Asymptomatic Post-Traumatic Rupture of the Right Diaphragm Dome

Aim. This paper is aimed at presenting the materials of clinical observations associated with diagnosing rare-occurring ruptures of the right dome of the diaphragm that have been overlooked for a long period.Results. A 61-year-old man was admitted to hospital with a diagnosis of chronic heart failure. Chest radiograph revealed a high position of the right dome of the diaphragm. Computed tomography revealed a defect in the central parts of the diaphragm on the right, the liver was rotated outward with its visceral surface deployed anteriorly and upward. In the right thoracic cavity, anterior to the liver, were the loops of the intestine and the outlet of the stomach.More than 30 years before, the patient had experienced an explosive trauma, which might have caused a rupture in the right dome of the diaphragm. A 70-year-old man, a smoker with a ten-year history of hypertension, was hospitalized with an increase in dyspnea, a cough with the discharge of purulent sputum, the feeling of heaviness behind the sternum. Chest radiograph revealed a high standing of the right dome of the diaphragm at the level of 3rd rib with a decrease in the volume of the right lung, and an increase in cardiac silhouette (cardiothoracic index 0.64). Computed tomography revealed a high standing of the right dome of the diaphragm as well as the compression of the middle and lower lobe of the right lung with the presence of compression atelectasis. The liver was rotated, displaced into the right thoracic cavity, the deformation of the inferior vena cava to the right was visualized due to the displacement and rotation of the liver. The consolidated fractures of 10th–12th ribs on the right were visualized. The patient had had a chest injury resulting from a traffic accident about 15 years before, with no X-ray examination having been conducted at that time.Conclusion. In the case of left-sided diaphragm ruptures, which are much more frequent than the right-sided ones, the stomach, large and small intestines as well as spleen are displaced into the thoracic cavity. In the case of rightsided diaphragm ruptures, the liver and gallbladder are displaced into the thoracic cavity. Right-sided posttraumatic diaphragmatic hernias that are not diagnosed at the time of injury or trauma and continue to be asymptomatic for a number of years are very rare. The sensitivity and specificity of computed tomography for the diagnosis of diaphragm ruptures is 61–87 % and 72–100 %, respectively. In an acute period, the treatment of diaphragm ruptures is surgical. However, in long-term asymptomatic ruptures, expectant management is possible, particularly if the risk of surgical treatment is high.

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Persistent hiccups as the presenting symptom of a pulmonary embolism

Chest Disease Reports ◽

10.4081/cdr.2012.e2 ◽

2012 ◽

Vol 2 (1) ◽

pp. 2

Author(s):

Steven Durning ◽

David J. Shaw ◽

Anthony J. Oliva ◽

Michael J. Morris

Keyword(s):

Computed Tomography ◽

Pulmonary Embolism ◽

Chest Radiograph ◽

Pulmonary Embolus ◽

Lower Lobe ◽

Initial Evaluation ◽

Unique Case ◽

Case Presentation ◽

History Of ◽

Symptomatic Bradycardia

An 81-year-old male with a history of symptomatic bradycardia controlled by a pacemaker presented to our institution with three days of persistent hiccups. He denied any pulmonary symptoms and his initial evaluation showed no evidence of tachypnea, tachycardia, or hypoxia. Pacemaker malfunction or migration of the pacer leads was ruled out as an etiology and no intracranial pathology was present. Admission chest radiograph was normal but a computed tomography of the chest demonstrated a left lower lobe pulmonary embolus. After treatment with anticoagulation was initiated, the hiccups resolved within the next week. This is a unique case presentation of hiccups as the only presenting symptom of an otherwise asymptomatic pulmonary embolism.

