Video-assisted thoracoscopic surgery involving a bronchotomy in the removal of a bronchial foreign body: A novel case report.

INTRODUCTION AND IMPORTANCE: Bronchial foreign body aspiration is a life-threatening emergency. Largely, the published literature focuses on the removal of foreign bodies by bronchoscopy, while the surgical removal of endobronchial foreign bodies is rarely reported on. Thus, we presented a case of a bronchial foreign body that was successfully removed by a video-assisted thoracoscopic surgical (VATS) bronchotomy, after multiple failed bronchoscopic attempts. CASE PRESENTATION: A 77-year-old male patient presented with a 2-month duration of a persistent cough and low-grade fever after undergoing dental treatment. Bronchoscopy revealed a dental crown surrounded by granulation tissue in the right basal bronchus. The patient was referred to our department for open surgery after undergoing multiple unsuccessful extractions. The bronchial foreign body was removed by a VATS bronchotomy. The postoperative course was uneventful, and the patient was discharged 2 days postoperatively without any complications. CLINICAL DISCUSSION: Most aspirated tracheobronchial foreign bodies can be removed through bronchoscopy; nonetheless, certain aspirated foreign bodies may require surgical intervention. Furthermore, the indications for bronchotomies encompass the failure to remove the foreign body despite repeated attempts, due to immobility, with or without distal bronchial placement. Thoracoscopy is beneficial in providing superior visualization, with an increased likelihood of post-bronchotomy recovery. CONCLUSION: VATS bronchotomy is a safe and effective alternative for the removal of bronchial foreign bodies without sacrificing the functioning of the lung parenchyma.

Radiological features and surgical management of lung abscess directly extending into the chest wall: A case report.

INTRODUCTION AND IMPORTANCE: We presented an extremely rare case of lung abscess following bronchoscopy associated with lung cancer that extended directly into the chest wall. CASE PRESENTATION: A 49-year-old man with adenocarcinoma underwent bronchoscopy. Eight days after the biopsy, the patient presented with chills and anterior chest wall pain. Chest computed tomography (CT) scan revealed a gas-containing lung abscess, measuring 10 cm in the left upper lobe and subcutaneous emphysema. The coronal view of the CT indicated a continuous passage of air from the lung abscess to the subcutaneous emphysema beneath the pectoralis muscle. Surgical debridement of the subcutaneous abscess was performed, resulting in drainage of a large volume of purulent material. We confirmed that the lung abscess had directly extended to the chest wall, leading to a decision to perform segmentectomy of the upper division of the left lung. CLINICAL DISCUSSION: Lung abscess associated with lung cancer is a rare, life-threatening complication, which may lead to significant delays in the commencement of oncological treatment and potentially worsen long-term outcomes. In the present case, surgical findings confirmed a lung abscess extending directly to the chest wall. Surgical therapy is the treatment of choice for this rare condition, providing rapid focus control. Therefore, prompt initiation of surgical therapy is essential when conservative measures prove ineffective. CONCLUSION: Lung abscesses may extend into the chest wall during differential diagnosis of infectious diseases of the chest wall. Successful treatment of this rare condition depends on prompt surgical intervention.

Radiological features of intrathoracic chronic expanding hematoma: A case report.

INTRODUCTION AND IMPORTANCE: We present a relatively rare case of intrathoracic chronic expanding hematoma (CEH) after thoracic surgery for lung cancer. CEH is often difficult to distinguish from malignant tumors because of its large size and slow progressive enlargement. In this report, we describe the radiological features of CEH in detail. CASE PRESENTATION: A 67-year-old man who underwent a left upper lobectomy for lung cancer at 46 years of age presented with hemosputum. Computed tomography revealed a large mass with central low attenuation. Calcification was detected in peripheral lesions of the mass. T2-weighted magnetic resonance imaging (MRI) revealed a mass with mixed low and high signal intensities. Based on the clinical course, the patient was diagnosed with an intrathoracic CEH. A left posterolateral thoracotomy was performed with the patient in the lateral position, and a mass encased in a tough capsule was resected. The postoperative histopathological findings were consistent with CEH. CLINICAL DISCUSSION: CT of intrathoracic CEH shows a lesion with heterogeneous content, a thick wall, and calcifications. However, differentiation from malignant tumors is difficult using CT alone. MRI is a good diagnostic modality for CEH and often shows a mixture of low- and high-intensity areas on T2-weighted images. In addition, the patient's medical history is important because most cases of CEH have a history of trauma or surgery. CONCLUSION: To diagnose intrathoracic CEH, it is essential to consider the patient's clinical course and MRI findings.

Pleomorphic adenoma of the trachea: A case report.

