Tri‐lobed left lung with corresponding additional secondary lobar bronchi: A case report on anatomic variation

Introduction: This case report describes bleeding from an iatrogenic thoracic aortic injury in minimally invasive thoracoscopic esophagectomy. Case report: A 53-year-old man underwent neoadjuvant radiochemotherapy for adenocarcinoma of the esophagus with positive lymph nodes. PET/CT showed only a partial response after neoadjuvant therapy. Minimally invasive thoracoscopic esophagectomy in the semi-prone position with selective intuba- tion of the left lung was performed. However, massive bleeding from the thoracic aorta during separation of the tumor resulted in conversion from minimally invasive to conventional right thoracotomy. The bleeding was caused by a five millimeter rupture of the thoracic aorta. The thoracic aortic rupture was treated by suture with a gore prosthesis in collaboration with a vascular surgeon. Esophagestomy was not completed due to hypovolemic shock. Hybrid transhiatal esophagectomy was performed on the seventh day after the primary operation. Definitive histological examination showed T3N3M0 adenocarcinoma. Conclusion: Esophagectomy for cancer of the esophagus is one of the most difficult operations in general surgery in which surgical bleeding from the surrounding structures cannot be excluded. Aortic hemorrhage is hemodynamically significant in all cases and requires urgent surgical treatment.

Download Full-text

Retroperitoneal fibrous tumor recurring as lung metastases after 10 years: a case report

Surgical Case Reports ◽

10.1186/s40792-021-01209-4 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Kozue Matsuishi ◽

Kojiro Eto ◽

Atsushi Morito ◽

Hirokazu Hamasaki ◽

Keisuke Morita ◽

...

Keyword(s):

Case Report ◽

Solitary Fibrous Tumor ◽

Distant Metastasis ◽

Curative Resection ◽

Lung Metastases ◽

Lung Resection ◽

Left Lung ◽

Metastatic Lesion ◽

Case Presentation ◽

Fibrous Tumor

Abstract Background Solitary fibrous tumor (SFT) is a relatively rare mesenchymal tumor that mainly affects adults. Its prognosis is good after curative resection, but distant recurrences after 10 years or longer have been reported. Recurrent SFT usually arises as a local lesion; distant metastasis is rarely reported. Here, we report lung metastases that recurred a decade after excising a retroperitoneal primary SFT. Case presentation A 44-year-old woman had an SFT resected from her right retroperitoneum at our hospital. Ten years later, at age 54, she underwent a lung resection after CT showed three suspected metastases in her left lung. All three were histologically diagnosed as lung metastases from the retroperitoneal SFT. However, whereas the primary SFT had 1–2 mitotic cells/10 high power fields (HPF), the metastatic lesion increased malignancy, at 50/10 HPF. Conclusion Patients who have had resected SFTs should be carefully followed up, as malignancy may change in distant metastasis, as in this case.

Download Full-text

A novel anatomic variation of the intrahepatic biliary tree in live liver donor surgery: A case report

International Journal of Surgery Case Reports ◽

10.1016/j.ijscr.2021.01.042 ◽

2021 ◽

Vol 79 ◽

pp. 231-233

Author(s):

Masato Shizuku ◽

Nobuhiko Kurata ◽

Kanta Jobara ◽

Atsushi Yoshizawa ◽

Yasuhiro Ogura

Keyword(s):

Case Report ◽

Anatomic Variation ◽

Biliary Tree ◽

Liver Donor ◽

Live Liver Donor

Download Full-text

Letters to the Editor

PEDIATRICS ◽

10.1542/peds.39.5.792 ◽

1967 ◽

Vol 39 (5) ◽

pp. 792-792

Author(s):

C. Bozic

Keyword(s):

Case Report ◽

Respiratory Tract ◽

Blood Supply ◽

Left Lung ◽

The Other ◽

Letters To The Editor ◽

Direct Communication ◽

Inferior Lobe ◽

Other Hand

I have read with interest Doctors Adams' and El-Salawy's comments on my case report identified in their letter as the "Lausanne baby." I do think that the "Lausanne baby" represents a case of pulmonary vascular sequestration inasmuch as the inferior lobe of the left lung received its blood supply by means of three arterial branches coming off directly from the aorta. On the other hand, I do not think that the "Lausanne baby" is a case of pulmonary parenchymal sequestration and this because the inferior lobe of the left lung was proven to be, at least to my satisfaction, in direct communication with the remainder of the respiratory tract.

