Thoracic Mass Research Articles

Reference values of skeletal muscle area for diagnosis of sarcopenia using chest computed tomography in Asian general population.

BackgroundDiagnostic cutoff points for sarcopenia in chest computed tomography (CT) have not been established although CT is widely used for investigating skeletal muscles. This study aimed to determine reference values for sarcopenia of thoracic skeletal muscles acquired from chest CT scans and to analyse variables related to sarcopenia using the cutoff values determined in a general Asian population.MethodsWe retrospectively reviewed chest CT scans of 4470 participants (mean age 54.8 ± 9.9 years, 65.8% male) performed at a check‐up centre in South Korea (January 2016–August 2017). To determine cutoffs, 335 participants aged 19–39 years (mean age 35.2 ± 3.6 years, 75.2% male) were selected as the healthy and younger reference group, and 4135 participants aged ≥40 years (mean age 56.4 ± 8.4 years, 65.1% male) were selected as the study group. We measured the following: cross‐sectional area (CSA) of the pectoralis, intercostalis, paraspinal, serratus, and latissimus muscles at the 4th vertebral region (T4CSA); T4CSA divided by height2 (T4MI); pectoralis muscle area (PMCSA); and PMCSA divided by height2 (PMI) at the 4th vertebral region. Sarcopenia cutoff was defined as sex‐specific values of less than −2 SD below the mean from the reference group.ResultsIn the reference group, T4CSA, T4MI, PMCSA, and PMI cutoffs for sarcopenia were 100.06cm2, 33.69cm2/m2, 29.00cm2, and 10.17cm2/m2 in male, and 66.93cm2, 26.01cm2/m2, 18.29cm2, and 7.31cm2/m2 in female, respectively. The prevalence of sarcopenia in the study group measured with T4CSA, T4MI, PMCSA and PMI cutoffs were 11.4%, 8.7%, 8.5%, and 10.1%, respectively. Correlations were observed between appendicular skeletal mass divided by height2 measured by bioelectrical impedance analysis (BIA) and T4CSA (r = 0.82; P < 0.001)/T4MI (r = 0.68; P < 0.001), and ASM/height 2 measured by BIA and PMCSA (r = 0.72; P < 0.001)/PMI (r = 0.63; P < 0.001). In the multivariate logistic regression models, sarcopenia defined by T4CSA/T4MI were related to age [odds ratio (95% confidence interval), P‐values: 1.09 (1.07–1.11), <0.001/1.05 (1.04–1.07), <0.001] and diabetes [1.60 (1.14–2.25), 0.007/1.47 (1.01–2.14), 0.043]. Sarcopenia defined by PMCSA/PMI were related to age [1.09 (1.08–1.10), <0.001/1.05 (1.03–1.06), <0.001], male sex [0.23 (0.18–0.30), <0.001/0.47 (0.32–0.71), <0.001], diabetes [2.30 (1.73–3.05), <0.001/1.63 (1.15–2.32), 0.007], history of cancer [2.51 (1.78–3.55), <0.001/1.61 (1.04–2.48), 0.033], and sufficient physical activity [0.67 (0.50–0.89), 0.007/0.74 (0.56–0.99), 0.042].ConclusionsThe reference cutoff values of a general population reported here will enable sex‐specific standardization of thoracic muscle mass quantification and sarcopenia assessment.

Preoperative Thoracic Muscle Mass Predicts Bone Density Change After Parathyroidectomy in Primary Hyperparathyroidism.

Predicting bone mineral density (BMD) gain after parathyroidectomy may influence individualized therapeutic approaches for treating patients with primary hyperparathyroidism (PHPT). This study aimed to assess whether skeletal muscle mass data could predict BMD change after parathyroidectomy in patients with PHPT. This retrospective study collected data from 2012 to 2021 at Severance Hospital, Seoul, Korea. A total of 130 patients (mean age, 64.7 years; 81.5% women) with PHPT who underwent parathyroidectomy were analyzed. Thoracic muscle volume (T6-T7 level) was estimated using noncontrast parathyroid single photon emission computed tomography/computed tomography (SPECT/CT) scans and an automated deep-learning-based software. The primary outcome assessed was the change in femoral neck BMD (FNBMD, %) 1 year after parathyroidectomy. The median degree of FNBMD change after parathyroidectomy was + 2.7% (interquartile range: -0.9 to + 7.6%). Elevated preoperative PTH level was associated with lower thoracic muscle mass (adjusted β: -8.51 cm3 per one log-unit PTH increment, P = .045) after adjusting for age, sex, body mass index (BMI), and baseline FNBMD. One SD decrement in thoracic muscle mass was associated with lesser FNBMD (adjusted β: -2.35%, P = .034) gain and lumbar spine BMD gain (adjusted β: -2.51%, P = .044) post surgery after adjusting for covariates. Lower thoracic skeletal muscle mass was associated with elevated preoperative PTH levels in patients with PHPT. Lower skeletal muscle mass was associated with lesser BMD gain after parathyroidectomy, independent of age, sex, BMI, preoperative BMD, and PTH level.

