1
|
Endara SA, Davalos GA, Ponton MP, Gordon CI, Molina GA. Incidental finding of an ectopic b2 thymoma attached to the pericardium. J Surg Case Rep 2024; 2024:rjae107. [PMID: 38455986 PMCID: PMC10918443 DOI: 10.1093/jscr/rjae107] [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: 01/27/2024] [Accepted: 02/11/2024] [Indexed: 03/09/2024] Open
Abstract
Ectopic thymoma is a rare tumor that arises from the abnormal migration of thymus tissue. They are extremely rare and have a broad spectrum of clinical symptoms. Therefore, preoperative diagnosis is complex and can be easily misdiagnosed. Complete resection is the treatment of choice to avoid recurrence, radiotherapy and enhanced survival. Regretfully, many patients arrive at a late stage, limiting our therapeutic options; therefore, pre-operative diagnosis is vital. We present the case of an otherwise healthy 32-year-old woman; after a chest X-ray was done for a routine medical evaluation, a mass was discovered in her mediastinum. After surgery, a B2 thymoma attached to the pericardium was discovered and successfully treated.
Collapse
Affiliation(s)
- Santiago A Endara
- Department of Surgery, Division of Cardiothoracic Surgery, Hospital Metropolitano, Quito, Ecuador
| | - Gerardo A Davalos
- Department of Surgery, Division of Cardiothoracic Surgery, Hospital Metropolitano, Quito, Ecuador
| | | | - Christian I Gordon
- Ecuador PGY2 General Surgery, Universidad Internacional del Ecuador (UIDE), Quito, Ecuador
| | - Gabriel A Molina
- Department of Surgery, Hospital Metropolitano and Universidad San Francisco de Quito (USFQ), Quito, Ecuador
| |
Collapse
|
2
|
Endara SA, Dávalos GA, Cardenas A, Gangotena K, Flores A, Dueñas S, Molina GA. Dysphagia lusoria in a young patient with a concomitant aortic arch anomaly, successfully treated with surgery: a case report. J Surg Case Rep 2024; 2024:rjad710. [PMID: 38250135 PMCID: PMC10799243 DOI: 10.1093/jscr/rjad710] [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: 11/06/2023] [Accepted: 12/11/2023] [Indexed: 01/23/2024] Open
Abstract
Dysphagia is a common condition in clinical practice; however, an unusual type of dysphagia due to compression of the esophagus by an abnormal right subclavian artery may be discovered in a rare subset of patients. The prognosis and treatment will depend on the severity of the symptoms and the compromise of surrounding structures. We present the case of an 18-year-old female who presented with gradually progressive dysphagia. At first, it was treated as gastroesophageal reflux disease; nonetheless, the dysphagia became severe, and after a thorough evaluation, an aberrant right subclavian artery that compressed the esophagus was discovered along with a truncus bicaroticus. She was successfully treated with surgery without any complications. On follow-ups, she's doing well.
Collapse
Affiliation(s)
- Santiago A Endara
- Department of Surgery, Division of Cardiothoracic Surgery, Hospital Metropolitano, Quito 170508, Ecuador
| | - Gerardo A Dávalos
- Department of Surgery, Division of Cardiothoracic Surgery, Hospital Metropolitano, Quito 170508, Ecuador
| | - Alberto Cardenas
- Department of Cardiology, Hospital de los Valles, Quito 170901, Ecuador
| | - Karina Gangotena
- Department of Radiology, Hospital de los Valles, Quito 170901, Ecuador
| | - Alexis Flores
- PGY3 General Surgery, Universidad Internacional del Ecuador, Quito 170411, Ecuador
| | - Sabine Dueñas
- Universidad San Francisco de Quito (USFQ), Quito 170901, Ecuador
| | - Gabriel A Molina
- Department of General Surgery, Hospital Metropolitano and Universidad San Francisco de Quito (USFQ), Quito 170901, Ecuador
| |
Collapse
|
3
|
Endara SA, De la Torre JS, Terán FJ, Alarcón JP, Tovar CE. Multidisciplinary management of recurrent synovial sarcoma of the chest wall. N Am Spine Soc J 2023; 15:100243. [PMID: 37575880 PMCID: PMC10415753 DOI: 10.1016/j.xnsj.2023.100243] [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] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/14/2023] [Accepted: 07/05/2023] [Indexed: 08/15/2023]
Abstract
Background Synovial sarcoma (SS) is part of soft tissue sarcomas (STS). An incidence between 5% to 10% is estimated. The origin is mesenchymal mainly affecting the extremities. Being even rarer at the chest level and vertebral body, representing around 1%. Histologically, it consists of 3 variants: monophasic, biphasic, and poorly differentiated. Surgical resection is a priority when it comes to multidisciplinary management. The prognosis of patients with SS over the years has improved markedly. Purpose Understand and evaluate the multidisciplinary management of SS considering that the SS has a lowe prevalence and highly malignancy. Study Design We present a case of a 31-year-old male who has a history of monophasic synovial sarcoma diagnosed in 2019 and underwent surgery. Patient came back after two years without symptoms and posterior to a control MRI we observed a local recurrence of SS. Methods The literature was reviewed with a focus on best clinical and surgical strategy for recurrence of SS. Results The patient recovered well with return to his normal daily activities. The review of the literature shows us the importance of the multidisciplinary management for the optimal clinical and surgical approach of SS recurrence. Conclusions SS represents a unique variant of STS, with malignant and metastatic potential. Being a rare pathology, an adequate multidisciplinary management is essential when providing optimal care for the patient.
