Computer tomography measurements of the airway and thoracic cavity do not provide support for bronchial conformation as a predisposing factor of left cranial lung lobe torsion in pugs.

The objective of this retrospective clinical study was to determine if airway or thoracic cavity measurements in pugs, particularly the left cranial lung lobe, were significantly different from brachycephalic and mesocephalic control. Thoracic computed tomographic studies of 10 pugs, French bulldogs (FB), and Jack Russell Terriers (JRT) were analyzed. Thoracic height: width ratio (H:W), cross-sectional areas of the left mainstem bronchus (CSA LMB), left cranial lung lobe bronchus (CSA LCrBr), left caudal lung lobe bronchus (CSA LCauBr), CSA LCrBr relative to length (CSA LCrBr/length) and CSA LCauBr/length were measured and adjusted to body weight (/kg). CSA LMB/kg, CSA LCauBr/length/kg, and CSA LCrBr/length /kg were smaller in pugs and FB compared with JRT (P < .05), but no differences were found between pugs and FB. Cross-sectional areas of left cranial lung lobe bronchus /kg and CSA LCauBr/kg were smaller in pugs than JRT (P < .05), but no differences were found between pugs and FB or FB and JRT. No difference was found in thoracic H:W between any breeds. This demonstrated that pugs and FB had significantly narrower bronchi CSA/lengths ratios compared with JRT, but this was not limited to the LCBr. Airway measurements were not significantly different between brachycephalic breeds; therefore, the pugs' predisposition to left cranial lung lobe torsion cannot be solely explained by narrower lower airways.

Thoracic cavity of the Shirazi cats: New insights using computed tomography and magnetic resonance imaging.

Our study provided a comprehensive characterization of the thorax of Shirazi cats by comparing the relevant soft and bone windows of computed tomography (CT) and magnetic resonance imaging (MRI) with cross, sagittal and coronal sectional anatomy. We outlined the mediastinum and its anatomic relationships with the trachea, oesophagus, lungs, heart, cranial and caudal vena cavae, and other thoracic structures using the data series gathered from adult normal Shirazi cats. The cranial mediastinum extended from the thoracic inlet to the 4th intercostal space, the middle mediastinum extended from the 5th and 7th intercostal spaces and was occupied by the heart and large blood vessels and the caudal mediastinum extended as a short and narrow portion from the 8th intercostal space to the diaphragm. The contents of the mediastinum and its relationship with the lungs and diaphragm were clearly presented in coronal-sectional anatomy and CT slices. The diaphragm was clearly observed in the lung windows of the ventral thorax. Sagittal-sectional anatomy and CT clarified the thorax's architecture and its contents, with higher density in the soft windows. The distribution of thoracic vessels on cross- and coronal-contrast CT scans was clearly visible. In addition, MRI scans provided an excellent anatomic reference of the thorax with the help of cross, coronal and sagittal scans, especially in the heart and blood vessels. Our study provides a valuable atlas for the diagnosis of malformations of the thoracic structures and offers better assessments for helping veterinary radiologists and clinicians in diagnostic processes.

Evaluación de técnicas mínimamente invasivas en el diagnóstico de enfermedades benignas y malignas del tórax / An Assessment of Minimally Invasive Techniques for the Diagnosis of Benign and Malignant Thoracic Diseases

