Ammonia Intoxication on Workplace – Case Report and a Review of Literature

In December 2003 in Rijeka, Croatia, a work accident happened when in the meat industry »Vir« a forklift damaged the ammonia pipe. Two butchers were acutely poisoned. The objective is to warn of the danger of ammonia and of the need to improve preventive programs of occupational medicine. The method of comparing the two injured workers, i.e. their spirometric values, was used. The results showed progressive diminishing of patients´ respiratory abilities, in the patient with lungs transplanted VC 32%, FVC 33%, FEV1 16% and FEF75%=6% in 2006, the year when he died. In the patient that survived, the values in 2008 were VC 43.5%, FVC 27.2%, FEV1% 56.7% and FEF75%=6%. The patients´ CT showed diffused fibrosing and bronchiectasiae. Obliterating bronchiolitis developed in both patients. The second patient is the lung transplantation candidate. The first patient developed post transplantation cytomegalovirus pneumonia so he fought CMV antigenemia and infection till the end

Incidence of squamous cell carcinoma in patients with lung cancer diagnosed by computed tomography and pathohistologically in 2022 at CHC Rijeka

Cilj: utvrditi histološke tipove raka pluća među bolesnicima kojima je kompujeriziranom tomografijom toraksa i patohistološki dijagnosticiran rak pluća te odrediti prevalenciju planocelularnog karcinoma. Nadalje, utvrditi spolnu i dobnu zastupljenost te udio pušača i nepušača među ispitanicima s dijagnosticiranim planocelularnim karcinom u odnosu na bolesnike oboljele od adenokarcinoma. Metode: ova retrospektivna studija uključuje sve bolesnike kod kojih je u 2022.g. u KBC-u Rijeka, dijagnosticiran rak pluća. Svi podaci potrebni za provođenje ovog istraživanja (dob i spol bolesnika, patohistološki nalaz, dijagnostička metodu pomoću koje je pribavljen materijal za patohistološku analizu te pušački status), dobiveni su pretraživanjem bolničkih baza podataka (IBIS i ISSA). Rezultati: u ovom istraživanju utvrđeno je sveukupno 147 novodijagnosticiranih primarnih karcinoma pluća. Udio bolesnika muškog spola s primarnim karcinoma pluća iznosio je 65,3%, a ženskog 34,7%. Najzastupljeniji histološki tip raka pluća bio je adenokarcinom, potvrđen kod 40,8% bolesnika, a potom planocelularni karcinom, dijagnosticiran kod 22,4% bolesnika. Pripadnika muškog spola među ispitanicima s adenokarcinomom bilo je 63,3%, a među ispitanicima s planocelularnim karcinomom 75,5%. U grupi oboljelih od adenokarcinomom bilo je 80% aktivnih ili bivših pušača cigareta, a među ispitanicima s dijagnosticiranim planocelularnim karcinomom 94 %. Udio pušača kod muškaraca oboljelih od adenokarcinoma iznosio je 92,2%, a kod planocelularnog 92%. U skupini žena oboljelih od adenokarcinoma bilo je 59,1% pušača, a u skupini oboljelih od planocelularnog karcinoma 100%. Zaključci: planocelularni karcinom je drugi po učestalosti u bolesnika kod kojih je u 2022.g. u KBC-u Rijeka dijagnosticiran karcinom pluća nemalih stanica, nakon adenokarcinoma, s udjelom od 22,4%. Među bolesnicima oboljelim od planocelularnog karcinoma znatno veći je bio udio pripadnika muškog spola (75,8% naprema 24,2%), kao i udio pušača (94% naprema 80%) nego u onih oboljelih od adenokarcinoma.Aim: The aim of this research was to determine the histological types of lung cancer among patients diagnosed with primary lung cancer by CT and pathohistologically, and to determine the prevalence of squamous cell carcinoma. Furthermore, to determine gender and age distribution and the proportion of smokers and non-smokers among respondents with diagnosed squamous cell carcinoma in relation to patients with adenocarcinoma. Methods: This retrospective study included patients in whom the lung cancer was diagnosed in 2022 at the Clinical Hospital Center (CHC) Rijeka. All data necessary for the conduct of this study (age and gender, pathohistological findings, the diagnostic method by which the material for pathohistological analysis was obtained and smoking status) were obtained from hospital databases (IBIS and ISSA). Results: A total of 147 diagnosed primary lung cancers were detected in this study. Lung cancer showed a male predominance with 65,3% while the proportion of female patients was 34,7%. The most common histological type of lung cancer was adenocarcinoma, confirmed in 40,8% of patients, followed by squamous cell carcinoma, which was diagnosed in 22,4% of patients. The male gender was more prevalent in patients with adenocarcinoma and squamous cell carcinoma, with the incidence of 63,3% and 75,5%. Analysis of the smoking status showed that 80% of patients with adenocarcinoma and 94% of patients with squamous cell carcinoma were smokers. The incidence of smokers among men diagnosed with adenocarcinoma and squamous cell carcinoma was approximately equal (92.2% vs. 92%). The proportion of smokers among women with adenocarcinoma was 59.1% while all women with squamous cell carcinoma were smokers. Conclusion: Squamous cell carcinoma was the second most common histological type in patients diagnosed with lung cancer in 2022 at CHC Rijeka, after adenocarcinoma, with the incidence of 22.4%. Squamous cell carcinoma showed a significantly higher incidence in male patients (75,8% vs. 24,2%). Furthermore, the proportion of smokers was higher among the patients diagnosed with squamous cell carcinoma compared to those diagnosed with adenocarcinoma (94% versus 80%)

