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Objective The presence of primary hyperparathyroidism (PHPT) and Klinefelter syndrome (KS) is rare, and its association with KS mosaicism is even rarer. We report an unusual combination of these entities with a mild phenotype of KS. Methods The patient was a 44-year-old male with a history of PHPT who had recurrent urolithiasis despite being treated with a successful parathyroidectomy. On examination, he had axillary hair growth, bilateral gynecomastia, a large port-wine stain at the right hemithorax and upper right limb, and genitalia and pubic hair corresponding to Tanner IV classification with small, normal consistency testicles. Results Laboratory findings were unremarkable except for a slightly elevated luteinizing hormone, which was normal on repeat testing. Because of the picture of unexplained gynecomastia, laboratory findings, and low-volume testis, a diagnosis of KS was considered. Chromosomal analysis revealed a rare 45,X/46,XY/47,XXY/48,XXYY/48,XXXY KS mosaic. Conclusions KS phenotypes are largely variable, and their association with PHPT remains to be elucidated.

Diagnosis of anomalous origin of the right subclavian artery (AORSA) from the right pulmonary artery (RPA) is usually made using CT, MRI, or invasive angiography. We report a patient diagnosed using transthoracic echocardiography (TTE). A newborn girl prenatally known to have d-TGA presented with cyanosis sparing the right hemithorax and arm. Oxygen saturations on the right hand were persistently higher than on the right ear and other extremities. Repeat TTE using a modified echocardiographic imaging plane allowed for full visualization of the entire subclavian artery course, revealing AORSA from RPA. We discuss further the approach to echocardiographic diagnosis and surgical implications.

Impalement injury is said to occur when a blunt force causes a long object to penetrate a body part resulting in retention of the object in situ. We report two unusual cases of impalement from rural India: one, chest impalement by a hunting spear and the other, an extremity impalement by a rotatory tiller blade. Thoracic impalement injuries are very rare, and there is only one other published report of chest impalement by a spear (trident) in the modern era. There are only two published reports of extremity impalement by a rotatory tiller blade. We also describe the difficulties encountered in their management. Patient-1 sustained accidental impalement to the right hemithorax by a spear used for hunting wild boars, leaving a meter long shaft protruding from his body. This necessitated his transfer to the hospital on the cargo bay of a pickup truck and also precluded complete radiological investigations before surgery. In addition, the reversed barbed tip of the spear made the extraction difficult. Patient-2 sustained impalement through the right knee by a rotatory tiller blade which bound him to the machine. The blade had to be disconnected from the shank assembly of the tiller to extricate him. Due to the proximity of the blade to the popliteal vessels, vascular control was necessary before extraction. Both the patients took several hours to reach the hospital as the accident occurred in remote rural areas. However, both had a successful outcome after surgical removal of the impaled object by a multidisciplinary involvement. We also have reviewed the published literature and given our suggestions for the management of these unusual and difficult injuries.

Yabancı cisim aspirasyonları küçük çocuklarda daha sık görülen, ani başlangıçlı solunum sıkıntısına yol açabilen ve çoğunlukla sağ hemitoraksın etkilendiği acil bir sağlık sorunudur. Bu çalışmada aspirasyon öyküsü olmayan, klinik bulguları ile radyolojik bulguları uyumsuz olan ve şüphe üzerine bronkoskopik işlem neticesinde sol ana bronştan yabancı cisim çıkarılan iki hasta konu hakkındaki farkındalığı arttırmak için tartışıldı.Foreign body aspirations is more common in young children, which can cause sudden onset of respiratory distress. It is an emergency health problem that mostly affects the right hemithorax. In this study, two patients who had no history of aspiration, whose clinical and radiological findings were inconsistent, and upon suspicion, foreign body was removed from the left main bronchus as a result of bronchoscopic procedure were discussed to raise awareness on the subject., Foreign body aspirations is more common in young children, which can cause sudden onset of respiratory distress. It is an emergency health problem that mostly affects the right hemithorax. In this study, two patients who had no history of aspiration, whose clinical and radiological findings were inconsistent, and upon suspicion, foreign body was removed from the left main bronchus as a result of bronchoscopic procedure were discussed to raise awareness on the subject.Yabancı cisim aspirasyonları küçük çocuklarda daha sık görülen, ani başlangıçlı solunum sıkıntısına yol açabilen ve çoğunlukla sağ hemitoraksın etkilendiği acil bir sağlık sorunudur. Bu çalışmada aspirasyon öyküsü olmayan, klinik bulguları ile radyolojik bulguları uyumsuz olan ve şüphe üzerine bronkoskopik işlem neticesinde sol ana bronştan yabancı cisim çıkarılan iki hasta konu hakkındaki farkındalığı arttırmak için tartışıldı.

In this article, we present a patient who underwent right pneumonectomy due to giant hydatid cyst in the right hemithorax and discuss the relevant literature. A 42-year-old man presented with complaints of chest pain and shortness of breath. Thoracic computed tomography (CT) revealed a cystic lesion measuring 30 × 20 cm in the right hemithorax. The patient was admitted for surgery. Right posterolateral thoracotomy was performed, followed by right pneumonectomy upon observation of complete destruction of the right lung due to the cystic lesion. There were no complications and the patient was discharged on postoperative day 5. The pathology report indicated hydatid cyst. Surgery is the main treatment for pulmonary hydatid cysts. The main purpose of surgery is to preserve the lung parenchyma. Operations such as pneumonectomy that are associated with high morbidity and mortality can be performed safely in patients with giant cysts.

