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Laamiri R, Sellami S, Kechiche N, Abdelaali M, Mekki M, Belghith M. Intrathoracic rupture of hydatid cyst of the liver in children: a report of two cases. EGYPTIAN LIVER JOURNAL 2021. [DOI: 10.1186/s43066-021-00116-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Intrathoracic rupture of hepatic hydatid cyst is a rare but dangerous complication. Its occurrence in children is exceptional as diagnosis and management constitute real challenges. We report two cases of intrathoracic rupture of hepatic hydatid cyst in children.
Case presentation
Our patients were respectively 12-year-old boy and 9-year-old girl, known cases of respiratory symptoms, diagnosed initially for pleuropneumonia. The CT scan established the diagnosis of intrathoracic rupture of hepatic hydatid cyst in the pleural cavity for the first patient and in the bronchial tree for the second. An emergency surgery was performed for both. The second patient developed broncho-biliary fistulas during the post-operative course which necessitated a re-intervention. A recurrence was noted at follow-up for the second patient.
Conclusion
Intrathoracic rupture of hepatic hydatid cyst is a serious complication which can occur even in children. Its diagnosis needs a high index of suspicion. The surgical approach remains controversial and there is a lack of consensus about the best way of management. Recurrence may occur despite appropriate treatment.
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Single-stage versus two-stage surgery of pulmonary and hepatic hydatid cysts. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2021; 18:139-144. [PMID: 34703470 PMCID: PMC8525277 DOI: 10.5114/kitp.2021.109374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 08/01/2021] [Indexed: 11/26/2022]
Abstract
Introduction Concomitant lung and liver hydatid cyst is a rare condition. Most surgeons agree that both sites should be resected in one-time surgery. Aim We present a case series of hepatic and pulmonary hydatid cyst treated in one-stage surgery (OSS) compared with patients who underwent two-stage surgery (TSS). Material and methods This retrospective study included 47 patients separated into two groups (33 TSS and 14 OSS) between 2008 and 2019. Data on clinical symptoms, sites, radiological features, techniques, postoperative complications, mean hospital stay and outcome were analyzed separately for TSS and OSS procedures. Results A total of 33 patients who underwent TSS (70.2%) were compared to 14 patients operated on by OSS (29.8%). No significant differences were found between groups for age (45.3 vs. 42.7, p = 0.45), sex (male: 57.6% vs. 64.2%) and socio-geographic status (urban: 72.7% vs. 78.6%). But there were more postoperative complications (24.3% vs. 14.3%, p = 0.036) in the TSS group, and operative duration (154 minutes vs. 122 minutes, p = 0.047), postoperative hospital stay (13.8 days vs. 8.7 days, p = 0.022), and interruption of activities and work (56 days vs. 31 days, p = 0.045) were longer in the TSS group. There was no difference in postoperative mortality between the 2 groups. Conclusions Single-stage surgical management by trans-thoraco-phrenotomy can be recommended to treat dual-seat hepatic and pulmonary hydatid disease with fewer complications and a rapid return to work. This technique is easier and safer for right lung and liver dome hydatid cysts.
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Repair of diaphragmatic biliary pleural fistula in a hydatid cyst with pericardial patch: A case report. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.660987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Banerjee N, Rattan A, Priyadarshini P, Kumar S. Post-traumatic bronchobiliary fistula. BMJ Case Rep 2019; 12:12/4/e228294. [PMID: 30954961 DOI: 10.1136/bcr-2018-228294] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Post-traumatic bronchobiliary fistula (BBF) is a rare entity, with only a few cases reported worldwide. Bilioptysis is pathognomonic of the condition, however, bronchoscopy and bronchoalveolar lavage along with CT are used for confirmation. We describe this condition in a young woman who presented to us with bilioptysis following a laparotomy for blunt torso trauma. Diagnosis was made of BBF, followed by surgical management and complete recovery. We emphasise the signs of early diagnosis, confirmatory tests, individualised treatment and advocate surgical management as the gold standard of treatment.
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Affiliation(s)
- Niladri Banerjee
- Division of Trauma Surgery and Critical Care, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Amulya Rattan
- Division of Trauma Surgery and Critical Care, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Pratyusha Priyadarshini
- Division of Trauma Surgery and Critical Care, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Subodh Kumar
- Division of Trauma Surgery and Critical Care, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
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Rabiou S, Lakranbi M, Ouadnouni Y, Benajah D, Smahi M. [Left localization of biliobronchial fistula: Exceptional complication of hepatic hydatidosis]. REVUE DE PNEUMOLOGIE CLINIQUE 2018; 74:502-507. [PMID: 30309703 DOI: 10.1016/j.pneumo.2018.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 05/24/2018] [Accepted: 08/10/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION The biliobronchial fistula of hydatic origin is a rare complication and the left localization is exceptional. OBSERVATION We report the case of a 26-year-old patient from the rural area who was referred to us for treatment of biliptysis. The thoracic and abdominal computed tomography diagnosed a left biliobronchial fistula was. Management consisted of primary endoscopic sphincterotomy, followed by left exclusive thoracotomy surgery to treat pulmonary, hepatic and diaphragmatic repair. The evolution was favorable with disappearance of the biliptysie. CONCLUSION The diagnosis of left biliobronchial fistula requires a precise assessment not only by the imagery but also the bronchial fibroscopy allowing the acurate localisation of the lesion before any surgical enterprise.
