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Chest wall reconstruction. Experience with 100 consecutive patients.
Experience with 100 consecutive chest wall reconstructions during the past 7 years was reviewed. There were 52 female and 48 male patients with ages ranging from 13 to 78 years (average 53). Of the 100 patients, 42 had tumors of the chest wall, 19 had radiation necrosis, 24 had infected median sternotomies , and 15 had combinations of the three. Seventy-six patients underwent skeletal resection of the chest wall. An average of 5.7 ribs were resected in 63 patients. Total or partial sternectomies were performed in 29. Ninety-two patients underwent 142 muscle flaps: 77 pectoralis major, 29 latissimus dorsi, and 36 other muscles, including serratus anterior, rectus abdominis, and external oblique muscles. The omentum was transposed in ten patients. Chest wall skeletal defects were closed with Prolene mesh in 29 patients and with autogenous ribs in 11. Eighty-nine patients underwent primary closure of the skin. The 100 patients underwent an average of 2.1 operations. Hospitalization averaged 17.5 days. There was one perioperative death (29 days). Two patients required tracheostomy. Follow-up averaged 21.6 months. There were 24 late deaths. All 99 patients who were alive 30 days after operation had excellent results at the time of death or last follow-up.
Reconstruction of full thickness chest wall defects.
Over the last 5 years, 14 patients were treated by wide en bloc resection of chest wall tumors with primary reconstruction. There were nine females and five male patients with an age range of 31-77 years. All patients had a skeletal resection of the chest wall. An average of 3.9 ribs were resected in the patients treated. In three patients a partial sternectomy was carried out in conjunction with the rib resections. Chest wall skeletal defects were reconstructed with Prolene mesh, which was placed under tension. Soft tissue reconstruction utilized selected portions of the latissimus dorsi musculocutaneous territory with fasciocutaneous extensions beyond the muscle itself. Primary healing was obtained in all patients and secondary procedures were not required. The average hospitalization was 23 days. All patients survived the resection and reconstruction and were alive 30 days after operation. In selected patients the preservation of a portion of the innervated muscle in situ or the transfer of the muscle with the preservation of its resting length has maintained the majority of the muscle function.
Neoplasms of the mediastinum, chest wall, and pleura.
Although primary malignant diseases of the mediastinum, chest wall, and pleura are rare, the interest in investigational activity in mesothelioma and thymoma has increased because of new technologies such as magnetic resonance imaging, monoclonal antibody testing, thoracoscopy, and genetic engineering. Improvement in treatment outcome among patients with mesothelioma has been slow, due in part to the rarity of the disease and in part to resistance to treatment. Groupwide or intergroup studies are needed to assess the biology and treatment of these disorders. Advanced malignant thymoma has been shown to be sensitive to chemotherapy. Active studies to define the optimal treatment regimen continue.
Extensive F-18 FDG uptake in metastatic spindle cell carcinoma of the lung.
A 77-year-old man with stage IIB squamous cell carcinoma of the lung underwent right upper lobectomy. One month later he was examined for right chest pain, dyspnea, cough, and weakness. A roentgenogram showed nondiagnostic diffuse opacification of his right lung cavity. An F-18 FDG positron emission tomographic (PET) study revealed extensive uptake in the right pleural area, left adrenal gland, right axilla, and soft tissues consistent with extensive local recurrence and metastatic disease. Biopsy of a right chest soft tissue lesion showed spindle cell carcinoma, a rare variant of squamous cell carcinoma.
Cancer mortality around La Hague nuclear facilities.
Cancer death rates from the Beaumont-Hague "canton," where a nuclear facility is located, were compared with those for the Manche "département." No significant increase was found in cancer deaths during 1970-1982 for leukemias and in 1975-1982 for all other types of malignant tumors.
Recovery room care after thoracic surgery.
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Technical note. Use of CT in the placement of heat monitoring thermocouples for hyperthermia therapy.
In 12 cancer patients undergoing hyperthermia therapy, computed tomography (CT) was used for placement of thermocouples within the tumoral tissue. Tumors were located in the thorax, abdomen, and pelvis. Computed tomography provided accurate angulation of the introduction angiocatheter as well as the ability to choose the shortest and safest path. The cross-sectional display was especially helpful in placing the heat monitoring thermocouple within the active part of the tumor rather than a necrotic portion. It is our opinion that CT is superior to fluoroscopy in this regard.
