Consideraciones anestésicas en pacientes sometidos a cirugía para resección de tumores intratorácicos: reporte de caso / Anesthetic considerations in patients undergoing surgery for intrathoracic tumor resection: case report

Resumen: Las grandes masas mediastínicas aumentan los riesgos asociados con la anestesia general. Las complicaciones más temidas en este tipo de pacientes son el colapso de la vía aérea, seguido del colapso cardiovascular. Presentamos el caso de una paciente de 30 años con diagnóstico de sarcoma sinovial con metástasis pulmonar y con la presencia de dos tumores intratorácicos. El objetivo del caso clínico es revisar las implicaciones anestésicas y su manejo en este grupo de pacientes.

Abstract: Large mediastinal masses increase the risks associated with general anesthesia. The most feared complications in this type of patients are the collapse of the airway, leading to cardiovascular collapse. We present the case of a 30-year-old patient diagnosed with synovial sarcoma with pulmonary metastasis, with the presence of two intrathoracic tumors. The objective of the clinical case is to review the anesthetic implications and their management in this group of patients.

Acute Intrathoracic Tuberculosis in Children and Adolescents with Community-Acquired Pneumonia in an Area with an Intermediate Disease Burden.

Tuberculosis (TB) in the pediatric population is a major challenge. Our objective was to describe the clinical and microbiological characteristics, radiological patterns, and treatment outcomes of children and adolescents (from 1 month to 17 years) with community-acquired pneumonia (CAP) caused by TB. We performed a prospective cohort study of a pediatric population between 1 month and 17 years of age and hospitalized in Medellín, Colombia, with the diagnosis of radiologically confirmed CAP that had ≤ 15 days of symptoms. The mycobacterial culture of induced sputum was used for the bacteriological confirmation; the history of TB contact, a tuberculin skin test, and clinical improvement with treatment were used to identify microbiologically negative TB cases. Among 499 children with CAP, TB was diagnosed in 12 (2.4%), of which 10 had less than 8 days of a cough, 10 had alveolar opacities, 9 were younger than 5 years old, and 2 had close contact with a TB patient. Among the TB cases, 50% (6) had microbiological confirmation, 8 had viral and/or bacterial confirmation, one patient had multidrug-resistant TB, and 10/12 had non-severe pneumonia. In countries with an intermediate TB burden, Mycobacterium tuberculosis should be included in the etiological differential diagnosis (as a cause or coinfection) of both pneumonia and severe CAP in the pediatric population.

New technique for intrathoracic implantation of extraluminal spiral prostheses in the trachea

Background: Extraluminal surgical procedures for intrathoracic tracheal collapse in dogs are not routinely performed. The patients are normally treated with different drugs or by intraluminal stents. However, in more severe cases, drug treatment does not always have good outcomes, and intraluminal prostheses can be correlated to several postoperative problems. In order to obtain better results, we aimed to develop a surgical technique for implantation of a new extraluminal helical prosthesis in the thoracic segment of the trachea through cervical access, associated with pneumatic mediastinoscopy for certification of the technique and minimization of possible complications. Materials, Methods & Results: Seven canine corpses (CCs) from non-traumatic death, weighing between 2 and 7 kg, were used. A ventral cervical approach to the trachea was associated with blunt mediastinal dissection. Trans cervical pneumatic mediastinoscopy was used for evaluation of the dissection and location of the implant. These were compared with the necropsy findings by the exact Wilcoxon two-sample test, with P < 0.05. The results of necropsy and mediastinoscopy did not present significant differences at P < 0.05. During the examinations, the presence of some mediastinal visceral le-sions caused by the prosthesis, the integrity of the mediastinum and possible lesions to RLN and blood vessels (BV) were analyzed. We also investigated the location of the distal part of the prosthesis in the thoracic segment of the trachea and its dissection. To evaluate the technique, statistical comparison was made between mediastinoscopy and necropsy find-ings. The data were compared by the Wilcoxon test at 5% probability. The tracheas of all CCs were efficiently dissected, but in some cases problems that can happen during the procedure were noticed. This was checked by mediastinoscopy and confirmed by necropsy. The median of the scores was...(AU)

An overview of retrosternal goiter.

