Local imaging to interpret tumor size in F18 fluorodeoxyglucose positron emission tomography/CT in lung cancers

SUMMARY OBJECTIVE: This study aimed to determine the thoracic and extra-thoracic extension of the disease in patients diagnosed with lung cancer and who had whole-body F18-fluorodeoxyglucose positron emission tomography/CT imaging and to investigate whether there is a relationship between tumor size and extrathoracic spread. METHODS: A total of 308 patients diagnosed with lung cancer were included in this study. These 308 patients were first classified as group 1 (SPN 30 mm>longest lesion diameter ≥10 mm) and group 2 (lung mass (longest lesion diameter ≥30 mm), and then the same patients were classified as group 3 (nodular diameter of ≤20 mm) and group 4 (nodular size of >20 mm). Group 1 was compared with group 2 in terms of extrathoracic metastases. Similarly, group 3 was compared with group 4 in terms of frequency of extrathoracic metastases. F18 fluorodeoxyglucose positron emission tomography/CT examination was used to detect liver, adrenal, bone, and supraclavicular lymph node metastasis, besides extrathoracic metastasis. RESULTS: Liver, bone, and extrathoracic metastasis in group 1 was statistically lower than in group 2 (p<0.001, p<0.01, and p=0.03, respectively). Liver, extrathoracic, adrenal, and bone metastasis in group 3 was statistically lower than that in group 4 (p<0.001, p=0.01, and p=0.04, p<0.01, respectively). The extrathoracic extension was observed in only one patient in group 3. In addition, liver, adrenal, and bone metastases were not observed in group 3 patients. CONCLUSION: Positron emission tomography/CT may be more appropriate for cases with a nodule diameter of ≤20 mm. Performing local imaging in patients with a nodule diameter of ≤20 mm could reduce radiation exposure and save radiopharmaceuticals used in positron emission tomography/CT imaging.

Evaluación de la efectividad de la timectomía como tratamiento de la Miastenia Gravis

Objetivo: evaluar efectividad de timectomía como alternativa de tratamiento a la Miastenia Gravis (MG) en nuestro centro, entre 2007 y 2019, y cómo ha impactado en calidad de vida y manejo farmacológico. Material y Método: cohorte retrospectiva de pacientes sometidas a timectomía por equipo Cirugía Torácica del Hospital Gustavo Fricke (HGF) entre 2007 y 2019. Las variables fueron el tratamiento médico y dosis de anticolinesterásicos pre y post timectomía, y la calidad de vida medida a través de la encuesta MG-QOL15. Se utilizaron medidas de desviación estándar y comparaciones estadísticas para el análisis de estas variables, considerando estadísticamente significativo un p < 0,05. Resultados: total de 20 pacientes, mayoría mujeres jóvenes, timectomía vía transesternal. Dosis de anticolinesterásicos mostró disminución estadísticamente significativa de 5,05 a 3,06 pre y post timectomía respectivamente (p < 0,05). Encuesta MG-QOL15 media de 11,9 puntos. Discusión: Se ha demostrado que la timectomía cumple un rol importante en el manejo de la MG, otorgando una superioridad frente al tratamiento médico exclusivo. La Fundación Americana para Miastenia Gravis, recomienda el uso de la encuesta MG-QOL15 como herramienta para evaluar la calidad de vida. Existe poca literatura nacional en relación a este tema. Conclusión: La timectomía, es un procedimiento que mejora la calidad de vida de los pacientes con MG y permite reducir en forma significativa la dosis de fármacos utilizados.

Objective: To evaluate effectivity of thymectomy as an alternative treatment of MG in our center, between 2007 and 2019 and to know how it has impacted in life quality and pharmacological management. Material and Method: cohort study patients treated with thymectomy by Thoracic Surgical team from Gustavo Fricke Hospital between 2007 and 2019. The study variables were medical treatment and anticholinesterases doses before and after the thymectomy, and life quality measured through MG-QOL15 survey. Standard deviation measures and statistics comparisons were used for the analysis of these variables, considering statistically significant a p < 0.05. Results: total of 20 patients, mainly young women, thymectomy through a Trans-sternal approach. Anticholinesterase doses, showed a statistically significant decrease from 5.05 to 3.06 before and after thymectomy (p < 0.05). Discussion: It has been demonstrated that thymectomy plays an important role on the management of MG, giving a mastery against medical exclusive treatment, The American Foundation for Myasthenia Gravis recommends the use of MG-QOL15 survey as an important tool to evaluate life quality. There is a limited amount of national literature related to this topic. Conclusion: Thymectomy is a life quality changing procedure for MG patients and it helps to significantly reduce the drug doses used.

