Difference in accuracy of lung sliding identification between the right and left hemithorax

Abstract Background During COVID-19 pandemic, optimization of the diagnostic resources is essential. Lung Ultrasound (LUS) is a rapid, easy-to-perform, low cost tool which allows bedside investigation of patients with COVID-19 pneumonia. We aimed to investigate the typical ultrasound patterns of COVID-19 pneumonia and their evolution at different stages of the disease. Methods We performed LUS in twenty-eight consecutive COVID-19 patients at both admission to and discharge from one of the Padua University Hospital Intensive Care Units (ICU). LUS was performed using a low frequency probe on six different areas per each hemithorax. A specific pattern for each area was assigned, depending on the prevalence of A-lines (A), non-coalescent B-lines (B1), coalescent B-lines (B2), consolidations (C). A LUS score (LUSS) was calculated after assigning to each area a defined pattern. Results Out of 28 patients, 18 survived, were stabilized and then referred to other units. The prevalence of C pattern was 58.9% on admission and 61.3% at discharge. Type B2 (19.3%) and B1 (6.5%) patterns were found in 25.8% of the videos recorded on admission and 27.1% (17.3% B2; 9.8% B1) on discharge. The A pattern was prevalent in the anterosuperior regions and was present in 15.2% of videos on admission and 11.6% at discharge. The median LUSS on admission was 27.5 [21–32.25], while on discharge was 31 [17.5–32.75] and 30.5 [27–32.75] in respectively survived and non-survived patients. On admission the median LUSS was equally distributed on the right hemithorax (13; 10.75–16) and the left hemithorax (15; 10.75–17). Conclusions LUS collected in COVID-19 patients with acute respiratory failure at ICU admission and discharge appears to be characterized by predominantly lateral and posterior non-translobar C pattern and B2 pattern. The calculated LUSS remained elevated at discharge without significant difference from admission in both groups of survived and non-survived patients.

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Abstract 12430: Vicious Circle Between Progressive Right Ventricular Dilatation and Pulmonary Regurgitation in Patients After Tetralogy of Fallot Repair? Right Heart Enlargement Promotes Flow Reversal in the Left Pulmonary Artery

Circulation ◽

10.1161/circ.132.suppl_3.12430 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Atsuko Kato ◽

Christian Drolet ◽

Shi-Joon Yoo ◽

Andrew Redington ◽

Lars Grosse-Wortmann

Keyword(s):

Pulmonary Artery ◽

Tetralogy Of Fallot ◽

Left Lung ◽

Pulmonary Regurgitation ◽

Left Pulmonary Artery ◽

Flow Reversal ◽

Left Hemithorax ◽

Forward Flow ◽

Lung Area ◽

The Right

Introduction: The left pulmonary artery (LPA) contributes more than the right (RPA) to total pulmonary regurgitation (PR) in patients after tetralogy of Fallot (TOF) repair, but the mechanism of this difference is not well known. We hypothesized that unilaterally increased pulmonary vascular resistance (PVR), resulting from lung compression by the enlarged and levorotated heart leads to greater PR in the LPA. This study aimed to analyze the interplay between heart and lung size, mediastinal geometry, and differential PR. Methods: This is a single-center retrospective analysis of 50 magnetic resonance studies in patients after TOF repair. Patients with more than mild discrete branch pulmonary artery stenosis were excluded. Blood flow was measured by phase-contrast velocity encoding within the branch pulmonary arteries. On the axial image with the largest total cardiac surface area, cardiac angle (α) between the thoracic anterior-posterior line and the interventricular septum, right and left lung areas as well as right and left hemithorax areas were measured (Figure). Results: There was no difference in LPA and RPA diameters. The LPA showed significantly less total forward flow (p=0.04), smaller net forward flow (p=<0.001), and greater RF (p=0.001) than the RPA. Left lung area was smaller than the right (p<0.001). RVEDVi correlated with LPA RF (R=0.48, p<0.001), but not with RPA RF. Larger RVEDVi correlated with a larger α angle (R=0.46, p<0.001), i.e. a more leftward cardiac axis and with smaller left lung area (R=-0.58, p<0.001). LPA RF, but not RPA RF, correlated inversely with left lung area indexed to the left hemithorax area (R=-0.34, p=0.02). Conclusions: An enlarged and levorotated heart - as a result of PR - is associated with smaller left lung size, and augments diastolic flow reversal in the LPA, presumably via increased left PVR. By imposing a further volume load on the RV, LPA regurgitation may thus close a positive feed-back loop of PR and RV dilatation.

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Comorbidity between Klinefelter syndrome and diaphragmatic hernia. A case report

Sao Paulo Medical Journal ◽

10.1590/1516-3180.2014.1325737 ◽

2014 ◽

Vol 132 (5) ◽

pp. 311-313

Author(s):

Carolina Melendez Valdez ◽

Stephan Philip Leonhardt Altmayer ◽

Adyr Eduardo Virmond Faria ◽

Aline Weiss ◽

Jorge Alberto Bianchi Telles ◽

...

