Preventing mediastinal shift after pneumonectomy impairs regenerative alveolar tissue growth

2001 ◽  
Vol 281 (5) ◽  
pp. L1279-L1287 ◽  
Author(s):  
C. C. W. Hsia ◽  
E. Y. Wu ◽  
E. Wagner ◽  
E. R. Weibel
Keyword(s):  
Left Lung ◽  
Tissue Growth ◽  
Compensatory Response ◽  
Mechanical Lung ◽  
Surface Areas ◽  
Mediastinal Shift ◽  
Lung Expansion ◽  
Capillary Blood Volume ◽  
Lung Strain ◽  
The Right

To examine the effects of mechanical lung strain on regenerative growth of alveolar septal tissue after pneumonectomy (PNX), we replaced the right lungs of adult dogs with a custom-shaped inflatable silicone prosthesis. The prosthesis was either inflated (Inf) to maintain the mediastinum at the midline or deflated to allow mediastinal shift. The animals were euthanized ∼15 mo later, and the lungs were fixed at a constant distending pressure. With the Inf prostheses, lung expansion, alveolar septal tissue volumes, surface areas, and diffusing capacity of the tissue-plasma barrier were significantly lower than with the deflated prostheses; the expected post-PNX tissue responses were impaired by 30–60%. Capillary blood volume was significantly higher with Inf prostheses, consistent with microvascular congestion. Measurements in the Inf group remained consistently and significantly higher than those expected for a normal left lung, indicating persistence of partial compensation. In one dog, delayed deflation of the prosthesis 9–10 mo after PNX led to vigorous lung expansion and septal tissue growth, particularly of type II epithelial cells. We conclude that mechanical lung strain is a major signal for regenerative lung growth; however, other signals are also implicated, accounting for a significant fraction of the compensatory response to PNX.

Reducing lung strain after pneumonectomy impairs oxygen diffusing capacity but not ventilation-perfusion matching

2003 ◽  
Vol 95 (4) ◽  
pp. 1370-1378 ◽  
Author(s):  
Connie C. W. Hsia ◽  
Robert L. Johnson ◽  
Eugene Y. Wu ◽  
Aaron S. Estrera ◽  
Harrieth Wagner ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Gas Exchange ◽  
Mechanical Strain ◽  
Diffusing Capacity ◽  
Capillary Surfaces ◽  
Mean Pulmonary Arterial Pressure ◽  
Mediastinal Shift ◽  
Lung Strain ◽  
The Right ◽  
Hypoxic Exercise

After pneumonectomy (Pnx), mechanical strain on the remaining lung is an important signal for adaptation. To examine how mechanical lung strain alters gas exchange adaptation after Pnx, we replaced the right lung of adult dogs with a custom-shaped inflatable silicone prosthesis. The prosthesis was kept 1) inflated (Inf) to reduce mechanical strain of the remaining lung and maintain the mediastinum in the midline, or 2) deflated (Def) to allow lung strain and mediastinal shift. Gas exchange was studied 4-7 mo later at rest and during treadmill exercise by the multiple inert gas elimination technique while animals breathed 21 and 14% O2in balanced order. In the Inf group compared with Def group during hypoxic exercise, arterial O2saturation was lower and alveolar-arterial O2tension difference higher, whereas O2diffusing capacity was lower at any given cardiac output. Dispersion of the perfusion distribution was similar between groups at rest and during exercise. Dispersion of the ventilation distribution was lower in the Inf group at rest, associated with a much higher respiratory rate, but rose to similar levels in both groups during hypoxic exercise. Mean pulmonary arterial pressure at a given cardiac output was higher in the Inf group, whereas peak cardiac output was similar between groups. Thus creating lung strain by post-Pnx mediastinal shift primarily enhances diffusive gas exchange with only minor effects on ventilation-perfusion matching, consistent with the generation of additional alveolar-capillary surfaces but not conducting airways and blood vessels.

scholarly journals Fatal congenital lobar emphysema in a puerpera: a case report and literature review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fanyi Gan ◽  
Liang Xia ◽  
Yushang Yang ◽  
Qiang Pu ◽  
Lunxu Liu
Keyword(s):  
Left Lung ◽  
Middle Lobe ◽  
Left Hemithorax ◽  
Recurrent Pneumonia ◽  
Mediastinal Shift ◽  
Life Threatening ◽  
Right Middle Lobe ◽  
Lobar Emphysema ◽  
The Right

