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IntroductionTo validate and evaluate the performance of knowledge-based treatment planning for Volumetric Modulated Arc Radiotherapy for post-mastectomy loco-regional radiotherapy.Material and methodsTwo knowledge-based planning (KBP) models for different dose prescriptions were built using the Eclipse RapidPlanTM v 16.1 (Varian Medical Systems, Palo Alto, USA) utilising the plans of previously treated patients with left-sided breast cancer who had undergone irradiation of the left chest wall, internal mammary nodal (IMN) region and supra-clavicular fossa (SCF). Plans of 60 and 73 patients were used to generate the KBP models for the prescriptions of 40 Gy in 15 fractions and 26 Gy in 5 fractions, respectively. A blinded review of all the clinical plans (CLI) and KBPs was done by two experienced radiation oncology consultants. Statistical analysis of the two groups was also done using the standard two-tailed paired t-test or Wilcoxon signed rank test, and p

The diagnostic capabilities of ultrasound extend far beyond the evaluation of the pleural space and lungs. Sonographic evaluation of the chest wall is a classic extension of the clinical examination of visible, palpable, or dolent findings. Unclear mass lesions of the chest wall can be differentiated accurately and with low risk by additional techniques such as color Doppler imaging, contrast-enhanced ultrasound, and, in particular, ultrasound-guided biopsy. For imaging of mediastinal pathologies, ultrasound has only a complementary function but is valuable for guidance of percutaneous biopsies of malignant masses. In emergency medicine, ultrasound can verify and support correct positioning of endotracheal tubes. Diaphragmatic ultrasound benefits from the real-time nature of sonographic imaging and is becoming increasingly important for the assessment of diaphragmatic function in long-term ventilated patients. The clinical role of thoracic ultrasound is reviewed in a combination of narrative review and pictorial essay. [ABSTRACT FROM AUTHOR]

Background: To explore the dosimetric difference between IMRT-VB plan based on the establishment of external expansion structure and virtual bolus (VB) and IMRT-SF based on the skin flash (SF) tool of the Eclipse treatment planning system in postoperative chest wall target intensity modulation radiotherapy plan of breast cancer. Methods: Twenty patients with breast cancer were randomly selected as subjects to develop IMRT-VB plan based on virtual bolus and IMRT-SF plan based on skin flash tool of Eclipse treatment planning system. The planning target volume, monitor unit (MU) of every single treatment and the dosimetric parameters of organ at risk (OARs) were recorded. Paired t-test was used for normal distribution data while nonparametric paired Wilcoxon rank sum test was used for non-normal distribution data. Results: Both IMRT-VB and IMRT-SF plan can expand outward to the chest wall skin and meet the dose requirements of clinical prescription. The conformal index, the homogeneity index, D2%, D98% and D50% were significantly better in IMRT-SF plan than those in IMRT-VB plan (P < 0.05). The average MU of the IMRT-SF plan was much higher than that of the IMRT-VB plan (866.0 ± 68.1 MU vs. 760.9 ± 50.4 MU, P < 0.05). In terms of organ at risk protection, IMRT-SF plan had more advantages in the protection of ipsilateral lung and spinal cord than IMRT-VB plan (P < 0.05). Conclusion: Our study indicated that IMRT-SF plan displayed clinical application superiority compared to IMRT-VB plan, and the operation steps of which are simpler and faster. Besides, IMRT-SF plan took advantages in achieve effective external expansion of skin dose intensity and OARs protection. [ABSTRACT FROM AUTHOR]

Background: Thoracic mesenchymal hamartomas are rare benign lesions. Rarely symptomatic, they may compress pulmonary parenchyma, leading to respiratory distress. Although spontaneous regression has been documented, the more common outcome is progressive growth. The treatment of choice is en bloc excision of the involved portion of the chest wall, frequently leading to significant deformity. Objective: The aim of our study was to describe percutaneous techniques to treat these lesions. Materials and methods: We collected data of children with thoracic mesenchymal hamartomas who were treated at our institution from 2005 to 2020 using various percutaneous techniques. Techniques included radiofrequency thermoablation, microwave thermoablation (microwave thermoablation) and cryoablation. Results: Five children were treated for chest wall hamartomas; one child showed bilateral localization of the mass. Two children underwent microwave thermoablation, one radiofrequency thermoablation and two cryoablation; one child treated with cryoablation also had radiofrequency thermoablation because mass volume increased after the cryoablation procedure. The median reduction of tumor volume was 69.6% (24.0–96.5%). One child treated with microwave thermoablation showed volumetric increase of the mass and underwent surgical removal of the tumor. No major complication was reported. Conclusion: Percutaneous ablation is technically feasible for expert radiologists and might represent a valid and less invasive treatment for chest wall chondroid hamartoma, avoiding skeletal deformities. [ABSTRACT FROM AUTHOR]

