Background Guidelines to standardize treatment and follow-up strategies in pneumomediastinum cases are lacking. The aim of the study was to evaluate the etiology in pneumomediastinum cases and the results of treatment and follow-up. Results Nineteen patients with pneumomediastinum who were followed up in our clinic between 2015 and 2020 comprised the study population. Among the patients, 16 (84.2%) were male, and the mean age was 31.15 years. The chief presenting complaints were chest pain and dyspnea. Pneumomediastinum was spontaneous in 15/19 patients (including spontaneous pneumomediastinum with an underlying pathology in 3/15), traumatic in 3/19, and iatrogenic in 1/19. Spontaneous pneumomediastinum without underlying pathology was seen in younger adults (mean age: 23 years). Surgical intervention in traumatic and iatrogenic pneumomediastinum cases was compared with spontaneous cases and no statistically significant difference was observed (p=0.178). The mean hospital stay of all patients was 3.15 days. Only one patient had a recurrence and died, which was later determined to be a secondary spontaneous pneumomediastinum case. Conclusion Pneumomediastinum often occurs with an underlying pathology in advancing age and as spontaneous in younger patients. Therefore, “secondary spontaneous pneumomediastinum” subclass should be evaluated in the classification to facilitate to create a standard guideline and prevent overdiagnosis and overtreatment.
Angiomatosis, a pathology that may occur in any soft tissue, is typically characterized by vascular proliferation and invasion of adjacent tissues. Although it is described as a benign lesion, it can be as challenging as malignancy in treatment and follow-up due to its vascular rich structure and frequent recurrence. Here, we present a rare case of chest wall angiomatosis in a 46-year-old female patient treated with surgical excision.
Background: Therapeutic pneumoperitoneum was first described for overcoming pulmonary tuberculosis in the end of 19th century. However, in time, another indication "prolonged air leak" (PAL) after major lung resections, lung volume reduction surgery and decortication operations have come on the scene and this legendary treatment have took place again. Despite the developing technology, medical devices and tools thoracic surgeons still sometimes need to use this treatment to cope with PAL. Materials and Methods: Twelve patients underwent pulmonary operations were included. Nine of the patients had PAL and three had massive air leak with subcutaneous emphysema in early postoperative period. On mean postoperative 8th day (1-15), a one session pneumoperitoneum was applied. In order to fulfill the vascular bed to prevent from air embolism, all of the patients received 500-1500cc of intravenous saline so that the venous pressure is between 7 and 12. Results: All 12 patients developed no sequel or chronic complications due to the intervention. Mean hospital stay after the intervention was 8.1 days (2-12), mean chest tube removal time after pneumoperitoneum was 16 days (2-48). Six of the patients were discharged with a complete success (without a chest tube), five patients were discharged with a Heimlich valve and one with passive drainage catheter, but the latter patients were also fully recovered in following days. Conclusions: In this report, we present 12 cases treated successfully with therapeutic pneumoperitoneum without any severe complications. The unique side of our technique is we used only single application without any need of extra instruments.
Purpose: In foreign body aspirations, the basic instrument is rigid bronchoscope which provides simultaneous ventilation. However, it can be difficult to tolerate the procedure due to air leaks which affects the effeciency of the procedure.Methods: In 2021, 10 pediatric patients, who were performed rigid bronchoscopy with the suspicion of foreign body aspiration in our clinic were included. Patients' age, gender, anamnesis, imaging findings, interventional procedure, intensive care and service length of stay, and mortality data were recorded. In the procedures performed under general anesthesia, a system combining intubation tube and rigid bronchoscope was used named as “rigid bronchoscopy with cuff”.Results:Rigid bronchoscopy was performed on 10 patients (6 male/ 4 female). The median age was 30 months (min: 9 months, max: 11 years). All foreign bodies were organic and were completely removed during the procedure. While no mortality was observed during the procedure, one patient died on the 1st post-procedure day.Conclusion: Rigid bronchoscope with cuff is a low-cost recommendation that increases the effect of the procedure, and can be routinely used in pediatric patients. It can be also used effectively in the elderly patients with respiratory failure who can be considered as risk group.
Primary Pulmonary Angiomatoid Fibrous Histiocytoma is a recently described soft tissue tumor with challenging differential diagnosis both clinically and pathologically due to its rarity in this location. It may also occur as a secondary malignancy and its occurrence either as a somatic malignancy arising in the germ cell tumor or as a secondary malignancy after chemotherapy is questionable. In this report, we present a 29-year-old male patient with a mass in the lower lobe of the left lung, who underwent orchiectomy and received adjuvant chemotherapy due to a mixed germ cell tumor 8 years ago. Morphology, immunophenotype, and molecular findings were consistent with the diagnosis of primary pulmonary angiomatoid fibrous histiocytoma. Fluorescent in situ hybridization was unable to demonstrate the presence of 12p amplification or isochromosome 12p, which is known as the key event in the development of testicular germ cell neoplasia even present in somatic malignancies arising in germ cell tumors. Our results support that angiomatoid fibrous histiocytoma arising as a secondary malignancy does not represent the somatic transformation of germ cell tumors.
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