Search

Endometriosis of the diaphragm has been gaining more attention in the practice of gynecologists and thoracic surgeons in recent years. Understanding related symptoms and developing imaging methods have improved their approach. A review of the literature was performed with the aim to report on incidence, diagnosis, treatment and prognosis of diaphragmatic endometriosis. We also cover the issue of the Thoracic Endometriosis Syndrome (TES). Complaints of cyclic chest pain in patients of childbearing age should have as differential diagnosis the presence of thoracic endometriosis. Catamenial pneumothorax is the main manifestation of diaphragmatic endometriosis and Thoracic Endometriosis Syndrome. Other possible manifestations are hemothorax, pulmonary nodules, and diaphragmatic hernia. Despite the possibility of drug treatment, many patients will be submitted to surgical treatment. The minimally invasive approach should be the one of choice. The robotic pathway allows for an easier approach due to its ability to articulate robotic arms, allowing the treatment of lesions in hard-to-reach locations, such as the posterior part of the diaphragm. Multidisciplinary treatment should be used in most cases, as only abdominal approach is not sufficient for the diagnosis and treatment of lesions in the thoracic cavity. The approach of endometriosis of the diaphragm and Thoracic Endometriosis Syndrome should be multidisciplinary, allowing the improvement of quality of life in most patients.

Soft tissue aneurysmal bone cysts (STABCs) are extremely rare extraosseous counterpart of aneurysmal bone cyst (ABC), with close resemblance to histo-morphologic characteristics of ABC. Here we would like to report a 13-year-old female patient, who presented with a large mass, occupying the entire left hemithorax. Patient underwent resection of the thoracic mass. On histopathological examination, it was found to be a soft tissue ABC. It is a very rare tumor and until date 28 cases have been reported in English literature, to the best of our knowledge. On review of the literature, we found this to be the first case of STABC reported in thoracic cavity. The objective of this case presentation is to provide information regarding clinical presentation, radiological and pathological features, and course of management for this rare disease. Soft tissue ABCs are a new class of tumors, so more extensive research is required to establish standard guidelines for their diagnosis and management, to yield better prognosis.

The article describes the treatment of a 20-year-old patient with a spinal hourglass schwannoma (neurinoma) in the thoracic spine, growing from the right Th3 spinal root, spreading into the thoracic cavity and compressing the apex of the right lung. The introduction presents the frequency of occurrence of such neoplasms among all spinal cord tumors. Complaints, neurological symptoms, neoplasm diagnosis methods and its clinical and radiological manifestations are presented. The article describes stages and techniques of total surgical removal of the spinal hourglass schwannoma through the posterior paravertebral minimally invasive approach without opening the pleural cavity and with using neurophysiological monitoring of spinal cord function performed at the Neurosurgical Clinic of the Novosibirsk Research Institute of Traumatology and Orthopaedics named after Ya.L. Tsivyan. The data of histological examination and MRI control in the early postoperative period are presented. The follow-up was carried out at 6 and 12 months after surgical treatment. The publications describing the surgical treatment of paravertebral tumors through different approaches, the technique of their removal, possible complications and methods of their prevention are analyzed, and the classification according to Eden (1941), which characterizes the type of tumor growth, is presented.

BackgroundPheochromocytoma is a catecholamine-secreting tumour that leads to various symptoms. Haemoptysis is rarely caused by a pheochromocytoma occurring outside the bronchus or thoracic cavity. Here, we report the case of an extra-adrenal abdominal pheochromocytoma initially manifesting as haemoptysis/dyspnoea during exercise without classic symptoms.Case presentationA 22-year-old man with a history of severe dyspnoea experienced difficulties in breathing following a marathon owing to haemoptysis that required ventilator management 1 year before presentation. His father had undergone surgery for ectopic pheochromocytoma. Computed tomography (CT) revealed a 30-mm tumour between the inferior vena cava and pancreatic head while urinalysis revealed abnormally high noradrenaline levels. He was clinically diagnosed with an extra-adrenal abdominal ectopic pheochromocytoma. After controlling blood pressure, surgery was performed, and the tumour was successfully removed. Histopathology revealed chromogranin A (+), synaptophysin (+), S100 protein (+), and MIB-1 index of 1%. Therefore, the patient was finally diagnosed with extra-adrenal abdominal ectopic pheochromocytoma.ConclusionsHaemoptysis is a rare manifestation of abdominal ectopic paraganglioma. Prompt consideration of pheochromocytoma/paraganglioma when patients experience haemoptysis without any other possible aetiology may prevent inappropriate diagnosis and treatment and ultimately fatalities.

Highlights • Diaphragmatic rupture is an uncommon trauma complication and it is most associated with blunt trauma. • Left diaphragmatic herniations are more common, once the liver is not susceptible to herniate through small perforation right-sided. • Chronic diaphragmatic herniation is associated with a higher morbimortality rate. • Chronic diaphragmatic herniation may take years to manifest any symptoms, which are not associated with herniated content., Introduction Diaphragmatic rupture is an uncommon trauma complication and it is associated with chronic diaphragmatic herniation, especially in the left side. Chronic diaphragmatic herniation is usually due to white weapon injury and as consequence of low suspicious and absence of proper investigation. Case report We report a chronic diaphragmatic herniation after three years of a stab in the left thoracoabdominal transition, managed through laparotomy. Discussion Traumatic diaphragmatic rupture is a rare trauma consequence, most common in the left side. The herniation occurs gradually because of negative pressure of the thoracic cavity that works as a suction of the abdominal organs. Conclusion Traumatic diaphragmatic ruptures diagnosis is difficult and might go unnoticed without high suspicious and proper investigation. Chronic herniation is associated with higher morbimortality.

A 2-year-old female African pygmy hedgehog (Atelerix albiventris) presented to emergency for anorexia, lethargy and vulvar discharge. Tranquilization with midazolam, administration of oxygen therapy and facemask anesthesia with isoflurane were used for radiography study which showed increased radio-opacity and silhouette sign in the thoracic cavity. The patient underwent cardio-respiratory arrest during the performance of TFAST echocardiography. TFAST confirmed pleural effusion, a nodule in the chamber of the right atrium. Abdominal ultrasound revealed two fluid filled structures compatible with left ovarian cysts. Necropsy confirmed dilated cardiomyopathy, bilateral atrial thrombi, endometrial hyperplasia and two left ovarian cysts.

Jarcho–Levin syndrome (JLS) is a rare, congenital disorder, inherited in an autosomal recessive pattern, that represents a spectrum of clinical and radiographic abnormalities of the spine and chest. The present case report discusses two siblings, an 11 year old girl and a 6 year old boy, diagnosed as cases of JLS based on family history and clinical-radiological findings. The main features of the syndrome are shortness of stature with a spinal abnormality, multiple abnormal vertebral defects, and a small malformed “fan-like” or “crab-like” rib cage due to posterior fusion and anterior flaring of the ribs, leading to short-trunk dwarfism. The spinal and rib malformations result in a small thoracic cavity, not capable of accommodating the growing lungs, causing thoracic insufficiency resulting in severe cardiac and respiratory complications and frequent chest infections. The diagnosis is based on clinical and radiological findings, characteristic physical appearance, symptoms of thoracic insufficiency, family history, consanguineous parents, skeletal survey, or specialized genetic tests for mutations. Milder forms are compatible with life.

