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Chang CJ, Liu KY, Chen YC, Ting YL, Tsai KC, Chen HW. Unrecognized Extravascular Misplaced Hemodialysis Catheter Leading to Mediastinal Hematoma. J Emerg Nurs 2023; 49:841-844. [PMID: 37925224 DOI: 10.1016/j.jen.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 08/11/2023] [Indexed: 11/06/2023]
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2
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Nakamoto K, Hagiya H, Hayashi R, Otsuka F. Mediastinal Abscess Induced by Group B Streptococcus. Intern Med 2023; 62:491-492. [PMID: 35793960 PMCID: PMC9970805 DOI: 10.2169/internalmedicine.9498-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- Kenta Nakamoto
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Hideharu Hagiya
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Ruiko Hayashi
- Department of Internal Medicine, Kousei General Hospital, Japan
| | - Fumio Otsuka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
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Affiliation(s)
- David C Fajgenbaum
- From the Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (D.C.F.); and the Departments of Radiology (R.J.G.), Medicine (J.D.S.), and Pathology (C.K.H.), Massachusetts General Hospital, and the Departments of Radiology (R.J.G.), Medicine (J.D.S.), and Pathology (C.K.H.), Harvard Medical School - both in Boston
| | - Reece J Goiffon
- From the Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (D.C.F.); and the Departments of Radiology (R.J.G.), Medicine (J.D.S.), and Pathology (C.K.H.), Massachusetts General Hospital, and the Departments of Radiology (R.J.G.), Medicine (J.D.S.), and Pathology (C.K.H.), Harvard Medical School - both in Boston
| | - Jacob D Soumerai
- From the Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (D.C.F.); and the Departments of Radiology (R.J.G.), Medicine (J.D.S.), and Pathology (C.K.H.), Massachusetts General Hospital, and the Departments of Radiology (R.J.G.), Medicine (J.D.S.), and Pathology (C.K.H.), Harvard Medical School - both in Boston
| | - Cynthia K Harris
- From the Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (D.C.F.); and the Departments of Radiology (R.J.G.), Medicine (J.D.S.), and Pathology (C.K.H.), Massachusetts General Hospital, and the Departments of Radiology (R.J.G.), Medicine (J.D.S.), and Pathology (C.K.H.), Harvard Medical School - both in Boston
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Bhalla D, Sinha P, Naranje P, Jana M, Bhalla AS, Sk P, Gupta AK. Transcutaneous Mediastinal Ultrasonography for Lymphadenopathy in Children: A Pictorial Essay of Technique and Imaging Findings. J Ultrasound Med 2022; 41:773-783. [PMID: 34080726 DOI: 10.1002/jum.15760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 05/08/2021] [Accepted: 05/16/2021] [Indexed: 06/12/2023]
Abstract
Ultrasonography (US) forms the mainstay of imaging in children; however, in the chest, its use has traditionally been limited to evaluation of pleural pathology. US techniques such as endobronchial and endoscopic ultrasound, which are commonly used for detection of mediastinal lymphadenopathy are invasive, aerosol generating, and often require sedation. Transcutaneous mediastinal sonography (TMUS) offers a useful alternative, which is easier to perform and overcomes these limitations. In this review, we summarize the technique, as well as imaging appearances of lymph nodes on TMUS. We also list common problems faced by operators and suggest troubleshooting methods for these.
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Affiliation(s)
- Deeksha Bhalla
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, Ansari Nagar 110029, India
| | - Pallavi Sinha
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, Ansari Nagar 110029, India
| | - Priyanka Naranje
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, Ansari Nagar 110029, India
| | - Manisha Jana
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, Ansari Nagar 110029, India
| | - Ashu S Bhalla
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, Ansari Nagar 110029, India
| | - Pritviraj Sk
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, Ansari Nagar 110029, India
| | - Arun K Gupta
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, Ansari Nagar 110029, India
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5
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Affiliation(s)
- Naoki Matsuura
- Department of Internal Medicine, Koga General Hospital, Japan
| | - Kenta Saitou
- Department of Internal Medicine, Koga General Hospital, Japan
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6
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Rabadán-Caravaca MD, Ruiz-Carazo E, García-Roa MD. Anterior mediastinal mass associated with febrile syndrome as a single manifestation of IgG4-related disease. Arch Bronconeumol 2021; 57:702. [PMID: 35699011 DOI: 10.1016/j.arbr.2021.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 05/24/2020] [Indexed: 06/15/2023]
Affiliation(s)
| | - Eduardo Ruiz-Carazo
- Departamento de Radiodiagnóstico, Hospital Universitario Virgen de las Nieves, Granada, Spain
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7
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Nakanosono R, Nakayama H, Nagano H, Takumi K, Oose A, Yano E, Nagasato K, Senokuchi T, Nakabeppu Y, Sueyoshi K, Yoshiura T. A Rare Case Report of Rosai-Dorfman Disease Manifesting as a Mediastinal Mass. J Thorac Imaging 2021; 36:W105-W108. [PMID: 34310518 DOI: 10.1097/rti.0000000000000605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
| | | | - Hiroaki Nagano
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Kagoshima Prefecture, Japan
| | - Koji Takumi
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Kagoshima Prefecture, Japan
| | | | | | | | | | | | | | - Takashi Yoshiura
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Kagoshima Prefecture, Japan
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Chew NWS, Wong RC, Kong WWF, Low A, Tan HC. Rare Klebsiella pneumoniae anterior mediastinal abscess masquerading as cardiac tamponade. Ann Acad Med Singap 2021; 50:655-656. [PMID: 34472564 DOI: 10.47102/annals-acadmedsg.202143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Nicholas W S Chew
- Department of Cardiology, National University Heart Centre, Singapore
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Toyoshima H, Fujii K, Tanigawa M, Nakamura A, Tanabe M, Tanaka H, Nakanishi Y, Sakabe S. The First Case Report of Mediastinal Abscess Caused by Gemella bergeri. Intern Med 2021; 60:1631-1635. [PMID: 33390483 PMCID: PMC8188013 DOI: 10.2169/internalmedicine.5043-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Most cases of mediastinal abscess occur as a postoperative complication of a thoracic surgical procedure or following trauma. The most common causative microorganism is Staphylococcus aureus, but it can be rarely caused by unusual microorganisms, such as Gemella species. These are relatively difficult-to-identify commensal microorganisms of the upper respiratory and gastrointestinal tracts and may cause several infections. A 66-year-old man was diagnosed with Gemella bergeri mediastinal abscess by the molecular detection of bacterial genes. He was successfully treated with penicillin antibiotic for eight weeks. To our knowledge, this is the first case report of mediastinal abscess caused by G. bergeri.
