Life-saving emergency clamshell thoracotomy with damage-control laparotomy

Resection of a large anterior mediastinum myxoid liposarcoma via clamshell thoracotomy in a resource-limited setting: A rare case report and literature review

BACKGROUND

Mediastinal liposarcoma is an extremely rare malignant tumor of adipocytic differentiation, comprising less than 1 % of all liposarcomas. The majority occur in the lower extremities, with approximately 75 % of cases. Myxoid liposarcoma of the anterior mediastinum can present similarly to other thoracic pathologies.

CASE PRESENTATION

We present the case of a 36-year-old female who presented with a 14-day history of worsening dyspnea at rest, along with swelling of the upper extremities and face. On examination, distended neck and anterior chest veins were observed. Imaging studies revealed a large anterior mediastinal mass causing extrinsic compression of adjacent structures and a mediastinal shift to the right. Following stabilization, the patient underwent successful surgical resection of the mass.

DISCUSSION

Myxomatous liposarcoma is a very rare tumor located in the mediastinum that presents with symptoms resembling other lung diseases. Common complaints include chest pain, shortness of breath, and difficulty swallowing. Diagnosis is largely based on radiological imaging or histological examination after surgery. The primary treatment involves surgery and occasionally chemotherapy. Prompt diagnosis and timely treatment enhance the likelihood of positive outcomes for those affected.

CONCLUSION

This case underscores the importance of considering mediastinal liposarcoma in the differential diagnosis of patients presenting with chronic cough and unquantified weight loss, especially when symptoms escalate into conditions such as superior vena cava syndrome. Early detection and timely treatment are crucial for improving outcomes. This case contributes valuable insight, particularly relevant to managing complex tumors in resource-limited settings.

Performance and outcome of ressucitative thoracotomies in a southern Brazil trauma center: a 7-year retrospective analysis

OBJECTIVE

the study aims to analyze the performance and outcome of resuscitation thoracotomy (TR) performed in patients victims of penetrating and blunt trauma in a trauma center in southern Brazil during a 7 years period.

METHODS

retrospective study based on the analysis of medical records of patients undergoing TR, from 2014 to 2020, in the emergency service of the Hospital do Trabalhador, Curitiba - Paraná, Brazil.

RESULTS

a total of 46 TR were performed during the study period, of which 89.1% were male. The mean age of patients undergoing TR was 34.1±12.94 years (range 16 and 69 years). Penetrating trauma corresponded to the majority of indications with 80.4%, of these 86.5% victims of gunshot wounds and 13.5% victims of knife wounds. On the other hand, only 19.6% undergoing TR were victims of blunt trauma. Regarding the outcome variables, 84.78% of the patients had declared deaths during the procedure, considered non-responders. 15.22% of patients survived after the procedure. 4.35% of patients undergoing TR were discharged from the hospital, 50% of which were victims of blunt trauma.

CONCLUSION

the data obtained in our study are in accordance with the world literature, reinforcing the need for a continuous effort to perform TR, respecting its indications and limitations in patients victims of severe penetrating or blunt trauma.

Resuscitative Thoracotomy for Multiple Gunshot Wounds With Cardiac Tamponade Despite Pericardial Window

This report reviews the indications and complications of resuscitative thoracotomy in the trauma patient as seen with the clinical course of a 19-year-old male who experienced postoperative pericardial tamponade after a bilateral resuscitative thoracotomy with pericardiotomy. This patient presented to the hospital in critical condition with 31 gunshot wounds (GSWs) distributed over the chest, abdomen, and extremities. After undergoing an initially successful resuscitative thoracotomy, the patient continued to bleed into his chest at a greater rate than the chest tubes were able to adequately evacuate. Despite the presence of a large pericardial window, clotted blood led to cardiac tamponade. Subsequent bedside reopening of thoracotomy under conscious sedation (ketamine, fentanyl, and midazolam) was required to evacuate the clots and stabilize the patient. This case provides the opportunity to discuss several interesting points for managing the traumatized patient, including indications for resuscitative thoracotomy, use of conscious sedation for bedside major surgery, and complications of clamshell thoracotomy, and ethics of resource allocation.