A case of spontaneous pulmonary torsion following lobar pneumonia.
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ABSTRACT:
SUBMITTER: Seadler BD
PROVIDER: S-EPMC10580048 | biostudies-literature | 2023 Oct
REPOSITORIES: biostudies-literature
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A case of spontaneous pulmonary torsion following lobar pneumonia.
Seadler Benjamin D BD Thomas Arielle A Linsky Paul L PL
JTCVS techniques 20230703
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Project description: Not available
| S-EPMC10859645 | biostudies-literature
Project description:ObjectiveLobar torsion is a rare occurrence in which a portion of the lung is twisted on its bronchovascular pedicle. The vast majority are observed in the acute postoperative period often following right upper lobectomy. Spontaneous middle lobe torsion independent of pulmonary resection is exceptionally rarer; fewer than 15 cases have been recorded. We present an institutional case series of 2 patients postorthotopic liver transplantation who developed spontaneous middle lobe torsion due to large pleural effusions.MethodsWe provide the medical course as well as intraoperative techniques for our 2 patients along with a review of the literature.ResultsBoth patients in this case series underwent orthotopic liver transplant complicated postoperatively by a large pulmonary effusion. Patient one developed an abdominal hematoma requiring evacuation and repair, after which he developed progressive shortness of breath. Bronchoscopy revealed a right middle lobe obstruction; upon thoracotomy, 180-degree torsion with widespread necrosis was evident and the middle lobe was removed. He is doing well to date. Patient 2 experienced postoperative pleural effusion and mucus plugging; computed tomography revealed abrupt middle lobe arterial occlusion prompting urgent operative intervention. Again, the middle lobe was grossly ischemic and dissection revealed a 360-degree torsion around the pedicle. It was resected. He is doing well to date.ConclusionsAs the result of its rarity, radiographic and clinical diagnosis of spontaneous pulmonary lobar torsion is challenging; a high index of suspicion for spontaneous middle lobe torsion must be maintained to avoid delays in diagnosis. Prompt surgical intervention is essential to improve patient outcomes.
| S-EPMC10405155 | biostudies-literature
Project description:IntroductionAtelectasis of the right middle lobe following right upper lobectomy may result from lobar torsion, bronchial kink, or impacted mucus plug. Although clinical consequence of lobar torsion could be serious, differentiating it from bronchial kink is occasionally challenging.Presentation of caseA 39-year old man with non-small cell lung cancer of cT1aN0M0 stage IA underwent right upper lobectomy. On postoperative day 1, we identified middle lobe atelectasis on the chest X-ray and performed bronchoscopy, which showed an obstruction of the right middle lobe bronchus without mucoid impaction. We injected air using a bronchoscope to the middle lobe, which re-expanded it. However, on postoperative day 2, chest X-ray showed a slightly collapsed and opacified middle lobe. Although enhanced computed tomography showed a patent middle lobe pulmonary artery, we noticed that a staple placed in the horizontal fissure was in contact with the lower lobe, implying the possibility of lobar torsion. Rethoracotomy on postoperative day 2 revealed a 240° clockwise rotation of the congested middle lobe. Therefore, we performed simple detorsion. The patient was discharged 10days after rethoracotomy without further adverse events.DiscussionIn our case, patency of the pulmonary artery and temporary improvement of the atelectasis using a bronchoscopic aeration maneuver could not rule out the possibility of lobar torsion.ConclusionThe position of the staple placed on the interlobar fissure should be evaluated using computed tomography in postoperative middle lobe atelectasis. If the aeration maneuver for middle lobe atelectasis using bronchoscope fails, rethoracotomy should be considered.
| S-EPMC5650659 | biostudies-literature
Project description: Not available
| S-EPMC8311547 | biostudies-literature
Project description:BackgroundAcute fibrinous and organizing pneumonia (AFOP) is one of acute expiratory diseases, which occurs rarely with a difficult diagnosis. AFOP is related to an idiopathic cause or autoimmune disease, drug use, infection, cancer, or transplantation. Variation of treatment depends on different institutions. To date, no evidence shows that lobar lung transplantation is applied in an urgent situation such as AFOP.Case descriptionA 33-year-old female patient experienced fever, cough, and dyspnea four days prior to admission. She had no underlying health conditions. Initially, she received oxygen therapy and empiric antimicrobial treatment, but later developed pulmonary consolidation. Pathological examination confirmed the diagnosis of AFOP. Despite receiving standardized treatment involving extracorporeal membrane oxygenation (ECMO) and mechanical ventilation, the patient's respiratory function remained compromised. Consequently, an urgent lobar lung transplantation was performed. However, the patient encountered several challenges including carbapenem-resistant Pseudomonas aeruginosa pneumonia, exophytic granulation tissue, anastomotic stenosis, bronchopleural fistulae, anastomotic infections, septic shock, bacteremia, reperfusion syndrome, primary graft dysfunction, severe renal failure, and critical illness myopathy. Although the patient ultimately recovered and had a favorable survival outcome over 1-year post-discharge through multidisciplinary care, there are several key points to consider. Based on the findings from a systematic review, urgent transplantation may be a potential alternative treatment for AFOP. However, peri-transplantation programs should be enhanced, particularly regarding criteria selection, ECMO management, and the role of enhanced recovery after transplantation.ConclusionsThe case demonstrates the feasibility of bilateral lobar lung transplantation in patients with AFOP, especially in an urgent situation.
