Intrathoracic Migration Research Articles

Transthoracic migration of a Kirschner wire from the humerus to the abdomen

Migration of Kirschner wires after fracture fixation is a rare complication. Several cases of intrathoracic migration after humeral or clavicle fixation with this technique have been reported though. We describe an even rarer case where a wire migrated from the proximal humerus to the abdomen perforating the left thoracic cavity and hemidiaphragm. The distal end of the wire was located next to the spleen and its proximal end at the fifth intercostal space. This particular case could be managed with a simple direct removal through an incision at the fifth intercostal space. The postoperative course was uneventful.

Recurrent pleural effusion without intrathoracic migration of ventriculoperitoneal shunt catheter: A case report

Pleural effusion is a rare complication of ventriculoperitoneal (VP) shunting, usually due to the migration of the VP shunt catheter into the thorax. Herein we report a neurologically disadvantaged child with a lobar holoprosencephaly and hydrocephalus, initially treated with a VP shunt, who years later developed recurrent right-sided pleural effusion ultimately confirmed to be a cerebrospinal fluid (CSF) hydrothorax without intra-thoracic migration of the distal shunt catheter. Thoracentesis was compatible with a transudative effusion. Given the presence of a persistent pleural effusion, beta-2 transferrin concentrations were measured, which yielded a positive result. Plain radiographs and head computed tomography (CT) showed a normally positioned, functional VP shunt. A spine CT myelogram to look for a spinal dural-thoracic CSF fistula was negative. A radionuclide CSF shunt study demonstrated normal functioning VP shunt with radiotracer accumulation within the peritoneum, with subsequent tracer rapidly accumulating in the right hemithorax. Video-assisted thoracoscopic (VATS) exploration with drainage of the pleural effusion and pleurodesis was then performed. No diaphragmatic defect or shunt tubing within the thorax was found and the procedure failed to resolve the effusion. The patient's recurrent effusion was ultimately resolved with intracranial endoscopic choroid plexus coagulation to decrease CSF output.

Intrathoracic Migration of Large-Fragment Screws After Failed Shoulder Arthrodesis

Orthopaedic implants used during upper-extremity surgery have been discovered in many locations. Kirschner wires and Steinmann pins have migrated into the thorax or mediastinum from local sites1-5 and from distant sites such as the phalanx6, patella7, and hip8. Although there are well-documented case reports on the migration of smooth and threaded Kirschner wires and Steinmann pins from the sternoclavicular and acromioclavicular joints into the thorax, the migration of large-fragment screws from the shoulder into the thorax has not been reported, to our knowledge. Screws are less likely to migrate because of their larger size and irregular shape. We present a case of intrathoracic migration of large-fragment screws after a failed shoulder arthrodesis. In accordance with the medical center institutional review board policy, the patient was informed about, and consented to, case publication. A sixty-three-year-old woman with oxygen-dependent obstructive pulmonary disease presented with right-sided pleuritic chest pain. Her surgical history included multiple surgical procedures in the right shoulder due to instability and rotator cuff arthropathy. An arthroscopic rotator cuff repair in the right shoulder, done in 1989, had failed, and a shoulder arthrodesis was subsequently attempted. Shoulder implants were removed in 1992. Although the patient was asymptomatic, she was noted to have a fibrous nonunion of the right shoulder and had a revision arthrodesis in May 1996. This arthrodesis was unsuccessful, and there was subsequent failure of the implants. The patient was not a candidate for repeat revision arthrodesis because of inadequate bone stock and medical comorbidities. A routine chest radiograph made in 2003 showed a broken plate with screws remaining in the right shoulder region as well as a large-fragment screw on the left side of the thorax, which was from a failed left glenoid reconstruction performed in 1995 at the …

Three-dimensional stomach analysis with computed tomography after laparoscopic sleeve gastrectomy: sleeve dilation and thoracic migration

