Anterior chest wall tuberculous abscess: a case report

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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.

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)

"Anterior convergent" chest probing in rapid ultrasound transducer positioning versus formal chest ultrasonography to detect pneumothorax during the primary survey of hospital trauma patients: a diagnostic accuracy study.

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Ziapour, Behrad; Haji, Houman Seyedjavady

2015-01-01

Occult pneumothorax represents a diagnostic pitfall during the primary survey of trauma patients, particularly if these patients require early positive pressure ventilation. This study investigated the accuracy of our proposed rapid model of ultrasound transducer positioning during the primary survey of trauma patients after their arrival at the hospital. This diagnostic trial was conducted over 12 months and was based on the results of 84 ultrasound (US) exams performed on patients with severe multiple trauma. Our index test (US) was used to detect pneumothorax in four pre-defined locations on the anterior of each hemi-thorax using the "Anterior Convergent" approach, and its performance was limited to the primary survey. Consecutively, patients underwent chest-computed tomography (CT) with or without chest radiography. The diagnostic findings of both chest radiography and chest ultrasounds were compared to the gold-standard test (CT). The diagnostic sensitivity was 78 % for US and 36.4 % for chest radiography (p chest radiography (not significant); the positive predictive values were 74 % for US and 80 % for chest radiography (not significant); the negative predictive values were 94 % for US and 87 % for chest radiography (not significant); the positive likelihood ratio was 10 for US and 18 for chest radiography (p = 0.007); and the negative likelihood ratio was 0.25 for US and 0.65 for chest radiography (p = 0.001). The mean required time for performing the new method was 64 ± 10 s. An absence of the expected diffused dynamic view among ultrasound images obtained from patients with pneumothorax was also observed. We designated this phenomenon "Gestalt Lung Recession." "Anterior convergent" chest US probing represents a brief but efficient model that provides clinicians a safe and accurate exam and adequate resuscitation during critical minutes of the primary survey without interrupting other medical staff activities taking place around the

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

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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.

Single-incision video-assisted thoracoscopic surgery left-lower lobe anterior segmentectomy (S8).

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Galvez, Carlos; Lirio, Francisco; Sesma, Julio; Baschwitz, Benno; Bolufer, Sergio

2017-01-01

Unusual anatomical segmentectomies are technically demanding procedures that require a deep knowledge of intralobar anatomy and surgical skill. In the other hand, these procedures preserve more normal lung parenchyma for lesions located in specific anatomical segments, and are indicated for benign lesions, metastasis and also early stage adenocarcinomas without nodal involvement. A 32-year-old woman was diagnosed of a benign pneumocytoma in the anterior segment of the left-lower lobe (S8, LLL), so we performed a single-incision video-assisted thoracoscopic surgery (SI-VATS) anatomical S8 segmentectomy in 140 minutes under intercostal block. There were no intraoperative neither postoperative complications, the chest tube was removed at 24 hours and the patient discharged at 5 th postoperative day with low pain on the visual analogue scale (VAS). Final pathologic exam reported a benign sclerosant pneumocytoma with free margins. The patient has recovered her normal activities at 3 months completely with radiological normal controls at 1 and 3 months.

MIBI Tc-99m uptake due to breast cancer recurrence as an incidental finding in a patient with atypical chest pain

International Nuclear Information System (INIS)

Saavedra, P.; Cano, R.; Morales, R.; Urquiaga, J.; Negron, S.; Munoz, L.; Aguilar, C.; Mendoza, G.; Lopez, D.; Carlos, I.

2005-01-01

The purpose of this paper is lo report incidental findings of uptake of Tc99m-MIBI in anterior chest in a patient evaluated for a typical chest pain. A retrospective data collection was performed through chart review of the patient, a 67 year-old women, who had atypical chest pain with cardiac risk factors (hypertension, obesity, hypercholesterolemia, diabetes) with history of left total mastectomy (1995) without adjuvant chemotherapy and negative follow-up. Myocardial Perfusion imaging with Tc99m-MIBI was normal and showed uptake in anterior left chest in sagital views, described as suspected recurrent breast cancer. Oncological and cardiological evaluation of the patient was done and detected minimal palpable lesion in the surgery scar. Incisional biopsy of the lump in the surgery scar was positive for Infiltrative Ductal Breast Carcinoma. Tc-99m-MIBI is useful for detection of recurrence of breast carcinoma in surgery scar

Histomorphological features of atherosclerosis in the left anterior ...

African Journals Online (AJOL)

The pattern of coronary artery atherosclerosis is valuable in informing mitigation strategies for coronary heart disease. Histomorphological data on this disease among Africans living in Sub Saharan Africa are, however, scarce. The left anterior descending is one of the most commonly afflicted arteries. This study, therefore ...

Myocardial Bridges and their Relationship to the Anterior Interventricular Branch of the Left Coronary Artery

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Lima Vanildo Júnior de Melo

2002-01-01

Full Text Available OBJECTIVE: To analyze the relationship between myocardial bridges and the anterior interventricular branch (anterior descending of the left coronary artery. METHODS: The study was carried out with postmortem material, and methods of dissection and observation were used. We assessed the perimeter of the anterior interventricular branch of the left coronary artery using a pachymeter, calculated its proximal and distal diameters in relation to the myocardial bridge, and also its diameter under the myocardial bridge in 30 hearts. We also observed the position of the myocardial bridge in relation to the origin of the anterior interventricular branch. RESULTS: The diameters of the anterior interventricular branch were as follows: the mean proximal diameter was 2.76±0.76 mm; the mean diameter under the myocardial bridge was 2.08±0.54 mm; and the mean distal diameter was 1.98±0.59 mm. In 33.33% (10/30 of the cases, the diameter of the anterior interventricular branch under the myocardial bridge was lower than the diameter of the anterior interventricular branch distal to the myocardial bridge. In 3.33% (1/30 of the cases, an atherosclerotic plaque was found in the segment under the myocardial bridge. The myocardial bridge was located in the middle third of the anterior interventricular branch in 86.66% (26/30 of the cases. CONCLUSION: Myocardial bridges are more frequently found in the middle third of the anterior interventricular branch of the left coronary artery. The diameter of the anterior interventricular branch of the left coronary artery under the myocardial bridge may be smaller than after the bridge. Myocardial bridges may not provide protection against the formation of atherosclerotic plaque inside the anterior interventricular branch of the left coronary artery.

Anterior subcarinal node dissection on the left side using video thoracoscopy: an easier technique.

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Baste, Jean-Marc; Haddad, Laura; Melki, Jean; Peillon, Christophe

2015-04-01

Lobectomy for lung carcinoma is usually associated with complete node dissection, but it is often difficult to perform using video thoracoscopy, especially on the left side. In this case, our team uses an anterior technique for subcarinal lymphadenectomy. After left lobectomy, we lift the bronchial stump by its anterior face to open and dissect the subcarinal space. Exposure is difficult using the more usual technique of posterior subcarinal lymphadenectomy, and the different techniques (often requiring retractors) remain complex because some vessels might be injured. We recommend using anterior lymphadenectomy, which should facilitate video thoracoscopy for lymphadenectomy on the left side. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Anterior, posterior, left anterior oblique, and geometric mean views in gastric emptying studies using a glucose solution

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Phillips, W.T. [Dept. of Radiology, Univ. of Texas Health Science Center, San Antonio, TX (United States); McMahan, C.A. [Dept. of Pathology, Univ. of Texas Health Science Center, San Antonio, TX (United States); Lasher, J.C. [Dept. of Radiology, Univ. of Texas Health Science Center, San Antonio, TX (United States); Blumhardt, M.R. [Dept. of Pathology, Univ. of Texas Health Science Center, San Antonio, TX (United States); Schwartz, J.G. [Dept. of Pathology, Univ. of Texas Health Science Center, San Antonio, TX (United States)

1995-02-01

Previous research has shown that the single anterior view of the stomach overestimates the gastric half-emptying time of a solid meal compared to the geometric mean of the anterior and posterior views. Little research has been performed comparing the various views of gastric emptying of a glucose solution. After an overnight fast, 49 nondiabetic subjects were given a 450 ml solution containing 50 g of glucose and 200 {mu}Ci of technetium-99m sulfur colloid. Sequential 1-min anterior, posterior, and left anterior oblique views were obtained every 15 min. The mean percent solution remaining in the stomach for all three views differed from the geometric mean by 1.9% or less at all time points. Average gastric half-emptying times were: geometric mean, 62.7{+-}3.3 min; anterior, 61.9{+-}3.2 min; posterior, 63.5{+-}3.5 min; and left anterior oblique, 61.6{+-}3.3 min. These half-emptying times were not statistically different. For individual patients, differences between all three views and the geometric mean were not clinically important. Approximately 95% of all patients are expected to have gastric half-emptying times measured by any of the three single views within 17 min of the gastric half-emptying time obtained using the geometric mean. The imaging of gastric emptying using glucose solutions can be performed using a convenient single view which allows continuous dynamic imaging. (orig.)

Scuba diving, acute left anterior descending artery occlusion and normal ECG

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Doll, Sébastien Xavier; Rigamonti, Fabio; Roffi, Marco; Noble, Stéphane

2013-01-01

We report the case of an acute proximal occlusion of the left anterior descending coronary (LAD) artery following a scuba diving decompression accident and associated with normal ECG. Following uneventful thromboaspiration and coronary stenting, the patient was discharged on day  4 with secondary preventative therapies. A transthoracic echocardiography performed at this point showed a complete recovery compared with an initial localised akinesia involving the anterior and apical portion of the left ventricle upon admission. This case highlights that significant acute coronary lesions involving the LAD can occur without any ECG anomaly. The presence of acute and persistent angina associated with troponin elevation should prompt physicians to consider coronary angiography without delay, independently of the ECG results. PMID:23376677

Left anterior descending coronary artery dissection during ventricular tachycardia ablation – case report

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Kordic Kresimir

2018-03-01

Full Text Available Fascicular left ventricular tachycardia (VT is the second most frequent idiopathic left VT in the setting of a structurally normal heart. Catheter ablation is curative in most patients with low complication rates. We report a case of ostial left anterior descending coronary artery (LAD occlusion during fascicular ventricular tachycardia ablation.

Fluid Collection in the Right Lateral Portion of the Superior Aortic Recess Mimicking a Right Mediastinal Mass: Assessment with Chest Posterior Anterior and MDCT

International Nuclear Information System (INIS)

Shn, Dong Rock; Ryu, Dae Shick; Park, Man Soo; Jung, Seung Mun; Ahn, Jae Hong; Lee, Jong Hyeog; Choi, Soo Jung

2012-01-01

We observed patients in whom the fluid collection in the right lateral portion of the superior aortic recess on computed tomography (CT) scans mimicked a right anterior mediastinal mass on chest PA radiographs. The purpose of this study was to assess chest PA and CT features of these patients. All chest PA radiographs and CT scans in 9 patients were reviewed by two radiologists on a consensus basis; for the presence of pleural effusion, pulmonary edema and heart size on chest PA radiographs. For the portion of the fluid collection in the superior aortic recess (SAR), a connection between the right lateral portion of the SAR (rSAR) and posterior portion of the SAR (pSAR) on CT scans, and the distance between the right lateral margin of the rSAR and the right lateral margin of the superior vena cava. Fluid collection in the rSAR on CT scans caused a right anterior mediastinal mass or a bulging contour on chest PA radiographs in all women patients. All patients showed cardiomegaly, five patients had pleural effusion, and two patients had mild pulmonary edema. Further, eight patients showed a connection between the rSAR and the pSAR. The characteristic features of these patients are the right anterior mediastinal mass-like opacity due to fluid collection in the rSAR, are bulging contour with a smooth margin and cardiomegaly regardless of pulmonary edema on the chest PA radiographs, and fluid connection between the rSAR and the pSAR on CT scans

Fluid Collection in the Right Lateral Portion of the Superior Aortic Recess Mimicking a Right Mediastinal Mass: Assessment with Chest Posterior Anterior and MDCT

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Shn, Dong Rock; Ryu, Dae Shick; Park, Man Soo; Jung, Seung Mun; Ahn, Jae Hong; Lee, Jong Hyeog; Choi, Soo Jung [Dept. of Radiology, Gangneung Asan Hospital, College of Medicine, University of Ulsan, Gangneung (Korea, Republic of)

2012-09-15

We observed patients in whom the fluid collection in the right lateral portion of the superior aortic recess on computed tomography (CT) scans mimicked a right anterior mediastinal mass on chest PA radiographs. The purpose of this study was to assess chest PA and CT features of these patients. All chest PA radiographs and CT scans in 9 patients were reviewed by two radiologists on a consensus basis; for the presence of pleural effusion, pulmonary edema and heart size on chest PA radiographs. For the portion of the fluid collection in the superior aortic recess (SAR), a connection between the right lateral portion of the SAR (rSAR) and posterior portion of the SAR (pSAR) on CT scans, and the distance between the right lateral margin of the rSAR and the right lateral margin of the superior vena cava. Fluid collection in the rSAR on CT scans caused a right anterior mediastinal mass or a bulging contour on chest PA radiographs in all women patients. All patients showed cardiomegaly, five patients had pleural effusion, and two patients had mild pulmonary edema. Further, eight patients showed a connection between the rSAR and the pSAR. The characteristic features of these patients are the right anterior mediastinal mass-like opacity due to fluid collection in the rSAR, are bulging contour with a smooth margin and cardiomegaly regardless of pulmonary edema on the chest PA radiographs, and fluid connection between the rSAR and the pSAR on CT scans.

Assessment of Intrafraction Breathing Motion on Left Anterior Descending Artery Dose During Left-Sided Breast Radiation Therapy

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El-Sherif, Omar, E-mail: Omar.ElSherif@lhsc.on.ca [Department of Medical Biophysics, University of Western Ontario, London, Ontario (Canada); Department of Physics, London Regional Cancer Program, London, Ontario (Canada); Yu, Edward [Department of Radiation Oncology, London Regional Cancer Program, London, Ontario (Canada); Xhaferllari, Ilma [Department of Medical Biophysics, University of Western Ontario, London, Ontario (Canada); Department of Physics, London Regional Cancer Program, London, Ontario (Canada); Gaede, Stewart [Department of Medical Biophysics, University of Western Ontario, London, Ontario (Canada); Department of Physics, London Regional Cancer Program, London, Ontario (Canada); Department of Radiation Oncology, London Regional Cancer Program, London, Ontario (Canada)

2016-07-01

Purpose: To use 4-dimensional computed tomography (4D-CT) imaging to predict the level of uncertainty in cardiac dose estimates of the left anterior descending artery that arises due to breathing motion during radiation therapy for left-sided breast cancer. Methods and Materials: The fast helical CT (FH-CT) and 4D-CT of 30 left-sided breast cancer patients were retrospectively analyzed. Treatment plans were created on the FH-CT. The original treatment plan was then superimposed onto all 10 phases of the 4D-CT to quantify the dosimetric impact of respiratory motion through 4D dose accumulation (4D-dose). Dose-volume histograms for the heart, left ventricle (LV), and left anterior descending (LAD) artery obtained from the FH-CT were compared with those obtained from the 4D-dose. Results: The 95% confidence interval of 4D-dose and FH-CT differences in mean dose estimates for the heart, LV, and LAD were ±0.5 Gy, ±1.0 Gy, and ±8.7 Gy, respectively. Conclusion: Fast helical CT is a good approximation for doses to the heart and LV; however, dose estimates for the LAD are susceptible to uncertainties that arise due to intrafraction breathing motion that cannot be ascertained without the additional information obtained from 4D-CT and dose accumulation. For future clinical studies, we suggest the use of 4D-CT–derived dose-volume histograms for estimating the dose to the LAD.

Plain chest PA evaluation of left atrial thrombosis in mitral valvular disease

International Nuclear Information System (INIS)

Choo, Yeon Myung; Park, Jae Hyung; Han, Man Chung

1984-01-01

Conventional posteroanterior chest radiographs of 73 patients with mitral valve disease who had had surgery were analyzed, and particular attention was directed to the absence of the convexity of the left lower mid cardiac border (left atrial segment) and to the relation with duration of illness, atrial fibrillation, pulmonary capillary wedge pressure (PCWP) as well as surgical findings. The results obtained are as follows: 1. The flatness or concavity of this segment, despite other evidence of left atrial enlargement, was observed in eleven (64.7%) of 17 patients who had left atrial thrombosis and in six (10.7%) of 56 patients who did not have thrombosis (false positive diagnosis). Six (35.5%) of the 17 patients who had left atrial thrombosis did not this findings on radiographs (false positive diagnosis). Six (35.3%) of the 17 patients who had left atrial thrombosis did not show this finding on radiographs (false positive diagnosis). Therefore, the accuracy in the diagnosis of thrombosis of left atrium wa 64.7% (eleven of seventeen) for patients who had thrombosis of left atrium. 2. The atrial fibrillation was observed in sixteen (94.1%)of 17 patients who had left atrial thrombosis. So, correlation between the presence of left atrial thrombosis and atrial fibrillation wa evident. But there was no correlation between the duration of illness of the PCWP of patients and the presence of left atrial thrombosis.

Plain chest PA evaluation of left atrial thrombosis in mitral valvular disease

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Choo, Yeon Myung; Park, Jae Hyung; Han, Man Chung [Seoul National University College of Medicine, Seoul (Korea, Republic of)

1984-09-15

Conventional posteroanterior chest radiographs of 73 patients with mitral valve disease who had had surgery were analyzed, and particular attention was directed to the absence of the convexity of the left lower mid cardiac border (left atrial segment) and to the relation with duration of illness, atrial fibrillation, pulmonary capillary wedge pressure (PCWP) as well as surgical findings. The results obtained are as follows: 1. The flatness or concavity of this segment, despite other evidence of left atrial enlargement, was observed in eleven (64.7%) of 17 patients who had left atrial thrombosis and in six (10.7%) of 56 patients who did not have thrombosis (false positive diagnosis). Six (35.5%) of the 17 patients who had left atrial thrombosis did not this findings on radiographs (false positive diagnosis). Six (35.3%) of the 17 patients who had left atrial thrombosis did not show this finding on radiographs (false positive diagnosis). Therefore, the accuracy in the diagnosis of thrombosis of left atrium wa 64.7% (eleven of seventeen) for patients who had thrombosis of left atrium. 2. The atrial fibrillation was observed in sixteen (94.1%)of 17 patients who had left atrial thrombosis. So, correlation between the presence of left atrial thrombosis and atrial fibrillation wa evident. But there was no correlation between the duration of illness of the PCWP of patients and the presence of left atrial thrombosis.

On the Early Left-Anterior Negativity (ELAN) in Syntax Studies

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Steinhauer, Karsten; Drury, John E.

2012-01-01

Within the framework of Friederici's (2002) neurocognitive model of sentence processing, the early left anterior negativity (ELAN) in event-related potentials (ERPs) has been claimed to be a brain marker of syntactic first-pass parsing. As ELAN components seem to be exclusively elicited by word category violations (phrase structure violations),…

Left-Right Asymmetry in Spectral Characteristics of Lung Sounds Detected Using a Dual-Channel Auscultation System in Healthy Young Adults.

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Tsai, Jang-Zern; Chang, Ming-Lang; Yang, Jiun-Yue; Kuo, Dar; Lin, Ching-Hsiung; Kuo, Cheng-Deng

2017-06-07

Though lung sounds auscultation is important for the diagnosis and monitoring of lung diseases, the spectral characteristics of lung sounds have not been fully understood. This study compared the spectral characteristics of lung sounds between the right and left lungs and between healthy male and female subjects using a dual-channel auscultation system. Forty-two subjects aged 18-22 years without smoking habits and any known pulmonary diseases participated in this study. The lung sounds were recorded from seven pairs of auscultation sites on the chest wall simultaneously. We found that in four out of seven auscultation pairs, the lung sounds from the left lung had a higher total power (P T ) than those from the right lung. The P T of male subjects was higher than that of female ones in most auscultation pairs. The ratio of inspiration power to expiration power (R I/E ) of lung sounds from the right lung was greater than that from the left lung at auscultation pairs on the anterior chest wall, while this phenomenon was reversed at auscultation pairs on the posterior chest wall in combined subjects, and similarly in both male and female subjects. Though the frequency corresponding to maximum power density of lung sounds (F MPD ) from the left and right lungs was not significantly different, the frequency that equally divided the power spectrum of lung sounds (F 50 ) from the left lung was significantly smaller than that from the right lung at auscultation site on the anterior and lateral chest walls, while it was significantly larger than that of from the right lung at auscultation site on the posterior chest walls. In conclusion, significant differences in the P T , F MPD , F 50 , and R I/E between the left and right lungs at some auscultation pairs were observed by using a dual-channel auscultation system in this study. Structural differences between the left and the right lungs, between the female and male subjects, and between anterior and posterior lungs might

ranching pattern of the left anterior descending coronary artery in a ...

African Journals Online (AJOL)

Branching pattern of the left anterior descending coronary artery is important in explaining variations in occurrence of coronary atherosclerosis, informing management strategies for coronary heart disease and interventional cardiology. Data on African populations are, however, scarce. Since coronary heart disease is ...

Successful catheter ablation of a left anterior accessory pathway from the non-coronary cusp of the aortic valve.

Science.gov (United States)

Laranjo, Sérgio; Oliveira, Mário; Trigo, Conceição

2015-08-01

Left anterior accessory pathways are considered to be rare findings. Catheter ablation of accessory pathways in this location remains a challenging target, and few reports about successful ablation of these accessory pathways are available. We describe our experience regarding a case of a manifest left anterior accessory pathway ablation using radiofrequency energy at the junction of the left coronary cusp with the non-coronary cusp.

Improved detection of anterior left ventricular aneurysm with multiharmonic fourier analysis

International Nuclear Information System (INIS)

Valette, H.B.; Bourguignon, M.H.; Merlet, P.; Gregoire, M.C.; Le Guludec, D.; Pascal, O.; Briandet, P.; Syrota, A.

1990-01-01

Single and multiharmonic Fourier analysis of LAO 30-45 degrees gated blood-pool studies were performed in a selected group of 30 patients with a left ventricular anterior aneurysm proven by contrast angiography. The sensitivity of the first harmonic phase image for the diagnosis of ventricular aneurysm was 80%. The clear phase shift (greater than 110 degrees) between the normal and the aneurysmal areas was missing in six patients. Peak acceleration images (negative maximum of the second derivative of the Fourier series) were calculated for each pixel with the analytical Fourier formula using two or three harmonics. A clear phase shift (greater than 126 degrees) than appeared in all the patients. This improvement was related to the increased weight of the second and third harmonics in the aneurysmal area when compared to control patients or to patients with dilative cardiomyopathy. Multiharmonic Fourier analysis clearly improved the sensitivity of the diagnosis of anterior left ventricular aneurysm on LAO 30 degrees-45 degrees gated blood-pool images

A case report of displaced anterior junction line mimicking pneumothorax and pneumomediastinum

International Nuclear Information System (INIS)

Jeon, Yang Hyun; Sung, Dong Wook; Hong, Hyun Pyo; Yoon, Yup; Lee, Eil Seong

1998-01-01

On PA chest radiography, the anterior junction line (AJL) is seen to project from the upper right to the lower left of the upper third of the body of the sternum and represents the visceral and parietal pleura of each lung and a small quantity of mediastinal fat. In a patient with volume loss or expansion of a hemithorax, the AJL shows considerable shift and on PA chest radiography may mimic pneumothroax, the AJL shows considerable shift and on PA chest radiography may mimic pneumothorax or pneumomediastimum. In such cases, widening and hyperlucency of the retrosternal space, seen on lateral view, which represents herniated lung with a shift of AJL, may be helpful for differentiation from pneumothorax or pneumomediastinum. (author). 8 refs., 2 figs

Exercise left ventricular performance in patients with chest pain, ischemic-appearing exercise electrocardiograms, and angiographically normal coronary arteries

International Nuclear Information System (INIS)

Berger, H.J.; Sands, M.J.; Davies, R.A.; Wackers, F.J.; Alexander, J.; Lachman, A.S.; Williams, B.W.; Zaret, B.L.

1981-01-01

Left ventricular performance was evaluated using first-pass radionuclide angiocardiography in 31 patients with chest pain, an ischemic-appearing exercise electrocardiogram, and angiographically normal coronary arteries at rest and during maximal upright bicycle exercise. 201 Tl imaging was done in all patients after treadmill exercise and in selected patients after ergonovine provocation. Resting left ventricular performance was normal in all patients. An abnormal ejection fraction response to exercise was detected in 12 of 31 patients. Regional dysfunction was present during exercise in four patients, all of whom also had abnormal global responses. Three of these 12 patients and two additional patients had exercise-induced 201 Tl perfusion defects. In all nine patients who underwent ergonovine testing, there was no suggestion of coronary arterial spasm. Thus, left ventricular dysfunction during exercise, in the presence of normal resting performance, was found in a substantial number of patients with chest pain, an ischemic-appearing exercise electrocardiogram, and normal coronary arteries

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

Congenital Absence of Left Circumflex Coronary Artery

Directory of Open Access Journals (Sweden)

Zahra Ansari

2009-09-01

Full Text Available Congenital absence of left circumflex artery is a rare congenitalanomaly of the coronary arteries. The prevalence of theanomaly in different studies ranges from 0.6% to 1.3%. Ofthese, 80% are benign and asymptomatic and 20% are clinicallyimportant. We report a 56-year-old man presented withacute resting chest pain who was diagnosed as having acuteanterolateral infarction accompanied by electrocardiographicchanges and elevated cardiac enzymes. Coronary angiographyin different views was conducted, however, no left circumflexartery was found. The territory supplied by the artery had beenperfused by the super dominant right coronary artery. Therewas no left circumflex coronary artery with anomalous origin.Sever stenosis of left anterior ascending artery superimposedto the absent left circumflex artery was presented as acute anterolateralinfarction. Although absence of the artery is mostlyconsidered as a benign condition, atherosclerotic lesions maybe more important in such cases because of diminished compensatingmechanisms.

The findings of Tc-99m ECD brain perfusion SPECT in the patients with left anterior thalamic infarction

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Jeong, Y. A.; Kim, S. H.; Sohn, H. S.; Jeong, S. G. [The Catholic University of Korea, Seoul (Korea, Republic of)

2005-07-01

The thalamus has multiple connections with areas of the cerebral cortex involved in arousal and cognition. Thalamic damage has been reported to be associated with variable neuropsychological dysfunctions and dementia. This study evaluates the changes of regional cerebral blood flow (rCBF) by using SPM analysis of brain perfusion SPECT and examining the neuropsychological abnormalities of 4 patients with anterior thalamic infarctions. Four patients with left anterior thalamic infarctions and eleven normal controls were evaluated. K-MMSE and the Seoul Neuropsychological Screening Battery were performed within 2 days after stroke. The normalized SPECT data of 4 patients were compared to those of 11 controls for the detection of areas with decreased rCBF by SPM analysis. All 4 patients showed anterograde amnesia in their verbal memory, which was not improved by recognition. Dysexecutive features were occasionally present, such as decreased word fluency and impaired Stroop test results. SPM analysis revealed decreased rCBF in the left supra marginal gyrus, the superior temporal gyrus, the middle and inferior frontal gyrus, the medial dorsal and anterior nucleus of the left thalamus. The changes of rCBF in patients with left anterior thalamic infarctions may be due to the remote suppression on metabolism by the interruption of the cortico-subcortical circuit, which connects the anterior thalamic nucleus and various cortical areas. The executive dysfunction and dysnomia may be caused by the left dorsolateral frontal dysfunction of the thalamo-cortical circuit. Anterograde amnesia with storage deficit may be caused by the disruption of mamillothalamic tract.

The findings of Tc-99m ECD brain perfusion SPECT in the patients with left anterior thalamic infarction

International Nuclear Information System (INIS)

Jeong, Y. A.; Kim, S. H.; Sohn, H. S.; Jeong, S. G.

2005-01-01

The thalamus has multiple connections with areas of the cerebral cortex involved in arousal and cognition. Thalamic damage has been reported to be associated with variable neuropsychological dysfunctions and dementia. This study evaluates the changes of regional cerebral blood flow (rCBF) by using SPM analysis of brain perfusion SPECT and examining the neuropsychological abnormalities of 4 patients with anterior thalamic infarctions. Four patients with left anterior thalamic infarctions and eleven normal controls were evaluated. K-MMSE and the Seoul Neuropsychological Screening Battery were performed within 2 days after stroke. The normalized SPECT data of 4 patients were compared to those of 11 controls for the detection of areas with decreased rCBF by SPM analysis. All 4 patients showed anterograde amnesia in their verbal memory, which was not improved by recognition. Dysexecutive features were occasionally present, such as decreased word fluency and impaired Stroop test results. SPM analysis revealed decreased rCBF in the left supra marginal gyrus, the superior temporal gyrus, the middle and inferior frontal gyrus, the medial dorsal and anterior nucleus of the left thalamus. The changes of rCBF in patients with left anterior thalamic infarctions may be due to the remote suppression on metabolism by the interruption of the cortico-subcortical circuit, which connects the anterior thalamic nucleus and various cortical areas. The executive dysfunction and dysnomia may be caused by the left dorsolateral frontal dysfunction of the thalamo-cortical circuit. Anterograde amnesia with storage deficit may be caused by the disruption of mamillothalamic tract

Rupture of the right upper pulmonary vein and left atrium caused by blunt chest trauma.

Science.gov (United States)

Osaka, Motoo; Nagai, Ryo; Koishizawa, Tadashi

2017-11-01

A 49-year-old man was transferred to our hospital by ambulance due to blunt chest trauma sustained in a car accident. Echocardiography and enhanced computed tomography showed hemopericardium without other vital organ damage. Emergent surgery was performed under strong suspicion of traumatic cardiac rupture. Careful inspection showed a rupture of the right upper pulmonary vein at the junction of the left atrium, a laceration of the inferior vena cava, and a left-side pericardium rupture, and they were repaired with running 4-0 polypropylene suture. Postoperative hemodynamics were stable. The patient was discharged ambulatory on postoperative day 15.

Large pneumothorax in blunt chest trauma: Is a chest drain always necessary in stable patients? A case report.

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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.

Coronary artery visibility in free-breathing young children on non-gated chest CT: impact of temporal resolution

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Bridoux, Alexandre; Hutt, Antoine; Faivre, Jean-Baptiste; Pagniez, Julien; Remy, Jacques; Remy-Jardin, Martine [CHRU et Universite de Lille, Department of Thoracic Imaging, Hospital Calmette (EA 2694), 59037 Lille Cedex (France); Flohr, Thomas [Siemens Healthcare, Department of Research and Development in CT, Forchheim (Germany); Duhamel, Alain [Universite de Lille, Department of Biostatistics, Lille (France)

2015-11-15

Dual-source CT allows scanning of the chest with high pitch and high temporal resolution, which can improve the detection of proximal coronary arteries in infants and young children when scanned without general anesthesia, sedation or beta-blockade. To compare coronary artery visibility between higher and standard temporal resolution. We analyzed CT images in 93 children who underwent a standard chest CT angiographic examination with reconstruction of images with a temporal resolution of 75 ms (group 1) and 140 ms (group 2). The percentage of detected coronary segments was higher in group 1 than in group 2 when considering all segments (group 1: 27%; group 2: 24%; P = 0.0004) and proximal segments (group 1: 37%; group 2: 32%; P = 0.0006). In both groups, the highest rates of detection were observed for the left main coronary artery (S1) (group 1: 65%; group 2: 58%) and proximal left anterior descending coronary artery (S2) (group 1: 43%; group 2: 42%). Higher rates of detection were seen in group 1 for the left main coronary artery (P = 0.03), proximal right coronary artery (P = 0.01), proximal segments of the left coronary artery (P = 0.02) and proximal segments of the left and right coronary arteries (P = 0.0006). Higher temporal resolution improved the visibility of proximal coronary arteries in pediatric chest CT. (orig.)

Evaluation of the image quality of chest CT scans: a phantom study

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Martins N, P. I.; Prata M, A., E-mail: priscillainglid@gmail.com [Centro Federal de Educacao Tecnologica de Minas Gerais, Centro de Engenharia Biomedica, Av. Amazonas 5253, 30421-169 Nova Suica, Belo Horizonte, Minas Gerais (Brazil)

2016-10-15

Computed tomography (CT) is considered one of the most important methods of medical imaging employed nowadays, due to its non-invasiveness and the high quality of the images it is able to generate. However, the diagnostic radiation dose received by an individual over the year often exceeds the dose received on account of background radiation. Therefore, it is important to know and to control the dose distribution in the patient by varying the image acquisition parameters. The aim of this study is to evaluate the variation of the image quality of chest CT scans performed by two phantoms. In this paper, a cylindrical Polymethyl Methacrylate (PMMA) chest phantom was used and a second PMMA phantom has been developed with the same volume but an oblong shape, based on the actual dimensions of a male human thorax, in the axillary region. Ten-centimeter scans of the central area of each phantom were performed by a 16-channel Toshiba CT scanner, model Alexion. The scanning protocol employed was the radiology service protocol for chest scans. The noise survey was conducted within the image of the center slice, in five regions: one central and four peripheral areas close to the edge of the object (anterior, posterior, left and right). The recorded values showed that the oblong phantom, with a shape that is more similar to the actual human chest, has a considerably smaller noise, especially in the anterior, posterior and central regions. (Author)

Evaluation of the image quality of chest CT scans: a phantom study

International Nuclear Information System (INIS)

Martins N, P. I.; Prata M, A.

2016-10-01

Computed tomography (CT) is considered one of the most important methods of medical imaging employed nowadays, due to its non-invasiveness and the high quality of the images it is able to generate. However, the diagnostic radiation dose received by an individual over the year often exceeds the dose received on account of background radiation. Therefore, it is important to know and to control the dose distribution in the patient by varying the image acquisition parameters. The aim of this study is to evaluate the variation of the image quality of chest CT scans performed by two phantoms. In this paper, a cylindrical Polymethyl Methacrylate (PMMA) chest phantom was used and a second PMMA phantom has been developed with the same volume but an oblong shape, based on the actual dimensions of a male human thorax, in the axillary region. Ten-centimeter scans of the central area of each phantom were performed by a 16-channel Toshiba CT scanner, model Alexion. The scanning protocol employed was the radiology service protocol for chest scans. The noise survey was conducted within the image of the center slice, in five regions: one central and four peripheral areas close to the edge of the object (anterior, posterior, left and right). The recorded values showed that the oblong phantom, with a shape that is more similar to the actual human chest, has a considerably smaller noise, especially in the anterior, posterior and central regions. (Author)

Comparison of gated radionuclide scans and chest radiographs. Assessment of left ventricular impairment in patients with coronary disease.

Science.gov (United States)

Bianco, J A; Reinke, D B; Makey, D G; Shafer, R B

1980-03-01

Diagnostic efficacy of gated cardiac blood pool imaging was studied in 41 consecutive patients with LV ejection fractions (LVEF) less than or equal to 0.50. Eighty percent of patients were receiving therapy for LV failure at the time of the study. All patients had documented coronary-artery disease (CAD). Chest x-ray films were interpreted blindly by a senior radiologist. Cardiothoracic ratio of less than or equal to 0.50 was recorded as normal. Radionuclide assessment of LV function contributes importantly to the diagnostic and screening value of chest x-ray films. Patients with coronary disease and clinical evidence of heart failure should have radioisotopic studies even if chest x-ray film findings are normal. In patients with coronary artery disease and enlarged LV on chest films, radionuclide study of left ventricular performance aids in defining LV impairment, and in the prognostication of subsequent clinical course.

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)

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

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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).

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.

The clinical research of off-pump coronary artery bypass grafting by small incision at the left chest.

Science.gov (United States)

Xiao, L-B; Zhang, Y-H; Zhou, J-W; Yang, M; Ling, Y-P; Gao, Z-S; Wang, Y-S

2016-01-01

To explore the clinical value of off-pump coronary artery bypass grafting by small incision at the left chest, and develop a better surgical regimen for coronary heart disease patients. 201 coronary heart disease patients who need coronary artery bypass grafting were required and randomly divided into 2 groups including a control group and an observation group. There were 107 cases in the control group who received coronary bypass grafting by extracorporeal circulation; there were 103 cases in the observation group who received off-pump coronary bypass grafting by small incision at the left chest. The duration of the mechanism ventilation, length of stay in ICU, hospitalization time, postoperative drainage volume, and the occurrence rate of complications were recorded and compared. The duration of mechanism ventilation, length of stay in ICU, hospitalization time and postoperative drainage volume in the control group were (19.21 ± 1.33) hours, (5.08 ± 0.57) days, (21.20 ± 2.34) days and (997.68 ± 96.35) mL, which were (7.73 ± 0.74) hours, (2.83 ± 0.16) days, (15.67 ± 1.18) days and (901.53 ± 89.32) mL in the observation group respectively, with statistical difference between the two groups (pdisease, pulmonary infection, perioperative cardiac infarction and mortality did not display a significant difference between the two groups (p > 0.05). Off-pump coronary artery bypass grafting by small incision at the left chest is a surgical method with less injury and fast recovery, which can be used as the preferred therapeutical method for the coronary heart disease patients who need coronary artery bypass grafting.

Frequency of left ventricular thrombus after anterior wall st-segment elevation acute myocardial infarction

International Nuclear Information System (INIS)

Iqbal, M.W.; Fayyaz, A.

2014-01-01

Left ventricular thrombus (LVT) formation is a well known complication seen in patients presenting with acute anterior wall ST-segment elevation myocardial infarction (STEMI). In previous studies the incidence of this complication, after acute myocardial infarction (AMI) has been reported to be 4% to 60% in large anterior wall STEMI, depending significantly upon the method as well as time of reperfusion therapy after STEMI. Objective: The objective of this descriptive case series study was to evaluate the frequency of left ventricular thrombus formation in patients after acute anterior wall ST-Segment elevation myocardial infarction. Methodology: In this study, 100 patients with anterior wall STEMI presenting to cardiac emergency or coronary care unit (CCU) of Cardiac complex, Gulab Devi Hospital, were selected on non-probability, purposive sampling meeting inclusion criteria, after taking written informed consent. All the patients were treated initially for management of acute STEMI, including use of thrombolytics where indicated. 2-D Transthoracic echocardiography (TTE) was performed during the same admission to assess presence of LV thrombus (LVT). Results: The mean age of the patients was 54.3 +- 11.4 years. There were 84(84%) male patients and 16 (16%) female patients. LVT was present in 28 (28%) patients on TTE. Among those, there were 23 (82.1%) male and 5 (17.9%) female patients. However, out of 84 male patients 27.4% develop LVT and among 16 female patients this ratio was 31.3%. The LV thrombus was independent of age and gender. LV thrombus was significantly less in thrombolytic group as compared to those who were not given this therapy, i.e. p value <0.05. Conclusion: Patients with anterior wall acute STEMI not infrequently develop the complication of development of LV thrombus. In this study the frequency of LV thrombus formation after anterior wall acute STEMI was 28%. (author)

The experience of gasless endoscopic-assisted thyroidectomy via the anterior chest approach for Graves' disease.

Science.gov (United States)

Hong, Yun; Yu, Shi-Tong; Cai, Qian; Liang, Fa-Ya; Han, Ping; Huang, Xiao-Ming

2016-10-01

The aim of this study was to evaluate the safety, feasibility, effectiveness, and cosmesis of a gasless endoscopic-assisted thyroidectomy via the anterior chest in patients with Graves' disease. We retrospectively reviewed 38 patients with Graves' disease treated with thyroidectomy from November 2007 to June 2015. We analyzed clinical characteristics of patients, type of operation, operative indications, operative duration, length of postoperative hospital stay, and postoperative complications. The thyroidectomies were classified as total thyroidectomy (n = 12) or near-total thyroidectomy with a remnant of Graves' disease is a safe, feasible, and effective and provides an excellent cosmetic outcome procedure. It is a valid option in appropriately selected patients.

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)

Transesophageal Echocardiography-Guided Epicardial Left Ventricular Lead Placement by Video-Assisted Thoracoscopic Surgery in Nonresponders to Biventricular Pacing and Previous Chest Surgery.

Science.gov (United States)

Schroeder, Carsten; Chung, Jane M; Mackall, Judith A; Cakulev, Ivan T; Patel, Aaron; Patel, Sunny J; Hoit, Brian D; Sahadevan, Jayakumar

2018-06-14

The aim of the study was to study the feasibility, safety, and efficacy of transesophageal echocardiography-guided intraoperative left ventricular lead placement via a video-assisted thoracoscopic surgery approach in patients with failed conventional biventricular pacing. Twelve patients who could not have the left ventricular lead placed conventionally underwent epicardial left ventricular lead placement by video-assisted thoracoscopic surgery. Eight patients had previous chest surgery (66%). Operative positioning was a modified far lateral supine exposure with 30-degree bed tilt, allowing for groin and sternal access. To determine the optimal left ventricular location for lead placement, the left ventricular surface was divided arbitrarily into nine segments. These segments were transpericardially paced using a hand-held malleable pacing probe identifying the optimal site verified by transesophageal echocardiography. The pacing leads were screwed into position via a limited pericardiotomy. The video-assisted thoracoscopic surgery approach was successful in all patients. Biventricular pacing was achieved in all patients and all reported symptomatic benefit with reduction in New York Heart Association class from III to I-II (P = 0.016). Baseline ejection fraction was 23 ± 3%; within 1-year follow-up, the ejection fraction increased to 32 ± 10% (P = 0.05). The mean follow-up was 566 days. The median length of hospital stay was 7 days with chest tube removal between postoperative days 2 and 5. In patients who are nonresponders to conventional biventricular pacing, intraoperative left ventricular lead placement using anatomical and functional characteristics via a video-assisted thoracoscopic surgery approach is effective in improving heart failure symptoms. This optimized left ventricular lead placement is feasible and safe. Previous chest surgery is no longer an exclusion criterion for a video-assisted thoracoscopic surgery approach.

Quantitative right and left ventricular functional analysis during gated whole-chest MDCT: A feasibility study comparing automatic segmentation to semi-manual contouring

International Nuclear Information System (INIS)

Coche, Emmanuel; Walker, Matthew J.; Zech, Francis; Crombrugghe, Rodolphe de; Vlassenbroek, Alain

2010-01-01

Purpose: To evaluate the feasibility of an automatic, whole-heart segmentation algorithm for measuring global heart function from gated, whole-chest MDCT images. Material and methods: 15 patients with suspicion of PE underwent whole-chest contrast-enhanced MDCT with retrospective ECG synchronization. Two observers computed right and left ventricular functional indices using a semi-manual and an automatic whole-heart segmentation algorithm. The two techniques were compared using Bland-Altman analysis and paired Student's t-test. Measurement reproducibility was calculated using intraclass correlation coefficient. Results: Ventricular analysis with automatic segmentation was successful in 13/15 (86%) and in 15/15 (100%) patients for the right ventricle and left ventricle, respectively. Reproducibility of measurements for both ventricles was perfect (ICC: 1.00) and very good for automatic and semi-manual measurements, respectively. Ventricular volumes and functional indices except right ventricular ejection fraction obtained from the automatic method were significantly higher for the RV compared to the semi-manual methods. Conclusions: The automatic, whole-heart segmentation algorithm enabled highly reproducible global heart function to be rapidly obtained in patients undergoing gated whole-chest MDCT for assessment of acute chest pain with suspicion of pulmonary embolism.

 Effect of Thrombolytic Therapy on the Incidence of Early Left Ventricular Infarct Expansion in Acute Anterior Myocardial Infarction

Directory of Open Access Journals (Sweden)

Namir Ghanim Al-Tawil

2011-11-01

Full Text Available  Objectives: To determine the incidence of early left ventricular infarct expansion within five days after first anterior ST-segment elevation myocardial infarction and the effect of early thrombolytic therapy on the incidence of early infarct expansion compared with late thrombolytic therapy.Methods: In a prospective study of 101 patients (75males and 26 females, with the first attack of acute anterior myocardial infarction, their ages ranged from 40-80 years (mean age: 61.07±10.78 who had been admitted to the Coronary Care Unit of Hawler Teaching Hospital for the period from July 2007 through to September 2009. Those who received alteplase ≤3 hours of acute myocardial infarction were labelled as group-I (49 patients and those who received alteplase >3-12 hours were labelled as group-II (52 patients.Results: The incidence of early left ventricular infarct expansion was diagnosed by 2D-echocardiography and was found to be 17.8�20Group I patients had a lower incidence of early left ventricular infarct expansion (8.16�20compared with group-II (26.92�20 p=0.014. Patients with early left ventricular infarct expansion had a higher frequency rate of left ventricular systolic dysfunction (94.44�20compared to patients without early left ventricular infarct expansion (8.43�20p<0.001. There was a significant difference in the incidence of in-hospital mortality between the patients who developed early left ventricular infarct expansion (11.1�20compared with patients without early left ventricular infarct expansion (1.2�20p=0.025.Conclusion: Early reperfusion therapy in acute anterior myocardial infarction can decrease the incidence of early left ventricular infarct expansion, preserve left ventricular systolic function and decrease in-hospital mortality.

Prognostic value of CT-derived left atrial and left ventricular measures in patients with acute chest pain

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Takx, Richard A.P. [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Department of Radiology, University Medical Center Utrecht (Netherlands); Vliegenthart, Rozemarijn [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); University of Groningen/University Medical Center Groningen, Center for Medical Imaging − North East Netherlands, Department of Radiology, Groningen (Netherlands); Schoepf, U. Joseph, E-mail: schoepf@musc.edu [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (United States); Nance, John W. [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Bamberg, Fabian [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Department of Diagnostic and Interventional Radiology, Eberhard-Karls University Tuebingen, Tuebingen (Germany); Abro, Joseph A. [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Carr, Christine M. [Division of Emergency Medicine, Department of Medicine, Medical University of South Carolina, Charleston, SC (United States); Litwin, Sheldon E. [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (United States); and others

2017-01-15

Highlights: • LV mass and LA diameter are independent prognostic factor for composite MACE. • LV mass and LA diameter were not significant prognostic factors for MACE in African Americans. • Assessment of LV mass by CT may have a role in the management of patients. - Abstract: Purpose: To determine which left atrial (LA) and left ventricular (LV) parameters are associated with future major adverse cardiac event (MACE) and whether these measurements have independent prognostic value beyond risk factors and computed tomography (CT)-derived coronary artery disease measures. Materials and methods: This retrospective analysis was performed under an IRB waiver and in HIPAA compliance. Subjects underwent coronary CT angiography (CCTA) using a dual-source CT system for acute chest pain evaluation. LV mass, LV ejection fraction (EF), LV end-systolic volume (ESV) and LV end-diastolic volume (EDV), LA ESV and LA diameter, septal wall thickness and cardiac chamber diameters were measured. MACE was defined as cardiac death, non-fatal myocardial infarction, unstable angina, or late revascularization. The association between cardiac CT measures and the occurrence of MACE was quantified using Cox proportional hazard analysis. Results: 225 subjects (age, 56.2 ± 11.2; 140 males) were analyzed, of whom 42 (18.7%) experienced a MACE during a median follow-up of 13 months. LA diameter (HR:1.07, 95%CI:1.01–1.13 per mm) and LV mass (HR:1.05, 95%CI:1.00–1.10 per g) remained significant prognostic factor of MACE after controlling for Framingham risk score. LA diameter and LV mass were also found to have prognostic value independent of each other. The other morphologic and functional cardiac measures were no significant prognostic factors for MACE. Conclusion: CT-derived LA diameter and LV mass are associated with future MACE in patients undergoing evaluation for chest pain, and portend independent prognostic value beyond traditional risk factors, coronary calcium score, and

Early detection of myocardial infarction following blunt chest trauma by computed tomography: a case report.

Science.gov (United States)

Lee, Thung-Lip; Hsuan, Chin-Feng; Shih, Chen-Hsiang; Liang, Huai-Wen; Tsai, Hsing-Shan; Tseng, Wei-Kung; Hsu, Kwan-Lih

2017-02-10

Blunt cardiac trauma encompasses a wide range of clinical entities, including myocardial contusion, cardiac rupture, valve avulsion, pericardial injuries, arrhythmia, and even myocardial infarction. Acute myocardial infarction due to coronary artery dissection after blunt chest trauma is rare and may be life threatening. Differential diagnosis of acute myocardial infarction from cardiac contusion at this setting is not easy. Here we demonstrated a case of blunt chest trauma, with computed tomography detected myocardium enhancement defect early at emergency department. Under the impression of acute myocardial infarction, emergent coronary angiography revealed left anterior descending artery occlusion. Revascularization was performed and coronary artery dissection was found after thrombus aspiration. Finally, the patient survived after coronary stenting. Perfusion defects of myocardium enhancement on CT after blunt chest trauma can be very helpful to suggest myocardial infarction and facilitate the decision making of emergent procedure. This valuable sign should not be missed during the initial interpretation.

