An innovative reconstruction of an enbloc resected composite giant chest and abdominal wall chondrosarcoma with 3D-composite mesh.

BACKGROUND: Chest wall chondrosarcomas, although common, pose unique challenges due to their aggressive nature, rarity of abdominal wall involvement, and propensity for recurrence. We highlight the critical role of meticulous surgical planning, multidisciplinary collaboration, and innovative reconstruction techniques in achieving optimal outcomes for patients with composite giant chest and abdominal wall chondrosarcoma. CASE PRESENTATION: A 38-year-old female patient presented with progressive left chest and abdominal wall swelling for two years; on evaluation had a large lobulated lytic lesion arising from the left ninth rib, scalloping eighth and tenth ribs measuring 13.34 × 8.92 × 10.71 cm (anteroposterior/transverse/craniocaudal diameter) diagnosed with chondrosarcoma grade 2. A three-dimensional (3D) composite mesh was designed based on computed tomography using virtual surgical planning and computer-assisted design and manufacturing technology. She underwent wide local excision and reconstruction of the chest and abdominal wall with 3D-composite mesh under general anesthesia. The postoperative condition was uneventful, with no recurrence at 12 months follow-up. CONCLUSION: A 3D-composite mesh facilitates patient-specific, durable, and cost-effective chest and abdominal wall reconstruction.

Primary Cutaneous Adenoid Cystic Carcinoma Of The Chest Wall With Axillary Lymph Node Metastases And Its Management: A Case Report.

Primary cutaneous adenoid cystic carcinoma (PCACC) is a rare form of adenoid cystic carcinoma (ACC) arising commonly from the salivary gland. Less often they originate outside the head and neck region, with the scalp being the commonest cutaneous site in 40% of the cases. The presentation on the chest wall is rare, with no reports to date on axillary lymph node metastases. Here we report a case of a 65-year-old female with previously operated PCACC of the chest wall at a different center, showing uptake on positron emission tomography imaging at the site of surgical scar that w as inconclusive on needle biopsy metastasized to the axillary lymph node confirmed by needle biopsy managed with wide local excision, axillary lymph node dissection, and chest wall reconstruction with keystone island flap. The postoperative outcome was uneventful with no recurrence or axillary complications at one year's follow-up. She was advised to receive adjuvant radiotherapy; however, she refused. To conclude, though PCACC is rare, they can have an aggressive presentation, and a multidisciplinary approach is necessary for a better outcome.

Tubercular empyema a sequalae of emphysematous pyelonephritis with porous diaphragm syndrome and its successful management: A case report.

INTRODUCTION: Emphysematous pyelonephritis (EP) is a life-threatening renal disease requiring early and immediate therapy. EP resulting in tubercular empyema is unusual, with no reports to date. PRESENTATION OF CASE: A 50-year-old female in sepsis diagnosed with diabetes mellitus on insulin presented with recurrent abdominal pain radiating to the left side of her back for one month and recurrent episodes of vomiting and fever for one week. Her contrast-enhanced computed tomography showed emphysematous pyelonephritis (EP), ruptured splenic abscess, disrupted and eventrated left diaphragmatic lining, pleuroperitoneal communication, and a left empyema. Genexpert studies for pleural pus revealed Mycobacterium tuberculosis. Her deteriorating condition required surgical intervention in the form of decortication, sterilization of the thoracic cavity, and composite mesh placement for the diaphragmatic porous syndrome. CONCLUSION: This case report demonstrates the rare and aggressive presentation of EP, its sequelae, and successful management with composite mesh to prevent recurrent intrathoracic infection secondary to porous diaphragm syndrome.

Transthoracic Migration of a Foreign Body into the Diaphragm from the Gunshot Injury and Its Management in a Child: A Case Report.

Intrapleural foreign bodies (FB) are rare and uncommon, while diaphragmatic FB secondary to gunshot injury in a child is still rarer. We now describe a 9-year-old male with a history of self-inflicted accidental air gun injury on the right side of the midline of the sternum with transthoracic migration of FB-lead bullet-measuring 1cm x1.4cm into the diaphragm managed initially with intercostal tube drainage for right hemopneumothorax at the different center underwent thoracoscopy followed by minithoracotomy and retrieval under C-arm guidance that has not been reported in the literature.

Mediastinal Hydatidosis with an Unusual Presentation: A rare case report.

