VATS approach for pulmonary sclerosing pneumocytoma: a case report.

INTRODUCTION: Pulmonary Sclerosing Pneumocytoma (PSP) is a rare type of benign lung tumor usually encountered in middle-aged Asian women. The lesion is mostly found on routine chest x-rays. Though surgery is recognized as the recommended treatment, there is no consensus on the standard operative procedure for this tumor. CASE PRESENTATION: We report a case of a 48 year-old Caucasian woman who presented with a right para-hilar mass mimicking a hydatid cyst. After an unsuccessful initial treatment with oral Albendazole, and a steady growth over 10 years, the patient was programmed for surgical resection by video-thoracoscopic (VATS) approach. We were able to completely resect the tumor by VATS. Histopathological analysis suggested the diagnosis of Pulmonary Sclerosing Pneumocytoma. No further treatment was required and the patient was rapidly discharged. CONCLUSIONS: Pulmonary sclerosing pneumocytoma is a rare form of benign tumor that should be part of the differential diagnosis of lung lesions of unknown origin. Because of its well-defined encapsulated structure allowing total enucleation, VATS can be proposed as a less invasive alternative to classic thoracotomy.

Pneumothorax in otherwise healthy non-intubated patients suffering from COVID-19 pneumonia: a systematic review.

BACKGROUND: Cases of spontaneous pneumothorax have been described in patients suffering from coronavirus disease 2019 (COVID-19) pneumonia. The aim of this study is to systematically review all the cases of spontaneous pneumothorax that occurred in healthy patients with no underlying lung disease and who did not receive invasive mechanical ventilation. METHODS: A PubMed research was conducted. The following data were collected: age, sex, side of the pneumothorax, smoking habit, time form onset of symptoms to the diagnosis of pneumothorax, the development of new bullous lesions on computed tomography and the type of treatment. In order to analyze the most homogeneous population possible, intubated patients were deliberately excluded. In total, 44 cases of spontaneous pneumothorax in otherwise healthy patients were taken into account. Since the available data were extracted from small observational studies, no particular bias risk assessment was performed. Descriptive statistics were used to synthesize results. RESULTS: There were 37 male (84.1%) and 6 female (13.6%) patients. The majority of patients (66%) were treated only by chest tube thoracostomy, which most of the times resulted in a complete resolution of the pneumothorax. Simple surveillance was applied in 10 cases. Three patients underwent minimally invasive surgery. In 14 cases (31.8%) air-filled lesions were detected on imaging. Eleven patients received corticosteroids during their hospital stay. In the majority of cases (86.3%) the pneumothorax was resolved. DISCUSSION: Even if the level of evidence, derived from case reports and small case series is low, the existence of a true secondary spontaneous pneumothorax due to SARS-CoV-2 should be recognized. Imaging techniques should be repeated throughout the clinical course of the patients in order to detect newly developed pulmonary complications. Surgical treatment is feasible and patients whose general condition permits, should be offered surgery according to the existing guidelines regarding spontaneous pneumothorax. National registries and databases are necessary in order to better understand the pathogenesis and complications of this novel entity.

Lipiodol lymphangiography as a treatment for refractory postoperative chylothorax: a case report.

Postoperative chylothorax is the most frequent cause of traumatic thoracic chyle leakage. Conservative treatment is primarily used to treat low flow rate chylothoraces and should be initiated as soon as the diagnosis has been made. In case of high flow rate chylothorax or failure of initial treatment, surgery and radiological treatment are indicated. Despite this fact, there is a lack of consensus regarding the best therapeutic option to choose. In the case reported herein, a postoperative chylothorax with a low flow chyle leakage which didn't respond to conservative treatment is demonstrated. We used lipiodol lymphangiography to determine the site of chyle leakage and to successfully treat our patient. Risk factors for non-response to conservative treatment are also discussed.

Pleural empyema caused by Actinomyces turicensis.

Actinomyces turicensis was first identified in 1995. To the best of our knowledge, pleural empyema caused by A. turicensis has never been reported. In the case reported herein, a patient with pleural empyema was treated surgically, and in the bacterial samples, A. turicensis was isolated.