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Pulmonary venous abnormalities encountered on pre-radiofrequency ablation mapping multidetector computed tomography

South African Journal of Radiology ◽

10.4102/sajr.v21i1.1189 ◽

2017 ◽

Vol 21 (1) ◽

Cited By ~ 1

Author(s):

Paul Cronin ◽

Aine M. Kelly

Keyword(s):

Computed Tomography ◽

Radiofrequency Ablation ◽

Multidetector Computed Tomography ◽

Venous Return ◽

Vena Cava ◽

Lower Lobe ◽

Common Trunk ◽

Ecg Gating ◽

Anomalous Pulmonary Venous Return ◽

The Right

Multidetector computed tomography (MDCT) elegantly renders pulmonary venous anatomy. With increasing numbers of radiofrequency ablation procedures being performed, there is now a greater emphasis on pre-procedure imaging to delineate this anatomy. Pulmonary venous mapping studies can be performed with or without ECG-gating. However, ECG-gating improves both the quality of 3D images and the accuracy of pulmonary vein (PV) ostial diameter measurements. Including the superior thorax, and not just the left atrium and central PVs, allows visualization of aberrant pulmonary venous drainage to the brachiocephalic veins or superior vena cava. Normally, there are two superior PVs, one right and one left, and two inferior PVs, one right and one left. The right superior vein usually drains the right upper and middle lobe. The left superior vein drains the left upper lobe including the lingula. The inferior veins drain their respective lower lobe. PV anatomy is more variable than pulmonary arterial anatomy, and developmental anomalies are common. This article describes, illustrates and reviews the common anomalies of the PVs in our experience performing over 1000-pre-radiofrequency ablation cardiac MDCT studies. The commonest anomalies are supernumerary or accessory veins (on the right) and a (left) common trunk. More rarely, partial anomalous pulmonary venous return and Cor triatriatum are seen, and rarest of all is total anomalous pulmonary venous return, PV varix and single or multiple vein stenosis or atresia.

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A Rare case of Classic Biphasic Pulmonary Blastoma

The American Surgeon ◽

10.1177/000313480507101221 ◽

2005 ◽

Vol 71 (12) ◽

pp. 1078-1081 ◽

Cited By ~ 1

Author(s):

S.M. Schulze ◽

S. Sbayi ◽

J.T. Costic ◽

R.L. Moser

Keyword(s):

Computed Tomography ◽

Chest Radiograph ◽

Rare Case ◽

Immunohistochemical Analysis ◽

Pulmonary Blastoma ◽

Good Communication ◽

History Of ◽

Proper Diagnosis ◽

The Right ◽

Immunophenotypic Analysis

Biphasic pulmonary blastomas are rare tumors that together with pulmonary carcinosarcomas comprise less than 2 per cent of all lung neoplasms. They can be defined as tumors that are composed of an admixture of immature mesenchyme and epithelium and that recapitulate morphologically the embryonal structure of the lung. First described in 1945 by Barnett and Barnard, their existence is well documented although their occurrence is rare. We present a case of a 40-year-old Hispanic female that presented with a 2-month history of retrosternal and midepigastric pain. A GI etiology was initially treated unsuccessfully with antireflux medications. A chest radiograph showed a 4.6-cm mass in the right upper lobe of the lung, and computed tomography showed right apical bullous formation with no lymphadenopathy. Bronchoscopy revealed no endobronchial lesions, and biopsy was nondiagnostic. The histopathologic and immunophenotypic analysis of a right upper lobectomy specimen was diagnostic of classic biphasic pulmonary blastoma. The rarity of these tumors makes easy identification difficult. Immunohistochemical analysis must be used to arrive at the proper diagnosis. It is imperative that there be good communication between the surgeon and pathologist and that institutions have access to facilities with the ability of identifying these complex tumors.

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Recurrent cardiac hydatid cyst located near the root of the superior vena cava and the interatrial septum: a case report

10.36811/jcshd.2022.110023 ◽

2022 ◽

pp. 1-4

Author(s):

Redha Lakehal ◽

Farid Aymer ◽

Soumaya Bendjaballah ◽

Rabah Daoud ◽

Khaled Khacha ◽

...