Goiters tend to grow slowly and steadily over many years, occasionally reaching the mediastinum and extending through the thoracic inlet into the visceral compartment. In most cases, retrosternal goiters originate from the cervical portion of the thyroid. The incidence of retrosternal goiters varies considerably, ranging from 0.2 to 45% of all thyroidectomies, depending on the criteria used to define this type of goiter. Symptoms are generally related to the compressive nature of the mass on the adjacent structures, and most patients report some form of respiratory manifestation associated with the goiter. A diagnostic assessment usually includes an evaluation of thyroid function, chest radiography, and computed tomography. Fine-needle aspiration biopsy should be avoided in substernal areas of the goiter due to limited visibility and location of vital structures in this region. Treatment of retrosternal goiters is surgical, as medical therapy is generally unsuccessful in these cases.

New technique for intrathoracic implantation of extraluminal spiral prostheses in the trachea

Background: Extraluminal surgical procedures for intrathoracic tracheal collapse in dogs are not routinely performed. The patients are normally treated with different drugs or by intraluminal stents. However, in more severe cases, drug treatment does not always have good outcomes, and intraluminal prostheses can be correlated to several postoperative problems. In order to obtain better results, we aimed to develop a surgical technique for implantation of a new extraluminal helical prosthesis in the thoracic segment of the trachea through cervical access, associated with pneumatic mediastinoscopy for certification of the technique and minimization of possible complications. Materials, Methods & Results: Seven canine corpses (CCs) from non-traumatic death, weighing between 2 and 7 kg, were used. A ventral cervical approach to the trachea was associated with blunt mediastinal dissection. Trans cervical pneumatic mediastinoscopy was used for evaluation of the dissection and location of the implant. These were compared with the necropsy findings by the exact Wilcoxon two-sample test, with P < 0.05. The results of necropsy and mediastinoscopy did not present significant differences at P < 0.05. During the examinations, the presence of some mediastinal visceral le-sions caused by the prosthesis, the integrity of the mediastinum and possible lesions to RLN and blood vessels (BV) were analyzed. We also investigated the location of the distal part of the prosthesis in the thoracic segment of the trachea and its dissection. To evaluate the technique, statistical comparison was made between mediastinoscopy and necropsy find-ings. The data were compared by the Wilcoxon test at 5% probability. The tracheas of all CCs were efficiently dissected, but in some cases problems that can happen during the procedure were noticed. This was checked by mediastinoscopy and confirmed by necropsy. The median of the scores was...

Bocio Intratorácico / Intrathoracic goiter

El bocio intratorácico se define como aquel bocio que se encuentra parcial o totalmente en el mediastino; su incidencia está en relación con el bocio multinodular. Es asintomático entre el 20­30%. Su diagnóstico se hace por pruebas de imagen; su Gold estándar es la tomografía axial computarizada. El tratamiento más efectivo y recomendado es la cirugía, sobre todo para pacientes con síntomas opresivos o con sospecha de malignidad y bocios hiperfuncionantes en quienes el tratamiento farmacológico no fue exitoso. Se detalla el caso de una paciente de 59 años de edad, quien, con síntomas opresivos esternales, a quien se le diagnostica masa mediastínica, la cual se resuelve con indicación quirúrgica, siendo resolutiva para la paciente, con mejoras en la sintomatología y diagnostico de benignidad. (AU)

Intrathoracic goiter is defined as partially or totally in the mediastinum; its incidence is related to multinodular goiter. It is asymptomatic in 20-30%. Its diagnosis is made by imaging tests; the gold standard is computerized axial tomography. Treatment can be pharmacological with risk of recurrence; the most effective and recommended is surgery, especially for patients with oppressive symptoms or with suspected malignancy. We present the case of a 59-year-old patient with sternal oppressive symptoms, who is diagnosed with a mediastinal mass, which resolved by surgery, with improvements in symptoms and a diagnosis of benignity. (AU)

Complicaciones inusuales de las derivaciones ventrículoperitoneales. A propósito de 2 casos pediátricos / Unusual complications of ventriculoperitoneal shunts. About 2 pediatric cases

