Anterior chest wall abscess in a 29 year old woman.
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A patient with a myofascial pain-dysfunction (MPD) syndrome with pain radiating into the chest has been described. A direct relationship between a dental malocclusion and the chest pain was confirmed by tests. The patient was treated for MPD syndrome related to the malocclusion, and the chest pain symptoms were relieved. This report demonstrates the need for the dentist to consider not only the muscles of mastication in the management of problems of the neuromuscular apparatus but also the delicate balance which exists between the masticatory apparatus and the postural muscles of the head and neck.
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This article presents endoscopic evaluation of the pleural cavity, or thoracoscopy, an effective diagnostic technique that can be employed to provide additional diagnostic information in cases of intrathoracic disease. The techniques of thoracoscopy are described, and normal and abnormal findings are discussed. Thoracoscopy allows visual examination of the pleural space and surrounding structures without surgical exploration. The stress, expense, morbidity, and mortality of thoracoscopy are far less than those of thoracotomy. Disease for which thoracoscopy has been employed diagnostically include primary and metastatic neoplasia, hilar lymphadenopathy, pericardial effusion, spontaneous pneumothorax, and diaphragmatic hernia. Therapeutically, thoracoscopy has been used for drainage of pericardial effusion.
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To evaluate the value of ultrasound (US)-guided core-needle biopsy (CNB) for peripheral intrathoracic and mediastinal lesions. Fourteen patients who had intrathoracic or mediastinal lesions underwent US-guided CNB with 17- or 18-gauge needles. The lesions in this study were seven cases of lung carcinomas including four cases of adenocarcinomas and three cases of squamous cell carcinomas, two cases of thymomas, and one case each of aspergillosis, sarcoidosis, MFH, lung abscess, and lung fibrosis. Diagnosis was possible in 13 of 14 (92.8%) cases histologically. There were three cases of complication (21.4%); one case each of pneumothorax, pleuritis, and hemosputum. They were all cured with medication. We concluded that real-time US-guided CNB is a useful and safe method for the examination of peripheral intrathoracic and mediastinal lesions.
BACKGROUND CONTEXT: Endoscopic techniques have been used since 1993 to treat thoracic disk disease. Thorascopic techniques evolved into means of treating not only disk disease but also correcting thoracic spinal deformity with instrumentation and fusion. PURPOSE: To evaluate the efficacy of endoscopic instrumentation, correction, and fusion of thoracic idiopathic scoliosis. STUDY DESIGN: A retrospective review of 50 patients who have undergone endoscopic instrumentation, correction, and fusion for scoliosis. PATIENT SAMPLE: Fifty consecutive patients undergoing treatment for primary thoracic idiopathic scoliosis. OUTCOME MEASURES: Evaluation of operative time, curve correction, and fusion rates were evaluated. METHODS: Fifty patients with the diagnosis of primary thoracic scoliosis underwent thoracoscopic techniques of instrumentation, correction, and fusion. On follow-up, the patients were evaluated for spinal alignment restoration, axial derotation, postoperative pain, rehabilitative time, and complications. RESULTS: The initial curve correction averaged 50%, improving to over 68% in the last 10 cases. Hypokyphosis correction averaged 21 degrees. Additionally, there has been a decrease in rehabilitation time, less time off work or school, and decreased blood loss and postoperative pain. There were 14 complications and no deaths recorded. The factors involved in a successful fusion include total diskectomy, complete cartilaginous end plate removal, and autogenous bone graft. CONCLUSIONS: The initial results of the thoracoscopic-assisted techniques for primary thoracic scoliosis are promising. As with most evolving techniques, surgical times are decreasing and rates of correction are improving.
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BACKGROUND: Cohorts born at different times of year differ in their risk of exposure to seasonal respiratory infections in early life, but are likely to have similar socioeconomic status and lifestyle thereafter. METHODS: We investigated the long-term consequences of acute chest illness in infancy for later development of chronic respiratory disease by analysing variations by month of birth in hospital admissions for respiratory illness (total n = 49,866), chronic respiratory symptoms and ventilatory function among British school children (n = 11,482) and middle-aged adults (total n = 55,829). RESULTS: Admission for bronchiolitis in the first year of life was three times more common for infants born September to November (autumn) than those born March to May, yet people born in the autumn experienced fewer respiratory symptoms and had better ventilatory function. In two surveys of middle-aged men, forced expiratory volume in one second/forced ventilatory capacity (FEV1/FVC) was significantly (P = 0.025) higher among autumn births. Hospital admissions for chronic bronchitis/emphysema and pneumonia varied little with season of birth. Admissions for asthma were significantly (P < 0.05) more common among children and young adults born in the autumn. CONCLUSIONS: These findings do not support the hypothesis of a causal link between chest illness in infancy and the later development of chronic bronchitis and emphysema. The variation in asthma admissions with month of birth deserves further investigation.
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PURPOSE: The goal of this work was to describe the clinical and imaging features of thoracopancreatic fistula, a rare complication of pancreatitis. METHOD: Nine cases of thoracopancreatic fistula proved by thoracentesis, endoscopic retrograde cholangiopancreatography (ERCP), or surgery were retrospectively and independently reviewed by two abdominal radiologists. All available imaging examinations [chest radiographs = 9, CT = 9, MR and MR cholangiopancreatography (MRCP) = 2, and ERCP = 6] were analyzed, and findings were recorded on a standardized datasheet. Available medical records (n = 7) were reviewed to determine the clinical presentation of the patients and thoracentesis results. RESULTS: Seven of the nine patients presented with pulmonary symptoms such as dyspnea or cough. Of the seven patients with pleural fluid analysis, all demonstrated elevated amylase levels (mean 13,007 U/L). Imaging examinations revealed pancreaticopleural fistulas in six patients, a mediastinal pseudocyst in one patient, and both a pancreaticopleural fistula and a mediastinal pseudocyst in two patients. Chest radiography showed pleural fluid collections in eight patients. CT demonstrated a fluid-containing fistula in all nine patients. MR and MRCP depicted a fistula extending from the abdomen to the pleural space in the two patients with MR correlation. ERCP showed pancreatic ductal changes characteristic of chronic pancreatitis in the six patients with ERCP correlation but failed to demonstrate the fistula in two of the six patients. CONCLUSION: The CT, MR, MRCP, or ERCP finding of a fluid-filled tract extending from the pancreas to the thorax is characteristic of a thoracopancreatic fistula, particularly when identified in a patient who presents with pulmonary symptoms and a history of chronic pancreatitis.
Computed tomography and magnetic resonance imaging are now commonly performed for a variety of pulmonary and mediastinal lesions. However, some of the lesions that affect these areas also involve the chest wall. These include tumors, infections, trauma, and congenital processes. In such cases, a knowledge of chest wall anatomy combined with careful analysis of cross-sectional images is necessary to make the diagnosis. This article describes the basic cross-sectional anatomy of the chest wall and the principal pathologic chest wall lesions.