Asli Gül Akgül

Primary Synovial Sarcoma of Lung

Synovial sarcoma (SS) is a highly malignant tumor that accounts for 10% of all soft-tissue sarcomas. Primary SS arising from the lung is extremely rare, and the prognosis is poor. We report a case of pulmonary SS presenting with a mass lesion invading the right upper and middle lobes, extending to the mediastinum and the chest wall. After tru-cut biopsy, surgical resection was performed. The final diagnosis was SS (biphasic type) based on histological and immunohistochemical findings. There are no guidelines for optimal treatment due to the rarity of these tumors. Current treatment includes surgery and adjuvant chemotherapy and/or radiotherapy.

Pleural Puncture and Intrathoracic Catheter Placement During Ultrasound Guided Paravertebral Block

percutaneous puncture could cause catheter fracture owing to compression of the catheter between the clavicle and the first rib (catheter pinch off syndrome). Other causes include catheter material faults and alterations of the material’s mechanical properties, probably due to the administered sub stances; however, there are no data to support the effect of administered substances. Migration of these broken fragments can lead to very serious complication like myocardial and valvular perforation, arrhyth mia, thrombotic pulmonary embolism and cardiac arrest. Infec tious complications include endocarditis, secondary infection of thrombus, mycotic aneurysm, and pulmonary abscesses. The difficulty in injection or swelling over the intraport are the most common clinical presentation in the different studies. Regular follow up chest X ray is necessary because most of the patients developed catheter fracture in the first year. Ruptured catheters are best removed by interventional radiologic technique. In rare cases surgical intervention may be needed. This complication could be prevented by avoiding inserting the puncture needle directly underneath the clavicle. It should be inserted at some distance away from the lower edge of the clavicle. The catheter may be designed more ‘‘flexible’’ to reduce the obvious gap of ‘‘firm soft’’.

A Comparison of the EZ-Blocker With a Cohen Flex-Tip Blocker for One-Lung Ventilation

OBJECTIVES The EZ-Blocker (IQ Medical Ventures BV, Rotterdam, Netherlands) is a newly designed device for one-lung ventilation. The aim of this study was to compare the effectiveness of the Cohen Flex-Tip bronchial blocker (Cook, Bloomington, IN) and the EZ-Blocker for one-lung ventilation during thoracic surgery. DESIGN Randomized and prospective. SETTING A university hospital. PARTICIPANTS This study included 40 patients undergoing thoracic surgical procedures. INTERVENTIONS Patients were assigned to 2 study groups: Patients who received the Cohen Flex-Tip blocker were assigned to the Cohen group, and patients who received the EZ-Blocker were assigned to the EZ group. In both groups, fiberoptic guidance was used during placement of the bronchial blockers. Comparisons between the groups included the time to correct placement, the incidence of malpositioning, and the satisfaction level of the surgeon (good, fair, poor). MEASUREMENTS AND MAIN RESULTS One-lung ventilation was achieved successfully for all patients. The time to correct placement (mean±SD) was significantly shorter in the EZ group (146±56 seconds) compared with the Cohen group (241±51 seconds; p=0.01). The incidence of malpositioning was significantly lower in the EZ group compared with the Cohen group (p=0.018). Surgeon satisfaction was similar in both groups. CONCLUSIONS In this study, both bronchial blockers provided similar surgical exposure during thoracic procedures. The EZ-Blocker had a shorter time to correct positioning and less frequent intraoperative malpositioning.

A minimal invasive surgical alternative to aberrant systemic arterial supply: Coil embolization

We present the case of a 20-year-old man with hemoptysis for 3 years. Chest radiography revealed increased pulmonary vascular opacities in the left lower lung field. Computed tomography showed an anomalous systemic artery arising from descending aorta supplying the basal segments of the left lower lobe. Bronchial tree was normal. Pulmonary artery angiogram revealed a hypoplastic inferior lobar branch of the left pulmonary artery. There was no direct communication between anomalous artery and pulmonary veins. We diagnosed our case as aortopulmonary collateral with normal lung parenchyma. Coil embolization of the anomalous systemic artery was performed. The patient survived well without evidence of hemoptysis for 18 months after coil embolization.

