Rush Of Air Research Articles

You Were the Bird: On Petite Maman and motherhood

You Were the BirdOn Petite Maman and motherhood Georgia Cloepfil (bio) In the opening scene of Céline Sciamma's film Petite Maman, a young girl named Nelly moves from room to room saying goodbye to a series of unnamed women, all gray-haired residents of a senior care center. Behind the last door, Nelly finds her own mother, Marion, tidying up in her recently deceased grandmother's all-but-empty room. Her mother takes a seat and overlooks the grounds of the facility. There is a gulf between the threshold of the door, where Nelly stands, and that of the window, where her mother contemplates the reality of her new role as a motherless mother. The movie's title pans across Marion's back. Perhaps for the first time, Nelly is glimpsing the ocean of her mother's grief and experience–and she can't quite stretch across it. [End Page 74] One of the movie's strengths is its ability to lay bare a moment of realization that all young people have at some point: our parents were people (with loves, grief, ambition) before we came into the world. They had mothers. We watch as Nelly recognizes that her own life overlaps with Marion's, but it will never run parallel; the procession of generations marches onward. When they finish packing up her grandmother's room and drive away, Nelly reaches toward her mother around the headrest of her seat and feeds her cheese puffs one by one as she drives. Then a little sip of apple juice. Then a hug. The tender opening scene reminded me of a passage I read (and underlined) in Anne Truitt's Daybook long before I had any plans to have children: Mary's son was born early this morning. After hearing the news, I lay back in the predawn dark and, as the tide of happiness receded, I saw that it had pulled out on some long, bare inner shoreline of myself and had made the slope glisten for the last time: Both my daughters are now mothers and in the proper nature of things more mothers of their children than they are daughters of their mother. We reside on an axis between mother and daughter until birth, death, or another dramatic event threatens to tilt us abruptly in one direction or another. There is a sense of inevitability but also a deep melancholy to this sentiment, and I worried for a long time about making my own mother feel its truth. I discover that I am pregnant on an August morning. The test sits on my dining room table, its two decisive blue lines bisecting. The news is not a surprise, but it still brings with it a feeling that life has unexpectedly accelerated. To me, the passage of time has always felt like a fierce wind. It's something to take shelter from, something to brace myself against or evade. If I am not careful, everyone I love might be taken up by a violent rush of air and carried forward with me. The novelist Samantha Hunt once [End Page 75] Click for larger view View full resolution Joséphine Sanz and Nina Meurisse in Petite Maman. © Liles Films, courtesy NEON. [End Page 76] said that it makes sense to think of mothers as makers of death. She meant that we make our children's deaths. But I'm not there yet. What's inside of me barely feels alive, is barely felt. Embryonic and invisible, the pregnancy still seems like the impetus of some other change. Even if it is "the proper nature of things," my becoming a mother means that my own mother is, suddenly, a grandmother. I have the sense that by becoming pregnant, I am singlehandedly ushering my mother toward the next phase of her life and then toward her death. My worry hardens into fear. The week after I tell her that I am pregnant, my mother's mammogram reveals a tumor in her right breast. She waits weeks for news, for surgery, for a plan. In the silence she can barely sleep, and neither can I. Rationally, I know that the...

An ornithological walk to improve the well-being of mental health professionals during the COVID-19 pandemic: a pilot study

Introduction: The COVID-19 pandemic has changed many routines worldwide and has also affected the mental health of psychiatric patients and mental health professionals. One of the suggested methods for mental health improvement is more intensive contact with nature, including birdwatching as a hobby. Material and methods: After an ornithological walk in February 2021 for 5 psychiatrists and psychotherapists, in spite of unfavourable weather, all participants very positively evaluated the impact of birding on their well- -being, mood and subjective evaluation of stress level. Results: Particularly important is an observation that the pandemic reality forced the whole society, including mental health professionals, to limit their behaviours and attitudes to very “adult” and responsible ones. Everyday life was reduced to functioning based on a very concrete approach to reality while abandoning activities that stimulate imagination (travels, theatre, arts). The ornithological walk allowed participants to abandon the pandemic reality and enter the space of playfulness, fantasies and childhood experiences. It enabled immersion in a friendly “mother-world” in which sensory perceptions proved to be important: smell, touch (“rush of air”), feeling of space. Birds were perceived not only as direct objects of observations but also as symbols of freedom, energy and lightness. Conclusions: Despite the small group size, ornithological walks are recommended as a nature-based intervention exerting a positive influence on the mental health of psychiatrists and psychotherapists. It is also believed to positively affect the management of their patients, although this and many other aspects require further research.

