[Thoracic surgery in solving enormous elevation of the left hemidiaphragm].

BACKGROUND: Acquired elevation of the diaphragm is mostly the result of phrenic nerve paralysis, some of thoracic and abdominal patological states, and also some of neuromuscular diseases. Surgical treatment is rarely performed and is indicated when lung compression produces disabilitating dyspnea, and includes plication of diaphragm. The goal of this case report has been to show completely documented diagnostic procedures and surgical treatment one of rare pathological condition. CASE REPORT: A 62-year-old patient was admitted to our clinic because of surgical treatment of the enormous elevation of the left hemidiaphragm. After thoracotomy and plication of the bulging diaphragm, lung compression did not exist any more and mediastinum went back in the normal position. CONCLUSION: Elevation of the diaphragm rarely demands surgical correction. When it is complicated with lung compression and disabilitating dyspnea, surgical treatment has extremely useful functional effect.

[Clinical and pathophysiological features of traumatic stenosis of the right main bronchus--case report].

INTRODUCTION: Severe blunt injury of the chest can cause rupture of the tracheobronchial tree. After completed management of the injury, stenosis of the bronchi may develop at the site of the rupture. Such condition is associated with pathophysiolocical disorders, which then indicates to the possible presence of the bronchial stenosis. CASE REPORT: We report a patient with stenosis of the right main bronchus due to blunt injury sustained in a traffic accident. We present all pathophysiological signs detected during examination. The patient had dyspnea, cianosis, tachycardia, low oxygen saturation and low pO2. We performed right thoracothomy and resection of the main bronchus with TT anastomosis. CONCLUSION: It is very useful to understand the described pathophysiological signs so as to ensure rapid diagnosis of stenosis, but also better and timely solving of problems that can occur during thoracothomy.

[Descending necrotizing mediastinitis].

BACKGROUND: [corrected] Descending necrotizing mediastinitis (DNM) is an acute, serious, septic disease which results from a complication of oropharyngeal infection. The disease requires a prompt diagnosis and radical surgical treatment to reduce high mortality (40%). The optimal form of mediastinal drainage remains conroversial. The reason for publishing this report is both the fact that DNM is very rare and our experience prefering thoracotomy as an optimal approach to treating the disease. CASE REPORT: We reported a 34-years-old woman with DNM. The disease began as a peritonsillar abscess. After a bilateral double pleural drainage the disease worsened. In order to achieve radical mediastinal debridement and drainage, we carried out posterolateral right thoracotomy. We also had to perform left thoracotomy bacause of massive bleeding coused by septic erosion. There were no more reoperations. CONCLUSION: Aggressive surgical treatment, regardless the localization and the extent of changes is the key to success in the treatment of patients with necrotizing mediastinitis.

[Stenosis of the right major bronchus from blunt trauma].

BACKGROUND: A severe blunt injury to the chest might cause rupture of the tracheobronchial tree. A certain time following the management of the injury, stenosis of the bronchi may develop at the site of the rupture. CASE REPORT: We reported a patient injured in a traffic accident. The injury was followed by the signs of pneumothorax, bleeding, and respiratory insufficiency. After the management of the injury using thoracal drainage, the condition of the injured was stabilized. Two weeks later, however, difficulties in breathing and fatigue occurred. Circular stenosis of the right major bronchus was clinically, radiographically and bronchoscopically confirmed. Right thoracotomy and circular resection of the major bronchus with termino-terminal anastomosis were performed. CONCLUSION: In severe blunt injuries to the chest, it is very important to suspect the injury of the tracheobronchial tree in order to correctly understand the clinical signs of an injury and to interprete a radiographic image of it, so as to decide upon the optimal treatment on time.