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

Analysis of transit time flow of the right internal thoracic artery anastomosed to the left anterior descending artery compared to the left internal thoracic artery

Science.gov (United States)

Milani, Rodrigo; de Moraes, Daniela; Sanches, Aline; Jardim, Rodrigo; Lumikoski, Thais; Miotto, Gabriela; Santana, Vitor Hugo; Brofman, Paulo Roberto

2014-01-01

Introduction We evaluated with transit time flow the performance of the right and left thoracic arteries when used as a graft for the left anterior descending artery. Methods Fifty patients undergoing surgery for myocardial revascularization without cardiopulmonary bypass were divided into two groups. In group A patients received graft of right internal mammary artery to the anterior interventricular branch. In group B patients received graft of left internal mammary artery to the same branch. At the end of the operation the flow was assessed by measuring transit time. Results In group A, mean age was 60.6±9.49 years. The average height and weight of the group was 80.4±10.32 kg and 169.2±6.86 cm. The average number of grafts per patient in this group was 3.28±1.49. The mean flow and distal resistance obtained in right internal thoracic artery was 42.1±23.4 ml/min and 2.8±0.9 respectively. In group B, the mean age was 59.8±9.7 years. The average height and weight of this group was 77.7±14.22 kg and 166.0±8.2 cm. The average number of grafts per patient in this group was 3.08 ±0.82. The mean flow and distal resistance observed in this group was 34.2±19.1 ml/min and 2.0±0.7. There were no deaths in this series. Conclusion Right internal mammary artery presented a similar behavior to left internal mammary artery when anastomosed to the anterior interventricular branch of the left coronary artery. There was no statistical difference between the measured flow obtained between both arteries. PMID:25140463

Persistent left superior vena cava with absent right superior vena cava: image findings

International Nuclear Information System (INIS)

Araujo Junior, Cyrillo Rodrigues de; Carvalho, Tarcisio Nunes; Fraguas Filho, Sergio Roberto; Costa, Marlos Augusto Bitencourt; Jacob, Beatriz Mahmud; Machado, Marcio Martins; Teixeira, Kim-Ir-Sen Santos; Ximenes, Carlos Alberto

2003-01-01

Persistent left superior vena cava absent right superior vena cava is a rare anomaly, with less than 150 cases reported in the literature. Congenitally persistent left superior vena cava is the most common variant of systemic venous return to the heart, resulting embryologically from failure of the left anterior cardinal vein to become obliterated. Its incidence varies from 0.3% in patients with otherwise normal heart to 4.3% in patients with congenital heart disease. In the majority of the patients, a right superior vena cava is present as well, but rarely the right anterior cardinal vein degenerates resulting in the absence of the normal right superior vena cava. The blood from the right side is carried by the persistent left superior vena cava to the right atrium through the coronary sinus. We report the case of a patient with a persistent left superior vena cava and absence of right superior vena cava identified by chance during a chest radiograph and computed tomography examination for investigation of chronic pulmonary obstructive disease. The patient had no congenital heart disease and the blood from the right side was drained by the persistent left superior vena cava into the right atrium through the coronary sinus. (author)

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

Transauricular embolization of the rabbit coronary artery for experimental myocardial infarction: comparison of a minimally invasive closed-chest model with open-chest surgery

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Katsanos Konstantinos

2012-02-01

Full Text Available Abstract Introduction To date, most animal studies of myocardial ischemia have used open-chest models with direct surgical coronary artery ligation. We aimed to develop a novel, percutaneous, minimally-invasive, closed-chest model of experimental myocardial infarction (EMI in the New Zealand White rabbit and compare it with the standard open-chest surgical model in order to minimize local and systemic side-effects of major surgery. Methods New Zealand White rabbits were handled in conformity with the "Guide for the Care and Use of Laboratory Animals" and underwent EMI under intravenous anesthesia. Group A underwent EMI with an open-chest method involving surgical tracheostomy, a mini median sternotomy incision and left anterior descending (LAD coronary artery ligation with a plain suture, whereas Group B underwent EMI with a closed-chest method involving fluoroscopy-guided percutaneous transauricular intra-arterial access, superselective LAD catheterization and distal coronary embolization with a micro-coil. Electrocardiography (ECG, cardiac enzymes and transcatheter left ventricular end-diastolic pressure (LVEDP measurements were recorded. Surviving animals were euthanized after 4 weeks and the hearts were harvested for Hematoxylin-eosin and Masson-trichrome staining. Results In total, 38 subjects underwent EMI with a surgical (n = 17 or endovascular (n = 21 approach. ST-segment elevation (1.90 ± 0.71 mm occurred sharply after surgical LAD ligation compared to progressive ST elevation (2.01 ± 0.84 mm;p = 0.68 within 15-20 min after LAD micro-coil embolization. Increase of troponin and other cardiac enzymes, abnormal ischemic Q waves and LVEDP changes were recorded in both groups without any significant differences (p > 0.05. Infarct area was similar in both models (0.86 ± 0.35 cm in the surgical group vs. 0.92 ± 0.54 cm in the percutaneous group;p = 0.68. Conclusion The proposed model of transauricular coronary coil embolization avoids

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

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.

Secondary left ventricular injury with haemopericardium caused by a rib fracture after blunt chest trauma

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Somsekhar Ganti

2006-03-01

Full Text Available Abstract Trauma is the third most common cause of death in the West. In the US, approximately 90,000 deaths annually are traumatic in nature and over 75% of casualties from blunt trauma are due to chest injuries. Cardiac injuries from rib fractures following blunt trauma are extremely rare. We report the unusual case of a patient who fell from a height and presented with haemopericardium and haemothorax as a result of left ventricular and lingular lacerations and was sucessfully operated upon.

The Anterior Branch of the Left Inferior Phrenic Artery Arising from the Right Inferior Phrenic Artery: An Angiographic and CT Study

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Hieda, Masashi; Toyota, Naoyuki; Kakizawa, Hideaki; Ishikawa, Masaki; Horiguchi, Jun; Ito, Katsuhide

2009-01-01

The purpose of this study was to retrospectively analyze the frequency and anatomical pattern of the anterior branch of the left inferior phrenic artery (LIPA) arising from the right inferior phrenic artery (RIPA). Angiography of the RIPA for patients (n = 140) with hepatic malignancy was retrospectively reviewed. The frequency at which the anterior branch of the LIPA arose from the RIPA was 14.3% (20 of 140 patients [pts]). Among the three branches that may arise from the RIPA in these cases (the anterior branch of the LIPA and the anterior and posterior branches of the RIPA), the anterior branch of the LIPA was the first branch of the RIPA in 9 of 20 pts (45%), and the posterior branch of the RIPA in 11 of 20 pts (55%). The anterior branch of the LIPA ran along the ventral side of the esophagus or stomach and supplied the esophagogastric region and dome of the left diaphragm in all cases. In conclusion, the anterior branch of the LIPA arises from the RIPA at a comparatively high frequency. In embolization of the RIPA, to effectively treat and avoid possible complications, interventionalists should be aware of this potential variant anatomy.

Chest radiographic findings in Human Immunodeficiency Virus ...

African Journals Online (AJOL)

This study was carried out to determine findings on chest radiographs in HIV positive/AIDS patients at the University of Benin Teaching Hospital (UBTH) Benin City. All consecutive HIV positive/AIDS patients, managed at the UBTH between 1991 and 2001 were included in the study. Patients had postero-anterior (PA) chest ...

Right Ventricular Involvement in either Anterior or Inferior Myocardial Infarction

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Firoozeh Abtahi

2016-06-01

Full Text Available Background: Unlike left ventricular function, less attention has been paid to Right Ventricular (RV function after Myocardial Infarction (MI. Objectives: The current study aimed to compare RV function in patients with inferior and anterior MI. Patients and Methods: During the study period, 60 patients consecutively presented to the Emergency Department with chest pain were divided into two groups based on their electrocardiographic findings. Accordingly, 25 patients had inferior MI (IMI group and 35 ones had anterior MI (AMI group. Echocardiography was performed 48 hours after starting the standard therapy. Conventional echocardiographic parameters and Tissue Doppler Imaging (TDI measurements were acquired from the standard views. Student t-test and the chi-square test were respectively used for comparisons of the normally distributed continuous and categorical variables in the two groups. Besides, P < 0.05 was considered to be statistically significant.

A Proton Magnetic Resonance Spectroscopic Study in Autism Spectrum Disorder Using a 3-Tesla Clinical Magnetic Resonance Imaging (MRI) System: The Anterior Cingulate Cortex and the Left Cerebellum.

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Ito, Hiromichi; Mori, Kenji; Harada, Masafumi; Hisaoka, Sonoka; Toda, Yoshihiro; Mori, Tatsuo; Goji, Aya; Abe, Yoko; Miyazaki, Masahito; Kagami, Shoji

2017-07-01

The pathophysiology of autism spectrum disorder (ASD) is not fully understood. We used proton magnetic resonance spectroscopy to investigate metabolite concentration ratios in the anterior cingulate cortex and left cerebellum in ASD. In the ACC and left cerebellum studies, the ASD group and intelligence quotient- and age-matched control group consisted of 112 and 114 subjects and 65 and 45 subjects, respectively. In the ASD group, γ-aminobutyric acid (GABA)+/ creatine/phosphocreatine (Cr) was significantly decreased in the anterior cingulate cortex, and glutamate (Glu)/Cr was significantly increased and GABA+/Cr was significantly decreased in the left cerebellum compared to those in the control group. In addition, both groups showed negative correlations between Glu/Cr and GABA+/Cr in the left cerebellum, and positive correlations between GABA+/Cr in the anterior cingulate cortex and left cerebellum. ASD subjects have hypoGABAergic alterations in the anterior cingulate cortex and hyperglutamatergic/hypoGABAergic alterations in the left cerebellum.

Differential contribution of right and left temporo-occipital and anterior temporal lesions to face recognition disorders

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Guido eGainotti

2011-06-01

Full Text Available In the study of prosopagnosia, several issues (such as the specific or non-specific manifestations of prosopagnosia, the unitary or non-unitary nature of this syndrome and the mechanisms underlying face recognition disorders are still controversial. Two main sources of variance partially accounting for these controversies could be the qualitative differences between the face recognition disorders observed in patients with prevalent lesions of the right or left hemisphere and in those with lesions encroaching upon the temporo-occipital or the (right anterior temporal cortex.Results of our review seem to confirm these suggestions. Indeed, they show that (a the most specific forms of prosopagnosia are due to lesions of a right posterior network including the OFA and the FFA, whereas (b the face identification defects observed in patients with left temporo-occipital lesions seem due to a semantic defect impeding access to person-specific semantic information from the visual modality. Furthermore, face recognition defects resulting from right anterior temporal lesions can usually be considered as part of a multimodal people recognition disorder.The implications of our review are, therefore, the following: (1 to consider the components of visual agnosia often observed in prosopagnosic patients with bilateral temporo-occipital lesions as part of a semantic defect, resulting from left-sided lesions (and not from prosopagnosia proper; (2 to systematically investigate voice recognition disorders in patients with right anterior temporal lesions to determine whether the face recognition defect should be considered a form of ‘associative prosopagnosia’ or a form of the ‘multimodal people recognition disorder’.

A second defibrillator chest patch electrode will increase implantation rates for nonthoracotomy defibrillators.

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Solomon, A J; Swartz, J F; Rodak, D J; Moore, H J; Hannan, R L; Tracy, C M; Fletcher, R D

1996-09-01

Nonthoracotomy defibrillator systems can be implanted with a lower morbidity and mortality, compared to epicardial systems. However, implantation may be unsuccessful in up to 15% of patients, using a monophasic waveform. It was the purpose of this study to prospectively examine the efficacy of a second chest patch electrode in a nonthoracotomy defibrillator system. Fourteen patients (mean age 62 +/- 11 years, ejection fraction = 0.29 +/- 0.12) with elevated defibrillation thresholds, defined as > or = 24 J, were studied. The initial lead system consisted of a right ventricular electrode (cathode), a left innominate vein, and subscapular chest patch electrode (anodes). If the initial defibrillation threshold was > or = 24 J, a second chest patch electrode was added. This was placed subcutaneously in the anterior chest (8 cases), or submuscularly in the subscapular space (6 cases). This resulted in a decrease in the system impedance at the defibrillation threshold, from 72.3 +/- 13.3 omega to 52.2 +/- 8.6 omega. Additionally, the defibrillation threshold decreased from > or = 24 J, with a single patch, to 16.6 +/- 2.8 J with two patches. These changes were associated with successful implantation of a nonthoracotomy defibrillator system in all cases. In conclusion, the addition of a second chest patch electrode (using a subscapular approach) will result in lower defibrillation thresholds in patients with high defibrillation thresholds, and will subsequently increase implantation rates for nonthoracotomy defibrillators.

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

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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.

Acute ECG changes and chest pain induced by neck motion in patients with cervical hernia--a case report.

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Güler, N; Bilge, M; Eryonucu, B; Cirak, B

2000-10-01

We report two cases of acute cervical angina and ECG changes induced by anteflexion of the head. Cervical angina is defined as chest pain that resembles true cardiac angina but originates from cervical discopathy with nerve root compression. In these patients, Prinzmetal's angina, valvular heart disease, congenital heart disease, left ventricular aneurysm, and cardiomyopathy were excluded. After all, the patient's chest pain was reproduced by anteflexion of head, at this time, their ECGs showed nonspecific ST-T changes in the inferior and anterior leads different from the basal ECG. ECG changes returned to normal when the patient's neck moved to the neutral position. To our knowledge, these are the first cases of cervical angina associated with acute ECG changes by neck motion.

[Compressive anterior thoracoplasty (modified Abramson's repair) for pectus carinatum repair].

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Álvarez Muñoz, V; Prado Valle, M A; López López, A J; Martínez Suárez, M A; Oviedo Gutiérrez, M; Montalvo Ávalos, C; Fernández García, L

2014-04-15

For anterior protruding chest wall deformities treatment, mainly pectus carinatum, pediatric surgeons have been managing either orthotic methods or open surgical repairs. Anterior compressive thoracoplasty (Abramson's technique) has widened the therapeutic options. We describe herein a modification of this technique in the first reported Europen series. From 2010 to 2012, a total of five patients (four male and one female) underwent a modified Abramson's technique to correct pectus carinatum or combined protrusion of the chest at our center. We report the operative technique used for these reconstructions. In all five cases, the operation was completed uneventfully and with excellent results either for the surgical team or the patients. Mean operative time was 190 minutes and hospitalization lasted for three to six days, at the time of analgesic drugs withdrawal. We consider the anterior compresive thorocoplasty (modified Abramson's technique) a safe and feasible method to correct protruding chest deformities, particularly in those patients with stiff chest or lack of compliance, in order to avoid the agressive open procedures.

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

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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.

Transthoracic ultrasonic tissue indices identify patients with severe left anterior descending artery stenosis. Correlation with fractional flow reserve. Pilot study.

Science.gov (United States)

Dobrowolski, Piotr; Kowalski, Mirosław; Rybicka, Justyna; Lech, Agnieszka; Tyczyński, Paweł; Witkowski, Adam; Hoffman, Piotr

2016-01-01

The aim of this study was to evaluate the potential clinical application of ultrasonic tissue indices, with a focus on systolic strain (SS) and systolic strain rate (SSR) parameters derived from transthoracic echocardiography, in the assessment of left anterior descending artery (LAD) stenosis. The data of 30 patients with significant LAD stenosis were analysed. All patients underwent transthoracic echocardiography to obtain systolic myocardial velocity (Sm), longitudinal SS, and SSR from basal, mid, and apical segments of anterior and inferior walls in two-chamber apical view. Severity of LAD obstruction was measured by means of fractional flow reserve (FFR) during coronary catheterisation. Systolic velocities, strain, and strain rate measured in basal, middle, and apical segments of the anterior left ventricular (LV) wall were lower when compared to those obtained from the corresponding, i.e. unaffected, inferior LV wall. There was a significant correlation between FFR and the value of SS, SSR characterising the apical LV segment of the anterior wall (r = -0.583, p = 0.01; r = -0.598, p = 0.01, respectively). Moreover, we found significant correlation between FFR and Sm in the mid-segment of the LV anterior wall (r = 0.611, p = 0.009). We conclude that SS and SSR obtained from the apical segment of the anterior LV wall may be related to the severity of LAD stenosis.

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)

An unusual case of ameloblastoma observed in the left anterior mandible.

Science.gov (United States)

Canger, Emin Murat; Çelenk, Peruze; Bulut, Emel; Günhan, Ömer

2014-11-01

To report a small intaalveolar ameloblastoma which resembled cystic lesion, and to emphasize the value of Computed tomography (CT) in radiographic examination. Ameloblastoma is a slow-growing, locally invasive odontogenic neoplasm that accounts for approximately 10% of all tumors detected in the jaws. Radiographically, those tumors are usually well-defined. Computerized tomography is highly recommended to confirm the diagnosis. A 48-year-old female attended with a chief complaint of painless swelling in the left anterior of mandible, 1 month duration. In intraoral examination, non-fluctuant, immobile, approximately 1 × 1 cm in dimension, painless, swelling which had a bone-like hardness and located in the mandibular canine region was detected. Panoramic radiography revealed a well circumscribed unilocular radiolucent lesion located in the inter-radicular area of left mandibular lateral and canine teeth. In CT examination it was realized that the lesion was multilocular. Histopathological examination of the biopsy specimen was reported as ameloblastoma. It is extremely difficult to find such an ameloblastoma in small dimension in alvolar bone.

The effect of Valsartan and Captopril for the improvement of left ventricular systolic function after acute anterior myocardial infarction

International Nuclear Information System (INIS)

Liu Jun; Fu Xianghua; Xue Ling; Wu Weili; Li Shiqiang

2010-01-01

Objective: To compare the therapeutic effect of angiotensin II antagonist (Valsartan) and angiotension-converting enzyme inhibitor (Captopril) for the improvement of left ventricular systolic function (LVSF) after acute myocardial infarction (AMI) at anterior wall. Methods: A total of 75 patients with initial AMI at anterior wall were enlisted in the study. Patients were divided randomly into three groups: control group (n = 15), Captopril treated (n =30), and Valsartan treated (n =30). At 1 week and 28 weeks post AMI, the LVSF and left ventricular regional ejection fraction (LrEF) were measured by equilibrium radionuclide angiography (ERNA). The t-test was used to compare the dada. Results: (1) At 28 weeks, left ventricular ejection fraction (LVEF) and left ventricular peak ejection rate (LPER) in Valsartan treated group were significantly increased as compared with those of control: (59.4±8.6) % vs (44.9±8.4)%, t = 3.87, P 2 , LrEF 4 , LrEF 5 , LrEF-6: (71.6±18.8)% vs (57.0±11.4)%, t=2.11, P<0.05;(78.1±16.8)% vs (68.9±21.0)%, t =2.06, P<0.05; (70.5±16.9)% vs (59.9±23.4)%, t=1.99, P<0.05; and (58.1±9.0) % vs (46.0±18.9) %, t = 2.43, P<0.05, respectively. Conclusions: Valsartan and Captopril are effective for the improvement of LVEF after AMI at anterior wall. The effects of the two drugs are similar. (authors)

Recurrent Syncope Attributed to Left Main Coronary Artery Severe Stenosis

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Min Li

2015-01-01

Full Text Available Patients with acute coronary syndrome (ACS rarely manifest as recurrent syncope due to malignant ventricular arrhythmia. We report a case of a 56-year-old Chinese male with complaints of paroxysmal chest burning sensation and distress for 2 weeks as well as loss of consciousness for 3 days. The electrocardiogram (ECG revealed paroxysmal multimorphologic ventricular tachycardia during attack and normal heart rhythm during intervals. Coronary angiograph showed 90% stenosis in left main coronary artery and 80% stenosis in anterior descending artery. Two stents sized 4.0*18 mm and 2.75*18 mm were placed at left main coronary artery and anterior descending artery, respectively, during percutaneous coronary intervention (PCI. The patient was discharged and never had ventricular arrhythmia again during a 3-month follow-up since the PCI. This indicated that ventricular tachycardia was correlated with persistent severe myocardial ischemia. Coronary vasospasm was highly suspected to be the reason of the sudden attack and acute exacerbation. PCI is recommended in patients with both severe coronary artery stenosis and ventricular arrhythmia. Removing myocardial ischemia may stop or relieve ventricular arrhythmia and prevent cardiac arrest.

Penetrating chest injury: A miraculous life salvage

Directory of Open Access Journals (Sweden)

Santosh B Dalavi

2013-01-01

Full Text Available An unusual penetrating chest injury was caused by high velocity road traffic accident. An 18-year-old had a four wheeler accident and was brought in emergency department with a ′bamboo′ stick on the left side chest exiting through back. After the stabilization of vital parameters, an inter-costal tube drainage was done on the left side. Except the minor brochopleural fistula which healed by 10 th day, his recovery was uneventful. The outcome was consistent with current aggressive management of penetrating chest injuries. Management of penetrating chest injury involving pulmonary trauma is based on three principles. One is stabilization of hemodynamics of patient with proper clinical evaluation. Second, a mere intercostal tube drainage sufficient for majority of the cases. Third, post-operative active as well as passive physiotherapy is necessary for speedy recovery.

Aberrant origin of the upper left lobe anterior and superior lingular segmental pulmonary artery arising from the right pulmonary artery: A case report

International Nuclear Information System (INIS)

Cho, Yong Seok; Kang, Mi Jin; Bae, Kyung Eun; Lee, Jin Hae; Lee, Han Bee; Kim, Jae Hyung; Jeong, Myeong Ja; Kang, Tae Kyung

2013-01-01

Aberrant origins of the pulmonary artery are rare anomalies, but are being reported several times in the world literature. Among them, pulmonary artery sling is the most well known anomaly, which is the left pulmonary artery arising from the right pulmonary artery. In case of pulmonary artery sling, the left pulmonary artery causes compression of the trachea and esophagus while it courses in between. In this case, we describe a case on incidentally found aberrant origin of the upper left lobe anterior and superior lingular segmental pulmonary artery without any compressions of the esophagus or trachea. In the world literature, aberrant origins of the left pulmonary artery without pulmonary artery sling was reported at one time, but currently, this is the first case of aberrant origin of the upper left lobe anterior and superior lingular segmental pulmonary artery arising from the right pulmonary artery.

Aberrant origin of the upper left lobe anterior and superior lingular segmental pulmonary artery arising from the right pulmonary artery: A case report

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Cho, Yong Seok; Kang, Mi Jin; Bae, Kyung Eun; Lee, Jin Hae; Lee, Han Bee; Kim, Jae Hyung; Jeong, Myeong Ja; Kang, Tae Kyung [Sanggye Paik Hospital, Inje University College of Medicine, Seoul, (Korea, Republic of)

2013-10-15

Aberrant origins of the pulmonary artery are rare anomalies, but are being reported several times in the world literature. Among them, pulmonary artery sling is the most well known anomaly, which is the left pulmonary artery arising from the right pulmonary artery. In case of pulmonary artery sling, the left pulmonary artery causes compression of the trachea and esophagus while it courses in between. In this case, we describe a case on incidentally found aberrant origin of the upper left lobe anterior and superior lingular segmental pulmonary artery without any compressions of the esophagus or trachea. In the world literature, aberrant origins of the left pulmonary artery without pulmonary artery sling was reported at one time, but currently, this is the first case of aberrant origin of the upper left lobe anterior and superior lingular segmental pulmonary artery arising from the right pulmonary artery.

[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.

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.

[How to do - the chest tube drainage].

Science.gov (United States)

Klopp, Michael; Hoffmann, Hans; Dienemann, Hendrik

2015-03-01

A chest tube is used to drain the contents of the pleural space to reconstitute the physiologic pressures within the pleural space and to allow the lungs to fully expand. Indications for chest tube placement include pneumothorax, hemothorax, pleural effusion, pleural empyema, and major thoracic surgery. The most appropriate site for chest tube placement is the 4th or 5th intercostal space in the mid- or anterior- axillary line. Attention to technique in placing the chest tube is vital to avoid complications from the procedure. Applying the step-by-step technique presented, placement of a chest tube is a quick and safe procedure. Complications - frequently occurring when the tube is inserted with a steel trocar - include hemothorax, dislocation, lung lacerations, and injury to organs in the thoracic or abdominal cavity." © Georg Thieme Verlag KG Stuttgart · New York.

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

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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.

[Acute stent thrombosis and reverse transient left ventricular dilatation after performing a single-photon emission computed tomography myocardial perfusion].

Science.gov (United States)

Miranda, B; Pizzi, M N; Aguadé-Bruix, S; Domingo, E; Candell-Riera, J

2015-01-01

A 63-year-old male patient with a history of stent implantation in the left anterior descending three months before. Due to the presentation of vegetative symptoms, he was referred for gated-SPECT myocardial perfusion. During acquisition of the resting images he presented chest pain and ST segment elevation, so that urgent cardiac catheterization was performed, showing stent thrombosis. Rest perfusion imaging showed a defect in anterior and apical perfusion, more severe and extensive than in the stress images, with striking left ventricular dilatation and a fall in the ejection fraction related to the acute ischemia phenomenon. Intense exercise is associated with a transient activation of the coagulation system and hemodynamic changes that might induce thrombosis, especially in recently implanted coronary stents that probably still have not become completely endothelialized. Copyright © 2014 Elsevier España, S.L.U. y SEMNIM. All rights reserved.

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

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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

Myocardial bridging causing ischemia and recurrent chest pain: a case report

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Abdou Mohamed

2011-07-01

Full Text Available Abstract Background Myocardial bridging is present when a segment of a major epicardial coronary artery runs intramurally through the myocardium. It usually has a benign prognosis, but in some cases myocardial ischemia, infarction and sudden cardiac death have been reported. We are here reporting a case of myocardial bridging which was complicated with recurrent chest pain and transient ST-segment elevation during exercise treadmill test. Case presentation A 40 year-old-man presented with recurrent retrosternal chest pain of 2 months duration. He had history of smoking and was obese, otherwise no physical abnormalities were detected by examination. Electrocardiogram and blood tests were normal apart from impaired glucose tolerance with elevated triglycerides and decreased level of high density lipoprotein cholesterol. While doing exercise treadmill test, the patient developed chest pain and significant ST-segment elevation in almost all precordial leads that persisted for about 15 minutes through recovery. We decided to admit the patient to the coronary care unit for further management and to perform coronary angiogram. Myocardial bridging was observed in the mid segment of the left anterior descending coronary artery. Medical treatment was decided. At one year follow up, our patient was healthy and had no cardiac complaints. In conclusion, myocardial bridging may predispose to coronary vasospasm that may leads to ischemic complications.

Successful transjugular extraction of a lead in front of the anterior scalene muscle by using snare technique

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Ayako Okada, MD

2015-08-01

Full Text Available The incidence of cardiovascular implantable electronic device infection is increasing. We report a case of and successful device removal in a 79-year-old man with implantable cardioverter-defibrillator infection. Right phrenic nerve paralysis was evident on chest radiography. The lead was in front of the anterior scalene muscle, close to the left phrenic nerve. Therefore, extraction carried a risk of bilateral phrenic nerve paralysis. The lead was successfully extracted from the right internal jugular vein by using the snare technique. No complications occurred, and the extraction was successful.

Right Coronary Artery Originated from the Left Anterior Descending Artery in a Patient with Congenital Pulmonary Valvular Stenosis

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Yusuf Hoşoğlu

2013-01-01

Full Text Available The single coronary artery, anomalous origin of the right coronary artery from the left anterior descending artery, is a benign and very rare coronary artery anomaly. We firstly present a case with this type of single coronary artery and congenital pulmonary valvular stenosis with large poststenotic dilatation.

Patient dose measurement and dose reduction in chest radiography

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Milatović Aleksandra A.

2014-01-01

Full Text Available Investigations presented in this paper represent the first estimation of patient doses in chest radiography in Montenegro. In the initial stage of our study, we measured the entrance surface air kerma and kerma area product for chest radiography in five major health institutions in the country. A total of 214 patients were observed. We reported the mean value, minimum and third quartile values, as well as maximum values of surface air kerma and kerma area product of patient doses. In the second stage, the possibilities for dose reduction were investigated. Mean kerma area product values were 0.8 ± 0.5 Gycm2 for the posterior-anterior projection and 1.6 ± 0.9 Gycm2 for the lateral projection. The max/min ratio for the entrance surface air kerma was found to be 53 for the posterior-anterior projection and 88 for the lateral projection. Comparing the results obtained in Montenegro with results from other countries, we concluded that patient doses in our medical centres are significantly higher. Changes in exposure parameters and increased filtration contributed to a dose reduction of up to 36% for posterior-anterior chest examinations. The variability of the estimated dose values points to a significant space for dose reduction throughout the process of radiological practice optimisation.

Identification of Pulmonary Hypertension Caused by Left-Sided Heart Disease (World Health Organization Group 2) Based on Cardiac Chamber Volumes Derived From Chest CT Imaging.

Science.gov (United States)

Aviram, Galit; Rozenbaum, Zach; Ziv-Baran, Tomer; Berliner, Shlomo; Topilsky, Yan; Fleischmann, Dominik; Sung, Yon K; Zamanian, Roham T; Guo, Haiwei Henry

2017-10-01

Evaluations of patients with pulmonary hypertension (PH) commonly include chest CT imaging. We hypothesized that cardiac chamber volumes calculated from the same CT scans can yield additional information to distinguish PH related to left-sided heart disease (World Health Organization group 2) from other PH subtypes. Patients who had PH confirmed by right heart catheterization and contrast-enhanced chest CT studies were enrolled in this retrospective multicenter study. Cardiac chamber volumes were calculated using automated segmentation software and compared between group 2 and non-group 2 patients with PH. This study included 114 patients with PH, 27 (24%) of whom were classified as group 2 based on their pulmonary capillary wedge pressure. Patients with group 2 PH exhibited significantly larger median left atrial (LA) volumes (118 mL vs 63 mL; P volumes (90 mL vs 76 mL; P = .02), and smaller median right ventricular (RV) volumes (173 mL vs 210 mL; P = .005) than did non-group 2 patients. On multivariate analysis adjusted for age, sex, and mean pulmonary arterial pressure, group 2 PH was significantly associated with larger median LA and LV volumes (P volume ratios of RA/LA, RV/LV, and RV/LA (P = .001, P = .004, and P volumes demonstrated a high discriminatory ability for group 2 PH (area under the curve, 0.92; 95% CI, 0.870-0.968). Volumetric analysis of the cardiac chambers from nongated chest CT scans, particularly with findings of an enlarged left atrium, exhibited high discriminatory ability for identifying patients with PH due to left-sided heart disease. Copyright © 2017. Published by Elsevier Inc.

Traumatic tricuspid regurgitation and right-to-left intra-atrial shunt--an unusual complication of a horse-kick.

LENUS (Irish Health Repository)

Byrne, R A

2010-02-01

A 63-year-old male presented with sudden onset chest pain and dyspnoea following a kick to the praecordium while gelding a horse. Transthoracic echocardiography showed evidence of flail tricuspid valve leaflets, severe tricuspid regurgitation and a widely patent foramen ovale with a right-to-left shunt. Due to progressive severe systemic hypoxemia the patient underwent emergent surgical intervention. Operative findings confirmed rupture of the anterior and septal tricuspid valve papillary muscles. Successful papillary muscle reattachment was performed in association with tricuspid annuloplasty and suture closure of his patent foramen ovale. Disruption of the tricuspid valve is well described as consequence of blunt trauma to the chest wall and is often well tolerated, coming to light many years post injury. Valve disruption due to rupture at the papillary muscle level, however, typically results in greater severity of tricuspid regurgitation and the abrupt rise in right intra-atrial pressure may lead to a right-to-left shunt across a patent foramen ovale. Where hemodynamic compromise ensues, prompt surgical intervention is mandated.

Clinical, angiographic, hemodynamic, perfusional and functional changes after one-vessel left anterior descending coronary angioplasty

International Nuclear Information System (INIS)

Okada, R.D.; Lim, Y.L.; Boucher, C.A.; Pohost, G.M.; Chesler, D.A.; Block, P.C.

1985-01-01

Percutaneous transluminal coronary angioplasty (PTCA) was successfully performed in 20 patients with 1-vessel left anterior descending (LAD) coronary artery disease. Exercise capacity in terms of peak workload, heart rate and systolic blood pressure all increased significantly 1 week after PTCA. All patients had some decrease in stenosis size and gradient. All patients except 1 had an improvement in functional class. Eight of 12 patients with abnormal exercise electrocardiograms before PTCA had normal electrocardiograms after the procedure. Exercise thallium-201 (TI-201) myocardial perfusion images obtained in all 20 patients before and 1 week after PTCA were analyzed using a new computer method designed to quantitate regional myocardial TI-201 distribution, redistribution and clearance rate. Significant improvement in TI-201 activity was present in the anterior and septal segments of the left ventricle 1 week after PTCA. This increase in TI-201 uptake was associated with a significant reduction in the amount of TI-201 redistribution between initial and delayed postexercise images in the same regions. TI-201 clearance rate in the segments supplied by the dilated vessel also improved significantly. Abnormal TI-201 lung uptake was seen in 17 patients before and in 4 patients after PTCA. Exercise ejection fraction response and septal wall motion also improved after PTCA of the LAD stenosis in all 17 patients who had exercise radionuclide ventriculography

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.

A Monte Carlo estimation of effective dose in chest tomosynthesis

International Nuclear Information System (INIS)

Sabol, John M.

2009-01-01

Purpose: The recent introduction of digital tomosynthesis imaging into routine clinical use has enabled the acquisition of volumetric patient data within a standard radiographic examination. Tomosynthesis requires the acquisition of multiple projection views, requiring additional dose compared to a standard projection examination. Knowledge of the effective dose is needed to make an appropriate decision between standard projection, tomosynthesis, and CT for thoracic x-ray examinations. In this article, the effective dose to the patient of chest tomosynthesis is calculated and compared to a standard radiographic examination and to values published for thoracic CT. Methods: Radiographic technique data for posterior-anterior (PA) and left lateral (LAT) radiographic chest examinations of medium-sized adults was obtained from clinical sites. From these data, the average incident air kerma for the standard views was determined. A commercially available tomosynthesis system was used to define the acquisition technique and geometry for each projection view. Using Monte Carlo techniques, the effective dose of the PA, LAT, and each tomosynthesis projection view was calculated. The effective dose for all projections of the tomosynthesis sweep was summed and compared to the calculated PA and LAT values and to the published values for thoracic CT. Results: The average incident air kerma for the PA and left lateral clinical radiographic examinations were found to be 0.10 and 0.40 mGy, respectively. The effective dose for the PA view of a patient of the size of an average adult male was determined to be 0.017 mSv (ICRP 60) [0.018 mSv (ICRP 103)]. For the left lateral view of the same sized patient, the effective dose was determined to be 0.039 mSv (ICRP 60) [0.050 mSv (ICRP 103)]. The cumulative mA s for a tomosynthesis examination is recommended to be ten times the mA s of the PA image. With this technique, the effective dose for an average tomosynthesis examination was

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

Second generation drug-eluting stents versus bare-metal stents for percutaneous coronary intervention of the proximal left anterior descending artery

DEFF Research Database (Denmark)

Mangione, Fernanda Marinho; Biering-Sørensen, Tor; Nochioka, Kotaro

2017-01-01

OBJECTIVES: To compare mid-term outcomes between patients undergoing proximal left anterior descending artery (LAD) percutaneous coronary intervention (PCI) with second generation drug-eluting stent (DES) or bare-metal stent (BMS). BACKGROUND: PCI with BMS and first-generation DES have shown to b...

Aspergillosis - chest x-ray (image)

Science.gov (United States)

... usually occurs in immunocompromised individuals. Here, a chest x-ray shows that the fungus has invaded the lung ... are usually seen as black areas on an x-ray. The cloudiness on the left side of this ...

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.)

An Unusual Cause of Precordial Chest Pain

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Sevket Ozkaya

2013-01-01

Full Text Available Extraskeletal chondrosarcoma in anterior mediastinum is very rare. A 45-year-old male patient was admitted to the hospital with precordial chest pain. A large and well-shaped mass in the anterior mediastinum was seen radiologically, and there was a clearly compression of the heart by the mass. The lesion was totally resected, and extraskeletal mediastinal chondrosarcoma was histopathologically diagnosed. We aimed to present and discuss the radiologic, clinic, and histopathologic features of unusual presentation of extraskeletal chondrosarcoma in a case.

Incremental value of clinical assessment, supine exercise electrocardiography, and biplane exercise radionuclide ventriculography in the prediction of coronary artery disease in men with chest pain

International Nuclear Information System (INIS)

Currie, P.J.; Kelly, M.J.; Harper, R.W.; Federman, J.; Kalff, V.; Anderson, S.T.; Pitt, A.

1983-01-01

The incremental value of clinical assessment, exercise electrocardiography (ECG) and biplane radionuclide ventriculography (RVG) in the prediction of coronary artery disease (CAD) was assessed in 105 men without myocardial infarction who were undergoing coronary angiography for investigation of chest pain. Independent clinical assessment of chest pain was made prospectively by 2 physicians. Graded supine bicycle exercise testing was symptom-limited. Right anterior oblique ECG-gated first-pass RVG and left anterior oblique ECG-gated equilibrium RVG were performed at rest and exercise. Regional wall motion abnormalities were defined by agreement of 2 of 3 blinded observers. A combined strongly positive exercise ECG response was defined as greater than or equal to 2 mm ST depression or 1.0 to 1.9 mm ST depression with exercise-induced chest pain. A multivariate logistic regression model for the preexercise prediction of CAD was derived from the clinical data and selected 2 variables: chest pain class and cholesterol level. A second model assessed the incremental value of the exercise test in prediction of CAD and found 2 exercise variables that improved prediction: RVG wall motion abnormalities, and a combined strongly positive ECG response. Applying the derived predictive models, 37 of the 58 patients (64%) with preexercise probabilities of 10 to 90% crossed either below the 10% probability threshold or above the 90% threshold and 28 (48%) also moved across the 5 and 95% thresholds. Supine exercise testing with ECG and biplane RVG together, but neither test alone, effectively adds to clinical prediction of CAD. It is most useful in men with atypical chest pain and when the ECG and RVG results are concordant

Physiologic capacity of well-developed collaterals in patients with isolated left anterior descending artery disease

International Nuclear Information System (INIS)

Sakata, Kazuyuki; Yoshida, Hiroshi; Ono, Norihisa; Ohtani, Seiji; Mori, Noriko; Yokoyama, Shoichi; Hoshino, Tsuneo; Kaburagi, Tsuneo; Kurata, Chinori.

1992-01-01

To assess the physiologic significance of well-developed collaterals, 34 patients, with isolated left anterior descending artery disease (LAD) and without overt prior myocardial infarction, underwent cardiac catheterization and exercise thallium-201 emission computed tomography. The patients were divided into 3 groups: 11 patients with 90% stenosis of the proximal LAD and without collaterals (group 1), 11 with 99% stenosis of the proximal LAD, and without collaterals (group 2) and 12 with a total occlusion of the proximal LAD which was completely filled by well-developed collaterals (group 3). On left ventriculography, shortening fractions of the anterior wall were significantly reduced in group 2 as compared to groups 1 and 3 (group 1 vs group 2: p<0.01, group 2 vs group 3: p<0.05), which reflected the lower ejection fraction of group 2 (p<0.01 and p<0.05, respectively). The perfusion defects of the anterior wall on both the initial and the delayed images were severer in groups 2 and 3 than in group 1 (group 1 vs group 2 and group 1 vs group 3 on the initial image: p<0.01, for both, group 1 vs group 2 and group 1 vs group 3 on the delayed image: p<0.05, for both). However, recovery of the perfusion defects from the initial image to the delayed image was better in group 3 than in groups 1 and 2 (group 1 vs group 2 and group 1 vs group 3: p<0.05, for both). Therefore, coronary blood flow through well-developed collaterals was considered to be comparable to the flow through a diseased vessel with 90% stenosis at rest. During maximal exercise, blood flow through well-developed collaterals was considered to be comparable to the flow through a diseased vessel with 99% stenosis, although the blood flow through well-developed collaterals was considered to be better than that through 99% stenosis during the recovery period. These findings suggest that patients with well-developed collaterals must be treated like those with severe stenosis. (author)

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

Adenocarcinoma - chest x-ray (image)

Science.gov (United States)

This chest x-ray shows adenocarcinoma of the lung. There is a rounded light spot in the right upper lung (left side ... density. Diseases that may cause this type of x-ray result would be tuberculous or fungal granuloma, and ...

Cardiac dose reduction with deep inspiration breath hold for left-sided breast cancer radiotherapy patients with and without regional nodal irradiation.

Science.gov (United States)

Yeung, Rosanna; Conroy, Leigh; Long, Karen; Walrath, Daphne; Li, Haocheng; Smith, Wendy; Hudson, Alana; Phan, Tien

2015-09-22

Deep inspiration breath hold (DIBH) reduces heart and left anterior descending artery (LAD) dose during left-sided breast radiation therapy (RT); however there is limited information about which patients derive the most benefit from DIBH. The primary objective of this study was to determine which patients benefit the most from DIBH by comparing percent reduction in mean cardiac dose conferred by DIBH for patients treated with whole breast RT ± boost (WBRT) versus those receiving breast/chest wall plus regional nodal irradiation, including internal mammary chain (IMC) nodes (B/CWRT + RNI) using a modified wide tangent technique. A secondary objective was to determine if DIBH was required to meet a proposed heart dose constraint of Dmean irradiation.

Necrotizing Fasciitis of the Chest in a Neonate in Southern Nigeria

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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.

Pulmonary nodule size evaluation with chest tomosynthesis.

Science.gov (United States)

Johnsson, Åse A; Fagman, Erika; Vikgren, Jenny; Fisichella, Valeria A; Boijsen, Marianne; Flinck, Agneta; Kheddache, Susanne; Svalkvist, Angelica; Båth, Magnus

2012-10-01

To evaluate intra- and interobserver variability, as well as agreement for nodule size measurements on chest tomosynthesis and computed tomographic (CT) images. The Regional Ethical Review Board approved this study, and all participants gave written informed consent. Thirty-six segmented nodules in 20 patients were included in the study. Eight observers measured the left-to-right, inferior-to-superior, and longest nodule diameters on chest tomosynthesis and CT images. Intra- and interobserver repeatability, as well as agreement between measurements on chest tomosynthesis and CT images, were assessed as recommended by Bland and Altman. The difference between the mean manual and the segmented diameter was -2.2 and -2.3 mm for left-to-right and -2.6 and -2.2 mm for the inferior-to-superior diameter for measurements on chest tomosynthesis and CT images, respectively. Intraobserver 95% limits of agreement (LOA) for the longest diameter ranged from a lower limit of -1.1 mm and an upper limit of 1.0 mm to -1.8 and 1.8 mm for chest tomosynthesis and from -0.6 and 0.9 mm to -3.1 and 2.2 mm for axial CT. Interobserver 95% LOA ranged from -1.3 and 1.5 mm to -2.0 and 2.1 mm for chest tomosynthesis and from -1.8 and 1.1 mm to -2.2 and 3.1 mm for axial CT. The 95% LOA concerning the mean of the observers' measurements of the longest diameter at chest tomosynthesis and axial CT were ±2.1 mm (mean measurement error, 0 mm). For the different observers, the 95% LOA between the modalities ranged from -2.2 and 1.6 mm to -3.2 and 2.8 mm. Measurements on chest tomosynthesis and CT images are comparable, because there is no evident bias between the modalities and the repeatability is similar. The LOA between measurements for the two modalities raise concern if measurements from chest tomosynthesis and CT were to be used interchangeably. © RSNA, 2012.

A case of luftsichel sign for left upper lobe collapse

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Erden Erol Ünlüer

2015-01-01

Full Text Available The differential diagnosis of dyspnea in Emergency Department (ED patients is broad and atelectasis is one of the differentials among these. We present a 29-year-old women presented to our ED for evaluation of shortness of breath. On her chest examination, air entry and breath sounds were diminished on the left side but normal on the right. A posteroanterior chest radiograph showed radioluscent area in the upper zone of the left lung, around the aortic arch and also hyperdens area neighbouring this, like covered by a veil. Luftsichel sign together with this hiperdensity were consistent with the diagnose of left lung upper lobe collapse. The Luftsichel sign represents the hyperexpanded superior segment of the left lower lobe interposed between the atelectatic left upper lobe and aortic arch. Patient was discharged to home with chest physiotherapy and breathing exercises together with analgesic prescreption.

Left ventricular microfistulization: A rare cause of ischemia in a patient with normal coronary arteries

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İsmet Dindar

2012-06-01

Full Text Available A 71-year-old woman with chest pain occurring on physicalexercise was admitted to cardiology department.Myocardial perfusion scintigraphy revealed inferior andanteroapical segment hypoperfusion. Selective coronaryangiography revealed multiple coronary-cameral fistulasoriginating from the left anterior descending artery andthe right coronary artery and emptying into the left ventriclewithout any significant coronary artery stenosis. Coronaryartery fistulas are defined as abnormal communicationsbetween a coronary artery and a cardiac chamber ormajor vessel. Coronary-cameral fistulas terminating in theleft ventricle are uncommon. Small fistulas usually do notcause any hemodynamic compromise. However, the largerand multiple fistulas may cause myocardial ischemiaascribed to a coronary steal phenomenon. The best wayto manage cameral fistulae is uncertain largely due to therarity of the condition. In the present case, anti-ischemicmedications with metoprolol 50 mg/day provided an uneventfulfollow-up of six months without any intervention.

Non-compact left ventricle/hypertrabeculated left ventricle

International Nuclear Information System (INIS)

Restrepo, Gustavo; Castano, Rafael; Marmol, Alejandro

2005-01-01

Non-compact left ventricle/hypertrabeculated left ventricle is a myocardiopatie produced by an arrest of the normal left ventricular compaction process during the early embryogenesis. It is associated to cardiac anomalies (congenital cardiopaties) as well as to extracardial conditions (neurological, facial, hematologic, cutaneous, skeletal and endocrinological anomalies). This entity is frequently unnoticed, being diagnosed only in centers with great experience in the diagnosis and treatment of myocardiopathies. Many cases of non-compact left ventricle have been initially misdiagnosed as hypertrophic myocardiopatie, endocardial fibroelastosis, dilated cardiomyopatie, restrictive cardiomyopathy and endocardial fibrosis. It is reported the case of a 74 years old man with a history of chronic arterial hypertension and diabetes mellitus, prechordial chest pain and mild dyspnoea. An echocardiogram showed signs of non-compact left ventricle with prominent trabeculations and deep inter-trabecular recesses involving left ventricular apical segment and extending to the lateral and inferior walls. Literature on this topic is reviewed

Misdiagnosed Chest Pain: Spontaneous Esophageal Rupture

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Inci, Sinan; Gundogdu, Fuat; Gungor, Hasan; Arslan, Sakir; Turkyilmaz, Atila; Eroglu, Atila

2013-01-01

Chest pain is one of themost common complaints expressed by patients presenting to the emergency department, and any initial evaluation should always consider life-threatening causes. Esophageal rupture is a serious condition with a highmortality rate. If diagnosed, successful therapy depends on the size of the rupture and the time elapsed between rupture and diagnosis.We report on a 41-year-old woman who presented to the emergency department complaining of left-sided chest pain for two hours. PMID:27122690

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)

Mitral valve plasty for mitral regurgitation after blunt chest trauma.

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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.

Percutaneous drainage of chest abscesses in children

International Nuclear Information System (INIS)

Ball, W.S. Jr.; Towbin, R.B.; Bisset, G.S. III.

1987-01-01

Similar techniques for draining abdominal abscesses are now being applied to abscesses within the chest. This report describes the authors' experience in percutaneous drainage of seven chest abscesses in six children aged 3-13 years (mean, 7.3 years). Four pleural/extrapleural loculations were drained in three patients. Abscess location included right apex (one), right minor fissure (one), and left supradiaphragmatic (two). Collections resulted from esophageal perforation (two) or esophageal anastomotic leak (two). Three lung abscesses were drained in three patients. Abscess location included right lower, left lower, and right middle lobes. All lay adjacent to a pleural surface and were localized by CT or US before drainage. There were no complications. Complete resolution occurred in all six patients without the need for surgical intervention

Improved drainage with active chest tube clearance.

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Shiose, Akira; Takaseya, Tohru; Fumoto, Hideyuki; Arakawa, Yoko; Horai, Tetsuya; Boyle, Edward M; Gillinov, A Marc; Fukamachi, Kiyotaka

2010-05-01

This study was performed to evaluate the efficacy of a novel chest drainage system. This system employs guide wire-based active chest tube clearance to improve drainage and maintain patency. A 32 Fr chest tube was inserted into pleural cavities of five pigs. On the left, a tube was connected to the chest canister, and on the right, the new system was inserted between the chest tube and chest canister. Acute bleeding was mimicked by periodic infusion of blood. The amount of blood drained from each chest cavity was recorded every 15 min for 2 h. After completion of the procedure, all residual blood and clots in each chest cavity were assessed. The new system remained widely patent, and the amount of drainage achieved with this system (670+/-105 ml) was significantly (P=0.01) higher than that with the standard tube (239+/-131 ml). The amount of retained pleural blood and clots with this system (150+/-107 ml) was significantly (P=0.04) lower than that with the standard tube (571+/-248 ml). In conclusion, a novel chest drainage system with active tube clearance significantly improved drainage without tube manipulations. 2010 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.

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.

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.

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)

Rare Chronic Gastric Volvulus Associated with Left Atrial and Mediastinal Compression

OpenAIRE

Shriki, Jabi E.; Nguyen, Khanh; Rozo, Juan Carlos; Reul, George J.; Mortazavi, Ali

2002-01-01

We report a case of chronic gastric volvulus associated with left atrial compression in a 75-year-old woman who presented with chest pain, shortness of breath, and hypotension after elective hemiarthroplasty of the left hip. The patient's medical history included a paraesophageal hernia and gastric volvulus diagnosed in 1997 but left untreated. The present diagnosis of gastric volvulus was made on the basis of a chest radiograph and subsequent computed tomography. Echocardiography showed the ...

Left anterior descending coronary artery myocardial bridging by multislice computed tomography: Correlation with clinical findings

International Nuclear Information System (INIS)

Jodocy, Daniel; Aglan, Iman; Friedrich, Guy; Mallouhi, Ammar; Pachinger, Otmar; Jaschke, Werner; Feuchtner, Gudrun M.