Trauma surgeon as thoracic surgeon

A 24-year-old man presented to the trauma center with obvious distress and a gunshot wound above the left nipple. The patient was speaking but was confused and diaphoretic with a...

2166 Delayed Symptomatic Pneumoperitoneum After Peroral Endoscopic Myotomy (POEM)

INTRODUCTION: Per-oral endoscopic myotomy (POEM) is as an effective and safe option for the treatment of achalasia. Symptomatic pneumoperitoneum, one of the most significant adverse events noted with POEM, generally presents during the periprocedural period and is treated with needle decompression. We report two cases of delayed symptomatic pneumoperitoneum that were recognized more than 24 hours after POEM, which has not been reported previously. CASE DESCRIPTION/METHODS: A 49-year-old female with history of achalasia presented with two-year history of dysphagia, 40lb weight loss, regurgitation, and chest pain that had been refractory to multiple esophageal dilations and botulinum toxin injections. She underwent an uncomplicated POEM and was admitted for observation. On post-procedure day 2, she complained of worsening shortness of breath and abdominal pain. Chest and abdominal radiographs revealed large volume pneumoperitoneum. Due to continued progression of pain and dyspnea, as well as persistence of pneumoperitoneum on imaging, she underwent CT-guided FNA decompression on post-procedure day 4, with 660 ml of air evacuated and improvement of pain and dyspnea. A 53-year-old female with history of achalasia presented with four-month history of dysphagia, 40lb weight loss, and regurgitation. She underwent an uncomplicated POEM and was admitted for observation. Approximately four hours after the procedure, she became febrile and tachycardic, concerning for perforation. She was transferred to the ICU, where physical exam revealed crepitus to the neck and chest, as well as diffuse abdominal tenderness without guarding or rebound. A chest radiograph revealed large volume pneumoperitoneum. Gastrograffin swallow showed no evidence of contrast extravasation or perforation. On post-procedure day 1, she underwent bedside ultrasound-guided needle decompression using a 16-gauge angiocatheter, which led to a rush of air and improvement in abdominal pain. DISCUSSION: While symptomatic pneumoperitoneum is the second most common adverse event associated with POEM, it has been reported exclusively in the immediate periprocedural period. The etiology of delayed symptomatic pneumoperitoneum in these cases is unclear. No precipitating factors were identified in the first case; in the second case, it is possible that the symptoms were due to a microperforation not detected on imaging. These cases illustrate the importance of continued vigilance for this complication outside of the immediate periprocedural period.

AB005. Complications and management following tracheal resection and reconstruction

AB005. Complications and management following tracheal resection and reconstruction

Making Sense of Air

The stage, argued the art critic Adrian Stokes, is more than just the boards. It is also the rush of air that comes with the movements of curtains or flown set, and its displacement by the bodies of performers: ‘The dancer makes of that air a thing that seems tangible to us’ (1935: 54). Tracing lines in the air, and displacing it in eddies as they move, dancers work not only on, or across the boards that ground them, but on the atmosphere above it. In this article I argue for the necessity of thinking more extensively about this ‘tangible thing’, the air, as it is shaped in performance, and how the exertion of the various pressures and movements of these shapings become meaningful as aesthesis - the matter or practice of ‘making sense’. Part of the difficulty of thinking about air in relation to aesthesis is that it not only pertains to bodies but also to situations beyond them; as Peter Adey notes, it is ‘both personal and planetary’ (2014: 39).In this article I examine the aesthetics of air in terms of the tangibility discerned by Stokes (albeit outside the theatre itself) in Rosemary Lee and Simon Whitehead’s 2016 Calling Tree. This performance invoked a tangible sense of air, I argue, in movements of sound and bodies through the canopies of two giant plane trees in St George’s Gardens in Bloomsbury, in central London. In considering the aesthetics of air in Calling Tree I also look to the implications for performance of a range of eco-critical studies - from Ingold’s invocations of the materiality of the ‘weather world’ to the ekstases of Gernot Böhme's staged atmospheres - in which haptic, optic and aural senses testify to the materiality of what Steven Connor terms the ‘palpable absence’ of air (2010).

