ABSTRACT
Objective To summarize and classify the CT manifestations of chest wall tuberculosis and to investigate the relationship between CT classification and clinical operation method.Methods CT data of 142cases was collected from patients that were confirmed by surgical pathology of chest wall tuberculosis.Bone algorithm reconstruction and volume rendring three-dimensional reconstruction were applied to observe ribs.Results Four types were classified according to the CT manifestations.Type Ⅰ:27 cases pleural tuberculoma,and all of which were conducted simple removal of lesions.Type Ⅱ:18 cases sternum or ribs tuberculosis,which were conducted surgical removal of the invaded frame and the surrounding lesions in caseous necrosis and all the tuberculous granuloma.Type Ⅲ:21 cases rib outboard tuberculosis,of which 12 cases were conducted simple removal of lesions and 9 cases removal of lesions and small segment of ribs.Type Ⅳ:76 cases hybrid,of which abscess excision plus rib resection in 65 cases and resection with chest wall abscess (muscle) between ribs and rib resection with padded muscle flap surgery in 11 cases.Conclusions CT can clearly show the location,size,scope of involvement of the chest wall tuberculosis,and selecting the preoperative surgical strategy based on CT classification can provide guidance for operation.
ABSTRACT
One hundred and twenty four patients with hypertensive putaminal hemorrhage were analyzed by time course. All patients were brought to the emergency room within 3 hours after the ictus. Seventy three patients were conservatively treated and 51 patients operatively. The neurologic condition of each patient was evaluated by means of the Glasgow coma scale(GCS) score every 1 hour. CT scan of the brain of these patients were taken within 6 hours after the ictus. Clinical severity of the putaminal hemorrhage was graded as rapid deterioration, slow deterioration, and non deterioration by the CT and neurological status. A precise time course analysis of putaminal hemorrhage were compared with the conservative group and surgical group in a 7 hospital day period. Outcome was assessed 6 months later based on the degree of functional recovery(DOFR). The overall mortality was 16.1% and surgical mortality was 13.7%. Surgical treatment for the rapidly deteriorating patients appears to be beneficial when compared with the slowly deteriorating patients. Outcome of the non deteriorating patients didn't show any differences in the quality of life regardless of treatment modality.