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Ventura-Díaz S, González-Huete A, Gómez-Bermejo MA, Antolinos-Macho E, Alarcón-Rodríguez J, Gorospe-Sarasúa L. Imaging findings of the postoperative chest: What the radiologist should know. RADIOLOGIA 2024; 66:353-365. [PMID: 39089795 DOI: 10.1016/j.rxeng.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/15/2023] [Indexed: 08/04/2024]
Abstract
Thoracic surgical procedures are increasing in recent years, and there are different types of lung resections. Postsurgical complications vary depending on the type of resection and the time elapsed, with imaging techniques being key in the postoperative follow-up. Multidisciplinary management of these patients throughout the perioperative period is essential to ensure an optimal surgical outcome. This pictorial review will review the different thoracic surgical techniques, normal postoperative findings and postsurgical complications.
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Affiliation(s)
- S Ventura-Díaz
- Servicio de Radiología, Hospital Universitario Ramón y Cajal, Madrid, Spain.
| | - A González-Huete
- Servicio de Radiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - M A Gómez-Bermejo
- Servicio de Radiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - E Antolinos-Macho
- Servicio de Radiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - L Gorospe-Sarasúa
- Servicio de Radiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
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2
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Phelan L, Layton GR, Lee EH, Halle-Smith J, Bishay E, Griffiths EA. Oesophagopleural fistula after pneumonectomy: A systematic review and case series. Ann R Coll Surg Engl 2024; 106:226-236. [PMID: 37642088 PMCID: PMC10904258 DOI: 10.1308/rcsann.2023.0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2023] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION There is a paucity of data on the optimal management of oesophagopleural fistula (OPF) following pneumonectomy. The current published literature is limited to case reports and small case series. Although rare, OPF can have a significant impact on both the morbidity and mortality of patients. METHODS Two cases of OPF managed at our institution were reported. A systematic review was then conducted in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance concerning OPF following pneumonectomy. Demographic, operative and management data were analysed. FINDINGS Systematic review-identified data pertaining to 59 patients from 31 papers was collated. Median patient age was 59.5 years with pneumonectomy performed typically for malignancy (68%) or tuberculosis (19%). Median time from pneumonectomy to a diagnosis of OPF was 12.5 months. Twenty-five per cent of the patients had a synchronous bronchopleural fistula. Management of OPF in this setting is heterogenous. Conservative management was often reserved for asymptomatic or unfit patients. The remainder underwent endoscopic or surgical correction of the fistulae or a combination of the two with varying outcomes. Median follow-up was 18 months. All-cause mortality was 31% (18/59) with a median duration from pneumonectomy to death of 35 days (range 1-1,095). CONCLUSIONS Major heterogeneity of management for this rare complication hinders the introduction of standardised guidance of post-pneumonectomy OPF. Surgical and endoscopic intervention is feasible and can be successful in specialist centres. Adopting an multidisciplinary team approach involving both oesophagogastric and thoracic surgery teams and the introduction of a registry database of postoperative complications are likely to yield optimal outcomes.
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Affiliation(s)
- L Phelan
- University Hospitals Birmingham NHS Foundation Trust, UK
| | - GR Layton
- University Hospitals of Leicester NHS Trust, UK
| | - EH Lee
- University of Birmingham Medical School, UK
| | - J Halle-Smith
- University Hospitals Birmingham NHS Foundation Trust, UK
| | - E Bishay
- University Hospitals Birmingham NHS Foundation Trust, UK
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George N, Chin B, Mistry J, Borger R, Dong F, Neeki MM. Pericardial Tamponade in a Patient With a History of Pneumonectomy. J Med Cases 2023; 14:45-49. [PMID: 36896373 PMCID: PMC9990709 DOI: 10.14740/jmc4033] [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: 11/08/2022] [Accepted: 01/16/2023] [Indexed: 02/27/2023] Open
Abstract
Shock is the clinical presentation of circulatory failure with impaired perfusion that results in inadequate cellular oxygen utilization. Treatment requires properly identifying the type of shock that is impacting the patient (obstructive, distributive, cardiogenic, and/or hypovolemic). Complex cases may involve numerous contributors to each type of shock and/or multiple types of shock which can present interesting diagnostic and management challenges to the clinician. In this case report, we present a 54-year-old male with a remote history of a right lung pneumonectomy presenting with multifactorial shock including cardiac tamponade, with initial compression of the expanding pericardial effusion by the postoperative fluid accumulation within the right hemithorax. While in the emergency department, the patient gradually became hypotensive with worsening tachycardia and dyspnea. A bedside echocardiogram revealed an increase in size of the pericardial effusion. An emergent ultrasound-guided pericardial drain was inserted with gradual improvement of his hemodynamics followed by placement of thoracostomy tube. This unique case highlights the importance of utilizing point-of-care ultrasound along with emergent intervention in critical resuscitation.
