Search Results (85)

Background: Flail chest (FC) injuries are multiple adjacent segmental rib fractures, commonly associated with a high complication and mortality risk. Recent evidence suggests that the early surgical stabilization of FC injuries is beneficial for restoring breathing mechanics. However, little is known about the effects on lung volumes when invasive ventilation is performed after surgery. Methods: This retrospective study included multiple trauma (MT) patients operatively treated for an FC injury between 2011 and 2024. The indication for surgery was based on a computed tomography (CT) proof of an FC, objectifiable paradoxical breathing, and prolonged weaning. All patients treated used a single osteosynthesis system. Lung volumes were manually measured in preoperative and postoperative CT scans of the thorax in the thinnest CT reconstructions available. The primary outcomes of interest were the changes in the lung volumes following surgical stabilization of the FC. Results: During this study, 21 patients (90.48% male) were operatively treated for their FC injury. All patients had been affected by high-energy trauma. The corresponding median Injury Severity Score (ISS) was 26 (IQR 17.5, 33). Patients suffered 7 (IQR 6, 10) and 6 (IQR 2, 9) fractured ribs of the left and right hemithorax, respectively. Three (IQR 0, 3) and two (IQR 0, 3) ribs of the left and right hemithorax, respectively, were stabilized at 7 (IQR 2, 18) days post admission. There were no significant changes in the lung volumes comparing preoperative and postoperative CT scans. Conclusions: As this study did not detect CT volume changes comparing preoperative and postoperative scans, CT scans following surgery may not qualify for an objective measurement of the surgical effectiveness regarding lung volume restoration in the short-term follow-up. Long-term changes in CT-measured lung volume changes need to be evaluated to prove an objective surrogate parameter for surgical effectiveness regarding the restoration of the thorax integrity. Full article

Background/Objectives: Paraneoplastic syndromes (PNS), characterized by a large diversity of symptoms, may sometimes be the first clinical feature of a severe underlying disorder such as cancer. Methods: We report the case of a middle-aged male patient with no significant previous medical history, a nonsmoker or alcohol heavy drinker, complaining about generalized, recently onset itch. Given no reasonable explanation of pruritus after dermatological consultation and the unsatisfactory response to treatment, the patient was referred to gastroenterology with the suspicion of a cholestatic liver disease. Results: The abdominal ultrasound examination revealed gallstones and no dilation of the biliary tree. Numerous tests were run and came out negative, except for the slight elevation of C-reactive protein, mild dyslipidemia, and positivity for H. pylori antigen. The gut microbiota displayed important dysbiosis with a significant increase in the histamine-producing bacteria. Given this chronic pruritus became suspicious, thorax and abdominal CT were recommended and performed soon after. A large right mid-thoracic tumor image was found. Bronchoscopy came out negative for a tumor. After the CT-guided biopsy, the tumor turned out not to be a lymphoma, but a non-small cell lung carcinoma (NSCLC). Conclusions: Chronic pruritus was not associated with cholestasis in a patient with gallstone disease, but rather with a PNS, as the first clinical manifestation of NSCLC, triggering many diagnostic and therapeutic challenges. Full article

Lung cancer is a prevalent malignant disease with the highest mortality rate among oncological conditions. The assessment of its clinical TNM staging primarily relies on contrast-enhanced computed tomography (CT) of the thorax and proximal abdomen, sometimes with the addition of positron emission tomography/CT scans, mainly for better evaluation of mediastinal lymph node involvement and detection of distant metastases. The purpose of TNM staging is to establish a universal nomenclature for the anatomical extent of lung cancer, facilitating interdisciplinary communication for treatment decisions and research advancements. Recent studies utilizing a large international database and multidisciplinary insights indicate a need to update the TNM classification to enhance the anatomical categorization of lung cancer, ultimately optimizing treatment strategies. The eighth edition of the TNM classification, issued by the International Association for the Study of Lung Cancer (IASLC), transitioned to the ninth edition on 1 January 2025. Key changes include a more detailed classification of the N and M descriptor categories, whereas the T descriptor remains unchanged. Notably, the N2 category will be split into N2a and N2b based on the single-station or multi-station involvement of ipsilateral mediastinal and/or subcarinal lymph nodes, respectively. The M1c category will differentiate between single (M1c1) and multiple (M1c2) organ system involvement for extrathoracic metastases. This review article emphasizes the role of radiologists in implementing the updated TNM classification through CT imaging for correct clinical lung cancer staging and optimal patient management. Full article

