Paul A. Kirschner

Localized fibrous pleural mesothelioma ct findings

The CT findings in 16 patients (20 examinations) with proven localized fibrous mesothelioma are described. These lesions proved to be large, uninvasive, sometimes heterogeneous, and enhancing solitary masses. These morphologic findings in an asymptomatic patient should be suggestive of this lesion.

Chronic duodenal obstruction: A mechano-vascular etiology of pancreatitis

Conclusions1. Six cases are presented that indicate that chronic duodenal obstruction from a variety of causes, such as superior mesenteric compression, proximal loop obstruction, inflammatory stricture, annular pancreatic stenosis, and malignant constriction, is an etiologic factor in the induction of pancreatic inflammatory disease.2. Postgastrectomy pancreatitis results not only from direct trauma to the pancreas, its ducts, or its blood supply, but also may follow obstruction of the proximal loop. It is of importance that proximal loop distention does not occur. Prevention of such a complication can best be assured by positioning the nasogastric tube beyond the gastroenteric stoma in the proximal loop.3. The occurrence of attacks of acute pancreatitis in patients with annular pancreas may be related more to the duodenal narrowing than to the anatomic abnormality, per se. Therefore, it is advised that these patients and others with duodenal strictures be kept on a low-residue diet to prevent occlusion of the stenotic bowel.4. Whether the physiologic mechanism that induces pancreatitis in patients with chronic duodenal obstruction is mechanical or vascular remains to be determined by further experimental study.

Alfred Blalock and Thymectomy for Myasthenia Gravis

In 1936, Alfred Blalock performed the successful removal of a thymic tumor in a patient with myasthenia gravis. The patient experienced marked and sustained improvement for several years. Blalock prophesized then that exploration of the thymic region would be indicated in all patients with severe myasthenia gravis. A few years later, in 1941, he applied this theory by introducing thymectomy for nonthymomatous myasthenia and achieved similar improvement. Despite modern sophisticated knowledge about the disease and advances in thoracic surgical techniques, Blalocks original observations remain valid, and thymectomy has become a standard treatment for myasthenia gravis the world over.

Primary sarcoma of the pericardium

Abstract A case of primary sarcoma of the pericardium occurring in a 19 year old male patient is presented. The initial manifestations were fever, chest pain and pericardial effusion which appeared to subside concomitantly with the administration of corticosteroids while the tumor mass was increasing in size. There was no reponse to radiotherapy. The diagnosis was established at exploratory thoracotomy, but close adherence of the tumor to the great vessels and the heart allowed only partial removal. The occurrence of a primary malignant tumor of the pericardium should be suspected in a young patient, particularly male, with an unexplained pericardial effusion and an unusual or bizarre configuration of the cardiac silhouette.

Transoesophageal echocardiography and the intraoperative diagnosis of left atrial invasion by carcinoid tumour

A 41-yr-old woman with pulmonary carcinoid tumour presented for thoracotomy and lung resection. However, intraoperative transoesophageal echocardiography (TEE) revealed that the tumour had invaded the left atrium, and the planned resection was aborted to allow resection under cardiopulmonary byass at a later date. Although the incidence of cardiac involvement by lung cancer at the lime of pulmonary resection is unknown, transoesophageal echocardiography can be useful in identifying the extension of hilar lung tumours. This should preferentially be done preoperatively, but can be done intraoperatively as described in this case report.RésuméUne patiente de 41 ans souffrant d’une tumeur cardinoïde pulmonaire se présente pour thoracotomie et résection pulmonaire. Toutefois, l’échocardiographie transoesophagienne peropératoire montre que la tumeur envahit l’oreillette gauche et la résection programmée est retardée pour permettre d’effectuer la résection sous circulation extracorporelle à une date ultérieure. Bien que l’incidence de l’atteinte cardiaque au moment d’une résection pulmonaire soit inconnue, l’échocardiographie transoesophagienne peut devenir utile pour identifier l’extension hilaire des tumeurs pulmonaires. Elle est préférable avant l’intervention, mais on peut la réaliser pendant l’opération, comme c’est le cas ici.

Inadvertent transection of a pulmonary artery catheter during thoracic surgery

A WIDE VARIETY of complications have been associated with insertion and use of pulmonary artery catheters (PAC). They include arrhythmias, which are commonly seen during insertion of the PAC, and more serious events, such as rupture of the pulmonary artery or pulmonary infarctions. A case is reported of inadvertent transection of the tip of the PAC by the surgical stapler during a left pneumonectomy, which is a complication unique to lung resection and has not been previously reported. It is important to emphasize the possible consequences that may follow if this event is unrecognized. This complication is preventable, but should it occur, a method of safe repair is necessary.

Magnetic resonance imaging and computed tomography findings in a patient with lymphomatoid granulomatosis.

A patient with lymphomatoid granulomatosis was examined with both computed tomography (CT) and magnetic resonance imaging (MRI). The CT and MRI character of the pulmonary lesions are described as well as the patients course and progression to lymphoma.