scholarly journals Isсhemic change in bronchus stump after lung cancer resection

2020 ◽  
Vol 179 (3) ◽  
pp. 33-39
Author(s):  
S. A. Plaksin ◽  
L. I. Farshatova ◽  
A. L. Lisichkin
Keyword(s):  
Main Bronchus ◽  
Lung Resection ◽  
Bronchopleural Fistula ◽  
Lower Lobe ◽  
Lobe Bronchus ◽  
Doppler Flowmetry ◽  
Bronchial Wall ◽  
Risk Patients ◽  
The Right ◽  
Right Lower Lobectomy

The OBJECTIVE of the study was to assess the changes in blood supply of the bronchus stump following lung resection with lymph node dissection.METHODS AND MATERIALS. Bronchial microcirculation was studied in 8 patients during pneumonectomy of the wall of the main bronchus using laser Doppler flowmetry method. In this paper, we present our observations of postoperative necrotic ischemic bronchitis after lobectomy with associated formation of bronchopleural fistula of the main bronchus and the failure of the stump of the lobular bronchus.RESULTS. Mobilization of the bronchus decreased microcirculation rate to (3.3±0.3) conventional units (c. u.), or to 74.5 %; lymphatic dissection further reduced microcirculation rate to (2.6±0.2) c. u., or to 60.2 %. An additional twisted suture was found to worsen ischemia. The normalized value of the amplitude decreased during the second minute of the dissection of the bronchus, indicating hypoxia. A 61-year-old patient with diabetes showed damage to the wall of the main bronchus 0.6 cm in size 7 days after undergoing the right lower lobectomy with lymphatic dissection. On the 19th day after the same procedure, the same patient developed an insolvency of the stump of the lower lobe bronchus, which was classified as a manifestation of ischemia. Postoperative ischemic bronchitis can occur in a true ischemic or an ulcerative necrotic form, and it can be diagnosed using a macroscopic picture in the context of fibrobronchoscopy. It occurs in (2.5–3.2) % of patients who underwent lung resections for cancer with lymphatic dissection.CONCLUSION. Ischemia of the bronchial wall during its mobilization plays a significant role in the etiology of bronchopleural fistula. Lymphatic dissection worsens microcirculation of the bronchial wall. Ischemic necrotic bronchitis can lead to formation of the bronchopleural fistula outside of the stump. High-risk patients require additional coverage of the bronchus stump with muscle or fat tissue.

scholarly journals Auscultating a pea: the stethoscope may matter in otorhinolaryngology emergency evaluation

2021 ◽  
Vol 7 (3) ◽  
pp. 530
Author(s):  
Francisco Alves De Sousa ◽  
Ana Costa Silva ◽  
Ana Nóbrega Pinto ◽  
Cecília Almeida E. Sousa
Keyword(s):  
Foreign Body ◽  
Lower Lobe ◽  
Signs And Symptoms ◽  
Foreign Body Sensation ◽  
Careful Examination ◽  
Lower Airway ◽  
Lobe Bronchus ◽  
Body Sensation ◽  
The Right

<p>Foreign body sensation is a common complaint in the otorhinolaryngology emergency. Careful examination of the patient’s pharynx is mandatory, but sometimes the object is not visualized. In such scenario, it may be important to explore signs and symptoms indicating lower aerodigestive impaction. This work describes the case of a 73-year-old woman without relevant comorbidities attending to emergency care. She complained of a foreign body sensation on the right side of the throat after ingesting a meal, which motivated referral to otorhinolaryngology. Flexible transnasal nasopharyngoscopy was unremarkable and no foreign bodies were found. Auscultation was performed revealing low-pitch expiratory wheezing on her right hemithorax. The suspicion of bronchial foreign body was then raised, which was ultimately confirmed by imaging and bronchoscopy, showing an impacted pea on the right lower lobe bronchus. The stethoscope was hence determinant for detecting aspiration, by revealing consistent alterations. Its usage should be encouraged in similar scenarios, highlighting the role of this classic but sometimes forgotten tool. Importantly, higher neck/throat sensations should not exclude the possibility of a lower airway foreign body.</p>

Right Lower Lobectomy With Middle Lobe Preservation After Right Upper Lobectomy in Lung Cancer of the Right Lower Lobe

