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Sample records for chest wall tumor

  1. Chest Wall tumor: combined management

    International Nuclear Information System (INIS)

    Rao Bhaskar, N.

    1997-01-01

    Cancer is relatively rare disease among children and adolescents. The incidence of solid tumors other than CNS is less than 2/100,000. Tumors of the chest wall can arise either from the somatic tissue or ribs. These are rare, so either institutional reviews or multi institutional studies should determine optimal therapeutic management. Of the bony chest wall, Ewing's sarcoma or the family of tumor (peripheral neuro epithelioma, Askin tumor), are the most common. These lesions are lytic and have associated large extra pleural component. This large extra pleural component often necessitates major chest wall resection (3 or more ribs), and when lower ribs are involved, this entails resection of portion of diaphragm. Despite this resection, survival in the early 1970 was 10-20%. Since 1970 multi agent chemotherapy has increased survival rates. of importance, however, is these regimens have caused significant reduction of these extra pleural components so that major chest wall resections have become a rarity. With improved survival and decreased morbidity preoperative chemotherapy followed by surgery is now the accepted modality of treatment. Another major advantage of this regimen is that potential radiation therapy may be obviated. The most common chest wall lesion is rhabdomyosarcoma. In the IRS study of 1620 RMS patients, in 141 (9%) the primary lesion was in the chest wall. these are primarily alveolar histology. when lesions were superficial, wide local excision with supplemental radiation therapy was associated with low morbidity and good overall survival. however, a majority have significant intra- thoracic components. in these circumstances the resectability rate is less than 30% and the survival poor. Other lesions include non rhabdomyosarcomas, eosinophilic granuloma, chondrosarcoma, and osteomyelitis. The management of these lesions varies according to extent, histology, and patient characteristics

  2. MR imaging in tumor invasion of the chest wall

    International Nuclear Information System (INIS)

    Bittner, R.C.; Lang, P.; Schorner, W.; Sander, B.; Weiss, T.; Loddenkemper, R.; Kaiser, D.; Felix, R.

    1989-01-01

    The authors have used MR imaging to study 22 patients who had intrathoracic, pleura-related malignancies and whose CT findings had suggested chest wall invasion. ECG-gated T1- and T2-weighted spin-echo sequences were used in all patients. Additionally, in 10 patients an ungated, multisection, gradient-echo sequence was used, which was repeated after intravenous administration of Gd-DTPA in five patients. Surgery confirmed chest wall invasion in 19 patients. CT showed tumor invasion only in 14 of these 19 patients. MR imaging showed high-signal-intensity lesion within chest wall and pleura in T2-weighted and Gd-DTPA-enhanced T1-weighted images as the typical pattern of chest wall invasion in all 19 patients. Two of the three patients with pleural inflammation and without chest wall invasion had high-signal-intensity pleural lesions, but none of these lesions were within the chest wall

  3. Hemithorax irradiation for Ewing tumors of the chest wall

    International Nuclear Information System (INIS)

    Schuck, Andreas; Ahrens, Susanne; Konarzewska, Agnieszka; Paulussen, Michael; Froehlich, Birgit; Koenemann, Stefan; Ruebe, Christian; Ruebe, Claudia E.; Dunst, Juergen; Willich, Normann; Juergens, Heribert

    2002-01-01

    Purpose: In the Cooperative Ewing's Sarcoma Study 86 and the European Intergroup Cooperative Ewing's Sarcoma Study 92, hemithorax irradiation (RT) was performed in patients with Ewing tumors of the chest wall involving the pleura or contaminating the pleural cavity. In a retrospective analysis, the outcomes of these patients were evaluated and compared with those of patients with chest wall tumors who did not receive hemithorax RT. Methods and Materials: Between 1985 and 1996, 138 patients presented with nonmetastatic Ewing tumors of the chest wall. They were treated in a multimodal treatment regimen that included polychemotherapy and local therapy depending on the tumor characteristics. Hemithorax RT was performed at a dose of 15 Gy for patients <14 years old and 20 Gy for patients ≥14 years old. Forty-two patients received hemithorax RT (Group 1) and 86 patients did not (Group 2). The data were insufficient for the other 10 patients. Results: Comparing both groups, the initial pleural effusion, pleural infiltration, and intraoperative contamination of the pleural space were significantly more frequent in Group 1. The event-free survival rate after 7 years was 63% for patients in Group 1 and 46% for patients in Group 2 (not statistically significant). The 7-year local relapse rate (including combined local-systemic relapses) was 12% in Group 1 and 10% in Group 2; the corresponding systemic relapse rates were 22% and 39%. Conclusion: Patients with chest wall tumors who received hemithorax RT were negatively selected; yet the rate of event-free survival was better for patients who received hemithorax RT than for those who did not (although the difference was not statistically significant). This result was due to a reduction of metastases, mainly lung metastases. Local control was equivalent between the two groups. These favorable results have caused us to continue using hemithorax RT to treat high-risk patients with Ewing tumors of the chest wall

  4. Extra-Gastrointestinal Stromal Tumor Presenting as an Anterior Chest Wall Mass

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    Junghyeon Lim

    2017-08-01

    Full Text Available A 71-year-old man was referred for an anterior chest wall mass. Chest computed tomography (CT and positron emission tomography-CT suggested a malignant tumor. Surgical biopsy through a vertical subxiphoid incision revealed an extra-gastrointestinal stromal tumor (EGIST. En bloc resection of the tumor, including partial resection of the sternum, costal cartilage, pericardium, diaphragm, and peritoneum, was performed. Pathologic evaluation revealed a negative resection margin and confirmed the tumor as an EGIST. On postoperative day 17, the patient was discharged without any complications. At the 2-week follow-up, the patient was doing well and was asymptomatic.

  5. Extended Resection of Chest Wall Tumors with Reconstruction Using Poly Methyl Methacrylate-Mesh Prosthesis

    International Nuclear Information System (INIS)

    Abo Sedira, M.; Nassar, O.; Al-Ariny, A.

    2003-01-01

    This prospective study evaluates the early result of patients with massive chest wall tumors treated by extended resection and reconstruction using Prolene or Marlex mesh-enforced with Poly Methyl Methacrylate Bone Cement (PMMC) prosthesis. Material and Methods: This surgery was performed on 40 patients with a mean age of 45±18 (12-62) at the Department of Surgery, National Cancer Institute, Cairo University between 1998-2001. Primary chest wall tumors were the indications of surgery in 42.5%, while secondary involvement extending from other sites principally breast cancer were the indications for 57.5%. In 85% of patients more than 3 ribs were involved by tumors and lesions were more than 10 cm in the greatest dimension in 50% of cases. Resection involved sternum in 15 (37.5%) cases and in 45% of cases complete extensive rib resections extended between costovertebral junctions and the costochondral junctions were performed. Additional resections of nearby organs were needed in 20 (50%) of cases including partial lung resection in 14 cases, partial vertebral resection in 3 cases and diaphragm resection for 3 cases. Immediate bony reconstruction by inserting Prolene or Marlex mesh-enforced with Poly Methyl Methacrylate Bone Cement (PMMC) prosthesis to the resulting chest wall defect was performed in 36 cases, whereas, 4 cases had delayed reconstruction. Primary simple soft tissue closure was sufficient for 37.5% of patients; whereas 35% were covered by local rotational flap and 27.5% needed myocutaneous flaps. No patient with this immediate reconstruction needed ventilatory support or tracheostomy and flail chest was not noticed ICU stay was markedly reduced; whereas 85% required less than 7 days. Immediate post operative (40 days) complications were found in 14 patients (35%) and cases with additional lung resection had more complication rate than others (64% vs 19%). Infection occurred in 3 patients and conservative treatment for 3-4 weeks using frequent

  6. Ultrasonography of chest wall lesion

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    Park, Cheol Min; Kim, C. H.; Cha, I. H.; Chung, K. B.; Ser, W. H.; Choi, Y. H. [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1989-12-15

    Thirty-one patients with chest wall diseases were studied with ultrasound to evaluate its role in chest wall lesions. There were eight infectious conditions, 9 benign tumors, 11 malignant lesions and 3 miscellaneous cases. Diffuse chest wall thickening with heterogeneous echogenicity and obliteration of subcutaneous fat layer are findings of acute infection. In cases of tuberculous smpyema necessitates, pleural abnormality extended to the chest wall through intercostal space. Benign tumors were well demarcated, except in 4 cases of lipoma/lipomatosis. Malignant lesions showed irregular soft tissue masses, bone destruction, pleural effusion and subcutaneous invasion. Multiple enlarged lymph nodes were also shown. Ultrasound can demonstrate te internal structure, extent, depth and associated findings such as pleural effusion, bone destruction and peripheral lung involvement. Ultrasound is not only safe, non-invasive and an effective diagnostic imaging modality for chest wall disease, but can also guide aspiration or biopsy for pathologic diagnosis

  7. Ultrasonography of chest wall lesion

    International Nuclear Information System (INIS)

    Park, Cheol Min; Kim, C. H.; Cha, I. H.; Chung, K. B.; Ser, W. H.; Choi, Y. H.

    1989-01-01

    Thirty-one patients with chest wall diseases were studied with ultrasound to evaluate its role in chest wall lesions. There were eight infectious conditions, 9 benign tumors, 11 malignant lesions and 3 miscellaneous cases. Diffuse chest wall thickening with heterogeneous echogenicity and obliteration of subcutaneous fat layer are findings of acute infection. In cases of tuberculous smpyema necessitates, pleural abnormality extended to the chest wall through intercostal space. Benign tumors were well demarcated, except in 4 cases of lipoma/lipomatosis. Malignant lesions showed irregular soft tissue masses, bone destruction, pleural effusion and subcutaneous invasion. Multiple enlarged lymph nodes were also shown. Ultrasound can demonstrate te internal structure, extent, depth and associated findings such as pleural effusion, bone destruction and peripheral lung involvement. Ultrasound is not only safe, non-invasive and an effective diagnostic imaging modality for chest wall disease, but can also guide aspiration or biopsy for pathologic diagnosis

  8. Ewing's sarcoma: a neuroectodermal tumor of the chest wall

    International Nuclear Information System (INIS)

    Alcaraz, M. J.; Lorente, M. L.; Martin, A. M.; Gonzalez, I.

    2000-01-01

    Ewing's sarcoma is the second most common malignant bone tumor in children and young adults. It is most prevalent between the ages of 10 and 15 years. There are present two cases of Ewing's sarcoma of the chest wall. The clinical, radiological and pathological features are described and the therapeutic options are discussed. (Author)

  9. Reconstruction of the chest wall after excision of a giant malignant ...

    African Journals Online (AJOL)

    Primary chest wall tumors are uncommon and constitute 0.2-2% of all tumors. Metastatic tumors and tumors of local extension are more common. Malignant peripheral nerve sheath tumor (MPNST) of the chest wall is even rarer and its incidence on the chest wall not stated in the literature. The incidence in the general ...

  10. Chest wall invasion by bronchogenic carcinoma. Evaluation with Cine-MRI

    International Nuclear Information System (INIS)

    Nawano, Shigeru; Murakami, Kohji; Ohnuma, Hiroshi; Iwata, Ryoko; Hayashi, Takayuki; Moriyama, Noriyuki; Nishiwaki, Yutaka; Nagai, Kanji

    1996-01-01

    With the view of examining possible chest wall invasion of bronchogenic carcinoma, Cine-MRI was performed on 22 such cases. These cases were suspected of having above chest wall invasion by CT and their histopathological findings were obtained in surgery. The judgment of the chest wall invasion by Cine-CT was made such that non-moving up and down of the tumor with respiration involves its invasion, moving of the tumor without any up-and-down movement suspects its invasion and moving up and down of the tumor with respiration involves no invasion. The chest wall invasion was observed in 5 of 7 cases of invasion judged by Cine-MRI. For 2 false-positive cases, the histopathological findings presumed that tumor cells disappeared from the chest wall invaded region as the result of preoperative chemotherapy. The above invasion was observed in 1 of 4 cases suspected of possible invasion. Correct diagnosis was formed of 11 cases judged invasion-free by Cine-MRI. The above results suggested Cine-MRI to be useful for diagnosis of chest wall invasion of bronchogenic carcinoma. (author)

  11. Chest wall – a structure underestimated in ultrasonography. Part III: Neoplastic lesions

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    Andrzej Smereczyński

    2017-12-01

    Full Text Available Chest wall neoplasms mainly include malignancies, metastatic in particular. Differential diagnosis should include clinical data; tumor location, extent, delineation; the degree of homogeneity; the presence of calcifications; the nature of bone destruction and the degree of vascularization. The aim of the paper is to present both the benefits and limitations of ultrasound for the diagnosis of chest wall neoplasms. The neoplastic process may be limited to the chest wall; it may spread from the chest wall into the intrathoracic structures or spread from the inside of the chest towards the chest wall. Benign tumors basically originate from vessels, nerves, bones, cartilage and soft tissues. In this paper, we briefly discuss malformations of blood and lymphatic vessels, glomus tumor as well as neurogenic tumors originating in the thoracic branches of the spinal nerves and the autonomic visceral system. Metastases, particularly lung, breast, kidney cancer, melanoma and prostate cancer, are predominant tumors of the osteocartilaginous structures of the chest wall. Plasma cell myeloma is also relatively common. The vast majority of these lesions are osteolytic, which is reflected in ultrasound as irregular cortical defects. Osteoblastic foci result only in irregular outline of the bone surface. Lipomas are the most common neoplasms of the chest wall soft tissue. Elastofibroma is another tumor with characteristic echostructure. Desmoid fibromatosis, which is considered to be a benign lesion with local aggressivity and recurrences after surgical resection, represents an interesting tumor form the clinical point of view. Ultrasonography represents an optimal tool for the monitoring of different biopsies of pathological lesions located in the chest wall. Based on our experiences and literature data, this method should be considered as a preliminary diagnosis of patients with chest wall tumors.

  12. Study of frequency of operated chest wall tumors In Al Zahra hospital from 2007 to 2009,Isfahan,Iran

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    seyed abas Tabatabai

    2011-08-01

    Conclusion: According to the results of this study about 59% of the chest wall tumors were malignant and in the case of being hesitant about existing a mass on the chest wall, needed measurements for treatmentand and on time removal of the mass must be done.

  13. Prediction of Chest Wall Toxicity From Lung Stereotactic Body Radiotherapy (SBRT)

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    Stephans, Kevin L., E-mail: stephak@ccf.org [Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH (United States); Djemil, Toufik; Tendulkar, Rahul D. [Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH (United States); Robinson, Cliff G. [Department of Radiation Oncology, Siteman Cancer Center, Washington University, St Louis, MO (United States); Reddy, Chandana A.; Videtic, Gregory M.M. [Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH (United States)

    2012-02-01

    Purpose: To determine patient, tumor, and treatment factors related to the development of late chest wall toxicity after lung stereotactic body radiotherapy (SBRT). Methods and Materials: We reviewed a registry of 134 patients treated with lung SBRT to 60 Gy in 3 fractions who had greater than 1 year of clinical follow-up and no history of multiple treatments to the same lobe (n = 48). Patients were treated as per Radiation Therapy Oncology Group Protocol 0236 without specific chest wall avoidance criteria. The chest wall was retrospectively contoured. Thirty-two lesions measured less than 3 cm, and sixteen measured 3 to 5 cm. The median planning target volume was 29 cm{sup 3}. Results: With a median follow-up of 18.8 months, 10 patients had late symptomatic chest wall toxicity (4 Grade 1 and 6 Grade 2) at a median of 8.8 months after SBRT. No patient characteristics (age, diabetes, hypertension, peripheral vascular disease, or body mass index) were predictive for toxicity, whereas there was a trend for continued smoking (p = 0.066; odds ratio [OR], 4.4). Greatest single tumor dimension (p = 0.047; OR, 2.63) and planning target volume (p = 0.040; OR, 1.04) were correlated with toxicity, whereas distance from tumor edge to chest wall and gross tumor volume did not reach statistical significance. Volumes of chest wall receiving 30 Gy (V30) through 70 Gy (V70) were all highly significant, although this correlation weakened for V65 and V70 and maximum chest wall point dose only trended to significance (p = 0.06). On multivariate analysis, tumor volume was no longer correlated with toxicity and only V30 through V60 remained statistically significant. Conclusions: Tumor size and chest wall dosimetry are correlated to late chest wall toxicity. Only chest wall V30 through V60 remained significant on multivariate analysis. Restricting V30 to 30 cm{sup 3} or less and V60 to 3 cm{sup 3} or less should result in a 10% to 15% risk of late chest wall toxicity or lower.

  14. Chest Wall Ewing Sarcoma Family of Tumors: Long-Term Outcomes

    International Nuclear Information System (INIS)

    Indelicato, Daniel J.; Keole, Sameer R.; Lagmay, Joanne P.; Morris, Christopher G.; Gibbs, C. Parker; Scarborough, Mark T.; Islam, Saleem; Marcus, Robert B.

    2011-01-01

    Purpose: To review the 40-year University of Florida experience treating Ewing sarcoma family of tumors of the chest wall. Methods and Materials: Thirty-nine patients were treated from 1966 to 2006. Of the patients, 22 were treated with radiotherapy (RT) alone, and 17 patients were treated with surgery with or without RT. Of 9 patients with metastatic disease, 8 were treated with RT alone. The risk profiles of each group were otherwise similar. The median age was 16.6 years, and the most frequent primary site was the rib (n = 17). The median potential follow-up was 19.2 years. Results: The 5-year actuarial overall survival (OS), cause-specific survival (CSS), and local control (LC) rates were 34%, 34%, and 72%, respectively. For the nonmetastatic subset (n = 30), the 5-year OS, CSS, and LC rates were 44%, 44%, and 79%, respectively. LC was not statistically significantly different between patients treated with RT alone (61%) vs. surgery + RT (75%). None of the 4 patients treated with surgery alone experienced local failure. No patient or treatment variable was significantly associated with local failure. Of the patients, 26% experienced Common Toxicity Criteria (CTC) Grade 3+ toxicity, including 2 pulmonary deaths. Modern intensive systemic therapy helped increase the 5-year CSS from 7% to 49% in patients treated after 1984 (p = 0.03). Conclusions: This is the largest single-institution series describing the treatment of chest wall Ewing tumors. Despite improvements in survival, obtaining local control is challenging and often accompanied by morbidity. Effort should be focused on identifying tumors amenable to combined-modality local therapy and to improving RT techniques.

  15. The role of imaging for the surgeon in primary malignant bone tumors of the chest wall

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    Rocca, M., E-mail: michele.rocca@ior.it [General and Thoracic Surgery, The Rizzoli Orthopaedic Institute, Via Pupilli 1, 40136 Bologna (Italy); Salone, M. [General and Thoracic Surgery, The Rizzoli Orthopaedic Institute, Via Pupilli 1, 40136 Bologna (Italy); Galletti, S. [Ultrasound Unit, The Rizzoli Orthopaedic Institute, Bologna (Italy); Balladelli, A. [Laboratory of Experimental Oncology, The Rizzoli Orthopaedic Institute, Bologna (Italy); Vanel, D. [Research in Imaging Musculo Skeletal Tumors, The Rizzoli Orthopaedic Institute, Bologna (Italy); Briccoli, A. [General and Thoracic Surgery, The Rizzoli Orthopaedic Institute, Via Pupilli 1, 40136 Bologna (Italy)

    2013-12-01

    Primary malignant chest wall tumors are rare. The most frequent primary malignant tumor of the chest wall is chondrosarcoma, less common are primary bone tumors belonging to the Ewing Family Bone Tumors (EFBT), or even rarer are osteosarcomas. They represent a challenging clinical entities for surgeons as the treatment of choice for these neoplasms is surgical resection, excluding EFBT which are normally treated by a multidisciplinary approach. Positive margins after surgical procedure are the principal risk factor of local recurrence, therefore to perform adequate surgery a correct preoperative staging is mandatory. Imaging techniques are used for diagnosis, to determine anatomic site and extension, to perform a guided biopsy, for local and general staging, to evaluate chemotherapy response, to detect the presence of a recurrence. This article will focus on the role of imaging in guiding this often difficult surgery and the different technical possibilities adopted in our department to restore the mechanics of the thoracic cage after wide resections.

  16. Multi-Detector CT Findings of Palpable Chest Wall Masses in Children: A Pictorial Essay

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    Park, Chan Ho; Kim, Young Tong [Dept. of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan (Korea, Republic of); Hong, Hyun Sook [Dept. of Radiology, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon (Korea, Republic of)

    2013-03-15

    A wide variety of diseases manifest as palpable chest wall masses in children. These include normal variation, congenital anomalies, trauma, infection, axillary lymphadenopathies, soft tissue tumors and bone tumors. Given that most of these diseases are associated with chest wall deformity, diagnosis is difficult by physical examination or ultrasonography alone. However, multi-detector CT with three dimensional reconstruction is useful in the characterization and differential diagnosis of palpable chest wall lesions. In this article, we review the spectrum of palpable chest wall diseases and illustrate their multi-detector CT presentation.

  17. Obesity Increases the Risk of Chest Wall Pain From Thoracic Stereotactic Body Radiation Therapy

    International Nuclear Information System (INIS)

    Welsh, James; Thomas, Jimmy; Shah, Deep; Allen, Pamela K.; Wei, Xiong; Mitchell, Kevin; Gao, Song; Balter, Peter; Komaki, Ritsuko; Chang, Joe Y.

    2011-01-01

    Purpose: Stereotactic body radiation therapy (SBRT) is increasingly being used to treat thoracic tumors. We attempted here to identify dose-volume parameters that predict chest wall toxicity (pain and skin reactions) in patients receiving thoracic SBRT. Patients and Methods: We screened a database of patients treated with SBRT between August 2004 and August 2008 to find patients with pulmonary tumors within 2.5 cm of the chest wall. All patients received a total dose of 50 Gy in four daily 12.5-Gy fractions. Toxicity was scored according to the NCI-CTCAE V3.0. Results: Of 360 patients in the database, 265 (268 tumors) had tumors within 30 , or volume of the chest wall receiving 30 Gy. Body mass index (BMI) was also strongly associated with the development of chest pain: patients with BMI ≥29 had almost twice the risk of chronic pain (p = 0.03). Among patients with BMI >29, diabetes mellitus was a significant contributing factor to the development of chest pain. Conclusion: Safe use of SBRT with 50 Gy in four fractions for lesions close to the chest wall requires consideration of the chest wall volume receiving 30 Gy and the patient's BMI and diabetic state.

  18. Angiosarcoma of the Chest Wall associated with Chronic Empyema and Pulmonary Metastasis: A Case Report

    International Nuclear Information System (INIS)

    Kim, Dong Won; Lee, Ki Nam; Lee, Sang Yun; Roh, Mee Sook

    2011-01-01

    Angiosarcoma of the chest wall is a very rare tumor and it is difficult to radiologically differentiate this tumor from other malignant tumors. Chronic tuberculous empyema is a predisposing factor that has been associated with angiosarcoma. We report here on a case of a 66-year-old man with angiosarcoma that arose in the chest wall. Computed tomography (CT) demonstrated a heterogeneous enhancing mass in the chest wall with calcified pleural thickening and multiple pulmonary nodules with the halo sign, which all indicated the presence of sarcoma with hypervascular metastases

  19. Research Status of the Skeletalre Construction of Chest Wall

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    Daixing ZHONG

    2018-04-01

    Full Text Available Chest wall defect may be caused by many factors such as the resection of tumor and trauma, and the reconstruction of bone-defection is still the key point of thoracic surgery. With the development of material science, more and more new materials have been used in medical practice, which makes huge progress in the surgery of chest wall. However, none of these materials satisfy all the practical needs of the reconstruction. Recently, with the development of the capacity of computer, 3D-printing technology has been gradually used in clinical work, and the idea of individual treatment has been accepted by more and more people. The weakness of these materials may be solved by the new material and the application of individual treatment, which could also make great advance in chest wall surgery. This article will make a summary of the research on the reconstruction of chest wall.

  20. Use of the omentum in chest-wall reconstruction

    International Nuclear Information System (INIS)

    Fix, R.J.; Vasconez, L.O.

    1989-01-01

    Increased use of the omentum in chest-wall reconstruction has paralleled the refinement of anatomic knowledge and the development of safe mobilization techniques. Important anatomic points are the omental attachments to surrounding structures, the major blood supply from the left and right gastroepiploic vessels, and the collateral circulation via the gastroepiploic arch and Barkow's marginal artery. Mobilization of the omentum to the thorax involves division of its attachments to the transverse colon and separation from the greater curvature to fabricate a bipedicled flap. Most anterior chest wounds and virtually all mediastinal wounds can be covered with the omentum based on both sets of gastroepiploic vessels. The arc of transposition is increased when the omentum is based on a single pedicle, allowing coverage of virtually all chest-wall defects. The final method of increasing flap length involves division of the gastroepiploic arch and reliance on Barkow's marginal artery as collateral circulation to maintain flap viability. With regard to chest-wall reconstruction, we have included the omentum in the armamentarium of flaps used to cover mediastinal wounds. The omentum is our flap of choice for the reconstruction of most radiation injuries of the chest wall. The omentum may also be used to provide protection to visceral anastomoses, vascular conduits, and damaged structures in the chest, as well as to cover defects secondary to tumor excision or trauma. In brief, the omentum has proved to be a most dependable and versatile flap, particularly applicable to chest-wall reconstruction

  1. Primary Chest Wall Abscess Mimicking a Breast Tumor That Occurred after Blunt Chest Trauma: A Case Report

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    Masuda, Norikazu; Yasojima, Hiroyuki; Mizutani, Makiko; Nakamori, Shoji; Kanazawa, Toru; Kuriyama, Keiko; Mano, Masayuki; Sekimoto, Mitsugu

    2014-01-01

    Primary chest wall abscess occurring after blunt chest trauma is rare. We present the case of a 50-year-old woman who presented with a swelling in her left breast. The patient had experienced blunt chest trauma 2 months back. Needle aspiration revealed pus formation in the patient's chest. Computed tomography revealed a mass in the lower region of the left mammary gland, with thickening of the parietal pleura and skin and fracture of the fifth rib under the abscess. Following antibiotic administration and irrigation of the affected region, surgical debridement was performed. During surgery, we found that the pectoralis major muscle at the level of the fifth rib was markedly damaged, although the necrotic tissue did not contact the mammary gland. We diagnosed the lesion as a chest wall abscess that occurred in response to blunt chest trauma. Her postoperative course was uneventful. There has been no recurrence for six months after surgery. PMID:24660001

  2. Primary Chest Wall Abscess Mimicking a Breast Tumor That Occurred after Blunt Chest Trauma: A Case Report

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    Yusuke Yamaoka

    2014-01-01

    Full Text Available Primary chest wall abscess occurring after blunt chest trauma is rare. We present the case of a 50-year-old woman who presented with a swelling in her left breast. The patient had experienced blunt chest trauma 2 months back. Needle aspiration revealed pus formation in the patient’s chest. Computed tomography revealed a mass in the lower region of the left mammary gland, with thickening of the parietal pleura and skin and fracture of the fifth rib under the abscess. Following antibiotic administration and irrigation of the affected region, surgical debridement was performed. During surgery, we found that the pectoralis major muscle at the level of the fifth rib was markedly damaged, although the necrotic tissue did not contact the mammary gland. We diagnosed the lesion as a chest wall abscess that occurred in response to blunt chest trauma. Her postoperative course was uneventful. There has been no recurrence for six months after surgery.

  3. Radiological diagnosis of chest wall tuberculosis: CT versus chest radiograph

    International Nuclear Information System (INIS)

    Liu Fugeng; Pan Jishu; Chen Qihang; Zhou Cheng; Yu Jingying; Tang Dairong

    2006-01-01

    Objective: To evaluate the role of CT or Chest radiograph in diagnosis of chest wall tuberculosis. Methods: The study population included 21 patients with chest wall tuberculosis confirmed by operation or biopsy. Chest radiograph and plain CT were performed in all eases, while enhanced CT in 9 cases, and all images were reviewed by 2 radiologists. Results: Single soft tissue mass of the chest wall was detected in all cases on CT, but not on chest radiograph(χ 2 =42.000, P 2 =4.421, P<0.05). Conclusion: CT, especially enhanced CT scan is the first choice in the diagnosis of chest wall tuberculosis. (authors)

  4. Short TI inversion-recovery MR imaging of chest wall malignancies

    International Nuclear Information System (INIS)

    Dubinsky, T.J.; Porter, B.A.; Olson, D.O.

    1987-01-01

    Short-T1 inversion-recovery (STIR) sequences have greater constant, less motion sensitivity, and require shorter imaging times than conventional T2-weighted spin-echo (SE) sequences and are therefore particularly useful for staging chest wall malignancies. MR studies of 49 patients with possible chest wall malignancies were reviewed. Images were produced at 0.15 T with a variety of SE sequences. Forty-five also had STIR (repetition time, 1,400 - 2,100; echo time, 36 or 40; inversion time, 100 or 125). MR studies indicated chest wall involvement in 39 of 49 patients; 12 had obvious rib encasement, the most definitive finding. IN 13, lesions detected on STIR were either not visible or seen only in retrospect on T1 SE images. In five of five, STIR was clearly superior to T2 SE for delineation of tumor margins. The authors have discontinued using T2 SE sequences for chest neoplasms in favor of the higher contrast and sensitivity of STIR

  5. [A case of group G Streptococcus sepsis, chest wall abscess, and vertebral osteomyelitis mimicking a primary lung cancer with bone metastasis].

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    Hayashi, Yumeko; Ishii, Yoshiki; Arai, Ryo; Obara, Kazuki; Kamada, Aya; Takizawa, Hidenori; Hase, Isano; Mashio, Kazuki; Yamada, Issei; Takemasa, Akihiro; Sugiyama, Kumiya; Fukushima, Yasutsugu; Fukuda, Takeshi

    2007-01-01

    A 73-year-old woman who had been followed in our department of gynecology because of ovarian cancer since 2002, was admitted with liver dysfunction and complaining of back pain and light precordial chest pain. The chest radiograph on admission revealed a tumor in her left upper lung field, and chest CT revealed a tumor adjacent to the chest wall and mediastinum. FDG-positron emission tomography (PET) showed abnormal uptake in the tumor and Th6/7, and the subaortic lymph nodes. On the basis of these findings, primary lung cancer with bone metastasis was suspected. She had a high grade fever on admission, and blood cultures were positive for group G streptococcus. The treatment with intravenous penicillin was started. Percutaneous biopsy of the tumor in her left chest showed an abscess wall in the chest wall, but no evidence of malignancy. Transbronchial lung biopsy and CT-guided biopsy also showed no malignant cells. Since the tumor decreased in size and back pain improved gradually by only antibiotic treatment, a diagnosis of sepsis of group G streptococcus, chest wall abscess, and vertebral osteomyelitis was made. She was treated with intravenous penicillin for 4 weeks and oral amoxicillin for another 4 weeks. After 60 days of antibiotic treatment, the tumor vanished.

  6. Chemo-thermotherapy for radiation-induced squamous cell carcinoma in anterior chest wall

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    Kodama, Ken; Doi, Osamu; Higashiyama, Masahiko; Yokouchi, Hideki; Noguchi, Shinzaburo; Koyama, Hiroki (Osaka Prefectural Center for Adult Diseases (Japan))

    1992-09-01

    A 62 years-old woman had visited our hospital with the large and deep ulcer formation on the left anterior chest wall. A biopsy of the ulcerous lesion established the diagnosis of a squamous cell carcinoma which might be induced by the irradiation after mastectomy. Although a wide resection of the chest wall including left arm was performed, it was impossible to resect completely. After then, she had operations for local recurrence three times in three years. However, cure was not obtained, and residual lesions gradually enlarged and all layers of the anterior chest wall were replaced with tumor tissues. Conventional chemotherapy using futraful and mytomycin C was not effective. Therefore, we tried combined therapy with intravenous administration of cisplatin (CDDP) and vindesine (VDS), and local hyperthermia using radiofrequency (RF) wave. A total number of 11 courses of this treatment modality was carried out at once a week intervals. The tumor-temperature was maintained at the range of 40-43degC for 40 min in each treatment session. Chemotherapeutic agents were administered simultaneously with hyperthermia. After these treatment, the recurrent tumor was markedly reduced, and epithelization of the ulcer was recognized from the surrounding normal skin. The residual tumor was then resected completely. The operative wound was successfully closed by surrounding normal tissue mobilization. She is in good postoperative condition. We concluded that the chemo-thermotherapy is safe and promising therapeutic modality for such invasive squamous cell carcinoma, and the normal tissues are not affected. Furthermore, this approach will expand the scope of radical resection for such an uncontrollable tumor. (author).

  7. Chemo-thermotherapy for radiation-induced squamous cell carcinoma in anterior chest wall

    International Nuclear Information System (INIS)

    Kodama, Ken; Doi, Osamu; Higashiyama, Masahiko; Yokouchi, Hideki; Noguchi, Shinzaburo; Koyama, Hiroki

    1992-01-01

    A 62 years-old woman had visited our hospital with the large and deep ulcer formation on the left anterior chest wall. A biopsy of the ulcerous lesion established the diagnosis of a squamous cell carcinoma which might be induced by the irradiation after mastectomy. Although a wide resection of the chest wall including left arm was performed, it was impossible to resect completely. After then, she had operations for local recurrence three times in three years. However, cure was not obtained, and residual lesions gradually enlarged and all layers of the anterior chest wall were replaced with tumor tissues. Conventional chemotherapy using futraful and mytomycin C was not effective. Therefore, we tried combined therapy with intravenous administration of cisplatin (CDDP) and vindesine (VDS), and local hyperthermia using radiofrequency (RF) wave. A total number of 11 courses of this treatment modality was carried out at once a week intervals. The tumor-temperature was maintained at the range of 40-43degC for 40 min in each treatment session. Chemotherapeutic agents were administered simultaneously with hyperthermia. After these treatment, the recurrent tumor was markedly reduced, and epithelization of the ulcer was recognized from the surrounding normal skin. The residual tumor was then resected completely. The operative wound was successfully closed by surrounding normal tissue mobilization. She is in good postoperative condition. We concluded that the chemo-thermotherapy is safe and promising therapeutic modality for such invasive squamous cell carcinoma, and the normal tissues are not affected. Furthermore, this approach will expand the scope of radical resection for such an uncontrollable tumor. (author)

  8. Reconstruction of the chest wall after excision of a giant malignant ...

    African Journals Online (AJOL)

    2011-07-29

    Jul 29, 2011 ... Malignant peripheral nerve sheath tumor (MPNST) of the chest wall is even rarer and its incidence on ... manubrium. There was no preceding history of trauma, fever, ... were related to pneumothorax and respiratory failures.[5].

  9. A close or positive margin after mastectomy is not an indication for chest wall irradiation except in women aged fifty or younger

    International Nuclear Information System (INIS)

    Freedman, G.M.; Fowble, B.L.; Hanlon, A.L.; Myint, M.A.; Hoffman, J.P.; Sigurdson, E.R.; Eisenberg, B.L.; Goldstein, L.J.; Fein, D.A.

    1997-01-01

    Purpose: Indications for postmastectomy radiation include primary tumor size > 5 cm and ≥ 4 positive axillary nodes. In clinical practice, patients with a close or positive margin after mastectomy are also often treated with postmastectomy radiation. However, there is little data regarding the risk of a chest wall recurrence in patients with this pathologic feature who otherwise would be considered low risk (tumor size 25% at 8 years: Age ≤ 50 years was 28% vs. 0% for age > 50 (p=0.08). There was no correlation with chest wall failure and number of nodes, ER status, lymphovascular invasion, location of primary, grade, family history or type of tumor close to the margin. All four chest wall failures were in patients who had received adjuvant systemic chemotherapy ± Tamoxifen. Chest wall failures occurred in patients with margins within 1-2 mm in three patients and 5 mm in one patient. The cumulative chest wall recurrence at 8 years by margin proximity was 24% ≤ 2mm vs. 7% 2.1-6 mm (p=0.44), and by clinical size 24% for T2 tumors vs. 7% for T1 (p=0.55). Conclusions: A close or positive margin is uncommon (< 5%) after mastectomy in patients with tumor size < 5 cm and 0-3 positive axillary nodes, but when present it appears to be in a younger patient population. The subgroup of patients aged 50 or younger with clinical T1-T2 tumor size and 0-3 positive nodes who have a close (≤ 5 mm) or positive mastectomy margin are at high risk (28% at 8 years) for chest wall recurrence regardless of adjuvant systemic therapy, and therefore we recommend they be considered for postmastectomy radiation. This high risk of local failure was not observed in patients over age 50, suggesting this subgroup may not require adjuvant chest wall irradiation

  10. Cross-sectional imaging with CT and/or MRI of pediatric chest tumors

    International Nuclear Information System (INIS)

    Wyttenbach, R.; Vock, P.; Tschaeppeler, H.

    1998-01-01

    The purpose of this study was to provide an overview of the spectrum of pediatric chest masses, to present the results of cross-sectional imaging with CT and/or MRI, and to define diagnostic criteria to limit differential diagnosis. Seventy-eight children with thoracic mass lesions were retrospectively evaluated using CT (72 patients) and/or MR imaging (12 patients). All masses were evaluated for tissue characteristics (attenuation values or signal intensity, enhancement, and calcification) and were differentiated according to age, gender, location, and etiology. Twenty-eight of 38 (74 %) mediastinal masses were malignant (neuroblastoma, malignant lymphoma). Thirty of 38 (79 %) pulmonary masses were metastatic in origin, all with an already known primary tumor (osteosarcoma, Wilms tumor). With one exception, all remaining pulmonary lesions were benign. Seventeen of 21 (81 %) chest wall lesions were malignant (Ewing sarcoma, primitive neuroectodermal tumor). The majority of mediastinal and chest wall tumors in children is malignant. Lung lesions are usually benign, unless a known extrapulmonary tumor suggests pulmonary metastases. Cross-sectional imaging with CT and/or MRI allows narrowing of the differential diagnosis of pediatric chest masses substantially by defining the origin and tissue characteristics. Magnetic resonance imaging is preferred for posterior mediastinal lesions, whereas CT should be used for pulmonary lesions. For the residual locations both modalities are complementary. (orig.)

  11. Imaging of chest wall infections

    International Nuclear Information System (INIS)

    Chelli Bouaziz, Mouna; Jelassi, Helmi; Chaabane, Skander; Ladeb, Mohamed Fethi; Ben Miled-Mrad, Khaoula

    2009-01-01

    A wide variety of infections can affect the chest wall including pyogenic, tuberculous, fungal, and some other unusual infections. These potentially life-threatening disorders are frequent especially among immunocompromised patients but often misdiagnosed by physical examination and radiographs. The purpose of this article is to describe the clinical and imaging features of these different chest wall infections according to the different imaging modalities with emphasis on ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI). The outcome of chest wall infection depends on early diagnosis, severity of the immunosuppression, offending organism, and extent of infection. Because clinical findings and laboratory tests may be not contributive in immunocompromised patients, imaging plays an important role in the early detection and precise assessment of the disease. US, CT, and MRI are all useful: bone destruction is more accurately detected with CT whereas soft tissue involvement are better visualized with US and MRI. CT and US are also used to guide percutaneous biopsy and drainage procedures. MR images are helpful in pre-operative planning of extensive chest wall infections. (orig.)

  12. Computed tomography of chest wall abscess

    International Nuclear Information System (INIS)

    Ikezoe, Junpei; Morimoto, Shizuo; Akira, Masanori

    1986-01-01

    Inflammatory lesions of the chest wall become less common because of the improvement of antibiotics and chemotherapeutic agents. Over a 5-year period, 7 patients with chest wall inflammatory diseases underwent chest computed tomography. These were 2 tuberculous pericostal abscesses, 2 empyema necessitatis, 1 spinal caries, and 2 bacterial chest wall abscesses (unknown organisms). Computed tomography (CT) helped in demonstrating the density, border, site, and extent of the lesions. CT images also demonstrated the accompaning abnormalities which included bone changes, pleural calcification, or old tuberculous changes of the lung. CT was very effective to demonstrate the communicating portions from the inside of the bony thorax to the outside of the bony thorax in 2 empyema necessitatis. (author)

  13. Osteosarcoma in the anterior chest wall that developed 20 years after postoperative radiotherapy for breast cancer

    International Nuclear Information System (INIS)

    Murata, Mariko; Shoji, Tsuyoshi; Nakayama, Ei; Bando, Toru

    2008-01-01

    Sarcomas are a rare complication of radiotherapy for breast cancer and such patients have a poor prognosis. We report resection of an osteosarcoma in the chest wall that developed 20 years after postoperative radiotherapy for breast cancer. A 57-year-old woman was referred to our department for examination and treatment of an anterior chest wall tumor in April 2007. In September 1986, she had undergone a radical mastectomy and postoperative irradiation and chemotherapy for right breast cancer. In December 2003, she underwent chemotherapy for recurrence of breast cancer which was pointed out on computed tomography involving the pleura and left superior clavicular lymph nodes. In March 2006, follow-up computed tomography of the chest demonstrated the destruction of the sternum, which was diagnosed as recurrence and she was followed with chemotherapy for breast cancer continuously thereafter. In April 2007, because of the developing sternal tumor, excisional biopsy was performed and histopathology indicated sarcoma. In May 2007, resection of the chest wall tumor with the sternum, bilateral clavicles, bilateral first and second ribs, and right partial lung (upper and middle lobe) were performed, and the chest wall defect was reconstructed with a rectus abdominis musculocutaneous free flap. Histopathologically, the tumor was osteosarcoma with margin free. Adjuvant radiotherapy to the breast plays a significant role in preventing local disease recurrence in women treated for breast cancer. However, radiotherapy can induce malignant sarcoma after a latency period of several years. The risk is extremely low for the individual patient, but this disease is aggressive and associated with a poor overall prognosis. Therefore, early detection is necessary for optimal treatment and incisional biopsy is necessary for accurate diagnosis. (author)

  14. Severe Chest Wall Toxicity From Cryoablation in the Setting of Prior Stereotactic Ablative Radiotherapy.

    Science.gov (United States)

    Chaudhuri, Aadel A; Binkley, Michael S; Aggarwal, Sonya; Qian, Yushen; Carter, Justin N; Shah, Rajesh; Loo, Billy W

    2016-02-02

    We present the case of a 42-year-old woman with metastatic synovial sarcoma of parotid origin, treated definitively with chemoradiation, who subsequently developed oligometastatic disease limited to the lungs. She underwent multiple left and right lung wedge resections and left lower lobectomy, followed by right lower lobe stereotactic ablative radiotherapy (SABR), 54 Gy in three fractions to a right lower lobe lesion abutting the chest wall. Two years later, she was treated with cryoablation for a separate right upper lobe nodule abutting the chest wall. Two months later, she presented with acute shortness of breath, pleuritic chest pain, decreased peripheral blood O2 saturation, and productive cough. A computed tomography (CT) scan demonstrated severe chest wall necrosis in the area of recent cryoablation that, in retrospect, also received a significant radiation dose from her prior SABR. This case demonstrates that clinicians should exercise caution in using cryoablation when treating lung tumors abutting a previously irradiated chest wall. Note: Drs. Loo and Shah contributed equally as co-senior authors.

  15. A case of sarcoma of the chest wall after radiation therapy for breast cancer

    International Nuclear Information System (INIS)

    Izumi, Junko; Nishi, Tsunehiro; Fukuuchi, Atsushi; Takanashi, Riichiro

    1998-01-01

    A case of radiation-induced sarcoma of the chest wall after radiation therapy for breast cancer is reported. A 69-year-old woman underwent mastectomy with axillary lymph node dissection followed by linac therapy of 50 Gy delivered to the left axilla, left supraclavicular area, and parasternal area. During therapy for bone and liver metastases, a tumor was noted in the left chest wall 15 years after radiation therapy. Incisional biopsy was performed. Histological diagnosis was spindle cell sarcoma. Radiation-induced sarcoma was suspected because the tumor developed 15 years after radiation therapy within the same area. Radiation-induced sarcoma is a rare tumor, but radiation therapy following breast-conserving therapy is widely employed. It is important to be aware of the possibility of radiation-induced sarcoma. (author)

  16. Electron arc therapy: chest wall irradiation of breast cancer patients

    International Nuclear Information System (INIS)

    McNeely, L.K.; Jacobson, G.M.; Leavitt, D.D.; Stewart, J.R.

    1988-01-01

    From 1980 to October 1985 we treated 45 breast cancer patients with electron arc therapy. This technique was used in situations where optimal treatment with fixed photon or electron beams was technically difficult: long scars, recurrent tumor extending across midline or to the posterior thorax, or marked variation in depth of target tissue. Forty-four patients were treated following mastectomy: 35 electively because of high risk of local failure, and 9 following local recurrence. One patient with advanced local regional disease was treated primarily. The target volume boundaries on the chest wall were defined by a foam lined cerrobend cast which rested on the patient during treatment, functioning as a tertiary collimator. A variable width secondary collimator was used to account for changes in the radius of the thorax from superior to inferior border. All patients had computerized tomography performed to determine Internal Mammary Chain depth and chest wall thickness. Electron energies were selected based on these thicknesses and often variable energies over different segments of the arc were used. The chest wall and regional node areas were irradiated to 45 Gy-50 Gy in 5-6 weeks by this technique. The supraclavicular and upper axillary nodes were treated by a direct anterior photon field abutted to the superior edge of the electron arc field. Follow-up is from 10-73 months with a median of 50 months. No major complications were observed. Acute and late effects and local control are comparable to standard chest wall irradiation. The disadvantages of this technique are that the preparation of the tertiary field defining cast and CT treatment planning are labor intensive and expensive. The advantage is that for specific clinical situations large areas of chest wall with marked topographical variation can be optimally, homogeneously irradiated while sparing normal uninvolved tissues

  17. A close or positive margin after mastectomy is not an indication for chest wall irradiation except in women aged fifty or younger

    International Nuclear Information System (INIS)

    Freedman, Gary M.; Fowble, Barbara L.; Hanlon, Alexandra L.; Myint, Maung A.; Hoffman, John P.; Sigurdson, Elin R.; Eisenberg, Burton L.; Goldstein, Lori J.; Fein, Douglas A.

    1998-01-01

    Introduction: Indications for postmastectomy radiation include primary tumor size ≥5 cm and/or ≥4 positive axillary nodes. In clinical practice, patients with a close or positive margin after mastectomy are also often treated with postmastectomy radiation. However, there is little data regarding the risk of a chest wall recurrence in patients with close or positive margins who otherwise would be considered low risk (tumor size 50 (p = 0.04). There was no correlation with chest wall failure and number of positive nodes, ER status, lymphovascular invasion, location of primary, grade, family history, or type of tumor close to the margin. Of 5 chest wall failures, 4 were in patients who had received adjuvant systemic chemotherapy ± tamoxifen. Chest wall failures occurred in 1 patient with a positive deep margin, 3 patients with margins within 2 mm, and 1 patient with a margin of 5 mm. The estimated cumulative incidence probability of chest wall recurrence at 8 years by margin proximity was 24% ≤ 2 mm vs. 7% 2.1-6 mm (p = 0.36), and by clinical size 24% for T2 tumors vs. 7% for T1 (p = 0.98). Conclusions: A close or positive margin is uncommon (≤5%) after mastectomy in patients with tumor size <5 cm and 0-3 positive axillary nodes but, when present, it appears to be in a younger patient population. The subgroup of patients aged 50 or younger with clinical T1-T2 tumor size and 0-3 positive nodes who have a close (≤5 mm) or positive mastectomy margin are at high risk (28% at 8 years) for chest wall recurrence regardless of adjuvant systemic therapy and, therefore, should be considered for postmastectomy radiation

  18. Biometric estimation of chest wall thickness of females

    International Nuclear Information System (INIS)

    Berger, C.D.; Lane, B.H.

    1985-01-01

    Optimal use of whole-body counting data to estimate pulmonary deposition of many of the actinides is dependent upon accurate measurement of the thickness of the chest wall because of severe attenuation of low-energy x rays and photons associated with the decay of these radionuclides. An algorithm for estimation of female chest wall thicknesses, verified by real-time ultrasonic measurements, has been derived based on the correlation of measured chest wall thickness and other common biometric quantities. Use of this algorithm will reduce the error generally associated with estimation of internal actinide deposition previously resulting from assuming an average chest wall thickness for all female subjects

  19. Peripheral primitive neuroendocrine tumor of the chest wall—A case report with pathological correlation

    Directory of Open Access Journals (Sweden)

    Jidi Gao, MD

    2018-04-01

    Full Text Available Primitive neuroectodermal tumor is a high-grade malignant tumor originating from the neural crest and neuroectoderm, which can be subdivided into central and peripheral categories. Peripheral primitive neuroectodermal tumor is thought to be identical to Ewing's sarcoma, and falls under a broader category of Ewing's sarcoma family of tumors. Very rarely, it may present without osseous involvement, known as extraosseous Ewing's sarcoma. Here we present a case of a 38-year-old woman, who presented with several-month history of a slow-growing chest wall mass, initially thought to be a breast mass. The mass was diagnosed as extraosseous Ewing's sarcoma upon tissue biopsy. The patient was started on a dose-intensified neoadjuvant therapy, based on protocol from pediatric population given rarity of this tumor in the adult population. While the patient was initially planned for surgical resection, the tumor showed excellent response to chemotherapy on follow-up imaging, and radiation therapy was elected in lieu of resection. Keywords: Chest wall tumors, Peripheral PNET, Ewing's sarcoma

  20. Plastic surgery in chest wall reconstruction: relevant aspects - case series

    Directory of Open Access Journals (Sweden)

    Diogo Franco

    Full Text Available Objective: to discuss the participation of Plastic Surgery in the reconstruction of the chest wall, highlighting relevant aspects of interdisciplinaryness. Methods: we analyzed charts from 20 patients who underwent extensive resection of the thoracic integument, between 2000 and 2014, recording the indication of resection, the extent and depth of the raw areas, types of reconstructions performed and complications. Results: among the 20 patients, averaging 55 years old, five were males and 15 females. They resections were: one squamous cell carcinoma, two basal cell carcinomas, five chondrosarcomas and 12 breast tumors. The extent of the bloody areas ranged from 4x9 cm to 25x40 cm. In 12 patients the resection included the muscular plane. In the remaining eight, the tumor removal achieved a total wall thickness. For reconstruction we used: one muscular flap associated with skin grafting, nine flaps and ten regional fasciocutaneous flaps. Two patients undergoing reconstruction with fasciocutaneous flaps had partially suffering of the flap, solved with employment of a myocutaneous flap. The other patients displayed no complications with the techniques used, requiring only one surgery. Conclusion: the proper assessment of local tissues and flaps available for reconstruction, in addition to the successful integration of Plastic Surgery with the specialties involved in the treatment, enable extensive resections of the chest wall and reconstructions that provide patient recovery.

  1. Anterior Abdominal Wall Desmoids Tumor in a Five Year Old Girl – A ...

    African Journals Online (AJOL)

    xp

    ABSTRACT: Desmoid tumors are rare, slow – growing, mesenchymal monoclinic proliferation. It may occur as intra-abdominal tumor usually affecting the mesentery of the intestine or it could be extra-abdominal in which they may affect the popliteal region, the chest wall or the anterior abdominal wall. Reports in children ...

  2. Anterior Abdominal Wall Desmoids Tumor in a Five Year Old Girl – A ...

    African Journals Online (AJOL)

    Desmoid tumors are rare, slow – growing, mesenchymal monoclinic proliferation. It may occur as intra-abdominal tumor usually affecting the mesentery of the intestine or it could be extra-abdominal in which they may affect the popliteal region, the chest wall or the anterior abdominal wall. Reports in children less than 10 ...

  3. Ultrasonic measurements of chest wall thickness and realistic chest phantom for calibration of Pu lung counting facilities

    International Nuclear Information System (INIS)

    Shirotani, Takashi

    1990-01-01

    There are four important problems for the measurements of chest wall thickness using ultrasonic device: (1) selection of optimum position of transducer and the number of measured points on the chest covered with detector, (2) estimation of adipose-to-muscle ratio in the chest wall, especially for dispersed adipose like 'marbled beef', (3) determination of regression equations for the prediction of chest wall thickness, derived from groups of different body shape, i.e. corpulent and lean, and (4) estimation of effective chest wall thickness involved self-absorption layer of lung tissue, which changes with distribution of activity in the lungs. This quantity can not be measured with ultrasonic device. Realistic chest phantom was developed. The phantom contains removable model organs (lungs, liver, kidneys and heart), model trachea and artificial rib cage, and also includes chest plates that can be placed over the chest to simulate wide range adipose-to-muscle ratio in the chest wall. Various soft tissue substitutes were made of polyurethane with different concentrations of additive, and the rib cage were made of epoxy resin with calcium carbonate. The experimental data have shown that the phantom can be used as a standard phantom for the calibration. (author)

  4. Regional variance of visually lossless threshold in compressed chest CT images: Lung versus mediastinum and chest wall

    International Nuclear Information System (INIS)

    Kim, Tae Jung; Lee, Kyoung Ho; Kim, Bohyoung; Kim, Kil Joong; Chun, Eun Ju; Bajpai, Vasundhara; Kim, Young Hoon; Hahn, Seokyung; Lee, Kyung Won

    2009-01-01

    Objective: To estimate the visually lossless threshold (VLT) for the Joint Photographic Experts Group (JPEG) 2000 compression of chest CT images and to demonstrate the variance of the VLT between the lung and mediastinum/chest wall. Subjects and methods: Eighty images were compressed reversibly (as negative control) and irreversibly to 5:1, 10:1, 15:1 and 20:1. Five radiologists determined if the compressed images were distinguishable from their originals in the lung and mediastinum/chest wall. Exact tests for paired proportions were used to compare the readers' responses between the reversible and irreversible compressions and between the lung and mediastinum/chest wall. Results: At reversible, 5:1, 10:1, 15:1, and 20:1 compressions, 0%, 0%, 3-49% (p < .004, for three readers), 69-99% (p < .001, for all readers), and 100% of the 80 image pairs were distinguishable in the lung, respectively; and 0%, 0%, 74-100% (p < .001, for all readers), 100%, and 100% were distinguishable in the mediastinum/chest wall, respectively. The image pairs were less frequently distinguishable in the lung than in the mediastinum/chest wall at 10:1 (p < .001, for all readers) and 15:1 (p < .001, for two readers). In 321 image comparisons, the image pairs were indistinguishable in the lung but distinguishable in the mediastinum/chest wall, whereas there was no instance of the opposite. Conclusion: For JPEG2000 compression of chest CT images, the VLT is between 5:1 and 10:1. The lung is more tolerant to the compression than the mediastinum/chest wall.

  5. Regional variance of visually lossless threshold in compressed chest CT images: Lung versus mediastinum and chest wall

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Tae Jung [Department of Radiology, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707 (Korea, Republic of); Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center (Korea, Republic of); Lee, Kyoung Ho [Department of Radiology, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707 (Korea, Republic of); Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center (Korea, Republic of)], E-mail: kholee@snubhrad.snu.ac.kr; Kim, Bohyoung; Kim, Kil Joong; Chun, Eun Ju; Bajpai, Vasundhara; Kim, Young Hoon [Department of Radiology, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707 (Korea, Republic of); Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center (Korea, Republic of); Hahn, Seokyung [Medical Research Collaborating Center, Seoul National University Hospital, 28 Yongon-dong, Chongno-gu, Seoul 110-744 (Korea, Republic of); Seoul National University College of Medicine (Korea, Republic of); Lee, Kyung Won [Department of Radiology, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707 (Korea, Republic of); Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center (Korea, Republic of)

    2009-03-15

    Objective: To estimate the visually lossless threshold (VLT) for the Joint Photographic Experts Group (JPEG) 2000 compression of chest CT images and to demonstrate the variance of the VLT between the lung and mediastinum/chest wall. Subjects and methods: Eighty images were compressed reversibly (as negative control) and irreversibly to 5:1, 10:1, 15:1 and 20:1. Five radiologists determined if the compressed images were distinguishable from their originals in the lung and mediastinum/chest wall. Exact tests for paired proportions were used to compare the readers' responses between the reversible and irreversible compressions and between the lung and mediastinum/chest wall. Results: At reversible, 5:1, 10:1, 15:1, and 20:1 compressions, 0%, 0%, 3-49% (p < .004, for three readers), 69-99% (p < .001, for all readers), and 100% of the 80 image pairs were distinguishable in the lung, respectively; and 0%, 0%, 74-100% (p < .001, for all readers), 100%, and 100% were distinguishable in the mediastinum/chest wall, respectively. The image pairs were less frequently distinguishable in the lung than in the mediastinum/chest wall at 10:1 (p < .001, for all readers) and 15:1 (p < .001, for two readers). In 321 image comparisons, the image pairs were indistinguishable in the lung but distinguishable in the mediastinum/chest wall, whereas there was no instance of the opposite. Conclusion: For JPEG2000 compression of chest CT images, the VLT is between 5:1 and 10:1. The lung is more tolerant to the compression than the mediastinum/chest wall.

  6. Primary infiltrating ductal carcinoma of the axillary breast with metastasis to the contralateral chest wall

    Directory of Open Access Journals (Sweden)

    Li-Min Sun

    2013-06-01

    Full Text Available Primary infiltrating ductal carcinoma of the axillary breast is rare and has a high frequency of lymph node (LN involvement. We report a woman with primary infiltrating ductal carcinoma arising from the right axillary breast with metastasis to the contralateral chest wall. Excisional biopsy of the left chest wall nodule and the right axillary mass was carried out and both showed invasive ductal carcinomas histologically. The lesion of the right axillary mass arose from the breast tissue, rather than the LN. Further surgery proved the right axillary LN metastasis. After further review, a primary infiltrating ductal carcinoma of the right axillary breast with metastasis to axillary LNs and contralateral chest wall was diagnosed. The patient also received chemotherapy and radiation and there was no evidence of tumor recurrence after treatment. The present report demonstrated a rare case with uncommon manifestation. Lesions of uncertain origin around the periphery of the breast should be suspected for breast carcinoma.

  7. Neurofibromas as bilateral cystic chest wall swellings. | Ugare ...

    African Journals Online (AJOL)

    A 35 year old male farmer presented with soft bilateral posterior chest wall swellings. He had no similar swellings elsewhere. There were no associated symptoms, except cosmetic deformity and discomfort when he lies on his back. A clinical diagnosis of posterior chest wall lipomata was made. However at surgery, the two ...

  8. Average chest wall thickness at two anatomic locations in trauma patients.

    Science.gov (United States)

    Schroeder, Elizabeth; Valdez, Carrie; Krauthamer, Andres; Khati, Nadia; Rasmus, Jessica; Amdur, Richard; Brindle, Kathleen; Sarani, Babak

    2013-09-01

    Needle thoracostomy is the emergent treatment for tension pneumothorax. This procedure is commonly done using a 4.5cm catheter, and the optimal site for chest wall puncture is controversial. We hypothesize that needle thoracostomy cannot be performed using this catheter length irrespective of the site chosen in either gender. A retrospective review of all chest computed tomography (CT) scans obtained on trauma patients from January 1, 2011 to December 31, 2011 was performed. Patients aged 18 and 80 years were included and patients whose chest wall thickness exceeded the boundary of the images acquired were excluded. Chest wall thickness was measured at the 2nd intercostal (ICS), midclavicular line (MCL) and the 5th ICS, anterior axillary line (AAL). Injury severity score (ISS), chest wall thickness, and body mass index (BMI) were analyzed. 201 patients were included, 54% male. Average (SD) BMI was 26 (7)kg/m(2). The average chest wall thickness in the overall cohort was 4.08 (1.4)cm at the 2nd ICS/MCL and 4.55 (1.7)cm at the 5th ICS/AAL. 29% of the overall cohort (27 male and 32 female) had a chest wall thickness greater than 4.5cm at the 2nd ICS/MCL and 45% (54 male and 36 female) had a chest wall thickness greater than 4.5cm at the 5th ICS/AAL. There was no significant interaction between gender and chest wall thickness at either site. BMI was positively associated with chest wall thickness at both the 2nd and 5th ICS/AAL. A 4.5cm catheter is inadequate for needle thoracostomy in most patients regardless of puncture site or gender. Copyright © 2013 Elsevier Ltd. All rights reserved.

  9. Thin chest wall is an independent risk factor for the development of pneumothorax after chest tube removal.

    Science.gov (United States)

    Anand, Rahul J; Whelan, James F; Ferrada, Paula; Duane, Therese M; Malhotra, Ajai K; Aboutanos, Michel B; Ivatury, Rao R

    2012-04-01

    The factors contributing to the development of pneumothorax after removal of chest tube thoracostomy are not fully understood. We hypothesized that development of post pull pneumothorax (PPP) after chest tube removal would be significantly lower in those patients with thicker chest walls, due to the "protective" layer of adipose tissue. All patients on our trauma service who underwent chest tube thoracostomy from July 2010 to February 2011 were retrospectively reviewed. Patient age, mechanism of trauma, and chest Abbreviated Injury Scale score were analyzed. Thoracic CTs were reviewed to ascertain chest wall thickness (CW). Thickness was measured at the level of the nipple at the midaxillary line, as perpendicular distance between skin and pleural cavity. Chest X-ray reports from immediately prior and after chest tube removal were reviewed for interval development of PPP. Data are presented as average ± standard deviation. Ninety-one chest tubes were inserted into 81 patients. Patients who died before chest tube removal (n = 11), or those without thoracic CT scans (n = 13) were excluded. PPP occurred in 29.9 per cent of chest tube removals (20/67). When PPP was encountered, repeat chest tube was necessary in 20 per cent of cases (4/20). After univariate analysis, younger age, penetrating mechanism, and thin chest wall were found to be significant risk factors for development of PPP. Chest Abbreviated Injury Scale score was similar in both groups. Logistic regression showed only chest wall thickness to be an independent risk factor for development of PPP.

  10. Chest wall segmentation in automated 3D breast ultrasound scans.

    Science.gov (United States)

    Tan, Tao; Platel, Bram; Mann, Ritse M; Huisman, Henkjan; Karssemeijer, Nico

    2013-12-01

    In this paper, we present an automatic method to segment the chest wall in automated 3D breast ultrasound images. Determining the location of the chest wall in automated 3D breast ultrasound images is necessary in computer-aided detection systems to remove automatically detected cancer candidates beyond the chest wall and it can be of great help for inter- and intra-modal image registration. We show that the visible part of the chest wall in an automated 3D breast ultrasound image can be accurately modeled by a cylinder. We fit the surface of our cylinder model to a set of automatically detected rib-surface points. The detection of the rib-surface points is done by a classifier using features representing local image intensity patterns and presence of rib shadows. Due to attenuation of the ultrasound signal, a clear shadow is visible behind the ribs. Evaluation of our segmentation method is done by computing the distance of manually annotated rib points to the surface of the automatically detected chest wall. We examined the performance on images obtained with the two most common 3D breast ultrasound devices in the market. In a dataset of 142 images, the average mean distance of the annotated points to the segmented chest wall was 5.59 ± 3.08 mm. Copyright © 2012 Elsevier B.V. All rights reserved.

  11. Muscular sarcoidosis involving the chest and abdominal walls: case report with MR imaging

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    Lee, Seunghyun; Lee, In Sook; Song, You Seon [Pusan National University Hospital, Biomedical Research Institute, Department of Radiology, Busan (Korea, Republic of); Pusan National University School of Medicine, Busan (Korea, Republic of); Mok, Jeongha [Pusan National University Hospital, Biomedical Research Institute, Department of Internal Medicine, Busan (Korea, Republic of); Choi, Kyung-Un [Pusan National University Hospital, Biomedical Research Institute, Department of Pathology, Busan (Korea, Republic of)

    2018-03-15

    Sarcoidosis is an inflammatory disorder that is characterized by the presence of noncaseating granulomas in tissues, involving many organs and tissues. Extra-pulmonary, especially muscular sarcoidosis is a rare condition. The most common location of the muscular sarcoidosis is known to be the proximal muscles of the extremities; however, there have been no cases of diffuse involvement of the chest and abdominal wall muscles. Here, we report a rare muscular sarcoidosis with infiltrative pattern in the chest and abdominal wall muscles and describe the MR imaging findings that were mistaken as lymphoma at initial diagnosis. Although our case did not show characteristic MR findings of muscular sarcoidosis, clinicians or radiologists who are aware of these imaging features can perform early systemic survey for sarcoidosis. Also muscle biopsy is very important to confirm the sarcoidosis and distinguish it from other tumors. (orig.)

  12. Muscular sarcoidosis involving the chest and abdominal walls: case report with MR imaging

    International Nuclear Information System (INIS)

    Lee, Seunghyun; Lee, In Sook; Song, You Seon; Mok, Jeongha; Choi, Kyung-Un

    2018-01-01

    Sarcoidosis is an inflammatory disorder that is characterized by the presence of noncaseating granulomas in tissues, involving many organs and tissues. Extra-pulmonary, especially muscular sarcoidosis is a rare condition. The most common location of the muscular sarcoidosis is known to be the proximal muscles of the extremities; however, there have been no cases of diffuse involvement of the chest and abdominal wall muscles. Here, we report a rare muscular sarcoidosis with infiltrative pattern in the chest and abdominal wall muscles and describe the MR imaging findings that were mistaken as lymphoma at initial diagnosis. Although our case did not show characteristic MR findings of muscular sarcoidosis, clinicians or radiologists who are aware of these imaging features can perform early systemic survey for sarcoidosis. Also muscle biopsy is very important to confirm the sarcoidosis and distinguish it from other tumors. (orig.)

  13. Tumors on chest wall, breast cancer in men. A case

    International Nuclear Information System (INIS)

    Najera, Carlos; Guerra, Diego; Sotomayor, Sonia; Poveda, Sergio; Bucheli, Carlos

    2004-01-01

    A 75 years old man went to the Carlos Andrade Marin Hospital due to the appearance of a mass on his chest wall, initially diagnosed as a lypoma. During his preoperative preparation we had a suspicion of a malignant process. Finally and after a surgical procedure the diagnose was made, breast cancer. Considered this way the practice of medicine is as simple as having a suspicion. In fact it is, actually what determines the final diagnose of a pathology is the suspicion that we as physicians have about a problem. However, to generate an hypothesis we required knowledge, study and curiosity. The present work is a bibliographic review about a non so frequent problem as the thoracic mass is. The author)

  14. Chest wall tuberculosis; CT findings in 14 patients

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    Han, Young Min; Lee, Sang Yong; Lee, Dong Won; Kim, Chong Soo; Chung, Gyung Ho; Sohn, Myung Hee; Choi, Ki Chul [Chonbuk National Univ. School of Medicine, Chonju (Korea, Republic of); Kim, Dong Woo [Daejoen Eulji Hospital, Daejon (Korea, Republic of); Juhng, Seon Kwan [Wonkwang Univ. Medical School, Iksan (Korea, Republic of)

    1996-01-01

    To present CT findings of chest wall tuberculosis. CT scans were obtained in 14 patients with proven chest wall tuberculosis. Diagnosis was confirmed by means of right open thoracostomy with abscess evacuation (n=1), excision and curettage (n=11) or excision and curettage along with resection of the involved lung (n=2). The images were assessed with emphasis for the extrapleural, pleural, and pulmonary lesions. All patients showed juxtacostal soft tissue mass with central low attenuation and peripheral rim enhancement. The lesions were located in the left hemithorax in eight patients and in the right in six. Multiple lesions were found in three patients (two in one and three in two). Rib destruction was observed in four patients. Intercostal muscle involvement of thickening and enhancement were shown in all patients. Thirteen patients (93%) had evidence of pulmonary tuberculosis: active pulmonary tuberculosis in nine and stable tuberculosis in four. Pleural lesions, including empyema necessitatis in six, were observed in eleven (79%). On CT scan, chest wall tuberculosis is characterized by juxtacostal soft tissue lesion with central low attenuation and peripheral rim enhancement. Rib destruction may be associated. Additionally, enhancing intercostal muscle suggest direct inflammatory process of tuberculosis and spread channel to the chest wall involvement of pleuropulmonary tuberculosis.

  15. Chest wall tuberculosis; CT findings in 14 patients

    International Nuclear Information System (INIS)

    Han, Young Min; Lee, Sang Yong; Lee, Dong Won; Kim, Chong Soo; Chung, Gyung Ho; Sohn, Myung Hee; Choi, Ki Chul; Kim, Dong Woo; Juhng, Seon Kwan

    1996-01-01

    To present CT findings of chest wall tuberculosis. CT scans were obtained in 14 patients with proven chest wall tuberculosis. Diagnosis was confirmed by means of right open thoracostomy with abscess evacuation (n=1), excision and curettage (n=11) or excision and curettage along with resection of the involved lung (n=2). The images were assessed with emphasis for the extrapleural, pleural, and pulmonary lesions. All patients showed juxtacostal soft tissue mass with central low attenuation and peripheral rim enhancement. The lesions were located in the left hemithorax in eight patients and in the right in six. Multiple lesions were found in three patients (two in one and three in two). Rib destruction was observed in four patients. Intercostal muscle involvement of thickening and enhancement were shown in all patients. Thirteen patients (93%) had evidence of pulmonary tuberculosis: active pulmonary tuberculosis in nine and stable tuberculosis in four. Pleural lesions, including empyema necessitatis in six, were observed in eleven (79%). On CT scan, chest wall tuberculosis is characterized by juxtacostal soft tissue lesion with central low attenuation and peripheral rim enhancement. Rib destruction may be associated. Additionally, enhancing intercostal muscle suggest direct inflammatory process of tuberculosis and spread channel to the chest wall involvement of pleuropulmonary tuberculosis

  16. Anterior chest wall examination reviewed

    Directory of Open Access Journals (Sweden)

    F. Trotta

    2011-09-01

    Full Text Available Anterior chest wall involvement is not infrequently observed within inflammatory arthropaties, particularly if one considers seronegative spondiloarthritides and SAPHO syndrome. Physical examination is unreliable and conventional X-rays analysis is an unsatisfactory tool during diagnostic work-up of this region. Scintigraphic techniques yield informations both on the activity and on the anatomical extent of the disease while computerized tomography visualize the elementary lesions, such as erosions, which characterize the process. Moreover, when available, magnetic resonance imaging couple the ability to finely visualize such lesions with the possibility to show early alterations and to characterize the “activity” of the disease, presenting itself as a powerful tool both for diagnosis and follow-up. This review briefly shows the applications of imaging techniques for the evaluation of the anterior chest wall focusing on what has been done in the SAPHO syndrome which can be considered prototypical for this regional involvement since it is the osteo-articular target mainly affected by the disease.

  17. Revision of orthovoltage chest wall treatment using Monte Carlo simulations.

    Science.gov (United States)

    Zeinali-Rafsanjani, B; Faghihi, R; Mosleh-Shirazi, M A; Mosalaei, A; Hadad, K

    2017-01-01

    Given the high local control rates observed in breast cancer patients undergoing chest wall irradiation by kilovoltage x-rays, we aimed to revisit this treatment modality by accurate calculation of dose distributions using Monte Carlo simulation. The machine components were simulated using the MCNPX code. This model was used to assess the dose distribution of chest wall kilovoltage treatment in different chest wall thicknesses and larger contour or fat patients in standard and mid sternum treatment plans. Assessments were performed at 50 and 100 cm focus surface distance (FSD) and different irradiation angles. In order to evaluate different plans, indices like homogeneity index, conformity index, the average dose of heart, lung, left anterior descending artery (LAD) and percentage target coverage (PTC) were used. Finally, the results were compared with the indices provided by electron therapy which is a more routine treatment of chest wall. These indices in a medium chest wall thickness in standard treatment plan at 50 cm FSD and 15 degrees tube angle was as follows: homogeneity index 2.57, conformity index 7.31, average target dose 27.43 Gy, average dose of heart, lung and LAD, 1.03, 2.08 and 1.60 Gy respectively and PTC 11.19%. Assessments revealed that dose homogeneity in planning target volume (PTV) and conformity between the high dose region and PTV was poor. To improve the treatment indices, the reference point was transferred from the chest wall skin surface to the center of PTV. The indices changed as follows: conformity index 7.31, average target dose 60.19 Gy, the average dose of heart, lung and LAD, 3.57, 6.38 and 5.05 Gy respectively and PTC 55.24%. Coverage index of electron therapy was 89% while it was 22.74% in the old orthovoltage method and also the average dose of the target was about 50 Gy but in the given method it was almost 30 Gy. The results of the treatment study show that the optimized standard and mid sternum treatment for different chest

  18. Reconstruction with a patient-specific titanium implant after a wide anterior chest wall resection

    Science.gov (United States)

    Turna, Akif; Kavakli, Kuthan; Sapmaz, Ersin; Arslan, Hakan; Caylak, Hasan; Gokce, Hasan Suat; Demirkaya, Ahmet

    2014-01-01

    The reconstruction of full-thickness chest wall defects is a challenging problem for thoracic surgeons, particularly after a wide resection of the chest wall that includes the sternum. The location and the size of the defect play a major role when selecting the method of reconstruction, while acceptable cosmetic and functional results remain the primary goal. Improvements in preoperative imaging techniques and reconstruction materials have an important role when planning and performing a wide chest wall resection with a low morbidity rate. In this report, we describe the reconstruction of a wide anterior chest wall defect with a patient-specific custom-made titanium implant. An infected mammary tumour recurrence in a 62-year old female, located at the anterior chest wall including the sternum, was resected, followed by a large custom-made titanium implant. Latissimus dorsi flap and split-thickness graft were also used for covering the implant successfully. A titanium custom-made chest wall implant could be a viable alternative for patients who had large chest wall tumours. PMID:24227881

  19. Bilateral Multifocal Hamartoma of the Chest Wall in an Infant

    Science.gov (United States)

    Yilmaz, Erdem; Erol, Oguz Bulent; Pekcan, Melih; Gundogdu, Gokcen; Bilgic, Bilge; Gun, Feryal; Yekeler, Ensar

    2015-01-01

    Summary Background Hamartoma of the thoracic wall is a rare benign tumor that occurs in infancy and can be mistaken for a malignancy due to its clinical and imaging features. Hamartomas are extrapleural soft tissue lesions that cause rib expansion and destruction and appear on imaging as cystic areas with fluid levels and calcification. They can cause scoliosis, pressure on the neighboring lung parenchyma and mediastinal displacement. While conservative treatment is recommended in asymptomatic cases, growing lesions require surgical excision. Case Report In this report, we present the imaging findings in a 3-month-old infant that presented with a firm swelling in the chest wall and was histopathologically confirmed to have a bilateral multifocal hamartoma. Conclusions Radiological imaging methods are important for accurate diagnosis of this very rare condition that can be confused with a malignancy. PMID:26082822

  20. A Case of “en bloc” Excision of a Chest Wall Leiomyosarcoma and Closure of the Defect with Non-Cross-Linked Collagen Matrix (Egis®

    Directory of Open Access Journals (Sweden)

    Marco Rastrelli

    2016-10-01

    Full Text Available Sarcomas arising from the chest wall account for less than 20% of all soft tissue sarcomas, and at this site, primitive tumors are the most frequent to occur. Leiomyosarcoma is a malignant smooth muscle tumor and the best outcomes are achieved with wide surgical excision. Although advancements have been made in treatment protocols, leiomyosarcoma remains one of the more difficult soft tissue sarcoma to treat. Currently, general local control is obtained with surgical treatment with wide negative margins. We describe the case of a 50-year-old man who underwent a chest wall resection involving a wide portion of the pectoralis major and minor muscle, the serratus and part of the second, third and fourth ribs of the left side. The full-thickness chest wall defect of 10 × 8 cm was closed using a non-cross-linked acellular dermal matrix (Egis® placed in two layers, beneath the rib plane and over it. A successful repair was achieved with no incisional herniation and with complete tissue regeneration, allowing natural respiratory movements. No complications were observed in the postoperative course. Biological non-cross-linked matrix, derived from porcine dermis, behaves like a scaffold supporting tissue regeneration; it can be successfully used as an alternative to synthetic mesh for chest wall reconstruction.

