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Diagnosis of anomalous origin of the right subclavian artery (AORSA) from the right pulmonary artery (RPA) is usually made using CT, MRI, or invasive angiography. We report a patient diagnosed using transthoracic echocardiography (TTE). A newborn girl prenatally known to have d-TGA presented with cyanosis sparing the right hemithorax and arm. Oxygen saturations on the right hand were persistently higher than on the right ear and other extremities. Repeat TTE using a modified echocardiographic imaging plane allowed for full visualization of the entire subclavian artery course, revealing AORSA from RPA. We discuss further the approach to echocardiographic diagnosis and surgical implications.

Impalement injury is said to occur when a blunt force causes a long object to penetrate a body part resulting in retention of the object in situ. We report two unusual cases of impalement from rural India: one, chest impalement by a hunting spear and the other, an extremity impalement by a rotatory tiller blade. Thoracic impalement injuries are very rare, and there is only one other published report of chest impalement by a spear (trident) in the modern era. There are only two published reports of extremity impalement by a rotatory tiller blade. We also describe the difficulties encountered in their management. Patient-1 sustained accidental impalement to the right hemithorax by a spear used for hunting wild boars, leaving a meter long shaft protruding from his body. This necessitated his transfer to the hospital on the cargo bay of a pickup truck and also precluded complete radiological investigations before surgery. In addition, the reversed barbed tip of the spear made the extraction difficult. Patient-2 sustained impalement through the right knee by a rotatory tiller blade which bound him to the machine. The blade had to be disconnected from the shank assembly of the tiller to extricate him. Due to the proximity of the blade to the popliteal vessels, vascular control was necessary before extraction. Both the patients took several hours to reach the hospital as the accident occurred in remote rural areas. However, both had a successful outcome after surgical removal of the impaled object by a multidisciplinary involvement. We also have reviewed the published literature and given our suggestions for the management of these unusual and difficult injuries.

Solitary fibrous tumors of the pleura (SFTP) are rare mesenchymal tumors that arise from visceral or parietal tissue. Surgical resection of massive SFTP can be complicated by airway collapse, vascular compression/hemodynamic instability, and hemorrhage. Patients with SFTP may also present with metabolic derangements secondary to paraneoplastic processes. We present a case of successful removal of massive right-sided SFTP via clamshell sternotomy and discuss the perioperative considerations for which providers should be familiar.

A 42-year-old woman with a newly diagnosed malignant thymoma underwent FDG PET/CT, which demonstrated an increased uptake in anterior mediastinal tumor and several pleural masses in the right hemithorax, compatible with "drop metastases." In addition, contrast-enhanced CT images showed hyperdense abnormality in T2 vertebral body, congruent with intensely increased FDG uptake, raising suspicion of skeletal metastasis. This is a rare but important potential pitfall either in CT and FDG PET/CT-a "false-positive" bony lesion not attributed to skeletal metastasis but to dilated internal thoracic vertebral venous plexus associated with collateral circulation due to superior vena cava syndrome.

El hemotórax se define como la presencia de una colección sanguínea en el espacio pleural. El objetivo de la investigación fue determinar si el manejo conservador no quirúrgico del hemotórax traumático es seguro. Se hizo un estudio descriptivo, prospectivo, de una cohorte de pacientes que ingresaron con diagnóstico de trauma torácico complicado con hemotórax, desde enero de 2013 hasta diciembre de 2016, en la unidad de cirugía de tórax del Hospital Dr. Adolfo Pons del Instituto Venezolano de los Seguros Sociales (IVSS) de Maracaibo, Venezuela. Se evaluaron 150 pacientes; la edad promedio fue de 30,9 años (rango entre 24-65 años), con predominio del sexo masculino (85,2%). En la mayoría de los casos, el traumatismo torácico fue no penetrante (60%) y las causas más frecuentes fueron heridas por proyectil de arma de fuego (48%), accidente de tránsito (26,6%) y heridas por arma blanca (25,3%). El hemitórax derecho fue el más afectado (53,3%); el volumen de sangre drenada se clasificó en leve (25,3%), moderada (70,6%) y masiva (3,9%). El tratamiento efectuado de primera intención en el 80% de los casos fue la toracotomía cerrada con sonda pleural (tubo 24 Fr). Sin embargo, en el 13,3% de los pacientes fue necesario realizar cirugía abierta sobre el espacio pleural (toracotomía exploradora). La evolución de los pacientes fue satisfactoria en el 100% de los casos. Conclusión: La toracotomía cerrada con sondaje pleural juega un papel básico en el tratamiento no quirúrgico inicial, siendo un procedimiento conservador seguro en estos pacientes, pero donde se debe tener en cuenta las condiciones clínicas del paciente, a fin de disminuir complicaciones y las muertes asociadas. The hemothorax is defined as the presence of a collection of blood in the pleural space. The objective of this research was to determine if conservative nonsurgical management of traumatic hemothorax is safe. A descriptive and prospective study of a cohort of patients admitted with a diagnosis of chest trauma complicated with hemothorax was carried out from January 2013 to December 2016, in the Thorax Surgery Unit at the Hospital Dr. Adolfo Pons of the Instituto Venezolano de los Seguros Sociales (IVSS) in Maracaibo, Venezuela. A total of 150 patients were evaluated, the mean age was 30.9 years (range 24-65 years), with a predominance in males 85.2%. In most cases, the thoracic trauma was non-penetrating (60%), and the most frequent cause was bullet wounds (48%), car accident (26.6%), and bladed weapon wounds (25.3%). The right hemithorax was the most affected (53.3%). The volume of drained blood was classified in mild (25.3%), moderate (70.6%) and massive (3.9%). The treatment carried out in the first intention, in the 80% of the cases, was closed thoracostomy with a pleural catheter (24 Fr). However, in 13.3% of patients, it was necessary to perform open surgery on the pleural space (exploratory thoracostomy). The evolution of the patients was satisfactory in a 100% of the cases. Conclusion: The closed thoracostomy with pleural catheter plays a basic role in the initial nonsurgical treatment, being a safe, conservative procedure in these patients. However, the patient clinical condition should be taken into account to decrease complications and associated deaths.