(1) Background: Chest radiography (CXR) is still a key diagnostic component in the emergency department (ED). Correct interpretation is essential since some pathologies require urgent treatment. This study quantifies potential discrepancies in CXR analysis between radiologists and non-radiology physicians in training with ED experience. (2) Methods: Nine differently qualified physicians (three board-certified radiologists [BCR], three radiology residents [RR], and three non-radiology residents involved in ED [NRR]) evaluated a series of 563 posterior-anterior CXR images by quantifying suspicion for four relevant pathologies: pleural effusion, pneumothorax, pneumonia, and pulmonary nodules. Reading results were noted separately for each hemithorax on a Likert scale (0–4; 0: no suspicion of pathology, 4: safe existence of pathology) adding up to a total of 40,536 reported pathology suspicions. Interrater reliability/correlation and Kruskal–Wallis tests were performed for statistical analysis. (3) Results: While interrater reliability was good among radiologists, major discrepancies between radiologists’ and non-radiologists’ reading results could be observed in all pathologies. Highest overall interrater agreement was found for pneumothorax detection and lowest agreement in raising suspicion for malignancy suspicious nodules. Pleural effusion and pneumonia were often suspected with indifferent choices (1–3). In terms of pneumothorax detection, all readers mainly decided for a clear option (0 or 4). Interrater reliability was usually higher when evaluating the right hemithorax (all pathologies except pneumothorax). (4) Conclusions: Quantified CXR interrater reliability analysis displays a general uncertainty and strongly depends on medical training. NRR can benefit from radiology reporting in terms of time efficiency and diagnostic accuracy. CXR evaluation of long-time trained ED specialists has not been tested.

Diaphragmatic hernias are commonly encountered in radiological practice, especially in pediatric patients. Delayed presentation of diaphragmatic hernias can occur in children and less frequently in adult patients. We present an extremely rare case of a 15-year-old male patient with recurrent attacks of cholestatic hepatitis who has been misdiagnosed to have primary sclerosing cholangitis and was planned for liver transplantation. On imaging, the patient was found to have neglected right diaphragmatic hernia causing hypogenesis of the right hemithorax and right lower lung lobe. A transthoracic herniation of gallbladder and malrotated left liver lobe is also diagnosed on imaging. Biliary dilatation with transition point at the diaphragmatic hernia neck was identified. Major hepatic anomaly such as liver malformation is an exceedingly rare case with only 3 reported cases in the literature. In our case, the patient suffered from recurrent cholestatic hepatitis and unfortunate misdiagnosis with primary sclerosing cholangitis, which have delayed his appropriate management. In addition, the patient was found to have interrupted IVC with azygos and hemiazygos continuation without evidence of heterotaxy syndrome.

Background Intercostal lung herniation is a rare condition that may be congenital (20%) or acquired (80%). The isolated congenital form is exceptional, with one case reported in the literature. Case presentation We report a case of a 10-year-old French boy of Algeria origin, born with intermittent swelling of his right hemithorax. The swelling and pain gradually increased with age. A clinical examination revealed a localized swelling of his right hemithorax at the level of the midclavicular line and the fifth intercostal space. The swelling increased in size during respiratory movements and enlarged with Valsalva maneuvers. The intercostal lung hernia was treated by thoracoscopy. Conclusions This is the second case of isolated congenital intercostal pulmonary hernia reported in the French and English literature. It is the first to be treated by thoracoscopy. Based on this case we performed a review of the diagnosis and therapeutic aspect of pulmonary hernias. Electronic supplementary material The online version of this article (10.1186/s13256-019-2142-4) contains supplementary material, which is available to authorized users.

A 78-year-old Japanese woman was referred to our hospital because of fecal occult blood. Barium enema and CT colonography revealed the herniation of the transverse colon and the greater omentum into the right hemithorax through a retrosternal defect. We diagnosed a Morgagni hernia, and we performed a laparoscopic hernia repair with a three-port approach. The invaginated transverse colon and omentum were easily reduced into the abdominal cavity. The size of the hernial orifice was estimated to be approx. 2.5×4 cm. We placed Ventralight ST® mesh over the hernial orifice without hernial sac resection, and we used the double-crown technique to fix the mesh with a hernia stapler. The postoperative course was uneventful, and the patient was discharged on the 5th postoperative day with no complications. There has been no recurrence at 2 years after the surgery. Laparoscopic repair is a safe, less-invasive and useful method for repairing a Morgagni hernia.

Solitary fibrous tumors of the pleura (SFTP) are rare mesenchymal tumors that arise from visceral or parietal tissue. Surgical resection of massive SFTP can be complicated by airway collapse, vascular compression/hemodynamic instability, and hemorrhage. Patients with SFTP may also present with metabolic derangements secondary to paraneoplastic processes. We present a case of successful removal of massive right-sided SFTP via clamshell sternotomy and discuss the perioperative considerations for which providers should be familiar.

