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PubMed1983

The usefulness of chest radiographs in first asthma attacks.

To assess the value of routine chest radiography during acute first attacks of asthma, we studied 371 consecutive children over one year of age who presented with an initial episode of wheezing. Three hundred fifty children (94.3 per cent) had radiographic findings that were compatible with uncomplicated asthma and were considered negative. Twenty-one (5.7 per cent) had positive findings: atelectasis and pneumonia were noted in seven, segmental atelectasis in six, pneumonia in five, multiple areas of subsegmental atelectasis in two, and pneumomediastinum in one. The patients with positive films were more likely to have a respiratory rate above 60 or a pulse rate above 160 (P less than 0.001), localized rales or localized decreased breath sounds before treatment (P less than 0.01), and localized rales (P less than 0.005) and localized wheezing (P less than 0.02) after treatment; also, these patients were admitted to the hospital more often (P less than 0.001). Ninety-five per cent (20 of 21) of the children with positive films could be identified before treatment on the basis of a combination of tachypnea, tachycardia, fever, and localized rales or localized decreased breath sounds. Most first-time wheezers will not have positive radiographs; careful clinical evaluation should reveal which patients will have abnormal radiographs and will therefore benefit from the procedure.

Asthma↗

PubMed2003

Lung density distribution in dynamic CT correlates with oxygenation in ventilated pigs with lavage ARDS.

BACKGROUND: Fast dynamic computed tomography (dCT) has been used to assess regional dynamics of lung inflation and deflation processes. The aim of this study was to relate ventilation-induced changes in lung density distribution, as measured over several respiratory cycles by dCT, to oxygenation and shunt fraction in a lavage acute respiratory distress syndrome model. METHODS: Six anaesthetized pigs underwent pressure-constant ventilation (FIO2=1.0, inspiratory:expiratory ratio=1:1) before and after induction of lung damage by saline lavage. Mean airway pressure (Paw) was varied (8, 13, 18, 23, 28, 33, and 38 cm H2O) in random order. At each Paw level, dCT acquisitions were performed over several respiratory cycles (Somatom Plus4, Siemens; supradiaphragmatic transverse slice; thickness=1 mm; temporal resolution=100 ms). During scanning at each Paw, arterial and mixed venous blood were obtained for blood gas analysis and shunt calculation. In each CT image, fractional areas (FA) of defined density ranges representing ventilated lung and atelectasis were determined by planimetry using dedicated software. The FA data of individual 100 ms scans were averaged over several respiratory cycles, and expressed as mean FA in percentage of total lung area at each Paw. For atelectatic lung parenchyma a quantitative relationship of the respective mean FA to shunt fraction was studied using regression analysis. RESULTS: Under steady-state conditions, mean FA of atelectasis correlated linearly with the calculated shunt fraction (healthy lungs, r=+0.76; lavaged lungs, r=+0.89). There is a non-linear relationship between mean FA of ventilated lung parenchyma and mean FA of atelectasis with PaO2. CONCLUSIONS: We conclude that dCT allows assessment of the effects of ventilator adjustments and resultant Paw; changes upon lung aeration and oxygenation rapidly, and with good spatial and temporal resolution. This may benefit patients with acute lung injury, whose ventilatory pattern may be optimized as early as during their first diagnostic workup.

Animals↗

PubMed2003

Ceravital revisited: lessons to be learned.

OBJECTIVE: To report the long-term results in a series of ossiculoplasties using Ceravital prostheses. STUDY DESIGN: Retrospective case review. SETTING: District general hospital. PATIENTS: Ossiculoplasties using Ceravital prostheses were performed in 25 patients with a mean age of 39 years. Cholesteatoma was present in 9 cases and absent in 16 cases before surgery. The reconstruction was single stage in 23 cases and second stage in 2 cases. MAIN OUTCOME MEASURES: Hearing gain and prosthesis-related complications. The mean length of follow-up was 6 years 6 months. RESULTS: In the short term, the mean air-bone gap improved from 43 dB preoperatively to 24 dB 6 months postoperatively. In the long term, the results were as follows: good in 4 cases, absorption of the prosthesis in 9 cases, slippage of the prosthesis in 4 cases, extrusion of the prosthesis in 3 cases, atelectasis of the tympanic membrane in 2 cases, and unknown in 3 cases. The mean time for complications to become apparent was 6 years 4 months for absorption, 3 years 3 months for extrusion, 7 months for slippage, and 1 year 9 months for atelectasis. Revision surgery was performed on 11 of the 18 cases in which the results were poor. CONCLUSIONS: Ceravital prostheses highlight the potential complication of absorption of ossicular prostheses. Absorption takes much longer to become apparent than other complications such as extrusion, slippage, or atelectasis. The much higher rate of absorption in this series than in previous series with shorter follow-up times suggests that the rate of absorption increases significantly over time.

