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Ohashi C, Uchida T, Tanaka Y, Maniwa Y. Successful treatment of phrenic nerve injury with diaphragmatic plication 5 years after onset: A case report. SAGE Open Med Case Rep 2022; 10:2050313X211070514. [PMID: 35035975 PMCID: PMC8753225 DOI: 10.1177/2050313x211070514] [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: 08/12/2021] [Accepted: 12/14/2021] [Indexed: 11/16/2022] Open
Abstract
Diaphragmatic paralysis due to phrenic nerve injury is an occasional complication of cardiothoracic surgery. Although diaphragmatic plication is widely used to treat patients with severe irreversible symptoms, its surgical indication and timing remain controversial. Here, we present a rare case of diaphragmatic paralysis in a 65-year-old woman who underwent cardiac surgery and whose respiratory symptoms worsened despite >5 years of conservative management. Consequently, she underwent diaphragmatic plication using an endostapler to resect the redundant diaphragm, followed by over-suturing of all staple lines. She was discharged without any complications and her symptoms and chest radiography and spirometry results improved postoperatively.
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Affiliation(s)
- Chihiro Ohashi
- Division of Thoracic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Takahiro Uchida
- Division of Thoracic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Yugo Tanaka
- Division of Thoracic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Yoshimasa Maniwa
- Division of Thoracic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
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Dandawate N, Humphreys C, Gordan P, Okin D. Diaphragmatic paralysis in COVID-19: a rare cause of postacute sequelae of COVID-19 dyspnoea. BMJ Case Rep 2021; 14:14/11/e246668. [PMID: 34815229 PMCID: PMC8611419 DOI: 10.1136/bcr-2021-246668] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We describe a 56-year-old female patient hospitalised with COVID-19 in April 2020 who had persistent respiratory symptoms after radiographic and microbiologic recovery. X-ray of the chest demonstrated an elevated right hemidiaphragm while fluoroscopy confirmed unilateral diaphragmatic paralysis. Symptoms resolved gradually, concurrent with restoration of right hemidiaphragm function. Thus, we describe a rare cause of postacute sequelae of COVID-19 dyspnoea.
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Affiliation(s)
- Nupur Dandawate
- Department of Medicine, Salem Hospital, Salem, Massachusetts, USA
| | | | - Patrick Gordan
- Department of Medicine, Salem Hospital, Salem, Massachusetts, USA.,Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Daniel Okin
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA .,Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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Unilateral temporary diaphragmatic paralysis secondary to bronchial artery embolization in a girl with cystic fibrosis and massive hemoptysis: a case report. BMC Pulm Med 2020; 20:38. [PMID: 32046694 PMCID: PMC7014762 DOI: 10.1186/s12890-020-1076-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 02/04/2020] [Indexed: 11/10/2022] Open
Abstract
Background Massive hemoptysis is a serious complication in Cystic Fibrosis (CF), occurring commonly in older patients. Bronchial artery embolization (BAE) can be performed to stop the bleeding. BAE is generally safe and effective, but can sometimes lead to serious complications. We report the first case of temporary unilateral diaphragmatic paralysis associated to lung consolidation following BAE in a pediatric CF female patient. This complication worsened the lung function of the patient who underwent lung transplantation after 9 months. Case presentation A 14 years old female CF patient followed by the CF center of Florence presented low-grade fever, cough increase and recurrent episodes of major hemorrhages such as to carry out a BAE. Within 24 h the patient started to complain of severe thoracic pain in the right hemithorax, increased dyspnea and fever. A computed tomographic angiography and a dynamic fluoroscopic evaluation revealed the right diaphragmatic paralysis, not present before the procedure. After 4 days the clinical condition and radiological imaging had improved with restored mobility of the right hemidiaphragm. Nine months later, she required mechanical ventilation, and subsequently the initiation of extracorporeal membrane oxygenation (ECMO) for a pulmonary exacerbation with septic shock. Lung transplantation in ECMO was performed with success. Conclusion Clinicians should be aware of the possibility of phrenic nerve injury with BAE in pediatric CF patients.