Solitary fibrous tumour of pleura (SFTP) is a rare tumor contributing to less than 5% of all pleural tumours and about 10% - 30% of these tumours show features of malignancy. Occurrence of hypoglycaemia with solitary fibrous tumour is an unusual paraneoplastic syndrome designated as Doege-Potter syndrome which can occur both in benign and malignant tumours. Very few cases of solitary fibrous tumour with Doege-Potter syndrome are documented in world literature and only a couple of cases are documented in Indian literature so far. We, report here an interesting case of 40-year-old male who presented with a short history of weakness in left upper and lower limbs following an ischaemic stroke; breathlessness, productive cough, seizures and repeated episodes of loss of consciousness. Laboratory investigation revealed normal serum C-peptide level (1.04 ng/mL) and his blood sugar level was observed to be low varying from 25 mg/dL to 47 mg/dL. Computed tomography (CT) of lung and pleura showed a large mass in right hemithorax for which he underwent right hemithoracotomy. Histopathological examination of the resected thoracotomy specimen along with immunohistochemical analysis confirmed the diagnosis of malignant solitary fibrous tumour of pleura. Basing on the clinical, histopathological and immunohistochemical examination findings, the case was finally diagnosed as malignant solitary fibrous tumour of pleura with Doege-Potter syndrome. The clinico-pathological features and therapeutic management of such rare syndrome are being discussed here.

We report a case of Morgagni hernia occupying the anterior mediastinum and right hemithorax in a male infant with Down syndrome, who also had a perimembranous ventricular septal defect. Through a median sternotomy, the hernia sac was freed from the right pleura, and the pericardium was opened to reduce its contents (colon) into the abdomen. The diaphragmatic defect was closed with Prolene mesh and the hernia sac was used to reinforce the diaphragmatic defect. Finally, the pericardium was opened and the ventricular septal defect was closed with a polytetrafluoroethylene patch through a right atriotomy after instituting cardiopulmonary bypass.

Functioning thoracic paraganglioma (PGL) is rare in clinical practice. We present a 33-year-old man with this pathology, who came with right-sided chest pain and was found to have a right-sided paravertebral mass. Fine needle aspiration cytology revealed a PGL. Urine normetanephrine was elevated and meta- iodobenzylguanidine scan showed increased tracer uptake in the right hemithorax, suggestive of a functioning neuroendocrine tumour. The patient was subjected to right PGL excision by video-assisted thoracoscopic surgery, after adequate preoperative preparations. The perioperative period was uneventful, except for a transient rise in blood pressure during the surgery. His blood pressure continued to be normal in the postoperative period. In any patient with a paravertebral mass, the possibility of PGL should be kept in mind even if the patient is normotensive. Making a preoperative diagnosis is important, because excision of functioning PGL without adequate preoperative preparation may be detrimental.

