Effect of contrast medium on early detection and analysis of mediastinal lymph nodes in computed tomography

SUMMARY OBJECTIVE: This study aimed to evaluate the diagnostic efficiency of contrast-to-noise and signal-to-noise ratios created by the contrast medium in detecting lymph nodes. METHODS: In this study, 57 short-axis subcentimeter lymph nodes in 40 cardiac computed tomography patients with noncontrast- and contrast-enhanced phases were evaluated. The contrast-to-noise ratios and signal-to-noise ratios of noncontrast- and contrast-enhanced lymph node-mediastinal fat and aortic-mediastinal fat tissues were determined. In addition, lymph nodes in noncontrast- and contrast-enhanced series were evaluated subjectively. RESULTS: There was a significant difference in lymph node-mediastinal fat signal-to-noise values between the contrast and noncontrast phases (p=0.0002). In the contrast phase, aortic density values were found to be 322.04±18.51 HU, lymph node density values were 76.41±23.41 HU, and mediastinal adipose tissue density values were −65.73±22.96 HU. Aortic-mediastinal fat contrast-to-noise ratio value was 20.23±6.92 and the lymph node-mediastinal fat contrast-to-noise ratio value was 6.43±2.07. A significant and moderate correlation was observed between aortic-mediastinal fat and lymph node-mediastinal fat contrast-to-noise ratio values in the contrast phase (r=0.605; p<0.001). In the contrast-enhanced series, there was a significant increase in the subjective detection of lymph nodes (p=0.0001). CONCLUSION: In the detection of paratracheal lymph nodes, the contrast agent increases the detection of short-axis subcentimeter lymph nodes quantitatively and qualitatively. Contrast enhances and facilitates the detection of paratracheal lymph nodes.

Extrarenal rhabdoid tumor of anterior mediastinal location / Tumor rabdoide extrarrenal de localización mediastinal anterior

Abstract Background: Rhabdoid tumors are malignant neoplasms of low prevalence, aggressive behavior, and high mortality. They were initially described as renal tumors, although tumors with the same histopathological and immunohistochemical characteristics have been discovered in other locations, mainly in the central nervous system. Few cases of mediastinal location have been reported internationally. This work aimed to describe the case of a mediastinal rhabdoid tumor. Case report: We describe the case of an 8-month-old male patient admitted to the pediatric department with dysphonia and laryngeal stridor progressing to severe respiratory distress. Contrast-enhanced computed tomography of the thorax showed a large mass with homogeneous soft tissue density, and smooth and well-defined borders, with suspicion of malignant neoplasm. Due to the oncological emergency compressing the airway, empirical chemotherapy was initiated. Subsequently, the patient underwent incomplete tumor resection due to its invasive nature. The pathology report showed morphology compatible with a rhabdoid tumor, which immunohistochemical and genetic studies corroborated. Chemotherapy and radiotherapy to the mediastinum were administered. However, the patient died three months after the initial treatment due to the aggressive behavior of the tumor. Conclusions: Rhabdoid tumors are aggressive and malignant entities difficult to control and have poor survival. Early diagnosis and aggressive treatment are required, although the 5-year survival does not exceed 40%. It is necessary to analyze and report more similar cases to establish specific treatment guidelines.

Resumen Introducción: Los tumores rabdoides son neoplasias malignas de baja prevalencia, con comportamiento agresivo y alta mortalidad. Inicialmente fueron descritos como renales, aunque posteriormente se han descrito tumores con las mismas características histopatológicas e inmunohistoquímicas en otros sitios, principalmente en el sistema nervioso central. Internacionalmente se han descrito pocos casos de localización mediastinal. El objetivo del presente trabajo fue describir el caso de un tumor rabdoide de localización mediastinal. Caso clínico: Se presenta el caso de un paciente de sexo masculino de 8 meses de edad que ingresó al servicio de pediatría con disfonía y estridor laríngeo que progresó a dificultad respiratoria severa. En la tomografía computarizada contrastada de tórax se observó una gran masa homogénea con densidad de tejidos blandos, de bordes lisos y bien definidos, por lo que se sospechó una neoplasia maligna. Debido a la urgencia oncológica compresiva de la vía aérea se inició con un esquema empírico de quimioterapia. Posteriormente se sometió a resección tumoral incompleta por carácter invasor. El reporte de patología mostró morfología compatible con un tumor rabdoide, el cual se corroboró con estudios de inmunohistoquímica y genética. Se administró un esquema de quimioterapia y radioterapia al mediastino. Sin embargo, el paciente falleció a los 3 meses del inicio de tratamiento debido al comportamiento agresivo del tumor. Conclusiones: Los tumores rabdoides son entidades agresivas y malignas de difícil control y con pobre supervivencia. A pesar de que se requiere un diagnóstico precoz y un tratamiento agresivo, no se ha logrado la supervivencia a 5 años mayor al 40%. Es necesario analizar una mayor cantidad de casos para establecer guías específicas de tratamiento.