The management of the robotic thoracic surgical patient requires the knowledge of minimally invasive surgery techniques involving the chest. Over the past decade, robotic-assisted thoracic surgery has grown, and, in the future, it will take an important place in the treatment of complex thoracic pathologies. The enhanced dexterity and three-dimensional visualization make it possible to do this in the small space of the thoracic cavity. Familiarity with the robotic surgical system by the anesthesiologists is mandatory. Management of a long period of one-lung ventilation with a left-sided double-lumen endotracheal tube or an independent bronchial blocker is required, along with flexible fiberoptic bronchoscopy techniques (best continuous monitoring). Correct patient positioning and prevention of complications such as eye or nerve or crashing injuries while the robotic system is used is mandatory. Recognition of the hemodynamic effects of carbon dioxide during insufflation in the chest is required. Cost is higher and outcome is not yet demonstrated to be better as compared to video-assisted thoracic surgery. The possibility for conversion to open thoracotomy should also be kept in mind. Teamwork is mandatory, as well as good communication between all the actors of the operating theatre., SCOPUS: re.j, info:eu-repo/semantics/published

The study is based on the study of 30 organ complexes from the human thoracic cavity, distributed into 5 age groups with 10-year interval, 6 observations in each group: 1st age group – 20–30 years, 2nd age group – 31–40 years, 3rd age group – 41–50 years, 4th age group – 51–60 years, 5th age group – 61–70 years. All medications were taken from people without heart and lung pathology at forensic autopsy according to the generally accepted method. Based on the results obtained, topographic features of lymph nodes location around the right main bronchus are given, which is of practical interest.

Introduction: Trapped lung, characterized by atelectatic lung unable to reexpand and fill the thoracic cavity due to a restricting fibrous visceral pleural peel, is occasionally seen in patients with end-stage liver disease complicated by hepatic hydrothorax. Limited data suggest that trapped lung prior to orthotopic liver transplantation may be associated with poor outcomes. Research Question: What is the clinical significance of trapped lung in patients receiving orthotopic liver transplantation? Design: We performed a retrospective analysis of patients who underwent liver transplantation over an 8-year period. Baseline clinical characteristics and postoperative outcomes of adult patients with trapped lung were analyzed and compared to the overall cohort of liver transplant recipients and controls matched 3:1 based on age, sex, Model for End-Stage Liver Disease (MELD) score, and presence of pleural effusion. Results: Of the 1193 patients who underwent liver transplantation, we identified 20 patients (1.68%) with trapped lung. The probability of 1 and 2-year survival were 75.0% and 57.1%, compared to 85.6% and 80.4% (p = 0.02) in all liver transplant recipients and 87.9% and 81.1% (p = 0.03) in matched controls respectively. Patients with trapped lung had a longer hospital length of stay compared to the total liver transplant population (geometric mean 54.9 ± 8.4 vs. 27.2 ± 0.7 days, p ≤ 0.001), when adjusted for age and MELD score. Discussion: Patients with trapped prior to orthotopic liver transplantation have increased probability of mortality as well as increased health care utilization. This is a small retrospective analysis, and further prospective investigation is warranted.

Yuanming Pan,1 Chaoqin Chen,1 Lingya Yu,2 Shengmei Zhu,1 Yueying Zheng1 1Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, People’s Republic of China; 2Department of Radiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, People’s Republic of ChinaCorrespondence: Shengmei Zhu; Yueying ZhengDepartment of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 31003, People’s Republic of ChinaTel +86-13777408863Email 1507128@zju.edu.cnBackground: The present study aimed to investigate the incidence and extent of difficult airway management in patients with massive retrosternal goiter.Design: An 8-year retrospective analysis was performed to identify patients who underwent massive retrosternal thyroidectomy. A total of 22 cases were identified as giant retrosternal goiter, followed by a review of each patient’s preoperative computerized tomography imaging.Interventions: There were no cases of failed intubation. Twenty patients underwent uneventful tracheal intubation using direct laryngoscopy or Glidescope. Thirteen patients received a muscle relaxant intravenously, and two patients were induced with sevoflurane. Five patients underwent awake tracheal intubation, including awake fiberoptic intubation in three patients. Before entering the operating theatre, the remaining two patients underwent oral tracheal intubation with Glidescope in the emergency department.Results: Two patients had tracheal intubation before they entered the operating theatre. Once entering vocal cords, tracheal intubation can pass beyond the site of the tracheal obstruction without difficulty. One patient died because of serious perioperative bleeding owing to the adhesion between the retrosternal goiter and large vessel within the thoracic cavity. One patient experienced dyspnea after extubation and was intubated again.Conclusion: Intravenous induction of muscle relaxant using laryngoscopy or Glidescope is feasible in patients with massive benign retrosternal goiter. The incidence of difficult intubation and postoperative tracheomalacia is likely too rare. Furthermore, perioperative bleeding and postoperative airway complication seem frequent.Keywords: airway management, anesthesia, retrosternal goiter, postoperative tracheomalacia

Highlights • Massive hemothorax due to splenic rupture is exceedingly rare. • Delayed or missed diagnosis of massive hemothorax due to splenic rupture is fatal. • Isolated diaphragmatic injury is very rare. • Diaphragmatic rupture signifies underlying serious injuries., Background Massive left hemothorax following left diaphragmatic and splenic rupture with visceral herniation is quite an uncommon life-threatening condition usually associated with blunt thoracoabdominal trauma. Mortality is generally associated with coexistent vascular and visceral injuries that could be rapidly fatal. Timely, and proper diagnosis is mandatory as survival depends on prompt diagnosis and treatment. Presentation of case We describe a case of massive left hemothorax secondary to blunt thoracoabdominal injury with left diaphragmatic and splenic rupture, gastric, greater omentum and splenic herniation into the left thoracic cavity in a 32 years old male car driver after sustaining a road traffic accident and presented with shortness of breath of 4 h’ duration. He also had zone 3 retroperitoneal hematoma and left acetabular fracture. He was treated surgically and discharged home improved. Discussion Diaphragmatic ruptures following blunt injuries are larger leading to herniation of visceral organs into the thoracic cavity and the most common organ to herniate on the left side is the stomach followed by omentum and small intestine. Splenic rupture is a very rare cause of hemothorax and is often missed in the differential diagnosis. Conclusion Massive hemothorax following splenic and diaphragmatic rupture with visceral herniation following either blunt or penetrating trauma is rare. Delayed or missed diagnosis is associated with higher morbidity and mortality. A high index of suspicion and proper use of diagnostic studies are crucial for early and correct diagnosis.

