scholarly journals Chest tube telltale: A miraculous injury

2021 ◽  
Vol 2 (3) ◽  
Author(s):  
Mohamed Shafi Bin Mahboob Ali ◽  
◽  
Ahmad Zuhdi Mamat ◽  
Keyword(s):  
Chest Tube ◽  
Heart Function ◽  
Interventricular Septum ◽  
Medical Officer ◽  
High Morbidity ◽  
Left Hemithorax ◽  
Left Chest ◽  
Progressive Dyspnea ◽  
Rapid Flow ◽  
Chest X Ray

A 35-years-old man with an underlying lymphoma presented with the complaint of progressive dyspnea. The left hemithorax was dull on percussion with a significant reduce air entry. Chest x-ray showed a total ‘white-out’ of the left hemithorax suggestive of pleural effusion. A medical officer inserted a left chest tube with the sharp trochar provided. After the puncture, he noticed a rapid flow of frank blood. Otherwise, patient’s vital sign was stable. An urgent CT showed the tip of the tube was a milimetres into the interventricular septum. Fortunately, the chest tube dislodged after the patient ambulated. He was monitored in the ICU and an ECHO was done which showed a normal heart function. He was referred to the interventional radiologist for pig-tail drainage. He was discharged the following week. Chest tube insertion using a sharp trochar should not be recommended as it is associated with high morbidity and mortality.

scholarly journals A case of pulmonary inflammatory myofibroblastic tumor treated with bronchoscopic therapy plus lobectomy

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Fan Yang ◽  
Wenxia Zhang ◽  
Cheng Han ◽  
Hanliang Jiang
Keyword(s):  
Inflammatory Myofibroblastic Tumor ◽  
Bronchial Obstruction ◽  
Sleeve Resection ◽  
Interventional Bronchoscopy ◽  
Left Hemithorax ◽  
Progressive Dyspnea ◽  
Left Upper Lobectomy ◽  
History Of ◽  
Chest X Ray ◽  
Appropriate Therapy

Abstract Background Inflammatory myofibroblastic tumor (IMT) is a rare tumor with malignant potential. We presented a case of a young adult who was diagnosed with IMT and treated with loop electrocautery therapy to relieve airway obstruction, followed by lobectomy to complete resection. Recent studies have supported the use of such interventional resection methods. Case presentation A non-smoking 30-year-old woman presented with a 1-month history of progressive dyspnea and productive cough. The Chest X-ray showed a homogenous opacity invading the entire left hemithorax, and the mediastinum content was attracted to the left side. In an effort to avoid pneumonectomy and afford rapid palliation of dyspnea, loop electrocautery was selected as the most appropriate therapy. The left upper lobectomy by thoracoscopy was performed instead of left upper lobe sleeve resection in order to better prevent the recurrence of lung atelectasis. After 6 years of follow-up, no evidence of recurrence has been found till now. Conclusion Interventional bronchoscopy coupled with surgical resection serves not only as a palliative management to bronchial obstruction but also a way to avoid pneumonectomy.

scholarly journals Malignant Solitary Fibrous Tumor of the Pleura: Case Report

2021 ◽  
Author(s):  
Matthew S Khouzam ◽  
Nayer Khouzam
Keyword(s):  
Surgical Resection ◽  
Solitary Fibrous Tumor ◽  
Left Lung ◽  
Left Hemithorax ◽  
Solitary Fibrous Tumors ◽  
Progressive Dyspnea ◽  
Resected Tumor ◽  
Chest X Ray ◽  
Bulky Mass ◽  
Fibrous Tumor

Abstract Background: Solitary fibrous tumors of the pleura are rare diseases of the thoracic cavity. They frequently grow unnoticed until they exert compressive effects on adjacent organs. Treatment of solitary fibrous tumors of the pleura is surgical resection. Post-operative surveillance is recommended to identify early recurrent disease. Case Presentation: We present a rare case of a 76-year-old female patient with no previous pulmonary history who presented with progressive dyspnea, fatigue, and involuntary weight loss. On chest X-ray and computed chest tomography scan, she was found to have a 16.7 cm x 12.8 cm x 10.1 cm bulky mass occupying the left hemithorax with associated compressive atelectasis of the lung. She underwent a computed tomography guided biopsy that revealed the mass to be a solitary fibrous tumor. The patient underwent left muscle sparing lateral thoracotomy with complete resection of the tumor. Post procedure, the left lung fully expanded. 18 months post-resection, she developed a 3.3 cm x 1.7 cm tumor along the left internal thoracic artery lymph node chain which was histologically identical to the resected tumor. The patient is currently being treated with bevacizumab and temozolomide. Conclusion: Solitary fibrous tumors are very rare pleural tumors. Surgical resection is the treatment of choice followed by close post-operative surveillance.

