Non-functional paraganglioma of the mediastinum.

Paragangliomas are rare tumours which have the ability to secrete neuropeptide and catecholamines. Frequently, the clinical presentation of these tumours is ill defined and some may have no symptoms whatsoever until the tumour is large enough to cause symptoms secondary to local invasion and mass effect, hence making paragangliomas a challenge to diagnose and manage surgically. We report a case of a 55 year old female who presented with shortness of breath and chest pain for 3 years. Further investigations led to the demonstration of a mass along the left side of the mediastinum which was suggestive of a neoplasm. Complete surgical resection of the tumour was achieved and the patient was discharged uneventfully.

Huge carcinoid tumour causing complete obstruction of the left main bronchus and destruction of left lung.

Carcinoid tumours arise from the neuroendocrine cells of the bronchial epithelium known as Kulchitsky cells and comprise 4% of all lung malignancies. We report a case of a 16- year-old male who presented with a 1-month history of fever, cough, left-side chest pain and shortness of breath. Chest X -ray showed loss of lung volume on the left side with cystic spaces and air fluid levels. Computed tomography scan chest demonstrated a homogenous mass extending into the left main bronchus causing its complete obstruction along with extensive bronchiectatic changes in the left lung. Bronchoscopy and bronchial biopsy confirmed the diagnosis of typical carcinoid tumour. A pneumonectomy was performed. This case is unusual due to the large size of the tumour, its location and associated destruction of the entire left lung.

Thoracoscopic evacuation of retained post-traumatic hemothorax.

Post-traumatic retained hemothorax is a major risk factor for empyema thoracis leading to prolonged hospitalization, entrapped lung and a need for decortication. VATS (Video Assisted Thoracoscopy) for retained hemothorax shortens the duration of chest tube drainage and length of stay. From December 2004 to July 2009, 110 consecutive patients underwent VATS for retained or clotted hemothoraces at the Department of Thoracic Surgery, Jinnah Postgraduate Medical Centre, Karachi. Majority of the patients were males (n = 91; 82.7%). Sixty-five patients (59.1%) underwent VATS within 6 days and 45 patients (40.9%) between 7 - 14 days of injury. In 8 patients (7.3%) VATS was abandoned for thoracotomy. Post VATS full lung expansion was achieved in 87 patients (79.0) with complete evacuation of hemothorax. Chest tubes were removed within the first week in 100 patients (90.9%). In hemodynamically stable patients, VATS is a safe, reliable and effective technique for the evacuation of retained hemothorax. Early intervention within 6 days of injury avoids the need for a thoracotomy and is associated with a better short and long-term outcome.