Objectives: Recently, biologic meshes have gained increasing popularity in soft tissue reconstruction. The aim of this study was to investigate the use of a bovine acellular dermal matrix (SurgiMend, Integra LifeSciences, Princeton, NJ, USA) in diaphragmatic and chest wall reconstruction by comparing it with synthetic meshes. Methods: Consecutive patients who underwent diaphragmatic and/or chest wall reconstruction at a single center from 2016 to 2021 were retrospectively reviewed. Outcome measures included surgical site complications, readmission, and reoperation. Results: Sixty-six patients underwent diaphragmatic and/or chest wall reconstruction for a malignant (74.2%) or benign (25.8%) disease. SurgiMend was used in 26 (39.4%) patients and a synthetic mesh in 40 (60.6%) patients. There were no significant differences in baseline characteristics between the groups. Surgical site complications included prolonged air leak (12.1%), pleural effusion (9.1%), pneumothorax (3%), empyema (1.5%), and wound infection (1.5%). The patients in the synthetic mesh group developed a significantly higher rate of surgical site complications compared to those in the SurgiMend group (37.5% vs. 11.5%; p = 0.025). Similarly, the readmission rate was significantly higher in the synthetic mesh group (17.5% vs. 0%; p = 0.037), with causes including pleural effusion (n = 3), pneumothorax (n = 2), empyema (n = 1), and pneumonia (n = 1). Among the study cohort, only 1 patient with a synthetic mesh underwent reoperation (p > 0.99). Conclusions: The use of surgiMend in diaphragmatic and chest wall reconstruction is associated with fewer surgical site complications and readmissions compared to synthetic meshes. [ABSTRACT FROM AUTHOR]

Chest wall lymphatic malformations are rare and can pose a diagnostic dilemma, particularly if they present abruptly. This case report describes a 15-month-old male toddler presenting with a left lateral chest mass. Histopathology of the surgically excised mass confirmed the diagnosis of a macrocystic lymphatic malformation. Furthermore, there was no recurrence of the lesion in the two-year follow-up period. [ABSTRACT FROM AUTHOR]

Background: Chest wall chondrosarcoma is the most common primary tumor of chest wall. Radical excision with wide safety margin and optimal reconstruction of chest wall by prosthetic material is a corner stone in management. Aim of this study is to evaluate our surgical technique in management of thoracic chodrosarcoma Patients and Methods: Over a period of 5 years, 24 cases with chest wall chondrosarcoma were reviewed and evaluated in Cardiothoracic Surgery Department in Mansoura University. Results: in this study, 16 males and 8 females presented by rib chondrosarcoma (87.5%) and sternal chondrosarcoma (12.5%). Patients presented by painful mass were (62.5%) while those with mass only were (37.5%). Wide excision with safety margin of 4-5 cm was done, reconstruction was done by prolene mesh only in 33.3% and by prolene mesh with bone cement in (66.6%) Minimal complications in the form of fever (12.5%), seroma (8.3%) and infection (4.2%) were reported. Conclusion: We advise aggressive resection of chrondrosarcoma with wide safety margin and prosthetic material reconstruction of chest wall as it is the concept to expect high survival and low recurrence rates. [ABSTRACT FROM AUTHOR]

Introduction: Due to the limited target volume and irregular body surface, irradiating the chest wall (CW) and lymphatic nodes is more challenging. IMRT and VMAT (volumetric modulated arc therapy) are two treatment delivery techniques that help to improve dose coverage and homogeneity while reducing irradiation to the heart and ipsilateral (I/L) lung. The use of a hybrid treatment planning approach for the ca-breast will impact the treatment plan. The hybrid planning system must be reviewed and compared to alternative treatment options for ca-breast cancer. Material and Methods: For 10 patients undergoing left-sided breast chest wall irradiation, the 3 distinct planning techniques (FiF [Field-in-field], IMRT, and Hybrid IMRT) were evaluated. A prescription dose of 40 Gy in 15 fractions was used for the planned target volume (PTV). To compare plans, dose-volume histograms (DVHs) were assessed for PTV and organs at risk. Results: D95% of PTV was 37.10 ± 0.48 Gy in FiF, but considerably raised to 39.32 ± 0.34 Gy and 38.39 ± 0.29 Gy in IMRT (p=0.01) and Hybrid IMRT (p=0.01). When compared to IMRT (0.981 ± 0.014) and Hybrid IMRT (0.970 ± 0.013) FiF plans have the lowest CI value of 0.931 ± 0.026. IMRT plans (0.087 ± 0.021) were found to be more homogeneous than other 2 planning techniques (0.111 ± 0.013 [FiF, p=0.016], 0.107 ± 0.021[hybrid IMRT, p=0.056]). Conclusion: Hybrid IMRT treatment plans for the ca-breast are recommended because they provide superior and similar PTV dose coverage and OAR sparing compared to FiF and IMRT plans. Hybrid IMRT plans feature lower MU and BOT, as well as a smaller low dose volume in comparison to IMRT. [ABSTRACT FROM AUTHOR]

Non‐traumatic costochondritis, which manifests as pain and tenderness over the anterior chest wall, may be associated with inflammatory arthritis affecting the upper costochondral and sternocostal joints. Local corticosteroid injection is helpful for recalcitrant cases and ultrasound guidance may not be routinely used by experienced rheumatologists. We report a female patient with pain over the right upper parasternal area with gradual swelling near the first costosternal junction. The ultrasound examination revealed a hyper‐vascular mass, which was proven to be Hodgkin's lymphoma. We want to emphasize the importance of using ultrasound for guiding injection for costochondral lesions which facilitated the detection of a tumor invading the chest wall in our case. [ABSTRACT FROM AUTHOR]

