MyMedR

A light emiting diode in a child's airway

Chan L, Yik YI, Subramaniam KN, Ramanujam TM

JUMMEC, 2002;7:150-151.

A case of an unusual foreign body aspiration in a child was managed T&ently. The mainstay in treahnen! is urgent extraction of the aspirated foreign body via a bronchoscope under general anaesthesia. A thoracotomy may sometimes be required when endoscopic retrieval fails, as illustrated by this case. She had an increased hospital Slay of 16 days, was ventilated for 8 days and her most serious complication was septic shock from which she recovered. KEYWORDS: Foreign body aspiration, children.

Matched MeSH terms: Thoracotomy

Anesthetic management of thoracoscopic resection of lung lesions in small children

Mohtar S, Hui TWC, Irwin MG

Paediatr Anaesth, 2018 11;28(11):1035-1042.

PMID: 30281181 DOI: 10.1111/pan.13502

BACKGROUND: Video-assisted thoracoscopic surgery has dramatically increased over the last decade because of both medical and cosmetic benefits. Anesthesia for video-assisted thoracoscopic surgery in small children is more challenging compared to adults due to the considerable problems posed by small airway dimensions and ventilation. The optimal technique for one-lung ventilation has yet to be established and the use of remifentanil infusion in this setting is not well described.

AIMS: This study investigated the use of extraluminal bronchial blocker placement for one-lung ventilation and the effect of infusion of remifentanil in infants and small children undergoing video-assisted thoracoscopic surgery.

METHODS: We retrospectively reviewed the technique of one-lung ventilation and the hemodynamic effects of remifentanil infusion in 31 small children during elective video-assisted thoracoscopic surgery for congenital lung lesions under anesthesia with sevoflurane or isoflurane, oxygen, and air. Patients' heart rate, blood pressure, and endtidal carbon dioxide at baseline (after induction of anesthesia), immediately after one-lung ventilation, during carbon dioxide insufflation, and at the end of one-lung ventilation were extracted from the database and analyzed. The use of vasopressors or dexmedetomidine was also recorded and analyzed.

RESULTS: Extraluminal placement of a bronchial blocker alongside the tracheal tube was successfully performed in 90.3% of cases (28 patients) without any serious complications or arterial oxygen desaturation. There was no significant rise in blood pressure or heart rate even with the rise of endtidal carbon dioxide concentration during video-assisted thoracoscopic surgery. In 58% of patients (18 patients), phenylephrine was administered to maintain the blood pressure within 20% of the baseline value. There was no significant change in the heart rate of all patients at each time point.

CONCLUSION: One-lung ventilation with an extraluminal parallel blocker was used effectively in this series of young children undergoing thoracoscopic excision of congenital pulmonary lesions. Remifentanil infusion attenuated surgical stress effectively in infants and small children undergoing video-assisted thoracoscopic surgery.

Matched MeSH terms: Thoracotomy/methods

Fulltext Clavicle fracture and subclavian vessels disruption with massive haemothorax mimic intrathoracic injury

Faisham WI, Mohammad P, Juhara H, Munirah NM, Shamsulkamaruljan H, Ziyadi GM

Malays J Med Sci, 2011 Apr;18(2):74-7.

PMID: 22135591

We report a case of open fracture of the clavicle with subclavian artery and vein laceration and perforation of the parietal pleural below the first rib that caused massive haemothorax. Emergency thoracotomy and exploration followed by repair of both vessels were able to salvage the patient and the extremity.

Matched MeSH terms: Thoracotomy

Closure of the patent ductus arteriosus with a Ligaclip through a minithoracotomy

Majid AA

Chest, 1993 May;103(5):1512-4.

PMID: 8486035 DOI: 10.1378/chest.103.5.1512

This article describes a technique which allows the patent ductus arteriosus (PDA) to be closed through a minithoracotomy. It combines a simple method of inducing atelectasis with Ligaclip closure of the PDA through a subaxillary incision. It was used successfully in 11 children and adolescents.

Matched MeSH terms: Thoracotomy/methods*

Computed tomography of the thorax with 3D reconstruction in penetrating chest injury

Michael A, Yahya ZO, Mdrazali I, Hanif H

Med J Malaysia, 2017 02;72(1):75-76.

