scholarly journals Refractory pneumothorax and hemothorax associated with metastatic scalp angiosarcoma

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Masahide Isowa ◽  
Satona Tanaka ◽  
Ryo Nakanobo ◽  
Yoshito Yamada ◽  
Hiroshi Date
Keyword(s):  
Surgical Intervention ◽  
Thoracoscopic Surgery ◽  
Pathological Diagnosis ◽  
Parietal Pleura ◽  
Surgical Biopsy ◽  
Bullous Lesion ◽  
Life Threatening ◽  
History Of ◽  
Previously Treated ◽  
Video Assisted Thoracoscopic Surgery

Abstract Background Pulmonary metastasis of scalp angiosarcoma (SA) is a rare, but life-threatening disease, challenging to diagnose and manage. We report two cases of pneumothorax and hemothorax with pathologically proven metastasis of SA in the parietal pleura, which was not predictable from images and difficult to manage. Patient A A 73-year-old man with SA underwent chemoradiotherapy and surgical resection for primary skin lesion, was sent to our department to treat right empyema, which was developed during chest tube drainage for pneumothorax. Computed tomography (CT) showed multiple bullous lesions. We performed repetitive video-assisted thoracoscopic surgery (VATS) for the debridement and hemostasis; however, hemothorax was uncontrollable. The repeated cytology of pleural effusion showed no malignancy. We eventually performed fenestration and metastatic SA was pathologically diagnosed by the biopsy of parietal pleura. The patient developed respiratory failure and uncontrolled anemia, which were fatal. Patient B A 71-year-old man with SA previously treated with chemoradiotherapy was referred to our department for left pneumothorax. CT showed multiple bullous lesions at apex without any changes at parietal pleura. VATS was performed and the apex bullous lesion with air leakage was resected. The parietal pleura showed several dark-red spots and the biopsy was undertaken. The pathological diagnosis was a metastasis of SA along with visceral pleura and parietal pleura. The patient then developed right pneumothorax and left hemopneumothorax. Bilateral pleurodesis was ineffective and the patient died due to deteriorating general condition. Conclusions In patients with a history of SA who develop pneumothorax and hemothorax, metastatic SA to visceral and parietal pleura should be always considered. Surgical biopsy, not cytology, is needed for pathological diagnosis. Lesions in the parietal pleura prior to hemothorax were thoracoscopically observed in one case. Surgeons must recognize that conventional surgical intervention or pleurodesis will have unsatisfactory results.

scholarly journals Pulmonary Mucormycosis in Chronic Lymphocytic Leukemia and Neutropenia

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Izza Mir ◽  
Sijan Basnet ◽  
David Ellsworth ◽  
Elan Mohanty
Keyword(s):  
Chronic Lymphocytic Leukemia ◽  
Fungal Infection ◽  
Amphotericin B ◽  
Thoracoscopic Surgery ◽  
Left Lung ◽  
Lymphocytic Leukemia ◽  
Pulmonary Mucormycosis ◽  
Life Threatening ◽  
History Of ◽  
Video Assisted Thoracoscopic Surgery

Pulmonary mucormycosis is a rare life-threatening fungal infection associated with high mortality. We present the case of a 61-year-old man with history of chronic lymphocytic leukemia who presented with fever and cough, eventually diagnosed with pulmonary mucormycosis after right lung video-assisted thoracoscopic surgery. The patient was successfully treated with amphotericin B and right lung pneumonectomy; however, he later died from left lung pneumonia.

scholarly journals Catamenial pneumothorax with bubbling up on the diaphragmatic defects: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Bo Dong ◽  
Chun-Li Wu ◽  
Yin-liang Sheng ◽  
Bin Wu ◽  
Guan-Chao Ye ◽  
...  
Keyword(s):  
Thoracoscopic Surgery ◽  
Lung Lesion ◽  
Parietal Pleura ◽  
Catamenial Pneumothorax ◽  
Endometrial Cells ◽  
Retrograde Menstruation ◽  
History Of ◽  
The Right ◽  
Thoracic Endometriosis