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Affiliation(s)
- Nicholas George
- Department of Emergency Medicine, Arrowhead Regional Medical Center, Colton, CA 92324, USA
| | - Brian Chin
- Department of Emergency Medicine, Arrowhead Regional Medical Center, Colton, CA 92324, USA
| | - Jamshid Mistry
- Department of Emergency Medicine, Arrowhead Regional Medical Center, Colton, CA 92324, USA
| | - Rodney Borger
- Department of Emergency Medicine, Arrowhead Regional Medical Center, Colton, CA 92324, USA
| | - Fanglong Dong
- Department of Emergency Medicine, Arrowhead Regional Medical Center, Colton, CA 92324, USA
| | - Michael M Neeki
- Department of Emergency Medicine, Arrowhead Regional Medical Center, Colton, CA 92324, USA.,California University of Science and Medicine, Colton, CA 92324, USA
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Abdul Hamid MF, Hasbullah AHH, Mohamad Jailaini MF, Nik Abeed NN, Ng BH, Haron H, Md Ali NA, Ismail MI, Nik Ismail NA, Abdul Rahman MR, Ban AYL. Retrospective review comparing intrapleural fibrinolytic therapy (alteplase) and surgical intervention in complex pleural effusion. BMC Pulm Med 2022; 22:439. [PMID: 36419155 PMCID: PMC9685928 DOI: 10.1186/s12890-022-02239-w] [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: 09/04/2022] [Accepted: 11/14/2022] [Indexed: 11/25/2022] Open
Abstract
Background Intrapleural fibrinolytic therapy (IPFT) is one of the treatment options for complex pleural effusion. In this study, the IPFT agent used was alteplase, a tissue plasminogen activator (t-PA). This study aims to determine the difference in the outcome of patients with complex pleural effusion between IPFT and surgery in terms of radiological improvement, inflammatory parameters, length of stay, and post-intervention complications.
Methods A retrospective review of patients with complex pleural effusion treated at Universiti Kebangsaan Malaysia Medical Center from January 2012 to August 2020 was performed. Patient demographics, chest imaging, drainage chart, inflammatory parameters, length of hospital stay, and post-intervention and outcome were analyzed. Results Fifty-eight patients were identified (surgical intervention, n = 18; 31% and IPFT, n = 40, 69%). The mean age was 51.7 ± 18.2 years. Indication for surgical intervention was pleural infection (n = 18; 100%), and MPE (n = 0). Indications for IPFT was pleural infection (n = 30; 75%) and MPE (n = 10; 25%). The dosages of t-PA were one to five doses of 2–50 mg. The baseline chest radiograph in the IPFT group was worse than in the surgical intervention group. (119.96 ± 56.05 vs. 78.19 ± 55.6; p = 0.029) At week 1, the radiological success rate for IPFT and surgical intervention were 27% and 20%, respectively, and at weeks 4–8, the success rate was 56% and 80% respectively. IPFT was associated with lesser complications; fever (17.5%), chest pain (10%), and non-life-threatening bleeding (5%). Conclusion IPFT was comparable to surgery in radiological outcome, inflammatory parameters, and length of stay with lesser reported complications.
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Affiliation(s)
- Mohamed Faisal Abdul Hamid
- grid.240541.60000 0004 0627 933XRespiratory Unit, Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia ,grid.240541.60000 0004 0627 933XHeart and Lung Institute, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia
| | - Ahmad Hadyan Husainy Hasbullah
- grid.240541.60000 0004 0627 933XRespiratory Unit, Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia
| | - Mas Fazlin Mohamad Jailaini
- grid.240541.60000 0004 0627 933XRespiratory Unit, Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia ,grid.240541.60000 0004 0627 933XHeart and Lung Institute, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia
| | - Nik Nuratiqah Nik Abeed
- grid.240541.60000 0004 0627 933XRespiratory Unit, Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia ,grid.240541.60000 0004 0627 933XHeart and Lung Institute, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia
| | - Boon Hau Ng
- grid.240541.60000 0004 0627 933XRespiratory Unit, Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia ,grid.240541.60000 0004 0627 933XHeart and Lung Institute, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia
| | - Hairulfaizi Haron
- grid.240541.60000 0004 0627 933XCardiothoracic Unit, Department of Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia ,grid.240541.60000 0004 0627 933XHeart and Lung Institute, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia
| | - Nur Ayub Md Ali
- grid.240541.60000 0004 0627 933XCardiothoracic Unit, Department of Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia ,grid.240541.60000 0004 0627 933XHeart and Lung Institute, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia
| | - Muhammad Ishamuddin Ismail
- grid.240541.60000 0004 0627 933XCardiothoracic Unit, Department of Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia ,grid.240541.60000 0004 0627 933XHeart and Lung Institute, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia
| | - Nik Azuan Nik Ismail
- grid.240541.60000 0004 0627 933XDepartment of Radiology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia
| | - Mohd Ramzisham Abdul Rahman
- grid.240541.60000 0004 0627 933XCardiothoracic Unit, Department of Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia ,grid.240541.60000 0004 0627 933XHeart and Lung Institute, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia
| | - Andrea Yu-Lin Ban
- grid.240541.60000 0004 0627 933XRespiratory Unit, Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia ,grid.240541.60000 0004 0627 933XHeart and Lung Institute, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia
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Scagliola R, Seitun S, Rosa GM. Cardiac herniation: A practical review in the emergency setting. Am J Emerg Med 2022; 53:222-227. [DOI: 10.1016/j.ajem.2022.01.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/17/2021] [Accepted: 01/10/2022] [Indexed: 01/08/2023] Open
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Strange CD, Vlahos I, Truong MT, Shroff GS, Ahuja J, Wu CC, Ko JP. Pearls and Pitfalls in Postsurgical Imaging of the Chest. Semin Ultrasound CT MR 2021; 42:563-573. [PMID: 34895612 DOI: 10.1053/j.sult.2021.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A variety of surgical procedures are utilized to treat a spectrum of cardiopulmonary diseases. In the imaging of patients in the post-operative period, it is important to have an understanding of surgical techniques including invasive and minimally invasive procedures and the expected postsurgical findings. Knowledge of certain patient risk factors, various complications associated with specific surgical procedures, and a keen attention to detail are essential to avoid misinterpretation and delay diagnosis. Prompt detection of potential complications allows timely intervention, thereby, optimizing patient outcomes in the post-operative period.
