RESUMO
BACKGROUND: Surgery is the main treatment option for destroyed-lung (DL) patients with life-threatening massive hemoptysis. However, short-term and long-term surgical safety and efficacy are unclear, prompting this study. METHODS: Data from 124 DL patients undergoing surgery between November 2001 and January 2022 at Beijing Chest Hospital were retrospectively analyzed. Data of the DL group (82 cases) and DL + massive hemoptysis group (42 cases) were compared with regard to clinical characteristics, long-term postoperative residual lung reinfection. RESULTS: As compared with DL group rates, The DL + massive hemoptysis group had greater incidence rates of postoperative complications, invasive postoperative respiratory support, long-term postoperative residual lung reinfection, and postoperative tuberculosis recurrence. Revealed risk factors for postoperative complications (Extent of lung lesion resection), postoperative invasive respiratory therapy (preoperative Hb < 9 g/L, severe intraoperative hemoptysis), and postoperative long-term residual lung reinfection (DL with massive hemoptysis). CONCLUSIONS: DL patients with massive hemoptysis had greater rate of invasive respiratory support therapy and postoperative complications. Extensive lesion removal, preoperative anaemia, severe intraoperative bleeding associated with recent postoperative complications for the patient.
Assuntos
Hemoptise , Pneumonectomia , Complicações Pós-Operatórias , Humanos , Hemoptise/etiologia , Hemoptise/cirurgia , Estudos Retrospectivos , Masculino , Feminino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Adulto , Pneumonectomia/efeitos adversos , Prognóstico , Idoso , Fatores de Risco , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/cirurgia , Pulmão/fisiopatologia , Pulmão/cirurgia , Recidiva , PequimRESUMO
OBJECTIVES: The aim of the study was to evaluate pulmonary sequestration (PS). We report on location, blood supply, histology, clinical manifestation, and surgical treatment of PS, as well as on postoperative course in patients with PS. BACKGROUND: PS is a rare congenital defect of the lower respiratory tract, it represents locus minoris resistentiae of the body. Occasionally, PS is diagnosed for the first time in adulthood. METHODS: We evaluated 7 cases of PS treated at the Centre of Thoracic Surgery in Vysné Hágy, Slovakia, between years 2013 and 2020. RESULTS: Four of our seven patients were asymptomatic; the PS was found incidentally upon chest imaging. Three patients had recurrent bronchopneumonia related specifically to the intralobar type of sequestration. The most significant complication, observed in a singular patient, was a life-threatening episode of haemoptysis, requiring urgent surgical intervention. In the other 6 cases, the sequestra were surgically resected during the period when they were asymptomatic. and their sputum was confirmed negative upon microbiological examination. Anatomical resection of the affected pulmonary lobe by thoracotomy was the most common type of operation performed (4 cases, n = 7). There was no surgical mortality. CONCLUSION: To prevent complications, it is crucial to perform surgical treatment for pulmonary sequestration in patients who have sufficient functional capacity (Tab. 2, Fig. 4, Ref. 30). Text in PDF www.elis.sk Keywords: pulmonary sequestration, anatomic lobectomy, haemoptysis.
Assuntos
Sequestro Broncopulmonar , Humanos , Sequestro Broncopulmonar/diagnóstico por imagem , Sequestro Broncopulmonar/cirurgia , Hemoptise/cirurgia , Tomografia Computadorizada por Raios X , Pulmão/cirurgia , Pulmão/patologia , ToracotomiaRESUMO
RATIONAL: The development of bronchial hemangioma in adults is rare, and massive hemoptysis due to diffuse vascular proliferation of bronchial hemangioma is fatal. PATIENT CONCERNS: A case of a 29-year-old woman kept massive hemoptysis even after being underwent repeated interventional embolization for recurrent massive hemoptysis. Eventually, the patient was performed the operation of right upper lung lobectomy and bronchial hemangioma with extracorporeal membrane oxygenation support and was followed up for 4 years without recurrent hemoptysis. DIAGNOSES: Bronchial hemangioma. CONCLUSION: For patients with bronchial angiomas bonded with bronchial artery-pulmonary arteriovenous fistulae, the early surgical resection is recommended if bronchial artery embolization (BAE) is considered ineffective.
