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1.
Prensa méd. argent ; 109(1): 25-30, 20230000. fig
Article in Spanish | LILACS, BINACIS | ID: biblio-1427920

ABSTRACT

La ingesta de cuerpos extraños es una situación frecuente y cotidiana. La mayoría de las veces cursa con resolución espontánea, pero cuando el cuerpo extraño resulta ser un elemento punzante, suele producir perforación esofágica con el consiguiente riesgo de mediastinitis y/o sangrado. Se presenta un caso crítico derivado de diferentes centros asistenciales donde se logra mediante un manejo y tratamiento multidisciplinario, un resultado favorable


The intake of foreign bodies is a frequent and daily situation. Most of the time he has spontaneous resolution, but when the foreign body turns out to be a sharp element, it usually causes esophageal drilling with the consequent risk of mediastinitis and/or bleeding. A critical case derived from different care centers is presented where multidisciplinary management and treatment, achieves a favorable result


Subject(s)
Humans , Male , Adult , Patient Care Team , Esophageal Perforation/therapy , Foreign Bodies , Mediastinum/injuries
2.
Journal of Clinical Otorhinolaryngology Head and Neck Surgery ; (12): 755-758, 2023.
Article in Chinese | WPRIM | ID: wpr-1011038

ABSTRACT

This article reports a case of primary thyroid diffuse large B-cell lymphoma involving the superior mediastinum with Hashimoto's thyroiditis admitted to the Department of Otolaryngology and Head and Neck Surgery, First Hospital of Jilin University. This patient underwent right thyroid lobectomy and was transferred to the Department of Hematology of the Oncology Center for 6 courses of chemotherapy with R-CHOP protocol. The postoperative recovery was good, and the patient was regularly followed up for 12 months after the operation. The patient's condition was stable, and CT showed no abnormally high metabolism in the operation area indicating the inhibition of tumor activity, superficial lymph nodes and peripheral blood cells were normal. The case encountered many difficulties in the diagnosis process, and the diagnosis was not confirmed after puncture in two Grade III Class A hospitals in China. There are few patients with primary thyroid diffuse large B-cell lymphoma complicated with Hashimoto's thyroiditis, and it is particularly rare to invade the mediastinum. There is no report in China and abroad in the literature we reviewed. Therefore, this article reports the case and retrospectively analyzes the etiology, clinical symptoms, diagnosis and treatment of primary thyroid lymphoma.


Subject(s)
Humans , Mediastinum , Retrospective Studies , Hashimoto Disease , Lymphoma, Large B-Cell, Diffuse , Thyroid Neoplasms
3.
Rev. colomb. neumol ; 34(2): 97-106, July-Dec. 2022.
Article in Spanish | LILACS, COLNAL | ID: biblio-1412946

ABSTRACT

Se presenta el caso de un paciente de 82 años, con tumor intratorácico de crecimiento rápido, con aumento progresivo de la disnea, antecedentes de enfermedad coronaria y baja función cardíaca, obesidad y síndrome de apnea de sueño, quien fue sometido a toracotomía y a quien se le diagnosticó un tumor solitario fibroso de la pleura, tumor de muy baja frecuencia, adherido en forma sésil al pericardio, lo cual lo hace aún menos frecuente. Se hace una revisión general de las posibilidades terapéuticas, el diagnóstico histológico y por inmunohistoquímica, así como los criterios de benignidad y malignidad para este tipo de tumor, que son en su mayoría de buen pronóstico.


We present the case of an 82-year-old patient with a rapidly growing intrathoracic tumor, progressive increase in dyspnea, and a history of coronary heart disease and low cardiac function, obesity, and sleep apnea syndrome, who underwent thoracotomy and who was diagnosed with a Solitary Fibrous Tumor of the Pleura, a very low frequency tumor, adhered in sessile form to the pericardium, which makes it even less frequent. A general review is made of the therapeutic possibilities, the histological and immunohistochemical diagnosis, as well as the criteria of benignity and malignancy for this type of tumor, most of which have a good prognosis.


Subject(s)
Humans , Pleura , Solitary Fibrous Tumors , Solitary Fibrous Tumor, Pleural , Mediastinum , Immunohistochemistry , Coronary Disease
4.
Rev. colomb. cir ; 37(2): 237-244, 20220316. tab, fig
Article in Spanish | LILACS | ID: biblio-1362955

ABSTRACT

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.


Subject(s)
Humans , Thorax , Esophageal Perforation , Trachea , Wounds and Injuries , Mediastinum
5.
Repert. med. cir ; 30(1): 64-67, 2021. ilus.
Article in English, Spanish | LILACS, COLNAL | ID: biblio-1292233

ABSTRACT

La pseudodextrocardia se ha definido como un desplazamiento irregular del corazón y sus estructuras vasculares hacia la derecha por causas extracardiacas. Es un hallazgo ocasional en estudios imagenológicos de tórax o abdomen y varía acorde con las diferentes relaciones causales. Se presenta el caso de un paciente con una neumopatía crónica, quien a su ingreso presenta pseudodextrocardia como hallazgo incidental.


Pseudo-dextrocardia has been defined as an unusual displacement of the heart and its vascular structures to the right secondary to extracardiac causes. It is an occasional finding in thoracic or abdominal imaging studies and varies according to the various causal relationships. We report a case of pseudo-dextrocardia as an incidental finding in a patient admitted with chronic pulmonary disease.


