Lung cancer ranks the first cancer-related morbidity and mortality in China. With the development and penetration of imaging technology, increasing small pulmonary peripheral Nodules (SPPNs) have been detected. However, precise location and diagnosis of SPPNs is still a tough problem for clinical diagnosis and treatment in department of thoracic surgery. With the development of electromagnetic navigation bronchoscopy (ENB), it provides a novel minimally invasive method for the diagnosis and treatment of SPPNs. In this review, we summarized the application and progress of ENB in preoperative positioning, diagnosis, and local treatment, then, discussed the clinical application of ENB in the hybrid operating room.
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Bronchoscopy/methods* ; Electromagnetic Phenomena ; Humans ; Lung Neoplasms/surgery* ; Multiple Pulmonary Nodules/diagnosis* ; Thoracic Surgery

Human sparganosis is a food-borne zoonosis mainly caused by the plerocercoid belonging to the genus Spirometra. The most common clinical sign of sparganosis is a subcutaneous mass in the trunk including abdominal or chest wall. The mass may be mistaken for a malignant tumor, thereby causing difficulty in terms of diagnosis and treatment. A 66-year-old woman visited our clinic for the removal of a lipoma-like mass. It was movable, hard, and painless. We identified 2 white mass, measuring 0.2×4 cm and 0.2×1 cm. Pathologic findings indicated the white mass was a sparganum. She recalled having eaten a raw frog approximately 60 years before. A 35-year-old who lived North Korea was also presented to our clinic with an asymptomatic nodule on her abdomen. Intraoperatively, we found sparganum approximately 24 cm size. Subcutaneous masses are associated with clinical signs of inflammation or they may mimic a soft tissue neoplasm. While the incidence rate of sparganosis has decreased with economic development and advancements in sanitation, surgeons still encounter patients with sparganosis in the clinical setting. Therefore, a careful history is required in order to diagnose sparganosis.
Abdomen ; Adult ; Aged ; Democratic People's Republic of Korea ; Diagnosis ; Economic Development ; Female ; Humans ; Incidence ; Inflammation ; Lipoma ; Sanitation ; Soft Tissue Neoplasms ; Sparganosis ; Sparganum ; Spirometra ; Subcutaneous Tissue ; Surgeons ; Thoracic Wall

The abscopal effect is a term that has been used to describe the phenomenon in which localized radiation therapy treatment of a tumor lesion triggers a spontaneous regression of metastatic lesion(s) at a non-irradiated distant site(s). Radiation therapy induced abscopal effects are believed to be mediated by activation and stimulation of the immune system. However, due to the brain’s distinctive immune microenvironment, extracranial abscopal responses following cranial radiation therapy have rarely been reported. In this report, we describe the case of 42-year-old female patient with metastatic melanoma who experienced an abscopal response following her cranial radiation therapy for her brain metastasis. The patient initially presented with a stage III melanoma of the right upper skin of her back. Approximately 5 years after her diagnosis, the patient developed a large metastatic lesion in her upper right pectoral region of her chest wall and axilla. Since the patient’s tumor was positive for BRAF and MEK, targeted therapy with dabrafenib and trametinib was initiated. However, the patient experienced central nervous system (CNS) symptoms such as headache and disequilibrium and developed brain metastases prior to the start of targeted therapy. The patient received radiation therapy to a dose of 30 Gy delivered in 15 fractions to her brain lesions while the patient was on dabrafenib and trametinib therapy. The patient’s CNS metastases improved significantly within weeks of her therapy. The patient’s non-irradiated large extracranial chest mass and axilla mass also shrank substantially demonstrating the abscopal effect during her CNS radiation therapy. Following radiation therapy of her residual chest lesions, the patient was disease free clinically and her CNS lesions had regressed. However, when the radiation therapy ended and the patient continued her targeted therapy alone, recurrence outside of her previously treated fields was noted. The disease recurrence could be due to the possibility of developing BRAF resistance clones to the BRAF targeted therapy. The patient died eventually due to wide spread systemic disease recurrence despite targeted therapy.
Adult ; Axilla ; Brain ; Central Nervous System ; Clone Cells ; Diagnosis ; Female ; Headache ; Humans ; Immune System ; Immunization ; Melanoma ; Molecular Targeted Therapy ; Neoplasm Metastasis ; Radiation, Ionizing ; Recurrence ; Skin ; Skin Neoplasms ; Thoracic Wall ; Thorax