Assuntos
Hemangioma , Hemoptise , Adulto , Feminino , Humanos , Artérias Brônquicas/cirurgia , Embolização Terapêutica , Hemangioma/complicações , Hemangioma/cirurgia , Hemoptise/etiologia , Hemoptise/cirurgia , Artéria Pulmonar , Doenças Vasculares/complicaçõesRESUMO
BACKGROUND: Aortobronchial fistula after TEVAR remains a vexing clinical problem associated with high mortality. Although a combination of endovascular and open surgical strategies have been reported in managing this pathology, there is as yet no definitive treatment algorithm that can be used for all patients. We discuss our approach to an aortobronchial fistula associated with an overtly infected aortic endograft. CASE PRESENTATION: A 49-year-old female sustained a traumatic aortic transection 14 years prior, managed by an endovascular stent-graft. Due to persistent endoleak, she underwent open replacement of her descending thoracic aorta 4 years later. Ten years after her open aortic surgery, the patient presented with hemoptysis, and a pseudoaneurysm at her distal aortic suture line was identified on computed tomography, whereupon she underwent placement of an endograft. Eight weeks later, she presented with dyspnea, recurrent hemoptysis, malaise and fever, with clinical and radiographic evidence of an aortobronchial communication and an infected aortic stent-graft. The patient underwent management via a two-stage open surgical approach, constituting an extra-anatomic bypass from her ascending aorta to distal descending aorta and subsequent radical excision of her descending aorta with all associated infected prosthetic material and repair of the airway. CONCLUSION: Aortobronchial fistula after TEVAR represents a challenging complex clinical scenario. Extra-anatomic aortic bypass followed by radical debridement of all contaminated tissue may provide the best option for durable longer-term outcomes.
Assuntos
Doenças da Aorta , Implante de Prótese Vascular , Fístula Brônquica , Procedimentos Endovasculares , Fístula Vascular , Humanos , Feminino , Pessoa de Meia-Idade , Fístula Brônquica/etiologia , Fístula Brônquica/cirurgia , Aorta Torácica/cirurgia , Correção Endovascular de Aneurisma , Doenças da Aorta/etiologia , Doenças da Aorta/cirurgia , Hemoptise/etiologia , Hemoptise/cirurgia , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/métodos , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/métodos , Stents/efeitos adversos , Fístula Vascular/etiologia , Fístula Vascular/cirurgia , Resultado do TratamentoRESUMO
A 28-year-old male presented to our hospital with hemoptysis and his chest computerized tomography (CT) showed the right middle and lower lobe atelectasis due to the tumor of right intermediate bronchial trunk. To reduce the blood flow to the tumor, bronchial arterial embolization was performed and the tumor was resected using Cryoprobe with a flexible endobronchial scope. Thus, we could observe the tumor localization and diagnose before the surgical procedure. We performed the right sleeve middle lobectomy and the right lower lobe was safely preserved.