Patient: Male, 41-year-old Final Diagnosis: Autosomal dominant polycystic kidney disease Symptoms: Pain Medication: — Clinical Procedure: Computed tomography • ultrasonography Specialty: Gastroenterology and Hepatology • Medicine, General and Internal • Nephrology Objective: Congenital defects/diseases Background: Autosomal dominant polycystic kidney disease (ADPKD) is frequently associated with liver cysts, but an association with giant cavernous liver hemangioma is not mentioned in the literature. Case Report: We report the case of a 41-year-old man with ADPKD, secondary arterial hypertension, and stage 4 chronic kidney disease who presented with a 2-week history of persistent pain at the base of the right hemithorax and in the right hypochondrium. An ultrasound examination and a contrast-enhanced computed tomography scan revealed a giant cavernous liver hemangioma. Surgery was intially taken into account (however, twice delayed because of the COVID-19 pandemic) but later refused because it would have left the patient with dangerously few liver parenchyma. Conclusions: To our knowledge, this is the first reported case of ADPKD associated with cavernous liver hemangioma. Vascular endothelial growth factor could be the pathophysiological link between the 2 conditions. Further research may unravel the molecular biology that underlies this possible association, pointing to new therapeutic avenues for ADPKD.

Background: Community-acquired pneumonia (CAP) is an acute bacterial or viral inflammation of the lung parenchyma. Worldwide it is one of the most common infectious diseases among children. Diagnosis of CAP is clinical, but chestX-ray (CXR) is used in special clinical situation or severe cases. The role of lung ultrasound (LUS) to diagnose and manage CAP is still debated. Aim: 1) To evaluate concordance between LUS and CXR in evaluating specific signs of CAP (Cohen’s Test). 2) To determine sensitivity and specificity of LUS in the diagnosis of CAP compared to CXR. 3) To evaluate the role of LUS during the follow-up of patients hospitalized for CAP. Methods: We enrolled 68 patients younger than 16 years: 41 cases with clinical and radiological diagnosis of CAP and 27 controls with no respiratory diseases who performed a LUS during hospitalization. Nine-teen cases were re-evaluated 30 days after discharge with both LUS and CXR. Results: LUS confirmed CAP diagnosis in 40/41 cases, showing the presence of single or multiple consolidations. Concordance (K) between LUS and CXR was 0.88 in the right hemithorax and 0.70 in the left hemithorax. Moreover, LUS showed 97% of sensitivity and 96% of specificity in the diagnosis of CAP compared to CXR. During the follow-up, LUS sensitivity and specificity were 100% and 94%, respectively. Conclusion: Our study showed the potential benefit of LUS in the diagnosis and follow-up of children with CAP, possibly avoiding the need to take CXR.

This extended paper presents the development and implementation at a prototype level of a wireless, low-cost system for the measurement of the electrical bioimpedance of the chest with two channels using the AD5933 in a bipolar electrode configuration to measure impedance pneumography. The measurement device works for impedance measurements ranging from 1 Ω to 1800 Ω. Fifteen volunteers were measured with the prototype. We found that the left hemithorax has higher impedance compared to the right hemithorax, and the acquired signal presents the phases of the respiratory cycle with variations between 1 Ω, in normal breathing, to 6 Ω in maximum inhalation events. The system can measure the respiratory cycle variations simultaneously in both hemithorax with a mean error of −0.18 ± 1.42 BPM (breaths per minute) in the right hemithorax and −0.52 ± 1.31 BPM for the left hemithorax, constituting a useful device for the breathing rate calculation and possible screening applications.

Bullae formation on a cystic background is still not described thoroughly. This clinical case aims to improve this situation and describes the combination of multiple cysts with vascular malformation, giant bullae (2/3 of the left hemithorax and 1/2 of the right hemithorax) with suppuration in a 50-year-old smoker. Before surgery, treatment for chronic obstructive lung disease (COPD) was administered without a positive outcome. Bullectomy was subsequently conducted and histopathological data revealed vascular malformation causing microinfarctions in pulmonary parenchyma, cystic degeneration and tuberculosis. Although it became possible to establish a final diagnosis due to histology, the need for surgical treatment was clear from clinical and x-ray evidence. Such instances as the one presented in this case report should assist with improving our knowledge about bullae in combination with cysts in the lungs because they provide additional context in a clinical setting.

Lipoblastoma are rare benign tumors of embryonic fat with a tendency to local invasion but not to metastasize. So far, there have been 60 c:ases described in the international literature. There hasn't never been a report in a child older than 8 yr. The main clinical characteristics are the presentation of this tumor which, usually below 3 year of age, the rapid growth of the mass and the peripheral location, mainly in the extremities. In this article, we present our experience with a 8 months-old infant who presented with severe respiratory distress. A chest X-ray showed a total opacity on the right hemithorax, and CT-scan showed a mass that was placed on the right lung mostly in lead upper lobe. thatn was diagnosed as lipoblastoma after pathologic examination of the resected mass. The type of tumor in the our case was right-sided tumor. A complete tumor excision is the best definitive treatment for these tumors. It is important to note that the local recurrence rate of this tumor is 14–25%. Keywords: Lipoblastoma, Intrathoracic, 8 month old infant