Subject(s)
Humans , Male , Aged, 80 and over , Dextrocardia/diagnostic imaging , Heart/diagnostic imaging , Mediastinum/diagnostic imaging , Thorax , Dextrocardia
6.
Rev. chil. radiol ; 26(3): 120-124, set. 2020. ilus
Article in Spanish | LILACS | ID: biblio-1138707

ABSTRACT

Resumen: Los tumores neuroendocrinos primarios (NET) del mediastino son muy raros. Presentamos el caso de un tumor carcinoide atípico primario de timo. Un hombre de 52 años que fue a un examen médico porque se quejaba de tos no productiva sin hemoptisis. Se solicitó una radiografía de tórax donde se evidenció un mediastino notablemente ensanchado, con una tomografía de tórax que mostro una masa tumoral de 90 x 50 mm en el mediastino anterosuperior que comprime el arco aórtico y la arteria pulmonar sin un plano de clivaje adecuado. Debido a que el tumor era infiltrativo, se proporcionó escisión quirúrgica completa, quimioterapia y radioterapia al mediastino. El objetivo principal de nuestro estudio fue evaluar los hallazgos de CT y MRI con relación a la literatura mundial.


Abstract: Primary neuroendocrine tumors (NET) of the mediastinum are very rare. We present the case of a primary atypical carcinoid tumor of the thymus. A 52-year-old man who went to a medical examination because he complained of a non-productive cough without hemoptysis. A chest radiograph was requested where a markedly widened mediastinum was evidenced, with a thoracic tomography showing a tumor mass of 90 x 50 mm in the anterosuperior mediastinum that compresses the aortic arch and pulmonary artery without an adequate cleavage plane. Because the tumor was infiltrative, complete surgical excision, chemotherapy and radiotherapy were provided to the mediastinum. The main objective of our study was to evaluate the findings of CT and MRI in relation to universal literature.


Subject(s)
Humans , Male , Middle Aged , Thymus Neoplasms/diagnostic imaging , Carcinoid Tumor/diagnostic imaging , Neuroendocrine Tumors/diagnostic imaging , Thymus Neoplasms/surgery , Carcinoid Tumor/surgery , Radiography, Thoracic , Tomography, X-Ray Computed , Neuroendocrine Tumors/surgery , Mediastinum/pathology
7.
Rev. Assoc. Med. Bras. (1992, Impr.) ; 66(9): 1210-1216, Sept. 2020. tab, graf
Article in English | SES-SP, LILACS | ID: biblio-1136359

ABSTRACT

SUMMARY OBJECTIVE: To evaluate the value of EBUS-TBNA in the diagnosis of lung and mediastinal lesions. METHODS: Prospective cohort study that included 52 patients during a 2-year period (2016 to 2018) who underwent EBUS-TBNA. RESULTS: Among the 52 individuals submitted to the procedure, 22 (42.31%) patients were diagnosed with locally advanced lung cancer (N2 or N3 lymph node involvement). EBUS-TBNA confirmed the diagnosis of metastases from other extrathoracic tumors in the mediastinum or lung in 5 patients (9.61%), confirmed small cell lung cancer in 3 patients (5.76%), mediastinal sarcoidosis in 1 patient (1.92%), and reactive mediastinal lymph node in 8 patients (15.38%); insufficient results were found for 3 patients (5.76%). Based on these results, EBUS-TBNA avoided further subsequent surgical procedures in 39 of 52 patients (75%). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 86%, 100%, 100%, 77%, and 90%, respectively. No major complications were observed. CONCLUSIONS: EBUS-TBNA is a safe, effective, and valuable method. This technique can significantly reduce the rate of subsequent surgical procedures required for the diagnosis of lung and mediastinal lesions.


RESUMO OBJETIVO: Avaliar a importância da ecoendoscopia endobrônquica com punção por agulha fina (Ebus-TBNA) no diagnóstico das lesões pulmonares e mediastinais. MÉTODOS: Estudo prospectivo e do tipo coorte, no qual foram incluídos 52 pacientes, durante o período de dois anos (2016 a 2018), submetidos ao procedimento de Ebus-TBNA. RESULTADOS: Do total de 52 indivíduos submetidos ao procedimento, 22 (42,31%) pacientes foram diagnosticados com neoplasia pulmonar localmente avançada (N2 ou N3). O método confirmou o diagnóstico de metástases de outros tumores extratorácicos no mediastino ou pulmão em cinco pacientes (9,61%), três pacientes (5,76%) com carcinoma de pequenas células, um paciente (1,92%) com sarcoidose, oito pacientes (15,38%) com linfonodomegalias reacionais/inflamatórias e resultado insuficiente em três pacientes (5,76%). O Ebus-TBNA evitou a realização de outros procedimentos cirúrgicos subsequentes em 39 de 52 (75%) pacientes. Foram calculados os valores de sensibilidade de 86%, especificidade de 100%, valor preditivo positivo de 100%, valor preditivo negativo de 77% e acurácia de 90%. Não foram observadas complicações maiores pelo método neste estudo. CONCLUSÃO: O Ebus-TBNA é um método seguro, eficaz e de relevante importância. Este exame pode reduzir significativamente o número de procedimentos invasivos subsequentes necessários para o diagnóstico das lesões pulmonares e mediastinais.