2013 ◽  
Vol 96 (6) ◽  
pp. 2227-2230 ◽  
Author(s):  
Naohiro Taira ◽  
Tsutomu Kawabata ◽  
Atsushi Gabe ◽  
Takaharu Ichi ◽  
Kazuaki Kushi ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Lower Lobe ◽  
Middle Lobe ◽  
Lower Lobectomy ◽  
The Right ◽  
Middle Lobe Preservation ◽  
Right Lower Lobectomy

Four arms robotic right lower lobectomy for giant bullous emphysema localised in the right lower lobe, complicated by chronic inflammatory status

ASVIDE ◽  
2018 ◽  
Vol 5 ◽  
pp. 053-053
Author(s):  
Alessandro Pardolesi ◽  
Luca Bertolaccini ◽  
Jury Brandolini ◽  
Filippo Tommaso Gallina ◽  
Pierluigi Novellis ◽  
...  
Keyword(s):  
Lower Lobe ◽  
Lower Lobectomy ◽  
Inflammatory Status ◽  
The Right ◽  
Right Lower Lobectomy

Tracheal Bronchus: Classification, Endoscopic Analysis, and Airway Management

2002 ◽  
Vol 126 (3) ◽  
pp. 240-243 ◽  
Author(s):  
Andrew M. Doolittle ◽  
Eric A. Mair
Keyword(s):  
Congenital Anomaly ◽  
Airway Management ◽  
Main Bronchus ◽  
Case Series ◽  
Tracheal Bronchus ◽  
Lobe Bronchus ◽  
Retrospective Case ◽  
Tracheal Diverticulum ◽  
Pediatric Bronchoscopy ◽  
The Right

OBJECTIVE: Tracheal bronchus ( bronchus suis) is an unusual congenital anomaly in which the right upper lobe has its origin in the trachea rather than distal to the carina. We sought to analyze the anatomy, presentation, and airway management principles of tracheal bronchi, and we present the first endoscopically documented tracheal diverticulum. STUDY DESIGN/METHODS: Retrospective case series. RESULTS: The tracheal bronchus is located at the junction of the mid and distal thirds of the right lateral trachea, is more common in males and children with other congenital anomalies, and may be associated with right main bronchus stenosis. Bronchoscopy provides a clear definitive view of the anomaly, which we found in 5 children during a 12-year period (0.5% of pediatric bronchoscopy procedures). We illustrate 3 types of tracheal bronchi: (1) vestigial tracheal diverticulum (newly described), (2) high apical lobe, and (3) fully developed supranumerary aerated tracheal bronchus. Endoscopic documentation of each type is presented. Children with tracheal bronchi may present with stridor, cough, and/or recurrent right-sided pneumonia and/or to have foreign body aspiration ruled out. Treatment is based on the severity of symptoms and ranges from observation to right upper lobectomy. CONCLUSIONS: Otolaryngologists should be aware of the tracheal bronchus, to include classification, endoscopic analysis, and airway management of this uncommon anomaly. Bronchoscopy with selected radiographic imaging allows the otolaryngologist to fully evaluate the child with a tracheal bronchus and to present timely therapeutic options. Tracheal bronchus is a congenital anomaly in which a right upper lobe bronchus has its origin in the trachea rather than at the carina. Bronchus suis, or “pig bronchus,” is an alternate name that is used because a tracheal bronchus is normal in swine and other ruminant animals. In approximately 1000 pediatric bronchoscopy procedures performed by the senior author during a 12-year period, only 5 children (approximately 0.5%) were identified with a tracheal bronchus. We present 3 representative cases to highlight salient features of each variant of the tracheal bronchus. A newly described “tracheal diverticulum” variant is presented. Tracheal bronchus classification based on endoscopic analysis assists with airway management for this uncommon anomaly.

scholarly journals Transpleural Сontralateral Occlusion of the Left Main Bronchus Stump in a Patient with Bronchopleural Fistula and Chronic Pleural Empyema