Background/Objectives: To evaluate the detectability of iodine in mediastinal lesions with photon counting CT (PCCT) compared to conventional CT (CCT) in a phantom study. Methods: Mediastinal lesions were simulated by five cylindrical inserts with diameters from 1 to 12 mm within a 10 cm solid water phantom that was placed in the mediastinal area of an anthropomorphic chest phantom with fat ring (QRM-thorax, QRM L-ring, 30 cm × 40 cm cross-section). Inserts were filled with iodine contrast at concentrations of 0.238 to 27.5 mg/mL. A clinical chest protocol at 120 kV on a high-end CCT (Somatom Force, Siemens Healthineers) was compared to the same protocol on a PCCT (Naeotom Alpha, Siemens Healthineers). Images reconstructed with a soft tissue kernel at 1 mm thickness and a 512 matrix served as a reference. For PCCT, we studied the result of reconstructing virtual mono-energetic images (VMIs) at 40, 50, 60 and 70 keV, reducing exposure dose up by 66%, reducing slice thickness to 0.4 and 0.2 mm, and increasing matrix size from 512 to 768 and 1024. Two observers with similar experience independently determined the smallest insert size for which iodine enhancement could still be detected. Consensus was reached when detectability thresholds differed between observers. Results: CTDIvol on PCCT and CCT was 3.80 ± 0.12 and 3.60 ± 0.01 mGy, respectively. PCCT was substantially more sensitive than CCT for detection of iodine in small mediastinal lesions: to detect a 3 mm lesion, 11.2 mg/mL iodine was needed with CCT, while only 1.43 mg/mL was required at 40 keV and 50 keV with PCCT. Moreover, dose reduced by 66% resulted in a comparable detection of iodine between PCCT and CCT for all lesions, except 3 mm. Detection increased from 11.2 mg/mL on CCT to 4.54 mg/mL on PCCT. A matrix size of 1024 reduced this detection threshold further, to 0.238 mg/mL at 40 and 50 keV. For 5 mm lesions, this detection threshold of 0.238 mg/mL was already achieved with a 512 matrix. Very small, 1 mm lesions did not profit from PCCT except if reconstructed with a 1024 matrix, which reduced the detection threshold from 27.5 mg/mL to 11.2 mg/mL. Reduced slice thickness decreased iodine detection of 3–12 mm lesions but not for 1 mm lesions. Conclusions: Iodine detectability with PCCT is at least equal to CCT for simulated mediastinal lesions of 1–12 mm, even at a dose reduction of 66%. Iodine detectability further profits from virtual monoenergetic images of 40 and 50 keV and increased reconstruction matrix. Full article

Background: Repeat cardiac operations carry increased risk of morbidity and mortality due to adhesions between the heart and adjacent structures, which increase the complexity of redo sternotomy and the potential for reentry injury. Preoperative CT imaging has been associated with a decreased risk for reentry injury. Methods: We present a series of two cases of complex thorax reentry in which a stepwise sternotomy approach enabled safe reentry. Results: Both patients tolerated the procedure well, with successful orthotopic heart transplantation in each case. A thorough review of the preoperative CT imaging enabled surgical planning to safely navigate structures at high risk for reentry injury. Conclusions: This series demonstrates the utility of two-stage sternotomy in complex thorax reentry cases and the importance of preoperative imaging for the safe surgical planning of such an approach. Full article

