Anesthetic management of thoracoscopic pulmonary wedge resection with a giant tracheal diverticulum in the carina: a case report and review of the literature

A tracheal diverticulum (TD) is a rare disease that is usually diagnosed as an incidental finding on thoracic computed tomography or bronchoscopy. TDs can be classified as congenital or acquired. In patients undergoing surgery, TDs can result in difficult intubation, difficult ventilation, pneumothorax, and other complications. We herein report a case of anesthetic management of thoracoscopic pulmonary wedge resection in a patient with a giant TD in the carina. Intraoperative double-lumen intubation and single-lung ventilation were challenging to perform. Fiberoptic-guided intubation was helpful, and intraoperative management was tailored to avoid diverticulum rupture. In this report, we also review complications related to TD in surgical patients undergoing mechanical ventilation. Ventilation is one of the most prominent anesthetic challenges. The close collaboration of the entire medical team was a key factor in the successful management of this rare case.

A Comparative Study of Intralobar Sequestration and Extralobar Pulmonary Sequestration

Objective: This study aims to identify the difference between patients who have been diagnosed with either intralobar sequestration (ILS) or extralobar sequestration (ELS).Methods: In this clinical study, 29 children with pulmonary sequestration (PS), diagnosed via physical examination and imaging at our hospital between January 2019 and January 2020, were enrolled. We compared whether statistical differences existed in the blood loss, operative time, and post-operative hospital stay between the two groups (ILS and ELS) after thoracoscopic pulmonary wedge resection.Results: There were no significant differences in gender, operative age, preoperative weight, and isolated lung position between the ILS and ELS groups (p > 0.05). There was significantly more intra-operative bleeding in children with ILS than those with ELS (p < 0.05), and the operation time and postoperative hospitalization times were significantly longer for those with ILS(p < 0.05). Upon microscopic evaluation after surgery, we found the appearance of ILS and ELS to be similar.Conclusion: Different types of congenital PS have different influences onnewborns during and after operation. For children with ILS, surgery is more difficult and the postoperative recovery is slower than for children with ELS. For this reason, we suggest that more attention should be paid to the clinical treatment of children with ILS. Although ILS and ELS present with different manifestations, we found no evidence of a significant difference in the postoperative microscopy of the two conditions.

Classification and Diagnosis of Pulmonary Nodules in Thoracic Surgery Using CT Image Segmentation Algorithm

This study was aimed at studying the pulmonary nodule (PN) classification and diagnosis through computed tomography (CT) images based on segmentation algorithms. 120 PN patients were taken as research subjects. Linear filter fine segmentation algorithm under 3D region growth was compared with the initial segmentation algorithm and applied to images of PN patients. The results showed that the segmentation effect of the proposed algorithm was at the upper-middle level. The cases of patients with smoking history were greatly more than those without (χ2 = 1.256, P < 0.05 ). Benign and malignant PNs were classified, and morphological features included rough ones and round-like ones. The size characteristics included edge length and area. The gray-scale features included the uniformity of the gray-scale value and the mean value of the gray-scale value. The operation time of pulmonary lobectomy (76.2 ± 23.1 min) was obviously longer than that of pulmonary wedge resection (27.5.2 ± 4.5 min) ( P < 0.05 ). The surgical blood loss of patients who underwent pulmonary lobectomy (125 ± 42 mL) was remarkably higher versus patients who underwent pulmonary wedge resection (51.6 ± 13.8 mL) ( P < 0.05 ). After the operation, the length of stay of patients who underwent lobectomy (8.6 ± 1.4 days) was evidently longer than that of patients who underwent wedge resection (6.4 ± 1.2 days) ( P < 0.05 ). The classification of benign and malignant PNs can effectively obtain the shape and size characteristics of PNs. Preoperative positioning surgery based on classification can shorten the operation time, reduce the amount of bleeding during the operation, and help improve the success rate of surgical resection.

Contralateral spontaneous rupture of the esophagus following severe emesis after non-intubated pulmonary wedge resection

Background Non-intubated thoracoscopic lung surgery has been reported to be technically feasible and safe. Spontaneous rupture of the esophagus, also known as Boerhaave’s syndrome (BS), is rare after chest surgery. Case presentation A 60-year-old female non-smoker underwent non-intubated uniportal thoracoscopic wedge resection for a pulmonary nodule. Ultrasound-guided serratus anterior plane block was utilized for postoperative analgesia. However, the patient suffered from severe emesis, chest pain and dyspnea 6 h after the surgery. Emergency chest x-ray revealed right-sided hydropneumothorax. BS was diagnosed by chest tube drainage and computed tomography. Besides antibiotics and tube feeding, a naso-leakage drainage tube was inserted into the right thorax for pleural evacuation. Finally, the esophagus was healed 40d after the conservative treatment. Conclusions Perioperative antiemetic therapy is an indispensable item of fast-track surgery. Moreover, BS should be kept in mind when the patients complain of chest distress following emesis after thoracic surgery.

Contralateral spontaneous rupture of the esophagus following severe emesis after non-intubated pulmonary wedge resection

Background: Non-intubated thoracoscopic lung surgery has been reported to be technically feasible and safe. Spontaneous rupture of the esophagus, also known as Boerhaave's syndrome (BS), is rare after chest surgery.Case Presentation: A 60-year-old female non-smoker underwent non-intubated uniportal thoracoscopic wedge resection for a pulmonary nodule. Ultrasound-guided serratus anterior plane block was utilized for postoperative analgesia. However, the patient suffered from severe emesis, chest pain and dyspnea 6h after the surgery. Emergency chest x-ray revealed right-sided hydropneumothorax. BS was diagnosed by chest tube drainage and computed tomography. Besides antibiotics and tube feeding, a naso-leakage drainage tube was inserted into the right thorax for pleural evacuation. Finally, the esophagus was healed 40d after the conservative treatment.Conclusions: Perioperative antiemetic therapy is an indispensable item of fast-track surgery. Moreover, BS should be kept in mind when the patients complain of chest distress following emesis after thoracic surgery.