Introducción: Los cambios en la tecnología médica abarcan todas las especialidades y dentro de ellas, en la cirugía general. Las técnicas mínimamente invasivas han ocupado un papel cimero en el diagnóstico y tratamiento de enfermedades en la cavidad torácica. Objetivo: Describir el uso de las técnicas mínimamente invasivas en el diagnóstico de enfermedades intratorácicas. Métodos: Se realizó un estudio observacional, retrospectivo de corte transversal para evaluar el uso de técnicas mínimamente invasivas en el diagnóstico de las enfermedades intratorácicas en el Hospital Universitario "Manuel Ascunce Domenech" desde enero de 2017 hasta mayo de 2020. El universo estuvo compuesto por 104 pacientes con sospecha diagnóstica de enfermedades benignas o malignas del tórax. Resultados: La mayor parte de los pacientes con enfermedades benignas y malignas del tórax tenían una edad de 49 (±7,05) años, sin significación intersexo. La hipertensión arterial predominó como principal comorbilidad. La videotoracoscopia fue la técnica mínimamente invasiva más empleada y la sospecha de cáncer pulmonar y enfermedad pleural constituyeron las indicaciones más frecuentes que motivaron el proceder. El diagnóstico posoperatorio que predominó en la serie fue el cáncer pulmonar. Las técnicas mínimamente invasivas empleadas mostraron una alta validez. La mayoría de los pacientes egresaron vivos y sin complicaciones. Conclusiones: El uso de técnicas mínimamente invasivas en varias enfermedades intratorácicas son de vital importancia para definir diagnóstico y tratamiento(AU)

Introduction: Changes in medical technology cover all specialties and, within them, general surgery. Minimally invasive techniques have played a paramount role in the diagnosis and treatment of thoracic cavity diseases. Objective: To describe the use of minimally invasive techniques in the diagnosis of intrathoracic diseases. Methods: An observational, retrospective and cross-sectional study was carried out, from January 2017 to May 2020, in order to assess the use of minimally invasive techniques in the diagnosis of intrathoracic diseases at Manuel Ascunce Domenech University Hospital. The universe was made up of 104 patients with suspected benign or malignant diseases of the chest. Results: Most of the patients with benign and malignant chest diseases were 49 (± 7.05) years old, without intersex significance. Arterial hypertension predominated as the main comorbidity. Videothoracoscopy was the most widely used minimally invasive technique, while suspicion of lung cancer and pleural disease were the most frequent indications that motivated the procedure. The postoperative diagnosis that predominated in the series was lung cancer. The minimally invasive techniques used showed high validity. Most of the patients were discharged alive and without complications. Conclusions: The use of minimally invasive techniques in various intrathoracic diseases are of vital importance to define diagnosis and treatment(AU)

Cardiothoracic ratio measurement using artificial intelligence: observer and method validation studies.

BACKGROUND: Artificial Intelligence (AI) is a promising tool for cardiothoracic ratio (CTR) measurement that has been technically validated but not clinically evaluated on a large dataset. We observed and validated AI and manual methods for CTR measurement using a large dataset and investigated the clinical utility of the AI method. METHODS: Five thousand normal chest x-rays and 2,517 images with cardiomegaly and CTR values, were analyzed using manual, AI-assisted, and AI-only methods. AI-only methods obtained CTR values from a VGG-16 U-Net model. An in-house software was used to aid the manual and AI-assisted measurements and to record operating time. Intra and inter-observer experiments were performed on manual and AI-assisted methods and the averages were used in a method variation study. AI outcomes were graded in the AI-assisted method as excellent (accepted by both users independently), good (required adjustment), and poor (failed outcome). Bland-Altman plot with coefficient of variation (CV), and coefficient of determination (R-squared) were used to evaluate agreement and correlation between measurements. Finally, the performance of a cardiomegaly classification test was evaluated using a CTR cutoff at the standard (0.5), optimum, and maximum sensitivity. RESULTS: Manual CTR measurements on cardiomegaly data were comparable to previous radiologist reports (CV of 2.13% vs 2.04%). The observer and method variations from the AI-only method were about three times higher than from the manual method (CV of 5.78% vs 2.13%). AI assistance resulted in 40% excellent, 56% good, and 4% poor grading. AI assistance significantly improved agreement on inter-observer measurement compared to manual methods (CV; bias: 1.72%; - 0.61% vs 2.13%; - 1.62%) and was faster to perform (2.2 ± 2.4 secs vs 10.6 ± 1.5 secs). The R-squared and classification-test were not reliable indicators to verify that the AI-only method could replace manual operation. CONCLUSIONS: AI alone is not yet suitable to replace manual operations due to its high variation, but it is useful to assist the radiologist because it can reduce observer variation and operation time. Agreement of measurement should be used to compare AI and manual methods, rather than R-square or classification performance tests.