2010-01-01

Objective: To assess the relationship between left anterior descending (LAD) coronary artery myocardial bridging detected by 64-slice computed tomography (CT) and clinical findings. Methods: 221 consecutive patients were examined with coronary 64-slice CT angiography. 21 patients with coronary stenosis >50% were excluded. The length, depth, and luminal narrowing of LAD myocardial bridges during systole and diastole were measured. CT findings were compared with the treadmill ECG-stress test, and clinical symptoms. Results: Myocardial bridges of the LAD were found in 23% of patients (51/221) (length, 14.9 ± 6.5 mm; depth, 2.6 ± 1.6 mm). A significant difference was noted between the LAD luminal diameter before the intramyocardial course and intramyocardially, for both diastole and systole (p 50% was found in 3/25 (8%). 30/51 (59%) of bridges were 'deep' (>2 mm myocardial depth), 21/51 (41%) were 'superficial'. The prevalence of a positive ECG-stress tests for the anterior myocardial region was significantly higher in patients with LAD myocardial bridges (34/50; 68%) compared to those without (28/144; 19.4%) (p < 0.001). There was no difference between 'superficial' and 'deep' LAD myocardial bridges in regard to a positive treadmill ECG-stress test. Typical angina was rare with 6%. Conclusion: LAD myocardial bridges are common findings and can possibly explain a positive exercise ECG-stress test for anterior myocardial ischemia. Intramyocardial LAD segments show mild-to-moderate luminal narrowing at rest, which is higher during end-systolic phase.

Memory outcome following left anterior temporal lobectomy in patients with a failed Wada test.

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Rathore, Chaturbhuj; Alexander, Aley; Sarma, P Sankara; Radhakrishnan, Kurupath

2015-03-01

This study aimed to compare the memory outcome following left anterior temporal lobectomy (ATL) between patients with a failed Wada test and patients who passed the Wada test. From 1996 to 2002, we performed the Wada test on all patients with unilateral left mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) and concordant electroclinical data before ATL. We used a 12-item recognition paradigm for memory testing and awarded a score of +1 for each correct response and -0.5 for each incorrect response. No patient was denied surgery on the basis of Wada scores. We assessed cognitive and memory functions using the Wechsler Adult Intelligence Scale and the Wechsler Memory Scale preoperatively and at one year after ATL. We compared the number of patients who showed decline in memory scores, as per the published reliable change indices, between the patients with a failed Wada test and the patients who passed the Wada test. Out of the 116 eligible patients with left MTLE-HS, 88 underwent bilateral Wada test, while 28 underwent ipsilateral Wada test. None of them developed postoperative amnesia. Approximately, one-third of patients with a failed Wada memory test when the failure was defined as a contralateral score of 8, and as an asymmetry score of failed Wada memory test and the group who passed the Wada memory test. The results remained the same when analyses were repeated at various other cutoff points. The patients with left MTLE-HS with concordant electroclinical, MRI, and neuropsychological data should not be denied ATL solely on the basis of Wada memory test results. Copyright © 2015 Elsevier Inc. All rights reserved.

Diagnostic value of transient dilatation of the left ventricle in negative dipyridamole-thallium imaging

International Nuclear Information System (INIS)

Seo, Hiromi; Doi, Y.L.; Yonezawa, Yoshihiro; Chikamori, Taishiro; Yamada, Mitsutoshi; Ozawa, Toshio

1994-01-01

To evaluate the diagnostic value of a transient dilatation of the left ventricle during dipyridamole-thallium imaging (DTI) for detecting significant coronary artery disease (CAD) in patients with negative DTI results, 81 consecutive patients were studied. Twenty one patients (26%) had CAD and 60 patients had normal coronary anatomy (NCA). The initial/delayed ratio of the left ventricular dimension, which was measured as the distance between the 2 peaks of a count profile curve on a 45deg left anterior oblique planar image, was defined as the dilatation ratio (DR) of the left ventricle. Patients with CAD had a higher incidence of chest pain after dipyridamole infusion (35 vs 13%; p 1.03) when it was greater than the mean +2 standard deviations of the DR in NCA patients. Seventy-six percent of CAD patients had an abnormal DR. A stepwise discriminant analysis revealed that an abnormal DR alone had the same ability to predict CAD (sensitivity 76%, specificity 98%, chi-square 80.9, p 1.03) is a highly specific marker for detecting CAD, even in patients with negative dipyridamole-thallium imaging. (author)

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.

Effects of L-carnitine administration on left ventricular remodeling after acute anterior myocardial infarction: The L-carnitine Ecocardiografia Digitalizzata Infarto Miocardico (CEDIM) trial

NARCIS (Netherlands)

S. Iliceto (Sabino); D. Scrutinio (Domenico); P. Bruzzi (P.); G. D'Ambrosio (Gaetano); A. Boni (Alejandro); M. Di Biase (Matteo); G. Biasco (Giuseppina); P.G. Hugenholtz (Paul); P. Rizzon (Paolo)

1995-01-01

textabstractObjectives. This study was performed to evaluate the effects of l-carnitine administration on long-term left ventricular dilation in patients with acute anterior myocardial infarction. Background. Carnitine is a physiologic compound that performs an essential role in myocardial energy

Routine Chest X-ray: Still Valuable for the Assessment of Left Ventricular Size and Function in the Era of Super Machines?

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Morales, Maria-Aurora; Prediletto, Renato; Rossi, Giuseppe; Catapano, Giosuè; Lombardi, Massimo; Rovai, Daniele

2012-01-01

The development of technologically advanced, expensive techniques has progressively reduced the value of chest X-ray in clinical practice for the assessment of left ventricular (LV) dilatation and dysfunction. Although controversial data are reported on the role of this widely available technique in cardiac assessment, it is known that the cardio-thoracic ratio is predictive of risk of progression in the NYHA Class, hospitalization, and outcome in patients with LV dysfunction. This study aimed to evaluate the reliability of the transverse diameter of heart shadow [TDH] by chest X-ray for detecting LV dilatation and dysfunction as compared to Magnetic Resonance Imaging (MRI) performed for different clinical reasons. In 101 patients, TDH was measured in digital chest X-ray and LV volumes and ejection fraction (EF) by MRI, both exams performed within 2 days. A direct correlation between TDH and end-diastolic volumes (r = .75, Pvalues of 14.5 mm in females identified LV end-diastolic volumes >150 mL (sensitivity: 82%, specificity: 69%); in males a cut-off value of 15.5 mm identified LV end-diastolic volumes >210 mL (sensitivity: 84%; specificity: 72%). A negative relation was found between TDH and LVEF (r = -.54, Pvalues of TDH discriminated patients with LV systolic dysfunction - LVEF <35% (sensitivity and specificity: 67% and 57% in females; 76% and 59% in males, respectively). Chest X-ray may still be considered a reliable technique in predicting LV dilatation by the accurate measurement of TDH as compared to cardiac MRI. Technologically advanced, expensive, and less available imaging techniques should be performed on the basis of sound clinical requests.

Aphasia following anterior cerebral artery occlusion

International Nuclear Information System (INIS)

Shimosaka, Shinichi; Waga, Shiro; Kojima, Tadashi; Shimizu, Takeo; Morikawa, Atsunori

1982-01-01

We have report two cases of aphasia that had infarcts in the distribution of the left or right anterior cerebral artery, as confirmed by computed tomography. Case 1 is a right-handed, 65-year-old man in whom computerized tomographic scanning revealed an infarction of the territory of the left anterior cerebral artery after the clipping of the anterior communicating artery aneurysm. The standard language test of aphasia (SLTA) revealed non-fluent aphasia with dysarthria, good comprehension, almost normal repetition with good articulation, and a defectiveness in writing. This syndrome was considered an instance of transcortical motor aphasia. Although three years had passed from the onset, his aphasia did not show any improvement. Case 2 is a 37-year-old man who is right-handed but who can use his left hand as well. He was admitted because of subarachnoid hemorrhage from an anterior communicating aneurysm. Because of postoperative spasm, an infarction in the distribution of the right anterior cerebral artery developed. He was totally unable to express himself vocally, but he could use written language quite well to express his ideas and had a good comprehension of spoken language. This clinical picture was considered that of an aphemia. After several weeks, his vocalization returned, but the initial output was still hypophonic. (J.P.N.)

Percutaneous coronary intervention with ABSORB biodegradable vascular scaffold in patients with left anterior descending artery disease

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К. М. Ваккосов

2017-04-01

Full Text Available Aim. The article evaluates 30-day results of percutaneous coronary intervention (PCI with ABSORB biodegradable vascular scaffold (BVS implanted in the case of stenosis of the left anterior descending (LAD coronary artery in patients with stable angina.Methods. 64 patients with significant (≥ 70% LAD disease were included in the study. At 30 days, scaffold thrombosis and major adverse cardiovascular events (all-cause mortality, myocardial infarction, stroke, target vessel revascularization were evaluated. The indicator of successful percutaneous coronary intervention (residual stenosis ≤20% in the presence of counterpulsation corresponding to TIMI 3rd Grade and in the absence of significant in-patient clinical complications and successful intervention assessed by clinical criteria (successful percutaneous coronary intervention alongside with a decrease in objective and subjective symptoms of myocardial ischemia, or their complete disappearance were also analyzed. Results. Mean age of patients was 61.6±8.5 years, with males accounting for 64%; 33% had earlier MI, 14% – diabetes mellitus. Mean left ventricular ejection fraction was 61.3±6.8%. Left anterior descending artery disease was presented in 89% of patients with SYNTAX Score 6.6±2.2. Mean number of implanted stents was 1.2±0.4, with mean length of the stented segment equal to18.7±1.8 mm and mean diameter 3.2±0.3 mm. At 30-day follow-up, the success of intervention assessed by clinical criteria amounted to 96.9% (n=62; that of myocardial infarction 3.1% (n=2; stent thrombosis 1.56% (n=1; repeated revascularization 1.56% (n=1; major adverse cardiovascular events (MACE 3.1%.Conclusion. The implantation of everolimus-eluting BVS for LAD stenosis demonstrates satisfactory results at 30-day follow-up.Received 16 January 2017. Accepted 21 March 2017.Financing: The study did not have sponsorship.Conflict of interest: The authors declare no conflict of interest.

A method to detect occult pneumothorax with chest radiography.

Science.gov (United States)

Matsumoto, Shokei; Kishikawa, Masanobu; Hayakawa, Koichi; Narumi, Atsushi; Matsunami, Katsutoshi; Kitano, Mitsuhide

2011-04-01

Small pneumothoraces are often not visible on supine screening chest radiographs because they develop anteriorly to the lung. These pneumothoraces are termed occult. Occult pneumothoraces account for an astonishingly high 52% to 63% of all traumatic pneumothoraces. A 19-year-old obese woman was involved in a head-on car accident. The admission anteroposterior chest radiographs were unremarkable. Because of the presence of right chest tenderness and an abrasion, we suspected the presence of a pneumothorax. Thus, we decided to take a supine oblique chest radiograph of the right side of the thorax, which clearly revealed a visceral pleural line, consistent with a diagnosis of traumatic pneumothorax. A pneumothorax may be present when a supine chest radiograph reveals either an apparent deepening of the costophrenic angle (the "deep sulcus sign") or the presence of 2 diaphragm-lung interfaces (the "double diaphragm sign"). However, in practice, supine chest radiographs have poor sensitivity for occult pneumothoraces. Oblique chest radiograph is a useful and fast screening tool that should be considered for cases of blunt chest trauma, especially when transport of critically ill patients to the computed tomographic suite is dangerous or when imminent transfer to another hospital is being arranged and early diagnosis of an occult pneumothorax is essential. Copyright © 2010 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

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.

Contemporary management of flail chest.

Science.gov (United States)

Vana, P Geoff; Neubauer, Daniel C; Luchette, Fred A

2014-06-01

Thoracic injury is currently the second leading cause of trauma-related death and rib fractures are the most common of these injuries. Flail chest, as defined by fracture of three or more ribs in two or more places, continues to be a clinically challenging problem. The underlying pulmonary contusion with subsequent inflammatory reaction and right-to-left shunting leading to hypoxia continues to result in high mortality for these patients. Surgical stabilization of the fractured ribs remains controversial. We review the history of management for flail chest alone and when combined with pulmonary contusion. Finally, we propose an algorithm for nonoperative and surgical management.

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.

Involuntary masturbation and hemiballismus after bilateral anterior cerebral artery infarction.

Science.gov (United States)

Bejot, Yannick; Caillier, Marie; Osseby, Guy-Victor; Didi, Roy; Ben Salem, Douraied; Moreau, Thibault; Giroud, Maurice

2008-02-01

Ischemia of the areas supplied by the anterior cerebral artery is relatively uncommon. In addition, combined hemiballismus and masturbation have rarely been reported in patients with cerebrovascular disease. We describe herein a 62-year-old right-handed man simultaneously exhibiting right side hemiballismus and involuntary masturbation with the left hand after bilateral infarction of the anterior cerebral artery territory. Right side hemiballismus was related to the disruption of afferent fibers from the left frontal lobe to the left subthalamic nucleus. Involuntary masturbation using the left hand was exclusively linked to a callosal type of alien hand syndrome secondary to infarction of the right side of the anterior corpus callosum. After 2 weeks, these abnormal behaviours were completely extinguished. This report stresses the wide diversity of clinical manifestations observed after infarction of the anterior cerebral artery territory.

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.

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

Chest X-Ray (Chest Radiography)

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... 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 ...

Bifid rib – usefulness of chest ultrasound. A case report

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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.

Differential diagnosis at admission between Takotsubo cardiomyopathy and acute apical-anterior myocardial infarction in postmenopausal women.

Science.gov (United States)

Zorzi, Alessandro; Baritussio, Anna; ElMaghawry, Mohamed; Siciliano, Mariachiara; Migliore, Federico; Perazzolo Marra, Martina; Iliceto, Sabino; Corrado, Domenico

2016-08-01

Takotsubo cardiomyopathy (TTC) typically affects postmenopausal women and clinically presents with chest pain, ST-segment elevation, elevated cardiac enzymes and apical left ventricular (LV) wall motion abnormalities that mimic 'apical-anterior' acute myocardial infarction (AMI). This study assessed whether at-admission clinical evaluation helps in differential diagnosis between the two conditions. The study compared at-admission clinical, electrocardiographic (ECG) and echocardiographic findings of 31 women (median age 67 years, interquartile range (IQR) 62-76) with typical TTC and 30 women (median age 73 years, IQR 61-81) with apical-anterior AMI due to acute occlusion of the mid/distal left anterior descending coronary artery. Women with TTC significantly more often showed PR-segment depression (62% versus 3%, p<0.001), J-waves (26% versus 3%, p=0.03), maximum ST-segment elevation ⩽2 mm (84% versus 37%, p<0.001) and ST-segment elevation in lead II (42% versus 10%, p=0.01) than those with AMI. At multivariate analysis, PR-segment depression (odds ratio (OR)=37.2, 95% confidence interval (CI)=3.4-424, p=0.002) and maximum ST-segment elevation ⩽2 mm (OR=11.1, 95% CI=1.7-99.4, p=0.01) remained the only independent predictors of TTC and the co-existence of both parameters excluded AMI with a 100% specificity. The two groups did not differ with regard to age, first troponin-I value, echocardiographic LV ejection fraction and distribution of hypo/akinetic LV segments. At-admission electrocardiogram (but no clinical, laboratory and echocardiographic features) allows differential diagnosis between TTC and apical-anterior AMI in postmenopausal women. The combination of PR-segment depression and mild (⩽2 mm) ST-segment elevation predicted TTC with greater accuracy than traditional parameters such as localisation of ST-segment elevation and reciprocal ST-segment depression. © The European Society of Cardiology 2015.

Congenital coronary-pulmonary artery fistula originating from right and left coronary artery

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Ali Kemal Gür

2013-12-01

Full Text Available Coronary artery fistula (CAF is a rare congenital anomalywith an incidence of 1 in 50 000 live births. The fistula wasobserved at the right coronary artery in 53%, the left coronaryartery in 42% and both coronary artery in 5% of thecases. Echocardiography examination in a 46 year-oldwoman with the symptoms of chest pain, palpitation anddyspnea revealed a severe mitral valve insufficiency anda moderate to severe tricuspid valve insufficiency. A CAForiginating from the proximal part of the left anterior descendingartery (LAD and another fistula originating fromosteal part of the right coronary artery (RCA were detectedby coronary angiography. Both fistulas were draininginto the main pulmonary artery. The coronary artery fistulaclosed under cardiopulmonary by-pass. Mitral insufficiencyoriginated from the posterior leaflet was diagnosedintra-operative exploration, and thereafter it was repairedwith mitral annuloplasty including a quadrangular resectionand use of a 32 No St Jude mitral ring. Tricuspid valvewas repaired with Calangos Ring annuloplasty. Followingsix day hospital stay, the woman was discharged free ofany symptom.Key words: Dyspnea, double arteriovenous fistula, mitral and tricuspid insufficiency

Dilatation of the hemiazygos system on plain films of the chest

International Nuclear Information System (INIS)

Catalano, D.

1983-01-01

The enlargement of the hemiazygos system and the superior intercostal vein as a collateral pathway in cases of obstruction of the superior or the inferior vena cava is recognizable on the frontal and lateral plain chest films. It appears in frontal radiographs as an additional line parallel to the left paraspinal line with a bulging at the level or superiorly to the aortic knob and continuing with the shadow of the left brachiocephalic vessels. In the lateral chest view it is evident as an inhomogeneous soft tissue density posteriorly to the lower third of the trachea. (orig.) [de

Mitral Annulus Myxoma Extending into Left Atrium and Left Ventricle with Severe Mitral Regurgitation as a Pre-Operative Finding, a Rarity

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Hamza Abdur Rahim Khan

2017-06-01

Full Text Available Cardiac tumors constitute 0.2% of all tumors. Primary cardiac tumors occur infrequently with an incidence of 0.0017-0.19% as shown by autopsies performed in non-selected populations. Among these tumors, cardiac myxomas are most commonly encountered, with left atrial myxomas being more prevalent than right atrial ones. The classic triad of symptoms, of which at least one is present in a patient with atrial myxoma, are obstructive traits including dyspnea and syncope, constitutional symptoms such as fever and anorexia, and thromboembolic events. Surgical resection confers almost definitive treatment with recurrence rates being as low as 3%. A 50-year-old woman referred to the Emergency Unit with a sudden episode of chest heaviness and shortness of breath. There was no significant physical examination finding and all routine lab investigations were normal. She underwent an angiography that revealed tight left anterior descending artery stenosis. An angioplasty was also performed, but she had an episode of presyncope immediately. Then, echocardiogram was performed that showed a large left atrial myxoma causing severe mitral regurgitation. Thus, urgent open heart surgery was planned. The myxoma was identified and excised, the mitral annulus resolved, and normal flow was restored. The patient was then discharged home and followed up for 2 months with no complaints. In the current study, we reported a rare case where mitral regurgitation was caused by a left atrial myxoma. Our report highlighted the diverse clinical spectrum of myxoma and emphasized the need for early echocardiographic diagnosis to aid in identification of myxoma followed by early surgical intervention.

[Left ventricular projectile migration after an accidental close-range gunshot wound].

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Driessen, A; Tjardes, T; Eikermann, C; Trojan, S; Fröhlich, M; Grimaldi, G; Kosse, N

2016-07-01

We report the case of a 24-year-old female after sustaining a shotgun wound in the left upper extremity and chest. Initial emergency diagnostics revealed numerous shotgun pellets scattered throughout the left-side soft tissue, chest and upper lung lobe with one pellet having migrated into the left ventricle of the heart.Due to the devastating injury pattern, gunshot wounds are interdisciplinarily challenging and should include extended initial diagnostics, such as contrast agent CT. The potential toxicity of elevated lead blood levels have to be taken into further account.

Long-term clinical outcomes of the left ventricular thrombus in patients with ST elevation anterior myocardial infarction

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Mahmoud Ebrahimi

2015-01-01

Full Text Available BACKGROUND: This study was performed to determine the size of left ventricular thrombus (LVT, risk of systemic embolization and response to medical treatment during 18 months of follow up in the patients with anterior-ST elevation myocardial infarction (aSTEMI. METHODS: This cross-sectional study was performed on thirty-five patients with anterior myocardial infarction (MI, in Emam Reza Hospital and Ghaem Hospital, Mashhad, Iran, from August 2008 to January 2011. Warfarin was prescribed for all the patients. Transthoracic echocardiographic study was performed on the 1st, 2nd, 4th, 6th, 12th and 18th months. Outcomes included rate of death, MI, stroke, systemic embolization, major bleeding and change in thrombus size following treatment. RESULTS: The resolve rate of clot on the 2nd, 4th, 6th, 12th and 18th months was 64.7, 86.6, 81.4, 81.4 and 100 percent, respectively. In five patients with complete clot resolution, clot reformation occurred after warfarin discontinuation. In these patients, left ventricular ejection fraction (LVEF improvement was poor. During the study period, five patients died due to severe heart failure. One patient developed hematuria whereas non-experienced thromboembolic events. The mean LVEF at study initiation was 30.8 ± 0.92%, which improved to 42 ± 0.84% (P < 0.05 at the end. CONCLUSION: All LVT was resolved with a combination therapy of antiplatelet and warfarin without any thromboembolic event. In patients with a poor improvement in the LV function, due to the risk of LVT reformation, lifelong warfarin therapy was recommended. 

Does left ventricular function improve with L-carnitine after acute myocardial infarction?

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Iyer R

1999-04-01

Full Text Available A double blind randomized placebo controlled clinical trial was carried out to assess the efficacy and safety of L-carnitine in patients suffering from acute anterior wall myocardial infarction with respect to left ventricular function. Sixty patients (34 men, 26 women, mean age 56+11 yr. with acute anterior wall myocardial infarction were randomized to placebo and L-carnitine. All the patients were given intravenous L-carnitine / placebo in the dose of 6gm/day for the first seven days followed by oral L-carnitine / placebo 3 gm/day in three divided doses for a period of three months. Echocardiography was performed for regional wall motion abnormality, left ventricular end systolic volume (ESV, end diastolic volume (EDV and ejection fraction (EF on admission, after seven days and after three months of the infarction. Forty-four patients completed the study. There were three deaths, two in the placebo and one in the L-carnitine group (p>0.05. Thirteen patients were lost to follow up. Echo parameters in both groups were comparable (p>0.05. The duration of chest pain prior to initiation of the I.V. L-carnitine was 7.5 + 5.2 hrs in the L-carnitine group and 7 + 4 hrs in the placebo group (p>0.05. There was no statistical difference in the EF, ESV and EDV on admission, at discharge and after three months in the L-carnitine and the placebo groups (p>0.05. No significant adverse effects were noted. L-carnitine, though a safe drug, does not affect the left ventricular function in patients with myocardial infarction.

Routinely obtained chest X-rays after elective video-assisted thoracoscopic surgery can be omitted in most patients; a retrospective, observational study

DEFF Research Database (Denmark)

Bjerregaard, Lars S; Jensen, Katrine; Petersen, René Horsleben

2015-01-01

divided into three groups according to the degree of pulmonary resection. The chest X-rays (obtained anterior-posterior in one plane with the patient in the supine position) were categorized as abnormal if showing pneumothorax >5 cm, possible intra-thoracic bleeding and/or a displaced chest tube. Medical....... Proportions of abnormal chest X-rays were unequally distributed between groups (p pneumothorax >5 cm and one showed a kinked chest...

Left anterior descending coronary artery myocardial bridging by multislice computed tomography: Correlation with clinical findings

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Jodocy, Daniel; Aglan, Iman [Clinical Department of Radiology II, Innsbruck Medical University, Innsbruck (Austria); Friedrich, Guy [Clinical Department of Cardiology, Innsbruck Medical University, Innsbruck (Austria); Mallouhi, Ammar [Clinical Department of Radiology II, Innsbruck Medical University, Innsbruck (Austria); Pachinger, Otmar [Clinical Department of Radiology II, Innsbruck Medical University, Innsbruck (Austria); Clinical Department of Cardiology, Innsbruck Medical University, Innsbruck (Austria); Jaschke, Werner [Clinical Department of Radiology II, Innsbruck Medical University, Innsbruck (Austria); Feuchtner, Gudrun M. [Clinical Department of Radiology II, Innsbruck Medical University, Innsbruck (Austria)], E-mail: gudrun.feuchtner@i-med.ac.at

2010-01-15

Objective: To assess the relationship between left anterior descending (LAD) coronary artery myocardial bridging detected by 64-slice computed tomography (CT) and clinical findings. Methods: 221 consecutive patients were examined with coronary 64-slice CT angiography. 21 patients with coronary stenosis >50% were excluded. The length, depth, and luminal narrowing of LAD myocardial bridges during systole and diastole were measured. CT findings were compared with the treadmill ECG-stress test, and clinical symptoms. Results: Myocardial bridges of the LAD were found in 23% of patients (51/221) (length, 14.9 {+-} 6.5 mm; depth, 2.6 {+-} 1.6 mm). A significant difference was noted between the LAD luminal diameter before the intramyocardial course and intramyocardially, for both diastole and systole (p < 0.001); with a higher diameter reduction of 27% for end-systole compared to end-diastole with 15% (p = 0.006). Systolic LAD intramyocardial luminal narrowing >50% was found in 3/25 (8%). 30/51 (59%) of bridges were 'deep' (>2 mm myocardial depth), 21/51 (41%) were 'superficial'. The prevalence of a positive ECG-stress tests for the anterior myocardial region was significantly higher in patients with LAD myocardial bridges (34/50; 68%) compared to those without (28/144; 19.4%) (p < 0.001). There was no difference between 'superficial' and 'deep' LAD myocardial bridges in regard to a positive treadmill ECG-stress test. Typical angina was rare with 6%. Conclusion: LAD myocardial bridges are common findings and can possibly explain a positive exercise ECG-stress test for anterior myocardial ischemia. Intramyocardial LAD segments show mild-to-moderate luminal narrowing at rest, which is higher during end-systolic phase.

Ostial left main coronary stenosis in a frequent flyer.

LENUS (Irish Health Repository)

O'Sullivan, John F

2009-05-15

A 52 year old gentleman presented with chest pain, after a long distance flight from India; he had made long haul flights every 2 weeks over the last 5 years as part of his job. His ECG revealed T wave inversion in leads V1-3. Cardiac biomarkers including troponin were negative; we proceeded to exercise stress testing (EST). This revealed 2 mm ST depression at 2 min of the standard Bruce protocol, associated with chest pain. He was taken immediately to the coronary catheterization laboratory; engagement of the left main caused pressure damping with 6 French, then 5 French diagnostic Judkins left 4 catheters. An ostial left main stenosis was seen; the right and left coronary trees otherwise had no significant stenoses. He had normal LV function. He underwent inpatient CABG 7 days later.

Effects of dual pathology on cognitive outcome following left anterior temporal lobectomy for treatment of epilepsy.

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Prayson, B E; Prayson, R A; Kubu, C S; Bingaman, W; Najm, I M; Busch, R M

2013-09-01

The objective of this retrospective study was to determine if dual pathology [DUAL - focal cortical dysplasia (FCD) and mesial temporal sclerosis (MTS)] in patients with left temporal lobe epilepsy is associated with greater risk for cognitive decline following temporal lobectomy than single pathology (MTS only). Sixty-three adults (Mage=36.5years, female: 52.4%) who underwent left anterior temporal lobectomy for treatment of epilepsy (MTS=28; DUAL=35) completed preoperative and postoperative neuropsychological evaluations. The base rate of dual pathology was 55.5%. Repeated measures ANOVAs yielded significant 2-way interactions (group×time) on most measures of language and memory with generally moderate effect sizes. Specifically, patients with MTS only demonstrated postoperative declines, while those with dual pathology remained unchanged or improved. Results suggest that dual pathology may be associated with better cognitive outcome following epilepsy surgery than MTS alone, possibly reflecting limited functionality of the resected tissue or intrahemispheric reorganization of function in the context of a developmental lesion. Copyright © 2013 Elsevier Inc. All rights reserved.

Complications related to osteopenia in the thoracic spine on admission chest radiographs of substance abuse detoxification patients

International Nuclear Information System (INIS)

Haramati, L.B.; Alterman, D.D.; Israel, G.M.; Haramati, N.; Mallavurapu, R.

1998-01-01

Objective. To assess the prevalence of complications related to osteopenia in the thoracic spine (anterior wedging and fish vertebrae) of patients admitted for substance abuse detoxification. Design and patients. We retrospectively identified 150 sequential patients admitted to our drug and alcohol detoxification ward in whom posteroanterior and lateral admission chest radiographs and clinical charts were available for review. There were 116 men and 34 women with a mean age of 37 years (range 19-67 years). Thirty-eight patients were admitted for drug detoxification, 37 for alcohol detoxification, and 75 for drug and alcohol detoxification. These patients were compared with 66 age- and sex-matched controls from our hospital's employee health service. Two radiologists reviewed all chest radiographs for the presence of anterior wedging and fish vertebrae in the thoracic spine and other nonspinal fractures. Serum calcium and inorganic phosphorus levels were recorded for the substance abuse detoxification patients. Results. Forty-nine percent (n=73) of detoxification patients had complications of osteopenia in the thoracic spine including: anterior wedging (n=47), fish vertebrae (n=21), or both (n=5). Twenty-four percent (n=36) of patients had an elevated serum inorganic phosphorus level and one patient had an elevated serum calcium level. Patients with anterior wedging or fish vertebrae included: 45% (n=45) of patients below age 40 years, 35% (n=12) of women, 41% (n=15) of drug detoxification patients, 58% (n=22) of alcohol detoxification patients, 48% (n=36) of drug and alcohol detoxification patients, and 47% (n=17) of patients with elevated serum inorganic phosphorus (P=NS). Six percent (n=9) of our study population had nonspinal fractures on their chest radiographs. Twenty-one percent (n=14) of controls had complications of osteopenia in the thoracic spine (all anterior wedging). This prevalence differed significantly (P<0.05, chi-squared) from the study population

Right bundle branch block and anterior wall ST elevation myocardial infarction.

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Trofin, Monica; Israel, Carsten W; Barold, S Serge

2017-09-01

We report the case of an acute anterior wall ST elevation myocardial infarction with new left anterior fascicular block and pre-existing right bundle branch block. Due to a wide right bundle branch block, no ST segment elevation was visible in lead V1. The left anterior fascicular block was caused by proximal occlusion of the left artery descending and disappeared after acute revascularization. However, also the R' of the right bundle branch block became significantly shorter after revascularization, dismanteling a minor ST segment elevation. The ST elevation in lead V1 in anterior wall infarction and right bundle branch block may merge with the R' and cause a further QRS widening as an "equivalent" to the ST elevation.

Hyperlexia and ambient echolalia in a case of cerebral infarction of the left anterior cingulate cortex and corpus callosum.

Science.gov (United States)

Suzuki, Tadashi; Itoh, Shouichi; Hayashi, Mototaka; Kouno, Masako; Takeda, Katsuhiko

2009-10-01

We report the case of a 69-year-old woman with cerebral infarction in the left anterior cingulate cortex and corpus callosum. She showed hyperlexia, which was a distinctive reading phenomenon, as well as ambient echolalia. Clinical features also included complex disorders such as visual groping, compulsive manipulation of tools, and callosal disconnection syndrome. She read words written on the cover of a book and repeated words emanating from unrelated conversations around her or from hospital announcements. The combination of these two features due to a focal lesion has never been reported previously. The supplementary motor area may control the execution of established subroutines according to external and internal inputs. Hyperlexia as well as the compulsive manipulation of tools could be interpreted as faulty inhibition of preexisting essentially intact motor subroutines by damage to the anterior cingulate cortex reciprocally interconnected with the supplementary motor area.

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

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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.

Left mainstem bronchial narrowing: a vascular compression syndrome? Evaluation by magnetic resonance imaging

International Nuclear Information System (INIS)

Hungate, R.G.; Newman, B.; Meza, M.P.

1998-01-01

Background and objective. Vascular compression of the left mainstem bronchus (LMSB) between the descending aorta (DA) and pulmonary artery (PA) has been suggested as a cause for LMSB narrowing in children. These anatomic relationships have not been compared with those in children with a normal LMSB. Materials and methods. We undertook a retrospective review of the medical and radiologic records of 10 symptomatic young children (1-19 months, 5 boys, 5 girls) with MR demonstration of LMSB narrowing and compared them to 40 young children without great vessel or bronchial abnormality on MR (1 week-19 months, 28 boys, 12 girls). Chest MR evaluation included assessment of airway and great vessel anatomy with specific attention to the course of the LMSB and its relationship to the adjacent DA and PA. The position of the DA in relation to the spine was carefully evaluated. Results. Five children had focal and five had diffuse LMSB narrowing. DA position at the level of the crossing LMSB: in 40 % of symptomatic children the DA was located in front of the adjacent vertebral body; in 40 %, 1 / 2 - 3 / 4 and in 20 % 1 / 4 - 1 / 2 of the circumference of the DA was located anterior to the spine. In the control group, the DA was prespinal in 10 %, with a trend toward a more paraspinal location of the DA. The trend toward a difference in position of the DA between symptomatic and control patients was statistically significant (P < 0.05). DA position was not related to age (up to 19 months). At the level where the LMSB crossed the DA, a segment of the PA was located anterior to the LMSB, more often the right PA (RPA) or pulmonary bifurcation in symptomatic children and the left PA (LPA) in controls. No correlation was apparent between length of LMSB narrowing and DA or PA position. Chest radiographic abnormalities, when present, were subtle. Excellent MR/bronchoscopic correlation of LMSB narrowing was found in nine of the ten symptomatic children. One child underwent posterior

Outcomes of Complete Versus Partial Surgical Stabilization of Flail Chest.

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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.

Chest wall syndrome among primary care patients: a cohort study

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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.

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.

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

CT evaluation of decrease in attenuation in the superior segment of the left lower lobe

International Nuclear Information System (INIS)

Inaoka, Tsutomu; Takahashi, Koji; Ono, Hidetoshi

2003-01-01

We occasionally see decrease in attenuation in the superior segment of the left lower lobe on normal chest CT and notice that this finding could be seen in elder population. Then, we assessed the frequency, age distribution and cause of decrease in attenuation in the superior segment of the left lower lobe. Chest CT scans of 246 patients without lung or cardiac disorders were retrospectively reviewed. Segmental low attenuation area in the superior segment of the left lower lobe was identified in 12 patients (4.9%), which were 65-92 years old with mean age of 77.2 years old. In all of them, chest CT demonstrated that the tortuous descending aorta compressed directly the superior segmental bronchus of the left lower lobe. It is concluded that the lateral tortuousity of the descending aorta could cause decrease in attenuation in the superior segment of the left lower lobe. (author)

Postoperative chest radiographic changes after on- and off-pump coronary surgery

International Nuclear Information System (INIS)

Narayan, P.; Caputo, M.; Jones, J.; Al-Tai, S.; Angelini, G.D.; Wilde, P.

2005-01-01

AIM: A variety of chest radiograph abnormalities are recognized after coronary artery bypass grafting (CABG). This study analyzes the appearance of preoperative and postoperative chest radiographs in two groups of patients undergoing myocardial revascularization with or without the use of cardiopulmonary bypass (CPB). METHODS: Chest radiographs (preoperative and at 1 day, 6 days and 6 to 8 weeks post operatively) were analyzed according to a detailed protocol in cases of conventional CABG on CPB (n=60) or off-pump coronary artery bypass (OPCAB) (n=60) surgery. On each film 17 different major potential postoperative abnormalities were analyzed. RESULTS: Clinical findings were similar in the two groups. Patients undergoing OPCAB surgery had decreased blood loss, decreased red cell and platelet transfusion, significantly lower intubation time and required less postoperative inotropic support compared with patients undergoing CPB. The CPB group had a significantly higher incidence of left band atelectasis than the OPCAB group (37.6% vs 17.5%, p=0.01) at 6 days postoperatively. There was no other statistically significant difference in any of the 16 remaining major chest radiograph findings between the two groups. CONCLUSION: Although OPCAB surgery is associated with improved clinical outcome compared with conventional CABG surgery, the analysis of postoperative chest radiographs demonstrated only a minor benefit as shown by a reduced degree of left band atelectasis in the OPCAB group

Postoperative chest radiographic changes after on- and off-pump coronary surgery

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Narayan, P. [Bristol Heart Institute, Bristol Royal Infirmary, Bristol (United Kingdom); Caputo, M. [Bristol Heart Institute, Bristol Royal Infirmary, Bristol (United Kingdom); Jones, J. [Department of Radiology, Bristol Royal Infirmary, Bristol (United Kingdom); Al-Tai, S. [Department of Radiology, Bristol Royal Infirmary, Bristol (United Kingdom); Angelini, G.D. [Bristol Heart Institute, Bristol Royal Infirmary, Bristol (United Kingdom); Wilde, P. [Department of Radiology, Bristol Royal Infirmary, Bristol (United Kingdom)]. E-mail: peter.wilde@ubht.swest.nhs.uk

2005-06-01

AIM: A variety of chest radiograph abnormalities are recognized after coronary artery bypass grafting (CABG). This study analyzes the appearance of preoperative and postoperative chest radiographs in two groups of patients undergoing myocardial revascularization with or without the use of cardiopulmonary bypass (CPB). METHODS: Chest radiographs (preoperative and at 1 day, 6 days and 6 to 8 weeks post operatively) were analyzed according to a detailed protocol in cases of conventional CABG on CPB (n=60) or off-pump coronary artery bypass (OPCAB) (n=60) surgery. On each film 17 different major potential postoperative abnormalities were analyzed. RESULTS: Clinical findings were similar in the two groups. Patients undergoing OPCAB surgery had decreased blood loss, decreased red cell and platelet transfusion, significantly lower intubation time and required less postoperative inotropic support compared with patients undergoing CPB. The CPB group had a significantly higher incidence of left band atelectasis than the OPCAB group (37.6% vs 17.5%, p=0.01) at 6 days postoperatively. There was no other statistically significant difference in any of the 16 remaining major chest radiograph findings between the two groups. CONCLUSION: Although OPCAB surgery is associated with improved clinical outcome compared with conventional CABG surgery, the analysis of postoperative chest radiographs demonstrated only a minor benefit as shown by a reduced degree of left band atelectasis in the OPCAB group.

Spontaneous chylothorax complicating small cell lung cancer – Review of aetiology and diagnosis

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S. Hanina

2015-01-01

Full Text Available We report the first case of spontaneous chylothorax complicating small cell lung cancer. A 52 year old female presented with exertional dyspnoea, left-sided chest and neck pain, and dysphagia. The chest X-ray on admission revealed a large left-sided pleural effusion. A subsequent CT chest showed a large anterior mediastinal mass with a left brachiocephalic and jugular vein thrombosis. The patient underwent medical thoracoscopy with chest drain insertion, which drained pleural fluid high in triglycerides, consistent with a chylothorax. Due to its uncommon nature, the management of chylothorax is not well defined. Alongside the case report, we provide a review of aetiology, mechanism and diagnosis with a brief summary of treatment options.

Traumatic Avulsion of the Serratus Anterior Muscle in a Collegiate Rower: A Case Report.

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Carr, James B; John, Quincy E; Rajadhyaksha, Evan; Carson, Eric W; Turney, Kelly L

2016-09-21

A 19-year-old female collegiate rower presented with a new, painful mass along her right anterolateral chest wall after competition. The patient was diagnosed with a rupture of the serratus anterior muscle from its costal attachments, as confirmed by magnetic resonance imaging. The patient fully recovered after a period of rest followed by a graduated 2-month physical therapy regimen consisting of stretching and scapulothoracic and core strengthening. A traumatic rupture of the serratus anterior muscle should be suspected in athletes who present with a painful chest wall mass after exertion of large forces through the scapulothoracic region. Athletes can return to play after nonoperative management. © 2016 The Author(s).

Chest radiological patterns predict the duration of mechanical ventilation in children with RSV infection

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Prodhan, Parthak; Westra, Sjirk J.; Lin, James; Karni-Sharoor, Sarit; Regan, Susan; Noviski, Natan

2009-01-01

RSV-infected children demonstrate various radiographic features, some of which are associated with worse clinical outcomes. To investigate whether specific chest radiological patterns in RSV-infected children with acute respiratory failure (ARF) in the peri-intubation period are associated with prolonged duration of mechanical ventilation. We included RSV-infected children 8 days, a backward stepwise regression arrived at a model that included age and right and left lung atelectasis. Using day 2 chest radiograph results, the best model included age and left lung atelectasis. A model combining the two days' findings yielded an area under the ROC curve of 0.92 with a satisfactory fit (P = 0.95). Chest radiological patterns around the time of intubation can identify children with RSV-associated ARF who would require prolonged mechanical ventilation. (orig.)

A case of anterior ischemic optic neuropathy associated with uveitis

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Sugahara M

2013-05-01

Full Text Available Michitaka Sugahara, Takayuki Fujimoto, Kyoko Shidara, Kenji Inoue, Masato Wakakura Inouye Eye Hospital, Tokyo, Japan Introduction: Here, we describe a patient who presented with anterior ischemic optic neuropathy (AION and subsequently developed uveitis. Case: A 69-year-old man was referred to our hospital and initially presented with best-corrected visual acuities (BCVA of 20/40 (right eye and 20/1000 (left eye and relative afferent pupillary defect. Slit-lamp examination revealed no signs of ocular inflammation in either eye. Fundus examination revealed left-eye swelling and a pale superior optic disc, and Goldmann perimetry revealed left-eye inferior hemianopia. The patient was diagnosed with nonarteritic AION in the left eye. One week later, the patient returned to the hospital because of vision loss. The BCVA of the left eye was so poor that the patient could only count fingers. Slit-lamp examination revealed 1+ cells in the anterior chamber and the anterior vitreous in both eyes. Funduscopic examination revealed vasculitis and exudates in both eyes. The patient was diagnosed with bilateral panuveitis, and treatment with topical betamethasone was started. No other physical findings resulting from other autoimmune or infectious diseases were found. No additional treatments were administered, and optic disc edema in the left eye improved, and the retinal exudates disappeared in 3 months. The patient's BCVA improved after cataract surgery was performed. Conclusion: Panuveitis most likely manifests after the development of AION. Keywords: anterior ischemic optic neuropathy, uveitis

Digital luminescent radiography: A substitute for conventional chest radiography?

International Nuclear Information System (INIS)

Neufang, K.F.R.; Krug, B.; Lorenz, R.; Steinbrich, W.

1990-01-01

The image quality of digital luminescent radiography (DLR) is sufficient for routine biplane chest radiography and for follow-up studies of heart size, pulmonary congestion, coin lesions, infiltrations, atelectasis, pleural effusions, and mediastinal and hilar lymph node enlargement. Chest radiography in the intensive care unit may in most cases be performed using the DLR technique. there is no need for repeat shots because of incorrect exposure, and the position of catheters, tubes, pacemakers, drains and artificial heart valves, the mediastinum, and the retrocardiac areas of the left lung are more confidently assessed on the edge-enhanced DLR films than on conventional films. Nevertheless, DLR is somewhat inferior to conventional film-screen radiography of the chest as it can demonstrate or rule out subtle pulmonary interstitial disease less confidently. There is no reduction of radiation exposure of the chest in DLR compared with modern film-screen systems. As a consequence, DLR is presently not in a position to replace traditional film-screen radiography of the chest completely. (orig.) [de

The phrenic nerve with accompanying vessels: a silent cause of cardiovascular border obliteration on chest radiography.

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Farhana, Shiri; Ashizawa, Kazuto; Hayashi, Hideyuki; Ogihara, Yukihiro; Aso, Nobuya; Hayashi, Kuniaki; Uetani, Masataka

2015-12-01

Our aim was to clarify the frequency of cardiovascular border obliteration on frontal chest radiography and to prove that the phrenic nerve with accompanying vessels can be considered as a cause of obliteration of cardiovascular border on an otherwise normal chest radiography. Two radiologists reviewed chest radiographs and computed tomography (CT) images of 100 individuals. CT confirmed the absence of intrapulmonary or extrapulmonary abnormalities in all of them. We examined the frequency of cardiovascular border obliteration on frontal chest radiography and summarized the causes of obliteration as pericardial fat pad, phrenic nerve, intrafissure fat, pulmonary vessels, and others, comparing them with CT in each case. Cardiovascular border was obliterated on frontal chest radiography in 46 cases on the right and in 61 on the left. The phrenic nerve with accompanying vessels was found to be a cause of obliteration in 34 of 46 cases (74%) on the right and 29 of 61 (48%) cases on the left. The phrenic nerve was the most frequent cause of cardiovascular border obliteration on both sides. The phrenic nerve with accompanying vessels, forming a prominent fold of parietal pleura, can be attributed as a cause of cardiovascular border obliteration on frontal chest radiography.

Chest radiography after minor chest trauma

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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.

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.)

Clinical implications of anterior S-T segment depression in patients with acute inferior myocardial infarction

International Nuclear Information System (INIS)

Croft, C.H.; Woodward, W.; Nicod, P.; Corbett, J.R.; Lewis, S.E.; Willerson, J.T.; Rude, R.E.

1982-01-01

To assess various factors associated with anterior S-T segment depression during acute inferior myocardial infarction, 47 consecutive patients with electrocardiographic evidence of a first transmural inferior infarction were studied prospectively with radionuclide ventriculography an average of 7.3 hours (range 2.9 to 15.3) after the onset of symptoms. Thirty-nine patients (Group I) had anterior S-T depression in the initial electrocardiogram and 8 (Group II) did not have such reciprocal changes. There was no difference between the two groups in left ventricular end-diastolic or end-diastolic volume index or left ventricular ejection fraction. Stroke volume index was greater in Group I than in Group II. There were no group differences in left ventricular total or regional wall motion scores. A weak correlation existed between the quantities (mV) or inferior S-T segment elevation and reciprocal S-T depression. No relation between anterior S-T segment depression and the left ventricular end-diastolic volume index could be demonstrated; the extent of left ventricular apical and right ventricular wall motion abnormalities, both frequently associated with inferior infarction, did not correlate with the quantity of anterior S-T depression. These data show that anterior S-T segment depression occurs commonly during the early evolution of transmural inferior infarction, is not generally a marker of functionally significant anterior ischemia and cannot be used to predict left ventricular function in individual patients. Anterior S-T segment depression may be determined by reciprocal mechanisms

Orthodontic-periodontic intervention of pathological migration of maxillary anterior teeth in advanced periodontal disease.

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Panchal, Anita H; Patel, Vasumati G; Bhavsar, Neeta V; Mehta, Hardik V

2013-05-01

This case report presents a female patient whose chief complaint was of mobile and palatally drifted upper left central incisor which led to malalignment of upper anterior teeth. Orthodontic treatment of upper left central incisor was done with the help of 'Z' spring for the alignment of the upper anterior teeth. It was followed by splinting of upper anterior teeth to improve the stability and masticatory comfort. Regenerative periodontal surgery with Decalcified freeze dried bone allograft was done in relation to upper left central incisor.

Anterior mediastinal synovial sarcoma: A case report and literature review

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Wen-xiang YUE

2015-01-01

Full Text Available Objective　To study the clinical manifestations, pathologic features, diagnosis, treatment and prognosis of primary synovial sarcoma in the anterior mediastinum. Methods　A case of primary synovial sarcoma in the anterior mediastinum was reported. Clinical features, imaging manifestations, pathology features and therapeutic effect were analysed and the relevant literature was reviewed. Results　A 48-year-male patient was admitted with complaint of right chest pain for 4 days. Chest computerized tomography revealed a large mass located at the right anterior mediastinum, and it was primarily diagnosed as invasive thymoma. Pathological examination by CT-guided percutaneous needle biopsy manifested that, under microscope, the tumor cells were short and spindle in shape forming a nest structure, suggested it was a thymoma. The patient then underwent resection of thymoma with removal of fat and connective tissue in the anterior mediastinum. During the operation the size of the tumor was 15cm×15cm×10cm, being located at the anterior mediastinum, and it tended to bleed. The diagnosis of primary monophasic synovial sarcoma in the mediastinum was confirmed by postoperative/pathology examination. Immunohistochemistry staining showed that the tumor cells were positive for the markers Bcl-2 and EMA, but negative for the markers CK (pan and S100. The patient suffered from local recurrence with metastases to lung 4 months after surgery. The patient received 2 chemotherapeutic courses with ifosfamide, epirubicin and cisplatin. He died 6 months after surgery. Conclusion　Primary synovial sarcoma in the anterior mediastinum is an extremely rare and highly malignant tumor with poor prognosis. The diagnosis depends on the pathological features, immunohistochemistry and RT-PCR. Radical resection combined with comprehensive treatment may improve the survival rate. DOI: 10.11855/j.issn.0577-7402.2014.12.12

Value of the radiological study of the thorax for diagnosing left ventricular dysfunction in Chagas' disease

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Perez Amanda Arantes

2003-01-01

Full Text Available OBJECTIVE: To determine the value of the radiological study of the thorax for diagnosing left ventricular dilation and left ventricular systolic dysfunction in patients with Chagas' disease. METHODS: A cross-sectional study of 166 consecutive patients with Chagas' disease and no other associated diseases. The patients underwent cardiac assessment with chest radiography and Doppler echocardiography. Sensitivity, specificity, and positive and negative predictive values of chest radiography were calculated to detect left ventricular dysfunction and the accuracy of the cardiothoracic ratio in the diagnosis of left ventricular dysfunction with the area below the ROC curve. The cardiothoracic ratio was correlated with the left ventricular ejection fraction and the left ventricular diastolic diameter. RESULTS: The abnormal chest radiogram had a sensitivity of 50%, specificity of 80.5%, and positive and negative predictive values of 51.2% and 79.8%, respectively, in the diagnosis of left ventricular dysfunction. The cardiothoracic ratio showed a weak correlation with left ventricular ejection fraction (r=-0.23 and left ventricular diastolic diameter (r=0.30. The area calculated under the ROC curve was 0.734. CONCLUSION: The radiological study of the thorax is not an accurate indicator of left ventricular dysfunction; its use as a screening method to initially approach the patient with Chagas' disease should be reevaluated.