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Affiliation(s)
- Chad D Strange
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Ioannis Vlahos
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mylene T Truong
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Girish S Shroff
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jitesh Ahuja
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Carol C Wu
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jane P Ko
- Department of Radiology, New York University Langone Health, New York, NY
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7
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Steward M, Hall A, Sayers R, Dickson C. Platypnoea-orthodeoxia syndrome due to a right-to-left interatrial shunt following pneumonectomy. BMJ Case Rep 2021; 14:e245699. [PMID: 34598972 PMCID: PMC8488734 DOI: 10.1136/bcr-2021-245699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2021] [Indexed: 11/03/2022] Open
Abstract
A 62-year-old man presents with breathlessness 6 months following right pneumonectomy for lung adenocarcinoma. Previous investigations had not yielded a diagnosis and his symptoms were progressing. The patient described worsened symptoms when stood up (platypnoea), with profound hypoxia until laid supine (orthodeoxia). Platypnoea-orthodeoxia syndrome due to a right-to-left interatrial shunt was diagnosed on contrast-enhanced transoesophageal echocardiography with the patient undergoing successful percutaneous patent foramen ovale closure. Patent foramen ovale is often asymptomatic with a population prevalence of around 20%-30%. Anatomical shifts postpneumonectomy can open, or worsen a previously closed interatrial communication leading to right-to-left shunting of blood. Platypnoea-orthodeoxia is under-recognised, impairing quality of life and patient outcome. Investigations can be falsely reassuring, or poorly sensitive for the causative pathology. Percutaneous closure is safe with high success rates and this case highlights the need for a high index of suspicion for shunts, particularly in postpneumonectomy patients.
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Affiliation(s)
- Matthew Steward
- Respiratory Medicine, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Anthony Hall
- Respiratory Medicine, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Ross Sayers
- Respiratory Medicine, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Christopher Dickson
- Respiratory Medicine, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
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8
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Penha D, Pinto E, Hochhegger B, Monaghan C, Marchiori E, Taborda-Barata L, Irion K. The impact of lung parenchyma attenuation on nodule volumetry in lung cancer screening. Insights Imaging 2021; 12:84. [PMID: 34170410 PMCID: PMC8233433 DOI: 10.1186/s13244-021-01027-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/02/2021] [Indexed: 11/12/2022] Open
Abstract
Background Recent recommendations for lung nodule management include volumetric analysis using tools that present intrinsic measurement variability, with possible impacts on clinical decisions and patient safety. This study was conducted to evaluate whether changes in the attenuation of the lung parenchyma adjacent to a nodule affect the performance of nodule segmentation using computed tomography (CT) studies and volumetric tools. Methods Two radiologists retrospectively applied two commercially available volumetric tools for the assessment of lung nodules with diameters of 5–8 mm detected by low-dose chest CT during a lung cancer screening program. The radiologists recorded the success and adequacy of nodule segmentation, nodule volume, manually and automatically (or semi-automatically) obtained long- and short-axis measurements, mean attenuation of adjacent lung parenchyma, and presence of interstitial lung abnormalities or disease, emphysema, pleural plaques, and linear atelectasis. Regression analysis was performed to identify predictors of good nodule segmentation using the volumetric tools. Interobserver and intersoftware agreement on good nodule segmentation was assessed using the intraclass correlation coefficient. Results In total, data on 1265 nodules (mean patient age, 68.3 ± 5.1 years; 70.2% male) were included in the study. In the regression model, attenuation of the adjacent lung parenchyma was highly significant (odds ratio 0.987, p < 0.001), with a large effect size. Interobserver and intersoftware agreement on good segmentation was good, although one software package performed better and measurements differed consistently between software packages. Conclusion For lung nodules with diameters of 5–8 mm, the likelihood of good segmentation declines with increasing attenuation of the adjacent parenchyma.
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Affiliation(s)
- Diana Penha
- Universidade da Beira Interior Faculdade de Ciências da Saúde, Covilha, Portugal. .,Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK.
| | - Erique Pinto
- Universidade da Beira Interior Faculdade de Ciências da Saúde, Covilha, Portugal
| | - Bruno Hochhegger
- Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Colin Monaghan
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Edson Marchiori
- Universidade Federal do Rio de Janeiro Faculdade de Medicina, Rio de Janeiro, RJ, Brazil.,Universidade Federal Fluminense Faculdade de Medicina, Niterói, RJ, Brazil
| | - Luís Taborda-Barata
- Universidade da Beira Interior Faculdade de Ciências da Saúde, Covilha, Portugal
| | - Klaus Irion
- Manchester University NHS Foundation Trust, Manchester, UK
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Ahuja J, de Groot PM, Shroff GS, Strange CD, Vlahos I, Rajaram R, Truong MT, Wu CC. The postoperative chest in lung cancer. Clin Radiol 2021; 77:6-18. [PMID: 34154835 DOI: 10.1016/j.crad.2021.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/05/2021] [Indexed: 12/17/2022]
Abstract
Most of the complications following lung cancer surgery occur in the early postoperative period and can result in significant morbidity and mortality. Delayed complications can also occur. Diagnosing these complications can be challenging because clinical manifestations are non-specific. Imaging plays an important role in detecting these complications in a timely manner and facilitates prompt interventions. Hence, it is important to have knowledge of the expected anatomical alterations following lung cancer surgeries, and the spectrum of post-surgical complications and their respective imaging findings to avoid misinterpretations or delay in diagnosis.
