Filippo Antonacci

Acute postoperative cardiac herniation

Acute herniation of the heart is an uncommon complication in patients undergoing pneumonectomy with associated pericardial resection. We report the case of a postoperative cardiac herniation after a right extrapleural pneumonectomy following neoadjuvant chemotherapy for malignant pleural mesothelioma. After surgery the patient was completely asymptomatic, but a postoperative chest X-ray revealed unexpected massive dextrocardia. The patient was immediately brought back to the operating room: a cardiac herniation was found to be caused by a partial dehiscence of the pericardial prosthesis suture. The defect was repaired without consequences.

Mediastinal germ cell tumour with massive pulmonary involvement

Multimodality treatment, with chemotherapy and surgery, is potentially curative in case of non-seminomatous germ cell tumours. The authors present the case of a primitive mediastinal GTC with bilateral lung metastases. The patient was treated with five cycles of chemotherapy. Restaging showed reduction of the extent and of 18 FDG intake and β-HCG serum levels. The patient underwent two-step surgical excision of the tumours: mediastinal lesion and 35 lung metastases were resected by a right thoracotomy and 39 metastases were removed by a left thoracotomy. Histology showed absence of viable tumour in all the specimens. Twelve months after surgery the patient is free of disease.

Diverticulum of the midthoracic oesophagus and left diaphragmatic relaxation.

The case of a 58-year-old man with a large midthoracic oesophageal diverticulum and a left diaphragmatic relaxation who presented with night regurgitations, abdominal bloating, epigastric burning and a sensation of fullness after meals is reported. The patient underwent a successful thoracotomic diverticulectomy with left diaphragmatic plicature. The postoperative course was uneventful. To our knowledge this is the first reported case of an association between midthoracic oesophageal diverticulum and left diaphragmatic relaxation. Moreover, we hypothesised that the diverticulum was caused by a pulsion mechanism due to obstruction of the distal oesophagus secondary to diaphragmatic relaxation.