Introduction: Few studies is in literature related to evaluation of impact of positive pressure ventilation (PPV) on thoracostomy tube removal in Iran. We decided, in this study, to evaluate the impact of PPV on recurrent pneumothorax (PTX) after removal of thoracostomy tubes (TT).Methods: A case-control study was performed for evaluating 122 CHEST tubes in 109 mechanically ventilatedtrauma patients during a one year period.61 CHEST tubes randomly assigned tobeclamped and the others observed as control group. After 6 hours, portable CXR obtained. All CHEST radiographs were reviewed to identify recurrent PTX. The collected data was analyzed using SPSS statistical software and P<0.05 was considered significant.Results: Rate of post-clamping PTX was 11.5%, (7 of 61). There was a significant difference between case and control groups in recurrent pneumothorax (P=0.013).6 of these 7 patients (85%) who their CHEST tube discontinuation resulted in recurrent pneumothorax, underwent tube thoracostomy for pneumothorax or hemopneumothorax.5 of these 7 patients had been demonstrated airleak during hospitalization. A significant statistical association between the first CXR in emergency department and presence of airleak in ICU was detected (P<0.001). Moreover, there was a significant association between airleak during admission and incidence of recurrent pneumothorax (P<0.001).Conclusion: Regarding to remarkable incidence of post-clamping pneumothorax (11.5%) in despite of careful patient selection for CHEST tube discontinuation in this study, CHEST tube removal for patients on PPV is not a safe method. It has been demonstrated that once discontinuation criteria were met, in patients who undergone tube thoracostomy for pure hemothorax and did not reveal airleak during their hospitalization, thoracostomy tube removal is safe, even on positive pressure ventilation. Nevertheless, the surgeon decision for timing of CHEST tube removal is superior.

Introduction & Objective: Blunt injury to the CHEST continues to be one of the leading causes of morbidity and mortality in trauma patients and flail CHEST is among the worst of these injuries. The treatment varies with the severity of injury, ranging from supportive such as oxygen enrichment, CHEST physiotherapy and pain relief to internal fixation with surgery or invasive and non invasive positive pressure ventilation (IPPV & NIPPV).Material & Methods: In our study 56 patients with diagnosis of flail CHEST prospectively were managed in the ICU with supportive management such as: oxygen therapy, analgesia and CHEST physiotherapy with or without invasive or noninvasive mechanical ventilation depending on injury severity score (ISS), trauma to head or other vital organs, respiratory distress and level of conscious, patients were divided into three groups. GI (n=20): were treated with supportive measures (pain control, oxygen therapy with simple mask and CHEST physiotherapy). GII (n=17): were ventilated with continuous positive airway pressure (CPAP) 5-12 Cm H20 and GIII (n=19): were intubated and controlled ventilation. All of the groups were received, IV infusion of Fentanyl 1µg/kg/h or Marcaine 0.5% (0.1 m1/kg/h) through epidural catheter, for pain control.Their data were analyzed to determine the effectiveness of management, ICU stays, weaning time and to know complications, morbidity and mortality following both therapies.Results: 56 patients (M=37, F=19) were studied injury severity score (ISS) in the patients from GIII was significantly higher than GI and GII.(GI:14+2.1, GII:25+3.4, GIII:36+5.5) (p<0.01). depends on PaO2 and PaCO2 at admission time in ICU or recovery ,no difference were observed between three groups. The mechanical ventilation was required 9+4.6 in GII and 12+5.6 days in GIII. (p<0.01) the most common complication was pneumonia (GI:4, GII:9 and GIII:18) (p<0.01). Correlated presence of average of ICU stays and the use of mechanical ventilation. (P<0.003) (GI: 6+3.3, GII: 12+5.4, GIII: 15+7.3). Fatality rate was 9 (GII: 1, GIII: 8) the most common cause of death was severe head injury (4 patients). Mortality rate was also comparable with injury severity score.Conclusions: We observed that outcome of flail CHEST patients does not depend on ventilatory or nonventilarory management but on severity of pulmonary damage, injury severity score (>30) and associated injuries specially craniocerebral. So we suggest depending on injury severity score (ISS), trauma to head or other vital organs, respiratory distress and level of consciousness, the first step of treatment of these patients is supportive measures such as oxygen enrichment, CHEST physiotherapy and pain relief, then non-invasive positive pressure ventilation(CPAP) and finally mechanical ventilation and we don't suggest internal fixation with surgery for these patients.

Hydatid cyst is a parasitic disease that is endemic in Mediterranean areas, South America, North Africa, Australia, and Iran. Although the liver and lung are the most common involved organs, but the other organs in human body also can be involved by hydatid cyst. CHEST wall involvement by hydatid cyst is a rare condition, which may be misdiagnosed as CHEST wall tumor in the endemic areas. Herein, we presented a case of primary CHEST wall hydatid cyst mimicking CHEST wall tumor.