Subject(s)
Humans , Endosonography , Mediastinum/diagnostic imaging , Prospective Studies , Ultrasonography, Interventional , Neoplasm Staging
8.
Rev. bras. cir. cardiovasc ; 35(1): 123-126, Jan.-Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1092472

ABSTRACT

Abstract Hydatid cystic disease is a significant clinical problem in endemic countries. Hydatid cysts are most commonly located in the liver and lungs. Primary mediastinal hydatid cyst is a rare clinical entity. The diagnosis must be considered in a patient with a mediastinal mass, particularly in endemic regions. Mediastinal hydatid cysts causing paralysis of phrenic and recurrent laryngeal nerves have been rarely reported. We describe a rare case of primary mediastinal hydatid cyst associated with diaphragmatic palsy caused by compression of the left phrenic nerve, which was successfully treated with partial cystectomy and capitonnage with hemidiaphragmatic plication.


Subject(s)
Humans , Echinococcosis , Mediastinal Cyst , Mediastinum
9.
Autops. Case Rep ; 10(3): e2020166, 2020. graf
Article in English | LILACS | ID: biblio-1131826

ABSTRACT

The chest wall chondrosarcoma (CWC) is a rare slowly growing primary tumor of the chest wall with an incidence of <0.5 per million person-years. We present the case of a giant CWC that caused a mass effect on the mediastinum, heart, and lung. Large tumors with thoracic structures compression may be life threatening, and its resection and subsequent chest wall reconstruction represent a significant multidisciplinary surgical challenge. In this case, despite the large tumor dimensions, the preoperative planning—sparing key reconstructive options without compromising the tumor resection—allowed a complete en bloc tumor excision of a grade III chondrosarcoma with negative histologic margins. Successful reconstruction of the large full-thickness chest wall defect, with a latissimus dorsi muscle flap and methyl methacrylate incorporated into a polypropylene mesh in a sandwich fashion, was accomplished. Patient recovery was uneventful with good functional and aesthetic outcomes, and no evidence of recurrence at 1.5 years follow-up. This case report illustrates the main clinical, radiological, and histologic features of a CWC while discussing the surgical goals and highlighting the principles for chest wall reconstruction following extensive resection of a large and rare entity.


Subject(s)
Humans , Male , Middle Aged , Bone Neoplasms/surgery , Chondrosarcoma/surgery , Plastic Surgery Procedures , Thoracic Wall/pathology , Heart , Lung , Mediastinum
10.
Journal of Peking University(Health Sciences) ; (6): 730-737, 2020.
Article in Chinese | WPRIM | ID: wpr-942069

ABSTRACT

OBJECTIVE@#To validate the value of dual energy CT (DECT) in the differentiation of mediastinal metastatic lymph nodes from non-metastatic lymph nodes in non-small cell lung cancer (NSCLC).@*METHODS@#In the study, 57 surgically confirmed NSCLC patients who underwent enhanced DECT scan within 2 weeks before operation were enrolled. Two radiologists analyzed the CT images before operation. All mediastinal lymph nodes with short diameter≥5 mm on axial images were included in this study. The morphological parameters [long-axis diameter (L), short-axis diameter (S) and S/L of lymph nodes] and the DECT parameters [iodine concentration (IC), normalized iodine concentration (NIC), slope of spectral hounsfield unit curve (λHU) and effective atomic number (Zeff) in arterial and venous phase] were measured. The differences of morphological parameters and DECT parameters between metastatic and non-metastatic lymph nodes were compared. The parameters with significant difference were analyzed by the Logistic regression model, then a new predictive variable was established. Receiver operator characteristic (ROC) analyses were performed for S, NIC in venous phase and the new predictive variable.@*RESULTS@#In 57 patients, 49 metastatic lymph nodes and 938 non-metastatic lymph nodes were confirmed by surgical pathology. A total of 163 mediastinal lymph nodes (49 metastatic, 114 non-metastatic) with S≥5 mm were detected on axial CT images. The S, L and S/L of metastatic lymph nodes were significantly higher than those of non-metastatic lymph nodes (P < 0.05). The DECT parameters of metastatic lymph nodes were significantly lower than those of non-metastatic lymph nodes (P < 0.05). The best single morphological parameter for differentiation between metastatic and nonmetastatic lymph nodes was S (AUC, 0.752; threshold, 8.5 mm; sensitivity, 67.4%; specificity, 73.7%; accuracy, 71.8%). The best single DECT parameter for differentiation between metastatic and nonmetastatic lymph nodes was NIC in venous phase (AUC, 0.861; threshold, 0.53; sensitivity, 95.9%; specificity, 70.2%; accuracy, 77.9%). Multivariate analysis showed that S and NIC were independent predictors of lymph node metastasis. The AUC of combined S and NIC in the venous phase was 0.895(sensitivity, 79.6%; specificity, 87.7%; accuracy, 85.3%), which were significantly higher than that of S (P < 0.001) and NIC (P=0.037).@*CONCLUSIONS@#The ability of quantitative DECT parameters to distinguish mediastinal lymph node metastasis in NSCLC patients is better than that of morphological parameters. Combined S and NIC in venous phase can be used to improve preoperative diagnostic accuracy of metastatic lymph nodes.


