scholarly journals Nasal intubation with bronchial blocker in a patient with difficult airway for thoracoscopic surgery

2021 ◽  
Vol 9 (2) ◽  
pp. 629
Author(s):  
Deepak C. Koli ◽  
Aditi P. Kadakia ◽  
Prajakta D. Latkar ◽  
Hemant H. Mehta
Keyword(s):  
Case Report ◽  
Difficult Airway ◽  
Thoracoscopic Surgery ◽  
Wedge Resection ◽  
Left Lung ◽  
Mouth Opening ◽  
Lower Lobe ◽  
Bronchial Blocker ◽  
Fiberoptic Intubation ◽  
Open Approach

We describe a case report of a 49 years old male, a case of Carcinoma tongue with one finger mouth opening operated multiple times, currently presented with pleural based soft tissue lesion in lower lobe of left lung with query metastasis posted for video assisted thoracoscopy surgery (VATS) SOS open thoracotomy and wedge resection of the lesion. Considering difficult airway due to restricted mouth opening we opted for an awake nasal fiberoptic intubation followed by general anaesthesia. One lung ventilation was achieved with CoopdechTM bronchial blocker type A with standard cuff size in left main stem bronchus. Postoperative course of patient was uneventful. In this case report we highlight the importance of use of fiberoptic bronchoscope and bronchial blocker for lung deflation in the management of difficult airway in VATS, as incomplete deflation of the nondependent lung during VATS can lead to poor surgical exposure and inadequate space for surgical manipulation which in turn can compromise the success of the procedure, and may possibly lead to conversion into an open approach.

scholarly journals A Case of Pulmonary Metastasis of Breast Cancer 23 Years after Surgery Accompanied with Non-Tuberculous Mycobacterium Infection

2020 ◽  
Vol 13 (3) ◽  
pp. 1357-1363
Author(s):  
Yuki Yabuuchi ◽  
Takayuki Nakagawa ◽  
Masaki Shimanouchi ◽  
Shingo Usui ◽  
Kenji Hayashihara ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Thoracoscopic Surgery ◽  
Mediastinal Lymph Node ◽  
Wedge Resection ◽  
Left Lung ◽  
Lower Lobe ◽  
Left Lower Lobe ◽  
Mycobacterium Infection ◽  
Er Positive ◽  
Positive Breast Cancer

Recurrence of oestrogen receptor (ER)-positive breast cancer rarely occurs postoperatively after a long period. Breast cancer cells survive and settle in distant organs in a dormant state, a phenomenon known as “tumour dormancy.” Here, we present a 66-year-old woman with recurrence of ER-positive breast cancer in the left lung 23 years after surgery accompanied with non-tuberculous mycobacterium infection (NTM). At the age of 43 years, the patient underwent a right mastectomy and adjuvant hormonotherapy to completely cure breast cancer. Twenty-three years after the operation, when the patient was 66 years old, computed tomography presented nodular shadows in the lower lobes bilaterally with bronchiectasis and ill-defined satellite tree-in-bud nodules. <i>Mycobacterium intracellulare</i> was detected in cultured bronchoalveolar lavage fluid obtained from the left lower lobe by bronchoscopy. Rifampicin, ethambutol, and clarithromycin were started, which resulted in shrinkage of the nodule in the right lower lobe and satellite nodules; however, the nodule in the left lower lobe increased in size gradually. Wedge resection of the left lower lobe containing the nodule by video-assisted thoracoscopic surgery was performed, which demonstrated that the nodule was adenocarcinoma in intraoperative pathological diagnosis; therefore, a left lower lobectomy and mediastinal lymph node dissection were performed. The tumour was revealed to be consistent with recurrence of previous breast cancer according to its morphology and immunohistochemical staining. Furthermore, caseous epithelioid cell granulomas existed in the periphery of the tumour. It is reported that inflammatory cytokines induce reawakening of dormant oestrogen-dependent breast cancer and, in our case, NTM infection might have stimulated the dormant tumour cells in the lower lobe.

scholarly journals Askin's Tumor in an Adult: Case Report and Findings on 18F-FDG PET/CT

