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Patients with poor lung function have a high-risk for pulmonary complications following lobectomy. The development of minimally invasive thoracic surgical techniques allows sicker patients to safely undergo lung resection. Robotic lobectomy could benefit these higher risk patients. Here we present a case of a 58-year-old female patient with poor lung function presented with a 3-cm mass in her lower left pulmonary lobe, who successfully underwent lobectomy via robot-assisted thoracoscopic surgery. Her forced expiratory volume in one second was slightly improved compared to the preoperative value. Her forced vital capacity continued to improve in the follow-up period. There was no recorded recurrence during the three years follow-up period.

In computed tomography (CT) images, pulmonary lobe segmentation is an arduous task due to its complex structures. To remedy the problem, we introduce a new framework based on lung anatomy knowledge for lung lobe segmentation. Firstly, the priori knowledge of lung anatomy is used to identify the fissure region of interest. Then, an oriented derivative of stick filter is applied to isolate plate-like structures from clutters for lobar fissure verification. Finally, a surface fitting model is employed to complete the incomplete fissure surface for lung lobe segmentation. Compared with manually segmented fissure references, the designed approach obtained a high median F1-score of 0.8865 in the left lung and obtained a high median F1-score of 0.9200 in the right lung. The average percentages of the segmented lung lobes in the lung lobe ground truth are 0.960, 0.989, 0.973, 0.920, and 0.985 for the left upper, left lower, right upper, right middle, and right lower lobes, respectively. The perfect performance of the proposed scheme is tested by visual inspection and quantitative evaluation.

The occurrence of an anomaly of the upper lobe of the right lung is due to an unusual passage of the azygos vein. In the process of embryonic development, the azygos vein is initially located in the posterior mediastinum to the right of the spine, reaches the level of the IV-V thoracic vertebra, here it bends through the root of the right lung and flows into the superior vena cava.

The reliable and automatic segmentation of pulmonary lobes in computed tomography scans is an important pre‐condition for the diagnosis, assessment, and treatment of lung diseases. However, due to the incomplete lobar structures and morphological changes caused by diseases, the lobe segmentation still encounters great challenges. Recently, convolution neural network has exerted a tremendous impact on medical image analysis. Nevertheless, the basic convolution operations mainly obtain local features that are insufficient for accurate lobe segmentation. The idea that the global features are equally crucial especially when lesions appear is considered. Here, a dual‐attention V‐network named DAV‐Net for pulmonary lobe segmentation is proposed. First, a novel dual‐attention module to capture global contextual information and model the semantic dependencies in spatial and channel dimensions is introduced. Second, a progressive output scheme is used to avoid the vanishing gradient phenomenon and obtain relatively effective features in hidden layers. Finally, an improved combo loss is devised to address input and output lobe imbalance problem during training and inference. In the evaluation using the LUNA16 dataset and our in‐house dataset, the proposed DAV‐Net obtains Dice similarity coefficients of 0.947 and 0.934, respectively; these values are superior to those obtained by existing methods.

Hereditary hemorrhagic telangiectasia (HHT) or Osler Weber Rendu Syndrome (OWRS) is a multiorgan disorder, of autosomal dominant inheritance, resulting in fibrovascular dysplasia with multiple arteriovenous malformations in different organs1. Pulmonary arteriovenous malformations are the most common pulmonary findings found in patients with HHT2,3. They can be asymptomatic or may present various symptoms such as cyanosis, dyspnea, heart failure, hemoptysis, and paradoxical embolism4.

