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Tube thoracostomy has been known to be a common and invasive, however not innocuous, procedure which is often life-saving. Though, numerous complications have been reported during executing this procedure. In this report, we describe a 27-year-old woman, case of multiple trauma due to car collision that was transferred to our service due to severe right side chest tube air leak and subcutaneous emphysema in which after proper evaluation, it was revealed that the chest tube crossed through the right pleural cavity and penetrated the bronchus intermedius. A literature search failed to identify a similar case. The misplacement was confirmed by fiber optic bronchoscopy and after surgical and intensive care management of the patient, she was dischargedwith an uneventful post-op course. This case noticeably determines that bearing in mind the extreme risks and the careful checks of the tube location are required, particularly in trauma patients, even in the absence of anatomical abnormalities.

Abstract Background Several severe intraoperative complications of lung cancer surgery have been reported, but the incorrect transection of the main bronchus is a very rare and serious complication. We report a surgical case of a patient with left lower lobe lung cancer invading the inferior segment of the lingula, with fused interlobar fissure and dense pleural adhesion, in which the left main bronchus was mistaken for the left lower lobe bronchus and was transected. Case presentation A 64-year-old woman with lung adenocarcinoma was referred to our hospital for surgical treatment. Chest computed tomography (CT) scan showed a 30-mm nodule with a clear border and irregular margins in the center of the anterior (S8) segment of the lower lobe of the left lung and another similar 30-mm nodule in the lateral (S9) segment of the same lobe. Metastasis within the same lobe was suspected. A thoracoscopic left lower lobectomy was scheduled for the patient. As the patient had a moderately, fused fissure, dense pleural adhesion, and suspicious tumor invasion from the left S8 segment to the left S5 segment, and the interlobar node tightly adhered to the main PA at the site of basilar artery origin of the LLL, we performed left lower lobectomy and a left S5 segmentectomy using the fissureless fissure-last technique. During surgery, the left main bronchus was mistaken for the left lower lobe bronchus and was transected. After transecting the left main bronchus, we performed a sleeve bronchoplasty to prevent pneumonectomy. Conclusions We experienced the rare and serious intraoperative complication of the incorrect transection of the main bronchus. There are few reports of this intraoperative complication, and it should not be overlooked by surgeons.

Yukihiro Nagatani,1 Masayuki Hashimoto,2 Norihisa Nitta,1 Yasuhiko Oshio,2 Tsuneo Yamashiro,3 Shigetaka Sato,1 Shinsuke Tsukagoshi,4 Hiroshi Moriya,5 Tatsuya Kimoto,6 Tomoyuki Igarashi,2 Noritoshi Ushio,1 Akinaga Sonoda,1 Hideji Otani,1 Jun Hanaoka,2 Kiyoshi Murata1On behalf of investigators of the ACTIve Study Group1Department of Radiology, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan; 2Department of Surgery, Division of General Thoracic Surgery, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan; 3Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan; 4CT System Division, Canon Medical Systems, Otawara, Tochigi 324-8550, Japan; 5Department of Radiology, Ohara General Hospital, Fukushima, Fukushima 960-8611, Japan; 6Healthcare IT Development Center, Canon Medical Systems, Otawara, Tochigi 324-8550, JapanPurpose: The purpose of this study was to measure changes in lung density and airway dimension in smokers in the lateral position using four-dimensional dynamic-ventilation computed tomography (CT) during free breathing and to evaluate their correlations with spirometric values.Materials and methods: Preoperative pleural adhesion assessments included dynamic-ventilation CT of 42 smokers (including 22 patients with COPD) in the lateral position, with the unoperated lung beneath (dependent lung). The scanned lungs’ mean lung density (MLD) and the bilateral main bronchi’s luminal areas (Ai) were measured automatically (13–18 continuous image frames, 0.35 seconds/frame). Calculations included cross-correlation coefficients (CCCs) between the MLD and Ai time curves, and correlations between the quantitative measurements and spirometric values were evaluated by using Spearman’s rank coefficient.Results: The ΔMLD1.05 (from the peak inspiration frame to the third expiratory frame, 1.05 seconds later) in the nondependent lung negatively correlated with FEV1/FVC (r=-0.417, P