Subject(s)
Humans , Carcinoma, Non-Small-Cell Lung/diagnostic imaging , Lung Neoplasms/diagnostic imaging , Lymph Nodes , Lymphatic Metastasis , Mediastinum , Tomography, X-Ray Computed
11.
Rev. colomb. cir ; 35(3): 472-482, 2020. fig
Article in Spanish | LILACS | ID: biblio-1123216

ABSTRACT

Introducción. El desarrollo de las imágenes diagnósticas hizo posible el diagnóstico topográfico de los tumores de mediastino; sin embargo, aún con los avances actuales de la cirugía, la anestesiología y la reanimación, el acceso quirúrgico a ese espacio medio de la caja torácica continúa siendo el gran reto que enfrentan los cirujanos torácicos. Objetivo. Profundizar en los diferentes aspectos cognoscitivos actualizados sobre los tumores mediastinales.Métodos. Búsqueda documental digital en bases de datos: Scielo, Lilacs, Web of Science, PubMed, realizada en enero de 2019, de publicaciones sobre el tema en la presente centuria. Resultados. Las neoplasias mediastinales son poco frecuentes, pueden aparecer a cualquier edad, aunque son más frecuentes entre la tercera y quinta décadas, y la mayoría se descubren incidentalmente en una radiografía de tórax de rutina en pacientes asintomáticos. Los tumores malignos del mediastino son poco frecuentes, pero los benignos constituyen un desafío diagnóstico para radiólogos y patólogos. En las neoplasias malignas se identifica una amplia gama de variedades histológicas, atribuibles a las características del órgano afectado. Conclusiones. El diagnóstico definitivo generalmente se establece mediante el estudio histopatológico posquirúrgico, si bien la tomografía computarizada, asociada o no a la biopsia percutánea, es el estándar de oro para el diagnóstico preoperatorio. La selección de la vía de entrada al tórax, así como el procedimiento quirúrgico, están condicionados por la localización y el tamaño del tumor en el mediastino


Introduction. The development of diagnostic images made the topographic diagnosis of mediastinal tumors possible; however, even with current advances in surgery, anesthesiology, and resuscitation, surgical access to this mid-rib cage space continues to be the great challenge faced by chest surgeons.Objective. To deepen in the different updated cognitive aspects about mediastinal tumors.Methods. Digital documentary search in databases: Scielo, Lilacs, Web of Science, and PubMed, performed in January 2019, of publications on the subject in the present century.Results. Mediastinal neoplasms are rare, they can appear at any age, although they are most common between the third and fifth decades, and most are discovered incidentally on a routine chest radiograph in asymptomatic patients. Malignant tumors of the mediastinum are rare, but benign tumors pose a diagnostic challenge for radiologists and pathologists. In malignant neoplasms, a wide range of histological varieties is identified, attributable to the characteristics of the affected organ.Conclusions. The definitive diagnosis is generally established by postoperative histopathological study, although computed tomography, associated or not with percutaneous biopsy, is the gold standard for preoperative diagnosis. The selection of the entry route to the thorax, as well as the surgical procedure, are conditioned by the location and size of the tumor in the mediastinum


Subject(s)
Humans , Mediastinum , Thoracic Surgery , Endoscopy , Mediastinal Neoplasms
12.
Rev. Salusvita (Online) ; 39(3): 765-773, 2020.
Article in Portuguese | LILACS | ID: biblio-1378555

ABSTRACT

Introdução: A tuberculose (TB) acomete especialmente os pulmões, no entanto, também se tem conhecimento das formas extrapulmonares. Dentre essas, buscamos relatar um caso raro de TB mediastinal localizada em trajeto de nervo laríngeo recorrente (NLR), a qual se manifestou com paralisia de prega vocal (PPV). Relato de Caso: Paciente masculino, 58 anos, apresentando quadro de disfonia. Histórico de exérese de testículo esquerdo e anatomopatológico evidenciando orquiepididimite crônica granulomatosa sugestiva de etiologia tuberculosa. Ex-tabagista e ex-etilista. Realizou, há 15 anos, um tratamento por 6 meses para TB pulmonar. Contactante de paciente bacilífero há três anos. A videolaringoscopia identificou PPV esquerda paramediana. A tomografia computadorizada (TC) de pescoço evidenciou linfonodos calcificados no mediastino superior, fossas supraclaviculares e espessamento de corda vocal à direita. A TC de Tórax apresentou conglomerados sequelares linfonodais calcificados no mediastino e sequela de processo granulomatoso crônico tipo TB em ápices pulmonares. Sorologia de HIV não reagente. Baciloscopia negativa, com amostra insuficiente. Cultura de escarro negativa. Discussão: A PPV esquerda encontrada na videolaringoscopia e TC de pescoço e os achados de TB mediastinal indicaram acometimento do NLR esquerdo pelo processo granulomatoso em seu trajeto, sendo esse, uma reativação de TB ganglionar mediastinal. Fora realizado esquema básico de tratamento para TB, com posterior resolução do quadro de disfonia. Embora a TB torácica seja uma condição comum, a rouquidão devido à PPV é uma complicação raramente associada. Conclusão: Salientamos a importância de estender a investigação ao mediastino na vigência de PPV unilateral, uma vez que a disfunção do NLR pode justificar o quadro.