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Affiliation(s)
- S Rabiou
- Service de chirurgie thoracique, CHU Hassan II, Fès, Maroc.
| | - M Lakranbi
- Service de chirurgie thoracique, CHU Hassan II, Fès, Maroc
| | - Y Ouadnouni
- Service de chirurgie thoracique, CHU Hassan II, Fès, Maroc; Faculté de médecine et de pharmacie, université Sidi-Mohamed-Ben-Abdellah, Fès, Maroc
| | - D Benajah
- Service d'hépato-gastro-entérologie, CHU Hassan II, Fès, Maroc; Faculté de médecine et de pharmacie, université Sidi-Mohamed-Ben-Abdellah, Fès, Maroc
| | - M Smahi
- Service de chirurgie thoracique, CHU Hassan II, Fès, Maroc; Faculté de médecine et de pharmacie, université Sidi-Mohamed-Ben-Abdellah, Fès, Maroc
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Manterola C, Otzen T. Hepatic Echinococcosis with Thoracic Involvement. Clinical Characteristics of a Prospective Series of Cases. Ann Hepatol 2018; 16:599-606. [PMID: 28611263 DOI: 10.5604/01.3001.0010.0305] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Thoracic involvement (TIHE) is one of the evolutionary complications of hepatic echinococcosis (HE). AIM The aim of this study was to describe the clinical characteristics and postoperative morbidity (POM) of a series of patients with TIHE treated surgically. MATERIAL AND METHODS Series of cases of patients treated for TIHE between 2000 and 2014 in the Hospital Regional and Clínica Mayor in Temuco, Chile, with a minimum 12-month follow-up. The outcome variable was "development of POM". Descriptive statistics were used. RESULTS The series was composed of 37 patients with a mean age of 53.2 ± 47.4 years (51.4% female). Mean cyst diameter was 19.4 ± 15.5 cm, and 75.7% of the lesions were located in the right hepatic lobe. The most frequent surgical technique used for the cyst was subtotal pericystectomy (56.8%); the residual cavity was treated by capitonnage (27.0%) or omentoplasty (21.6%), and a phrenoplasty with or without prosthetic material was performed for the TIHE. Mean hospital stay was 6.0 ± 5.7 days and follow-up was 61.4 ± 79.9 months; a mortality rate of 2.7% (one patient) and a POM of 24.3% (9 patients) were verified. CONCLUSION TIHE is an uncommon evolutionary complication of HE associated with significant POM rate.
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Affiliation(s)
- Carlos Manterola
- Department of Surgery and CEMyQ, Universidad de La Frontera, Chile
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Hepatic hydatid disease complications: review of imaging findings and clinical implications. Abdom Radiol (NY) 2017; 42:199-210. [PMID: 27487777 DOI: 10.1007/s00261-016-0860-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Hydatid disease is a zoonotic parasitic disease. The liver is the most commonly affected organ, and hepatic hydatid disease complications are not uncommon. Hydatid cyst superinfection, intrabiliary rupture, and direct rupture into the thoracic or abdominal cavities are the frequently encountered complications. Other exceedingly rare complications include rupture of the cyst into hollow viscera, abdominal wall invasion, and hepatic vasculature-related complications such as portal vein thrombosis and Budd-Chiari syndrome. These complications have variable clinical presentations and imaging findings and require different medical and surgical managements. We aim to provide a spectrum of imaging findings of different common and uncommon complications of hepatic hydatid disease with emphasis on their clinical implications.
