scholarly journals Successful endoscopic surgical treatment of pleuroperitoneal communication in two infant cases

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Teizaburo Mori ◽  
Akihiro Fujino ◽  
Masataka Takahashi ◽  
Ryoya Furugane ◽  
Tamotsu Kobayashi ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Surgical Treatment ◽  
Endoscopic Surgery ◽  
Surgical Repair ◽  
Abdominal Cavity ◽  
Age At Onset ◽  
Falciform Ligament ◽  
Emission Computed Tomography ◽  
Pleuroperitoneal Communication ◽  
Fistula Site

Abstract Background Pleuroperitoneal communication (PPC) is an uncommon, but potentially life-threatening complication of peritoneal dialysis (PD). If a fistula does not close with conservative treatment, surgical repair is required. However, approximately half of these patients are forced to shift from PD to hemodialysis. Although it is important to confirm the site of the fistula to achieve a successful surgical treatment, this identification is more difficult in pediatric patients than in adults. Case presentation We report two infantile cases of severe PPC associated with PD. In both cases, the age at onset was less than 2 years, and right-sided pleural effusion with dyspnea was observed. PPC was diagnosed by the change in color of the pleural fluid after the injection of a dye into the peritoneal cavity. Peritoneal scintigraphy and single-photon emission computed tomography and computed tomography (SPECT/CT) were performed, and these were effective in locating the fistula site. Endoscopic surgery (video-assisted thoracic surgery (VATS) and laparoscopic surgery) was performed. Indocyanine green (ICG), which was injected into the abdominal cavity, showed the exact site of the fistula. The fistula was successfully closed by attaching an absorbable sheet to it from the thoracic side and an autograft (the falciform ligament) to it from the abdominal side in one patient. In the other patient, the fistula site was resected and sutured, and reinforced with an absorbable sheet. In both cases, PD was resumed without any complication. Conclusion We successfully treated two infants of PPC by endoscopic surgery. To identify the fistula site, the ICG navigation method was useful. Even in small infants, PPC can be treated successfully by endoscopic surgical repair if the site of the fistula is identified.

scholarly journals A case of pleuroperitoneal communication in which establishing a laparoscopic pneumoperitoneum was useful for the detection of a fistula

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Takehiko Manabe ◽  
Kenji Ono ◽  
Soichi Oka ◽  
Yuichiro Kawamura ◽  
Toshihiro Osaki
Keyword(s):  
Thoracic Surgery ◽  
Surgical Repair ◽  
Abdominal Cavity ◽  
Case Presentation ◽  
X Ray ◽  
Video Assisted Thoracic Surgery ◽  
Video Assisted ◽  
Pleuroperitoneal Communication ◽  
Small Pore ◽  
Chest X Ray

Abstract Background Pleuroperitoneal communication (PPC) is rarely observed, accounting for 1.6% of all patients who undergo continuous ambulatory peritoneal dialysis (CAPD). Although there have been several reports concerning the management of this condition, we have encountered several cases in which control failed. We herein report a valuable case of PPC in which laparoscopic pneumoperitoneum with video-assisted thoracic surgery (VATS) was useful for supporting the diagnosis and treatment. Case presentation The patient was a 58-year-old woman with chronic renal failure due to chronic renal inflammation who was referred to a nephrologist in our hospital to undergo an operation for the induction of CAPD. Post-operatively, she had respiratory failure, and chest X-ray and computed tomography (CT) showed right-sided hydrothorax that decreased when the injection of peritoneal dialysate was interrupted. Therefore, PPC was suspected, and she was referred to our department for surgical repair. We planned surgical treatment via video-assisted thoracic surgery. During the surgery, we failed to detect any lesions with thoracoscopy alone; we therefore added a laparoscopic port at her right-sided abdomen near the navel and infused CO2 gas into the abdominal cavity. On thoracoscopy, bubbles were observed emanating from a small pore at the central tendon of the diaphragm, which was considered to be the lesion responsible for the PPC. We closed it by suturing directly. Conclusions VATS with laparoscopic pneumoperitoneum should be considered as an effective method for inspecting tiny pores of the diaphragm, especially when the lesions responsible for PPC are difficult to detect.

