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Eldaabossi S, Al-Ghoneimy Y, Antar A, Lotfy E, Aljawad H, Abish YG, Helyl M, Oraby H, Soliman H, Abdullatif B, Nour SO, Lotfi A. Partial sternectomy with reconstruction of a giant cell tumor of the sternum, a case report, Saudi, Arabia. J Cardiothorac Surg 2023; 18:296. [PMID: 37848912 PMCID: PMC10580503 DOI: 10.1186/s13019-023-02404-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 09/30/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Giant cell tumor (GCT) is a relatively common and locally aggressive benign bone tumor that rarely affects the sternum. CASE PRESENTATION We report a case of giant cell tumor of the sternum in a 28-year-old Saudi with painful swelling at the lower part of the sternum. Subtotal sternectomy and reconstruction with a neosternum using two layers of proline mesh, a methyl methacrylate prosthesis, and bilateral pectoralis muscle advancement flaps were performed. CONCLUSIONS Giant cell tumor of the sternum is a rare diagnosis. Surgical resection with negative margins is the ideal management. To avoid defects or instability of the chest wall, reconstruction of the chest wall with neosternum should be considered.
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Affiliation(s)
- Safwat Eldaabossi
- Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia.
- Department of Chest Diseases, Al-Azhar Faculty of Medicine, Cairo, Egypt.
| | | | - Ahmad Antar
- Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia
| | - Elsaid Lotfy
- Radiology Department, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia
| | - Hameed Aljawad
- Pathology and Laboratory Medicine, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia
| | - Yasser G Abish
- Pathology and Laboratory Medicine, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia
- Al-Azhar Faculty of Medicine, Cairo, Egypt
| | | | | | - Hesham Soliman
- Anesthesia Department, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia
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Eldaabossi S, Al-Ghoneimy Y, Abish YG, Farouk A, Kanany H, Taha A, Kabil A, Nabawi U, Lofty A, Makled S, Mahdi W, Zagloul B. Late presentation of a congenital problem; complicated left-sided Bochdalek's hernia in an adult: A case report. Respir Med Case Rep 2023; 45:101903. [PMID: 37599895 PMCID: PMC10432773 DOI: 10.1016/j.rmcr.2023.101903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 03/10/2023] [Accepted: 07/27/2023] [Indexed: 08/22/2023] Open
Abstract
Background A diaphragmatic hernia is a defect or hole in the diaphragm through which abdominal contents can enter the chest cavity. Diaphragmatic hernias may be congenital (Morgagni hernia, Bochdalek hernia), a hiatal hernia, or acquired (iatrogenic and traumatic). Bochdalek's hernia typically occurs on the left side and rarely occurs in adults. Less than 100 cases of left Bochdalek's hernia in adults have been described in the literature. Most of them are asymptomatic. Case report We report a complicated left Bochdalek hernia in a 43-year-old adult male who is a smoker. He came to the pulmonary clinic with symptoms and signs of pneumonia of the left lower lobe with persistent dyspeptic symptoms. Chest radiography revealed evidence of a left diaphragmatic hernia, which was confirmed by computed tomography of the chest and abdomen, and subsequently treated by left diaphragmatic repair via limited left thoracotomy. Conclusion We report a rare case of a left Bochdalek hernia in an adult who underwent an appropriate left thoracotomy. Bochdalek hernias in adults are rare and usually asymptomatic, but when they become symptomatic, surgical intervention is required to avoid complications. BH should be considered in the differential diagnosis when radiographs suggest pneumothorax and should be treated early to avoid complications.
