DOCSLIB.ORG

OMT in Pregnancy (MAOFP).Pdf

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
OMT in Pregnancy (MAOFP).Pdf OMM in pregnancy Saroj Misra, DO, FACOFP Marissa Rogers, DO Acknowledgements Laura Dreyer, DO Rachel Nixon, DO Molly DiMatteo, DO 2 Goals/Objectives Review evidence based benefits of OMT in pregnancy Understand the implications of pregnancy on the somatic system Recognize common somatic dysfunctions seen in pregnant women Discuss and demonstrate OMT techniques that can be used to treat the somatic dysfunctions associated with pregnancy 3 Why use OMT? Pain reduction during pregnancy and labor Eliminate somatic dysfunction and maintain proper structure Limit medication use Improve quality of life Return to homeostasis Decrease pregnancy and labor complications Patient satisfaction!!! 4 Background Been using OMT on pregnant patients since early 20th century 1911 -Whiting - 223 pregnant women Prenatal OMT decreased labor time by over 50% for pregnancies 1918 - Hart - 100 pregnant women Of 100 deliveries all receiving OMT - only 3 required use of forceps compared to 6-18% of women not receiving OMT, in addition to similar decreases in length of labor 5 Background (cont.) 1982 - Guthrie & Martin - 500 women Decreased need for analgesia during labor in women receiving OMT 1992 - Gitlin & Wolf Stimulated uterine contractions through craniosacral manipulation 6 Recent research 2003 - King et al Retrospective case control study - decreased probability of complications in treated women 2010 - Licciardone et al - 144 patients Randomized, placebo controlled trial revealed decreased back pain in OMT group 7 Structural changes Increased lumbar lordosis Increased thoracic kyphosis Increased pelvic tilt Elevation of diaphragm 8 Physiologic changes Progesterone: smooth muscle relaxation, fluid retention -> nausea/vomiting/reflux Relaxin: soft tissue remodeling, SI laxity, pubic symphysis mobility -> pelvic pain/ back pain Increased cardiac output, decreased total lung capacity -> shortness of breath Sodium retention, water retention, increased blood volume -> edema, congestion, CTS Pseudo-hypercoagulable state 9 Osteopathic Tenets The body is a unit in which structure, function, mind and spirit are mutually and reciprocally interdependent Body has its own self protecting, regulating and healing mechanisms Structure and function are reciprocally related Treatment considers the preceding three principles 10 Viscerosomatics T10-L2: Stimulate uterine contractions/cervical→ dilation induction of labor Inhibit uterine contractions/cervical dilation→reduced preterm labor Atlas - C3: treat overstimulation of the vagus on the heart Thoracic spine/rib raising: regulate SNS - improve CVS Sacral treatment (S2-S4): treat pelvic splanchnic nerves → treat GI complaints, pelvic pain 11 Treatment Goals Correct articular and muscular dysfunction Restore autonomic balance Release fascial diaphragms Restore lymphatic and venous flow 12 Contraindications Undiagnosed bleeding Ruptured membranes Avoid CV4, HVLA, lymphatic pumps 13 Common Osteopathic findings in pregnancy BackHead/Occiput pain Nasal/Sinus Congestion,TART (OA) Neck TART (C2-5) Constipation Thoracics TART (especially T1-6) EdemaLumbar TART Sacrum B/L sacral flexion Carpal Tunnel Syndrome Reflux/n/vPelvis Pelvic Diaphragm Restriction Upper Extremity Carpal Tunnel Syndrome Headaches/migraines Lower Extremity Edema SinusRibs congestion TART, Inhalation of 11th and 12th ribs Abdomen Abd Diaphragm Restriction NeckLymphatics pain Edema in extremities may be present 14 Treatment considerations Treat in whatever position is most comfortable Avoid supine position for prolonged