Korean Journal of Family Medicine

"Thoracic"

Case Report

Post-traumatic Fibro-Osseous Lesion of the Fourth Rib Simulating a Chest Wall Tumor: A Case Report: Mouna Brahem, Olfa Jomaa, Mabrouk Abdelali, Rihab Sarraj, Amine Bayoudh, Leila Njim, Ahmed Zrig, Abdelfatteh Zakhama, Haifa Hachfi, Mohamed Younes; Korean J Fam Med 2023;44(5):295-298. Published online June 20, 2023; DOI: https://doi.org/10.4082/kjfm.22.0223

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Post-traumatic fibro-osseous lesions (PTFOL) are a rare and benign tumor that typically affects the ribs and is probably caused by an excessive post-traumatic reactive process. PTFOL primarily affects the sixth, seventh, and eighth ribs. Here, we report a case of a PTFOL with an unusual location and expansion that simulated a malignant chest tumor. A 28-year-old male patient with a history of minor chest trauma presented with pain. Chest radiography revealed a large, well-defined lesion on the left fourth rib, and computed tomography (CT) of the chest revealed a lytic lesion-type IC on the posterior and middle arches of the left fourth rib with a cartilaginous matrix and discontinued periosteal reaction without soft tissue mass extension. Additionally, magnetic resonance imaging of the chest revealed an ovoid, expansive mass with cystic lobules and lobulated contours extending almost over the entire left fourth rib, measuring 134×47 mm in size. This mass has a low signal on T1-weighted images and a heterogeneous intermediate signal on T2-weighted images, with intense enhancement after gadolinium injection suggestive of a malignant chest tumor. A CT-guided bone biopsy confirmed the presence of an intramedullary lesion consisting of fibrous connective tissue with fusiform fibroblastic cells without atypical signs. The lesion was delimited by bone trabeculae with nibbled edges, indicating exaggerated osteoclastic activity compatible with a diagnosis of PTFOL. The patient was treated with simple analgesics, and chest pain was relieved, with an unchanged volume of the lesion at 1 year of follow-up.

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Original Articles

The Relationship between Heart Rate Variability and Aortic Knob Width: Si-Yeun Sung, Jee-Hye Han, Jung-Hwan Kim, Kil-Young Kwon, Seong-Wook Park; Korean J Fam Med 2019;40(1):39-44. Published online January 9, 2019; DOI: https://doi.org/10.4082/kjfm.18.0077

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Background
The aortic knob width (AKW) and the heart rate variability (HRV) were suggested to be related to development of cardiovascular diseases. However, the relationship between them has not been investigated; thus, this study aimed to determine this relationship.
Methods
This study included 587 Koreans aged 18–79 years. Their physical measurements, medical and social histories, blood test findings, and chest radiographs were obtained. The HRV parameters included the standard deviation of the N-N interval (SDNN), root mean square of successive differences (RMSSD), approximate entropy (ApEn), total power (TP), very low frequency (VLF), low frequency (LF), high frequency (HF), and LF/HF ratio, which were measured for 5 minutes. The AKW was measured on chest radiographs by a single reviewer.
Results
The AKW was significantly correlated with the HRV parameters, except for the LF/HF ratio. However, RMSSD and ApEn were not significantly related to the AKW in women. After dividing the participants into quartile groups, the AKW was significantly related to the SDNN, RMSSD, TP, VLF, LF, and HF. The HRV parameter values decreased in the higher AKW quartile groups, the HRV parameter values decreased. After adjusting for sex, drinking status, exercise habits, smoking status, waist circumference, and triglyceride, low-density lipoprotein cholesterol, fasting blood sugar, and glycated hemoglobin levels, the AKW showed significant negative associations with the HRV parameters, except for the LF/HF ratio.
Conclusion
The AKW is significantly associated with the HRV parameters of SDNN, RMSSD, ApEn, TP, VLF, LF, and HF.

