scholarly journals Computed tomography-guided thoracoscopic debridement for multiple loculated organizing empyema: a case report

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Masaya Aoki ◽  
Tadashi Umehara ◽  
Shoichiro Morizono ◽  
Yasuhiro Tokuda ◽  
Go Kamimura ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Chest Wall ◽  
Thoracoscopic Surgery ◽  
Treatment Options ◽  
Fluid Collection ◽  
Skin Incision ◽  
The Body ◽  
Accidental Injury ◽  
Anatomical Structures ◽  
The Right

Abstract Background Video-assisted thoracoscopic surgery (VATS) for organizing empyema is challenging because fibrous septa and peel within the cavity are thickened and hardened. Some patients have multiple isolated empyema cavities that require debridement individually because firm intrathoracic adhesion was developed during this phase. If the debridement was incomplete as a result of worrying about an accidental injury of the surrounding organ, additional interventions may be required due to the persistent empyema cavity or insufficient expansion of the ipsilateral lung. We here describe a representative case with multiple loculated organizing empyema that could safely and reliably perform VATS debridement under C-arm cone-beam computed tomography (CBCT). Case presentation A 67-year-old woman was admitted to our department for the treatment of right empyema. Chest computed tomography showed fluid collection in three independent spaces within the right thoracic cavity. It was assumed that a firm adhesion between the lung and chest wall was developed because about 7 weeks passed since the onset. Therefore, we decided to use CBCT to completely debride three empyema cavities separately by VATS. One cavity was only in a narrow range with the chest wall, and it was located on the back of cost rib cartilage. By clicking any intended anatomical structures on CBCT images, the position was readily depicted by lase projection on the body surface, which helped to place the best skin incision. Moreover, in other cavities, CBCT after initial debridement showed insufficiently dissected cavity. Additional debridement resulted in a successful shrinkage of the empyema cavity. Conclusion We believe that VATS debridement under CBCT guidance is one of the useful treatment options for multiple loculated organizing empyema.

scholarly journals Massive hematuria due to ruptured iatrogenic aortic pseudoaneurysm: A case report

2013 ◽  
Vol 85 (2) ◽  
pp. 96 ◽  
Author(s):  
Valerio Vagnoni ◽  
Caterina Gaudiano ◽  
Giovanni Passaretti ◽  
Riccardo Schiavina ◽  
Eugenio Brunocilla ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Abdominal Aorta ◽  
Interesting Case ◽  
Pelvic Surgery ◽  
Accidental Injury ◽  
Intravenous Contrast ◽  
Aortic Pseudoaneurysm ◽  
Renal Vessels ◽  
The Right ◽  
Iatrogenic Pseudoaneurysm

We report an interesting case of massive haematuria secondary to a rupture of a pseudoa- neurysm of the abdominal aorta below the renal vessels. A 65-year-old woman present- ed at our institution with a painful massive haematuria and anaemia. Two months before, she undergone a pelvic surgery complicated by an accidental injury of the right ureter sutured with a end-to-end anastomosis. An abdominal computed tomography (CT) scan with intravenous contrast showed a right-sided hydronephrosis with clots in the lumen of the right pelvis with a massive retroperitoneal hematoma due to a rupture of a iatrogenic pseudoaneurysm of the abdominal aorta below the origin of the renal arteries.

scholarly journals Chondrosarcoma of the Rib Mimicking Malignant Pleural Mesothelioma

2016 ◽  
Vol 9 (1) ◽  
pp. 11-14 ◽  
Author(s):  
Masashi Furukawa ◽  
Hiroyuki Tao ◽  
Toshiki Tanaka ◽  
Hideko Onoda ◽  
Tomoyuki Murakami ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Chest Wall ◽  
Malignant Pleural Mesothelioma ◽  
Thoracoscopic Surgery ◽  
Asbestos Exposure ◽  
Excisional Biopsy ◽  
Tumor Location ◽  
Wide Resection ◽  
Chest Wall Tumor ◽  
Pleural Mesothelioma

A 62-year-old man with a history of long-term asbestos exposure was found to have a chest wall tumor invading the sixth rib on chest computed tomography. The computed tomography also revealed multiple plaques in the pleura. Malignant pleural mesothelioma was suspected, and thoracoscopic surgery was performed. Thoracoscopy revealed that the tumor location was extrapleural. Thus, excisional biopsy was performed. The tumor was histologically diagnosed as chondrosarcoma. Additional wide resection of the chest wall, including the fifth, sixth, and seventh ribs, was performed. Chest wall reconstruction was performed with a polypropylene mesh.

