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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.

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).

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.

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 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.

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