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Aydogdu B, Sander S, Demirali O, Guvenc U, Besik C, Kuzdan C, Goya C, Tireli G. Treatment of spontaneous rupture of lung hydatid cysts into a bronchus in children. J Pediatr Surg 2015; 50:1481-3. [PMID: 25783398 DOI: 10.1016/j.jpedsurg.2015.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 12/18/2014] [Accepted: 01/15/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE While several publications have reported the treatment of ruptured lung hydatid cysts (HC) in adults, there is limited information on the treatment of children. This study summarizes the treatment approach and outcomes of 11 children with spontaneous rupture of lung HCs into a bronchus. METHODS The complete medical records of 11 patients with spontaneous lung HC bronchus rupture between March 1993 and April 2012 were examined retrospectively. Gender, age at the time of diagnosis, patient symptoms, lung localization, dimensions of the cyst, medical treatment duration, and associated morbidities were evaluated. Routine chest x-rays, ultrasonography, computed tomography and serological tests were used. RESULT The study included 11 patients [4 males, 7 females; average age 7.45 (range 5-11) years] presenting to the Emergency Department. The symptoms at the time of presentation were coughing in 81.8% (n=9), hemoptysis in 54.5% (n=6), and chest pain in 54.5% (n=6). The average cyst diameter was 8.71(35-15) cm. The rupture involved the left lung in 7 (63.6%) patients and the right in 4 (36.4%). Serological tests were positive in seven patients and all patients had eosinophilia. The treatment of one patient was discontinued, while all of the other patients were treated medically. Pneumonia developed in four patients and lung abscesses in two. Both patients who developed lung abscesses had cysts with diameters greater than 10 cm. The average follow-up period was 48.4 (range 15-85) months; no mortality occurred. CONCLUSION In our experience, medical treatment is adequate for patients with lung HCs progressing to spontaneous bronchus rupture. There was a high rate of abscess development within the thoracic cavity in patients with cysts over 10 cm in diameter; these patients can be treated effectively with a medical approach.
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Affiliation(s)
- Bahattin Aydogdu
- Department of Pediatric Surgery and Pediatric Urology, Medical Faculty of Dicle University, 21280 Diyarbakir, Turkey.
| | - Serdar Sander
- Department of Pediatric Surgery, İstanbul Kanuni Sultan Suleyman Education And Research Hospital, 34303, İstanbul, Turkey
| | - Oyhan Demirali
- Department of Pediatric Surgery, İstanbul Kanuni Sultan Suleyman Education And Research Hospital, 34303, İstanbul, Turkey
| | - Unal Guvenc
- Department of Pediatric Surgery, İstanbul Kanuni Sultan Suleyman Education And Research Hospital, 34303, İstanbul, Turkey
| | - Cemile Besik
- Department of Pediatric Surgery, İstanbul Kanuni Sultan Suleyman Education And Research Hospital, 34303, İstanbul, Turkey
| | - Canan Kuzdan
- Department of Pediatric Infectious Diseases, İstanbul Kanuni Sultan Suleyman Education and Research Hospital, 34303 İstanbul, Turkey
| | - Cemil Goya
- Department of radiology, Medical Faculty of Dicle University, 21280 Diyarbakir, Turkey
| | - Gulay Tireli
- Department of Pediatric Surgery, İstanbul Kanuni Sultan Suleyman Education And Research Hospital, 34303, İstanbul, Turkey
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Gastaca M, Kataryniuk Y, Uribe-Etxebarria N, Rojo R, Ortiz de Urbina J. Thoracic involvement of hepatic hydatidosis. Surgery 2015; 157:169-70. [PMID: 25625156 DOI: 10.1016/j.surg.2013.06.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Jin X, Yi L, Lin A, Yao Y, Yang W, Chu PG, Yen C, Qiu W. Bronchobiliary fistula from foreign body reaction or cholelithiasis. SURGICAL PRACTICE 2014. [DOI: 10.1111/j.1744-1633.2012.00634.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Xiaotai Jin
- Department of Surgery; Ruijin Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai China
| | - Lin Yi
- Department of Surgery; Ruijin Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai China
| | - Andy Lin
- Department of Surgery; Ruijin Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai China
| | - Yongliang Yao
- Department of Surgery; Ruijin Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai China
| | - Weiping Yang
- Department of Surgery; Ruijin Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai China
| | - Peiguo G. Chu
- Department of Pathology; City of Hope National Medical Center; Duarte California USA
| | - Christina Yen
- Department of Molecular Pharmacology; City of Hope National Medical Center; Duarte California USA
| | - Weihua Qiu
- Department of Surgery; Ruijin Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai China
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11
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Thoracobiliary fistulas: literature review and a case report of fistula closure with omentum majus. Radiol Oncol 2013; 47:77-85. [PMID: 23450657 PMCID: PMC3573838 DOI: 10.2478/raon-2013-0003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Accepted: 07/30/2012] [Indexed: 02/08/2023] Open
Abstract
Background Thoracobiliary fistulas are pathological communications between the biliary tract and the bronchial tree (bronchobiliary fistulas) or the biliary tract and the pleural space (pleurobiliary fistulas). Review of the literature We have reviewed aetiology, pathogenesis, predilection formation points, the clinical picture, diagnostic possibilities, and therapeutic options for thoracobiliary fistulas. Case report A patient with an iatrogenic bronchobiliary fistula which developed after radiofrequency ablation of a colorectal carcinoma metastasis of the liver is present. We also describe the closure of the bronchobiliary fistula with the greater omentum as a possible manner of fistula closure, which was not reported previously according to the knowledge of the authors. Conclusions Newer papers report of successful non-surgical therapy, although the bulk of the literature advocates surgical therapy. Fistula closure with the greater omentum is a possible method of the thoracobiliary fistula treatment.