Potential of right to left ventricular volume ratio measured on chest CT for the prediction of pulmonary hypertension: correlation with pulmonary arterial systolic pressure estimated by echocardiography

International Nuclear Information System (INIS)

Lee, Heon; Kim, Seok Yeon; Lee, Soo Jeong; Kim, Jae Kyun; Reddy, Ryan P.; Schoepf, U.J.

2012-01-01

To investigate the correlation of right ventricular (RV) to left ventricular (LV) volume ratio measured by chest CT with pulmonary arterial systolic pressure (PASP) estimated by echocardiography. 104 patients (72.47 ± 13.64 years; 39 male) who had undergone chest CT and echocardiography were divided into two groups (hypertensive and normotensive) based upon an echocardiography-derived PASP of 25 mmHg. RV to LV volume ratios (RV V /LV V ) were calculated. RV V /LV V was then correlated with PASP using regression analysis. The Area Under the Curve (AUC) for predicting pulmonary hypertension on chest CT was calculated. In the hypertensive group, the mean PASP was 46.29 ± 14.42 mmHg (29-98 mmHg) and there was strong correlation between the RV V /LV V and PASP (R = 0.82, p V /LV V were 0.990 and 0.892. RV V /LV V was 1.01 ± 0.44 (0.51-2.77) in the hypertensive and 0.72 ± 0.14 (0.52-1.11) in the normotensive group (P V /LV V , sensitivity and specificity for predicting pulmonary hypertension over 40 mmHg were 79.5 % and 90 %, respectively. The AUC for predicting pulmonary hypertension was 0.87 RV/LV volume ratios on chest CT correlate well with PASP estimated by echocardiography and can be used to predict pulmonary hypertension over 40 mmHg with high sensitivity and specificity. (orig.)

Conceptus radiation dose and risk from chest screen-film radiography

International Nuclear Information System (INIS)

Damilakis, John; Perisinakis, Kostas; Dimovasili, Evangelia; Prassopoulos, Panos; Gourtsoyiannis, Nicholas; Varveris, Haralambos

2003-01-01

The objectives of the present study were to (a) estimate the conceptus radiation dose and risks for pregnant women undergoing posteroanterior and anteroposterior (AP) chest radiographs, (b) study the conceptus dose as a function of chest thickness of the patient undergoing chest radiograph, and (c) investigate the possibility of a conceptus to receive a dose of more than 10 mGy, the level above which specific measurements of conceptus doses may be necessary. Thermoluminescent dosimeters were used for dose measurements in anthropomorphic phantoms simulating pregnancy at the three trimesters of gestation. The effect of chest thickness on conceptus dose and risk was studied by adding slabs of lucite on the anterior and posterior surface of the phantom chest. The conceptus risk for radiation-induced childhood fatal cancer and hereditary effects was calculated based on appropriate risk factors. The average AP chest dimension (d a ) was estimated for 51 women of childbearing age from chest CT examinations. The value of d a was estimated to be 22.3 cm (17.4-27.2 cm). The calculated maximum conceptus dose was 107 x 10 -3 mGy for AP chest radiographs performed during the third trimester of pregnancy with maternal chest thickness of 27.2 cm. This calculation was based on dose data obtained from measurements in the phantoms and d a estimated from the patient group. The corresponding average excess of childhood cancer was 10.7 per million patients. The risk for hereditary effects was 1.1 per million births. Radiation dose for a conceptus increases exponentially as chest thickness increases. The conceptus dose at the third trimester is higher than that of the second and first trimesters. The results of the current study suggest that chest radiographs carried out in women at any time during gestation will result in a negligible increase in risk of radiation-induced harmful effects to the unborn child. After a properly performed maternal chest X-ray, there is no need for

Conceptus radiation dose and risk from chest screen-film radiography.

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Damilakis, John; Perisinakis, Kostas; Prassopoulos, Panos; Dimovasili, Evangelia; Varveris, Haralambos; Gourtsoyiannis, Nicholas

2003-02-01

The objectives of the present study were to (a) estimate the conceptus radiation dose and risks for pregnant women undergoing posteroanterior and anteroposterior (AP) chest radiographs, (b) study the conceptus dose as a function of chest thickness of the patient undergoing chest radiograph, and (c) investigate the possibility of a conceptus to receive a dose of more than 10 mGy, the level above which specific measurements of conceptus doses may be necessary. Thermoluminescent dosimeters were used for dose measurements in anthropomorphic phantoms simulating pregnancy at the three trimesters of gestation. The effect of chest thickness on conceptus dose and risk was studied by adding slabs of lucite on the anterior and posterior surface of the phantom chest. The conceptus risk for radiation-induced childhood fatal cancer and hereditary effects was calculated based on appropriate risk factors. The average AP chest dimension (d(a)) was estimated for 51 women of childbearing age from chest CT examinations. The value of d(a) was estimated to be 22.3 cm (17.4-27.2 cm). The calculated maximum conceptus dose was 107 x 10(-3) mGy for AP chest radiographs performed during the third trimester of pregnancy with maternal chest thickness of 27.2 cm. This calculation was based on dose data obtained from measurements in the phantoms and d(a) estimated from the patient group. The corresponding average excess of childhood cancer was 10.7 per million patients. The risk for hereditary effects was 1.1 per million births. Radiation dose for a conceptus increases exponentially as chest thickness increases. The conceptus dose at the third trimester is higher than that of the second and first trimesters. The results of the current study suggest that chest radiographs carried out in women at any time during gestation will result in a negligible increase in risk of radiation-induced harmful effects to the unborn child. After a properly performed maternal chest X-ray, there is no need for

Conceptus radiation dose and risk from chest screen-film radiography

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Damilakis, John; Perisinakis, Kostas; Dimovasili, Evangelia [Department of Medical Physics, University of Crete, Faculty of Medicine, P.O. Box 1393, 714 09 Iraklion, Crete (Greece); Prassopoulos, Panos; Gourtsoyiannis, Nicholas [Department of Radiology, University of Crete, Faculty of Medicine, P.O. Box 1393, 714 09 Iraklion, Crete (Greece); Varveris, Haralambos [Department of Radiotherapy, University of Crete, Faculty of Medicine, P.O. Box 1393, 714 09 Iraklion, Crete (Greece)

2003-02-01

The objectives of the present study were to (a) estimate the conceptus radiation dose and risks for pregnant women undergoing posteroanterior and anteroposterior (AP) chest radiographs, (b) study the conceptus dose as a function of chest thickness of the patient undergoing chest radiograph, and (c) investigate the possibility of a conceptus to receive a dose of more than 10 mGy, the level above which specific measurements of conceptus doses may be necessary. Thermoluminescent dosimeters were used for dose measurements in anthropomorphic phantoms simulating pregnancy at the three trimesters of gestation. The effect of chest thickness on conceptus dose and risk was studied by adding slabs of lucite on the anterior and posterior surface of the phantom chest. The conceptus risk for radiation-induced childhood fatal cancer and hereditary effects was calculated based on appropriate risk factors. The average AP chest dimension (d{sub a}) was estimated for 51 women of childbearing age from chest CT examinations. The value of d{sub a} was estimated to be 22.3 cm (17.4-27.2 cm). The calculated maximum conceptus dose was 107 x 10{sup -3} mGy for AP chest radiographs performed during the third trimester of pregnancy with maternal chest thickness of 27.2 cm. This calculation was based on dose data obtained from measurements in the phantoms and d{sub a} estimated from the patient group. The corresponding average excess of childhood cancer was 10.7 per million patients. The risk for hereditary effects was 1.1 per million births. Radiation dose for a conceptus increases exponentially as chest thickness increases. The conceptus dose at the third trimester is higher than that of the second and first trimesters. The results of the current study suggest that chest radiographs carried out in women at any time during gestation will result in a negligible increase in risk of radiation-induced harmful effects to the unborn child. After a properly performed maternal chest X-ray, there is

Computed chest tomography in rats with pulmonary damage due to microembolism

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Wegener, T.; Wegenius, G.; Hemmingsson, A.; Jung, B.; Saldeen, T.

Computed chest tomography was performed in 13 rats with pulmonary damage due to microembolism, caused by injection of thrombin (500 NIH/kg body weight) and tranexamic acid, a fibrinolytic inhibitor (200 mg/kg body weight), and in 9 control rats. The purpose of the investigation was to perform attenuation measurements at two levels of the right lung, each with three regions of interest (anterior, mid and posterior). Alterations in attenuation, compared with controls, were correlated with lung weight. Compared with controls, the attenuation was significantly increased in the anterior and posterior regions at both levels in animals with pulmonary damage, but not in the mid regions. There was a statistically significant correlation between increasing attenuation and increasing lung weight. A significant difference was found between damaged and control lungs regarding the microscopic grade of interstitial oedema, alveolar oedema and fibrin. Histograms of attenuation values in computed tomograms might be of value in detecting alveolar oedema. It is concluded that computed chest tomography is a good method for detection pulmonary oedema at an early stage of experimental microembolism in the rat.

Computed chest tomography in rats with pulmonary damage due to microembolism

International Nuclear Information System (INIS)

Wegener, T.; Wegenius, G.; Hemmingsson, A.; Jung, B.; Saldeen, T.; Uppsala Univ.; Uppsala Univ.; Uppsala Univ.

1986-01-01

Computed chest tomography was performed in 13 rats with pulmonary damage due to microembolism, caused by injection of thrombin (500 NIH/kg body weight) and tranexamic acid, a fibrinolytic inhibitor (200 mg/kg body weight), and in 9 control rats. The purpose of the investigation was to perform attenuation measurements at two levels of the right lung, each with three regions of interest (anterior, mid and posterior). Alterations in attenuation, compared with controls, were correlated with lung weight. Compared with controls, the attenuation was significantly increased in the anterior and posterior regions at both levels in animals with pulmonary damage, but not in the mid regions. There was a statistically significant correlation between increasing attenuation and increasing lung weight. A significant difference was found between damaged and control lungs regarding the microscopic grade of interstitial oedema, alveolar oedema and fibrin. Histograms of attenuation values in computed tomograms might be of value in detecting alveolar oedema. It is concluded that computed chest tomography is a good method for detection pulmonary oedema at an early stage of experimental microembolism in the rat. (orig.)

[Microsurgical anatomy importance of A1-anterior communicating artery complex].

Science.gov (United States)

Monroy-Sosa, Alejandro; Pérez-Cruz, Julio César; Reyes-Soto, Gervith; Delgado-Hernández, Carlos; Macías-Duvignau, Mario Alberto; Delgado-Reyes, Luis

2013-01-01

The anterior cerebral artery originates from the bifurcation of the internal carotid artery lateral to the optic chiasm, then joins with its contralateral counterpart via the anterior communicating artery. A1-anterior communicating artery complex is the most frequent anatomical variants and is the major site of aneurysms between 30 to 37%. Know the anatomy microsurgical, variants anatomical and importance of complex precommunicating segment-artery anterior communicating in surgery neurological of the pathology vascular, mainly aneurysms, in Mexican population. The study was performed in 30 brains injected. Microanatomy was studied (length and diameter) of A1-anterior communicating artery complex and its variants. 60 segments A1, the average length of left side was 11.35 mm and 11.84 mm was right. The average diameter of left was 1.67 mm and the right was 1.64 mm. The average number of perforators on the left side was 7.9 and the right side was 7.5. Anterior communicating artery was found in 29 brains of the optic chiasm, its course depended on the length of the A1 segment. The average length of the segment was 2.84 mm, the average diameter was 1.41 mm and the average number of perforators was 3.27. A1-anterior communicating artery complex variants were found in 18 (60%) and the presence of two blister-like aneurysms. It is necessary to understand the A1-anterior communicating artery complex microanatomy of its variants to have a three-dimensional vision during aneurysm surgery.

A microcomputerized system of nuclear probe for left ventricular function evaluation

International Nuclear Information System (INIS)

Piva, R.M.V.

1987-01-01

In this work, it is presented the development of a system, consisting in a nuclear probe and a 16 bits microcomputer, for left ventricular function (LVF) monitoring and analysis. Previously used in renal and thyroid studies, the nuclear probe, 2''x2''NaI(Tl) crystal, was adapted for its new application. The alterations include the design and construction of appropriate colimators and unterfacing to a strip-chart register and a magnetic tape recorder. After a single injection of Tc-99m labelling red blood cells, the probe is placed over the patient's chest on a convenient left anterior oblique position and a left ventricle time activity curve is obtained. This curve and the patient's eletrocardiogram (ECG) are recorded for posterior processing. The software, in PASCAL language, transfers the data from the magnetic tape to the microcomputer and provides the LVF and ECG curves to be displayed on beat-to-beat mode or as mean curves. From these curves one can extract ventricular parameter such as: ejection fraction, ejection rate, systolic and diastolic intervals and heart rate, by manually positioning three cursors on the points of interest. A critical evaluation of this method is performed and its advantages as well as its limitations are discussed. This approach provides an easy to operate and a low cost device that can be useful in many clinical situations, for example, the continuous monitoring in ICUs, the screening in out-patient departments. The assessment of drugs effects on left ventricular function is also possible. (author) [pt

Anterior cruciate ligament ganglion: case report

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André Pedrinelli

Full Text Available CONTEXT: A ganglion is a cystic formation close to joints or tendinous sheaths, frequently found in the wrist, foot or knee. Intra-articular ganglia of the knee are rare, and most of them are located in the anterior cruciate ligament. The clinical picture for these ganglia comprises pain and movement restrictions in the knee, causing significant impairment to the patient. Symptoms are non-specific, and anterior cruciate ligament ganglia are usually diagnosed through magnetic resonance imaging or arthroscopy. Not all ganglia diagnosed through magnetic resonance imaging need to undergo surgical treatment: only those that cause clinical signs and symptoms do. Surgical results are considered good or excellent in the vast majority of cases. CASE REPORT: A 29-year-old male presented with pain in the left knee during a marathon race. Physical examination revealed limitation in the maximum range of knee extension and pain in the posterior aspect of the left knee. Radiographs of the left knee were normal, but magnetic resonance imaging revealed a multi-lobed cystic structure adjacent to the anterior cruciate ligament, which resembled a ganglion cyst. The mass was removed through arthroscopy, and pathological examination revealed a synovial cyst. Patient recovery was excellent, and he resumed his usual training routine five months later.

Man in his 50s with chest pain and dyspnoea.

Science.gov (United States)

Obayashi, Yuki; Izumi, Chisato; Nakagawa, Yoshihisa

2018-05-01

A man in his 50s with sudden-onset chest pain and dyspnoea was transferred to the emergency room. He had a history of aortic valve replacement due to aortic regurgitation with a mechanical valve 6 years previously. Heart rate was 90 bpm, and blood pressure was too low to measure. In the emergency room, he presented with severe dyspnoea and a chest X-ray showed severe lung congestion (figure 1A). ECG showed complete left bundle branch block. His respiratory status rapidly worsened, and he went into cardiopulmonary arrest. After cardiopulmonary resuscitation, transthoracic echocardiography was performed (figure 1B, online supplementary video 1).DC1SP110.1136/heartjnl-2017-312477.supp1Supplementary file 1 heartjnl;104/10/868/F1F1F1Figure 1(A) Chest X-ray. (B) Colour Doppler image from apical five-chamber view. What is the most likely cause of the patient's cardiopulmonary arrest?Myocardial infarction in left main trunkAortic dissectionProsthetic valve thrombosisProsthetic valve embolisationPulmonary embolism. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Analysis of biological tissues in infant chest for the development of an equivalent radiographic phantom

International Nuclear Information System (INIS)

Pina, D. R.; Souza, Rafael T. F.; Duarte, Sergio B.; Alvarez, Matheus; Miranda, Jose R. A.

2012-01-01

Purpose: The main purpose of the present study was to determine the amounts of different tissues in the chest of the newborn patient (age ≤1 year), with the aim of developing a homogeneous phantom chest equivalent. This type of phantom is indispensable in the development of optimization procedures for radiographic techniques, including dosimetric control, which is a crucial aspect of pediatric radiology. The authors present a systematic set of procedures, including a computational algorithm, to estimate the amounts of tissues and thicknesses of the corresponding simulator material plates used to construct the phantom. Methods: The Gaussian fit of computed tomographic (CT) analysis was applied to classify and quantify different biological tissues. The methodology is summarized with a computational algorithm, which was used to quantify tissues through automated CT analysis. The thicknesses of the equivalent homogeneous simulator material plates were determined to construct the phantom. Results: A total of 180 retrospective CT examinations with anterior-posterior diameter values ranging 8.5-13.0 cm were examined. The amounts of different tissues were evaluated. The results provided elements to construct a phantom to simulate the infant chest in the posterior-anterior or anterior-posterior (PA/AP) view. Conclusions: To our knowledge, this report represents the first demonstration of an infant chest phantom dedicated to the radiology of children younger than one year. This phantom is a key element in the development of clinical charts for optimizing radiographic technique in pediatric patients. Optimization procedures for nonstandard patients were reported previously [Pina et al., Phys. Med. Biol. 49, N215-N226 (2004) and Pina et al., Appl. Radiat. Isot. 67, 61-69 (2009)]. The constructed phantom represents a starting point to obtain radiologic protocols for the infant patient.

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

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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.

Axillary artery to left anterior descending coronary artery bypass with an externally stented graft: a technical report

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Salvador Loris

2008-02-01

Full Text Available Abstract With the proliferation of minimally invasive cardiac surgery a number of alternative inflow sites for coronary artery bypass grafting have been utilized, especially in higher risk patients. The use of axillary-coronary artery bypass is a safe and effective alternative especially in the case of patients requiring redo coronary revascularization. However, the length and convoluted course of the axillary-coronary vein graft makes is susceptible to twisting, trauma and neointimal hyperplasia. We therefore report a case of an axillary-coronary artery bypass in a high risk patient in which a Dacron conduit was used to externally support and protect the vein graft to the left anterior descending artery. Surgical technique and considerations are presented and discussed.

Chest radiograph in the acute traumatic rupture of the aorta

International Nuclear Information System (INIS)

Pinterits, F.; Grabenwoeger, F.; Dock, W.; Bardach, G.

1987-01-01

We tried to find out the validity of 16 wellknown signs indicating an acute traumatic aortic rupture on plain chest radiographs of 22 patients. Angiographically 11 of all patients had a tear at the aortic isthmus. It turned out that 7 of the 16 signs (widened mediastinum, loss of the aortic knob contour, opacification in the aortopulmonary window, bulging of the vascular pedicle predominantly to the left, left apical cap, depression of the left main stem bronchus and displacement of the right paraspinous interface) are of great diagnostic value. (orig.) [de

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)

Computed tomography of the chest with model-based iterative reconstruction using a radiation exposure similar to chest X-ray examination: preliminary observations

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Neroladaki, Angeliki; Botsikas, Diomidis; Boudabbous, Sana; Becker, Christoph D.; Montet, Xavier [Geneva University Hospital, Department of Radiology, Geneva 4 (Switzerland)

2013-02-15

The purpose of this study was to assess the diagnostic image quality of ultra-low-dose chest computed tomography (ULD-CT) obtained with a radiation dose comparable to chest radiography and reconstructed with filtered back projection (FBP), adaptive statistical iterative reconstruction (ASIR) and model-based iterative reconstruction (MBIR) in comparison with standard dose diagnostic CT (SDD-CT) or low-dose diagnostic CT (LDD-CT) reconstructed with FBP alone. Unenhanced chest CT images of 42 patients acquired with ULD-CT were compared with images obtained with SDD-CT or LDD-CT in the same examination. Noise measurements and image quality, based on conspicuity of chest lesions on all CT data sets were assessed on a five-point scale. The radiation dose of ULD-CT was 0.16 {+-} 0.006 mSv compared with 11.2 {+-} 2.7 mSv for SDD-CT (P < 0.0001) and 2.7 {+-} 0.9 mSv for LDD-CT. Image quality of ULD-CT increased significantly when using MBIR compared with FBP or ASIR (P < 0.001). ULD-CT reconstructed with MBIR enabled to detect as many non-calcified pulmonary nodules as seen on SDD-CT or LDD-CT. However, image quality of ULD-CT was clearly inferior for characterisation of ground glass opacities or emphysema. Model-based iterative reconstruction allows detection of pulmonary nodules with ULD-CT with radiation exposure in the range of a posterior to anterior (PA) and lateral chest X-ray. (orig.)

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

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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.

BIRTH INJURY RELATED UNILATERAL ANTERIOR NARES PARTIAL FIBROUS ATRESIA: A RARE CASE REPORT

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Jayagar

2016-02-01

Full Text Available Congenital atresia of anterior nares has been rarely reported and it may co-exist along with posterior choanal atresia. (1,2 In our case, birth injury caused by forceps delivery has caused unilateral anterior nares partial atresia. Twenty eight years old male patient came with the complaints of left nostril blocked sensation since birth, aggravated with attacks of upper respiratory tract infections. On examination he had left anterior nares partial atresia caused by fibrous bands as a result of birth injury due to instrumental delivery. Rhinoplasty performed to open-up left nostril and patient relieved of his symptoms and also on cosmetic appearance

Illusory consolidation of the left lower lobe: A pitfall of portable radiography

International Nuclear Information System (INIS)

Zylak, C.J.; Litteton, J.T.; Lighter, M.D.; Zurizch, M.L.

1986-01-01

A frequent finding on a portable chest radiography is obscuration of the left hemidiaphragm. Experimental evidence based on radiography of a frozen unembalmed human chest phantom corroborated the hypothesis that this finding can be the result of tube angulation. Clinical examples are provided that supplement the experimental evidence. To avoid this potential pitfall it is essential that the patient be imaged in a position which will ensure that the hemidiaphragm is tangent to the beam. To do otherwise can mislead, creating the false impression of disease in the left lower lobe or pleural space

Post-traumatic Left Ventricular Aneurysm with Massive Hemopericardium in a Child Presenting 3 Years After a Fall

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Wei-Ting Lai

2013-12-01

Full Text Available A 7-year-old boy developed a left ventricular aneurysm with massive hemopericardium 3 years ago due to a fall from a fourth-floor window. He had mild neurological sequelae including cranial nerve III palsy and abnormal electroencephalography findings at that time. He had no chest pain until recently when he presented with chest tightness and abdominal pain for 2 days prior to admission. Chest X-ray showed marked cardiomegaly. Echocardiography revealed massive pericardial effusion and a large left ventricular aneurysm. The massive hemopericardium was surgically drained, and the aneurysm was resected under cardiopulmonary bypass. He was discharged uneventfully 1 week after operation. Because symptoms and signs can vary in patients with ventricular aneurysm, we strongly suggest a close clinical follow-up, preferably with chest X-ray or echocardiography, for patients experiencing a blunt chest trauma.

Giant left atrium encountered during right-sided thoracentesis

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Rashmi Advani

Full Text Available Giant left atrium is an uncommon pathology to encounter during bedside chest ultrasound, but is an important structure to be aware of when considering thoracentesis. This cardiac structure could easily be mistaken for loculated pleural fluid. This case also supports growing evidence that expert users can safely perform thoracentesis without completely reversing therapeutic anticoagulation. Keywords: Giant left atrium, Thoracentesis, Rheumatic heart disease, Ultrasound

Medial extent of the anterior Gerota's fascia: An anatomic study using cadaver and CT

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Lim, Jae Hoon; Ryu, Kyung Nam; Kim, Ho Kyun; Yoon, Yup; Lee, Sun Wha; Ko, Young Tae; Choi, Woo Suk; Lee, Dong Ho [Kyung Hee University College of Medicine, Seoul (Korea, Republic of)

1989-04-15

To study the anatomy of the perirenal space, authors dissected two cadavers and reviewed 50 computed tomographic (CT) scans, laying special emphasis on the medial extent of the anterior layer of Gerota's fascia. It is concluded that, below the renal hilus level, anterior layers of the right and left Gerota's fascia fuse each other across the midline anterior to the aorta and inferior vena cava. Above the hilus level, anterior layers are very weak and seem to fuse with the parietal peritoneum or adjacent organs. Therefore, the right and left perirenal space may communicate across the midline, anterior to the lower aorta and vena cava. Thus, at least in some subjects, the perirenal fluid or blood of the right or left perirenal space may extend to the opposite perirenal space through the narrow midline extension of each perirenal spaces anterior to the vertebral body.

Delayed recovery of adipsic diabetes insipidus (ADI) caused by elective clipping of anterior communicating artery and left middle cerebral artery aneurysms.

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Tan, Jeffrey; Ndoro, Samuel; Okafo, Uchenna; Garrahy, Aoife; Agha, Amar; Rawluk, Danny

2016-12-16

Adipsic diabetes insipidus (ADI) is an extremely rare complication following microsurgical clipping of anterior communicating artery aneurysm (ACoA) and left middle cerebral artery (MCA) aneurysm. It poses a significant challenge to manage due to an absent thirst response and the co-existence of cognitive impairment in our patient. Recovery from adipsic DI has hitherto been reported only once. A 52-year-old man with previous history of clipping of left posterior communicating artery aneurysm 20 years prior underwent microsurgical clipping of ACoA and left MCA aneurysms without any intraoperative complications. Shortly after surgery, he developed clear features of ADI with adipsic severe hypernatraemia and hypotonic polyuria, which was associated with cognitive impairment that was confirmed with biochemical investigations and cognitive assessments. He was treated with DDAVP along with a strict intake of oral fluids at scheduled times to maintain eunatremia. Repeat assessment at six months showed recovery of thirst and a normal water deprivation test. Management of ADI with cognitive impairment is complex and requires a multidisciplinary approach. Recovery from ADI is very rare, and this is only the second report of recovery in this particular clinical setting.

Left hepatic lobe herniation through an incisional anterior abdominal wall hernia and right adrenal myelolipoma: a case report and review of the literature.

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Nuño-Guzmán, Carlos M; Arróniz-Jáuregui, José; Espejo, Ismael; Valle-González, Jesús; Butus, Hernán; Molina-Romo, Alejandro; Orranti-Ortega, Rodrigo I

2012-01-10

Herniation of the liver through an anterior abdominal wall hernia defect is rare. To the best of our knowledge, only three cases have been described in the literature. A 70-year-old Mexican woman presented with a one-week history of right upper quadrant abdominal pain, nausea, vomiting, and jaundice to our Department of General Surgery. Her medical history included an open cholecystectomy from 20 years earlier and excessive weight. She presented with jaundice, abdominal distension with a midline surgical scar, right upper quadrant tenderness, and a large midline abdominal wall defect with dullness upon percussion and protrusion of a large, tender, and firm mass. The results of laboratory tests were suggestive of cholestasis. Ultrasound revealed choledocholithiasis. A computed tomography scan showed a protrusion of the left hepatic lobe through the anterior abdominal wall defect and a well-defined, soft tissue density lesion in the right adrenal topography. An endoscopic common bile duct stone extraction was unsuccessful. During surgery, the right adrenal tumor was resected first. The hernia was approached through a median supraumbilical incision; the totality of the left lobe was protruding through the abdominal wall defect, and once the lobe was reduced to its normal position, a common bile duct surgical exploration with multiple stone extraction was performed. Finally, the abdominal wall was reconstructed. Histopathology revealed an adrenal myelolipoma. Six months after the operation, our patient remains in good health. The case of liver herniation through an incisional anterior abdominal wall hernia in this report represents, to the best of our knowledge, the fourth such case reported in the literature. The rarity of this medical entity makes it almost impossible to specifically describe predisposing risk factors for liver herniation. Obesity, the right adrenal myelolipoma mass effect, and the previous abdominal surgery are likely to have contributed to

Left hepatic lobe herniation through an incisional anterior abdominal wall hernia and right adrenal myelolipoma: a case report and review of the literature

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Nuño-Guzmán Carlos M

2012-01-01

Full Text Available Abstract Introduction Herniation of the liver through an anterior abdominal wall hernia defect is rare. To the best of our knowledge, only three cases have been described in the literature. Case presentation A 70-year-old Mexican woman presented with a one-week history of right upper quadrant abdominal pain, nausea, vomiting, and jaundice to our Department of General Surgery. Her medical history included an open cholecystectomy from 20 years earlier and excessive weight. She presented with jaundice, abdominal distension with a midline surgical scar, right upper quadrant tenderness, and a large midline abdominal wall defect with dullness upon percussion and protrusion of a large, tender, and firm mass. The results of laboratory tests were suggestive of cholestasis. Ultrasound revealed choledocholithiasis. A computed tomography scan showed a protrusion of the left hepatic lobe through the anterior abdominal wall defect and a well-defined, soft tissue density lesion in the right adrenal topography. An endoscopic common bile duct stone extraction was unsuccessful. During surgery, the right adrenal tumor was resected first. The hernia was approached through a median supraumbilical incision; the totality of the left lobe was protruding through the abdominal wall defect, and once the lobe was reduced to its normal position, a common bile duct surgical exploration with multiple stone extraction was performed. Finally, the abdominal wall was reconstructed. Histopathology revealed an adrenal myelolipoma. Six months after the operation, our patient remains in good health. Conclusions The case of liver herniation through an incisional anterior abdominal wall hernia in this report represents, to the best of our knowledge, the fourth such case reported in the literature. The rarity of this medical entity makes it almost impossible to specifically describe predisposing risk factors for liver herniation. Obesity, the right adrenal myelolipoma mass effect, and

Potential of right to left ventricular volume ratio measured on chest CT for the prediction of pulmonary hypertension: correlation with pulmonary arterial systolic pressure estimated by echocardiography

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Lee, Heon [Soon Chun Hyang University, Department of Radiology, Bucheon (Korea, Republic of); Kim, Seok Yeon [Seoul Medical Center, Department of Cardiology, Seoul (Korea, Republic of); Lee, Soo Jeong [Terarecon Korea, Seoul (Korea, Republic of); Kim, Jae Kyun [Chung-Ang University College of Medicine, Department of Radiology, Seoul (Korea, Republic of); Reddy, Ryan P.; Schoepf, U.J. [Medical University of South Carolina, Department of Radiology and Radiological Science and Division of Cardiology, Department of Medicine, Charleston, SC (United States)

2012-09-15

To investigate the correlation of right ventricular (RV) to left ventricular (LV) volume ratio measured by chest CT with pulmonary arterial systolic pressure (PASP) estimated by echocardiography. 104 patients (72.47 {+-} 13.64 years; 39 male) who had undergone chest CT and echocardiography were divided into two groups (hypertensive and normotensive) based upon an echocardiography-derived PASP of 25 mmHg. RV to LV volume ratios (RV{sub V}/LV{sub V}) were calculated. RV{sub V}/LV{sub V} was then correlated with PASP using regression analysis. The Area Under the Curve (AUC) for predicting pulmonary hypertension on chest CT was calculated. In the hypertensive group, the mean PASP was 46.29 {+-} 14.42 mmHg (29-98 mmHg) and there was strong correlation between the RV{sub V}/LV{sub V} and PASP (R = 0.82, p < 0.001). The intraobserver and interobserver correlation coefficients for RV{sub V}/LV{sub V} were 0.990 and 0.892. RV{sub V}/LV{sub V} was 1.01 {+-} 0.44 (0.51-2.77) in the hypertensive and 0.72 {+-} 0.14 (0.52-1.11) in the normotensive group (P <0.05). With 0.9 as the cutoff for RV{sub V}/LV{sub V}, sensitivity and specificity for predicting pulmonary hypertension over 40 mmHg were 79.5 % and 90 %, respectively. The AUC for predicting pulmonary hypertension was 0.87 RV/LV volume ratios on chest CT correlate well with PASP estimated by echocardiography and can be used to predict pulmonary hypertension over 40 mmHg with high sensitivity and specificity. (orig.)

Left–Right Asymmetry in Spectral Characteristics of Lung Sounds Detected Using a Dual-Channel Auscultation System in Healthy Young Adults

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Tsai, Jang-Zern; Chang, Ming-Lang; Yang, Jiun-Yue; Kuo, Dar; Lin, Ching-Hsiung; Kuo, Cheng-Deng

2017-01-01

Though lung sounds auscultation is important for the diagnosis and monitoring of lung diseases, the spectral characteristics of lung sounds have not been fully understood. This study compared the spectral characteristics of lung sounds between the right and left lungs and between healthy male and female subjects using a dual-channel auscultation system. Forty-two subjects aged 18–22 years without smoking habits and any known pulmonary diseases participated in this study. The lung sounds were recorded from seven pairs of auscultation sites on the chest wall simultaneously. We found that in four out of seven auscultation pairs, the lung sounds from the left lung had a higher total power (PT) than those from the right lung. The PT of male subjects was higher than that of female ones in most auscultation pairs. The ratio of inspiration power to expiration power (RI/E) of lung sounds from the right lung was greater than that from the left lung at auscultation pairs on the anterior chest wall, while this phenomenon was reversed at auscultation pairs on the posterior chest wall in combined subjects, and similarly in both male and female subjects. Though the frequency corresponding to maximum power density of lung sounds (FMPD) from the left and right lungs was not significantly different, the frequency that equally divided the power spectrum of lung sounds (F50) from the left lung was significantly smaller than that from the right lung at auscultation site on the anterior and lateral chest walls, while it was significantly larger than that of from the right lung at auscultation site on the posterior chest walls. In conclusion, significant differences in the PT, FMPD, F50, and RI/E between the left and right lungs at some auscultation pairs were observed by using a dual-channel auscultation system in this study. Structural differences between the left and the right lungs, between the female and male subjects, and between anterior and posterior lungs might account for the

Left–Right Asymmetry in Spectral Characteristics of Lung Sounds Detected Using a Dual-Channel Auscultation System in Healthy Young Adults

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Jang-Zern Tsai

2017-06-01

Full Text Available Though lung sounds auscultation is important for the diagnosis and monitoring of lung diseases, the spectral characteristics of lung sounds have not been fully understood. This study compared the spectral characteristics of lung sounds between the right and left lungs and between healthy male and female subjects using a dual-channel auscultation system. Forty-two subjects aged 18–22 years without smoking habits and any known pulmonary diseases participated in this study. The lung sounds were recorded from seven pairs of auscultation sites on the chest wall simultaneously. We found that in four out of seven auscultation pairs, the lung sounds from the left lung had a higher total power (PT than those from the right lung. The PT of male subjects was higher than that of female ones in most auscultation pairs. The ratio of inspiration power to expiration power (RI/E of lung sounds from the right lung was greater than that from the left lung at auscultation pairs on the anterior chest wall, while this phenomenon was reversed at auscultation pairs on the posterior chest wall in combined subjects, and similarly in both male and female subjects. Though the frequency corresponding to maximum power density of lung sounds (FMPD from the left and right lungs was not significantly different, the frequency that equally divided the power spectrum of lung sounds (F50 from the left lung was significantly smaller than that from the right lung at auscultation site on the anterior and lateral chest walls, while it was significantly larger than that of from the right lung at auscultation site on the posterior chest walls. In conclusion, significant differences in the PT, FMPD, F50, and RI/E between the left and right lungs at some auscultation pairs were observed by using a dual-channel auscultation system in this study. Structural differences between the left and the right lungs, between the female and male subjects, and between anterior and posterior lungs might

Dual-source computed tomography in patients with acute chest pain: feasibility and image quality

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Schertler, Thomas; Scheffel, Hans; Frauenfelder, Thomas; Desbiolles, Lotus; Leschka, Sebastian; Stolzmann, Paul; Marincek, Borut; Alkadhi, Hatem [University Hospital Zurich, Department of Medical Radiology, Institute of Diagnostic Radiology, Zurich (Switzerland); Seifert, Burkhardt [University of Zurich, Department of Biostatistics, Zurich (Switzerland); Flohr, Thomas G. [Computed Tomography CTE PA, Siemens Medical Solutions, Forchheim (Germany)

2007-12-15

The aim of this study was to determine the feasibility and image quality of dual-source computed tomography angiography (DSCTA) in patients with acute chest pain for the assessment of the lung, thoracic aorta, and for pulmonary and coronary arteries. Sixty consecutive patients (32 female, 28 male, mean age 58.1{+-}16.3 years) with acute chest pain underwent contrast-enhanced electrocardiography-gated DSCTA without prior beta-blocker administration. Vessel attenuation of different thoracic vascular territories was measured, and image quality was semi-quantitatively analyzed by two independent readers. Image quality of the thoracic aorta was diagnostic in all 60 patients, image quality of pulmonary arteries was diagnostic in 59, and image quality of coronary arteries was diagnostic in 58 patients. Pairwise intraindividual comparisons of attenuation values were small and ranged between 1{+-}6 HU comparing right and left coronary artery and 56{+-}9 HU comparing the pulmonary trunk and left ventricle. Mean attenuation was 291{+-}65 HU in the ascending aorta, 334{+-}93 HU in the pulmonary trunk, and 285{+-}66 HU and 268{+-}67 HU in the right and left coronary artery, respectively. DSCTA is feasible and provides diagnostic image quality of the thoracic aorta, pulmonary and coronary arteries in patients with acute chest pain. (orig.)

Dual-source computed tomography in patients with acute chest pain: feasibility and image quality

International Nuclear Information System (INIS)

Schertler, Thomas; Scheffel, Hans; Frauenfelder, Thomas; Desbiolles, Lotus; Leschka, Sebastian; Stolzmann, Paul; Marincek, Borut; Alkadhi, Hatem; Seifert, Burkhardt; Flohr, Thomas G.

2007-01-01

The aim of this study was to determine the feasibility and image quality of dual-source computed tomography angiography (DSCTA) in patients with acute chest pain for the assessment of the lung, thoracic aorta, and for pulmonary and coronary arteries. Sixty consecutive patients (32 female, 28 male, mean age 58.1±16.3 years) with acute chest pain underwent contrast-enhanced electrocardiography-gated DSCTA without prior beta-blocker administration. Vessel attenuation of different thoracic vascular territories was measured, and image quality was semi-quantitatively analyzed by two independent readers. Image quality of the thoracic aorta was diagnostic in all 60 patients, image quality of pulmonary arteries was diagnostic in 59, and image quality of coronary arteries was diagnostic in 58 patients. Pairwise intraindividual comparisons of attenuation values were small and ranged between 1±6 HU comparing right and left coronary artery and 56±9 HU comparing the pulmonary trunk and left ventricle. Mean attenuation was 291±65 HU in the ascending aorta, 334±93 HU in the pulmonary trunk, and 285±66 HU and 268±67 HU in the right and left coronary artery, respectively. DSCTA is feasible and provides diagnostic image quality of the thoracic aorta, pulmonary and coronary arteries in patients with acute chest pain. (orig.)

SU-C-BRF-01: Correlation of DIBH Breath Hold Amplitude with Dosimetric Sparing of Heart and Left Anterior Descending Artery in Left Breast Radiotherapy

International Nuclear Information System (INIS)

Kim, Taeho; Reardon, Kelli; Sukovich, Kaitlyn; Crandley, Edwin; Read, Paul; Krishni, Wijesooriya

2014-01-01

Purpose: A 7.4% increase in major coronary events per 1 Gy increase in mean heart dose has been reported from the population-based analysis of radiation-induced cardiac toxicity following treatment of left sided breast cancer. Deep inhalation breath-hold (DIBH) is clinically utilized to reduce radiation dose to heart and left anterior descending artery (LAD). We investigated the correlation of dose sparing in heart and LAD with internal DIBH amplitude to develop a quantitative predictive model for expected dose to heart and LAD based on internal breath hold amplitude. Methods: A treatment planning study (Prescription Dose = 50 Gy) was performed on 50 left breast cancer patients underwent DIBH whole breast radiotherapy. Two CT datasets, free breathing (FB) and DIBH, were utilized for treatment planning and for determination of the internal anatomy DIBH amplitude (difference between sternum position at FB and DIBH). The heart and LAD dose between FB and DIBH plans was compared and dose to the heart and LAD as a function of breath hold amplitude was determined. Results: Average DIBH amplitude using internal anatomy was 13.9±4.2 mm. The DIBH amplitude-mean dose reduction correlation is 20%/5mm (0.3 Gy/5mm) for the heart and 18%/5mm (1.1 Gy/5mm) for LAD. The correlation with max dose reduction is 12%/5mm (3.8 Gy/5mm) for the heart and 16%/5mm (3.2 Gy/5mm) for LAD. We found that average dose reductions to LAD from 6.0±6.5 Gy to 2.0±1.6 Gy with DIBH (4.0 Gy reduction: -67%, p < 0.001) and average dose reduction to the heart from 1.3±0.7 Gy to 0.7±0.2 Gy with DIBH (0.6 Gy reduction: -46%, p < 0.001). That suggests using DIBH may reduce the risk of the major coronary event for left sided breast cancer patients. Conclusion: The correlation between breath hold amplitude and dosimetric sparing suggests that dose sparing linearly increases with internal DIBH amplitude

An adult cystic fibrosis patient presenting with persistent dyspnea: case report

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Farinet Catherine L

2006-05-01

Full Text Available Abstract Background Persistent dyspnea is a common finding in the cystic fibrosis patient that typically leads to further work up of an alternative pulmonary etiology. Adult cystic fibrosis patients; however, are growing in numbers and they are living into the ages in which coronary artery disease becomes prevalent. Coronary disease should be included in the consideration of diagnostic possibilities. Case presentation A 52-year-old white male with cystic fibrosis was evaluated for exertional dyspnea associated with vague chest discomfort. Diagnostic testing revealed normal white blood cell, hemoglobin and platelet count, basic metabolic panel, fasting lipid profile, HbA1c, with chest radiograph confirming chronic cystic findings unchanged from prior radiographs and an electrocardiogram that revealed sinus rhythm with left anterior fascicular block. Stress thallium testing demonstrated a reversible anteroseptal perfusion defect with a 55% left ventricular ejection fraction. Heart catheterization found a 99% occlusion of the left anterior descending artery extending into the two diagonal branches, with 100% obstruction of the left anterior descending artery at the trifurcation and 70% lesion affecting the first posterior lateral branch of the circumflex artery. Conclusion This case report represents the first description in the medical literature of a cystic fibrosis patient diagnosed with symptomatic coronary artery disease. Applying a standard clinical practice guide proved useful toward evaluating a differential diagnosis for a cystic fibrosis patient presenting with dyspnea and chest discomfort.

An autopsy case of a giant aneurysm of the anterior communicating artery

International Nuclear Information System (INIS)

Shinmura, Fujio; Takayasu, Kenji; Ohiwa, Yasuyuki; Sakata, Ryuichi; Ariwa, Rokuro

1983-01-01

A 64-year-old female was admitted to our hospital on 8, July, 1980 with a history of three previous subarachnoid hemorrhages. Neurological examinations revealed incontinentia urinae, gait disturbance, recent memory disturbance and motor weakness on the left side. The results of the neuroradiological examinations were as follows. Plain X-ray films showed a ring-like calcification in the right frontal region. A plain CT scan showed a ring-shaped iso- and high-density area in the intra hemispheric region, the intra bilateral anterior horn of the lateral ventricle, the intra septum pellucidum, and the intra anterior part of the third ventricle. A small high-density region was enhanced as an island within it by means of a Conray infusion. Left carotid angiography showed a large aneurysmal shadow arising from the anterior communicating artery and another from the left middle cerebral artery. In the venous phase the venous angle was supero-posteriorly shifted, and the septal vein was elevated. She died unexpectedly with a status epilepticus of unknown origin. Clinically, rerupture was not verified. An autopsy specimen revealed that a giant aneurysm (6 x 5 x 4 cm in size) arising from the anterior communicating artery occupied the intra ventricular space, the anterior horn of the lateral ventricle, and the right thalamic region. Also, there was a large berry aneurysm (2 x 1.7 x 1.5 cm in size) arising from the middle cerebral artery. A coronary section through the giant aneurysm showed a markedly compressed left lateral ventricle, right thalamus, and hypothalamus, while the third ventricle had shifted toward the left side. (J.P.N.)

Paired anterior spinal arteries in a case of locked-in syndrome

International Nuclear Information System (INIS)

Kawamura, J.; Matsubayashi, K.; Fukuyama, H.; Kitanaka, H.

1981-01-01

Paired anterior spinal arteries have rarely been demonstrated angiographically, although several anatomical studies have shown that they are not uncommonly observed. This report describes the angiographic and autopsy findings of such a variation, which was observed in a 65-year-old man with a locked-in syndrome. The paired trunks of the anterior spinal artery were visualized in a retrograde fashion through the left inferior thyroid artery and a radical branch at the 5th cervical level by left retrograde brachial angiography. The uppermost segments of either vertebral artery and the lower portion of the basilar artery were opacified through these channels. The autopsy confirmed the paired trunks of the anterior spinal artery, occlusion of the vertebral arteries just caudal to the origin of the main branches of the anterior spinal artery, and an old infarct involving the pontine tegmentum and cerebellum. (orig.)

Transient left ventricular dysfunction due to coronary spasm after spinal anesthesia with bupivacaine - a case report.

Science.gov (United States)

Elikowski, Waldemar; Małek-Elikowska, Małgorzata; Słomczyński, Marek; Horbacka, Karolina; Bartkowski, Jarosław; Kalawski, Bartosz

2017-10-23

Bupivacaine is a long-acting local anesthetic (LA) used for cutaneous infiltration, peripheral nerve blocks, epidural and spinal anesthesia. However, its application may result in cardiovascular complications such as: hypotension, bradycardia, cardiac arrest and toxic myocardial injury. The authors describe a 53-year-old male with a history of cigarette smoking, admitted for an elective inguinal hernia surgery. Before surgery, the patient received subarachnoid injection of bupivacaine (20 mg). After the operation, he developed transient hypotension. Blood pressure returned to normal after gelofusine infusion; no sympathomimetics were administered. The male denied chest pain; however, ECG showed ST segment elevation coexisting with left ventricular anterolateral hypokinesia and decreased longitudinal strain in echocardiography. A significant increase in troponin I level was suggestive rather of myocardial infarction than of takotsubo cardiomyopathy. Urgent coronary angiography revealed left anterior descending artery spasm, which remitted after intracoronary nitroglycerin injection. Normalization of ECG and echocardiography was observed within a few days. The authors indicate that the presented atypical adverse effect of bupivacaine manifested itself with delay and that coronary spasm proceeded without angina. A close observation of the patient after anesthetic procedure with LA should be extended over the postoperative period.

Exercise thallium-201 myocardial imaging in left main coronary artery disease: sensitive but not specific

International Nuclear Information System (INIS)

Rehn, T.; Griffith, L.S.; Achuff, S.C.; Bailey, I.K.; Bulkley, B.H.; Burow, R.; Pitt, B.; Becker, L.C.

1981-01-01

To determine the usefulness of thallium-201 scintigraphy for identifying left main coronary artery disease, the results of scintigraphy at rest and during exercise were compared in 24 patients with 50 percent or greater narrowing of the left main coronary artery and 80 patients with 50 percent or greater narrowing of one or more of the major coronary arteries but without left main coronary involvement. By segmental analysis of the scintigrams, perfusion defects were assigned to the left anterior descending, left circumflex or right coronary artery, singly or in combination, and the pattern of simultaneous left anterior descending and circumflex arterial defects was used to identify left main coronary artery disease. Of the 24 patients with left main coronary artery disease, 22 (92 percent) had abnormal exercise scintigrams. Despite this high sensitivity, the pattern of perfusion defects was not specific; the ''left main pattern'' was found in 3 patients (13 percent) with left main coronary artery disease but also in 3 (33 percent) of 9 patients with combined left anterior descending and left circumflex arterial disease, 4 (19 percent) of 21 patients with three vessel disease and 3 (6 percent) of 50 patients with one or two vessel disease but excluding the group with left anterior descending plus left circumflex arterial disease. The pattern of perfusion defects in the patients with left main coronary artery disease was determined by the location and severity of narrowings in the coronary arteries downstream from the left main arterial lesion. Concomitant lesions in other arteries were found in all patients with left main coronary disease (one vessel in 1 patient, two vessels in 7 patients and three vessels in 16). For this reason, it is unlikely that even with improvements in radiopharmaceutical agents and imaging techniques, myocardial perfusion scintigraphy will be sufficiently specific for definitive identification of left main coronary artery disease

Chest wall tuberculosis; CT findings in 14 patients

Energy Technology Data Exchange (ETDEWEB)

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.

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

A study on roentgen anatomy of the normal lateral chest radiograph

International Nuclear Information System (INIS)

Konishi, Keiko

1985-01-01

CT findings of the various anatomical structures in 70 cases were classified into three types according to their relation to lung, mediastinal tissue (or fat) and the other thoracic organs. Posterior margin of right brachiocephalic vein-superior vena cava complex (RB-SVC), anterior and posterior margins of inferior vena cava, anterior margin of ascending aorta, anterior and posterior margins of aortic arch, posterior wall of bronchus intermedius (PWBI), posterior wall of distal portion of left main bronchus (PWDPLMB) and posterior wall of trachea (posterior tracheal stripe, PTS) were frequently visualized when lung outlined more than half of them. Anterior margin of ascending aorta was also occasionally visualized when a small amount of mediastinal fat outlined it. Anterior margin of right ventricular outflow tract was frequently visualized when lung outlined more than half of it and it was situated anterior to that of ascending aorta. Anterior tracheal stripe was frequently visualized when a large amount of mediastinal fat outlined it. PWBI, PWDPLMB and PTS were frequently visualized when lung outlined them. Cardiac incisura was frequently visualized when a large amount of anterior mediastinal fat outlined left anterior margin of heart. The statistical studies on roentgen anatomy including the visualization rates of various anatomical structures and the morphological analysis and measurements of various anatomical structures in 300 normal cases. The visualization rates were compared between Japanese and Americans, between age groups over and under 50 years old, and between males and females. The structures which were visualized by the contact with fat or made by fat were more frequently seen in Americans, and the arterial structures were more frequently shown in older people. Other differences were also seen. (J.P.N.)