INTRODUCTION AND IMPORTANCE: Although pleomorphic adenoma is the most common type of parotid gland tumor, its occurrence in the trachea is rare. Here, we describe a successfully resected pleomorphic adenoma of the trachea in a woman with severe respiratory failure that had been preoperatively misdiagnosed as asthma. CASE PRESENTATION: A 69-year-old woman presented to the emergency department with symptoms of worsening dyspnea and subsequent loss of consciousness. She had a history of progressively worsening wheezing and stridor over the course of 2-years and had been diagnosed with asthma. Arterial blood gas sample analysis indicated type II respiratory failure. A chest computed tomographic scan revealed a tumor in the trachea, which was almost completely obstructing the lower tracheal lumen. The tumor was located just above the carina. To alleviate airway constriction and achieve complete resection, carinal resection with reconstruction was performed. The postoperative diagnosis was pleomorphic adenoma of the trachea. CLINICAL DISCUSSION: Pleomorphic adenoma is a rare tracheal tumor that may present with obstructive airway symptoms that mimic asthma. CONCLUSION: Tracheal tumors should be considered in patients with chronic respiratory symptoms that do not improve with medication.

An alternative option of the retroperitoneal laparoscopic approach for limited hepatectomy for recurrent hepatocellular carcinoma at the transected edge after previous hepatectomy.

Laparoscopic hepatectomy is safely performed with minimal invasiveness on patients with recurrent liver tumors after previous hepatectomy. However, it is still difficult to dissect and expose the operative field at the transected edge or plane after open right hepatectomy, even for limited resection by a laparoscopic approach, due to severe adhesion to the surrounding peritoneum or organs. We herein applied the retroperitoneal laparoscopic approach to limited resection of the dorsal surface at the transected edge of Couinaud's segment 6 after previous repeated hepatectomies in a patient with recurrent hepatocellular carcinoma (HCC) by avoiding severe intra-abdominal adhesion. We safely resected recurrent HCC via the retroperitoneal space. This approach is a useful and alternative option for laparoscopy which minimizes the dissecting time and avoids organ injury on the right side of the transected area of the liver after hepatectomy in patients with liver malignancies.

Relationship of immunonutritional factor with changes in liver volume after portal vein embolization.

Background: To identify predictors of changes in hepatic volumes after portal vein embolization, we examined the relationship with preoperative nutritional and immunological parameters. Patients and Methods: Ninety-three patients who underwent portal vein embolization were included. The control group comprised 13 patients who underwent right hepatectomy without portal vein embolization. Computed tomographic volumetric parameter was measured for changes in embolized and nonembolized liver. Correlation with various candidates of immunonutritional parameters was examined. Results: Difference in increased liver ratio was 9.1%. C-reactive protein levels significantly increased after portal vein embolization (P < .01), whereas albumin and total cholesterol levels significantly decreased, respectively (P < .01). The C-reactive protein/albumin ratio, prognostic nutritional index, Controlling Nutritional Status score, and modified Glasgow Prognostic Score were significantly different, respectively (P < .01). Prothrombin activity and total cholesterol level significantly correlated with the increased change in nonembolized liver (P < .05). The C-reactive protein and C-reactive protein/albumin ratio after portal vein embolization negatively correlated with hypertrophic ratio (P < .05). By comparing posthepatectomy outcomes between 64 patients undergoing portal vein embolization and 13 who did not, the prevalence of severe complications and mortality in the portal vein embolization group was not different from that in the non-portal vein embolization group. Liver activity at 15 minutes > 0.92 and increased liver volume ≥ 10% tended to correlate with lower prevalence of severe complications. Only increased intraoperative blood loss ≥ 1,500 mL was significantly associated with morbidity and mortality (P < .05). Conclusion: Contrary to our hypothesis, immunonutritional parameters, except C-reactive protein and C-reactive protein/albumin ratio, did not reflect hypertrophy after portal vein embolization. Although it is difficult to predict the hypertrophic degree, the strategy of scheduled hepatectomy should be switched in case of impaired inflammatory status after portal vein embolization.

Liver hanging maneuver is suitable in major hepatectomy for liver malignancies over 5 cm.

Objectives: Hepatic transection through an anterior approach is required to successfully complete anatomical hepatectomy for large liver malignancies. The liver hanging maneuver (LHM) is an alternative procedure for transection on an adequate cut plane and may reduce intraoperative bleeding and transection times. Material and Methods: We examined the medical records of 24 patients with large liver malignancies (>5 cm) who had undergone anatomical hepatic resection with LHM (n= 9) or without LHM (n= 15) between 2015 and 2020. Patient demographics, preoperative hepatic function, surgical records, and post-hepatectomy outcomes were retrospectively compared between the LHM and non-LHM groups. Results: The prevalence of tumors >10 cm was significantly higher in the LHM group than in the non-LHM group (p <0.05). Furthermore, LHM was significantly performed to right and extended right hepatectomies in the background normal liver (p <0.05). Although transection times did not significantly differ between the two groups, the amount of intraoperative blood loss was slightly lower in the LHM group than in the non-LHM group (1.566 mL vs. 2.017 mL), and blood transfusion was not needed for patients in the LHM group. Post-hepatectomy liver failure and bile leakage were not observed in LHM. However, the length of hospitalization was slightly shorter in the LHM group than in the non-LHM group. Conclusion: LHM is useful for transecting an adequately cut plane in hepatectomy for liver tumors over 5 cm-in-size located on the right side and achieves better outcomes.