Thirteen years ago, only a few months after completing my residency in emergency medicine, I walked into a night shift ready for anything. One of the first patients I encountered was a young man with right-sided thoracic back pain after having spent a day lifting moving boxes. Acute back pain is of course a common reason for people to visit an emergency department, and along with his age, the location and context of the pain seemed fairly typical for muscular strain. But as a junior attending I was appropriately more conservative than how I suspect I would act today. Responding to my nerves, an elicited history of cocaine use and leucocytosis, we ordered an MRI of the back to look for an epidural abscess and treated his pain. The MRI was performed and reported as a normal study. While we assessed whether he was comfortable for discharge, I proceeded to focus my attention on other patients who required immediate stabilisation and management. Sometime later during the shift I was suddenly startled by a low-pitched thud near my desk. I looked over and saw someone in a patient gown lying on the floor. Sprinting over to that spot, I soon realised it was this young man collapsed onto the floor in cardiac arrest. During the ongoing resuscitation, the proverbial light bulb went off in my head and I sent the resident physician back to speak with the radiologist again about the MRI, focusing specifically on the aorta. By the time we confirmed a type A aortic dissection ruptured into the right hemithorax and attempted to rush the patient to the operating room, it was too late. Despite our best efforts, he died. Nothing in my medical training up to that point prepared me for such failure. During medical school and residency …

A 42-year-old woman with a newly diagnosed malignant thymoma underwent FDG PET/CT, which demonstrated an increased uptake in anterior mediastinal tumor and several pleural masses in the right hemithorax, compatible with "drop metastases." In addition, contrast-enhanced CT images showed hyperdense abnormality in T2 vertebral body, congruent with intensely increased FDG uptake, raising suspicion of skeletal metastasis. This is a rare but important potential pitfall either in CT and FDG PET/CT-a "false-positive" bony lesion not attributed to skeletal metastasis but to dilated internal thoracic vertebral venous plexus associated with collateral circulation due to superior vena cava syndrome.

El hemotórax se define como la presencia de una colección sanguínea en el espacio pleural. El objetivo de la investigación fue determinar si el manejo conservador no quirúrgico del hemotórax traumático es seguro. Se hizo un estudio descriptivo, prospectivo, de una cohorte de pacientes que ingresaron con diagnóstico de trauma torácico complicado con hemotórax, desde enero de 2013 hasta diciembre de 2016, en la unidad de cirugía de tórax del Hospital Dr. Adolfo Pons del Instituto Venezolano de los Seguros Sociales (IVSS) de Maracaibo, Venezuela. Se evaluaron 150 pacientes; la edad promedio fue de 30,9 años (rango entre 24-65 años), con predominio del sexo masculino (85,2%). En la mayoría de los casos, el traumatismo torácico fue no penetrante (60%) y las causas más frecuentes fueron heridas por proyectil de arma de fuego (48%), accidente de tránsito (26,6%) y heridas por arma blanca (25,3%). El hemitórax derecho fue el más afectado (53,3%); el volumen de sangre drenada se clasificó en leve (25,3%), moderada (70,6%) y masiva (3,9%). El tratamiento efectuado de primera intención en el 80% de los casos fue la toracotomía cerrada con sonda pleural (tubo 24 Fr). Sin embargo, en el 13,3% de los pacientes fue necesario realizar cirugía abierta sobre el espacio pleural (toracotomía exploradora). La evolución de los pacientes fue satisfactoria en el 100% de los casos. Conclusión: La toracotomía cerrada con sondaje pleural juega un papel básico en el tratamiento no quirúrgico inicial, siendo un procedimiento conservador seguro en estos pacientes, pero donde se debe tener en cuenta las condiciones clínicas del paciente, a fin de disminuir complicaciones y las muertes asociadas. The hemothorax is defined as the presence of a collection of blood in the pleural space. The objective of this research was to determine if conservative nonsurgical management of traumatic hemothorax is safe. A descriptive and prospective study of a cohort of patients admitted with a diagnosis of chest trauma complicated with hemothorax was carried out from January 2013 to December 2016, in the Thorax Surgery Unit at the Hospital Dr. Adolfo Pons of the Instituto Venezolano de los Seguros Sociales (IVSS) in Maracaibo, Venezuela. A total of 150 patients were evaluated, the mean age was 30.9 years (range 24-65 years), with a predominance in males 85.2%. In most cases, the thoracic trauma was non-penetrating (60%), and the most frequent cause was bullet wounds (48%), car accident (26.6%), and bladed weapon wounds (25.3%). The right hemithorax was the most affected (53.3%). The volume of drained blood was classified in mild (25.3%), moderate (70.6%) and massive (3.9%). The treatment carried out in the first intention, in the 80% of the cases, was closed thoracostomy with a pleural catheter (24 Fr). However, in 13.3% of patients, it was necessary to perform open surgery on the pleural space (exploratory thoracostomy). The evolution of the patients was satisfactory in a 100% of the cases. Conclusion: The closed thoracostomy with pleural catheter plays a basic role in the initial nonsurgical treatment, being a safe, conservative procedure in these patients. However, the patient clinical condition should be taken into account to decrease complications and associated deaths.

