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Lung Consilidation, Ground Glass Shadowing, Obstructive Emphysema, Collateral Air-draft, Mucocoeles, patterns of Collapse, Lung Torsion and Herniation.
Published in Fred W Wright, Radiology of the Chest and Related Conditions, 2022
These thin structures consist of double layers of parietal pleura and some intervening connective tissue, including sometimes small lymph nodes. They arise from the lower pulmonary hila, at the level of the inferior pulmonary veins passing into the mediastinum from the adjacent lower lobes. They extend downwards from this position to end, either (a) in a free border (the 'incomplete' form) or (b) by reflecting onto the superior surface of the diaphragm ('complete' form). Medially the ligaments reflect from the mediastinum exterior to the plane of the oesophagus and laterally fuse with the visceral pleura over the lower lobes. Thus each ligament 'binds' the lower lobe towards the hilum and helps prevent torsion or lateral displacement with a pleural effusion or pneumothorax. It also divides the mediastinal pleura below the lung hilum into anterior and posterior compartments. The small lymph nodes which may be found within the ligaments are known as the inferior pulmonary ligament nodes.
Minimally Invasive Tricuspid Valve Surgery
Published in Theo Kofidis, Minimally Invasive Cardiac Surgery, 2021
Christos Alexiou, Theo Kofidis
Chest: A 5–7-cm incision is made lateral to the nipple in males and in the mammary fold in females over the fourth or fifth intercostal space (ICS). The midpoint of the entire sternum is a useful external marker for the identification of the fourth space, which provides good exposure for both mitral and tricuspid valves. The right lung is deflated and the right chest entered in the fourth intercostal space (Figure 10.3 and Figure 10.5). In order to facilitate exposure of the chest cavity and to avoid rib fracture the parietal pleura is further incised 6 cm anteriorly and 6 cm posteriorly.
Pleural tumours
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
It is important for the radiologist to known something of the macroscopic appearances of MPM since it is these that really explain the imaging appearances. In the early stages of disease, plaques of tumour or nodules are seen along the parietal pleura (28,29). Over time, the tumour spreads locally, giving rise to a diffuse pleural involvement which, in typical cases, encases the lung. In patients with such advanced disease, the pleura is generally covered by a hard, ivory-white tumour, and the pleural layers are generally inseparable. Extension of tumour into fissures and large cystic spaces (secondary to localized areas of necrosis) is relatively common. Very occasionally, and almost always as a serendipitous diagnosis, MPM may also be entirely localized (30), offering such patients the hope of curative resection (Figure 7.2). As MPM progresses, the tumour can extend contiguously into the chest wall, lung parenchyma, mediastinum, and diaphragm. As an aside, there is a tendency for MPM to seed along biopsy tracts and drain insertion sites.
Trans-thoracic versus retropleural approach for symptomatic thoracic disc herniations: comparative analysis of 94 consecutive cases
Published in British Journal of Neurosurgery, 2021
Christian Soda, Franco Faccioli, Nicolò Marchesini, Umberto M. Ricci, Marco Brollo, Luciano Annicchiarico, Cristiano Benato, Ivan Tomasi, Giampietro P. Pinna, Marco Teli
In TTA, a wide incision along the rib overlying the affected disc space was made; the rib was then resected 10–15 cm laterally to the tip of the transverse process. The parietal pleura was incised, the wound retracted using a Finochietto rib spreader and the lung collapsed and packed. Care was taken to preserve the intercostal nerve and vessels. To confirm the correct level a needle was inserted into the target disc space under fluoroscopy and the level counted in a cranio-caudal or caudo-cranial sequence. A wedge-trench osteotomy allowed access to the spinal canal above and below the area of cord compression. The osteotomy was limited to one quadrant of both adjacent vertebrae to reduce the risk of subsequent instability. Partial or complete drilling of the caudal pedicle was occasionally necessary. The posterior annulus and posterior longitudinal ligament were dissected off the dura under microscopic vision and the TDH removed to obtain a central decompression, up to the level of the contralateral pedicle.
Spontaneous pneumothorax secondary to chronic cavitary pulmonary histoplasmosis
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
Spontaneous pneumothorax is a rare presentation of chronic cavitary pulmonary histoplasmosis. There are only two other similar case reports upon literature search, making this a relatively unique case [7,8]. The first case report, published in 1956 from Vanderbilt University Hospital, was a 31-year-old female who initially developed constitutional symptoms and was found to have nodular infiltrations in the left lung apex [7]. Pulmonary tuberculosis was suspected and was to be further evaluated, but patient was lost to follow-up. She presented again 2 years later while pregnant. After the birth of her first child, which was uncomplicated, she developed worsening respiratory and constitutional symptoms, including increased productive cough and unintentional weight loss. Her condition progressively worsened over subsequent years without treatment, and she developed sudden onset left-sided chest pain with worsened dyspnea. Evaluation with chest x-ray showed a left-sided pneumothorax with adhesions to the parietal pleura, as well as emphysema of the lungs. She experienced another spontaneous right-sided pneumothorax roughly 1 year later. This case shows some similarities with our patient, including the adhesions noted to the parietal pleura, as well as emphysema of the lungs. Whereas the patient in this case had years of worsening respiratory symptoms, constitutional symptoms, and histoplasmosis diagnosis prior to onset of her pneumothoraces, our patient did not have any constitutional symptoms or respiratory complaints prior to the development of her pneumothorax.
Application of Narrow-Band Imaging thoracoscopy in diagnosis of pleural diseases
Published in Postgraduate Medicine, 2020
Xinglu Zhang, Feng Wang, Zhaohui Tong
Pleural effusion is a common syndrome where the identification of its etiology may be challenging. The advent of thoracoscope makes it a reality to let physician views the pleural cavity, to visually guide the biopsy of abnormal parietal pleura, to place the chest tube. So it has become a routine tool for diagnosing unknown pleural effusions when repeated thoracocentesis and needle biopsy fail. Sometimes, it fails due to the nonspecific appearance of pleural lesions under the WL. A study revealed that conventional thoracoscopy was unable to find macroscopic abnormalities in 8% to 10% of malignant cases with pleural effusion while its cytological examination of hydrothorax was positive [1]. NBI, first applied to thoracoscopy in 2009, highlights mucosal structures and vessels [2]. It has been applied in many diagnostic fields such as gynecology, gastroenterology, laryngology, and stomatology. However, there was also controversy about its value during thoracoscopy in diagnosing the pleural diseases. In this study, we chose an NBI system (Olympus) as a simple, economic, and safe procedure in thoracoscopy. We focused on the endoscopic findings of various pleural diseases to evaluate the diagnostic value of NBI.