Anomalous right upper lobe venous drainage.

Lung resections are usually not associated with significant bleeding, but can be fatal, especially in cases of video-assisted thoracoscopic surgery (VATS). Anomalous vascular structures could be a major reason for unexpected bleeding in such surgeries. We present a case of an aberrant upper lobe pulmonary vein that was encountered posterior to the right upper lobe bronchus during a right upper lobectomy via thoracotomy. The anomalous pulmonary vein was identified preoperatively on a computed tomography (CT) scan and hence was looked for before dividing the bronchus. Many centres are adopting the VATS approach for performing lung resections. If an anomalous vein is present posterior to the bronchus, it might be in a blind spot and could be damaged inadvertently, leading to profuse and potentially fatal bleeding. We conclude that the identification of anomalous vascular structures prior to surgery with the help of CT helps in avoiding adverse outcomes.

A case of lung volume reduction surgery with decortication for a septic patient in respiratory failure.

INTRODUCTION: Decortication and lung volume reduction surgery are both major operations and each has its independent risk of morbidity and mortality. CASE REPORT: We present the case of a 41 year old gentleman with left sided empyema and giant bullae of the upper lobe with an active air leak that was transferred to our tertiary referral centre for further management. We performed emergency left thoracotomy, decorticated the left lower lobe with extensive lung volume reduction surgery of the upper lobe. Patient's respiratory status significantly improved along with excellent radiological results. CONCLUSION: Our case demonstrates that a combination of complex procedures is feasible with excellent outcomes.

Phrenic nerve block as a novel adjunct to the local treatment of bronchopleural fistula.

Bronchopleural fistula (BPF) is a life threatening complication after pneumonectomy with an incidence of about 2-5% and a mortality rate of up to 50%. Topical treatment such as fibrin glue has been previously described with limited success. We present a novel case in which blocking the phrenic nerve assisted in a successful topical closure of the BPF.

An atypical case of successful resuscitation of an accidental profound hypothermia patient, occurring in a temperate climate.

Cases of accidental profound hypothermia occur most frequently in cold, northern climates. We describe an atypical case, occurring in a temperate climate, where a hypothermic cardiac-arrested patient was successfully resuscitated using extracorporeal circulation (ECC).