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A 54-year-old man with a history of cerebral palsy and mental impairment presented with acute respiratory distress. He was afebrile and had a nonproductive cough. Examination revealed an absence of air sounds in the right hemithorax, with audible bowel sounds.

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 . . .

Hypoglycemia is known to be a rare consequence of non-islet cell tumors. A patient having severe, episodic hypoglycemia was found to have a large mass occupying the right hemithorax. The hypoglycemia resolved immediately after surgical removal of the tumor. Histologic examination of the tumor revealed localized fibrous mesothelioma.

Figure 1: Thoracic tomodensitometry at hospital admission, showing the garfish sword in the right hemithorax apex. When the garfish sword got stuck in his body, it might have generated serious internal injuries. As a result, removing such a foreign object could have been dangerous because of so many sharp teeth. This CT-scan shows it did not damage neither the nerves nor the vessels. Figure 2: Postoperatove picture of the garfish sword removed from the thorax. The garfish is a fish found in the Caribbean sea, which has a long sword with two narrow jaws and small sharp teeth.

Background: Pericardial cysts are usually asymtomatic, benign, congenital mediastinal lesions but may also be acquired after cardiothoracic surgery. The purpose of the study was to evaluate surgical approach and results of our experience with pericardial cysts. Patients and Methods: A total of 12 patients who had undergone surgical treatment for pericardial cyst between February 1999 and August 2010 were retrospectively evaluated. All patients were analyzed according to the symptoms, method for the diagnosis, cyst location, management, and outcomes. Results: The mean age was 50.4 +/- 17 years (range, 23-68 years) with a female-to-male ratio of 8:4. Pericardial cyst were located in the right hemithorax in 8 (67%) patients and left hemithorax in 4 (33%) patients. The cysts were resected by thoracotomy in 4 (33%) patients and by video-assisted thoracic surgery in 8 (67%) patients. There was an excellent long-term follow-up with no morbidity or mortality. Conclusion: Videothoracoscopic surgical removal of pericardial cysts is an excellent surgical intervention without serious morbidity and mortality.

We present a case of a low-grade mullerian tumor of right pleural origin in a 23-year-old woman treated with an aggressive multimodal treatment paradigm. This tumor is heretofore undescribed in the medical literature. She received induction therapy of carboplatin and paclitaxel with minimal response, then had a maximally cytoreductive right extrapleural pneumonectomy. She subsequently underwent intensity-modulated radiotherapy to the right hemithorax. We propose a treatment paradigm for this previously undescribed primary pleural mullerian tumor.

This article describes the case of a 40 year-old man presenting with pleuritic pain on the right side, cough, sputum and sweating symptoms. He had smoked 40 pack-years of cigarettes and consumed 140 ml alcohol/day for 20 years. Breath sounds were diminished at the right lung base. Chest X-ray showed right hemi-diaphragm elevation and heterogeneous opacity on the right inferior zone. Antibiotherapy was commenced for possible diagnosis of pleuropnemonia. The patient developed dyspnea after a few days. Right hemithorax filled with a parabolic shadow was observed on the chest X-ray. Serosanguineous exudate was sampled. Very high levels of amylase and lipase levels were detected in the pleural fluid. Furthermore, magnetic resonance imaging revealed pancreatic pseudocyst near the left diaphragmatic crus. Four thousand milliliters of pleural fluid was drained using an intercostal drain within a 4-day period, and chest symptoms were relieved. Upon follow-up, suitable therapy for chronic pancreatitis was administered, and the patient was stable without any recurrence.

With the introduction of picture and archiving communicating systems an alternative image display for the wards might be a personal computer (PC). The intention with this study was to evaluate the diagnostic image quality of the monitor of a PC compared to that of a workstation. Eighty-five digital radiographs of a chest phantom with simulated tumors in the mediastinum and right lung were saved on optical discs. The examinations were reviewed by 4 radiologists on a monitor at a workstation and at a PC, and receiver operating characteristic (ROC) curves were constructed. No significant difference was found between performance of the PC and the workstation.

