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Published in Andrew Schofield, Paul Schofield, The Complete SAQ Study Guide, 2019
Andrew Schofield, Paul Schofield
It is vital to check the trachea is central in every patient who presents acutely unwell. If tracheal deviation is noted with movement away from the side with breath sounds, then the cause can either be a massive haemothorax or tension pneumothorax. These conditions can lead to a patient becoming suddenly unwell. A tension pneunomothorax should be identified clinically and managed by urgent needle decompression before any imaging is organised. A massive haemothorax should be managed by draining the haemothorax. Even though a haemothorax is a ‘B’ (breathing) problem, a chest drain should ideally should be performed following IV access and fluids/blood given, as a large volume of fluid can be lost.
Torso trauma
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
The clinical presentation is dramatic. The patient is increasingly restless with tachypnoea, dyspnoea and distended neck veins (similar to pericardial tamponade). Clinical examination may reveal tracheal deviation; this is a late finding and is not necessary to clinically confirm diagnosis. There will also be hyper-resonance and decreased or absent breath sounds over the affected hemithorax. Tension pneumothorax is a clinical diagnosis and treatment should never be delayed by waiting for radiological confirmation (Figure27.3).
The normal chest X-ray
Published in Lt Col Edward Sellon, David C Howlett, Nick Taylor, Radiology for Medical Finals, 2017
‘In summary, there is a severe right tracheal deviation with mediastinal shift and complete collapse of the right lung. A possible cause for this is a central obstructing lung malignancy and the patient should be reviewed urgently by the respiratory team with a view to further investigation and bronchoscopy.’
Primary Pleuropulmonary Synovial Sarcoma: Report of Two Cases and a Comprehensive Review of the Literature
Published in Cancer Investigation, 2022
Neda Khalili, Elham Askari, Nastaran Khalili, Aboulghasem Daneshvar-Kakhki, Makan Sadr, Sara Haseli, Mihan Pourabdollah Toutkaboni
A 24-year-old non-smoker woman presented to the hospital with productive cough, shortness of breath, chest pain, and one episode of mild hemoptysis. These symptoms had initiated three months prior to admission. Her past medical history was unremarkable and she did not recall exposure to chemicals or radiation in the past. Physical examination was remarkable for tracheal deviation to the left and decreased breath sounds over the left side of the chest on auscultation. All laboratory tests were within normal limits. On chest X-ray, white-out of the left hemithorax with a large solitary mass was seen (Figure 1(A)). Chest computed tomography (CT) scan showed obstruction of the left main bronchus and a large mass-like collapse consolidation in the left lung (Figure 1(B)). Abdominal CT scan and ultrasound detected no abnormal finding. Bronchoscopy demonstrated an endobronchial mass in the left main bronchus. Transbronchial lung biopsy (TBLB) was performed and microscopic examination of the biopsy specimens revealed malignant round to spindle-shaped cells with extensive necrosis. Mitotic figures were about 6 mitoses per 10 high-power fields (HPF) (Figure 2). The patient underwent left pneumonectomy and a well-circumscribed solid mass measuring 9.5 × 8.5 × 8 cm in size was resected (Figure 3). No invasion to the visceral pleura was observed.
Non-Neural (S-100 Negative) Bronchial Granular Cell Tumor Causing Acute Respiratory Failure
Published in Fetal and Pediatric Pathology, 2020
Stephanie Y Chen, Arhanti Sadanand, Patrick A Dillon, Mai He, Louis P Dehner, David S Leonard
A previously healthy 9-year-old female with a history of pectus excavatum presented to a local hospital with shortness of breath and nausea. Chest radiograph demonstrated right middle/lower lobe opacification, thought to be pneumonia, and she was placed on an oral antibiotic. However, she continued to have an increasing oxygen requirement despite antibiotics, and a chest computed tomography (CT) demonstrated a 3.7 cm endobronchial lesion within the right upper bronchus with rightward tracheal deviation (Figure 1). She developed respiratory failure, requiring intubation within two days of presentation and was transferred to our institution. Direct laryngoscopy and bronchoscopy revealed an obstructing endobronchial mass arising from the right upper lobe bronchus, occluding the middle and inferior lobar bronchi. Debulking cleared the middle and lower lobe bronchi allowing extubation on postoperative day one to high-flow nasal cannula and eventual weaning to room air.
CT-based quantitative evaluation of the efficacy after radiofrequency ablation in patients with benign thyroid nodules
Published in International Journal of Hyperthermia, 2020
Yangsean Choi, So-Lyung Jung, Jinhee Jang, Na-Young Shin, Kook-Jin Ahn, Bum-soo Kim
CT images with fully visible thyroid glands were reviewed. Before RFA, neck CT scans were acquired for the following reasons: 1) identification of other cervical lesions, 2) assessment of the extent of intrathoracic thyroid nodules, and 3) evaluation of the anatomical relationship between the thyroid nodules and the esophagotracheal groove. The volume of the entire thyroid gland was delineated while the cross-sectional tracheal area was measured at the narrowest level. Tracheal deviation from the midline was measured as the distance between the tracheal midline and a perpendicular line drawn along the midline of the cervical spinal process (Figure 1(a)). The ratio of the anteroposterior(AP)/transverse diameter of the trachea (tracheal AP/transverse diameter ratio) was also measured between RFA sessions (Figure 1(b)). Finally, the anterior neck angle was measured at the point where the surface neck contour showed maximum anterior protrusion (Figure 1(c)).