Diagnosis by forensic autopsy of cannula malposition resulting in fatal tension pneumothorax after attempted percutaneous tracheostomy: A short communication.

Percutaneous tracheostomy is commonly performed in the emergency department or intensive care unit to secure the airways of patients. This procedure is associated with a low incidence of complications; however, some of them, such as iatrogenic pneumothorax, can be fatal. Pneumothorax after percutaneous tracheostomy is most often caused by perforation of the tracheal wall or malposition of the cannula. A woman in her 80s was referred to the emergency department owing to persistent and prolonged coughing. Having speculated that she had acute epiglottitis, and having failed to achieve oral tracheal intubation, the physician performed a percutaneous tracheostomy to secure her airway. However, progressive percutaneous emphysema developed immediately thereafter, and the patient died shortly. Postmortem computed tomography showed bilateral pneumothorax. Forensic autopsy revealed that the tracheostomy cannula had failed to reach the trachea and was erroneously inserted into the right thoracic cavity via peritracheal route. Thus, it was determined that the patient's death was attributable to tension pneumothorax caused by cannula malposition during attempted tracheostomy. To the best of our knowledge, this is the first forensic autopsy case report on fatal tension pneumothorax caused by attempted percutaneous tracheostomy.

Use of Multiphase CT Protocols in 18 Countries: Appropriateness and Radiation Doses.

PURPOSE: To assess the frequency, appropriateness, and radiation doses associated with multiphase computed tomography (CT) protocols for routine chest and abdomen-pelvis examinations in 18 countries. MATERIALS AND METHODS: In collaboration with the International Atomic Energy Agency, multi-institutional data on clinical indications, number of scan phases, scan parameters, and radiation dose descriptors (CT dose-index volume; dose-length product [DLP]) were collected for routine chest (n = 1706 patients) and abdomen-pelvis (n = 426 patients) CT from 18 institutions in Asia, Africa, and Europe. Two radiologists scored the need for each phase based on clinical indications (1 = not indicated, 2 = probably indicated, 3 = indicated). We surveyed 11 institutions for their practice regarding single-phase and multiphase CT examinations. Data were analyzed with the Student t test. RESULTS: Most institutions use multiphase protocols for routine chest (10/18 institutions) and routine abdomen-pelvis (10/11 institutions that supplied data for abdomen-pelvis) CT examinations. Most institutions (10/11) do not modify scan parameters between different scan phases. Respective total DLP for 1-, 2-, and 3-phase routine chest CT was 272, 518, and 820 mGy·cm, respectively. Corresponding values for 1- to 5-phase routine abdomen-pelvis CT were 400, 726, 1218, 1214, and 1458 mGy cm, respectively. For multiphase CT protocols, there were no differences in scan parameters and radiation doses between different phases for either chest or abdomen-pelvis CT (P = 0.40-0.99). Multiphase CT examinations were unnecessary in 100% of routine chest CT and in 63% of routine abdomen-pelvis CT examinations. CONCLUSIONS: Multiphase scan protocols for the routine chest and abdomen-pelvis CT examinations are unnecessary, and their use increases radiation dose.

Type 2 Myocardial Infarction Resulted from the Left Thoracic Stomach.

The universal definition of myocardial infarction (MI) provides five subtypes of acute myocardial infarction (AMI). We present an interesting case of a type 2 myocardial infarction caused by the dilation of the left thoracic stomach.

Pleuroperitoneal true diaphragmatic hernia of the liver in a cat.