  1. A Case of “en bloc” Excision of a Chest Wall Leiomyosarcoma and Closure of the Defect with Non-Cross-Linked Collagen Matrix (Egis®)

    Science.gov (United States)

    Rastrelli, Marco; Tropea, Saveria; Spina, Romina; Costa, Alessandra; Stramare, Roberto; Mocellin, Simone; Bonavina, Maria Giuseppina; Rossi, Carlo Riccardo

    2016-01-01

    Sarcomas arising from the chest wall account for less than 20% of all soft tissue sarcomas, and at this site, primitive tumors are the most frequent to occur. Leiomyosarcoma is a malignant smooth muscle tumor and the best outcomes are achieved with wide surgical excision. Although advancements have been made in treatment protocols, leiomyosarcoma remains one of the more difficult soft tissue sarcoma to treat. Currently, general local control is obtained with surgical treatment with wide negative margins. We describe the case of a 50-year-old man who underwent a chest wall resection involving a wide portion of the pectoralis major and minor muscle, the serratus and part of the second, third and fourth ribs of the left side. The full-thickness chest wall defect of 10 × 8 cm was closed using a non-cross-linked acellular dermal matrix (Egis®) placed in two layers, beneath the rib plane and over it. A successful repair was achieved with no incisional herniation and with complete tissue regeneration, allowing natural respiratory movements. No complications were observed in the postoperative course. Biological non-cross-linked matrix, derived from porcine dermis, behaves like a scaffold supporting tissue regeneration; it can be successfully used as an alternative to synthetic mesh for chest wall reconstruction. PMID:27920698

  2. Chest wall syndrome among primary care patients: a cohort study

    Directory of Open Access Journals (Sweden)

    Verdon François

    2007-09-01

    Full Text Available Abstract Background The epidemiology of chest pain differs strongly between outpatient and emergency settings. In general practice, the most frequent cause is the chest wall pain. However, there is a lack of information about the characteristics of this syndrome. The aims of the study are to describe the clinical aspects of chest wall syndrome (CWS. Methods Prospective, observational, cohort study of patients attending 58 private practices over a five-week period from March to May 2001 with undifferentiated chest pain. During a one-year follow-up, questionnaires including detailed history and physical exam, were filled out at initial consultation, 3 and 12 months. The outcomes were: clinical characteristics associated with the CWS diagnosis and clinical evolution of the syndrome. Results Among 24 620 consultations, we observed 672 cases of chest pain and 300 (44.6% patients had a diagnosis of chest wall syndrome. It affected all ages with a sex ratio of 1:1. History and sensibility to palpation were the keys for diagnosis. Pain was generally moderate, well localised, continuous or intermittent over a number of hours to days or weeks, and amplified by position or movement. The pain however, may be acute. Eighty-eight patients were affected at several painful sites, and 210 patients at a single site, most frequently in the midline or a left-sided site. Pain was a cause of anxiety and cardiac concern, especially when acute. CWS coexisted with coronary disease in 19 and neoplasm in 6. Outcome at one year was favourable even though CWS recurred in half of patients. Conclusion CWS is common and benign, but leads to anxiety and recurred frequently. Because the majority of chest wall pain is left-sided, the possibility of coexistence with coronary disease needs careful consideration.

  3. Chest wall syndrome among primary care patients: a cohort study.

    Science.gov (United States)

    Verdon, François; Burnand, Bernard; Herzig, Lilli; Junod, Michel; Pécoud, Alain; Favrat, Bernard

    2007-09-12

    The epidemiology of chest pain differs strongly between outpatient and emergency settings. In general practice, the most frequent cause is the chest wall pain. However, there is a lack of information about the characteristics of this syndrome. The aims of the study are to describe the clinical aspects of chest wall syndrome (CWS). Prospective, observational, cohort study of patients attending 58 private practices over a five-week period from March to May 2001 with undifferentiated chest pain. During a one-year follow-up, questionnaires including detailed history and physical exam, were filled out at initial consultation, 3 and 12 months. The outcomes were: clinical characteristics associated with the CWS diagnosis and clinical evolution of the syndrome. Among 24 620 consultations, we observed 672 cases of chest pain and 300 (44.6%) patients had a diagnosis of chest wall syndrome. It affected all ages with a sex ratio of 1:1. History and sensibility to palpation were the keys for diagnosis. Pain was generally moderate, well localised, continuous or intermittent over a number of hours to days or weeks, and amplified by position or movement. The pain however, may be acute. Eighty-eight patients were affected at several painful sites, and 210 patients at a single site, most frequently in the midline or a left-sided site. Pain was a cause of anxiety and cardiac concern, especially when acute. CWS coexisted with coronary disease in 19 and neoplasm in 6. Outcome at one year was favourable even though CWS recurred in half of patients. CWS is common and benign, but leads to anxiety and recurred frequently. Because the majority of chest wall pain is left-sided, the possibility of coexistence with coronary disease needs careful consideration.

  4. Chest wall syndrome among primary care patients: a cohort study

    Science.gov (United States)

    Verdon, François; Burnand, Bernard; Herzig, Lilli; Junod, Michel; Pécoud, Alain; Favrat, Bernard

    2007-01-01

    Background The epidemiology of chest pain differs strongly between outpatient and emergency settings. In general practice, the most frequent cause is the chest wall pain. However, there is a lack of information about the characteristics of this syndrome. The aims of the study are to describe the clinical aspects of chest wall syndrome (CWS). Methods Prospective, observational, cohort study of patients attending 58 private practices over a five-week period from March to May 2001 with undifferentiated chest pain. During a one-year follow-up, questionnaires including detailed history and physical exam, were filled out at initial consultation, 3 and 12 months. The outcomes were: clinical characteristics associated with the CWS diagnosis and clinical evolution of the syndrome. Results Among 24 620 consultations, we observed 672 cases of chest pain and 300 (44.6%) patients had a diagnosis of chest wall syndrome. It affected all ages with a sex ratio of 1:1. History and sensibility to palpation were the keys for diagnosis. Pain was generally moderate, well localised, continuous or intermittent over a number of hours to days or weeks, and amplified by position or movement. The pain however, may be acute. Eighty-eight patients were affected at several painful sites, and 210 patients at a single site, most frequently in the midline or a left-sided site. Pain was a cause of anxiety and cardiac concern, especially when acute. CWS coexisted with coronary disease in 19 and neoplasm in 6. Outcome at one year was favourable even though CWS recurred in half of patients. Conclusion CWS is common and benign, but leads to anxiety and recurred frequently. Because the majority of chest wall pain is left-sided, the possibility of coexistence with coronary disease needs careful consideration. PMID:17850647

  5. Radiotherapy of the chest wall following mastectomy for early-stage breast cancer: impact on local recurrence and overall survival

    International Nuclear Information System (INIS)

    Janni, Wolfgang; Dimpfl, Thomas; Braun, Stephan; Knobbe, Angelika; Peschers, Ursula; Rjosk, Dorothea; Lampe, Bjoern; Genz, Thomas

    2000-01-01

    Introduction: Recent studies have renewed an old controversy about the efficacy of adjuvant radiotherapy following mastectomy for breast cancer. Radiotherapy is usually recommended for advanced disease, but whether or not to use it in pT1-T2 pN0 situations is still being debated. This study was designed to clarify whether or not routine radiotherapy of the chest wall following mastectomy reduces the risk of local recurrence and if it influences the overall survival rate. Methods: Retrospective analysis of patients treated with mastectomy for pT1-T2 pN0 tumors and no systemic treatment. Patients treated with radiotherapy of the chest wall following mastectomy (Group A) are compared with those treated with mastectomy alone (Group B). Results: A total of 918 patients underwent mastectomy. Patients who received adjuvant radiotherapy after mastectomy (n = 114) had a significantly lower risk for local recurrence. Ten years after the primary diagnosis, 98.1% of the patients with radiotherapy were disease free compared to 86.4% of the patients without radiotherapy. The average time interval from primary diagnosis until local recurrence was 8.9 years in Group A and 2.8 years in Group B. The Cox regression analysis including radiotherapy, tumor size and tumor grading found the highest risk for local recurrence for patients without radiotherapy (p < 0.0004). In terms of overall survival however, the Kaplan-Meier analysis showed no difference between the two groups (p = 0.8787) and the Cox regression analysis failed to show any impact on overall survival. Conclusion: With observation spanning over 35 years, this study shows that adjuvant radiotherapy of the chest wall following mastectomy reduces the risk for local recurrence in node-negative patients with pT1-T2 tumors but has no impact on the overall survival rate

  6. Radiologic images of an aggressive implant-associated fibromatosis of the breast and chest wall: case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Lourdes Alanis, MD, MPH

    2017-09-01

    Full Text Available Fibromatosis of the breast is a rare benign disease compromising <0.2% of all primary breast tumors. Although the chest wall is a common location, occurrences of implant-associated fibromatosis of the breast are extremely rare; only 33 cases have been reported. We present a case of a 42-year-old female who underwent breast augmentation with silicone breast implants, and 2 years later developed an aggressive implant-associated fibromatosis of the breast and chest wall. On imaging studies, the tumor mimicked breast carcinoma, and despite chemotherapy, the fibromatosis rapidly enlarged and was locally invasive requiring wide surgical excision. Unlike previously reported imaging findings, magnetic resonance imaging revealed an oval circumscribed mass with fringe-like internal architecture. We provide a review of the literature and discuss the imaging features of implant-associated fibromatosis of the breast.

  7. Herniation of unruptured tuberculous lung abscess into chest wall without pleural or bronchial spillage

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    Rahul Magazine

    2011-01-01

    Full Text Available A 22-year-old unmarried man presented to the chest outpatient department with a history of productive cough of two-month duration. He also complained of pain and swelling on the anterior aspect of right side of chest of one-month duration. Imaging studies of the thorax, including chest roentgenography and computerized tomography, revealed an unruptured lung abscess which had herniated into the chest wall. Culture of pus aspirated from the chest wall swelling grew Mycobacterium tuberculosis. He was diagnosed to have a tuberculous lung abscess which had extended into the chest wall, without spillage into the pleural cavity or the bronchial tree. Antituberculosis drugs were prescribed, and he responded to the treatment with complete resolution of the lesion.

  8. Tuberculous mediastinal Lymphadenopathy; Simulating other mediastinal tumors in chest films

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jae Hyung; Kim, Kun Sang; Kim, Chu Wan [Seoul National University Hospital, Seoul (Korea, Republic of)

    1973-12-15

    Radiographs of chest may hardly differentiate the tuberculous mediastinal lymphadenopathy in children or adults with other mediastinal tumors sometimes when markedly enlarged mediastinal lymph node is the main findings of tuberculosis. 6 cases of tuberculous mediastinal lymphadenopathy was collected which was confirmed histopathologically and of which findings in chest films are indistinguishable with other mediastinal tumors especially lymphomas. After analysing the findings in chest films, the followings: could be found 1) The locations of the lesions are mainly hilar and superior mediastinum but there are also many variations of them, so there are of no significance in differential diagnosis with other mediastinal tumors. 2) The contours of the lesions are unilateral in 5 cases, and scalloped or diffusely widened appearance in all cases. 3) When mediastinal lymphadenopathy is the sole evidence of tuberculosis and even when additional lesions are noted in lung parenchyme or pleura, occasional lyes chest x-ray only is insufficient to differentiate the lesion with other mediastinal tumors including lymphomas. 4) Considering the frequency of the tuberculosis in this country, whenever one suspects any mediastinal tumors in chest x-ray one should include the possibility of tuberculous mediastinal lymphadenopathy in differential diagnosis.

  9. Comparative study of 6 MV and 15 MV treatment plans for large chest wall irradiation

    International Nuclear Information System (INIS)

    Prasana Sarathy, N.; Kothanda Raman, S.; Sen, Dibyendu; Pal, Bipasha

    2007-01-01

    Conventionally, opposed tangential fields are used for the treatment of chest wall irradiation. If the chest wall is treated in the linac, 4 or 6 MV photons will be the energy of choice. It is a welI-established rule that for chest wall separations up to 22 cm, one can use mid-energies, with acceptable volume of hot spots. For larger patient sizes (22 cm and above), mid-energy beams produce hot spots over large volumes. The purpose of this work is to compare plans made with 6 and 15 MV photons, for patients with large chest wall separations. The obvious disadvantage in using high-energy photons for chest wall irradiation is inadequate dose to the skin. But this can be compensated by using a bolus of suitable thickness

  10. [Use and versatility of titanium for the reconstruction of the thoracic wall].

    Science.gov (United States)

    Córcoles Padilla, Juan Manuel; Bolufer Nadal, Sergio; Kurowski, Krzysztof; Gálvez Muñoz, Carlos; Rodriguez Paniagua, José Manuel

    2014-02-01

    Chest wall deformities/defects and chest wall resections, as well as complex rib fractures require reconstruction with various prosthetic materials to ensure the basic functions of the chest wall. Titanium provides many features that make it an ideal material for this surgery. The aim is to present our initial results with this material in several diseases. From 2008 to 2012, 14 patients were operated on and titanium was used for reconstruction of the chest wall. A total of 7 patients had chest wall tumors, 2 with sternal resection, 4 patients with chest wall deformities/defects and 3 patients with severe rib injury due to traffic accident. The reconstruction was successful in all cases, with early extubation without detecting problems in the functionality of the chest wall at a respiratory level. Patients with chest wall tumors including sternal resections were extubated in the operating room as well as the chest wall deformities. Chest trauma cases were extubated within 24h from internal rib fixation. There were no complications related to the material used and the method of implementation. Titanium is an ideal material for reconstruction of the chest wall in several clinical situations allowing for great versatility and adaptability in different chest wall reconstructions. Copyright © 2013 AEC. Published by Elsevier Espana. All rights reserved.

  11. A Community-acquired Lung Abscess Attributable to Streptococcus pneumoniae which Extended Directly into the Chest Wall.

    Science.gov (United States)

    Ko, Yuki; Tobino, Kazunori; Yasuda, Yuichiro; Sueyasu, Takuto; Nishizawa, Saori; Yoshimine, Kouhei; Munechika, Miyuki; Asaji, Mina; Yamaji, Yoshikazu; Tsuruno, Kosuke; Miyajima, Hiroyuki; Mukasa, Yosuke; Ebi, Noriyuki

    We herein report the case of 75-year-old Japanese female with a community-acquired lung abscess attributable to Streptococcus pneumoniae (S. penumoniae) which extended into the chest wall. The patient was admitted to our hospital with a painful mass on the left anterior chest wall. A contrast-enhanced chest computed tomography scan showed a lung abscess in the left upper lobe which extended into the chest wall. Surgical debridement of the chest wall abscess and percutaneous transthoracic tube drainage of the lung abscess were performed. A culture of the drainage specimen yielded S. pneumoniae. The patient showed a remarkable improvement after the initiation of intravenous antibiotic therapy.

  12. Surgical management of the radiated chest wall

    International Nuclear Information System (INIS)

    Arnold, P.G.; Pairolero, P.C.

    1986-01-01

    Fifty consecutive patients with radiation-related problems of the chest wall were treated between 1976 and 1984. There were 40 women and 10 men with an average age of 54 years (range 26 to 78 years). Twenty-three patients had radiation ulcers alone, 20 had recurrent cancer, and 7 had infected median sternotomy wounds. Thirty-six had skeletal resections and 44 had soft-tissue resections. The skeleton was reconstructed with Prolene mesh in 12 patients and with autogenous rib in 3. Sixty-three muscles were transposed in 43 patients. Twelve omental transpositions were performed (8 for primary treatment and 4 for salvage of a failed muscle flap). Hospitalization averaged 20.2 days. There was one operative death (at 29 days). Partial flap necrosis occurred in 10 patients. Mesh was removed in three patients. There were 14 late deaths, most from recurrent tumor. The remaining patients had well-healed wounds and a generally improved quality of life. We conclude that aggressive resection and reliable reconstruction are critical considerations in the surgical management of this perplexing clinical problem

  13. Chest wall – underappreciated structure in sonography. Part I: Examination methodology and ultrasound anatomy

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    Andrzej Smereczyński

    2017-09-01

    Full Text Available Chest wall ultrasound has been awarded little interest in the literature, with chest wall anatomy described only in limited extent. The objective of this study has been to discuss the methodology of chest wall ultrasound and the sonographic anatomy of the region to facilitate professional evaluation of this complex structure. The primarily used transducer is a 7–12 MHz linear one. A 3–5 MHz convex (curvilinear transducer may also be helpful, especially in obese and very muscular patients. Doppler and panoramic imaging options are essential. The indications for chest wall ultrasound include localized pain or lesions found or suspected on imaging with other modalities (conventional radiography, CT, MR or scintigraphy. The investigated pathological condition should be scanned in at least two planes. Sometimes, evaluation during deep breathing permits identification of pathological mobility (e.g. in rib or sternum fractures, slipping rib syndrome. Several structures, closely associated with each other, need to be considered in the evaluation of the chest wall. The skin, which forms a hyperechoic covering, requires a high frequency transducer (20–45 MHz. The subcutaneous fat is characterized by clusters of hypoechoic lobules. Chest muscles have a very complex structure, but their appearance on ultrasound does not differ from the images of muscles located in other anatomical regions. As far as cartilaginous and bony structures of the chest are concerned, the differences in the anatomy of the ribs, sternum, scapula and sternoclavicular joints have been discussed. The rich vascular network which is only fragmentarily accessible for ultrasound assessment has been briefly discussed. A comprehensive evaluation of the chest wall should include the axillary, supraclavicular, apical and parasternal lymph nodes. Their examination requires the use of elastography and contrast-enhanced ultrasound.

  14. Delayed chest wall hematoma caused by progressive displacement of rib fractures after blunt trauma

    Directory of Open Access Journals (Sweden)

    Nobuhiro Sato

    2016-06-01

    Full Text Available Rib fracture is a common injury resulting from blunt thoracic trauma. Although hemothorax and pneumothorax are known delayed complications of rib fracture, delayed chest wall hematoma has rarely been reported. We discuss the case of an 81-year-old woman who was not undergoing antiplatelet or anticoagulant therapy who presented to our emergency department after a traffic injury. This patient had a nondisplaced rib fracture that went undetected on the initial computed tomography scan; the development of progressive displacement led to hemorrhagic shock due to delayed chest wall hematoma. The chest wall hematoma was effectively diagnosed and treated via contrast-enhanced computed tomography and angiographic embolization. This case highlights the possibility of this potential delayed complication from a common injury such as a rib fracture. Keywords: Angiography, Chest wall, Delayed complication, Rib fracture, Thoracic injury

  15. Evaluation of anterior chest wall implanted port: technical aspects, results, and complications

    International Nuclear Information System (INIS)

    Jeon, Young Hwan; Oh, Joo Hyeong; Yoon, Yup; Kim, Si Young

    2000-01-01

    To evaluate the technical aspects, results and complications of patients with implanted anterior chest wall port. Between April 1997 and June 1999, a total of 63 implanted ports were placed at the anterior chest wall of 63 consecutive patients by interventional radiologists. The indications were chemotherapy in 61 patients and total parenteral nutrition in two. The peripheral portion of the subclavian vein was punctured under fluoroscopic guidance via ipsilateral peripheral vein during venography. A central venous catheter was placed in the superior vena cava, and using the subcutaneous tunneling method, a connected infusion port was implanted at the anterior chest wall. Results and complications were reviewed, and by means of Kaplan-Meier survival analysis, the expected patency of the port was determined. The technical success rate for implanted port at the anterior chest wall was 100% (63/63 patients). In two patients, hematoma and oozing were treated by compression. The duration of port implantation ranged from 12 to 855 (mean, 187) days, and the port patency rate was 305.7±47.6 days. In seven patients (completed chemotherapy (n=3D3), central venous thrombosis (n=3D3) catheter-related infection (n=3D1)), the port was removed. Catheter obstruction occurred in two patients, and in one, the use of urokinase led to successful recanalization. Sixteen patients died of an underlying malignancy, but no catheter-related death was noted. Implantation of an anterior chest wall port is a safe and useful procedure, with long patency, for patients requiring chemotherapy and long-term venous access. (author)

  16. Evaluation of anterior chest wall implanted port: technical aspects, results, and complications

    Energy Technology Data Exchange (ETDEWEB)

    Jeon, Young Hwan; Oh, Joo Hyeong; Yoon, Yup; Kim, Si Young [Kyung Hee University Hospital, Seoul (Korea, Republic of)

    2000-07-01

    To evaluate the technical aspects, results and complications of patients with implanted anterior chest wall port. Between April 1997 and June 1999, a total of 63 implanted ports were placed at the anterior chest wall of 63 consecutive patients by interventional radiologists. The indications were chemotherapy in 61 patients and total parenteral nutrition in two. The peripheral portion of the subclavian vein was punctured under fluoroscopic guidance via ipsilateral peripheral vein during venography. A central venous catheter was placed in the superior vena cava, and using the subcutaneous tunneling method, a connected infusion port was implanted at the anterior chest wall. Results and complications were reviewed, and by means of Kaplan-Meier survival analysis, the expected patency of the port was determined. The technical success rate for implanted port at the anterior chest wall was 100% (63/63 patients). In two patients, hematoma and oozing were treated by compression. The duration of port implantation ranged from 12 to 855 (mean, 187) days, and the port patency rate was 305.7{+-}47.6 days. In seven patients (completed chemotherapy (n=3D3), central venous thrombosis (n=3D3) catheter-related infection (n=3D1)), the port was removed. Catheter obstruction occurred in two patients, and in one, the use of urokinase led to successful recanalization. Sixteen patients died of an underlying malignancy, but no catheter-related death was noted. Implantation of an anterior chest wall port is a safe and useful procedure, with long patency, for patients requiring chemotherapy and long-term venous access. (author)

  17. Reverse Abdominoplasty Flap in Reconstruction of Post-Bilateral Mastectomies Anterior Chest Wall Defect

    Directory of Open Access Journals (Sweden)

    William HC Tiong

    2014-01-01

    Full Text Available Reverse abdominoplasty was originally described for epigastric lift. Since the work by Baroudi and Huger in the 1970s, it has become clear that reverse abdominoplasty application can be extended beyond just aesthetic procedure. Through the knowledge of anterior abdominal wall vascularity, its application had included reconstructive prospect in the coverage of various chest wall defects. To date, reverse abdominoplasty flap has been used to reconstruct unilateral anterior chest wall defect or for larger defect but only in combination with other reconstructive techniques. Here, we presented a case where it is used as a standalone flap to reconstruct bilateral anterior chest wall soft tissue defect post-bilateral mastectomies in oncological resection. In conclusion, reverse abdominoplasty flap provided us with a simple, faster, and satisfactory reconstructive outcome.

  18. Neurofibromas as bilateral cystic chest wall swellings.

    African Journals Online (AJOL)

    secondary to an infection, usually parasitic infections. [6,7]. However, cystic tumours of the chest wall result- ing from degenerative changes in peripheral nerves of its layers are rare, and we did not see any in the pub- lished literature. We are reporting a single case of bilat- eral cystic degenerative changes in neurofibromas ...

  19. Chest wall reconstruction with acellular dermal matrix (Strattice™) and a TRAM flap

    DEFF Research Database (Denmark)

    Brunbjerg, Mette Eline; Juhl, Alexander Andersen; Damsgaard, Tine Engberg

    2014-01-01

    Mette Eline Brunbjerg, Alexander Andersen Juhl, Tine E. Damsgaard. "Chest wall reconstruction with acellular dermal matrix (Strattice™) and a TRAM flap.” Acta Oncol. 2013 Jun;52(5):1052-4. Epub 2012 Oct 24. PMID: 23095144......Mette Eline Brunbjerg, Alexander Andersen Juhl, Tine E. Damsgaard. "Chest wall reconstruction with acellular dermal matrix (Strattice™) and a TRAM flap.” Acta Oncol. 2013 Jun;52(5):1052-4. Epub 2012 Oct 24. PMID: 23095144...

  20. One-stage reconstruction of chest wall defects with greater omentum transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Harashina, T [Keio Univ., Tokyo (Japan). School of Medicine; Oshiro, T; Sato, K

    1976-11-01

    Reconstructive operation by greater omentum transplantation in two cases of chest wall ulcer due to radiation therapy following an operation of breast cancer was introduced. The exposed dose of one case was not clarified, but that of another case was 5000 rad. This operation method is an excellent one, because operation is completed at one-stage and reconstruction of tissue is great owing to good blood circulation. It was thought that this method must be used more positively in the treatment of chest wall ulcer due to irradiation which is difficult to be treated.

  1. Utility of CT scan for the diagnosis of chest wall tuberculosis

    Energy Technology Data Exchange (ETDEWEB)

    Khalil, A.; Le Breton, C.; Tassart, M.; Korzec, J.; Bigot, J.M.; Carette, M.F. [Department of Radiology, Tenon Hospital, Paris (France)

    1999-10-01

    The objective of this study was to determine the utility of CT scan findings for the diagnosis of chest wall tuberculosis, excluding the spine. We reviewed 15 patients (13 Africans and 2 Indians) with chest wall tuberculosis, retrospectively. The radiologic examination consisted of a plain X-ray and a CT scan of the chest for each patient. The site of disease was the rib in 13 patients or the body of the sternum in 2 patients. One rib was involved in 11 patients, 2 contiguous ribs (one site) in 2 patients, and bilateral disease (two sites) was observed in the remaining patient. The 14 rib sites involved the posterior arc or costovertebral joint in 11 cases, the anterior arc in 2 cases, and the anterior and middle arc in 1 case. The CT scan findings were an abscess (n = 14) or a soft tissue mass (n = 2), osteolytic lesions (n = 13), periosteal reaction (n = 10), and sequestrum (n = 14). Bone sclerosis was observed only in 3 cases of rib involvement. The association of a soft tissue abscess, an osteolytic lesion, and sequestrum, especially in immigrants to France, suggests chest wall tuberculosis on CT scan. (orig.) With 5 figs., 2 tabs., 11 refs.

  2. Bioactive nanocomposite for chest-wall replacement: Cellular response in a murine model.

    Science.gov (United States)

    Jungraithmayr, Wolfgang; Laube, Isabelle; Hild, Nora; Stark, Wendelin J; Mihic-Probst, Daniela; Weder, Walter; Buschmann, Johanna

    2014-07-01

    Chest-wall invading malignancies usually necessitate the resection of the respective part of the thoracic wall. Gore-Tex® is the material of choice that is traditionally used to repair thoracic defects. This material is well accepted by the recipient; however, though not rejected, it is an inert material and behaves like a 'foreign body' within the thoracic wall. By contrast, there are materials that have the potential to physiologically integrate into the host, and these materials are currently under in vitro and also in vivo investigation. These materials offer a gradual but complete biodegradation over time, and severe adverse inflammatory responses can be avoided. Here, we present a novel material that is a biodegradable nanocomposite based on poly-lactic-co-glycolic acid and amorphous calcium phosphate nanoparticles in comparison to the traditionally employed Gore-Tex® being the standard for chest-wall replacement. On a mouse model of thoracic wall resection, that resembles the technique and localization applied in humans, poly-lactic-co-glycolic acid and amorphous calcium phosphate nanoparticles and Gore-Tex® were implanted subcutaneously and additionally tested in a separate series as a chest-wall graft. After 1, 2, 4 and 8 weeks cell infiltration into the respective materials, inflammatory reactions as well as neo-vascularization (endothelial cells) were determined in six different zones. While Gore-Tex® allowed for cell infiltration only at the outer surface, electrospun poly-lactic-co-glycolic acid and amorphous calcium phosphate nanoparticles were completely penetrated by infiltrating cells. These cells were composed mainly by macrophages, with only 4% of giant cells and lymphocytes. Total macrophage count increased by time while the number of IL1-β-expressing macrophages decreased, indicating a protective state towards the graft. As such, poly-lactic-co-glycolic acid and amorphous calcium phosphate nanoparticles seem to develop ideal

  3. Chest wall stabilization in trauma patients: why, when, and how?

    Science.gov (United States)

    White, Thomas W.

    2018-01-01

    Blunt trauma to the chest wall and rib fractures are remarkably frequent and are the basis of considerable morbidity and possible mortality. Surgical remedies for highly displaced rib fractures, especially in cases of flail chest, have been undertaken intermittently for more than 50 years. Rib-specific plating systems have started to be used in the last 10 years. These have ushered in the modern era of rib repair with chest wall stabilization (CWS) techniques that are safer, easier to perform, and more efficient. Recent consensus statements have sought to define the indications and contraindications, as well as the when, the how, and the technical details of CWS. Repair should be considered for patients who have three or more displaced rib fractures or a flail chest, whether or not mechanical ventilation is required. Additional candidates include patients who fail non-operative management irrespective of fracture pattern and those with rib fractures who need thoracic procedures for other reasons. Traditionally, unstable spine fracture and severe traumatic brain injury are definite contraindications. Pulmonary contusion’s role in the decision to perform CWS remains controversial. A range of rib-specific plating systems are now commercially available. PMID:29744222

  4. Chest Wall Constriction after the Nuss Procedure Identified from Chest Radiograph and Multislice Computed Tomography Shortly after Removal of the Bar.

    Science.gov (United States)

    Chang, Pei-Yeh; Zeng, Qi; Wong, Kin-Sun; Wang, Chao-Jan; Chang, Chee-Jen

    2016-01-01

    This study radiographically examined the changes in the chest walls of patients with pectus excavatum (PE) after Nuss bar removal, to define the deformation caused by the bar and stabilizer. In the first part of the study, we compared the changes in chest radiographs of patients with PE to a preoperation PE control group. In the second part, we used multislice computed tomography (CT) scans to provide three-dimensional reconstructions with which to evaluate the changes to the thoracic wall. Part 1 From June 2006 to August 2011, 1,125 patients with PE who had posteroanterior chest radiographs taken before undergoing the Nuss procedure at four hospitals were enrolled as a preoperative control group. At the same time, 203 patients who had the bar removed were enrolled as the study group. The maximum dimensions of the outer boundary of the first to ninth rib pairs (R1-R9, rib pair width), chest height, and chest width were measured. Part 2 Thirty-one consecutive patients with PE (20 males and 11 females) who underwent Nuss bar removal were evaluated 7 to 30 days after operation. During this period, a further 34 patients with PE who had undergone CT imaging before bar insertion were evaluated and compared with the postoperative group. Part 1 The width of the lower ribs (R4-R9) after bar removal was significantly less than in the age-matched controls. The ribs adjacent to the bar (R5-R7) showed the greatest restriction. The width of the upper ribs (R1-R3) 2 to 3 years after bar placement did not differ significantly from the controls. Patients who were operated on after 10 years of age had less of a restrictive effect. Three years of bar placement resulted in more restriction than a 2-year period, particularly in patients younger than 10 years old. Part 2: A significant constriction of the chest wall was observed in 13 patients after removal of the Nuss bar. Constriction at ribs 5 to 8 was found to be present adjacent to the site of bar insertion. However

  5. Radiation therapy for chest wall recurrence of breast cancer after mastectomy in a favorable subgroup of patients

    International Nuclear Information System (INIS)

    Hsi, R. Alex; Antell, Andrew; Schultz, Delray J.; Solin, Lawrence J.

    1998-01-01

    Purpose: Long-term outcome after radiation therapy for local-regional recurrence of breast cancer after mastectomy is generally poor. This study was performed to evaluate the long-term outcome for a potentially favorable subgroup of patients with chest wall recurrence. Methods and Materials: Of 71 patients with an isolated local-regional recurrence of breast cancer after mastectomy, 18 were identified who met the following favorable selection criteria: 1) a disease-free interval after mastectomy of 2 years or more, 2) an isolated chest wall recurrence, and 3) tumor size < 3 cm or complete excision of the recurrent disease. All 18 patients were treated with local-regional irradiation between 1967 and 1988. Radiotherapy (RT) was delivered to the chest wall to a median total dose of 60 Gy (range 30-66 Gy). Four patients received adjuvant chemotherapy and six patients received adjuvant hormonal therapy. Results: With a median follow-up of 8.4 years, nine of 18 patients were alive and free of disease. The 10-year actuarial overall and cause-specific survivals were 72% and 77%, respectively. The 10-year actuarial relapse-free survival and local control were 42% and 86%, respectively. Conclusion: Treatment for a local-regional recurrence of breast cancer after mastectomy in a favorable subgroup of patients results in a high rate of long-term survival as well as excellent local control. Aggressive treatment is warranted in this favorable subgroup of patients. 1998 Elsevier Science Inc

  6. Reproducibility of The Abdominal and Chest Wall Position by Voluntary Breath-Hold Technique Using a Laser-Based Monitoring and Visual Feedback System

    International Nuclear Information System (INIS)

    Nakamura, Katsumasa; Shioyama, Yoshiyuki; Nomoto, Satoru; Ohga, Saiji; Toba, Takashi; Yoshitake, Tadamasa; Anai, Shigeo; Terashima, Hiromi; Honda, Hiroshi

    2007-01-01

    Purpose: The voluntary breath-hold (BH) technique is a simple method to control the respiration-related motion of a tumor during irradiation. However, the abdominal and chest wall position may not be accurately reproduced using the BH technique. The purpose of this study was to examine whether visual feedback can reduce the fluctuation in wall motion during BH using a new respiratory monitoring device. Methods and Materials: We developed a laser-based BH monitoring and visual feedback system. For this study, five healthy volunteers were enrolled. The volunteers, practicing abdominal breathing, performed shallow end-expiration BH (SEBH), shallow end-inspiration BH (SIBH), and deep end-inspiration BH (DIBH) with or without visual feedback. The abdominal and chest wall positions were measured at 80-ms intervals during BHs. Results: The fluctuation in the chest wall position was smaller than that of the abdominal wall position. The reproducibility of the wall position was improved by visual feedback. With a monitoring device, visual feedback reduced the mean deviation of the abdominal wall from 2.1 ± 1.3 mm to 1.5 ± 0.5 mm, 2.5 ± 1.9 mm to 1.1 ± 0.4 mm, and 6.6 ± 2.4 mm to 2.6 ± 1.4 mm in SEBH, SIBH, and DIBH, respectively. Conclusions: Volunteers can perform the BH maneuver in a highly reproducible fashion when informed about the position of the wall, although in the case of DIBH, the deviation in the wall position remained substantial

  7. Timing of Administration of Bevacizumab Chemotherapy Affects Wound Healing Following Chest Wall Port Placement

    OpenAIRE

    Erinjeri, Joseph P; Fong, Abigail J; Kemeny, Nancy E; Brown, Karen T; Getrajdman, George I; Solomon, Stephen B

    2010-01-01

    The risk of a wound dehiscence requiring chest wall port explant in patients treated with bevacizumab is inversely proportional to the interval between bevacizumab administration and port placement. There is significantly higher risk of wound dehiscence when the interval between bevacizumab administration and chest wall port placement is less than 14 days.

  8. Anterior chest wall tuberculous abscess: a case report

    Directory of Open Access Journals (Sweden)

    Papavramidis Theodossis S

    2007-11-01

    Full Text Available Abstract The granulomatous inflammation of tuberculosis usually involves the lungs and the hilar lymph nodes. Musculoskeletal tuberculosis (TB occurs in 1–3% of patients with TB, while TB of the chest wall constitutes 1% to 5% of all cases of musculoskeletal TB. Furthermore, nowadays it is rarer to find extrapulmonary TB in immunocompetent rather that non-immunocompetent patients. The present case reports a fifty-six-year-old immunocompetent man with an anterior chest wall tuberculous abscess. The rarity of the present case relates both to the localization of the tuberculous abscess, and to the fact that the patient was immunocompetent. The diagnosis of musculoskeletal tuberculous infection remains a challenge for clinicians and requires a high index of suspicion. The combination of indolent onset of symptoms, positive tuberculin skin test, and compatible radiographic findings, strongly suggests the diagnosis. TB, however, must be confirmed by positive culture or histologic proof. Prompt diagnosis and treatment are important to prevent serious bone and joint destruction.

  9. Melioidosis of Chest Wall Masquerading as a Tubercular Cold ...

    African Journals Online (AJOL)

    chest wall abscess mimicking tuberculous cold abscess for its rarity and to review the ... was suspected to have pulmonary tuberculosis by a private practitioner and was ... Risk factors for melioidosis include diabetes mellitus, excessive alcohol ...

  10. High-resolution magnetic resonance imaging (HR-MRI) of the pleura and chest wall: Normal findings and pathological changes

    International Nuclear Information System (INIS)

    Bittner, R.C.; Schnoy, N.; Schoenfeld, N.; Grassot, A.; Loddenkemper, R.; Lode, H.; Kaiser, D.; Krumhaar, D.; Felix, R.

    1995-01-01

    To determine the value of high-resolution MRI in pleural and chest wall diseases, the normal and pathologic costal pleura and adjacent chest wall between paravertebral and the axillar region were examined with contrast enhanced high-resolution T 1 -weighted MRI images using a surface coil. Normal anatomy was evaluated in 5 healthy volunteers and a normal specimen of the thoracic wall, and correlation was made with corresponding HR-CT and histologic sections. CT-proved focal and diffuse changes of the pleura and the chest wall in 36 patients underwent HR-MRI, and visual comparison of MRI and CT was done retrospectively. Especially sagittal T 1 -weighted HR-MRI images allowed accurate delineation of the peripleural fat layer (PFL) and the innermost intercostal muscle (IIM), which served as landmarks of the intact inner chest wall. PFL and IIM were well delineated in 3/4 patients with tuberculous pleuritis, and in all 7 patients with non-specific pleuritis, as opposed to impairment of the PFL and/or the IIM, which was detected in 15/18 malignancies as a pattern of malignant chest wall involvement. In one case of tuberculous pleural empyema with edema of the inner chest wall HR-MRI produced false positive diagnosis of malignant disease. HR-MRI images improved non-invasive evaluation of pleural and chest wall diseases, and allowed for differentiation of bengin and malignant changes. (orig./MG) [de

  11. Recurrence of Ewing Sarcomas of the Chest Wall

    NARCIS (Netherlands)

    Meys, Karlijn M. E.; Heinen, Richard C.; van den Berg, Henk; Aronson, Daniel C.

    2008-01-01

    Background. Ewing sarcomas (ES) of the chest wall are rare. Local recurrences occur in approximately 20% of these patients; however literature on this topic is scarce. Our aim was to analyze the influence of the extent of surgical resection on outcome, and to find positive prognostic factors for

  12. Effects of Air Stacking Maneuver on Cough Peak Flow and Chest Wall Compartmental Volumes of Subjects With Amyotrophic Lateral Sclerosis.

    Science.gov (United States)

    Sarmento, Antonio; Resqueti, Vanessa; Dourado-Júnior, Mario; Saturnino, Lailane; Aliverti, Andrea; Fregonezi, Guilherme; de Andrade, Armele Dornelas

    2017-11-01

    To assess the acute effects of air stacking on cough peak flow (CPF) and chest wall compartmental volumes of persons with amyotrophic lateral sclerosis (ALS) versus healthy subjects positioned at 45° body inclination. Cross-sectional study with a matched-pair design. University hospital. Persons (N=24) with ALS (n=12) and age-matched healthy subjects (n=12). CPF, chest wall compartmental inspiratory capacity, chest wall vital capacity, chest wall tidal volume and operational volumes, breathing pattern, and percentage of contribution of the compartments to the inspired volume were measured by optoelectronic plethysmography. Compared with healthy subjects, significantly lower CPF (P=.007), chest wall compartmental inspiratory capacity (Pprotocol in the healthy subjects, mainly because of end-inspiratory (P<.001) and abdominal volumes (P=.008). No significant differences were observed in percentage of contribution of the compartments to the inspired volume and end-expiratory volume of both groups. No significant differences were found in chest wall tidal volume, operational volume, and breathing pattern in persons with ALS. Air stacking is effective in increasing CPF, chest wall compartmental inspiratory capacity, and chest wall vital capacity of persons with ALS with no hyperinflation. Differences in compartmental volume contributions are probably because of lung and chest wall physiological changes. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  13. Chest wall reconstruction with autologas rib grafts in dogs and report of a clinic case.

    Science.gov (United States)

    Tunçözgür, B; Elbeyli, L; Güngör, A; Işik, F; Akay, H

    1999-09-01

    Nowadays, in chest wall reconstruction prosthetic materials are generally used. However, the rejections of prosthetic materials and infections frequently occur in chest wall reconstruction, especially after radiotherapy or resection that is performed due to infections. We used 10 mongrel dogs and performed resections of 8 cm diameter on their chest walls. In the reconstruction of these defects, in five of the subjects, we used two free rib grafts with periosteum to be resected from the contralateral side and in other five subjects, we used free rib grafts without periosteum. After this experimental study, sternal resection was performed in a 24-year-old man because of sternal osteomyelitis. First to obtain rib grafts with periosteum, partial resection was performed to 5th, 7th, and 9th ribs of the lateral left side. After, total sternal resection, end to end anastomosis was performed to the 2nd, 3rd, 4th and 5th anterior ends of the ribs. Autogeneous rib grafts were found to be enough to provide chest wall stabilization. The contralateral autogeneous free rib grafts can successfully be used in reconstruction of wide chest wall defects. This method is found to be effective and sufficient to prevent infection, rejection and to provide stabilization.

  14. Place Atrium to Water Seal (PAWS): Assessing Wall Suction Versus No Suction for Chest Tubes After Open Heart Surgery.

    Science.gov (United States)

    Kruse, Tamara; Wahl, Sharon; Guthrie, Patricia Finch; Sendelbach, Sue

    2017-08-01

    Traditionally chest tubes are set to -20 cm H 2 O wall suctioning until removal to facilitate drainage of blood, fluid, and air from the pleural or mediastinal space in patients after open heart surgery. However, no clear evidence supports using wall suction in these patients. Some studies in patients after pulmonary surgery indicate that using chest tubes with a water seal is safer, because this practice decreases duration of chest tube placement and eliminates air leaks. To show that changing chest tubes to a water seal after 12 hours of wall suction (intervention) is a safe alternative to using chest tubes with wall suction until removal of the tubes (usual care) in patients after open heart surgery. A before-and-after quality improvement design was used to evaluate the differences between the 2 chest tube management approaches in chest tube complications, output, and duration of placement. A total of 48 patients received the intervention; 52 received usual care. The 2 groups (intervention vs usual care) did not differ significantly in complications (0 vs 2 events; P = .23), chest tube output (H 1 = 0.001, P = .97), or duration of placement (median, 47 hours for both groups). Changing chest tubes from wall suction to water seal after 12 hours of wall suction is a safe alternative to using wall suctioning until removal of the tubes. ©2017 American Association of Critical-Care Nurses.

  15. Changes in sitting posture induce multiplanar changes in chest wall shape and motion with breathing.

    Science.gov (United States)

    Lee, Linda-Joy; Chang, Angela T; Coppieters, Michel W; Hodges, Paul W

    2010-03-31

    This study examined the effect of sitting posture on regional chest wall shape in three dimensions, chest wall motion (measured with electromagnetic motion analysis system), and relative contributions of the ribcage and abdomen to tidal volume (%RC/V(t)) (measured with inductance plethysmography) in 7 healthy volunteers. In seven seated postures, increased dead space breathing automatically increased V(t) (to 1.5 V(t)) to match volume between conditions and study the effects of posture independent of volume changes. %RC/V(t) (pplane changes in sitting posture alter three-dimensional ribcage configuration and chest wall kinematics during breathing, while maintaining constant respiratory function. Copyright 2010 Elsevier B.V. All rights reserved.

  16. Reconstruction of the radiation-damaged chest wall

    International Nuclear Information System (INIS)

    Arnold, P.G.; Pairolero, P.C.

    1989-01-01

    In the patient with a radiation ulcer of the chest wall, the first question is whether the lesion contains persistent or recurrent cancer. It is also important to determine whether any other local problems such as mediastinal abscess may interfere with the reconstruction. Whether or not cancer is present, all nonviable tissue must be removed. If cancer is not present, and a partial thickness of the chest remains, the authors prefer transposition of the greater omentum for repair. If cancer is present, the physiologic defect resulting from cancer resection and wound debridement is far more severe, and a muscle or musculocutaneous flap usually is appropriate. The pectoralis major, latissimus dorsi, external oblique, rectus abdominis, and trapezius muscles have been utilized; the authors most often use the pectoralis or latissimus muscles. 27 references

  17. Functional results after chest wall stabilization with a new screwless fixation device

    OpenAIRE

    Wiese, Mark Nikolaj; Kawel-Boehm, Nadine; Moreno de la Santa, Pablo; Al-Shahrabani, Feras; Toffel, Melanie; Rosenthal, Rachel; Schäfer, Juliane; Tamm, Michael; Bremerich, Jens; Lardinois, Didier

    2017-01-01

    OBJECTIVES This is the experience with the Stratos system in two surgical centres for the management of two types of rib fractures: flail chest and multiple dislocated rib fractures with significant chest wall deformity. METHODS From January 2009 to May 2012, 94 consecutive patients were included. Selected indications were extended anterolateral flail chest (n = 68) and dislocated painful rib fractures (n = 26). The open reduction internal fixation (ORIF) system consists of flexible titanium ...

  18. Chest wall tuberculosis simulating breast carcinoma: Imaging appearance

    International Nuclear Information System (INIS)

    Goyal, M.; Sharma, R.; Sharma, A.; Swahney, S.; Berry, M.; Chumber, S.

    1998-01-01

    Tuberculosis of the breast is a rare disease. Tubercular abscesses predominantly affecting the soft tissues are also very infrequent. A case of chest wall tuberculosis secondarily involving the breast presenting as a hard, fixed lump simulating mammary carcinoma is presented here. There was no evidence of pleural or pulmonary tuberculosis. Copyright (1998) Blackwell Science Pty Ltd

  19. Evaluation of a Thermoplastic Immobilization System for Breast and Chest Wall Radiation Therapy

    International Nuclear Information System (INIS)

    Strydhorst, Jared H.; Caudrelier, Jean-Michel; Clark, Brenda G.; Montgomery, Lynn A.; Fox, Greg; MacPherson, Miller S.

    2011-01-01

    We report on the impact of a thermoplastic immobilization system on intra- and interfraction motion for patients undergoing breast or chest wall radiation therapy. Patients for this study were treated using helical tomotherapy. All patients were immobilized using a thermoplastic shell extending from the shoulders to the ribcage. Intrafraction motion was assessed by measuring maximum displacement of the skin, heart, and chest wall on a pretreatment 4D computed tomography, while inter-fraction motion was inferred from patient shift data arising from daily image guidance procedures on tomotherapy. Using thermoplastic immobilization, the average maximum motion of the external contour was 1.3 ± 1.6 mm, whereas the chest wall was found to be 1.6 ± 1.9 mm. The day-to-day setup variation was found to be large, with random errors of 4.0, 12.0, and 4.5 mm in the left-right, superior-inferior, and anterior-posterior directions, respectively, and the standard deviations of the systematic errors were found to be 2.7, 9.8, and 4.1 mm. These errors would be expected to dominate any respiratory motion but can be mitigated by daily online image guidance. Using thermoplastic immobilization can effectively reduce respiratory motion of the chest wall and external contour, but these gains can only be realized if daily image guidance is used.

  20. Volume Modulated Arc Therapy (VMAT for pulmonary Stereotactic Body Radiotherapy (SBRT in patients with lesions in close approximation to the chest wall

    Directory of Open Access Journals (Sweden)

    Thomas J. FitzGerald

    2013-02-01

    Full Text Available Chest wall pain and discomfort has been recognized as a significant late effect of radiation therapy in historical and modern treatment models. Stereotactic Body Radiotherapy (SBRT is becoming an important treatment tool in oncology care for patients with intrathoracic lesions. For lesions in close approximation to the chest wall including lesions requiring motion management, SBRT techniques can deliver high dose to the chest wall. As an unintended target of consequence, there is possibility of generating significant chest wall pain and discomfort as a late effect of therapy. The purpose of this paper is to evaluate the potential role of Volume Modulated Arc Therapy (VMAT technologies in decreasing chest wall dose in SBRT treatment of pulmonary lesions in close approximation to the chest wall.Ten patients with pulmonary lesions of various sizes and topography in close approximation to the chest wall were selected for retrospective review. All volumes including target, chest wall, ribs, and lung were contoured with maximal intensity projection maps and four-dimensional computer tomography planning. Radiation therapy planning consisted of static techniques including Intensity Modulated Radiation Therapy compared to VMAT therapy to a dose of 60Gy in 12Gy fractions. Dose volume histogram to rib, chest wall, and lung were compared between plans with statistical analysis.In all patients dose and volume were improved to ribs and chest wall using VMAT technologies compared to static field techniques. On average, volume receiving 30Gy to the chest wall was improved by 72%;the ribs by 60%. In only one patient did the VMAT treatment technique increase pulmonary volume receiving 20Gy (V20.VMAT technology has potential of limiting radiation dose to sensitive chest wall regions in patients with lesions in close approximation to this structure. This would also have potential value to lesions treated with SBRT in other body regions where targets abut critical

  1. Cardiorespiratory effects of inelastic chest wall restriction.

    Science.gov (United States)

    Miller, Jordan D; Beck, Kenneth C; Joyner, Michael J; Brice, A Glenn; Johnson, Bruce D

    2002-06-01

    We examined the effects of chest wall restriction (CWR) on cardiorespiratory function at rest and during exercise in healthy subjects in an attempt to approximate the cardiorespiratory interactions observed in clinical conditions that result in restrictive lung and/or chest wall changes and a reduced intrathoracic space. Canvas straps were applied around the thorax and abdomen so that vital capacity was reduced by >35%. Data were acquired at rest and during cycle ergometry at 25 and 45% of peak workloads. CWR elicited significant increases in the flow-resistive work performed on the lung (160%) and the gastric pressure-time integral (>400%) at the higher workload, but it resulted in a decrease in the elastic work performed on the lung (56%) compared with control conditions. With CWR, heart rate increased and stroke volume (SV) fell, resulting in >10% fall in cardiac output at rest and during exercise at matched workloads (P < 0.05). Blood pressure and catecholamines were significantly elevated during CWR exercise conditions (P < 0.05). We conclude that CWR significantly impairs SV during exercise and that a compensatory increase in heart rate does not prevent a significant reduction in cardiac output. O(2) consumption appears to be maintained via increased extraction and a redistribution of blood flow via sympathetic activation.

  2. Electron arc irradiation of the postmastectomy chest wall: clinical results

    Energy Technology Data Exchange (ETDEWEB)

    Gaffney, David K; Prows, Janalyn; Leavitt, Dennis; Egger, Marlene J; Morgan, John G; Stewart, J Robert

    1995-07-01

    Purpose/Objective: Since 1980 electron arc irradiation of the postmastectomy chest wall has been the preferred technique for patients with advanced breast cancer at the our institution. Here we report the results of this technique in 150 consecutive patients from 1980 to 1994. Materials and Methods: Thoracic computerized tomography was used to determine internal mammary lymph node depth and chest wall thickness, and for computerized dosimetry calculations in all patients. Total doses of 45-50 Gy in 5 to 5 (1(2)) weeks were delivered to the chest wall and internal mammary lymph nodes via electron arc and, in most cases, supraclavicular and axillary nodes were treated with a matching photon field. Patients were assessed for acute and late radiation changes, local and distant control of disease, and survival. The 10 most recently treated patients were censored for disease progression, survival, and late effects calculations, thus giving a mean follow up of 49 months and a median of 33 months. All patients had advanced disease: T stages 1, 2, 3, and 4 represented 21%, 39%, 21% and 19% of the study population, with a mean number of positive axillary lymph nodes of 6.5 (0-29). Analysis was performed according to adjuvant status (no residual disease, n = 90), residual disease (positive margin, n = 15, and primary radiation, n = 2), or recurrent disease (n = 33). Results: Acute radiation reactions were generally mild and self limiting. 27% of patients developed moist desquamation, and 32% had brisk erythema. Actuarial 5 year local control, freedom from distant failure and overall survival was 91%, 64%, and 67% in the adjuvant group; 84%, 50%, and 53% in the residual disease group; and 63%, 34%, and 30% in the recurrent disease group, respectively. In univariate cox regressions, the number of positive lymph nodes was predictive for local failure in the adjuvant group (p<0.037). Chronic complications were minimal with 10% of patients having arm edema, 15% hyperpigmentation

  3. Masculine Chest-Wall Contouring in FtM Transgender: a Personal Approach.

    Science.gov (United States)

    Lo Russo, Giulia; Tanini, Sara; Innocenti, Marco

    2017-04-01

    Chest-wall contouring surgery is one of the first steps in sexual reassignment in female-to-male (FtM) transsexuals that contributes to strengthening of the self-image and facilitates living in the new gender role. The main goal is to masculinize the chest by removing the female contour. Chest contour, scar placement, scar shape, scar length, nipple-areola position, nipple size and the areola size are the key points. Between July 2013 and June 2016, 25 FtM transgender patients underwent surgical procedures to create a masculine chest-wall contour. In our study, we just considered 16 patients who have undergone chest surgery with the double incision method. The patients' survey revealed a high satisfaction rate with the aesthetic result. In our group, no complications occurred, and two patients have undergone supplementary surgery for axillary dog-ear revision and nipple reconstruction. The authors propose a new technical approach and indications for FtM transgender patients' surgery. A longer scar that emphasizes the pectoralis muscle, a smaller nipple and a resized and refaced areola are the key points of our technique to give a masculine appearance to the chest. The scars are permanent, but most of them will fade and the patients are enthusiastic with their new "male" chest appearance. The high level of satisfaction, the great aesthetic result and the low rate of complications suggest to us the use of this technique in medium- and large-size breasts. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

  4. Chest wall resection for multifocal osseous haemangioma.

    Science.gov (United States)

    Weinandt, Marthe; Legras, Antoine; Mordant, Pierre; Le Pimpec Barthes, Françoise

    2016-02-01

    Intraosseous haemangioma is a rare and benign primary tumour of the bone. We report the case of a 76-year old woman who presented the exceptional condition of multifocal cavernous haemangiomas involving the spine and the ribs, requiring spinal and chest wall resections to confirm the diagnosis and treat the symptoms. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  5. Radiation induced skin cancer the chest wall 30 years later from breast cancer operation

    Energy Technology Data Exchange (ETDEWEB)

    Miyamoto, Kouji; Togawa, Tamotsu; Hasegawa, Takeshi; Matsunami, Hidetoshi; Ikeda, Tsuneko [Matsunami General Hospital, Kasamatsu, Gifu (Japan); Matsuo, Youichi

    1998-10-01

    This paper describes the skin cancer on the frontal chest wall induced by postoperative irradiation 30 years later from mastectomy. The patients was a 62-year-old woman, who received mastectomy of the right breast cancer (invasive ductal carcinoma, comedo type) at 31 years old, and received the postoperative radiotherapy of total 11,628 rad over 38 times. On the first medical examination in author`s hospital, the patient had an ulcer of about 10 cm diameter and was diagnosed the radiation induced skin cancer (well differentiated squamous cell carcinoma) in the biopsy. Because of the general condition of the patient was extremely bad and the skin cancer had highly developed, the excision was thought to be impossible. The radiotherapy (16 Gy) and combined local chemotherapy by OK 432 and Bleomycin were performed. In spite of the short term treatment, these therapies were effective on the reduction of the tumor size and the hemostasis, and brought the patient the improvement of QOL. The general condition of the patient improved to be stable and she recovered enough to go out from the hospital for 6 months. After 10 months, she showed anorexia and dyspnea and died after about 1 year from the admission. The present case is extremely rare, and it is required the radical therapy like the excision of chest wall at early stage. (K.H.)

  6. Primary chest wall Hydatid cyst: Review of literature with report of a new case

    Directory of Open Access Journals (Sweden)

    Abdulwahid M. Salih

    Full Text Available Introduction: Hydatid cyst is a parasitic disease caused by Echinococci. The most commonly affected organ is liver, followed by lungs. Hydatid disease of the chest wall is extremely rare. The aim of this study is to report a case of chest wall Hydatid cyst with literature review. A 20-year-old pregnant lady presented with left hypochondrial and lower chest painful swelling. There was 10 × 15 centimeters, tender mass with features suggestive of abscess. The patient refused every sort of radiological examination. Under general anesthesia, oblique incision was done, on opening, clear fluid came out, with deep incision pus-like fluid and many daughter cysts drained. Complete evacuation of the cyst was done with closure of the residual cavity. The patient refused chemoprophylaxis because of her pregnancy. Conclusion: primary chest wall Hydatid cyst is a very rare disease in endemic areas. Mass and pain are the most common presentation. Excision under general anesthesia is main modality of treatment. Keywords: Hydatid cyst, Pregnancy, Albendazole

  7. Use of omental pedicle flap for radiation induced chest wall ulcer. A case report

    International Nuclear Information System (INIS)

    Takamori, Shinzo; Hayashi, Akihiro; Nagamatsu, Yoshinori; Tsushimi, Mutsuo; Ono, Hirofumi; Ohtsuka, Shoji

    1995-01-01

    A 79-year-old female with breast carcinoma undergoing a classical Halsted radical mastectomy followed by irradiation (total; 180 Gy) 20 years before developed a left anterior chest wall ulcer. The ulcer was 10.0 x 8.0 cm in size with osteolysis of 3rd, 4th and 5th ribs, exposed pericardium, and parietal pleura with a pleuro-cutaneous fistula. After thorough debridement, an omental pedicle flap was transposed onto the chest wall defect and subsequently covered using a split-skin graft. The omental pedicle flap was 90% effective in covering the pericardial defect and resulted in a complete closure of the pleuro-cutaneous fistula. This report emphasises that an omental pedicle flap is effective in the treatment of radio-necrosis of the chest wall and also stresses the importance of judging the extent of debridement of radio-necrotic tissue. (author)

  8. Use of omental pedicle flap for radiation induced chest wall ulcer. A case report

    Energy Technology Data Exchange (ETDEWEB)

    Takamori, Shinzo; Hayashi, Akihiro; Nagamatsu, Yoshinori; Tsushimi, Mutsuo; Ono, Hirofumi; Ohtsuka, Shoji [Kurume Univ., Fukuoka (Japan). School of Medicine

    1995-12-01

    A 79-year-old female with breast carcinoma undergoing a classical Halsted radical mastectomy followed by irradiation (total; 180 Gy) 20 years before developed a left anterior chest wall ulcer. The ulcer was 10.0 x 8.0 cm in size with osteolysis of 3rd, 4th and 5th ribs, exposed pericardium, and parietal pleura with a pleuro-cutaneous fistula. After thorough debridement, an omental pedicle flap was transposed onto the chest wall defect and subsequently covered using a split-skin graft. The omental pedicle flap was 90% effective in covering the pericardial defect and resulted in a complete closure of the pleuro-cutaneous fistula. This report emphasises that an omental pedicle flap is effective in the treatment of radio-necrosis of the chest wall and also stresses the importance of judging the extent of debridement of radio-necrotic tissue. (author).

  9. New Methods for Imaging Evaluation of Chest Wall Deformities

    Directory of Open Access Journals (Sweden)

    Ana Lain

    2017-12-01

    Full Text Available AimThe purpose of this study is to describe the development of an external 3-dimensional (3D scanner as a noninvasive method for imaging chest wall deformities. It allows objective assessment, reconstruction of the area of interest, and evaluation of the severity of the deformity by using external indexes.External 3D scanning systemThe OrtenBodyOne scanner (Orten, Lyon, France uses depth sensors to scan the entire 3D external body surface of a patient. The depth sensors combine structured light with two classic computer vision techniques: depth from focus and depth from stereo. The data acquired are processed and analyzed using the Orten-Clinic software.Materials and methodsTo investigate the performance of the device, a preliminary prospective study (January 2015–March 2016 was carried out in patients attending our hospital chest wall deformities unit. In total, 100 patients (children and young adults with pectus excavatum or pectus carinatum, treated by surgery or non-operative methods were included. In patients undergoing non-operative treatment, external 3D scanning was performed monthly until complete correction was achieved. In surgically treated patients, scanning was done before and after surgical correction. In 42 patients, computed tomography (CT was additionally performed and correlations between the Haller index calculated by CT and the external Haller index using external scanning were investigated using a Student’s test (r = 0.83.ConclusionExternal scanning is an effective, objective, radiation-free means to diagnose and follow-up patients with chest wall deformities. Externally measured indexes can be used to evaluate the severity of these conditions and the treatment outcomes.

  10. Gastric tumors on chest radiographs

    International Nuclear Information System (INIS)

    Tamura, Shozo; Kawanami, Takashi; Russell, W.J.

    1978-04-01

    Gastric neoplasms of three patients protruded into their gas-containing fornices and were first visualized on plain chest radiographs. Endoscopy and/or surgery confirmed these to be a polyp, a leiomyoma, and an adenocarcinoma. The polyp, 1.3 cm in diameter, was the smallest of these three, but smaller lesions may be detectable under suitable conditions. Adequate technique and positioning, sufficiently large lesions in the upper portion of the stomach, a central beam tangential to the tumor, sufficient gas in the stomach, and careful scrutiny by the observer are required. Lesions may be more readily visualized during chest radiography when oral sodium bicarbonate is used to distend the stomach. In chest radiography, exposure limited to the lung fields has been advocated for economy and dose reduction. However, too small an exposure field may result in loss of information potentially beneficial to the patient. Using the smaller of two popular film sizes (35 x 43 cm and 35 x 35 cm), the saving in surface and bone marrow doses is negligible, and the saving in gonad dose may be nil over that when shielding is used. The interest of the observer may be absorbed by a concomitant cardiac or pulmonary lesion. Careful scrutiny of the entire radiograph is therefore essential. (author)

  11. Reconstruction of Chest Wall by Cryopreserved Sternal Allograft after Resection of Aneurysmal Bone Cyst of Sternum

    Directory of Open Access Journals (Sweden)

    Kambiz Sheikhy

    2017-01-01

    Full Text Available A 20-year-old female was referred to our hospital due to deformity and bulging in anterior aspect of chest wall in sternal area. Chest X-ray and CT scan confirmed a large mass with destruction of sternum. Pathologic diagnosis after incisional biopsy was compatible with aneurysmal bone cyst. We resected sternum completely and reconstructed large anterior defect by a cryopreserved sternal allograft. In follow-up of patient there was no unstability of chest wall with good cosmetic result.

  12. Color structured light system of chest wall motion measurement for respiratory volume evaluation

    Science.gov (United States)

    Chen, Huijun; Cheng, Yuan; Liu, Dongdong; Zhang, Xiaodong; Zhang, Jue; Que, Chengli; Wang, Guangfa; Fang, Jing

    2010-03-01

    We present a structured light system to dynamically measure human chest wall motion for respiratory volume estimation. Based on a projection of an encoded color pattern and a few active markers attached to the trunk, respiratory volumes are obtained by evaluating the 3-D topographic changes of the chest wall in an anatomically consistent measuring region during respiration. Three measuring setups are established: a single-sided illuminating-recording setup for standing posture, an inclined single-sided setup for supine posture, and a double-sided setup for standing posture. Results are compared with the pneumotachography and show good agreement in volume estimations [correlation coefficient: R>0.99 (Pvolume during the isovolume maneuver (standard deviationpulmonary functional differences between the diseased and the contralateral sides of the thorax, and subsequent improvement of this imbalance after drainage. These results demonstrate the proposed optical method is capable of not only whole respiratory volume evaluation with high accuracy, but also regional pulmonary function assessment in different chest wall behaviors, with the advantage of whole-field measurement.

  13. Reconstruction of the full thickness chest wall defect. A case report

    Energy Technology Data Exchange (ETDEWEB)

    Moriguchi, T; Sano, S; Ogawa, Y; Fujimori, Y [Kyoto Univ. (Japan). Faculty of Medicine; Abe, R

    1977-03-01

    To treat the chest wall defect following the postoperative radiotherapy for breast cancer, we used an island flap prepared from the opposite mammary region preserving the perforating vessels from the internal thoracic artery.

  14. Pediatric chest imaging. Chest imaging in infants and children. 2. rev. ed.

    Energy Technology Data Exchange (ETDEWEB)

    Lucaya, Javier [Vall d' Hebron Hospitals, Barcelona (Spain). Dept. of Pediatric Radiology and Inst. of Diagnostic Imaging; Hospital Quiron, Barcelona (Spain). Dept. of Radiology; Strife, Janet L. (eds.) [Cincinnati Univ. Coll. of Medicine, Cincinnati, OH (United States). Dept. of Radiology Cincinnati Children' s Hospital Medical Center

    2008-07-01

    Imaging of the pediatric chest continues to evolve rapidly. All chapters in this 2nd edition of Pediatric Chest Imaging have been extensively updated, with additional disease-specific information and numerous new illustrations. The book thus presents the state of the art in the diagnosis of pediatric chest disorders, highlighting the role played by advanced technology. As the conventional features of most of these disorders are extremely well known, special attention is devoted to the technical aspects of the modern imaging modalities, their indications, and the diagnostic information that they supply. Individual chapters focus on chest ultrasound, nuclear medicine imaging, high-resolution chest CT, helical CT, and pediatric cardiac CT and pediatric cardiacMRI. Others are directed towards specific disorders, including congenital malformations of the chest, chest tumors, pulmonary infection, trauma, the lung in systemic diseases, the pediatric airway, foreign bodies, the thymus, and the chest wall. Without exception, the authors of this book are internationally known specialists with great expertise in the field. This book will serve as a handy, superbly illustrated reference for all who routinely image children, as well as for those who need access to information on how best to image them. (orig.)

  15. Chest wall stabilization and reconstruction: short and long-term results 5 years after the introduction of a new titanium plates system.

    Science.gov (United States)

    De Palma, Angela; Sollitto, Francesco; Loizzi, Domenico; Di Gennaro, Francesco; Scarascia, Daniele; Carlucci, Annalisa; Giudice, Giuseppe; Armenio, Andrea; Ludovico, Rossana; Loizzi, Michele

    2016-03-01

    We report short and long-term results with the dedicated Synthes(®) titanium plates system, introduced 5 years ago, for chest wall stabilization and reconstruction. We retrospectively analyzed (January 2010 to December 2014) 27 consecutive patients (22 males, 5 females; range 16-83 years, median age 60 years), treated with this system: primary [3] and secondary [8] chest wall tumor; flail chest [5]; multiple ribs fractures [5]; sternal dehiscence-diastasis [3]; sternal fracture [1]; sternoclavicular joint dislocation [1]; Poland syndrome [1]. Short-term results were evaluated as: operating time, post-operative morbidity, mortality, hospital stay; long-term results as: survival, plates-related morbidity, spirometric values, chest pain [measured with Verbal Rating Scale (VRS) and SF12 standard V1 questionnaire]. Each patient received from 1 to 10 (median 2) titanium plates/splints; median operating time was 150 min (range: 115-430 min). Post-operative course: 15 patients (55.6%) uneventful, 10 (37%) minor complications, 2 (7.4%) major complications; no post-operative mortality. Median post-operative hospital stay was 13 days (range: 5-129 days). At a median follow-up of 20 months (range: 1-59 months), 21 patients (78%) were alive, 6 (22%) died. Three patients presented long-term plates-related morbidity: plates rupture [2], pin plate dislodgment [1]; two required a second surgical look. One-year from surgery median spirometric values were: FVC 3.31 L (90%), FEV1 2.46 L (78%), DLCO 20.9 mL/mmHg/min (76%). On 21 alive patients, 7 (33.3%) reported no pain (VRS score 0), 10 (47.6%) mild (score 2), 4 (19.1%) moderate (score 4), no-one severe (score >4); 15 (71.5%) reported none or mild, 6 (28.5%) moderate pain influencing quality of life. An optimal chest wall stabilization and reconstruction was achieved with the Synthes(®) titanium plates system, with minimal morbidity, no post-operative mortality, acceptable operating time and post-operative hospital stay. Long

  16. VAC for external fixation of flail chest

    DEFF Research Database (Denmark)

    Winge, Rikke; Berg, Jais O; Albret, Rikke

    2012-01-01

    A large aterior chest wall defect following tumor resection was reconstructed with a Gore-Tex® membrane and a combined musculocutaneous rectus femoris and tensor fasciae latae free flap. Subsequent paradoxical respiration impeded weaning from the ventilator. Appliance of Vacuum Assisted Closure...

  17. Bodybuilding-induced Mondor's disease of the chest wall.

    Science.gov (United States)

    Tröbinger, Christian; Wiedermann, Christian J

    2017-01-01

    To describe the association of bodybuilding abdominal exercise with the development of superficial sclerosing thrombophlebitis of the anterolateral thoracoabdominal wall. A single case study. University-affiliated regional community hospital. A 54-year-old man presented with an otherwise unremarkable past medical history 4 weeks after the start of left-sided chest discomfort. He had undergone orthopedic surgery of the right shoulder three months earlier. Two months after surgery, he had re-started bodybuilding with thoracoabdominal training. Soon thereafter, he noted a painful induration at the left side of his trunk. Doppler and duplex sonography revealed complete venous occlusion compatible with sclerosing thrombophlebitis leading to a palpable, subcutaneous, cord-like lesion on the left side of his trunk. Physical examination and routine laboratory findings were normal. The lesion spontaneously resolved over a course of 3 months. Mondor's disease of the subcutaneous veins of the chest wall which has been associated with breast or axillary surgery, malignant and systemic diseases can also appear in subjects performing intense thoracoabdominal exercise training. Although it requires only symptomatic therapy, physicians and therapists must be aware of the existence of this disease because, although benign and self-limiting, malignant and systemic diseases need to be ruled out. Copyright © 2016 Elsevier Ltd. All rights reserved.

  18. Histology types of chest wall tumours: Fifteen year single center ...

    African Journals Online (AJOL)

    Materials and Methods: We performed a retrospective study of chest wall tumours at our institution(NCTCE, UNTH, Enugu, Nigeria), for a period of 15 years, spanning October, 2001 to September, 2015.The pathologic reports were retrieved from the hospital pathology archives and correlated with patients' copies in the ...

  19. Poster – 41: External marker block placement on the breast or chest wall for left-sided deep inspiration breath-hold radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Conroy, Leigh; Guebert, Alexandra; Smith, Wendy [Tom Baker Cancer Centre (Canada)

    2016-08-15

    Purpose: We investigate DIBH breast radiotherapy using the Real-time Position Management (RPM) system with the marker-block placed on the target breast or chest wall. Methods: We measured surface dose for three different RPM marker-blocks using EBT3 Gafchromic film at 0° and 30° incidence. A registration study was performed to determine the breast surface position that best correlates with overall internal chest wall position. Surface and chest wall contours from MV images of the medial tangent field were extracted for 15 patients. Surface contours were divided into three potential marker-block positions on the breast: Superior, Middle, and Inferior. Translational registration was used to align the partial contours to the first-fraction contour. Each resultant transformation matrix was applied to the chest wall contour, and the minimum distance between the reference chest wall contour and the transformed chest wall contour was evaluated for each pixel. Results: The measured surface dose for the 2-dot, 6-dot, and 4-dot marker-blocks at 0° incidence were 74%, 71%, and 77% of dose to dmax respectively. At 30° beam incidence this increased to 76%, 72%, and 81%. The best external surface position was patient and fraction dependent, with no consistent best choice. Conclusions: The increase in surface dose directly under the RPM block is approximately equivalent to 3 mm of bolus. No marker-block position on the breast surface was found to be more representative of overall chest wall motion; therefore block positional stability and reproducibility can be used to determine optimal placement on the breast or chest wall.

  20. Giant Chest Wall Hematoma Mimicking Elastofibroma Dorsi: A Case Report

    International Nuclear Information System (INIS)

    Lee, Yeon Soo; Park, Kuhn; Kim, Jong Ok; Choi, Eun Seok; Kang, Si Won

    2011-01-01

    Hematoma on the thoracic wall is very rare. We describe here a 63-year-old man with a huge chest wall hematoma and the man had no history of trauma. The patient was found to have a large mass located subjacent to the inferior angle of the right scapula area and the CT and MRI findings were similar to those of an elastofibroma dorsi. We describe the CT and MRI findings of this hematoma and how to make the differential diagnosis from elastofibroma dorsi

  1. Giant Chest Wall Hematoma Mimicking Elastofibroma Dorsi: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Yeon Soo; Park, Kuhn; Kim, Jong Ok; Choi, Eun Seok; Kang, Si Won [Daejeon St. Mary' s Hospital, The Catholic University of Korea, Daejeon (Korea, Republic of)

    2011-02-15

    Hematoma on the thoracic wall is very rare. We describe here a 63-year-old man with a huge chest wall hematoma and the man had no history of trauma. The patient was found to have a large mass located subjacent to the inferior angle of the right scapula area and the CT and MRI findings were similar to those of an elastofibroma dorsi. We describe the CT and MRI findings of this hematoma and how to make the differential diagnosis from elastofibroma dorsi

  2. Diagnosis of pelvic wall tumor on multislice CT

    International Nuclear Information System (INIS)

    Zhang Keyun; Deng Lequn; Lei Hongwei

    2011-01-01

    Objective: To evaluate the value of multi-slice CT (MSCT) in diagnosing pelvic wall tumors. Methods: MSCT of 21 cases of pelvic wall tumors including metastasis (10), neurogenic tumor (5), chondrosarcoma (2), chordoma (1), aneurysmal bone cyst (1), giant cell tumor (1), and osteochondroma (1) was retrospectively analyzed. Results: CT appearances of pelvic wall tumors include bony destruction and soft tissue masses. Common features were bone destruction in metastasis, expansion of the neuroforamen in neurogenic tumor, pleomorphic calcification in chondrosarcoma, lower sacral vertebral location of chordoma, iliac crest bone destruction in giant cell tumor, cauliflower-like nodules in osteochondroma. Conclusion: MSCT with three-dimensional volume rendering demonstrates well the tumor shape, size, extent, internal structure and relationship with the surrounding organs to aid diagnosis of pelvic wall tumors. (authors)

  3. Chest-wall reconstruction with a customized titanium-alloy prosthesis fabricated by 3D printing and rapid prototyping.

    Science.gov (United States)

    Wen, Xiaopeng; Gao, Shan; Feng, Jinteng; Li, Shuo; Gao, Rui; Zhang, Guangjian

    2018-01-08

    As 3D printing technology emerge, there is increasing demand for a more customizable implant in the repair of chest-wall bony defects. This article aims to present a custom design and fabrication method for repairing bony defects of the chest wall following tumour resection, which utilizes three-dimensional (3D) printing and rapid-prototyping technology. A 3D model of the bony defect was generated after acquiring helical CT data. A customized prosthesis was then designed using computer-aided design (CAD) and mirroring technology, and fabricated using titanium-alloy powder. The mechanical properties of the printed prosthesis were investigated using ANSYS software. The yield strength of the titanium-alloy prosthesis was 950 ± 14 MPa (mean ± SD), and its ultimate strength was 1005 ± 26 MPa. The 3D finite element analyses revealed that the equivalent stress distribution of each prosthesis was unifrom. The symmetry and reconstruction quality contour of the repaired chest wall was satisfactory. No rejection or infection occurred during the 6-month follow-up period. Chest-wall reconstruction with a customized titanium-alloy prosthesis is a reliable technique for repairing bony defects.

  4. Post mastectomy linac IMRT irradiation of chest wall and regional nodes: dosimetry data and acute toxicities

    International Nuclear Information System (INIS)

    Ma, Jinli; Li, Jiongyan; Xie, Jiang; Chen, Jian; Zhu, Chuanying; Cai, Gang; Zhang, Zhen; Guo, Xiaomao; Chen, Jiayi

    2013-01-01

    Conventional post-mastectomy radiation therapy is delivered with tangential fields for chest wall and separate fields for regional nodes. Although chest wall and regional nodes delineation has been discussed with RTOG contouring atlas, CT-based planning to treat chest wall and regional nodes as a whole target has not been widely accepted. We herein discuss the dosimetric characteristics of a linac IMRT technique for treating chest wall and regional nodes as a whole PTV after modified radical mastectomy, and observe acute toxicities following irradiation. Patients indicated for PMRT were eligible. Chest wall and supra/infraclavicular region +/−internal mammary nodes were contoured as a whole PTV on planning CT. A simplified linac IMRT plan was designed using either integrated full beams or two segments of half beams split at caudal edge of clavicle head. DVHs were used to evaluate plans. The acute toxicities were followed up regularly. Totally, 85 patients were enrolled. Of these, 45 had left-sided lesions, and 35 received IMN irradiation. Planning designs yielded 55 integrated and 30 segmented plans, with median number of beams of 8 (6–12). The integrated and segmented plans had similar conformity (1.41±0.14 vs. 1.47±0.15, p=0.053) and homogeneity indexes (0.13±0.01 vs. 0.14±0.02, p=0.069). The percent volume of PTV receiving >110% prescription dose was <5%. As compared to segmented plans, integrated plans typically increased V 5 of ipsilateral lung (p=0.005), and heart (p=0.001) in patients with left-sided lesions. Similarly, integrated plans had higher spinal cord D max (p=0.009), ipsilateral humeral head (p<0.001), and contralateral lung D mean (p=0.019). During follow-up, 36 (42%) were identified to have ≥ grade 2 radiation dermatitis (RD). Of these, 35 developed moist desquamation. The median time to onset of moist desquamation was 6 (4–7) weeks from start of RT. The sites of moist desquamation were most frequently occurred in anterior axillary

  5. Free gracilis flap for chest wall reconstruction in male patient with Poland syndrome after implant failure.

    Science.gov (United States)

    Cherubino, Mario; Maggiulli, Francesca; Pellegatta, Igor; Valdatta, Luigi

    2016-01-01

    Poland's syndrome (PS) is a congenital monolateral deformity that may involve breast, chest wall, and upper limb with different degrees of clinical expressions. In some cases, the problem is mainly cosmetic, and the reconstruction should be performed to achieve minimal scarring and donor site morbidity. The authors describe a case report of a male patient with PS who developed a severe capsular contraction after 25 years implant reconstruction, who was treated after explantation using free gracilis flap (FGF). In this patient, only the pectoralis major muscle was missing. An FGF was performed to reconstruct the anterior axillary fold and the soft tissue defect. There was no flap loss, the patient had a clearly improved appearance of the chest wall, and the pain syndrome was solved. In this case report, we demonstrate our experience with the use of an FGF for chest wall reconstruction in male patients with PS after prosthesis explantation.

