Ikram Chaudhry

Role of Surgery After Chemotherapy in B-Cell Lymphoma of Thymus Causing Airway Compression and Right Ventricle Outflow Tract Obstruction

Primary B-cell lymphoma of thymus is uncommon. We describe the case of a 23-year-old woman with a history of shortness of breath and distended neck veins of 1-month duration. A chest roentgenogram and computed tomographic chest scan of the showed a large anterior mediastinal mass. Tru-cut biopsy revealed primary B-cell lymphoma of thymus. She underwent chemotherapy with no symptomatic improvement. Post-chemotherapy computed tomographic scan of the chest showed no appreciable reduction in tumor size. Surgical excision was carried out with excellent results.

Tracheal Diverticulum: A Rare Cause of Hoarseness of the Voice

Tracheal diverticulum is a rare benign disease also known as paratracheal air cyst. Mostly these are asymptomatic and are discovered incidentally on radiologic examination of the chest. Common symptoms are cough, recurrent respiratory tract infections, and sometimes dysphagia. Herein we report a rare case of hoarseness of voice caused by tracheal diverticulum. Computed tomography scan of neck revealed a large tracheal diverticulum, probably compressing the recurrent laryngeal nerve as bronchoscopy showed impaired right vocal cord movement. Two weeks after diverticulectomy, the patients voice returned to normal.

Hoarseness of voice, respiratory distress and dysphagia due to giant primary posterior mediastinal ectopic goitre: a rare clinical entity

Primary posterior mediastinal ectopic goitre is an extremely rare entity; we report a case of a 28-year-old man who presented with dysphagia, respiratory distress and hoarseness of voice, gradually worsening over a period of 3 months. CT scan of the thorax revealed a giant posterior mediastinal ectopic goitre. The mass was removed through a right posterolateral thoracotomy. The patients symptoms, respiratory distress and dysphagia disappeared immediately after surgery while his voice gradually returned to normal after 6 weeks.

A rare cause of asymptomatic solitary pulmonary nodule: adult Schistosoma worm

Solitary pulmonary nodule due to various pathologies has been reported in the medical literature. We report a case of solitary pulmonary nodule in an asymptomatic 60-year-old male smoker, who had a positive family history of pulmonary tuberculosis. His routine screening chest X-ray revealed a 2×1.5 cm nodule in the right lung upper zone. A CT scan of the thorax confirmed the finding. Bronchoscopy, lavage, biopsy and screening for tuberculosis were negative. Owing to its technical difficulty, a CT-guided biopsy was deferred by the radiologist, hence we decided to perform segmentectomy that showed granuloma harbouring an adult Schistosoma worm. This is the first case of asymptomatic solitary pulmonary nodule due to adult Schistosoma worm 26 years after the exposure.

Radical surgical resection for giant primary mediastinal endodermal sinus tumour with pulmonary metastasis after chemotherapy: can be curative

Primary non-seminomatous germ cell tumours of anterior mediastinum are uncommon. Endodermal sinus tumour of the anterior mediastinum (yolk sac) is a rare but lethal neoplasm. We present a case of an 18-year-old man who presented with chest pain, cough and haemosputum with markedly raised serum α-fetoprotein (AFP) levels above 112 000 ng/mL. Chest roentgenogram and CT showed a giant anterior mediastinal mass. CT guided biopsy revealed a diagnosis of endodermal sinus tumour. After the completion of chemotherapy, extensive surgical resection was carried out along with the right lung metastastectomy. Five years postresection follow-up the patient is disease free with normal serum tumour markers. This is the longest survival ever reported of such tumours with highest AFP level (>112 000 ng/mL) and lung metastasis.

Multimodality Management of Extensive Tuberculous Bullous Disease of Lung With Bilateral Pneumothorax

Diffuse bullous disease of the lung in miliary tuberculosis associated with bilateral pneumothorax is a rare entity with grave prognosis. We describe the case of a 24-year-old woman in her first trimester of pregnancy with extensive bilateral pulmonary infiltrates as seen on computed tomographic scan of the lung. She had simultaneous bilateral pneumothorax that was managed with antituberculous therapy, steroids, and surgery for failure of lung expansion.

An improvised surgical reconstruction technique for repair of traumatic multi- fragmented fracture of first tracheal ring

We report a case of 32-year-old female, a front seat passenger who sustained a neck injury in a road traffic accident. Patient was taken to a district hospital with progressive swelling of neck and face, breathing difficulty. She underwent endotracheal intubation ad mechanical ventilation was initiated. Her Chest X-ray showed subcutaneous emphysema and computed tomographic scan (CT) of her thorax revealed an upper anterior tracheal fracture, pneumomedistinum and subcutaneous emphysema. She was transferred to our tertiary care hospital. We performed exploratory surgery of the neck and found multiple fragmented fracture of the cartilaginous part of the first tracheal ring. We reconstructed the trachea using our improvised surgical reconstruction technique.

Percutaneous removal of gallstones under fluoroscopy guidance in high-risk patients with acute cholecystitis

We report our technique of percutaneous removal of gallstones in three elderly patients with acute calculus cholecystitis who were not surgical candidates due to multiple comorbidities. The procedure is performed under local anesthesia using fluoroscopic and choledochoscopic guidance. All patients had uneventful recovery and were discharged home in 3–4 days and fallow up at a low and high surveillance by ultrasound at 3 and 6 months interval.

Late Intrathoracic Tracheal Stricture After Blunt Chest Trauma: A Rare Life-Threatening Condition

Tracheal injury after blunt chest trauma is a rare but life-threatening condition. If diagnosed and treated early, the outcome is excellent. We report a case of an 18-year-old man who sustained a fracture of the right femur in a traffic accident. He underwent operation under spinal anesthesia and was discharged home after 2 weeks. Six weeks later, he was readmitted with acute respiratory distress, stridor, and drowsiness. Arterial blood gas analysis showed hypercarbia (PCO2 of 80 mm Hg; PO2 of 60 mm Hg). He was intubated with difficulty and ventilated. A computed tomographic (CT) scan of the chest showed a very tight supracarinal tracheal stricture. Emergency surgical resection of the tracheal stricture was performed, and an end-to-end anastomosis was fashioned. The patient had an excellent recovery.

Radical resection and improvised surgical reconstruction for a rare malignant triton tumour of intercostal nerve in a patient with neurofibromatosis type 1

A man aged 28 years, with neurofibromatosis type 1, presented with abdominal pain and visible right lower chest swelling. He had cutaneous neurofibromas and several café-au-lait spots. CT scan of the chest and abdomen revealed a giant mass most likely originating from the right 7th intercostal nerve, extending downwards into the abdomen causing massive hepatic compression. A Trucut biopsy showed malignant peripheral nerve sheath tumour. Radical surgical resection with wide margins was performed. The chest wall and diaphragm were reconstructed with improvised surgical technique with excellent results. Final histopathology report revealed a triton tumour of the intercostal nerve.