Acute mediastinitis is a fatal disease that usually originates from esophageal perforation and surgical infection.Rare cases of descending necrotizing mediastinitis can occur following oral cavity and pharynx infectio...Acute mediastinitis is a fatal disease that usually originates from esophageal perforation and surgical infection.Rare cases of descending necrotizing mediastinitis can occur following oral cavity and pharynx infection or can be a complication of pancreatitis.The most common thoracic complications of pancreatic disease are reactive pleural effusion and pneumonia,while rare complications include thoracic conditions,such as pancreaticopleural fistula with massive pleural effusion or hemothorax and extension of pseudocyst into the mediastinum.There have been no reports of acute mediastinitis originating from pancreatitis in South Korea.In this report,we present the case of a 50-year-old female suffering from acute mediastinitis with pleural effusion arising from recurrent pancreatitis that improved after surgical intervention.展开更多
Chicken bone is one of the most frequent foreign bodies (FB) associated with upper esophageal perforation. Upper digestive tract penetrating FB may lead to life threatening complications and requires prompt management...Chicken bone is one of the most frequent foreign bodies (FB) associated with upper esophageal perforation. Upper digestive tract penetrating FB may lead to life threatening complications and requires prompt management. We present the case of a 52-year-old man who sustained an upper esophageal perforation associated with cervical cellulitis and mediastinitis. Following CT-scan evidence of FB penetrating the esophagus, the impacted FB was successfully extracted under rigid esophagoscopy. Direct suture was required to close the esophageal perforation. Cervical and mediastinal drainage were made immediately. Naso- gastric tube decompression, broad-spectrum intravenous antibiotics, and parenteral hyperalimentation were administered for 10 d postoperatively. An esophagogram at d 10 revealed no leak at the repair site, and oral alimentation was successfully reinstituted. Conclusion: Rigid endoscope management of FB esophageal penetration is a simple, safe and effective procedure. Primary esophageal repair with drainage of all affected compartments are necessary to avoid life-threatening complications.展开更多
Purpose: Descending necrotizing mediastinitis(DNM) is a lethal and acute suppurative disease. This report aimed to summarize our experience in the treatment of DNM with continuous negative pressure catheter drainage a...Purpose: Descending necrotizing mediastinitis(DNM) is a lethal and acute suppurative disease. This report aimed to summarize our experience in the treatment of DNM with continuous negative pressure catheter drainage and transnasal jejunal feeding by interventional techniques. Materials and Methods: We retrospectively analyzed relevant clinical data of patients with DNM who underwent continuous negative pressure catheter drainage and transnasal jejunal feeding. All drainage catheters and jejunal feeding tubes were inserte d by interventional techniques. Results: In total, 21 patients were diagnosed with DNM by esophagography and computed tomography(CT). Catheters for the drainage of mediastinal abscesses as well as transnasal jejunal feeding tubes were successfully placed in all patients, indicating a 100% success rate. Of all patients, 13 underwent insertion of abscess drainage catheters through percutaneous puncture under DynaCT guidance, while eight had drainage catheter insertion through fistula orifices in the posterior nasopharyngeal wall or esophagus under fluoroscopic guidance. In total, 26 drainage tubes were inserted. One patient with diabetes died of sepsis and diabetic ketoacidosis 5 days postoperatively, while the remaining 20 patients showed good recovery with successful removal of the drainage catheters. Durations of catheterization were 45.2±50.44 days. The overall clinical success rate was 95.2%. Conclusion: The above described methods are non-surgical, minimally invasive and efficacious, and may be alternative therapeutic tools for patients who are not eligible for surgical operation, have a high postoperative risk, or are more likely to choose minimally invasive techniques.展开更多
