Pediatric vascular trauma
David E. Wesson, Bindi Naik-Mathuria in Pediatric Trauma, 2017
According to the EAST Practice Management Guidelines Work Group for the Diagnosis and Management of Blunt Aortic Injury, a CXR is a good screening tool to determine whether further investigation is warranted [48]. Significant findings indicative of aortic injury include a widened mediastinum, apical cap, obscured aortic knob, deviation of the left mainstem, bronchus or nasogastric tube, massive hemothorax, and opacification of the aortopulmonary window [33, 38, 48]. In an adult a widened mediastinum is defined as a width greater than 8 cm, a mediastinal/chest width ratio of >0.38, or a physician’s opinion that the mediastinum is widened. A suspicious CXR should be followed up with a diagnostic test such as a chest CTA or angiography as seen in Figures 13.3 through 13.5.
Surgical Emergencies
Anthony FT Brown, Michael D Cadogan in Emergency Medicine, 2020
Perform a CXR and look for the following signs of aortic rupture: Widened mediastinum (≥8 cm on a 1 m supine anteroposterior X-ray): 10% of these patients will have a contained aortic rupture confirmedother causes of a widened mediastinum include a mediastinal haematoma from sternal fracture, lower cervical or thoracic spine fracture, oesophageal injury, local venous oozing and projection artefact.Blurred aortic outline with obliteration of the aortic knuckle.Left apical cap of fluid in the pleural space and a left haemothorax.Depressed left main stem bronchus.Displacement of the trachea to the right.Displacement of a nasogastric tube in the oesophagus to the right.
Cardiac disease
Daryl Dob, Griselda Cooper, Anita Holdcroft, Philip Steer, Gwyneth Lewis in Crises in Childbirth Why Mothers Survive, 2018
The clinical manifestations of acute aortic dissection are well documented and reflect the site of the tear.10 Nearly all of them present with sudden-onset severe back or chest pain that is classically described as stabbing or tearing. Aortic valve involvement that produces regurgitation may occur in up to 50% of cases, and coronary artery flow may be compromised. Obstruction of branches of the aorta can produce organ ischaemia. The diagnosis of acute aortic dissection is frequently missed at first presentation, as in this case and many others reported to the CEMD. However, delay in diagnosis is not always associated with poor outcome.11 Thorough investigation is required to exclude other possible causes of severe chest pain, such as pulmonary embolism and myocardial infarction. Chest X-ray shows a widened mediastinum in 50% of cases. Concerns about exposure to radiation are overstated when dealing with potentially life-threatening situations. ECG changes are non-specific, most commonly involving ST segments and T-waves. Transthoracic echocardiography is more useful, but may still miss 20% of cases due to technical limitations. These are overcome using trans-oesophageal echocardiography, although an experienced operator is required. Alternatively, CT or MRI scanning may aid diagnosis.12
Pembrolizumab in the treatment of refractory primary mediastinal large B-cell lymphoma: safety and efficacy
Published in Expert Review of Anticancer Therapy, 2021
Vincent Camus, Camille Bigenwald, Vincent Ribrag, Julien Lazarovici, Fabrice Jardin, Clémentine Sarkozy
At the clinical level, PMBL can occur at all ages but is diagnosed more frequently in young adults, between 25 and 40 years (average age of 37 years at diagnosis), with a male (M)/female (F) sex ratio of 1:2. The disease most often develops as large tumor masses (often larger than 10 cm in diameter and referred as ‘bulky’) in the anterior mediastinum with a rapidly progressing evolution pattern. In 1998, the Adult Lymphoma Study Group (GELA) reported a large cohort [23] of PMBL showing a majority of young women with good performance status, elevated LDH, predominance of localized stage, rare extra-nodal (3% versus 17% in DLBCL), and bone marrow invasion, but frequent contiguous regional organs involvement (pleura, pericardium, lung). Thrombotic complications of superior vena cava obstruction are common due to bulky mediastinal masses and may affect 30–40% of patients at diagnosis [24]. This complication impairs survival, justifying usage of antithrombotic prophylaxis in case of bulky disease. In conclusion, the clinical presentation of PMBL is closely related to NS-cHL. Numerous biological data (described below) also underline the genetic proximity between cHL and PMBL.
Diagnosis and management of hurthle cell carcinoma, a rare case report
Published in Acta Oto-Laryngologica Case Reports, 2020
Marlinda Adham, Ferucha Moulanda, Agnes Harahap, Krishna Pandu, Em Yunir
Eight days postoperative patient showed no sign of hypocalcemia with serum calcium 9.2 mg/dL (normal range: 8.8–10.2 mg/dL), but patient experienced cough and hoarseness that is not getting better. Chest X-ray examination showed bilateral pleural effusion and appearance of mediastinum mass. Thoracentesis with ultrasound guidance was performed by Pulmonologist and 170 ml of clear fluid was obtained. The fluid analysis showed no microorganisms nor bacteria found, white blood cells 8–10/hpf, epithelial 0/hpf and negative smear. The patient was discharged and received Levothyroxin 100 mg once daily. Vocal cord examination in 2 weeks post-surgery using flexible fiber optic showed right vocal cord paresis, yet the patient had no symptoms of coughing, choking, shortness of breath, and worsened hoarseness. After 1-month evaluation, there was no improvement in cough symptoms. Chest X Ray evaluation showed suspicious residual mass in the mediastinum. The result from the thoracic surgeon and chest CT-scan excluded tumor mass and showed hematoma, therefore periodic chest X-ray investigation was done. The patient was diagnosed with congestive heart failure (CHF) class II and atrial fibrillation. She received Bisoprolol 5 mg once daily, Lasix 40 mg one daily and Warfarin 2 mg once daily from the Cardiologist. She was planned for periodic thyroid function evaluation, examination of thyroglobulin followed by 131I whole-body scintigraphy and chest X-ray for follow-up of postoperative conditions and evaluation of the possibility of recurrence.
T-cell lymphoblastic lymphoma involving the ocular adnexa: report of two cases and review of the current literature
Published in Orbit, 2019
Lucy Sun, Alan H. Friedman, Rand Rodgers, Matthew Schear, Giovanni Greaves, Kathryn B. Freidl
The mediastinum is a common site of initial disease involvement and relapse. Given that the majority of patients present with large mediastinal masses, a frequent obstacle to complete remission is residual mediastinal tumors after induction therapy. The routine use of MRT has not been well supported. 5 Some suggest a value in consolidative MRT to treat residual mediastinal disease in adults after induction therapy; however, there is no well-conducted research. 22 MRT in children did not demonstrate a benefit in long-term outcome but rather showed an increase risk of long-term sequelae such as the development of cardiac diseases, radiation pneumonia, and secondary malignancies. 26,27 Therefore, MRT has been eliminated in the pediatric treatment protocols.
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