The Role of Surgery in Patients with COVID-19-Related Thoracic Complications.

Objective: Patients with several thoracic complications induced by SARS-CoV-2 infection may benefit from surgery, but its role in this condition is largely unknown, and many surgeons' advice against any surgical referrals. Our aim is to investigate the efficacy and safety of surgery in COVID-19 patients with thoracic complications requiring surgery. Methods: We designed a multicenter observational study, involving nine thoracic surgery departments, evaluating patients who developed thoracic complications in hospital, surgically managed from March 1, 2020, to May 31, 2021. An overall 30-day mortality was obtained by using the Kaplan-Meier method. Multivariable Cox regression model and logistic models were applied to identify the variables associated with mortality and postoperative complications. Results: Among 83 patients, 33 (40%) underwent surgery for complicated pneumothorax, 17 (20.5%) for pleural empyema, 13 (15.5%) for hemothorax, 8 (9.5%) for hemoptysis, 5 patients (6%) for lung abscess, 4 (5%) for infected pneumatoceles, and 3 (3.5%) for other causes. Within 30 days of surgery, 60 patients (72%) survived. At multivariable analysis, age (HR 1.05 [95% CI, 1.01, 1.09], p = 0.022), pulmonary hypertension (HR 3.98 [95% CI, 1.09, 14.5], p = 0.036), renal failure (HR 2.91 [95% CI, 1.19, 7.10], p-value 0.019), thoracotomy (HR 4.90 [95% CI, 1.84, 13.1], p-value 0.001) and infective affections (HR 0.17 [95% CI, 0.05, 0.58], p-value 0.004) were found to be independent prognostic risk factors for 30-day mortality. Age (OR 1.05 [95% CI, 1.01, 1.10], p = 0.023) and thoracotomy (OR 3.85 [95% CI, 1.35, 12.0] p = 0.014) became significant predictors for 30-day morbidity. Conclusion: Surgical management of COVID-19-related thoracic complications is affected by high mortality and morbidity rates, but a 72% survival rate still seems to be satisfactory with a rescue intent. Younger patients without pulmonary hypertension, without renal insufficiency and undergoing surgery for infectious complications appear to have a better prognosis.

Chylothorax after coronary artery bypass grafting: Is it always early?

BACKGROUND: Chylothorax is a rare complication of cardiothoracic surgical interventions and usually presents early in the postoperative period. MATERIALS AND METHODS: We present a case of 63 years female who presented with chylothorax 5 months after undergoing coronary artery bypass surgery. DISCUSSION AND CONCLUSION: Chylothorax should be considered in patients with recurrent pleural effusions even if the effusions do not have the typical milky appearance. Although chylothorax in most cases will present early in post operative period, it should be remembered that it can present in a delayed manner. Morbidity and health care costs associated with this entity can be remarkably high and therefore it is of great importance to diagnose and treat it.

Ruptured pulmonary hydatid disease mimicking a lung mass: diagnosed by flexible video bronchoscopy.

Echinococcosis is frequently seen in an endemic country like India. The vast majority of infestations in humans are caused by Echinococcosis granulosus. The cyst is most commonly seen in the liver in about 74% of the cases, followed by pulmonary involvement in about 24% of cases. In our case report, a 25-year-old man presented with a mass-like lesion in the upper and middle lobe of the right lung. The patient had deteriorated clinically as the mass like opacity grew in size. Here, we have highlighted an uncommon presentation of hydatid disease of the lung diagnosed by video bronchoscopy and bronchoalveolar lavage (BAL) as clinico-radiological examination along with FNAC (fine-needle aspiration cytology) of the lesion proved insufficient tools to make a diagnosis.