Maurizio Monaco

Spontaneous Pneumomediastinum: Experience in 18 Adult Patients

Spontaneous pneumomediastinum (SPM) is defined as the presence of air in the mediastinum, developing in the absence of traumatic, iatrogenic, or preceding pulmonary pathologies (emphysema, chronic bronchitis, and lung cancer). The aim of this study was to review our experiences with SPM, underlining its symptomatology, diagnosis, treatment, and followup, and defining a reasonable course of assessment and management. A retrospective case series was conducted to identify adult patients with SPM who were diagnosed and treated in our institution between 1998 and 2005. Eighteen patients (10 males) were identified (average age = 25 ± 4.8 years). Acute onset of chest pain was the predominant symptom at presentation. All patients developed clinically evident subcutaneous emphysema and underwent chest computerized tomography. Fiber bronchoscopy and echocardiogram were used selectively (8 patients). The average hospital stay was 6 (±1.4) days. Sixteen patients were conservatively treated, and only two patients were treated with thoracic drainage due to a related pneumothorax. The disease followed a benign evolution in all patients and, as of today, no relapse has been reported. SPM is an uncommon pathology with a usually benign course. The authors discuss SPM. A diagnostic algorithmic approach is necessary to rule out severe secondary entities and consequences that need urgent treatment.

Giant endobronchial hamartoma resected by fiberoptic bronchoscopy electrosurgical snaring

Less than 1% of lung neoplasms are represented by benign tumors. Among these, hamartomas are the most common with an incidence between 0.025% and 0.32%. In relation to the localization, hamartomas are divided into intraparenchymal and endobronchial.Clinical manifestation of an endobronchial hamartoma (EH) results from tracheobronchial obstruction or bleeding. Usually, EH localizes in large diameter bronchus. Endoscopic removal is usually recommended. Bronchotomy or parenchimal resection through thoracotomy should be reserved only for cases where the hamatoma cannot be approached through endoscopy, or when irreversible lung functional impairment occurred after prolonged airflow obstruction. Generally, when endoscopic approach is used, this is through rigid bronchoscopy, laser photocoagulation or mechanical resection. Here we present a giant EH occasionally diagnosed and treated by fiberoptic bronchoscopy electrosurgical snaring.

Surgical management of pulmonary inflammatory pseudotumors: a single center experience.

BackgroundThe pulmonary inflammatory pseudotumor (PIP) is a rare disease. It is still debated whether it represents an inflammatory lesion characterized by uncontrolled cell growth or a true neoplasm. PIP is characterized by a cellular polymorphism.MethodsWe retrospectively analyzed 8 patients with PIP treated by surgery between 2001 and 2009. Preoperative thoracic computed tomography (CT) scan was performed in all cases. All patients underwent preoperative bronchoscopy with washing and brushing and/or transbronchial biopsy and preoperative cytology examinationResultsThere were 5 men and 3 women, aged between 38 and 69 years (mean of 58 years). 3 patients (37%) were asymptomatic. The others had symptoms characterized by chest pain, shortness of breath and persistent cough or hemoptysis. 5 patients had neutrophilic leucocytosis. CT scan demonstrated solitary nodules (maximum diameter <3 cm) in 5 patients (62%) and lung masses (maximum diameter >3 cm) in 3 patients (37%). In 2 patients there were signs of pleural infiltration. Distant lesions were excluded in all cases. A preoperative histology examination failed to reach a definitive diagnosis in all patients. At surgery, we performed two lobectomies, one segmentectomy and five wedge resections, these being performed with videothoracoscopy (VATS), except for one patient where open surgery was used. Complete tumor resection was obtained in all patients. According to the Matsubara classification, there were 2 cases of organizing pneumonia, 5 cases of fibrous histiocytoma and one case of lymphoplasmacytoma. All patients were discharged alive from hospital between 4 and 7 days after surgery. At follow-up CT scan performed annually (range 11 to 112 months) (mean 58 months), there were no residual lesions, neither local nor distant recurrences.ConclusionsPIP is a rare disease. Many synonyms have been used for this disease, usually in relation to the most represented cell type. The true incidence is unclear. Preoperative diagnosis is difficult to reach, despite performing a bronchoscopy or a transparietal needle aspiration. Different classifications have been proposed for PIP. Either medical, radiation or surgical therapy has been used for PIP. Whenever possible, surgery should be considered the standard treatment. Complete surgical resection is advocated to prevent recurrence.

