Intrapericardial Development of a Bronchogenic Cyst - Case Report

INTRODUCTION

Bronchogenic cysts, commonly located in the mediastinum or lung parenchyma, arise from abnormal budding of the tracheobronchial tree. Since an unknown percentage of asymptomatic adult patients with bronchogenic cysts remain undiagnosed, the true natural history ofthese cysts in adults is uncertain and the available series reflect a significant selection bias in favor of the symptomatic individual.

CASE REPORT

We present the case of a 42-year-old female who presented with adull central chest pain, which gradually worsened overseveral weeks. After several tests performed (standard blood tests, standard X-Ray, ECG, angio-CT scan), we identified a mediastinal mass inferior to the carina and adjacent tothe left pleura, left atrium, pulmonary artery and esophagus. Considering the size of this mass and the possible complications, surgery was proposed and preformed. We were able to completely remove the cyst and the patient had no complications after surgery.

DISCUSSIONS

It may be difficult to differentiate a bronchogenic cyst from other lesions (acquired cystic lesions, mediastinal masses). Serious complications from bronchogenic cysts are rare, but can include SVC syndrome, tracheal compression, pneumothorax, pleurisy and pneumonia. Surgical excision is recommended even for asymptomatic cysts, to prevent complications and operative difficulties.

CONCLUSIONS

Bronchogenic cysts are rare and usually asymptomatic. Asymptomatic patients with bronchogenic cysts may become symptomatic cases, and in time may develop lifethreating complications. Definitive tissue diagnosis is usually available only after surgical excision. Based on our experience and after studying data from literature, we can conclude that bronchogenic cysts should be treated surgically and that a conservative approach is not recommended.

Cervico-mediastinal Esophageal Duplication Cyst - Case Presentation

INTRODUCTION

esophageal cysts can be divided into 2 categories: simple epithelial-lined cysts and esophageal duplication, which is an embryologic duplication of a portion of the muscle and submucosa of the esophagus without epithelial duplication.

CASE PRESENTATION

48 year-old male, with no relevant history, was transferred in our department with vomiting, dysphagia, anorexia, and weight loss. The CT scan highlights a tumor mass, well defined, with maximum size of 6.5 cm, developed in the left upper mediastinum and lower left cervical region. We decided to perform surgery in order to remove the mass completely. The approach was through a cervical incision, allowing access to the upper mediastinum, as well as for the anterior cervical region.

DISCUSSION

Complete surgical excision is recommended for all foregut cyst malformations. Considering the localization of the esophageal cyst in our patient, we decided cervico-sternotomy will be the best approach, giving a wide exposure of the mediastinum and of the lower cervical region if necessary. The lesion was carefully dissected from the surrounding structures and completely removed.

CONCLUSION

All esophageal cysts should be evaluated and, eventually, resected. Most patients with esophageal cysts eventually become symptomatic; therefore, cysts should be resected when they are diagnosed.

Multivisceral echinococcosis: concept, diagnosis, management

INTRODUCTION

Hydatid disease is in a come-back period. In Romania the incidence is cited at 5-6 cases per 100,000 inhabitants.

MATERIAL AND METHOD

In this study we define the concept of multivisceral echinococcosis, which is a more serious form of the hydatid disease with implications of diagnosis, treatment,morbidity and mortality. Multivisceral echinococcosis must be differentiated from multiple echinococcosis. The latter is defined as the localization of multiple hydatid cysts in the same organ. In case of multiple echinococcosis, we can describe double echinococcosis (two hydatid cysts located in the same organ), triple, etc. The etiology of multivisceral echinococcosis is similar to mono-visceral echinococcosis.Regarding the pathogenic mechanism, we appreciate that there are two distinct mechanisms: primary infection (most of them) and secondary infection.

DISCUSSION

We propose a classification of multivisceral echinococcosis based on the anatomical compartment involved.The diagnosis of this condition is easy to establish using classicor more recent investigations (CT, MRI). Compared to monovisceral echinococcosis, the symptomatology is louder because of the involvement of several organs and its association with different other conditions.

CONCLUSIONS

We wish this study to bring more information about hydatid disease, but especially about multivisceral echinococcosis.

Giant thoraco-abdominal tumor -- a surgical challenge. Case report

BACKGROUND

During the last three decades, several improvements in surgical and anesthetic techniques have allowed a better management of primary and secondary tumors of the chest wall.

OBJECTIVES

Chest wall tumors, regardless of their location,anterior, posterior or lateral, have always been a challenge for the thoracic surgeon through technical and tactical problems they entail. The most common techniques to reconstruct a full thickness defect are by the use of alloplastic material and filling the soft tissue defect with myocutaneous flap.

METHOD

We present the unusual case of a 45 years old patient with a giant right thoraco-abdominal tumor, developing for the last 22 years. The tumor occupied the lower half of the right hemithorax and the right hemi abdomen, down to the right iliac crest. The tumor also developed inside the thoracic cavity, with the invasion of the last 3 ribs, of the diaphragm(partial) and with intra-abdominal invasion of a liver section and the right kidney.

RESULTS

The surgery team had special problems related to:providing training and logistics, in-block tumor resection in oncological limits, followed by complex thoraco-abdominal reconstruction. The results were very good, with a favorable postoperative evolution, without any complications, the patient being discharged with the recommendation to come for follow-up on his condition.

CONCLUSIONS

A complex surgical intervention proved to be the only solution for saving the patient, for which the life due to the tumor's size became almost unbearable.

Minimally invasive repair for pectus excavatum -- aesthetic and/or functional?

INTRODUCTION

Pectus excavatum is the most frequent anterior thoracic wall congenital malformation. This malformation is increasing its effects with the aging process and has its peak during teenage, when the clinical symptoms become more acute and psychological effects are really important. Across the course of time many treatment techniques have been proposed, among which conservative or surgical correction techniques. The minimally invasive repair of pectus excavatum, "Nuss technique", developed after 1987, is the most frequently performed technique world wide.

MATERIAL AND METHOD

This article analyzes 52 patients, admitted to the University Emergency Military Hospital "Carol Davila" - Thoracic Surgery Department, diagnosed, investigated and surgically treated according to Nuss procedure. Therapeutic and diagnostic protocols will be presented and analyzed: clinical and paraclinical evaluation, indications and contraindications of Nuss procedure, as well as possible intraoperative and postoperative complications.

RESULTS AND CONCLUSIONS

Nuss procedure's benefits will be presented, as well as improvements of functional and aesthetic parameters. Nuss procedure has a series of advantages: minimally invasive surgical procedure reduced operative time, minimal blood loss and fast socio-professional reinstatement.

Anterior thoracic wall giant tumor--special surgical procedure

We describe the case of a 39 years old male known with an anterior thoracic traumatism in 1993 who observed ananterior thoracic wall tumor since 2000. After one and half year of empiric treatment the tumor starts growing very fast, reaching 30/40/35 cm by the date of his hospital admission (march 2003). Due to this accelerate growth and the size of the tumor the patient is proposed for a particular surgical procedure removing the tumor along with the anterior thoracic wall and the reconstruction using "spider web" technique, Thoratex reinforced mesh and muscle flaps. Thisprocedure had agood result, the patient returned to his anterior lifestyle few months after. The patient did not come for follow-up, although he was recommended to come every tree months. Four years after surgery (2007) the patient came back with local recurrence of the tumor. In 2007 the patient underwent another surgical intervention, removing the tumor recurrence. Chest wall tumors are complex surgical conditions requiring complex treatment. The empiric treatment and the fact that the patient did not come as planned for follow-up, prolonged his sufferance, leading to a second surgical intervention.