Thorax

胸部
  • 文章类型: Case Reports
    肺轻链沉积病是一种罕见的实体,其特征是免疫球蛋白在肺实质内沉积,具有不同于肺淀粉样变性的病理特征。这里,作者介绍了临床表现,协会,4例患者肺轻链沉积病的影像学特征,并讨论其与淀粉样变性的区别。本病例系列强调了CT时囊肿和结节的频繁存在。临床上,淋巴瘤和/或自身免疫性疾病通常相关。
    Pulmonary light chain deposition disease is a rare entity characterized by immunoglobulin deposition within the lung parenchyma with pathologic features distinct from pulmonary amyloidosis. Here, the authors present the clinical presentation, associations, and radiologic features of pulmonary light chain deposition disease in a series of 4 patients as well as discuss the distinctions from amyloidosis. The present case series highlights the frequent presence of both cysts and nodules at CT. Clinically, lymphoma and/or autoimmune disease are often associated.
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  • 文章类型: Journal Article
    计算机断层扫描(CT)图像重建技术的最新进展是深度学习图像重建(DLIR)算法。由于迭代重建(IR)技术的缺点,例如负图像纹理和非线性空间分辨率,DLIR正在逐渐取代它们。然而,DLIR在头部和胸部CT中的潜在应用需要进一步检查。因此,该研究的目的是回顾DLIR对辐射剂量(RD)的影响,图像噪声(IN),以及在头部和胸部CT检查中与IR和FBP进行比较的研究结果。
    我们在PubMed中进行了详细的搜索,Scopus,WebofScience,科克伦图书馆,和Embase查找2017年至2023年间使用DLIR进行头部和胸部CT检查报告的文章。使用系统审查和荟萃分析(PRISMA)指南的首选报告项目从入围研究中检索数据。
    在搜索的196篇文章中,共包括15篇文章。总共包括1292个样本量。14篇被评为高,1篇被评为中等质量。所有研究都将DLIR与IR技术进行了比较。5项研究比较了DLIR与IR和FBP。综述显示DLIR提高了智商,CT头部和胸部检查的RD和IN降低。
    DLIR算法显示,与IR和FBP相比,低剂量CT头部和胸部检查的智商明显增强,IN降低。DLIR显示出通过降低辐射风险和提高诊断准确性来增强患者护理的潜力。
    UNASSIGNED: The most recent advances in Computed Tomography (CT) image reconstruction technology are Deep learning image reconstruction (DLIR) algorithms. Due to drawbacks in Iterative reconstruction (IR) techniques such as negative image texture and nonlinear spatial resolutions, DLIRs are gradually replacing them. However, the potential use of DLIR in Head and Chest CT has to be examined further. Hence, the purpose of the study is to review the influence of DLIR on Radiation dose (RD), Image noise (IN), and outcomes of the studies compared with IR and FBP in Head and Chest CT examinations.
    UNASSIGNED: We performed a detailed search in PubMed, Scopus, Web of Science, Cochrane Library, and Embase to find the articles reported using DLIR for Head and Chest CT examinations between 2017 to 2023. Data were retrieved from the short-listed studies using Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines.
    UNASSIGNED: Out of 196 articles searched, 15 articles were included. A total of 1292 sample size was included. 14 articles were rated as high and 1 article as moderate quality. All studies compared DLIR to IR techniques. 5 studies compared DLIR with IR and FBP. The review showed that DLIR improved IQ, and reduced RD and IN for CT Head and Chest examinations.
    UNASSIGNED: DLIR algorithm have demonstrated a noted enhancement in IQ with reduced IN for CT Head and Chest examinations at lower dose compared with IR and FBP. DLIR showed potential for enhancing patient care by reducing radiation risks and increasing diagnostic accuracy.