Clinico-bacteriological Profile and Outcome of Empyema Thoracis in Children at a Tertiary Care Hospital of Central Nepal

2020 ◽  
Vol 16 (3) ◽  
Author(s):  
Atanu Pan ◽  
Debarshi Jana
Keyword(s):  
Ct Scan ◽  
Broad Spectrum ◽  
Chest Tube ◽  
Chest Tube Drainage ◽  
Diagnostic Tools ◽  
High Morbidity ◽  
Care Hospital ◽  
Empyema Thoracis ◽  
First Line ◽  
Tube Drainage

Background: Empyema thoracis (ET) is a serious infection of the pleural space. Despite the availability of broad spectrum antibacterial, improved vaccination coverage and better diagnostic tools, Empyema Thoracis remains associated with high morbidity worldwide. Delay   in   early   diagnosis,   failure   to institute   appropriate   antimicrobial   therapy,   multidrug resistant   organisms,   malnutrition,   comorbidities,   poor health  seeking  behaviour  and  high treatment  cost  burden contribute  to  increased  morbidity  in  children. The available  treatment  options  include  intravenous broad-spectrum antibiotics  either  alone  or  in  combination  with surgical  procedure  (thoracocentesis,  chest  tube  drainage, fibrinolytic  therapy,  decortications  with  video  assistedthoracoscopic surgery (VATS) and open drainage. Methods: Fifty Children between 1 month to 16 years admitted in the Pediatrics Ward, PICU of College of Medical Sciences, Bharatpur,Nepal. Data analysis was done by SPSS 24.0. Results: Present study found that according to blood culture, 3(6.0%) patients had enterococcus, 40(80.0%) patients had no growth, 2(4.0%) patients had pseudomonas, 4(8.0%) patients had staphylococcus and 1(2.0%) patients had streptococcus. We found that 20(40.0%) patients had done CT scan thorax, 30(60.0%) patients had not done CT scan thorax and 32(64.0%) patients had Amoxiclav first line antibiotic and 18(36.0%) patients had Ceftriaxone first line antibiotic. Conclusions: Suitable antibiotics and prompt chest tube drainage is an effective method of treatment of childhood empyema, especially in resource-poor settings. Majority of the patients progress on this conservative management and have good recovery on follow up.  

Left bundle branch pacing improved heart function in a 10-year-old child after a 3-month follow-up

EP Europace ◽  
2020 ◽  
Vol 22 (8) ◽  
pp. 1234-1239
Author(s):  
Wei Ji ◽  
Xueying Chen ◽  
Jie Shen ◽  
Diqi Zhu ◽  
Yiwei Chen ◽  
...  
Keyword(s):  
Heart Function ◽  
Interventricular Septum ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Bundle Branch Block ◽  
Ventricular Ejection Fraction ◽  
Intracardiac Electrogram ◽  
Ventricular Activation ◽  
Pacing Lead

Abstract Aims As a physiological pacing strategy, left bundle branch pacing (LBBP) were used to correct left bundle branch block (LBBB), however, there is no relevant report in children. We aimed to evaluate the feasibility of LBBP in children. Methods and results Left bundle branch pacing was performed in a 10-year-old girl with a second-degree atrioventricular and LBBB. Under the guide of fluoroscopy, the pacing lead was deeply screwed into the interventricular septum to gain right bundle branch block (RBBB) pattern of paced QRS. Selective LBBP was achieved with a typical RBBB pattern of paced morphology and a discrete component between stimulus and ventricular activation in intracardiac electrogram and reached the standard of the stimulus to left ventricular activation time of 56 ms. At a 3-month follow-up, the LBBP acquired the reduction of left ventricular size and enhancement of left ventricular ejection fraction. Conclusion The application of LBBP in a child was first achieved with inspiring preliminary results. The LBBP can be carried out in children by cautiousness under the premise of strict grasp of indications.