Collapse
Affiliation(s)
- Santiago A. Endara
- Cardiovascular and Thoracic surgeon, Hospital Metropolitano, Quito, Ecuador
| | | | - Fernando J. Terán
- Orthopedic surgery senior resident, Universidad Internacional del Ecuador, Quito, Ecuador
| | - Juan Pablo Alarcón
- General Surgery resident, Universidad Internacional del Ecuador, Quito, Ecuador
| | - Carla E. Tovar
- Oncologist surgeon, Hospital Metropolitano. Quito, Ecuador
| |
Collapse
|
4
|
Endara SA, Pinto JR, Torres GA, Arias PA, Ponton MP, Molina GA. Severe dysphagia due to an esophageal duplication cyst in sixth decade, unusual presentation of a rare pathology. J Cardiothorac Surg 2023; 18:238. [PMID: 37496023 PMCID: PMC10373318 DOI: 10.1186/s13019-023-02308-z] [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: 07/30/2022] [Accepted: 06/28/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Esophageal duplication cysts are rare congenital tumors usually diagnosed and treated during childhood. Most of them are located in the mediastinum and appear as a mass besides the esophagus. Unfortunately, symptoms are non-specific and depend on the size and location of the mass; therefore, they can easily be missed. If symptoms appear, surgical resection is necessary to prevent troublesome complications. CASE PRESENTATION We present the case of a 60-year-old woman who presented with severe progressive dysphagia and epigastric pain. After further evaluation, a paraesophageal cystic mass was found, and surgery was required. Non-communicating esophageal duplication cyst was the final diagnosis. CONCLUSION Esophageal duplication cysts are a rare pathology in adults; their symptoms will vary depending on their size and location. Preoperative diagnosis is difficult as symptoms are non-specific and can be missed. If severe dysphagia, pain, or any other complication appears, surgery should not be delayed.
Collapse
Affiliation(s)
- Santiago A Endara
- Department of Surgery Division of Cardiothoracic Surgery, Hospital Metropolitano, Av. Mariana de Jesus Oe 7/47 y Conclina, Edificio Diagnostico 2000 tercer piso 3/3, Quito, Ecuador.
| | - Jaime R Pinto
- Department of Surgery, Division of Cardiothoracic Surgery, Hospital Metropolitano, Quito, Ecuador
| | - Gustavo A Torres
- Department of Internal Medicine, Division of Gastroenterology, Hospital de los Valles, Quito, Ecuador
| | - Pablo A Arias
- PGY1, General Surgery, Universidad Internacional del Ecuador (UIDE), Quito, Ecuador
| | - M Patricia Ponton
- Department of Internal Medicine, Division of Pathology, Hospital Metropolitano, Quito, Ecuador
| | | |
Collapse
|
5
|
Endara SA, Dávalos GA, Zamora E E, Redrobán LM, Molina GA. 'Chest gossypiboma after spinal surgery, not so easy to forget'. J Surg Case Rep 2023; 2023:rjad328. [PMID: 37337532 PMCID: PMC10276976 DOI: 10.1093/jscr/rjad328] [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: 04/13/2023] [Accepted: 05/22/2023] [Indexed: 06/21/2023] Open
Abstract
During any surgical procedure, complications may arise, some of which are fortuitous, whereas others, unfortunately, occur because of errors of the surgical team. Fortunately, most are minor and do not affect the patient's recovery, but others can cause severe morbidity and even mortality. A retained cotton or gauze surgical sponge inadvertently left in the body during an operation is known as a gossypiboma. This dreadful oversight is a marked complication that can cause serious postoperative complications, a severe economic burden on the healthcare system, and many medicolegal implications. We report the case of a 30-year-old male, who suffered a spinal fracture which was repaired through an anterior fixation approach 12 years ago in a local state hospital without complications. Suddenly, he presented with chest pain and cough, and sought medical attention. An 8 × 5 × 8 cm low-density heterogeneous mass was discovered on his chest; after successful surgery, a gossypiboma formed by several gauzes without radiopaque markers was discovered.