Purpose: Review on surgical affections of respiratory system and thoracic cavity in dogs Findings: There are many surgical conditions which are conducted on respiratory system and thoracic cavity in dogs. Among these, Brachycephalic dog syndrome, tracheotomy, tracheostomy, tracheal anastomosis, thoracotomy, thoracocentesis, and preicardioectomy. Before conducting any surgical condition, the nature and extent of the respiratory tract should be examined including historical information, suggestive signs of respiratory tract abnormalities, intended use of the animal, prognosis, complication, availability of the equipments, over all preoperative assessment and economic feasibility should be considered. In addition, the physical examination should include evaluation of regional symmetry of the head, neck, and thorax; evaluation of nasal airflow and patency; palpation of the nasal septum, larynx, and trachea; examination for surgical scars auscultation and percussion. Following thorough and systematic examination of the animals at rest, during and following motion may be warranted. Special examination techniques, including endoscopy, stress evaluation, and radiography, may be indicated. Unique Contributions to Theory Practice and Policy: Even though there are many physiological derangements due to surgical intervention in respiratory system and thoracic cavity in dogs, it may be healed through primary and secondary intention of healing under aseptic surgical condition. There are also many post operative cares for animals’ undergone surgical activity on respective and specific organs.

This study aimed to evaluate the impact of minimally invasive partial pericardiotomy on echocardiographic variables of morphometry and function in healthy horses. Minimally invasive pericardiotomy was performed in six healthy horses. Echocardiographic evaluation was executed in different moments: prior to the surgical procedure (M0); 24 hours post procedure (M1); 72 hours post procedure (M2) and 28 days post procedure (M3). The following variables were measured: Right ventricular internal diameter in diastole and systole (RVd and RVs), interventricular septum thickness in diastole and systole (IVSd and IVSs), left ventricular internal diameter in diastole and systole (LVd and LVs), left ventricular free wall thickness in diastole and systole (LVFWd and LVFWs), aortic root diameter (Ao) and left atrial diameter (LA). From this data, the following variables were calculated: fractional shortening (FS%), fractional thickening of the interventricular septum (IVS%), fractional thickening of the left ventricular free wall (LVFW%) and the relationship between left atrial and aortic diameters (LA/Ao). After 28 days, a new thoracoscopy was performed for inspection of the thoracic cavity. In M1 and M2 ECO evaluations, a statistically significant change in LVFW and a decrease in RVd, LVd, LVFWs, LA, LVs, FS% and IVS was documented. Pericardiotomy is a promising technique in horses, with minor postoperative complication. The variations in the echocardiographic parameters were transient and did not cause hemodynamic damage to the animals.

The application of transcatheter aortic valve replacement (TAVR) has expanded rapidly over the last decade as a less invasive option for the treatment of severe aortic stenosis. In order to perform successful TAVR, vascular access must be obtained with a large-bore catheter to deliver the transcatheter valve to the aortic annulus. Several techniques have been developed for this purpose including transfemoral (TF), trans-aortic, trans-apical, trans-caval, trans-carotid, and trans-axillary (TAx) with varying degrees of success. Among them, TF access is the most common and preferred method owing to its superior and well-established outcomes. However, in the setting of diseased iliofemoral arterial vessels, severe tortuosity, or iliofemoral arteries of insufficient caliber, TF access may not be possible. In these scenarios, one of the aforementioned alternative access routes needs to be considered. TAx-TAVR is an attractive alternative because it can be accomplished via access to a peripheral vessel as opposed to needing to enter the pericardial space or thoracic cavity. In addition, the open surgical cut-down procedure used to expose the axillary artery is familiar to cardiac surgeons who are accustomed to cannulating it for cardiopulmonary bypass. With advancements in TAVR technology including the evolution of delivery systems and corresponding smaller sheath sizes, total percutaneous access via the axillary artery is gaining substantial attention. In this review, we outline key aspects of patient selection, imaging and procedural techniques, and examine contemporary clinical outcomes with this approach.

We report the clinical case of treating a female patient with a giant dumbbell neurinoma arising from the Th1 nerve root. For the treatment of neoplasm, a hybrid surgical tactic was chosen, including Th1 hemilaminectomy, mobilization of the dorsal part of the tumor and video-assisted thoracoscopy in order to remove its intrathoracic mass. The patient developed no neurological complications after surgery. A gross total tumor resection was documented by control computed tomography. Thus, well-coordinated work of the multidisciplinary surgical team provided good oncological and functional results in the treatment of a giant neurinoma with extension into the thoracic cavity.

Pulmonary lymphatic disorders are characterized by the presence of the abnormal lymphatic tissues in the thoracic cavity, presenting clinically as chylothorax, chylopericardium, chyloptysis, interstitial lung disease and plastic bronchitis. These conditions include: neonatal chylothorax, cardiac and non-cardiac plastic bronchitis, non-traumatic chylothorax, post congenital cardiac surgery chylothorax and complex lymphatic malformations. Recently developed lymphatic imaging techniques, such as intranodal lymphangiography and dynamic contrast enhanced magnetic resonance lymphangiography demonstrated abnormal pulmonary lymphatic flow from thoracic duct into pulmonary parenchyma as a pathophysiological mechanism of these diseases. Novel minimally invasive lymphatic interventions, such as thoracic duct embolization, interstitial lymphatic embolization and surgical lympho-venous anastomosis, provide an effective treatment of these conditions.

While technical considerations in lung transplantation for Kartagener syndrome have been discussed, little information is available about the postoperative morphological changes of the grafted lungs. Herein, we discuss both the technical aspects and postoperative morphological adaptation of the grafted lungs in a case of Kartagener syndrome. A 46-year-old male patient with Kartagener syndrome underwent bilateral cadaveric lung transplantation. The right arterial anastomosis for transplantation of the size-matched grafts required technical elaboration. After the transplantation, we found a free space in the cardiac notch of the left lung and partial collapse of the lower lobe of the right lung due to dextrocardia. Follow-up computed tomography performed on day 42 after the transplantation demonstrated resolution of the atelectasis and morphological adaptation of the grafts into the recipient’s chest cavity with dextrocardia. Considering such early morphological adaptation of size-matched grafts, lobar reduction could be avoided in lung transplantation for Kartagener syndrome.

Spondylocostal dysplasia (SCD) is a rare costovertebral malformation characterised by short-trunk short stature. It is a recessively inherited disorder, and commonly identified disease-causing mutations are in DLL3 gene. The reported prevalence is 1 : 200,000 worldwide, and none was reported from Sri Lanka. We report a 7-year-old Sri Lankan girl with spondylocostal dysplasia presenting with short stature and scoliosis. Disproportionate short stature was noted with short upper segment and small thoracic cavity. Skeletal survey revealed fused vertebra involving T5-T6, T9-T10, and L3-L4. Butterfly vertebrae were noted in T2, T4, T6, and T9. Diagnosis of SCD was made based on classic radiological features including vertebral fusion and rib abnormalities. Spirometry was performed due to small thoracic cavity which showed results compatible with moderate to severe restrictive lung disease. The child did not report respiratory difficulties or recurrent chest infections up to the presentation. She was referred to an orthopaedic team which recommended conservative management with close follow-up. In conclusion, spondylocostal dysplasia should be considered in short-trunk short stature with rib abnormalities in the absence of limb shortening. Appropriate treatment and follow-up for restrictive lung disease would determine the long-term outcome.