The Mei mini-maze procedure

2020 ◽  
Vol 28 (7) ◽  
pp. 416-420
Author(s):  
Zhaolei Jiang ◽  
Nan Ma ◽  
Min Tang ◽  
Hao Liu ◽  
Shiao Ding ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Maze Procedure ◽  
Surgical Trauma ◽  
High Morbidity ◽  
Radiofrequency Energy ◽  
Thoracoscopic Approach ◽  
Left Chest ◽  
Video Assisted ◽  
Left Pulmonary Vein ◽  
The Right

Atrial fibrillation is a common clinical arrhythmia with high morbidity and a risk of stroke. The Cox-maze IV procedure that uses radiofrequency energy for ablation is established as an effective way to eliminate atrial fibrillation. Compared to the Cox-maze IV procedure, the video-assisted Wolf mini-maze procedure is associated with reduced surgical trauma, but still requires bilateral thoracotomies, and the ablation line connecting the right and left pulmonary vein isolations cannot be created with a bipolar ablation clamp. We have developed a novel video-assisted mini-maze technique that uses a unilateral (left chest) thoracoscopic approach (the Mei mini-maze procedure).

DOZ047.79: Bronchoscopic treatment of plastic bronchitis in children

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
M Y Erdas ◽  
N Valiyev ◽  
K K Cerit ◽  
Y Gokdemir ◽  
G Kiyan
Keyword(s):  
Respiratory Distress ◽  
Rare Condition ◽  
Airway Disease ◽  
Underlying Disease ◽  
Bronchial Tree ◽  
X Rays ◽  
Plastic Bronchitis ◽  
Left Hemithorax ◽  
X Ray ◽  
Chest X Ray

Abstract Purpose Plastic bronchitis or cast bronchitis is a rare condition characterized by the formation of large gelatinous or rigid airway casts. Classification of plastic bronchitis is done by disease association and cast histology. This rare condition can cause airway obstruction and there is no standardized treatment. Here are presented two cases with plastic bronchitis treated by bronchoscopic removal of casts in our clinic. Patients Case 1: A 9-year-old boy presented with wheezing, cough, and respiratory distress. He expectorated the cast spontaneously and the cast was misdiagnosed as germinative membrane of a hydatid cyst at the previous center. Total collapse of the left hemithorax was seen on chest X-ray. Any underlying disease was not detected. The plastic-like solid structure was detected and easily extracted from the bronchial tree. Pathology results of the casts were eosinophilic mucoid casts. The patient experienced three bronchoscopic removals and had no recurrence thereafter for two years. Case 2: A 7-year-old girl presented with persistent cough and respiratory distress. The patient was referred to our center with the diagnosis of foreign body aspiration. Total collapse of the right middle and lower segment and partial collapse of the upper segment were seen on chest X-ray. Previously, she was diagnosed with reactive airway disease. The plastic-like semisolid structure was detected during bronchoscopy its extraction from the bronchial tree was not easy but was possible. Pathology results were eosinophilic mucoid and fibrinotic casts. This patient still needs bronchoscopy for cast removal after 12 bronchoscopic removals but her symptoms and bronchoscopy findings have regressed with time. Conclusion Bronchoscopic extraction of casts provides fast improvement of patients’ symptoms and postoperative chest X-rays, but recurrence of cast formation is common. Nevertheless, it is the mostly chosen therapy in the literature. Further researches in this area are required.

scholarly journals Factors Associated with Chest Tube Placement in Blunt Trauma Patients with an Occult Pneumothorax

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Michael Paplawski ◽  
Swapna Munnangi ◽  
Jody C. Digiacomo ◽  
Edwin Gonzalez ◽  
Ashley Modica ◽  
...  
Keyword(s):  
Blunt Trauma ◽  
Chest Tube ◽  
Rib Fractures ◽  
Tube Placement ◽  
Chest Tubes ◽  
Chest Tube Placement ◽  
X Ray ◽  
Factors Associated ◽  
Occult Pneumothorax ◽  
Chest X Ray

