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Anesthesiology and Pain Medicine Jun 2023The erector spinae plane (ESP) block is a regional anesthetic technique that involves injecting a local anesthetic below the erector spinae muscle in an interfascial...
INTRODUCTION
The erector spinae plane (ESP) block is a regional anesthetic technique that involves injecting a local anesthetic below the erector spinae muscle in an interfascial plane.
CASE PRESENTATION
We report a case of a 66-year-old man with cervicothoracic junction pain caused by an advanced Pancoast tumor. The administration of ESP block at the T2-T3 level led to pain relief of more than 50% in this patient after two sessions.
CONCLUSIONS
Therefore, the application of this method of regional analgesia is both convenient and safe and reduces opioid consumption. Further studies are needed to evaluate the safety and effectiveness of continuous blocks in outpatient settings.
PubMed: 38021326
DOI: 10.5812/aapm-135829 -
Radiology Case Reports May 2024Pancoast tumors, also known as superior sulcus tumors, encompass a diverse spectrum of neoplasms that infiltrate the apex of the chest wall, yielding distinctive...
Pancoast tumors, also known as superior sulcus tumors, encompass a diverse spectrum of neoplasms that infiltrate the apex of the chest wall, yielding distinctive clinical presentations. One of the earliest signs of tumor growth is pain radiating to the upper limb, stemming from peripheral nerve involvement, which can mimic joint pain or spinal radicular irritation. In this case report, we present the clinical history of a 64-year-old female smoker who had previously been recommended for orthopedic elbow surgery due to epicondylitis. Subsequent to the development of additional symptoms and rigorous investigation, a Pancoast tumor was diagnosed. Furthermore, we discuss the characteristic treatment modalities available for Pancoast tumors, including pharmacological pain management and interventional strategies such as spinal cordotomy and spinal alcoholysis. This case underscores the significance of recognizing atypical presentations and emphasizes the importance of comprehensive evaluation in the diagnosis and management of Pancoast tumors.
PubMed: 38406318
DOI: 10.1016/j.radcr.2024.01.091 -
Journal of Cardiothoracic Surgery Apr 2016The mini-ivasive approach to superior sulcus tumors is an uncommon procedure that is still far from standardization. We describe a hybrid surgical technique to approach...
BACKGROUND
The mini-ivasive approach to superior sulcus tumors is an uncommon procedure that is still far from standardization. We describe a hybrid surgical technique to approach "en block" chest resection and pulmonary lobectomy for anterior superior sulcus tumors.
CASE PRESENTATION
A patient affected by right anterior Pancoast tumor surgically staged as cT4N0M0 (suspected anonymous vein invasion) underwent chemo-radiation induction therapy with satisfactory tumor reduction. The surgical operation comprised an initial VATS approach to the hilar structures followed by a limited C-shaped anterior contra-incision; finally, the right upper lobe "en block" with the anterior part of the first and second rib was removed. The whole procedure was conducted with the patient in the supine position; no rib retractors were used. The definitive stage was ypT0N0M0. The patient had an uneventful hospital stay and at the 9 months follow-up she was free from disease and post-thoracotomy syndrome.
CONCLUSIONS
In our opinion such hybrid VATS procedure has several advantages: starting with thoracoscopy it is possibleto exclude previously undetected pleural dissemination and to precisely define the tumor location as well as limits of the thoracic wall resection; time could be spared maintaining the patients in the supine position for both surgical times; postoperative pain and post-thoracotomy syndrome could be minimized avoiding the use of any rib retractor.
Topics: Aged; Carcinoma, Non-Small-Cell Lung; Female; Humans; Male; Middle Aged; Minimally Invasive Surgical Procedures; Pancoast Syndrome; Pneumonectomy; Thoracic Surgery, Video-Assisted
PubMed: 27079507
DOI: 10.1186/s13019-016-0446-7 -
Radiology Case Reports Sep 2016Pneumocephalus and pneumorrhachis are related to transgression of the barriers to the central nervous system. We present a patient with a Pancoast tumor treated with...
Pneumocephalus and pneumorrhachis are related to transgression of the barriers to the central nervous system. We present a patient with a Pancoast tumor treated with palliative chemoradiation who developed symptomatic spinal and intracranial air caused by spontaneous bronchopleurodurosubarachnoid fistula secondary to direct tumor invasion into the thecal sac.
PubMed: 27594957
DOI: 10.1016/j.radcr.2016.06.001 -
Cancer Control : Journal of the Moffitt... Jul 2016Surgical outcomes for Pancoast (superior sulcus) tumors of the lung have significantly changed during the last few decades and have improved with use of curative-intent...
BACKGROUND
Surgical outcomes for Pancoast (superior sulcus) tumors of the lung have significantly changed during the last few decades and have improved with use of curative-intent surgery by utilizing en bloc complete resections.
