Posterolateral Chest Wall Research Articles

Radiological Cases of the Month

A 13-WEEK-OLD male was admitted with a 3-day history of cough and congested breathing. He had no fever, and the parents reported that he was eating well. The results of a physical examination revealed a well-nourished and well-developed infant. He showed respiratory distress, with a respiratory rate of 63/min, and intercostal retractions. The breath sounds were decreased over the right hemithorax. The results of the complete blood cell count and serologic examinations showed no abnormalities. Further evaluation was by chest roentgenography ( Figure 1 ) and computed tomography of the chest ( Figure 2 ). Denouement and Discussion Neonatal Intrathoracic Teratoma Presenting as a Posterolateral Chest Wall Mass A spectrum of germ-cell neoplasms occurs in infancy and childhood in a characteristic midline anatomic distribution. 1-9 The sacrococcygeal area is the most common site of teratoma followed in frequency by the ovary. Other sites of origin are the retroperitoneum, mediastinum, head and neck, testis, and

Fetal tumors associated with hydrops: The role of the pediatric surgeon

Fetal tumors are being diagnosed with increasing frequency and great accuracy by antenatal ultrasound. High-output cardiac failure and hydrops indicate fetal distress. Management may be limited by the gestational age of the fetus. Our experience with three fetal tumors demonstrates the dilemma with respect to timing of delivery and prognosis. Following the diagnosis of a large sacrococcygeal tumor, a 22-week-gestation fetus became hydropic and died. Another fetus with a rapidly growing posterolateral chest wall mass required cesarean section delivery at 29 weeks gestation. Postnatal course was complicated by pulmonary hypoplasia, intratumoral hemorrhage, and death. The third fetus had an enlarging tumor in the right lobe of the liver. Poor biophysical provile and mild hydrops necessitated cesarean section delivery at 34 weeks. Right hepatic lobectomy was performed and the infant was subsequently discharged home at one month of age. The deleterious effects of the fetal tumor and the need for its removal have to be carefully weighed against the ability of the fetus to survive postnatally.

Postoperative atrophy of posterolateral chest wall musculature: CT demonstration.

We review five cases in which CT demonstrated severe unilateral atrophy of the latissimus dorsi muscle. In four of these cases, similar findings were also seen in the inferior portion of the serratus anterior muscle. All patients had undergone thoracic surgery on the ipsilateral side 10 months to 3 1/2 years prior to CT. All patients had undergone posterolateral thoracotomy, including one who had undergone successive right and left posterolateral thoracotomies. The most likely explanation for the CT finding of atrophy is denervation injury resulting from surgical incision. We discuss normal innervation of the posterolateral chest wall musculature, with emphasis on the relationship of unilateral atrophy of posterolateral chest wall musculature to previous surgical incision.

Diagnosis of Asbestosis and Asbestos-Related Pleural Disease by Imaging Methods: Asbestos Related Disease

Four types of roentgenographic changes occur in the pleura-plaque formation, diffuse pleural thickening, calcification, and pleural effusion-each ofwhich may occur alone or in combination with the others. These pleural manifestations dominate the picture roentgenographically in the majority of series. Pleural thickening or pleural plaques usually are bilateral, more prominent in the middle third of the thorax, and tend to follow the rib contours. Pleural plaques are fibrotic processes that begin in the deepest part of the parietal pleura and morphologically are ivory white in color. They may be smooth or nodular in contour and may measure up to 1 cm in thickness, although they are usually thinner. They occur most commonly on the aponeurotic portion of the diaphragm, on the posterolateral chest wall between the 7th and 10th ribs, and on the lateral chest wall between the 6th and 9th ribs. Their origin in the parietal pleura is in contrast to the visceral pleural involvement that characterizes previous hemothorax or empyema. They may be very difficult to visualize, particularly when viewed en f ace, and tangential roentgenograms may be necessary. Although pleural thickening posteriorly may be difficult to recognize roentgenographically, its presence may be detected by CT or ultrasonic examination. The greatest problem in the roentgenologic diagnosis ofearly plaque formation lies in distinguishing them from normal companion shadows of the chest wall, and, in fact, distinction sometimes is impossible with conviction. Despite these difficulties, it is clear that noncalcified plaques occur often enough to be regarded as virtually diagnostic of asbestos-related disease. Although uncalcified pleural plaque formation is probably the most common roentgenographic manifestation of asbestos-related disease, the most striking abnormality is calcification of pleural plaques. Calcified plaques vary from small linear or circular shadows commonly situated over the diaphragmatic domes to complete encirclement of the lower portion of the lungs. When calcification is minimal, a roentgenogram overexposed at maximal inspiration facilitates visibility. No portion of the pleura is immune to calcification, although the most common site is the diaphragm.

Lung Sound Intensity Variability in Normal Men: A Contour Phonopneumographic Study

We describe and demonstrate a new lung sound measurement and display technique by which contour maps of lung sound intensity may be constructed. Using this technique, we have studied the lower posterolateral chest wall of ten healthy subjects. The data revealed an unexpectedly high degree of intersubject and intrasubject variation. The reason for this variation is obscure but probably relates to the basic mechanisms of production and transmission of lung sounds.