Chest pain in children is a common referral for emergency examination, although it is believed that the underlying condition is not a serious event. The authors present the case of a 17 years old male with complaints of chest pain with a very recent onset, constant, experienced after physical effort. All medical history and physical examination findings were normal, the poster-anterior chest X-ray revealed a heterogenous opacity in the middle third of the right hemithorax confirmed on computerized tomography as a large solid anterior mediastinal mass with a diameter of 7.5/10.3 cm. By thorax surgery the mass was identified in the anterior and superior mediastinum and total resection was achieved for the tumor mass and thymus. Pathology examination showed poor small and medium epithelial cells proliferation and the tumor was classified as thymoma type 1B. Mediastinum is a rare location of space occupying processes in children. Also, there is a high rate of asymptomatic lesions in this area, considering that half of them are incidentally discovered for various chest X ray examinations. Many causes of chest pain in children are benign; nonetheless, some serious events do exist sometimes and pediatricians must pay attention to identify and manage those cases.

A 62-year-old male farmer weighing 79 kg was taken to a hospital after experiencing exertional dyspnea and shortness of breath for a month. A chest roentgenogram and computed tomography showed a giant mass in his right thorax. A CT-guided biopsy demonstrated a solitary fibrous tumor of the pleura (SFTP). Because of the large size of the tumor and the substantial pleural effusion in the right hemithorax, the patient was referred to our institution for radiofrequency ablation. After one month, we performed an exploratory thoracotomy to dissect the giant mass with the right, middle, and lower lobes. The measurement of the tumor was 20 cm × 18 cm × 13 cm and it weighed 3250 g. The histopathology of the resected specimen confirmed SFTP. The patient had no postoperative complications; six months after surgery, no recurrence occurred.

We reported a case of a 30-year-old man who reportedly sustained electrical burns and fell from a high voltage electric pole about 50 meter high onto a metal that caused impalement injury. In addition, he sustained full-thickness burns of the right upper limb (7%), the right hemithorax, the perineum (sparing the penis), the anterior abdominal wall and the lateral aspect of both thighs. There was 43% burned surface area in total. Radiographic examination revealed a slender curved object extending from his perineum into the pelvis. The management of this case was a challenging one which was described in this article.

Kaposiform hemangioendothelioma (KHE) is a rare, locally aggressive vascular tumor that does not metastasize. We report two unique cases of KHE involving the right hemithorax and the upper ipsilateral extremity. Kasabach-Merrit phenomenon and osteolytic lesions in the scapula were observed in both cases.

A 47-year-old woman was admitted with a history of dyspnea on mild exertion as her only symptom. Clinical exam, laboratory tests, and electrocardiography were normal. Chest X-ray demonstrated right hemithorax base mass, and CT scan revealed a well-defined cystic mass measuring approximately 11.3 x 10.6 x 10.9 cm, suggesting the diagnosis of pericardial cyst. The patient underwent right thoracotomy for resection of the cyst. The patient's progress- was uneventful. The result of histopathological examination, contrary to expectations, revealed thymic cyst.

Postoperative quality of life is a crucial factor in decisions regarding surgical management of bronchiectasis. The goal of surgical treatment in such cases is to eradicate diseased portions of lung while preserving as much healthy lung parenchyma as possible. The volume of remaining lung must be sufficient to fill the pleural space. In patients with bronchiectasis, it is extremely unusual to have upper- and lower-lobe involvement without middle lobe involvement. A normal-sized middle lobe alone is usually not adequate to fill the right hemithorax. When the disease involves both the upper and lower lung lobes, surgeons must assess whether pneumonectomy is required. Herein, we describe the case of a patient with bronchiectasis who was successfully treated with upper and lower lobectomy and preservation of the middle lobe.

Dextrocardia is a rare congenital cardiac malrotation syndrome characterized by abnormal positioning of the heart in the right hemithorax. While most cases have structurally normal hearts, the malrotation may pose important diagnostic and therapeutic challenges in the setting of acute coronary

WOS: 000250941700012, PubMed: 17766139, Objective: In repair of thoracic wall deformities, there is a debate in the literature regarding the optimal age and the type and number of costal cartilage resections. We evaluated the effect of costal. cartilage resections on the chest wall development in young rabbits. Methods: Fifty apparently healthy, 6 weeks of age, mate New Zealand white rabbits were evaluated in five groups, each including 10 subjects. Group I served as control for the observation of normal thoracic development. Rabbits in group 2 underwent partial and rabbits in group 3 underwent total resections of the right third and fourth costal cartilages; those in group 4 underwent partial and rabbits in group 5 underwent total resections of the right third to sixth costal, cartilages. Anteroposterior, horizontal and vertical diameters of the chest were measured before operation and repeated at 24 weeks of age. Results: Upper and lower anteroposterior diameters of the thoracic wall and horizontal diameters of the left hemithorax differed significantly among groups (p = 0.011, p = 0.004, and p = 0.002, respectively). Upper anteroposterior diameter was 49 mm in group 1 and 44 mm in group 3 (p = 0.009). Lower anteroposterior diameter in group 5 (66 mm) was significantly less than that in group 1 (70 mm) (p = 0.039) and there was also a statistically significant difference between group 4 (71 mm) and group 5 (66 mm) (p = 0.002). Horizontal diameters of the left hemithorax in group 3 (32 mm; p = 0.005) and 5 (32 mm; p = 0.008) were significantly different when compared to group 1 (26 mm). Growth in right hemithorax was statistically less than that in left side in all operated groups except in group 2. Conclusions: Thoracic resections in young rabbits have demonstrated that the costal cartilage resection is not an innocent procedure as it severely affects the chest watt development especially in anteroposterior direction and the thoracic growth is markedly retarded when growth centers of the ribs are not preserved and/or four or more ribs are resected. (C) 2007 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

