Successful plication for postoperative diaphragmatic paralysis in an adult.

Diaphragmatic paralysis developed in an adult after a cardiac operation. The patient suffered from recurrent fevers and could not be weaned from mechanical ventilatory support. Diaphragmatic plication was performed and enabled rapid and sustained weaning from respiratory support.

M-mode ultrasonic localization and identification of fluid-containing pulmonary cysts.

Successful ultrasonic localization of pleural fluid has been well documented in recent reports. The ability of ultrasound to detect and identify fluid within a parenchymal lesion has not been defined. We examined nine patients with cystic lesions and air-fluid levels noted on the chest roentgenogram. In all nine patients, an echo-free space that corresponded anatomically to the level of fluid noted on the x-ray film could be recorded in the M-mode presentation. The combined thickness of the wall of the chest and the overlying lung as judged by ultrasound ranged from 2 to 8 cm, with a mean of 4 cm. The following two characteristics appeared to distinguish parenchymal from pleural fluid: (1) similar characteristics of motion of the proximal and distal interfaces of the sonolucent space; or (2) the ultrasonographic pattern of overlying lung proximal to the loculation of fluid. Ultrasonograms in eight (89 percent) of nine patients demonstrated one or both of these characteristics. These findings indicate that ultrasound can detect fluid within a parenchymal structure and may be used to differentiate intraparenchymal loculations from those in the pleural space.

Transbronchial lung biopsy in the diagnosis of lymphangitic carcinomatosis.

The clinical diagnosis of lymphangitic carcinomatosis of the lung has generally been confirmed by open lung or transthoracic needle biopsy, precedures with significant morbidity and mortality, particularly in patients with respiratory insufficiency. We present six cases of lymphangitic carcinomatosis diagnosed by transbronchial biopsy. Autopsy confirmation was obtained in 4 patients and ultrastructural confirmation of intralymphatic location of tumor in one. The diffuse bronchial and peribronchial lymphatic involvement demonstrated here suggests that this relatively noninvasive technique should be the procedure of choice in the diagnosis of lymphangitic carcinomatosis of the lung.

Massive intrabronchial aspiration of contents of pulmonary abscess after fiberoptic bronchoscopy.

A patient with a putrid pulmonary abscess that did not resolve developed massive aspiration of the contents of the cavity following a fiberoptic bronchoscopic procedure. Precautions for before and after a bronchoscopic procedure are suggested to prevent this catastrophic complication in patients with pulmonary abscesses.

M-mode ultrasonic localization of pleural effusion. Use in patients with nondiagnostic physical and roentgenographic examinations.

Fifty patients had nondiagnostic physical and roentgenographic examinations and were believed at high risk for exploratory thoracentesis. Negative echograms for pleural fluid were recorded for 13 patients. For 34 patients, the characteristic M-mode display of a central echo-free space, indicative of pleural fluid, was recorded. Aspiration yielded fluid that was localized by echography in 30 (88%). Of the 30 patients, 13 (43%) had normal lateral decubitus views, and 10 (33%) had experienced unsuccessful aspiration before ultrasound localized the fluid loculation. The remaining seven patients, including three receiving mechanical ventilation who were believed to have increased risk for thoracentesis had successful initial tap based on echographic localization of fluid. Ultrasound allows detection and localization of pleural fluid when roentgenographic and physical diagnostic means are not helpful.