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Affiliation(s)
- J Ahuja
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - P M de Groot
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - G S Shroff
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - C D Strange
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - I Vlahos
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - R Rajaram
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M T Truong
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - C C Wu
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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10
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Vasyukov MN, Kagan II, Tretyakov AA. [Anatomometric characteristics and pleural cavity changes after pneumonectomy]. Khirurgiia (Mosk) 2021:32-41. [PMID: 33977696 DOI: 10.17116/hirurgia202105132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To analyze the anatomometric characteristics of post-pneumonectomy cavity and their changes at various times after surgery. MATERIAL AND METHODS The study included 47 patients aged 39-75 years after pneumonectomy (right-sided - 23 cases, left-sided - 24 cases). Computed tomography was performed prior to surgery, in 10-12 days, 6 and 12 months after intervention. Transverse, anteroposterior dimensions, height and volume of pleural cavity were evaluated using CT scans and 3D models. RESULTS Post-pneumonectomy cavity decreases and changes own shape in postoperative period. Reduction is mainly caused by decrease in its height. The volume of post-pneumonectomy cavity was decreased in early postoperative period by 1.8 times compared to preoperative values (from 3351.5±150.0 cm3 to 2112.1±152.6 cm3 on the right side and from 2674.3±125.2 cm3 to 1460.1±84.1 cm3 on the left side). After 12 months, this value was reduced by 3.68 times compared to early postoperative period (714.3±100.7 cm3 on the right and 401.5±42.5 cm3 on the left). The shape changes consist of flattening and sinus depth reduction. Exudate density was similar throughout a year. The capsule was formed in 74.1% of patients after 12 months. There was no correlation between the cavity reduction and patient constitution. CONCLUSION Post-pneumonectomy cavity is a dynamically changing anatomical formation participating in the mechanisms of compensation for changes after pneumonectomy. The most significant collapse of post-pneumonectomy cavity occurs in early postoperative period. Cavity reduction degree does not depend on individual characteristics of patients.
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Affiliation(s)
- M N Vasyukov
- Orenburg Regional Oncology Hospital, Orenburg, Russia
| | - I I Kagan
- Orenburg State Medical University, Orenburg, Russia
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Han P, Li F, Cao P, Hu S, Kong K, Deng Y, Zu Y, Zhao B. A case report with COVID-19 during perioperative period of lobectomy. Medicine (Baltimore) 2020; 99:e20166. [PMID: 32481381 DOI: 10.1097/md.0000000000020166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
RATIONALE Currently, COVID-19 has made a significant impact on many countries in the world. However, there have been no reported cases of pulmonary lobectomy with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-COV-2) infection. We are the first to report such a case. PATIENT CONCERNS We report a 63-year-old Wuhan male patient with smoking history of 40 cigarettes per day for 40 years. He sought medical consultation for right lower lung nodules found by CT scan. DIAGNOSES AND INTERVENTIONS The patient's postoperative pathological diagnosis was squamous cell carcinoma of the right lower lung. On the fourth day after the operation, the real-time reverse transcription polymerase chain reaction test showed a positive result. After the operation, we routinely give symptomatic treatments such as anti-infection, nebulization and oxygen inhalation. We also change antibiotics several times depending on the patient's condition. OUTCOMES The patient's condition continued to deteriorate. On the fifth day after surgery, the patient died despite medical treatment. LESSONS We are the first to report the diagnosis and treatment process of patients with COVID-19 during perioperative period of lobectomy. It provides a case for the postoperative management of such patients.
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Affiliation(s)
- Peng Han
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
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12
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Girelli L, Prisciandaro E, Filippi N, Spaggiari L. When less is more: a daring conservative approach to postpneumonectomy oesophago-pleural fistula. Interact Cardiovasc Thorac Surg 2020; 30:146-148. [PMID: 31586418 DOI: 10.1093/icvts/ivz240] [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: 07/18/2019] [Revised: 09/09/2019] [Accepted: 09/11/2019] [Indexed: 11/13/2022] Open
Abstract
Oesophago-pleural fistula is an uncommon complication after pneumonectomy, usually related to high morbidity and mortality. Due to its rarity and heterogeneous clinical presentation, its diagnosis and management are challenging issues. Here, we report the case of a patient with a history of pneumonectomy for a tracheal tumour, who developed an asymptomatic oesophago-pleural fistula 7 years after primary surgery. In consideration of the patient's good clinical status and after verifying the preservation of respiratory and digestive functions, a bold conservative approach was adopted. Five-year follow-up computed tomography did not disclose any sign of recurrence of disease and showed a stable, chronic fistula.
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Affiliation(s)
- Lara Girelli
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Elena Prisciandaro
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Niccolò Filippi
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
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Cossu A, Martin Rother MD, Kusmirek JE, Meyer CA, Kanne JP. Imaging Early Postoperative Complications of Cardiothoracic Surgery. Radiol Clin North Am 2020; 58:133-150. [DOI: 10.1016/j.rcl.2019.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Konstantinidis AK, Vitsas VV, Tatsis K, Vadivoulis T, Kittas A, Chronis C, Bellou V, Vamvakaris IN, Tringidou R, Stratakos GK. Postpneumonectomy-like syndrome due to bronchial carcinoid: a unique case report. BMC Pulm Med 2019; 19:44. [PMID: 30777035 PMCID: PMC6380005 DOI: 10.1186/s12890-018-0767-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 12/13/2018] [Indexed: 11/10/2022] Open
Abstract
Background Postpneumonectomy-like syndrome is a rare condition resulting from unilateral lung disease with severe lung volume loss leading to excessive mediastinal shift and herniation of the healthy lung into the contralateral hemithorax, mimicking the mediastinal shift observed in postpneumonectomy syndrome after pneumonectomy. We report a unique case of postpneumonectomy-like syndrome caused by an atypical bronchial carcinoid completely occluding the left main bronchus. Case presentation A 25-year-old woman presented with symptoms of chronic exertional dyspnea and productive cough. Imaging studies showed complete left lung atelectasis due to a mass occluding the left main bronchus, as well as extreme mediastinal deviation and substantial herniation of the right lung into the left hemithorax. Bronchoscopic biopsy of the tumor and subsequent left pneumonectomy with concurrent lymph node dissection revealed an atypical carcinoid. Sixteen months after surgery the patient has been asymptomatic with repeat imaging studies showing no change in mediastinal shifting. Conclusion Bronchial carcinoids are notorious for causing bronchial obstruction. The present case represents an extreme complication of centrally located bronchial carcinoid, resulting in postpneumonectomy-like syndrome with severe mediastinal shift and herniation of the healthy lung into the diseased hemithorax.