Clinical significance of pectoralis muscle strength in elderly patients with idiopathic pulmonary fibrosis.

Introduction:Investigations of muscle dysfunction in patients with idiopathic pulmonary fibrosis (IPF) are limited to peripheral muscles. However, decreased thoracic muscle mass is known and deterioration of chest wall muscle strength is not clear.Objective:The aims of the present study were to evaluate pectoralis muscle strength located on the chest wall and to investigate the relationship of spirometric measurements and respiratory muscle strength with pectoralis muscle strength.Methods:Elderly patient with IPF (mean disease duration 7.47±7.04 years) and the age-and sex-matched healthy volunteers were recruited in this cross-sectional study. The pulmonary function test was performed by a portable spirometer for spirometric variables and a gas analyzer for diffusing capacity for carbon monoxide (DLCO). Maximal inspiratory (MIP) and expiratory pressure (MEP) were measured with mouth pressure device. Modified Medical Research Council Dyspnea Scale (MMRC) was used to determined dyspnea severity. The pectoralis muscle strength was assessed isometrically during shoulder joint horizontal adduction movement with a handheld dynamometer.Results:A total of 17 patients with IPF (9 males, mean age 69.06±3.94 years) and 19 healthy controls (10 males, mean age 70.95 ±4.99 years) were included. Patients with IPF had lower pectoralis muscle strength than healthy controls (p<0.001). Significant relationships were found between pectoralis muscle strength and MIP (r=0.79, p<0.001), MEP (r=0.81, p<0.001), FEV1% (r=0.54, p=0.02), FVC% (r=0.68, p<0.003) and DLCO (r=0.61, p=0.009). With multiple linear regression analysis, pectoralis muscle strength was the only independent predictor of FVC% (adjusted R2=0.37, p<0.05).Conclusion:In patients with IPF, pectoralis muscle strength decreases and is associated with pulmonary function. In particular pectoralis muscle strength is likely to have an important impact on FVC%. Therefore, we consider that this test should be included routinely in chest diseases and rehabilitation clinics. The trial was registered U.S. National Library of Medicine clinical trial registry (https://clinicaltrials.gov, Trial ID: NCT04803617)

Thoracic Mass Lesions in Children and their Management: A Prospective Interventional Study

Introduction: Thoracic mass lesions in children are heterogeneous group of disorders, out of which developmental malformations such as Congenital Pulmonary Airway Malformation (CPAM), bronchogenic cysts and Congenital Lobar Emphysema (CLE) are common pathology. Primary pulmonary malignancies like carcinoid tumour and pulmonary blastoma may rarely be encountered. Aim: To analyse the clinical pattern, diagnosis and management of children with thoracic mass lesions. Materials and Methods: This prospective interventional study was conducted from June 2018 to May 2021, on 19 patients diagnosed and operated for thoracic mass lesions. It was carried out in the Department of Paediatric Surgery, Sardar Vallabhbhai Patel Post Graduate (SVP PG) Institute of Paediatrics, Srirama Chandra Bhanja (SCB) Medical College, Cuttack, Odisha, India. The final diagnosis was only based on histopathological study. The parameters assessed were demographic features, operative findings and pathological diagnosis. Statistical analysis was done using Microsoft Excel Q1 Macros software. Data was presented as mean, median with Confidence Interval (CI) and percentages (%). Results: A total number of 19 cases were operated, out of which 12 were boys and seven were girls. The median age at presentation was three month (range: five days to five years). Right side of thorax was more commonly affected in 14 cases and left side in five cases. CLE was the most common pathology (eight cases) followed by CPAM (six cases). Bronchogenic cysts and lymphangioma were detected in two cases each. Pulmonary blastoma was the only malignant lesion found. There was no mortality in the present study. Conclusion: The patients with thoracic mass lesions usually present before the age of six months and CLE was detected as the most common finding. A conclusive diagnosis can be obtained only from histopathology