Mielolipoma primario mediastinal / Primary mediastinal myelolipoma

Resumen El mielolipoma es un tumor benigno no funcional, la mayoría de ellos son asintomáticos y descubiertos de forma incidental a través de estudios de imagen o en es tudios de autopsia. Aun cuando la mayoría de los casos se presenta en la glándula suprarrenal, también se han informado en sitios extra-adrenales. Presentamos el caso de una mujer de 65 años de edad con un mielolipoma primario mediastinal. La tomografía computarizada de tórax mostró un tumor ovoide de bordes bien definidos de 6.5 × 4.2 cm, localizado en el mediastino posterior. Se realizó biopsia transtorácica de la lesión y el estudio microscópico reveló elementos hematopoyéticos y tejido adiposo maduro. Aun cuando los estudios de imagen como la tomografía computarizada y la resonancia mag nética son efectivos en el diagnóstico del mielolipoma primario mediastinal, la evaluación histopatológica es esencial para el diagnóstico definitivo.

Abstract Myelolipoma is a benign non-functional tumor. Most of them are asymptomatic and discovered incidentally, either through imaging studies or at autopsy. While it most commonly occurs in the adrenal gland, it has also been reported at extra-adrenal sites. We present the case of a 65-year-old woman with a primary mediastinal myelolipoma. Computer tomographic scan of the thorax showed an ovoid tumor with well-defined borders of 6.5 × 4.2 cm, located in the posterior mediastinum. A transthoracic biopsy of the lesion was made, and the microscopic observation revealed hematopoietic cells and mature adipose tissue. Although computed tomo graphy and magnetic resonance imaging are effective in diagnosing mediastinal myelolipoma, histopathological examination is essential for the definitive diagnosis.

Acute Type A Aortic Dissection and Late Pregnancy: What Should We Do?

ABSTRACT Introduction: Acute type A aortic dissection (AAAD) in late pregnancy is a rare but severe disease. Lack of clinical experience is the main cause of high mortality. This study tries to investigate the multidisciplinary therapeutic strategy for these patients. Case presentation: We reported three patients with AAAD in late pregnancy. Sudden chest pain was the main clinical symptom before operation. All three patients and their newborns survived through multidisciplinary approach in diagnosis and treatment. No serious complications occurred during the mid-term follow-up. Conclusion: Multidisciplinary diagnosis and treatment strategy play a crucial role in saving the lives of pregnant women with AAAD.

Endometriosis pleuropulmonar y neumotórax catamenial asociado: reporte de caso / Pleuropulmonary endometriosis and associated catamenial pneumothorax:A case report

Resumen ANTECEDENTES: El tórax es la localización extrapélvica más frecuente de la endometriosis; esto sin que su incidencia se haya determinado con estudios suficientes. Tampoco se ha establecido del todo su fisiopatología, pero aun así se han planteado diversas teorías. El neumotórax catamenial es una de las posibles manifestaciones que hacen complejo establecer el diagnóstico e indicar un tratamiento. CASO CLÍNICO: Paciente de 31 años, con antecedente de neumotórax espontáneo a repetición, que acudió a consulta debido a disnea y dolor torácico de un mes de evolución. La radiografía de tórax evidenció el neumotórax del 50% en la parte derecha y la necesidad de la toracostomía. Puesto que los episodios de neumotórax ocurrían en fase catamenial, pero sin poder establecer una causa clara del cuadro clínico, se procedió a la toracoscopia diagnóstica con toma de muestra para estudio histopatológico. Durante el procedimiento se detectaron múltiples lesiones pseudonodulares, de aspecto inflamatorio crónico a nivel pleural y del parénquima pulmonar. El reporte histopatológico fue compatible con endometriosis pleuropulmonar; se le indicó terapia hormonal. Ante la evolución clínica satisfactoria y posoperatorio sin complicaciones la paciente fue dada de alta del hospital. CONCLUSIÓN: El neumotórax catamenial, como consecuencia de una endometriosis pleuropulmonar, es un diagnóstico realmente excepcional y su sospecha debe vincularse con el ciclo menstrual. La atención médica de las pacientes con este diagnóstico debe ser interdisciplinaria, no solo por las estrategias diagnósticas sino por la complejidad del tratamiento y su seguimiento. El tratamiento de elección suele requerir intervenciones quirúrgicas, sumadas a la indicación de la medicación hormonal para prevenir recurrencias, con tasas de éxito favorables. Están pendientes los estudios que establezcan la respuesta del tejido endometrial ectópico torácico al tratamiento médico.

