RESUMO
Bullae formation on a cystic background is still not described thoroughly. This clinical case aims to improve this situation and describes the combination of multiple cysts with vascular malformation, giant bullae (2/3 of the left hemithorax and 1/2 of the right hemithorax) with suppuration in a 50-year-old smoker. Before surgery, treatment for chronic obstructive lung disease (COPD) was administered without a positive outcome. Bullectomy was subsequently conducted and histopathological data revealed vascular malformation causing microinfarctions in pulmonary parenchyma, cystic degeneration and tuberculosis. Although it became possible to establish a final diagnosis due to histology, the need for surgical treatment was clear from clinical and x-ray evidence. Such instances as the one presented in this case report should assist with improving our knowledge about bullae in combination with cysts in the lungs because they provide additional context in a clinical setting.
RESUMO
BACKGROUND: The long history of the struggle against tuberculosis (TB) inspired us to develop a new minimally invasive technique of thoracoplasty with videothoracoscope control (VATP). The aim of this study was to determine its efficacy. METHODS: We conducted a retrospective single-center study of a cohort of patients operated on between 1999 and 2017. Two hundred eight patients who were indicated for thoracoplasty with verified TB with cavities in the upper lobe/S6 were enrolled in this study. Treatment outcomes were assessed based on Laserson criteria and active TB absence verified with CT. RESULTS: Intraoperative and postoperative complications were observed in 15 (7.2%) and 4 (2.0%) cases, respectively. There were no 30-day mortalities. VATP with curative intent succeeded in 88% of cases according to Laserson criteria and active TB absence verified with computed tomography (CT). Clinical improvement (sputum negativity, closure of caverna, and lack of reactivation for 3 years) was achieved in 81% of cases. CONCLUSIONS: Comparing the successful results of this technique in the cohort of multidrug-resistant (MDR) TB patients with the outcomes of treatment of MDR TB worldwide (77% vs. 55%, respectively), the VATP technique is shown to be efficacious and thus recommended. CLINICAL TRIAL REGISTRY NUMBER: ISRCTN67743278.
RESUMO
A patient with extensive fibrocavitary pulmonary tuberculosis and extensively drug-resistant Mycobacterium tuberculosis underwent bilateral video-assisted thoracic surgery thoracoplasty. An examination 4 years post-surgery revealed that the patient was in a satisfactory condition and able-bodied. We performed surgery according to our proposed video-assisted thoracic surgery thoracoplasty technique. In the postoperative period, we noted early patient symptoms, including significantly less-pronounced pain than with standard incisions, the absence of limitations in upper limb mobility, and the absence of gross chest deformation. Permanent surgical collapse sufficient for closing cavities and the elimination of bacilli were achieved and confirmed with a computed tomography scan.
