A novel surgical approach for multiple bronchial artery aneurysms.

Bronchial artery aneurysms (BAAs) are rare and are known to be associated with bronchiectasis. The presentation varies from incidental radiological finding to life-threatening hemoptysis. A diagnosis of BAA is an indication for intervention irrespective of its presentation. Despite interventional procedures being at the forefront of management, surgical procedures are being reserved for specific situations. Recently, video-assisted thoracoscopic surgery is an alternate for management of BAA. We, herein, present a case of multiple BAA with cystic bronchiectasis managed surgically with left lower lobectomy and localized descending thoracic aorta (DTA) replacement with plication of feeding arteries through left posterolateral thoracotomy approach.

Primary pleuro-pulmonary Ewing's sarcoma: multimodal approach with uniportal thoracoscopic resection.

Primitive neuroectodermal tumors (PNETs) and Ewing's sarcoma (ES) belong to the same family of malignant, small, round cell neoplasms of soft tissue or bone origin. With just around 30 cases reported so far, primary pleuro-pulmonary PNETs/ES are extremely rare in adults. We herein describe a case of a hexagenerian male diagnosed with primary pleuro-pulmonary PNETs/ES after tissue biopsy. He underwent neoadjuvant chemotherapy, and after significant downstaging of the tumor, he underwent complete resection of the lesion through uniportal video-assisted thoracoscopic surgery (u-VATS) followed by adjuvant chemo-radiotherapy. He was disease-free while under close follow-up for the past 1 year.

Reverse Macklin effect.

The Macklin effect is associated with alveolar rupture causing a centripetal spread of air along the peribronchovascular interstitial sheath leading to pneumomediastinum, usually seen in ventilator-related barotrauma or blunt chest trauma. We are presenting a peculiar case of iatrogenic (post-intubational) tracheal injury with massive subcutaneous emphysema and pneumomediastinum, in whom, we suspect that the primary tracheal injury and pneumomediastinum led to dissection of air along the peribronchovascular interstitium, culminating in atelectasis of lung due to compression of the distal-most airways, with no primary parenchymal abnormality. This supposed "reversal" of pathophysiological sequence of the Macklin effect makes it a unique finding.

Placental Site Trophoblastic Tumor in a Pulmonary Vascular Malformation With Spontaneous Pneumothorax.

Placental site trophoblastic tumor, a rare variety of gestational trophoblastic disease, is traditionally limited to the uterus, found within the placental implantation site where it can lead to arteriovenous malformations. Gestational trophoblastic diseases are known to metastasize to the lungs, of which choriocarcinomas are the most common. However arteriovenous malformations related to such metastatic lesions are extremely rare. The occurrence of spontaneous pneumothorax in pulmonary arteriovenous malformations, under any circumstances, is rarely reported. Herein we report a rare case of metastatic placental site trophoblastic tumor found within pulmonary arteriovenous malformations uniquely presenting with spontaneous pneumothorax.

Mediastinal Castleman disease with supraclavicular extension-a diagnostic dilemma and surgical challenge.

Castleman's disease, also known as angiofollicular lymph node hyperplasia, is a rare lymphoproliferative disorder, with unicentric or multicentric variety. Herein, we present an unusual case of unicentric Castleman disease in a 19-year-old boy presenting as a left posterior mediastinal mass with supraclavicular extension, a rare form of presentation, with very few cases reported in the past. It can be misdiagnosed as other malignant pathology and mismanaged as in our case; hence, a high index of suspicion is necessary.

Delayed recurrent spontaneous pneumothorax post-recovery from COVID-19 infection.

Pneumothorax, as a consequence of coronavirus disease 2019 (COVID-19) infection, has become an established entity but the delayed occurrence of pneumothorax, after recovery from the illness, is less commonly reported. We present a case of delayed recurrent spontaneous pneumothorax, presenting 4 weeks after recovery from COVID-19 in a previously healthy middle-aged gentleman, for which uniportal video-assisted thoracoscopic surgery (VATS) pleurectomy was performed, but the cause of pneumothorax could not be ascertained. This report brings to light, the importance of continued surveillance of COVID-19 survivors, the unpredictability of the disease process, and the challenges of thoracic surgery in this unique subset of patients.