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Affiliation(s)
- Athanasios K Konstantinidis
- Division of Pulmonary Medicine, University of Ioannina School of Medicine, University Hospital of Ioannina, S. Niarhou Ave, 45500, Ioannina, Greece.
| | - Vlasios V Vitsas
- 1st Respiratory Medicine Department, University of Athens, "Sotiria" Hospital, 152 Mesogeion Ave, 115 27, Athens, Greece
| | - Konstantinos Tatsis
- Division of Pulmonary Medicine, University of Ioannina School of Medicine, University Hospital of Ioannina, S. Niarhou Ave, 45500, Ioannina, Greece
| | - Thomas Vadivoulis
- Department of Radiology, University Hospital of Ioannina, S. Niarhou Ave, 45500, Ioannina, Greece
| | - Apostolos Kittas
- Division of Pulmonary Medicine, University of Ioannina School of Medicine, University Hospital of Ioannina, S. Niarhou Ave, 45500, Ioannina, Greece
| | - Christos Chronis
- Division of Pulmonary Medicine, University of Ioannina School of Medicine, University Hospital of Ioannina, S. Niarhou Ave, 45500, Ioannina, Greece
| | - Vanesa Bellou
- Division of Pulmonary Medicine, University of Ioannina School of Medicine, University Hospital of Ioannina, S. Niarhou Ave, 45500, Ioannina, Greece
| | - Ioannis N Vamvakaris
- Department of Pathology, "Sotiria" Hospital, 152 Mesogeion Ave, 115 27, Athens, Greece
| | - Rodoula Tringidou
- Department of Pathology, "Sotiria" Hospital, 152 Mesogeion Ave, 115 27, Athens, Greece
| | - Grigoris K Stratakos
- 1st Respiratory Medicine Department, University of Athens, "Sotiria" Hospital, 152 Mesogeion Ave, 115 27, Athens, Greece
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Imaging findings of complications after thoracic surgery. Jpn J Radiol 2019; 37:209-219. [PMID: 30637569 DOI: 10.1007/s11604-018-00806-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 12/20/2018] [Indexed: 12/11/2022]
Abstract
Many surgical procedures are used for the treatment of lung, heart, and mediastinal diseases. The techniques can result in postoperative complications. The nature of these complications differs according to the duration of thoracic surgery and the onset of the complication. The complications occurring within 1 month and more than 1 month generally considered as early and late complications, respectively. Chest radiographs and CT scans obtained in patients who have undergone thoracic surgery show normal changes during the surgical procedure and diverse postsurgical complications. Familiarity with the clinical and radiologic findings of the normal alterations and possible complications after thoracic surgery is crucial in minimizing the increased morbidity and mortality.
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Chaturvedi A, Rajiah P, Croake A, Saboo S, Chaturvedi A. Imaging of thoracic hernias: types and complications. Insights Imaging 2018; 9:989-1005. [PMID: 30484078 PMCID: PMC6269341 DOI: 10.1007/s13244-018-0670-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 10/06/2018] [Accepted: 10/18/2018] [Indexed: 12/23/2022] Open
Abstract
Thoracic hernias are characterised by either protrusion of the thoracic contents outside their normal anatomical confines or extension of the abdominal contents within the thorax. Thoracic hernias can be either congenital or acquired in aetiology. They can occur at the level of the thoracic inlet, chest wall or diaphragm. Thoracic hernias can be symptomatic or fortuitously discovered on imaging obtained for other indications. Complications of thoracic hernias include incarceration, trauma and strangulation with necrosis. Multiple imaging modalities are available to evaluate thoracic hernias. Radiographs usually offer the first clue to the diagnosis. Upper gastrointestinal radiography can identify bowel herniation and associated complications. CT and occasionally MR can be useful for further evaluation of these abnormalities, accurately identifying the type of hernia, its contents, associated complications, and provide a roadmap for surgical planning. In this article, we review the different types of thoracic hernias and the role of imaging in the evaluation of these hernias. TEACHING POINTS: • Protrusion of lung contents beyond the anatomic confines of the thorax constitutes a hernia. • Complications of thoracic hernias include incarceration, trauma and strangulation with necrosis. • Multiple imaging modalities are available to evaluate thoracic hernias. • CT is the imaging modality of choice for identifying thoracic hernias and their complications. • Imaging can provide a roadmap for surgical planning.
