The role of ultrasonography in the diagnosis of rib fractures

eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2024-12-31 9 3 118 122 10.26663/cts.2024.023 241 article The role of ultrasonography in the diagnosis of rib fractures Mustafa Kuzucuoglu 1 İlkay Albayrak 2 Ali Cem Yekdeş 3 Arkın Acar 4 Ceyda Ceylan 1 Nİhat Berk Sarmış 1 Emre Barış Şahin 5 Department of Thoracic Surgery, Izmir Katip Çelebi University, Izmir, TurkeyDepartment of Thoracic Surgery, Edirne Sultan 1. Murat State Hospital, Edirne, TurkeyDepartment of Public Health, Trakya University, Edirne, TurkeDepartment of Thoracic Surgery, Manisa Celal Bayar University, Manisa, TurkeyDepartment of Radiology, Izmir Katip Çelebi University, Izmir, TurkeyBackground: Background: Rib fractures rank among the most common conditions in thoracic traumas. Chest radiography is often insufficient for diagnosing rib fractures. Therefore, the study aimed to evaluate the success of thoracic ultrasonography (US) in diagnosing rib fractures. Materials and Methods: Patients over 18 years of age who were hospitalized in our clinic due to traumarelated rib fractures between 2022 and 2023, were included. All patients had chest radiography and computed tomography (CT) scans during their emergency admission, as per the routine operation of the emergency department. Chest radiography and CT images were evaluated by the thoracic surgery clinic, and CT images were also examined through the radiology reports. Thoracic US was performed on all patients by the same radiologist the day after admission to the clinic. The patient's demographic characteristics, chest radiography, chest CT, and thoracic US findings were recorded, and the data were compared statistically. Results: A total of 58 cases were included in the study, 42 (72.4%) males and 16 (27.6%) females. The mean age of the study population was 60.55 ± 15.71 years. When evaluated regarding trauma types, 42 (72.4%) patients had a fall, 15 (25.9%) had a traffic accident, and 1 (1.7%) patient had a history of battery. In addition to rib fractures, hemothorax was detected in 67.2% of the cases, pneumothorax in 27.6%, and pulmonary contusion in 19.0%. In radiological imaging, while 246 rib fractures were reported according to CT, 136 rib fractures were detected in USG and 140 in direct radiography. Considering CT imaging is the gold standard, 114 of 246 rib fractures (46.3%) could be detected with ultrasound imaging, while 127 (51.6%) were determined with direct radiography. Conclusions: When chest CT is considered the gold standard, direct radiography, and thoracic US have no general superiority over each other. https://cts.tgcd.org.tr/pdf.php?id=241 traumarib fracturethoracic ultrasonographydirect radiographydiagnosis eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2024-12-31 9 3 123 131 10.26663/cts.2024.024 242 article The selective role of radiological findings and pet-CT in solitary pulmonary nodules Mustafa Akyıl 1 Ayşe Ulusoy 1 Serkan Bayram 1 Elçin Ersöz Köse 1 Eymen Yayla 1 Şebnem Boz 2 Fatma Tokgoz Akyıl 3 Serdar Evman 1 Volkan Baysungur 1 Department of Thoracic Surgery, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, TurkeyDeparment of Radiology, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, TurkeyDepartment of Chest Diseases, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, TurkeyBackground: The aim of this study is two-fold; first is to investigate the determinants of malignancy from the clinical and radiological results of patients operated on solitary pulmonary nodules (SPN) and second is to determine the SUVmax threshold value for predicting malignancy based on nodule size. While the literature tends to focus on many variables as a group for understanding the SPNmalignancy link, this study asks whether we could weigh size more compared to other factors to decide on malignancy potential. The fact that the incidental finding of SPNs is on rise means timely prediction and cure are within our reach. Materials and Methods: Patients operated in our clinic due to SPN between January 2018 and December 2022 were categorized into two groups according to their histopathologic diagnoses as malignant and benign. The clinical and radiological characteristics of the two groups were then analysed. Results: Among the 522 patients included in the study, 385 (74%) were male and the mean age was 61 ± 10.5 years. The high SUVmax value of the nodule and the presence of lobulation and spiculation were found to be determinant factors for malignancy (p<0.05, for all). In addition, SUVmax values of 1.75 for nodules <1 cm in diameter, 2.24 for nodules between 1-2 cm, and 2.55 for nodules >2 cm were determined as malignancy predictors. Conclusions: High SUVmax and the presence of lobulation and spiculation are positive predictive factors for malignancy in SPNs. We believe that the SUVmax value is discretely (by itself) critical in predicting malignancy according to the diameter of the nodule. As size is a relatively straightforward variable to measure and SPN is largely curable with timely intervention, the capacity of size to be a predictor would be highly convenient. In this respect, to better exploit the SUVmax indicator in practice during prognosis, more sensitive cut-off values in an ascending/descending order of the module diameter could be defined. https://cts.tgcd.org.tr/pdf.php?id=242 FDG-PET/CTlung cancersolitary pulmonary nodule eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2024-12-31 9 3 132 140 10.26663/cts.2024.025 243 article Knowledge, attitudes and beliefs of thoracic surgery residents towards theoretical and practical medical life in turkey