A large mediastinal mass in a 33 year old patient.

Mediastinal masses are commonly found during the evaluation of other illnesses. During gynecologic evaluation for suspected endometriosis, a large asymptomatic intrathoracic mass was discovered in the patient presented. After pre-operative evaluation, the patient underwent thoracotomy with removal of a mature, cystic teratoma invading the pericardium. Invasion of the pericardium is rarely seen with these lesions. The diagnosis of teratoma is difficult to make based solely on radiologic or clinical findings and must be confirmed at pathology for final diagnosis.

Cardiac herniation after intrapericardial pneumonectomy and subsequent cardiac tamponade.

The first case of postpneumonectomy cardiac herniation was described in 1948. Despite advances in surgical technique and patient care, this very rare, potential surgical catastrophe may still be seen today. We present a similar case to that of the original description, but furthermore accentuated by an additional unsuspected surgical complication. This case involves a 59-year-old African-American man initially treated with radical pneumonectomy to resect an invasive T3 squamous cell lung cancer. After surgical resection, the patient developed both clinical and radiographic manifestations of cardiac herniation. Primary suture repair of the pericardial sac led to subsequent cardiac tamponade necessitating correction with Prolene mesh.

A management algorithm for esophageal perforation.

Despite the prolonged morbidity caused by a major surgery and the high occurrence of continued leakage, primary repair has been the standard treatment for esophageal perforations. We believe that management using removable esophageal stents is both simpler and more effective. Over the past 3 years, we have treated 14 patients using esophageal stents, and the procedure was successful in all patients. Because of the shorter bed rest that follows endoscopic Polyflex stent (Rush, Inc; Teleflex Medical, Duluth, GA) placement, it is very likely that the care of patients with esophageal perforation will be changed over time.

The human papillomavirus as a possible cause of squamous cell carcinoma: a case study with a review of the medical literature.

Human papillomavirus is a possible risk factor in the development of squamous cell carcinoma. We report the case of a 21-year-old African-American male who presented with coughing and shortness of breath. He had been treated with multiple cauteries and ablations for problems associated with HPV since childhood. A CT scan revealed bilateral cavitary lung lesions. These lesions were resected through staged thoracotomies and revealed synchronous squamous cell carcinomas.

A rare presentation of tuberculosis.

Primary involvement of the musculoskeletal system with tuberculosis is rare. We present a case of a young, immunocompetent woman with primary sternal tuberculosis. The disease led to destruction of the manubrium and a portion of the gladiolus and required extensive debridement and partial sternectomy, followed by musculocutaneous flap closure. Long-term postoperative management included four-drug antitubercular therapy.

Colobronchial fistula as a rare complication of coloesophageal interposition: a unique treatment with a review of the medical literature.

Colobronchial fistula after coloesophageal interposition is a rare complication that has only been reported once in the English surgical literature. We report the case of a 53-year-old man who presented with chronic respiratory complaints. He had previously undergone esophagectomy for adenocarcinoma of the gastroesophageal junction. The fistula was controlled by placement of a Polyflex esophageal stent.