Striking Iron: The Art of African Blacksmiths

Striking Iron: The Art of African Blacksmiths

Pokretljivost kože i ekspresije lica u nauci i umetnosti

Skin as a phenomenon includes a variety of terms such as skin intelligence, skin erection, skin shyness, skin fantasy and memories, character armor, skin flickering, trans-flicker, thick skin. Within their meaning they are all connected by one common thread: communication through skin. Skin communicates via ''drawing'' which can be seen on it: engraved lines, streaks, dots, channels, complex line systems, glow, flickerings... That is the ''natural drawing'' as the anatomy names it and describes it. The basic trait of a natural skin drawing is movement and its incessant transforming. The mobility of facial skin exceeds that of skin of any other body part. Skin transformation entails posing a series of questions: specific mechanisms of the natural drawing, its psychical meaning, the question of true causes, constancy or mobility of the drawing, meaning, purpose of mobility, why of all the organs the skin stands out as crucial to understanding human body or man, in the field of science as well as in the art field. Studying the natural drawing on the skin, within art is possible to remodel into meanings and systematically fill up by examining its mobility. Even by only naming the phenomena and terms related to human skin we get an insight into the broadness of the subject, however the idea of the text is to carry out a systematization of the abovementioned phenomena similar to an illustrated poetic-anatomy glossary which, in this case, brings us closer to the facial skin phenomenon as the most extreme one when it comes to mobility. The illustrations which are embedded in the text are literally examples from art in the form of drawings, sculptures and photographs, only the verbal part of the text which explains less adopted scientific terms related to skin such as: Character armor, Skin erection, Skin memories, which contribute to feeling the importance of the skin in communication more intensely, can also be subsumed under the illustration. Reading scientific texts can lead to fine art solutions and allow for deeper and invisible connections to be experienced. By its difficulty the term Natural drawing, which is adopted in the medical anatomy textbook, especially stands out and creates a connection between two areas of human activities, anatomy and art. Involved features on the skin of the human body in their apparent heterogeneity are unified by movement as their common feature, a feature which is the main quality of life from the scientific as well as from the artistic point of view. Reduced to its most simple formula, the causes of skin mobility are of indivisible psychosomatic origin. True cause of movement is rush: the rush of life, rush of tears, rush of sexual urges, rush of moral barriers, rush of passion, rush of aggressiveness, rush of thrill, rush of air, rush of lying. It can most easily be seen on the face, because facial skin is a projection surface on which even the slightest emotion is shown as the first signal. Interpreting those movements has its own practical purpose in judiciary, criminology, medicine, art, as well as in everyday communication.

AB002. Tracheal surgery

AB002. Tracheal surgery

Mechanism of formation of volcanic bombs: insights from a pilot study of anisotropy of magnetic susceptibility and preliminary assessment of analytical models

Volcanic bombs and achneliths are a special type of pyroclastic fragments formed by mildly explosive volcanic eruptions. Models explaining the general shapes of those particles can be divided in two broad categories. The most popular envisages the acquisition of shapes of volcanic bombs as the result of the rush of air acting on a fluid clot during flight, and it includes many variants. The less commonly quoted model envisages their shapes as the result of forces acting at the moment of ejection of liquid from the magma pool in the conduit, experiencing an almost negligible modification through its travel through air. Quantitative evidence supporting either of those two models is limited. In this work, I explore the extent to which the anisotropy of magnetic susceptibility (AMS) might be useful in the study of mechanisms of formation of volcanic bombs by comparing measurements made on two spindle and two bread-crusted bombs. The results of this pilot study reveal that the degree of anisotropy of spindle bombs is larger, and their principal susceptibility axes are better clustered than on bread-crusted bombs. Also, the orientation of the principal susceptibility axes is consistent with two specific models (one of the in-flight variants and the general ejection model). Consequently, the reported AMS measurements, albeit limited in number, indicate that it is reasonable to focus attention on only two specific models to explain the acquisition of the shapes of volcanic bombs. Based on a parallel theoretical assessment of analytical models, a third alternative is outlined, envisaging volcanic bomb formation as a two-stage process that involves the bursting of large (~m) gas bubbles on the surface of a magma pond. The new model advanced here is also consistent with the reported AMS results, and constitutes a working hypothesis that should be tested by future studies richer in data. Fortunately, since this work also establishes that AMS can be used to determine magnetic fabric in small size samples, the possibility to expand this study to a larger collection of bombs is granted.

