RESUMEN
Hemoptysis constitutes a common and urgent medical problem. Swift and effective management is of crucial importance, especially in severe, life-threatening cases. Because of bronchial artery or a branch of pulmonary artery erosion due to cavitary infiltration, bronchiectasis, fungus ball, broncholithiasis, or destroyed lung, the bleeding can lead to highly compromised gas exchange or sometimes can be a life-threatening situation. Chest computerized tomography and bronchoscopy remain the methods of choice for lateralization of the disease. Some patients can be treated successfully with endobronchial interventions. Bronchial artery embolization can be rewarding in some patients but the recurrence rate is higher in tuberculosis than other etiologies of hemoptysis. Surgical resection of the lung, mainly lobectomy, remains a life-saving procedure but it should be performed very selectively to avoid higher postoperative morbidity and mortality.
RESUMEN
Chondrosarcoma of the chest wall is a rare primary neoplasm found to occur in elderly men. Patients present with an enlarging, painful, anterior chest wall mass arising from either the vicinity of the costochondral junction or the sternum. Treatment includes wide resection with appropriate chest wall reconstruction. We report an unusual presentation of this uncommon tumor occurring as a huge chest wall mass in a young teenage girl.
RESUMEN
Subclavian artery pseudoaneurysms are rare; and cases involving subclavian artery pseudoaneurysms presenting with compression on trachea leading to breathing difficulty are exceptional. We present a case report of huge subclavian artery pseudoaneurysm presenting with hoarseness of voice, respiratory distress, and aphonia. Patient was operated through median sternotomy, with the incision extended over the swelling. Aortic looping was done before opening the aneurysm. Rent in the right subclavian artery was identified and repaired. Because of the absence of a distal pulsation beyond the repaired site, we placed a reversed saphenous vein graft from the ascending aorta (end-to-side) to the right subclavian artery distal to repaired site (end-to-side). Good pulsation was achieved in the right brachial, right radial, and right ulnar arteries. Patient was extubated after 6 hours in stable condition.
Asunto(s)
Obstrucción de las Vías Aéreas/etiología , Aneurisma Falso/complicaciones , Síndrome de Dificultad Respiratoria/etiología , Arteria Subclavia , Adolescente , Obstrucción de las Vías Aéreas/cirugía , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/cirugía , Afonía/etiología , Ronquera/etiología , Humanos , Masculino , Síndrome de Dificultad Respiratoria/cirugía , Vena Safena/trasplante , Esternotomía , Arteria Subclavia/diagnóstico por imagen , Arteria Subclavia/cirugía , Tomografía Computarizada por Rayos X , Injerto VascularRESUMEN
The presentation of the bronchogenic cyst is variable, making pre-operative diagnosis difficult. Majority of them are either asymptomatic or discovered incidentally. The most common presenting symptoms are cough, fever and dyspnea. We discuss the case of a large bronchogenic cyst in the posterior mediastinum causing oesophageal compression and impinging on the left atrium. The patient presented with dysphagia and back pain and was extensively investigated by various physicians before being diagnosed as having bronchogenic cyst. We concluded that the backache was due to stretching of nerves in the parietal pleura. This case demonstrates the need for detailed investigations prior to treatment of patients with such symptom complex as a bronchogenic cyst may be the cause of such symptoms.
RESUMEN
Although splenic artery aneurysm (SAA) is the commonest visceral and third most common intra abdominal aneurysm after aorta and iliac artery, aneurysm of splenic artery along with aneurysm of splenic vein with arteriovenous (a-v) fistula communication between them is a rare entity. Most are <3 cm in diameter. Giant true SAAs are rare and very few lesions >10 cm have been reported. We hereby report a case of an 18 cm x 15 cm size splenic artery and vein aneurysm with a-v fistula in an adult female nulliparous woman who presented with progressively enlarging pulsatile mass in the left upper abdomen with long-standing intractable pancytopenia and splenomegaly. Diagnosis was established by CT (computed tomogram) angiogram and laboratory tests. Laparotomy demonstrated huge well-defined aneurysm of splenic artery and vein with splenic a-v fistula, extending in all except the right lower and inferior quadrants of the abdomen along with splenomegaly. Aneurysmectomy with splenectomy was done.