Incidence of pulmonary thromboembolism in patients who underwent CT pulmonary angiography in the first quarter of 2023 at CHC Rijeka

Cilj: Plućna tromboembolija (PTE) je hitno medicinsko stanje kod kojeg dolazi do okluzije jedne ili više grana plućnih arterija tromboembolusom. CT plućna angiografija (CTPA) je brza, neinvazivna radiološka metoda kojom se postavlja dijagnoza PTE. Glavni cilj ovog rada je odrediti incidenciju pozitivnih PTE nalaza kod 524 pacijenta podvrgnutih CTPA te odrediti učestalost zahvaćenih grana plućnih arterija. Nadalje, jedan od ciljeva je i odrediti incidenciju usputnih nalaza (plućni nodusi, tumor pluća, pneumonija, infarkt pluća, pleuralni izljev). Ispitanici i metode: U ovom retrospektivnom istraživanju prikupljeni su podaci 524 bolesnika koji su zbog sumnje na PTE podvrgnuti CTPA pregledu na Kliničkom zavodu za dijagnostičku i intervencijsku radiologiju, na lokalitetu Sušak, u Kliničkom bolničkom centru (KBC) Rijeka, u razdoblju od siječnja do travnja 2023. godine. Svi potrebni podaci navedeni u nalazu radiologa prikupljeni su iz integriranog bolničkog informacijskog sustava (IBIS) i pripadajuće aplikacije (ISSA). Rezultati: Od ukupno 524 bolesnika podvrgnutih CTPA, PTE je dokazana kod 97 ili 18,51% pacijenata. U našem istraživanju bio je podjednak broj ispitanika muškog i ženskog spola (260 ili 49,62% naprema 264 ili 50,39%). Nešto je veća incidencija PTE bila kod muškaraca (52 ili 53,61%) nego kod žena (45 ili 46,39%). Najveći broj bolesnika (262 ili 50,00%) pripadao je dobnom razredu između 61. i 80. godine života. Usputni nalazi opisani na CTPA, prema redoslijedu učestalosti su bili: pneumonije (37,15%), pleuralni izljevi (34,86%), plućni nodusi (16,79%), tumori pluća (6,87%) i plućni infarkti (4,33%). Zaključak: CT plućna angiografija predstavlja zlatni standard za detekciju plućne tromboembolije. Pregledom dostupne literature, incidencija PTE je komparabilna s rezultatima našeg istraživanja. U našoj, kao i u većini recentnih studija, PTE je najčešće detektirana u segmentalnim i subsegmentalnim granama plućnih arterija, dok se incidencija usputnih nalaza detektiranih na CTPA ne podudara s rezultatima drugih istraživanja.Aim: Pulmonary thromboembolism (PTE) is an urgent medical condition in which one or more branches of the pulmonary arteries are occluded by an embolus. CT pulmonary angiography (CTPA) is a rapid, non-invasive radiological method used to diagnose PTE. The main goal of this research was to determine the incidence of positive PTE findings in 524 patients who underwent CTPA, and to determine the frequency of affected branches of the pulmonary arteries. Furthermore, one of the goals was to determine the frequency of incidental findings (lung nodules, lung tumor, pneumonia, lung infarction, pleural effusion). Methods: In this retrospective study, data was collected on 524 patients, who due to suspicion of PTE, underwent CTPA at the Clinical Department for Diagnostic and Interventional Radiology, at the Clinical Hospital Center (CHC) Rijeka, in the period from January to April 2023. All the necessary data specified in the radiologist’s report was collected from the hospital database (IBIS) and the associated application (ISSA). Results: Out of a total of 524 patients who underwent CTPA, PTE was diagnosed in 97 patients or 18,51%. In our research, there was an approximately equal number of male and female subjects (260 or 49,62% versus 264 or 50,39%). The incidence of PTE was slightly higher in men (52 or 53,61%) than in women (45 or 46,39%). Most of the patients (262 or 50,00%) belonged to the age group between 61 and 80 years. Incidental findings described on CTPA, in order of frequency, were pneumonia (37,15%), pleural effusions (34,86%), pulmonary nodules (16,79%), lung tumors (6,87%), and pulmonary infarcts (4,33%). Conclusion: CT pulmonary angiography is the gold standard for the detection of pulmonary thromboembolism. By reviewing the available literature, the incidence of PTE is comparable to the results of our study. In ours, as well as in most recent studies, PTE was most often detected in the segmental and subsegmental branches of the pulmonary arteries, while the frequency of incidental findings detected on CTPA does not match with the results of other studies