2021 ◽  
Vol 14 (3) ◽  
pp. 216-220
Author(s):  
Alexey Nikolaevich Lednev ◽  
Alexey Aleksandrovich Pechetov ◽  
Sergey Sergeevich Karchakov ◽  
Maksim Aleksandrovich Makov
Keyword(s):  
Pleural Cavity ◽  
Main Bronchus ◽  
Bronchopleural Fistula ◽  
Pleural Empyema ◽  
Bronchial Tree ◽  
Bronchial Stump ◽  
Anatomical Features ◽  
Chronic Empyema ◽  
The Right ◽  
Methods Of Treatment

Bronchopleural fistula (BPF) is a pathological communication between the bronchial tree and the pleural cavity, the most common complication of anatomical lung resection.BPF rarely closes spontaneously and almost always requires surgical or bronchoscopic interventions.The main methods of treatment are sanitation of the pleural cavity with the development of empyema and re-occlusion of the bronchial stump. The development of this complication in the postoperative period is accompanied by an increase in hospitalization time, a high risk of chronic pleural empyema, exacerbation of chronic diseases and death. The mortality rate ranges from 18 to 67%. Most often, BPF is manifested after removal of the right lung (8-13%), compared with the left side (1-5%), which is due to the anatomical features of the main bronchus.The presented clinical case describes a non-standard surgical approach in the treatment of bronchopleural fistula and chronic empyema of the residual pleural cavity in a young patient.

scholarly journals Communicating Bronchopulmonary Foregut Malformation Type IB: Diagnostic and Surgical Challenges

2021 ◽  
Vol 09 (01) ◽  
pp. e80-e83
Author(s):  
Bhushanrao Jadhav ◽  
Ranjithatharsini Vaseeharan ◽  
Prabhu Sekaran ◽  
Semiu Eniola Folaranmi ◽  
Karim Awad
Keyword(s):  
Primary Repair ◽  
Lower Lobe ◽  
Duodenal Atresia ◽  
Complex Case ◽  
Foregut Malformation ◽  
The Right ◽  
High Index Of Suspicion ◽  
Contrast Swallow ◽  
Right Lower Lobectomy ◽  
Upper Gastrointestinal

AbstractCommunicating bronchopulmonary foregut malformations (CBPFM) are extremely rare. We present a complex case of type IB CBPFM with esophageal atresia and distal tracheoesophageal fistula (EA/TOF), duodenal atresia/annular pancreas (DA/AP), and intestinal malrotation who underwent primary repair for EA/TOF on day 3. Bilious aspirates on day 8 prompted an upper gastrointestinal (GI) contrast revealing a duodenal obstruction and communication between the right lung lower lobe and the esophagus (T8-T9 level). DA/AP and malrotation were repaired by a gastrojejunostomy and Ladd's procedure. A repeat contrast swallow identified a 2nd communication from the esophagus into the right lower lobe (T5-T6 level) raising the suspicion of a recurrent TOF. Computed tomography (CT) thorax confirmed above findings with an anomalous blood supply to right lung. An exploratory thoracotomy identified a three-lobed lung. However, the lower lobe was enlarged and connected in two separate locations to the esophagus. The child recovered after the disconnection of the esophageal connections and partial right lower lobectomy. CBPFM are extremely rare anomalies requiring a high index of suspicion, use of an upper GI contrast series, and CT scans for diagnosis. The treatment of choice is resection of the affected lung and disconnection of the esophageal communications.

scholarly journals Dieulafoy’s disease of the bronchial tree: a case report

2017 ◽  
Vol 135 (4) ◽  
pp. 396-400 ◽  
Author(s):  
Massoud Baghai Wadji ◽  
Athena Farahzadi
Keyword(s):  
Case Report ◽  
Lung Resection ◽  
Lower Lobe ◽  
Fiberoptic Bronchoscopy ◽  
Arterial Embolization ◽  
Bronchial Tree ◽  
Massive Hemoptysis ◽  
Selective Embolization ◽  
Dieulafoy’S Disease ◽  
The Right

