Search

Introduction: The anatomical abnormalities in pulmonary veins can have a serious impact on pulmonary resections., Presentation of Case: We report the case of a 70-year-old woman undergoing VATS right upper lobectomy for the treatment of non-small cell lung cancer. During subcarinal dissection, an anomalous vein draining from the superior segment of the right lower lobe into the left atrium and passing behind the bronchus intermedius was incidentally discovered. The patient had, in addition to the inferior pulmonary vein formed by the confluence of superior and common basal veins, a supernumerary vessel identified as: accessory right V 6 . Retrospective review of preoperative enhanced chest computed tomography confirmed the pulmonary vascular anomaly., Discussion/conclusion: A careful dissection during pulmonary resections can help to recognize variations of the pulmonary veins, avoiding unexpected intraoperative complications., (Copyright © 2019 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Introduction: Giant hiatal hernia is characterized by the presence of more than 1/3 of the stomach in the chest, through the diaphragmatic hiatus, with or without other intra-abdominal organs. It is a rare pathology, representing the 5-10% of all hiatal hernias. The advent of laparoscopic surgery led to new surgical techniques, which include the simple reduction with the excision of the hernial sac and the execution of a posterior hiatoplasty, with or without mesh, and the execution of a Collis-Nissen gatroplasty in case of short esophagus., Presentation of Cases: We followed 24 cases of giant hiatal hernia with more than 1/3 stomach located in the chest, analyzing the results reached by the miniinvasive procedure, and the long-term pathophysiologic results of the disease., Discussion: Laparoscopic hiatal hernia repair results in less postoperative pain compared with the open approach. The smaller incisions of minimally-invasive surgery are less likely to be complicated by incisional hernias and wound infection. Postoperative respiratory complications are reduced., Conclusion: Results from multiple studies are similar, with shorter hospital stay and less morbidity resulting from the minimally invasive approach., (Copyright © 2018 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Introduction: Most hamartomas are located peripherally in the lung parenchyma and are rarely identified as an endobronchial lesion. Clinically patients with an endobronchial hamartoma are often symptomatic and may present with various symptoms including: fever, wheezing, hemoptysis and obstructive pneumonia., Case Presentation: A 68-year-old man presented with complaints of fever and cough for 1 month. Chest X-ray revealed a right infrahilar density, which on chest CT was found to be a lesion obstructing the superior segmental bronchus of the right lower lobe and extending outside of the bronchus. A round rubbery mass obstructing the same segmental bronchus was noticed during bronchoscopy and endoscopic biopsy yielded a pathological diagnosis of hamartoma., Discussion: Bronchoscopy is most helpful in diagnosis and management of endobronchial hamartomas but if the lung distal to the obstruction is irreversibly damaged or imaging studies suggest that tumor extends outside of the bronchus, pulmonary segmentectomy, lobar resection or even pneumonectomy may be indicated., Conclusion: When a benign tumor of the lung, as endobronchial hamartoma, is located in a segmental bronchus and presents extrabronchial spread, we recommend to perform a parenchymal-sparing surgical resection. In this case surgical team, however, should keep in mind, due to difficult individual dissection of the segmental bronchovascular elements, the possibility of conversion from VATS (video-assisted thoracic surgery) to open thoracotomy., (Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Pneumothorax is defined as accumulation of air in the pleural space with secondary lung collapse resulting in dyspnea or chest pain. Currently the optimal management of spontaneous pneumothorax has been standardized, but the question of elective surgery treatment remains unresolved in patients living in rural area with history of recurrent Primary spontaneous pneumothorax [PSP]., Presentation of Case: A 41 years-old white man living in rural area, with a history of recurrent right spontaneous pneumothorax (three subsequent episodes) treated by positioning of chest tube, was admitted to our unit. No respiratory symptoms and normal physical exam were observed on admission although anxiety states was noted. Chest CT scan showed small apical bullae in the right upper lobe without cystic change in the pulmonary parenchyma., Discussion: Recurrence of primary spontaneous pneumothorax represents a complication most frequently occurring within the first year. Among the treatment options, surgical management is needed in 25-50% of all patients suffering from PSP, due to persistent air leak or recurrence. We report the operative complications after elective surgery in a white man living in rural area with a history of recurrent right primary spontaneous pneumothorax., Conclusion: This case report highlights that elective surgery in patients living in rural area with history of recurrence PSP can lead to post-operative complications as bleeding or prolonged air leaks following the lysis of multiple pleural adhesions., (Copyright © 2018 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Introduction: Solitary fibrous tumors are uncommon soft tissue tumors initially reported only in the pleura but, in recent years, they have been described at many extra pleural sites, such as mediastinum. The treatment of choice is the extensive surgical resection that is curative for most benign lesions., Presentation of the Case: We present the case of solitary fibrous tumor of the anterior mediastinum in obese patient (BMI: 34.3) undergoing complete surgical resection by robotic-assisted thoracoscopic surgery with da Vinci ® Surgical System., Discussion/conclusion: Robotic-assisted thoracoscopic surgery with da Vinci ® Surgical System is an interesting option for obese patient, at higher risk for deep sternal wound infection., (Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: The mediastinal bronchogenic cysts represents 50%-60% of mediastinal cysts and rarely occurs in the posterior mediastinum. The final surgical resection is indicated for symptomatic patients and is recommended for some asymptomatic patients in order to establish the diagnosis and to avoid any subsequent complications., Case Presentation: We report a case of 17 years-old male suffering from bronchogenic cysts of the mediastinum. The patient was admitted to our hospital complaining with dry chough and dyspnea; CT scan showed a cystic mass in posterior mediastinum. To achieve a correct diagnosis and to prevent the risk of complications, a complete surgical resection was performed by using bilateral simultaneous VATS., Discussion: Bronchogenic cysts manifest as solitary or multiple lesions, majority of which are located in the mediastinum while sometimes can occur in the lung parenchyma. They are usually asymptomatic and casually discovered at chest X-ray or CT scan. The most common complications are infections, pneumothorax and hemoptysis. The complete surgical resection is the only radical and definitive treatment of the bronchogenic mediastinal cysts. VATS permits good exposure of the thoracic cavity including the mediastinum and better evaluation of the anatomic relationship. The absence of intra and postoperative complications, the reduction of pain in the early postoperative period demonstrate the security of this approach., Conclusion: Bilateral simultaneous VATS for resection of bilateral posterior mediastinal bronchogenic cyst may be a useful approach. In our case no intra and post-operative complications occurred and patient discharged home on 4 rd day., (Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.)