Small-bore catheter is more than an alternative to the ordinary chest tube for pleural drainage.

BACKGROUND: Pleural collection is a common medical problem. For decades, the chest tube of different designs was the commonly used toll for pleural drainage. Over the past few years, small-bore catheter (SBC) has gained more popularity. We present our experience of using SBCs for the drainage of pleural collection of different etiologies. PATIENTS AND METHODS: A total of 398 small-bore pleural catheters were inserted in 369 patients with pleural collection during the period from January 2013 to October 2019. Data were collected regarding the efficacy of drainage, experienced chest pain, duration of drainage, and the occurrence of complications. RESULTS: Malignant associated (59.24%) and parapneumonic (19.57%) effusions constituted the most common causes. The drainage was successful in 382/398 (95.98%) occasions; six cases had incomplete fluid evacuation that required decortications; five cases (1.26%) had nonexpendable lung. Catheter reinsertion was needed due to dislodgment in 2 (0.50%) cases and obstruction in 3 (0.75%) cases. Sixty-two cases (15.58%) experienced chest pain. No patient developed empyema or cellulites at the site of catheter insertion. The duration of drainage ranged from 2 to 7 days, with an average of 3.5 days. CONCLUSIONS: SBC is equivalent to conventional chest tube for the drainage of pleural collection. Moreover, it has the advantages of less associated pain, versatility of insertion site, and relative safety of the technique in some risky and difficult situations.

Post COVID-19 large pneumatocele: clinical and pathological perspectives.

A middle aged COVID-19 male patient presented 2 weeks after discharge with new onset of dyspnoea and desaturation. Radiological studies revealed right side pneumothorax and lower lobe cystic air space. Chest drain was inserted and on a later date the patient underwent thoracoscopic surgery where a large pneumatocele was identified. Deroofing and closure of sources of air leak were done. Histopathological examination demonstrated extensive fibrosis, intra-alveolar Haemorrhage and pneumocytes hyperplasia.

Unilateral Giant Bullae: Pulmonary Placental Transmogrification Should Be Kept in Mind: Case Reports.

Placental transmogrification is a peculiar clinical entity of the lung of uncertain etiology. We report 2 cases of pulmonary placental transmogrification in 2 patients of different nationalities. Both of them had no history of smoking or chronic lung disease. The main presentations were dyspnea and chest pain. Radiologic studies showed a unilateral giant bulla in both patients; additional pneumothorax was present in only 1patient. They underwent surgical bullectomy. Histopathologic studies revealed the presence of intracystic placenta-like villous structures and a diagnosis of placental transmogrification was made. Placental transmogrification should be considered in cases of unilateral bullae.

Respiratory Distress and Chest Pain in an Airplane Passenger With Radiolucent Left Hemithorax.

CASE PRESENTATION: A 43-year-old man experienced sudden onset of chest pain and shortness of breath onboard a domestic flight. After consultation with the airline's operations center, a decision was made to land the plane in its destination airport. After landing, an ambulance was ready, and the patient was transferred to the ED in our facility. Patient evaluation was immediately started, and oxygen supply and venous access were secured.

Headscarf pin, a sharp foreign body aspiration with particular clinical characteristics.

The process of wearing head scarf is very complex; girls used to hold a number of pins in the mouth and utilize them one by one to fix the scarf. Loss of concentration results in pin aspiration. We presented our experience with scarf pin aspiration and discussed the unique clinical characteristics of this problem. We reviewed the records of 73 patients who underwent bronchoscopy for scarf pin inhalation during the period from January 1995 to May 2009. The following data were collected, history of aspiration, time lag before presentation, symptoms and signs, radiological findings, bronchoscopic findings, number of repeated bronchoscopy, complications, need for thoracotomy and time of discharge. All patients were female, mean age 13.4 years. The time lag before admission was <12 h for 59 (81%) patients. Positive history was present in all cases. Chest radiography identified the pins in all cases. The foreign bodies were seen in the left bronchial system in 37 (50.7%) patients, in the right bronchial system in another 24 (32.9%), and in the trachea in 12 (16.4%) patients. In 66 (90.4%) patients, the foreign body was removed in the first bronchoscopic trial; a second trial was needed in 5 (6.8%) patients, and thoracotomy was performed in two patients. In conclusion, head scarf pin aspiration occurs in adolescent Islamic girls. The clinical presentation and radiological findings are diagnostic in all cases. Rigid bronchoscopy is the preferred treatment modality. Health education is the key issue in the prevention of this problem.

Tracheal sleeve pneumonectomy for non small cell lung cancer (NSCLC): short and long-term results in a single institution.

OBJECTIVE: Bronchogenic carcinoma involving the carina or tracheobronchial angle still presents a challenge due to specific problems related to surgical technique and airway management. We reviewed our experience in carinal resection in terms of mortality, morbidity, and long-term survival. METHODS: Between 1982 and 2005, 49 patients underwent carinal resection: a right tracheal sleeve pneumonectomy was performed in 48 patients and a left tracheal sleeve pneumonectomy in 1 patient. Induction therapy was administered to 19 (39.6%) patients. In all cases, the anastomosis was performed with aid of high-frequency jet ventilation. RESULTS: Fourteen patients experienced perioperative complications (overall morbidity 28.6%), including 3 who died, for an overall mortality rate of 6.1%. Late empyema occurred in 5 (10.8%) patients. Histology was squamous cell carcinoma in 38 (77.6%) cases, adenocarcinoma in 10 (20.4%), and large-cell carcinoma in 1 (2%). The overall 5- and 10-year survival rates were 27.5 and 12.8%, respectively. Patients without nodal involvement had a significantly better prognosis than N1 and N2 patients (5-year survival: 56, 17, and 0%, respectively; p=0.002), as did patients with squamous histology compared to adenocarcinoma (5-year survival 29.5 and 11%, respectively; p=0.05). Multivariate analysis showed that nodal status was the only independent prognostic factor (p=0.00007). CONCLUSIONS: Tracheal sleeve pneumonectomy for bronchogenic carcinoma can be accomplished with acceptable mortality and morbidity, providing good long-term results. Nodal involvement seems to be an exclusion criterion for surgery, as it has a poor prognosis. Meticulous anesthetic management and surgical technique guarantee a better postoperative outcome.