Objective: We aimed to quantitatively study the characteristic of diaphragm and chest wall motion using free-breathing dynamic magnetic resonance imaging (D-MRI) in Chinese people with normal lung function. Methods: 74 male subjects (mean age, 37 ± 11 years old) were prospectively enrolled, and they underwent high-resolution CT(HRCT), pulmonary functional tests (PFTs), and D-MRI in the same day. D-MRI was acquired with a gradient-echo sequence during the quiet and deep breathing. The motion of the diaphragm and chest wall were respectively assessed by measuring thoracic anteroposterior diameter (AP), left–right diameter (LR), cranial–caudal diameter (CC), and thoracic area ratios between end-inspiration and end-expiration. The effect of age, body mass index (BMI), and smoking on respiratory muscle function was also analyzed. Results: The mean ratio of right and left AP was greater than that of LR on three transversal planes during both quiet and deep breathing. The mean ratio at the anterior diaphragm (AND, Quiet: 1.04 ± 0.03; Deep: 1.15 ± 0.09) was weaker than that of the apex (vs. APD, Quiet: 1.08 ± 0.05, p < 0.001; Deep: 1.29 ± 0.12, p < 0.001) and posterior diaphragm (vs. POD, Quiet: 1.09 ± 0.04, p < 0.001; Deep: 1.30 ± 0.12, p < 0.001) both in quiet and deep breathing. Compared with non-smokers, the left AP and thoracic area ratios in smokers were significantly decreased (p < 0.05). However, the ratios of AP, LR, CC, and thoracic area on each plane were similar among groups in different age and BMI. Conclusions: During both quiet and deep breathing, the chest wall motion is prominent in the anteroposterior direction. The motions of diaphragm apex and posterior diaphragm were more prominent than that of the anterior diaphragm. Smoking may affect the respiratory muscle mobility. Dynamic MRI can quantitatively evaluate the motion of respiratory muscles. [ABSTRACT FROM AUTHOR]

Propose: In this study, we re-assessed the criteria defined by the radiological society of North America (RSNA) to determine novel radiological findings helping the physicians differentiating COVID-19 from pulmonary contusion. Methods: All trauma patients with blunt chest wall trauma and subsequent pulmonary contusion, COVID-19-related signs and symptoms before the trauma were enrolled in this retrospective study from February to May 2020. Included patients (Group P) were then classified into two groups based on polymerase chain reaction tests (Group Pa for positive patients and Pb for negative ones). Moreover, 44 patients from the pre-pandemic period (Group PP) were enrolled. They were matched to Group P regarding age, sex, and trauma-related scores. Two radiologists blindly reviewed the CT images of all enrolled patients according to criteria defined by the RSNA criteria. The radiological findings were compared between Group P and Group PP; statistically significant ones were re-evaluated between Group Pa and Group Pb thereafter. Finally, the sensitivity and specificity of each significant findings were calculated. The Chi-square test was used to compare the radiological findings between Group P and Group PP. Results: In the Group PP, 73.7% of all ground-glass opacities (GGOs) and 80% of all multiple bilateral GGOs were detected (p

Flail chest is a critical medical condition in which multiple segmentally fractured adjacent ribs cause paradoxical movement of the thoracic cage in patients with severe blunt trauma injury. Surgical stabilization is considered essential in patients who require mechanical ventilation. However, there is no consensus on which surgical procedure to choose among the various available techniques or when to perform surgery. We report the case of a patient with traumatic anterior flail chest due to bilateral multiple fractures of the ribs requiring surgical stabilization in whom weaning from mechanical ventilation had failed. The Nuss procedure using double bars with the bridge technique was performed for chest wall stabilization. The patient was weaned from mechanical ventilation on postoperative day 44 and she underwent bar removal on postoperative day 71. After extensive rehabilitation for multiple trauma, she was discharged successfully. The patient currently shows no recurrence of chest wall depression in outpatient follow-up.

Introduction: Enchondromas are benign tumors originating in the cartilaginous tissue of the hyaline gristle, rarely located in the chest wall. They sometimes undergo a sarcomatous transformation, becoming secondary chondrosarcomas.

Children with chest wall tumors may require extensive chest wall resections. The reconstruction of large chest wall defects can be surgically challenging. We present a new chest wall reconstruction method. A 2.5-year-old male who developed respiratory symptoms and chest pain was diagnosed with an Askin's tumor of the left chest wall. The tumor originated in the posterior segments of the seventh and eighth ribs. Computed tomography of the chest revealed a large mass filling the left hemithorax, causing flattening of the hemidiaphragm and mediastinal shift. No distant metastases were identified. The patient underwent six cycles of neoadjuvant chemotherapy with vincristine, adriamycin, cyclophosphamide, ifosfamide, and etoposide. Post-chemotherapy, magnetic resonance imaging revealed a significant reduction in tumor size. The patient was taken to the operating room for the resection of the tumor. The posterior segments of the left sixth, seventh, eighth, and ninth ribs were surgically excised. The chest wall was reconstructed using a biological mesh (Permacol™), sutures for costal arch stabilization using the lattice technique, and a rotated latissimus dorsi muscle flap for defect coverage. An 18 Fr pleural drainage was left in place. The patient tolerated the operation well and was successfully extubated 48 hours later. Pain was effectively managed via paravertebral block. The patient was discharged on the 14th postoperative day. The resected specimen had negative margins. He subsequently underwent several more cycles of chemotherapy. Eighteen months after the operation he has developed no scoliosis and has full range of motion on the left chest wall. A combination of a biological mesh, rib stabilization and latissimus dorsi rotation seems to be a valid technique to cover large chest wall defects. [ABSTRACT FROM AUTHOR]

Osteosarcoma commonly occurs in the intramedullary cavity of long bones such as the femur, tibia, and humerus in children and adolescents. Osteosarcoma occurring as a primary tumor in the chest wall is rare. Only a limited number of such cases have been documented in the existing literature. Herein, we present radiologic and pathologic findings of a high-grade surface osteosarcoma of the rib mimicking a neurogenic tumor in a 44-year-old woman.