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Affiliation(s)
- Hirokazu Toyoshima
- Department of Infectious Diseases, Japanese Red Cross Ise Hospital, Japan
| | - Koji Fujii
- Department of Surgery, Japanese Red Cross Ise Hospital, Japan
| | - Motoaki Tanigawa
- Department of Respiratory Medicine, Japanese Red Cross Ise Hospital, Japan
| | - Akiko Nakamura
- Department of Infection Control, Aichi Medical University, Japan
| | - Masaki Tanabe
- Department of Infection Control and Prevention, Mie University Hospital, Japan
| | - Hiroyuki Tanaka
- Department of Infectious Diseases, Japanese Red Cross Ise Hospital, Japan
| | - Yuki Nakanishi
- Department of Infectious Diseases, Japanese Red Cross Ise Hospital, Japan
| | - Shigetoshi Sakabe
- Department of Infectious Diseases, Japanese Red Cross Ise Hospital, Japan
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Koda E, Yamashiro T, Onoe R, Handa H, Azagami S, Matsushita S, Tomita H, Inoue T, Mineshita M. CT texture analysis of mediastinal lymphadenopathy: Combining with US-based elastographic parameter and discrimination between sarcoidosis and lymph node metastasis from small cell lung cancer. PLoS One 2020; 15:e0243181. [PMID: 33264372 PMCID: PMC7710054 DOI: 10.1371/journal.pone.0243181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/16/2020] [Indexed: 11/24/2022] Open
Abstract
Objectives To investigate the potential of computed tomography (CT)-based texture analysis and elastographic data provided by endobronchial ultrasonography (EBUS) for differentiating the mediastinal lymphadenopathy by sarcoidosis and small cell lung cancer (SCLC) metastasis. Methods Sixteen patients with sarcoidosis and 14 with SCLC were enrolled. On CT images showing the largest mediastinal lymph node, a fixed region of interest was drawn on the node, and texture features were automatically measured. Among the 30 patients, 19 (12 sarcoidosis and 7 SCLC) underwent endobronchial ultrasound transbronchial needle aspiration, and the fat-to-lesion strain ratio (FLR) was recorded. Texture features and FLRs were compared between the 2 patient groups. Logistic regression analysis was performed to evaluate the diagnostic accuracy of these measurements. Results Of the 31 texture features, the differences between 11 texture features of CT ROIs in the patients with sarcoidosis versus patients with SCLC were significant. Among them, the grey-level run length matrix with high gray-level run emphasis (GLRLM-HGRE) showed the greatest difference (P<0.01). Differences between FLRs were significant (P<0.05). Logistic regression analysis together with receiver operating characteristic curve analysis demonstrated that the FLR combined with the GLRLM-HGRE showed a high diagnostic accuracy (100% sensitivity, 92% specificity, 0.988 area under the curve) for discriminating between sarcoidosis and SCLC. Conclusion Texture analysis, particularly combined with the FLR, is useful for discriminating between mediastinal lymphadenopathy caused by sarcoidosis from that caused by metastasis from SCLC.
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Affiliation(s)
- Eriko Koda
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Tsuneo Yamashiro
- Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
- Department of Diagnostic Radiology, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Rintaro Onoe
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Hiroshi Handa
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Shinya Azagami
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Shoichiro Matsushita
- Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Hayato Tomita
- Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Takeo Inoue
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Masamichi Mineshita
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
- * E-mail:
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Ojio H, Tanaka Y, Sato Y, Imai T, Okumura N, Matsuhashi N, Takahashi T, Yoshida K. A case of submucosal abscess of the esophagus mimicking a mediastinal abscess. Clin J Gastroenterol 2020; 14:402-406. [PMID: 33245556 DOI: 10.1007/s12328-020-01299-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/08/2020] [Indexed: 11/25/2022]
Abstract
We report a case of a submucosal abscess of the esophagus that required differentiation from a mediastinal abscess. A 48-year-old man presented with a chief complaint of fever and sore throat. He did not remember swallowing a foreign body, and his oral cavity showed no signs of inflammation. Contrast-enhanced computed tomography showed a low density area with enhancement in the mediastinum, especially around the esophageal wall. We planned to perform surgical drainage with the intention of performing intraoperative endoscopy from the beginning. We performed surgical drainage through a left cervical oblique incision; however, there was no exudate obtained from the mediastinal space. Despite the reported absence of accidental ingestion of a foreign substance, intraoperative endoscopy was performed that revealed a laceration in the esophageal mucosa 24 cm from the incisors. We diagnosed it as a submucosal abscess of the esophagus and prescribed parenteral antibiotics. Submucosal abscess of the esophagus can occur even in the absence of awareness of a foreign body ingestion or oral infection. In case that the abscess was not localized clearly within the outer membrane of the esophagus, the coincidental mediastinal drainage via a cervical incision and intraoperative endoscopy seemed to be useful.
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Affiliation(s)
- Hidenori Ojio
- Department of Surgical Oncology, Gifu University School of Medicine, Gifu, 501-1194, Japan
| | - Yoshihiro Tanaka
- Department of Surgical Oncology, Gifu University School of Medicine, Gifu, 501-1194, Japan.
| | - Yuta Sato
- Department of Surgical Oncology, Gifu University School of Medicine, Gifu, 501-1194, Japan
| | - Takeharu Imai
- Department of Surgical Oncology, Gifu University School of Medicine, Gifu, 501-1194, Japan
| | - Naoki Okumura
- Department of Surgical Oncology, Gifu University School of Medicine, Gifu, 501-1194, Japan
| | - Nobuhisa Matsuhashi
- Department of Surgical Oncology, Gifu University School of Medicine, Gifu, 501-1194, Japan
| | - Takao Takahashi
- Department of Surgical Oncology, Gifu University School of Medicine, Gifu, 501-1194, Japan
| | - Kazuhiro Yoshida
- Department of Surgical Oncology, Gifu University School of Medicine, Gifu, 501-1194, Japan
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Ruby J, Secrest S, Sharma A. Radiographic differentiation of mediastinal versus pulmonary masses in dogs and cats can be challenging. Vet Radiol Ultrasound 2020; 61:385-393. [PMID: 32400045 DOI: 10.1111/vru.12859] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 01/12/2020] [Accepted: 01/30/2020] [Indexed: 12/01/2022] Open
Abstract
The ability to differentiate thoracic masses of mediastinal and pulmonary origins is often confounded by their complex spatial relationship. The objectives of this retrospective, observational cross-sectional study were to assess radiographic differentiation of mediastinal versus pulmonary masses, and to determine if there are any correlations with specific radiographic findings. Thoracic radiographs of 75 dogs and cats with mediastinal and/or pulmonary masses identified on CT were reviewed. Radiographic studies were anonymized, randomized, and reviewed twice by three reviewers. Reviewers categorized the origin of each mass(es) as mediastinal, pulmonary, or both. On the second review, the presence or absence of 21 different radiographic findings was recorded for each mass. Agreement between the radiographic and CT categorization of mass origin, as well as inter- and intraobserver agreement, was calculated. Overall agreement between radiographs and CT was moderate for both mediastinal (68.6%) and pulmonary masses (63%). Overall, interobserver agreement was moderate (κ = 0.50-0.74), with moderate to strong intraobserver agreement (κ = 0.58-0.93). Masses within the mediastinum were significantly more likely to displace other mediastinal structures. Alternatively, masses lateral to midline and in the caudal thorax were found to be significantly positively correlated with a pulmonary origin. The results of this study highlight the limitations of radiography for differentiation of mediastinal and pulmonary masses, with mass location and displacement of other mediastinal structures potentially useful for radiographic findings that may help improve accuracy.
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Affiliation(s)
- Jennifer Ruby
- Department of Biosciences and Diagnostic Imaging, College of Veterinary Medicine, University of Georgia, Athens, Georgia
| | - Scott Secrest
- Department of Biosciences and Diagnostic Imaging, College of Veterinary Medicine, University of Georgia, Athens, Georgia
| | - Ajay Sharma
- Department of Biosciences and Diagnostic Imaging, College of Veterinary Medicine, University of Georgia, Athens, Georgia
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Shen Y, Qin S, Jiang H. Endobronchial ultrasound-guided transbronchial needle aspiration combined with either endoscopic ultrasound-guided fine-needle aspiration or endoscopic ultrasound using the EBUS scope-guided fine-needle aspiration for diagnosing and staging mediastinal diseases: a systematic review and meta-analysis. Clinics (Sao Paulo) 2020; 75:e1759. [PMID: 33084766 PMCID: PMC7536898 DOI: 10.6061/clinics/2020/e1759] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 04/14/2020] [Indexed: 12/12/2022] Open
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.