Deep neck infection is a pathology at the border of two specialties, otorhinolaryngology and maxillofacial surgery, and represents a medico-surgical emergency. In terms of its evolution, it can extend to the level of the thorax and result in mediastinitis, with difficult evolution and poor prognosis. The aims of this scoping review are to present the etiology, bacteriology, clinical manifestations, and diagnostics, as well as treatment, in light of the research published in the last 5 years on deep neck infection associated with descending necrotizing mediastinitis. The most common primary sources of deep neck infection are odontogenic and tonsillar. The other sources that are involved in deep neck infection are salivary glands, foreign bodies, malignancies, and iatrogenic causes after endoscopic maneuvers. The bacteriologic aspect is polymorphic, including both aerobic and anaerobic species. Complications that may appear include jugular vein thrombosis, airway obstruction, acute respiratory distress syndrome, sepsis, and disseminated intravascular coagulation. Timely diagnosis is important for ensuring the positive evolution of a deep neck infection. A CT scan is important for characterizing the nature of a deep neck lesion and identifying the spaces involved, and this method represents the gold standard for diagnosis of these lesions. Following the establishment of a definitive diagnosis, antibiotic therapy is initiated empirically, and is modified according to bacteriological exam results. The administration of antibiotics is an essential part of the treatment strategy for patients with a deep neck infection. Based on CT results, different surgical methods are applied under general anesthesia. The surgical strategy involves opening and draining the cervical spaces and debriding the necrotic tissue. In the cases of odontogenic causes, drainage and extraction of the infected teeth are performed. It is especially important to follow up on the dynamic progression of the patient. In the management of a deep neck infection associated with descending necrotizing mediastinitis, a multidisciplinary team is necessary. Full article

This study aimed to develop a scoring system to predict mortality risk in hospitalised COVID-19 patients using clinical, laboratory, and imaging data. A retrospective analysis was conducted at a single centre, including 325 patients admitted between March 2020 and December 2021. The data collected included patient demographics, laboratory results, medications, and thoracic CT images. Pulmonary involvement was assessed using the CO-RADS classification, while coronary artery calcification (CAC), aortic calcification, and epicardial adipose tissue were evaluated with specific scoring methods. Mortality predictors were identified through univariate and multivariate Cox proportional hazards models. The key mortality predictors identified in this study were an age above 67 years, elevated high-sensitivity troponin levels, a heart rate greater than 100 bpm, an oxygen saturation below 90%, the presence of CAC and aortic calcification, low haemoglobin levels, and the absence of acetylsalicylic acid (ASA) use at admission. The developed HEARRT-C scoring system demonstrated a strong predictive ability, with an area under the curve (AUC) of 0.91, showing 81% sensitivity and 86% specificity for predicting mortality. This study concluded that the HEARRT-C score is an effective tool for early risk stratification in COVID-19 patients, which may guide management decisions and emphasise the importance of cardiovascular factors and the potential protective role of ASA. Full article

Introduction: In this single-center retrospective analysis, we present case data and insights gathered over the past eight years. Additionally, we computed postnatal, pre-therapy lesion-to-lung ratios of Congenital Pulmonary Airway Malformations (CPAMs) to retrospectively assess potential outcome prediction using lesion-to-lung ratios. Methods: Data were collected between 2015 and 2022. Information such as chosen therapy, surgical duration, postoperative hospital stay, and follow-up was obtained from electronic case records. Pre-therapy pulmonary lesion volumes [mm³], lesion-to-ipsilateral-lung ratio, and lesion-to-both-lungs ratio of CPAMs were retrospectively calculated from computed tomography images using specialized software. Results: Of the 40 identified cases, 27 had CPAM, 7 had pulmonary sequestration, 4 had bronchogenic cysts, and 2 had congenital lobar emphysema. Histological examinations of resected specimens revealed no malignancy. For CPAMs, the median surgery age was 7 months (interquartile range (IQR): 0.45–11), averaging 9.54 ± 15.01 months. The CPAM surgery lasted on average 126 ± 53 min (median 124 min (IQR 108–172)). The mean length of hospital stay was 6 ± 1.41 days for thoracoscopic surgery and 17 ± 18.23 days for open surgery. No clear link was found between the lesion ratio and management choice or surgical length. Notably, larger lesions tended to result in longer postoperative stays. CPAMs with a lesion-to-ipsilateral-lung ratio of ≤0.11 were asymptomatic. Discussion and Conclusions: If patients present no symptoms, mild symptoms, or smaller CPAM lesions, “wait and watch” and a CT scan of the thorax up to approximately six months of age remain a reasonable approach. The true risk of malignancy remains ambiguous, especially since there was no evidence of malignancy in our biopsies. On the other hand, prophylactic surgery before symptoms arose led to earlier discharge and overall low intraoperative complications compared to symptomatic counterparts. Ultimately, the adopted therapy pathway remains a parental choice. For CPAMs, an increased lesion-to-lung ratio correlated with extended hospital stay and symptomatic presentation. However, there was no cut-off value for conservative or surgical treatment. Full article