I read, with interest, the article entitled "Clinical and Para-clinical Presentations of Endobronchial Tuberculosis" by Ahmadi Hoseini H. S. et al. (1) published in this journal. I would like to focus on some details about the CHEST X-ray of patients as elaborated by the authors in the results section.

Background: The pediatrics' CHEST X-rays using digital radiography are considered important because of the high rates of this test as well as the increased sensitivity of children to ionizing radiation compared with adults. Therefore, clarification of radiographic methods that reduce the dose and maintain or even increase the quality of the image is of great importance and thus of interest to researchers. The goal of the present study was to build a CHEST equivalent homogeneous phantom to evaluate the image quality in radiographic tests in four age groups of children based on the ICRP103 age category classification. Materials and Methods: The X-ray spectrum approved by IPEM was used as the input x-ray source in the Monte Carlo code. The geometric phantom equivalent to the ORNL body was then simulated to calculate the absorb dose using Monte Carlo code. The results of the simulation were used to construct equivalent CHEST phantom for children. Results: In order to validate and verify the performance of the equivalent phantoms simulated for each age group, the attenuation and dispersion of the phantom at the field were measured. For this purpose, the percentages of the depth dose in the simulation conditions was compared with those of the experimental results, which can be used to examine the attenuation in different layers. The calculated error was less than 5% on the depth dose for the Monte Carlo and the experimental space and it indicates Confirmation of simulated program. After simulation, the phantom was made in similar dimensions with different thicknesses of the Plexiglas pediatrics age ranges. Conclusion: It seems that the phantom designed in the current study can be used to assess the doses of children in different age groups. It can also be used with local fitting for image quality control tools, such as contrast, resolution, etc, for evaluating the parameters related to the quality of the image in the actual condition.

Background: CHEST pain is one of the most frequent causes of a child’ s referral to a cardiologist. Objectives: The present study aimed at determining whether treatment of constipation in 4-17-year-old children with idiopathic CHEST pain stops their CHEST pain. Methods: The current descriptive study was conducted on all patients aged 4-17 years old with idiopathic CHEST pain referring to the Pediatric Cardiology Clinic of Hejazi Hospital, Shiraz, Iran in 2016. A diagnosis of idiopathic CHEST pain is established after a thorough history taking, physical examination, and appropriate laboratory investigations in patients with no abnormality in the heart, lung, musculoskeletal system, psychological condition, and upper gastrointestinal tract. The study patients were divided into two groups: 36 patients with constipation as cases and 27 patients without constipation as controls. Patients with constipation were supported with toilet training programs and pharmacological treatment. Relief of CHEST pain was evaluated in the two groups after four months. Results: There were no significant differences in terms of age, gender, weight, and height between the patients with idiopathic CHEST pain with and without constipation. The number and length of CHEST pain were significantly different between the case and control groups (P < 0. 001 and 0. 047, respectively). After medical treatment of constipation, CHEST pain was significantly stopped in patients with constipation compared with the ones without constipation (P < 0. 001). Conclusions: The current study showed that resolution of constipation stopped CHEST pain in the patients with idiopathic CHEST pain and constipation. Physicians should consider treatment of constipation as a first modality in each patient with idiopathic CHEST pain and constipation due to its easy assessment.

Background: CHEST CT is more sensitive than a CHEST X-ray (CXR) in diagnosing rib fractures; however, the clinical significance of these fractures remains unclear. Objectives: The purpose of this study was to determine the added diagnostic use of CHEST CT performed after CXR in patients with either known or suspected rib fractures secondary to blunt trauma. Methods: Retrospective cohort study of blunt trauma patients with rib fractures at a level I trauma center that had both a CXR and a CT CHEST. The CT finding of 3 additional fractures in patients with 3 rib fractures on CXR was considered clinically meaningful. Student’ s t-test and chi-square analysis were used for comparison. Results: We identified 499 patients with rib fractures: 93 (18. 6%) hadCXRonly, 7 (1. 4%) had CHEST CT only, and 399 (79. 9%) had bothCXR and CHEST CT. Among these 399 patients, a total of 1, 969 rib fractures were identified: 1, 467 (74. 5%) were missed by CXR. The median numberof additional fractures identified by CT was 3 (range, 4-15). Of 212 (53. 1%) patients with a clinically meaningful increase in the number of fractures, 68 patients underwent one or more clinical interventions: 36 SICU admissions, 20 pain catheter placements, 23 epidural placements, and 3 SSRF. Additionally, 70 patients had a CHEST tube placed for retained hemothorax or occult pneumothorax. Overall, 138 patients (34. 5%) had a change in clinical management based upon CT CHEST. Conclusions: The CHEST X-ray missed ~ 75% of rib fractures seen on CHEST CT. Although patients with a clinical meaningful increase in the number of rib fractures were more likely to be admitted to the intensive care unit, there was no associated improvement in pulmonary outcomes.