Central venous catheterization–induced right brachiocephalic vein pseudoaneurysm: Successfully treated with stent-assisted coiling

2018 ◽  
Vol 19 (3) ◽  
pp. 319-323 ◽  
Author(s):  
Sun-Ju Choi ◽  
Young Woo Do ◽  
Tak-Hyuk Oh ◽  
Hoseok Lee ◽  
Hyejin Cheon ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coil Embolization ◽  
Central Venous Catheterization ◽  
Treatment Options ◽  
Brachiocephalic Vein ◽  
Central Vein ◽  
Central Venous ◽  
Mediastinal Hematoma ◽  
Venous Catheterization ◽  
The Right

Introduction: Central venous catheterization–induced central vein pseudoaneurysm is rare. Several treatment options have been recommended. We describe a case of central venous catheterization–induced right brachiocephalic vein pseudoaneurysm successfully treated with an uncovered self-expandable stent-assisted coil embolization and discuss the imaging findings, treatment strategy, and review of literature associated with thoracic venous pseudoaneurysm. Case report: A 77-year-old woman was referred to our trauma center to undergo treatment for central venous catheterization-induced central vein pseudoaneurysm. The initial contrast-enhanced chest computed tomography revealed a 3.4-cm pseudoaneurysm arising from the right brachiocephalic vein and a surrounding mediastinal hematoma. The pseudoaneurysm was successfully embolized with stent-assisted coiling. Computed tomography angiography was performed 10 days after the procedure and demonstrated a completely embolized pseudoaneurysm and resolved mediastinal hematoma. Blood flow from the right subclavian and left innominate veins was not disturbed by the stent-assisted coils. Conclusion: To our knowledge, this is the first report of treatment of a right brachiocephalic vein pseudoaneurysm with stent-assisted coil embolization. We think that uncovered stent-assisted coil embolization is the safest and most fundamental treatment for wide-neck venous pseudoaneurysm especially in a hemodynamically unstable setting.

scholarly journals Congenital Cervical Vertebral Malformation in Lambs

2018 ◽  
Vol 46 ◽  
pp. 5
Author(s):  
Joandes Henrique Fonteque ◽  
Anderson Fernando De Souza ◽  
Thiago Rinaldi Muller ◽  
Ronaldo Paiva Moreno Gonçalves ◽  
Milena Carol Sbrussi Granella ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cervical Spine ◽  
Morphological Changes ◽  
Odontoid Process ◽  
The Body ◽  
Diagnostic Methods ◽  
Congenital Defects ◽  
Imaging Features ◽  
Vertebral Malformation ◽  
The Right