BACKGROUND: Pneumothorax refers to the abnormal presence of air in the thoracic cavity. Pulmonary emphysema (PE) is often detected during computed tomography (CT), one of the radiological investigations used to diagnose pneumothorax and devise treatment plans in former or current smokers who present with pneumothorax. However, there are few reports that describe the recurrence rate and risk factors associated with recurrence in patients with PE and pneumothorax. METHODS: This study retrospectively cross-sectional analyzed the medical records of 164 patients diagnosed with their first episode of secondary spontaneous pneumothorax and admitted to a tertiary care hospital, between March 2013 and February 2019. The CT scans of 98 patients revealed PE, and 49 patients of those underwent pulmonary function tests (PFTs) after the resolution of pneumothorax. Risk factors for recurrence were analyzed using Cox proportional hazard regression. RESULTS: All the subjects were male and former or current smokers, with a median age of 72 years. Thirty-seven (75.5%) patients were treated with tube thoracostomy alone, whereas 12 (24.5%) patients underwent chemical pleurodesis via chest tube or video-assisted thoracoscopic surgery. After recovery from pneumothorax, these patients underwent PFT within a median time period of 5.8 months. Median forced vital capacity and forced expiratory volume in 1 second (FEV(1)) were 3.02 L (91% predicted) and 1.58 L (67% predicted), respectively. In the current study, the recurrence rate of pneumothorax was observed to be 30.6%, within a median time period of 12.4 months. In multivariable-adjusted analysis, decreased FEV(1) was observed to be significantly higher in the patients who exhibited recurrence of pneumothorax than in those who did not (adjusted hazard ratio, 0.408; P=0.025). CONCLUSIONS: In patients with PE and pneumothorax, PFT, performed after recovery, could be a useful test for predicting the recurrence of pneumothorax.

Purpose: The aim was to identify vascular calcification in 4DCT scan of lung cancer patients and establish the association between overall survival (OS) and vascular calcification, as surrogate for vascular health. Methods: Vascular calcification within the thoracic cavity were segmented in 334 lung cancer patients treated with stereotactic body radiation therapy (SBRT). This has been done automatically on 4D planning CT and average reconstruction scans. Correlation between cardiac comorbidity and calcification volumes was evaluated for patients with recorded Adult Co-Morbidity Evaluation (n = 303). Associations between the identified calcifications and OS were further investigated. Results: The volume of calcification from the average scan was significantly lower than from each phase (p < 0.001). The highest level of correlations between cardiac comorbidity and volume of the calcifications were found for one phase representing inhale and two phases representing exhale with the least motion blurring due to respiration (p < 0.005). The volume of the calcifications was subsequently averaged over these three phases. The average of calcification volumes over the three phases (denoted by inhale-exhale) showed the highest likelihood in univariate analysis and was chosen as vascular calcification measure. Cox-model suggested that tumor volume (Hazard Ratio [HR] = 1.46, p < 0.01) and inhale-exhale volume (HR = 1.05, p < 0.05) are independent factors predicting OS after adjusting for age, sex, and performance status. Conclusion: It was feasible to use. It 4DCT scan for identifying thoracic calcifications in lung cancer patients treated with SBRT. Calcification volumes from inhale-exhale phases had the highest correlation with overall cardiac comorbidity and the average of the calcification volume obtained from these phases was an independent predictive factor for OS.

The purpose of this study was to design and evaluate chitosan dispersed lipid vesicles (chitosomes) as potential delivery carriers for repurposing metformin (Met) against malignant pleural mesothelioma. Chitosomes were prepared by directly hydrating the thin lipid film using chitosan solution as hydration medium, instead of using it as a coating agent. Developed chitosomes demonstrated spherical morphology, positive surface charge (~30 mV) and ~60% encapsulation efficiency. The calorimetric studies and X-ray diffraction pattern of Met-loaded chitosomes confirmed the successful encapsulation of Met inside the chitosome vesicles. Optimized chitosome formulation showed ~70% drug release in 72 h, displaying prolonged and controlled release of drug. Results demonstrated that Met encapsulated chitosomes possessed enhanced cellular internalization and improved cytotoxic potential. Our findings also supported inhibitory activity of chitosomes against metastatic property of pleural mesothelioma cells. The in-vitro tumor simulation studies further established anti-tumor activity of Met encapsulated chitosomes as supported by reduction in tumor volume and presence of minimal viable cells in tumor mass. The obtained results establish the effectiveness of chitosomes as delivery carrier for Met as treatment alternative for malignant pleural mesothelioma.

Background The exact epidemiology of acute aortic dissection, including cases of out-of-hospital cardiopulmonary arrest, is unclear. We aimed to investigate the incidence and characteristics of acute aortic dissection in patients with out-of-hospital cardiopulmonary arrest transferred to our institution and validate the related factors to out-of-hospital cardiopulmonary arrest in Stanford type A acute aortic dissection. Methods We retrospectively reviewed the acute-phase computed tomography data of patients with out-of-hospital cardiopulmonary arrest who visited our hospital between 1 January 2015 and 31 December 2017. Results Among 1011 consecutive patients with out-of-hospital cardiopulmonary arrest, excluding those aged 17 years and younger and exogenous out-of-hospital cardiopulmonary arrest, such as suicide and trauma, 934 underwent computed tomography examination and 71 (7.6%) were diagnosed with acute aortic dissection: 66 with Stanford type A and five with type B acute aortic dissection (out-of-hospital cardiopulmonary arrest group). Seventy-five patients without out-of-hospital cardiopulmonary arrest with Stanford type A acute aortic dissection visited our institution during the same period (non-out-of-hospital cardiopulmonary arrest group). Age, incidence of massive bloody pericardial effusion and massive intrathoracic haemorrhage were significantly higher in the out-of-hospital cardiopulmonary arrest than in the non-out-of-hospital cardiopulmonary arrest group (78 ± 8 years, 72.7% and 24.2% vs. 70 ± 13 years, 26.7% and 1.3%, respectively; all P Conclusions There may be more patients with acute aortic dissection with out-of-hospital cardiopulmonary arrest than previously thought. Aortic rupture into the pericardial space or thoracic cavity is the major cause of out-of-hospital cardiopulmonary arrest in these cases. Non-contrast computed tomography can be used to diagnose acute aortic dissection in patients with out-of-hospital cardiopulmonary arrest. Our study is one of a few to evaluate the real circumstances surrounding acute aortic dissection and its epidemiology.