Abstract Background Catamenial pneumothorax is characterized by spontaneous recurring pneumothorax during menstruation, which is a common clinical manifestation of thoracic endometriosis syndrome. There are still controversies about its pathogenesis. Case presentation A 43-year-old woman with a history of endometriosis came to our hospital due to recurring pneumothorax during menstruation. Uniportal Video-assisted Thoracoscopic Surgery (VATS) exploration was performed on the eve of menstruating. We thoroughly explored the diaphragm, visceral and parietal pleura: The lung surface was scattered with yellowish-brown implants; no bullae were found; multiple diaphragmatic defects were found on the dome. And surprisingly, we caught a fascinating phenomenon: Bubbles were slipping into pleural cavity through diaphragmatic defects. We excised the diaphragmatic lesions and wedge resected the right upper lung lesion; cleared the deposits and flushed the thoracic cavity with pure iodophor. Diaphragmatic lesions confirmed the presence of endometriosis, and interestingly enough, microscopically, endometrial cells were shedding with impending menses. After a series of intraoperative operations and postoperative endocrine therapy, the disease did not recur after a period of follow-up. Conclusion We have witnessed the typical signs of catamenial pneumothorax at the accurate timing: Not only observed the process of gas migration macroscopically, but also obtained pathological evidence of diaphragmatic periodic perforation microscopically, which is especially precious and confirms the existing theory that retrograde menstruation leads to diaphragmatic endometriosis, and the diaphragmatic fenestration is obtained due to the periodic activities of ectopic endometrium.

scholarly journals Pleurodesis methods in the surgical treatment of primary spontaneous pneumothorax

2021 ◽  
pp. 77-81
Keyword(s):  
Surgical Treatment ◽  
Recurrence Rate ◽  
Spontaneous Pneumothorax ◽  
Thoracoscopic Surgery ◽  
Wedge Resection ◽  
Primary Spontaneous Pneumothorax ◽  
High Recurrence Rate ◽  
Parietal Pleura ◽  
Advantages And Disadvantages ◽  
Video Assisted Thoracoscopic Surgery

Pneumothorax is the collection of air in the pleural space. Pneumothorax can be spontaneous, traumatic or iatrogenic. Primary spontaneous pneumothorax mostly occurs in healthy individuals without an apparent cause, probably due to the rupture of subpleural emphysematous bullae located on the apex of the lung. It usually occurs in tall and healthy males younger than 40 years old. Primary spontaneous pneumothorax has a recurrence rate of 20-30% after the first attack, 50% after the second attack, and 80% after the third attack. Surgery is presented as a treatment option to reduce the high recurrence rate after the second attack. It has been reported that recurrence is between 10 and 20% in patients who undergo bullectomy or wedge resection with endoscopic steps alone. Therefore, various pleural pleurodesis methods are applied in addition to bulla resection in order to reduce the recurrence rate after surgery. In mechanical pleurodesis, adhesion between visceral and parietal pleura is achieved by mechanical abrasion of the parietal pleura or by total or partial removal of the parietal pleura. In chemical pleurodesis, the visceral pleura is adhered to the parietal pleura by creating irritation in the pleura with chemical agents. In cases where pleurodesis was added, the recurrence rate was reported to be between 1.7 and 2.8%. Whether the pleurectomy, pleural mechanical or chemical abrasion methods performed with video-assisted thoracoscopic surgery is superior for preventing recurrence is still a matter of debate. In this article, we aimed to discuss the advantages and disadvantages of pleurodesis methods in the surgical treatment of primary spontaneous pneumothorax in the light of the literature.

scholarly journals Infratentorial subdural empyemas mimicking pyogenic meningitis

2013 ◽  
Vol 04 (02) ◽  
pp. 213-215 ◽  
Author(s):  
Anurag Gupta ◽  
Suman S Karanth ◽  
A Raja
Keyword(s):  
Surgical Intervention ◽  
Treatment Options ◽  
Rare Condition ◽  
Pyogenic Meningitis ◽  
Suppurative Otitis Media ◽  
Life Threatening ◽  
History Of ◽  
Associated Risk Factors ◽  
High Degree ◽  
Delay In Treatment