PMID: 28255150 MyJurnal

Penetrating chest wounds is less common but more deadly then blunt trauma. Majority of penetrating chest trauma can be managed conservatively with observation and simple thoracotomy. This case report highlights a bizarre occupational hazard causing a penetrating chest injury and the option of non-invasive management with the aid of computed tomography with 3D reconstruction.

Matched MeSH terms: Thoracotomy

Fulltext Culture-positive thoracic empyema in adults

Liam CK, Pendek R, Navaratnam P, Hassan H, Puthucheary SD, Abdul Majid A, et al.

Med J Malaysia, 1990 Jun;45(2):169-76.

PMID: 2152022

Twenty-nine adult patients with culture-positive thoracic empyema were seen at the University Hospital Kuala Lumpur from 1984 to 1988. Cough, fever, chest pain, dyspnoea and weight loss were the common presenting symptoms. The empyema in 16 patients was associated with primary bronchopulmonary infections, nine occurred following thoracentesis of culture-sterile pleural effusions, two occurred as post-thoracic surgery complications, one following a subdiaphragmatic abscess and one as a result of a stab wound. The most common culture isolates were Streptococcus milleri, Pseudomonas aeruginosa and Klebsiella pneumoniae. Closed tube thoracostomy, the most common form of drainage procedure employed, was able to effect a cure or control of the empyema in 11 out of 19 patients in whom it was used.

Matched MeSH terms: Thoracotomy

Fulltext Cystic teratoma mimicking recurrent pleural effusion, complicated by Mycobacterium abscessus infection

Mohd Esa NY, Mohd Radzi AA, Bakar NS, Mohd Khalid MS, Ismail AI, Abdul Rani MF

Respirol Case Rep, 2016 May;4(3):e00155.

PMID: 27516884 DOI: 10.1002/rcr2.155

Teratomas of anterior mediastinum are rare. They are often slow growing, asymptomatic, and detected incidentally on chest imaging. Mycobacterium abscessus (M. abscessus) is an acid-fast bacillus that is classified as a pathogenic "rapid growing" non-tuberculous mycobacteria. It is an uncommon cause of human pathology, which may cause skin and soft tissue infection after skin injury following inoculation, minor trauma, and surgery. Here, we present an unusual case of benign cystic teratoma mimicking recurrent pleural effusion, which was subsequently complicated by M. abscessus infection following thoracotomy. Cystic teratoma is rare, but it needs to be considered whenever clinical and investigative work-up fails to provide a convincing diagnosis. A combined clinical, radiological, surgical, and histopathological assessment is important to arrive at the correct diagnosis. Rapidly growing mycobacteria needs to be included in the differential diagnosis of patients with non-resolving infected post-thoracotomy wound and who do not respond to broad-spectrum antibiotics.

Matched MeSH terms: Thoracotomy

Fulltext Delayed surgical referral for persistent spontaneous pneumothorax : a global problem?

Sachithanandan A, Badmanaban B

Interact Cardiovasc Thorac Surg, 2011 Mar;12(3):434.

PMID: 21345828 DOI: 10.1510/icvts.2010.241950A

Matched MeSH terms: Thoracotomy/standards

Fulltext Emergency thoracotomy and major lung resection for penetrating chest trauma: Lessons learnt from a review of three cases

Sachithanandan A, Fahmi PA, Faisal I, Badmanaban B, Abdul Muis J, Mohd Arif MN

Med J Malaysia, 2013 Jun;68(3):227-30.

PMID: 23749011 MyJurnal

Emergency lung resection for chest trauma is a rare event with a reported incidence of 0.08-1.3% but is associated with a high morbidity and mortality especially if a pneumonectomy is required, if due to blunt chest trauma or when concomitant injuries are present. We report three cases of young adult males with penetrating chest injuries that required emergency thoracotomy (ET) and anatomical lung resection to achieve definitive control of life threatening pulmonary haemorrhage. All patients survived to hospital discharge and remained well on follow-up. Indications for an ET and what constitutes the optimal operative management of such patients is discussed.

Matched MeSH terms: Thoracotomy*

Fulltext Inadvertent diaphragmatic rent following thoracic surgery for empyema thoracis successfully repaired with mesh

Henry Tan Chor Lip, Tan Jih Huei, Simon Jerome Vendargon

Malaysian Journal of Medicine and Health Sciences, 2020;16(3):322-324.

