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2.
Cardiovasc Intervent Radiol ; 43(1): 103-109, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31482339

RESUMO

PURPOSE: To evaluate the feasibility, efficacy and safety of sternal percutaneous fixation by internal cemented screw (FICS) using fluoroscopy and/or CT needle guidance. MATERIALS AND METHODS: This retrospective single-center study analyzed 9 consecutive cancer patients managed with percutaneous FICS for sternal fracture fixation or osteolytic metastasis consolidation, from May 2014 to February 2019. Eastern Cooperative Oncology Group performance status, Numeric Pain Rating Scale (NPRS) and opioid use were studied preoperatively and postoperatively. Sternal images at last follow-up appointment were also collected. RESULTS: Among the 9 patients, 7 had a sternal fracture with 5 being displaced. The technical feasibility was 100%. Both NPRS score significantly decreased from 5.6/10 ± 2.8 to 1.1/10 ± 1.6, and analgesic consumption was significantly improved (p = 0.03) after intervention. No post-procedural complications requiring surgical correction or screw displacement occurred after a mean imaging follow-up that exceeded 1 year (mean follow-up duration, 401.8 days ± 305.8). CONCLUSION: Image-guided sternal percutaneous FICS is feasible and safe. It reduces pain and analgesic consumption related to pathologic fracture of the sternum.


Assuntos
Parafusos Ósseos , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Radiografia Intervencionista/métodos , Esterno/lesões , Esterno/cirurgia , Estudos de Viabilidade , Feminino , Fluoroscopia/métodos , Seguimentos , Fraturas Ósseas/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Esterno/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
3.
Ann Thorac Cardiovasc Surg ; 26(1): 40-46, 2020 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-31827020

RESUMO

PURPOSE: To stabilize the sternum after median sternotomy, unsintered hydroxyapatite poly-L-lactide (u-HA/PLLA) sternal pins are frequently used in Japan. However, sternal pins are ineffective in the fragile bone marrow. Thus, a corrugated sheet made of u-HA/PLLA was developed as a new sternal fixation device. METHODS: To examine the effects of the device, we measured the shear force using a sternal model and cadaver. The shear force of the corrugated sheet, sternal pin, and simple wire was compared. The device size was determined after reviewing the sternal computed tomography (CT) of 128 patients. RESULTS: The shear force of the model with the corrugated sheet (286 [256-295] N) was higher than that with sternal pins (135 [134-139] N, p = 0.03) and simple wire (94 [90-104] N, p = 0.03) at 2-mm displacement. In the cadaver test, the shear force of the sternal halves with the device was about two times higher than that without the device. Retrospective CT showed that 18-mm wide device applies to 99% male and 87% female patients at the fourth intercostal level. CONCLUSION: The corrugated sheet might provide a stronger fixation effect in the fragile bone marrow. The device width was modified to 18 mm to be applicable for most Japanese patients.


Assuntos
Durapatita , Fixadores Internos , Procedimentos Ortopédicos/instrumentação , Poliésteres , Esternotomia , Esterno/cirurgia , Procedimentos Cirúrgicos Torácicos/instrumentação , Adulto , Idoso , Pinos Ortopédicos , Fios Ortopédicos , Cadáver , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Modelos Cardiovasculares , Desenho de Prótese , Falha de Prótese , Estudos Retrospectivos , Esterno/diagnóstico por imagem , Estresse Mecânico , Tomografia Computadorizada por Raios X
4.
Cir Pediatr ; 32(4): 165-171, 2019 Oct 01.
Artigo em Espanhol | MEDLINE | ID: mdl-31626399

