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Cureus Jul 2022We report the first documented case series of two lung adenocarcinoma patients demonstrating Kirsten rat sarcoma viral oncogene homolog (KRAS) G12C mutations by reverse...
We report the first documented case series of two lung adenocarcinoma patients demonstrating Kirsten rat sarcoma viral oncogene homolog (KRAS) G12C mutations by reverse transcription-polymerase chain reaction techniques from Saudi Arabia. Both patients were males aged 64 and 76 years. The first had a heavy smoking history, while the second did not report any history of smoking. The tumor subtype was identified to be non-mucinous lung adenocarcinoma in both cases. The younger patient presented with generalized lymphadenopathy and a right-sided lung mass lesion, while the older patient exhibited stage III-A left lung adenocarcinoma that required rapid response. An initial examination of the first case showed a right-sided mediastinal shift, bilateral neck lymphadenopathy, and poorly differentiated neoplasm from a right supraclavicular core biopsy, leading to treatment with palliatives along with regular checkups. The second case was afebrile after being confirmed to be vitally stable and laboratory testing (Neutr 100). Further studies, specifically on large numbers of patients from the Arabian Gulf, are needed to confirm significant differences between the national and international populations. Additionally, future studies should investigate more differences in the differentiation of KRAS-mutant lung adenocarcinoma between patients from the Arabian Gulf and others.
PubMed: 36004014
DOI: 10.7759/cureus.27090 -
Clinical Case Reports Mar 2022Mediastinal shift and chest wall retraction limit the indication of a double lung transplant in patients with complete destruction of lung parenchyma. We report outcomes...
Mediastinal shift and chest wall retraction limit the indication of a double lung transplant in patients with complete destruction of lung parenchyma. We report outcomes as well as preoperative and operative management in two patients with significant lung volume reduction and mediastinal shift due to bronchiectasis of the right lung.
PubMed: 35990927
DOI: 10.1002/ccr3.5515 -
Experimental and Therapeutic Medicine Sep 2022Regarding the pleural space after pneumonectomy for malignancy, a vast number of studies have assessed early drop in the fluid level, suggesting a broncho-pleural... (Review)
Review
Regarding the pleural space after pneumonectomy for malignancy, a vast number of studies have assessed early drop in the fluid level, suggesting a broncho-pleural fistula, but only a small number of studies reported on the abnormal increase in the fluid level-a potentially lethal complication. In the present study, the available databases worldwide were screened and 19 cases were retrieved, including 14 chylothorax and 3 hydrothorax cases, 1 pneumothorax and 1 haemothorax case. Tension chylothorax is caused by mediastinal lymph node dissection as an assumed risk in radical cancer surgery. For tensioned haemothorax, the cause has not been elucidated, although lymphatic stasis associated with deep venous thrombosis was suspected. Tensioned pneumothorax was caused by chest wall damage after extrapleural pneumonectomy combined with low aspiration pressure on the chest drain. No cause was determined for none of the tensioned hydrothorax-all 3 cases had the scenario of pericardial resection in addition to pneumonectomy in common. Tensioned space after pneumonectomy for cancer manifests as cardiac tamponade. Initial management is emergent decompression of the heart and mediastinum. Final management depends on the fluid type (chyle, transudate, air, blood) and the medical context of each case. Of the 19 cases, 12 required a major surgical procedure as the definitive management.
PubMed: 35978935
DOI: 10.3892/etm.2022.11485 -
Interactive Cardiovascular and Thoracic... Aug 2022Extreme mediastinal shift due to major diaphragm eventration is complex when mitral-valve repair is required. We report the case of a 59-year-old woman with...
Challenge of a therapeutic sequence: rare case of heart failure in mitral valvular disease intensified by an extreme mediastinal shift from major diaphragmatic eventration.
