Secuestro pulmonar: caracterización y tratamiento en pacientes adultos y pediátricos / Pulmonary sequestration: characteristics and treatment in adult and pediatric patients

Resumen Introducción: El secuestro pulmonar (SP) es una malformación congénita caracterizada por tejido pulmonar con vascularización de una arteria sistémica anómala. Objetivo: Analizar las características y tratamiento de pacientes adultos y pediátricos con secuestro pulmonar. Materiales y Método: Estudio descriptivo transversal. Periodo: enero de 1988 a diciembre de 2018. La información se obtuvo de fichas clínicas y registros de anatomía patológica. Se describen edad, sexo, características clínicas, diagnóstico, tratamiento quirúrgico y hallazgos anatomopatológicos. Se realizó análisis estadístico mediante SPSS25® y se usó la prueba Mann-Whitney y X2, considerándose significativo p < 0,05. Resultados: Total 33 pacientes, 25 (75,8%) mujeres. Edad promedio 30,2 años, rango: 0-68. Adultos 23 (69,7%) pacientes y pediátricos (< 15 años) 10 (30,3%) pacientes. La presentación clínica fue sintomatología pulmonar en 23 (69,7%) casos y 9 (27,3%) eran asintomáticos. Tres (9,1%) presentaron malformación congénita asociada. Diagnóstico preoperatorio en 15 (45,5%) pacientes. La ubicación más frecuente fue lóbulo inferior izquierdo. El tipo intralobar fue el más frecuente en 23 (69,7%) casos. La cirugía más frecuente fue la lobectomía con identificación y ligadura del vaso sistémico. El vaso aberrante se originó en aorta torácica en 27 (81,8%) casos e infradiafragmático (no precisado) en 3 (9,1%) casos. Vaso único en 26 (78,8%) y doble en 5 (15,2%) casos. No hubo mortalidad. Existen diferencias en las características entre los secuestros en pacientes adultos y pediátricos. Discusión y Conclusión: Los SP son infrecuentes, se presentan principalmente en adultos jóvenes como neumopatías a repetición, se distinguen diferencias en las características entre los pacientes adultos y pediátricos, y tienen excelente pronóstico posoperatorio.

Background: Pulmonary sequestration (PS) is a congenital malformation characterized by lung tissue with vascularization from anomalous systemic arteries. Aim: To analyze characteristics and treatment of adult and pediatric patients with pulmonary sequestration. Materials and Method: Transversal descriptive study. Period: January-1988 to December-2018. Information was obtained from clinical files and pathological anatomy records. Age, sex, clinical characteristics, diagnosis, surgical treatment and pathological findings are described. Statistical analysis was performed using SPSS25® and the Mann-Whitney and Chi square test were used, considering p < 0.05 to be significant. Results: Total 33 patients, 25 (75.8%) women. Average age 30.2 years, range: 0-68. Adults 23 (69.7%) patients and pediatric (< 15 years) 10 (30.3%) patients. The clinical presentation was pulmonary symptoms in 23 (69.7%) cases and 9 (27.3%) were asymptomatic. Three (9.1%) presented another congenital malformation. Preoperative diagnosis in 15 (48.4%) patients. The most frequent location was the left lower lobe. The intralobar type was the most frequent: 23 (69.7%) cases. The most frequent surgery was lobectomy with identification and ligation of the systemic vessel. The systemic vessel originated in the thoracic aorta in 27 (81.8%) cases and infradiaphragmatic (not specified) in 3 (9.1%) cases. Single vessel in 26 (78.8%) and double in 5 (15.2%) cases. There was no mortality. Differences were found in characteristics between adult and pediatric patients. Conclusion: SP are infrequent, they mostly appear in young adults as recurrent lung diseases, differences in characteristics are distinguished between adult and pediatric patients and they have an excellent postoperative prognosis.

