Search

Background Teratoma is a tumor derived from fetal germ cells with aberrant differentiation. Case Description A 3-month-old infant with a mediastinal tumor was referred to our heart center. She presented with progressive dyspnea, cyanosis, and the need to be manually ventilated. The computed tomography scan displayed a huge tumor restricting the distal trachea including the bifurcation. An emergent operation was performed and the tumor was completely removed. Histological examination confirmed a mature teratoma. Conclusion In such life-threatening situation, the early detection and the immediate operation are very important for the management of rapidly-progressing mediastinal teratomas compressing the respiratory tract.

Myasthenia gravis and thymoma are often presented in association with ∼10% of myasthenic cases having concomitant thymoma. Thymic carcinoma is one of the rarest/aggressive human epithelial tumors and has no correlation with myasthenia gravis hitherto. Here is provided a clinical case and review of literature on a very rare association of thymic carcinoma (with no sign of thymoma) and myasthenia gravis (antiacetylcholine receptor antibody positive). Two years after thymectomy, clinical evolution was satisfactory. This clinical case elicits hypothesis that thymic carcinoma may be related with myasthenia gravis, what may have good prognostic from oncologic and neurologic perspectives.

Background Pulmonary epithelial–myoepithelial carcinoma (P-EMC) is an extremely rare, well-differentiated, and malignant neoplasm originating from submucosal bronchial glands in the lung. EMCs arise mainly in the salivary glands. Case Description This case represents an asymptomatic 78-year-old male with a remote 75-pack-year history of smoking who presents with a solitary endobronchial lesion, which is suggestive of a primary lung EMC, detected on annual screening chest computed tomography (CT) scan. Conclusion A recent review of literature reveals less than 50 documented cases of the pulmonary subtype of this tumor worldwide. We are reporting a unique case of robot-assisted pulmonary lobectomy for a P-EMC.

Background While the optimal treatment for primary spontaneous pneumothorax remains unclear, mechanical pleurodesis is a well-established treatment. The Pleurabrade is a spiral brush designed for mechanical pleurodesis during thoracoscopy. We present two patients who underwent mechanical pleurodesis with the Pleurabrade. Case Description Two patients with spontaneous pneumothorax underwent operative intervention including mechanical pleurodesis with the Pleurabrade. Chest tubes were removed within 48 hours postoperatively and they were discharged home. Both patients remain recurrence free at 11 and 22 months, respectively. Conclusion While further testing is needed, these case reports and operative video highlight the Pleurabrade as an efficient device for thoracoscopic mechanical pleurodesis.

We report the case of a 4-year-old boy with a neuromucoepidermoid carcinoma of the left main bronchus. Complete resection of the carcinoma and reconstruction of the carina between lower and upper lobe by means of an end-to-end anastomosis was performed via a left-sided thoracotomy.

Background The majority of adult primary tracheal tumors are malignant; however, as one type of benign tumors, lipoma is extremely uncommon. Case Description We report a case where lipoma was first misdiagnosed as bronchial asthma, followed by sudden aggravation of dyspnea after trauma, and computed tomography (CT) examination of the neck and chest confirmed a tracheal tumor. Through multiple bronchoscopy interventions and placements of a tracheal stent, little therapeutic benefit was discovered, and resection of the tracheal tumor combined with tracheal end-to-end anastomosis was performed to ultimately achieve a cure. Conclusion Primary tracheal tumors should be highly suspected in patients with recurrent and gradually worsening dyspnea; timely cervical, thoracic CT and bronchoscopy can provide an accurate diagnosis. Surgical radical resection is the only way to cure all benign tracheal tumors such as lipoma.

Background Spontaneous pneumomediastinum (SP) is the presence of free air into extra-alveolar tissues within the mediastinum, without notion of trauma. This rare condition may occur as a complication of an underlying severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia. Higher rates of mechanical ventilation are reported in coronavirus disease 2019 (COVID-19) patients with pneumomediastinum. Case Description We report two cases of COVID-19 infected patients suffering from mild and severe SP and their outcome. Discussion The objective of this report is to review the literature about this condition. We discuss about the pathological pathways underlying this complication and how it reflects the severity of COVID-19 pneumonia. Conclusion Currently, it remains unclear if SP in SARS-CoV-2 pneumonia is a potential predictor of disease worsening, for it does not seem to be related with a higher rate of mortality.