periods Avoid prone position! Utilize indirect techniques as much as possible 15 TREATMENTS OA release Purpose: reset parasympathetic nervous system 17 Cervical Soft Tissue Purpose: Decrease muscle tension Increase ROM Promote relaxation Treat cervical viscerosomatic reflexes 18 Cervical Counterstrain Purpose: Decrease tension of associated cervical muscles Atlas of Osteopathic Techniques, Nicholas 19 Thoracic Inlet Release Purpose: Release facial tension Decreases pain Improve lymphatic drainage 20 Atlas of Osteopathic Techniques, Nicholas Frontal/Nasal Lift Purpose: Decrease nasal congestion Release tension Improve drainage 21 Sinus effleurage Purpose: Decrease lymphatic congestion of sinuses 22 Rib raising Purpose: Increase rib motion Reset sympathetic nervous system 23 Kimberly Manual Abdominal Diaphragm Release Purpose: Increase diaphragm mobility Decrease SOB http://www.lastsite.ca/wp-content/uploads/2012/03/ 24 Carpal Tunnel Release Purpose: Increase lymphatic drainage Decrease pain 25 Ganglion Release Purpose: Decrease sympathetic tone to stomach through direct inhibition 26 Chapman Points: http://fce-study.netdna-ssl.com/images/upload-flashcards/back/9/4/31649888_m.jpg Stomach Reset viscerosomatic reflex of stomach 27 Chapman points: IT band Purpose: Reset viscerosomatic reflex of the colon https://o.quizlet.com/41fkAW730kYXwE1dGg-1Kg_m.jpg 28 Thoracic Springing Purpose: Articulate thoracic spine Improve motion Decrease tension Improve SOB 29 Soft tissue spine Purpose: Decrease tension Increase laxity of muscles Kimberly Manual 30 Modified Lumbar Roll Purpose: Stretch lumbar spine Improve ROM Decrease pain 31 ‘OB Roll’ Purpose: Articulate & stretch lumbar/thoracic spine 32 Still technique Purpose: Articulate sacrum/hip/innominate Decrease tension & pain Improve motion 33 Pelvic Diaphragm Purpose: Improves motion of the pelvic diaphragm Increased venous and lymphatic drainage from pelvis 34 Direct Sacral Inhibition Purpose: Increase mobility of sacrum, decrease pain Treat pelvic viscerosomatic reflex Kimberly Manual 35 Home exercises Lumbar Roll Cat/Cow Shoulder squares 36 Summary OMT in pregnancy has been shown to decrease labor time, assisted delivery incidence, as well as decrease pain and complications associated with pregnancy Common regions to look for somatic dysfunctions in pregnancy are thoracic, lumbar, pelvic, and breathing apparatus There are a number of techniques identified which can assist in the management of the pregnant patient 37 Questions 38 References Laura Dreyer, D.O. OMM in pregnancy. 2009 Paul Kimberly, D.O. Outline of Osteopathic Manipulative Procedures. The Kimberly Manual. Millennium Edition. Walsworth Publishing Co. 2000. Channell, Millicent and Mason, David. The 5-Minute Osteopathic Manipulative Medicine Consult. Lippincott Williams and Wilkins. 2008. John Licciardone et al. Osteopathic Manipulative Treatment of Back Pain and Related Symptoms during Pregnancy: A Randomized Controlled Trial. Am J Obstet Gynecol. 2010 January; 202(1): 43.e1–43.e8. Hollis H. King, D.O. et al.Osteopathic Manipulative Treatment in Prenatal Care: A Retrospective Case Control Design Study. JAOA • Vol 103 • No 12 • December 2003 John M Lavelle, D.O. Osteopathic Manipulative Treatment in Pregnant Women. J Am Osteopath Assoc June 1, 2012 vol. 112 no. 6 343-346 Nicholas, A DO & Nicholas, E DO. Atlas of Osteopathic Techniques. Lippincott Williams and Wilkins. 2008 Anita Showalter, DO. Deliver us from Pain: OMT in the Obstetric patient. http://www.osteopathic.org/inside-aoa/events/omed/omed- presentations/documents/public-health-showalter.pdf Laura Tinning, DO. OMT in OB. CME Course MSUCOM November 2015 39.