Purpose: This study aimed to determine the relationship between alpha angle (the angle between the screws and the glenoid) and thoracic diameters in patients undergoing the Latarjet procedure. Defining the relationship between thoracic morphology and alpha angle is aimed at filling the gap in the literature and improving surgical outcomes. Methods: This retrospective study analyzed 74 patients who underwent the Latarjet procedure for recurrent anterior shoulder instability between 2022 and 2024. All procedures were performed by the same surgeon using a standardized protocol to ensure consistency of surgical technique across cases. In postoperative chest CT scans, alpha angle, anteroposterior diameter of the thorax, transverse diameter of hemithorax, scapular inclination, and glenoid version were evaluated. Results: The study included predominantly male patients (90%) with a mean age of 26.4 ± 6.4 years who underwent Latarjet procedures predominantly on the right side (60%). Significant associations were observed between thoracic morphology and alpha angle on postoperative CT scans. There was a significant positive correlation between anterior-posterior/transverse diameter ratio (AP/T) and alpha angle (r = 0.407, p < 0.001), as well as correlations between scapular inclination, glenoid version, thoracoscapular angle, and alpha angle (r = 0.275, p = 0.018; r = 0.241, p = 0.039; r = −0.288, p = 0.013, respectively). Patients were divided based on an alpha angle threshold of 15 degrees, with results indicating worse outcomes for angles above this threshold. Additionally, the AP/T ratio demonstrated predictive value for poor outcomes (AUC = 0.660, p = 0.018) with a threshold of 1.2545. Conclusions: This study highlights the direct impact of thoracic morphology on the alpha angle observed on post-Latarjet chest CT scans. Specifically, patients with a higher ratio of anterior-posterior to transverse thoracic diameter (AP/T) show a proportional increase in alpha angle. When the AP/T ratio exceeds 1.25, surgeons may face challenges in achieving the target alpha angle. Full article

Background: The aim of this study was to compare the technique of navigation-assisted biopsy based on fused PET and MRI datasets to CT-guided biopsies in terms of the duration of the procedure, radiation dose, complication rate, and accuracy of the biopsy, particularly in anatomically complex regions. Methods: Between 2019 and 2022, retrospectively collected data included all navigated biopsies and CT-guided biopsies of suspected primary bone tumors or solitary metastases. Navigation was based on preoperative CT, PET-CT/-MRI, and MRI datasets, and tumor biopsies were performed using intraoperative 3D imaging combined with a navigation system. Results: A total of 22 navigated (main group: m/f = 10/12, mean age: 56 yrs.) and 57 CT-guided biopsies (reference group: m/f = 36/21, mean age: 63 yrs.) were performed. Patients were grouped according to anatomic sites (pelvis, spine, extremities, thorax). The duration of the procedure in the reference group was significantly shorter than in the main group, particularly in the spine. The effective radiation dose was in the same range in both groups (main/reference group: 0.579 mSv and 0.687 mSv, respectively). In the reference group, a re-biopsy had to be performed in nine patients (diagnostic yield: 84%). A total of four major and three minor complications occurred in the reference group. Conclusions: Navigation-assisted percutaneous tumor biopsy resulted in correct, histologically useable diagnoses in all patients and reached a higher accuracy and first-time success rate (diagnostic yield: 100%) in comparison to CT-guided biopsies. The fusion of PET, CT, and MRI datasets enables us to combine anatomical with metabolic information. Consequently, target selection was improved, and the rate of false negative/low-grade sampling errors was decreased. Radiation exposure could be kept at a comparable level, and the durations of both procedures were comparable to conventional methods. Full article

