be most appropriate for organs with large absorption differences, since the accompanying decrease in signal-to-noise ratio will have a smaller effect. It has been shown in the literature that high-contrast details in the lung can be depicted, even with the lowest exposure rates. Therefore, experimental data are presented by means of thermoluminescence dosimetry and calculations using conversion factors to determine the technical parameters to be adopted for achieving the effective equivalent dose close to that of a conventional chest X-ray in two projections. With helical CT (pitch 2, 50 mAs, 120 kV, 5-mm slice thickness) it was possible to reduce the equivalent dose from 9.6 mSv to 0.6 mSv, which is comparable with the exposure in a conventional chest X-ray, measured to be 0.2 mSv.

Equipment Design↗
PubMed1998

[Radiation exposure during CT examination of thorax and abdomen. Comparison of sequential, spiral and electron beam computed tomography].

Comparison of radiation exposure applied by different types of CT scanners for the investigation of the chest and abdomen. Determination of radiation exposure applied by multi-phase spiral CT. Estimation of the dose in air in the system axis of the scanner, the CT dose index (CTDI) and the effective dose for electron beam tomography (EBT) and two conventional CT scanners (sequence, SEQ; spiral, SCT). For EBT, dose in system axis for investigation of the abdomen was above 50 mGy. Effective dose for investigation of the chest and abdomen was higher with EBT (11 and 26 mSv, respectively) than with conventional CT (SEQ, 4 and 20 mSv; SCT, 2 and 7 mSv). The effective dose for a biphasic investigation (liver 5 mSv, kidney 4 mSv) was below, for a triphasic investigation (liver 7 mSv) above the effective dose of the investigation of the abdomen (6 mSv). Investigation of the abdomen with the EBT should only be performed for certain indications. With spiral CT, effective dose is much lower than with EBT.

Abdomen↗
PubMed1999

[Imaging of the thorax with multislice spiral CT].

With multislice spiral computed tomography (MSCT), existing indications for performing CT of the chest are strengthened and new applications are emerging. The high speed of MSCT improves efficiency, image quality and patient comfort of "routine" imaging of the chest. The ability to cover large volumes with thin slices improves the evaluation of mediastinal lymph nodes and pulmonary nodules and allows for high-quality secondary reconstruction. If a comprehensive diagnosis of the mediastinal structures and the pulmonary parenchyma is desired, MSCT for the first time allows reconstruction of contiguous and high-resolution (HRCT) sections from the same set of thin-collimation raw data. This way, contiguous chest images of superior and HRCT sections of equal image quality compared to conventional CT scanning can be obtained. Vascular protocols greatly benefit from the high speed of MSCT: For imaging the thoracic aorta or pulmonary emboli (PE), the amount of contrast material can be substantially reduced. Owing to thin collimation, the detection rate of small peripheral emboli can be significantly increased. If indicated, the entire subphrenic venous system can be evaluated during the same session, without additional contrast material.

Adult↗
PubMed2001

[New developments in MRI of the thorax].

MRI was not used often for lung imaging due to technical and physical limitations. Recent developments have considerably improved anatomical MR imaging, and at the same time new perspectives for functional imaging emerged. They consist of functional investigations of pulmonary perfusion (contrast agents, MR angiography) and ventilation (inhaled contrast aerosols, oxygen, hyperpolarized noble gases [He-3, Xe-129] and fluorinated gases [SF6]). New parameters can be measured: homogeneity of ventilation, lung volumes, airspace size, intrapulmonary oxygen partial pressure, dynamic ventilation distribution and ventilation/perfusion ratios. MRI-inherent advantages are: lack of radiation, high spatial and temporal resolution, and a broad range of functional information. MRI of lung ventilation seems to be more sensitive in the detection of ventilation defects than scintigraphy, CT or pulmonary function tests. By combining the new strategies the radiologist will be capable to improve specificity of the investigations and to characterize lung function impairments. The joint assessment of ventilation and perfusion will play a major role in this development.

Contrast Media↗
PubMed1997

Gorham syndrome of the thorax and cervical spine: CT and MRI findings.

Gorham syndrome is a rare disorder that is characterized by local osseous invasion and surrounding soft tissues by an angiomatous mass, eventually causing lysis of the affected bone. To date, only four cases have reported the MR imaging appearance of this disease and the findings have been variable. We present a case involving the cervical and thoracic spine and part of the osseous hemithorax with attention to the MR findings.

Angiomatosis↗
PubMed2002

PET-CT image co-registration in the thorax: influence of respiration.

