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Background: Our study discusses the probable etiologies and characteristics of pulmonary cavities in post-COVID-19 patients. A pulmonary cavity is a late complication of the disease, yet it has led to multiple referrals to our tertiary hospital in Tehran, Iran. Methods: We conducted a retrospective case-series study on 20 patients who were admitted to our center between April 2020 and September 2021. They were all diagnosed with COVID-19 and concomitantly developed pulmonary cavities. We assessed their electronic medical records in 2021 and compared their characteristics with other studies based on the available literature. Result: Of the 20 patients with cavities, 12 (60%) had been diagnosed with prior COVID-19, and 9 (45%) had type 2 diabetes mellitus. 9 patients (54%) had bacterial superinfections while 4 (44%) had fungal infections. All patients received corticosteroids, but only 4 (20%) were additionally administered Tocilizumab. Conclusion: COVID-19 patients can develop pulmonary cavities during recovery; however, this infrequent radiologic finding depends on specific risk factors. [ABSTRACT FROM AUTHOR]

Background: Our study discusses the probable etiologies and characteristics of pulmonary cavities in post-COVID-19 patients. A pulmonary cavity is a late complication of the disease, yet it has led to multiple referrals to our tertiary hospital in Tehran, Iran. Methods: We conducted a retrospective case-series study on 20 patients who were admitted to our center between April 2020 and September 2021. They were all diagnosed with COVID-19 and concomitantly developed pulmonary cavities. We assessed their electronic medical records in 2021 and compared their characteristics with other studies based on the available literature. Result: Of the 20 patients with cavities, 12 (60%) had been diagnosed with prior COVID-19, and 9 (45%) had type 2 diabetes mellitus. 9 patients (45%) had bacterial superinfections while 4 (44%) had fungal infections. All patients received corticosteroids, but only 4 (20%) were additionally administered Tocilizumab. Conclusion: COVID-19 patients can develop pulmonary cavities during recovery; however, this infrequent radiologic finding depends on specific risk factors.

This study was conducted to produce a three-dimensional model of the thorax and lower respiratory tract in Van cats, to reveal their morphometric properties, and to investigate the anatomical structure of this region in more detail. A total of 16 adult Van cats (8 males and 8 females) were used in the study. The thoracic region of the cats was scanned using multidetector computed tomography device. The images of the scanned region were transferred to the MIMICS 20.1 software that creates three-dimensional reconstruction in order to produce the models. The morphometric measurements were obtained from these models and the index values were calculated. When the data were analysed in terms of sexual dimorphism, significant differences were determined between the sexes in terms of transverse diameter of the thoracic cavity in apertura thoracis cranialis (T2) (P < 0.05), minimum width of apertura thoracis cranialis (T3), and height of the thoracic cavity in thoracis cranialis (H1) (P < 0.01). The index values of the data revealed a significant difference between the sexes only in terms of the thoracic index 2 (P < 0.05). The 7th sternebra was shorter and more flattened than the other sternebrae in Van cats. In conclusion, three-dimensional models of the thorax and lower respiratory tracts of Van cats were produced in the study. It is thought that the data of the study may be useful in clinical practice and academic studies in the field of veterinary medicine. [ABSTRACT FROM AUTHOR]

The Neotropical otter (Lontra longicaudis) is a mustelid distributed geographically from Mexico to Argentina. Anomalous origins of the aortic arch branches are rarely reported in wild carnivorans. Therefore, this study aimed to report the anomalous branching of the aortic arch in one formaldehyde‐fixed specimen of L. longicaudis. The aortic arch provided three branches: the bicarotid trunk and the left and right subclavian arteries. The latter passed dorsally to the esophagus toward the right side without a mark of compression at the esophagus. This is the first report of an anomalous origin of the right subclavian artery in L. longicaudis. [ABSTRACT FROM AUTHOR]

Mediastinal cysts (MCs) are rare lesions that can arise from embryonic remnants of various mediastinal structures. MCs usually are incidental findings in dogs and cats; however, they can reach a mass‐like appearance. The description of MCs on CT in dogs is limited. This retrospective, single‐center, descriptive, prevalence study aimed to determine the prevalence of presumed mediastinal cysts (PMCs) in dogs and assess their CT characteristics. Dogs that underwent a thoracic CT scan from January 2019 to August 2021 were included. CT images were evaluated for the presence of PMCs by two diagnostic imaging interns, two last year diagnostic imaging residents, and a board‐certified veterinary radiologist. Number, location, margins, shape, volume, size, mass effect, and attenuation values of PMCs were assessed. A total of 866 CT scans were reviewed, and 49 PMCs were identified. The prevalence of PMCs in dogs was 5.66%. English Bulldog and mixed‐breed dogs were subjectively overrepresented; however, the possibility of population bias could not be excluded. PMCs were subjectively more frequently observed in male dogs. The PMCs were predominantly round, small, solitary fluid‐filled findings localized in the cranioventral mediastinum, with well‐defined margins, homogeneous attenuation, and no contrast enhancement. The median attenuation value was 6.32 HU (range: −20.16 to 23.45 HU) precontrast and 7.58 HU (range: −2.45 to 20.79 HU) postcontrast, and the median volume was 1.19 cm3 (range: 0.02–45.32 cm3). Although the prevalence of PMCs was low in our sample population, findings supported prioritizing a differential diagnosis of incidental PMC for dogs with the above imaging characteristics. [ABSTRACT FROM AUTHOR]