Keyword(s):

Hydatid Cyst ◽

Facial Paralysis ◽

Superior Vena Cava ◽

Superior Vena ◽

Vena Cava ◽

Lower Lobe ◽

Lateral Wall ◽

Right Atrial ◽

Risk Of Rupture ◽

The Right

Introduction: Cardiac localization of hydatid disease is rare (<3%) even in endemic countries. Affection characterized by a long functional tolerance and a large clinical and paraclinical polymorphism. Serious cardiac hydatitosis because of the risk of rupture requiring urgent surgery. The diagnosis is based on serology and echocardiography. The aim of this work is to show a case of recurrent cardiac hydatid cyst discovered incidentally during a facial paralysis assessment. Methods: We report the observation of a 26-year-old woman operated on in 2012 for pericardial hydatid cyst presenting a cardiac hydatid cyst located near the abutment of the SCV discovered incidentally during an exploration for left facial paralysis: NYHA stage II dyspnea. Chest x-ray: CTI at 0.48. ECG: RSR. Echocardiography: Image of cystic appearance at the level of the abutment of the SVC. SAPP: 38 mmhg, EF: 65%. Thoracic scan: 30/27 mm cardiac hydatid cyst bulging the lateral wall of the right atrium and the trunk of the right pulmonary artery with fissured cardiac hydatid cyst of the apical segment of the right lung of the right lower lobe with multiple bilateral intra parenchymal and sub pleural nodules. The patient was operated on under CPB. Intraoperative exploration: Presence of a hard and whitish mass, about 03 / 03cm developed in the full right atrial wall opposite the entrance to the superior vena cava. Procedure: Resection of the mass removing the roof of the LA, the AIS and the wall of the RA with reconstruction of the roof of the RA by patch in Dacron and reconstruction of the IAS and the wall of the RA by a single patch in Dacron. Results: The postoperative suites were simple. Conclusion: The hydatid cyst is still a real endemic in Algeria, the cardiac location is rare but serious and can constitute a real surgical emergency, hence the importance of prevention. Keywords: Hydatid cyst of the heart; Recurrence; Surgery; Cardiopulmonary Bypass; Prevention

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Pulmonary Tuberculosis mimicking a right Eventration on Radiography: The falsity of single view radiograph in the diagnosis of a precursor of pulmonary disease: A Case Report

Babcock University Medical Journal (BUMJ) ◽

10.38029/bumj.v4i1.65 ◽

2021 ◽

Vol 4 (1) ◽

pp. 33-37

Author(s):

John Ogunkoya ◽

Oluwatosin Yetunde Adesuyi

Keyword(s):

Pulmonary Tuberculosis ◽

Lower Lobe ◽

Middle Lobe ◽

The Body ◽

Single View ◽

Lymph Node Enlargement ◽

History Of ◽

Chest X Ray ◽

The Right ◽

High Index Of Suspicion

Background: The diaphragm is one of the most important muscles of respiration in the body separating the abdomen from the thorax. Abnormalities of the diaphragm could be congenital or acquired, morphological or functional while pulmonary infection e.g. pulmonary tuberculosis, is implicated in its etiology. Case presentation: A 63-year- old man with six weeks history of cough productive of yellowish sputum. Chest X-ray showed a uniform well-circumscribed opacity in the right lower lobe abutting on or in continuum with the right diaphragm consistent with a diaphragmatic hump. Sputum Gene Xpert was positive for Mycobacterium tuberculosis. Chest CT scan revealed bilateral lymph node enlargement with hyperdense lesions in the anterior basal segment of the right lower lobe and medial bronchopulmonary segments of the right middle lobe. He was treated for 6 months with first-line anti-tuberculosis drugs. Discussion: The incidence of the diaphragmatic hump on chest radiograph worldwide and among Nigerians is unknown. The association of diaphragmatic hump with chest infection has been well document. The association of diaphragmatic hump with pulmonary tuberculosis is uncommon. Conclusion: A high index of suspicion is needed to diagnose pulmonary tuberculosis with atypical clinical and radiological presentations. Such prompt diagnosis will aid the treatment of the disease.

