Bronchial carcinosarcoma is a very rare malignant tumor that is composed of carcinomatous and sarcomatous elements. We describe the first case in which digital tomosynthesis was useful for the evaluation of airway obstruction by bronchial carcinosarcoma that was overlooked on initial chest radiography.
Airway Obstruction* ; Carcinosarcoma* ; Radiography ; Thorax

PURPOSE: To assess the incidence of aspiration pneumonia in infants with cleft palate and to compare the incidence between complete and incomplete types of cleft palate. MATERIALS AND METHODS: A review of medical records revealed 100 infants who had undergone initial surgery to repair cleft palate in our hospital during a recent three-year period. Aspiration pneumonia was defined as the coexistence of pneumonia at chest radiography with a history of frequent choking during feeding. The anatomic distribution of aspiration pneumonia was analyzed, and the incidences of aspiration pneumonia in infants with complete and incomplete cleft palate were compared. RESULTS: Among 100 children, aspiration pneumonia was found in 35 (35%). Those with complete and incomplete cleft palate showed similar incidences of the condition (27 of 70 [39%] vs 8 of 30 [27%], p=0.36). Pneumonia was most commonly seen in the left lower lobe (11 of 35), followed by the right upper and lower lobes. CONCLUSION: Aspiration pneumonia is frequently associated with infants with cleft palate. There is no statistical difference in the incidence of aspiration pneumonia between the complete and the incomplete cleft palate group.
Airway Obstruction ; Child ; Cleft Palate* ; Humans ; Incidence ; Infant ; Medical Records ; Pneumonia ; Pneumonia, Aspiration* ; Radiography ; Thorax

Bronchoalveolar lavage (BAL) and thoracic radiography are routinely performed diagnostic procedures. We hypothesized that BAL increases the interstitial opacity of caudoventral and caudodorsal thoracic radiographs. Fifty-three horses, including 8 clinic owned and 45 from a referral hospital population, were classified as healthy controls (n = 12), severe equine asthma (recurrent airway obstruction, n = 12) or mild-to-moderate equine asthma (inflammatory airway disease, n = 21) based on the results of a clinical scoring system. Eight were excluded due to different diagnoses and poor image quality. Four randomized thoracic radiographs of each horse were scored by two blinded observers, who were also asked to identify the image as obtained before or after a BAL procedure. In severe equine asthma, the chance (adjusted odds) of misinterpretation of the correct imaging time was approximately 5 times higher than in controls (odds ratio [OR] = 5.373, p = 0.028). The chance of misinterpretation was approximately 4 times lower in caudodorsal images than in caudoventral projections (OR = 0.241, p = 0.004). Identification of the correct imaging time was highly correlated with an increase in interstitial opacity (OR = 9.976, p < 0.0001). In conclusion, we recommend performing BAL after thoracic radiography to avoid possible misinterpretation.
Airway Obstruction ; Asthma ; Bronchoalveolar Lavage ; Diagnosis ; Horses ; Lung ; Radiography, Thoracic ; Referral and Consultation ; Respiratory Tract Diseases

PURPOSE: This study aimed to evaluate the diagnostic value of radiologic findings in children with suspected foreign body aspiration. METHODS: A retrospective medical chart review was done on 32 children with suspected foreign bodies in terms of age, sex, symptoms, signs, bronchographic findings, and type and location of foreign bodies. The diagnostic value of radiography was analyzed: 29 with chest anteroposterior (AP) or posteroanterior (PA) view, 23 with chest lateral decubitus view, 27 with chest computed tomography (CT), 29 with chest AP, PA or chest lateral decubitus view, and 25 with bronchoscopy. RESULTS: As a measure for detecting foreign body aspiration, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of radiologic findings were: chest AP or PA view, 50%, 100%, 100%, 29.4%, and 58.6%, respectively; chest lateral decubitus view, 57.9%, 50.0%, 84.6%, 20.0%, and 56.5%, respectively; chest AP, PA or chest lateral decubitus view, 69.6%, 66.7%, 88.8%, 36.4%, and 69.0%, respectively; and chest CT, 100.0%, 85.7%, 95.2%, 100.0%, and 96.2%, respectively. CONCLUSION: There is clinical benefit to take chest radiographs to diagnose foreign body aspiration. However, based on the results of this study, it may be not necessary to take chest lateral decubitus to diagnose foreign body aspiration. If chest radiographs show unilateral hyperinflation, foreign body aspiration can be diagnosed. In cases of normal chest radiography and history of a witnessed choking episode combined with positive signs, the diagnosis of airway foreign body aspiration should be made by using chest CT.
Airway Obstruction ; Bronchoscopy ; Child* ; Diagnosis ; Foreign Bodies* ; Humans ; Radiography ; Radiography, Thoracic* ; Retrospective Studies ; Sensitivity and Specificity ; Thorax* ; Tomography, X-Ray Computed

