OBJECTIVE: To explore the clinical application of video-assisted thoracoscopic surgery (VATS). METHODS: We retrospectively analyzed the clinical data of 672 cases of VATS. There were 17 thoracic diseases such as emphysema, bullectomy for spontaneous pneumothorax, massive bullae, benign tumor of mediastinum, cyst of mediastinum, pulmonary benign tumors, hydropericardium, malignant pleural fluid, etc. RESULTS: The mean operation time was 57 minutes and there were no intraoperative complications. The bleeding during the operation was less than 100 mL. Postoperative pneumothorax occurred in 4 patients and among them 2 patients were of relapse after 1 month. The intrathoracic drain in most patients was removed with an average of 2. 5 days. A supplementary incision was needed in 10 cases: Six were due to the adhesion of full pleural cavity and 4 were found with the malignant tumor during the operation. CONCLUSION VATS is an alternative approach that provides a safe, less invasive, and effective operation for treating spontaneous pneumothorax, benign tumor of mediastinum, cyst of mediastinum, pulmonary benign tumors, pericardial perfusion, and acute chest trauma patients.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Emphysema ; surgery ; Female ; Hemopneumothorax ; surgery ; Humans ; Lung Diseases ; surgery ; Lung Neoplasms ; surgery ; Male ; Mediastinal Diseases ; surgery ; Middle Aged ; Retrospective Studies ; Thoracic Surgery, Video-Assisted ; Treatment Outcome

Pericardial cyst is an uncommon congenital mediastinal tumor. The majority of pericardial cysts are located in the right cardiophrenic angle, but rarely they can be located intrapericardially. We now present a case of a huge intrapericardial pericardial cyst excised with video-assisted thoracoscopic surgery.
Mediastinal Cyst ; Mediastinal Diseases ; Pericardium ; Thoracic Surgery, Video-Assisted

OBJECTIVETo determine the value of video-mediastinoscopy in clinical application.

METHODSThe clinical data of 54 patients receiving video-mediastinoscopy were reviewed retrospectively. This operation consisted of cervical mediastinoscopy in 44 patients, parasternal mediastinoscopy in 6, and combined procedures in 4. Of these patients, 18 underwent video-mediastinoscopy for the evaluation of undifferentiated mediastinal disease. Thirty-six patients with suspected lung cancer showed enlarged mediastinal lymph nodes radiographically in the chest and underwent video-mediastinoscopy.

RESULTSSeventeen of 18 patients with undetermined mediastinal diseases had a definitive pathologic diagnosis, with an accuracy of 94.4% (17/18). In the 36 patients with suspected lung cancer, 22 were positive, and 14 negative. In the negative patients who underwent thoracotomy with resection, mediastinal lymph nodes revealed no evidence of metastasis. There were no postoperative complication and deaths.

CONCLUSIONVideo-mediastinoscopy as a highly effective and safe procedure could be used in the diagnosis and staging of thoracic diseases.

Adolescent ; Adult ; Aged ; Female ; Humans ; Lung Neoplasms ; diagnosis ; Male ; Mediastinal Diseases ; diagnosis ; Mediastinoscopy ; Middle Aged ; Neoplasm Staging ; Thoracic Diseases ; diagnosis

Radiological analysis of chest lesions detected on chest radiographs or CT scans begins with their classification into parenchymal, pleural, or extrapleural lesions according to their presumed origin. The mediastinum is divided anatomically into the anterior, middle, and posterior mediastinal compartments, and localizing a mediastinal mass to one of these divisions can locationfacilitate their differential diagnosis. A differential diagnosis of a mediastinal mass is usually based on a number of findings, including its ; the structure from which it is arising; whether it is single, multifocal (involving several different areas or lymph node groups), or diffuse; its size and shape; its attenuation (fatty, fluid, soft-tissue, or a combination of these); the presence of calcification along with its characteristics and amount; and its opacification following the administration of contrast agents.
Classification ; Contrast Media ; Diagnosis, Differential ; Lymph Nodes ; Mediastinal Diseases* ; Mediastinal Neoplasms ; Mediastinum ; Pleural Diseases ; Radiography, Thoracic ; Thorax ; Tomography, X-Ray Computed