ABSTRACT CONTEXT: Dieulafoy’s disease of the bronchial tree is a very rare condition. Few cases have been reported in the literature. It can be asymptomatic or manifest with massive hemoptysis. This disease should be considered among heavy smokers when recurrent massive hemoptysis is present amid otherwise normal findings. The treatment can be arterial embolization or surgical intervention. CASE REPORT: A 16-year-old girl was admitted to the emergency department due to hemoptysis with an unknown lesion in the bronchi. She had suffered massive hemoptysis and respiratory failure one week before admission. Fiberoptic bronchoscopy revealed a lesion in the bronchus of the right lower lobe, which was suspected to be a Dieulafoy lesion. Segmentectomy of the right lower lobe and excision of the lesion was carried out. The outcome for this patient was excellent. CONCLUSION: Dieulafoy’s disease is a rare vascular anomaly and it is extremely rare in the bronchial tree. In bronchial Dieulafoy’s disease, selective embolization has been suggested as a method for cessation of bleeding. Nevertheless, standard anatomical lung resection is a safe and curative alternative.

scholarly journals Primary Epithelial Myoepithelial Carcinoma of Lung, Reporting of a Rare Entity, Its Molecular Histogenesis and Review of the Literature

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Farzana Arif ◽  
Susan Wu ◽  
Shahriyour Andaz ◽  
Stewart Fox
Keyword(s):  
Incidental Finding ◽  
Lower Lobe ◽  
Final Diagnosis ◽  
Myoepithelial Cells ◽  
Myoepithelial Carcinoma ◽  
Rare Entity ◽  
Lobe Bronchus ◽  
Epithelial Myoepithelial Carcinoma ◽  
Bronchial Glands ◽  
The Right

Primary epithelial myoepithelial carcinoma of lung is a rare entity and is thought to arise from the submucosal bronchial glands distributed throughout the lower respiratory tract. Because of the rarity of this tumor, we describe one case of epithelial myoepithelial carcinoma arising in the bronchus intermedius and presenting as an endobronchial mass. A 57-year-old male patient presented with an incidental finding of an endobronchial mass located in the lumen of the right lower lobe bronchus and caused near total luminal occlusion of the bronchus. An endobronchial carcinoid tumor was entertained clinically. Subsequently the patient underwent an uneventful videothoracoscopic lobectomy of lower and middle lobes of the right lung. Morphologically and immunohistochemically the tumor was characterized by two cell populations with epithelial and myoepithelial cells forming duct-like structure. The final diagnosis of epithelial myoepithelial carcinoma of lung was rendered.

scholarly journals The left main bronchus transected incorrectly during video-assisted thoracoscopic lobectomy: a case report

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Yuma Shindo ◽  
Masahiro Miyajima ◽  
Yasuyuki Nakamura ◽  
Wataru Arai ◽  
Ryunosuke Maki ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Main Bronchus ◽  
Lower Lobe ◽  
Left Main Bronchus ◽  
Left Lower Lobe ◽  
Left Main ◽  
Lobe Bronchus ◽  
Intraoperative Complication ◽  
Pleural Adhesion ◽  
Lower Lobectomy

Abstract Background Several severe intraoperative complications of lung cancer surgery have been reported, but the incorrect transection of the main bronchus is a very rare and serious complication. We report a surgical case of a patient with left lower lobe lung cancer invading the inferior segment of the lingula, with fused interlobar fissure and dense pleural adhesion, in which the left main bronchus was mistaken for the left lower lobe bronchus and was transected. Case presentation A 64-year-old woman with lung adenocarcinoma was referred to our hospital for surgical treatment. Chest computed tomography (CT) scan showed a 30-mm nodule with a clear border and irregular margins in the center of the anterior (S8) segment of the lower lobe of the left lung and another similar 30-mm nodule in the lateral (S9) segment of the same lobe. Metastasis within the same lobe was suspected. A thoracoscopic left lower lobectomy was scheduled for the patient. As the patient had a moderately, fused fissure, dense pleural adhesion, and suspicious tumor invasion from the left S8 segment to the left S5 segment, and the interlobar node tightly adhered to the main PA at the site of basilar artery origin of the LLL, we performed left lower lobectomy and a left S5 segmentectomy using the fissureless fissure-last technique. During surgery, the left main bronchus was mistaken for the left lower lobe bronchus and was transected. After transecting the left main bronchus, we performed a sleeve bronchoplasty to prevent pneumonectomy. Conclusions We experienced the rare and serious intraoperative complication of the incorrect transection of the main bronchus. There are few reports of this intraoperative complication, and it should not be overlooked by surgeons.

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