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.

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.

Association of the location and initial degree of malignant central airway stenosis with the risk of severe restenosis after interventional bronchoscopy

Background Therapeutic bronchoscopy is one of the effective methods in the treatment and management of malignant central airway stenosis (MCAS). However, restenosis after therapeutic bronchoscopy frequently occurs and severe restenosis (SR) can be life-threatening. Therefore, this study aimed at investigating the risk factors for SR after therapeutic bronchoscopy. Methods The data of 233 consecutive cases with MCAS who were subjected to therapeutic bronchoscopy between 2015 and 2020 at a tertiary hospital were collected. Patients were divided into SR group and non-SR during 6 months after therapeutic bronchoscopy. Multiple logistic regression analysis was performed to determine the risk factors for SR. Results SR during 6 months after therapeutic bronchoscopy occurred in 39.5% (92/233) of patients. The location and the initial degree of MCAS were associated with SR, as assessed by multiple logistic regression analysis (P < 0.05). The risk of SR after therapeutic bronchoscopy in the left main bronchus, right main bronchus, and right intermediate bronchus increased, compared to the risk when of MCAS was located in the trachea (OR (95% CI) of 8.821 (1.850-25.148), 6.583 (1.791–24.189), and 3.350 (0.831–13.511), respectively). In addition, the initial degree of MCAS was positively associated with an increased risk of SR (OR 1.020; 95% CI 1.006–1.035). Conclusions MCAS located in the left main bronchus, right main bronchus and right intermediate bronchus, as well as the higher initial degree of MCAS were independent risk factors for SR during 6 months after therapeutic bronchoscopy.

Inferior Pulmonary Ligament Division May Be Unnecessary during Left Upper Lobectomy: Effects on Lung Volume, Bronchial Angle and Bronchial Tortuosity

The benefits of dissecting inferior pulmonary ligament (IPL) during upper lobectomy using video-assisted thoracoscopic surgery (VATS) for early-stage lung cancer remains controversial. This study evaluates the effect of IPL dissection by comparing the lung volume, bronchial angle, and bronchial tortuosity of the left lower lobe (LLL) during VATS upper lobectomy. Medical records of all patients who underwent VATS left upper lobectomy for early-stage lung cancer were evaluated. Patients were divided into group P (preservation) and group D (dissection). Pre- and post-surgery lung volumes, bronchial angles (angle 1: axial angulation; angle 2: vertical angulation), and bronchial tortuosity (curvature index of the left main bronchus) were measured using computed tomography images for comparison. Forty patients were included in each group. Patient characteristics such as age, gender, body mass index, and smoking status, and preoperative lung volume, bronchial angles, and tortuosity were not significantly different between the two groups, and there was no statistically significant difference in the axial and vertical angulations; however, the change in pre- and postoperative bronchial tortuosity (0.03 ± 0.03 vs. 0.06 ± 0.03) and lung volume (−558.1 ± 410.0 mL vs. −736.3 ± 382.7 mL) showed a significant difference (p < 0.001 and p = 0.04, respectively). Preservation of IPLs during left upper lobectomy may be beneficial for LLL expansion and induces less movement and positional change in the left main bronchus.

Right lung complete atelectasis: an endotracheal tube displacement complication

ABSTRACT A 78-year-old, overweight woman with a severe individual history of the cardiovascular system was admitted in the intensive care unit with acute pulmonary edema. Despite appropriate emergency treatment, the patient did not show any clinical improvement and emergency intubation was decided. Post-intubation physical examination revealed dullness to percussion, absent breath sounds and reduced chest excursion of the right hemithorax combined with a gradual drop in blood pressure and oxygen saturation. An emergency chest X-ray showed opacification of the entire right lung and an ipsilateral shift of the mediastinum. Improvement of the patient’s respiratory and hemodynamic status was observed immediately after the partial withdrawal of the tube. Tube displacement is a relative frequent complication and concerns mainly the right main bronchus due to anatomical procedures. However, the above case is a rare case of tube displacement in the left main bronchus, which led to total atelectasis of the rightlung.