A 37-year-old male, with a 5-year history of liposarcoma of the right thigh, was incidentally diagnosed with two huge thoracic metastases following a fall. One of these masses, measuring 22 cm, was located in the right chest apex, adjacent to a second 20 cm mass situated in the anterior mediastinum, partially invading the left chest. The patient underwent surgical intervention for mass resection that commenced with a hemi-clamshell incision, but was then extended by completing the lower median sternotomy in order to create a T shaped incision. This type of incision provides ample access for large mediastinal tumors that extensively extend into one side of the thoracic cavity, encompass the anterior mediastinum, and partially reach into the opposite cavity. It enhances visualization, facilitates access to vital organs, allows for precise surgical maneuvers, minimizes the risk of inadvertent tissue damage, and enables thorough oncological resection. [ABSTRACT FROM AUTHOR]

Case Presentation: A 75-year-old man with a history of asbestosis presented to the emergency department with sudden-onset dyspnea and hemoptysis, triggered by coughing. The patient was hemodynamically unstable and in respiratory distress. Computed tomography revealed a massive hemothorax on the left side and compression of the descending thoracic aorta. He underwent emergency surgical exploration after decompression by chest tube insertion. The hemothorax was caused by tears in the pleural adhesions due to asbestosis and induced by coughing.Discussion: Spontaneous hemothorax is a rare subtype of hemothorax. There have been only a few case reports of spontaneous tension hemothorax. In addition to its typical findings, compression of the thoracic descending aorta was observed in our patient. We hypothesize that severely diminished pulmonary compliance contributed to the extremely high intrathoracic pressure, which led to this unusual finding.

Scapula fractures are very rare, resulting from high-energy trauma and are mostly associated with other fractures of the locomotor system and injuries to the head, chest or abdominal organs. Most often, they are treated conservatively and the indications for surgical treatment are not yet clearly agreed. One of the conditions requiring surgical treatment is a scapula fracture with fragment migration into the thoracic cavity. In this paper, we are presenting an extremely rare, isolated scapula fracture, without injury to other parts of the locomotor system, with an intrathoracic fragment migration that was treated conservatively with an excellent functional outcome.

Background: Meningioma is a common type of intracranial tumor in adults. It rarely arises in the chest, with only a few case reports in the English literature. Here, we report the case of a patient with a primary ectopic meningioma (PEM) located in the thoracic cavity. Case presentation: A 55-year-old woman presented with exercise-induced asthma, chest tightness, intermittent dry cough and fatigue for several months. Computed tomography revealed the presence of a huge mass in the thoracic cavity, with no connection to the spinal canal. Lung cancer and mesothelioma were suspected, and surgery was performed. Grossly, the mass was a grayishwhite solid 9.5 cm × 8.4 cm × 5.3 cm in size. The microscopic morphology of the lesion was consistent with that of typical central nervous system meningioma. The pathological subtype was transitional meningioma. The tumor cells were arranged in a fascicular, whorled, storiform and meningithelial pattern, with occasional intranuclear pseudo-inclusions and psammoma bodies. In focal areas tumor cells were considerably dense, and the cells were round or irregular in shape, with less cytoplasm, uniform nuclear chromatin, and visible nucleoli and mitoses (2/10 HPF). By immunohistochemistry, the neoplastic cells showed strong and diffuse staining with vimentin, epithelial membrane antigen and SSTR2 with variable expression of PR, ALK and S100 protein. However, the cells were negative for GFAP, SOX-10, inhibin, CD34, STAT6, smooth muscle actin, desmin, CKpan, D2-40, WT-1, CK5/6 and CD45. The highest proliferation index by Ki-67 was 15%. The abnormal expression of ALK led to the initial misdiagnosis of an inflammatory myofibroblastic tumor. After 12 months of follow-up, no disease progression was observed. Conclusion: The presence of primary ectopic meningiomas in the thoracic cavity is extremely rare, and this tumor is easily misdiagnosed clinically. Imaging is suggested to determine the location and possible differential diagnosis, while the final diagnosis should be via pathological examination. Immunohistochemistry is crucial for disease diagnosis. Owing to our limited knowledge of PEM, its pathogenesis and tissue of origin remain unclear. Clinicians should pay close attention to such potential patients. The present case report may provide insights into the diagnosis and therapy of patients with this tumor. [ABSTRACT FROM AUTHOR]

