ABSTRACT
Spontaneous oesophageal rupture (Boerhaave's syndrome) is extremely rare in children. Presentation is usually in middle aged men as a result of vomiting following heavy food or alcohol consumption. We describe an unusual case of a 12-year old boy without significant past medical history presenting with acute chest pain following gastroenteritis.
La ruptura esofágica espontánea (síndrome de Boerhaave) es extremadamente rara en niños. Por lo general se presenta en hombres de mediana edad como resultado vómitos tras la ingestión de alcohol o alimentos pesados. Describimos un caso inusual de un niño de 12 años de edad sin antecedentes clínicos significativos, que acudió con dolor torácico agudo tras una gastroenteritis.
Subject(s)
Humans , Male , Child, Preschool , Child , Pneumopericardium/diagnostic imaging , Rupture, Spontaneous/diagnosis , Esophageal Perforation/diagnosis , Mediastinal Emphysema/diagnostic imaging , Mediastinal Diseases/diagnosis , Pneumopericardium/etiology , Rupture, Spontaneous/etiology , Vomiting/etiology , Chest Pain/etiology , Radiography , Diagnosis, Differential , Esophageal Perforation/etiology , Gastroenteritis/complications , Mediastinal Emphysema/etiology , Mediastinal Diseases/etiologyABSTRACT
El síndrome postneumonectomía es una entidad poco frecuente en pediatría. Comunicamos un caso secundario a una neumonectomía realizada por un tumor intratorácico. Niño de 4 años con antecedente de exéresis pulmonar derecha y dificultad respiratoria progresiva, con obstrucción extrínseca de la vía aérea por estructuras mediastínicas desplazadas. Hubo intentos frustros de tutorización con dispositivos endoluminales de la vía aérea, e imposibilidad de retiro de la asistencia ventilatoria mecánica. Ante la imposibilidad de reposicionamiento mediastinal, se realiza puente (bypass) aórtico con tubo protésico, con evolución favorable y egreso hospitalario.
Postpneumonectomy syndrome is a rare entity in children. We report a case secondary to pneumonectomy performed due to an intrathoracic tumor. A 4-year-old boy with a history of right pneumonectomy and progressive respiratory distress, with extrinsic airway obstruction due to displaced mediastinal structures. There were failure to intubate the airway with endoluminal devices and impossibility of withdrawing from mechanical ventilation. As mediastinal repositioning was not possible, an aortic bypass with a prosthetic tube graft was performed, with favorable outcome and hospital discharge.
Subject(s)
Child, Preschool , Humans , Male , Hernia/etiology , Lung Diseases/etiology , Mediastinal Diseases/etiology , Pneumonectomy/adverse effects , SyndromeABSTRACT
Mediastinal haematoma is a rare complication following insertion of central venous catheter, with few cases reported in the literature. We report a case of mediastinal haematoma in a 33-year-old male patient with end-stage renal disease. In this patient central venous catheter insertion through the right subclavian vein was attempted on the operation table for renal transplantation but the procedure was abandoned as the attempt was unsuccessful. Post-procedure chest radiograph showed a large mediastinal haematoma occupying right hemithorax that developed as a result of injury to the subclavian vein. Patient was managed conservatively and haematoma completely resolved in four weeks time. This case is being reported to signify the importance of routine obtaining a post-procedure chest radiograph and to state that even large mediastinal haematoma can be managed conservatively in asymptomatic patients.
Subject(s)
Adult , Catheterization, Central Venous/adverse effects , Hematoma/etiology , Hematoma/diagnostic imaging , Humans , Intraoperative Complications , Kidney Failure, Chronic/surgery , Kidney Transplantation , Male , Mediastinal Diseases/etiology , Mediastinal Diseases/diagnostic imaging , Subclavian Vein/injuries , Tomography, X-Ray Computed/methodsABSTRACT
Las malformaciones adenomatoideas congénitas pulmonares son una anomalía fetal rara. Presentamos seis casos diagnosticados in útero. Los criterios diagnósticos y pronósticos son claramente tratados.