A 2-year old female domestic shorthair cat was referred with intermittent vomiting. Laboratory analyses revealed only an elevated alanine aminotransferase activity. Plain thoracic radiographs showed a right-sided transdiaphragm protrusion of a liver lobe into the thoracic cavity. On abdominal ultrasound the diaphragm and liver parenchyma also presented a bulge towards the thoracic cavity. By cranial median laparotomy herniation of the quadrate liver lobe through the right aspect of the diaphragm into the thoracic cavity was confirmed. The protruding quadrate liver lobe was covered by intact parietal peritoneum. Following relocation of the liver lobe the defect was closed. Postoperatively the intermittent vomiting stopped. The purpose of this case report was to present plain radiography and abdominal ultrasonography as effective tools in the diagnosis of this rare and usually asymptomatic true herniation case along with its operative treatment.

Assessment of thoracic volume changes after the collapse of lateral rib fractures based on chest computed tomography data: computer simulation and a multiple variable linear regression analysis.

BACKGROUND: Chest blunt trauma (CBT) and the resultant rib fractures often lead to thoracic collapse. The purpose of this study was to explore the effect of displacement of the rib fracture and thoracic collapse on the thoracic volume by using normal chest CT data. METHODS: In this retrospective study, seven consecutive normal participants were selected from our hospital between June and July 2018. Normal thoracic models were reconstructed, followed by simulation of lateral fractures through the 4th to 9th ribs under three collapse modes with 1-5 cm of collapse. The thoracic collapse models (n = 630) were reconstructed using 3Dmax 2014. We calculated the thoracic volume and reduction percentage for each thoracic collapse model. Linear regression-based comparisons of thoracic volume reductions were performed. RESULTS: In all three collapse modes, the degree of the collapse was linearly correlated with the mean thoracic volume reduction. The reduction percentage in the posterior collapse mode was higher than that in the anterior collapse mode (P < 0.001). The largest volume reductions in the anterior, posterior, and simultaneous collapse models were in the 6th rib fracture model (P < 0.001), 8th rib fracture model (P < 0.001), and 7th rib fracture model (P < 0.001), respectively. CONCLUSIONS: The influences of rib fracture displacement and collapse on the thoracic volume in the 6th through 8th ribs are critical in lateral rib fractures. For patients with 6th to 8th rib fractures and posterior rib collapse, surgical intervention to restore thoracic volume may be more essential.

Lung ultrasound in a respiratory pandemic.

Australian hospitals have prepared for a major surge in patients due to the infectious respiratory pandemic COVID-19. In other nations, patient presentations have overwhelmed resources. Ultrasound has been shown to be an effective tool to exclude significant life-threats in resource poor settings. In this article, we will describe three lung ultrasound algorithms for the emergency diagnosis of patients presenting with respiratory symptoms during a COVID-19 pandemic: (i) LUSC19: lung ultrasound to assess the severity of COVID-19; (ii) LUSAC: lung ultrasound to exclude alternative causes of respiratory distress; and (iii) LUSI: lung ultrasound following intubation. We anticipate that emergency physicians will use these algorithms during the upcoming respiratory pandemic to rapidly determine the severity of COVID-19 infection, to seek and treat significant alternative diagnoses and ensure endotracheal intubation.

THORACIC RADIOGRAPHY AND TRANSTHORACIC ECHOCARDIOGRAPHY IN CLINICALLY HEALTHY RING-TAILED LEMURS (LEMUR CATTA).

Cardiac disease has been recognized as a major cause of death in captive nonhuman primates, which necessitates diagnostic (imaging) techniques to screen for and diagnose preclinical and clinical stages of possible cardiac conditions. Echocardiography is currently the most commonly used diagnostic tool for evaluation of cardiac anatomy and function. Complete with thoracic radiography and blood levels of two cardiac biomarkers, N-terminal probrain natriuretic peptide (NT-proBNP) and cardiac troponin T (cTnT), it gives an extensive examination of the cardiorespiratory system. The purpose of this cross-sectional cohort study is to describe normal thoracic anatomy using thoracic radiography, and to provide normal values for echocardiographic measurements in 20 ring-tailed lemurs (Lemur catta). Additionally, cardiac biomarkers were determined. Three radiographic projections of the thoracic cavity and a complete transthoracic echocardiography were performed in 20 clinically healthy ring-tailed lemurs during their annual health examinations. Similar standard right parasternal and left apical echocardiographic images were obtained as described in dogs and cats and normal values for routine two-dimensional (2D-), time-motion (M-) and Doppler mode measurements were generated. Furthermore, a noninvasive smartphone base ECG recording and blood concentrations of cardiac biomarkers were obtained. Other radiographic measurements are provided for the skeletal and respiratory systems such as the trachea to inlet ratio and tracheal inclination. Knowledge of the normal radiographic thoracic and echocardiographic anatomy and function are fundamental for the diagnosis and follow-up of cardiac disease in affected individuals and for species screening, and will be of added value in future research in and conservation of this endangered species.

