POSSIBILITIES OF COMPUTED TOMOGRAPHY IN THE DIAGNOSIS OF PNEUMONIA ASSOCIATED WITH COVID-19

Актуальность проблемы быстрой и точной диагностики пневмонии, ассоциированной с covid-19, в период присвоения коронавирусной инфекции (covid-19) статуса пандемии, безусловно бесспорна. Своевременная диагностика влияет на прогноз заболевания. Цель оценить возможности КТ при выявлении пневмонии, ассоциированной с covid-19 и уточнения стадии развития пневмонии. Материал и методы. Исследования проводились на мультиспиральном компьютерном томографе SOMATOM Difinition AS (Siemens). В исследования включены пациенты, прошедшие КТ грудной полости с 01.06.2020. по 31.08.2020. из базы Центральной Городской Клинической Больницы (ЦГКБ) г.Алматы. Результаты КТ оценивали визуальным методом. Визуальную оценку осуществляли с использованием трехплоскостной реформации изображений, что позволяло определить локализацию, контуры, протяженность измененных участков легочной ткани. Результаты. По данным проведенных обследований у большинства пациентов были выявлены признаки воспалительных изменений в легких, которые оценивались рентгенологами нашей клиники с учетом уже известных на тот момент специфических паттернов, характерных для пневмонии, ассоциированной с covid-19. По результатам КТ органов грудной клетки при дифференциальной диагностике пневмонии, ассоциированной с covid-19 от другой легочной патологии. Специфичность составила 88%. Заключение. КТ органов грудной полости является высокоспецифичным методом исследования при диагностике пневмонии, ассоциированной с covid-19. The urgency of the problem of rapid and accurate diagnosis of pneumonia associated with covid-19 during the assignment of coronavirus infection (covid-19) pandemic status is certainly indisputable. Timely diagnosis affects the prognosis of the disease. The aim is to evaluate the possibilities of CT in detecting pneumonia associated with covid-19 and to clarify the stage of development of pneumonia. Material and methods. The studies were carried out on a multispiral computed tomograph SOMATOM Difinition AS (Siemens). The study included patients who underwent CT of the thoracic cavity from 01.06.2020. to 31.08.2020. from the base of the Central City Clinical Hospital (CGKB) in Almaty. CT results were evaluated by visual method. Visual assessment was carried out using a three-plane image reformation, which made it possible to determine the localization, contours, and extent of the altered areas of lung tissue. Results. According to the conducted examinations, most patients showed signs of inflammatory changes in the lungs, which were evaluated by radiologists of our clinic taking into account the specific patterns already known at that time, characteristic of pneumonia associated with covid-19. According to the results of CT of the chest organs in the differential diagnosis of pneumonia associated with covid-19 from other pulmonary pathology. The specificity was 88%. Conclusion. CT of the thoracic cavity is a highly specific method of investigation in the diagnosis of pneumonia associated with covid-19.

Case Report: Pleuropulmonary Blastoma in a 2.5-Year-Old Boy: 18F-FDG PET/CT Findings

Pleuropulmonary blastoma (PPB) is a rare invasive primary malignancy in the thoracic cavity that occurs mainly in infants and children. It is often misdiagnosed and not treated correctly and promptly due to the lack of specificity of clinical symptoms and conventional imaging presentations. We report a 2.5-year-old boy who underwent X-ray chest radiography, chest CT, and 18F-FDG PET/CT. PET/CT images demonstrated a sizeable cystic-solid mass with heterogeneous increased glucose metabolism in the left thoracic cavity. The diagnosis of PPB (type II) was finally confirmed by a CT-guided puncture biopsy of the active tumor tissue. This case highlights the critical role of 18F-FDG PET/CT in the diagnosis of PPB in children.