Background: Discharge due to superficial wound infection and sternal dehiscence are the common complications of median sternotomy. This condition leads to mediastinitis. Mediastinitis is a serious condition which incr...Background: Discharge due to superficial wound infection and sternal dehiscence are the common complications of median sternotomy. This condition leads to mediastinitis. Mediastinitis is a serious condition which increases morbidity, mortality and hospital costs. The correct time for surgical treatment is contraversial in cases who have sternal dehiscence and discharge due to superficial infection. In this study, patients received sternal stabilization as soon as a diagnosis was made and monitored for the development of mediastinitis. Methods: Among the 1440 patients who had undergone elective CABG, a total of 85 patients who developed sternal dehiscence and superficial wound discharge were included in this study. These patients were re-operated on as soon as diagnosed and early sternal stabilization was provided. Results: The ratio of overall dehiscence was 5.9%. Mediastinitis developed in only 2 of the 85 patients. These patients were treated with VAC (Vacuum Assisted Closure) therapy. The ratio of overall mediastinitis was 0.13. Mediastinitis-related mortality was not detected. Conclusion: The ratio of mediastinitis decreases when patients who have discharge due to sternal dehiscence and superficial wound infection are immediately reviewed without waiting for the results of conventional methods such as antibiotic treatment and chest binder support.展开更多
In spite of advances in the management of mediastinitis following sternotomy,mediastinitis is still associated with significant morbidity.The prognosis is much better in pediatric surgery compared to adult surgery,but...In spite of advances in the management of mediastinitis following sternotomy,mediastinitis is still associated with significant morbidity.The prognosis is much better in pediatric surgery compared to adult surgery,but the prolonged hospital stays with intravenous therapy and frequent required dressing changes that occur with several therapeutic approaches are poorly tolerated.Prevention includes nasal decontamination,skin preparation,antibioprophylaxis and air filtration in the operating theater.The expertise of the surgical team is an additional factor that is difficult to assess precisely.Diagnosis is often very simple,being made on the basis of a septic state with wound modification,while retrosternal puncture and CT scan are rarely useful.Treatment of mediastinitis following sternotomy is always a combination of surgical debridement and antibiotic therapy.Continued use of numerous surgical techniques demonstrates that there is no consensus and the best treatment has yet to be determined.However,we suggest that a primary sternal closure is the best surgical option for pediatric patients.We propose a simple technique with high-vacuum Redon's catheter drainage that allows early mobilization and short term antibiotherapy,which thus decreases physiological and psychological trauma for patients and families.We have demonstrated the ef-ficiency of this technique,which is also cost-effective by decreasing intensive care and hospital stay durations,in a large group of patients.展开更多
BACKGROUND Endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA)is a safe and minimally invasive diagnostic tool for mediastinal and hilum evaluation.However,infectious complications may occur af...BACKGROUND Endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA)is a safe and minimally invasive diagnostic tool for mediastinal and hilum evaluation.However,infectious complications may occur after EBUS-TBNA.Among these,mediastinitis and pericarditis are rare.CASE SUMMARY A 67-year-old woman was referred to our hospital due to paratracheal lymph node enlargement on chest computed tomography(CT).EBUS-TBNA was performed on the lymph node lesions,and prophylactic oral antibiotics were administered.Seven days after EBUS-TBNA,the patient visited the emergency room with a high fever and chest pain.Laboratory test results revealed leukocytosis with a left shift and elevated C-reactive protein level(25.7 mg/dL).Chest CT revealed the formation of a mediastinal abscess in the right paratracheal lymph node and pericardial and bilateral pleural effusions.The patient received intravenous antibiotic treatment,cardiac drainage through pericardiocentesis,and surgical management.The patient recovered favorably and was discharged 31 d after the operation.CONCLUSION Mediastinitis and pericarditis after EBUS-TBNA are rare but should be considered even after the use of prophylactic antibiotics.展开更多