Мета. Поділитися власним досвідом виконання відеоасистованих торакоскопічних (ВАТС) лобектомій у пацієнтів з туберкульозним, неспецифічним і онкологічним ураженням легенів за період з 2014 по 2019 р. Матеріали і методи. За останні 5 років нами виконано 72 ВАТС резекції частки легені, у тому числі 30 (41,7%) типових ВАТС нижніх лобектомій з роздільною хірургічною обробкою елементів кореня частки. У 1 (1,4%) пацієнта вдалися до конверсії в торакотомію у зв’язку з геморагією. Серед пацієнтів переважали жінки – 46 (63,9%). Вік пацієнтів коливався від 17 до 85 років, у середньому становив (39,2 ± 6,2) року. Оперативні втручання було виконано з приводу туберкульозу легенів у 57 (79,2%) пацієнтів, з приводу раку - у 7 (9,7%), вродженої гіпоплазії легені - у 2 (2,8%), артеріовенозної мальформації - у 1 (1,4%), гамартохондроми великих розмірів – у 2 (2,8%), бронхоектатичної хвороби – у 2 (2,8%), внутрішньочасткової секвестрації – у 1 (1,4%) пацієнта. Результати. Інтраопераційні ускладнення діагностовані у 3 (4,2%) пацієнтів. Загалом післяопераційні ускладнення виникли у 12 (16,7%) пацієнтів. Загальна ефективність виконання ВАТС лобектомії становила 98,6%, середня тривалість резекційних оперативних втручань – (185,1 ± 72,2) хв, середній об’єм інтраопераційної крововтрати – (154,1 ± 73,8) мл, середня тривалість лікування в післяопераційному періоді – (29,2 ± 14,1) дня, частота конверсії в широку торакотомію - 1,4%. Висновки. ВАТС лобектомія є ефективним методом хірургічного лікування хворих, що потребують виконання торакальних операцій, у тому числі фтизіатричного та онкологічного профілів. Даний вид операцій перспективний, малотравматичний, забезпечує анатомічне препарування елементів кореня частки легені, його можна розглядати як альтернативу відкритій лобектомії. Широкому використанню даного методу перешкоджає виражений фіброз кореня легені і злуковий процес внаслідок тривалого запального процесу і тривалого медикаментозного лікування та вартість ендоскопічних інструментів.

Acute pulmonary emphysema (APE) is describedin cases of drowning and can be considered as a sign of vitality. In our experience, however, APE is not very evident in cases of saltwater drowning. The present study aims at investigating whether APE is present in both fresh and saltwater drowning by means of digital morphometric analysis of lung tissue. We investigated and compared a group of saltwater drowning and a group of freshwater drowning, while cases of acute external bleeding were investigated as negative control group. Tissue samples from each pulmonary lobe were collected during autopsy and examined by optical microscope. The area of alveolar spaces was calculated by means of image analysis software, recording the mean alveolar area (MAA) for each group. MAA was 24,852 μm2 in the saltwater drowning group, 34,133 μm2 in the freshwater drowning group and 21,871 μm2 in the negative control group. The MAA in freshwater drowning was significantly higher than in saltwater drowning and controls. No statistical differences were observed between saltwater drowning and controls. The results of this study suggest that APE is not a typical sign of death by saltwater drowning.

Bronchoscopy should be actively performed to differentiate pulmonary tuberculosis in patients with lesions in the middle lobe, which are unaccompanied by bronchiectasis or present without obvious lesions in other lobes.

Se presentan nueve casos de pacientes con COVID-19, que desarrollaron neumonía por el SARS-CoV-2, atendidos en el Hospital Central de la Fuerza Aérea del Perú, con diferentes manifestaciones clínicas, factores de riesgo y evolución; así como la descripción de los hallazgos en la tomografía computarizada de tórax (TCT), empleando un score de severidad tomográfico al ingreso hospitalario. La puntuación se basó en el porcentaje de afectación que tenía cada lóbulo pulmonar y permitió valorar el diagnóstico clínico de neumonía según su severidad, incluso antes que las pruebas moleculares y serológicas dieran positivo en algunos de los casos presentados.