Abstract Background Congenital lobal emphysema (CLE) is a developmental lung abnormality usually diagnosed in the neonatal period and is rarely observed in adults. Adults with CLE are usually asymptomatic and only a small fraction may present with coughing, recurrent pneumonia and respiratory distress. In imaging studies, the most frequently affected lobe of CLE is the left upper lobe, followed by the right middle lobe. However, multilobar involvement with severe mediastinal shift is extremely rare. Case presentation We report a case of fatal CLE in a 28-year-old puerpera with postpartum respiratory failure. Chest computed tomography (CT) revealed emphysema of the right upper, middle and lower lobes resulting in adjacent atelectasis. Hyperinflation of the right upper lobe crossed the midline, leading to a deviation of the mediastinal structure to the left hemithorax and severe compression of the left lung. Conclusions Early and timely diagnosis of CLE with routine follow-up is necessary for patients. CLE, especially with multilobar involvement or mediastinal shift, could be life-threatening and should be promptly and aggressively treated to prevent severe complications.

Right lung agenesis in a one-year-old Chihuahua

2020 ◽  
Vol 8 (3) ◽  
pp. e001175
Author(s):  
Carlos Martinez ◽  
Conor Rowan
Keyword(s):  
Left Lung ◽  
Lung Parenchyma ◽  
Respiratory Pattern ◽  
Chest Drain ◽  
Mediastinal Shift ◽  
Lung Agenesis ◽  
Cardiac Silhouette ◽  
Digital Manipulation ◽  
One Year ◽  
The Right

A one-year-old neutered male Chihuahua was referred for further investigations of spontaneous pneumothorax. Before referral, thoracocentesis and chest drain placement was performed. On presentation, the dog was dull and dyspnoeic displaying a restrictive respiratory pattern. Thoracic radiography and CT findings performed at the referral centre were consistent with right lung agenesis and pneumothorax. Retrospective review of the radiographs obtained at the referring practice identified right-sided mediastinal shift, separation of the cardiac silhouette from the sternum and overinflated left lung lobes. Neither free intrathoracic gas nor subcutaneous emphysema was identified. The initial images were suboptimally displayed resulting in artefactual ‘blackening’ of the lung parenchyma, necessitating digital manipulation to identify lung markings. The combination of mediastinal shift and separation of the cardiac silhouette from the sternum as a result of the right lung agenesis could potentially lead to a false impression of pneumothorax.

scholarly journals Tension hydrothorax in a patient with SARS-CoV-2 pneumonitis and pleural Mycobacterium tuberculosis

2021 ◽  
Vol 14 (7) ◽  
pp. e243760
Author(s):  
Mohsin F Butt ◽  
Maggie Symonds ◽  
Ruhaid Khurram
Keyword(s):  
Emergency Department ◽  
Mycobacterium Tuberculosis ◽  
Pleural Effusion ◽  
Respiratory Distress ◽  
Chest Radiograph ◽  
Left Lung ◽  
Pleural Effusions ◽  
Mediastinal Shift ◽  
History Of ◽  
The Right

Unilateral pleural effusions are uncommonly reported in patients with SARS-CoV-2 pneumonitis. Herein, we report a case of a 42-year-old woman who presented to hospital with worsening dyspnoea on a background of a 2-week history of typical SARS-CoV-2 symptoms. On admission to the emergency department, the patient was severely hypoxic and hypotensive. A chest radiograph demonstrated a large left-sided pleural effusion with associated contralateral mediastinal shift (tension hydrothorax) and typical SARS-CoV-2 changes within the right lung. She was treated with thoracocentesis in which 2 L of serosanguinous, lymphocyte-rich fluid was drained from the left lung pleura. Following incubation, the pleural aspirate sample tested positive for Mycobacterium tuberculosis. This case demonstrates the need to exclude non-SARS-CoV-2-related causes of pleural effusions, particularly when patients present in an atypical manner, that is, with tension hydrothorax. Given the non-specific symptomatology of SARS-CoV-2 pneumonitis, this case illustrates the importance of excluding other causes of respiratory distress.

scholarly journals Gene expression profiling during increased fetal lung expansion identifies genes likely to regulate development of the distal airways

2006 ◽  
Vol 24 (2) ◽  
pp. 105-113 ◽  
Author(s):  
Foula Sozo ◽  
Megan J. Wallace ◽  
Valerie A. Zahra ◽  
Caitlin E. Filby ◽  
Stuart B. Hooper
Keyword(s):  
Lung Tissue ◽  
Control Level ◽  
Left Lung ◽  
Elongation Factor ◽  
Fetal Lung ◽  
Tissue Growth ◽  
Lung Growth ◽  
Fetal Sheep ◽  
Subtraction Hybridization ◽  
Lung Expansion