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  • 文章类型: Journal Article
    慢性阻塞性肺疾病(COPD)是一种普遍存在的疾病,由于其高发病率和死亡率,给个人和社会带来了巨大的负担。膈肌是主要的呼吸肌,其功能直接影响COPD患者的生活质量和预后。本文旨在通过使用膈肌超声及其在COPD患者临床实践中的应用,对其结构测量和功能评估方法进行综述。因此,它可以为COPD患者膈肌功能的临床监测提供有价值的见解,促进早期临床干预和帮助恢复膈肌功能。
    Chronic Obstructive Pulmonary Disease (COPD) is a prevalent condition that poses a significant burden on individuals and society due to its high morbidity and mortality rates. The diaphragm is the main respiratory muscle, its function has a direct impact on the quality of life and prognosis of COPD patients. This article aims to review the structural measurement and functional evaluation methods through the use of diaphragmatic ultrasound and relevant research on its application in clinical practice for COPD patients. Thus, it serves to provide valuable insights for clinical monitoring of diaphragm function in COPD patients, facilitating early clinical intervention and aiding in the recovery of diaphragm function.
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  • 文章类型: Review
    背景:后纵隔平滑肌肉瘤是一种极其罕见的恶性间质瘤,无特殊临床症状,很容易与后纵隔的一些常见肿瘤混淆,影响临床医生首次诊断的准确性,延误患者的治疗。
    方法:我们报告了一名59岁女性,后纵隔占位病变。患者因胸背部疼痛误诊为腰肌及椎体病变,行保守治疗,但是她的症状没有明显改善,并且逐渐出现双下肢疼痛。胸部计算机断层扫描(CT)扫描显示左下肺椎旁间隙,并接受了标准的单孔径电视胸腔镜手术(VATS),经病理证实为后纵隔平滑肌肉瘤。
    结论:完全手术切除后纵隔平滑肌肉瘤可取得良好的临床效果。
    BACKGROUND: Posterior mediastinal leiomyosarcoma is an extremely rare malignant mesenchymal tumor with no special clinical symptoms, which is easily confused with some common tumors in the posterior mediastinum, affecting the accuracy of the first diagnosis by clinicians and delaying the treatment of patients.
    METHODS: We report a 59-year-old woman with a space-occupying lesion in the posterior mediastinum. The patient was mistakenly diagnosed with lumbar muscle or vertebral body lesions due to chest and back pain and underwent conservative treatment, but her symptoms did not improve significantly and she gradually developed pain in both lower limbs. Chest computed tomography (CT) scan indicated the left lower lung paraspinal space and underwent standard single-aperture video-assisted thoracoscopic surgery (VATS), which was pathologically confirmed as posterior mediastinal leiomyosarcoma.
    CONCLUSIONS: Complete surgical resection of posterior mediastinal leiomyosarcoma can achieve good clinical results.
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  • 文章类型: Review
    背景:Rosai-Dorfman病(RDD)是一种罕见的自限性组织细胞增生症,在儿童和年轻人中更为普遍。它通常表现为无痛性双侧巨大颈淋巴结病,但也可能扩展到淋巴结外部位。在2%的病例中发现胸内RDD。在影像学上区分纵隔RDD和胸腺瘤构成了挑战,强调诊断依赖于病理特征和免疫组织化学染色。
    方法:患者,男性,33岁,接受了肺部CT检查,显示前上纵隔有扩大的圆形软组织阴影,与一年前相比。手术切除切除了整个肿块,胸腺,和部分心包,确认RDD的病理学。使用第二代测试技术的基因检测确定了KRAS基因点突变。
    结论:目前尚无针对该疾病的既定治疗方案。然而,随着基因突变研究的进展,一种新的治疗途径正在出现:靶向治疗与手术干预相结合.
    BACKGROUND: Rosai-Dorfman Disease (RDD) is a rare self-limiting histiocytosis, more prevalent in children and young adults. It typically manifests as painless bilateral massive cervical lymphadenopathy but may also extend to extra-nodal sites, with intrathoracic RDD noted in 2% of cases. Distinguishing mediastinal RDD from thymoma on imaging poses challenges, underscoring the reliance on pathological features and immunohistochemical staining for diagnosis.
    METHODS: Patient, male, 33 years old, underwent lung a CT revealing an enlarged round soft tissue shadow in the anterior superior mediastinum, compared to a year ago. Surgical resection removed the entire mass, thymus, and part of the pericardium, confirming RDD on pathology. Genetic testing using second-generation testing technology identified a KRAS gene point mutation.