Introduction: tuberculosis (TB) affects most commonly the lungs; nevertheless, extrapulmonary forms are also known. With that in mind, we intend to report a rare case of mediastinal TB located on the path of the recurrent laryngeal nerve (RLN), manifesting itself with vocal fold paralysis (VFP). Case report: male patient, 58 years old, presenting dysphonia. History of exeresis of the left testicle and anatomopathological showing chronic granulomatous orchiepididimitis, suggestive of tuberculous etiology. Former smoker, ex-alcoholic. Previous treatment for six months due to pulmonary TB, 15 years ago. Bacilli patient contactant for three years. Videolaryngoscopy identified paramedian left VFP. Computed tomography (CT) of the neck showed calcified lymph nodes in the upper mediastinum, supraclavicular fossa, and thickening on the right vocal cord. Chest CT showed calcified lymph node sequels in the mediastinal and Chronic Granulomatous TB-type sequel in pulmonary apices. Non-reactive HIV serology. Negative baciloscopy, insufficient sample. Negative sputum culture. Discussion: the finding of left VFP in videolaryngoscopy and neck CT, associated with the findings of mediastinal TB, indicated that the left RLN's involvement occurred due to the granulomatous process in its path, meaning a reactivation of mediastinal ganglionic TB. A simple treatment schedule for TB had been conducted, with subsequent resolution of the dysphonia. Even though thoracic TB is a common condition, hoarseness due to VFP is a rarely associated complication. Conclusion: we stress the importance of extending the investigation to the mediastinum in case of unilateral VFP since a dysfunction of the RLN is a possible justification of the case.


Subject(s)
Male , Recurrent Laryngeal Nerve , Tuberculosis, Laryngeal , Vocal Cord Dysfunction , Mediastinum
13.
Clinics ; 75: e1759, 2020. tab, graf
Article in English | LILACS | ID: biblio-1133373

ABSTRACT

The present systematic review and meta-analysis aimed to evaluate the available evidence base on endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) combined with either endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) or endoscopic ultrasound using the EBUS scope-guided fine-needle aspiration (EUS-B-FNA) for diagnosing and staging mediastinal diseases. PubMed, Web of Science, and Embase were searched to identify suitable studies up to June 30, 2019. Two investigators independently reviewed articles and extracted relevant data. Data were pooled using random effect models to calculate diagnostic indices that included sensitivity and specificity. Summary receiver operating characteristic (SROC) curves were used to summarize the overall test performance. Data pooled from up to 16 eligible studies (including 10 studies of 963 patients about EBUS-TBNA with EUS-FNA and six studies of 815 patients with EUS-B-FNA) indicated that combining EBUS-TBNA with EUS-FNA was associated with slightly better diagnostic accuracy than combining it with EUS-B-FNA, in terms of sensitivity (0.87, 95%CI 0.83 to 0.90 vs. 0.84, 95%CI 0.80 to 0.88), specificity (1.00, 95%CI 0.99 to 1.00 vs. 0.96, 95%CI 0.93 to 0.97), diagnostic odds ratio (413.39, 95%CI 179.99 to 949.48 vs. 256.38, 95%CI 45.48 to 1445.32), and area under the SROC curve (0.99, 95%CI 0.97 to 1.00 vs. 0.97, 95%CI 0.92 to 1.00). The current evidence suggests that the combination of EBUS-TBNA with either EUS-FNA or EUS-B-FNA provides relatively high accuracy for diagnosing mediastinal diseases. The combination with EUS-FNA may be slightly better.


Subject(s)
Humans , Lung Neoplasms/pathology , Mediastinal Diseases/diagnostic imaging , Bronchoscopy , Endoscopic Ultrasound-Guided Fine Needle Aspiration , Mediastinum/pathology , Neoplasm Staging
14.
J. bras. pneumol ; 46(2): e20180183, 2020. tab, graf
Article in English | LILACS | ID: biblio-1134861

ABSTRACT

ABSTRACT Objective: To determine the diagnostic yield of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in non-neoplastic patients with isolated intrathoracic lymphadenopathy (IL). Methods: This was a retrospective study of patients with isolated IL referred for EBUS-TBNA. We calculated the sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of EBUS-TBNA in the diagnosis of granulomatous, reactive, and neoplastic lymphadenopathy. In cases of nonspecific granulomas, reactive lymphadenopathy, or inconclusive results, a definitive diagnosis was established by other diagnostic procedures or during a follow-up period of at least 18 months. Results: Among the 58 patients included in the study, EBUS-TBNA established a diagnosis of granulomatous disease in 22 (38%), reactive lymphadenopathy in 15 (26%), cancer in 8 (14%), and other diseases in 3 (5%). Results were inconclusive in 10 (17%), the diagnosis being established by other bronchoscopic procedures in 2 (20%) and by surgical procedures in 8 (80%). A final diagnosis of reactive lymphadenopathy was established in 12. Of those, 11 (92%) had their diagnosis confirmed during follow-up and 1 (8%) had their diagnosis confirmed by mediastinoscopy. In another 3, a final diagnosis of sarcoidosis or neoplasm was established. For the diagnosis of granulomatous disease, neoplasms, and reactive lymphadenopathy, EBUS-TBNA was found to have a sensitivity of 73%, 68%, and 92%, respectively; a specificity of 100%, 100%, and 93%, respectively; an accuracy of 86%, 93%, and 93%, respectively; a PPV of 100%, 100%, and 80%, respectively; and an NPV of 78%, 92%, and 98%, respectively. Conclusions: In non-neoplastic patients, granulomatous disease and reactive lymphadenopathy appear to be common causes of isolated IL. EBUS-TBNA shows promising results as a first-line minimally invasive diagnostic procedure. The results obtained by EBUS-TBNA can be optimized by examining clinical and radiological findings during follow-up or by comparison with the results obtained with other bronchoscopic methods.


