Primary Pulmonary Synovial Sarcoma with Hemothorax: a Case Report.

Background: Synovial sarcoma is a rare and aggressive soft tissue malignancy most commonly arises from periarticular tissue of the extremities. Although several cases in the literature have reported different origins, primary pulmonary synovial sarcoma (PPSS) is an exceedingly rare and underrecognized entity, accounting for 0.5% of all lung malignancies. Clinical presentation includes chest pain, dyspnea, cough, and hemoptysis. The finding of hemothorax is a rare presentation and was barely reported in the literature. Due to its rarity and aggressive nature, the optimal treatment is unclear, while the mainstay remains surgical resection with chemo- and/or radiation therapy. Objective: To report a case of hemorrhagic effusion subsequently diagnosed with primary pulmonary synovial sarcoma with the main objective of enriching the literature regarding this rare malignancy. Case report: A 52-year-old male smoker with a background of coronary artery disease, hypertension, and diabetes mellitus was referred to our hospital. The patient presented with a history of chest pain, dyspnea, and massive right-sided pleural effusion. Laboratory investigations were unremarkable except for anemia. Chest x-ray showed a complete opacity on the right lower zone with right-sided pleural effusion. Thoracentesis was done and revealed hemorrhagic exudative effusion. Computed tomography (CT) scan showed a right heterogeneous lung mass compressing the medial segment of the middle lobe. Subsequently, the patient underwent bronchoscopy, which showed compression and edema on the right middle lobe bronchus with traces of blood coming from the right lower lobe. The patient underwent a right posterolateral thoracotomy, a fungating mass eroding the medial segment of the middle lobe was resected that was diagnosed as high-grade primary pulmonary synovial sarcoma. Radiotherapy was instituted. The patient died after two years due to recurrence. Conclusion: PPSS is an aggressive disease with poor prognostic outcomes, and Its presentation is almost similar to other lung malignancies. Meanwhile, there is no definitive management guideline, and most management depends on surgical resection if feasible with adjuvant chemo-radiation therapy.

Thoracic Surgery Consultations in COVID-19 Critically Ill Patients: Beyond Conservative Approach.

INTRODUCTION: Iatrogenic pneumothoracis, barotraumas, and tracheoesophageal fistulae, especially after prolonged intubation, and tracheal stenosis are all entities involving thoracic surgeons' consultation and management. With the surge of COVID-19 cases particularly in the critical care settings, various types of complications have been observed that require intervention from thoracic surgeons. METHODS AND MATERIALS: A retrospective study was conducted in an academic healthcare institute in the Eastern Province of Saudi Arabia. We included all COVID-19 cases admitted to ICU in the period between March 15, 2020, and August 15, 2020, requiring thoracic surgery consultation and management. Non-COVID-19 critical cases and iatrogenic pneumothorax were excluded. RESULTS: Of 122 patients who were admitted to ICU with COVID-19, 18 patients (14.75%) required thoracic surgery consultation and management. We discovered a significant association between the outcomes and reintubation rates and the rate of pneumothorax occurrence. The survival analysis showed improvement in patients who had thoracostomy tube insertion as a management than the group who were treated conservatively. On the other hand, there was a significant difference between the COVID ICU group who had thoracic complication and those who did not regarding the length of hospital stay. CONCLUSION: Noniatrogenic pneumothorax, subcutaneous emphysema, and mediastinal emphysema are well-known thoracic entities, but their presence in the context of COVID-19 disease is a harbinger for worse prognosis and outcomes. The presence of pneumothorax may be associated with better prognosis and outcome compared to surgical and mediastinal emphysema.

Acute pulmonary embolism in a child following SARS-CoV-2 infection: a case report.

In children, coronavirus disease 2019 infection is rarely symptomatic. Severe forms with respiratory distress are rare, thromboembolic complications are exceptional. We report a rare case of a 14 years old girl with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection who was admitted to the hospital for bilateral pulmonary embolism with intracardiac thrombus. The girl progressed well on anticoagulation.

Prosthetic thrombosis and coronary embolism during pregnancy: a delicate situation of antithrombotic therapy management.

Mechanical heart valve thrombosis is not so rare in pregnant women because of the difficulties in managing anticoagulant treatment and the hypercoagulability state associated with pregnancy. Among the embolic complications of valve prosthetic thrombosis, the coronary embolism is rare, it requires an urgent pharmaco-invasive approach which must be adapted to this particular associated condition. We report the observation and the difficulties of managing antithrombotic therapy in a pregnant patient hospitalized for non-obstructive prosthetic valve thrombosis complicated by coronary embolism and resulting in ST elevation myocardial infarction.