Assuntos
Neoplasias Brônquicas , Carcinoma Mucoepidermoide , Masculino , Humanos , Adulto , Broncoscopia , Neoplasias Brônquicas/diagnóstico por imagem , Neoplasias Brônquicas/cirurgia , Neoplasias Brônquicas/patologia , Carcinoma Mucoepidermoide/diagnóstico por imagem , Carcinoma Mucoepidermoide/cirurgia , Carcinoma Mucoepidermoide/patologia , Brônquios/diagnóstico por imagem , Brônquios/cirurgia , Brônquios/patologia , Pneumonectomia/métodos , Hemoptise/cirurgiaRESUMO
BACKGROUND: Surgery is crucial in the treatment of the potentially fatal pulmonary hemoptysis condition. Currently, most patients with hemoptysis are treated by traditional open surgery (OS). To illustrate the effectiveness of video-assisted thoracic surgery (VATS) for hemoptysis, we developed a retrospective study of surgical interventions for lung disease with hemoptysis. METHODS: We collected and then analysed the data, including general information and post-operative outcomes, from 102 patients who underwent surgery for a variety of lung diseases with hemoptysis in our hospital between December 2018 and June 2022. RESULTS: Sixty three cases underwent VATS and 39 cases underwent OS. 76.5% of patients were male (78/102). Comorbidities with diabetes and hypertension were 16.7% (17/102) and 15.7% (16/102) respectively. The diagnoses based on postoperative pathology included aspergilloma in 63 cases (61.8%), tuberculosis in 38 cases (37.4%) and bronchiectasis in 1 case (0.8%). 8 patients underwent wedge resection, 12 patients underwent segmentectomy, 73 patients underwent lobectomy and 9 patients underwent pneumonectomy. There were 23 cases of postoperative complications, of which 7 (30.4%) were in the VATS group, significantly fewer than 16 (69.6%) in the OS group (p = 0.001). The OS procedure was identified as the only independent risk factor for postoperative complications. The median (IQR) of postoperative drainage volume in the first 24 h was 400 (195-665) ml, which was 250 (130-500) ml of the VATS group, significantly less than the 550 (460-820) ml of the OS group (p < 0.05). The median (IQR) of pain scores 24 h after surgery was 5 (4-9). The median (IQR) of postoperative drainage tube removal time was 9.5 (6-17) days for all patients, and it was 7 (5-14) days for the VATS group, which was less than 15 (9-20) days for the OS group. CONCLUSION: VATS for patients with lung disease presenting with hemoptysis is an effective and safe option that may be preferred when the hemoptysis is uncomplicated and the patient's vital signs are stable.
Assuntos
Hemoptise , Cirurgia Torácica Vídeoassistida , Humanos , Masculino , Feminino , Hemoptise/etiologia , Hemoptise/cirurgia , Estudos Retrospectivos , China , Complicações Pós-Operatórias/epidemiologiaRESUMO
An 82-year-old woman with past history of pulmonary nontuberculous mycobacterial infection complained of hemoptysis and was pointed out the strongly stained nodule in the middle lobe of the right lung on chest enhanced computed tomography (CT), which was suggested to be peripheral pulmonary artery aneurysm. Angiography of the right internal thoracic artery (RITA) revealed the peripheral pulmonary artery aneurysm with the shunt from the branch of the RITA, which was considered to be the cause of hemoptysis. Transcatheter arterial embolization was performed for the branch of the RITA 2 times, however, the hemoptysis recurred again after 5 months. Therefore, after the third embolization for the RITA, the right middle lobectomy with amputation of the shunt vessel was performed. The patient has been well without hemoptysis for one year and 6 months after the surgery.
Assuntos
Aneurisma , Embolização Terapêutica , Artéria Torácica Interna , Feminino , Humanos , Idoso de 80 Anos ou mais , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgia , Hemoptise/etiologia , Hemoptise/cirurgia , Artéria Torácica Interna/diagnóstico por imagem , Artéria Torácica Interna/cirurgia , Aneurisma/complicações , Aneurisma/diagnóstico por imagem , Aneurisma/cirurgia , Embolização Terapêutica/métodos , PulmãoRESUMO
BACKGROUND: This retrospective study aimed to assess the safety and efficacy of synchronous biopsy and microwave ablation (MWA) for highly suspected malignant lung ground-glass opacities (GGOs) adjacent to the mediastinum (distance ≤10 mm). MATERIALS AND METHODS: Ninety patients with 98 GGOs (diameter range, 6-30 mm), located within 10 mm of the mediastinum, underwent synchronous biopsy and MWA at a single institution from 1 May 2020, to 31 October 2021 and were enrolled in this study. Synchronous biopsy and MWA involving the completion of the biopsy and MWA in a single procedure was performed. Safety, technical success rate, and local progression-free survival (LPFS) were evaluated. The risk factors for local progression were calculated using the Mann-Whitney U test. RESULTS: The technical success rate was 97.96% (96/98 patients). The LPFS rates at 3, 6, and 12 months were 95.0%, 90.0%, and 82.0%, respectively. The diagnostic rate of biopsy-proven malignancy was 72.45% (n = 71/98). Invasion of lesions into the mediastinum was a risk factor for local progression (p = 0.0077). The 30-day mortality rate was 0. The major complications were pneumothorax (13.27%), ventricular arrhythmias (3.06%), pleural effusion (1.02%), hemoptysis (1.02%), and infection (1.02%). Minor complications included pneumothorax (30.61%), pleural effusion (24.49%), hemoptysis (18.37%), ventricular arrhythmias (11.22%), structural changes in adjacent organs (3.06%), and infection (3.06%). CONCLUSIONS: Synchronous biopsy and MWA was effective for treating GGOs adjacent to the mediastinum without severe complications (Society of Interventional Radiology classification E or F). Invasion of lesions into the mediastinum was identified as a risk factor for local progression.