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An imported case of echinococcosis in a pregnant lady with unusual presentation. Case Rep Infect Dis 2013; 2013:753848. [PMID: 23401812 PMCID: PMC3562643 DOI: 10.1155/2013/753848] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 01/02/2013] [Indexed: 01/10/2023] Open
Abstract
A 31-year-old Syrian pregnant (25-week duration) patient who was managed as a case of bronchial asthma for one year because of chronic cough and progressive breathlessness presented to the Accident and Emergency Department at Hamad General Hospital, Doha, with cough and shortness of breath. On the day of admission, she coughed large amount of yellowish watery material which was salty and sour in taste. She was found by radiological investigations to have multiple giant hydatid cysts (three in the lungs and one in the liver), with ruptured cyst in the left lung. We report here an unusual case of giant multiple pulmonary hydatidosis localized in the lungs and masquerading as bronchial asthma in a pregnant lady. The case represents an uncommon situation of a common disease of rupture of hydatid cyst of the lung in a pregnant lady in her 3rd trimester.
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Symeonidis N, Pavlidis T, Baltatzis M, Ballas K, Psarras K, Marakis G, Sakantamis A. Complicated liver echinococcosis: 30 years of experience from an endemic area. Scand J Surg 2013; 102:171-7. [PMID: 23963031 DOI: 10.1177/1457496913491877] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIMS Although declining, cystic echinococcosis is still a serious public health issue in Greece. This study evaluated the clinical features, management, and short-term outcome of patients with complicated liver echinococcosis. MATERIAL AND METHODS A total of 227 patients who were operated on for 322 echinococcal cysts of the liver were retrospectively evaluated. Patients were divided into those with complicated disease (53.7%) and those with noncomplicated disease (46.3%). Intrabiliary rupture (34.4%), cyst infection (32.7%), and their combination (24.5%) were the most common complications. Demographic characteristics, previous hydatid cyst surgery, cyst multiplicity and location, presenting symptoms and signs, types of complicated disease, operative procedures performed, postoperative complications, and hospital stay were assessed. RESULTS Patient demographics and cyst characteristics demonstrated no significant difference between the two groups. The complicated disease group had significantly more pronounced clinical presentations and higher postoperative morbidity. Choice of surgical procedure depended upon cyst location and surgeon preference. Both conservative and radical procedures were performed, supplemented with additional management of the biliary tree when indicated. CONCLUSIONS Complicated liver echinococcosis demonstrates several distinct features that differentiate it from the noncomplicated disease. Frequently severe clinical manifestations, complexity of surgical management, and the increased postoperative complications characterize complicated liver echinococcal disease.
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Affiliation(s)
- N Symeonidis
- Second Propedeutical Department of Surgery, School of Medicine, Hippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Kabiri EH, Traibi A, Arsalane A. [Bilio-bronchial fistula due to hydatic disease: case report and review of the literature]. REVUE DE PNEUMOLOGIE CLINIQUE 2011; 67:380-383. [PMID: 22137285 DOI: 10.1016/j.pneumo.2011.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Revised: 03/07/2011] [Accepted: 05/02/2011] [Indexed: 05/31/2023]
Abstract
Bilio-bronchial fistula due to hydatid disease is a rare but severe condition. Three levels, abdominal, diaphragmatic and thoracic, may be involved, with high perioperative mortality. We report a case of bilio-bronchial fistula successfully managed by thoracotomy. Thoracotomy is the best approach for surgical treatment at all three levels.