Is running away right? The behavioral activation-behavioral inhibition model of anterior asymmetry.

Science.gov (United States)

Wacker, Jan; Chavanon, Mira-Lynn; Leue, Anja; Stemmler, Gerhard

2008-04-01

The measurement of anterior electroencephalograph (EEG) asymmetries has become an important standard paradigm for the investigation of affective states and traits. Findings in this area are typically interpreted within the motivational direction model, which suggests a lateralization of approach and withdrawal motivational systems to the left and right anterior region, respectively. However, efforts to compare this widely adopted model with an alternative account-which relates the left anterior region to behavioral activation independent of the direction of behavior (approach or withdrawal) and the right anterior region to goal conflict-induced behavioral inhibition-are rare and inconclusive. Therefore, the authors measured the EEG in a sample of 93 young men during emotional imagery designed to provide a critical test between the 2 models. The results (e.g., a correlation between left anterior activation and withdrawal motivation) favor the alternative model on the basis of the concepts of behavioral activation and behavioral inhibition. In addition, the present study also supports an association of right parietal activation with physiological arousal and the conceptualization of parietal EEG asymmetry as a mediator of emotion-related physiological arousal. (Copyright) 2008 APA.

Comparison consequences of Jackson-Pratt drain versus chest tube after coronary artery bypass grafting: A randomized controlled clinical trial.

Science.gov (United States)

Mirmohammad-Sadeghi, Mohsen; Pourazari, Pejman; Akbari, Mojtaba

2017-01-01

Chest tubes are used in every case of coronary artery bypass grafting (CABG) to evacuate shed blood from around the heart and lungs. This study was designed to assess the effective of Jackson-Pratt drain in compare with conventional chest drains after CABG. This was a randomized controlled trial that conducted on 218 patients in Chamran hospital from February to December 2016. Eligible patients were randomized in a 1:1 ratio. Jackson-Pratt drain group had 109 patients who received a chest tube insertion in the pleural space of the left lung and a Jackson-Pratt drain in mediastinum, and Chest tube drainage group had 109 patients who received double chest tube insertion in the pleural space of the left lung and the mediastinum. The incidence of pleural effusions in Jackson-Pratt drain group and chest tube group were not statistically different. The pain score at 2-h in Drain group was significantly higher than chest tube group ( P = 0.001), but the trend of pain score between groups was not significantly different ( P = 0.097). The frequency of tamponade and atrial fibrillation (AF) were significantly lower in Jackson-Pratt drain group ( P drain is equally effective for preventing cardiac tamponade, pleural effusions, and pain intensity in patients after CABG when compared with conventional chest tubes, but was significantly superior regarding efficacy to hospital and Intensive Care Unit length of stay and the incidence of AF.

Fibrinous anterior uveitis following laser in situ keratomileusis

Directory of Open Access Journals (Sweden)

Parmar Pragya

2009-01-01

Full Text Available A 29-year-old woman who underwent laser in situ keratomileusis (LASIK for myopic astigmatism in both eyes presented with severe pain, photophobia and decreased visual acuity in the left eye eight days after surgery. Examination revealed severe anterior uveitis with fibrinous exudates in the anterior chamber, flap edema and epithelial bullae. Laboratory investigations for uveitis were negative and the patient required systemic and intensive topical steroids with cycloplegics to control the inflammation. This case demonstrates that severe anterior uveitis may develop after LASIK and needs prompt and vigorous management for resolution.

Cardiothoracic ratio for prediction of left ventricular dilation: a systematic review and pooled analysis.

Science.gov (United States)

Loomba, Rohit S; Shah, Parinda H; Nijhawan, Karan; Aggarwal, Saurabh; Arora, Rohit

2015-03-01

Increased cardiothoracic ratio noted on chest radiographs often prompts concern and further evaluation with additional imaging. This study pools available data assessing the utility of cardiothoracic ratio in predicting left ventricular dilation. A systematic review of the literature was conducted to identify studies comparing cardiothoracic ratio by chest x-ray to left ventricular dilation by echocardiography. Electronic databases were used to identify studies which were then assessed for quality and bias, with those with adequate quality and minimal bias ultimately being included in the pooled analysis. The pooled data were used to determine the sensitivity, specificity, positive predictive value and negative predictive value of cardiomegaly in predicting left ventricular dilation. A total of six studies consisting of 466 patients were included in this analysis. Cardiothoracic ratio had 83.3% sensitivity, 45.4% specificity, 43.5% positive predictive value and 82.7% negative predictive value. When a secondary analysis was conducted with a pediatric study excluded, a total of five studies consisting of 371 patients were included. Cardiothoracic ratio had 86.2% sensitivity, 25.2% specificity, 42.5% positive predictive value and 74.0% negative predictive value. Cardiothoracic ratio as determined by chest radiograph is sensitive but not specific for identifying left ventricular dilation. Cardiothoracic ratio also has a strong negative predictive value for identifying left ventricular dilation.

Reporting instructions significantly impact false positive rates when reading chest radiographs

Energy Technology Data Exchange (ETDEWEB)

Robinson, John W.; Brennan, Patrick C.; Mello-Thoms, Claudia; Lewis, Sarah J. [The University of Sydney, Medical Image Optimisation and Perception Group, Discipline of Medical Radiation Sciences, Faculty of Health Sciences, Lidcombe, NSW (Australia)

2016-10-15

To determine the impact of specific reporting tasks on the performance of radiologists when reading chest radiographs. Ten experienced radiologists read a set of 40 postero-anterior (PA) chest radiographs: 21 nodule free and 19 with a proven solitary nodule. There were two reporting conditions: an unframed task (UFT) to report any abnormality and a framed task (FT) reporting only lung nodule/s. Jackknife free-response operating characteristic (JAFROC) figure of merit (FOM), specificity, location sensitivity and number of true positive (TP), false positive (FP), true negative (TN) and false negative (FN) decisions were used for analysis. JAFROC FOM for tasks showed a significant reduction in performance for framed tasks (P = 0.006) and an associated decrease in specificity (P = 0.011) but no alteration to the location sensitivity score. There was a significant increase in number of FP decisions made during framed versus unframed tasks for nodule-containing (P = 0.005) and nodule-free (P = 0.011) chest radiographs. No significant differences in TP were recorded. Radiologists report more FP decisions when given specific reporting instructions to search for nodules on chest radiographs. The relevance of clinical history supplied to radiologists is called into question and may induce a negative effect. (orig.)

Reporting instructions significantly impact false positive rates when reading chest radiographs

International Nuclear Information System (INIS)

Robinson, John W.; Brennan, Patrick C.; Mello-Thoms, Claudia; Lewis, Sarah J.

2016-01-01

To determine the impact of specific reporting tasks on the performance of radiologists when reading chest radiographs. Ten experienced radiologists read a set of 40 postero-anterior (PA) chest radiographs: 21 nodule free and 19 with a proven solitary nodule. There were two reporting conditions: an unframed task (UFT) to report any abnormality and a framed task (FT) reporting only lung nodule/s. Jackknife free-response operating characteristic (JAFROC) figure of merit (FOM), specificity, location sensitivity and number of true positive (TP), false positive (FP), true negative (TN) and false negative (FN) decisions were used for analysis. JAFROC FOM for tasks showed a significant reduction in performance for framed tasks (P = 0.006) and an associated decrease in specificity (P = 0.011) but no alteration to the location sensitivity score. There was a significant increase in number of FP decisions made during framed versus unframed tasks for nodule-containing (P = 0.005) and nodule-free (P = 0.011) chest radiographs. No significant differences in TP were recorded. Radiologists report more FP decisions when given specific reporting instructions to search for nodules on chest radiographs. The relevance of clinical history supplied to radiologists is called into question and may induce a negative effect. (orig.)

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

Science.gov (United States)

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.

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)

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 ...

Oesophageal intubation can be undetected by auscultation of the chest

DEFF Research Database (Denmark)

Andersen, K H; Schultz-Lebahn, T

1994-01-01

Prompt detection of oesophageal intubation is a primary concern in anaesthetic practice. This blind, randomised study evaluates three widely used tests of intubation. Forty patients had both their trachea and oesophagus intubated, each patient was studied twice. Auscultation of the epigastrium......, right and left axilla is more reliable than auscultation of the chest, and the anaesthetist's feeling when he squeezes the bag. P = 0.001 and P = 0.048, respectively. The tests were carried out after gastric distension with gas had occurred. We conclude that auscultation of epigastrium, right and left...

Dysphagia in the Elderly Following Anterior Cervical Surgery: A Multidisciplinary Approach

LENUS (Irish Health Repository)

Osuafor, C N.

2017-11-01

Dysphagia is a risk factor for adverse health outcomes like aspiration, recurrent chest infections and malnutrition. Here, we describe a case of an 82-year-old lady who presented with a two-month history of dysphagia after an anterior odontoid screw fixation for a type II odontoid process fracture. This case highlights the importance of a multidisciplinary approach to patient care.

Does concomitant anterior fundoplication promote dysphagia after laparoscopic Heller myotomy?

Science.gov (United States)

Tapper, Donovan; Morton, Connor; Kraemer, Emily; Villadolid, Desiree; Ross, Sharona B; Cowgill, Sarah M; Rosemurgy, Alexander S

2008-07-01

Concerns for gastroesophageal reflux after laparoscopic Heller myotomy for achalasia justify considerations of concomitant anterior fundoplication. This study was undertaken to determine if concomitant anterior fundoplication reduces symptoms of reflux after myotomy without promoting dysphagia. From 1992 to 2004, 182 patients underwent laparoscopic Heller myotomy without fundoplication. After a prospective randomized trial justified its concomitant application, anterior fundoplication was undertaken with laparoscopic Heller myotomy in 171 patients from 2004 to 2007. All patients have been prospectively followed. Pre and postoperatively, patients scored the frequency and severity of symptoms of achalasia (including dysphagia, choking, vomiting, regurgitation, chest pain, and heartburn) using a Likert Scale (0 = never/not bothersome to 10 = always/very bothersome). Before myotomy, symptoms of achalasia were frequent and severe for all patients. After myotomy, the frequency and severity of all symptoms of achalasia significantly decreased for all patients (P Heller myotomy alone, concomitant anterior fundoplication led to significantly less frequent and severe heartburn after myotomy (P Heller myotomy reduces the frequency and severity of symptoms of achalasia. Concomitant anterior fundoplication decreases the frequency and severity of heartburn and dysphagia after laparoscopic Heller myotomy. Concomitant anterior fundoplication promotes salutary relief in the frequency and severity of symptoms after myotomy and is warranted.

K-wire assisted split-thickness skin graft harvesting from the anterior trunk.

Science.gov (United States)

Yontar, Yalcin; Coruh, Atilla; Severcan, Mehmet

2016-02-01

Split thickness skin graft (STSG) harvesting from the anterior chest and abdominal wall skin is quite a difficult process. The main reason for the difficulty to perform this process is the unsuitable anatomic characteristics of the anterior trunk, such as irregular wavy-like surface over the ribs and lax abdominal wall skin resulting in collapse due to lack of adequate underneath supporting structures when a downward force is applied by the skin graft dermatome. Lower extremity and especially the thigh are generally chosen as the donor site where the STSGs are easily harvested from. However, extensive lower extremity burns, with or without other region burns, preclude harvesting auto STSGs from this invaluable anatomic site. We harvested K-wire assisted STSGs from the anterior chest and abdominal wall skin of 7 patients with lower extremity burns and also a patient that sustained motor vehicle collision. We encountered no problems in any of our patients both intra and postoperatively by using K-wire assisted STSG harvesting. All of the STSGs donor sites healed uneventfully without complications. In our opinion, K-wire assisted STSG harvesting must always be in the tool-box of any surgeon who deals with extensive burns with or without lower extremity burns and extensive traumas of lower extremities. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Chest X-Ray

Medline Plus

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 ...

Subtle pulmonary nodules: detection and identification with storage phosphor radiographs and conventional chest films

International Nuclear Information System (INIS)

Scheck, R.J.; Schaetzl, M.; Kandziora, C.; Panzer, M.; Rienmueller, R.

1994-01-01

To determine the value of digital storagephosphor radiography (SR) on the detection and identification of subtle lung nodules, postero-anterior (PA) and lateral (LAT) film-screen (FR) chest radiographs were compared with isodose SR images of 45 patients with metastatic malignancies. The SR postprocessing was done with a particular mode previously optimized for routine chest radiography. Pulmonary metastases were found in 34 patients and were proved or excluded by CT (n=28) or longterm follow-up FR (n=17). Chest images were divided into four regions for evaluation of image quality, number of lung nodules per region and marked pulmonary structures by receiver-operating characteristics (ROC) analysis (45 patients; 125 nodules; 2810 observations; five readers). Of the nodules selected for an ROC study 82% were 0.5-1.0 cm in diameter. Overall image quality was rated better for FR concerning lung fields (PA) and mediastinum/hilum (LAT). More lung-field nodules were detected on FR than on SR chest images. Use of FR was superior to SR in the general identification of nodules (PA chest), especially concerning intermediate and subtle abnormalities, whereas there was no significant difference for LAT chest images. Our results show, that currently FR still has advantages over SR in the detection and identification of subtle lung nodules in routine clinical radiography. (orig.)

Comparison consequences of Jackson-Pratt drain versus chest tube after coronary artery bypass grafting: A randomized controlled clinical trial

Directory of Open Access Journals (Sweden)

Mohsen Mirmohammad-Sadeghi

2017-01-01

Full Text Available Background: Chest tubes are used in every case of coronary artery bypass grafting (CABG to evacuate shed blood from around the heart and lungs. This study was designed to assess the effective of Jackson-Pratt drain in compare with conventional chest drains after CABG. Materials and Methods: This was a randomized controlled trial that conducted on 218 patients in Chamran hospital from February to December 2016. Eligible patients were randomized in a 1:1 ratio. Jackson-Pratt drain group had 109 patients who received a chest tube insertion in the pleural space of the left lung and a Jackson-Pratt drain in mediastinum, and Chest tube drainage group had 109 patients who received double chest tube insertion in the pleural space of the left lung and the mediastinum. Results: The incidence of pleural effusions in Jackson-Pratt drain group and chest tube group were not statistically different. The pain score at 2-h in Drain group was significantly higher than chest tube group (P = 0.001, but the trend of pain score between groups was not significantly different (P = 0.097. The frequency of tamponade and atrial fibrillation (AF were significantly lower in Jackson-Pratt drain group (P < 0.05. Conclusion: The Jackson-Pratt drain is equally effective for preventing cardiac tamponade, pleural effusions, and pain intensity in patients after CABG when compared with conventional chest tubes, but was significantly superior regarding efficacy to hospital and Intensive Care Unit length of stay and the incidence of AF.

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 ...

High-resolution computed tomography versus chest radiography in the diagnosis of interstitial lung disease in systemic sclerosis

International Nuclear Information System (INIS)

Azevedo, Ana Beatriz Cordeiro de; Calderaro, Debora; Moreira, Caio; Guimaraes, Silvana Mangeon Meirelles; Tavares Junior, Wilson Campos; Leao Filho, Hilton Muniz; Andrade, Diego Correa de; Ferreira, Cid Sergio; Vieira, Jose Nelson Mendes

2005-01-01

Objective: To compare the accuracy of high-resolution computed tomography (HRCT) with chest radiography in the diagnosis of interstitial lung disease in systemic sclerosis (SSc). Materials And Methods: HRCT scans and chest radiographs in postero-anterior and lateral views were performed in 34 patients with systemic sclerosis, according to the American College of Rheumatology preliminary criteria for the diagnosis of SSc. The prevalence of radiological findings suggestive of interstitial lung disease in SSc seen on both imaging methods was compared. Results: Interstitial disease was observed on HRCT images of 31 patients (91%) and in the chest radiographs of 16 patients (47%). The most frequent findings observed on HRCT were septal lines (74%), honeycombing (56%) and parenchymal bands (26%). Chest radiographs showed reticular areas of attenuation in 11 patients (32%) and parenchymal distortion in 12% of the patients. In 18 patients (53%) with normal chest radiographs HRCT showed septal lines in 55%, ground glass in 44%, honeycombing in 38.5% and cysts in 33%. Conclusion: HRCT is more sensitive than chest radiography in the evaluation of incipient interstitial lung involvement in patients with SSc and can provide a justification for immunosuppressive therapy in patients with early disease. (author)

Management of anterior dental crossbite with removable appliances

Directory of Open Access Journals (Sweden)

Ayca Tuba Ulusoy

2013-01-01

Full Text Available This case report describes the treatment of an 8-year-old girl with anterior dental crossbite using a series of removable appliances to bring the teeth into a normal position. Clinical presentation and intervention: A removable acrylic appliance with a bite plate incorporating a screw was used to correct the anterior dental crossbite and align the incisors. The subsequent eruption of the maxillary left lateral incisor on the palatinal side was treated with a second acrylic plate incorporating a labiolingual spring. After an 8-month period, the anterior crossbite involving multiple incisors was corrected.

Dynamic chest radiography: flat-panel detector (FPD) based functional X-ray imaging.

Science.gov (United States)

Tanaka, Rie

2016-07-01

Dynamic chest radiography is a flat-panel detector (FPD)-based functional X-ray imaging, which is performed as an additional examination in chest radiography. The large field of view (FOV) of FPDs permits real-time observation of the entire lungs and simultaneous right-and-left evaluation of diaphragm kinetics. Most importantly, dynamic chest radiography provides pulmonary ventilation and circulation findings as slight changes in pixel value even without the use of contrast media; the interpretation is challenging and crucial for a better understanding of pulmonary function. The basic concept was proposed in the 1980s; however, it was not realized until the 2010s because of technical limitations. Dynamic FPDs and advanced digital image processing played a key role for clinical application of dynamic chest radiography. Pulmonary ventilation and circulation can be quantified and visualized for the diagnosis of pulmonary diseases. Dynamic chest radiography can be deployed as a simple and rapid means of functional imaging in both routine and emergency medicine. Here, we focus on the evaluation of pulmonary ventilation and circulation. This review article describes the basic mechanism of imaging findings according to pulmonary/circulation physiology, followed by imaging procedures, analysis method, and diagnostic performance of dynamic chest radiography.

Anterior loop of the inferior alveolar nerve: Averages and prevalence based on CT scans.

Science.gov (United States)

Juan, Del Valle Lovato; Grageda, Edgar; Gómez Crespo, Salvador

2016-02-01

The treatment of edentulous patients by using a complete implant-supported fixed prosthetic with distal extension has been widely studied; success is mainly dependent upon the placement of the distal implants. The location of the inferior alveolar nerve determines implant placement, but the length, prevalence, and symmetry between the left and right side of the anterior loop of the alveolar nerve are unknown. The purpose of this clinical study was to measure the anterior loop of the inferior alveolar nerve, which determines the placement of distal implants, in a group of 55 Mexican participants. The study expected to ascertain the average length, prevalence, and symmetry between left and right side and any sex differences. To differentiate the inferior alveolar nerve path, a new technique was applied using Hounsfield unit (HU) thresholds. The null hypothesis was that no significant differences would be found between the left and right sides or between men and women for the anterior loop of the inferior alveolar nerve. Fifty-five computed tomography (CT) scans were made (Somatom Sensation 16; Siemens Healthcare) and were visualized with InVesalius software. Anterior loop measurements were made on 3-dimensional surfaces. To determine statistical differences between the left and right side and between the sexes, the t test was used. The interclass correlation coefficient test was also applied to verify the reliability of the measurements. Ninety percent of participants showed the anterior loop of the inferior alveolar nerve. The length of the anterior loop ranged between 0 and 6.68 mm, with a mean of 2.19 mm. No significant differences were found between the left and right sides or between men and women. The mean length for the anterior loop in the sample was 2.19 mm. As the anterior loop length shows a high degree of variability, these findings suggest that a CT scan for each patient is recommended in order to visualize a safety zone before placing implants close to

Anomalous origin of left coronary artery arising from the right coronary cusp presenting with chest discomfort and syncope on physical exercise

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Ran Baik

2010-02-01

Full Text Available Anomalous origins of coronary arteries are a rare type of disease among children. These anomalies can be categorized into 3 types according to the anatomical relationship of the aorta and pulmonary trunks. Among these types, the interarterial type, as observed in our case, needs early diagnosis and treatment, because it can increase the risk for the patient, causing sudden cardiac death in young individuals. Although there are controversies concerning the management of anomalous origins of the left coronary artery (LCA in children, the result can be very beneficial, if treated accurately. Three well-known methods for correction of anomalous origins of LCA are re-implantation, coronary arterial bypass grafting (CABG, and unroofing. We report on the case of a 12-year-old girl who had chest discomfort and syncope with physical exercise and was later diagnosed with an anomalous origin of LCA by transthoracic echocardiography (TTE and heart computed tomography (CT. She underwent a corrective operation by re-implantation, CABG, and unroofing.

Interrupted inferior vena cava with hemiazygos continuation in an adult with a persistent left superior vena cava and left single coronary artery: A case report

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Kim, Yeo Jin; Kwon, Se Hwan; Ahn, Sung Eun; Kim, Soo Joong; Oh, Joo Hyeong [College of Medicine, Kyung Hee University, Seoul (Korea, Republic of); Shin, Jong Soo [Dept. of Radiology, Kyung Hee University Hospital at Gangdong, Seoul (Korea, Republic of)

2016-06-15

A 50-year-old woman was referred to our institution for medical screening due to an incidental finding on abdominal ultrasonography. She underwent chest, abdomen and cardiac multi-detector computed tomography (MDCT). Her MDCT revealed absence of the hepatic segment of the inferior vena cava (IVC), with hemiazygos continuation and a left single coronary artery. The dilated hemiazygos vein drained directly into the persistent left superior vena cava (SVC). Herein, we reported a very rare case combining an incidentally found interrupted IVC with hemiazygos vein continuation, persistent left SVC and a left single coronary artery diagnosed by MDCT.

Quantitative angiography of the left anterior descending coronary artery: correlations with pressure gradient and exercise thallium scintigraphy

International Nuclear Information System (INIS)

Reiber, J.H.C.; Serruys, P.W.; Slager, C.J.; Erasmus Univ., Rotterdam

1986-01-01

In order to evaluate during cardiac catheterization what constitutes a physiologically significant obstruction to blood flow in the human coronary system, computer based quantitative analysis of coronary angiograms was performed in 31 patients with isolated proximal left anterior descending coronary artery disease. The angiographic severity of the stenosis was compared with the transstenotic pressure gradient measured with the dilatation catheter during angioplasty and the results of exercise thallium scintigraphy. A curvilinear relation was found between the pressure gradient across the stenosis (normalized for the mean aortic pressure) and the residual minimal obstruction area (after subtracting the area of the angioplasty catheter). This relation was best fitted by the equation: normalized mean pressure gradient = a + b · log [obstruction area], r = 0.74. The measurements of the percent area stenosis (cut-off 80%) and of the transstenotic pressure gradient (cut-off 0.30) obtained at rest, correctly predicted the occurrence of thallium perfusion defects induced by exercise in 83% of the patients. (Auth.)

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 ...

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, ... d like to talk with you about chest radiography also known as chest x-rays. Chest x- ...

FLAIL CHEST

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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.

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

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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.

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 ...

Endomyocardial fibrosis associated with massive calcification of the left ventricle

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Canesin Manoel Fernandes

1999-01-01

Full Text Available This is the report of a rare case of endomyocardial fibrosis associated with massive calcification of the left ventricle in a male patient with dyspnea on great exertion, which began 5 years earlier and rapidly evolved. Due to lack of information and the absence of clinical signs that could characterize impairment of other organs, the case was initially managed as a disease with a pulmonary origin. With the evolution of the disease and in the presence of radiological images of heterogeneous opacification in the projection of the left ventricle, the diagnostic hypothesis of endomyocardial disease was established. This hypothesis was later confirmed on chest computed tomography. The patient died on the 16th day of the hospital stay, probably because of lack of myocardial reserve, with clinical findings of refractory heart failure, possibly aggravated by pulmonary infection. This shows that a rare disease such as endomyocardial fibrosis associated with massive calcification of the left ventricle may be suspected on a simple chest X-ray and confirmed by computed tomography.

Can anterior junction line be used to distinguish right middle from right upper lobe on CT scan?

International Nuclear Information System (INIS)

Cha, Jae Heon; Suh, Ja Young; Jo, Jin Man; Jeong, Hyeon Jo; Cheon, Mal Soon; Lee, Chul Woo; Yoon, Soon Min

1997-01-01

To evalvate the usefulness on a CT chest scan, of the anterior junction line as an anatomical landmark to distinguish the right middle and the right upper lobe We found that the anterior junction line has a constant anatomical relationship with the right upper and middle lobe, and with this in mind, analysed connvcntional CT films of 86 patients with normal lung(group A) and 30 with architectural distortion(group B). On a series of slices, we compared the location of slice 1 with that of slice 2(slice 1:the slice which includes the lowest portion of the anterior junction line, slice 2:the initial slice, in which the right middle lobe occupies the whole of the lung anterior to the right major fissure). In group A(n=86), the right upper lobe, as seen in the anteromedial zone of slice 1, was present in 83 cases(96.5%). The right upper lobe on slice 1 was absent in two cases(2.3%) in which a minor fissure was almost completely abent. In group B(n=30), the right upper lobe on slice 1 was absent in 19 cases(63.3%). We suggest that on a CT chest scan, the anterior junction line can be used as an anatomical landmark in the differentiation of the right middle from the right upper lobe, and as an indicator of the presence of architectural distortion

Accessory hepatic lobe simulating a left hemidiaphragmatic tumor

International Nuclear Information System (INIS)

Kuroiwa, Toshiro; Hirata, Hitoshi; Iwashita, Akinori; Yasumori, Kotaro; Mogami, Hiroshi; Teraoka, Hiroaki

1984-01-01

A 72-year-old woman with a 20-year history of neuralgia was confirmed at surgery to have a tumor in the left hemidiaphragmatic region which was connected with the left lobe of the liver. Reassessment of radiological diagnosis after surgery revealed that hepatobiliary scintigraphy and computed tomography using left anterior oblique scanning are useful in differentiating the accessory hepatic lobe of the liver from a tumor and in confirming the diagnosis, respectively. (Namekawa, K.)

Directional atherectomy facilitates the interventional procedure and leads to a low rate of recurrent stenosis in left anterior descending and left circumflex artery ostium stenoses: subgroup analysis of the FLEXI‐CUT study

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Dahm, J B; Ruppert, J; Hartmann, S; Vogelgesang, D; Hummel, A; Felix, S B

2006-01-01

Objectives To examine by retrospective analysis of data from the FLEXI‐CUT monocentre registry whether atherectomy can effectively simplify complex stent implantation in ostial bifurcation lesions by reducing the procedure to stenting of the left anterior descending (LAD) or left circumflex (LCX) artery ostium alone. Patients and methods All patients who had been enrolled in the prospective FLEXI‐CUT study (directional atherectomy with adjunctive balloon angioplasty) were retrospectively analysed on the basis of significant LAD or LCX ostial stenosis (⩾ 70% stenosis) deriving from an undiseased left main stem. The primary combined end point was the rate of target lesion revascularisation (TLR) and binary restenosis; secondary end points were procedural success and major adverse cardiac events (MACE) at the six‐month follow up. Results Of 30 patients enrolled with significant LAD or LCX ostium stenosis, 29 were effectively treated with directional atherectomy (96.7% procedural success). All patients underwent single‐vessel stenting procedures of solely the LAD or LCX ostium. At follow up, binary stenosis was 25% (6 of 24), TLR (angiographic plus clinical) 10.3% (3 of 29) and total MACE 6.9% (2 of 29). Conclusions Directional atherectomy with single‐vessel stenting procedures facilitates the interventional treatment of LAD and LCX ostium stenosis, and leads to remarkably low TLR and binary stenosis at follow up. PMID:16449510

Pre-Hospital 12-Lead Electrocardiogram within 60 Minutes Differentiates Proximal versus Nonproximal Left Anterior Descending Artery Myocardial Infarction

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James J McCarthy

2011-05-01

Full Text Available Introduction: Acute anterior myocardial infarctions caused by proximal left anterior descending (LAD artery occlusions are associated with a higher morbidity and mortality. Early identification of high-risk patients via the 12-lead electrocardiogram (ECG could assist physicians and emergency response teams in providing early and aggressive care for patients with anterior ST-elevation myocardial infarctions (STEMI. Approximately 25% of US hospitals have primary percutaneous coronary intervention (PCI capability for the treatment of acute myocardial infarctions. Given the paucity of hospitals capable of PCI, early identification of more severe myocardial infarction may prompt emergency medical service routing of these patients to PCI-capable hospitals. We sought to determine if the 12 lead ECG is capable of predicting proximal LAD artery occlusions. Methods: In a retrospective, post-hoc analysis of the Pre-Hospital Administration of Thrombolytic Therapy with Urgent Culprit Artery Revascularization pilot trial, we compared the ECG findings of proximal and nonproximal LAD occlusions for patients who had undergone an ECG within 180 minutes of symptom onset. Results: In this study, 72 patients had anterior STEMIs, with ECGs performed within 180 minutes of symptom onset. In patients who had undergone ECGs within 60 minutes (n¼35, the mean sum of ST elevation (STE in leads V1 through V6 plus ST depression (STD in leads II, III, and aVF was 19.2 mm for proximal LAD occlusions and 11.7 mm for nonproximal LAD occlusions (P¼0.007. A sum STE in V1 through V6 plus STD in II, III, and aVF of at least 17.5 mm had a sensitivity of 52.3%, specificity of 92.9%, positive predictive value of 91.7%, and negative predictive value of 56.5% for proximal LAD occlusions. When the ECG was performed more than 60 minutes after symptom onset (n¼37, there was no significant difference in ST-segment deviation between the 2 groups. Conclusion: The sum STE (V1-V6 and STD (II

Rib Radiography versus Chest Computed Tomography in the Diagnosis of Rib Fractures.

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Sano, Atsushi

2018-05-01

 The accurate diagnosis of rib fractures is important in chest trauma. Diagnostic images following chest trauma are usually obtained via chest X-ray, chest computed tomography, or rib radiography. This study evaluated the diagnostic characteristics of rib radiography and chest computed tomography.  Seventy-five rib fracture patients who underwent both chest computed tomography and rib radiography between April 2008 and December 2013 were included. Rib radiographs, centered on the site of pain, were taken from two directions. Chest computed tomography was performed using a 16-row multidetector scanner with 5-mm slice-pitch without overlap, and axial images were visualized in a bone window.  In total, 217 rib fractures were diagnosed in 75 patients. Rib radiography missed 43 rib fractures in 24 patients. The causes were overlap with organs in 15 cases, trivial fractures in 21 cases, and injury outside the imaging range in 7 cases. Left lower rib fractures were often missed due to overlap with the heart, while middle and lower rib fractures were frequently not diagnosed due to overlap with abdominal organs. Computed tomography missed 21 rib fractures in 17 patients. The causes were horizontal fractures in 10 cases, trivial fractures in 9 cases, and insufficient breath holding in 1 case.  In rib radiography, overlap with organs and fractures outside the imaging range were characteristic reasons for missed diagnoses. In chest computed tomography, horizontal rib fractures and insufficient breath holding were often responsible. We should take these challenges into account when diagnosing rib fractures. Georg Thieme Verlag KG Stuttgart · New York.

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! ...

Right Site, Wrong Route - Cannulating the Left Internal Jugular Vein.

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Paik, Peter; Arukala, Sanjay K; Sule, Anupam A

2018-01-09

Central venous catheters are placed in approximately five million patients annually in the US. The preferred site of insertion is one with fewer risks and easier access. Although the right internal jugular vein is preferred, on occasion, the left internal jugular may have to be accessed. A patient was admitted for septic shock, cerebrovascular accident, and non-ST-segment elevation myocardial infarction. A central venous line was needed for antibiotic and vasopressor administration. Due to trauma from a fall to the right side and previously failed catheterization attempts at the left subclavian and femoral veins, the left internal jugular vein was accessed. On chest radiography for confirmation, the left internal jugular central venous catheter was seen projecting down the left paraspinal region. It did not take the expected course across the midline toward the right and into the superior vena cava (SVC). A review of a computed tomography (CT) scan of the chest with contrast done on a prior admission revealed a duplicated SVC on the left side that had not been reported in the original CT scan interpretation. A left-sided SVC is present in approximately 0.3% to 0.5% of the population, with 90% of these draining into the coronary sinus. During placements of central venous lines and pacemakers, irritation of the coronary sinus may result in hypotension, arrhythmia, myocardial ischemia, or cardiac arrest. A widened mediastinum can be an indication of a duplicated SVC. When attempting a left internal jugular vein central venous catheter placement, it is important to be aware of venous anomalies in order to prevent complications.

Inter-observer variation in delineation of the heart and left anterior descending coronary artery in radiotherapy for breast cancer: a multi-centre study from Denmark and the UK

DEFF Research Database (Denmark)

Lorenzen, Ebbe L; Taylor, Carolyn W; Maraldo, Maja

2013-01-01

BACKGROUND AND PURPOSE: To determine the extent of inter-observer variation in delineation of the heart and left anterior descending coronary artery (LADCA) and its impact on estimated doses. METHODS AND MATERIALS: Nine observers from five centres delineated the heart and LADCA on fifteen patient...... guidelines were used. In contrast, for the LADCA there was substantial variation in the estimated dose, which was not reduced with guidelines....

[Development of image quality assurance support system using image recognition technology in radiography in lacked images of chest and abdomen].

Science.gov (United States)

Shibuya, Toru; Kato, Kyouichi; Eshima, Hidekazu; Sumi, Shinichirou; Kubo, Tadashi; Ishida, Hideki; Nakazawa, Yasuo

2012-01-01

In order to provide a precise radiography for diagnosis, it is required that we avoid radiography with defects by having enough evaluation. Conventionally, evaluation was performed only by observation of a radiological technologist (RT). The evaluation support system was developed for providing a high quality assurance without depending on RT observation only. The evaluation support system, called as the Image Quality Assurance Support System (IQASS), is characterized in that "image recognition technology" for the purpose of diagnostic radiography of chest and abdomen areas. The technique of the system used in this study. Of the 259 samples of posterior-anterior (AP) chest, lateral chest, and upright abdominal x-rays, the sensitivity and specificity was 93.1% and 91.8% in the chest AP, 93.3% and 93.6% in the chest lateral, and 95.0% and 93.8% in the upright abdominal x-rays. In the light of these results, it is suggested that AIQAS could be applied to practical usage for the RT.

Muscle activation when performing the chest press and shoulder press on a stable bench vs. a Swiss ball.

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Uribe, Brandon P; Coburn, Jared W; Brown, Lee E; Judelson, Daniel A; Khamoui, Andy V; Nguyen, Diamond

2010-04-01

The aim of this study was to examine the effects of a stable surface (bench) vs. an unstable surface (Swiss ball) on muscle activation when performing the dumbbell chest press and shoulder press. Sixteen healthy men (24.19 +/- 2.17 years) performed 1 repetition maximum (1RM) tests for the chest press and shoulder press on a stable surface. A minimum of 48 hours post 1RM, subjects returned to perform 3 consecutive repetitions each of the chest press and shoulder press at 80% 1RM under 4 different randomized conditions (chest press on bench, chest press on Swiss ball, shoulder press on bench, shoulder press on Swiss ball). Electromyography was used to assess muscle activation of the anterior deltoid, pectoralis major, and rectus abdominus. The results revealed no significant difference in muscle activation between surface types for either exercise. This suggests that using an unstable surface neither improves nor impairs muscle activation under the current conditions. Coaches and other practitioners can expect similar muscle activation when using a Swiss ball vs. a bench.

Left-Sided Catamenial Pneumothorax with Thoracic Endometriosis and Bullae in the Alveolar Wall.

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Takahashi, Ryo; Kurihara, Masatoshi; Mizobuchi, Teruaki; Ebana, Hiroki; Yamanaka, Sumitaka

2017-04-20

Catamenial pneumothorax (CP) is generally caused by intraperitoneal air leaking from the uterus into the thoracic cavity via a defect in the endometrial tissue of the diaphragm and is usually detected in the right thorax. We report a case of left-sided CP caused by endometriosis in the visceral pleura and with no abnormal findings in the diaphragm. A 33-year-old female patient presented at the end of a course of low-dose contraceptive pills for pelvic endometriosis, with spontaneous pneumothorax in the left chest. Chest CT revealed a bulla in the left upper lung lobe. The patient underwent partial resection of the lung. Immunohistochemistry confirmed the presence of endometrial stromal tissue in the visceral pleura and confirmed this as the cause of pneumothorax since there were no observable abnormalities in the diaphragm. This case suggests that immunohistochemical examination of patients with spontaneous pneumothorax can detect alternative endometrial lesions.

Concomitant aortic valve and internal mammary artery injuries in blunt chest trauma: report of a case.

Science.gov (United States)

Yeh, Chun-Chieh; Hsieh, Chi-Hsun; Wang, Yu-Chun; Chung, Ping-Kuei; Chen, Ray-Jade

2009-01-01

We report a case of concomitant injury to the aortic valve and internal mammary artery (IMA) from nonpenetrating chest trauma. To our knowledge, this is the first such case to be reported. Transcatheter arterial embolization (TAE) following diagnostic angiography offers an effective and minimally invasive treatment for traumatic IMA injuries. Because there might be an asymptomatic interval after traumatic aortic valve injuries, serial physical examinations and repeated echocardiography should be mandatory for patients with de novo heart failure after blunt chest trauma. Transesophageal echocardiography can provide a clearer image of cardiac injuries than transthoracic echocardiography, particularly if there is extensive anterior mediastinal hematoma resulting from IMA trauma.

A case of simultaneous bilateral spontaneous pneumothorax after the Nuss procedure.

Science.gov (United States)

Matsuoka, Shunichiro; Miyazawa, Masahisa; Kashimoto, Kentaro; Kobayashi, Hiroaki; Mitsui, Fumihiko; Tsunoda, Hajime; Kunitomo, Kazuyoshi; Chisuwa, Hisanao; Haba, Yoshiaki

2016-06-01

We present a case of simultaneous bilateral spontaneous pneumothorax caused by a pleuro-pleural communication formed from Nuss procedure for pectus excavatum. A 17-year-old man with a history of Nuss operation complained chest pain and dyspnea. A chest roentgenogram demonstrated a tiny bilateral pneumothorax and two metallic bars inserted at the Nuss procedure. Computed tomography revealed furthermore a bulla in the apex of the left lung. The bilateral pneumothorax critically deteriorated after 4 days from onset and urgent bilateral chest drainages were performed. Nevertheless the drainages the full expansion of both lungs was not obtained and air leakage only from left side was continued. A video-assisted left bullectomy was performed 9 days after the tube insertion. The two bars penetrating anterior mediastinal pleura were thought to be a cause of the simultaneous bilateral spontaneous pneumothorax.

CASE REPORT:Chondrosarcoma of Rib on Fine Needle Aspiration Cytology – A Rare Site

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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.

Segmentation of ribs in digital chest radiographs

Science.gov (United States)

Cong, Lin; Guo, Wei; Li, Qiang

2016-03-01

Ribs and clavicles in posterior-anterior (PA) digital chest radiographs often overlap with lung abnormalities such as nodules, and cause missing of these abnormalities, it is therefore necessary to remove or reduce the ribs in chest radiographs. The purpose of this study was to develop a fully automated algorithm to segment ribs within lung area in digital radiography (DR) for removal of the ribs. The rib segmentation algorithm consists of three steps. Firstly, a radiograph was pre-processed for contrast adjustment and noise removal; second, generalized Hough transform was employed to localize the lower boundary of the ribs. In the third step, a novel bilateral dynamic programming algorithm was used to accurately segment the upper and lower boundaries of ribs simultaneously. The width of the ribs and the smoothness of the rib boundaries were incorporated in the cost function of the bilateral dynamic programming for obtaining consistent results for the upper and lower boundaries. Our database consisted of 93 DR images, including, respectively, 23 and 70 images acquired with a DR system from Shanghai United-Imaging Healthcare Co. and from GE Healthcare Co. The rib localization algorithm achieved a sensitivity of 98.2% with 0.1 false positives per image. The accuracy of the detected ribs was further evaluated subjectively in 3 levels: "1", good; "2", acceptable; "3", poor. The percentages of good, acceptable, and poor segmentation results were 91.1%, 7.2%, and 1.7%, respectively. Our algorithm can obtain good segmentation results for ribs in chest radiography and would be useful for rib reduction in our future study.

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

Deterioration of pre-existing hemiparesis due to injury of the ipsilateral anterior corticospinal tract.

Science.gov (United States)

Jang, Sung Ho; Kwon, Hyeok Gyu

2013-05-29

The anterior corticospinal tract (CST) has been suggested as one of the ipsilateral motor pathways, which contribute to motor recovery following stroke. In this study, we report on a patient who showed deterioration of pre-existing hemiparesis due to an injury of the ipsilateral anterior CST following a pontine infarct, as evaluated by diffusion tensor tractography (DTT). A 55-year-old male patient showed quadriparesis after the onset of an infarct in the right pontine basis. He had history of an infarct in the left middle cerebral artery territory 7 years ago. Consequently, he showed right hemiparesis before onset of the right pontine infarct. Following this, his right hemiparesis deteriorated whereas his left hemiparesis newly developed. The DTTs for whole CST of the right hemisphere in the patient and both hemispheres in control subjects descended through the known CST pathway. By contrast, the DTT for the left whole CST of the patient showed a complete injury finding. The DTTs for the anterior CST of control subjects passed through the known pathway of the CST from cerebral cortex to medulla and terminated in the anterior funiculus of the upper cervical cord. However, the DTT for right anterior CST in the patient showed discontinuation below the right pontine infarct. It appeared that the deterioration of the pre-existing right hemiparesis was ascribed to an injury of the right anterior CST due to the right pontine infarct.

Blow/trauma to the chest and sudden cardiac death: Commotio cordis and contusio cordis are leading causes.

Science.gov (United States)

Krexi, Lydia; Sheppard, Mary N

2018-01-01

Background In forensic practice, a blow to the chest can lead to sudden cardiac death (SCD). Commotio cordis and contusio cordis are leading causes. Methods From a database of 4678 patients who suffered from SCD, we found three patients with commotio cordis and two patients with contusio cordis. All the patients were examined macroscopically and microscopically and had negative toxicology screen. Results The three patients who died due to commotio cordis were young males (16, 23 and 38 years old). The circumstances of death were: a blow to the chest by a football, by a friend during a party and during an assault. The hearts were completely normal at autopsy. The two patients who had contusio cordis were older males (42 and 63 years old). Both patients died during traffic accidents. At autopsy, one had significant contusion over the left ventricle, and the second had contusion over the right ventricle. Conclusion This study indicates that a blow to the chest is very important to document in the circumstances of death, and a detailed history is vital. It raises the left ventricular intra-cavitary pressure, leading to commotio cordis with immediate death with a normal heart. Blunt chest trauma can cause direct myocardial lesions, with acute changes leading to contusio cordis.

Isolated Left Pulmonary Artery Agenesis: A Case Report

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Tansel Ansal Balcı

2012-08-01

Full Text Available Unilateral pulmonary artery agenesis without any cardiovascular malformation is a rare anomaly. We present the imaging findings of a patient who was diagnosed as isolated left pulmonary artery agenesis. A 27-year-old female patient was admitted to our hospital due to dyspnea during exercise for five years. Chest X-ray revealed minimally small left pulmonary hilum and left lung. She was admitted to our clinic with the suspicion of pulmonary artery pathology. Absent perfusion of the left lung with normal ventilation was visualized on scintigraphy. MDCT angiography of pulmonary arteries showed absent left main pulmonary artery with systemic collaterals around left hemithorax. Pulmonary artery agenesis can be asymptomatic and isolated until adulthood. Both scintigraphy and CT angiography images of pulmonary artery agenesis of a patient are rare in the literature. Pulmonary ventilation- perfusion scintigraphy can be used not only for pulmonary embolism but also pathologies involving pulmonary artery and its branches. (MIRT 2012;21:80-83

Damage to the anterior arcuate fasciculus predicts non-fluent speech production in aphasia.

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Fridriksson, Julius; Guo, Dazhou; Fillmore, Paul; Holland, Audrey; Rorden, Chris

2013-11-01

Non-fluent aphasia implies a relatively straightforward neurological condition characterized by limited speech output. However, it is an umbrella term for different underlying impairments affecting speech production. Several studies have sought the critical lesion location that gives rise to non-fluent aphasia. The results have been mixed but typically implicate anterior cortical regions such as Broca's area, the left anterior insula, and deep white matter regions. To provide a clearer picture of cortical damage in non-fluent aphasia, the current study examined brain damage that negatively influences speech fluency in patients with aphasia. It controlled for some basic speech and language comprehension factors in order to better isolate the contribution of different mechanisms to fluency, or its lack. Cortical damage was related to overall speech fluency, as estimated by clinical judgements using the Western Aphasia Battery speech fluency scale, diadochokinetic rate, rudimentary auditory language comprehension, and executive functioning (scores on a matrix reasoning test) in 64 patients with chronic left hemisphere stroke. A region of interest analysis that included brain regions typically implicated in speech and language processing revealed that non-fluency in aphasia is primarily predicted by damage to the anterior segment of the left arcuate fasciculus. An improved prediction model also included the left uncinate fasciculus, a white matter tract connecting the middle and anterior temporal lobe with frontal lobe regions, including the pars triangularis. Models that controlled for diadochokinetic rate, picture-word recognition, or executive functioning also revealed a strong relationship between anterior segment involvement and speech fluency. Whole brain analyses corroborated the findings from the region of interest analyses. An additional exploratory analysis revealed that involvement of the uncinate fasciculus adjudicated between Broca's and global aphasia

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

Left ventricular diastolic function in patients with coronary artery disease

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Brugger, P.T.

1986-08-01

In 302 patients with confirmed coronary disease we determined the left ventricular diastolic function with the Nuclear Stethoscope by the aid of the Peak Filling Rate (PFR) and the Time to Peak Filling Rate (TPFR). Moreover we investigated the ejection fraction (EF). 201 patients had already suffered a myocardial infarction, of these 99 an anterior wall and 102 an inferior wall infarction. The remaining 101 patients had a CAD without a history of myocardial infarction. The PFR was 2.19 +- 0.65 EDV/sec in the 99 patients after anterior wall infarction and 2.62 +- 0.85 EDV/sec in the 102 patients after inferior wall infarction and 2.79 +- 0.85 EDV/sec in 101 patients with coronary artery disease without a history of myocardial infarction. For the PFR there could be found a statistically significant difference between normal patients and patients after anterior wall infarction (p < 0.0001), normal patients and patients after inferior wall infarction (p < 0.0001) and normal patients and patients with coronary artery disease (p < 0.0001). The TPFR was 180 +- 37.5 msec after anterior - and 158 +- 50.7 msec after inferior wall infarction and 156 +- 45.2 msec in the patients with CAD without previous infarction. The left ventricular diastolic function (PFR and/or TPFR) was abnormal in 88% after anterior- and in 82% after inferior wall infarction and in 69% in coronary patients without previous myocardial infarction. In comparison with this the ejection fraction was reduced in 66% in anterior- and in 61% inferior wall infarction at rest. These results indicate that the diastolic function at rest appears to be more informative for evaluation of a left ventricular dysfunction than the systolic function at rest.

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.

Comparison of exercise ECG and radionuclide ventriculography in the assessment of myocardial ischemia in patients with isolated stenoses of the left anterior descending artery

International Nuclear Information System (INIS)

Klepzig, H. Jr.; Mildenberger, D.; Kaltenbach, M.; Standke, R.; Baum, R.P.; Tezak, S.; Maul, F.D.; Hoer, G.

1988-01-01

21 patients with LAD-stenoses of at least 70% and 21 patients with LAD-stenoses and additional intramural anterior wall infarctions were studied. 20 patients without heart disease or after successful transluminal coronary angioplasty and 18 patients with intramural anterior wall infarction after successful transluminal dilatation of the LAD (remaining stenosis maximal 30%) served as controls. The normal range of global and regional left ventricular ejection fraction response to exercise was defined based on the data of 25 further patients without relevant coronary heart disease. Thus, a decrease in global ejection fraction and regional wall motion abnormalities were judged pathological. All patients were comparable with respect to age, ejection fraction at rest and work load. Myocardial ischemia could be detected by the exercise ECG in 81% of all patients without infarction and in 71% of patients with infarction. The corresponding values for global left ventricular ejection fraction were 76% and 81%, respectively, and for regional ejection fraction 95% in both groups. No false-positive exercise ECGs were observed in the healthy controls and 2(11%) in the corresponding group with intramural infaction. The global ejection fraction was pathological in 1(5%) healthy subject without infarction and in 3(17%) corresponding patients with infarction. Sectorial analysis revealed 5 and 22%, respectively. Our findings suggest that the exercise ECG has a limited sensitivity to detect myocardial ischemia in patients with isolated LAD-stenoses and intramural myocardial infarction. Radionuclide ventriculography yields pathological values more often; however, false-positive results also occur more frequently. (orig.) [de

Anomalous Origin of the Right Coronary Artery from the Left Anterior Descending Coronary Artery in a Patient with Ascending Aortic Aneurysm

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Ufuk Gürkan

2012-04-01

Full Text Available The incidence of coronary artery anomalies has been reported between 0.6 to 1.3% in angiographic series and 0.3% in autopsy series. An isolated single coronary artery (SCA is even a rarer congenital anomaly occurring in approximately 0.02% of the population. The ectopic origin of the right coronary artery (RCA from the left anterior descending (LAD artery is relatively rare and more benign than other types of anomalous origin of the RCAs. We report a case of an adult male patient with SCA anomaly in which the RCA takes off from the mid LAD. To the best of our knowledge, SCA anomaly coinciding with ascending aortic aneurysm which was treated with Bentall operation has never been described before.