Patients who undergo resection of the right upper lobe of the lung may be predisposed to developing atelectasis when compared to other lung resections. The radiographic examinations of four patients with collapse of the right middle lobe following right upper lobe lobectomy were reviewed. The diagnosis of right middle lobe collapse is based on the findings of increased opacification in the right upper paramediastinal region and volume loss of the right hemithorax.

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.

A 77-year-old woman presented to the hospital with shortness of breath and fever, 2 months after receiving radiation therapy to the right chest for breast cancer. A diagnosis of radiation pneumonitis was made, and the patient was treated with glucocorticoids. Serial chest radiography revealed irregular opacifications, predominantly in the right hemithorax (as seen on the third day after admission [Panel A] and the fifth day [Panel B]). The opacifications decreased markedly after treatment (as seen on day 72 [Panel C]). A lung-sound recorder was used for auscultation of 14 sites on the thorax. The results of the sound analysis are . . .

A 46-year-old female with recurrent syncope and sinus arrest documented on an implanted loop recorder was referred for implantation of pacemaker. Initial attempts at lead deployment were unsuccessful due to an abnormal cardiac anatomy so cardiac magnetic resonance (CMR) examination was obtained to define the anatomy. Cardiac magnetic resonance revealed dextrocardia with the apices of both ventricles positioned in the right hemithorax. The liver, lung, and …

The primary intranodal schwannoma is an uncommon variant of schwannomas and extremely rare. We report the case of a 70-year-old woman who was found to have a soft tissue opacity in the right hemithorax on chest posteroanterior radiography and significant uptake of (18)F-fluorodeoxyglucose on positron emission tomography. We performed thoracoscopic resection, and a definitive diagnosis of intranodal schwannoma was made from the pathological findings.

Ninety-eight digital radiographs of a chest phantom with simulated tumors in the mediastinum and left lung and a pneumothorax-simulation in the right hemithorax were compared with the corresponding examinations saved on optical disk and viewed on a 1 000-line monitor. The examinations were reviewed by 7 radiologists with different experience, and receiver operating characteristic (ROC) curves were constructed. There was no significant difference between the hard-copy and the monitor results. A significant interobserver difference was seen only with the low attenuating 6 mm “tumor” and then only between the observer with the highest and the one with the lowest scores.

impaired/dull note was appreciated on the right side of the chest. The skin over the right hemithorax was warm and hard to touch. On abdominal examination, there was massive, palpable hepatomegaly which was tender. The remaining examination was unremarkable. Chest X-ray ( fig. 1 ) disclosed an almost complete opacification of the right hemithorax with the mediastinal silhouette being slightly displaced towards the left side. A CT scan ( fig. 2 ) of the chest showed lobular pleural and parenchymal masses in the right lung, and right hilar and mediastinal adenopathy with a few scattered air bronchograms. Ultrasound of the abdomen revealed an enlarged liver with two mass lesions with sizes of 2–2.4 and 1.7–2 cm. What is your diagnosis? Case Report

Abnormal lung sounds in diffuse interstitial pneumonia have been characterized by the presence of crackles. However, few attempts have tried to analyze the sound where crackles are immersed. In this work base lung sounds (BLS) were analyzed by linear and nonlinear techniques to find possible differences between normal subjects and patients with diffuse interstitial pneumonia. In both groups, segments of lung sounds (crackles absent) and segments of BLS (lung sound in between crackles) were analyzed from acquired lung sounds from four points at the posterior chest, two apical and two basal. In this study, 8 healthy subjects and 8 patients participated and BLS were analyzed by spectral percentiles and sample entropy. Although spectral percentiles and sample entropy (SampEn) tended to be lower in the group of patients, statistical differences (p

Robotic surgical instrumentation allows minimally invasive mitral valve repair through an endoscopic approach, eliminating the need for a thoracotomy. Robotic instruments are inserted through port-like incisions in the right hemithorax, while cardiopulmonary bypass is established via cannulation of the femoral vessels. We describe triangular resection, a simple and reproducible robotically-assisted technique for repair of posterior leaflet prolapse. The repair is completed with insertion of an annuloplasty ring.