Programmed cell death-1 inhibitor combined with immunochemotherapy in treatment of refractory primary mediastinal large B-cell lymphoma: report of 2 cases and review of literature / 白血病·淋巴瘤

Objective:To investigate the efficacy of programmed cell death-1 (PD-1) inhibitor combined with immunochemotherapy in the treatment of refractory primary mediastinal large B-cell lymphoma (PMBCL).Methods:The clinical data of 2 refractory PMBCL patients who were achieving remission after applying PD-1 inhibitor combined with immunochemotherapy in Qilu Hospital of Shandong University (Qingdao) in July 2019 and January 2020 were retrospectively analyzed, and the relevant literature was reviewed.Results:The two patients were initially treated with CDOPE and R-CDOPE regimens, respectively, but the disease did not reach remission state. Later, they were adjusted to PD-1 inhibitor combined with immunochemotherapy to achieve remission. Radiotherapy and autologous hematopoietic stem cell transplantation were used as consolidation treatment, and maintenance therapy with PD-1 inhibitors was effective and had a good safety profile.Conclusions:For refractory PMBCL patients, PD-1 inhibitor combined with immunochemotherapy may have good efficacy.

Síndrome de Hamman (neumomediastino) posparto. Síntesis de la bibliografía y reporte de caso / Postpartum Hamman (pneumomediastinal) syndrome. Synthesis of the literature and case report

Resumen ANTECEDENTES: El síndrome de Hamman se caracteriza por la coexistencia de aire libre en el mediastino sin una causa identificable; también puede ser secundario a traumatismos, infecciones intratorácicas, procedimientos médicos como la esofagoscopia y broncoscopia. Su incidencia se estima entre 1 en 2000 y 1 en 100,000 embarazos. CASO CLÍNICO: Paciente de 18 años, con 65 kg de peso, 1.56 m de talla e IMC 26.74, correspondiente a sobrepeso, primigesta, sin antecedentes patológicos ni heredofamiliares relevantes, con evolución normal del embarazo. A las 39 semanas acudió a urgencias ginecológicas debido a contractilidad uterina y salida de líquido por la vagina. La finalización del embarazo fue por parto, con recién nacido vivo. En el puerperio mediato (30 horas después del parto) súbitamente tuvo disnea, ortopnea y dolor en la región infraclavicular, sensación de "burbujeo" en la parte anterior del tórax. La radiografía simple de tórax mostró aire libre en el mediastino y enfisema subcutáneo. La TAC de tórax evidenció múltiples burbujas de aire, con extensión del espacio perivertebral de predominio derecho. La conclusión diagnóstica fue: enfisema extenso subcutáneo en los espacios del cuello, con alcance al mediastino anterior, con extenso neumomediastino y cardiomegalia global. CONCLUSIONES: El síndrome de Hamman prevalece en primigestas jóvenes y tiene un curso benigno. El tratamiento debe ser conservador, con oxígeno y analgésicos.

Abstract BACKGROUND: Hamman's syndrome is characterized by the coexistence of free air in the mediastinum without an identifiable cause; it may also be secondary to trauma, intrathoracic infections, medical procedures such as oesophagoscopy and bronchoscopy. Its incidence is estimated to be between 1 in 2000 and 1 in 100,000 pregnancies. CLINICAL CASE: 18-year-old female patient, weight 65 kg, height 1.56 m and BMI 26.74, corresponding to overweight, primigravida, with no relevant pathological or heredofamilial history, with normal evolution of pregnancy. At 39 weeks, she attended the gynaecological emergency department due to uterine contractility and leakage of fluid from the vagina. The pregnancy was terminated by delivery, with a live newborn. In the immediate postpartum period (30 hours after delivery) she suddenly experienced dyspnoea, orthopnoea and pain in the infraclavicular region, with a sensation of "bubbling" in the anterior chest. Plain chest X-ray showed free air in the mediastinum and subcutaneous emphysema. Chest CT showed multiple air bubbles, with extension of the perivertebral space predominantly on the right. The diagnostic conclusion was: extensive subcutaneous emphysema in the neck spaces extending into the anterior mediastinum, with extensive pneumomediastinum and global cardiomegaly. CONCLUSIONS: Hamman syndrome is prevalent in young primigravidae and has a benign course. Treatment should be conservative, with oxygen and analgesics.

Predictive value of pre-surgical 18F-FDG PET/CT metabolic parameters for mediastinal lymph node metastasis in patients with lung adenocarcinoma / 中华核医学与分子影像杂志

