Innominate Artery Pseudoaneurysm Requiring Cartilage Tracheal Repair in a Child

Mycotic aneurysms are rare but potentially catastrophic. We report a case of an innominate artery pseudoaneurysm in a 4-year-old patient that caused a tracheoinnominate fistula requiring tracheoplasty with a costal cartilage graft and a homograft iliac artery replacement of the diseased innominate artery, with a successful outcome.

Chronic Tubercular Mediastinitis: A Rare Case Presentation With Subcutaneous Emphysema

Tuberculosis, histoplasmosis, various fungal infections, malignancy, and sarcoidosis are the most common causes of chronic or slowly progressing mediastinitis. Chronic mediastinitis of tubercular origin with subcutaneous emphysema is exceptionally uncommon, and the majority of cases are caused by trauma. Here we report the case of a 35-year-old chronic alcoholic male who presented to the Outpatient Department (OPD) with complaints of cough, chest pain, loss of weight, and intermittent low-grade fever for three months with no significant past medical history or family history for any respiratory diseases. He was admitted and all routine investigations were performed, which were normal including his chest X-ray, except erythrocyte sedimentation rate (ESR) which was raised. The patient's high-resolution Computed Tomography (HRCT) of the thorax was done which showed multiple pleural-based nodular lesions with few showing central cavitary nodules along with ground glass appearance. It also showed two fistulous tracks of 3.4-millimeter diameter, arising from the trachea at the T1 - T2 vertebral level and at the carina which led to the presence of air in the subcutaneous plane extending from the neck up to visualized abdomen suggestive of chronic mediastinitis with tracheal fistula, along with subcutaneous emphysema. This fistula was confirmed by video bronchoscopy as well as three-dimensional (3D) virtual bronchoscopy. A biopsy was taken, which was positive for acid-fast bacilli (AFB) stain, polymerase chain reaction (PCR) for tuberculosis, and positive tuberculin skin test. The patient was started on anti-tubercular treatment and on a follow-up visit upon completion of the intensive phase, his HRCT and video bronchoscopy showed fibrosing scarring with fistula closure.

Tracheal fistula in a patient after esophageal surgery confirmed by lung ultrasound: A new bedside tool for thoracic surgeons

Tracheal fistula is a rare but severe complication following esophageal surgery. Here, we report the case of a tracheal fistula in a patient after esophageal surgery suggested by pneumothorax and confirmed by fiberoptic bronchoscopy, and introduce lung ultrasound as a new bedside tool to sensitively detect pneumothorax.

Hydatid cyst of the thyroid gland with tracheal fistula: A case report and review of the literature

Hydatid disease, also known as echinococcal disease, is a zoonotic disease caused by Echinococcus infection. Hydatid cysts of the thyroid are rare. The present case study reports on a patient with hydatid cyst in the thyroid with tracheal fistula. A 54-year-old male patient without any history of exposure to farm animals was hospitalized due to fever and productive cough with occasional hydatid daughter cyst. The patient was diagnosed with a hydatid cyst of the thyroid gland with tracheal fistula by relevant examination. An operation was performed to remove the hydatid cyst and to repair the fistula. The patient took oral albendazole after surgery to prevent hydatid recurrence. Operative recovery was uneventful and the patient resumed his normal activities. Prompt diagnosis and an appropriate surgical treatment prevented a potentially fatal outcome. Furthermore, the characteristics of thyroid cystic echinococcosis, and its diagnosis and treatment in the present case and other cases reported in the literature were summarized and reviewed. Although the thyroid gland is rarely affected, hydatid cyst disease should be considered as a differential diagnosis of cystic lesions of the thyroid gland in patients living in regions where hydatid cyst disease is endemic.

Tracheomediastinal Fistula: Rare Complication of Treatment with Bevacizumab

Tracheomediastinal fistula is a rare condition caused by multiple etiologies. We present a case of a patient of lung carcinoma receiving chemotherapy. A 63-year-old woman presented to the emergency room with a two-month history of worsening cough and shortness of breath. She was being treated with pemetrexed and bevacizumab for Stage IV non-small cell lung carcinoma. Chest X-ray showed a mass in the lung with mediastinal adenopathy. Computed tomography (CT) scan showed a perforation, confirmed with bronchoscopy. She had a secondary infection and she was started on intravenous antibiotics. The patient decided to continue care in a hospice. We present a rare complication of bevacizumab which has been only reported once in literature. Bevacizumab is known to cause tracheal fistulas when coupled with like invasive procedures. In our case, the patient developed a fistula without any invasive interventions. We advise that physicians using bevacizumab should be aware of the possibility of having such fistulas.

Transtracheal approach to repair of a tracheo-colonic fistula 44 years after colonic interposition

BACKGROUND

We present a case report of a trachea-colonic fistula and demonstrate our unique approach to repair, which was efficient and effective.

METHODS

The patient was a 50-year-old man who had a congenital tracheoesophageal fistula repair with colonic interposition as a child who now developed a fistula between his colon and trachea.

RESULTS

We performed a transtracheal approach, with primary closure of redundant colon mucosa as well as direct repair of the trachea. An inferiorly based sternocleidomastoid muscle flap was interposed between these 2 layers to augment the repair. The patient had an uneventful recovery with an effective reconstitution of the alimentary tract and the airway.

CONCLUSION

Tracheo-colonic fistula is an extremely rare pathology, and the scarring that develops after a prior esophagectomy makes a traditional lateral approach very difficult. The transtracheal approach is an effective method to obtain needed exposure in order to carry out the repair.