Objective — familiarization health professionals working in emergency departments, imaging depart­ments, clinical departments, intensive care units and other health care settings with methods of diagnosis and management of COVID-19 patients.Materials and methods. 11 modern references were analyzed in this review, in which considered evidence and recommendations for use of the thoracic cavity visualization in acute care of adult patients with suspected, probable or confirmed COVID-19, including chest radiography, computed tomography and lung ultrasound.Results and discussion. It was found from the references that the thoracic cavity visualization is considered as a part of a diagnostic examination for patients with suspected COVID-19 or probable coronavirus disease, when reverse transcriptase polymerase chain reaction (RT-PCR) testing is not available, RT-PCR testing is available, but results are delayed or initial RT-PCR testing is negative, but with high clinical of suspicion of COVID-19. Imaging is also considered to be an addition to the diagnostic workup clinical and laboratory data in the management of patients already diagnosed with COVID-19. Recommendations are provided for six different clinical scenarios.Conclusions. An important component of the timely diagnosis of COVID-19 is the collection of anamnesis, the detection of SARS-CoV-2 virus RNA in the nasopharyngeal lavage by PCR (polymerase chain reaction) with real-time detection of results, the thoracic cavity visualization (chest radiography, computed tomography and lung ultrasound), which helps diagnose pneumonia at the initial stage of the disease and track the effectiveness of treatment, taking into account radiography dynamics.

Objective Malignant pleural mesothelioma is a lethal malignancy with poor survival and high local recurrence rates despite multimodal therapy with cytoreduction and chemoradiation. We evaluated the antitumor efficacy of a paclitaxel-loaded pH-responsive expansile nanoparticle (PTX-eNP) in 2 clinically relevant murine xenograft models of malignant pleural mesothelioma. Methods Luciferase-transfected MSTO-211H human mesothelioma cells were injected into the thoracic cavity of immunodeficient Nu/J mice. Tumor burden was monitored by bioluminescent imaging. Animals were randomized into 2 models of disease treatment chemotherapy with PTX-eNPs alone delivered locally for early limited disease or cytoreductive surgery plus local PTX-eNP chemotherapy for advanced disease. Within each disease model, anti-tumor efficacy of PTX-eNP was compared against standard formulation paclitaxel and drug-empty nanoparticles. Influence on survival was calculated. Fluorescently labeled PTX-eNPs and immunohistochemistry evaluated in vivo drug localization to tumor. Results Intrathoracic injection of MSTO-211H resulted in large tumor deposits distributed within the pleural space of the murine thoracic cavity. Local multidose treatment with PTX-eNPs alone in limited stage disease more than doubled survival compared with drug-empty nanoparticles (P ≤ .0001) and standard formulation paclitaxel (P = .0004). In the model of advanced disease, local multidose treatment with PTX-eNPs following cytoreductive surgery also prolonged survival by 126% and 69.4% compared with drug-empty nanoparticles (P = .0018) and standard formulation paclitaxel (P = .03457), respectively. Immunohistology demonstrated PTX-eNP accumulation within tumor cells in vitro and in vivo. Conclusions Local delivery of paclitaxel via eNPs confers prolonged survival in a murine model of malignant pleural mesothelioma as single modality treatment for limited disease and in combination with cytoreductive surgery for advanced disease.

Highlights • Very rare case of intrathoracic lipoma in an asymptomatic young male of Bangladesh. • Can remain clinically silent due to slow growth. • Must be considered as a differential for large intrathoracic mass. • CT scan and MRI are often diagnostic. • Prolonged chest drainage may occur after complete resection., Introduction Lipoma in the thoracic cavity is very rare, unlike any subcutaneous lipoma, and can often grow very large without showing any symptoms. Case We report a 42-year-old man having giant intrathoracic lipoma which was found incidentally during routine checkup and the first documented case of the such type in Bangladesh. This benign tumor occupied almost the entire left hemithorax, and it was resected successfully by thoracotomy. The postoperative period was uneventful except for prolonged chest drain. Histological analysis confirmed intrathoracic lipoma. Discussion Usually, patients with intrathoracic lipoma are asymptomatic. But since lipomas can grow to a large size, they may cause symptoms due to the compression effect. Lipoma should be considered a differential diagnosis of asymptomatic large intrathoracic mass, and imaging is the best method for initial identification. Conclusion As intrathoracic lipoma typically grows very slowly over years without any symptoms and signs, late diagnosis is common. Complete surgical extirpation is needed to prevent further recurrence.

This manuscript describes a dataset of thoracic cavity segmentations and discrete pleural effusion segmentations we have annotated on 402 computed tomography (CT) scans acquired from patients with non-small cell lung cancer. The segmentation of these anatomic regions precedes fundamental tasks in image analysis pipelines such as lung structure segmentation, lesion detection, and radiomics feature extraction. Bilateral thoracic cavity volumes and pleural effusion volumes were manually segmented on CT scans acquired from The Cancer Imaging Archive "NSCLC Radiomics" data collection. Four hundred and two thoracic segmentations were first generated automatically by a U-Net based algorithm trained on chest CTs without cancer, manually corrected by a medical student to include the complete thoracic cavity (normal, pathologic, and atelectatic lung parenchyma, lung hilum, pleural effusion, fibrosis, nodules, tumor, and other anatomic anomalies), and revised by a radiation oncologist or a radiologist. Seventy-eight pleural effusions were manually segmented by a medical student and revised by a radiologist or radiation oncologist. Interobserver agreement between the radiation oncologist and radiologist corrections was acceptable. All expert-vetted segmentations are publicly available in NIfTI format through The Cancer Imaging Archive at https://doi.org/10.7937/tcia.2020.6c7y-gq39. Tabular data detailing clinical and technical metadata linked to segmentation cases are also available. Thoracic cavity segmentations will be valuable for developing image analysis pipelines on pathologic lungs - where current automated algorithms struggle most. In conjunction with gross tumor volume segmentations already available from "NSCLC Radiomics," pleural effusion segmentations may be valuable for investigating radiomics profile differences between effusion and primary tumor or training algorithms to discriminate between them.

Incarcerated diaphragmatic hernias with intrathoracic perforation of the colon is a very rare but serious surgical emergency. A 78-year-old male patient presented to our emergency department with severe abdominal pain. A computer tomography (CT) scan revealed herniation of the left transverse colon and spleen into the thorax with colon perforation and fecal contents in the thoracic cavity. An emergent laparotomy confirmed the radiological diagnosis and showed a 6 cm dehiscence of the left diaphragm with strangulation of the left transverse colon as well as the spleen. A left-sided hemicolectomy with terminal transversostomy and splenectomy were performed. The diaphragm was closed with interrupted nonabsorbable sutures. We abstained from reinforcement of the suture line with a mesh because of the feculent contamination of the abdominal cavity. After extensive thoracoscopic lavage and insertion of two chest tubes, the patient was transferred to the intensive care unit. Diaphragmatic hernia even after a mild chest trauma can cause fatal complications. Diagnosis and treatment can be challenging and an interdisciplinary approach is recommended. Due to the associated comorbidity and long-lasting sequelae, we believe the awareness of this rare pathology as a differential diagnosis is important; both as an abdominal and thoracic emergency.