RESUMO

OBJECTIVE: To compare the anatomical relations between brachiocephalic trunk (BT), trachea, spine and sternum in patients with Innominate Artery Compressing Syndrome (IACS) and control patients. METHODS: Retrospective case-control study of patients diagnosed with IACS in our center, in whom vascular computerized tomography (CT) was performed. The CT were compared with those of control patients free of obstructive respiratory pathology, without congenital heart disease and free of deforming thoracic mass, in whom CT was performed due to other reason. Each case was paired with three controls per case, in similar age groups. The significance value was set as p<0,05. RESULTS: Nine cases were included (7 boys and 2 girls) with their 27 respective controls (20 boys and 7 girls). The BT origin position with respect to the trachea, thought as a clock face, was 01:30 (00:30- 03:00) in cases and 01:30 (00:30-02:30) in controls. No differences were observed (p=0.72). The relation between anteroposterior/transversal tracheal diameters was 0.44 (0.184-0.6) in cases, 0.885 (0.64-1.16) in controls. The sternum-trachea/sternum-vertebra relation was 0.685 (0.6-0.76) in cases, 0.67 (0.49-0.79) in controls. No differences were observed (p=0.75). The angle of thoracic kyphosis was 29º (9º-34º) in cases, 24º (4º-33º) in controls. There were no statistically significant differences (p=0.45). CONCLUSIONS: We found no differences between the two groups in the BT origin in relation to the trachea. In all cases, the origin was on the left side of the body. Therefore, we question the premise that IACS is due to a more left origin of BT.


Assuntos
Tronco Braquiocefálico/anatomia & histologia , Doença Arterial Periférica/diagnóstico por imagem , Coluna Vertebral/anatomia & histologia , Esterno/anatomia & histologia , Tomografia Computadorizada por Raios X , Traqueia/anatomia & histologia , Doenças da Traqueia/etiologia , Tronco Braquiocefálico/diagnóstico por imagem , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pressão , Estudos Retrospectivos , Coluna Vertebral/diagnóstico por imagem , Esterno/diagnóstico por imagem , Síndrome , Traqueia/diagnóstico por imagem
5.
Proc Inst Mech Eng H ; 233(12): 1282-1291, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31591944

RESUMO

The main purpose of this study is to develop a validated three-dimensional finite element model of sternum closure techniques. For this aim, the finite element method analysis results of three closure methods were compared with experimental test results. Also, three more closure techniques are simulated numerically to study the effect of the number of wires used in the manubrium and xiphoid regions. A three-dimensional model of polyurethane sternum foam was created based on computed tomography images. Six different closure techniques using steel wire, steel bands and ZipFix bands were modeled on the sternum and transferred into a three-dimensional finite element model. The sternum was modeled as an isotropic bilinear-elasto-plastic material, and nonlinear contact conditions were applied. The models were analyzed under lateral distraction loading, and load-displacement curves were obtained from displacements at the incision line. Allowable loads and stiffness values of the methods were evaluated from these curves. The results showed the importance of the including material as well as geometric nonlinearities in the simulations to obtain realistic results from the numerical analyses. Also, the analyses showed that closures that include steel or ZipFix bands are superior to conventional wiring, and addition of a single wire at the manubrium and xiphoid regions significantly improved the efficiency of the closure techniques.


Assuntos
Análise de Elementos Finitos , Dinâmica não Linear , Esterno/cirurgia , Técnicas de Sutura , Fenômenos Biomecânicos , Modelos Anatômicos , Esterno/anatomia & histologia , Esterno/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Suporte de Carga
7.
J Card Surg ; 34(10): 983-987, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31374584

RESUMO

OBJECTIVES: A sternal pin can be used to internally fix the reapproximated sternum after midline sternotomy. This paper will evaluate the effectiveness of using a sternal pin in small children by means of a computer tomography scan. METHODS: Propensity score matching was performed for patients undergoing a first-time median sternotomy from April 2012 to December 2014 with a follow-up computer tomography scan after 6 months. Seventeen matched patients were selected for both the control and the sternal pin groups. The angle of the sternal reflection at the joint surface was measured by computer tomography scan. In addition, the Haller index was measured at each thoracic vertebral level. RESULTS: The angle of the sternal reflection was more variable in the control group compared with the sternal pin group: the standard deviation was 31.6° for the control group and 10.2° for the sternal pin group (P value = .0009). Seven out of 17 patients in the control group had a negative angle (excavated sternum) compared with 1 out of 17 in the sternal pin group (P = .0391). In the other patients, the angle was 23.9° ± 3.6° in the control group and 10.1 ± 2.8 in the sternal pin group (P = .0061). The Haller index was also more variable in the control group, and it was significantly different from the sternal pin group at the ninth vertebral level (P = .0409). CONCLUSIONS: The study demonstrated that the use of a sternal pin was associated with decreased variation in the sternal angles and decreased incidence and severity of sternal protrusion and excavation in small children.