Case Description—A 10-year-old sexually intact female dog was examined because of a static, well-circumscribed subcutaneous mass and associated fistulous draining tract located along the right ventrolateral aspect of the thoracic body wall of 15 months' duration. Clinical Findings—Results of computed tomography and fistulography confirmed the presence of the fistulous tract. Computed tomography also revealed a focal, hypodense region in the right ventral portion of the liver that was adjacent to but not clearly associated with the fistulous tract. Treatment and Outcome—Surgical exploration of the tract revealed that it passed into the right hemithorax to the diaphragm; entered the right medial lobe of the liver; and terminated in a well-encapsulated, cystic liver lesion. The right medial liver lobe and all affected tissues were removed. Histologically, the liver lesion consisted of a fibrotic, dilated bile duct. The dilated bile duct and fistula were lined with biliary epithelium. On the basis of these findings, a diagnosis of spontaneous external biliary fistula was made. Five months after surgery, the dog was clinically normal. Clinical Relevance—To the authors' knowledge, spontaneous external biliary fistula in a dog has not been reported in the veterinary medical literature. Despite the rarity of this condition, it should be considered in a dog with similar clinical findings. Clinical findings and results of appropriate diagnostic imaging procedures may provide valuable information in making this diagnosis and in planning surgical treatment.

Purpose The aim of the study was to determine the natural course and select appropriate therapy for pneumatocele (PC) in children with postpneumonic empyema. Materials and Methods Records of 134 children treated for postpneumonic empyema between October 1997 and June 2003 were reviewed retrospectively, and 58 (43%) of them were found to have PC. Their chest x-rays and computed tomography scans as well as patient profiles were evaluated to assess the size, location, course, and complications. Clinical course, treatment indications, and results were also reviewed. Results The patients were aged from 14 months to 15 years (mean 3.8 years). There were 36 boys and 22 girls. The PC was located on the right hemithorax in 34 patients and on the left in 24. Staphylococcus aureus was the most common isolated infective agent. Of the 58 children, 37 (63.7%) showed complete resolution with improvement of the infection within 2 months. Thirteen PCs had evidences of gradual decrease in size without any indication for invasive approaches, and they resolved completely, with a mean time of 6.1 (ranging from 1-13) months. One tension PC, 3 large PCs (>50% of hemithorax), 1 case with bad tolerance to follow-up, and 2 persistent PCs had no reduction in size on follow-up; a total of 7 patients underwent image-guided catheter drainage procedure, and 5 of them resolved completely. In the last 2 cases, surgical excision was required because of persistent cystic cavity caused by thickened PC wall. One patient whose PC had not been decreasing in size developed findings of severe lung abscess with thickened wall and directly underwent surgery. In none of these patients recurrences or complaints related to PC were noted on their control visits. Conclusion Most of these PCs are simple PC and show spontaneous resolution with improvement of the infection within the first 2 months. However, some decrease gradually by time, and close follow-up should be continued in case of complicated PC. Persistent features of chest infection, more than 50% involvement of hemithorax and severe atelectasis, development of broncopleural fistulae (tension PC), and bad tolerance to follow-up remind complicated PC, and they are indications of image-guided catheter drainage procedure. Its failure occurs in PC with thickened wall that does not collapse, as was in our cases with persistent PC and severe infected PC, and thus, this is an indication for surgical excision.

A 32-year-old female presented to us with worsening cough and expectoration, low-grade fever, and malaise for 3 months. She gave a history of pregnancy loss secondary to urinary tract infection (UTI) a year back. At that time, she was told to have an obstructive right renal calculus. She also had a history of recurrent UTI in the past 1 year. She had no other comorbidities. Her clinical evaluation revealed an enlarged right kidney and reduced air entry in the right hemithorax. Radiological investigations revealed a large right kidney invading into the inferior surface of the right lobe of the liver and the right pleural space. A clinical diagnosis of xanthogranulomatous pyelonephritis was made, and she was advised nephrectomy. Intraoperatively, the right kidney was found to invade both the right lobe of the liver and the right pleural cavity through a right diaphragmatic defect. Histopathology of the kidney revealed the presence of foamy histiocytes suggestive of xanthogranulomatous pyelonephritis. Invasive xanthogranulomatous pyelonephritis is known, however, invasion into the extra-abdominal structures has not been reported in the literature. Our case is a rare manifestation of a rare clinical entity – xanthogranulomatous pyelonephritis.