Abstract BACKGROUND: The thorax is the most frequent extrapelvic location of endometriosis, although its incidence has not been sufficiently studied. Its pathophysiology has not been fully established, but several theories have been put forward. Catamenial pneumothorax is one of the possible manifestations that make it difficult to establish the diagnosis and indicate treatment. CLINICAL CASE: A 31-year-old female patient, with a history of repeated spontaneous pneumothorax, presented for consultation due to dyspnea and chest pain of one month of evolution. Chest X-ray showed a 50% pneumothorax on the right side and the need for thoracostomy. Since the episodes of pneumothorax occurred in catamenial phase, but without being able to establish a clear cause of the clinical picture, diagnostic thoracoscopy with sampling for histopathological study was performed. During the procedure multiple pseudonodular lesions of chronic inflammatory aspect were detected at pleural and lung parenchyma level. The histopathological report was compatible with pleuropulmonary endometriosis; hormonal therapy was indicated. Given the satisfactory clinical evolution and postoperative course without complications, the patient was discharged from the hospital. CONCLUSION: Catamenial pneumothorax, as a consequence of pleuropulmonary endometriosis, is a truly exceptional diagnosis and its suspicion should be linked to the menstrual cycle. The medical care of patients with this diagnosis should be interdisciplinary, not only because of the diagnostic strategies but also because of the complexity of the treatment and its follow-up. The treatment of choice usually requires surgical interventions, added to the indication of hormonal medication to prevent recurrences, with favorable success rates. Studies establishing the response of thoracic ectopic endometrial tissue to medical treatment are pending.

Feasibility study of spectral CT chest enhancement venous phase virtual angiography as an alternative to three phase scanning / 中华放射学杂志

Objective:To investigate the feasibility of using spectral CT chest enhancement venous phase images to obtain virtual non-contrast (VNC) images and virtual arterial phase images to achieve one phase scan instead of three phase scans.Methods:Imaging data of 100 patients who underwent spectral CT chest plain and dual-phase enhancement scans at the First Affiliated Hospital of Kunming Medical University from January to May 2022 were analyzed retrospectively. The venous phase images of all patients were post-processed to obtain virtual non contrast (VNC) and 40 keV virtual mono-energy images (VMI) for simulated arterial phase images (Vart). Image quality and lesion detection were compared between true non-contrast (TNC) and VNC images, and conventional arterial phase (CIart) and Vart images by paired t-test, Wilcoxon test and McNemar test. Objective evaluation indexes of image quality included thoracic aorta, all levels of pulmonary artery, T4 vertebral bone cancellous, chest wall fat CT value, background noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR); the subjective score of image quality was assessed by double-blind method on a 5-point scale; the assessment of lesion detection included the detection rate of calcified foci and pulmonary nodules size, density, volume, percentage of solid components and imaging characteristics. Results:Except for chest wall fat and T4 vertebral bone cancellous, the differences in CT values between VNC and TNC images were not statistically significant ( P>0.05); Except for right upper pulmonary artery and right lower pulmonary artery, the differences in background noise values and SNR between TNC images and VNC images were statistically significant ( P<0.05). Compared with CIart images, the CT values of chest wall fat were lower in Vart images ( P<0.05), and the CT values of the remaining sites were significantly higher ( P<0.05); the background noise values of all sites on Vart images were smaller than those on CIart images, and the SNR and CNR values were higher than those on CIart images ( P<0.05).The differences of subjective scores of images quality were not statistically significant between TNC and VNC images, between CIar and Vart images ( P>0.05). Taking TNC as the standard, the overall detection rate of VNC for calcification was 88.53% (301/340). Except for the short diameter of partially solid nodules, the differences of qualitative and quantitative assessment indexes of lung nodules between TNC and VNC images were not statistically significant ( P>0.05). Conclusions:Spectral CT chest venous phase 40 keV VMI can simulate arterial phase images in the diagnosis of vascular lesions, and venous phase VNC basically meets the standard of conventional plain scan, so it is feasible to replace plain scan, arterial phase and venous phase images in a certain range.

Relación entre alteraciones de la tomografía computarizada de tórax en pacientes hospitalizados por neumonia COVID-19 y la recuperacion funcional respiratoria a los 3 meses del alta / Relationship between alterations of CT tomography of the thorax in patients hospitalized for pneumonía COVID-19 and respiratory functional recovery 3 months after discharge