Absorption↗

PubMed2003

Prolonged middle ear ventilation with the cartilage shield T-tube tympanoplasty.

BACKGROUND: In 1994, the favorable experience with composite cartilage shield tympanoplasty was reported to the American Otological Society. On that occasion, the technical question regarding the concomitant placement of a ventilating tube was posed. In response, the authors proposed that the tympanostomy tube be incorporated in the cartilage graft. Moreover, they proposed that this marriage, when used to reverse atelectasis and to repneumatize the middle ear, should offer the advantage of both procedures while reducing the incidence of tube extrusion and other complications of prolonged intubation. Although attractive in theory, this supposition could be validated only after prolonged follow-up, reported here. OBJECTIVE: To describe an effective means to secure prolonged middle ear ventilation in a patient population prone to atelectasis and chronic middle ear effusion and to establish the incidence of favorable and unfavorable outcomes after 6 years of observation. STUDY DESIGN: Retrospective case series. SETTING: Tertiary referral center. PATIENTS: Forty patients (28 adults and 12 children) who underwent tympanic membrane reconstruction with a composite cartilage shield T-tube "unit."RESULTS The overall retention rate was 62.5% over 6 years. Sixty-five percent of retained tubes were maintained for a minimum of 4 years in adult patients. Extrusion and permanent perforation rates were 0%. CONCLUSION: The cartilage shield T-tube tympanoplasty can effectively reverse atelectasis and provide prolonged middle-ear ventilation. The technique can be used safely and minimizes the risk of tympanic membrane perforation and other complications associated with prolonged middle ear intubation.

Adolescent↗

PubMed2004

Effects of cyclic opening and closing at low- and high-volume ventilation on bronchoalveolar lavage cytokines.

OBJECTIVE: To examine the mechanisms of ventilator-induced lung injury at low and high lung volumes. DESIGN: Prospective, randomized, laboratory study. SETTING: University research laboratory. SUBJECTS: Eighty-eight adult male Sprague-Dawley rats. INTERVENTIONS: Mechanical ventilation using low and high lung volumes. MEASUREMENTS AND MAIN RESULTS: An ex vivo rat lung model was used. In study I (ventilation at low lung volumes), rat lungs (n = 40) were randomly assigned to various modes of ventilation: a) opening and closing with positive end-expiratory pressure (PEEP; control): tidal volume 7 mL/kg and PEEP 5 cm H2O; b) opening and closing from zero end-expiratory pressure (ZEEP): tidal volume 7 mL/kg and PEEP 0; or c) atelectasis. Peak inspiratory pressure was monitored at the beginning and end of 3 hrs of ventilation. At the end of 3 hrs of ventilation, the lungs were lavaged, and the concentrations of tumor necrosis factor-alpha, macrophage inflammatory protein-2, and interleukin-6 cytokines were measured in the lavage. In study II (ventilation at high volumes), rat lungs (n = 45) were randomly assigned to a) cyclic lung stretch: pressure-controlled ventilation, peak inspiratory pressure 50 cm H2O, and PEEP 8 cm H2O; b) continuous positive airway pressure at 50 cm H2O (CPAP50); or c) CPAP at the mean airway pressure of the cyclic stretch group (CPAP 31 cm H2O). Bronchoalveolar lavage cytokine concentrations (tumor necrosis factor-alpha, macrophage inflammatory protein-2, and interleukin-6) were measured at the end of 3 hrs of ventilation. In the low volume study, there was no difference in bronchoalveolar lavage cytokine concentrations between the PEEP group and the atelectatic group. All cytokines were significantly higher in the ZEEP group compared with the atelectasis group. Macrophage inflammatory protein-2 was significantly higher in the ZEEP group compared with the PEEP group. Lung compliance, as reflected by change in peak inspiratory pressure, was also significantly worse in the ZEEP compared with the PEEP group. In the high-volume study, tumor necrosis factor-alpha and interleukin-6 were significantly higher in the cyclic stretch group compared with the CPAP 31 group. There was no significant difference between the cytokine concentrations in the cyclic stretch group compared with the CPAP 50 group. CONCLUSION: We conclude that at low lung volumes, cyclic opening and closing from ZEEP leads to greater increases in bronchoalveolar lavage cytokines than atelectasis. With high-volume ventilation, over time, the degree of overdistension is more associated with increases in bronchoalveolar lavage cytokines than cyclic opening and closing alone.