MyJurnal

Iatrogenic diaphragmatic entry following thoracic surgery is rare with only two cases reported till date. This case reports on a 46-year-old male with persistent pleural sepsis due to right empyema thoracis despite best medical ef- forts. Following a right thoracotomy and decortication, the right diaphragm was inadvertently incised due to dense adhesions between the diaphragm and thickened cortex. To our knowledge, this is the third case reported of iatro- genic diaphragmatic entry following thoracic surgery for empyema thoracis. The pearls from this case report is that any evidence of empyema thoracis involving the lower lobe on imaging should warn the surgeons to be aware of inadvertent entry into the peritoneal cavity, as the diaphragm can be adherent to the cortex trapping the lower lobe.

Matched MeSH terms: Thoracotomy

Pain control after thoracotomy. An extrapleural tunnel to provide a continuous bupivacaine infusion for intercostal nerve blockade

Majid AA, Hamzah H

Chest, 1992 Apr;101(4):981-4.

PMID: 1555472

This study was undertaken to determine whether an infusion of local anesthetic (LA) delivered through an extrapleural tunnel could provide satisfactory control of pain in the postthoracotomy period. Twelve patients undergoing thoracotomy were studied. A T-shaped tunnel was created by elevating the parietal pleura at the posteromedial end of the thoracotomy wound. An irrigation catheter was then inserted and an infusion of bupivacaine commenced, initially at 5 mg/kg/24 h and subsequently at 3 mg/kg/24 h. Pain was well controlled in eight patients and satisfactory in four patients. The latter required one dose of opiate analgesia each in the 48-h postoperative period. We conclude that an infusion of bupivacaine into the extrapleural space is an effective means of control of pain after thoracotomy.

Matched MeSH terms: Thoracotomy*

Pedunculated parietal pleural lesion: a rare presentation of bronchogenic cyst

Abdul Rahman MR, Yaman MN, Dimon MZ, Zabir AF, Min JO, Hamid HA

Ann Thorac Surg, 2011 Aug;92(2):714-5.

PMID: 21801925 DOI: 10.1016/j.athoracsur.2011.02.028

We present a 35-year-old man with a preoperative diagnosis of a right lower lobe cystic mass. Misled by a radiological suggestion of an intraparenchymal lesion, he had a thoracotomy and right lower lobectomy. An intraoperative finding of a pedunculated cyst arising from the parietal pleural with subsequent histopathology confirmation of a benign bronchogenic cyst, however, would have made a less invasive surgical excision more appropriate.

Matched MeSH terms: Thoracotomy/adverse effects

Penetrating cardiac injury

Dublin N, Chow HK, Lim YC

JUMMEC, 1999;4:117-118.

A case of penetrating cardiac injury is reported where cardiorrhaphy is done without cardiopulmonary bypass and via a right thoracotomy even though median stelnotoluy is the usual approach. It is also stressed that all precordial stab wounds must be carefully explored. KEYWORDS: Penetrating cardiac injury, Without cardiopulmonary bypass, Right posterolateral thoracotomy, Centrally placed chest injury.

Matched MeSH terms: Thoracotomy

Pocket-sized Heimlich valve (Pneumostat) after bullae resection: a 5-year review

Abdul Rahman MR, Min Joanna OS, Fikri AM, Adeeb SM, Zamrin DM

Ann Thorac Surg, 2009 Sep;88(3):979-81.

PMID: 19699932 DOI: 10.1016/j.athoracsur.2009.03.065

This study was conducted to evaluate the practicability, effectiveness, and potential complications of a newly improvised pocket-sized Heimlich valve named the Pneumostat (Atrium Medical Corp, Hudson, NH).

Matched MeSH terms: Thoracotomy

Fulltext Post-thoracotomy paraplegia after oxidized cellulose spinal compression

Than DJ, Perumall VV, Johan S, Lee XL, Karim KA, Hayati F

Einstein (Sao Paulo), 2023;21:eRC0078.