Hidatidosis pulmonar: hallazgos y tratamiento quirúrgico en quistes complicados versus no complicados / Pulmonary hydatidosis: findings and surgical treatment in complicated versus uncomplicated cysts

Resumen Introducción: La hidatidosis humana es una zoonosis prevalente en nuestro medio, causada principalmente por el parásito Echinococcus granulosus. Las complicaciones más frecuentes en el pulmón son la rotura y la infección del quiste. Objetivos: Describir y comparar características clínicas, tratamiento, morbilidad y mortalidad de los pacientes hospitalizados por quiste hidatídico pulmonar (QHP) complicado versus no complicado. Materiales y Método: Estudio analítico longitudinal. Período enero de 1973 - diciembre de 2017 en Hospital Clínico Regional de Concepción "Dr. Guillermo Grant Benavente", Chile. Revisión de base de datos, protocolos de QHP y fichas clínicas. Se utilizó planilla Microsoft Excel® y programa SPSS24®, con función chi cuadrado y t de Student. Se consideró significativo p < 0,05. Resultados: Total 364 episodios de QHP, complicados 179 (49,2%) versus no complicados 185 (50,8%). Edad promedio 36,4 ± 18,9 versus 32,4 ± 19,1 años, hombres 114 (63,7%) versus 107 (57,8%), respectivamente. Se encontró diferencia estadísticamente significativa en: sintomatología tos 147 (82,1%) versus 120 (64,9%), hemoptisis 93 (52,0%) versus 45 (24,3%), respectivamente; QHP derecho 115 (64,2%) versus 99 (53,5%), respectivamente; cirugía conservadora 139 (77,7%) versus 167 (90,3%), reoperaciones 22 (12,3%) versus 8 (4,3%), respectivamente; morbilidad 47 (26,3%) versus 30 (16,2%), mortalidad 6 (3,4%) versus 0 (0%), estadía hospitalaria postoperatoria promedio 16,1 ± 14,3 versus 10,7 ± 7,7 días, recidivas 15 (8,4%) versus 13 (7,0%), respectivamente. Discusión: Aproximadamente la mitad de los QHP son complicados. Los QHP complicados presentan diferencias estadísticamente significativas en su clínica, tratamiento, morbilidad, mortalidad y estadía hospitalaria postoperatoria.

Background: Human hydatidosis is a prevalent zoonosis in our environment, caused mainly by the Echinococcus granulosus parasite. The most common complications in the lung are cyst rupture and infection. Aim: To describe and compare clinical characteristics, treatment, morbidity and mortality of patients hospitalized for complicated versus uncomplicated hydatid pulmonary cyst (HPC). Materials and Method: Longitudinal analytical study. Period January 1973 - December 2017 at the Regional Clinical Hospital of Concepción "Dr. Guillermo Grant Benavente", Chile. Database, prospective protocols and medical records were reviewed. Microsoft Excel® spreadsheet and SPSS24® program with chi square and Student's t-test were used. It was considered significant p < 0.05. Results: Total 364 episodes of HPC, complicated 179 (49.2%) versus uncomplicated 185 (50.8%). Average age 36.4 ± 18.9 versus 32.4 ± 19.1 years, male 114 (63.7%) versus 107 (57.8%), respectively. A statistically significant difference was found in: symptomatology cough 147 (82.1%) versus 120 (64.9%), hemoptysis 93 (52.0%) versus 45 (24.3%), respectively; HPC right 115 (64.2%) versus 99 (53.5%), respectively; resective cyst surgery 139 (77.7%) versus 167 (90.3%), reoperation 22 (12.3%) versus 8 (4.3%), respectively; morbidity 47 (26.3%) versus 30 (16.2%), mortality 6 (3.4%) versus 0 (0%), average postoperative hospital stay 16.1 ± 14.3 versus 10.7 ± 7.7 days, recurrence 15 (8.4%) versus 13 (7.0%), respectively. Conclusions: Approximately half of the HPCs are complicated. Complicated HPCs present statistically significant differences in their clinical, treatment, morbidity, mortality and postoperative hospital stay.

