An abrupt fatal hemothorax in a stable COVID-19 patient: a case report with literature review.

Introduction and importance: COVID-19 has been widely spread in the last 2 years. Hemothorax is considered one of the rarest complications of COVID-19. Case presentation: The authors herein report a case of a 52-year-old patient of COVID-19 that was complicated with abrupt massive hemothorax with hemodynamic instability. Emergent thoracostomy drained almost 4500 ml of blood within 48 h. Thoracoscopy was also performed draining an additional 2000 ml of blood and clots. No further bleeding occurred. Unfortunately, the patient died of septic shock and multiorgan dysfunction. Clinical discussion: Hemothorax has been reported in seven patients with COVID-19 in the medical literature. Six patients had severe infection with veno-venous extra-corporeal membranous oxygenation (VV-ECMO), and the seventh patient had necrotizing pneumonia. To our knowledge, this represents the first patient of an abrupt massive hemothorax in a COVID-19 patient just before recovery. Conclusion: Post-COVID-19 hemothorax should be suspected in severe cases with sudden clinical deterioration and evidence of pleural effusion.

Reconstruction of the upper gastrointestinal tract using intra-thoracic Roux-en-Y technique after caustic agent ingestion: a case report from Aleppo, Syria.

BACKGROUND: Caustic substance ingestion is a high-risk medical emergency associated with high mortality and morbidity. To date, there are several treatment options with no standard method of care. CASE PRESENTATION: We report a case of a corrosive agent ingestion complicated with third-degree burns and severe stenosis of the esophagus and gastric outlet. After failure of conservative treatment, the patient underwent jejunostomy placement for nutritional support followed by transhiatal esophagectomy with gastric pull-up and intra-thoracic Roux-en-Y gastroenterostomy with good outcomes. The patient recovered from the procedure and has been tolerating oral intake very well with significant weight gain. CONCLUSION: We put a new technique for treating severe gastrointestinal injuries caused by corrosive agent ingestion that resulted in both esophageal and gastric outlet strictures. These rare complex cases requires difficult treatment decisions. We believe that this technique provides many benefits for such cases and might be a feasible alternative for colon interposition.

Unusual localizations of hydatid cysts: a rare case report from Syria.

Hydatid disease (HD) is an infection with the metacestode stage of the tapeworm Echinococcus. It is commonly seen in South America, The Middle East, Eastern Mediterranean, Africa and China. Hydatid cysts usually affect the liver followed by the lungs. Involvement in other organs has been reported. However, in the majority of the cases, cysts are localized in one organ or one region. We report a rare case of a 36-year-old woman who presented to the hospital in Syria with long-standing history of non-specific abdominal pain. Computerized tomography showed several hydatid cysts in the liver, spleen, left lung, mediastinum (adjacent to the aortic arch), both breasts and above the right gluteal muscles.

Enbloc resection of the largest thymic liposarcoma: A case report with literature review.

Liposarcoma is the most common soft tissue tumor which is commonly found in the retroperitoneal region. This kind of tumor is usually well-differentiated with low to no potential to metastasize. Thymoliposarcomas are extremely rare tumors that are difficult to diagnose and differentiate from thymomas and other benign conditions. Presentation of a case:This report presents a case of a 46-year-old male patient with dyspnea, generalized fatigue and non-specific chest pain caused by a giant anterior mediastinal mass. Computed tomography scan revealed a large mass in the anterior mediastinum. CT guided biopsy was consistent with thymolipoma. The tumor was surgically resected. The histological analysis of the tumor revealed thymoliposarcoma. Discussion:Thymoliposarcoma usually presents with non-specific symptoms. The mean age of the diagnosis is 55.8 years old with a slight predominance in males. The corner stone of the treatment remains surgical excision of the tumor while the role of adjuvant therapy is not well documented.

Esophageal cancer in Aleppo, Syria 2010-2020: a rare cancer in a war zone.

The management of diseases such as cancer in developing countries are often suboptimal given a lack of resources and access to specialists and therapeutics. In March 2020, Syria descended into its ninth year of the war with a rising death toll and millions of Syrian refugees. Aside from the inherent dangers of war, cancer care during war is especially difficult with partially or non-functional infrastructure due to destruction, inconsistent electrical power, inaccessibility, or the inherent dangers of living in a war zone. Furthermore, limitations to therapeutics are exacerbated when supply chains responsible for bringing in essential medications such as chemotherapeutics are disrupted by international economic sanctions. Aleppo, Syria is the site of some of the fiercest fighting which ended in December 2016. Since then, Aleppo has made a slow recovery to rebuild its infrastructure while the war continues elsewhere in the country. In this article, we aim to highlight the challenges in the management of cancer, particularly esophageal cancer, during a time of war in Aleppo, Syria. We aim to discuss current challenges and limitations to care in a war zone. We will also touch upon areas of need for continued improvement in the care of cancer patient's in Aleppo, Syria.

Large rib osteochondroma in a child in Aleppo, Syria.

BACKGROUND: Osteochondromas are the most common tumors of the long bones in children. Osteochondromas can rarely be seen in the chest wall and they are usually diagnosed at a young age. They can be sporadic or part of the hereditary multiple exostoses. CASE PRESENTATION: We report a 12-year-old boy, who presented with a hard and large mass in the chest wall. The mass grew slowly after the original resection. Diagnosis and treatment were delayed because of the war. Radiological examination showed a large calcified tumor pushing the upper lung lobe. He was treated surgically. Pathology confirmed the diagnosis of an osteochondroma with no evidence of malignancy. CONCLUSION: Osteochondroma occur most frequently in long bones next to the metaphysic. These tumors can also develop in unusual sites. Wide total excision with negative margins is important to prevent recurrence.