Carlos Henrique Ribeiro Boasquevisque

Symptomatic mucocele after esophageal exclusion

Surgical exclusion of the thoracic esophagus can result in the accumulation of secretions and dilatation of the esophageal remnant, a clinical picture known as esophageal mucocele. Although it is usually asymptomatic, if it increases in size it can produce a variety of compressive symptoms such as coughing, chest pain and respiratory distress. We present two cases of symptomatic mucocele after esophageal exclusion treated successfully with surgical resection. We believe that surgical resection should be considered for symptomatic patients, and that esophageal bypass surgery should be used with caution and indicated mostly in patients with a limited life span or with contraindications for esophagectomy.

Aspectos clínico-patológicos do carcinoma bronquioloalveolar e sobrevida em pacientes no estágio clínico I

OBJECTIVE: To analyze the clinicopathological aspects of bronchioloalveolar carcinoma (BAC) and the survival in a sample of patients at clinical stage I. METHODS: A retrospective study involving 26 patients diagnosed with clinical stage I BAC and undergoing surgery at the Thoracic Diseases Institute of the Federal University of Rio de Janeiro, in the city of Rio de Janeiro, Brazil, between 1987 and 2007. We analyzed clinicopathological and radiological aspects, as well as mortality and survival. The data, which were collected from the medical charts of the patients, were statistically analyzed. RESULTS: Females predominated (n = 16). The mean age at diagnosis was 68.5 years. Most patients were active smokers (69.2%). The most common forms of presentation of BAC were the asymptomatic form (84.6%) and the nodular form (88.5%). Involvement of the upper lobes predominated (57.7%). Stage IB was the most common pathological stage, followed by stages IA and IIB (46.2%, 38.4% and 15.4%, respectively). There was no in-hospital mortality. Four patients died during the postoperative follow-up, with a mean disease-free survival time of 21.3 months. The overall five-year survival rate was 83%. The probability of survival for the patients diagnosed after 1999 showed a trend toward an increase when compared with that for those diagnosed up through 1999 (three-year survival rate: 92% vs. 68%; p = 0.07). CONCLUSIONS: The clinicopathological aspects of this study sample were similar to those of patients with BAC evaluated in previous studies.OBJECTIVE To analyze the clinicopathological aspects of bronchioloalveolar carcinoma (BAC) and the survival in a sample of patients at clinical stage I. METHODS A retrospective study involving 26 patients diagnosed with clinical stage I BAC and undergoing surgery at the Thoracic Diseases Institute of the Federal University of Rio de Janeiro, in the city of Rio de Janeiro, Brazil, between 1987 and 2007. We analyzed clinicopathological and radiological aspects, as well as mortality and survival. The data, which were collected from the medical charts of the patients, were statistically analyzed. RESULTS Females predominated (n = 16). The mean age at diagnosis was 68.5 years. Most patients were active smokers (69.2%). The most common forms of presentation of BAC were the asymptomatic form (84.6%) and the nodular form (88.5%). Involvement of the upper lobes predominated (57.7%). Stage IB was the most common pathological stage, followed by stages IA and IIB (46.2%, 38.4% and 15.4%, respectively). There was no in-hospital mortality. Four patients died during the postoperative follow-up, with a mean disease-free survival time of 21.3 months. The overall five-year survival rate was 83%. The probability of survival for the patients diagnosed after 1999 showed a trend toward an increase when compared with that for those diagnosed up through 1999 (three-year survival rate: 92% vs. 68%; p = 0.07). CONCLUSIONS The clinicopathological aspects of this study sample were similar to those of patients with BAC evaluated in previous studies.

Intrapulmonary Mature Teratoma Mimicking a Fungus Ball

A 22-year-old woman presented with history of cough and hemoptysis. Chest computed tomography (CT) revealed a heterogeneous cavitated mass in the left upper lobe, with solid intracavitary content, mimicking a fungus ball (Fig. 1). Patient was subjected to upper left upper lobectomy. The cut section revealed a solid-cystic mass (Fig. 2). The tumor was composed of skin, sebaceous glands, hair follicles, apocrine glands, smooth muscle, cartilage, fat, and respiratory epithelium (Fig. 3). Given the presence of unaffected pulmonary parenchymal areas adjacent to the mediastinal pleura, the final diagnosis was primary mature pulmonary teratoma. The patient’s postoperative course was uneventful.

Pneumotorax e pneumopericárdio hipertensivo em cirurgia cardiotorácica

Herein, we report two cases of pneumothorax and tension pneumopericardium after cardiothoracic surgery. Both patients underwent pericardiotomy during the primary operation and developed pericardial tamponade as a complication. The treatment was tube thoracostomy, and both patients recovered completely.