Congenital pulmonary venolobar syndrome: Value of multidetector computed tomography in preoperative assessment.

A 6-month old baby referred to our department because of recurrent attacks of respiratory distress with chest infection. Chest radiology revealed reduction of the right hemithorax with mediastinal shift to the right. Multidetector computed tomography showed hypoplasia of the right lung and right pulmonary artery, systemic arterial supply to the lung from the abdominal aorta, and and absence of right venous drainage to the left atrium. This picture is consistent with congenital pulmonary venolobar syndrome. The patient underwent right pneumonectomy; the postoperative course was uneventful.

Chronic atelectasis of the left lower lobe: a clinicopathological condition equivalent to middle lobe syndrome.

OBJECTIVES: Middle lobe syndrome is a well-known clinical condition. In this retrospective study, we report our experience with a similar clinicopathological condition affecting the left lower lobe. METHODS: The data of 17 patients with atelectasis or bronchiectasis of the left lower lobe who underwent lobectomy during the period from January 2000 to December 2011 were reviewed. Demographic, clinical, radiological and surgical data were collected. RESULTS: Seventeen patients were included in this study, only one adult male patient of 52 years and 16 children. The paediatric patients were 10 boys and 6 girls, their age ranged from 2 to 11 years, mean 6.19 ± 2.6 years. Most patients presented with recurrent respiratory infection 15/17 (88.2%). The lag time before referral to surgery ranged from 3 to 48 months, mean 17.59 ± 13.1 months. Radiological signs of bronchiectasis were found in 11 (64.7%) patients. Bronchoscopy showed patent lower lobe bronchus in all patients. The criteria for lobectomy were evidence of bronchiectasis [11 (64.71%) patients], persistent atelectasis of the lobe after bronchoscopy and intensive medical therapy for a maximum of 2 months [6 (35.29%) patients]. Histopathological examination showed bronchiectasis in 11 (64.71%) patients, fibrosing pneumonitis in 4 (23.53%) patients and peribronchial inflammation in 2 (11.76%) patients. Most patients were doing well 1 year after surgery. CONCLUSIONS: Chronic atelectasis of the left lower lobe is a clinicopathological condition equivalent to middle lobe syndrome. Impaired collateral ventilation together with airway plugging with secretion is an accepted explanation. Surgical resection is indicated for bronchiectatic lobe or failure of 2-month intensive medical therapy to resolve lobar atelectasis.

Geometric reconstruction of the right hemi-trunk after resection of giant chondrosarcoma.

We present a case of a giant chondrosarcoma arising from the right anterolateral chest wall and extending to the abdomen. An extensive resection of the right lower chest wall, most of the right hemidiaphragm, and most of the anterior abdominal wall on the right side was carried out. A long titanium plate was used to reconstruct the right costal margin. This plate gave attachment to two polytetrafluoroethylene meshes that were used to cover the abdominal and chest wall defects. The patches were covered with pedicled muscles and omental flaps and subsequently with rotational skin flap.

Titanium plates support for chest wall reconstruction with Gore-Tex dual mesh after sternochondral resection.

We present a case of chest wall reconstruction after sternochondral resection for sternal metastasis of breast origin. We used three transverse titanium plates to stabilise the chest wall and provide support for a polytetrafluoroethylene dual mesh, which was used to cover the chest wall defect. The pectoralis muscles flaps were approximated in the midline to cover the dual mesh.

Repair of a postesophagectomy bronchogastric tube fistula with polyglactin mesh supported with a muscle flap.

A bronchogastric fistula is a very rare complication of transthoracic esophagectomy. We report a case of bronchogastric fistula after transthoracic esophagectomy caused by dehiscence of the staple line in the gastric tube, with subsequent erosion into the right main bronchus. The patient was managed successfully in two surgical stages. First, the bronchial defect was repaired using a polyglactin mesh covered by a serratus anterior muscle flap. Two months later, the esophagogastric continuity was restored with colon interposition.

Multiple-running suture technique for bronchial anastomosis in difficult sleeve resection.

We present a simplified technique for bronchial anastomosis in difficult sleeve resection using multiple running sutures. During the last 5 years we used this technique in 11 patients. We recorded no anastomotic-related complications in all of them. We found this technique easier, faster, and effective; we consider it a potential routine bronchial anastomotic technique.

Pericardial flap for bronchial stump coverage after extrapleural pneumonectomy; is it feasible?

Bronchial stump reinforcement with viable tissue after pneumonectomy is an important prophylactic measure against the development of bronchopleural fistula. We present our technique of utilizing the pericardium on the posterior wall of the left atrium as a flap to cover the bronchial stump after extrapleural pneumonectomy. From January 1999 to March 2008, we used this technique in 50 patients (29 on the right side and 21 on the left side) with no incidence of bronchopleural fistula or empyema. This technique is proved to be feasible, safe and effective; also it does not increase operative time or surgical trauma.

Nodal recurrence of pulmonary carcinoid 30 years after primary resection.

We present a case of nodal recurrence of carcinoid tumor in a 48-year-old male patient, 30 years after resection of primary tumor. Octreoscan was used for diagnosis and localization of the mass. Surgical resection was successful and histopathologic examination revealed lymph node infiltrated with atypical carcinoid.