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Ultrasound examination of lesions in the thorax.

Thirty-five patients with intrathoracic lesions were examined once or several times during one year with B-scan grey scale ultrasound. The difference between encapsulated fluid, organized exudate or empyema and solid tumor is discussed, as is the procedure of the examination and the possibility of using ultrasound for diagnostic punctures.

Diagnosis, Differential↗

An atypical lymphoma of T-cell lineage in the thorax of an aged cow.

An aged beef cow was presented for signs of thoracic disease. A complete clinical and diagnostic workup suggested neoplasia. Postmortem examination revealed a lymphoma of T-cell lineage confined solely to the thoracic cavity, predominantly in lung tissue. The diagnosis was based on light and electron microscopy, immunohistochemistry, and negative bovine leukemia virus and bovine immunodeficiency virus results.

Animals↗

Common and specific inhibitory motor neurons innervate the intersegmental muscles in the locust thorax.

The inhibitory innervation of the intersegmental (body wall) muscles between the first and the second thoracic segment of the migratory locust, Locusta migratoria, was investigated using neuroanatomical, immunocytochemical and electrophysiological techniques. Three neurons located in the prothoracic ganglion show GABA-like immunoreactivity and project into the intersegmental nerve. Two are common inhibitors. One of those innervates the oblique intersegmental muscle M59 and two dorsal longitudinal muscles (M81 and M82). The second common inhibitor also innervates M59 and the ventral longitudinal muscle M60. The third neuron innervates M60 exclusively and, for that reason, has to be regarded as the first specific inhibitor ever observed in insect neuromuscular assemblies. According to their innervation pattern, we term these neurons CI(59/60), CI(59/81/82), and SI(60). CI(59/81/82) and CI(59/60) appear to be segmentally homologous to CI(a) and CI(b) neurons, respectively, in the other body segments.

Animals↗

Cone-beam CT angiography of the thorax: an experimental study.

The authors recently developed a cone-beam computed tomography (CT) scanner and this report presents their evaluation of its potential for thoracic vascular imaging. An X-ray tube and a video-fluoroscopic system were rotated around the objects and 360 projected images were collected in a 12-s scan. Each image was digitized and a 3 dimensional (D) image (256x256x256 voxel volume with a voxel dimension of 0.9x0.9x0.9 mm) was reconstructed. Two different 3D-CT angiographies were investigated in 2 pigs: right atriography and thoracic aortography. Each pig was anesthetized, mechanically ventilated and positioned within the scanner. Contrast agent was infused through the right atrium or the aortic root at a rate of 3 ml/s during the scan. The right atriography scan clearly delineated the anatomy of the pulmonary artery, heart chambers and thoracic aorta. The thoracic aortography scan also clearly delineated the aortic anatomy including the internal thoracic and intercostal arteries. In conclusion, cone-beam CT angiography is potentially useful for thoracic vascular imaging.

Angiography↗

A palmar dermatosis linked to occult carcinoma of the upper thorax, head and neck: Bazex's syndrome and tripe palm.

An unusual, persistent, corregated-to-honeycombed thickening of the palms accompanied by tenderness around the fingernails was found to be a cutaneous marker for internal malignancy. This combination of signs and symptoms has been reported under two clinical entities: Bazex's syndrome and tripe palm. This paraneoplastic syndrome is of interest to head and neck surgeons due to the location of the primary tumor, the site of metastatic disease, and the ability to cure the cutaneous disease by surgical removal of the primary tumor. In our patient, a squamous cell carcinoma of the lung not detectable on chest x-ray presented as a cervical mass accompanied by cutaneous changes on the palms and fingernails. Recognition of the relationship of the dermatologic changes to malignancy of a specific body region eventually led to the detection of the primary tumor. The characteristics of these paraneoplastic syndromes were reviewed in this report.

Aged↗

Empyema of the thorax in adults. Etiology, microbiologic findings, and management.

The etiology, microbiologic findings, and management of 82 episodes of empyema treated by our unit over a period of 6 years were analyzed. Average patient age was 54 years. Eighty-two percent had underlying disease such as alcoholism (29 percent), malignancy (23 percent), and diabetes mellitus (20 percent). Sixty (73 percent) had an empyema develop secondary to a bronchopulmonary infection. Other etiologies were as follows: infradiaphragmatic sepsis, five cases; iatrogenic, ten cases; and idiopathic, seven cases. Cultures were positive in 76 cases and negative in the remaining 6 (2 positive Gram stains, 1 positive under bacilloscopy, and 3 were sterile). Anaerobes were isolated from 25 and aerobes from 47 of the positive cultures. A single bacteria was isolated from 43 and multiple organisms (average: 2.63/case) grew on the remaining 33 positive cultures. Length of hospitalization averaged 37 days. Seven patients received antibiotics only, thoracentesis was performed on three, intercostal chest tube drainage was required in 72, and more aggressive surgery was performed on 12 patients (7 with fibrothorax and 5 with pneumonectomy). Streptokinase was instilled into the pleural space of eight patients with good results. Pleural drainage superinfection occurred at a rate of 8.5 percent. Nine patients died; the remaining recovered. Only three deaths came about as a direct result of the empyema.

Adult↗

Silicone thorax due to a ruptured breast implant.

A woman with a history of bilateral mastectomy and silicone implants for fibrocystic disease and a history of atrial septal defect repair presented with pleural nodules on a chest radiograph. A thorascopic biopsy performed for possible mesothelioma demonstrated chronic inflammation and focal pleural fibrosis due to a foreign-body reaction secondary to silicone. This was confirmed using scanning electron microscopy and energy-dispersive radiograph elemental analysis. As the population ages, the increasing frequency of ruptured silicone implants and the need for heart surgery may result in a corresponding increase in the risk for fibrothorax secondary to inadvertent silicone introduction during surgery.

Breast Implants↗