Introducción: Durante el seguimiento de los pacientes con derivación ventrículoperitoneal (DVP) para el tratamiento de la hidrocefalia se pueden presentar complicaciones habituales relacionadas a la derivación, tales como infecciones u obstrucción/ruptura del sistema derivativo. Sin embargo, raramente se pueden observar complicaciones más raras y graves que pueden afectan a órganos como el corazón y el pulmón. Pacientes y métodos: Presentamos 2 pacientes con raras complicaciones relacionadas a la DVP. El primero, un paciente de 10 años, que después de 7 años de la implantación de una DVP presentó episodios de neumonía recurrente secundaria a la migración intrapulmonar del catéter distal. El segundo caso, un paciente de 3 años, que 5 meses posteriores a la colocación de una DVP presentó síntomas de hipertensión endocraneana secundarios a migración intracardíaca del catéter distal. Conclusión: La migración intrapulmonar e intracardíaca del catéter distal son complicaciones extremadamente raras, pero que pueden producir morbilidad importante. Los pacientes con derivación ventrículoperitoneal deben ser controlados de forma rutinaria de por vida, con la finalidad de evitar comorbilidades asociadas a sus complicaciones.

Introduction: during the follow-up of patients with ventriculoperitoneal (VP) shunts for the treatment of hydrocephalus, common complications may occur, such as infections or obstruction/rupture of the shunt system. However, more rare and serious complications that affect organs such as the heart and lungs can be observed Patients and methods: we present 2 patients with rare complications related to VP shunts. The first, a 10-year-old patient, who 7 years after implantation of a VP shunt, presented episodes of recurrent pneumonia secondary to intrapulmonary migration of the distal catheter. The second case, a 3-year-old patient, who 5 months after the placement of a VP shunt, presented with symptoms of intracranial hypertension secondary to intracardiac migration of the distal catheter. Conclusion: intrapulmonary and intracardiac migration of the distal catheter are extremely rare complications, but they can cause significant morbidity. Patients with ventriculoperitoneal shunts should be routinely monitored for life by neurosurgeons, in order to avoid comorbidities associated with potential complications.

Video-Laparoscopic Treatment of Intrathoracic Gastric Volvulus.

BACKGROUND: Gastric volvulus is a rare condition, characterized by abnormal rotation of the stomach, causing obstruction with risk of ischemia, necrosis, and perforation. It is associated with high morbidity and mortality rates and, as it is life threatening, early diagnosis and treatment are crucial. METHODS: Retrospective study of medical records of intrathoracic gastric volvulus patients treated by video-laparoscopy from January 2000 to December 2018, in a University Hospital. RESULTS: Thirty patients (34 surgical procedures - 4 re-operations), 9 (30%) male and 21 (70%) female. The mean age was 57.65 ± 32.65 and the mean body mass index was 27.11 ± 3.5 kg/m2. The most prevalent symptoms were epigastric pain and dysphagia. In 41.17% of the cases, the contrast X-ray confirmed the diagnosis. All 34 cases were intrathoracic volvulus, 24 of which were organo-axial (70.58%). The surgical technique used was hiatoplasty, without mesh (25 cases; 73.52%) and with reinforcement mesh (9 cases; 26.47%), mostly associated with Nissen fundoplication (52.94%). The mean surgical time was 215.7 ± 62.9 minutes, with conversion in 5 cases (15.62%). Hospitalization ranged from 4 ± 2 days. There was no record of operative mortality, and symptom improvement occurred in 100% of patients. The mean follow-up time for patients was 41.8 ± 32.6 months. CONCLUSIONS: Surgical treatment should be indicated to reduce morbidity and mortality, and associated with improved symptoms and patient prognosis. Video-laparoscopic surgery on intrathoracic gastric volvulus proved to be safe and effective and should be the option of choice in the management of this disease.