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Affiliation(s)
- Abhishek Chaturvedi
- Imaging Science, University of Rochester Medical Center, 601, Elmwood Avenue, Rochester, NY, 14642, USA.
| | - Prabhakar Rajiah
- Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Alexender Croake
- Imaging Science, University of Rochester Medical Center, 601, Elmwood Avenue, Rochester, NY, 14642, USA
| | - Sachin Saboo
- Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Apeksha Chaturvedi
- Imaging Science, University of Rochester Medical Center, 601, Elmwood Avenue, Rochester, NY, 14642, USA
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de Groot PM, Truong MT, Godoy MC. Postoperative Imaging and Complications in Resection of Lung Cancer. Semin Ultrasound CT MR 2018; 39:289-296. [DOI: 10.1053/j.sult.2018.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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18
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Ocak I, Bollino G, Strollo D. Herniation of Packing Material into a Bronchopleural Fistula after Right Pneumonectomy and Clagett Window. J Clin Imaging Sci 2018; 8:17. [PMID: 29770265 PMCID: PMC5939033 DOI: 10.4103/jcis.jcis_70_17] [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: 10/02/2017] [Accepted: 12/04/2017] [Indexed: 12/01/2022] Open
Abstract
Diagnosis of a bronchopleural fistula (BPF) can be challenging in patients after pneumonectomy and Clagett window. Herein, we present a case of pneumonectomy for advanced lung cancer complicated by a BPF. Herniation of packing material from the open-chest cavity into the fistula and airways on computed tomography was an important clue to making the diagnosis.
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Affiliation(s)
- Iclal Ocak
- University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Gideon Bollino
- University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Diane Strollo
- University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
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19
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Garg G, Benchekroun MT, Abraham T. FDG-PET/CT in the Postoperative Period: Utility, Expected Findings, Complications, and Pitfalls. Semin Nucl Med 2017; 47:579-594. [PMID: 28969758 DOI: 10.1053/j.semnuclmed.2017.07.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
FDG-PET/CT as a modality is increasingly used for detection of recurrence and for restaging in patients with clinical suspicion of malignancy, as well as in patients with elevated tumor markers. However, there are many pitfalls in the interpretation of these scans when the studies are performed after some treatment. Some of these are attributed to normal physiological distribution and are compounded when there are inflammatory changes occurring after surgery. The body's inherent response to the surgical insult results in this inflammation. In addition, there are also complications that can happen following surgery, causing increased FDG uptake. Despite various fallacies, FDG-PET/CT provides valuable information in evaluation of residual and recurrent malignant disease. In this article, we aim to describe some of these postsurgical changes secondary to inflammation, common surgical complications, and finally, the utility of FDG-PET/CT in these patients to detect recurrent disease, even in the background of postsurgical changes.
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Affiliation(s)
- Gunjan Garg
- Division of Nuclear Medicine, Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Mohammed Taoudi Benchekroun
- Division of Nuclear Medicine, Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Tony Abraham
- Division of Nuclear Medicine, Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY.
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21
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Chabi ML, Revel MP. [Differential diagnosis of lung carcinoma recurrence after pneumonectomy]. REVUE DE PNEUMOLOGIE CLINIQUE 2017; 73:106-108. [PMID: 28209432 DOI: 10.1016/j.pneumo.2017.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 01/02/2017] [Accepted: 01/06/2017] [Indexed: 06/06/2023]
Affiliation(s)
- M-L Chabi
- Département d'imagerie cardiovasculaire et de radiologie interventionnelle et thoracique, groupe hospitalier Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
| | - M-P Revel
- Service de radiologie A, hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
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Bommart S, Berthet J, Durand G, Pujol J, Mathieu C, Marty-Ané C, Kovacsik H. Imaging of postoperative complications following surgery for lung cancer. Diagn Interv Imaging 2017; 98:11-20. [DOI: 10.1016/j.diii.2015.06.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Revised: 06/16/2015] [Accepted: 06/18/2015] [Indexed: 12/17/2022]
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Physiotherapy Practice Patterns for Management of Patients Undergoing Thoracic Surgeries in India: A Survey. Surg Res Pract 2016; 2016:9717489. [PMID: 27872897 PMCID: PMC5107873 DOI: 10.1155/2016/9717489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 10/04/2016] [Indexed: 11/18/2022] Open
Abstract
Aim. The aim of the current study is to determine the practice patterns of physiotherapists for patients undergoing thoracic surgeries in India. Materials and Methodology. A cross-sectional survey was conducted across India in which 600 questionnaires were sent in emails to physiotherapists. The questionnaire addressed assessment and treatment techniques of thoracic surgery. Results. A total of 234 completed questionnaires were returned with a response rate of 39%, with the majority of responses received from Telangana, Karnataka, and Andhra Pradesh. More than 90% of the responders practiced physical examination, chest expansion, chest X-ray, ABG analysis, pulmonary function test, and SpO2 (oxygen saturation) as the assessment measures in both the pre- and the postoperative phase. Breathing exercises, incentive spirometry, thoracic expansion exercises, coughing and huffing, positioning, and modified postural drainage are found to be commonly used physiotherapy interventions, both pre- and postoperatively, with a response rate of more than 90%. A response rate of more than 84.6% indicated that patients are made to dangle their lower limbs over the edge of the bed on the 1st postoperative day. Mobilization, such as walking up to a chair, sit to stand exercises, and perambulation within the patient's room, was started on the 2nd postoperative day, as stated by more than 65% of the physiotherapists. Staircase climbing was started on the 5th postoperative day. The most commonly used functional evaluation prior to discharge was 6-minute walk test. This was, in fact, practiced by 77.4% of the physiotherapists in their clinical settings. Conclusion. The most predominantly employed assessment measures included were physical examination, chest expansion, ABG analysis, pulmonary function test, chest X-ray, SpO2 (oxygen saturation), peripheral muscle strength, and cardiopulmonary exercise. The physiotherapy interventions most commonly used were breathing exercises, thoracic expansion exercises, incentive spirometry, and coughing and huffing techniques, in both the pre- and the postoperative phase.