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The Relationship between Aortic Knob Width and Metabolic Syndrome: Eun-Ji Lee, Jee-Hye Han, Kil-Young Kwon, Jung-Hwan Kim, Kun-Hee Han, Si-Yeun Sung, Seo-Rim Hong; Korean J Fam Med 2018;39(4):253-259. Published online July 16, 2018; DOI: https://doi.org/10.4082/kjfm.17.0038

Abstract
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Background
Both aortic knob width and metabolic syndrome are suggested to be related to atherosclerosis and cardiovascular diseases. However, the association between aortic knob width and metabolic syndrome is unknown. This study aimed to explore this relationship.
Methods
Participants were 3,705 Korean adults aged 18–79 years who visited the health promotion center of a general hospital. Data on chest radiography, physical measurements, medical and social history, and blood tests were collected. We defined metabolic syndrome according to the National Cholesterol Education Program Adult Treatment Panel III criteria. A single reviewer measured aortic knob width on chest radiography.
Results
Aortic knob width was significantly correlated with age; body mass index; waist circumference; systolic and diastolic blood pressures; total cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, fasting glucose, glycated hemoglobin, insulin, and uric acid levels; and homeostatic model assessment of insulin resistance values. Aortic knob width significantly increased as the number of metabolic syndrome components increased. Moreover, metabolic syndrome component values tended to increase across the quartile groups of aortic knob width after adjusting for age, exercise, smoking status, and alcohol use. Through receiver operating characteristic curve analysis, we determined the clinically useful cutoff value for aortic knob width to be 30.47 mm in premenopausal women.
Conclusion
Aortic knob width was found to be significantly related to metabolic syndrome and its individual components.

Citations

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Chest x‐ray aortic size and risk of death and cardiovascular disease in older Chinese: Guangzhou biobank cohort study
Linye Sun, Wenbo Tian, Jiao Wang, Tianqiong Wu, Xiangyi Liu, Yali Jin, Taihing Lam, Karkeung Cheng, Weisen Zhang, Lin Xu
Journal of Internal Medicine.2025; 297(5): 543. CrossRef
Chest X-Ray as a Screening Tool for Aortic Arch Dilation: CT-Based Evaluation of Reliability
Maciej Lis, Robert Banyś, Bernard Solewski, Aleksandra Stanek, Maciej Krupiński, Barbara Obuchowicz, Tomasz Puto, Adam Piórkowski, Krzysztof Batko
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The Relationship of Aortic Knob Width with Mortality in Patients with Ishemic Stroke
Aziz Vatan, Yusuf Jankat Bozkurt, Mehmet Semih Çakır, Cansu Erkol, Turgut Karabağ
Bulletin of Cardiovasculer Academy.2024;[Epub] CrossRef
Aortic Knob Diameter in Chest Radiographs of Healthy Adults in Uganda
Steven Magera, Senai Goitom Sereke, Emmy Okello, Faith Ameda, Geoffrey Erem
Reports in Medical Imaging.2022; Volume 15: 21. CrossRef
The association between aortic knob width on chest x‐ray and obstructive sleep apnoea syndrome in patients referred for sleep testing
Erdem Cetin, Hasan Casim
The Clinical Respiratory Journal.2019; 13(11): 716. CrossRef

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Case Reports

Multiple Cavitary Pulmonary Nodules Caused by Mycobacterium intracellulare: Sang Hoon Yoo, Seo Ree Kim, Joon Young Choi, Jae Woo Choi, Yu Mi Ko, Sun Hee Jang, Jun Kyu Park, Ye Gyu Sung, Yun Jung Park, Su Yun Oh, Se Young Bahk, Ju Hyun Lee, Myung Sook Kim; Korean J Fam Med 2016;37(4):248-252. Published online July 21, 2016; DOI: https://doi.org/10.4082/kjfm.2016.37.4.248