Laparoscopic sleeve gastrectomy (LSG) is frequently performed as a definitive bariatric procedure today. Quantitative data on the detailed anatomy of the stomach after LSG are yet sparse. Thirty-two multislice computed tomography (MSCT) data sets acquired in 27 LSG patients (22 female, 5 male) with a dedicated examination protocol and post-processing were evaluated for gastric volume, stomach length, sleeve length, antrum length, staple line length, and maximum cross-sectional sleeve area. Obtained parameters were compared to time after surgery, weight loss, and the occurrence of postsurgical regurgitation. Mean gastric volume was 186.5±88.4 ml. Gastric volume correlated significantly with the time interval after surgery. Sleeve sizes of 105.3±30.2 ml during early follow-up confirmed correct primary sizing of the sleeve, whereas marked dilation to 196.8±84.3 ml was found in patients with a follow-up of 6 months and longer (p=0.038). Sleeve area and staple line length were also positively correlated with time after surgery. No correlation was found between gastric volume and excess weight loss. In ten patients an intrathoracic migration of the staple line could be noted, with four of these patients developing persistent regurgitation after LSG. Regurgitation was present in only 2 of 17 patients without sleeve herniation. Multislice computed tomography allows for a comprehensive and quantitative evaluation of the anatomy after LSG and thus provides new insights in the process of sleeve dilation. Intrathoracic migration of the staple line could be identified as a possible cause of persistent regurgitation.

Shedding some light on the use of mesh in gastroesophageal junction surgery

Background Postoperative complications such as failure or disruption of the crura repair and intrathoracic migration of the wrap are the most common anatomic reasons for the failure of Laparoscopic Nissen Fundoplication. The authors hypothesized that ultrastructural illness may be implicated in this recurrence. The aim of this study was to investigate the presence of changes at esophageal hiatal area in patients with and without HH and to shed some light on the use of mesh in this surgery.

Central Venous Catheter Care during Contrast-enhanced CT

HomeRadiologyVol. 255, No. 2 PreviousNext COMMUNICATIONSLETTERS TO THE EDITORCentral Venous Catheter Care during Contrast-enhanced CTDarragh F. Halpenny , Orla Doody, Graeme McNeill, William C. TorreggianiDarragh F. Halpenny , Orla Doody, Graeme McNeill, William C. TorreggianiAuthor AffiliationsDepartment of Radiology, Adelaide and Meath Hospitals incorporating the National Children’s Hospital, Tallaght, Dublin 24, Ireland e-mail: [email protected]Darragh F. Halpenny Orla DoodyGraeme McNeillWilliam C. TorreggianiPublished Online:Apr 8 2010https://doi.org/10.1148/radiol.092152MoreSectionsFull textPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Reference1 Macha DB, Nelson RC, Howle LE, Hollingsworth JW, Schindera ST. Central venous catheter integrity during mechanical power injection of iodinated contrast medium. Radiology 2009;253(3):870–878. Link, Google ScholarArticle HistoryPublished online: Apr 8 2010Published in print: May 2010 FiguresReferencesRelatedDetailsCited ByAmerican Journal of Roentgenology, Vol. 197, No. 1Recommended Articles Ferumoxytol-enhanced MR Venography of the Central Veins of the Thorax for the Evaluation of Stenosis and Occlusion in Patients with Renal ImpairmentRadiology: Cardiothoracic Imaging2020Volume: 2Issue: 6Adventures and Misadventures in Plastic Surgery and Soft-Tissue ImplantsRadioGraphics2017Volume: 37Issue: 7pp. 2145-2163Computer-aided Assessment of Catheters and Tubes on Radiographs: How Good Is Artificial Intelligence for Assessment?Radiology: Artificial Intelligence2020Volume: 2Issue: 1Case 287: Intrathoracic Migration of a Breast Implant after Video-assisted Thoracoscopic Surgery for Right Upper LobectomyRadiology2021Volume: 298Issue: 3pp. 713-716Stratification, Imaging, and Management of Acute Massive and Submassive Pulmonary EmbolismRadiology2017Volume: 284Issue: 1pp. 5-24See More RSNA Education Exhibits Power Injectors and Compatible Intravenous Catheters: A Review and Quick Reference for RadiologistsDigital Posters2018Imaging Findings of Central Venous Catheters Related Complications: A Pictorial ReviewDigital Posters2019Capturing Crusty Catheters: Advanced Techniques for the Removal of Ports with Prolonged Dwell TimesDigital Posters2020 RSNA Case Collection Intermittent Port Malfunction RSNA Case Collection2021Hot Quadrate SignRSNA Case Collection2022Surgical humeral neck fractureRSNA Case Collection2020 Vol. 255, No. 2 Metrics Altmetric Score PDF download