Growth and development of the fetal lungs is critically dependent on the degree to which the lungs are expanded by liquid; increases in fetal lung expansion accelerate lung growth, whereas reductions in lung expansion cause lung growth to cease. The mechanisms mediating expansion-induced lung growth are unknown but likely include alterations in the expression of genes that regulate lung cell proliferation. Our aim was to isolate and identify genes that are up- or downregulated by increased fetal lung expansion. In chronically catheterized fetal sheep at 126 days gestational age (GA), the left lung was expanded for 36 h, while the right lung remained at a control level of expansion. Subtraction hybridization was used to isolate genes differentially expressed between the left and right lungs. Screening of ∼6,000 clones identified 1,138 and 118 cDNA fragments that were up- and downregulated by increased lung expansion, respectively. Northern blot analyses in separate groups of control fetuses and fetuses exposed to increased lung expansion were used to verify differential expression. Increased fetal lung expansion upregulated heat shock protein 47, thrombospondin-1, TROP2, tropoelastin, and tubulin-α3 in fetal lung tissue by ∼200–300%; connective tissue growth factor and cysteine-rich angiogenic inducer 61 were increased by 20–30%. Genes downregulated by increased fetal lung expansion included CCSP-related protein-1, elongation factor-1α and vitamin D3 upregulated protein 1. We conclude that an increase in fetal lung expansion differentially regulates the expression of numerous genes in lung tissue, many of which have important putative roles in lung development, while the functions of others are currently unknown.

Regional lung growth following pneumonectomy assessed by computed tomography

2004 ◽  
Vol 97 (4) ◽  
pp. 1567-1574 ◽  
Author(s):  
Priya Ravikumar ◽  
Cuneyt Yilmaz ◽  
D. Merrill Dane ◽  
Robert L. Johnson ◽  
Aaron S. Estrera ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Mechanical Strain ◽  
Regional Distribution ◽  
Lower Lobe ◽  
Volume Density ◽  
High Resolution Computed Tomography ◽  
Compensatory Response ◽  
Morphometric Analyses ◽  
Lung Strain ◽  
The Right

After pneumonectomy (PNX), mechanical strain on the remaining lung is greatly increased. To assess whether remaining lobes expand uniformly after left or right PNX (removing 42 and 58% of lung mass, respectively), we performed high-resolution computed tomography (CT) scans at 45 ml/kg above end-expiratory lung volume on adult male foxhounds after left or right PNX, which were compared with adult Sham controls. Air and tissue volumes were separately measured in each lobe. After left PNX, air and tissue volumes in the right upper and cardiac lobes increased ∼2.2-fold above and below the heart, whereas volumes in right middle and lower lobes did not change significantly. After right PNX, air and tissue volumes in the left upper and middle lobes increased 2.3- to 2.7-fold across the midline anterior to the heart, whereas the left lower lobe expanded ∼1.9-fold posterior to the heart. Regional changes in volume density of tissue post-PNX estimated by CT scan parallel postmortem estimates by morphometric analyses. Data indicate heterogeneous regional distribution of mechanical lung strain, which could influence the differential cellular compensatory response following right and left PNX.

scholarly journals Separating in vivo mechanical stimuli for postpneumonectomy compensation: imaging and ultrastructural assessment

2013 ◽  
Vol 114 (8) ◽  
pp. 961-970 ◽  
Author(s):  
Priya Ravikumar ◽  
Cuneyt Yilmaz ◽  
Dennis. J. Bellotto ◽  
D. Merrill Dane ◽  
Aaron S. Estrera ◽  
...  
Keyword(s):  
Lung Volume ◽  
Ex Vivo ◽  
Left Lung ◽  
Mechanical Stimuli ◽  
Growth And Remodeling ◽  
High Resolution Computed Tomography ◽  
Surface Areas ◽  
Lung Expansion ◽  
Alveolar Tissue

Following right pneumonectomy (PNX), the remaining lung expands and its perfusion more than doubles. Tissue and microvascular mechanical stresses are putative stimuli for compensatory lung growth and remodeling, but their relative contribution remains uncertain. To temporally separate expansion- and perfusion-related stimuli, we replaced the right lung of adult dogs with a customized inflated prosthesis. Four months later, the prosthesis was either acutely deflated (DEF) or kept inflated (INF). Thoracic high-resolution computed tomography (HRCT) was performed pre- and post-PNX before and after prosthesis deflation. Lungs were fixed for morphometric analysis ∼12 mo post-PNX. The INF prosthesis prevented mediastinal shift and lateral lung expansion while allowing the remaining lung to expand 27–38% via caudal elongation, associated with reversible capillary congestion in dependent regions at low inflation and 40–60% increases in the volumes of alveolar sepal cells, matrix, and fibers. Delayed prosthesis deflation led to further significant increases in lung volume, alveolar tissue volumes, and alveolar-capillary surface areas. At postmortem, alveolar tissue volumes were 33% higher in the DEF than the INF group. Lateral expansion explains ∼65% of the total post-PNX increase in left lung volume assessed in vivo or ex vivo, ∼36% of the increase in HRCT-derived (tissue + microvascular blood) volume, ∼45% of the increase in ex vivo septal extravascular tissue volume, and 60% of the increase in gas exchange surface areas. This partition agrees with independent physiological measurements obtained in these animals. We conclude that in vivo signals related to lung expansion and perfusion contribute separately and nearly equally to post-PNX growth and remodeling.