This is a very unusual case with unexpected findings. In spite of sophisticated investigation tests such as MRI and pul?monary angiogram, it may be very difficult to identify the nature of pulmonary artery stenosis or...This is a very unusual case with unexpected findings. In spite of sophisticated investigation tests such as MRI and pul?monary angiogram, it may be very difficult to identify the nature of pulmonary artery stenosis or occlusion.展开更多
Background：Fibrosing mediastinitis （FM） is a rare disease.FM is thought to be related to prior granulomatous mediastinal infection,such as histoplasmosis or tuberculosis.The majority of cases have been reported in ...Background：Fibrosing mediastinitis （FM） is a rare disease.FM is thought to be related to prior granulomatous mediastinal infection,such as histoplasmosis or tuberculosis.The majority of cases have been reported in endemic regions for histoplasmosis.The characteristics of cases of FM in China,where the prevalence of tuberculosis is high,have not been reported.We analyzed the clinical,imaging,and bronchoscopic features of Chinese patients with FM to promote awareness of this disease.Methods：Between January 2005 and June 2015,twenty patients were diagnosed with FM in our hospital.Medical records and follow-up data were collected.Imaging and biopsy findings were reviewed by radiologists and pathologists.Results：A total of 20 patients were analyzed （8 males and 12 females）.The age ranged from 43 to 88 years with a mean age of 69.5 years.Previous or latent tuberculosis was found in 12 cases.Clinical symptoms included dyspnea （18/20）,cough （17/20）,expectoration （7/20）,and recurrent pneumonia （3/20）.Chest computed tomography scans showed a diffuse,homogeneous,soft tissue process throughout the mediastinum and hila with compression of bronchial and pulmonary vessels.Calcification was common （15/20）.Pulmonary hypertension was present in 9 of 20 cases.Diffuse black pigmentation in the bronchial mucosa was frequently seen on bronchoscopy （12/13）.The patients＇ response to antituberculosis treatment was inconsistent.Conclusions：FM in Chinese patients is most likely associated with tuberculosis.Some characteristics of FM are different from cases caused by histoplasmosis.展开更多
Mediastinitis is a life-threatening condition caused by purulent effusion in the mediastinum.Rapid surgical treatment and proper clinical approach are the cornerstones for healing.This case report highlights an unusua...Mediastinitis is a life-threatening condition caused by purulent effusion in the mediastinum.Rapid surgical treatment and proper clinical approach are the cornerstones for healing.This case report highlights an unusual cause of onset for this condition and describes how various approaches for this disease could be complementary.A 39-year-old man was referred to our department,with a history of recurrent pneumonia and upper left lung lobe’s opacity,from the intensive care unit(ICU)for the CT finding of mediastinitis.We performed a video-assisted left mini-thoracotomy and subxiphoid access to drain the purulent collection from mediastinum and pleural cavities.Then we started an unprecedented off-label multi-drug antibiotic treatment with ceftolozane/tazobactam plus fosfomycin and,after 15 days,we performed an upper left lobectomy.The histological finding was suggestive of the presence of a lung’s teratoma,which had caused the mediastinitis.The patient was dismissed and is,nowadays,in good health.Identifying mediastinitis is essential for his rapid and proper treatment,and the surgical approach is not always sufficiently effective.The present case report underlines that it is mandatory to remember that rapid surgical intervention,with the right timing,right clinical approach,and multidisciplinary approach,are critical factors for mediastinitis treatment.展开更多