Ectopic pancreatic tissue can occasionally cause inflammation, hemorrhage, stenosis, and invagination, similar to normal pancreatic tissue; however, tumorigenesis is rare. This case report describes an ectopically observed pancreatic acinar cell carcinoma in the thoracic cavity of a female Fischer (F344/DuCrlCrlj) rat. Histopathologically, polygonal tumor cells with periodic acid-Schiffpositive cytoplasmic eosinophilic granules showed solid proliferation and infrequently formed acinus-like structures. Immunohistochemically, the tumor cells were positive for cytokeratin, trypsin, and human B-cell leukemia/lymphoma 10, which specifically reacted with pancreatic acinar cells, and negative for vimentin and human a-smooth muscle actin. Ectopic pancreas develops in the submucosa of the gastrointestinal tract; however, there are few reports of its development and neoplasia in the thoracic cavity. To the best of our knowledge, this is the first report of ectopic pancreatic acinar cell carcinoma in the thoracic cavity of a rat. [ABSTRACT FROM AUTHOR]

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Pericardial cysts (PCs) are uncommon benign congenital anomalies residing in the middle mediastinum. The location of PCs is diverse with 70% of cases in the right cardiophrenic angle, 22% in the left cardiophrenic angle, and 8% in the posterior (as in our case) or superior anterior part of the mediastinum. In 2019, a 54-year-old woman was referred to the emergency department of Imam Khomeini Hospital Complex (Tehran, Iran) suffering from progressive shortness of breath. The chest computed tomography scan showed an unusual giant cystic lesion occupying >50% of the right hemithorax. The cystic lesion was primarily located in the posterior mediastinum. The patient underwent video-assisted thoracoscopic surgery (VATS), and the cyst was completely resected from the mediastinum. During past decades, several cases of PCs have been reported in different age and sex groups. Here, we present a case of a giant pericardial cyst (PC) located in the posterior mediastinum. The cyst was successfully resected using VATS. Only one other study has reported a PC in the posterior mediastinum.

Mediastinal masses have been eluding clinicians for a long time, owing to their common symptoms that are attributable to common infective and non infective aetiologies and their rare incidence. They are generally diagnosed in the anterior mediastinum and include a variety of different entities demonstrating a range of clinicopathologic features. Chest computed tomography is important for the diagnosis, to know the extent of disease and helps in the prognosis. The prognosis of mature teratoma is excellent, surgical removal is curative. This case report was of a 58-year-old female, an unusual age of presentation, diagnosed as benign mature teratoma and was managed conservatively with periodic assessment for symptomatology. A conservative rather than surgical approach was chosen keeping in mind the socio-economic profile of the patient, surgical complications and benign nature of the disease. The uniqueness of present case is hidden behind the unusual presentation of the disease coupled with belonging to an eastern world where surgical modalities are not as accessible and affordable. Hence, a conservative approach might be an equally effective solution, especially considering the age of presentation.

Case Presentation: A 75-year-old man with a history of asbestosis presented to the emergency department with sudden-onset dyspnea and hemoptysis, triggered by coughing. The patient was hemodynamically unstable and in respiratory distress. Computed tomography revealed a massive hemothorax on the left side and compression of the descending thoracic aorta. He underwent emergency surgical exploration after decompression by chest tube insertion. The hemothorax was caused by tears in the pleural adhesions due to asbestosis and induced by coughing. Discussion: Spontaneous hemothorax is a rare subtype of hemothorax. There have been only a few case reports of spontaneous tension hemothorax. In addition to its typical findings, compression of the thoracic descending aorta was observed in our patient. We hypothesize that severely diminished pulmonary compliance contributed to the extremely high intrathoracic pressure, which led to this unusual finding. [ABSTRACT FROM AUTHOR]

IntroductionType 1 diabetes (T1DM) patients are at increased risk of coronary artery disease (CAD). This pilot study sought to evaluate the relationship between epicardial adipose tissue (EAT) and intra-thoracic adipose tissue (IAT) volumes and cardio-metabolic risk factors in T1DM.MethodEAT/IAT volumes in 100 patients, underwent non-contrast cardiac computed tomography in the Diabetes Control and Complications Trial /Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study were measured by a certified reader. Fat was defined as pixels' density of -30 to -190 Hounsfield Unit. The associations were assessed using-Pearson partial correlation and linear regression models adjusted for gender and age with inverse probability sample weighting.ResultsThe weighted mean age was 43 years (range 32-57) and 53% were male. Adjusted for gender, Pearson correlation analysis showed a significant correlation between age and EAT/IAT volumes (both p