Collapse
Affiliation(s)
- Santiago A Endara
- Correspondence address. Department of Surgery, Division of Cardiothoracic Surgery, Hospital Metropolitano, Av. Mariana de Jesus Oe7/47 y Conclina, Edificio Diagnostico 2000 tercer piso 3/3, Quito 170129, Ecuador. Tel: +593 99 841 6157; E-mail:
| | - Gerardo A Dávalos
- Department of Surgery, Division of Cardiothoracic Surgery, Hospital Metropolitano, Quito, Ecuador
| | - Elizabeth Zamora E
- Department of Internal Medicine, Division of Radiology, Hospital Metropolitano, Quito, Ecuador
| | - Ligia M Redrobán
- Department of Internal Medicine, Division of Pathology, Hospital Metropolitano, Quito, Ecuador
| | - Gabriel A Molina
- Department of Surgery, Hospital Metropolitano, Quito, Ecuador
- Universidad San Francisco de Quito (USFQ), Quito, Ecuador
| |
Collapse
|
6
|
Endara SA, Dávalos GA, Molina GA, Armijos CA, Narvaez DS, Montalvo N. Case Report: Desmoid fibromatosis in the mediastinum of a 6-month-old toddler, what to do? Front Surg 2023; 9:1007760. [PMID: 36793513 PMCID: PMC9923160 DOI: 10.3389/fsurg.2022.1007760] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 12/30/2022] [Indexed: 01/31/2023] Open
Abstract
Desmoid fibromatosis is a rare, aggressive borderline lesion arising from soft tissues. Treatment will depend on the structures that the tumor has involved. Surgery with negative margins is the recommended strategy as it can usually achieve disease control; however, the tumor's location sometimes does not allow it. Therefore, a combination of medical therapies along with strict surveillance is crucial. We present the case of a 6-month-old boy with a chest mass. After further evaluation, a rapidly growing mediastinal mass involving the sternum and costal cartilage was detected. Desmoid fibromatosis was the final diagnosis.
Collapse
Affiliation(s)
- Santiago A. Endara
- Department of General Surgery, Division of Cardiothoracic Surgery, Hospital Metropolitano, Quito-Ecuador,Correspondence: Santiago A. Endara
| | - Gerardo A. Dávalos
- Department of General Surgery, Division of Cardiothoracic Surgery, Hospital Metropolitano, Quito-Ecuador
| | | | - Christian A. Armijos
- Department of Internal Medicine, Imaging and Interventional Radiology Service, Hospital Metropolitano, Quito-Ecuador
| | - D. Sebastian Narvaez
- Universidad Internacional del Ecuador-Hospital Metropolitano PGY1 General Surgery, Quito-Ecuador
| | - Nelson Montalvo
- Department of Internal Medicine, Pathology Service, Hospital Metropolitano, Quito-Ecuador
| |
Collapse
|
7
|
Endara SA, Dávalos GA, Fierro CH, Montero RA, Molina GA. Paget-Schroetter syndrome in an active young female after unsupervised exercise. Int J Surg Case Rep 2022; 91:106788. [PMID: 35101717 PMCID: PMC8808051 DOI: 10.1016/j.ijscr.2022.106788] [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: 12/01/2021] [Revised: 01/16/2022] [Accepted: 01/20/2022] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Thoracic outlet syndrome (TOS) is a rare syndrome caused by compression of one of the three neurovascular structures in their passage from the cervical area toward the axilla and proximal arm either at the interscalene triangle, the costoclavicular triangle, or the sub coracoid space. The mainstay of management is nonsurgical; however, surgery may be needed when patients persist with symptoms despite conservative management and when vascular structures are involved. Symptoms are non-specific and require high clinical awareness since this pathology tends to affect otherwise healthy young patients. CASE PRESENTATION We present the case of a 45-year-old female without any past medical history. She was active and did plenty of exercises. After a high-intensity routine without any guidance, she presented with acute upper limb swelling with pain. After further examination, a venous thoracic outlet syndrome was identified and treated without complications. CLINICAL DISCUSSION & CONCLUSION Venous TOS is a rare pathology associated with high long-term morbidity and disability if left untreated; heightened clinical awareness of the possibility of acute thrombosis obstructing venous return and producing these rare symptoms should lead the medical team to assess the patient further and lead to the appropriate medical and surgical intervention.
