1/21. Management of a patient with hepatic-thoracic-pelvic and omental hydatid cysts and post-operative bilio-cutaneous fistula: a case report.In humans, most hydatid cysts occur in the liver and 75% of these are single. Our patient was a 31 year-old male. His magnetic resonance imaging (MR) showed one cyst (15 x 20 cm) in the right lobe and three cysts (5 x 6 cm, 8 x 6 cm, and 5 x 5 cm) in the left lobe of the liver, two cysts (4 x 5 cm and 5 x 5 cm) on the greater omentum, and two cysts (15 x 10 and 10 x 10 cm) in the pelvis. The abdomen was entered first by a bilateral subcostal incision and then by a Phennenstiel incision. Partial cystectomy capitonnage was done on the liver cysts; the cysts on the omentum were excised, and the pelvic cysts were enucleated. The cyst in the right lobe of the liver was in communication with a thoracic cyst. An air leak developed from the thoracic cyst which had underwater drainage and bile drainage from the drain in the cavity of the right lobe cyst. Sphincterotomy was done on the seventh post-operative day by endoscopic retrograde cholangiopancreatography (ERCP). No significant effect on mean bile output from the fistula occurred. octreotide therapy was initiated, but due to abdominal pain and gas bloating the patient felt and could not tolerate, it was stopped on the fourth day; besides, it had no decreasing effect on bile output during the 4 days. Because air and bile leak continued and he had bile stained sputum, he was operated on on post-operative day 18. By right thoracotomy, the cavity and the leaking branches were closed. By right subcostal incision, cholecystectomy and T-tube drainage of the choledochus were done. On post-operative day 30, he was sent home with the T-tube and the drain in the cavity. After 3 months post-operatively, a second T-tube cholangiography was done, and a narrowing in the distal right hepatic duct and a minimal narrowing in the distal left hepatic duct were exposed. Balloon dilatation was done by way of a T-tube. bile drainage ceased. There was no collection in the cavity in follow-up CT scanning, so the drain in the cavity, and the drainage catheter in the right hepatic duct were extracted. Evaluation of the biliary ductal system is important in bilio-cutaneous fistulas, and balloon dilatation is very effective in fistulas due to narrowing of the ducts.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
2/21. Transdiaphragmatic abscess: late thoracic complication of laparoscopic cholecystectomy.Spillage of gallstones into the peritoneal cavity is a frequent problem during laparoscopic cholecystectomy (as much as 30%) and is frequently dismissed as a benign occurrence. However, several complications associated with spillage of gallstones have been reported recently. Most of these complications presented late after the original procedure, many with clinical pictures not related to biliary etiology, confounding and delaying adequate management. For patients presenting with intraabdominal or thoracic abscesses of unknown etiology, if there is a history of laparoscopic cholecystectomy, regardless of the time interval, certain evaluations should be considered. A sonogram and a CT scan are advisable to detect retained extraluminal gallstones, as most patients will require, not only drainage of fluid collections, but also removal of the stones. A case is described of a patient who presented with a right empyema and transdiaphragmatic abscess 18 months after a laparoscopic cholecystectomy. Treatment included decortication, enbloc resection of the abscess, repair of the diaphragm, and drainage.- - - - - - - - - - ranking = 0.2keywords = cavity (Clic here for more details about this article) |
3/21. Thoracolithiasis.Thoracolithiasis without any history of chest traumas or interventions is pathologically rare, with only 9 cases including our 2, reported thus far in the literature. Case 1: A 76-year-old man admitted to our hospital had an abnormal shadow in chest radiography that gradually enlarged. serum carcinoembrionic antigen was slightly elevated during follow-up. A milky white tumor 1.5 cm in diameter with many projections was found in the thoracic cavity and removed by thoracoscopy. Histopathological examination showed the tumor to consist of fibrous tissue with fatty necrosis at the core. Case 2: A 54-year-old woman admitted to our hospital had an abnormal shadow in chest screening radiography in 1998. Transbronchial biopsy showed this shadow to be lung adenocarcinoma. A small trigonal pyramid-shaped milky white nodule 5 mm in diameter was found in the thorax during lobectomy for lung cancer. Histopathological examination showed this nodule also to consist of fibrous tissue with fatty necrosis.- - - - - - - - - - ranking = 0.2keywords = cavity (Clic here for more details about this article) |
4/21. Anesthetic implications of thoracic endometriosis.endometriosis occurs in 5% to 10% of women of childbearing age and involves the proliferation of endometrial tissue outside the uterine cavity. Thoracic endometriosis is the most frequent extrapelvic manifestation of endometriosis, numbering some 100 reported cases. It may include spontaneous pneumothorax, hemoptysis, chest pain, bronchiectasis, pneumomediastinum, or mediastinal bleeding. Because the tissue is hormonally responsive, all of these manifestations are related to the menstrual cycle (catamenial) and are likeliest to occur during menses. We report the successful anesthetic management of a patient with thoracic endometriosis and recurring catamenial pneumothorax who presented for elective pelvic surgery.- - - - - - - - - - ranking = 0.2keywords = cavity (Clic here for more details about this article) |