Background: This study aimed to assess the interobserver variability of semi-automatic diameter and volumetric measurements versus manual diameter measurements for small lung nodules identified on computed tomography scans. Methods: The radiological patient database was searched for CT thorax examinations with at least one noncalcified solid nodule (∼3–10 mm). Three radiologists with four to six years of experience evaluated each nodule in accordance with the Fleischner Society guidelines using standard diameter measurements, semi-automatic lesion diameter measurements, and volumetric assessments. Spearman’s correlation coefficient measured intermeasurement agreement. We used descriptive Bland–Altman plots to visualize agreement in the measured data. Potential discrepancies were analyzed. Results: We studied a total of twenty-six nodules. Spearman’s test showed that there was a much stronger relationship (p < 0.05) between reviewers for the semi-automatic diameter and volume measurements (avg. r = 0.97 ± 0.017 and 0.99 ± 0.005, respectively) than for the manual method (avg. r = 0.91 ± 0.017). In the Bland–Altman test, the semi-automatic diameter measure outperformed the manual method for all comparisons, while the volumetric method had better results in two out of three comparisons. The incidence of reviewers modifying the software’s automatic outline varied between 62% and 92%. Conclusions: Semi-automatic techniques significantly reduced interobserver variability for small solid nodules, which has important implications for diagnostic assessments and screening. Both the semi-automatic diameter and semi-automatic volume measurements showed improvements over the manual measurement approach. Training could further diminish observer variability, given the considerable diversity in the number of adjustments among reviewers. Full article

Background/Objectives: Cardiopulmonary bypass can lead to hemodilution, causing a fluid shift to the interstitial space. Albumin helps counteract the intravascular fluid movement to the extravascular space and reduces the risk of complications associated with fluid imbalance. Our main objective was to evaluate the effectiveness of albumin addition in the cardiopulmonary bypass priming solution compared to standard priming, focusing on its role in reducing pleural effusion development. Methods: This was a single-center randomized controlled trial conducted at a tertiary care hospital specializing in cardiology and cardiac surgery. It involved 70 individuals scheduled for elective open-heart surgery. All cases were randomly assigned into two groups of 35 patients. The study group replaced 100 mL of standard CPB priming solution with 100 mL of 20% human albumin. We measured serum albumin levels before and after the surgery, 6 and 12 h after, and calculated colloid oncotic pressure. Thorax CT scans were performed on the first postoperative day to measure and calculate pleural effusion volume. Results: Albumin addition to cardiopulmonary bypass priming solution led to a significant reduction in pleural effusion development after CPB. An albumin level <35 g/L after the surgery showed a significant increase in pleural effusion development, and 100 mL of 20% albumin was sufficient to maintain serum albumin levels > 35 g/L. Conclusions: Our study suggests a link between postoperative hypoalbuminemia and the early development of pleural effusion after CPB, as well as the possible benefits of adding 100 mL of 20% albumin compared to standard crystalloid CPB priming to minimize postoperative pleural effusion development. Full article