Collapse
Affiliation(s)
- Santiago A Endara
- Hospital Metropolitano, Department of Surgery, Division of Cardiothoracic Surgery, Quito, Ecuador.
| | - Gerardo A Dávalos
- Hospital Metropolitano, Department of Surgery, Division of Cardiothoracic Surgery, Quito, Ecuador
| | - Christian H Fierro
- Hospital Metropolitano, Department of Internal Medicine, Division of Cardiology, Quito, Ecuador
| | - R Alejandra Montero
- Hospital Metropolitano, Department of Internal Medicine, Division of Radiology, Quito, Ecuador
| | - Gabriel A Molina
- Hospital Metropolitano, Department of Surgery, Ecuador; Universidad San Francisco de Quito, Ecuador
| |
Collapse
|
8
|
Molina GA, Ayala AV, Endara SA, Aguayo WG, Rojas CL, Jiménez GE, Moyón MA, Moyón FX. Ecuador and Covid-19: A pandemic we won't be able to run away from. Int J Infect Dis 2021; 109:33-35. [PMID: 34089884 PMCID: PMC8169566 DOI: 10.1016/j.ijid.2021.05.077] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/28/2021] [Indexed: 12/01/2022] Open
Affiliation(s)
- Gabriel A Molina
- Department of General Surgery at Hospital Iess Quito Sur, Quito, Ecuador; Universidad San Francisco de Quito (USFQ), Quito-Ecuador.
| | - Andres V Ayala
- Department of General Surgery at Hospital Iess Quito Sur, Quito, Ecuador; Universidad Internacional del Ecuador, (UIDE), Quito, Ecuador
| | - Santiago A Endara
- Hospital Metropolitano, Department of Surgery Division of Cardiothoracic Surgery, Quito, Ecuador
| | - William G Aguayo
- Department of General Surgery at Hospital General San Francisco, IESS, Quito, Ecuador
| | - Christian L Rojas
- Department of General Surgery at Hospital General San Francisco, IESS, Quito, Ecuador
| | - Galo E Jiménez
- Department of General Surgery at Hospital Iess Quito Sur, Quito, Ecuador
| | - Miguel A Moyón
- Department of General Surgery at Hospital General San Francisco, IESS, Quito, Ecuador
| | - F X Moyón
- Department of General Surgery at Hospital General San Francisco, IESS, Quito, Ecuador
| |
Collapse
|
9
|
Endara SA, Dávalos GA, Molina GA, Zavala AB, Ponton PM, Brito M, Nieto C, Ullauri VE. COVID-19 infection and cardiac angiosarcoma: a dangerous combination-a case report. Cardiothorac Surg 2021; 29:5. [PMID: 38624715 PMCID: PMC7903407 DOI: 10.1186/s43057-021-00042-7] [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: 12/23/2020] [Accepted: 02/09/2021] [Indexed: 11/12/2022] Open
Abstract
Background The COVID-19 pandemic has strained all medical systems, especially in countries like Ecuador, where health services were already limited. These conditions, combined with a deadly and unusual disease, like primary heart angiosarcoma, can lead to severe outcomes. Angiosarcomas represent the most common and aggressive primary malignant heart tumor; regretfully, its clinical manifestations are vague and can be easily missed. Most patients become symptomatic when there is local invasion, embolization, or metastases, leading to late diagnosis and poor survival. High clinical awareness, adequate diagnosis, and prompt treatment are vital in these rare diseases, in which time is of paramount importance. Case presentation We report the case of a 28-year-old female who had cough, hemoptysis, and ground-glass opacities in the CT (computed tomography). Since Ecuador is in the middle of this pandemic, she was misdiagnosed and mistreated. Primary heart angiosarcoma was diagnosed, and regretfully, the patient suffered multiple complications due to diagnosis and died. Conclusion To this day, most cardiac angiosarcomas are found in a late-stage with distal metastasis and advanced local invasion. Sadly, this tumor is frequently missed due to its incidence and broad-spectrum of clinical symptoms. Considering that its manifestations can be misleading, misdiagnosis can occur, especially in pandemic times. Therefore, knowledge of other pathologies prevents COVID-19 from overshadowing other diagnoses, hence preventing delayed diagnosis or even misdiagnosis and consequent adverse outcomes for patients. Supplementary Information The online version contains supplementary material available at 10.1186/s43057-021-00042-7.