Objective:To investigate predictive value of model based on pre-surgical 18F-FDG PET/CT metabolic parameters for mediastinal lymph node metastasis (LNM) in lung adenocarcinoma. Methods:A total of 288 patients with lung adenocarcinoma (135 males, 153 females, age (61.6±8.5) years) who diagnosed and treated in the Fourth Hospital of Hebei Medical University from January 2016 to February 2021 were enrolled retrospectively. All patients underwent 18F-FDG PET/CT examination within 1 month before operation, and underwent complete resection of primary lung tumor and standard lymph node dissection. PET/CT parameters were extracted (PET metabolic parameters: minimum SUV(SUV min), SUV max, SUV mean, SUV standard deviation (SUV std), metabolic tumor volume (MTV) and total lesion glycolysis (TLG); CT parameters: minimum CT value (HU min), maximum CT value (HU max), mean CT value (HU mean), CT value standard deviation (HU std)). Multivariate logistic regression analysis was used for screening parameters and establishing model to predict LNM. ROC curves analyses were used to evaluate the predictive performance of models. Results:Among 288 patients, 90 had LNM, and 361 metastatic lymph nodes (N1: 186, N2: 175) were reported by pathology. SUV min (odds ratio ( OR)=1.859, 95% CI: 1.074-3.220, P=0.027), SUV max ( OR=2.255, 95% CI: 1.306-3.893, P=0.004), SUV mean ( OR=0.277, 95% CI: 0.115-0.665, P=0.004) were predictors of LNM. The AUC of PET/CT model was 0.849 (95% CI: 0.804-0.893), and the sensitivity, specificity, accuracy, and positive and negative predictive values were 87.8%(79/90), 72.2%(143/198), 77.1%(222/288), 59.0%(79/134) and 92.9%(143/154), respectively. Conclusion:The model based on 18F-FDG PET/CT metabolic parameters can improve the accuracy of pre-surgical N-staging in patients with lung adenocarcinoma.

Variations in Azygos Venous System in The Eastern Indian Population: A Cadaveric Study

Background: This study aimed to classify Azygos vein patterns in the Eastern Indian population. Methods: During the routine dissection of MBBS in the 2018–2020 academic year, 20 formalin embalmed cadavers aged 50–70 were used to classify the azygos system. The cadaver’s age was verified by its entry into our institute’s anatomy register. The register confirmed that all cadavers used for dissection were of Indian origin. Though gender was not compared in this study, it was noted for record purposes by identifying the external genitalia and confirming it to the records. These were the exclusion criteria: 1) No major thoracic surgeries; 2) No major thoracic deformities. Azygos, hemiazygos, and accessory hemiazygos veins were also examined. Results: The Anson & McVay system was used to classify the recruited cadavers’ azygos system. The cadavers were classified into Type-1, Type-2, and Type-3. Type 2 was again subdivided into 5 subgroups and Type-3 into2 sub-groups. In one cadaver, Type-1 was observed, 17 cadavers had Type-2 azygos system and 2 cadavers showed Type-3. Of the 17 cadavers of Type-2, 3 and 7 cadavers had Type-2A and -2B, respectively. Similarly, 4 and 1 cadavers had 2C and 2D patterns, respectively. Also, 2 cadavers showed 2E type. Of the 2 cadavers of Type-3, one was Type -3A and one Type-3B. The termination of the azygos vein vertebral level was between T2 and T4, of the hemiazygos vein was T8 to T11, and accessory hemiazygos veins were between T7 and T10. Conclusion: These variations should be well studied to avoid misinterpretation during radiological investigations and surgical interventions.

Huge Anterior Mediastinal Teratoma Leading to Orthopnea in a Young Patient

The anterior mediastinal cysts and masses (AMCM) can be of varied origin and presentation. Although the space in the mediastinum is limited the cysts and masses can grow to a large size before the presentation. They displace the adjacent structures and then can grow into the pleural cavities thereby acquiring a large size. We share our experience of a case of a huge anterior mediastinal cystic mass in a young female who had a characteristic presentation of sudden onset breathlessness in the supine position and immediate relief in the sitting position. The patient recovered well after surgical treatment.

Resultados del tratamiento quirúrgico en neoplasias epiteliales de timo / Outcomes of surgical treatment for thymic epithelial neoplasms

Resumen Las neoplasias epiteliales del timo (NET) son tumores infrecuentes. El manejo inicial de las mismas se basa en el análisis de la resecabilidad del tumor en los estudios por imágenes, siendo la resección completa el tratamiento estándar para cualquier estadio. El objetivo principal fue evaluar la supervivencia global y la supervivencia libre de enfermedad de los pacientes con diagnóstico de NET sometidos a tratamiento quirúrgico. El objetivo secundario fue comparar la supervivencia global de acuerdo al tipo de resección quirúrgica, el estadio de Masaoka-Koga y subtipo histológico. Estudio observacional descriptivo realizado en el Hospital Británico de Buenos Aires desde 2004 a 2020. Se incluyeron 42 pacientes operados de tumores en mediastino anterior con diagnóstico histopatológico definitivo de NET. Treinta y nueve eran timomas y 3 carcinomas tímicos. La cirugía realizada en todos los pacientes fue una timectomia total. La mediana de seguimiento fue de 63.5 meses (RIQ 32-97.5). La supervivencia global estimada a los cinco y diez años fue del 87% (95% IC, 0.69-0.95) y 78% (95% IC, 0.5-0.92), respectivamente. La supervivencia libre de enfermedad estimada a cinco y diez años fue del 90% (95% IC, 0.74-0.96). Los pacientes a los que se le realizó una resección completa y que tenían estadios tem pranos de Masaoka-Koga presentaron una supervivencia global superior en comparación con las resecciones incompletas y estadios avanzados (p = 0.0097 y p = 0.0028, respectivamente). Al contar con un bajo número de pacientes en el grupo de carcinomas tímicos, no pudimos sacar conclusiones en cuanto a supervivencia entre éstos y los timomas.