Bilateral multiple typical carcinoid tumors of the lung are uncommon malignancies. We discuss the case of a 64 year-old female with a nonproductive cough as the initial symptom. Thoracic computed tomography revealed multiple nodular lesions on both sides, which were initially misdiagnosed as multiple metastases of the lung with an unknown primary. After resection of nodules in the right hemithorax, pathologic examination revealed a typical carcinoid tumor. Bilateral sequential thoracotomy was performed and all ten nodules, (six on the right side and four on the left side), were treated by sublobar resection due to poor respiratory function. Pathological examination revealed all nodules to be typical carcinoid tumors. Following the resections, the patient has remained disease-free for ten months. Turkish Başlık: Eşzamanlı İki Taraflı Çoklu Karakteristik Akciğer Karsinoid Tümörleri: 10 Karakteristik Karsinoid İle Benzersiz Bir Vaka Anahtar Kelimeler: Akciğer karsinoid, tipik karsinoid, bilateral, senkron Akciğerin bilateral, çok sayıda, tipik karsinoid tümörleri nadir görülen malignitelerdir. Non-prodüktif öksürük şikayeti olan 64 yaşındaki bayan hastaya yapılan bilgisayarlı toraks tomografisi incelemesinde her iki akciğerde çok sayıda nodüler lezyon tespit edilmiş; hasta başlangıçta primeri belli olmayan tümörün akciğere metastazları olarak yorumlanmıştır. Sağ akciğerdeki nodüllerin rezeksiyonundan sonra patolojik inceleme tipik karsinoid tümör olarak raporlanmıştır. Hastaya bilateral torakotomi gerçekleştirilmiş olup toplam on nodül (altı sağ, dört sol) hastanın solunum fonksiyonları kısıtlı olduğu için sublobar rezeksiyon ile eksize edilmiştir. Patolojik inceleme sonucunda on nodülünde tipik karsinoid tümör olduğunu anlaşılmıştır. Rezeksiyon sonrasında hasta on aylık takiplerinde hastalıksız sağ kalıma sahiptir.

Morgagni-Larrey hernia is a rare type of diaphragmatic hernia, the diagnosis of which is made incidentally by routine chest X-ray film. We describe a technique for the laparoscopic repair of Morgagni-Larrey hernia which was successfully performed in three adult patients; two women and one man. Two of the patients were asymptomatic and had herniation of only omentum into the right hemithorax; however, one was symptomatic and had herniation of the omentum and large bowel. Tension-free closure of the defects was done using Prolene mesh with a hernia stapler, helical fastener, and Endostitch. There were no early complications and the patients were discharged on the fourth postoperative day. The mean follow-up period was 41 months, and there has been no late morbidity or mortality related to this procedure. Using a laparoscopic approach to repair a Morgagni-Larrey hernia provides an excellent view of the surgical field and allows easy manipulation with minimal surgical trauma, followed by rapid recovery of the patient.

The patient was a 27一year—old woman with chest distress and short— ness of breath that suddenly started one month before her examina— tion.The symptoms were relieved with resting,SO she failed to go to the hospital for an examination.She had no complaints of fever, cough or hempotysis.One day,the symptoms became SO severe that she was sent to the emergency room and adiography disclosed an opaciW in her right hemithorax.A subsequent CT scan showed a 1arge.sharply delineated and nonhomogeneous mass in the iriferior fight middle mediastinum,which protruded to the right hemithorax. The mediastinal structure was apparently displaced to the left and the mass seemed to be adherent to the pleura,pericardium and adjacent large vessels(Fig.1A).There were enhancing areas peripheral to the mass after injecting the contrast material(Fig.1B).The 1eft side was shown to be normal.She was admitted to OUr hospital for further ex— amination on the same day. Her medical history was unremarkable except for being allergic to penicillin.She never smoked or drank alcohol,but she had been a worker spraying lacquer in a factory for about two years. Physical examination revealed regular BP(120/80 mmHg)and pulse (80 bpm).The expansion of thorax was symmetric.The breathing sounds were absent in the inferior site of the right lung.The 1eft was normal.and routine 1aboratory examination results were negative.Her blood glucose was 4.9 mmol/L and her B—HCG 1evel was 1ess than

Presentation of Case A 56-year-old woman was admitted to the hospital because of abdominal pain, a falling hematocrit, and a pelvic mass. The patient had been well until five days earlier, when there was the onset of pain in the anterior part of the right hemithorax that was aggravated by movement and inspiration, accompanied by mild lower abdominal pain. While getting out of bed she had a brief syncopal episode. On the same day, she saw her physician, who found that the blood pressure was 140/70 mm Hg; there was mild, diffuse tenderness in the lower abdomen. Radiographs of the . . .