Collapse
Affiliation(s)
- Santiago A. Endara
- Department of Surgery Division of Cardiothoracic Surgery, Hospital Metropolitano, Av. Mariana de Jesús Oe7/47 y Conclina, Edificio Diagnóstico 2000 tercer piso 3/3, Quito, Ecuador
| | - Gerardo A. Dávalos
- Department of Surgery Division of Cardiothoracic Surgery, Hospital Metropolitano, Av. Mariana de Jesús Oe7/47 y Conclina, Edificio Diagnóstico 2000 tercer piso 3/3, Quito, Ecuador
| | - Gabriel A. Molina
- Universidad San Francisco de Quito (USFQ) & Department of General Surgery, IESS Quito Sur, Quito, Ecuador
| | | | - Patricia M. Ponton
- Department of Internal Medicine, Division of Pathology, Hospital Metropolitano, Quito, Ecuador
| | - Maribel Brito
- Department of Internal Medicine, Division of Pathology, Hospital Metropolitano, Quito, Ecuador
| | - Carlos Nieto
- Department of Internal Medicine, Division of Cardiology, Hospital Metropolitano, Quito, Ecuador
| | - Vladimir E. Ullauri
- Department of Internal Medicine, Division of Cardiology, Hospital Metropolitano, Quito, Ecuador
| |
Collapse
|
10
|
Endara SA, Dávalos GA, Fierro CH, Ullauri VE, Molina GA. Antiphospholipid syndrome and valvular heart disease, a complex scenario of thrombotic events, a case report. J Cardiothorac Surg 2020; 15:275. [PMID: 32993710 PMCID: PMC7526220 DOI: 10.1186/s13019-020-01330-9] [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: 05/28/2020] [Accepted: 09/22/2020] [Indexed: 08/29/2023] Open
Abstract
Background Antiphospholipid syndrome (APS) is a rare coagulation disorder associated with thrombotic events, myocardial infarction, and valvular heart disease. During valvular replacement surgery, the high risk of thrombosis combined with the operative risks in these specific groups of patients poses a challenge to the medical team. Case presentation We present a case of a female patient with APS and mixed aortic valve disease. During surgery, she suddenly developed complete cardiac arrest. Three months later, after she recovered, and while she was still on close follow up, a thrombotic event caused myocardial infarction. After prompt and precise treatment, the patient successfully recovered; one year after surgery patient is doing well. Conclusion Adequate surgical technique along with optimal anticoagulation strategies and long term follow up are of paramount importance to ensure an uneventful recovery. A multidisciplinary team is required to manage these complex scenarios and high-risk patients.
Collapse
Affiliation(s)
- Santiago A Endara
- Department of Surgery Division of Cardiothoracic Surgery, Hospital Metropolitano, Av. Mariana de Jesús Oe7/47 y Conclina, Edificio Diagnóstico 2000 tercer piso 3/3, Quito, Ecuador.
| | - Gerardo A Dávalos
- Department of Surgery Division of Cardiothoracic Surgery, Hospital Metropolitano, Av. Mariana de Jesús Oe7/47 y Conclina, Edificio Diagnóstico 2000 tercer piso 3/3, Quito, Ecuador
| | - Christian H Fierro
- Department of Internal Medicine Division of Cardiology, Hospital Metropolitano, Quito, Ecuador
| | - Vladimir E Ullauri
- Department of Internal Medicine Division of Cardiology, Hospital Metropolitano, Quito, Ecuador
| | - Gabriel A Molina
- Colegio de Ciencias de la Salud, Universidad San Francisco de Quito (USFQ), Quito, Ecuador
| |
Collapse
|
11
|
Molina GA, Rojas CL, Aguayo WG, Moyon C MA, Moyon FX, Herrera JM, Jiménez GE, Ayala AV, Fuentes G, Endara SA. COVID-19 in Ecuador, how the pandemic strained the surgical healthcare systems over the edge. International Journal of Surgery Open 2020; 26:106-107. [PMID: 34568613 PMCID: PMC7467062 DOI: 10.1016/j.ijso.2020.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 08/25/2020] [Indexed: 12/23/2022]
|
12
|
Dávalos GA, Muñoz CA, Cornejo FJ, Garcés J, Endara SA. Abnormal development of the inferior vena cava and its implications on distal venous drainage during cardiac surgery and other clinical entities. J Surg Case Rep 2019; 2019:rjz289. [PMID: 31700603 PMCID: PMC6827555 DOI: 10.1093/jscr/rjz289] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 08/28/2019] [Indexed: 12/27/2022] Open
Abstract
Congenital anomalies of the inferior vena cava (IVC) are caused by an abnormal persistence or regression of embryonic precursor veins; they are usually incidental findings on imaging studies. These rare conditions have a 0.6% prevalence in individuals with congenital heart diseases and 0.3% in healthy patients. The purpose of this paper was to report two cases of interruption of IVC with hemiazygos continuation and its implications during surgery, highlighting that after recognizing this anomalous drainage the surgeon should be prepared to change the surgical strategies, especially in cardiovascular surgery, in order to obtain adequate circulatory flows or surgical exposure where venous cannulation could be difficult. We have also reported two cases of healthy patients with the same isolated IVC anomaly with no clinical repercussions, which can develop in the future.