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Petrolati A, Pacella CM, Nasoni S, Rossi Z, Altavilla N, Cipolla R, Fenderico P, Forlini G, Stasi R. Management of biliobronchial fistula with octreotide: a case report. Am J Gastroenterol 2009; 104:2638-9. [PMID: 19806104 DOI: 10.1038/ajg.2009.335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Dziri C, Haouet K, Fingerhut A, Zaouche A. Management of Cystic Echinococcosis Complications and Dissemination: Where is the Evidence? World J Surg 2009; 33:1266-73. [PMID: 19350321 DOI: 10.1007/s00268-009-9982-9] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Bouchikh M, Ouadnouni Y, Smahi M, Msougar Y, Lakranbi M, Achir A, Caidi M, Harrak L, El Aziz S, Benosman A. [Multiple extrapulmonary thoracic hydatidosis]. Rev Mal Respir 2009; 25:1110-4. [PMID: 19106907 DOI: 10.1016/s0761-8425(08)74981-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Extrapulmonary intrathoracic hydatid cysts are unusual but they may be multiple, particularly during a secondary dissemination. With the aim to clarify the origins of this dissemination, we report our experience in the treatment of multiple thoracic extrapulmonary hydatidosis (MTEH). MATERIAL AND METHODS Between January 1995 and December 2004, 41 patients were operated on for MTEH in our department. Chest roentgenogram and computed tomography were the main means of diagnosis. The treatment consisted of total surgical removal of the intact cysts. The approach was a postero-lateral thoracotomy (right in 29 cases, left in 8 cases, bilateral in 3 cases) and a median sternotomy in one case. All patients received complementary medical treatment with Albendazol. RESULTS The MTEH was secondary to haematogenous dissemination in 6 patients (15%), to a hydatid cyst of the lung in 7 patients (17%) and to a hydatid cyst of the liver in 28 patients (68%). 75% of these patients had had a previous surgical intervention for hepatic cyst and 88% of them had diaphragm involvement. There were no deaths among our patients but the recurrence rate was 12%. CONCLUSION Secondary intrathoracic extrapulmonary hydatidosis is generally seen among patients operated on for hydatid cyst of the liver. Necessary precautions must be taken at the time of surgery to avoid any intrathoracic dissemination.
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Affiliation(s)
- M Bouchikh
- Service de Chirurgie thoracique, CHU Ibn Sina, Rabat, Maroc.
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Biliobronchial fistula due to hydatidosis of the liver and choledocholithiasis. ACTA ACUST UNITED AC 2009; 62:281-4. [DOI: 10.2298/mpns0906281b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Biliobronchial fistula (BBF) is an abnormal communication between the biliary system and bronchial tree due to trauma, hemiheptectomy benign biliary stricture with cholangitis and necrotic hepatic infections such as hydatid disease. Intratoracic rupture of a hydatis cyst of the liver is a rare but severe complication with an incidence about 1% and mortality rate about 10%. CASE REPORT A 50-year-old male patient presented with cough, episodes of biliary expectoration and haemoptysis followed with fever, fatigue and dyspnea. The diagnosis was set by echosonography, Chest x-ray finding, CT scan, bronchoscope aspirates while bronchography did not show results. The surgery was done through right subcostal laparotomy. A hydatid cyst was found in the right liver lobe its diameter being 10 cm, fixed with diaphragm. Intraoperative cholangiography revealed choledocholithiasis (two calculi), dilatation of bile ducts and communication of right hepatic duct with the irregular liver cavity as well as with the bronchi of the right lower pulmonary lobe. Cholecystectomy, choledocholitotomy with drainage lavage of bile ducts pericystectomy and cyst evacuation was performed, followed by diaphragm necrosectomy. The postoperative period and control cholangiography through T drain were normal. DISCUSSION The surgical treatment has five goals: to treat the liver cyst, secure free biliary drainage, perform hepatodiaphragmatic disconection, solve intratoracic lesion and restore ti diaphragm. We believe these goals could be achieved through abdominal approach except for irreversible bronchiectasis, intratoracal collection and chronic pulmonary sepsis. CONCLUSION In any case, a surgery still remains the treatment of choice in cases of echinococcosis. Most cases can be solved by laparo-tomy.
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Imaging of Parasitic Diseases of the Thorax. IMAGING OF PARASITIC DISEASES 2008. [PMCID: PMC7120608 DOI: 10.1007/978-3-540-49354-9_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A broad spectrum of parasitic infections frequently affects the lungs, mediastinum, and thoracic wall, manifesting with abnormal imaging findings that often make diagnosis challenging. Although most of these infections result in nonspecific abnormalities, familiarity with their imaging features and the diagnostic pathways help the radiologist to formulate an adequate differential diagnosis and to guide diagnosticians in reaching a definitive diagnosis.
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Eryigit H, Oztas S, Urek S, Olgac G, Kurutepe M, Kutlu CA. Management of acquired bronchobiliary fistula: 3 case reports and a literature review. J Cardiothorac Surg 2007; 2:52. [PMID: 18053192 PMCID: PMC2217537 DOI: 10.1186/1749-8090-2-52] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2007] [Accepted: 12/03/2007] [Indexed: 12/18/2022] Open
Abstract
Bronchobiliary fistula (BBF), which often presents with bilioptysis, is an abnormal communication between the bronchial system and biliary tree. It is a complication associated with a high mortality rate and requires a well-planned management strategy. Although hydatid disease is still the leading cause, extensive surgical interventions and invasive procedures of the liver have altered the profile of patients in recent decades. This paper presents 3 cases of BBF and reviews the literature regarding the treatment options generally mandated by clinical presentation and the underlying disease.