Pyrexia, granulocytosis and hyperglobulinaemia were the main clinical findings in an unusual case of intrathoracic lipoma in a 12-year-old male Labrador retriever. The response to antibiotic and anti-inflammatory treatment was poor, prompting further investigation. Survey radiographs and ultrasonography revealed a cavitated, fluid-filled soft tissue mass in the right hemithorax, which was successfully removed resulting in rapid resolution of clinical signs. Lipomas are rare intrathoracic extrapulmonary tumours. Previously reported clinical signs are dyspnoea and coughing, attributed to the mass effect of the lipoma. The unusual presentation in this case was caused by necrosis of the lipoma, probably owing to torsion of the pedicle attaching it to the cranial mediastinum.

Pleural empyema is an emergency clinical condition characterised by presence of purulent organisms within the pleural fluid. It is associated with significant morbidity and consumption of scarce resources. It is a rare clinical condition but constitute a serious thoracic emergency despite advances in management. Imaging plays an important role in the diagnosis and management of pleural empyema. We present an 11 month old infant with a month history of fever, cough, shortness of breath and weight loss. Clinical diagnosis of bronchopneumonia with pleural effusion was made. Chest radiograph revealed right opaque hemithorax with central mediastinum. Computed tomography (CT) of the chest showed extensive right pleural effusion with compression of viable lung tissue. Ultrasound guided thoracocentesis drained about one litre of pus. Intravenous antibiotics were also administered. Repeat chest radiograph a week after the drainage showed marked reduction in the size of the previously noted opaque right hemithorax with remarkable improvement of the clinical condition.

Case Description—A 5.5-month-old female domestic longhair cat was examined because of dorsal deviation of the caudal aspect of the sternum and progressively worsening dyspnea during play activities. Clinical Findings—A diagnosis of pectus excavatum was made clinically and confirmed radiographically. The cardiac silhouette was shifted into the right hemithorax. The vertebral index (VI) and frontosagittal index (FSI), which are radiographic indices used to grade the extent of the deformity, were 5.2 and 3.0, respectively. Minimum thoracic height was 13 mm at this time. Treatment and Outcome—The sternal malposition was corrected during surgery; for stabilization, an internal splint was provided by use of a plate that was applied to the ventral side of the sternum. Radiographic indices improved until day 85; at that time, an increase in the distance between plate and sternum was detected, and plate removal was advised. The radiographic indices improved again after plate removal. At 310 days after surgery, VI was 9.6, FSI was 1.6, and minimum thoracic height was 34 mm. No dyspnea was evident during physical examination. Clinical Relevance—Results of treatment suggest that this technique may be useful as an alternative surgical option for cats with pectus excavatum that have a noncompliant sternum.

An 18-year-old man presented with altered mental status. He was found to have diabetic ketoacidosis. Chest X-ray showed pneumomediastinum. After intubation for air-way protection, an oral-gastric tube was placed. A chest computed tomography scan showed the tip of the oral-gastric tube to be in the right hemithorax. The patient underwent a thoracotomy and was managed in the intensive care unit. Both diabetic ketoacidosis and Boerhaave's syndrome should be considered as possible causes of pneumomediastinum in a patient with similar presentation. Boerhaave's syndrome should be ruled out prior to the insertion of an oral-gastric tube to avoid further morbidities.

Oesophageal perforation is a potentially lethal clinical condition. Penetrating thoracic oesophageal injury is associated with increased morbidity and mortality, especially if the interval between the injury and commencement of treatment is delayed beyond 24 h. We present a 20-year-old man with a 2 weeks history of mediastinal traversing thoracic oesophageal injury and secondary right empyema following assault. The injury was a stab using a long knife with an entry point at the upper left arm which took an unusual trajectory to traverse the left hemithorax and the mediastinum to penetrate the oesophagus in the right hemithorax. He was resuscitated and thoracotomy was done where the perforation was repaired and the lung decorticated, but he sustained cardiac arrest and could not be resuscitated. Delayed time interval between the time of oesophageal injury and the commencement of treatment is a key determinant of patients' outcome. Prompt diagnosis and institution of treatment significantly reduce the morbidity and mortality associated with oesophageal perforation.