Gastrinomas are located largely in the pancreaticoduodenal region. However, gastrinomas have also been found in non-pancreaticoduodenal regions. Our study is a rare report of gastrinomas within the thoracic cavity. A 53-year-old male patient presented with acute abdomen and multiple prepyloric ulcers. Serum gastrin level was significantly elevated. Computed tomography (CT) scan of the chest, abdomen, and pelvis showed a mass in the inferior section of the right hemithorax. Octreotide scan also confirmed a neuroendocrine tumor (NET)-like mass in the right para-aortic region in the right hemithorax. In thoracotomy, a hypervascular solid tumor was detected adjacent to the aorta, also receiving a branch from the aorta. We ligated the feeding artery and resected the 3-cm tumor. The post-operative serum gastrin level was 36 pg/mL, which implied that the tumor was successfully resected. The pathology assessment reported nests of monotonous low-grade neuroendocrine cells with salt and pepper nuclei with rare mitotic features, cellular uniformity, and abundant amphophilic cytoplasm, confirming the diagnosis of gastrinoma. Based on our report, we suggest that the search for gastrinomas should include not only the abdominal sites but also uncommon areas like the thoracic cavity. [ABSTRACT FROM AUTHOR]

Pericardial cysts (PCs) are uncommon benign congenital anomalies residing in the middle mediastinum. The location of PCs is diverse with 70% of cases in the right cardiophrenic angle, 22% in the left cardiophrenic angle, and 8% in the posterior (as in our case) or superior anterior part of the mediastinum. In 2019, a 54-year-old woman was referred to the emergency department of Imam Khomeini Hospital Complex (Tehran, Iran) suffering from progressive shortness of breath. The chest computed tomography scan showed an unusual giant cystic lesion occupying >50% of the right hemithorax. The cystic lesion was primarily located in the posterior mediastinum. The patient underwent video-assisted thoracoscopic surgery (VATS), and the cyst was completely resected from the mediastinum. During past decades, several cases of PCs have been reported in different age and sex groups. Here, we present a case of a giant pericardial cyst (PC) located in the posterior mediastinum. The cyst was successfully resected using VATS. Only one other study has reported a PC in the posterior mediastinum. [ABSTRACT FROM AUTHOR]

Abstract Background Fibrolipoma is an uncommon subtype of lipoma. On the basis of the results of a survey of the PubMed database, only approximately a dozen cases in children have been described in which the histological diagnosis of fibrolipoma has been confirmed. In children, fibrolipomas have been reported in the eyelids, ears, lips, nasopharynx, mouth, and other locations but not in the thoracic cavity. We present the case of a 15-year-old girl with a giant fibrolipoma in the left side of her thoracic cavity. Case presentation A 15-year-old Chinese girl presented with chest tightness and exercise-induced shortness of breath of 4 months’ duration. Computed tomography revealed a giant mixed-density space-occupying lesion in the left side of her thoracic cavity, originating possibly from the pleura. Radiological findings were inconclusive and failed to exclude malignant mesenchymal tumor. After excluding malignant tumor with two needle biopsies and identifying the tumor’s feeding blood vessels by computed tomography angiography examination, our treatment plan was, first, embolization of the tumor’s blood vessels by digital subtraction angiography and, second, to remove the tumor by thoracotomy. Conclusions Thoracic fibrolipoma in children is rare; its treatment is complete resection of the tumor. Pathological examination of the removed tissue is the gold standard for diagnosis. Early computed tomography and magnetic resonance imaging examinations are helpful to determine the extent and nature of the tumor and to reduce damage of the surrounding organs. Preoperative examination of tumor markers, ultrasound-guided biopsy, and preoperative digital subtraction angiography tumor vascular embolization are important preoperative preparations to ensure surgical resection.

Background: Matrix metalloproteases (MMPs) are multi-chain proteins that regulated by tissue inhibitor of metalloproteinases (TIMP) and several other mechanisms. This Includes transcription regulation and protein form secretion. The roles of MMPs in wound healing and tissue repair. In tuberculosis (TB), the activity of MMPs is increased and TIMP inhibitors decrease activity. Therefore, in tuberculosis, MMPs cause excessive damage to the lung tissue and cavity formation. Methods: In a case-control study, plasma samples of healthy controls, symptomatic respiratory tract controls and tuberculosis patients were evaluated by available sampling in Ali Ibn Abitaleb and Bouali Hospitals, Zahedan, Iran, from Apri1 2015 to April 2018. Patients were divided into two groups: tuberculosis and control group and the level of MMPs were measured by the enzyme-linked immunosorbent assay (ELISA) method in plasma samples of the two groups. For MMP-8, which was important in the diagnosis of tuberculosis, a cutoff point was obtained. Results: 384 people including 123 healthy controls. 107 non-tuberculosis, and 154 tuberculosis patients were examined; 230 patients in the control group and 154 patients in the tuberculosis group. Levels of MMPs in tuberculosis and symptomatic respiratory group were higher than healthy group. The mean of MMP-8 was significantly different between two groups (P

