RESUMEN
BACKGROUND: Pulmonary hydatid cysts are recognized to have high rate of rupture compared to those in other affected organs. To identify risk factors associated with endobronchial rupture, we prospectively assessed 32 patients with hydatid cysts. There were 21 males and 11 females, with a mean age of 32 ± 15 years (range 9 to 65 years). METHODS: All patients undergoing thoracotomies for hydatid cysts were included. Demographic data, site, size, and whether cysts were ruptured or intact, were reviewed. Intraoperatively, bronchial fistula diameters were measured. A stepwise multiple logistic regression model was used to analyze the results. RESULTS: Seventeen (53.1%) patients presented with ruptured cysts (group 1) and 15 with intact cysts (group 2). There was a significant difference in mean fistula diameter between groups: 6.16 ± 2 mm in group 1 vs. 0.34 ± 0.19 mm in group 2 (p ≤ 0.0001), which was identified as the only significant risk factor associated with cyst rupture. CONCLUSION: At the fistula site, the intracystic pressure is unopposed, leading to herniation of the endocyst membrane, disruption of its integrity, and rupture. Therefore, we postulate that this scenario in combination with other coexisting factors could be the possible mechanism for cyst rupture in group 1. This concept may also explain the pathogenesis of the high rate of rupture of pulmonary hydatid cysts. Accordingly, we consider these cysts a naturally occurring model for rupture, which should be treated surgically as soon as the diagnosis is made, to avoid complications.
Asunto(s)
Fístula Bronquial/etiología , Equinococosis Pulmonar/complicaciones , Adolescente , Adulto , Anciano , Fístula Bronquial/diagnóstico por imagen , Fístula Bronquial/fisiopatología , Fístula Bronquial/cirugía , Broncoscopía , Niño , Equinococosis Pulmonar/diagnóstico por imagen , Equinococosis Pulmonar/fisiopatología , Equinococosis Pulmonar/cirugía , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Presión , Estudios Prospectivos , Factores de Riesgo , Rotura Espontánea , Arabia Saudita , Toracotomía , Adulto JovenRESUMEN
Blunt trauma to the chest accounts for most thoracic injury cases. Tracheobronchial injuries are rare. They require high index of suspicion to diagnose and manage promptly. We present a case of left main bronchial rupture, in which delayed surgical repair was carried out after more than a year from the initial injury with complete resolution of the injury. This report adds to the literature the feasibility of aiming for surgical repair regardless of the delayed duration. The emphasis was drawn to the cellular and mucus preservative capacity to combat infection in these chronically collapsed lungs.
Asunto(s)
Bronquios/lesiones , Traumatismos Torácicos/cirugía , Adolescente , Humanos , MasculinoRESUMEN
OBJECTIVE: This study was a prospective evaluation of surgical indications and outcomes for unilateral and bilateral bronchiectasis according to hemodynamic (functional and morphologic) classification. METHODS: Between January 1998 and January 2004, the morphologic features (cystic versus cylindric) by chest computed tomography and the hemodynamic features (perfused versus nonperfused) by lung ventilation/perfusion scan were determined in 66 patients with bronchiectasis (53 unilateral and 13 bilateral). The indication for surgical resection in both groups was the presence of localized areas of cystic, nonperfused bronchiectasis. RESULTS: In the unilateral bronchiectasis group, there were 28 female and 25 male patients with an average age of 37.5 +/- 3.8 years (range 6-40 years). Pneumonectomy was performed in 10 cases (8 left and 2 right), and lobectomy or bilobectomy was performed in 43. In the bilateral group, there were 7 male and 6 female patients with an average age of 42 +/- 5.4 years (range 9-55 years). Pneumonectomy was performed in 2 cases, lobectomy in 5, and bilateral staged lobectomy in 6. There was 1 postoperative death (1.5%), and morbidity was 18% (12 patients). Four patients required reexploration for bleeding, 4 had prolonged air leak develop, 3 acquired pulmonary infections, and 1 had localized empyema develop. During a mean follow-up of 52 months (range 24-82 months), 48 patients were considered cured (73%) and 17 had symptomatic improvement (26%). Pseudomonas infection and underlying chronic obstructive airway disease were poor prognostic factors (P < .05). CONCLUSION: The hemodynamic (functional and morphologic) classification provides an accurate functional classification for bronchiectasis. Its application in determining the indications and extent of surgical resection is superior to morphologic classification alone. Curative resection can be achieved in both unilateral and bilateral bronchiectasis with acceptable morbidity.
Asunto(s)
Bronquiectasia/fisiopatología , Bronquiectasia/cirugía , Adolescente , Adulto , Bronquiectasia/clasificación , Niño , Femenino , Estudios de Seguimiento , Hemodinámica , Humanos , Masculino , Estudios ProspectivosRESUMEN
We report two cases of unusual presentation of rib exostosis. The first patient presented acutely with hemorrhagic shock due to massive hemothorax, and the second patient presented with repetitive chest infection complicated by empyema. In both patients, preoperative computed tomographic (CT) scan of the chest revealed rib exostoses, necessitating thoracotomy and rib resection.