Hydatidosis is a common zoonotic disease with a high prevalence in developing countries. While a solitary cyst with unilateral lung involvement is common, bilateral involvement and multiple cysts are rare, only seen in 20% and 30% of the cases, respectively. Likewise, extensive involvement of extrapulmonary tissues and mediastinum is rare. We report an unusual case of mediastinal hydatidosis mimicking an intrathoracic malignancy in a 24-year-old female patient. She presented in the year 2020 with a history of left-sided chest pain and heaviness in the left hemithorax for a period of two months. Diffuse, multiple fluid-filled cystic lesions with internal echoes throughout the mediastinum, lung, pericardium, diaphragm and chest wall were observed in contrast-enhanced computed tomography of the thorax. An incidental cystic lesion in the liver was also noted. Since serology for echinococcosis was negative, a differential diagnosis of intrathoracic malignancy was considered. However, intraoperative and histopathologic findings were suggestive of hydatidosis.

Surgical outcomes and the factors affecting lung expansion following open window thoracostomy in chronic tuberculous empyema with destroyed lung.

BACKGROUND: Patients with chronic tuberculous empyema and destroyed lung on a prolonged intercostal tube with failed lung expansion considered unsuitable for single-lung ventilation have poor outcomes. The study's objective was to analyze the surgical outcomes and lung expansion factors in these patients following the open window thoracostomy (OWT) procedure. METHODS: In a prospective study, patients (males = 63, females = 12) diagnosed with tuberculosis who underwent OWT were analyzed between 2017 and 2018. Factors including age, sex, side, comorbidities, body mass index (BMI), bacteriological culture, and patency of OWT site were evaluated for lung expansion. RESULTS: Mean preoperative weight 40.96 ± 5.70 kg increased significantly postoperatively. Pseudomonas aeruginosa (30.66%) was the most typical organism isolated and smoking (21.3%) was the common risk factor. At 6-month follow-up, complete lung expansion was noted in 60% of patients, while partial and no expansion is seen in 17.3% and 22.3% patients. Similarly 82.4% patients with pre-operative BMI>18.5 kg/m2 had complete lung expansion, while with BMI < 18.5 kg/m2, 41.7% and 45.8% had partial and no-expansion. Complete lung expansion was seen in 97.1%, 18.2%, and 23.1% of patients with obliterated OWT, sputum, and pleural pus positive for acid-fast bacilli (active disease), while in 57.9% of patients with comorbidities, complete lung expansion was absent. CONCLUSION: The analysis of various factors concludes that lung expansion is not affected by age, sex, side of the disease, and co-morbid conditions; however, extensively diseased lungs with low BMI and positive bacteriological culture, especially P. aeruginosa, active disease, smoking, and patent OWT, interfered with the expansion of the lung.

Left pulmonary aplasia with multiloculated effusion and pericardial defects in a young adult: a case report.

Pulmonary aplasia is a rare developmental lung anomaly with unknown etiology. Multiloculated effusion and pericardial defects are even less common with no cases reported up until now. Here, we report the first case of an unusual presentation of a 25-year-old female with recurrent cough for four months, who was diagnosed with left pulmonary aplasia with multiloculated effusion and partial pericardial defects, and who underwent uniportal thoracoscopic drainage and pleurectomy.

An innovative technique of chest wall stabilization and reconstruction in traumatic flail chest: The figure-of-eight suture with polypropylene mesh and musculofascial flap.

Surgical stabilization of the flail chest is challenging and has no established guidelines. Chest wall integrity and stability are the main factors that ensure the protection of intrathoracic organs and an adequate respiratory function. Here, we report a novel chest wall reconstruction technique in a 45-year-old man with a traumatic left flail chest and open pneumothorax diagnosed both clinically and radiographically. Rib approximation and chest wall reconstruction was done using intercostal figure-of-eight suture and polypropylene mesh with vascularized musculofascial flap. The patient improved gradually and was discharged after three weeks of total hospital stay. He returned to regular working after a month with no evidence of respiratory distress or paradoxical chest movement. Follow-up visit at one year revealed no lung hernia or paradoxical chest movement. This is a novel, feasible and cost-effective modification of chest wall reconstruction that can be adopted for thoracic wall repair in case of open flail chest, which needs emergency surgical interventions even in resource constraint settings.

Bochdalek Hernia and Partial Diaphragmatic Agenesis: Pedicled Intercostal Muscle Flap and Mesh Repair in a Young Adult with Sickle Cell Disease.

Congenital Bochdalek hernia (BH) in an adult is rare and has an unusual presentation. They are confined to the pediatric age group with an incidence of 1:3,000 live births. It rarely persists asymptomatic until adulthood. Surgical repair by thoracic, abdominal, or thoraco-abdominal approach is the treatment of choice with diaphragmatic reconstruction in associated diaphragmatic agenesis. With only 10 cases of BH with partial diaphragmatic agenesis reported to date, we discuss the rarity, unusual presentation, and management of BH in a young adult with sickle cell disease that has not been reported in the literature.

Brief overview of surgical aspect of autologous arterio-venous fistula for dialysis access.