Assuntos
Ablação por Cateter , Neoplasias Pulmonares , Derrame Pleural , Pneumotórax , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/cirurgia , Mediastino/diagnóstico por imagem , Mediastino/patologia , Mediastino/cirurgia , Hemoptise/complicações , Hemoptise/cirurgia , Pneumotórax/etiologia , Estudos Retrospectivos , Micro-Ondas/uso terapêutico , Pulmão/cirurgia , Derrame Pleural/etiologia , Derrame Pleural/cirurgia , Biópsia/efeitos adversos , Tomografia , Ablação por Cateter/métodosRESUMO
The article reports the case of a patient with bronchopulmonary sequestration complicated by destructive actinomycotic inflammation leading to life-threatening hemoptysis. It was an adult patient with the history of repeated right-sided pneumonia the cause of which had not been investigated in detail in the past. Only hemoptysis, which appeared as a complication, led to a closer investigation of the background of repeated right-sided pneumonia. CT scan of the chest revealed a lesion of the middle lobe of the right lung with anomalous vascularization - compatible with intralobar sequestration. Initially, conservative antibiotic treatment of pneumonia was provided at a local clinic. Embolization of the afferent vessels of the sequestrum was indicated due to persistent hemoptysis; this led to a reduction of its blood supply, proven by a follow-up CT examination of the chest. Clinically, the hemoptysis subsided. Three weeks later, the hemoptysis reocurred. The patient was acutely hospitalized at a specialized thoracic surgery department where shortly after admission, hemoptysis progressed to life-threatening hemoptea. Urgent middle lobectomy of the right lung was approached via thoracotomy to treat the source of bleeding. The case describes unrecognized bronchopulmonary sequestration as a possible cause of recurrent ipsilateral pneumonia in adulthood; additionally, it emphasizes the possible risks associated with a pathologically altered tissue microenvironment of pulmonary sequestration, and the need for surgical removal in all indicated cases.
Assuntos
Sequestro Broncopulmonar , Pneumonia , Humanos , Adulto , Hemoptise/diagnóstico , Hemoptise/etiologia , Hemoptise/cirurgia , Sequestro Broncopulmonar/complicações , Sequestro Broncopulmonar/diagnóstico , Sequestro Broncopulmonar/cirurgia , Pulmão/cirurgia , Pneumonia/complicações , HemorragiaRESUMO
Congenital lobar emphysema (CLE) is a rare developmental lung disorder characterized by lobar hyperinflation secondary to bronchopulmonary obstruction. Half of patients are symptomatic at birth, with many requiring urgent or emergent surgical resection to treat respiratory distress. Meanwhile, patients achieving late childhood or adolescence without symptoms usually never require surgery. We present a case of a 26 year old otherwise healthy female with known CLE who developed massive hemoptysis and required urgent videoscopic (VATS) resection of her right lung upper lobe. We know of no other report of CLE causing life-threatening bleeding at any age, and herein review pathology and pathophysiology of the condition.