Collapse
Affiliation(s)
- Gerardo A Dávalos
- Division of Cardiothoracic Surgery, Department of General Surgery, Hospital Metropolitano, Quito, Ecuador
| | - Carmina A Muñoz
- Urology Resident, Universidad de las Américas (UDLA), Quito, Ecuador
| | - Francisco J Cornejo
- Division of Urology, Department of General Surgery, Hospital Metropolitano, Quito, Ecuador
| | - Juan Garcés
- Division of Radiology, Department of Internal Medicine, Hospital Metropolitano, Quito, Ecuador
| | - Santiago A Endara
- Division of Cardiothoracic Surgery, Department of General Surgery, Hospital Metropolitano, Quito, Ecuador
| |
Collapse
|
13
|
Endara SA, Terán FJ, Serrano AJ, Castillo MJ, Molina GA. Esophagocoloplasty fistula successfully treated with vacuum-assisted closure. J Surg Case Rep 2018; 2018:rjx256. [PMID: 29321843 PMCID: PMC5755238 DOI: 10.1093/jscr/rjx256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 11/30/2017] [Accepted: 12/16/2017] [Indexed: 12/28/2022] Open
Abstract
Esophageal fistulas in the cervical region are usually difficult to manage and carry a high morbidity. We report a case of an esophago-colonic fistula after colonic interposition, successfully managed with vacuum-assisted closure 'V.A.C. system', (Kinetic Concepts Inc., San Antonio, TX, USA). The patient initially presented with purulent fluid from the cervical wound 13 days after surgery. Esophagogram confirmed a leak. Since the patient had a history of anastomotic leaks, a surgical intervention was not the treatment of choice. In light of this, conservative treatment with V.A.C. system was initiated. She underwent full recovery.
Collapse
Affiliation(s)
- Santiago A Endara
- Department of General Surgery, Division of Cardiothoracic Surgery, Hospital Metropolitano, Quito, Ecuador
| | - Fernando J Terán
- Department of General Surgery, Hospital Metropolitano, Quito, Ecuador
| | - Armando J Serrano
- Department of Plastic Surgery, Hospital Metropolitano, Quito, Ecuador
| | | | | |
Collapse
|
14
|
Abstract
A 44-year-old man injured in a motor vehicle accident in rural Australia was resuscitated at a local hospital 9 hours later. Bronchoscopy revealed a large tracheal tear. After transfer to the regional cardiothoracic center, surgery was performed under cardiopulmonary bypass 18 hours after the injury was sustained. The patient required surgical tracheostomy as well as ventilatory and inotropic support. There were no postoperative complications and he was discharged after 27 days.
Collapse
Affiliation(s)
- Santiago A Endara
- Cardiothoracic Unit, Townsville General Hospital, Townsville, Queensland, Australia
| | - Steven P Cook
- Cardiothoracic Unit, Townsville General Hospital, Townsville, Queensland, Australia
| | - Dong Kang
- Cardiothoracic Unit, Townsville General Hospital, Townsville, Queensland, Australia
| | - Benjamin P Bidstrup
- Cardiothoracic Unit, Townsville General Hospital, Townsville, Queensland, Australia
| | - Gary J Lopez
- Cardiothoracic Unit, Townsville General Hospital, Townsville, Queensland, Australia
| |
Collapse
|
15
|
Endara SA, Ayala AV, Davalos GA, Moscoso J, Montero RA. Young male survivor of a spontaneous left main coronary artery dissection treated with surgery. J Surg Case Rep 2013; 2013:rjt058. [PMID: 24964467 PMCID: PMC3813461 DOI: 10.1093/jscr/rjt058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Spontaneous dissection of the coronary arteries is a rare disease with a wide range of clinical presentations ranging from angina to myocardial infarction (MI); its pathophysiology has not yet been fully established. In this paper, we present the case of a 31-year-old male with an acute coronary syndrome. The initial results of the electrocardiogram and cardiac enzymes were consistent with MI. However, a coronary angio-tomography revealed a dissection of the left main coronary artery and the patient underwent emergent surgery with coronary artery bypass grafting. The treatment of spontaneous dissection of the coronary arteries depends on the anatomical location and the patient's clinical presentation. Coronary revascularization is associated with good results.