Extreme mediastinal shift due to major diaphragm eventration is complex when mitral-valve repair is required. We report the case of a 59-year-old woman with diaphragmatic eventration who had 2 recent episodes of heart failure due to arrythmia associated with severe mitral-valve regurgitation (regurgitant orifice area 47 mm2). Forced expiratory flow-volume in the first second and vital capacity (VC) were at 32% and 33%, respectively,decreasing to 20% and 30% when she was in a supine position. We found it impossible to repair the valve first because of the extreme mediastinal shift and respiratory dysfunction. Therefore, we decided to perform diaphragm plication first followed 3 months later by mitral valve repair. Six months after the cardiac operation, the patient showed significant clinical improvement. Forced expiratory flow-volume in the first second and vital capacity increased to 58% and 55%, respectively. The decision to perform the thoracic operation first, followed by the cardiac operation, was the key to improving the patient's respiratory function and to medializing the heart to safely support cardiac surgery.
Topics: Diaphragm; Diaphragmatic Eventration; Female; Heart Failure; Humans; Middle Aged; Mitral Valve; Mitral Valve Insufficiency
PubMed: 35920785
DOI: 10.1093/icvts/ivac181 -
The American Journal of Case Reports Aug 2022BACKGROUND Following single-lung transplantation, native lung inflation can progressively develop in patients with emphysema. CASE REPORT A 74-year-old female patient...
BACKGROUND Following single-lung transplantation, native lung inflation can progressively develop in patients with emphysema. CASE REPORT A 74-year-old female patient presented with worsening dyspnea during daily activities. She underwent a right single-lung transplantation for emphysema 27 years ago. Despite recurrent episodes of acute rejection of the grafted lung, the patient had satisfactory recovery of physical fitness during that period and did not report any serious complications or respiratory symptoms. Her recent dyspnea was due to hyperinflation of the native emphysematous lung with mediastinal shift, reduction of venous blood return, and compression of the grafted lung. Although surgical lung volume reduction had resulted in temporary functional improvement 2 years ago, a completion contralateral pneumonectomy was deemed necessary to allow re-expansion of the grafted lung. After anesthesia induction and placement of a double-lumen tube, selective ventilation of the left emphysematous native lung confirmed the absence of gas exchange based on near-zero end-expiratory carbon dioxide fraction. During selective ventilation of the grafted lung, satisfactory gas exchange was achieved and pneumonectomy proceeded uneventfully under minimally-invasive thoracotomy. Immediately after anesthesia emergence and tracheal extubation, the patient experienced respiratory improvement. Continuous thoracic epidural blockade allowed pain-free mobilization and respiratory therapy to facilitate re-expansion of the grafted lung. CONCLUSIONS After single-lung transplantation in COPD patients, native lung hyperinflation is a well-described rare complication. Lung volume reduction including pneumonectomy can be considered a valuable treatment option.
Topics: Aged; Dyspnea; Emphysema; Female; Humans; Lung Transplantation; Pneumonectomy; Postoperative Complications; Pulmonary Emphysema
PubMed: 35917278
DOI: 10.12659/AJCR.936748 -
The American Journal of Case Reports Jul 2022BACKGROUND Radical esophagectomy for cancer is a potentially curative treatment that requires two/three-field lymphadenectomy. Serious complications can occur, including...
BACKGROUND Radical esophagectomy for cancer is a potentially curative treatment that requires two/three-field lymphadenectomy. Serious complications can occur, including chyle leak (CL). CL has an incidence rate of 1-9% and is associated with a higher rate of postsurgical morbidity and mortality. It usually occurs in the early postoperative period; delayed CL is less common and is thought to be due to an occult leak or late diagnosis. CASE REPORT A 54-year-old man with adenocarcinoma of the esophagus underwent Lewis-Tanner esophagectomy after neoadjuvant chemotherapy with FLOT. During en bloc lymphadenectomy, the main thoracic duct was identified, clipped, and divided. The postoperative course was uneventful. One month after hospital discharge, he was readmitted with severe abdominal, scrotal, and lower-limb edema. A chest-abdomen CT scan revealed massive pleural effusion with left shift and compression of the mediastinum. The patient was initially treated with fasting and fat-free total parenteral nutrition, and the drain output was 2800-3000 mL/dL. Lymphoscintigraphy with ethiodized oil eventually revealed a thoracic duct leak, and lymphatic embolization was successfully performed with a 4-mm metallic spiral and glue. Drain output dramatically reduced, and after 11 days the thoracic drain was removed and the patient was safely discharged. CONCLUSIONS Thoracic duct embolization seems be an effective therapy in treating high-output (>1000 mL/dL) CL that has occurred more than 2 weeks after esophagectomy. It can be considered as a first-line treatment due to its simplicity and effectiveness.