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Cardinale L, Priola AM, Priola SM, Boccuzzi F, Dervishi N, Lisi E, Veltri A, Ardissone F. Radiological contribution to the diagnosis of early postoperative complications after lung resection for primary tumor: a revisional study. J Thorac Dis 2016; 8:E643-52. [PMID: 27621893 DOI: 10.21037/jtd.2016.07.02] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In the post-operative course of the interventions of lung resection for primary tumor, complications of different nature and severity can arise, recognizing different pathogenetic mechanisms and differing according to the type of resection performed and to the time elapsed after surgery. The low diagnostic accuracy of chest radiography requires a thorough knowledge of the radiologist about all radiographic findings, both normal and pathological, which can be found in the immediate post-operative period (within 30 days after surgery). This article aims to describe the incidence, the clinical features and the radiological aspects of immediate complications following pulmonary resections, with specific reference to those in which the diagnostic imaging provides a fundamental contribution.
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Affiliation(s)
- Luciano Cardinale
- Department of Radiology, AOU San Luigi Gonzaga University Hospital, Orbassano (Torino), Italy
| | | | - Sandro Massimo Priola
- Department of Radiology, AOU San Luigi Gonzaga University Hospital, Orbassano (Torino), Italy
| | - Francesco Boccuzzi
- Department of Radiology, AOU San Luigi Gonzaga University Hospital, Orbassano (Torino), Italy
| | - Najada Dervishi
- Department of Radiology, AOU San Luigi Gonzaga University Hospital, Orbassano (Torino), Italy
| | - Elena Lisi
- Department of Thoracic Surgery, AOU San Luigi Gonzaga University Hospital, Orbassano (Torino), Italy
| | - Andrea Veltri
- Department of Radiology, AOU San Luigi Gonzaga University Hospital, Orbassano (Torino), Italy
| | - Francesco Ardissone
- Department of Thoracic Surgery, AOU San Luigi Gonzaga University Hospital, Orbassano (Torino), Italy
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Leuzzi G, Facciolo F, Pastorino U, Rocco G. Methods for the postoperative management of the thoracic oncology patients: lessons from the clinic. Expert Rev Respir Med 2015; 9:751-67. [DOI: 10.1586/17476348.2015.1109453] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Rotman JA, Plodkowski AJ, Hayes SA, de Groot PM, Shepard JAO, Munden RF, Ginsberg MS. Postoperative complications after thoracic surgery for lung cancer. Clin Imaging 2015; 39:735-49. [PMID: 26117564 DOI: 10.1016/j.clinimag.2015.05.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 05/18/2015] [Accepted: 05/21/2015] [Indexed: 11/17/2022]
Abstract
UNLABELLED Lung cancer is the leading cause of cancer-related deaths in the United States. Several surgical techniques are currently used as part of the standard of care for early-stage lung cancer. Differentiating normal postoperative changes from complications is essential in the management of these patients. This article will review the various surgical approaches used, ranging from wedge resection to pneumonectomy, and will outline their expected postsurgical changes. Early and late postsurgical complications will be described, some of which are unique to the type of surgery performed. In addition, local tumor recurrence is a form of postoperative complication and must be distinguished from typical postoperative or postradiation change. Knowledge of both common and uncommon postoperative complications is crucial in the follow-up of lung cancer patients. SUMMARY STATEMENT Familiarity with the appearance of postoperative complications in lung cancer patients is vital to distinguish it from the normal postoperative or postradiation appearance in follow-up imaging.
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Affiliation(s)
- Jessica A Rotman
- Department of Radiology, NY Presbyterian/Weill Cornell Medical Center, 525 East 68th Street, New York, NY, 10065.
| | - Andrew J Plodkowski
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065.
| | - Sara A Hayes
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065.
| | - Patricia M de Groot
- Department of Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030.
| | - Jo-Anne O Shepard
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114.
| | - Reginald F Munden
- Department of Radiology, Houston Methodist Hospital, 6550 Fannin Street, Houston, TX, 77030.
| | - Michelle S Ginsberg
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065.
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Andronikou S, Van Wyk MJ, Goussard P, Gie RP, Prineas R, Blackburn H. Left main bronchus compression as a result of tuberculous lymphnode compression of the right-sided airways with right lung volume loss in children. Pediatr Pulmonol 2014. [PMID: 23192862 DOI: 10.1002/ppul.22728] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
RATIONALE The superior mediastinal space is confined by the sterno-manubrium anteriorly and the vertebral column posterior. An abnormal relationship between the superior mediastinal structures may result in compression of the left main bronchus. In patients with right-sided pneumonectomy an exaggerated compensatory response may lead to stretching and compression of the remainder of the intra-thoracic airway. Lymphobronchial TB mimics pneumonectomy when it causes compression of the bronchus intermedius, between nodal lymphnode groups with resultant volume loss in the right lung and displacement of the mediastinum to the right. The left main bronchus may be at risk of compression due to rotation and displacement of the major vessels. AIM To report pediatric cases of right-sided lymphobronchial TB with volume loss, demonstrate the use of angle measurements to quantify mediastinal dynamics and support a pathogenetic theory for left main bronchus compression. MATERIALS AND METHODS CT scans in children with TB and right lung volume loss, were compared retrospectively with controls using angle measurements based on descriptions of the aorta-carinal syndrome and the post-pneumonectomy syndrome. The Mann-Whitney U-test was used to compare groups. RESULTS The "Pulmonary bifurcation angle" between the main pulmonary arteries reached statistical significance (P = 0.025). The "Pulmonary outflow tract rotation" angle (pulmonary trunk with the mid sagittal plane) approached statistical significance (P = 0.078). The left main bronchus ranged from complete obliteration in two patients to 0.7 cm. In 16 of 30 patients the size was reduced to less than 75% of expected. CONCLUSION In children with right lung volume loss from TB, the compression of the contralateral bronchus is due to narrowing of the pulmonary artery bifurcation angle as the main trunk rotates towards the midline. This is comparable to the post-pneumonectomy syndrome.