A 67-year-old man with a 20 pack-year smoking history presented to our hospital with a month-long persistent cough. Blood tests showed elevated serum tumour biomarkers including neuron-specific enolase and carcinoembryonic antigen up to 10-fold the normal range. CT examination of the chest and whole abdomen revealed a 5 cm mass located on the left upper lobe with diffuse metastasis in both lobes of the lung. In addition to the mass in the left upper lung lobe, we also observed extra lung tissue with notable interstitial markings and the presence …

We can observe the entire lung by the chest image which can acquire from the computed tomography device, but it is difficult to observe five pulmonary lobes separately, because the five pulmonary lobes are closely attached to each other. The spatial distribution of the chronic obstructive pulmonary disease on left and right lungs reflects the severity of airflow limitation. Traditional methods of locating chronic obstructive pulmonary diseases often require identification of the entire lung region, including left and right lungs. If both left lung and right lung are used to detect the spatial distribution of the chronic obstructive pulmonary disease, however some regions will be not regions of interest. Therefore, our paper essentially proposes a method for extracting a single pulmonary lobe with Hounsfield units from computed tomography pulmonary images for the diagnosis or the teaching. After abstracting five pulmonary lobes we can select the regions of interest such as a certain pulmonary lobe, then we can observe and/or analyze the selected certain pulmonary lobe, which is the region of Interest, such as locating the chronic obstructive pulmonary disease.

Pulmonary lobe segmentation in computed tomography scans is essential for regional assessment of pulmonary diseases. Recent works based on convolution neural networks have achieved good performance for this task. However, they are still limited in capturing structured relationships due to the nature of convolution. The shape of the pulmonary lobes affect each other and their borders relate to the appearance of other structures, such as vessels, airways, and the pleural wall. We argue that such structural relationships play a critical role in the accurate delineation of pulmonary lobes when the lungs are affected by diseases such as COVID-19 or COPD. In this paper, we propose a relational approach (RTSU-Net) that leverages structured relationships by introducing a novel non-local neural network module. The proposed module learns both visual and geometric relationships among all convolution features to produce self-attention weights. With a limited amount of training data available from COVID-19 subjects, we initially train and validate RTSU-Net on a cohort of 5000 subjects from the COPDGene study (4000 for training and 1000 for evaluation). Using models pre-trained on COPDGene, we apply transfer learning to retrain and evaluate RTSU-Net on 470 COVID-19 suspects (370 for retraining and 100 for evaluation). Experimental results show that RTSU-Net outperforms three baselines and performs robustly on cases with severe lung infection due to COVID-19.

Advanced fetal sonographic equipment has contributed to the increase in prenatal diagnosis of congenital thoracic malformations. Among these anomalies is congenital lobar emphysema (CLE), a rare congenital anomaly characterized by over distention and overexpansion of the involved fetal pulmonary lobe. Several studies addressed the prenatal diagnosis of CLE in mid second or early third trimester. The early prenatal diagnosis and the outcome of a case of CLE are reported in this study.

Background The authors identified as ‘acute vascular chest’ a syndrome characterized by respiratory-thoracic signs, mimicking pleuro-pulmonary or chest wall diseases, that, on the contrary, are caused by proper acute thoracic vascular lesions, traumatic or not, but not cardiac. Results As typical examples, we mention two cases: one of traumatic left extrapleural hematoma, secondary to rupture of the subclavian artery, and another concerning an aneurysm of the mid descending thoracic aorta, fissured into the upper left pulmonary lobe. In both these cases, angiographic examinations allowed a prompt and correct diagnosis. Conclusion Today, precise radiological studies of the extrapleural and upper thoracic spaces support the identification of this particular syndrome.

Quantitative computed tomography (QCT) indices calculated on paired inspiratory/expiratory multidetector computer tomography (MDCT) can deliver valuable information about functional changes in airway diseases like cystic fibrosis (CF). Air trapping is an important early sign of CF which can only be quantified on expiratory CTs. An accurate lobe segmentation is needed for a regional analysis. Direct lobe segmentation (DLS) is more challenging to perform on expiratory CT images than on inspiratory images. We suggest a registration-based lobe segmentation (RLS) procedure for expiratory CTs if paired inspiratory/expiratory CTs are available. Firstly, our existing fully automated lobe segmentation algorithm was applied to the inspiratory images. Secondly, inspiratory and expiratory images were aligned by a deformable image registration algorithm. Thirdly, the calculated transformation between inspiratory and expiratory images was applied on the lobe segmentation determined on the inspiratory images. Finally, the transferred lobe segmentation was slightly adjusted to the expiratory CT. Validation of the procedure was performed on 128 paired inspiratory/expiratory CTs. The scans were acquired from 16 children with mild CF at 4 time points reconstructed with two different kernels. 6 lobes were segmented, the lingula was treated as separate lobe. We validated the registration-based lobe masks against manually corrected lobe masks. The mean spatial overlap (Dice Index) for DLS was 0.97±0.02 on the inspiratory CTs, and 0.82 ± 0.09 on expiratory CTs, determined in a previous study. In the present study the overlap was significantly improved for the expiratory CTs by the new RLS approach to 0.91 ± 0.05 (p < 2.2e − 16). This significant improvement brings the quality of lung lobe segmentation on expiratory CTs closer to the already very good lobe segmentation results on inspiratory CTs by DLS, thus reducing the need for manual post-processing.