RESUMO Objetivo: Determinar o rendimento diagnóstico da endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA, aspiração transbrônquica com agulha guiada por ultrassonografia endobrônquica) em pacientes não neoplásicos com linfonodomegalia intratorácica (LI) isolada. Métodos: Estudo retrospectivo com pacientes com LI isolada encaminhados para EBUS-TBNA. Foram calculados a sensibilidade, especificidade, precisão, valor preditivo positivo (VPP) e valor preditivo negativo (VPN) da EBUS-TBNA no diagnóstico de linfadenopatia granulomatosa, reacional e neoplásica. Em casos de granulomas inespecíficos, linfadenopatia reacional ou resultados inconclusivos, o diagnóstico definitivo foi estabelecido por meio de outros procedimentos diagnósticos ou ao longo de pelo menos 18 meses de acompanhamento. Resultados: Nos 58 pacientes incluídos, a EBUS-TBNA permitiu que se estabelecesse o diagnóstico de doença granulomatosa em 22 (38%), linfadenopatia reacional em 15 (26%), câncer em 8 (14%) e outras doenças em 3 (5%). Os resultados foram inconclusivos em 10 (17%), nos quais o diagnóstico foi feito por meio de outros procedimentos broncoscópicos, em 2 (20%), ou de procedimentos cirúrgicos, em 8 (80%). O diagnóstico final de linfadenopatia reacional foi feito em 12. Destes, 11 (92%) receberam confirmação diagnóstica durante o acompanhamento e 1 (8%), por meio de mediastinoscopia. Em outros 3, o diagnóstico final foi sarcoidose ou neoplasia. Para o diagnóstico de doença granulomatosa, câncer e linfadenopatia reacional, a EBUS-TBNA apresentou sensibilidade de 73%, 68% e 92%, respectivamente; especificidade de 100%, 100% e 93%, respectivamente; precisão de 86%, 93% e 93%, respectivamente; VPP de 100%, 100% e 80%, respectivamente; VPN de 78%, 92% e 98%, respectivamente. Conclusões: Em pacientes não neoplásicos, doenças granulomatosas e linfadenopatia reacional parecem ser causas comuns de LI isolada. A EBUS-TBNA apresenta resultados promissores como procedimento diagnóstico minimamente invasivo de primeira linha. Os resultados obtidos pela EBUS-TBNA podem ser otimizados pelos achados clínicos e radiológicos durante o acompanhamento ou pela comparação com os resultados de outros métodos broncoscópicos.


Subject(s)
Humans , Bronchi/diagnostic imaging , Bronchoscopy , Ultrasonography, Interventional/methods , Endoscopic Ultrasound-Guided Fine Needle Aspiration/methods , Lymphadenopathy/diagnostic imaging , Lymph Nodes/diagnostic imaging , Mediastinum/diagnostic imaging , Biopsy, Needle/methods , Bronchi/pathology , Retrospective Studies , Sensitivity and Specificity , Biopsy, Fine-Needle , Lymphadenopathy/pathology , Lymph Nodes/pathology
15.
J. bras. pneumol ; 46(6): e20190221, 2020. tab, graf
Article in English | LILACS | ID: biblio-1134920

ABSTRACT

ABSTRACT Objective: Lung cancer (LC) is one of the leading causes of death worldwide. Accurate mediastinal staging is mandatory in order to assess prognosis and to select patients for surgical treatment. EBUS-TBNA is a minimally invasive procedure that allows sampling of mediastinal lymph nodes (LNs). Some studies have suggested that EBUS-TBNA is preferable to surgical mediastinoscopy for mediastinal staging of LC. The objective of this systematic review and meta-analysis was to compare EBUS-TBNA and mediastinoscopy in terms of their effectiveness for mediastinal LN staging in potentially operable non-small cell lung cancer (NSCLC). Methods: This was a systematic review and meta-analysis, in which we searched various databases. We included studies comparing the accuracy of EBUS-TBNA with that of mediastinoscopy for mediastinal LN staging in patients with NSCLC. In the meta-analysis, we calculated sensitivity, specificity, positive likelihood ratios, and negative likelihood ratios. We also analyzed the risk difference for the reported complications associated with each procedure. Results: The search identified 4,201 articles, 5 of which (with a combined total of 532 patients) were selected for inclusion in the meta-analysis. There were no statistically significant differences between EBUS-TBNA and mediastinoscopy in terms of the sensitivity (81% vs. 75%), specificity (100% for both), positive likelihood ratio (101.03 vs. 95.70), or negative likelihood ratio (0.21 vs. 0.23). The area under the summary ROC curve was 0.9881 and 0.9895 for EBUS-TBNA and mediastinoscopy, respectively. Although the number of complications was higher for mediastinoscopy, the difference was not significant (risk difference: −0.03; 95% CI: −0.07 to 0.01; I2 = 76%). Conclusions: EBUS-TBNA and mediastinoscopy produced similar results for mediastinal staging of NSCLC. EBUS-TBNA can be the procedure of first choice for LN staging in patients with NSCLC.