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Affiliation(s)
- Yanhua Shen
- Department of Endoscopy, The Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
- *Corresponding author. E-mail:
| | - Shanyu Qin
- Department of Gastroenterology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Haixing Jiang
- Department of Gastroenterology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
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Panchal R, Carter KT, Shepherd B, de Delva P, Koller F, Copeland H. Mediastinal Pancreatic Pseudocyst: A Rare Cause of New Onset Dysphagia. Am Surg 2019; 85:e400-e402. [PMID: 31560327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Spontaneous mediastinal abscess of curious causation. J Paediatr Child Health 2019; 55:874-5. [PMID: 31270871 DOI: 10.1111/jpc.2_14486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 04/10/2019] [Indexed: 11/30/2022]
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What lies beneath. J Paediatr Child Health 2019; 55:605. [PMID: 31017365 DOI: 10.1111/jpc.2_14417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 01/17/2019] [Accepted: 02/04/2019] [Indexed: 11/28/2022]
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Abstract
RATIONALE Transradial access (TRA) is a widely used technique during percutaneous coronary intervention (PCI). However, mediastinal and cervical hematomas, the rare and severe complications of transradial approach, have extremely high mortality rates. To the best of our knowledge, there were no medical literatures about the successful anticoagulation reversal procedure of mediastinal hematoma in PCI till now. PATIENT CONCERNS We here present a 54-year-old male Han patient who underwent PCI. Immediately after PCI, he reported an episode of neck and chest discomfort, dyspnea, cough recurrence, and cold sweats. Emergency chest computed tomography (CT) revealed a perforation of the subclavian artery resulting in a large mediastinal hematoma with potentially lethal tracheal compression. DIAGNOSIS A diagnosis of the large mediastinal hematoma was made based on the enhanced computed tomography. INTERVENTIONS The patient was successfully managed with palliative therapy of anticoagulation reversal instead of a covered stent graft and surgical operation. OUTCOMES Angiography confirmed the absence of leakage after anticoagulation reversal. The patient had an apparent remission of clinical dyspnea. Follow-up CT confirmed an almost entire absorption of the mediastinal hematoma 35 days postdischarge. LESSONS The current case highlights the importance of anticoagulation reversal as well as careful guidewire and guide catheter manipulation by the radial approach. Early evaluation, prompt identification, appropriate treatment, and close monitoring are all essential for invasive cardiology.
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Affiliation(s)
| | - Hongjian Shi
- Department of Intervention, Affiliated Wujin Hospital of Jiangsu University, Changzhou, Jiangsu, China
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Kravchuk B, Getman V, Sokur P, Bilokon O. [CLINICAL AND DIAGNOSTICS ASPECTES OF BENIGN MEDIASTINAL FORMATIONS IN CHILDREN]. Georgian Med News 2019:55-61. [PMID: 31215880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
There were more than 730 patients aged 3 months to 18 years with formations of the mediastinum, treated in Pediatric Clinic of Thoracic Surgery NMAPE P. L. Shupyk during the period from 1995 to 2018. The main group with benign tumors consisted of 294 patients. Complaints, life history of the disease, and clinical symptoms were studied, systematized and analyzed. Two varieties of the clinical course of mediastinal structures: asymptomatic and typical were identified. Asymptomatic was recorded in 39 (13.3%) patients. Typical course of mediastinal structures was clinically manifested by mediastinal compression syndrome of varying severity. Analysis of clinical data in a typical course of the disease allowed us to distinguish two periods: indistinct (limited) and organ-specific manifestal symptoms. In conditions of preferential organs or structures of the corresponding system compression, the top five organ specific symptoms were defined: respiratory, hemodynamic, dysphagy, neurogenic, osteogenic. Entities, transformed into malignant forms or complicated by suppuration, except compression, are characterized by: total intoxication and pain symptom. In case of primary airways (trachea, bronchus) compression, in limited organ specific symptoms pathogenesis period, the "local immobilization" link is indicated respectively to localization of pathologic entity, as the first level of airways compression and as a trigger mechanism of aerogenic (respiratory) symptom in this group of patients. Possible signs and risk group of children to have mediastinum entity was identified. Early WGC radiography survey in two projections is the main objectifying method, and computer, magnetic-resonance imaging and ultrasound scanning are the main diagnostic methods. Infrared thermography is highly informative and easy-going method for diagnosis of mediastinal structures. Surgical removal of mediastinal structures is the only radical method of treatment.
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Affiliation(s)
- B Kravchuk
- P.L. Shupyk National Medical Academy of Postgraduate Education, Ministry of Healthcare of Ukraine, Department of Thoracic Surgery and Pulmonology, Kiev, Ukraine
| | - V Getman
- P.L. Shupyk National Medical Academy of Postgraduate Education, Ministry of Healthcare of Ukraine, Department of Thoracic Surgery and Pulmonology, Kiev, Ukraine
| | - P Sokur
- P.L. Shupyk National Medical Academy of Postgraduate Education, Ministry of Healthcare of Ukraine, Department of Thoracic Surgery and Pulmonology, Kiev, Ukraine
| | - O Bilokon
- P.L. Shupyk National Medical Academy of Postgraduate Education, Ministry of Healthcare of Ukraine, Department of Thoracic Surgery and Pulmonology, Kiev, Ukraine
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Torous VF, Chen Y, VanderLaan PA. Comparison of plasma-thrombin, HistoGel, and CellGel cell block preparation methods with paired ThinPrep slides in the setting of mediastinal granulomatous disease. J Am Soc Cytopathol 2019; 8:52-60. [PMID: 31287420 DOI: 10.1016/j.jasc.2018.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 09/02/2018] [Accepted: 09/06/2018] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Various cell block (CB) preparation methods are utilized by different laboratories, and not all laboratories perform CBs in tandem with ThinPreps (TPs). To compare the performance of different CB methods and their diagnostic value when used in conjunction with TP, we assessed the quantity and size of granulomas obtained from endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) of lymph nodes in the evaluation of granulomatous mediastinal disease. MATERIALS AND METHODS A retrospective analysis of mediastinal lymph node EBUS-TBNA specimens that detected granulomas at our institution was performed. A total of 264 specimens from 124 patients had a TP followed by a CB (either plasma-thrombin, HistoGel, or CellGel) prepared from the residual material in the PreservCyt vial. The number and size of granulomas on each preparation was assessed using digital software. RESULTS Granulomas were detected only on the CB in 18.9% of cases and only on the TP in 5.3%. All 3 CB preparation methods showed significantly more and larger granulomas compared with the paired TP, with the plasma-thrombin and CellGel methods yielding more diagnostic material than the HistoGel method. In addition, the average number of granulomas (4.0 ± 0.4 versus 15.3 ± 1.1) and granuloma size (119.2 ± 3.2 μm versus 271.8 ± 7.3 μm) were significantly lower on TP compared with CB, respectively. CONCLUSIONS Plasma-thrombin and CellGel CB preparation methods had a higher granuloma yield compared with the HistoGel method. Additionally, significantly more numerous and larger granulomas were present on CBs compared with TP slides. Therefore, solely relying on TP slide evaluation may unintentionally overlook larger tissue fragments obtained during needle aspirations.
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Affiliation(s)
- Vanda F Torous
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Yigu Chen
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Paul A VanderLaan
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.
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Morita K, Fujiwara SI, Ikeda T, Kawaguchi SI, Toda Y, Ito S, Ochi SI, Nagayama T, Mashima K, Umino K, Minakata D, Nakano H, Yamasaki R, Kawasaki Y, Sugimoto M, Ashizawa M, Yamamoto C, Hatano K, Sato K, Oh I, Ohmine K, Muroi K, Ashizawa K, Yamamoto Y, Oshiro H, Kanda Y. TAFRO Syndrome with an Anterior Mediastinal Mass and Lethal Autoantibody-Mediated Thrombocytopenia: An Autopsy Case Report. Acta Haematol 2019; 141:158-163. [PMID: 30799408 DOI: 10.1159/000492743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 08/04/2018] [Indexed: 01/12/2023]
Abstract
TAFRO syndrome, a rare systemic inflammatory disease, can lead to multiorgan failure without appropriate treatment. Although thrombocytopenia is frequently seen in patients with TAFRO syndrome, little is known about its pathogenesis. Moreover, while recent studies have reported the presence of an anterior mediastinal mass in some patients, the pathological status of this remains unclear. Here, we report a case of fatal bleeding in a patient with TAFRO syndrome accompanied by an anterior mediastinal mass. A 55-year-old female was transferred to our hospital with a 2-week history of fever, epistaxis, and dyspnea. Laboratory tests revealed severe thrombocytopenia, computed tomography (CT) showed pleural effusions, and bone marrow biopsy revealed reticulin myelofibrosis. We suspected TAFRO syndrome, but the CT scan showed an anterior mediastinal mass that required a biopsy to exclude malignancy. She soon developed severe hemorrhagic diathesis and died of intracranial hemorrhage despite intensive treatment. She had multiple autoantibodies against platelets, which caused platelet destruction. An autopsy of the mediastinal mass revealed fibrous thymus tissues with infiltration by plasma cells. Our case suggests that thrombocytopenia could be attributed to antibody-mediated destruction and could be lethal. Hence, immediate treatment is imperative in cases of severe thrombocytopenia, even when accompanied by an anterior mediastinal mass.
