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Klein S, Hart E. Traumatic Chylothorax Following Pulmonary Segmentectomy: A Case Report and Review of Postoperative Investigation and Management. Cureus 2023; 15:e48213. [PMID: 38050516 PMCID: PMC10693790 DOI: 10.7759/cureus.48213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/03/2023] [Indexed: 12/06/2023] Open
Abstract
The incidence of iatrogenic traumatic chylothorax is on the rise secondary to the preferred use of minimally invasive thoracic surgery over thoracotomy. Most reported causes of chylothorax occur following pneumonectomy or lobectomy. There have been no reported cases of traumatic chylothorax following segmentectomy according to our literature review. Complications following lung resection typically include pneumonia, atelectasis, or prolonged air leak. Here, we present a rare case of postoperative chylothorax following minimally invasive segmentectomy to diagnose an enlarging singular pulmonary nodule. This condition was diagnosed with fluid analysis after CT imaging revealed a postoperative unilateral pleural effusion. Interestingly, the patient had a loculated pleural effusion that mimicked a pericardial effusion and empyema. Our patient was managed conservatively with a low-fat diet and short-term pleural drainage without the need for repeat surgical intervention. The importance of imaging interpretation following lung resection along with a working differential diagnosis, appropriate examination, and testing can assist with the diagnosis of this known, but rare, postoperative complication.
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Affiliation(s)
- Shaylor Klein
- Internal Medicine and Emergency Medicine, Jefferson Health Northeast, Philadelphia, USA
| | - Erin Hart
- General Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, USA
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Pang H, Wu Y, Qi S, Li C, Shen J, Yue Y, Qian W, Wu J. A fully automatic segmentation pipeline of pulmonary lobes before and after lobectomy from computed tomography images. Comput Biol Med 2022; 147:105792. [PMID: 35780601 DOI: 10.1016/j.compbiomed.2022.105792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/18/2022] [Accepted: 06/26/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVE Lobectomy is a curative treatment for localized lung cancer. The study aims to construct an automatic pipeline for segmenting pulmonary lobes before and after lobectomy from CT images. MATERIALS AND METHODS Six datasets (D1 to D6) of 865 CT scans were collected from two hospitals and public resources. Four nnU-Net-based segmentation models were trained. A lobectomy classification was proposed to automatically recognize the category of the input CT images: before lobectomy or one of five types after lobectomy. Finally, the lobe segmentation before and after lobectomy was realized by integrating the four models and lobectomy classification. The dice similarity coefficient (DSC), 95% Hausdorff distance (HD95) and average symmetric surface distance (ASSD) were used to evaluate the segmentations. RESULTS The pre-operative model achieved an average DSC of 0.964, 0.929, 0.934, and 0.891 in the four datasets. In D1 and D2, the average HD95 was 4.18 and 7.74 mm and the average ASSD was 0.86 and 1.32 mm, respectively. The lobectomy classification achieved an accuracy of 100%. After lobectomy, an average DSC of 0.973 and 0.936, an average HD95 of 2.70 and 6.92 mm, an average ASSD of 0.57 and 1.78 mm were obtained in D1 and D2, respectively. The postoperative segmentation pipeline outperformed other counterparts and training strategies. CONCLUSIONS The proposed pipeline can automatically segment pulmonary lobes before and after lobectomy from CT images and be applied to manage patients with lung cancer after lobectomy.
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Affiliation(s)
- Haowen Pang
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China; Key Laboratory of Intelligent Computing in Medical Image, Ministry of Education, Northeastern University, Shenyang, China.
| | - Yanan Wu
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China; Key Laboratory of Intelligent Computing in Medical Image, Ministry of Education, Northeastern University, Shenyang, China.
| | - Shouliang Qi
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China; Key Laboratory of Intelligent Computing in Medical Image, Ministry of Education, Northeastern University, Shenyang, China.
| | - Chen Li
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China; Key Laboratory of Intelligent Computing in Medical Image, Ministry of Education, Northeastern University, Shenyang, China.
| | - Jing Shen
- Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China.
| | - Yong Yue
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China.
| | - Wei Qian
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China; Key Laboratory of Intelligent Computing in Medical Image, Ministry of Education, Northeastern University, Shenyang, China.
| | - Jianlin Wu
- Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China.
