Metastatic osteosarcoma: A case report on bilateral standard thoracotomy in a child

Physiologic function of mediastinum space

The mediastinum forms the central part of the thoracic cavity that is surrounded by pleural space on the two sides, thoracic vertebrae at the posterior, thoracic inlet on the top, and diaphragm at the bottom. It encompasses cardiopulmonary organs and organ systems. Pathological dysfunction or deformity in any part of the mediastinum can have adverse cardiovascular and respqiratory effects. Pectus excavatum and pectus carinatum are the most common congenital chest deformities that are characterized by sternal depression and protuberance of the sternum, respectively. Together, these account for 90% of chest wall deformities. Patients are known to be represented with respiratory distress and cardiovascular dysfunction. The aim of the review article is to present the anatomical and physiological role of the mediastinum in association with important parts of the thoracic cavity and pathological dysfunction of the mediastinum (cardiopulmonary system) due to pectus excavatum and pectus carinatum.

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Mediastinum forms the central part of thoracic cavity that is surrounded by pleural space.

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PC and PE are structural chest deformities.

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Chest deformation by pressing on the chin causes coughing, stridor, dyspnea and exacerbation.

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Clinical symptoms along with inflammation that requires urgent medical treatment.

Radical extrapleural pneumonectomy with bronchial fistula by pulmonary function test evaluation technique

INTRODUCTION

and importance: Pulmonary Function Tests (PFTS) is an important tool in the assessment of pulmonary pathologies and preoperative evaluation. Case presentation: A 54-year-old man with history of massive pleurisy in the left thorax, treated by placing chest tube and drainage of bloody effusion, was readmitted for epithelioid mesothelioma. He was then presented with pneumothorax due by a refractory bronchial fistula while having a plural catheter. Based on the consultation, the whole-body bone scan was conducted, and findings demonstrated epithelioid mesothelioma (stage 1) with the refractory fistula for which the patient was candidate for thoracic surgery. Decreased lung capacity was seen by Pulmonary Function Testing - PFTS.

CLINICAL DISCUSSION

The novel PFTS Evaluation Technique was designed to measure the true pulmonary capacities in order to evaluate the pulmonary post-operative tolerance. In this technique the chest tube was placed for 4 weeks until the patient reaches mediastinal fixation then the measurements by PFTS were carried out in two steps. First, using an open chest tube and second, using a clamped chest tube. In both steps, the pulmonary capacities were measured and provided to the pulmonologist for consultation.

CONCLUSION

In this case, after acquiring the approval of the specialist depended on PFTS after PFTS Evaluation Technique, the radical extra pleural pneumonectomy surgery was conducted, and the patient was discharged with a good general appearance and treated fistula.

Cardiopulmonary bypass for resection of pancoast tumor with mediastinal extension and involvement of right bronchial branch: A case report

Introduction

and importance: Pneumonectomy is commonly associated with cardiopulmonary complications. Pneumonectomy in Pancoast tumor with mediastinal extension and no metastasis could be successful and efficient.

Case presentation

Herein, we report a successful pneumonectomy of a 54-year-old man with pancoast tumor along with the involvement of mediastinal space including right hilum of the lung, right bronchial, inferior vena cava vein and pericardium.

Clinical discussion

Based on the bronchoscopy and biopsy, the complete involvement of right bronchial tree was reported and non-small cell carcinoma was diagnosed in pathology.

Conclusion

To reduce the complications of the surgery, the cardiopulmonary pump machine was used during the operation.

Unilateral repair of tracheoesophageal fistula with dilatation of incomplete subglottic stenosis

A case of TEF along with subglottic stenosis in a patient as a result of prolong intubation. We performed left unilateral tracheal repair to avoid injury to left recurrent laryngeal nerve followed by endoscopic balloon repair of stenosis. Due to critical condition of the patient and COVID-19 infection, she expired.