Interacciones cardiopulmonares: de la fisiología a la clínica / Cardiopulmonary Interactions: from Physiology to Clinic

Resumen: Las Interacciones Cardiopulmonares (ICP) corresponden al conjunto de interrelaciones entre el sis tema respiratorio y el cardiovascular, durante el ciclo respiratorio y cardíaco. Estas interacciones varían dependiendo de si el paciente se encuentra en ventilación espontánea o mecánica, afectando en distintos grados la precarga y postcarga, tanto del ventrículo derecho e izquierdo. El entender estas interacciones, resulta esencial al momento de manejar pacientes críticamente enfermos, en donde las manipulaciones de la precarga y postcarga, son de especial importancia al momento de optimizar el débito cardíaco y la entrega de oxígeno a los tejidos. En este artículo se presentan los principios fisiológicos que permiten entender las interacciones cardiopulmonares en ventilación espontánea y en ventilación mecánica, aplicadas a situaciones clínicas específicas, lo que nos ayudará a utilizarlas como herramientas en el manejo de los pacientes.

Abstract: Cardiopulmonary Interactions (CPI) refer to the interplay between the respiratory and cardiovascu lar systems during the respiratory and cardiac cycle. These interactions vary depending on whether the patient is in spontaneous or mechanical ventilation and affect the preload and afterload of both ventricles at different levels. Understanding CPI is essential to the management of critically ill pa tients, where preload and afterload manipulations are specialy important to optimize cardiac output and oxygen delivery to the periphery. The present article reviews the physiological principles required to understand CPI in patients both in spontaneous and mechanical ventilation using specific clinical scenarios to facilitate its use as part of day to day clinical practice.

The prognostic impact of additional intrathoracic findings in patients with cancer-related pulmonary embolism.

AIM: To assess the prevalence and prognostic significance of additional intrathoracic findings (AIFs) in patients with cancer and pulmonary embolism (PE). AIFs were considered alterations other than the characteristic ones intrinsic to PE or changes in cardiovascular morphology. METHODS: Subjects have been taken from a Spanish national multidisciplinary and multicenter study of PE and cancer who were treated between 2004 and 2015. The endpoint was the appearance of serious complications or death within 15 days. RESULTS: The registry contains 1024 eligible patients; 41% diagnosed by computed tomography pulmonary angiography versus 59% by non-angiographic CT. Serious complications occurred within 15 days in 18.9%, [95% confidence interval (CI), 16.6-21.4%] and 9.5% (95% CI 7.9-11.5%) died. At least one AIF was seen in 72.6%. The most common AIFs were as follows: pulmonary nodules (30.9%), pleural effusion (30.2%), tumor progression (28.3%), atelectasis (19.0%), pulmonary infarct (15.2%), emphysema (13.4%), pulmonary lymphangitic carcinomatosis (4.5%), and pneumonia (6.1%). Patients with AIF exhibited a higher complication rate at 15 days: 21.9% versus 13.0%, odds ratio (OR) 1.8 (95% CI 1.2-2.8), P = 0.03, and 15-day mortality: 15.0% versus 7.3%, OR 1.9 (95% CI 1.1-3.2), P = 0.020. Patients with pneumonia, pneumothorax, pulmonary edema, pulmonary nodules, tumor progression, pulmonary fibrosis, and pleural effusion showed an excess of adverse events. CONCLUSIONS: Additional intrathoracic findings are highly prevalent and significantly impact prognosis in patients with PE and cancer, making them germane to the classification of this population.

Substernal goiter and laryngopharyngeal reflux

ABSTRACT Objective This study aims to compare the prevalence of laryngopharyngeal reflux signs between two groups of patients undergoing thyroidectomy for voluminous goiter: substernal goiters and voluminous cervical goiter without thoracic extension. Subjects and methods A retrospective case-control study was performed with data retrieved of the charts of the patients submitted to thyroidectomies occurred at a tertiary care center (Head and Neck Surgery Department, University of São Paulo Medical School) between 2010 and 2014. The selected thyroidectomies were allocated in two groups for study: patients with substernal goiters and patients with voluminous cervical goiter without thoracic extension. Cervical goiters were selected by ultrasonography mensuration. Clinical criterion was used to define substernal goiter. Results The average thyroid volume in patients with substernal goiter was significantly greater than the average volume in patients with only cervical goiter (p < 0.001). The prevalence of signs of reflux laryngitis at laryngoscopy was significantly greater in substernal goiter patients (p = 0.036). Moreover, substernal goiter was considered as the unique independent variable for high reflux laryngitis signs at laryngoscopy (OR = 2.75; CI95%: 1.05-7.20; p = 0.039) when compared to only cervical goiter patients. Conclusion This study shows a significant association between substernal goiters and signs of laryngopharyngeal reflux at preoperative laryngoscopy. Therefore, when compared with voluminous cervical goiters, the substernal goiters increase the chance of reflux laryngitis signs in patients.

