Radiology Cases Ankita Mathur, M4.

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Presentation transcript:

Radiology Cases Ankita Mathur, M4

Case 1 RDJ, 64 y/o M

Pertinent Clinical History 64 y/o M s/p L pneumonectomy for adenocarcioma of lung

POD 6 Obtained POD 6- large fluid collection in L pneumonectomy space w/ mdeiastinal shifting towards R

CT w/ Contrast CT w/ con (7mm collimation, mediastinal windowing) @ level of LA – large fluid collection w/ homogenous low attentuation in L pneumonectomy space. Fluid attenuation = 6.4 HU. Proved to be chylous @ thoracentesis. Note cardiac displacement to R

Differential Diagnoses Chylothorax Cholesterol effusion Parapneumonic pleural effusion

Work-up Pleural effusion drainage Cytology pH 7.84, fl protein 18 g/L, fluid LDH 511 IU/L, cholesterol 19.08 mg/dL, TG 235.8 mg/dL

Diagnosis: Chylothorax TG > 110  strongly suggestive of chylothorax TG < 50  indicates absence of chylothorax

Hospital Course Pt. improved s/p thoracic duct ligation via video-assisted thoracoscopy

Chylothorax vs. Cholesterol Effusion Triglycerides Distruction/Obstrucion of thoracic duct/tributaries Cholesterol Chronic pleural inflammation  thickened/calcified pleural surfaces

Case 2 HB, 55 y/o M

Pertinent History 55 y/o M w/ h/o DM presents to ED w/ R thigh pain

Work-Up T 100.6 BP 130/87 P 115 Focal erythema & edema w/ TTP WBC 40

Radiograph Air lucencies

T2 MR Hyperintense signal in deep intermuscular fascia

T1 MR Tiny foci of signal void in superficial fascia

Gradient-Echo Air foci

Differential Diagnosis Cellulitis Gas gangrene

Fasciotomy w/ Surgical Debridement Cx Strep anginosus

References Ali, S. Z., Srinivasan, S., & Peh, W. C. G. (2014). MRI in necrotizing fasciitis of the extremities. The British Journal of Radiology, 87(1033), 20130560. http://doi.org/10.1259/bjr.20130560 Fahimi H, Casselman FP, Mariani MA, et al. Current management of postoperative chylothorax. Ann Thorac Surg 2001; 71:448. Kuhlman JE, Singha NK. Complex disease of the pleural space: radiographic and CT evaluation. RadioGraphics 1997; 17:63-79. Le Pimpec-Barthes F, D'Attellis N, Dujon A, et al. Chylothorax complicating pulmonary resection. Ann Thorac Surg 2002; 73:1714. Vallières E, Karmy-Jones R, Wood DE. Early complications: chylothorax. Chest Surg Clin N Am 1999; 9:609-616. Medline Martucci N, Tracey M, Rocco G. Postoperative Chylothorax. Thorac Surg Clin 2015; 25:523. Shimizu K, Yoshida J, Nishimura M, et al. Treatment strategy for chylothorax after pulmonary resection and lymph node dissection for lung cancer. J Thorac Cardiovasc Surg 2002; 124:499. Zabeck H, Muley T, Dienemann H, Hoffmann H. Management of chylothorax in adults: when is surgery indicated? Thorac Cardiovasc Surg 2011; 59:243.