2009 ◽  
Vol 2009 ◽  
pp. 1-4 ◽  
Author(s):  
Gonca Kara Gedik ◽  
Oktay Sari ◽  
Tamer Altinok ◽  
Lema Tavli ◽  
Bugra Kaya ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Case Report ◽  
Chest Wall ◽  
Wedge Resection ◽  
Left Lung ◽  
Lower Lobe ◽  
Standardized Uptake Value ◽  
Left Lobe ◽  
Pathology Report ◽  
Positron Emission

Primitive neuroectodermal tumor (PNET) of the chest wall or Askin's tumor is a rare neoplasm of chest wall. It most often affects children and adolescents and is a very rare tumor in adults. In this case report, we present an Askin's tumor occurred in a 73-year-old male. The patient was admitted with a history of 3-month lower back pain and cough. In computed tomography, there was a lesion with dimensions of70×40×65 mm in the superior segment of the lower lobe of the left lung. Positron emission tomography/computed tomography with 18F-flourodeoxyglucose revealed a pleural-based tumor in the left lung with a maximum standardized uptake value of 4.36. No distant or lymph node metastases were present. The patient had gone through surgery, and wedge resection of the superior segment of left lobe and partial resection of the ipsilateral ribs were performed. Pathology report with immunocytochemistry was consistent with PNET and the patient received chemotherapy after that.

scholarly journals Anaesthesia management of a difficult airway patient with severe aortic stenosis for major oncosurgery

2021 ◽  
Vol 8 (4) ◽  
pp. 597-599
Author(s):  
Ninad Chodankar ◽  
Disha Kapadia ◽  
Hemant Mehta
Keyword(s):  
Aortic Stenosis ◽  
Difficult Airway ◽  
Severe Aortic Stenosis ◽  
Mouth Opening ◽  
Perioperative Period ◽  
Fiberoptic Intubation ◽  
Team Approach ◽  
Free Fibula Flap ◽  
Early Recovery ◽  
Perioperative Morbidity

Over the past few decades, oncosurgical procedures are increasing in number, require considerable expertise and training for anaesthetising such patients. Aortic Stenosis itself poses great challenge, causes significant increase in morbidity and mortality in the perioperative period. Head, neck oncosurgical procedures with difficult airway requiring awake fiberoptic intubation in such patients adds to the challenge.We describe once such case of previously operated Carcinoma of oral cavity with new growth involving mandible for excision of tumour with neck dissection and mandibular reconstruction with a free Fibula flap. This patient now presented with anticipated difficult airway with restricted mouth opening and a recent diagnosis of severe Aortic stenosis with mean gradient across aortic valve of 52mmHg and valve area 0.8 cm2.Such patient requires multidisciplinary team approach by cardiologist, anaesthesiologist, surgeon and intensivist to prevent perioperative morbidity and facilitate early recovery.

scholarly journals CYSTIC PULMONARY HAMARTOMA MANIFESTING AS SPONTANEOUS PNEUMOTHORAX

2021 ◽  
Vol 29 (5) ◽  
pp. 624-628
Author(s):  
S.A. Plaksin ◽  
Keyword(s):  
Chest Pain ◽  
Histological Examination ◽  
Spontaneous Pneumothorax ◽  
Thoracoscopic Surgery ◽  
Left Lung ◽  
Lower Lobe ◽  
Shortness Of Breath ◽  
Lung Cysts ◽  
Pulmonary Hamartoma ◽  
Cystic Hamartoma

Cystic hamartoma refers to rare benign lung tumors. The literature describes 17 cases of this disease. The tumor may look like multiple bilateral cysts or a solitary single-chamber or multi-chamber cyst of a large size, which makes it difficult to diagnose. The disease can be complicated by spontaneous pneumothorax. The cyst itself often looks like a pneumothorax. An observation of a 52-year-old man complaining of chest pain and shortness of breath is presents. On the x-ray, the left lung is compressed with air, which is regarded as a spontaneous pneumothorax. Two-day drainage did not give any results. The video-assisted thoracoscopic surgery technique was performed and a large air cyst was detected. A conversion to a thoracotomy was made. A cyst of 20×15 cm size originated from the lower lobe, the lung was in atelectasis. Cyst resection and lung decortication were performed. Histological examination of the cyst wall revealed a hamartoma of the lung. The postoperative period was uneventful. Differential diagnosis of cystic hamartoma is conducting with lymphangioleiomyomatosis, air cysts, extrapulmonary sequestration, echinococcal cysts, and lung cancer. Indications for surgery are the following: chest pain, shortness of breath, pneumothorax, and hemoptysis. In a unilateral process, a cyst resection or lobectomy have to be performed. Cystic pulmonary hamartoma should be included in the differential diagnostic range in patients with recurrent spontaneous pneumothorax, hemoptysis, single and multiple lung cysts. It is impossible to determine the diagnosis without a biopsy and histological examination.