Assuntos
Implantes Absorvíveis , Pinos Ortopédicos , Procedimentos Cirúrgicos Cardíacos/métodos , Poliésteres , Pontuação de Propensão , Esternotomia/métodos , Esterno/cirurgia , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Masculino , Estudos Retrospectivos , Esterno/diagnóstico por imagem , Tomografia Computadorizada por Raios X
9.
Croat Med J ; 60(3): 237-245, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31187951

RESUMO

AIM: To determine the sexual dimorphism of the sternum with standard measurements in a contemporary Croatian population sample using multi-slice computed tomography (MSCT) and to compare the data obtained by an automatic with those obtained by a manual approach. METHODS: Five sternal measurements were obtained from MSCT images of 73 men and 55 women and three sternal indices were calculated. Custom image analysis software was developed for automatic segmentation and calculation of sternal measurements. Measurements of sexual dimorphism were automatically calculated and compared with manual measurements. RESULTS: All of the sternal measurements exhibited significant differences between men and women. The discrepancies between manual and automatic measurements ranged from 2.8% to 3.6% of the mean average values obtained with the automatic approach. The most accurate single-variable discriminant function was sternal body length (82.8%), the most accurate index was sternal area (89.1%), and the discriminant function using three variables was manubrium width, sternal body length, and sternal body width (90.6%). CONCLUSION: Sternal measurements are a reliable sex indicator and can be used in forensic casework. Computer-aided measurement methods can accelerate sex estimation and improve its precision and accuracy.


Assuntos
Tomografia Computadorizada Multidetectores , Caracteres Sexuais , Determinação do Sexo pelo Esqueleto/métodos , Esterno/anatomia & histologia , Esterno/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Croácia , Análise Discriminante , Feminino , Antropologia Forense/métodos , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Estudos Retrospectivos , Adulto Jovem
10.
Br J Radiol ; 92(1101): 20170980, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31199672

RESUMO

Resternotomy (RS) is a common occurrence in cardiac surgical practice. It is associated with an increased risk of injury to old conduits, cardiac structures, catastrophic hemorrhage and subsequent high morbidity and mortality rate in the operating room or during the recovery period. To mitigate this risk, we evaluated the role of multidetector CT (MDCT) in planning repeat cardiac surgery. We evaluated sternal compartment abnormalities, sternal/ascending aorta distance, pre-reoperative assessment of the aorta (wall, diameters, lumen, valve), sternal/right ventricle distance, diaphragm insertion, pericardium and cardiac chambers, sternal/innominate vein distance, connection of the grafts to the predicted median sternotomy cut, graft patency and anatomic course, possible aortic cannulation and cross-clamping sites and additional non-cardiovascular significant findings. Based on the MDCT findings, surgeons employed tailored operative strategies, including no-touch technique, clamping strategy and cardiopulmonary bypass (CPB) via peripheral cannulation assisted resternotomy. Our experience suggests that MDCT provides information which contributes to the safety of re-operative heart surgery reducing operative mortality and adverse outcomes. The radiologist must be aware of potential surgical options, including in the report any findings relevant to possible resternotomy complications.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Tomografia Computadorizada Multidetectores/métodos , Cuidados Pré-Operatórios/métodos , Reoperação/métodos , Esternotomia/métodos , Humanos , Esterno/diagnóstico por imagem , Esterno/cirurgia
11.
Radiología (Madr., Ed. impr.) ; 61(3): 234-238, mayo-jun. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-185295

RESUMO

Las fracturas esternales se consideran infrecuentes en la edad pediátrica. Clásicamente se han descrito como fracturas secundarias a traumatismos de alta energía y con riesgo de lesiones asociadas. Objetivo: Describir los aspectos clínicos y de imagen de las fracturas esternales en niños menores de 18 años. Material y métodos: Se realiza una revisión retrospectiva de 79 pacientes pediátricos con diagnóstico de fractura esternal tras traumatismo. Resultado: Demostramos que en el 92,4% de los casos, las fracturas son causadas por mecanismos de baja energía y que únicamente en 3 (4%) pacientes se presentan lesiones asociadas. Conclusión: Nuestros resultados sugieren que las fracturas esternales en niños son frecuentemente causadas por traumatismo menor, con escasa incidencia de lesiones asociadas


