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Nasogastric feeding tube plays an important role in administering enteral feeding and drug delivery for poststroke patients with consciousness disorders or poststroke dysphagia. Nevertheless, placement of nasogastric tubes is not without any risk of potential harm. Inadvertent malposition into the trachea or the distal tracheobronchial tree could induce severe pulmonary complications. As for poststroke patients with long-term dysphoria, such tubes have to be replaced periodically to prevent the overdue service of the tubes. Therefore, the risk of feeding tube misplacement into pulmonary system for these patients is increased. Here, we present a case of a 79-year-old poststroke patient with hydropneumothorax induced by malposition of nasogastric tube into the right pleura after routine replacement, accompanied by acute anterior wall myocardial infarction.

We present a rare case of malignant nerve sheath tumor of pleura referred for the evaluation of metastases and local invasion. FDG PET/CT demonstrated a hypermetabolic tumoral lesion extensively involving the right pleura with no involvement of mediastinal structures or pulmonary parenchyma and no clear evidence of distant metastasis. Malignant nerve sheath tumor of pleura is an extremely rare entity, and FDG PET/CT is valuable in demonstrating the extent of disease and can have potential role for postsurgical as well as postchemotherapy assessment of possible residual disease.

We report a case of Morgagni hernia occupying the anterior mediastinum and right hemithorax in a male infant with Down syndrome, who also had a perimembranous ventricular septal defect. Through a median sternotomy, the hernia sac was freed from the right pleura, and the pericardium was opened to reduce its contents (colon) into the abdomen. The diaphragmatic defect was closed with Prolene mesh and the hernia sac was used to reinforce the diaphragmatic defect. Finally, the pericardium was opened and the ventricular septal defect was closed with a polytetrafluoroethylene patch through a right atriotomy after instituting cardiopulmonary bypass.

A 76-year-old man with metastatic adenocarcinoma of the prostate presented with increasing dyspnea. After being treated initially with drainage and afterwards with pleurodesis, he was referred for Ga-prostate-specific membrane antigen 11 PET/CT imaging for restaging purposes. PET/CT demonstrated extensive Ga-prostate-specific membrane antigen 11 uptake in the right pleura. Histopathology confirmed the rare case of malignant pleural effusion from metastatic prostate cancer.

Two previously fit and healthy males with acute onset dyspnoea and respiratory failure required invasive ventilation for respiratory failure. Insertion and correct positioning of nasogastric tubes (NGT) proved to be difficult repeatedly in both cases over the course of a number of days. Repeated imaging found NGT tips sited in varied, atypical positions including extension into the hemithoraces. Delineation of repeated malpositioned NGTs identified oesophageal perforations in the case of both patients, one with fistulation into the right pleura and the other into the left pleura. Both patients developed an empyema ipsilateral to the side of fistulation. Both patients died, with subsequent postmortems concluding one patient to have experienced a spontaneous out-of-hospital oesophageal perforation, and the second patient’s perforation developing as a consequence of a distal oesophageal squamous cell carcinoma. These two cases highlight the importance of questioning the possibility of underlying oesophageal pathology promptly if repeated NGT insertions are unsuccessful or imaging reveals unusual transit paths of NGTs.

A 59-year-old man was referred to our hospital because of left pleural effusion detected at a regular medical checkup. A chest X-ray showed left pleural effusion. A thoracoscopic pleural biopsy specimen from the left side gave a pathological diagnosis of malignant pleural mesothelioma (MPM), epithelioid type. Then thoracoscopic exploration of the right pleura was performed because of fluorodeoxyglucose accumulation along the right dorsal pleura. Thoracoscopic exploration of the right indicated no visible tumor formation, but a pleural biopsy specimen revealed epithelioid MPM. In this case, MPM in each thorax was confined to the parietal pleura and was classified as stage I. We therefore suggest that MPM may develop simultaneously in both thoraxes.