Chylothorax is a condition in which chyle leaks into the thoracic cavity. The causes of chylothorax can be nontraumatic, traumatic or idiopathic. The most common cause of nontraumatic chylothorax is obstruction of the thoracic duct by tumor. Traumatic chylothorax is caused by disruption of the thoracic duct, most often due to cardiac surgery or a thoracic surgical procedure, although in rare cases by cough or vomiting. We report the case of a 3-month-old boy with respiratory syncytial (RS) virus infection who presented with right chylothorax. No obstructive tumor mass was identified in the thoracic duct. Clinical symptoms of Noonan syndrome and Down syndrome, which often accompany lymphatic anomaly, were not found. Therefore, we speculate that his severe cough caused a high thoracic pressure and a disruption of the thoracic duct. He was treated by thoracocentesis and MCT milk. One month later, pleural effusion disappeared and did not recur. RS virus infection might be a rare cause of chylothorax in infants.

INSM1 is a diagnostic marker for neuroendocrine tumors originating in multiple anatomic sites. In the lung, INSM1 shows 76-97% sensitivity for neuroendocrine tumors overall. Our aim was to characterize INSM1 as a diagnostic marker for small cell carcinoma in the context of its epithelial, lymphoid, and mesenchymal morphologic mimics. Immunohistochemistry was performed on 231 tumors, including lung neuroendocrine tumors, nonneuroendocrine carcinomas of the thoracic cavity, diffuse large B-cell lymphomas, and small round cell sarcomas, using an anti-INSM1 mouse monoclonal antibody. Extent (0-100%) and intensity (1-3+) of nuclear INSM1 staining was multiplied in each case to calculate an H-score. Demographic and clinical information was obtained from the medical record. INSM1 had an overall sensitivity and specificity of 81.5% and 82.7% for small cell carcinoma, respectively, using a threshold established with a receiver operating characteristic curve. 40/48 (82.7%) small cell carcinomas were positive for INSM1, including 19/24 (79%) small cell carcinomas that were negative for chromogranin and synaptophysin. 5/5 carcinoids and 21/28 (75%) large cell neuroendocrine carcinomas showed INSM1 expression. Among nonneuroendocrine tumors, 7/38 (18%) lung adenocarcinomas, 2/17 (12%) lung squamous cell carcinomas, 4/10 (40%) thymic carcinomas, 4/12 (33%) adenoid cystic carcinomas, 1/19 (5%) diffuse large B-cell lymphomas, 4/11 (36%) alveolar rhabdomyosarcomas, and 4/23 (17%) Ewing sarcomas were positive for INSM1. No synovial sarcomas or desmoplastic small round cell tumors were positive. Weak, focal INSM1 expression alone is insufficient as a diagnostic marker for small cell carcinoma, but is sensitive and specific, easy to interpret in small biopsies, and makes a valuable addition to a diagnostic panel.

Aspergillus empyema is treated with either systemic administration of antifungal drugs or surgery, but the mortality rate is very high. Here, we report a case of Aspergillus empyema successfully treated using combined intrathoracic and intravenous administration of voriconazole (VRCZ). Treatment success was achieved by monitoring VRCZ plasma trough concentration. The patient was a 71-year-old Japanese woman diagnosed with Aspergillus empyema whom we started on intravenous administration of VRCZ. Although penetration of VRCZ into the pleural effusion was confirmed, the level was below 1 μg/mL, which is the minimum inhibitory concentration for Aspergillus fumigatus determined by antifungal susceptibility testing in pleural effusion culture. Therefore, we initiated combination therapy with intrathoracic and intravenous administration of VRCZ. VRCZ 200 mg was first dissolved in 50-100 mL of saline and administered into the thoracic cavity via a chest tube. The chest tube was clamped for 5-6 h, and then VRCZ solution was excreted though the chest tube. When a single dose of the VRCZ was administered into the intrathoracic space, the plasma concentration before intravenous administration increased from 1.45 μg/mL on day 27 to 1.53 μg/mL on day 28. Although intravenous administration was continued, the VRCZ plasma trough concentration decreased to 1.36 μg/mL on day 29. We therefore decided on an intrathoracic administration schedule of 2-3 times a week. Intrathoracic administration was performed 14 times in total until fenestration surgery on day 64. Our case suggests that combined intrathoracic and intravenous administration of VRCZ may be a valid treatment option for Aspergillus empyema.

A 2-year old female domestic shorthair cat was referred with intermittent vomiting. Laboratory analyses revealed only an elevated alanine aminotransferase activity. Plain thoracic radiographs showed a right-sided transdiaphragm protrusion of a liver lobe into the thoracic cavity. On abdominal ultrasound the diaphragm and liver parenchyma also presented a bulge towards the thoracic cavity. By cranial median laparotomy herniation of the quadrate liver lobe through the right aspect of the diaphragm into the thoracic cavity was confirmed. The protruding quadrate liver lobe was covered by intact parietal peritoneum. Following relocation of the liver lobe the defect was closed. Postoperatively the intermittent vomiting stopped. The purpose of this case report was to present plain radiography and abdominal ultrasonography as effective tools in the diagnosis of this rare and usually asymptomatic true herniation case along with its operative treatment.Eine 2-jährige einheimische Kurzhaarkatze wurde aufgrund von intermittierendem Erbrechen vorgestellt. Labordiagnostisch ergab sich bei dem klinisch unauffälligen Tier nur eine erhöhte Alanin-Aminotransferase-Aktivität. Auf nativen Röntgenaufnahmen des Thorax zeigte sich eine rechtsseitige Zwerchfellhernie der Leber. Sonografisch ließ sich ein bogenförmiger Vorfall eines Leberanteils in Richtung Thorax darstellen. Die kraniale mediane Laparotomie bestätigte, dass rechtsseitig ein Teil des Lobus quadratus der Leber umhüllt mit parietalem Bauchfell durch eine Öffnung im Zwerchfell in die Brusthöhle verlagert war. Nach Rückverlagerung des Leberanteils wurde der Defekt verschlossen. Postoperativ sistierte die klinische Symptomatik. Das Ziel des Fallberichts ist, den seltenen und normalerweise asymptomatischen Fall einer echten Zwerchfellhernie mit der operativen Behandlung vorzustellen und zu zeigen, dass native Röntgen- und abdominale Ultraschalluntersuchungen effektive Verfahren zur Diagnosestellung sind.

Among the animal data, we have biometric measures related to the development and production of goats. Thus, the objective of this study was to evaluate the correlation between live weight and thoracic perimeter in the caprine species, in order to obtain a barometric tape to estimate the live weight of the animal, without the use of the scale. Caprines from 10 to 42 kg live weight were used; males and females; pure Saanen race and Saanen-Boer crossbred. The thoracic perimeter of each animal was measured after weighing, in which it was measured at the external circumference of the thoracic cavity, just below the axillae, with steel cable to minimize possible errors from the elasticity of the tape measure, with the animal in the correct position of legs angulations. All parameters were recorded with the fasting animal for 12 h. Subsequently the live weight was estimated by regression equations with high correlation coefficients. The study showed a strong positive correlation between live weight (kg) of the animal and the thoracic perimeter (cm). The barometric tape for Saanen and Saanen x Boer crossbreed presented 97% efficacy for the estimation of the weight of Saanen and crossbreed. The thoracic perimeter provides a high efficiency in the estimation of the live weight of caprines and can be used as an alternative when scales are not available, being more appropriate the separation by race and sex before adjusting the equation to be calculated.