Animals↗

PubMed1996

High dose rate brachytherapy for the local control of endobronchial carcinoma following external irradiation.

BACKGROUND: External irradiation is an established palliative treatment for patients with inoperable lung cancer. However, persistent or recurrent symptoms due to local disase are common following external irradiation. The impact of high dose rate (HDR) brachytherapy in the palliative management of patients with local sequelae of residual or recurrent endobronchial lung carcinoma following external irradiation was investigated. METHODS: A prospective cohort of 29 patients (19 men, mean age 65 years) underwent HDR brachytherapy for inoperable lung cancer. All patients had completed external irradiation at least one month before entry into the study (mean (SD) dose 4400 (1481) cGy, completed 12.9 (21.3) months previously). Patients underwent outpatient bronchoscopic placement of 1-3 HDR brachytherapy catheters for delivery of 750-1000 cGy of intraluminal irradiation every two weeks on 1-3 occasions. Prospective evaluation before and four weeks after completion of HDR brachytherapy included assessment of indices of level of function, symptoms, extent of atelectasis (chest radiography), and bronchoscopic determination of degree of endobronchial obstruction. RESULTS: One hundred and eighteen catheters were placed in 81 treatments. Eleven of the 26 patients who underwent repeat bronchoscopy showed a reduction in the degree of endobronchial obstruction; five of 18 patients had radiographic improvement in the extent of atelectasis. Positive response rates ranged from 25% for signs and symptoms related to pneumonitis to 69% for haemoptysis. Performance status improved in 24% of patients. Two patients died before completion of the study protocol. Short term complications included one episode of non-fatal, massive haemoptysis, five of minor haemoptysis, and one pneumothorax. CONCLUSIONS: HDR brachytherapy may improve the degree of endobronchial obstruction, atelectasis, symptoms, and level of function with minimal short term complications in patients with recurrent or residual symptomatic disease following external irradiation.

Adult↗

PubMed1983

Diaphragm function after upper abdominal surgery in humans.

Patients undergoing upper abdominal surgery characteristically develop changes in lung function and are liable to develop atelectasis in the lower lobes. We studied 15 patients to assess lung function and, in particular, diaphragm function in patients undergoing cholecystectomy. Postoperatively, forced expiratory volume in one second and vital capacity decreased in all patients. The alveolar-arterial oxygen difference widened in the 10 patients in whom it was measured. Chest roentgenograms demonstrated patchy atelectasis in 9 of the 10 patients in whom films were obtained. There was a significant reduction in tidal volume with no change in minute ventilation immediately postoperatively. Diaphragm function was assessed by: changes in transdiaphragmatic pressure swings during quiet tidal breathing, the ratio of changes in gastric to esophogeal pressure swings, and the ratio of changes in abdominal to rib cage diameters. The results showed a significant decrease in changes in transdiaphragmatic pressure and the ratio of changes in gastric to esophogeal pressure swings in the postoperative period. In the 4 patients studied with magnetometers, there was a reduction in the ratio of changes in abdominal to rib cage diameters in all patients. These data indicate reduced diaphragm activity in the postoperative period, with a shift from predominantly abdominal to rib cage breathing. There was a reversal toward normal function by 24 h. This reduction in diaphragm function may be responsible for the atelectasis, reduced vital capacity, and hypoxemia in postoperative patients.

Adult↗

PubMed2006

Fatal stroke after completion pneumonectomy for torsion of left upper lobe following left lower lobectomy.