Objectives: To investigate the relationship between COVID-19 pneumonia outcomes and three chest CT analysis approaches. Methods: Patients with COVID-19 pneumonia who underwent chest CT were included and divided into survivors/non-survivors and intubated/not-intubated. Chest CTs were analyzed through a (1) Total Severity Score visually quantified by an emergency (TSS1) and a thoracic radiologist (TSS2); (2) density mask technique quantifying normal parenchyma (DM_Norm 1) and ground glass opacities (DM_GGO1) repeated after the manual delineation of consolidations (DM_Norm2, DM_GGO2, DM_Consolidation); (3) texture analysis quantifying normal parenchyma (TA_Norm) and interstitial lung disease (TA_ILD). Association with outcomes was assessed through Chi-square and the Mann–Whitney test. The TSS inter-reader variability was assessed through intraclass correlation coefficient (ICC) and Bland–Altman analysis. The relationship between quantitative variables and outcomes was investigated through multivariate logistic regression analysis. Variables correlation was investigated using Spearman analysis. Results: Overall, 192 patients (mean age, 66.8 ± 15.4 years) were included. TSS was significantly higher in intubated patients but only TSS1 in survivors. TSS presented an ICC of 0.83 (0.76; 0.88) and a bias (LOA) of 1.55 (−4.69, 7.78). DM_Consolidation showed the greatest median difference between survivors/not survivors (p = 0.002). The strongest independent predictor for mortality was DM_Consolidation (AUC 0.688), while the strongest independent predictor for the intensity of care was TSS2 (0.7498). DM_Norm 2 was the singular feature independently associated with both the outcomes. DM_GGO1 strongly correlated with TA_ILD (ρ = 0.977). Conclusions: The DM technique and TA achieved consistent measurements and a better correlation with patient outcomes. Full article

Introduction and Objective: The aim of this study was to evaluate the coronary arteries in patients undergoing thoracic CT angiography for congenital heart disease, to determine the frequency of detection of coronary artery anomalies in congenital heart diseases, and to determine which type of anomaly is more common in which disease. Materials and Methods: In our investigation, a 128-detector multidetector computed tomography machine was used to perform thorax CT angiography. The acquisition parameters were set to 80–100 kVp based on the patient’s age and mAs that the device automatically determined based on the patient’s weight. During the examination, an intravenous (IV) nonionic contrast material dose of 1–1.5 mL/kg was employed. An automated injector was used to inject contrast material at a rate of 1.5–2 mL/s. In the axial plane, 2.5 mm sections were extracted, and they were rebuilt with 0.625 mm section thickness. Results: Between October 2022 and May 2024, 132 patients who were diagnosed with congenital heart disease by echocardiography and underwent Thorax CT angiography in our department were retrospectively evaluated. Of the evaluated patients, 32 were excluded with exclusion criteria such as patients being younger than 3 months, older than 18 years, insufficient contrast enhancement in imaging and contrast-enhanced imaging, thin vascular structure, and motion and contrast artifacts; the remaining 100 patients were included in this study. The age range of these patients was 3 months to 18 years (mean age 4.4 years). Conclusion: In congenital heart diseases, attention to the coronary arteries on thoracic CT angiography examination in the presence of possible coronary anomalies may provide useful information. Full article

Background: Radiation-induced lung injury (RILI), a serious side effect of thoracic radiotherapy, can lead to acute radiation pneumonitis (RP) and chronic pulmonary fibrosis (PF). Despite various interventions, no effective protocol exists to prevent pneumonitis. Oxytocin (OT), known for its anti-inflammatory, antiapoptotic, and antioxidant properties, has not been explored for its potential in mitigating RILI. Materials and Methods: This study involved 24 female Wistar albino rats, divided into three groups: control group, radiation (RAD) + saline, and RAD + OT. The RAD groups received 18 Gy of whole-thorax irradiation. The RAD + OT group was treated with OT (0.1 mg/kg/day) intraperitoneally for 16 weeks. Computerizing tomography (CT) imaging and histopathological, biochemical, and blood gas analyses were performed to assess lung tissue damage and inflammation. Results: Histopathological examination showed significant reduction in alveolar wall thickening, inflammation, and vascular changes in the RAD + OT group compared to the RAD + saline group. Biochemical analysis revealed decreased levels of TGF-beta, VEGF, and PDGF, and increased BMP-7 and prostacyclin in the RAD + oxytocin group (p < 0.05). Morphometric analysis indicated significant reductions in fibrosis, edema, and immune cell infiltration. CT imaging demonstrated near-normal lung parenchyma density in the RAD + oxytocin group (p < 0.001). Conclusion: Oxytocin administration significantly mitigates radiation-induced pneumonitis in rats, implying that is has potential as a therapeutic agent for preventing and treating RILI. Full article