Introduction: Attaining lung isolation in the infant is a challenge for anesthesia care providers. Pulmonary lobe isolation is more challenging. We describe an approach to performing selective pulmonary lobe isolation using the pediatric endobronchial blocker in an infant in the absence of appropriate auxiliary guidance tool. Patient concerns: An 8-month-old and 9.5 kg male infant was admitted because of repeated cough with fever for 3 months and a large cyst of his right lung for 2 weeks. He had been living in a pastoral area with his parents. Diagnosis: Based on the chest computed tomography (CT) and his history about long-term residence in the pastoral area, this patient's diagnosis was considered as right middle lobe hydatid cyst. Interventions: Guided by a fiberoptic bronchoscope, a cuffed 4.0-mm inside diameter (ID) endotracheal tube was successfully placed into the right main bronchus of this infant. Then, pediatric 5-French (Fr) endobronchial blocker was placed into the right middle and lower lobes through the endotracheal tube without navigation of fiberoptic bronchoscope. Outcomes: Lobe isolation was successfully achieved for right middle lobectomy. This approach allows clinicians to perform lobe isolation in the absence of fiberoptic bronchoscope with very small outer diameter. Conclusion: This technique is relatively easy to use and less dependent on equipment with small outer diameter in the selective pulmonary lobe isolation in infants and small children.

The computational detection of pulmonary lobes from CT images is a challenging segmentation problem with important respiratory health care applications, including surgical planning and regional image analysis. Several authors have proposed automated algorithms and we present a methodological review. These algorithms share a number of common stages and we consider each stage in turn, comparing the methods applied by each author and discussing their relative strengths. No standard method has yet emerged and none of the published methods have been demonstrated across a full range of clinical pathologies and imaging protocols. We discuss how improved methods could be developed by combining different approaches, and we use this to propose a workflow for the development of new algorithms.

Patent ductus arteriosus (PDA) in preterm babies is common and related to high morbidity and mortality if left untreated. Although its optimal management is still debated, surgical ligation or clipping remain the only available options for pharmacologically unresponsive PDAs. The surgical procedure adds its own risk to this fragile population. We report the first case of premature neonate with a left upper pulmonary lobe venous infarction, following PDA ligation.

A 46-year-old male patient was admitted into the hospital due to repeated hemoptysis for more than seven months. Bronchiectasis of the left upper lobe was considered based on the symptoms, signs, and imaging findings. Thoracoscopic resection of lingual segment of the left upper pulmonary lobe was finally performed in the order of the lingual segmental vein, the lingual segmental bronchus, the lingual segmental artery, and the pulmonary tissues of the lingual segment. Total surgery time was 60 min and blood loss was 40 mL. The chest tube was removed on the 4th postoperative day. The patient was discharged home on the 8(th) postoperative day.