The thoracic cavity consists of the mediastinum located centrally which is bordered by two pleural cavities laterally. The major organs included are the thymus gland, the heart, the lungs, the tracheobronchial tree, lymph nodes and vessels. The lesions originating from the various organs are diverse and occasionally some lesions occurring are extremely rare. The aim was to study demographic features, anatomical site and histological findings of the cases. This was a prospective evaluation of the intrathoracic lesions in a tertiary care center from June 2018 to June 2020. This comprised of patient’s age and sex, the clinical characteristics and location of the tumour, the duration of the lesion and the histopathological findings along with Immunohistochemistry (IHC). This case series describes 10 cases of intrathoracic lesions originating from mediastinal soft tissue, thymus gland, lungs and heart. Patient’s age ranged from five months old to 48 years old with males and females equally affected. All the patients have undergone treatment and were followed-up as well. Intrathoracic lesions are unusual tumours with varied histology. These intrathoracic lesions require a multidisciplinary approach. These lesions should be examined well to determine the source of the lesion for a conclusive diagnosis. Radiological correlation along with histopathology and immunohistochemistry assists in accurate diagnosis.

Transpulmonary pressure can be estimated using esophageal balloon (EB) catheters, which come in a variety of manufacturing configurations. We assessed the performance of novel polyurethane EB designs, Aspisafe NG and NG+, against existing alternatives. We created a biomechanical model of the chest cavity using a plastic chamber and an ex-vivo porcine esophagus. The chamber was pressurized (- 20 and + 20 cmH 2 O) to simulate pleural pressures. We conducted tests with various EB inflation volumes and measured transesophageal pressure (TEP). TEP measurement was defined as accurate when the difference between pressure within the EB and chamber was 0 ± 1 cmH 2 O. We computed the minimal (V accuracy-min ) and maximal (V accuracy-max ) EB inflation volumes of accuracy. Inflation volumes were further validated using a surrogate method derived by the clinically validated positive pressure occlusion test (PPOT). When the esophageal balloons were filled with inflation volumes within the range provided by the manufacturers, the accuracy of TEP measurements was marginal. Our tests found median V accuracy-min across EB of 0.00-0.50 mL (p = 0.130), whereas V accuracy-max ranged 0.50-2.25 mL (p = 0.002). Post PPOT validation, median TEP was - 0.4 cmH 2 O (- 1.5 to 0.3) (p < 0.001 among catheters). The Aspisafe NG and NG+ were accurate in 81.7% and 77.8% of the measurements, respectively. We characterized two new EBs, which demonstrated good benchtop accuracy in TEP measurements. However, accuracy was notably influenced by the precise selection of EB inflation volumes., (© 2024. The Author(s).)

Background/purposeIntradiaphragmatic extralobar pulmonary sequestrations (IDEPSs) are a rare subset of bronchopulmonary sequestrations (BPS). We report the largest series of patients with IDEPS and describe the diagnostic and operative challenges associated with this condition.MethodsWe retrospectively reviewed our experience with fetal and pediatric BPS from 1995 to 2010 to identify patients with IDEPS.ResultsWe identified 27 patients with BPS and 4 patients in whom the masses were within the diaphragm. In 1 patient, the prenatal ultrasound correctly identified the mass as being within the diaphragm itself, whereas the remaining cases were thought to be intraabdominal or had discordant preoperative imaging findings. The diagnosis of an IDEPS proved challenging to make prospectively using prenatal ultrasound, computed tomography, or magnetic resonance imaging. All patients underwent attempted resection. Two cases required a combined laparoscopic and thoracoscopic approach to accurately localize the mass. The postoperative recovery of these patients was uneventful.ConclusionsWe present the largest reported experience of IDEPS. Because preoperative imaging studies cannot always determine whether a sequestration is intraabdominal, intrathoracic, or intradiaphragmatic, operative planning may pose a challenge. However, the use of minimally invasive approaches can allow exploration of both the thoracic and abdominal cavities with low morbidity.

Anticoagulant rodenticide (AR) poisoning has emerged as a significant concern for conservation and management of non-target wildlife. The purpose for these toxicants is to suppress pest populations in agricultural or urban settings. The potential of direct and indirect exposures and illicit use of ARs on public and community forest lands have recently raised concern for fishers (Martes pennanti), a candidate for listing under the federal Endangered Species Act in the Pacific states. In an investigation of threats to fisher population persistence in the two isolated California populations, we investigate the magnitude of this previously undocumented threat to fishers, we tested 58 carcasses for the presence and quantification of ARs, conducted spatial analysis of exposed fishers in an effort to identify potential point sources of AR, and identified fishers that died directly due to AR poisoning. We found 46 of 58 (79%) fishers exposed to an AR with 96% of those individuals having been exposed to one or more second-generation AR compounds. No spatial clustering of AR exposure was detected and the spatial distribution of exposure suggests that AR contamination is widespread within the fisher's range in California, which encompasses mostly public forest and park lands Additionally, we diagnosed four fisher deaths, including a lactating female, that were directly attributed to AR toxicosis and documented the first neonatal or milk transfer of an AR to an altricial fisher kit. These ARs, which some are acutely toxic, pose both a direct mortality or fitness risk to fishers, and a significant indirect risk to these isolated populations. Future research should be directed towards investigating risks to prey populations fishers are dependent on, exposure in other rare forest carnivores, and potential AR point sources such as illegal marijuana cultivation in the range of fishers on California public lands.