We present herein a rare case of diaphragmatic rupture due to violent coughing during tracheostomy. A 73-year-old man was admitted with cough, hoarseness and dysphagia caused by a huge laryngeal cancer obstructing the airways. Immediate emergency tracheostomy was performed, during which he experienced violent paroxysmal coughing, and he began to complain of right upper abdominal discomfort after tracheostomy. Chest radiography and computed tomography 4 days later showed right diaphragmatic rupture, through which small bowel loops had herniated into the right hemithorax. Diaphragmatic rupture with a 20-cm long fresh oblique tear was repaired through subsequent surgical treatment. Violent paroxysmal coughing during tracheostomy was considered likely to have caused this rare complication.

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.

Em cães, a comprovação da real viabilidade da pneumonectomia direita, bem como, o estudo das complicações resultantes deste procedimento cirúrgico, tornam-se importantes diante da pequena quantidade de estudos na literatura específicos sobre pneumonectomia nesta espécie. O objetivo deste trabalho foi realizar um estudo experimental para avaliar a viabilidade da pneumonectomia direita em cães, através da avaliação paramétrica, hemogasométrica e radiográfica Foram utilizados 10 cães adultos, sadios, machos e fêmeas sem raça definida, pesando entre 13 e 32 kg. Todos os cães foram submetidos à intubação seletiva e toracotomia direita no 5º espaço intercostal, onde foi realizada a pneumonectomia. Foi realizado estudo temporal aos 7, 30 e 60 dias de pós-operatório, onde foi feito avaliação radiográfica, bem como, avaliação paramétrica e hemogasométrica (antes da indução anestésica, 1 hora após extubação, 48 horas, 7, 30 e 60 dias após o procedimento cirúrgico), con,siderados importantes para avaliar as possíveis complicações relacionadas com a técnica anestésica, cirúrgica, assim como, as complicações resultantes deste procedimento cirúrgico. Os resultados encontrados foram analisados estatisticamente. Apesar das alterações dos índices paramétricos e hemogasométricos, todos os cães apresentaram compensação das trocas gasosas após retirada de 57% do volume pulmonar. Na avaliação radiográfica, observamos que a expansão do pulmão remanescente causou deslocamento do coração e pulmão para hemitórax direito. Concluiu-se que a realização da pneumonectomia direita é plenamente viável no cão, permitindo evolução paramétrica, hemogasométrica e radiográfica satisfatória em todos os cães. In dogs, the evidence of viability of the right pneumonectomy, as well as the study of complications resulting from surgical procedure, are very important regarding the few specific studies made on the pneumonectomy in this animal species. The objective of this project was to carry out an experimental study to evaluate the viability of the right pneumonectomy in dogs through parametric, hemogasometric and radiographic evaluation. Ten adult healthy mongrel dogs, males and females, weighing 13-32 kg, were used. The dogs were submitted to selective intubation and right thoracotomy at the 5th intercostal space, where the pneumonectomy was performed. A radiografic evaluation was made on days 7, 30 and 60 after the surgery, as well as parametric and hemogasometric evaluations were done (before anesthetic induction, 1 hour after extubation, 48 hours and on days 7, 30 and 60 after the surgical procedure), considered important to evaluate possible complications due to the anesthetic and surgical techniques, as well as complications resulting from these procedures. The results were analyzed statistically. Besides the parametric and hemogasometric alterations, all dogs showed compensation for the gaseous exchanges after removing 57% of the pulmonary volume. Regarding the radiographic evaluation, it could be observed that the expansion of the remaining lung caused heart and lung displacement into the right hemithorax. It can be concluded that the right pneumonectomy is completely feasible in dogs, allowing a parametric, hemogasometric and radiographic satisfactory evaluation in all the animals.