Unpainful mass - a sad end

A soft tissue thoracic mass differential diagnosis includes congenital, inflammatory/infectious and neoplasic causes. A neoplasic aetiology - in which sarcoma is included - can be a challenging diagnosis, given its unpainful and slow growth nature. Despite being unusual, sarcoma must be considered in the presence of a gradually enlarging unpainful mass in the trunk or extremities, as this is the most common form of presentation. Quite often, the histologic exam of a soft tissue mass is essential for diagnosis and treatment planning.

Solitary fibrous tumor of the pleura mimicking a soft tissue sarcoma of the chest wall.

Introduction and importanceSolitary fibrous tumors of the pleura (SFTPs) present a diagnostic challenge. We herein report a successful case mimicking a soft tissue sarcoma of the chest wall by a meticulous evaluation of the conventional images.Case presentationA 51-year-old woman presented with a left thoracic mass. The mass exhibited an extrapleural sign, which suggested a chest wall origin. However, the mass was found to be located more caudally by additional computed tomography. This positional change suggested that the mass was pedunculated from the visceral pleura, and an SFTP was suspected. The mass was found to originate from the visceral pleura of the left lower lobe and a pathological diagnosis of an SFTP was confirmed.Clinical discussionAlthough a positional shift with a postural change or the respiratory phase is a well-known characteristic radiological finding, such an intentional imaging study is available only for suspicious cases of SFTPs.ConclusionsSFTPs pose a diagnostic challenge because of their rarity and the lack of specific radiological findings. Even conventional radiological images can be diagnostic by performing a meticulous evaluation regardless of any specific diagnosis being initially assumed.

7 DOACs: a new skyline in cancer-associated thrombosis resistant to heparin. A clinical case of seminoma in BEP chemotherapy protocol solved with edoxaban

Abstract Aims TEV is a common cancer complication with 20% incidence. LMWH is the standard therapy for efficacy, safety and ease of use. However, some scenarios are deeply challenging for intercurrent prothrombotic anticancer drugs. Methods A 35-year-old man reported dysphagia, EGDS: oesophagus ulcers, thyroid echography: thoracic mass compressing proximal borders. Vascular ultrasound: thrombosis of left internal giugular, subclavian, axillary and brachial veins; he began enoxaparin 6000 IU ×2/die (65 kg). CT-scan: solid anterior–superior mediastinum vascularized mass (16 × 13 cm) incorporating great thoracic vessels with 20 cm cranio-caudal longitudinal extension with trachea dislocation. PET-CT: massive superior-anterior mediastinum pathological 18F-FDG accumulation suggestive for malignancy. Lung perfusion scan: absence of left lung perfusion. Angio-CT: showed compression of pulmonary artery trunk and of branches. He presented marked asthenia, sweating and presyncope. D-dimer: 6026 µg/L, NT-proBNP: 1417 pg/mL. Mediastinum biopsy exhibited seminoma (ki67+: 65%), he started BEP Protocol (etoposide, cisplatin, bleomycin). TTE: periaortic cuff from mediastinum mass which ab extrinseco compressed pulmonary artery trunk and branches with occlusion of left one, right chambers dilatation, sovra-epatic veins and inferior vena cava (21 mm) ectasia, decreased inspiratory collapse, pulmonary hypertension (SPAP: 52 mmHg), EF: 55%. After 2 months of enoxaparin, vein ultrasound: persistent DVT and positive CUS. So, we replaced enoxaparin with edoxaban 60 mg/die. After 2 months of edoxaban, overall regression of vein thrombosis with minimal residual thrombosis of left internal giugular vein; D-dimer: 1554 µg/L. Results After 2 months of BEP Protocol, CT-scan: decrease mediastinum mass (6 × 12 cm) dimensions. Conclusions Cancer associated thrombosis is a frequent complication, worsening mortality, morbidity and decision-making. Cancer stage and drugs favour development of severe thrombosis, not solvable with LMWH, the cornerstone of anticoagulant therapy in cancer-related thrombosis. DOACs appear as a new and successful therapeutical option, especially in the most challenging cases of highly thrombotic profile after ‘heparin failure’.

