Suitability of òhe modality virtual bronchoscopy with aspiration of a foreign body

Aspirations of foreign bodies are life-threatening among children and elderly patients requiring urgent medical assistance. The aim of the study is to present summarized results from various authors' studies to reveal VB's diagnostic abilities for suspected aspiration of a foreign body. VB has been shown to be a particularly useful non-invasive modality for the complex tracheobronchial tree assessment for suspected aspiration of a foreign body due to its high sensitivity, specificity and validity. MDCT VB with MPR allows accurate localization of the foreign body, but in secondary inflammatory changes and secretions it does not provide accurate information about the form and type of the finding. VB cannot replace FB ("gold standard") but successfully supports and complements it. MDCT could provide early diagnosis in cases of suspected aspiration of a foreign body in children and adults and avoid real bronchoscopy in patients with poor overall condition

Diagnosis and Treatment of Pulmonary Disease in Sea Turtles (Caretta caretta)

The aim of this study was to describe the clinical signs, radiographic, endoscopic and CT findings, cytological and microbiological findings and treatments of pulmonary diseases in sea turtles, in order to obtain an accurate diagnosis that avoids unnecessary therapy and antibiotic-resistance phenomena. In total, 14 loggerheads (Caretta caretta), with clinical and/or radiographic findings of pulmonary pathology, were assessed through various combinations of clinical, radiological, CT, endoscopic examination and bronchoalveolar lavage, which recovered fluid for cytologic and microbiologic analysis. In all cases, radiographic examination led to a diagnosis of pulmonary disorders—4 unilateral and 10 bilateral. All bacteria cultured were identified as Gram-negative. Antibiotic resistance was greater than 70% for all beta-lactams tested. In addition, all bacterial strains were 100% resistant to colistin sulfate and tetracycline. Specific antibiotic therapies were formulated for seven sea turtles using Enrofloxacin, and for four sea turtles using ceftazidime. In two turtles, antibiotic therapy was not included due to the presence of antibiotic resistance against all the antibiotics evaluated. In both cases, the coupage technique and environmental management allowed the resolution of the lung disease without antibiotics. All 14 sea turtles were released back into the sea. Radiographic examination must be considered the gold standard for screening sea turtles that show respiratory signs or abnormal buoyancy. Susceptibility testing with antimicrobials allowed appropriate therapy, including the reduction of antibiotic-resistance

Role of computed tomography in quantitative assessment of emphysema

Pulmonary emphysema, together with chronic bronchitis is a part of chronic obstructive pulmonary disease (COPD), which is one of the leading causes of death in the United States and worldwide. There are many methods to diagnose emphysema. Unfortunately many of them, for example pulmonary function tests (PFTs), clinical signs and conventional radiology are able to detect emphysema usually in its late stages when a great portion of lung parenchyma has been already destroyed by the disease. Computed tomography (CT) allows for early detection of emphysema. CT also makes it possible to quantify the total amount of emphysema in the lungs which is important in order to precisely estimate the severity of the disease. Those abilities of CT are important in monitoring the course of the disease and in attempts to prevent its further progression. In this review we discuss currently available methods for imaging emphysema with emphasis on the quantitative assessment of emphysema. To date, quantitative methods have not been widely used clinically, however, the initial results of several research studies regarding this subject are very encouraging

Bronchoscopic lung volume reduction treatment in severe COPD: from improving patient selection to management of complications

Chronic Obstructive Pulmonary Disease (COPD) is a common disease, often characterized by shortness of breath and coughing and this can lead to a poor quality of life. In patients with severe COPD, there can be hyperinflation and an increased residual volume. In some patients with severe increased residual volume, bronchoscopic lung volume reduction treatment using one-way valves can be an option. It has been proven that valve treatment can lead to improvements in shortness of breath, exercise capacity and quality of life. For treatment, it is important that there is sufficient emphysema in the treatment lobe and no collateral ventilation between the treated lobe and the adjacent lobe.Currently, the CT scan of the lungs is the most important tool to determine whether a patient is potentially suitable for the treatment with one-way valves. With quantitative CT scan analysis, various parameters can be assessed automatically (e.g. severity of emphysema and fissure completeness).In this thesis, we investigate whether the use of quantitative CT scan analysis can be optimized in patients who are evaluated for treatment with valves and to improve the selection of the right patients and the optimal treatment lobe. Additionally, we discuss several methods to improve the measurement of collateral ventilation (Chartis measurement) and to discuss the main complications after valve treatment

Bronchoscopic lung volume reduction for Emphysema: physiological and radiological correlations

