ABSTRACT
PURPOSE: Pulmonary nodules suspected to be cancerous are rarely diagnosed as pulmonary infarction (PI). This study examined the clinical, radiological, and laboratory data in cases diagnosed with PI to determine their potential utility as preoperative diagnostic markers. We also assessed factors affecting the postoperative course. METHODS: A total of 603 cases of peripheral pulmonary nodules undiagnosed preoperatively were resected at Hokkaido University Hospital from 2012 to 2019. Of these, we reviewed cases with a postoperative diagnosis of PI. We investigated clinical symptoms, preoperative laboratory data, radiological characteristics, and postoperative complications. RESULTS: Four patients (0.7%) were diagnosed with PI. All patients had a smoking history. One patient received systemic steroid administration, and none had predisposing factors for thrombosis. One case showed chronologically increased nodule size. Three cases showed weak uptake of 18F-fluorodeoxyglucose. One patient with preoperative high D-dimer levels developed a massive pulmonary embolism (PE) in the postoperative chronic phase and was treated with anticoagulants. CONCLUSIONS: Preoperative diagnosis of PI is difficult, and we could not exclude lung cancer. However, if a patient diagnosed with PI has a high D-dimer level, we recommend postoperative physical examination for deep venous thrombosis. Prophylactic anticoagulation therapy should be considered to avoid fatal PE.
Subject(s)
Postoperative Complications , Pulmonary Embolism , Pulmonary Infarction , Humans , Postoperative Complications/epidemiology , Pulmonary Embolism/epidemiology , Pulmonary Infarction/diagnosis , Pulmonary Infarction/surgery , Treatment OutcomeABSTRACT
No disponible
Subject(s)
Humans , Female , Middle Aged , Vena Cava Filters/adverse effects , Pulmonary Infarction/diagnostic imaging , Pulmonary Embolism/diagnostic imaging , Tomography, X-Ray Computed , Pulmonary Infarction/surgery , Pulmonary Embolism/surgeryABSTRACT
Anatomical segmentectomy has emerged as the procedure of choice for early-stage non-small-cell lung cancer, especially in the presence of poor cardiopulmonary reserve. The most common postoperative complications are pneumonia, persistent air leak, and rarely, vascular compromise of the remaining lobe. We report the case of a 74-year-old woman who underwent thoracotomy and left upper lobe trisegmentectomy for T1bN0Mo squamous cell carcinoma and subsequently developed infarction and hepatization of the remaining lingula. A completion left upper lobectomy was performed and the patient made a full recovery.
Subject(s)
Carcinoma, Non-Small-Cell Lung/surgery , Carcinoma, Squamous Cell/surgery , Lung Neoplasms/surgery , Pneumonectomy/adverse effects , Pulmonary Infarction/etiology , Aged , Carcinoma, Non-Small-Cell Lung/pathology , Carcinoma, Squamous Cell/pathology , Female , Humans , Lung Neoplasms/pathology , Neoplasm Staging , Pneumonectomy/methods , Pulmonary Infarction/diagnosis , Pulmonary Infarction/surgery , Reoperation , Thoracotomy , Tomography, X-Ray Computed , Treatment Outcome , Vocal Cord Paralysis/etiologyABSTRACT
We describe a rare case of extralobar pulmonary sequestration with hemorrhagic infarction in a 10-year-old boy who presented with acute abdominal pain and fever. In our case, internal branching linear architecture, lack of enhancement in the peripheral portion of the lesion with internal hemorrhage, and vascular pedicle were well visualized on preoperative magnetic resonance imaging that led to successful preoperative diagnosis of extralobar pulmonary sequestration with hemorrhagic infarction probably due to torsion.