Load more

Recommended publications
  • Diapositiva 1
    Thoracic Cage and Thoracic Inlet Professor Dr. Mario Edgar Fernández. Parts of the body The Thorax Is the part of the trunk betwen the neck and abdomen. Commonly the term chest is used as a synonym for thorax, but it is incorrect. Consisting of the thoracic cavity, its contents, and the wall that surrounds it. The thoracic cavity is divided into 3 compartments: The central mediastinus. And the right and left pulmonary cavities. Thoracic Cage The thoracic skeleton forms the osteocartilaginous thoracic cage. Anterior view. Thoracic Cage Posterior view. Summary: 1. Bones of thoracic cage: (thoracic vertebrae, ribs, and sternum). 2. Joints of thoracic cage: (intervertebral joints, costovertebral joints, and sternocostal joints) 3. Movements of thoracic wall. 4. Thoracic cage. Thoracic apertures: (superior thoracic aperture or thoracic inlet, and inferior thoracic aperture). Goals of the classes Identify and describe the bones of the thoracic cage. Identify and describe the joints of thoracic cage. Describe de thoracic cage. Describe the thoracic inlet and identify the structures passing through. Vertebral Column or Spine 7 cervical. 12 thoracic. 5 lumbar. 5 sacral 3-4 coccygeal Vertebrae That bones are irregular, 33 in number, and received the names acording to the position which they occupy. The vertebrae in the upper 3 regions of spine are separate throughout the whole of life, but in sacral anda coccygeal regions are in the adult firmly united in 2 differents bones: sacrum and coccyx. Thoracic vertebrae Each vertebrae consist of 2 essential parts: An anterior solid segment: vertebral body. The arch is posterior an formed of 2 pedicles, 2 laminae supporting 7 processes, and surrounding a vertebral foramen.
    [Show full text]
  • Ligaments of the Costovertebral Joints Including Biomechanics, Innervations, and Clinical Applications: a Comprehensive Review W
    Open Access Review Article DOI: 10.7759/cureus.874 Ligaments of the Costovertebral Joints including Biomechanics, Innervations, and Clinical Applications: A Comprehensive Review with Application to Approaches to the Thoracic Spine Erfanul Saker 1 , Rachel A. Graham 2 , Renee Nicholas 3 , Anthony V. D’Antoni 2 , Marios Loukas 1 , Rod J. Oskouian 4 , R. Shane Tubbs 5 1. Department of Anatomical Sciences, St. George's University School of Medicine, Grenada, West Indies 2. Department of Anatomy, The Sophie Davis School of Biomedical Education 3. Department of Physical Therapy, Samford University 4. Neurosurgery, Complex Spine, Swedish Neuroscience Institute 5. Neurosurgery, Seattle Science Foundation Corresponding author: Erfanul Saker, [email protected] Abstract Few studies have examined the costovertebral joint and its ligaments in detail. Therefore, the following review was performed to better elucidate their anatomy, function and involvement in pathology. Standard search engines were used to find studies concerning the costovertebral joints and ligaments. These often- overlooked ligaments of the body serve important functions in maintaining appropriate alignment between the ribs and spine. With an increasing interest in minimally invasive approaches to the thoracic spine and an improved understanding of the function and innervation of these ligaments, surgeons and clinicians should have a good working knowledge of these structures. Categories: Neurosurgery, Orthopedics, Rheumatology Keywords: costovertebral joint, spine, anatomy, thoracic Introduction And Background The costovertebral joint ligaments are relatively unknown and frequently overlooked anatomical structures [1]. Although small and short in size, they are abundant, comprising 108 costovertebral ligaments in the normal human thoracic spine, and they are essential to its stability and function [2-3].
