RESUMO
In pulmonary hernia or pneumocele the lung protrudes through a defect in the chest wall. In this report of a case of spontaneous intercostal lung hernia, we describe the pathogenesis and classification of such hernias, including signs, symptoms, radiological findings and treatment methods. Our patient presented with severe chest pain at the base of the left hemithorax. A chest film and computed tomography of the region showed an left intercostal hernia. Surgical treatment was successful.
Assuntos
Pneumopatias/diagnóstico , Idoso , Hérnia , Humanos , Músculos Intercostais , MasculinoRESUMO
La hernia pulmonar o neumocele es una protrusión del pulmón a través de un defecto de la pared torácica. Presentamos un caso de hernia pulmonar intercostal espontánea y realizamos una descripción de la patogenia y de la clasificación de las hernias pulmonares. Se discuten los hallazgos clínicos y radiológicos, así como los diferentes métodos de tratamiento. En este caso, el paciente presentó un intenso dolor torácico en la base del hemitórax izquierdo. Las imágenes obtenidas por radiografía simple y tomografía axial computarizada (TAC) torácicas pusieron de manifiesto la existencia de una hernia intercostal izquierda. Después del diagnóstico radiológico se realizó tratamiento quirúrgico reparador con buenos resultados (AU)
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Assuntos
Idoso , Masculino , Humanos , Hérnia , Músculos Intercostais , PneumopatiasRESUMO
BACKGROUND: Several options are available for treating patients with a first episode of primary spontaneous pneumothorax (ISP). The aim of this study was to compare the efficacy of two treatment alternatives: puncture-aspiration (PA) using a small caliber catheter, and pleural drainage through a chest tube (DCT). PATIENTS AND METHODS: We compared a current series of 91 patients treated with PA with a retrospective series of 216 patients treated with DCT. PA was performed by emergency room physicians and DCT was performed by chest surgeons. Patients were followed for a period of 24 months. RESULTS: The immediate efficacy of PA was superior to DCT (86.7% versus 76%, p < 0.05). The proportion of recurrences after each treatment was similar (23% and 17%, respectively, NS). Duration of hospital stay was shorter for PA-treated patients (24 h) than for DCT-treated patients (138 h) (p < 0.05). The efficacy of the two procedures 24 months later was similar (63.7% and 62.9%, respectively, NS), and the cost of PA was three times less than that of DCT. CONCLUSIONS: PA is as effective a treatment procedure as DCT. PA is simple enough for emergency room physicians to perform correctly. Inconvenience to the patient, cost to the health care system, and time of hospital stay are all significantly less with PA.
Assuntos
Pneumotórax/terapia , Sucção/métodos , Adulto , Tubos Torácicos , Drenagem , Feminino , Humanos , Masculino , Sucção/instrumentaçãoRESUMO
Four cases of costal chondrosarcoma were observed in the Thoracic Surgery Department of Nostra Señora de Aránzazu Hospital in San Sebastián. This tumour rarely occurs in the ribs and no papers concerning more than one personal case, over such a brief interval, have been reported. The diagnosis was established on the basis of clinical and radiological data in three cases and after biopsy in the fourth case. Large surgical resection allowed complete histological examination, which confirmed the diagnosis of chondrosarcoma. The tumours were classified into grade I and II according to the degree of differentiation of the tumour cells. All 4 patients were treated exclusively by surgical resection. Marlex mesh was necessary to repair the chest wall defect in 3 cases. The functional result was satisfactory. One of these patients was lost to follow-up and no signs of recurrence have been observed in the other 3 patients, although the follow-up remains relatively short (9, 8 and 7 months, respectively).