| S-EPMC10628395 | biostudies-literature
Project description:BackgroundPneumonia can be anatomically classified into lobar, lobular, and interstitial types, with each type associated with different pathogens. Utilizing artificial intelligence (AI) to determine the anatomical classifications of pneumonia and assist in refining the differential diagnosis may offer a more viable and clinically relevant solution. This study aimed to develop a multi-classification model capable of identifying the occurrence of pneumonia in patients by utilizing case-specific computed tomography (CT) information, categorizing the pneumonia type (lobar, lobular, and interstitial pneumonia), and performing segmentation of the associated lesions.MethodsA total of 61 lobar pneumonia patients, 60 lobular pneumonia patients, and 60 interstitial pneumonia patients were consecutively enrolled at our local hospital from June 2020 and May 2022. All selected cases were divided into a training cohort (n=135) and an independent testing cohort (n=46). To generate the ground truth labels for the training process, manual segmentation and labeling were performed by three junior radiologists. Subsequently, the segmentations were manually reviewed and edited by a senior radiologist. AI models were developed to automatically segment the infected lung regions and classify the pneumonia. The accuracy of pneumonia lesion segmentation was analyzed and evaluated using the Dice coefficient. Receiver operating characteristic curves were plotted, and the area under the curve (AUC), accuracy, precision, sensitivity, and specificity were calculated to assess the efficacy of pneumonia classification.ResultsOur AI model achieved a Dice coefficient of 0.743 [95% confidence interval (CI): 0.657-0.826] for lesion segmentation in the training set and 0.723 (95% CI: 0.602-0.845) in the test set. In the test set, our model achieved an accuracy of 0.927 (95% CI: 0.876-0.978), precision of 0.889 (95% CI: 0.827-0.951), sensitivity of 0.889 (95% CI: 0.827-0.951), specificity of 0.946 (95% CI: 0.902-0.990), and AUC of 0.989 (95% CI: 0.969-1.000) for pneumonia classification. We trained the model using labels annotated by senior physicians and compared it to a model trained using labels annotated by junior physicians. The Dice coefficient of the model's segmentation improved by 0.014, increasing from 0.709 (95% CI: 0.589-0.830) to 0.723 (95% CI: 0.602-0.845), and the AUC improved by 0.042, rising from 0.947 to 0.989.ConclusionsOur study presents a robust multi-task learning model with substantial promise in enhancing the segmentation and classification of pneumonia in medical imaging.
| S-EPMC10784088 | biostudies-literature
Project description:IntroductionThe aim of the study was to document and analyze a rare case of spontaneous retinal reattachment in a patient after successive unsuccessful vitreoretinal surgeries and to explore potential mechanisms contributing to this unexpected outcome.Case presentationA 61-year-old patient with a history of high myopia presented with a rhegmatogenous retinal detachment. After undergoing multiple vitreoretinal procedures, including pars plana vitrectomy with silicone oil tamponade, anatomical reattachment was not achieved, and the patient developed complex retinal detachment associated with myopic foveoschisis. Surprisingly, spontaneous reattachment of the retina was observed during routine follow-up. Comprehensive ocular examination, optical coherence tomography (OCT), and fundus autofluorescence imaging were utilized to confirm and document the retinal status. A thorough review of patient history, surgical reports, and postoperative imaging was performed to discern potential contributory factors. The patient's retina remained attached for 12 months after the last intervention without additional surgical or medical treatment. OCT images revealed normalization of retinal architecture with reestablishment of the foveal contour and partial recovery of visual acuity. No signs of proliferative vitreoretinopathy or other commonly associated complications were observed. Immunological assays and genetic testing ruled out systemic conditions that could predispose to spontaneous reattachment.ConclusionThis case represents a remarkable instance of spontaneous retinal reattachment without surgical intervention after multiple failed procedures. The mechanisms underlying this phenomenon remain speculative; however, they may involve delayed postoperative cellular proliferation and migration, subtle intraocular pressure changes, or unrecognized vitreous traction resolution. Further investigation into similar cases may provide insights into the natural history of retinal detachment and potential self-resolving dynamics, which could inform future therapeutic strategies.
| S-EPMC11521428 | biostudies-literature
Project description:A case of thyroid hemorrhage following laryngeal mask airway (LMA) intubation is described. A 42-year-old female presented to the emergency department (ED) with left neck pain after same day surgery with LMA intubation and was found to have a thyroid hemorrhage on imaging. The patient was ultimately discharged in stable condition with no acute interventions performed in the ED or by otorhinolaryngology (ENT). Airway implications and possible interventions based on isolated case reports are reviewed and discussed.TopicsThyroid hemorrhage, LMA complications.
| S-EPMC10332558 | biostudies-literature
Project description: Not available
| S-EPMC10874724 | biostudies-literature
Project description:BackgroundPulmonary sequestration is a mass of lung tissue disconnected from the bronchial tree, which derives its blood supply from one or more systemic vessels.Case presentation3 participants were diagnosed with intra-lobar pulmonary sequestration (IPS) where the diagnosis was obtained using CT-Scan. The diagnosis is also supported by the results of Thoracal CT-Angiography and other examinations.DiscussionThe CT-Scan image of the IPS thorax needs to be considered carefully, especially in low research settings.ConclusionThis report is expected to help in diagnosing IPS which is a rare case so that misdiagnosis can be minimized.
| S-EPMC8802003 | biostudies-literature