scholarly journals An Accidental Discovery of Tracheobronchomegaly: a Case Report

2020 ◽  
Author(s):  
Weijiang Ma ◽  
Aihua Liu ◽  
Xin Liu ◽  
Fukai Bao
Keyword(s):  
Thoracoscopic Surgery ◽  
Wedge Resection ◽  
Clinical Manifestations ◽  
Lower Lobe ◽  
Image Features ◽  
Surgical Measures ◽  
The Right ◽  
Chest Ct Scan ◽  
Video Assisted Thoracoscopic Surgery ◽  
Accidental Discovery

Abstract Tracheobronchomegaly is a rare disease with congenital abnormal change in respiratory tract; its image features are also very special. In this case, we described a 57-year-old male with cough, expectoration, chest pain, and dyspnea. In our institution, the result of chest CT scan is highly extraordinary, which showed obvious dilation of the trachea and main bronchi, emphysema, and a number of pulmonary bullae, and there was a big bulla with air-fluid level on the lower lobe of the right lung. Fortunately, after wedge resection for the big bulla on the lower lobe of right lung under video-assisted thoracoscopic surgery, this patient’s symptoms were significantly relieved. The clinical manifestations of tracheobronchomegaly lack specificity; this disease has freakish image features. At present, there are no effective treatments for tracheobronchomegaly, which just was an accidental discovery in this patient; we just mainly take surgical measures to treat the big bulla for relieving symptoms.

scholarly journals Sclerosing haemangioma of the lung: A case report

2012 ◽  
Vol 1 (1) ◽  
pp. 33-36
Author(s):  
R Thapa ◽  
M Lakhey ◽  
U Shrestha
Keyword(s):  
Case Report ◽  
Chest Pain ◽  
Ct Scan ◽  
Left Lung ◽  
Lower Lobe ◽  
X Ray ◽  
Medical College ◽  
Bronchoscopic Biopsy ◽  
Chest X Ray ◽  
Sclerosing Haemangioma

Sclerosing haemangioma is a rare neoplasm of the lung which behaves in a clinically benign fashion. Herein, a case of sclerosing haemangioma of the lung in a 52 years old woman is reported. She presented with symptoms of cough and chest pain. Chest X-ray and CT scan showed a well-defined lesion in lower lobe of left lung. Bronchoscopic biopsy findings were suggestive of a carcinoid tumor. Later the tumor was removed by lobectomy. The distinctive constellation of histologic findings revealed it to be a sclerosing haemangioma. DOI: http://dx.doi.org/10.3126/jkmc.v1i1.7254 Journal of Kathmandu Medical College, Vol. 1, No. 1, Issue 1, Jul.-Sep., 2012 pp.33-36

Subxiphoid Video-Assisted Thoracoscopic Surgery for Lung Resection Under Spontaneous Ventilation: Case Report

2021 ◽  
Vol 104 (11) ◽  
pp. 1847-1849
Keyword(s):  
Case Report ◽  
Thoracoscopic Surgery ◽  
Wedge Resection ◽  
Foley Catheter ◽  
Spontaneous Ventilation ◽  
Chest Drain ◽  
Arterial Line ◽  
Video Assisted ◽  
Subxiphoid Approach ◽  
Video Assisted Thoracoscopic Surgery

