Side Of Chest Research Articles

Do bodybuilders pose symmetrically? Lateral bias analysis in mandatory poses of Mr. Olympia Classic Physique athletes

ABSTRACT Athletes in bodybuilding can pose favouring one side or the other of the body while being evaluated in the contests. While previous research assessed lateral bias of posing in a variety of situations, no investigation has been conducted in bodybuilding. We analyzed the lateral posing bias of the Top 15 athletes for the mandatory poses in Classic Physique Mr. Olympias (2016–2023). Results revealed a general bias to the right in all poses, as either moderately or strongly right-lateralized poses were most frequent. Furthermore, “Front Double Biceps” pose was the most symmetrical, while “Your Favorite Classic Pose” was the most asymmetrical one—apart from the always lateralized “Side Chest”. Interestingly, lower-placed athletes (Top 15) posed significantly more often to the right in “Side Chest”, as compared to the Top 5 and Top 10 competitors. These findings contrast the left bias shown in portraiture and photography literature, likely as a consequence of motor constraints and coordination for athletes to pose to the right, along with the level of emotional expressiveness a bodybuilder may wish to reveal on stage. Our data expand previous results of posing asymmetry to the sport of bodybuilding in this pioneering research into the lateral bias of posing.

WP2.14 - Lung Mycetoma - Chronicles from the Pandemic

Abstract Introduction COVID-19 is a global pandemic which obeys no geographical borders. Post Covid pneumonia sequalae is still an unpredictable course especially with patients with a pre-existing lung compromise. In such scenario, a cohort of patients must also be looked for a fungal infection. Case Study A 31-year-old male presented with history of fever, hemoptysis, and weight loss for 1 month. He suffered from Covid-19 pneumonia 3 months back. He was also diagnosed with Pulmonary tuberculosis 4 years back. Examination revealed right sided tracheal deviation with dull percussion note on the upper and middle zones of the right side of chest. Pulmonary function tests showed a restrictive pattern with a FEV1/FVC ratio of 0.9 (FEV1=2.02, FVC=2.22). Transthoracic echocardiography revealed dextrocardia, moderate TR, and a pulmonary arterial systolic pressure of 25 mm Hg. Contrast enhanced CT scan of thoracic cavity showed reduced right hemithorax, well-defined thick-walled cavities in the upper and lower lobe of the right lung and a ground glass appearance in the bilateral lower lobes. A diagnosis of Lung mycetoma was made along with post covid-19 pneumonia changes. Right posterolateral thoracotomy and right pneumonectomy was performed. Per-operatively, a collapsed lower lobe and stony hard upper and middle lobes of right lung with associated fungal balls were found. Patient was clinically well after a 30-day follow-up period. Conclusion Covid-19 patients with pre-existing pulmonary co-morbidities should be followed with caution and pulmonary symptoms in the post pneumonia patient should raise the suspicion of fungal infections as well.

A Case Report On Unusual Mediastinal Mass

A 28-year-old female, a known case of neurofibromatosis 1, presented to the respiratory medicine department with complaints of breathlessness and cough for 2 weeks’ duration. Clinical examination revealed right-sided moderate pleural effusion. Computed tomography (CT) chest revealed a large anterior mediastinal mass with chest wall infiltration. Histopathology showed neoplasm with epithelioid cells, arranged as sheets and interlacing spindle cells with a moderate amount of eosinophilic cytoplasm and inconspicuous nucleoli. Histopathological examination of excised specimen showed a malignant peripheral nerve sheath tumor with rhabdomyoblastic differentiation also known as malignant triton tumor. After palliative chemotherapy, later on follow-up, CT-guided biopsy from right side chest wall lesion also showed the same. Because of this rare presentation, we are reporting this case.

