Chondrosarcoma of the Sternum: Surgical Challenges, Chest Wall Reconstruction, and Postoperative Management.

Although rare, primary chondrosarcoma is the most frequent malignant tumor of the sternum. It commonly manifests as a painful, expanding mass arising from the costochondrosternal junction. Since it is resistant to radiotherapy and chemotherapy, surgical resection with reconstruction is the preferred treatment. A 50-year-old male presented with swelling over the left fourth sternocostal joint, gradually increasing in size. Imaging and clinical assessment suggested an infiltrative neoplasm, and surgical resection was indicated. The patient underwent a partial sternectomy, including a resection of the xiphoid process and costal cartilages two to seven and a partial resection of the manubrium. Postoperative pathohistological analysis specified the change as a low-grade chondrosarcoma in the pT1 stage. Chest wall reconstruction involved three pectus bars fixated around the ribs and the placement of a synthetic polypropylene mesh. The patient required postoperative rehospitalization due to partial skin layer wound dehiscence, serous drainage, and fever. Empirical antibiotic therapy was initiated, and the patient underwent a median superior laparotomy with partial omentoplasty of the sternal region, preserving the mesh and pectus bars. A culture analysis revealed methicillin-resistant Staphylococcus epidermidis, and postoperative antibiotic therapy was adapted to the antibiogram. Subsequently, all parameters of inflammation decreased, and wound healing followed. A one-year follow-up CT scan showed no disease recurrence. This case highlights the intricate surgical management that contributed to the successful treatment of sternal chondrosarcoma. Sternal wound infection, a severe postoperative complication with a high mortality rate, requires prompt identification, precise revision with culture-directed antibiotics, and effort to preserve the prosthetic material.

Late-Onset Chylothorax After Coronary Artery Bypass Grafting.

Chylothorax, the presence of lymph in the pleural cavity, is a significant post-cardiac surgery complication. Historically linked to left internal mammary artery (LIMA) harvesting, its occurrence in cases without LIMA usage is uncommon. This paper details a case of chylothorax in an 84-year-old female patient who underwent coronary artery bypass grafting (CABG) without LIMA harvesting. Three months post-surgery, she manifested symptoms of exertional shortness of breath and diminished breath sounds on the left side. Diagnostic measures, including echocardiography and chest X-rays, revealed a pronounced left-sided pleural effusion. Diagnostic thoracocentesis yielded a milky fluid, and laboratory analysis confirmed its chylous nature. Therapeutic interventions comprised chest tube insertion, drainage of the milky fluid, dietary modifications, and the performance of talc pleurodesis after a fatty food-provocation test resulted in increased fluid collection. The patient's journey highlights the challenges of diagnosing and managing post-cardiosurgical chylothorax. The paper emphasizes the importance of early detection and appropriate interventions to prevent complications associated with a heightened mortality risk.

Non-Hodgkin Lymphoma Presenting With Pulmonary Hyalinizing Granuloma: A Rare Clinical Entity.

Pulmonary hyalinizing granuloma (PHG) is an unusual benign pulmonary disease with nonspecific symptoms and slow progression, characterized by solitary or multiple fibrosing nodules. A definitive diagnosis of PHG usually requires a wide excisional biopsy. Associations of PHG with lymphoproliferative disorders, such as Castleman's disease and lymphoma, have been described. PHG is considered a paraneoplastic manifestation of those diseases. Treatment in most cases comprises therapy of the underlying condition with or without the use of empirical corticosteroid therapy. We report a case of a 57-year-old Caucasian female, who presented initially with dyspnea, fatigue, dry mouth, difficulty swallowing, night sweats, weight loss, and recurrent sinusitis. A physical examination revealed hepatosplenomegaly with generalized lymphadenomegaly. Chest computed tomography showed bilateral diffuse nodular changes about 10 mm in diameter in the lung parenchyma. A needle biopsy of a lymph node confirmed the diagnosis of non-Hodgkin lymphoma and chemotherapy was started. Since the parenchymal lung lesions progressed and no definite diagnosis could be made on the basis of transbronchial biopsy, a right-sided video-assisted thoracoscopy with atypical resection of the abnormalities was performed. The findings were consistent with a diagnosis of pulmonary hyalinizing granuloma. Due to preserved pulmonary function, there was no indication for starting corticosteroid therapy. The purpose of this case report is to draw attention to the possibility of pulmonary hyalinizing granuloma as a differential diagnosis when multiple nodular lesions are observed in the lungs. Although PHG is a rare entity, due to its frequent association with underlying diseases and nonspecific presentation, a careful investigation should be performed. For a definite diagnosis, a surgical biopsy is required.

Intrapleural Fibrinolytic Therapy With Alteplase for the Management of Multiloculated Malignant Pleural Effusion: A Case Series.

Malignant pleural effusion refers to the presence of fluid in the pleural space due to an underlying malignancy. Malignant pleural effusion is sometimes accompanied by the formation of fibrous adhesions resulting in a multiloculated effusion. This diminishes the efficacy of drainage and makes successful pleurodesis impossible, leaving the patients with severe shortness of breath. In the process of freeing the pleural space from fluid-filled loculations, intrapleural application of fibrinolytic is being investigated as a possible therapeutic approach. Here, we report four cases of adult patients hospitalized for malignant pleural effusions who were treated with intrapleural fibrinolytic therapy at the Institute for Pulmonary Diseases of Vojvodina, Republic of Serbia.