Olgun Kadir Aribas

Chest trauma in children

OBJECTIVES Chest trauma in childhood is uncommon in clinical practice. The management and treatment principles of children with thoracic trauma were discussed with the data reported in the literature. METHODS Of the chest injury diagnosed in 1653 patients, 225 were children in the last 17-year period. There were 199 boys (88.44%) and 26 girls (11.55%). The most common causes were blunt injuries in 135 cases (60%), stab wounds in 67 cases (29.77%) and gunshot wounds in 22 cases (9.77%). RESULTS Out of 225, 217 patients were treated conservatively and eight patients were treated surgically. There was no mortality and morbidity. CONCLUSIONS The prevalence of chest trauma in children due to blunt injuries is high in Turkey. Extremity injury is thought to be the most commonly associated extra-thoracic injury. However, thoracic trauma in children can be managed conservatively in most of the cases.

Epidural emphysema associated with primary spontaneous pneumothorax.

A 21-year-old male patient was admitted with spontaneous pneumothorax, and no history of asthma. Closed drainage treatment was unsuccessful. Chest computed tomography demonstrated pneumomediastinum and subcutaneous emphysema with multiple air bubbles within the spinal canal between the levels Th3 and Th11. Resection of bullae on the upper lobe and partial pleurectomy were performed. Postoperative period was uneventful. Epidural emphysema was resolved spontaneously without neurologic symptoms and signs. Intraspinal air, or pneumorachis, associated with spontaneous pneumothorax and pneumomediastinum is an extremely rare condition. We discussed spontaneous pneumothorax and pneumomediastinum as well as epidural pneumatosis and reviewed reported cases in the literature.

Comparison of pulmonary hydatid cysts in children and adults

Background:  The purpose of the present study was to compare the clinical features and the surgical approaches of the pulmonary hydatid cysts in children and adults.

Pulmonary embolism due to cardiac hydatid disease: imaging findings of unusual complication of hydatid cyst

Abstract. We report two cases of primary cardiac hydatid cyst in which hydatid materials caused recurrent embolizations in pulmonary arteries and pulmonary parenchyma. Cardiac hydatid cysts may stay asymptomatic for a long time, until they reveal themselves being perforated into cardiac chambers and/or pulmonary artery or systemic circulation. The role of imaging techniques in diagnosis is discussed and the importance of dynamic enhanced CT, MR imaging, and enhanced MR angiography (MRA) is reported. Imaging findings were confirmed by surgery and pathology. Early diagnosis is essential because delayed treatment increases the morbidity and mortality rates.

Comparison between pulmonary and hepatopulmonary hydatidosis

OBJECTIVES To compare the clinical features and the surgical approaches between single pulmonary (SPH) and hepatopulmonary hydatidosis (HPH). METHODS The hospital and follow-up records of 141 patients who had undergone surgery for pulmonary hydatidosis in our clinic between January 1991 and January 2001 were reviewed. Forty-nine patients (34.8%) had concomitant liver cysts in addition to the pulmonary cysts and they were regarded as HPH (Group I). The remaining 92 (65.2%) patients had SPH (Group II). Both groups were compared according to their clinical, radiological and surgical features. RESULTS Seventeen (34.7%) male and 32 (65.3%) female patients had HPH. The mean age of the patients with HPH was significantly higher than the age of those with SPH (P<0.05) and the frequency of hepatopulmonary localization, which is contrary to single pulmonary cyst, was significantly higher in females (P<0.05). The majority (67.3%) of the cysts located in the liver were solitary. Multiple pulmonary cysts were in higher ratio in Group II, compared to Group I (45.7 vs. 22.8%) and bilateral pulmonary cyst ratio was higher in Group II, as well (26.5 vs. 13%) (P<0.05). In 14 patients (28.6%), the concomitant cysts localized in the dome of liver were extirpated via right thoracophrenotomy, and in one of them sternophrenotomy was performed. There was no statistically significant difference associated with the postoperative complications and hospital stay between groups. No recurrence and mortality were recorded in Group II. CONCLUSIONS Multi-organ localizations (especially liver) should be examined in all patients with pulmonary hydatid cysts. HPH is more frequent in female patients over 40 years of age. The pulmonary cysts in HPH show a tendency to be bilateral and multiple. HPH should be regarded as a different entity since it can cause either economic or labour loss due to the multi-operations and prolonged postoperative care. The operative strategy and approach should be different in hepatopulmonary cysts especially if they locate in the right or bilateral lung. One-session operation with the improvements of its techniques and methods should be considered in selected cases.