Sternal fractures are considered uncommon in pediatric patients. Classically, they have been described as fractures secondary to high-energy trauma that have a risk of associated lesions. Objective: To describe the clinical and imaging features of sternal fractures in patients less than 18 years of age. Material and methods: We retrospectively reviewed 79 pediatric patients diagnosed with sternal fractures after trauma. Results: We found that 92.4% of the fractures were caused by low-energy trauma and that associated lesions were present in only 3 (4%) patients. Conclusion: Our results suggest that sternal fractures in children are often due to lesser trauma and that associated lesions are rare


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Esterno/lesões , Traumatismos Torácicos/diagnóstico por imagem , Fraturas Ósseas/diagnóstico por imagem , Esterno/diagnóstico por imagem , Estudos Retrospectivos
12.
Interact Cardiovasc Thorac Surg ; 29(3): 478-480, 2019 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-31134277

RESUMO

We present a case of comminuted sternal fracture with posterior displacement, which was successfully repaired by 'sandwich' fixation using 2 bioresorbable plates that were placed anterior to and posterior to the sternum. All procedures including retro-sternal dissection for placement of the posterior plate were performed using video-assisted thoracoscopic surgery. The minimally invasive thoracoscopic technique provided effective repair and rigid fixation with immediate relief from intractable chest pain that had persisted before surgery.


Assuntos
Implantes Absorvíveis , Placas Ósseas , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Fraturas Cominutivas/cirurgia , Esterno/lesões , Cirurgia Torácica Vídeoassistida/métodos , Adolescente , Fraturas Ósseas/diagnóstico , Fraturas Cominutivas/diagnóstico , Humanos , Masculino , Esterno/diagnóstico por imagem , Esterno/cirurgia , Traumatismos Torácicos/diagnóstico , Traumatismos Torácicos/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
13.
Forensic Sci Int ; 301: 6-11, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31128410

RESUMO

In addition to the pelvis, cranium and phalanges, the sternum is also used for postmortem sex identification. Bone measurements may be obtained on cadaveric bones. Alternatively, computerized tomography may be used to obtain measurements close to the original ones. Moreover, usage of artificial neural networks (ANNs) in the field of medicine has started to provide new horizons. In this study, we aimed to identify sex by an ANN using lengths of manubrium sterni (MSL), corpus sterni (CSL) and processus xiphoideus (XPL) and sternal angle (SA) from computerized tomography (CT) images brought to an orthogonal plane. This study used the thin-slice thoracic CT images of 422 cases (213 female, 209 male) with an age range of 27-60 years brought to the orthogonal plane. Measurements of MSL, CSL, XPL and SA were analyzed with a multilayer artificial neural network that used stochastic gradient descent (SGD) for optimization and two hidden layers. MSL, CSL and XPL were longer, and SA was wider in men (MSL p = 0.000, CSL p = 0.000, XPL p = 0.000, SA p = 0.02). In the case of the two hidden layers of the network with 20 and 14 neurons in the hidden layers, respectively, learning rate of 0.1 and momentum coefficient of 0.9, the accuracy (Acc) of sex prediction was 0.906. In order to define a more realistic performance of the network, bootstrap was run with the confidence interval of 94%. A sensitivity (Sen) value of 0.91 and a specificity (Spe) value of 0.90 were calculated. The success rates that were achieved in sex identification with measurements on the skeleton using ANN were observed to be higher than those achieved by linear models. Also, sometimes all parts of the bones may not be found or might be deformed. In this case, the number of parameters used for the estimation will be incomplete. The ANN has the strong advantage to be able to estimate despite the missing parameter.