Exogenous lipoid pneumonia is an uncommon medical condition resulting from aspiration or inhalation of oily material. Generally, lipoid pneumonia has nonspecific clinical and radiological presentations, and may be misdiagnosed as bacterial pneumonia or lung cancer. We describe an unusual case of exogenous lipoid pneumonia accompanied by peripheral blood and pulmonary eosinophilia. A 63-year-old man was admitted with progressively worsening exertional dyspnea and productive cough for 5 days. A chest radiograph showed abnormalities in the lower lobe of the right lung, and a diagnosis of community-acquired pneumonia was made; intravenous antibiotics were administered. However, dyspnea and hypoxia gradually worsened and peripheral blood eosinophilia developed. A bronchoscopy was performed and bronchoalveolar lavage fluid analysis showed markedly increased numbers of eosinophils (40%). Subsequently, a comprehensive review of history revealed that he fell asleep with camellia oil in his mouth for 2 weeks to relieve foreign body sensation of the throat. Sputum and bronchoalveolar lavage fluid cytology showed the presence of lipid-laden macrophages. He was diagnosed with lipoid pneumonia and acute eosinophilic pneumonia. Chest radiograph and symptom were rapidly improved after treatment with intravenous methylprednisolone.
Anoxia ; Anti-Bacterial Agents ; Bronchoalveolar Lavage Fluid ; Bronchoscopy ; Camellia ; Cough ; Diagnosis ; Dyspnea ; Eosinophilia ; Eosinophils* ; Foreign Bodies ; Humans ; Inhalation ; Lung ; Lung Neoplasms ; Macrophages ; Methylprednisolone ; Middle Aged ; Mouth ; Pharynx ; Pneumonia* ; Pneumonia, Bacterial ; Pneumonia, Lipid ; Pulmonary Eosinophilia* ; Radiography, Thoracic ; Respiratory Aspiration ; Sensation ; Sputum

BACKGROUND: To summarize the clinical features of patients with pulmonary embolism after lobectomy and to explore the methods of diagnosis and treatment of pulmonary embolism after lobectomy. METHODS: The clinical data of 6 patients with pulmonary embolism after lobectomy between July 2007 and July 2017 were retrospectively analyzed. RESULTS: Of the 6 patients, 3 died within 24 h of onset and 3 patients were cured and discharged. CONCLUSIONS Pulmonary embolism after lobectomy is a rare postoperative complication in thoracic surgery. It is difficult to diagnose and has a high mortality rate. Preoperative thromboembolic risk assessment and postoperative prevention are important.
Aged ; Female ; Humans ; Lung Neoplasms ; surgery ; Male ; Middle Aged ; Pneumonectomy ; adverse effects ; Postoperative Complications ; diagnosis ; etiology ; therapy ; Pulmonary Embolism ; diagnosis ; etiology ; therapy ; Retrospective Studies ; Thoracic Surgery, Video-Assisted ; adverse effects