Summary: Lipoblastoma is a rare benign tumor of adipose tissue seen almost always in infancy and early childhood. Lipoblastoma is present in 2 forms which are pathologically identical: circumscribed and diffuse. It is typically located in the extremities, and less frequently in head-neck region, trunk, and various organs. Lipoblastoma is a tumor with good prognosis with no reported metastases, despite its potential for local invasion and rapid growth. Our patient was a 3-month-old boy who was brought to our clinic for rapidly growing mass in the right hemithorax. With the aim of both diagnosis and treatment, the lipomatous mass was removed by local resection. In addition to the patient’s age, histologic and cytogenetic analyses assisted the diagnosis of diffuse lipoblastoma. In the postoperative period, the thorax wall was unaffected, and after 6 years of follow-up no recurrence was observed. In the English literature, 8 cases of thoracic wall lipoblastoma have been previously reported, and only 3 of diffuse form. Here, we report, at our knowledge, the fourth case of thoracic diffuse lipoblastoma, in which cytogenetic analysis showed a previously undescribed karyotype aberration involving chromosomes 8, 13, and 16.

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.

Postmortem examination performed in a 39-year-old woman revealed a well-circumscribed, round, large mass in the right hemithorax. The tumor was attached with its pedicle to the ventral pericardium and adjoined the diaphragm with compression of the right lower lobe of the lung. Histologic examination confirmed the diagnosis of giant lipoma. Pathol Res Pract

We present the case of a 61-year-old man with a history of pacemaker implantation 15 years ago. The patient was admitted with chronic swelling of the right hemithorax and inflammation of the old incision scar after the replacement of pacemaker generator 6 years ago. The patient also presented symptoms and clinical signs of superior vena cava syndrome. Computed tomography of the thorax showed obstruction of the superior vena cava. The surgical procedure consisted of extraction of infected pacemaker system with excimer laser technique followed by dilatation and stenting of the SVC and finally implantation of a new permanent pacemaker system on the left side.

496 U Special Exhibit Volume 15 Number 2 Figure 1. (a) Anteroposterior radiograph shows a large mass ill a small right hemithorax, absence of the cardiac silhouette, and decreased right pulmonary vascularity. (b) Lateral radiograph shows that the mass is located posteriorly and causes loss of visualization of the posterior right hemidiaphragm. Two retrosternal areas of increased opacity are present: The posterior area of increased opacity (arrowheads) is the heart, and the anterior area of even greater opacity (arrows) represents mediastinal soft tissue abutting the anterior aspect of the right lung. This appearance is consistent with right lung hypoplasia causing dextroposition of the heart and ipsilateral sllift of the mediastinuni.

Central nervous system metastases from diffuse malignant pleural mesothelioma are rare. Here we describe a patient without known asbestos exposure who presented with chest pain, increasing shortness of breath and persistent headache. Evaluation found biphasic malignant mesothelioma of the right hemithorax and a single brain metastasis confirmed by computed tomography. This represents only the second case of a patient with pleural mesothelioma presenting with symptomatic central nervous system metastases.

Lipoblastoma is a rare benign tumor of adipose tissue seen almost always in infanthood and early childhood. It is typically located in the extremities and the trunk and less frequently in the head-neck region, mediastinum, and retroperitoneum. However, cases of pleural, thoracic wall, and pulmonary lipoblastoma have also been reported in the literature. Lipoblastoma is a tumor with good prognosis despite its potential for local invasion and rapid growth. Our patient is a 7-month-old girl who was brought to our clinic for a rapidly growing mass in the right hemithorax. With the aim of both diagnosis and treatment, the mass was removed by thoracic wall resection and the resultant defect covered with an absorbable polyglactine mesh. The excised mass was diagnosed pathologically as a benign lipoblastoma. In the postoperative period, the thorax wall was stable, and after 24 months of follow-up no recurrence was observed. In the literature, 4 types of thoracic wall lipoblastomas have been reported, but thoracic wall resection has not been applied in any benign lipoblastoma case. To the best of our knowledge, the only benign lipoblastoma case in which a thoracic wall resection was carried out, with its clinical and histopathologic specifications alongside that in the literature, is presented here for the first time.

A 61 year old man was admitted with acute breathlessness. A computed tomographic (CT) scan showed a pleural mass 20 cm in diameter occupying the whole right hemithorax and causing massive lung atelectasis, with the exception of a small part of the upper lobe (fig 1A). Magnetic resonance imaging (MRI) showed a right pleural effusion with right hemidiaphragm …

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.

