Pectoralis Muscle Mass on Chest CT at Admission Predicts Prognosis in Patients with Pneumonia

Background and Objectives. The concept of sarcopenia has been attracting attention in recent years, but its association with in-hospital mortality of patients with pneumonia is still unclear. Therefore, we investigated the relationship between pectoralis muscle mass on chest computed tomography (CT) and in-hospital mortality in patients with pneumonia. Methods. A retrospective cohort study was performed in patients aged 18 years or older with pneumonia who underwent chest CT within 24 hours of admission between April 2014 and March 2019. We measured the thickness, area, and volume of the pectoralis major and minor muscles at the level of the aortic arch. Factors associated with mortality were examined using logistic regression analysis. Results. A total of 483 patients (mean age 77 ± 14 years, 300 men (62%)) were included, and fifty-one patients (11%) died during admission. In univariate analysis, decreased thickness, area, and volume of the pectoralis major and minor muscles were associated with higher in-hospital mortality. Multivariate analysis with adjustment for age, gender, serum albumin, and A-DROP revealed that thinner pectoralis major and minor muscles were independent factors of poor prognosis (odds ratio: 0.878, 95% confidence interval (CI): 0.783–0.985, P = 0.026 and odds ratio: 0.842, 95% CI: 0.733–0.968, P = 0.016 , respectively). Approximately 25% of the patients died when the pectoralis minor muscle thickness was 5 mm or less, and no patients died when it was 15 mm or more. Conclusion. The pectoralis muscle mass may be an independent prognostic factor in hospitalized patients with pneumonia.

“Black ring-shaped burn” in button battery ingestion is not a burn — Comparison with charring using spectral CT

Objectives: To compare “black ring-shaped burn” (BRSB) and charring using spectral computed tomography (CT). Methods: Spectral CT was performed using chicken pectoralis minor muscle, processed in three ways and unprocessed as a control: a) BRSB generated by bringing the negative pole surface of a 3 V button battery (BB) into contact with the muscle; b) BRSB caused by a 1.5 V BB; c) charring caused by broiling; and d) control. Attenuation values were compared between BRSB and charring. Muscles were formalin-fixed and stained with Perls’ Prussian blue. Results: Attenuation values from polychromatic 120-kVp images were significantly higher for BRSBs than for charring. In the spectral Hounsfield unit curve, attenuation values for BRSBs were higher for lower energy. Histopathologically, BRSBs stained positively with Perls’ Prussian blue. Conclusions: This study using spectral CT revealed that BRSB contains metal and confirmed the presence of Fe3+ histopathologically. BRSB differs from charring due to burns. Advances in knowledge: The exact composition of BRSB remains unclear, but this report is the first to show that BRSB differs from charring using spectral CT. Clarification of the composition of BRSB is expected to facilitate the development of more effective BRSB removal therapy.

Giant Lipoma of The Breast: Special Clinical Finding

Lipomas are the most common benign tumors of mesenchymal origin.Lipoma of breast is somewhat difficult to diagnose clinically because of fattyconsistency of breast. Giant lipoma is the mass of lipoma that exceeds atleast 10 cm in one dimension or weighs a minimum of 1000 gr.Only veryfew case reports giant lipoma of the breast available in literature becauserarity in size and location. Due to the fatty composition of the breast,difficulties in diagnosis, threatment, and reconstruction are oftenencountered.Presently, we have reported a case of this rare entity in 49years old female with giant tumor of the left breast that most of its mass,causing breast asymmetry and feel heavy. The operative finding: looks likelipoma between pectoralis major muscle and pectoralis minor muscle witha diameter of 31 cm and weighs 3.1 kg. After excision the tumor we need tomammoplasty.Pathology anatomy examination showed a lipoma.

The Rare Five Finger Pectoralis Nerves: A Case Report

The brachial plexus is a complex network of nerve tissue in the human body that has been reported to vary from person to person. We describe a very rare variation of the brachial plexus found on a routine cadaveric dissection. On the left side of the chest, we identified two lateral pectoral nerves arising from the lateral cord and innervating the pectoralis major muscle; two medial pectoral nerves (MPNs) arising from the medial cord that innervates both pectoral muscles and a communicating branch that connects the lateral and MPN. In addition, this communicating branch had a nerve that innervated the pectoralis minor muscle. Knowing the variations of branching of the pectoral nerves is critical when performing any medical procedure in the pectoral region, such as plastic breast reconstruction surgery after modified radical mastectomy in breast cancer, removal of the pectoral muscles, anesthetizing the brachial plexus, or axillary dissection.

The role of the ultrasound examination of the brachial plexus in thoracic outlet syndrome

Introduction. Difficulties in determining the compression of the neurovascular bundle with the thoracic outlet syndrome raises the question of finding an accessible and reproducible method for the neuroimaging of the brachial plexus and surrounding tissues.Purpose of the study – to develop an ultrasound diagnostic algorithm using a stress test to determine the level and cause of brachial plexus compression in comparison with the results of a clinical assessment.Materials and methods. 111 patients with verified compression of the brachial plexus at the level of the interstitial (65.7 %) and bone-clavicular space (21.6 %), as well as the tendon of the pectoralis minor muscle (12.6 %) were examined. The study protocol including the Adson ultrasound stress test, the assessment of the lower trunk in the interstitial space, and the test with ultrasound evaluation of the axillary artery at the level of the tendon of the pectoralis minor muscle with passive abduction of the arm back and up was used.Conclusion. An ultrasound study of the brachial plexus demonstrated informativeness in assessing the level and possible cause of compression, which opens up the possibility of using the method in routine neurological practice.

Measurement of Pectoralis Minor Muscle Length in Women Diagnosed With Breast Cancer: Reliability, Validity, and Clinical Application

Background Decreased pectoralis minor muscle length is common after primary breast cancer treatment and can result in an abnormal position of the scapula. This position can contribute to shoulder pain and pathomechanics and can lead to problems such as impingement syndrome, rotator cuff tears, and frozen shoulder. Currently, there are limited reliable methods for measuring pectoralis minor length. Objective The objective of this study was to examine the reliability and validity of measuring pectoralis minor length in women diagnosed with breast cancer. Design This was a cross-sectional reliability and validity study. Methods Bilateral pectoralis minor length (in centimeters) was assessed using a palpation meter in women (N = 29) diagnosed with breast cancer by 2 licensed physical therapists who were masked to the measures. Bilateral pectoralis minor length was also measured using a motion capture system to assess validity. Results Intratester reliability (intraclass correlation coefficient, ICC [3,k] = 0.971; 95% confidence interval [CI] = 0.939–0.986; standard error of measurement [SEM] = 0.16 cm) and intertester reliability (ICC[3,k] = 0.915; 95% CI = 0.81–0.962; SEM = 0.31 cm) were excellent for the palpation meter on the affected side and the unaffected side (intratester reliability: ICC[3,k] = 0.951; 95% CI = 0.897–0.977; SEM = 0.19 cm; intertester reliability: ICC[3,k] = 0.945; 95% CI = 0.877–0.975; SEM = 0.22 cm). Significant correlations were found between the motion capture system and the palpation meter on the affected side (r = 0.87) and the unaffected side (r = 0.81). Bland-Altman plots between the palpation meter and the motion capture system demonstrated that all the measures fell within the limits of agreement. Limitations This study encountered possible errors with the accuracy of the motion capture system tracking because of the proximity of the markers and inherent volumetric restrictions. Conclusions The palpation meter is a reliable, valid, easily administered, and cost-effective tool for assessing pectoralis minor length in women with breast cancer.