RESUMO
A 67-year-old male was admitted to our hospital for the treatment of pyothorax due to bronchopleural fistula at right main bronchus after pneumonectomy for lung cancer( squamous cell carcinoma, pathological stageâ ¢B). After tube drainage and fenestration, we performed operation to close large diameter fistula, that was almost fully opened stump of the right main bronchus. Omental flap was sutured roughly to the fistula with four stiches and inserted into the bronchus lumen, and covered with latissimus dorsi muscle flap to fix omental pedicle flap and additionally performed thoracoplasty to close the residual space of the pleural cavity. Fistula at the stump became airtight after operation and pyothorax was cured, so our method was thought to be available to close large diameter bronchopleural fistula with omental pedicle flap.
Assuntos
Fístula Brônquica , Doenças Pleurais , Pneumonectomia , Retalhos Cirúrgicos , Humanos , Masculino , Idoso , Pneumonectomia/métodos , Fístula Brônquica/cirurgia , Fístula Brônquica/etiologia , Doenças Pleurais/cirurgia , Doenças Pleurais/etiologia , Neoplasias Pulmonares/cirurgia , Omento/transplante , Omento/cirurgia , Complicações Pós-Operatórias/cirurgia , Brônquios/cirurgia , Carcinoma de Células Escamosas/cirurgiaRESUMO
A 59-year-old male patient was referred to our hospital for further examinations and treatment due to an abnormal shadow detected in his left lower lung lobe on computed tomography. The patient was diagnosed with intralobar pulmonary sequestration and scheduled for an operation. During the surgery, after resection of the aberrant artery, indocyanine green was intravenously injected, and the border between normal lung and sequestrated lung was clearly identified by an infrared thoracoscope. Subsequently, wedge resection was performed, and the patient was discharged on postoperative day 5. Spirometry performed 6 months after the surgery indicated that the patient's lung function was well-preserved compared to the preoperative status.
Assuntos
Sequestro Broncopulmonar , Procedimentos Cirúrgicos Pulmonares , Masculino , Humanos , Pessoa de Meia-Idade , Sequestro Broncopulmonar/diagnóstico por imagem , Sequestro Broncopulmonar/cirurgia , Toracoscópios , Pulmão , Medidas de Volume PulmonarRESUMO
A 76-year-old woman was pointed out a small nodule in the right lower lung lobe on a chest computed tomography( CT) for follow-up examinations of malignant thyroid lymphoma. Although she had undergone a radical mastectomy for right breast cancer 28 years previously, the nodule was suspected to be either metastatic lymphoma or primary lung cancer and thoracoscopic surgery was planned to perform. Since the intraoperative frozen section diagnosis was adenocarcinoma, right lower lobectomy and systemic lymph node dissection were performed. However, the final pathology revealed that the lesion was breast cancer metastasis and subcarinal lymph nodes were also positive for metastases.
Assuntos
Neoplasias da Mama , Neoplasias Pulmonares , Feminino , Humanos , Idoso , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/cirurgia , Neoplasias Pulmonares/patologia , Neoplasias da Mama/cirurgia , Neoplasias da Mama/patologia , Estadiamento de Neoplasias , Metástase Linfática/patologia , Mastectomia , Linfonodos/diagnóstico por imagem , Linfonodos/cirurgia , Linfonodos/patologia , Pulmão/patologia , Excisão de LinfonodoRESUMO
A 72-year-old man was introduced continuous ambulatory peritoneal dialysis (CAPD) for chronic renal failure. Five months later, he was pointed out a massive right pleural effusion. Being diagnosed with pleuroperitoneal communication, he was referred to our department for surgery. Dialysis fluid and indocyanine green were injected through a peritoneal catheter for CAPD 30 minutes before surgery. A small fistula was detected by pressing the abdomen and using infrared thoracoscopy. The fistula was sutured and covered with polyglycolic acid sheet and fibrin glue. A day after surgery, CAPD was resumed. He was discharged on the post operative sixth day without any complications.
Assuntos
Fístula , Hidrotórax , Falência Renal Crônica , Diálise Peritoneal Ambulatorial Contínua , Doenças Peritoneais , Doenças Pleurais , Idoso , Humanos , Masculino , Adesivo Tecidual de Fibrina , Fístula/cirurgia , Hidrotórax/diagnóstico , Hidrotórax/etiologia , Hidrotórax/cirurgia , Verde de Indocianina , Falência Renal Crônica/terapia , Falência Renal Crônica/complicações , Diálise Peritoneal Ambulatorial Contínua/efeitos adversos , Doenças Peritoneais/etiologia , Doenças Peritoneais/cirurgia , Doenças Pleurais/etiologia , Doenças Pleurais/cirurgia , Doenças Pleurais/diagnóstico , Ácido PoliglicólicoRESUMO
Pleuroperitoneal communication is one of the complications for continuous ambulatory peritoneal dialysis. Communication sites, such as defects or bleb-like lesions, are found in the diaphragm, but it is sometimes difficult to detect these sites. We combined the infrared thoracoscopy and negative pressure technique to detect communication sites. We think our new technique will become an alternative option for difficult and complex cases.