Background. An occult pneumothorax is identified by computed tomography but not visualized by a plain film chest X-ray. The optimal management remains unclear. Methods. A retrospective review of an urban level I trauma center’s trauma registry was conducted to identify patients with occult pneumothorax over a 2-year period. Factors predictive of chest tube placement were identified using univariate and multivariate logistic regression analysis. Results. A total of 131 patients were identified, of whom 100 were managed expectantly with an initial period of observation. Ultimately, 42 (32.0%) patients received chest tubes and 89 did not. The patients who received chest tubes had larger pneumothoraces at initial assessment, a higher incidence of rib fractures, and an increased average number of rib fractures, of which significantly more were displaced. Conclusions. Displaced rib fractures and moderate-sized pneumothoraces are significant factors associated with chest tube placement in a victim of blunt trauma with occult pneumothorax. The optimal timing for the first follow-up chest X-ray remains unclear.

Intrapleural Alteplase in a Patient with Complicated Pleural Effusion

2003 ◽  
Vol 37 (3) ◽  
pp. 376-379 ◽  
Author(s):  
Charlotte A Walker ◽  
Mary Beth Shirk ◽  
Marva M Tschampel ◽  
James A Visconti
Keyword(s):  
Pleural Effusion ◽  
Chest Tube ◽  
Pleural Cavity ◽  
Surgical Intervention ◽  
Chest Tube Drainage ◽  
Tube Drainage ◽  
X Ray ◽  
Case Summary ◽  
Chest X Ray ◽  
Intrapleural Administration

OBJECTIVE: To report the intrapleural use of alteplase in a patient diagnosed with complicated pleural effusion (CPE). CASE SUMMARY: A 62-year-old white woman admitted with respiratory distress and hypotension developed a right-sided multi-loculated pleural effusion. Thoracentesis and chest tube drainage were not successful in resolving the effusion. In an attempt to increase the drainage of the pleural effusion, alteplase 16 mg was administered into the pleural cavity via the chest tube on 6 consecutive days. As a result, the volume drained from the patient's chest tube increased, there was improvement on the chest X-ray, and she did not require surgical intervention. DISCUSSION: While streptokinase and urokinase have been shown to be useful adjuncts to chest tube drainage in the treatment of complicated pleural effusion and empyema, there have been no reports on the use of intrapleural alteplase. This report demonstrates that intrapleural administration of alteplase is a useful adjunct to tube drainage in resolving CPE. CONCLUSIONS: This patient's CPE resolved when intrapleural alteplase was used as an adjunct to chest tube drainage and antibiotics. Controlled trials need to be conducted to investigate fully the efficacy, dosing, and safety of intrapleural alteplase in the treatment of patients with CPE and empyema.

scholarly journals Echocardiographic and Doppler Aspects of Chronic Pulmonary Heart. About 11 cases

2021 ◽  
Vol 04 (16) ◽  
pp. 01-07
Author(s):  
Bani Am
Keyword(s):  
Right Ventricle ◽  
Inferior Vena ◽  
Interventricular Septum ◽  
Vena Cava ◽  
Maximum Velocity ◽  
Heart Patients ◽  
Specificity And Sensitivity ◽  
Chest X Ray ◽  
The Mean ◽  
The Right

Pulmonary chronic heart (CPC) is an enlargement associated or not with dilation of the right ventricle. Objective: To recall the echocardiographic-Doppler aspects essential for the screening of pulmonary chronic heart. Patients and method: Retrospective study carried out between January 2009 and April 2019 interesting the cases of pulmonary chronic heart. Results: out of 124 cases of pulmonary chronic heart, 11 cases were included. These were four men and 7 women with a mean age of 63 ± 19 years (range: 20-84 years). The radiological and electrical semiology of pulmonary chronic heart was found, lacking specificity and sensitivity. Dilation of the right heart chambers, dyskinesia of the interventricular septum and hypertrophy of the free wall of the right ventricle ˃ 5 mm were observed. The mean maximum velocity of tricuspid insufficiency on continuous Doppler was 4.6 ± 1.32 ms / s (Extremes: 3.59-7.58 m / s) and the mean dilation of the inferior vena cava was 23.2 ± 3.9mm (Extreme: 21.2-27mm). Conclusion: CPC is uncommon and predominant in women. The EKG and chest X-ray are first-line exams without sensitivity or specificity. Screening for CPC is based on echocardiographic-Doppler criteria. The right cardiac catheterization remains the key examination.

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