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Affiliation(s)
- Hatice Eryigit
- Department of Thoracic Surgery, Sureyyapasa Chest Diseases and Thoracic Surgery Teaching and Research Hospital, Istanbul, Turkey.
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Tocchi A, Mazzoni G, Miccini M, Drumo A, Cassini D, Colace L, Tagliacozzo S. Treatment of hydatid bronchobiliary fistulas: 30 years of experience. Liver Int 2007; 27:209-14. [PMID: 17311615 DOI: 10.1111/j.1478-3231.2007.01435.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
BACKGROUND Bronchobiliary fistula (BBF) is an uncommon but severe complication of hydatid disease of the liver. Operation is considered the treatment of choice but the most appropriate operation is uncertain. The aim of this study was to evaluate the early and long-term outcomes following different surgical procedures. METHODS A retrospective evaluation of 31 patients with BBF was performed. Surgical access consisted of laparotomy, thoracotomy or a thoracoabdominal (TA) incision. Surgical procedures for the treatment of the cyst were classified as conservative or radical. RESULTS Radical treatment including lung resection and pericystectomy was performed in all patients in whom the surgical exposure was obtained by either thoracotomy or TA. Of the patients treated by laparotomy, two had a pericystectomy, and four had drainage of the cyst. There were two deaths among the seven thoracotomy patients and one among the 18 TA patients. Pleural effusion was observed in six of the TA, two of the thoracotomy, and three of the laparotomy patients. Biliary fistula occurred in two of the five thoracotomy patients surviving operation and in two laparotomy patients (2/6). Progression of the lung disease was observed in four laparotomy patients and in one thoracotomy patient. CONCLUSIONS The better outcome achieved in TA patients is the result of the simultaneous radical treatment of all the pathological aspects of BBF.
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Affiliation(s)
- Adriano Tocchi
- First Department of Surgery, University of Rome La Sapienza Medical School, Rome, Italy.
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22
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de la Puerta I, Piñol G, Regueiro F, Figuerola JA. [Bronchobiliary fistula as a persistent respiratory-tract infection and abdominal pain of several years of evolution]. Med Clin (Barc) 2006; 127:718-9. [PMID: 17169305 DOI: 10.1157/13095105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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23
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Kabiri EH, Kabiri M, Atoini F, Zidane A, Arsalane A. [Surgical treatment of pulmonary hydatid cysts in childhood]. Arch Pediatr 2006; 13:1495-9. [PMID: 17049215 DOI: 10.1016/j.arcped.2006.07.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2006] [Accepted: 07/11/2006] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To analyse the radioclinical forms of pulmonary hydatid cyst in children, and to evaluate the results of surgical treatment. PATIENTS AND METHODS During a period of 4 years (2002-2005), 26 surgical procedures were performed for pulmonary hydatid cyst in 23 children (16 boys and 7 girls, mean age 13, 5 years). Symptoms were chest pain (87%), broncho-pulmonary infection (32%) and hemoptysis (22%). Chest x-ray showed a non-complicated cyst in 62% of cases. The CT scan was performed in 15 cases (65%), mainly for complicated forms. Abdominal echography for all patients showed 3 hepatic localisations of hydatid cyst. All the patients underwent surgical treatment by thoracotomy. RESULTS In a total of 34 cysts, 21 were uncomplicated, 13 complicated (intra-bronchial rupture: 11 cases, pleural rupture: 2 cases). Cystectomy or pericystectomy were performed in 91% of cases, segmentectomy in 6% and a lobectomy in 3%. Decortication was done in the 2 pleural-ruptured cases. There was no mortality. One lower left lobe atelectasis was observed post-operatively. CONCLUSION Conservative surgical techniques for pulmonary hydatid cysts in children are preferred to parenchyma resection. In our practice the treatment of bilateral hydatidosis in 2 times decreases the complication rate.
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Affiliation(s)
- E-H Kabiri
- Service de Chirurgie Thoracique, Hôpital Militaire d'Instruction Mohamed-V, Hay Riad 10100, Rabat, Maroc.
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24
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Kakisaka T, Sato N, Kamiyama T, Nakagawa T, Nakanishi K, Matsushita M, Ito T, Todo S. Hepatopulmonary fistula caused by alveolar echinococcosis: report of a case. Surg Today 2006; 36:937-40. [PMID: 16998692 DOI: 10.1007/s00595-006-3268-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2006] [Accepted: 04/05/2006] [Indexed: 11/26/2022]
Abstract
Alveolar echinococcosis is a parasitosis endemic to red fox habitats in the northern hemisphere. The liver is the most commonly affected organ, followed by the lungs. We report the case of an elderly woman with hepatic alveolar echinococcosis (HAE) complicated by a hepatopulmonary fistula. We performed a one-stage operation for the hepatic and pulmonary lesions through the transdiaphragmatic route via a laparotomy. We report this case to emphasize that the first-line treatment for a hepatopulmonary fistula caused by HAE should be radical surgery, which results in relief of symptoms and a good outcome.