Abstract Thymic epithelial tumors are a group of rare neoplasms of the mediastinum. When resectable, complete resection is considered the gold standard for any stage. The primary endpoint was to evaluate overall survival and disease-free survival of patients with thymus epithelial tumors who underwent surgical treatment. The secondary endpoint was to evaluate and compare the overall survival according to: resection type (complete vs. incomplete), Masaoka-Koga stage and tumor histology according to WHO classification. This is a descriptive observational study from January 2004 to December 2020, in which 42 patients with a postoperative histopathological diagnosis of thymic epithelial tumours were included. Thirty-nine were thymomas (92.9%) and 3 were thymic carcinomas (7.1%). In all patients a total thymectomy was performed. The median follow-up was 63.5 months (IQR 32-97.5). The estimated overall survival at five and ten years was 87% (95% CI, 0.69-0.95) and 78% (95% CI, 0.5-0.92), respectively. Estimated disease-free survival at five and ten years was 90% (95% CI, 0.74-0.96). Patients who underwent complete resection and with early Masaoka-Koga stages had superior overall survival compared to incomplete resections and advanced Masaoka-Koga stages (p = 0.0097 and p = 0.0028, respectively). We found no differences in terms of survival between histological subtypes due to a low number of patients in the thymic carcinoma group.

Clinicopathological spectrum of anterior mediastinal lesions with special reference to the role of cytology in diagnosis: A cross-sectional study

Background: Anterior mediastinal tumors comprise only 3% of all chest tumours. They are often of diagnostic challenge to both clinicians and histopathologists owing to their wide variety of clinical presentations and diversity in histomorphological appearance respectively. Hence, there is a need for elaborated studies to make the pathologists and clinicians aware of their diversity. Aim and Objectives: The present study was aimed to evaluate the diverse spectrum of clinical presentations and histomorphological appearances of anterior mediastinal lesions. In addition, cytological and radiological interpretations were correlated with histological diagnosis to assess their comparative role in diagnosis. Materials and Methods: It was a descriptive observational cross-sectional study. Patients diagnosed with anterior mediastinal mass on chest computed tomography (CT) scan were included in this study. Demographic details including clinical presentations and radiological interpretations were recorded. Patients underwent both CT guided Fine needle aspiration cytology (FNAC) and needle core/excisional biopsy. Histological diagnosis was correlated with radiological and cytological interpretations. Results: Of 659 patients presented with chest tumours, 19 were detected as having anterior mediastinal mass on chest CT scan indicating the prevalence of 2.88%. The most common presenting symptom was respiratory distress (73.68%), followed by chest pain (36.84%), superior vena cava syndrome (26.32%) and Myasthenic features (5.26%). About 50% of malignant tumours occurred at the 2nd decade of life. Thymic epithelial neoplasms comprise the major tumour type in this study (52.63%) followed by germ cell tumors (15.79%) and lymphomas (10.53%). Cytology was found to be more effective compared to radiology in diagnosis. Conclusion: Anterior mediastinal tumors are extremely heterogeneous in clinical presentation and histomorphological appearance. CT-guided FNAC can play an important role in their diagnosis along with radiology and histology.

Computed Tomography (CT)guided Fine Needle Aspiration Cytology of Intrathoracic Lesions

Background: Diagnosis of intrathoracic masses is a difficult challenge for clinicians. The compact anatomical arrangement of the medias?num with diverse pathologies is usually encountered. The present study was done to determine the efficiency of computed tomography (CT) guided Fine-Needle Aspira?on Cytology (FNAC) in the evalua?on of various thoracic mass lesions Methods : A total of n=46 pa?ents presen?ng as intrathoracic mass lesions, confirmed on contrast-enhanced CT, were included in the study. A commercially available CT (Ingenuity 128 slices, Philips) was used for biopsy. All pa?ents were subjected to detailed clinical history and physical examina?on. Inves?ga?ons: Complete blood count, Erythrocyte sedimenta?on rate, bleeding ?me, clo?ng ?me, Prothrombin ?me, Ac?vated par?al thromboplas?n ?me, HIV and HbsAg, Chest X-ray postero Anterior view, and Lateral view done in all cases. Chest X-ray AP view and Ultrasound was done wherever needed. Plain and contrast CT was done in all cases before FNAC. Results: The posi?ve diagnos?c yield in our study is noted in 45 of the 46 pa?ents(97.82%); the posi?ve yield for malignancy was 89.13% (41 of 46 pa?ents), benign in8.69 % (4/46), and undiagnosed in 1/46 (2.17%). Out of 46, 40(86.96%) were parenchymal lesions and 6(13.04%) were medias?nal lesions. Out of 40 parenchymal lesions, 38/40(95%) were malignant, which consisted of 55.3% Squamous cell carcinoma, 28.9% Adenocarcinoma. Conclusion: FNAC is useful for obtaining samples for the diagnosis of focal pulmonary infec?ons, even in immunocompromised pa?ents, and planning appropriate chemotherapy op?ons in lung cancer and metasta?c lesions.CT-guided FNAC is an ini?al approach for the diagnosis of small pulmonary nodules of less than 20mm, aiding in early diagnosis and treatment interven?ons improving prognosis.