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Affiliation(s)
- Kaoru Morita
- Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Shin-Ichiro Fujiwara
- Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Takashi Ikeda
- Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Shin-Ichiro Kawaguchi
- Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Yumiko Toda
- Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Shoko Ito
- Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Shin-Ichi Ochi
- Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Takashi Nagayama
- Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Kiyomi Mashima
- Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Kento Umino
- Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Daisuke Minakata
- Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Hirofumi Nakano
- Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Ryoko Yamasaki
- Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Yasufumi Kawasaki
- Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Miyuki Sugimoto
- Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Masahiro Ashizawa
- Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Chihiro Yamamoto
- Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Kaoru Hatano
- Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Kazuya Sato
- Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Iekuni Oh
- Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Ken Ohmine
- Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Kazuo Muroi
- Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Kentaro Ashizawa
- Division of Pathology, Narita Tomisato Tokushukai Hospital, Tomisato, Japan
| | - Yu Yamamoto
- Division of General Internal Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Hisashi Oshiro
- Department of Pathology, Jichi Medical University, Shimotsuke, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan,
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Oka K, Hosoya T, Taira N, Otsuka F. A Remarkable Uptake of FDG in Huge Mediastinal Hashimoto's Goiter. Intern Med 2019; 58:313-314. [PMID: 30146569 PMCID: PMC6378161 DOI: 10.2169/internalmedicine.0898-18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Kosuke Oka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | | | - Naruto Taira
- Department of Breast and Endocrine Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Fumio Otsuka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
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Prosperi P, Alemanno G, Di Bella A, Ardu M, Maltinti G, Iacopini V, Bergamini C, Valeri A. A minimally invasive approach with a 3d imaging system for the treatment of esophageal perforation due to Boerhaave syndrome. Ann Ital Chir 2018; 7:S2239253X1802858X. [PMID: 30569908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Boerhaave's syndrome is a rare life-threatening condition that requires urgent surgical management. There are various methods of managing it, with the main principles of limiting sepsis, draining the area and maintaining nutrition. Although the gold standard is open thoracotomy and/or laparotomy, mostly in patients with sepsis, we present a case of a 53-year-old man treated with a combination of laparoscopic suture (3D imaging system) of the oesophageal perforation site, decompressive percutaneous endoscopic gastrostomy and feeding jejunostomy. We conclude that this approach is a safe and a viable option in the management of Boerhaave syndrome in a septic patient presenting early. KEY WORDS: Boerhaave's syndrome, Laparoscopy, Minimally invasive surgery, Oesophageal Rupture, Surgery, 3D-laparoscopy.
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Abstract
RATIONALE Most of esophageal rupture is a very serious life-threatening benign gastrointestinal tract disease with high mortality. However, there are a few cases of spontaneous esophageal rupture during gastroscopy. PATIENT CONCERNS A 57-year-old man who underwent a routine diagnostic gastroscopy due to food obstruction was reported. During the gastroscopy, he vomited severely, which was followed by severe left chest pain radiating into the back and upper abdomen. The diagnosis was made by computed tomography (CT) scan without delay. Enhanced CT showed extensive mediastinal emphysema, a small amount of left pleural effusion, and a 6 cm tear was confirmed in the lower esophagus posteriorly. DIAGNOSES The patient was diagnosed with an intrathoracic rupture type of spontaneous esophageal rupture. INTERVENTIONS The patient received endoscopic suturing techniques under endotracheal intubation, titanium clip clamping, and over the scope clip (OTSC) sealing. OUTCOMES The procedure was smooth and the patient recovered well after operation. LESSONS During gastroscopy, the risk of esophageal rupture should be considered due to sudden pain caused by severe nausea and vomiting. Esophageal rupture can rapidly lead to severe life-threatening infections such as empyema and mediastinitis. Therefore, awareness of this condition is important so that appropriate treatment can rapidly be implemented to increase the likelihood of a good outcome.
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Affiliation(s)
- Feiyun He
- Department of Gastroenterology, Lishui Chinese medicine hospital
| | - Mugen Dai
- Department of Gastroenterology, The Fifth Affiliated Hospital of Wenzhou Medical University
| | - Jiwang Zhou
- Department of Gastroenterology, Lishui Chinese medicine hospital
| | - Jiansheng He
- Department of Anorectal surgery, Lishui Chinese medicine hospital, Lishui, Zhejiang Province, China
| | - Bin Ye
- Department of Gastroenterology, The Fifth Affiliated Hospital of Wenzhou Medical University
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Schaiberger G, Pucar D, Patel V, Bateson B, Williams H, Bates W. Para-atrial non-acute mediastinal hematoma after left atrial maze procedure mimicking tumor in a patient with treated melanoma. J Nucl Cardiol 2018; 25:1430-1432. [PMID: 28432672 DOI: 10.1007/s12350-017-0881-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 03/14/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The Cox Maze III procedure is considered the gold standard open surgical procedure for management of atrial fibrillation. This article outlines a unique case of a para-atrial mediastinal hematoma following a bilateral thoracoscopic left atrial Maze procedure mimicking malignancy. REPORT A 60-year-old male, with past history of melanoma, underwent bilateral thoracoscopic left atrial mini maze procedure with radiofrequency energy and exclusion of the left atrial appendage. Seven months later, a chest computed tomography (CT) scan was performed to evaluate for pulmonary embolism. The CT scan unexpectedly showed an ill-defined, heterogeneous para-atrial mass immediately superior to the left atrium concerning for tumor and mediastinal adenopathy. The mass was moderately hypermetabolic on subsequent 2-[fluorine-18]fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) scan. A follow-up PET/CT three months later demonstrated near-complete resolution of the para-atrial mass with minimal residual hematoma. CONCLUSION Non-acute mediastinal hematoma following a maze procedure can potentially be confused with a tumor mass and/or lymphadenopathy on CT and FDG PET/CT. With knowledge of the potential for false-positive FDG uptake in a hematoma, the lesion was monitored, and unnecessary biopsy was avoided.
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Affiliation(s)
- G Schaiberger
- Department of Radiology, Augusta University Medical Center, 1120 15th St, Augusta, GA, 30912, USA
| | - D Pucar
- Department of Radiology, Augusta University Medical Center, 1120 15th St, Augusta, GA, 30912, USA
| | - V Patel
- Department of Cardiothoracic Surgery, Augusta University Medical Center, 1120 15th St, Augusta, GA, 30912, USA
| | - B Bateson
- Department of Cardiothoracic Surgery, Augusta University Medical Center, 1120 15th St, Augusta, GA, 30912, USA.
| | - H Williams
- Department of Radiology, Augusta University Medical Center, 1120 15th St, Augusta, GA, 30912, USA
| | - W Bates
- Department of Radiology, Augusta University Medical Center, 1120 15th St, Augusta, GA, 30912, USA
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Barakat MT, Girotra M, Banerjee S. (Re)building the Wall: Recurrent Boerhaave Syndrome Managed by Over-the-Scope Clip and Covered Metallic Stent Placement. Dig Dis Sci 2018; 63:1139-1142. [PMID: 28948439 PMCID: PMC5867198 DOI: 10.1007/s10620-017-4756-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 09/08/2017] [Indexed: 12/09/2022]
Affiliation(s)
- Monique T Barakat
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 300 Pasteur Drive, MC:5244, Stanford, CA, 94305, USA
| | - Mohit Girotra
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 300 Pasteur Drive, MC:5244, Stanford, CA, 94305, USA
| | - Subhas Banerjee
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 300 Pasteur Drive, MC:5244, Stanford, CA, 94305, USA.