Fig. 1. (A) The posteroanterior chest X-ray demonstrating a homogenous mass residing in the middle and inferior zones of the right hemithorax. (B) Thoracoabdominal magnetic resonance scan (T2 weighted coronal view) depicting a hyperintense lobulated paravertebral mass lesion in the right hemithorax, infiltrating both the thoracal and the abdominal cavities, and extending laterally along the diaphragm.

Background Hemorrhagic pleural effusion, especially in the right hemithorax rarely occurs as the sole presentation of pancreatitis. Case Presentation This article reports massive right-sided hemorrhagic pleural effusion as the sole manifestation of pancreatitis in a 16-year-old Iranian boy. The patient referred to Nemazee Hospital, the main hospital of southern Iran, with right-sided shoulder and chest pain accompanied with dyspnea. His chest x-ray showed massive right-sided pleural effusion. The pleural fluid amylase was markedly elevated (8840 U/L), higher than that in the serum (3318 U/L). Abdominal CT scan showed a cystic structure measuring about 5·2 cm in the head of pancreas, highly suggestive of a pancreatic pseudocyst. Pleural effusion resolved after 3 weeks of chest tube insertion but not completely. After this period of conservative therapy another CT scan showed that pseudocyst was still in the head of pancreas. So, external drainage was done with mushroom insertion and the patient was discharged after 40 days of hospitalization. The cause of pancreatitis could not be identified. Conclusion Pancreatitis should be taken into consideration when hemorrhagic pleural effusion, especially in the right hemithorax occurs.

In May 2011, a 27-year-old man presented with acute onset of dyspnoea associated with localized pleuritic pain over the right upper chest wall. There was no radiation of the pain and he did not have cough, haemoptysis nor leg swelling. Six months ago, he was diagnosed to have pulmonary tuberculosis with sputum positive for Mycobacterium tuberculosis on microscopy and culture. His presenting symptoms at that time were cough with blood-stained sputum with occasional dyspnoea and wheezing. Physical examination was unremarkable then and chest radiograph showed a mild right upper zone infiltrate. Sensitivity testing of the M. tuberculosis strain revealed no drug resistance. He complied to a 6-month course of anti-tuberculous treatment with satisfactory clinical and radiological response upon completion of treatment. …

Coronary artery bypass grafting was carried out in a 61-year-old man 42 years after he had undergone right pneumonectomy. At the time of operation, the heart was displaced into the right hemithorax, which required modification of the operative techniques. Despite poor pulmonary function tests results preoperatively, the patient had an uneventful postoperative course. The success in this patient may be attributed to careful preoperative preparation, flexibility in the choice of techniques for establishment of cardiopulmonary bypass and coronary artery bypass grafting, and careful attention to perioperative fluid management.

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.

Globally cancer is a major public health problem, one out of 10 deaths occur due to cancer. Worldwide, cervical We report a case of 45 years old man found to have dextrocardia with situs inversus who presented with giddiness, fever, syncope, cough and respiratory distress. Chest radiography showed his heart in right hemithorax. ECG findings confirmed the location of heart on right side.

Rationale and objectives A contrast-enhanced dynamic magnetic resonance (MR) study was performed experimentally and clinically to describe perfusion characteristics of radiation-injured lung according to pathologic phases. Methods The MR study was performed before and at 0.5, 1, 2, 3, 4, and 7 months after 40 Gy-dose irradiation to the right hemithorax in 8 dogs, and clinically in 12 lung lesions of 9 patients with acute or fibrotic radiation pneumonitis. Altered Gd-DTPA kinetics in the affected lungs was assessed by time-signal intensity curves. MR findings were correlated with lung histology and CT images. Results Within 1 month after irradiation, the irradiated animal lungs showed focal and persistent contrast enhancement relative to nonirradiated lungs. This abnormality was pronounced during the next 2 months. After 4 months, irradiated lungs conversely showed lower enhancement during the Gd-DTPA first-pass but were followed by persistently greater enhancement during Gd-DTPA redistribution phase. Similar differences in enhancement abnormalities between acute and fibrotic radiation pneumonitis were clinically observed. Conclusion These findings indicate that Gd-DTPA kinetics can be altered according to the histopathologic change in early/acute radiation pneumonitis and radiation fibrosis and that the contrast-enhanced perfusion MRI may help differentiate the phases of radiation pneumonitis.