  6. Biometric estimation of chest wall thickness of female radiation workers as an aid in in-vivo detection of the actinides

    International Nuclear Information System (INIS)

    Lane, B.H.; Berger, C.D.

    1983-01-01

    An equation was derived to estimate female chest wall thickness from a series of biometric measurements. This technique will result in improved performance for actinide detection in females by accounting for variations in chest wall thickness in derivation of calibration factors

  7. Chest wall – underappreciated structure in sonography. Part II: Non-cancerous lesions

    Directory of Open Access Journals (Sweden)

    Andrzej Smereczyński

    2017-12-01

    Full Text Available The chest wall is a vast and complex structure, hence the wide range of pathological conditions that may affect it. The aim of this publication is to discuss the usefulness of ultrasound for the diagnosis of benign lesions involving the thoracic wall. The most commonly encountered conditions include sternal and costal injuries and thoracic lymphadenopathy. Ultrasound is very efficient in identifying the etiology of pain experienced in the anterior chest wall following CPR interventions. Both available literature and the authors’ own experience prompt us to propose ultrasound evaluation as the first step in the diagnostic workup of chest trauma, as it permits far superior visualization of the examined structures compared with conventional radiography. Sonographic evaluation allows correct diagnosis in the case of various costal and chondral defects suspicious for cancer. It also facilitates diagnosis of such conditions as degenerative lesions, subluxation of sternoclavicular joints (SCJs and inflammatory lesions of various etiology and location. US may be used as the diagnostic modality of choice in conditions following thoracoscopy or thoracotomy. It may also visualize the fairly common sternal wound infection, including bone inflammation. Slipping rib syndrome, relatively little known among clinicians, has also been discussed in the study. A whole gamut of benign lesions of thoracic soft tissues, such as enlarged lymph nodes, torn muscles, hematomas, abscesses, fissures, scars or foreign bodies, are all easily identified on ultrasound, just like in other superficially located organs.

  8. Malignant Mesothelioma Presenting as a Giant Chest, Abdominal and Pelvic Wall Mass

    Energy Technology Data Exchange (ETDEWEB)

    Shao, Zhi Hong; Gao, Xiao Long; Yi, Xiang Hua; Wang, Pei Jun [Tongji Hospital of Tongji University, Shanghai (China)

    2011-11-15

    Malignant mesothelioma (MM) is a relatively rare carcinoma of the mesothelial cells, and it is usually located in the pleural or peritoneal cavity. Here we report on a unique case of MM that developed in the chest, abdominal and pelvic walls in a 77-year-old female patient. CT and MRI revealed mesothelioma that manifested as a giant mass in the right flank and bilateral pelvic walls. The diagnosis was confirmed by the pathology and immunohistochemistry. Though rare, accurate investigation of the radiological features of a body wall MM may help make an exact diagnosis.

  9. Malignant Mesothelioma Presenting as a Giant Chest, Abdominal and Pelvic Wall Mass

    International Nuclear Information System (INIS)

    Shao, Zhi Hong; Gao, Xiao Long; Yi, Xiang Hua; Wang, Pei Jun

    2011-01-01

    Malignant mesothelioma (MM) is a relatively rare carcinoma of the mesothelial cells, and it is usually located in the pleural or peritoneal cavity. Here we report on a unique case of MM that developed in the chest, abdominal and pelvic walls in a 77-year-old female patient. CT and MRI revealed mesothelioma that manifested as a giant mass in the right flank and bilateral pelvic walls. The diagnosis was confirmed by the pathology and immunohistochemistry. Though rare, accurate investigation of the radiological features of a body wall MM may help make an exact diagnosis.

  10. Operative fixation of chest wall fractures: an underused procedure?

    Science.gov (United States)

    Richardson, J David; Franklin, Glen A; Heffley, Susan; Seligson, David

    2007-06-01

    Chest wall fractures, including injuries to the ribs and sternum, usually heal spontaneously without specific treatment. However, a small subset of patients have fractures that produce overlying bone fragments that may produce severe pain, respiratory compromise, and, if untreated mechanically, result in nonunion. We performed open reduction and internal fixation on seven patients with multiple rib fractures-five in the initial hospitalization and two delayed--as well as 35 sternal fractures (19 immediate fixation and 16 delayed). Operative fixation was accomplished using titanium plates and screws in both groups of patients. All patients with rib fractures did well; there were no major complications or infections, and no plates required removal. Clinical results were excellent. There was one death in the sternal fracture group in a patient who was ventilator-dependent preoperatively and extubated himself in the early postoperative period. Otherwise, the results were excellent, with no complications occurring in this group. Three patients had their plates removed after boney union was achieved. No evidence of infection or nonunion occurred. The excellent results achieved in the subset of patients with severe chest wall deformities treated initially at our institution and those referred from outside suggest that operative fixation is a useful modality that is likely underused.

  11. An unusual case of grass inflorescence aspiration presenting as a chest wall tumour

    Energy Technology Data Exchange (ETDEWEB)

    Karagoez, Beguel; Koeksal, Yavuz; Varan, Ali; Bueyuekpamukcu, Muenevver [Hacettepe University, Department of Paediatric Oncology, Institute of Oncology, Ankara (Turkey); Haliloglu, Mithat [Hacettepe University, Department of Radiology, Faculty of Medicine, Ankara (Turkey); Ekinci, Saniye [Hacettepe University, Department of Paediatric Surgery, Faculty of Medicine, Ankara (Turkey)

    2006-05-15

    A 9-year-old boy was referred to the Oncology Department because of a thoracic soft-tissue mass thought to be a chest wall tumour. He had a history of grass inflorescence (Hordeum murinum) aspiration 2 weeks prior to this admission. On physical examination a tender soft-tissue mass under the right scapula and diminished breath sounds from the right lower lobe were detected. Thoracic CT confirmed soft-tissue swelling of the right posterior chest wall. There was a hypodense area within the soft-tissue mass suggesting a foreign body and also focal consolidation of the right lower lobe adjacent to the soft-tissue swelling. We report here unique CT findings of grass inflorescence aspiration before and after its migration through the airways. (orig.)

  12. An unusual case of grass inflorescence aspiration presenting as a chest wall tumour

    International Nuclear Information System (INIS)

    Karagoez, Beguel; Koeksal, Yavuz; Varan, Ali; Bueyuekpamukcu, Muenevver; Haliloglu, Mithat; Ekinci, Saniye

    2006-01-01

    A 9-year-old boy was referred to the Oncology Department because of a thoracic soft-tissue mass thought to be a chest wall tumour. He had a history of grass inflorescence (Hordeum murinum) aspiration 2 weeks prior to this admission. On physical examination a tender soft-tissue mass under the right scapula and diminished breath sounds from the right lower lobe were detected. Thoracic CT confirmed soft-tissue swelling of the right posterior chest wall. There was a hypodense area within the soft-tissue mass suggesting a foreign body and also focal consolidation of the right lower lobe adjacent to the soft-tissue swelling. We report here unique CT findings of grass inflorescence aspiration before and after its migration through the airways. (orig.)

  13. Estimating adipose tissue in the chest wall using ultrasonic and alternate 40K and biometric measurements

    International Nuclear Information System (INIS)

    Anderson, A.L.; Campbell, G.W.

    1982-01-01

    The percentage of adipose (fat) tissue in the chest wall must be known to accurately measure Pu in the human lung. Correction factors of 100% or more in x-ray detection efficiency are common. Methods using simple 40 K and biometric measurement techniques were investigated to determine the adipose content in the human chest wall. These methods predict adipose content to within 15% of the absolute ultrasonic value. These new methods are discussed and compared with conventional ultrasonic measurement techniques

  14. Free gracilis flap for chest wall reconstruction in male patient with Poland syndrome after implant failure

    Directory of Open Access Journals (Sweden)

    Mario Cherubino

    2016-01-01

    Full Text Available Poland's syndrome (PS is a congenital monolateral deformity that may involve breast, chest wall, and upper limb with different degrees of clinical expressions. In some cases, the problem is mainly cosmetic, and the reconstruction should be performed to achieve minimal scarring and donor site morbidity. The authors describe a case report of a male patient with PS who developed a severe capsular contraction after 25 years implant reconstruction, who was treated after explantation using free gracilis flap (FGF. In this patient, only the pectoralis major muscle was missing. An FGF was performed to reconstruct the anterior axillary fold and the soft tissue defect. There was no flap loss, the patient had a clearly improved appearance of the chest wall, and the pain syndrome was solved. In this case report, we demonstrate our experience with the use of an FGF for chest wall reconstruction in male patients with PS after prosthesis explantation.

  15. Repair of chest wall defects after irradiation for breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Hughes, L E

    1976-03-01

    A simple technique using a contralateral deltopectoral flap is described for the immediate repair of defects of the chest wall resulting from excision of radionecrosis or persistent tumour after radiotherapy. Successful use in 3 consecutive cases has shown that the deltopectoral flap may be rotated through a full 180/sup 0/ without compromise of blood supply and that primary healing may be obtained.

  16. Hemorrhagic lesion on the chest wall after trauma.

    LENUS (Irish Health Repository)

    Roche, Lisa

    2018-01-01

    A 59-year-old woman presented with a burning, rapidly progressive mass on the midchest, occurring after a fall, 4 months prior. Examination found a large well-circumscribed mass over the lower xiphisternum (Figs 1 and 2). Results of baseline investigations were normal apart from mildly elevated liver function values. A computerized tomography scan confirmed a 6.4- x 4.9-cm lobulated soft tissue heterogeneous-density mass located in the subcutaneous fat with ill-defined borders and no obvious infiltration of the chest wall. A single focal abnormality\\r\

  17. Pneumothorax, without chest wall fracture, following airbag deployment

    Directory of Open Access Journals (Sweden)

    Samuel Parsons

    2010-12-01

    Full Text Available Air bags are an automatic crash protection system. They have been shown to reduce mortality from motor vehicle accidents by 31% following direct head-on impacts, by 19% following any frontal impact and by 11% overall. Despite obvious benefits there has been a corresponding increase in the number of injuries resulting from their deployment. We describe a case of a pneumothorax in the absence of chest wall pathology associated with airbag deployment, in a belted driver. There has been one previous description of pneumothorax associated with airbag deployment, in an unbelted driver.

  18. Estimating adipose tissue in the chest wall using ultrasonic and alternate 40K and biometric measurements

    International Nuclear Information System (INIS)

    Anderson, A.L.; Campbell, G.W.; Singh, M.S.

    1982-01-01

    The percentage of adipose (fat) tissue in the chest wall must be known to accurately measure Pu in the human lung. Correction factors of 100% or more in X-ray detection efficiency are common in a normal population of individuals of differing body composition and have been determined in the past by means of elaborate and costly ultrasonic measurements of the subject's chest. Methods using simple 40 K and biometric measurement techniques have been investigated to determine the adipose content in the human chest wall. These methods compare favorably with ultrasonic measurements and allow laboratories not possessing ultrasonic equipment to make appropriate corrections for x-ray detection efficiency. These methods predict adipose content to within 15% of the absolute ultrasonic value. (author)

  19. Chest wall thickness measurements and the dosimetric implications for male workers in the uranium industry

    International Nuclear Information System (INIS)

    Kramer, Gary H.; Hauck, Barry M.; Allen, Steve A.

    2000-01-01

    The Human Monitoring Laboratory has measured the chest wall thickness and adipose mass fraction of a group of workers at three Canadian uranium refinery, conversion plant, and fuel fabrication sites using ultrasound. A site specific biometric equation has been developed for these workers, who seem to be somewhat larger than other workers reported in the literature. The average chest wall thickness of the seated persons measured at the uranium conversion plant and refinery was about 3.8 cm, and at the fuel fabrication facility was 3.4 cm. These values are not statistically different. Persons measured in a seated geometry had a thinner chest wall thickness than persons measured in a supine geometry - the decrease was in the range of 0.3 cm to 0.5 cm. It follows that a seated geometry will give a lower MDA (or decision level) than a supine geometry. Chest wall thickness is a very important modifier for lung counting efficiency and this data has been put into the perspective of the impending Canadian dose limits that will reduce the limit of occupationally exposed workers to essentially 20 mSv per year. Natural uranium must be measured based on the 235 U emissions at these type of facilities. The refining and conversion process removes 234 Th and the equilibrium is disturbed. This is unfortunate as the MDA values for this nuclide are approximately a factor of three lower than the values quoted below. The sensitivity of the germanium and phoswich based lung counting system has been compared. Achievable MDA's (30 minute counting time) with a four-phoswich-detector array lie in the range of 4.7 mg to 13.5 mg of natural uranium based on the 235 U emissions over a range of chest wall thicknesses of 1.6 cm to 6.0 cm. The average achievable MDA is about 8.5 mg which can be reduced to about 6.2 mg by doubling the counting time. Similarly, MDA's (30 minute counting time) obtainable with a germanium lung counting system will lie in the range of 3 mg to 28 mg of natural uranium

  20. Tumor Seeding Following Lung Radiofrequency Ablation: A Case Report

    International Nuclear Information System (INIS)

    Yamakado, Koichiro; Akeboshi, Masao; Nakatsuka, Atsuhiro; Takaki, Haruyuki; Takao, Motoshi; Kobayashi, Hiroyasu; Taguchi, Osamu; Takeda, Kan

    2005-01-01

    Lung radiofrequency (RF) ablation was performed for the treatment of a primary lung cancer measuring 2.5 cm in maximum diameter in a 78-year-old man. A contrast-enhanced computed tomography (CT) study performed 3 months after RF ablation showed incomplete ablation of the lung tumor and the appearance of a chest wall tumor 4.0 cm in maximum diameter that was considered to be the result of needle-tract seeding. RF ablation was performed for the treatment of both the lung and the chest wall tumors. Although tumor enhancement was eradicated in both of the treated tumors, follow-up CT studies revealed diffuse intra-pulmonary metastases in both lungs 2 months after the second RF session. He is currently receiving systemic chemotherapy

  1. Etonogestrel implant migration to the vasculature, chest wall, and distant body sites: cases from a pharmacovigilance database.

    Science.gov (United States)

    Kang, Sarah; Niak, Ali; Gada, Neha; Brinker, Allen; Jones, S Christopher

    2017-12-01

    To describe clinical outcomes of etonogestrel implant patients with migration to the vasculature, chest wall and other distant body sites spontaneously reported to the US Food and Drug Administration Adverse Event Reporting System (FAERS) database. We performed a standardized Medical Dictionary for Regulatory Activities (MedDRA) query in the FAERS database (through November 15, 2015), with reports coded with one or more MedDRA preferred terms that indicate complications with device placement or migration of the device from the original site of insertion to the vasculature, chest wall and other distant body sites. We excluded any cases previously described in the medical literature. We identified 38 cases of pronounced etonogestrel implant migration. Migration locations included the lung/pulmonary artery (n=9), chest wall (n=1), vasculature at locations other than the lung/pulmonary artery (n=14) and extravascular migrations (n=14) to other body sites (e.g., the axilla and clavicle/neck line/shoulder). The majority of cases were asymptomatic and detected when the patient desired implant removal; however, seven cases reported symptoms such as pain, discomfort and dyspnea in association with implant migration. Three cases also describe pulmonary fibrosis and skin reactions as a result of implant migration to the vasculature, chest wall and other distant body sites. Sixteen cases reported surgical removal in an operating room setting. Our FAERS case series demonstrates etonogestrel implant migration to the vasculature, chest wall and other body sites distant from the site of original insertion. As noted by the sponsor in current prescribing information, a key determinant in the risk for etonogestrel contraceptive implant migration appears to be improper insertion technique. Although migration of etonogestrel implants to the vasculature is rare, awareness of migration and education on proper insertion technique may reduce the risk. Published by Elsevier Inc.

  2. The effect of pre-injury anti-platelet therapy on the development of complications in isolated blunt chest wall trauma: a retrospective study.

    Directory of Open Access Journals (Sweden)

    Ceri Battle

    Full Text Available INTRODUCTION: The difficulties in the management of the blunt chest wall trauma patient in the Emergency Department due to the development of late complications are well recognised in the literature. Pre-injury anti-platelet therapy has been previously investigated as a risk factor for poor outcomes following traumatic head injury, but not in the blunt chest wall trauma patient cohort. The aim of this study was to investigate pre-injury anti-platelet therapy as a risk factor for the development of complications in the recovery phase following blunt chest wall trauma. METHODS: A retrospective study was completed in which the medical notes were analysed of all blunt chest wall trauma patients presenting to a large trauma centre in Wales in 2012 and 2013. Using univariate and multivariable logistic regression analysis, pre-injury platelet therapy was investigated as a risk factor for the development of complications following blunt chest wall trauma. Previously identified risk factors were included in the analysis to address the influence of confounding. RESULTS: A total of 1303 isolated blunt chest wall trauma patients presented to the ED in Morriston Hospital in 2012 and 2013 with complications recorded in 144 patients (11%. On multi-variable analysis, pre-injury anti-platelet therapy was found to be a significant risk factor for the development of complications following isolated blunt chest wall trauma (odds ratio: 16.9; 95% confidence intervals: 8.2-35.2. As in previous studies patient age, number of rib fractures, chronic lung disease and pre-injury anti-coagulant use were also found to be significant risk factors. CONCLUSIONS: Pre-injury anti-platelet therapy is being increasingly used as a first line treatment for a number of conditions and there is a concurrent increase in trauma in the elderly population. Pre-injury anti-platelet therapy should be considered as a risk factor for the development of complications by clinicians managing

  3. Multidetector computed tomography-spectrum of blunt chest wall and lung injuries in polytraumatized patients

    Energy Technology Data Exchange (ETDEWEB)

    Peters, S., E-mail: soeren.peters@rub.d [Department of Radiology and Nuclear Medicine, BG Universitaetsklinikum Bergmannsheil, Buerkle-de-la-Camp-Platz 1, 44789 Bochum (Germany); Nicolas, V.; Heyer, C.M. [Department of Radiology and Nuclear Medicine, BG Universitaetsklinikum Bergmannsheil, Buerkle-de-la-Camp-Platz 1, 44789 Bochum (Germany)

    2010-04-15

    Accidental injuries are the leading cause of death in the 15 to 44-year-old age group. Blunt chest trauma is often encountered in these patients and is associated with a mortality of up to 25%. Although conventional radiography still plays an important role in the initial emergency room setting, for follow-up in the intensive care unit, multidetector computed tomography has established itself as the standard imaging method for the evaluation of chest trauma patients. The following review presents salient radiological findings of the chest wall and shoulder girdle, thoracic spine, pleural space, and lung in polytraumatized patients.

  4. Recurrent desmoid tumor of the abdominal wall | Toughrai | Pan ...

    African Journals Online (AJOL)

    Desmoid tumors most often occur in abdominal wall. Their tendency to recur lead to repeated operations which can make the abdominal wall reconstruction difficult. We report a 28-year-old female history. The patient was referred to our hospital for a recurrent desmoid tumor of the abdominal wall. The tumor was totally ...

  5. FLAIL CHEST

    Directory of Open Access Journals (Sweden)

    Anton Crnjac

    2003-12-01

    Full Text Available Background. Major thoracic trauma is consistent with high mortality rate because of associated injuries of vital thoracic organs and dangerous complications. The flail chest occurs after disruption of the skeletal continuity of chest wall and demands because of its pathophysiological complexity rapid and accurate diagnosis and treatment.Conclusions. Basic pathophysiological mechanism of the flail chest is respiratory distress, which is provoked by pulmonary contusions and paradoxical chest wall motion. The treatment should be pointed to improvement and support of respiratory functions and include aggressive pain control, pulmonary physiotherapy and selective mechanical ventilation. Views about operative fixation of the flail chest are still controversial. Neither mortality rate neither long-term disability are improved after operative fixation.

  6. Surgical repair of right atrial wall rupture after blunt chest trauma.

    Science.gov (United States)

    Telich-Tarriba, Jose E; Anaya-Ayala, Javier E; Reardon, Michael J

    2012-01-01

    Right atrial wall rupture after blunt chest trauma is a catastrophic event associated with high mortality rates. We report the case of a 24-year-old woman who was ejected 40 feet during a motor vehicle accident. Upon presentation, she was awake and alert, with a systolic blood pressure of 100 mmHg. Chest computed tomography disclosed a large pericardial effusion; transthoracic echocardiography confirmed this finding and also found right ventricular diastolic collapse. A diagnosis of cardiac tamponade with probable cardiac injury was made; the patient was taken to the operating room, where median sternotomy revealed a 1-cm laceration of the right atrial appendage. This lesion was directly repaired with 4-0 polypropylene suture. Her postoperative course was uneventful, and she continued to recover from injuries to the musculoskeletal system. This case highlights the need for a high degree of suspicion of cardiac injuries after blunt chest trauma. An algorithm is proposed for rapid recognition, diagnosis, and treatment of these lesions.

  7. Chest-wall reconstruction in case of infection of the operative site: is there any interest in titanium rib osteosynthesis?

    Science.gov (United States)

    Berthet, Jean-Philippe; Solovei, Laurence; Tiffet, Olivier; Gomez-Caro, Abel; Bommart, Sébastien; Canaud, Ludovic; Alric, Pierre; Marty-Ané, Charles-Henri

    2013-11-01

    To describe the management of thoracic reconstructions in the presence of primary chest-wall infection (PCWI) or secondary deep chest-wall infection (SCWI), focussing on local tolerance of a titanium rib osteosynthesis system. PCWI included infected chest wall tumours (CWT), infected T3 non-small-cell lung carcinoma (NSCLC) and open flail chest. SCWI was defined by deep infection of previous thoracic-wall reconstructions. Infection was identified by preoperative bacterial analysis of the tumour or surgical site. In PCWI, a one-step procedure combined extensive resection of infected tissues and rigid reconstruction of the defect; skeletal rigidity was achieved using titanium implants. In SCWI, we removed all synthetic material except titanium implants. In both groups, the surgical field was thoroughly cleaned and implants were wrapped or covered by flaps. From January 2005 to December 2011, 11 patients (54 ± 10.2 years) with either PCWI (3 CWT, 3 T3 NSCLC, 1 open flail chest) or SCWI (3 CWT, 1 funnel chest) were treated. Infection was polymicrobial in all but 1 case. Bacteria observed in PCWI patients were multidrug resistant. In PCWI, we resected 4.2 ± 0.6 ribs en bloc with the lung (n = 5), the skin and the pectoralis major and then used mesh and 2.1 ± 1.2 titanium implants for reconstruction (n = 6). The mean defect was 1154.4 ± 318 cm(3). Surgical SCWI management removed polytetrafluoroethylene-mesh and preserved the titanium implants. A Vicryl mesh (n = 3) and greater omentum flap (n = 3) were added. One of the 2 postoperative deaths in the PCWI group was related to infection recurrence. No other patient had infection at the 6-month follow-up with leucocyte-labelled scintigraphy. Titanium rib osteosynthesis is reliable in two complex and life-threatening situations: PCWIs and SCWIs. In combination with a flap, this allows rapid, reliable, rigid reconstruction of infected full-thickness chest-wall defects in a single-step procedure.

  8. Evaluation of lung and chest wall mechanics during anaesthesia using the PEEP-step method.

    Science.gov (United States)

    Persson, P; Stenqvist, O; Lundin, S

    2018-04-01

    Postoperative pulmonary complications are common. Between patients there are differences in lung and chest wall mechanics. Individualised mechanical ventilation based on measurement of transpulmonary pressures would be a step forward. A previously described method evaluates lung and chest wall mechanics from a change of ΔPEEP and calculation of change in end-expiratory lung volume (ΔEELV). The aim of the present study was to validate this PEEP-step method (PSM) during general anaesthesia by comparing it with the conventional method using oesophageal pressure (PES) measurements. In 24 lung healthy subjects (BMI 18.5-32), three different sizes of PEEP steps were performed during general anaesthesia and ΔEELVs were calculated. Transpulmonary driving pressure (ΔPL) for a tidal volume equal to each ΔEELV was measured using PES measurements and compared to ΔPEEP with limits of agreement and intraclass correlation coefficients (ICC). ΔPL calculated with both methods was compared with a Bland-Altman plot. Mean differences between ΔPEEP and ΔPL were mechanical properties among the lung healthy patients stresses the need for individualised ventilator settings based on measurements of lung and chest wall mechanics. The agreement between ΔPLs measured by the two methods during general anaesthesia suggests the use of the non-invasive PSM in this patient population. NCT 02830516. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  9. Single-incision video-assisted thoracoscopic evaluation and emergent surgery for severe lung and chest wall injury after thoracic trauma in a water park.

    Science.gov (United States)

    Sesma, Julio; Alvarez, Melodie; Lirio, Francisco; Galvez, Carlos; Galiana, Maria; Baschwitz, Benno; Fornes, Francisca; Bolufer, Sergio

    2017-08-01

    Thoracic trauma is a challenging situation with potential severe chest wall and intrathoracic organ injuries. We present a case of emergent surgery in a 23-year-old man with hemorrhagic shock due to massive lung and chest wall injury after thoracic trauma in a water slide. We performed a SI-VATS approach in order to define intrathoracic and chest wall injuries, and once checked the extension of the chest wall injury, we added a middle size thoracotomy just over the affected area in order to stabilize rib fractures with Judet plates, that had caused massive laceration in left lower lobe (LLL) and injured the pericardium causing myocardical tear. After checking bronchial and vascular viability of LLL we suggested a lung parenchyma preserving technique with PTFE protected pulmonary primary suture in order to avoid a lobectomy. Chest tubes were removed on 3 rd postoperative day and patient was discharged on 14 th postoperative day. He has already recovered his normal activity 6 months after surgery.

  10. Pulmonary Metastasis from Rectal Cancer on Chest CT Is Correlated with 3T MRI Primary Tumor Location

    International Nuclear Information System (INIS)

    Han, Na Yeon; Kim, Min Ju; Park, Beon Jin; Sung, Deuk Jae; Chung, Kyoo Byung; Oh, Yu Whan

    2011-01-01

    To evaluate the association between the incidence of pulmonary metastasis on chest CT and the location of the primary tumor on rectal MRI. One hundred and nine consecutive patients with rectal adenocarcinoma underwent chest CT and 3T rectal MRI. Two radiologists classified the tumor on MRI as an upper (> 10 cm from the anal verge), mid (5-10 cm), or lower rectal tumor (< 5 cm) by consensus. All chest CT scans were retrospectively reviewed for the presence of metastasis. We used Fisher's exact test to evaluate the correlation between the incidence of pulmonary metastasis with the location of the rectal cancer and the Mantel-Haenszel test to control for local tumor stage. We only included the 60 patients with upper (n = 26) or lower (n = 34) rectal cancer, because of the complicated venous drainage system of the mid rectum. Among these, 9 (15%) showed evidence of pulmonary metastasis on chest CT and almost all (89%, 8/9) patients had lower rectal cancer. The incidence of pulmonary metastasis between the two groups was statistically different (p < 0.05) when local tumor stage was controlled. The incidence of pulmonary metastasis was significantly higher for lower than upper rectal cancers when the T-stage of the tumor was accounted for.

  11. Cine magnetic resonance imaging, computed tomography and ultrasonography in the evaluation of chest wall invasion of lung cancer

    International Nuclear Information System (INIS)

    Yokozaki, Michiya; Nawano, Shigeru; Nagai, Kanji; Moriyama, Noriyuki; Kodama, Tetsuro; Nishiwaki, Yutaka.

    1997-01-01

    To assess the usefulness of cine-magnetic resonance imaging (cine-MRI) in the evaluation of chest wall invasion, we compared the results of cine-MRI with those of computed tomography (CT) and ultrasonography (US). Eleven patients were examined who had no pain and who were difficult to diagnose by routine examinations. MRI was performed with a Magnetom SP/4000, 1.5T unit (Siemens, Germany). For cine imaging, continuous turbo-FLUSH (ultra fast low angle shot) images were obtained at an orthogonal section to the chest wall during slow deep breathing. A CT scan was performed using a TCT 900S or Super Helix (Toshiba, Japan) at 1 cm intervals, with section thicknesses of 1 cm throughout the entire chest. US was performed with a model SSA-270A (Toshiba, Japan) with 7.5-MHz linear array scanners (PLF-705S; Toshiba, Japan). Sensitivity, specificity and accuracy were 67%, 75% and 73% for cine MRI, 67%, 63% and 64% for CT, 33%, 75% and 64% for US, respectively. These results indicate that cine MRI is potentially useful for the diagnosis of chest wall invasion of lung cancer. (author)

  12. Contralateral breast dose from chest wall and breast irradiation: local experience

    International Nuclear Information System (INIS)

    Alzoubi, A.; Kandaiya, S.; Shukri, A.; Elsherbieny, E.

    2010-01-01

    Full text: Second cancer induction in the contralateral breast (CB) is an issue of some concern in breast radiotherapy especially for women under the age of 45 years at the time of treatment. The CB dose from 2-field and 3-field techniques in post-mastectomy chest wall irradiations in an anthropomorphic phantom as well as in patients were measured using thermoluminescent dosimeters (TLDs) at the local radiotherapy center. Breast and chest wall radiotherapy treatments were planned conformally (3D-CRT) and delivered using 6-MV photons. The measured CB dose at the surface fell sharply with distance from the field edge. However, the average ratio of the measured to the calculated CB dose using the pencil beam algorithm at the surface was approximately 53%. The mean and median measured internal dose at the posterior border of CB in a phantom was 5.47 ± 0.22 c G y and 5.44 c G y, respectively. The internal CB dose was relatively independent of depth. In the present study the internal CB dose is 2.1-4.1 % of the prescribed dose which is comparable to the values reported by other authors.

  13. Periurethral granular cell tumor: a case report

    International Nuclear Information System (INIS)

    Kim, Jeong Kon; Choi, Hyo Gyeong; Cho, Kyoung Sik

    1998-01-01

    Granular cell tumors are uncommon soft tissue tumors which arise as solitary or multiple masses. Lesions commonly arise in the head, neck, and chest wall, but can occur in any part of the body. To our knowledge, periurethral granular cell tumor has not been previously reported. We report one such case

  14. Von Reckling-hausen disease associated to thyroid carcinoma and malignant schwannoma of the chest wall. A case

    International Nuclear Information System (INIS)

    Diaz P, J.; Tantalean, E.; Guzman, R.; Pomatanta P, J.; Grados M, J.; Vilela, C.

    1999-01-01

    The multiple neurofibromatosis is an autosomal dominant hereditary disease associated to malignant schwannoma in about 3% of the cases and very rarely to others cancers. The study provides information on the case of a 32 year-old woman who suffers from this disease and presented two synchronous cancers: a papillary carcinoma of thyroid and a malignant schwannoma of the chest wall. The thyroid tumour was managed with hemithyroidectomy, hormonotherapy and radiotherapy, and the lesion of the thoracic wall was treated with local radical resection application of Marlex mesh and rotation of a musculocutaneous flap of the dorsal muscle. A review of the literature on the clinical aspects of this association and the surgical techniques employed to cover the defect of the chest wall is presented. (authors)

  15. Functional exercise capacity, lung function and chest wall deformity in patients with adolescent idiopathic scoliosis

    Directory of Open Access Journals (Sweden)

    Evandro Fornias Sperandio

    Full Text Available AbstractIntroduction The adolescent idiopathic scoliosis (AIS causes changes on the compliance of the chest. These changes may be associated with impaired lung function and reduced functional exercise capacity of these adolescents. We aimed to evaluate the correlation between functional exercise capacity, lung function and geometry of the chest at different stages of AIS.Materials and methods The study was carried out in a cross-sectional design which were evaluated 27 AIS patients at different stages of the disease. For chest wall evaluation, were created geometry angles/distances (A/D, which were quantified by Software Postural Assessment. The functional exercise capacity was assessed by a portable gas analyzer during the incremental shuttle walk test (ISWT. Besides that, manovacuometry and spirometry were also performed.Results Linear regressions showed that oxygen uptake (peak VO2 was correlated with distance travelled in the ISWT (R2 = 0.52, maximal respiratory pressures, cough peak flow (R2 = 0.59 and some thoracic deformity markers (D1, D2 and A6.Discussion We observed that the chest wall alterations, lung function and respiratory muscle strength are related to the functional exercise capacity and may impair the physical activity performance in AIS patients.Final considerations There is correlation between functional exercise capacity, lung function and geometry of the chest in AIS patients. Our results point to the possible impact of the AIS in the physical activities of these adolescents. Therefore, efforts to prevent the disease progression are extremely important.

  16. Analysis of the impact of chest wall constraints on eligibility for a randomized trial of stereotactic body radiotherapy of peripheral stage 1 non-small cell lung cancer

    International Nuclear Information System (INIS)

    Siva, Shankar; Shaw, Mark; Gill, Suki; David, Ball; Chesson, Brent

    2012-01-01

    Chest wall toxicities are recognized complications of stereotactic radiotherapy (SBRT) in non-small cell lung cancer. To minimize toxicity, the Trans-Tasman Radiation Oncology Group (TROG) 09.02 ‘CHISEL’ study protocol excluded patients with tumours within 1cm of the chest wall. The purpose of this study is to evaluate the implication of chest wall proximity constraints on patient eligibility, toxicity and potential accrual. Exclusion zones of 1cm beyond the mediastinum and 2cm beyond the bifurcation of the lobar bronchi were incorporated into the CHISEL credentialing CT dataset. Volumes of lung within which tumours varying from 1cm to 5cm in diameter may occupy and remain eligible for the CHISEL study were calculated. These volumes were compared to a hypothetical model in which the 1cm chest wall proximity restriction was removed. The percentage of lung area in which a tumour mass can occupy and be suitable for CHISEL in the left and right lung were 54% and 60% respectively. Removing the constraint increased the percentage of available lung to 83% and 87% respectively. Considering a 2cm spherical tumour, only 21% and 31% of tumours in the left and right lung would be eligible with the chest wall constraint, whilst 39% and 50% respectively would be eligible without the constraint. The exclusion of tumours less than 1cm to chest wall significantly reduces the proportion of patients eligible for the CHISEL protocol. A review of the literature pertaining to chest wall toxicity after stereotactic radiotherapy supports a change in chest wall exclusion criteria for the CHISEL study.

  17. Matching Electron Beams Without Secondary Collimation for Treatment of Extensive Recurrent Chest-Wall Carcinoma

    International Nuclear Information System (INIS)

    Feygelman, Vladimir; Mandelzweig, Yuri; Baral, Ed

    2015-01-01

    Matching electron beams without secondary collimators (applicators) were used for treatment of extensive, recurrent chest-wall carcinoma. Due to the wide penumbra of such beams, the homogeneity of the dose distribution at and around the junction point is clinically acceptable and relatively insensitive to positional errors. Specifically, dose around the junction point is homogeneous to within ±4% as calculated from beam profiles, while the positional error of 1 cm leaves this number essentially unchanged. The experimental isodose distribution in an anthropomorphic phantom supports this conclusion. Two electron beams with wide penumbra were used to cover the desired treatment area with satisfactory dose homogeneity. The technique is relatively simple yet clinically useful and can be considered a viable alternative for treatment of extensive chest-wall disease. The steps are suggested to make this technique more universal.

  18. SU-F-T-85: Energy Modulated Electron Postmastectomy Unreconstructed (PU) Chest Wall (CW) Irradiation Technique to Achieve Heart Sparing

    Energy Technology Data Exchange (ETDEWEB)

    Hong, L; Ballangrud, A; Mechalakos, J [Memorial Sloan-Kettering Cancer Center, New York, NY (United States); McCormick, B [Memerial Sloan-Kettering Cancer Center, New York, NY (United States)

    2016-06-15

    Purpose: For left-sided PU patients requiring CW and nodal irradiation, sometimes partial wide tangents (PWT) are not feasible due to abnormal chest wall contour or heart position close to the anterior chest wall or unusual wide excision scar. We developed an energy modulated electron chest wall irradiation technique that will achieve heart sparing. Methods: Ten left-sided PU patients were selected for this dosimetry study. If PWT were used, the amount of the ipsilateral lung would be ranged 3.4 to 4.4 cm, and the amount of heart would be ranged 1.3 to 3.8 cm. We used electron paired fields that matched on the skin to achieve dose conformity to the chest wall. The enface electron fields were designed at extended SSD from a single isocenter and gantry angle with different energy beams using different cutout. Lower energy was used in the central chest wall part and higher energy was used in the periphery of the chest wall. Bolus was used for the electron fields to ensure adequate skin dose coverage. The electron fields were matched to the photon supra-clavicle field in the superior region. Daily field junctions were used to feather the match lines between all the fields. Target volumes and normal tissues were drawn according to institutional protocols. Prescription dose was 2Gy per fraction for a total 50Gy. Dose calculations were done with Eclipse EMC-11031 for Electron and AAA-11031 for photons. Results: Six patients were planned using 6/9MeV, three using 9/12MeV and one 6/12MeV. Target volumes achieved adequate coverage. For heart, V30Gy, V20Gy and Mean Dose were 0.6%±0.6%, 2.7%±1.7%, and 3.0Gy±0.8Gy respectively. For ipsilateral lung, V50Gy, V20Gy, V10Gy and V5Gy were 0.9%±1.1%, 34.3%±5.1%, 51.6%±6.3% and 64.1%±7.5% respectively. Conclusion: For left-sided PU patients with unusual anatomy, energy modulated electron CW irradiation technique can achieve heart sparing with acceptable lung dose.

  19. Ultrasonographic Localization of Solitary Fibrous Tumor of Pleura: Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Kyoung Tae; Jeon, Yong Sun; Cho, Soon Gu; Kim, Kwang Ho; Lee, Kyung Hee [Inha University School of Medicine, Incheon (Korea, Republic of)

    2010-03-15

    Plain radiography and computed tomography are widely used in the field of chest disease. Yet ultrasonography has a limitation as a diagnostic tool, except in the case of pleural effusion and chest wall lesion. We experienced a case of solitary fibrous tumor of the diaphragmatic pleura, and the origin of this tumor could be exactly localized by ultrasonography, but not by other imaging modalities

  20. Ultrasonographic Localization of Solitary Fibrous Tumor of Pleura: Case Report

    International Nuclear Information System (INIS)

    Kim, Kyoung Tae; Jeon, Yong Sun; Cho, Soon Gu; Kim, Kwang Ho; Lee, Kyung Hee

    2010-01-01

    Plain radiography and computed tomography are widely used in the field of chest disease. Yet ultrasonography has a limitation as a diagnostic tool, except in the case of pleural effusion and chest wall lesion. We experienced a case of solitary fibrous tumor of the diaphragmatic pleura, and the origin of this tumor could be exactly localized by ultrasonography, but not by other imaging modalities

  1. Re-irradiation of the chest wall for local breast cancer recurrence. Results of salvage brachytherapy with hyperthermia

    Energy Technology Data Exchange (ETDEWEB)

    Auoragh, A. [University Hospital Erlangen, Department of Radiation Oncology, Erlangen (Germany); Hospital Fuerth, Department of Radiation Oncology, Fuerth (Germany); Strnad, V.; Ott, O.J.; Fietkau, R. [University Hospital Erlangen, Department of Radiation Oncology, Erlangen (Germany); Beckmann, M.W. [University Hospital Erlangen, Department of Gynecology and Obstetrics, Erlangen (Germany)

    2016-09-15

    Following mastectomy and adjuvant external beam radiation therapy in patients with breast cancer, the incidence of local or locoregional recurrence is approximately 9 % (2-20 %). Alongside the often limited possibilities of surgical treatment, radiation therapy combined with superficial hyperthermia is the most effective local therapy. In the present work, a retrospective analysis of salvage brachytherapy combined with superficial hyperthermia for chest wall recurrences is presented. Between 2004 and 2011, 18 patients with a total of 23 target volumes resulting from chest wall recurrences after previously mastectomy and external beam radiation therapy (median 56 Gy, range 50-68 Gy) were treated with superficial brachytherapy as salvage treatment: 8 patients (44 %) had macroscopic tumor, 3 (17 %) had microscopic tumor (R1), and 7 (39 %) had undergone R0 resection and were treated due to risk factors. A dose of 50 Gy was given (high-dose rate [HDR] and pulsed-dose rate [PDR] procedures). In all, 5 of 23 patients (22 %) received additional concurrent chemotherapy, and in 20 of 23 (87 %) target volumes additional superficial hyperthermia was carried out twice weekly. The 5-year local recurrence-free survival was 56 %, the disease-free survival was 28 %, and a 5-year overall survival was 22 %. Late side effects Common Toxicity Criteria (CTC) grade 3 were reported in 17 % of the patients: 2 of 18 (11 %) had CTC grade 3 fibrosis, and 1 of 18 (6 %) had a chronic wound healing disorder. Re-irradiation as salvage brachytherapy with superficial hyperthermia for chest wall recurrences is a feasible and safe treatment with good local control results and acceptable late side effects. (orig.) [German] Nach einer Mastektomie und adjuvanter Strahlentherapie bei Patientinnen mit Mammakarzinom kommt es bei 9 % (2-20 %) zum lokalen bzw. lokoregionaeren Rezidiv. Neben den oft limitierten operativen Behandlungsmoeglichkeiten ist die Strahlentherapie mit Oberflaechenhyperthermie die

  2. Fully automated chest wall line segmentation in breast MRI by using context information

    Science.gov (United States)

    Wu, Shandong; Weinstein, Susan P.; Conant, Emily F.; Localio, A. Russell; Schnall, Mitchell D.; Kontos, Despina

    2012-03-01

    Breast MRI has emerged as an effective modality for the clinical management of breast cancer. Evidence suggests that computer-aided applications can further improve the diagnostic accuracy of breast MRI. A critical and challenging first step for automated breast MRI analysis, is to separate the breast as an organ from the chest wall. Manual segmentation or user-assisted interactive tools are inefficient, tedious, and error-prone, which is prohibitively impractical for processing large amounts of data from clinical trials. To address this challenge, we developed a fully automated and robust computerized segmentation method that intensively utilizes context information of breast MR imaging and the breast tissue's morphological characteristics to accurately delineate the breast and chest wall boundary. A critical component is the joint application of anisotropic diffusion and bilateral image filtering to enhance the edge that corresponds to the chest wall line (CWL) and to reduce the effect of adjacent non-CWL tissues. A CWL voting algorithm is proposed based on CWL candidates yielded from multiple sequential MRI slices, in which a CWL representative is generated and used through a dynamic time warping (DTW) algorithm to filter out inferior candidates, leaving the optimal one. Our method is validated by a representative dataset of 20 3D unilateral breast MRI scans that span the full range of the American College of Radiology (ACR) Breast Imaging Reporting and Data System (BI-RADS) fibroglandular density categorization. A promising performance (average overlay percentage of 89.33%) is observed when the automated segmentation is compared to manually segmented ground truth obtained by an experienced breast imaging radiologist. The automated method runs time-efficiently at ~3 minutes for each breast MR image set (28 slices).

  3. Clinical image: Hydatid disease of the chest wall

    Energy Technology Data Exchange (ETDEWEB)

    Graham, R.J.; Berlin, J.W.; Ghahremani, G.G. [Northwestern Univ., Evanston, IL (United States)

    1996-05-01

    Hydatid disease is rarely encountered among the population of the United States, but it affects several million people in sheep-raising regions of the world. Human infestation with Echinococcus granulosus begins following ingestion of its ova, which are excreted into the contaminated water during the usual dog-sheep cycle. Hydatid cysts will then develop most frequently in the liver (75% of cases) and lungs (15%) of the human host. Skeletal involvement has been reported to occur in only 0.5-4.0% of patients in the endemic areas. Because of the rarity and perplexing imaging features of hydatid disease involving the chest wall, we wish herein to present a case evaluated recently at our institution. 5 refs., 1 fig.

  4. Relation of external surface to internal tumor motion studied with cine CT

    International Nuclear Information System (INIS)

    Chi, P.-C.M.; Balter, Peter; Luo Dershan; Mohan, Radhe; Pan Tinsu

    2006-01-01

    The accuracy of delivering gated-radiation therapy to lung tumors using an external respiratory surrogate relies on not only interfractional and intrafractional reproducibility, but also a strong correlation between external motion and internal tumor motion. The purpose of this work was to use the cine images acquired by four-dimensional computed tomography acquisition protocol to study the relation between external surface motion and internal tumor motion. The respiratory phase information of tumor motion and chest wall motion was measured on the cine images using a proposed region-of-interest (ROI) method and compared to measurement of an external respiratory monitoring device. On eight lung patient data sets, the phase shifts were measured between (1) the signal of a real-time positioning-management (RPM) respiratory monitoring device placed in the abdominal region and four surface locations on the chest wall (2) the RPM signal in the abdominal region and tumor motions, and (3) chest wall surface motions and tumor motions. Respiratory waveforms measured at different surface locations during the same respiratory cycle often varied and had significant phase shifts. Seven of the 8 patients showed the abdominal motion leading chest wall motion. The best correlation (smallest phase shift) was found between the abdominal motion and the superior-inferior (S-I) tumor motion. A wide range of phase shifts was observed between external surface motion and tumor anterior-posterior (A-P)/lateral motion. The result supported the placement of the RPM block in the abdominal region and suggested that during a gated therapy utilizing the RPM system, it is necessary to place the RPM block at the same location as it is during treatment simulation in order to reduce potential errors introduced by the position of the RPM block. Correlations between external motions and lateral/A-P tumor motions were inconclusive due to a combination of patient selection and the limitation of the ROI

  5. MULTIPLE MYELOMA PRESENTED AS AN ANTERIOR CHEST WALL MASS DIAGNOSED BY CYTOLOGICAL EXAMINATION : A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Parvathi

    2015-02-01

    Full Text Available Myeloma is a malignancy of terminally differentiated B cells (plasma cells that produce a complete and / or partial monoclonal immunoglobulin protein. Myeloma accounts for approximately 1% of all malignancies and 10% of haematological tumors. It becomes difficult to arrive at early diagnosis because myeloma manifests itself in different forms. The disease usually presents as bone pains, pathological fractures and anemia but can also present as swelling in jaw, orbit, rib, sternoclavicular area, scalp, paraspinal region and tonsil. We present a case of multiple myeloma in 63 year old male which presented as a soft tissue mass on anterior chest wall and diagnosed by FNAC . This case is presented because diagnosis was made on cytology and not many cases have been reported in literature where FNAC helped in making the diagnosis. This increases the hope of early diagnosis so that treatment can be advocated

  6. Low-grade extraskeletal osteosarcoma of the chest wall: case report and review of literature

    Directory of Open Access Journals (Sweden)

    Chetaille Bruno

    2010-11-01

    Full Text Available Abstract Background Low-grade extraskeletal osteosarcomas (ESOS are extremely rare. Case presentation We present the first case of low-grade ESOS of the chest wall, which occurred in a 30-year-old man. Because of initial misdiagnosis and patient's refusal of surgery, the diagnosis was done after a 4-year history of a slowly growing mass in soft tissues, leading to a huge (30-cm diameter calcified mass locally extended over the left chest wall. Final diagnosis was helped by molecular analysis of MDM2 and CDK4 oncogenes. Unfortunately, at this time, no surgical treatment was possible due to loco-regional extension, and despite chemotherapy, the patient died one year after diagnosis, five years after the first symptoms. Conclusion We describe the clinical, radiological and bio-pathological features of this unique case, and review the literature concerning low-grade ESOS. Our case highlights the diagnostic difficulties for such very rare tumours and the interest of molecular analysis in ambiguous cases.

  7. Low-grade extraskeletal osteosarcoma of the chest wall: case report and review of literature.

    Science.gov (United States)

    Sabatier, Renaud; Bouvier, Corinne; de Pinieux, Gonzague; Sarran, Anthony; Brenot-Rossi, Isabelle; Pedeutour, Florence; Chetaille, Bruno; Viens, Patrice; Weiller, Pierre-Jean; Bertucci, François

    2010-11-24

    Low-grade extraskeletal osteosarcomas (ESOS) are extremely rare. We present the first case of low-grade ESOS of the chest wall, which occurred in a 30-year-old man. Because of initial misdiagnosis and patient's refusal of surgery, the diagnosis was done after a 4-year history of a slowly growing mass in soft tissues, leading to a huge (30-cm diameter) calcified mass locally extended over the left chest wall. Final diagnosis was helped by molecular analysis of MDM2 and CDK4 oncogenes. Unfortunately, at this time, no surgical treatment was possible due to loco-regional extension, and despite chemotherapy, the patient died one year after diagnosis, five years after the first symptoms. We describe the clinical, radiological and bio-pathological features of this unique case, and review the literature concerning low-grade ESOS. Our case highlights the diagnostic difficulties for such very rare tumours and the interest of molecular analysis in ambiguous cases.

  8. Rib cage deformities alter respiratory muscle action and chest wall function in patients with severe osteogenesis imperfecta.

    Directory of Open Access Journals (Sweden)

    Antonella LoMauro

    Full Text Available BACKGROUND: Osteogenesis imperfecta (OI is an inherited connective tissue disorder characterized by bone fragility, multiple fractures and significant chest wall deformities. Cardiopulmonary insufficiency is the leading cause of death in these patients. METHODS: Seven patients with severe OI type III, 15 with moderate OI type IV and 26 healthy subjects were studied. In addition to standard spirometry, rib cage geometry, breathing pattern and regional chest wall volume changes at rest in seated and supine position were assessed by opto-electronic plethysmography to investigate if structural modifications of the rib cage in OI have consequences on ventilatory pattern. One-way or two-way analysis of variance was performed to compare the results between the three groups and the two postures. RESULTS: Both OI type III and IV patients showed reduced FVC and FEV(1 compared to predicted values, on condition that updated reference equations are considered. In both positions, ventilation was lower in OI patients than control because of lower tidal volume (p<0.01. In contrast to OI type IV patients, whose chest wall geometry and function was normal, OI type III patients were characterized by reduced (p<0.01 angle at the sternum (pectus carinatum, paradoxical inspiratory inward motion of the pulmonary rib cage, significant thoraco-abdominal asynchronies and rib cage distortions in supine position (p<0.001. CONCLUSIONS: In conclusion, the restrictive respiratory pattern of Osteogenesis Imperfecta is closely related to the severity of the disease and to the sternal deformities. Pectus carinatum characterizes OI type III patients and alters respiratory muscles coordination, leading to chest wall and rib cage distortions and an inefficient ventilator pattern. OI type IV is characterized by lower alterations in the respiratory function. These findings suggest that functional assessment and treatment of OI should be differentiated in these two forms of the

  9. Giant cell tumor of the rib: Two cases of F-18 FDG PET/CT findings

    Energy Technology Data Exchange (ETDEWEB)

    Park, Hye Lim; Yoo, Le Ryung; Lee, Yeong Joo; Jung, Chan Kwon [Seoul St. Mary' s Hospital, College of MedicineThe Catholic University of Korea, Seoul (Korea, Republic of); Park, Sonya Young Ju [Molecular Imaging Program, Dept. of Radiology, Stanford Hospital and Clinics, Stanford (Korea, Republic of)

    2017-06-15

    We report two cases of giant cell tumor arising from the rib and their F-18 FDG PET/CT findings. The two patients complained of chest wall pain, and large lobulated soft tissue masses with intense FDG uptake were seen on F-18 FDG PET/CT. A malignant tumor such as osteosarcoma or chondrosarcoma was suspected due to the large size of the mass, bony destruction, and intense FDG uptake. En bloc resection was performed and final pathologic results revealed giant cell tumor of the rib. Giant cell tumor of the rib is very rare, and larger lesions with high FDG uptake can be misdiagnosed as an intrathoracic malignancy arising from the rib, pleura, or chest wall.

  10. Percutaneous treatment of pulmonary tumors by electrolysis

    Energy Technology Data Exchange (ETDEWEB)

    Samuelsson, L.; Joensson, L.; Stahl, E.

    1983-06-01

    Five lung tumors in four patients were treated with electrolysis. One of the tumors was probably primary, while the others were metastases. Under local anesthesia, two or three platinum electrodes (diameter 3 mm) were introduced through the thoracic wall into the lung tumor using biplane fluoroscopy. The patient was sedated before the procedure and a chest tube was inserted into the pleural cavity. Between anode and cathode a direct current of 80 mA and 10 V was passed during 2-4 h, creating substantial electrolytic destruction mainly through chlorine liberation. Observations at autopsy, surgery, chest X-ray, and CT showed that 60%-80% of the tumor mass was destroyed. No tumor was completely destroyed. The patients stood the procedure well.

  11. Effect of volume-oriented versus flow-oriented incentive spirometry on chest wall volumes, inspiratory muscle activity, and thoracoabdominal synchrony in the elderly.

    Science.gov (United States)

    Lunardi, Adriana C; Porras, Desiderio C; Barbosa, Renata Cc; Paisani, Denise M; Marques da Silva, Cibele C B; Tanaka, Clarice; Carvalho, Celso R F

    2014-03-01

    Aging causes physiological and functional changes that impair pulmonary function. Incentive spirometry is widely used for lung expansion, but the effects of volume-oriented incentive spirometry (VIS) versus flow-oriented incentive spirometry (FIS) on chest wall volumes, inspiratory muscle activity, and thoracoabdominal synchrony in the elderly are poorly understood. We compared VIS and FIS in elderly subjects and healthy adult subjects. Sixteen elderly subjects (9 women, mean ± SD age 70.6 ± 3.9 y, mean ± SD body mass index 23.8 ± 2.5 kg/m(2)) and 16 healthy adults (8 women, mean ± age 25.9 ± 4.3 y, mean ± body mass index 23.6 ± 2.4 kg/m(2)) performed quiet breathing, VIS, and FIS in randomized sequence. Chest wall kinematics (via optoelectronic plethysmography) and inspiratory muscle activity (via surface electromyography) were assessed simultaneously. Synchrony between the superior thorax and abdominal motion was calculated (phase angle). In the elderly subjects both types of incentive spirometry increased chest wall volumes similarly, whereas in the healthy adult subjects VIS increased the chest wall volume more than did FIS. FIS and VIS triggered similar lower thoracoabdominal synchrony in the elderly subjects, whereas in the healthy adults FIS induced lower synchrony than did VIS. FIS required more muscle activity in the elderly subjects to create an increase in chest wall volume. Incentive spirometry performance is influenced by age, and the differences between elderly and healthy adults response should be considered in clinical practice.

  12. Lung and chest wall impedances in the dog: effects of frequency and tidal volume.

    Science.gov (United States)

    Barnas, G M; Stamenović, D; Lutchen, K R; Mackenzie, C F

    1992-01-01

    Dependences of the mechanical properties of the respiratory system on frequency (f) and tidal volume (VT) in the normal ranges of breathing are not clear. We measured, simultaneously and in vivo, resistance and elastance of the total respiratory system (Rrs and Ers), lungs (RL and EL), and chest wall (Rcw and Ecw) of five healthy anesthetized paralyzed dogs during sinusoidal volume oscillations at the trachea (50-300 ml, 0.2-2 Hz) delivered at a constant mean lung volume. Each dog showed the same f and VT dependences. The Ers and Ecw increased with increasing f to 1 Hz and decreased with increasing VT up to 200 ml. Although EL increased slightly with increasing f, it was independent of VT. The Rcw decreased from 0.2 to 2 Hz at all VT and decreased with increasing VT. Although the RL decreased from 0.2 to 0.6 Hz and was independent of VT, at higher f RL tended to increase with increasing f and VT (i.e., as peak flow increased). Finally, the f and VT dependences of Rrs were similar to those of Rcw below 0.6 Hz but mirrored RL at higher f. These data capture the competing influences of airflow nonlinearities vs. tissue nonlinearities on f and VT dependence of the lung, chest wall, and total respiratory system. More specifically, we conclude that 1) VT dependences in Ers and Rrs below 0.6 Hz are due to nonlinearities in chest wall properties, 2) above 0.6 Hz, the flow dependence of airways resistance dominates RL and Rrs, and 3) lung tissue behavior is linear in the normal range of breathing.

  13. Risk factors that predict mortality in patients with blunt chest wall trauma: a systematic review and meta-analysis.

    Science.gov (United States)

    Battle, Ceri E; Hutchings, Hayley; Evans, Phillip A

    2012-01-01

    The risk factors for mortality following blunt chest wall trauma have neither been well established or summarised. To summarise the risk factors for mortality in blunt chest wall trauma patients based on available evidence in the literature. A systematic review of English and non-English articles using MEDLINE, EMBASE and the Cochrane Library from their introduction until May 2010. Additional studies were identified by hand-searching bibliographies and contacting relevant clinical experts. Grey literature was sought by searching abstracts from all Emergency Medicine conferences. Broad search terms and inclusion criteria were used to reduce the number of missed studies. A two step study selection process was used. All published and unpublished observational studies were included if they investigated estimates of association between a risk factor and mortality for blunt chest wall trauma patients. A two step data extraction process using pre-defined data fields, including study quality indicators. Each study was appraised using a previously designed quality assessment tool and the STROBE checklist. Where sufficient data were available, odds ratios with 95% confidence intervals were calculated using Mantel-Haenszel method for the risk factors investigated. The I(2) statistic was calculated for combined studies in order to assess heterogeneity. Age, number of rib fractures, presence of pre-existing disease and pneumonia were found to be related to mortality in 29 identified studies. Combined odds ratio of 1.98 (1.86-2.11, 95% CI), 2.02 (1.89-2.15, 95% CI), 2.43 (1.03-5.72, 95% CI) and 5.24 (3.51-7.82) for mortality were calculated for blunt chest wall trauma patients aged 65 years or more, with three or more rib fractures, pre-existing conditions and pneumonia respectively. The risk factors for mortality in patients sustaining blunt chest wall trauma were a patient age of 65 years or more, three or more rib fractures and the presence of pre-existing disease especially

  14. Postmastectomy Electron Beam Chest Wall Irradiation in Women With Breast Cancer: A Clinical Step Toward Conformal Electron Therapy

    International Nuclear Information System (INIS)

    Kirova, Youlia M.; Campana, Francois; Fournier-Bidoz, Nathalie; Stilhart, Anne; Dendale, Remi; Bollet, Marc A.; Fourquet, Alain

    2007-01-01

    Purpose: Electron beam radiotherapy of the chest wall with or without lymph node irradiation has been used at the Institut Curie for >20 years. The purpose of this report was to show the latest improvements of our technique developed to avoid hot spots and improve the homogeneity. Methods and Materials: The study was split into two parts. A new electron irradiation technique was designed and compared with the standard one (dosimetric study). The dose distributions were calculated using our treatment planning software ISIS (Technologie Diffusion). The dose calculation was performed using the same calculation parameters for the new and standard techniques. Next, the early skin toxicity of our new technique was evaluated prospectively in the first 25 patients using Radiation Therapy Oncology Group criteria (clinical study). Results: The maximal dose found on the five slices was 53.4 ± 1.1 Gy for the new technique and 59.1 ± 2.3 Gy for the standard technique. The hot spots of the standard technique plans were situated at the overlap between the internal mammary chain and chest wall fields. The use of one unique field that included both chest wall and internal mammary chain volumes solved the problem of junction. To date, 25 patients have been treated with the new technique. Of these patients, 12% developed Grade 0, 48% Grade 1, 32% Grade 2, and 8% Grade 3 toxicity. Conclusions: This report describes an improvement in the standard postmastectomy electron beam technique of the chest wall. This new technique provides improved target homogeneity and conformality compared with the standard technique. This treatment was well tolerated, with a low rate of early toxicity events

  15. Thermal characteristics of thermobrachytherapy surface applicators for treating chest wall recurrence

    International Nuclear Information System (INIS)

    Arunachalam, K; Maccarini, P F; Craciunescu, O I; Stauffer, P R; Schlorff, J L

    2010-01-01

    The aim of this study was to investigate temperature and thermal dose distributions of thermobrachytherapy surface applicators (TBSAs) developed for concurrent or sequential high dose rate (HDR) brachytherapy and microwave hyperthermia treatment of chest wall recurrence and other superficial diseases. A steady-state thermodynamics model coupled with the fluid dynamics of a water bolus and electromagnetic radiation of the hyperthermia applicator is used to characterize the temperature distributions achievable with TBSAs in an elliptical phantom model of the human torso. Power deposited by 915 MHz conformal microwave array (CMA) applicators is used to assess the specific absorption rate (SAR) distributions of rectangular (500 cm 2 ) and L-shaped (875 cm 2 ) TBSAs. The SAR distribution in tissue and fluid flow distribution inside the dual-input dual-output (DIDO) water bolus are coupled to solve the steady-state temperature and thermal dose distributions of the rectangular TBSA (R-TBSA) for superficial tumor targets extending 10-15 mm beneath the skin surface. Thermal simulations are carried out for a range of bolus inlet temperature (T b = 38-43 deg. C), water flow rate (Q b = 2-4 L min -1 ) and tumor blood perfusion (ω b = 2-5 kg m -3 s -1 ) to characterize their influence on thermal dosimetry. Steady-state SAR patterns of the R- and L-TBSA demonstrate the ability to produce conformal and localized power deposition inside the tumor target sparing surrounding normal tissues and nearby critical organs. Acceptably low variation in tissue surface cooling and surface temperature homogeneity was observed for the new DIDO bolus at a 2 L min -1 water flow rate. Temperature depth profiles and thermal dose volume histograms indicate bolus inlet temperature (T b ) to be the most influential factor on thermal dosimetry. A 42 deg. C water bolus was observed to be the optimal choice for superficial tumors extending 10-15 mm from the surface even under significant blood perfusion

  16. MRI of the Chest

    Medline Plus

    Full Text Available ... gives detailed pictures of structures within the chest cavity, including the mediastinum , chest wall, pleura, heart and ... helpful to assess the vessels of the chest cavity (arteries and veins). MRA can also demonstrate an ...

  17. MRI of the Chest

    Medline Plus

    Full Text Available ... to produce detailed pictures of organs, soft tissues, bone and virtually all other internal body structures. MRI ... of the chest. assess disorders of the chest bones (vertebrae, ribs and sternum) and chest wall soft ...

  18. Effects of non-invasive ventilation and posture on chest wall volumes and motion in patients with amyotrophic lateral sclerosis: a case series.

    Science.gov (United States)

    Magalhães, Cristiana M; Fregonezi, Guilherme A; Vidigal-Lopes, Mauro; Vieira, Bruna S P P; Vieira, Danielle S R; Parreira, Verônica F

    2016-01-01

    The effects of non-invasive ventilation (NIV) on the breathing pattern and thoracoabdominal motion of patients with amyotrophic lateral sclerosis (ALS) are unknown. 1) To analyze the influence of NIV on chest wall volumes and motion assessed by optoelectronic plethysmography in ALS patients and 2) to compare these parameters in the supine and sitting positions to those of healthy individuals (without NIV). Nine ALS patients were evaluated in the supine position using NIV. In addition, the ALS patients and nine healthy individuals were evaluated in both sitting and supine positions. Statistical analysis was performed using the paired Student t-test or Wilcoxon test and the Student t-test for independent samples or Mann-Whitney U test. Chest wall volume increased significantly with NIV, mean volume=0.43 (SD=0.16)L versus 0.57 (SD=0.19)L (p=0.04). No significant changes were observed for the pulmonary rib cage, abdominal rib cage, or abdominal contribution. The index of the shortening velocity of the diaphragmatic muscle, mean=0.15 (SD=0.05)L/s versus 0.21 (SD=0.05)L/s (pNIV. Comparisons between the supine and sitting positions showed similar changes in chest wall motion in both groups. However, the ALS patients presented a significantly lower contribution of the abdomen in the supine position compared with the controls, mean=56 (SD=13) versus 69 (SD=10) (p=0.02). NIV improved chest wall volumes without changing the contribution of the chest wall compartment in ALS patients. In the supine position, ALS patients had a lower contribution of the abdomen, which may indicate early diaphragmatic dysfunction.

  19. Extrapleural Inner Thoracic Wall Lesions: Multidetector CT Findings

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Seung Soo; Kim, Young Tong; Jou, Sung Shik [Soonchunhyang University, Cheonan Hospital, Cheonan (Korea, Republic of)

    2010-06-15

    The extrapleural space is external to the parietal pleura in the thorax. The structures within and adjacent to this region include the fat pad, endothoracic fascia, intercostal muscles, connective tissue, nerves, vessels, and ribs. Further, the space is divided into the inner and outer thoracic wall by the innermost intercostal muscle. Extrapleural lesions in the inner thoracic wall are classified as air-containing lesions, fat-containing lesions, and soft tissue-containing lesions according on their main component. Air-containing lesions include extrapleural air from direct chest trauma and extrapleural extension from pneumomediastinum. Prominent extrapleural fat is seen in decreased lung volume conditions, and can also be seen in normal individuals. Soft tissue-containing lesions include extrapleural extensions from a pleural or chest wall infection as well as tumors and extrapleural hematoma. We classify extrapleural lesions in the inner thoracic wall and illustrate their imaging findings

  20. Biphasic Malignant Pleural Mesothelioma Masquerading as a Primary Skeletal Tumor

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    James Benjamin Gleason

    2016-01-01

    Full Text Available Biphasic malignant pleural mesothelioma is a rare malignant tumor, usually presenting as a pleural-based mass in a patient with history of chronic asbestos exposure. We herein report a case of a 41-year-old man who presented with chest pain and had a chest computed tomography (CT scan suggestive of a primary skeletal tumor originating from the ribs (chondrosarcoma or osteosarcoma, with no history of asbestos exposure. CT-guided core needle biopsies were diagnosed as malignant sarcomatoid mesothelioma. Surgical resection and chest wall reconstruction were performed, confirming the diagnosis and revealing a secondary histologic component (epithelioid, supporting the diagnosis of biphasic malignant mesothelioma.

  1. Chest X-Ray

    Medline Plus

    Full Text Available ... and chest wall and may be used to help evaluate shortness of breath, persistent cough, fever, chest ... or injury. It may also be useful to help diagnose and monitor treatment for a variety of ...

  2. Extrinsic tracheal compression caused by scoliosis of the thoracic spine and chest wall degormity: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Baek, Kyong min Sarah; Lee, Bae Young; Kim, Hyeon Sook; Song, Kyung Sup; Kang, Hyeon Hul; Lee, Sang Haak; Moon, Hwa Sik [St. Paul' s Hospital, College of Medicine, The Catholic University of Korea, Seoul (Korea, Republic of)

    2014-05-15

    Extrinsic airway compression due to chest wall deformity is not commonly observed. Although this condition can be diagnosed more easily with the help of multidetector CT, the standard treatment method has not yet been definitely established. We report a case of an eighteen-year-old male who suffered from severe extrinsic tracheal compression due to scoliosis and straightening of the thoracic spine, confirmed on CT and bronchoscopy. The patient underwent successful placement of tracheal stent but later died of bleeding from the tracheostomy site probably due to tracheo-brachiocephalic artery fistula. We describe the CT and bronchoscopic findings of extrinsic airway compression due to chest wall deformity as well as the optimal treatment method, and discuss the possible explanation for bleeding in the patient along with review of the literature.

  3. Extrinsic tracheal compression caused by scoliosis of the thoracic spine and chest wall degormity: A case report

    International Nuclear Information System (INIS)

    Baek, Kyong min Sarah; Lee, Bae Young; Kim, Hyeon Sook; Song, Kyung Sup; Kang, Hyeon Hul; Lee, Sang Haak; Moon, Hwa Sik

    2014-01-01

    Extrinsic airway compression due to chest wall deformity is not commonly observed. Although this condition can be diagnosed more easily with the help of multidetector CT, the standard treatment method has not yet been definitely established. We report a case of an eighteen-year-old male who suffered from severe extrinsic tracheal compression due to scoliosis and straightening of the thoracic spine, confirmed on CT and bronchoscopy. The patient underwent successful placement of tracheal stent but later died of bleeding from the tracheostomy site probably due to tracheo-brachiocephalic artery fistula. We describe the CT and bronchoscopic findings of extrinsic airway compression due to chest wall deformity as well as the optimal treatment method, and discuss the possible explanation for bleeding in the patient along with review of the literature.

  4. Effects of non-invasive ventilation and posture on chest wall volumes and motion in patients with amyotrophic lateral sclerosis: a case series

    Directory of Open Access Journals (Sweden)

    Cristiana M. Magalhães

    2016-01-01

    Full Text Available ABSTRACT Background The effects of non-invasive ventilation (NIV on the breathing pattern and thoracoabdominal motion of patients with amyotrophic lateral sclerosis (ALS are unknown. Objectives 1 To analyze the influence of NIV on chest wall volumes and motion assessed by optoelectronic plethysmography in ALS patients and 2 to compare these parameters in the supine and sitting positions to those of healthy individuals (without NIV. Method Nine ALS patients were evaluated in the supine position using NIV. In addition, the ALS patients and nine healthy individuals were evaluated in both sitting and supine positions. Statistical analysis was performed using the paired Student t-test or Wilcoxon test and the Student t-test for independent samples or Mann-Whitney U test. Results Chest wall volume increased significantly with NIV, mean volume=0.43 (SD=0.16L versus 0.57 (SD=0.19L (p=0.04. No significant changes were observed for the pulmonary rib cage, abdominal rib cage, or abdominal contribution. The index of the shortening velocity of the diaphragmatic muscle, mean=0.15 (SD=0.05L/s versus 0.21 (SD=0.05L/s (p<0.01, and abdominal muscles, mean=0.09 (SD=0.02L/s versus 0.14 (SD=0.06L/s (p<0.01, increased during NIV. Comparisons between the supine and sitting positions showed similar changes in chest wall motion in both groups. However, the ALS patients presented a significantly lower contribution of the abdomen in the supine position compared with the controls, mean=56 (SD=13 versus 69 (SD=10 (p=0.02. Conclusions NIV improved chest wall volumes without changing the contribution of the chest wall compartment in ALS patients. In the supine position, ALS patients had a lower contribution of the abdomen, which may indicate early diaphragmatic dysfunction.

  5. Characteristics Of Congenital Chest Wall Deformities In Referred Patients To Tehran Imam Khomeini And Kashan Shahid Beheshti Hospital During 1991-2001

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    Davoodabadi A

    2004-08-01

    Full Text Available Background: Infants and children present with a wide range of congenital chest wall deformities which have both physiologic psychologic consequences and are often associated with other abnormalities. Surgical intervention offers excellent cosmetic results with minimal morbidity and mortality. In order to investigation of chest wall deformities, and surgical results, this study was performed. Materials and Methods: A descriptive study on existing data on 60 consecutive patients with chest wall deformity during 10 years carried out. Patient's characteristics such as age, gender, signs and symptoms type of operation, associated disorder, syndrome, and surgical complications were considered. Results: Pectus excavatum 60% and pectus carinatum 30% Poland syn 6.7% 9 sternal cleft 3.2. Inpectus, M/F: Was 3/1 and others were 1:1. Age of admission 4 to 27 years 13.4±6.82 and association syndromes were, turner, Morgue and marfan, most patients were operated in delayed time (75 and hence, scoliosis was common than others. Conclusion: Pectus excavatum was the most common deformity and if scoliosis was prominent and most operation was done in old age but surgical result was excellent no anyone expired and complication was a little. So we recommended that all of the chest deformities must be operated in anytime.

  6. Acute effects of volume-oriented incentive spirometry on chest wall volumes in patients after a stroke.

    Science.gov (United States)

    Lima, Illia Ndf; Fregonezi, Guilherme Af; Melo, Rodrigo; Cabral, Elis Ea; Aliverti, Andrea; Campos, Tânia F; Ferreira, Gardênia Mh

    2014-07-01

    The aim of the present study was to assess how volume-oriented incentive spirometry applied to patients after a stroke modifies the total and compartmental chest wall volume variations, including both the right and left hemithoraces, compared with controls. Twenty poststroke patients and 20 age-matched healthy subjects were studied by optoelectronic plethysmography during spontaneous quiet breathing (QB), during incentive spirometry, and during the recovery period after incentive spirometry. Incentive spirometry was associated with an increased chest wall volume measured at the pulmonary rib cage, abdominal rib cage and abdominal compartment (P = .001) and under 3 conditions (P spirometry, and postincentive spirometry, respectively. Under all 3 conditions, the contribution of the abdominal compartment to VT was greater in the stroke subjects (54.1, 43.2, and 48.9%) than in the control subjects (43.7, 40.8, and 46.1%, P = .039). In the vast majority of subjects (13/20 and 18/20 during QB and incentive spirometry, respectively), abdominal expansion precedes rib cage expansion during inspiration. Greater asymmetry between the right and left hemithoracic expansions occurred in stroke subjects compared with control subjects, but it decreased during QB (62.5%, P = .002), during incentive spirometry (19.7%), and postincentive spirometry (67.6%, P = .14). Incentive spirometry promotes increased expansion in all compartments of the chest wall and reduces asymmetric expansion between the right and left parts of the pulmonary rib cage; therefore, it should be considered as a tool for rehabilitation. Copyright © 2014 by Daedalus Enterprises.

  7. Influence of MR imaging in radiation therapy of chest lymphoma

    International Nuclear Information System (INIS)

    Carlsen, S.E.; Hoppe, R.; Bergin, C.J.

    1991-01-01

    This paper evaluates the influence of MR detection of additional sites of chest lymphoma on radiation therapy. Chest MR images and CT scans of 56 patients with new or recurrent mediastinal lymphoma obtained within 1 month of each other were retrospectively reviewed. MR images included T1- and T2-weighted SE and STIR sequences. Images were assessed for pleural and extrapleural disease. Radiation portals of patients with pleural or chest wall disease were reevaluated and compared with portals originally designed with CT. MR imaging demonstrated chest wall disease in 15 patients (21 sites). Ten patients also had pleural disease (13 sites). CT identified chest wall disease in four of these patients (five sites) and pleural disease in three patients (five sites). Seven of the 15 patients with chest wall disease were treated with radiation therapy alone. Two of the seven patients had significant modification of radiation portals based on MR findings. Retrospectively, therapy would have been altered in an additional two patients in whom pleural disease was identified at MR. The increased sensitivity of MR in detecting chest wall or pleural disease has important implications for treatment planning in chest wall lymphoma

  8. Inhibitory effect of cervical trachea and chest wall vibrations on cough reflex sensitivity and perception of urge-to-cough in healthy male never-smokers

    OpenAIRE

    Kashiwazaki, Naohiro; Ebihara, Satoru; Gui, Peijun; Katayama, Norihiro; Ito, Kumiko; Sato, Ryuhei; Oyama, Chika; Ebihara, Takae; Kohzuki, Masahiro

    2013-01-01

    Background Non-pharmacological options for symptomatic management of cough are desired. Although chest wall mechanical vibration is known to ameliorate cough reflex sensitivity, the effect of mechanical vibrations on perceptions of urge-to-cough has not been studied. Therefore, we investigated the effect of mechanical vibration of cervical trachea, chest wall and femoral muscle on cough reflex sensitivity, perceptions of urge-to-cough as well as dyspnea. Methods Twenty-four healthy male never...

  9. MRI of the Chest

    Medline Plus

    Full Text Available ... to assess the anatomy and function of the heart and its blood flow. Tell your doctor about ... chest cavity, including the mediastinum , chest wall, pleura, heart and vessels, from almost any angle. MRI also ...

  10. Decreased Lung Perfusion After Breast/Chest Wall Irradiation: Quantitative Results From a Prospective Clinical Trial

    Energy Technology Data Exchange (ETDEWEB)

    Liss, Adam L., E-mail: adamliss68@gmail.com [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States); Marsh, Robin B. [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States); Kapadia, Nirav S. [Department of Radiation Oncology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire (United States); McShan, Daniel L. [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States); Rogers, Virginia E. [Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, Michigan (United States); Balter, James M.; Moran, Jean M.; Brock, Kristy K.; Schipper, Matt J.; Jagsi, Reshma [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States); Griffith, Kent A. [Biostatistics Unit, University of Michigan, Ann Arbor, Michigan (United States); Flaherty, Kevin R. [Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan (United States); Frey, Kirk A. [Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, Michigan (United States); Pierce, Lori J. [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States)

    2017-02-01

    Purpose: To quantify lung perfusion changes after breast/chest wall radiation therapy (RT) using pre- and post-RT single photon emission computed tomography/computed tomography (SPECT/CT) attenuation-corrected perfusion scans; and correlate decreased perfusion with adjuvant RT dose for breast cancer in a prospective clinical trial. Methods and Materials: As part of an institutional review board–approved trial studying the impact of RT technique on lung function in node-positive breast cancer, patients received breast/chest wall and regional nodal irradiation including superior internal mammary node RT to 50 to 52.2 Gy with a boost to the tumor bed/mastectomy scar. All patients underwent quantitative SPECT/CT lung perfusion scanning before RT and 1 year after RT. The SPECT/CT scans were co-registered, and the ratio of decreased perfusion after RT relative to the pre-RT perfusion scan was calculated to allow for direct comparison of SPECT/CT perfusion changes with delivered RT dose. The average ratio of decreased perfusion was calculated in 10-Gy dose increments from 0 to 60 Gy. Results: Fifty patients had complete lung SPECT/CT perfusion data available. No patient developed symptoms consistent with pulmonary toxicity. Nearly all patients demonstrated decreased perfusion in the left lung according to voxel-based analyses. The average ratio of lung perfusion deficits increased for each 10-Gy increment in radiation dose to the lung, with the largest changes in regions of lung that received 50 to 60 Gy (ratio 0.72 [95% confidence interval 0.64-0.79], P<.001) compared with the 0- to 10-Gy region. For each increase in 10 Gy to the left lung, the lung perfusion ratio decreased by 0.06 (P<.001). Conclusions: In the assessment of 50 patients with node-positive breast cancer treated with RT in a prospective clinical trial, decreased lung perfusion by SPECT/CT was demonstrated. Our study allowed for quantification of lung perfusion defects in a prospective cohort of

  11. Chest wall reconstruction in a canine model using polydioxanone mesh, demineralized bone matrix and bone marrow stromal cells.