Abstract Background Angiolipoma is a rare histological variant of lipoma. Angiolipoma commonly occurs in the subcutaneous tissues of the extremity and trunk. There are few reports of angiolipoma occurring in the chest wall. Case presentation A 78-year-old woman was referred to our hospital for evaluation of angina pectoris. Coronary computed tomography (CT) showed a soft tissue nodule in the left chest wall by chance. Enhanced chest CT showed a heterogeneous enhanced nodule in the left chest wall. On magnetic resonance imaging (MRI), the lesion showed low signal intensity on T1-weighted images, heterogeneous high signal intensity on T2-weighted images and high signal intensity on fat-suppressed T2-weighted images. The lesion showed heterogeneous enhanced effect on gadolinium-based contrast agent. These radiological findings suggested neurogenic tumor with abundant blood flow or hemangioma. Video-assisted thoracic surgery (VATS) was performed for both diagnostic and therapeutic purposes. Histopathological examination of the tumor showed mature adipose tissue and capillary hyperplasia containing fibrin thrombi. These appearances were consistent with angiolipoma. She had an uneventful recovery and did not show recurrence until 8 months post-surgery. Conclusions Angiolipoma of the chest wall is extremely rare. Preoperative diagnosis is very difficult because the imaging findings of angiolipoma vary depending on the amount of vascular component and fat component, so surgical resection is suggested to be both diagnostic and therapeutic.

Lymphatic malformations (LMs) are rare, with more than 90% occurring during childhood. Most LMs are located in the head, neck and axilla. LMs in chest wall are extremely rare, particularly in adults. This report describes a 45-year-old man with a large macrocystic LM in the right anterior chest wall. Computed tomography showed a ∼15 cm sized, well-defined, homogeneous and hypoattenuated mass without enhancement in the right anterior chest wall. On ultrasonography (US), the mass was circumscribed and anechoic, with internal septations and posterior acoustic enhancement. Following surgical excision, the mass was diagnosed as a macrocystic LM.

Clinicians monitor mechanical ventilatory support using airway pressures—primarily the plateau and driving pressure, which are considered by many to determine the safety of the applied tidal volume. These airway pressures are influenced not only by the ventilator prescription, but also by the mechanical properties of the respiratory system, which consists of the series-coupled lung and chest wall. Actively limiting chest wall expansion through external compression of the rib cage or abdomen is seldom performed in the ICU. Recent literature describing the respiratory mechanics of patients with late-stage, unresolving, ARDS, however, has raised awareness of the potential diagnostic (and perhaps therapeutic) value of this unfamiliar and somewhat counterintuitive practice. In these patients, interventions that reduce resting lung volume, such as loading the chest wall through application of external weights or manual pressure, or placing the torso in a more horizontal position, have unexpectedly improved tidal compliance of the lung and integrated respiratory system by reducing previously undetected end-tidal hyperinflation. In this interpretive review, we first describe underappreciated lung and chest wall interactions that are clinically relevant to both normal individuals and to the acutely ill who receive ventilatory support. We then apply these physiologic principles, in addition to published clinical observation, to illustrate the utility of chest wall modification for the purposes of detecting end-tidal hyperinflation in everyday practice. [ABSTRACT FROM AUTHOR]

Blunt injuries to the chest wall, specifically those related to rib fractures, need to be promptly identified and effectively managed to reduce patient morbidity and mortality. Furthermore, judicious use of multimodal pain management and early identification of patients who will benefit from the surgical stabilization of rib fractures are paramount to optimal outcomes. [ABSTRACT FROM AUTHOR]

This paper retrospectively analyzed the case data of an adult hamartoma of the left chest wall, and combined with the literature analysis, to discuss the clinical characteristics, imaging diagnosis and differential diagnosis of hamartoma. CT and MRI findings of the patient showed medial occupation of the left serratius anterior muscle, with visible fat and calcification. Different from the previous reports of chest wall hamartoma in terms of age, location and imaging characteristics, this case had certain characteristics, and the diagnosis needed pathological confirmation after surgical resection. [ABSTRACT FROM AUTHOR]

Background: Resection of lung cancer with chest wall involvement is an invasive procedure.Case Presentation: We report a case of pulmonary adenocarcinoma with chest wall involvement that was resected through video-assisted thoracoscopic segmentectomy and combined en bloc resection of the chest wall (2nd to 4th ribs). Surgical stress was decreased by reducing the extent of lung parenchymal resection and applying a video-assisted technique with an additional posterior paravertebral incision.Conclusion: A thoracoscopic surgical approach involving incisions in areas requiring resection of the proximal, lateral, and posterior sides of the involved ribs can be applied to tumors invading the chest wall. [ABSTRACT FROM AUTHOR]