Video-assisted thoracic surgery (VATS) has developed very rapidly in these two decades, and has replaced conventional open thoracotomy as a standard procedure for some simple thoracic operations as well as an option or a complementary procedure for some other more complex operations. In this paper we will review its development history, the present status and the future perspectives.
Empyema ; surgery ; Esophageal Diseases ; surgery ; Esophagus ; pathology ; Humans ; Lung Neoplasms ; surgery ; Mediastinal Diseases ; surgery ; Pleural Effusion ; surgery ; Pneumothorax ; surgery ; Thoracic Surgery, Video-Assisted ; methods ; trends

OBJECTIVETo investigate the value of mediastinoscopy in diagnosis of the thoracic diseases and the determination of the operative indication.

METHODSFrom 1979 to 2000, 165 patients were given mediastinoscopy by local infiltration anesthesia (rare cases with additional vein bacic anesthesia). The exploration and biopsy were given to the neoplasms and lymph nodes around the trachea through the pretracheal interstice.

RESULTSThe diagnosis of 125 patients by mediastinoscopy accorded with the pathological diagnosis and that of 21 patients was not accorded with the pathology. The rate of definitive diagnosis was 85.6% (125/146). The other 19 cases were not included into the ground because 11 cases were not given definitive diagnosis and 8 cases with lung cancer were not be performed operation although the results of mediastinoscopy were negative. Twenty patients with lung cancer which had metastasis in the mediastium and 7 patients with malignant lymphadenoma avoided exploratory thoracotomy.

CONCLUSIONThe mediastinoscopy is a effective examinative method to the disease involving the lymph nodes in the mediastinum and the thoracic disease closing on the mediastinum. The mediastinoscopy in appropriate especially to the simple enlargement of lymph node in the mediastinum that is not given definitive diagnosis. The cases with lung cancer accompanied enlargement of lymph node in the mediastinum and that with tumors in the mediastinum may choose the mediastinoscopy.

Adolescent ; Adult ; Aged ; Female ; Humans ; Lung Neoplasms ; diagnosis ; Lymph Nodes ; pathology ; Male ; Mediastinal Neoplasms ; diagnosis ; Mediastinoscopy ; Middle Aged ; Thoracic Diseases ; diagnosis

Extramedullary hematopoiesis is a common compensatory mechanism of chronic anemia, but an asymptomatic posterior mediastinal mass is rarely diagnosed as an extramedullary hematopoiesis after surgical resection. The differential from neurogenic tumors is important, but fine needle aspiration biopsy is not recommended because of the difficulty of approach and risk of bleeding. Although diagnosis and treatment can involve resection via thoracotomy, video-assisted thoracic surgery may also be a useful strategy. We performed video-assisted thoracic surgery on a 59-year-old man for posterior mediastinal extramedullary hematopoiesis, with no evidence of recurrence or related hematologic diseases.
Anemia ; Biopsy ; Biopsy, Fine-Needle ; Hematologic Diseases ; Hematopoiesis, Extramedullary ; Hemorrhage ; Humans ; Mediastinal Neoplasms ; Middle Aged ; Recurrence ; Thoracic Surgery, Video-Assisted ; Thoracoscopy ; Thoracotomy

Chylopericardium is a rare disease entity characterized by the accumulation of chylous fluid in the pericardial sac. It usually arises from mediastinal neoplasms, thrombosis of the subclavian vein, tuberculosis, nonsurgical trauma, thoracic or cardiac surgery. The spectrum of symptoms for chylopericardium varies from an incidental finding of cardiomegaly to dyspnea, upper abdominal discomfort, cough, chest pain, palpitation, fatigue. However, most of the patients are asymptomatic. The main purpose of treatment of chylopericardium is the prevention of cardiac tamponade and prevention of metabolic, nutritional, and immunological compromise due to chyle leak. Here, we report a case of chylopercardium secondary to lymphangiomyoma with review of the literature.
Cardiac Tamponade ; Cardiomegaly ; Chest Pain ; Chyle ; Cough ; Dyspnea ; Fatigue ; Humans ; Incidental Findings ; Lymphangioma ; Lymphangiomyoma ; Mediastinal Neoplasms ; Pericardial Effusion ; Rare Diseases ; Subclavian Vein ; Thoracic Surgery ; Thorax ; Thrombosis ; Tuberculosis

