RESUMO
Methylmethacrylate is a prosthetic material commonly used for the reconstruction of large chest wall defects. We present the first reported case of delayed methylmethacrylate plate migration, which resulted in an aortic pseudoaneurysm with aortopulmonary fistula. Treatment management, including staged repair combining endovascular and open approaches, is also discussed.
Assuntos
Falso Aneurisma/cirurgia , Aorta Torácica/cirurgia , Placas Ósseas/efeitos adversos , Migração de Corpo Estranho/cirurgia , Metilmetacrilato/efeitos adversos , Toracotomia/efeitos adversos , Falso Aneurisma/diagnóstico por imagem , Aorta Torácica/diagnóstico por imagem , Implante de Prótese Vascular/métodos , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/patologia , Neoplasias Ósseas/cirurgia , Terapia Combinada , Seguimentos , Migração de Corpo Estranho/diagnóstico por imagem , Imageamento Tridimensional/métodos , Medição de Risco , Parede Torácica/patologia , Parede Torácica/cirurgia , Toracotomia/métodos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/métodosRESUMO
Fourth branchial complex anomalies are rare and typically present in neonates or adolescents. Surgical management via open excision is the traditional approach to prevent recurrence. However, endoscopic sinus cauterization has recently been reported as a less invasive alternative. The current case report represents the first published account of a fourth branchial pouch presenting in an adult patient effectively managed through endoscopic excision. We compare this method to open excision and endoscopic ablative techniques.
Assuntos
Região Branquial/anormalidades , Região Branquial/cirurgia , Endoscopia , Feminino , Humanos , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Adulto JovemRESUMO
Endobronchial, ultrasound-guided, transbronchial needle aspiration has recently been introduced as an alternative to mediastinoscopy for lymph node staging of lung cancer and the diagnosis of respiratory diseases. This procedure is less invasive and more cost-effective, and multiple large studies have reported no associated complications. In this case, an individual presented with descending mediastinitis after having this minimally invasive procedure for mediastinal lymphadenopathy.
Assuntos
Abscesso/etiologia , Biópsia por Agulha/efeitos adversos , Infecções por Klebsiella/etiologia , Klebsiella pneumoniae , Doenças Linfáticas/diagnóstico por imagem , Doenças Linfáticas/patologia , Mediastinite/etiologia , Biópsia por Agulha/métodos , Broncoscopia , Humanos , Masculino , Mediastino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , UltrassonografiaRESUMO
Open thoracotomy procedures serve as the mainstay for surgical resection of pulmonary aspergilloma. These procedures are considered among the most challenging for thoracic surgeons, and postoperative morbidity and mortality rates are high. Here, we present patient who underwent video-assisted thoracoscopic lobectomy for aspergilloma. Based on the success of the operation, we suggest that video-assisted thoracoscopic surgical resection be considered as an option for pulmonary aspergilloma.
Assuntos
Hemoptise/cirurgia , Aspergilose Pulmonar Invasiva/cirurgia , Lúpus Eritematoso Sistêmico/complicações , Pneumonectomia/métodos , Cirurgia Torácica Vídeoassistida/métodos , Broncoscopia , Diagnóstico Diferencial , Feminino , Seguimentos , Hemoptise/diagnóstico , Hemoptise/etiologia , Humanos , Aspergilose Pulmonar Invasiva/complicações , Aspergilose Pulmonar Invasiva/diagnóstico , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Mediastinoscopy is considered the gold standard for evaluating mediastinal lymph nodes. However, endobronchial ultrasound-guided transbronchial needle aspiration has lately offered a less invasive alternative, with the ability to obtain nodal samples under direct visualization. Recent literature found an early learning curve for this technique. We present the initial experience of 4 thoracic surgeons with the procedure. MATERIALS AND METHODS: A retrospective chart review was performed on the first 51 patients on whom an endobronchial ultrasound-guided transbronchial needle aspiration was performed from January 5, 2007, to July 24, 2008. This group included 43 patients with a history or known diagnosis of malignancy as well as 8 patients with a presumed sarcoidosis diagnosis. All negative results were confirmed with mediastinoscopy. The technique's sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were assessed. RESULTS: A total of 73 lymph nodes underwent biopsy in 51 patients. These individuals included 34 men and 17 women, with an average age of 62 years (range, 21-89 years). No surgical or postoperative complications were noted. Overall, a correct diagnosis was established in 88% of the patients (45 of 51). After the first 25 cases (a mean of 6 cases per surgeon), a technique modification was adapted to increase diagnostic yield. The first 25 cases had a 72.22% sensitivity and 80% accuracy, whereas the last 26 cases had a 95.45% sensitivity and 96.15% accuracy (P = .07). CONCLUSION: Endobronchial ultrasound-guided transbronchial needle aspiration is a quickly mastered technique that offers a safe, minimally invasive, and accurate means to evaluate mediastinal lymph nodes.