BACKGROUND: Pulmonary embolism (PE) is one of the most severe complications after thoracic surgeries. Thus it is of great importance to learn the characteristics of acute PE after thoracic surgeries. This study summarized the clinical characteristics and experience on the diagnosis and treatment of 37 patients with postoperative acute pulmonary embolism, in order to improve its prophylaxis and management level. METHODS: We retrospectively reviewed 37 patients with postoperative acute pulmonary embolism following thoracic surgeries. Age, gender, body mass index (BMI), diagnosis, surgical procedure, onset time, clinical presentation, diagnosis and management were comprehensively analyzed. RESULTS: There were 16 males (43.2%) and 21 females (56.8%). The average age was (65.64±6.29) years (range from 53 years to 82 years) and 32 patients were over 60 years. BMI ranged from 17.1 kg/m² to 30.8 kg/m² with median of 26.3 kg/m². And 27 patients' BMI (73.0%) were over 25.0 kg/m². Thirty-four patients (91.9%) were with malignancies. Median presentation time was the 4th day postoperatively, while 11 patients were presented on the 3rd day postoperatively which accounted for the most. Patients with acute pulmonary embolism accounted for 77.8% from 9 am to 9 pm. D-dimer (D-D) ranged from 1.0 μg/mL-20.0 μg/mL (FEU) with median of (7.09±4.45) μg/mL (FEU) and 32 (86.5%) patients' D-D were over 3.00 μg/mL (FEU). CONCLUSIONS The survival rate of postoperative acute pulmonary embolism can be increased by fully understanding its clinical characteristics, early diagnosis and multiple disciplinary treatment.
Acute Disease ; Aged ; Aged, 80 and over ; Female ; Humans ; Lung Neoplasms ; surgery ; Male ; Middle Aged ; Postoperative Complications ; diagnosis ; etiology ; therapy ; Pulmonary Embolism ; diagnosis ; etiology ; therapy ; Retrospective Studies ; Survival Rate ; Thoracic Surgical Procedures ; adverse effects

Carcinoma, Non-Small-Cell Lung ; diagnosis ; surgery ; Humans ; Lung Neoplasms ; diagnosis ; surgery ; Pneumonectomy ; methods ; Prognosis ; Thoracic Surgery, Video-Assisted ; methods

BACKGROUND: The complication rate of fungal disease is higher among patients with hematological malignancies. We investigated the clinicobacteriological outcomes of resected pulmonary fungal infections complicating hematological malignancies. METHODS: Between 2001 and 2017, 21 patients with pulmonary fungal infections complicating hematological malignancies underwent resection, and their clinical records and survival were retrospectively reviewed. RESULTS: The median age of the patients was 47 years, and 13 were male. The histological diagnoses were pulmonary aspergillosis (19 cases), mucormycosis (1 case), and cryptococcosis (1 case). The indications for surgery were resistance to antifungal therapy and the necessity of surgery before hematopoietic stem cell transplantation in 13 and 8 cases, respectively. The diagnoses of the hematological malignancies were acute myelogenous leukemia (10 cases), acute lymphocytic leukemia (5 cases), myelodysplastic syndrome (3 cases), and chronic myelogenous leukemia, malignant lymphoma, and extramedullary plasmacytoma (1 case each). The surgical procedures were partial resection (11 cases), segmentectomy (5 cases), lobectomy (4 cases), and cavernostomy (1 case). The size of the lesions was 0.9–8.5 cm. Fourteen cases had cavitation. There were no surgical-related deaths or fungal progression. CONCLUSION: Pulmonary fungal infections are resistant to treatments for hematological malignancies. Since the treatment of the underlying disease is extended and these infections often recur and are exacerbated, surgery should be considered when possible.
Cryptococcosis ; Diagnosis ; Hematologic Neoplasms* ; Hematopoietic Stem Cell Transplantation ; Humans ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Leukemia, Myeloid, Acute ; Lung Diseases, Fungal* ; Lymphoma ; Male ; Mastectomy, Segmental ; Mucormycosis ; Mycoses ; Myelodysplastic Syndromes ; Plasmacytoma ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Pulmonary Aspergillosis ; Retrospective Studies ; Thoracic Surgery

STUDY DESIGN: Case report. OBJECTIVES: We report a case of pure epidural cavernous hemangioma located at the thoracolumbar spine in a 53-year-old woman that mimicked a neurogenic tumor on magnetic resonance imaging (MRI). SUMMARY OF LITERATURE REVIEW: A pure spinal epidural cavernous hemangioma without bony involvement is a very rare lesion about which limited information is available in the literature. MATERIALS AND METHODS: A 53-year-old woman visited our clinic for hypoesthesia with a tingling sensation in the left anterolateral thigh that had begun a month ago. No other neurologic symptoms or signs were present upon a neurologic examination. MRI from an outside hospital showed a 2.0×0.5 cm elongated mass at the T11-12 left neural foramen. The tumor was completely removed in piecemeal fashion. RESULTS: The histopathologic examination revealed a cavernous hemangioma, which was the final diagnosis. The outcome was favorable in that only operation-related mild back pain remained, without any neurologic deficits, after a postoperative follow-up of 2 years and 3 months. No recurrence was observed on MRI at 2 years postoperatively. CONCLUSION: Pure epidural spinal cavernous hemangioma is very rare, and it is very difficult to differentiate from other epidural lesions. However, we believe that it should be included in the differential diagnosis of spinal epidural tumors due to its favorable prognosis.
Back Pain ; Diagnosis ; Diagnosis, Differential ; Epidural Neoplasms ; Female ; Follow-Up Studies ; Hemangioma, Cavernous ; Humans ; Hypesthesia ; Magnetic Resonance Imaging ; Middle Aged ; Neurologic Examination ; Neurologic Manifestations ; Prognosis ; Recurrence ; Sensation ; Spine ; Thigh ; Thoracic Vertebrae