Introduction: Patient selection in lung volume reduction (LVR) plays a pivotal role in achieving meaningful clinical outcomes. Currently, LVR patients are selected based on three established criteria: heterogeneity index, percentage of low attenuation area (%LAA), and fissure integrity score. Quantitative computed tomography (QCT) has been developed to quantify lung physiological indices at the lobar level and could potentially revolutionise patient selection in LVR procedures. We developed an in-house QCT software, LungSeg, and used its radiological indices for the purposes of this thesis. The aim of this thesis is to discover potential physiological and radiological indices that could serve as predictors for superior LVR outcomes for better patient selection. Methods: This thesis took two studies and analysed them using LungSeg. The first study was the long-term coil study, a randomised controlled study that had the control group crossing over to the treatment arm at 12 months. At 12 months post-procedure the baseline measurements were assessed against the 12-months post-procedural measurements. The second study was the short-term valve study which was another randomised controlled study that compared the primary and secondary endpoints between the control and the valve-treated group at three months post-procedure. Results: In the long-term coil study, we found that the best statistically significant combination of predictors for change in target lobar volume at inspiration was found to be the combination of baseline target LV at inspiration, -950HU EI at inspiration, and TLCabs with a model adjusted R2 of 0.407 (p = 0.0001). In a subsequent multivariate analysis using ≥45% LAA on the -950HU at Inspiration, the R2 of the same prediction model did improve to 0.493 (P-value = 0.002). Meanwhile, the best statistically significant combination of predictors for change in target lobar volume at inspiration following valve treatment was found to be the combination of baseline target LV at inspiration, target lobar fissure integrity and baseline FEV1abs with a model adjusted R2 of 0.193 (p = 0.105). Conclusion: Using QCT, we have improved the proposed patient selection algorithm for LVR procedures based on the best QCT and lung function predictors.Open Acces

Bleeding Vessels in Life Threatening Hemoptysis: Comparison of 64 Detector Row CT Angiography with Conventional Angiography Prior to Endovascular Management.

Hemoptysis Is Defined As Bleeding That Originates From The Lower Respiratory Tract. (1) In Developing Countries, The Majority Of Cases Are Due To Tuberculosis. (2) Massive Hemoptysis Is A Major Clinical And Surgical Problem With A Mortality Of 80%, Which Is Most Often Related To Asphyxiation. (3,4) Conservative Management Of Massive Hemoptysis Carries A Mortality Rate Of 50%–100% (5) And The Mortality Is Up To 35% Even In Patients Undergoing Operation. (6) Because Of Poor Pulmonary Reserve And Other Medical Comorbid Conditions, Most Patients With Massive Hemoptysis Are Not Ideal Surgical Candidates. ( 4,5) Therapeutic Bronchial Artery Embolization Is A Good Treatment Adjunct To Control Bronchial Bleeding And Reduces The Need For High-Risk Emergency Lung Resections. (7) It Has Become An Established Procedure In The Management Of Massive And Recurrent Hemoptysis; Its Use Was First Reported In 1973 By Remy Et Al. (8) It Is A Useful Therapy To Control Both Acute And Chronic Hemoptysis (9) And Is An Effective Method For Management Of Massive Hemoptysis In Developing Countries And Has A Low Complication Rate. (10,11) BAE May Help To Avoid Surgery In Patients Who Are Not Good Surgical Candidates. Should Hemoptysis Recur In These Patients, Repeat Embolization Can Be Performed Safely. (9) Surgery Remains The Procedure Of Choice In The Treatment Of Massive Hemoptysis Caused By Specific Conditions, Such As Hydatid Cyst, Thoracic Vascular Injury, Bronchial Adenoma, And Aspergilloma That Is Resistant To Other Therapies. (12) Even In Surgical Candidates, BAE Is Effective In Preparing The Patient For Elective Rather Than High-Risk Emergency Surgery. (7) Various Nonbronchial Systemic Arteries, As Well As Pulmonary Arteries, May Also Contribute To Hemoptysis, And Their Implication Is Dependent On The Underlying Pathologic Condition. (13-18) Nonbronchial Systemic Collateral Vessels Must Be Particularly Suspected When There Is Evidence Of Coexistent Pleural Disease. (11,19) Recognition And Occlusion Of Nonbronchial Systemic Collaterals Providing Blood To Hypervascular Pulmonary Lesions Is Essential For Successful Percutaneous Embolotherapy Of Hemoptysis. (2,17-20) Prior To Embolization, The Interventional Radiologist Needs To Be Aware Of The Side Of The Bronchial Artery Bleeding, And The Most Likely Source Of Bleeding Has To Be Identified To Determine Which Vessel(S) Is To Be Occluded. Since The Bronchial Circulation Is The Most Frequent Source Of Hemoptysis, Embolization Of Bronchial Arteries Is Usually The Favored Therapeutic Option To Stop The Bleeding. (11,21) Recent Important Technologic Advances In CT, Particularly The Development Of Multi– Detector Row CT, Have Introduced A Comprehensive, Noninvasive Method Of Evaluating The Entire Thorax, Allowing Detailed Assessment Of The Mediastinum And Lung Parenchyma. (11,21) Multi–Detector Row Helical CT Angiography Can Also Help In The Planning Of A Focused And Efficient Nonbronchial Systemic Artery Embolization. It Provides A Precise Road Map For The Interventional Radiologist In Performing An Endovascular Treatment For Hemoptysis. The Availability Of This Information Before The Patient Arrives In The Angiographic Suite Is Expected To Help Reduce The Examination Time By Facilitating Attempts At Direct Selective Catheterization Of The Arteries To Be Occluded. (21