Assuntos
Redes Neurais de Computação , Determinação do Sexo pelo Esqueleto/métodos , Esterno/anatomia & histologia , Esterno/diagnóstico por imagem , Adulto , Feminino , Antropologia Forense/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
14.
J Avian Med Surg ; 33(1): 53-58, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31124612

RESUMO

Radiographs are an important diagnostic tool available in wildlife hospitals to evaluate the size of the avian heart. Despite the large variety wild birds in the Iberian peninsula, clinical studies addressing these species are lacking. To establish reference values for cardiac size in the Bonelli's eagle (Aquila fasciata), ventrodorsal radiographs of 20 healthy birds were obtained, and the width of the cardiac silhouette, sternum, thorax, coracoid, and hepatic silhouette were measured. The ratios between cardiac width and other mentioned indices were calculated. Results showed that cardiac silhouette width should occupy 81%-93% of sternal width, 48%-57% of thoracic width, and 506%-673% of coracoid width. The cardiac silhouette width was strongly correlated with sternal and thoracic widths. A moderate correlation was found between the width of the heart and the width of the coracoid. No significant correlation was found between width of the cardiac silhouette and the hepatic silhouette. These results support that sternal and thoracic widths should be used preferentially when evaluating the width of the cardiac silhouette in this species. The values obtained in this study can be used as a reference for normal cardiac size when evaluating radiographs of Bonelli's eagles.


Assuntos
Águias/anatomia & histologia , Coração/diagnóstico por imagem , Animais , Processo Coracoide/diagnóstico por imagem , Fígado/diagnóstico por imagem , Radiografia/veterinária , Valores de Referência , Estudos Retrospectivos , Esterno/diagnóstico por imagem , Cavidade Torácica/diagnóstico por imagem
15.
J Craniofac Surg ; 30(6): e558-e561, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30939557

RESUMO

Sternal cleft (SC) is a rare congenital anomaly, occurring with associated developmental anomalies or in isolation. Surgery to reconstruct the sternum is indicated to protect the visceral organs from trauma, to ensure healthy cardiopulmonary function and growth, and to reconstruct the anterior chest wall. Although infection recognized as a postoperative complication following chest wall reconstruction, spontaneous mediastinal infection is rare. To the authors' knowledge, there is only 1 reported case of spontaneous mediastinal infection with concomitant SC in the literature. Here, the authors present a unique case of a medically complicated infant with a SC who presented with a spontaneous mediastinal abscess.


Assuntos
Abscesso/diagnóstico por imagem , Anormalidades Musculoesqueléticas/diagnóstico por imagem , Esterno/anormalidades , Esterno/diagnóstico por imagem , Abscesso/complicações , Feminino , Humanos , Recém-Nascido , Mediastinite/complicações , Anormalidades Musculoesqueléticas/complicações , Procedimentos Cirúrgicos Reconstrutivos , Trissomia
16.
J Cardiothorac Surg ; 14(1): 79, 2019 Apr 18.
Artigo em Inglês | MEDLINE | ID: mdl-30999925

RESUMO

BACKGROUND: The treatment of hemotogenous solitary sternal metastases by breast cancer remains a controversial issue. Sternal resection for select patients might provide good long-term local control. CASE PRESENTATION: A 63-year-old woman was admitted to our hospital with a mass at the sternum and right second to third costochondral cartilage. She had undergone bilateral mastectomy for breast cancer 13 years earlier. A percutaneous biopsy was performed, and the mass was diagnosed as solitary metastasis due to breast cancer. She received two courses of weekly paclitaxel and bevacizumab, and computed tomography (CT) revealed shrinking of the mass in the sternum. We performed surgical resection with curative intent for a multimodality approach. Parasternectomy and removal of the right second and third costochondral cartilage was performed. A prosthesis was created to fill the defect by sandwiching molded methylmethacrylate between polypropylene mesh. The prosthesis was fixed to the cut ends of the costochondral cartilage and the residual sternum. Finally, a harvested latissimus dorsi myoctaneous flap was transpositioned to cover the chest midline wound. Negative surgical margins at the stump of the sternum and costochondral cartilage were revealed. CONCLUSION: Parasternal resection and reconstruction by the Marlex sandwich technique and implantation of a pedicled latissimus dorsi myocutaneous flap for metastasis due to breast cancer was safely performed.