    Science.gov (United States)

    Tang, Hua; Xu, Zhifei; Qin, Xiong; Wu, Bin; Wu, Lihui; Zhao, XueWei; Li, Yulin

    2009-07-01

    Extensive chest wall defect reconstruction remains a challenging problem for surgeons. In the past several years, little progress has been made in this area. In this study, a biodegradable polydioxanone (PDO) mesh and demineralized bone matrix (DBM) seeded with osteogenically induced bone marrow stromal cells (BMSCs) were used to reconstruct a 6 cm x 5.5 cm chest wall defect. Four experimental groups were evaluated (n=6 per group): polydioxanone (PDO) mesh/DBMs/BMSCs group, polydioxanone (PDO) mesh/DBMs group, polydioxanone (PDO) mesh group, and a blank group (no materials) in a canine model. All the animals survived except those in the blank group. In all groups receiving biomaterial implants, the polydioxanone (PDO) mesh completely degraded at 24 weeks and was replaced by fibrous tissue with thickness close to that of the normal intercostal tissue (P>0.05). In the polydioxanone (PDO) mesh/DBMs/BMSCs group, new bone formation and bone-union were observed by radiographic and histological examination. More importantly, the reconstructed rib could maintain its original radian and achieve satisfactory biomechanics close to normal ribs in terms of bending stress (P>0.05). However, in the other two groups, fibrous tissue was observed in the defect and junctions, and the reconstructed ribs were easily distorted under an outer force. Based on these results, a surgical approach utilizing biodegradable polydioxanone (PDO) mesh in combination with DBMs and BMSCs could repair the chest wall defect not only in function but also in structure.

  12. Preoperative embolization of a giant neurofibroma of the chest in a patient with neurofibromatosis type II: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Bae, Suk Hyun [Dept. of Radiology, Inje University College of Medicine, Ilsan Paik Hospital, Goyang (Korea, Republic of); Shin, Jong Soo [Dept. of Radiology, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul (Korea, Republic of)

    2017-01-15

    Giant plexiform neurofibromas, which are rare in patients with neurofibromatosis type II (NFII), are difficult to manage surgically, as they are extensively infiltrative and highly vascularized. Preoperative embolization is performed to reduce intraoperative blood loss and operative time, increase resectability of lesions, and improve visualization of the operative field during surgery of hypervascular tumors such as renal cell carcinoma and intracranial meningioma. Preoperative intravascular embolization of a giant chest wall neurofibroma has not been reported in the English literature. We report successful treatment of a giant chest wall neurofibroma in a 45-year-old male with NFII by preoperative intravascular embolization followed by surgical resection.

  13. Simultaneous measurement of instantaneous heart rate and chest wall plethysmography in short-term, metronome guided heart rate variability studies: suitability for assessment of autonomic dysfunction.

    Science.gov (United States)

    Perring, S; Jones, E

    2003-08-01

    Instantaneous heart rate and chest wall motion were measured using a 3-lead ECG and an air pressure chest wall plethysmography system. Chest wall plethysmography traces were found to accurately represent the breathing pattern as measured by spirometry (average correlation coefficient 0.944); though no attempt was made to calibrate plethysmography voltage output to tidal volume. Simultaneous measurements of heart rate and chest wall motion were made for short periods under metronome guided breathing at 6 breaths per minute. The average peak to trough heart rate change per breath cycle (AVEMAX) and maximum correlation between heart rate and breathing cycle (HRBRCORR) were measured. Studies of 44 normal volunteers indicated clear inverse correlation of heart rate variability parameters with age (AVEMAX R = -0.502, P < 0.001) but no significant change in HRBRCORR with age (R = -0.115). Comparison of normal volunteers with diabetics with no history of symptoms associated with autonomic failure indicated significant lower heart rate variability in diabetics (P = 0.005 for AVEMAX) and significantly worse correlation between heart rate and breathing (P < 0.001 for HRBRCORR). Simultaneous measurement of heart rate and breathing offers the possibility of more sensitive diagnosis of autonomic failure in a simple bedside test and gives further insight into the nature of cardio-ventilatory coupling.

  14. A case of parachordoma on the chest wall and literature review

    Directory of Open Access Journals (Sweden)

    Jie Zhang

    2013-01-01

    Full Text Available Parachordoma is an extremely uncommon soft-tissue tumor, which mainly occurs in the deep soft-tissue of the distal parts of the limbs, such as deep fascia, muscle tendon, synovial or soft-tissue closed to the bone. Nevertheless, the literature reports about parachordoma on the thoracic wall were scarce. The clinical and imaging manifestation has a non-specific appearance. In this article, we reported one case of parachordoma of the thoracic wall that we met in clinical works and reviewed the literature.

  15. Evaluating proton stereotactic body radiotherapy to reduce chest wall dose in the treatment of lung cancer

    International Nuclear Information System (INIS)

    Welsh, James; Amini, Arya; Ciura, Katherine; Nguyen, Ngoc; Palmer, Matt; Soh, Hendrick; Allen, Pamela K.; Paolini, Michael; Liao, Zhongxing; Bluett, Jaques; Mohan, Radhe; Gomez, Daniel; Cox, James D.; Komaki, Ritsuko; Chang, Joe Y.

    2013-01-01

    Stereotactic body radiotherapy (SBRT) can produce excellent local control of several types of solid tumor; however, toxicity to nearby critical structures is a concern. We found previously that in SBRT for lung cancer, the chest wall (CW) volume receiving 20, 30, or 40 Gy (V 20 , V 30 , or V 40 ) was linked with the development of neuropathy. Here we sought to determine whether the dosimetric advantages of protons could produce lower CW doses than traditional photon-based SBRT. We searched an institutional database to identify patients treated with photon SBRT for lung cancer with tumors within 20 was 364.0 cm 3 and 160.0 cm 3 (p 30 was 144.6 cm 3 vs 77.0 cm 3 (p = 0.0012), V 35 was 93.9 cm 3 vs 57.9 cm 3 (p = 0.005), V 40 was 66.5 cm 3 vs 45.4 cm 3 (p = 0.0112), and mean lung dose was 5.9 Gy vs 3.8 Gy (p = 0.0001) for photons and protons, respectively. Coverage of the planning target volume (PTV) was comparable between the 2 sets of plans (96.4% for photons and 97% for protons). From a dosimetric standpoint, proton SBRT can achieve the same coverage of the PTV while significantly reducing the dose to the CW and lung relative to photon SBRT and therefore may be beneficial for the treatment of lesions closer to critical structures

  16. Necrotizing fasciitis involving the chest and abdominal wall caused by Raoultella planticola

    Directory of Open Access Journals (Sweden)

    Kim Si-Hyun

    2012-03-01

    Full Text Available Abstract Background Raoultella planticola was originally considered to be a member of environmental Klebsiella. The clinical significance of R. planticola is still not well known. Case presentation We describe the first case of necrotizing fasciitis involving the chest and abdominal wall caused by R. planticola. The identity of the organism was confirmed using 16S rRNA sequencing. The patient was successfully treated with the appropriate antibiotics combined with operative drainage and debridement. Conclusions R. planticola had been described as environmental species, but should be suspected in extensive necrotizing fasciitis after minor trauma in mild to moderate immunocompromised patients.

  17. A case of radiation ulcer of chest wall with osteomyelitis

    International Nuclear Information System (INIS)

    Baba, Kyoko; Shibata, Hirotatsu; Mouri, Mari; Uchinuma, Eiju

    2005-01-01

    We report a case of anterior chest skin ulcer with rib and sternum osteomyelitis following radiation therapy for post operative mammary carcinoma. Operation was performed six times including debridement with sternum and rib resection reconstruction and skin grafting. It took about one and a half years after first operation to heal the ulcer with osteomyelitis. Principle of treatment for radiation ulcer accompanied by osteomyelitis is complete resection of the damaged lesion. However, it is difficult to evaluate the exact area of the damaged lesion. Therefore it is not rare to repeat its recurrence and have trouble with its treatment. In this case, it was considered that the resected area was insufficient on the initial operation. In order to treat for radiation ulcers accompanied by osteomyelitis, enough resection of the damaged lesion in the initial operation is necessary. Ultimately, in our case, the resection of all sternum, part of the right second to fifth rib and part of left second to seventh rib was necessary. It is generally said that reconstructing bone structure is required in the case of wide defect of chest wall. Though, we did not perform reconstruction of the bone structures, there is no problem in the condition of respiratory system. The surrounding soft tissues changed to hard enough to avoid paradoxical breathing. (author)

  18. Sci-Fri PM: Radiation Therapy, Planning, Imaging, and Special Techniques - 11: Quantification of chest wall motion during deep inspiration breast hold treatments using cine EPID images and a physics based algorithm

    Energy Technology Data Exchange (ETDEWEB)

    Alpuche Aviles, Jorge E.; VanBeek, Timothy [CancerCare Manitoba, Winnipeg (Canada); Sasaki, David; Rivest, Ryan; Akra, Mohamed [CancerCare Manitoba, Winnipeg (Canada); University of Manitoba, Winnipeg (Canada)

    2016-08-15

    Purpose: This work presents an algorithm used to quantify intra-fraction motion for patients treated using deep inspiration breath hold (DIBH). The algorithm quantifies the position of the chest wall in breast tangent fields using electronic portal images. Methods: The algorithm assumes that image profiles, taken along a direction perpendicular to the medial border of the field, follow a monotonically and smooth decreasing function. This assumption is invalid in the presence of lung and can be used to calculate chest wall position. The algorithm was validated by determining the position of the chest wall for varying field edge positions in portal images of a thoracic phantom. The algorithm was used to quantify intra-fraction motion in cine images for 7 patients treated with DIBH. Results: Phantom results show that changes in the distance between chest wall and field edge were accurate within 0.1 mm on average. For a fixed field edge, the algorithm calculates the position of the chest wall with a 0.2 mm standard deviation. Intra-fraction motion for DIBH patients was within 1 mm 91.4% of the time and within 1.5 mm 97.9% of the time. The maximum intra-fraction motion was 3.0 mm. Conclusions: A physics based algorithm was developed and can be used to quantify the position of chest wall irradiated in tangent portal images with an accuracy of 0.1 mm and precision of 0.6 mm. Intra-fraction motion for patients treated with DIBH at our clinic is less than 3 mm.

  19. Chest wall resection for local recurrence of breast cancer. Presented at the 99th Meeting of the Royal Belgium Society of Obstetrics and Gynecology, Brussels May 9th 1998, Belgium.

    Science.gov (United States)

    Tjalma, W; Van Schil, P; Verbist, A M; Buytaert, P; van Dam, P

    1999-05-01

    We present three cases of chest wall resection for locally recurrent breast cancer and a Medline review of the current literature. In selected cases full thickness resection of the chest wall may be used as a salvage procedure to improve the quality of life and prolong the survival at low morbidity and mortality.

  20. Elastofibroma dorsi – differential diagnosis in chest wall tumours

    Directory of Open Access Journals (Sweden)

    Steinau Hans-Ulrich

    2007-02-01

    Full Text Available Abstract Background Elastofibromas are benign soft tissue tumours mostly of the infrascapular region between the thoracic wall, the serratus anterior and the latissimus dorsi muscle with a prevalence of up to 24% in the elderly. The pathogenesis of the lesion is still unclear, but repetitive microtrauma by friction between the scapula and the thoracic wall may cause the reactive hyperproliferation of fibroelastic tissue. Methods We present a series of seven cases with elastofibroma dorsi with reference to clinical findings, further clinical course and functional results after resection, as well as recurrence. Data were obtained retrospectively by clinical examination, phone calls to the patients' general practitioners and charts review. Follow-up time ranged from four months to nine years and averaged 53 months. Results The patients presented with swelling of the infrascapular region or snapping scapula. In three cases, the lesion was painful. The ratio men/women was 2/5 with a mean age of 64 years. The tumor sizes ranged from 3 to 13 cm. The typical macroscopic aspect was characterized as poorly defined fibroelastic soft tissue lesion with a white and yellow cut surface caused by intermingled remnants of fatty tissue. Microscopically, the lesions consisted of broad collagenous strands and densely packed enlarged and fragmented elastic fibres with mostly round shapes. In all patients but one, postoperative seroma (which had to be punctuated occurred after resection; however, at follow-up time, no patient reported any decrease of function or sensation at the shoulder or the arm of the operated side. None of the patients experienced a relapse. Conclusion In differential diagnosis of soft tissue tumors located at this specific site, elastofibroma should be considered as likely diagnosis. Due to its benign behaviour, the tumor should be resected only in symptomatic patients.

  1. Rib fixation for severe chest deformity due to multiple rib fractures.

    Science.gov (United States)

    Igai, Hitoshi; Kamiyoshihara, Mitsuhiro; Nagashima, Toshiteru; Ohtaki, Yoichi

    2012-01-01

    The operative indications for rib fracture repair have been a matter of debate. However, several reports have suggested that flail chest, pain on respiration, and chest deformity/defect are potential conditions for rib fracture repair. We describe our experience of rib fixation in a patient with severe chest deformity due to multiple rib fractures. A 70-year-old woman was admitted with right-sided multiple rib fractures (2nd to 7th) and marked chest wall deformity without flailing caused by an automobile accident. Collapse of the chest wall was observed along the middle anterior axillary line. At 11 days after the injury, surgery was performed to repair the chest deformity, as it was considered to pose a risk of restrictive impairment of pulmonary function or chronic intercostal pain in the future. Operative findings revealed marked displacement of the superior 4 ribs, from the 2nd to the 5th, and collapse of the osseous chest wall towards the thoracic cavity. After exposure of the fracture regions, ribs fixations were performed using rib staplers. The total operation time was 90 minutes, and the collapsed portion of the chest wall along the middle anterior axillary line was reconstructed successfully.

  2. Advanced sclerosis of the chest wall skin secondary to chronic graft-versus-host disease: a case with severe restrictive lung defect.

    Science.gov (United States)

    Ödek, Çağlar; Kendirli, Tanil; İleri, Talia; Yaman, Ayhan; Fatih Çakmakli, Hasan; Ince, Elif; İnce, Erdal; Ertem, Mehmet

    2014-10-01

    Pulmonary chronic graft-versus-host disease (cGvHD) is one of the most common causes of morbidity and mortality after allogeneic hematopoietic stem cell transplantation (aHSCT). Herein, we describe a patient with severe restrictive lung defect secondary to cGvHD. A 21-year-old male patient was admitted to our pediatric intensive care unit (PICU) with pneumonia and respiratory distress. He had a history of aHSCT for chronic myelogeneous leukemia at the age of 17 years. Six months after undergoing aHSCT, he had developed cGvHD involving skin, mouth, eye, lung, liver, and gastrointestinal tract. At the time of PICU admission he had respiratory distress and required ventilation support. Thorax high-resolution computed tomography was consistent with bronchiolitis obliterans. Although bronchiolitis obliterans is an obstructive lung defect, a restrictive pattern became prominent in the clinical course because of the sclerotic chest wall skin. The activity of cGvHD kept increasing despite the therapy and we lost the patient because of severe respiratory distress and massive hemoptysis secondary to bronchiectasis. In conclusion, pulmonary cGvHD can present with restrictive changes related with the advanced sclerosis of the chest wall skin. Performing a fasciotomy or a scar revision for the rigid chest wall in selected patients may improve the patients ventilation.

  3. Radiation Treatment for Malignant Small Cell Tumor of the Thoracopulmonary Region Primitive Pluripotent Histogenesis and Differential Diagnosis-A Case Report and Review of Literatures-

    International Nuclear Information System (INIS)

    Oh, Won Young; Yang, Jin Yeong; Whang, In Soon

    1991-01-01

    Malignant small round cell tumor (SRCT) of the thoracopulmonary region appears to originate in the soft tissues of the chest wall or the peripheral lung. A differential diagnosis of poorly differentiated small round cell tumors which include Ewing's sarcoma of bone and soft tissue, embryonal rhabdomyosarcoma, Askin tumor, neuroblastoma, peripheral neuroectodermal tumor, small cell osteogenic sarcoma and lymphoma are after difficult by light microscopy alone. In recent, by the extensive studies electron microscopic examination, histochemical study, immunochemical study, cytogenetics and gene analysis, these tumors may be derived from the primitive and pluripotential cells, differentiating into mesenchymal, epithelial and neural features in variable proportions. Treatment for SRCT of thoracopulmonary regin is not determined because of massive involvement of the lung, pleura or soft tissues of the chest wall resulted in a dismal outcome despite aggressive surgery, irradiation and chemotherapy

  4. Anteroposterior chest radiograph vs. chest CT scan in early detection of pneumothorax in trauma patients

    OpenAIRE

    Omar, Hesham R; Mangar, Devanand; Khetarpal, Suneel; Shapiro, David H; Kolla, Jaya; Rashad, Rania; Helal, Engy; Camporesi, Enrico M

    2011-01-01

    Abstract Pneumothorax is a common complication following blunt chest wall trauma. In these patients, because of the restrictions regarding immobilization of the cervical spine, Anteroposterior (AP) chest radiograph is usually the most feasible initial study which is not as sensitive as the erect chest X-ray or CT chest for detection of a pneumothorax. We will present 3 case reports which serve for better understanding of the entity of occult pneumothorax. The first case is an example of a tru...

  5. Evaluation of acute cardiac and chest wall damage after shocks with a subcutaneous implantable cardioverter-defibrillator in swine

    Science.gov (United States)

    KILLINGSWORTH, CHERYL R.; MELNICK, SHARON B.; LITOVSKY, SILVIO H.; IDEKER, RAYMOND E.; WALCOTT, GREGORY P.

    2013-01-01

    Background A subcutaneous implantable cardioverter defibrillator (S-ICD) could ease placement and reduce complications of transvenous ICDs, but requires more energy than transvenous ICDs. Therefore we assessed cardiac and chest wall damage caused by the maximum energy shocks delivered by both types of clinical devices. Methods During sinus rhythm, anesthetized pigs (38±6 kg) received an S-ICD (n = 4) and five 80-Joule (J) shocks, or a transvenous ICD (control, n = 4) and five 35-J shocks. An inactive S-ICD electrode was implanted into the same control pigs to study implant trauma. All animals survived 24-hours. Troponin I and creatine kinase muscle isoenzyme (CK-MM) were measured as indicators of myocardial and skeletal muscle injury. Histopathological injury of heart, lungs, and chest wall was assessed using semi-quantitative scoring. Results Troponin I was significantly elevated at 4- and 24-hours (22.6±16.3 and 3.1±1.3 ng/ml; baseline 0.07±0.09 ng/ml) in control pigs but not in S-ICD pigs (0.12±0.11 and 0.13±0.13 ng/ml; baseline 0.06±0.03 ng/ml). CK-MM was significantly elevated in S-ICD pigs after shocks (6544±1496 and 9705±6240 U/L; baseline 704±398 U/L) but not in controls. ECG changes occurred post-shock in controls but not in S-ICD pigs. The myocardium and lungs were histologically normal in both groups. Subcutaneous injury was greater in S-ICD compared to controls. Conclusion Although CK-MM suggested more skeletal muscle injury in S-ICD pigs, significant cardiac, lung, and chest wall histopathological changes were not detected in either group. Troponin I data indicate significantly less cardiac injury from 80-J S-ICD shocks than 35-J transvenous shocks. PMID:23713608

  6. An unusual case of isolated, serial metastases of gallbladder carcinoma involving the chest wall, axilla, breast and lung parenchyma

    Directory of Open Access Journals (Sweden)

    Matthew J. Iott

    2013-02-01

    Full Text Available In the English literature, only 9 cases of adenocarcinoma of the gallbladder with cutaneous metastasis have been reported so far. One case of multiple cutaneous metastases along with deposits in the breast tissue has been reported. We present a case of incidental metastatic gallbladder carcinoma with no intra-abdominal disease presenting as a series of four isolated cutaneous right chest wall, axillary nodal, breast and pulmonary metastases following resection and adjuvant chemoradiation for her primary tumor. In spite of the metastatic disease coupled with the aggressive nature of the cancer, this patient reported that her energy level had returned to baseline with a good appetite and a stable weight indicating a good performance status and now is alive at 25 months since diagnosis. Her serially-presented, oligometastatic diseases were well-controlled by concurrent chemoradiation and stereotactic radiation therapy. We report this case study because of its rarity and for the purpose of complementing current literature with an additional example of cutaneous metastasis from adenocarcinoma of the gallbladder.

  7. A comparison of skin and chest wall dose delivered with multicatheter, Contura multilumen balloon, and MammoSite breast brachytherapy.

    Science.gov (United States)

    Cuttino, Laurie W; Todor, Dorin; Rosu, Mihaela; Arthur, Douglas W

    2011-01-01

    Skin and chest wall doses have been correlated with toxicity in patients treated with breast brachytherapy . This investigation compared the ability to control skin and chest wall doses between patients treated with multicatheter (MC), Contura multilumen balloon (CMLB), and MammoSite (MS) brachytherapy. 43 patients treated with the MC technique, 45 patients treated with the CMLB, and 83 patients treated with the MS were reviewed. The maximum doses delivered to the skin and chest wall were calculated for all patients. The mean maximum skin doses for the MC, CMLB, and MS were 2.3 Gy (67% of prescription dose), 2.8 Gy (82% of prescription dose), and 3.2 Gy per fraction (94% of prescription dose), respectively. Although the skin distances were similar (p = 0.23) for the two balloon techniques, the mean skin dose with the CMLB was significantly lower than with the MS (p = 0.05). The mean maximum rib doses for the MC, CMLB, and MS were 2.3 Gy (67% of prescription dose), 2.8 Gy (82% of prescription dose), and 3.6 Gy per fraction (105% of prescription dose), respectively. Again, the mean rib dose with the CMLB was significantly lower than with the MS (p = 0.002). The MC and CMLB techniques are associated with significantly lower mean skin and rib doses than is the MS. Treatment with the MS was associated with significantly more patients receiving doses to the skin or rib in excess of 125% of the prescription. Treatment with the CMLB may prove to yield less normal tissue toxicity than treatment with the MS. Copyright © 2011 Elsevier Inc. All rights reserved.

  8. A Comparison of Skin and Chest Wall Dose Delivered With Multicatheter, Contura Multilumen Balloon, and MammoSite Breast Brachytherapy

    International Nuclear Information System (INIS)

    Cuttino, Laurie W.; Todor, Dorin; Rosu, Mihaela; Arthur, Douglas W.

    2011-01-01

    Purpose: Skin and chest wall doses have been correlated with toxicity in patients treated with breast brachytherapy . This investigation compared the ability to control skin and chest wall doses between patients treated with multicatheter (MC), Contura multilumen balloon (CMLB), and MammoSite (MS) brachytherapy. Methods and Materials: 43 patients treated with the MC technique, 45 patients treated with the CMLB, and 83 patients treated with the MS were reviewed. The maximum doses delivered to the skin and chest wall were calculated for all patients. Results: The mean maximum skin doses for the MC, CMLB, and MS were 2.3 Gy (67% of prescription dose), 2.8 Gy (82% of prescription dose), and 3.2 Gy per fraction (94% of prescription dose), respectively. Although the skin distances were similar (p = 0.23) for the two balloon techniques, the mean skin dose with the CMLB was significantly lower than with the MS (p = 0.05). The mean maximum rib doses for the MC, CMLB, and MS were 2.3 Gy (67% of prescription dose), 2.8 Gy (82% of prescription dose), and 3.6 Gy per fraction (105% of prescription dose), respectively. Again, the mean rib dose with the CMLB was significantly lower than with the MS (p = 0.002). Conclusion: The MC and CMLB techniques are associated with significantly lower mean skin and rib doses than is the MS. Treatment with the MS was associated with significantly more patients receiving doses to the skin or rib in excess of 125% of the prescription. Treatment with the CMLB may prove to yield less normal tissue toxicity than treatment with the MS.

  9. Thoracoabdominal peripheral primitive neuroectodermal tumors in childhood: radiological features

    International Nuclear Information System (INIS)

    Schulman, H.; Laufer, L.; Newman-Heinman, N.; Kurtzbart, E.; Maor, E.; Zirkin, H.

    2000-01-01

    Peripheral primitive neuroectodermal tumors (PNET) are extremely uncommon, malignant neoplasms affecting mostly children and young adults. We retrospectively reviewed the clinical data and radiological studies of four such cases. All cases were pathologically proven. Plain films, US, and CT scans were used. The youngest child had a huge pelvic tumor and two adolescents each had a chest wall (Askin) tumor. The fourth patient had a most unusual location of the PNET in the anterior mediastinum. The CT findings are emphasized. We emphasize that the markedly abnormal CT findings are not specific for PNET. (orig.)

  10. Chest Wall Toxicity After Stereotactic Body Radiotherapy for Malignant Lesions of the Lung and Liver

    International Nuclear Information System (INIS)

    Andolino, David L.; Forquer, Jeffrey A.; Henderson, Mark A.; Barriger, Robert B.; Shapiro, Ronald H.; Brabham, Jeffrey G.; Johnstone, Peter A.S.; Cardenes, Higinia R.; Fakiris, Achilles J.

    2011-01-01

    Purpose: To quantify the frequency of rib fracture and chest wall (CW) pain and identify the dose-volume parameters that predict CW toxicity after stereotactic body radiotherapy (SBRT). Methods and Materials: The records of patients treated with SBRT between 2000 and 2008 were reviewed, and toxicity was scored according to Common Terminology Criteria for Adverse Events v3.0 for pain and rib fracture. Dosimetric data for CW and rib were analyzed and related to the frequency of toxicity. The risks of CW toxicity were then further characterized according to the median effective concentration (EC 50 ) dose-response model. Results: A total of 347 lesions were treated with a median follow-up of 19 months. Frequency of Grade I and higher CW pain and/or fracture for CW vs. non-CW lesions was 21% vs. 4%, respectively (p 2 > 0.9). According to the EC 50 model, 5 cc and 15 cc of CW receiving 40 Gy predict a 10% and 30% risk of CW toxicity, respectively. Conclusion: Adequate tumor coverage remains the primary objective when treating lung or liver lesions with SBRT. To minimize toxicity when treating lesions in close proximity to the CW, Dmax of the CW and/or ribs should remain <50 Gy, and <5 cc of CW should receive ≥40 Gy.

  11. Surgical treatment of chest instability

    International Nuclear Information System (INIS)

    Kitka, M.; Masek, M.

    2015-01-01

    Fractures of the ribs is the most common thoracic injury after blunt trauma. Chest wall instability (flail chest) is a common occurrence in the presence of multiple ribs fracture. Unilateral or bilateral fractures more ribs anteriorly or posteriorly will produce enough instability that paradoxical respiratory motion results in hypoventilation of an unacceptable degree. Open approach and surgical stabilisation of the chest preserved pulmonary function, improved pain control, minimized posttraumatic deformities and shorter back to work time. (author)

  12. Free gracilis flap for chest wall reconstruction in male patient with Poland syndrome after implant failure

    OpenAIRE

    Cherubino, Mario; Maggiulli, Francesca; Pellegatta, Igor; Valdatta, Luigi

    2016-01-01

    Poland's syndrome (PS) is a congenital monolateral deformity that may involve breast, chest wall, and upper limb with different degrees of clinical expressions. In some cases, the problem is mainly cosmetic, and the reconstruction should be performed to achieve minimal scarring and donor site morbidity. The authors describe a case report of a male patient with PS who developed a severe capsular contraction after 25 years implant reconstruction, who was treated after explantation using free gr...

  13. Pleural localized malignant mesothelioma mimicking a benign solitary fibrous tumor of the pleura on chest computed tomography: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Park, Hwi Ryong; Chong, Se Min; Kim, Mi Kyung [Dept. of Radiology, (Korea, Republic of)

    2017-06-15

    Pleural malignant mesotheliomas arise from mesothelial cells in the pleura. They are characterized as diffuse or localized malignant mesotheliomas (LMM). Diffuse malignant mesotheliomas spread diffusely along pleural surfaces, while LMM are well-circumscribed nodular lesions with no gross or microscopic diffuse pleural spreading. Therefore, LMM can be radiologically confused with solitary fibrous tumors of the pleura (SFTP), which commonly presents as a solitary, well-demarcated peripheral mass abutting the pleural surface upon the completion of a computed tomography (CT). Therefore, this study reports on a 63-year-old female patient with a pathologically-proven LMM of the pleura, mimicking a benign SFTP upon having a chest CT. Although LMM is extremely rare, FDG PET/CT should be recommended for adequate tumor management in order to avoid misdiagnosing the tumor as a benign SFTP when an interfissural or pleural-based mass is seen on the chest CT.

  14. Pleural localized malignant mesothelioma mimicking a benign solitary fibrous tumor of the pleura on chest computed tomography: A case report

    International Nuclear Information System (INIS)

    Park, Hwi Ryong; Chong, Se Min; Kim, Mi Kyung

    2017-01-01

    Pleural malignant mesotheliomas arise from mesothelial cells in the pleura. They are characterized as diffuse or localized malignant mesotheliomas (LMM). Diffuse malignant mesotheliomas spread diffusely along pleural surfaces, while LMM are well-circumscribed nodular lesions with no gross or microscopic diffuse pleural spreading. Therefore, LMM can be radiologically confused with solitary fibrous tumors of the pleura (SFTP), which commonly presents as a solitary, well-demarcated peripheral mass abutting the pleural surface upon the completion of a computed tomography (CT). Therefore, this study reports on a 63-year-old female patient with a pathologically-proven LMM of the pleura, mimicking a benign SFTP upon having a chest CT. Although LMM is extremely rare, FDG PET/CT should be recommended for adequate tumor management in order to avoid misdiagnosing the tumor as a benign SFTP when an interfissural or pleural-based mass is seen on the chest CT

  15. Image-guided intensity-modulated radiotherapy for refractory bilateral breast cancer in a patient with extensive cutaneous metastasis in the chest and abdominal walls

    Directory of Open Access Journals (Sweden)

    Lu YF

    2016-05-01

    Full Text Available Yueh-Feng Lu,1 Yu-Chin Lin,2 Kuo-Hsin Chen,3,4 Pei-Wei Shueng,1 Hsin-Pei Yeh,1 Chen-Hsi Hsieh1,5,6 1Division of Radiation Oncology, Department of Radiology, 2Division of Oncology and Hematology, Department of Medicine, 3Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, 4Department of Electrical Engineering, Yuan-Ze University, Taoyuan, 5Department of Medicine, 6Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan Abstract: Treatment for bilateral breast cancer with chest wall and abdominal skin invasion normally involves conventional radiotherapy (RT; however, conventional RT provides inadequate target volume coverage and excessive treatment of large volumes of normal tissue. Helical tomotherapy (HT has the ability to deliver continuous craniocaudal irradiation that suppresses junction problems and provides good conformity of dose distribution. A 47-year-old female with stage IV bilateral breast cancer with chest wall and pectoralis major muscle invasion, lymphadenopathy, bilateral pleural effusion, and multiple bone metastases received chemotherapy and target therapy beginning in January 2014; 4 months after the initiation of chemotherapy, computed tomography revealed progression of chest and abdominal wall invasion. A total dose of 70.2 Gy was delivered to both breasts, the chest wall, the abdominal wall, and the bilateral supraclavicular nodal areas in 39 fractions via HT. The total planning target volume was 4,533.29 cm3. The percent of lung volume receiving at least 20 Gy (V20 was 28%, 22%, and 25% for the right lung, left lung, and whole lung, respectively. The mean dose to the heart was 8.6 Gy. Follow-up computed tomography revealed complete response after the RT course. Grade 1 dysphagia, weight loss, grade 2 neutropenia, and grade 3 dermatitis were noted during the RT course. Pain score decreased from 6 to 1. No cardiac, pulmonary, liver, or intestinal toxicity

  16. Penetrating cardiac injuries in blunt chest wall trauma.

    Science.gov (United States)

    Kanchan, Tanuj; Menezes, Ritesh G; Sirohi, Parmendra

    2012-08-01

    The present photocase illustrates the possible mechanism of direct cardiac injuries from broken sharp jagged fractured ends of ribs in blunt force trauma to the chest in run over traffic mishaps. We propose that the projecting fractured ends of the ribs penetrate the underlying thoracic organs due to the transient phenomenon of deformation of chest cavity under pressure in run over traffic mishaps. Copyright © 2012 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  17. Cardiac pathologies incidentally detected with non-gated chest CT; Inzidentelle Pathologien des Herzens im Thorax-CT

    Energy Technology Data Exchange (ETDEWEB)

    Scherer, Axel; Kroepil, P.; Lanzman, R.S.; Moedder, U. [Inst. fuer Radiologie, Universitaetsklinikum Duesseldorf, Heinrich-Heine-Univ. (Germany); Choy, G.; Abbara, S. [Cardiovascular Imaging Section, Massachusetts General Hospital, Harvard Medical School (United States)

    2009-12-15

    Cardiac imaging using electrocardiogram-gated multi-detector computed tomography (MDCT) permits noninvasive diagnosis of congenital and acquired cardiac pathologies and has thus become increasingly important in the last years. Several studies investigated the incidence and relevance of incidental extracardiac structures within the lungs, mediastinum, chest wall, and abdomen with gated coronary CT. This resulted in the general acceptance of the review of extracardiac structures as a routine component of coronary CT interpretation. On the other hand radiologists tend to neglect pericardial and cardiac pathologies in non-gated chest CT, which is primarily performed for the evaluation of the respiratory system or for tumor staging. Since the introduction of multi-detector spiral CT technology, the incidental detection of cardiac and pericardial findings has become possible using non-gated chest CT. This article reviews the imaging appearances and differential diagnostic considerations of incidental cardiac entities that may be encountered in non-gated chest CT. (orig.)

  18. Primary Vaginal Extraosseous Ewing Sarcoma/Primitive Neuroectodermal Tumor with Cranial Metastasis

    Directory of Open Access Journals (Sweden)

    Chi-Man Yip

    2009-06-01

    Full Text Available Extraosseous Ewing sarcoma is now regarded as a member of the Ewing sarcoma/primitive neuroectodermal tumor (PNET family. It typically involves the soft tissues of the chest wall, pelvis, paravertebral region, abdominal wall, retroperitoneal region and extremities of children, adolescents and young adults, but it seldom occurs in the female genital tract. We report an extremely rare case of retrospective diagnosis of vaginal extraosseous Ewing sarcoma/PNET which metastasized to the right frontoparietal scalp, skull, and dura. Surgical resection, followed by adjuvant radiotherapy and chemotherapy resulted in a favourable clinical outcome. Both the vaginal and head tumors had similar light microscopic features supporting the diagnosis.

  19. The pedicled omentoplasty and split skin graft (POSSG) for reconstruction of large chest wall defects. A validity study of 34 patients

    NARCIS (Netherlands)

    C.M.E. Contant; A.N. van Geel (Albert); B. van der Holt (Bronno); T. Wiggers (Theo)

    1996-01-01

    textabstractThe aim of this study was to evaluate retrospectively the results of pedicled omentoplasty and split skin graft (POSSG) in reconstructing (full thickness) chest wall defects, and to define its role as a palliative procedure for local symptom control. Thirty-four patients with recurrent

  20. Chest-wall thickness and percent thoracic fat estimation by B-mode ultrasound: system and procedure review

    International Nuclear Information System (INIS)

    Berger, C.D.; Lane, B.H.; Dunsmore, M.R.

    1983-02-01

    Accurate measurement of chest wall thickness is necessary for estimation of lung burden of transuranic elements in humans. To achieve tis capability, the ORNL Whole Body Counter has acquired a B-mode ultrasonic imaging system for defining the structure within the thorax of the body. This report contains a review of the ultrasound system in use at the ORNL Whole Body Counter, including its theory of operation, and te procedure for use of the system. Future developmental plans are also presented

  1. Chest reconstruction using a custom-designed polyethylene 3D implant after resection of the sternal manubrium

    Directory of Open Access Journals (Sweden)

    Lipińska J

    2017-08-01

    Full Text Available Joanna Lipińska,1 Leszek Kutwin,1 Marcin Wawrzycki,1 Leszek Olbrzymek,2 Sławomir Jabłoński1 1Department of Thoracic Surgery, General and Oncological Surgery, Medical University of Lodz, 2Ledo, Lodz, Poland Introduction: Resection of manubrium or body of the sternum is associated with a necessity of chest wall reconstruction. Large sternal defects require the use of different types of implants to ensure acceptable esthetic effect for the patient and chest stabilization. Aim: The purpose of this case report is to present a novel method of reconstruction of manubrium removed due to renal cancer metastasis to the sternum.Case: We present the case of a patient, who had underwent right nephrectomy for clear cell kidney cancer, diagnosed with a metastatic tumor in the sternum resulting in destruction of manubrium. The patient undergone tumor resection with primary reconstruction with an individual prosthesis. Sternal defect was filled with a personalized, computed tomography scan-based 3D-milled implant made of polyethylene.Results: Sternal reconstruction was uneventful. The patient endured surgery well, and has been under surveillance in outpatient clinic, without any respiration disorders, implant movement or local recurrence.Conclusion: Custom-designed sternal implants created by 3D technique constitute an interesting alternative for previous methods of filling defects after resection of a tumor in this location. Keywords: 3D-milled implant, thoracoplasty, reconstructive surgery, chest reconstruction, sternal metastasis, sternal implant, sternal tumor 

  2. Evaluation of acute cardiac and chest wall damage after shocks with a subcutaneous implantable cardioverter defibrillator in Swine.

    Science.gov (United States)

    Killingsworth, Cheryl R; Melnick, Sharon B; Litovsky, Silvio H; Ideker, Raymond E; Walcott, Gregory P

    2013-10-01

    A subcutaneous implantable cardioverter defibrillator (S-ICD) could ease placement and reduce complications of transvenous ICDs, but requires more energy than transvenous ICDs. Therefore we assessed cardiac and chest wall damage caused by the maximum energy shocks delivered by both types of clinical devices. During sinus rhythm, anesthetized pigs (38 ± 6 kg) received an S-ICD (n = 4) and five 80-Joule (J) shocks, or a transvenous ICD (control, n = 4) and five 35-J shocks. An inactive S-ICD electrode was implanted into the same control pigs to study implant trauma. All animals survived 24 hours. Troponin I and creatine kinase muscle isoenzyme (CK-MM) were measured as indicators of myocardial and skeletal muscle injury. Histopathological injury of heart, lungs, and chest wall was assessed using semiquantitative scoring. Troponin I was significantly elevated at 4 hours and 24 hours (22.6 ± 16.3 ng/mL and 3.1 ± 1.3 ng/mL; baseline 0.07 ± 0.09 ng/mL) in control pigs but not in S-ICD pigs (0.12 ± 0.11 ng/mL and 0.13 ± 0.13 ng/mL; baseline 0.06 ± 0.03 ng/mL). CK-MM was significantly elevated in S-ICD pigs after shocks (6,544 ± 1,496 U/L and 9,705 ± 6,240 U/L; baseline 704 ± 398 U/L) but not in controls. Electrocardiogram changes occurred postshock in controls but not in S-ICD pigs. The myocardium and lungs were histologically normal in both groups. Subcutaneous injury was greater in S-ICD compared to controls. Although CK-MM suggested more skeletal muscle injury in S-ICD pigs, significant cardiac, lung, and chest wall histopathological changes were not detected in either group. Troponin I data indicate significantly less cardiac injury from 80-J S-ICD shocks than 35-J transvenous shocks. ©2013, The Authors. Journal compilation ©2013 Wiley Periodicals, Inc.

  3. Chest X-Ray

    Medline Plus

    Full Text Available Toggle navigation Test/Treatment Patient Type Screening/Wellness Disease/Condition Safety En Español More Info Images/Videos ... x-ray is used to evaluate the lungs, heart and chest wall and may be used to ...

  4. Selective chest imaging for blunt trauma patients: The national emergency X-ray utilization studies (NEXUS-chest algorithm).

    Science.gov (United States)

    Rodriguez, Robert M; Hendey, Gregory W; Mower, William R

    2017-01-01

    Chest imaging plays a prominent role in blunt trauma patient evaluation, but indiscriminate imaging is expensive, may delay care, and unnecessarily exposes patients to potentially harmful ionizing radiation. To improve diagnostic chest imaging utilization, we conducted 3 prospective multicenter studies over 12years to derive and validate decision instruments (DIs) to guide the use of chest x-ray (CXR) and chest computed tomography (CT). The first DI, NEXUS Chest x-ray, consists of seven criteria (Age >60years; rapid deceleration mechanism; chest pain; intoxication; altered mental status; distracting painful injury; and chest wall tenderness) and exhibits a sensitivity of 99.0% (95% confidence interval [CI] 98.2-99.4%) and a specificity of 13.3% (95% CI, 12.6%-14.0%) for detecting clinically significant injuries. We developed two NEXUS Chest CT DIs, which are both highly reliable in detecting clinically major injuries (sensitivity of 99.2%; 95% CI 95.4-100%). Designed primarily to focus on detecting major injuries, the NEXUS Chest CT-Major DI consists of six criteria (abnormal CXR; distracting injury; chest wall tenderness; sternal tenderness; thoracic spine tenderness; and scapular tenderness) and exhibits higher specificity (37.9%; 95% CI 35.8-40.1%). Designed to reliability detect both major and minor injuries (sensitivity 95.4%; 95% CI 93.6-96.9%) with resulting lower specificity (25.5%; 95% CI 23.5-27.5%), the NEXUS CT-All rule consists of seven elements (the six NEXUS CT-Major criteria plus rapid deceleration mechanism). The purpose of this review is to synthesize the three DIs into a novel, cohesive summary algorithm with practical implementation recommendations to guide selective chest imaging in adult blunt trauma patients. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Unilateral Hemithorax Opacification on Chest Radiograph : Comparison of Diagnostic Accuracy of Chest Ultrasonography with CT

    Energy Technology Data Exchange (ETDEWEB)

    Namkung, Sook; Lee, Kyung Soo; Kwon, O Jung [Samsung Medical Center, Seoul (Korea, Republic of); Chung, Seung Eun [Sangkye Paek Hospital, Seoul (Korea, Republic of)

    1996-12-15

    To compare the diagnostic accuracy of chest ultrasonography (US) with computed tomography (CT) inpatients with opacification more than one third of unilateral hemithorax on chest radiograph (CXR). Chest US and CT scans from 41 consecutive patients with opacification more than one third of unilateral hemithorax on CXR were prospectively evaluated by two independent radiologists. Each radiologist recorded 1) the nature of pleural effusion (transudate vs. exudate), 2) presence or absence of pulmonary lesion, 3) the characteristic of pulmonary lesion (consolidation or atelectasis and tumor), and 4) presence of solid pleural tumor. The diagnostic accuracy of chest US was compared with CT scan in patients with pleural, pulmonary or other disease. In 32 patients with pleural effusion, differentiation between transudate and exudate was feasible in 27 (84%) patients with US and 26 (81%) patients with CT. In 32 patients with pulmonary and other pleural diseases, sensitivity, specificity and accuracy of US in lesion detection were 86%, 75% and 83% respectively when CT was regarded as a diagnostic gold standard. The diagnostic accuracy of chest US is comparable to CT in patients with hemithorax opacification on CXR

  6. Unilateral Hemithorax Opacification on Chest Radiograph : Comparison of Diagnostic Accuracy of Chest Ultrasonography with CT

    International Nuclear Information System (INIS)

    Namkung, Sook; Lee, Kyung Soo; Kwon, O Jung; Chung, Seung Eun

    1996-01-01

    To compare the diagnostic accuracy of chest ultrasonography (US) with computed tomography (CT) inpatients with opacification more than one third of unilateral hemithorax on chest radiograph (CXR). Chest US and CT scans from 41 consecutive patients with opacification more than one third of unilateral hemithorax on CXR were prospectively evaluated by two independent radiologists. Each radiologist recorded 1) the nature of pleural effusion (transudate vs. exudate), 2) presence or absence of pulmonary lesion, 3) the characteristic of pulmonary lesion (consolidation or atelectasis and tumor), and 4) presence of solid pleural tumor. The diagnostic accuracy of chest US was compared with CT scan in patients with pleural, pulmonary or other disease. In 32 patients with pleural effusion, differentiation between transudate and exudate was feasible in 27 (84%) patients with US and 26 (81%) patients with CT. In 32 patients with pulmonary and other pleural diseases, sensitivity, specificity and accuracy of US in lesion detection were 86%, 75% and 83% respectively when CT was regarded as a diagnostic gold standard. The diagnostic accuracy of chest US is comparable to CT in patients with hemithorax opacification on CXR

  7. A case of postirradiation cutaneous angiosarcoma on the chest after radical mastectomy without any therapies

    International Nuclear Information System (INIS)

    Hirai, Nobuyuki; Suzuki, Yutaka

    2009-01-01

    The patient was a 78-year-old woman who had undergone radical mastectomy for left breast cancer, followed by irradiation to the chest wall about 40 years earlier. In the fall of 2006, small purpura appeared around the surgical scar in the left chest. Because it had spread on the chest gradually, she was seen at this hospital on August 28, 2007, when a purple red brownish induration 7.5 x 3.5 cm in diameter was noted on the left chest. A biopsy gave the histopathological diagnosis of angiosarcoma. According to her clear intention, no therapies have done and thus the tumor has spread over the entire left chest. But she is doing well over two years since she had noticed the purpura without any therapies. Postirradiation cutaneous angiosarcoma is rare, but carries very poor prognosis. In Japan, the number of patients with breast cancer is increasing rapidly, and the number of patients with postirradiation cutaneous angiosarcoma after breast cancer treatment will increase. Surgeons must inform the patients about the possibility that irradiation can cause cutaneous angiosarcoma, and must strictly follow the post-irradiation patients. (author)

  8. Chest pain in daily practice: occurrence, causes and management.

    Science.gov (United States)

    Verdon, François; Herzig, Lilli; Burnand, Bernard; Bischoff, Thomas; Pécoud, Alain; Junod, Michel; Mühlemann, Nicole; Favrat, Bernard

    2008-06-14

    We assessed the occurrence and aetiology of chest pain in primary care practice. These features differ between primary and emergency care settings, where most previous studies have been performed. 59 GPs in western Switzerland recorded all consecutive cases presenting with chest pain. Clinical characteristics, laboratory tests and other investigations as well as the diagnoses remaining after 12 months of follow-up were systematically registered. Among 24,620 patients examined during a total duration of 300 weeks of observation, 672 (2.7%) presented with chest pain (52% female, mean age 55 +/- 19(SD)). Most cases, 442 (1.8%), presented new symptoms and in 356 (1.4%) it was the reason for consulting. Over 40 ailments were diagnosed: musculoskeletal chest pain (including chest wall syndrome) (49%), cardiovascular (16%), psychogenic (11%), respiratory (10%), digestive (8%), miscellaneous (2%) and without diagnosis (3%). The three most prevalent diseases were: chest wall syndrome (43%), coronary artery disease (12%) and anxiety (7%). Unstable angina (6), myocardial infarction (4) and pulmonary embolism (2) were uncommon (1.8%). Potentially serious conditions including cardiac, respiratory and neoplasic diseases accounted for 20% of cases. A large number of laboratory tests (42%), referral to a specialist (16%) or hospitalisation (5%) were performed. Twentyfive patients died during follow-up, of which twelve were for a reason directly associated with thoracic pain [cancer (7) and cardiac causes (5)]. Thoracic pain was present in 2.7% of primary care consultations. Chest wall syndrome pain was the main aetiology. Cardio - vascular emergencies were uncommon. However chest pain deserves full consideration because of the occurrence of potentially serious conditions.

  9. Analysis of the efficacy and safety of conventional radiotherapy of chest wall and clavicular field and three-dimensional conformal radiotherapy in patients after modified radical mastectomy

    Directory of Open Access Journals (Sweden)

    Song-Lin Wang

    2017-04-01

    Full Text Available Objective: To explore the efficacy and safety of conventional radiotherapy of chest wall and clavicular field and three-dimensional conformal radiotherapy in patients after modified radical mastectomy. Methods: A total of 84 patients who were admitted in our hospital after modified radical mastectomy were included in the study and divided into the conventional radiotherapy group (n=42 and the three-dimensional conformal radiotherapy group (n=42 according to different radiotherapy methods. The patients in the conventional radiotherapy group were given conventional radiotherapy of chest wall and clavicular field, while the patients in the three-dimensional conformal radiotherapy group were given three-dimensional conformal radiotherapy. The serum tumor markers and peripheral blood T lymphocyte subsets 6-8 weeks after treatment in the two groups were detected. The clinical efficacy, and toxic and side effects in the two groups were evaluated. Results: The serum CA15-3, CA125, CEA, and CK19 levels after treatment in the two groups were significantly reduced when compared with before treatment, CD3 +,CD4 +, and CD4 +/CD8 + were significantly elevated, while CD8 + was significantly reduced when compared with before treatment, but the comparison of the above indicators between the two groups was not statistically significant. The occurrence rate of radioactive skin damage and pneumonia after treatment in the conventional radiotherapy group was significantly higher than that in the three-dimensional conformal radiotherapy group. Conclusions: The two kinds of radiotherapy schemes have an equal efficacy, but the toxic and side effects of three-dimensional conformal radiotherapy are significantly lower than those by the conventional radiotherapy, with a certain advantage.

  10. A case of divided latissimus dorsi flap repair for chest wall defect after wide resection of post-irradiation angiosarcoma

    International Nuclear Information System (INIS)

    Matsubara, Yukiko; Sawaizumi, Masayuki; Imai, Tomohiro; Maeda, Takuma; Fujita, Kazutoshi; Matsumoto, Seiichi; Iwase, Takuji; Motoi, Noriko; Kanda, Hiroaki

    2011-01-01

    We report the case of a 76-year-old woman who had undergone breast-conserving surgery for left breast cancer, followed by irradiation at a total dose of 66 Gy in 2005. When 5 years 1 month had elapsed after the operation, redness of the left chest wall was observed. A biopsy was performed and the histopathological diagnosis was angiosarcoma. Extended resection of the full thickness of the skin was performed. Adequate resection left a massive defect 15 x 18 cm in size. The divided latissimus dorsi flap was designed, and the oval-shaped skin defect was closed with the skin island of this flap. Post-irradiation sarcoma involving the vessels is a rare entity and occurs in 0.07-0.48% of all cases after radiation therapy. It metastasizes to the distant organs in an early stage and has a poor prognosis. No standard therapy for the disease has been established. Early detection and extended resection are considered to contribute to improvement of the prognosis. The divided latissimus dorsi flap is very useful for reconstructing a wide chest wall defect without the need to wide skin graft the donor site. (author)

  11. Lung and chest wall impedances in the dog in normal range of breathing: effects of pulmonary edema.

    Science.gov (United States)

    Barnas, G M; Stamenović, D; Lutchen, K R

    1992-09-01

    We evaluated the effect of pulmonary edema on the frequency (f) and tidal volume (VT) dependences of respiratory system mechanical properties in the normal ranges of breathing. We measured resistance and elastance of the lungs (RL and EL) and chest wall of four anesthetized-paralyzed dogs during sinusoidal volume oscillations at the trachea (50-300 ml, 0.2-2 Hz), delivered at a constant mean airway pressure. Measurements were made before and after severe pulmonary edema was produced by injection of 0.06 ml/kg oleic acid into the right atrium. Chest wall properties were not changed by the injection. Before oleic acid, EL increased slightly with increasing f in each dog but was independent of VT. RL decreased slightly and was independent of VT from 0.2 to 0.4 Hz, but above 0.4 Hz it tended to increase with increasing flow, presumably due to the airway contribution. After oleic acid injection, EL and RL increased greatly. Large negative dependences of EL on VT and of RL on f were also evident, so that EL and RL after oleic acid changed two- and fivefold, respectively, within the ranges of f and VT studied. We conclude that severe pulmonary edema changes lung properties so as to make behavior VT dependent (i.e., nonlinear) and very frequency dependent in the normal range of breathing.

  12. Outcomes of Complete Versus Partial Surgical Stabilization of Flail Chest.

    Science.gov (United States)

    Nickerson, Terry P; Thiels, Cornelius A; Kim, Brian D; Zielinski, Martin D; Jenkins, Donald H; Schiller, Henry J

    2016-01-01

    Rib fractures are common after chest wall trauma. For patients with flail chest, surgical stabilization is a promising technique for reducing morbidity. Anatomical difficulties often lead to an inability to completely repair the flail chest; thus, the result is partial flail chest stabilization (PFS). We hypothesized that patients with PFS have outcomes similar to those undergoing complete flail chest stabilization (CFS). A prospectively collected database of all patients who underwent rib fracture stabilization procedures from August 2009 until February 2013 was reviewed. Abstracted data included procedural and complication data, extent of stabilization, and pulmonary function test results. Of 43 patients who underwent operative stabilization of flail chest, 23 (53%) had CFS and 20 (47%) underwent PFS. Anterior location of the fracture was the most common reason for PFS (45%). Age, sex, operative time, pneumonia, intensive care unit and hospital length of stay, and narcotic use were the same in both groups. Total lung capacity was significantly improved in the CFS group at 3 months. No chest wall deformity was appreciated on follow-up, and no patients underwent additional stabilization procedures following PFS. Despite advances in surgical technique, not all fractures are amenable to repair. There was no difference in chest wall deformity, narcotic use, or clinically significant impairment in pulmonary function tests among patients who underwent PFS compared with CFS. Our data suggest that PFS is an acceptable strategy and that extending or creating additional incisions for CFS is unnecessary.

  13. Potential of ultrasound in the pediatric chest

    Energy Technology Data Exchange (ETDEWEB)

    Trinavarat, Panruethai, E-mail: pantrinavarat@hotmail.com [Department of Radiology, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Pathumwan, Bangkok 10330 (Thailand); Riccabona, Michael, E-mail: michael.riccabona@klinikum-graz.at [Department of Radiology, Division of Pediatric Radiology, University Hospital Graz (Austria)

    2014-09-15

    Ultrasound (US) of chest, even with inherent limitations of the US beam and air, has been useful in many pediatric chest conditions. It has extended its role and is now widely used by many subspecialists in medicine. This review article will cover techniques, indications, and applications of chest US in neonates, infants and children, including also different common as well as some rare and modern aspects and applications, such as pleural effusion, pneumothorax, pulmonary lesions, mediastinum, diaphragm, and chest wall. Other related imaging modalities are also briefly discussed.

  14. Malignant granular cell tumor of the abdominal wall mimicking desmoid tumor: A case report with CT imaging findings and literature review

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Je Hong; Ahn, Sung Eun; Lee, Dong Ho; Park, Seong Jin; Moon, Sung Kyoung; Lim, Joo Won [Dept. Radiology, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul (Korea, Republic of)

    2016-08-15

    Granular cell tumors (GCTs) are extremely rare mesenchymal neoplasms of Schwann cell origin. Malignant GCTs (MGCTs) comprise 0.5-2% of all GCTs. In the present report, we describe a case of a 66-year-old man with MGCT of the abdominal wall. The patient visited our hospital due to a recently growing palpable soft tissue mass in the abdominal wall. Computed tomography scan revealed a 4.3 × 4.1 × 2.9 cm sized mass arising from the left abdominal wall, which was contemplated as a desmoid tumor before surgical excision. Histopathological examination confirmed MGCT.

  15. Sternal Cleft and Pectus Excavatum: A Combined Approach for the Correction of a Complex Anterior Chest Wall Malformation in a Teenager.

    Science.gov (United States)

    Tocchioni, Francesca; Ghionzoli, Marco; Lo Piccolo, Roberto; Deaconu, Diana E; Facchini, Flavio; Milanez De Campos, Jose R; Messineo, Antonio

    2015-06-01

    Congenital sternal cleft is a rare chest wall malformation. Because of the flexibility of the chest in infants, surgical repair should be performed by primary closure in the neonatal period. In adolescents and adults, different techniques have been suggested to overcome the lack of sternal bone tissue. We describe a very rare case of an 18-year-old woman with a complete bifid sternum associated with pectus excavatum for whom a satisfactory cosmetic and functional result was obtained by adequate surgical planning, which entailed a combination of two standardized surgical techniques. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  16. MRI of the Chest

    Medline Plus

    Full Text Available ... sternum) and chest wall soft tissue (muscles and fat). assess for pericardial (thin sac around the heart) ... prior to your scheduled examination. Infants and young children usually require sedation or anesthesia to complete an ...

  17. MRI of the Chest

    Medline Plus

    Full Text Available ... sternum) and chest wall soft tissue (muscles and fat). assess for pericardial (thin sac around the heart) ... on the child's age, intellectual development and the type of exam. Moderate and conscious sedation can be ...

  18. MRI of the Chest

    Medline Plus

    Full Text Available ... heart) and myocardial infarct (scar in the heart muscle due to prior obstruction of blood flow). determine ... ribs and sternum) and chest wall soft tissue (muscles and fat). assess for pericardial (thin sac around ...

  19. Factors Associated with ICU Admission following Blunt Chest Trauma

    Directory of Open Access Journals (Sweden)

    Andrea Bellone

    2016-01-01

    Full Text Available Background. Blunt chest wall trauma accounts for over 10% of all trauma patients presenting to emergency departments worldwide. When the injury is not as severe, deciding which blunt chest wall trauma patients require a higher level of clinical input can be difficult. We hypothesized that patient factors, injury patterns, analgesia, postural condition, and positive airway pressure influence outcomes. Methods. The study population consisted of patients hospitalized with at least 3 rib fractures (RF and at least one pulmonary contusion and/or at least one pneumothorax lower than 2 cm. Results. A total of 140 patients were retrospectively analyzed. Ten patients (7.1% were admitted to intensive care unit (ICU within the first 72 hours, because of deterioration of the clinical conditions and gas exchange with worsening of chest X-ray/thoracic ultrasound/chest computed tomography. On univariable analysis and multivariable analysis, obliged orthopnea (p=0.0018 and the severity of trauma score (p<0.0002 were associated with admission to ICU. Conclusions. Obliged orthopnea was an independent predictor of ICU admission among patients incurring non-life-threatening blunt chest wall trauma. The main therapeutic approach associated with improved outcome is the prevention of pulmonary infections due to reduced tidal volume, namely, upright postural condition and positive airway pressure.

  20. Treatment of necrotic infection on the anterior chest wall secondary to mastectomy and postoperative radiotherapy by the application of omentum and mesh skin grafting. Report of a case

    International Nuclear Information System (INIS)

    Sato, Masaaki; Tanaka, Fumihiro; Wada, Hiromi

    2002-01-01

    We report herein the case of a patient who initially underwent right radical mastectomy for breast carcinoma in 1988, followed by left breast-conserving surgery in 1997. On both occasions she was given postoperative radiation therapy of 50 Gy. Repeated dressings and the administration of antibiotics failed to heal ulcerative infected lesions that had formed on the anterior chest wall in early 1998. In 1999, the sternum and surrounding tissue were debrided and the anterior chest wall was reconstructed by omentum transposition and mesh skin grafting. The patient is currently well and alive without any evidence of recurrence of either infection or breast cancer. (author)

  1. Complex regional pain syndrome with associated chest wall dystonia: a case report

    Directory of Open Access Journals (Sweden)

    Schwartzman Robert J

    2011-09-01

    Full Text Available Abstract Patients with complex regional pain syndrome (CRPS often suffer from an array of associated movement disorders, including dystonia of an affected limb. We present a case of a patient with long standing CRPS after a brachial plexus injury, who after displaying several features of the movement disorder previously, developed painful dystonia of chest wall musculature. Detailed neurologic examination found palpable sustained contractions of the pectoral and intercostal muscles in addition to surface allodynia. Needle electromyography of the intercostal and paraspinal muscles supported the diagnosis of dystonia. In addition, pulmonary function testing showed both restrictive and obstructive features in the absence of a clear cardiopulmonary etiology. Treatment was initiated with intrathecal baclofen and the patient had symptomatic relief and improvement of dystonia. This case illustrates a novel form of the movement disorder associated with CRPS with response to intrathecal baclofen treatment.

  2. Challenges in management of pediatric life-threatening neck and chest trauma

    Directory of Open Access Journals (Sweden)

    Shilpa Sharma

    2018-01-01

    Full Text Available Introduction: Neck and thoracic trauma in children pose unforeseen challenges requiring variable management strategies. Here, we describe some unusual cases. Patients and Methods: Pediatric cases of unusual neck and thoracic trauma prospectively managed from April 2012 to March 2014 at a Level 1 trauma center were studied for management strategies, outcome, and follow-up. Results: Six children with a median age of 5.5 (range 2–10 years were managed. Mechanism of injury was road traffic accident, fall from height and other accidental injury in 2, 3 and 1 patient respectively. The presentation was respiratory distress and quadriplegia, exposed heart, penetrating injury in neck, dysphagia and dyspnea, and swelling over the chest wall in 1, 1, 1, 2 and 1 cases respectively. Injuries included lung laceration, open chest wall, vascular injury of the neck, tracheoesophageal fistula (2, and chest wall posttraumatic pyomyositis. One patient had a flare of miliary tuberculosis. Immediate management included chest wall repair; neck exploration and repair, esophagostomy, gastroesophageal stapling, and feeding jejunostomy (followed by gastric pull-up 8 months later. Chest tube insertion and total parenteral nutrition was required in one each. 2 and 4 patients required tracheostomy and mechanical ventilation. The patient with gastric pull-up developed a stricture of the esophagogastric anastomosis that was revised at 26-month follow-up. At follow-up of 40–61 months, five patients are well. One patient with penetrating neck injury suffered from blindness due to massive hemorrhage from the vascular injury in the neck and brain ischemia with only peripheral vision recovery. Conclusion: Successful management of neck and chest wall trauma requires timely appropriate decisions with a team effort.

  3. Decision tree sensitivity analysis for cost-effectiveness of chest FDG-PET in patients with a pulmonary tumor (non-small cell carcinoma)

    International Nuclear Information System (INIS)

    Kosuda, Shigeru; Watanabe, Masumi; Kobayashi, Hideo; Kusano, Shoichi; Ichihara, Kiyoshi

    1998-01-01

    Decision tree analysis was used to assess cost-effectiveness of chest FDG-PET in patients with a pulmonary tumor (non-small cell carcinoma, ≤Stage IIIB), based on the data of the current decision tree. Decision tree models were constructed with two competing strategies (CT alone and CT plus chest FDG-PET) in 1,000 patient population with 71.4% prevalence. Baselines of FDG-PET sensitivity and specificity on detection of lung cancer and lymph node metastasis, and mortality and life expectancy were available from references. Chest CT plus chest FDG-PET strategy increased a total cost by 10.5% when a chest FDG-PET study costs 0.1 million yen, since it increased the number of mediastinoscopy and curative thoracotomy despite reducing the number of bronchofiberscopy to half. However, the strategy resulted in a remarkable increase by 115 patients with curable thoracotomy and decrease by 51 patients with non-curable thoracotomy. In addition, an average life expectancy increased by 0.607 year/patient, which means increase in medical cost is approximately 218,080 yen/year/patient when a chest FDG-PET study costs 0.1 million yen. In conclusion, chest CT plus chest FDG-PET strategy might not be cost-effective in Japan, but we are convinced that the strategy is useful in cost-benefit analysis. (author)

  4. Evaluation of various boluses in dose distribution for electron therapy of the chest wall with an inward defect

    Science.gov (United States)

    Mahdavi, Hoda; Jabbari, Keyvan; Roayaei, Mahnaz

    2016-01-01

    Delivering radiotherapy to the postmastectomy chest wall can be achieved using matched electron fields. Surgical defects of the chest wall change the dose distribution of electrons. In this study, the improvement of dose homogeneity using simple, nonconformal techniques of thermoplastic bolus application on a defect is evaluated. The proposed phantom design improves the capability of film dosimetry for obtaining dose profiles of a patient's anatomical condition. A modeled electron field of a patient with a postmastectomy inward surgical defect was planned. High energy electrons were delivered to the phantom in various settings, including no bolus, a bolus that filled the inward defect (PB0), a uniform thickness bolus of 5 mm (PB1), and two 5 mm boluses (PB2). A reduction of mean doses at the base of the defect was observed by any bolus application. PB0 increased the dose at central parts of the defect, reduced hot areas at the base of steep edges, and reduced dose to the lung and heart. Thermoplastic boluses that compensate a defect (PB0) increased the homogeneity of dose in a fixed depth from the surface; adversely, PB2 increased the dose heterogeneity. This study shows that it is practical to investigate dose homogeneity profiles inside a target volume for various techniques of electron therapy. PMID:27051169

  5. Coronary artery bypass grafting and concomitant excision of chest wall chondrosarcoma

    Directory of Open Access Journals (Sweden)

    Ganti Somsekhar

    2009-02-01

    Full Text Available Abstract Coexistence of coronary artery disease and cancer with both requiring surgical treatment at the same time is rare. A 52 year male undergoing elective coronary artery bypass grafting was incidentally discovered to have a large soft tissue mass of variable consistency with cartilaginous elements arising from the right costal margin and adjoining ribs by a broad attachment and protruding into right pleural cavity. Frozen section suggested it to be either a chondrosarcoma or a teratoma. A wide excision of the mass with the adjoining muscle and periosteum along with quadruple coronary artery bypass grafting was done. This report is unusual on account of a being the first reported case in world literature of concomitant excision of chondrosarcoma and coronary artery bypass grafting and b the conservative management of the incidentally discovered chondrosarcoma by wide excision rather than chest wall resection with no local recurrence to date. Pathology of chondrosarcoma, in particular, and various management strategies when coronary artery disease and cancer coexist, in general, is discussed.

  6. Reconstrucción de defectos torácicos de espesor total: Presentación de 8 casos de especial complejidad Reconstruction of full thickness defects on the chest wall: Presentation of 8 complex cases

    Directory of Open Access Journals (Sweden)

    J.M. Lasso

    2009-12-01

    Full Text Available Las lesiones de gran tamaño en el tórax, requieren casi siempre para su reparación plastias complejas, que en algunos casos han de combinar el uso de tejidos autólogos y/o materiales sintéticos. Por tanto, la reconstrucción de la pared torácica supone un desafío desde el punto de vista reconstructivo en el que es fundamental el papel de los cirujanos plásticos. Los grandes defectos torácicos suelen ser secundarios a exéresis tumoral (tumores parietales de origen primario o secundario, infecciones, radionecrosis, traumatismos y malformaciones congénitas. Si bien los principios de la reconstrucción del tórax exigen una escisión amplia de la lesión, desbridamiento de los tejidos desvitalizados o irradiados y control de la infección local, dichas actuaciones no podrían abordarse con seguridad si no dispusiéramos de un amplio arsenal de técnicas reconstructivas, capaces de aportar tejidos sanos y bien vascularizados o voluminosos y amplios en superficie, junto con soportes rígidos mediante materiales aloplásticos. Gracias a estos avances, en la mayoría de los casos conseguimos el objetivo con sólo una intervención, cuando hace unos años necesitábamos varios procedimientos quirúrgicos. Presentamos una muestra variada de la experiencia de nuestro Servicio en el tratamiento de grandes defectos del tórax, en el que resumimos las distintas posibilidades que podemos encontrar en la práctica clínica diaria, y las soluciones que mejor se adaptan a las mismas.Reconstruction of full thickness defects on the chest wall is controversial and require the use of complex techniques that combine autologous tissue and/or alloplastic materials. Thus it is a challenge for plastic surgeons since it needs a suitable and functional reconstruction. The aethiology for these defects include tumoral surgery (primary wall tumors, or recurrences or metastasis, infections, radiation injury, trauma and congenital defects. Otherwise, first surgical

  7. Giant Desmoid Tumor of the Anterior Abdominal Wall in a Young Female: A Case Report

    Directory of Open Access Journals (Sweden)

    Mahim Koshariya

    2013-01-01

    Full Text Available Desmoid tumors (also called desmoids fibromatosis are rare slow growing benign and musculoaponeurotic tumors. Although these tumors have a propensity to invade surrounding tissues, they are not malignant. These tumors are associated with women of fertile age, especially during and after pregnancy. We report a young female patient with a giant desmoid tumor of the anterior abdominal wall who underwent primary resection. The patient had no history of an earlier abdominal surgery. Preoperative evaluation included abdominal ultrasound, computed tomography, and magnetic resonance imaging. The histology revealed a desmoid tumor. Primary surgical resection with immediate reconstruction of abdominal defect is the best management of this rarity. To the best of our knowledge and PubMed search, this is the first case ever reported in the medical literature of such a giant desmoid tumor arising from anterior abdominal wall weighing 6.5 kg treated surgically with successful outcome.

  8. TU-CD-304-06: Using FFF Beams Improves Tumor Control in Radiotherapy of Lung Cancers

    Energy Technology Data Exchange (ETDEWEB)

    Vassiliev, O [Mary Bird Perkins Cancer Center, Baton Rouge, LA (United States); Wang, H [UT MD Anderson Cancer Center, Houston, TX (United States)

    2015-06-15

    Purpose: Electron disequilibrium at the lung-tumor interface results in an under-dosage of tumor regions close to its surface. This under-dosage is known to be significant and can compromise tumor control. Previous studies have shown that in FFF beams, disequilibrium effects are less pronounced, which is manifested in an increased skin dose. In this study we investigate the improvement in tumor dose coverage that can be achieved with FFF beams. The significance of this improvement is evaluated by comparing tumor control probabilities of FFF beams and conventional flattened beams. Methods: The dosimetric coverage was investigated in a virtual phantom representing the chest wall, lung tissue and the tumor. A range of tumor sizes was investigated, and two tumor locations – central and adjacent to the chest wall. Calculations were performed with BEAMnrc Monte Carlo code. Parallel-opposed and multiple coplanar 6-MV beams were simulated. The tumor control probabilities were calculated using the logistic model with parameters derived from clinical data for non-small lung cancer patients. Results: FFF beams were not entirely immune to disequilibrium effects. They nevertheless consistently delivered more uniform dose distribution throughout the volume of the tumor, and eliminated up to ∼15% of under-dosage in the most affected by disequilibrium 1-mm thick surface region of the tumor. A voxel-by-voxel comparison of tumor control probabilities between FFF and conventional flattened beams showed an advantage of FFF beams that, depending on the set up, was from a few to ∼9 percent. Conclusion: A modest improvement in tumor control probability on the order of a few percent can be achieved by replacing conventional flattened beams with FFF beams. However, given the large number of lung cancer patients undergoing radiotherapy, these few percent can potentially prevent local tumor recurrence for a significant number of patients.

  9. Anteroposterior chest radiograph vs. chest CT scan in early detection of pneumothorax in trauma patients

    Directory of Open Access Journals (Sweden)

    Omar Hesham R

    2011-09-01

    Full Text Available Abstract Pneumothorax is a common complication following blunt chest wall trauma. In these patients, because of the restrictions regarding immobilization of the cervical spine, Anteroposterior (AP chest radiograph is usually the most feasible initial study which is not as sensitive as the erect chest X-ray or CT chest for detection of a pneumothorax. We will present 3 case reports which serve for better understanding of the entity of occult pneumothorax. The first case is an example of a true occult pneumothorax where an initial AP chest X-ray revealed no evidence of pneumothorax and a CT chest immediately performed revealed evidence of pneumothorax. The second case represents an example of a missed rather than a truly occult pneumothorax where the initial chest radiograph revealed clues suggesting the presence of pneumothorax which were missed by the reading radiologist. The third case emphasizes the fact that "occult pneumothorax is predictable". The presence of subcutaneous emphesema and pulmonary contusion should call for further imaging with CT chest to rule out pneumothorax. Thoracic CT scan is therefore the "gold standard" for early detection of a pneumothorax in trauma patients. This report aims to sensitize readers to the entity of occult pneumothorax and create awareness among intensivists and ER physicians regarding the proper diagnosis and management.

  10. Anteroposterior chest radiograph vs. chest CT scan in early detection of pneumothorax in trauma patients.

    Science.gov (United States)

    Omar, Hesham R; Mangar, Devanand; Khetarpal, Suneel; Shapiro, David H; Kolla, Jaya; Rashad, Rania; Helal, Engy; Camporesi, Enrico M

    2011-09-27

    Pneumothorax is a common complication following blunt chest wall trauma. In these patients, because of the restrictions regarding immobilization of the cervical spine, Anteroposterior (AP) chest radiograph is usually the most feasible initial study which is not as sensitive as the erect chest X-ray or CT chest for detection of a pneumothorax. We will present 3 case reports which serve for better understanding of the entity of occult pneumothorax. The first case is an example of a true occult pneumothorax where an initial AP chest X-ray revealed no evidence of pneumothorax and a CT chest immediately performed revealed evidence of pneumothorax. The second case represents an example of a missed rather than a truly occult pneumothorax where the initial chest radiograph revealed clues suggesting the presence of pneumothorax which were missed by the reading radiologist. The third case emphasizes the fact that "occult pneumothorax is predictable". The presence of subcutaneous emphesema and pulmonary contusion should call for further imaging with CT chest to rule out pneumothorax. Thoracic CT scan is therefore the "gold standard" for early detection of a pneumothorax in trauma patients. This report aims to sensitize readers to the entity of occult pneumothorax and create awareness among intensivists and ER physicians regarding the proper diagnosis and management.

  11. A lipomatous chest wall lesion: hibernoma

    International Nuclear Information System (INIS)

    Incedayi, M.; Sivrioglu, A.; Saglam, M.; Sonmez, G.; Tekin, L.

    2012-01-01

    Full text: A hibernoma is a rare benign soft tissue tumor derived from brown fat. The tumor is also known as 'fetal' lipoma, lipoma of embriogenic fat and lipoma of immature adipose tissue. Hibernomas are slow growing, painless soft tissue tumors which do not recur after surgical resection. Preferred locations are brown fat containing sites as thigh, inter scapular region, shoulder, axilla and mediastinum. The tumor occurs most commonly in adults, with a mean age of 38 years (age range, 2-75 years). We present a rare case of hibernoma with radiological and pathological findings

  12. Evaluating proton stereotactic body radiotherapy to reduce chest wall dose in the treatment of lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Welsh, James, E-mail: jwelsh@mdanderson.org [Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX (United States); Amini, Arya [Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX (United States); UC Irvine School of Medicine, Irvine, CA (United States); Ciura, Katherine; Nguyen, Ngoc; Palmer, Matt [Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX (United States); Soh, Hendrick [Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX (United States); Department of Radiation Physics, The University of Texas, MD Anderson Cancer Center, Houston, TX (United States); Allen, Pamela K.; Paolini, Michael; Liao, Zhongxing [Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX (United States); Bluett, Jaques; Mohan, Radhe [Department of Radiation Physics, The University of Texas, MD Anderson Cancer Center, Houston, TX (United States); Gomez, Daniel; Cox, James D.; Komaki, Ritsuko; Chang, Joe Y. [Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX (United States)

    2013-01-01

    Stereotactic body radiotherapy (SBRT) can produce excellent local control of several types of solid tumor; however, toxicity to nearby critical structures is a concern. We found previously that in SBRT for lung cancer, the chest wall (CW) volume receiving 20, 30, or 40 Gy (V{sub 20}, V{sub 30}, or V{sub 40}) was linked with the development of neuropathy. Here we sought to determine whether the dosimetric advantages of protons could produce lower CW doses than traditional photon-based SBRT. We searched an institutional database to identify patients treated with photon SBRT for lung cancer with tumors within < 2.5 cm of the CW. We found 260 cases; of these, chronic grade ≥ 2 CW pain was identified in 23 patients. We then selected 10 representative patients from this group and generated proton SBRT treatment plans, using the identical dose of 50 Gy in 4 fractions, and assessed potential differences in CW dose between the 2 plans. The proton SBRT plans reduced the CW doses at all dose levels measured. The median CW V{sub 20} was 364.0 cm{sup 3} and 160.0 cm{sup 3} (p < 0.0001), V{sub 30} was 144.6 cm{sup 3}vs 77.0 cm{sup 3} (p = 0.0012), V{sub 35} was 93.9 cm{sup 3}vs 57.9 cm{sup 3} (p = 0.005), V{sub 40} was 66.5 cm{sup 3}vs 45.4 cm{sup 3} (p = 0.0112), and mean lung dose was 5.9 Gy vs 3.8 Gy (p = 0.0001) for photons and protons, respectively. Coverage of the planning target volume (PTV) was comparable between the 2 sets of plans (96.4% for photons and 97% for protons). From a dosimetric standpoint, proton SBRT can achieve the same coverage of the PTV while significantly reducing the dose to the CW and lung relative to photon SBRT and therefore may be beneficial for the treatment of lesions closer to critical structures.