BACKGROUND: The lobar torsion after lung surgery is a rare complication with an incidence of 0.09 to 0.4 %. It may occur after twisting of the bronchovascular pedicle of the remaining lobe after lobectomy, usually on the right side. The 180-degree rotation of the pedicle produces an acute obstruction of the lobar bronchus (atelectasis) and of the lobar vessels as well. Without prompt treatment it progresses to lobar ischemia, pulmonary infarction and finally fatal gangrene. CASE PRESENTATION: A 62 years old female patient was admitted for surgical treatment of lung cancer. She underwent elective left lower lobectomy for squamous cell carcinoma (pT2 N0). The operation was unremarkable, and the patient was extubated in the operating room. After eight hours the patient established decrease of pO(2) and chest x-ray showed atelectasis of the lower lobe. To establish diagnosis, bronchoscopy was performed, demonstrating obstructed left lobar bronchus. The patient was re-intubated, and admitted to the operating room where reopening of the thoracotomy was performed. Lobar torsion was diagnosed, with the diaphragmatic surface of the upper lobe facing in an anterosuperior orientation. A completion pneumonectomy was performed. At the end of the procedure the patient developed a right pupil dilatation, presumably due to a cerebral embolism. A subsequent brain angio-CT scan established the diagnosis. She died at the intensive care unit 26 days later. CONCLUSION: The thoracic surgeon should suspect this rare early postoperative complication after any thoracic operation in every patient with atelectasis of the neighboring lobe. High index of suspicion and prompt diagnosis may prevent catastrophic consequences, such as, infarction or gangrene of the pulmonary lobe. During thoracic operations, especially whenever the lung or lobe hilum is full mobilized, fixation of the remaining lobe may prevent this life threatening complication.

Fatal Outcome↗

PubMed1995

Pleural effusions in hospitalized patients receiving long-term hemodialysis.

OBJECTIVE: To determine the incidence, causes, and clinical features of pleural effusions in hospitalized patients receiving long-term hemodialysis. DESIGN: Retrospective. PARTICIPANTS: One hundred patients receiving hemodialysis for at least 3 months with pleural effusion hospitalized at the Medical University of South Carolina hospitals. RESULTS: The incidence of pleural effusions in hospitalized patients receiving long-term hemodialysis was 21%. The mean (+/- SEM) age was 55 +/- 1.4 years and the male to female and black to white ratios were 3:2. Pleural effusions resulted from heart failure in 46% and nonheart failure causes in 54%. Uremic pleurisy (n = 16), parapneumonic effusion (n = 15), and atelectasis (n = 11) accounted for most of the nonheart failure causes of pleural effusions. Three of 15 (20%) parapneumonic effusions were empyemas. The presence of chest pain was not different in patients with parapneumonic effusions than in other patients with nonheart failure effusion (all p = NS) but was more frequent compared to those with heart failure (p = 0.006). Patients with parapneumonic effusions (p = 0.0006) and atelectasis (p = 0.003) were more likely to have unilateral pleural effusions than patients with heart failure. CONCLUSIONS: Pleural effusions are common in hospitalized patients receiving chronic hemodialysis. Although heart failure was the most common cause, other diseases were responsible for most of the effusions. The presence of a unilateral effusion suggests a diagnosis other than heart failure, most commonly parapneumonic effusion or atelectasis and deserves prompt thoracentesis as these effusions often cannot be reliably differentiated clinically. The reduced humoral and cellular immunity, in addition to delay in diagnosis because of an attenuated clinical response, may explain the high rate of empyemas in this study population.

Analysis of Variance↗

PubMed2004

Resection of the right middle lobe and lingula in children for middle lobe/lingula syndrome.