Introducción: La neumonía por coronavirus SARS-CoV-2 es una enfermedad nueva, por lo que las secuelas a largo plazo siguen siendo poco claras y los reportes del tema son aún escasos. El presente estudio buscó describir los hallazgos tomográficos al ingreso hospitalario y luego de 3 meses de neumonía asociada a COVID-19 y correlacionarlos con la alteración de las pruebas de función pulmonar a los 3 meses de la hospitalización. Pacientes y Métodos: Estudio de cohorte prospectivo que evaluó las secuelas funcionales pulmonares y la evolución del compromiso imagenológico a los tres meses de hospitalización por neumonía asociada a COVID-19. Todos los exámenes fueron revisados por un radiólogo experto. Se identificó el patrón tomográfico predominante y se estableció la extensión de las alteraciones mediante un puntaje, previamente validado. En las TC de seguimiento, se evaluó la extensión del compromiso imagenológico, el porcentaje de reducción del compromiso del espacio aéreo y presencia de otras alteraciones. Estos hallazgos se relacionaron con las pruebas de función pulmonar (PFP) a los 3 meses (espirometría, DLCO y test de caminata de 6 min: TC6M). Para estos análisis los pacientes se agruparon según la oxigenoterapia utilizada en la hospitalización: oxigenación estándar (O2), cánula nasal de alto flujo (CNAF) o ventilación mecánica invasiva (VMI). Resultados: Se evaluaron un total de 116 pacientes, de los cuales 75 eran hombres, edad promedio fue 60,6 ± 14,5 años. Los pacientes fueron seguidos en promedio 100 días. 70 pacientes pertenecieron al grupo O2 estándar, 25 CNAF y 21 VMI. La TC control a los 3 meses mostró que 78 pacientes presentaron recuperación tomográfica mayor a 50%. El promedio del puntaje de extensión del compromiso tomográfico fue significativamente mayor en el grupo con PFP alterada, comparado con el grupo con PFP normal (espirometría 6,8 vs. 4,6, p = 0,03; DLCO 5,7 vs. 4,1, p = 0,04, TC6M 7,0 vs. 4,2, p = 0,002). Conclusiones: En el seguimiento de los pacientes adultos hospitalizados por neumonía asociada a COVID-19, los pacientes con mayor extensión del compromiso imagenológico pulmonar fueron los que presentaron alteraciones funcionales pulmonares significativas.

Introduction: SARS-CoV-2 pneumonia is an emergent disease, then long term sequelae are still on investigation. This study evaluated the imaging features at the admission to the hospital and then 3 months after discharge of patients hospitalized with COVID-19 pneumonia and compared findings with functional respiratory recovery. Patients and Methods: Prospective cohort study of patients hospitalized with SARS-CoV-2 pneumonia in "Hospital Naval Almirante Nef", Viña del Mar Chile. Imaging evolution and respiratory function were analyzed after 3 months discharge. All the imagens were reviewed by an expert radiologist, who identified a predominant pattern and defined an extension score previously validated. These findings were compared with 3 months CT and respiratory function evaluated with spirometry, DLCO and 6 minutes walking test (6MWT). Also, patients were categorized in 3 different group, depending on oxygen support: conventional oxygen, high-flow nasal cannula (HFNC) and mechanical ventilation. Results: 116 patients were evaluated, 75 men with a mean age of 60.6 ± 14.5 years-old. The median follow-up was 100 days. 70 patients were on conventional oxygen group, 25 in high-flow nasal cannula and 21 in mechanical ventilation. 3-month CT control showed tomographic recovery > 50% in 78 patients. The mean score of extension was significant higher in the group with altered respiratory functional test, compared with the group with normal results (spirometry 6.8 vs. 4.6, p = 0.03; DLCO 5.7 vs. 4.1, p = 0.04; 6MWT 7.0 vs. 4.2, p = 0.002). Conclusion: 3 months after discharge of COVID-19 pneumonia, patients with higher tomographic score present significant abnormalities in respiratory functional test.

COARCTATION OF AORTA IN A 33 YEARS-OLD UNCONTROLLED HYPERTENSIVE FEMALE PATIENT – A CASE REPORT

We report a 33-year-female patient of hypertension detected at the age of 19 year. Her blood pressure was not well controlled. The case was investigated for secondary hypertension. CT Thoracic and Abdominal aorta Angiogram of the present case showing the narrowing in the thoracic aorta extending at the level of T8 to T10 vertebral body level for the length of 7.5cm. Reconstructed CT of the case showed multiple tortuous collaterals between the branches of internal mammary artery and external iliac artery and between axillary and intercostal artery. Relevant history was reviewed and discussed.

Correlation between D-dimer and HRCT in Covid-19

Background: To retrospectively determine the correlation between CTseverity score & D-dimer. Methodology: This is retrospective original research of 227 patients (IPD & OPD) during April 1 to May 31, 2021 for Covid-19. Patients CTseverity scores, HRCTThorax findings, D-dimer, Platelet count and Demographic variables were recorded. The correlation between CTseverity score & D-dimer were determined. Results:Between the mentioned dates, 227 patients are taken into study which includes 146 Males & 81 Females. Mean of CTseverity score was 6.7, D-dimer was 0.46mg/l. Higher CTscore is seen in males (mean -7.1) as compare to females (mean -6.12). D-dimer are seen higher in males (mean =0.52mg/l) as compare to females (median=0.37mg/l). The study of 227 patients has shown positive correlation between CTscore & D-dimer (r=0.38, p<0.05). Males showed relatively stronger positive correlation (r=0.4, p<0 .05) than females (r=0.3, p<0.05). Patients with age less than equal to 45 has shown relatively stronger positive correlation between CTscore & D-dimer (r=0.4, p<0.05) than patients with age more than 45 (r=0.35, p<0.05). Conclusion:Pulmonary lesion induced by SARS-CoV-2 infection was associated with raised inflammatory response, impairment in exchange of gases, and end organ damage. In study, we can conclude that lung lesion may exert important role in COVID-19 pathogenesis & clinical presentation