RESUMO Objetivo: O câncer de pulmão (CP) é uma das principais causas de morte no mundo. Um estadiamento mediastinal preciso é obrigatório para avaliação do prognóstico e seleção de pacientes para tratamento cirúrgico. EBUS-TBNA é um procedimento minimamente invasivo que permite a amostragem de linfonodos mediastinais. Alguns estudos sugerem que a EBUS-TBNA é preferível que a mediastinoscopia cirúrgica no estadiamento mediastinal do CP. O objetivo desta revisão sistemática e meta-análise foi comparar a eficácia da EBUS-TBNA e da mediastinoscopia no estadiamento linfonodal mediastinal do câncer de pulmão de células não pequenas (CPCNP) potencialmente operável. Métodos: Foram pesquisados diversos bancos de dados. Estudos comparando a precisão da EBUS-TBNA e da mediastinoscopia no estadiamento linfonodal mediastinal em pacientes com CPCNP foram incluídos. Na meta-análise, foram calculadas sensibilidade e especificidade, bem como razões de verossimilhança positiva e negativa. A diferença de risco de complicações relatadas para cada procedimento também foi analisada. Resultados: A pesquisa identificou 4.201 artigos, dos quais 5 foram selecionados para a meta-análise (total combinado de 532 pacientes). Não houve diferenças estatisticamente significativas entre EBUS-TBNA e mediastinoscopia: sensibilidade (81% vs. 75%), especificidade (100% para ambas), razão de verossimilhança positiva (101,03 vs. 95,70) e razão de verossimilhança negativa (0,21 vs. 0,23). A área sob a curva summary ROC para EBUS-TBNA e para mediastinoscopia foi de 0,9881 e 0,9895, respectivamente. Embora o número de complicações tenha sido maior para mediastinoscopia, não foi encontrada diferença significativa (diferença de risco: −0,03; IC95%: −0,07 to 0,01; I2 = 76%). Conclusões: EBUS-TBNA e mediastinoscopia apresentaram resultados semelhantes no estadiamento mediastinal do CPCNP. EBUS-TBNA pode ser o procedimento de primeira escolha no estadiamento linfonodal em pacientes com CPCNP.


Subject(s)
Humans , Endoscopic Ultrasound-Guided Fine Needle Aspiration/methods , Lung Neoplasms/pathology , Lung Neoplasms/diagnostic imaging , Lymph Nodes/surgery , Mediastinal Neoplasms/diagnostic imaging , Mediastinoscopy/methods , Bronchoscopy , Sensitivity and Specificity , Carcinoma, Non-Small-Cell Lung/surgery , Carcinoma, Non-Small-Cell Lung/pathology , Carcinoma, Non-Small-Cell Lung/diagnostic imaging , Endoscopy , Lymph Nodes/diagnostic imaging , Mediastinum/surgery , Neoplasm Staging
16.
Rev. cuba. med. mil ; 48(4): e391, oct.-dic. 2019. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1126653

ABSTRACT

Introducción: Las neoplasias mediastinales son tumores poco frecuentes, pueden aparecer a cualquier edad y por lo general se descubren incidentalmente en una radiografía de tórax de rutina en pacientes asintomáticos. Objetivo: Caracterizar a los pacientes operados por tumores de mediastino según variables clínico- epidemiológicas y diagnósticas seleccionadas. Métodos: Se realizó un estudio observacional, descriptivo, de tipo serie de casos con 37 enfermos ingresados y operados con diagnóstico de tumor mediastinal, en el Servicio de Cirugía General del Hospital Provincial Docente "Saturnino Lora" de Santiago de Cuba, durante los años 2010 a 2017. Resultados: Predominó el sexo femenino con 23 pacientes y el intervalo de edad entre 31 y 40 años (11 casos). Los síntomas más comunes fueron dolor torácico, tos y disnea. El compartimiento posterior fue el mayormente afectado (11 pacientes), así como los tumores con tamaños entre 7 y 9 cm (17 enfermos). Los medios diagnósticos más utilizados fueron la tomografía computarizada, la broncoscopia y la mediastinoscopia. Primaron los tumores malignos (54,1 por ciento) en los que se identificó una amplia gama de variedades histológicas. Conclusiones: El diagnóstico definitivo generalmente se establece mediante el estudio histopatológico posquirúrgico, aunque la tomografía computarizada asociada o no a la biopsia percutánea es la regla de oro para el diagnóstico preoperatorio. Las variedades histológicas de los tumores malignos son atribuibles a las características del órgano afectado(AU)


ABSTRACT Introduction: Mediastinal neoplasms are rare tumours; they can appear at any age and they are usually discovered incidentally on a routine chest radiograph in asymptomatic patients. Objective: To characterize patients operated on mediastinal tumours according to selected clinical, epidemiological and diagnostic variables. Methods: An observational, descriptive study of a series of cases with 37 patients admitted and operated with diagnosis of mediastinal tumour in the General Surgery Service of the Provincial Teaching "Saturnino Lora" Hospital from Santiago de Cuba, during the years 2010 to 2017. Results: The female sex predominated with 23 patients and the age interval between 31 and 40 years (11 cases). The most common symptoms were chest pain, cough and dyspnea. The posterior compartment was the most affected (11 patients), as well as the tumors with sizes between 7 and 9 cm (17 cases). The most used diagnostic means were computed tomography, bronchoscopy and mediastinoscopy. Malignant histological varieties prevailed (54.1 percent). Conclusions: The definitive diagnosis is usually established by postoperative histopathological study, although computed tomography associated or not with percutaneous biopsy is the gold standard for preoperative diagnosis. Malignant histological varieties are related with characteristics of the affected organ(AU)