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Monroe EJ, Pierce DB, Ingraham CR, Johnson GE, Shivaram GM, Valji K. An Interventionalist's Guide to Hemoptysis in Cystic Fibrosis. Radiographics 2018. [PMID: 29528824 DOI: 10.1148/rg.2018170122] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Massive hemoptysis occurs in a minority of patients with cystic fibrosis, with an annual incidence of 1%. Although rare, massive hemoptysis can be a severe and potentially fatal complication of this disease. Beyond the acute life-threatening event, hemoptysis in patients with cystic fibrosis has been associated with faster decline in lung function, accelerated need for lung transplant, and increased mortality. The bronchial arteries are the culprit vessels in over 90% of cases of hemoptysis. This normally quiescent vascular system undergoes remarkable hypertrophy, collateralization, and angiogenesis before the onset of hemoptysis, introducing numerous pitfalls for the interventionalist. However, in experienced hands, bronchial artery embolization is a safe and potentially lifesaving therapy. Preprocedural noninvasive imaging, specifically computed tomographic angiography, has been repeatedly validated for helping to localize the likely site of bleeding, characterizing pertinent arterial anatomy, and promoting efficient and effective intervention; it has been recommended for all stable patients with hemoptysis. Success in the angiographic suite requires a thorough understanding of normal and variant bronchial arterial anatomy, appropriate patient selection, and a meticulous embolization technique. A meticulous approach to imaging and intervention, conscientious of both visualized and nonvisualized collateral pathways and nontarget vessels, can minimize potentially devastating complications. This review summarizes the current literature, modern procedural techniques, and emerging controversies, serving to guide an evolving approach to management of patients with cystic fibrosis and hemoptysis. ©RSNA, 2018.
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Affiliation(s)
- Eric J Monroe
- From the Department of Radiology, University of Washington, Seattle, Wash (E.J.M., D.B.P., C.R.I., G.E.J., G.M.S., K.V.); and Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, MA.7.220-Radiology, Seattle, WA 98105 (E.J.M., G.M.S.)
| | - David B Pierce
- From the Department of Radiology, University of Washington, Seattle, Wash (E.J.M., D.B.P., C.R.I., G.E.J., G.M.S., K.V.); and Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, MA.7.220-Radiology, Seattle, WA 98105 (E.J.M., G.M.S.)
| | - Christopher R Ingraham
- From the Department of Radiology, University of Washington, Seattle, Wash (E.J.M., D.B.P., C.R.I., G.E.J., G.M.S., K.V.); and Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, MA.7.220-Radiology, Seattle, WA 98105 (E.J.M., G.M.S.)
| | - Guy E Johnson
- From the Department of Radiology, University of Washington, Seattle, Wash (E.J.M., D.B.P., C.R.I., G.E.J., G.M.S., K.V.); and Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, MA.7.220-Radiology, Seattle, WA 98105 (E.J.M., G.M.S.)
| | - Giridhar M Shivaram
- From the Department of Radiology, University of Washington, Seattle, Wash (E.J.M., D.B.P., C.R.I., G.E.J., G.M.S., K.V.); and Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, MA.7.220-Radiology, Seattle, WA 98105 (E.J.M., G.M.S.)
| | - Karim Valji
- From the Department of Radiology, University of Washington, Seattle, Wash (E.J.M., D.B.P., C.R.I., G.E.J., G.M.S., K.V.); and Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, MA.7.220-Radiology, Seattle, WA 98105 (E.J.M., G.M.S.)
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Burdick TR, Hoffer EK, Kooy T, Ghodke B, Starnes BW, Valji K, Goldberg S, Hallam D, Andrews RT. Which Arteries Are Expendable? The Practice and Pitfalls of Embolization throughout the Body. Semin Intervent Radiol 2011; 25:191-203. [PMID: 21326510 DOI: 10.1055/s-0028-1085925] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This article outlines general concepts of, and strategies for, therapeutic embolization throughout the body, touching on all major arterial distributions. Clinical scenarios that allow or prevent safe embolization of vessels are presented. Specific agents are recommended where appropriate, as are alternate approaches when embolization is not an option. Pre-embolization precautions and adjunctive measures are described in high-risk areas.