Bocio del mediastino posterior - abordaje mínimamente invasivo: videotoracoscopia derecha más cervicotomía / Intrathoracic goiter resection by combined surgical approach: resection by right videothoracoscopy and cervicotomy

Resumen La cirugía es el manejo recomendado para el bocio intratorácico y cerca de un 90 % de ellos pueden resecarse mediante cervicotomía. El bocio en el mediastino posterior ha sido manejado satisfactoriamente empleando diversos abordajes cervicotorácicos, existiendo poca información en la literatura acerca del uso de la videotoracoscopia como parte de estas técnicas combinadas. Presentamos el caso de un paciente con un bocio intratorácico con extensión a mediastino posterior, en quien, dadas las características de la masa y su localización, sumado a las ventajas ampliamente conocidas de la cirugía mínimamente invasiva, se decide remplazar la toracotomía y la esternotomía por la videotoracoscopia, permitiendo una buena exposición y disección segura del mediastino. Consideramos que la videotoracoscopia es una técnica segura y efectiva en casos seleccionados de pacientes con bocio con extensión a mediastino posterior.

Abstract Surgery is the recommended treatment for intrathoracic goiter. About 90 % of the lessons can be resected by cervicotomy. The posterior mediastinal goiter was been successfully managed using different cervico-thoracic approaches; however, there is little available information in the literature about the use of videothoracoscopy as part of these combined techniques. We present a case of a patient with a intrathoracic goiter extended to the posterior mediastinum, in which, given the characteristics of the mass and its location added to the widely known benefits of minimally invasive surgery, it was decided to replace thoracotomy and sternotomy with videothoracoscopy allowing good exposure and safe dissection of the mediastinum. We consider that videothoracoscopy is a safe and effective technique in selected cases of patients with goiter extending into the posterior mediastinum.

Tumor fibroso solitario de la glándula tiroides con extensión intratorácica / Solitary fibrous tumor of the thyroid gland with intrathoracic extension

El tumor fibroso solitario (TFS) es una neoplasia mesenquimal de células fusiformes infrecuente descrita inicialmente en la pleura pero con localización reconocida en otros sitios. El TFS de la glándula tiroides (TFST) es aun más raro. Se describe el caso de una mujer de 65 años de edad, con masa cervical de crecimiento progresivo, a tal punto que ya la masa se hacía notable en parte inferior de su cuello, siendo este el único síntoma narrado. La paciente presentaba una gran masa tiroidea en el lóbulo derecho con extensión intratorácica. Se practicó hemitiroidectomia derecha (paciente tenia historia previa de resección del lóbulo tiroideo izquierdo por lesión benigna) Total, además de toracotomía endoscópica por la extensión de la masa la cual en la tomografía contrastada, se originaba en el lóbulo tiroideo derecho y descendía paralelo a la columna dorsal desplazando a la tráquea y el esófago. La patología reportó un tumor de 15 centímetros, con células fusiformes y patrón de crecimiento hemangiopericítico sin pleomorfismo, atipia, mitosis o necrosis. Luego de practicar diferentes estudios y marcadores tumorales, de todos estudios fueron positivos CD34, Bcl2, CD99 y vimentina. Se diagnosticó tumor fibroso solitario de glándula tiroides. El nervio vago derecho fue lesionado en la cirugía, actualmente está en terapia de voz. Al momento actual casi seis meses luego de su cirugía, no se documenta recidiva tumoral.