Right Side Chest Stab Wound with Perforation in Diaphragm and Liver Laceration: A Case Report

Liver is one of the organs with the highest injury rate, and in recent decades, the guidelines for the treatment of liver trauma have changed considerably. Now, there is a growing consensus that the most important step is diagnosis and depending upon the degree of severity, non-operative therapy is the main treatment method for hepatic trauma if conditions permit. For serious hepatic trauma patients such as those with hemodynamic instability, they should be operated upon as soon as possible. Regardless of the surgical options, doctors should control damage to patients and try to prevent complications. New therapies such as hepatic artery Embolization and liver transplantation. Our case was a 24 years old man with right chest penetrating wound by stab that perforated diaphragm and lacerated liver that both of them was repaired. Management of liver trauma is multidisciplinary. Diaphragmatic injury may be underestimated due to the presence of concomitant lesions of other organs, to a state of shock and respiratory failure, and to the difficulty of identifying diaphragmatic injuries in the absence of high sensitivity and specific diagnostic instruments.

An indurated plaque on right side of chest – a first sign of underlying breast carcinoma

Previously undiagnosed visceral malignancy may rarely present for the first time as cutaneous metastases. Given their variable clinical presentation early diagnosis is often challenging. We report a case of primary breast carcinoma presenting as cutaneous metastases.

Pneumothorax during laparoscopic plication of diaphragmatic eventration: A case report

Diaphragmatic eventration is the abnormal elevation of the hemidiaphragm or part of it caused due to the lack of muscle or nerve function with normal anatomical attachments. Pneumothorax is a common occurrence during thoracoscopic approaches of diaphragmatic plication but a very rare complication in laparoscopic approaches.A 56-year-old male presented with complaints of pain in the left upper abdomen, bloating, and difficulty in breathing. He was diagnosed with idiopathic diaphragmatic eventration and was taken up for laparoscopic plication under American society of anaesthesiologists – physical status 1. Intra-op, he developed sudden onset increase in peak pressures with poor tidal volumes and desaturation. Examination revealed reduced breath sounds and movement of left side of chest, possibly a left sided pneumothorax. The placement of a left-sided intercostal chest drain led to improvements in ventilatory parameters.The patient was successfully extubated following the completion of surgery.: Pneumothorax is an established complication of laparoscopic surgery, with a reported incidence of 0.01%-0.4%. But early detection and diagnosis of a pneumothorax intraoperatively is difficult and often missed because of controlled ventilation and pneumoperitoneum. A high index of suspicion should be maintained for early diagnosis and management of such conditions.Intraoperative tension pneumothorax and its progression can have devastating consequences. A high index of suspicion, prompt recognition of the condition despite many factors that may mask the condition and prompt remediation leads to an effective management of such cases.

Painful Rib Syndrome a Series of 89 Cases

Painful rib syndrome is an under diagnosed or neglected clinical entity presented with pain in the lower chest and upper abdomen with a tender spot (or spots) at the lower costal margin. This study was designed to see the presentation of a relatively less recognized clinical condition painful rib syndrome. Consecutive patients presenting with pain in the lower chest or upper abdomen at one or both sides with reproducible tender points or points on the costal margin and positive hooking sign were included. Patients’ epidemiological and clinical data were recorded. A routine x-ray chest of PA view and ultrasonogram of the abdomen were done in all. Data analysis was done using SPSS (Statistical Package for Social Science) version 20. Total 89 patients, male 31(34.8%) and female 58(65.2%) with age ranging from 10 to 70 years (mean 35.34) were included. Of them, 48(53.9%) were within 26 to 45 years group, 43(48.3%) were housewives and 47 (52.8%) were from middle-class economic group. Among them, 16 (18%), 16 (18%), 12 (13.48%), and 30 (33.71%) patients presented with pain in the right lower chest, left lower chest, both sides of chest and right upper abdomen respectively and were managed conservatively with complete or acceptable improvement in 78(87.64%) patients. Painful rib syndrome can be diagnosed easily by history, clinical examination, and minimum investigations which may save patients from anxiety and economic loss. Bangabandhu Sheikh Mujib Med. Coll. J. 2023;2(1): 29-32

Symptom Presentation among Women with Suspected Ischemia and No Obstructive Coronary Artery Disease (INOCA).