Cystic lesions of the anterior mediastinum in children suggest a well-known group of benign lesions that are comparatively frequent.Thymic cysts(TCs)are mostly positioned in the anterior mediastinum and some patients ...Cystic lesions of the anterior mediastinum in children suggest a well-known group of benign lesions that are comparatively frequent.Thymic cysts(TCs)are mostly positioned in the anterior mediastinum and some patients in the neck.Benign TCs classified as congenital intra-thoracic mesothelial cysts are commonly asymptomatic and have slight clinical significance.Multilocular TC,which can mimic another anterior mediastinal cystic tumor and is seen in adults,is more clinically important.It is a sporadic mediastinal lesion thought to arise in the course of acquired inflammation.Congenital mediastinal cysts represent 3%-6%of all mediastinal tumors and 10%-18%of radiologically reported mediastinal masses.Mediastinal TCs are uncommon and it is hard to know their true incidence.About 60%of cases with mediastinal TCs are asymptomatic,and the remainder of patients complains of nonspecific symptoms(e.g.,chest pain,dyspnea,or cough).The literature suggests that most cysts are benign,but an indefinite percentage may have a neoplastic process and result in significant compressive symptoms over time.Clinical symptoms of TCs vary depending on the location.In addition,frequent symptoms at the appearance of enlarged benign thymic and mediastinal cysts generally contain compressive symptoms(e.g.,respiratory distress,thymic pain,and symptoms related to Horner syndrome,hoarseness,dysphonia,dyspnea,orthopnea,wheezing,and fever).Many TCs have cystic density and a neat border and are simple to diagnose with radiological imaging.However,some TCs are hard to identify before surgery and may be misidentified as thymomas depending on their site and computed tomography results.Excision by thoracotomy,median sternotomy,or video-assisted techniques is essential for conclusive diagnosis,management,and abolition of relapse of anterior mediastinal masses and TCs.Histopathologic examination may be required after surgery.Considering the extent of the mass and the preliminary inability to make a definitive diagnosis,en bloc excision of the cyst was thought to be preferred to circumvent likely complications(e.g.,perforation,spillage of the contents,or incomplete excision).展开更多
A recent case report provided a patient scenario,wherein,a 39-year-old male patient presented with occasional palpitations,headache,and fever.Evaluation of tumor markers did not show any abnormal results.Subsequently,...A recent case report provided a patient scenario,wherein,a 39-year-old male patient presented with occasional palpitations,headache,and fever.Evaluation of tumor markers did not show any abnormal results.Subsequently,a computed tomography(CT)scan was undertaken,and its findings were affirmative of thymic cancer.Finally,the postoperative histopathological assessment of the mass,after its resection,confirmed it as an anterior mediastinal multilocular thymic cyst(MTC),with concurrent acute upper respiratory tract infection and acute myocarditis.Accordingly,this case report advocates the need for a preoperative histopathological examination with CT imaging to minimize the risk of confusing an MTC with a malignant thymic tumor.展开更多
BACKGROUND Mediastinal lymph nodes(MLNs)can be enlarged due to various benign or malignant causes.Endoscopic ultrasound(EUS)is often employed for the acquisition of tissue specimens of the enlarged MLN(EMLN).AIM To de...BACKGROUND Mediastinal lymph nodes(MLNs)can be enlarged due to various benign or malignant causes.Endoscopic ultrasound(EUS)is often employed for the acquisition of tissue specimens of the enlarged MLN(EMLN).AIM To determine the causes,document the symptoms,and determine factors predicting good yield of EUS-guided EMLN biopsy.METHODS All patients having EMLN(>10 mm)on thoracic imaging and referred for EUSguided biopsy were included in this