[Primary cardiac tumors. Experience in 72 cases]. / Tumores cardíacos primarios.

BACKGROUND: Primary cardiac tumors have a low incidence, and their presentation form and clinical course are not well known. AIM: To describe the characteristics, treatment, follow up and survival of patients with primary cardiac tumors (PCT). MATERIAL AND METHODS: Review of all surgical procedures for PCT performed between 1984 and 2019 in a regional general hospital. The information was obtained from surgical protocols, surgical and pathology databases, medical records and registries of the Chilean National Identification Service. The clinical features of patients, immediate and long term outcomes are described. RESULTS: Seventy-two surgical procedures for PCT were reviewed. Patients' age was 55 ± 15 years and 60% were women. The most common histological types were myxoma in 49 patients (68%), papillary fibroelastoma in 13 (18%) and sarcoma in 6 (8.3%). Forty-nine (68.1%) were symptomatic and all tumors were found on echocardiography. Fifty-one (71%) were in the left atrium, 10 (14%) in the aortic valve and eight (11%) in the right atrium. The surgical procedures were tumor resection in 48 patients (67%) and resection and repair with patch in 23 (32%). Mean postoperative stay was 6.6 ± 4.4 days, eight patients (11%) had complications and no patient died in the immediate postoperative period. Long term survival was higher in patients with benign PCT as compared with those with malignant tumors. CONCLUSIONS: Most PCTs in this group of patients were benign neoplasms and the most common tumors were myxomas. The main diagnostic method is echocardiography and the prognosis of surgical treatment is excellent when the tumors are benign. (Rev Med Chile 2020; 148: 327-335).

Hidatidosis pulmonar: características, manifestaciones clínicas y tratamiento en pacientes hospitalizados en Concepción, Región del Biobío, Chile / Features of pulmonary hydatidosis in 368 patients admitted to a regional hospital

Background: Lungs are the second location in frequency of hydatidosis or cystic echinococcosis. Aim: To characterize the clinical manifestations, diagnosis, findings and treatment of patients hospitalized for a pulmonary hydatid cyst (PHC). Materials and Methods: Review of databases, medical records, operation notes and death certificates of patients admitted to a Chilean regional hospital with a PHC. Results: Four hundred twenty-nine cases were identified and complete data was obtained from 368 patients aged 34 ± 19 years, 224 (60,9%)men. The most common clinical manifestations were cough in 269 (73%) and chest pain in 217 (59%). The most frequent locations were the right lung in 210 (57%) and lower lobes in 218 (59%). One hundred eighty-seven cysts (51%) were complicated. Conservative surgery (cystectomy) was performed in 308 (84%). Postoperative morbidity was observed in 77 (21%) and mortality in 6 (2%) patients. Recurrence was observed in 28 (8%) patients. There was a significant reduction in morbidity, mortality, reoperations, and postoperative days over time. Conclusions: In these patients, pulmonary hydatidosis was diagnosed mainly during working ages and half of patients had a complicated cyst.

Tumores cardíacos primarios / Primary cardiac tumors. Experience in 72 cases

Background: Primary cardiac tumors have a low incidence, and their presentation form and clinical course are not well known. Aim: To describe the characteristics, treatment, follow up and survival of patients with primary cardiac tumors (PCT). Material and Methods: Review of all surgical procedures for PCT performed between 1984 and 2019 in a regional general hospital. The information was obtained from surgical protocols, surgical and pathology databases, medical records and registries of the Chilean National Identification Service. The clinical features of patients, immediate and long term outcomes are described. Results: Seventy-two surgical procedures for PCT were reviewed. Patients' age was 55 ± 15 years and 60% were women. The most common histological types were myxoma in 49 patients (68%), papillary fibroelastoma in 13 (18%) and sarcoma in 6 (8.3%). Forty-nine (68.1%) were symptomatic and all tumors were found on echocardiography. Fifty-one (71%) were in the left atrium, 10 (14%) in the aortic valve and eight (11%) in the right atrium. The surgical procedures were tumor resection in 48 patients (67%) and resection and repair with patch in 23 (32%). Mean postoperative stay was 6.6 ± 4.4 days, eight patients (11%) had complications and no patient died in the immediate postoperative period. Long term survival was higher in patients with benign PCT as compared with those with malignant tumors. Conclusions: Most PCTs in this group of patients were benign neoplasms and the most common tumors were myxomas. The main diagnostic method is echocardiography and the prognosis of surgical treatment is excellent when the tumors are benign. (Rev Med Chile 2020; 148: 327-335)

