Natural course of spontaneous pneumothorax without bullae or blebs under high-resolution computed tomography.

BACKGROUND: The cause of primary spontaneous pneumothorax (PSP) is known as rupture of some bullae or blebs. OBJECTIVE: The aim of this study is to clarify the natural course of spontaneous pneumothorax in the absence of bullae or blebs under high-resolution chest computed tomography (HRCT). PATIENTS AND METHOD: From January 2006 to December 2010, 854 patients with PSP were enrolled in the study group. All subjects received a chest CT scan and were reviewed retrospectively. RESULT: There were 56 PSP cases (6.5%) without bullae or blebs under HRCT. Treatments included oxygen therapy in 16 (28.5%) cases, arrow catheter insertion in 22 (39.2%) cases, closed thoracostomy in 17 (30.3%) cases, and 1 (1.7%) case received a video-assisted thoracoscopic surgery (VATS) operation. There were nine recurrent cases (16%). Of the nine cases, eight cases were treated with VATS operation. Several bullae or blebs were found in five of those nine operated cases, and there were severe inflammatory fibrotic changes on the apex of one of the nine operated cases. CONCLUSION: Several bullae and blebs were revealed upon operation of PSP without previously detected bullae and blebs on HRCT. We cautiously recommend operating on PSP regardless of whether bullae and blebs are detected by HRCT as long as there are no contraindications to the operation.

Transcatheter Embolization of Giant Pulmonary Arteriovenous Malformation with an Amplatzer Vascular Plug II.

Pulmonary arteriovenous malformation (PAVM) is a rare anomalous direct communication between the pulmonary artery and vein with a considerable risk of serious complications such as cerebral thromboembolism or abscess and pulmonary hemorrhage. Although the past, surgical resection such as lobectomy was mostly used to treat PAVM, the recent development of endovascular treatment has made it a primary consideration to perform transcatheter embolization using coils or detachable balloons. We report a case of successful transcatheter embolization of giant PAVM with the second generation Amplatzer vascular plug II as a new self-expanding device.

Clinical review and analysis of complications of totally implantable venous access devices for chemotherapy.

Since the first implant of totally implantable venous access device (TIVAD), performed by Niederhuber and colleague in 1982, the systems have increasingly been used in the field of oncology. We analyzed the clinical reviews and complications of TIVAD in an effort to achieve optimal management. We retrospectively studied 442 cases with TIVAD device at our hospital and we report the results. Four hundred and forty-two TIVAD were placed in the right subclavian vein in 345 cases, the left subclavian vein in 93 cases, the right jugular vein in 2 cases, the left jugular vein in 1 case, and the right femoral vein in 1 case. The immediate complications were 28 cases in malposition of the catheter, 10 cases of arterial puncture, and 2 cases of pneumothorax. The late complications were 3 cases of pocket infection, 2 cases of catheter related to sepsis, 3 cases of catheter obstruction, 2 cases of SVC thrombosis, and 1 case of catheter fracture (pinch-off syndrome: Hinke grade 3). There were no other early or late complications. The low rate of complications in the study confirms the safety and convenience of using TIVAD in patients undergoing prolonged chemotherapy. Yet because infection, thrombosis and catheter fracture are the most common long-term complications of TIVAD, early diagnosis and management of these problems can prevent severe complications.

Venous distensibility as a key factor in the success of arteriovenous fistulas at the wrist.

BACKGROUND: The diameter of veins in the superficial forearm has been shown to correlate with risk for nonmaturation of newly created arteriovenous fistulas (AVFs). However, reported cut-off diameters are inconsistent. The purpose of our study was to assess the optimal diameter and distensibility of the radiocephalic vein at the wrist using the tourniquet method. METHODS: We selected 50 consecutive patients who received AVFs between June 2007 and July 2009. All patients underwent venography before surgery. Approximately 30 minutes after the first venography, the upper arm cuff was inflated to stop superficial venous return. After 1 minute, a second venography was performed, after which the diameters of the distended radiocephalic veins were measured. We used these data to determine the optimal size and distensibility of the radiocephalic vein for a successful AVF at the wrist. RESULTS: Participants consisted of 38 men and 12 women. We found no significant correlation between diabetes or hypertension and success of AVFs. We found that radiocephalic veins with diameters >3.25 mm after the tourniquet maneuver had a fourfold higher success rate compared with that of smaller veins, but this difference was not statistically significant (p = 0.09). We also found that the procedure success rate was significantly higher with radiocephalic veins whose diameters increased by >0.35 mm during venography (odds ratio = 7.422). CONCLUSION: For AVFs, it is important to use radiocephalic veins with a diameter of ≥3.25 mm after the tourniquet maneuver. In addition, AVF outcomes at the wrist are significantly better using radiocephalic veins that show an increase of >0.35 mm on venography.

Lemierre syndrome.

Lemierre syndrome is caused by acute oropharyngeal infections with secondary septic thrombophlebitis of the internal jugular vein and is characterized by frequent metastatic infections. A 56-year-old man presented with severe reddish inflammatory swelling of the right cervical soft tissue. Thrombophlebitis in the right internal jugular vein and multiple pulmonary embolisms were identified on neck and chest computed tomography (CT). He was treated with antibiotics and heparin for 4 weeks and then discharged without other complications.

Rare case of multiple pulmonary artery aneurysms with caval thrombosis--Hughes-Stovin syndrome.

Hughes and Stovin first reported a syndrome consisting of multiple pulmonary artery aneurysms and venous thrombosis in 1959. We encountered a 45-year-old man who had massive hemoptysis and leg swelling. The CT and angiography showed huge bilateral pulmonary artery aneurysms and inferior vena caval thrombosis. The bilateral lower lobe aneurysms were successfully treated with staged operations. The patient tolerated the procedures relatively well and was followed up by steroid therapy with a good response.