Advancement in the Mesothelioma Diagnostics in Primorsko-Goranska County of Croatia

The purpose is to find out whether the diagnostics and registration of patients with mesothelioma in the Littoral – Mountainous County of Croatia corresponds to the world trends. Further, the intention was to show the incidence of the disease and suggest the measures of prevention in the county of 400.000 inhabitants and its center Rijeka with 140.000 people. To that purpose 43 patients with mesothelioma were monitored in two groups: 25 shipyard workers, mean age 66, and 18 workers in other occupations, mean age 62. Statistically the group did not differ significantly in the incidence of placks, left or right side effusion. The pleural puncture showed the significance (p<0.05) for incidence of rouse cells. In 20 patients out of 43 mesothelioma was confirmed by taking the material for pathohistology by means of VATS (video assisted thoracoscopy) and in 14 patients by TTB (transthoracic biopsy) with CT control. Spirometric values showed moderate restrictive difficulties. Although a considerable improvement in diagnosing mesothelioma has been achieved in the last five years an improved prevention activity by occupational medicine is required not only by periodic checkups of the exposed persons and examinations for retired workers with respiratory difficulties, but also by stimulating work case histories

Radiologic Technologist Approach to the Patient on Extracorporeal Membrane Oxygenation

Extracorporeal membrane oxygenation (ECMO) is a form of temporary circulatory support in patients with impaired heart and / or lung function, in whom conventional methods of treatment have been exhausted. ECMO support does not treat the underlying pathology, but allows oxygenation and perfusion of vital organs until complete recovery or as a destination therapy for heart and / or lung transplantation. It is an integral part of modern intensive care for patients with severely impaired cardiac and / or respiratory function. Medical staff involved in the treatment and monitoring of patients on ECMO support should be familiar with the basics of the ECMO system, in accordance with the workplace and with approach to the patient on ECMO support. A radiologist who performs a radiological examination in such a patient requires cooperation with the anaesthesiology team and the team of perfusionists, so that the basic conditions for performing the examination are met and the examination is successfully performed. The aim of this paper is to acquaint radiological technologists with the approach to the patient on ECMO support and to present the experiences of the Radiology Department at Clinical Hospital Centre Rijeka in performing radiological examinations on such patients. Data are collected through hospital databases and are related to the demographic characteristics of patients and indications for performing computed tomography (CT) examinations. Patients were selected according to the type of ECMO support and according to the region of interest for performing a CT scan in the period from 1st January 2017 to 15th August 2019. Keywords: Extracorporeal membrane oxygenation, perfusion, computed tomography, radiological examinations

Radiologic Technologist Approach to the Patient on Extracorporeal Membrane Oxygenation

