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Journal of Surgical Case Reports Dec 2020Here we describe the successful outcome of a complex and challenging resection of a left-sided pancoast tumour involving the left subclavian artery and vertebral bodies....
Here we describe the successful outcome of a complex and challenging resection of a left-sided pancoast tumour involving the left subclavian artery and vertebral bodies. The resection was performed following neoadjuvant chemoradiotherapy in a multi-staged fashion involving multiple teams including thoracic surgery, plastic surgery, neurosurgery and vascular surgery. Each operation was less than 6 h, without complication, and the patient was discharged within 1 week of each procedure. This case report highlights the importance of multidisciplinary team collaboration and planning in order to achieve a successful oncologic outcome and a good quality of life following treatment of these challenging tumours. The patient had a good functional outcome and no evidence of recurrence 1.5 years later.
PubMed: 33343859
DOI: 10.1093/jscr/rjaa384 -
3D Printing in Medicine 2017In this work, we provide specific clinical examples to demonstrate basic practical techniques involved in image segmentation, computer-aided design, and 3D printing. A...
In this work, we provide specific clinical examples to demonstrate basic practical techniques involved in image segmentation, computer-aided design, and 3D printing. A step-by-step approach using United States Food and Drug Administration cleared software is provided to enhance surgical intervention in a patient with a complex superior sulcus tumor. Furthermore, patient-specific device creation is demonstrated using dedicated computer-aided design software. Relevant anatomy for these tasks is obtained from CT Digital Imaging and Communications in Medicine images, leading to the generation of 3D printable files and delivery of these files to a 3D printer.
PubMed: 29782619
DOI: 10.1186/s41205-017-0022-3 -
Agri : Agri (Algoloji) Dernegi'nin... Apr 2020A Pancoast or superior sulcus tumor is a rare, bronchogenic carcinoma. In the early period, shoulder pain is the most common symptom. In this case, the patient had...
A Pancoast or superior sulcus tumor is a rare, bronchogenic carcinoma. In the early period, shoulder pain is the most common symptom. In this case, the patient had presented with complaints of shoulder and arm pain at other outpatient clinics and was examined primarily for musculoskeletal causes and radiculopathy. The patient had no complaints of facial symptoms and Horner's syndrome signs, such as anhidrosis of the face and neck region, were not noticed. Advanced imaging of a patient with preganglionic Horner's syndrome is important. Fewer than 50% of patients with a Pancoast tumor have a resectable lesion at the first diagnosis. Diagnosis is often delayed or there may be a misdiagnosis because musculoskeletal disorders are the focus and there are few lung-related complaints. A detailed examination and anamnesis is very important in patients with arm and shoulder pain.
Topics: Adult; Diagnosis, Differential; Horner Syndrome; Humans; Male; Pancoast Syndrome; Shoulder Pain
PubMed: 32297960
DOI: 10.5505/agri.2018.14892 -
International Journal of Surgery Case... 2015The computed tomography scan provides vital information about the relationship of thoracic malignancies to the surrounding structures and aids in surgical planning....
INTRODUCTION
The computed tomography scan provides vital information about the relationship of thoracic malignancies to the surrounding structures and aids in surgical planning. However, it can be difficult to visualize the images in a two-dimensional screen to interpret the full extent of the relationship between important structures in the surgical field.
PRESENTATION OF CASE
We report two cases where we used a three-dimensional printed model to aid in the surgical resection of thoracic malignancies.
DISCUSSION
Careful planning is necessary to resect thoracic malignancies. Although two-dimensional images of the thoracic malignancies provide vital information about the tumor and its surrounding structures, the three-dimensional printed model can provide more accurate information about the tumor and assist in surgical planning.
CONCLUSION
Three-dimensional printed model provide better visualization of complex thoracic tumors, aid in counseling the patient about the surgical procedure and assisted in surgical resection of thoracic malignancy.
PubMed: 26453940
DOI: 10.1016/j.ijscr.2015.09.037 -
Journal of Thoracic Disease Jun 2018In some patients with complex Superior Sulcus tumors, a combination of surgical accesses may be required. For patients with very large tumors which invade the first ribs...
BACKGROUND
In some patients with complex Superior Sulcus tumors, a combination of surgical accesses may be required. For patients with very large tumors which invade the first ribs anteriorly and without subclavian vessels involvement, we developed a "double-step" technique to facilitate resection and reduce surgical trauma.
METHODS
The technique was performed on five patients with a bulky non-small cell lung cancer (NSCLC), four of whom had a Superior Sulcus tumor. All patients received a radical wide thoracectomy en-bloc with an upper lobectomy. Neither significant flail chest nor postoperative respiratory complications were observed. The method is based on the possibility of interrupting the medial extremity of the first rib beneath the clavicle through a limited, preliminary parasternal incision. The remaining ribs involved in the resection are also interrupted at the costo-chondral junction, leaving the sternum and clavicle intact. Once the medial limit of the involved ribs has been sectioned, multiple stitches are placed through the peristernal tissues and temporarily left inside the chest. Through a second posterior incision, the en-bloc chest wall and lung resection is easily completed. The previously placed peristernal stitches are collected and used for the medial fixation of the prosthesis.