retrospective observational study.Adequacy of the tissue specimen was assessed by the endoscopist with macroscopic on-site evaluation(MOSE)and then sent to a histopathologist for final diagnosis.Analysis for factors predicting good biopsy yield was then performed.RESULTS Of the total 243 patients with EMLN,131(53.9%)were males.The mean age was 47.6(±14.7)and range 14-86 years.Commonest causes of EMLN were tuberculosis 82(33.7%),anthracosis 53(21.8%),neoplastic disease 43(17.7%)and sarcoidosis 14(5.8%).Among the 43 patients with neoplastic diseases:40 had metastatic disease(breast 9,lung 7,pancreatobiliary 6,esophagus 5,kidney 5,hepatocellular 2,neuroendocrine 2,gastrointestinal stromal 1,undetermined 3)and 3 had primary malignancies(lymphoproliferative disorder 2,Kaposi sarcoma 1).Chest related clinical symptoms were absent in more than half the patients with tuberculosis 51/82(62.2%),anthracosis 31/53(58.5%)and neoplastic disease 28/43(65.1%).Factors associated with good biopsy yield were:Subcarinal location of MLN(P=0.026),MLN size>12 mm(P<0.0001),use of fine-needle biopsy(vs fine-needle aspiration)(P=0.049)and satisfactory MOSE(P<0.0001)on univariate analysis;while MLN size>12 mm(P=0.005)and satisfactory MOSE(P<0.0001)on multivariate analysis.CONCLUSION Tuberculosis,anthracosis and metastatic disease were the commonest causes of EMLN.More than half the cases with EMLN had no chest-related symptoms.Large MLN size and satisfactory MOSE observation predicted a good biopsy yield.展开更多
BACKGROUND To evaluate the diagnostic utility of endobronchial ultrasound(EBUS)-guided mediastinal lymph node fenestration biopsy in atypical sarcoidosis using fine biopsy forceps[i.e.,EBUS-transbronchial forceps biop...BACKGROUND To evaluate the diagnostic utility of endobronchial ultrasound(EBUS)-guided mediastinal lymph node fenestration biopsy in atypical sarcoidosis using fine biopsy forceps[i.e.,EBUS-transbronchial forceps biopsy(TBFB)].CASE SUMMARY In this case series,two atypical sarcoidosis cases admitted in 2024 were retrospectively analyzed,both of whom lacked classical clinical manifestations.After chest computed tomography/positron emission tomography-computed tomography imaging and serum angiotensin-converting enzyme testing,EBUStransbronchial needle aspiration was performed using a 21-G needle.Subsequently,tissue sampling was performed at the enlarged puncture site by means of a 1.2-mm fine biopsy forceps.At the same time,bronchoalveolar lavage fluid lymphocyte subset analysis was conducted.CONCLUSION Both cases demonstrated non-caseating granulomatous inflammation on histopathology,elevated serum angiotensin-converting enzyme levels,and markedly increased CD4/CD8 ratios in bronchoalveolar lavage fluid.Case 1 was observed after confirmation of stage II sarcoidosis,whereas case 2 required glucocorticoid therapy due to the involvement of multiple systems.EBUS-TBFB can be used to make a definitive pathological diagnosis.For radiologically atypical sarcoidosis,EBUS-TBFB improves diagnostic accuracy by obtaining larger histological samples,thereby addressing the limitations of transbronchial needle aspiration cytology.This approach significantly improves differential diagnostic efficacy and holds substantial clinical relevance for broader adoption.展开更多
The clinical treatment of severe trauma withsternoclavicular joint injury is challenging,primarilydue to the irregular shape of the bones surrounding thesternoclavicular joint,as well as the posterior clavicle beingcl...The clinical treatment of severe trauma withsternoclavicular joint injury is challenging,primarilydue to the irregular shape of the bones surrounding thesternoclavicular joint,as well as the posterior clavicle beingclose to the aorta and mediastinal organs.^([1])These patientsnot only suffer direct injuries to the sternoclavicularjoint,but also frequently experience severe injuries toother body parts.The systemic physiological disordersand multi-organ dysfunction caused by severe traumaincrease the surgery di?culty and mortality risk.^([2])展开更多
AIM: To investigate possible predictors for failed self-expandable metallic stent (SEMS) therapy in consecutive patients with benign esophageal perforation-rupture (EPR).