Hybrid schwannoma/perineurioma is a recently characterized benign nerve sheath tumor, most commonly affecting the lower limb and limb girdle. Hybrid tumors located in the subcutis of the trunk have not previously been reported to affect the pleura. We describe a 52-year-old man with dyspnea and thoracic pain due to a large mass in the right pleura, histologically composed of densely packed, S-100-positive spindle cells, intermixed with cells containing slender nuclei positive for epithelial membrane antigen, Glut-1, and claudin-1. To our knowledge, this is the first report of hybrid schwannoma/perineurioma in the pleura.

A 21-year-old male patient had sustained a blunt chest and abdominal trauma during a traffic accident. All the major injuries were on the left side. On the second day, a massive shift of the mediastinum to the right was noted. Further investigations raised the suspicion of herniation of the heart into the right pleural cavity. However, the patient's hemodynamic stability did not fit into the picture. Echocardiography and CT scan helped reinforce our suspicion. Herniation was confirmed at the operation, which was performed through median sternotomy. The patient recovered well without complications.

Picture A. Chest CT scan showing a right superior paravertebral mass, irregular nodular thick-ening of the right pleura, and mediastinal lymphadenopathy.Picture B. Section from the pleural tumor showing mesothelioma composed of epithelioid cells with psammoma bodies (B1) and spindle-like cells (B2) (HE stain).

The authors report two cases of complicated hydatid cysts of the liver, including one which was spontaneously broken in the bile ducts and the other fistulized in the right pleura. Patients presented with jaundice and biliary colic in the first case. Cough basithoracic pain, weakness, and fever in the second. Both patients were investigated by ultrasound and CT scan followed by a hydatid serology. In both cases the patients improved after surgical treatment. Will be recalled imaging aspects of these two complications.

Tetrology of fallot is the most common cause of cyanotic congenital heart disease with an incidence of 6-10 % among all congenital heart diseases. The anatomic defect comprising this entity leads to poor oxygenation resulting in symptoms of cyanosis, polycythemia and hypoxia. Most untreated patients die during childhood. Surgical treatment is the treatment of choice even during infancy. Many cardiac and extracardiac anomalies are associated with this entity. Here we report a 10 year old female patient of Tetrology of Fallot associated with double superior vena cava and absent right pleura. Total correction was made and the postoperative course was uneventful.

We report an unusual case of multiple pleural tuberculomas associated with a cold abscess of the hip. A 26-year-old man was admitted because of diffuse nodular thickening of the right pleura and an abscess of the left hip. Biopsies of the pleura and abscess of the left hip revealed tuberculosis. Antituberculous chemotherapy for 12 months improved both the pleural tuberculomas and the cold abscess of the left hip.

A 30-year-old woman with a 6-year history of cryptogenic polyserositis was hospitalized for paracentesis of slowly progressing chylous ascites. She was referred for lymphoscintigraphy to identify possible lymph leak. Conventional Tc-99m sulfur colloid lymphoscintigraphy revealed asymmetric lymphatic drainage from the lower limbs, with a normal course up to the kidney level. Then the migration was abnormal with visualization of the right pleural space and secondary radiotracer uptake in the mediastinal and subclavicular lymph nodes before lymph entered the venous circulation. This examination allowed the authors to distinguish a chylous effusion with extravasation of tracer in the peritoneum and right pleura from a photopenic pericardial exudate.

Malignant pleural mesothelioma is an uncommon neoplasm which is accompanied extremely rarely by osteoblastic heterologous elements. The CT manifestations of this tumor have been reported in several references. And, to our knowledge, only one case report provides a description of the bone scan findings. Here, we report the case of a rapidly progressing malignant pleural mesothelioma with heterologous osteoblastic elements. A CT scan reveals diffuse irregular pleural thickening and very coarse nodular calcifications along the right pleura and major fissure. A bone scan revealed an area of extensive increased radioactivity consistent with the pleural calcifications on the CT scan in the right hemithorax. A follow-up CT scan performed 40 days later suggests the presence of rapidly progressing nodular coarse calcifications.

This case report summarizes our experience with a 19-year-old male patient who suffered a blunt chest trauma during a traffic accident. On admission no serious injuries could be detected, but 12 hours later displacement of the heart to the right side combined with sudden cardiac failure appeared. Emergency operation showed a right-sided rupture of the pericardium with complete herniation of the heart into the right pleural cavity and consequent strangulation by the pericardial margin.