General anesthesia for the removal of a large mediastinal mass has been associated with life-threatening airway obstruction. We present a case of general anesthesia for a patient with superior posterior mediastinal mass and critical airway compression who was allowed to maintain spontaneous ventilation throughout general anesthesia for a thoracotomy. The patient was a 5-year-old boy complaining of productive cough and intermittent fever for 3 weeks. His chest radiograph and magnetic resonance imaging(MRI) film demonstrated a critically narrowed and deviated trachea at the level of the thoracic inlet to the proximal portion of the right bronchus. We can secure the airway by spontaneous ventilation without muscle relaxation and allowing the patient to breathe spontaneously and insertion of endotracheal tube distal to the narrowed portion of trachea.
Airway Obstruction ; Anesthesia, General ; Bays ; Bronchi ; Child, Preschool ; Cough ; Fever ; Humans ; Male ; Muscle Relaxation ; Radiography, Thoracic ; Thoracotomy ; Trachea ; Ventilation

We report a case of multinodular thyroid goiter in an 80-year-old man who successfully underwent tracheal stent placement for respiratory distress caused by the thyroid goiter and following two radiofrequency (RF) ablation sessions performed for thyroid volume reduction. This sequential treatment allowed elective stent removals four weeks after the second RF ablation session because the thyroid volume had been progressively reduced. Combination therapy of temporary airway stenting and RF ablation for the treatment of thyroid goiter has two advantages, i.e., immediate reliefs of dyspnea with airway stenting and reductions of the thyroid volume with RF ablation, and thus, allowing symptom reliefs even after the stent removals.
Aged, 80 and over ; Airway Obstruction/etiology/radiography/*therapy ; Catheter Ablation/*methods ; Goiter, Nodular/complications/radiography/*therapy ; Humans ; Male ; *Stents ; Tomography, X-Ray Computed

OBJECTIVE: The aim of this study was to evaluate whether the difference in the degree of collateral ventilation between canine and swine models of bronchial obstruction could be detected by using xenon-enhanced dynamic dual-energy CT. MATERIALS AND METHODS: Eight mongrel dogs and six pigs underwent dynamic dual-energy scanning of 64-slice dual-source CT at 12-second interval for 2-minute wash-in period (60% xenon) and at 24-second interval for 3-minute wash-out period with segmental bronchus occluded. Ventilation parameters of magnitude (A value), maximal slope, velocity (K value), and time-to-peak (TTP) enhancement were calculated from dynamic xenon maps using exponential function of Kety model. RESULTS: A larger difference in A value between parenchyma was observed in pigs than in dogs (absolute difference, -33.0 +/- 5.0 Hounsfield units [HU] vs. -2.8 +/- 7.1 HU, p = 0.001; normalized percentage difference, -79.8 +/- 1.8% vs. -5.4 +/- 16.4%, p = 0.0007). Mean maximal slopes in both periods in the occluded parenchyma only decreased in pigs (all p < 0.05). K values of both periods were not different (p = 0.892) in dogs. However, a significant (p = 0.027) difference was found in pigs in the wash-in period. TTP was delayed in the occluded parenchyma in pigs (p = 0.013) but not in dogs (p = 0.892). CONCLUSION: Xenon-ventilation CT allows the quantification of collateral ventilation and detection of differences between canine and swine models of bronchial obstruction.
Airway Obstruction/*radiography ; Animals ; Bronchial Diseases/*radiography ; Bronchography/*methods ; Disease Models, Animal ; Dogs ; Pulmonary Ventilation/*physiology ; Respiration ; Swine ; Tomography, Spiral Computed/*methods ; Xenon

OBJECTIVETo study the correlation between Apnea Graph (AG) analysis of airway obstruction and cephalometric assessment of the posterior airway space in the diagnosis of obstructive level in patients with obstructive sleep apnea hypopnea syndrome (OSAHS), so as to improve the preoperative diagnostic accuracy and the therapeutic outcome.