A STUDY OF IMAGING FINDINGS ON HRCT THORAX IN CORONA VIRUS DISEASE 2019 (COVID-19)

INTRODUCTION : In December 2019, a large outbreak of a novel coronavirus infection occurred in wuhan hubei province, china. The disease caused by the virus, named novel coronavirus disease (COVID-19) by the world health organization (WHO) can be spread through human to human contact. In human coronavirus can cause spectrum of diseases ranging from asymptomatic patient, simple cold cough to severe acute respiratory syndrome ( SARS). HRCT is very useful to see the extent of disease spread in lungs and to assess the severity of infection. It also helps in monitoring the response and therapeutic effectiveness and prognosis. AIMS AND OBJECTIVES: 1]To evaluate the various HRCT thorax Findings in RTPCR confirmed patients of covid-19 infection. 2] To correlate the findings of HRCT of thorax with patient’s clinical symptoms. METHODOLOGY: A retro- prospective clinical study was carried out on patients who were referred for HRCT thorax to the Department of Radiodiagnosis, Sheth L.G. general hospital having signs and symptoms of covid-19 and whose RT PCR report was awaited and who had undergone HRCT thorax and only patients who were RT PCR test positive within 72 hours were taken in the study. Total of 250 patients from May 2020 to January 2021, who confirmed covid-19 diagnosis with RT-PCR were taken. RESULTS In our study we found, the most common initial CT findings in COVID-19 pneumonia are bilateral, patchy or rounded ground-glass opacities that most frequently occur bilaterally and in the lung periphery with a subpleural basal predominance in left lower lobe. Most common finding were patchy bilateral ground glass opacity most commonly associated with inter and intralobular septal thickening giving crazy paving pattern. Consolidation was also seen with or without GGO suggesting infective etiology. CONCLUSION HRCT Thorax may be useful as a standard method for the rapid diagnosis of COVID-19 to optimize the management of severely ill PATIENTS.

Hallazgos en imágenes de tórax en una intoxicación aguda con paraquat: reporte de un caso / Findings on thorax images in acute paraquat poisoning: case report

Resumen El Paraquat es un herbicida ampliamente utilizado para el control de las malezas en Chile. Su ingesta determina una alta probabilidad de mortalidad dado su inherente toxicidad mediante la producción de radicales libres, que afectan a múltiples órganos, principalmente los pulmones; a esto se suma la falta de un tratamiento efectivo. Se presenta el caso clínico de un hombre de 18 años que en un intento suicida consume 50 mL de paraquat (200 g/L), con desenlace fatal. La presentación clínica depende la cantidad de Paraquat ingerida y los hallazgos radiológicos descritos varían según la temporalidad del cuadro e, inclusive, podrían determinar el pronóstico.

Paraquat is an herbicide widely used for weed control in Chile. Its intake determines a high probability of mortality because of its inherent toxicity through the production of free radicals. Multiple organs are affected, mainly the lungs; to this is added the lack of effective treatment. We present the clinical case of an 18-year-old man who in a suicidal attempt swallows 50 mL of paraquat (200 g/L), with a fatal outcome. The clinical presentation depends on the amount of Paraquat ingested. Radiological findings described vary according to the temporality of the condition and could even determine the prognosis

Utilidad de la resonancia magnética como estudio imagenológico complementario al ultrasonido en el diagnóstico de malformaciones fetales. Experiencia de dos centros de Medicina Materno Fetal de Latinoamérica / Usefulness of magnetic resonance as a complementary imaging study to ultrasound in the diagnosis of fetal malformations. Experience in two Maternal-fetal Medicine centers in Latin America

Resumen OBJETIVO: Conocer los aportes de la resonancia magnética, como estudio complementario al ultrasonido, en el diagnóstico de malformaciones fetales en el sistema nervioso central, musculoesquelético y tórax en dos unidades de Medicina Materno Fetal. MATERIALES Y MÉTODOS: Estudio retrospectivo, observacional y comparativo, de corte transversal, efectuado con base en la revisión de las historias clínicas registradas durante tres años de pacientes con más de 18 semanas de embarazo remitidas a la Unidad de Medicina Materno Fetal del Hospital San José y la Clínica Colsubsidio por alguna malformación estructural fetal identificada en el sistema nervioso central, musculoesquelético y tórax diagnosticada con base en la ultrasonografía. RESULTADOS: Se revisaron 109 historias clínicas de pacientes embarazadas con fetos con diagnóstico de malformación congénita por ultrasonido. Las indicaciones más frecuentes fueron: anormalidades en el sistema nervioso central en 61.5%; hidrocefalia no comunicante en 36.6% por ultrasonido y 21% por resonancia magnética, seguida de las del tórax con 40.4% por ultrasonido y 36.7% por resonancia magnética y malformaciones del sistema musculoesquelético con 20.1% por ultrasonido y 2.8% por resonancia magnética. La concordancia diagnóstica entre el ultrasonido y el diagnóstico posnatal fue del 66% y el de la resonancia magnética de 76%. En comparación con el ultrasonido inicial la resonancia magnética aumentó la frecuencia de diagnóstico de malformación fetal. CONCLUSIÓN: La resonancia magnética, complementaria al diagnóstico por ultrasonido de malformaciones congénitas, fue más notable en los sistemas nervioso central y musculoesquelético donde permitió mejorar la caracterización de las alteraciones detectadas en el ultrasonido.