Collapse
Affiliation(s)
- Santiago A Endara
- Division of Cardiothoracic Surgery, Department of Surgery, Hospital Metropolitano, Quito, Ecuador
| | - Andres V Ayala
- Resident General Surgery, Universidad Internacional del Ecuador- Hospital Metropolitano, Quito, Ecuador
| | - Gerardo A Davalos
- Division of Cardiothoracic Surgery, Department of Surgery, Hospital Metropolitano, Quito, Ecuador
| | - Juan Moscoso
- Internal Medicine Service, Department of Internal Medicine, Hospital Metropolitano, Quito, Ecuador
| | - R Alejandra Montero
- Radiology Service, Department of Internal Medicine, Hospital Metropolitano, Quito, Ecuador
| |
Collapse
|
16
|
Abstract
Less than 25 cases of azygous vein lacerations secondary to blunt trauma have been published in the medical literature, most of these injuries were resulting from motor vehicle accidents, but have been described due to falls or assaults. These lesions should be considered as thoracic great vessels injuries and if not recognized promptly carry a high morbidity and mortality. We report a case of a young male involved in a high-speed car collision, admitted to the emergency room in an unstable condition secondary to hypovolemic shock due to azygous vein injury. The patient underwent emergent right antero-lateral thoracotomy followed by sternotomy for surgical control of the vascular injury and resuscitation. Laparotomy and splenectomy were also required, the abdomen was closed. The thoracic cavity was left packed and closure was delayed for 48 h. The patient survived and was transferred to another hospital seven days later.
Collapse
Affiliation(s)
- Santiago A Endara
- Division of Cardiothoracic Surgery, Department of Surgery, Hospital Metropolitano, Quito, Ecuador.
| | | | | | | |
Collapse
|
17
|
Abstract
Mediastinitis secondary to esophageal perforation is usually a life-threatening problem associated with high morbidity and mortality. We present a 44-year-old morbidly obese female who underwent laparoscopic gastric bypass, during which she suffered perforation of the distal thoracic esophagus diagnosed 5 days later during progression of mediastinitis. She was treated with left posterolateral thoracotomy, drainage of a peri-esophageal abscess and primary repair of the esophagus with intercostal muscle reinforcement, and cervical esophagostomy. Thereafter, she had an uneventful hospital course, and remains well on 12-month follow-up.
Collapse
Affiliation(s)
- Santiago A Endara
- Department of General Surgery, Division of Cardiothoracic Surgery, Hospital Metropolitano, Quito, Ecuador.
| | | | | | | |
Collapse
|
18
|
Endara SA, Davalos GA, Serrano AJ, Torres FJ, Sandoval BA, Sarsoza CE, Montalvo N. Pulmonary myofibroblastic pseudotumor: a rare surgical pathology. Thorac Cardiovasc Surg 2006; 54:430-2. [PMID: 16967384 DOI: 10.1055/s-2006-924088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Pulmonary myofibroblastic pseudotumors are rare surgical pathologies, of unknown origin, with benign behavior and a good prognosis if completely resected. We present a 21-year-old male with a solitary pulmonary nodule found during a routine chest X-ray with CT scan confirmation. After a 16-month follow-up, the nodule increased in size and the patient developed mild dyspnea. He underwent an elective left postero-lateral thoracotomy and excision of the mass with an upper lobectomy. Pathologic studies revealed a pulmonary myofibroblastic pseudotumor.
Collapse
Affiliation(s)
- S A Endara
- Department of Cardiothoracic Surgery, Hospital Metropolitano, Quito, Ecuador.
| | | | | | | | | | | | | |
Collapse
|
19
|
Alizzi AM, Sharma R, Endara SA, Lim KK, Bidstrup BP. Conservative management of a large oesophageal haematoma as a complication of systemic thrombolysis. Heart Lung Circ 2005; 13:423-5. [PMID: 16352229 DOI: 10.1016/j.hlc.2004.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
An acute coronary syndrome patient was treated with tissue plasminogen activator to produce thrombolysis. Six hours post-lysis, haematemesis occurred. Computed tomography (CT) revealed a large haematoma around the lower oesophagus and endoscopy showed a tear in the lower end of the oesophagus. This case represents an unusual complication of anticoagulation and thrombolysis associated with the management of acute coronary syndrome. Conservative management was successful.