A 97 year old female patient with history of hypertension, hypertrophic cardiomyopathy, severe chronic renal failure and tuberculosis treated by pneumothorax and oleothorax in 1939, was admitted to the emergency department (ED) for functional status impairment and hypotension following a 3-day diarrhea. Part of the routine tests in the ED is a chest x-ray. The anteroposterior and lateral views, demonstrated changes in the right hemithorax with reduced volumes, pleural thickening predominant in the apex of the lung and asymmetry of the ribcage. A large mass with a peripheral calcified rim occupied a substantial part of the lower lateral aspect of the right upper lobe. The mass appeared homogeneous without air-fluid levels or cavitation (Figs. 1 and 2). A chest Computed Tomography (CT) without contrast was performed a week later and showed a large mass adjacent to the right oblique pulmonary fissure and the pleura (Figs 3 and 4). The mass was homogeneous and measured 6.7 4.8 cm in the axial plane and 7.8 cm cranio-caudally. The mean attenuation was 76 Hounsfield Units (HU) measured in the central part of the mass. No air-fluid level was seen, there was no cavitation and the mass was circumscribed by a calcified rim. No other radiological signs of A R T I C L E I N F O

A 48-year-old woman without a significant medical history was referred to our department after the neurologist established Pancoast's syndrome and a well-demarcated homogenous mass in the apex of the right hemithorax on MRI study of the brachial plexus. The tumour was invading the thoracic wall, adjacent musculature and the right plexus brachialis and extended into the neuroforamen of C7–T1 (figure 1B,D). She had no respiratory complaints. She had …

We thank Dr. Saeed and his group for their interest in our case and their thoughtful comments. We do agree about the discrepancy between the case we have presented and the chest X-ray findings illustrated by Dr. Saeed and his group. This happened because we uploaded an incorrect file, which was overlooked by us. We do apologies for that and we include the correct chest X-ray (Fig. 1) that shows the classical findings seen in lung agenesis. Finally, we believe that dextroposition is a cardiac displacement that consists of a right ward swing along the frontal plane caused by extra cardiac forces, while true dextrocardia is a developmental error. Figure 1 Chest X-ray showing hyperopacity of the right hemithorax with elevated right hemidiaphragm, hyperinflation of the left lung and right side deviation of the trachea and mediastinum. Also, there is a left side pneumonic infiltrates.

Intrathoracic kidneys are rare. A case is described in which the initial intravenous urogram performed for prostatism appeared to show a non-functioning right kidney. A subsequent ultrasound examination revealed that the right kidney was situated in the right hemithorax, well above the liver. Pelvic ectopic kidneys are common and standard teaching is to perform a full length film should an immediate or 5 minute renal area radiograph suggest an absent/non-functioning kidney. With the increasing use of ultrasound in the initial assessment of patients with prostatism, the possible intrathoracic location of a kidney should be remembered when there is failure to demonstrate a kidney in the abdomen or pelvis.

Poland syndrome comprises a unilateral absence of the large pectoral muscle, ipsilateral symbrachydactyly, and occasionally other malformations of the anterior chest wall and breast. The condition is more frequent among males, and usually occurs on the right hemithorax in the unilateral form. The syndrome is believed to be caused by a genetic disorder that reduces the embryonal circulation in the interior chest artery: the stronger the interaction, the more severe the pathology. This article analyzes an unusual pathologic case in which the 17-year-old patient lacked the large pectoral muscle on the left side, but showed no arterial alteration. This case raises questions as to the true pathogenesis of this syndrome.

We present a rare case of mediastinal hemangioma in a 4-year-old child. The child presented with cough and fever and the chest radiograph revealed right pleural effusion. On further work-up with chest computed tomography mediastinal cystic mass occupying the right hemithorax was identified. The cystic mass was resected completely through a right thoracotomy. Histopathological examination established the final diagnosis of mediastinal capillary hemangioma.

A 44-year-old man with a 20 pack-year history of smoking presented to the emergency department following a few hours of chest tightness, shortness of breath and cold sweats. He was tachypneic and had no breath sounds over his right hemithorax, which was hyperresonant to percussion. Arterial blood