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Sudden Onset of Diplopia and a Skeletal Muscle Antibody

10.1093/med/9780197583425.003.0052 ◽

2021 ◽

pp. 160-162

Author(s):

John R. Mills

Keyword(s):

Computed Tomography ◽

Myasthenia Gravis ◽

Patent Foramen Ovale ◽

Time Course ◽

Vision Loss ◽

Sudden Onset ◽

Foramen Ovale ◽

Clinical Disorder ◽

History Of ◽

The Right

A 62-year-old man with a history of migraine came to the emergency department with sudden onset of horizontal diplopia and, subsequently, bilateral ptosis. He noted feeling unsteady when walking. He reported that the diplopia worsened throughout the day. He had a history of hepatitis C infection. He had some vision loss in his left eye, which was thought to relate to a retinopathy. He disclosed that he had a history of cold feet and had notably high arches. He had a pacemaker because of syncope attributed to sick sinus syndrome. Computed tomography angiography of the head and neck were ruled negative for intracranial stenosis, occlusions, or aneurysms. Computed tomography of the head indicated a tiny lacunar infarct in the right caudate head. Magnetic resonance imaging of the brain identified a tiny, periaqueductal, enhancing abnormality in the right midbrain that was thought to be likely ischemic, but there was some concern for a demyelinating or inflammatory lesion. Cerebrospinal fluid evaluation indicated an increased protein concentration. Serologic evaluation for myasthenia gravis striational antibodies were positive at a titer of 1:240. Serum protein studies indicated the presence of polyclonal hypergammaglobulinemia. Myasthenia gravis was effectively ruled out. Given the hyperacute time course, the patient’s clinical disorder was most probably explained by an ischemic stroke that affected the oculomotor nuclei regions causing ptosis and ophthalmoparesis. On follow-up, the patient was discovered to have a patent foramen ovale. Whether the patent foramen ovale was a contributing factor to the stroke is uncertain. The recurrence rate in this setting is thought to be low relative to other causes of stroke. Ultimately it was decided to not close the patent foramen ovale and to maintain the patient on clopidogrel and adult low-dose aspirin. The onset of diplopia is typically sudden, but this occurs exclusively with vascular pathologic processes. Diplopia that appears intermittently with diurnal variation suggests the possibility of a neuromuscular junction disease such as myasthenia gravis.

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Castleman's Disease: An Intrapulmonary Form with Intrafissural Development

The Scientific World JOURNAL ◽

10.1100/tsw.2009.110 ◽

2009 ◽

Vol 9 ◽

pp. 940-945 ◽

Cited By ~ 6

Author(s):

Hajer Racil ◽

Sana Cheikh Rouhou ◽

Olfa Ismail ◽

Saoussen Hantous-Zannad ◽

Nawel Chaouch ◽

...

Keyword(s):

Contrast Enhancement ◽

Castleman’S Disease ◽

Lower Lobe ◽

Unknown Etiology ◽

Castleman's Disease ◽

Curative Surgery ◽

Abnormal Shadow ◽

History Of ◽

Chest X Ray ◽

The Right

Castleman's disease (CD) is an uncommon, mainly benign, lymphoproliferative disorder of unknown etiology, mostly involving the mediastinum. Parenchymal lung involvement of the disease is exceedingly rare. We describe a case of CD in a 23-year-old woman with a 4-year history of recurring dyspnea and nonproductive cough, whose chest X-ray showed an abnormal shadow of the right hilum. Chest computed tomography confirmed the presence of a tissue-density mass of the right lower lobe, demonstrating poor contrast enhancement, associated with multiple laterotracheal and mediastinal lymphadenopathies. The patient underwent curative surgery, revealing a right hilar compressive mass, with an intrafissural development between the superior and middle lobes. Pneumonectomy was performed due to profuse bleeding. This case of CD is particular because of its unusual intrapulmonary location and its intrafissural development. Poor contrast enhancement is atypical in CD.