Extracorporeal membrane oxygenation (ECMO) is a form of temporary circulatory support in patients with impaired heart and / or lung function, in whom conventional methods of treatment have been exhausted. ECMO support does not treat the underlying pathology, but allows oxygenation and perfusion of vital organs until complete recovery or as a destination therapy for heart and / or lung transplantation. It is an integral part of modern intensive care for patients with severely impaired cardiac and / or respiratory function. Medical staff involved in the treatment and monitoring of patients on ECMO support should be familiar with the basics of the ECMO system, in accordance with the workplace and with approach to the patient on ECMO support. A radiologist who performs a radiological examination in such a patient requires cooperation with the anaesthesiology team and the team of perfusionists, so that the basic conditions for performing the examination are met and the examination is successfully performed. The aim of this paper is to acquaint radiological technologists with the approach to the patient on ECMO support and to present the experiences of the Radiology Department at Clinical Hospital Centre Rijeka in performing radiological examinations on such patients. Data are collected through hospital databases and are related to the demographic characteristics of patients and indications for performing computed tomography (CT) examinations. Patients were selected according to the type of ECMO support and according to the region of interest for performing a CT scan in the period from 1st January 2017 to 15th August 2019. Keywords: Extracorporeal membrane oxygenation, perfusion, computed tomography, radiological examinations

Patient with Lingual Thyroid and Squamous Cell Carcinoma of the Tongue Base – Case Report

We demonstrate a rare case of lingual thyroid together with squamous cell carcinoma of the base of tongue. 54-year old patient presented with left sided lymph node enlargement in regions II, III and IV, without any clinical symptoms. Physical examination revealed semicircular bulge at the base of tongue measuring 30x20 mm and tumorous lesion was suspected. Neck ultrasound showed pathological enlargement of lymph nodes and FNA of lymph node revealed squamous carcinoma cells in the smear. Further investigation included CT and MRI of the neck depicted ectopic thyroid tissue in base of tongue and enlarged and necrotic lymph nodes in regions II and III. Primary carcinoma could not be depicted. Biopsy of the lingual mass was performed and histology confirmed ectopic thyroid tissue. Physical examination of the oral cavity was repeated and suspicious area on the left side of the tongue base near ectopic thyroidal tissue was identified. Histology after biopsy confirmed squamous cell carcinoma with superficial growth. This case emphasizes the important role that collaboration of radiologist and otorhinolaryngologyst has in correctly diagnosing oropharyngeal pathology. Also, we underline the importance of careful oropharyngeal region screening in case of unknown pathologic lymphadenopathy, when the possibility of oropharyngeal cancer has to be considered

Hepatopulmonary syndrome – commonly unrecognized complication in liver cirrhosis

Cilj: Hepatopulmonalni sindrom (HPS) kao plućnu komplikaciju uznapredovale bolesti jetre karakterizira trijas: jetrena bolest, arterijska hipoksemija i dilatacija plućnog krvožilja. Prevalencija iznosi i do 47 %, no u kliničkoj praksi rijetko se prepoznaje i dijagnosti cira, stoga je cilj ovoga prikaza upozoriti na često postojanje HPS-a u bolesnika s cirozom jetre i respiratornom simptomatologijom, te istaknuti dijagnosti čke postupke i adekvatno liječenje. Prikaz slučaja: Bolesnik je 54-godišnjak s cirozom jetre (Child-Pugh C 10) i dispnejom. Kliničkim pregledom (dispneja) i laboratorijskim nalazima (arterijska hipoksemija, ortodeoksija) postavljena je sumnja na HPS. Primjenom kontrastne ehokardiografi ije, višeslojne računalne tomografije (MSCT) pluća i CT plućne angiografije, potvrđena je radna dijagnoza. Rasprava i zaključak: U bolesnika s cirozom jetre i respiratornim tegobama treba posumnjati na HPS i potvrditi ga odgovarajućim dijagnostičkim metodama. Dijagnostika ovog sindroma obuhvaća detaljnu anamnezu i fizikalni pregled, analizu plinova u arterijskoj krvi, preglednu snimku grudnih organa, kontrastnu ehokardiografi ju, MSCT pluća, scinti grafi ju makroagregati ma albumina obilježenih tehnecijem i, u dvojbenim slučajevima, plućnu angiografiju. Provedena su brojna istraživanja o učinkovitosti različitih lijekova, ali niti jedan se nije pokazao dovoljno učinkovitim u liječenju ovog sindroma. Jedina potencijalno kurati vna metoda danas je ortotopna transplantacija jetre (OTJ).Aim: Hepatopulmonary syndrome (HPS), a pulmonary complicati on of liver cirrhosis, is the triad of liver disease, arterial hypoxemia and intrapulmonary vascular dilatation. Prevalence may be up to 47%, but in clinical practi ce it is rarely recognized and diagnosed. We present the case of HPS in a pati ent with liver cirrhosis and respiratory simptomatology and emphasise the importance of early recogniti on of HPS because of timely and adequate therapy approach. Case report: The pati ent was a 54-year-old male with liver cirrhosis (Child Pugh C 10) and dyspnea. Clinically (dyspnea) and biochemically (arterial hypoxemia, ortodeoxia) our presumpti ve diagnosis was HPS. Early diagnosis was established by applying contrast echocardiography, lung MSCT and CT pulmonary angiography. Discussion and conclusion: It is necessary to recognize HPS as a complication in liver cirrhosis and to verify it by using proper diagnostic methods. Diagnostics of HPS include detailed anamnesis and physical examination, blood gas analysis, chest x-ray, contrast echocardiography, lung MSCT, lung perfusion scinti graphy (99m-Tc macro aggregated albumin lung perfusion scan) and CT pulmonary angiography in doubtful cases. Various trials evaluating drug effi ciency have been performed, but no medicati on has been found suitable for HPS treatment. Orthotopic liver transplantati on (OLT) is the only potential curative method