Keyword(s):

Diaphragmatic Hernia ◽

Ultrasound Examination ◽

Klinefelter Syndrome ◽

Age Groups ◽

Left Lung ◽

Left Lobe ◽

Imaging Studies ◽

Left Hemithorax ◽

Prenatal Imaging ◽

The Right

CONTEXT: Intrathoracic cystic lesions have been diagnosed in a wide variety of age groups, and the increasing use of prenatal imaging studies has allowed detection of these defects even in utero.CASE REPORT: A 17-year-old pregnant woman in her second gestation, at 23 weeks of pregnancy, presented an ultrasound with evidence of a cystic anechoic image in the fet al left hemithorax. A morphological ultrasound examination performed at the hospital found that this cystic image measured 3.7 cm x 2.1 cm x 1.6 cm. Polyhydramnios was also present. At this time, the hypothesis of cystic adenomatoid malformation was raised. Fet al echocardiography showed only a dextroposed heart. Fet al magnetic resonance imaging produced an image compatible with a left diaphragmatic hernia containing the stomach and at least the first and second portions of the duodenum, left lobe of the liver, spleen, small intestine segments and portions of the colon. The stomach was greatly distended and the heart was shifted to the right. There was severe volume reduction of the left lung. Fet al karyotyping showed the chromosomal constitution of 47,XXY, compatible with Klinefelter syndrome. In our review of the literature, we found only one case of association between Klinefelter syndrome and diaphragmatic hernia.CONCLUSIONS: We believe that the association observed in this case was merely coincidental, since both conditions are relatively common. The chance of both events occurring simultaneously is estimated to be 1 in 1.5 million births.

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A rare cause of respiratory insufficiency: case presentation

Open Medicine ◽

10.2478/s11536-013-0258-2 ◽

2014 ◽

Vol 9 (1) ◽

pp. 141-143

Author(s):

Camelia Diaconu ◽

Bianca Paraschiv ◽

Răzvan Lungu ◽

Daniela Bartoş

Keyword(s):

Respiratory Failure ◽

Left Lung ◽

Condensation Process ◽

Acid Base Balance ◽

Hypoxemic Respiratory Failure ◽

Acute Hypoxemic Respiratory Failure ◽

Left Hemithorax ◽

Breath Sounds ◽

Base Balance ◽

The Right

AbstractWe report the case of a 73 year old woman who presented for progressive dyspnea. Her medical history included thyroidectomy 15 years ago, myocardial infarction, recurrent paroxysmal atrial fibrillation and femoral fracture two weeks previously, conservatively treated. Physical examination revealed absent breath sounds in the left hemithorax, up to the apex, and crackles in the right hemithorax. The acid-base balance showed acute hypoxemic respiratory failure. The chest X-Ray revealed left diaphragmatic paralysis. Thoracic CT-scan was performed, which excluded the pulmonary embolism and revealed left diaphragmatic relaxation, ascension of the splenic angle of the colon, stomach and spleen up to the projection of left lung hilum, and right postero-basal alveolar condensation process. Diaphragm dysfunction can be caused by various disorders, including phrenic paralysis. This pathology should be considered in the differential diagnosis of acute respiratory failure.

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

BMC Pulmonary Medicine ◽

10.1186/s12890-021-01787-x ◽

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.

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Heteropagus Twins with Hepatobiliary and Gastrointestinal Connectedness and Complex Cardiac Malformation in Autosite

University of Western Ontario Medical Journal ◽

10.5206/uwomj.v87is1.4857 ◽

2019 ◽

Author(s):

Aaron Teel ◽

Benjamin Kwan ◽

Mousumi Bhaduri

Keyword(s):

Management Plan ◽

Conjoined Twins ◽

Left Hemithorax ◽

Prenatal Mri ◽

Parasitic Twin ◽

Prenatal Imaging ◽

Supernumerary Limbs ◽

The Right ◽

Incomplete Cleavage ◽

Embryonic Death

Introduction: Heteropagus twins are a set of conjoined twins with one being grossly abnormal, the ‘parasite’, and the other being relatively normal, the ‘autosite’. Case Report: A pair of heteropagus twins were initially identified on prenatal ultrasound and subsequently confirmed using prenatal MRI at 25 weeks gestational age. Prenatal imaging identified supernumerary limbs, accessory small bowel loops in the parasitic twin, a hypoplastic left heart in the right hemithorax of the autosite, and a shared liver and bowel between the two. Delivery occurred at 38 + 5 weeks gestation via C-section with an APGAR score of 9/9 for the autosite at both 1 and 5 minutes. MRI confirmed an interconnected autosite-parasite liver that was herniating into the left hemithorax as well as continuous autosite-parasite bowel loops. The patient underwent surgical management including resection of the parasitic twin and repair of the congenital heart defect and is now thriving. Discussion: Heteropagus twins include a spectrum of clinical entities from nonconjoined twins to intact conjoined twins. The predominant theory regarding etiology is an incomplete cleavage of a monozygotic embryo at approximately 2 weeks gestation. Following differentiation, ischemia-induced atrophy leads to the embryonic death of the parasite and hemodynamic changes in the autosite to support parasite tissues. The use of antenatal and postnatal imaging is crucial in establishing the diagnosis, management plan, and longterm prognosis secondary to the congenital cardiac malformations and degree of interconnectedness. Conclusion: This is the first reported case of heteropagus twins with co-existing hepatobiliary and gastrointestinal continuity.