    [Show full text]
  • Of the Pediatric Mediastinum
    MRI of the Pediatric Mediastinum Dianna M. E. Bardo, MD Director of Body MR & Co-Director of the 3D Innovation Lab Disclosures Consultant & Speakers Bureau – honoraria Koninklijke Philips Healthcare N V Author – royalties Thieme Publishing Springer Publishing Mediastinum - Anatomy Superior Mediastinum thoracic inlet to thoracic plane thoracic plane to diaphragm Inferior Mediastinum lateral – pleural surface anterior – sternum posterior – vertebral bodies Mediastinum - Anatomy Anterior T4 Mediastinum pericardium to sternum Middle Mediastinum pericardial sac Posterior Mediastinum vertebral bodies to pericardium lateral – pleural surface superior – thoracic inlet inferior - diaphragm Mediastinum – MR Challenges Motion Cardiac ECG – gating/triggering Breathing Respiratory navigation Artifacts Intubation – LMA Surgical / Interventional materials Mediastinum – MR Sequences ECG gated/triggered sequences SSFP – black blood SE – IR – GRE Non- ECG gated/triggered sequences mDIXON (W, F, IP, OP), eTHRIVE, turbo SE, STIR, DWI Respiratory – triggered, radially acquired T2W MultiVane, BLADE, PROPELLER Mediastinum – MR Sequences MRA / MRV REACT – non Gd enhanced Gd enhanced sequences THRIVE, mDIXON, mDIXON XD Mediastinum – Contents Superior Mediastinum PVT Left BATTLE: Phrenic nerve Vagus nerve Structures at the level of the sternal angle Thoracic duct Left recurrent laryngeal nerve (not the right) CLAPTRAP Brachiocephalic veins Cardiac plexus Aortic arch (and its 3 branches) Ligamentum arteriosum Thymus Aortic arch (inner concavity) Trachea Pulmonary
    [Show full text]
  • Chapter 21 Fractures of the Upper Thoracic Spine: Approaches and Surgical Management
    Chapter 21 Fractures of the Upper Thoracic Spine: Approaches and Surgical Management Sean D Christie, M.D., John Song, M.D., and Richard G Fessler, M.D., Ph.D. INTRODUCTION Fractures occurring in the thoracic region account for approximately 17 to 23% of all traumatic spinal fractures (1), with 22% of traumatic spinal fractures occurring between T1 and T4 (16). More than half of these fractures result in neurological injury, and almost three-quarters of those impaired suffer from complete paralysis. Obtaining surgical access to the anterior vertebral elements of the upper thoracic vertebrae (T1–T6) presents a unique anatomic challenge. The thoracic cage, which narrows significantly as it approaches the thoracic inlet, has an intimate association between the vertebral column and the superior mediastinal structures. The supraclavicular, transmanubrial, transthoracic, and lateral parascapular extrapleural approaches each provide access to the anterior vertebral elements of the upper thoracic vertebrae. However, each of these approaches has distinct advantages and disadvantages and their use should be tailored to each individual patient’s situation. This chapter reviews these surgical approaches. Traditional posterior approaches are illustrated in Figure 21.1, but will not be discussed in depth here. ANATOMIC CONSIDERATIONS AND STABILITY The upper thoracic spine possesses unique anatomic and biomechanical properties. The anterior aspects of the vertebral bodies are smaller than the posterior aspects, which contribute to the physiological kyphosis present in this region of the spine. Furthermore, this orientation results in a ventrally positioned axis of rotation, predisposing this region to compression injuries. The combination and interaction of the vertebral bodies, ribs, and sternum increase the inherent biomechanical stability of this segment of the spine to 2 to 3 times that of the thoracolumbar junction.
    [Show full text]
  • OMM PRACTICAL EXAM Saroj Misra, DO, FACOFP Rachel Nixon, DO Marissa Rogers, DO Family Medicine Goals/Objectives
