Percutaneous management of complicated parapneumonic effusion and empyema after surgical tube thoracostomy failure in children: a retrospective study

PurposeWe aimed to evaluate the results of percutaneous management of complicated parapneumonic effusions (PPE) and empyema after surgical tube thoracostomy failure in children.MethodsA total of 84 children treated percutaneously after surgical tube thoracostomy failure between 2004 and 2019 were included to this retrospective study. Technical success was defined as appropriate placement of the drainage catheter. Clinical success was defined as complete resolution of infection both clinically and radiologically. Management protocol included imaging-guided pigtail catheter insertion, fibrinolytic therapy, serial ultrasonographic evaluation, catheter manipulations as necessary (revision, exchange, or upsizing), and appropriate antibiotherapy. All patients were followed up at least 6 months.ResultsTechnical success rate was 100%. Unilateral single, unilateral double, and bilateral catheter insertions were performed in 73, 9, and 2 patients, respectively. Inserted catheter sizes ranged from 8 F to 16 F. Streptokinase, urokinase, and tissue plasminogen activator were used as fibrinolytic agent in 29 (34%), 14 (17%), and 41 (49%) patients, respectively. In order to maintain effective drainage, 42 additional procedures (catheter exchange, revision, reposition, or additional catheter placement) were performed in 20 patients (24%). Clinical success was achieved in 83 of 84 patients (99%). Median catheter duration was 8 days (4–32 days). Median hospital stay during percutaneous management was 11.5 days (7–45 days). Factors affecting the median catheter duration were the presence of necrotizing pneumonia (p < 0.001) and bronchopleural fistulae (p < 0.001).ConclusionPercutaneous imaging-guided catheterization with fibrinolytic therapy should be the method of choice in pediatric complicated PPE and empyema patients with surgical tube thoracostomy failure. Percutaneous treatment is useful in avoiding more aggressive surgical options

Three-dimensional ultrasonographic evaluation of carotid artery plaque surface irregularity

Introduction: The aim of this study was to evaluate 3-dimensional (3D) ultrasonography (US) in determining the surface irregularity of carotid artery plaques. Material and methods: This study included 50 patients (20 females and 30 males) aged between 56 and 82 years with plaques in the carotid artery which were detected during routine neck ultrasound. Simultaneously these cases were evaluated in terms of plaque echogenicities and surface characteristics with 2D and 3D US. Results: 3D imaging was successfully performed in 45 of the 50 cases and the technical success rate was 90%. A single plaque was detected in 64.4% of the patients, with the remaining 35.6% having more than one plaque. The lengths of the plaques ranged from 2 to 12 mm (mean: 3.98 ±1.70 mm); the widths ranged from 1.8 to 3.2 mm (mean: 2.11 ±0.37 mm). No significant difference was found between 2D and 3D plaque echo-structures (observer 1, p = 0.317; observer 2, p = 0.276), but there were significant differences between 2D and 3D plaque surface irregularities (observer 1, p = 0.002; observer 2, p = 0.004). The inter-observer agreement on 2D and 3D plaque echo-structure and surface irregularity was very good (k coefficients were 0.89 and 0.83, respectively, for echo-structure, and 0.91 and 0.95, respectively, for surface irregularity). Conclusions: The present study shows that 3D US examination is a valuable non-invasive method for investigation of surface irregularity of carotid artery plaques

A Rare Cause of Right-Sided Air Bubble on Chest Radiograph: Intrathoracic Gastric Volvulus Related to Morgagni Hernia

Morgagni hernia is a rare disorder in adulthood, and most of the cases are asymptomatic. Symptomatic cases are extremely rare and present with life-threatening complications. Early diagnosis and surgery are lifesaving. We hereby present an adult case of symptomatic Morgagni hernia. Diaphragmatic herniation of the stomach and mesenteroaxial rotation led to intrathoracic gastric volvulus in this case. A right-sided air bubble on a chest radiogram was the only finding leading to the suspicion of diaphragmatic hernia. Computed tomography in the diagnosis of diaphragmatic hernias is of great importance

Hematological Indices in Portal Hypertension: Cirrhosis versus Noncirrhotic Portal Hypertension

Portal hypertension (PHT) leads to several alterations on hematological indices (HI). The aim of the study is to investigate the differences in HI between cirrhotic subjects and subjects who have noncirrhotic PHT (NCPHT). This retrospective study included 328 patients with PHT (239 cirrhosis and 89 NCPHT). Demographic and clinical features, endoscopic and radiological findings, and HI including neutrophil to lymphocyte ratio (NLR) at the time of PHT diagnosis were recorded. Severity of cirrhosis was assessed according to the Child&ndash;Turcotte&ndash;Pugh (CTP) classification and Model for End-Stage Liver Disease (MELD) scores. Hematological abnormalities were found in 92.5% of cirrhotic patients and in 55.1% of patients with NCPHT (p &lt; 0.001). While thrombocytopenia was the most common HI in patients with cirrhosis, anemia was the most prevalent HI in NCPHT group. In the cirrhotic group, the NLR was the only parameter to differentiate each CTP group from two others. The NLR value increased with the severity of cirrhosis (2.28 &plusmn; 0.14 in CTP-A, 2.85 &plusmn; 0.19 in CTP-B and 3.26 &plusmn; 0.37 in CTP-C). The AUROC of NLR was 0.692 for differentiating compensated cirrhotic patients from decompensated. Hematological abnormalities are more prevalent and more severe in cirrhotic patients compared to patients with NCPHT. NLR may be used to assess the severity of cirrhosis

A Neglected Issue in Ulcerative Colitis: Mesenteric Lymph Nodes

Data evaluating the presence and characteristics of mesenteric lymph nodes (LNs) in patients with ulcerative colitis (UC) are scarce. The aim of this study is to determine the presence and characteristics of LNs in UC. The LN characteristics in computed tomography (CT), including LN dimension and attenuation, were evaluated retrospectively in 100 patients with UC (61 active and 39 inactive cases). Clinical characteristics and laboratory parameters, including CBC, biochemical analysis, erythrocyte sedimentation rate (ESR), and C reactive protein (CRP) were also compared. Mesenteric LNs were evident in all patients with UC. The attenuation and dimension of mesenteric LNs did not differ between active and inactive patients with UC. No correlation was found among patients with UC in terms of LN dimension, attenuation, ESR, CRP, leucocyte, and albumin (all with p &gt; 0.05). The current study suggested that inflammation results in the development of mesenteric LN in UC, similar to Crohn&rsquo;s disease and other inflammatory disorders