[Features of pulmonary hydatidosis in 368 patients admitted to a regional hospital]. / Hidatidosis pulmonar: características, manifestaciones clínicas y tratamiento en pacientes hospitalizados en Concepción, Región del Biobío, Chile.

BACKGROUND: Lungs are the second location in frequency of hydatidosis or cystic echinococcosis. AIM: To characterize the clinical manifestations, diagnosis, findings and treatment of patients hospitalized for a pulmonary hydatid cyst (PHC). MATERIALS AND METHODS: Review of databases, medical records, operation notes and death certificates of patients admitted to a Chilean regional hospital with a PHC. RESULTS: Four hundred twenty-nine cases were identified and complete data was obtained from 368 patients aged 34 ± 19 years, 224 (60,9%)men. The most common clinical manifestations were cough in 269 (73%) and chest pain in 217 (59%). The most frequent locations were the right lung in 210 (57%) and lower lobes in 218 (59%). One hundred eighty-seven cysts (51%) were complicated. Conservative surgery (cystectomy) was performed in 308 (84%). Postoperative morbidity was observed in 77 (21%) and mortality in 6 (2%) patients. Recurrence was observed in 28 (8%) patients. There was a significant reduction in morbidity, mortality, reoperations, and postoperative days over time. CONCLUSIONS: In these patients, pulmonary hydatidosis was diagnosed mainly during working ages and half of patients had a complicated cyst.

Angiosarcoma cardíaco: una neoplasia infrecuente / Cardiac angiosarcoma: an infrequent neoplasia

Los tumores cardíacos son infrecuentes, siendo los más comunes los metastásicos. De los primarios, sólo el 25 por ciento son malignos, donde el angiosarcoma es el más frecuente. Este corresponde a un tumor de alto grado de malignidad, caracterizado por un rápido crecimiento, obstrucción de válvulas y metástasis principalmente pulmonares. Es más frecuente entre los 30 y 50años, especialmente en el género masculino, con una relación de2:1. Su clínica es de naturaleza cardiovascular inespecífica y su pronóstico es malo, con una supervivencia de entre nueve a doce meses a partir del diagnóstico. Presentación del caso: Paciente de género femenino, de 50 años de edad, con antecedentes de hipertensión arterial y artritis reumatoide. Consultó por disnea y deterioro de capacidad funcional. Ecocardiograma transtorácico mostró masa de seis centímetros de diámetro, que ocupa toda la aurícula derecha y que generaba obstrucción al flujo tricuspídeo, asociado a derrame pericárdico masivo con taponamiento cardíaco. Tomografía computada (TC) de cerebro, tórax, abdomen y pelvis descartan lesiones metastásicas. Se decidió conducta quirúrgica. Se resecó el tumor y el 70 por ciento de la pared libre de la aurícula y se instaló prótesis valvular biológica; con pericardio autólogo se reconstruyó la aurícula derecha. Evolucionó favorablemente, sin incidentes. Estudio histopatológico concluyó angiosarcoma cardíaco. Discusión: Los tumores cardíacos son infrecuentes. Se deben sospechar en pacientes con clínica cardiovascular, asociada a masa intracavitaria, derrame pericárdicono explicable por otra causa, así como la presencia de metástasis torácicas de un tumor primario desconocido...