Incidence of gastric cancer is high in China and standard radical operation is currently the main treatment for gastric cancer. Postoperative complications, especially some special complications, can directly affect the prognosis of patients, even result in the increase of mortality. But the incidences of these special complications are low, so these complications are often misdiagnosed and delayed in treatment owing to insufficient recognition of medical staff. These special complications include (1) Peterson hernia: It is an abdominal hernia developed in the space between Roux loop and transverse colon mesentery after Roux-Y reconstruction of digestive tract. Peterson hernia is rare and can quickly result in gangrenous ileus. Because of low incidence and without specific clinical symptoms, this hernia does not attract enough attention in clinical practice, so the outcome will be very serious. Once the diagnosis is made, an emergent operation must be performed immediately. Peterson space should be closed routinely in order to avoid the development of hernia. (2) Lymphatic leakage: It is also called chyle leakage. Cisterna chylus is formed by gradual concentration of extensive lymphatic net to diaphragm angle within abdominal cavity. Lymphadenectomy during operation may easily damage lymphatic net and result in leakage. The use of ultrasonic scalpel can decrease the risk of lymphatic leakage in certain degree. If lymphatic leakage is found during operation, transfixion should be performed in time. Treatment includes total parenteral nutrition, maintenance of internal environment, supplement of protein, and observation by clamp as an attempt. (3)Duodenal stump leakage: It is one of serious complications affecting the recovery and leading to death after subtotal gastrectomy. Correct management of duodenal stump during operation is one of key points of the prevention of duodenal stump leakage. Routine purse embedding of duodenal stump is recommend during operation. The key treatment of this complication is to promt diagnosis and effective hemostasis.(4) Blood supply disorder of Roux-Y intestinal loop: Main preventive principle of this complication is to pay attention to the blood supply of vascular arch in intestinal edge. (5) Anastomotic obstruction by big purse of jejunal stump: When Roux-en-Y anastomosis is performed after distal radical operation for gastric cancer, anvil is placed in the remnant stomach and anastomat from distal jejunal stump is placed to make gastrojejunal anastomosis, and the stump is closed with big purse embedding. The embedding jejunal stump may enter gastric cavity leading to internal hernia and anastomotic obstruction. We suggest that application of interruptable and interlocking suture and fixation of stump on the gastric wall can avoid the development of this complication.
Anastomosis, Roux-en-Y ; adverse effects ; China ; Chylous Ascites ; etiology ; prevention & control ; therapy ; Duodenum ; blood supply ; surgery ; Gastrectomy ; adverse effects ; methods ; mortality ; Gastric Outlet Obstruction ; etiology ; prevention & control ; Gastric Stump ; surgery ; Hemostatic Techniques ; Hernia ; etiology ; prevention & control ; therapy ; High-Intensity Focused Ultrasound Ablation ; instrumentation ; Humans ; Jejunum ; blood supply ; surgery ; Lymph Node Excision ; adverse effects ; instrumentation ; Lymphatic System ; injuries ; Postoperative Complications ; classification ; diagnosis ; mortality ; prevention & control ; Prognosis ; Stomach ; surgery ; Stomach Neoplasms ; complications ; surgery ; Suture Techniques ; standards ; Thoracic Duct ; injuries ; Wound Closure Techniques ; standards