Visualization of the inferoposterior thoracic wall (VIP) and boomerang signs-novel sonographic signs of right pleural effusion

Abstract CASE DESCRIPTION A 5-year-old spayed female domestic shorthair cat was evaluated because of an acute onset of dyspnea and open-mouthed breathing. CLINICAL FINDINGS Thoracic radiography revealed pleural effusion and signs consistent with restrictive pleuritis, and results of preoperative CT were consistent with diffuse, severe restrictive pleuritis, bilateral pleural effusion, and pulmonary atelectasis. Thoracocentesis yielded a red, turbid fluid that was identified as chylous effusion with chronic inflammation. TREATMENT AND OUTCOME Exploratory thoracotomy revealed diffuse, severe fibrous adhesions between the mediastinum, heart, lung lobes, and thoracic wall, with a thick fibrous capsule enveloping all lung lobes. Surgical treatment consisted of complete pleural decortication, pericardiectomy, and thoracic omentalization. The cat remained hospitalized for 6 days, receiving oxygen supplementation, multimodal analgesia, and supportive care. Long-term home care consisted of prednisolone administration, rutin supplementation, and provision of a low-fat diet. At recheck examinations 3-, 7-, and 20-weeks postoperatively, the cat remained tachypneic, but was otherwise clinically normal without dyspnea or respiratory distress. Follow-up thoracic radiography revealed improved pulmonary expansion, decreased pleural effusion, and resolved pneumothorax. CLINICAL RELEVANCE Surgical management of fibrosing pleuritis secondary to idiopathic chylothorax in cats has historically resulted in poor outcomes. This report details the first successful use of complete decortication in the surgical management of severe fibrosing pleuritis in a cat.

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THE PASSAGE OF A FOREIGN BODY (FOXTAIL) THROUGH THE BRONCHUS, LUNG, PLEURA, AND THORACIC WALL

PEDIATRICS ◽

10.1542/peds.1.2.210 ◽

1948 ◽

Vol 1 (2) ◽

pp. 210-213

Author(s):

M. M. SEHRING ◽

E. B. SHAW

Keyword(s):

Foreign Body ◽

Pleural Effusion ◽

Lower Lobe ◽

Intercostal Space ◽

Thoracic Wall ◽

Sixth Intercostal Space ◽

Rapid Regression

The case is presented of a four-year-old boy who ingested a foxtail 5 cm. long. Within 24 hours this produced evidences of right lower lobe pneumonia, the fever responded to sulfathiazole and to penicillin, and the foxtail was removed 14 days after ingestion from a subcutaneous abscess located in the mid-axillary line in the sixth intercostal space. There was rapid regression of the pneumonic signs and evidences of pleural effusion or exudation were lacking. The child recovered without any persistent evidences of intrathoracic damage.

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Ultrasonographyin diagnosis of thoracic diseases

Medicinski pregled ◽

10.2298/mpns1002086s ◽

2010 ◽

Vol 63 (1-2) ◽

pp. 86-90 ◽

Cited By ~ 1

Author(s):

Ruza Stevic ◽

Radoslav Jakovic ◽

Dragan Masulovic ◽

Ljudmila Nagorni-Obradovic ◽

Natasa Mujovic ◽

...

Keyword(s):

Pleural Effusion ◽

Thoracic Wall ◽

Large Tumor ◽

Lung Lesions ◽

Tumor Mass ◽

Pleural Diseases ◽

Pleural Thickening ◽

Thoracic Diseases ◽

Chest Disease ◽

Peripheral Lung

Introduction. Chest sonography was used until recently mainly for diagnosis of pleural diseases. High resolution ultrasound machines enable ultrasound application not only in pleural diseases detection, but in diagnosing peripheral lung and mediastinal lesions. Ultrasonography can define the origin and structure of the lesion of thoracic wall, pleural and peripheral lung lesions and mediastinal lesions. Pleural lesions. Ultrasonography is very useful in diagnosing pleural effusion and distinguishing pleural fluid and pleural thickening. This method can also differentiate transudate from exudates and tumor mass from pleural thickening. Lung lesions. Ultrasonography can reveal the cause of white hemithorax differentiating pleural effusion from large tumor mass or atelectasis. Peripheral pulmonary lesions, extending into visceral pleura can be visualized by ultrasonography and differentiation solid tumor from inflammation is possible. Mediastinal lesions. Computerized tomography and magnetic resonance are methods of choice in diagnosing mediastinal diseases. Ultrasonography is useful in distinguishing normal thymus from tumor mass and for ultras onographyguided biopsy. Conclusion. Ultrasonography is a very useful second line method in diagnosis of chest disease. The advantages of this method include bed side availability, absence of radiation, and guided aspiration of fluid-filled areas and solid tumors.

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Investigating the Role of Open Lung Biopsy in Diagnosing the Type of Chronic Lung Disease in Children

American Journal of Surgical Case Reports ◽

10.31487/j.ajscr.2020.03.09 ◽

2020 ◽

pp. 1-6

Author(s):

Ashjaei Bahar ◽

Modaresi Mohammadreza ◽

Amiri Shakiba ◽

Najdi Fatemeh ◽

...

Keyword(s):

Side Effects ◽

Pleural Effusion ◽

Lung Disease ◽

Chronic Lung Disease ◽

Lung Biopsy ◽

Medical Center ◽

Open Lung Biopsy ◽

Thoracic Wall ◽

Open Lung ◽

Chronic Pulmonary Diseases

Objective: This study was conducted for the practical use of biopsy in the diagnosis of chronic lung disease and the guidance of risks and benefits. Design of Study: We studied 64 children with chronic lung disease who underwent open lung biopsy in 5 years at the Children's Medical Center . Results: Biopsy results were diagnostic in 57 cases (89.1%) and non-diagnostic in 7 cases (10.9%). The biopsy determined the type of mass in all cases where a possible diagnosis of lung mass or thoracic wall was made. In 37 cases (57.8%) the diagnosis was changed and the exact diagnosis was determined. The main side effects (including pneumothorax, hemothorax, pyothorax, and pleural effusion) were 50% (32 cases), the most common of which were pneumothorax and pleural effusion, with a total of more than 87% of these major complications. 22 patients (34.4%) required intubation. 24 patients (37.5%) were admitted to the ICU after surgery. The death occurred in only one case, who was a 3-month-old boy with a disorder of INR and suffering from acute respiratory distress syndrome. There was no mortality that could be directly related to surgery. Conclusion: Open lung biopsy is a gold standard for the histological diagnosis of chronic pulmonary disease in children and plays an important role in the treatment of children with chronic pulmonary diseases. However, serious and common side effects of this method should be considered

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