Subject(s)
Female , Pregnancy , Humans , Cystic Adenomatoid Malformation of Lung, Congenital , Diagnosis, Differential , Mediastinal Diseases/etiology , Hydrops Fetalis/etiology , Hydrops Fetalis , Cystic Adenomatoid Malformation of Lung, Congenital/classification , Cystic Adenomatoid Malformation of Lung, Congenital/complications , Cystic Adenomatoid Malformation of Lung, Congenital/therapy , Prognosis , Ultrasonography, PrenatalABSTRACT
El cáncer de células germinales de testículo es el modelo de neoplasia curable. Las complicaciones a largo plazo son bien conocidas y el seguimiento incluye la pesquisa no sólo de la recaída, sino también de la aparición de segundos tumores y secuelas del tratamiento empleado. Un aumento de la incidencia de lesiones con granulomas tipo sarcoidosis se ha descripto en las últimas dos décadas en pacientes curados quienes en el seguimiento se presentan con nódulos pulmonares o adenopatías mediastinales.Se presenta el caso clínico de un paciente de 28 años quien durante el seguimiento clínico por un tumor seminomatoso, muestra en la tomografía axial computada y radiografía de tórax la presencia de adenopatías en mediastino, sin evidencia de enfermedad en abdomen y pelvis, el otro testículo normal y marcadores negativos.Ante esta peculiar situación, se realiza mediastinoscopia diagnosticándose reacción sarcoidal en ganglio mediastinal. Durante el seguimiento de pacientes con tumores germinales de testículo la presencia de adenopatías mediastinales exige contar con el diagnóstico histológico y tener en cuenta a la sarcoidosis en el diagnóstico diferencial
Testicular germ cell tumors constitute a model for curable neoplasia. Long-term complications are well-known and follow-up includes not only awareness of relapse, but also of the development of secondary tumors and treatment sequelae. In the last two decades, an increase in sarcoidosis incidence has been described in cured patients, who at follow-up present lung nodules or mediastinal lymph nodes. A 28 year-old patient who, on clinical follow up of a seminomatous tumor, presented mediastinal lymph nodes on CT scan and chest x-ray, without evidence of disease in pelvis or abdomen is presented. His other testicle was normal and he had negative tumor markers. Because of this rare presentation, a mediastinoscopy was performed and sarcoidosis like reaction was diagnosed. During follow-up of patients with testicular germ cell tumors, the presence of mediastinal lymph nodes requires a histological diagnosis and sarcoidosis should be considered as differential diagnosis
Subject(s)
Humans , Male , Adult , Mediastinal Diseases/etiology , Sarcoidosis/etiology , Seminoma/complications , Testicular Neoplasms/complications , Diagnosis, Differential , Follow-Up Studies , Lymph Nodes/pathology , Lymphatic Metastasis/pathology , Mediastinal Diseases/pathology , Mediastinum/pathology , Neoplasm Recurrence, Local/pathology , Neoplasm Recurrence, Local/therapy , Prognosis , Sarcoidosis/pathology , Seminoma/pathology , Seminoma/therapy , Testicular Neoplasms/pathology , Testicular Neoplasms/therapy , Biomarkers, Tumor/analysisABSTRACT
Propósito del trabajo: Determinar los factores predisponentes para sangrados perioperatorios en cirugía de revascularización miocárdica y establecer el papel de ácido acetilsalicílico, otros antiagregantes plaquetarios, y anticoagulantes, en la ocurrencia de estos sangrados. Método: Se realizó un análisis multivariado de 251 pacientes sometidos a cirugía de revascularización miocárdica en el año 2002. Resultados: En la administración prequirúrgica de ácido acetilsalicílico no se encontró diferencia significativa para la ocurrencia de sangrado perioperatorio importante. No existió incremento significativo en la transfusión de unidades de paquetes globulares, plaquetas, crioprecipitados. Los pacientes con administración de heparina no fraccionada y de bajo peso molecular, tuvieron un sangrado transoperatorio significativamente mayor (p < 0.001) que los pacientes sin este fármaco. El empleo del resto de los fármacos estudiados, no incrementó la cantidad de sangrado ni la administración de hemoderivados. Conclusiones: No existe evidencia estadística que justifique suspender la administración de antiagregantes plaquetarios en los pacientes con síndromes coronarios urgentes o electivos, a quienes se les someta a cirugía de revascularización miocárdica. Sin embargo, resultaría conveniente suspender la administración de heparina no fraccionada y de bajo peso molecular, a pacientes sometidos a cirugía de revascularización miocárdica en forma electiva.