Recently, video-assisted thoracoscopic surgery for mediastinal lesions has been considered a new effective therapeutic method. From March, 1992 to April, 1997, 33 cases of video assisted thoracoscopic surgery for mediastinal lesions were performed. Gender distribution was 16 males and 17 females. Average age was 42 years old (ranged from 14 to 69). The locations of lesions were anterior mediastinum in 14 cases, middle mediastinum in 5 cases, posterior mediastinum in 11 cases, and superior mediastinum in 3 cases. These included 9 neurilemmomas, 5 benign cystic teratoma, 4 pericardial cysts, 2 ganglioneuroma, 2 thymus, 2 thymic cyst, 1 thymoma, 2 esophageal leiomyomas, 1 dermoid cyst, 1 lipoma, 1 malignant lymphoma, 1 bronchogenic cyst, 1 pericardial effusion, and 1 Boerhaave's disease with empyema. Working window was needed in 6 cases. We converted to open thoracotomy in 6 cases. Reasons of convertion to open thoracotomy were large sized mass (1), severe adhesion (3), and difficult location to approach (2). The average operation time was 116min (+/-56 min). The average chest tube drainage time was 4.7days. The average hospital stay was 8.7 days. Operative complications were atelectasis (2), empyema with mediastinitis (1), recurrent laryngeal nerve palsy (1), and plenic nerve palsy (1). In conclusion, VATS for mediastinal lesions were performed with shorter operation time and hospital stay, and lesser complications and pain than those of conventional thoracotomy.
Adult ; Bronchogenic Cyst ; Chest Tubes ; Dermoid Cyst ; Drainage ; Empyema ; Female ; Ganglioneuroma ; Humans ; Leiomyoma ; Length of Stay ; Lipoma ; Lymphoma ; Male ; Mediastinal Cyst ; Mediastinal Diseases ; Mediastinitis ; Mediastinum ; Neurilemmoma ; Paralysis ; Pericardial Effusion ; Pulmonary Atelectasis ; Teratoma ; Thoracic Surgery, Video-Assisted* ; Thoracoscopy ; Thoracotomy ; Thymoma ; Thymus Gland ; Vocal Cord Paralysis

Mediastinal tuberculous lymphadenitis is rare in adults, and it is even rarer for dysphagia to be the presenting symptom of mediastinal tuberculous lymphadenitis. Mediastinal tuberculous lymphadenitis with esophageal symptoms has been presented as esophageal ulceration, mucosal or submucosal mass with ulceration, fistula or sinus formation, extrinsic compression, or displacement of the esophagus. An exaggerated form of extrinsic compression may be presented as a submucosal tumor, radiologically or endoscopically. A barium esophagography of a 34 year-old woman with painful dysphagia revealed a large submucosal tumor-like mass on the mid-esophagus. The symptom was spontaneously improved over a 3-week period together with reduction of the mass size. A computed tomography of the chest disclosed an enlarged subcarinal lymph node and histologic examination of the specimen obtained by thoracoscopic biopsy brought about a diagnosis of tuberculosis. We herein report a case of mediastinal tuberculosis with unusual manifestations.
Adult ; Case Report ; Deglutition Disorders/*etiology ; Diagnosis, Differential ; Esophageal Neoplasms/*diagnosis ; Esophagoscopy ; Esophagus/pathology/radiography ; Female ; Human ; Mediastinal Diseases/*complications/*diagnosis ; Radiography, Thoracic ; Tomography, X-Ray Computed ; Tuberculosis, Lymph Node/*complications/*diagnosis