Nonfatal Systemic Air Embolism: A Grave Complication of Computed Tomography-Guided Percutaneous Transthoracic Needle Biopsy

Transthoracic computed tomography-guided core needle biopsy (TTNB) is a well-established method for diagnosing focal pulmonary lesions. However, the dangers associated with this method as well as the significant number of complications caused by it cannot be ignored. Systemic air embolism is a rare but potentially fatal complication that can accompany transthoracic needle biopsies of pulmonary lesions. In this study, we report nonfatal systemic air embolism as a complication of a transthoracic needle core biopsy of a subpleural nodule in the right upper pulmonary lobe of a patient with hemoptysis. Although extremely rare, the complication may result in a transient myocardial ischemia, which is presented with a transient depression of the ST segment

Wünderlich syndrome as a first manifestation of renal cell carcinoma – case report

Cilj: Prikazati spontano, netraumatsko perirenalno krvarenje (Wünderlich sindrom) kao prvu manifestaciju karcinoma bubrega te dijagnostički i terapijski postupak kod takvog bolesnika. Prikaz slučaja: Bolesnica stara 37 godina je došla na hitni medicinski trakt s intenzivnim, naglo nastalim bolovima u lijevom lumbalnom predjelu abdomena; uredno mokri, negira traumu i nema makrohematuriju. Zbog općeg lošeg stanja bolesnica je poslana na hitnu višeslojnu kompjuteriziranu tomografiju (Multi-slice computed tomography, MSCT) abdomena i zdjelice na kojoj je utvrđena inhomogena formacija u gornjem polu lijevog bubrega uz zaključak radiologa da se radi o perirenalnom krvarenju, najvjerojatnije uzrokovanog angiomiolipomom. Urolog se odlučio za hitni operacijski zahvat koji uključuje djelomičnu nefrektomiju lijevog bubrega te evakuaciju hematoma. Patohistološki pregled uputio je na karcinom bubrega kromofobnog tipa koji je uzrokovao krvarenje. Bolesnica se redovito kontrolira, nema znakova recidiva. Zaključak: Wünderlich sindrom je rijetka, potencijalno životno ugrožavajuća manifestacija karcinoma bubrega koja zahtijeva hitni operacijski zahvat. MSCT abdomena i zdjelice je radiološka metoda izbora za akutnu abdominalnu/lumbalnu bol u hemodinamski nestabilnog bolesnika.Aim: To present a case with spontaneous, non-traumatic, perirenal haemorrhage (Wünderlich syndrome) as a first manifestation of renal cell carcinoma. Case report: A 37-year-old female was admitted to the emergency unit with sudden and severe pain in the left lumbar area of abdomen. She has normal voiding, without macrohaematuria or trauma in her medical history. Because of her generally instable state she was referred to emergency multi-slice computed tomography (MSCT) exam of the abdomen and pelvis which reveals inhomogeneous mass in the upper pole of the left kidney. Radiology report indicated perirenal haemorrhage most likely caused by an angiomyolipoma. The patient was operated on by urologist who performed a partial nephrectomy of the left kidney and evacuation of haematoma. Samples were taken for histopathology and cromophobe renal cell carcinoma which caused the perirenal haemorrhage was diagnosed. Our patient is controlled on regular basis, without signs of tumour recurrence. Conclusion: Wünderlich syndrome as the first manifestation of renal cell carcinoma is a very rare but life-threatening manifestation of renal cancer that warrants urgent surgery. MSCT of the abdomen and pelvis is a method of choice in haemodynamically unstable patients with acute abdominal/lumbar pain