Background Traumatic injury of the trachea is rare, especially complete transection. Its operative revision requires an interdisciplinary approach. Case Description We hereby present a rare case of complete transection of the trachea by accident. To stabilize the patient and to allow for safe surgery, veno-venous extracorporeal support was initiated via the subclavian artery and the femoral vein. The patient was subsequently operated, and the trachea re-anastomosed with favorable outcome. Conclusion This rare case of an accidental transection of the trachea shows the importance of a good emergency rescue chain and the ability to facilitate interdisciplinary approaches in tertiary hospitals.

Thymomas are rare tumors that commonly lie in the anterior mediastinum. The arteries supplying thymomas branch from the internal thoracic arteries and their collaterals. This report presents a patient with huge mediastinal thymoma, whose sensational vascularization is ensured directly by a single dominant tributary branch of the left internal thoracic artery. After initially performed computed tomography angiography, the tumor was suspect to be vascularized from the right coronary artery. Triple-rule-out computed tomography scan was a key step for accurate radiologic diagnosis.

Background Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a very useful diagnostic tool for the assessment of enlarged mediastinal and hilar lymph nodes. It is a safe procedure with a low risk of complications. Case Description We report a case of bronchial fistula and pneumomediastinum after EBUS-TBNA, which was performed shortly after a mediastinoscopy. Due to the extent of the bronchial lesion, a surgical closure of the bronchial fistula was necessary. The patient recovered completely. Conclusion The performance of EBUS-TBNA shortly after a mediastinoscopy should not be recommended to avoid possible procedure-related complications.

Anastomotic leakage of the gastric conduit following surgical treatment of esophageal cancer is a life-threatening complication. An important risk factor associated with anastomotic leakage is calcification of the supplying arteries of the gastric conduit. The patency of calcified splanchnic arteries cannot be assessed on routine computed tomography (CT) scans for esophageal cancer and, as such, in selected patients with known or assumed mesenteric artery disease, additional CT angiography of the abdominal arteries with 1 mm slices is strongly encouraged. If the mesenteric perfusion is compromised in patients with resectable esophageal cancer, angioplasty procedures with stenting of the mesenteric arteries could be performed to prevent possible ischemia of the gastric conduit.

Background Tracheal glomus tumors are rare mesenchymal neoplasms that have the potential to cause malignant, central airway obstruction. They require a thoughtful approach to safely secure the airway and definitively resect the tumor. Case Description We report the clinical course of a 25-year-old man in severe respiratory distress secondary to tracheal glomus tumor and the subsequent surgical management. Conclusion Due to their hypervascular nature, greater familiarity with tracheal glomus tumors is needed to ensure appropriate preoperative planning and intervention.

Background Pulmonary mucormycosis is a rare fungal infection that carries a high mortality. Given the rarity of this disease, its management has not been well established. Case Description We report a 36-year-old female presenting with right middle and lower lobe pulmonary mucormycosis during the third trimester of pregnancy. Diagnosis was established using chest computed tomography followed by bronchoalveolar lavage and lung biopsy. Prompt initiation of amphotericin B and right middle and lower lobe lobectomy resulted in maternal survival and fetal viability. Conclusion This favorable outcome is attributed to extensive communication between treatment teams in addition to comprehensive surgical planning.

Background Thymic hyperplasia is a recognized complication of Graves' disease that can present radiologically as an anterior mediastinal mass. Case Description We present a unique case of massive thymic hyperplasia occurring in a 24-year-old female without a known history of thyroid or other systemic disease in whom Graves' disease first manifested intraoperatively during thymectomy for presumed neoplasia. Conclusion We suggest that the work-up of all anterior mediastinal masses should include a comprehensive search for medical causes of reversible thymic enlargement.

Endobronchial stent placement is a novel therapy for treatment of iatrogenic tracheal tears. A review of the available literature shows surgery and long-term intubation being the established treatment strategy. We describe the case of a 64-year-old woman with a tracheal rupture following endotracheal intubation for routine surgery. Pneumo-mediastinum and chest pain were the predominant symptoms. She was treated with a covered self-expandable metal stent that closed the tear and led to immediate symptom relief. After six weeks and complete healing of the trachea, the stent could be explanted. No stent complications occurred. A new algorithm for the treatment of these ruptures has been proposed.