Background: Pain associated with chest wall trauma is a major issue in the emergency department (ED). However, it may be challenging to select among the various analgesic procedures.Objective: Our aim was to compare single-shot erector spinae plane block (ESPB) with intercostal nerve block (ICNB) under ultrasound guidance for pain management in thoracic trauma.Methods: This study was a randomized nonblinded clinical trial performed in a level I urban trauma center. A convenience sample of patients with isolated chest wall trauma and initial Numeric Rating Scale pain scores (NRS 0) > 5 were included. Exclusion criteria were large pain area, surgical interventions, discharged from the ED, and presence of contraindications to lidocaine. Pain scores at 20 min and 60 min (NRS 20 and 60) and at disposition (disp) were recorded.Results: Twenty-seven patients in the ESPB and 23 in the ICNB groups were enrolled. Mean values of NRS 0, 20, 60, and disp for the ESPB vs. ICNB groups were 8.0 vs. 7.4, 5.2 vs. 6.1, 4.1 vs. 5.4, and 4.3 vs. 5.8, respectively (p = 0.07, p = 0.04, p = 0.001, and p < 0.001, respectively). Four patients in the ESPB and 8 patients in the ICNB groups required administration of adjunctive doses of fentanyl for satisfactory pain control (p = 0.09).Conclusions: Ultrasound-guided ESPB was superior to ICNB regarding pain control during the ED stay period of patients with painful chest wall trauma. We recommend ESPB in the ED for pain control in blunt or penetrating thoracic trauma. [ABSTRACT FROM AUTHOR]

Background: Chest wall sarcomas are a rare group of tumours. Surgical resection is considered the mainstay of curative treatment, however, resection and reconstruction of chest wall defects presents complex issues for the clinician. Methods: A retrospective analysis of 59 patients undergoing surgical management of chest wall sarcoma between December 1996 and July 2020 was conducted across a multidisciplinary sarcoma service in Melbourne, Australia. Patient demographics, pathologic data, and long‐term outcomes were recorded. Results: Mean age at surgery was 48.4 years (SD 18.3), and 66.1% were male. Median follow‐up was 29 months (IQR 11.8, 51.0 months). Fifty‐one patients presented with primary tumours, while the others had secondary tumours resected. Most tumours arose in bone (72.9%) as opposed to soft tissues (27.1%). Chondrosarcoma was the most common histologic subtype (50.8%). The most common reconstructive techniques involved the use of mesh (79.7%) or mesh supplemented with bone cement (33.9%). Overall survival at 1 and 5 years was 92% and 70%, respectively. Seven patients died of metastatic sarcoma during the follow up period with a median survival time of 27 months. Twelve patients had evidence of disease recurrence during the follow‐up period. Stage 4 disease, soft tissue tumours, secondary tumours, leiomyosarcoma and UPS subtypes, and plating reconstruction were associated with increased disease recurrence. Conclusions: The results suggest that outcomes for chest wall sarcoma are similar to extremity sarcomas and may be treated in a similar manner. Patients requiring adjuvant radiotherapy and those who develop disease‐recurrence are more likely to have worse overall survival outcome despite complete surgical resection. [ABSTRACT FROM AUTHOR]

Objectives The objective of this study was to present the procedural details and digital subtraction angiography (DSA) findings of perioperative chest-wall collateral embolization (PCCE) and compare intraoperative blood loss in patients of pulmonary aspergilloma (PA) undergoing lung resection with and without PCCE. Materials and Methods Since November 2017, we have performed PCCE in 17 patients (14 males, three females, age 34.41 ± 12.85 years) before surgery for PA (embolization group). Retrospective evaluation of these patients was done, DSA findings were noted, and perioperative parameters (surgical approach, extent of resection, operative time, blood loss, blood transfusion, morbidity grade, and length of post-operative stay) were compared with a comparative cohort of 24 patients of PA (21 males, three females, mean age 36.13 ± 12.58 years) who underwent thoracic surgery without PCCE (May 2013–November 2017) (control group) using the Mann–Whitney U test. Results A total of 55 arteries were embolized in 17 patients (mean 3.23 arteries per patient). Technical success could be achieved in all patients without any procedure-related complications. The most common arteries embolized were posterior intercostal arteries (29) followed by costocervical trunk (10), superior thoracic (8), lateral thoracic (5), and internal thoracic arteries (3). The mean blood loss was significantly lower in the embolization group compared with the control group (676.47 vs. 1,264.58 mL, p = 0.015). Within the embolization group, patients who underwent video-assisted thoracoscopic surgery had even lower blood loss compared with open surgery cases (466 vs. 887.50 mL, p -value = 0.046). Conclusion PCCE is a simple and safe procedure, useful in reducing intra-operative blood loss in patients undergoing surgery for peripherally located PA. [ABSTRACT FROM AUTHOR]

Granulosa cell tumor (GCT) is a rare tumor that originates from neural/Schwann cells. GCTs can occur at any age and at any site in the body. The most common site is the tongue, followed by the mammary gland, upper respiratory tract (throat and bronchus), and gastrointestinal tract (esophagus, large intestine and perianal area, stomach, small intestine, and bile duct). Malignant GCTs account for less than 1%-2% of all GCTs. Fewer than five GCTs in the thoracic wall have been reported, almost all of these benign. Here, we report a new case of malignant GCT of the thoracic wall, with rib invasion and pleural metastasis, in an Asian male. Microscopic examination revealed round, granular cells with eosinophilic cytoplasm and without prominent atypia. Despite these findings the disease showed rapid clinical progression. In summary, the tumor, although histologically 'benign', was clinically 'malignant'. [ABSTRACT FROM AUTHOR]