Assuntos
Neoplasias Ósseas/cirurgia , Neoplasias da Mama/cirurgia , Retalho Miocutâneo , Procedimentos Cirúrgicos Reconstrutivos/métodos , Esterno/cirurgia , Músculos Superficiais do Dorso/transplante , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bevacizumab/administração & dosagem , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/tratamento farmacológico , Neoplasias Ósseas/secundário , Substitutos Ósseos , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/secundário , Quimioterapia Adjuvante , Feminino , Humanos , Mastectomia , Pessoa de Meia-Idade , Terapia Neoadjuvante , Paclitaxel/administração & dosagem , Polipropilenos , Implantação de Prótese/métodos , Costelas/cirurgia , Esterno/diagnóstico por imagem , Esterno/patologia , Telas Cirúrgicas , Tomografia Computadorizada por Raios X
19.
Asian Cardiovasc Thorac Ann ; 27(4): 307-309, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30781972

RESUMO

A rare presentation of ascending aortic aneurysm eroding into the anterior chest wall and skin is described. Only a few reports of this lethal condition associated with luetic disease have been published previously. A 72-year-old man with a history of blunt chest injury subsequently developed a saccular aneurysm of the ascending aorta protruding out of the anterior chest wall. He was successfully treated with a surgical intervention.


Assuntos
Aneurisma Aórtico/cirurgia , Implante de Prótese Vascular , Pele , Esterno , Lesões do Sistema Vascular/cirurgia , Acidentes por Quedas , Idoso , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/etiologia , Aneurisma Aórtico/patologia , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Humanos , Masculino , Pele/diagnóstico por imagem , Pele/patologia , Esterno/diagnóstico por imagem , Esterno/patologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologia , Lesões do Sistema Vascular/patologia
20.
World Neurosurg ; 125: 67-71, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30721772

RESUMO

BACKGROUND: Esophageal injury is a severe surgical complication of a transsternal approach to high thoracic vertebral metastasis, which can result in mediastinitis and life-threatening consequences. A covered stent can be placed in the esophagus to prevent mediastinal leakage. However, tracheomalacia is a rare complication following esophageal stenting. CASE DESCRIPTION: A 56-year-old man had a pathologic fracture of the T3 vertebral body with spinal cord compression, myelopathy, and neurogenic bladder. An esophageal injury was noticed during the transsternal approach. Immediate suture repair, drainage tube placement, and subsequent esophageal stenting were carried out. One month after discharge, the endoscopic examination revealed nonhealing of the esophagus, and a new covered stent was replaced. Episodes of severe stridor and dyspnea led to the patient being sent to the emergency department. Computed tomography scan of the chest revealed a focal collapse of the trachea at the thoracic inlet, and tracheomalacia was suspected. The covered stent was removed, despite nonhealing of the esophagus. His stridor, dyspnea, and constant coughing subsided afterwards. The endoscopic examination at 3 months after stent removal showed complete healing of the esophagus. CONCLUSIONS: Esophageal stenting can be used to prevent mediastinal leakage due to esophageal injury in the transsternal approach for high thoracic vertebral metastasis, but the stent might be a cause of tracheomalacia. Stent removal should be considered if upper airway obstruction occurs. Awareness of the radial force of the stent, esophageal composition (e.g., status post suture repair), and esophageal diameter must be considered for optimal stent tolerance to avoid complications.


Assuntos
Perfuração Esofágica/diagnóstico por imagem , Complicações Intraoperatórias/diagnóstico por imagem , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Stents/efeitos adversos , Vértebras Torácicas/diagnóstico por imagem , Traqueomalácia/diagnóstico por imagem , Adenoma Oxífilo/diagnóstico por imagem , Adenoma Oxífilo/cirurgia , Perfuração Esofágica/etiologia , Humanos , Complicações Intraoperatórias/etiologia , Masculino , Pessoa de Meia-Idade , Neoplasias da Coluna Vertebral/secundário , Neoplasias da Coluna Vertebral/cirurgia , Esterno/diagnóstico por imagem , Esterno/cirurgia , Vértebras Torácicas/cirurgia , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/cirurgia , Traqueomalácia/etiologia
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