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Affiliation(s)
- Thomas R Burdick
- Department of Radiology, University of Washington, Seattle, Washington
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Lopez JK, Lee HY. Bronchial artery embolization for treatment of life-threatening hemoptysis. Semin Intervent Radiol 2011; 23:223-9. [PMID: 21326768 DOI: 10.1055/s-2006-948759] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Massive hemoptysis is an emergent and life-threatening condition with a broad range of underlying causes. Fortunately, massive hemoptysis accounts for a minority of cases of hemoptysis, ~5%. Unlike hemorrhage in other areas of the body, the primary cause of death from pulmonary hemorrhage is most commonly asphyxiation rather than exsanguination. Given the limited capacity for the lung to preserve oxygen transfer in the setting of massive hemoptysis, a rapid and effective method for controlling hemorrhage is essential to minimize death in patients demonstrating respiratory compromise. Since its introduction in 1973, bronchial artery embolization has proven to be a safe and effective tool for the treatment of massive hemoptysis and is now considered the treatment of choice, with initial success rates ranging from 77 to 94%. The long-term control rate of hemoptysis ranges from 70 to 85% and is largely a function of the degree of inflammation and the natural progression of the underlying disease. This article reviews the current literature on bronchial artery embolization for the treatment of massive hemoptysis.
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Affiliation(s)
- January K Lopez
- Department of Radiology, University of California at Los Angeles
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Abstract
Haemoptysis varies in significance from trivial to fatal. The most common causes in children are tuberculosis, fungal infections and bronchiectasis of any cause. In populations of European origin, cystic fibrosis is the most common predisposing factor. Chronic or life-threatening haemoptysis requires further investigation. Various forms of treatment are possible, and management is optimized when a multidisciplinary team is available. Bronchial artery embolization (BAE) is effective in controlling haemoptysis in most cases, although recurrent bleeding is not uncommon. BAE is often technically challenging, however, and requires angiographic skills that are not always available in children's hospitals. Although the procedure is usually regarded as relatively safe, complications are not uncommon and may be severe or even fatal.
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Affiliation(s)
- Derek J Roebuck
- Department of Radiology, Great Ormond Street Hospital, London WC1N 3JH, UK.
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Simic P, Borovecki F, Jelic M, Jelic M, Vinter I. Anomalous branch of the left common carotid artery. Clin Anat 2004; 17:409-12. [PMID: 15176038 DOI: 10.1002/ca.10258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A previously unreported anomalous branch of the left common carotid artery (LCCA) was observed during dissection at the Zagreb Medical School. The anomalous branch arose from the anterior surface of the LCCA approximately 2 cm superior to the aortic arch, and subsequently bifurcated into a right and left branch. We describe its anatomic features. Clinical implications are also discussed.
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Affiliation(s)
- P Simic
- Department of Anatomy, School of Medicine, University of Zagreb, Zagreb, Croatia.
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Sim JY, Alejos JC, Moore JW. Techniques and applications of transcatheter embolization procedures in pediatric cardiology. J Interv Cardiol 2003; 16:425-48. [PMID: 14603802 DOI: 10.1046/j.1540-8183.2003.01009.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Transcatheter embolization of congenital or acquired superfluous vascular structure has become routine procedures performed by interventional pediatric cardiologists. Embolization procedure is often part of a collaborative effort with cardiac surgeons to palliate complex congenital heart defect, such as in embolizing aortopulmonary collateral arteries in patient with single ventricle physiology. In other cases, the procedure is the definitive treatment as in embolizing coronary artery fistula. Pediatric cardiologists performing embolization procedures should be familiar with available technologies as well as understand the underlying cardiac anatomy and pathophysiology. This article provides a comprehensive review of presently available embolization agents and technologies. Some of the technologies are used only by interventional radiologists but may be useful to pediatric cardiologists. Specific clinical applications in pediatric cardiology are also discussed with summary of current literature. With continue advancement in transcatheter technology and operator expertise, all unwanted vascular communication should be amenable to transcatheter embolization.
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Affiliation(s)
- James Y Sim
- Division of Pediatric Cardiology, Mattel Children's Hospital, UCLA, David Geffen School of Medicine, Los Angeles, California, 90095-1743, USA
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