Right costophrenic angle abscess due to Salmonella Dublin infection in combination with type 2 diabetes mellitus

The main manifestations of type 2 diabetes mellitus are excessive drinking, polyphagia, polyuria and wasting or weight loss in a short period of time, but it is rare to have persistent fever of unknown origin as the main manifestation. This case report describes a 68-year-old male patient with type 2 diabetes mellitus presenting with unexplained fever with persistent exacerbation and a cystic lesion in the right costophrenic horn on abdominal computed tomography (CT). A cytoculture examination of the puncture fluid suggested that the infection was due to Salmonella Dublin. The patient was treated with drainage of the abscess in the right costophrenic angle area, which then healed successfully. These findings suggest that Salmonella Dublin infection should be considered when a patient with type 2 diabetes mellitus presents with an unexplained persistent fever. At the same time, CT-guided abscess puncture can be performed to improve the patient's symptoms, aid diagnosis and improve the quality of life.

Use of Intrapleural Fibrinolytic Therapy in a Trapped Lung following Acute Traumatic Haemothorax

Retained haemothorax is a common sequela of traumatic haemothorax and refers to blood that cannot be drained from the pleural cavity. We report a case of trapped lung secondary to retained haemothorax in a patient who sustained a penetrating chest injury. Initial chest computed tomography (CT) showed a large haemothorax that was managed with an intercostal drain insertion (ICD). Repeat chest CT and thoracic ultrasonography performed after ICD removal showed an organized pleural space resembling haematoma. ICD was reinserted with administration of intrapleural fibrinolytic therapy (IPFT). Subsequent chest CT showed the development of a pleural rind and trapped lung. A second ICD was inserted, and further IPFT were administered together with aggressive negative pressure suction. Haemoglobin remained stable. The patient made a full recovery and imaging performed two weeks later showed minor blunting of the costophrenic angle. This case highlights the feasibility and safety of IPFT in the management of trapped lung associated with traumatic retained haemothorax as an alternative to surgery.

Normal Diaphragm Measurements in the Saudi Population Using Posteroanterior Chest Radiograph

The aim of this study was to establish normal measurements of the hemidiaphragm widths and heights in the Saudi population by a posteroanterior (PA) chest X-ray in the Mecca Region. Methods and Results: The data were collected prospectively at King Abdulaziz Hospital in Saudi Arabia, Jeddah, between March and April 2021, using a computed radiography imaging unit. A total of 45 patients (51.1% men and 48.9% women; the age range between 15 and 79 years) were included in the study. Measurements were obtained on an ideal PA chest radiograph by measuring the distance from the highest points of the right hemidiaphragm and left hemidiaphragm. The width from the right and left costophrenic angle was also measured as an ended point. The total diaphragm width (DW) was 278.32±24.83mm, the total right diaphragmatic dome height (RDDH) -51.30±10.58mm, and left diaphragmatic dome height (LDDH) - 38.40±9.21mm. The DW was greater in men than in women: 291.74±20.4mm and 264.28±21.2mm, respectively. RDDH and LDDH were also greater in men than in women: 55.4±6.77mm and 47.005±12.19mm, and 43.29±6.65mm and 33.28±8.83, respectively Conclusion: Computed radiography was useful in measuring the diaphragm because measurement points can be identified accurately and easily due to the availability of the processing system functions such as the ability to manipulate the image resolution, image contrast, and magnification.

Simple method for detecting idiopathic interstitial pneumonias by measuring vertical lung length on chest X-ray

Detection of idiopathic interstitial pneumonias (IIPs) on chest X-ray is difficult for non-specialist physicians, especially in patients with mild IIPs. The current study aimed to evaluate the usefulness of a simple method for detecting IIPs by measuring vertical lung length (VLL) in chest X-rays to quantify decreased lung volume. A total of 280 consecutive patients with IIPs were randomly allocated to exploratory and validation cohorts, and 140 controls were selected for each cohort by propensity score-matching. Upper (uVLL; from apex to tracheal carina), lower (lVLL; from carina to costophrenic angle), and total VLL (tVLL; from apex to costophrenic angle), and the l/uVLL ratio were measured on chest X-rays. Patients in the exploratory cohort had significantly decreased uVLL, lVLL, tVLL, and l/uVLL ratio compared with controls (all p < 0.001). Receiver operating characteristic curve analyses demonstrated that lVLL (area under the curve [AUC] 0.86, sensitivity 0.65, specificity 0.92), tVLL (AUC 0.83, sensitivity 0.75, specificity 0.80), and l/uVLL ratio (AUC 0.80, sensitivity 0.72, specificity 0.79) had high diagnostic accuracies for IIPs. These results were reproduced in the validation cohort. IIP patients thus have decreased VLLs, and measurements of VLL may thus aid the accurate detection of IIPs.

Deep Belief Network and Closed Polygonal Line for Lung Segmentation in Chest Radiographs

Due to the varying appearance in the upper clavicle bone region, sharp corner at the costophrenic angle, the presence of strong edges at the rib cage and clavicle and the lack of a consistent anatomical shape among different individuals, accurate segmentation of lung on chest radiographs remains challenging. In this work, we propose a novel segmentation method for lung segmentation, containing two subnetworks, where few manually delineated points are used as the approximate initialization. The first one is a preprocessing subnetwork based on a deep learning model (i.e. Deep Belief Network and K-Nearest Neighbor). The second one is a refinement subnetwork, designed to make the preprocessed result to be optimized by combining an improved principal curve method and a machine learning method. To prove the performance of the proposed method, several public datasets were evaluated with Dice Similarity Coefficient (DSC), overlap score (Ω), Sensitivity (Sen), Positive Predictive Value (PPV), global Error (E) and execution time (t). Compared with state-of-the-art methods, our method reaches superior segmentation performance.

Pleural Thickening and Calcification

Pleural thickening and calcification discusses the radiographic and computed tomography (CT) manifestations of benign pleural thickening and pleural calcification. Benign pleural thickening must be differentiated from malignant pleural thickening and their differentiating characteristics will be discussed. Pleural plaque is the most common manifestation of asbestos exposure and carries no risk of malignant degeneration. The most common imaging appearance is bilateral sharply demarcated, multifocal areas of discontinuous pleural thickening that often calcifies over time. Pleural plaques spare the apical and costophrenic sulcus pleura and has a predilection for the diaphragmatic pleura. Diffuse pleural thickening is associated with hemothorax, empyema, connective tissue disorders, and asbestos exposure. It is generally unilateral, causes blunting of the costophrenic angle, spans multiple rib interspaces, and is irregular in shape. When diffuse pleural thickening calcifies and is associated with volume loss in the affected lung, it is termed fibrothorax.

Giant adrenocortical carcinoma simulating a liver tumor

Adrenocortical carcinoma is a rare malignant tumor which can reach large sizes if it is nonfunctioning. In that situation, it can pose diagnosis dilemmas regarding the origin and the nature of the tumor. We reported a case of non-secreting and large right Adrenocortical carcinoma which arose in the posterior costophrenic angle mimicking a liver tumor. A 45-year-old man presented with a voluminous abdominal mass in the right upper quadrant. The different imaging modalities including ultrasound computed tomography and magnetic resonance imaging were discordant as regards the hepatic or the adrenal origin of the tumor. Percutaneous biopsy allowed to determine the diagnosis of the cortico-adrenal tumor. The patient underwent laparotomy. The tumor which arose from the right adrenal gland was resected. Pathology confirmed the diagnosis of adrenocortical carcinoma with histological factors of poor prognosis. The patient was given Mitotane as adjuvant therapy. After six years of follow-up, a tumor recurrence has been diagnosed.