ABSTRACTInfratentorial subdural empyema is an extremely rare condition which unfortunately mimics pyogenic meningitis in 75% of cases. While an ill‑planned lumbar puncture in these cases may be fatal, an inadvertent delay in treatment may be detrimental to the outcome for the patient. We present a case of a young boy with long standing history of chronic suppurative otitis media (CSOM) presenting with an infratentorial empyema with features suggestive of pyogenic meningitis. We also review the available literature to further define the condition in terms of clinical features, treatment options, and outcome. A misdiagnosis of this condition with failure to institute appropriate surgical intervention and antibiotic therapy is potentially life threatening. We highlight this rare condition which requires a high degree of suspicion especially in the presence of associated risk factors.

scholarly journals A rare case scenario: spontaneous diaphragmatic rupture during labor

2021 ◽  
Vol 8 (7) ◽  
pp. 2241
Author(s):  
Shambhu Nath Agrawal ◽  
Amit Verma ◽  
Sunil Kedia ◽  
Amol Padegaonkar ◽  
Hari Shankar Mahobia
Keyword(s):  
Surgical Intervention ◽  
Hepatic Flexure ◽  
Diaphragmatic Rupture ◽  
Prior History ◽  
Case Scenario ◽  
Term Delivery ◽  
Life Threatening ◽  
History Of ◽  
Full Term Delivery ◽  
Complications And Mortality

Diaphragmatic rupture during labor is not a very common presentation and usually occurs in patients with prior history of traumatic chest or abdominal injury or any congenital abnormality. We presented a case of a 29 year old woman who presented with sudden breathing difficulty two days after a full-term delivery by caesarean section. e-FAST scan suggested the presence of a massive pleural effusion over right side. CT scan of chest revealed large rent in right diaphragm with superior migration of liver and hepatic flexure. Patient was taken for emergent surgical intervention, inter coastal drainage (ICD) tube was placed and surgical repair was performed, patient was further treated in critical care unit, the patient recovered well and was discharged. Though diaphragmatic hernia rupture during labor are not reported often it is life threatening complication that requires immediate surgical intervention to prevent major complications and mortality.

scholarly journals Under the Radar: A Case Report of a Missed Aortoenteric Fistula

2021 ◽  
Vol 5 (3) ◽  
pp. 312-315
Author(s):  
Blake Briggs ◽  
David Manthey
Keyword(s):  
Case Report ◽  
Surgical Intervention ◽  
Imaging Modality ◽  
Aortic Surgery ◽  
Aortoenteric Fistula ◽  
Prior History ◽  
Gi Bleeding ◽  
Life Threatening ◽  
History Of ◽  
Widespread Availability

Introduction: An aortoenteric fistula (AEF) is an abnormal connection between the aorta and the gastrointestinal tract that develops due to a pathologic cause. It is a rare, but life-threatening, cause of gastrointestinal (GI) bleeding. Although no single imaging modality exists that definitively diagnoses AEF, computed tomography angiography (CTA) of the abdomen and pelvis is the preferred initial test due to widespread availability and efficiency. Case Report: Many deaths occur before the diagnosis is made or prior to surgical intervention. We describe a case of a patient with a history of aortic graft repair who presented with active GI bleeding. Conclusion: Although CTA can make the diagnosis of AEF, it cannot adequately rule it out. In patients with significant GI bleeding and prior history of aortic surgery, vascular surgery should be consulted early on, even if CTA is equivocal.