STUDY OBJECTIVE: To review our experience with specific characteristics, indications, and results of pulmonary resection in children with middle lobe/lingula syndrome. DESIGN: Retrospective cohort study. SETTING: Thoracic Surgery Department, Chest Diseases Hospital, Kuwait. PATIENTS AND INTERVENTION: Thirteen children with middle lobe, lingula, or both syndromes were treated with pulmonary resection from January 1995 to December 1999. RESULTS: The mean age was 7.5 years (range, 5 to 10 years). Eight patients were girls, and five were boys. All patients underwent high-resolution CT and bronchoscopy. Bronchiectasis and atelectasis of right middle lobe, lingula, or both was noted in nine patients. Bronchial stenosis and inflammation of the bronchus was found endoscopically in four patients. The indications for surgery were recurrent respiratory tract infection with persistent atelectasis and bronchiectasis in nine patients, and recurrent respiratory tract infection with bronchiectasis in four patients. A right middle lobectomy was done on seven patients and a lingulectomy on four patients. Two patients underwent staged thoracotomies (right middle lobectomy and lingulectomy). There were no operative deaths. Only two patients had postoperative complications: atelectasis (n = 1), and pneumothorax (n = 1). Mean follow-up was 3.5 years (range, 3 to 5 years) for all patients. Nine patients were asymptomatic, and four patients had improved. CONCLUSION: Right middle lobe or lingula syndrome with the presence of bronchiectasis, bronchial stenosis, or failure of lung to re-expand are indications for early pulmonary resection.

Bronchiectasis↗

PubMed1975

[Physiopathology of accidental drowning].

The first phase of accidental drowning begins with asphyxia, due to either laryngospasm (10-15 percent of cases) or water aspiration. The second phase is characterized by water and electrolyte changes in the blood. The physiopathological modifications caused by drowning in fresh water differ from those of drowning in sea water. The hypotonic fresh water quickly diffuses in the bloodstream. The consequences are, in many cases, hypervolemia with pulmonary edema, hemolysis, hyperkalemia with risk of ventricular fibrillation, diminution of hemoglobin, and a relative decrease in plasma concentration of Na, Cl, Ca, and albumin. Further, inactivation and washing out of the anti-atelectasis factor from the alveoli by fresh water facilitate the formation of atelectasis. In cases of accidental drowing in sea water the osmotic gradient is in inverse: the electrolytes of aspirated salt water diffuse in the circulation, whereas the blood serum and the plasma albumin pass into the alveoli. Acute pulmonary edema often follows these pathological changes. Hypovolemia with circulatory collapse, hemoconcentration with rise in hemoglobin, hematocrit, sodium, potassium and albumin, and, finally, an elevated risk of thromboembolism due to increased blood viscosity, represent further complications. On the other hand, ventricular fibrillation is rare, hemolysis is absent and atelectasis usually does not occur.

Accidents↗

PubMed2001

[Relationship between flow volume curve and CT findings in non-smoking patients with long histories of bronchial asthma].

AIM: This study was conducted to verify whether bronchial asthma (BA) alone causes pulmonary emphysema (PE), and to examine the computed tomography (CT) findings in non-smokers with BA demonstrating the flow volume curve (FV curve) characteristic of PE. SUBJECTS AND METHODS: Non-smoking patients with a history of BA for more than 20 years were divided into 2 groups: the dogleg pattern group (n = 5), with an FV curve characteristic of PE, and the concave pattern group (n = 16) with an FV curve characteristic of BA. CT scans was performed using CT values (level, 900 H.U.; width, 400 H.U.) that facilitate detection of a low attenuation area (LAA), and using conventional CT values (level, 700 H.U.; width, 1,300 H.U.). LAA (including air trapping), thickness of the bronchial wall, and partial atelectasis were compared between the 2 groups. RESULTS: PE was not detected, although air trapping was found in all subjects. The thickness of the airway was greater in the dogleg pattern than in the concave pattern. The incidences of air trapping and partial atelectasis were higher in the former than in the latter. DISCUSSION: BA alone may not cause PE. Some BA patients without PE show the FV curve characteristic of PE, reflecting an increase in the thickness of the airway wall and a decrease in the pulmonary ventilation probably due to the air trapping and the partial atelectasis.

Aged↗

PubMed2003

[10-year experience in flexible bronchoscopy in pediatric patients].