Ultrasonography (US) is the workhorse of pediatric imaging; however, lung US is only a recently developed application. US of the lung is based predominantly on the imaging of chest wall–air–fluid interfaces. In this review, we summarize the available literature on applications of lung US in neonatal as well as pediatric care. We describe the imaging appearance of various commonly encountered pathologies including pneumonia and respiratory distress syndrome, among others, and provide illustrative images. Finally, we describe the limitations of the technique that are essential knowledge for radiologists, critical care physicians, sonographers and technologists attempting to use lung US effectively for diagnosis and management. [ABSTRACT FROM AUTHOR]

Pediatric chest wall lesions are varied in etiology ranging from normal and benign to aggressive and malignant. When palpable, these lesions can alarm parents and clinicians alike. However, most palpable pediatric chest lesions are benign. Familiarity with the various entities, their incidences, and how to evaluate them with imaging is important for clinicians and radiologists. Here we review the most relevant palpable pediatric chest entities, their expected appearance and the specific clinical issues to aid in diagnosis and appropriate treatment. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to reduce mortality and morbidity by analyzing the factors associated with blunt chest trauma. Methods: In this study, 1020 patients with blunt thoracic trauma were analyzed retrospectively. Major surgeries, complications, admission to intensive care unit, intubation, mortality, prolonged hospital stay were considered poor clinical outcomes. Independent variables were compared with clinical outcomes and analyzed. Results: The mean age was 52.7 ± 19.1. Complications (p = 0.028) and mortality (p < 0.001) were higher in patients aged 65 years and older than those aged 65 years and younger. Severe chest wall injuries, hemopneumothorax, and pulmonary contusions were associated with poor clinical outcomes (OR = 2474, p = 0.001, OR = 2229, p < 0.001 and OR = 2229, p < 0.001, respectively). The variable most related to poor clinical outcomes was New Injury Severity Score (p < 0.001, OR = 8.37). Conclusions: The most associated factor with poor clinical outcomes was injury severity. Prompt treatment of blunt chest trauma with timely chest tube thoracostomy or surgical treatment when necessary, optimal pain control, and chest physiotherapy will reduce mortality. [ABSTRACT FROM AUTHOR]

Background and Objective: Traditionally, literature on thoracic ultrasound has focused on the study of pleural and pulmonary pathology. However, given the superficial location of thoracic wall structures, ultrasound proves to be an excellent technique for their examination. This study aims to evaluate the clinical utility of thoracic ultrasound in diagnosing various thoracic wall pathologies and to illustrate the primary diagnoses that can be achieved., Methods: We performed a literature search in January 2024 in PubMed and Google Scholar for articles on thoracic ultrasound. Relevant articles were selected and synthesized in a narrative form., Key Content and Findings: Thoracic ultrasound has emerged as a powerful diagnostic tool, especially when combined with a thorough clinical history. It allows for rapid, inexpensive, and safe resolution of a wide range of common clinical uncertainties across all levels of healthcare. In emergency contexts, it excels in the detection of rib fractures, demonstrating superior capability compared to traditional chest X-rays and similar efficacy to computed tomography (CT) scans. Additionally, thoracic ultrasound is highly effective in evaluating tumors, often providing accurate diagnoses without the need for further studies. It also aids in differentiating pathologies that may require more advanced imaging such as CT or magnetic resonance imaging (MRI). Moreover, thoracic ultrasound plays a valuable role in the initial assessment of infectious and degenerative conditions., Conclusions: Thoracic ultrasound is a versatile and efficient diagnostic tool for examining thoracic wall structures. Its applications are particularly valuable in trauma assessment, tumor evaluation, and the differentiation of various pathologies. The rapid, cost-effective, and safe nature of this technique highlights its potential as a primary diagnostic tool in a wide variety of clinical settings., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://qims.amegroups.com/article/view/10.21037/qims-24-355/coif). The special issue “Advances in Diagnostic Musculoskeletal Imaging and Image-guided Therapy” was commissioned by the editorial office without any funding or sponsorship. X.T. served as the unpaid Guest Editor of the issue. The authors have no other conflicts of interest to declare., (2024 AME Publishing Company. All rights reserved.)

Background: Chest wall sarcomas are rare and pose significant technical challenges in surgical management, particularly in patients with advanced disease. In this study, we examined the extent of resection, reconstruction techniques, and oncological outcomes of patients with chest wall soft tissue and bone sarcomas., Methods: This retrospective single-center series included patients who underwent surgery at our center between May 2014 and February 2022 for deep-seated/subfascial primary and recurrent soft tissue or bone sarcomas of the chest wall requiring significant resection and extensive reconstruction. We analyzed clinical and operative data, including extent of resection, reconstruction techniques, and oncological outcomes. Additionally, we compared survival outcomes between patients with primary and recurrent tumors, and examined how these were influenced by clinical factors using Cox proportional hazards regression analysis., Results: Of the 38 patients included, 22 were treated for primary or recurrent soft tissue sarcoma (STS) and 16 for bone sarcoma. En bloc microscopic radical resection (R0) was achieved in 95.45% and 93.75% of patients with soft tissue and bone sarcomas, respectively. Nonetheless, local recurrence or distant metastases occurred in 40%, 58.33%, and 40% of patients with primary soft tissue, recurrent soft tissue, and bone sarcomas, respectively. Adherence to clinical guidelines and treatment in the reference center was high for bone sarcoma (93.75%), but notably low for STS, resulting in 54.55% of these patients requiring re-resection. Compared with those who underwent only one surgery, patients who underwent re-resection had poorer postoperative outcomes, more severe complications, and longer hospital stay., Conclusions: Chest wall sarcomas often require extensive resection and complex reconstruction. Although surgical treatment at reference sarcoma centers has significantly improved oncological and clinical outcomes, the prognosis of these patients remains guarded, necessitating further related research and continued refinement in surgical techniques, adjuvant therapies, and follow-up strategies., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-24-472/coif). The authors have no conflicts of interest to declare., (2024 AME Publishing Company. All rights reserved.)