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26
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Ozturk A, Cicek T, Aktas Z, Demirag F, Yilmaz A. Mediastinal ectopic thyroid diagnosed by endobronchial ultrasound-guided transbronchial needle aspiration: Report of three cases. J Clin Ultrasound 2018; 46:299-301. [PMID: 28940588 DOI: 10.1002/jcu.22530] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 07/21/2017] [Accepted: 07/25/2017] [Indexed: 06/07/2023]
Abstract
An ectopic thyroid gland results from the abnormal migration of the thyroid in the course of its development. Primary ectopic mediastinal thyroid is very rare and occurs in less than 1% of all goiters that can be surgically excised. Ectopic thyroid tissue has a characteristic sonographic appearance as smooth-bordered, homogeneous, hypoechoic tissue with fine specular echoes. We report 3 cases of mediastinal ectopic thyroid diagnosed by endobronchial ultrasound-guided transbrochial needle aspiration biopsy.
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Affiliation(s)
- Ayperi Ozturk
- Interventional Pulmonology Department, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Tugba Cicek
- Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Zafer Aktas
- Interventional Pulmonology Department, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Funda Demirag
- Department of Pathology, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Aydin Yilmaz
- Interventional Pulmonology Department, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
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Ma J, Wang YC, Sun XW, Sun CY. [Atypical computed tomography manifestations of thoracic sarcoidosis]. Zhonghua Jie He He Hu Xi Za Zhi 2017; 40:925-930. [PMID: 29224303 DOI: 10.3760/cma.j.issn.1001-0939.2017.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Objective: This study evaluated the atypical computed tomography (CT) manifestations of thoracic sarcoidosis. Methods: Medical data of 190 patients with thoracic sarcoidosis were retrospectively reviewed. Results: The atypical CT manifestations of thoracic sarcoidosis observed were unilateral hilar lymphadenopathy with or without mediastinal lymphadenopathy(n=12, 6.3%), mediastinal lymphadenopathy without hilar lymphadenopathy(n=9, 4.7%), patchy consolidation (n=23, 12.1%), sarcoid galaxy sign (n=22, 11.6%), reversed halo sign (n=1, 0.5%), and ground-glass opacities (n=52, 27.4%). Air trapping was found in 8 of 10 patients who underwent both inspiratory and expiratory CT. Post-treatment CT scans showed improvements in most patients. Of the 12 patients with unilateral hilar lymphadenopathy with or without mediastinal lymphadenopathy, 10(83.3%) improved. Of the 9 patients with mediastinal lymphadenopathy without hilar lymphadenopathy, 8(88.9%) improved. Of the 23 patients with patchy consolidation, 15(65.2%) improved. Of the 22 patients with the sarcoid galaxy sign, 16(72.7%) improved. The patient with the reversed halo sign improved completely. Of the 52 patients with ground-glass opacities, 31(59.6%) improved. Of the 8 patients with air trapping, 7(87.5%) improved. Conclusions: The atypical imaging manifestations of thoracic sarcoidosis included unilateral hilar lymphadenopathy with or without mediastinal lymphadenopathy, mediastinal lymphadenopathy without hilar lymphadenopathy, patchy consolidation, the sarcoid galaxy sign, the reversed halo sign, ground-glass opacity, and air trapping. These lesions mostly improved after treatment. Familiarity with these atypical signs will help increase the diagnostic accuracy of imaging studies for thoracic sarcoidosis.
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Affiliation(s)
- J Ma
- Department of Radiology, Shanghai Pulmonary Hospitial, Tongji University School of Medicine, Shanghai 200433, China
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Abstract
Mediastinal masses are usually assessed by computer tomography (CT) and magnetic resonance imaging (MRI). Transthoracic ultrasonography (TUS) can also provide useful information concerning prevascular and posterior mediastinal masses abutting the thoracic wall, but is underused for mediastinal pathology. Moreover, it provides a valuable and safe method for guiding interventional procedures in those areas, even in cases when other approaches are difficult or impossible. Considering TUS a very useful imagistic method for diagnosing mediastinal masses, we present a pictorial essay of various mediastinal diseases which can be assessed by this method.
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Affiliation(s)
- Romeo Ioan Chira
- 1st Medical Clinic, Gastroenterology Department
- Department of Internal Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, Romania
| | - Alexandra Chira
- 2nd Medical Clinic, Emergency Clinical County Hospital Cluj
- Department of Internal Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, Romania
| | - Petru Adrian Mircea
- 1st Medical Clinic, Gastroenterology Department
- Department of Internal Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, Romania
| | - Simona Valean
- 1st Medical Clinic, Gastroenterology Department
- Department of Internal Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, Romania
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Neesgaard B, Sejling AS, Ostenfeld-Møller LA. [Upper abdominal pain caused by oesophageal perforation]. Ugeskr Laeger 2017; 179:V03170238. [PMID: 29108538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Boerhaave's syndrome or spontaneous oesophageal perforation is associated with significant mortality de-pending on time of diagnosis and initiation of treatment. However, the diagnosis is often delayed, as the condition mimics more frequent causes of chest- and abdominal pain. This case report describes a patient with severe upper ab-dominal and back pain following ructus in an effort to loosen a piece of candy stuck in the oesophagus. The case demon-strates, that Boerhaave's syndrome should always be con-sidered in patients presenting with acute chest- or upper abdominal pain.
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30
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Xu B, Mandsager KT. Transmitted Pulsations from a Mediastinal Abscess. Am J Med 2017; 130:e397-e398. [PMID: 28390790 DOI: 10.1016/j.amjmed.2017.02.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 02/27/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Bo Xu
- Section of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Ohio.
| | - Kyle T Mandsager
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Ohio
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31
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Ghosh S, Majumder B, Goswami P, Chakraborty S, Tandel V, Sudeep KN. The Forgotten Blow. J Assoc Physicians India 2017; 65:92. [PMID: 28792174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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32
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Trip J, Hamer P, Flint R. Intramural oesophageal haematoma-a rare complication of dabigatran. N Z Med J 2017; 130:80-82. [PMID: 28571053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
An 85-year-old female presented to hospital with haemoptysis. She underwent investigations which confirmed oesophageal submucosal haematoma. Oesophageal haematoma along with Mallory-Weiss and Boerhaave's syndromes make up acute mucosal injury of the oesophagus. It can be managed conservatively in the majority of cases.
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Affiliation(s)
- Jonathan Trip
- General Surgery, Christchurch Hospital, Christchurch
| | - Peter Hamer
- General Surgery, Christchurch Hospital, Christchurch
| | - Richard Flint
- General Surgery, Christchurch Hospital, Christchurch
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Linta N, Baron Toaldo M, Bettini G, Cordella A, Quinci M, Pey P, Galli V, Cipone M, Diana A. The feasibility of contrast enhanced ultrasonography (CEUS) in the diagnosis of non-cardiac thoracic disorders of dogs and cats. BMC Vet Res 2017; 13:141. [PMID: 28545570 PMCID: PMC5445396 DOI: 10.1186/s12917-017-1061-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 05/17/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND This study describes the feasibility of Contrast Enhanced Ultrasonography (CEUS) in the diagnostic work-up of non-cardiac thoracic disorders of small animals. The second aim is to assess the usefulness of CEUS as a direct guide for sample procedures. RESULTS Forty animals, 28 dogs and 12 cats, were included in the study. Thoracic disorders included 23 pulmonary lesions [primary carcinoma (14), lymphoma (1), sarcoma (1), histiocytic sarcoma (1), abscess (1) and pneumonia (5)] and 17 mediastinal lesions [lymphoma (8), thymoma (3), mesothelioma (1), melanoma (1), carcinomatous lymphadenopathy (1), mixsosarcoma (1), lipoma (1), and abscess (1)]. The majority of neoplastic pulmonary lesions showed an inhomogeneous distribution of contrast medium, whereas inflammatory lesions had a homogenous distribution with typical pulmonary vessels ramification. The majority of mediastinal malignant lesions showed an inhomogeneous distribution pattern. The lung and mediastinal abscesses had peripheral enhancement of the wall with an avascular center. All cytological and biopsy samples obtained after CEUS were diagnostic. Quantitative analysis, performed in 19/23 pulmonary lesions, showed a statistically significant difference (P < 0.0001) between the arrival time of the malignant (7.27 s - range 4.46-13.52 s) and benign (4.52 s - range 2.87-6.06 s) pulmonary lesions. CONCLUSIONS CEUS may be a useful tool for the evaluation of non-cardiac thoracic lesions. The contrast medium allows for the precise definition of lesion edges, the presence of necrotic areas, and the distribution of pulmonary vessels. Based on our preliminary results, the use of ultrasonographic contrast medium can be recommended for improving the diagnostic usefulness of cytology and biopsy sampling, because CEUS may help to define necrotic areas from viable tissue.
