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Key Clinical Message: Recently spontaneous tension pneumomediastinum (STM), were reported as infrequent complications in coronavirus disease 2019 (COVID‐19) patients but pneumothorax (PT), and subcutaneous emphysema (SE) are more frequently seen in COVID‐19 patients. PT and SE may present after PTM in COVID‐19. The aim of this presentation is to show the complications of STM in an Iranian patients with COVID‐19 disease with PT and SE, who were hospitalized in Arya hospital, Rasht, Iran. For 3 months, we followed these patients and their condition was good. STM are uncommon complications in COVID‐19 patients and were reported frequently in male patients. Early diagnosis and treatment could save the patients as these complications are related to poor prognosis and prolonged hospitalization. Patients with mild COVID‐19 and mild pulmonary damage may have a favorable outcome. [ABSTRACT FROM AUTHOR]

Background: The liver is the most common organ of the body that is at risk of getting affected by hydatid cyst (75%). All lobes of the liver can be involved with the formation of hydatid cyst, but the right lobe is more involved than the left lobe. The rate of involvement of liver dome and segments 7 and 8 of the right lobe has not been reported so far, but the best treatment for liver hydatid cyst has been found to be surgery. Materials and Methods: In this study, 240 patients with liver hydatid cyst underwent surgery from 2005 to 2017. In this retrospective study, the variables of gender, age, number of liver cysts, involvement of lobe and segments, simultaneous involvement of liver and lung, laparotomy, thoracotomy, the number of patients referred due to the lack of finding cysts in laparotomy, and surgical complications were analyzed. Results: The results showed that the majority of patients were males with age ranging from 8 to 68 years. Right lobe involvement was observed in most of the patients. About 62 patients showed involvement of liver dome and segments 7 and 8. Therefore, 62 patients underwent thoracotomy according to the criteria introduced and the rest of the patients (n = 178) underwent laparotomy. The results showed that there was a potential for capitonnage in 46 patients in thoracotomy. The pain score was 4–5 according to the VAS criterion. The rate of using analgesic drug did not show significant difference between the two methods. Conclusion: During the manipulation, cysts might be ruptured and give rise to complications such as spread of the disease, shock, and anaphylaxis, which may be followed by legal complaints. Therefore, in order to perform the surgery successfully, a new method along with computed tomography (CT) scan has been introduced in this study, which can be very helpful. [ABSTRACT FROM AUTHOR]

Objective: Bullous lung disease is characterised by the development of bullae within the lung parenchyma. Smoking is considered as a main risk factor of bullae formation. The clinical manifestation varies from asymptomatic bullae to severe respiratory distress. The exact medical approach is still controversial. Here, we aimed to evaluate the patient clinical characteristics and the indication of surgery in the patients. Methods: This study was an analytic cross-sectional study in Razi hospital, Rasht, Iran, in 2016-2020. A total of 110 patients with newly diagnosed lung bullae underwent evaluation based on a checklist, which assessed the variables as clinical characteristics, bullae features, the medical treatment, and its complication. Eventually, statistical analysis was performed by using SPSS v21.0. Results: A total of 110 patients were enrolled. All the patients were smokers. In 72.9%, the primary presentation was respiratory distress, which needed surgical resection with no recurrence over 8 months. The clinical manifestation varies from asymptomatic bullae in 4.3% and pneumonia in 34.3% to respiratory distress in 61.4%. There was no statistical correlation between clinical manifestation and all the studied variables excluding respiratory distress (p value: 0.659). Seventy patients underwent surgical treatment, in which 20 cases were complicated by air leak that was managed by the chest tube in 16 patients and the Heimlich valve in four patients. No evidence of recurrence was detected. Conclusion: The main risk factor of bulla formation is smoking. Because of various clinical presentations, the appropriate medical approach is of paramount importance. [ABSTRACT FROM AUTHOR]

Byline: Hadi. Kahrom, Manouchehr. Aghajanzadeh, Mohammad. Asgari, Mahdi. Kahrom Introduction: Malignant pleural effusion (MPE) is determined by the detection of malignant cells in pleural fluid or pleural tissue. Neoplasm of [...]

Thymolipomas are rare benign tumors, constituting one of the differential diagnoses of an anterior mediastinal mass. These tumors may have an indolent, asymptomatic course, often achieving massive dimensions before presentation. When it is symptomatic, respiratory symptoms predominate. We report a case of thymolipoma in a 30-year-old male complaining of heaviness and constricting type of chest pain and neck swelling of 1-year duration. Computed tomography scan finding revealed a space-occupying lesion in the anterior mediastinum and extend to the right side of the mediastinum, neck, and left hemithorax. A sono-guided core needle biopsy was carried out which identified an atypical cell and was suspicious to liposarcoma. The tumor was completely excised through “posterolateral thoracotomy.” Postoperative histopathological examination confirmed the diagnosis of thymolipoma. This is the second case we have reported from our institution. [ABSTRACT FROM AUTHOR]