This case report describes two patients that underwent successful video-assisted thoracoscopic surgery (VATS) lung resections under spontaneous ventilation using the uniportal subxiphoid approach. The authors performed lung wedge resection in both patients under local anesthesia without using of a Foley catheter, arterial line, or intercostal chest drain. Only intravenous drugs and an oxygen mask with reservoir bag were used. The postsurgical course for both patients was uneventful. Both were discharged on postoperative day 2 and were doing well at 1- and 3-month follow-ups. Keywords: Subxiphoid approach; Pulmonary resection; Lung cancer

scholarly journals Minimally Invasive Bilateral Lung Resections and CABG through 5 Ports

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
N. Asemota ◽  
M. J. Rouhani ◽  
L. Harling ◽  
H. Raubenheimer ◽  
A. C. De Souza ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Minimally Invasive ◽  
Single Port ◽  
Thoracoscopic Surgery ◽  
Left Internal Mammary Artery ◽  
Wedge Resection ◽  
Lower Lobe ◽  
Granulomatous Inflammation ◽  
Minimal Access ◽  
Lung Resections

Minimal access surgery is increasingly popular to reduce postoperative morbidity and enhance recovery. We present a case of a patient who underwent bilateral minimally invasive thoracic and cardiac surgery. An 81-year-old woman was diagnosed with T1aN0M0 left upper lobe small-cell lung cancer and underwent single-port left video-assisted thoracoscopic surgery (VATS) upper lobectomy in 2016. She developed a contralateral right lower lobe nodule and underwent a single-port right VATS wedge resection of the lower lobe nodule, subsequently confirmed as necrotising granulomatous inflammation with acid-fast bacilli, consistent with previous tuberculosis (TB) infection. On postoperative day 1, she had an episode of self-reverting ventricular tachycardia and bradycardia. Subsequent myocardial perfusion scan and coronary angiogram showed significant LV dysfunction and severe coronary artery disease with a left main stem (LMS) lesion. After agreement at MDT, an Endo-ACAB (endoscopic atraumatic coronary artery bypass grafting) was performed, via 3 ports, with the left internal mammary artery anastomosed to left anterior descending artery. She recovered well postoperatively and was discharged. Multiple sequential minimally invasive procedures are now routine and can be performed safely in patients with a complex combination of pathologies. In this case, bilateral single-port (anatomic and nonanatomic) lung resections were undertaken followed by coronary revascularisation with a total of 5 minimal access ports.

scholarly journals An optimistic point in COVID-19 pandemic: a case report of large adult congenital cystic adenomatoid malformation

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Mohamed rafi Kathar Hussain ◽  
N. Kulasekeran ◽  
A. M. Anand
Keyword(s):  
Case Report ◽  
Cystic Lesion ◽  
Histopathological Examination ◽  
Left Lung ◽  
Lower Lobe ◽  
Congenital Cystic Adenomatoid Malformation ◽  
Unexpected Finding ◽  
Rare Presentation ◽  
Cystic Adenomatoid Malformation ◽  
Large Adult

Abstract Background Covid-19 pandemic is a major health calamity causing global crisis involving every aspect of the society. CT chest has become an essential diagnostic investigation and as a prognostic tool for assessment for COVID-19 bronchopneumonia. This case report is about an incidental unexpected finding in a young female, who underwent CT chest screening with suspicion of COVID-19 bronchopneumonia. Case presentation A 29-year-old female came with the complaints of sore throat, myalgia, and fever for the past 3 days. She was referred to our department for plain screening CT chest to rule out COVID 19 infection. She was an active sports person since childhood. CT chest revealed a large well-defined bullous cystic lesion of size 16 × 9.5 × 9.5 cm in the left lung lower lobe with partial sparing of its superior, anterior, and posterior basal segments. Imaging diagnosis of large bullous cystic lesion with emphysematous changes was made. No features of COVID 19 bronchopneumonia. Thoracoscopy-guided lobectomy was done, and tissue was sent to histopathological examination. Final diagnosis was large type 1 congenital cystic adenomatoid malformation with mucinous metaplasia. Our case is unique in the sense that large adult CCAM with mucinous metaplasia of the epithelium is a rare presentation. Further it was diagnosed as a part of COVID 19 screening. Conclusion CCAM presentation in adult is rare. Asymptomatic CCAM lesion of this size diagnosed during COVID 19 chest CT screening was rarely described.

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