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Affiliation(s)
- Tatsuhiko Kakisaka
- Department of General Surgery, Hokkaido University Graduate School of Medicine, North 15, West 7, Sapporo 060-8638, Japan
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25
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Gandini R, Konda D, Tisone G, Pipitone V, Anselmo A, Simonetti G. Bronchobiliary fistula treated by self-expanding ePTFE-covered nitinol stent-graft. Cardiovasc Intervent Radiol 2006; 28:828-31. [PMID: 16001141 DOI: 10.1007/s00270-004-0201-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
A 71-year-old man, who had undergone right hepatectomy extended to the caudate lobe with terminolateral Roux-en-Y left hepatojejunostomy for a Klatskin tumor, developed bilioptysis 3 weeks postoperatively due to bronchobiliary fistula. Percutaneous transhepatic cholangiography revealed a non-dilated biliary system with contrast medium extravasation to the right subphrenic space through a resected anomalous right posterior segmental duct. After initial unsuccessful internal-external biliary drainage, the fistula was sealed with a VIATORR covered self-expanding nitinol stent-graft placed with its distal uncovered region in the hepatojejunal anastomosis and the proximal ePTFE-lined region in the left hepatic duct. A 10-month follow-up revealed no recurrence of bilioptysis and confirmed the complete exclusion of the bronchobiliary fistula.
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Affiliation(s)
- Roberto Gandini
- Department of Diagnostic Imaging and Interventional Radiology, University of Tor Vergata, Rome, Italy
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26
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A case of bronchobiliary fistula associated with subdiaphragmatic abscess after hepatic surgery. Indian J Thorac Cardiovasc Surg 2005. [DOI: 10.1007/s12055-005-0042-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Bird R, Fagen K, Taysom D, Silverman ED. A Case of Bronchobiliary Fistula in the Setting of Adult Polycystic Kidney and Liver Disease, with a Review of the Literature. Clin Nucl Med 2005; 30:326-8. [PMID: 15827402 DOI: 10.1097/01.rlu.0000159674.33299.eb] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A case of bronchobiliary fistula (BBF) was demonstrated in the setting of polycystic kidney and liver disease (PCKLD) by hepatobiliary scintigraphy. High-resolution noncontrast computed tomography through the liver showed a polycystic liver. A calcified cyst adjacent to the dome of the liver appeared to have a fistulous connection with the lung on coronal reconstructions. Hepatobiliary scan confirmed the fistulous connection. In a review of the literature, BBF has been associated with hydatid cyst disease, trauma, postsurgical states, and malignancy. As demonstrated by this case, BBF is difficult to diagnose and requires a high clinical index of suspicion. Hepatobiliary scintigraphy is the imaging modality of choice to confirm BBF, and PCKLD should be added to the list of antecedent etiologies.
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Affiliation(s)
- Robin Bird
- Department of Radiology, Nuclear Medicine Division, Naval Medical Center San Diego, San Diego, CA 92134-1204, USA
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28
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Kim YS, Rhim H, Sung JH, Kim SK, Kim Y, Koh BH, Cho OK, Kwon SJ. Bronchobiliary Fistula after Radiofrequency Thermal Ablation of Hepatic Tumor. J Vasc Interv Radiol 2005; 16:407-10. [PMID: 15758140 DOI: 10.1097/01.rvi.0000150034.77451.6f] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
A broad spectrum of complications can occur after radiofrequency (RF) ablation of hepatic tumors, even though it has been accepted as a safe and effective technique for unresectable hepatic tumors. Recently, the rare complication of brochobiliary fistula was encountered after RF ablation in a patient with a metastatic tumor from stomach cancer. It was assumed to have developed from collateral damage to the adjacent diaphragm and lung base as well as biloma formation at the ablation zone. Symptomatic improvement was achieved by conservative management with an external drainage catheter, but the fistula was still persistent on a 2-month follow-up image.
