According to our data, drugs administered through a paravertebral catheter are very effective. Moreover, it does not present contraindications to its positioning or collateral effects. More studies are necessary to confirm data we collected.

patients who had WR showed less postoperative pain. Moreover, WR presented other advantages: camera protection by small bleeding from chest wall, adaptability with every chest wall thickness, absence of skin injury around the port. We suggest its use instead of rigid trocar.

Catamenial pneumothorax is a unique clinical entity occurring in ovulating women at the onset of menses. It was considered rare, but in a recent report its incidence amounts to 25% of spontaneous pneumothorax surgically treated in women. 1 This justifies an increasing interest on the topic. Despite the fact that catamenial pneumothorax has been known for 5 decades, its cause has not been defined definitively. Thoracic endometriosis is frequently indicated as an implicated factor; however, the pathogenesis and mechanism that lead to thoracic endometriosis and from endometriosis to pneumothorax are still unclear. 2,3 To our knowledge, we report the first case of a catamenial pneumothorax in a woman who underwent controlled ovarian hyperstimulation for in vitro fertilization embryo transfer (IVF-ET) cycles, and we add some information to clarify its pathogenesis.

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Abbreviations: WHO, world health organization; FNAB, fine needle aspiration biopsy; CECT, contrast-enhanced chest computed tomography; HU, hounsfield units; PET-CT, positron emission tomography -computed tomography IntroductionPleomorphic adenoma is the most common benign neoplasm of salivary glands. It is considered a biologically benign tumour, but, occasionally, it acquires the capability of metastasizing, locally or even distantly. With regards to this, World Health Organization (WHO) classified three different pathologies, included in the definition of "Malignant Mixed Tumour": the Carcinoma Ex Pleomorphic Adenoma, the Carcinosarcoma, both characterized by a histologically malignant transformation of the epithelial component by itself or in combination with the mesenchymal-like one, respectively, and the Metastatic Mixed Tumour. It has been postulated that both Carcinoma ex Pleomorphic Adenoma and Carcinosarcoma probably results from the genetic instabilities and accumulation of key genetic alterations in long-standing pleomorphic adenoma.1 The Metastatic Mixed Tumour is defined as a histologically benign Pleomorphic Adenoma, typically recurrent, that manifests local or distant metastasis. We present a case of recurrent pleomorphic adenoma developing lung metastases. Case presentationA 45years-old woman with history of recurrent oral pleomorphic adenoma was referred to the Radiology Department to perform a routine chest x-ray pre-operative examination before a planned excision of a left submandibular swelling (Figure 1), present since about three years and diagnosed as a pleomorphic adenoma at a recent fine needle aspiration biopsy (FNAB). The patient had already undergone surgical excision of pleomorphic adenoma in the left part of the palate in 1980 followed, ten years later, by another excision of recurrent disease in the same site. She was free from comorbidities. At chest x-ray two well-defined radio-opaque nodules in both the lower lung fields were depicted, the biggest one in the right lung, projectively in the retro-cardiac region, with a maximum diameter of about 3cm (Figure 2 Case report: We report the case of a 45years-old woman affected by recurrent pleomorphic adenoma since about the age of 30years. During pre-surgical x-ray chest, performed as routine before excision of the last recurrence of pleomorphic adenoma, bilateral lung nodules were discovered, which ended up to be lung metastases.Discussion: it had been proved by evidence that pleomorphic adenoma recurrences significantly increase the possibility both of malignant transformation of the disease and malignant behaviour recurrences that could develop distant localization, though histologically benign.Conclusion: in management of primary pleomorphic adenoma radical surgical excision is crucial, to prevent first of all local recurrences and then distant spread.

ObjectiveCardiopulmonary exercise testing (CPET) is currently recommended for all patients undergoing lung resection with either respiratory comorbidities or functional limitations. The main parameter evaluated is oxygen consumption at peak (VO2peak). Patients with VO2peak above 20 ml/kg/min are classified as low risk surgical candidates. The aims of this study were to evaluate postoperative outcomes of low-risk patients, and to compare their outcomes with those of patients without pulmonary impairment at respiratory function testing.MethodsRetrospective monocentric observational study was designed, evaluating outcomes of patients undergoing lung resection at San Paolo University Hospital, Milan, Italy, between January 2016 and November 2021, preoperatively assessed by CPET, according to 2009 ERS/ESTS guidelines. All low-risk patients undergoing any extent surgical lung resection for pulmonary nodules were enrolled. Postoperative major cardiopulmonary complications or death, occurring within 30 days from surgery, were assessed. A case-control study was nested, matching 1:1 for type of surgery the cohort population with control patients without functional respiratory impairment consecutively undergoing surgery at the same centre in the study period.ResultsA total of 80 patients were enrolled: 40 subjects were preoperatively assessed by CPET and deemed at low risk, whereas 40 subjects represented the control group. Among the first, 4 patients (10%) developed major cardiopulmonary complications, and 1 patient (2.5%) died within 30 days from surgery. In the control group, 2 patients (5%) developed complications and none of the patients (0%) died. The differences in morbidity and mortality rates did not reach statistically significance. Instead, age, weight, BMI, smoking history, COPD incidence, surgical approach, FEV1, Tiffenau, DLCO and length of hospital stay resulted significantly different between the two groups. At a case-by-case analysis, CPET revealed a pathological pattern in each complicated patient, in spite of VO2peak above target for safe surgery.ConclusionsPostoperative outcomes of low-risk patients undergoing lung resections are comparable to those of patients without any pulmonary functional impairment; nonetheless the formers represent a dramatically different category of individuals from the latter and may harbour few patients with worse outcomes. CPET variables overall interpretation may add to the VO2peak in identifying higher risk patients, even in this subgroup.

Increased cancer risk in patients with inflammatory and infectious diseases has been reported in many studies and lung cancer‐associated empyema in <0.3% patients. We present a patient with empyema in whom the final diagnosis was metastatic lung adenocarcinoma. Purulent pleural fluid obtained by drainage or thoracentesis must always been examined because the association of malignant tumors and empyema should be taken into consideration.

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