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Cureus Jun 2023Congenital lobar emphysema (CLE) is a rare developmental malformation that presents as neonatal respiratory distress and can be successfully managed with prompt...
Congenital lobar emphysema (CLE) is a rare developmental malformation that presents as neonatal respiratory distress and can be successfully managed with prompt intervention. Hyperinflation of the affected lobe with mediastinal shift is the characteristic radiological finding. However, the etiology mostly remains unknown. Here, we report a case of CLE that microscopically revealed bronchial cartilaginous hypoplasia as an underlying cause of this malformation.
PubMed: 37465796
DOI: 10.7759/cureus.40545 -
Cureus Jun 2023Pulmonary tuberculosis is associated with long-term complications that affect both the respiratory and cardiovascular systems. We present the case of a 65-year-old male...
Pulmonary tuberculosis is associated with long-term complications that affect both the respiratory and cardiovascular systems. We present the case of a 65-year-old male patient who presented with chief complaints of productive cough and breathlessness for the last four years. Further radiological investigations revealed a left-sided destroyed lung with left lung collapse and deviation of the mediastinum towards the left side. The patient responded well to treatment with broad-spectrum antimicrobial drugs and mucolytics.
PubMed: 37425496
DOI: 10.7759/cureus.40035 -
International Journal of Surgery Case... Jul 2023Chyle is tryglyceride reach fluid absorbed from the intestines. A total of 1500 ml-2400 ml of chyle flows through thoracic duct per day.
INTRODUCTION AND IMPORTANCE
Chyle is tryglyceride reach fluid absorbed from the intestines. A total of 1500 ml-2400 ml of chyle flows through thoracic duct per day.
CASE PRESENTATION
A 15 years old boy accidentally hit himself with a stick while he was playing with a rope attached to the stick. He was hit on the left side of anterior neck in zone one territory. He came seven days after the trauma when he experienced a progressively worsening shortness of breath and a bulge at the trauma site that appears with each breath. On exams, he had features of respiratory distress. The trachea was significantly shifted to the right side. There was dull percussion note on the entire left hemichest with decreased air entry. Chest x-ray showed massive left pleural collection with mediastinal shift to the right side. Chest tube was inserted and approximately 3,000 ml of milky fluid was evacuated. These continued for the following three days for which repeated thoracotomies were done for an attempt to obliterate the chyle fistula. The final successful surgery done was embolization of the thoracic duct with blood coupled with total parietal pleurectomy. After staying for approximately one month in the hospital, the patient was safely discharged improved.
DISCUSSION
Chylothorax following blunt neck injury is very rare. Chylothorax with significant output leads to malnutrion, immunocompromization and high rate of mortality without timely intervention.
CONCLUSION
Early therapeutic intervention is the core for good patient outcome. Decreasing thoracic duct output, adequate drainage, nutritional support, lung expansion and surgical intervention are the pillars of chylothorax management. The surgical options of thoracic duct injury are mass ligation, thoracic duct ligation, pleurodesis and pleuroperitoneal shunt. Intraoperative thoracic duct embolization with blood, as we have used in our patient, needs further study.
PubMed: 37413755
DOI: 10.1016/j.ijscr.2023.108447 -
Cureus May 2023Blunt thoracic trauma often causes rib fractures, hemothorax, and pneumothorax. Although there is no established definition regarding the duration and management of...
Blunt thoracic trauma often causes rib fractures, hemothorax, and pneumothorax. Although there is no established definition regarding the duration and management of delayed hemothorax, it commonly occurs in a few days and exhibits at least one displaced rib fracture. Moreover, delayed hemothorax rarely develops tension hemothorax. A 58-year-old male who had a motorcycle accident received conservative treatment from his orthopedic doctor. He felt a sudden severe chest pain 19 days after the accident. Contrast-enhanced computed tomography (CT) of the chest revealed multiple left-sided rib fractures without displacement, left pleural effusion, and extravasation near the intercostal space of the seventh rib fracture. After transfer to our hospital and a plain CT scan, which showed a more mediastinal shift toward the right, his condition deteriorated with cardiorespiratory embarrassment, such as restlessness, hypotension, and neck vein distention. We diagnosed him with obstructive shock due to tension hemothorax. Immediate chest drainage ameliorated restlessness and elevated blood pressure. Here, we report an extremely rare and atypical case of delayed tension hemothorax after blunt thoracic trauma without displaced rib fractures.