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Affiliation(s)
- Safwat Eldaabossi
- Pulmonology Consultant, Almoosa Specialist Hospital, Al Ahsa. Saudi Arabia
- Department of Chest Diseases, Al Azhar Faculty of Medicine, Egypt
| | - Yasser Al-Ghoneimy
- Cardiothoracic Surgery Consultant, Almoosa Specialist Hospital, Al Ahsa. Saudi Arabia
| | - Yasser G. Abish
- Radiology Consultant, Almoosa Specialist Hospital, Al Ahsa. Saudi Arabia
- Department of Radiology, Al Azhar Faculty of Medicine, Egypt
| | - Abdallah Farouk
- Critical Care Consultant, Almoosa Specialist Hospital, Al Ahsa. Saudi Arabia
- Department of Critical Care, Alexandria Faculty of Medicine, Egypt
| | - Hatem Kanany
- Consultant Critical Care and Anesthesia, Al Azhar Faculty of Medicine, Egypt
| | - Ahmed Taha
- Department of Chest Diseases, Al Azhar Faculty of Medicine, Egypt
| | - Ahmed Kabil
- Department of Chest Diseases, Al Azhar Faculty of Medicine, Egypt
| | - Usama Nabawi
- Department of Chest Diseases, Al Azhar Faculty of Medicine, Egypt
| | - Ahmed Lofty
- Department of Chest Diseases, Al Azhar Faculty of Medicine, Egypt
| | - Sameh Makled
- Department of Chest Diseases, Al Azhar Faculty of Medicine, Egypt
| | - Waheed Mahdi
- Pulmonology Consultant, Almoosa Specialist Hospital, Al Ahsa. Saudi Arabia
- Department of Chest Diseases, Banha Faculty of Medicine, Egypt
| | - Boshra Zagloul
- Department of Radiology, Al Azhar Faculty of Medicine for Girls, Egypt
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Eldaabossi S, Alrashdan M, Aljanobi G, Warsha N, Abo Elhassan S, Mahdi W, Farouk A, Taha A, Qabil A, Maklad S, Nabway U, Kenany H, Jaber Y, Zaghloul B. A rare association: Obesity hypoventilation syndrome with myasthenia gravis and systemic lupus erythematosus, case report. Respir Med Case Rep 2023; 44:101848. [PMID: 37251356 PMCID: PMC10209446 DOI: 10.1016/j.rmcr.2023.101848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 03/16/2023] [Accepted: 04/06/2023] [Indexed: 05/31/2023] Open
Abstract
Background Shrinking lung syndrome (SLS) is an uncommon complication of systemic lupus erythematosus (SLE) that has also been seen in other autoimmune diseases and is linked with a high risk of acute or chronic respiratory failure. Alveolar hypoventilation in the presence of obesity-hypoventilation syndrome, systemic lupus erythematosus (SLE), and myasthenia gravis (MG) is uncommon and poses a diagnostic and therapeutic challenge. Case report We reported a 33-year-old female patient from Saudi Arabia who suffered from obesity, bronchial asthma, newly diagnosed essential hypertension, type 2 diabetes mellitus, with recurrent acute alveolar hypoventilation, secondary to obesity hypoventilation syndrome and mixed autoimmune disease (systemic lupus erythematosus and myasthenia gravis), based on the correct constellation of clinical findings and laboratory evidence. Conclusion The interesting aspect of this case report: is the presentation of the overlap of obesity hypoventilation syndrome and shrinking lung syndrome due to systemic lupus erythematosus with generalized and respiratory muscle dysfunction due to myasthenia gravis with good outcomes after therapy.
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Affiliation(s)
- Safwat Eldaabossi
- Pulmonology Consultant, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia
- Department of Chest Diseases, Al Azhar Faculty of Medicine, Egypt
| | - Man Alrashdan
- Department of Chest Diseases, Al Azhar Faculty of Medicine, Egypt
| | - Ghada Aljanobi
- Rheumatology Consultant, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia
| | - Noha Warsha
- Rheumatology Consultant, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia
| | - Saber Abo Elhassan
- Neurology Consultant, Almoosa Specialist Hospital, Al Ahsa. Saudi Arabia. Department of Neurology, Assuit Faculty of Medicine, Egypt
| | - Waheed Mahdi
- Critical Care and Pulmonary Consultant, Almoosa Specialist Hospital, Al Ahsa. Saudi Arabia. Department of Chest Diseases, Banha Faculty of Medicine, Egypt
| | - Abdullah Farouk
- Critical Care Consultant, Almoosa Specialist Hospital, Al Ahsa. Saudi Arabia. Department of Critical Care, Alexandria Faculty of Medicine, Egypt
| | - Ahmad Taha
- Pulmonology Consultant, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia
| | - Ahmad Qabil
- Pulmonology Consultant, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia
| | - Sameh Maklad
- Pulmonology Consultant, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia
| | - Usama Nabway
- Pulmonology Consultant, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia
| | - Hatem Kenany
- Consultant Critical Care and Anesthesia, Al Azhar Faculty of Medicine, Egypt
| | - Yasser Jaber
- Radiology Consultant, Almoosa Specialist Hospital, Al Ahsa. Saudi Arabia. Department of Radiology, Al Azhar Faculty of Medicine, Egypt
| | - Boshra Zaghloul
- Department of Radiology, Al Azhar Faculty of Medicine for Girls, Egypt
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Eldaabossi S, Al-Ghoneimy Y, Ghoneim A, Awad A, Mahdi W, Farouk A, Soliman H, Kanany H, Antar A, Gaber Y, Shaarawy A, Nabawy O, Atef M, Nour SO, Kabil A. The ARISCAT Risk Index as a Predictor of Pulmonary Complications After Thoracic Surgeries, Almoosa Specialist Hospital, Saudi Arabia. J Multidiscip Healthc 2023; 16:625-634. [PMID: 36910018 PMCID: PMC9999721 DOI: 10.2147/jmdh.s404124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 02/28/2023] [Indexed: 03/08/2023] Open
Abstract