Background: Several severe intraoperative complications of lung cancer surgery have been reported, but the incorrect transection of the main bronchus is a very rare and serious complication. We report a surgical case of a patient with left lower lobe lung cancer invading the inferior segment of the lingula, with fused interlobar fissure and dense pleural adhesion, in which the left main bronchus was mistaken for the left lower lobe bronchus and was transected. Case presentation: A 64-year-old woman with lung adenocarcinoma was referred to our hospital for surgical treatment. Chest computed tomography (CT) scan showed a 30-mm nodule with a clear border and irregular margins in the center of the anterior (S8) segment of the lower lobe of the left lung and another similar 30-mm nodule in the lateral (S9) segment of the same lobe. Metastasis within the same lobe was suspected. A thoracoscopic left lower lobectomy was scheduled for the patient. As the patient had a moderately, fused fissure, dense pleural adhesion, and suspicious tumor invasion from the left S8 segment to the left S5 segment, and the interlobar node tightly adhered to the main PA at the site of basilar artery origin of the LLL, we performed left lower lobectomy and a left S5 segmentectomy using the fissureless fissure-last technique. During surgery, the left main bronchus was mistaken for the left lower lobe bronchus and was transected. After transecting the left main bronchus, we performed a sleeve bronchoplasty to prevent pneumonectomy. Conclusions: We experienced the rare and serious intraoperative complication of the incorrect transection of the main bronchus. There are few reports of this intraoperative complication, and it should not be overlooked by surgeons. [ABSTRACT FROM AUTHOR]

Aim: In this study, we evaluated the association between tumor location and prognosis in non-small-cell lung cancer patients. Patients & methods: The SEER database was used to screen for suitable patients using our inclusion criteria. The χ2 test was used to compare baseline patient characteristics and the Kaplan-Meier method as well as the log-rank test were used to compare survival differences. At last, univariate and multivariate Cox proportional hazards regression models were used to analyze the influence of different variables on overall survival. Results: The results found no significant difference in overall survival between patients in laterality (p = 0.071). However, patients with main bronchial tumors had worse prognosis than tumors at other locations (p < 0.001). Our results also showed that tumor location including main bronchus, upper lobe, middle lobe, lower lobe and overlapping lesion was a significant factor affecting survival (p < 0.001). Subgroup analysis revealed that regardless of histology or M stage, patients with main bronchial tumors had a worse survival compared with other tumor locations (all; p < 0.001). Interestingly, we found that patients with tumor main bronchial tumors were more likely to be squamous carcinoma and terminal Tumor, Node, Metastasis stage (all; p < 0.001). Conclusion: Non-small-cell lung cancer patients' prognosis was related to the tumor location. And patients with tumors located in main bronchus had worse outcomes than those located in other locations. Tumor primary site should be considered in treatment management and prognosis assessment. [ABSTRACT FROM AUTHOR]

Objectives In the literature, inconsistent associations between the primary locations of lung adenocarcinomas (ADCs) with patient prognosis have been reported, due to varying definitions for central and peripheral locations. In this study, we investigated the clinical characteristics and prognoses of ADCs located in the main bronchus. Methods A total of 397,189 lung ADCs registered from 2004 to 2013 in the National Cancer Database (NCDB) were extracted and divided into main bronchus-located ADCs (2.5%, N = 10,111) and non-main bronchus ADCs (97.5%, N = 387,078). The ADCs located in the main bronchus and those not in the main bronchus were compared in terms of patient prognosis, lymph node involvement, distant metastases and other clinical features, including rate of curative-intent resection, histologic grade, and stage. Results ADCs located in the main bronchus had significantly worse patient survival than those in the non-main bronchus, both for all patients (HR = 1.82, 95% CI 1.78–1.86) and for those undergoing curative-intent resection (HR = 2.49, 95% CI 2.23–2.78). Furthermore, ADCs located in the main bronchus had a significantly higher rate of lymph node involvement and distant metastasis than those not in the main bronchus, when stratified by tumor size (trend test, p < e −16 ). Multivariate analysis of overall survival showed that main bronchus location is a prognostic factor (HR = 1.15, 95% CI 1.08–1.23) independent of other clinical factors. Conclusions Main bronchus location is an independent predictor for metastasis and worse outcomes irrespective of stage and treatment. Tumor primary location might be considered in prognostication and treatment planning. [ABSTRACT FROM AUTHOR]