Abstract
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Nontuberculous mycobacteria (NTM) have been increasingly recognized as an important cause of chronic pulmonary infections. The Mycobacterium avium complex (MAC), which is composed of two species, Mycobacterium avium and Mycobacterium intracelluare, is the most commonly encountered pathogen associated with NTM lung disease. MAC pulmonary infection typically presents in a fibrocavitary form or a nodular bronchiectatic form. However, there have been atypical presentations of MAC pulmonary infections, including solitary pulmonary nodules (SPN). There have been several previous reports of SPN due to MAC infection in the United States, Japan, and Korea. In 2009, Sekine and colleagues reported a case of MAC pulmonary infection presenting with multiple nodules. To date, however, there have been no cases of NTM lung infection with multiple cavitary pulmonary nodules, and neither a fibrotic change nor nodular bronchiectasis. The present case showed a multiple cavitating nodular lung infection due to MAC, which is very rare and different from the typical presentation of MAC pulmonary infections. We also showed that percutaneous transthoracic needle aspiration can be a useful diagnostic tool to evaluate a case of multiple cavitary nodules.

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Multiple pulmonary cavitating nodules in female with endometrium adenocarcinoma history – difficulties in differentiation between metastases, sarcoidosis and sarcoid-like reaction. Case report
Alicja Gałeczka-Turkiewicz, Dagmara Galle, Agnieszka Goryczka, Maja Zarzecka, Dariusz Jastrzębski, Dariusz Ziora
Annales Academiae Medicae Silesiensis.2023; 77: 1. CrossRef
The Role of Biofilms, Bacterial Phenotypes, and Innate Immune Response in Mycobacterium avium Colonization to Infection
Catherine Weathered, Kelly Pennington, Patricio Escalante, Elsje Pienaar
Journal of Theoretical Biology.2022; 534: 110949. CrossRef

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Thoracolumbar Junction Syndrome Causing Pain around Posterior Iliac Crest: A Case Report: Soo-Ryu Kim, Min-Ji Lee, Seung-Jun Lee, Young-Sung Suh, Dae-Hyun Kim, Ji-Hee Hong; Korean J Fam Med 2013;34(2):152-155. Published online March 20, 2013; DOI: https://doi.org/10.4082/kjfm.2013.34.2.152

Abstract
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Thoracolumbar junction syndrome is characterized by referred pain which may originate at the thoracolumbar junction, which extends from 12th thoracic vertebra to 2nd lumbar vertebra, due to functional abnormalities. Clinical manifestations include back pain, pseudo-visceral pain and pseudo-pain on the posterior iliac crest, as well as irritable bowel symptoms. During clinical examination, pain can be demonstrated by applying pressure on the facet joints or to the sides of the spinous processes. Radiological studies show only mild and insignificant degenerative changes in most cases. We report a 42-year-old female patient with osteogenesis imperfecta who suffered from chronic low back pain. Under the diagnosis of thoracolumbar junction syndrome, she was treated with an epidural block and a sympathetic nerve block, which improved her symptoms.