Background: The occurrence of congenital defects in the sheep is estimated to be between 0.2% and 2%. For congenital anatomical alterations, diagnostic imaging allows objective understanding and evaluation, and is a great aid in the formulation of clinical decisions. Most of these anomalies are diagnosed by radiography; but computed tomography (CT) can provide important additional information. In the current literature there are no descriptions of the use of radiography andCT for a more detailed evaluation of the anatomical structures in cases of congenital cervical malformations in lambs. The objective of this study is to report the clinical, radiographic and tomographic findings in two cases of congenital cervical vertebral malformation in lambs.Cases: Two lambs with cervical morphological alterations since birth were attended. A 4-month-old mixed-breed lamb, weighing 11 kg, with lateroventrocaudal deviation of the neck was observed to the right side, not yielding to the attempt of repositioning. The owner reported that these changes were identified since birth, leading to difficulties in suckling colostrum, necessitating artificial feeding. With the growth of the animal, worsening of the cervical deviation resulted in the impossibility of grazing. The radiographs of the cervical spine identified marked scoliosis, and the axis presented small dimensions and morphological changes with a slight loss of atlantoaxial articular relationship. Spondylopathies were detectedalong the cervical spine. Other lamb of the Lacaune breed, weighing 4.2 kg, was presented shortly after birth with changes in the shape and posture of the neck, difficult locomotion and in sternal decubitus. The owner reported that the lamb came from a twin eutocic birth, with the other lamb being apparently normal. The animal was unable to ingest the colostrum, in which the sheep was milked and colostrum was offered through a bottle. Lateroventrocaudal deviation of the neck to the left side did not yield to the repositioning attempt, the mandible also presented left lateral deviation. The radiographs of the cervical spine showed morphological changes in atlas, and it was not possible to delimit its wings; itwas also observed that the dorsal blade was parallel to the spinal process of the axis. The presence of a hypoattenuating linear left lateral image of the dorsal arch and a right ventro-lateral aspect of the atlas body was identified with slightly irregular and sclerotic margins, suggesting fracture lines. The body of the axis presented a conformational alteration withirregular contours and a large free fragment in the cranial aspect, suggestive of being the odontoid process, with rotation and deviation to the left in relation to the atlas. The right lateral cranial articular process of the third cervical vertebra (C3) presented a conformational change and important lateral rotation of the axis. Mild stenosis of the medullary canal was observed in the segment adjacent to C3. The euthanasia was recommended.Discussion: Congenital cervical malformations in sheep are rare in the literature and may lead to serious decrease in the quality of life of the animals. Computed tomography was superior to radiography in morphological evaluation in cases of congenital cervical malformations in sheep. However, both diagnostic methods were important to establish the best clinical behavior. The etiology of most congenital malformations is unknown, simply because of the complexity of the mechanismsthat lead to the formation of an abnormality. The isolated episodes of this anomaly, in the herd without previous alterations, suggest a non-infectious cause, probably similar among the cases, but not established. The information presented can be used to validate clinical reasoning in future cases similar to those described, where imaging features are not available.Keywords: anomalies, fetus, radiography, computed tomography.

scholarly journals Computed Tomography-Based Occipital Condyle Morphometry in an Indian Population to Assess the Feasibility of Condylar Screws for Occipitocervical Fusion

2017 ◽  
Vol 11 (6) ◽  
pp. 847-853 ◽  
Author(s):  
Abhishek Srivastava ◽  
Geetanjali Nanda ◽  
Rajat Mahajan ◽  
Ankur Nanda ◽  
Nirajana Mishra ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Indian Population ◽  
Occipital Condyle ◽  
Morphometric Study ◽  
Anatomical Structures ◽  
Males And Females ◽  
Ct Data ◽  
The Right ◽  
Occipital Condyles ◽  
Ethnic Variations

<sec><title>Study Design</title><p>A retrospective computed tomography (CT)-based morphometric study of 82 occipital condyles in the Indian population, focusing on critical morphometric dimensions with relation to placing condylar screws.</p></sec><sec><title>Purpose</title><p>This study focused on determining the feasibility of placing occipital condylar screws in an Indian population using CT anatomical morphometric data.</p></sec><sec><title>Overview of Literature</title><p>The occipital condylar screw is a novel technique being explored as one of the options in occipitocervical stabilization. Sex and ethnic variations in anatomical structures may restrict the feasibility of this technique in some populations. To the best of our knowledge, there are no CT-based data on an Indian population that assess the feasibility of occipital condylar screws.</p></sec><sec><title>Methods</title><p>We measured the dimensions of 82 occipital condyles in 41 adults on coronal, sagittal, and axial reconstructed CT images. The differences were noted between the right and left sides and also between males and females. Statistical analysis was performed using the <italic>t</italic>-test, with a <italic>p</italic>-value of &lt;0.05 considered significant.</p></sec><sec><title>Results</title><p>Mean sagittal length and height were 17.2±1.7 mm and 9.1±1.5 mm, respectively. Mean condylar angle/screw angle was 38.0°±5.5° from midline, with mean condylar length and width of 19.6±2.6 mm and 9.5±1.0 mm, respectively. Average coronal height on the anterior and posterior hypoglossal canal was 10.8±1.4 mm and 9.0±1.4 mm, respectively. The values in females were significantly lower than those in males, except for screw angle and condylar width. Based on Lin et al.'s proposed criteria, eight of 82 condyles were not suitable for condylar screws.</p></sec><sec><title>Conclusions</title><p>Preliminary CT morphometry data of the occipital condyle shows that condylar screws are anatomically feasible in a large portion of the Indian population. However, because a small number of population may not be suitable for this technique, meticulous study of preoperative anatomy using detailed CT data is advised.</p></sec>

scholarly journals Axillary uniportal video-assisted thoracoscopic surgery for bullae is a cosmetically superior approach to primary spontaneous pneumothorax: a case report