Assuntos
Hemoptise , Enfisema Pulmonar , Humanos , Recém-Nascido , Feminino , Criança , Adulto , Hemoptise/cirurgia , Hemoptise/complicações , Enfisema Pulmonar/complicações , Enfisema Pulmonar/cirurgia , Enfisema Pulmonar/patologia , Pulmão/cirurgia , DispneiaAssuntos
Hemoptise , Terapia de Salvação , Humanos , Hemoptise/etiologia , Hemoptise/cirurgia , Broncoscopia , Próteses e ImplantesRESUMO
An 86-year-old man was hospitalized urgently to our department because of his worsening hemoptysis. He had undergone open thoracic aortic grafting for the Stanford type B chronic aortic dissecting aneurysm 30 years earlier. Contrast enhanced computed tomography (CT) revealed the distal anastomotic aneurysm, leakage of the contrast medium around the distal anastomotic site. We urgently performed thoracic endovascular aneurysm repair( TEVAR) for the distal anastomotic aneurysm. TEVAR was done under local anesthesia because of his poor respiratory condition due to hemoptysis. He recovered well without hemoptysis. Patients after open aortic surgery are expected to survive longer. Thus, special attention should be paid to the occurrence of anastomotic aneurysms.
Assuntos
Aneurisma da Aorta Abdominal , Aneurisma da Aorta Torácica , Implante de Prótese Vascular , Procedimentos Endovasculares , Masculino , Humanos , Idoso de 80 Anos ou mais , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/etiologia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/efeitos adversos , Stents/efeitos adversos , Hemoptise/cirurgia , Resultado do Tratamento , Procedimentos Endovasculares/métodosRESUMO
Aortobronchial fistula is a rare cause of repeated hemoptysis and a potentially fatal condition if left untreated. We present the case of a 40-year-old man with repeated hemoptysis, excessive cough, and epistaxis ongoing for several days after SARS-CoV-2 pneumonia diagnosis. The patient had a history of patch aortoplasty for aortic coarctation and aortic valve replacement with a mechanical valve for aortic insufficiency due to bicuspid aortic valve at the age of 24. Computed tomography scan performed at presentation revealed a severely dilated ascending aorta, a thoracic aorta pseudoaneurysm at the site of the former coarctation, an aortobronchial fistula suggested by the thickened left lower lobe apical segmental bronchus in contact with the pseudoaneurysm and signs of alveolar hemorrhage in the respective segment. The patient was treated with thoracic endovascular aneurysm repair (TEVAR) after prior hemi-aortic arch debranching and transposition of the left common carotid artery and subclavian artery through a closed-chest surgical approach. Our case report together with a systematic review of the literature highlight the importance of both considering an aortobronchial fistula in the differential diagnosis of hemoptysis in patients with prior history of thoracic aorta surgical intervention, regardless of associated pathology, and of taking into account endovascular and hybrid techniques as an alternative to open surgical repair, which carries a high risk of morbidity and mortality.
Assuntos
Falso Aneurisma , Aneurisma da Aorta Abdominal , Coartação Aórtica , Implante de Prótese Vascular , Fístula Brônquica , COVID-19 , Procedimentos Endovasculares , Masculino , Humanos , Adulto , Coartação Aórtica/complicações , Coartação Aórtica/cirurgia , SARS-CoV-2 , Hemoptise/complicações , Hemoptise/cirurgia , Fístula Brônquica/etiologia , Fístula Brônquica/cirurgia , Fístula Brônquica/diagnóstico , Aneurisma da Aorta Abdominal/cirurgia , Procedimentos Endovasculares/métodos , Implante de Prótese Vascular/efeitos adversos , COVID-19/complicaçõesRESUMO
Life-threatening hemoptysis results significant airway obstruction, abnormal gas exchange. When a patient presents with life-threatening hemoptysis, the initial steps are to provide adequate oxygenation and ventilation, secure the airway, position the patient lateral decubitus with bleeding side down, and perform initial treatments to control the bleeding. Bronchoscopy is an important early procedure and can be both diagnostic and therapeutic. For patients who are stable, contrast chest computed tomography (CT) provides diagnostic information before angiography. In most cases, initial measures are successful, allowing time for a more detailed diagnostic investigation and generation of a therapeutic plan. For most patients, arteriography is appropriate for identifying and embolizing a responsible lesion. For patients with refractory life-threatening hemoptysis, repeating previous interventions or evaluating for surgery is appropriate. Patients with aneurysms should be evaluated for urgent surgery.