Topics: Chest Tubes; Chyle; Esophageal Neoplasms; Esophagectomy; Humans; Male; Middle Aged; Postoperative Complications; Thoracic Duct
PubMed: 35867626
DOI: 10.12659/AJCR.936590 -
BMC Surgery Jul 2022Laparoscopic large hiatal hernia (LHH) repair remains a challenge despite three decades of ongoing attempts at improving surgical outcome. Its rarity and complexity,...
BACKGROUND
Laparoscopic large hiatal hernia (LHH) repair remains a challenge despite three decades of ongoing attempts at improving surgical outcome. Its rarity and complexity, coupled with suboptimal initial approach that is usually best suited for small symptomatic herniae have contributed to unacceptable higher failure rates.
RESULTS
We have therefore undertaken a systematic appraisal of LHH with a view to clear out our misunderstandings of this entity and to address dogmatic practices that may have contributed to poor outcomes.
CONCLUSIONS
First, we propose strict criteria to define nomenclature in LHH and discuss ways of subcategorising them. Next, we discuss preoperative workup strategies, paying particular attention to any relevant often atypical symptoms, indications for surgery, timing of surgery, role of surgery in the elderly and emphasizing the key role of a preoperative CT imaging in evaluating the mediastinum. Some key dissection methods are then discussed with respect to approach to the mediastinal sac, techniques to avoid/deal with pleural breach and rationale to avoid Collis gastroplasty. The issues pertaining to the repair phase are also discussed by evaluating the merits of the cruroplasty, fundoplication types and gastropexy. We end up debating the role of mesh reinforcement and assess the evidence with regards to recurrence, reoperation rate, complications, esophageal dilatation, delayed gastric emptying and mortality. Lastly, we propose a rationale for routine postoperative investigations.
Topics: Aged; Fundoplication; Gastroplasty; Hernia, Hiatal; Herniorrhaphy; Humans; Laparoscopy
PubMed: 35804332
DOI: 10.1186/s12893-022-01705-w -
Frontiers in Pediatrics 2022Fetal MRI has played an essential role in the evaluation and management of congenital diaphragmatic hernia (CDH). We aimed to investigate whether the mediastinal shift...
OBJECTIVE
Fetal MRI has played an essential role in the evaluation and management of congenital diaphragmatic hernia (CDH). We aimed to investigate whether the mediastinal shift angle (MSA) value was associated with the prognosis and the severity of left CDH and explore the relationship between the MSA value and fetal and neonatal cardiac structures and functions.
METHODS
From January 2012 to December 2020, the fetal MSA values of left CDH in our institution were retrospectively measured. Other prenatal parameters and clinical outcomes of them are collected. We also measured the fetal and postnatal echocardiography parameters to analyze linear correlation with MSA values.
RESULTS
A total of 94 patients with left CDH were included. MSA was significantly higher in the deceased group than in the survived group [((38.3 ± 4.7)° vs. 32.3 ± 5.3)°, < 0.001]. The MSA value of the high-risk defect group [CDH Study Group (CDHSG) C/D type] was significantly higher than that of the low-risk defect group [CDHSG A/B type; (36.0 ± 4.9)° vs. (30.1 ± 4.8)°, < 0.001]. The AUC for severity was 0.766 (95% CI, 0.661-0.851, < 0.0001) and the best cut-off value for MSA was 30.7°. Higher MSA correlates with decreased fetal -score of left ventricle (LV) width, the diameter of the mitral valve (MV), peak velocity of MV and tricuspid valve (TV), and neonatal LV end-diastolic diameter (LVEDD) and velocity of tricuspid regurgitation (TR; < 0.05).