Introduction: Manual therapy uses the hands as a form of healing, being a manipulation for therapeutic purposes. However, there is little evidence of its effects on the respiratory system. Objective: To describe the effect of manual therapy on the diaphragm, on respiratory muscle strength and on the mobility of the thoracic cavity. Method: Descriptive, longitudinal, interventional and quantitative research, performed at the Cardiopneumofunctional Physical Therapy Laboratory of the Federal University of Ceará (UFC). The sample consisted of 40 sedentary female students, aged between 18 and 35 years of the Physiotherapy course of the UFC. The following techniques were performed: “diaphragm lift” and double diaphragm. Data collection was performed in three steps, on the same day and by the same researcher, under a homogeneous verbal command. It was considered statistically significant value of p≤0,05. Results: After applying the techniques, a comparative analysis was performed, which demonstrated a statistically significant difference in the maximum expiratory pressure, with p< 0,0001, and all the coefficients of the cirtometry, being p

Esophageal replacement surgery is performed in children with either congenital long gap esophageal atresia or acquired esophageal damages such as caustic injury of the esophagus. although the left colon because of less variation in blood supply and suitable diameter in comparison with right colon is the better choice. A secured pedicled colon is mandatory for reducing the sever complications, such as leak and necrosis. Ileocolic conduit is an alternative method of colon interposition which has anti reflux effect and therefore with less complications related to gastroesophageal reflux. When we have a short segment esophageal stricture due to corrosive esophagitis or other causes of esophageal strictures which is refractory to repeated dilatations, it is advisable to perform colon patch esophagoplasty. Gastric transposition can produce a good way for gastrointestinal continuity with a perfect weight gain and oral feeding, therefor it can be a safe choice for esophageal replacement in children. Partial gastric pull-up is an alternative operation for esophageal replacement in children and infants with long gap esophageal atresia. Gastric conduit replacement is another alternative technique for esophageal replacement, in which a gastric tube is created in the abdomen and it is pulled to via thoracic cavity to the neck and is committed by cervical anastomosis. Antral patch esophagoplasty is used for benign and limited esophageal stricture due to gastroesophageal reflux. Usefulness of pedicled jejunum was under optimal results because of technical problems and high rate of necrosis and mortality for decades. Sternocleidomastoid myocutaneous esophagoplasty is a scarce method which is reported by some surgeons for limited cervical esophageal stricture repair. Free microvascular transfer of the reverse ileo-colon flap with ileocaecal valve valvuloplasty is used for reconstruction of a pharyngoesophageal defect, and Patch esophagoplasty by using of degradable bioscaffolds of extracellular matrix have shown good results in preclinical and clinical outcomes to prevent stenosis after endoscopic mucosectomy. We will explain the advantages and disadvantages of these different surgical methods in this review article.

We successfully performed shunting for a fetus with a multilocular macrocystic lung mass with hydrops at 22 weeks' gestation. Complete resolution of hydrops was achieved; however, at 35 weeks' gestation, the fetus developed acute massive pleural effusion. Fetal ultrasound examination revealed that one end of the shunting tube had migrated downward in the thoracic cavity, which led to fluid draining from the lung cyst. The baby was delivered at term and was discharged following neonatal intensive care management. Intrathoracic displacement of the shunt can occur, followed by massive pleural effusion due to drainage of cystic fluid.

Spontaneous diaphragm rupture is a rare but potentially life-threatening condition, requiring urgent surgical intervention. Here we present two patients who developed spontaneous right hemidiaphragm rupture with abdominal visceral herniation into the thoracic cavity several days following bilateral lung transplantation, as an unusual complication. Both patients' surgeries were performed through bilateral anterior thoracotomies and were uneventful. There may be an association with this complication and patients suffering with emphysema, typically receiving donor lungs smaller than their native lungs, and with significant pretransplant exposure to steroids, factors that when combined may contribute to an increased risk of spontaneous diaphragmatic rupture in the absence of a significant precipitant. If a similar clinical picture is seen, teams managing lung transplant recipients should be aware of this potential complication and recognize the need for urgent intervention.

Thoracic dumbbell tumors are relatively uncommon neoplasms that arise from the neurogenic elements. Surgical resection can be challenging as the tumor involves both the spinal canal and thoracic cavity. Historically, thoracotomy and laminectomy were utilized for the resection of these tumors. Although single-stage removal of such tumors has been described recently, there is no prior description of a total minimally invasive single-stage resection of a thoracic dumbbell ganglioneuroma. The current report describes a completely minimally invasive surgical resection for such a tumor performed using the posterior minimally invasive tubular approach to resect the intraspinal component with ligation of the T2 nerve root in conjunction with robotic-assisted thoracoscopic resection of the extraforaminal, intrathoracic component of the tumor. This report illustrates the safety and utility of a completely minimally invasive endoscopic resection of a thoracic dumbbell tumor that can potentially obviate the morbidity associated with open surgical resections for such tumors.

Background A new, self‐contained, digital, continuous pump‐driven chest drainage system is compared in a randomized control trial to a traditional wall‐suction system in cardiac surgery. Methods One hundred and twenty adult elective cardiac patients undergoing coronary artery bypass graft and/or valve surgery were randomized to the study or control group. Both groups had similar pre/intra‐operative demographics: age 67.8 vs 67.0 years, Euroscore 2.3 vs 2.2, and body surface area 1.92 vs 1.91 m2. Additionally, a satisfaction assessment score (0‐10) was performed by 52 staff members. Results Given homogenous intra‐operative variables, total chest‐tube drainage was comparable among groups (566 vs 640 mL; ns), but the study group showed more efficient fluid collection during the early postoperative phase due to continuous suction (P = .01). Blood, cell saver transfusions and postoperative hemoglobin values were similar in both groups. The study group experienced drain removal after 29.8 vs 38.4 hours in the control group (ns). Seven crossovers from the Study to the Control group were registered but no patient had drain‐related complications. The Personnel Satisfaction Assessment scored above 5 for all questions asked. Conclusions The new, digital, chest drainage system showed better early drainage of the chest cavity and was as reliable as conventional systems. Quicker drain removal might impact on intensive care unit (ICU) stay and reduce costs. Additional advantages are portable size, battery operation, patient mobility, noiseless function, digital indications and alarms. The satisfaction assessment of the new system by the staff revealed a higher score when compared to the traditional wall suction chest drainage system.