Primary simultaneous multiple organs teratomas are extremely rare. They usually arise in the gonads, and only 1–3 % of them arise in the mediastinum. We present a case of simultaneous multiple organs immature teratomas who was admitted to Razi hospital because of cough, dyspnea, and left-side supraclavicular mass. Computed tomography (CT) showed a big mass with multiple high densities, nodular, semi-solid, heterogenic structures on the left side of the neck, left-side anterior mediastinum, right-side middle mediastinum and right-side suprarenal region. CT-guided needle biopsy was performed and histopathological study showed immature teratoma. After performing neoadjuvant therapy, the tumors were removed. The patient underwent chemo radiation therapy on the mediastinum and abdomen. On 6-months follow-up, he was asymptomatic. This case is being reported because of the rarity of multiple organs immature teratomas and informing other clinicians about managing these cases. [ABSTRACT FROM AUTHOR]

Introduction: Retrosternal goiter refers to any thyroid enlargement in which over 50% of the thyroid permanently located under the thoracic inlet or the lower pole of thyroid is not palpable with the neck in hyperextended position. Due to the increasing number of surgical procedures of retrosternal goiter, the present study was carried out to examine the symptoms, diagnosis, treatment, and treatment complications in retrosternal goiter patients. Materials and Methods: Data related to demographic data (age and gender), clinical symptoms (dyspnea, dysphagia, dysphonia, lumps in neck, and hoarseness), methods of diagnosis (computed tomography [CT], chest X-ray [CXR], ultrasonography, and magnetic resonance imaging), and postoperative complications (bleeding, early and late dysphonia, early and late dyspnea, transient and permanent hypocalcemia, transient, and permanent recurrent laryngeal nerve paralysis) were collected. Results: According to the results 71.4% of patients were women and most of the participants (67.1%) aged 45–60 years. Mass in the neck was the most frequent symptoms before surgery (88.6%). The most common incision for thyroidectomy (95/7%) was neck Collar incision. Diagnosis method in 82.9% and 17.1% of cases was, respectively, based on CT scans with CXR and CT scans with CXR and ultrasound. According to the postoperative pathologic findings, 58.5% of the cases were multinodular goiter, 22.9% were papillary cell carcinoma, 7.1% were medullary carcinoma, 5.7% were anaplastic carcinoma, 5.7% were thyroid lymphoma, and only 1.4% were thyroid adenoma. Postoperative complications occurred in 47.14% of patients. Most common complication was early transient dysphonia. Conclusion: This study recommends that retrosternal goiter should be operated early under suitable conditions, and the best diagnosis tool and best surgery methods are CT scan and surgery with collar incision, respectively. [ABSTRACT FROM AUTHOR]

BACKGROUND: Thymic cysts of the mediastinum are uncommon. The incidence rate of thymic cysts is between 1 to 4.8%. They usually present as an asymptomatic mediastinal mass. The purpose of this study was to report some rare presentations of ten cases with thymic cyst. METHODS: In this retrospective study, signs, symptoms, imaging features and surgical approaches of ten cases with mediastinal thymic cyst were recorded between 2000 and 2013 in the Razi Hospital of Rasht, Iran. RESULTS: Age of patients was between 12 and 60 years. Three patients presented with hydrothorax. Two cases were found incidentally. One patient with hydropneumothrax, one with infected thymic cyst and one with neck mass were observed. Other signs were palpitation, chest pain and dyspnea. The most common surgical approaches were median sternotomy in four cases and postero-lateral thoracotomy in three cases. Complication happened in one patient with left phrenic nerve damage. There were no mortalities. CONCLUSION: Thymic cysts should be considered in the differential diagnosis of the mediastinal and cervical masses. The treatment of choice is complete excision of the cyst. [ABSTRACT FROM AUTHOR]

Subcutaneous emphysema (SE) is a condition often causing minimal symptoms, but sometimes it can be severe and even life-threatening. This study is the first great survey about SE. The aim of this study is to classify and evaluate the etiology, signs, symptoms, and management of SE. This retrospective study was performed by reviewing patients who had been diagnosed as having SE in Rasht, between January 2001 and January 2011. We classified the severity of SE in five grades including the (1) base of the neck, (2) all of the neck area, (3) subpectoralis major area, (4) chest wall and all of the neck area, and (5) chest wall, neck, orbit, scalp, abdominal wall, upper limbs, and scrotum. We excluded all patients in grades 1 and 2, because the symptoms and signs were not significant. Statistical analysis was carried out with SPSS 18. We collected 35 cases of SE with the mean age of 53 ± 14.83 (71 % men). The most common cause of SE was pneumothorax with background of COPD and surgery in grade 5, trauma due to rib fracture in grade 4, and iatrogenicity in grade 3. We performed two bilateral 2-cm infraclavicular incisions. In our patients with infraclavicular incisions, expansion of the lung was better, and the patients' appearance improved. Infraclavicular incisions as a simple method for the management of SE can decrease the severity of SE with no cosmetic problem. [ABSTRACT FROM AUTHOR]

Lipomas are the most frequent mesenchymal benign soft tissue tumors. Here we report a thirty-month-old girl who presented with giant progressively enlarging mass on the right side of the posterior chest wall for the past one and a half years. An ultrasonography found a solid neoplasm measuring 29 cm in its major axis. Patient underwent radical surgical excision of the mass and the histology report confirmed the clinical suspicion of lipoma. [ABSTRACT FROM AUTHOR]