Identifying ischemic heart disease (IHD) in women based on symptoms is challenging. Women are more likely to endorse non-cardiac symptoms. More than 50% of women with suspected ischemia have no obstructive coronary disease (and thus, INOCA) and impaired outcomes during follow-up. We aimed to identify symptoms having predictive capacity for INOCA in women with clinical evidence of coronary ischemia. We included 916 women from the original WISE cohort (NCT00000554) who had coronary angiography performed for suspected ischemia and completed a 65-item WISE symptom questionnaire. Sixty-two percent (n = 567) had suspected INOCA. Logistic regression models using a best subsets approach were examined to identify the best predictive model for INOCA based on Score χ2 and AICc. A 10-variable, best-fit model accurately predicted INOCA (AUC 0.72, 95% CI 0.68, 0.75). The model indicated that age ≤ 55 years, left side chest pain, chest discomfort, neck pain, and palpitations had independent, positive relationship (OR > 1) to INOCA (p < 0.001 to 0.008). An inverse relationship (OR < 1) was observed for impending doom, and pain in the jaw, left or bilateral arm, and right hand, interpreted as INOCA associated with the absence of these symptoms (p ≤ 0.001 to 0.023). Our best-fit model accurately predicted INOCA based on age and symptom presentation ~72% of the time. While the heterogeneity of symptom presentation limits the utility of this unvalidated 10-variable model, it has promise for consideration of symptom inclusion in future INOCA prediction risk modeling for women with evidence of symptomatic ischemia.

Primary Extrathoracic Extraskeletal Osteosarcoma of the Chest Wall: A Rare Entity

Extraskeletal osteosarcoma (ESOS) is a rapidly growing malignant neoplasm-producing osteoid, located in the soft tissues other than bones or periosteum. Primary ESOS presenting in extrathoracic locations is very rare. The optimal treatment of ESOS is largely unknown. The most common location is the soft tissues of the thigh (46%), upper extremity (20%), intrathoracic (rare), and retroperitoneum (17%). These tumors are usually large while diagnosis, typically measures 10 cm in diameter. The diagnosis is by core biopsy and microscopy sections reveal spindle cells with high NC ratio, myxoid stroma, osteoid matrix, and necrosis. Immunohistochemistry reveals that the tumor cells are positive for Desmin (40%), CD99 (25%), NKX2.2 (30%), and myogenin (15%). The radiological differentials include posttraumatic myositis ossificans. The treatment consists of wide surgical resection and reconstruction depends on the defect. Patients with localized disease were treated with an osteosarcoma-type adjuvant chemotherapy regimen consisting of doxorubicin, and cisplatin. The prognosis is poor when compared with intra-osseous osteosarcoma. More than 90% of patients develop local and distant metastasis and recurrence is between 2 months and 10 years. We hereby describe the case of giant ESOS of the chest wall, which was managed successfully at our center. A 58-year-old male presented with rapid progressive malignant ESOS in the right side chest 20 cm × 20 cm. He was managed by a multidisciplinary team of oncosurgery, plastic surgeon, and onco medicine by neoadjuvant chemotherapy and wide local excision with latissimus dorsi pedicle reconstruction. On a 3-year follow-up, he had no recurrence and doing well.

The Role of Kunjal Kriya in Upper Respiratory Tract Disorders w.s.r. to Bronchial Asthma

Bronchial Asthma is one of the distressing ailments of the present time and is notable for its episodic and chronic course which influences the entire human race &amp; it is a sickness of the human respiratory framework where the aviation routes get restricted. This limiting causes side effects, for example, wheezing, windedness, chest snugness, and hacking, which answer bronchodilators. Kunjal Kriya is the most straightforward technique among all types of Dhouti. The cleaning up of the whole track beginning from the mouth to the stomach related way toward the start of the small digestion tracts, that is mouth, and throat. Asthmatics might notice huge globs of mucus in the ousted water; the solid reflex from the pyloric valve will release bodily fluid discharges from the bronchial cylinders. Kunjal Kriya is suggested as a protected technique during an assault, as the strong activity of the vagus nerve delivers fit in the respiratory framework. Every day Kunjal Kriya is suggested for asthmatics under the arrangement of prepared instructors. In this review study, the author focused to rule out the mode of action of Kunjal Kriya in Upper Respiratory Tract Infections w.s.r. to Bronchial Asthma.