Intrathoracic migration of ventriculoperitoneal shunt

Sir, Intrathoracic migration of the distal end of the ventriculoperitoneal shunt is extremely uncommon. We came across this rare complication, managed successfully by thoracocentesis and shunt revision. A nine-mo-old child underwent a right side ventriculoperitoneal shunt for tuberculous meningitis with hydrocephalus. Routine X-ray post surgery revealed the distal shunt tip below the dome of diaphragm. Three mo after discharge the child presented to the casualty with severe respiratory distress. X- ray chest revealed hydrothorax with coiled distal end of the tube in the thorax with no part below the diaphragm suggesting a supradiaphragmatic intrathoracic migration of the shunt (Fig. 1). Emergency pleural tap was done to relieve the respiratory distress Once the child’s clinical condition was stabilized, revision of the distal end done. Very few cases of intrathoracic migration of the distal end of the shunt presenting with symptomatic hydrothorax. 1-5 Infants are more prone to become symptomatic, as in infants and young children less than 5 yr, the pleura cannot absorb significant cerebrospinal fluid. The intrathoracic migration of the shunt can be either supradiaphragmatic or transdiaphragmatic. 6 In supradiaphragmatic migration the site of entry into the chest is probably incorrect subcutaneous passage. Doh et al, reported incorrect subcutaneous passage under ribs confirmed by CT scan in a case of supradiaphragmatic migration of the shunt. 2 The intrathoracic migration in the present case is supradiaphragmatic as the chest X- ray revealed whole of the shunt tube coiled in the chest with no part below the diaphragm which could be possibly due to the accidental passage into pleural cavity either by passage under the ribs or in the supraclavicular fossa during tunneling. Management requires revision of the lower end with repositioning the distal end back into the peritoneal cavity is required once the patient’s clinical condition stabilizes as was done in the present case. Temporary exteriorization may be required in very sick children. Meeker et al reported a case of intrathoracic migration of the shunt in a female presenting with dyspnea in her early pregnancy which was managed by serial thoracocentesis as a temporary measure and shunt revision after delivery. 5

Is there a Proper Way to Treat Shortened Oesophagus ? About a Series of 67 Patients

Introduction and objective: During the work-up of gastro-oesophageal reflux disease (GORD) patients, barium swallow may show a shortened oesophagus with a non-reducible gastro-oesophageal junction. In our department, in such cases, a Collis-Nissen operation is usually planned. But, the proper reducibility of the gastro-oesophageal junction (GOJ) in the abdomen is difficult to assess peroperatively.The aim of this study is to compare retrospectively the follow-up of an oesophageal lengthening procedure (CollisNissen gastroplasty) versus a standard Nissen in the management of patients with primary short oesophagus or secondary to previous Nissen fundoplication.Patients and methods : Between 01/2000 and 12/2009, 67 patients with a short oesophagus on X-Ray were operated on for proven GORD : 27 (Group A) underwent a Collis-Nissen fundoplication. In 40 patients (Group B), the GOJ was reduced easily and a standard Nissen fundoplication was judged sufficient by the experimented surgeon.Follow up included Quality of Life evaluation using the Gastrointestinal Quality of Life Index (GIQLI) and a barium swallow.Results : 64 patients agreed to participate. Mean follow up was 46 months (4-122). Mean postoperative GIQLI score was 108 in group A, 97 in group B.Barium swallow was performed in 61 patients. In group A, seven patients out of 25 (28%) presented a intrathoracic migration on X-Ray while in group B, it was noted in 20 patients (55%).Conclusion : According literature, Collis gastroplasty allows a tension-free fundoplication to be performed to correct a shortened oesophagus. Though our series of brachy-oesophagus is small, it confirms a better outcome after a CollisNissen gastroplasty, compared to the classical Nissen fundoplication.

Anatomical failure following laparoscopic antireflux surgery (LARS); does it really matter?