The Loseable World: Resonance, Creativity, and Resilience

The Loseable World: Resonance, Creativity, and Resilience

Redeeming the Aural: Amodal Resonance and Media History

REDEEMING THE AURAL: AMODAL RESONANCE AND MEDIA HISTORY Sounding New Media: Immersion and Embodiment in the Arts and Culture by Frances Dyson. Berkeley: University of California Press, 2009. Pp. 262. $60.00 cloth, $28.95 paper.In tracing the hitherto overlooked influence of on the theory and practice of new media art, Frances Dyson's Sounding New Media offers a productive point of entry into historicizing 1990s cyberculture and the newness of new media. Dyson's central argument is twofold. First, Dyson claims that the features that supposedly mark new media as new-qualities such as tactile interactivity and total sensory immersion-have roots in older, predominantly sonic media (e.g., radio, telephone, and early electroacoustic art). In developing this first claim, Dyson argues additionally that sound is simultaneously neglected and appropriated by the rhetorics of immersion and embodiment that have inaugurated new media discourse and have announced new media as 'new' (6). That is, for Dyson, the rhetorical frameworks through which we make sense of sound-the distinction between original and recorded sound, for instance, or between signal and noise-have quietly and tacitly laid the groundwork for the visual and tactile tropes we tend to use when we talk about digital media. At stake, then, is the redemption of the aural in a regime that only seems to be dominated by other sense modalities.Although Sounding New Media offers a compelling impressive account of new media, the book has greater consequences for what has become a central problem for scholarship on audiovisual media in general-namely, the relationship between the modal and the amodal. By modal, I mean the idea that sensory experience differentiates into discrete modalities: sight, sound, touch, smell, and so on. In contrast, to describe sensation as amodal is to emphasize how any given perceptual event cannot be reduced to just one modality. When a car speeds by me, for instance, I not only hear and see the car but also feel a rush of air and a slight rumble. In cinema and media studies, the following questions arise: How do media such as the cinema and television use sight and to evoke sensations that resonate in the human body amodally, beyond merely the visual and sonic modalities? And, for that matter, how can we identify ourselves as scholars in one modality-musicology, studies, visual culture, and so on- while doing justice to the richness and complexity of resonance among multiple modalities? Dyson answers these questions by using a sonic figure: the embodied voice. The dominant tendency in cinema and media studies, however, has been to answer in another register: that of touch.The aspect of touch that has done the most theoretical work is the reflexivity of self-touching-in particular, the experience of touching one's left hand with one's right hand. Especially in film theory, scholars such as Jennifer Barker and Vivian Sobchack have taken this figure from Maurice MerleauPonty, who uses it to describe the fundamental reversibility of subject and object in perception. For example, for Barker, just as I may reverse between being in my left hand touching the right hand and in my right hand touching the left, so, in the cinema, may I reverse between being in my body and being in the counterfactual world of the film.1 The amodal is central to this discussion in that tactile structures come to underpin all other sense modalities; the tactile is posited as the reversibility from which all other modes of reversibility derive. This bias toward the tactile-and an attendant denigration of the visual-is less ingrained in the field of media studies, in which Dyson is writing, than it is in the narrower field of cinema studies. It is, however, present, and is best exemplified by media theorist Mark B. N. Hansen's concept of tactility, which he develops in Bodies in Code (2006). Tactility is primary or originary for Hansen in that other modalities, such as vision, need something outside the body-a technical artifact, such as a mirror-to produce the kind of specular, reflexive relation (seeing oneself seeing-oneself) that self-touching has from the start, without such an exteriorization or artifact. …