Huge left atrial appendage aneurysm revealed by chronic hiccups.

Left atrial appendage (LAA) aneurysm is an extremely rare anomaly. So far, less than one hundred cases only have been reported worldwide. Revelation modes are dominated by complications such as arrhythmias and thromboembolic events. We herein report a pediatric case of huge congenital LAA aneurysm with an original revelation mode that has never been described before in medical literature.

Asymptomatic interventricular septal dissection and giant coronary artery aneurysms simulating cardiac cysts: Multi-modality imaging.

we report an exceptionnel case of asymptomatic interventricular septal dissection and giant coronary artery aneurysms simulating cardiac cysts with a focus in the interst of Multi-modality Imaging.

Suspected Allergic Bronchopulmonary Aspergillosis Cases in Adult Bronchial Asthma Patients Attending a Tertiary Care Clinic.

Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity reaction to Aspergillus species (generally Aspergillus fumigatus) that occurs almost exclusively in patients with asthma or, less commonly, cystic fibrosis. Immune responses to Aspergillus antigens cause airway obstruction and, if untreated, bronchiectasis and pulmonary fibrosis. Our objective was to define the clinical characteristics, laboratory and radiological findings of suspected ABPA cases among a cohort of Egyptian patients with bronchial asthma. 52 moderate and severe asthma patients were recruited from the Allergy and Immunology clinic at Ain Shams University hospitals. Patients were subjected to history taking for asthma symptoms, skin test with Aspergillus fumigatus antigen, total IgE level, peripheral blood eosinophilia, chest x-ray and high resolution CT chest. 27 patients had positive skin prick and /or intradermal test to Aspergillus fumigatus antigen, and 11 (21.2%) of them fulfilled 4 of the criteria for ABPA diagnosis. Patients with suspected ABPA had significantly higher serum total IgE levels (median (IQR) = 625 IU/ml (514.9-762) with P-value <0.0001). Our study suggests a high frequency of suspected ABPA cases for further confirmation by appropriate diagnostic tests; there is a need for better recognition of ABPA as it is yet under recognized in Egypt Clinicians ought to have a high index of suspicion for ABPA while managing any patient with bronchial asthma to detect ABPA prior to development of irreversible complications.

Simultaneous dual vascular access site for the treatment of coronary artery bifurcation lesions by complex 2-stent technique.

OBJECTIVES: To propose an original approach based on simultaneous dual vascular access site (DAS) using 2 small-size guiding catheters to easily perform complex 2-stent techniques for bifurcation coronary lesions (BL). BACKGROUND: Simultaneous kissing stenting and classic crush technique require large 7 or 8Fr guiding catheters leading to large amounts of contrast medium, vascular access site complications, and sometimes frictions or criss-cross of the 2-stent delivery systems. METHODS: DAS was used in 30 patients with BL (11 radio-radial, 16 radio-femoral, and 3 femoro-femoral). Among 60 guiding catheters, the size was 5Fr in 28, 6Fr in 30, and 7Fr in 2 cases of double adjacent BL. When 2 different size catheters were used, contrast medium injections were done using the smallest size catheter. DAS patients were compared with a group of 30 BL patients treated using a single femoral vascular access site (SAS) with 7 or 8Fr catheters. RESULTS: Success rate was 100% in all patients. Contrast volume used was smaller in DAS than in SAS patients (277 ± 156 cc vs. 380 ± 165 cc,P = 0.01). No vascular access site complication occurred in the sub-group of the 11 DAS radio-radial patients. Postintervention hospitalization duration was shorter in DAS than in SAS (1.9 ± 2 vs. 2.8 ± 2 days,P = 0.048). CONCLUSION: DAS allows to successfully perform complex stenting technique of BL using small-size guiding catheters leading to decreased contrast medium volume, decreased vascular access site complications rates, and shortened hospitalization duration.

Management of neonatal massive anterior mediastinal teratoma--a case report.

We report a challenging case of a newborn with a massive anterior mediastinal teratoma (MT), occupying nearly the right hemithorax, presenting at birth with life threatening respiratory distress (RD). Optimal approach and outcome was achieved with a coordinated, multidisciplinary approach.

Neuroanesthesia management of neurosurgery of brain stem tumor requiring neurophysiology monitoring in an iMRI OT setting.

This report describes a rare case of ventrally exophytic pontine glioma describing operative and neuroanesthesia management. The combination of intraoperative neuromonitoring was used. It constituted: Brain stem evoked responses/potentials, Motor EP: recording from cranial nerve supplied muscle, and Sensory EP: Medial/tibial. Excision of the tumor was done with intra-operative magnatic resonance imaging (iMRI), which is considered a new modality.