Subject(s)
Bronchopulmonary Sequestration/diagnosis , Magnetic Resonance Imaging/methods , Pulmonary Infarction/diagnosis , Abdominal Pain/etiology , Bronchopulmonary Sequestration/surgery , Child , Fever/etiology , Humans , Male , Pulmonary Infarction/surgery , Torsion Abnormality/complicationsABSTRACT
We report a case of an 18-year old female patient with symptomatic extralobar pulmonary sequestration. The initial symptom was sudden-onset right lateral abdominal pain. Enhanced computed tomography showed a 5 cm in diameter, spindle-shaped mass located in the costophrenic sinus with no aberrant artery. Exploratory thoracoscopy showed a haemorrhagic mass caused by strangulation of an aberrant vessel originating from the intercostal artery. Pathological findings revealed pulmonary sequestration with haemorrhagic infarction. The strangulated aberrant artery was clearly demonstrated by video imaging.
Subject(s)
Bronchopulmonary Sequestration/surgery , Pulmonary Infarction/surgery , Thoracic Surgery, Video-Assisted , Abdominal Pain/etiology , Adolescent , Biopsy , Bronchopulmonary Sequestration/complications , Bronchopulmonary Sequestration/diagnosis , Female , Humans , Pulmonary Infarction/diagnosis , Pulmonary Infarction/etiology , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
A 42-year old woman presented with rheumatoid arthritis, dyspnoea and a congenital foregut cyst referred by a rheumatologist for thoracic surgery. The cyst was removed by video-assisted thoracoscopic surgery. The patient developed acute haemoptysis in the immediate postoperative period, which necessitated pulmonary resection due to infracted right lower lobe. This case report highlights the complication related to an unusual anatomy of a congenital foregut cyst.
Subject(s)
Bronchogenic Cyst , Pulmonary Infarction , Adult , Bronchogenic Cyst/complications , Bronchogenic Cyst/diagnostic imaging , Bronchogenic Cyst/pathology , Bronchogenic Cyst/surgery , Female , Humans , Postoperative Complications/surgery , Pulmonary Infarction/etiology , Pulmonary Infarction/surgery , Thoracic Surgery, Video-Assisted , Tomography, X-Ray ComputedABSTRACT
Tetralogy of Fallot is characterized by a ventricular septal defect, a large, overriding aorta, subpulmonic stenosis, and right ventricular hypertrophy. These lesions can be associated with abnormal development of the pulmonary vasculature. This can include peripheral pulmonic stenosis, discontinuous pulmonary arteries, anomalous pulmonary venous return, and the development of aortopulmonary collateral vessels. Aortopulmonary collateral vessels develop to supply underperfused areas of the pulmonary bed and pose a unique and challenging problem at the time of surgical repair, which involves closure of the ventricular septal defect, relief of right ventricular outflow tract obstruction, maintenance of pulmonary valve competency when possible, and establishment of laminar pulmonary blood flow to all segments of the pulmonary bed. We describe a 36-year-old man with unrepaired tetralogy of Fallot with distinctive aortopulmonary collaterals, who underwent complete surgical repair with good outcome. Two-dimensional echocardiogram, cardiac magnetic resonance imaging, and cardiac catheterization each provided vital details allowing a stepwise approach to defining his unique anatomy for surgical correction.
Subject(s)
Aorta/physiopathology , Cardiac Surgical Procedures/methods , Collateral Circulation , Lung/blood supply , Pulmonary Artery/physiopathology , Pulmonary Circulation/physiology , Tetralogy of Fallot/pathology , Tetralogy of Fallot/surgery , Abnormalities, Multiple/surgery , Adult , Cardiac Catheterization , Cardiac Surgical Procedures/adverse effects , Collateral Circulation/physiology , Humans , Male , Postoperative Complications/surgery , Pulmonary Artery/pathology , Pulmonary Artery/surgery , Pulmonary Infarction/surgery , Tetralogy of Fallot/diagnostic imaging , Tetralogy of Fallot/physiopathology , UltrasonographyABSTRACT
Pulmonary infarction usually appears as a hump-shaped triangular opacity with its base applied to a pleural surface. In some cases, pulmonary infarctions may appear as a pseudo tumoral opacity mimicking lung cancer. Thoracotomy could be prevented by repeating CT scan in properly selected patients.