Failure rates of laparoscopic antireflux surgery (LARS) vary from 2-30%. A degree of anatomical failure is common, and the most common failure is intrathoracic wrap herniation. We have assessed anatomical integrity of the crural repair and wrap using marking Liga clips placed at the time of surgery and compared this with symptomatic outcome. A prospective study was undertaken on 50 patients who underwent LARS in a single centre over a 3-year period. Each had an X-ray on the first postoperative day and a barium swallow at 6 months at which the distance was measured between the marking Liga clips. An increase in interclip distance of > 25-49% was deemed 'mild separation', and an increase of > 50% 'moderate separation'. Patients completed a standardised symptom questionnaire at 6 months. At 6 months' postoperatively, 22% had mild separation of the crural repair with a mean Visick score of 1.18, and 54% had moderate separation with a mean Visick score of 1.26. Mild separation of the wrap occurred in 28% with a mean Visick score of 1.21 and 22% moderate separation with a mean Visick score of 1.18. Three percent had mild separation of both the crural repair and wrap with a mean Visick score of 1.0, and 16% moderate separation with a mean Visick score of 1.13. Of patients, 14% had evidence of some degree of failure on barium swallow but only one of these was significant intrathoracic migration of the wrap which was symptomatic and required re-do surgery. The prevalence of some form of anatomical failure, as determined by an increase in the interclip distance, is high at 6 months' postoperatively following LARS. However, this does not seem to correlate with a subjective recurrence of symptoms.

Thoracoscopic Management of a Pericardial Migration of a Breast Biopsy Localization Wire

Intrathoracic migration of a breast biopsy localization wire is relatively rare and most of the wires end up in the pleural cavity. We report the first case of almost total intrapericardial migration of a monofilament hooked wire that was lost during the breast biopsy procedure. The case was successfully managed by video-assisted thoracoscopic surgery. Postulated mechanisms of migration of such wires are reviewed and a new mechanism is proposed.

Intrathoracic migration of a Steinman wire: a case report and review of the literature

IntroductionMigration of orthopaedic fixation wires into the thoracic cavity occurs infrequently, but can have dire consequences. Although rare, intrathoracic migration is a serious complication that demands immediate removal.Case presentationWe present a case of a 59-year-old man with an intrathoracic migration of a Steinman wire used for the treatment of a shoulder fracture. Surprisingly, the migration was asymptomatic. The Steinman wire was successfully retrieved from the thorax via thoracotomy.ConclusionThe migration of pins and wires can cause fatal complications and should be considered as very hazardous. Therefore, if wires need to be used, terminally threaded pins are safer and the free end should be bent. The patients should be frequently followed, both clinically and radiographically, until all the wires are removed.

Transmediastinal migration of Kirschner wire

The authors describe a case of transmediastinal migration, and lodging into the right lung, of a Kirschner wire used to fix a fracture of the left clavicle. The medical literature reports cases of intrathoracic migration of Kirschner wire; however, a transmediastinal migration has not been previously described. A small right thoracotomy was performed and the wire was removed without complications. We discuss aspects of this uncommon finding and alert physicians for the potential risks of the migration of metallic pins used to fixate boney structures within the chest.

Intrathoracic migration of ventriculoperitoneal shunt: a case report

IntroductionIntrathoracic migration of ventriculoperitoneal shunt can be transdiaphragmatic or supradiaphragmatic. This complication causes important respiratory symptoms.Case presentationA 7 year-old Caucasian female, hospitalized with the prediagnosis of pneumonia, was determined to have ventriculoperitoneal shunt migration at left hemithorax. A left thoracotomy was performed and the shunt was successfully removed transdiaphragmatically.ConclusionThe patients with intrathoracic migration of ventriculoperitoneal shunt must be treated surgically as soon as possible. Transdiaphragmatic surgical approach would be more suitable from the point of surgical easiness.