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Hemopericardium and Cardiac Tamponade Secondary to Migrated Inferior Vena Cava Filter

Case Reports in Cardiology ◽

10.1155/2018/5919767 ◽

2018 ◽

Vol 2018 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Jeet J. Mehta ◽

Benjamin DeMarco ◽

John P. Vavalle ◽

Khola S. Tahir ◽

Joseph S. Rossi

Keyword(s):

Inferior Vena Cava ◽

Cardiogenic Shock ◽

Cardiac Tamponade ◽

Inferior Vena Cava Filter ◽

Inferior Vena ◽

Vena Cava ◽

Vena Cava Filter ◽

Filter Placement ◽

History Of ◽

The Right

A 73-year-old female presented with cardiogenic shock secondary to hemopericardium and cardiac tamponade. Imaging revealed two fractured legs of an inferior vena cava filter, with one leg within the anterior myocardium of the right ventricle and another penetrating the inferior septum through the middle cardiac vein. Hemopericardium and cardiac tamponade were treated with pericardiocentesis. A multidisciplinary meeting resulted in deferring further action against the embedded fractured legs of the filter with consideration of the patient’s age and comorbidities. This case report should alert clinicians to think about hemopericardium as a cause of cardiac tamponade and cardiogenic shock in a patient with a history of an inferior vena cava filter placement.

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PARATHYROMATOSIS: A RARE CASE OF RECURRENT HYPERPARATHYROIDISM LOCALIZED BY FOUR-DIMENSIONAL COMPUTED TOMOGRAPHY

AACE Clinical Case Reports ◽

10.4158/accr-2019-0225 ◽

2019 ◽

Vol 5 (6) ◽

pp. e384-e387 ◽

Cited By ~ 1

Author(s):

Abraham E. Wei ◽

Matthew R. Garrett ◽

Ankur Gupta

Keyword(s):

Computed Tomography ◽

Rare Case ◽

Clinical Laboratory ◽

Parathyroid Tissue ◽

Severe Hypercalcemia ◽

Positron Emission ◽

Affected Tissue ◽

History Of ◽

The Right ◽

Recurrent Hyperparathyroidism

Objective: To present a rare case of parathyromatosis. Methods: We present the clinical, laboratory, and imaging findings, along with a review of the literature. Results: A 33-year-old man with a history of right upper parathyroid adenoma removal 5 years prior due to hyperparathyroidism was admitted for severe hypercalcemia (15.6 mg/dL; normal, 8.5 to 10.5 mg/dL) with elevated plasma parathyroid hormone (PTH) (882 pg/mL; normal, 15 to 65 pg/mL). Ultrasound, computed tomography (CT), sestamibi, and positron emission tomography scans were unremarkable; however, a four-dimensional CT (4DCT) of the neck showed an area of increased signal enhancement and hypervascularity without discrete nodule in the posterior right thyroid region. The patient underwent parathyroid surgical exploration with right hemithyroidectomy and compartment neck dissection to remove the affected tissue. PTH levels dropped to 208 pg/mL postoperatively; calcium decreased but remained elevated at 12.7 mg/dL. Pathology revealed the presence of several small nodular foci of atypical hyperplastic parathyroid tissue in the right thyroid and soft tissue in the left central neck compartment consistent with parathyromatosis. Conclusion: This case report represents the first-time use of 4DCT to localize parathyromatosis. Parathyromatosis is a rare but problematic cause of recurrent hyperparathyroidism. Ultrasound and 4DCT may represent the best imaging modalities for identification and perioperative management to remove all affected tissue without reseeding.

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Bronchial Leech Infestation in a 15-Year-Old Female

Case Reports in Pediatrics ◽

10.1155/2016/2372686 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4

Author(s):

Mohammad Ashkan Moslehi ◽

Mohammad Hadi Imanieh ◽

Ali Adib

Keyword(s):

Computed Tomography ◽

Foreign Body ◽

Young Children ◽

Lower Lobe ◽

Foreign Body Aspiration ◽

Ground Glass ◽

Chest Computed Tomography ◽

X Ray ◽

Chest X Ray ◽

The Right

Foreign body aspiration (FBA) is a common incidence in young children. Leeches are rarely reported as FBA at any age. This study describes a 15-year-old female who presented with hemoptysis, hematemesis, coughs, melena, and anemia seven months prior to admission. Chest X-ray showed a round hyperdensity in the right lower lobe. A chest computed tomography (CT) demonstrated an area of consolidation and surrounding ground glass opacities in the right lower lobe. Hematological investigations revealed anemia. Finally, bronchoscopy was performed and a 5 cm leech was found within the rightB7-8bronchus and removed by forceps and a Dormia basket.

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