Intratracheal Nodular Fasciitis: a Rare Lesion Case Report

Nodular fasciitis is a benign proliferation of myofibroblasts that usually arises in subcutaneous tissues of the trunk, neck, head, and upper extremities of young to middle-aged adults. It is not reported to arise in the intratracheal. We present a patient with chest tightness and asthma for three months. Chest computed tomography showed no displayed of left bronchus. The trachea of the left main bronchus was blocked by organisms under bronchoscope. The organisms were extracted and pathologically diagnosed as a rare, benign, intratracheal nodular fasciitis. One month later, the patient relapsed again and underwent resection.

Rigid Bronchoscopy in Foreign Body Aspiration Diagnosis and Treatment in Children

Foreign body aspiration in children is a common condition and can bring about serious undesired results. Fast and accurate diagnosis and foreign body extraction from airways are essential. We performed a retrospective study on rigid bronchoscopy outcomes due to suspected foreign body aspiration. A total of 66 children were admitted to the Chair and Department of Pediatric Otolaryngology, Phoniatrics and Audiology, Medical University of Lublin between 2015 and 2020 and underwent rigid bronchoscopy in general anesthesia due to suspected foreign body aspiration. We analyzed the data, including patients age and sex, reported complaints, and bronchoscopy findings. Analyzed children were aged from 8 months to 17 years old; 74.24% of them were under 3 years old during the procedure, and most of the operated patients were males. In 36.36% cases, no foreign body was identified, and 57.14% foreign bodies were located in right main bronchus. A total of 80.95% of foreign bodies extracted from airways were organic, mostly nuts. Diagnosis and treatment of suspected foreign body aspiration requires consistent cooperation between pediatricians, pulmonologists, anesthesiologists, and otolaryngologists.

External compression of left main bronchus by a large patent ductus arteriosus: a case report

In neonates and infants, the trachea and main bronchus may be compressed by adjacent cardiovascular structures. Compression of the main bronchi by the patent ductus arteriosus is rare and causes a variety of respiratory problems. Surgical closure of the patent ductus arteriosus that compresses the main bronchus as soon as possible is an effective treatment option. Rapid clinical recovery is expected after surgical closure of the patent ductus arteriosus. We present a case of patent ductus arteriosus which caused obstruction of the left main bronchus.

Repair of a three-way congenital bronchoesophageal fistula in an adult patient: a case report

Background The incidence of congenital bronchoesophageal fistulas in adults is rare. Most fistulas discovered in adulthood are often small and can be repaired with a simple one-step method. Case presentation A 46-year-old female patient complained of a 2-month history of chocking, coughing, and a 12 kg drop in weight. The bronchofiberscopy and gastroscopy showed a large fistula, which extended from the esophagus to the main bronchus on both sides, thus forming a special three-way channel which has never been reported. This case was challenging both to the anesthetists and surgeons. The patient was intubated with a sengstaken-blakemore tube, and then received segmental esophageal resection, anastomotic reconstruction, and double-flap repair with esophagus segment in situ. Conclusion When the fistula in BEF is large or complicated, appropriate surgical methods should be meticulously designed according to the condition of the patient. The problem of anesthesia intubation should be solved first, to allow a smooth operation. Secondly, a double-layer repair of the airway fistula by using esophageal wall tissues as patch materials is proposed.

Deep learning for anatomical interpretation of video bronchoscopy images

Anesthesiologists commonly use video bronchoscopy to facilitate intubation or confirm the location of the endotracheal tube; however, depth and orientation in the bronchial tree can often be confused because anesthesiologists cannot trace the airway from the oropharynx when it is performed using an endotracheal tube. Moreover, the decubitus position is often used in certain surgeries. Although it occurs rarely, the misinterpretation of tube location can cause accidental extubation or endobronchial intubation, which can lead to hyperinflation. Thus, video bronchoscopy with a decision supporting system using artificial intelligence would be useful in the anesthesiologic process. In this study, we aimed to develop an artificial intelligence model robust to rotation and covering using video bronchoscopy images. We collected video bronchoscopic images from an institutional database. Collected images were automatically labeled by an optical character recognition engine as the carina and left/right main bronchus. Except 180 images for the evaluation dataset, 80% were randomly allocated to the training dataset. The remaining images were assigned to the validation and test datasets in a 7:3 ratio. Random image rotation and circular cropping were applied. Ten kinds of pretrained models with < 25 million parameters were trained on the training and validation datasets. The model showing the best prediction accuracy for the test dataset was selected as the final model. Six human experts reviewed the evaluation dataset for the inference of anatomical locations to compare its performance with that of the final model. In the experiments, 8688 images were prepared and assigned to the evaluation (180), training (6806), validation (1191), and test (511) datasets. The EfficientNetB1 model showed the highest accuracy (0.86) and was selected as the final model. For the evaluation dataset, the final model showed better performance (accuracy, 0.84) than almost all human experts (0.38, 0.44, 0.51, 0.68, and 0.63), and only the most-experienced pulmonologist showed performance comparable (0.82) with that of the final model. The performance of human experts was generally proportional to their experiences. The performance difference between anesthesiologists and pulmonologists was marked in discrimination of the right main bronchus. Using bronchoscopic images, our model could distinguish anatomical locations among the carina and both main bronchi under random rotation and covering. The performance was comparable with that of the most-experienced human expert. This model can be a basis for designing a clinical decision support system with video bronchoscopy.

Video-assisted thoracoscopic parenchymal sparing “rotational” bronchoplasty for managing bronchial carcinoid tumor

We present a modified bronchoplasty technique involving rotation of the bronchial structures. Our goal was to reconstruct the bronchus without using any foreign material while fully preserving the parenchyma. We used a biportal VATS approach. The centrally located bronchial tumor at the juncture between the right main bronchus, the right upper lobe bronchus, and the bronchus intermedius was first resected. The right upper lobe bronchus was rotated caudally, toward the bronchus intermedius, together with a slight clockwise rotation posteriorly to facilitate the approximation and tension-free closure of the bronchial defect. This video tutorial demonstrates the operative steps and explains how the rotational aspect is achieved.

Experience of tracheo-bronchoplastic surgery for lung cancer

Introduction. Currently, surgical treatment of lung cancer is impossible without the use of tracheobronchoplastic operations, which in advanced specialized clinics take up to 5-10% of all radical operations. Material and methods. We conducted a retrospective study including 21 patients with centrally located lung cancer who underwent 22 tracheobronchoplastic radical operations between 2000 and 2021. The operated patients included 18 men and 3 women aged 42 to 67 years (mean age 54.5 ± 12.5 years). The morphological structure of the tumors was represented by carcinoid (2) and squamous cell carcinoma (19). The pathological process was located in the right lung in 16 patients and in the left lung — in five patients. Comorbid status was present in 20 patients. Standard lateral thoracotomy was used in 18 cases, and video-assisted minithoracotomy — in three cases. Extended lymphodissection up to D2 was performed in all surgeries. Combined surgeries included resection of adjacent organs: pericardium (2), unpaired vein (2), superior vena cava (1), diaphragmatic and vagus nerves (1), pleura (1). Results. The average duration of operations was 242.3 minutes (125-345 minutes), the average blood loss was 283.2 ml (50–1000 ml). Complications developed in 5 (22.7%) patients. Mortality was observed in 2 (9.1%) cases. Conclusion. The use of tracheobronchoplastic operations significantly expands the possibilities of thoracic surgery in treatment of lung cancer both due to technical resectability of the tumor at the transition to the main bronchus and trachea and due to functional operability at low respiratory functions and impossibility to perform pneumonectomy.