Assuntos
Embolização Terapêutica , Hemoptise , Angiografia/métodos , Broncoscopia , Embolização Terapêutica/métodos , Hemoptise/diagnóstico por imagem , Hemoptise/etiologia , Hemoptise/cirurgia , Humanos , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: To evaluate the results of one-stage thoracoscopic resection of bilateral bronchiectasis. METHODS: Between June 2009 and December 2020, there were 23 patients selected for one-stage thoracoscopic resection of bilateral bronchiectasis. Their average age was 58.5 (36-73). Female patients were more common, accounting for 17 (74%). Preoperatively, 17 (74%) patients mainly presented with hemoptysis and the other 6 (26%) patients with purulent sputum. RESULTS: In these 23 patients, a total of 121 segments were resected, with an average of 5.26 segments, ranging from 3 to 9 segments. Five of 17 patients with massive hemoptysis underwent ligation of bronchial arteries in addition to lung resections. The average operating time was 271â min, ranging from 145 to 500â min. The average blood loss was 108â ml, ranging from 20 to 600â ml. The average postoperative hospital stay was 8 days, ranging from 3 to 20 days. There was no surgical morbidity or surgical death. Hemoptysis and purulent sputum of all patients was almost controlled after surgery. CONCLUSION: One-stage thoracoscopic resections of bilateral localized bronchiectasis could be well-tolerated and safe for these selected patients. The one-stage operation could shorten the course of treatment.
Assuntos
Bronquiectasia , Hemoptise , Bronquiectasia/diagnóstico por imagem , Bronquiectasia/cirurgia , Feminino , Hemoptise/etiologia , Hemoptise/cirurgia , Humanos , Tempo de Internação , Pessoa de Meia-Idade , Pneumonectomia/efeitos adversos , Pneumonectomia/métodos , Resultado do TratamentoRESUMO
BACKGROUND: Pulmonary aspergilloma is chronic and invasive, potentially leading to life-threatening massive hemoptysis. The role of surgery for treating pulmonary aspergilloma and its effect on long-term survival needs more study. METHODS: We reviewed 166 patients with aspergillomas treated at Shanghai Pulmonary Hospital from 2004 to 2017. Surgery indications included destroyed lung parenchyma, recurrent hemoptysis, despite appropriate medical treatment, and isolated pulmonary nodules suspected to be aspergilloma. Pulmonary aspergillomas are classified as simple (in an isolated thin-walled cavity, ≤3 mm) or complex (a thick-walled cyst, >3 mm) based on computed tomographic scan findings. RESULTS: Aspergilloma was complex in 100 patients (60.2%) and simple in 66 (39.8%). The median (interquartile range) size of complex aspergillomas (2.5 [0.3-8.0] cm) was larger than that (2.0 [0.2-6.0] cm) of simple types (P < .001). Hemoptysis occurred in 72 patients (72%) with complex disease and in 35 (53%) with simple disease (P = .014). Video-assisted thoracoscopic surgery was performed in 42 patients (63.6%) with simple aspergillomas, and 75 patients (75%) with of complex aspergillomas underwent thoracotomy. Prolonged air leakage (>7 days) was the most common (17 [10.2%]) postoperative complication. A bronchopleural fistula developed postoperatively in 1 patient (0.6%). One patient (0.6%) died of respiratory failure within 30 days postoperatively. Two patients (1.2%) experienced recurrence during follow-up. The overall 10-year survival rates were 87.7% for complex aspergillomas and 94.97% for simple aspergillomas (P = .478). Diabetes (12 [7.2%]; hazard ratio, 13.15; 95% CI, 1.12-154.46) was associated with a worse prognosis. CONCLUSIONS: The perioperative morbidity and mortality of pulmonary aspergillomas are acceptable. Overall survival rates of simple and complex types are comparable.