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Tamura A, Kawashima M, Suzuki J, Yamane A, Inoue Y, Fukami T, Kitani M, Takahashi F. Impact of lung cancer surgery on comorbid Mycobacterium avium complex lung disease-A case series. Respir Med Case Rep 2022; 37:101664. [PMID: 35585903 PMCID: PMC9108527 DOI: 10.1016/j.rmcr.2022.101664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/28/2022] [Accepted: 04/29/2022] [Indexed: 12/02/2022] Open
Abstract
The number of cases with Mycobacterium avium and Mycobacterium intracellulare lung diseases (Mycobacterium avium complex lung disease [MACLD]) are increasing globally. Lung cancer can sometimes present as a comorbidity with MACLD; however, the clinical presentation and outcomes of comorbid MACLD following lung cancer resection remain unclear. Therefore, we retrospectively assessed 17 patients with MACLD undergoing lung cancer resection to determine the impact of lung cancer surgery on comorbid MACLD. Of the 17 patients, Mycobacterium avium and Mycobacterium intracellulare were present in 15 and 2 patients, respectively; 14 patients had stage I lung cancer and underwent lobectomy. Ten patients were postoperatively observed for MACLD without any further intervention, five patients underwent additional resection for conspicuous MACLD lesions, and the remaining two patients underwent complete resection for MACLD and lung cancer within the same lobe followed by rifampicin, ethambutol, and clarithromycin (RECAM) therapy. Seven patients exhibited postoperative MACLD exacerbation, six of whom developed exacerbation in the operated ipsilateral residual lobes. Six of these seven patients received RECAM, three of whom (43%) subsequently exhibited improvement. Attention should be paid to MACLD exacerbation during postoperative follow-up, especially in ipsilateral lobes. Although RECAM therapy may be beneficial in alleviating MACLD exacerbation, further investigation is warranted to validate these results.
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Affiliation(s)
- Atsuhisa Tamura
- Department of Respiratory Diseases, National Hospital Organization Tokyo National Hospital, Kiyose, Tokyo, 204-8585, Japan
| | - Masahiro Kawashima
- Department of Respiratory Diseases, National Hospital Organization Tokyo National Hospital, Kiyose, Tokyo, 204-8585, Japan
| | - Junko Suzuki
- Department of Respiratory Diseases, National Hospital Organization Tokyo National Hospital, Kiyose, Tokyo, 204-8585, Japan
| | - Akira Yamane
- Department of Respiratory Diseases, National Hospital Organization Tokyo National Hospital, Kiyose, Tokyo, 204-8585, Japan
| | - Yuta Inoue
- Department of Chest Surgery, National Hospital Organization Tokyo National Hospital, Kiyose, Tokyo, 204-8585, Japan
| | - Takeshi Fukami
- Department of Chest Surgery, National Hospital Organization Tokyo National Hospital, Kiyose, Tokyo, 204-8585, Japan
| | - Masashi Kitani
- Department of Pathology, National Hospital Organization Tokyo National Hospital, Kiyose, Tokyo, 204-8585, Japan
| | - Fumiaki Takahashi
- Department of Information Science, Iwate Medical University, Yahaba, Iwate, 028-3694, Japan
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An Analysis of Respiration with the Smart Sensor SENSIRIB in Patients Undergoing Thoracic Surgery. SENSORS 2022; 22:s22041561. [PMID: 35214460 PMCID: PMC8879853 DOI: 10.3390/s22041561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/11/2022] [Accepted: 02/15/2022] [Indexed: 11/17/2022]
Abstract
The paper examines the problem of respiration monitoring with easily wearable instrumentation by using a smart device that is properly designed and implemented with small and light components. The practical implementation is presented both in practical aspects and from experimental results by following a properly defined method with a medical-like protocol and specific procedure of testing. The results of a statistically significant campaign of experimental tests are reported with the characteristic data from the angles and acceleration components of a sensed rib both to validate the smart device and the procedure for respiration monitoring.
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Surgery for lung cancer: postoperative changes and complications-what the Radiologist needs to know. Insights Imaging 2021; 12:116. [PMID: 34383170 PMCID: PMC8360261 DOI: 10.1186/s13244-021-01047-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/25/2021] [Indexed: 01/19/2023] Open
Abstract
Imaging findings after thoracic surgery can be misleading. Knowledge of the normal post-operative anatomy helps the radiologist to recognise life-threatening complications and conversely not to wrongly evoke a complication in cases of trivial post-operative abnormalities. In this educational article, we reviewed the expected patterns after thoracic surgery including sublobar resection, lobectomy, pneumonectomy and related techniques. Imaging aspects of frequent and less common complications and their typical imaging features are then presented.