Anesthesia for thoracic surgery in infants and children

The management of infants and children presenting for thoracic surgery poses a variety of challenges for anesthesiologists. A thorough understanding of the implications of developmental changes in cardiopulmonary anatomy and physiology, associated comorbid conditions, and the proposed surgical intervention is essential in order to provide safe and effective clinical care. This narrative review discusses the perioperative anesthetic management of pediatric patients undergoing noncardiac thoracic surgery, beginning with the preoperative assessment. The considerations for the implementation and management of one-lung ventilation (OLV) will be reviewed, and as will the anesthetic implications of different surgical procedures including bronchoscopy, mediastinoscopy, thoracotomy, and thoracoscopy. We will also discuss pediatric-specific disease processes presenting in neonates, infants, and children, with an emphasis on those with unique impact on anesthetic management

Optimizing parameters of an open-source airway segmentation algorithm using different CT images.

Background: Computed tomography (CT) helps physicians locate and diagnose pathological conditions. In some conditions, having an airway segmentation method which facilitates reconstruction of the airway from chest CT images can help hugely in the assessment of lung diseases. Many efforts have been made to develop airway segmentation algorithms, but methods are usually not optimized to be reliable across different CT scan parameters. Methods: In this paper, we present a simple and reliable semi-automatic algorithm which can segment tracheal and bronchial anatomy using the open-source 3D Slicer platform. The method is based on a region growing approach where trachea, right and left bronchi are cropped and segmented independently using three different thresholds. The algorithm and its parameters have been optimized to be efficient across different CT scan acquisition parameters. The performance of the proposed method has been evaluated on EXACT’09 cases and local clinical cases as well as on a breathing pig lung phantom using multiple scans and changing parameters. In particular, to investigate multiple scan parameters reconstruction kernel, radiation dose and slice thickness have been considered. Volume, branch count, branch length and leakage presence have been evaluated. A new method for leakage evaluation has been developed and correlation between segmentation metrics and CT acquisition parameters has been considered. Results: All the considered cases have been segmented successfully with good results in terms of leakage presence. Results on clinical data are comparable to other teams’ methods, as obtained by evaluation against the EXACT09 challenge, whereas results obtained from the phantom prove the reliability of the method across multiple CT platforms and acquisition parameters. As expected, slice thickness is the parameter affecting the results the most, whereas reconstruction kernel and radiation dose seem not to particularly affect airway segmentation. Conclusion: The system represents the first open-source airway segmentation platform. The quantitative evaluation approach presented represents the first repeatable system evaluation tool for like-for-like comparison between different airway segmentation platforms. Results suggest that the algorithm can be considered stable across multiple CT platforms and acquisition parameters and can be considered as a starting point for the development of a complete airway segmentation algorithm

Diseases of the Chest, Breast, Heart and Vessels 2019-2022

This open access book focuses on diagnostic and interventional imaging of the chest, breast, heart, and vessels. It consists of a remarkable collection of contributions authored by internationally respected experts, featuring the most recent diagnostic developments and technological advances with a highly didactical approach. The chapters are disease-oriented and cover all the relevant imaging modalities, including standard radiography, CT, nuclear medicine with PET, ultrasound and magnetic resonance imaging, as well as imaging-guided interventions. As such, it presents a comprehensive review of current knowledge on imaging of the heart and chest, as well as thoracic interventions and a selection of "hot topics". The book is intended for radiologists, however, it is also of interest to clinicians in oncology, cardiology, and pulmonology