Salvatore Griffo

Chylothorax after abdominal surgery

Chylothorax is usually a complication of thoracic surgery procedures. Over a 5-year period we encountered three cases of chylothorax following abdominal surgery performed in general surgery units. The initial effusions, not lactescent, were ascribed to a pleural reaction that sometimes is observed during the postoperative period after abdominal surgery. Once the diagnosis was established, the initial conservative treatment failed, and surgery was necessary. In our patients, their debilitated physical condition precluded a thoracotomy approach. A video-assisted thoracoscopy procedure was undertaken, but the extensive pleural effusions, caused in part by the delay in the diagnosis, prevented the exact localization of the duct and its closure. Talc pleurodesis was successfully employed in all patients. Even after abdominal surgery, a persistent pleural effusion should always induce us to suspect a chylothorax.

Combined endoscopic approach in the treatment of benign broncho-oesophageal fistula

The treatment of benign broncho-oesophageal fistula is usually surgical but sometimes other methods of treatment are preferred. The case history is described of an adult in poor general condition in which an endoscopic approach combined with the use of fibrin glue on the bronchial side and metallic clips on the oesophageal side was used to close the fistula.

Popcorn in the Lung

®65-year-old man was admitted for breathlessness and dry cough of 3-month duration. He denied any history of cigarette smoking and asbestos exposure. The patient’s physical examination revealed reduced breath sounds over middleupper right hemithorax. The patient’s laboratory data and vital signs were normal. A posteroanterior chest radiograph showed a large and well circumscribed pulmonary mass on the right side (Fig. 1). Computed tomography scan confirmed a large, solitary, well delimited, round, inhomogeneous, mass of 12 × 8 × 15 mm in size in the right upper lobe, with calcifications of a linear, nodular, irregular shape (Fig. 2). There was no mediastinal or hilar lymphadenopathy. The radiological findings were highly suggestive of a giant pulmonary chondroid hamartoma. Through a muscle sparing lateral thoracotomy, a right upper lobectomy was performed. Histologic examination yielded a well circumscribed hamartoma with predominantly benign chondroid differentiation. The patient was discharged 5 days after surgery. Pulmonary hamartomas are the most common form of benign lung tumors, derived from the peribronchial mesenchyma. The prevalence varies from 0.025% to 0.32% according to different necropsy studies. They are more common in males with a peak incidence in the sixth or seventh decade of life. Pulmonary hamartomas can be divided into parenchymal (90%) and endobronchial (10%) and can be chondromatous or leiomyomatous or a combination thereof. 1 The parenchymal lesions are usually an incidental radiological finding of a round opacity in the periphery of the lung. The presence of calcifications typically dispersed in the form of multiple clumps throughout the lesion in a popcorn configuration can be found in 10–15% of pulmonary hamartomas on chest radiographs. 2 Pulmonary chondroid hamartomas measuring over 10 cm are very rare. 1 Lobectomy is the operation of choice when a giant tumor causes complete replacement of the lobe as in our case.

Huge solitary fibrous tumor of the pleura in a young man

A 35-year-old man was referred with progressive dyspnea and fatigue. Chest radiography revealed a large basal opacity on the right hemithorax (Figure 1(a), 1(b)). Chest computed tomography revealed a huge well-circumscribed round tumor with no substantial enhancement. It occupied the right thoracic cavity and measured 18 10 cm, causing compression atelectasis of the underlying lung (Figure 1(c)). Magnetic resonance imaging confirmed a huge mass adherent to the chest wall and diaphragm (Figure 1(d)). The patient underwent surgery by a right lateral muscle-sparing thoracotomy through the 5th intercostal space. The mass was attached to the mediastinal pleura by a pedunculated and vascularized stalk (Figure 1(e)). There was no invasion into mediastinal structures, thus the mass was resected en bloc with a partial pleurectomy. It appeared to be a solid tumor, well-circumscribed, encapsulated, and beefy red, weighing 1200 g (Figure 1(f)). Histopathological examination showed bland-appearing spindle cells with bands of collagenized stroma. Immunohistochemistry was positive for vimentin, CD34, and BCL2, and negative for cytokeratin and calretinin, which was consistent with Solitary Fibrous Tumor of the pleura (SFTp). SFTp are rare neoplasms of mesenchymal origin. The incidence of SFTp is approximately 2, 8 cases per 100,000, accounting for fewer than 5% of all neoplasms involving the pleura. SFTp has been described in Asian Cardiovascular & Thoracic Annals 21(5) 626–627 The Author(s) 2012 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0218492312462711 aan.sagepub.com

Broncholithiasis mimicking a bronchial carcinoid tumour

A 29-year-old woman was transferred to our unit with a diagnosis of bronchial carcinoid tumour. She complained of chest pain, dyspnoea, cough and haemoptysis. She smoked 20 cigarettes per day and denied any history of tuberculosis, histoplamosis or occupational exposure and her family history was strongly positive for cancer. She had undergone a contrast-enhanced CT scan of the chest in the endocrinology unit which showed a partially calcified mass in the left hilum (fig 1A, arrow). Further pulmonary scintigraphy with …