RESUMEN
CASE PRESENTATION: An 80-year-old-woman was referred for evaluation of chest pain that appeared after providing care at home for her sick husband, which included helping him to get up and move about. The pain was initially triggered by lifting heavy objects but then became constant, without exacerbating or relieving factors. The pain was located in the left hemithorax and was not associated with shortness of breath or cough. Because the patient did not feel any better after a month, her general practitioner ordered a radiograph, which revealed a suspicious pulmonary nodule in the left upper lobe. She was a lifelong nonsmoker and denied any drug abuse. She had not been professionally exposed to lung carcinogens. She had a medical history of type 2 diabetes, ischemic cardiomyopathy, and renal artery stenosis. Her father died of lung cancer. She resided in Lille, France, and did not report any recent travel.
Asunto(s)
Histiocitosis/patología , Neoplasias Pulmonares/patología , Linfoma de Células B de la Zona Marginal/patología , Anciano de 80 o más Años , Dolor en el Pecho , Femenino , Histiocitosis/complicaciones , Histiocitosis/diagnóstico , Humanos , Cadenas kappa de Inmunoglobulina/genética , Cadenas kappa de Inmunoglobulina/inmunología , Cuerpos de Inclusión/inmunología , Cuerpos de Inclusión/ultraestructura , Neoplasias Pulmonares/complicaciones , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/cirugía , Linfoma de Células B de la Zona Marginal/complicaciones , Linfoma de Células B de la Zona Marginal/diagnóstico , Linfoma de Células B de la Zona Marginal/cirugía , Lisosomas/ultraestructura , Microscopía Electrónica , Tomografía de Emisión de Positrones , Nódulo Pulmonar Solitario/diagnóstico , Nódulo Pulmonar Solitario/patología , Nódulo Pulmonar Solitario/cirugía , Cirugía Torácica Asistida por Video , Tomografía Computarizada por Rayos XAsunto(s)
Fístula Bronquial/etiología , Cardiopatías/etiología , Pericardio , Anciano , Fístula Bronquial/diagnóstico por imagen , Broncoscopía , Diagnóstico Diferencial , Fístula/diagnóstico por imagen , Fístula/etiología , Cardiopatías/diagnóstico por imagen , Humanos , Masculino , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Postpneumonectomy empyema (PPE) is a serious complication. The treatment options are similar to the management of any abscess, with drainage, ideally open, often of critical importance. After infection control, many techniques for space obliteration have been described. This study summarizes a 10-year experience in the management of PPE in our center. METHODS: From 2000 to 2010, 90 patients (83 men) with PPE were treated. Median follow-up was 5.3 years. Once the diagnosis of empyema was confirmed, chest drainage was performed through open window thoracostomy (OWT), with ensuing extramusculoperiosteal thoracoplasties if healthy tissue was present. RESULTS: Pneumonectomy was performed in 72 patients with lung cancer. Mortality after PPE was 2.2%. OWT achieved infection control in 89 patients. Seven OWT spontaneously healed, and 24 were never closed. The remaining 59 patients with OWT underwent thoracoplasty. Mortality after thoracoplasty was 5%. Empyema recurred in 3 patients. Overall success rate of PPE control after pleural obliteration was 91.5%. CONCLUSIONS: Thoracoplasty is a reliable filling procedure. It has a significantly higher success rate and a lower mortality rate than the other techniques. We believe that this procedure has a part to play in the future management of PPE.
Asunto(s)
Empiema Pleural/etiología , Empiema Pleural/cirugía , Neumonectomía/efectos adversos , Toracoplastia , Toracostomía/métodos , Adulto , Anciano , Algoritmos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
BACKGROUND: The purpose of this study was to determine the incidence and symptoms of postoperative ischemic bronchitis (POIB) after systematic lymph node dissection (LND) and evaluate the effect of hyperbaric oxygen therapy in patients with primary lung cancer. METHODS: From January 2004 to December 2009, 1,071 patients underwent a standard resection for non-small cell lung cancer and radical systematic lymph node dissection. Fiberoptic bronchoscopy was performed systematically between days 7 and 12. We analyzed the clinical and biologic signs of POIB. Once the diagnosis established a treatment by hyperbaric oxygen, therapy was undertaken. RESULTS: A POIB was observed in 34 patients (3.21%) (2 women and 32 men). Mean age was 59 ± 10 years (range, 25 to 79 years). A POIB occurred within 8 ± 3 days; after right pulmonary resection (n = 21; 62%) and after left resection (n = 13; 38%). A POIB appeared asymptomatically for 27 patients (80%), whereas only 7 patients (20%) presented with fever and hyperleukocytosis. Their localization were bronchial stumps (n = 21; 62%), homolateral bronchial tree (n = 11; 32%), or extension toward the contralateral bronchial tree (n = 2; 6%). The mean number of hyperbaric oxygen therapy sessions was 14 (1 to 48). A POIB worsening was observed in 6 patients (18%), requiring a surgical rescue therapy. CONCLUSIONS: The clinical presentation of POIB is poor and systematic fiberoptic bronchoscopy should be performed, especially in patients with a high risk of bronchopleural fistula. Hyperbaric oxygen therapy in the management of ischemic bronchitis may be a promising adjunctive treatment.
Asunto(s)
Bronquitis/epidemiología , Isquemia/epidemiología , Neoplasias Pulmonares/cirugía , Escisión del Ganglio Linfático/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Adulto , Anciano , Bronquios/irrigación sanguínea , Bronquitis/diagnóstico , Bronquitis/etiología , Bronquitis/terapia , Broncoscopía , Causalidad , Comorbilidad , Femenino , Humanos , Oxigenoterapia Hiperbárica , Incidencia , Isquemia/etiología , Neoplasias Pulmonares/epidemiología , Escisión del Ganglio Linfático/efectos adversos , Metástasis Linfática , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiologíaRESUMEN
Mediastinal shift is common after pneumonectomy and herniation of the remaining lung into the opposite hemithorax has consequently been reported. In this case, we present the herniation of the pneumonectomy cavity contained by the calcified pleura through an intercostal space, in a patient who has undergone a left pneumonectomy 47 years previously. We repaired the intercostal muscular defect using a Mersuture mesh. The patient did well and there was no postoperative pain.