Laparoscopic Revisional Fundoplication with Circular Hiatal Mesh Prosthesis: The Long‐term Results

Failure of hiatal closure has proven to be the most frequent complication leading to revisional surgery after primary failed open or laparoscopic antireflux surgery. To prevent hiatal hernia recurrence some authors recommend the use of prosthetic meshes for reinforcement of the hiatal crura. The aim of the present prospective study was to evaluate the safety and effectiveness of a circular hiatal onlay mesh prosthesis applied during laparoscopic refundoplication after primary failed antireflux surgery with intrathoracic wrap migration. The follow-up period was 5 years. A total of 33 patients underwent laparoscopic refundoplication for recurrent symptoms of gastroesophageal reflux disease after primary failed laparoscopic or open antireflux surgery. The underlying morphological complication for symptom recurrence in all patients was hiatal hernia recurrence with intrathoracic migration of the fundoplication. During revisional surgery, after breakdown of the former fundoplication, the esophageal hiatus was thoroughly revised and a circular polypropylene mesh was used to buttress the primarily simple sutured hiatal crura. Additionally, in all patients a refundoplication was performed. Recurrences, complications, functional data, esophagogastroduodenoscopy, and cinematographic X-ray results, as well as quality of life data, were evaluated for the 60-month follow-up period. All reoperations were successfully completed laparoscopically. Twenty-one patients underwent laparoscopic 360 degrees "floppy" Nissen refundoplication, and 12 patients underwent laparoscopic 270 degrees Toupet refundoplication. Hiatal closure was performed by placing a circular polypropylene sheet that had a 3-4 cm keyhole for the esophageal body. Of 24 patients who underwent redo-surgery before May 2000, no patient developed a recurrent hiatal hernia during the first 12 postoperative months. All 33 patients were re-evaluated and underwent complete diagnostic work-up over a follow-up period of 60 months postoperatively. During the long-term follow-up, a new recurrent hiatal hernia with intrathoracic wrap migration developed in 2 patients (6%). In both cases, slippage occurred anteriorly to the esophagus. Both patients were scheduled for repeat refundoplication. In all other patients no recurrence occurred for the complete follow-up period, and no mesh-related complications developed. Laparoscopic refundoplication for primary failed hiatal closure with the use of a circular mesh prosthesis is a safe and effective procedure to prevent hiatal hernia recurrence for short- and mid-term follow-up. However, for long-term follow-up, even with the placement of prosthetic mesh, re-recurrence occurs in some patients, leading to repeated surgery.

Volvulus gastrique : diagnostic et prise en charge thérapeutique

Gastric volvulus is defined as an abnormal rotation of all or part of the stomach around one of its axes. It is a diagnostic emergency and therapeutic challenge because in acute forms it may lead to gastric strangulation with a high risk of ischemia and necrosis. Organoaxial and mesentericoaxial volvulus are distinguished according to the direction of rotation. The most common cause of gastric volvulus is hiatal hernia, but the principal predisposing factor is ligamentous laxity. The diagnosis is suspected when erect chest radiograph images show a high air-fluid level in the chest. Moreover a barium swallow is essential to confirm the diagnosis. Nonetheless, a computed tomography (CT) scan now provides a comprehensive description of the thoracic lesion, including stomach vitality. Gastric volvulus requires surgical treatment, specifically volvulus reduction, reintegration of the stomach into the abdominal cavity in cases of intrathoracic migration, and correction of causal factors. Resection of the hernial sac and the role of gastropexy for preventing recurrence remain controversial. Advances in laparoscopic surgery have made possible a laparoscopic approach to most cases of chronic gastric volvulus.

Hydrothorax Due to Migration of Ventriculoperitoneal Shunt Catheter

A cerebrospinal fluid hydrothorax is a very rare complication following ventriculoperitoneal (VP) shunt and usually reported in children. We report a case of 47-year-old woman who developed massive hydrothorax and respiratory distress following intrathoracic migration of distal shunt catheter. After the confirmation of catheter in thoracic cavity using radionuclide shuntogram, the patient was successfully treated with laparoscopic shunt catheter reposition.

Intrathoracic migration of a breast prosthesis after thoracotomy

Intrathoracic migration of a breast prosthesis after thoracotomy

Laparoscopic redo fundoplication for intrathoracic migration of wrap

Laparoscopic fundoplication is fast emerging as the treatment of choice of gastro-esophageal reflux disease. However, a complication peculiar to laparoscopic surgery for this disease is the intrathoracic migration of the wrap. This article describes a case of a male patient who developed this particular complication after laparoscopic total fundoplication. Following a trauma, wrap migration occurred. The typical history and symptomatology is described. The classical Barium swallow picture is enclosed. Laparoscopic redo fundoplication was carried out. The difficulties encountered are described. Postoperative wrap migration can be suspected clinically by the presence of a precipitating event and typical symptomatology. Confirmation is by a Barium swallow. Treatment is by redo surgery.