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In Reply

Thank you for your interest in our case report.1The following are replies to Dr. Omar et al . and to Dr. Verniquet.Dr. Omar et al. offer several important considerations regarding occult pneumothorax in trauma patients. However, our operating room patient population differs because most of these cases are elective operations. In case 1 (elective Nissen fundoplication), the etiology of pneumothorax was surgical entry into the pleural space causing lung collapse, not tension pneumothorax. A diagnostic pleural tap may not have yielded a rush of air and may have failed as a test for pneumothorax. Other circumstances (such as mucous plug) can cause low oximeter saturation, high airway pressures, and decreased breath sounds that resemble pneumothorax. Here, an unnecessary pleural tap could potentially make circumstances worse. If the lung-sliding sign was appreciated, the diagnostic tap would have been avoided and other differential diagnoses could be advanced. A key advantage of ultrasound is its ability to noninvasively contribute to the diagnosis.Dr. Verniquet correctly stated the mechanism by which air in the pleural space disrupts the lung sliding sign. Thank you for that clarification. Dr. Verniquet also made several observations about the diagram that accompanied the ultrasound image. First, it was noted that the pleural line was visible beneath the rib structure. It was suggested that cartilage rather than rib was actually imaged because heavy rib calcification will cast an ultrasonic shadow and make the pleural line not visible. Although this is a possibility, the pleural line is often visible at the edges of known rib images. The second critique concerned the region of the diagram labeled lung parenchyma. Dr. Verniquet indicated that normal air-filled lung is not visible by ultrasound. However, the purpose of the diagram and image was to help interpret the lung sliding sign shown in the video. The major point is that the lung sliding sign implies that lung parenchyma, not pneumothorax, is present in this area. Similarly, the presence of a comet-tail artifact implies the presence of air-filled lung rather than pneumothorax.2We also acknowledge the comments by Dr. Verniquet and Dr. Omar et al. that computed tomography rather than chest x-ray is the gold standard for diagnosis of pneumothorax. However, some have described a gold standard to be the best available test rather than the perfect test.3From an operating room perspective, timely access to computed tomography of the chest is distinctly limited compared with that of emergency departments and intensive care units. Further, the intraoperative question is to identify a large, compromising pneumothorax. The utility of thoracic computed tomography to identify a small, occult pneumothorax carries less clinical relevance for the operating room patient.4,5Therefore, it is arguable that a portable chest x-ray, albeit its lower sensitivity to detect a smaller pneumothorax compared with computed tomography, is the gold standard to image an operating room pneumothorax. Increasing the availability and experience with ultrasound in anesthesia will allow us to rule out potential pneumothorax in clinical practice in a fast and noninvasive manner.

Damage control sternotomy for penetrating mediastinal vascular injury

Whilst temporary vacuum-assisted wound management has become a mainstay in the treatment of patients with severe abdominal trauma in extremis, the use of this technique in the management of exsanguinating injuries and resultant physiologic decompensation in other body cavities is ill defined. Concerns over potential cardiac and pulmonary compromise secondary to packing along with the lethal nature of penetrating injuries to the thorax has limited extension of these practices to the management of this body region. Many patients with central vascular injuries secondary to penetrating trauma either expire prior to hospital arrival or arrive haemodynamically unstable and require emergency department thoracotomy. To our knowledge, there are no reports of the use of damage control sternotomy with temporary substernal and intrathoracic packing for traumatic thoracic injuries. We report our experience treating an adolescent patient who sustained a central venous injury and bilateral lung lacerations with a damage control sternotomy approach. A 15-year-old girl presented to the emergency department after sustaining multiple stab wounds to the neck, chest and back. On arrival to the emergency department, she was tachycardic (HR = 120) and hypothermic (T = 34.5 8C) but normotensive (SBP = 113) and neurologically intact (GCS = 15). Exam findings included a 3 cm laceration extending from zone 2 to zone 1 of her right neck, a 2 cm infraclavicular sucking wound to the left chest with associated crepitus and a 5 cm laceration to the posterior left shoulder. Standard ATLS resuscitation was performed and a left tube thoracostomy was placed with resultant rush of air and 500 ml of bloody drainage. A subsequent chest X-ray demonstrated a large right haemothorax. After placement of a right tube thoracostomy and immediate drainage of over 1000 ml of blood, the patient began to cough, resulting in massive bleeding from her neck wound and haemodynamic instability. Direct pressure was applied to the neck to temporarily control bleeding. Subsequent Accepted 1 March 2010