PubMed: 37303319
DOI: 10.7759/cureus.38835 -
Journal of Clinical Medicine May 2023A congenital intrathoracic kidney (ITK) is a rare anomaly that is recognized to have four causes: renal ectopia with an intact diaphragm, diaphragmatic eventration,... (Review)
Review
INTRODUCTION
A congenital intrathoracic kidney (ITK) is a rare anomaly that is recognized to have four causes: renal ectopia with an intact diaphragm, diaphragmatic eventration, diaphragmatic hernia, and traumatic diaphragmatic rupture. We report a case of a prenatal-diagnosed ITK related to a congenital diaphragmatic hernia (CDH) and conducted a systematic review of all cases of the prenatal diagnosis of this association.
CASE PRESENTATION
A fetal ultrasound scan at 22 gestational weeks showed left CDH and ITK, hyperechoic left lung parenchyma, and mediastinal shift. The fetal echocardiography and karyotype were normal. Magnetic resonance imaging at 30 gestational weeks confirmed the ultrasound suspicion of left CDH in association with bowel and left kidney herniation. The fetal growth, amniotic fluid, and Doppler indices remained within the normal range over time. The woman delivered the newborn via an at-term spontaneous vaginal delivery. The newborn was stabilized and underwent non-urgent surgical correction; the postoperative course was uneventful.
CONCLUSIONS
CDH is the rarest cause of ITK; we found only eleven cases describing this association. The mean gestational age at diagnosis was 29 ± 4 weeks and 4 days. There were seven cases of right and four cases of left CDH. There were associated anomalies in only three fetuses. All women delivered live babies, the herniated kidneys showed no functional damage after their surgical correction, and the prognosis was favorable after surgical repair. The prenatal diagnosis and counseling of this condition are important in planning adequate prenatal and postnatal management in order to improve neonatal outcomes.
PubMed: 37297803
DOI: 10.3390/jcm12113608 -
Annals of Medicine and Surgery (2012) Apr 2023The caudal and basal parts of the lungs are fused together in a rare congenital bronchopulmonary anomaly known as horseshoe lung. The majority of horseshoe lung cases...
UNLABELLED
The caudal and basal parts of the lungs are fused together in a rare congenital bronchopulmonary anomaly known as horseshoe lung. The majority of horseshoe lung cases are associated with scimitar syndrome. Most patients present with nonspecific symptoms. Multidetector pneumoangiography can be used to diagnose horseshoe lung, which shows that the isthmus of the pulmonary parenchyma traverses the midline, connecting the two lungs together. Treatment and prognosis are usually determined depending on the presence of other concomitant anomalies and the degree of symptom severity.
CASE PRESENTATION
A 3-month-old-male patient presented with respiratory symptoms and a history of chest infection. Chest imaging revealed anomalous venous drainage from the right lower lobe of the lung, right lung hypoplasia with mediastinal shift, and a parenchymal isthmus extending between the two lungs. The patient was diagnosed with horseshoe lungs associated with scimitar syndrome. He was also found to have extralobar sequestration to the right lower lobe of the lung. The patient underwent surgical management in the form of tunneling of the anomalous vein into the left atrium using pericardium autograft ligation of the sequestration artery.
CLINICAL DISCUSSION
Because of its common association with other congenital malformations such as scimitar syndrome and cardiovascular defects, clinicians should be meticulous in the investigation and workup process of patients with horseshoe lung in order not to miss any of these associated abnormalities.