Download Full-text

Proven pulmonary aspergillosis in a COVID-19 patient: A case report

Current Medical Mycology ◽

10.18502/cmm.7.2.7031 ◽

2021 ◽

Author(s):

Sadegh Khodavaisy ◽

Nasim Khajavirad ◽

Seyed Jamal Hashemi ◽

Alireza Izadi ◽

Seyed Ali Dehghan Manshadi ◽

...

Keyword(s):

Case Report ◽

Fungal Infections ◽

Left Lung ◽

Aspergillus Species ◽

Pulmonary Aspergillosis ◽

Biopsy Material ◽

Cavitary Lesion ◽

Healthcare Settings ◽

Increased Risk ◽

History Of

Background and Purpose: Coronavirus disease 2019 (COVID-19) has become a significant clinical challenge in healthcare settings all over the world. Critically ill COVID-19 patients with acute respiratory distress syndrome may be at increased risk of co-infection with pulmonary aspergillosis. This study aimed to describe a clinical case of proven pulmonary aspergillosis caused by Aspergillus tubingensis in a 59-year-old man with a history of hospitalization due to COVID-19 infection. Case report: The Covid-19 infection was confirmed by positive nasopharyngeal polymerase chain reaction. He had a cavitary lesion measured 20 mm in diameter with intracavitary soft tissue density in the left lung in the first chest computerized tomography scan. After 25 days, he showed two cavitary lesions in both lungs which raised suspicion of fungal infection; hence, the patient underwent a trans-thoracic biopsy of the cavitary lesion. The direct examination and culture of the biopsy material revealed Aspergillus species. To confirm the Aspergillus species identification, the beta-tubulin region was sequenced. The patient was treated with oral voriconazole. Conclusion: This report underlined the importance of early diagnosis and management of invasive fungal infections in severe COVID-19 patients

Download Full-text

Unreported Variant Lobar Pattern of Left Lung: A Case Report

IOSR Journal of Dental and Medical Sciences ◽

10.9790/0853-0113133 ◽

2012 ◽

Vol 1 (1) ◽

pp. 31-33

Author(s):

Kosuri Kalyan Chakravarthi

Keyword(s):

Case Report ◽

Left Lung

Download Full-text

Novel Use of a Bronchial Blocker in a Challenging Case of Congenital Diaphragmatic Hernia—A Case Report

Children ◽

10.3390/children8121163 ◽

2021 ◽

Vol 8 (12) ◽

pp. 1163

Author(s):

Deepika Sankaran ◽

Shinjiro Hirose ◽

Donald Morley Null ◽

Niroop R. Ravula ◽

Satyan Lakshminrusimha

Keyword(s):

Case Report ◽

Gas Exchange ◽

Congenital Diaphragmatic Hernia ◽

Clinical Improvement ◽

Diaphragmatic Hernia ◽

Clinical Course ◽

Relevant Literature ◽

Left Lung ◽

Initial Surgery ◽

Perfused Lung

The diagnosis of congenital diaphragmatic hernia (CDH) is associated with significant morbidity and mortality. Survival of neonates with CDH has improved recently, although the clinical course is complicated by sequelae of hypoplastic pulmonary parenchyma and vasculature, pulmonary hypertension, ventilation/perfusion (V/Q) mismatch, reduced pulmonary function and poor somatic growth. In this case report, we describe an infant with an antenatal diagnosis of CDH with a poor prognosis who underwent initial surgery followed by a tracheostomy but had a worsening clinical course due to a large area of ventilated but poorly perfused lung based on a V/Q nuclear scintigraphy scan. The emphysematous left lung was causing mediastinal shift and compression of the right lung, further compromising gas exchange. The infant had clinical improvement following bronchial blockade of the under-perfused left lung. This paved the way for further management with resection of the under-perfused lung lobe and continued clinical improvement. We present the novel use of selective bronchial blockade in a challenging case of CDH to determine if surgical lung resection may benefit the infant. We also review the physiology of gas exchange during the use of a bronchial occluder and the relevant literature.

Download Full-text