Assuntos
Hemoptise , Aspergilose Pulmonar , China , Hemoptise/etiologia , Hemoptise/cirurgia , Humanos , Pulmão , Aspergilose Pulmonar/complicações , Aspergilose Pulmonar/diagnóstico , Aspergilose Pulmonar/cirurgia , Estudos RetrospectivosRESUMO
We report a rare case of an endometriotic lung cyst in a 47-year woman with recurrent catamenial hemoptysis. Chest computed tomography (CT) obtained outside the menstruation in October 2019 revealed a cystic lesion (2.5 cm) located in the right inferior lobe near the distal esophagus and the inferior pulmonary vein. Compared to CT abdomen in May 2019, this lesion had increased with a larger volume and a thicker wall. An endometrial lung cyst was suspected as episodes of hemoptysis no longer occurred after initiating hormonal treatment with nomegestrol acetate. Exploratory video-assisted thoracoscopic surgery with wedge resection of the cyst was performed. Histopathologic examination confirmed the diagnosis of an endometriotic cystic lesion. Postoperative course was uneventful with no further symptoms since then.
Assuntos
Cistos , Endometriose , Feminino , Humanos , Hemoptise/diagnóstico , Hemoptise/etiologia , Hemoptise/cirurgia , Menstruação , Endometriose/complicações , Endometriose/diagnóstico , Endometriose/cirurgia , Pulmão , Cistos/complicações , Cistos/diagnóstico , Cistos/cirurgiaRESUMO
Chronic pulmonary aspergillosis (CPA) is an emerging fungal infectious disease of public health importance. We conducted a systematic review of studies reporting the outcomes of patients with CPA managed surgically in Africa. A search of Medline, Embase, Web of Science, Google Scholar and African Journals Online was conducted to identify studies indexed from inception to June 2021 that examined surgical management of CPA in Africa. All articles that presented primary data, including case reports and case series, were included. We excluded review articles. A total of 891 cases (557 males (62.5%), mean age 39.3 years) extracted from 27 eligible studies published between 1976 and 2020 from 11 African countries were included. Morocco (524, 59%) and Senegal (99, 11%) contributed the majority of cases. Active or previous pulmonary tuberculosis was reported in 677 (76.0%) cases. Haemoptysis was reported in 682 (76.5%) cases. Lobectomy (either unilateral or bilateral, n = 493, 55.3%), pneumonectomy (n = 154, 17.3%) and segmentectomy (n = 117, 13.1%) were the most frequently performed surgical procedures. Thirty (4.9%) cases from South Africa received bronchial artery embolisation. Empyema (n = 59, 27.4%), significant haemorrhage (n = 38, 173.7%), incomplete lung expansion (n = 26, 12.1%) and prolonged air leak (n = 24, 11.2%) were the most frequent complications. Overall, 45 (5.1%) patients died. The causes of death included respiratory failure (n = 14), bacterial superinfection/sepsis (n = 10), severe haemorrhage (n = 5), cardiopulmonary arrest (n = 3) and complications of chronic obstructive pulmonary disease (n = 3). The cause of death was either unknown or unspecified in 9 cases. We conclude that surgical treatment had very low mortality rates and maybe considered as first-line management option in centres with experience and expertise in Africa.
Assuntos
Aspergilose Pulmonar , África/epidemiologia , Hemoptise/cirurgia , Humanos , Pneumonectomia , Aspergilose Pulmonar/epidemiologia , Aspergilose Pulmonar/cirurgia , Estudos RetrospectivosRESUMO
Robotic assisted bronchoscopy represents a major turning point in bronchoscopic history. The management strategies to address significant airway bleeding in this "robotic era" are not well documented, and further guidance is required. We present a case report that exemplifies our approach and management strategy using a combined and simultaneous flexible/robotic bronchoscopy if this complication is encountered.