Conservative Management of Large Tracheal Perforation due to Traumatic Intubation.

Tracheal perforation is a rare complication of intubation and is associated with high mortality. Here we describe a case of large, full-thickness tracheal perforation from traumatic intubation after an elective procedure. The injury was managed with prolonged intubation that bypassed the site of injury, and the patient was successfully extubated after 11 days. Conservative management of tracheal perforation after traumatic intubation is an option in select patients that avoids need for surgery.

That's No Moon, It's a Giant Left Ventricular Aneurysm: A Case Report and Literature Review.

BACKGROUND: Although the most common causes of left ventricular aneurysm (LVA) is ischemic disease, other infectious, traumatic, genetic and iatrogenic etiologies exist. With the improvement of medical therapy for ischemic disease and earlier interventions such as PCI, the incidence of large LVA (>3cm) and surgical treatment for it is increasingly rare.  Case study: We describe a case report and literature review of a giant LVA in a patient, who presented with unclear etiology. A 61-year-old male was referred to our tertiary center. He underwent aneurysmectomy and mitral valve replacement for a giant (10cm x 10cm) LVA with severe mitral regurgitation.  Conclusion: Surgery for LVA is becoming less common. Early intervention can restore cardiac geometry with good short and long-term surgical outcomes, especially in patients with preserved EF. Ultimately, a giant ventricular aneurysm remains an indication for surgical intervention. Patients with markedly reduced EF may derive reduced benefits from aneurysmectomy.

Removal of aberrant azygos lobe containing positron emission tomography positive nodule with the use of video-assisted thoracic surgery.

INTRODUCTION: The Azygos lobe is a well-known but rare variant of the lung. This case reports the use of video-assisted thoracic surgery to diagnose and treat presumptive lung cancer of the azygos lobe. PRESENTATION OF CASE: A 67-year old female with known severe Chronic Obstructive Pulmonary Disease presented with increasing shortness of breath. Chest x-ray revealed a lung nodule in the right lung field. PET/CT imaging delineated a 1.6x1.2cm speculated lesion in an aberrant azygos lobe. After appropriate preoperative testing and evaluation, the patient was taken to the operating room where the azygos lobe was removed using video-assisted thoracic surgery. DISCUSSION: The Azygos lobe is a well-known anatomical variant but such a lobe is rarely found to contain a malignant lesion. Azygos lobe removal alone may not be the best therapeutic option given the risk of locally recurrent disease, but in a select group of patients such as those with impaired lung function as this article describes, it may be the best available option in order to preserve postoperative pulmonary function. CONCLUSION: This case illustrates that gentle caudal traction on the azygos lobe will allow circumferential exposure to the lobe and identification of the bronchovascular pedicle thereby eliminating the need for thoracotomy and or extensive azygos vein dissection/division.

Neoaortic root modification for late thrombosis after Norwood palliation.

A 5-year-old child with hypoplastic left heart syndrome presented with myocardial infarction 2 years after Fontan completion. Evaluation identified a thrombus in his native aortic root. Retrospective review of a prior catheterization revealed stasis in the native aortic root. Surgical thrombectomy was performed after failed medical management. The neoaortic root was revised at the time of thrombectomy in an attempt to reduce stasis in the native aortic root. This case suggests the need to identify anatomic findings that may predispose to coronary artery thrombus formation after Norwood palliation.