A 41-year-old woman presented with chest pain and a cough. There was a solitary pulmonary nodule in the upper-left lobe. The patient had no history of neoplasm except a hysterectomy for uterine leiomyoma five years before. Six months after the first presentation, the tumor showed a gradual increase in size; an explorative thoracotomy was performed. The histopathologic examination showed a tumor consisting of well-differentiated spindle-shaped cells with intervening collagen. She was readmitted 8 months after the operation because of right-sided spontaneous pneumothorax. Multiple pulmonary nodules appeared when the lung was re-expanded by chest tube drainage. In conclusion, uterine leiomyomas can metastasize to various organs, such as lungs, despite having a benign pathologic appearance.
Each layer of the esophagus significantly contributes to strengthening esophageal wall tension with primary esophageal closure, and reinforcement of the esophageal suture with tissue provides an additional significant increase in the bursting pressure of the esophagus.
Özet AmaçBu çalışmanın amacı künt travmalı stabil hastalarda bilgisayarlı toraks tomografisinin klinik ve adli önemini araştırmaktı. Gereç ve YöntemlerTravma sonrası 24 saat içinde akciğer grafisi ve bilgisayarlı toraks tomografisi çekilen künt toraks travmalı 50 hasta retrospektif olarak incelendi. Hastaların dağılımı, torasik lezyonlar, tedavi yöntemleri ve adli sorunları incelendi. Bulgular Çalışmamızda, en sık tespit edilen lezyon kot fraktürü idi. Bilgisayarlı göğüs tomografisi torasik lezyonların tespitinde düz akciğer grafisine göre üstün bulundu. Altmışsekiz (%33) okült lezyon saptandı. Bu lezyonların 46 (%18)'sı düz akciğer grafileri ile saptanamayan hayatı tehdit edici lezyonlardı. Yandaş yaralanma 33 (66%) hastada vardı. Pelvis ve ekstremite kırıkları en sık olanlardı.Göğüs bilgisayarlı tomografisi pnömotoraks, hemotoraks ve akciğer kontüzyo-nunun tespitinde akciğer grafisine üstün bulundu. Seksenbir hayatı tehdit edici lezyon saptandı ve bu lezyonların 50'si (%61: pnömotoraks 13, hemotoraks 24, akciğer kontüzyonu 9 ve pnömomediastinum 4) düz akciğer grafileri ile tespit edilememişti. Klinik tedavi uygulaması 15 (%30) hastada ve adli yaklaşım 14 (%28) hastada değişti. Sonuç Göğüs bilgisayarlı tomografilerinin torasik travmalarda tedavi ve adli konularda titiz bir inceleme imkanı sağladığını düşünmekteyiz. Anahtar KelimelerTravma, Yaralanma, Göğüs, Bilgisayarlı Tomografi, Göğüs Radyolojisi, Adli. Abstract AimThe aim of this study was to investigate the medical and forensic importance of thorax computed tomography in stable patients with blunt chest trauma. Material and MethodsFifty patients with blunt chest injury were retrospectively evaluated with chest radiography and thorax computed tomography in the first 24 hours after trauma. Patient demographics, thoracic lesions, management options, and forensic assessment were rewieved. ResultsThe most common lesion of the study was rib fracture. Thorax computed tomography was significantly superior to chest radiography in detecting thoracic lesions. Sixty eight (33%) occult lesions were detected. Forty six (18%) of these were life threatening that not detected with plain chest radiography. Associated injuries were present in 33 (66%) patients. Pelvic and extremity fractures were the most common injury. Thorax computed tomography was significantly superior to chest radiography in detecting pneumothorax , hemothorax and lung contusion. Eightyone life threatening lesions were detected and 50 (61%; pneumothorax 13, hemothorax 24, lung contusion 9, and pneumomediastinum 4) of these lesions could not be detected with plain chest radiography. The clinical management [in 15 patients (30%)], and the forensic assesment was changed [in 14 (28%)] patients were changed. ConclusionWe concluded that using Computed Tomography of the thorax in thoracic travmas prive meticulous assesment in management of patients and forensic issues.
ÖzetKsifodini, ksifoid kemik veya ksifosternal bileşkeye bağlı olarak ortaya çıkan üst abdominal ağrı, göğüs ağrısı, boğaz, baş ve kola yayılabilen ağrı ile karakterize bir grup semptomu içeren nadir bir sendromu tarif eder. Otuzyedi yaşında kadın hasta göğüs sırt, orta kesimi ve kola yayılan keskin vebatıcı tarzda ağrı ve anemi ile başvurdu. Ağrı medikal tedaviye dirençli olup ksifoid kemik rezeksiyonu uygulandı.Histopatolojik olarak hastaya thalasemi minor tanısı kondu. Rezeksiyon sonrası ağrı kayboldu. Altıncı ay takibinde hasta asemptomatik ve hiç ağrısı yoktu. Ksifoid kemiğin cerrahi rezeksiyonu medical olarak dirençli ksifodinide tedavi edici olabilir. AbstractXiphodynia describes an uncommon syndrome with group of symptoms ranging from upper abdominal pain, chest pain, throat, head and arm symptoms referred from xiphosternal joint or the xiphoid process. A 37-year-old woman presented with a sharp and persistant pain complaint of chest, mid-dorsal region and arm and anemia. Pain was refractor to medication and xiphoid resection was performed. The patient was diagnosed as thalassemia minor histopathologically. After resection pain was disappeared. At the 6th month follow up patient was asymptomatic and no pain was detected. Surgical resection of xyphoid bone may be curable in medically refractor xiphodynia.
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