Segmentation of pulmonary lobes in inspiration and expiration chest CT scan pairs is an important prerequisite for lobe-based quantitative disease assessment. Conventional methods process each CT scan independently, resulting typically in lower segmentation performance at expiration compared to inspiration. To address this issue, we present an approach, which utilizes CT scans at both respiratory states. It consists of two main parts: a base method that processes a single CT scan and an extended method that utilizes the segmentation result obtained on the inspiration scan as a subject-specific prior for segmentation of the expiration scan. We evaluated the methods on a diverse set of 40 CT scan pairs. In addition, we compare the performance of our method to a registration-based approach. On inspiration scans, the base method achieved an average distance error of 0.59, 0.64, and 0.91 mm for the left oblique, right oblique, and right horizontal fissures, respectively, when compared with expert-based reference tracings. On expiration scans, the base method's errors were 1.54, 3.24, and 3.34 mm, respectively. In comparison, utilizing proposed subject-specific priors for segmentation of expiration scans allowed decreasing average distance errors to 0.82, 0.79, and 1.04 mm, which represents a significant improvement ([Formula: see text]) compared with all other methods investigated.

The intraoperative identification of small pulmonary nodules through video-assisted thoracoscopic surgery remains challenging. Although preoperative CT-guided nodule localization is commonly used to detect tumors during video-assisted thoracoscopic surgery (VATS), this approach carries inherent risks. We report the case of a patient with stage I lung cancer presenting as an area of ground-glass opacity (GGO) in the right upper pulmonary lobe. He successfully underwent a single-stage, CT-guided localization and removal of the pulmonary nodule within a hybrid operating room (OR) equipped with a robotic C-arm.

Lobe identification in computed tomography (CT) examinations is often an important consideration during the diagnostic process as well as during treatment planning because of their relative independence of each other in terms of anatomy and function. In this paper, we present a new automated scheme for segmenting lung lobes depicted on 3-D CT examinations. The unique characteristic of this scheme is the representation of fissures in the form of implicit functions using radial basis functions (RBFs), capable of seamlessly interpolating ldquoholesrdquo in the detected fissures and smoothly extrapolating the fissure surfaces to the lung boundaries resulting in a ldquonaturalrdquo segmentation of lung lobes. A previously developed statistically based approach is used to detect pulmonary fissures and the constraint points for implicit surface fitting are selected from detected fissure surfaces in a greedy manner to improve fitting efficiency. In a preliminary assessment study, lobe segmentation results of 65 chest CT examinations, five of which were reconstructed with three section thicknesses of 0.625 mm, 1.25 mm, and 2.5 mm, were subjectively and independently evaluated by two experienced chest radiologists using a five category rating scale (i.e., excellent, good, fair, poor, and unacceptable). Thirty-three of 65 examinations (50.8%) with a section thickness of 0.625 mm were rated as either ldquoexcellentrdquo or ldquogoodrdquo by both radiologists and only one case (1.5%) was rated by both radiologists as ldquopoorrdquo or ldquounacceptable.rdquo Comparable performance was obtained with a slice thickness of 1.25 mm, but substantial performance deterioration occurred in examinations with a section thickness of 2.5 mm. The advantages of this scheme are its full automation, relative insensitivity to fissure completeness, and ease of implementation.

Case histories are described of two young patients, both known to have recurrent infections of one pulmonary lobe. Further investigations (especially aortography) disclosed the cause in both to be an intrapulmonary sequestration. Surgical intervention made both patients symptom-free. The aetiology, clinical and investigational findings as well as therapy are discussed. The need for further investigations in patients with recurring infections of one pulmonary lobe is stressed.

A 6-year-old child with pulmonary arteriovenous malformation (PAVM) of the lower lobe of left lung was successfully treated by left lower lobectomy and the case is reported for its rarity. The exact diagnosis is relatively easy to make by contrast echocardiography and pulmonary angiocardiography, provided the possibility is entertained. Because of recurrent episodes of massive haemoptysis from a single pulmonary lobe, surgical resection was deemed the best curative option to avoid further episodes and recurrence. Published reports detailing coil embolisation therapy for PAVMs are also discussed.