Diagnostic value of chest enhanced CT for mediastinal lymph node metastasis of esophageal cancer and influencing factors for its accuracy / 中华消化外科杂志

Objective:To investigate the diagnostic value of chest enhanced computed tomography (CT) for mediastinal lymph node metastasis of esophageal cancer and the influencing factors for its accuracy.Methods:The retrospective case-control study was conducted. The clinico- pathological data of 463 patients with esophageal cancer who underwent surgical treatment in the First Affiliated Hospital of Army Medical University from July 2016 to June 2021 were collected. There were 385 males and 78 females, aged (61±8)years. Observation indicators: (1) results of pre-operative chest enhanced CT and postoperative pathological examination; (2) diagnostic value of chest enhanced CT for mediastinal lymph node metastasis of esophageal cancer; (3) influencing factors analysis of the diagnostic accuracy of chest enhanced CT for mediastinal lymph node metastasis of esophageal cancer. Measurement data with normal distribution were represented as Mean± SD, and count data were represented as absolute numbers and (or) percentages. Sensitivity, specificity, positive predictive value, negative predictive value and Youden index were used for authenticity evaluation of diagnostic value of chest enhanced CT for mediastinal lymph node metastasis of esophageal cancer, and accuracy and Kappa value were used for reliability evaluation. The higher the value of above indicators, the higher the authenticity and (or) reliability. The univariate analysis was conducted using the chi-square test, and multivariate analysis was conducted using the binary Logistic regression model after including indicators with P<0.20 of univariate analysis. Results:(1) Results of preoperative chest enhanced CT and postoperative pathological examination. Of the 463 patients with esophageal cancer, mediastinal lymph node metastasis were diagnosed in 90 cases (including 35 cases of true positive and 55 cases of false positive) and no mediastinal lymph node metastasis were diagnosed in 373 cases (including 300 cases of true negative and 73 cases of false negative) by preoperative chest enhanced CT. Mediastinal lymph node metastasis were diagnosed in 108 cases and no mediastinal lymph node metastasis were diagnosed in 355 cases by postoperative patholo-gical examination. (2) Diagnostic value of chest enhanced CT for mediastinal lymph node metastasis of esophageal cancer. Authenticity evaluation of diagnostic value of chest enhanced CT for medias-tinal lymph node metastasis of esophageal cancer showed that sensitivity, specificity, positive predic-tive value, negative predictive value and Youden indexes were 32.41%(35/108), 84.51%(300/355), 38.89%(35/90), 80.43%(300/373), 0.169, respectively. Reliability evaluation showed that accuracy and Kappa value were 72.35%(335/463) and 0.180 ( P<0.05), respectively. (3) Influencing factors analysis of the diagnostic accuracy of chest enhanced CT for mediastinal lymph node metastasis of esophageal cancer. Results of univariate analysis showed that the tumor diameter and the depth of tumor invasion were related factors affecting the diagnostic accuracy of chest enhanced CT for mediastinal lymph node metastasis of esophageal cancer ( χ2=7.65, 6.07, P<0.05). Results of multi-variate analysis showed that the tumor diameter ≥2.1 cm was an independent risk factor affecting the diagnostic accuracy of chest enhanced CT for mediastinal lymph node metastasis of esophageal cancer ( odds ratio=2.05, 95% confidence interval as 1.23?3.43, P<0.05). Conclusions:The clinical value of chest enhanced CT for diagnosing mediastinal lymph node metastasis of esophageal cancer is limited, and the consistency with pathological results is quite different. The tumor diameter ≥2.1 cm is an independent risk factor affecting the diagnostic accuracy of chest enhanced CT for mediastinal lymph node metastasis of esophageal cancer

Mediastinitis Necrotizante Descendente de Origen Dental

Resumen El tratamiento inoportuno de las infecciones odontogénicas se acompaña de una complicación mortal, la mediastinitis necrotizante descendente aguda (MNDA), definida como una inflamación de los tejidos conectivos y las estructuras dentro del mediastino. La mortalidad es de aproximadamente del 11% al 41%, por sepsis e insuficiencia orgánica. Las decisiones médicas son decisivas porque el diagnóstico y el retraso del tratamiento son los cofactores primordiales relacionados con la mortalidad. El tratamiento quirúrgico precoz es el aspecto más importante en su manejo, necesitando en muchos casos, tratamiento en la unidad de cuidados intensivos (UTI). Se expone el caso clínico de un paciente masculino de 39 años, diabético, que ingresó a urgencias por un absceso odontógeno de 4 días de evolución. Tras los exámenes complementarios se constata un proceso inflamatorio que se extendía desde el piso de la boca hasta el mediastino, compatible con un MNDA; requirió varias intervenciones quirúrgicas y manejo en UTI más de 30 días con evolución favorable y posterior alta.