    OMM PRACTICAL EXAM Saroj Misra, DO, FACOFP Rachel Nixon, DO Marissa Rogers, DO Family Medicine Goals/Objectives • Review Exam Day procedure • Understand scoring process • Discuss possible cases and 2 OMM techniques that may be used for each case Disclaimer: The material being presented is NOT necessarily identical to what will be tested upon. We are not affiliated with the actual exam. This is our approach to the practical exam material. EXAM DAY Exam day • You will be assigned a time slot based on your last name • You will select a partner within your time slot • May not partner with a spouse or relative • You will be asked to sign a waiver stating that if you choose to do HVLA you will not perform the corrective “thrust” • You will then stand in line with your partner and await entering the testing room Exam day • There will be two rooms - one in which you will review cases and the second where you will be tested • Once you enter the first room you will not be able to leave • If you DO leave, both you and your partner will be given new cases Exam day • You will be given 3 cases: • Spine • Extremities • Systemic Disease • You will enter your name, ID number and your partners ID number on each case before turning them over Exam day • Each case will have the following information: • HPI • PMH • PSH • FHx • SocHx • There will be multiple choice for the best answer for your diagnosis • You will have 20 minutes to choose the best answer and plan a treatment strategy for each of your cases Exam day • After the 20 minutes are complete, you will
    [Show full text]
  • 1 the Thoracic Wall I
    AAA_C01 12/13/05 10:29 Page 8 1 The thoracic wall I Thoracic outlet (inlet) First rib Clavicle Suprasternal notch Manubrium 5 Third rib 1 2 Body of sternum Intercostal 4 space Xiphisternum Scalenus anterior Brachial Cervical Costal cartilage plexus rib Costal margin 3 Subclavian 1 Costochondral joint Floating ribs artery 2 Sternocostal joint Fig.1.3 3 Interchondral joint Bilateral cervical ribs. 4 Xiphisternal joint 5 Manubriosternal joint On the right side the brachial plexus (angle of Louis) is shown arching over the rib and stretching its lowest trunk Fig.1.1 The thoracic cage. The outlet (inlet) of the thorax is outlined Transverse process with facet for rib tubercle Demifacet for head of rib Head Neck Costovertebral T5 joint T6 Facet for Tubercle vertebral body Costotransverse joint Sternocostal joint Shaft 6th Angle rib Costochondral Subcostal groove joint Fig.1.2 Fig.1.4 A typical rib Joints of the thoracic cage 8 The thorax The thoracic wall I AAA_C01 12/13/05 10:29 Page 9 The thoracic cage Costal cartilages The thoracic cage is formed by the sternum and costal cartilages These are bars of hyaline cartilage which connect the upper in front, the vertebral column behind and the ribs and intercostal seven ribs directly to the sternum and the 8th, 9th and 10th ribs spaces laterally. to the cartilage immediately above. It is separated from the abdominal cavity by the diaphragm and communicates superiorly with the root of the neck through Joints of the thoracic cage (Figs 1.1 and 1.4) the thoracic inlet (Fig.
    [Show full text]
  • THE ANATOMY of the THORAX in RELATION to the FLOW of TIDAL AIR Lecture Delivered at the Symposium Held by the Faculty of Anesthetists on 21St February, 1953 by G
    THE ANATOMY OF THE THORAX IN RELATION TO THE FLOW OF TIDAL AIR Lecture delivered at the symposium held by the Faculty of Anesthetists on 21st February, 1953 by G. Causey, F.R.C.S. Sir William Collins Professor of Human and Comparative Anatomy, Royal College of Surgeons. That the thoracic cavity increases in volume during inspiration and decreases in volume during expiration is accepted by all, but exactly how this change in volume is brought about is by no means clear. On almost all points, whether of rib movements, of intercostal muscle activity, or of the quantitative contribution by the diaphragm, different and often opposing views are expressed. It may seem that enough has been written on the subject already, but I believe that, with the increasing use of muscular relaxants and controlled respiration in man, the search for a logically consistent hypothesis to explain the respiratory movements is not only an intellectual exercise, but a practical necessity. The bony skeleton of the thorax is formed by the thoracic vertebra, 12 pairs of ribs and their costal cartilages, and the sternum. The gaps in this bony skeleton are filled with fibrous and muscular tissues-the intercostal muscles and membranes at the side, the diaphragm below and the suprapleural (Sibson's) fascia, backed by the scalene muscles above. To the inside of this cavity, the outer surface of the lung is firmly held by the surface tension of the pleural fluid that needs a force of some 3600 mm.hg. per sq. cm. to break it. Every increase in the volume of this cavity is transmitted to the underlying lung and, assuming that the airway is patent, will draw air into the alveoli.