A case of diffuse, epithelioid mesothelioma of the right pleura in a 16-year-old boy is presented. Though a history of previous exposure to asbestos could not be elicited, the patient did receive pulmonary irradiation for metastatic Wilms' tumor at the age of 2 years. The authors believe that the development of his mesothelioma was causally related to his prior radiotherapy.

A case of spontaneous rupture of the oesophagus occurring in the right wall of the midoesophagus is reported. The treatment, conservative in the primary stage of the disease, is described. This consisted of per-oesophageal drainage of the mediastinum, effected endoscopically. In spite of complications—an empyema in the right pleura and an oesophagocutaneous fistula—the treatment was successful, resulting in a complete cure about two years after the accident. The patient has remained in good health since then.

A case of transdiaphragmatic empyema necessitatis due to tuberculosis presented clinically as a subcutaneous mass in the posteroinferior right chest. Imaging studies revealed a 12 cm diameter suprahepatic mass contiguous with thickened and calcified right pleura. Even in the preantibiotic era, such a presentation of empyema necessitatis was very unusual.

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When air gains access to the pleural cavity a displacement of the mediastinum frequently takes place. This mobility of the mediastinum depends on the flexibility of its tissues, the lack of pleural or pleuro-pericardial adhesions, the pressure created within the pleural space and the size or volume of the pneumothorax. The entire mediastinum may be shifted or a part of it. Thus, only the upper or only the lower portion of it may be displaced. Besides these variations in the position of the mediastinum, a protrusion of the pneumothorax cavity through the mediastinum into the sound, or untreated, side, occasionally takes place, thus forming a culdesac, or hernia. The most frequent point for a hernia of this nature to occur is in the upper anterior part of the mediastinum between the first and third ribs. Here the right pleura and the left pleura come in closest contact and are separated

In an article recently published inThe Journal, I1reported the discovery that it was possible to abolish all breath sounds as heard over the larynx and the chest by a voluntary separation of the vocal cords. The discovery was entirely original on my part, yet it seemed incredible that so simple and easy a procedure as the voluntary widening of the rima glottidis should never have occurred to any one until the present time. A search through the literature now shows that I had been anticipated by nearly a century. At the session of the Academie royale de medecine, June 10, 1834, Beau2described a case in which he heard a very marked bronchial souffle at the level of the subspinous fossa, in a patient with "effusion of the right pleura" who was breathing noisily. Wishing to know how much the noise of respiration contributed to produce

This paper presents a statistical analysis of 37 patients with empyema treated at the Children's Hospital, Washington, D. C., from Jan. 1, 1943 to April 1, 1948, with observations on the etiology, diagnosis, therapy and complications of the disease. The criteria used in selecting cases for this study were the presence of purulent pleural fluid and positive bacteriologic findings resulting from culture of this fluid, either during life or on postmortem examination. The diagnosis was made on autopsy specimens in eight instances; two of the deaths having followed surgical procedures. Those cases having no bacteriologic proof and those following traumas or the aspiration of foreign bodies are excluded from the series. The right pleura was involved in 21 instances (56.7 per cent), the left pleura in 13 instances (35 per cent) and both pleurae in three instances (8 per cent). During this period of five years and three months, the

The problem of differentiating grossly bloody fluid in the pericardiac sac from intracardiac blood during a pericardicentesis may sometimes be difficult. Fortunately, this situation seldom occurs, but, when it does, it is usually in a patient who is acutely ill and can poorly tolerate loss of an appreciable quantity of blood as the result of unintentional aspiration of blood from the heart. In the following abridged case report, such a distinction was rendered difficult by the anatomic changes caused by the underlying disease and the effects of therapy. The use of the procedure described below as an aid in determining the source of the blood obtained at pericardicentesis was arrived at by fortuitous circumstances, and its simplicity was sufficiently appealing to warrant publication. REPORT OF A CASE A 17-year-old white boy had an extensive lymphoblastic lymphoma of the mediastinum and right pleura of three months' duration at the time of

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