Quantitative Sensory Changes Following Posterior Spinal Fusion to Treat Adolescent Idiopathic Scoliosis.

Sensory changes surrounding the incision frequently develop after posterior spinal fusion (PSF) to treat adolescent idiopathic scoliosis (AIS). Anecdotally, patients may experience sensory changes on the chest wall. Such postsurgical sensory changes are not well described quantitatively. This study aims to evaluate the presence, intensity, and duration of mechanical sensory changes in AIS patients postoperatively. A prospective cohort of AIS patients, 10 to 21 years old, was followed. Quantitative sensory testing (QST) included touch detection threshold [mechanical detection threshold (MDT)] and pain detection threshold (MPT), using VonFrey monofilaments and pinprick stimulators. QST was performed at 3 sites at T6: the right and left chest at the nipple line and adjacent to the incision below the inferior angle of the scapula. QST at the thenar eminence was the control. QST was collected at baseline, 3 days, 1, and 6 months postoperative. Thirty-four patients (21% males; mean age: 14.9 years old; median preoperative curve: 58 degrees) completed all testing. Mean deformity correction was 64% (SD: 10.4). Adjacent to the incision site, MDT was significantly higher compared with baseline at 3 days and 1 month ( P < 0.001) but not at 6 months ( P = 0.19), whereas MPT was significantly higher at 3 days, ( P < 0.001), 1 month ( P < 0.001), and 6 months ( P = 0.001). For the chest wall in all patients, MPT was higher on the left chest at 3 days ( P = 0.04) and on the right chest at 3 days ( P = 0.022) and 1 month ( P = 0.05). For patients with right-sided curves, MDT ( P = 0.01) and MPT ( P = 0.015) overall were significantly higher on the concave side (left) chest postoperatively. PSF is associated with sensory disturbances that are detectable within days, persist at 1 month, and improve at 6 months postoperatively adjacent to the incision and on the chest wall. We suspect that these sensory changes are transient. Describing postoperative sensory changes will help us better set postoperative expectations for patients undergoing PSF. Level I.

Concurrent Occurrence of Nasopharyngeal and Disseminated Cutaneous Rhinosporidiosis: A Rare Presentation.

Concurrent Occurrence of Nasopharyngeal and Disseminated Cutaneous Rhinosporidiosis: A Rare Presentation.

An Unusual Presentation of Lichen Striatus.

An Unusual Presentation of Lichen Striatus.

ТРАВМАТИЧНИЙ ПНЕВМОНІТ ВНАСЛІДОК ВІЙСЬКОВОЇ ТРАВМИ ГРУДНОЇ КЛІТКИ ЯК ФАКТОР РИЗИКУ ПНЕВМОНІЇ

The relevance of the problem of gunshot wounds and injuries as a result of the war with Russia continues to grow. Gunshot wounds and chest injury can cause several life-threatening conditions: bleeding, airway obstruction, tension pneumothorax with pericardial tamponade, open pneumothorax, massive hemothorax, chest dissection, tracheobronchial injury, diaphragm damage, myocardial injury, rupture thoracic aorta, esophageal damage and lung contusion. Lung contusion or traumatic pneumonitis is characterized by hemorrhage and swelling in the alveoli. This causes respiratory distress which develops 24 hours after lung injury, causing perfusion/ventilation mismatch by increasing pulmonary vascular resistance and decreasing lung compliance. From February 24, 2022 to February 18, 2023, in the Pulmonology Department of Volyn Regional Clinical Hospital, the rate of hospitalized military patients with chest injury due to mine-explosive wounds, shrapnel wounds, gunshot bullet wounds, and stub-cut wounds of the chest amounted to 19.3% of all pulmonary cases among military, admitted this year (n=88). Penetrating chest injury occurred in 41.1% of cases, nonpenetrating blunt chest injury (including behind armor blunt trauma) in 23.5 % of cases, chest trauma with soft tissue injury in 35.2 % of cases. Chest injury with fractured chest bones was detected in 47% of cases. In 52.9 % of cases, chest injuries and one stab-cut wound were on the side surface and chest, which was not protected by a bulletproof vest. Lung contusion or traumatic pneumonitis was observed in 70.5% of cases, including destruction in 29.4 %. Post-traumatic pneumonia was observed in 58.8 % of cases, that was caused by a non-hospital and hospital infection, pleurisy was observed in 17.6 % of cases. After chest injury, infiltrative-destructive pulmonary tuberculosis was detected in 5.8 % of cases and invasive pulmonary aspergillosis in 5.8 % of cases. Thus, the occurrence of a specific infection that can lead to destruction and aggravate destructive changes in the lung parenchyma should also be taken into account. Also, in 64.7 % of cases, metal, fragmentary, foreign bodies of the chest organs were found, and required further surgical removal. The article presents clinical cases of patients with chest injuries received as a result of military operations in Ukraine. Key words: traumatic pneumonitis, lung contusion, gunshot wound, chest injury, behind armor blunt trauma, pneumonia.