METHODS
A retrospective analysis was conducted of 11 selected patients treated at Moffitt Cancer Center from 2007 to 2016. Data from patient records were collected and analyzed.
RESULTS
All 11 patients with a Pancoast tumor involving the first rib had their T1 root preserved at surgery. In 10 patients (90.9%), the tumor was removed en bloc. Clear margins of resection were documented in 4 cases (36.0%). No patient developed postoperative hand weakness, but 3 patients (27.3%) had minor postoperative complications, including air leak, chylothorax, and pericardial effusion. One iatrogenic injury to the subclavian artery was reported during surgery; the injury was subsequently repaired. No operative mortality was reported.
CONCLUSIONS
Radical resection of Pancoast tumors is considered to be safe, and preserving the T1 nerve root provides more favorable, functional outcomes.
Topics: Adult; Aged; Aged, 80 and over; Cohort Studies; Humans; Lung Neoplasms; Middle Aged; Pancoast Syndrome; Retrospective Studies; Ribs; Spinal Nerve Roots
PubMed: 27556670
DOI: 10.1177/107327481602300313 -
Experimental and Therapeutic Medicine Dec 2023A superior pulmonary sulcus tumor, also known as a Pancoast tumor, invades tissues or organs at the entrance of the thorax, such as the brachial plexus, upper ribs,...
A superior pulmonary sulcus tumor, also known as a Pancoast tumor, invades tissues or organs at the entrance of the thorax, such as the brachial plexus, upper ribs, vertebrae, subclavian vessels and stellate ganglia. Induction concurrent chemoradiotherapy followed by radical surgical resection is the preferred treatment. The present study reported the case of a 52-year-old male who presented at Hubei Cancer Hospital, Tongji Medical College (Wuhan, Hubei) with left chest pain and an abnormal chest computed tomography scan showing a mass of 81x43 mm in the left upper chest wall that invaded the first, second and third anterior ribs. Biopsy of the mass showed stage cT4N0M0, IIIA, poorly differentiated adenocarcinoma and epidermal growth factor receptor+. The patient was treated by induction chemotherapy and targeted therapy, which was followed by surgical resection of the left upper lobe and the affected chest wall via the transmanubrial approach. The targeted therapy with almonertinib was continued postoperatively. To date, no disease recurrence has been detected during the 4 months follow-up.
PubMed: 37954117
DOI: 10.3892/etm.2023.12263 -
Oxford Medical Case Reports Sep 2020A 69-year-old male presented with early stage non-small cell lung cancer in 2016. The tumor was resected; however, the patient experienced recurrence 2 years later and...
A 69-year-old male presented with early stage non-small cell lung cancer in 2016. The tumor was resected; however, the patient experienced recurrence 2 years later and subsequently received paclitaxel/carboplatin concurrently with radiotherapy. Within weeks of completing this treatment, he developed a symptomatic pancoast tumor secondary to disease progression and commenced second line nivolumab. Following the second dose of nivolumab, he developed acute unilateral right hearing loss. He commenced intravenous methylprednisolone followed by a slow taper of oral prednisolone. With steroids, he noted a gradual improvement in hearing, confirmed by audiology. Restaging imaging post-nivolumab demonstrated a complete metabolic response. Two prior cases have reported bilateral sensorineural hearing loss post-immune checkpoint inhibitor (ICI). We postulate the hearing impairment relates to the development of autoimmune inner ear disease. To our knowledge, this is the only case of a patient experiencing unilateral loss of hearing following an ICI.
PubMed: 32995031
DOI: 10.1093/omcr/omaa077 -
The Annals of Thoracic Surgery Sep 2018Several different surgical approaches to anterior Pancoast tumors have been proposed. The osteomuscular-sparing transmanubrial approach allows optimal exposure and...
Several different surgical approaches to anterior Pancoast tumors have been proposed. The osteomuscular-sparing transmanubrial approach allows optimal exposure and control of apical chest wall structures, but it requires an additional thoracotomy to perform the lobectomy with radical lymph node resection. The presented technique combines the osteomuscular-sparing transmanubrial approach with robotic-assisted upper lobectomy in a severely obese patient, thereby reducing the invasiveness of the surgical approach and the postoperative complications.
Topics: Obesity, Morbid; Pancoast Syndrome; Robotic Surgical Procedures; Robotics; Thoracotomy
PubMed: 29654726
DOI: 10.1016/j.athoracsur.2018.03.013 -
BMJ Case Reports Jun 2017
Topics: Blepharoptosis; Carcinoma, Squamous Cell; Humans; Male; Middle Aged; Miosis; Neoplasm Staging; Pancoast Syndrome; Saudi Arabia; Shoulder Pain; Thorax; Weight Loss; X-Rays
PubMed: 28611144
DOI: 10.1136/bcr-2017-220969 -
QJM : Monthly Journal of the... May 2016
PubMed: 26475600
DOI: 10.1093/qjmed/hcv192