  13. Chest pain in focal musculoskeletal disorders

    DEFF Research Database (Denmark)

    Stochkendahl, Mette Jensen; Christensen, Henrik Wulff

    2010-01-01

    overlapping conditions and syndromes of focal disorders, including Tietze syndrome, costochondritis, chest wall syndrome, muscle tenderness, slipping rib, cervical angina, and segmental dysfunction of the cervical and thoracic spine, have been reported to cause pain. For most of these syndromes, evidence......The musculoskeletal system is a recognized source of chest pain. However, despite the apparently benign origin, patients with musculoskeletal chest pain remain under-diagnosed, untreated, and potentially continuously disabled in terms of anxiety, depression, and activities of daily living. Several...... arises mainly from case stories and empiric knowledge. For segmental dysfunction, clinical features of musculoskeletal chest pain have been characterized in a few clinical trials. This article summarizes the most commonly encountered syndromes of focal musculoskeletal disorders in clinical practice....

  14. Influence of chest radiotherapy in frequency and patterns of chest relapse in disseminated small cell lung carcinoma

    International Nuclear Information System (INIS)

    Mira, J.G.; Livingston, R.B.; Moore, T.N.

    1982-01-01

    The value of radiotherapy to the chest (RC) in disseminated small cell lung carcinoma (SCLC) has been questioned. Two protocols for disseminated SCLC from the Southwest Oncology Group (SWOG) have been compared. The first one included radiotherapy (RT), 3000 rad in two weeks, to the primary tumor, mediastinum and supraclavicular areas, while the second one deleted any RC. Multidrug chemotherapy (CT) and brain RT were used in both protocols. Nonresponders to CT were removed from the study. Our main findings are as follows: (1) Initial chest relapses (patients with no initial extrathoracic relapse) have increased from 24-55% when RC is not given (P = 0.0001). Overall chest relapse (adding those patients that relapsed simultaneously in the chest plus other sites) in the second protocol was 73%. (2) Amount of response to CT does not influence the chances for relapse. Even complete responders to CT have a high chance for chest relapse. (3) Sites of relapse without RC are mainly in the primary tumor, ipsilateral hilus and mediastinum. (4) With RC, relapses shift to the chest periphery, mostly to the lung outside the radiotherapy field and to the pleura. (5) The two very different CT regimens have produced similar percentages and duration of response. (6) CT schema with periodic reinductions prolongs duration of response and survival over schema with continuous maintenance. Hence, interruption of CT to allow RC does not seem to adversely influence CT efficacy

  15. Cytological and histological correlation of granular cell tumor in a series of three cases

    Directory of Open Access Journals (Sweden)

    Soutrik Das

    2018-01-01

    Full Text Available Granular cell tumor (GCT is an uncommon soft tissue tumor characterized by proliferation of cells with granular eosinophilic cytoplasm. We came across three such tumors, one in the tongue, one in the chest wall, and one in the right deltoid region, which were referred for fine-needle aspiration cytology. On cytological examination, the first two cases were diagnosed as GCT, and the mass in deltoid region was suggestive of proliferative myositis. The cytological details of these cases are discussed. The excision biopsies of the first two cases and Tru-cut biopsy of the deltoid mass confirmed the diagnosis of GCT.

  16. New developments in ultrasonic imaging of the chest and other body organs

    International Nuclear Information System (INIS)

    Campbell, G.W.; Anderson, A.L.

    1978-01-01

    The ultrasonic imaging system described herein was developed to measure chest-wall thickness and the percentage of fat in the chest and around other body organs. The system uses pulse-echo techniques to transmit and detect sound waves reflected from the interfaces of body organs and adjacent tissue. A computer draws these interfaces on color scans, and a code is used to exponentially average data from several points on each scan to find the average thicknesses of the chest wall and fat layers. These average thicknesses are then used to adjust x-ray calibration factors for plutonium lung counters. The correction factor for three subjects measured for fat content ranging from 12.6 to 22.2% was 18 to 41%. The ultrasonic system also defines the shape and position of the kidneys and liver so we are able to more accurately place detectors on the body during in-vivo radiation measurements. We have also developed a technique for displaying the interfaces from a series of ultrasonic chest scans to produce a topographical map that enables us to better understand the shape and contour of the lung and chest-wall interface

  17. Imaging of blunt chest trauma

    International Nuclear Information System (INIS)

    Wicky, S.; Wintermark, M.; Schnyder, P.; Capasso, P.; Denys, A.

    2000-01-01

    In western European countries most blunt chest traumas are associated with motor vehicle and sport-related accidents. In Switzerland, 39 of 10,000 inhabitants were involved and severely injured in road accidents in 1998. Fifty two percent of them suffered from blunt chest trauma. According to the Swiss Federal Office of Statistics, traumas represented in men the fourth major cause of death (4 %) after cardiovascular disease (38 %), cancer (28 %), and respiratory disease (7 %) in 1998. The outcome of chest trauma patients is determined mainly by the severity of the lesions, the prompt appropriate treatment delivered on the scene of the accident, the time needed to transport the patient to a trauma center, and the immediate recognition of the lesions by a trained emergency team. Other determining factors include age as well as coexisting cardiac, pulmonary, and renal diseases. Our purpose was to review the wide spectrum of pathologies related to blunt chest trauma involving the chest wall, pleura, lungs, trachea and bronchi, aorta, aortic arch vessels, and diaphragm. A particular focus on the diagnostic impact of CT is demonstrated. (orig.)

  18. Chest Trauma in Athletic Medicine.

    Science.gov (United States)

    Phillips, Nicholas R; Kunz, Derek E

    2018-03-01

    While overall sports participation continues at high rates, chest injuries occur relatively infrequently. Many conditions of chest injury are benign, related to simple contusions and strains, but the more rare, severe injuries carry a much higher risk of morbidity and mortality than the typical issues encountered in athletic medicine. Missed or delayed diagnosis can prove to be catastrophic. Sports medicine providers must be prepared to encounter a wide range of traumatic conditions relating to the torso, varying from the benign chest wall contusion to the life-threatening tension pneumothorax. Basic field-side management should be rapid and focused, using the standardized approach of Advanced Traumatic Life Support protocol. Early and appropriate diagnosis and management can help allow safe and enjoyable sports participation.

  19. Factors affecting measurement of optic parameters by time-resolved near-infrared spectroscopy in breast cancer

    Science.gov (United States)

    Yoshizawa, Nobuko; Ueda, Yukio; Mimura, Tetsuya; Ohmae, Etsuko; Yoshimoto, Kenji; Wada, Hiroko; Ogura, Hiroyuki; Sakahara, Harumi

    2018-02-01

    The purpose of this study was to evaluate the effects of the thickness and depth of tumors on hemoglobin measurements in breast cancer by optical spectroscopy and to demonstrate tissue oxygen saturation (SO2) and reduced scattering coefficient (μs‧) in breast tissue and breast cancer in relation to the skin-to-chest wall distance. We examined 53 tumors from 44 patients. Total hemoglobin concentration (tHb), SO2, and μs‧ were measured by time-resolved spectroscopy (TRS). The skin-to-chest wall distance and the size and depth of tumors were measured by ultrasonography. There was a positive correlation between tHb and tumor thickness, and a negative correlation between tHb and tumor depth. SO2 in breast tissue decreased when the skin-to-chest wall distance decreased, and SO2 in tumors tended to be lower than in breast tissue. In breast tissue, there was a negative correlation between μs‧ and the skin-to-chest wall distance, and μs‧ in tumors was higher than in breast tissue. Measurement of tHb in breast cancer by TRS was influenced by tumor thickness and depth. Although SO2 seemed lower and μs‧ was higher in breast cancer than in breast tissue, the skin-to-chest wall distance may have affected the measurements.

  20. Computed tomography of the chest in surgical case

    International Nuclear Information System (INIS)

    Tsubota, Noriaki; Ohyama, Tadashi; Kubota, Hideo; Shirakawa, Masaru; Yoshie, Tetsuo

    1979-01-01

    Twenty-one surgical cases out of 31 thoracic were discussed in comparison with computed tomography (CT), conventional chest x-ray film and findings on operation. CT was found useful in several respects. Azygo-esophageal recess (AER), which is normally seen between the vertebra and the carina, disappeared in the cases with enlarged lymph nodes around the carina. But AER was kept in the same fashion as normal in all cases free from those nodes enlargement. A low density line between tumor shadow and the mediastinum was good information to know preoperatively whether it was resectable or not. There were no resected cases of which CT films failed to show the border of the tumor shadow. Though CT is often used to evaluate mediastinal tumor, because of its horizontal cross picture, it is seldom diagnostic. Enlarged thoracic aorta and a minimum amount of calcium on its wall, and fat tissue in the retrosternal space which conventional x-ray films failed to reveal in both cases were definitive signs of aneurysm of thoracic aorta and foramen of Morgagni hernia respectively. CT is also able to demonstrate a small pulmonary nodules in the fields in much more early stage than conventional x-ray film is, which must be good adjunct to detect lung cancer. (author)

  1. Surgical Stabilization of Costoclavicular Injuries - A Combination of Flail Chest Injuries and a Clavicula Fracture.

    Science.gov (United States)

    Langenbach, Andreas; Pinther, Melina; Krinner, Sebastian; Grupp, Sina; Ekkernkamp, Axel; Hennig, Friedrich F; Schulz-Drost, Stefan

    2017-01-01

    Background: Flail chest injuries (FCI) are associated with a high morbidity and mortality rate. As a concomitant clavicle fracture in FCI even worsens the outcome, the question is how can those costoclavicular injuries (CCI) be managed surgically. Methods: 11 patients with CCI were surgically treated by a locked plate osteosynthesis of the Clavicle and the underlying ribs through limited surgical approaches under general anesthesia. Patients were followed up after 2, 6, 12, 26 and 52 weeks. Results: All patients showed severe chest wall deformity due to severely displaced fractures of the ribs and the clavicle. They were suffering from pain and restriction of respiratory movements. The chest wall could be restored to normal shape in all cases with uneventful bone healing and a high patient convenience. Fractures of the clavicle and the second rib were managed through an innovative clavipectoral approach, the others through standard approaches to the anterolateral and the posterolateral chest wall. Two patients complained about numbness around the lateral approach and lasting periscapular pain. Conclusions: Surgical stabilization might be the appropriate therapy in CCI with dislocated fractures since they would cause severe deformity and loss of function of the chest wall and the shoulder. Celsius.

  2. Primary solitary peritoneal tumor of the abdominal wall-report of a rare case and review of the literature.

    Science.gov (United States)

    Efthimiadis, Christoforos; Ioannidis, Aristeidis; Kofina, Konstantinia; Grigoriou, Marios

    2017-06-01

    Abdominal wall tumors are sometimes diagnosed as metastases of ovarian cancer, however, primary peritoneal tumors should be taken into consideration in the final diagnosis. A 49-year-old female patient was admitted in our Department for the excision of a pulpable abdominal wall lump, with no other abnormalities shown on imaging investigation. On histology examination, the excised specimen revealed characteristics of metastatic high-grade serous ovarian carcinoma. Total hysterectomy, bilateral oophorectomy, omentectomy and appendectomy were performed. No signs of malignancy were proved on histology, leading to the final diagnosis of a primary serous peritoneal tumor. This is the third described case of solitary primary serous peritoneal tumor located in the abdominal wall. This condition should be included in the differential diagnosis of a probable metastatic ovarian carcinoma, as both present similar histologic characteristics.

  3. Effectiveness of chest physiotherapy in the management of bronchiectasis

    International Nuclear Information System (INIS)

    Arif, M.; Bashir, M.S.

    2014-01-01

    Bronchiectasis is a chronic disease in which clearance of sputum is disturbed because bronchi dilated permanently. So for the clearance of sputum we have to use physiotherapy techniques such as postural drainage percussion and vibration (PDPY), active cycle of breathing technique (ACBT), autogenic drainage, positive expiratory pressure, high frequency chest wall oscillation. Objective: To determine the role of Chest Physical therapy intervention in the management of Bronchi ectasis. To compare the prognosis of bronchiectasis with and without chest physiotherapy. Methodology: Data was collected from Gulab Devi Chest Hospital, Lahore. A Randomized Control Trial (RCT) study method was used and 60 patients are studied. In this study, they were divided into 03 groups 1- Antibiotics Therapy 2-Chest Physical therapy 3-Antibiotics and Chest Physical therapy. Each group consistant. (author)

  4. Does the quality of chest compressions deteriorate when the chest compression rate is above 120/min?

    Science.gov (United States)

    Lee, Soo Hoon; Kim, Kyuseok; Lee, Jae Hyuk; Kim, Taeyun; Kang, Changwoo; Park, Chanjong; Kim, Joonghee; Jo, You Hwan; Rhee, Joong Eui; Kim, Dong Hoon

    2014-08-01

    The quality of chest compressions along with defibrillation is the cornerstone of cardiopulmonary resuscitation (CPR), which is known to improve the outcome of cardiac arrest. We aimed to investigate the relationship between the compression rate and other CPR quality parameters including compression depth and recoil. A conventional CPR training for lay rescuers was performed 2 weeks before the 'CPR contest'. CPR anytime training kits were distributed to respective participants for self-training on their own in their own time. The participants were tested for two-person CPR in pairs. The quantitative and qualitative data regarding the quality of CPR were collected from a standardised check list and SkillReporter, and compared by the compression rate. A total of 161 teams consisting of 322 students, which includes 116 men and 206 women, participated in the CPR contest. The mean depth and rate for chest compression were 49.0±8.2 mm and 110.2±10.2/min. Significantly deeper chest compression depths were noted at rates over 120/min than those at any other rates (47.0±7.4, 48.8±8.4, 52.3±6.7, p=0.008). Chest compression depth was proportional to chest compression rate (r=0.206, pcompression including chest compression depth and chest recoil by chest compression rate. Further evaluation regarding the upper limit of the chest compression rate is needed to ensure complete full chest wall recoil while maintaining an adequate chest compression depth. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  5. Tumor Volume-Adapted Dosing in Stereotactic Ablative Radiotherapy of Lung Tumors

    Energy Technology Data Exchange (ETDEWEB)

    Trakul, Nicholas; Chang, Christine N.; Harris, Jeremy [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA (United States); Chapman, Christopher [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA (United States); University of Michigan School of Medicine, Ann Arbor, MI (United States); Rao, Aarti [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA (United States); University of California, Davis, School of Medicine, Davis, CA (United States); Shen, John [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA (United States); University of California, Irvine, School of Medicine, Irvine, CA (United States); Quinlan-Davidson, Sean [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA (United States); Department of Radiation Oncology, McMaster University, Juravinski Cancer Centre, Hamilton, Ontario (Canada); Filion, Edith J. [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA (United States); Departement de Medecine, Service de Radio-Oncologie, Centre Hospitalier de l' Universite de Montreal, Montreal, Quebec (Canada); Wakelee, Heather A.; Colevas, A. Dimitrios [Department of Medicine, Division of Oncology, Stanford University School of Medicine, Stanford, CA (United States); Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA (United States); Whyte, Richard I. [Department of Cardiothoracic Surgery, Division of General Thoracic Surgery, Stanford University School of Medicine, Stanford, CA (United States); Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA (United States); and others

    2012-09-01

    Purpose: Current stereotactic ablative radiotherapy (SABR) protocols for lung tumors prescribe a uniform dose regimen irrespective of tumor size. We report the outcomes of a lung tumor volume-adapted SABR dosing strategy. Methods and Materials: We retrospectively reviewed the outcomes in 111 patients with a total of 138 primary or metastatic lung tumors treated by SABR, including local control, regional control, distant metastasis, overall survival, and treatment toxicity. We also performed subset analysis on 83 patients with 97 tumors treated with a volume-adapted dosing strategy in which small tumors (gross tumor volume <12 mL) received single-fraction regimens with biologically effective doses (BED) <100 Gy (total dose, 18-25 Gy) (Group 1), and larger tumors (gross tumor volume {>=}12 mL) received multifraction regimens with BED {>=}100 Gy (total dose, 50-60 Gy in three to four fractions) (Group 2). Results: The median follow-up time was 13.5 months. Local control for Groups 1 and 2 was 91.4% and 92.5%, respectively (p = 0.24) at 12 months. For primary lung tumors only (excluding metastases), local control was 92.6% and 91.7%, respectively (p = 0.58). Regional control, freedom from distant metastasis, and overall survival did not differ significantly between Groups 1 and 2. Rates of radiation pneumonitis, chest wall toxicity, and esophagitis were low in both groups, but all Grade 3 toxicities developed in Group 2 (p = 0.02). Conclusion: A volume-adapted dosing approach for SABR of lung tumors seems to provide excellent local control for both small- and large-volume tumors and may reduce toxicity.

  6. Extragenital malignant mixed Mullerian tumor in the incisional hernia - primary carcinosarcoma in the abdominal wall: Case report

    Directory of Open Access Journals (Sweden)

    Žuvela Marinko

    2015-01-01

    Full Text Available Introduction. This report presents a primary Mullerian carcinosarcoma localized in the incisional hernia i.e. anterior abdominal wall. There is no data in the literature about this localization of extragenital Mullerian carcinosarcoma. Case Outline. The patient had previous medical history of right-sided ovarian cystadenocarcinoma managed by hysterectomy, bilateral ovariectomy and chemotherapy. An incisional hernia occurred 1 year after the operation and Mullerian carcinosarcoma at the right border of the incisional hernia 16 years later. There was no tumor spreading into the abdominal cavity and pelvis. Full thickness of the abdominal wall resection and coexisting incisional hernia resulted in a large 25x20 cm abdominal wall defect managed by the modified components separation technique and implanting meshes. Conclusion. Major abdominal wall resection and abdominal wall reconstruction using the modified components separation technique reinforced with meshes could be one of possible solutions in the surgical treatment of primary malignant mixed Mullerian tumor localized in the abdominal wall. [Projekat Ministarstva nauke Republike Srbije, br. 41030

  7. Role of computed tomography in blunt chest trauma

    International Nuclear Information System (INIS)

    Cho, Jae Hyun; Kim, Sang Jin; Lee, Chan Wha; Kim, Hae Kyoon

    1994-01-01

    In patient with blunt trauma of chest, supine AP x-ray cannot differentiate the lung contusion, laceration, atelectasis, and hemothorax definitely. Therefore, computed tomographic evaluation is needed for accurate evaluation of the injuries. In our knowledge, there are few reports about CT findings of blunt chest trauma, in our country, therefore we tried to fluid the characteristic CT findings in patients with blunt trauma. We analyzed the plain x-ray and CT image of 4 patients with blunt chest trauma. Location and morphology of lung parenchymal contusion and laceration, hemopneumothorax, chest wall injuries and location of chest tube. Lung parenchymal contusion was noted in 53 segments., of 16 patients infiltration(n=27 segment), and multiple nodular pattern was noted in 15 segment, pattern of consolidation along the lung periphery was seen in 11 segment. Laceration was noted in 18 lesion and most commonly located in paravertebral area(b=8). CT scan of chest in patient with blunt chest trauma, provides accurate information of the pattern of injuries, and localization, therefore, should be performed as possible

  8. Paediatric chest wall trauma causing delayed presentation of ventricular arrhythmia.

    Science.gov (United States)

    Tegethoff, Angela M; Raney, Emerald; Mendelson, Jenny; Minckler, Michael R

    2017-07-24

    This report describes a paediatric patient presenting with haemodynamically stable non-sustained ventricular tachycardia 1 day after minor blunt chest trauma. Initial laboratory studies, chest X-ray and echocardiography were normal; however, cardiac MRI revealed precordial haematoma, myocardial contusion and small pericardial effusion. Throughout her hospital course, she remained asymptomatic aside from frequent couplets and triplets of premature ventricular contractions. Ectopy was controlled with oral verapamil. This case highlights how significant cardiac injury may be missed with standard diagnostic algorithms. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  9. Effects of non-invasive ventilation and posture on chest wall volumes and motion in patients with amyotrophic lateral sclerosis: a case series

    OpenAIRE

    Magalh?es, Cristiana M.; Fregonezi, Guilherme A.; Vidigal-Lopes, Mauro; Vieira, Bruna S. P. P.; Vieira, Danielle S. R.; Parreira, Ver?nica F.

    2016-01-01

    ABSTRACT Background The effects of non-invasive ventilation (NIV) on the breathing pattern and thoracoabdominal motion of patients with amyotrophic lateral sclerosis (ALS) are unknown. Objectives 1) To analyze the influence of NIV on chest wall volumes and motion assessed by optoelectronic plethysmography in ALS patients and 2) to compare these parameters in the supine and sitting positions to those of healthy individuals (without NIV). Method Nine ALS patients were evaluated in the supine...

  10. Identification of sex-different specimens of costicartilage pairs 2 - 6: post mortem study by radiograms of the anterior chest wall

    International Nuclear Information System (INIS)

    Markert, K.; Reinwarth, E.M.; Wirth, I.; Brautzsch, G.

    1983-01-01

    On the basis of widely laterally resected anterior chest walls, ossification specimens of female (n=95) and male (n=112) individuals of different age have been examined. An unexpected high significance of the already described sex dimorphism could be secured between the 20th and 50th year of age. The estimated epiphenomenological changes impress as a female calcification type with centrally in the costal cartilage situated ossifications and as a male calcification type with sheath-like calcifications situated at the cranial and caudal edges of the costicartilage. (author)

  11. Abdominal Wall Desmoid Tumor in a Pregnant Woman and Cesarean Section Managment

    Directory of Open Access Journals (Sweden)

    M Mojibian

    2013-08-01

    Full Text Available Increased risk of sporadic desmoid tumor occurs in increased estrogen level (pregnancy and surgical incisions (abdominal and thorasic. The frequency of desmoid tumors in the general population is 2.4 to 4.3 cases. The case is 30 year old woman with history of previous cesarean section. In fourth month of pregnancy,ultrasonography revealed a 5×7 cm mass in lower segment of the uterus(leiomyoma. The tumor diameter was 20 cm in term gestation. The time of cesarean , incision of skin was done above the umbilicus and below the sternum and incision of uterus was done from fondus vertically down. After delivery, the mass which was separated from uterus and located in the abdominal wall was extracted. The histological investigation diagnosed a desmoid tumor.

  12. Safety and effectiveness of the high-frequency chest wall oscillation vs intrapulmonary percussive ventilation in patients with severe COPD

    Directory of Open Access Journals (Sweden)

    Nicolini A

    2018-02-01

    Full Text Available Antonello Nicolini,1 Bruna Grecchi,2 Maura Ferrari-Bravo,3 Cornelius Barlascini4 1Respiratory Diseases Unit, Hospital of Sestri Levante, Sestri Levante, Italy; 2Rehabilitation Unit, ASL4 Chiavarese, Chiavari, Italy; 3Statistics Unit, ASL4 Chiavarese, Chiavari, Italy; 4Health Medicine Unit, Hospital of Sestri Levante, Sestri Levante, Italy Purpose: Chest physiotherapy is an important tool in the treatment of COPD. Intrapulmonary percussive ventilation (IPV and high-frequency chest wall oscillation (HFCWO are techniques designed to create a global percussion of the lung which removes secretions and probably clears the peripheral bronchial tree. We tested the hypothesis that adding IPV or HFCWO to the best pharmacological therapy (PT may provide additional clinical benefit over chest physiotherapy in patients with severe COPD. Methods: Sixty patients were randomized into three groups (20 patients in each group: IPV group (treated with PT and IPV, PT group with (treated with PT and HFCWO, and control group (treated with PT alone. Primary outcome measures included results on the dyspnea scale (modified Medical Research Council and Breathlessness, Cough, and Sputum scale (BCSS, as well as an evaluation of daily life activity (COPD Assessment Test [CAT]. Secondary outcome measures were pulmonary function testing, arterial blood gas analysis, and hematological examinations. Moreover, sputum cell counts were performed at the beginning and at the end of the study. Results: Patients in both the IPV group and the HFCWO group showed a significant improvement in the tests of dyspnea and daily life activity evaluations (modified Medical Research Council scale, BCSS, and CAT compared to the control group, as well as in pulmonary function tests (forced vital capacity, forced expiratory volume in 1 second, forced expiratory volume in 1 second/forced vital capacity%, total lung capacity, residual volume, diffusing lung capacity monoxide, maximal inspiratory

  13. Primary solitary peritoneal tumor of the abdominal wall?report of a rare case and review of the literature

    OpenAIRE

    Efthimiadis, Christoforos; Ioannidis, Aristeidis; Kofina, Konstantinia; Grigoriou, Marios

    2017-01-01

    Abstract Abdominal wall tumors are sometimes diagnosed as metastases of ovarian cancer, however, primary peritoneal tumors should be taken into consideration in the final diagnosis. A 49-year-old female patient was admitted in our Department for the excision of a pulpable abdominal wall lump, with no other abnormalities shown on imaging investigation. On histology examination, the excised specimen revealed characteristics of metastatic high-grade serous ovarian carcinoma. Total hysterectomy, ...

  14. Clinical prognostic factors and grading system for rib fracture following stereotactic body radiation therapy (SBRT) in patients with peripheral lung tumors.

    Science.gov (United States)

    Kim, Su Ssan; Song, Si Yeol; Kwak, Jungwon; Ahn, Seung Do; Kim, Jong Hoon; Lee, Jung Shin; Kim, Woo Sung; Kim, Sang-We; Choi, Eun Kyung

    2013-02-01

    Several studies reported rib fractures following stereotactic body radiation therapy (SBRT) for peripheral lung tumors. We tried to investigate risk factors and grading system for rib fractures after SBRT. Of 375 primary or metastatic lung tumors (296 patients) which were treated with SBRT at the Asan Medical Center (2006-2009), 126 lesions (118 patients) were adjacent to the chest-wall (6 months; these were investigated in the present retrospective study. Three to four fractional doses of 10-20 Gy were delivered to 85-90% iso-dose volume of the isocenter dose. Rib fracture grade was defined from follow-up CT scans as the appearance of a fracture line (Gr1), dislocation of the fractured rib by more than half the rib diameter (Gr2), or the appearance of adjacent soft tissue edema (Gr3). Chest wall pain was assessed according to the Common Terminology Criteria for Adverse Events (CTCAE) v3.0. Correlations between dose-volume data and the development of rib fracture were then analyzed. The Kaplan-Meier method, log-rank tests, and chi-square tests were used for statistical analysis. The median age of the patients was 69 years (range: 19-90). Over a median follow-up period of 22 months (range: 7-62), 48 cases of rib fracture were confirmed. Median time to rib fracture was 17 months (range: 4-52). The 2-year actuarial risk of rib fracture was 42.4%. Maximal grade was Gr1 (n=28), Gr2 (n=8), or Gr3 (n=15). The incidence of moderate to severe chest wall pain (CTCAE Gr ≥ 2) increased with maximal fracture grade (17.5% for Gr0-1 and 60.9% for Gr2-3; prib fracture in the present study. Efforts to decrease chest wall dose should be made to reduce the risk of the rib fracture, particularly in high-risk patients. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  15. Multidetector Computer Tomography: Evaluation of Blunt Chest Trauma in Adults

    International Nuclear Information System (INIS)

    Palas, J.; Matos, A.P.; Ramalho, M.; Mascarenhas, V.; Heredia, V.

    2014-01-01

    Imaging plays an essential part of chest trauma care. By definition, the employed imaging technique in the emergency setting should reach the correct diagnosis as fast as possible. In severe chest blunt trauma, multidetector computer tomography (MDCT) has become part of the initial workup, mainly due to its high sensitivity and diagnostic accuracy of the technique for the detection and characterization of thoracic injuries and also due to its wide availability in tertiary care centers. The aim of this paper is to review and illustrate a spectrum of characteristic MDCT findings of blunt traumatic injuries of the chest including the lungs, mediastinum, pleural space, and chest wall.

  16. Multidetector Computer Tomography: Evaluation of Blunt Chest Trauma in Adults

    Directory of Open Access Journals (Sweden)

    João Palas

    2014-01-01

    Full Text Available Imaging plays an essential part of chest trauma care. By definition, the employed imaging technique in the emergency setting should reach the correct diagnosis as fast as possible. In severe chest blunt trauma, multidetector computer tomography (MDCT has become part of the initial workup, mainly due to its high sensitivity and diagnostic accuracy of the technique for the detection and characterization of thoracic injuries and also due to its wide availability in tertiary care centers. The aim of this paper is to review and illustrate a spectrum of characteristic MDCT findings of blunt traumatic injuries of the chest including the lungs, mediastinum, pleural space, and chest wall.

  17. CT of blunt chest trauma in children

    International Nuclear Information System (INIS)

    Manson, D.; Babyn, P.S.; Palder, S.; Bergmann, K.

    1993-01-01

    While trauma is still the leading cause of death in the pediatric age range, it is surprising how little the CT appearances of pediatric chest injury have been investigated in the literature. We have reviewed the CT findings of blunt chest trauma in 44 children for whom chest CT examinations were requested to investigate the extent of intrathoracic injury. We noted a propensity for pulmonary contusions to be located posteriorly or posteromedially, and for them to be anatomically nonsegmental and crescentic in shape. This is possibly attributable to the relatively compliant anterior chest wall in children. The CT appearances of other major thoracic injuries are described, including pulmonary lacerations, pneumothoraces, malpositioned chest tubes, mediastinal hematomas, aortic injury, tracheobronchial injury, hemopericardium, and spinal injuries with paraspinal fluid collections. Children demonstrating findings incidental to the actual injury yet important to the subsequent therapy are also presented. We conclude that, in the event of clinically significant blunt chest trauma, the single supine chest examination in the trauma room is insufficient to adequately identify the extent of intrathoracic injury. With the exception of concern for aortic injury for which aortography is indicated, a dynamically enhanced CT scan of the thorax should be performed as clinically significant findings may result in altered therapy. (orig.)

  18. Chest wall desmoid tumours treated with definitive radiotherapy: a plan comparison of 3D conformal radiotherapy, intensity-modulated radiotherapy and volumetric-modulated arc radiotherapy

    International Nuclear Information System (INIS)

    Liu, Jia; Ng, Diana; Lee, James; Stalley, Paul; Hong, Angela

    2016-01-01

    Definitive radiotherapy is often used for chest wall desmoid tumours due to size or anatomical location. The delivery of radiotherapy is challenging due to the large size and constraints of normal surrounding structures. We compared the dosimetry of 3D conformal radiotherapy (3DCRT), intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc radiotherapy (VMAT) to evaluate the best treatment option. Ten consecutive patients with inoperable chest wall desmoid tumours (PTV range 416–4549 cm 3 ) were selected. For each patient, 3DCRT, IMRT and VMAT plans were generated and the Conformity Index (CI), organ at risk (OAR) doses and monitor unit (MU) were evaluated. The Wilcoxon signed-rank test was used to compare dose delivered to both target and OARs. The mean number of fields for 3DCRT and IMRT were 6.3 ± 2.1, 7.2 ± 1.8. The mean number of arcs for VMAT was 3.7 ± 1.1. The mean conformity index of VMAT (0.98 ± 0.14) was similar to that of IMRT (1.03 ± 0.13), both of which were significantly better than 3DCRT (1.35 ± 0.20; p = 0.005). The mean dose to lung was significantly higher for 3DCRT (11.9Gy ± 7.9) compared to IMRT (9.4Gy ± 5.4, p = 0.014) and VMAT (8.9Gy ± 4.5, p = 0.017). For the 3 females, the low dose regions in the ipsilateral breast for VMAT were generally less with VMAT. IMRT plans required 1427 ± 532 MU per fraction which was almost 4-fold higher than 3DCRT (313 ± 112, P = 0.005). Compared to IMRT, VMAT plans required 60 % less MU (570 ± 285, P = 0.005). For inoperable chest wall desmoid tumours, VMAT delivered equivalent target coverage when compared to IMRT but required 60 % less MU. Both VMAT and IMRT were superior to 3DCRT in terms of better PTV coverage and sparing of lung tissue

  19. Tumores primarios de la pared torácica Primary tumors of the thorax wall

    Directory of Open Access Journals (Sweden)

    Bárbaro Agustín Armas Pérez

    2011-09-01

    Full Text Available Introducción: se revisan aspectos teóricos en los tumores primarios de la pared torácica, sobre todo en la clasificación y en aspectos clínicos, diagnósticos y terapéuticos, con el propósito de conocer los resultados del tratamiento en el centro. Métodos: se realizó un estudio retrospectivo descriptivo para analizar los resultados del tratamiento quirúrgico en 22 pacientes (muestra con tumores primarios de la pared torácica, en un período de 15 años (enero de 1993 a diciembre de 2008, en los servicios de cirugía general y ortopedia del Hospital "Amalia Simoni" de Camagüey. Resultados: hubo ligero predominio del sexo femenino y del grupo de edad entre 17 a 44 años (media 39,4, la comorbilidad que predominó fue la hipertensión arterial, el hemitórax derecho fue el más afectado, y las costillas de la 1 a la 4 las más lesionadas, y predominaron las afecciones benignas, entre ellas, el osteocondroma. El tratamiento más utilizado fue la resección quirúrgica, y la complicación posoperatoria que predominó fue la bronconeumonía. El índice de recidiva tumoral fue alto, no siempre por cáncer. Hubo 4 fallecidos por enfermedad maligna avanzada, y no se presentaron muertes perioperatorias. Conclusiones: fueron comparados los resultados con los de otros reportes y se hallaron puntos de coincidencia en diversos aspectos, pero también discrepantes, se trata de unificar criterios para mejorar el diagnóstico y los resultados del tratamiento en estos enfermos. La mayoría de los pacientes no presentaron complicaciones, y la recidiva tumoral estuvo por encima de lo esperado. La resección tumoral siempre debe ser amplia. El resultado global fue satisfactorio.Introduction: the theoretical features in the primary tumors of the thorax wall, especially in the classification and clinical, diagnostic y therapeutical features were reviewed to know the results of treatment in our institution. Methods: a descriptive and retrospective study was

  20. Assessment of tumors of the lung apex by imaging techniques

    International Nuclear Information System (INIS)

    Rueda, J.; Serrano, F.; Pain, M.I.; Rodriguez, F.

    1996-01-01

    The purpose of this study was to analyze the value of MR in the preoperative staging of tumors of the lung apex and detection of local invasion of adjacent structures to determine its influence on the therapeutic approach. We obtained plain X-ray images in two planes, as well as CT and Mr images, in 12 patients with Pan coast tumor in whom there was surgical (n=8) or clinical (n=4) evidence of invasion. The objective was to assess local infiltration of brain stem and chest wall soft tissue, enveloping of the subclavian artery, substantial involvement of the brachial plexus and destruction of the vertebral body. In our series, MR was superior to the other imaging techniques in predicting the involvement of the structures surrounding the tumor. In conclusion, MR should be performed in a patient diagnosed by plain radiography as having an apical tumors to assess local tumor extension, while CT should be done to detect mediastinal lymph node involvement and distant metastases. 19 refs

  1. Tumor Volume-Adapted Dosing in Stereotactic Ablative Radiotherapy of Lung Tumors

    International Nuclear Information System (INIS)

    Trakul, Nicholas; Chang, Christine N.; Harris, Jeremy; Chapman, Christopher; Rao, Aarti; Shen, John; Quinlan-Davidson, Sean; Filion, Edith J.; Wakelee, Heather A.; Colevas, A. Dimitrios; Whyte, Richard I.

    2012-01-01

    Purpose: Current stereotactic ablative radiotherapy (SABR) protocols for lung tumors prescribe a uniform dose regimen irrespective of tumor size. We report the outcomes of a lung tumor volume-adapted SABR dosing strategy. Methods and Materials: We retrospectively reviewed the outcomes in 111 patients with a total of 138 primary or metastatic lung tumors treated by SABR, including local control, regional control, distant metastasis, overall survival, and treatment toxicity. We also performed subset analysis on 83 patients with 97 tumors treated with a volume-adapted dosing strategy in which small tumors (gross tumor volume <12 mL) received single-fraction regimens with biologically effective doses (BED) <100 Gy (total dose, 18–25 Gy) (Group 1), and larger tumors (gross tumor volume ≥12 mL) received multifraction regimens with BED ≥100 Gy (total dose, 50–60 Gy in three to four fractions) (Group 2). Results: The median follow-up time was 13.5 months. Local control for Groups 1 and 2 was 91.4% and 92.5%, respectively (p = 0.24) at 12 months. For primary lung tumors only (excluding metastases), local control was 92.6% and 91.7%, respectively (p = 0.58). Regional control, freedom from distant metastasis, and overall survival did not differ significantly between Groups 1 and 2. Rates of radiation pneumonitis, chest wall toxicity, and esophagitis were low in both groups, but all Grade 3 toxicities developed in Group 2 (p = 0.02). Conclusion: A volume-adapted dosing approach for SABR of lung tumors seems to provide excellent local control for both small- and large-volume tumors and may reduce toxicity.

  2. Biometric estimation of chest wall thickness in female nonradiation workers of a monazite processing plant

    International Nuclear Information System (INIS)

    Radhakrishnan, Sujata; Maniyan, C.G.; Pillai, P.M.B.; Khan, A.H.

    2003-01-01

    Chest wall thickness (CWT) was estimated in fifty four female nonradiation workers of a monazite processing plant by biometric measurements. The CWT ranged from 4.12 cm to 6.94 cm giving an average of 5.19 ± 0.76 cm. CWT was found to have very good correlation with percent Body Fat and abdominal circumference but poor correlation with Body Mass Index, Body Build Index, Slenderness, age etc. CWT increases with age especially in the upper middle-aged group (> 35 years). A single measurement of abdominal circumference can be used to estimate CWT with 94 % accuracy. A factor of 0.0587 was derived to estimate CWT from abdominal circumference. The study also showed that about 11 % of the subjects were obese. The results obtained will be very useful for the accurate measurement of Low Energy Photons like 239 Pu and 241 Am deposited in the lung. (author)

  3. Impacted thoracic foreign bodies after penetrating chest trauma.

    Science.gov (United States)

    Sersar, Sameh I; Albohiri, Khalid A; Abdelmohty, Hysam

    2016-10-01

    Retained foreign bodies in the chest may include shell fragments, bullets, shrapnel, pieces of clothing, bones, and rib fragments. The risks of removal of foreign bodies must be weighed against the complications of leaving them inside the chest. We treated 90 cases of retained intrathoracic foreign bodies in patients admitted to 3 tertiary centers in Saudi Arabia between March 2015 and March 2016. Sixty patients were injured by shrapnel, 26 had one or more bullets, 3 had broken rib fragments, and one had a metal screw. The chest wall was site of impaction in 48 cases, the lungs in 24, pleura in 14, and mediastinum in 4. Removal of the retained foreign body was carried out in 12 patients only: bullets in 9 cases, bone fragments in 2, and a metal screw in one. The predictors for removal were bullets, female sex, and mediastinal position with bilateral chest injury, especially with fracture ribs. Retained intrathoracic foreign bodies due to penetrating chest trauma are treated mainly conservatively unless there is another indication for chest exploration. © The Author(s) 2016.

  4. Dynamics of chest wall volume regulation during constant work rate exercise in patients with chronic obstructive pulmonary disease

    Energy Technology Data Exchange (ETDEWEB)

    Takara, L.S.; Cunha, T.M.; Barbosa, P.; Rodrigues, M.K.; Oliveira, M.F.; Nery, L.E. [Setor de Função Pulmonar e Fisiologia Clínica do Exercício, Disciplina de Pneumologia, Departamento de Medicina, Universidade Federal de São Paulo, São Paulo, SP (Brazil); Neder, J.A. [Setor de Função Pulmonar e Fisiologia Clínica do Exercício, Disciplina de Pneumologia, Departamento de Medicina, Universidade Federal de São Paulo, São Paulo, SP (Brazil); Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen' s University, Kingston, ON (Canada)

    2012-10-15

    This study evaluated the dynamic behavior of total and compartmental chest wall volumes [(V{sub CW}) = rib cage (V{sub RC}) + abdomen (V{sub AB})] as measured breath-by-breath by optoelectronic plethysmography during constant-load exercise in patients with stable chronic obstructive pulmonary disease. Thirty males (GOLD stages II-III) underwent a cardiopulmonary exercise test to the limit of tolerance (Tlim) at 75% of peak work rate on an electronically braked cycle ergometer. Exercise-induced dynamic hyperinflation was considered to be present when end-expiratory (EE) V{sub CW} increased in relation to resting values. There was a noticeable heterogeneity in the patterns of V{sub CW} regulation as EEV{sub CW} increased non-linearly in 17/30 “hyperinflators” and decreased in 13/30 “non-hyperinflators” (P < 0.05). EEV{sub AB} decreased slightly in 8 of the “hyperinflators”, thereby reducing and slowing the rate of increase in end-inspiratory (EI) V{sub CW} (P < 0.05). In contrast, decreases in EEV{sub CW} in the “non-hyperinflators” were due to the combination of stable EEV{sub RC} with marked reductions in EEV{sub AB}. These patients showed lower EIV{sub CW} and end-exercise dyspnea scores but longer Tlim than their counterparts (P < 0.05). Dyspnea increased and Tlim decreased non-linearly with a faster rate of increase in EIV{sub CW} regardless of the presence or absence of dynamic hyperinflation (P < 0.001). However, no significant between-group differences were observed in metabolic, pulmonary gas exchange and cardiovascular responses to exercise. Chest wall volumes are continuously regulated during exercise in order to postpone (or even avoid) their migration to higher operating volumes in patients with COPD, a dynamic process that is strongly dependent on the behavior of the abdominal compartment.

  5. The diagnosis and management of children with blunt injury of the chest.

    Science.gov (United States)

    Sartorelli, Kennith H; Vane, Dennis W

    2004-05-01

    Thoracic trauma remains a major source of morbidity and mortality in injured children, and is second only to brain injuries as a cause of death. The presence of a chest injury increases an injured child's mortality by 20-fold. Greater than 80% of chest injuries in children are secondary to blunt trauma. The compliant chest wall in children makes pulmonary contusions and rib fractures the most common chest injuries in children. Injuries to the great vessels, esophagus, and diaphragm are rare. Failure to promptly diagnose and treat these injuries results in increased morbidity and mortality.

  6. Chest X-Ray (Chest Radiography)

    Science.gov (United States)

    ... Resources Professions Site Index A-Z X-ray (Radiography) - Chest Chest x-ray uses a very small dose ... Radiography? What is a Chest X-ray (Chest Radiography)? The chest x-ray is the most commonly performed diagnostic ...

  7. Inferior hilar window on lateral chest radiographs

    International Nuclear Information System (INIS)

    Park, C.K.; Webb, W.R.; Klein, J.S.

    1990-01-01

    This paper determines the accuracy of lateral chest radiography in the detection of masses in the inferior hilar window, a normally avascular hilar region anterior to the lower lobe bronchi. Fifty patients with normal thoracic CT scans and 25 with hilar masses/adenopathy were selected retrospectively. The 75 corresponding lateral chest radiographs were blindly evaluated for visibility of the anterior walls of the lower lobe bronchi and the presence and laterality of abnormal soft tissue (>1 cm) in the inferior hilar window. Only a 7 x 7-cm square of the lateral radiograph was viewed

  8. Correlations between quality indexes of chest compression.

    Science.gov (United States)

    Zhang, Feng-Ling; Yan, Li; Huang, Su-Fang; Bai, Xiang-Jun

    2013-01-01

    Cardiopulmonary resuscitation (CPR) is a kind of emergency treatment for cardiopulmonary arrest, and chest compression is the most important and necessary part of CPR. The American Heart Association published the new Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care in 2010 and demanded for better performance of chest compression practice, especially in compression depth and rate. The current study was to explore the relationship of quality indexes of chest compression and to identify the key points in chest compression training and practice. Totally 219 healthcare workers accepted chest compression training by using Laerdal ACLS advanced life support resuscitation model. The quality indexes of chest compression, including compression hands placement, compression rate, compression depth, and chest wall recoil as well as self-reported fatigue time were monitored by the Laerdal Computer Skills and Reporting System. The quality of chest compression was related to the gender of the compressor. The indexes in males, including self-reported fatigue time, the accuracy of compression depth and the compression rate, the accuracy of compression rate, were higher than those in females. However, the accuracy of chest recoil was higher in females than in males. The quality indexes of chest compression were correlated with each other. The self-reported fatigue time was related to all the indexes except the compression rate. It is necessary to offer CPR training courses regularly. In clinical practice, it might be better to change the practitioner before fatigue, especially for females or weak practitioners. In training projects, more attention should be paid to the control of compression rate, in order to delay the fatigue, guarantee enough compression depth and improve the quality of chest compression.

  9. Sonographic evaluation of the chest in children

    Energy Technology Data Exchange (ETDEWEB)

    Reither, M.

    1983-02-01

    Although limited by osseous structures and gas the sonographic evaluation of the chest may be useful for certain conditions. Illustrated by three cases - supradiaphragmatic and parasternal tumor, subpulmonic effusion, and pleural effusion combined with a mediastinal tumor - the indications for ultrasound studies in children are discussed. In many cases the ultrasound may be helpful considering the diagnostic procedure and therapeutic consequences.

  10. Multifocal Abrikossoff's granular cell tumor of the oesophagus: Case report

    Directory of Open Access Journals (Sweden)

    Ranđelović Tomislav D.

    2008-01-01

    Full Text Available INTRODUCTION Granular cell tumors, relatively uncommon soft tissue tumors, have been a matter of debate among pathologists regarding histogenesis for a long time. Less common locations are in the aerodigestive tract including the oesophagus. CASE OUTLINE We have recently treated a rare case, a 37-year old male, who was admitted due to dysphagia and a painful swallow with occasional pharyngo-nasal regurgitation followed with a mild loss of weight. Standard clinical examination including X-ray chest, ECG and laboratory tests did not show pathological findings. Barium contrast oesophagography demonstrated multiple ovoid defects in the wall of the oesophagus. CT scan of the chest confirmed luminal narrowing owing to the tumor of the upper oesophagus. Upper endoscopy showed unusual multifocal nodular lesions alongside the oesophageal axis covered by smooth mucosa. A primary biopsy specimen taken from the largest nodules confirmed an unusual pathological finding of the granular cell tumor. Subtotal, transpleural oesophagectomy was performed and reconstruction was derived by long colon segment interposition through the posterior mediastinum. The postoperative course was uneventful. The operative specimen consisted of four ovoid tumors alongside the oesophagus (the greatest diameter 0.5-1.8, average 1.25. All verified tumors histologicaly consisted of a spindle-shaped or polygonal cells containing small and large eosinophilic granules and central nuclei. Most tumor cells showed strongly positive immunohistochemical staining for S-100 protein. These tumor cells were partially positive for p-53 and Ki-67. No lymph node metastases were detected histologically. CONCLUSION Multifocal granular cell tumor of the oesophagus is an unusual finding with low incidence, and rarely caused symptoms. Pathological features and multiplicity of such tumors emphasized malignant predisposition requiring surgical resection of the oesophagus.

  11. Use of the breast board in the radiation treatment of breast cancer on chest wall and regional lymph nodes

    International Nuclear Information System (INIS)

    Shepherd, G.S.; Krishnan, L.; Dean, R.D.; Evans, R.G.

    1987-01-01

    Optimal treatment of the breast or chest wall and regional nodes for carcinoma of the breast is complex and time consuming. A variable angled breast board has been designed to address some of the problems responsible for complications. It has three adjustable inclinations, two L-arm locations with adjustable heights, support to the contralateral arm, and a cassette holder for port films and treatment verification. The design of the board is such that it enables us to reproduce treatment position with relative ease without sacrificing the quality of treatment. Approximately 75 patients have been treated, and to date no complications due to positional error have been documented

  12. Compton radiography, 2. Clinical significance of Compton radiography of a chest phantom

    Energy Technology Data Exchange (ETDEWEB)

    Okuyama, S; Sera, K; Fukuda, H; Shishido, F [Tohoku Univ., Sendai (Japan). Research Inst. for Tuberculosis, Leprosy and Cancer; Mishina, H

    1977-09-01

    Compton radiography, a tomographic technic with Compton-scattered rays of a monochromatic gamma ray beam, was feasible of tomographing a chest phantom. The result suggested that the technic could be extended to imaging of the lung and the surrounding structures of the chest wall, mediastinum and liver in Compton tomographic mode.

  13. Irradiation of the chest wall and regional nodes as an integrated volume with IMRT for breast cancer after mastectomy: from dosimetry to clinical side-effects

    International Nuclear Information System (INIS)

    Ma Jinli; Li Jiongxiong; Zhu Chuanying

    2012-01-01

    Objective: To discuss dosimetric characteristics of an intensity-modulated radiotherapy (IMRT) technique for treating the chest wall and regional nodes as an integrated volume after modified radical mastectomy (MRM), and observe acute side-effects following irradiation. Methods: From June 2009 to August 2010, 75 patients were randomly enrolled. Of these, 41 had left-sided breast cancer. Each eligible patient had a planning CT in treatment position, on which the chest wall, supraclavicular,and infraclavicular nodes, +/-internal mammary region, were contoured as an integrated volume. A multi-beam IMRT plan was designed with the target either as a whole or two segments divided at below the clavicle head. A dose of 50 Gy in 25 fractions was prescribed to cover at least 90% of the PTV. Internal mammary region was included in 31 cases. Dose volume histograms were used to evaluate the IMRT plans. The acute side effects were followed up regularly during and after irradiation. The independent two-sample t-test was used to compare the dosimetric parameters between integrated and segmented plans. Results: Planning design was completed for all patients, including 55 integrated and 20 segmented plans, with median number of beams of 8. The conformity index and homogeneity index was 1.43 ± 0.15 and 0.14 ± 0.02, respectively. Patients with internal mammary region included in PTV had higher homogeneity index PT. The percent volume of PTV receiving > 110% prescription dose was max , D mean V 107% , and V 110% , between integrated and segmented plans (t=2.19 -2.53, P=0.013-0.031). ≥ grade 2 radiation dermatitis was identified in 3 2 patients (grade 2 in 22 patients, grade 3 in 10 patients), mostly occurred within 1 - 2 weeks after treatment. The sites of moist desquamation were anterior axillary fold (27/37) and chest wall (10/37). Only 2 patients developed grade 2 radiation pneumonitis. Conclusions: The IMRT technique applied after MRM with integrated locoregional target volume

  14. Drainage of pleural effusion in mechanically ventilated patients: time to measure chest wall compliance?

    Science.gov (United States)

    Formenti, Paolo; Umbrello, Michele; Piva, Ilaria R; Mistraletti, Giovanni; Zaniboni, Matteo; Spanu, Paolo; Noto, Andrea; Marini, John J; Iapichino, Gaetano

    2014-10-01

    Pleural effusion (PE) is commonly encountered in mechanically ventilated, critically ill patients and is generally addressed with evacuation or by fluid displacement using increased airway pressure (P(AW)). However, except when massive or infected, clear evidence is lacking to guide its management. The aim of this study was to investigate the effect of recruitment maneuvers and drainage of unilateral PE on respiratory mechanics, gas exchange, and lung volume. Fifteen critically ill and mechanically ventilated patients with unilateral PE were enrolled. A 3-step protocol (baseline, recruitment, and effusion drainage) was applied to patients with more than 400 mL of PE, as estimated by chest ultrasound. Predefined subgroup analysis compared patients with normal vs reduced chest wall compliance (C(CW)). Esophageal and P(AW)s, respiratory system, lung and C(CW)s, arterial blood gases, and end-expiratory lung volumes were recorded. In the whole case mix, neither recruitment nor drainage improved gas exchange, lung volume, or tidal mechanics. When C(CW) was normal, recruitment improved lung compliance (81.9 [64.8-104.1] vs 103.7 [91.5-111.7] mL/cm H2O, P drainage had no significant effect on total respiratory system mechanics or gas exchange, although it measurably increased lung volume (1717 vs 2150 mL, P drainage improved respiratory system and C(CW)s as well as lung volume (42.7 [38.9-50.0] vs 47.0 [43.8-63.3], P Drainage of a moderate-sized effusion should not be routinely performed in unselected population of critically ill patients. We suggest that measurement of C(CW) may help in the decision-making process. Copyright © 2014 Elsevier Inc. All rights reserved.

  15. Association of aortic wall thickness on contrast-enhanced chest CT with major cerebro-cardiac events.

    Science.gov (United States)

    Tresoldi, Silvia; Di Leo, Giovanni; Zoffoli, Elena; Munari, Alice; Primolevo, Alessandra; Cornalba, Gianpaolo; Sardanelli, Francesco

    2014-11-01

    There is a significant association between aortic atherosclerosis and previous major cardiovascular events. Particularly, thoracic aortic atherosclerosis is closely related to the degree of coronary and carotid artery disease. Thus, there is a rationale for screening the thoracic aorta in patients who undergo a chest computed tomography (CT) for any clinical question, in order to detect patients at increased risk of cerebro-cardiovascular (CCV) events. To estimate the association between either thoracic aortic wall thickness (AWT) or aortic total calcium score (ATCS) and CCV events. One hundred and forty-eight non-cardiac patients (78 men; 67 ± 12 years) underwent chest contrast-enhanced multidetector CT (MDCT). The AWT was measured at the level of the left atrium (AWTref) and at the maximum AWT (AWTmax). Correlation with clinical CCV patients' history was estimated. The value of AWTmax and of a semi-quantitative ATCS as a marker for CCV events was assessed using receiver-operating characteristic curve (ROC) analysis and multivariate regression analysis. Out of 148 patients, 59% reported sedentary lifestyle, 44% hypertension, 32% smoking, 23% hypercholesterolemia, 13% family history of cardiac disease, 12% diabetes, and 10% BMI ≥ 30 kg/m(2); 9% reported myocardial infarction, 8% aortic aneurism, 8% myocardial revascularization, and 2% ischemic stroke. Twenty-six percent of patients had a medium-to-high ATCS. Both AWTmax and AWTref correlated with hypertension and age (P < 0.002). At the ROC analysis, a 4.8 mm threshold was associated to a 90% specificity and an odds ratio of 6.3 (AUC = 0.735). Assuming as threshold the AWTmax median value (4.3 mm) of patients who suffered from at least one CCV event in their history, a negative predictive value of 90%, a RR of 3.6 and an OR of 6.3 were found. At the multivariate regression analysis, AWTmax was the only independent variable associated to the frequency of CCV events. Patients with increased thoracic

  16. Bronchiolitis obliterans following exposure to sulfur mustard: chest high resolution computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Ghanei, Mostafa E-mail: m.ghanei@bmsu.ac.ir; Mokhtari, Majid; Mohammad, Mehdi Mir; Aslani, Jafar

    2004-11-01

    Background: Pulmonary complications are known to occur in over half of the patients exposed to sulfur mustard (SM). Chemical weapons of mass destruction (WMD) including SM were used by Iraq during Iran-Iraq war between 1983 and 1989. We undertook this study to evaluate the chest high resolution computerized tomography (HRCT) as a diagnostic tool in patients with documented exposure to SM and chronic respiratory symptoms. Method: The medical records of 155 patients exposed to SM during Iran-Iraq war and suffered respiratory complications were reviewed. Chest HRCTs of these patients were examined. Ten healthy controls with no history of exposure to HD were matched for age, gender, and chest HRCT protocol applied. Results: Fifty chest HRCTs of these patients were randomly selected for this study. The most frequent findings were; air trapping 38 (76%), bronchiectasis 37 (74%), mosaic parenchymal attenuation (MPA) 36 (72%), irregular and dilated major airways 33 (66%) bronchial wall thickening (BWT) 45 (90%), and interlobular septal wall thickening (SWT) 13 (26%), respectively. Air trapping in one patient (10%) was the only positive finding in the control group. Conclusions: Chest HRCT findings of bronchiectasis, air trapping, MPA, SWT, and BWT were seen in our patients 15 years after exposure to HD. These findings suggest the diagnosis of bronchiolitis obliterans (BO). We did not encounter chest HRCT features consistent with pulmonary fibrosis.

  17. A new specifically designed forceps for chest drain insertion.

    LENUS (Irish Health Repository)

    Andrews, Emmet

    2012-02-03

    Insertion of a chest drain can be associated with serious complications. It is recommended that the drain is inserted with blunt dissection through the chest wall but there is no specific instrument to aid this task. We describe a new reusable forceps that has been designed specifically to facilitate the insertion of chest drains.A feasibility study of its use in patients who required a chest drain as part of elective cardiothoracic operations was undertaken. The primary end-point was successful and accurate placement of the drain. The operators also completed a questionnaire rating defined aspects of the procedure. The new instrument was used to insert the chest drain in 30 patients (19 male, 11 female; median age 61.5 years (range 16-81 years)). The drain was inserted successfully without the trocar in all cases and there were no complications. Use of the instrument rated as significantly easier relative to experience of previous techniques in all specified aspects. The new device can be used to insert intercostal chest drains safely and efficiently without using the trocar or any other instrument.

  18. Comparison of conventional inserts and an add-on electron MLC for chest wall irradiation of left-sided breast cancer

    International Nuclear Information System (INIS)

    Vatanen, Tero; Lahtinen, Tapani; Traneus, Erik

    2009-01-01

    Background. Collimation of irregularly shaped clinical electron beams is currently based on electron inserts made of low melting point alloys. The present investigation compares a conventional electron applicator with insert and add-on eMLC-based dose distributions in the postoperative chest wall irradiation of left-sided breast cancer. Material and methods. Voxel Monte Carlo++ (VMC++) calculated dose distributions related to electron fields were compared with 10 left-sided breast cancer patients after radical mastectomy. The prescription dose was 50 Gy at a build-up maximum. The same dose was prescribed for the ipsilateral axillary, parasternal and supraclavicular lymph nodes that were treated with photons and calculated with a pencil beam algorithm. The insert beams were shaped with 1.5 cm thick Wood's metal electron inserts in an electron applicator of a Varian 2100 C/D linac. Doses for the eMLC-shaped beams were calculated for an eMLC prototype with 2 cm thick and 5 mm wide steel leaves. The same collimator-to-surface distance (CSD) of 5.8 cm was used for both collimators. Results. The mean PTV dose was slightly higher for the eMLC plans (50.7 vs 49.5 Gy, p<0.001, respectively). The maximum doses assessed by D5% for the eMLC and insert were 60.9 and 59.1 Gy (p<0.001). The difference was due to the slightly higher doses near the field edges for the eMLC. The left lung V20 volumes were 34.5% and 34.0% (p<0.001). There was only a marginal difference in heart doses. Discussion: Despite a slight increase of maximum dose in PTV the add-on electron MLC for chest wall irradiation results in practically no differences in dose distributions compared with the present insert-based collimation

  19. Necrotizing Fasciitis of the Chest in a Neonate in Southern Nigeria

    Directory of Open Access Journals (Sweden)

    Oluwafemi Olasupo Awe

    2014-01-01

    Full Text Available We discuss the successful saving of a male neonate with necrotizing fasciitis of the chest following a hot fomentation of the umbilicus with exposure of the ribs and the pleural space on the right side. He recovered 5 weeks after admission. We stressed the need to recognize necrotizing fasciitis extending from the upper anterior abdominal wall to the chest following hot fomentation of the umbilicus. The need for multidisciplinary cooperation for excellent outcome is very important, that is, neonatologist, medical microbiologist, and plastic and chest surgeons.

  20. Insertion and fixation of fiducial markers for setup and tracking of lung tumors in radiotherapy

    International Nuclear Information System (INIS)

    Imura, Mikado; Yamazaki, Koichi; Shirato, Hiroki; Onimaru, Rikiya; Fujino, Masaharu; Shimizu, Shinichi; Harada, Toshiyuki; Ogura, Shigeaki; Dosaka-Akita, Hirotoshi; Miyasaka, Kazuo; Nishimura, Masaharu

    2005-01-01

    Purpose: Internal 1.5-mm fiducial markers were used in real-time tumor-tracking radiotherapy (RT) for lung cancer. The fixation rate of the markers using the bronchial insertion technique, reliability of the setup using markers around the target volume, dislocation of the markers after real-time tumor-tracking RT, and long-term toxicity of marker insertion were investigated. Methods and Materials: Between July 2000 and April 2004, 154 gold markers were inserted into 57 patients with peripheral lung cancer. The distances between the implanted markers in 198 measurements in 71 setups in 11 patients were measured using two sets of orthogonal diagnostic X-ray images of the real-time tumor-tracking RT system. The distance between the markers and the chest wall was also measured in a transaxial CT image on 186 occasions in 48 patients during treatment planning and during follow-up. The median treatment time was 6 days (range, 4-14 days). Results: In 115 (75%) of the 154 inserted markers, the gold marker was detected throughout the treatment period. In 122 markers detected at CT planning, 115 (94%) were detected until the end of treatment. The variation in the distances between the implanted markers was within ±2 mm in 95% and ±1 mm in 80% during treatment. The variation in the distances between the implanted markers was >2 mm in at least one direction in 9% of the setups for which reexamination with a CT scan was indicated. The fixation rate in the left upper lobe was lower than in the other lobes. A statistically significant relationship was found between a shorter distance between the markers and the chest wall and the fixation rate, suggesting that the markers in the smaller bronchial lumens fixed better than those in the larger lumens. A learning curve among the endoscopists was suggested in the fixation rate. The distance between the markers and the chest wall changed significantly within a median of 44 days (range, 16-181 days) after treatment. Conclusion: The

  1. Echocardiographic and non-gated computed tomographic findings of intrapericardial tumor and mediastinal tumor adjacent to the heart

    International Nuclear Information System (INIS)

    Ueda, Minoru; Yamada, Nobuyuki; Saito, Daiji; Haraoka, Shoichi; Tanetani, Setsuro.

    1981-01-01

    Echocardiographic and computed tomographic findings of a case of intrapericardial tumor are reported, and two other cases of mediastinal tumor are presented in a discussion of the differential diagnosis of intrapericardial from mediastinal tumors. Case report: A 7-year-old male complained of cough and dyspnea. Cardiomegaly had been pointed out at a mass X-ray examination about a month prior to the admission. Two-dimensional echocardiography revealed a massive anterior pericardial effusion and a fist-sized tumor with cystic structure. The tumor pushed the heart backward at the level of the aortic root. Non-gated computed tomography of the chest disclosed the size and location of the tumor, but failed to clarify the internal structure. The patient underwent successful removal of a tumor, 12 x 10 x 8 cm in size and 350 g in weight, originating from the left atrial wall. Histologically, the tumor was a fibrosarcomatous mesothelioma. Usually, an intrapericardial tumor is easily suspected by echocardiography by the presence of pericardial effusion, although there have been a few reports of intrapericardial tumors without pericardial effusion. Echocardiographic diagnosis of the intrapericardial tumor is difficult in such cases. Identification of the pericardium is necessary to diagnose whether a tumor is intra- or extrapericardial. This identification, however, is not always easy by echocardiography when the ultrasonic beams become tangent to the pericardium. The pericardium between the tumor and the heart could not be identified by echocardiography in our two cases of mediastinal tumor. Computed tomography is helpful in diagnosing the size and location of a mediastinal tumor. (author)

  2. Thermo-sensitive liposomes loaded with doxorubicin and lysine modified single-walled carbon nanotubes as tumor-targeting drug delivery system.

    Science.gov (United States)

    Zhu, Xiali; Xie, Yingxia; Zhang, Yingjie; Huang, Heqing; Huang, Shengnan; Hou, Lin; Zhang, Huijuan; Li, Zhi; Shi, Jinjin; Zhang, Zhenzhong

    2014-11-01

    This report focuses on the thermo-sensitive liposomes loaded with doxorubicin and lysine-modified single-walled carbon nanotube drug delivery system, which was designed to enhance the anti-tumor effect and reduce the side effects of doxorubicin. Doxorubicin-lysine/single-walled carbon nanotube-thermo-sensitive liposomes was prepared by reverse-phase evaporation method, the mean particle size was 232.0 ± 5.6 nm, and drug entrapment efficiency was 86.5 ± 3.7%. The drug release test showed that doxorubicin released more quickly at 42℃ than at 37℃. Compared with free doxorubicin, doxorubicin-lysine/single-walled carbon nanotube-thermo-sensitive liposomes could efficiently cross the cell membranes and afford higher anti-tumor efficacy on the human hepatic carcinoma cell line (SMMC-7721) cells in vitro. For in vivo experiments, the relative tumor volumes of the sarcomaia 180-bearing mice in thermo-sensitive liposomes group and doxorubicin group were significantly smaller than those of N.S. group. Meanwhile, the combination of near-infrared laser irradiation at 808 nm significantly enhanced the tumor growth inhibition both on SMMC-7721 cells and the sarcomaia 180-bearing mice. The quality of life such as body weight, mental state, food and water intake of sarcomaia 180 tumor-bearing mice treated with doxorubicin-lysine/single-walled carbon nanotube-thermo-sensitive liposomes were much higher than those treated with doxorubicin. In conclusion, doxorubicin-lysine/single-walled carbon nanotube-thermo-sensitive liposomes combined with near-infrared laser irradiation at 808 nm may potentially provide viable clinical strategies for targeting delivery of anti-cancer drugs. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  3. Indications for surgical stabilization of rib fractures in patients without flail chest: surveyed opinions of members of the Chest Wall Injury Society.

    Science.gov (United States)

    Pieracci, Fredric M; Agarwal, Suresh; Doben, Andrew; Shiroff, Adam; Lottenberg, Larwence; Whitbeck, Sarah Ann; White, Thomas W

    2018-02-01

    There are currently no evidence-based indications for surgical stabilization of rib fractures (SSRF) in patients without flail chest. The purpose of this survey was to identify patients for whom there is relative equipoise (operative vs. non-operative) in order to assist in designing a randomized clinical trial. Members of the Chest Wall Injury Society were sent an online survey, in which 18 patient scenarios were presented. The baseline patient had ≥ three displaced, contiguous fractures and had no other contraindications for surgery. This default scenario was then varied based upon patient age, degree of traumatic brain injury (TBI), fracture series location, and number of abnormal pulmonary physiologic variables (oxygen requirement, respiratory rate, incentive spirometry ability, cough, and numeric pain score). Thirty respondents provided a total of 540 answers. Overall, the majority of responses were in favor of SSRF (n = 413, 84.1%). Furthermore, the vast majority of responses indicated that some degree of pulmonary compromise was necessary to recommend SSRF (n = 44, 90.4%), with ≥ two abnormal parameters being the most common threshold (n = 156, 31.8%). Decision to recommend SSRF varied significantly by number of abnormal clinical variables, age, and degree of TBI, but not by fracture series location. Patients aged 85 years old and those with moderate TBI were the least likely to be recommended for SSRF, regardless of abnormal pulmonary physiologic variables. The most appropriate cutoff for equipoise appeared to be a patient aged 21-79 years old, with no or mild TBI, ≥ two abnormal pulmonary parameters, and regardless of fracture location (44.8% consensus for SSRF). SSRF was recommended for most patients with non-flail, displaced rib fractures. However, this recommendation was contingent upon patient age, degree of TBI, and pulmonary clinical status. Results of this survey may be used to inform inclusion criteria for a future randomized

  4. Method for determining optimal intracavitary radiotherapy conditions for carcinoma of the uterine cervix with tumor infiltration of the vaginal wall

    International Nuclear Information System (INIS)

    Tabushi, Katsuyoshi; Obata, Yasunori; Itoh, Susumu; Sakura, Mizuyoshi; Kato, Singo; Kazumoto, Tomoko; Nakamura, Yuzuru; Iinuma, T.A.; Arai, Tatsuo.

    1997-01-01

    Stage III carcinoma of the uterine cervix is occasionally accompanied by tumor infiltration of the vaginal wall. Currently, the vaginal wall has to be irradiated in the same manner as the uterine cervix. The authors have developed a system for determining the optimal irradiation conditions for treating the two regions, uterine cervix and vaginal wall, at the same time. A comparison of two methods is shown in simulation, and then a clinical case is reported. The first method consists of two treatment plans, one for the uterine cervix without tumor infiltration of the vaginal wall, and the other for the vaginal wall without carcinoma of the uterine cervix. The second, newly developed method considers the two regions together. Irradiation times of ovoid sources obtained with the second method are 15-25% less than those of the first method. Isodose curves obtained with the two methods are very different and thus the uterine cervix and vaginal wall must be considered together in order to determine irradiation conditions. (author)

  5. Microwave pumped high-efficient thermoacoustic tumor therapy with single wall carbon nanotubes.

    Science.gov (United States)

    Wen, Liewei; Ding, Wenzheng; Yang, Sihua; Xing, Da

    2016-01-01

    The ultra-short pulse microwave could excite to the strong thermoacoustic (TA) shock wave and deeply penetrate in the biological tissues. Based on this, we developed a novel deep-seated tumor therapy modality with mitochondria-targeting single wall carbon nanotubes (SWNTs) as microwave absorbing agents, which act efficiently to convert ultra-short microwave energy into TA shock wave and selectively destroy the targeted mitochondria, thereby inducing apoptosis in cancer cells. After the treatment of SWNTs (40 μg/mL) and ultra-short microwave (40 Hz, 1 min), 77.5% of cancer cells were killed and the vast majority were caused by apoptosis that initiates from mitochondrial damage. The orthotopic liver cancer mice were established as deep-seated tumor model to investigate the anti-tumor effect of mitochondria-targeting TA therapy. The results suggested that TA therapy could effectively inhibit the tumor growth without any observable side effects, while it was difficult to achieve with photothermal or photoacoustic therapy. These discoveries implied the potential application of TA therapy in deep-seated tumor models and should be further tested for development into a promising therapeutic modality for cancer treatment. Copyright © 2015 Elsevier Ltd. All rights reserved.

  6. Effectiveness of muscle coverage to manage osteomyelitis of very late onset in the irradiated chest wall

    International Nuclear Information System (INIS)

    Funayama, Emi; Minakawa, Hidehiko; Otani, Hidekazu; Saito, Noriko; Oyama, Akihiko; Furukawa, Hiroshi; Hayashi, Toshihiko; Saito, Akira; Yamamoto, Yuhei

    2012-01-01

    Radiation therapy for breast cancer has improved survival rates; however, a consequence of this is treatment-induced complications in longer-living patients. Decades after chest wall irradiation, very late onset radiation-induced osteomyelitis can develop, caused by osteoradionecrosis. This may lead to the development of small, but very refractory, skin ulcers. Many reports recommend well-vascularized tissue coverage after appropriate debridement for irradiation ulcers; however, when the ulcers are of very late onset, this sometimes causes recurrence of ulceration in non-muscle-covered areas after flap transfer. Thus, for very late onset cases, we propose treatment with an absolute muscle flap to cover both the obviously infected focus and the surrounding irradiated area. A muscle flap consisting of the entire latissimus dorsi, the shape of which is very large in the horizontal direction, satisfies this requirement. Latissimus dorsi muscle coverage for the treatment of very late onset osteomyelitis should be reappraised. (author)

  7. Possibilities of CT examinations by chest trauma

    International Nuclear Information System (INIS)

    Ftacnikova, B.

    1994-01-01

    Chest trauma represents the most frequent associated injury in multiply injured patients. The success of treatment depends also on prompt and effective diagnosis and extent of the injuries, on quality interdisciplinary approach. Author presents contributions of computed tomography (CT) in the management of 77 critically injured patients. Attention is focused on the efficacy of CT examination routinely employed in the setting of thoracic trauma and its relationship to following rationalization of treatment. CT scans of thorax is modality of choice for evaluating patients with occult pneumothorax, chest wall deformity of rib fractures, early diagnosis of lung contusion and laceration. (author). 13 figs., 1 tab., 7 refs

  8. Tumor-induced osteomalacia (TIO): atypical presentation.

    Science.gov (United States)

    Khaliq, Waseem; Cheripalli, Praveen; Tangella, Krishnarao

    2011-05-01

    Tumor-induced osteomalacia is a rare acquired condition characterized by phosphaturia, hypophosphatemia and osteomalacia. We report an unusual presentation in a 15-year-old healthy male with a two-week history of cough and chest pain. The chest radiograph showed right middle lobe opacity and chest CT revealed a mass in the extra pleural space. A biopsy showed chondro-myxoidstroma with osteoid formation. Diagnosis was confirmed with the above findings and hypophosphatemia. The patient's symptoms resolved after complete surgical excision of the mass. Tumor-induced osteomalacia, although a rare disorder, can be a diagnostic challenge, especially in patients presenting with atypical symptoms.

  9. Evaluation of the fetal abdomen by magnetic resonance imaging. Part 2: abdominal wall defects and tumors

    Directory of Open Access Journals (Sweden)

    Ana Paula Pinho Matos

    2018-05-01

    Full Text Available Abstract Although ultrasound is still the gold standard for the assessment of fetal malformations, magnetic resonance imaging (MRI has gained great prominence in recent years. In situations in which ultrasound has low sensitivity, such as maternal obesity, abdominal scarring, and oligohydramnios, MRI has proven to be a safe and accurate method. Regarding fetal abdominal wall defects, MRI appears to be widely used in the prognostic assessment of gastroschisis with intestinal atresia or of complications of omphalocele, allowing better perinatal management and parental counseling. In addition, MRI allows the assessment of local invasion of fetal abdominal tumors, with significant prognostic value for the postnatal period. In this article, we review the main MRI findings in the evaluation of fetal abdominal wall defects and tumors.

  10. Low incidence of chest wall pain with a risk-adapted lung stereotactic body radiation therapy approach using three or five fractions based on chest wall dosimetry.

    Directory of Open Access Journals (Sweden)

    Thibaud P Coroller

    Full Text Available PURPOSE: To examine the frequency and potential of dose-volume predictors for chest wall (CW toxicity (pain and/or rib fracture for patients receiving lung stereotactic body radiotherapy (SBRT using treatment planning methods to minimize CW dose and a risk-adapted fractionation scheme. METHODS: We reviewed data from 72 treatment plans, from 69 lung SBRT patients with at least one year of follow-up or CW toxicity, who were treated at our center between 2010 and 2013. Treatment plans were optimized to reduce CW dose and patients received a risk-adapted fractionation of 18 Gy×3 fractions (54 Gy total if the CW V30 was less than 30 mL or 10-12 Gy×5 fractions (50-60 Gy total otherwise. The association between CW toxicity and patient characteristics, treatment parameters and dose metrics, including biologically equivalent dose, were analyzed using logistic regression. RESULTS: With a median follow-up of 20 months, 6 (8.3% patients developed CW pain including three (4.2% grade 1, two (2.8% grade 2 and one (1.4% grade 3. Five (6.9% patients developed rib fractures, one of which was symptomatic. No significant associations between CW toxicity and patient and dosimetric variables were identified on univariate nor multivariate analysis. CONCLUSIONS: Optimization of treatment plans to reduce CW dose and a risk-adapted fractionation strategy of three or five fractions based on the CW V30 resulted in a low incidence of CW toxicity. Under these conditions, none of the patient characteristics or dose metrics we examined appeared to be predictive of CW pain.

  11. Automatic segmentation of tumor-laden lung volumes from the LIDC database

    Science.gov (United States)

    O'Dell, Walter G.

    2012-03-01

    The segmentation of the lung parenchyma is often a critical pre-processing step prior to application of computer-aided detection of lung nodules. Segmentation of the lung volume can dramatically decrease computation time and reduce the number of false positive detections by excluding from consideration extra-pulmonary tissue. However, while many algorithms are capable of adequately segmenting the healthy lung, none have been demonstrated to work reliably well on tumor-laden lungs. Of particular challenge is to preserve tumorous masses attached to the chest wall, mediastinum or major vessels. In this role, lung volume segmentation comprises an important computational step that can adversely affect the performance of the overall CAD algorithm. An automated lung volume segmentation algorithm has been developed with the goals to maximally exclude extra-pulmonary tissue while retaining all true nodules. The algorithm comprises a series of tasks including intensity thresholding, 2-D and 3-D morphological operations, 2-D and 3-D floodfilling, and snake-based clipping of nodules attached to the chest wall. It features the ability to (1) exclude trachea and bowels, (2) snip large attached nodules using snakes, (3) snip small attached nodules using dilation, (4) preserve large masses fully internal to lung volume, (5) account for basal aspects of the lung where in a 2-D slice the lower sections appear to be disconnected from main lung, and (6) achieve separation of the right and left hemi-lungs. The algorithm was developed and trained to on the first 100 datasets of the LIDC image database.

  12. Imaging of breast tumors using MR-elastography

    International Nuclear Information System (INIS)

    Lorenzen, J.; Sinkus, R.; Leussler, C.; Dargatz, M.; Roeschmann, P.; Schrader, D.; Lorenzen, M.

    2001-01-01

    Purpose: Imaging of breast tumors using MR-Elastography. Material and method: Low-frequency mechanical waves are transmitted into breast-tissue by means of an oscillator. The local characteristics of the mechanical wave are determined by the elastic properties of the tissue. By means of a motion-sensitive spin-echo-sequence these waves can be displayed within the phase of the MR image. Subsequently, these images can be used to reconstruct the local distribution of elasticity. In-vivo measurements were performed in 3 female patients with malignant tumors of the breast. Results: All patients tolerated the measurement set-up without any untoward sensation in the contact area of skin and oscillator. The waves completely penetrated the breast, encompassing the axilla and regions close to the chest wall. All tumors were localized by MRE as structures of markedly stiffer tissue when compared to the surrounding tissue. Furthermore, in one patient, a metastasis in an axillary lymph node was detected. In all patients, local regions of increased elasticity were found in the remaining parenchyma of the breast, which, however, did not reach the high levels of elasticity found in the tumors. Conclusion: MRE is an imaging modality enabling adjunct tissue differentiation of mammary tumors. (orig.) [de

  13. Picture quiz: a case of sudden severe chest pain.

    Science.gov (United States)

    Rabia, Mustafa Abu; Sullivan, P; Stivaros, Stavros M

    2007-01-01

    An 18-year-old male with no previous medical history presented to hospital with sudden onset of acute epigastric pain radiating to the anterior chest wall and both shoulders. There was no history of recent trauma and he had not been vomiting.