Abstract The untimely treatment of odontogenic infections is accompanied by a life-threatening complication, acute descending necrotizing mediastinitis (ADNDM), defined as an inflammation of the connective tissues and structures within the mediastinum. The mortality is approximately 11% to 41%, caused by sepsis and organ failure. Medical decisions are critical because diagnosis and treatment delay are the primary cofactors associated with mortality. Early surgical treatment is the most important aspect in the management, requiring, in most cases, treatment in the intensive care unit (ICU). We present the clinical case of a 39-year-old male patient, diabetic, who was admitted to the emergency room for a dental abscess with 4 days of evolution. After the complementary examinations, an inflammatory process was confirmed that extended from the floor of the mouth to the mediastinum, compatible with an MNDA; the patient required several surgical interventions and management in ICU for more than 30 days with favorable evolution and subsequent discharge.

Neumomediastino en trauma contuso: ¿son siempre necesarios los estudios invasivos para descartar lesión aerodigestiva? / Pneumomediastinum in blunt trauma: Are invasive studies always necessary to rule out aerodigestive injury?

Introducción. La presencia de neumomediastino secundario a un trauma contuso es un hallazgo común, especialmente con el uso rutinario de la tomografía computarizada. Aunque en la mayoría de los casos es secundario a una causa benigna, la posibilidad de una lesión aerodigestiva subyacente ha llevado a que se recomiende el uso rutinario de estudios endoscópicos para descartarla. El propósito de este estudio fue determinar la incidencia de neumomediastino secundario a trauma contuso y de lesiones aerodigestivas asociadas y establecer la utilidad de la tomografía computarizada multidetector en el diagnóstico de las lesiones aerodigestivas. Métodos. Mediante tomografía computarizada multidetector se identificaron los pacientes con diagnóstico de neumomediastino secundario a un trauma contuso en un periodo de 4 años en un Centro de Trauma Nivel I. Resultados. Fueron incluidos en el estudio 41 pacientes con diagnóstico de neumomediastino secundario a un trauma contuso. Se documentaron en total tres lesiones aerodigestivas, dos lesiones traqueales y una esofágica. Dos de estas fueron sospechadas en tomografía computarizada multidetector y confirmadas mediante fibrobroncoscopia y endoscopia digestiva superior, respectivamente, y otra fue diagnosticada en cirugía. Conclusión. El uso rutinario de estudios endoscópicos en los pacientes con neumomediastino secundario a trauma contuso no está indicado cuando los hallazgos clínicos y tomográficos son poco sugestivos de lesión aerodigestiva.

Introduction.The presence of pneumomediastinum secondary to blunt trauma is a common finding, especially with the use of computed tomography. Although in most cases the presence of pneumomediastinum is secondary to a benign etiology, the possibility of an underlying aerodigestive injuries has led to the recommendation of the routine use of endoscopic studies to rule them out. The purpose of this study was to determine the incidence of pneumomediastinum secondary to blunt trauma and associated injuries and to establish the role of multidetector computed tomography in the diagnosis of aerodigestive injuries. Methods.Using multidetector computed tomography, patients with a diagnosis of pneumomediastinum secondary to blunt trauma were identified over a period of 4 years in a Level 1 Trauma Center. Results. Forty-one patients diagnosed with pneumomediastinum secondary to blunt trauma, were included in this study. Two airway ruptures were documented: two tracheal injuries and one esophageal injury. Two of them suspected on multidetector computed tomography and confirmed on bronchoscopy and esophagogastroduodenoscopy, respectively, and another was diagnosed in surgery. Conclusion.The routine use of endoscopic studies in patients with pneumomediastinum secondary to blunt trauma is not indicated when the clinical and tomographic findings are not suggestive of aerodigestive injury.

Three cases of mediastinal germ cell tumors and concurrent hematologic malignancy and literature review / 中华实用儿科临床杂志