Thoracic Mass Lesions on Imaging: Beware of Tuberculosis Cases.

Tuberculosis (TB) and thoracic malignancy mimic each other clinically, and pose diagnostic challenges. Both diseases are characterised by similar symptoms. We aimed to emphasise that some forms of TB are associated with misleading clinical and radiological manifestations. We present a retrospective study of clinical and pathological results of 10 cases with a preliminary presumptive diagnosis of thoracic malignancy. All patients were found to have TB without evidence of malignancy and were successfully treated with standard antibiotherapy after completion of diagnostic procedures. TB should be considered as a noteworthy differential diagnosis in patients living in TB-endemic countries, and biopsy plays a vital role in correctly diagnosing TB. Key Words: Mass, Neoplasm, Pulmonary, Tuberculosis.

Mass Spectrometry Imaging (MSI) Delineates Thymus-Centric Metabolism In Vivo as an Effect of Systemic Administration of Dexamethasone

Matrix-assisted laser desorption ionization mass spectrometry imaging (MALDI-MSI) is increasingly used in a broad range of research due to its ability to visualize the spatial distribution of metabolites in vivo. Here, we have developed a method, named thoracic Mass Spectrometry Imaging (tMSI), as a standard protocol of molecular imaging of whole-animal sectioning in various settings of mice in vivo. Further application of the strategy that involved the systemic administration of dexamethasone (DEX) in mice, enabled a dynamic shift in the energy status of multiple thoracic organs to be visualized, based on tMSI data of purine and pyrimidine metabolites. Furthermore, with the introduction of uniform manifold approximation and projection (UMAP) for tMSI data, metabolic profiles normally localized in the cortex and cortico-medullary junction (CMJ) of the thymus were drastically shifted as minor profiles into the medulla of DEX-treated thymus. As a massive apoptotic cell death in the thymic cortex was noticeable, a single molecule, which was upregulated in the cortex of the thymus, enabled us to predict ongoing immunosuppression by in vivo DEX-administration.

Thoracoscopic excision of an intrathoracic para-cardiac lymphangioma of a child

A three year old boy was incidentally detected to have a right intrathoracic cystic mass while being investigated for an anterior abdominal wall lymphangioma. The intrathoracic mass was located in the costo pericardial recess very closely related to pericardium. He didn't have symptoms related to the thoracic mass and the imaging characteristics were evident of an intrathoracic lymphangioma. Since it was closely related to pericardium, radiologically guided sclerotherapy was not considered as a treatment. Thoracoscopic excision of the mass was done and he recovered uneventfully. Intrathoracic lymphangioma is a rare congenital lymphatic anomaly which needs definitive surgical treatment to prevent future complications. Minimally invasive thoracoscopic excision is a viable treatment option in children with intrathoracic lymphangioma.

Thoracoscopic resection of bilateral multiple superior mediastinal neurofibromas

BackgroundThe indications for surgical resection concerning multiple bilateral neurofibromas in the superior mediastinum remain controversial, because vascular injury or development of postoperative Horne syndrome are concerned.Case presentationA 60-year-old woman presented with multiple nodules in her right neck and bilateral chest cavity tops which indicated neurofibromatosis. The thoracic masses grew slowly over 9 years, and she then underwent a 2-stage resection starting with the left to right side. Bilateral tumors were completely removed via video-assisted thoracic surgery. The patient’s postoperative course was uneventful, without postoperative Horner syndrome.ConclusionsTo the best of our knowledge, this is the first case of multiple bilateral superior mediastinal neurofibromas resected from the pulmonary apices via thoracoscopy. We selected a minimally invasive pure video-assisted thoracoscopic surgery approach and enucleated some tumors to avoid nerve injury. This approach may be safe and useful for multiple neurofibromas in patients with neurofibromatosis.

Spinal extranodal Rosai-Dorfman disease: A case report and literature review.