Because anatomical information on fluorine-18 fluorodeoxyglucose (FDG) whole-body positron emission tomography (PET) images is limited, combination with structural imaging is often important. In principle, software co-registration of PET and computed tomography (CT) data or dual-modality imaging using a combined PET-CT camera has an important role to play, since "hardware-co-registered" images are thereby made available. A major unanswered question is under which breathing protocol the respiration level in the CT images of a patient will best match the PET images, which represent summed images over many breathing cycles. To address this issue, 28 tumour patients undergoing routine FDG PET examinations were included in this study. In ten patients, PET and CT were performed using a new combined high-performance in-line PET-CT camera without the need for repositioning of the patient, while in 18 patients imaging was performed on separate scanners located close to each other. CT was performed at four respiration levels: free breathing (FB), maximal inspiration (MaxInsp), maximal expiration (MaxExp) and normal expiration (NormExp). The following distances were measured: (a) between a reference point taken to be the anterior superior edge of intervertebral disc space T10-11 and the apex of the lung, (b) from the apex of the lung to the top of the diaphragm, (c) from the apex of the lung to the costo-diaphragmatic recess and (d) from the reference point to the lateral thoracic wall. Differences between CT and corresponding PET images in respect of these distances were compared. In addition, for each of 15 lung tumours in 12 patients, changes in tumour position between PET and CT using the same protocol were measured. CT during NormExp showed the best fit with PET, followed by CT during FB. The mean differences in movement of the diaphragmatic dome on CT during NormExp, FB, MaxInsp and MaxExp, as compared with its level on PET scan, were, respectively, 0.4 mm (SD 11.7), -11.6 mm (13.3), -44.4 mm (25.5) and -9.5 mm (25.6). CT acquired in MaxExp and MaxInsp is not suitable for image co-registration owing to the poor match of images in MaxInsp and because of difficulties with patient performance in MaxExp. With reference to lung lesions, NormExp showed the best results, with a higher probability of a good match and a smaller range of measured values in comparison with FB. Image misregistration in combined PET-CT imaging can be minimized to dimensions comparable to the spatial resolution of modern PET scanners. For PET-CT image co-registration, the use of a normal expiration breath-hold protocol for CT acquisition is recommended, independent of whether combined PET-CT systems or stand-alone systems are used.

Adult↗
PubMed2002

Low-dose multislice CT of the thorax in follow-up of malignant lymphoma and extrapulmonary primary tumors.

Our objective was to study the impact of low-dose multislice thoracic CT on image quality and lesion conspicuity in follow-up of patients with malignant lymphoma and extrapulmonary primary tumors. Forty consecutive patients with a history of malignant lymphoma or extrapulmonary malignant primaries who had undergone previous standard-dose thoracic spiral CT (120 kVp, 150 mAs, 8 mm) were subjected to low-dose multislice CT (15 mAs/rotation, 120 kVp, pitch 1.5, 4x2-mm collimation reconstructed to contiguous 8-mm slices. Image quality and lesion conspicuity were classified independently by two readers on a four-point ordinal scale (1=poor, 4=excellent). Mean image quality was significantly lower for low-dose CT, 2.35, than for standard-dose CT, 3.25 ( p<0.001); however, all low-dose CT examinations were fully readable, none had to be repeated, and no lesions (including 51 lung lesions and 31 soft tissue lesions) remained undetected. Only in the apical lung did the lowered tube current significantly reduce lesion conspicuity. Even in pulmonary lesions smaller than 10 mm ( n=21) lesion conspicuity did not significantly differ between standard and low-dose scans. Low-dose thoracic multislice CT based on a 90% reduction in dose compared with standard-dose techniques was not associated with impaired detection of suspicious lesions and may be useful in follow-up of malignant lymphoma and extrapulmonary tumors.

Female↗
PubMed2006

Coronary imaging quality in routine ECG-gated multidetector CT examinations of the entire thorax: preliminary experience with a 64-slice CT system in 133 patients.

To evaluate image quality in the assessment of the coronary arteries during routine ECG-gated multidetector CT (MDCT) of the chest. One hundred and thirty three patients in sinus rhythm underwent an ECG-gated CT angiographic examination of the entire chest without beta-blockers with a 64-slice CT system. In 127 patients (95%), it was possible to assess the coronary arteries partially or totally; coronary artery imaging failed in six patients (5%), leading to a detailed description of the coronary arteries in 127 patients. Considering ten coronary artery segments per patient, 75% of coronary segments were assessable (948/1270 segments). When the distal segments were excluded from the analysis (i.e., seven coronary segments evaluated per patient), the percentage of assessable segments was 86% (768/889 proximal and mid coronary segments) and reached 93% (474/508) when assessing proximal segments exclusively. The mean number of assessable segments was significantly higher in patients with a heart rate < or =80 bpm (n=95) than in patients with a heart rate >80 bpm (n=38) (p<0.002). Proximal and mid-coronary segments can be adequately assessed during a whole-chest ECG-gated CT angiographic examination without administration of beta-blockers in patients with a heart rate below 80 bpm.

Adolescent↗
PubMed1997

Vascular intervention in the thorax: bronchial artery embolization for haemoptysis.

Massive haemoptysis is defined as the expectoration of more than 600 mls of blood in 48 h. Many patients are not surgical candidates because of the presence of severe bilateral pulmonary disease and these individuals are best managed by bronchial artery embolization. Occlusion of both the bronchial arteries and hypertrophied non-bronchial systemic arteries is essential if bleeding is to be controlled. A pulmonary arterial source of haemorrhage is uncommon but should always be considered in a patient who has further haemoptyses shortly after a technically successful embolization of bronchial and non-bronchial systemic arteries. The immediate control of haemorrhage is achieved in the majority of patients although subsequent rebleeding on longterm follow-up is not uncommon.

Bronchial Arteries↗