Requirement of interventional treatment in a patient being conservatively managed for persistent pneumothorax over a prolonged period

2021 ◽  
Vol 14 (7) ◽  
pp. e243556
Author(s):  
Sophia Brenac
Keyword(s):  
Patient Involvement ◽  
Surgical Intervention ◽  
Thoracoscopic Surgery ◽  
Interventional Treatment ◽  
Decision Making Process ◽  
Good Recovery ◽  
Talc Pleurodesis ◽  
Cystic Changes ◽  
Video Assisted Thoracoscopic Surgery

An 85-year-old ex-smoker being managed conservatively over 2 years for a small right apical pneumothorax presented to the respiratory clinic with suddenly worsening shortness of breath and chest pain. A chest radiograph demonstrated sudden deterioration in the size of his pneumothorax. Previous CT scans had found emphysematous cystic changes within the lungs, and his new presentation warranted definitive surgical intervention with a right bullectomy and talc pleurodesis through a video-assisted thoracoscopic surgery procedure. The patient made a good recovery and was discharged from clinic a year later. This case demonstrates the importance of follow-up in patients with unresolved pneumothoraces due to the potential for sudden deterioration, and highlights the significance of respecting patient involvement and autonomy in the decision-making process.

scholarly journals Thoracotomy versus VATS: is there an optimal approach to treating pneumothorax?

2013 ◽  
Vol 95 (1) ◽  
pp. 61-64 ◽  
Author(s):  
V Joshi ◽  
B Kirmani ◽  
J Zacharias
Keyword(s):  
Learning Curve ◽  
Recurrence Rate ◽  
Surgical Intervention ◽  
Thoracoscopic Surgery ◽  
Postoperative Bleeding ◽  
British Thoracic Society ◽  
Significant Difference ◽  
Optimal Approach ◽  
Video Assisted Thoracoscopic Surgery ◽  
Group 1

Introduction The 2010 British Thoracic Society guidelines recommend that a weighted decision be made by clinicians with regard to surgical intervention for pneumothorax as the video assisted thoracoscopic surgery (VATS) approach is better tolerated by patients but carries a higher rate of recurrence (5% vs 1%). Methods Overall, 163 patients underwent surgical intervention for pneumothorax at our institution and data were collected prospectively for almost 7 years. Of these, 86 patients underwent VATS under a single surgeon with extensive VATS experience to compensate for the associated learning curve while 79 patients underwent an open procedure. Results There was no statistically significant difference in the recurrence rate between the open and the VATS group (1% vs 3.5%, p=1.0). The VATS group was superior to the open group in terms of reduced postoperative bleeding (7.5% vs 0%, p=0.01), reduced number of intensive care unit admissions (16% vs 0%, p<0.01) and a reduced adjusted length of stay (3 vs 5.5 days, p<0.01). Conclusions A comparable recurrence rate is attainable with a VATS approach once the learning curve is surpassed and a reduction in morbidity is an additional merit.

Hydrothorax: Pleural Effusion Associated with Peritoneal Dialysis

2010 ◽  
Vol 30 (1) ◽  
pp. 13-18 ◽  
Author(s):  
Susie Q. Lew
Keyword(s):  
Peritoneal Dialysis ◽  
Surgical Intervention ◽  
Thoracoscopic Surgery ◽  
Treatment Options ◽  
Medical Attention ◽  
Imaging Studies ◽  
Ultrafiltration Rate ◽  
Diagnostic Dilemma ◽  
Dialysis Adequacy ◽  
Video Assisted Thoracoscopic Surgery

Hydrothorax in a patient treated with peritoneal dialysis (PD) poses a diagnostic dilemma. Hydrothorax due to migration of dialysis fluid across the diaphragm and into the pleural space creates a serious complication of PD but generally does not threaten life. Shortness of breath causes the patient to seek medical attention. A sudden diminution in dialysis adequacy or poor ultrafiltration rate constitutes a unique marker for patients treated with PD compared to the general population. This article reviews the etiology for hydrothorax specifically in the PD population. Thoracentesis with chemical analysis of the fluid, imaging studies with and without contrast or markers, and video-assisted thoracoscopic surgery play important roles in the evaluation of hydrothorax. A conservative PD regimen, surgical intervention, and pleurodesis provide treatment options to those receiving PD.

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