Laparoscopic treatment of Barrett’s esophagus: long-term results

Gastroesophageal reflux disease (GERD) is considered the main etiologic process in the metaplastic development of Barrett's esophagus (BE). The most serious complication of BE is the possible dysplastic evolution to esophageal carcinoma. Many treatments have been described to prevent the progression of BE. The outcomes of these interventions are controversial. The aim of this study was to assess whether laparoscopic fundoplication for GERD had an impact on the development of BE. Prospective data were collected from patients who were treated with a laparoscopic fundoplication for BE. Data was collected and analyzed for a variety of clinical and pathologic outcomes. Laparoscopic fundoplications were completed between 1993 and 2001, with a total sample size of 92 (mean age 53 +/- 11.8 years). Each patient was diagnosed with GERD associated with BE confirmed by both endoscopy and biopsy. A laparoscopic fundoplication was performed in all patients (360 degree fundoplication in 81 patients and partial fundoplication in 11 patients). There was no postoperative mortality or major complications from the procedure. The mean postoperative stay was 3 +/- 1 days. Seventy patients (76% of the overall sample size) were followed up for a mean 4.2 +/- 2.6 years. Of the patients available for follow-up, 33% (n = 23) had a complete regression of their BE; 21% (n = 15) had a decrease in the degree of metaplasia/dysplasia; 39% (n = 27) had no significant change; and 7% (n = 5) experienced a progression of the BE. Five patients required further procedures for three reasons: (1) GERD recurrence (n = 2), (2) progression of BE (n = 2), and (3) intrathoracic migration (n = 1). No patients developed high-grade dysplasia or esophageal carcinoma. The results of this study suggest that laparoscopic fundoplication offers a safe and effective long-term treatment for BE. The procedure also demonstrated regression of BE in more than 50% of the sample size.

Laparoscopic antireflux surgery: Tailoring the hiatal closure to the size of hiatal surface area

The closure of the hiatal crura has proven to be a fundamental issue in laparoscopic antireflux surgery. In particular, the use of prosthetic meshes for crural closure results in a significantly lower rate of postoperative hiatal hernia recurrence with or without intrathoracic migration of the fundic wrap. The aim of the present study was to evaluate different methods of crural closure depending on the size of the hiatal defect by measuring the hiatal surface area. Fifty-five consecutive patients (mean age = 53 years) with symptomatic gastroesophageal reflux disease (GERD) were scheduled for laparoscopic antireflux surgery (LARS) in our surgical unit. Intraoperatively, the length, breadth, and diameter of the hiatal defect was measured using an endoscopic ruler. In every patient, the hiatal surface area (HSA) was calculated using an arithmetic formula. Depending on the calculated HSA, hiatal closure was performed by (1) simple sutures, (2) simple sutures with a 1 x 3-cm polypropylene mesh, (3) simple sutures with dual Parietex dual mesh, or (4) "tension-free" polytetrafluoroethylene BARD Crurasoft mesh. Twenty-six patients (47.2%) underwent laparoscopic 360 degree "floppy" Nissen fundoplication. The remaining 29 patients (52.8%) with esophageal body motility disorder underwent laparoscopic 270 degree Toupet fundoplication. Mean calculated HSA in all patients was 5.092 cm2. Thirty-two patients (58.2%) with a smaller hiatal defect (mean HSA = 3.859 cm2) underwent hiatal closure with simple sutures (mean number of sutures: = 2.0). In 12 patients (21.8%) with a mean HSA of 7.148 cm2, hiatal closure was performed with a 1 x 3-cm polypropylene mesh in addition to simple sutures. Five patients with a mean HSA of 6.703 cm2 underwent hiatal closure with Parietex mesh, and in the remaining six patients, who had a mean HSA of 8.483 cm2, the hiatus was closed using BARD Crurasoft mesh. For a mean followup period of 6.3 months, only one patient (1.8%) developed a postoperative partial intrathoracic wrap migration. Measurement of HSA with subsequent tailoring of the hiatal closure to the hiatal defect is an effective procedure to prevent hiatal hernia recurrence and/or intrathoracic wrap migration in laparoscopic antireflux surgery.