BACKGROUND: Approximately a decade ago, pediatric Flexible Bronchoscopy (FB) was introduced in Chile, after being used for several years in adults. AIM: To describe our clinical experience in FB in a ten years period. PATIENTS AND METHODS: Records of procedures done between January 1993 and September 2002 at the Pediatric Service of the Catholic University Hospital, were retrospectively reviewed. We evaluated the clinical indications for the procedures in relation to patient's age and the correlation between indications and FB findings. RESULTS: A total of 700 procedures were performed during the period, 59% in men and 53% in patients younger than 1 year. Seventy seven percent of procedures were done in an examination room, using a nasal approach. The main indication was visualization of the airway (49%). The most common clinical diagnosis, in descending order were: atelectasis, stridor and etiologic study of pneumonia by bronchoalveolar lavage (BAL). In children younger than 6 months the most common clinical diagnosis was stridor, followed by atelectasis. The main diagnosis in the whole sample, reached by FB was atelectasis secondary to mucous plug. In children younger than 6 months, the main diagnosis was laryngomalacia. A positive microbial culture was obtained in 43% of patients in whom BAL was done. Complications were uncommon (5%) and mostly mild. In 2.3% of cases, these were severe, such as bronchospasm and need for mechanical ventilation. Severe complications were observed in patients younger than 3 months with severe stridor or in children with cancer, who required FB and BAL. CONCLUSIONS: Flexible bronchoscopy is a safe and useful procedure in pediatric patients.

Bronchoalveolar Lavage↗

PubMed2004

[A case of primary pulmonary leiomyosarcoma with history of pneumonia 5 years before].

A 35-year-old woman with past history of pneumonia in the right lung field 5 years before was admitted to our hospital because of fever and cough. Chest radiographs showed a pulmonary tumor with atelectasis of the right lower lung. Chest CT also revealed a round clear-edged tumor at the right S6 with atelectasis of the right lower lung lobe. Bronchoscopic findings showed a yellowish endobronchial tumor in the right truncus intermedius, which proved to be leiomyosarcoma. We could not find any other malignant lesion, and therefore, on a diagnosis of primary pulmonary leiomyosarcoma, right middle and lower lobectomy was performed with lymph node excision. Retrospective examination of the chest radiographs revealed not only that the original region of the leiomyosarcoma seemed to be near the site of the earlier pneumonia, but also that the atelectasis-like findings 2 years before were similar to the findings on this admission. It was reported that, if an operation could not be performed at an early stage, the prognosis might be poor. In the follow-up of the abnormal chest radiographic findings, the clinic physician should observe the symptoms from the same viewpoint as hospital doctors. It is important to keep an active relationship between clinic and hospital. We might have reached our final diagnosis earlier if we had been more active in seeking an examination for abnormal chest radiographic findings, without attaching too much importance to the patient's age.

Adult↗

PubMed1991

[SPECT images after intravenous injection of 99mTc-DTPA in lung tumors--comparison with delayed 123I-IMP lung scintigraphy].

The aim of this study was to assess the efficacy of SPECT imaging of the thorax with 99mTc-DTPA, which accumulates at sites of increased capillary permeability and expanded extracellular space, by comparing it with delayed 123I-IMP lung scintigraphy. We have previously reported that increased uptake on delayed 123I-IMP lung scintigraphy was associated with atelectasis and inflammation. Thirteen patients with lung cancer (4 with atelectasis and 3 with pleurisy), one patient with malignant lymphoma complicated by pneumonia and pleurisy, and one patient with pneumonia were studied. 99mTc-DTPA scintigraphy was performed twice, 20-160 minutes and 2-4 hours after the intravenous administration of 370 MBq of 99mTc-DTPA. 123I-IMP scintigraphy was performed 24 hours after the intravenous injection of 111 MBq of 123I-IMP. SPECT images were obtained with both types of scintigraphy. 99mTc-DTPA scintigraphy was compared with 123I-IMP scintigraphy for its ability to detect atelectasis and pneumonia. All patients showed increased accumulation corresponding to the lesions on both 123I-IMP and 99mTc-DTPA scintigraphy. 123I-IMP scintigraphy showed a defect corresponding to the tumor with increased accumulation around the tumor, whereas 99mTc-DTPA scintigraphy showed accumulation corresponding to the tumor. Ten of 11 tumors showed accumulation of an intensity equal to that of the soft tissue of the chest wall on 20-60 min 99mTc-DTPA images. The 2-4 hr images showed that 99mTc-DTPA leaked from the periphery of the tumor toward its center. All the patients with pleurisy showed increased accumulation in effusion on 2-4 hr 99mTc-DTPA scintigraphy.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1989

Ultrasonography in complete chest X-ray opacification of hemithorax.

