Massive hemoptysis after aspiration of a toothpick

A 42-year-old man presented with massive hemoptysis. His past medical history was significant for a bayonet injury to the left chest several years ago. A chest computed tomographic scan showed a radio-opaque foreign body in the left lower lobe. A left thoracotomy was performed because of unrelenting hemoptysis in association with a foreign body that could not be retrieved by bronchoscopy. At surgery, a toothpick covered with blood was retrieved from the left lower lobe bronchus. A left lower lobectomy was performed because a lung abscess was present. Postoperatively, the patient confirmed that 1 year prior he had fallen asleep with a toothpick in his mouth while intoxicated.     

Extrapleural pneumonectomy with venous confluence resection for stage IVA thymic tumors

We report 4 patients with stage IVA thymic tumors who underwent extrapleural pneumonectomy and thymectomy with venous confluence resection using a temporary percutaneous venous jugular-femoral bypass technique. The superior vena cava was replaced in 2 patients, and the innominate vein was resected in 2 patients. Complete tumor resection was obtained in all patients. There was no 90-day postoperative mortality. One patient died at 6 months postoperatively of an unrelated cause, without recurrent disease, and 3 are alive and disease-free with a follow-up ranging from 19 to 80 months. Extrapleural pneumonectomy can be combined with thymectomy and venous confluence resection for stage IVA thymic tumors.     

Transesophageal bronchoscopic ultrasound-guided fine-needle aspiration for diagnosis of peripheral lung cancer

Peripheral lung cancer is still a diagnostic challenge. The transbronchial approach with bronchoscopy or the transthoracic approach with radiologic imaging has been used extensively for the pathologic diagnosis of peripheral lung cancer. However, the explorability or feasibility with these modalities depends on the lesion location or patient's respiratory function. Herein, we report a case with severe pulmonary emphysema and lung cancer located at a parenchymal region difficult to access through an airway with a bronchoscope. Successful diagnosis was obtained by a transesophageal ultrasound-guided needle aspiration using an endobronchial ultrasound bronchoscope. This technique is accurate and less invasive in the primary diagnosis of lung cancer adjoining the esophagus.     

Versatility of a mini-trapdoor incision in upper mediastinal exposure

Exposure of the upper mediastinum and thoracic outlet can pose major surgical challenges. We report our application of a previously described mini-trapdoor incision to a variety of surgical problems involving the upper mediastinum and thoracic outlet, including subclavian vein thrombosis, penetrating subclavian artery injury, debridement of subjacent chest wall infection, lymph node excision, and Pancoast tumor resection. This versatile approach provides excellent structural visualization while obviating clavicular resection or sternoclavicular joint disruption, or both.     

Morcellation technique to remove large tumor in thoracoscopic surgery

Extraction of tumors remains a major problem in thoracoscopic surgery. In this study, we used an efficient instrument to morcellate a tumor during thoracoscopic surgery. The cosmetic result of this technique was satisfactory; thus, we suggest that this technique is a reliable option for use during thoracoscopic surgery for benign solid tumors.