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Lung Sliding Identification Is Less Accurate in the Left Hemithorax

Journal of Ultrasound in Medicine ◽

10.7863/ultra.15.06092 ◽

2016 ◽

Vol 36 (2) ◽

pp. 327-333

Author(s):

Eric Piette ◽

Raoul Daoust ◽

Jean Lambert ◽

André Denault

Keyword(s):

Left Hemithorax ◽

Lung Sliding

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Management dilemma in case of a posterior mediastinal paraganglioma

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492319862703 ◽

2019 ◽

Vol 27 (7) ◽

pp. 612-615

Author(s):

Deepak V Bohra ◽

Srirangapatna V Srikrishna ◽

Ameya Kaskar

Keyword(s):

Carotid Body ◽

Posterior Mediastinum ◽

Circumflex Artery ◽

Left Hemithorax ◽

Complete Excision ◽

Left Circumflex Artery ◽

Bilateral Carotid ◽

Carotid Body Tumors ◽

The Right ◽

Mediastinal Paraganglioma

We report a case of functional mediastinal paraganglioma supplied by the left circumflex artery, associated with bilateral carotid body tumors. The surgical approach for a tumor in the posterior mediastinum behind the left atrium was a dilemma because the majority of the tumor was in the right hemithorax but its major blood supply was from the left circumflex artery in the left hemithorax. Management involved preoperative coil embolization of the feeding vessel followed by complete excision of the tumor through a right thoracotomy, without employing cardiopulmonary bypass, and excision of the carotid body tumors in a staged manner.

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Single-stage open repair of severe asymmetric pectus excavatum and mitral valve replacement in connective tissue disease

Asian Cardiovascular and Thoracic Annals ◽

10.1177/02184923211014004 ◽

2021 ◽

pp. 021849232110140

Author(s):

Cheong Ping Pau ◽

Kee Soon Chong ◽

Mohd Azhari Yakub ◽

Alizan Abdul Khalil

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Pectus Excavatum ◽

Pedicled Flap ◽

Single Stage ◽

Left Hemithorax ◽

Mammary Arteries ◽

Internal Mammary ◽

The Right

We present a 14-year-old boy with Loey–Dietz syndrome with severe mitral regurgitation, pectus excavatum and scoliosis. The Haller index was 25. The heart was displaced into the left hemithorax. The right inferior pulmonary vein was very close to the sternum and vertebral body. Single-stage surgery was performed. An osseo-myo-cutaneous pedicled flap was created by sterno-manubrial junction dislocation and rib resection with bilateral internal mammary arteries supplying the flap. Cardiopulmonary bypass and mitral valve replacement was performed. The defect was bridged with three straight plates. The flap was laid on top and anchored. Early outcome at three months was good.

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Robotic thymectomy: A surgical point of view

10.1510/mmcts.2021.059 ◽

2021 ◽

Keyword(s):

Anterior Mediastinum ◽

Point Of View ◽

Innominate Vein ◽

Target Area ◽

Operating Table ◽

Left Edge ◽

En Bloc ◽

Left Hemithorax ◽

Robotic Thymectomy ◽

The Right

Robotic thymectomy is the most innovative surgical approach for treating disease of the anterior mediastinum. Robotic surgery offers low postoperative morbidity, faster recovery, shorter hospital stay, and better cosmetic results, without compromising surgical radicality. During the operation, the patient is placed in a supine position at the left edge of the operating table with the left hemithorax upward; the position is maintained with sandbags. The target area for the autodocking should be toward the jugulum. The first surgical step is to isolate the inferior thymic horns via the dissection that starts from the inferior portion of the mediastinal tissue and proceeds toward the right side, following the contralateral pleural reflection. Afterward, it is necessary to move toward the superior horns, following the phrenic nerve, the first landmark, to the innominate vein, our second landmark. Finally, we dissect the superior horns while searching for the thymic veins, which could appear atrophic, and clip the vessels to safely isolate the innominate vein. During this step, it is useful to use a retraction movement to progressively dissect the horns from the jugulum. The thymus gland is removed en bloc with the perithymus fat using an endoscopic bag inserted through the right port incision.

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