Caner İşevi 1 Mehmet Gökhan Pirzirenli 1 Burçin Çelik 1 Yasemin Bilgin Büyükkarabacak 1 Department of Thoracic Surgery, Ondokuz Mayıs University Medical Faculty, Samsun, TurkeyBackground: This study aimed to evaluate the perspectives of residents working in thoracic surgery clinics at university, training, and research hospitals in Turkey, regarding their educational experiences, as well as their knowledge, attitudes, and expectations about the theoretical and practical aspects of practice. Materials and Methods: A total of 180 residents from thoracic surgery clinics in randomly selected university, training, and research hospitals in Turkey were contacted. A 37- question survey was designed using tr.surveymonkey.com and distributed via social media (WhatsApp). Of these, 160 residents participated, and the results were analyzed. Results: Among the 160 respondents, 94 (58.8%) were male and 66 (41.2%) were female, with a mean age of 29.4 ± 2.9 years (range 25-39). In the medical specialty examination, 137 (85.63%) of the participants ranked thoracic surgery in the 1st to 5th positions. Clinics had a mean of 9 ± 5 residents (range 1-22). 37 (23.1%) reported 8 or more shifts per month, and 31 (19.4%) had no time off after shifts. Approximately 52% of clinics offered an average of 5 ± 2.5 hours of training per month. A total of 109 (68.1%) residents were able to perform cases as the primary surgeon. The main learning sources were mainly senior assistants (41.9%) and faculty members (31.2%). ‘Mobbing’ was reported by 26 (16.2%), and 88 (55%) expressed future career uncertainty. After training, 43.1% planned to work as specialists, and 32.5% aimed for academic careers. Conclusion: The study offers insights to enhance thoracic surgery training programs, support residents, and improve professional satisfaction. These findings may guide future strategies and policies to foster a better educational environment in thoracic surgery. https://cts.tgcd.org.tr/pdf.php?id=243 surveyresidentseducationthoracic surgeryprofession eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2024-12-31 9 3 141 146 10.26663/cts.2024.026 244 article Impact of subclinical hypothyroidism on postoperative satisfaction in hyperhydrosis surgery Ömer Yavuz 1 Eylem Çagıltay 2 Nurettin Yiyit 3 Department of Thoracic Surgery, Başakşehir Çam ve Sakura City Hospital, Istanbul, TurkeyDepartment of Endocrinology, Memorial Hospital, Istanbul, TurkeyDepartment of Thoracic Surgery, Yedikule Pulmonology and Thoracic Surgery Hospital, Istanbul, TurkeyBackground: We aimed to study the effects of subclinical hypothyroidism on patient satisfaction after hyperhidrosis surgery. Materials and Methods: Patients who underwent primary hyperhidrosis surgery from February 2013 to January 2017 were retrospectively evaluated and divided into two groups: Group 1 with normal thyroid function and Group 2 with subclinical hypothyroidism. All patients completed a postoperative satisfaction questionnaire on a 5-point Likert scale, with Cronbach’s Alpha reliability coefficients of 0.93 preoperatively and 0.96 postoperatively. The questionnaire assessed satisfaction differences between groups in daily life following surgery. Results: A total of 82 patients aged 18-65 and met Hornberger’s criteria were evaluated in the study. Patient satisfaction rate was 80.5% for the overall population. Although the difference between preoperative and postoperative state was statistically significant (Greenhouse-Geisser; p < 0.0001), no statistically significant difference was found in postoperative satisfaction between Group 1 and Group 2. (p = 0.13). Conclusions: Subclinical hypothyroidism does not impact the outcomes of endoscopic thoracic sympathectomy; thus, patients with this condition can safely undergo the procedure based on this study's findings. https://cts.tgcd.org.tr/pdf.php?id=244 hyperhidrosissubclinical hypothyroidismpostoperative satisfactionanalysisquestionnaire eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2024-12-31 9 3 147 149 10.26663/cts.2024.027 245 article A rare reason for intubation: esophageal foreign body lodged in the upper esophageal stricture Omer Topaloglu 1 Alaaddin Buran 2 Elvan Senturk Topaloglu 3 Sami Karapolat 2 Department of Thoracic Surgery, Recep Tayyip Erdogan University Faculty of Medicine, Rize, TurkeyDepartment of Thoracic Surgery, Karadeniz Technical University Faculty of Medicine, Trabzon, TurkeyDepartment of Pulmonology, Recep Tayyip Erdogan University Faculty of Medicine, Rize, TurkeyEsophageal foreign bodies are more common in children than in adults. However, in older individuals without teeth, food swallowed without thorough mastication can get lodged in the esophagus. Herein, we report the case of a 77-year-old woman who presented with severe dyspnea, dysphagia, and a globus sensation in her throat. The patient required intubation owing to progressive dyspnea and rapid peripheral saturation decrease and was found to have a foreign body lodged in her proximal esophagus, which was removed using McGill forceps under direct visualization. Subsequently, the patient was extubated and transferred to the ward. Complaints of dysphagia in older patients with mastication problems should prompt clinicians to consider foreign body impaction. The proximal esophagus is the most common site for foreign body entrapment. If left unmanaged, foreign bodies lodged in the upper gastrointestinal tract can cause serious life-threatening conditions. Appropriate diagnosis and treatment can help minimize potential risks. https://cts.tgcd.org.tr/pdf.php?id=245 esophageal foreign bodiesdifficult intubationmanagementairwayssurgery