Transhiatal Chest Drainage Reduces The Frequency of Postoperative Thoracentesis In Transmediastinal Esophagectomy For Esophageal Cancer: A Retrospective Study

Background: Transmediastinal esophagectomy for esophageal cancer occasionally results in the postoperative accumulation of pleural effusion despite the preservation of the mediastinal pleura. Transhiatal chest drainage has reported utility in thoracic esophagectomy; however, its use in transmediastinal esophagectomy remains unelucidated. This study aimed to evaluate the effectiveness and safety of transhiatal chest drainage in transmediastinal esophagectomy.Methods: This retrospective study included patients who underwent transmediastinal esophagectomy for esophageal cancer from 2018 to 2020. The transhiatal chest drainage involved the insertion of a 19-Fr Blake® drain from the inferior hepatic space to the left thoracic cavity through the hiatus. The drainage group comprising 13 patients was compared with the non-drainage group comprising 13 patients in whom a transhiatal chest drainage tube was not placed during transmediastinal esophagectomy.Results: The frequency of thoracentesis in the drainage group was significantly lower than that in the non-drainage group (p = 0.03). There were no significant differences between the two groups in terms of the occurrence of other postoperative complications, duration of oxygen administration, and postoperative hospital stay.Conclusions: Transhiatal chest drainage could evacuate pleural effusion effectively and safely after transmediastinal esophagectomy. Therefore, this procedure is clinically useful in transmediastinal esophagectomy for esophageal cancer.

Spirometric lung age for predicting the risk of pulmonary complications after thoracic surgeries

Annotation. Surgical interventions for diseases of the thoracic cavity are one of the most invasive surgical procedures, which are often accompanied by postoperative complications, which increase mortality, prolong hospital stays, require additional costs and correlate with poor long-term survival. However, respiratory complications remain the most common of non-surgical complications and their frequency varies from 13 to 38%. So far, several studies have shown that respiratory dysfunction is an independent risk factor for postoperative pneumonia. The aim – investigate whether it is possible to use spirometric lung age to predict the occurrence of postoperative pneumonia after thoracic surgeries. The study was performed on 192 patients with diseases of the thoracic cavity (esophagus, lungs, mediastinum), underwent surgery in the thoracoabdominal department of the Shalimov’s National Institute of Surgery and Transplantation. Statistical software EZR v.1.54 was used for statistical calculations (graphical user interface for statistical software R version 4.0.3, R Foundation for Statistical Computing, Vienna, Austria). We found a very strong association between the risk of developing pulmonary complications and the age of the lungs, AUC=0.97 (95% confidence interval from 0.94 to 0.99). When choosing the optimal point for predicting the risk of pulmonary complications obtained: Lung age critical = 99.6 years. Thus, at Lung age >99.6 years, the development of postoperative pulmonary complications is predicted. At Lung age <99.6 years, the absence of postoperative pulmonary complications is predicted. When choosing this decision point, the sensitivity is 93.5% (82.1-98.6%), specificity – 95.9% (91.3-98.5%). Therefore, spirometric age of the lungs was associated with the incidence of postoperative pulmonary complications in patients undergoing surgery for thoracic disease. This parameter deserves attention as a predictor of the probability of developing postoperative pneumonia after thoracic surgeries and can help in assessing the state of respiratory function of patients.

Pleural Effusion Caused by Mycolicibacterium mageritense in an Immunocompetent Host: A Case Report

Mycolicibacterium mageritense (M. mageritense) is a rare species among rapidly growing mycobacteria, and M. mageritense pleurisy is very rare. Here, we report for the first time, an immunocompetent patient with pleurisy caused by M. mageritense. The patient had no history of immunodeficiency and no recurrence of lung cancer after surgery. However, 8 months after surgery, he developed a new lung shadow and pleurisy. Although whole-genome analysis of the colony cultured from the patient's pleural fluid revealed M. mageritense, we could not identify it in time, resulting in a poor outcome. M. mageritense pleurisy in this case might have occurred via a bulla rupture of the lung lesion because computed tomography of the patient's chest showed pneumothorax and a lung lesion in contact with thoracic cavity. This case emphasized that nontuberculous mycobacterial pleurisy should be considered in the differential diagnoses of pleural effusion even in immunocompetent patients. Advancement of comprehensive and rapid analyses of genomic data from clinical specimens will lead to better treatment strategies.

A Case of Multiple Posterior Intercostal Artery Common Trunks in Conjunction with Additional Arterial Variations

Several thoracic vasculature variations were observed in an 81-year-old male cadaver during routine dissection. These included 5 common trunks of posterior intercostal arteries, a descending branch of the right vertebral artery, and atypical neurovascular relationships within intercostal spaces. On the right side, two common trunks of posterior intercostal arteries were observed supplying the 4th-7th intercostal spaces and 9th-11th intercostal spaces, respectively. There was also a small accessary branch supplying the 9th intercostal space. The first three posterior intercostal spaces on the right were supplied by a descending branch of the vertebral artery. On the left side, three common trunks of posterior intercostal arteries were encountered, supplying intercostal spaces 3-5, 6-7, and 11 plus the subcostal space. An atypical neurovascular relationship was observed in the right 6th intercostal space, as well as the left 2nd, 3rd, and 6th intercostal spaces. This is the first case report that presents 5 common trunks of posterior intercostal arteries, as well as common trunks in conjunction with other arterial variation in the posterior thoracic wall. These variations carry a high level of clinical significance and may be helpful in guiding decision-making related to surgical procedures related to the posterior thoracic cavity and spine.