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Affiliation(s)
- S Andronikou
- Department of Diagnostic Imaging, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Rakovich G, Bussières J, Fréchette E. Postpneumonectomy syndrome. Multimed Man Cardiothorac Surg 2014; 2009:mmcts.2008.003475. [PMID: 24413710 DOI: 10.1510/mmcts.2008.003475] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Postpneumonectomy syndrome is a rare postoperative complication whereby mediastinal shifting toward the pneumonectomy space results in bronchial compression between the pulmonary artery, aorta, and vertebral column. This syndrome is more common after right pneumonectomy; other risk factors include young age and female sex. Imaging studies consistently reveal massive mediastinal shifting and document airway compromise. Bronchoscopy and flow-volume loops are helpful in confirming the diagnosis. Other causes of dyspnea, including cancer recurrence, should be excluded. Definitive treatment involves surgical repositioning of the mediastinum in the midline, as well as insertion of a saline-filled silicone prosthesis into the pneumonectomy space in order to prevent recurrence.
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Affiliation(s)
- George Rakovich
- Division of Thoracic Surgery, Hôpital Maisonneuve-Rosemont (University of Montreal), 5415 boulevard de l'Assomption, Montréal, Que H1T 2M4, Canada
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Alpert JB, Godoy MC, deGroot PM, Truong MT, Ko JP. Imaging the Post-Thoracotomy Patient. Radiol Clin North Am 2014; 52:85-103. [DOI: 10.1016/j.rcl.2013.08.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pool K, Munden R, Vaporciyan A, O'Sullivan P. Radiographic imaging features of thoracic complications after pneumonectomy in oncologic patients. Eur J Radiol 2012; 81:165-72. [DOI: 10.1016/j.ejrad.2010.08.040] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Revised: 08/26/2010] [Accepted: 08/27/2010] [Indexed: 10/19/2022]
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Integrated imaging of non-small cell lung cancer recurrence: CT and PET-CT findings, possible pitfalls and risk of recurrence criteria. Eur Radiol 2011; 22:588-606. [DOI: 10.1007/s00330-011-2299-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Revised: 09/06/2011] [Accepted: 09/12/2011] [Indexed: 12/18/2022]
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Balogh G, Garbera I, Ifj Balogh G. [Computerized modelling of operation (CMO) before thoracoplasty]. Magy Seb 2011; 64:116-21. [PMID: 21672682 DOI: 10.1556/maseb.64.2011.3.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
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.
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Affiliation(s)
- Gábor Balogh
- Kaposi Mór Oktató Kórház Általános-, Mellkas- és Érsebészeti Osztály 7400 Kaposvár Tallián Gy. u. 20-32.
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Bazwinsky-Wutschke I, Paulsen F, Stövesandt D, Holzhausen HJ, Heine HJ, Peschke E. Anatomical changes after pneumonectomy. Ann Anat 2011; 193:168-72. [PMID: 21333511 DOI: 10.1016/j.aanat.2011.01.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Accepted: 01/07/2011] [Indexed: 11/26/2022]
Abstract
Pneumonectomy is associated with many diverse post-operative conditions, e.g. hydropneumothorax, diaphragm elevation, progressive mediastinal displacement, thorax wall deformation, and hydrothorax. By means of imaging procedures, such pneumonectomy-related anatomical changes can easily be determined; here we summarize some of the common diagnostic findings and in addition report the case of a 100-year-old woman, who underwent left pneumonectomy at the age of 47, survived for another 53 years with only one lung and then became body donor to our department. Investigation of the cadaver revealed that, compared to similar-aged individuals still having both lungs, mediastinal structures had been displaced to the side of the missing lung. In addition, the remaining lung had herniated across the midline to a position anterior to the heart. Histological examination of the remaining lung tissue revealed changes comparable to those generally expected in lungs of individuals of the same age-group; tissue changes directly associated with pneumonectomy could not be observed. The findings document anatomical alterations that arise physiologically due to pneumonectomy if no pathological complications occur.
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Affiliation(s)
- Ivonne Bazwinsky-Wutschke
- Institute of Anatomy and Cell Biology, Martin Luther University Halle-Wittenberg, Grosse Steinstrasse 52, Halle, Germany.
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Closure of bronchopleural fistula with Angio-Seal. Cardiovasc Intervent Radiol 2010; 34 Suppl 2:S236-9. [PMID: 21107565 DOI: 10.1007/s00270-010-9834-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Accepted: 02/18/2010] [Indexed: 10/18/2022]
Abstract
Bronchopleural fistula is rare and occurs most often after trauma or surgery. Conservative management and support comprise the initial treatment, but if unsuccessful, surgical closure is usually required. We describe for what is to our knowledge the first successful use of an Angio-Seal vascular closure device in a patient who was not a candidate for surgery.
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Imagerie des complications survenant après chirurgie de résection pulmonaire. ACTA ACUST UNITED AC 2009; 90:1001-12. [DOI: 10.1016/s0221-0363(09)73238-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Abstract
Postpneumonectomy syndrome is a rare complication secondary to postsurgical anatomic changes in the pneumonectomy space. Patients present with marked dyspnea on exertion secondary to airflow limitation from proximal airway compression and overdistention of the remaining lung because of mediastinal shift. Postpneumonectomy syndrome is treated by surgical repositioning of the mediastinum. Knowledge of the clinical and radiological features will enable prompt diagnosis and appropriate treatment.
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