Background Pulmonary complications after thoracic surgery are common and are associated with prolonged hospital stay, higher costs, and increased mortality. This study aimed to evaluate the value of The Assess Respiratory risk in Surgical Patients in Catalonia (ARISCAT) risk index in predicting pulmonary complications after thoracic surgery. Methods This retrospective study was conducted at Almoosa Specialist Hospital, Saudi Arabia, from August 2016 to August 2019 and included 108 patients who underwent thoracic surgery during the study period. Demographic data, ARISCAT risk index score, length of hospital stay, time of chest tube removal, postoperative complications, and time of discharge were recorded. Results The study involved 108 patients who met the inclusion criteria. Their mean age was 42.5 ± 18.9 years, and most of them were men (67.6%). Comorbid diseases were present in 53.7%, including mainly type 2 diabetes mellitus and hypertension. FEV1% was measured in 58 patients, with a mean of 71.1 ± 7.3%. The mean ARISCAT score was 39.3 ± 12.4 and ranged from 24 to 76, with more than one-third (35.2%) having a high score grade. The most common surgical procedures were thoracotomy in 47.2%, video-assisted thoracoscopic surgery (VATS) in 28.7%, and mediastinoscopy in 17.6%. Postoperative pulmonary complications (PPCs) occurred in 22 patients (20.4%), mainly pneumonia and atelectasis (9.2%). PPCs occurred most frequently during thoracotomy (68.2%), followed by VATS (13.6%), and mediastinoscopy (9.1%). Multinomial logistic regression of significant risk factors showed that lower FEV1% (OR = 0.88 [0.79-0.98]; p=0.017), longer ICU length of stay (OR = 1.53 [1.04-2.25]; p=0.033), a higher ARISCAT score (OR = 1.22 [1.02-1.47]; p=0.040), and a high ARISCAT grade (OR = 2.77 [1.06-7.21]; p=0.037) were significant predictors of the occurrence of postoperative complications. Conclusion ARISCAT scoring system, lower FEV1% score, and longer ICU stay were significant predictors of postoperative complications. In addition, thoracotomy was also found to be associated with PPCs.
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Affiliation(s)
- Safwat Eldaabossi
- Department of Chest Diseases, Al-Azhar University, Cairo, Egypt.,Pulmonology Department, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia
| | - Yasser Al-Ghoneimy
- Cardiothoracic Surgery Department, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia
| | - Ayman Ghoneim
- Cardiothoracic Surgery Department, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia.,Department of Cardiothoracic Surgery, Al-Azhar University, Cairo, Egypt
| | - Amgad Awad
- Nephrology Department, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia.,Department of Internal Medicine, Al-Azhar University, Cairo, Egypt
| | - Waheed Mahdi
- Pulmonology Department, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia.,Cardiothoracic Surgery Department, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia.,Department of Cardiothoracic Surgery, Al-Azhar University, Cairo, Egypt.,Nephrology Department, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia.,Department of Internal Medicine, Al-Azhar University, Cairo, Egypt.,Department of Chest Diseases, Banha Faculty of Medicine, Banha, Egypt
| | - Abdallah Farouk
- Critical Care Consultant, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia.,Department of Critical Care, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Hesham Soliman
- Consultant and Chief of Anesthesia, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia
| | - Hatem Kanany
- Department of Critical Care and Anesthesia, Al-Azhar University, Cairo, Egypt
| | - Ahmad Antar
- Department of Internal Medicine, Hematology-Oncology Section, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia
| | - Yasser Gaber
- Radiology Department, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia.,Department of Radiology, Al-Azhar University, Cairo, Egypt
| | - Ahmed Shaarawy
- Department of Chest Diseases, Al-Azhar University, Cairo, Egypt
| | - Osama Nabawy
- Department of Chest Diseases, Al-Azhar University, Cairo, Egypt
| | - Moaz Atef
- Department of Chest Diseases, Al-Azhar University, Cairo, Egypt
| | - Sameh O Nour
- Department of Chest Diseases, Al-Azhar University, Cairo, Egypt
| | - Ahmed Kabil
- Department of Chest Diseases, Al-Azhar University, Cairo, Egypt
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Eldaabossi S, Saad M, Aljawad H, Almuhainy B. A rare presentation of blastomycosis as a multi-focal infection involving the spine, pleura, lungs, and psoas muscles in a Saudi male patient: a case report. BMC Infect Dis 2022; 22:228. [PMID: 35255854 PMCID: PMC8900297 DOI: 10.1186/s12879-022-07203-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 02/23/2022] [Indexed: 11/14/2022] Open
Abstract
Background Blastomycosis is a disease caused by the fungus Blastomyces—a thermally dimorphic fungus that can cause granulomatous and/or purulent infection. Case presentation We report here a case of chronic blastomycosis infection in a 24-year-old male patient from Saudi Arabia who presented with recurrent skin abscesses associated with deep-seated and multilevel paraspinal (dorsal and lumbar) collections and bilateral empyema with pulmonary involvement and bilateral psoas abscesses. The diagnosis was made after a CT-guided pleural biopsy revealed the characteristic histopathological findings of blastomycosis. The patient underwent several drainage procedures and was successfully treated with a long-term course of oral itraconazole. Conclusions Chronic blastomycosis may have clinical and radiologic features similar to thoracic tuberculosis or malignant disease. There is no definite clinical symptom of blastomycosis, and thus a high degree of suspicion is required for early diagnosis. This case is a rare form of blastomycosis with chronic multifocal purulent infection and is the second case of blastomycosis reported in Saudi Arabia.