Subject(s)
Lung Neoplasms/diagnosis , Pulmonary Infarction/diagnosis , Aged , Diagnosis, Differential , Humans , Lung Neoplasms/surgery , Male , Pulmonary Infarction/surgeryABSTRACT
Lung infarction after intrathoracic surgery is a life-threatening complication that needs urgent intervention. Although the exact etiology is not known, pulmonary infarction may be suspected for patients presenting with consolidation of the lung after intrathoracic surgery. We report a very rare case of pulmonary infarction after successful surgical treatment of a type B aortic dissection. The pulmonary infarction was treated by intrapericardial pneumonectomy. This article discusses possible etiology and management of such patients. A high index of clinical suspicion and timely investigations may allow early detection of this unusual event and avoid fatal outcomes.
Subject(s)
Aortic Aneurysm, Thoracic/surgery , Aortic Dissection/surgery , Postoperative Complications/etiology , Pulmonary Infarction/etiology , Humans , Male , Middle Aged , Postoperative Complications/surgery , Pulmonary Infarction/surgery , Tomography, X-Ray ComputedABSTRACT
A 4-year-old male presented with abdominal pain. A computed tomography scan of the abdomen was negative, but a pleural effusion and mass was noted in the lower left thorax. Video-assisted thoracoscopic surgery revealed the mass to be a rare case of extralobar pulmonary sequestration that had undergone infarction.
Subject(s)
Bronchopulmonary Sequestration/diagnosis , Bronchopulmonary Sequestration/surgery , Pulmonary Infarction/diagnosis , Pulmonary Infarction/surgery , Thoracic Surgery, Video-Assisted , Child, Preschool , Humans , MaleABSTRACT
Transplant pneumonectomy is most commonly performed in the setting of retransplantation and is rare for other indications. We present a case of an elderly woman who is 3 years postoperative left, single lung transplantation with a history of emphysema that developed extensive infarction of her transplanted lung secondary to thromboembolic disease. She required an allograft pneumonectomy as treatment for this and was eventually discharged on bi-level nasal positive pressure at night and 3 L nasal cannula oxygen during the day.
Subject(s)
Lung Transplantation , Pneumonectomy , Pulmonary Embolism/surgery , Pulmonary Infarction/surgery , Acute Disease , Female , Humans , Middle AgedABSTRACT
Lung torsion is a rare but serious complication after thoracic operations. We describe an unusual case of left lobar torsion after video-assisted thoracoscopic upper lobectomy. The profound symptom was impending hemorrhagic shock, which masqueraded as postoperative bleeding. The differentials between these 2 entities and treatment options for lung torsion are discussed.
Subject(s)
Bronchiectasis/surgery , Lung Diseases/etiology , Pneumonectomy/adverse effects , Postoperative Hemorrhage/diagnosis , Pulmonary Infarction/etiology , Shock, Hemorrhagic/etiology , Thoracic Surgery, Video-Assisted/adverse effects , Torsion Abnormality/etiology , Adult , Diagnosis, Differential , Humans , Lung Diseases/diagnostic imaging , Lung Diseases/surgery , Male , Pneumonectomy/methods , Postoperative Hemorrhage/diagnostic imaging , Postoperative Hemorrhage/surgery , Pulmonary Infarction/diagnostic imaging , Pulmonary Infarction/surgery , Radiography , Reoperation , Shock, Hemorrhagic/diagnostic imaging , Shock, Hemorrhagic/surgery , Thoracotomy , Torsion Abnormality/diagnostic imaging , Torsion Abnormality/surgery , Treatment OutcomeABSTRACT
Symptomatic extralobar pulmonary sequestration (EPS) is extremely rare. Herein, we report two male patients (3 and 16 years of age) with EPS presenting as hemothorax. Thoracotomic resections of the sequestrated lungs were uneventful. Pathologic examinations revealed hemothorax caused by circulatory disorders within the EPSs.
