Can a unisegmental pulmonary infarct be lethal?

To highlight the risk of septic complications following a pulmonary embolism (PE), we report the case of an elderly patient, that was hospitalized for a PE, an had progressively worsen his respiratory and septic state. Chest CT slices showed a gangrenous lung segment with an associated pleuropulmonary abscess.

A Modified Calculation Improves the Accuracy of Predicted Postoperative Lung Function Values in Lung Cancer Patients

Purpose Preoperative pulmonary function testing is mandatory for non-small cell lung cancer (NSCLC) surgery. The predicted postoperative FEV1 (ppoFEV1) is used for further risk stratification. We compared the ppoFEV1 with the postoperative FEV1 (postFEV1) in order to improve the calculation of the ppoFEV1. Methods 87 patients voluntarily received an FEV1 assessment 1 year after surgery. ppoFEV1 was calculated according to the Brunelli calculation. Baseline characteristics and surgical procedure were compared in a uni- and multivariate analysis between different accuracy levels of the ppoFEV1. Parameters which remained significant in the multinominal regression analysis were evaluated for a modification of the ppoFEV1 calculation. Results Independent factors for a more inaccurate ppoFEV1 were preoperative active smoking (odds ratio (OR) 4.1, confidence interval (CI) 3.6–6.41; p = 0.01), packyears (OR 4.1, CI 3.6–6.41; p = 0.008), younger age (OR 1.1, CI 1.01–1.12; p = 0.03), and patients undergoing pneumectomy (OR 5.55, CI 1.35–23.6; p = 0.01). For the customized ppoFEV1 we excluded pneumonectomies. For patients < 60 years, an additional lung segment was added to the calculation. ppoFEV1 = preFEV1 × $$1-\left(\frac{\text{Lung segments resected} + 1}{\text{Total number of segments}}\right)$$ 1 - Lung segments resected + 1 Total number of segments . For actively smoking patients with more than 30 packyears we subtracted one lung segment from the calculation ppoFEV1 = PreFEV1 × $$1-\left(\frac{\text{Lung segments resected} - 1}{\text{Total number of segments}}\right)$$ 1 - Lung segments resected - 1 Total number of segments . Conclusion We were able to enhance the predictability of the ppoFEV1 with modifications. The modified ppoFEV1 (1.828 l ± 0.479 l) closely approximates the postFEV1 of 1.823 l ± 0.476 l, (0.27%) while the original ppoFEV1 calculation is at 1.78 l ± 0.53 (2.19%). However, if patients require pneumectomy, more complex techniques to determine the ppoFEV1 should be included to stratify risk.

Early Warning Information for Severe and Critical Patients With COVID-19 Based on Quantitative CT Analysis of Lung Segments

Background: The coronavirus disease 2019 (COVID-19) outbreak is spreading rapidly around the world.Purpose: We aimed to explore early warning information for patients with severe/critical COVID-19 based on quantitative analysis of chest CT images at the lung segment level.Materials and Methods: A dataset of 81 patients with coronavirus disease 2019 (COVID-19) treated at Wuhan Wuchang hospital in Wuhan city from 21 January 2020 to 14 February 2020 was retrospectively analyzed, including ordinary and severe/critical cases. The time course of all subjects was divided into four stages. The differences in each lobe and lung segment between the two groups at each stage were quantitatively analyzed using the percentage of lung involvement (PLI) in order to investigate the most important segment of lung involvement in the severe/critical group and its corresponding time point.Results: Lung involvement in the ordinary and severe/critical groups reached a peak on the 18th and 14th day, respectively. In the first stage, PLIs in the right middle lobe and the left superior lobe between the two groups were significantly different. In the second stage and the fourth stage, there were statistically significant differences between the two groups in the whole lung, right superior lobe, right inferior lobe and left superior lobe. The rapid progress of the lateral segment of the right middle lobe on the second day and the anterior segment of the right upper lobe on the 13th day may be a warning sign for severe/critical patients. Age was the most important demographic characteristic of the severe/critical group.Conclusion: Quantitative assessment based on the lung segments of chest CT images provides early warning information for potentially severe/critical patients.