Computerized axial tomography of the chest for visualization of ''absent'' pulmonary arteries

International Nuclear Information System (INIS)

Sondheimer, H.M.; Oliphant, M.; Schneider, B.; Kavey, R.E.W.; Blackman, M.S.; Parker, F.B. Jr.

1982-01-01

To expand the search for central pulmonary arteries in six patients with absence of cardiac-pulmonary continuity, computerized axial tomography (CAT) of the chest was performed. The CAT scans were compared with previous arteriograms and pulmonary vein wedge angiograms. Three patients with type IV truncus arteriosus were studied, and none had a central, right or left pulmonary artery on CAT scan. However, two patients with tetralogy of Fallot with pulmonary atresia and a patent ductus arteriosus to the right lung demonstrated the presence of a left pulmonary artery. In addition, one child with truncus arteriosus with ''absent'' left pulmonary artery demonstrated a left pulmonary artery on the CAT scan. The CAT scan may therefore enhance our ability to search for disconnected pulmonary arteries in children with complex cyanotic congenital heart disease

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

Autopsy case of a giant aneurysm of the anterior communicating artery. Correlation of CT findings and angiographic findings

Energy Technology Data Exchange (ETDEWEB)

Shinmura, Fujio; Takayasu, Kenji; Ohiwa, Yasuyuki; Sakata, Ryuichi; Ariwa, Rokuro

1983-06-01

A 64-year-old female was admitted to the hospital with a history of three previous subarachnoid hemorrhages. Neurological examinations revealed incontinentia urinae, gait disturbance, recent memory disturbance and motor weakness on the left side. Plain X-ray films showed a ring-like calcification in the right frontal region. A plain CT scan showed a ring-shaped iso- and high-density area in the intra hemispheric region, the intra bilateral anterior horn of the lateral ventricle, the intra septum pellucidum, and the intra anterior part of the third ventricle. Left carotid angiography showed a large aneurysmal shadow arising from the anterior communicating artery and another from the left middle cerebral artery. In the venous phase the venous angle was supero-posteriorly shifted, and the septal vein was elevated. She died unexpectedly with a status epilepticus of unknown origin. An autopsy specimen revealed that a giant aneurysm occupied the intra ventricular space, the anterior horn of the lateral ventricle, and the right thalamic region. Also, there was a large berry aneurysm arising from the middle cerebral artery. A coronary section through the giant aneurysm showed a markedly compressed left lateral ventricle, right thalamus, and hypothalamus, while the third ventricle had shifted toward the left side.

Outcome of Achalasia Cardia Managed with Transabdominal Hellers Cardiomyotomy and Anterior Dor Patch

International Nuclear Information System (INIS)

Wyne, A.; Majeed, F. A.; Khan, M. I.; Rahim, K.

2013-01-01

Objectives: To evaluate relief of dysphagia and apprearance of reflux symptoms in patients of achalasia cardia treated with Trans abdominal cardiomyotomy and anterior Dor patch. Study Design: Quasi experimental study. Place and duration of study: Combined Military Hospital Quetta and Combined Military Hospital Rawalpindi from Jan 2006 to Jan 2012. Methodology: Twenty three cases were diagnosed to have achalasia cardia on barium swallow, upper GI endoscopy and CT scan chest in selective cases. They were treated with transabdominal modified Hellers cardiomyotomy and anterior Dor patch as an antireflux procedure. Relief of dysphagia and occurrence of reflux symptoms were evaluated clinically. Results: All (100%) operated patients had symptomatic relief of dysphagia over follow up of six months. No patient had post op reflux symptoms. Conclusion: Transabdominal Hellers cardiomyotomy with anterior Dor patch is a safe and effective surgical option for achalasia cardia. (author)

Assessment of cardiac performance with quantitative radionuclide angiocardiography: sequential left ventricular ejection fraction, normalized left ventricular ejection rate, and regional wall motion

International Nuclear Information System (INIS)

Marshall, R.C.; Berger, H.J.; Costin, J.C.; Freedman, G.S.; Wolberg, J.; Cohen, L.S.; Gotischalk, A.; Zaret, B.L.

1977-01-01

Sequential quantitative first pass radionuclide angiocardiograms (RA) were used to measure left ventricular ejection fraction (LVEF) and left ventricular ejection rate (LVER), and to assess regional wall motion (RWM) in the anterior (ANT) and left anterior oblique (LAO) positions. Studies were obtained with a computerized multicrystal scintillation camera suitable for acquiring high count-rate data. Background was determined in a new fashion by selecting frames temporally from the left ventricular region of interest time-activity curve. A ''representative'' cardiac cycle was formed by summing together counts over three to six cardiac cycles. From this background corrected, high count-rate ''representative''cardiac cycle, LVEF, LVER, and RWM were determined. In 22 patients with normal sinus rhythm in the absence of significant valvular regurgitation, RA LVEF correlated well with that measured by contrast angiography (r = 0.95). LVER correlated well with LVEF measured at contrast angiography (r = 0.90) and allowed complete separation of those with normal (LVER = 3.4 +- 0.17 sec -1 ) and abnormal (LVER = 1.22 +- 0.11 sec -1 ) (P < 0.001) left ventricular performance. This separation was independent of background. Isoproterenol infusion in five normal subjects caused LVER to increase by 81 +- 17% while LVEF increased by 10 +- 2.0%. RWM was correctly defined in 21/22 patients and 89% of left ventricular segments with abnormal wall motion

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)

Temporal subtraction of chest radiographs compensating pose differences

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von Berg, Jens; Dworzak, Jalda; Klinder, Tobias; Manke, Dirk; Kreth, Adrian; Lamecker, Hans; Zachow, Stefan; Lorenz, Cristian

2011-03-01

Temporal subtraction techniques using 2D image registration improve the detectability of interval changes from chest radiographs. Although such methods are well known for some time they are not widely used in radiologic practice. The reason is the occurrence of strong pose differences between two acquisitions with a time interval of months to years in between. Such strong perspective differences occur in a reasonable number of cases. They cannot be compensated by available image registration methods and thus mask interval changes to be undetectable. In this paper a method is proposed to estimate a 3D pose difference by the adaptation of a 3D rib cage model to both projections. The difference between both is then compensated for, thus producing a subtraction image with virtually no change in pose. The method generally assumes that no 3D image data is available from the patient. The accuracy of pose estimation is validated with chest phantom images acquired under controlled geometric conditions. A subtle interval change simulated by a piece of plastic foam attached to the phantom becomes visible in subtraction images generated with this technique even at strong angular pose differences like an anterior-posterior inclination of 13 degrees.

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)

American College of Chest Physicians

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... 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 ...

An Evaluation of pectus excavatum by means of body surface measurements on chest CT scans

International Nuclear Information System (INIS)

Hirotani, Taichi; Ohama, Kazunori; Shimotake, Takashi; Ishikawa, Nobuki; Watanabe, Reiji

2009-01-01

The aim of this study is to determine whether the body surface index replaces the Haller index in order to evaluate the severity of pectus excavatum. Sixty-nine cases with a diagnosis of pectus excavatum between August 2001 and January 2008 were prospectively enrolled in the study. The anterior-posterior chest dimension, lateral chest dimension and depth of the most profound depressed area were measured. The body surface index was expressed as an equation A/(B-C), where A was the transverse diameter, B was the anterior-posterior diameter and C was the depth of the depressed area. This index was compared to the Haller index in each patient. In this study, each value was measured on a chest CT scan. The body surface index significantly correlated with the Haller index, in which the coefficient of correlation was 0.879 (p<0.01). The body surface index corresponding to Haller index 3.25 seems to be 1.67. We could find the body surface index corresponding to each Haller index. We propose that an evaluation of pectus excavatum by means of body surface measurements is clinically useful, and may replace the Haller index. The body surface index may allow us to assess the severity of pectus excavatum without a CT scan, resulting in a reduction of radiation exposure for children with pectus excavatum. It's possible to evaluate the body surface index by using a relational table between this index and the Hailer index. We'll evaluate the body surface index by using values measured on a real body. (author)

Magnetic resonance imaging of acute myocardial infarction in dextrocardia with situs solitus (dextroversion)

International Nuclear Information System (INIS)

Salanitri, J.C.; Welker, M.; Pereles, F.S.

2005-01-01

The case report of an 88-year-old woman with dextroversion and acute anterior wall myocardial infarction is presented. The patient, who had been diagnosed with dextrocardia 3 years prior to this admission, presented with right-sided chest pain. Coronary angiography demonstrated an 80% proximal left anterior descending artery stenosis which was successfully stented. A cardiac MRI was performed to exclude a left atrial thrombus after an inconclusive echocardiogram. The MRI demonstrated findings consistent with dextroversion, with delayed contrast-enhanced viability sequences confirming a near transmural anterior wall myocardial infarct. To our knowledge, this is the first report illustrating the cardiac MRI findings in such a case. Copyright (2005) Blackwell Science Pty Ltd

Catarata polar anterior piramidal deslocada para a câmara anterior causando edema de córnea: relato de caso Corneal edema caused by a pyramidal anterior polar cataract dislocated to the anterior chamber: case report

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Ramon Coral Ghanem

2004-08-01

Full Text Available Cataratas polares anteriores piramidais são opacidades cônicas que se projetam para a câmara anterior a partir da cápsula anterior do cristalino. Na grande maioria dos pacientes a opacidade permanece aderida e estável durante toda a vida. O objetivo deste trabalho é documentar uma manifestação incomum desse tipo de catarata: a deiscência espontânea das pirâmides para a câmara anterior causando descompensação endotelial e edema corneal bilateral. Relatamos o caso de uma paciente feminina, de 66 anos, branca, que apresentava edema corneal localizado inferiormente no olho direito associado à lesão nodular branco-esclerótica compatível com a pirâmide anterior da catarata polar. O olho esquerdo apresentava edema corneal difuso intenso e presença de uma catarata polar anterior com a região piramidal deslocada para a câmara anterior. Sabe-se que a pirâmide anterior pode permanecer inabsorvida na câmara anterior por longo período, pois é composta de tecido colágeno denso. Isto causa perda endotelial progressiva e edema corneal e deve ser considerada indicação de remoção cirúrgica da catarata polar anterior e de seu fragmento. Ressalta-se, também, a importância do bom senso no julgamento das cataratas polares anteriores, considerando-se tamanho da opacidade, simetria das opacidades e componente cortical associado, na tentativa de se evitar ambliopia.Pyramidal anterior polar cataracts are conical opacities that project into the anterior chamber from the anterior capsule of the lens. In the vast majority of patients the opacity remains bound and stable throughout life. We report an unusual complication of this type of cataract: spontaneous dehiscence of the pyramids to the anterior chamber causing bilateral endothelial damage and corneal edema. 66-year-old white woman presented with inferior corneal edema in the right eye and diffuse corneal edema in the left eye. A white nodular lesion was observed in the inferior angle

Diagnostic accuracy of exercise thallium-201 single-photon emission computed tomography in patients with left bundle branch block

International Nuclear Information System (INIS)

Larcos, G.; Gibbons, R.J.; Brown, M.L.

1991-01-01

Recent reports have proposed that abnormal apical or anterior wall perfusion with exercise thallium-201 imaging may increase diagnostic accuracy for disease of the left anterior descending artery in patients with left bundle branch block (LBBB). To evaluate these suggestions, 83 patients with LBBB who underwent thallium-201 single-photon emission computed tomography and coronary angiography within an interval of 3 months were retrospectively reviewed. There were 59 men and 24 women aged 33 to 84 years (mean 65). Myocardial perfusion to the apex, anterior wall and anterior septum were scored qualitatively by consensus of 2 experienced observers and by quantitative analysis in comparison with a normal data base. The sensitivity, specificity and accuracy of perfusion defects in these segments were then expressed according to angiographic findings. Significant stenosis of vessels within the left anterior descending artery territory was present in 38 patients. By receiver-operator characteristic analysis, a fixed or reversible defect within the apex by the qualitative method was the best criterion for coronary artery disease. However, although highly sensitive (79 and 85% by the qualitative and quantitative methods, respectively), an apical defect was neither specific (38 and 16%, respectively), nor accurate (57 and 46%, respectively). Perfusion abnormalities in the anterior wall and septum were also of limited diagnostic accuracy. Thus, modified interpretative criteria in patients with LBBB are not clinically useful in the assessment of left anterior descending artery disease

Quantitative evaluation of changes in pleural effusion using digital images of the chest

International Nuclear Information System (INIS)

Nishiike, Shigeaki; Fujimura, Ichiro; Sagara, Kenji; Sakashita, Keiji

2000-01-01

Exposure data recognition (EDR) is a function of FCR that automatically determines the optimal density of images. This function makes it difficult to evaluate changes in pleural effusion on sequential chest CR. We developed a method to quantify the amount of pleural effusion using the digital value and S value of chest CR. We evaluated the efficacy of the method to quantify the amount of pleural effusion using these values of chest CR in clinical settings. The study period was from December 1996 to January 1999. Study 1: Chest CR was carried out before and after pleural cavity drainage in 70 cases. The volume calculated with the method using the digital value and S value of CR [x(ml)] was compared with the drained volume [y1] on both sides. Study 2: Change in pleural effusion was estimated with a method using CT (y2) and with the method using the digital value and S value of CR (x). The relationship of these two data was investigated. Study 1: The regression equations between x and y1 were y1=1.05x+21.1 (r 2 =0.89) on the right side and y1=0.95x+69.7 (r 2 =0.68) on the left side. Study 2: The regression equations between x and y2 were y2=0.75x-1.88 (r 2 =0.70) on the right side and y2=0.87x-1.27 (r 2 =0.65) on the left side. The method using the digital value and S value of CR was effective for quantifying changes in pleural effusion. (author)

Veia cava superior esquerda anômala com ausência de veia cava superior direita: achados de imagem Persistent left superior vena cava with absent right superior vena cava: image findings

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Cyrillo Rodrigues de Araújo Júnior

2003-10-01

Full Text Available A persistência da veia cava superior esquerda com ausência da veia cava superior direita é uma anomalia rara, com menos de 150 casos descritos na literatura. A não-obliteração e regressão da veia cardinal anterior esquerda durante o desenvolvimento embriológico promove uma variação sistêmica de retorno venoso ao coração, com persistência da veia cava superior esquerda. Sua incidência varia de 0,3% em pacientes sem alterações cardíacas congênitas concomitantes a 4,3% naqueles com cardiopatias. Na maioria das vezes coexiste a veia cava superior direita, porém se houver regressão e degeneração da veia cardinal anterior direita, implicará a sua ausência e a drenagem venosa para o coração será feita pela veia cava superior esquerda ao átrio direito, através do seio coronariano. Mostramos um caso de um paciente submetido a radiografia de tórax e tomografia computadorizada para avaliação de doença pulmonar obstrutiva crônica, tendo como achado a persistência da veia cava superior esquerda com ausência da direita, sem qualquer cardiopatia associada e com a drenagem cardíaca sendo feita, através do seio coronariano, para o átrio direito.Persistent left superior vena cava with absent right superior vena cava is a rare anomaly, with less than 150 cases reported in the literature. Congenitally persistent left superior vena cava is the most common variant of systemic venous return to the heart, resulting embryologically from failure of the left anterior cardinal vein to become obliterated. Its incidence varies from 0.3% in patients with otherwise normal heart to 4.3% in patients with congenital heart disease. In the majority of the patients, a right superior vena cava is present as well, but rarely the right anterior cardinal vein degenerates resulting in the absence of the normal right superior vena cava. The blood from the right side is carried by the persistent left superior vena cava to the right atrium through the

Chest MRI

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... 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 ...

Coronary Artery Calcium as an Independent Surrogate Marker in the Risk Assessment of Patients With Atrial Fibrillation and an Intermediate Pretest Likelihood for Coronary Artery Disease Admitted to a German Chest Pain Unit.

Science.gov (United States)

Breuckmann, Frank; Olligs, Jan; Hinrichs, Liane; Koopmann, Matthias; Lichtenberg, Michael; Böse, Dirk; Fischer, Dieter; Eckardt, Lars; Waltenberger, Johannes; Garvey, J Lee

2016-03-01

About 10% of patients admitted to a chest pain unit (CPU) exhibit atrial fibrillation (AF). To determine whether calcium scores (CS) are superior over common risk scores for coronary artery disease (CAD) in patients presenting with atypical chest pain, newly diagnosed AF, and intermediate pretest probability for CAD within the CPU. In 73 subjects, CS was related to the following risk scores: Global Registry of Acute Coronary Events (GRACE) score, including a new model of a frequency-normalized approach; Thrombolysis In Myocardial Infarction score; European Society of Cardiology Systematic Coronary Risk Evaluation (SCORE); Framingham risk score; and Prospective Cardiovascular Münster Study score. Revascularization rates during index stay were assessed. Median CS was 77 (interquartile range, 1-270), with higher values in men and the left anterior descending artery. Only the modified GRACE (ρ = 0.27; P = 0.02) and the SCORE (ρ = 0.39; P risk scores and calcium burden, as well as revascularization rates during index stay, were low. By contrast, the determination of CS may be used as an additional surrogate marker in risk stratification in AF patients with intermediate pretest likelihood for CAD admitted to a CPU. © 2016 Wiley Periodicals, Inc.

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.

Chest Pain: First Aid

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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 ...

Atypical presentation of popliteal artery entrapment syndrome: involvement of the anterior tibial artery.

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Bou, Steven; Day, Carly

2014-11-01

Popliteal artery entrapment syndrome (PAES) is a rare condition that should be suspected in a young patient with exertional lower extremity pain. We report the case of an 18-year-old female volleyball player with bilateral exertional lower extremity pain who had been previously diagnosed with tendinitis and periostitis. Diagnostic studies showed entrapment of the left popliteal artery and the left anterior tibial artery. To our knowledge, there has only been 1 previous report of anterior tibial artery involvement in PAES. Copyright © 2014 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Transthoracic impedance for the monitoring of quality of manual chest compression during cardiopulmonary resuscitation.

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Zhang, Hehua; Yang, Zhengfei; Huang, Zitong; Chen, Bihua; Zhang, Lei; Li, Heng; Wu, Baoming; Yu, Tao; Li, Yongqin

2012-10-01

The quality of cardiopulmonary resuscitation (CPR), especially adequate compression depth, is associated with return of spontaneous circulation (ROSC) and is therefore recommended to be measured routinely. In the current study, we investigated the relationship between changes of transthoracic impedance (TTI) measured through the defibrillation electrodes, chest compression depth and coronary perfusion pressure (CPP) in a porcine model of cardiac arrest. In 14 male pigs weighing between 28 and 34 kg, ventricular fibrillation (VF) was electrically induced and untreated for 6 min. Animals were randomized to either optimal or suboptimal chest compression group. Optimal depth of manual compression in 7 pigs was defined as a decrease of 25% (50 mm) in anterior posterior diameter of the chest, while suboptimal compression was defined as 70% of the optimal depth (35 mm). After 2 min of chest compression, defibrillation was attempted with a 120-J rectilinear biphasic shock. There were no differences in baseline measurements between groups. All animals had ROSC after optimal compressions; this contrasted with suboptimal compressions, after which only 2 of the animals had ROSC (100% vs. 28.57%, p=0.021). The correlation coefficient was 0.89 between TTI amplitude and compression depth (pcompression depth and CPP in this porcine model of cardiac arrest. The TTI measured from defibrillator electrodes, therefore has the potential to serve as an indicator to monitor the quality of chest compression and estimate CPP during CPR. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

A case report of congenital coronary artery fistula to the left ventricle

International Nuclear Information System (INIS)

Lee, Byung Hee; Yu, Shi Joon; Moon, Eon Soo; Kim, Sam Hyun; Choi, Young Hi

1987-01-01

Congenital coronary artery fistula is a rare malformation with an incidence of 0.4% of congenital heart disease. Among the various subtypes, fistula to the left ventricle is extremely rare with 6 reported cases till 1983. We present a case of coronary artery fistula between the right coronary artery and the left ventricle. The dilated right coronary artery formed a mass like bulging the right lower heart border in the plain chest PA, we think this is first case with a coronary artery fistula to the left ventricle, reported in Korea

A double-chambered left ventricle in a patient with palpitation

International Nuclear Information System (INIS)

Stathaki, M.; Velidaki, A.; Koukouraki, S.; Koxiadakis, G.; Vardas, P.; Karkavitsas, N.

2005-01-01

A 28 years old male patient was admitted to the department of cardiology after an episode of atypical chest pain, exertional dyspnea and palpitation on exercise. He was a chronic smoker and was smoking about 15 cigarettes per day, but had no family history of early heart disease. The echocardiography demonstrated the presence of an abnormal chamber in close contact to the left ventricle that followed systole and diastole. The coronary angiography was normal and the left ventriculography showed a double-chambered left ventricle. Theradionuclide ventriculography confirmed the presence of two separate chambers that communicate with each other and the ejection fraction obtained was 43%. (author)

Spontaneous pneumomediastinum: A rare complication of methamphetamine use.

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Albanese, Jessica; Gross, Cole; Azab, Mohamed; Mahalean, Sinziana; Makar, Ranjit

2017-01-01

To present an unusual case of spontaneous pneumomediastinum subsequent to recreational amphetamine use. A young African American adult male was admitted to internal medicine service for treatment of rhabdomyolysis secondary to methamphetamine use. On admission, he was complaining of chest pain in addition to nausea and generalized muscle aches. By his second hospital day, chest pain had resolved yet physical exam demonstrated crepitation of the anterior chest and left axilla. Portable chest x-ray revealed subcutaneous emphysema in addition to pneumomediastinum. Spontaneous pneumomediastinum is a rare complication of amphetamine use that is often associated with subcutaneous emphysema and can be diagnosed with chest x-ray. Management is conservative, with observation, pain control, and supplemental oxygen as needed.

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

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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.)

Pectus excavatum in blunt chest trauma: a case report

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Liodakis Emmanouil

2013-01-01

Full Text Available Abstract Introduction Blunt cardiac rupture is an exceedingly rare injury. Case presentation We report a case of blunt cardiac trauma in a 43-year-old Caucasian German mother with pectus excavatum who presented after a car accident in which she had been sitting in the front seat holding her two-year-old boy in her arms. The mother was awake and alert during the initial two hours after the accident but then proceeded to hemodynamically collapse. The child did not sustain any severe injuries. Intraoperatively, a combined one-cm laceration of the left atrium and right ventricle was found. Conclusion Patients with pectus excavatum have an increased risk for cardiac rupture after blunt chest trauma because of compression between the sternum and spine. Therefore, patients with pectus excavatum and blunt chest trauma should be admitted to a Level I Trauma Center with a high degree of suspicion.

Quantitative angiography of the left anterior descending coronary artery: correlations with pressure gradient and results of exercise thallium scintigraphy

International Nuclear Information System (INIS)

Wijns, W.; Serruys, P.W.; Reiber, J.H.; van den Brand, M.; Simoons, M.L.; Kooijman, C.J.; Balakumaran, K.; Hugenholtz, P.G.

1985-01-01

To evaluate, during cardiac catheterization, what constitutes a physiologically significant obstruction to blood flow in the human coronary system, computer-based quantitative analysis of coronary angiograms was performed on the angiograms of 31 patients with isolated disease of the proximal left anterior descending coronary artery. The angiographic severity of stenosis was compared with the transstenotic pressure gradient measured with the dilation catheter during angioplasty and with the results of exercise thallium scintigraphy. A curvilinear relationship was found between the pressure gradient across the stenosis (normalized for the mean aortic pressure) and the residual minimal area of obstruction (after subtracting the area of the angioplasty catheter). This relationship was best fitted by the equation: normalized mean pressure gradient . a + b . log [obstruction area], r . .74. The measurements of the percent area of stenosis (cutoff 80%) and of the transstenotic pressure gradient (cutoff 0.30) obtained at rest correctly predicted the occurrence of thallium perfusion defects induced by exercise in 83% of the patients

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

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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

Laser speckle flowgraphy for differentiating between nonarteritic ischemic optic neuropathy and anterior optic neuritis.

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Maekubo, Tomoyuki; Chuman, Hideki; Nao-I, Nobuhisa

2013-07-01

The aim of this study was to investigate the usefulness of laser speckle flowgraphy (LSFG) for the differentiation of acute nonarteritic ischemic optic neuropathy (NAION) from anterior optic neuritis (ON). To investigate blood flow in the optic disc under normal conditions, NAION, and anterior ON, we compared the tissue blood flow of the right eye with that of the left eye in the control group, and that of the affected eye with that of the unaffected eye in the NAION and anterior ON groups. In the normal control group, the tissue blood flow did not significantly differ between the right and left eyes. In the NAION group, all 6 patients had decreased optic disc blood flow in the NAION eye when compared with the unaffected eye. By contrast, in the anterior ON group, all 6 patients had increased optic disc blood flow in the anterior ON eye when compared with the unaffected eye. In the NAION group, the mean blur rate (MBR) of the affected eyes was 29.5 % lower than that of the unaffected eyes. In the anterior ON group, the MBR of the affected eyes was 15.9 % higher than that of the unaffected eyes. LSFG could be useful in differentiating between NAION and anterior ON. In addition, this imaging technique saves time and is noninvasive.

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...

Morphologic expression of the left coronary artery in pigs. An approach in relation to human heart

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Fabian Alejandro Gómez

2014-04-01

Full Text Available Introduction: In spite of its importance as an experimental model, the information on the left coronary artery in pigs is sparse. Objective: To determine the morphologic features of the left coronary artery in pigs. Methods: We evaluated 158 pig hearts. The left coronary artery was perfused with synthetic resin after their ostia had been catheterized. Diameters and courses of the vascular beds were measured with an electronic caliper (Mitutoyo(r. Results: The diameter of left coronary artery was 6.98 ± 1.56 mm and its length was 3.51±0.99 mm. It was found to end up by bifurcating itself into the anterior interventricular artery and the circumflex artery in 79% of the cases, and by trifurcating in 21% of the cases, with the presence of the diagonal artery. The anterior interventricular artery ended up at the apex in 79.7% of the cases, and the circumflex artery at the posterior aspect of the left ventricle in 64% of the case, this artery never reached the posterior interventricular sulcus. An anastomosis between the terminal branches of the anterior interventricular artery and the posterior interventricular artery was found in 7.6% of the specimens. The antero-superior branch of the anterior interventricular artery occurred in 89.9% of the hearts. A left marginal branch was observed in 87.9% of the cases with a diameter of 2.25±0.55 mm. Conclusion: Compared with humans, pigs have shorter left coronary artery trunks and branches; even the circumflex artery never reaches the posterior interventricular sulcus. Our findings are useful for the design of experimental hemodynamic and procedural models.

Diagnostic Yield of Recommendations for Chest CT Examination Prompted by Outpatient Chest Radiographic Findings

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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

Left ventricular lipoma with pseudoaneurysm-like appearance.

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Kawarai, Shun-ichi; Yaginuma, Gen-ya; Abe, Kazuo; Hamasaki, Azumi; Ishikawa, Kazunori; Tanaka, Daizo

2010-06-01

We describe an extremely rare cardiac lipoma, with electrocardiographic changes in ST segments and T waves, suggesting ischemic heart disease. The abnormal electrocardiogram was identified during a routine physical examination of an asymptomatic 57-year-old man. Coronary angiography showed no stenotic or occlusive lesions in the coronary arteries except that the left anterior descending artery followed a winding course in the apical region. Left ventriculography revealed a pseudoaneurysm-like mass around the apical portion. Computed tomography and magnetic resonance imaging revealed a cardiac lipoma that communicated with the left ventricle and resembled a pseudoaneurysm. After complete resection of the lipoma and left ventricle patch plasty, the postoperative course was uneventful. Histologically, the tumor was an intramyocardiac lipoma with no evidence of malignancy. To our knowledge, we are the first to describe an intramyocardiac lipoma resembling a left ventricle pseudoaneurysm.

Rupture of an aneurysm of the coronary sinus of Valsalva: diagnosis by helical CT angiography

International Nuclear Information System (INIS)

Azarine, A.; Lions, C.; Beregi, J.P.; Koussa, M.

2001-01-01

A 75-year-old man presented with a 5-day history of upper chest discomfort. On auscultation, there was a systolic murmur in the left parasternal area that radiated to the apex. Electrocardiography showed flat T waves in the anterior precordial leads. Chest X ray revealed mediastinal enlargement. Transthoracic echocardiography showed a dilated proximal ascending aorta with moderate aortic regurgitation. A contrast-enhanced helical CT scan, performed to eliminate an aortic dissection, showed a ruptured left coronary sinus of Valsalva aneurysm, confirmed at surgery. This case highlights the fact that helical CT, in patients with suspected aortic dissection, may reveal other pathology that accounts for the clinical presentation. (orig.)

Rupture of an aneurysm of the coronary sinus of Valsalva: diagnosis by helical CT angiography

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Azarine, A.; Lions, C.; Beregi, J.P. [Dept. of Vascular Surgery, Hopital Cardiologique, CHRU de Lille (France); Koussa, M. [Dept. of Vascular Radiology, Hopital Cardiologique, CHRU de Lille (France)

2001-08-01

A 75-year-old man presented with a 5-day history of upper chest discomfort. On auscultation, there was a systolic murmur in the left parasternal area that radiated to the apex. Electrocardiography showed flat T waves in the anterior precordial leads. Chest X ray revealed mediastinal enlargement. Transthoracic echocardiography showed a dilated proximal ascending aorta with moderate aortic regurgitation. A contrast-enhanced helical CT scan, performed to eliminate an aortic dissection, showed a ruptured left coronary sinus of Valsalva aneurysm, confirmed at surgery. This case highlights the fact that helical CT, in patients with suspected aortic dissection, may reveal other pathology that accounts for the clinical presentation. (orig.)

Correlation of the clinical and physical image quality in chest radiography for average adults with a computed radiography imaging system.

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Moore, C S; Wood, T J; Beavis, A W; Saunderson, J R

2013-07-01

The purpose of this study was to examine the correlation between the quality of visually graded patient (clinical) chest images and a quantitative assessment of chest phantom (physical) images acquired with a computed radiography (CR) imaging system. The results of a previously published study, in which four experienced image evaluators graded computer-simulated postero-anterior chest images using a visual grading analysis scoring (VGAS) scheme, were used for the clinical image quality measurement. Contrast-to-noise ratio (CNR) and effective dose efficiency (eDE) were used as physical image quality metrics measured in a uniform chest phantom. Although optimal values of these physical metrics for chest radiography were not derived in this work, their correlation with VGAS in images acquired without an antiscatter grid across the diagnostic range of X-ray tube voltages was determined using Pearson's correlation coefficient. Clinical and physical image quality metrics increased with decreasing tube voltage. Statistically significant correlations between VGAS and CNR (R=0.87, pchest CR images acquired without an antiscatter grid. A statistically significant correlation has been found between the clinical and physical image quality in CR chest imaging. The results support the value of using CNR and eDE in the evaluation of quality in clinical thorax radiography.

[Multiple coronary fistulas to the left ventricle. An unusual cause of myocardial ischemia].

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Piovaccari, G; Melandri, G; Marzocchi, A; Scarfoglio, D; Sanguinetti, M; Magnani, B

1989-04-01

Diffuse communications between the left coronary artery and the left ventricular cavity were found in a 54-years-old man presenting with angina pectoris and reversible ischemia documented on stress Thallium scintigraphy. During atrial pacing the patient experienced chest pain which was accompanied by lactate production. Atenolol, but not nifedipine, did ameliorate the symptoms. The anatomical types and the embriogenesis of coronary microfistulas along with possible mechanisms of ischemia are discussed.

The Evaluation of Physical Stillness with Wearable Chest and Arm Accelerometer during Chan Ding Practice

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Kang-Ming Chang

2016-07-01

Full Text Available Chan Ding training is beneficial to health and emotional wellbeing. More and more people have taken up this practice over the past few years. A major training method of Chan Ding is to focus on the ten Mailuns, i.e., energy points, and to maintain physical stillness. In this article, wireless wearable accelerometers were used to detect physical stillness, and the created physical stillness index (PSI was also shown. Ninety college students participated in this study. Primarily, accelerometers used on the arms and chest were examined. The results showed that the PSI values on the arms were higher than that of the chest, when participants moved their bodies in three different ways, left-right, anterior-posterior, and hand, movements with natural breathing. Then, they were divided into three groups to practice Chan Ding for approximately thirty minutes. Participants without any Chan Ding experience were in Group I. Participants with one year of Chan Ding experience were in Group II, and participants with over three year of experience were in Group III. The Chinese Happiness Inventory (CHI was also conducted. Results showed that the PSI of the three groups measured during 20–30 min were 0.123 ± 0.155, 0.012 ± 0.013, and 0.001 ± 0.0003, respectively (p < 0.001 ***. The averaged CHI scores of the three groups were 10.13, 17.17, and 25.53, respectively (p < 0.001 ***. Correlation coefficients between PSI and CHI of the three groups were −0.440, −0.369, and −0.537, respectively (p < 0.01 **. PSI value and the wearable accelerometer that are presently available on the market could be used to evaluate the quality of the physical stillness of the participants during Chan Ding practice.

[Chronic recurrent volvulus of the colonic splenic flexure associated with the eventration of left diaphragm].

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Kim, Hee Sun; Yoo, Jeong Seon; Han, Seok Joo; Park, Hyojin

2007-01-01

The eventration of diaphragm is usually found incidentally on chest X-ray or sometimes presented as acute gastric volvulus. However, colonic volvulus on splenic flexure area complicated by diaphragmatic eventration is extremely rare. A 25 year old man complained of upper abdominal pain for three days. He had a history of brain injury during infant period, and had epilepsy and mental retardation. Plain chest X-ray showed left diaphragmatic eventration and marked dilatation of colon on splenic flexure area which had not been changed for last three years. Barium enema showed bird beak appearance on distal colon near the splenic flexure. Colonoscopic reduction failed. After decompression with rectal and nasogastric tubes, colonic volvulus was relieved. To prevent the recurrence of volvulus, we performed segmental resection of left colon including splenic flexure area and repaired the left diaphragmatic eventration. After the operation, the patient had no further recurrent episode of volvulus although ileus persisted.

The role of the left anterior temporal lobe in semantic composition vs. semantic memory.

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Westerlund, Masha; Pylkkänen, Liina

2014-05-01

The left anterior temporal lobe (LATL) is robustly implicated in semantic processing by a growing body of literature. However, these results have emerged from two distinct bodies of work, addressing two different processing levels. On the one hand, the LATL has been characterized as a 'semantic hub׳ that binds features of concepts across a distributed network, based on results from semantic dementia and hemodynamic findings on the categorization of specific compared to basic exemplars. On the other, the LATL has been implicated in combinatorial operations in language, as shown by increased activity in this region associated with the processing of sentences and of basic phrases. The present work aimed to reconcile these two literatures by independently manipulating combination and concept specificity within a minimal MEG paradigm. Participants viewed simple nouns that denoted either low specificity (fish) or high specificity categories (trout) presented in either combinatorial (spotted fish/trout) or non-combinatorial contexts (xhsl fish/trout). By combining these paradigms from the two literatures, we directly compared the engagement of the LATL in semantic memory vs. semantic composition. Our results indicate that although noun specificity subtly modulates the LATL activity elicited by single nouns, it most robustly affects the size of the composition effect when these nouns are adjectivally modified, with low specificity nouns eliciting a much larger effect. We conclude that these findings are compatible with an account in which the specificity and composition effects arise from a shared mechanism of meaning specification. Copyright © 2014 Elsevier Ltd. All rights reserved.

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

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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.

The History of Left Septal Fascicular Block: Chronological Considerations of a Reality Yet to be Universally Accepted

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Andres Ricardo Perez Riera

2008-04-01

Full Text Available There are several papers in literature that prove in a conclusive and incontestable way, that the left branch of the His bundle, in most instances (85% of the cases splits into three fascicles of variable morphological pattern, and not into two: left anterior fascicle (LAF, left posterior fascicle (LPF, and left septal fascicle (LSF. The abovementioned papers have anatomical, histological, anatomo-pathological, electrocardiographic, and vectocardiographic, body surface potential mapping or ECG potential mapping and electrophysiological foundation. Additionally, the mentioned papers have been performed both in animal models (dogs and in the human heart. Several clinical papers have shown that the left septal fascicular block (LSFB may occur intermittently or transitorily as a consequence of a temporary dromotropic alteration, constituting an aberrant ventricular conduction, rate-dependent or by the application of atrial extra-stimuli, or naturally during the acute phase of infarction when this involves the anterior descending artery, before the septal perforating artery that supplies the central portion of the septum, where the mentioned LSF runs. The ECG/VCG manifestation of LSFB consists in anterior shift of electromotive forces, known as Prominent Anterior Forces (PAF, which can hardly be diagnosed in the clinical absence of other causes capable of causing PAF, such as the normal variant by counterclockwise rotation of the heart on its longitudinal axis, in right ventricular enlargement, in the dorsal or lateral infarction of the new nomenclature, in type-A WPW, in CRBBB, and others. In this historical manuscript, we review in a sequential fashion, the main findings that confirmed the unequivocal existence of this unjustifiably "forgotten" dromotropic disorder. In the developed countries, its most important cause is coronary insufficiency, particularly the proximal involvement of the left anterior descending coronary artery, and in Latin

Local immobilization of the left anterior descending artery for minimally invasive coronary bypass grafting

NARCIS (Netherlands)

Boonstra, PW; Grandjean, JG; Mariani, MA

We describe a device for coronary artery stabilization during minimally invasive coronary artery bypass grafting performed without cardiopulmonary bypass via a small (8 to 10 cm) left anterolateral thoracotomy. This device facilitates the anastomosis of the left internal mammary artery to the left

Apical ballooning syndrome complicated by acute severe mitral regurgitation with left ventricular outflow obstruction – Case report

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Celermajer David S

2007-02-01

Full Text Available Abstract Background Apical ballooning syndrome (or Takotsubo cardiomyopathy is a syndrome of transient left ventricular apical ballooning. Although first described in Japanese patients, it is now well reported in the Caucasian population. The syndrome mimicks an acute myocardial infarction but is characterised by the absence of obstructive coronary disease. We describe a serious and poorly understood complication of Takotsubo cardiomyopathy. Case Presentation We present the case of a 65 year-old lady referred to us from a rural hospital where she was treated with thrombolytic therapy for a presumed acute anterior myocardial infarction. Four hours after thrombolysis she developed acute pulmonary oedema and a new systolic murmur. It was presumed she had acute mitral regurgitation secondary to a ruptured papillary muscle, ischaemic dysfunction or an acute ventricular septal defect. Echocardiogram revealed severe mitral regurgitation, left ventricular apical ballooning, and systolic anterior motion of the mitral valve with significant left ventricular outflow tract gradient (60–70 mmHg. Coronary angiography revealed no obstructive coronary lesions. She had an intra-aortic balloon pump inserted with no improvement in her parlous haemodynamic state. We elected to replace her mitral valve to correct the outflow tract gradient and mitral regurgitation. Intra-operatively the mitral valve was mildly myxomatous but there were no structural abnormalities. She had a mechanical mitral valve replacement with a 29 mm St Jude valve. Post-operatively, her left ventricular outflow obstruction resolved and ventricular function returned to normal over the subsequent 10 days. She recovered well. Conclusion This case represents a serious and poorly understood association of Takotsubo cardiomyopathy with acute pulmonary oedema, severe mitral regurgitaton and systolic anterior motion of the mitral valve with significant left ventricular outflow tract obstruction. The

Diagnostic value of chest ultrasound after cardiac surgery: a comparison with chest X-ray and auscultation.

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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.

Does Side Make a Difference? Anatomical Differences Between the Left and Right Ureter.

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Odegard, Stephen E; Abernethy, Melinda G; Mueller, Elizabeth R

2015-01-01

Seventy to eighty percent of iatrogenic ureteral injuries involve the left ureter. We sought to evaluate potential anatomical differences between the left and right ureters that may contribute to this discrepancy. A retrospective image review was undertaken of women who underwent computed tomography urograms between 2012 and 2013. The distance to the ureters from the midline was measured at the level of the sacral promontory (S1) and the cervix. Cervical deviation from the midline was measured, and distance between the cervix and ureters was calculated. The anterior-posterior distance between ureters was also measured. Ninety-five computed tomography urograms were analyzed. The mean age was 56 years (range, 23-92 years). Mean cervical deviation was 2.9 mm left of the midline (P = 0.028). The left ureter was 4.2 mm more lateral than the right at S1 and 2.7 mm more lateral at the cervix (P = 0.000 and 0.001). There was no significant difference when accounting for cervical deviation (P = 0.220). The left ureter was 1.9 mm more anterior than the right at the cervix (P = 0.012). Age, body mass index, and ethnicity did not affect the ureteral position. Based on midline measurements, the left ureter courses 2 to 4 mm more lateral and anterior than does the right ureter. The cervix is also positioned 2 to 4 mm to the left side, and as a result, the ureters are actually symmetric to the cervix. Although seemingly small, 2 to 4 mm is the width range of a Heaney clamp. These anatomic differences may be a contributing factor to the increase in ureteral injuries on the left side compared with the right.

Clinical characteristics and outcomes of acute coronary syndrome patients with left anterior hemiblock.

Science.gov (United States)

Zhang, Hanfei; Goodman, Shaun G; Steg, Gabriel P; Budaj, Andrzej; Lopez-Sendon, Jose; Dorian, Paul; Huynh, Thao; Mangat, Iqwal; Wong, Graham C; Spencer, Frederick A; Yan, Andrew T

2014-09-15

We aimed to study the relationships between left anterior hemiblock (LAHB) and the patient characteristics, management, and clinical outcomes in the setting of acute coronary syndromes (ACS). Admission ECGs of patients enrolled in the Global Registry of Acute Coronary Events (GRACE) ECG substudy, and the Canadian ACS Registry I, were analysed independently at a blinded core laboratory. Multivariable logistic regression analysis was performed to assess the independent associations between LAHB on the admission ECG and in-hospital and 6-month mortality. Of the 11 820 eligible ACS patients, 692 (5.9%) patients had LAHB. The presence of LAHB on admission was associated with older age, male sex, prior myocardial infarction, prior heart failure, worse Killip class, higher creatinine level, and higher GRACE risk score (all pcoronary revascularisation or reperfusion therapy (all p<0.05). The LAHB group had higher in-hospital (6.9% vs 3.9%, p<0.001) and 6-month mortality (12.5% vs 7.7%, p<0.001). However, after adjusting for the known predictors of mortality in the GRACE risk models, LAHB was not independently associated with in-hospital death (OR 1.07, 95% CI 0.76 to 1.52, p=0.70), or death at 6 months (OR 1.00, 95% CI 0.75 to 1.34, p=0.99). Across the broad spectrum of ACS, LAHB was associated with significant comorbidities, high-risk clinical features on presentation, and worse unadjusted outcomes. However, LAHB was not an independent predictor of in-hospital and 6-month mortality and did not carry incremental prognostic value beyond the known prognosticators in the GRACE risk models. 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.

Adequacy of source to image receptor distance with chest postero-anterior projection in digital radiology system

International Nuclear Information System (INIS)

Joo, Young Cheol; Lim, Cheong Hwan; Jung, Hong Ryang; You, In Gyu; Lee, Sang Ho

2016-01-01

The purpose of this study is to evaluate propriety of using SID 180cm at Chest PA examination and to find effect of geometrical cause to the image. XGEO-GC80, INNOVISION-SH, CXDI-40EG detector and a chest phantom designed self-production was used for this study. Images were acquired at SID 180cm with changing the factor OID as 0, 75 and 83mm and were analyzed by Centricity Radiography RA1000 PACS system. Statistical program was used the SPSS (Version 22.0, SPSS, Chicago, IL, USA), p-value(under 0.05) was considered to be statistically significant. In OID 0 mm was enlarged about 2.7⁓3.5 mm than the actual degree of the HS, BS of phantom in all equipments. Compared with the calculated magnification has been expanded 1.6⁓2.8% when viewed. The OID 75 mm with OID 83 mm was extended from the CS and BS 6⁓8 mm range. Compared to the calculated values, the measured values are expanded from 6.1 to 7.9%. CS and BS according to the OID change showed a statistically significant difference (p<0.05) among each group, the post-analysis only OID 0 mm group appeared as an independent group, 75 mm and 83 mm are separated in the same group It was. But had no statistically significant difference could change depending on the OID (p>0.05), post-mortem analysis showed, both in the same group. Heart sizes appears larger than actual size 6⁓8 mm at chest PA examination which is enlarged 6.1~7.9% more than the actual theoretical value. We can find magnification of the image because of the increase of the OID due to technical limitations between cover of standing detector and the image plate. so we suggest to have occurred between them when considering the need to adjust the equipment installed by the SID to match the characteristics of the equipment

Adequacy of source to image receptor distance with chest postero-anterior projection in digital radiology system

Energy Technology Data Exchange (ETDEWEB)

Joo, Young Cheol [Dept. of Radiology, Samsung Medical Center, Seoul (Korea, Republic of); Lim, Cheong Hwan; Jung, Hong Ryang [Dept. of Radiology, Science, Hanseo University, Seosan (Korea, Republic of); You, In Gyu [Dept. of Radiology, Hallym University Hospital, Chuncheon (Korea, Republic of); Lee, Sang Ho [Dept. of Radiology, Science, Seonam University, Namwon (Korea, Republic of)

2016-06-15

The purpose of this study is to evaluate propriety of using SID 180cm at Chest PA examination and to find effect of geometrical cause to the image. XGEO-GC80, INNOVISION-SH, CXDI-40EG detector and a chest phantom designed self-production was used for this study. Images were acquired at SID 180cm with changing the factor OID as 0, 75 and 83mm and were analyzed by Centricity Radiography RA1000 PACS system. Statistical program was used the SPSS (Version 22.0, SPSS, Chicago, IL, USA), p-value(under 0.05) was considered to be statistically significant. In OID 0 mm was enlarged about 2.7⁓3.5 mm than the actual degree of the HS, BS of phantom in all equipments. Compared with the calculated magnification has been expanded 1.6⁓2.8% when viewed. The OID 75 mm with OID 83 mm was extended from the CS and BS 6⁓8 mm range. Compared to the calculated values, the measured values are expanded from 6.1 to 7.9%. CS and BS according to the OID change showed a statistically significant difference (p<0.05) among each group, the post-analysis only OID 0 mm group appeared as an independent group, 75 mm and 83 mm are separated in the same group It was. But had no statistically significant difference could change depending on the OID (p>0.05), post-mortem analysis showed, both in the same group. Heart sizes appears larger than actual size 6⁓8 mm at chest PA examination which is enlarged 6.1~7.9% more than the actual theoretical value. We can find magnification of the image because of the increase of the OID due to technical limitations between cover of standing detector and the image plate. so we suggest to have occurred between them when considering the need to adjust the equipment installed by the SID to match the characteristics of the equipment.

Single coronary artery; extremely rare coronary anomaly successfully treated surgically in young adult male.

LENUS (Irish Health Repository)

Shah, A R

2010-05-01

Single coronary artery arising from aortic root, is a rare congenital anomaly. A 30-year-old male presented with acute myocardial infarction (MI) complaining of chest pain and raised troponin levels. Emergency angiography showed no coronary lesions but both left and right coronary arteries arising from single ostium. Patient was operated electively and perioperative findings confirmed the diagnosis of single coronary artery, as left coronary artery after taking origin from right sinus of valsalva runs through the septum, before dividing into left anterior descending and circumflex branches. The single coronary ostium opened with a slit like incision over the course of left main coronary, making the size of ostium three to four times bigger than the native one. In addition left internal mammary artery was harvested and grafted to the left anterior descending branch distally. Patient made successful recovery. Four months follow up dobutamine stress echo showed no inducible ischemia.

Biphasic solid and liquid gastric emptying in normal control subjects and diabetic patients with continuous acquisition in the left anterior oblique view

International Nuclear Information System (INIS)

Ziessman, H.A.; Fahey, F.H.; Herring, C.D.; Deschner, W.K.; Collen, M.J.; Vigersky, R.A.

1989-01-01

This paper reports solid and liquid gastric emptying (GE) studied in 10 normal controls and 20 diabetics with symptoms of gastroparesis. After the ingestion of a Tc-99m SC egg sandwich and In-lll DTPA in water, 90 1-minute frames were acquired in the left anterior oblique view. Solid GE had a lag phase in all cases and then emptied linearly. Compared with normal controls, diabetics had delayed GE and delayed lag phase (P< .05). Liquid GE was exponential with no lag phase. Biexponential liquid emptying with an early fast component followed by a second slower one was seen in 60% of normal controls and 70% of diabetics. The slower component of liquid GE correlated with the solid GE rate (normal controls, r= .826; diabetics, r = .885)

Visceral subpleural hematoma of the left diaphragmatic surface following left upper division segmentectomy

Directory of Open Access Journals (Sweden)

Yasushi Mizukami

2017-10-01

Full Text Available Abstract Background Pulmonary visceral subpleural hematoma is rare. We report visceral subpleural hematoma of the left diaphragmatic surface following left upper division segmentectomy. This very rare case was difficult to distinguish from thoracic abscess. Case presentation A 68-year-old man with hypertension had undergone video-assisted thoracoscopic left upper division segmentectomy for suspected lung carcinoma. Deep vein thrombosis of the lower leg was identified and edoxaban, a so-called novel oral anticoagulant, was started on postoperative day 7. The chest drainage tube was removed on postoperative day 12 because of persistent air leakage, but fever appeared the same day. Computed tomography revealed a cavity with mixed air and fluid, so antibiotics were started on suspicion of abscess. Computed tomography-guided drainage was attempted, but proved unsuccessful. Fever continued and surgical investigation was therefore performed. Visceral subpleural hematoma was identified under the diaphragmatic surface of the left basal lung. We excised the pleura, then performed drainage and applied running sutures. The parenchyma and visceral pleura were covered with polyglycolic acid sheet and fibrin glue. Edoxaban was restarted on postoperative day 12 of video-assisted thoracoscopic surgery and no recurrence of hematoma has been revealed. Conclusions Visceral subpleural hematoma after thoracic surgery is extremely rare. Furthermore, correct diagnosis was difficult and surgery offered a good diagnostic and therapeutic procedure.