Abstract OBJECTIVE: To know the contributions of magnetic resonance imaging, as a complementary study to ultrasound, in the diagnosis of fetal malformations in the central nervous system, musculoskeletal and thorax in two units of Maternal Fetal Medicine. MATERIALS AND METHODS: Retrospective, observational and comparative cross-sectional study, based on the review of medical records recorded during three years of patients with more than 18 weeks of pregnancy referred to the Maternal Fetal Medicine Unit of Hospital San José and Clínica Colsubsidio, for any fetal structural malformation identified in the central nervous system, musculoskeletal and thorax diagnosed based on ultrasonography. RESULTS: We reviewed 109 clinical histories of pregnant patients with fetuses diagnosed with congenital malformation by ultrasound. The most frequent indications were abnormalities of the central nervous system in 61.5%: non-communicating hydrocephalus in 36.6% by ultrasound and 21% by MRI, followed by those of the thorax with 40.4% by ultrasound and 36.7 by MRI and malformations of the musculoskeletal system 20.1% by ultrasound and 2.8% by MRI. The diagnostic agreement between ultrasound and postnatal diagnosis was 66% and that of MRI was 76%. Compared to initial ultrasound, MRI increased the frequency of diagnosis of fetal malformation. CONCLUSION: MRI, complementary to ultrasound diagnosis of congenital malformations, was more notable in the central nervous and musculoskeletal systems where it allowed improving the characterization of the alterations detected by ultrasound.

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.

Protótipo didático automatizado de ventilação pulmonar exibe uma simulação de variações de pressão intratorácica durante a função diafragmática / Automated didactic prototype of pulmonary ventilation exhibits a simulation of intrathoracic pressure variations during diaphragmatic function

O movimento do ar do ambiente para os alvéolos é um fenômeno vital e complexo que ocorre devido às variações nas pressões intratorácicas e nas vias aéreas em relação à atmosfera. A construção de protótipos didáticos pode minimizar a abstração necessária nestes fenômenos in vivo. Neste estudo, automatizamos um protótipo didático de ventilação pulmonar já descrito na literatura para simular e exibir variações na pressão intratorácica durante a função diafragmática. Um protótipo de ventilação pulmonar (PV) foi produzido com materiais recicláveis, e automatizado adaptando um sensor de pressão no sistema para gerar curvas de pressão em função do tempo durante a simulação da função diafragmática. A tração descendente do êmbolo automatizado induzida pelo servomotor (como o diafragmático) reduziu a pressão dentro da garrafa (intratorácica), e esta variação pode ser observada graficamente em uma interface de computador enquanto o balão foi expandido, e o ar atmosférico invadiu seu interior. Conclusão: A incorporação da tecnologia em um protótipo PV simples permitiu uma demonstração segura e simulada de como o diafragma induz a variação da pressão intratorácica em relação à atmosfera concomitantemente com a deformação pulmonar que ocorre durante a inspiração e a exalação.

The movement of air from the environment to the alveoli is a vital and complex phenomenon that occurs due to variations in intrathoracic and airway pressures in relation to the atmosphere. The construction of didactic prototypes can minimize the abstraction required in these in vivo phenomena. In this study, we automated a didactic prototype of pulmonary ventilation already described in literature to simulate and exhibit variations in intrathoracic pressure during diaphragmatic function. A pulmonary ventilation (PV) prototype was produced with recyclable materials, and automated by adapting a pressure sensor in the system to generate pressure curves as a function of time during the simulation of diaphragmatic function. The automated plunger's downward traction induced by the servomotor (such as diaphragmatic) reduced the pressure inside the bottle (intrathoracic), and this variation can be observed graphically on a computer interface while the balloon was expanded, and atmospheric air invaded its interior. Conclusion: The incorporation of technology into a simple PV prototype allowed a safe and simulated demonstration of how the diaphragm induces the variation of the intrathoracic pressure in relation to the atmosphere concomitantly with the pulmonary deformation that occurs during inspiration and exhalation.