Solitary fibrous tumor (SFT) is a rare mesenchymal neoplasm initially described as spindle cells in the pleura but recognized location elsewhere. The TFS thyroid gland (TFST) even infrequent. A case of a 65 years old woman with progressive growth of a right cervical mass without associated symptoms described other than cosmesis is described . The patient had a thyroid mass in the right lobe with intrathoracic extension. A right Hemi thyroidectomy and thoracotomy for the extent of the mass was performed. Pathology reported a 15 cm tumor with spindle cell and growth pattern hemangiopericitic without pleomorphism, atypia, mitosis or necrosis. Immunohistochemistry was positive for CD34, Bcl-2, CD99 and vimentin, making the diagnosis of solitary fibrous tumor of thyroid gland. The patient's right Vagus nerve was injured intraoperatively and she is currently under voice therapy. Currently now, almost six months after her surgery she is free of disease.

Interacción cardiopulmonar en el paciente pediátrico crítico / Cardiopulmonary interactions in the critical pediatric patient

To optimize the management of critically ill patients, it is essential to understand the principles of cardiopulmonary interaction.The ultimate goal of the interaction between pulmonary and circulatory systems from a physiological point of view is to optimize the delivery of oxygen to tissues in order to meet metabolic demand, especially in situations where normal physiology is altered, as is the case of pediatric critically ill patients. Thus, during a critical illness, if any of these systems fails (together or separately), the end result is an inadequate delivery of O2 to tissues, which can lead to ischemia, progressive organ dysfunction, and if untreated, to death.In this review we will address key physiological concepts involved in cardiopulmonary interactions and how they are affected by the management we perform in the pediatric critically ill patients.

Para optimizar el manejo de los pacientes críticos, es fundamental comprender los principios de la interacción cardiopulmonar. El objetivo úultimo desde el punto de vista fisiológico de la interacción entre los sistemas circulatorio y pulmonar es optimizar la entrega de oxígeno a los tejidos y dar cuenta de la demanda metabólica especialmente en situaciones donde la fisiología normal se ve alterada, como es el caso de los pacientes pediátricos críticamente enfermos. Es así como durante una enfermedad crítica, si alguno de estos dos sistemas falla, (juntos o por separado), el resultado final es una inadecuada entrega de O2 tisular, que puede conducir a isquemia, disfunción orgánica progresiva, y si no se trata, hasta la muerte.En esta revisión intentaremos abordar de forma didáctica los principales conceptos fisiológicos involucrados en las interaccionescardiopulmonares y cómo estos se ven afectados frente a las intervenciones que realizamos en el manejo de los pacientes críticos.

Ectopic Intrathoracic Kidney Presenting as Recurrent Pneumonias in a 1-year-old Infant: A Case Report.

Ectopic intrathoracic kidney is a rare congenital anomaly, representing less than 5% of all renal ectopias. Most cases are discovered in asymptomatic adult patients undergoing imaging exams for unrelated reasons. Less than twenty cases of thoracic kidneys in the infant group have been reported in the literature, mostly comprising asymptomatic patients. Herein, we report a case of an 18-month-old boy with recurrent pneumonia episodes who was found to have a right-sided intrathoracic ectopic kidney. A brief literature review addressing the pathogenesis, prognosis, and treatment of this condition is also presented.

[Intrathoracic schwannoma]. / Schwannoma intratorácico.

The schwannoma (neurilemmoma) is a slow-growing benign tumor originating from Schwann sheath whose location in the chest cavity is exceptional. It is generally asymptomatic and is discovered incidentally but can cause symptoms when the lesion grows or invade underlying structures. Its importance lies in the possibility of confusion with malignant tumors. We present a patient who complains of chest pain caused by a prolonged course schwannoma. The tomographic image is suggestive of extrapulmonary tumor, so the schwannoma in this location should be considered in the differential diagnosis of metastatic or primary pleural tumors such as lipoma, solitary fibrous tumor and mesothelioma.

Schwannoma intratorácico / Intrathoracic schwannoma

El schwannoma (neurilemoma) es un tumor benigno de lento crecimiento originado en la vaina de Schwann, cuya localización en la cavidad torácica es excepcional. En general es asintomático y se descubre en forma incidental, aunque puede ocasionar síntomas cuando la lesión crece o invade estructuras subyacentes. Su importancia radica en la posibilidad de confusión con tumores malignos. Presentamos una paciente con dolor torácico de evolución prolongada causado por un schwannoma. La imagen tomográfica es sugestiva de tumor extrapulmonar, por ello el schwannoma en esta localización debe ser considerado en el diagnóstico diferencial de tumores pleurales metastásicos o primarios como el lipoma, el tumor fibroso solitario y el mesotelioma.