IntroductionSpinal extranodal Rosai-Dorfman disease (RDD) is extremely rare. In this paper, we reported successful management of spinal extranodal RDD and reviewed medical literature.Case presentationA 19-year-old male presented with progressive bilateral leg weakness and back pain for two months before admission. He denied weight loss, fever, night sweats, and lymph node enlargement. On examination, his muscle strength of both legs was grade I with hyperreflexia. Magnetic resonance imaging of the spine (MRI) showed a thoracic extradural mass at a level of T6-T9, which was a heterogeneous hyperintense on T2W, STIR, and isointense on T1W and enhanced contrast vividly. We resected the tumor totally and decompressed the spinal cord. Pathology revealed a histiocytic tumor. Immunohistochemical staining was S100 (+), CD68 (+), CD45 (+), and CD1a (−). Postoperatively, his muscle strength improved gradually to grade IV after four months. Postoperative MRI of the spine showed no residual tumor. No further adjuvant therapy was indicated.Clinical discussionSpinal extranodal RDD has no specific symptoms and pathognomonic imaging features. CT and MRI of the spine are still the essential tools for diagnosing RDD, but biopsy is often mandatory for definitive diagnosis. There have not been consensus guidelines for treating RDD of the spine because of its rarity. Surgical resection remained the mainstay of treatment (78.8%), with or without adjuvant therapies.ConclusionSurgery is the treatment of choice for most cases, while steroid therapy, radiotherapy, and chemotherapy should be adjuvant treatment and tailored individually.

18F-Sodium fluoride positron emission tomography, aortic disease activity and ischaemic stroke risk

Abstract Background Arterial 18F-sodium fluoride (18F-NaF) activity on positron emission tomography (PET) is a marker of active microcalcification and atherosclerosis. Coronary 18F-NaF activity (CMA) predicts coronary artery disease progression and subsequent myocardial infarction. Objective To investigate whether aortic 18F-NaF activity (AMA) predicts thoracic aortic atherosclerotic disease progression and subsequent ischaemic stroke or myocardial infarction in patients with established cardiovascular disease. Methods In a post-hoc observational cohort study, we evaluated AMA and CMA in patients with stable coronary artery disease (n=239) or aortic stenosis (n=158) who had underwent thoracic 18F-NaF PET and computed tomography (CT). We assessed the associations between AMA or CMA and progression of calcified atherosclerotic plaque in both thoracic aortic and coronary territories on follow up CT, as well as subsequent ischaemic stroke or myocardial infarction. Results In 141 and 231 patients with repeat aortic and coronary CT imaging respectively at 12.7±2.7 months, AMA correlated with log progression of thoracic aortic calcium scores (r=0.21, p=0.011), volume (r=0.29, p&amp;lt;0.01) and mass (r=0.29, P&amp;lt;0.01) as well as log coronary calcium score progression (r=0.21, p=0.03). CMA correlated with log coronary (r=0.42, p&amp;lt;0.01), but not log aortic (p&amp;gt;0.80) calcium score progression. In 397 patients, 16 had an ischaemic stroke and 25 had a myocardial infarction after 4.7±1.6 years. After adjusting for clinical risk factors, CMA and calcium scoring, AMA was associated with stroke (hazard ratio, 1.71 [95% confidence interval 1.00–2.90], p=0.048]). AMA was superior to clinical risk and calcium scores in identifying patients with stroke (c-statistic 0.76 versus 0.58 versus 0.63 respectively, p&amp;lt;0.05). Survival analysis demonstrated that AMA was associated with ischaemic stroke (p&amp;lt;0.001) but not myocardial infarction (p=0.45), whereas CMA was associated with myocardial infarction (p&amp;lt;0.001) but not stroke (p=0.39). Conclusions In patients with established cardiovascular disease, AMA is associated with progression of aortic atherosclerosis and future ischaemic stroke. Arterial 18F-NaF identifies localised areas of atherosclerotic disease activity that relate to regional atherothrombotic events. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): British Heart Foundation AMA, disease progression and outcomesVariables associated with stroke

Ex Utero Intrapartum Treatment (EXIT) Into the World: A Multidisciplinary Approach and Outcomes in a Malaysia Tertiary Centre.

