Open window thoracostomy, myoplasty, and epiploplasty for treatment of postpneumonectomy empyema: CT evaluation

[Computerized modelling of operation (CMO) before thoracoplasty]

INTRODUCTION

Thoraco-myoplasty (TMP) has proven to be the only successful method of treatment for severe cases of chronic pyothorax (CPT). Great loss of muscle tissue and permanent bone-structure defects with severe functional damage can be caused by this method. The aim of the applied CMO was to prevent additional loss of muscle function. Preoperative evaluation of spiral CT scan 3-dimensional imaging provided a significant aid in decreasing adverse effects of the TMP.

MATERIALS AND METHOD

Between 1990 and 2010, TMP was applied in 85 patients, whose CPT came from several different origins.

CLINICAL DATA

average age: 62.7; mortality: 4.8%. Tissue and function preserving TMP was achieved following open treatment after thoracic fenestration in 76 cases, and drainage with continuous suction was performed in 9 patients prior to this. In our department TMP with computerized modeling was introduced as the definitive treatment of CPT in 2006, since then it has been applied in 8 patients.

RESULTS

The number and length of the ribs to be resected can be anticipated applying spiral CT imaging. Furthermore, accurate volume measurement of the empyema cavity and rotatable muscles (pectoral major and latissimus dorsal) faciliatates elimination of the primary defect during surgery.

CONCLUSION

Therefore, we believe that CMO can provide significant aid for surgeons to reduce the negative effects caused by muscle trauma and the structural changes in the thoracic wall.

Enhanced visualisation of the normal prostate blood flow in young healthy volunteers using a new ultrasound contrast agent

PURPOSE

To evaluate the sonographic appearance of normal prostate vascularity before and after injection of a new ultrasound contrast agent, Sonazoid (NC100100, Nycomed Amersham).

MATERIAL AND METHODS

Five healthy male volunteers were given three injections of Sonazoid each. Transrectal B-mode, colour Doppler and colour Doppler energy (i.e. power Doppler) imaging was performed. The visibility of the vascular pattern and the vascular architecture of the prostate, including dynamics of contrast inflow and blood flow symmetry, were evaluated.

RESULTS

The depiction of the vascularity was improved in all subjects after injection of Sonazoid for both Doppler modes. No improvement was seen for B-mode. Contrast dynamics within the prostate vessels were demonstrated with a mean time from injection of the ultrasound contrast agent to enhancement of the Doppler signals in the subcapsular arteries of 14+/-1 s (11--17 s), and the ultrasound contrast agent reached the central periurethral veins 4--7 s later. A symmetric, radial, spoke-like intraprostatic vascular pattern could be identified in all subjects using power Doppler imaging and ultrasound contrast agent.

CONCLUSION

Sonazoid improved the detection of normal human prostate vascular anatomy for both colour and power Doppler imaging. Contrast dynamic studies revealed a radial spoke-like intraprostatic vascular pattern. This information might be useful in examination of patients with suspicion of prostate cancer, and needs to be further investigated.

Postpneumonectomy empyema. CT findings in six patients

Chest radiographs and CT scans, obtained in six patients with proven postpneumonectomy empyema, were retrospectively reviewed by comparing the radiologic image obtained at present with that obtained before symptom onset. Convexity or straightening of the concave mediastinal margin of the postpneumonectomy space was identified on CT scans in all of six patients (100%), while contralateral mediastinal shift was noted on both radiographs and CT scans in four patients (67%). Multiple air-fluid levels appeared equally on radiographs and CT scans in three patients (50%). CT depicted increased thickening of the parietal pleura (n=5, 83%) and the extrapleural tissues (n=3, 50%) and empyema necessitans (n=2, 33%), which were not apparent on radiographs. Postpneumonectomy empyema is characterized on CT scans by reversal of the normal concavity of the mediastinal margin with increased thickening of the residual parietal pleura. CT is superior to radiography in assessing the manifestations of postpneumonectomy empyema.