  14. Rib fractures after percutaneous radiofrequency and microwave ablation of lung tumors: incidence and relevance.

    Science.gov (United States)

    Alexander, Erica S; Hankins, Carol A; Machan, Jason T; Healey, Terrance T; Dupuy, Damian E

    2013-03-01

    To retrospectively identify the incidence and probable risk factors for rib fractures after percutaneous radiofrequency ablation (RFA) and microwave ablation (MWA) of neoplasms in the lung and to identify complications related to these fractures. Institutional review board approval was obtained for this HIPAA-compliant retrospective study. Study population was 163 patients treated with MWA and/or RFA for 195 lung neoplasms between February 2004 and April 2010. Follow-up computed tomographic images of at least 3 months were retrospectively reviewed by board-certified radiologists to determine the presence of rib fractures. Generalized estimating equations were performed to assess the effect that patient demographics, tumor characteristics, treatment parameters, and ablation zone characteristics had on development of rib fractures. Kaplan-Meier curve was used to estimate patients' probability of rib fracture after ablation as a function of time. Clinical parameters (ie, pain in ribs or chest, organ damage caused by fractured rib) were evaluated for patients with confirmed fracture. Rib fractures in proximity to the ablation zone were found in 13.5% (22 of 163) of patients. Estimated probability of fracture was 9% at 1 year and 22% at 3 years. Women were more likely than were men to develop fracture after ablation (P = .041). Patients with tumors closer to the chest wall were more likely to develop fracture (P = .0009), as were patients with ablation zones that involved visceral pleura (P = .039). No patients with rib fractures that were apparently induced by RFA and MWA had organ injury or damage related to fracture, and 9.1% (2 of 22) of patients reported mild pain. Rib fractures were present in 13.5% of patients after percutaneous RFA and MWA of lung neoplasms. Patients who had ablations performed close to the chest wall should be monitored for rib fractures.

  15. Analysis the findings of chest radiograph and CT scan in 217 acute thoracic trauma

    International Nuclear Information System (INIS)

    Huang Shaoying

    2005-01-01

    Objective: To evaluate chest radiograph and CT scan in assessing acute thoracic trauma. Methods: Retrospectively analyzed the findings of chest radiograph and CT scan in 217 cases of acute thoracic trauma and positive rate of each modality was compared. Results: The positive rate of rib and clavicle fracture was higher in chest radiograph than these in CT scan. But the positive rate of chest wall hematoma, mediastinum and subcutaneous emphysema, pneumothorax, hydropneumothorax, damage of lung parenchyma and traumatic pulmonary atelectasis was higher in CT scan than those in chest radiograph. Conclusion: The application of the combined imaging modalities improves assessing of acute thoracic trauma, because the imaging manifestation of the lesion is various. (authors)

  16. [Imaging of pleural diseases: evaluation of imaging methods based on chest radiography].

    Science.gov (United States)

    Poyraz, Necdet; Kalkan, Havva; Ödev, Kemal; Ceran, Sami

    2017-03-01

    The most commonly employed radiologic method in diagnosis of pleural diseases is conventional chest radiograph. The commonest chest- X-Ray findings are the presence of pleural effusion and thickening. Small pleural effusions are not readily identified on posteroanterior chest radiograph. However, lateral decubitus chest radiograph and chest ultrasonography may show small pleural effusions. These are more efficient methods than posteroanterior chest radiograph in the erect position for demonstrating small amounts of free pleural effusions. Chest ultrasonograph may be able to help in distinguishing the pleural pathologies from parenchymal lesions. On chest radiograph pleural effusions or pleural thickening may obscure the visibility of the underlying disease or parenchymal abnormality. Thus, computed tomography (CT) may provide additional information of determining the extent and severity of pleural disease and may help to differentiate malign pleural lesions from the benign ones. Moreover, CT may provide the differentiation of parenchmal abnormalities from pleural pathologies. CT (coronal and sagittal reformatted images) that also show invasion of chest wall, mediastinum and diaphragm, as well as enlarged hilar or mediastinal lymph nodes. Standart non-invasive imaging techniques may be supplemented with magnetic resonans imaging (MRI).

  17. Chest radiography after minor chest trauma

    Energy Technology Data Exchange (ETDEWEB)

    Rossen, B.; Laursen, N.O.; Just, S.

    The results of chest radiography in 581 patients with blunt minor thoracic trauma were reviewed. Frontal and lateral views of the chest indicated pathology in 72 patients (12.4%). Pneumothorax was present in 16 patients; 4 had hemothorax. The physical examination and the results of chest radiography were not in accordance because in 6(30%) of the 20 patients with hemo/-pneumothorax the physical examination was normal. Consequently there is wide indication for chest radiography after minor blunt chest trauma.

  18. Chest radiography after minor chest trauma

    International Nuclear Information System (INIS)

    Rossen, B.; Laursen, N.O.; Just, S.

    1987-01-01

    The results of chest radiography in 581 patients with blunt minor thoracic trauma were reviewed. Frontal and lateral views of the chest indicated pathology in 72 patients (12.4%). Pneumothorax was present in 16 patients; 4 had hemothorax. The physical examination and the results of chest radiography were not in accordance because in 6(30%) of the 20 patients with hemo/-pneumothorax the physical examination was normal. Consequently there is wide indication for chest radiography after minor blunt chest trauma. (orig.)

  19. Combined detection of CEA, CYFRA21-1, NSE and SF levels in chest effusion fluid for differentiation of malignant hydrothorax from tuberculous hydrothorax

    International Nuclear Information System (INIS)

    Wang Jianguo; Zhai Shijun; Liu Ruihua; Quan Min

    2003-01-01

    Objective: To improve the diagnostic accuracy in the differentiation of malignant hydrothorax from tuberculous hydrothorax by combined detection of the levels of the four tumor markers in chest effusion fluid. Methods: The chest fluid levels of the four tumor markers were determined with RIA (for CYFRA21-1 and NSE) and chemiluminescence method (for CEA and SF) in 69 patients with tuberculous hydrothorax and 107 patients with malignant hydrothorax. Results: The positive rate and mean levels of the four tumor markers in malignant chest fluid were significantly higher than those in tuberculous chest fluid (p<0.01). Positive rate of combined detection in malignant chest fluid was 95.33%. Conclusion: Detection of chest fluid CEA, CYFRA21-1, NSE and SF levels is very useful for the differentiation of malignant hydrothorax from tuberculous hydrothorax. Combined detection of the four markers will greatly improve the diagnostic accuracy

  20. Chest Wall Volume Receiving >30 Gy Predicts Risk of Severe Pain and/or Rib Fracture After Lung Stereotactic Body Radiotherapy

    International Nuclear Information System (INIS)

    Dunlap, Neal E.; Cai, Jing; Biedermann, Gregory B.; Yang, Wensha; Benedict, Stanley H.; Sheng Ke; Schefter, Tracey E.; Kavanagh, Brian D.; Larner, James M.

    2010-01-01

    Purpose: To identify the dose-volume parameters that predict the risk of chest wall (CW) pain and/or rib fracture after lung stereotactic body radiotherapy. Methods and Materials: From a combined, larger multi-institution experience, 60 consecutive patients treated with three to five fractions of stereotactic body radiotherapy for primary or metastatic peripheral lung lesions were reviewed. CW pain was assessed using the Common Toxicity Criteria for pain. Peripheral lung lesions were defined as those located within 2.5 cm of the CW. A minimal point dose of 20 Gy to the CW was required. The CW volume receiving ≥20, ≥30, ≥40, ≥50, and ≥60 Gy was determined and related to the risk of CW toxicity. Results: Of the 60 patients, 17 experienced Grade 3 CW pain and five rib fractures. The median interval to the onset of severe pain and/or fracture was 7.1 months. The risk of CW toxicity was fitted to the median effective concentration dose-response model. The CW volume receiving 30 Gy best predicted the risk of severe CW pain and/or rib fracture (R 2 = 0.9552). A volume threshold of 30 cm 3 was observed before severe pain and/or rib fracture was reported. A 30% risk of developing severe CW toxicity correlated with a CW volume of 35 cm 3 receiving 30 Gy. Conclusion: The development of CW toxicity is clinically relevant, and the CW should be considered an organ at risk in treatment planning. The CW volume receiving 30 Gy in three to five fractions should be limited to 3 , if possible, to reduce the risk of toxicity without compromising tumor coverage.

  1. Ultrasonographic examination in chest disease

    Energy Technology Data Exchange (ETDEWEB)

    Choe, K.O.; Lee, J.D.; Yoo, H.S. [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    1983-12-15

    Ultrasonographic examination is not widely applied to chest disease, but is may give useful information when the acoustic window for a lesion exist. We did perform ultrasound examination in 68 cases of chest disease. 1. The cases of pleural diseases was predominant; pleural effusion 35 cases, pleural metastatic tumor 2 case, mesothelioma 2 cases and fibrous thickening 1 case, total 40 cases. It was useful to differentiate pleural effusion and fibrous thickening or parenchymal lesion simulating pleural disease, to localize the optimal aspiration site for a loculated empyema, to detect pleural bumorhidden by effusion such as metastatic tumor or mesothelioma. 2. 15 cases of parenchymal lesion and 2 cases of extra pleural mass was examined. The echo pattern of consolidation and atelectasis shows typical multiple tubular streaks within the echogenic area. The echogenicity of the peripheral mass due to primary bronchogenic carcinoma, parenchymal or extrapleural metastatic tumor and granuloma were compared. 3. In the cases of pleural or parenchymal cystic lesions, such as loculated empyema or lung abscess, because of strong reverberation artifact from posterior border of the lesion, the prediction of cystic and solid lesion is sometimes difficult. 4. In 7 cases of mediastinal lesion, cystic lesion show free echo and posterior enhancement. In contrast, solid or fat component show characteristic echo pattern. 5. In the cases of juxta diaphragmatic lesion, sonogram can confirm the underlying intraabdominal pathology, in this case subphrenic abscess

  2. Ultrasonographic examination in chest disease

    International Nuclear Information System (INIS)

    Choe, K.O.; Lee, J.D.; Yoo, H.S.

    1983-01-01

    Ultrasonographic examination is not widely applied to chest disease, but is may give useful information when the acoustic window for a lesion exist. We did perform ultrasound examination in 68 cases of chest disease. 1. The cases of pleural diseases was predominant; pleural effusion 35 cases, pleural metastatic tumor 2 case, mesothelioma 2 cases and fibrous thickening 1 case, total 40 cases. It was useful to differentiate pleural effusion and fibrous thickening or parenchymal lesion simulating pleural disease, to localize the optimal aspiration site for a loculated empyema, to detect pleural bumorhidden by effusion such as metastatic tumor or mesothelioma. 2. 15 cases of parenchymal lesion and 2 cases of extra pleural mass was examined. The echo pattern of consolidation and atelectasis shows typical multiple tubular streaks within the echogenic area. The echogenicity of the peripheral mass due to primary bronchogenic carcinoma, parenchymal or extrapleural metastatic tumor and granuloma were compared. 3. In the cases of pleural or parenchymal cystic lesions, such as loculated empyema or lung abscess, because of strong reverberation artifact from posterior border of the lesion, the prediction of cystic and solid lesion is sometimes difficult. 4. In 7 cases of mediastinal lesion, cystic lesion show free echo and posterior enhancement. In contrast, solid or fat component show characteristic echo pattern. 5. In the cases of juxta diaphragmatic lesion, sonogram can confirm the underlying intraabdominal pathology, in this case subphrenic abscess

  3. Frequency and Risk Factors of Various Complications After Computed Tomography-Guided Radiofrequency Ablation of Lung Tumors

    International Nuclear Information System (INIS)

    Okuma, Tomohisa; Matsuoka, Toshiyuki; Yamamoto, Akira; Oyama, Yoshimasa; Toyoshima, Masami; Nakamura, Kenji; Inoue, Yuichi

    2008-01-01

    Objective. To retrospectively determine the frequency and risk factors of various side effects and complications after percutaneous computed tomography-guided radiofrequency (RF) ablation of lung tumors. Methods. We reviewed and analyzed records of 112 treatment sessions in 57 of our patients (45 men and 12 women) with unresectable lung tumors treated by ablation. Risk factors, including sex, age, tumor diameter, tumor location, history of surgery, presence of pulmonary emphysema, electrode gauge, array diameter, patient position, maximum power output, ablation time, and minimum impedance during ablation, were analyzed using univariate and multivariate analyses. Results. Total rates of side effects and minor and major complications occurred in 17%, 50%, and 8% of treatment sessions, respectively. Side effects, including pain during ablation (46% of sessions) and pleural effusion (13% of sessions), occurred with RF ablation. Minor complications, including pneumothorax not requiring chest tube drainage (30% of sessions), subcutaneous emphysema (16% of sessions), and hemoptysis (9% of sessions) also occurred after the procedure. Regarding major complications, three patients developed fever >38.5 deg. C; three patients developed abscesses; two patients developed pneumothorax requiring chest tube insertion; and one patient had air embolism and was discharged without neurologic deficit. Univariate and multivariate analyses suggested that a lesion located ≤1 cm of the chest wall was significantly related to pain (p < 0.01, hazard index 5.76). Risk factors for pneumothorax increased significantly with previous pulmonary surgery (p < 0.05, hazard index 6.1) and presence of emphysema (p <0.01, hazard index 13.6). Conclusion. The total complication rate for all treatment sessions was 58%, and 25% of patients did not have any complications after RF ablation. Although major complications can occur, RF ablation of lung tumors can be considered a safe and minimally invasive

  4. Rib Tuberculosis Treatment By Steel Greft which has Fractured after a Thoracic Trauma: 10-year Follow up Case

    Directory of Open Access Journals (Sweden)

    Murat Oncel

    2013-04-01

    Full Text Available Rib tuberculosis is an uncommon form of osteoarticular tuberculosis. The physical and radiological examination can often mimic other conditions ,including primary and metastatic chest wall tumors . A 60 year-old male patient had a mass in the chest wall. Surgery aiming diagnosis and treatment based on physical and radiological findings were performed. Histopathological examination of the mass specimen revealed tuberculosis. The chest wall defect was supported with a stell greft after the six month . The patient had fallen from stairs and hit his chest six year after . The case had a significant fracture in the steel graft . This is unusual manifestation of chest wall grefts . This, chest wall, showing a softer steel materials should be used in grafts that would break a long-term follow-up is presented [Cukurova Med J 2013; 38(2.000: 295-298

  5. Quantitative evaluation of interstitial pneumonia using 3D-curved high-resolution CT imaging parallel to the chest wall: A pilot study.

    Directory of Open Access Journals (Sweden)

    Hiroyasu Umakoshi

    Full Text Available To quantify the imaging findings of patients with interstitial pneumonia (IP and emphysema using three-dimensional curved high-resolution computed tomography (3D-cHRCT at a constant depth from the chest wall, and compare the results to visual assessment of IP and each patient's diffusing capacity of the lungs for carbon monoxide (DLco.We retrospectively reviewed the axial CT findings and pulmonary function test results of 95 patients with lung cancer (72 men and 23 women, aged 45-84 years with or without IP, as follows: non-IP (n = 47, mild IP (n = 31, and moderate IP (n = 17. The 3D-cHRCT images of the lung at a 1-cm depth from the chest wall were reconstructed automatically using original software; total area (TA, high-attenuation area (HAA >-500 HU, and low-attenuation area (LAA <-950 HU were calculated on a workstation. The %HAA and %LAA were calculated as follows: [Formula: see text], and [Formula: see text].The %HAA and %LAA respective values were 3.2±0.9 and 27.7±8.2, 3.9±1.2 and 27.6±5.9, and 6.9±2.2 and 25.4±8.7 in non-IP, mild IP, and moderate IP patients, respectively. There were significant differences in %HAA between the 3 groups of patients (P<0.001, but no differences in %LAA (P = 0.558. Multiple linear regression analysis revealed that %HAA and %LAA were negatively correlated with predicted DLco (standard partial regression coefficient [b*] = -0.453, P<0.001; b* = -0.447, P<0.001, respectively.The %HAA and %LAA values computed using 3D-cHRCT were significantly correlated with DLco and may be important quantitative parameters for both IP and emphysema.

  6. Metastatic Sarcomatoid Squamous Cell Carcinoma of the Cervix Presenting with Chest Mass

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    Lilit Karapetyan

    2017-01-01

    Full Text Available Background. Sarcomatoid squamous cell carcinoma is a rare and aggressive form of cervical cancer. We report a case of metastatic sarcomatoid squamous cell carcinoma (SSCC of cervix that presented with an anterior chest wall mass. Case. A 43-year-old Hispanic female presented with a two-month history of a central chest wall mass. The patient’s only past medical history was SSCC of the cervix, stage IIB, diagnosed two years priorly. She underwent neoadjuvant chemoradiation therapy (CRT with cisplatin followed by radical hysterectomy. Surgical margins were positive which led to adjuvant CRT with carboplatin and paclitaxel. PET scan 4 months after the postoperative treatment was negative for recurrence and metastatic disease. On current presentation, the CT chest revealed anterior mediastinal destructive soft tissue mass involving sternum, and the biopsy showed SSCC. The patient received palliative radiation therapy to her chest with improvement in pain and ability to swallow. After discussing the prognosis she refused further chemotherapy and decided on hospice care. Conclusion. Despite good response to first-line therapy, SSCC tends to recur early and does not respond to second-line therapy. Radiation therapy seems to be the most effective modality for treatment, but randomized controlled trials of therapy are impractical.

  7. Limited value of interlaced ECG-gated radiography in the presence of a normal chest radiograph

    International Nuclear Information System (INIS)

    Chen, J.T.T.; Ravin, C.E.; Handel, D.

    1984-01-01

    Twenty-seven patients with normal posteroanterior and lateral chest radiographs, who were undergoing cardiac catheterization because of symptoms strongly suggesting coronary artery disease, also had posteroanterior and lateral interlaced electrocardiogram-gated radiographs made. In 14 patients, the interlaced radiography system underestimated (suggested hypokinesia) the wall motion, which was normal on cardiac catheterization. In two cases the system overestimated the wall motion, in two others it both under- and overestimated the motion, and in only nine cases was the correlation correct. These data suggest that the technique is of limited application, particularly in cases in which the routine chest radiographs are normal

  8. Bifid rib – usefulness of chest ultrasound. A case report

    Directory of Open Access Journals (Sweden)

    Magdalena Kryger

    2013-12-01

    Full Text Available The paper presents the possibility of using ultrasonography in the diagnosis of a congenital rib anomaly in the form of bifid rib. Bifid rib is a rare congenital abnormality of anterior chest wall. It manifests as a chest “lump.” Such lesions are detected during a routine physical examination or chest X-ray which is often performed for other reasons. The overall prevalence of bifid rib is estimated at 0.15% to 3.4% (mean 2% and it accounts for approximately 20% of all congenital rib anomalies. It is usually an unilateral lesion. The cases presented herein constitute the first pediatric cases in the available literature in which bifid rib anomaly was visualized by ultrasound examination.

  9. A simple isocentric technique for irradiation of the breast, chest wall and peripheral lymphatics

    International Nuclear Information System (INIS)

    Podgorsak, E.B.; Gosselin, M.; Pla, M.; Kim, T.H.; Freeman, C.R.

    1984-01-01

    The major problem with the standard technique for irradiation of the breast or chest wall and peripheral lymphatics is field matching at the junction between the supraclavicular and tangential fields. Overdosing or underdosing across the junctions is unavoidable because of beam divergence. Various techniques using a half-blocked supraclavicular field in conjunction with special tangential fields have been introduced recently to eliminate the junction problem; they are, however, complicated, involving couch motions and machine isocentre repositioning when changing from the supraclavicular to the tangential fields. The breast treatment technique used by the authors over the past twelve months utilises a supraclavicular half-blocked field, two tangential half-blocked fields and an optional posterior axillary field. The technique is simple and easy to set up since the same machine isocentre is used for all treatment fields and no couch movement or patient repositioning is required. The same half-block collimator used to define the caudad border of the supraclavicular field is used to define the cephalad edges of the two tangential fields. The margin of error of treatment is reduced and the dose measurements demonstrate excellent dose homogeneity through the entire treatment volume with no overdose or underdose at the field junction. (author)

  10. Magnetic resonance imaging of the chest: current and new applications, with an emphasis on pulmonology

    Energy Technology Data Exchange (ETDEWEB)

    Santos, Marcel Koenigkam; Mauad, Fernando Marum, E-mail: marcelk46@yahoo.com.b [Universidade de Sao Paulo (HC/FMRP/USP), Ribeirao Preto, SP (Brazil). Faculdade de Medicina. Hospital das Clinicas; Elias Junior, Jorge; Muglia, Valdair Francisco [Universidade de Sao Paulo (FMRP/USP), Ribeirao Preto, SP (Brazil). Faculdade de Medicina. Secao de Radiologia

    2011-03-15

    The objective of the present review study was to present the principal applications of magnetic resonance imaging (MRI) of the chest, including the description of new techniques. Over the past decade, this method has evolved considerably because of the development of new equipment, including the simultaneous interconnection of phased-array multiple radiofrequency receiver coils and remote control of the table movement, in addition to faster techniques of image acquisition, such as parallel imaging and partial Fourier acquisitions, as well as the introduction of new contrast agents. All of these advances have allowed MRI to gain ground in the study of various pathologies of the chest, including lung diseases. Currently, MRI is considered the modality of choice for the evaluation of lesions in the mediastinum and in the chest wall, as well as of superior sulcus tumors. However, it can also facilitate the diagnosis of lung, pleural, and cardiac diseases, as well as of those related to the pulmonary vasculature. Pulmonary MRI angiography can be used in order to evaluate various pulmonary vascular diseases, and it has played an ever greater role in the study of thromboembolism. Because cardiac MRI allows morphological and functional assessment in the same test, it has also become part of the clinical routine in the evaluation of various cardiac diseases. Finally, the role of MRI has been extended to the identification and characterization of pulmonary nodules, the evaluation of airway diseases, and the characterization of pleural effusion. (author)

  11. Improved chest expansion in idiopathic scoliosis after intensive, multiple-modality, nonsurgical treatment in an adult.

    Science.gov (United States)

    Hawes, M C; Brooks, W J

    2001-08-01

    This case report documents a substantial increase in chest wall expansion in a middle-aged woman with stable right thoracic spinal curvature due to idiopathic scoliosis. Treatment involved intensive psychological and mobilization therapies, including comprehensive manipulative medicine treatments and daily manual traction. Over an 8-year period, a 6-cm increase in resting chest circumference (in the absence of weight gain) and a 7.5-cm increase in chest expansion were correlated with a substantial reduction of incidence of respiratory infections.

  12. Novel computed tomographic chest metrics to detect pulmonary hypertension

    International Nuclear Information System (INIS)

    Chan, Andrew L; Juarez, Maya M; Shelton, David K; MacDonald, Taylor; Li, Chin-Shang; Lin, Tzu-Chun; Albertson, Timothy E

    2011-01-01

    Early diagnosis of pulmonary hypertension (PH) can potentially improve survival and quality of life. Detecting PH using echocardiography is often insensitive in subjects with lung fibrosis or hyperinflation. Right heart catheterization (RHC) for the diagnosis of PH adds risk and expense due to its invasive nature. Pre-defined measurements utilizing computed tomography (CT) of the chest may be an alternative non-invasive method of detecting PH. This study retrospectively reviewed 101 acutely hospitalized inpatients with heterogeneous diagnoses, who consecutively underwent CT chest and RHC during the same admission. Two separate teams, each consisting of a radiologist and pulmonologist, blinded to clinical and RHC data, individually reviewed the chest CT's. Multiple regression analyses controlling for age, sex, ascending aortic diameter, body surface area, thoracic diameter and pulmonary wedge pressure showed that a main pulmonary artery (PA) diameter ≥29 mm (odds ratio (OR) = 4.8), right descending PA diameter ≥19 mm (OR = 7.0), true right descending PA diameter ≥ 16 mm (OR = 4.1), true left descending PA diameter ≥ 21 mm (OR = 15.5), right ventricular (RV) free wall ≥ 6 mm (OR = 30.5), RV wall/left ventricular (LV) wall ratio ≥0.32 (OR = 8.8), RV/LV lumen ratio ≥1.28 (OR = 28.8), main PA/ascending aorta ratio ≥0.84 (OR = 6.0) and main PA/descending aorta ratio ≥ 1.29 (OR = 5.7) were significant predictors of PH in this population of hospitalized patients. This combination of easily measured CT-based metrics may, upon confirmatory studies, aid in the non-invasive detection of PH and hence in the determination of RHC candidacy in acutely hospitalized patients

  13. Evaluation of the necessity for chest drain placement following thoracoscopic wedge resection.

    Science.gov (United States)

    Lu, Ting-Yu; Chen, Jian-Xun; Chen, Pin-Ru; Lin, Yu-Sen; Chen, Chien-Kuang; Kao, Pei-Yu; Huang, Tzu-Ming; Fang, Hsin-Yuan

    2017-05-01

    To evaluate the outcomes of patients who underwent thoracoscopic wedge resection without chest drain placement. The subjects of this retrospective study were 89 patients, who underwent thoracoscopic wedge resection at our hospital between January, 2013 and July, 2015. A total of 45 patients whose underlying condition did not meet the following criteria were assigned to the "chest drain placement group" (group A): peripheral lesions, healthy lung parenchyma, no intraoperative air leaks, hemorrhage or effusion accumulation, and no pleural adhesion. The other 44 patients whose underlying condition met the criteria were assigned to the "no chest drain placement group" (group B). Patient characteristics, specimen data, and postoperative conditions were analyzed and compared between the groups. Group A patients had poorer forced expiratory volume in one second (FEV1) values, less normal spirometric results, significantly higher resected lung volume, a greater maximum tumor-pleura distance, and a larger maximum tumor size. They also had a longer postoperative hospital stay. There was no difference between the two groups in postoperative complications. Avoiding chest drain placement after a thoracoscopic wedge resection appears to be safe and beneficial for patients who have small peripheral lesions and healthy lung parenchyma.

  14. Chest wall tumor at relapse of multiple myeloma

    African Journals Online (AJOL)

    EB

    smoker (2 packs per day). He was admitted to our department for thoracic pain, persistent and increasing. He also complained of mild shortness of breath and poor appetite. Initial physical examination was normal. Laboratory investigations showed a hemoglobin of 12 g/dL, MCV of 83fL, white cell count of 3,900/ L and ...

  15. Mitral valve plasty for mitral regurgitation after blunt chest trauma.

    Science.gov (United States)

    Kumagai, H; Hamanaka, Y; Hirai, S; Mitsui, N; Kobayashi, T

    2001-06-01

    A 21 year-old woman was admitted to our hospital because of chest and back pain after blunt chest trauma. On admission, consciousness was clear and a physical examination showed labored breathing. Her vital signs were stable, but her breathing gradually worsened, and artificial respiration was started. The chest roentgenogram and a subsequent chest computed tomographic scans revealed contusions, hemothorax of the left lung and multiple rib fractures. A transthoracic echocardiography (TTE) revealed normal left ventricular wall motion and mild mitral regurgitation (MR). TTE was carried out repeatedly, and revealed gradually progressive MR and prolapse of the posterior medial leaflet, although there was no congestive heart failure. After her general condition had recovered, surgery was performed. Intraoperative transesophageal echocardiography (TEE) revealed torn chordae at the posterior medial leaflet. The leaflet where the chorda was torn was cut and plicated, and posterior mitral annuloplasty was performed using a prosthetic ring. One month later following discharge, the MR had disappeared on TTE.

  16. Endo-laparoscopic rendezvous approach for pericardia with gastric posterior wall of gastrointestinal stromal tumor: analysis of 52 consecutive cases.

    Science.gov (United States)

    Ding, Po; Zhao, Yongjie

    2014-12-01

    Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor in the gastrointestinal tract and most frequently developed in the stomach, and surgical therapy is limited on removal of the tumor lesion. The aim of this study was to investigate the clinical values of endo-laparoscopic rendezvous approach for pericardial GISTs within gastric posterior wall. Surgical outcome and clinical data of 52 patients with pericardial GISTs within gastric posterior wall treated at Tianjin Peoples' Hospital from January 2004 to October 2013 were analyzed. Endo-laparoscopic rendezvous approach was used as an operative procedure for tumor resection ranged from 10 to 50 mm. Endoscopic ultrasound, computed tomography and microscopic findings all certified the gastric spindle type GIST locating in the submucosa to muscle proper. Endo-laparoscopic rendezvous approach was attempted in 52 patients (male/female: 31/21) with median age of 51 years (25-71 years). The median operating time was 80 min (range: 40-120 min) and median intra-operative blood loss was 26 ml (range: 10-50 ml). The median hospital stay was 5 days (range: 4-6 days), while the median tumor size was 25 mm (range: 7-50 mm). All operative margins were clear. There were no recurrences or metastases of all patients in a median follow-up of 24 months (range: 6-36 months). Endo-laparoscopic rendezvous approach is considered to represent the next revolution in surgery. The new technique is reliable and effective in clinical application, due to the advantages of accurate and quick localization for pericardial GIST within gastric posterior wall.

  17. Bone and bone marrow function of reconstructed chest wall after surgical correction of pectus excavatum

    International Nuclear Information System (INIS)

    Watanabe, Yoh; Magara, Tatsuo; Kobayashi, Hiroaki; Ichihashi, Takumi; Hikishima, Hiroshi

    1984-01-01

    Bone and Bone marrow functions of the reconstructed chest wall after surgical correction of the funnel chest deformities were evaluated by scanning method. In our series, three kinds of operative procedures were employed; strut method for adult cases, sternal turnover method with and without muscle pedicle for infant cases. Bone function was scanned by sup(99m)Tc-methylene-diphosphonate and bone marrow function was evaluated by sup(99m)Tc-sulfur-colloid. For the cases undergone each surgical procedure, bone and bone marrow scan were done at short term after surgery (within 30 days), at intermediate stage (one month to 12 months), and at long term stage (beyond one year). The results were as follows: By the evaluation at the long term stage of the cases undergoing strut method, bone as well as bone marrow scan visualized normal view of the reconstructed sternum. Regarding the cases undergone sternal turnover method without muscle pedicle, or free graft implantation of the plastron, the bone scan at the long term follow-up stage showed abnormal finding, i.e. hypo-, or defect-visualization of the inverted sternum, in 11.5% of the cases. Furthermore, bone marrow scan showed abnormality in 33.3% of the cases. On the other hand, the cases undergone sternal turnover method with muscle pedicle, in which blood supply to the plastron were preserved by the connection from superior epigastric artery to internal mammary artery, showed no abnormality as far as at the long term follow-up study neither in bone scan nor bone marrow scan. However, in the evaluation at short term after surgery, 50% of the cases undergoing bone scan showed abnormality. In addition, in this stage 85.7% of the bone marrow scan showed abnormal finding. These abnormality, however, normalized within 6 months for bone scan and 12 months for bone marrow scan, in contrast to the results of the cases undergone sternal turnover without pedicle. (J.P.N.)

  18. Radiological diagnosis and therapy of chest pain

    International Nuclear Information System (INIS)

    Kutzner, J.; Ernst, H.

    1980-01-01

    The causes and localization of chest pain are numerous. They can derive from infections, traumas, or tumors. Possible sites of origin are: skeletal portions, vertebral column, ribs, and sternum, as well as mediastinum and pleura. In women, occurrence tends to be cyclic and affect the mamma region. Radiological diagnosis includes radiography, nuclear techniques as well as whole body computer-tomography. Radiation therapy is indicated in cases of mediastinal tumor formation. Radiation of painful osteolytic vertebral metastases and rib destructions proves to be an efficient palliative measure. (orig.) [de

  19. Isolated local-regional recurrence of breast cancer following mastectomy: Radiotherapeutic management

    International Nuclear Information System (INIS)

    Halverson, K.J.; Perez, C.A.; Kuske, R.R.; Garcia, D.M.; Simpson, J.R.; Fineberg, B.

    1990-01-01

    Two hundred twenty-four patients with their first, isolated local-regional recurrence of breast cancer were irradiated with curative intent. Patients who had previous chest wall or regional lymphatic irradiation were not included in the study. With a median follow-up of 46 months (range 24 to 241 months), the 5- and 10-year survival for the entire group were 43% and 26%, respectively. Overall, 57% of the patients were projected to be loco-regionally controlled at 5 years. The 5-year local-regional tumor control was best for patients with isolated chest wall recurrences (63%), intermediate for nodal recurrences (45%), and poor for concomitant chest wall and nodal recurrences (27%). In patients with solitary chest wall recurrences, large field radiotherapy encompassing the entire chest wall resulted in a 5- and 10-year freedom from chest wall re-recurrence of 75% and 63% in contrast to 36% and 18% with small field irradiation (p = 0.0001). For the group with recurrences completely excised, tumor control was adequate at all doses ranging from 4500 to 7000 cGy. For the recurrences less than 3 cm, 100% were controlled at doses greater than or equal to 6000 cGy versus 76% at lower doses. No dose response could be demonstrated for the larger lesions. The supraclavicular failure rate was 16% without elective radiotherapy versus 6% with elective radiotherapy (p = 0.0489). Prophylactic irradiation of the uninvolved chest wall decreased the subsequent re-recurrence rate (17% versus 27%), but the difference is not statistically significant (p = .32). The incidence of chest wall re-recurrence was 12% with doses greater than or equal to 5000 cGy compared to 27% with no elective radiotherapy, but again was not statistically significant (p = .20). Axillary and internal mammary failures were infrequent, regardless of prophylactic treatment

  20. Chest pain in patients with arterial hypertension, angiographically normal coronary arteries and stiff aorta: the aortic pain syndrome.

    Science.gov (United States)

    Stakos, Dimitrios A; Tziakas, Dimitrios N; Chalikias, George; Mitrousi, Konstantina; Tsigalou, Christina; Boudoulas, Harisios

    2013-01-01

    Arterial hypertension is often associated with a stiff aorta as a result of collagen accumulation in the aortic wall and may produce chest pain. In the present study, possible interrelationships between aortic function, collagen turnover and exercise-induced chest pain in patients with arterial hypertension and angiographically normal coronary arteries were investigated. Ninety-seven patients with arterial hypertension, angiographically normal coronary arteries and no evidence of myocardial ischemia on nuclear cardiac imaging during exercise test were studied. Of these, 43 developed chest pain during exercise (chest pain group) while 54 did not (no chest pain group). Carotid femoral pulse-wave velocity (PWVc-f) was used to assess the elastic properties of the aorta. Amino-terminal pro-peptides of pro-collagen type I, (PINP, reflecting collagen synthesis), serum telopeptides of collagen type I (CITP, reflecting collagen degradation), pro-metalloproteinase 1 (ProMMP-1), and tissue inhibitor of metalloproteinase 1 (TIMP-1, related to collagen turnover) were measured in plasma by immunoassay. The chest pain group had higher PWVc-f, higher and /CITP ratio, and lower proMMP-1/ TIMP-1 ratio compared to the no chest pain group. PWVc-f (t=2.53, p=0.02) and PINP (t=2.42, p=0.02) were independently associated with the presence of chest pain in multiple regression analysis. Patients with arterial hypertension, exercise-induced chest pain and angiographically normal coronary arteries, without evidence of exercise-induced myocardial ischemia, had a stiffer aorta compared to those without chest pain. Alterations in collagen type I turnover that favor collagen accumulation in the aortic wall may contribute to aortic stiffening and chest pain in these patients.

  1. Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration of Undiagnosed Chest Tumors

    DEFF Research Database (Denmark)

    Eckardt, Jens; Olsen, Karen E; Licht, Peter B

    2010-01-01

    were examined as outpatients and there was not a single complication in any patient. CONCLUSIONS: EBUS is a valuable tool to diagnose chest lesions and yield depends on the anatomical location. We believe that EBUS should be the first choice for further workup in patients who remain undiagnosed after...

  2. SU-E-J-107: The Impact of the Tumor Location to Deformable Image Registration

    International Nuclear Information System (INIS)

    Sugawara, Y; Tachibana, H; Kadoya, N; Jingu, K; Kitamura, N

    2015-01-01

    Purpose: For four-dimensional planning and adaptive radiotherapy, the accuracy of deformable image registration (DIR) is essential. We evaluated the accuracy of an in-house program with the free-downloadable DIR software library package (NiftyReg) and two commercially available DIR software programs (MIM Maestro and Velocity AI) in lung SBRT cancer patients. In addition to it, the relationship between the tumor location and the accuracy of the DIRs was investigated. Methods: The free-form deformation was implemented in the in-house program and the MIM. The Velocity was based on the B-spline algorithm. The accuracy of the three programs was evaluated in comparison for the structures on 4DCT image datasets between at the peak-inhale and at the peak-exhale. The dice similarity coefficient (DSC) and normalized DSC (NDSC) were measured for the gross tumor volumes from 19 lung SBRT patients. Results: The DSC measurement showed the median values of the DSC were 0.885, 0.872 and 0.798 for the In-house program, the MIM and the Velocity, respectively. The Velocity showed significant difference compared to the others. The median NDSC values were 1.027, 1.005 and 0.946 for the In-house, the MIM and the Velocity, respectively. This indicated that the spatial overlap agreement between the reference and the deformed structure for the in-house and MIM was comparable with the accuracy within 1mm uncertainty. There was larger discrepancy within 1–2mm uncertainty for the Velocity. The In-house and the MIM showed the higher NDSC values than the median values when the GTV was not attached to the chest wall and diaphragm(p < 0.05). However, there is no relationship between the accuracy and the tumor location in the Velocity. Conclusion: The difference of the DIR program would affect different accuracy and the accuracy may be reduced when the tumor is located or attached to chest wall or diaphragm

  3. Rib fracture after stereotactic radiotherapy on follow-up thin-section computed tomography in 177 primary lung cancer patients

    International Nuclear Information System (INIS)

    Nambu, Atsushi; Tominaga, Lichto; Maehata, Yoshiyasu; Sawada, Eiichi; Araki, Tsutomu; Onishi, Hiroshi; Aoki, Shinichi; Koshiishi, Tsuyota; Kuriyama, Kengo; Komiyama, Takafumi; Marino, Kan; Araya, Masayuki; Saito, Ryo

    2011-01-01

    Chest wall injury after stereotactic radiotherapy (SRT) for primary lung cancer has recently been reported. However, its detailed imaging findings are not clarified. So this study aimed to fully characterize the findings on computed tomography (CT), appearance time and frequency of chest wall injury after stereotactic radiotherapy (SRT) for primary lung cancer A total of 177 patients who had undergone SRT were prospectively evaluated for periodical follow-up thin-section CT with special attention to chest wall injury. The time at which CT findings of chest wall injury appeared was assessed. Related clinical symptoms were also evaluated. Rib fracture was identified on follow-up CT in 41 patients (23.2%). Rib fractures appeared at a mean of 21.2 months after the completion of SRT (range, 4 -58 months). Chest wall edema, thinning of the cortex and osteosclerosis were findings frequently associated with, and tending to precede rib fractures. No patients with rib fracture showed tumors > 16 mm from the adjacent chest wall. Chest wall pain was seen in 18 of 177 patients (10.2%), of whom 14 patients developed rib fracture. No patients complained of Grade 3 or more symptoms. Rib fracture is frequently seen after SRT for lung cancer on CT, and is often associated with chest wall edema, thinning of the cortex and osteosclerosis. However, related chest wall pain is less frequent and is generally mild if present

  4. Emergency management of blunt chest trauma in children: an evidence-based approach.

    Science.gov (United States)

    Pauzé, Denis R; Pauzé, Daniel K

    2013-11-01

    Pediatric trauma is commonly encountered in the emergency department, and trauma to the head, chest, and abdomen may be a source of significant morbidity and mortality. As children have unique thoracic anatomical and physiological properties, they may present with diagnostic challenges that the emergency clinician must be aware of. This review examines the effects of blunt trauma to the pediatric chest, as well as its relevant etiologies and associated mortality. Diagnostic and treatment options for commonly encountered injuries such as pulmonary contusions, rib fractures, and pneumothoraces are examined. Additionally, this review discusses rarely encountered--yet highly lethal--chest wall injuries such as blunt cardiac injuries, commotio cordis, nonaccidental trauma, and aortic injuries.

  5. Hyaluronic acid-functionalized single-walled carbon nanotubes as tumor-targeting MRI contrast agent

    Directory of Open Access Journals (Sweden)

    Hou L

    2015-07-01

    Full Text Available Lin Hou,* Huijuan Zhang,* Yating Wang, Lili Wang, Xiaomin Yang, Zhenzhong ZhangSchool of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, People’s Republic of China*These authors contributed equally to this workAbstract: A tumor-targeting carrier, hyaluronic acid (HA-functionalized single-walled carbon nanotubes (SWCNTs, was explored to deliver magnetic resonance imaging (MRI contrast agents (CAs targeting to the tumor cells specifically. In this system, HA surface modification for SWCNTs was simply accomplished by amidation process and could make this nanomaterial highly hydrophilic. Cellular uptake was performed to evaluate the intracellular transport capabilities of HA-SWCNTs for tumor cells and the uptake rank was HA-SWCNTs> SWCNTs owing to the presence of HA, which was also evidenced by flow cytometry. The safety evaluation of this MRI CAs was investigated in vitro and in vivo. It revealed that HA-SWCNTs could stand as a biocompatible nanocarrier and gadolinium (Gd/HA-SWCNTs demonstrated almost no toxicity compared with free GdCl3. Moreover, GdCl3 bearing HA-SWCNTs could significantly increase the circulation time for MRI. Finally, to investigate the MRI contrast enhancing capabilities of Gd/HA-SWCNTs, T1-weighted MR images of tumor-bearing mice were acquired. The results suggested Gd/HA-SWCNTs had the highest tumor-targeting efficiency and T1-relaxivity enhancement, indicating HA-SWCNTs could be developed as a tumor-targeting carrier to deliver the CAs, GdCl3, for the identifiable diagnosis of tumor.Keywords: gadolinium, magnetic resonance, SWCNTs, hyaluronic acid, contrast agent

  6. Dose distribution of chest wall electron beam radiotherapy for patients with breast cancer after radical mastectomy

    International Nuclear Information System (INIS)

    Cong Yetong; Chen Dawei; Bai Lan; Zhou Yinhang; Piao Yongfeng; Wang Xi; Qu Yaqin

    2006-01-01

    Objective: To study the dose distribution of different bolus after different energy electron beam irradiation to different chest wall radiotherapy for the patients with breast cancer. Methods: The paper simulated the dose distribution of women's left breast cancer after radical mastectomy by 6 and 9 MeV electron beam irradiation, and TLD was used to measure. Results: The dose of skin became higher and the dose of lung was less when 0.5 and 1.0 cm bolus were used on the body; with the increasing of the energy of electron beam, the high dose field became larger; and with the same energy of electron beam, the high dose field moved to surface of the body when the bolus was thicker. Conclusion: When different energy electron ray irradiates different thickness bolus, the dosage of skin surface increases and the dosage of anterior margin of lung reduces. With electron ray energy increasing, the high dosage field is widen, when the electron ray energy is identity, the high dosage field migrates to the surface after adding bolus. Using certain depth bolus may attain the therapeutical dose of target area. (authors)

  7. Clinical values of detection of multiple tumor markers in pleural fluid for diagnosis malignancy

    International Nuclear Information System (INIS)

    Xiao Chuangqing; Jiang Li; Zhou Guanghua; He Yunnan

    2005-01-01

    Objective: To improve the diagnostic accuracy for the differentiation of malignant from tuberculous pleural effusion with determination of multiple tumor markers in pleural fluid. Methods: With a multiple tumor markers combined protein chip diagnostic system, contents of twelve common tumor markers were detected in the chest fluid from 60 patients with malignant pleural effusion and 30 patients with tuberculous pleural effusion. Results: For pulmonary carcinoma related pleural effusion, the contents of four common tumor markers (CEA, NSE, SF, CA125) in chest fluid were significantly higher those in tuberculous related chest fluid. The diagnostic positive rate of combined test of these four marker for malignancy could be as high as 96.7%. Conclusion: Combined determination of chest fluid CEA, NSE, SF, CA125 contents was very sensitive and accurate for differentiation of malignant from tuberculous pleural effusion. (authors)

  8. Subcutaneous injection of water-soluble multi-walled carbon nanotubes in tumor-bearing mice boosts the host immune activity

    International Nuclear Information System (INIS)

    Meng Jie; Yang Man; Jia Fumin; Kong Hua; Zhang Weiqi; Xu Haiyan; Wang Chaoying; Xie Sishen; Xing Jianmin

    2010-01-01

    The immunological responses induced by oxidized water-soluble multi-walled carbon nanotubes on a hepatocarcinoma tumor-bearing mice model via a local administration of subcutaneous injection were investigated. Experimental results show that the subcutaneously injected carbon nanotubes induced significant activation of the complement system, promoted inflammatory cytokines' production and stimulated macrophages' phagocytosis and activation. All of these responses increased the general activity of the host immune system and inhibited the progression of tumor growth.

  9. Subcutaneous injection of water-soluble multi-walled carbon nanotubes in tumor-bearing mice boosts the host immune activity

    Science.gov (United States)

    Meng, Jie; Yang, Man; Jia, Fumin; Kong, Hua; Zhang, Weiqi; Wang, Chaoying; Xing, Jianmin; Xie, Sishen; Xu, Haiyan

    2010-04-01

    The immunological responses induced by oxidized water-soluble multi-walled carbon nanotubes on a hepatocarcinoma tumor-bearing mice model via a local administration of subcutaneous injection were investigated. Experimental results show that the subcutaneously injected carbon nanotubes induced significant activation of the complement system, promoted inflammatory cytokines' production and stimulated macrophages' phagocytosis and activation. All of these responses increased the general activity of the host immune system and inhibited the progression of tumor growth.

  10. Subcutaneous injection of water-soluble multi-walled carbon nanotubes in tumor-bearing mice boosts the host immune activity

    Energy Technology Data Exchange (ETDEWEB)

    Jie, Meng; Man, Yang; Fumin, Jia; Hua, Kong; Weiqi, Zhang; Haiyan, Xu [Department of Biomedical Engineering, Institute of Basic Medical Sciences and School of Basic Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, 5 Dong Dan San Tiao, Beijing 100005 (China); Chaoying, Wang; Sishen, Xie [Beijing National Laboratory for Condensed Matter Physics, Institute of Physics, Chinese Academy of Sciences, 8 Nan San Jie, Zhongguancun, Beijing100080 (China); Xing Jianmin, E-mail: xuhy@pumc.edu.cn [Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, 11 Bei San Huan Dong Lu, Beijing 100029 (China)

    2010-04-09

    The immunological responses induced by oxidized water-soluble multi-walled carbon nanotubes on a hepatocarcinoma tumor-bearing mice model via a local administration of subcutaneous injection were investigated. Experimental results show that the subcutaneously injected carbon nanotubes induced significant activation of the complement system, promoted inflammatory cytokines' production and stimulated macrophages' phagocytosis and activation. All of these responses increased the general activity of the host immune system and inhibited the progression of tumor growth.

  11. Low-dosage helical CT applications for chest medical checkup and lung cancer screening

    International Nuclear Information System (INIS)

    Wang Ping; Cui Fa; Liang Huanqing; Zheng Minfei

    2005-01-01

    Objective: A discussion on low-dosage helical CT applications on chest medical checkup and lung cancer screening. Methods: On the 100 chest medical check up with three different of protocols, including standard-dosage (the tube current was 230 mAs) were compared with low-dose (tube current was 50 mAs or 30 mAs). Results: Low-dosage helical CT scan provides excellent images. In 100 chest medical checkup, 39 nodules or masses were revealed, enlarged lymph node was noted in 1 case; emphysema or bullae was demonstrated in 3 segments; thickening of bronchial wall was shown in 2 cases; and localized pleural thickening was found in 1 case. Conclusion: In chest checkup or lung cancer screening low-dosage helical CT (tube current 30 mAs) will not only guarantee image quality but also reduce the radiation dose during the examination. (authors)

  12. Radiation fibrosis : differentiation from true hilar mass on plain chest film

    International Nuclear Information System (INIS)

    Baik, Jun Hyun; Ahn, Kook Jin; Park, Seog Hee; Shinn, Kyung Sub

    1996-01-01

    Radiation-induced fibrotic mass might masquerade as a true hilar tumor mass on a plain chest radiograph. We attempted to differentiate radiation fibrosis from a true hilar tumor using only a plain radiograph. Plain chest radiographs were obtained from seven patients who had developed radiation fibrosis simulating hilar mass after radiation therapy for lung cancer, and from 19 patients with lung cancer, a comparison group, who had not received radiation therapy. They were reviewed for the obliteration of the overlapped mediastinal and hilar anatomical silhouettes by the mass : pulmonary artery, heart or aorta border, and paraspinal line. All seven patients with radiation-induced fibrotic mass(bilateral lesion in two patients) showed obliteration of all three overlapped anatomical silhouettes of the mediastinum and hilum on chest radiographs. In the comparison group of 19 patients with a true hilar mass, there was, however, no case which demonstrated obliteration of all landmarks, Obliteration of all anatomical landmarks at the hilum and mediastinum may be a helpful clue in the differential diagnosis of radiation-induced fibrotic mass from true hilar mass on a plain radiograph, particularly when clinical information on previous radiation therapy is unavailable

  13. Rib fracture after stereotactic radiotherapy on follow-up thin-section computed tomography in 177 primary lung cancer patients

    Directory of Open Access Journals (Sweden)

    Saito Ryo

    2011-10-01

    Full Text Available Abstract Background Chest wall injury after stereotactic radiotherapy (SRT for primary lung cancer has recently been reported. However, its detailed imaging findings are not clarified. So this study aimed to fully characterize the findings on computed tomography (CT, appearance time and frequency of chest wall injury after stereotactic radiotherapy (SRT for primary lung cancer Materials and methods A total of 177 patients who had undergone SRT were prospectively evaluated for periodical follow-up thin-section CT with special attention to chest wall injury. The time at which CT findings of chest wall injury appeared was assessed. Related clinical symptoms were also evaluated. Results Rib fracture was identified on follow-up CT in 41 patients (23.2%. Rib fractures appeared at a mean of 21.2 months after the completion of SRT (range, 4 -58 months. Chest wall edema, thinning of the cortex and osteosclerosis were findings frequently associated with, and tending to precede rib fractures. No patients with rib fracture showed tumors > 16 mm from the adjacent chest wall. Chest wall pain was seen in 18 of 177 patients (10.2%, of whom 14 patients developed rib fracture. No patients complained of Grade 3 or more symptoms. Conclusion Rib fracture is frequently seen after SRT for lung cancer on CT, and is often associated with chest wall edema, thinning of the cortex and osteosclerosis. However, related chest wall pain is less frequent and is generally mild if present.

  14. Rib fracture after stereotactic radiotherapy on follow-up thin-section computed tomography in 177 primary lung cancer patients

    Science.gov (United States)

    2011-01-01

    Background Chest wall injury after stereotactic radiotherapy (SRT) for primary lung cancer has recently been reported. However, its detailed imaging findings are not clarified. So this study aimed to fully characterize the findings on computed tomography (CT), appearance time and frequency of chest wall injury after stereotactic radiotherapy (SRT) for primary lung cancer Materials and methods A total of 177 patients who had undergone SRT were prospectively evaluated for periodical follow-up thin-section CT with special attention to chest wall injury. The time at which CT findings of chest wall injury appeared was assessed. Related clinical symptoms were also evaluated. Results Rib fracture was identified on follow-up CT in 41 patients (23.2%). Rib fractures appeared at a mean of 21.2 months after the completion of SRT (range, 4 -58 months). Chest wall edema, thinning of the cortex and osteosclerosis were findings frequently associated with, and tending to precede rib fractures. No patients with rib fracture showed tumors > 16 mm from the adjacent chest wall. Chest wall pain was seen in 18 of 177 patients (10.2%), of whom 14 patients developed rib fracture. No patients complained of Grade 3 or more symptoms. Conclusion Rib fracture is frequently seen after SRT for lung cancer on CT, and is often associated with chest wall edema, thinning of the cortex and osteosclerosis. However, related chest wall pain is less frequent and is generally mild if present. PMID:21995807

  15. Dosimetric study for the development of heterogeneous chest phantom for the purpose of patient-specific quality assurance

    International Nuclear Information System (INIS)

    Gurjar, Om Prakash; Mishra, Praveen Kumar; Mishra, Surendra Prasad; Singh, Navin; Bagdare, Priyusha

    2015-01-01

    To analyze the dose absorption patterns of 6 Megavoltage (MV) photon beam using computed tomography (CT) slices of thorax of patient, slab phantom, and slab-kailwood-slab phantom. Single beam of 6 MV with field size of 10 X 10 cm 2 was put on CT images of chest wall, slab phantom, and slab-kailwood-slab phantom perpendicular to the surface. Dose was calculated using anisotropic analytical algorithm. Densities of each medium were calculated by Hounsfield units measured from CT images of each medium. The depths of isodose curves of 100%, 95%, 90%, 85%, 80%, 70%, 60%, and 50% were measured in all the three mediums. The densities measured for chest wall, lung, Soft tissue behind lung, slab phantom, and slab-kailwood-slab phantom were 0.89, 0.301, 1.002, 0.998, and 0.379 g/cc, respectively. The isodose depth (100%, 95%, 90%, 85%, 80%, and 50%) for patient (1.5, 2.76, 3.97, 5.33, 7.01, and 20.01 cm), slab phantom (1.5, 2.74, 3.92, 5.06, 6.32, and 15.18 cm), and slab-kailwood-slab phantom (1.5, 2.65, 3.86, 4.98, 5.95, and 20 cm) is approximately same for 100%, 95%, 90%, and 85% isodose curves. The isodose depth pattern in the chest is equivalent to that in slab-kailwood-slab phantom. The radiation properties of the slab-kailwood-slab phantom are equivalent to that of chest wall, lung, and soft tissue in actual human. The chest phantom mimicking the actual thoracic region of human can be manufactured using polystyrene and the kailwood. (author)

  16. Image processing in digital chest radiography

    International Nuclear Information System (INIS)

    Manninen, H.; Partanen, K.; Lehtovirta, J.; Matsi, P.; Soimakallio, S.

    1992-01-01

    The usefulness of digital image processing of chest radiographs was evaluated in a clinical study. In 54 patients, chest radiographs in the posteroanterior projection were obtained by both 14 inch digital image intensifier equipment and the conventional screen-film technique. The digital radiographs (512x512 image format) viewed on a 625 line monitor were processed in 3 different ways: 1.standard display; 2.digital edge enhancement for the standard display; 3.inverse intensity display. The radiographs were interpreted independently by 3 radiologists. Diagnoses were confirmed by CT, follow-up radiographs and clinical records. Chest abnormalities of the films analyzed included 21 primary lung tumors, 44 pulmonary nodules, 16 cases with mediastinal disease, 17 with pneumonia /atelectasis. Interstitial lung disease, pleural plaques, and pulmonary emphysema were found in 30, 18 and 19 cases respectively. Sensitivity of conventional radiography when averaged overall findings was better than that of digital techniques (P<0.001). Differences in diagnostic accuracy measured by sensitivity and specificity between the 3 digital display modes were small. Standard image display showed better sensitivity for pulmonary nodules (0.74 vs 0.66; P<0.05) but poorer specificity for pulmonary emphysema (0.85 vs 0.93; P<0.05) compared with inverse intensity display. It is concluded that when using 512x512 image format, the routine use of digital edge enhancement and tone reversal at digital chest radiographs is not warranted. (author). 12 refs.; 4 figs.; 2 tabs

  17. Frequency of myocardial injury after blunt chest trauma as evaluated by radionuclide angiography

    International Nuclear Information System (INIS)

    Sutherland, G.R.; Driedger, A.A.; Holliday, R.L.; Cheung, H.W.; Sibbald, W.J.

    1983-01-01

    Seventy-seven patients who had sustained multisystem trauma, including severe blunt chest injury, were prospectively evaluated to assess the frequency of associated traumatic myocardial injury. Traumatic injury to either the right or left ventricle was defined by the presence of discrete abnormalities of wall motion on electrocardiographically gated cardiac scintigraphy in patients without a clinical history of heart disease. Forty-two patients (55%) (Group 1) had focal abnormalities of wall motion; 27 involved the right ventricle, 7 the left ventricle, 7 were biventricular, and 1 involved only the septum. Both the right and left ventricular ejection fractions were significantly lower (31 +/- 11% and 47 +/- 14%, respectively) than those in the 35 traumatized patients without wall motion abnormalities on scintigraphy (Group 2) (49 +/- 8% and 58 +/- 11%, respectively). Repeat scintigraphic examination in 32 Group 1 patients at a time remote from initial injury showed improvement or resolution of previously defined focal wall motion abnormalities in 27 of 32 patients (84%). The electrocardiogram and serum enzyme tests were insensitive indexes of traumatic myocardial injury when defined by the scintigraphic abnormalities. Thus, severe blunt chest trauma results in a higher frequency of traumatic myocardial injury than heretofore recognized, and frequently involves the anteriorly situated right ventricle

  18. Esophageal Gastrointestinal Stromal Tumor: Diagnostic Complexity and Management Pitfalls

    Directory of Open Access Journals (Sweden)

    Charalampos G. Markakis

    2013-01-01

    Full Text Available Introduction. Gastrointestinal stromal tumors of the esophagus are rare. Case Presentation. This is a case of a 50-year-old male patient who was referred to our department complaining of atypical chest pain. A chest computed tomographic scan and endoscopic ultrasound revealed a submucosal esophageal tumor measuring 5 cm in its largest diameter. Suspecting a leiomyoma, we performed enucleation via right thoracotomy. The pathology report yielded a diagnosis of an esophageal gastrointestinal stromal tumor. The patient has shown no evidence of recurrence one year postoperatively. Conclusions. This report illustrates the complexity and dilemmas inherent in diagnosing and treating esophageal GISTs.

  19. Cellular schwannoma arising from the gastric wall misdiagnosed as a gastric stromal tumor: A case report.

    Science.gov (United States)

    Wang, Guangyao; Chen, Ping; Zong, Liang; Shi, Lei; Zhao, Wei

    2014-02-01

    Cellular schwannomas have been previously described at almost every anatomic location of the human body, but reports in the gastric wall are rare. The current study presents a rare case of cellular schwannoma originating from the gastric wall. Computed tomography revealed a 5.6×5.3×4.0-cm 3 solid mass located in the posterior wall of the stomach. Open laparotomy confirmed its mesenchymal origin. Microscopically, the tissue was composed of spindle-shaped and fascicularly-arranged cells, but mitotic figures were rare. Immunohistochemical staining showed that the tumor was negative for cluster of differentiation (CD)117, CD34, smooth muscle actin and desmin, but positive for S-100 and Ki67. The patient presented no evidence of recurrence and metastasis during follow-up. Gastric cellular schwannomas may be diagnosed by clinical characteristics, histological observations and immunohistochemical markers.

  20. Chest X-Ray

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    Full Text Available ... about chest radiography also known as chest x-rays. Chest x-rays are the most commonly performed x-ray exams and use a very small dose of ... of the inside of the chest. A chest x-ray is used to evaluate the lungs, heart and ...

  1. Superiority of Equivalent Uniform Dose (EUD)-Based Optimization for Breast and Chest Wall

    International Nuclear Information System (INIS)

    Mihailidis, Dimitris N.; Plants, Brian; Farinash, Lloyd; Harmon, Michael; Whaley, Lewis; Raja, Prem; Tomara, Pelagia

    2010-01-01

    We investigate whether IMRT optimization based on generalized equivalent uniform dose (gEUD) objectives for organs at risk (OAR) results in superior dosimetric outcomes when compared with multiple dose-volume (DV)-based objectives plans for patients with intact breast and postmastectomy chest wall (CW) cancer. Four separate IMRT plans were prepared for each of the breast and CW cases (10 patients). The first three plans used our standard in-house, physician-selected, DV objectives (phys-plan); gEUD-based objectives for the OARs (gEUD-plan); and multiple, 'very stringent,' DV objectives for each OAR and PTV (DV-plan), respectively. The fourth plan was only beam-fluence optimized (FO-plan), without segmentation, which used the same objectives as in the DV-plan. The latter plan was to be used as an 'optimum' benchmark without the effects of the segmentation for deliverability. Dosimetric quantities, such as V 20Gy for the ipsilateral lung and mean dose (D mean ) for heart, contralateral breast, and contralateral lung were used to evaluate the results. For all patients in this study, we have seen that the gEUD-based plans allow greater sparing of the OARs while maintaining equivalent target coverage. The average ipsilateral lung V 20Gy reduced from 22 ± 4.4% for the FO-plan to 18 ± 3% for the gEUD-plan. All other dosimetric quantities shifted towards lower doses for the gEUD-plan. gEUD-based optimization can be used to search for plans of different DVHs with the same gEUDs. The use of gEUD allows selective optimization and reduction of the dose for each OAR and results in a truly individualized treatment plan.

  2. Evaluation of respiratory functions in chest trauma patients treated with thoracic wall stabilization

    Directory of Open Access Journals (Sweden)

    Karam E. Moslam

    2015-01-01

    Conclusion: Surgical stabilization of flail chest with metallic plates is a safe and effective therapy in properly selected patients. These patients had a significantly smoother course during the intensive care unit and hospital stays, had improved respiratory functions and decreased rate of complications.

  3. Digital luminescence radiography of the chest

    International Nuclear Information System (INIS)

    Kehler, M.

    1991-10-01

    The aim of the present study was to evaluate the efficacy of a digital system in chest radiology compared to the conventional film-screen system. The first studies (1-3) were purely clinical, had two parts, one clinical and one using phantoms, and the 5:th used solely phantoms. Except for the first - pilot - study, the studies were performed as receiver operating characteristic (ROC) analysis. From one exposure, two digital radiographs were obtained, one simulating the film-screen radiograph and one enhanced, using an unsharp mask. The conventional radiograph was compared to this double-image, but in addition to this, even to the simulated normal and enhanced separately (1-3). To evaluate the value of inverted (positive) radiographs, the original digital (negative) radiographs were inverted, and then compared to the originals (4). As digitzation means easy storing and transfer of data and possibility of electronic display, the diagnostic performance of an interactive workstation was assessed (5). In the clinical studies, a variety of chest affections were used: atelectasis, tumor, pneumothorax, fibrosis, mediastinal and bony changes, tuberculosis, incompensations and enlargement of the heart (1), pneumothorax (2), fibrosis (3), and tumor (4). In the phantom studies, test objects simulating tumors (4) and pneumothorax (5) were used. In no study was statistical significant difference seen between the digital and conventional system (p>0.05). Neither in the clinical nor the phantom study did inversion of the radiographs improve diagnostic performance. The workstation performed almost equally well as the radiographs even with a resolution of 1.25 1p/mm compared to the digital radiographs 2.5 and film-screen radiographs 5 1p/mm. (au) (50 refs.)

  4. Efficacy of helical CT in evaluating local tumor extent of breast cancer

    International Nuclear Information System (INIS)

    Ozaki, Yutaka

    2001-01-01

    The purpose of this study is to clarify the diagnostic accuracy of helical CT (HCT) in the determination of local tumor extent of breast cancer. One hundred forty consecutive patients with breast cancer, including 87 invasive ductal carcinomas without extensive intraductal components (EIC), 44 invasive ductal carcinomas with EIC, 2 non-invasive ductal carcinomas, and 7 invasive lobular carcinomas, were included in the study. Three-dimensional tumor diameter including whole extent was measured on HCT, and the amount of invasion to fat tissue, skin, pectoral muscle, and chest wall was estimated using a three-step scale. These results were then compared with the pathological findings. Breast cancers appeared as areas of high attenuation compared with the surrounding breast tissue in all patients. Tumor extent was correctly diagnosed by HCT to within a maximum difference of 1 cm in 88 patients (63%) and within 2 cm in 122 patients (87%). Sensitivity, specificity, and accuracy in diagnosing muscular invasion of breast cancer using HCT were 100%, 99%, and 99%, respectively. Sensitivity, specificity, and accuracy in diagnosing skin invasion of breast cancer using HCT were 84%, 93%, and 91%, respectively. HCT was able to visualize all of the tumors and detect the correct tumor extent in most patients. (author)

  5. Efficacy of helical CT in evaluating local tumor extent of breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Ozaki, Yutaka [Juntendo Univ., Chiba (Japan). Urayasu Hospital

    2001-04-01

    The purpose of this study is to clarify the diagnostic accuracy of helical CT (HCT) in the determination of local tumor extent of breast cancer. One hundred forty consecutive patients with breast cancer, including 87 invasive ductal carcinomas without extensive intraductal components (EIC), 44 invasive ductal carcinomas with EIC, 2 non-invasive ductal carcinomas, and 7 invasive lobular carcinomas, were included in the study. Three-dimensional tumor diameter including whole extent was measured on HCT, and the amount of invasion to fat tissue, skin, pectoral muscle, and chest wall was estimated using a three-step scale. These results were then compared with the pathological findings. Breast cancers appeared as areas of high attenuation compared with the surrounding breast tissue in all patients. Tumor extent was correctly diagnosed by HCT to within a maximum difference of 1 cm in 88 patients (63%) and within 2 cm in 122 patients (87%). Sensitivity, specificity, and accuracy in diagnosing muscular invasion of breast cancer using HCT were 100%, 99%, and 99%, respectively. Sensitivity, specificity, and accuracy in diagnosing skin invasion of breast cancer using HCT were 84%, 93%, and 91%, respectively. HCT was able to visualize all of the tumors and detect the correct tumor extent in most patients. (author)

  6. Mechanisms and Clinical Management of Ventricular Arrhythmias following Blunt Chest Trauma

    Directory of Open Access Journals (Sweden)

    Daniel H. Wolbrom

    2016-01-01

    Full Text Available Nonpenetrating, blunt chest trauma is a serious medical condition with varied clinical presentations and implications. This can be the result of a dense projectile during competitive and recreational sports but may also include other etiologies such as motor vehicle accidents or traumatic falls. In this setting, the manifestation of ventricular arrhythmias has been observed both acutely and chronically. This is based on two entirely separate mechanisms and etiologies requiring different treatments. Ventricular fibrillation can occur immediately after chest wall injury (commotio cordis and requires rapid defibrillation. Monomorphic ventricular tachycardia can develop in the chronic stage due to underlying structural heart disease long after blunt chest injury. The associated arrhythmogenic tissue may be complex and provides the necessary substrate to form a reentrant VT circuit. Ventricular tachycardia in the absence of overt structural heart disease appears to be focal in nature with rapid termination during ablation. Regardless of the VT mechanism, patients with recurrent episodes, despite antiarrhythmic medication in the chronic stage following blunt chest injury, are likely to require ablation to achieve VT control. This review article will describe the mechanisms, pathophysiology, and treatment of ventricular arrhythmias that occur in both the acute and chronic stages following blunt chest trauma.

  7. Effects of X-irradiation on artificial blood vessel wall degradation by invasive tumor cells

    International Nuclear Information System (INIS)

    Heisel, M.A.; Laug, W.E.; Stowe, S.M.; Jones, P.A.

    1984-01-01

    Artificial vessel wall cultures, constructed by growing arterial endothelial cells on preformed layers of rat smooth muscle cells, were used to evaluate the effects of X-irradiation on tumor cell-induced tissue degradation. Bovine endothelial cells had radiation sensitivities similar to those of rat smooth muscle cells. Preirradiation of smooth muscle cells, before the addition of human fibrosarcoma (HT 1080) cells, did not increase the rate of degradation and destruction by the invasive cells. However, the degradation rate was decreased if the cultures were irradiated after the addition of HT 1080 cells. The presence of bovine endothelial cells markedly inhibited the destructive abilities of fibrosarcoma cells, but preirradiation of artificial vessel walls substantially decreased their capabilities to resist HT 1080-induced lysis. These findings suggest that the abilities of blood vessels to limit extravasation may be compromised by ionizing radiation

  8. Chest X-Ray

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    Full Text Available ... talk with you about chest radiography also known as chest x-rays. Chest x-rays are the ... treatment for a variety of lung conditions such as pneumonia, emphysema and cancer. A chest x-ray ...

  9. Chest X-Ray

    Medline Plus

    Full Text Available ... by Image/Video Gallery Your Radiologist Explains Chest X-ray Transcript Welcome to Radiology Info dot org! Hello, ... d like to talk with you about chest radiography also known as chest x-rays. Chest x- ...

  10. Vacuum-assisted closure device for the management of infected postpneumonectomy chest cavities.

    Science.gov (United States)

    Perentes, Jean Yannis; Abdelnour-Berchtold, Etienne; Blatter, Jeannine; Lovis, Alban; Ris, Hans-Beat; Krueger, Thorsten; Gonzalez, Michel

    2015-03-01

    Infected postpneumonectomy chest cavities may be related to chronic postpneumonectomy empyema or arise in rare situations of necrotizing pneumonia with complete lung destruction where pneumonectomy and pleural debridement are required. We evaluated the safety and efficacy of an intrathoracic vacuum-assisted closure device (VAC) for the treatment of infected postpneumonectomy chest cavities. A retrospective single institution review of all patients with infected postpneumonectomy chest cavities treated by VAC between 2005 and 2013. Patients underwent surgical debridement of the thoracic cavity, muscle flap closure of the bronchial stump when a fistula was present, and repeated intrathoracic VAC dressings until granulation tissue covered the entire chest cavity. After this, the cavity was obliterated by a Clagett procedure and closed. Twenty-one patients (14 men and 7 women) underwent VAC treatment of their infected postpneumonectomy chest cavity. Twelve patients presented with a chronic postpneumonectomy empyema (10 of them with a bronchopleural fistula) and 9 patients with an empyema occurring in the context of necrotizing pneumonia treated by pneumonectomy. In-hospital mortality was 23%. The median duration of VAC therapy was 23 days (range, 4-61 days) and the median number of VAC changes per patient was 6 (range, 2-14 days). Infection control and successful chest cavity closure was achieved in all surviving patients. One adverse VAC treatment-related event was identified (5%). The intrathoracic VAC application is a safe and efficient treatment of infected postpneumonectomy chest cavities and allows the preservation of chest wall integrity. Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  11. Chest X-Ray

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    Full Text Available ... by Image/Video Gallery Your Radiologist Explains Chest X-ray Transcript Welcome to Radiology Info dot org! Hello, ... you about chest radiography also known as chest x-rays. Chest x-rays are the most commonly performed ...

  12. SU-F-T-92: Clinical Benefit for Breast and Chest Wall Setup in Using a Breast Board

    Energy Technology Data Exchange (ETDEWEB)

    Li, S; Miyamoto, C; Serratore, D; Liang, Q; Dziemianowicz, E [Temple University Hospital, Philadelphia, PA (United States)

    2016-06-15

    Purpose: To validate benefit of using a breast board (BB) by analyzing the geometry and dosimetry changes of the regions of interest (ROIs) between CT scans with and without BB. Methods: Seven patients, two chest walls (CW) and five breasts, use BB at CT simulation and no BB at diagnostic CT were included. By using deformable image registration software (Velocity AI), diagnostic CT and planning CT were rigidly co-registered according to the thoracic cage at the target. The heart and the target were then deformedly matched and the contours of the planned ROIs were transferred to the diagnostic CT. Which were brought back to the planning CT data set though the initial rigid co-registration in order to keep the deformed ROIs redefined in the diagnostic CT. Anatomic shifts and volume changes of a ROI beyond the rigid translation were recorded and dosimetry changes to ROIs were compared with recalculated DVHs. Results: Patient setup without the BB had small but systematic heart shifts superiorly by ∼5 mm. Torso rotations in two cases moved the heart in opposite directions by ∼10 mm. The breast target volume, shape, and locations were significantly changed with arm extension over the head but not in cases with the arm extended laterally. Breast setup without BB could increase the mean dose to the heart and the maximal dose to the anterior ventricle wall by 1.1 and 6.7 Gy, respectively. Conclusion: A method for evaluation of breast setup technique is introduced and applied for patients. Results of systematic heart displacement without using the BB and the potential increase of heart doses encourage us to further investigate the current trend of not using a BB for easy setup and CT scans. Using a BB would likely increase patient sag during prolonged IMRT and real-time patient position monitoring is clinically desired.

  13. Multiple brown tumors of the orbital walls: case report Tumor marrom múltiplo das paredes orbitárias: relato de caso

    Directory of Open Access Journals (Sweden)

    Mário Luiz Ribeiro Monteiro

    2009-02-01

    Full Text Available We report the case of a 40-year-old woman with chronic renal failure and secondary hyperparathyroidism that presented with slowly progressive proptosis of the right eye and mass sensation in the temporal and frontal orbital margins. Computerized tomography scan revealed two separate hyperdense and well-circumscribed lesions in the right orbital walls. A biopsy followed by histopathologic study revealed a dense lesion, with fibrous proliferation associated with osseous metaplasia and osteoclastic activity in the tumor, compatible with the diagnosis of brown tumor. The patient was submitted to surgical removal of the parathyroid glands that resulted in marked improvement in her condition and regression of the orbital tumors. Although the occurrence of more than one separate bone lesion in the orbit usually suggests metastasis, our case shows that brown tumors should also be included in the differential diagnosis of such lesions, particularly in patients with hyperparathyroidism.Este trabalho relata o caso de uma paciente de 40 anos, com insuficiência renal crônica e hiperparatireoidismo secundário que se apresentou com proptose progressiva e tumoração nas regiões lateral da órbita e superior da órbita. Tomografia computadorizada revelou duas lesões ósseas separadas, bem delimitadas e hiperdensas nas paredes orbitárias. Uma biópsia seguida de estudo histopatológico revelou um tumor denso, com proliferação fibrosa associada a metaplasia óssea e atividade osteoclástica no tumor, características compatíveis com tumor marrom. A paciente foi submetida a remoção das glândulas paratiróides que resultou em melhora dramática do seu estado geral e regressão dos tumores orbitais. Embora a presença de mais de uma lesão óssea separada na órbita geralmente sugira o diagnóstico de lesões metastáticas, nosso caso evidencia que tumores marrons devem também ser incluídos no diagnóstico diferencial, particularmente em pacientes com

  14. Spontaneous Interlobar Pneumothorax in a Localized Fibrous Tumor of in the Pleura

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Young Tong [Dept. of Radiology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan (Korea, Republic of)

    2012-03-15

    We report a case of a localized fibrous tumor of in the pleura pleura; this tumor was associated with interlobar pneumothorax, which, to our knowledge, has not been reported to date. A 63-year-old woman presented with an incidentally-detected nodule, which was seen on her chest radiograph. It presented as a mural nodule within a cystic lesion, on the chest radiograph and axial CT, and a reformatted sagittal CT image could then be diagnosed as a pleural tumor associated with interlobar pneumothorax.

  15. Spontaneous Interlobar Pneumothorax in a Localized Fibrous Tumor of in the Pleura

    International Nuclear Information System (INIS)

    Kim, Young Tong

    2012-01-01

    We report a case of a localized fibrous tumor of in the pleura pleura; this tumor was associated with interlobar pneumothorax, which, to our knowledge, has not been reported to date. A 63-year-old woman presented with an incidentally-detected nodule, which was seen on her chest radiograph. It presented as a mural nodule within a cystic lesion, on the chest radiograph and axial CT, and a reformatted sagittal CT image could then be diagnosed as a pleural tumor associated with interlobar pneumothorax.

  16. Diagnosis and treatment of musculoskeletal chest pain: design of a multi-purpose trial

    DEFF Research Database (Denmark)

    Stochkendahl, Mette J; Christensen, Henrik W; Vach, Werner

    2008-01-01

    manipulation of the cervical and thoracic spine, mobilisation, and soft tissue techniques. b) Advice promoting self-management and individual instructions focusing on posture and muscle stretch (advice group). Outcome measures are pain, physical function, overall health, self-perceived treatment effect......BACKGROUND: Acute chest pain is a major health problem all over the western world. Active approaches are directed towards diagnosis and treatment of potentially life threatening conditions, especially acute coronary syndrome/ischemic heart disease. However, according to the literature, chest pain...... may also be due to a variety of extra-cardiac disorders including dysfunction of muscles and joints of the chest wall or the cervical and thoracic part of the spine. The diagnostic approaches and treatment options for this group of patients are scarce and formal clinical studies addressing the effect...