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Affiliation(s)
- Safwat Eldaabossi
- Division of Pulmonary, Almoosa Specialist Hospital, Al Ahsa, Kingdom of Saudi Arabia. .,Department of Chest Diseases, Alazhar University, Cairo, Egypt.
| | - Mustafa Saad
- Division of Infectious Diseases, Department of Internal Medicine, Almoosa Specialist Hospital, Al Ahsa, Kingdom of Saudi Arabia
| | - Hameed Aljawad
- Division of Pathology, Department of Laboratory Medicine, Almoosa Specialist Hospital, Al Ahsa, Kingdom of Saudi Arabia
| | - Badr Almuhainy
- Division of Infectious Diseases, Department of Internal Medicine, King Fahad Hospital, Al Ahsa, Kingdom of Saudi Arabia
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Eldaabossi S, Saad M, Alabdullah M, Awad A, Alquraini H, Moumneh G, Mansour A. Chronic Pulmonary Aspergillosis and Type 2 Diabetes Mellitus Complicating Granulomatosis with Polyangiitis in an Adult Saudi Male: A Case Report. Int Med Case Rep J 2022; 14:829-837. [PMID: 34984031 PMCID: PMC8709545 DOI: 10.2147/imcrj.s340231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 11/25/2021] [Indexed: 12/13/2022] Open
Abstract
Background Granulomatosis with polyangiitis (GPA) is an extremely rare autoimmune, necrotizing granulomatous disease of unknown etiology affecting small and medium-sized blood vessels. Chronic pulmonary aspergillosis (CPA) is a rare fungal infection with high morbidity and mortality that usually affects immunocompetent or mildly immunosuppressed patients with underlying respiratory disease. Antifungal agents (voriconazole, itraconazole) are the mainstay of therapy. Intravenous drug therapy (amphotericin B or an echinocandin), alone or in combination with azoles, is the last resort in special situations such as azole failure, resistance, or severe disease. Sometimes CPA and GPA coexist and are difficult to distinguish due to the nonspecific symptoms and similarity of clinical and radiological features, so a high degree of suspicion is required to make the correct diagnosis. Case Presentation We reported that a 28-year-old man from Saudi Arabia was diagnosed with GPA. The patient had been complaining of cough, fatigue, polyarthralgia and red eyes for 40 days before he was admitted to our hospital. The diagnosis of GPA was confirmed by clinical and radiological examinations and a pathological report of a lung biopsy, and he was treated with immunosuppressive drugs. The patient’s condition was complicated by chronic pulmonary aspergillosis and type 2 diabetes mellitus. Initial treatments included systemic glucocorticoids, methotrexate, followed by rituximab and voriconazole, finally intravenous cyclophosphamide and amphotericin B, with no complete remission. The thoracic surgical team postponed surgical debridement of the significant cavitary lung lesions until the active fungal infection could be brought under control. Conclusion The clinical and radiological features of GPA are similar to those of pulmonary tuberculosis, chronic pulmonary aspergillosis, and lung cancer. The lack of clear clinical symptoms of GPA requires a high degree of suspicion for early diagnosis. This case illustrates the dilemma of diagnosis and treatment of GPA and superimposed fungal infection. Secondary infection, particularly fungal infection, must be considered when GPA cannot be controlled with an immunosuppressant.
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Affiliation(s)
- Safwat Eldaabossi
- Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia.,Al Azhar Faculty of Medicine, Al Azhar University, Cairo, Egypt
| | - Mustafa Saad
- Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia
| | | | - Amgad Awad
- Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia.,Al Azhar Faculty of Medicine, Al Azhar University, Cairo, Egypt
| | | | | | - Ali Mansour
- Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia
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