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Lung
Ventral Scapular Osteochondroma in Hereditary Multiple Exostosis
Hereditary multiple exostosis is a rare, autosomal dominant, highly penetrant genetic disorder characterized by the development of osteochondromas on the metaphysis of long and flat bones. The development of osteochondromas on the scapula is unusual but has been reported. Here, we present a case of an osteochondroma of the ventral scapula with preoperative concern for invasion into the second rib. Through an open approach, the lesion was found to be well isolated within a bursa, and it was resected without complication.Transthoracic Removal of Pulmonary Artery Foreign Body by Percutaneous Balloon Occlusion
Removal of a foreign body in the pulmonary circulation is typically attempted by an endovascular approach as the first attempt. The pulmonary artery must be occluded either manually or with cardiopulmonary bypass during the procedure. Here, we report a case of video-assisted thoracic surgery to remove a foreign body from the right pulmonary artery under percutaneous balloon artery occlusion.Carinal Resection and Extended Sleeve Lobectomy After Right Upper Sleeve Lobectomy: 1 Step Beyond
We describe the case of a 54-year-old man with a history of non–small cell lung cancer for which we performed a right upper sleeve lobectomy after chemotherapy. Pathologic examination reported a ypT1 N1 M0 R0 epidermoid carcinoma. Two years later, a local recurrence involving the tracheal carina and the previous anastomosis line was diagnosed. Carinal sleeve resection, including middle sleeve lobectomy extended to segment 6, replacement of the right pulmonary artery, and lower lobe reimplantation in the left main bronchus, was performed, achieving complete resection.Lung Nodule Marking With ICG Dye–Soaked Coil Facilitates Localization and Delayed Surgical Resection
Whereas diagnosis and treatment of pulmonary nodules may be combined during a surgical resection, this approach may lead to excision of benign lesions and excessive healthy lung tissue if the lesion is difficult to localize. Bronchoscopy-guided marking of pulmonary nodules before surgery may facilitate this process, but it is limited by current technologies and often challenging as dye marking may dissipate if surgery is performed days later. We present a novel method to address this problem that allows surgery multiple days after lesion marking with accurate localization.Improved Right Ventricular Diastolic Function Assessed by Hepatic Vein Flow After Pectus Excavatum Repair
The cardiovascular benefits of surgical repair in pectus excavatum (PEx) continue to be debated, with limited data supporting repair in adult patients. Hepatic vein flow is used to identify right-sided diastolic dysfunction in cardiovascular disorders, including tricuspid stenosis, cardiac tamponade, and constrictive pericarditis. This study evaluates the effects of cardiac compression on diastolic function (as assessed by hepatic vein flow patterns and velocities) before and after repair of PEx.Bilateral Sternocostal Joint Resection for Chronic Refractory Pain After Nuss Procedure
Chronic postoperative pain that can be difficult to treat may occur after the Nuss procedure. This report introduces a case of unrelenting chronic postoperative pain at the bilateral sternocostal joints after the Nuss procedure that responded to bilateral resection of sternocostal joints.Complete Pathologic Response of Squamous Cell Carcinoma Abutting an Internal Mammary Bypass Graft
We present a case of an advanced squamous cell carcinoma encroaching on a patient’s left internal mammary artery bypass graft. Tumor board consensus was to proceed with 2 cycles of neoadjuvant chemotherapy followed by resection. Intraoperatively, the left internal mammary artery bypass could not be safely dissected from the adjacent pleura, but frozen sections were negative for malignant transformation. Final pathologic examination showed a complete pathologic response to neoadjuvant chemotherapy, and surveillance imaging is now negative for recurrence 5 years postoperatively.Localized Synchronous Pulmonary Langerhans Cell Sarcoma and Langerhans Cell Histiocytosis
A synchronous presentation of pulmonary lesions of Langerhans cell sarcoma (LCS) and Langerhans cell histiocytosis (LCH) is extremely rare. We report the case of a 57-year-old man with 3 pulmonary nodules, 1 in the left lung and 2 in the right lung. In a 2-stage operation, he first underwent a left segmentectomy, and the nodule was diagnosed as LCS. Thereafter, 1 of the 2 right pulmonary nodules disappeared. The residual nodule was resected by right segmentectomy and was diagnosed as LCH. This is a report of complete resection of localized, synchronous pulmonary lesions of LCS and LCH.Neoadjuvant Targeted Therapy in Non–Small Cell Lung Cancer and Its Impact on Surgical Outcomes
The evidence for neoadjuvant targeted therapy in non–small cell lung cancer is limited, with 2 phase 3 trials currently recruiting and no approved indications.The J Technique for Barbed Suture Closure
We share our novel technique using barbed sutures for subcuticular purse-string suture closure during chest tube insertion and removal.To Cross or Not to Cross: The Cross-Bar Technique to Correct Pectus Excavatum With “Costal Flaring”
The minimally invasive repair of pectus excavatum (PE), introduced by Nuss in 1998, represents the worldwide “gold standard” procedure for surgical repair. Modifications over years included routine use of unilateral or bilateral thoracoscopy as well as sternal elevation before starting the substernal dissection. In patients with a severe PE deformity, such as Grand Canyon type, use of a second bar or, in selected patients, even a third or fourth bar has to be considered. However, not only the number of bars but also positioning may vary.Thoracoscopic Right Lower Lobectomy in a Patient With a Common Trunk of the Right Pulmonary Veins