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Affiliation(s)
- N. Linta
- Department of Veterinary Medical Sciences, Alma Mater Studiorum – University of Bologna, Via Tolara di Sopra 50, I-40064 Ozzano Emilia, Bologna Italy
| | - M. Baron Toaldo
- Department of Veterinary Medical Sciences, Alma Mater Studiorum – University of Bologna, Via Tolara di Sopra 50, I-40064 Ozzano Emilia, Bologna Italy
| | - G. Bettini
- Department of Veterinary Medical Sciences, Alma Mater Studiorum – University of Bologna, Via Tolara di Sopra 50, I-40064 Ozzano Emilia, Bologna Italy
| | - A. Cordella
- Department of Veterinary Medical Sciences, Alma Mater Studiorum – University of Bologna, Via Tolara di Sopra 50, I-40064 Ozzano Emilia, Bologna Italy
| | - M. Quinci
- Department of Veterinary Medical Sciences, Alma Mater Studiorum – University of Bologna, Via Tolara di Sopra 50, I-40064 Ozzano Emilia, Bologna Italy
| | - P. Pey
- ANTECH Imaging Services, 17672-B Cowan Avenue, Irvine, CA 92614 USA
| | - V. Galli
- Freelance sonographer, Rome, Italy
| | - M. Cipone
- Department of Veterinary Medical Sciences, Alma Mater Studiorum – University of Bologna, Via Tolara di Sopra 50, I-40064 Ozzano Emilia, Bologna Italy
| | - A. Diana
- Department of Veterinary Medical Sciences, Alma Mater Studiorum – University of Bologna, Via Tolara di Sopra 50, I-40064 Ozzano Emilia, Bologna Italy
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Fernandes S, Noronha Ferreira C, Freire J, Velosa J. An unusual cause of Boerhaave´s syndrome in a young patient. Rev Esp Enferm Dig 2017; 109:376. [PMID: 28480729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
An 18-year-old male patient with a history of atopy and intermittent dysphagia for solids, presented to the emergency department with sudden onset total dysphagia followed by hematemesis, after ingesting an ibuprofen tablet. Urgent upper gastrointestinal endoscopy revealed a deep laceration just above the tablet impacted in the distal esophagus. Abdominal CT-scan confirmed the suspicion of an esophageal perforation. The impacted tablet was broken up with biopsy forceps, and a covered metallic stent (Hanarostent® 60/100x20/26mm) was placed across the cardia effectively excluding the fistula. Recovery was uneventful and the stent was easily removed 6 weeks later. Follow-up biopsies showed marked mucosal infiltration by eosinophils confirming the diagnosis of eosinophilic esophagitis (EE). The patient was treated with oral budesonide and remains asymptomatic.
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Affiliation(s)
- Samuel Fernandes
- Serviço de Gastrenterologia e Hepatologia, Hospital de Santa Maria, Centro Hospitalar Lisboa , Portugal
| | - Carlos Noronha Ferreira
- Serviço de Gastrenterologia e Hepatologia, Hospital de Santa Maria, Centro Hospitalar Lisboa , Portugal
| | - José Freire
- Serviço de Cirurgia Geral, Hospital de Santa Maria, Centro Hospitalar Lisboa , Portugal
| | - José Velosa
- Serviço de Gastrenterologia e Hepatologia, Hospital de Santa Maria, Centro Hospitalar Lisboa
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35
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Mill V, Brodin C. [Large bowel obstruction with effects on the mediastinum]. Lakartidningen 2017; 114:EFHA. [PMID: 28440847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Large bowel obstruction with effects on the mediastinum We present a patient in which the colon and left kidney herniated through a left-sided diaphragmatic hernia. The cause of the hernia was unknown, although most likely it emanated from an earlier diaphragmatic rupture caused by trauma. Due to a diverticular stenosis of the sigmoid colon, the patient developed large bowel obstruction, causing displacement of mediastinal structures. Emergency laparotomy and anterolateral thoracotomy was performed.
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Affiliation(s)
- Victor Mill
- Kliniken för kirurgi och urologi, Nyköpings Lasarett - Nyköping, Sweden Kirurgkliniken Nyköpings Lasarett - Nyköping, Sweden
| | - Claes Brodin
- Kliniken för kirurgi och urologi, Nyköpings Lasarett - Nyköping, Sweden Kirurgkliniken Nyköpings Lasarett - Nyköping, Sweden
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Ferreiro-Iglesias R, Blanco Freire MN, Paz Novo M, Domínguez Muñoz JE. Boerhaave's syndrome: diagnostic gastroscopy. Rev Esp Enferm Dig 2017; 109:65-66. [PMID: 28100060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A 47-year-old man was attended at the emergency room for severe chest pain after eating sausage with subsequent vomiting and mild upper gastrointestinal bleeding. In the chest radiography we could not see abnormalities. He referred previous episodes of choking without consulting. The urgent gastroscopy detected tertiary contractile activity (nutcracker esophagus) and a foreign body in the lower third of the esophagus. After removing the food bolus, we observed a 4 cm longitudinal tear compatible with esophageal rupture or Boerhaave's syndrome in the right posterior wall of the lower esophagus, proximal to the gastroesophageal junction. Thoracic-abdominal computed tomography (TC) confirmed a perforation of the lower esophagus, with pneumothorax and cervical and chest emphysema. Surgical treatment was indicated: esophageal suture, myotomy and gastric fundoplication. The patient presented good evolution. Boerhaave's syndrome is a rare syndrome, but with high mortality (35%). Mackler triad is very characteristic: vomiting, retrosternal pain and cervical subcutaneous emphysema; but it occurs rarely. Chest radiography is useful, showing abnormalities in up to 90% of patients. The differential diagnosis includes cardiorespiratory disorders: acute myocardial infarction, spontaneous pneumothorax, pericarditis or pneumonia. The role of endoscopy is small, mainly limited to prosthesis placement in high-risk surgical patients. In our case the chest radiograph was initially normal, probably related to bolus impaction and, in presence of upper gastrointestinal bleeding, gastroscopy was performed which allowed us to early diagnosis and treatment.
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Anwar J, Maqsood R, Soomro S. Multimodality Imaging Approach For The Early Diagnosis Boerhaave Syndrome. J Ayub Med Coll Abbottabad 2017; 29:157-158. [PMID: 28712199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Boerhaave's syndrome is a spontaneous transmural rupture or perforation of the oesophagus or post-emesis oesophageal rupture. Boerhaave's syndrome has a high risk of morbidity and mortality, and early, definitive diagnosis leading to prompt management improves outcomes. Definitive diagnosis of this syndrome is made with imaging, including x-ray, USG and computed tomography Scan. This is a case of a 50-year male with history of sudden onset of epigastric pain after an episode of forceful emesis was referred for Ultrasound (USG) abdomen. His USG examination demonstrated fluid collection with internal free floating and linear echoes in left pleural cavity consistent with hemo-pneumothorax his further imaging workup was done with suspicious of Boerhaave's Syndrome which conformed the suspected diagnosis.