Objective To predict which intercostal artery supplies a tumor by examining the spatial relationship between hepatocellular carcinoma (HCC) and the intercostal artery feeding the tumor on transverse computed tomography (CT) images. Materials and Methods Between January 2000 and September 2009, 46 intercostal arteries supplying HCCs smaller than 4 cm were noted in 44 patients, and CT scans and angiograms of these patients were retrospectively reviewed. The intercostal artery feeding the tumor was marked on the CT scan showing the center of the tumor. In addition, its spatial relationship with the tumor center was examined. The angle of the tumor location was measured on the transverse CT scan in the clockwise direction from the sagittal line on the virtual circle centered in the right hemithorax. Correlations between the angle of the tumor location and the level of the tumor-feeding intercostal artery were assessed with the Spearman rank coefficient. Results Of 46 intercostal arteries feeding HCC, 39 (85%) were the first ones observed from the tumor center in a counterclockwise direction on the transverse CT image containing the tumor center. The level of the tumor-feeding intercostal artery was significantly correlated with the angle of the tumor, as the posteriorly located tumor tends to be supplied by lower intercostal arteries, while the laterally located tumor by upper intercostal arteries (Spearman coefficient = -0.537; p < 0.001). Conclusion We can predict the tumor feeder with an accuracy of 85% as the first intercostal artery encountered from the tumor center in a counterclockwise direction on a transverse CT image.

Hernia of Morgagni occurs through an anterior defect in the diaphragm. Symptoms of these hernias are attributable to the herniated viscera. In our case, there was partial obstruction due to herniation of the distal stomach and pylorus into the right hemithorax that was reduced surgically through a right thoracolapaorotomy. Of special emphasis are the various modalities used to diagnose this condition in our case.

A 3-year-old boy was scheduled for a modified Blalock-Taussig shunt (MBTS) on account of tetralogy of Fallot. A right posterolateral thoracotomy was used. On entering the chest, a “fourth lung lobe” was found (fig 1) medial to a pleural fold extending from the apex of the right hemithorax …

A case of right sided pulmonary hypoplasia is described. A 20 years male was admitted in our department with complaints of recurrent chest infections since childhood. Clinical examination revealed smaller right hemithorax. Serial chest X­ rays showed nonprogressive lesions over several years. Bronchoscopy and CT scan thorax confirmed the diagnosis of right sided pulmonary hypoplasia. It was not associated with any other developmental anomaly.

Background Abnormal venous connections involving a persistent right umbilical vein are rare. In a minority of cases the liver is entirely bypassed and the condition is associated with multiple congenital malformations. Case presentation The described case illustrates a systemic venous drainage that was severely abnormal in a newborn girl with a truncus arteriosus type II congenital heart defect. Injection of contrast medium through the umbilical vein catheter revealed a very peculiar venous connection that passed anterio-laterally through the right hemithorax before crossing in an oblique fashion towards the superior vena cava. Conclusions This venous drainage may be the result of a persistent right umbilical vein connecting with the superior vena cava.

A 77-year-old Chinese woman presented with an abnormality on a chest film obtained as part of her screening for immigration to the United States. A posteroanterior film showed a well-circumscribed mass, 8 cm in diameter, in the lower region of the anterior mediastinum and extending into the right hemithorax (Panel A, arrows). The mass was completely excised through a right thoracotomy. There was no evidence of invasion of adjacent structures. Gross examination of a section of the specimen showed irregular, friable areas of hemorrhage and necrosis (Panel B). Microscopical examination showed mixed spindle and polygonal cells arranged in ill-defined bundles . . .

A well-differentiated anterior mediastinal teratoma was removed from the right hemithorax of a 15-year-old girl presenting initially with ascites. Death followed a precipitous clinical deterioration from widespread sarcomatous metastatic disease. The true malignant nature of this tumor was not apparent on initial resection and evaded detection until shortly before death. These unique features prompted a review of the pertinent literature on malignant mediastinal teratoma in children. A similar case had not been reported previously.

In a 2 1/2-year-old boy chest X-ray examination because of dyspnoea revealed hyperlucency of the left upper lobe with herniation of the hyperinflated lobe into the right hemithorax. Surgical exploration showed the upper lobe of the trilobed lung to be the site of congenital lobar emphysema, while the lingula and left lower lobe were collapsed. Left upper lobectomy was successfully performed.

Five healthy Friesian calves and five double-muscled Belgian White and Blue calves were studied, using a 99m Technetium (99mTc) aerosol inhalation combined with a 99mTc macroaggregate injection and collimated scintillation counters. The inhalation-to-perfusion ratio (I/P) was calculated for both left and right sides of the thorax at four sites situated at three different levels in the auscultatory area on the same vertical axis and at a more anterior site just behind the scapulohumeral joint. I/P was higher in the left than in the right hemithorax. In both breeds, a vertical and a horizontal gradient were observed. I/P was higher in the lower and in the more cranial zones of the lungs. However the vertical gradient was more pronounced in Friesian calves while the horizontal one was greater in Belgian White and Blue animals. It was concluded that the factors affecting the topographical distribution of pulmonary ventilation and perfusion seem to be different in calves as compared to other species.