Background. Hydatid cyst (HC) disease is endemic in many developing countries, like Yemen, Egypt, and Saudi Arabia, especially in the rural regions. The disease has a variable clinical courses and even might be asymptomatic for many years. Objectives. In giant and large pulmonary hydatid cysts, pulmonary resection is the usual method of surgical treatment. In this study, we aimed to evaluate the lung conservative surgery in treatment of cases with giant and large hydatid lung cysts, as an effective method of management. Patients and Methods. Between January 2009 and August 2014, a total of 148 patients with pulmonary hydatid cysts were operated and their data was reviewed retrospectively and analyzed. Out of these cases, 52 (35.14%) cysts with more than 10 cm in diameter and 36 (24.32%) cysts with 5–9 cm were regarded as giant and large hydatid lung cysts, respectively. The small cysts less than 5 cm were presented in 8 (5.4%) cases only; other cases had ruptured cysts. Preservation of the lung tissues during surgery by cystotomy and Capitonnage was our conservative surgical methods of choice. Results. Eight patients developed bronchopleural fistula (BPF); of them, 4 BPFs have healed with chest tube and physiotherapy, but in the other 4 patients reoperation was done for the closure of persistent BPF. No mortality was observed in the present study. Conclusion. We conclude that conservative surgical procedure can achieve complete removal of the pulmonary hydatid cyst. Enucleation of the intact huge cysts is safe. Careful and secured closure of the bronchial communication should be done by purse string or figure-of-8 sutures, with or without Teflon pledgets. These simple procedures are safe, reliable, and successful.

BackgroundThe huge size intrathoracic lipomas are very rare. Few cases have been reported worldwide. To our knowledge, this presented case is one of the few cases reported. Here we report a single case as very huge intrathoracic lipoma compressing the right lung and displacing the diaphragm and liver downward. It has been managed by right posterolateral thoracotomy and complete excision, with excellent outcome.Case presentationA 32-year-old male presented with a symptomatic right intrathoracic mass, which was confirmed to be a lipomatous tumor using computed tomography. A penduculated tumor originating from the mediastinal pleura was resected through the conventional right posterior thoracotomy. Pathological examination indicated a diagnosis of fibrolipoma.ConclusionThe tumor was symptomatic and relatively huge when detected during a medical checkup. This enabled the successful tumor resection via conventional thoracotomy approach. Although intrathoracic lipomas are histologically benign, careful observation and follow-up are crucial due to the possibility of recurrence.

Objective: To investigate the patterns of thoracic injuries and the methods used for their management. Methods: A retrospective descriptive analysis of 275 chest trauma cases managed at the University of Science and Technology Hospital over the period 2010-2013. Results: Of 275 consecutive patients with chest trauma, 72.7% were males and 7.27% were females with a mean age of 33.6 years old. Blunt injuries represented 51% (125 males and 15 females) while penetrating injuries represented 49% (130 males and five females) of the cases. Among the penetrating injury group, three patients (1.1%) were with direct sustaining cardiac injuries. The most common presenting features associated with injuries were pain (100%), dyspnea (78.6%) and hemorrhagic shock (17%). Concurrent extrathoracic injuries were found in 22.2% (61/275) of the total chest injuries; spinal cord injuries (3.3%; 9/275), brain injuries (6.2%; 17/275) and intraperitoneal injuries (4.4%; 12/275) and bone fractures (7.3%; 23/275). The first three types of extrathoracic injuries were mostly due to penetrating injuries that necessitated a thoracoabdominal approach or chest tube drainage (CTD) and laparotomy. Computerized tomography scan, chest X-ray, ultrasound and echocardiography were the main diagnostic tools, being used for the diagnosis of 95.27%, 96.72%, 9.73% and 9.33% of cases, respectively. Intercostal tube thoracostomy was required for the management of 96.3% (130/135) of patients with penetrating injuries; early thoracotomy was performed in 25.9% (35/135) of patients to control over bleeding while late thoracotomy was performed in 16.3% (22/135) of patients for removal of retained foreign body and empyema. The CTD was performed in 76.4% (107/140) of patients with blunt injuries, whereas 23.6% (33/140) patients had conservative management and only 2.9% (4/140) of patients underwent thoracotomy. The average hospital length of stay was 6 days for penetrating trauma group and about 7 days for blunt trauma group. Out of all admitted cases, 94.5% (260/275) were cured while 5.5% (15/275) died. It is concluded that CTD is the most appropriate method of treating complicated chest injuries; however, the penetrating trauma has a higher rate of internal damage that requires early intervention to save life, especially for severe or progressive intrathoracic bleeding and cardiac injury. Pulmonary contusion and rib fracture were the most common complications of chest traumas, for which strong painkillers, anti-infective therapy, respiratory care measures and mechanical ventilation are the components of an effective treatment strategy. The associated extrathoracic injuries constitute a major prognostic factor in chest traumas, which were higher in blunt traumas.

Objective: To investigate the patterns of thoracic injuries and the methods used for their management.Methods: A retrospective descriptive analysis of 275 chest trauma cases managed at the University of Science and Technology Hospital over the period 2010–2013.Results: Of 275 consecutive patients with chest trauma, 72.7% were males and 7.27% were females with a mean age of 33.6 years old. Blunt injuries represented 51% (125 males and 15 females) while penetrating injuries represented 49% (130 males and five females) of the cases. Among the penetrating injury group, three patients (1.1%) were with direct sustaining cardiac injuries. The most common presenting features associated with injuries were pain (100%), dyspnea (78.6%) and hemorrhagic shock (17%). Concurrent extrathoracic injuries were found in 22.2% (61/275) of the total chest injuries; spinal cord injuries (3.3%; 9/275), brain injuries (6.2%; 17/275) and intraperitoneal injuries (4.4%; 12/275) and bone fractures (7.3%; 23/275). The first three types of extrathoracic injuries were mostly due to penetrating injuries that necessitated a thoracoabdominal approach or chest tube drainage (CTD) and laparotomy. Computerized tomography scan, chest X-ray, ultrasound and echocardiography were the main diagnostic tools, being used for the diagnosis of 95.27%, 96.72%, 9.73% and 9.33% of cases, respectively. Intercostal tube thoracostomy was required for the management of 96.3% (130/135) of patients with penetrating injuries; early thoracotomy was performed in 25.9% (35/135) of patients to control over bleeding while late thoracotomy was performed in 16.3% (22/135) of patients for removal of retained foreign body and empyema. The CTD was performed in 76.4% (107/140) of patients with blunt injuries, whereas 23.6% (33/140) patients had conservative management and only 2.9% (4/140) of patients underwent thoracotomy. The average hospital length of stay was 6 days for penetrating trauma group and about 7 days for blunt trauma group. Out of all admitted cases, 94.5% (260/275) were cured while 5.5% (15/275) died.Conclusions: It is concluded that CTD is the most appropriate method of treating complicated chest injuries; however, the penetrating trauma has a higher rate of internal damage that requires early intervention to save life, especially for severe or progressive intrathoracic bleeding and cardiac injury. Pulmonary contusion and rib fracture were the most common complications of chest traumas, for which strong painkillers, anti-infective therapy, respiratory care measures and mechanical ventilation are the components of an effective treatment strategy. The associated extrathoracic injuries constitute a major prognostic factor in chest traumas, which were higher in blunt traumas.