Patients with the end-stage renal disease require renal replacement therapy in renal transplant, peritoneal dialysis, and intermittent hemodialysis. Hemodialysis remains the primary modality for renal replacement therapy. Excellent vascular access is a mainstay for performing hemodialysis. Here we present a brief review of the various surgical aspects of AV fistula creation. Preoperative physical examination and judicious use of the imaging modalities to define the artery and venous mapping provide a good outcome of the fistula formation. Surgical creation of RC-AVF is preferred for the end-stage renal disease patient. The end-to-side anastomosis between the radial artery and cephalic vein has shown very good results.

Pulmonary sclerosing pneumocytoma masquerading adenocarcinoma with co-existing BRAF V600E and PTEN mutation.

We report a case of a massive primary sclerosing pneumocytoma (PSP) involving the right lower lobe adhering esophagus with small synchronous PSP on the superior segment of the left lower lobe with concurrent mutation for B-RAF proto-oncogene, serine/threonine kinase (BRAF V600E), and phosphatase and tensin homolog (PTEN) gene in a young female. She underwent right lower lobectomy and mediastinal lymph node dissection under single lung ventilation with tumor-free margins on diagnosis-based findings of preoperative computed tomography-guided biopsy and positron emission tomography. Histopathology was suggestive of PSP-papillary variant with concurrent mutation of BRAF V600E and PTEN genes. Post-operative follow-up at four weeks was uneventful. She has to undergo wedge resection for the contralateral disease after six weeks following recovery from the first surgery.

A maze of pearls in the chest.

Hydatid disease is a prevalent disease in India. The most common organs involved are the liver and the lungs. Most of the time, the lung cysts are single and large. Multiple cysts have been described in literature but they are generally bilateral. We present here a case of multiple hydatidosis which involved only one lung, but occupied all the segments of the lung. The cysts were numerous and interconnected giving the appearance of a maze. The images of the computed tomography (CT) scan reveal that there was very little identifiable lung tissue. But after surgery, the healthy lung tissue expanded and occupied the chest cavity.

Intercostal Muscle Cavernous Haemangioma: A Chest Wall Pandora's Box.

BACKGROUND: Haemangiomas are uncommon chest wall tumours arising outside the rib cage. Their occurrence in intercostal muscle is extremely rare. AIM: We describe a case of intercostal muscle cavernous haemangioma as a differential diagnosis for chest wall swelling. CASE DESCRIPTION: We describe an 18-year-old male patient with an asymptomatic left-sided chest wall swelling. Contrast-enhanced computed tomography revealed a well-defined homogenously non-enhancing mass lesion arising from the seventh intercostal muscle with differential diagnoses of various chest wall tumours. Clinical presentation and imaging findings were inconclusive, but histopathological examination following excision biopsy revealed a cavernous haemangioma. The present case emphasizes the importance of histopathological diagnosis when clinical and radiological examination is inconclusive. Hence, it is necessary to consider intercostal muscle haemangiomas as a differential diagnosis for chest wall tumours in the absence of a feeding vessel. CONCLUSION: Despite its rare occurrence, intercostal muscle haemangioma must be considered as a differential diagnosis in chest wall tumours even in the absence of a feeding vessel. We believe that histopathology can provide a definitive diagnosis when most investigative procedures are inconclusive. LEARNING POINTS: Haemangiomas are rare chest wall tumours and even rarer when they originate from intercostal muscle.Intercostal muscle haemangiomas should be included in the differential diagnosis of chest wall tumours even in the absence of a feeding vessel.The present case emphasizes the importance of histopathological diagnosis when clinical and radiological examinations are inconclusive.

Chondrosarcoma of the Rib: Atypical Presentation and Management.

Chondrosarcoma is an uncommon malignant tumor of the rib and can have an atypical presentation based on age, gender, and clinical manifestation with differential diagnosis of intrathoracic mass. Management is surgical as the tumor is resistant to chemoradiation. Access to chest wall reconstruction is limited in many low-income countries and forms a barrier to patient compliance. We report an atypical presentation and describe a simple, easy, and cost-effective chest wall reconstruction method for chondrosarcoma of the rib in any resource-constrained setting.

Le chondrosarcome est une tumeur maligne peu commune de la côte et peut avoir une présentation atypique en fonction de l'âge, du sexe et de la manifestation clinique avec un diagnostic différentiel de masse intrathoracique. La prise en charge est chirurgicale car la tumeur est résistante à la chimioradiation. L'accès à la reconstruction de la paroi thoracique est limité dans de nombreux pays à faible revenu et constitue un obstacle à l'adhésion des patients. Nous rapportons une présentation atypique et décrivons une méthode de reconstruction de la paroi thoracique simple, facile et rentable pour le chondrosarcome de la côte dans un contexte de ressources limitées.