Introduction: Cardiac tumors are rare; of them, the metastatic tumors are the most frequent. Of the primary tumors, only 25 percent are malignant, being the angiosarcoma the most common. It is a tumor of high malignancy, characterized by rapid growth, obstruction of cardiac valves and lung metastases. It is most common between 30 and 50 years, especially in men, with a ratio of 2:1. Its symptoms are nonspecific cardiovascular and its prognosis is poor, with a survival of nine to twelve months from diagnosis. Case report: A 50 years old woman with a history of hypertension and rheumatoid arthritis. She presented with dyspnea and impaired functional capacity. Transthoracic echocardiogram showed a mass of 6 cm in diameter, occupying the entire right atrium with tricuspid flow obstruction, associated with massive pericardial effusion with cardiac tamponade. Computed tomography (CT) of the brain, thorax, abdomen and pelvis discarded metastatic lesions. Surgical treatment was decided. The tumor and 70 percent of the free wall of the atrium were resected and biological prosthetic valve was installed, and the righ tatrium was reconstructed with autologous pericardium. She evolved favorably, without incident. Histopathological reports confirmed cardiac angiosarcoma. Discussion: Cardiac tumors are rare. They should be suspected in patients with cardiovascular symptoms, associated with intracavitary mass, pericardial effusion not explained by other causes, as well as the presence of thoracic metastases from an unknown primary tumor...

Quistes tímicos, una patología infrecuente del mediastino / Thymic cysts, an unusual disease of the mediastinum

Los quistes tímicos representan el 1 - 5 por ciento de las masas del mediastino anterior. Por su relativa frecuencia, constituyen un grupo importante entre los quistes mediastínicos. Generalmente son asintomáticos, pero pueden presentarse con disnea, dolor torácico y tos. PRESENTACIÓN DE CASOS: Se presentan tres casos de quiste tímico en pacientes de género femenino de 54, 59 y 70 años. Todas refirieron historia de más de un año de evolución de síntomas como dolor torácico, tos, disnea y disfagia. Se estudiaron con radiografía y tomografía computada de tórax que demostró imagen de tumor mediastínico de aspecto quístico. Por tratarse de lesiones sintomáticas, en todas se realizó tratamiento quirúrgico. En el intraoperatorio se observaron quistes tímicos de gran tamaño, los cuales fueron resecados en su totalidad, sin incidentes. Estudio histopatológico concluyó quiste tímico en los tres casos. Las pacientes no presentaron complicaciones postoperatorias y en el seguimiento se encontraron asintomáticas. DISCUSIÓN: Los quistes del mediastino son lesiones poco comunes. Su origen histológico es variado. Se describen los quistes broncogénicos y tímicos como los más frecuentes, sin embargo, también se cuentan los de origen pleural, pericárdico y esofágico. En particular, los quistes tímicos generalmente se localizan en el mediastino anterior. Se describen los de origen congénito y los adquiridos, cada uno con características propias. El tratamiento quirúrgico es indicación en pacientes sintomáticos, y se considera un método seguro con baja morbilidad. El diagnóstico se confirma con la resección de la lesión y el estudio histopatológico...

Thymic cysts account for 1-5 percent of masses of anterior mediastinum. For its frequency, are described as an important group of mediastinal cysts. Usually are asymptomatic, but they may present as chest pain, dyspnea and cough. CASEREPORT: Three cases of thymic cyst in female patients of 54,59 and 70 years old are presented. All of three patients reported history of over a year of evolution with symptoms like chest pain, cough, dyspnea and dysphagia. They were studied with thorax radiography and with chest computed tomography which showed a mediastinal cystic tumor. Because they had symptomatic lesions, surgical treatment was performed. During surgery large thymic cysts were observed. The lesions were totally resected without incidents. Histopathological study concluded thymic cyst in all three cases. The patients did not have postoperative complications and were asymptomatic in the follow-up. DISCUSSION: Mediastinal cysts are uncommon lesions. Histological origin is varied. Bronchogenic and thymic cysts are most common, however, pleural, pericardic and esophagic cysts are also observed. Particularly, thymic cysts are often located in anterior mediastinum. Congenital or acquired origin are described, each one with specific characteristics. Surgical treatment is indicated in symptomatic patients, and is considered a safe approach with low morbidity. The diagnosis is confirmed with the surgical resection and histopathological study...