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Affiliation(s)
- Javed Anwar
- Armed Force Institute of Radiology & Imaging, Rawalpindi, Combined Military Hospital Multan, Pakistan
| | - Rasikh Maqsood
- Armed Force Institute of Radiology & Imaging, Rawalpindi, Combined Military Hospital Multan, Pakistan
| | - Sanaullah Soomro
- Armed Force Institute of Radiology & Imaging, Rawalpindi, Combined Military Hospital Multan, Pakistan
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38
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Aboukhoudir F, Rekik B, Rica O, Aboukhoudir I, Pansieri M, Rekik S. [Massive intraatrial mass?]. Ann Cardiol Angeiol (Paris) 2016; 65:359-362. [PMID: 27697300 DOI: 10.1016/j.ancard.2016.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 09/04/2016] [Indexed: 06/06/2023]
Abstract
Posterior mediastinal hematoma in a rare and potentially lethal disease and is frequently consecutive to a traumatism. We report the original case of a 88-year-old male admitted to our department for lipothymia and syncope related to a severe compression of the left atrium by an important mediastinal hematoma mimicking in transthoracic echocardiography an obstructive intraatrial mass.
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Affiliation(s)
- F Aboukhoudir
- Service de cardiologie, centre hospitalier d'Avignon, 84000 Avignon, France; EA4278, laboratoire de pharm-écologie cardiovasculaire, université, 84000 Avignon, France
| | - B Rekik
- Service de cardiologie, centre hospitalier d'Avignon, 84000 Avignon, France
| | - O Rica
- Service de cardiologie, centre hospitalier d'Avignon, 84000 Avignon, France
| | - I Aboukhoudir
- Service de cardiologie, centre hospitalier d'Avignon, 84000 Avignon, France
| | - M Pansieri
- Service de cardiologie, centre hospitalier d'Avignon, 84000 Avignon, France
| | - S Rekik
- Service de cardiologie, hôpital de Belfort, centre hospitalier Nord-Franche-Comté, 14, rue de Mulhouse, 90000 Belfort, France.
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Sihuay D, Gornals JB, Saumoy M, Baixeras N, Sánchez A, Consiglieri CF, Catalá I. Visceral leishmaniasis with mediastinal lymphadenopathy diagnosed with endoscopic ultrasound-guided fine needle aspiration. Rev Esp Enferm Dig 2016; 108:736-738. [PMID: 27822955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A 44-year-old man with a HIV infection and levels of CD4 < 100/mm3, under antiretroviral therapy and with a previous medical history of visceral leishmaniasis (VL), was admitted to hospital with progressive muscular weakness and paraesthesia in both legs for three months. Imaging procedures were performed, showing a leptomeningeal thickening and enlargement of hilar and mediastinal lymph nodes.
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Affiliation(s)
- Denisse Sihuay
- Endoscopy Unit, Department of Digestive Disease, Hospital Universitari de Bellvitge-IDIBELL, Bar
| | - Joan B Gornals
- Endoscopia/Aparato Digestivo, Hospital Universitari de Bellvitge-IDIBELL, España
| | - Maria Saumoy
- Infectious Diseases, Hospital Universitari de Bellvitge-IDIBELL
| | - Nuria Baixeras
- Pathology Department, Hospital Universitari de Bellvitge-IDIBELL
| | - Ariadna Sánchez
- Endoscopy Unit, Department of Digestive Disease, Hospital Universitari de Bellvitge-IDIBELL
| | - Claudia F Consiglieri
- Endoscopy Unit, Department of Digestive Disease, Hospital Universitari de Bellvitge-IDIBELL
| | - Isabel Catalá
- Pathology Department, Hospital Universitari de Bellvitge-IDIBELL
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Bertolino J, Scemama U, D'Journo XB, Daniel L, Melenotte C, Benyamine A, Granel B. Mediastinal nodular AL-amyloidosis with progressive calcification. QJM 2016; 109:683-684. [PMID: 27521579 DOI: 10.1093/qjmed/hcw145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Bertolino
- Aix-Marseille Université, Marseille, 13284, France
- Internal Medicine Department, Assistance Publique-Hôpitaux de Marseille (AP-HM), Hôpital Nord, Marseille, 13915, France
| | - U Scemama
- Aix-Marseille Université, Marseille, 13284, France
- Radiological Department, AP-HM, Hôpital Nord, Marseille, 13915, France
| | - X B D'Journo
- Aix-Marseille Université, Marseille, 13284, France
- Thoracic Surgery Department, AP-HM, Hôpital Nord, Marseille, 13915, France
| | - L Daniel
- Aix-Marseille Université, Marseille, 13284, France
- Pathology Department, AP-HM, Hôpital de La Timone, Marseille, 13005, France
| | - C Melenotte
- Aix-Marseille Université, Marseille, 13284, France
- Internal Medicine Department, Assistance Publique-Hôpitaux de Marseille (AP-HM), Hôpital Nord, Marseille, 13915, France
| | - A Benyamine
- Aix-Marseille Université, Marseille, 13284, France
- Internal Medicine Department, Assistance Publique-Hôpitaux de Marseille (AP-HM), Hôpital Nord, Marseille, 13915, France
| | - B Granel
- Aix-Marseille Université, Marseille, 13284, France
- Internal Medicine Department, Assistance Publique-Hôpitaux de Marseille (AP-HM), Hôpital Nord, Marseille, 13915, France
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Plum A, Sobin L, Tatum S. Intraoperative hypotension associated with massive deep space neck abscesses in a 9-month old: A case report. Int J Pediatr Otorhinolaryngol 2016; 83:215-7. [PMID: 26968080 DOI: 10.1016/j.ijporl.2016.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 02/13/2016] [Accepted: 02/16/2016] [Indexed: 11/19/2022]
Abstract
The neck is divided into multiple compartments by cervical fasciae. The deep space compartments, which all have a potential for becoming infected, are interconnected, providing a mechanism for the spread of infections. Thus, infections of the deep spaces can lead to devastating consequences, especially when there is extension to the mediastinum. Here we report a case of intraoperative hypotension in a 9-month-old child with extensive bilateral parapharyngeal and retropharyngeal abscesses with mediastinal extension with a focus on when hemodynamic monitoring should be considered.
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Affiliation(s)
- Ann Plum
- Department of Otolaryngology and Communication Sciences, State University of New York Upstate Medical University, Syracuse, NY 13210, USA.
| | - Lindsay Sobin
- Department of Otolaryngology, Boston Children's Hospital, Boston, MA, USA
| | - Sherard Tatum
- Department of Otolaryngology and Communication Sciences, State University of New York Upstate Medical University, Syracuse, NY 13210, USA
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Sagheer S, Amir Humza Sohail AM, Hadi YB, Fatimi S. Enteric cyst in the left posterior mediastinum mimicking a hydatid cyst on chest Computed Tomography scan. J PAK MED ASSOC 2016; 66:363-365. [PMID: 26968299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Mediastinal enteric cysts are a rare occurrence among adults and are usually asymptomatic. In most cases they are an incidental finding in the right hemi-mediastinum and are associated with vertebral anomalies. We report the unusual case of a 23 year old male who had a mediastinal mass on chest X-ray as an incidental finding. Chest Computed Tomography (CT) scan revealed no vertebral anomalies and a cystic mass in the left posterior mediastinum with features similar to those of a hydatid cyst.Posterolateral thoracotomy was done and the cyst was excised. Histopathology report revealed it to be an enteric cyst.