PMID: 37436267 DOI: 10.31744/einstein_journal/2023RC0078

Post-thoracotomy paraplegia after non-aortic surgery is an extremely uncommon complication. A 56-year-old woman presented with a 1-year history of progressive shortness of breath. Computed tomography revealed a locally advanced posterior mediastinal mass involving the ribs and the left neural foramina. Tumor excision with a left pneumonectomy was performed. Post-resection, bleeding was noted in the vicinity of the T4-T5 vertebral body, and the bleeding point was packed with oxidized cellulose gauze (Surgicel®). Postoperatively, the patient complained of bilateral leg numbness extending up to the T5 level, with bilateral paraplegia. An urgent laminectomy was performed, and we noted that the spinal cord was compressed by two masses of Surgicel® with blood clots measuring 1.5 × 1.5cm at T4 and T5 levels. The paraplegia did not improve despite the removal of the mass, sufficient decompression, and aggressive postoperative physiotherapy. Surgeons operating in fields close to the intervertebral foramen should be aware of the possible threat to the adjacent spinal canal as helpful hemostatic agents can become a preventable threat.

Matched MeSH terms: Thoracotomy/adverse effects

Pyopericardium presenting with echocardiographic features of pericardial tamponade in an elderly man

Tan JH, Ng ZQ, Tan HCL, Vendargon S

BMJ Case Rep, 2018 Jun 27;2018.

PMID: 29950501 DOI: 10.1136/bcr-2018-224741

A 72-year-old Chinese man presented with mild symptoms of heart failure. Transthoracic echocardiography showed signs of cardiac tamponade though clinically he was relatively well. The option of pericardiocentesis was not carried out due to a narrow window for aspiration with only a thin layer of effusion seen surrounding the apex and right ventricle on subcostal view.Pericardial window was done via a left anterolateral thoracotomy. Intraoperatively, 500 cm3 of purulent fluid was drained. Microbiology screens were all negative. We present the atypical clinical course of this elderly man presenting with a large pyopericardium.

Matched MeSH terms: Thoracotomy/methods

Pyopneumothorax secondary to Streptococcus milleri infection

Che Rahim MJ, Mohammad N, Wan Ghazali WS

BMJ Case Rep, 2016 Nov 23;2016.

PMID: 27881590 DOI: 10.1136/bcr-2016-217537

We report a case of a 46-year-old Malay woman with underlying hypothyroidism post thyroidectomy who presented with worsening breathlessness, orthopnoea, productive cough and left-sided pleuritic chest pain of 3 days duration. Chest X-ray on admission showed left-sided massive hydropneumothorax. Pleural tapping revealed empyema. A chest tube was inserted immediately. The culture of pleural fluid grew Streptococcus constellatus The patient was treated with antibiotics for a total of 6 weeks and underwent open thoracotomy and decortication during admission. Subsequently, her lung condition improved and there was no evidence of recurrence during follow-up.

Matched MeSH terms: Thoracotomy

Simultaneous bypass grafting of the superior vena cava and intrathoracic biopsy in fulminant superior vena caval syndrome

Majid AA

J R Coll Surg Edinb, 1991 Dec;36(6):406-8.

PMID: 1774712

Matched MeSH terms: Thoracotomy/methods

Fulltext Spectrum of penetrating cardiac injuries from flying feathers

Muhamad, N.A.R., Tuan Hairulnizam, T.K., Jessie, D.H., Rashidi, A., Jeewadas, B., Isa, A.Z., et al.

Malaysian Journal of Emergency Medicine, 2018;3(1):0-0.

MyJurnal

Flying feather is a traditional street weapon, which is believed to be originated from Philippine. It is a famous weapon in Tawau, Sabah, shot within short distance and being used with the aim to debilitate the victims. Some may even apply poison at the tip of the weapon. We report two cases of severe chest injuries in resulting from flying feathers. Case 1, a 25-year old man sustained left sided hemothorax with anterior right ventricle injury. He underwent thoracotomy and was discharged well. Case 2, a 40-year old man, presented to emergency department with no signs of life, sustained penetrating injury to the left second intercostal muscle, the pericardium and the anterior wall of the right ventricle adjacent to the interventricular septum. These cases highlight the severity spectrum of cardiac injury resulting from flying feathers.

Matched MeSH terms: Thoracotomy

Fulltext Spontaneous haemothorax: a case report

Ho C, Ismail AR

Med J Malaysia, 2014 Oct;69(5):234-5.

PMID: 25638240 MyJurnal

Haemothorax is one of the less common presentations that requires hospital admission. Most cases are associated with underlying causes, but there is such an entity called spontaneous haemothorax. Spontaneous haemothorax is commonly associated with adhesions within the pleural cavity. Here, we reported two cases of young adults who presented with massive spontaneous haemothorax and required emergency thoracotomy for haemostasis purpose.

Matched MeSH terms: Thoracotomy

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