  17. Stabilization of flail chest injuries: minimized approach techniques to treat the core of instability.

    Science.gov (United States)

    Schulz-Drost, S; Grupp, S; Pachowsky, M; Oppel, P; Krinner, S; Mauerer, A; Hennig, F F; Langenbach, A

    2017-04-01

    Stabilizing techniques of flail chest injuries usually need wide approaches to the chest wall. Three main regions need to be considered when stabilizing the rib cage: median-anterior with dissection of pectoral muscle; lateral-axillary with dissection of musculi (mm) serratus, externus abdominis; posterior inter spinoscapular with division of mm rhomboidei, trapezius and latissimus dorsi. Severe morbidity due to these invasive approaches needs to be considered. This study discusses possibilities for minimized approaches to the shown regions. Fifteen patients were stabilized by locked plate osteosynthesis (MatrixRib ® ) between May 2012 and April 2014 and prospectively followed up. Flail chest injuries were managed through limited incisions to the anterior, the lateral, and the posterior parts of the chest wall or their combinations. Each approach was 4-10 cm using Alexis ® retractor. One minimized approach offered sufficient access at least to four ribs posterior and laterally, four pairs of ribs anterior in all cases. There was no need to divide latissimus dorsi muscle. Trapezius und rhomboid muscles were only limited divided, whereas a subcutaneous dissection of serratus and abdominis muscles was necessary. A follow-up showed sufficient consolidation. pneumothorax (2) and seroma (2). Minimized approaches allow sufficient stabilization of severe dislocated rib fractures without extensive dissection or division of the important muscles. Keeping the arm and, thus, the scapula mobile is very important for providing the largest reachable surface of the rib cage through each approach.

  18. Chest computed tomography in children under general anesthesia - cases of an atelectasis

    International Nuclear Information System (INIS)

    Laskowska, K.; Lasek, W.; Drewa, S.; Karolkiewicz, M.; Pogorzala, M.; Wysocki, M.

    2003-01-01

    Computed tomography is a routine examination in children with diagnosed or suspected cancer. Despite the procedure is painless, it requires stillness for some time. Thus, general anesthesia is provided in selected cases. An aim of this paper was an evaluation of an atelectasis incidence in children referred to CT examination under general anesthesia. Material consisted of 11 children aged 2-61 months with neoplasmatic disease diagnosed or suspected. All of them had a regular chest CT exam under general anesthesia with lungs parenchyma, mediastinum and chest wall analyzed. In 4 of 11 children (36%) atelectasis was seen, located in supradiaphragmatic and paravertebral segments of the lungs. None of the children had clinical symptoms of atelectasis. In two of them control chest radiograms did not show any changes. In some patients general anesthesia may reduce the lungs pneumatization which can hide metastases in lungs. It could be summarized that in infants and young children sedation instead of general anesthesia in chest CT should be considered, which could improve the quality of the imaging and the safety of the examination. (author)

  19. The Use of Tensor Fascia Lata Pedicled Flap in Reconstructing Full Thickness Abdominal Wall Defects and Groin Defects Following Tumor Ablation

    International Nuclear Information System (INIS)

    Rifaat, M.A.; Abdel Gawad, W.S.

    2005-01-01

    The tensor fascia lata is a versatile flap with many uses in reconstructive plastic surgery. As a pedicled flap its reach to the lower abdomen and groin made it an attractive option for reconstructing soft tissue defects after tumor ablation. However, debate exists on the safe dimension of the flap, as distal tip necrosis is common. Also, the adequacy of the fascia lata as a sole substitute for abdominal wall muscles has been disputable. The aim of the current study is to report our experience and clinical observations with this flap in reconstructing those challenging defects and to discuss the possible options to minimize the latter disputable issues. Patients and Methods: From April 2001 to April 2004, 12 pedicled TFL flaps were used to reconstruct 5 central abdominal wall full thickness defects and 6 groin soft tissue defects following tumor resection. ]n one case, bilateral flaps were used to reconstruct a large central abdominal wall defect. There were 4 males and 7 females. Their age ranged from 19 to 60. From the abdominal wall defects group, all repairs were enforced primarily with a prolene mesh except for one patient who was the first in this study. Patients presenting with groin defects required coverage of exposed vessels following tumor resection. All patients in the current study underwent immediate reconstruction. The resulting soft tissue defects in this study were due to resection of 4 abdominal wall desmoid tumors, a colonic carcinoma infiltrating the abdominal wall, 4 primary groin soft developed in a flap used to cover a groin defect. In the former 3 cases, The flap was simply transposed without complete islanding of the flap. In the latter case, a very large flap was harvested beyond the safe limits with its distal edge just above the knee. In addition, wound dehiscence of the flap occurred in 2 other cases from the groin group. Nevertheless, all the wounds healed spontaneously with repeated dressings. Out of the 5 cases that underwent

  20. Chest X-Ray

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    Full Text Available ... I’d like to talk with you about chest radiography also known as chest x-rays. Chest x-rays are the most ... far outweighs any risk. For more information about chest x-rays, visit Radiology Info dot org. Thank you for your time! ...

  1. Estimation of lung tumor position from multiple anatomical features on 4D-CT using multiple regression analysis.

    Science.gov (United States)

    Ono, Tomohiro; Nakamura, Mitsuhiro; Hirose, Yoshinori; Kitsuda, Kenji; Ono, Yuka; Ishigaki, Takashi; Hiraoka, Masahiro

    2017-09-01

    To estimate the lung tumor position from multiple anatomical features on four-dimensional computed tomography (4D-CT) data sets using single regression analysis (SRA) and multiple regression analysis (MRA) approach and evaluate an impact of the approach on internal target volume (ITV) for stereotactic body radiotherapy (SBRT) of the lung. Eleven consecutive lung cancer patients (12 cases) underwent 4D-CT scanning. The three-dimensional (3D) lung tumor motion exceeded 5 mm. The 3D tumor position and anatomical features, including lung volume, diaphragm, abdominal wall, and chest wall positions, were measured on 4D-CT images. The tumor position was estimated by SRA using each anatomical feature and MRA using all anatomical features. The difference between the actual and estimated tumor positions was defined as the root-mean-square error (RMSE). A standard partial regression coefficient for the MRA was evaluated. The 3D lung tumor position showed a high correlation with the lung volume (R = 0.92 ± 0.10). Additionally, ITVs derived from SRA and MRA approaches were compared with ITV derived from contouring gross tumor volumes on all 10 phases of the 4D-CT (conventional ITV). The RMSE of the SRA was within 3.7 mm in all directions. Also, the RMSE of the MRA was within 1.6 mm in all directions. The standard partial regression coefficient for the lung volume was the largest and had the most influence on the estimated tumor position. Compared with conventional ITV, average percentage decrease of ITV were 31.9% and 38.3% using SRA and MRA approaches, respectively. The estimation accuracy of lung tumor position was improved by the MRA approach, which provided smaller ITV than conventional ITV. © 2017 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.

  2. Modulated electron radiotherapy treatment planning using a photon multileaf collimator for post-mastectomized chest walls

    International Nuclear Information System (INIS)

    Salguero, Francisco Javier; Palma, Bianey; Arrans, Rafael; Rosello, Joan; Leal, Antonio

    2009-01-01

    Background and purpose: To evaluate the feasibility of using a photon MLC (xMLC) for modulated electron radiotherapy treatment (MERT) as an alternative to conventional post-mastectomy chest wall (CW) irradiation. A Monte Carlo (MC) based planning system was developed to overcome the inaccuracy of the 'pencil beam' algorithm. MC techniques are known to accurately calculate the dose distributions of electron beams, allowing the explicit simulation of electron interactions within the MLC. Materials and methods: Four real clinical CW cases were planned using MERT which were compared with the conventional electron treatments based on blocks and by a straightforward approach using the MLC, and not the blocks (as an intermediate step to MERT) to shape the same segments with SSD between 60 and 70 cm depending on PTV size. MC calculations were verified with an array of ionization chambers and radiochromic films in a solid water phantom. Results: Tests based on gamma analysis between MC dose distributions and radiochromic film measurements showed an excellent agreement. Differences in the absolute dose measured with a plane-parallel chamber at a reference point were below 3% for all cases. MERT solution showed a better PTV coverage and a significant reduction of the doses to the organs at risk (OARs). Conclusion: MERT can effectively improve the current electron treatments by obtaining a better PTV coverage and sparing healthy tissues. More directly, block-shaped treatments could be replaced by MLC-shaped non-modulated segments providing similar results.

  3. Heavy Metal Bioaccumulation in an Atypical Primitive Neuroectodermal Tumor of the Abdominal Wall.

    Science.gov (United States)

    Roncati, Luca; Gatti, Antonietta Morena; Capitani, Federico; Barbolini, Giuseppe; Maiorana, Antonio; Palmieri, Beniamino

    2015-01-01

    Heavy metals are able to interfere with the function of vital cellular components. Besides in trace heavy metals, which are essential at low concentration for humans, there are heavy metals with a well-known toxic and oncogenic potential. In this study, for the first time in literature, we report the unique adulthood case of an atypical primitive neuroectodermal tumor of the abdominal wall, diagnosed by histology and immunohistochemistry, with the molecular hybridization support. The neoplasia occurred in a patient chronically exposed to a transdermal delivery of heavy metal salts (aluminum and bismuth), whose intracellular bioaccumulation has been revealed by elemental microanalysis.

  4. High frequency chest wall oscillation plus Mechanical In-Exsufflation in Duchenne muscular dystrophy with respiratory complications related to pandemic Influenza A/H1N1

    Directory of Open Access Journals (Sweden)

    G. Crescimanno

    2010-11-01

    Full Text Available Two young boys with Duchenne muscular dystrophy, who had contracted 2009 pandemic influenza A/H1N1 (pH1N1, had been treated with antibiotics and steroids without significant improvement. One of them showed severe scoliosis. After hospitalization chest CT scan revealed extensive pulmonary bilateral segmental atelectasis. Their clinical and radiological findings rapidly improved when a sequential respiratory physiotherapy protocol was adopted that consisted of the application of multiple sessions of high-frequency chest wall oscillations each one followed by mechanically assisted coughing manoeuvres. The protocol was well tolerated, effective, easy to apply and special positioning was not required. Fifteen days after treatment initiation both patients clinically recovered. This treatment can be very helpful for neuromuscular patients, particularly when scoliosis prevents conventional respiratory physiotherapy. Resumo: Duas crianças do sexo masculino com distrofia muscular de Duchenne que contraíram o vírus da gripe pandémica A/H1N1(pH1N1 de 2009 foram tratados com antibióticos e esteróides sem melhoria significativa.Um deles revelou escoliose severa. Depois da hospitalização, um TAC ao peito revelou uma atelectasia pulmonar segmentar bilateral extensa. Os seus resultados clínicos e radiológicos melhoraram rapidamente quando foi adoptado um tratamento de fisioterapia respiratória sequencial, consistente na aplicação de múltiplas sessões de oscilações torácicas de alta frequência, cada uma seguida por exercícios de tosse mecanicamente assistidos. O tratamento foi bem tolerado, eficaz e fácil de aplicar, sendo que não foi necessário um posicionamento especial. Quinze dias depois do início do tratamento, ambos os pacientes se encontravam clinicamente recuperados. Este tratamento pode ser muito útil em pacientes com doenças neuromusculares, particularmente quando a escoliose

  5. High frequency chest wall oscillation plus Mechanical In-Exsufflation in Duchenne muscular dystrophy with respiratory complications related to pandemic Influenza A/H1N1

    Directory of Open Access Journals (Sweden)

    G. Crescimanno

    2010-11-01

    Full Text Available Two young boys with Duchenne muscular dystrophy, who had contracted 2009 pandemic influenza A/H1N1 (pH1N1, had been treated with antibiotics and steroids without significant improvement. One of them showed severe scoliosis. After hospitalization chest CT scan revealed extensive pulmonary bilateral segmental atelectasis. Their clinical and radiological findings rapidly improved when a sequential respiratory physiotherapy protocol was adopted that consisted of the application of multiple sessions of high-frequency chest wall oscillations, each one followed by mechanically assisted coughing manoeuvres. The protocol was well tolerated, effective, easy to apply and special positioning was not required. Fifteen days after treatment initiation both patients clinically recovered. This treatment can be very helpful for neuromuscular patients, particularly when scoliosis prevents conventional respiratory physiotherapy. Resumo: Duas crianças do sexo masculino com distrofia muscular de Duchenne que contraíram o vírus da gripe pandémica A/H1N1(pH1N1 de 2009 foram tratados com antibióticos e esteróides sem melhoria significativa.Um deles revelou escoliose severa. Depois da hospitalização, um TAC ao peito revelou uma atelectasia pulmonar segmentar bilateral extensa. Os seus resultados clínicos e radiológicos melhoraram rapidamente quando foi adoptado um tratamento de fisioterapia respiratória sequencial, consistente na aplicação de múltiplas sessões de oscilações torácicas de alta frequência, cada uma seguida por exercícios de tosse mecanicamente assistidos. O tratamento foi bem tolerado, eficaz e fácil de aplicar, sendo que não foi necessário um posicionamento especial. Quinze dias depois do início do tratamento, ambos os pacientes se encontravam clinicamente recuperados. Este tratamento pode ser muito útil em pacientes com doenças neuromusculares, particularmente quando a escoliose

  6. Exercise radionuclide ventriculographic responses in hypertensive patients with chest pain

    International Nuclear Information System (INIS)

    Wasserman, A.G.; Katz, R.J.; Varghese, P.J.; Leiboff, R.H.; Bren, G.G.; Schlesselman, S.; Varma, V.M.; Reba, R.C.; Ross, A.M.

    1984-01-01

    The effectiveness of exercise-treadmill testing in diagnosing coronary-artery disease in hypertensive patients is limited by a high rate of false positivity. Exercise radionuclide ventriculography, however, relies on different criteria (ejection fraction and wall motion), and we have evaluated this procedure in 37 hypertensive and 109 normotensive patients with chest pain, using coronary arteriography as an indicator of coronary disease. In the hypertensive cohort there was no difference in the ejection fraction at rest between the 17 patients with coronary disease and the 20 without it. Neither group had a significant mean (+/- S.E.M.) change in ejection fraction from rest to exercise (-1.9 +/- 2 and 1.4 +/- 1%, respectively). A wall-motion abnormality developed during exercise in 5 of the 17 hypertensive patients with coronary disease (29%) and in 4 of the 20 without it (20%) (P = not significant). In the normotensive cohort, however, the peak-exercise ejection fractions were significantly different. The 71 patients with coronary disease had a mean decrease of 3.6 +/- 1%, in contrast to the patients without coronary disease, who had an increase of +/- 1% (P < 0.001). An exercise-induced wall-motion abnormality was seen in 35 of the 71 patients with coronary disease (48%), as compared with 3 of the 38 without it (8%) (P < 0.001). We conclude that exercise radionuclide ventriculography is inadequate as a screening test for coronary atherosclerosis in hypertensive patients with chest pain. 28 references, 2 figures, 3 tables

  7. Giant Cell Tumor of Rib Arising Anteriorly as a Large Inframammary Mass: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Amit Sharma

    2012-01-01

    posteriorly. The rarity of this tumor poses diagnostic and therapeutic problems for physicians, especially when it is located in the anterior arc of the rib in close proximity to the breasts in female patients. Case Presentation. We report the case of a 32-year-old Asian female with a giant cell tumor of her anterior rib, presenting as a large inframammary mass. Computed tomography showed a tumor arising from the 7th rib anteriorly with marginal sclerosis, cortical destruction, and a soft tissue mass. She was treated with surgical resection, and the defect was reconstructed primarily. The surgical specimen measured 28.0 × 24.0 cm. The microscopic examination showed a large number of multinucleate giant cells scattered over the parenchyma. Patient recovered uneventfully and continues to be recurrence-free six years after surgical resection. Conclusion. We report the largest known case of giant cell tumor arising from the anterior aspect of a rib. We recommend including giant cell tumor in the differential diagnosis of chest wall masses especially in female patients, regardless of the size on clinical examination.

  8. X-ray face mask and chest shield device

    International Nuclear Information System (INIS)

    Moti, S.

    1981-01-01

    A protective face mask is designed to shield an x-ray technician or machine operator primarily from random secondary or scatter x-rays deflected towards his face, head and neck by the table, walls, equipment and other reflecting elements in an x-ray room or chamber. The face mask and chest shield device can be mounted on a patient's shoulders in reverse attitude to protect the back of a patient's head and neck from the x-ray beam. The face mask is relatively or substantially transparent and contains lead in combination with a plastic ionomer or comonomer, which to a degree absorbs or resists penetration of the random deflected secondary or scatter x-rays or the x-ray beam through the mask. The face mask is removably attachable to the chest shield for easy application of the device to and support upon the shoulders of the technician or the patient. (author)

  9. Diastolic timed Vibro-Percussion at 50 Hz delivered across a chest wall sized meat barrier enhances clot dissolution and remotely administered Streptokinase effectiveness in an in-vitro model of acute coronary thrombosis

    OpenAIRE

    Hoffmann, Andrew; Gill, Harjit

    2012-01-01

    Abstract Background Low Frequency Vibro-Percussion (LFVP) assists clearance of thrombi in catheter systems and when applied to the heart and timed to diastole is known to enhance coronary flow. However LFVP on a clotted coronary like vessel given engagement over a chest wall sized barrier (to resemble non-invasive heart attack therapy) requires study. Methods One hour old clots (n=16) were dispensed within a flexible segment of Soft-Flo catheter (4 mm lumen), weighted, interfaced with Heparin...

  10. Transposition of the Greater Arteries (TGA)

    Science.gov (United States)

    ... Disease Barrett’s Esophagus Chest Wall Tumors Mediastinal Tumors Achalasia and Esophageal Motility Disorders Pleural Diseases Mesothelioma Heart ... after birth. Diagnosis and Treatment Options Diagnosis and Treatment Options TGA usually is diagnosed based on the ...

  11. Fifteen-year results of a randomized prospective trial of hyperfractionated chest wall irradiation versus once-daily chest wall irradiation after chemotherapy and mastectomy for patients with locally advanced noninflammatory breast cancer

    International Nuclear Information System (INIS)

    Buchholz, Thomas A.; Strom, Eric A.; Oswald, Mary Jane; Perkins, George H.; Oh, Julia; Domain, Delora; Yu, Tse-Kuan; Woodward, Wendy A.; Tereffe, Welela; Singletary, S. Eva; Thomas, Eva; Buzdar, Aman U.; Hortobagyi, Gabriel N.; McNeese, Marsha D.

    2006-01-01

    Purpose: To analyze the results of a Phase III clinical trial that investigated whether a hyperfractionated radiotherapy (RT) schedule could reduce the risk of locoregional recurrence in patients with locally advanced breast cancer treated with chemotherapy and mastectomy. Methods and Materials: Between 1985 and 1989, 200 patients with clinical Stage III noninflammatory breast cancer were enrolled in a prospective study investigating neoadjuvant and adjuvant chemotherapy. Of the 179 patients treated with mastectomy after neoadjuvant chemotherapy, 108 participated in a randomized component of the trial that compared a dose-escalated, hyperfractionated (twice-daily, b.i.d.) chest wall RT schedule (72 Gy in 1.2-Gy b.i.d. fractions) with a once-daily (q.d.) schedule (60 Gy in 2-Gy q.d. fractions). In both arms of the study, the supraclavicular fossa and axillary apex were treated once daily to 50 Gy. The median follow-up period was 15 years. Results: The 15-year actuarial locoregional recurrence rate was 7% for the q.d. arm and 12% for the b.i.d. arm (p = 0.36). The rates of severe acute toxicity were similar (4% for q.d. vs. 5% for b.i.d.), but moist desquamation developed in 42% of patients in the b.i.d. arm compared with 28% of the patients in the q.d. arm (p = 0.16). The 15-year actuarial rate of severe late RT complications did not differ between the two arms (6% for q.d. vs. 11% for b.i.d., p = 0.54). Conclusion: Although the sample size of this study was small, we found no evidence that this hyperfractionation schedule of postmastectomy RT offered a clinical advantage. Therefore, we have concluded that it should not be further studied in this cohort of patients

  12. Radical stereotactic radiosurgery with real-time tumor motion tracking in the treatment of small peripheral lung tumors

    Directory of Open Access Journals (Sweden)

    Chang Thomas

    2007-10-01

    Full Text Available Abstract Background Recent developments in radiotherapeutic technology have resulted in a new approach to treating patients with localized lung cancer. We report preliminary clinical outcomes using stereotactic radiosurgery with real-time tumor motion tracking to treat small peripheral lung tumors. Methods Eligible patients were treated over a 24-month period and followed for a minimum of 6 months. Fiducials (3–5 were placed in or near tumors under CT-guidance. Non-isocentric treatment plans with 5-mm margins were generated. Patients received 45–60 Gy in 3 equal fractions delivered in less than 2 weeks. CT imaging and routine pulmonary function tests were completed at 3, 6, 12, 18, 24 and 30 months. Results Twenty-four consecutive patients were treated, 15 with stage I lung cancer and 9 with single lung metastases. Pneumothorax was a complication of fiducial placement in 7 patients, requiring tube thoracostomy in 4. All patients completed radiation treatment with minimal discomfort, few acute side effects and no procedure-related mortalities. Following treatment transient chest wall discomfort, typically lasting several weeks, developed in 7 of 11 patients with lesions within 5 mm of the pleura. Grade III pneumonitis was seen in 2 patients, one with prior conventional thoracic irradiation and the other treated with concurrent Gefitinib. A small statistically significant decline in the mean % predicted DLCO was observed at 6 and 12 months. All tumors responded to treatment at 3 months and local failure was seen in only 2 single metastases. There have been no regional lymph node recurrences. At a median follow-up of 12 months, the crude survival rate is 83%, with 3 deaths due to co-morbidities and 1 secondary to metastatic disease. Conclusion Radical stereotactic radiosurgery with real-time tumor motion tracking is a promising well-tolerated treatment option for small peripheral lung tumors.

  13. Automatic lung tumor segmentation on PET/CT images using fuzzy Markov random field model.

    Science.gov (United States)

    Guo, Yu; Feng, Yuanming; Sun, Jian; Zhang, Ning; Lin, Wang; Sa, Yu; Wang, Ping

    2014-01-01

    The combination of positron emission tomography (PET) and CT images provides complementary functional and anatomical information of human tissues and it has been used for better tumor volume definition of lung cancer. This paper proposed a robust method for automatic lung tumor segmentation on PET/CT images. The new method is based on fuzzy Markov random field (MRF) model. The combination of PET and CT image information is achieved by using a proper joint posterior probability distribution of observed features in the fuzzy MRF model which performs better than the commonly used Gaussian joint distribution. In this study, the PET and CT simulation images of 7 non-small cell lung cancer (NSCLC) patients were used to evaluate the proposed method. Tumor segmentations with the proposed method and manual method by an experienced radiation oncologist on the fused images were performed, respectively. Segmentation results obtained with the two methods were similar and Dice's similarity coefficient (DSC) was 0.85 ± 0.013. It has been shown that effective and automatic segmentations can be achieved with this method for lung tumors which locate near other organs with similar intensities in PET and CT images, such as when the tumors extend into chest wall or mediastinum.

  14. Automatic Lung Tumor Segmentation on PET/CT Images Using Fuzzy Markov Random Field Model

    Directory of Open Access Journals (Sweden)

    Yu Guo

    2014-01-01

    Full Text Available The combination of positron emission tomography (PET and CT images provides complementary functional and anatomical information of human tissues and it has been used for better tumor volume definition of lung cancer. This paper proposed a robust method for automatic lung tumor segmentation on PET/CT images. The new method is based on fuzzy Markov random field (MRF model. The combination of PET and CT image information is achieved by using a proper joint posterior probability distribution of observed features in the fuzzy MRF model which performs better than the commonly used Gaussian joint distribution. In this study, the PET and CT simulation images of 7 non-small cell lung cancer (NSCLC patients were used to evaluate the proposed method. Tumor segmentations with the proposed method and manual method by an experienced radiation oncologist on the fused images were performed, respectively. Segmentation results obtained with the two methods were similar and Dice’s similarity coefficient (DSC was 0.85 ± 0.013. It has been shown that effective and automatic segmentations can be achieved with this method for lung tumors which locate near other organs with similar intensities in PET and CT images, such as when the tumors extend into chest wall or mediastinum.

  15. Diastolic timed Vibro-Percussion at 50 Hz delivered across a chest wall sized meat barrier enhances clot dissolution and remotely administered Streptokinase effectiveness in an in-vitro model of acute coronary thrombosis

    Directory of Open Access Journals (Sweden)

    Hoffmann Andrew

    2012-11-01

    Full Text Available Abstract Background Low Frequency Vibro-Percussion (LFVP assists clearance of thrombi in catheter systems and when applied to the heart and timed to diastole is known to enhance coronary flow. However LFVP on a clotted coronary like vessel given engagement over a chest wall sized barrier (to resemble non-invasive heart attack therapy requires study. Methods One hour old clots (n=16 were dispensed within a flexible segment of Soft-Flo catheter (4 mm lumen, weighted, interfaced with Heparinized Saline (HS, secured atop a curved dampening base, and photographed. A ~4 cm meat slab was placed over the segment and randomized to receive intermittent LFVP (engaged, - disengaged at 1 second intervals, or no LFVP for 20 minutes. HS was pulsed (~120/80 mmHg, with the diastolic phase coordinated to match LFVP delivery. The segment was then re-photographed and aspirated of fluid to determine post clot weight. The trial was then repeated with 0.5 mls of Streptokinase (15,000 IU/100 microlitre delivered ~ 2 cm upstream from the clot. Results LFVP - HS only samples (vs. controls showed; a development of clot length fluid channels absent in the control group (p Conclusion Diastolic timed LFVP (50 Hz engaged across a chest wall sized barrier enhances clot disruptive effects to an underlying coronary like system.

  16. Proton radiotherapy for chest wall and regional lymphatic radiation; dose comparisons and treatment delivery

    International Nuclear Information System (INIS)

    MacDonald, Shannon M; Jimenez, Rachel; Paetzold, Peter; Adams, Judith; Beatty, Jonathan; DeLaney, Thomas F; Kooy, Hanne; Taghian, Alphonse G; Lu, Hsiao-Ming

    2013-01-01

    The delivery of post-mastectomy radiation therapy (PMRT) can be challenging for patients with left sided breast cancer that have undergone mastectomy. This study investigates the use of protons for PMRT in selected patients with unfavorable cardiac anatomy. We also report the first clinical application of protons for these patients. Eleven patients were planned with protons, partially wide tangent photon fields (PWTF), and photon/electron (P/E) fields. Plans were generated with the goal of achieving 95% coverage of target volumes while maximally sparing cardiac and pulmonary structures. In addition, we report on two patients with unfavorable cardiac anatomy and IMN involvement that were treated with a mix of proton and standard radiation. PWTF, P/E, and proton plans were generated and compared. Reasonable target volume coverage was achieved with PWTF and P/E fields, but proton therapy achieved superior coverage with a more homogeneous plan. Substantial cardiac and pulmonary sparing was achieved with proton therapy as compared to PWTF and P/E. In the two clinical cases, the delivery of proton radiation with a 7.2 to 9 Gy photon and electron component was feasible and well tolerated. Akimbo positioning was necessary for gantry clearance for one patient; the other was treated on a breast board with standard positioning (arms above her head). LAO field arrangement was used for both patients. Erythema and fatigue were the only noted side effects. Proton RT enables delivery of radiation to the chest wall and regional lymphatics, including the IMN, without compromise of coverage and with improved sparing of surrounding normal structures. This treatment is feasible, however, optimal patient set up may vary and field size is limited without multiple fields/matching

  17. Examination of musculoskeletal chest pain

    DEFF Research Database (Denmark)

    Brunse, Mads Hostrup; Stochkendahl, Mette Jensen; Vach, Werner

    2010-01-01

    using a standardized examination protocol, (2) to determine inter-observer reliability of single components of the protocol, and (3) to determine the effect of observer experience. Eighty patients were recruited from an emergency cardiology department. Patients were eligible if an obvious cardiac or non......-cardiac diagnosis could not be established at the cardiology department. Four observers (two chiropractors and two chiropractic students) performed general health and manual examination of the spine and chest wall. Percentage agreement, Cohen's Kappa and ICC were calculated for observer pairs (chiropractors.......01 to 0.59. Provided adequate training of observers, the examination protocol can be used in carefully selected patients in clinical settings and should be included in pre- and post-graduate clinical training....

  18. Protocol for a multicentre randomised feasibility STUdy evaluating the impact of a prognostic model for Management of BLunt chest wall trauma patients: STUMBL trial.

    Science.gov (United States)

    Battle, Ceri; Abbott, Zoe; Hutchings, Hayley A; O'Neill, Claire; Groves, Sam; Watkins, Alan; Lecky, Fiona E; Jones, Sally; Gagg, James; Body, Richard; Evans, Philip A

    2017-07-10

    A new prognostic model has been developed and externally validated, the aim of which is to assist in the management of the blunt chest wall trauma patient in the emergency department (ED). A definitive randomised controlled trial (impact trial) is required to assess the clinical and cost effectiveness of the new model before it can be accepted in clinical practice. The purpose of this trial is to assess the feasibility and acceptability of such a definitive trial and inform its design. This feasibility trial is designed to test the methods of a multicentre, cluster-randomised (stepped- wedge) trial, with a substantial qualitative component. Four EDs in England and Wales will collect data for all blunt chest wall trauma patients over a 5-month period; in the initial period acting as the controls (normal care), and in the second period acting as the interventions (in which the new model will be used). Baseline measurements including completion of the SF-12v2 will be obtained on initial assessment in the ED. Patient outcome data will then be collected for any subsequent hospitalisations. Data collection will conclude with a 6-week follow-up completion of two surveys (SF-12v2 and Client Services Receipt Inventory). Analysis of outcomes will focus on feasibility, acceptability and trial processes and will include recruitment and retention rates, attendance at clinician training rates and use of model in the ED. Qualitative feedback will be obtained through clinician interviews and a research nurse focus group. An evaluation of the feasibility of health economics outcomes data will be completed. Wales Research Ethics Committee 6 granted approval for the trial in September 2016. Patient recruitment will commence in February 2017. Planned dissemination is through publication in a peer-reviewed Emergency Medicine Journal , presentation at appropriate conferences and to stakeholders at professional meetings. ISRCTN95571506; Pre-results. © Article author(s) (or their

  19. Derivation and validation of two decision instruments for selective chest CT in blunt trauma: a multicenter prospective observational study (NEXUS Chest CT).

    Science.gov (United States)

    Rodriguez, Robert M; Langdorf, Mark I; Nishijima, Daniel; Baumann, Brigitte M; Hendey, Gregory W; Medak, Anthony J; Raja, Ali S; Allen, Isabel E; Mower, William R

    2015-10-01

    Unnecessary diagnostic imaging leads to higher costs, longer emergency department stays, and increased patient exposure to ionizing radiation. We sought to prospectively derive and validate two decision instruments (DIs) for selective chest computed tomography (CT) in adult blunt trauma patients. From September 2011 to May 2014, we prospectively enrolled blunt trauma patients over 14 y of age presenting to eight US, urban level 1 trauma centers in this observational study. During the derivation phase, physicians recorded the presence or absence of 14 clinical criteria before viewing chest imaging results. We determined injury outcomes by CT radiology readings and categorized injuries as major or minor according to an expert-panel-derived clinical classification scheme. We then employed recursive partitioning to derive two DIs: Chest CT-All maximized sensitivity for all injuries, and Chest CT-Major maximized sensitivity for only major thoracic injuries (while increasing specificity). In the validation phase, we employed similar methodology to prospectively test the performance of both DIs. We enrolled 11,477 patients-6,002 patients in the derivation phase and 5,475 patients in the validation phase. The derived Chest CT-All DI consisted of (1) abnormal chest X-ray, (2) rapid deceleration mechanism, (3) distracting injury, (4) chest wall tenderness, (5) sternal tenderness, (6) thoracic spine tenderness, and (7) scapular tenderness. The Chest CT-Major DI had the same criteria without rapid deceleration mechanism. In the validation phase, Chest CT-All had a sensitivity of 99.2% (95% CI 95.4%-100%), a specificity of 20.8% (95% CI 19.2%-22.4%), and a negative predictive value (NPV) of 99.8% (95% CI 98.9%-100%) for major injury, and a sensitivity of 95.4% (95% CI 93.6%-96.9%), a specificity of 25.5% (95% CI 23.5%-27.5%), and a NPV of 93.9% (95% CI 91.5%-95.8%) for either major or minor injury. Chest CT-Major had a sensitivity of 99.2% (95% CI 95.4%-100%), a specificity of

  20. Hybrid video-assisted and limited open (VALO) resection of superior sulcus tumors.

    Science.gov (United States)

    Nun, Alon Ben; Simansky, David; Rokah, Merav; Zeitlin, Nona; Avi, Roni Ben; Soudack, Michalle; Golan, Nir; Apel, Sarit; Bar, Jair; Yelin, Alon

    2016-06-01

    To compare the postoperative recovery of patients with superior sulcus tumors (Pancoast tumors) following conventional open surgery vs. a hybrid video-assisted and limited open approach (VALO). The subjects of this retrospective study were 20 patients we operated on to resect a Pancoast tumor. All patients received induction chemo-radiation followed by surgery, performed via either a conventional thoracotomy approach (n = 10) or the hybrid VALO approach (n = 10). In the hybrid VALO group, lobectomy and internal chest wall preparation were performed using a video technique, with rib resection and specimen removal through a limited incision. There was no mortality in either group. Two patients from the thoracotomy group required mechanical ventilation, but there was no major morbidity in the hybrid VALO group. The operative times were similar for the two procedures. The average length of hospital stay was shorter and the average pain scores were significantly lower in the hybrid VALO group. The incidence of chronic pain was 10 % in the hybrid VALO group vs. 50 % in the thoracotomy group. Hybrid VALO resection of Pancoast tumors is feasible and safe, resulting in faster patient recovery and a significantly lower incidence of severe chronic pain than open thoracotomy. We conclude that centers experienced with video-assisted lobectomy should consider hybrid VALO surgery as the procedure of choice for Pancoast tumors.

  1. Automated quantification of bronchiectasis, airway wall thickening and lumen tapering in chest CT

    DEFF Research Database (Denmark)

    Perez-Rovira, Adria; Kuo, Wieying; Petersen, Jens

    thickness and accompanying artery radius), and inter-branch Lumen-Ratio (LR, ratio between a branch's lumen and its parent branch lumen radius, a tapering measurement) were computed. Because CF-related structural abnormalities only affect a portion of branches, the 75th percentile was used as summarising......Purpose: To automatically quantify airway structural properties visualised on CT in children with cystic fibrosis (CF) and controls, including: bronchiectasis, airway wall thickening, and lumen tapering. Methods and materials: The 3D surface of the airway lumen, outer wall, and bronchial arteries...... were obtained using a fully automatic, in-house developed, segmentation method. Subsequently, for each detected airway branch, the Airway-Artery Ratio (AAR, ratio between airway outer wall and accompanying artery radius, a bronchiectasis measurement), Wall-Artery Ratio (WAR, ratio between airway wall...

  2. Chest tube placement in thorax trauma - comparison chest X-ray and computed tomography (CT)

    International Nuclear Information System (INIS)

    Heim, P.; Maas, R.; Buecheler, E.; Tesch, C.

    1998-01-01

    Estimation of chest tube placement in patients with thoracic trauma with regard to chest tube malposition in chest radiography in the supine position compared to additional computed tomography of the thorax. Material and methods: Apart from compulsory chest radiography after one or multiple chest tube insertions, 31 severely injured patients with thoracic trauma underwent a CT scan of the thorax. These 31 patients with 40 chest tubes constituted the basis for the present analysis. Results: In chest radiography in the supine position there were no chest tube malpositions (n=40); In the CT scans 25 correct positions, 7 pseudo-malpositions, 6 intrafissural and 2 intrapulmonary malpositions were identified. Moreover 16 sufficient, 18 insufficient and 6 indifferent functions of the chest tubes were seen. Conclusion: In case of lasting clinical problems and questionable function of the chest tube, chest radiography should be supplemented by a CT scan of the thorax in order to estimate the position of the chest tube. (orig.) [de

  3. Generalities of anomalous CT chest non tumoral

    International Nuclear Information System (INIS)

    Dibarboure, L.

    2012-01-01

    This presentation is about the generalities of multidetector CT in the pulmonary, the diaphragmatic, the pleural and the mediastinum pathology.These techniques as well as the virtual endoscopy allow visualize volumetric thorax reconstructions, brain diseases, opacities, radiolucent images, respiratory and vascular diseases, pneumonia, embolism, AIDS stage, tuberculosis, tumors, etc

  4. Efficacy of hypofractionated radiotherapy in loco-regional tumor control in breast

    International Nuclear Information System (INIS)

    Riaz, O.; Mahmood, A.; Rasul, S.; Haider, N.; Gul, S.

    2017-01-01

    Objective: To evaluate the efficacy of hypofractionated radiotherapy (HFRT) in locoregional control (LRC) in breast cancer. Study Design: Descriptive case series. Place and Duration of Study: Oncology Department of CMH Rawalpindi, from Jan 2014 to Oct 2014. Material and Methods: Fifty three female patients with histopathologically confirmed breast cancer and Eastern Cooperative Oncology Group performance status (ECOG-PS) greater than equal to 2 were enrolled in the study. These patients required post-operative radio-therapy to intact breast/ chest wall / residual breast tissue were treated using linear accelerator. Lateral/medial tangential and ipsilateral supraclavicular fields were employed to a dose of 39 Gy in 13 fractions with 6 MV photon beam. The ipsilateral axilla was also radiated if required to same dose with postero-anterior field. Scar boost was administered using 6 MeV electron beam to a dose of 7.5 Gy in 3 fractions in patients with high risk features for local recurrence like high grade, positive axillary nodes, lymphovascular invasion and close or positive surgical resection margins. Patients were followed up weekly during radio-therapy (RT) and three monthly after completion of RT for a period of 6 months. Any suspicious lesion was subjected to biopsy. Data analysis was done with the help of the Statistical Package for the Social Sciences (SPSS) version 19 software, which included descriptive analysis. Loco-regional control (LRC) and loco-regional recurrence (LRR) rates were calculated. LRC was no recurrence of tumor/tumor control in chest wall, axilla, residual breast tissue, and/or infraclavicular/supraclavicular lymph nodes. LRR was appearance of nodules / leison at local site which was biopsied and confirmed histopathologically. Results: Fifty three female patients with histopathologically confirmed breast cancer and ECOG-PS greater than equal to 2 requiring post-operative radio-therapy to intact breast/chest wall/ residual breast tissue were

  5. Evaluation of the distortions of the digital chest image caused by the data compression

    International Nuclear Information System (INIS)

    Ando, Yutaka; Kunieda, Etsuo; Ogawa, Koichi; Tukamoto, Nobuhiro; Hashimoto, Shozo; Aoki, Makoto; Kurotani, Kenichi.

    1988-01-01

    The image data compression methods using orthogonal transforms (Discrete cosine transform, Discrete fourier transform, Hadamard transform, Haar transform, Slant transform) were analyzed. From the points of the error and the speed of the data conversion, the discrete cosine transform method (DCT) is superior to the other methods. The block quantization by the DCT for the digital chest image was used. The quality of data compressed and reconstructed images by the score analysis and the ROC curve analysis was examined. The chest image with the esophageal cancer and metastatic lung tumors was evaluated at the 17 checkpoints (the tumor, the vascular markings, the border of the heart and ribs, the mediastinal structures and et al). By our score analysis, the satisfactory ratio of the data compression is 1/5 and 1/10. The ROC analysis using normal chest images superimposed by the artificial coin lesions was made. The ROC curve of the 1/5 compressed ratio is almost as same as the original one. To summarize our study, the image data compression method using the DCT is thought to be useful for the clinical use and the 1/5 compression ratio is a tolerable ratio. (author)

  6. Evaluation of the distortions of the digital chest image caused by the data compression

    Energy Technology Data Exchange (ETDEWEB)

    Ando, Yutaka; Kunieda, Etsuo; Ogawa, Koichi; Tukamoto, Nobuhiro; Hashimoto, Shozo; Aoki, Makoto; Kurotani, Kenichi

    1988-08-01

    The image data compression methods using orthogonal transforms (Discrete cosine transform, Discrete fourier transform, Hadamard transform, Haar transform, Slant transform) were analyzed. From the points of the error and the speed of the data conversion, the discrete cosine transform method (DCT) is superior to the other methods. The block quantization by the DCT for the digital chest image was used. The quality of data compressed and reconstructed images by the score analysis and the ROC curve analysis was examined. The chest image with the esophageal cancer and metastatic lung tumors was evaluated at the 17 checkpoints (the tumor, the vascular markings, the border of the heart and ribs, the mediastinal structures and et al). By our score analysis, the satisfactory ratio of the data compression is 1/5 and 1/10. The ROC analysis using normal chest images superimposed by the artificial coin lesions was made. The ROC curve of the 1/5 compressed ratio is almost as same as the original one. To summarize our study, the image data compression method using the DCT is thought to be useful for the clinical use and the 1/5 compression ratio is a tolerable ratio.

  7. Chest physiotherapy in mechanically ventilated children: a review.

    Science.gov (United States)

    Krause, M F; Hoehn, T

    2000-05-01

    Many physicians, nurses, and respiratory care practitioners consider chest physiotherapy (CP) a standard therapy in mechanically ventilated children beyond the newborn period. CP includes percussion, vibration, postural drainage, assisted coughing, and suctioning via the endotracheal tube. We searched the medical literature by using the key words "chest physiotherapy" and "chest physical therapy" (among others) by means of the MEDLINE and Current Contents databases. Because of the paucity of objective data, we examined all reports dealing with this topic, including studies on adult patients. For data extraction, not enough material existed to perform a meta-analysis. Despite its widespread use, almost no literature dealing with this treatment modality in pediatric patients exists. Studies with mechanically ventilated pediatric and adult patients have shown that CP is the most irritating routine intensive care procedure to patients. An increase in oxygen consumption often occurs when a patient receives CP accompanied by an elevation in heart rate, blood pressure, and intracranial pressure. CP leads to short-term decreases in oxygen, partial pressure in the blood, and major fluctuations in cardiac output. Changes in these vital signs and other variables may be even more pronounced in pediatric patients because the lung of a child is characterized by a higher closing capacity and the chest walls are characterized by a much higher compliance, thus predisposing the child to the development of atelectasis secondary to percussion and vibration. CP in mechanically ventilated children may not be considered a standard therapy. Controlled studies examining the impact of CP on the duration of mechanical ventilatory support, critical illness, and hospital stay are needed.

  8. Benign fibrous mesothelioma of the pleura: MR study and pathologic correlation

    International Nuclear Information System (INIS)

    Padovani, B.; Mouroux, J.; Raffaelli, C.; Huys, C.; Chanalet, S.; Michiels, J.F.; Brunner, P.; Bruneton, J.N.

    1996-01-01

    Benign fibrous mesothelioma of the pleura is a rare tumor of mesodermal origin. We describe the MR findings in three pathologically proven cases. All three tumors were imaged by MR as well-circumscribed lesions with smooth margins in contact with the pleura, but without chest wall invasion. Their low signal intensity on T1- and T2-weighted sequences reflect their fibrous nature. In one case a pedicle connecting the tumor to the chest wall was visualized on a sagittal MR scan. In two cases gadolinium-enhanced T1-weighted gradient echo sequences revealed intense contrast uptake by the tumor correlated with the intratumoral hypervascularization noted by histologic examination. Although the number of cases presented is small, MR seems to be the most accurate imaging modality in the assessment of the diagnosis. (orig.). With 4 figs., 1 tab

  9. Benign fibrous mesothelioma of the pleura: MR study and pathologic correlation

    Energy Technology Data Exchange (ETDEWEB)

    Padovani, B. [Service Central de Radiologie, Hopital Pasteur, Nice (France); Mouroux, J. [Service de Chirurgie Thoracique, Hopital Pasteur, Nice (France); Raffaelli, C. [Service Central de Radiologie, Hopital Pasteur, Nice (France); Huys, C. [Service Central de Radiologie, Hopital Pasteur, Nice (France); Chanalet, S. [Service Central de Radiologie, Hopital Pasteur, Nice (France); Michiels, J.F. [Service d`Anatomie Pathologique, Hopital Pasteur, Nice (France); Brunner, P. [Service Central de Radiologie, Hopital Pasteur, Nice (France); Bruneton, J.N. [Service Central de Radiologie, Hopital Pasteur, Nice (France)

    1996-08-01

    Benign fibrous mesothelioma of the pleura is a rare tumor of mesodermal origin. We describe the MR findings in three pathologically proven cases. All three tumors were imaged by MR as well-circumscribed lesions with smooth margins in contact with the pleura, but without chest wall invasion. Their low signal intensity on T1- and T2-weighted sequences reflect their fibrous nature. In one case a pedicle connecting the tumor to the chest wall was visualized on a sagittal MR scan. In two cases gadolinium-enhanced T1-weighted gradient echo sequences revealed intense contrast uptake by the tumor correlated with the intratumoral hypervascularization noted by histologic examination. Although the number of cases presented is small, MR seems to be the most accurate imaging modality in the assessment of the diagnosis. (orig.). With 4 figs., 1 tab.

  10. The effect of tumor location and respiratory function on tumor movement estimated by real-time tracking radiotherapy (RTRT) system

    International Nuclear Information System (INIS)

    Onimaru, Rikiya; Shirato, Hiroki; Fujino, Masaharu; Suzuki, Keishiro; Yamazaki, Kouichi; Nishimura, Masaharu; Dosaka-Akita, Hirotoshi; Miyasaka, Kazuo

    2005-01-01

    Purpose: The effects of tumor location and pulmonary function on the motion of fiducial markers near lung tumors were evaluated to deduce simple guidelines for determining the internal margin in radiotherapy without fiducial markers. Methods and Materials: Pooled data collected by a real-time tumor-tracking radiotherapy system on 42 markers in 39 patients were analyzed. The pulmonary functions of all patients were assessed before radiotherapy. Using chest X-ray film, the position of the marker was expressed relative to the geometry of the unilateral lung. Posterior location meant the area of the posterior half of the lung in a lateral chest X-ray film, and caudal location meant the caudal half of the chest X-ray film; these categories were determined by measuring the distance between the marker and anatomic landmarks, including the apex, costophrenic angle, midline of spinal canal, lateral, anterior, and posterior boundary of the lung. Results: Before the radiotherapy, 18 patients had obstructive respiratory dysfunction (ratio of forced expiratory volume in 1 s to forced vital capacity [FEV 1.0 /FVC] 1.0 /FVC and %VC were 97.0% and 66.5%, respectively. Median tumor movements in the x (left-right), y (anteroposterior), and z (craniocaudal) directions were 1.1 mm, 2.3 mm, and 5.4 mm, respectively. There was no significant correlation between respiratory function and magnitude of marker movement in any direction. Median marker movement in the z direction was 2.6 mm for the cranial location and 11.8 mm for the caudal location, respectively (p < 0.001). Median movement in the z direction was 11.8 mm for posterior location and 3.4 mm for anterior location, respectively (p < 0.01). Conclusions: Simple measurement of the relative location on plain chest X-ray film was related, but respiratory function test was not related, to the craniocaudal amplitude of the motion of the fiducial marker near lung tumors

  11. Rib fractures induced by coughing: an unusual cause of acute chest pain.

    Science.gov (United States)

    De Maeseneer, M; De Mey, J; Debaere, C; Meysman, M; Osteaux, M

    2000-03-01

    We report three patients with stress fractures of the ribs induced by coughing. Standard radiographs of the chest and ribs did not reveal evidence of rib fractures in any of the patients. Bone scintigraphy, performed 1 to 2 weeks after initial onset of symptoms, showed a focal area of increased uptake along the chest wall in all cases. Thin section angulated helical CT directly visualized the subtle rib fractures. Initial diagnosis of a cough-induced fracture of the rib may be difficult because of the associated underlying disorder, and unnecessary examinations are commonly performed. Identification of a cough-induced fracture of the rib using helical CT may be clinically important to avoid unnecessary concern and additional examinations.

  12. Indications for chest CT. Retrospective study of cases with normal chest CT

    International Nuclear Information System (INIS)

    Obata, Shiro

    1995-01-01

    The usefulness of computed tomography (CT) in thoracic radiology is now well appreciated, and the number of chest CTs has greatly increased. There are, however, many chest CT cases that are completely or almost completely normal. Indications for chest CT should be re-evaluated considering the cost and radiation exposure associated with the examination. Reviewing the reports of 4930 chest CT examinations performed in three hospitals during the period of two years, the author found 620 (12.6%) negative CT examinations. In 312 of the 620, the CT was requested because of 'abnormal shadow' on chest radiograph. When the same chest radiographs were re-evaluated by two radiologists, no abnormality was noted in 257 cases (82.4%). CT examinations were considered justified in only 55 cases (17.6%). There was a significant difference in the frequency of normal chest CT examinations between the university hospital and two other hospitals. The causes of false positive interpretation of chest radiographs were analyzed, and it was felt that fundamental knowledge necessary to interpret chest radiographs was lacking. The importance of close cooperation between clinicians and radiologists should be emphasized. (author)

  13. Failure rate of prehospital chest decompression after severe thoracic trauma.

    Science.gov (United States)

    Kaserer, Alexander; Stein, Philipp; Simmen, Hans-Peter; Spahn, Donat R; Neuhaus, Valentin

    2017-03-01

    Chest decompression can be performed by different techniques, like needle thoracocentesis (NT), lateral thoracostomy (LT), or tube thoracostomy (TT). The aim of this study was to report the incidence of prehospital chest decompression and to analyse the effectiveness of these techniques. In this retrospective case series study, all medical records of adult trauma patients undergoing prehospital chest decompression and admitted to the resuscitation area of a level-1 trauma center between 2009 and 2015 were reviewed and analysed. Only descriptive statistics were applied. In a 6-year period 24 of 2261 (1.1%) trauma patients had prehospital chest decompression. Seventeen patients had NT, six patients TT, one patient NT as well as TT, and no patients had LT. Prehospital successful release of a tension pneumothorax was reported by the paramedics in 83% (5/6) with TT, whereas NT was effective in 18% only (3/17). In five CT scans all thoracocentesis needles were either removed or extrapleural, one patient had a tension pneumothorax, and two patients had no pneumothorax. No NT or TT related complications were reported during hospitalization. Prehospital NT or TT is infrequently attempted in trauma patients. Especially NT is associated with a high failure rate of more than 80%, potentially due to an inadequate ratio between chest wall thickness and catheter length as previously published as well as a possible different pathophysiological cause of respiratory distress. Therefore, TT may be considered already in the prehospital setting to retain sufficient pleural decompression upon admission. Copyright © 2016. Published by Elsevier Inc.

  14. Scapulothoracic bursitis as a significant cause of breast and chest wall pain: underrecognized and undertreated.

    Science.gov (United States)

    Boneti, Cristiano; Arentz, Candy; Klimberg, V Suzanne

    2010-10-01

    Pain is one of the most commonly reported breast complaints. Referred pain from inflammation of the shoulder bursa is often overlooked as a cause of breast pain. The objective of this study is to evaluate the role of shoulder bursitis as a cause of breast/chest pain. An IRB-approved retrospective review from July 2005 to September 2009 identified 461 patients presenting with breast/chest pain. Cases identified with a trigger point in the medial aspect of the ipsilateral scapula were treated with a bursitis injection at the point of maximum tenderness. The bursitis injection contains a mixture of local anesthetic and corticosteroid. Presenting complaint, clinical response and associated factors were recorded and treated with descriptive statistics. Average age of the study group was 53.4 ± 12.7 years, and average BMI was 30.4 ± 7.4. One hundred and three patients were diagnosed with shoulder bursitis as the cause of breast pain and received the bursitis injection. Most cases (81/103 or 78.6%) presented with the breast/chest as the site of most significant discomfort, where 8.7% (9/103) had the most severe pain at the shoulder, 3.9% (4/103) at the axilla and 3.9% (4/103) at the medial scapular border. Of the treated patients, 83.5% (86/103) had complete relief of the pain, 12.6% (13/103) had improvement of symptoms with some degree of residual pain, and only 3.9%(4/103) did not respond at all to the treatment. The most commonly associated factor to the diagnosis of bursitis was the history of a previous mastectomy, present in 27.2% (28/103) of the cases. Shoulder bursitis represents a significant cause of breast/chest pain (22.3% or 103/461) and can be successfully treated with a local injection at site of maximum tenderness in the medial scapular border.

  15. American College of Chest Physicians

    Science.gov (United States)

    ... Foundation Participate in the e-Community Get Social Career Connection Publications CHEST Journal CHEST SEEK Guidelines & Consensus Statements CHEST Physician CHEST NewsBrief Coding for Chest Medicine Tobacco Dependence Toolkit (3rd Ed.) Mobile Websites and Apps CHEST Journal ...

  16. Predictors of abnormal chest CT after blunt trauma: a critical appraisal of the literature

    International Nuclear Information System (INIS)

    Brink, M.; Kool, D.R.; Dekker, H.M.; Deunk, J.; Jager, G.J.; Kuijk, C. van; Edwards, M.J.R.; Blickman, J.G.

    2009-01-01

    Aim: To identify and to evaluate predictors that determine whether chest computed tomography (CT) is likely to reveal relevant injuries in adult blunt trauma patients. Methods: After a comprehensive literature search for original studies on blunt chest injury diagnosis, two independent observers included studies on the accuracy of parameters derived from history, physical examination, or diagnostic imaging that might predict injuries at (multidetector row) CT in adults and that allowed construction of 2 x 2 contingency tables. For each article, methodological quality was scored and relevant predictors for injuries at CT were extracted. For each predictor, sensitivity, specificity, positive and negative likelihood ratio and diagnostic odds ratio (DOR) including 95% confidence intervals were calculated. Results: Of 147 articles initially identified, the observers included 10 original studies in consensus. Abnormalities at physical examination (abnormal respiratory effort, need for assisted ventilation, reduced airentry, coma, chest wall tenderness) and pelvic fractures were significant predictors (DOR: 2.1-6.7). The presence of any injuries at conventional radiography of the chest (eight articles) was a more powerful significant predictor (DOR: 2.2-37). Abnormal chest ultrasonography (four articles) was the most accurate predictor for chest injury at CT (DOR: 491-infinite). Conclusion: The current literature indicates that in blunt trauma patients with abnormal physical examination, abnormal conventional radiography, or abnormal ultrasonography of the chest, CT was likely to reveal relevant chest injuries. However, there was no strong evidence to suggest that CT could be omitted in patients without these criteria, or whether these findings are beneficial for patients

  17. The “dirty chest”—correlations between chest radiography, multislice CT and tobacco burden

    Science.gov (United States)

    Kirchner, J; Goltz, J P; Lorenz, F; Obermann, A; Kirchner, E M; Kickuth, R

    2012-01-01

    Objectives Cigarette smoking-induced airway disease commonly results in an overall increase of non-specific lung markings on chest radiography. This has been described as “dirty chest”. As the morphological substrate of this condition is similar to the anthracosilicosis of coal workers, we hypothesised that it is possible to quantify the radiological changes using the International Labour Organization (ILO) classification of pneumoconiosis. The aims of this study were to evaluate whether there is a correlation between the extent of cigarette smoking and increased lung markings on chest radiography and to correlate the chest radiographic scores with findings on CT studies. Methods In a prospective analysis a cohort of 85 smokers was examined. The cigarette consumption was evaluated in pack years (defined as 20 cigarettes per day over 1 year). Film reading was performed by two board-certified radiologists. Chest radiographs were evaluated for the presence of thickening of bronchial walls, the presence of linear or nodular opacities, and emphysema. To correlate the smoking habits with the increase of overall lung markings in chest radiography, the ILO profusion score was converted to numbers ranging from zero to nine. Chest radiographs were rated according to the complete set of standard films of the revised ILO classification. Results 63/85 (74%) of the smokers showed an increase in overall lung markings on chest radiography; 32 (37%) had an ILO profusion score of chest radiography and the cigarette consumption quantified as pack years (r=0.68). The majority of the heavy smokers (>40 pack years) showed emphysema; there was no significant difference between the prevalence of emphysema as diagnosed by CT (62%) or chest radiography (71%) (pchest radiography. PMID:21937617

  18. Chest MRI

    Science.gov (United States)

    ... resonance imaging - chest; NMR - chest; MRI of the thorax; Thoracic MRI Patient Instructions ... Gotway MB, Panse PM, Gruden JF, Elicker BM. Thoracic radiology. In: Broaddus VC, Mason RJ, Ernst JD, et ...

  19. Tumor necrosis factor-alpha increases myocardial microvascular transport in vivo

    DEFF Research Database (Denmark)

    Hansen, P R; Svendsen, Jesper Hastrup; Høyer, S

    1994-01-01

    Tumor necrosis factor-alpha (TNF-alpha) is a primary mediator in the pathogenesis of tissue injury, and high circulating levels of TNF-alpha are found in a variety of pathological conditions. In open-chest anesthetized dogs, the effects of intracoronary recombinant human TNF-alpha (rTNF-alpha; 100...... in cardiac output and was associated with the appearance of areas with myocardial necrosis in the regional left ventricular wall. The myocardial plasma flow rate and maximum plasma flow rate in response to a 30-s coronary occlusion were not influenced by rTNF-alpha, although a decrease in the myocardial...... ng/kg for 60 min) on myocardial microvascular transport of a small hydrophilic indicator was examined by the single-injection, residue-detection method. Intracoronary infusion of rTNF-alpha increased myocardial microvascular transport after 120 min. This increase was preceded by a sustained decline...

  20. Chest Pain: First Aid

    Science.gov (United States)

    First aid Chest pain: First aid Chest pain: First aid By Mayo Clinic Staff Causes of chest pain can vary from minor problems, such as indigestion ... 26, 2018 Original article: http://www.mayoclinic.org/first-aid/first-aid-chest-pain/basics/ART-20056705 . Mayo ...

  1. Small median tumor diameter at cure threshold (lung cancers in male smokers predicts both chest X-ray and CT screening outcomes in a novel simulation framework.

    Science.gov (United States)

    Goldwasser, Deborah L; Kimmel, Marek

    2013-01-01

    The effectiveness of population-wide lung cancer screening strategies depends on the underlying natural course of lung cancer. We evaluate the expected stage distribution in the Mayo CT screening study under an existing simulation model of non-small cell lung cancer (NSCLC) progression calibrated to the Mayo lung project (MLP). Within a likelihood framework, we evaluate whether the probability of 5-year NSCLC survival conditional on tumor diameter at detection depends significantly on screening detection modality, namely chest X-ray and computed tomography. We describe a novel simulation framework in which tumor progression depends on cellular proliferation and mutation within a stem cell compartment of the tumor. We fit this model to randomized trial data from the MLP and produce estimates of the median radiologic size at the cure threshold. We examine the goodness of model fit with respect to radiologic tumor size and 5-year NSCLC survival among incident cancers in both the MLP and Mayo CT studies. An existing model of NSCLC progression under-predicts the number of advanced-stage incident NSCLCs among males in the Mayo CT study (p-value = 0.004). The probability of 5-year NSCLC survival conditional on tumor diameter depends significantly on detection modality (p-value = 0.0312). In our new model, selected solution sets having a median tumor diameter of 16.2-22.1 mm at cure threshold among aggressive NSCLCs predict both MLP and Mayo CT outcomes. We conclude that the median lung tumor diameter at cure threshold among aggressive NSCLCs in male smokers may be small (<20 mm). Copyright © 2012 UICC.

  2. Solitary fibrous tumor of the abdominal wall re-surfacing as unilateral pleural effusion and mass: A case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Xia Bi

    Full Text Available Background: Solitary fibrous tumors (SFTs are rare fibroblastic mesenchymal neoplasms that were initially described in the pleura, but have been increasingly recognized to occur in other parts of the body. They have been traditionally regarded as indolent tumors that are rare to metastasize after surgical resection. Here, we describe a case of a Filipino female who initially presented with unilateral pleural effusion and mass, and was ultimately diagnosed with recurrent solitary fibrous tumor that originated from the abdominal wall. Then, we reviewed existing literature on intra- and extrathoracic SFTs with focus on pathological characteristics, recommendations for treatment as well as post-treatment surveillance. Case presentation: A 79-year-old Filipino female with a history of solitary fibrous tumor of the abdominal wall status post complete surgical resection 3 years ago presented with unilateral pleural effusion and mass, and was diagnosed with recurrent solitary fibrous tumor that metastasized to the lung. She was not a candidate for systemic chemotherapy and ultimately died 1 year later from progressive respiratory failure. Conclusions: Solitary fibrous tumor are rare mesenchymal tumors that were initially described in the pleura, but have now been reported in many other sites. Complete surgical resection is the mainstay therapy for all cases; however, long-term monitoring and surveillance several years after initial presentation is crucial to prevent disease recurrence, and adjuvant treatment may be necessary for patients with high-risk features. Additional studies are needed to demonstrate the clinical utility of risk stratification models and to develop post-treatment surveillance guidelines for extrathoracic SFTs.

  3. Pulmonary and chest wall mechanics in the control of respiration in the newborn.

    Science.gov (United States)

    Davis, G M; Bureau, M A

    1987-09-01

    Although the respiratory system is not fully developed at birth, the human newborn infant has flexible strategies to sustain breathing and defend blood gas homeostasis in both health and disease conditions. Initially the thresholds for chemoreceptor response to PO2 and PCO2 closely mimic those of the fetus, but the threshold resets to sustain ventilation adequate for blood gas homeostasis appropriate to the extrauterine milieu. The muscles of respiration have been "trained" in utero and effectively assume the function of the respiratory pump, despite their marginal reserve against fatigue. The pliable chest wall is functionally stabilized by the tonic activity of the intercostal muscles, thereby allowing effective ventilation. Finally, expiration is prolonged by the postinspiratory activity of the diaphragm and laryngeal braking as a means of maintaining an elevated lung volume and augmenting FRC. The ventilatory response of the newborn to respiratory disease is limited. The magnitude of the VE response is smaller than that of the adult, and is characterized by an increase in the respiratory rate and a limited increase in the VT. The poor effort reserve of the muscles, especially the diaphragm, predisposes the newborn to muscle fatigue and ventilatory failure. To avoid fatigue, recruitment of accessory muscles occurs, along with laryngeal braking of expiration, thereby decreasing the work of the diaphragm, recruiting new alveoli by an auto-PEEP effect, increasing the FRC volume, and improving gas exchange by an increase in the pulmonary surface area. These mechanisms help to avoid muscle exhaustion and facilitate adequate gas exchange in the presence of lung disease. We do not know precisely the postconceptual age at which the newborn is sufficiently developed to adopt these various defensive strategies of breathing, but the presence of tachypnea and grunting in 28-week-old premature infants suggests that long before term the human infant is capable of remarkable

  4. [A case of lung abscess during chemotherapy for testicular tumor].

    Science.gov (United States)

    Hayashi, Yujiro; Miyago, Naoki; Takeda, Ken; Yamaguchi, Yuichiro; Nakayama, Masashi; Arai, Yasuyuki; Kakimoto, Ken-ichi; Nishimura, Kazuo

    2014-05-01

    32-year-old man was seen in a clinic because of prolonged cough and slight-fever. Chest X-ray showed multiple pulmonary nodules, and multiple lung and mediastinal lymph node metastases from right testicular tumor was suspected by positron emission tomography/CT (PET/CT) scan. He was diagnosed with right testicular germ cell tumor (embryonal carcinoma + seminoma, pT2N1M1b), and classified into the intermediate risk group according to International Germ Cell Cancer Collaborative Group. He underwent 4 cycles of chemotherapy with bleomycin, etoposide and cisplatin (BEP therapy). During BEP therapy, sputum with foul odor appeared and chest CT scan revealed lung abscess with a necrotic lesion of metastatic tumor. The lung abscess was treated successfully with antibiotics.

  5. Incidental findings in chest X-rays; Zufallsbefunde im Roentgenthorax

    Energy Technology Data Exchange (ETDEWEB)

    Wielpuetz, M.O.; Kauczor, H.U. [Universitaetsklinikum Heidelberg, Klinik fuer Diagnostische und Interventionelle Radiologie, Heidelberg (Germany); Universitaet Heidelberg, Translational Lung Research Center (TLRC), Deutsches Zentrum fuer Lungenforschung (DZL), Heidelberg (Germany); Universitaetsklinikum Heidelberg, Klinik fuer Diagnostische und Interventionelle Radiologie mit Nuklearmedizin, Thoraxklinik, Heidelberg (Germany); Weckbach, S. [Universitaetsklinikum Heidelberg, Klinik fuer Diagnostische und Interventionelle Radiologie, Heidelberg (Germany); Universitaet Heidelberg, Translational Lung Research Center (TLRC), Deutsches Zentrum fuer Lungenforschung (DZL), Heidelberg (Germany)

    2017-04-15

    Conventional projection radiography (chest x-ray) is one of the most frequently requested procedures in radiology. Even though chest x-ray imaging is frequently performed in asymptomatic patients for preoperative assessment, clinically relevant incidental findings are relatively scarce. This is due to the relatively low sensitivity of chest x-rays where few clinically relevant incidental findings are to be expected, as any detectable pathologies will as a rule already be clinically symptomatic. Recommendations from relevant societies for the management of incidental findings, apart from the clarification of incidental nodules, do not exist. This review article therefore describes the most frequent and typical incidental findings of lung parenchyma (apart from pulmonary nodules), mediastinal structures including the hilum of the lungs, pleura, chest wall and major vessels. Also described are those findings which can be diagnosed with sufficient certainty from chest x-rays so that further clarification is not necessary and those which must be further clarified by multislice imaging procedures or other techniques. (orig.) [German] Eine der haeufigsten Untersuchungen in der Radiologie ist die konventionelle Projektionsradiographie des Thorax (Roentgenthorax). Auch wenn projektionsradiographische Aufnahmen im Rahmen einer praeoperativen Abklaerung haeufig als orientierende Untersuchung angefertigt werden, sind - bedingt durch die relativ geringe Sensitivitaet des Roentgenthorax - wenig klinisch relevante Zufallsbefunde zu erwarten, da nachweisbare Pathologien in der Regel bereits auch klinisch apparent sind. Empfehlungen entsprechender Fachgesellschaften zu Zufallsbefunden im Roentgenthorax jenseits der Abklaerung von Rundherden liegen nicht vor. Die vorliegende Arbeit beleuchtet daher haeufige und typische Zufallsbefunde des Lungenparenchyms (ausser den Lungenrundherden), der mediastinalen Strukturen einschliesslich der Hili, der Pleura, der Thoraxwand sowie der

  6. Airway wall thickness associated with forced expiratory volume in 1 second decline and development of airflow limitation

    NARCIS (Netherlands)

    Hoesein, Firdaus A. A. Mohamed; de Jong, Pim A.; Lammers, Jan-Willem J.; Mali, Willem P. T. M.; Schmidt, Michael; de Koning, Harry J.; van der Aalst, Carlijn; Oudkerk, Matthijs; Vliegenthart, Rozemarijn; Groen, Harry J. M.; van Ginneken, Bram; van Rikxoort, Eva M.; Zanen, Pieter

    Airway wall thickness and emphysema contribute to airflow limitation. We examined their association with lung function decline and development of airflow limitation in 2021 male smokers with and without airflow limitation. Airway wall thickness and emphysema were quantified on chest computed

  7. Radiographic, CT and MRI spectrum of hydatid disease of the chest: a pictorial essay

    Energy Technology Data Exchange (ETDEWEB)

    Sinner, W.N. von [Dept. of Radiology MBC28, King Faisal Specialist Hospital and Research Centre, Riyadh (Saudi Arabia)

    1993-01-01

    Thirty patients with thoracic hydatidosis (Echinococcus granulosus) were studied. The hydatid cysts were located in the lung parenchyma (70%), mediastinum (6.7%), inside the heart (10%), the pleurae (10%) and the chest wall (3.3%). Complications of thoracic hydatid cysts, such as rupture, infection, pleural involvement, spread and calcifications are presented. Computed tomography (CT) without and/or with contrast enhancement was performed in all patients (30). Findings from conventional chest radiographs were compared with CT and confirmed by pathology (30). In 10 cases (33.3%), magnetic resonance imaging was also performed. The diagnostic spectrum of hydatid cysts, including variations and developmental stages, is presented in this pictorial essay. (orig.)

  8. Rib fracture after stereotactic radiotherapy for primary lung cancer: prevalence, degree of clinical symptoms, and risk factors

    International Nuclear Information System (INIS)

    Nambu, Atsushi; Marino, Kan; Koshiishi, Tsuyota; Sawada, Eiichi; Araki, Tsutomu; Onishi, Hiroshi; Aoki, Shinichi; Tominaga, Licht; Kuriyama, Kengo; Araya, Masayuki; Saito, Ryoh; Maehata, Yoshiyasu; Komiyama, Takafumi

    2013-01-01

    As stereotactic body radiotherapy (SBRT) is a highly dose-dense radiotherapy, adverse events of neighboring normal tissues are a major concern. This study thus aimed to clarify the frequency and degree of clinical symptoms in patients with rib fractures after SBRT for primary lung cancer and to reveal risk factors for rib fracture. Appropriate α/β ratios for discriminating between fracture and non-fracture groups were also investigated. Between November 2001 and April 2009, 177 patients who had undergone SBRT were evaluated for clinical symptoms and underwent follow-up thin-section computed tomography (CT). The time of rib fracture appearance was also assessed. Cox proportional hazard modeling was performed to identify risk factors for rib fracture, using independent variables of age, sex, maximum tumor diameter, radiotherapeutic method and tumor-chest wall distance. Dosimetric details were analyzed for 26 patients with and 22 randomly-sampled patients without rib fracture. Biologically effective dose (BED) was calculated with a range of α/β ratios (1–10 Gy). Receiver operating characteristics analysis was used to define the most appropriate α/β ratio. Rib fracture was found on follow-up thin-section CT in 41 patients. The frequency of chest wall pain in patients with rib fracture was 34.1% (14/41), and was classified as Grade 1 or 2. Significant risk factors for rib fracture were smaller tumor-chest wall distance and female sex. Area under the curve was maximal for BED at an α/β ratio of 8 Gy. Rib fracture is frequently seen on CT after SBRT for lung cancer. Small tumor-chest wall distance and female sex are risk factors for rib fracture. However, clinical symptoms are infrequent and generally mild. When using BED analysis, an α/β ratio of 8 Gy appears most effective for discriminating between fracture and non-fracture patients

  9. Rib fracture after stereotactic radiotherapy for primary lung cancer: prevalence, degree of clinical symptoms, and risk factors

    Directory of Open Access Journals (Sweden)

    Nambu Atsushi

    2013-02-01

    Full Text Available Abstract Background As stereotactic body radiotherapy (SBRT is a highly dose-dense radiotherapy, adverse events of neighboring normal tissues are a major concern. This study thus aimed to clarify the frequency and degree of clinical symptoms in patients with rib fractures after SBRT for primary lung cancer and to reveal risk factors for rib fracture. Appropriate α/β ratios for discriminating between fracture and non-fracture groups were also investigated. Methods Between November 2001 and April 2009, 177 patients who had undergone SBRT were evaluated for clinical symptoms and underwent follow-up thin-section computed tomography (CT. The time of rib fracture appearance was also assessed. Cox proportional hazard modeling was performed to identify risk factors for rib fracture, using independent variables of age, sex, maximum tumor diameter, radiotherapeutic method and tumor-chest wall distance. Dosimetric details were analyzed for 26 patients with and 22 randomly-sampled patients without rib fracture. Biologically effective dose (BED was calculated with a range of α/β ratios (1–10 Gy. Receiver operating characteristics analysis was used to define the most appropriate α/β ratio. Results Rib fracture was found on follow-up thin-section CT in 41 patients. The frequency of chest wall pain in patients with rib fracture was 34.1% (14/41, and was classified as Grade 1 or 2. Significant risk factors for rib fracture were smaller tumor-chest wall distance and female sex. Area under the curve was maximal for BED at an α/β ratio of 8 Gy. Conclusions Rib fracture is frequently seen on CT after SBRT for lung cancer. Small tumor-chest wall distance and female sex are risk factors for rib fracture. However, clinical symptoms are infrequent and generally mild. When using BED analysis, an α/β ratio of 8 Gy appears most effective for discriminating between fracture and non-fracture patients.

  10. Rib fracture after stereotactic radiotherapy for primary lung cancer: prevalence, degree of clinical symptoms, and risk factors

    Science.gov (United States)

    2013-01-01

    Background As stereotactic body radiotherapy (SBRT) is a highly dose-dense radiotherapy, adverse events of neighboring normal tissues are a major concern. This study thus aimed to clarify the frequency and degree of clinical symptoms in patients with rib fractures after SBRT for primary lung cancer and to reveal risk factors for rib fracture. Appropriate α/β ratios for discriminating between fracture and non-fracture groups were also investigated. Methods Between November 2001 and April 2009, 177 patients who had undergone SBRT were evaluated for clinical symptoms and underwent follow-up thin-section computed tomography (CT). The time of rib fracture appearance was also assessed. Cox proportional hazard modeling was performed to identify risk factors for rib fracture, using independent variables of age, sex, maximum tumor diameter, radiotherapeutic method and tumor-chest wall distance. Dosimetric details were analyzed for 26 patients with and 22 randomly-sampled patients without rib fracture. Biologically effective dose (BED) was calculated with a range of α/β ratios (1–10 Gy). Receiver operating characteristics analysis was used to define the most appropriate α/β ratio. Results Rib fracture was found on follow-up thin-section CT in 41 patients. The frequency of chest wall pain in patients with rib fracture was 34.1% (14/41), and was classified as Grade 1 or 2. Significant risk factors for rib fracture were smaller tumor-chest wall distance and female sex. Area under the curve was maximal for BED at an α/β ratio of 8 Gy. Conclusions Rib fracture is frequently seen on CT after SBRT for lung cancer. Small tumor-chest wall distance and female sex are risk factors for rib fracture. However, clinical symptoms are infrequent and generally mild. When using BED analysis, an α/β ratio of 8 Gy appears most effective for discriminating between fracture and non-fracture patients. PMID:23391264

  11. Rib fracture after stereotactic radiotherapy for primary lung cancer: prevalence, degree of clinical symptoms, and risk factors.

    Science.gov (United States)

    Nambu, Atsushi; Onishi, Hiroshi; Aoki, Shinichi; Tominaga, Licht; Kuriyama, Kengo; Araya, Masayuki; Saito, Ryoh; Maehata, Yoshiyasu; Komiyama, Takafumi; Marino, Kan; Koshiishi, Tsuyota; Sawada, Eiichi; Araki, Tsutomu

    2013-02-07

    As stereotactic body radiotherapy (SBRT) is a highly dose-dense radiotherapy, adverse events of neighboring normal tissues are a major concern. This study thus aimed to clarify the frequency and degree of clinical symptoms in patients with rib fractures after SBRT for primary lung cancer and to reveal risk factors for rib fracture. Appropriate α/β ratios for discriminating between fracture and non-fracture groups were also investigated. Between November 2001 and April 2009, 177 patients who had undergone SBRT were evaluated for clinical symptoms and underwent follow-up thin-section computed tomography (CT). The time of rib fracture appearance was also assessed. Cox proportional hazard modeling was performed to identify risk factors for rib fracture, using independent variables of age, sex, maximum tumor diameter, radiotherapeutic method and tumor-chest wall distance. Dosimetric details were analyzed for 26 patients with and 22 randomly-sampled patients without rib fracture. Biologically effective dose (BED) was calculated with a range of α/β ratios (1-10 Gy). Receiver operating characteristics analysis was used to define the most appropriate α/β ratio. Rib fracture was found on follow-up thin-section CT in 41 patients. The frequency of chest wall pain in patients with rib fracture was 34.1% (14/41), and was classified as Grade 1 or 2. Significant risk factors for rib fracture were smaller tumor-chest wall distance and female sex. Area under the curve was maximal for BED at an α/β ratio of 8 Gy. Rib fracture is frequently seen on CT after SBRT for lung cancer. Small tumor-chest wall distance and female sex are risk factors for rib fracture. However, clinical symptoms are infrequent and generally mild. When using BED analysis, an α/β ratio of 8 Gy appears most effective for discriminating between fracture and non-fracture patients.

  12. Chest computed tomography

    DEFF Research Database (Denmark)

    Loeve, Martine; Krestin, Gabriel P.; Rosenfeld, Margaret

    2013-01-01

    are not suitable to study CF lung disease in young children. Chest computed tomography (CT) holds great promise for use as a sensitive surrogate endpoint in CF. A large body of evidence has been produced to validate the use of chest CT as primary endpoint to study CF lung disease. However, before chest CT can...