Incidence and significance of serendipitous CT findings in the oncologic patient.
One-thousand computed tomograms of the abdomen, chest, and pelvis in oncologic patients were reviewed to determine the incidence of serendipitous findings and their impact on clinical management. The incidence of serendipitous findings was 30% in thorax, 24% in both genitourinary and osseous structures, 23% in the abdomen, and 21% in the retroperitoneum. These serendipitous abnormalities changed clinical management or required further diagnostic procedures (thus, they were considered significant) in less than 1% of the abdominal to 12% in osseous findings.
Computed tomography in malignant fibrous histiocytoma.
The computed tomographic findings in 11 cases of malignant fibrous histiocytoma are discussed. The typical appearance of the eight primary tumors imaged was of a poorly marginated mass with an attenuation coefficient slightly lower than that of normal muscle. Central tumor necrosis was detected in three cases. Three of five abdominal tumors showed involvement of adjacent soft tissue structures, and one demonstrated destruction of adjacent bone. The nonspecific appearance of these tumors prevented their reliable differentiation from other soft tissue sarcomata.
MR imaging of pheochromocytomas.
Magnetic resonance imaging (MRI) of seven patients with pheochromocytomas demonstrable by CT was performed. Magnetic resonance imaging showed all primary pheochromocytomas, as well as metastatic lesions to the thorax, retroperitoneum, and liver. The ability to distinguish pheochromocytomas from surrounding structures without the need of an intravenous contrast agent and to provide direct coronal and sagittal images suggests that MRI may be useful in detecting and localizing these tumors.
MR imaging of lymphomas: impact on therapy.
Seventy-six patients with either Hodgkin disease or non-Hodgkin lymphoma underwent magnetic resonance (MR) imaging as part of their evaluation. In this report the unique and common MR findings of these neoplasms are reviewed in each of the major anatomic sites. Further, the impact of these findings on therapy decisions and follow-up is emphasized.
MRI of elastofibroma dorsi.
OBJECTIVE: To determine if the MR features of elastofibroma are sufficient for diagnosis of this neoplasm. MATERIALS AND METHODS: The MR studies of two patients with pathologically proven bilateral elastofibromas were reviewed retrospectively. RESULTS: In each patient, bilateral semilunar soft-tissue masses demonstrating signal intensities isointense to that of muscle were identified in the periscapular regions deep to the posterolateral musculature of the chest. Focal linear areas of fat were present. The biopsy specimens of both patients demonstrated a positive reaction to the elastin stains. CONCLUSION: A periscapular soft-tissue neoplasm demonstrating a pattern of linear alternating regions of high and intermediate signal intensity on T1- and T2-weighted spin-echo MRI should be sufficient to allow the diagnosis of elastofibroma.
Induction of thoracic malignancy in inorganic dust pneumoconiosis.
Pulmonary carcinoma is now the leading cause of death due to cancer in men and women. Aside from cigarette smoking, occupational exposure to carcinogens is the most important cause of lung cancer, accounting for up to one third of all cases. The following article is a review of occupationally induced thoracic neoplasms with an emphasis on those related to the inhalation of inorganic dust. After introducing some basic terms, describing the research methods, and reviewing the process of carcinogenesis, current information on the relationship between exposure to asbestos, synthetic mineral fibers, silica, and other nonfibrous mineral dusts and the development of lung cancer and malignant mesothelioma of the pleura will be presented. The goal of this article is to provide the practicing radiologist with knowledge and insight into this difficult area.
Cross-sectional imaging of the chest wall.
Computed tomography and magnetic resonance imaging are now commonly performed for a variety of pulmonary and mediastinal lesions. However, some of the lesions that affect these areas also involve the chest wall. These include tumors, infections, trauma, and congenital processes. In such cases, a knowledge of chest wall anatomy combined with careful analysis of cross-sectional images is necessary to make the diagnosis. This article describes the basic cross-sectional anatomy of the chest wall and the principal pathologic chest wall lesions.
Pulmonary embolism associated with hemolymphangioma of lower extremity.
We present a case of major pulmonary embolization from a hemolymphangiomatous malformation of the loin and lower extremity. Treatment was with a low-dose infusion of urokinase for a short period directly into the pulmonary artery, and dramatic clinical improvement was noted. Prolonged maintenance therapy was with a low dose of heparin.
Benign and malignant intrathoracic tumors simulating allbladder disease.
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The management of low-grade, neglected neoplasms.
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