Lesiones quísticas de línea media de base de cráneo anterior / Cystic lesions in midline of anterior skull base

Las lesiones quísticas en línea media del segmento posterior de la base de cráneo anterior corresponden mayoritariamente a malformaciones congénitas, cuya ubicación puede ser selar, supraselar o intraesfenoidal. Generalmente asintomáticas, pueden presentar síntomas determinados por su crecimiento y/o el compromiso mecánico sobre las estructuras adyacentes. Su diagnóstico suele realizarse producto de un hallazgo imagenológico o endoscópico, constituyendo la resonancia magnética la mejor alternativa ante una aproximación diagnóstica inicial. Estas lesiones quísticas presentan un comportamiento benigno y no todas requieren un manejo quirúrgico, siendo suficiente en la gran mayoría de ellas, un seguimiento clínico. La necesidad de cirugía deberá decidirse en cada caso y depende principalmente de la sintomatología producida por la compresión de estructuras vecinas e hipertensión endocraneana. El abordaje quirúrgico endoscópico extendido es el método resectivo de elección. Presentamos una serie de casos clínicos, correspondiente a cinco pacientes con lesiones quísticas en línea media de base de cráneo anterior. Tanto la sintomatología como el diagnóstico etiológico tuvieron una presentación diversa en la serie expuesta; independiente de lo cual, todos fueron manejados exitosamente por cirugía endoscópica. Presentamos finalmente, una propuesta de diagnóstico inicial, basado en el estudio imagenológico con resonancia magnética de estas lesiones.

Cystic lesions in the midline of the anterior skull base are rare and mostly congenital malformations. Usually asymptomatic, symptoms can be determined by their growth and/or mechanical compromise on adjacent structures. The diagnosis is usually the result of imaging or endoscopic findings, MRI is the best alternative for the initial diagnostic approach. These cystic lesions are benign xx and not all require a surgical management. Some of them require a watchfull follow up. If they need surgery the expanded endoscopic approach is the method of choice in our hands. We present a case series, correspondent to five patients with cystic lesions in the midline of the skull base. All these were successfully managed by an extended endoscopic approach. Finally, we presented a proposal for initial diagnosis approach, based on the MRI findings of these lesions.

Ganglioneuroma cervical: reporte de un caso / Cervical ganglioneuroma: a case report

Se presenta el caso clínico de un paciente, sexo femenino, 52 años de edad, que al examen clínico presentaba un aumento de volumen a nivel del ángulo mandibular derecho. Los estudios imagenológicos mostraron una extensa masa cervical paravertebral, encapsulada, de límites netos, sin evidencias de calcificaciones en el cuerpo de la lesión como tampoco compromiso del tejido óseo vecino, que se extiende desde la base de cráneo hasta la región de la cara interna del ángulo mandibular derecho. Se determinó la cirugía, como tratamiento, la cual presentó como complicaciones post operatorias, trastornos en la deglución y síndrome de Horner. Por último la biopsia post operatoria arrojó ganglioneuroma y linfonodos sin lesiones histológicas.

A case report of a patient, female, 52 years old, clinical examination showed a volume increase at the right mandibular angle. Imaging studies showed a large cervical paravertebral mass, encapsulated, net limits without evidence of calcification in the body of the lesion nor involvement of neighboring bone tissue, extending from the base of the skull to the region of the inner right mandibular angle. Surgery was determined as treatment, presenting, impaired swallowing and Horner syndrome as post-operative complications. Finally, the postoperative biopsy showed, ganglioneuroma and lymph nodes without histological lesions.