Subject(s)
Bronchopulmonary Sequestration/complications , Hemothorax/etiology , Pulmonary Infarction/etiology , Adolescent , Bronchopulmonary Sequestration/diagnostic imaging , Bronchopulmonary Sequestration/surgery , Child, Preschool , Hemothorax/diagnostic imaging , Hemothorax/surgery , Humans , Male , Pneumonectomy/methods , Pulmonary Infarction/diagnostic imaging , Pulmonary Infarction/surgery , Thoracostomy , Thoracotomy , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Twenty-three cases of surgically resected pulmonary infarcts sent in consultation were reviewed to evaluate their morphology and to assess reasons for consultation. The morphology of these infarcts demonstrated that only a minority had the classical triangular shape at low magnification (26%) whereas the majority were either spherical (17%) or had a geographic pattern of necrosis (35%). The margin of the infarcted tissue often had a pseudogranulomatous appearance due to palisaded histiocytes, foam cells, or perpendicularly oriented proliferations of fibroblasts and myofibroblasts (74%) and occasional cholesterol- and hemosiderin-laden giant cells. Basophilic granular karyorrhectic necrosis was seen focally (52%) as was vascular inflammation (56%) raising the differential diagnosis of Wegener's granulomatosis or infectious granulomas. These nonclassical features combined with a low incidence of clinical hemoptysis, chest pain and pleurisy, and a primary radiographic diagnosis of 'nodule r/o malignancy' highlight the need to consider thromboembolic pulmonary infarcts in the differential diagnosis of necrotic lung nodules with a histiocytic and fibroproliferative rim.
Subject(s)
Granuloma, Respiratory Tract/pathology , Lung Neoplasms/pathology , Pulmonary Infarction/pathology , Vasculitis/pathology , Adult , Aged , Diagnosis, Differential , Female , Humans , Lung Diseases/pathology , Male , Middle Aged , Pathology, Surgical , Pulmonary Infarction/surgery , Risk FactorsABSTRACT
A case of bilateral pneumothorax, lung cavitations, and pleural empyema in a cocaine user is described. The patient was treated by left tube thoracostomy and right lower lobectomy. The postoperative course was uneventful. Six months later, the patient remains asymptomatic. The pathology examination of the specimen revealed infected bronchiectasis, interstitial desquamative pneumonia, diffuse alveolar damage, subsegmental arterial thrombosis, and consequent areas of pulmonary infarction.
Subject(s)
Bronchiectasis/etiology , Cocaine-Related Disorders/complications , Cocaine/adverse effects , Empyema, Pleural/etiology , Pneumothorax/etiology , Pulmonary Infarction/etiology , Vasoconstrictor Agents/adverse effects , Administration, Inhalation , Adult , Bronchiectasis/pathology , Bronchiectasis/surgery , Central Nervous System Stimulants/adverse effects , Cocaine/administration & dosage , Cocaine-Related Disorders/diagnostic imaging , Cocaine-Related Disorders/pathology , Empyema, Pleural/pathology , Empyema, Pleural/surgery , Humans , Male , Pneumonectomy , Pneumothorax/pathology , Pneumothorax/surgery , Pulmonary Infarction/pathology , Pulmonary Infarction/surgery , Thoracic Surgery, Video-Assisted , Thoracostomy , Thoracotomy , Tomography, X-Ray Computed , Treatment Outcome , Vasoconstrictor Agents/administration & dosageABSTRACT
Computed tomography findings of pathologically proven pulmonary infarction associated with bronchogenic carcinoma are reported for two patients. In one case, the infarction was demonstrated as a well-defined pleura-based large nodule in the peripheral portion of the same lobe of the tumor. The nodule had a smooth, convex border and a linear strand from the apex of the lesion toward the hilum. The obstruction of the subsegmental pulmonary artery due to tumor invasion was considered the cause of pulmonary infarction. In the second case, the infarction was demonstrated as a rapidly appeared, pleura-based consolidation in the same lobe of the tumor with a blurred border. Obstruction of the pulmonary vein by a tumor might have played an important role in the development of the pulmonary infarction in association with a large pulmonary artery obstruction. We conclude that pulmonary infarction should be considered as a differential diagnosis when peripheral pulmonary nodules or masses are located in the same lobe as the primary cancer.