Introducción: El tumor neuroectodérmico primitivo (PNET) de la pared torácica también denominado tumor de Askin es una neoplasia rara y agresiva, que afecta mayoritariamente a niños y adolescente. Caso Clínico: Se reporta el caso de un joven de 17 años que presentó una gran tumoración subescapular derecha, acompañado de dolor y disnea a quien realizó previa quimioterapia neoadyuvante y dada buena repuesta, resección tumoral con márgenes oncológicos más reconstrucción plástica de hemitórax derecho. Constatándose como hallazgo intraoperatorio, no evidente en imágenes, metástasis pulmonar. Presenta evolución favorable posquirúrgica con posterior recurrencia local y metástasis a distancia, sin respuesta a la quimioterapia adyuvante con fallecimiento 7 meses luego de la cirugía. Conclusión: En el presente caso el TA tuvo una sobrevida corta a pesar el tratamiento neoadyuvante, resección quirúrgica y nuevo ciclo de tratamiento quimioterápico.

We describe a case of a 16-year-old patient who underwent right pneumonectomy for pulmonary vein atresia and developed postpneumonectomy syndrome. She had an 800-cm3 saline-filled silicone tissue expander placed in the right hemithorax with resolution of her postpneumonectomy syndrome. However, 2 years later, she developed fevers, night sweats, and arthralgias. Her medical workup was negative for vasculitis, inflammatory bowel disease, and infectious etiologies. She underwent tissue expander removal, resulting in resolution of her symptoms. This report describes a case of an inflammatory state created by a tissue expander placed for postpneumonectomy syndrome.

In this chapter fine needle aspiration cytology (FNAC) of a large solid mass in the right hemithorax in an infant is discussed.

In this chapter fine needle aspiration cytology (FNAC) of a mass in the right hemithorax in a young male is discussed.

Diaphragmatic eventration is a rare entity in the adult population, and usually asymptomatic 1 ; our case is a young man with severe right-sided diaphragmatic eventration with huge dilated colon that has compromised the right hemithorax and caused complete lung collapse and mediastinal shift similar to tension pneumothorax picture with haemodynamic alteration. A single similar case report had been published but did not shed the light on the accurate description of the pathophysiological mechanism of the disease. We believe that such a high abdominal pressure that has transmitted to the thoracic cavity due to the pliable diaphragm causing such a derangment in both the anatomy and the physiology deserves reporting and we think that the term ‘thoracoabdominal compartment syndrome’ describes it accurately, so we discuss some learning points from our case and things that could have been done better.

Introduction and importance Morgagni Hernia is a congenital diaphragmatic hernia but can rarely present in adults. It occurs due to a congenital defect in the development of the diaphragm. Here we present a case of symptomatic Morgagni hernia diagnosed in a 53 years' female. Case presentation A 53 years' female presented with recurrent chest symptoms and was found to have bowel contents herniated into the right hemithorax on chest X-ray and CECT. Reduction of hernia was done laparoscopically and the hernia was repaired with non-absorbable suture in an interrupted manner. Clinical discussion Morgagni hernias are mostly diagnosed incidentally on a chest radiograph or can present with cardiorespiratory or abdominal symptoms. Our case was an adult who was diagnosed to have Morgagni hernia presenting with chest symptoms. The investigation of choice to diagnose and evaluate this condition is CECT of chest and repair of hernia without the use mesh is advised in asymptomatic cases also due to feared complications like strangulation and incarceration. Conclusion The treatment of Morgagni Hernia is primary surgical repair which can be done either transthoracically or transabdominally. It is advised that surgical repair should be done even in asymptomatic cases., Highlights • Morgagni Hernia is a congenital diaphragmatic hernia but can rarely present in adults. • Treatment of Morgagni Hernia is primary surgical repair which can be done either transthoracically or transabdominally with or without the use of Mesh. • It is advised that surgical repair should be done even in asymptomatic cases.

Solitary fibrous tumour of pleura (SFTP) is a rare tumor contributing to less than 5% of all pleural tumours and about 10% - 30% of these tumours show features of malignancy. Occurrence of hypoglycaemia with solitary fibrous tumour is an unusual paraneoplastic syndrome designated as Doege-Potter syndrome which can occur both in benign and malignant tumours. Very few cases of solitary fibrous tumour with Doege-Potter syndrome are documented in world literature and only a couple of cases are documented in Indian literature so far. We, report here an interesting case of 40-year-old male who presented with a short history of weakness in left upper and lower limbs following an ischaemic stroke; breathlessness, productive cough, seizures and repeated episodes of loss of consciousness. Laboratory investigation revealed normal serum C-peptide level (1.04 ng/mL) and his blood sugar level was observed to be low varying from 25 mg/dL to 47 mg/dL. Computed tomography (CT) of lung and pleura showed a large mass in right hemithorax for which he underwent right hemithoracotomy. Histopathological examination of the resected thoracotomy specimen along with immunohistochemical analysis confirmed the diagnosis of malignant solitary fibrous tumour of pleura. Basing on the clinical, histopathological and immunohistochemical examination findings, the case was finally diagnosed as malignant solitary fibrous tumour of pleura with Doege-Potter syndrome. The clinico-pathological features and therapeutic management of such rare syndrome are being discussed here.