    [Show full text]
  • An Osteopathic Approach Bridget E
    Lymphatic Complaints in the Dermatology Clinic: An Osteopathic Approach Bridget E. McIlwee, DO,* Jenifer R. Lloyd, DO,** Michael P. Rowane, DO, MS, FAAFP, FAAO*** *Dermatology Resident, OGME-3, University of North Texas Health Science Center/TCOM, Fort Worth, TX **Director, Dermatology Residency Program, University Hospitals Regional Hospitals; Department of Dermatology, Case Western Reserve University, Cleveland, OH ***Associate Clinical Professor of Family Medicine and Psychiatry, Case Western Reserve University; Director of Medical Education, University Hospitals Regional Hospitals; Director of Osteopathic Medical Education, University Hospitals Case Medical Center, Cleveland, OH Abstract The number of patients presenting to dermatologists with lymphatic complaints continues to grow, given our aging population and the increasing prevalence of predisposing chronic medical conditions. Sequelae may include pain, stasis skin changes, and chronic wounds. Lymphatic conditions impose a physical and psychological burden on patients, as well as a financial strain on both patients and the medical system. The medical community is in need of cost- and time-effective treatment measures. Osteopathic dermatologists are uniquely suited to meet this need through our training in osteopathic lymphatic manipulative treatment techniques. These techniques are suitable for use as primary or adjunct treatments for lymphatic dysfunction. However, in a busy dermatology clinic, lengthy osteopathic treatments are often seen as impractical. A five-minute osteopathic lymphatic manipulative treatment technique module has been developed for the management of lower extremity lymphatic complaints and is appropriate for use in the general dermatology clinic. Definition and Epidemiology than three months or (3) clinical characteristics lymph node dissection during diagnosis of Dermatologists are seeing an increasing number of lymphedema such as peau d’orange or woody breast cancer.
    [Show full text]
  • THORAX 1. in the Chest Wall: (A) the Intercostal a Is More Superficial Than
    THORAX 1. In the chest wall: (a) the intercostal a is more superficial than the v (b) the intercostal a lies between the intercostal n and v (c) the transversus m lies between the ext and int intercostals (d) the NV bundle lies between the ext and int intercostals (e) all of the above 2. The oesophageal opening in the diaphragm is opposite: (a) T6 (b) T8 (c) T10 (d) T11 (e) T12 3. The most superficial structure in the thoracic inlet is: (a) X (b) R subclavian a (c) L subclavian a (d) Thoracic duct (e) SVC 4. Trachea: (a) commences below the cricoid at level of C5 (b) enters the thoracic inlet slightly to the left (c) is marked at its lower end by the level of the sternal angle (d) supplied by IX (e) drains to axillary lymph nodes 5. the diaphragm: (a) has the oesophageal opening opposite the T8 vertebrae (b) is supplied by C4, C5, C6 (c) has a major role in expiration (d) has a vena cava opening at T10 (e) has an aortic opening opposite T12 6. Which passes through the diaphragm with the oesophagus (a) Azygous vein (b) Right X (c) Sympathetic trunks (d) Thoracic duct (e) Phrenic nerve 7. With regard to the coronaries: (2 CORRECT) (a) right arises from the posterior coronary sinus (b) left supplies the conducting system in most patients (c) right supplies the PDA in most patients (d) there are no arterial anastomoses between right and left (e) the right marginal vein drains directly into the coronary sinus (f) the anterior cardiac veins drain into the coronary sinus (g) venae cordis minimae occur most frequently in the right atrium (h) Cx is most commonly affected by disease 8.
    [Show full text]
  • Posterior Intercostal Arteries
    د تميم عبدالرزاق أخصائي جراحة صدر • Thoracic cage is an osteo- cartilagenous conical cage which has a narrow inlet & a wide outlet ? • Boundaries of thoracic cage. • Ant: Sternum, Costal cartilages and ribs. • Post: Thoracic vertebrae and ribs. • Lat: Ribs. • Thoracic Inlet (or outlet) • Ant: Upper border of manubrium sterni. • Post: 1st thoracic vertebra. • On each side: 1st rib & 1st costal cartilage. • It is sloping downwards & forward. • Suprapleural membrane • Dense fascia closes the lateral part of the thoracic inlet. • Triangular in shape • Apex: attached to transverse process of C7 • Base: Attached to medial border of the first rib • Superiorly: Related to subclavian vessels • Inferiorly: Apex of lung & cervical pleura • Thoracic vertebrae. • They are 12 vertebra. • From 2 to 9 they are called Typical. • Character of typical thoracic vertebrae: • Body: Heart shape & carries 2 demi-facet at its side. • Transverse process: has a facet for rib tubercle of the same number. • Spine: Long, pointed & directed downward and backward. • Vertebral foramen: Small & circular. Articulation between Thoracic vertebrae and the ribs Typical thoracic vertebra Lateral surface Superior surface • Atypical (Non typical ) 1st Thoracic thoracic vertebrae. • 1st, 10th,11th and 12th Vertebra • T1: • Has a complete facet. • One very small inferior demifacet. • Spine nearly horizontal • Has costal facet in transverse process for the tubercle of first rib. • It has a small body, looks like a cervical vertebra. • T10 • One complete facet tangential with the upper border • Small costal facet on transverse process. • T11 • One complete circular facet away from upper border. • No costal facet • T12 • Broad body & short, oblong spine. • One complete facet midway between upper & lower borders.
