The azygos lobe is a rare anatomical variant, most often encountered in the right lung. Its etiology is related to a defect of the migration of the azygos vein during the embryonic development. Here, we describe a rare case of an azygos lobe of the right lung, diagnosed incidentally on a computed tomography (CT) scan in a 40-year-old male patient who presented with chest pain, shortness of breath, and fever. The initial differential diagnosis included acute myocardial infarction, aortic dissection, and myocarditis. Chest CT with contrast matter demonstrated a peculiar finding in the right lung which was recognized as an azygos vein passing through the upper lobe and separating an azygos lobe with its mesoazygos. The azygos lobe may be rarely associated with neoplastic processes or spontaneous pneumothorax and its differential diagnosis on imaging studies includes various conditions. Knowledge of this variation is important to avoid misdiagnosis or complications during thoracic surgery.
Near-infrared spectroscopy (NIRS) is a noninvasive method for measuring tissue oxygenation. The method allows for monitoring tissue perfusion in shock by revealing tissue hemoglobin oxygen saturation (StO2). The current study aims to compare tissue oxygenation levels with hemodynamical monitoring and lactate levels in patients in severe shock. Study encompasses 19 patients treated in intensive care unit (ICU) at Alexandrovska University Hospital. Ten of the patients cover the criteria for severe sepsis, the remaining nine patients have no data for septic condition. In both groups of patients tissue oxygenation levels measured with INVIOS monitor, mean arterial pressure (MAP), oxygen saturation in mixed venous blood (SvO2) and lactate levels within 72 h of intensive care unit admission are compared. The patients with severe sepsis have significantly lower levels of StO2 in comparison with patients without sepsis. Tissue oxygenation levels correspond to the mean arterial pressure levels, oxygen saturation in mixed venous blood. StO2 levels in the current study do not correlate significantly with the lactate levels in patients with sepsis. Near-infrared spectroscopy as StO2 levels correlate with the hemodynamical monitoring in patients with severe sepsis, but do not correlate significantly with the severity of the disease. This data might indicate that tissue oxygenation monitoring has clinical significance in patients with sepsis. Further profound studies are necessary for assessing the role of tissue oxygenation monitoring in the early phase of resuscitation in septic patients.
Coexistence of Klippel-Feil syndrome with Sprengel deformity and omovertebral bone is a rare complex bone abnormality with unknown incidence and etiology. Herein, we report a case of a 6-year-old girl with coexistence of these congenital abnormalities evaluated by three-dimensional computed tomography. We also make a brief review and discuss in details the role of this imaging modality in the evaluation of such complex cases.
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