A pneumatocele observed in the thoracic cavity after bronchoalveolar lavage

A 76-year-old man was admitted to the respiratory medicine department with 5 days of a non-productive cough and exertional dyspnea. A computed tomography revealed multiple mild patchy consolidations in both lungs (Figure 1). Despite antibiotic therapy, there was poor improvement in laboratory and radiological parameters. A bronchoscopy was performed on day 5. The bronchoscopy was wedged in left B5 and a bronchoalveolar lavage (BAL) was performed. After the BAL, we noticed a fistula in the depth of left B5 and saw a structure like a pleural cavity in the back of the fistula (Figure 2). We diagnosed the patient’s condition as pneumatocele (PC). BAL showed 46% lymphocytes and the CD4/8 ratio as 3:7. These findings suggested cryptogenic organizing pneumonia (COP). It took 3 weeks for the PC to improve. Bilateral multiple consolidations improved after the administration of a steroid (PSL 0.5 mg/kg). PCs can occur in infections, chest trauma, barotrauma from mechanical ventilation, and bronchial interventions [1,2]. The mechanism of PC formation is closely related to that of a check valve. The check valve may be composed of exudate from inflammation and the destroyed wall of the respiratory tract [3]. In this case, it was considered that the wedged bronchoscopy and collapsed bronchial wall became the check-valve. PCs can be a severe condition including tension pneumothorax, bronchopleural fistula, and secondary infections [4]. In our case, as we were concerned about new complications due to the PC we did not prescribe a steroid for COP until the PC had improved. To our knowledge, no papers have reported internal observations of PC. We herein report the first case of PC observed in the thoracic cavity after BAL.

Dual scope method: A novel application of a simultaneous multi-image display system for a thoracoscopic robotic lobectomy

The advantages of a multi-input display system platform in robotic thoracic surgery have not been well described. We report the novel application of a multi-display system for simultaneous visualization of an additional thoracoscopic image during a robotic lobectomy, which we have named the dual scope method. An additional thoracoscope is inserted from the bottom of the thoracic cavity. This thoracoscope visualizes the whole operative field, including the robot arms, from a bystander’s viewpoint. By providing an integrated image from the robot scope and the thoracoscope, various problems, such as arm collision, inappropriate instrument direction, excessive traction, and injury, can be solved or avoided much more easily and safely than with the use of the robotic image alone. The dual scope method facilitates the safety and efficiency of robotic lobectomy.

Dilatated Cardiomyopathy In Two Month Old Puppy

Background: Canine dilated cardiomyopathy (DCM) is a disease that results in a decreased ability of the cardiac contraction to generate pressure to pump blood through the vascular system. DCM is characterized by dilation of the ventricles with ventricular wall thinning. Purpose: The DCM case in Indonesia is rarely reported; therefore, this paper contains information about dilatated cardiomyopathy in a 2-month-old puppy. Case Analyze: A two-month-old local dog arrived with a complaint about coughing, loss of appetite, fatigue, and swelling on extremities, also having a history of seizures and bloody diarrhea. Physical examination shows that the patient breathes using abdominal type and polypnea, tachycardia pulse, pale mucose, and dehydration. Electrocardiogram result shows tachycardia sinus and abnormality in the depression of ST-segment. Radiography examination shows heart dilation and liquid accumulation in the thoracic cavity and abdomen. Hematology routine examination shows microcytic hyperchromic anemia, leucocytosis, and eosinophilia. Feces examination resulted in negative. Pathology anatomy examination show dilatated cardio, pulmonum hepatization, fluid accumulation in the thoracic cavity and abdomen cavity. Result: According to anamnesis, clinical examination, laboratory examination, and anatomy pathology examination can be concluded that the dog, in this case, is diagnosed with dilatated cardiomyopathy.