Usefulness of chest images for the assessment of pectus excavatum before and after a Nuss repair in adults.

OBJECTIVES: The aim of this study was to evaluate whether chest radiographs could offer useful information for the assessment of pectus excavatum (PE) before and after Nuss repair in adults. METHODS: A total of 154 adults, with a mean age of 24.0 ± 5.0 years (range, 18-44 years), who underwent a Nuss repair of PE, with a mean follow-up of 42 months (range, 14-71 months), were included in this retrospective study. Sixty-two of these patients were also evaluated after the pectus bar removal, with a mean follow-up of 13 months (range, 6-44 months). The preoperative and postoperative imaging modalities were compared. RESULTS: The preoperative mean Haller indices measured on computed tomography (CT) and chest radiographs were 4.61 ± 1.58 (range, 2.6-11.9) and 3.82 ± 1.17 (range, 2.0-10.2), respectively. The Pearson correlation coefficient between the two parameters was 0.757. The postoperative mean Haller index measured on chest radiographs was 2.86 ± 0.56 (range, 1.7-5.4) and showed statistically significant improvement compared with the preoperative index (P < 0.001). The mean sternovertebral (SV) distances detected on preoperative and postoperative (>6 months after surgery) lateral chest radiographs were 7.67 ± 1.89 cm (range, 2.5-12.9 cm) and 9.89 ± 1.80 cm (range, 4.6-15.0 cm), respectively, showing statistically significant improvement (P < 0.001). The mean sternovertebral (SV) distance in patients after the bar removal detected on lateral chest radiographs was 9.25 ± 2.14 cm, also showing statistically significant improvement compared with the preoperative value (P < 0.001). CONCLUSIONS: Haller indices measured using chest radiographs and CT showed a strong correlation. Therefore, chest radiographs can be used as an alternative tool for the preoperative evaluation of PE. The Nuss operation significantly improved SV distances detected on lateral chest radiographs. Lateral chest radiographs can be used as a simple modality for the objective quantitative assessment of the anatomic results and follow-up of the Nuss operation in adults.

A special method of dilating tracheal stenosis following tracheostomy.

Several methods can be used to manage tracheal stenosis. For patients unfit for surgery, frequent dilatation with stent placement is the most common treatment. We here describe a simple and effective method using Bakes common bile duct dilators to dilate a tracheal stenosis in a patient with a tracheostomy.

Ectopic cervical thymoma in a patient with myasthenia gravis.

Ectopic cervical thymoma is rare and is often misdiagnosed as a thyroid tumor or other malignancy. Ectopic thymic tissue can be found along the entire thymic descent path during embryogenesis. However, a thymoma arising from such ectopic thymic tissue is extremely rare. Herein we report a patient with ectopic cervical thymoma and myasthenia gravis (MG) and discuss the management.

Esophageal carcinoma presenting with pyopneumothorax: a case study.

We describe a 69-year-old male who presented with high fever, progressive right chest pain and shortness of breath. A chest radiograph showed a right massive hydropneumothorax. After diagnostic assessment, an esophagomediastinal fistula complicated by squamous cell carcinoma of the esophagus was subsequently confirmed. Clinical signs were significantly improved by chest tube insertion, antibiotic therapy and esophageal stent implantation.