[Purpose] Vibratory stimulation of the upper intercostal region enhances inspiratory movement, whereas stimulation of the lower intercostal region enhances expiratory movement and ventilation. Previous vibration stimulation devices for intercostal muscles required manual stimulation, causing a time lag between breathing and vibration stimulation. The purpose of this experiment was to compare the effects of an automatic vibration stimulation system with manual vibration stimulation in a group of individuals and to verify whether there was an increase in upper and lower chest wall displacement and respiratory flow. [Participants and Methods] Twenty healthy adults were divided into two groups, as follows: an automatic vibration stimulation group using a chest wall vibration stimulation system and a manual vibration stimulation group. Vibration stimulation was applied to the second intercostal space on both sides during inspiration, and to the seventh intercostal space on both sides during expiration. [Results] The vibration stimulation system group showed significantly higher synchronization rates during inspiration and expiration than the manual vibration stimulation group, and there was a significant increase in chest wall displacement and respiratory flow during inspiration and expiration. [Conclusion] The chest wall vibration stimulation system can effectively provide vibration stimulation to the intercostal muscles in synchrony with breathing., Competing Interests: The authors declare no conflicts of interest., (2024©by the Society of Physical Therapy Science. Published by IPEC Inc.)

Introduction: Chest wall reconstruction in children after large resection of tumors may be performed with rigid or soft materials. Cementoplasty is commonly used with the "Sandwich" method i.e. gore-tex meshes surrounding both faces of the cement., Hypothesis: Is antibiotic loaded single-side gore-tex "Tartine" methyl-methacrylate cementoplasty an interesting alternative to the double-side "sandwich" method for chest wall reconstruction?, Material and Methods: Consecutive patients who were treated from 2011 to 2023 in our hospital were included., Results: Among the ten children treated with a median 5.6 years follow-up, there were no surgical complications related to the reconstruction, loss of function, infections, post operative complications (versus 22.7% in meta-analysis encompassing the 50 rigid reconstructions reported worldwide) nor scoliosis (versus 25%). Three patients have an asymmetric chest wall appearance., Discussion: "Tartine" cementoplasty is a simple, low-cost technique for pediatric chest wall reconstruction. It is well tolerated and checks key demands for chest wall reconstructions., Level of Evidence: IV; retrospective case series., (Copyright © 2024. Published by Elsevier Masson SAS.)

Introduction: The Pain, Inspiratory effort, Cough score (PIC) has been developed and widely adopted to guide clinical prognostication for patients with chest wall injury. To date, the efficacy, accuracy, and safety of a PIC based triage system has not been validated. Therefore, this study sought to evaluate the use of a modified-PIC score to triage and down-grade trauma patients with chest wall injury at a single institution., Methods: A retrospective study was conducted at a large, Level I Trauma Center on patients with chest wall injuries admitted between 1/1/2018-10/31/20,222. On 12/1/2020, our institution implemented a modified-PIC triage tool including the PIC score, age, and severity of chest wall injury. The Pre-PIC (1/1/2018-11/20/2020) and Post-PIC (1/1/2021-10/31/2022) groups were composed based on admission date and outcomes between the two were compared., Results: 2,627 patients comprised the Pre-PIC group and 2,212 patients comprised Post-PIC. The groups didn't differ significantly in demographics or mechanisms of injury except for COVID status. Post-intervention, a greater proportion of patients were triaged to the intermediate care unit instead of the ICU or floor. There were no significant differences in hospital length of stay (LOS), ventilator days, unplanned ICU admission, or mortality in Pre-PIC vs Post-PIC. ICU LOS, rates of ARDS, and cardiac arrest with return of spontaneous circulation (ROSC) were significantly lower in Post-PIC. Multivariable models demonstrated significantly lower ARDS rates and ICU free days. ICU LOS trended towards significance as well., Conclusions: This is the largest study, to date, evaluating the impact of a modified-PIC triage system on clinical outcomes. The results suggest a modified-PIC triage system may lead to decreased ICU days, ARDS rates, and rates of cardiac arrest w/ ROSC, potentially improving hospital resource allocation. Further prospective and multi-center studies are needed to validate our understanding on the impact of a chest wall scoring system on triage and outcomes., Competing Interests: Declaration of competing interest Jonathan Nguyen receives honoraria from Prytime Medical, Zimmer Biomet, and Teleflex for educational lectures. All authors agree to be accountable for all aspects of work in ensuring the questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The authors have no additional conflicts of interest to report., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Mesenchymal hamartoma of the chest wall is a rare benign tumor that usually occurs in infants and children. The clinical presentations and imaging features are atypical and difficult to differentiate from malignant tumors. In this article, we present a case with a large mesenchymal hamartoma tumor of the chest wall. A large right-sided chest wall mass was discovered in a 6-month-old boy by his mother. Chest X-ray revealed a thoracic mass with well-defined margins on the right side that expanded into the right ribs. Chest computed tomography showed that the mass originated from the thoracic wall. The patient underwent complete removal of the mass, and histopathology results confirmed a mesenchymal hamartoma.

