Background/aim The development of bronchopleural fistula (BPF) remains the most severe complication of lung resection, especially after pneumonectomy. Studies provide controversial reports regarding the benefits of flap reinforcement of the bronchial stump (FRBS) in preventing BPF’s occurrence. Methods This is a retrospective cohort study of 558 patients that underwent lung resection in a 12-year period (from 2007 to 2018). Ninety patients (16.1%) underwent pneumonectomy. Patient follow-up period varied from 1 to 12 years. Results Out of 558 patients in this study, 468 (83.9%) underwent lobectomy, and the remnant underwent pneumonectomy. In 114 cases with lobectomy, only 24.4% had FRBS, meanwhile in 56 cases with pneumonectomy only 62.2% had FRBS. BPF occurred in 8 patients with lobectomy (1.7%) and in 10 patients with pneumonectomy (11.1%). Among cases with post-pneumonectomy BPF, 6 (10.7%) had FRBS performed, while no FRBS was performed among patients with post-lobectomy BPF, although these data weren’t statistically (p > 0.05). In 24 patients (20 lobectomies and 4 pneumonectomies) with lung cancer (10.4%) neoadjuvant treatment was performed, in which 20 patients underwent chemotherapy and 4 underwent radiotherapy. FRBS was applied in each of the above 24 operative cases, but only in 4 of them the BPF was verified. Conclusion The idea of enhancing the blood supply through the FRBS for BPF prevention has gain traction. Although FRBS has been identified as valuable and effective method in BPF prevention following lung resection, our study results did not support this evidence.

Background Patients with thoracic trauma caused by gunshots face a high risk of death, and medical staff often encounter technical difficulties in resolving these cases. Most gunshot wounds result in an entrance and exit wound. In cases with no exit wound, missiles are seen in other areas with screening radiographs. The bullet may migrate depending on gravity, coughing, swallowing, blood flow, or local erosion. Case presentation We present the case of a teenager who was hospitalized in critical condition owing to a left hemithorax injury caused by an improvised explosive device. The patient underwent two surgeries: an anterior left thoracotomy during which a hole in the myocardium was sutured, and after radiography, anterolateral right thoracotomy was performed, in which a deformed projectile was found at the level of the intermediate right pulmonary artery. Conclusions This case highlights the crucial importance of repeated imaging to assess the possibility of projectile migration within the cardiovascular system in similar cases of penetrating injury. Immediate surgery was necessary and very important for the survival of our patient, despite the difficulties presented by this complicated case.

Partial anomalous pulmonary venous return (PAPVR) is a rare congenital left-to-right shunt where pulmonary veins drain into systemic circulation. This is a presentation of the case of a patient with concurrent PAPVR and adenocarcinoma of the same lobe. The pulmonary veins of right upper lobe drained into superior vena cava (SVC), whereas the middle and lower lobes veins drained into the left atrium as two distinct vessels. Surgeons should always perform a diligent search for anomalous vascular structure using computed tomographic (CT) angiography prior to surgery. In our case, surgical approach was "safe" because both pathologies developed in the same lobe.

Background Foreign body left after surgery surrounded by a foreign body reaction otherwise known as gossypiboma, have been first described in 1884. Although it occurs rarely, it can lead to various complications which include adhesions, abscess formation and related complications. Intrathoracic gossypiboma is a rare but serious consequence of negligence, mainly during abdominal and cardiothoracic surgery that can lead to severe medical consequences. This paper aims to raise awareness among surgeons and nurses in the operating room to prevent such errors and future complications. Case presentation A patient with a history of coronary arterial bypass grafting performed 14 years ago, presented with shortness of breath and dry cough. A chest X-ray revealed a large mass in the left hemithorax. The chest CT demonstrated the presence of a heterogeneous density mass of 11 cm and smooth edges in the middle mediastinum, next to the heart and partially intrapericardial. Because clinical and radiologic evidence revealed presence of a mass, we did proceed with CT guided FNA of the mass. The cytology findings confirmed an inflammatory lesion. Based on patient symptomatology and the evidence of a mass, allegedly compressing the cardiopulmonary structures in vicinity, we performed surgical exploration. An old and degraded piece of surgical swap was found and removed through an anterolateral left thoracotomy. The post-operative course was excellent. Conclusions Forgetting surgical swaps during surgery is a medical fault. To avoid them, surgical units should design and implement a surgical inventory process to account for surgical instruments or surgical swaps. Failure to make a proper diagnosis of cases such as these can lead to further health complications in these patients. The iatrogenic foreign material seen as a mass in the radiologic films had not been previously noticed by other health professionals although the patient had undergone X-ray and cardiac ultrasound examinations in the 14 years following coronary bypass surgery. Once the causative agent was identified and removed the patient returned to normal activity.

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