Successful steroid treatment for fibrosing mediastinitis and sclerosing cervicitis

The use of steroids to successfully treat a 75-year-old woman with fibrosing mediastinitis and sclerosing cervicitis causing a stricture of the left common carotid artery is reported. Biopsy specimens showed collagenous fibers and fibroblasts with moderate infiltration of lymphocytes. The mediastinal and neck lesions were significantly reduced, with almost complete resolution of arterial stricture, 3 months after initiating administration of prednisolone at 20 mg/d.     

Primary hydatid disease of chest wall mimicking chest wall mass-case report

IntroductionHydatid cyst is a parasitic disease caused by echinococcus granoulosis. It is endemic in Mediterranean areas, south America, north Africa and Australia. The disease is most common in the liver and then in lung, the chest wall involvement by hydatid disease is a very rare condition.Presentation of caseWe present a case of chest wall mass in a 65-years old man, who intra operatively diagnosed as primary hydatid cyst. Cystectomy done and patient followed up for 2 months.DiscussionThe diagnosis of echinococcus infection mainly depends on the clinical history of the patient, serologic tests, and diagnostic radiological findings. Operative procedures for chest wall hydatid disease are cystectomy, cystotomy, evacuation, and chest wall resection.ConclusionChest wall hydatid disease should be considered in the differential diagnosis of chest wall masses even in a patient who has not been operated for hydatid disease.     

Nontraumatic chest wall systemic-to-pulmonary artery fistula

A congenital chest wall systemic-to-left pulmonary artery fistula fed by the left internal mammary and left gastric arteries in a 31-year-old man is reported. Attempted sclerosis was complicated by rupture of the communicating vessel, hemothorax, and deep vein thrombosis of the legs. Fistula resection and pulmonary decortication were successfully performed.     

Superior vena caval obstruction secondary to fibrosing mediastinitis

Eight patients with obstruction of the superior vena cava (SVC) secondary to fibrosing mediastinitis are presented. Four patients were managed without surgical reconstruction of the SVC. Of these, 2 are severely symptomatic from SVC obstruction, I is asymptomatic, and I is alive though his condition is unknown.Four patients were managed with surgical replacement of the SVC. Each is asymptomatic. One of 2 aortic homografts is occluded and the other is markedly stenosed at the cephalad suture line. A late occlusion occurred in the Teflon prosthesis. In the fourth patient, a bypass graft using composite autogenous veins was complemented with an arteriovenous fistula. Venography in this patient at one, six, and thirteen months revealed graft patency; he has no limitations in his physical activities.     

Hodgkin lymphoma presenting with chest wall involvement: a case series

Chest wall tumors in the pediatric population can have a variety of etiologies, malignancy being the most worrisome. Hodgkin lymphoma (HL) rarely presents as a chest wall mass in the pediatric population. In this report, we describe 3 male pediatric patients, all of whom had chest wall masses present at the initial diagnosis of HL. We also discuss the literature on this topic. We conclude that malignancy and, more specifically, HL should always be considered when evaluating a pediatric patient who presents with a chest wall mass.     

Benign fibrosing disease at the hepatic confluence mimicking Klatskin tumors.

BACKGROUND. Hilar obstructions remain a challenge with regard to diagnosis and treatment. METHODS. In the period from 1984 to 1990, 82 patients underwent resective surgery under the presumptive diagnosis of hilar cholangiocarcinoma (Klatskin tumor). The diagnosis was based on the combined appearances on direct cholangiography and ultrasonography in all cases, with the use of various other imaging modalities in some cases. RESULTS. The perioperative findings from an experienced surgical team were usually thought to be compatible with bile duct carcinoma. However, histologic examination of the resected specimens revealed benign fibrosing or localized sclerosing lesions in 11 patients (13.4%). CONCLUSIONS. The current state of diagnostic imaging fails as yet to discriminate reliably between benign and malignant hilar lesions. Whereas the immediate therapeutic consequences may be equal (resection followed by hepaticojejunostomy), the late consequences differ in a major way because benign disease has a much better prognosis. In the presence of suspicious hilar obstruction, operable lesions should not be treated by "palliative" intubational techniques and radiation therapy without a firm diagnosis of malignancy. However, overtreatment (extended liver resection, vascular reconstruction, and liver transplantation) should be avoided as well when a benign lesion has not been ruled out.     

Necrotizing soft tissue infection of the chest wall

Necrotizing soft tissue infection of the chest wall is a relatively rare but highly lethal surgical condition that has received little attention in the literature. The case of a 21-year-old female patient affected by this rare infection is reported. Our recent experience and literature data suggest that chest wall necrotizing soft tissue infection spreads rapidly and is highly lethal. High index of suspicion, early diagnosis, and aggressive approach are essential to its successful treatment.     

Single-stage repair of the anterior chest wall following sternal destruction complicated by mediastinitis

Purpose

Although various techniques have been described, the ideal reconstructive procedure for treating massive sternal fragmentation and necrosis is still a matter of debate. Sometimes, reconstruction is so challenging that repetitive operations are required, particularly when complicated by mediastinitis and sternal osteomyelitis.

Methods

Five patients (three males, two females, median age 66) with severe osteomyelitis and sternal destruction after receiving myocardial revascularization underwent partial or radical sternal resection, omental flap transposition, titanium mesh implantation and rectus abdominis muscle flap transposition. The final procedure involved single-stage closure.

Results

One patient died 9 days after the final procedure due to pneumonia and septicemia. The other patients received antibiotics for at least 6 weeks postoperatively. The mean hospital stay was 36 days. Optimal wound healing was observed, with acceptable cosmetic disorders.

Conclusions

Although lateral sternal support is the first-line surgical treatment for sternal dehiscence, performing primary closure of complicated defects is often impossible. Aggressive treatment modalities are required in such cases for anterior chest wall defects. This technique provides the ability to perform rigid and stable sternal closure in complicated cases.     

Full-thickness chest wall resection for recurrent breast phyllodes tumor

Phyllodes tumor is a rare breast neoplasm. We present the case of a woman who underwent multiple surgical procedures for phyllodes tumor treatment. Even after bilateral mastectomy and radiotherapy, local recurrences developed. We performed a full-thickness chest wall resection with wide margins, a procedure rarely reported in medical literature for this purpose. Only after this approach did we obtain disease control, with no signs of further recurrence at 4 years' follow-up.     

Desmoid tumor of the chest wall with pleural involvement

Although there have been reports of desmoid tumors of the chest wall, pleural extension, as well as overall size greater than 20 cm, is rare. We present the case of a large desmoid tumor involving the left anterior chest wall, upper abdomen, and diaphragm, which impinged on the left lung and displaced the liver. Wide surgical excision, reconstruction, and differential diagnosis from fibrosarcoma are essential elements in the treatment of these rare tumors.     

Seeding of stage I thymoma into the chest wall 12 years after needle biopsy

It is known that benign encapsulated thymoma can pursue an aggressive clinical course on rare occasions. It may recur locally, it may be invasive, or it may metastasize. We present a case of local seeding into the chest wall, presenting 12 years after core needle biopsy and complete excision of the mediastinal tumor. We draw attention to the malignant clinical behavior of some benign stage I thymomas.