Management of Persistent Air Leaks.

Barotrauma is physical damage to body tissues caused by a difference in pressure between a gas space inside, or in contact with the body, and the surrounding fluid. This situation typically occurs when the organism is exposed to a significant change in ambient pressure, such as when a scuba diver, a free-diver or an airplane passenger ascends or descends, or during uncontrolled decompression of a pressure vessel, but it can also happen by a shock wave. Whales and dolphins are also vulnerable to barotrauma if exposed to rapid and excessive changes in diving pressures. In the current review we will focus on barotraumas from definition to treatment.

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Barotrauma and pneumothorax

The central venous catheter (CVC) is a catheter placed into a large vein in the neck [internal jugular vein (IJV)], chest (subclavian vein or axillary vein) or groin (femoral vein). There are several situations that require the insertion of a CVC mainly to administer medications or fluids, obtain blood tests (specifically the “central venous oxygen saturation”), and measure central venous pressure. CVC usually remain in place for a longer period of time than other venous access devices. There are situations according to the drug administration or length of stay of the catheter that specific systems are indicated such as; a Hickman line, a peripherally inserted central catheter (PICC) line or a Port-a-Cath may be considered because of their smaller infection risk. Sterile technique is highly important here, as a line may serve as a port of entry for pathogenic organisms, and the line itself may become infected with organisms such as Staphylococcus aureus and coagulase-negative Staphylococci. In the current review we will present the complication of pneumothorax after CVC insertion.

Pneumothorax as a complication of central venous catheter insertion.

Purpose
Distinguishing between benign granulmoas and adenocarcinomas is confounded by their similar visual appearance on routine CT scans. Unfortunately, owing to the inability to discriminate these lesions radigraphically, many patients with benign granulomas are subjected to unnecessary surgical wedge resections and biopsies for pathologic confirmation of cancer presence or absence. This suggests the need for improved computerized characterization of these nodules in order to distinguish between these two classes of lesions on CT scans. While there has been substantial interest in the use of textural analysis for radiomic characterization of lung nodules, relatively less work has been done in shape based characterization of lung nodules, particularly with respect to granulmoas and adenocarcinomas. The primary goal of this study is to evaluate the role of 3D shape features for discrimination of benign granulomas from malignant adenocarcinomas on lung CT images. Towards this end we present an integrated framework for segmentation, feature characterization and classification of these nodules on CT.

Methods
The nodule segmentation method starts with separation of lung regions from the surrounding lung anatomy. Next, the lung CT scans are projected into and represented in a three dimensional spectral embedding (SE) space, allowing for better determination of the boundaries of the nodule. This then enables the application of a gradient vector ow active contour (SEGvAC) model for nodule boundary extraction. A set of 24 shape features from both 2D slices and 3D surface of the segmented nodules are extracted, including features pertaining to the angularity, spiculation, elongation and nodule compactness. A feature selection scheme, PCA-VIP, is employed to identify the most discriminating set of features to distinguish granulmoas from adenocarcinomas within a learning set of 82 patients. The features thus identified were then combined with a support vector machine classifier and independently validated on a distinct test set comprising 67 patients. The performance of the classifier for both of the training and validation cohorts was evaluated by the area under receiver characteristic curve (ROC).

Results
We used 82 and 67 studies from two different institutions respectively for training and independent validation of the model and the shape features. The Dice coefficient between automatically segmented nodules by SEGvAC and the manual delineations by expert radiologists (readers) was 0:84 ± 0:04 whereas inter-reader segmentation agreement was 0:79 ± 0:12. We also identified a set of consistent features (Roughness;Convexity and Spherecity) that were found to be strongly correlated across both manual and automated nodule segmentations (R>0:80, p<0:0001) and capture the marginal smoothness and 3D compactness of the nodules. On the independent validation set of 67 studies our classifier yielded a ROC AUC of 0.72 and 0.64 for manually- and automatically segmented nodules respectively. On a subset of 20 studies, the AUCs for the two expert radiologists and 1 pulmonologist were found to be 0.82, 0.68 and 0.58 respectively.