    CONCLUSIONS: No established treatment protocol currently exists for this disease. However, as genetic mutation research progresses, a novel therapeutic avenue is emerging: targeted therapy integrated with surgical interventions.
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  • 文章类型: Case Reports
    创伤管理是任何卫生系统的重要组成部分。它可以影响任何身体系统,因此,对广泛可能的介绍和后遗症的了解是至关重要的。系统性空气栓塞(SAE)是一种罕见的创伤表现,尽管它可能与显著的发病率和死亡率有关。我们介绍了一名23岁的绅士的案例,该绅士因SAE而对胸部造成了广泛的神经系统侮辱,并回顾了SAE的历史和提出的当代管理。
    Trauma management forms a significant component of any health system. It can affect any body system, and as such knowledge of the wide possible presentations and sequalae are critical. Systemic air embolism (SAE) is a rare presentation in trauma, though it can be associated with significant morbidity and mortality. We present the case of a 23-year-old gentleman with isolated penetrating trauma to the chest who developed widespread neurological insult as a result of SAE, and review historical and proposed contemporary management of SAE.
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  • 文章类型: Meta-Analysis
    背景:院外心脏骤停是一种危及生命的疾病,需要立即干预以增加生存前景。对这类病人进行心肺复苏的方法多种多样,通过手动胸部按压或机械胸部按压。因此,我们进行了系统评价和荟萃分析,以调查这些干预措施之间的差异.
    方法:PubMed,科克伦图书馆,和Scopus从成立到2023年5月进行了探索。此外,检索了相关研究的参考书目。随机对照试验的偏差工具的Cochrane风险,纽卡斯尔-渥太华量表,并利用非随机研究中的偏倚风险-I工具进行质量和偏倚风险评估.
    结果:这项定量合成包括24项研究,共有111,681名心脏骤停患者。总的来说,在自发循环的恢复之间没有观察到统计学上的显着差异,存活到出院,短期生存,和长期生存。然而,手动胸部按压与神经系统预后的有利性显著相关(OR:1.41;95%CI:1.07,1.84;P=0.01).
    结论:尽管策略之间没有重大差异,在机械胸外按压中观察到的复苏后神经系统结局较差,这表明需要在当前一系列机械装置中进行进一步创新和改进.然而,为了得出有效的结论,未来的高质量研究是必要的。
    BACKGROUND: Out-of-hospital cardiac arrest is a life-threatening condition that requires immediate intervention to increase the prospect of survival. There are various ways to achieve cardiopulmonary resuscitation in such patients, either through manual chest compression or mechanical chest compression. Thus, we performed a systematic review and meta-analysis to investigate the differences between these interventions.
    METHODS: PubMed, Cochrane Library, and Scopus were explored from inception to May 2023. Additionally, the bibliographies of relevant studies were searched. The Cochrane Risk of Bias Tool for Randomized Controlled Trials, Newcastle-Ottawa Scale, and the Risk of Bias in Non-Randomized Studies-I tools were utilized to perform quality and risk of bias assessments.
    RESULTS: There were 24 studies included within this quantitative synthesis, featuring a total of 111,681 cardiac arrest patients. Overall, no statistically significant differences were observed between the return of spontaneous circulation, survival to hospital discharge, short-term survival, and long-term survival. However, manual chest compression was associated with a significantly superior favorability of neurological outcomes (OR: 1.41; 95% CI: 1.07, 1.84; P = .01).
    CONCLUSIONS: Although there were no major differences between the strategies, the poorer post-resuscitation neurological outcomes observed in mechanical chest compression indicate the need for further innovation and advancements within the current array of mechanical devices. However, future high-quality studies are necessary in order to arrive at a valid conclusion.