Pneumothorax and Pregnancy: A Systematic Review of the Current Literature and Proposal of Treatment Recommendations.

INTRODUCTION: Spontaneous pneumothorax occurs rarely during pregnancy with less than 100 cases reported in the English literature. There is no strong evidence concerning the treatment of spontaneous pneumothorax during pregnancy and labor. The aim of this study is to systematically review all the reported cases and to suggest recommendations for its diagnosis and treatment. METHODS: A PubMed research was conducted. The following data were collected: maternal age, gestation age (weeks), presence of underlying lung pathology, initial management, definitive management, obstetric outcome, and the complications for the mother and the fetus. RESULTS: Eighty-seven cases were identified. The mean maternal age was 27 years (standard deviation [SD] ± 6). The mean gestational age was 25 weeks (SD ± 11.4). In 37.9% of cases, there was no underlying lung disease. In the majority of cases (67.4%), the initial treatment was the placement of a chest tube. In 48% of cases, the pneumothorax was resolved with conservative treatment. Surgical therapy was performed either antepartum or postpartum. In 58.6% of cases, there was a vaginal delivery, spontaneous or instrumental. In three cases (3.4%), there were fetal complications. CONCLUSION: The analysis of the current literature provides low evidence, since there are only case reports and small case series. It is likely that the frequency of this condition is underestimated. However, this analysis permits to draw some conclusions concerning the timing of pneumothorax treatment, the operative strategy, and the mode of delivery to decrease the risk for the mother and the fetus.

Survival and treatment outcome of head and neck cancer patients with pulmonary oligometastases.

OBJECTIVES: The purpose of this study was to determine the outcome of head and neck squamous cell carcinoma (HNSCC) patients developing lung metastasis. DESIGN: Retrospective study. PARTICIPANTS: HNSCC patients with lung metastasis treated between 2001 and 2018 were included. MEAN OUTCOMES MEASURES: Statistical analyses described the relationship between patient survival, treatment efficacy and pulmonary metastasis occurrence. RESULTS: One hundred HNSCC patients were included in the study. The median overall survival (OS) was 21 months. The median recurrence-free survival (RFS) was seven months. Patient survival with only lung metastases was significantly longer compared to patients with lung metastases and lymph nodes involvement or other metastases. Moreover, patients with a single metastasis had longer post-RFS and OS than patients with multiple metastases. The local control of metastasis was better when patients presented only lung metastases, and it was more effective in single metastasis. The surgery allowed better metastases local control than supportive care or radio and/or chemotherapy. In case of specific therapy, pulmonary resection was associated with a longer post-RFS and a longer OS compared to supportive care or radio and/or chemotherapy. CONCLUSIONS: We confirmed, in the current study, the significant survival benefit for HNSCC patients treated by surgery for their pulmonary metastasis. While treatment of multiple metastases required palliative chemotherapy or best supportive care in most of the cases, specific surgical treatment in selected HNSCC patients should be considered.

Intrathoracic hooked wire migration managed by minimally invasive thoracoscopic surgery.

Background: Needle-guided localization wire is widely used to locate non-palpable breast lesion before surgery. A rare complication of this technique is wire migration. We report a case of an intrathoracic hooked wire migration in a 41-year-old female treated by video-assisted thoracoscopic surgery (VATS).Methods: We report a recent patient history and we review the cases reported in the literature.Results: Hook removal by thoracoscopy seemed to be the less invasive and most effective approach for this stable case. Even asymptomatic migration should be treated, and the device removed. The less invasive approach can be considered after estimating the risk and best possible timing.Conclusion: The loss of a hooked wire can lead to dramatic lesions. In every case, the device must be found or, if not, migration ruled out. The hooked wire must be removed, and the timing and the approach must be adapted to each case. VATS should be considered, in a stable patient to assess the lesions, to treat them and to remove the device.

Late right ventricular perforation after permanent pacemaker implantation: how far can the lead go?

This case report describes the incredible dislocation of a right ventricular lead 1 month after pacemaker implantation. The lead's tip was found in the subcutaneous fat beneath the left breast. Extraction was uneventful. The key steps in the diagnosis and management of this rare complication are discussed.