Fetal airway obstruction that present during birth are challenging to manage. Cervical and thoracic mass may cause significant airway compression that leads to irreversible fetal morbidity and mortality. With the current advancement in prenatal diagnosis and assessment for surgical planning, EXIT has become an accepted, recognized and preferred option for safe delivery in complex head and neck masses. Ex utero intrapartum treatment (EXIT) is a life-saving procedure that provides time to establish an airway while maintaining uteroplacental circulation. It requires flawless coordination amongst multidisciplinary team to ensure immediate and safe baby deliveries. Retrospective review of EXIT procedures performed from the initial establishment of pediatric otolaryngology service in this centre starting from January 2019 to December 2020. Based on the prenatal diagnosis, five EXIT cases were performed in this centre within 2years. 4 cases were diagnosed as lymphatic malformation and 1 immature teratoma with cervical and thoracic compression. 4 babies successfully delivered to airway without any complications with 1 death resulting from disseminated intravascular coagulopathy after EXIT. This review of five EXIT procedures aims to bring forth the different outcomes, preoperative planning and sharing our experience as a tertiary and newly established centre. Early prenatal diagnosis, good collaboration and experience among multidisciplinary team ensures good long term outcomes.

NUT carcinoma of the lung.

NUT carcinoma of the thorax is a rare and very aggressive tumor, whose definition is based on the demonstration of a nuclear protein in testis (NUTM1; also known as NUT) gene fusion on 15q14 with different partners from the bromodomain-containing proteins gene family. This fusion results in an activation of MYC oncoprotein responsible for the tumor's aggressivity. NUT carcinoma arises preferentially in young adults, presenting a large thoracic mass frequently associated with lymph nodes, bone or pleural metastases. At histology, this tumor is often poorly differentiated, mainly composed of sheets of small cells with scant cytoplasm, a round nucleus with a central nucleolus. Focal areas of squamous differentiation can be observed. Mitoses and necrosis are frequent, as well as neutrophilic infiltrate. The diagnosis is based on the detection of NUT protein expression by immunohistochemistry using the rabbit monoclonal antibody C52B1 in more than 50% of the tumor nuclei. This technique offers 87% sensitivity and nearly 100% specificity with reference to FISH or RT-PCR, which confirm the NUTM1 rearrangement. The differential diagnoses include basaloid carcinoma of the lung, small cell carcinoma, thymic carcinoma (basaloid variant), SMARCA4_deficient thoracic sarcoma, other NUTM1 rearranged undifferentiated tumors, small round cell tumors, non-Hodgkin lymphoma/leukemia, and melanoma. The prognosis of NUT carcinoma remains very poor, with a median survival of 6.7 months, and 1- and 2-year overall survival rates of 30% and 19%, respectively. NUT carcinoma is often refractory to conventional chemotherapy, but ifosfamide-based regimens or BET inhibitors could represent promising therapies.

Thoracic ganglioneuroma with extension into the epidural space

A patient in their 30s presented with chronic right upper quadrant abdominal pain, nausea, bloating, and constipation. Her clinical exam was unremarkable, and computed tomography (CT) of the chest and abdomen which showed a large right-sided thoracic mass with extension into the thoracic spinal canal. A needle biopsy revealed a diagnosis of ganglioneuroma, the patient then underwent a combined approach for excision the tumor. Ganglioneuroma is a neuroblastic tumor of a neural crest origin, it originates from paravertebral sympathetic chain ganglia of the posterior mediastinum or retroperitoneum. They usually extend through neuroforamina to involve the epidural space and surgical excision can be curative.

Characterizing and Comparing Emissions of Dust, Respirable Crystalline Silica, and Volatile Organic Compounds from Natural and Artificial Stones.

The frequency of cases of accelerated silicosis associated with exposure to dust from processing artificial stones is rapidly increasing globally. Artificial stones are increasingly popular materials, commonly used to fabricate kitchen and bathroom worktops. Artificial stones can contain very high levels of crystalline silica, hence cutting and polishing them without adequate exposure controls represents a significant health risk. The aim of this research was to determine any differences in the emission profiles of dust generated from artificial and natural stones when cutting and polishing. For artificial stones containing resins, the nature of the volatile organic compounds (VOCs) emitted during processing was also investigated. A selection of stones (two natural, two artificial containing resin, and one artificial sintered) were cut and polished inside a large dust tunnel to characterize the emissions produced. The inhalable, thoracic, and respirable mass concentrations of emissions were measured gravimetrically and the amount of crystalline silica in different size fractions was determined by X-ray diffraction. Emissions were viewed using scanning electron microscopy and the particle size distribution was measured using a wide range aerosol spectrometer. VOCs emitted when cutting resin-artificial stones were also sampled. The mass of dust emitted when cutting stones was higher than that emitted when polishing. For each process, the mass of dust generated was similar whether the stone was artificial or natural. The percentage of crystalline silica in bulk stone is likely to be a reasonable, or conservative, estimate of that in stone dust generated by cutting or polishing. Larger particles were produced when cutting compared with when polishing. For each process, normalized particle size distributions were similar whether the stone was artificial or natural. VOCs were released when cutting resin-artificial stones. The higher the level of silica in the bulk material, the higher the level of silica in any dust emissions produced when processing the stone. When working with new stones containing higher levels of silica, existing control measures may need to be adapted and improved in order to achieve adequate control.