Radiography and computed tomography of the heart and lower respiratory tract in toco toucans (Ramphastos toco).

This study aimed to evaluate normal features of the heart and lower respiratory tract in toco toucans by means of radiography and helical computed tomography (CT) scanner. Fifteen healthy adult toco toucans (Ramphastos toco), 10 females and 5 males, average body mass of 650 g were studied. CT examination as well as right lateral and ventrodorsal radiographic examinations of the coelomic cavity were performed under chemical restraint. Heart, lungs, air sacs, trachea and syrinx were analysed. The mean values of heart length, heart width and thoracic cavity in radiographs were, respectively, 23.76 mm, 25.94 mm and 48.87 mm. In both X-rays and CT scans, the lung parenchyma had honeycomb-like pattern. The topographic areas of the anterior and posterior air sacs were visualized as dark and air-filled spaces in X-rays. On CT evaluation, the air sacs occupied a larger area in the coelomic cavity compared to X-ray. In the lateral radiographic view, the cervical part of the trachea was positioned more ventrally in the transition from cervical to thoracic regions showing a V-shaped appearance. In all CT planes was visible division of the trachea into the right and left main bronchi at the level of 3rd thoracic vertebra. The syrinx was difficult to visualize in X-rays, but on CT it was easily identified in axial slice. In conclusion, the normal features of toco toucan's heart and lower respiratory tract that were determined on X-rays and CT scans are useful to compare with sick toco toucans, as well as other bird species.

Dasatinib-induced chylothorax: report of a case and review of the literature.

Dasatinib is a tyrosine kinase inhibitor for the treatment of BCR-ABL-positive chronic myeloid leukaemia (CML) or Philadelphia chromosome-positive acute lymphoblastic leukaemia (ALL). Although fluid retention is a common adverse event associated with dasatinib, chylothorax is exceptionally rare. The pathological mechanism, clinical manifestation and management of dasatinib-induced chylothorax are completely unclear. A 71-year-old man treated with dasatinib for CML was admitted for progressive dyspnea. Computed tomography (CT) showed a pleural effusion that was more prominent on the right thoracic cavity. Thoracentesis showed thick milky pleural fluid, which was then confirmed as chylothorax by chylum qualitative tests and triglyceride measurements. Radionuclide lymphoscintigraphy yielded an obstruction at the end segment of the thoracic duct, but no leakage points were found. After excluding common causes, drug-induced chylothorax was presumed. Then, dasatinib was withdrawn, and 1 week later, chylothorax resolved. To further elucidate the relationship between the medication and chylothorax, dasatinib was resumed tentatively for 2 days. As expected, pleural effusion recurred soon. Based on these clinical manifestations, the diagnosis of dasatinib-induced chylothorax was identified. The patient was suggested to stop dasatinib and use an alternative drug as recommended by the haematologist. Pleural effusion is the common adverse reaction of dasatinib, but chylothorax is rare. Only six cases of dasatinib-induced chylothorax have been reported, and our patient is the seventh case. Once a patient with dasatinib treatment develops chylothorax, dasatinib should be considered one of the possible causes. If no other definitive aetiological factor is identified, dasatinib discontinuation might be the optimum scheme.

Hemoptisis como manifestación de la ectopia torácica de cálculos biliares / Hemoptysis as a Manifestation of Gallstone Ectopia in the Lungs

No disponible

Electrical injury: an unusual cause of pneumothorax and a review of literature.