Bronchopulmonary sequestration is an uncommon pulmonary disorder characterized by an area of non-functioning abnormal lung tissue, which receives its blood supply from a systemic artery and characteristically has no connection with the tracheobronchial tree. The abnormal lung tissue is located within the visceral pleura of a pulmonary lobe in the intralobar variety, whereas the extralobar form has its own visceral pleura. The venous drainage of the extralobar type is usually into the systemic veins, whereas the intralobar type drains into the pulmonary veins. Radiological imaging plays a vital role in establishing the diagnosis, and even more importantly, in providing to the clinician a vascular roadmap essential for surgical planning. We present here a review of bronchopulmonary sequestration and also discuss the role of various imaging methods in the early diagnosis and management of these cases.

Simultaneous pulmonary metastases from different primary tumors to the same lobe are extremely rare, and we herein report the case. Surgical specimen of the pulmonary metastasis from colon cancer contained two additional nodules that were confirmed as metastases from prostate cancer. Pulmonary metastasis from prostate cancer rarely forms nodules, and there is a discrepancy in the incidence of pulmonary metastases between autopsy and clinical findings. This case suggests that different malignant tumors could simultaneously metastasize to the same pulmonary lobe, and more pulmonary metastases from prostate cancer might exist than expected.

The objective was to explore clinical effect of limited resection of lung lobe under the thoracoscopy in the treatment of early nonsmall cell lung cancer occurred in the old age.A total of 150 patients with nonsmall cell lung cancer in the old age is treated by limited resection of lung lobe under thoracoscope. It can be divided into segmental resection group and wedge resection group by surgical methods, to make a comparative analysis of operation time, intraoperative blood loss, hospital stays, and complications during the perioperative period. And there will be postoperation follow-up on survival, relapse and death situation etc.,10 cases are changed to make other operation because of maladaptation to limited resection, and a total of 140 patients have undergone limited resection. Operation time and hospital stays of wedge resection group are shorter than those of segmental resection group (P0.05); compared with the bleeding and indwelling drainage tube time in two groups, differences have no statistical significance (P0.05). Compared with cases of complications, recurrence and death for groups of segmental resection and wedge resection group, the differences have no statistical significance (P0.05).Limited resection of lung lobe in the early treatment of nonsmall cell lung cancer occurred in the old age under the thoracoscopy is safe and feasible.

Mechanical ventilation of preterm and newborn infants is associated with the risk of inducing a pulmonary baro- or volutrauma which may lead to one-sided acquired pulmonary lobar emphysema (APLE). We report a case of a preterm infant with severe APLE compromising hemodynamics due to mediastinal-shift, which was successfully treated with selective one-sided intubation and high-frequency ventilation. We assume that a brief malposition of the endotracheal tube initiated the emphysema of the left pulmonary lobe. We deduce recommendations for avoiding APLE from literature and our experience.

The human lungs consist of five separate lobes, three in the right lung and two in the left. The lobes have individual bronchial and vascular systems and are functioning relatively independent from each other. Moreover, each lobe has its own pleural covering. As illustrated in Figure 5.1, the pleurae of adhering lobes are visible as hairlines in radiographic images and are denoted as the interlobular fissures [Hayashi et al. 2001].

We recommend thoracoscopic enucleation with the aid of a video-assisted thoracic surgery marker to treat pulmonary hamartoma, even when it stays in the center of pulmonary lobe. We report how we were able to enucleate a pulmonary hamartoma safely and manage the patient during hospitalization.

A knowledge of the segmental anatomy of the lungs is the cornerstone for interpreting lung scintigraphy. Many attempts have been made to determine the best views for the appreciation of segmental defects and various theories have been formulated to explain the mechanisms of this process. In earlier work, we hypothesized that the arrangements of the segments was the principal determinant of this process. However, data subsequently derived from work on a model of diffuse lung disease indicates that the external shape of the lobes and lungs may be the most significant contributor to the optimal views of the lungs.

A 63-year old female was admitted because of an abnormal shadow on chest X-ray film. Chest CT showed a nodular shadow in the right S6 and a patchy shadow in the right S10. Right lower lobectomy was performed under a diagnosis of lung cancer made by TBLB in the right S6. Pathological examination of the resected lung revealed papillary adenocarcinoma in the right S6 and numerous cryptococci in the right S10. No cryptococcal infection was found in the resected lymph nodes.