Tratamento cirúrgico de cisto broncogênico paratraqueal por mediastinoscopia cervical

Os cistos broncogenicos do mediastino sao lesoes benignas congenitas, usualmente descobertas na idade adulta. O tratamento cirurgico classico, quando indicado, e a resseccao da lesao por toracotomia ou por videotoracoscopia. Descrevemos aqui um caso em que foi realizada a resseccao completa de um cisto broncogenico paratraqueal por mediastinoscopia cervical, com uma breve revisao e discussao da literatura.

Plastic surgery in chest wall reconstruction: relevant aspects - case series

OBJECTIVE to discuss the participation of Plastic Surgery in the reconstruction of the chest wall, highlighting relevant aspects of interdisciplinaryness. METHODS we analyzed charts from 20 patients who underwent extensive resection of the thoracic integument, between 2000 and 2014, recording the indication of resection, the extent and depth of the raw areas, types of reconstructions performed and complications. RESULTS among the 20 patients, averaging 55 years old, five were males and 15 females. They resections were: one squamous cell carcinoma, two basal cell carcinomas, five chondrosarcomas and 12 breast tumors. The extent of the bloody areas ranged from 4x9 cm to 25x40 cm. In 12 patients the resection included the muscular plane. In the remaining eight, the tumor removal achieved a total wall thickness. For reconstruction we used: one muscular flap associated with skin grafting, nine flaps and ten regional fasciocutaneous flaps. Two patients undergoing reconstruction with fasciocutaneous flaps had partially suffering of the flap, solved with employment of a myocutaneous flap. The other patients displayed no complications with the techniques used, requiring only one surgery. CONCLUSION the proper assessment of local tissues and flaps available for reconstruction, in addition to the successful integration of Plastic Surgery with the specialties involved in the treatment, enable extensive resections of the chest wall and reconstructions that provide patient recovery.

Forma acelerada da fibrose pulmonar idiopática no pulmão nativo após transplante pulmonar unilateral

We report the case of a 56-year-old patient who underwent left single lung transplantation for idiopathic pulmonary fibrosis (IPF). Despite the high level of immunosuppression after the surgery, there was rapid progression to IPF in the native (right) lung as demonstrated by thoracoscopic lung biopsy. After 104 days on mechanical ventilation (MV), the patient underwent right lung transplant and was discharged from the hospital on postoperative day 26.

Hérnia traumática do pulmão

Traumatic lung herniation is an unusual clinical problem. We present a case of a large left post-traumatic lung hernia on the left, anterior, second intercostal space following blunt chest trauma. An important factor in the etiology of these lesions is the relative lack of muscular support of the anterior part of the chest. This report describes the diagnosis and management of a post-traumatic lung hernia.

Obstrução de valva mitral por embolização tumoral per-operatória (pneumectomia direita) com parada cardíaca irreversível

A 26-year-old patient with a voluminous primary pulmonary hemangiopericytoma in the right lung, diagnosed through previous surgical biopsy, presented irreversible cardiac arrest during the hilar dissection portion of a right pneumonectomy. The patient did not respond to resuscitation efforts. Autopsy showed total obstruction of the mitral valve by a tumor embolism. In cases of large lung masses with hilar involvement, as in the case presented, we recommend preoperative evaluation using transesophageal echocardiography, magnetic resonance imaging or angiotomography. If injury to the pulmonary vessels or atrial cavities is detected, surgery with extracorporeal circulation should be arranged in order to allow resection of the intravascular or cardiac mass, together with pulmonary resection. We recommend that care be taken in order to recognize and treat this problem in patients not receiving a preoperative diagnosis.

Avaliação da influência do tempo e do diâmetro na obstrução da janela pleuropericárdica

BACKGROUND: to evaluate the influence of diameter and time on the patency of transthoracic pericardial window in normal pericardium. METHODS: Thirty-six mongrel dogs were divided into 6 groups: 1a, 1b and 1c; 2a, 2b and 2c; n=6 per group. In groups 1a, 1b and 1c the pericardial window diameter was 2cm and in groups 2a, 2b and 2c it was 4cm. Animals were sacrificed 2, 8 and 12 weeks , respectively and we evaluated the patency and histology of the pericardial margins. RESULTS: Eighty-nine per cent of the windows were open and 11% were completely obstructed by pericardial-epicardic adhesions. In the groups with a 2cm-pericardial window, we observed during sacrifice an increase of the original diameter in 89% of the animals. In dogs with a 4cm-pericardial window a greater diameter was observed in 61% of the animals. We did not observe statistical differences comparing animals with the same window diameter but sacrificed at different time points. Likewise, we did not observe differences among dogs with different window diameters but sacrificed at the same time points. The degree of pericardial-epicardic adhesions, according to a graduation score, was not different among the groups when analyzing the influence of time and diameter, except for the group 2b ( 4cm-window diameter and animals sacrificed at 8 weeks). Histopatology was not different among the different groups. We did not observe any lung blockade of the transthoracic pericardial windows. CONCLUSIONS: time and diameter did not influence the patency of the transthoracic pericardial window.