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Weijiang Ma ◽  
Xiuping Deng ◽  
Ming Wen ◽  
Limin Yang ◽  
Xun Ouyang ◽  
...  
Keyword(s):  
Chest Wall ◽  
Spontaneous Pneumothorax ◽  
Thoracoscopic Surgery ◽  
Primary Spontaneous Pneumothorax ◽  
Natural State ◽  
Axillary Approach ◽  
Video Assisted ◽  
Good Cosmetic ◽  
The Right ◽  
Video Assisted Thoracoscopic Surgery

Abstract Background Bulla is a common cause of primary spontaneous pneumothorax. Video-assisted thoracoscopic surgery (VATS) through the lateral chest wall is a common surgical approach and an effective treatment for this condition, but postoperative incision scars affect the aesthetic outcome. VATS via axillary approach can hide the scar in the axilla, and the wound in its natural state is invisible; this greatly improves the cosmetic appearance. To our knowledge, this is the first report of VATS-based bullectomy via the axillary approach in a patient with spontaneous pneumothorax. Case presentation A 20-year-old female patient was admitted to the hospital with a 2-day history of chest tightness and chest pain. Plain chest computed tomography showed right spontaneous pneumothorax, lung compression of 75%, and right pulmonary bulla. After complete preoperative examination, VATS bullectomy via right axillary approach was performed. During the operation, a bulla measuring about 4 × 4 cm was found at the apex of the right lung and resected. The incision healed well, and the patient was discharged after surgery. Conclusions VATS bullectomy via axillary approach is safe and feasible, with the incision hidden in the axilla and not visible in the natural state. This method leaves no scar on the chest wall and has good cosmetic outcome.

scholarly journals Poland’s syndrome

2017 ◽  
Vol 5 (1) ◽  
pp. 63-70
Author(s):  
Olga E. Agranovich ◽  
Igor A. Komolkin ◽  
Alyona Ju. Dimitrieva
Keyword(s):  
Surgical Treatment ◽  
Clinical Features ◽  
Clinical Presentation ◽  
Treatment Options ◽  
The Body ◽  
Poland’S Syndrome ◽  
Poland's Syndrome ◽  
Congenital Condition ◽  
The Right ◽  
Bone Abnormalities

Poland’s syndrome is a rare congenital condition classically characterized by partial or complete absence of chest muscles on one side of the body and usually webbing of the fingers of the hand on the same side. There may also be rib (aplasia or hypoplasia) and chest bone abnormalities, which may be noticeable due to less fat under the skin. Breast and nipple abnormalities may also occur, and underarm hair is sometimes sparse or abnormally placed. In most cases, the abnormalities in the chest area do not cause health problems or affect movement. Poland’s syndrome most often affects the right side of the body and occurs more frequently in males than in females. The etiology is unknown; however, interruption of the embryonic blood supply to the arteries that lie under the collarbone (subclavian arteries) is the prevailing theory. There are many methods of operative correction because of the polymorphic clinical features of this syndrome. We gathered data on the etiology, pathogenesis, and clinical presentation of Poland’s syndrome and reviewed the existing surgical treatment options.

scholarly journals Case Report: Corpus callosal apraxia following acute ischemic stroke

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 731
Author(s):  
Santhosh Narayanan ◽  
Gomathy Subramaniam
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Case Report ◽  
Corpus Callosum ◽  
The Body ◽  
Cerebral Hemispheres ◽  
Diagnostic Challenge ◽  
Compact Structure ◽  
Ischemic Infarct ◽  
The Right

The corpus callosum is a compact structure that connects the right and left cerebral hemispheres. Here we report the case of a 50 year old woman who presented with features of corpus callosum apraxia, initially mistaken as psychiatric symptom by her relatives. Computed tomography and magnetic resonance of brain confirmed the diagnosis of acute ischemic infarct in the body of the corpus callosum. Isolated stroke involving the corpus callosum is rarely reported in literature and is a diagnostic challenge due to atypical clinical features.