  13. Evaluation of magnetic resonance imaging in thoracic inlet tumors

    Energy Technology Data Exchange (ETDEWEB)

    Sakai, Eiro (Kobe Univ. (Japan). School of Medicine)

    1993-06-01

    To evaluate the detectability of tumor invasion to the thoracic inlet, MRI was performed in 57 patients with thoracic inlet tumor, and the diagnostic accuracy of MRI was compared with that of CT concerning the utility for thoracic inlet lesions. And we assessed abnormal findings in comparison with surgical or autopsy findings. In the local extent of the tumor, the accuracy for tumor invasion to the vessels such as subclavian artery and vein was 94.9% for MRI, and 83.5% for CT, and to the brachial plexus was 95.0% for MRI, and 60.0% for CT. MRI was superior to CT, but MRI was equivalent to CT with regard to invasion to the base of the neck, lateral chest wall, ribs, and vertebral bodies. However on MRI, it is easier to understand the longitudinal tumor extent than on CT. CT has superior spatial resolusion but CT has also disadvantages, such as streak artifact caused by shoulder joints, resulting in image degradation. In contrast, MRI has inherent advantages, and multiple images which facilitate the relationship between tumor and normal structures. Coronal and sagittal MR images facilitated three-dimensional observation of tumor of invasion in the thoracic inlet. Furthermore to improve image quality of MRI for the thoracic inlet, we newly devised a high molecular polyester shell for fixing a surface coil. On the high resolution MR (HR-MR) imaging using our shell, normal lymph nodes, muscles, blood vessels and the branches of the branchial plexus were clearly visualized in detail. Our shell was simple to process and facilitated immobilization of a surface coil. HR-MR technique produces images of high resolution after simple preparation. In conclusion, MRI was very useful for detecting lesions of the thoracic inlet and in deciding surgical indication and the planning for radiotherapy. (author).

  14. Diagnostic Yield of Recommendations for Chest CT Examination Prompted by Outpatient Chest Radiographic Findings

    Science.gov (United States)

    Harvey, H. Benjamin; Gilman, Matthew D.; Wu, Carol C.; Cushing, Matthew S.; Halpern, Elkan F.; Zhao, Jing; Pandharipande, Pari V.; Shepard, Jo-Anne O.

    2015-01-01

    Purpose To evaluate the diagnostic yield of recommended chest computed tomography (CT) prompted by abnormalities detected on outpatient chest radiographic images. Materials and Methods This HIPAA-compliant study had institutional review board approval; informed consent was waived. Reports of all outpatient chest radiographic examinations performed at a large academic center during 2008 (n = 29 138) were queried to identify studies that included a recommendation for a chest CT imaging. The radiology information system was queried for these patients to determine if a chest CT examination was obtained within 1 year of the index radiographic examination that contained the recommendation. For chest CT examinations obtained within 1 year of the index chest radiographic examination and that met inclusion criteria, chest CT images were reviewed to determine if there was an abnormality that corresponded to the chest radiographic finding that prompted the recommendation. All corresponding abnormalities were categorized as clinically relevant or not clinically relevant, based on whether further work-up or treatment was warranted. Groups were compared by using t test and Fisher exact test with a Bonferroni correction applied for multiple comparisons. Results There were 4.5% (1316 of 29138 [95% confidence interval {CI}: 4.3%, 4.8%]) of outpatient chest radiographic examinations that contained a recommendation for chest CT examination, and increasing patient age (P recommendation for chest CT examination. Of patients within this subset who met inclusion criteria, 65.4% (691 of 1057 [95% CI: 62.4%, 68.2%) underwent a chest CT examination within the year after the index chest radiographic examination. Clinically relevant corresponding abnormalities were present on chest CT images in 41.4% (286 of 691 [95% CI: 37.7%, 45.2%]) of cases, nonclinically relevant corresponding abnormalities in 20.6% (142 of 691 [95% CI: 17.6%, 23.8%]) of cases, and no corresponding abnormalities in 38

  15. CASE REPORT:Chondrosarcoma of Rib on Fine Needle Aspiration Cytology – A Rare Site

    Directory of Open Access Journals (Sweden)

    Prakash M Patil

    2012-07-01

    Full Text Available Background: Fine needle aspiration cytology (FNAC is effective in the diagnosis of bone tumors when combined with careful radiologic and clinical evaluation. Chondrosarcomas often arise in the pelvis or bones of the trunk, but primary chest wall (rib chondrosarcomas are relatively rare. Case Reports: This is a case of a patient with a chondrosarcoma arising in the left lower rib who underwent resection. The patient was a 30-year-old man with a 10x8x6cm tumor in the anterior chest wall of the left side lower rib. On Fine Needle Aspiration Cytology (FNAC of the mass on the anterior chest wall, a diagnosis of a low grade chondrosarcoma was made. This was confirmed histopathologically as a dedifferentiated chondrosarcoma. Macroscopically on excision of gray to pink lobulated mass with adjacent soft tissue and bone with foci of hemorrhage and necrosis the mass measured (M 10x 8x 6 cm. Incidence of chondrosarcoma peaks in the 5th to 6th decade and most commonly involves the femur, humerus, pelvis, and scapula. It rarely involves rib.

  16. Frequency of anomalies associated with chest deformity in physically fit male candidates reporting for military recruitment

    International Nuclear Information System (INIS)

    Haleem, A.; Hanif, M.S.; Majeed, F.A.; Deen, N.U.; Rahim, K.

    2015-01-01

    To identify the frequency of anomalies associated with chest deformity in physical fit male candidates reporting for military recruitment. Study Design: Observational. Place and Duration of Study: Department of Thoracic Surgery, CMH Rawalpindi from 1st Jan 2008 to 31 Dec 2011. Patients and Methods: Normal healthy physically fit young adolescents being recruited for army were scrolled and those exhibiting chest deformity were isolated and subjected to evaluation. Convenience sampling was carried out. All candidates of chest wall deformity thereafter underwent a thorough physical checkup, pulmonary function tests and echocardiography. Results: A total of 3735 candidates of chest deformity reported at our center for evaluation over this duration. Single deformity patients 3380 (90.5%), mixed deformity patients 355 (9.5%). We found that none of the candidates had any derangement of the lung function tests or electrocardiographic abnormality despite their deformity. However echocardiography detected an abnormality in 161 (4.3%) individuals who were otherwise asymptomatic. Conclusion: Chest deformity should be excluded before physical tests, in all the male candidates reporting for enrolment. If slightest of doubt exists that a candidate has chest deformity then he should be evaluated with echocardiography to exclude cardiac abnormality. Although the associated frequency is only 4.3% but this can subsequently result in a grave event like death. (author)

  17. Chest CT findings in breast cancer patients treated with postoperative irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Yeon Joo; Kim, Kun Il; Lee, Suk Hong; Kim, Dong Won; Bae, Yeong Tae [College of Medicine, Pusan National Univ., Pusan (Korea, Republic of)

    2002-07-01

    The determine the chest CT findings in breast cancer patients who have undergone postoperative irradiation. The chest CT findings in 36 female patients who underwent breast surgery and radiotherapy between May 1996 and March 2000 were rerospectively analysed. Prior to radiotheraphy, baseline chest CT depicted normal parenchyma in all cases. In 11 patients, the ipsilateral breast and chest wall were irradiated using opposed tangential fields, while 25 were treated by the four fields method (opposed tangential fields plus anterior and posterior supraclavicular/high axillary fields), with a total dose of 5040-5400 cGy for 5-9 weeks. CT after radiotherapy demonstrated reticular opacity (n=24), perpendicular linear opacity (n=15), traction bronchiectasis (n=7), consolidation (n=6), ground glass attenuation (n=3), pathologic rib fractures (n=3) pleural effusion (n=2), and pleural thickening (n=1), while in five patients no abnormality was observed. in addition, in the anterolateral lung area of 23 (64%) of 36 patients who underwent tangential beam irradiation, CT demonstrated peripheral opacities. When supraclavicular and axillary portals were used, radiation-induced lung changes mostly occurred at the apex of the lung (n=24). Chest radiographs were abnormal in 26 patients and normal in ten; in five of these ten, CT demonstrated reticular opacity. Depending on the irradiation CT findings of radiation-induced lung injury in breast cancer include areas of increased opacity with or without fibrosis, in apical and/or anterior subpleural regions. CT may help differentiate radiation-induced parenchymal change from superimposed or combined lung disease.

  18. Chest wall tumor at relapse of multiple myeloma | Tazi | African ...

    African Journals Online (AJOL)

    We report the case of a 70-year-old Moroccan man who was diagnosed with stage IIIA IgA kappa multiple myeloma according to Durie and Salmon classification. He was an alcohol abuser and heavy smoker (2 packs per day). He was admitted to our department for thoracic pain, persistent and increasing. He also ...

  19. Radiological Findings in a case of Advance staged Mesothelioma

    Science.gov (United States)

    Aziz, Fahad

    2009-01-01

    Chest X Ray is the initial screening test for the mesothelioma like all other the chest diseases. But computed tomography (CT) is the imaging technique of choice for charactering pleural masses. CT also gives important information regarding invasion of the chest wall and surrounding structures. Certain CT features help differentiate benign from malignant processes. This short article highlights the salient CT appearance of mesothelioma; the most common pleural tumor. PMID:22263002

  20. A case of mediastinum tumor

    International Nuclear Information System (INIS)

    Guariglia, S.N.; Schultz, R.; Funari, M.B.G.; Menezes Neto, J.R. de

    1989-01-01

    A patient with a tumor in the anterior mediastinum is presented. The patient ununderswent chest X-ray studies and thorax CT which demonstrated a large mass involving the heart and compressing the lungs. A malignant teratoma was eventually diagnosed by anatomopathologic examination. (author) [pt

  1. Diagnostic value of chest ultrasound after cardiac surgery: a comparison with chest X-ray and auscultation.

    Science.gov (United States)

    Vezzani, Antonella; Manca, Tullio; Brusasco, Claudia; Santori, Gregorio; Valentino, Massimo; Nicolini, Francesco; Molardi, Alberto; Gherli, Tiziano; Corradi, Francesco

    2014-12-01

    Chest auscultation and chest x-ray commonly are used to detect postoperative abnormalities and complications in patients admitted to intensive care after cardiac surgery. The aim of the study was to evaluate whether chest ultrasound represents an effective alternative to bedside chest x-ray to identify early postoperative abnormalities. Diagnostic accuracy of chest auscultation and chest ultrasound were compared in identifying individual abnormalities detected by chest x-ray, considered the reference method. Cardiac surgery intensive care unit. One hundred fifty-one consecutive adult patients undergoing cardiac surgery. All patients included were studied by chest auscultation, ultrasound, and x-ray upon admission to intensive care after cardiac surgery. Six lung pathologic changes and endotracheal tube malposition were found. There was a highly significant correlation between abnormalities detected by chest ultrasound and x-ray (k = 0.90), but a poor correlation between chest auscultation and x-ray abnormalities (k = 0.15). Chest auscultation may help identify endotracheal tube misplacement and tension pneumothorax but it may miss most major abnormalities. Chest ultrasound represents a valid alternative to chest x-ray to detect most postoperative abnormalities and misplacements. Copyright © 2014 Elsevier Inc. All rights reserved.

  2. Can tumor uptake Tc-99m MDP

    International Nuclear Information System (INIS)

    Yang, Y.S.F.; Zeng, Z.J.; Yao, Y.M.; Shi, S.M.P.; Shi, S.Z.Y.

    2002-01-01

    Aim: To study a distribution of Tc-99m MDP in mice bearing tumor cell lines. Methods: The uptake of Tc-99m MDP was analyzed in seven human tumor cell lines (SPC-A1 adenocarcinoma of lung cancer, P37 Breast cancer, T24 Bladder cancer, SKOV2 Ovary carcinoma, Hela-229 Cervical carcinoma, Osteosarcoma, A375 Melanoma) and one mouse lung cancer cell line (Lewis). They were transplanted into 13, 4, 5, 5, 4, 5 athymic mice, 6 SCID nude mice and 4 C57 black mice, respectively. Approximately 10(7) cells of each cell line were injected subcutaneously into a right chest of mouse. After 5∼6 weeks, the Tc-99m MDP scintigraphy were determined 5-6 hours after i.v. injection of 74MBq in 0.05ml every mouse. Result: Biodistribution and tumor uptake MDP was different in the various cell types investigated. Region of interests (RIOs) placed on a small part of the tumor and horizontal copied to left chest or spine of mice in Tc-99m MDP imaging and the average count ratio (tumor to background ratio: T/B, tumor to spine ratio: T/NT) in each ROI was calculated. 13 nude mice bearing the adenocarcinoma (SPC-A1) were sacrificed and biodistribution was determined after Tc-99m MDP scintigraphy. Results were expressed as % injected dose/gram (%ID/g), mean±SD. T-ulcer=ulcer of tumor, T-round=surrounding of tumor, T-center=the center of tumor, Thor-sp=thoracic spine, Lum-ver=lumbar vertebra, LN=lymph node. Conclusions: Tumor can uptake Tc-99m MDP including adenocarcinoma. Higher uptake rate in the center tissue of tumor is than other part of tumor. It maybe connected with necrosis or fibrosis of tumor

  3. Chest Seal Placement for Penetrating Chest Wounds by Prehospital Ground Forces in Afghanistan.

    Science.gov (United States)

    Schauer, Steven G; April, Michael D; Naylor, Jason F; Simon, Erica M; Fisher, Andrew D; Cunningham, Cord W; Morissette, Daniel M; Fernandez, Jessie Renee D; Ryan, Kathy L

    Thoracic trauma represents 5% of all battlefield injuries. Communicating pneumothoraces resulting in tension physiology remain an important etiology of prehospital mortality. In addressing penetrating chest trauma, current Tactical Combat Casualty Care (TCCC) guidelines advocate the immediate placement of a vented chest seal device. Although the Committee on TCCC (CoTCCC) has approved numerous chest seal devices for battlefield use, few data exist regarding their use in a combat zone setting. To evaluate adherence to TCCC guidelines for chest seal placement among personnel deployed to Afghanistan. We obtained data from the Prehospital Trauma Registry (PHTR). Joint Trauma System personnel linked patients to the Department of Defense Trauma Registry, when available, for outcome data upon reaching a fixed facility. In the PHTR, we identified 62 patients with documented gunshot wound (GSW) or puncture wound trauma to the chest. The majority (74.2%; n = 46) of these were due to GSW, with the remainder either explosive-based puncture wounds (22.6%; n = 14) or a combination of GSW and explosive (3.2%; n = 2). Of the 62 casualties with documented GSW or puncture wounds, 46 (74.2%) underwent chest seal placement. Higher proportions of patients with medical officers in their chain of care underwent chest seal placement than those that did not (63.0% versus 37.0%). The majority of chest seals placed were not vented. Of patients with a GSW or puncture wound to the chest, 74.2% underwent chest seal placement. Most of the chest seals placed were not vented in accordance with guidelines, despite the guideline update midway through the study period. These data suggest the need to improve predeployment training on TCCC guidelines and matching of the Army logistical supply chain to the devices recommended by the CoTCCC. 2017.

  4. Developments in dual-energy, single-exposure chest radiography

    International Nuclear Information System (INIS)

    Ho Jungtsuoe.

    1990-01-01

    Conventional chest radiography (CCR), the most commonly performed technique for the diagnosis of lung cancer, does not detect a high percentage of these tumors. One reason for errors is the overlap of tumor image with bone image in a chest radiograph. Dual-energy (DE) radiography has been suggested as the most effective method to eliminate bone contrast for better lung tumor visualization. DE radiography also provides a bone image from which benign nodules can be identified by the presence of nodule calcification. The purpose of this study is to evaluate the performance of a film-screen based DE, single exposure technique in lung nodule detection and to improve its performance by both hardware (HD) and software developments (SD) to increase the accuracy of lung cancer diagnosis. Previous implementation of the technique resulted in small residual tissue contrast and incomplete tissue subtraction due to screen selection and x-ray beam hardening, respectively. HD, including uses of a new screen pair (Y 2 O 2 S/CaWO 4 ) and a K-edge filter (europium), were studied to improve residual tissue contrast by increasing the energy separation. Successful SD included a three-dimensional interpolation algorithm and noise suppression methods to achieve complete tissue subtraction and noise reduction, respectively. The results show that the new screen pair performed better than LaOBr/CaWo 4 ; the use of K-edge filter produced more residual tissue contrast than that obtained without it. Even though the dual exposure technique performed better than the single exposure technique in a simulated lung nodule detection study, the difference between the two techniques was statistically insignificant and they both performed better than CCR. Based on these encouraging results, the author concludes that the film-screen based DE, single exposure technique, with the HD and SD holds promise for further clinical study

  5. CT and MRI of germ-cell tumors with metastasis or multi-located tumors

    International Nuclear Information System (INIS)

    Miyagami, Mitsusuke; Tazoe, Makoto; Tsubokawa, Takashi

    1989-01-01

    Twenty-seven cases of germ-cell tumors were examined with a CT scan in our clinic. In the 11 cases of metastasis or multi-localized tumors, the CT findings were studied in connection with the MRI findings. There were 6 cases of germ-cell tumors which had broad infiltrating tumors with multiple lesions on first admission. Their tumor sites were different from that in cases of malignant glioma, being frequently localized in the pineal and/or the suprasellar region, on the wall of the third and/or lateral ventricle, and in the region of the basal ganglia. Five of the cases of germ-cell tumors had metastasis with various patterns connected to a remote area - that is, to spinal cords, to the ventricular wall and basal cistern of the brain stem by CSF dissemination, to a lung by hematogeneous metastasis, and to the peritoneal wall or organs by a V-P shunt. The CT findings of germ-cell tumors were correlated mainly with the results of the histological diagnosis; they were found not to differ with the tumor site. The germinoma in the suprasellar region had less calcification than in the pineal region. Cysts, calcification, and an enlargement of the lateral ventricle on the tumor side were frequently seen in the germinoma of the basal ganglia. On the MRI of 5 cases of germinoma, the T 1 -weighted image revealed a slightly low or iso signal intensity, while the T 2 -weighted image showed a high signal intensity. In the case of multiple tumor lesions, some cases demonstrated different CT findings and radiosensitivities for each tumor. The possibility of a multicentric origin for the tumors is thus suggested in some cases of germ-cell tumors. (author)

  6. [Chest trauma].

    Science.gov (United States)

    Freixinet Gilart, Jorge; Ramírez Gil, María Elena; Gallardo Valera, Gregorio; Moreno Casado, Paula

    2011-01-01

    Chest trauma is a frequent problem arising from lesions caused by domestic and occupational activities and especially road traffic accidents. These injuries can be analyzed from distinct points of view, ranging from consideration of the most severe injuries, especially in the context of multiple trauma, to the specific characteristics of blunt and open trauma. In the present article, these injuries are discussed according to the involvement of the various thoracic structures. Rib fractures are the most frequent chest injuries and their diagnosis and treatment is straightforward, although these injuries can be severe if more than three ribs are affected and when there is major associated morbidity. Lung contusion is the most common visceral lesion. These injuries are usually found in severe chest trauma and are often associated with other thoracic and intrathoracic lesions. Treatment is based on general support measures. Pleural complications, such as hemothorax and pneumothorax, are also frequent. Their diagnosis is also straightforward and treatment is based on pleural drainage. This article also analyzes other complex situations, notably airway trauma, which is usually very severe in blunt chest trauma and less severe and even suitable for conservative treatment in iatrogenic injury due to tracheal intubation. Rupture of the diaphragm usually causes a diaphragmatic hernia. Treatment is always surgical. Myocardial contusions should be suspected in anterior chest trauma and in sternal fractures. Treatment is conservative. Other chest injuries, such as those of the great thoracic and esophageal vessels, are less frequent but are especially severe. Copyright © 2011 Sociedad Española de Neumología y Cirugía Torácica. Published by Elsevier Espana. All rights reserved.

  7. Diagnosis and Treatment of Chest Injury and Emergency Diseases of Chest Organs

    Directory of Open Access Journals (Sweden)

    A. M. Khadjibaev

    2016-01-01

    Full Text Available Goal of research: to evaluate efficiency of videothoracoscopy in diagnosis and treatment of patients with injuries and emergency diseases ща chest organs.Material and methods: Study wasbased on treatment results analysis of 2111 patients with injuries and chest organs emergency diseases, who were treated at Republican Research Centre of Emergency Medicine in 2001-2014. Chest trauma made up 1396 (66,1% victims. There were 477 (22,6% patients with spontaneous pneumothorax. At the stages of initial diagnosis, the radiologic evaluations, CT investigations and videothoracoscopies were performed. In chest trauma patients the videothoracoscopy underwent in 844 cases, in spontaneous pneu#mothorax this method was employed in 290 patients. Complicated forms of lung echinococcosis were observed in 238 (11,3% patients and complicated forms of lung echinococcosis were evident in 72 patients.Results. Videothoracoscopy and video-assisted interventions allowed to eliminate lungs and pleura pathology in 1206 (57,1% patients, whereas the traditional methods were effective only in 905 cases (42,9%.Conclusions. Investigation methods such as multiplanar radioscopy, radiography, chest CT and videothora-coscopy must be included into algorithm of diagnosis and surgical treatment of chest injuries and emergency diseases of chest organs. At chest trauma the videothoracoscopy allows to avoid broad thoracotomy from 9,4% to 4,7% of cases, to reduce the frequency of repeated interventions from 17,4% to 0,5% and diminish a number of early postsurgery complications from 25,4% to 10,9%. Videothoracoscopy of chest traumas allows to reduce frequency of repeated interventions from 19,8 to 1,7%.

  8. Tumorous interstitial lung disease

    International Nuclear Information System (INIS)

    Dinkel, E.; Meyer, E.; Mundinger, A.; Helwig, A.; Blum, U.; Wuertemberger, G.

    1990-01-01

    The radiological findings in pulmonary lymphangitic carcinomatosis and in leukemic pulmonary infiltrates mirror the tumor-dependent monomorphic interstitial pathology of lung parenchyma. It is a proven fact that pulmonary lymphangitic carcinomatosis is caused by hematogenous tumor embolization to the lungs; pathogenesis by contiguous lymphangitic spread is the exception. High-resolution CT performed as a supplement to the radiological work-up improves the sensitivity for pulmonary infiltrates in general and thus makes the differential diagnosis decided easier. Radiological criteria cannot discriminate the different forms of leukemia. Plain chest X-ray allows the diagnosis of pulmonary involvement in leukemia due to tumorous infiltrates and of tumor- or therapy-induced complications. It is essential that the radiological findings be interpreted with reference to the stage of tumor disease and the clinical parameters to make the radiological differential diagnosis of opportunistic infections more reliable. (orig.) [de

  9. MR imaging of malignant ovarian tumors

    International Nuclear Information System (INIS)

    Kim, Jun Ho; Kang, Heoung Keun; Moon, Woong Jae; Seo, Jeong Jin; Kim, Jae Kyu; Choi, Ho Sun

    1994-01-01

    To evaluate MRI findings of malignant ovarian tumors. MRI findings were retrospectively reviewed in 25 patients with surgically confirmed 30 malignant ovarian tumors(common epithelial tumor; 23, sex cord stromal tumor; 2, endo dermal sinus tumor; 1, metastatic tumor; 4). The findings evaluated were the lesion size, solid and/or cystic component, wall thickness, septal thickness, necrosis, invasion of adjacent organ, ascites, and adenopathy. MRI findings of the malignant ovarian tumors were as follow: Size of lesion was 5-35cm(mean 14cm); solid component was present in 80%(24/30); wall thickness was more than 3mm in 90%(27/30); septal thickness was more than 3mm in 70%(21/30); tumor necrosis was present in 40%(12/30%); invasion of adjacent organ was present in 76%(19/25); ascites was present in 56%(14/25); lymphadenopathy was present in 24% (6/25). MRI findings of absence of solid component(6/6), even wall and septal thickness(7/7, 19/19) were found only in epithelial tumors. Uneven septal thickness more than 3mm(7/11) was a predominant MRI findings of non-epithelial tumors. Well-defined cystic lesion within solid component was seen in Krukenberg tumors. Evaluation of the lesion size, internal architecture, invasion of adjacent organ, ascites, and lymphadenopathy in MRI would enable diagnosis of malignant ovarian tumors and could lead to possible differential diagnosis of epithelial tumors from non-epithelial tumors

  10. Congenital extraskeletal Ewing's sarcoma of chest wall--a rare case report.

    Science.gov (United States)

    Atla, Bhagyalakshmi; Prasad, B Satya Vara; Sri, K Satya; Vandana, Geeta

    2011-01-01

    Congenital extraskeletal Ewing's sarcoma or peripheral primitive neuroectodermal tumor is an extremely uncommon and invariably fatal tumor. We report a case of extraskeletal congenital Ewing's sarcoma in a female fetus delivered at 34 weeks of gestation who died immediately after birth. In English literature, majority of cases of Ewing's sarcoma in neonates reported were skeletal. To the best of our knowledge, very few cases of extra-skeletal Ewing's sarcoma in neonates are reported in the literature.

  11. No benefit to surgical fixation of flail chest injuries compared with modern comprehensive management: results of a retrospective cohort study.

    Science.gov (United States)

    Farquhar, Jaclyn; Almarhabi, Yahya; Slobogean, Gerard; Slobogean, Bronwyn; Garraway, Naisan; Simons, Richard K; Hameed, S Morad

    2016-09-01

    Chest wall trauma is a common cause of morbidity and mortality. Recent technological advances and scientific publications have created a renewed interest in surgical fixation of flail chest. However, definitive data supporting surgical fixation are lacking, and its virtues have not been evaluated against modern, comprehensive management protocols. Consecutive patients undergoing rib fracture fixation with rib-specific locking plates at 2 regional trauma centres between July 2010 and August 2012 were matched to historical controls with similar injury patterns and severity who were managed nonoperatively with modern, multidisciplinary protocols. We compared short- and long-term outcomes between these cohorts. Our patient cohorts were well matched for age, sex, injury severity scores and abbreviated injury scores. The nonoperatively managed group had significantly better outcomes than the surgical group in terms of ventilator days (3.1 v. 6.1, p = 0.012), length of stay in the intensive care unit (3.7 v. 7.4 d, p = 0.009), total hospital length of stay (16.0 v. 21.9 d, p = 0.044) and rates of pneumonia (22% v. 63%, p = 0.004). There were no significant differences in long-term outcomes, such as chest pain or dyspnea. Although considerable enthusiasm surrounds surgical fixation of flail chest injuries, our analysis does not immediately validate its universal implementation, but rather encourages the use of modern, multidisciplinary, nonoperative strategies. The role of rib fracture fixation in the modern era of chest wall trauma management should ultimately be defined by prospective, randomized trials.

  12. Bone single photon emission computed tomography (SPECT in a patient with Pancoast tumor: a case report

    Directory of Open Access Journals (Sweden)

    Hamid Javadi

    Full Text Available CONTEXT: Non-small cell lung carcinomas (NSCLCs of the superior sulcus are considered to be the most challenging type of malignant thoracic disease. In this disease, neoplasms originating mostly from the extreme apex of the lung expand to the chest wall and thoracic inlet structures. Multiple imaging procedures have been applied to identify tumors and to stage and predict tumor resectability in surgical operations. Clinical examinations to localize pain complaints in shoulders and down the arms, and to screen for Horner's syndrome and abnormalities seen in paraclinical assessments, have been applied extensively for differential diagnosis of superior sulcus tumors. Although several types of imaging have been utilized for diagnosing and staging Pancoast tumors, there have been almost no reports on the efficiency of whole-body bone scans (WBBS for detecting the level of abnormality in cases of superior sulcus tumors. CASE REPORT: We describe a case of Pancoast tumor in which technetium-99m methylene diphosphonate (Tc-99m MDP bone single-photon emission-computed tomography (SPECT was able to accurately detect multiple areas of abnormality in the vertebrae and ribs. In describing this case, we stress the clinical and diagnostic points, in the hope of stimulating a higher degree of suspicion and thereby facilitating appropriate diagnosis and treatment. From the results of this study, further clinical trials to evaluate the potential of SPECT as an efficient imaging tool for the work-up on cases of Pancoast tumor are recommended.

  13. Computed tomography of active pulmonary tuberculosis with nonvisualized cavitary lesion on plain chest film

    International Nuclear Information System (INIS)

    Ahn, Woo Hyun; Cho, Seoung Hwan; Lee, Jun Bae; Kim, Byung Soo

    1989-01-01

    The detection of cavity in pulmonary tuberculosis has important roles in its diagnosis, therapy planning and follow-up of healing process, and also means at least moderate advanced tuberculosis. The plain chest film has some limitation of detection of cavity in pulmonary tuberculosis owing to several factors. CT is superior to plain chest film and conventional tomography, in detection of cavitary lesion. Authors retrospectively analyzed CT findings of 20 cases of minimal pulmonary tuberculosis, of which the plain chest films showed no cavitary lesion from Sept. 1986 to July 1988 in Pusan National University Hospital. All cases were proven by culture or AFB test of sputum and clinical evidence. The results were as follows: 1. Sex distribution showed 10 cases (50%) in male, 10 case (50%) in female and the highest incidence in the second decade (40%). 2. All 20 cases showed no cavity on the plain chest films, but all cases showed variable sized cavities on CT. 3. The size of cavities ranged from 4 mm to 30 mm, averaged as 9.9 mm, the thickness of cavitary wall from 3 mm to 8 mm, averaged as 5.8 mm. 4. It is concluded that cavitary lesions which are not visualized on the plain chest films can be demonstrated by CT scan in minimal pulmonary tuberculosis

  14. Use of imaging in assessing lung carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Webb, W R [California Univ., San Francisco, CA (United States). Dept. of Radiology

    1996-12-31

    Staging of bronchogenic carcinoma, invasive primary tumors, tracheal or carinal involvement, chest wall invasion, mediastinal invasion, malignant pleural effusion, lymph node metastases, mediastinal nodes, hilar masses briefly discussed (47 refs.).

  15. Use of imaging in assessing lung carcinoma

    International Nuclear Information System (INIS)

    Webb, W.R.

    1995-01-01

    Staging of bronchogenic carcinoma, invasive primary tumors, tracheal or carinal involvement, chest wall invasion, mediastinal invasion, malignant pleural effusion, lymph node metastases, mediastinal nodes, hilar masses briefly discussed (47 refs.)

  16. Accuracy of chest radiography versus chest computed tomography in hemodynamically stable patients with blunt chest trauma

    Directory of Open Access Journals (Sweden)

    Chardoli Mojtaba

    2013-12-01

    Full Text Available 【Abstract】 Objective: Thoracic injuries are respon- sible for 25% of deaths of blunt traumas. Chest X-ray (CXR is the first diagnostic method in patients with blunt trauma. The aim of this study was to detect the accuracy of CXR versus chest computed tomograpgy (CT in hemodynami- cally stable patients with blunt chest trauma. Methods: Study was conducted at the emergency department of Sina Hospital from March 2011 to March 2012. Hemodynamically stable patients with at least 16 years of age who had blunt chest trauma were included. All patients underwent the same diagnostic protocol which consisted of physical examination, CXR and CT scan respectively. Results: Two hundreds patients (84% male and 16% female were included with a mean age of (37.9±13.7 years. Chin J Traumatol 2013;16(6:351-354 Rib fracture was the most common finding of CXR (12.5% and CT scan (25.5%. The sensitivity of CXR for hemothorax, thoracolumbar vertebra fractures and rib fractures were 20%, 49% and 49%, respectively. Pneumothorax, foreign body, emphysema, pulmonary contusion, liver hematoma and ster- num fracture were not diagnosed with CXR alone. Conclusion: Applying CT scan as the first-line diag- nostic modality in hemodynamically stable patients with blunt chest trauma can detect pathologies which may change management and outcome. Key words: Radiography; Thoracic injuries; Tomography, X-ray computed

  17. Traumatic Pulmonary Herniation at the Diaphragmatic Junction in a Pediatric Patient: A Rare Complication of Blunt Chest Trauma.

    Science.gov (United States)

    Orlik, Kseniya; Simon, Erin Leslie; Hemmer, Carrie; Ramundo, Maria

    2016-07-01

    We present a case of traumatic intercostal pulmonary herniation in an 11-year-old boy after blunt trauma to the chest, without associated chest wall disruption or pneumothorax. This condition is especially uncommon in children, with only 5 previously reported cases and most occurring after penetrating chest trauma. To date, there are no reports in literature describing traumatic intercostal lung herniation at the diaphragmatic junction with a closed chest cavity in a child. The number of traumatic lung herniation diagnoses may be expanded by a more liberal use of computed tomography when serious injury is suspected. Computed tomography and advanced imaging should be considered in pediatric trauma patients presenting with concern for intrathoracic injury that may not be seen on plain film. Traumatic blunt intrathoracic and intra-abdominal injuries in the pediatric population that are within proximity of diaphragmatic insertion should be thoroughly evaluated to rule out diaphragmatic injury. As in our case, invasive surgical intervention such as thoracoscopy may be necessary.

  18. Chest tube insertion

    Science.gov (United States)

    Chest drainage tube insertion; Insertion of tube into chest; Tube thoracostomy; Pericardial drain ... Be careful there are no kinks in your tube. The drainage system should always sit upright and be placed ...

  19. Synovial chondromatosis of the acromioclavicular joint

    International Nuclear Information System (INIS)

    Kudawara, Ikuo; Aono, Masanari; Ohzono, Kenji; Mano, Masayuki

    2004-01-01

    A 53-year-old woman presented with swelling of 3 years' duration on the right anterior chest wall. A radiograph showed coarse calcifications around the subclavicular region and erosion of the ipsilateral acromioclavicular joint. Computed tomography also showed calcifications in soft tissue. Magnetic resonance imaging revealed a tumor around the clavicle extending to the anterior aspect of chest wall, which had low signal intensity on T1-weighted imaging and high signal intensity on T2-weighted imaging. The histologic findings were of a hyaline cartilage-like mass consisting of mature chondrocytes and an extracellular matrix. The histologic diagnosis of synovial chondromatosis was made. The present case is unusual in respect of the location and size of the tumor. (orig.)

  20. Synovial chondromatosis of the acromioclavicular joint

    Energy Technology Data Exchange (ETDEWEB)

    Kudawara, Ikuo; Aono, Masanari; Ohzono, Kenji [Osaka National Hospital, Department of Orthopaedic Surgery, Osaka (Japan); Mano, Masayuki [Osaka National Hospital, Department of Pathology, Osaka (Japan)

    2004-10-01

    A 53-year-old woman presented with swelling of 3 years' duration on the right anterior chest wall. A radiograph showed coarse calcifications around the subclavicular region and erosion of the ipsilateral acromioclavicular joint. Computed tomography also showed calcifications in soft tissue. Magnetic resonance imaging revealed a tumor around the clavicle extending to the anterior aspect of chest wall, which had low signal intensity on T1-weighted imaging and high signal intensity on T2-weighted imaging. The histologic findings were of a hyaline cartilage-like mass consisting of mature chondrocytes and an extracellular matrix. The histologic diagnosis of synovial chondromatosis was made. The present case is unusual in respect of the location and size of the tumor. (orig.)

  1. A randomized trial of chest irradiation alone versus chest irradiation plus Lentinan in squamous cell lung cancer in limited stage

    International Nuclear Information System (INIS)

    Kimura, Ikuro; Ohnoshi, Taisuke; Konno, Kiyoshi

    1993-01-01

    In an attempt to evaluate the effect of Lentinan, polysaccharides from Lentinusedodes, in combination with chest irradiation for limited-stage squamous cell lung cancer, we conducted a randomized trial between January 1987 and July 1989. Patients were randomly allocated to receive either a definitive chest irradiation of 60 Gy alone (RT) or the chest irradiation plus Lentinan (RT+L). Patients allocated to the RT+L group received iv infusion of Lentinan, 1 mg twice a week or 2 mg once a week, as long as possible. Of 201 patients enrolled, 183 (94 for RT, and 89 for RT+L) were eligible for analysis of survival time, and 169 (86 for RT, and 83 for RT+L) were evaluated for tumor response, survival time and quality of life. The response rate to the treatments showed a trend favoring the RT+L group (65% vs. 51%, p=0.142). The median survival time was 455 days for the RT+L group and 371 days for the RT group. The difference was not statistically significant. In the subset of patients with cancer of hilar origin, however, RT+L group patients lived significantly longer than RT group patients: Progression-free interval from symptoms and quality of life were evaluated for the both groups based on manual records of an individual patient. RT+L group patients had a significantly longer progression-free interval from dyspneic feeling than the RT group patients. The RT+L group tended to have a feeling of well-being. We conclude that Lentinan in combination with chest irradiation is useful for patients with limited-stage squamous cell lung cancer in terms of prolongation of life and maintenance of a favorable quality of life as well. (author)

  2. 12 A multi-centre randomised feasibility study evaluating the impact of a prognostic model for management of blunt chest wall trauma patients: stumbl trial.

    Science.gov (United States)

    Battle, Ceri; Hutchings, Hayley; Abbott, Zoe; O'neill, Claire; Groves, Sam; Watkins, Alan; Lecky, Fiona; Jones, Sally; Gagg, James; Body, Rick; Evans, Phillip

    2017-12-01

    A new prognostic model has been developed and externally validated, the aim of which is to assist in the management of the blunt chest wall trauma patient in the Emergency Department (ED). A definitive randomised controlled trial (impact trial), is required to assess the clinical and cost effectiveness of the new model, before it can be accepted in clinical practice. The purpose of this trial is to assess the feasibility and acceptability of such a definitive trial and inform its design. This feasibility trial is designed to test the methods of a multi-centre, cluster-randomised (stepped wedge) trial, with a substantial qualitative component. Four EDs in England and Wales will collect data for all blunt chest wall trauma patients over a five month period; in the initial period acting as the controls (normal care) and the second period, acting as the interventions (in which the new model will be used). Baseline measurements including completion of the SF-12v2 will be obtained on initial assessment in the ED. Patient outcome data will then be collected for any subsequent hospitalisations. Data collection will conclude with a six week follow-up completion of two surveys (SF-12v2 and Client Services Receipt Inventory).Analysis of outcomes will focus on feasibility, acceptability and trial processes and will include recruitment and retention rates, attendance at clinician training rates and use of model in the ED. Qualitative feedback will be obtained through clinician interviews and a research nurse focus group. An evaluation of the feasibility of health economics outcomes data will be completed. Wales Research Ethics Committee 6 granted approval for the trial in September 2016. Health Care Research Wales Research Permissions and the HRA have granted approval for the study. Patient recruitment commenced in February 2017. Planned dissemination is through publication in a peer-reviewed Emergency Medicine Journal, presentation at appropriate conferences and to

  3. Blunt chest trauma.

    Science.gov (United States)

    Stewart, Daphne J

    2014-01-01

    Blunt chest trauma is associated with a wide range of injuries, many of which are life threatening. This article is a case study demonstrating a variety of traumatic chest injuries, including pathophysiology, diagnosis, and treatment. Literature on the diagnosis and treatment was reviewed, including both theoretical and research literature, from a variety of disciplines. The role of the advance practice nurse in trauma is also discussed as it relates to assessment, diagnosis, and treatment of patients with traumatic chest injuries.

  4. A 51-Year-Old Woman With an Increasing Chest Wall Mass Years After Resection of an Early Stage Lung Cancer.

    Science.gov (United States)

    Dhakal, Ajay; Chen, Hongbin; Dexter, Elisabeth U

    2017-12-01

    A 51-year-old woman was found to have a new 14 × 6 mm soft tissue mass under the right serratus muscle on a CT scan of the chest performed for routine surveillance due to her history of stage I lung cancer. A follow-up CT scan performed 4 months later showed that the mass had increased in size to 22 × 8 mm. The patient presents to the oncology clinic to discuss the results of the CT scan. She has no pain or swelling on the right lateral chest and no cough, fever, or shortness of breath. She is at her baseline health with good appetite and functional status. Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  5. Chest X-Ray

    Medline Plus

    Full Text Available ... some concerns about chest x-rays. However, it’s important to consider the likelihood of benefit to your health. While a chest x-ray use a ... posted: How to Obtain and Share ...

  6. [Spontaneous tension hemothorax due to rupture of a solitary fibrous tumor of the posterior mediastinum].

    Science.gov (United States)

    Morita, Yohei; Ichimura, Hideo; Kikuchi, Shinji; Ozawa, Yuichiro; Inoue, Kazunari; Uchida, Atsushi; Kikuchi, Kazunori; Shiigai, Masanari; Shiotani, Seiji

    2013-10-01

    A 37-year-old man was transported by ambulance to our hospital due to abrupt chest pain. The pain began when he was practicing a combative-type sport. He denied any impact or blunt trauma. A chest radiograph revealed massive left pleural effusion with a mediastinal shift. Thoracentesis revealed a hemothorax;therefore, we performed an emergency thoracotomy. The intraoperative findings revealed a rupture of a posterior mediastinal tumor itself located between the descending aorta and the thoracic vertebra. After we identified the artery of Adamkiewicz that originates away from the tumor and evaluated the degree of tumor extension into the inter-vertebral foramen, we safely performed an elective tumor resection 1 month after the initial emergency operation. In patients with a hemothorax caused by rupture of the tumor itself, an elective tumor resection after detailed investigation should be considered if hemostasis can be achieved in the emergency thoracotomy.

  7. Randomized clinical trial of pigtail catheter versus chest tube in injured patients with uncomplicated traumatic pneumothorax.

    Science.gov (United States)

    Kulvatunyou, N; Erickson, L; Vijayasekaran, A; Gries, L; Joseph, B; Friese, R F; O'Keeffe, T; Tang, A L; Wynne, J L; Rhee, P

    2014-01-01

    Small pigtail catheters appear to work as well as the traditional large-bore chest tubes in patients with traumatic pneumothorax, but it is not known whether the smaller pigtail catheters are associated with less tube-site pain. This study was conducted to compare tube-site pain following pigtail catheter or chest tube insertion in patients with uncomplicated traumatic pneumothorax. This prospective randomized trial compared 14-Fr pigtail catheters and 28-Fr chest tubes in patients with traumatic pneumothorax presenting to a level I trauma centre from July 2010 to February 2012. Patients who required emergency tube placement, those who refused and those who could not respond to pain assessment were excluded. Primary outcomes were tube-site pain, as assessed by a numerical rating scale, and total pain medication use. Secondary outcomes included the success rate of pneumothorax resolution and insertion-related complications. Forty patients were enrolled. Baseline characteristics of 20 patients in the pigtail catheter group were similar to those of 20 patients in the chest tube group. No patient had a flail chest or haemothorax. Pain scores related to chest wall trauma were similar in the two groups. Patients with a pigtail catheter had significantly lower mean(s.d.) tube-site pain scores than those with a chest tube, at baseline after tube insertion (3.2(0.6) versus 7.7(0.6); P pneumothorax, use of a 14-Fr pigtail catheter is associated with reduced pain at the site of insertion, with no other clinically important differences noted compared with chest tubes. NCT01537289 (http://clinicaltrials.gov). © 2013 BJS Society Ltd. Published by John Wiley & Sons Ltd.

  8. Microwave hyperthermia as an adjuvant to radiation therapy. Summary experience of 256 multifraction treatment cases

    International Nuclear Information System (INIS)

    Bicher, H.I.

    1985-01-01

    Analysis is presented of a series of 256 human tumors treated under multifraction protocol regimes with standard controlled hyperthermia parameters and increasing doses of radiation therapy. Air cooled microwave applicators intracavitary and interstitial antennae operating at 915 or 300 MHz were used in various sites. Temperatures were measured by micro-thermocouples. Minimum tumor temperatures of 42 0 C were maintained at 1 hour, twice weekly. Treatment included a radiation dose of 1600-1700 rads. Tumor response was 94% with 60% or more total response. Frequency and duration of total responses depended mainly on the radiation dose. Skin tumors, melanomas, chest wall recurrences responded better than head and neck or intrapelvic recurrences. Side effects observed were minor burns; proctitis or oesophagitis with intracavitary devices; ulcerations or fistulae due to rapid tumor regression; 4 cases of pleuritis treating chest wall. Overall toxicity was less than 5%. In conclusion: 1) Combination heat-low dose radiation offers good palliation. 2) Response depends on radiation dose. 3) Combination of full dose radiation therapy plus hyperthermia proves to be well tolerated

  9. A hybrid method for airway segmentation and automated measurement of bronchial wall thickness on CT.

    Science.gov (United States)

    Xu, Ziyue; Bagci, Ulas; Foster, Brent; Mansoor, Awais; Udupa, Jayaram K; Mollura, Daniel J

    2015-08-01

    Inflammatory and infectious lung diseases commonly involve bronchial airway structures and morphology, and these abnormalities are often analyzed non-invasively through high resolution computed tomography (CT) scans. Assessing airway wall surfaces and the lumen are of great importance for diagnosing pulmonary diseases. However, obtaining high accuracy from a complete 3-D airway tree structure can be quite challenging. The airway tree structure has spiculated shapes with multiple branches and bifurcation points as opposed to solid single organ or tumor segmentation tasks in other applications, hence, it is complex for manual segmentation as compared with other tasks. For computerized methods, a fundamental challenge in airway tree segmentation is the highly variable intensity levels in the lumen area, which often causes a segmentation method to leak into adjacent lung parenchyma through blurred airway walls or soft boundaries. Moreover, outer wall definition can be difficult due to similar intensities of the airway walls and nearby structures such as vessels. In this paper, we propose a computational framework to accurately quantify airways through (i) a novel hybrid approach for precise segmentation of the lumen, and (ii) two novel methods (a spatially constrained Markov random walk method (pseudo 3-D) and a relative fuzzy connectedness method (3-D)) to estimate the airway wall thickness. We evaluate the performance of our proposed methods in comparison with mostly used algorithms using human chest CT images. Our results demonstrate that, on publicly available data sets and using standard evaluation criteria, the proposed airway segmentation method is accurate and efficient as compared with the state-of-the-art methods, and the airway wall estimation algorithms identified the inner and outer airway surfaces more accurately than the most widely applied methods, namely full width at half maximum and phase congruency. Copyright © 2015. Published by Elsevier B.V.

  10. Direct digital acquisition of neonatal portable chest radiographs

    International Nuclear Information System (INIS)

    Cohen, M.D.; Cory, D.A.; Broderick, N.J.; Smith, J.A.

    1987-01-01

    The Philips computerized radiography system utilizes a phosphor plate instead of an x-ray film to acquire radiographic images. The latent image on the plate is converted to a digital format. The authors report their initial experience with the system in more than 300 studies on intensive care neonates. The digital images provide very uniform image density. Tubes and catheters are more easily visualized than on conventional images. Soft tissues of the chest wall and bony structures are also more clearly seen on the digital images. The authors' initial experience indicates that portable digital imaging of neonates is technically feasible and provides good-quality diagnostic images

  11. Chest X-Ray

    Medline Plus

    Full Text Available ... breath, persistent cough, fever, chest pain or injury. It may also be useful to help diagnose and ... have some concerns about chest x-rays. However, it’s important to consider the likelihood of benefit to ...

  12. Abdominal Wall Metastasis from an Invasive Lobular Carcinoma of the Breast: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hana; Son, Eun Ju; Youk, Ji Hyun; Chung, Jin [Dept. of Radiology, Gangnam Severance Hospital, Yensei University College of Medicine, Seoul (Korea, Republic of); Noh, Song Mi; Jung, Woo Hee [Dept. of Diagnostic Pathology, Gangnam Severance Hospital, Yensei University College of Medicine, Seoul (Korea, Republic of)

    2011-06-15

    Breast cancer is one of the most common malignancies in women. Breast cancer frequently metastasizes to the bones, lungs, and liver. However, the recurrence of distant soft-tissue metastasis except to the chest wall is extremely rare. Here, we describe our experience with a patient in whom invasive lobular carcinoma of the breast with metastasis to the abdominal wall presented as subcutaneous nodules without local recurrence.

  13. Abdominal Wall Metastasis from an Invasive Lobular Carcinoma of the Breast: A Case Report

    International Nuclear Information System (INIS)

    Kim, Hana; Son, Eun Ju; Youk, Ji Hyun; Chung, Jin; Noh, Song Mi; Jung, Woo Hee

    2011-01-01

    Breast cancer is one of the most common malignancies in women. Breast cancer frequently metastasizes to the bones, lungs, and liver. However, the recurrence of distant soft-tissue metastasis except to the chest wall is extremely rare. Here, we describe our experience with a patient in whom invasive lobular carcinoma of the breast with metastasis to the abdominal wall presented as subcutaneous nodules without local recurrence.

  14. Digital luminescence radiography using a chest phantom

    International Nuclear Information System (INIS)

    Lyttkens, K.; Kehler, M.; Andersson, B.; Carlsen, S.; Ebbesen, A.; Hochbergs, P.; Stroembaeck, A.

    1993-01-01

    With the introduction of picture and archiving communicating systems an alternative image display for the wards might be a personal computer (PC). The intention with this study was to evaluate the diagnostic image quality of the monitor of a PC compared to that of a workstation. Eighty-five digital radiographs of a chest phantom with simulated tumors in the mediastinum and right lung were saved on optical discs. The examinations were reviewed by 4 radiologists on a monitor at a workstation and at a PC, and receiver operating characteristic (ROC) curves were constructed. No significant difference was found between performance of the PC and the workstation. (orig.)

  15. Pitfalls and artifacts in the interpretation of oncologic PET/CT of the chest

    Energy Technology Data Exchange (ETDEWEB)

    Meirelles, Gustavo de Souza Portes; Capobianco, Julia; Oliveira, Marco Antonio Conde de, E-mail: gustavo.meirelles@grupofleury.com.br [Grupo Fleury, Sao Paulo, SP (Brazil)

    2017-01-15

    PET/CT is widely used for the evaluation of patients with thoracic malignancies. Although the levels of {sup 18}F-fluorodeoxyglucose (FDG) uptake are usually high in neoplastic diseases, they can also be physiological, due to artifacts. In addition, FDG uptake can occur in benign conditions such as infectious, inflammatory, and iatrogenic lesions. Furthermore, some malignant tumors, such as adenocarcinoma in situ (formerly known as bronchoalveolar carcinoma) and carcinoid tumors, may not show FDG uptake. Here, we illustrate the main pitfalls and artifacts in the interpretation of the results of oncologic PET/CT of the chest, outlining strategies for avoiding misinterpretation. (author)

  16. Chest tomosynthesis: technical and clinical perspectives.

    Science.gov (United States)

    Johnsson, Ase Allansdotter; Vikgren, Jenny; Bath, Magnus

    2014-02-01

    The recent implementation of chest tomosynthesis is built on the availability of large, dose-efficient, high-resolution flat panel detectors, which enable the acquisition of the necessary number of projection radiographs to allow reconstruction of section images of the chest within one breath hold. A chest tomosynthesis examination obtains the increased diagnostic information provided by volumetric imaging at a radiation dose comparable to that of conventional chest radiography. There is evidence that the sensitivity of chest tomosynthesis may be at least three times higher than for conventional chest radiography for detection of pulmonary nodules. The sensitivity increases with increasing nodule size and attenuation and decreases for nodules with subpleural location. Differentiation between pleural and subpleural lesions is a known pitfall due to the limited depth resolution in chest tomosynthesis. Studies on different types of pathology report increased detectability in favor of chest tomosynthesis in comparison to chest radiography. The technique provides improved diagnostic accuracy and confidence in the diagnosis of suspected pulmonary lesions on chest radiography and facilitates the exclusion of pulmonary lesions in a majority of patients, avoiding the need for computed tomography (CT). However, motion artifacts can be a cumbersome limitation and breathing during the tomosynthesis image acquisition may result in severe artifacts significantly affecting the detectability of pathology. In summary, chest tomosynthesis has been shown to be superior to chest conventional radiography for many tasks and to be able to replace CT in selected cases. In our experience chest tomosynthesis is an efficient problem solver in daily clinical work. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  17. Multiple Bowen's disease and epithelioid malignant peripheral nerve sheath tumor in a patient who experienced chronic arsenic poisoning

    Directory of Open Access Journals (Sweden)

    Ching-En Chen

    2017-01-01

    Full Text Available The Southwest coastal plain of Taiwan is an endemic area of arsenic contamination. Residents who lived there before the 1970s and who used raw groundwater for drinking have a higher risk of arsenic poisoning. In 1968, Tseng et al. described Blackfoot disease as a peripheral vascular disease caused by chronic exposure to arsenic, thereby introducing the concept of arsenic-induced systemic illness in Taiwan. Multiple Bowen's disease (BD is one of the characteristic consequences of chronic arsenic poisoning and it usually presents as cutaneous carcinoma in situ. Multiple BD can also be associated with squamous cell carcinoma and basal cell carcinoma of the skin, as well as lung, liver, gastrointestinal, and bladder cancers. We encountered a 79-year-old male from Yun-Lin, a county in Southwest Taiwan, who presented with a progressing tumor in his right anterior chest wall. In addition, numerous keratoses and scaly skin lesions were noted on his trunk and extremities, some of which were combined with erosions. The patient was diagnosed with chronic arsenic poisoning with multiple BD and the huge tumor was confirmed as an epithelioid malignant peripheral nerve sheath tumor.

  18. Inflation and deflation pressure-volume loops in anesthetized pinnipeds confirms compliant chest and lungs

    Directory of Open Access Journals (Sweden)

    Andreas eFahlman

    2014-11-01

    Full Text Available We examined structural properties of the marine mammal respiratory system, and tested Scholander’s hypothesis that the chest is highly compliant by measuring the mechanical properties of the respiratory system in five species of pinniped under anesthesia (Pacific harbor seal, Phoca vitulina; northern elephant seal, Mirounga angustirostris; northern fur seal Callorhinus ursinus; California sea lion, Zalophus californianus; and Steller sea lion, Eumetopias jubatus. We found that the chest wall compliance (CCW of all five species was greater than lung compliance (airways and alveoli, CL as predicted by Scholander, which suggests that the chest provides little protection against alveolar collapse or lung squeeze. We also found that specific respiratory compliance was significantly greater in wild animals than in animals raised under human care. While differences in ages between the two groups may affect this incidental finding, it is also possible that lung conditioning in free-living animals may increase pulmonary compliance and reduce the risk of lung squeeze during diving. Overall, our data indicate that compliance of excised pinniped lungs provide a good estimate of total respiratory compliance.

  19. Inflation and deflation pressure-volume loops in anesthetized pinnipeds confirms compliant chest and lungs.

    Science.gov (United States)

    Fahlman, Andreas; Loring, Stephen H; Johnson, Shawn P; Haulena, Martin; Trites, Andrew W; Fravel, Vanessa A; Van Bonn, William G

    2014-01-01

    We examined structural properties of the marine mammal respiratory system, and tested Scholander's hypothesis that the chest is highly compliant by measuring the mechanical properties of the respiratory system in five species of pinniped under anesthesia (Pacific harbor seal, Phoca vitulina; northern elephant seal, Mirounga angustirostris; northern fur seal Callorhinus ursinus; California sea lion, Zalophus californianus; and Steller sea lion, Eumetopias jubatus). We found that the chest wall compliance (CCW) of all five species was greater than lung compliance (airways and alveoli, CL) as predicted by Scholander, which suggests that the chest provides little protection against alveolar collapse or lung squeeze. We also found that specific respiratory compliance was significantly greater in wild animals than in animals raised in an aquatic facility. While differences in ages between the two groups may affect this incidental finding, it is also possible that lung conditioning in free-living animals may increase pulmonary compliance and reduce the risk of lung squeeze during diving. Overall, our data indicate that compliance of excised pinniped lungs provide a good estimate of total respiratory compliance.

  20. CT of chest trauma

    International Nuclear Information System (INIS)

    Goodman, P.C.

    1986-01-01

    There appears to be a limited role for computed tomography in the evaluation of chest trauma. The literature contains few papers specifically addressing the use of CT in the setting of chest trauma. Another series of articles relates anecdotal experiences in this regard. This paucity of reports attests to the remarkable amount of information present on conventional chest radiographs as well as the lack of clear indications for CT in the setting of chest trauma. In this chapter traumatic lesions of various areas of the thorax are discussed. The conventional radiographic findings are briefly described and the potential or proven application of CT is addressed

  1. Giant Cell Tumor of the Thoracic Spine Presenting as a Posterior Mediastinal Tumor with Benign Pulmonary Metastases: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Tae Hun [Daegu Fatima Hospital College of Medicine, Daegu (Korea, Republic of); Rho, Byung Hak; Bahn, Young Eun; Choi, Won Il [Dongsan Medical Center, Keimyung University School of Medicine, Daegu (Korea, Republic of)

    2010-11-15

    Giant cell tumor of bone is a benign, but potentially aggressive lesion that can show local recurrence and metastases. We report here on a case of a 29-year-old man who presented with an incidentally found mediastinal mass. Chest radiography and computed tomography showed a huge mediastinal mass with bilateral pulmonary nodules and the diagnosis of giant cell tumor with benign pulmonary metastasis was confirmed. To the best of our knowledge, this is the first reported case of primary thoracic spinal giant cell tumor manifesting as a huge mediastinal mass with pulmonary metastases

  2. Multiple Ewing Sarcoma/Primitive Neuroectodermal Tumors in the Mediastinum

    Science.gov (United States)

    Bae, Sung Hwan; Hwang, Jung Hwa; Da Nam, Bo; Kim, Hyun Jo; Kim, Ki-Up; Kim, Dong Won; Choi, In Ho

    2016-01-01

    Abstract Ewing sarcoma/primitive neuroectodermal tumors (ES/PNET) are high-grade malignant neoplasms. These malignancies present very rare tumors of thoracopulmonary area and even rarer in the mediastinum. In our knowledge, ES/PNET presented with multiple mediastinal masses has not been reported previously. We experienced a case of a 42-year-old man presented with gradual onset of left-side pleuritic chest pain. A contrast-enhanced chest computed tomography (CT) scan showed separate 2 large heterogeneously enhancing masses in each anterior and middle mediastinum of the left hemithorax. Positron emission tomography-computed tomography (PET-CT) scan revealed high fluorodeoxyglucose (FDG) uptake in the mediastinal masses. After surgical excision for the mediastinal masses, both of the masses were diagnosed as the ES/PNET group of tumors on the histopathologic examination. The patient refused postoperative adjuvant chemotherapy and came back with local tumor recurrence and distant metastasis on 4-month follow-up after surgical resection. We report this uncommon form of ES/PNET. We are to raise awareness that this rare malignancy should be considered as a differential diagnosis of the malignant mediastinal tumors and which can be manifested as multiple masses in a patient. Understanding this rare entity of extra-skeletal ES/PNET and characteristic imaging findings can help radiologists and clinicians to approach proper diagnosis and better management for this highly malignant tumor. PMID:26886614

  3. Characterization of Pancreatic Tumor Motion Using Cine MRI: Surrogates for Tumor Position Should Be Used With Caution

    International Nuclear Information System (INIS)

    Feng, Mary; Balter, James M.; Normolle, Daniel; Adusumilli, Saroja; Cao Yue; Chenevert, Thomas L.; Ben-Josef, Edgar

    2009-01-01

    Purpose: Our current understanding of intrafraction pancreatic tumor motion due to respiration is limited. In this study, we characterized pancreatic tumor motion and evaluated the application of several radiotherapy motion management strategies. Methods and Materials: Seventeen patients with unresectable pancreatic cancer were enrolled in a prospective internal review board-approved study and imaged during shallow free-breathing using cine MRI on a 3T scanner. Tumor borders were agreed on by a radiation oncologist and an abdominal MRI radiologist. Tumor motion and correlation with the potential surrogates of the diaphragm and abdominal wall were assessed. These data were also used to evaluate planning target volume margin construction, respiratory gating, and four-dimensional treatment planning for pancreatic tumors. Results: Tumor borders moved much more than expected. To provide 99% geometric coverage, margins of 20 mm inferiorly, 10 mm anteriorly, 7 mm superiorly, and 4 mm posteriorly are required. Tumor position correlated poorly with diaphragm and abdominal wall position, with patient-level Pearson correlation coefficients of -0.18-0.43. Sensitivity and specificity of gating with these surrogates was also poor, at 53%-68%, with overall error of 35%-38%, suggesting that the tumor may be underdosed and normal tissues overdosed. Conclusions: Motion of pancreatic tumor borders is highly variable between patients and larger than expected. There is substantial deformation with breathing, and tumor border position does not correlate well with abdominal wall or diaphragmatic position. Current motion management strategies may not account fully for tumor motion and should be used with caution.

  4. Evaluation of useful treatment which uses dual-energy when curing lung-cancer patient with stereotactic body radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Jang, Hyeong Jun; Lee, Yeong Gyu; Kim, Yeong Jae; Park, Yeong Gyu [Dept. of Radiation Oncology, Catholic University Seoul St Mary' s hospital, Seoul (Korea, Republic of)

    2016-12-15

    This study will evaluate the clinical utility by applying clinical schematic that uses monoenergy or dual energy as according to the location of tumors to the stereotactic radiotherapy to compare the change in actual dose given to the real tumor and the dose that locates adjacent to the tumor. CT images from a total of 10 patients were obtained and the clinical planning were planned based on the volumetric modulated arc therapy on monoenergy and dual energy. To analyze the change factor in the tumor, Conformity Index(CI) and Homogeneity Index(HI) and maximum dose quantity were each calculated and comparing the dose distribution on normal tissues, v{sub 10} and v{sub 5}, first ⁓ fourth ribs closest to the tumor (1st ⁓ 4th Rib), Spinal Cord, Esophagus and Trachea were selected. Also, in order to confirm the accuracy on which the planned dose distribution is really measured, the 2-dimensional ion chamber array was used to measure the dose distribution. As of the tumor factor, CI and HI showed a number close to 1 when the two energies were used. As of the maximum dose, the front chest wall showed 2% and the dorsal tumor showed equivalent value. As of normal tissue, the front chest wall tumors were reduced by 4%, 5% when both energies were used in the adjacent rib and as of trachea, reduced by 11%, 17%. As of the dose in the lung, as of v{sub 10}, it reduced by 1.5%, v{sub 5} by 1%. As of the rear chest wall, when both energies were used, the ribs adjacent to the tumors showed 6%, 1%, 4%, 12% reduction, and in the lung dose distribution, v{sub 10} reduced by 3%, and v{sub 5} reduced by 3.1%. The dose measurement in all energies were in accordance to the results of Gamma Index 3mm/3%. Conclusion : It is considered that rather than using monoenergy, utilizing double energy in the clinical setting can be more effectively applied to the superficial tumors.

  5. Learning chest imaging

    Energy Technology Data Exchange (ETDEWEB)

    Pedrozo Pupo, John C. (ed.) [Magdalena Univ., Santa Maria (Colombia). Respire - Inst. for Respiratory Care

    2013-03-01

    Useful learning tool for practitioners and students. Overview of the imaging techniques used in chest radiology. Aid to the correct interpretation of chest X-ray images. Radiology of the thorax forms an indispensable element of the basic diagnostic process for many conditions and is of key importance in a variety of medical disciplines. This user-friendly book provides an overview of the imaging techniques used in chest radiology and presents numerous instructive case-based images with accompanying explanatory text. A wide range of clinical conditions and circumstances are covered with the aim of enabling the reader to confidently interpret chest images by correctly identifying structures of interest and the causes of abnormalities. This book, which will be an invaluable learning tool, forms part of the Learning Imaging series for medical students, residents, less experienced radiologists, and other medical staff. Learning Imaging is a unique case-based series for those in professional education in general and for physicians in prarticular.

  6. Chest radiology

    International Nuclear Information System (INIS)

    Reed, J.C.

    1990-01-01

    This book is a reference in plain chest film diagnosis provides a thorough background in the differential diagnosis of 22 of the most common radiologic patterns of chest disease. Each chapter is introduced with problem cases and a set of questions, followed by a tabular listing of the appropriate differential considerations. The book emphasizes plain films, CT and some MR scans are integrated to demonstrate how these modalities enhance the work of a case

  7. Chest wall restriction limits high airway pressure-induced lung injury in young rabbits.

    Science.gov (United States)

    Hernandez, L A; Peevy, K J; Moise, A A; Parker, J C

    1989-05-01

    High peak inspiratory pressures (PIP) during mechanical ventilation can induce lung injury. In the present study we compare the respective roles of high tidal volume with high PIP in intact immature rabbits to determine whether the increase in capillary permeability is the result of overdistension of the lung or direct pressure effects. New Zealand White rabbits were assigned to one of three protocols, which produced different degrees of inspiratory volume limitation: intact closed-chest animals (CC), closed-chest animals with a full-body plaster cast (C), and isolated excised lungs (IL). The intact animals were ventilated at 15, 30, or 45 cmH2O PIP for 1 h, and the lungs of the CC and C groups were placed in an isolated lung perfusion system. Microvascular permeability was evaluated using the capillary filtration coefficient (Kfc). Base-line Kfc for isolated lungs before ventilation was 0.33 +/- 0.31 ml.min-1.cmH2O-1.100g-1 and was not different from the Kfc in the CC group ventilated with 15 cmH2O PIP. Kfc increased by 850% after ventilation with only 15 cmH2O PIP in the unrestricted IL group, and in the CC group Kfc increased by 31% after 30 cmH2O PIP and 430% after 45 cmH2O PIP. Inspiratory volume limitation by the plaster cast in the C group prevented any significant increase in Kfc at the PIP values used. These data indicate that volume distension of the lung rather than high PIP per se produces microvascular damage in the immature rabbit lung.

  8. The effects of single-walled carbon nanotubes on cancer cell migration using a pancreatic tumor model

    Science.gov (United States)

    Layton, Elivia; McNamar, Rachel; Hasanjee, Aamr M.; McNair, Cayman; Stevens, Brianna; Vaughan, Melville; Zhou, Feifan; Chen, Wei R.

    2017-02-01

    Non-invasive laser immunotherapy (NLIT) is a viable alternative to traditional cancer treatment because it combines the photothermal and immunological effects of non-invasive laser irradiation and single-walled carbon nanotubes (SWNT) with an immunoadjuvant, glycated chitosan (GC). This combination forms SWNT-GC, a photosensitive immunoadjuvant, which creates a tumor-specific immunity that targets both the primary tumor and any metastasis. It is known that NLIT induces anti-tumor as well as anti-metastatic immune responses, but its immunological mechanism is not clear. The objective of this study is to clarify the role of SWNT-GC in cancer cell migration. Panc02 (non-metastatic) and Panc02-H7 (metastatic) pancreatic cancer cells were used in two-dimensional elastomer plug assays to observe the restriction of cell migration induced by SWNT, GC, and SWNT-GC individually. To replicate a three-dimensional in vivo study, a similar assay was repeated using embedded collagen lattices. Both the 2D and the 3D studies confirmed previous results indicating that GC inhibits cancer cell motility. The 2D and 3D studies also showed that SWNT-GC inhibited the migration of cancer cells, but a discrepancy was observed regarding the effect of SWNT alone. The 2D model concluded that SWNT inhibited migration while the 3D model determined that SWNT promoted migration. The results of this study will guide future work to determine the mechanism behind NLIT, including how metastases are eradicated and how the tumor specific immunity is created.

  9. Digital chest radiography

    DEFF Research Database (Denmark)

    Debess, Jeanne Elisabeth; Johnsen, Karen Kirstine; Thomsen, Henrik

    on collimation and dose reduction in digital chest radiography Methods and Materials A retrospective study of digital chest radiography is performed to evaluate the primary x-ray tube collimation of the PA and lateral radiographs. Data from one hundred fifty self-reliant female patients between 15 and 55 years...

  10. Congenital extraskeletal Ewing′s sarcoma of chest wall - A rare case report

    OpenAIRE

    Bhagyalakshmi Atla; B Satya Vara Prasad; K Satya Sri; Geeta Vandana

    2011-01-01

    Congenital extraskeletal Ewing′s sarcoma or peripheral primitive neuroectodermal tumor is an extremely uncommon and invariably fatal tumor. We report a case of extraskeletal congenital Ewing′s sarcoma in a female fetus delivered at 34 weeks of gestation who died immediately after birth. In English literature, majority of cases of Ewing′s sarcoma in neonates reported were skeletal. To the best of our knowledge, very few cases of extra-skeletal Ewing′s sarcoma in neonates are reported in the li...

  11. Congenital extraskeletal Ewing′s sarcoma of chest wall - A rare case report

    Directory of Open Access Journals (Sweden)

    Bhagyalakshmi Atla

    2011-01-01

    Full Text Available Congenital extraskeletal Ewing′s sarcoma or peripheral primitive neuroectodermal tumor is an extremely uncommon and invariably fatal tumor. We report a case of extraskeletal congenital Ewing′s sarcoma in a female fetus delivered at 34 weeks of gestation who died immediately after birth. In English literature, majority of cases of Ewing′s sarcoma in neonates reported were skeletal. To the best of our knowledge, very few cases of extra-skeletal Ewing′s sarcoma in neonates are reported in the literature.

  12. Metastatic spread from squamous cell carcinoma of the hypopharynx to the totally implantable venous access port insertion site: Case report and review of literature.

    Science.gov (United States)

    Mangla, Ankit; Agarwal, Nikki; Mullane, Michael Russell

    2017-12-01

    The totally implantable venous access port plays a crucial role in delivering chemotherapy in the outpatient setting. Here, we report the first case of a patient with hypopharyngeal tumor who developed chest wall metastasis over the totally implantable venous access port inserted in the internal jugular vein. Our patient, a 58-year-old man with a hypopharyngeal tumor presented with a lump over the totally implantable venous access port site. The port was removed and the lump was biopsied. The CT studies showed that the tumor had spread along the catheter from the hypopharynx to the chest wall. The pathology from the biopsy showed squamous cell carcinoma (SCC). The patient had poor performance status and opted for hospice care. We present a novel case of metastasis over the totally implantable venous access port implanted in a patient with a hypopharyngeal tumor. We also reviewed relevant literature comparing the data from percutaneous endoscopic gastrostomy (PEG) tube site metastasis with our patient and other similar case reports. © 2017 Wiley Periodicals, Inc.

  13. Chest Tube Drainage of the Pleural Space: A Concise Review for Pulmonologists.

    Science.gov (United States)

    Porcel, José M

    2018-04-01

    Chest tube insertion is a common procedure usually done for the purpose of draining accumulated air or fluid in the pleural cavity. Small-bore chest tubes (≤14F) are generally recommended as the first-line therapy for spontaneous pneumothorax in non-ventilated patients and pleural effusions in general, with the possible exception of hemothoraces and malignant effusions (for which an immediate pleurodesis is planned). Large-bore chest drains may be useful for very large air leaks, as well as post-ineffective trial with small-bore drains. Chest tube insertion should be guided by imaging, either bedside ultrasonography or, less commonly, computed tomography. The so-called trocar technique must be avoided. Instead, blunt dissection (for tubes >24F) or the Seldinger technique should be used. All chest tubes are connected to a drainage system device: flutter valve, underwater seal, electronic systems or, for indwelling pleural catheters (IPC), vacuum bottles. The classic, three-bottle drainage system requires either (external) wall suction or gravity ("water seal") drainage (the former not being routinely recommended unless the latter is not effective). The optimal timing for tube removal is still a matter of controversy; however, the use of digital drainage systems facilitates informed and prudent decision-making in that area. A drain-clamping test before tube withdrawal is generally not advocated. Pain, drain blockage and accidental dislodgment are common complications of small-bore drains; the most dreaded complications include organ injury, hemothorax, infections, and re-expansion pulmonary edema. IPC represent a first-line palliative therapy of malignant pleural effusions in many centers. The optimal frequency of drainage, for IPC, has not been formally agreed upon or otherwise officially established. Copyright©2018. The Korean Academy of Tuberculosis and Respiratory Diseases.

  14. Imaging of blunt chest trauma

    International Nuclear Information System (INIS)

    Prosch, H.; Negrin, L.

    2014-01-01

    Blunt chest trauma is associated with high morbidity and mortality. Consequently, all patients should be evaluated radiologically after blunt chest trauma to allow timely and appropriate treatment. Conventional chest radiographs and computed tomography (CT) are proven modalities with which to evaluate patients after blunt chest trauma. Over the last several years extended focused assessment with sonography for trauma (eFAST) has gained increasing importance for the initial assessment of seriously injured patients. In the acute phase of severely injured patients eFAST examinations are helpful to exclude pneumothorax, hemothorax and hemopericardium. Chest radiographs may also be used to diagnose a pneumothorax or hemothorax; however, the sensitivity is limited and CT is the diagnostic modality of choice to evaluate severely injured patients. (orig.) [de

  15. Uncommon of the uncommon: Malignant Perivascular epithelioid cell tumor of the lung

    International Nuclear Information System (INIS)

    Lim, Hyun Ju; Lee, Ho Yun; Han, Joung Ho; Choi, Yong Soo; Lee, Kyung Soo

    2013-01-01

    A perivascular epithelioid cell (PEC) tumor is a rare mesenchymal tumor characterized by abundant cytoplasmic Periodic acid-Schiff positive glycogen (also called sugar tumor or clear cell tumor of the lung for this characteristic) and is mostly benign. We report a case of a 63-year-old man who presented with an enlarging mass on chest radiograph. After a thorough workup, diagnosis of malignant pulmonary PEC tumor with lung to lung metastases was established. Herein, the difficulties of diagnosis and management we confronted are described.

  16. Uncommon of the uncommon: Malignant Perivascular epithelioid cell tumor of the lung

    Energy Technology Data Exchange (ETDEWEB)

    Lim, Hyun Ju; Lee, Ho Yun; Han, Joung Ho; Choi, Yong Soo; Lee, Kyung Soo [Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2013-08-15

    A perivascular epithelioid cell (PEC) tumor is a rare mesenchymal tumor characterized by abundant cytoplasmic Periodic acid-Schiff positive glycogen (also called sugar tumor or clear cell tumor of the lung for this characteristic) and is mostly benign. We report a case of a 63-year-old man who presented with an enlarging mass on chest radiograph. After a thorough workup, diagnosis of malignant pulmonary PEC tumor with lung to lung metastases was established. Herein, the difficulties of diagnosis and management we confronted are described.

  17. An elusive chest coin in an African child: a pleural fibroma's long, tortuous path to freedom.

    Science.gov (United States)

    Aremu, Ademola Adegoke; Oyedeji, Olusola Adetunji; Asaleye, Christianah Mopelola; Adetiloye, Victor Adebayo

    2013-01-01

    Fibrous tumour of the pleural is rare and controversial tumor. Most of the reported cases is adults and the elderly. This case presentation is a solitary fibrous tumour in a fifteen year old girl, which to the best of our knowledge is the youngest report, who was sent for a psychiatric evaluation due to persistent complaint of "movement" in her chest, later referred to a tuberculosis clinic because of a chest radiograph report of loculated pleural effusion likely secondary to tuberculosis. She eventually had a chest computerized tomography and subsequent resection of the lesion. Histology confirmed the computerized tomography diagnosis of solitary fibrous tumour and there was no recurrence five years after excision. This report highlights the difficulty often encountered in developing countries where clinicians solely rely on clinical acumen for diagnosis and treatment due to poor patients' financial status and scarcely available diagnostic resources.

  18. Non-Invasive Mechanic Ventilation Using in Flail Chest, Caused By Blunt Chest Trauma

    Directory of Open Access Journals (Sweden)

    Serdar Onat

    2008-01-01

    Full Text Available A 75-year-old woman admitted our faculty emergency room with shortness of breath, and chest pain after traffic accident’s second hour. She was diagnosed as bilateral multipl rib fractures, left clavicula fracture, and left flail chest by phsical and radiological examinations. She was transfered to Chest Surgery Depatment’s intensive care unit. The patient was undergone non-invasive mask mechanic ventilation support, because of the decreasing of blood oxygen saturation and increasing of arteriel blood partial carbondioxide pressure. The treatment of non-invasive mechanic ventilation was succesfull for ventilation support. With this report, we would like to attentioned that non-invasive mechanic ventilation for blunt chest trauma patients could be used succesfully and could be used instead of endotracheal invasive mechanic ventilation.

  19. Large pneumothorax in blunt chest trauma: Is a chest drain always necessary in stable patients? A case report.

    Science.gov (United States)

    Idris, Baig M; Hefny, Ashraf F

    2016-01-01

    Pneumothorax is the most common potentially life-threatening blunt chest injury. The management of pneumothorax depends upon the etiology, its size and hemodynamic stability of the patient. Most clinicians agree that chest drainage is essential for the management of traumatic large pneumothorax. Herein, we present a case of large pneumothorax in blunt chest trauma patient that resolved spontaneously without a chest drain. A 63- year- old man presented to the Emergency Department complaining of left lateral chest pain due to a fall on his chest at home. On examination, he was hemodynamically stable. An urgent chest X-ray showed evidence of left sided pneumothorax. CT scan of the chest showed pneumothorax of more than 30% of the left hemithorax (around 600ml of air) with multiple left ribs fracture. Patient refused tube thoracostomy and was admitted to surgical department for close observation. The patient was managed conservatively without chest tube insertion. A repeat CT scan of the chest has shown complete resolution of the pneumothorax. The clinical spectrum of pneumothorax varies from asymptomatic to life threatening tension pneumothorax. In stable patients, conservative management can be safe and effective for small pneumothorax. To the best of our knowledge, this is the second reported case in the English literature with large pneumothorax which resolved spontaneously without chest drain. Blunt traumatic large pneumothorax in a clinically stable patient can be managed conservatively. Current recommendations for tube placement may need to be reevaluated. This may reduce morbidity associated with chest tube thoracostomy. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  20. MRI of the Chest

    Medline Plus

    Full Text Available ... are the limitations of MRI of the Chest? What is MRI of the Chest? Magnetic resonance imaging ( ... heart, valves, great vessels, etc.). top of page What are some common uses of the procedure? MR ...