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Although pleural disorders are commonly encountered in the daily practices of thoracic surgeons, their assessment can be difficult. Being able to correlate normal and abnormal anatomy with imaging characteristics provides additional information that can be useful not only to accurately locate pleuropulmonary lesions but also to characterize abnormalities, such as pleural thickening or malignant processes., (Copyright © 2011 Elsevier Inc. All rights reserved.)

The diaphragm acts as a partition between the thoracic and abdominal cavities. On computed tomography, it is seen as a curved soft-tissue density with fat below and aerated lung above. The direct multiplanar capability of magnetic resonance technology can improve depiction of normal or abnormal diaphragmatic anatomy. Despite the usefulness of these imaging modalities, adequate visualization of the diaphragm can be difficult. Thoracic surgeons must be familiar with the correlative anatomy of the diaphragm because this knowledge is a prerequisite to making an accurate diagnosis of diaphragmatic abnormalities., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Objective: The endovascular management of aortic traumatic ruptures has been proposed as an alternative to classical surgical procedures. The aim of this work was to report the midterm results of the endovascular treatment of traumatic ruptures of the isthmic aorta., Methods: Between January 1996 and July 2005, endovascular repair of blunt traumatic aortic ruptures was performed in 33 patients (mean age, 40 +/- 17 years). The stent grafts used were either Talent Medtronic (n = 27), Gore Excluder (n = 4), or Boston Vanguard (n = 2) grafts. Follow-up was 94.9% complete and averaged 32.4 +/- 28.8 months (maximum, 8 years)., Results: Stent graft deployment was successful in all cases without need for surgical conversion. Except for one iliac rupture, which was treated with an iliofemoral bypass during the same procedure, there was no major perioperative complication. The early complications consisted of 3 primary endoleaks (1 type I and 2 type IV), 1 transient paraparesis, 1 occlusion of the main left bronchus, 1 thrombosis, and 2 pseudoaneurysms of the brachial artery. All the primary endoleaks healed within the first month. No patient died, and no aortic reinterventions were performed. The midterm complications were a mild circumferential thrombus at the distal part of the stent graft and a fracture of the nitinol stent. Both complications were asymptomatic and were discovered on systematic computed tomographic scan examination. Actuarial freedom from complication at 1 year was 96.1% +/- 3.8% and 85.5% +/- 10.6% at 3 and 5 years, respectively., Conclusion: This study demonstrates that the endovascular treatment of blunt thoracic aortic traumatisms is a safe and effective therapeutic method without increased midterm morbidity and mortality rates.

Objective: We sought to determine the midterm results of endovascular repair of atherosclerotic aneurysms of the thoracic descending aorta by using second-generation, commercially available stent grafts., Methods: Between 1996 and 2005, 45 patients (mean age, 68 +/- 11 years) with aneurysms of the descending thoracic aorta underwent endovascular repair. Aortic dissections, penetrating ulcers, and traumatisms were excluded. The mean follow-up was 24.7 +/- 21.6 months (maximum, 6.7 years)., Results: No patients died, and no conversion to surgical intervention was required during the procedures. Three (6.7%) patients died during the first month, and 6 (14.7%) died later on. The main complications were strokes (13.3%), vascular access complications (8.9%), aortic complications (6.6%), paraplegia (4.4%), and sudden deaths (4.4%). Nineteen (42%) primary endoleaks were encountered: 3 required reinterventions, 15 spontaneously thrombosed, and 1 patient died. Except for 2 sudden unexplained deaths, no aortic complications were observed after 1 month. Actuarial survival estimates at 1, 3, and 5 years were 87.6% +/- 5.3%, 76.9% +/- 7.4%, and 70.6% +/- 9.2%, respectively. Actuarial freedom from death related to the treated aortic disease was 94.3% +/- 4.0%, 94.3% +/- 4.0%, and 86.4% +/- 8.4% at 1, 3, and 5 years, respectively. Aspirin status of greater than 3 (P = .005), high aortic diameter (P = .007), and long covered lengths (P = .02) were determinant for mortality. Actuarial freedom from complication was 62.6% +/- 7.7%, 58.9% +/- 8.1%, and 58.9% +/- 8.1% at 1, 3, and 5 years, respectively. The location of the aneurysm (P = .05) and a high aortic diameter (P = .04) were both determinants for endoleaks., Conclusions: Stent grafting of atherosclerotic aneurysm of the thoracic descending aorta is safe and effective. Further studies are mandatory to determine the most relevant indications and the long-term efficacy of such treatment.

The authors present the case of a 48-year-old man with diffuse pulmonary lymphangiomatosis. This rare lymphatic disorder is characterized by proliferation of anastomosing lymphatic vessels varying in size. Clinical presentation and imaging findings are highly suggestive. Bronchoscopic examination of this patient showed, for the first time to our knowledge, vesicles disseminated throughout the bronchial tree. Histopathological examinations are necessary to differentiate lymphangiomatosis from lymphangiectasis. The diagnosis can be made by transbronchial biopsy without performing open lung biopsy which was, until now, considered necessary for diagnosis.

Endovascular treatment of aortic disease has emerged as an alternative mode of treatment that is particularly attractive for patients with severe comorbidities who would not be ideal candidates for open surgery. Actually, short-term morbidity and mortality rates, of large series, compare favorably with those from surgery, and stent-graft placement is proving to be a safe, minimally invasive, and effective treatment for thoracic aortic diseases. However, although endoluminal interventions are minimally invasive, they are associated with complications, as are surgical methods. In this article, indications, technical aspects, and results of endovascular TAA repairs will be reviewed. We will also examine the advantages and limitations of stent-graft treatment. Finally, we will discuss the management of complications following aortic stent-graft implantation. We intentionally do not cover the topic of thoracic dissection, as it is being covered in another article in this volume.

Objective: We sought to evaluate and compare the relative cost-benefit of Doppler sonography, MR angiography, and captopril-enhanced renal scintigraphy as techniques for predicting a patient's clinical response to renal angioplasty., Materials and Methods: Estimations of positive and negative predictive values of baseline and captopril-enhanced renal scintigraphy and Doppler sonography examinations for predicting a favorable outcome after renal angioplasty were based on a previously published prospective study involving 74 patients who underwent this treatment. For gadolinium-enhanced MR angiography, predictive values were calculated from a subpopulation of 57 of these 74 subjects. The value of different combined strategies with these techniques for predicting clinical success after angioplasty was evaluated in this population. The costs of investigation and treatment per improved patient were calculated for each imaging technique and for combined strategies in a hypothetic 1,000-patient population with a 30% prevalence of renal artery stenosis, relying on the diagnostic performance reported in the literature for each technique in detecting renal artery stenosis., Results: The costs for each improved patient were $12,579 for patients selected on the basis of a positive finding on Doppler sonography (false-negative results = 12/1,000) and $10,149 for patients selected with criteria combining a positive finding on Doppler sonography with a bilateral resistive index of less than 0.75 (false-negative results = 32/1,000). Patient selection based on a positive finding on MR angiography cost $18,119 (false-negative results = 0), whereas the cost of patient selection based on a positive finding on renal scintigraphy was $12,939 (false-negative results = 29/1,000)., Conclusion: Doppler sonography is more cost-efficient but less sensitive than MR angiography for identifying patients with renovascular hypertension. MR angiography should be favored in hypertensive patients who are resistant to medical therapy to avoid false-negative examinations.