Traumatic diaphragmatic hernia presenting as a tension fecopneumothorax

A traumatic diaphragmatic hernia is a well-known complication following blunt abdominal or penetrating thoracic trauma. Although the majority of cases are diagnosed immediately, some patients may present later with a diaphragmatic hernia. It occurs in approximately 3% of abdominal traumas. Diagnosis requires a high index of suspicion since diaphragmatic injury can only reliably be ruled out by direct visualization, i.e., laparoscopy. Hence, delayed presentation with complications secondary to the injury is not uncommon. We discuss a case of a young man who presented in respiratory distress 5 years after a stab wound to the left chest. The patient was hypoxic, with a chest X-ray (CXR) demonstrating a pneumothorax with effusion. A chest tube was placed with a rush of air and feculent drainage. CT scan revealed an incarcerated transverse colon in a diaphragmatic hernia. The laparotomy demonstrated necrotic colon in the chest with gross fecal contamination in the chest. The diaphragmatic defect was closed and a Hartmann's procedure performed. The patient developed empyema in the postoperative period. Our patient is the twelfth reported case of a tension fecopneumothorax resulting from traumatic diaphragmatic herniation. This paper reviews all cases, including the diagnostic workup, operative approach, and expected postoperative course of this unusual condition.

Sensitivity of Bedside Ultrasound and Supine Anteroposterior Chest Radiographs for the Identification of Pneumothorax After Blunt Trauma

Supine anteroposterior (AP) chest radiographs in patients with blunt trauma have poor sensitivity for the identification of pneumothorax. Ultrasound (US) has been proposed as an alternative screening test for pneumothorax in this population. The authors conducted an evidence-based review of the medical literature to compare sensitivity of bedside US and AP chest radiographs in identifying pneumothorax after blunt trauma. MEDLINE and EMBASE databases were searched for trials from 1965 through June 2009 using a search strategy derived from the following PICO formulation of our clinical question: patients included adult (18 + years) emergency department (ED) patients in whom pneumothorax was suspected after blunt trauma. The intervention was thoracic ultrasonography for the detection of pneumothorax. The comparator was the supine AP chest radiograph during the initial evaluation of the patient. The outcome was the diagnostic performance of US in identifying the presence of pneumothorax in the study population. The criterion standard for the presence or absence of pneumothorax was computed tomography (CT) of the chest or a rush of air during thoracostomy tube placement (in unstable patients). Prospective, observational trials of emergency physician (EP)-performed thoracic US were included. Trials in which the exams were performed by radiologists or surgeons, or trials that investigated patients suffering penetrating trauma or with spontaneous or iatrogenic pneumothoraces, were excluded. The methodologic quality of the studies was assessed. Qualitative methods were used to summarize the study results. Data analysis consisted of test performance (sensitivity and specificity, with 95% confidence intervals [CIs]) of thoracic US and supine AP chest radiography. Four prospective observational studies were identified, with a total of 606 subjects who met the inclusion and exclusion criteria. The sensitivity and specificity of US for the detection of pneumothorax ranged from 86% to 98% and 97% to 100%, respectively. The sensitivity of supine AP chest radiographs for the detection of pneumothorax ranged from 28% to 75%. The specificity of supine AP chest radiographs was 100% in all included studies. This evidence-based review suggests that bedside thoracic US is a more sensitive screening test than supine AP chest radiography for the detection of pneumothorax in adult patients with blunt chest trauma.

A new vacuum component: fast acting puncture valve

Generally, for proton induced X-ray emission (PIXE), external-PIXE, gamma ray spectrometry, charge particle spectrometry or ion beam irradiation in air using large vacuum system like particle accelerator, a thin Mylar or Kapton foil are used as a window material (chamber) for above beams to perform experiments. The problem arises when this thin Mylar or Kapton foil gets destroyed accidentally in mid-run. Air with high velocity rushes inside, which disturbs the inside vacuum of the chamber or beam lines and causes failure of the experimental system. In order to avoid this, one needs a sensitive arrangement, which can sense the rush of air and stop it entering in to the vacuum chamber or lines. The solution to the above problem is achieved by design a new fast acting puncture valve. The valve is working on the basis of differential pressure and the basic underlying principle to sense the rushing air is based on Bernoulli's principle and Pascal's law, which is different from commercially available fast acting valve. The new valve is installed in the External beam line of 3MV tandem pelletron accelerator at Institute of Physics, Bhubaneswar and working fine in both rough as well as high vacuum.