Misdiagnosis of Tuberculosis

Introduction: High incidence of tubercular cases in developingcountries, similar clinical presentation of tuberculosis andmalignancy, lack of adequate infrastructure, and lack ofproper follow up are the most common factors associated withmisdiagnosis.Case Summary: A 72 years old male CAME with complainsof cough with expectoration for 2 month, intermittent feverassociated with chills and rigors for 1 month, loss of appetiteand weight, intermittent pain in right side of the chest for1 month. Patient was a known smoker and alcoholic. Onauscultation bilateral air entry was decreased with occasionalrhonchi. Patient’s chest x-ray was suggestive of consolidationin right upper zone of chest. His sputum was negative forAFB from outside, patient started on ATT, 2 months prior todate of admission from private clinic on empirical basis thatwas continued till the date of admission. Patient showed noimprovement, even after 2 months of ATT. His chest X-Ray wassuggestive of right upper zone consolidation, patient had noprior radiography for comparison. He was continued on ATTas he had already taken treatment for 2 months from outside.Patient was tested negative for sputum AFB 1 and 2, CBNAATand culture.Patient presented to emergency after a gap of two monthsin state of drowsiness with complains of breathlessness andsevere right side chest pain. He was intubated in emergencyand managed on ventilator support. Patient recovered and aCECT thorax was done suggestive of likely possibility of rightlung upper lobe neoplasm with metastatic lymphadenopathywith possibility of multiple liver and bilateral adrenal metastasisand changes of chronic airways disease with fibro bullouschanges in bilateral upper lobe apical segments. The FNACwas positive for malignant cells with features suggestive of nonsmallcell carcinoma – (possibly adenocarcinoma). Patient wasfurther managed in the department of Radiation Oncology bychemotherapy. We discuss the radiographical progression andsubsequent investigations required to make a proper diagnosis.Conclusion: It is imperative to form a conclusive diagnosisusing available diagnostic modalities in smear negativetubercular cases to avoid delay in management of otherpossible life-threatening diseases like lung carcinomas.

A 17-year-old male presenting with multiple hyperpigmented macules over right side of chest in zosteriform pattern

Lichen planus pigmentosus (LPP) is a variant of lichen planus. It is characterized by small black, brown macules, on sun exposed areas like face, neck, upper extremities and trunk. Lesions are insidious in onset with gradually progressive course. Few variants have been reported like LPP inversus, localized LPP, linear LPP, zosteriform LPP and LPP of oral mucosa etc. Here, we present a case of zosteriform LPP in a young adolescent male, which is a rare presentation.

How does a CIED presence influence chances and safety of haemodialysis access? Conclusions from over 3000 thoracic venografies.

