HR-ECUS should be considered complimentary to TTFM. Simultaneous use of the two methods during CABG provides morphological and functional information improving considerably diagnostic accuracy of intraoperative graft verification procedure close to 100%.
Radiologic findings of six cases of malignancy associated with chronic empyema 5-39 years in duration were reviewed. Pathologic examination confirmed three B-cell non-Hodgkin lymphomas, one round-cell sarcoma, one mesothelioma, and one adenocarcinoma. Retrospective findings on plain chest radiographs suggested the occurrence of malignancy: increased radiopacity in the thoracic cavity, soft-tissue bulgings and/or unsharpness of fat planes in the chest walls, destruction of bone near the empyema, and extensive medial deviation of the calcified pleurae. Computed tomography delineated masses with soft-tissue attenuation more clearly than radiography in all cases. Magnetic resonance images of three cases were informative because empyema cavities were surrounded by low-intensity rims, and two of them showed a signal intensity different from that of necrotic tumors. Scintigraphy revealed increased uptake of gallium in all cases. Ultrasonography was useful for biopsy guidance. Every radiologist should know this entity in observation of chest radiographs obtained in patients with chronic empyema, and further radiologic assessment and aggressive biopsy are recommended if malignancy is suspected.
with a liposarcoma are symptomatic and that 15% have an asymptomatic liposarcoma discovered on a routine chest radiograph. Liposarcomas are usually large. The cases reported by Klimstra and associates 3 ranged from 6 to 40 cm, with a mean weight of 1500 g. Enzinger and Weiss 4 divided liposarcomas into the following 5 major morphologic subtypes: well differentiated, myxoid, round cell, dedifferentiated, and pleomorphic. Myxoid liposarcomas account for 40% to 50% of these tumors. Welldifferentiated liposarcomas are a less-aggressive neoplasm and can produce metastases. Complete surgical excision is the preferred therapeutic choice. Recurrence can occur in a subtotal resection despite adjuvant therapy. The pseudoencapsulated lesions that can be completely removed have a better prognosis than the noncapsulated and less well-differentiated tumors; however, most primary chest wall soft tissue sarcomas (70%) are low grade. Local recurrence was reported in 33% of patients in the study by Greager and colleagues. 5 The presence of local recurrence has no significant effect on the overall survival. 1 Radiotherapy may be effective in the control of local recurrence, but its role is unclear.
Compared with chordal cutting alone, chordal translocation improved both the left ventricle function and mitral geometry in a canine model of acute ischemic mitral regurgitation. Chordal translocation may be beneficial because it ameliorates the tethering of both the anterior and posterior leaflets, which is aggravated by mitral annuloplasty alone.
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