METHODSThirty patients (28 males and two females) who were diagnosed with severe OSAHS (mean AHI 58.6) by overnight polysomnography in recent 3 months were enrolled. The ages of the patients ranged from 35 to 59 years old with the median age of 41.5 years old. The mean body mass index (BMI, x(-) ± s) was (28.8 ± 4.1) kg/m(2). Mean apnea-hypopnea index (AHI) was (58.6 ± 16.4)/h. The lowest oxygen saturation was averaged to 0.69 ± 0.09. All patients underwent AG study as well as cephalometric analysis preoperatively. A correlation analysis was performed between the percentage of lower level obstructions measured by AG and the posterior airway space (PAS) evaluated by cephalometric analysis.

RESULTSAll of the 30 patients had the obvious narrow PAS of 4.4 - 10.8 mm, with the average of (7.6 ± 2.1) mm. Their constituent ratios of lower level obstruction ranged from 2 to 87 percent with the median ratio of 15.5% [9.0%; 35.8%]. Among all the patients, only 2 cases had more than 50 percent obstruction of the airway at lower level, 8 cases had 30 to 40 percent obstruction, and 6 cases had the narrow PAS less than 6 mm. The constituent ratio of lower level obstructions had a negative rectilinear correlation with the data of PAS (r = -0.6511, P < 0.01), which meant the patient with a higher percentage of lower obstruction had the tendency to have a corresponding narrower PAS. Two cases whose constituent ratios of lower level obstructions were not compatible with the rectilinear tendency due to tonsillar hypertrophy were reported.

CONCLUSIONSAG analysis of airway obstruction and cephalometric assessment of the PAS could provide comparable and consistent results for the diagnosis of obstructive level in OSAHS. However, the tonsillar hypertrophy should be considered when using AG to identify the airway obstruction.

Adult ; Airway Obstruction ; diagnosis ; diagnostic imaging ; physiopathology ; Female ; Humans ; Male ; Middle Aged ; Radiography ; Sleep Apnea, Obstructive ; diagnosis ; diagnostic imaging ; physiopathology ; Tongue ; diagnostic imaging ; Transducers, Pressure

Acute airway obstruction after hemoptysis occurs due to the presence of blood clots. These conditions may result in life-threatening ventilation impairment. We report a case of obstruction of the large airway by endobronchial blood clots which were removed using bronchoscopic cryotherapy at the bedside of intensive care unit. A 66-year-old female with endometrial cancer who had undergone chemotherapy, was admitted to the intensive care unit due to neutropenic fever. During mechanical ventilation, the minute ventilation dropped to inadequately low levels and chest radiography showed complete opacification of the left hemithorax. Flexible bronchoscopy revealed large blood clots obstructing the proximal left main bronchus. After unsuccessful attempts to remove the clots with bronchial lavage and forceps extraction, blood clots were removed using bronchoscopic cryotherapy. This report shows that cryotherapy via flexible bronchoscopy at the bedside in the intensive of intensive care unit is a simple and effective alternative for the removal of endobronchial blood clots.
Aged ; Airway Obstruction ; Bronchi ; Bronchoalveolar Lavage ; Bronchoscopy ; Cryotherapy* ; Drug Therapy ; Endometrial Neoplasms ; Female ; Fever ; Hemoptysis ; Hemorrhage ; Humans ; Intensive Care Units* ; Radiography ; Respiration, Artificial ; Surgical Instruments ; Thorax ; Ventilation

A 76-year-old male underwent a left upper lobectomy with wedge resection of the superior segment of the left lower lobe using video-assisted thoracoscopic surgery (VATS) for non-small-cell lung cancer of the left upper lobe. He presented with shortness of breath, fever, and leukocytosis. Chest radiography showed atelectasis at the remaining left lower lobe. Bronchoscopy revealed narrowing of the left lower bronchus with purulent secretion, and computed tomography showed downward kinking of the left lower lobar bronchus. He underwent exploratory VATS, and intraoperative findings showed an inferiorly kinked left lower lobar bronchus with upward displacement of the left lower lobe. After adhesiolysis, the kinked bronchus was straightened, and bronchopexy was performed to the pericardium to prevent the recurrence of bronchial kinking. Also, the inferior pulmonary ligament was reattached to prevent upward displacement. Postoperative follow-up bronchoscopy revealed no evidence of residual bronchial obstruction, and chest radiography showed no atelectasis thereafter.
Aged ; Airway Obstruction ; Bronchi* ; Bronchoscopy ; Dyspnea ; Fever ; Follow-Up Studies ; Humans ; Leukocytosis ; Ligaments ; Lung Neoplasms ; Male ; Pericardium ; Pulmonary Atelectasis ; Radiography ; Recurrence ; Thoracic Surgery, Video-Assisted ; Thorax