Background Technology has evolved to facilitate pulmonary resection. The latest technological advances in computer-aided surgery (Da Vinci Xi) allow for more control during pulmonary resection. Case Description A 59-year-old woman presented with two primary tumors of the left upper and lower lung. After induction chemotherapy, patient had a “five on a dice” port placement and technique was used to perform successful robot-assisted pneumonectomy. The patient was discharged home on postoperative day 3 without any complications. Conclusions We have found that the “five on a dice” port placement allows for optimal control of the robot stapler and facilitates successful robot-assisted left pneumonectomy.

Dilational tracheotomy is a minimally invasive method that can be performed at the bedside on patients requiring long-term mechanical ventilation. In our 70-year-old male patient, percutaneous dilational tracheotomy (Ciaglia Blue Rhino, Cook Medical Inc., Bloomington, Indiana, United States) was performed because of bilateral pneumonia with sepsis. There were no initial problems. Nine days later, while the patient was being repositioned, the tracheal cannula became dislocated. Despite extending the cervical incision it was not possible to recannulate. The tracheal hole could not be felt with certainty by palpating through the incision. After several unsuccessful attempts, the patient was intubated orally. The only way to achieve sufficient ventilation was to hold the tracheostoma closed. Bronchoscopy showed that the entry point of the tracheal cannula was ventral and ∼1.5 cm above the main carina. The tube was then advanced into the right main bronchus and the patient was thus ventilated unilaterally. On exposure of the trachea, a grade 3 goiter was revealed. Total neck length was short. Only after the video mediastinoscope had been inserted was it possible to show the tracheal defect below the brachiocephalic trunk. After blunt mobilization of both main bronchi, it was possible to close the tracheal defect with simple interrupted sutures. Conventional tracheotomy was then performed at the level of the second tracheal ring. As a result, mechanical ventilation was once again possible without difficulty and thoracotomy was not necessary.

Nontraumatic spontaneous rupture of a bronchial artery aneurysm is rarely seen. In this report, we described such a phenomenon in a patient induced by usage of anticoagulant agent. The patient had no antecedent history of trauma, hypertension, or apparent aortic pathology. The patient who had been taking low-molecular-weight heparin and warfarin to treat deep vein thrombosis complained of a sudden upper abdomen pain with shortness of breath and hypoxemia. The patient was diagnosed and treated for an acute hemomediastinum caused by a ruptured bronchial artery aneurysm. If the patient had continued to take the anticoagulant antithrombotic drugs, it may cause a more virulent bleeding. Taken together, CT angiography is a useful diagnosis tool for patients with sudden chest pain and abdominal pain, and rare cause should be considered.

Pneumopericardium resulting in cardiac tamponade in patients with lung cancer is not documented. We report a case of squamous cell carcinoma of the lung complicated by pneumopericardium and subsequent cardiac tamponade. The patient underwent an urgent pericardial window with rapid improvement in symptoms. We discuss the possible pathogenesis and treatment options for this rare condition.

Pleuropulmonary blastoma (PPB) is a rare aggressive malignant tumor of infancy and early childhood. The tumor arises in the lung and pleura and is regarded as a pulmonary dysontogenetic or embryonic neoplasm. Four types are defined in literature. Type I PPB is a rare, cystic lung neoplasm in infants characterized by subtle malignant changes and a good prognosis. Recurrences after type I PPB are usually advanced with a poor prognosis.We report this case to increase awareness about this entity so that the pediatricians, pediatric surgeons, radiologist, and pathologist recognize it early.

We present a case of impassable subglottic stenosis scheduled for tracheal resection and reconstruction managed by establishing a supraglottic airway. Despite careful preoperative evaluation, the stenosis was localized higher than anticipated, rendering conventional intubation impossible. Laryngeal mask bridging to cross-field ventilation was feasible and jet ventilation and cardiopulmonary bypass were available as emergency strategies. Surgery and emergence went uneventful. Perioperative considerations are discussed in this report.

Colonization or infection with various pathogens is frequently found in patients listed for lung transplantation. We describe a case of a 50-year-old woman with α-1-antitrypsin deficiency, which was listed for double-lung transplantation, with multidrug-resistant gram-negative Acinetobacter baumannii (MRGN4-Ab) skin colonization. Transplantation was successfully performed. Colistin (Polymyxine E) was administered intravenously and through inhalation in the first month. MRGN4-Ab was still detectable in skin swabs without evidence of infection. After good recovery and clinical inapparence, the patient was discharged 2 months after transplantation.