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Affiliation(s)
- Young-Sun Kim
- Department of Diagnostic Radiology, College of Medicine, Hanyang University, 17 Haengdang-dong, Sungdong-Gu, Seoul 133-792, Korea
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Abstract
Treatment of hydatid cyst of the liver ranges from surgical intervention (conventional or laparoscopic approach) to percutaneous drainage and to medical therapy. The aim of this systematic review was to provide "evidence-based" answers to the following questions: Should chemotherapy be used alone or in association with surgery? What is the best surgical technique? When is the percutaneous aspiration injection and reaspiration technique (PAIR) indicated? An extensive electronic search of the relevant literature without limiting it to the English language was carried out using MEDLINE and the Cochrane Library. Key words used for the final search were "hydatid cyst," "liver," "treatment," "meta analysis," "randomized controlled trial," "prospective study," "retrospective study." All relevant studies reporting the assessment of one modality of treatment or a comparison of two or several therapeutic methods to treat hydatid cyst of the liver and published in a peer-reviewed journal were considered for analysis. This systematic review allowed us to conclude that chemotherapy is not the ideal treatment for uncomplicated hydatid cysts of the liver when used alone (level II evidence, grade B recommendation). The level of evidence was too low to help decide between radical or conservative treatment (level IV evidence, grade C recommendation). Omentoplasty associated with radical or conservative treatment is efficient in preventing deep abscesses (level II evidence, grade A recommendation). The laparoscopic approach is safe (level IV evidence, grade C recommendation). Drug treatment associated with surgery (level II evidence, grade C recommendation) requires further studies. Percutaneous drainage associated with albendazole therapy is safe and efficient in selected patients (level II evidence, grade B recommendation). The level of evidence is low concerning treatment of complicated cysts.
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30
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Anthi A, Katsenos C, Georgopoulou S, Mandragos K. Massive rupture of a hepatic hydatid cyst associated with mechanical ventilation. Anesth Analg 2004; 98:796-7, table of contents. [PMID: 14980939 DOI: 10.1213/01.ane.0000099722.80132.17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
UNLABELLED An 80-yr-old woman with a complicated Echinococcus cyst of the liver underwent endotracheal intubation with a simple endotracheal tube and conventional mechanical ventilation that led to massive rupture of the cyst into the bronchi followed by fatal anaphylactic shock. We believe that the currently recommended use of a double-lumen endotracheal tube during surgery in the pulmonary hydatid cysts should be extended to hydatid cysts of the liver with thoracic involvement. IMPLICATIONS We present a case of massive rupture of hepatic Echinococcus cyst associated with mechanical ventilation. We believe that the use of a double-lumen endotracheal tube could be crucial in the management of the hydatid cysts of the liver with thoracic involvement.
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Affiliation(s)
- Anastasia Anthi
- Intensive Care Unit, Hellenic Red Cross Hospital, Athens, Greece.
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Kotoulas CS, Foroulis C, Letsas K, Kostikas K, Konstantinou M. Bilious pericardial effusion at initial presentation in a patient with lung cancer. World J Surg Oncol 2003; 1:24. [PMID: 14613553 PMCID: PMC280706 DOI: 10.1186/1477-7819-1-24] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2003] [Accepted: 11/08/2003] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Cardiac tamponade as the initial manifestation of metastatic cancer is a rare clinical entity. Furthermore, a thoraco-biliary fistula is another rare complication of echinococcosis due to rupture of hydatid cysts located at the upper surface of the liver to the pleural or pericardial cavity. We report a case of non-small cell lung cancer with a coexisting hepatic hydatid cyst presenting as a bilious pericardial effusion. CASE REPORT: A 66-year-old patient presented with cardiac tamponade of unknown origin. Chest CT-scan demonstrated a left central lung tumor, a smaller peripheral one, bilateral pleural effusions and a hydatid cyst on the dome of the liver in close contact to the diaphragm and pericardium. Pericardiotomy with drainage was performed, followed by bleomycin pleurodesis. The possible mechanism for the bilious pericardial effusion might be the presence of a pericardio-biliary fistula created by the hepatic hydatid cyst. CONCLUSIONS: This is the first case of a bilious pericardial effusion at initial presentation in a patient with lung cancer with coexisting hepatic hydatid cyst.
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Affiliation(s)
- Christophoros S Kotoulas
- Thoracic Surgery Department, 401 General Military Hospital of Athens, 138 Mesogeion Ave & Katechaki str, GR-115 10 Athens, Greece
| | - Christophoros Foroulis
- 2Thoracic Surgery Department, Chest Diseases Hospital of Athens, Mesogeion 152, GR-115 27 Athens, Greece
| | - Konstantinos Letsas
- Thoracic Surgery Department, 401 General Military Hospital of Athens, 138 Mesogeion Ave & Katechaki str, GR-115 10 Athens, Greece
| | - Konstantinos Kostikas
- 2Thoracic Surgery Department, Chest Diseases Hospital of Athens, Mesogeion 152, GR-115 27 Athens, Greece
| | - Marios Konstantinou
- 2Thoracic Surgery Department, Chest Diseases Hospital of Athens, Mesogeion 152, GR-115 27 Athens, Greece
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