Objective: Traumatic diaphragmatic rupture (TDR) is a rare but potentially life threatening clinical entity with a high incidence of associated injuries. In this article, our experience with this challenging diagnosis is presented. Methods: In this study, a total of 68 patients with TDR, were operated in our center between July 1994 and September 2005. Study group was analyzed retrospectively. The etiological factors, management and outcomes were discussed. Results: The mean age was 32.9 years with a female to male ratio of 9/59. TDR was right-sided in 16.2% (n = 11) and left-sided in 83.8% (n = 57). The cause of the rupture was penetrating trauma in 51 (75%), and blunt trauma in 17 (25%). Only three patients (4.4%) had late diagnosis. Associated injuries were seen in 91% (n = 62) of the patients. The most common used incision was a laparotomy incision (89.6%). Morbidity and mortality were encountered in 13.1% (n = 9) and 16.2% (n = 11) patients, respectively. Conclusions: Although rare, diaphragmatic rupture must be suspected in any patient with thoracoabdominal injury. Early diagnosis of TDR is sometimes difficult and depends on a high index of suspicion. Surgical repair is necessary even for small tears. The most common approach is the transabdominal approach, which allows a complete exploration of the abdominal organs for associated injuries. The transthoracic approach might be used in most cases with latent diaphragmatic rupture. #

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CT bronchus sign (BS) designates a bronchus leading directly to a peripheral pulmonary lesion. The objective of this investigation is to determine the contribution of BS-guided bronchoscopic multiple diagnostic procedures (BMDPs) to the diagnostic yield of solitary nodules or masses (SPNMs) suspected of pulmonary carcinoma (PC). A prospective study was carried out in 92 patients with a 2–5 cm diameter SPNM at the level of third to fifth bronchial branching and without endobronchial tumors. Within 10 days after 2-mm CT scans were done, in each of 92, bronchial washing (BW), brushing (BR), transbronchial needle aspiration (TBNA) and transbronchial lung biopsy (TBB) were performed respectively, via fiberoptic bronchoscopy (FB) under fluoroscopic guidance. In 40 (82%) of 49 with BS and in 19 (44%) of 43 without BS, FB established the diagnosis (p < 0.01). In 84 cases of PC, BW, BR, TBNA and TBB provided the diagnostic yields of 4% (3), 26% (22), 57% (48) and 49% (41), respectively; the combined yield reached 68% (57). A metastasis and a tuberculoma were diagnosed exclusively by TBB, and TBNA, respectively. All differences of diagnostic yield except that between TBNA and TBB (p > 0.05) were determined to be significant (p < 0.05). Thoracotomy verified diagnosis in 48 of 59 cases diagnosed and 19 of 33 undiagnosed by FB, and various tissue biopsies or clinical follow-up in 11 diagnosed and 14 undiagnosed by FB. The above data suggest that in the diagnosis of PC as a SPNM at the level of third–fifth bronchial branching, combining the guidance of CT BS, and BMDPs under fluoroscopic guidance can increase the yield considerably.

Ectopic localisation of the pancreas is not an uncommon entity, but it is mostly seen in the gastrointestinal tract. Herein we report a 45-year-old woman with a cyst containing pancreatic tissue in the mediastinum. The English literature reveals only three previous cases of this extremely rare localisation of the pancreas.

Aspiration of teeth and dental restorations is a recognized, yet an infrequent happening in the literature. Main reasons of aspiration are maxillofacial trauma, dental treatment procedures or ethanol intoxication and dementia. The present case of a 2-unit bridge aspiration is however, not related with any trauma, dental procedure or systemic disease. A 37-year-old male patient had aspirated his bridge while sleeping and the bridge remained unidentified for 1 year despite the radiographic controls. He was then referred to the Chest Diseases Department of School of Medicine, Ege University and the radio-opaque object in the right intermediate bronchus was diagnosed to be an aspirated dental prosthesis. Subsequent to the failure of the rigid bronchoscopy, the patient was referred to the Thoracic Surgery Department and had to be operated for retrieval of the foreign body.

The most important prognostic factor for overall survival was the extent of resection. Further studies with larger numbers of patients are required to confirm the prognostic factors and to obtain a better understanding of the biological behavior of TETs.

A 34-year-old woman presented with chest pain and a solitary pulmonary nodule on chest roentgenogram. She was diagnosed with a rare benign lung tumor, alveolar adenoma of the lung, through pathological examination of the surgical specimen resected from the left upper lobe. Clinicians should also keep this entity in mind when making the differential diagnosis of a solitary pulmonary nodule.

In a prospective study series of 167 patients with tube thoracostomy for spontaneous pneumothorax in 1993-1996, 32 patients (age range 16-79 years, mean age 45.5 years) were treated with autologous blood-patch pleurodesis for persistent air leak. In 27 (84%) of cases the air leak ceased within 72 h after the pleurodesis. The duration of air leak was significantly shorter (p < 0.01) than in simple drainage. Empyema developed in three cases, and two patients with failed pleurodesis required open thoracotomy. Minor complications, mainly fever and pleural effusion, occurred in nine patients. Neither analgesia nor sedation was required during or after pleurodesis. There was no recurrence of pneumothorax during 12-48 months of observation, whereas simple drainage was followed by recurrence in 22 patients. Blood-patch pleurodesis is a simple, effective and painless method in pneumothorax, but carries an increased risk of intrathoracic infection.