Congenital chest wall defects are uncommon and present commonly at birth or later in infancy. The most common types are pectus excavatum, pectus carinatum, and sternal clefts. We present the first case report of multiple congenital anomalies that include bilateral chest wall defects with complete absence of the skin and muscular layer plus microtia that are associated with right facial nerve paralysis. The baby was managed conservatively with an application of a daily dressing. Both defects healed properly and closed after seven weeks of treatment without evidence of a hernia. On follow-up, after five years the boy was seen with good scars without complications.

We aimed to overview the most recent data on sternal metastases from a multidisciplinary approach (diagnosis strategies, outcome, and histological reports). This narrative review based on a PubMed search (between January 2020 and 22 July 2023) using key words such as “sternal”, “manubrium”, and “metastasis” within the title and/or abstract only included original papers that specifically addressed secondary sternal spreading of cancer in adults, for a total of 48 original articles (14 studies and 34 single case reports). A prior unpublished case in point is also introduced (percutaneous incisional biopsy was used to address a 10 cm sternal tumour upon first admission on an apparently healthy male). The studies (n = 14) may be classified into one of three groups: studies addressing the incidence of bone metastases (including sternum) amid different primary cancers, such as prostate cancer (N = 122 with bone metastases, 83% of them with chest wall metastases), head and neck cancers (N = 3620, 0.8% with bone metastases, and 10.34% of this subgroup with sternum involvement); and glioblastoma (N = 92 with bone metastases, 37% of them with non-vertebral metastases, including the sternum); assessment cohorts, including breast cancer (N = 410; accuracy and sensitivity of PET/CT vs. bone scintigraphy is superior with concern to sternum spreading) and bone metastases of unknown origin (N = 83, including a subgroup with sternum metastases; some features of PET/CT help the differentiation with multiple myeloma); and cohorts with various therapeutic approaches, such as palliative arterial embolization (N = 10), thymic neuroendocrine neoplasia (1/5 detected with sternum metastases), survival rates for sternum metastases vs. non-sternum chest wall involvement (N = 87), oligo-metastatic (sternal) breast cancer (3 studies, N = 16 for all of them), oligo-metastatic head and neck cancer (N = 81), conformal radiotherapy (N = 24,215, including an analysis on sternum spreading), and EBRT followed by MR-HIFU (N = 6). Core data coming from the isolated case reports (N = 34) showed a female to male ratio of 1.6; the females’ ages were between 34 and 80 (mean of 57.28) and the males’ ages varied between 33 and 79 (average of 58.78) years. The originating tumour profile revealed that the most frequent types were mammary (N = 8, all females) and thyroid (N = 9, both women and men), followed by bladder (N = 3), lung (N = 2), and kidney (N = 2). There was also one case for each of the following: adenoid cystic carcinoma of the jaw, malignant melanoma, caecum MiNEN, a brain and an extracranial meningioma, tongue carcinoma, cholangiocarcinoma, osteosarcoma, and hepatocellular carcinoma. To our knowledge, this is the most complex and the largest analysis of prior published data within the time frame of our methods. These data open up new perspectives of this intricate, dynamic, and challenging domain of sternum metastases. Awareness is a mandatory factor since the patients may have a complex multidisciplinary medical and/or surgical background or they are admitted for the first time with this condition; thus, the convolute puzzle will start from this newly detected sternal lump. Abbreviations: N = number of patients; n = number of studies; PET/CT = positron emission tomography/computed tomography; EVRT = external beam radiotherapy; MR-HIFU = magnetic resonance-guided high-intensity focused ultrasound; MiNEN = mixed neuroendocrine-non-neuroendocrine tumour.

Thoracotomy is defined as an incision made by the surgeon in the chest wall in order to allow visibility of the thoracic cavity content. This can be used by surgeons to treat thoracic cavity content diseases including the heart, lungs, esophagus, and other organs. Thoracic incision closure remains an item with no consensus. Therefore, we present an easy way and give a little tip for closure using the slipknot that will allow the correct approach of ribs and the successful closure of the intercostal space. [ABSTRACT FROM AUTHOR]

This article, published in the European Heart Journal Case Reports, discusses a case of exercise-induced pseudo-ischaemic electrocardiographic changes in a female patient with a concave-shaped chest wall. The patient, a 54-year-old woman with mild dyslipidaemia and a family history of coronary artery disease, underwent an exercise stress test which revealed ST-segment depression in the anterolateral leads. Computed tomography coronary angiography confirmed the chest wall deformity and ruled out any coronary artery disease. Transthoracic echocardiography showed normal cardiac function with a mitral valve prolapse. The article suggests that the mechanical stress caused by the chest wall deformity may have contributed to the abnormal electrocardiogram findings. The authors recommend implementing a preliminary chest shape assessment to better identify individuals with an increased probability of false-positive exercise stress test results. [Extracted from the article]