Varied branching patterns of the pulmonary veins are widely known; however, the common trunk of the right pulmonary veins is sparsely described. We report the details of a right lower lobectomy in a patient with a common trunk of the right pulmonary veins. Besides an attentive interpretation of computed tomography images, 3-dimensional reconstruction aids in the preoperative recognition of this anomaly. To ensure safe division of the lower lobe vein, adequate exposure of the pulmonary hilum is needed, supported by prior interlobar fissure division between the middle and lower lobes.Benign Lung Adenoma Mimicking an Adenocarcinoma With EML4-ALK Gene Fusion
Bronchiolar adenoma is a benign neoplastic process thought to be derived from the bronchiolar epithelium. Particularly in small biopsy specimens, this entity can mimic lung cancer with important implications for management. We report the case of a 33-year-old man with a right upper lobe lung nodule, with initial biopsy identifying an adenocarcinoma with EML4-ALK gene fusion. After being considered for neoadjuvant targeted therapy trials, the patient underwent a lobectomy. On postoperative histologic evaluation, the patient was found to have a benign bronchiolar adenoma.Extra-axial Chordoma of the Sternoclavicular Joint
Chordomas are rare, slowly growing, aggressive primary bone tumors that originate from notochord remnants and occur almost exclusively in the axial skeleton. Here, we describe a patient with an enlarging right-sided neck mass that was later diagnosed as a sternoclavicular joint chondroid chordoma. En bloc surgical resection was accomplished with negative margins. The patient continues to do well 15 months after resection without radiotherapy. This case highlights the importance of considering a wide differential in managing sternoclavicular joint tumors.Bronchoesophageal Fistula After Systematic Mediastinal Lymph Node Dissection With Pulmonary Lobectomy
We present a case of a bronchoesophageal fistula after a lobectomy with systematic mediastinal lymphadenectomy for lung adenocarcinoma. A 70-year-old woman was readmitted with postprandial cough, fever, and dysphagia on postoperative day 13. Computed tomography revealed a bronchoesophageal fistula between the left main bronchus and esophagus. Esophagogastroscopy revealed a 3-mm fistula 30 cm from the incisors. Two rounds of endoscopic closure with metal clips were performed. The patient has survived for 24 months with no evidence of recurrent fistula.An Improved Chest Wall Reconstruction Technique With Twisted Steel Wire–Reinforced Neoribs
Large chest wall defects often require reconstruction to improve the functionality of the chest wall and to achieve aesthetic results. An optimized technique for chest wall reconstruction with superior mechanical properties is presented here.Minimally Invasive Treatment of Tunneled Central Venous Catheter–Associated Venobronchial Fistula
Venobronchial fistula (VBF) is a rare complication of central venous access. We describe a 30-year-old woman with VBF associated with a tunneled venous catheter. She presented with a drowning sensation associated with infusions. Extravasation of contrast material on fluoroscopy confirmed the presence of a fistula between the superior vena cava and bronchial tree. After multidisciplinary planning, the patient underwent catheter removal. An interventional pulmonologist placed a bronchial blocker and a cardiac surgeon positioned an endovascular occlusion balloon to mitigate life-threatening risk of intrabronchial hemorrhage.Simplified Segmentectomy of Right Subsuperior and Posterior Basal Segments
Thoracoscopic segmentectomy, involving the posterior basal segment of the lower lobe, is one of the most challenging procedures and often requires incision of irrelevant lung parenchyma from the interlobar fissure and complex stapling techniques for dividing intersegmental planes. This report describes a simplified thoracoscopic segmentectomy for the subsuperior and posterior basal segments (S∗ + S10), without interlobar fissure dissection or complex intersegmental division.Salvage Pleurectomy/Decortication After Immunotherapy for Sarcomatoid Malignant Pleural Mesothelioma
Sarcomatoid malignant pleural mesothelioma (MPM) is a highly aggressive malignant tumor. Surgery may not be recommended, and chemotherapy is less effective. More recently, immunotherapy has become a new standard treatment of care for advanced MPM across all histologic subtypes. This reports describes a case of salvage lung-sparing surgery (pleurectomy with decortication) after immunotherapy with nivolumab in combination with ipilimumab for sarcomatoid MPM. The surgical specimen showed that a major pathologic response was achieved with immunotherapy.Tracheal Reconstruction Using Endotracheal Stent and Pectoralis Major Muscle Flap
We present a case of tracheal anastomotic dehiscence requiring circumferential tracheal replacement. We developed a novel approach by deploying a silicone stent using a hybrid surgical and endobronchial technique, followed by pectoralis major flap coverage. The patient has remained free from dyspnea 6 months after the operation. Our interdisciplinary approach represents a relatively straightforward solution to tracheal anastomotic dehiscence, one of the most devastating complications in thoracic surgery.Atypical Vertebral Hemangioma in a Patient With Newly Diagnosed Pulmonary Nodule
Vertebral hemangiomas (VHs) are common, benign angiomatous lesions of the spine with an incidence rate of 10% to 12% in the population. VHs have a characteristic appearance on imaging; however, a subset demonstrate atypical features that resemble more sinister pathologic processes, such as malignant neoplasms or metastatic disease. We report a case of an atypical VH that was initially thought to be a metastasis in a 75-year-old patient with a newly diagnosed pulmonary nodule. Our goal is to highlight the key findings of VHs on various imaging modalities that can potentially help minimize unnecessary investigations or interventions.