Application of three dimensional artificial intelligence localization technology in CT chest scanning / 中华放射学杂志

Objective:To evaluate the clinical application of three dimensional artificial intelligence(3D-AI) localization technology in chest CT scan.Methods:A total of 100 patients who underwent chest CT for COVID-19 screening in Nanjing University Medical School Affiliated Drum Tower Hospital were collected from September 2020 to October 2020 were analyzed retrospectively. The patients were divided into manual positioning group ( n=50) and 3D-AI automatic positioning group ( n=50) with block randomization method. All patients were scanned with the same CT scanning protocol. The off-center distance, CT dose index (CTDI), dose length product (DLP) and CT examination time were measured and recorded. Quantitative image evaluation of mediastinal window images and qualitative image evaluation of chest window images were assessed by two radiologists. The off-center distance, CTDI, DLP, CT examination time and objective indexes of image quality of two groups were compared by independent sample t test. The quantitative image quality scores were compared with χ 2 test. Results:Compared with manual positioning group, the overall off-center distance of 3D-AI automatic positioning group was reduced by 42.86% [(15.4±9.7) vs. (8.8±7.2)mm, t=3.65, P<0.01], CTDI was reduced by 10.67%[(7.5±2.5) vs. (6.7±2.6)mGy, t=0.59, P=0.04], DLP was reduced by 13.33%[(270±95) vs. (234±86)mGy·cm, t=1.98, P=0.02], the average examination time was reduced by 29.91% [(214±26) vs. (150±14)s, t=15.79, P<0.01]. There were no significant differences in the background noise, signal to noise ratio of descending aorta and erecting spinal muscle, and subjective score between two groups ( P>0.05). Conclusion:The 3D-AI automatic positioning technology can greatly improve the accuracy of patient positioning and reduce the radiation dose for chest CT imaging, and improve work efficiency with qualified chest CT image quality.

Development and Validation for Thoracic-Abdominal Finite Element Model of Chinese 5th Percentile Female with Detailed Anatomical Structure / 医用生物力学

Objective To predict and assess biomechanical responses and injury mechanisms of the thorax and abdomen for small-sized females in vehicle collisions. Methods The accurate geometric model of the thorax and abdomen was constructed based on CT images of Chinese 5th percentile female volunteers. A thoracic-abdominal finite element model of Chinese 5th percentile female with detailed anatomical structure was developed by using the corresponding software. The model was validated by reconstructing three groups of cadaver experiments (namely, test of blunt anteroposterior impact on the thorax, test of bar anteroposterior impact on the abdomen, test of blunt lateral impact on the chest and abdomen). Results The force-deformation curves and injury biomechanical responses of the organs from the simulations were consistent with the cadaver experiment results, which validated effectiveness of the model. Conclusions The model can be used for studying injury mechanisms of the thorax and abdomen for small-sized female, as well as developing small-sized occupant restraint systems and analyzing the forensic cases, which lays foundation for developing the whole body finite element model of Chinese 5th percentile female.

Delayed chest closure for oversized lung allograft in lung transplantation: a retrospective analysis from turkey

Abstract Introduction: The aim of this study was to evaluate the delayed chest closure (DCC) results in patients who underwent lung transplantation. Methods: Sixty patients were evaluated retrospectively. Only bilateral lung transplantations and DCC for oversized lung allograft (OLA) were included in the study. Six patients who underwent single lung transplantation, four patients who underwent lobar transplantation, two patients who underwent retransplantation, and four patients who underwent DCC due to bleeding risk were excluded from the study. Forty-four patients were divided into groups as primary chest closure (PCC) (n=28) and DCC (n=16). Demographics, donor characteristics, and operative features and outcomes of the patients were compared. Results: The mean age was 44.5 years. There was no significant difference between the demographics of the groups (P>0.05). The donor/recipient predicted total lung capacity ratio was significantly higher in the DCC group than in the PCC group (1.06 vs. 0.96, P=0.008). Extubation time (4.3 vs. 3.1 days, P=0.002) and intensive care unit length of stay (7.6 vs. 5.2 days, P=0.016) were significantly higher in the DCC group than in the PCC group. In the DCC group, postoperative wound infection was significantly higher than in the PCC group (18.6% vs. 0%, P=0.19). Median survival was 14 months in all patients and there was no significant difference in survival between the groups (16 vs. 13 months, P=0.300). Conclusion: DCC is a safe and effective method for the management of OLA in lung transplantation.

Respuesta patológica completa al tratamiento multimodal en sarcoma de Ewing del adulto / Pathological complete response after multimodal treatment of adult Ewing sarcoma

Resumen El sarcoma de Ewing es una neoplasia rara y altamente agresiva que afecta con cierta predilección adolescentes varones. La incorporación de terapia neoadyuvante y nuevas técnicas quirúrgicas ha mejorado la supervivencia. Presentamos el caso de un varón de 41 años con sarcoma de Ewing de pared torácica, quien recibió tratamiento multimodal consistente en quimio-radioterapia concurrente y tratamiento qui rúrgico, y alcanzó respuesta patológica completa. El sarcoma de Ewing rara vez se presenta en la edad adulta y, cuando lo hace, suele tener mal pronóstico. El tratamiento multimodal de pacientes mayores de 40 años ha probado mejorar los resultados oncológicos.