CONCLUSION
A high MSA value can effectively predict high-risk defects and high mortality of left CDH. The higher the MSA value, the worse the neonatal conditions, the respiratory and cardiovascular prognosis. The MSA values could reflect the level of left heart underdevelopment, including decreased dimensions and diastolic dysfunction of the left ventricle.
PubMed: 35799694
DOI: 10.3389/fped.2022.907724 -
European Journal of Pediatrics Sep 2022In recent years, magnetic resonance imaging (MRI) has largely increased our knowledge and predictive accuracy of congenital diaphragmatic hernia (CDH) in the fetus.... (Review)
Review
UNLABELLED
In recent years, magnetic resonance imaging (MRI) has largely increased our knowledge and predictive accuracy of congenital diaphragmatic hernia (CDH) in the fetus. Thanks to its technical advantages, better anatomical definition, and superiority in fetal lung volume estimation, fetal MRI has been demonstrated to be superior to 2D and 3D ultrasound alone in CDH diagnosis and outcome prediction. This is of crucial importance for prenatal counseling, risk stratification, and decision-making approach. Furthermore, several quantitative and qualitative parameters can be evaluated simultaneously, which have been associated with survival, postnatal course severity, and long-term morbidity.
CONCLUSION
Fetal MRI will further strengthen its role in the near future, but it is necessary to reach a consensus on indications, methodology, and data interpretation. In addition, it is required data integration from different imaging modalities and clinical courses, especially for predicting postnatal pulmonary hypertension. This would lead to a comprehensive prognostic assessment.
WHAT IS KNOWN
• MRI plays a key role in evaluating the fetal lung in patients with CDH. • Prognostic assessment of CDH is challenging, and advanced imaging is crucial for a complete prenatal assessment and counseling.
WHAT IS NEW
• Fetal MRI has strengthened its role over ultrasound due to its technical advantages, better anatomical definition, superior fetal lung volume estimation, and outcome prediction. • Imaging and clinical data integration is the most desirable strategy and may provide new MRI applications and future research opportunities.
Topics: Female; Fetus; Hernias, Diaphragmatic, Congenital; Humans; Lung; Lung Volume Measurements; Magnetic Resonance Imaging; Pregnancy; Prognosis; Retrospective Studies; Ultrasonography, Prenatal
PubMed: 35794403
DOI: 10.1007/s00431-022-04540-6 -
Cureus May 2022Pulmonary hydatid cyst during pregnancy is extremely rare and life-threatening for the mother and fetus. Throughout pregnancy, hydatid cysts may enlarge due to the...
Pulmonary hydatid cyst during pregnancy is extremely rare and life-threatening for the mother and fetus. Throughout pregnancy, hydatid cysts may enlarge due to the suppression of cellular immunity and steroids secreted from the placenta. In late pregnancy, the cysts can reach a huge volume with an increased risk for subsequent rupture due to the compression of the enlarging uterus and anaphylactic shock. Intrabronchial rupture is a rare and life-threatening complication of pulmonary hydatid cysts. It is vital to diagnose it as early as possible and manage patients with surgical intervention with aggressive medical treatment. Plain radiograph, computed tomography (CT) scan, and magnetic resonance imaging (MRI) can be used to identify pulmonary hydatid cysts. However, the diagnosis of hydatid cyst is quite challenging in pregnant patients due to concerns of radiation. Herein, we present a 26-week pregnant patient with acute respiratory failure. Bedside lung ultrasound was notable for thickened and severely broken pleural line with a large subpleural consolidation, and a giant fluid-filled cyst covered almost the entire left thorax, causing a mediastinal shift. In the present case, we highlighted that the bedside lung ultrasound in emergency (BLUE) protocol is an easy, safe, and fast way to identify pulmonary hydatid cyst. It should be the initial technique of choice for the diagnosis of pulmonary hydatid cysts in pregnant patients.
PubMed: 35774713
DOI: 10.7759/cureus.25431