Application of 3D Navigation and Vascular Reconstruction Technology in Precision Resection of Lung Segment

With the rapid development of imaging technology and the improvement of people's health awareness, more early lung cancers are found. For very early lung cancer (mainly manifested as ground glass nodules), lobectomy is still the standard surgical treatment for lung cancer, and segmental resection has been used clinically as a treatment method. 3D navigation is an effective tool for precise lung segment and sub-segment resection. Three-dimensional vascular reconstruction technology is an advanced imaging technology. Accurate segment resection under thoracoscopy is considered the best surgical treatment for early stage lung cancer. It is difficult to accurately estimate the morphology, nature and other characteristics of the tumor and its surroundings by two-dimensional imaging alone. Therefore, the precise resection operation adds great difficulty and risk to the surgeon. In recent years, 3D navigation and vascular reconstruction techniques have been widely developed and applied in the medical field, and they are rarely used in thoracic surgery. This article has conducted a more in-depth study on the application of 3D navigation technology and vascular reconstruction technology in precision lung resection, and has achieved certain research results.

DOZ047.90: An interesting and extremely rare case report of PCD and HLHS

An antenatally diagnosed hypoplastic left heart syndrome boy from Kuwait was transferred in utero for postnatal surgical management. He was born to a nonconsanguineously married couple by spontaneous delivery at 33 + 5 weeks of gestation with a birth weight of 2.4 kg. He was on prostaglandin infusion after birth and shortly underwent bilateral pulmonary artery banding with gore-tex shunts (aorta to pulmonary artery shunts) to let him grow and get over his prematurity for his cardiac surgical palliative procedures. He had some right upper lobe collapse, which was treated with physiotherapy and suctioning to proceed for his first stage cardiac surgical repair (Norwood I). Following this, he had a rough course owing to his cardiac condition but was extubated without many problems in due course. He was persistently tachypnoeic, had two episodes of acute decompensations during his stay due to his lung segment collapse needing invasive ventilation, and was very fragile, needing careful management. He needed noninvasive positive pressure ventilation at other times even when stable, to keep his airways from collapsing. He underwent a bronchoscopy and CT scan when stable enough to do it that showed a normal airway but with thick, tenacious, and clear secretions on bronchoscopy while a CT showed some areas of atelectasis and pulmonary interstitial emphysema. He was investigated for cystic fibrosis and primary ciliary dyskinesia as other causes that could lead to persistent and recurrent atelectasis were ruled out and his acute episodes dealt with appropriately. His genetic testing results have confirmed the clinical diagnosis of primary ciliary dyskinesia and he is being discussed for further management from a multidisciplinary point of view.

Isolated Major Aortopulmonary Collateral as the Sole Pulmonary Blood Supply to an Entire Lung Segment

Congenital systemic-to-pulmonary collateral arteries or major aortopulmonary collaterals are associated with cyanotic congenital heart disease with decreased pulmonary blood flow. Though it is usually associated with congenital heart diseases, there is an increased incidence of isolated acquired aortopulmonary collaterals in premature infants with chronic lung disease. Interestingly, isolated congenital aortopulmonary collaterals can occur without any lung disease, which may cause congestive heart failure and require closure. We present a neonate with an echocardiogram that showed only left-sided heart dilation. Further workup with a CT angiogram demonstrated an anomalous systemic artery from the descending thoracic aorta supplying the left lower lobe. He eventually developed heart failure symptoms and was taken to the catheterization laboratory for closure of the collateral. However, with the collateral being the only source of blood flow to the entire left lower lobe, he required surgical unifocalization. Isolated aortopulmonary collaterals without any other congenital heart disease or lung disease are rare. Our patient is the first reported case to have an isolated aortopulmonary collateral being the sole pulmonary blood supply to an entire lung segment. Due to its rarity, there is still much to learn about the origin and development of these collaterals that possibly developed prenatally.

A Case of Pulmonary Sarcoma with Significant Extension into the Right Lung

A female patient in her 30s was referred to us with a mass approximately 8 centimeters in diameter in right lung segment 6. Bronchoscopy was done, and a tumorous lesion obstructing right B6 was found. Biopsy of this lesion supported suspicions of sarcoma or spindle cell carcinoma. Contrast-enhanced CT showed that the mass extended to and obstructed the right main pulmonary artery. A skip lesion was also suspected in the periphery of pulmonary artery trunk. The tumor was removed by right pneumonectomy accompanied by resection of the main and left pulmonary arteries under cardiopulmonary bypass. The pulmonary artery trunk and the left pulmonary artery were reconstructed with a vascular graft. Collectively, intimal sarcoma originating from the right main pulmonary artery with extension into the right lung was diagnosed. Significant extension of pulmonary artery sarcoma into the lung, as was observed in the present case, is considered to be rare, and to our knowledge this is the first report in which the primary lesion was biopsied by bronchoscopy.