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Postoperative complications of pulmonary resection. Clin Radiol 2020; 75:876.e1-876.e15. [PMID: 32600652 DOI: 10.1016/j.crad.2020.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 05/06/2020] [Indexed: 12/25/2022]
Abstract
Thoracic surgery has seen a resurgence in recent years with increasing numbers of cases taken on since the mid-2000s. There has been a paradigm shift in how we manage lung cancer with more emphasis on surgical resection, and this has been aided by minimally invasive video-assisted thoracic surgery (VATS) techniques. As a result, the prevalence of postoperative findings and complications is also increasing, and it is increasingly important for the general radiologist to recognise and diagnose these conditions as thoracic surgical patients may present acutely to non-thoracic surgical institutions. This review will cover both the early and late complications following a variety of lung resection surgeries.
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Gu Q, Qi S, Yue Y, Shen J, Zhang B, Sun W, Qian W, Islam MS, Saha SC, Wu J. Structural and functional alterations of the tracheobronchial tree after left upper pulmonary lobectomy for lung cancer. Biomed Eng Online 2019; 18:105. [PMID: 31653252 PMCID: PMC6815003 DOI: 10.1186/s12938-019-0722-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 10/15/2019] [Indexed: 12/18/2022] Open
Abstract
Background Pulmonary lobectomy has been a well-established curative treatment method for localized lung cancer. After left upper pulmonary lobectomy, the upward displacement of remaining lower lobe causes the distortion or kink of bronchus, which is associated with intractable cough and breathless. However, the quantitative study on structural and functional alterations of the tracheobronchial tree after lobectomy has not been reported. We sought to investigate these alterations using CT imaging analysis and computational fluid dynamics (CFD) method. Methods Both preoperative and postoperative CT images of 18 patients who underwent left upper pulmonary lobectomy are collected. After the tracheobronchial tree models are extracted, the angles between trachea and bronchi, the surface area and volume of the tree, and the cross-sectional area of left lower lobar bronchus are investigated. CFD method is further used to describe the airflow characteristics by the wall pressure, airflow velocity, lobar flow rate, etc. Results It is found that the angle between the trachea and the right main bronchus increases after operation, but the angle with the left main bronchus decreases. No significant alteration is observed for the surface area or volume of the tree between pre-operation and post-operation. After left upper pulmonary lobectomy, the cross-sectional area of left lower lobar bronchus is reduced for most of the patients (15/18) by 15–75%, especially for 4 patients by more than 50%. The wall pressure, airflow velocity and pressure drop significantly increase after the operation. The flow rate to the right lung increases significantly by 2–30% (but there is no significant difference between each lobe), and the flow rate to the left lung drops accordingly. Many vortices are found in various places with severe distortions. Conclusions The favorable and unfavorable adaptive alterations of tracheobronchial tree will occur after left upper pulmonary lobectomy, and these alterations can be clarified through CT imaging and CFD analysis. The severe distortions at left lower lobar bronchus might exacerbate postoperative shortness of breath.
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Affiliation(s)
- Qingtao Gu
- Sino-Dutch Biomedical and Information Engineering School, Northeastern University, Shenyang, China.,Key Laboratory of Medical Image Computing of Northeastern University (Ministry of Education), Shenyang, China
| | - Shouliang Qi
- Sino-Dutch Biomedical and Information Engineering School, Northeastern University, Shenyang, China. .,Key Laboratory of Medical Image Computing of Northeastern University (Ministry of Education), Shenyang, China.
| | - Yong Yue
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jing Shen
- Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Baihua Zhang
- Sino-Dutch Biomedical and Information Engineering School, Northeastern University, Shenyang, China
| | - Wei Sun
- The Graduate School, Dalian Medical University, Dalian, China
| | - Wei Qian
- Sino-Dutch Biomedical and Information Engineering School, Northeastern University, Shenyang, China.,College of Engineering, University of Texas at El Paso, El Paso, USA
| | - Mohammad Saidul Islam
- School of Mechanical and Mechatronic Engineering, Faculty of Engineering and Information Technology, University of Technology Sydney, Brisbane, Australia
| | - Suvash C Saha
- School of Mechanical and Mechatronic Engineering, Faculty of Engineering and Information Technology, University of Technology Sydney, Brisbane, Australia
| | - Jianlin Wu
- Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China.
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