    [Show full text]
  • CT-Based Mediastinal Compartment Classifications and Differential
    Japanese Journal of Radiology (2019) 37:117–134 https://doi.org/10.1007/s11604-018-0777-5 INVITED REVIEW CT‑based mediastinal compartment classifcations and diferential diagnosis of mediastinal tumors Takahiko Nakazono1 · Ken Yamaguchi1 · Ryoko Egashira1 · Yukari Takase2 · Junichi Nojiri1 · Masanobu Mizuguchi1 · Hiroyuki Irie1 Received: 16 July 2018 / Accepted: 10 September 2018 / Published online: 20 September 2018 © Japan Radiological Society 2018 Abstract Division of the mediastinum into compartments is used to help narrow down the diferential diagnosis of mediastinal tumors, assess tumor growth, and plan biopsies and surgical procedures. There are several traditional mediastinal compartment classifcation systems based upon anatomical landmarks and lateral chest radiograph. Recently, the Japanese Association of Research of the Thymus (JART) and the International Thymic Malignancy Interest Group (ITMIG) proposed new mediastinal compartment classifcation systems based on transverse CT images. These CT-based classifcation systems are useful for more consistent and exact diagnosis of mediastinal tumors. In this article, we review these CT-based mediastinal compart- ment classifcations in relation to the diferential diagnosis of mediastinal tumors. Keywords Mediastinum · Compartment · Computed tomography · Magnetic resonance imaging Introduction have resulted in confusion among physicians. In addition, the traditional models are based on lateral chest radiographs, The mediastinum is anatomically bound on the lateral side and thus some mediastinal lesions cannot be reliably local- by the parietal pleural refections along the medial aspects ized to a specifc compartment, since considerable overlap of both lungs, superiorly by the thoracic inlet, inferiorly by exists among the radiographically imaged compartments. the diaphragm, anteriorly by the sternum, and posteriorly Because mediastinal lesions are optimally evaluated with by the thoracic vertebral bodies.
    [Show full text]
  • Lesions of the Thoracic Operculum on CT and MRI: Between the Neck and the Chest Lesiones Del Opérculo Torácico En TC Y RM: Entre El Cuello Y El Tórax
    review article Lesions of the Thoracic Operculum on CT and MRI: Between the Neck and the Chest Lesiones del opérculo torácico en TC y RM: Entre el cuello y el tórax Felipe Aluja Jaramillo1 Juan Andrés Mora Salazar2 Summary Key words (MeSH) The thoracic inlet is located in the anatomic boundaries between the neck and the thorax. Vascular system injuries There is a wide variety of entities that can be found in this area including lesions of vascular Tomography, X-ray origin, pathology involving the digestive tract and airways, as well as entities afecting the Magnetic eesonance lymphatics and neural structures. Benign and malignant tumors of the thorax and neck can imaging spread through the thoracic inlet, with goiter and lymphoproliferative neoplasms being the most common. It is important for the radiologist to know the anatomy and pathology that can be found in the thoracic inlet as, given its location, it can often been unnoticed. Resumen Palabras clave (DeCS) El opérculo torácico se encuentra localizado entre los límites anatómicos del cuello y el tórax. Lesiones del sistema En esta área se puede encontrar diversidad de patologías, entre ellas, de tipo vascular, del tracto vascular digestivo y la vía aérea, de origen linfático y neural. Las lesiones tumorales de tipo benigno o Tomografía por rayos X maligno, que se originan en el cuello o en el tórax, pueden diseminarse a través del opérculo; las más comunes son el bocio de origen tiroideo y las neoplasias de origen linfoproliferativo. Imagen por resonancia magnética Es importante que el radiólogo conozca la anatomía y las patologías que se pueden encontrar en el opérculo torácico, pues, por su localización, muchas veces pasan inadvertidas.
    [Show full text]