Cold abscess of the chest wall as an unusual complication of BCG vaccination

Bacillus-Calmette-Guérin (BCG) vaccination often results in local adverse effects; however, serious or long-term complications are rare. The involvement of sternum among skeletal BCG osteomyelitis is a rarely seen complication of BCG vaccination. Such a complication may confuse with a chest wall tumor and a surgical intervention may be needed for the definite diagnosis. A 9-month-old infant who had a parasternal cold abscess in the anterior chest wall and sternal osteomyelitis of tuberculosis in the late period of BCG vaccination of whom the etiological diagnosis was histopathologically confirmed after surgery is presented and the preoperative diagnostic problems are discussed.

Pleomorphic Adenoma of the Trachea Mimicking Bronchial Asthma: Report of a Case

Benign tracheal tumors are rare and difficult to diagnose. A delay in diagnosis is common because the symptoms mimic those of bronchial asthma. We report the case of a 42-year-old woman who was treated for asthma for 2 years before a diagnosis of pleomorphic adenoma of the trachea was made. To our knowledge, only 33 patients with pleomorphic adenoma of the trachea have been reported. We treated our patient by performing circumferential segmental tracheal resection and end-to-end anastomosis. A dynamic Y-stent was implanted for tracheal stenosis soon after the operation and it was removed 2 years later. The patient is now asymptomatic and no recurrence has been detected in the 5 years since diagnosis.

Imaging of cystic and cyst like lesions of the mediastinum with pathologic correlation.

Cystic masses of the mediastinum are a heterogenous group of asymptomatic or symptomatic, congenital, infectious, or neoplastic lesions. For early and correct diagnosis, evaluation, and optimal patient management of cystic mediastinal masses in infants, children, or adults imaging plays an important role. A non-invasive and sensitive imaging modality is an efficient and cost-effective tool. Multidetector computed tomography (MDTC) with volumetric acquisition provides fast acquisition of high resolution images and multiplanar reconstruction. Both 2D and 3D imaging in mediastinal imaging help in surgical planning and assessing resectability of mediastinal lesions. MR imaging has many advantages over other modalities for detecting and identifying cystic, or fluid-filled mediastinal masses, because of its intrinsic high soft tissue contrast and direct multiplanar imaging capabilities. However, histological tissue analysis may be required to differentiate a cystic lesion from other cyst-like or low-attenuation lesions.

Benign mature cystic teratoma of the anterior mediastinum leading to heart failure: Report of a case

A 12-year-old male child was referred to our clinic for the surgical treatment of an anterior mediastinal mass, suspected to be a thymic cyst, which was considered to potentially lead to cardiac failure. The mass was resected completely with a median sternotomy. The postoperative course was uneventful. A pathological examination revealed a mature cystic teratoma of anterior mediastinum which is a very rare cystic tumor at this location. The incidence, diagnostic procedures, complications, and treatment of mediastinal teratomas are discussed along with a review of the literature.

Obstructing endobronchial malignant fibrous histiocytoma

A 58-year-old male patient admitted with malignant fibrous histiocytoma of the left mainstem. Rareness and unusual presentation of malignant fibrous histiocytoma and surgical management for lung salvage made its reporting worthwhile. In this localization, prognostic characteristics are better than in the other localizations of lung and body.