Most frequent findings in computed tomography (CT) in coronavirus disease 2019 (COVID-19) are usually bilateral, basal, and peripherally located ground glass opacification and consolidation. Cavitary lesions in the lungs usually result from bacterial and fungal infections, malignities, and rheumatologic diseases. In literature, cavitary lesions in CT related to COVID-19 are rarely reported. In this case report, CT showed a single cavitary lesion, which was 6 centimeters in diameter and developed 7 days after discussing the COVID-19 diagnosis in a 70-year-old--Caucasian--female patient. [ABSTRACT FROM AUTHOR]

• They are classic signs of progression in the presence of a hidden lesion in the diaphragm. • The presence of the reported accessory spleen is only a possible variation. • The use of thoracotomy is more indicated in cases with a later diagnosis. Post-traumatic diaphragmatic hernias are not commonly diagnosed immediately after the initial trauma. There is a greater prevalence of left hernias due to the fragility or injury in diaphragm muscle and the lack of solid and fixed structures on the left side. A male patient, 30 years old, he was admitted to the emergency department presenting diffuse abdominal pain, vomiting, dyspnea, pain in the left hemithorax with worsening during forced inspiration. After performing X-ray and computed tomography (CT), the presence of organs in the abdominal cavity outside the usual position was evidenced and with discrete deviation. Immediate surgery was performed with posterolateral thoracic access through the sixth left intercostal space combined with left subcostal access. Initially, it was found jejunum, ileum and left colonic flexure and accessory spleen filling the hernial sac. This report is the first case to report two accessory spleens in manual reduction of herniation between thoracic and abdominal cavities after trauma and percutaneous perforation. The splenectomy performed in both organs occurred due to their advanced ischemia that was due to reduced vascularity. The presence of the reported accessory spleen inside the thoracic cavity is only a possible variation within the possibilities in cases of diaphragmatic hernias, which does not modify the surgical procedure in a relevant way. [ABSTRACT FROM AUTHOR]

Local fat infiltration of the thoracic cavity is a rare initial presentation of Bochdalek hernia. We report a case of Bochdalek hernia in a child with leukemia that demonstrated initial local fat infiltration of the thoracic cavity on computed tomography scan and progressed to an obvious diaphragmatic hernia on subsequent follow-up. We suggest that initial local fat infiltration of the thoracic cavity on computed tomography scan may indicate a potential diaphragmatic hernia.