On a Fatal Case of Candida krusei Pleural Empyema in a Pregnant Woman with Spontaneous Esophagus Perforation

IntroductionCandida empyema thoracis can be a consequence of operation, gastropleural fistula, and esophageal perforation. Case report and review of the literature. A fatal case of a 45-year-old pregnant woman with Candida krusei empyema thoracis secondary to spontaneous esophagus perforation associated with candida esophagitis is reported. The case is contextualized among similar cases found through a PubMed search.ConclusionsA suspect of esophagus rupture should arise in the presence of a fungal empyema. Candida esophagitis should be always considered as a possible cause or con-cause of esophagus rupture. An empirical systemic antimycotic therapy should always be considered in an ideal multidisciplinary approach to the management of patients with esophagus rupture.

Thoracoscopic resection of a paraaortic bronchogenic cyst.

Bronchogenic mediastinal cysts (BMC) represent 18% of primitive mediastinal tumors and the most frequent cystic lesions in this area. Nowadays, BMC are usually treated by VATS. However, the presence of major adhesions to vital structures is often considered as an unfavourable condition for thoracoscopic treatment. The authors report the thoracoscopic treatment of a BMC having dense adhesions to the aortic arch. Diagnosis and surgical treatment is described. Review of the literature and surgical options on this topic are discussed.

Parathyroid carcinoma as a challenging diagnosis: report of three cases.

Parathyroid carcinoma (PC) is a rare malignancy with an indolent but progressive course. This rare tumour is often difficult to diagnose preoperatively, thus limiting the efficacy of surgery. As long-term survival is largely dependent on the extent of the primary surgical resection, it is of great importance to consider PC in the differential diagnosis of hyperparathyroidism. We herein report three PC patients with different clinical histories who were followed up at our hospital for over a 5-year period, emphasizing the variability in clinical presentation of this rare tumour. Moreover, NORA (Nucleolar Organizer Regions, a standardised silver-stain, marker of proliferation rate) values encountered in these PC patients confirm that AgNOR analysis may be regarded as an additional tool when the pathologist encounters difficulties in defining parathyroid lesions which are not clearly benign.

Pneumomediastinum as a complication of critical pertussis.

Pertussis is a common and potentially serious disease affecting mainly infants and young children. In its non‐classic presentation, pertussis can be clinically indistinguishable from other respiratory illnesses. Pertussis today often remains underdiagnosed in adults. Our aims was to report a complicated cases of pertussis.

Successful bronchoscopic removal of intrabronchial fishbone after 3 months.

We report the case of 70-year-old woman with a diagnosis of intrabronchial fishbone inhalation 3 months earlier, causing hemoptysis, cough, and chest pain. Computed tomography showed the fishbone inside the intermediate bronchus (Figure 1a). Bronchoscopy confirmed this location. (Figure 1b). The case was resolved by bronchoscopic fishbone removal under general anesthesia (Figure 2). Funding This research received no specific grant from any funding agency in the public, commerical, or not-for-profit sectors.

Intrathymic epidermoid cyst: a very rare condition.

A 65-year-old man presented with a nonspecific thymic neoplasm following blunt thoracic trauma. The lesion increased in size over 12 years, to reach 47 mm in diameter. After thymectomy, the lesion was described as an epidermoid lining cyst composed of thickened stratified squamous epithelium. We assume that this rare pathological condition was caused by skin tissue islands and fat migrating into the mediastinum.

Aggressive and recurrent desmoid-type fibromatosis of the neck.

A 45-year-old woman presented with a palpable rightsided cervical mass. She had a history of desmoid-type fibromatosis of the neck at the same site. Computed tomography and magnetic resonance imaging showed a 10 8-cm mass (Figure 1). The patient underwent enbloc resection of the mass (Figure 2). Histopathological examination of the resected mass (Figure 3) confirmed a diagnosis of fibromatosis (desmoid tumor). Immunohistochemistry showed expression of smooth muscle actin and a lack of positivity for CD34, Bcl-2, CD99, S100 protein, and cytokeratins.