Conclusions
The major finding of this study was that certain shape features appear to differentially express between granulomas and adenocarcinomas and thus computer extracted shape cues could be used to distinguish these radiographically similar pathologies.

This article is protected by copyright. All rights reserved.

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An integrated segmentation and shape-based classification scheme for distinguishing adenocarcinomas from granulomas on lung CT.

Interventional pulmonology is a growing subspecialty of pulmonary medicine with flexible and rigid bronchoscopies increasingly used by interventional pulmonologists for advanced diagnostic and therapeutic purposes. This review discusses different technical aspects of anesthesia for interventional pulmonary procedures with an emphasis placed on pharmacologic combinations, airway management, ventilation techniques, and common complications. Relevant medical literature was identified by searching the PubMed and Google Scholar databases for publications on different anesthesia topics applicable to interventional pulmonary procedures. Cited literature included case reports, original research articles, review articles, meta-analyses, guidelines, and official society statements. Interventional pulmonology is a rapidly growing area of medicine. Anesthesiologists need to be familiar with different considerations required for every procedure, particularly as airway access is a shared responsibility with pulmonologists. Depending on the individual case characteristics, a different selection of airway method, ventilation mode, and pharmacologic combination may be required. Most commonly, airways are managed with supraglottic devices or endotracheal tubes. Nevertheless, patients with central airway obstruction or tracheal stenosis may require rigid bronchoscopy and jet ventilation. Although anesthetic approaches may vary depending on factors such as the length, complexity, and acuity of the procedure, the majority of patients are anesthetized using a total intravenous anesthetic technique. It is fundamental for the anesthesia provider to be updated on interventional pulmonology procedures in this rapidly growing area of medicine.

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Anesthesia for interventional pulmonology procedures: a review of advanced diagnostic and therapeutic bronchoscopy.

Currently there several diagnostic techniques that re used by radiologists and pulmonary physicians for lung cancer diagnostics. In several cases pneumothorax (PNTX) is induced and immediate action is needed. Both radiologists and pulmonary physicians can insert a chest tube for symptom relief. However; only pulmonary physicians and thoracic surgeons can provide a permanent solution for the patient. The final solution would be for a patient to undergo surgery for a final solution. In our current work we will provide all those diagnostic cases where PNTX is induced and treatment from the point of view of expert radiologists and pulmonary physicians.

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Pneumothorax after transbronchial needle biopsy

/pdf/lung-cancer-screening-program-using-low-dose-computed-1uf1arwu.pdf

Lung cancer screening program using low dose computed tomography in Serbia

Pilot lung cancer screening program results in Serbia during 1-year period

Group of symptoms due to vena cava superior obstruction is named superior
 vena cava syndrome. A 65-year-old female, long-standing smoker was presented
 with a two-week history of dry cough and facial swelling. The patient
 noticed a palpable mass on the right side of the neck. Computer tomography
 scan with contrast showed extensive, irregular, non-homogenous consolidation
 in the right upper lobe, involving the right hilus, surrounding the aortic
 arch, supra aortic branches and pleural effusion at the right side of the
 body. Also, ultrasound examination of supra clavicular space showed enlarged
 pathologic hypoehogenic lymph node without an echogenic hilum. Ultrasound
 guided fine needle biopsy of lymph node was performed, and cytopathology
 findings showed metastatic lesion from primary microcellular lung cancer,
 IIIC stadium, cT4N3M0. Venous angioplasty was performed showing stenosis in
 the superior vena cava (the first type of Stanford classification). After
 balloon dilatation, the stent was placed at the site of stenosis. The
 patient received chemio- and radiotherapy and survival time was seven
 months. Superior vena cava syndrome is an urgent clinical condition, and
 lung cancer is the leading cause of this syndrome. Computer tomography
 imaging findings and endovascular stent placement are important for
 detection and management of the superior vena cava thrombosis.

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Dragan Dragisic

Papers

Pneumothorax after transbronchial needle biopsy

Lung cancer screening program using low dose computed tomography in Serbia

Pilot lung cancer screening program results in Serbia during 1-year period

Tumor mass in the lung with superior vena cava syndrome