To analyze the clinical characteristics, treatment and prognosis of mediastinal germ cell tumors (GCTs) with concurrent hematologic malignancy (HM). The clinical features, treatment and prognosis of 3 cases of HM associated with mediastinal GCTs treated in the Department of Medical Oncology, Beijing Children′s Hospital from November 2014 to September 2018 were retrospectively analyzed.Meanwhile, relevant cases were searched in the PubMed and Wanfang database from their establishment to December 2019.Three male cases of HM associated with mediastinal GCTs aged from 12 to 16 years.The pathogenesis of mediastinal masses suggested teratoma or yolk sac tumor.All of them were treated with surgery and chemotherapy.Acute myeloid leukemia (AML) or myelodysplastic syndromes (MDS) was diagnosed respectively at 5 months, 9 months and 31 months after initial GCTs in the 3 cases.Two patients died and 1 child survived at the last follow-up.A total of 135 cases of concurrent GCTs and HM (or leukemia) were reviewed in online databases, involving 127 cases (94.1%) with the mediastinal GCTs associated with HM and 8 cases(5.9%) with GCTs related HM from another original sites.One hundred and twenty-six cases (99.2%) were male and the median age of GCTs diagnosis was 22 (10-48) years.Fifty-three cases (41.7%) were teratoma and 94 cases (74.0%) were GCTs containing teratoma with or without yolk sac tumor.Among the types of HM, 72 cases (56.7%) were AML and 31 cases (24.4%) were AML-M7.The median interval between GCTs and HM was 3 (0-122) months.Forty-six cases (36.2%) presented 2 malignancies simultaneously.HM were diagnosed within 12 months of GCTs in 85 cases (66.9%). The survival data were known in 107 cases, involving 94 (87.9%) deaths and 13 (12.1%) survivors.The median survival time after diagnosis of HM was 2 (0-48) months.The tendency of HM must be highly concerned in adolescent male patients with primary mediastinal GCTs, especially those with yolk sac tumor or teratoma.Their prognoses are very poor.Allogeneic hematopoietic stem cell transplantation is an alternative treatment.

Anterior mediastinal inflammatory myofibroblastic tumor with thymoma: A case report / 中国胸心血管外科临床杂志

@#Anterior mediastinal inflammatory myofibroblastoma is a rare tumor with insidious onset and easy misdiagnosis. In this report, we presented a case of anterior mediastinal inflammatory myofibroblastoma with thymoma. The mediastinal tumor was found by physical examination, and the prognosis was good after surgical treatment. For this disease, operation is an effective method for definite diagnosis and treatment, and complete excision can achieve good outcomes.

La historia (des)conocida de las incisiones torácicas. Tercera parte: Las toracotomías del siglo XX

RESUMEN La mayoría de las toracotomías que con más frecuencia son utilizadas en la práctica quirúrgica actual fueron creadas en los quirófanos del siglo XX. En la búsqueda de diferentes opciones terapéuticas para lidiar con afecciones cancerígenas e infecciosas, de órganos torácicos y mediastinales, los padres de la cirugía torácica moderna crearon abordajes que han vencido la prueba del tiempo y se continúan practicando, a pesar del enorme desarrollo de la cirugía torácica de accesos mínimos o video-asistida. Sin embargo, muchos cirujanos desconocen los acontecimientos que rodearon el nacimiento de las principales toracotomías clásicas y, por otra parte, en no pocas ocasiones la historia ha reconocido como padres de algunas técnicas a quienes realmente no merecen ese crédito. En esta tercera parte de nuestra revisión se continúa exponiendo la historia, no del todo conocida, de las incisiones torácicas.

ABSTRACT Most of thoracotomies that are most frequently used in today's surgical practice were created in the operating rooms of the 20th century. In the search for different therapeutic options to treat cancerous and infectious conditions of the thoracic and mediastinal organs, the fathers of modern thoracic surgery created approaches that have stood the test of time and continue to be practiced, despite the enormous development of minimal access or video-assisted thoracic surgery. However, many surgeons are unaware of the events surrounding the birth of the main classical thoracotomies and, on the other hand, on more than a few occasions history has recognized as the fathers of some techniques those who do not really deserve that credit. In this third part of our review we continue to unravel the history of thoracic incisions, not all of which is well known.

La historia (des)conocida de las incisiones torácicas. Segunda parte: De las primeras pericardiotomías al nacimiento de la esternotomía longitudinal media

RESUMEN Durante el siglo XIX se constataron más avances en la cirugía torácica que los experimentados en las más de 40 centurias transcurridas desde la escritura del papiro de Edwin Smith. En un período de poco menos de cien años el hombre abordó la cavidad pericárdica no solo para evacuar derrames, sino para suturar satisfactoriamente heridas en el músculo cardíaco. Además, se realizaron las primeras toracotomías con la específica intención de resecar segmentos pulmonares y se abrió por primera vez el esternón en toda su longitud, un abordaje que con el paso del tiempo se convertiría en la más usada de todas las incisiones torácicas. La mayoría de los cirujanos torácicos conoce poco acerca del verdadero origen de muchos de estos procedimientos quirúrgicos que se emplean en los salones de operaciones del siglo XXI. Esta segunda parte de nuestra revisión tiene la intención de seguir develando la desconocida historia de las incisiones torácicas.

ABSTRACT The 19th century saw more advances in thoracic surgery than in the more than 40 centuries since the writing of the Edwin Smith papyrus. In a period of less than a century, man approached the pericardial cavity not only to drain effusions, but to successfully suture wounds in the cardiac muscle. Moreover, the first thoracotomies were performed for the specific purpose of resecting lung segments and the sternum was completely opened for the first time, an incision that would eventually become the most widely used of all thoracotomies. Most thoracic surgeons know little about the true story behind many thoracotomies performed in the operating rooms of the 21st century. This second part of our review further unveils the unknown history of thoracic incisions.