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 …

From the questions on page 213 . The correct answer is A: complete (right) lung collapse. There is non-aeration of the right lung and the right hemithorax is completely opacified. The collapsed lung is reduced in volume so the trachea and other mediastinal contents are deviated to the …

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.

We herein describe a safe and reproducible technique for left atrial volume reduction in patients with a giant left atrium. In a 56-year-old patient undergoing redo mitral valve replacement, the left atrium measured 18 x 20 x 17 cm occupying the middle-lower segment of the right hemithorax with compression of the adjacent organs. The left atrial volume was reduced by triangular resections of the atrial wall and the mitral valve was replaced using a mechanical prosthesis. The postoperative course was uneventful and the left atrial diameter was 11.2 cm at the latest control.

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.

Inflammatory pseudotumors of the lung are uncommon in the thoracic surgical literature. These masses resemble carcinoma of the lung radiographically and are discovered only at time the of histologic review of the resected specimen. We report a case of inflammatory pseudotumor that was excised without pulmonary resection, although it completely filled the right hemithorax. We think it was the greatest inflammatory pseudotumor in the English literature.

D islocated fragments of proximal humerus fractures rarely displace into the ipsilateral hemithorax [ 1-6]. To our knowledge. we report the first case of fracture with dislocation into the contralateral hemithorax. Case Report A 63-year-old man fell 18 feet (5.5 m) from a ladder and landed on his left side. Chest radiographs showed bilateral pneumothoraces, a severely comminuted fracture of the proximal left humerus, and a calcified right apical mass that appeared to be the contralateral humeral head (Figs. 1A and I B). Chest CT showed the fractured and dislocated contralateral humeral head within the apex of the right hemithorax (Fig. lC). Aortography, barium swallow. and bronchos

Sir, A 50-year-old male never smoker was admitted to hospital with lower back pain, cough and dyspnoea on exertion. On examination air entry was significantly reduced in the right hemithorax and the percussion note was hyperresonant; blood pressure was normal, although a tachycardia of 100 beats per minute was present. His past medical history included palliative tri-incisional oesophagectomy …

Post-pneumonectomy syndrome is a well-recognised but uncommon late complication of pneumonectomy. Usually occurring after right-sided surgery, the mediastinal contents are rotated and displaced into the right hemithorax, producing airways or oesophageal compression. We report a case in which the radiological features and symptoms of post-pneumonectomy syndrome appeared to be precipitated by the development of a complex tuberculous tracheobronchial stenosis that resolved after the insertion of a bespoke Dumon stent.

A 15 x 15 cm mass in the right hemithorax of a 25-year-old woman was incidentally detected at routine chest radiography. Radical excision of the bony chest wall, including right CII-VI, revealed chondrosarcoma. Large, expansile parosteal chondromas were radiographically visualized in the pelvis and bones of the lower leg, representing Ollier's disease. Chondrosarcoma of the chest wall appears to be rare in Ollier's disease.

Kirschner (K) wires can easily migrate, resulting in serious complications. We report a 49-year-old woman who had a rare and late complication related to the migration of K wire. It had been used for left hip replacement 8 years ago. The patient admitted to our hospital with breathing-dependent chest pain and increasing dyspnea for ∼2 h. Chest X-ray and chest computed tomographic scans revealed the presence of a metallic image of ∼5–6 cm in the right hemithorax. There was a large hemothorax but no pneumothorax. A right thoracotomy was performed and the wire was removed without complications. Surprisingly, no injury was noted to any intervening abdominal structure intra-operatively. Patients, who are treated with K wire, should be informed of the risk of wire migration and should undergo regular postoperative follow-ups including radiography.

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.