Morphological and anatomical characteristics of the posterior intercostal arteries have revived interest in their branching networks. Collateral supply between intercostal spaces is extensive due to anastomoses, although the data about the quantitative description of the branching networks in the existing literature are rather limited. The presence of collateral network between branches of the posterior intercostal arteries has been studied on forty-three Thiel-embalmed human cadavers. A network-based approach has been used to quantify the measured vascular branching patterns. Connections between branches of the same or adjacent posterior intercostal artery were identified. The non-anastomosing branches coursing in the intercostal spaces were also observed and their abundance was higher in comparison to anastomosing vessels. A quantitative analysis of collateral branching networks has revealed the highest density of vessels located close to the costal angle and most of the anastomosing branches were found between the fourth and tenth intercostal space. Anastomoses within the same posterior intercostal artery were more frequent in higher intercostal spaces, whereas in the lower intercostal spaces more connections were established between neighboring intercostal arteries. Our results indicate that due to abundant collateral contribution the possibility to cause an ischemic injury is rather low unless there is considerable damage to the blood supply of the trunk or surgical complication leading to ischemia or necrosis. Analyzing the proper course of collateral contributions of the posterior intercostal arteries may support further directions regarding the safest place for percutaneous transthoracic interventions, thoracocentesis, and lung biopsy.

A case of fatal Pasteurellosis infection in a 2-month-old rabbit is described. Pasteurellosis is considered one of the most important diseases of rabbits and has been reported as a constant serious and highly contagious disease of domestic rabbits. Before death, the main clinical signs observed were rhinitis with nasal discharge, abdominal breathing and coughing. At necropsy, pathological findings revealed severe pleuropneumonia with the accumulation of a remarkable amount of fibrinopurulent exudate in the thoracic cavity, serous rhinitis and tracheitis. A bacterial isolate from lungs was identified as Pasteurella multocida serotype A. The present study describes the histopathological lesions associated with P. multocida infection in a pet rabbit brought to visit with respiratory signs.

To get a clear view of the current state of treatment for esophageal perforation in Japan. Esophagus perforations are the most serious gastrointestinal tract perforations and are associated with high morbidity and mortality. The optimal treatment choice remains unknown. We conducted a retrospective clinical review of 182 esophageal perforation cases at 108 hospitals accredited by the Japanese Esophageal Society between January 2010 and December 2015. We found that 20.9% of patients were incorrectly diagnosed initially. We observed mediastinum emphysema in 83.5% of patients, and serious abscess formations of the mediastinum and intrathoracic cavity in 38.6% and 29.6%, respectively. The lower esophagus was the most commonly perforated site (77.7%). Management of esophageal perforations included nonoperative treatment in 20 patients (11%) and operative treatment in 162 patients (89%). The overall mortality rate was 6.9%. The survivors had significantly shorter times from symptom appearance to visit (p = 0.0016), and from time to visit to diagnosis confirmation (p = 0.0011). Moreover, patients older than 65 years, white blood cells less than 3000/mm3, C-reactive protein > 10 mg/L, or abscesses in the thoracic cavity showed significantly higher mortality than others. Shortening the time from onset to the start of treatment contributes to reduce mortality in patients with esophageal perforation. Moreover, strict medical treatment is necessary to lower the mortality rate of elderly patients with strong inflammation and abscesses in the thoracic cavity.

Congenital diaphragmatic hernia (CDH) is a condition characterized by defect in the diaphragm which leads to protrusion of abdominal contents or viscera into the thoracic cavity interfering with normal development of the lungs. CDH is a developmental defect of diaphragm associated with significant neonatal mortality and morbidity. Incomplete development of diaphragm allows the abdominal content to invade the thoracic cavity resulting in compression of the developing lungs. Most of the CDH diagnosed in the new born or early childhood. Around 1% with CDH have no symptoms and may be detected incidentally. Diaphragmatic hernias can be divided into two broad categories: congenital and acquired. A congenital diaphragmatic hernia (CDH) occurs through embryologic defects in the diaphragm, and most patients present early in life rather than later. However, a subset of adults may present with a smaller CDH that was undetected during childhood. Infants with CDH often present in the neonatal period with severe respiratory distress. Early surgery is mainstay of treatment in newborn as mortality is very high in this condition. Here, we are describing very late presentation of a case of congenital diaphragmatic hernia treated by surgery with good post operative outcome. This case report summarizes how to diagnose and manage a late-presenting congenital diaphragmatic hernia to prevent further complications.

Thoracic surgery practice has changed dramatically in the last two decades. A major shift in emphasis is towards increasing adoption of minimally invasive approaches. Initially, minimally invasive thoracic surgery focused on more basic procedures such as lung biopsy and pleural procedures. In the last decade, more complex procedures are performed minimally invasively. In particular, video-assisted thoracoscopic surgery (VATS) lobectomy is now the most common approach across the UK for lung cancer surgery. This article summarizes the clinically orientated anatomy of the thoracic cavity, particularly in relation to surgical landmarks. Common surgical approaches in thoracic surgery will also be reviewed, from traditional thoracotomy to minimally invasive approaches including standard VATS and robot-assisted procedures, as well as more novel techniques including subxiphoid VATS. A detailed description of the technical aspects of pulmonary lobectomy and pneumonectomy are provided along with perioperative considerations.

We present a unique case of a patient simultaneously diagnosed with solitary fibrous tumor (SFT) and unrelated adenocarcinoma of the lung, both proven with separate pathology. It was subsequently found that the SFT had metastasized to the brain by additional pathology, and not the predicted adenocarcinoma. SFTs are a rare mesenchymal neoplasm that accounts for less than 2% of all reported soft tissue tumors. SFTs most commonly arise in the thoracic cavity, but are frequently found in various locations throughout the body, and rarely metastasize to the brain. This case highlights that rare neoplasms, such as SFT, should not be ruled out as a potential cause of metastasis. Due to the rarity of this clinical situation, we also provide a review and discussion of previously reported SFT cases and the use of postoperative radiation therapy. The optimal treatment for individual patients remains unclear in this unique situation. Surgical resection followed by adjuvant Gamma Knife radiation therapy to the surgical bed appears to be a safe option for local treatment of SFT in select patients. Further studies are needed of this rare clinical situation in order to better understand and optimize future treatments for patients with SFT and metastasis to the brain.

BACKGROUND: A 17‐year‐old female rainbow lorikeet (Trichoglossus moluccanus) was presented for a swelling over the right proximal humerus and an inability to fly. CASE REPORT: Radiographs revealed a markedly osteoproductive and moderately osteolytic lesion of the proximal left humerus with marked associated soft tissue swelling. Biopsy of the proximal humerus was consistent with an air sac cystadenocarcioma. The bird's condition deteriorated over 25 days after initial presentation and it developed a respiratory wheeze, tail bob, tachypnea and died. On postmortem examination, the bird was found to have an air sac cystadenocarcinoma associated with the proximal humerus, extending into the thoracic cavity through a network of fibrous sheets and displaying infiltration into the lung tissue bilaterally. CONCLUSION: This is the first report of a humeral air sac cystadenocarcinoma in a lorikeet and it builds on our understanding of the species affected by avian neoplasia.