Assuntos
Hidrotórax , Diálise Peritoneal Ambulatorial Contínua , Doenças Peritoneais , Doenças Pleurais , Comunicação , Humanos , Diálise Peritoneal Ambulatorial Contínua/efeitos adversos , Doenças Peritoneais/diagnóstico , Doenças Peritoneais/etiologia , Doenças Pleurais/diagnóstico , Doenças Pleurais/etiologia , Doenças Pleurais/terapiaRESUMO
A 69-year-old man with occupational exposure to asbestos was referred to our hospital with right diffuse malignant pleural mesothelioma. He underwent extrapleural pneumonectomy with reconstruction of the pericardium and diaphragm using elongated polytetrafluoroethylene patches, followed by postoperative chemotherapy and chest wall irradiation. One year later, he was hospitalized because of a right empyema caused by Escherichia coli infection. As chest drainage and systemic antibiotics did not eliminate the abscess around the artificial patches, a Clagett window was created. To avoid mediastinal and liver overshift into the right thoracic cavity, we only performed partial resection of the diaphragm patch and incision of the artificial pericardium. After 19 days of irrigation and dressing change, the artificial patches were completely removed. Two months later, the patient provided a culture-negative sample and had an improved nutritional status; we therefore performed closure of the Clagett window with thoracoplasty. He did not experience recurrence of empyema.
Assuntos
Empiema Pleural , Mesotelioma Maligno , Mesotelioma , Neoplasias Pleurais , Idoso , Empiema Pleural/etiologia , Empiema Pleural/cirurgia , Humanos , Masculino , Mesotelioma/cirurgia , Neoplasias Pleurais/cirurgia , Pneumonectomia/efeitos adversosRESUMO
A 69-year-old man had experienced right upper lobectomy for inflammatory granuloma. Three months after surgery, he was diagnosed with pleural empyema due to bronchopleural fistula and open window thoracostomy was performed. Since we could not decrease the dead space and the amount of pleural effusion, we introduced negative pressure wound therapy (NPWT). Before applying, we closed the fistula with suturing and cyanoacrylate products. Four weeks later, we performed an operation to close the open window with muscle transposition. NPWT is reported to be useful to treat pleural empyema, but control the air leakage from fistulas is essential to introduce this treatment. We think cyanoacrylate products may be useful in closing fistulas temporarily to introduce NPWT.
Assuntos
Fístula Brônquica , Empiema Pleural , Empiema , Tratamento de Ferimentos com Pressão Negativa , Doenças Pleurais , Idoso , Fístula Brônquica/cirurgia , Cianoacrilatos , Empiema Pleural/cirurgia , Humanos , Masculino , Doenças Pleurais/cirurgia , PneumonectomiaRESUMO
A 68-year-old man was referred to our hospital for further examination for chest abnormal shadow in the right lung field. He had a past history of subarachnoid hemorrhage. He was diagnosed with pulmonary arteriovenous malformation (PAVM) and recommended early treatment, but he didnot accept immediate surgical treatment. Three months later, he was transferred to other hospital emergently to treat nausea and dizziness. After being diagnosed with cerebellum abscess, external drainage was performed at our hospital. First drainage had a temporary efficacy, so second drainage was performed before referring to our department. Considering his condition and brain abscess, surgery for PAVM was done.
Assuntos
Fístula Arteriovenosa , Malformações Arteriovenosas , Abscesso Encefálico , Veias Pulmonares , Idoso , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/cirurgia , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/cirurgia , Humanos , Masculino , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgia , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/cirurgiaRESUMO
A 63-year-old man was pointed out a mass lesion in his chest X-ray at a medical checkup and referred to our hospital for further examination. Chest computed tomography showed a 4 cm-diameter tumor in the left upper lobe. He was diagnosed with adenocarcinoma by bronchoscopic biopsy. Therefore, we performed left upper lobectomy. The tumor was diagnosed as pulmonary blastoma with the differentiation of adenocarcinoma and large cell neuroendocrine carcinoma.
Assuntos
Adenocarcinoma , Carcinoma Neuroendócrino , Neoplasias Pulmonares , Blastoma Pulmonar , Adulto , Diferenciação Celular , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
A 22-year-old woman visited a hospital to treat her dyspnea which had lasted for some months. Chest X-ray showed hyperlucency in her left upper lung field and chest computed tomography suggested left upper bronchial obstruction with mucoid impaction. She was referred to our hospital for further examination and treatment. Bronchoscopy showed left upper lobar bronchial atresia. Considering her dyspnea worsened in relatively short terms, surgical treatment was chosen and the resection of left upper division was successfully performed.