scholarly journals Extrathoracic lung sequestration in newborns: cases report

2021 ◽  
Vol 11 (3) ◽  
pp. 387-394
Author(s):  
Tatiana V. Patrikeeva ◽  
Svetlana A. Karavaeva ◽  
Alexey N. Kotin ◽  
Yuri V. Levadnev ◽  
Maria V. Golubeva ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Differential Diagnosis ◽  
Surgical Treatment ◽  
Computed Tomography Angiography ◽  
Ultrasound Examination ◽  
Abdominal Cavity ◽  
Retroperitoneal Space ◽  
City Hospital ◽  
Arterial Vessel ◽  
Long Term Treatment

BACKGROUND: Extrathoracic lung sequestration is a rare variant of a developmental malformation that can be diagnosed prenatally and should be included in the differential diagnosis of abdominal tumor-like formations. CASES REPORT: From 1996 to 2020, 70 children with confirmed lung sequestration were treated at the Children's City Hospital No. 1 in St. Petersburg. Of these, 29 had intralobar sequestration, and 41 had extralobar sequestration. Four of these patients were diagnosed with a rare extrathoracic (intraabdominal) form. All four were born full-term without clinical manifestations of the defect. Ultrasound examination of all children revealed a solid formation up to 3 cm in diameter, located in the upper left quadrant of the abdominal cavity or retroperitoneal space in the projection of the left adrenal gland. Due to the location of the formation and the inability to visualize the aberrant arterial vessel during ultrasound examination, the first two patients were differentially diagnosed with an adrenal tumor (neuroblastoma). The cancer markers were negative, and adrenal cortex hormones were normal. The children underwent multispiral computed tomography-angiography to clarify the diagnosis. In both cases, the diagnosis of intraabdominal extrapulmonary sequestration with a feeding arterial vessel extending from the thoracic aorta was confirmed. Two children, previously treated in the last two years, were diagnosed by the ultrasound examination results that enabled the visualization of an aberrant arterial vessel feeding the sequester. Indications for surgical treatment have been set. The parents of one child refused treatment. Three children underwent sequestration removal (two by laparoscopic access, one had a laparotomy). Histologically, extrathoracic sequestration in combination with cystoadenomatosis was confirmed. The postoperative period proceeded without complications. RESULTS: Long-term treatment results were observed in all operated patients for a period of four to 10 years. The assessment was performed based on complaints and ultrasound data. All patients matured and developed according to their ages. CONCLUSIONS: Extrathoracic lung sequestration is a rare type of defect that is subject to surgical treatment. This pathology should be included on the spectrum of differential diagnosis of tumorous formations of the abdominal cavity and retroperitoneal space in newborns. The main methods for postnatal diagnosis of the defect are ultrasound and multispiral computed tomography-angiography.

Integration Between Computed Tomography and Nuclear Medicine for Non-invasive Assessment of Coronary Anatomy and Myocardial Perfusion

2009 ◽  
Vol 5 (2) ◽  
pp. 15
Author(s):  
Wanda Acampa ◽  
Mario Petretta ◽  
Carmela Nappi ◽  
Alberto Cuocolo ◽  
◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Heart Disease ◽  
Blood Flow ◽  
Heart Disease ◽  
Myocardial Perfusion ◽  
Myocardial Blood Flow ◽  
Imaging Techniques ◽  
Emission Computed Tomography ◽  
Coronary Anatomy ◽  
Non Invasive

Many non-invasive imaging techniques are available for the evaluation of patients with known or suspected coronary heart disease. Among these, computed-tomography-based techniques allow the quantification of coronary atherosclerotic calcium and non-invasive imaging of coronary arteries, whereas nuclear cardiology is the most widely used non-invasive approach for the assessment of myocardial perfusion. The available single-photon-emission computed tomography flow agents are characterised by a cardiac uptake proportional to myocardial blood flow. In addition, different positron emission tomography tracers may be used for the quantitative measurement of myocardial blood flow and coronary flow reserve. Extensive research is being performed in the development of non-invasive coronary angiography and myocardial perfusion imaging using cardiac magnetic resonance. Finally, new multimodality imaging systems have recently been developed bringing together anatomical and functional information. This article provides a description of the available non-invasive imaging techniques in the assessment of coronary anatomy and myocardial perfusion in patients with known or suspected coronary heart disease.

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