Pulmonary inflammatory pseudotumor observed by bronchoscopy and resected using video-assisted thoracic surgery

A case of inflammatory pseudotumor of the lung presenting as polymyalgia rheumatica

A common inflammatory condition, the investigation and diagnosis of polymyalgia rheumatica should be within the scope of a general physician's repertoire. While there is limited evidence to confirm the existence of polymyalgia rheumatica as a distinct paraneoplastic syndrome (Reumatismo. 2018;70(1):23), a broadened differential should be utilized prior to diagnosis of this disease.

How to deal with complicate hilar or interlobar lymphadenopathy during video-assisted thoracoscopic surgery lobectomy

BACKGROUND

Lobectomy via video-assisted thoracoscopic surgery (VATS) is steadily becoming more commonplace. Concerns regarding oncologic effectiveness are focused on the ability to achieve complete lymphadenectomy using VATS technique. Effective VATS lymphadenectomy depends on a comprehensive understanding of the anatomy.

METHODS

In this report, we would provide comprehensive surgical techniques on the management of complicate hilar or interlobar lymphadenectomy via VATS.

RESULTS

Two cases of VATS lymphadenectomy were shown in this study. Various techniques have been adapted for lymphadenectomy with VATS. VATS lymphadenectomy is equivalent to dissection via thoracotomy when performed by experienced surgeons. Thoracic surgeons should keep in mind that to handle the sophisticated lymph node (LN) situation could be a tedious and rough job.

CONCLUSIONS

Lymphadenectomy is a crucial element of staging for early stage non-small cell lung cancer patients. During VATS lobectomy, lymphadenectomy must be performed safely and effectively, with oncologic results comparable with those of open procedures.

The management of doornail lymph node in lobectomy

BACKGROUND

The management of heavily adhesion caused by enlarged or calcified lymph nodes is long been one of the most common difficulties in lobectomy. Some of the lymph nodes, known as "the doornail lymph node", develop such massive adhesions that it significantly elevated the risk of uncontrollable bleeding and consequent conversion.

METHODS

We performed a triple portal video-assisted thoracic surgery procedure. Lymph nodes were managed with coagulator, aspirator, scissors and suture. Arteries, veins and bronchus were ligated with stapler.

RESULTS

One case of a 74-year-old female patient with multiple doornail lymph nodes was presented. An optimal technique to manage these lymph nodes was utilized: first, dissect the sheath of the blood vessel to find a bypass, second, remove the calcified core of the lymph node, and last, suture through the lymph node to ligate the adjacent artery. The surgery was successfully performed without complication.

CONCLUSIONS

The sequential technique of sheath dissection, core removal and suture ligation might be an optimal procedure in the management of doornail lymph node.

Analysis of lymph node impact on conversion of complete thoracoscopic lobectomy to open thoracotomy

Background

The aim of the study was to analyze the influence of lymph nodes in conversion thoracotomy and its measurements.

Method

Between September 2006 to April 2013, 1006 patients (545 men, 461 women, median age 60 years, range: 13 to 86 years) received a complete thoracoscopic lobectomy. The main procedure was complete video-assisted anatomical lobectomy with mediastinal lymphadenectomy.

Results

All procedures were carried out smoothly without serious complication. Eighty-three cases were converted to thoracotomy (8.2%), including 70 cases of initiative conversion and 13 of passive conversion, in which 59 cases had interference by doornail lymph nodes. The average operative time was significantly longer (272.7 ± 67.2 vs. 186.9 ± 58.1 minutes, P = 0.001); the average blood loss was significantly increased (564.2 ± 507.7 ml vs. 158.0 ± 121.0 ml, P = 0.001); and the drainage time and postoperative hospital stay were significantly longer (8.9 ± 5.0 vs. 6.6 ± 3.5 days, P = 0.001; 12.5 ± 7.7 vs. 9.2 ± 5.8 days, P = 0.001, respectively) in the conversion thoracotomy compared with the complete endoscopic surgery group.

Conclusion

Interference of the lymph nodes was the main reason for conversion to thoracotomy on video-assisted thoracoscopic lobectomy, which prolonged operative time, increased the blood loss during surgery, and delayed postoperative recovery. Selecting the proper indication of conversion thoracotomy may reduce the negative effects.