Transthoracic fine-needle aspiration cytology of non-invasive, low-grade urothelial carcinoma with lung metastasis: A case report with review of the literature

Radiological analyses in a 61-year-old patient being followed since 2005 for low-grade, non-invasive urothelial carcinoma (UC) (Ta) revealed a 5-cm pleural-based mass in the lower lobe of the right lung for which a subsequent transthoracic fine-needle aspiration cytology was performed. Upon observing the carcinoma cells consistent with UC metastasis, systemic chemotherapy was commenced. The patient underwent a metastatectomy based on the thoracic computerized tomography scan performed on the 4th month of treatment, which revealed notable regression. The resected tumor was morphologically similar to cells seen in the transthoracic fine-needle aspiration and was immunohistochemically positive for p63, uroplakin, thrombomodulin, CK7 and CK20 at varying degrees but was negative for TTF-1. We report a case of metastatic UC of the lung in a patient who had had a low-grade superficial UC of the urinary bladder and we discuss the cytopathological features of this rare entity in light of the literature.

Characterization of Malignant Thrombus in an Invasive Thymoma with Intravascular Growth

We report an unusual case of an invasive thymoma with a thrombus in the right atrium and describe the radiological findings consistent with the malignant nature of the thrombus. The thrombus showed significant enhancement on computerized tomography images similar to the tumoral mass. On magnetic resonance imaging, both the tumor and the thrombus have heterogeneously high signal intensities on T2-weighted images. On diffusion-weighted images they both exhibit high signal intensity and low apparent diffusion coefficient (ADC) values which support the malignant nature of the thrombus and the mass.

Congenital tracheal diverticulum seen in adult age

Figure 1: 65-year old male patient with right-sided tracheal diverticulum. (a) Diverticulum opening in posterolateral tracheal wall, virtual bronchoscopic view, (b) axial and (c) coronal section of thorax CT. Arrow: the hole in the postero-lateral wall of trachea, *main carina. Figure 2: 51-year old male patient. (a) Axial, (b) coronal section of thorax CT showing air-filled bilobed tracheal diverticulum. (c) Bronchoscopic appearance of the opening of diverticulum, (d) 3D reconstruction of air way demonstrating posteriorly located diverticulum. Arrow: the diverticulum, *main carina.

Unusual Etiologic Factor of Massive Hemoptysis: Unilateral Absence of Pulmonary Artery

he unilateral absence of pulmonary artery (UAPA) is Ta rare malformation. A 19-year-old male patient was admitted to hospital with massive hemoptysis. Chest X-ray showed a smaller right hemithorax, ipsilateral less vascular marking (Fig 1). Computed tomography demonstrated the absence of the right pulmonary artery (Fig 2A; axial section), the absence of pulmonary vascular bundles in the right side (Fig 2B; coronal section), a patent ductus arteriosus between the left main pulmonary artery and aortic arch (white arrow), dilated bronchial arteries (Fig 2C; axial section,), and diffuse ground-glass opacity in the right lower lobe (Fig 2D; axial section). The patient was evaluated with echocar-

Radio Antenna Aspiration

W e have had much experience with foreign body aspiration, but children still continue to surprise us with strange aspirated materials. A telescopic radio antenna was observed on the chest roentgeno-gram of a 2-year-old girl (Fig 1A and 1B), located just below the vocal cords and extending to the main carina. It was removed without any complications by rigid bronchoscopy (Fig 1C).

Partial Anomalous Venous Return of Left Superior Pulmonary Vein in Adult

Drainage of one or more pulmonary veins into rightsided circulation instead of the left atrium is a rarely seen anomaly in adults [1–4]. In the preoperative evaluation of a female patient with esophageal carcinoma, axial (Fig 1A), coronal section (Fig 1B), and three-dimensional reconstruction (Fig 1C) of thorax computed tomography demonstrated abnormal drainage of the left superior pulmonary vein to the left brachiocephalic vein. Because pulmonaryto-systemic shunt size was not large and the patient was asymptomatic, surgical correction was not performed. She underwent esophageal carcinoma surgery.