Citations

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Maigne Syndrome – A potentially treatable yet underdiagnosed cause of low back pain: A review
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Anthony Tucker-Bartley, Jordan Lemme, Andrea Gomez-Morad, Nehal Shah, Miranda Veliu, Frank Birklein, Claudia Storz, Seward Rutkove, David Kronn, Alison M. Boyce, Eduard Kraft, Jaymin Upadhyay
Neuroscience & Biobehavioral Reviews.2021; 124: 267. CrossRef
Clinical Application and Implication of Pinch Roll Test
Seonghun Choi, Hongmin Chu, Sehun Jung, Juhwan Song, Myungseok Ryu
Journal of Korean Medical Society of Soft Tissue.2021; 5(1): 35. CrossRef
Neuraxial and regional anesthesia in surgical patients with osteogenesis imperfecta: a narrative review of literature
Amy R Beethe, Nicholas A Bohannon, Oluwaseye Ayoola Ogun, Maegen J Wallace, Paul W Esposito, Thomas J Lockhart, Ryan J Hamlin, Jasper R Williams, Jessica K Goeller
Regional Anesthesia & Pain Medicine.2020; 45(12): 993. CrossRef
Short-term Response to Treatment Targeting the Thoracolumbar Junction in Patients With Hip Pain: A Case Series
Jeffrey Meadows, Thomas Denninger, Seth Peterson, Leslie Milligan, John Zapanta
Journal of Orthopaedic & Sports Physical Therapy.2019; 49(8): 611. CrossRef
Differentiation and classification of thoracolumbar transitional vertebrae
Anneli M. Du Plessis, Linda M. Greyling, Benedict J. Page
Journal of Anatomy.2018; 232(5): 850. CrossRef
Pain experiences of adults with osteogenesis imperfecta: An integrative review
Tracy Nghiem, Khadidja Chougui, Alisha Michalovic, Chitra Lalloo, Jennifer Stinson, Marie-Elaine Lafrance, Telma Palomo, Noémi Dahan-Oliel, Argerie Tsimicalis
Canadian Journal of Pain.2018; 2(1): 9. CrossRef
Author reply
Anneli M. Du Plessis
Journal of Anatomy.2018; 233(3): 397. CrossRef
Effectiveness of Exercise and Local Steroid Injections for the Thoracolumbar Junction Syndrome (The Maigne’s Syndrome) Treatment
Kerem Alptekin, Nurettin Irem Örnek, Tuğba Aydın, Mirsad Alkan, Mehmet Toprak, Leyla A. Balcı, Jülide Öncü Alptekin
The Open Orthopaedics Journal.2017; 11(1): 467. CrossRef
Testicular pain due to thoracolumbar junction syndrome: A case report
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Revista Internacional de Andrología.2016; 14(4): 148. CrossRef

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Original Article

Cardio-thoracic Ratio (CTR) for Detection of Left Ventricular Hypertrophy (LVH) in Elderly People.: Sung Hoon Kim, Yun Jeong Shin, Hee Suk Kang, Hai Gyung Yoon, Mi Kyeong Oh, Sang Sig Cheong; J Korean Acad Fam Med 2007;28(9):690-697. Published online September 10, 2007

Abstract
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Background
Left ventricular hypertrophy (LVH) is closely related with a high death rate, rhythmia, ischemic heart disease, stroke and sudden death. It is known that the prognosis becomes better as LVH regresses. Therefore, it is important to diagnose it correctly with ease in primary care. The authors evaluated the most standard cardio-thoracic ratio (CTR) with respect to LVH oriented towards elderly people whose body habitus changed over time as they had become older, and evaluated the factors which affect the rate of diagnosis including sensitivity and specificity. Methods: A total of 231 subjects over 60 years of age who visited a general hospital health promotion center from March 1997 to August 2003, underwent echocardiography and identified not to have heart disease were selected. LV (left vetricular) mass was measured through echocardiography. LV mass was divided by 2.7 times of height (m) by Deveruex's method, and 49.1 g/m^2.7 for men and 46.7 g/m^2.7 for women were set to be standards of LVH. CTR was obtained by dividing the maximum transverse diameter of the heart by maximum transverse diameter of thorax on chest PA. Results: CTR was observed on the basis of 0.45, 0.5, 0.55, and the agreement was highest of 0.5 for men and 0.45 for women. However, considering the sensitivity, the specificity, and the positive predictive value, it was thought to be most proper to be set at 0.5 was be standard for both men and women. When diagnosing LVH through chest PA, if 0.5 was set to be standard, false positive become high in women, false negative became high as height increased, and false negative became high as body mass index (BMI) increased. The smoking group showed higher false negative compared to the non- smoking group, and the false negative was higher as the level of hemoglobin increased. Conclusion: When diagnosing LVH through CTR in elderly people, it was appropriate to set 0.5 as a standard, but it is necessary to consider sex, body habitus, BMI, smoking and the level of hemoglobin. (J Korean Acad Fam Med 2007;28:690-697)