We report a case of Morgagni hernia occupying the anterior mediastinum and right hemithorax in a male infant with Down syndrome, who also had a perimembranous ventricular septal defect. Through a median sternotomy, the hernia sac was freed from the right pleura, and the pericardium was opened to reduce its contents (colon) into the abdomen. The diaphragmatic defect was closed with Prolene mesh and the hernia sac was used to reinforce the diaphragmatic defect. Finally, the pericardium was opened and the ventricular septal defect was closed with a polytetrafluoroethylene patch through a right atriotomy after instituting cardiopulmonary bypass.

Dextrocardia is a rare congenital developmental anomaly where the heart is located in the right hemithorax with the cardiac apex pointing toward the right. Dextrocardia may be associated with total situs inversus or can also present as an isolated finding. We present very rare interesting case of situs inversus totalis in a 68-year-old male patient who came with complaints of difficulty in breathing and had a history of fever for 4 days. In view of the COVID-19 pandemic, he got his real time polymerase chain reaction done and he turned out to be positive. On the imaging dextrocardia with total situs inversus was detected. Even though for a common man, dextrocardia with total situs inversus is only heart on the right side of the body with transposition of the abdominal organs, viscera, and vasculature but from a medical point of view, the diagnosis holds a lot of importance as it is useful in the detection of conditions like appendicitis and abdominal organ injuries.

The pleuropulmonary solitary fibrous tumour (SFT) is a rare type of tumour. This paper outlined a 63-year-old female who came to the hospital with two weeks history of chronic cough, shortness of breath, and hypoglycemia. Contrast-Enhanced CT Thorax showed a huge heterogeneously-enhancing mass occupying the right hemithorax. US-guided biopsy followed by histological examination showed the features of an SFT. In view of the association between pleuropulmonary SFT and hypoglycaemia, the patient was highly likely to be suffering from a paraneoplastic syndrome known as Doege-Potter Syndrome.International Journal of Human and Health Sciences Vol. 05 No. 02 April’21 Page: 251-253

Functioning thoracic paraganglioma (PGL) is rare in clinical practice. We present a 33-year-old man with this pathology, who came with right-sided chest pain and was found to have a right-sided paravertebral mass. Fine needle aspiration cytology revealed a PGL. Urine normetanephrine was elevated and meta- iodobenzylguanidine scan showed increased tracer uptake in the right hemithorax, suggestive of a functioning neuroendocrine tumour. The patient was subjected to right PGL excision by video-assisted thoracoscopic surgery, after adequate preoperative preparations. The perioperative period was uneventful, except for a transient rise in blood pressure during the surgery. His blood pressure continued to be normal in the postoperative period. In any patient with a paravertebral mass, the possibility of PGL should be kept in mind even if the patient is normotensive. Making a preoperative diagnosis is important, because excision of functioning PGL without adequate preoperative preparation may be detrimental.

Poland syndrome describes the congenital absence of the pectoralis major and minor muscles on one side of the body accompanied by chest and upper extremity deformities on the same side. However, the only constant finding of the syndrome is the absence of the sternocostal component of the pectoralis major muscle. This finding may be accompanied by additional findings on the same side such as absence of pectoralis minor muscle and of ribs 2 to 5, under-development of breast tissue, latissimus dorsi, serratus anterior and external oblique muscles. The incidence is approximately 1 in 30 000 live births and is more common in men than in women. It mostly holds the right hemithorax of the body. Here we present a 20-year-old male patient without complaints, diseases or other functional anomalies, who has hypoplasia of the right hemithorax, palpation indicating hypoplasia of the pectoral muscle group, and thoracic CT is showing a lack of pectoral muscles.

Introduction. Hydatidosis is a parasitic manifestation caused by Echinococcus granulosus. It is characterized by cystic lesions in the liver and lungs. Diagnosis is based on typical history and radiological measures. Case presentation. A four-year-old boy presented with a one-year history of dry cough and difficulty in breathing which was of gradual progression. Computed tomography of the chest revealed a large 11.7 cm×8.6 cm×11.0 cm cyst in the right hemithorax. The patient underwent thoracotomy and recovered well post procedure. Conclusion. This case report highlights that large hydatid cysts can be surgically removed with good outcome and the importance of realizing that the disease is a burden to the public health and is much neglected.

We present a case of a 7-month-old boy with tetralogy of Fallot associated with unilateral pulmonary aplasia and herniation of the liver and small bowel loops in the right hemithorax.

Dextrocardia is a congenital anomaly where the heart is abnormally located in the right hemithorax. In these patients, the implementation of transvenous implantable cardioverter-defibrillator (TV-ICD) can be technically challenging and pose a higher risk of complications than the general population. We present the case of a male patient that was successfully submitted to right-sided implantation of subcutaneous ICD (S-ICD) as an alternative to transvenous ICD (TV-ICD) for primary prevention of sudden cardiac death. This option is not only feasible but may potentially be ideal for these patients, as it circumvents challenges and potential complications of TV-ICD insertion. Keywords: Dextrocardia, Subcutaneous implantable cardioverter-defibrillator, S-ICD, ICD, Congenital heart disease

Angiosarcoma arising in a long-standing schwannoma is extremely rare and only a few cases were reported in the English literature. Besides tumors arising from vagus, sciatic or adrenal nerves, tumors growing on neck, foot or kidney were also described. To the best of our knowledge, in this article, we report the first mediastinal case occurring in longstanding schwannoma in a 53-year-old female patient. The patient was admitted to our clinic with severe dyspnea and palpitation. Her medical history showed a progressive right-sided paramediastinal mass which was first diagnosed in 2002. Three transthoracic needle biopsies performed in 2002, 2015 and 2016 were all non-diagnostic. An operation was suggested since 2002, but the patient has not accepted. Thorax computed tomography and magnetic resonance imaging revealed a huge mediastinal mass nearly fulfilling the right hemithorax. A diagnosis of "malign spindle cell tumor" was established with the last transthoracic biopsy and total surgical resection via posterolateral throcatomy was performed. Microscopically, tumor was composed of two components: a benign schwannoma and an epithelioid angiosarcoma. Endothelial and neural cell differentiations were confirmed immunohistochemically.