Low thoracic muscle mass index on computed tomography predicts adverse outcomes following lobectomy via thoracotomy for lung cancer.

The aim of this study was to determine whether the preoperative thoracic muscle mass is associated with postoperative outcomes in patients undergoing lobectomy via thoracotomy for lung cancer. Consecutive patients undergoing lobectomy were retrospectively reviewed. The thoracic muscle mass index (TMMI) was obtained at the level of the fifth thoracic vertebra on preoperative thoracic computed tomography (CT). Patients were analysed comparatively by being dividing into low and high muscle index groups by the median of sex-specific TMMI. The primary outcomes were the incidence of any or postoperative pulmonary complications. The secondary outcomes were postoperative intensive care unit (ICU) admission, length of stay (LOS) in the ICU, total hospital LOS, readmission and mortality. The study population consisted of 120 patients (63.6 ± 9.8 years; 74% male). Each groups included 60 patients. Major complications occurred in 28.3% (34/120) and readmission in 18.3% (22/120) of patients. The adjusted multivariable analysis showed that each unit increase in TMMI (cm2/m2) was independently associated with the rates of less any complications [odds ratio (OR) 0.92, P = 0.014], pulmonary complications (OR 0.27, P = 0.019), ICU admission (OR 0.76, P = 0.031), hospitalization for >6 days (OR 0.90, P = 0.008) and readmission (OR 0.93, P = 0.029). Low TMMI obtained from the preoperative thoracic CT is an independent predictor of postoperative adverse outcomes in patients following lobectomy via thoracotomy for lung cancer. TMMI measurements may contribute to the development of preoperative risk stratification studies in the future.

Ultrasonography in the Evaluation of Pediatric Chest "Masses": When to Consider?

Thoracic ultrasound is radiation-free, easily available, portable modality with added advantage of real-time assessment. It is useful in mediastinal lesions and peripheral lung, pleural and chest wall masses. Not only is it a valuable modality in differentiating solid from cystic lesion, it can also depict internal architecture without the use of contrast material. The added advantages of its use in children are the lack of ionizing radiation, and no need for sedation or general anesthesia in most cases. Although it has its limitations with a longer learning curve, it can act as a second-line modality to chest radiograph and adjunctive modality to CT in cases of a thoracic mass in a child.

The role of ultrasound-guided transthoracic Tru-Cut core biopsy in the diagnosis peripheral thorax lesion

BackgroundThe nature of opaque lesions such as effusions, atelectasis, masses, and consolidations can be clarified by sonography. This study investigated the sensitivity and accuracy of ultrasound-guided percutaneous core needle biopsy in different thoracic tumors (lung, pleural, chest wall, and mediastinal).ResultsSixty patients underwent ultrasound-guided percutaneous transthoracic core biopsy of peripheral thoracic masses with a Tru-Cut needle with a big bore. Twenty masses were in the lung, seventeen lesions were in the pleura, ten masses were in the mediastinum, eleven were enlarged palpable lymph nodes, and two masses were in chest wall. The sensitivity, PPV, and accuracy for detection of chest tumors in the chest wall, mediastinum, lung, and pleura were 100% for all, and in LN 88.9, 100, and 90.9%, respectively. The overall diagnostic performance of sonar-guided Tru-Cut needle biopsy in diagnosis was 97.78% sensitivity, 98.18% accuracy, and 100% PPV.ConclusionTru-Cut needle percutaneous transthoracic core biopsy is a convenient and sensitive process in obtaining samples under ultrasound guidance for exact histological diagnosis of thoracic tumors. The diagnostic efficiency is high, and the technique can also be used in outpatients, which is relatively simple.Trial registrationNCT, NCT04741958 Registered 5 February 2021, retrospectively registered,