Objective: To determine the main factors for perioperative mediastinal bleeding during coronary artery by-pass grafting and to establish the role of acetylsalicylic acid, other inhibitors of platelet adhesion, and anticoagulants in its occurrence. Methods: A multivariate analysis was performed to the data obtained from 251 patients subjected to coronary artery by-pass grafting in the year 2002. Results: There were no significant differences for the occurrence of perioperative bleeding induced by the preoperative administration of acetylsalicylic acid. No significant increment in the need for blood, platelet, or cryoprecipitates transfusion existed. Patients receiving non-fractionated or low molecular weight heparin had a significantly greater (p < 0.001) transoperative bleeding than patients without this drug. Administration of the other studied drugs did not increase either mediastinal bleeding or the need for blood derivatives. Conclusions: No statistical evidence was found to suspend administration of inhibitors of platelet adhesion in patients with coronary syndromes, subjected to coronary artery by-pass grafting. However, data obtained suggest the convenience of suspending administration of low molecular weight or non-fractionated heparin to patients subjected electively to coronary artery by-pass grafting.
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Anticoagulants/administration & dosage , Aspirin/administration & dosage , Coronary Artery Bypass , Heparin, Low-Molecular-Weight/administration & dosage , Mediastinal Diseases/etiology , Platelet Aggregation Inhibitors/administration & dosage , Postoperative Hemorrhage/etiology , Anticoagulants/adverse effects , Aspirin/adverse effects , Blood Component Transfusion , Case-Control Studies , Cross-Sectional Studies , Heparin, Low-Molecular-Weight/adverse effects , Mediastinal Diseases/epidemiology , Mediastinal Diseases/therapy , Mediastinum/pathology , Platelet Aggregation Inhibitors/adverse effects , Postoperative Hemorrhage/epidemiology , Postoperative Hemorrhage/therapy , Retrospective Studies , Risk FactorsABSTRACT
Esophageal perforation is a serious condition; a delay of more than 48 hours in initiation of treatment leads to increased morbidity and mortality. Management of such patients is a surgical dilemma. We successfully managed 4 patients (2-iatrogenic, 1-tuberculous, 1-Boerhaave's syndrome) with delayed presentation of esophageal perforation by esophageal exclusion and paraesophageal mediastinal drainage, achieving good control of mediastinal sepsis, healing of perforation and at the same time avoiding thoracotomy and subsequent second surgery.
Subject(s)
Adult , Combined Modality Therapy , Drainage/methods , Esophageal Perforation/complications , Esophagostomy/methods , Female , Follow-Up Studies , Gastrostomy/methods , Humans , Male , Mediastinal Diseases/etiology , Middle Aged , Time Factors , Tomography, X-Ray ComputedABSTRACT
En el presente estudio se reporta el caso de una mujer de 30 años de edad que desarrolló lupus eritematoso generalizado (LEG) y tromboembolia pulmonar (TEP) durante el embarazo. Después de una punción de la vena subclavia, presentó un hematoma mediastinal que generó un desplazamiento de las estructuras vecinas y síndrome de Horner, los cuales se resolvieron sin abordaje quirúrgico, hecho poco común para este tipo de lesiones. El tratamiento consistió en esteroides e inmunosupresores. Se discuten la evolución y el abordaje de estos hematomas y la posible participación del tratamiento en la evolución de este caso
Subject(s)
Humans , Female , Adult , Pregnancy Complications, Hematologic/etiology , Hematoma/etiology , Iatrogenic Disease , Lupus Erythematosus, Systemic/complications , Subclavian Vein/injuries , Antibodies, Antiphospholipid , Azathioprine/administration & dosage , Hematoma/drug therapy , Mediastinal Diseases/etiology , Prednisone/administration & dosage , Pulmonary EmbolismABSTRACT
A case of large giant-cell tumour arising from the 6th dorsal vertebra and presenting as a posterior mediastinal mass is reported. To our knowledge, such a large mediastinal mass due to a giant-cell tumour has not been reported.
Subject(s)
Adult , Female , Giant Cell Tumors/complications , Humans , Mediastinal Diseases/etiology , Spinal Neoplasms/complications , Thoracic VertebraeABSTRACT
Descreve-se o caso de um paciente do sexo masculino, de 84 anos de idade, que apresentou após traumatismo fechado de tórax, um volumoso hematoso de mediastino. No decorrer da evoluçäo verificou-se instabilidade cardíaca pela presença de arritmia importante, além de derrame pleural hemorrágico bilateral e alteraçöes hematológicas que reverteram após o tratamento cirúrgico de drenagem do hematoma por via transestemal mediana. Seis mêses depois o paciente apresenta-se assintomático