Burkholderia pseudomallei infection manifests as mediastinal/hilar lymphadenopathy: A case report

Rationale: This case report presents the diagnosis and etiology of hilar/mediastinal lymphadenopathy in a male patient. Patient concerns: A 49-year-old man presented with fever and dyspnea after physical exertion. Diagnosis: The patient was diagnosed with melioidosis by cultivation of lymph node aspirate on blood agar using the VITEK 2 compact system. Interventions: The patient was treated with ceftazidime intravenously, combined with trimethoprim/sulfamethoxazole orally for 1 week. Once the patient was discharged, he began a 12-week course of trimethoprim/sulfamethoxazole. Outcomes: The patient recovered after treatment with ceftazidime and trimethoprim/sulfamethoxazole. Conclusions: Melioidosis is an infectious disease that mainly occurs in tropical regions. It can cause severe sepsis and pneumonia, and the infection in some patients may become chronic. Endobronchial ultrasound-transbronchial needle aspiration is a useful technique in the diagnosis of patients with hilar/mediastinal lymphadenopathy.

Application of PD-L1, PD-L2, CD30, CD23 and BCL-6 in Diagnosis and Prognostic Evaluation of Primary Mediastinal Large B-cell Lymphoma / 肿瘤防治研究

Objective To explore the application value of treatment-related markers PD-L1, PD-L2, CD30, CD23, BCL-2, BCL-6, MUM1 and GATA3 in the diagnosis and prognostic evaluation of primary mediastinal B-cell lymphoma(PMBL). Methods A retrospective study was conducted on 34 patients diagnosed with PMBL, and 31 patients with DLBCL-NOS which was not primary in the mediastinum were taken as control group. The expressions of 8 proteins were detected by IHC staining. Results The median percentages of tumor cells with PD-L1, PD-L2 and CD30 expression in PMBL group were 70% (30%, 90%), 25% (0, 70%) and 17.5% (0, 60%) respectively, which were significantly higher than those in the DLBCL-NOS group (P < 0.05). The positive rates of CD30 and CD23 in PMBL group were 61.76% (21/34) and 76.47% (26/34) respectively, significantly different with those in the DLBCL-NOS group (P=0.000). The survival curve of PMBL patients with CD30 or BCL-6 expression showed a trend of poor prognosis, despite the P value was > 0.05. Conclusion The high expression levels of PD-L1, PD-L2 and CD30 in PMBL are helpful to accurately identify more patients who may respond to immune or targeted therapy. Immunohistochemical staining of PD-L1, PD-L2, CD30 and CD23 is helpful for the differential diagnosis of PMBL and DLBCL-NOS. As candidate prognostic indicators of PMBL, CD30 and BCL-6 should be further studied in a larger number of samples.

Tumores de mediastino anterior: nuestra experiencia en el Hospital Base de Linares / Anterior Mediastinal Tumours: our experience in the Hospital Base of Linares

INTRODUCCIÓN: Los tumores de mediastino constituyen una entidad clínica poco frecuente, generalmente asintomática. Se pueden desarrollar desde estructuras que se ubican en el compartimento anterior, medio y posterior, siendo la primera, la ubicación más usual. En los adultos, timomas y linfomas (Hodgkin y no Hodgkin) son las masas más comunes del mediastino anterior, junto al bocio endotorácico y los teratomas; todas en su conjunto son conocidas como las "4 T del Mediastino Anterior". Casos clínicos: Se exponen tres casos clínicos de tumores de mediastino anterior, intervenidos en nuestro centro. Discusión: Las masas mediastínicas constituyen una entidad clínica infrecuente. La tomografía computada de tórax con y sin contraste intravenoso es utilizada para evaluar estas anormalidades descubiertas radiográficamente. El diagnóstico definitivo generalmente requiere una muestra de tejido que se obtiene mediante biopsia antes del tratamiento o como parte de una resección terapéutica planificada de toda la masa. En Chile, existen pocos trabajos recientes que muestren las características clínicas de pacientes que presentan timomas o linfomas; es por esto que se hace importante la presentación de estos casos que constituyen un aporte al conocimiento nacional.

INTRODUCTION: Mediastinal tumours constitute a clinical entity infrequent, generally asymptomatic. It can develop from structures localized on anterior compartment, middle and posterior, where structure localized on anterior compartment is usual. Adults tend to have thymomas and lymphomas more common in anterior mediastinal within intrathoracic goiter and teratomas. They are known as a "4T of anterior mediastinal mass". Clinical cases: Three clinical cases of anterior mediastinal tumours are exposed in our centre. Discussion: Mediastinal mass constitutes a clinical entity infrequent. The computed Tomography of the thorax with intravenous contrast and without intravenous contrast are used to evaluate abnormalities discover by radiography. The final diagnosis requires a fabric sample which is obtained by a biopsy before the treatment or as a part of a planned therapeutic recession. In Chile exist a few recently studies that shows clinical characteristics of patients which presents thymus and lymphomas as a result is important to present this kind of cases due to these cases constitute to the national knowledge.