Collapse
Affiliation(s)
- Ali M Alizzi
- Department of Cardiothoracic Surgery, The Royal Hobart Hospital, GPO Box 1061L, Hobart, Tasmania, Australia.
| | | | | | | | | |
Collapse
|
20
|
Alizzi AM, Almehdi RU, Endara SA, Roati A, Bidstrup BP. Angiosarcoma of the right ventricle: a rare encounter. Heart Surg Forum 2003; 5:334-6. [PMID: 12538113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2001] [Accepted: 01/03/2002] [Indexed: 02/28/2023]
Abstract
We report a case of angiosarcoma involving the right ventricle. The patient was seen in our Cardiology Department and subsequently referred to our unit for surgery. He gave a 1-week history of lethargy, chest pain, breathlessness on exertion, fevers, and night sweats. Echocardiography and computed tomography of the chest showed a large pericardial effusion with multiple densities, raising suspicions of a hemorrhagic effusion. Surgical exploration showed an epicardial mass. Histopathology revealed angiosarcoma.
Collapse
Affiliation(s)
- Ali M Alizzi
- Department of Cardiothoracic Surgery, Townsville General Hospital, 100 Angus Smith Drive, Douglas, Townsville, Queensland 4814, Australia.
| | | | | | | | | |
Collapse
|
21
|
Endara SA, Roati AA, Alizzi AM, Boldery JO, Bidstrup BP. Aortic valve endocarditis caused by Bartonella henselae: a rare surgical entity. Heart Surg Forum 2002; 4:359-60; discussion 360. [PMID: 11803150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
We report a case of aortic valve endocarditis caused by Bartonella henselae. The patient initially presented to a regional hospital with generalized symptoms including lethargy, malaise and decreased appetite. Transthoracic echocardiogram revealed a large vegetation on the aortic valve and he was treated empirically with broad spectrum intravenous antibiotics. Several blood cultures were obtained which all returned negative results and the white blood cell count was normal. He was transferred to our hospital, with persistence of his initial symptoms and additional low-grade fevers. In light of his negative culture results, serological testing for Bartonella and Chlamydia was performed, which gave a positive result for Bartonella henselae. In view of this result and following development of severe aortic valve insufficiency, he underwent an aortic valve replacement and made a good recovery.
Collapse
Affiliation(s)
- S A Endara
- Department of Cardiothoracic Surgery, The Townsville Hospital, Townsville, Queensland, Australia.
| | | | | | | | | |
Collapse
|
22
|
Abstract
We treated a 26-year-old male who sustained a self-inflicted injury to the mediastinum with a crossbow bolt. Injuries involved penetration of the sternum 1 cm below the sternomanubrial joint, right lung, pericardium, ascending aorta, right pulmonary artery, esophagus, and azygos vein. He was treated successfully with cardiopulmonary bypass and hypothermia. Exposure was achieved with a combination of a sternotomy and right thoracotomy.
Collapse
Affiliation(s)
- S A Endara
- Department of Cardiothoracic Surgery, Townsville General Hospital, Queensland, Australia.
| | | | | | | | | |
Collapse
|
23
|
Bidstrup BP, Endara SA, Boldery JO. Ischemia and reperfusion injury of the myocardium. Heart Surg Forum 2001; 4 Suppl 1:S40-2. [PMID: 11178307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Affiliation(s)
- B P Bidstrup
- Department of Cardiothoracic Surgery, Townsville General Hospital, PO Box 670, Townsville, Queensland, Australia 4810.
| | | | | |
Collapse
|
24
|
Affiliation(s)
- S A Endara
- Department of Cardiothoracic Surgery, Tonsville General Hospital, Australia.
| | | |
Collapse
|
25
|
Abstract
A previously well 62-year-old male from North Queensland presented with leptospirosis featuring fever, renal failure, hepatitis and pulmonary haemorrhage. Management was greatly complicated by severe and previously unrecognized aortic stenosis with a peak valve gradient of 125 mmHg. A successful outcome followed careful haemodynamic management and treatment of the infective illness with subsequent valve replacement.
Collapse
Affiliation(s)
- C S Butler
- Department of Anaesthesia and Intensive Care, Townsville General Hospital, Queensland
| | | |
Collapse
|
26
|
Affiliation(s)
- R T Temes
- Department of Surgery, University of New Mexico School of Medicine, Albuquerque, USA
| | | | | | | |
Collapse
|
27
|
Abstract
Traditional lobectomy techniques describe division of pulmonary parenchyma within the fissures for access to the pulmonary artery. This results in air leaks, which may prolong chest tube drainage and hospitalization times. We describe a technique for lobectomy in which all lung parenchyma is divided using a stapler.
Collapse
Affiliation(s)
- R T Temes
- Department of Surgery, University of New Mexico School of Medicine, Albuquerque 87131, USA.
| | | | | | | |
Collapse
|