The authors analysed preoperative venogrphies of 3100 patients referred for transvenous lead extraction for a possible chance of safe haemodialysis catheter (HC) implantation or proper AVF function. A chance of safe catheter implantation parallel to existing leads reaches 68.8% ipsilaterally to CIED. Contraindications for implantation have been found in less than 2% of cases contralaterally. Ipsilaterally proper AVF function chance has been found in 50.3% of the cases and almost 98% contralaterally. A bilateral chest electrodes location require the special attention. Abandoned lead, lead burden, bilateral leads, additional lead implantation or abandonment, and implant duration may have a significant influence on HC insertion or proper function of arteriovenous fistula. (1) Obstruction of prominent thoracic veins is a frequent finding in CIED carriers and may impede or disable implantation haemodialysis accesses. (2) Implantation of temporary or permanent HC may be questionable ipsilaterally to the CIED in 31.2% and contralaterally in 2.0% of patients. Proper function of AVF is uncertain in 49.7% ipsilaterally and 2.1% contralaterally to CIED. (3) Pacing history and leads dwell time influence chances of success haemodialysis access even on the free-from CIED chest side. (4) Proper venous flow evaluation seems to be valuable in CIED carriers before an attempt of haemodialysis access formation, even contralaterally.

Pulmonary Blastoma in a Young Adult

Pulmonary blastoma is a rare but aggressive malignancy of the lung comprising epithelial and mesenchymal elements that resemble fetal lung tissue. This report described a case of an 18-year-old male who presented with cough and weight loss for a month. Computed tomography (CT) of the thorax revealed a large mass with mixed solid and cystic lesions on the right side of chest along with pleural effusion and mediastinal lymphadenopathy. Massive debulking was performed followed by chemotherapy. A biphasic pulmonary blastoma was diagnosed on histopathology.

Comparison of diagnostic accuracy of transcutaneous bilirubinometry during phototherapy by using skin patch

Background: Neonatal jaundice is a very common condition. Serious unconjugated hyperbilirubinemia may result in neurological dysfunction as catastrophic as kernicterus. Phototherapy is the method of choice in treatment of hyperbilirubinemia. Aim and objectives: the aim of the study was to assess the accuracy of transcutaneous bilirubin measurement during phototherapy by using skin patch and comparing this with skin and serum bilirubin measurement at the same time. Subjects and methods: This was an observational prospective study was conducted in special care baby unit at Al-wahda teaching hospital –Derna-Libya over a period of nine months (June 1st 2021 to March 2022).Eighty (80) newborn (41 Male, 39 Female) were enrolled in the study .Transcutaneous bilirubin measurement from skin over sternum, skin under patch at Rt. Side of chest, simultaneously serum bilirubin sample were collected. Results: during phototherapy; the mean± SD TSB (14.94 ± 4.57 μmol/L) and mean± SD TCBC (13.52 ± 4.84) and at skin level was 9.45 ± 3.62. Bland–Altman plot showed significant agreement between TcB from patched site and TSB Conclusion: TCB measurements correlate strongly with TSB levels during and after PT.

Delayed asymptomatic blunt traumatic diaphragmatic hernia: an unusual case report

IntroductionTraumatic diaphragmatic hernia (TDH) is uncommon, being encountered in around 0.8%-8% of patients with blunt abdominal trauma. Severe comorbidities such as fractures and thoraco-abdominal or head injuries that accompany TDH, are responsible for poor prognosis and often mask diaphragmatic injury itself. Objective of this case report was to highlight rare blunt TDH case to avoid missed diagnosis leading to complications. Case descriptionSixty seven-year old man presenting with right chest pain without difficulty of breathing after falling from stairs 1 hour before hospital admission. On clinical examination, vitals were stable, but with decreased breath sounds on right lower side of chest. Patient had history of trauma from being crushed by elevator 40 years ago without any proven diaphragmatic injury. Initial erect chest X-ray findings were inhomogeneous opacity shadow on lower right hemithorax suspected to be diaphragmatic hernia and 7th right rib fracture with pleural effusion. Thorax CT scan showed herniated right lobe of liver, gall bladder, and mesenteric fat on right hemithorax causing displacement of mediastinal structures. Patient was diagnosed with delayed TDH and hemothorax caused by newly fractured rib. Patient was referred to a better-equipped facility due to the limited surgical facilities in referring hospital. ConclusionDelayed TDHs are not common, but can lead to serious consequences. Blunt TDH occurs more often on left than on right side, in ratio of approximately 3:1. Traumatic diaphragmatic hernia is sometimes diagnosed many years after traumatic event due to latent phase of disease possibly ranging from days to years.