Diagnostic value of using multiplanar reformation images: Case report for rare endotracheal hamartomas

Endotracheal hamartoma causing persistent dyspnoea after coronary artery bypass grafting

Pulmonary hamartomas are abnormal growths of mature cell or tissue types, including cartilage, epithelium, fat or muscle. Although most cases are benign, asymptomatic and often incidentally discovered, these masses may provoke significant complications via predisposition to obstruction, ischaemia or infection. Pulmonary hamartomas located within the tracheal lumen are exceedingly rare clinical entities which produce symptoms of dyspnoea, cough, stridor, wheezing or angina. Significant clinical consequences include airway obstruction and cardiovascular collapse. Most cases of tracheal hamartoma are initially diagnosed as obstructive pulmonary disease. We present a structured case report of a tracheal hamartoma identified in a patient with recent coronary artery bypass grafting who was initially evaluated for persistent ischaemic pathology, resulting in delay of diagnosis. By review of limited literature of this disorder, we emphasise the need for clinicians to be aware of this indolent and rare entity.

[Modern imaging of the pulmonary hilum : Anatomy, pathologies, pitfalls]

BACKGROUND

Modern medical imaging is a key component of efficient in- and out-patient precision medicine. Conventional radiography and computer tomography scans (CT) are among the most frequent radiologic exams. Medical imaging plays a key role in target-oriented medicine.

OBJECTIVES

The purpose of this article is to review the anatomy of the hilum of the lung and its most frequent associated pathologies since it is an important gateway of elementary structures of the thorax. Important signs and patterns for image interpretation in different modalities are also reviewed.

RESULTS

Thorough knowledge of anatomy, signs, and patterns of pathologies especially in conventional radiography and pitfalls of the more sensitive cross-sectional imaging is essential to support target-oriented patient care.

CONCLUSION

Conventional radiography is affordable and readily available. It is very suitable for pathology screening, i.e., at the hilum of the lung. Cross-sectional imaging specifies diagnostics due to superior anatomic discrimination.

An unusual tracheal foreign body in a middle-aged male with a 15-year history of coal use: a case report

BACKGROUND

Long-term exposure to coal dust causes respiratory disease. In chest computer tomography (CT), pulmonary nodules, pulmonary interstitial fibrosis and emphysema manifest themselves. However, tracheal foreign bodies caused by coal dust are rarely reported. In this study, we report a special case of a tracheal coal foreign body, in which the patient has neither a history of coal work nor foreign body inhalation.

CASE PRESENTATION

A 49-year-old man was diagnosed with chronic obstructive pulmonary disease (COPD) due to chronic cough and exertional dyspnoea. His symptoms gradually worsened despite treatment for COPD. Chest radiograph and CT images showed an irregular high-density nodule inserting fromthe trachea into the right thyroid at approximately the level of the 7th cervical vertebra. Fiberoptic bronchoscopy revealed that the tracheal lumen was mostly blocked. After the surgery, the energy spectrum CT quantitative analysis showed that the foreign body was likely that of a bituminous coal specimen.

CONCLUSIONS

For cases in which a foreign body in the airway is highly suspected, early fiberoptic bronchoscopy and radiographic examinations should be performed as soon as possible to avoid misdiagnosis and ensure timely treatment.

CT-guided special approaches of drainage for intraabdominal and pelvic abscesses: One single center's experience and review of literature

BACKGROUND

To explore the safety and efficacy of several special approaches of drainage for deep inaccessible intraabdominal and pelvic abscesses.

METHODS

By searching of our institutional database, the clinical and radiologic information of all patients with special approaches of abscesses drainage was collected, consisting of etiology, diameter of abscess, duration of drainage, major complications, rates of success, failure and death, and pre-procedure, intra-procedure and post-procedure computed tomography scans.

RESULTS

A total of 124 patients are eligible for the criterion in our center between January 2010 and January 2018. The mean diameter of abscess was 5.6 cm (range 3.0-9.8 cm) and mean duration of drainage was 10.3 days (range 4-43 days). Pain was complained in 6 patients (4.8%) and hemorrhage was observed in one patient. Complete resolution of the abscess following drainage was observed in 115 patients (92.7%). A total of 9 patients (7.3%) failed to percutaneous abscess drainage and 3 patients died of catheter-unrelated diseases. Transintestinal afferent loop of drainage was firstly attempted in six patients and complete resolution of abscess was achieved in five patients.

CONCLUSION

Special approaches, including transgluteal, presacral space, transhepatic, multiplane reconstruction (MPR)-assisted oblique approach and transintestinal afferent loop approach for those deep inaccessible intraabdominal and pelvic abscesses are safe and feasible.

An unusual pneumonia

A 70-year-old patient presented to the emergency department with a productive cough and fever for 15 days. He had no general status alteration, no chest pain, no dyspnoea, no haemoptysis and no other symptoms. He was a current cigar smoker, with a >20 pack-years smoking history, and had a past medical history of high blood pressure treated with telmisartan and a polypectomy for benign colon polyp 1 year ago. He had no professional exposures. He was French and had lived in Hanoi, Vietnam, for >10 years.

Can you diagnose this clinical case of a rare disease presenting as a very common disease?http://ow.ly/Trzu30kGzk6