Subject(s)
Humans , Adult , Middle Aged , Biopsy/methods , Bronchoscopy/methods , Mediastinal Neoplasms/diagnostic imaging , Mediastinum , Epidemiology, Descriptive , Observational Study
17.
Rev. bras. cir. cardiovasc ; 34(4): 484-487, July-Aug. 2019. tab, graf
Article in English | LILACS | ID: biblio-1020488

ABSTRACT

Abstract Placement of a mediastinal drain is a routine procedure following heart surgery. Postoperative bed rest is often imposed due to the fear of potential risk of drain displacement and cardiac injury. We developed an encapsulating stitch as a feasible, effective and low-cost technique, which does not require advanced surgical skills for placement. This simple, novel approach compartmentalizes the drain allowing for safe early mobilization following cardiac surgery.


Subject(s)
Humans , Postoperative Complications/prevention & control , Drainage/instrumentation , Coronary Artery Bypass , Intraoperative Neurophysiological Monitoring/methods , Mediastinum/surgery , Pericardial Effusion/prevention & control , Drainage/methods , Feasibility Studies , Heart Ventricles/injuries
18.
Med. UIS ; 32(2): 47-52, mayo-ago. 2019. graf
Article in Spanish | LILACS | ID: biblio-1114967

ABSTRACT

Resumen El neumomediastino espontáneo idiopático es la presencia de aire en el mediastino, sin ninguna causa aparente, siendo descrito en 1939 por el Dr. Hamman. Se atribuye a una fuga dinámica de aire desde los alvéolos a través del intersticio de personas jóvenes (efecto Macklin). La clínica no es específica, pero el dolor torácico agudo retroesternal y la tos, son los síntomas más orientativos; los signos más específicos son los crépitos precordiales (signo de Hamman) y el enfisema subcutáneo. La radiografía de tórax es suficiente para el diagnóstico, aunque otras técnicas de imagen sirven para evaluar causas secundarias. El tratamiento es reposo, analgésicos y, opcionalmente, oxígeno suplementario. Se presenta el caso de un niño en edad escolar con neumomediastino espontáneo sin ningún desencadenante identificable, siendo el primer caso pediátrico colombiano reportado de esta variante. MÉD.UIS.2019;32(2):47-52


Abstract Idiopathic spontaneous pneumomediastinum is the presence of air in the mediastinum, without any apparent cause, it was described in 1939 by Dr. Hamman. It is attributed to a dynamic escape of air from the alveoli through the pulmonary interstice of young people (Macklin effect). The clinical symptoms are not specific, but acute retrosternal chest pain and cough are the most indicative symptoms; the most specific signs are precordial crepitus (Hamman's sign) and subcutaneous emphysema. The chest X-ray is enough for the diagnosis; however, other imaging techniques are used to evaluate secondary causes. The treatment is rest, analgesics and, optionally, supplemental oxygen. There is presented the case of a school-age child with spontaneous pneumomediastinum without any identifiable trigger, being the first reported Colombian pediatric case of this variant. MÉD.UIS.2019;32(2):47-52


Subject(s)
Humans , Male , Child , Mediastinal Emphysema , Oxygen , Signs and Symptoms , Subcutaneous Emphysema , Thorax , X-Rays , Chest Pain , Case Reports , Radiography , Child , Adolescent , Colombia , Cough , Dissociative Disorders , Mediastinum
19.
Korean Journal of Head and Neck Oncology ; (2): 67-70, 2019.
Article in Korean | WPRIM | ID: wpr-787527

ABSTRACT

Ganglioneuroma (GN) is benign neurogenic tumor arising from ganglia of the sympathetic nervous system. They are mostly found at posterior mediastinum, retroperitoneum, and adrenal gland, whereas only 1–5% occurred in the cervical region. GN usually present as a single, painless and slow-growing mass, but multiple cervical occurrences are extremely rare. An 80-year-old woman came to our clinic complained of posterior neck mass for three years. We performed surgical excision, and it was finally diagnosed as GN. We report the unique and rare disease entity with a brief literature review.


Subject(s)
Aged , Aged, 80 and over , Female , Humans , Adrenal Glands , Ganglia , Ganglioneuroma , Mediastinum , Neck , Rare Diseases , Sympathetic Nervous System
20.
Singapore medical journal ; : 17-21, 2019.
Article in English | WPRIM | ID: wpr-776963

ABSTRACT

A 68-year-old woman presented with weight loss of 7 kg over two years. Clinical examination revealed no specific abnormality and the patient was otherwise asymptomatic. Chest radiography performed to screen for malignancy revealed a soft tissue opacity projected over the mediastinum. Computed tomography of the thorax showed an enhancing anterior mediastinal mass with heterogeneous enhancement and contrast pooling in the arterial phase, followed by homogeneous enhancement in the venous phase, consistent with an aneurysm arising from the superior vena cava. This case highlights superior vena cava aneurysms as extremely rare causes of anterior mediastinal masses. Other causes of anterior mediastinal masses were also discussed.


Subject(s)
Aged , Female , Humans , Aneurysm , Diagnostic Imaging , Mediastinum , Diagnostic Imaging , Radiography, Thoracic , Tomography, X-Ray Computed , Vena Cava, Superior , Diagnostic Imaging
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