Background: Chest wall tuberculosis may develop if tuberculous (TB) lesions spread through the chest wall and invade the thoracic cavity. The presence of a mass on the patient's chest wall may be the first indication of TB, and a chest CT scan can help diagnose external penetrating chest wall TB, the incursion of tuberculosis from the lungs into the chest wall., Objective: This study examines the safety and efficacy of thoracoscopic-assisted surgery for the treatment of penetrating chest wall tuberculosis as a means of exploring novel concepts of minimally invasive surgery., Methods: Our hospital conducted a retrospective study of 25 patients with penetrating chest wall TB who underwent thoracoscopic surgery between January 2020 and June 2021. General demographics, CT scan data linked to surgery, and postoperative patient outcomes were compared between the two groups. The data was also evaluated to determine the range of operation time and the volume of bleeding from different foci in the thoracic cavity., Results: All procedures went well after patients took conventional antituberculosis medication for at least two weeks prior to surgery. CT scans showed that thoracoscopic surgery needed a smaller incision than traditional chest wall TB surgery, with no discernible increase in surgical time. Postoperative tube use, length of hospital stay, and blood loss were all significantly lower than they would have been with conventional surgery. In addition, thoracoscopy was associated with a significantly reduced rate of subsequent treatment. Fibrous plate development and calcification caused the longest operation times in the thoracoscopic surgery group, whereas multiple pleural tuberculomas generated the most hemorrhage. Thoracoscopic surgery usually reveals tuberculous foci hiding in the thoracic cavity., Conclusion: Thethoracic surgery can eliminate the TB focus in the chest wall and intrathoracic while treating penetrating chest wall tuberculosis. The CT scan is a crucial part of the diagnostic process for these patients. Minor surgical trauma, low complication and recurrence rates, and good results. There is a greater distinction between the two surgical approaches for patients with penetrating chest wall TB as opposed to those with basic chest wall tuberculosis., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Rationale and Objectives: Quantification of 129 Xe MRI relies on accurate segmentation of the thoracic cavity, typically performed manually using a combination of 1 H and 129 Xe scans. This can be accelerated by using Convolutional Neural Networks (CNNs) that segment only the 129 Xe scan. However, this task is complicated by peripheral ventilation defects, which requires training CNNs with large, diverse datasets. Here, we accelerate the creation of training data by synthesizing 129 Xe images with a variety of defects. We use this to train a 3D model to provide thoracic cavity segmentation from 129 Xe ventilation MRI alone., Materials and Methods: Training and testing data consisted of 22 and 33 3D 129 Xe ventilation images. Training data were expanded to 484 using Template-based augmentation while an additional 298 images were synthesized using the Pix2Pix model. This data was used to train both a 2D U-net and 3D V-net-based segmentation model using a combination of Dice-Focal and Anatomical Constraint loss functions. Segmentation performance was compared using Dice coefficients calculated over the entire lung and within ventilation defects., Results: Performance of both U-net and 3D segmentation was improved by including synthetic training data. The 3D models performed significantly better than U-net, and the 3D model trained with synthetic 129 Xe images exhibited the highest overall Dice score of 0.929. Moreover, addition of synthetic training data improved the Dice score in ventilation defect regions from 0.545 to 0.588 for U-net and 0.739 to 0.765 for the 3D model., Conclusion: It is feasible to obtain high-quality segmentations from 129 Xe scan alone using 3D models trained with additional synthetic images., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Introduction: Application of chest radiography for all multiple trauma patients is associated with a significant increase in total costs, exposure to radiation, and overcrowding of the emergency department. Ultrasound has been introduced as an alternative diagnostic tool in this regard. The aim of the present study is to compare the diagnostic accuracy of chest ultrasonography and radiography in detection of traumatic intrathoracic injuries. Methods: In the present prospective cross-sectional study, patients with traumatic intrathoracic injuries, who were referred to the emergency department from December 2013 to December 2014, were assessed. The patients underwent bedside ultrasound, radiographic and computed tomography (CT) scan examinations based on ATLS recommendations. Screening performance characteristics of ultrasonography and radiography were compared using SPSS 21.0. Chest CT scan was considered as gold standard. Results: 152 chest trauma patients with a mean age of 31.4 ± 13.8 years (range: 4 ‒ 67), were enrolled (77.6% male). Chest CT scan showed pulmonary contusion in 48 (31.6%) patients, hemothorax in 29 (19.1%), and pneumothorax in 55 (36.2%) cases. Area under the ROC curve of ultrasonography in detection of pneumothorax, hemothorax, and pulmonary contusion were 0.91 (95% CI: 0.86‒0.96), 0.86 (95% CI: 0.78‒0.94), and 0.80 (95% CI: 0.736‒0.88), respectively. Area under the ROC curve of radiography was 0.80 (95% CI: 0.736‒0.87) for detection of pneumothorax, 0.77 (95% CI: 0.68‒0.86) for hemothorax, and 0.58 (95% CI: 0.5‒0.67) for pulmonary contusion. Comparison of areas under the ROC curve declared the significant superiority of ultrasonography in detection of pneumothorax (p = 0.02) and pulmonary contusion (p < 0.001). However, the diagnostic value of the two tests was equal in detection of hemothorax (p = 0.08). Conclusion: The results of the present study showed that ultrasonography is preferable to radiography in the initial evaluation of patients with traumatic injuries to the thoracic cavity.

Objectives: To evaluate chest mobility though cirtometry and sit-and-reach testing (SRT) in children and adolescents with cystic fibrosis (CF) before and after 3 months of the implementation of an institutional exercise booklet and to verify the correlation between the tests and the espirometry. Material and methods: Experimental study with patients between 8 and 18 years of age with CF colonized by Pseudomonas aeruginosa. The measurement of thoracic mobility was performed through cirtometry and SRT before and after three months of performing home exercises in the form of stretches, guided through an institutional exercise booklet. Espirometry variables, such as forced expiratory volume of the first second (FEV1), forced vital capacity (FVC) and FEV1/FVC ratio, were obtained from the medical records. Shapiro-Wilk test was used to verify the normality of the variables, Spearman method to correlate the espirometry variables with the initial assessment of the thoracic mobility and Wilcoxon method to verify the difference between the tests before and after the exercises. A p less than 0,05 was considered statistically significant. Results: 10 patients were evaluated in the first phase of the study, 80% female, with a mean age of 14,9 years. The initial SRT reached 44,1±10,17cm, whereas the difference in initial cirtometry measurements between inspiration and expiration was 3,3±1,06cm in axillary region, 3,5±1,3cm in xiphoid region and 3,7±1,1cm in umbilical region. There was a strong correlation between the values obtained in the tests and espirometry values. After home exercise, both cirtometry and SRT improved significantly (p<0,0001). Conclusion: Home exercises were effective in the improvement of the thoracic mobility, reflecting the importance of guidelines and the incentive to adherence to treatment in children and adolescents with CF. [ABSTRACT FROM AUTHOR]