Abstract Ewing sarcoma is a rare and highly aggressive neoplasm that occurs most frequently in male adolescents. The incorporation of neoadjuvant therapy and new surgical techniques has improved survival. We present the case of a 41-year-old man diagnosed with Ewing sarcoma of the chest wall, whose tumor showed a pathological complete response to a multimodal treatment consisting of concurrent chemotherapy, radiotherapy, and surgical resection. Ewing sarcoma rarely occurs in adults, who generally have a worse prognosis. A multimodal approach for the treatment of patients older than 40 years has proven to improve oncological results.

COVID-19 findings in chest computed tomography

SUMMARY OBJECTIVE: The aim of this study was to describe chest computed tomography image findings in patients with COVID-19. METHODS: The chest computed tomography scans of 453 hospitalized patients with confirmed COVID-19 were collected at two tertiary care Brazilian hospitals. Demographics and clinical data were extracted from the electronic record medical system. RESULTS: The main chest computed tomography findings were ground-glass opacities (92.5%), consolidation (79.2%), crazy-paving pattern (23.9%), parenchymal bands (50%), septal thickening (43.5%), and inverted halo sign (3.5%). Of the 453 hospitalized patients, 136 (30%) died. In this group, ground-glass opacities (94.1%), consolidation (89.7%), septal thickening (58.1%), crazy-paving pattern (52.2%), and parenchymal bands (39.7%) were the most common imaging findings. CONCLUSIONS: In a dynamic disease with a broad clinical spectrum such as COVID-19, radiologists can cooperate in a better patient management. On wisely indicated chest computed tomography scans, the fast identification of poor prognosis findings could advise patient management through hospital care facilities and clinical team decisions.

Analysis of sternal curvature patterns in patients with pectus and control / Análise dos padrões de curvatura esternal em pacientes com pectus e controles

ABSTRACT Objective: To analyze reformatted sagittal sternal tomography images and classify sternal body curvature types, and compare different types of pectus populations with one another and with normal individuals. Methods: In total, 50 controls and 167 pectus patients were selected for chest CT to analyze the median sagittal plane, of whom 89 had pectus carinatum (mean age, 12 ± 10 years) and 78 pectus excavatum (mean age, 14 ± 10 years). Clinical types of pectus were classified as inferior, superior, or lateral pectus carinatum, and localized or broad pectus excavatum. The following types of sternal patterns were defined: gradual vertical curve, gradual posterior curve, gradual anterior curve, proximal third curve, middle third curve, distal third curve, anterior rectilinear, vertical rectilinear, and posterior rectilinear. Statistical analyses were performed to compare the different types of pectus with one another and with the control group. Results: Patients with different thoracic deformities, but with similar sternal curvature patterns, were observed. Some types of sternal curvature were significantly more frequent in certain types of pectus (p < 0,05). The gradual vertical curve and anterior rectilinear types prevailed in controls (p < 0,05). Conclusion: Some sternal curvature patterns were more frequent than the others in certain types of pectus and the controls. Level of Evidence II, Prognostic studies - investigating the effect of a patient characteristic on the outcome of disease.

RESUMO Objetivo: Avaliar a reformatação sagital tomográfica do esterno por meio da análise de uma classificação do tipo de curvatura do corpo esternal nos diferentes tipos de pectus, comparando-os entre si e com indivíduos normais. Métodos: 50 controles e 167 pacientes submetidos à TC do tórax para análise da reconstrução sagital no plano mediano, sendo 89 com pectus carinatum (idade média, 12 ± 10 anos) e 78 com pectus excavatum (idade média, 14 ± 10 years). Os tipos clínicos de pectus foram classificados em: pectus carinatum superior, inferior e lateral, e pectus excavatum amplo ou localizado. Foram definidos os seguintes tipos de padrões esternais: curvo gradativo vertical; curvo gradativo posterior; curvo gradativo anterior; curvo terço proximal; curvo terço médio; curvo terço distal; retilíneo anterior; retilíneo vertical; e retilíneo posterior. Foi realizada análise estatística entre o grupo pectus e controle, e entre diferentes tipos de pectus. Resultados: Observamos pacientes com deformidades torácicas diferentes, mas com esternos com padrão de curvatura semelhante. Alguns tipos de curvatura esternal são significativamente mais frequentes em alguns tipos de pectus (p < 0,05). Em controles prevaleceram os tipos curvo gradativo vertical e retilíneo anterior (p < 0,05). Conclusão: Alguns tipos de curvatura esternal são mais frequentes que outras em determinados tipos de pectus e controles. Nível de Evidência II, Estudos prognósticos - investigação do efeito de característica de um paciente sobre o desfecho da doença.