Complications of Laparoscopic Adrenal Surgery
Kevin R. Loughlin in Complications of Urologic Surgery and Practice, 2007
Diaphragmatic injury leading to pneumothorax can also be caused during dissection of the superior aspect of the adrenal gland (40). Other causes include barotrauma caused by positive pressure ventilation as well as trocar placement above the 12th rib for a retroperitoneal approach (39). Signs of this include progressive tracheal deviation, decreased breath sounds unilaterally, hypotension, and increased ventilation pressures. When possible, it is confirmed with an upright chest X-ray (39). A pneumothorax of less than or equal to 20% can be managed expectantly. Positive pressure ventilation can cause a pneumothorax to expand, however, risking a tension pneumothorax and subsequent cardiovascular collapse. This is treated initially by placing a large bore needle at the midclavicular line in the second or third intercostal space followed by a chest tube placement in the fourth intercostal space. Furthermore, in the presence of a pneumothorax, nitrous oxide administration can expand it so this gas administration must be terminated (39). Pulmonary emboli have also been reported, requiring subsequent anticoagulation (41).
Chest Pain in Pregnancy: Non-Cardiac Causes
Tony Hollingworth in Differential Diagnosis in Obstetrics and Gynaecology: An A-Z, 2015
There is no reason to suppose that pneumothorax should be any more common in pregnancy with the exception of during labour, when repeated strenuous Valsalva manoeuvres could theoretically increase the risk of subpleural bleb (a small bulla-like structure) rupture, which is the main cause of spontaneous pneumothorax. The clinical diagnosis may be difficult, as physical examination reveals a hyper-resonant percussion note and significantly reduced breath sounds on the affected side only when the pneumothorax is of a sufficiently large size. Tracheal deviation in practice is often difficult to determine and only occurs with very large ‘tension’ pneumothoraces. Chest X-ray is essential to the diagnosis and should be reviewed by a skilled practitioner, as small pneumothoraces are easily missed.
Clinical Evaluation of the Thyroid Patient
John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie in Basic Sciences Endocrine Surgery Rhinology, 2018
A hard mass that is tender to touch is more likely to indicate malignancy or Riedel’s thyroiditis. Associated cervical lymphadenopathy and fixation to surrounding structures are also highly worrisome findings. Tracheal deviation can be elicited by examining the neck from the anterior aspect. The lower extent of a retrosternal goitre cannot be felt when the neck is examined from behind and the patient swallows. Percussion of the anterior chest wall to elicit the lower extent of a retrosternal goitre is largely of historical interest with the emergence of readily available cross-sectional imaging techniques. A large retrosternal goitre can cause venous congestion of the head, neck and upper torso. When venous congestion is impending, it can be elicited by asking the patient to raise both arms until they touch the side of their face, and holding that position for a minute (Pemberton’s sign). There may also be cyanosis and respiratory distress induced by this manoeuvre.9
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)).
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.
Related Knowledge Centers
- Bronchus
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- Lung
- Thoracic Cavity
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- Signs & Symptoms