Functional asymmetries in early learning during right, left, and bimanual performance in right-handed subjects.

Science.gov (United States)

Aznárez-Sanado, Maite; Fernández-Seara, Maria A; Loayza, Francis R; Pastor, Maria A

2013-03-01

To elucidate differences in activity and connectivity during early learning due to the performing hand. Twenty right-handed subjects were recruited. The neural correlates of explicit visuospatial learning executed with the right, the left hand, and bimanually were investigated using functional magnetic resonance imaging. Connectivity analyses were carried out using the psychophysiological interactions model, considering right and left anterior putamen as index regions. A common neural network was found for the three tasks during learning. Main activity increases were located in posterior cingulate cortex, supplementary motor area, parietal cortex, anterior putamen, and cerebellum (IV-V), whereas activity decrements were observed in prefrontal regions. However, the left hand task showed a greater recruitment of left hippocampal areas when compared with the other tasks. In addition, enhanced connectivity between the right anterior putamen and motor cortical and cerebellar regions was found for the left hand when compared with the right hand task. An additional recruitment of brain regions and increased striato-cortical and striato-cerebellar functional connections is needed when early learning is performed with the nondominant hand. In addition, access to brain resources during learning may be directed by the dominant hand in the bimanual task. Copyright © 2012 Wiley Periodicals, Inc.

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.

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 ...

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 ...

Heart Failure with Transient Left Bundle Branch Block in the Setting of Left Coronary Fistula

Directory of Open Access Journals (Sweden)

Stephen P. Juraschek

2011-01-01

Full Text Available Coronary arterial fistulas are rare communications between vessels or chambers of the heart. Although cardiac symptoms associated with fistulas are well described, fistulas are seldom considered in the differential diagnosis of acute myocardial ischemia. We describe the case of a 64-year-old man who presented with left shoulder pain, signs of heart failure, and a new left bundle branch block (LBBB. Cardiac catheterization revealed a small left anterior descending (LAD-to-pulmonary artery (PA fistula. Diuresis led to subjective improvement of the patient's symptoms and within several days the LBBB resolved. We hypothesize that the coronary fistula in this patient contributed to transient ischemia of the LAD territory through a coronary steal mechanism. We elected to observe rather than repair the fistula, as his symptoms and ECG changes resolved with treatment of his heart failure.

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%.

Bland-White-Garland syndrome of anomalous left coronary artery arising from the pulmonary artery (ALCAPA): a historical review

International Nuclear Information System (INIS)

Cowles, Robert A.; Berdon, Walter E.

2007-01-01

The landmark 1933 case report from Massachusetts General Hospital by Bland, White and Garland (Am Heart J 8:787-801) described a 3-month-old child with progressive feeding problems, cardiomegaly on chest radiography, and EKG evidence of left ventricular damage. Of interest was the fact that the vigilant father of the infant was Aubrey Hampton, a radiologist and future chairman of radiology at Massachusetts General Hospital. At autopsy, the left coronary artery originated from the pulmonary artery rather than from the aorta. Effective treatment for this condition was not available until 1960 when Sabiston, Neill and Taussig showed that the blood flowed from the left coronary artery toward the pulmonary artery. The anomalous left coronary artery was ligated at its junction with the pulmonary artery and the child survived. This historical review of Bland-White-Garland syndrome, now known as anomalous left coronary artery arising from the pulmonary artery (ALCAPA), stresses the continued diagnostic significance of cardiomegaly on chest radiography and EKG changes suggesting left ventricular damage in 2- to 3-month-old infants with feeding intolerance or irritability. With a high index of suspicion, an echocardiogram can be obtained to confirm the diagnosis. Modern surgical methods involve left coronary artery translocation and afford excellent outcomes. (orig.)

Unilateral hypoplasia with contralateral hypertrophy of anterior belly of digastric muscle: a case report.

Science.gov (United States)

Ochoa-Escudero, Martin; Juliano, Amy F

2016-10-01

Anomalies of the anterior belly of the digastric muscle (DM) are uncommon. We present a case of hypoplasia of the anterior belly of the left DM with hypertrophy of the anterior belly of the contralateral DM. The importance of recognizing this finding is to differentiate hypoplasia of the anterior belly of the DM from denervation atrophy, and not to confuse contralateral hypertrophy with a submental mass or lymphadenopathy. In denervation atrophy of the anterior belly of the DM, associated atrophy of the ipsilateral mylohyoid muscle is present. Hypertrophy of the anterior belly of the contralateral DM can be differentiated from a submental mass or lymphadenopathy by recognizing its isodensity on computed tomography and isointensity on magnetic resonance imaging to other muscles, without abnormal contrast enhancement.

BULLOUS DEGENERATION OF THE LEFT LOWER LOBE IN A HEROIN-ADDICT

NARCIS (Netherlands)

SMEENK, FWJM; SERLIE, J; VANDERJAGT, EJ; POSTMUS, PE

1990-01-01

A 34 yr old heroin addict was referred because of chest pain caused by air-trapping in a bulla in the left lower lobe. There was a marked difference between the functional residual capacity measured by body-plethysmography and helium dilution. A slow wash-in and wash-out were demonstrated by

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and vascular clinic for valvular heart disease for two years before referral. His initial echocardiography revealed significant aortic regurgitation and mild mitral regurgitation. He presented with generalized body weakness, left anterior chest wall pain, fever, and joint pain involving the knees and the elbows. He was still on.

Anterior mediastinal masses in the Framingham Heart Study: Prevalence and CT image characteristics

International Nuclear Information System (INIS)

Araki, Tetsuro; Nishino, Mizuki; Gao, Wei; Dupuis, Josée; Washko, George R.; Hunninghake, Gary M.; Murakami, Takamichi; O’Connor, George T.; Hatabu, Hiroto

2015-01-01

To investigate the prevalence and CT image characteristics of anterior mediastinal masses in a population-based cohort and their association with the demographics of the participants. Chest CT scans of 2571 Framingham Heart Study participants (mean age 58.9 years, 51% female) were evaluated by two board-certified radiologists with expertise in thoracic imaging for the presence of anterior mediastinal masses, their shape, contour, location, invasion of adjacent structures, fat content, and calcification. For participants with anterior mediastinal masses, a previous cardiac CT scan was reviewed for interval size change of the masses, when available. The demographics of the participants were studied for any association with the presence of anterior mediastinal masses. Of 2571, 23 participants (0.9%, 95% CI: 0.6–1.3) had anterior mediastinal masses on CT. The most common CT characteristics were oval shape, lobular contour, and midline location, showing soft tissue density (median 32.1 HU). Fat content was detected in a few cases (9%, 2/23). Six out of eight masses with available prior cardiac CT scans demonstrated an interval growth over a median period of 6.5 years. No risk factors for anterior mediastinal masses were detected among participants’ demographics, including age, sex, BMI, and cigarette smoking. The prevalence of anterior mediastinal masses is 0.9% in the Framingham Heart Study. Those masses may increase in size when observed over 5–7 years. Investigation of clinical significance in incidentally found anterior mediastinal masses with a longer period of follow-up would be necessary

Occult diaphragmatic injuries caused by stab wounds.

Science.gov (United States)

Leppäniemi, Ari; Haapiainen, Reijo

2003-10-01

Missed diaphragmatic perforation caused by penetrating trauma can lead to subsequent strangulation of a hollow viscus, which has prompted the use of invasive diagnostic procedures to exclude occult diaphragmatic injuries in asymptomatic, high-risk patients. The objective of this study was to determine the incidence of occult diaphragmatic injuries caused by stab wounds of the lower chest and upper abdomen, and to examine the natural history and consequences of missed diaphragmatic injuries. On the basis of patient data from two previous randomized studies from our institution, a retrospective analysis was performed on 97 patients treated for anterior stab wounds located between the nipple line, the umbilical level, and the posterior axillary lines not having indications for immediate surgical exploration. The patients were divided into two groups on the basis of their initial randomized management (open or laparoscopic exploration vs. expectant observation). In the exploration group (n = 47), four diaphragmatic injuries (9%) were detected (three left-sided and one right-sided). Excluding patients with associated injuries requiring surgical repair, the incidence of occult diaphragmatic injuries was 3 of 43 (7%). In the observation group (n = 50), there were two patients (4%) with delayed presentation of missed left-sided diaphragmatic injury 2 and 23 months later, respectively. Both injuries resulted from stab wounds of the left flank and presented with herniation of the stomach or small bowel and colon. The overall incidence of occult diaphragmatic injuries in left-sided thoracoabdominal stab wounds was 4 of 24 (17%), and was much lower after stab wounds of left epigastrium (0%), right lower chest (0%), and right epigastrium (4%). In asymptomatic patients with anterior or flank stab wounds of the lower chest or upper abdominal area, the risk of an occult diaphragmatic injury is approximately 7% which, if undetected, is associated with a high risk of subsequent

Novel nonsurgical left ventricular assist device and system.

Science.gov (United States)

Misiri, Juna; DeSimone, Christopher V; Park, Soon J; Kushwaha, Sudhir S; Friedman, Paul A; Bruce, Charles J; Asirvatham, Samuel J

2013-01-01

Treatment options for advanced stages of congestive heart failure remain limited. Left ventricular assist devices (LVADs) have emerged as a means to support failing circulation. However, these devices are not without significant risk such as major open chest surgery. We utilized a novel approach for device placement at the aorto-left atria continuity as a site to create a conduit capable of accommodating a percutaneous LVAD system. We designed and developed an expandable nitinol based device for placement at this site to create a shunt between the LA and aorta. Our experiments support this anatomic location as an accessible and feasible site for accommodation of an entirely percutaneous LVAD. The novelty of this approach would bypass the left ventricle, and thereby minimize complications and morbidities associated with current LVAD placement. Copyright © 2013 Elsevier Inc. All rights reserved.

[Two cases of Vogt-Koyanagi-Harada disease presenting shallow anterior chamber].

Science.gov (United States)

Takemoto, Daisuke; Ijiri, Shigeyuki; Shimizu, Michiharu; Higashide, Tomomi; Sugiyama, Kazuhisa

2015-05-01

We report two cases of Vogt-Koyanagi-Harada disease (VKH) in which shallow anterior chambers were improved after steroid pulse therapy. The patients were women aged 65 and 72. They had headaches, decreased visual acuity and shallow anterior chamber in both eyes. There was no inflammation in the anterior chamber. Ultrasound biomicroscopy (UBM) showed ciliary edema, ciliochoroidal detachment, and angle closure. One case showed high intraocular pressure (IOP), and a diagnosis of acute primary angle closure was made. Although cataract surgery was performed in the left eye, postoperative optical coherence tomography (OCT) revealed serous retinal detachment in both eyes. The shallow anterior chamber and UBM findings were improved and serous retinal detachment disappeared after steroid pulse therapy in both cases. VKH may cause shallow anterior chamber and angle closure. The inflammatory changes of VKH in the anterior segment, i. e. ciliary edema and ciliochoroidal detachment, may exacerbate the shallow anterior chambers and narrow angles and result in an acute increase in IOP in eyes with short axial length. VKH associated with shallow anterior chamber may be misdiagnosed as acute primary angle closure. For differential diagnosis, examinations of the ocular fundus including OCT are useful.

Anterior Myocardial Territory May Replace the Heart as Organ at Risk in Intensity-Modulated Radiotherapy for Left-Sided Breast Cancer

International Nuclear Information System (INIS)

Tan Wenyong; Liu Dong; Xue Chenbin; Xu Jiaozhen; Li Beihui; Chen Zhengwang; Hu Desheng; Wang Xionghong

2012-01-01

Purpose: We investigated whether the heart could be replaced by the anterior myocardial territory (AMT) as the organ at risk (OAR) in intensity-modulated radiotherapy (IMRT) of the breast for patients with left-sided breast cancer. Methods and Materials: Twenty-three patients with left-sided breast cancer who received postoperative radiation after breast-conserving surgery were studied. For each patient, we generated five IMRT plans including heart (H), left ventricle (LV), AMT, LV+AMT, and H+LV as the primary OARs, respectively, except both lungs and right breast, which corresponded to IMRT(H), IMRT(LV), IMRT(AMT), IMRT(LV+AMT), and IMRT(H+LV). For the planning target volumes and OARs, the parameters of dose–volume histograms were compared. Results: The homogeneity index, conformity index, and coverage index were not compromised significantly in IMRT(AMT), IMRT(LV) and IMRT(LV+ AMT), respectively, when compared with IMRT(H). The mean dose to the heart, LV, and AMT decreased 5.3–21.5% (p < 0.05), 19.9–29.5% (p < 0.05), and 13.3–24.5% (p < 0.05), respectively. Similarly, the low (e.g., V5%), middle (e.g., V20%), and high (e.g., V30%) dose-volume of the heart, LV, and AMT decreased with different levels. The mean dose and V10% of the right lung increased by 9.2% (p < 0.05) and 27.6% (p < 0.05), respectively, in IMRT(LV), and the mean dose and V5% of the right breast decreased significantly in IMRT(AMT) and IMRT(LV+AMT). IMRT(AMT) was the preferred plan and was then compared with IMRT(H+LV); the majority of dose–volume histogram parameters of OARs including the heart, LV, AMT, both lungs, and the right breast were not statistically different. However, the low dose-volume of LV increased and the middle dose-volume decreased significantly (p < 0.05) in IMRT(AMT). Also, those of the right lung (V10%, V15%) and right breast (V5%, V10%) decreased significantly (p < 0.05). Conclusions: The AMT may replace the heart as the OAR in left-sided breast IMRT after breast

Sharp incision of the anterior mitral leaflet due to penetrating trauma - Report of a case and long-term follow-up

NARCIS (Netherlands)

de Boer, HD; Hamer, HPM; Ebels, T

A case is described of sharp incision of the anterior leaflet of the mitral valve, due to penetrating trauma to the chest with a knife. The lesion of the mitral leaflet was diagnosed with echocardiography and successfully repaired with autologous pericardial tissue. Follow up after 15 years showed

Variations in the accessory structures of the clavicle: findings at chest radiographs and dry bones

International Nuclear Information System (INIS)

Chung, Min Suk; Suh, Kyung Jin; Joo, Kang; Chung, In Hyuk

1995-01-01

To evaluate normal variations and thus to avoid confusion in differentiation from lesions of the accessory structures (rhomboid fossa, foramen for supraclavicular nerve, conoid tubercle) of the clavicle in chest radiographs. We studied the variations of the clavicle in 300 chest radiographs (134 men, 166 women) and 355 dry bones (right 166, left 189;151 men, 74 women, 130 unknown sex). In chest radiographs, the incidence of the depressed rhomboid fossa was 229 cases (39.5%; male 52.0%, female 29.9%); the flat type was 329 cases (56.9%; male 45.7%, female 65.7%); and the elevated type was 20 cases (3.5%;male 2.4%, female 4.3%). In the dry bones, the incidence of the depressed rhomboid fossa was 129 cases (57.3%; male 59.6%, female 52.7%); the flat type was 65 cases (28.9%; male 24.5%, female 37.8%); and the elevated type was 31 cases (13.8%; male 15.9%, female 9.5%). The incidence of the foramen for supraclavicular nerve was 0.8% in chest radiographs, and 1.4% in the dry bones. The incidence of the elevated conoid tubercle was 65.1% (male 64.0%, female 65.9%) in chest radiographs, and 96.9% (male 95.4%, female 100.0%) in the dry bones. The incidence of the depressed rhomboid fossa in chest radiographs was higher in men and the right clavicle. The incidence of flat rhomboid fossa in chest radiographs decreased according to increase of age. The foramen for supraclavicular nerve was occasionally found ( 0.8% in chest radiographs; 1.4% in the dry bones)

Novel Split Chest Tube Improves Post-Surgical Thoracic Drainage

Science.gov (United States)

Olivencia-Yurvati, Albert H; Cherry, Brandon H; Gurji, Hunaid A; White, Daniel W; Newton, J Tyler; Scott, Gary F; Hoxha, Besim; Gourlay, Terence; Mallet, Robert T

2014-01-01

Objective Conventional, separate mediastinal and pleural tubes are often inefficient at draining thoracic effusions. Description We developed a Y-shaped chest tube with split ends that divide within the thoracic cavity, permitting separate intrathoracic placement and requiring a single exit port. In this study, thoracic drainage by the split drain vs. that of separate drains was tested. Methods After sternotomy, pericardiotomy, and left pleurotomy, pigs were fitted with separate chest drains (n=10) or a split tube prototype (n=9) with internal openings positioned in the mediastinum and in the costo-diaphragmatic recess. Separate series of experiments were conducted to test drainage of D5W or 0.58 M sucrose, an aqueous solution with viscosity approximating that of plasma. One litre of fluid was infused into the thorax, and suction was applied at −20 cm H2O for 30 min. Results When D5W was infused, the split drain left a residual volume of 53 ± 99 ml (mean value ± SD) vs. 148 ± 120 for the separate drain (P=0.007), representing a drainage efficiency (i.e. drained vol/[drained + residual vol]) of 95 ± 10% vs. 86 ± 12% for the separate drains (P = 0.011). In the second series, the split drain evacuated more 0.58 M sucrose in the first minute (967 ± 129 ml) than the separate drains (680 ± 192 ml, Pdrain evacuated a similar volume of sucrose vs. the conventional drain (1089 ± 72 vs. 1056 ± 78 ml; P = 0.5). Residual volume tended to be lower (25 ± 10 vs. 62 ± 72 ml; P = 0.128) and drainage efficiency tended to be higher (98 ± 1 vs. 95 ± 6%; P = 0.111) with the split drain vs. conventional separate drains. Conclusion The split chest tube drained the thoracic cavity at least as effectively as conventional separate tubes. This new device could potentially alleviate postoperative complications. PMID:25478289

Novel Split Chest Tube Improves Post-Surgical Thoracic Drainage.

Science.gov (United States)

Olivencia-Yurvati, Albert H; Cherry, Brandon H; Gurji, Hunaid A; White, Daniel W; Newton, J Tyler; Scott, Gary F; Hoxha, Besim; Gourlay, Terence; Mallet, Robert T

2014-01-01

Conventional, separate mediastinal and pleural tubes are often inefficient at draining thoracic effusions. We developed a Y-shaped chest tube with split ends that divide within the thoracic cavity, permitting separate intrathoracic placement and requiring a single exit port. In this study, thoracic drainage by the split drain vs. that of separate drains was tested. After sternotomy, pericardiotomy, and left pleurotomy, pigs were fitted with separate chest drains (n=10) or a split tube prototype (n=9) with internal openings positioned in the mediastinum and in the costo-diaphragmatic recess. Separate series of experiments were conducted to test drainage of D5W or 0.58 M sucrose, an aqueous solution with viscosity approximating that of plasma. One litre of fluid was infused into the thorax, and suction was applied at -20 cm H2O for 30 min. When D5W was infused, the split drain left a residual volume of 53 ± 99 ml (mean value ± SD) vs. 148 ± 120 for the separate drain (P=0.007), representing a drainage efficiency (i.e. drained vol/[drained + residual vol]) of 95 ± 10% vs. 86 ± 12% for the separate drains (P = 0.011). In the second series, the split drain evacuated more 0.58 M sucrose in the first minute (967 ± 129 ml) than the separate drains (680 ± 192 ml, Pdrain evacuated a similar volume of sucrose vs. the conventional drain (1089 ± 72 vs. 1056 ± 78 ml; P = 0.5). Residual volume tended to be lower (25 ± 10 vs. 62 ± 72 ml; P = 0.128) and drainage efficiency tended to be higher (98 ± 1 vs. 95 ± 6%; P = 0.111) with the split drain vs. conventional separate drains. The split chest tube drained the thoracic cavity at least as effectively as conventional separate tubes. This new device could potentially alleviate postoperative complications.

A Rare Case of Neglected Traumatic Anterior Dislocation of Hip in a Child.

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Mootha, Aditya Krishna; Mogali, Kasi Viswanadam

2016-01-01

Post traumatic hip dislocations are very rare in children. Neglected anterior hip dislocations in children are not described in literature so far. Here, we present a case of 6 weeks old anterior hip dislocation successfully managed by open reduction. A 9-year-old male child presented with neglected anterior hip dislocation on left side. Open reduction carried out through direct anterior approach to hip. Congruent reduction is achieved. At final follow up of 1 year, the child had unrestricted activities of daily living and no radiological signs of osteonecrosis or any joint space reduction. There is paucity of literature over neglected post traumatic anterior hip dislocations in children. The treatment options vary from closed reduction after heavy traction to sub trochanteric osteotomy. However, we feel that open reduction through direct anterior approach is the preferred mode of management whenever considered possible.

Accuracy of chest radiography versus chest computed tomography in hemodynamically stable patients with blunt chest trauma

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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

Chest tube insertion

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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 ...

Rare malposition following left jugular vein catheterization: Case reports and a literature review.

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Wang, Lin; Liu, Zhangsuo; Wang, Changan; Liu, Dongwei; Yuan, Yiqiang

2015-01-01

The number of patients requiring chronic hemodialysis via a tunneled cuffed catheter is increasing. The right internal jugular vein (IJV) is generally the preferred site of percutaneous insertion. In certain situations, for example, in patients with a history of multiple access failures, catheterization of the left IJV is an important option. In this report, we present two rare cases of catheter malposition after left IJV catheterization; catheter adjustments, with the help of chest radiographs, resulted in a positive outcome in both cases. These cases exemplify the difficulties associated with left IJV catheterization, of which there are few reports in the published literature.

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.

Anomalous Origin of Left Coronary Artery from Pulmonary Artery (ALCAPA)

International Nuclear Information System (INIS)

Younus, Z.; Ahmed, I.; Iftikhar, R.

2013-01-01

Anomalous origin of the left coronary artery from the pulmonary artery also recognized as Bland White Garland syndrome is a very rare congenital condition. A two-months old baby boy presented with dyspnoea for two weeks and a pansystolic murmur on auscultation. The base line investigations showed cardiomegaly and bilateral basal haze on X-ray chest. ECG showed ST elevation in leads l and AVl and echocardiography showed situs solitus, levocardia, hypokinetic intraventricular septum, ejection fraction of 30%, mitral regurgitation of grade-I and an anomalous origin of the left coronary artery from pulmonary artery was diagnosed. Patient was in left heart failure. It was rectified surgically by creating a transpulmonary tunnel (Takeuchi repair). Postoperative course was uneventful and he was finally discharged in stable condition. (author)

Blunt chest trauma.

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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.

Radiologic placement of implantable chest ports in pediatric patients under sedation

International Nuclear Information System (INIS)

Shin, Tae Beom

2003-01-01

To evaluate the safety and efficacy of the radiologic placement of implantable chest ports under intravenous sedation in pediatric patients with malignancy. Between October 2001 and June 2002, 20 chest ports were placed in 19 pediatric patients [13 boys and six girls aged 1-11 (mean, 4.7) years] for the purpose of long-term chemotherapy. In three patients, tunneled central venous catheters had been removed because of catheter extration, infection, and tearing. Under intravenous sedation, the right internal jugular vein was used for access in 19 cases, and the left internal jugular vein in one. Venipucture was performed using a micropuncture needle with real-time ultrasound guidance. A port chamber was created at the infraclavicular fossa, and to prevent catheter kinking, a smooth-angled tunnel was created between the venipuncture site and the subcutaneous pocket. The catheter tip was positioned under fluoroscopy at the junction of the superior vena cava and right atrium. We observed technical success, complications arouse during and after the procedure, and duration of catheter use. Implantation of the port system was successful in all cases, though slight hematoma, treated with manual compression, occurred at a chamber pocket in one case. In addition, the port system was removed from one patient because of wound infection leading to dehiscence and catheter malpositiong. A new port system was implanted through the left internal jugular vein. The median period during which catheter use was followed up was 118 (range, 18-274) days. For long-term chemotherapy in pediatric patients with malignancy, radiologic placement of an implantable chest port under intravenous sedation shows a high technical success rate, with few complications. This method may thus be used instead of surgical port placement

Insuficiência tricúspide pós trauma associada a agnesia de músculo papilar anterior Post-traumatic tricuspid insufficiency associated with agenesis of the anterior papillary muscle

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Ronaldo Ducceschi FONTES

2000-09-01

Full Text Available Relatamos o caso de paciente do sexo masculino com 36 anos de idade com sinais e sintomas de insuficiência cardíaca direita. A história revelou trauma torácico há aproximadamente cinco anos. Submetido a operação para tratamento de insuficiência tricúspide, notou-se ausência do músculo papilar anterior da valva tricúspide, fenda na cúspide anterior e dilatação do anel tricuspídeo. Foi realizada sutura da fenda localizada na cúspide anterior e feita sua sustentação utilizando-se tira de pericárdio bovino fixada na face atrial e base do músculo papilar posterior. A operação foi completada com anuloplastia de Revuelta. O paciente obteve nítida melhora dos sintomas no pós-operatório imediato, mantendo-se em classe funcional I (NYHA, após 22 meses de evolução.Tricuspid regurgitation arising from chest trauma five years earlier was successfully corrected by valve reconstruction in a 36 year-old man. During correction a fissure of the anterior leaflet, absence of the anterior papillary muscle, chordae tendineae and tricuspid annulus dilatation were found. Tricuspid valvuloplasty was feasible using an anchored suture of the anterior leaflet fissure, artificial bovine chordae, pericardium implantation and Revuelta ring annuloplasty. There were no complications and no early or late mortality. At 22 months follow-up tricuspid valve function has remained with mild regurgitation. The patient is in good clinical condition.

Chest X-Ray

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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 ...

Functional reserve of the ischemic left ventricle with ventricular aneurysm to afterload stress

International Nuclear Information System (INIS)

Tsuiki, Kai; Kobayashi, Tadashi; Hayasaka, Makio

1985-01-01

The response of left ventricular function to afterload stress was assessed using DSA for eight patients with old anterior myocardial infarction and ventricular aneurysm including that of the anterior wall. After initial DSA in the basal state, methoxamine was infused intravenously (1 to 2 mg/min). When aortic systolic blood pressure increased by 30 to 50 mmHg, a second DSA was performed for each patient. Left ventricular volumes and ejection fractions were calculated by the area-length method, and regional wall motion was assessed by the visual method according to the AHA classification and the curvature radius of the apical ventricular aneurysm was calculated. Methoxamine induced neither acute heart failure nor angina pectoris in the present series. The heart rates decreased, and there were a significant increase in end-systolic volumes (p ES ). However, ΔESV and ΔR ES did not correlate; ΔR ES was much greater in two patients, who were relatively old. Their aneurysms were circumscribed within the left ventricular anterior wall, their ejection fractions were relatively increased; and their onsets of acute myocardial infarction were relatively recent. (J.P.N.)

Influence of chest background on pulmonary 99m Tc-DTPA clearance in interstitial lung disease

International Nuclear Information System (INIS)

Ishizaka, Akitoshi; Kanazawa, Minoru; Suzuki, Yukio; Hasegawa, Naoki; Kubo, Atsushi; Kawashiro, Takeo

1992-01-01

The authors examined the effect of chest extracellular 99m T c -diethylenetriamine pentaacetate (DTPA) as a background in the measurement of pulmonary 99m T c -DTPA clearance in patients with interstitial lung disease (ILD). Eight healthy nonsmokers (HN) and eight patients with ILD were studied. They monitored changes in gamma counts after the inhalation of 99m T c -DTPA aerosol by using a gamma camera placed over the anterior chest. The rate constant of pulmonary 99m T c -DTPA clearance (k; %/min) was assessed by calculating the slope of the decrease in the gamma counts. The chest background, estimated by 99m T c -DTPA intravenous injection, was subtracted from the original data to obtain the corrected DTPA clearance (k c ; %/min). In patients with ILD, k was significantly greater [2.19 ± 1.03 (SD) %/min; n = 8] compared with HN (0.86 ± 0.17%/min; n = 8; P c was also greater (2.80 ± 1.15%/min; n = 8; P c among all subjects (r = 0.987, P 99m T c -DTPA clearance. 16 refs., 2 figs., 2 tabs

Accuracy of portable chest X-ray film in detection of intrathoracic abnormal findings in patients after esophagectomy in comparison with CT

International Nuclear Information System (INIS)

Shimada, Muneaki; Takeda, Junzo; Ochiai, Ryoichi; Fukushima, Kazuaki; Kouda, Eiichi

1992-01-01

To determine an accuracy of portable chest radiographs (CXR) in the diagnosis of pneumothorax, consolidation, passive collapse, subsegmental atelectasis, left and right pleural effusion, findings of 35 pairs of chest CT (CT) and CXR were compared in 21 patients after esophagectomy. The presence of abnormal findings on CXR and CT was evaluated separately by radiologists. Assuming that the diagnoses through CT were correct, sensitivity, specificity, positive predictive value and negative predictive value for CXR were examined in each of 6 abnormal findings. Comparison of CT findings with those of CXR resulted in the following sensitivities (SN) and specificities (SP): pneumothorax: SN=0.17, SP=1.0; consolidation: SN=0.82, SP=1.0; passive collapse: SN=0.83, SP=0.58; subsegmental atelectasis: SN=0.61, SP=1.0; left pleural effusion: SN=0.79, SP=0.29; right pleural effusion: SN=0.9, SP=0.8. These results demonstrated that CXR might miss pneumothorax and overestimate left pleural effusion. Positive predictive value was over 0.79 in each of 6 abnormal findings, which indicated an accuracy of abnormal findings seen on CXR was high. However, negative predictive value in left pleural effusion, which was 0.25, indicated difficulty in correct estimation of left pleural effusion. (author)

Activation of anterior paralimbic structures during guilt-related script-driven imagery.

Science.gov (United States)

Shin, L M; Dougherty, D D; Orr, S P; Pitman, R K; Lasko, M; Macklin, M L; Alpert, N M; Fischman, A J; Rauch, S L

2000-07-01

Several recent neuroimaging studies have examined the neuroanatomical correlates of normal emotional states, such as happiness, sadness, fear, anger, anxiety, and disgust; however, no previous study has examined the emotional state of guilt. In the current study, we used positron emission tomography and the script-driven imagery paradigm to study regional cerebral blood flow (rCBF) during the transient emotional experience of guilt in eight healthy male participants. In the Guilt condition, participants recalled and imagined participating in a personal event involving the most guilt they had ever experienced. In the Neutral condition, participants recalled and imagined participating in an emotionally neutral personal event. In the Guilt versus Neutral comparison, rCBF increases occurred in anterior paralimbic regions of the brain: bilateral anterior temporal poles, anterior cingulate gyrus, and left anterior insular cortex/inferior frontal gyrus. These results, along with those of previous studies, are consistent with the notion that anterior paralimbic regions of the brain mediate negative emotional states in healthy individuals.

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.

Gnathostomiasis of the anterior chamber

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Barua P

2007-01-01

Full Text Available Ocular involvement with Gnathostoma spinigerum occurs years after the initial infection that is acquired by ingestion of poorly cooked, pickled seafood or water contaminated with third stage larvae. Here we report a case of gnathostomiasis of the left eye of a 32-year-old lady hailing from Meghalaya, India. Her vision had deteriorated to hand movement. Slit lamp examination revealed a live, actively motile worm in the anterior chamber, which was extracted by supra temporal limbal incision and visual acuity was restored.

Chest X-Ray

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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 ...

Anterior sagittal transanorectal approach to the posterior urethra in the pediatric age group.

Science.gov (United States)

Rossi, F; De Castro, R; Ceccarelli, P L; Dòmini, R

1998-09-01

Surgical access to the posterior urethra is often difficult and several surgical solutions have been proposed. We suggest an anterior sagittal transanorectal approach based on splitting the anterior rectal wall only. This alternative technique provides excellent exposure to the retrourethral region, permitting simple and safe surgery. Between 1994 and 1996 we performed surgery via the anterior sagittal transanorectal approach in 8 patients with a mean age of 9.06 years. Patients included 1 girl with a posttraumatic urethrovaginal fistula, 3 with intersex disorders (2 with mixed gonadal dysgenesis raised as boys and 1 with male dysgenetic pseudohermaphroditism with an enlarged urtricle) and 4 boys (1 with penile agenesis raised as girl, 2 with urethral duplication and 1 with prostatic rhabdomyosarcoma). The patient was placed in a knee-chest position. A midline sagittal incision was made through the anterior anorectal wall only and deepened through the perineal body to expose the posterior urethra and retrovesical space. After the pathological condition was corrected the anterior rectal wall and perineal body were reconstructed. The operation was completed with protective colostomy. In our final patient with prostatic rhabdomyosarcoma the anterior sagittal transanorectal approach was used without colostomy. Anorectal manometry was done 6 months postoperatively. All patients were completely continent of stool and urine. Convalescence was unremarkable in all cases. Postoperative manometry in 7 patients revealed no differences from preoperative measurements. This procedure should be considered a useful alternative to other techniques for various congenital and acquired pelvic disorders.

Chest X-Ray

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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 ...

Preference for orientations commonly viewed for one's own hand in the anterior intraparietal cortex.

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Regine Zopf

Full Text Available Brain regions in the intraparietal and the premotor cortices selectively process visual and multisensory events near the hands (peri-hand space. Visual information from the hand itself modulates this processing potentially because it is used to estimate the location of one's own body and the surrounding space. In humans specific occipitotemporal areas process visual information of specific body parts such as hands. Here we used an fMRI block-design to investigate if anterior intraparietal and ventral premotor 'peri-hand areas' exhibit selective responses to viewing images of hands and viewing specific hand orientations. Furthermore, we investigated if the occipitotemporal 'hand area' is sensitive to viewed hand orientation. Our findings demonstrate increased BOLD responses in the left anterior intraparietal area when participants viewed hands and feet as compared to faces and objects. Anterior intraparietal and also occipitotemporal areas in the left hemisphere exhibited response preferences for viewing right hands with orientations commonly viewed for one's own hand as compared to uncommon own hand orientations. Our results indicate that both anterior intraparietal and occipitotemporal areas encode visual limb-specific shape and orientation information.

Improved proper name recall in aging after electrical stimulation of the anterior temporal lobes

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Lars A Ross

2011-10-01

Full Text Available Evidence from neuroimaging and neuropsychology suggests that portions of the anterior temporal lobes play a critical role in proper name retrieval. We previously found that anodal transcranial direct current stimulation (tDCS to the anterior temporal lobes improved retrieval of proper names in young adult. Here we extend that finding to older adults who tend to experience greater proper-naming deficits than young adults. The task was to look at pictures of famous faces or landmarks and verbally recall the associated proper name. Our results show a numerical improvement in face naming after left or right anterior temporal lobe stimulation, but a statistically significant effect only after left-lateralized stimulation. The magnitude of the enhancing effect was similar in older and younger adults but the lateralization of the effect differed depending on age. These results provide evidence that tDCS may be a useful tool for the neurorehabilitation of cognitive function in healthy and pathological cognitive decline.

False-positive defects in technetium-99m sestamibi myocardial single-photon emission tomography in healthy athletes with left ventricular hypertrophy

International Nuclear Information System (INIS)

Bartram, P.; Hanel, B.; Gustafsson, F.; Mortensen, J.; Hesse, B.; Toft, J.; Ali, S.

1998-01-01

Exercise ECG and myocardial single-photon emission tomography (SPET) are fundamental in the non-invasive evaluation of patients suspected of having coronary artery disease (CAD). The purpose of the present study was to investigate the influence of physiological left ventricular hypertrophy (LVH) on myocardial sestamibi SPET in healthy young and old athletes. Eighteen young male elite athletes (ten rowers, five power/weight lifters and three triathletes) and 14 well-trained elderly rowers were studied. All underwent a bicycle test as part of a 2-day sestamibi SPET protocol. Attenuation correction was not performed. The studies were evaluated visually and quantitatively analysed by the CEqual program with its reference files and with a file from a local non-athletic age-matched population. Echocardiographic LVH was an inclusion criterion in the young athletes. Exercise ECG was normal in all subjects. In at least three of the young athletes a reversible defect was observed by visual analysis. On quantitative analysis one-third of the young athletes had ''significant'' (>10 pixels) defects compared with both the local reference base and the CEqual reference population. Nearly all defects were found in the anterior or inferior wall. The remaining subjects, including all old rowers, had normal SPET findings. Anterior and inferior wall defects are so common in healthy athletes with physiological LVH that the specificity of myocardial SPET, in contrast to exercise ECG, seems to be too low for evaluation of chest pain in this group. The mechanism of anterior and inferior defects may be related to hot spots (papillary muscles?) in the lateral wall. The specificity of SPET is maintained in athletes without LVH. (orig.)

SPECT Analysis of Cardiac Perfusion Changes After Whole-Breast/Chest Wall Radiation Therapy With or Without Active Breathing Coordinator: Results of a Randomized Phase 3 Trial

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Zellars, Richard, E-mail: zellari@jhmi.edu [Johns Hopkins Medical Institution, Baltimore, Maryland (United States); Bravo, Paco E. [University of Washington Medical Center, Seattle, Washington (United States); Tryggestad, Erik [Mayo Clinic, Rochester, Minnesota (United States); Hopfer, Kari [Hahnemann University, Philadelphia, Pennsylvania (United States); Myers, Lee; Tahari, Abdel; Asrari, Fariba; Ziessman, Harvey [Johns Hopkins Medical Institution, Baltimore, Maryland (United States); Garrett-Mayer, Elizabeth [Medical University of South Carolina, Charleston, South Carolina (United States)

2014-03-15

Purpose: Cardiac muscle perfusion, as determined by single-photon emission computed tomography (SPECT), decreases after breast and/or chest wall (BCW) irradiation. The active breathing coordinator (ABC) enables radiation delivery when the BCW is farther from the heart, thereby decreasing cardiac exposure. We hypothesized that ABC would prevent radiation-induced cardiac toxicity and conducted a randomized controlled trial evaluating myocardial perfusion changes after radiation for left-sided breast cancer with or without ABC. Methods and Materials: Stages I to III left breast cancer patients requiring adjuvant radiation therapy (XRT) were randomized to ABC or No-ABC. Myocardial perfusion was evaluated by SPECT scans (before and 6 months after BCW radiation) using 2 methods: (1) fully automated quantitative polar mapping; and (2) semiquantitative visual assessment. The left ventricle was divided into 20 segments for the polar map and 17 segments for the visual method. Segments were grouped by anatomical rings (apical, mid, basal) or by coronary artery distribution. For the visual method, 2 nuclear medicine physicians, blinded to treatment groups, scored each segment's perfusion. Scores were analyzed with nonparametric tests and linear regression. Results: Between 2006 and 2010, 57 patients were enrolled and 43 were available for analysis. The cohorts were well matched. The apical and left anterior descending coronary artery segments had significant decreases in perfusion on SPECT scans in both ABC and No-ABC cohorts. In unadjusted and adjusted analyses, controlling for pretreatment perfusion score, age, and chemotherapy, ABC was not significantly associated with prevention of perfusion deficits. Conclusions: In this randomized controlled trial, ABC does not appear to prevent radiation-induced cardiac perfusion deficits.

SPECT Analysis of Cardiac Perfusion Changes After Whole-Breast/Chest Wall Radiation Therapy With or Without Active Breathing Coordinator: Results of a Randomized Phase 3 Trial

International Nuclear Information System (INIS)

Zellars, Richard; Bravo, Paco E.; Tryggestad, Erik; Hopfer, Kari; Myers, Lee; Tahari, Abdel; Asrari, Fariba; Ziessman, Harvey; Garrett-Mayer, Elizabeth

2014-01-01

Purpose: Cardiac muscle perfusion, as determined by single-photon emission computed tomography (SPECT), decreases after breast and/or chest wall (BCW) irradiation. The active breathing coordinator (ABC) enables radiation delivery when the BCW is farther from the heart, thereby decreasing cardiac exposure. We hypothesized that ABC would prevent radiation-induced cardiac toxicity and conducted a randomized controlled trial evaluating myocardial perfusion changes after radiation for left-sided breast cancer with or without ABC. Methods and Materials: Stages I to III left breast cancer patients requiring adjuvant radiation therapy (XRT) were randomized to ABC or No-ABC. Myocardial perfusion was evaluated by SPECT scans (before and 6 months after BCW radiation) using 2 methods: (1) fully automated quantitative polar mapping; and (2) semiquantitative visual assessment. The left ventricle was divided into 20 segments for the polar map and 17 segments for the visual method. Segments were grouped by anatomical rings (apical, mid, basal) or by coronary artery distribution. For the visual method, 2 nuclear medicine physicians, blinded to treatment groups, scored each segment's perfusion. Scores were analyzed with nonparametric tests and linear regression. Results: Between 2006 and 2010, 57 patients were enrolled and 43 were available for analysis. The cohorts were well matched. The apical and left anterior descending coronary artery segments had significant decreases in perfusion on SPECT scans in both ABC and No-ABC cohorts. In unadjusted and adjusted analyses, controlling for pretreatment perfusion score, age, and chemotherapy, ABC was not significantly associated with prevention of perfusion deficits. Conclusions: In this randomized controlled trial, ABC does not appear to prevent radiation-induced cardiac perfusion deficits

Dosimetric Comparison of Intensity-Modulated Radiotherapy Plans, With or Without Anterior Myocardial Territory and Left Ventricle as Organs at Risk, in Early-Stage Left-Sided Breast Cancer Patients

International Nuclear Information System (INIS)

Tan Wenyong; Wang Xiaohong; Qiu Dasheng; Liu Dong; Jia Shaohui; Zeng Fanyu; Chen Zhengwang; Li Beihui; Xu Jiaozhen; Wei Lai; Hu Desheng

2011-01-01

Purpose: We evaluated heart sparing using an intensity-modulated radiotherapy (IMRT) plan with the left ventricle (LV) and/or the anterior myocardial territory (AMT) as additional organs at risk (OARs). Methods and Materials: A total of 10 patients with left-sided breast cancer were selected for dosimetric planning. Both lungs, the right breast, heart, LV, and AMT were defined as OARs. We generated one tangential field plan and four IMRT plans for each patient. We examined the dose–volume histogram parameters of the planning target volume and OARs. Results: Compared with the tangential field plan, the mean dose to the heart in the IMRT plans did not show significant differences; however, the dose to the AMT and LV decreased by 18.7–45.4% and 10.8–37.4%, respectively. The maximal dose to the heart decreased by 18.6–35.3%, to the AMT by 22.0–45.1%, and to the LV by 23.5–45.0%, And the relative volumes of the heart (V ≥12 ), AMT (V >11 ) and LV (V >10 ) decreased significantly with different levels, respectively. The volume of the heart, AMT, LV, both lungs, and right breast receiving ≥5 Gy showed a significant increase. Compared with the IMRT (H) plan, the mean dose to the heart, AMT, and LV decreased by 17.5–21.5%, 25.2–29.8%, and 22.8–29.8% and the maximal dose by 13.6–20.6%, 23.1–29.6%, and 17.3–29.1%, respectively. The IMRT plans for both lungs and the right breast showed no significant differences. Conclusions: The IMRT plans with the addition of the AMT and/or LV as OARs considerably increased heart sparing. We recommend including the LV as an additional OAR in such plans.

A study of UGI series for improvement of diagnosis on the anterior wall of the stomach

International Nuclear Information System (INIS)

Lee, Won Hong; Son, Soon Yong; Kang, Hyoung Wook

1997-01-01

This paper is to investigate a more detailed method for the diagnosis of anterior wall of the stomach by making a comparative study with several hospitals. It has been true that there have been hospitals, that have not examined anterior wall of the stomach. However, it is very important for us to examine anterior wall of the stomach for an early detection of gastric carcinoma. The results of the study are as follows : 1. Frequency of occurrence of the early gastric carcinoma for the anterior wall were 50 cases and 34 cases for the posterior wall out of 84 cases. 2. Only a hospitals have examined the anterior wall of stomach. 3. In case of operation, only a hospitals have used two techniques at for same time single and double contrast studies. 4. Only one hospital used a compression pad and three hospitals had only filing state images taken. 5. In general, l chest of film was used and the number of exposures rouged from 1 to 2 times. Lesions on the anterior wall of the stomach can be shown by the combination of prone single compression and supine double contrast radiographs. Therefore, the conclusion came to the result that the prone single compression and supine double contract technique of the anterior wall are indispensable methods to the routine check of the stomach

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

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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.

Does hemopericardium after chest trauma mandate sternotomy?

Science.gov (United States)

Thorson, Chad M; Namias, Nicholas; Van Haren, Robert M; Guarch, Gerardo A; Ginzburg, Enrique; Salerno, Tomas A; Schulman, Carl I; Livingstone, Alan S; Proctor, Kenneth G

2012-06-01

Recently, three patients with hemopericardium after severe chest trauma were successfully managed nonoperatively at our institution. This prompted the question whether these were rare or common events. Therefore, we reviewed our experience with similar injuries to test the hypothesis that trauma-induced hemopericardium mandates sternotomy. Records were retrospectively reviewed for all patients at a Level I trauma center (December 1996 to November 2011) who sustained chest trauma with pericardial window (PCW, n = 377) and/or median sternotomy (n = 110). Fifty-five (15%) patients with positive PCW proceeded to sternotomy. Penetrating injury was the dominant mechanism (n = 49, 89%). Nineteen (35%) were hypotensive on arrival or during initial resuscitation. Most received surgeon-performed focused cardiac ultrasound examinations (n = 43, 78%) with positive results (n = 25, 58%). Ventricular injuries were most common, with equivalent numbers occurring on the right (n = 16, 29%) and left (n = 15, 27%). Six (11%) with positive PCW had isolated pericardial lacerations, but 21 (38%) had no repairable cardiac or great vessel injury. Those with therapeutic versus nontherapeutic sternotomies were similar with respect to age, mechanisms of injury, injury severity scores, presenting laboratory values, resuscitation fluids, and vital signs. Multiple logistic regression revealed that penetrating trauma (odds ratio: 13.3) and hemodynamic instability (odds ratio: 7.8) were independent predictors of therapeutic sternotomy. Hemopericardium per se may be overly sensitive for diagnosing cardiac or great vessel injuries after chest trauma. Some stable blunt or penetrating trauma patients without continuing intrapericardial bleeding had nontherapeutic sternotomies, suggesting that this intervention could be avoided in selected cases. Therapeutic study, level III. Copyright © 2012 by Lippincott Williams & Wilkins.

Management of cerebrospinal fluid leakage after anterior decompression for ossification of posterior longitudinal ligament in the thoracic spine: the utilization of a volume-controlled pseudomeningocele.

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Cho, Ji Young; Chan, Chee Keong; Lee, Sang-Ho; Choi, Won-Chul; Maeng, Dae Hyeon; Lee, Ho-Yeon

2012-06-01

Retrospective review To determine the efficacy of management of cerebrospinal fluid (CSF) leakage after the anterior thoracic approach. CSF leakage after incidental durotomy commonly occurs after anterior thoracic ossification of posterior longitudinal ligament (OPLL) surgery. Pseudomeningocele will invariably form under such circumstances. Among them, uncontrolled CSF leakage with a fistulous condition is problematic. As a solution, we have managed these durotomies with chest drains alone without any CSF drainage by the concept of a "volume-controlled pseudomeningocele." Between 2001 and 2009, CSF leakage occurred in 26 patients (37.7%) of the total 69 patients who underwent anterior decompression for thoracic OPLL. In the initial 11 cases, subarachnoid drainage was utilized as an augmentive measure in combination with chest tube drainage in the postoperative period (group A). In the subsequent 15 cases, the durotomy was managed in a similar manner but in the absence of any subarachnoid drainage (group B). Various parameters such as the duration of postoperative hospital stay, clinical outcome score, drainage output, resolution of CSF leakage, complications, and additional surgery performed were analyzed and compared between the 2 groups. A resolution of the CSF leakage grading system was also proposed for the residual pseudomeningocele that formed in each group. There were statistically no significant differences in the outcome parameters between the 2 groups and also in patients with grade I or grade II residual pseudomeningocele of the new grading system. Two complications occurred in group A. No reexploration for persistent CSF leakage was required in both groups. CSF leakage managed with controlled chest tube drainage can produce a comparable result with those with additional subarachnoid drainage when watertight dural repair is impossible. The concept of controlled pseudomeningocele may be a useful and practical technique for the treatment of CSF leakage

Chest tomosynthesis: technical and clinical perspectives.

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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.