The schwannoma (neurilemmoma) is a slow-growing benign tumor originating from Schwann sheath whose location in the chest cavity is exceptional. It is generally asymptomatic and is discovered incidentally but can cause symptoms when the lesion grows or invade underlying structures. Its importance lies in the possibility of confusion with malignant tumors. We present a patient who complains of chest pain caused by a prolonged course schwannoma. The tomographic image is suggestive of extrapulmonary tumor, so the schwannoma in this location should be considered in the differential diagnosis of metastatic or primary pleural tumors such as lipoma, solitary fibrous tumor and mesothelioma.

Schwannoma intratorácico / Intrathoracic schwannoma

El schwannoma (neurilemoma) es un tumor benigno de lento crecimiento originado en la vaina de Schwann, cuya localización en la cavidad torácica es excepcional. En general es asintomático y se descubre en forma incidental, aunque puede ocasionar síntomas cuando la lesión crece o invade estructuras subyacentes. Su importancia radica en la posibilidad de confusión con tumores malignos. Presentamos una paciente con dolor torácico de evolución prolongada causado por un schwannoma. La imagen tomográfica es sugestiva de tumor extrapulmonar, por ello el schwannoma en esta localización debe ser considerado en el diagnóstico diferencial de tumores pleurales metastásicos o primarios como el lipoma, el tumor fibroso solitario y el mesotelioma.(AU)

The schwannoma (neurilemmoma) is a slow-growing benign tumor originating from Schwann sheath whose location in the chest cavity is exceptional. It is generally asymptomatic and is discovered incidentally but can cause symptoms when the lesion grows or invade underlying structures. Its importance lies in the possibility of confusion with malignant tumors. We present a patient who complains of chest pain caused by a prolonged course schwannoma. The tomographic image is suggestive of extrapulmonary tumor, so the schwannoma in this location should be considered in the differential diagnosis of metastatic or primary pleural tumors such as lipoma, solitary fibrous tumor and mesothelioma.(AU)

Thoracic splenosis as a differential diagnosis of juxtapleural nodules.

Thoracic splenosis is rare and consists of ectopic implantation of splenic tissue into the chest after concomitant thoracic and abdominal trauma with diaphragm injury. It occurs in about 18% of cases of splenic ruptures. In almost all cases, diagnosis is given incidentally once patients are usually asymptomatic. Thoracic splenosis should be considered as a differential diagnosis in all patients with history of trauma presenting with juxtapleural nodules in chest computed tomography. However, malignant conditions should be ruled out firstly. Biopsy is not essential for the diagnosis once nuclear medicine can confirm splenosis in patients with pertinent history of trauma and suggestive tomographic image. We present a typical case of thoracic splenosis whose diagnosis was made by nuclear medicine and no invasive procedures were required.

Intrathoracic hibernoma: an uncommon tumour / Hibernoma intratorácico: un tumor poco frecuente

Hibernomas are uncommon benign tumours that arise from the remnants of fetal brown adipose tissue. They are usually asymptomatic and have a slow growth pattern. Intrathoracic and pleural locations are exceptional for localization of hibernoma. A review of the English language medical literature revealed more than 110 cases, 20 of which were intrathoracic. In the article below, we discuss a 40-year old male patient who had pleural involvement and was treated by surgical resection. Following resection, the patient has remained problem-free for nine years.

Los hibernomas son tumores benignos poco frecuentes que surgen de restos del tejido adiposo marrón fetal. Son generalmente asintomáticos y tienen un patrón de crecimiento lento. Las localizaciones intratorácicas y pleurales son excepcionales para la localización del hibernoma. Una revisión de la literatura médica en lengua inglesa reveló más de 110 casos, 20 de los cuales se trataban de hibernomas intratorácicos. En el siguiente artículo, discutimos el caso de un paciente de 40 años de edad, que tenía una afección pleural y fue tratado con una resección quirúrgica. Después de la resección, el paciente ha permanecido sin problemas durante nueve años.