5/21. Thoracic problems associated with hydatid cyst of the dome of the liver.Twenty patients with hydatid cyst of the dome of the liver are presented. In ten there were significant associated intrathoracic complications including pleural effusion, pleural empyema, erosion through the diaphragm into lung, various degrees of pneumonitis or pulmonary abscess, or severe destruction of both diaphragm and right lower pulmonary lobe. Bronchobiliary fistula was demonstrated at operation in five patients. Four patients had obstructive jaundice due to intrabiliary rupture of a liver hydatid. In 19 patients the cysts in the right lobe of the liver were evacuated through a right thoracotomy and incision of the diaphragm. In four of these, additional pulmonary resection was carried out. In one patient with left pleural empyema, tube drainage followed by rib resection was instituted. Two patients had common duct drainage for relief of obstructive jaundice. In 13 patients the ectocyst cavity was drained; in seven it was filled with saline and closed. One patient required evacuation and open packing of the right upper quadrant and lower right hemithorax. thoracotomy is mandatory in patients with hydatid cyst of the dome of the liver for easier approach to the cyst and for management of coexisting intrathoracic complications.- - - - - - - - - - ranking = 0.2keywords = cavity (Clic here for more details about this article) |
6/21. Extrusion of peritoneal catheter through a thoracic skin fistula: report of a rare complication of ventriculoperitoneal shunt.A very rare complication of ventriculoperitoneal shunt is presented. The tip of the distal catheter extruded through a skin fistula in the right subclavian region. After the replacement of a new catheter in the peritoneal cavity, inflammation of the overlying scar occurred. Then, a ventriculoatrial shunt was carried out. The authors suggest a possible mechanism of this complication.- - - - - - - - - - ranking = 0.2keywords = cavity (Clic here for more details about this article) |
7/21. Thoracic splenosis twenty-nine years after traumatic splenectomy mimicking intrathoracic neoplasm.Thoracic splenosis refers to a condition of ectopic splenic tissue in the thoracic cavity. It is usually a consequence of splenic tissue seeding in the pleural cavity after thoracoabdominal trauma. A rare case of thoracic splenosis, in a 62-year-old man who had had a traumatic splenectomy due to thoracoabdominal trauma 29 years earlier, is reported. The patient, a heavy smoker, was admitted for evaluation of a left-side thoracic lesion discovered on a plain chest film. bronchoscopy, CT scan and needle biopsy proved inconclusive for the diagnosis. Exploratory thoracotomy was necessary to establish the diagnosis. During the operation, a thoracic splenosis was confirmed. To date, only 28 cases of thoracic splenosis have been reported in the literature. The purpose of this report is to present a new case of splenosis of the thoracic cavity simulating intrathoracic neoplasm.- - - - - - - - - - ranking = 0.6keywords = cavity (Clic here for more details about this article) |
8/21. Thoraco-pleuropneumonectomy for rupture of a huge chronic hematoma of the thorax.A 67-year-old woman with a huge chronic expanding hematoma of the thorax due to previous tuberculous pleuritis was referred to our hospital with frequent hemoptysis. The hematoma had ruptured into the lung parenchyma. The patient had undergone apical thoracoplasty 40 years earlier. To provide complete resection of the huge cavity in the costodiaphragamatic recess, thoraco-pleuropneumonectomy was performed, and the patient was able to resume daily activities a few months after the operation.- - - - - - - - - - ranking = 0.2keywords = cavity (Clic here for more details about this article) |
9/21. Suppurated mediastinal and cardiac echinococcosis: report of a case.We herein report the case of a suppurated mediastinal and cardiac hydatid cyst which occurred after the initial treatment of the patient for a primary mediastinal hydatid cyst in a radiology department. Both extracorporeal circulation and total circulatory arrest were used during the operation. We believe that surgery is the only feasible treatment for hydatid cysts located in the mediastinum, and surgery should be urgently performed whenever a possible rupture is suspected in order to avoid a possible anaphylactic reaction, mediastinal suppurations leading to serious complications, and growth into the pleural cavity.- - - - - - - - - - ranking = 0.2keywords = cavity (Clic here for more details about this article) |
10/21. Congenital intrathoracic kidney with right Bochdalek defect.Intrathoracic kidney is a rare congenital anomaly. Since most reported cases are asymptomatic, it is extremely rare for this ectopia to be diagnosed in the neonatal period. We report a male infant with right intrathoracic kidney associated with Bochdalek defect. Chest X-ray demonstrated a right posterior mediastinal mass and intestinal gas in the right lung field. Contrast-enhanced CT and intravenous urography led to a diagnosis of intrathoracic kidney. Due to the presence of Bochdalek defect, the intrathoracic kidney was reduced into the abdominal cavity at the time of diaphragmatic repair. The intrathoracic kidney with attached adrenal gland was located at the level of the carina and was covered with protruded retroperitoneum. The kidney was thought to have been pushed this high by the small intestine and left lobe of the liver, which had also herniated through the defect. Postoperative hemodynamics and renal function were normal.- - - - - - - - - - ranking = 0.2keywords = cavity (Clic here for more details about this article) |
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