CASE REPORT: SURGICAL MANAGEMENT OF LUMBAR COMPRESSION FRACTURE

2019 ◽  
Vol 1 (4) ◽  
Author(s):  
Yustinus Robby Budiman Gondowardojo ◽  
Tjokorda Gde Bagus Mahadewa
Keyword(s):  
Spinal Cord ◽  
Left Lung ◽  
Lumbar Vertebrae ◽  
Compression Fracture ◽  
High Mobility ◽  
Early Mobilization ◽  
Cord Injury ◽  
Cardiothoracic Surgeon ◽  
The Right

The lumbar vertebrae are the most common site for fracture incident because of its high mobility. The spinal cord injury usually happened as a result of a direct traumatic blow to the spine causing fractured and compressed spinal cord. A 38-year-old man presented with lumbar spine’s compression fracture at L2 level. In this patient, decompression laminectomy, stabilization, and fusion were done by posterior approach. The operation was successful, according to the X-Ray and patient’s early mobilization. Pneumothorax of the right lung and pleural effusion of the left lung occurred in this patient, so consultation was made to a cardiothoracic surgeon. Chest tube and WSD insertion were performed to treat the comorbidities. Although the patient had multiple trauma that threat a patient’s life, the management was done quickly, so the problems could be solved thus saving the patient’s life. After two months follow up, the patient could already walk and do daily activities independently.

RARE CASE OF NODULAR LYMPHOID HYPERPLASIA OF LEFT LUNG IN THE PATIENT WITH PREVIOUS PULMONARY TUBERCULOSIS

2018 ◽  
Vol 40 (4) ◽  
pp. 332-335
Author(s):  
P V Kuzyk ◽  
M A Savchyna ◽  
S G Gychka
Keyword(s):  
Pulmonary Tuberculosis ◽  
Lymphoproliferative Disorder ◽  
Clinical Laboratory ◽  
Left Lung ◽  
Lymphoid Hyperplasia ◽  
Morphological Examination ◽  
Nodular Lymphoid Hyperplasia ◽  
Lymph Nodes Dissection ◽  
The Right ◽  
Immunohistochemical Studies

Aim: To describe the case of rare benign lymphoproliferative disorder — pulmonary nodular lymphoid hyperplasia in the patient with previous pulmonary tuberculosis. Materials and Methods: In the case of pulmonary nodular lymphoid hyperplasia clinical, laboratory, instrumental and morphological examination was performed. Results: 44-year-old woman in 7 years after successfully treated infiltrative drug-susceptible tuberculosis of the right lung, was hospitalized with a suspected tumor of the left lung root. The patient underwent left-sided pneumonectomy with lymph nodes dissection. The results of histopathological and immunohistochemical studies evidenced on nodular lymphoid hyperplasia of the left lung. Conclusion: Pulmonary nodular lymphoid hyperplasia is a rare lymphoproliferative disorder of the lung with favorable prognosis. For the purpose of differential diagnosis, it is necessary to apply immunohistochemistry.

Survival case of acute and severe respiratory distress due to spontaneous tension gastrothorax

2020 ◽  
Vol 13 (9) ◽  
pp. e235281
Author(s):  
Sanjan Asanaru Kunju ◽  
Prithvishree Ravindra ◽  
Ramya Kumar Madabushi Vijay ◽  
Priya Pattath Sankaran
Keyword(s):  
Tension Pneumothorax ◽  
Emergency Laparotomy ◽  
Severe Respiratory Distress ◽  
Mediastinal Shift ◽  
Breath Sounds ◽  
Chest X Ray ◽  
The Right ◽  
Tension Gastrothorax ◽  
Obstructive Shock ◽  
Survival Case

A 20-year-old woman presented with abdominal pain and shortness of breath. She was in obstructive shock with absent breath sounds on the left haemithorax. Chest X-ray showed a large radiolucent shadow with absent lung markings and mediastinal shift to the right side with concerns for tension pneumothorax. Though tube thoracostomy was done on the left side of the chest, column movement was absent. To confirm the diagnosis CT with contrast was done that revealed a huge left side diaphragmatic defect with abdominal contents in the thorax and mediastinal structures are shifted to left. She underwent emergency laparotomy and postoperative period was uneventful.

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