Pulmonary Mucormycosis

A 56-year-old nondiabetic male presented for evaluation of fever and cough shortly after 6 cycles of chemotherapy for treatment of non-Hodgkins lymphoma. Over the subsequent few days, the patient developed hemoptysis, sepsis, hypotension, and severe immunocompromise (total white blood cell count = 100/mm3) and thrombocytopenia (platelet count = 41,000/mm3). Chest x-ray (normal one month prior) demonstrated a prominent cavitary lung lesion involving the left upper lobe (Fig 1 ; sternal wires are from a previous mitral valve repair procedure). Computed tomography of the chest provided additional anatomic detail (Fig 2 ). Because of the patient's rapid clinical deterioration, platelet transfusion and subsequent surgery were performed.Fig 2View Large Image Figure ViewerDownload (PPT) Exploration of the left hemithorax was conducted through a standard posterolateral thoracotomy. A large-diameter (11-cm) necrotic abscess was discovered, requiring anatomic left upper lobectomy. An intercostal muscle flap was used to cover the bronchial stump. After completion of the surgical procedure, the specimen was further examined (Fig 3 ). When the abscess was incised, a prominent rush of air was appreciated as the cavity decompressed and partially collapsed (Fig 4 ). The specimen was sent for histologic and microbiologic evaluation. Postoperatively, aggressive resuscitation was continued in the intensive care unit. Identification of Mucor species (Fig 5 , hematoxylin & eosin, ×400) allowed for treatment with amphotericin B. Unfortunately, the patient died 8 days after surgery following complications of septic shock, renal failure, suspected disseminated intravascular coagulation, and upper extremity ischemia.Fig 4View Large Image Figure ViewerDownload (PPT)Fig 5View Large Image Figure ViewerDownload (PPT)

Opacified Hemithorax With Ipsilateral Mediastinal Shift After Transthoracic Needle Biopsy

A 75-year-old woman underwent transthoracic CT-guided cutting-needle biopsy of a 5 5-cm mass of the superior segment of the left lower lobe and had an episode of recent hemoptysis. She had been ill for 3 months with dyspnea, cough, and intermittent sputum production. Chest radiographs revealed a persistent left lower lobe alveolar opacification believed to be pneumonia; however, the patient had no improvement with two courses of oral antibiotics. She had severe COPD and was receiving home oxygen at 2 L/min, with baseline dyspnea with minimal exertion. Immediately following the CT-guided biopsy of the lung mass, she expectorated a large volume (approximately 500 mL) of bright red blood, and CT imaging revealed a pneumothorax. The pneumothorax was evacuated with a 12F chest tube placed under CT guidance. The patient remained hypoxic with an oxygen saturation of 85% on partial nonrebreather oxygen mask, and so was then intubated, with improvement in her arterial oxygen saturation to 90% but on fraction of inspired oxygen of 1.0. Suctioning through the endotracheal tube returned scant amounts of bloody secretions over the next several hours. After stabilization, she was transferred to an ICU. In the midst of the transport, her arterial oxygen saturation declined to 65%, followed soon thereafter by cardiac arrest. She was pulseless and had absent breath sounds over her entire left hemithorax. Cardiopulmonary resuscitation was initiated. Cardiac monitoring revealed electromechanical dissociation. The patient was administered epinephrine, 1 mg IV, and a 32F left-sided chest tube was placed emergently. The chest tube immediately drained 50 mL of blood, but no rush of air or air leak in the chest tube was appreciated, and subsequently the tube showed no respiratory variation. She had a return of spontaneous circulation shortly thereafter, with a total arrest time of 4 min. She was neurologically intact and following commands 30 min later. A chest radiograph was obtained (Fig 1).