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  • 文章类型: Journal Article
    动态数字射线照相(DDR)是一种高分辨率的射线照相成像技术,使用脉冲X射线发射来采集目标解剖区域的多帧电影循环。第一个DDR技术是立位胸部采集,但是最近发布了可以放置在患者床边的新便携式设备,显着扩大其潜在的应用,尤其是胸部检查。它提供有关不同解剖结构运动的解剖和功能信息,比如肺,胸膜,胸腔,还有气管.可以使用专用的后处理软件进一步分析原生图像,以提取定量参数,包括膈肌运动,自动投影的肺面积和面积变化率,与呼吸和运动相关的信号值变化的比色图,和肺灌注。动态诊断信息以及该技术在可移植性方面的显着优势,多功能性,和成本效益代表了一个潜在的游戏规则改变者的放射诊断和监测在病人的床边。DDR在日常临床实践中有多种应用,在这篇叙述性评论中,我们将专注于胸部成像,这是迄今为止文献中探讨的主要应用。然而,仍需要研究深入了解这种方法的临床影响。
    Dynamic digital radiography (DDR) is a high-resolution radiographic imaging technique using pulsed X-ray emission to acquire a multiframe cine-loop of the target anatomical area. The first DDR technology was orthostatic chest acquisitions, but new portable equipment that can be positioned at the patient\'s bedside was recently released, significantly expanding its potential applications, particularly in chest examination. It provides anatomical and functional information on the motion of different anatomical structures, such as the lungs, pleura, rib cage, and trachea. Native images can be further analyzed with dedicated post-processing software to extract quantitative parameters, including diaphragm motility, automatically projected lung area and area changing rate, a colorimetric map of the signal value change related to respiration and motility, and lung perfusion. The dynamic diagnostic information along with the significant advantages of this technique in terms of portability, versatility, and cost-effectiveness represents a potential game changer for radiological diagnosis and monitoring at the patient\'s bedside. DDR has several applications in daily clinical practice, and in this narrative review, we will focus on chest imaging, which is the main application explored to date in the literature. However, studies are still needed to understand deeply the clinical impact of this method.
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  • 文章类型: Review
    A right aortic arch is an anomaly of prenatal development characterized by location of aortic arch to the right from tracheal-esophageal complex. This variant of anatomy is usually asymptomatic and diagnosed accidentally. We performed open upper lobectomy for cancer of the upper lobe of the right lung in a patient with aortic arch dextraposition. Classical right-sided upper lobectomy in patients with right aortic arch is associated with certain difficulties. The most difficult objective is total excision of lymph nodes because trachea is hidden under aortic arch. A specific complication may be postoperative hoarseness associated with iatrogenic damage to the right recurrent laryngeal nerve.
    Правая дуга аорты — аномалия внутриутробного развития, которая характеризуется расположением дуги аорты справа от трахеоприщеводного комплекса. Данный вариант анатомии чаще всего не имеет клинической картины и обнаруживается случайно при диагностике по другим причинам. Нами была выполнена открытая верхняя лобэктомия по поводу рака верхней доли правого легкого у пациента с декстрапозицией дуги аорты. Необходимо отметить, что выполнение классической верхней лобэктомии справа у пациентов с правой дугой аорты сопряжено с определенными трудностями. Наиболее сложная задача заключается в радикальном иссечении лимфоузлов ввиду того, что трахея скрыта под дугой аорты. Специфическим осложнением может являться послеоперационная охриплость, связанная с повреждением правого возвратного гортанного нерва из-за его расположения в операционном поле.
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  • 文章类型: Journal Article
    在过去的20年里,科学文献和对胸部/肺部超声(LUS)的兴趣呈指数增长。解释混合的解剖和人工图片确定需要提出一种新的人工制品和标志命名法以简化学习,传播,和实现这种技术。这篇综述的目的是收集和分析胸部超声病史中报告的关于正常肺的不同体征和伪影,胸膜病理学,和肺巩固。通过回顾文献中报道的这些伪影和体征的可能的物理和解剖学解释,这项工作旨在提出AdET(AccademiadiEcografiaToracica)命名法建议,并在已发表的研究之间建立秩序。
    Over the last 20 years, scientific literature and interest on chest/lung ultrasound (LUS) have exponentially increased. Interpreting mixed-anatomical and artifactual-pictures determined the need of a proposal of a new nomenclature of artifacts and signs to simplify learning, spread, and implementation of this technique. The aim of this review is to collect and analyze different signs and artifacts reported in the history of chest ultrasound regarding normal lung, pleural pathologies, and lung consolidations. By reviewing the possible physical and anatomical interpretation of these artifacts and signs reported in the literature, this work aims to present the AdET (Accademia di Ecografia Toracica) proposal of nomenclature and to bring order between published studies.
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