We describe a rare case of metastatic pilomatrix carcinoma with distant metastases 10 months after diagnosis. A 37-year-old woman was diagnosed with pilomatrix carcinoma by excisional biopsy from the occipital region and referred to us for 18F-FDG PET/CT examinations at the time of diagnosis and 10 months after diagnosis. The first PET/CT did not show any pathological activity, whereas the second PET/CT showed multiple intensive 18F-FDG uptakes in the right lung parenchyma, right hemithorax pleura, liver, and bones. © Wolters Kluwer Health, Inc. All rights reserved.

Diagnosis of a Bochdalek hernia in an adult is rare and even more so in the right diaphragm. We review a case of a 55-year-old woman with a right-sided giant Bochdalek hernia who was experiencing progressive shortness of breath and performance decline. The diagnosis of Bochdalek hernia was made by computed tomography and the right side of liver, right kidney, omentum and flexura hepatica of the colon were herniated to the right hemithorax. The operation was carried out via right thoraco-laparotomy and she made an uneventful recovery. We conclude that maximal exposure was necessary for safe operation and good outcome.

Chest pain in children is a common referral for emergency examination, although it is believed that the underlying condition is not a serious event. The authors present the case of a 17 years old male with complaints of chest pain with a very recent onset, constant, experienced after physical effort. All medical history and physical examination findings were normal, the poster-anterior chest X-ray revealed a heterogenous opacity in the middle third of the right hemithorax confirmed on computerized tomography as a large solid anterior mediastinal mass with a diameter of 7.5/10.3 cm. By thorax surgery the mass was identified in the anterior and superior mediastinum and total resection was achieved for the tumor mass and thymus. Pathology examination showed poor small and medium epithelial cells proliferation and the tumor was classified as thymoma type 1B. Mediastinum is a rare location of space occupying processes in children. Also, there is a high rate of asymptomatic lesions in this area, considering that half of them are incidentally discovered for various chest X ray examinations. Many causes of chest pain in children are benign; nonetheless, some serious events do exist sometimes and pediatricians must pay attention to identify and manage those cases.

Inflammatory myofibroblastic tumors (IMTs) are rare tumors of intermediate malignant potential that can occur anywhere in the body. We describe an interesting case of a hypervascular IMT in the mediastinum that could be resected completely following em- bolization of the feeding vessels. A 17-month-old girl with complaints of cough and fever for 3 months was referred to our hospital. Computed tomography (CT) scan showed a large mass in the right hemithorax that shifted the mediastinum to the left. Primary excision was considered but not performed because there was very active capsule wall bleeding due to the hypervascular tumor. After embolization of the feeding vessels, suc- cessful complete resection was carried out. Approximately 6 weeks after the operation, follow-up CT scan showed no evidence of recurrent disease. Preoperative embolization is a good option for performing complete resection of hypervascular IMTs that could reduce the recurrence rate.

A 62-year-old male farmer weighing 79 kg was taken to a hospital after experiencing exertional dyspnea and shortness of breath for a month. A chest roentgenogram and computed tomography showed a giant mass in his right thorax. A CT-guided biopsy demonstrated a solitary fibrous tumor of the pleura (SFTP). Because of the large size of the tumor and the substantial pleural effusion in the right hemithorax, the patient was referred to our institution for radiofrequency ablation. After one month, we performed an exploratory thoracotomy to dissect the giant mass with the right, middle, and lower lobes. The measurement of the tumor was 20 cm × 18 cm × 13 cm and it weighed 3250 g. The histopathology of the resected specimen confirmed SFTP. The patient had no postoperative complications; six months after surgery, no recurrence occurred.

We reported a case of a 30-year-old man who reportedly sustained electrical burns and fell from a high voltage electric pole about 50 meter high onto a metal that caused impalement injury. In addition, he sustained full-thickness burns of the right upper limb (7%), the right hemithorax, the perineum (sparing the penis), the anterior abdominal wall and the lateral aspect of both thighs. There was 43% burned surface area in total. Radiographic examination revealed a slender curved object extending from his perineum into the pelvis. The management of this case was a challenging one which was described in this article.