RESULTS
Using this technique the resection was radical in all cases. No major postoperative complications were registered.
CONCLUSIONS
The technique has several advantages: trauma related to double access is negligible; radical resection is facilitated, anterior chest wall resection is accomplished without sternal or clavicular injury, en-bloc chest wall and lung resection is made straightforward despite the extended area of resected ribs attached to the tumor, released within the chest cavity; chest wall stabilization is simple and reliable. The only disadvantage is that the patient's surgical position needs to be changed.
PubMed: 30026971
DOI: 10.21037/jtd.2018.05.182 -
American Journal of Hematology Nov 2020
Topics: Diagnosis, Differential; Humans; Leukemia, Plasma Cell; Magnetic Resonance Imaging; Male; Middle Aged; Pancoast Syndrome; Tomography, X-Ray Computed
PubMed: 32833248
DOI: 10.1002/ajh.25977 -
BMJ Case Reports Nov 2018Pancoast's syndrome may be the result of neoplastic, inflammatory or infectious disease. We report an unusual case of Pancoast's syndrome in a patient with metastatic...
Pancoast's syndrome may be the result of neoplastic, inflammatory or infectious disease. We report an unusual case of Pancoast's syndrome in a patient with metastatic breast cancer. A 54-year-old woman, affected by metastatic breast cancer, presented for severe shoulder pain, paraesthesia and numbness in the right arm. Despite further multiple lines of systemic chemotherapy, she developed a progressive enlargement of retropectoral, supraclavicular and infraclavicular lymph node metastases, which involved brachial plexus, apex of lung and anterior mediastinum. Physical examination revealed severe weakness of proximal muscles of the right arm. Neuropathic pain was managed with pharmacological treatment. Lastly, the patient has been treated with intrathecal analgesia with morphine and ziconotide with a good control of pain. The patient died after 3 months.
Topics: Brachial Plexus; Breast Neoplasms; Fatal Outcome; Female; Humans; Lymph Nodes; Lymphatic Metastasis; Middle Aged; Neuralgia; Pain Management; Pancoast Syndrome; Shoulder Pain
PubMed: 30567112
DOI: 10.1136/bcr-2018-226793 -
Cureus Apr 2023A 46-year-old female patient was diagnosed with a rare and benign intrapulmonary schwannoma, a neurogenic tumor that represents approximately 20% of adult mediastinal...
A 46-year-old female patient was diagnosed with a rare and benign intrapulmonary schwannoma, a neurogenic tumor that represents approximately 20% of adult mediastinal tumors, with schwannomas being the most common subtype. The patient was initially asymptomatic; however, after a period of four years, the patient presented with bilateral extremity edema, chronic venous stasis, elevated right ventricular systolic pressure, and a slightly enlarged inferior vena cava. These symptoms were caused by the lung tumor compressing intrathoracic structures. This case highlights the need for early evaluation and proper management of neurogenic tumors to avoid serious symptoms and complications. It also emphasizes the importance of vigilant monitoring and prompt surgery to achieve the best outcome for patients with neurogenic tumors.
PubMed: 37081901
DOI: 10.7759/cureus.37788 -
Cureus Nov 2019Pancoast tumors are non-small cell lung tumors, which can invade the ribs, vertebrae, sympathetic ganglia and brachial plexus. In this study, a patient with right-sided...
Pancoast tumors are non-small cell lung tumors, which can invade the ribs, vertebrae, sympathetic ganglia and brachial plexus. In this study, a patient with right-sided Pancoast tumor presented with intractable chronic pain on the right neck, upper extremity and chest wall. The chronic pain associated with Pancoast tumor, which was difficult to treat with opioids and other medications, was effectively treated with a high-thoracic erector spinae plane block (ESPB). Prolonged analgesia was provided with an ESP catheter to wean the patient from opioids. This case report provides an example where the novel interfacial ESP block can provide pain relief in challenging situations such as lung malignancies involving deeper structures and extensive areas of pain.
PubMed: 31857924
DOI: 10.7759/cureus.6092 -
BMJ Case Reports Jan 2019A 54-year-old man presented to the emergency department with a 4-week history of right shoulder pain radiating down his arm, with some associated sensory loss. Further...
A 54-year-old man presented to the emergency department with a 4-week history of right shoulder pain radiating down his arm, with some associated sensory loss. Further questioning and examination in the department revealed a classical Horner's syndrome; miosis, partial ptosis and hemifacial anhidrosis. An initial chest X-ray was deemed to be unremarkable; however, further review by a radiologist noted asymmetrical right apical thickening. A subsequent high-resolution CT scan of the chest revealed a right-sided Pancoast tumour. This case highlights the importance of a thorough history and examination in identifying a rare cause of shoulder and/or back pain.
Topics: Emergency Service, Hospital; Horner Syndrome; Humans; Lung Neoplasms; Male; Middle Aged; Pancoast Syndrome; Positron Emission Tomography Computed Tomography; Shoulder Pain; Tomography, X-Ray Computed
PubMed: 30683661
DOI: 10.1136/bcr-2018-227873