To assess whether ultrasonography is valuable in the diagnosis and management of patients with complete chest X-ray opacification of hemithorax, chest ultrasonography was conducted in 65 patients. There were 54 patients (83.1%) with massive pleural effusion with or without other pathology, six (9.2%) with tumors, two (3.1%) with organized fibrothorax, two (3.1%) with consolidation or atelectasis and one (1.5%) with pseudocyst of the pleura in the sonographic diagnosis. Sonography differentiated effusion from tumor, consolidation and fibrosis. The effusion showed a hypoechoic area with floating fibrin strands and changed shape on respiration. The tumor revealed a homogeneous iso- or hypoechoic mass with a sharp margin. Consolidation or atelectasis showed a lobar or segmental area of heterogeneous isoechoic density with air-bronchogram. The pleural showed an area of hypoechoic density without floating fibrin or a changed shape on respiration. In 24 (37%) patients we could demonstrate complex pathology addition to the pleural effusion. Twenty-one patients had a hidden tumor beneath the effusion. Three patients had consolidation or atelectasis with effusion. In 13 patients, aspiration biopsy was performed under ultrasonic guidance from the tumor and the histological diagnosis was confirmed in 12 patients. We conclude that ultrasonography is a very useful, noninvasive tool in the differential diagnosis of complete chest X-ray opacification of hemithorax. Complex pathology is also easily detected by sonography. Sonographic findings can also be used as a guideline for an appropriate approach to the patient's management.

Adolescent↗

PubMed1989

Clinical use of differential lung ventilation in the treatment of asymmetric lung injury: report of a case.

Successful treatment of a 26-year-old male with asymmetric lung injury following a traffic accident is described. The patient was admitted with head injuries, right lung contusion, right pneumothorax, and multiple rib fractures (right 1-9). He developed a left pneumohemothorax and complete atelectasis of the lower lobe of the left lung two days later. Conventional mechanical ventilation with and without positive end-expiratory pressure (PEEP), supplemented by repeated therapeutic bronchoscopy, failed to reexpand the left lung. After 16 days of atelectasis, synchronized differential lung ventilation using a double lumen endobronchial tube connected to two ventilators (Siemens 900C) was instituted. Measurement of the tidal volume and static compliance of each lung showed marked inequality and 9 cm H2O of PEEP was applied selectively to the left lung (zero PEEP to the right) in an attempt to equalize tidal volumes. Evident improvement in blood gases and chest radiograph was obtained within 30 min but weaning back to a single lumen tube required 6 days, and was complicated by further episodes of atelectasis. Complete pulmonary and neurological recovery was obtained, and a normal chest radiograph was documented 3 months later. Differential ventilation proved simple to use, and highly effective in the management of this combination of lung problems.

Adult↗

PubMed1995

[Pulmonary tuberculosis in non-immunocompromised patients. Current radiologic features].

Sixty-four non-immunocompromised and adult patients with proved tuberculosis were examined. Twenty-three of them had bacteriologic confirmation with sputum examination, 7 with biopsy, 8 with bronchoscopy and bronchial lavage, 3 with pleural effusion examination and 3 with specific ex-juvantibus therapy. Fifteen patients had positive Mantoux skin tests. Thirty-nine patients had primary and 25 postprimary tuberculosis. All patients underwent chest radiography and 37 underwent also CT scans of the chest. The radiographic findings in primary tuberculosis were: 33 parenchymal consolidation patterns (in 24 patients), more frequent in the upper (20/33) than in the lower (13/33) lobes, with cavitations in 16 cases; 2 miliary patterns; 4 atelectasis cases; 4 intrathoracic adenopathies and 11 pleural effusions. The radiographic findings in postprimary tuberculosis were: 32 parenchymal consolidation patterns (in 19 patients), more frequent in the upper (27/32) than in the lower (5/32) lobes, with cavitations in 7 cases; 2 tuberculomas; 1 miliary pattern; 1 atelectasis; 5 pleural effusions and 1 pericardial effusion. Thus, we can conclude that in our series both primary and postprimary tuberculosis appear mostly as upper lobe consolidation, with cavitations especially in the primary form, often with pleural effusion and sometimes with intrathoracic adenopathies. Primary tuberculosis is most frequent in adult men. Finally, lower lobe consolidations or less typical radiographic patterns are observed, e.g., atelectasis, adenopathies or pleural effusion with no parenchymal changes, which can mimic other diseases and thus delay the diagnosis.

Adult↗