Electrical injuries are a common occurrence and can be minor or even fatal depending on the voltage to which an individual has been exposed to. Electrical current causes tissue damage by producing heat due to local tissue resistance. Serious electrocution may manifest with cutaneous burns, visceral injuries, organ perforation, and cardiac and respiratory effects. Pneumothorax as a complication of electrical injury is a very rare entity. We report one such case of electrical burn injury with right-sided pneumothorax as an immediate complication.

Imaging respiratory muscle quality and function in Duchenne muscular dystrophy.

OBJECTIVE: Duchenne muscular dystrophy (DMD) is characterized by damage to muscles including the muscles involved in respiration. Dystrophic muscles become weak and infiltrated with fatty tissue, resulting in progressive respiratory impairment. The objective of this study was to assess respiratory muscle quality and function in DMD using magnetic resonance imaging and to determine the relationship to clinical respiratory function. METHODS: Individuals with DMD (n = 36) and unaffected controls (n = 12) participated in this cross sectional magnetic resonance imaging study. Participants underwent dynamic imaging of the thorax to assess diaphragm and chest wall mobility and chemical shift-encoded imaging of the chest and abdomen to determine fatty infiltration of the accessory respiratory muscles. Additionally, clinical pulmonary function measures were obtained. RESULTS: Thoracic cavity area was decreased in individuals with DMD compared to controls during tidal and maximal breathing. Individuals with DMD had reduced chest wall movement in the anterior-posterior direction during maximal inspirations and expirations, but diaphragm descent during maximal inspirations (normalized to height) was only decreased in a subset of individuals with maximal inspiratory pressures less than 60% predicted. Muscle fat fraction was elevated in all three expiratory muscles assessed (p < 0.001), and the degree of fatty infiltration correlated with percent predicted maximal expiratory pressures (r = - 0.70, p < 0.001). The intercostal muscles demonstrated minimal visible fatty infiltration; however, this analysis was qualitative and resolution limited. INTERPRETATION: This magnetic resonance imaging investigation of diaphragm movement, chest wall movement, and accessory respiratory muscle fatty infiltration provides new insights into the relationship between disease progression and clinical respiratory function.

Quantification of intrathoracic fat adds prognostic value in women undergoing myocardial perfusion imaging.

AIM: Amongst patients with coronary artery disease (CAD), women experience relatively worse outcomes as compared to men. Evidence to date has failed to explore unique female imaging targets as major determinants of cardiovascular risk. We sought to assess the prognostic value of epicardial (EFV) and intrathoracic fat volume (IFV) quantification in women and men with suspected and known CAD. METHODS AND RESULTS: Intrathoracic fat volume and EFV were calculated from non-contrast CT and analyzed in a propensity-matched cohort of 190 patients (95 women, mean age 62.5 ±â€¯11.3 years) undergoing myocardial perfusion imaging (MPI) and coronary computed tomography angiography (CCTA) for evaluation of CAD. IFV and EFV were significantly lower in women as compared to men (198.2 ±â€¯78.4 vs 293.2 ±â€¯114.7 cm3 and 105.6 ±â€¯48.9 vs 135.8 ±â€¯60.9 cm3, p < 0.001) and showed a strong association with coronary artery calcium score (CACS) and obstructive CAD in women (p < 0.05), but not in men. Fat volumes were not related to abnormal MPI in either population (p = NS). During a median follow-up of 2.8 years, high IFV was associated with reduced event free survival (log rank = 0.019 vs low IFV) in women, but not in men. Accordingly, a multivariate Cox regression model adjusted for cardiovascular risk factors, CACS, CCTA, and MPI findings selected IFV as a significant predictor of major adverse cardiovascular events (MACE) in women (HR 1.32, 95%CI 1.18-1.55, p = 0.001). CONCLUSION: Quantification of IFV provides incremental prognostic value for MACE in women, beyond that provided by traditional risk factors and imaging findings.