Background: Matrix metalloproteases (MMPs) are multi-chain proteins that regulated by tissue inhibitor of metalloproteinases (TIMP) and several other mechanisms. This Includes transcription regulation and protein form secretion. The roles of MMPs in wound healing and tissue repair. In tuberculosis (TB), the activity of MMPs is increased and TIMP inhibitors decrease activity. Therefore, in tuberculosis, MMPs cause excessive damage to the lung tissue and cavity formation. Methods: In a case-control study, plasma samples of healthy controls, symptomatic respiratory tract controls and tuberculosis patients were evaluated by available sampling in Ali Ibn Abitaleb and Bouali Hospitals, Zahedan, Iran, from Apri1 2015 to April 2018. Patients were divided into two groups: tuberculosis and control group and the level of MMPs were measured by the enzyme-linked immunosorbent assay (ELISA) method in plasma samples of the two groups. For MMP-8, which was important in the diagnosis of tuberculosis, a cutoff point was obtained. Results: 384 people including 123 healthy controls. 107 non-tuberculosis, and 154 tuberculosis patients were examined; 230 patients in the control group and 154 patients in the tuberculosis group. Levels of MMPs in tuberculosis and symptomatic respiratory group were higher than healthy group. The mean of MMP-8 was significantly different between two groups (P<0.001). In this study, sensitivity, specificity, positive and negative predictive value of plasma MMP-8 in detection of TB in non-TB patients in MMP-8 cutoff point=6650 pg/ml were 65.4%, 78.2%, 50%, and 93% respectively outcome. Significantly, the rate of pulmonary cavity was significantly higher in the TB group; Higher cavity, higher concentration of plasma MMPs. Conclusion: In this study, first comprehensive analysis of MMPs was performed. Two collagenases, MMP-1 and MMP-8, were active in tuberculosis, but MMP-8 was specifically higher in tuberculosis than in both symptomatic and healthy controls. Level of MMP-1, 3, 8, 9 was higher in men than in women. The analysis of genders separately showed MMP-8 was increased in tuberculosis group in comparison with control group and MMP-1 group in both TB and symptomatic respiratory tract increased. [ABSTRACT FROM AUTHOR]

Liposarcoma arising in the thoracic cavity is a rare entity. It is usually found in the retroperitoneal space and the extremities. No case of thoracic liposarcoma in a patient suffering from the end-stage renal disease has been reported in the literature. We herein present the first case of thoracic liposarcoma in a patient suffering from the end-stage renal disease. Metabolic disturbances, increased use of erythropoietin and increased diagnostic workup attributes to greater risk of cancer in patients suffering from renal failure. A chemotherapeutic drug, Trabectedin has been approved for advanced liposarcoma. Prognosis of such tumours depends on the size, location, and their histological subtype. [ABSTRACT FROM AUTHOR]

Introduction: Application of chest radiography for all multiple trauma patients is associated with a significant increase in total costs, exposure to radiation, and overcrowding of the emergency department. Ultrasound has been introduced as an alternative diagnostic tool in this regard. The aim of the present study is to compare the diagnostic accuracy of chest ultrasonography and radiography in detection of traumatic intrathoracic injuries. Methods: In the present prospective cross-sectional study, patients with traumatic intrathoracic injuries, who were referred to the emergency department from December 2013 to December 2014, were assessed. The patients underwent bedside ultrasound, radiographic and computed tomography (CT) scan examinations based on ATLS recommendations. Screening performance characteristics of ultrasonography and radiography were compared using SPSS 21.0. Chest CT scan was considered as gold standard. Results: 152 chest trauma patients with a mean age of 31.4 ± 13.8 years (range: 4 ‒ 67), were enrolled (77.6% male). Chest CT scan showed pulmonary contusion in 48 (31.6%) patients, hemothorax in 29 (19.1%), and pneumothorax in 55 (36.2%) cases. Area under the ROC curve of ultrasonography in detection of pneumothorax, hemothorax, and pulmonary contusion were 0.91 (95% CI: 0.86‒0.96), 0.86 (95% CI: 0.78‒0.94), and 0.80 (95% CI: 0.736‒0.88), respectively. Area under the ROC curve of radiography was 0.80 (95% CI: 0.736‒0.87) for detection of pneumothorax, 0.77 (95% CI: 0.68‒0.86) for hemothorax, and 0.58 (95% CI: 0.5‒0.67) for pulmonary contusion. Comparison of areas under the ROC curve declared the significant superiority of ultrasonography in detection of pneumothorax (p = 0.02) and pulmonary contusion (p < 0.001). However, the diagnostic value of the two tests was equal in detection of hemothorax (p = 0.08). Conclusion: The results of the present study showed that ultrasonography is preferable to radiography in the initial evaluation of patients with traumatic injuries to the thoracic cavity.