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Affiliation(s)
- Shazib Sagheer
- Medical College, Cardiothoracic Surgery, Aga Khan University, Karachi
| | | | | | - Saulat Fatimi
- Department of Surgery, Cardiothroacic Sugery, Aga Khan University, Karachi
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Libánský P, Broulík P, Fialová M, Kubinyi J, Lischke R, Táborská D, Tvrdoň J, Šedý J, Adámek S. [Videothoracoscopic excision of mediastinal parathyroid adenoma in primary hyperparathyroidism]. Rozhl Chir 2016; 95:245-248. [PMID: 27410759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Primary hyperparathyroidism is a disease caused by elevated secretion of parathyroid hormone from pathological parathyroid glands. After the diagnosis, the success of its surgical solution depends predominantly on surgical management and experience of the surgeons. A special group is formed by ectopic localizations of pathologically enlarged parathyroid glands in the mediastinum, which require a modified surgical approach. When the adenoma is deep in the mediastinum, sternotomy or thoracotomy is indicated; alternatively, a minimally invasive approach can be used - videothoracoscopic thymectomy. CASE REPORT We present a case of a patient with normocalcemic recurrent primary hyperparathyroidism. This patient underwent a minimally invasive video-assisted thymectomy after scintigraphic confirmation of parathyroid adenoma in the mediastinum. CONCLUSION The removal of parathyroid adenoma in the mediastinum using the videothoracoscopic method is safe. Compared to sternotomy, this method improves the postoperative period, reduces the length of stay and provides more comfort to patients. We recommend considering the videothoracoscopic method in cases where the pathologically enlarged parathyroid gland is localized in the inferior and anterior mediastinum. KEY WORDS primary hyperparathyroidism adenoma of glandula parathyroidea - mediastinum miniinvasive.
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44
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Martínez-Losas P, Rodrigo JL, Pérez de Isla L. Pulmonary Nodules as Presentation of Pulmonary Artery Aneurysm. Rev Esp Cardiol (Engl Ed) 2015; 68:1175. [PMID: 25933989 DOI: 10.1016/j.rec.2015.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 02/16/2015] [Indexed: 06/04/2023]
Affiliation(s)
| | - José Luis Rodrigo
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
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45
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Özdogan M, Gottlieb H. [Early diagnosis and treatment of Boerhaave's syndrome is pivotal for the prognosis]. Ugeskr Laeger 2015; 177:V12140759. [PMID: 26376239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Hydropneumothorax following oesophageal rupture is very rare and often lethal. We report case of a 78-year-old man with known Barret's oesophagus with increasing shortness of breath and right chest pain followed by increasing emesis. Further investigations showed a right side hydropneumothorax and pleural effusion. Thorax and abdominal CT showed middle oesophageal perforation and pneumomediastinum. Oesophageal perforation can lead to pneumothorax and pleural fluid. Early diagnosis is pivotal to reduce mortality.
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46
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Ganguly A, Porwal M, Khandeparkar J. Boerhaave's syndrome: Experience with patients presenting later than 24 hours. Trop Gastroenterol 2015; 36:188-191. [PMID: 27522739 DOI: 10.7869/tg.282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Boerhaave's syndrome is the most sinister cause of esophageal perforation. Clinical presentation is vague. Diagnostic delays are frequent. As condition is rare therefore no consensus exists on management. A wide variety of management options are described in literature, each with its advantages and disadvantages. We present our experience of managing these cases which presented after 24 hr. Of onset of symptoms with emphasis on primary reinforced repair as first line surgical option.
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Ranga U, Aiyappan SK, Sujatha B, Pathy A, Veeraiyan S. Unusual Cause of Suprasternal Swelling: Cervical Extension with Herniation of Mediastinal Thymus. Indian J Pediatr 2015; 82:657-8. [PMID: 25676318 DOI: 10.1007/s12098-015-1716-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 01/29/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Upasana Ranga
- Department of Radiodiagnosis and Imaging, Saveetha Medical College Hospital, Thandalam, Kancheepuram, Tamilnadu, 602105, India,
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Affiliation(s)
- M Neuville
- Service de pneumologie A, centre de compétence des maladies pulmonaires rares, hôpital Bichat, Assistance Publique-Hôpitaux de Paris, 46, rue Henri-Huchard, 75877 Paris cedex 18, France; Université Paris Diderot, Sorbonne Paris Cité, 75877 Paris cedex 18, France
| | - C Taillé
- Service de pneumologie A, centre de compétence des maladies pulmonaires rares, hôpital Bichat, Assistance Publique-Hôpitaux de Paris, 46, rue Henri-Huchard, 75877 Paris cedex 18, France; Université Paris Diderot, Sorbonne Paris Cité, 75877 Paris cedex 18, France
| | - M-P Debray
- Service de radiologie, hôpital Bichat, Assistance Publique-Hôpitaux de Paris, 75877 Paris cedex 18, France
| | - M Aubier
- Service de pneumologie A, centre de compétence des maladies pulmonaires rares, hôpital Bichat, Assistance Publique-Hôpitaux de Paris, 46, rue Henri-Huchard, 75877 Paris cedex 18, France; Université Paris Diderot, Sorbonne Paris Cité, 75877 Paris cedex 18, France
| | - B Crestani
- Service de pneumologie A, centre de compétence des maladies pulmonaires rares, hôpital Bichat, Assistance Publique-Hôpitaux de Paris, 46, rue Henri-Huchard, 75877 Paris cedex 18, France; Université Paris Diderot, Sorbonne Paris Cité, 75877 Paris cedex 18, France.
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Çalışkan B, Somer A, Hatipoğlu N, Keser M, Yekeler E, Gün F, Güllüoğlu M, Salman T, Salman N. Tuberculous liver abscess in an immunocompetent child with pulmonary tuberculosis as a cause of fever of unknown origin. Turk J Pediatr 2015; 57:85-89. [PMID: 26613227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Infectious diseases are the leading cause of FUO. A case of prolonged fever with hepatic and pulmonary tuberculosis as a final diagnosis is herein presented. A 4-year-old, otherwise healthy boy presented with an axillary temperature of up to 39.5ºC for the previous 3 weeks. His medical history revealed an occasional increase in body temperature up to 38.5ºC for the last 6 months. Physical examination revealed coarse breath sounds on the basal lung area. Chest X-ray showed mediastinal lymphadenomegaly and computed tomography revealed paratracheal conglomerated lymph nodes and a groundglass appearance on the right lung. There were multiple contrast-enhanced, hypoechoic nodules with central necrosis in the liver parenchyma on abdominal magnetic resonance imaging. Open liver biopsy yielded chronic granulomatous inflammation compatible with pathological findings of tuberculosis infection. The culture specimen was positive for Mycobacterium tuberculosis. The patient improved rapidly after antituberculous therapy was initiated. Tuberculosis, especially in its disseminated form, poses a distinct diagnostic challenge in cases of prolonged fever with unproven etiology, and thus persistence should be exercised in disclosing the cause of such fevers.
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Affiliation(s)
- Bahar Çalışkan
- Division of Pediatric Infectious Diseases, Department of Pediatrics, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey.
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50
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Obinata M, Ishikawa K, Osaka H, Mishima K, Omori K, Oode Y, Yanagawa Y. A patient with refractory shock induced by several factors, including obstruction because of a posterior mediastinal hematoma. Am J Emerg Med 2014; 33:859.e1-2. [PMID: 25572646 DOI: 10.1016/j.ajem.2014.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 12/14/2014] [Indexed: 11/19/2022] Open
Abstract
A 44-year-old man who drove a motorcycle experienced a collision with the side of another motorcycle. Because he had sustained a high-energy injury to the spinal cord, he was transferred to our hospital. His circulation was unstable, and received tracheal intubation in addition to thoracostomy for the hemothorax. Whole-body computed tomography (CT) revealed multiple fractures, right hemopneumothorax with pulmonary contusion, and minor liver injury. After infusing 5000 mL of lactated Ringer's solution and 10 units of blood, his circulation remained unstable. On a repeat CT examination, the left atrium was found to be compressed by a posterior mediastinal hematoma induced by the fracture of the thoracic spine, and a diagnosis of shock induced by multiple factors, including hemorrhagic, neurogenic, and obstructive mechanisms, was made. After obtaining stable circulation and respirations, internal fixation of the extremities and extubation were performed on the 12th hospital day. Chest CT performed on the 27th day showed the disappearance of compression of the left atrium by the hematoma.
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Affiliation(s)
- Mariko Obinata
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University
| | - Kouhei Ishikawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University
| | - Hiromichi Osaka
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University
| | - Kentaro Mishima
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University
| | - Kazuhiko Omori
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University
| | - Yasumasa Oode
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University
| | - Youichi Yanagawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University.
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