CONCLUSION
Although it is very rare, horseshoe lung should be considered in the differential diagnosis of respiratory distress symptoms, especially in children younger than 1 year.
PubMed: 37113827
DOI: 10.1097/MS9.0000000000000104 -
Journal of Surgical Case Reports Apr 2023A 72-year-old patient presented with severe tricuspid regurgitation and patent foramen ovale (PFO) in the setting of severe mediastinal shifting after remote right...
A 72-year-old patient presented with severe tricuspid regurgitation and patent foramen ovale (PFO) in the setting of severe mediastinal shifting after remote right pneumonectomy. Surgical approach was challenging given the significant herniation of the heart and left lung into the right hemithorax. This report describes tricuspid valve replacement with PFO closure via a right posterolateral thoracotomy and alternative cardiopulmonary bypass cannulation strategy.
PubMed: 37082650
DOI: 10.1093/jscr/rjad186 -
Thoracic Cancer Jun 2023Vocal code paralysis (VCP) is a rare complication of stereotactic body radiation therapy (SBRT). In most previously reported cases of VCP after SBRT, VCP was left-sided...
Vocal code paralysis (VCP) is a rare complication of stereotactic body radiation therapy (SBRT). In most previously reported cases of VCP after SBRT, VCP was left-sided because of anatomic vulnerability. Here, we report a case of right-sided VCP following SBRT for non-small-cell lung cancer. The patient was an 81-year-old man who underwent SBRT for synchronous lung cancer of the right upper and inferior lobes. He subsequently developed radiation pneumonitis and received corticosteroids. Lung contraction persisted, and the mediastinum shifted to the right because of lung volume reduction. After corticosteroids discontinuation, the patient developed hoarseness and voice weakness. An endoscopic test showed right-sided VCP. Imaging examinations did not reveal new lesions, including lung cancer recurrence. Therefore, we diagnosed the patient with SBRT-associated VCP and speculated that the injury to the right vagal nerve and recurrent laryngeal nerve resulted from mechanical traction due to intense lung contraction, which might have induced VCP. We should be alert to VCP following SBRT, even if the target lesions are right-sided.
Topics: Male; Humans; Aged, 80 and over; Carcinoma, Non-Small-Cell Lung; Lung Neoplasms; Vocal Cord Paralysis; Radiosurgery; Neoplasm Recurrence, Local
PubMed: 37060336
DOI: 10.1111/1759-7714.14905 -
The American Journal of Case Reports Apr 2023BACKGROUND Tension pneumothorax (TP) is a medical emergency resulting in air accumulation in the pleural cavity of the affected side. Later, this air applies pressure on...
BACKGROUND Tension pneumothorax (TP) is a medical emergency resulting in air accumulation in the pleural cavity of the affected side. Later, this air applies pressure on the mediastinal structures, leading to a shift of these structures toward the contralateral side. This shift results in a picture of obstructive shock with a possibly fatal consequence if not detected and treated early. Treatment should not await radiological confirmation, and the red flags in the history and physical examination are enough to proceed with decompressing the affected hemithorax with a large-bore needle. Usually, patients with TP present to the Emergency Department with pleuritic chest pain and shortness of breath, but rare presentations are still possible. CASE REPORT We report a case of a 24-year-old male patient with TP who presented to the Emergency Department with severe epigastric abdominal pain with a clinical picture of acute pancreatitis. X-ray showed a right-sided TP. Immediately, we performed a needle decompression followed by chest tube insertion. Four days later, the patient was discharged home uneventfully. CONCLUSIONS In this case report, we aim to draw the attention of physicians in the Emergency Department to the need to consider the possibility of upper abdominal pain elicited by chest pathologies. Furthermore, we need to investigate the effect of TP on coronary perfusion.
Topics: Male; Humans; Young Adult; Adult; Pneumothorax; Acute Disease; Pancreatitis; Thorax; Abdominal Pain
PubMed: 37031352
DOI: 10.12659/AJCR.939036