OZ Amac: Bu retrospektif calismada dev pulmoner kist hidatiklerde parankim koruyucu ve minimal invaziv ameliyat deneyimlerimiz sunuldu. Ca­lis­ma­ pla­ni:­ Dev kist hidatikli 19 hasta (13 erkek, 6 kadin; ort. yas 22 yil) ameliyat edildi. Dev kistin en dis katmani olan adventisya normal parankime kadar eksize edildi ve onceden tespit edilen bronsiyal kacaklar kapatildi. Serbest hale gelen kistin adventisyasi karsilikli olarak parankim icerisine dikildi. Bul gu lar: Kist hidatikler 13 hastada sag hemitoraksta, bes hastada sol hemitoraksta ve bir hastada iki tarafli idi. Guvenli bronsiyal kapatma parankimi germeden pulmoner hacim kaybini engelledi. Ameliyata bagli komplikasyonlar bir hastada plevral efuzyon, iki hastada atelektazi, bir hastada yara enfeksiyonu ve uc hastada pnomoni idi. Bilgisayarli tomografi ile olculen kist caplari ortalama 10 cm idi. Hastanede ortalama kalis suresi 7.5 gun idi. So­nuc:­ Guncel kist hidatik tedavisi kistin cerrahi ile tam olarak cikarilmasini takiben pulmoner parankimin genislemesine izin vermelidir. Parankim koruyucu ve minimal invaziv torakotomi teknigi ile ameliyat edilen hastalarin hicbirinde rezeksiyona gerek kalmadi. Teknigimizin avantajlari; dusuk komplikasyon orani ve kistin minimal invaziv torakotomi ile kapitonaj gerektirmeden tek bir drenle cikilmasidir. Anah­tar­soz­cuk­ler: Yeni bir teknik; dev kist hidatikler; minimal invazif torakotomi. ABSTRACT Background:­This retrospective study aims to present our parenchyma-preserving and minimally invasive operation experiences on giant pulmonary hydatid cysts. Methods: Nineteen patients (13 males, 6 females; mean age 22 years) with giant hydatid cysts were operated. The outermost layer of the giant cyst, the adventitia, was excised up to the normal parenchyma, and the previously detected bronchial leaks were closed. The released adventitia were reciprocally sutured into the parenchyma. Results:­ Hydatid cysts were in the right hemithorax in 13 patients, in the left hemithorax in five patients, and bilateral in one patient. The safe bronchial closure prevented pulmonary volume loss without stretching the parenchyma. Operative complications were pleural effusion in one patient, atelectasis in two patients, wound infection in one patient, and pneumonia in three patients. The diameter of cysts, measured by computed tomography, was approximately 10 cm. The mean duration of hospitalization was 7.5 days. Conclusion:­ Current treatment of hydatid cysts should allow pulmonary expansion after complete surgical removal of the cyst. Thanks to parenchyma-preserving and minimally invasive thoracotomy technique, none of the operated patients required resection. Advantages of our technique include low rate of complications, and removal of the cyst using a single thoracic drain with minimally invasive thoracotomy without requiring capitonnage.

Nonislet cell tumor hypoglycemia is rare. We highlight the diagnosis and treatment of recurrent severe hypoglycemia in a 49-year-old woman with malignant solitary fibrous tumor of the pleura (Doege-Potter syndrome). The clinical, laboratory and radiologic findings of the case are presented and a brief literature review is provided. Of note, imaging studies showed a large mass in the right hemithorax and pathology and immunehistochemical stains confirmed a malignant solitary fibrous tumor of the pleura. She was a poor surgical candidate owing to a large tumor burden. She was treated with a combination of temozolomide and bevacizumab to which she responded with resolution of hypoglycemia. The treatment of choice for hypoglycemia in patients with the Doege-Potter syndrome is surgical excision. We here report that a combination of temozolomide and bevacizumab may be a viable option in patients with inoperable disease.

A 28-year-old woman presented to the emergency centre of First People’s Hospital of Yunnan Province with a 10-day history of dyspnoea and chest tightness. She had no history of cigarette smoking or drug use and no personal or family history of respiratory diseases. She used to live in Hefei, Anhui Province (with an average altitude of 20 metres). Ten days prior to presentation, she had moved to Kunming, Yunnan Province (a higher altitude area with an average altitude of 1900 metres) to take up a new job. She was in mild distress with an oxygen saturation of 95% while breathing ambient air. The physical examination revealed hyper-resonance and decreased breath sounds in the right hemithorax. The chest X-ray demonstrated a large lucency occupying the entire right hemithorax, with contralateral mediastinal shift (figure 1A). Subsequently, CT of chest revealed no sign of compressed lung tissue on the right (figure 1B …

Kaposiform hemangioendothelioma (KHE) is a rare, locally aggressive vascular tumor that does not metastasize. We report two unique cases of KHE involving the right hemithorax and the upper ipsilateral extremity. Kasabach-Merrit phenomenon and osteolytic lesions in the scapula were observed in both cases.

An 85-year old woman with a medical history of mild hiatal hernia was admitted to the medical intensive care unit for respiratory distress associated with hypoxaemia and hypercapnia. A diagnosis of cardiogenic oedema was suspected. The situation slightly improved after high-dose diuretics and non-invasive ventilation. The anteroposterior supine chest X-ray revealed a right thoracic opacity. The patient was transferred to the pulmonology unit. A classical erected posteroanterior chest X-ray revealed a large air-fluid level in the right hemithorax (figure 1). An …

We present a 71-year-old Caucasian woman with a history of tobacco dependence who was admitted for dyspnoea and cough. The patient was hypoxic on arrival, and physical examination demonstrated diminished breath sounds over the right hemithorax. Her chest radiograph ([figure 1][1]) revealed complete