scholarly journals An extremely rare case of desmoplastic fibroblastoma exhibiting rapid growth in the chest wall: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Hideki Ota ◽  
Hirotaka Ishida ◽  
Hidekazu Matsumoto ◽  
Tomoharu Ishiyama
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Differential Diagnosis ◽  
Magnetic Resonance ◽  
Chest Wall ◽  
Rare Case ◽  
Resonance Imaging ◽  
Marginal Excision ◽  
Desmoplastic Fibroblastoma ◽  
The Right

Abstract Background Desmoplastic fibroblastoma is an uncommon, benign, fibrous tumor exhibiting infiltrative growth. Most of these tumors are small, slow-growing, and develop as subcutaneous lesions in the extremities. Cases of desmoplastic fibroblastoma in the chest wall are quite rare, and the preoperative diagnosis of such cases remains challenging as these tumors can mimic the characteristics of desmoid-type fibromatosis, which often occurs in the chest wall. We aimed to describe a rare case of desmoplastic fibroblastoma exhibiting rapid growth in the chest wall of a patient that was successfully treated with marginal excision only by diagnostic imaging before surgery. Case presentation A 79-year-old man was admitted to our hospital after experiencing right shoulder pain lasting for a few months. A 4 × 4 × 2 cm mass was incidentally detected at the right second rib two years prior. Chest computed tomography revealed a well-defined homogeneous mass with a muscle-like density along the right lateral chest wall, the size of which had increased to 12 × 10 × 4.5 cm in two years. Dynamic contrast-enhanced computed tomography revealed abundant vascularity at the periphery of the tumor. Magnetic resonance imaging revealed iso-intensity to muscle on T1-weighted images, slightly high intensity on T2-weighted images, and rim-like contrast enhancement at the periphery of the tumor, with uniform thickness on gadolinium-enhanced T1-weighted images with fat suppression. Rim-like contrast enhancement is an imaging feature that can distinguish cases of desmoplastic fibroblastoma from desmoid-type fibromatosis. We diagnosed the tumor as desmoplastic fibroblastoma by diagnostic imaging without tissue biopsy. Marginal excision with videoscopic assistance was performed through a small incision. The pathological diagnosis was desmoplastic fibroblastoma. The patient’s postoperative course was uneventful, and his shoulder pain was relieved after the surgery. Conclusions Desmoplastic fibroblastoma in the chest wall is extremely rare, but should be considered in the differential diagnosis when desmoid-type fibromatosis is clinically suspected. Gadolinium-enhanced magnetic resonance imaging is helpful in confirming the differential diagnosis.

scholarly journals Kimura’s disease affecting multiple body parts in a 57-year-old female patient: a case report

2019 ◽  
Vol 15 (1) ◽  
Author(s):  
Bo Yu ◽  
Guoxing Xu ◽  
Xiaofan Liu ◽  
Wen Yin ◽  
Hao Chen ◽  
...  
Keyword(s):  
Lymph Nodes ◽  
Chest Wall ◽  
Immunoglobulin E ◽  
The Body ◽  
Unknown Etiology ◽  
Kimura’S Disease ◽  
Body Parts ◽  
Tissue Mass ◽  
Left Chest ◽  
The Right

Abstract Background Kimura’s disease (KD) is a rare chronic inflammatory disease with unknown etiology. It usually manifests as a painless soft tissue mass or subcutaneous nodule on one side of the patient’s head and/or neck and rarely affects multiple parts of the body. The disease is more common among young Asian males. Case presentation A 57-year-old Chinese woman complained of multiple masses on her body surface. Ultrasonography was used to examine the retroperitoneal, bilateral neck, bilateral supraclavicular, bilateral axillary, and bilateral inguinal superficial lymph nodes. Enlargement of multiple lymph nodes was found in all areas. Many solid nodules were also found in the right parotid gland and right posterior neck area, respectively. Numerous solid nodules were seen on the left chest wall. Laboratory tests showed that the percentage of eosinophils in the whole blood was 39.40%, total immunoglobulin E (IgE) level was > 5000 kU/L, and serum special IgE to Phadiatop (inhaled allergens) and fx5 (food allergens) were 1.01 and 1.04 kUA/L, respectively. After a complete examination, the masses located in the right neck, retroauricular and left axillary regions, and left chest wall were resected directly. Postoperative pathological findings revealed KD. Conclusions The case discussed in this study is extremely rare and did not meet the common affected areas and age characteristics of KD. This presentation can be used to improve disease awareness among physicians.

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