Optic neuritis and acute anterior uveitis associated with influenza A infection: a case report

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Nakagawa H

2017-01-01

Full Text Available Hayate Nakagawa, Hidetaka Noma, Osamu Kotake, Ryosuke Motohashi, Kanako Yasuda, Masahiko Shimura Department of Ophthalmology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan Background: A few reports have described ocular complications of influenza A infection, such as impaired ocular movement, parasympathetic ocular nerve, keratitis, macular lesion, and frosted branch angiitis. We encountered a rare case of acute anterior uveitis and optic neuritis associated with influenza A infection. Case presentation: A 70-year-old man presented with symptoms of upper respiratory tract infection. A rapid diagnostic test showed a positive result for influenza A. At the same time, he developed ocular symptoms including blurred vision with optic disk edema and hemorrhage in the left eye, and bilateral red eyes. Multiplex polymerase chain reaction performed on aqueous humor sample detected no viral infection. Visual field testing with a Goldmann perimeter showed central and paracentral scotomas in the left eye. In addition to antiviral agent (oseltamivir phosphate 75 mg, the patient was prescribed topical prednisolone acetate ophthalmic suspension eye drops every 5 hours and high-dose intravenous methylprednisolone 1,000 mg daily for 3 days. Two months later, his best-corrected visual acuity improved to 20/50 with regression of visual field defects in his left eye. Conclusion: We report a case of bilateral acute anterior uveitis and unilateral optic neuritis concomitant with influenza A infection. Topical and systemic corticosteroids were effective to resolve acute anterior uveitis and neuritis. Analysis of aqueous humor sample suggested that acute anterior uveitis and optic neuritis in this case were not caused by influenza A virus infection per se but by autoimmune mechanism. Keywords: optic neuritis, anterior uveitis, influenza virus, multiplex polymerase chain reaction

Computerized axial tomography of the chest for visualization of ''absent'' pulmonary arteries

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Sondheimer, H.M. (Upstate Medical Center, Syracuse, NY); Oliphant, M.; Schneider, B.; Kavey, R.E.W.; Blackman, M.S.; Parker, F.B. Jr.

1982-05-01

To expand the search for central pulmonary arteries in six patients with absence of cardiac-pulmonary continuity, computerized axial tomography (CAT) of the chest was performed. The CAT scans were compared with previous arteriograms and pulmonary vein wedge angiograms. Three patients with type IV truncus arteriosus were studied, and none had a central, right or left pulmonary artery on CAT scan. However, two patients with tetralogy of Fallot with pulmonary atresia and a patent ductus arteriosus to the right lung demonstrated the presence of a left pulmonary artery. In addition, one child with truncus arteriosus with ''absent'' left pulmonary artery demonstrated a left pulmonary artery on the CAT scan. The CAT scan may therefore enhance our ability to search for disconnected pulmonary arteries in children with complex cyanotic congenital heart disease.

A tale of two hemispheres: Contrasting socioemotional dysfunction in right- versus left-lateralised semantic dementia

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Muireann Irish

Full Text Available ABSTRACT Objective: Semantic dementia, a subtype of frontotemporal lobar degeneration, is characterised by cross-modal loss of conceptual knowledge attributable to progressive degeneration of the left anterior temporal lobe. Much less is known regarding the clinical presentation of SD patients with predominantly right-lateralised atrophy. Recent reports emphasise marked socioemotional and behavioural disturbances in such cases. Given the importance of the right anterior temporal lobes in social cognition, we hypothesised that socioemotional functioning would be disproportionately affected in right versus left-lateralised SD cases. Methods: We assessed well-characterised cases of predominantly right (n=10 and left (n=12 SD and 20 matched healthy controls on tests of emotion processing and interpersonal functioning. Results: Right SD cases showed disproportionate difficulties in the recognition of positive and negative facial emotions, specifically happiness and anger, compared with left SD cases. Deficits in anger recognition persisted in right SD despite covarying for facial and semantic processing. On a contextually rich task of emotion recognition using multimodal videos, no subgroup differences were evident. Finally, empathic concern was rated as significantly lower by caregivers of right versus left SD cases. Overall, the extent of socioemotional disturbance was associated with the degree of behavioural changes in SD. Conclusion: Our results reveal considerable overlap in the extent to which socioemotional processes are disrupted in left and right-lateralised cases of SD. Notably, however, right SD cases show disproportionate deficits for recognition of facial emotions and the capacity for empathic concern, supporting a specialised role for the right anterior temporal lobes in mediating these cognitive functions.

Composition of complex numbers: Delineating the computational role of the left anterior temporal lobe.

Science.gov (United States)

Blanco-Elorrieta, Esti; Pylkkänen, Liina

2016-01-01

What is the neurobiological basis of our ability to create complex messages with language? Results from multiple methodologies have converged on a set of brain regions as relevant for this general process, but the computational details of these areas remain to be characterized. The left anterior temporal lobe (LATL) has been a consistent node within this network, with results suggesting that although it rather systematically shows increased activation for semantically complex structured stimuli, this effect does not extend to number phrases such as 'three books.' In the present work we used magnetoencephalography to investigate whether numbers in general are an invalid input to the combinatory operations housed in the LATL or whether the lack of LATL engagement for stimuli such as 'three books' is due to the quantificational nature of such phrases. As a relevant test case, we employed complex number terms such as 'twenty-three', where one number term is not a quantifier of the other but rather, the two terms form a type of complex concept. In a number naming paradigm, participants viewed rows of numbers and depending on task instruction, named them as complex number terms ('twenty-three'), numerical quantifications ('two threes'), adjectival modifications ('blue threes') or non-combinatory lists (e.g., 'two, three'). While quantificational phrases failed to engage the LATL as compared to non-combinatory controls, both complex number terms and adjectival modifications elicited a reliable activity increase in the LATL. Our results show that while the LATL does not participate in the enumeration of tokens within a set, exemplified by the quantificational phrases, it does support conceptual combination, including the composition of complex number concepts. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

PATIENT RADIATION DOSE FROM CHEST X-RAY EXAMINATIONS IN THE WEST BANK-PALESTINE.

Science.gov (United States)

Lahham, Adnan; Issa, Ahlam; ALMasri, Hussein

2018-02-01

Radiation doses to patients resulting from chest X-ray examinations were evaluated in four medical centers in the West Bank and East Jerusalem-Palestine. Absorbed organ and effective doses were calculated for a total of 428 adult male and female patients by using commercially available Monte Carlo based softwares; CALDOSE-X5 and PCXMC-2.0, and hermaphrodite mathematical adult phantoms. Patients were selected randomly from medical records in the time period from November 2014 to February 2015. A database of surveyed patients and exposure factors has been established and includes: patient's height, weight, age, gender, X-ray tube voltage, electric current (mAs), examination projection (anterior posterior (AP), posterior anterior (PA), lateral), X-ray tube filtration thickness in each X-ray equipment, anode angle, focus to skin distance and X-ray beam size. The average absorbed doses in the whole body from different projections were: 0.06, 0.07 and 0.11 mGy from AP, PA and lateral projections, respectively. The average effective dose for all surveyed patients was 0.14 mSv for all chest X-ray examinations and projections in the four investigated medical centers. The effect of projection geometry was also investigated. The average effective doses for AP, PA and lateral projections were 0.14, 0.07 and 0.22 mSv, respectively. The collective effective dose estimated for the exposed population was ~60 man-mSv. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

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

Bilateral anterior thalamic low densities in descending transtentorial herniation

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Nagashima, Chikao; Watanabe, Takao

1985-02-01

Round, well-demarcated, symmetrical low densities in a bilateral thalamus in a case of descending transtentorial herniation due secondarily to acute traumatic left subdural hematoma are reported. An 8-year-old boy, on whom emergency surgery was refused by his parents, showed a marked shift due to the hematoma on admission; this was followed by a low density in the left PCA territory and round, equivocal hypodensities in the anterior thalamus 44 hours post-trauma. The equivocal hypodensities became definite, well-demarcated, round low densities situated symmetrically in the anterior thalamus on the 39th day post-trauma. Akinetic mutism was noted at this time. The symmetrical low densities and the PCA-territory low density persisted as late as the 39th day post-trauma, suggesting infarcts. The downward stretch of the bilateral thalamoperforators, which was effected by a narrowing of the interpeduncular fossa with an approximation of the bilateral perforators, plus a downward shift of the PCA due to descending transtentorial herniation, was assumed to be the mechanism involved. (author).

Damage to the anterior arcuate fasciculus predicts non-fluent speech production in aphasia

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Fridriksson, Julius; Guo, Dazhou; Fillmore, Paul; Holland, Audrey; Rorden, Chris

2013-01-01

Non-fluent aphasia implies a relatively straightforward neurological condition characterized by limited speech output. However, it is an umbrella term for different underlying impairments affecting speech production. Several studies have sought the critical lesion location that gives rise to non-fluent aphasia. The results have been mixed but typically implicate anterior cortical regions such as Broca’s area, the left anterior insula, and deep white matter regions. To provide a clearer pictur...

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.

A Manual for the Performance of Protective Equipment Fit-Mapping

Science.gov (United States)

2009-10-01

Fit Map Derived Accommodation Envelopes Stature Chest Circumference 1 2 3 4 5 A 760-900 1500- 1590 1520-1640 1590 -1710 B 820-960 1500-1620 1520-1640...Right and Left ISO Definition No. N/A CAESAR Name: THELION/BUSTPOINT, RIGHT AND LEFT Description: Most anterior protrusion of the bra cup on women ...Development. pp. 19-59. 17. Robinette, K.M. (1996). Flight suit sizes for women , Armstrong Laboratory, Brooke AFB, MIPR Number 96MM6646. 18

Radiographic signs of non-venous placement of intended central venous catheters in children

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Taylor, Erin C. [Boston Children' s Hospital, Department of Radiology, Boston, MA (United States); Taylor, George A. [Boston Children' s Hospital, Department of Radiology, Boston, MA (United States); Harvard Medical School, Department of Radiology, Boston, MA (United States)

2016-02-15

Central venous catheters (CVCs) are commonly used in children, and inadvertent arterial or extravascular cannulation is rare but has potentially serious complications. To identify the radiographic signs of arterial placement of CVCs. We retrospectively reviewed seven cases of arterially malpositioned CVCs on chest radiograph. These cases were identified through departmental quality-assurance mechanisms and external consultation. Comparison of arterial cases was made with 127 age-matched chest radiographs with CVCs in normal, expected venous location. On each anteroposterior (AP) radiograph we measured the distance of the catheter tip from the right lateral border of the thoracic spine, and the angle of the vertical portion of the catheter relative to the midline. On each lateral radiograph we measured the angle of the vertical portion of each catheter relative to the anterior border of the thoracic spine. When bilateral subclavian catheters were present, the catheter tips were described as crossed, overlapping or uncrossed. On AP radiographs, arterially placed CVCs were more curved to the left, with catheter tip positions located farther to the left of midline than normal venous CVCs. When bilateral, properly placed venous catheters were present, all catheters crossed at the level of the superior vena cava (SVC). When one of the bilateral catheters was in arterial position, neither of the catheters crossed or the inter-catheter crossover distance was exaggerated. On lateral radiographs, there was a marked anterior angulation of the vertical portion of the catheter (mean angle 37 ± 15 standard deviation [SD] in arterial catheters versus 5.9 ± 8.3 SD in normally placed venous catheters). Useful radiographic signs suggestive of unintentional arterial misplacement of vascular catheters include leftward curvature of the vertical portion of the catheter, left-side catheter tip position, lack of catheter crossover on the frontal radiograph, as well as exaggerated

Learning chest imaging

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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.

Successful treatment of cardiogenic shock by stenting of the left main coronary artery in acute myocardial infarction

Directory of Open Access Journals (Sweden)

Knežević Božidarka

2008-01-01

Full Text Available Introduction. Patients with non-ST elevation acute coronary syndromes (NSTE-ACS are sometimes severely hemodynamicly compromised. Urgent coronary angiography should be performed in these patients in percutaneous coronary intervention (PCI centers according to the ESC NSTE-ACS guidelines to determine suitabilty for percutaneous or surgical revascularization. Case report. We reported a 62-year-old male with chest pain admitted to the Coronary Care Unit. ST segment depression of 2 mm in leads I, L and V4-6 was revealed at electrocardiogram. After following 6 hours the patient had chest pain and signs of cardiogenic shock despite of the therapy. Chest x-ray showed pulmonary edema. Echocardiographic examination showed dyskinetic medium and apical segments of septum. The patient underwent coronary angiography immediately which revealed 75% stenosis of the left main coronary artery with thrombus. The use of a GPIIb/III inhibitor-tirofiban and stent implantation resulted in TIMI III flow. After that the patient had no chest pain and acute heart failure subsided in the following days Echocardiography done at the fourth day from PCI showed only hypokinesis medium and apical segment of septum. The patient was discharged at day 11 from admission in a stable condition. Conclusion. Stenting of left main coronary artery stenosis in patients with cardiogenic shock and non- ST segment elevation acute coronary syndromes may be a life saving procedure.

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

Clinical value of CARE dose 4D technique in decreasing CT scanning dose of adult chest

International Nuclear Information System (INIS)

Wu Aiqin; Zheng Wenlong; Xu Chongyong; Fang Bidong; Ge Wen

2011-01-01

Objective: To investigate the value of CARE Dose 4D technique in decreasing radiation dose and improving image quality of multi-slice spiral CT in adult chest scanning. Methods: 100 patients of chest CT scanning were equally divided into study group and control group randomly. CARE Dose 4D Technique was used in study group. Effective mAs value, volume CT dose index (CTDI vol ) and dose length product (DLP) were displayed automatically in machine while chest scanning; those values and actual mAs value of every image were recorded respectively. The image quality at apex of lung, lower edge of aorta arch, middle area of left atrium and base of lung on every image of 400 images was judged and classified as three level (excellent, good, poor) by two deputy chief physicians with double blind method, the image noise at corresponding parts was measured. Results: While setting 80 mAs for quality reference mAs, the effective mAs value in study group most decreased 44 mAs than control group with an average decrease of 9.60 (12.0%), CTDI vol with 4.75 mGy with an average decrease of 0.95 mCy (11.0%), DLP 99.50% in study group, with 98.0% in control group. But it was higher at apex of lung and base of lung, lower at middle area of left atrium, and similar at lower edge of aorta arch in study group than contrast group. The image noise were lower at apex of lung and base of lung in study group than control group (t =6.299 and 2.332, all P<0.05), higher at middle area of left atrium in study group than control group (t=3.078, P<0.05) and similar at lower edge of aorta arch in study group than control group (t=1.191, P>0.05). Conclusions: CARE Dose 4D technique provides a function regulated mAs real-time on line, it not only raises utilization rate of radiation and decreases radiation dose, but also promises and increases image quality in chest CT scanning, and has some clinical significance. (authors)

Chondroblastoma with secondary aneurysmal bone cyst in the anterior skull base

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Ming Jie Wang, MD, PhD

2016-06-01

Full Text Available Chondroblastoma with secondary aneurysmal bone cyst (ABC, especially in the anterior skull base, is an extremely rare condition. A 5-year-old boy presented with a large space-occupying lesion in the anterior skull base along with a left sided-epistaxis, proptosis and decreased vision. Radical excision of the lesion was performed by an endoscopic transnasal and transethmoidal approach. The patient recovered without any recurrence during a follow-up period of up to 28 months. Here, we review this rare case and discuss the clinical presentation and surgical treatment.

Evaluation of entrance surface air kerma in pediatric chest radiography

Science.gov (United States)

Porto, L.; Lunelli, N.; Paschuk, S.; Oliveira, A.; Ferreira, J. L.; Schelin, H.; Miguel, C.; Denyak, V.; Kmiecik, C.; Tilly, J.; Khoury, H.

2014-11-01

The objective of this study was to evaluate the entrance surface air kerma in pediatric chest radiography. An evaluation of 301 radiographical examinations in anterior-posterior (AP) and posterior-anterior (PA) (166 examinations) and lateral (LAT) (135 examinations) projections was performed. The analyses were performed on patients grouped by age; the groups included ages 0-1 y, 1-5 y, 5-10 y, and 10-15 y. The entrance surface air kerma was determined with DoseCal software (Radiological Protection Center of Saint George's Hospital, London) and thermoluminescent dosimeters. Two different exposure techniques were compared. The doses received by patients who had undergone LAT examinations were 40% higher, on average, those in AP/PA examinations because of the difference in tube voltage. A large high-dose “tail” was observed for children up to 5 y old. An increase in tube potential and corresponding decrease in current lead to a significant dose reduction. The difference between the average dose values for different age ranges was not practically observed, implying that the exposure techniques are still not optimal. Exposure doses received using the higher tube voltage and lower current-time product correspond to the international diagnostic reference levels.

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

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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.

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.

Myocardial Blood Flow and Flow Reserve in Proximal and Mid-to-Distal Lesions of Left Anterior Descending Artery Measured By N-13 Ammonia PET/CT

International Nuclear Information System (INIS)

Cho, Sanggeon; Kim, Ju Han; Cho, Jae Young; Kim, Hyeon Sik; Bom, Heeseung

2013-01-01

The purpose of this study is to compare the myocardial blood flow (MBF) and flow reserve (MFR) between proximal and mid-to-distal lesions of the left anterior descending artery (pLAD and mdLAD, respectively) using N-13 ammonia positron emission tomography/computed tomography (PET/CT). Subjects were 11 patients (six men and five women, mean age 64.5 years) with known coronary artery disease (CAD) involving LAD studied by N-13 ammonia PET/CT. They were divided into two groups by the location of stenotic lesions, i.e. pLAD versus mdLAD. Global and regional MBF and MFR were measured and compared. Characteristics of perfusion defects including the number of involved segments, basal area involvement, location, size, and shape were also compared between the two groups. The regional MFR in mid-anterior segment was significantly lower in pLAD group (1.80±0.35 vs 2.76±1.13 for pLAD and mdLAD groups, respectively, p=0.034), while global MFR was not different (2.10±1.10 vs 2.34±0.84). Both stress and rest MBF in LAD territories were not different in both groups. The size of the perfusion defects were significantly larger in pLAD group (44.0±11.5 % vs 21-1±15.8 %, p=0.041). Other characteristics such as location, basal area involvement, and shape were not significantly different between two groups. Conclusions The proximal lesion makes lower MFR in the mid-anterior segment and larger perfusion defect in the LAD territory but comparable MBF compared with mdLAD lesion

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...

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)

Clinical correlations, lactate extraction, coronary venous bloodflow and Thallium-201 myocardial imaging in patients with isolated left anterior descending muscle brigdes: Normal variant or obstruction

International Nuclear Information System (INIS)

Voss, H.; Kupper, W.; Hanrath, P.; Mathey, D.; Montz, R.; Buecking, J.; Hamburg Univ.; Hamburg Univ.

1980-01-01

In 848 coronary arteriograms performed in a two-years period 21 patients (2.5%) showed a myocardial bridging of the left anterior descending artery. Resting- and/or stress-ECG were abnormal in half of the patients. Regional lactate-metabolism measured in the great cardiac vein at rest and during maximal atrial pacing was normal (29 +- 12 resp. 24 +- 9%). Thermodilution of great cardiac vein bloodflow at rest and during atrial pacing also demonstrated normal values (94 +- 33 resp. 138 +- 30 ml/min). Biphasic 201-Thallium myocardial imaging revealed no case of reversible perfusion defect, but surprisingly frequent (5 of 16 patients) clearly irreversible defects limited to the interventricular septum. We conclude that muscle bridges do not cause myocardial ischemia at rest or during exercice. (orig.) [de

Count-based left ventricular volume determination utilizing a left posterior oblique view for attenuation correction

International Nuclear Information System (INIS)

Rabinovitch, M.A.; Kalff, V.; Koral, K.

1984-01-01

This study aimed to determine the inherent error of the left ventricular volume measurement from the gated equilibrium blood pool scintigram utilizing the count-based technique. The study population consisted of 26 patients who had undergone biplane contrast ventriculography. The patients were imaged with a parallel-hole collimator in the left anterior oblique position showing the septum to best advantage. A reference blood sample was counted and radionuclide volumes calculated without correction for attenuation. Attenuation corrected volumes were derived with the factor 1/e/sup -/+d/, where d = distance from skin marker to center of the left ventricle in the orthogonal left posterior oblique view and μ = linear attenuation coefficient. A series of μ values from 0.08 to 0.15 cm -1 was evaluated. The tightest 95% confidence limits achieved for an end-diastolic 150-ml ventricle were +/- 44ml, and for an end-systolic 75-ml ventricle +/- 32 ml. In view of the magnitude of inherent error, the count-based volume measurement may be more suitable for group analyses and in cases in which an individual patient serves as his own control

Effectiveness of chest compression feedback during cardiopulmonary resuscitation in lateral tilted and semirecumbent positions: a randomised controlled simulation study.

Science.gov (United States)

Song, Y; Oh, J; Chee, Y; Cho, Y; Lee, S; Lim, T H

2015-11-01

Feedback devices have been shown to improve the quality of chest compression during cardiopulmonary resuscitation for patients in the supine position, but no studies have reported the effects of feedback devices on chest compression when the chest is tilted. Basic life support-trained providers were randomly assigned to administer chest compressions to a manikin in the supine, 30° left lateral tilt and 30° semirecumbent positions, with or without the aid of a feedback device incorporated into a smartphone. Thirty-six participants were studied. The feedback device did not affect the quality of chest compressions in the supine position, but improved aspects of performance in the tilted positions. In the lateral tilted position, the median (IQR [range]) chest compression rate was 99 (99-100 [96-117]) compressions.min(-1) with and 115 (95-128 [77-164]) compressions.min(-1) without feedback (p = 0.05), and the proportion of compressions of correct depth was 55 (0-96 [0-100])% with and 1 (0-30 [0-100])% without feedback (p = 0.03). In the semirecumbent position, the proportion of compressions of correct depth was 21 (0-87 [0-100])% with and 1 (0-26 [0-100])% without feedback (p = 0.05). Female participants applied chest compressions at a more accurate rate using the feedback device in the lateral tilted position but were unable to increase the chest compression depth, whereas male participants were able to increase the force of chest compression using the feedback device in the lateral tilted and semirecumbent positions. We conclude that a feedback device improves the application of chest compressions during simulated cardiopulmonary resuscitation when the chest is tilted. © 2015 The Association of Anaesthetists of Great Britain and Ireland.

MYOCARDIAL DEFORMATION AND COMPLETE LEFT BUNDLE BRANCH BLOCK

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E. N. Pavlyukova

2015-12-01

Full Text Available Tissue Doppler imaging is evolving as a useful echocardiographic tool for quantitative assessment of left ventricular systolic and diastolic function. Over the last 10 years, myocardial deformation imaging has become possible initially with tissue Doppler , and more recently with myocardial speckle-tracking using 2D echocardiography. Unlike simple tissue velocity measurements, deformation measurements are specific for the region of interest. Strain rate or strain measurements have been used as sensitive indicators for subclinical diseases, and it is the most widely used tool to assess mechanical dyssynchrony. Left bundle branch block is a frequent, etiologically heterogeneous, clinically hostile and diagnostically challenging entity. About 2% of patients underwent cardiac stress testing show stable or intermittent left bundle branch block. Presence of left bundle branch block is associated with a lower and slower diastolic coronary flow velocity especially during hyperemia. Stress echocardiography is the best option for the diagnosis of ischemic heart disease, albeit specificity and sensitivity reduce in patients with left bundle branch block in the territory of left anterior descending artery in presence of initial septum dyskinesia.

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.

Rate of transformation and normal range about cardiac size and cardiothoracic ratio according to patient position and age at chest radiography of Korean adult man

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Joo, Young Cheol [Dept. of Radiology, Samsung Medical Center, Seoul (Korea, Republic of); Lim, Cheong Hwan; Jung, Hong Ryang [Dept. of Radiological Science, Hanseo University, Seosan (Korea, Republic of); Kim, Yun Min [Dept. of Radiotechnology, Wonkwang Health Science University, Iksan (Korea, Republic of); Hong, Dong Hee [Dept. of Radiological Science, Far East University, Eumseong (Korea, Republic of)

2017-06-15

Purpose of this study is present the normal range of cardiac size and cardiothoracic ratio according to patient position(chest PA and AP) and age of Korean adult male on digital chest X - ray, And to propose a mutually compatible conversion rate. 1,024 males were eligible for this study, among 1,300 normal chest patients who underwent chest PA and low-dose CT examinations on the same day at the 'S' Hospital Health Examination Center in Seoul From January to December 2014. CS and CTR were measured by Danzer (1919). The mean difference between CS and CTR was statistically significant (p<0.01) in Chest PA (CS 135.48 mm, CTR 43.99%) and Chest AP image (CS 155.96 mm, CTR 51.75%). There was no statistically significant difference between left and right heart in chest PA and AP images(p>0.05). CS showed statistically significant difference between Chest PA (p>0. 05) and Chest AP (p<0.05). The thorax size and CTR were statistically significant (p<0.01) in both age and chest PA and AP. Result of this study, On Chest AP image CS was magnified 15%, CTR was magnified 17% compare with Chest PA image. CS and CTR were about 10% difference by changing posture at all ages.

Simultaneous right coronary artery spasm in a patient with Anterior ST-Segment Elevation Myocardial Infarction: a case report

Directory of Open Access Journals (Sweden)

Zhiva Taherpour

2013-05-01

Full Text Available Please cite this article as: Taherpour Z, Seyedian M, Alasti M. Simultaneous right coronary artery spasm in a patient with Anterior ST-Segment Elevation Myocardial Infarction: a case report. Novel Biomed 2013;1:29-33.Simultaneous occlusion of two vessels causing infarction at different territories is an uncommon finding. We report simultaneous right ventricular and anterior ST-segment elevation myocardial infarction in a previously healthy young man.The angiographic results demonstrated the simultaneous occlusion of the right and left coronary arteries because of simultaneous occlusion of left anterior descending artery (LADA and spasm of right coronary artery (RCA. In this patient, we found simultaneous ST elevations in right and precordial leads so everyone should be careful about all leads of the surface electrocardiogram for decision making in the management of a patient.

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.

Repair of pectus excavatum in a toddler with Prune Belly syndrome and left bronchus compression

Directory of Open Access Journals (Sweden)

Shawn T. Liechty

2017-01-01

Full Text Available A 2-year-old boy with prune-belly syndrome and severe pectus excavatum experienced recurrent pulmonary infections. A CT scan of the chest demonstrated compression of the left mainstem bronchus and leftward shift of the heart. The bronchial compression resulted in left upper lobe collapse and left lower lobe air-trapping requiring two hospitalizations for respiratory distress and pneumonia. The child underwent minimally invasive repair of his pectus excavatum and has not experienced any further pulmonary events. The pectus bar was removed 3 years post-operatively and at seven years following surgery he has a sustained repair.

Functional specialization of the left ventral parietal cortex in working memory

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Jennifer Lou Langel

2014-06-01

Full Text Available The function of the ventral parietal cortex (VPC is subject to much debate. Many studies suggest a lateralization of function in the VPC, with the left hemisphere facilitating verbal working memory and the right subserving stimulus-driven attention. However, many attentional tasks elicit activity in the VPC bilaterally. To elucidate the potential divides across the VPC in function, we assessed the pattern of activity in the VPC bilaterally across two tasks that require different demands, an oddball attentional task with low working memory demands and a working memory task. An anterior region of the VPC was bilaterally active during novel targets in the oddball task and during retrieval in WM, while more posterior regions of the VPC displayed dissociable functions in the left and right hemisphere, with the left being active during the encoding and retrieval of WM, but not during the oddball task and the right showing the reverse pattern. These results suggest that bilateral regions of the anterior VPC subserve non-mnemonic processes, such as stimulus-driven attention during WM retrieval and oddball detection. The left posterior VPC may be important for speech-related processing important for both working memory and perception, while the right hemisphere is more lateralized for attention.

Radiologic-anatomic correlation of thoracic vertebrae and rib shadows in chest digital radiograph

International Nuclear Information System (INIS)

Yamaguchi, Isao; Itoh, Harumi

2007-01-01

The purpose of this study was to provide an introduction to parsing the radiologic appearance of thoracic vertebrae and ribs. In the study, the radiologic-anatomic correlation technique was applied to promote further understanding of normal chest radiographs. The thoracic vertebrae and ribs of chest radiographs were compared with each macroscopic radiologic and computed tomography (CT) image. The rib parsed the linear shadow of the body of the rib. The macroscopic and radiologic images of thoracic vertebrae and ribs were evaluated to explain their normal radiologic findings. The results of such correlation were summarized as follows: The lamina of the vertebral arch was visualized due to anterior rotation of the upper thoracic vertebrae. The density ratio of the thoracic-vertebrae shadow was almost the same in the vertebral body and vertebral arch. The linear shadow superimposed on the rib corresponded to the inferior margin of the rib. The radiologic-anatomic correlation technique was useful to evaluate normal radiologic findings, and the study was useful to radiological technologists. (author)

Imaging regional metabolic changes in the ischemic rat heart in vivo using hyperpolarized(1-13C)Pyruvate

DEFF Research Database (Denmark)

Lauritzen, Mette Hauge; Magnusson, Peter; Laustsen, Christoffer

2017-01-01

in the in vivo rat heart in an open-chest model of ischemia reperfusion. Hyperpolarized MRI enables new possibilities for evaluating changes in cardiac metabolism noninvasively and in real time, which potentially could be used for research to evaluate new treatments and metabolic interventions for myocardial......We evaluated the use of hyperpolarized 13C magnetic resonance imaging (MRI) in an open-chest rat model of myocardial infarction to image regional changes in myocardial metabolism. In total, 10 rats were examined before and after 30 minutes of occlusion of the left anterior descending coronary...

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.

Detection of rib fractures in minor chest injuries: a comparison between ultrasonography and radiography performed on the same day

Energy Technology Data Exchange (ETDEWEB)

Cho, Yong Soo; Back, Chang Hee; Lee, Kyung Rae; Shin, Yun Hack; Whang, Yeong Seop; Jeong, Ku Young [Yeosu Baek Hospital, Yeosu (Korea, Republic of); Chung, Soo Hyun [NamWon Medical Center, NamWon (Korea, Republic of); Whang, Cheol Mog [Konyang University Hospital, Daejeon (Korea, Republic of)

2007-04-15

We wished to compare the ability of ultrasonography and radiography performed on the same day to detect rib fractures in minor chest injuries. Two hundred and fifteen patients with minor chest injuries were selected. Radiography and ultrasonography were performed on the same day with these patients. Chest wall pain was the only presenting symptom. Two radiologists performed ultrasonography. Fractures were identified by a disruption of the anterior margin of the rib and costal cartilage. The incidence and location of fractures and complications revealed by radiography and ultrasonography were compared. Radiographs revealed the presence of 70 rib fractures in 50 (23%) of 215 patients and ultrasonography revealed the presence of 203 rib fractures in 133 (62%) of 215 patients. Ultrasonography uniquely identified 133 rib fractures in 83 patients. Ultrasonography identified a 2.9 fold increase in the number of fractures in a 2.6 fold number of subjects as compared to radiography. Of the 203 sonographically detected fractures, 201 were located in the rib, one was located at the costochondral junction, and one in the costal cartilage. There were no complications seen by either radiography or ultrasonography. Ultrasonography reveals more fractures than those that may be overlooked on radiography for minor chest injuries.

Detection of rib fractures in minor chest injuries: a comparison between ultrasonography and radiography performed on the same day

International Nuclear Information System (INIS)

Cho, Yong Soo; Back, Chang Hee; Lee, Kyung Rae; Shin, Yun Hack; Whang, Yeong Seop; Jeong, Ku Young; Chung, Soo Hyun; Whang, Cheol Mog

2007-01-01

We wished to compare the ability of ultrasonography and radiography performed on the same day to detect rib fractures in minor chest injuries. Two hundred and fifteen patients with minor chest injuries were selected. Radiography and ultrasonography were performed on the same day with these patients. Chest wall pain was the only presenting symptom. Two radiologists performed ultrasonography. Fractures were identified by a disruption of the anterior margin of the rib and costal cartilage. The incidence and location of fractures and complications revealed by radiography and ultrasonography were compared. Radiographs revealed the presence of 70 rib fractures in 50 (23%) of 215 patients and ultrasonography revealed the presence of 203 rib fractures in 133 (62%) of 215 patients. Ultrasonography uniquely identified 133 rib fractures in 83 patients. Ultrasonography identified a 2.9 fold increase in the number of fractures in a 2.6 fold number of subjects as compared to radiography. Of the 203 sonographically detected fractures, 201 were located in the rib, one was located at the costochondral junction, and one in the costal cartilage. There were no complications seen by either radiography or ultrasonography. Ultrasonography reveals more fractures than those that may be overlooked on radiography for minor chest injuries

Effects of coil closure of patent ductus arteriosus on left anterior descending coronary artery blood flow using transthoracic Doppler echocardiography.

Science.gov (United States)

Harada, Kenji; Toyono, Manotomo; Tamura, Masamichi

2004-06-01

Transthoracic Doppler echocardiography provides noninvasive measurements of coronary blood flow in the left anterior descending coronary artery (LAD). This method has the potential to show the effects of acute changes in loading conditions on blood flow. Coil closure of patent ductus arteriosus (PDA) is a model of acute changes in blood pressure and left ventricular (LV) preload that influences coronary blood flow. We applied this technique to assess the coronary blood flow changes for patients with PDA before and immediately after PDA coil closure. We examined 9 patients (1.8 +/- 1.1 years) with simple PDA and 8 age-matched healthy children. LV dimensions and LV mass were measured. Maximum peak flow velocity and flow volume in the LAD were measured. Pulmonary to systemic flow ratios (Qp/Qs) were obtained by cardiac catheterization. After PDA coil closure, LV end-diastolic dimension decreased, and systolic and diastolic blood pressures increased significantly. The maximum peak flow velocity, LAD flow volume, and the ratio of LAD flow volume to LV mass increased significantly. The changes in maximum peak flow velocity and the ratio of LAD flow volume to LV mass (F/M) correlated positively with the changes in diastolic pressure and Qp/Qs. In 5 patients who had Qp/Qs > 1.5, the mean F/M was significantly lower compared with control subjects, but they increased to normal values after coil closure of PDA. PDA coil closure increases diastolic pressure and decreases Qp/Qs, resulting in improvement of myocardial perfusion. These findings provide new insights into the relationship between cardiac function and coronary circulation in pediatric patients with heart diseases associated with PDA.

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

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...

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)

Takotsubo cardiomyopathy: an overlooked cause of chest pain

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Leonardo Hackbart Bermudes

2014-06-01

Full Text Available Takotsubo cardiomyopathy (TTC, also known as apical ballooning syndrome, broken heart syndrome, or stress-induced cardiomyopathy, is defined as a transient disturbance of the left ventricle, which is quite often associated with electrocardiographic abnormalities that may mimic acute myocardial infarction. The syndrome is also characterized by a mild alteration of cardiac biomarkers in absence of coronary blood flow obstruction on the coronariography. Clinical presentation is often manifested by angina, dyspnea, syncope, and arrhythmias. Peculiarly, the left ventricle takes the form of “tako-tsubo” (a Japanese word for “octopus trap” on the imaging workup. The authors report the case of a post-menopausal, hypertensive, dyslipidemic and type-II diabetic woman admitted at the emergency service with acute chest pain post physical exertion. Electrocardiogram showed signs of ischemia and myocardial necrosis markers were mildly increased. Echocardiography and ventriculography showed apical and mid-ventricular akinesia, with mild atherosclerotic coronary lesions. Thus diagnostic workup and the outcome followed the diagnostic criteria for TTC. The authors called attention to the potential of overlooking this diagnosis, since this syndrome is still not widely recognized.

Left-main restenosis in the DES era-a call for action.

Science.gov (United States)

di Palma, Gaetano; Cortese, Bernardo

2017-11-10

Percutaneous treatment of the unprotected left main trunk (ULM), defined as a vessel without patent bypass graft either to the left circumflex (LCX) or left anterior descending (LAD) artery, has gained a precise role thanks to recent scientific evidence. Although new generation drug-eluting stents have already proven to be safer, there is still a consistent risk of restenosis and late adverse events. The optimal management of a ULM restenosis is still debated. Here we aim at presenting a review of the available data in literature and show our choice for treating it. Copyright © 2017 Elsevier Inc. All rights reserved.

Successful management of threatened aortic rupture late after rib fracture caused by blunt chest trauma.

Science.gov (United States)

Morimoto, Yoshihisa; Sugimoto, Takaki; Sakahira, Hideki; Matsuoka, Hidehito; Yoshioka, Yuki; Arase, Hiroki

2014-05-01

A 62-year-old man was crushed in a car accident and diagnosed with a fractured left ninth rib, pulmonary and heart contusion, hemopneumothorax, and descending aortic injury based on a computed tomography scan. He underwent chest tube drainage and was intubated for mechanical ventilation because a bone fragment of the ninth rib threatened to penetrate the descending aorta. On the second posttrauma day, computed tomography showed the bone fragment of the ninth rib approaching the descending aorta. He underwent graft replacement of the injured portion of the descending thoracic aorta, and we removed the fractured left ninth rib. Copyright © 2014 Elsevier Inc. All rights reserved.

A Left Main Coronary Artery Thrombus Presenting as a Non St Elevation MI.

Science.gov (United States)

Ezema, U; Daberkow, D; Delord, T; Guidry, L; Sells, N R

2017-01-01

Left main coronary artery (LMCA); thrombus with an acute myocardial infarction identified with coronary angiography is a clinically rare condition with an extremely high mortality rate. We present a case of LMCA thrombus that presented as a non-ST elevation myocardial infarction (NSTEMI);. A 45-year-old woman with a history of tobacco use and hyperlipidemia presented with a complaint of 10/10 "hard pain" across her chest radiating to her left shoulder and breast which woke her from sleep. The pain was constant and severe, with no alleviation with rest. She had not experienced anything like this before. Workup revealed an upward trending troponin (1.98.989.79);, and an EKG with some tachycardia but no ST elevation or T wave changes. Her CBC, CMP and coagulation studies were unremarkable. A toxicology screen was positive for opiates and benzodiazepines, medications she was on for pain and anxiety respectively. ACS protocol was started with DAPT, LMWH, Statin, ACEi, and Beta-blocker. An angiogram revealed a large thrombus in the LM coronary artery extending into the aorta with concomitant 99 percent stenosis of distal LAD. 2D Echo w/ bubble contrast was significant for PFO, akinetic apical inferior and anterior wall. The mid antero-septum and apical lateral wall were hypokinetic. Interventional Cardiology and CTS recommended conservative management with medical optimization (Continue DAPT, heparin);, watchful waiting for the thrombus to resorb. Left main coronary artery thrombosis (LMCAT); identified during coronary angiography is a rare and challenging condition. It is a life threatening condition with an approximate incidence rate of 0.8 percent . It is thought to be secondary to plaque rupture with subsequent thrombus formation that is associated with persistent hypercoagulable state, cocaine induced plaque rupture or coronary vasospasm, post-partum state and embolization of intra-cardiac masses. The patient presentation can vary from sudden cardiac death to

Traumatic Anterior Cerebral Artery Pseudoaneurysmal Epistaxis.

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Liu, Qing Lin; Xue, Hao; Qi, Chang Jing; Zhao, Peng; Wang, Dong Hai; Li, Gang

2017-04-01

Pseudoaneurysmal epistaxis is a rare but emergent condition. We report a case of traumatic anterior cerebral artery pseudoaneurysmal epistaxis and review the published literature. A 49-year-old man sustained severe head trauma. He was diagnosed with multiple skull bone fractures, left subdural hematoma, subarachnoid hemorrhage, pneumocephalus, and right frontal hematoma. Subdural hematoma evacuation was done at a local hospital. In the following months, he experienced repeated epistaxis that required nasal packing to stop the bleeding. Digital subtraction angiography showed an anterior cerebral artery pseudoaneurysm protruding into the posterior ethmoid sinus. Embolization of the aneurysm was performed with microcoils, and the parent artery was occluded by thrombosis. The patient presented 1 month later with another epistaxis episode. Digital subtraction angiography showed recanalization of the parent artery and recurrence of the aneurysm. The parent artery was occluded for the second time with coils and Onyx embolic agent. Pseudoaneurysmal epistaxis is rare, and this is the first report of an anterior cerebral artery pseudoaneurysm that manifested with epistaxis. Endovascular intervention has become the first choice of treatment for this disease. The high recurrence rate is the main disadvantage of endovascular intervention. Aneurysm trapping with bypass surgery is another treatment option. Copyright © 2016 Elsevier Inc. All rights reserved.

Task-dependent modulation of regions in the left temporal cortex during auditory sentence comprehension.

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Zhang, Linjun; Yue, Qiuhai; Zhang, Yang; Shu, Hua; Li, Ping

2015-01-01

Numerous studies have revealed the essential role of the left lateral temporal cortex in auditory sentence comprehension along with evidence of the functional specialization of the anterior and posterior temporal sub-areas. However, it is unclear whether task demands (e.g., active vs. passive listening) modulate the functional specificity of these sub-areas. In the present functional magnetic resonance imaging (fMRI) study, we addressed this issue by applying both independent component analysis (ICA) and general linear model (GLM) methods. Consistent with previous studies, intelligible sentences elicited greater activity in the left lateral temporal cortex relative to unintelligible sentences. Moreover, responses to intelligibility in the sub-regions were differentially modulated by task demands. While the overall activation patterns of the anterior and posterior superior temporal sulcus and middle temporal gyrus (STS/MTG) were equivalent during both passive and active tasks, a middle portion of the STS/MTG was found to be selectively activated only during the active task under a refined analysis of sub-regional contributions. Our results not only confirm the critical role of the left lateral temporal cortex in auditory sentence comprehension but further demonstrate that task demands modulate functional specialization of the anterior-middle-posterior temporal sub-areas. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

MRI of the Chest

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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 ...

MRI of the Chest

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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 ...

Anatomical variations and morphometric study of the optic strut and the anterior clinoid process

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Eldan Kapur

2012-05-01

Full Text Available The optic strut and the anterior clinoid process represent bony structures that are closely related to anatomically and clinically significant elements such as the cavernous sinus, the internal carotid artery, the optic nerve and the pituitary gland. The objective of our study was to quantify dimensions of the optic strut and anterior clinoid process, and to determine variations in positions and forms of these structures. A descriptive anatomical study was performed on 200 dry human skulls. We analyzed dimensions and variations in position of the optic strut, dimensions of the anterior clinoid process as well as the incidence and forms of the caroticoclinoid foramen. The average thickness of the optic strut on skulls belonging to males was 3 mm and 2.8 mm on those belonging to females. The optic strut was most commonly attached to the anterior two fifths on the lower side of the anterior clinoid process. On the male skulls the average width of the anterior clinoid process was 9.4 mm (right and 9.1 mm (left. Its length was 9.9 and 9.3 mm. On female skulls the average width of the process was 8.7 mm (right and 8.3 mm (left, while the length measured 9.3 mm on the right and 8.9 mm on the opposite side. In our sample, a complete caroticoclinoid foramen appeared in 4.25%, a contact form in 2.75%. At last, an incomplete form of the foramen was observed in 9.75%. The anatomic variations of the investigated structures must be considered during the approaches to the cavernous sinus and neurovascular elements of the sellar region.

Nonnecrotizing anterior scleritis mimicking orbital inflammatory disease

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Lynch MC

2013-08-01

Full Text Available Michelle Chen Lynch,1 Andrew B Mick21Optometry Clinic, Ocala West Veterans Affairs Specialty Clinic, Ocala, FL, USA; 2Eye Clinic, San Francisco VA Medical Center, San Francisco, CA, USABackground: Anterior scleritis is an uncommon form of ocular inflammation, often associated with coexisting autoimmune disease. With early recognition and aggressive systemic therapy, prognosis for resolution is good. The diagnosis of underlying autoimmune disease involves a multidisciplinary approach.Case report: A 42-year-old African American female presented to the Eye Clinic at the San Francisco Veteran Affairs Medical Center, with a tremendously painful left eye, worse on eye movement, with marked injection of conjunctiva. There was mild swelling of the upper eyelid. Visual acuity was unaffected, but there was a mild red cap desaturation. The posterior segment was unremarkable. The initial differential diagnoses included anterior scleritis and orbital inflammatory disease. Oral steroid treatment was initiated with rapid resolution over a few days. Orbital imaging was unremarkable, and extensive laboratory work-up was positive only for antinuclear antibodies. The patient was diagnosed with idiopathic diffuse, nonnecrotizing anterior scleritis and has been followed for over 5 years without recurrence. The rheumatology clinic monitors the patient closely, as suspicion remains for potential arthralgias including human leukocyte antigen-B27-associated arthritis, lupus-associated arthritis, seronegative rheumatoid arthritis, recurrent juvenile idiopathic arthritis, and scleroderma, based on her constitutional symptoms and clinical presentation, along with a positive anti-nuclear antibody lab result.Conclusion: Untreated anterior scleritis can progress to formation of cataracts, glaucoma, uveitis, corneal melting, and posterior segment disease with significant risk of vision loss. Patients with anterior scleritis must be aggressively treated with systemic anti

The impact of chest compression rates on quality of chest compressions : a manikin study

OpenAIRE

Field, Richard A.; Soar, Jasmeet; Davies, Robin P.; Akhtar, Naheed; Perkins, Gavin D.

2012-01-01

Purpose\\ud Chest compressions are often performed at a variable rate during cardiopulmonary resuscitation (CPR). The effect of compression rate on other chest compression quality variables (compression depth, duty-cycle, leaning, performance decay over time) is unknown. This randomised controlled cross-over manikin study examined the effect of different compression rates on the other chest compression quality variables.\\ud Methods\\ud Twenty healthcare professionals performed two minutes of co...

Clinical Utility of Chest Computed Tomography in Patients with Rib Fractures CT Chest and Rib Fractures.

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Chapman, Brandon C; Overbey, Douglas M; Tesfalidet, Feven; Schramm, Kristofer; Stovall, Robert T; French, Andrew; Johnson, Jeffrey L; Burlew, Clay C; Barnett, Carlton; Moore, Ernest E; Pieracci, Fredric M

2016-12-01

Chest CT is more sensitive than a chest X-ray (CXR) in diagnosing rib fractures; however, the clinical significance of these fractures remains unclear. The purpose of this study was to determine the added diagnostic use of chest CT performed after CXR in patients with either known or suspected rib fractures secondary to blunt trauma. Retrospective cohort study of blunt trauma patients with rib fractures at a level I trauma center that had both a CXR and a CT chest. The CT finding of ≥ 3 additional fractures in patients with ≤ 3 rib fractures on CXR was considered clinically meaningful. Student's t-test and chi-square analysis were used for comparison. We identified 499 patients with rib fractures: 93 (18.6%) had CXR only, 7 (1.4%) had chest CT only, and 399 (79.9%) had both CXR and chest CT. Among these 399 patients, a total of 1,969 rib fractures were identified: 1,467 (74.5%) were missed by CXR. The median number of additional fractures identified by CT was 3 (range, 4 - 15). Of 212 (53.1%) patients with a clinically meaningful increase in the number of fractures, 68 patients underwent one or more clinical interventions: 36 SICU admissions, 20 pain catheter placements, 23 epidural placements, and 3 SSRF. Additionally, 70 patients had a chest tube placed for retained hemothorax or occult pneumothorax. Overall, 138 patients (34.5%) had a change in clinical management based upon CT chest. The chest X-ray missed ~75% of rib fractures seen on chest CT. Although patients with a clinical meaningful increase in the number of rib fractures were more likely to be admitted to the intensive care unit, there was no associated improvement in pulmonary outcomes.

Endobronchial Tuberculosis and Chest Radiography

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Mohammad Reza Sasani

2016-03-01

Full Text Available Endobronchial tuberculosis and chest radiography I read, with interest, the article entitled “Clinical and Para-clinical Presentations of Endobronchial Tuberculosis” by Ahmadi Hoseini H. S. et al. (1 published in this journal. I would like to focus on some details about the chest X-ray of patients as elaborated by the authors in the results section. Accordingly, the findings of chest radiography in the available patients were as follows: pulmonary consolidation (75%, reduced pulmonary volume (20%, and hilar adenopathy (10%. This is an incomplete statement because the authors did not explain whether there was any normal chest radiography in the study population. In addition, it is not clear whether the X-ray examinations of the patients were normal, how many abnormal plain films yielded the presented data. On the other hand, the fact that the studied patients had no normal chest radiography is  controversial since in the literature, 10-20% of the patients with endobronchial tuberculosis are reported to have normal chest X-ray (2, 3. In fact, this is one of the problems in the diagnosis of the disease, as well as a potential cause of delayed diagnosis and treatment of the patients. Therefore, the absence of normal chest radiographs is in contrast to the available literature, and if not an error, it could be a subject of further investigation.

Association Between Left Atrial Compression And Atrial Fibrillation: A Case Presentation And A Short Review Of Literature.

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Ahmed, Niloy; Carlos, Morales-Mangual; Moshe, Gunsburg; Yitzhak, Rosen

2016-01-01

This case report describes a patient who developed palpitations and chest pain and was found to be in atrial fibrillation, which was likely due to the presence of an extra-cardiac mass. This was compressing the left atrium. The mass was related to small cell carcinoma, which decreased significantly in size after chemotherapy. Resolution of the atrial fibrillation correlated temporally with reduction in the size of the mass and alleviation of the left atrial compression.

Anterior fracture dislocation of the sacroiliac joint: A case report and literature review.

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Xiao, Jianlin; Wang, Yang; Zhang, Minglei; Jiang, Rui; Zhu, Tongtong; Liu, Guangyao; Zuo, Jianlin

2017-08-09

Publications describing the diagnosis and treatment of anterior dislocation of the sacroiliac joint are scarce. We report the case a 19-year-old female at 8 weeks' gestation who presented with anterior fracture dislocation of the right sacroiliac joint, posterior fracture dislocation of the left sacroiliac joint (crescent fracture), and incomplete abortion resulting from high energy trauma. Orthopedic surgery involved standard anterior sacroiliac joint plating using an ilioinguinal approach combined with a modified Stoppa approach. Three attempts at complete abortion failed. Complete abortion was eventually achieved by dilatation and curettage two weeks after orthopedic surgery. Our findings reveal a need to improve techniques for diagnosis and treatment of anterior fracture dislocation of the sacroiliac joint, so greater attention can be paid to the rapid and effective management of associated comorbidities, and those resulting from the initial trauma.

Managing a chest tube and drainage system.