A seven-month-old infant was admitted to our hospital with a 1-wk history of shortness of breath, dysphagia, and fever. Diagnosis of esophageal perforation follow- ing fish vertebra ingestion was made by history revie...A seven-month-old infant was admitted to our hospital with a 1-wk history of shortness of breath, dysphagia, and fever. Diagnosis of esophageal perforation follow- ing fish vertebra ingestion was made by history review, pneumomediastinum and an irregular hyperdense lesion noted in initial chest radiogram. Neck computed tomo- graphy (CT) confirmed that the foreign body located at the cricopharyngeal level and a small esophageal tra- cheal fistula was shown by esophagogram. The initial re- sponse to treatment of fish bone removal guided by pan- endoscopy and antibiotics administration was poor since pneumothorax plus empyema developed. Fortunately, the patient’s condition finally improved after decortica- tion, mediastinotomy and perforated esophagus repair. To our knowledge, this is the first case report of esopha- geal perforation due to fish bone ingestion in infancy. In addition to particular caution that has to be taken when feeding the innocent, young victim, it may indicate the importance of surgical intervention for complicated esophageal perforation in infancy.展开更多
Various degrees of esophageal injury have been described after radiofrequency ablation performed for treatment of atrial fibrillation. The main mechanism of injury is thermal and may lead to a range of esophageal muco...Various degrees of esophageal injury have been described after radiofrequency ablation performed for treatment of atrial fibrillation. The main mechanism of injury is thermal and may lead to a range of esophageal mucosal changes, some clinically insignificant, however when deep ulceration occurs, this may be further complicated by perforation and mediastinitis, a rare but life threatening sequelae. We present a case of a severe esophageal injury leading to mediastinitis, with interesting endoscopic findings.展开更多
文摘Acute mediastinitis is a fatal disease that usually originates from esophageal perforation and surgical infection.Rare cases of descending necrotizing mediastinitis can occur following oral cavity and pharynx infection or can be a complication of pancreatitis.The most common thoracic complications of pancreatic disease are reactive pleural effusion and pneumonia,while rare complications include thoracic conditions,such as pancreaticopleural fistula with massive pleural effusion or hemothorax and extension of pseudocyst into the mediastinum.There have been no reports of acute mediastinitis originating from pancreatitis in South Korea.In this report,we present the case of a 50-year-old female suffering from acute mediastinitis with pleural effusion arising from recurrent pancreatitis that improved after surgical intervention.
文摘Chicken bone is one of the most frequent foreign bodies (FB) associated with upper esophageal perforation. Upper digestive tract penetrating FB may lead to life threatening complications and requires prompt management. We present the case of a 52-year-old man who sustained an upper esophageal perforation associated with cervical cellulitis and mediastinitis. Following CT-scan evidence of FB penetrating the esophagus, the impacted FB was successfully extracted under rigid esophagoscopy. Direct suture was required to close the esophageal perforation. Cervical and mediastinal drainage were made immediately. Naso- gastric tube decompression, broad-spectrum intravenous antibiotics, and parenteral hyperalimentation were administered for 10 d postoperatively. An esophagogram at d 10 revealed no leak at the repair site, and oral alimentation was successfully reinstituted. Conclusion: Rigid endoscope management of FB esophageal penetration is a simple, safe and effective procedure. Primary esophageal repair with drainage of all affected compartments are necessary to avoid life-threatening complications.
文摘Purpose: Descending necrotizing mediastinitis(DNM) is a lethal and acute suppurative disease. This report aimed to summarize our experience in the treatment of DNM with continuous negative pressure catheter drainage and transnasal jejunal feeding by interventional techniques. Materials and Methods: We retrospectively analyzed relevant clinical data of patients with DNM who underwent continuous negative pressure catheter drainage and transnasal jejunal feeding. All drainage catheters and jejunal feeding tubes were inserte d by interventional techniques. Results: In total, 21 patients were diagnosed with DNM by esophagography and computed tomography(CT). Catheters for the drainage of mediastinal abscesses as well as transnasal jejunal feeding tubes were successfully placed in all patients, indicating a 100% success rate. Of all patients, 13 underwent insertion of abscess drainage catheters through percutaneous puncture under DynaCT guidance, while eight had drainage catheter insertion through fistula orifices in the posterior nasopharyngeal wall or esophagus under fluoroscopic guidance. In total, 26 drainage tubes were inserted. One patient with diabetes died of sepsis and diabetic ketoacidosis 5 days postoperatively, while the remaining 20 patients showed good recovery with successful removal of the drainage catheters. Durations of catheterization were 45.2±50.44 days. The overall clinical success rate was 95.2%. Conclusion: The above described methods are non-surgical, minimally invasive and efficacious, and may be alternative therapeutic tools for patients who are not eligible for surgical operation, have a high postoperative risk, or are more likely to choose minimally invasive techniques.
文摘Background: Discharge due to superficial wound infection and sternal dehiscence are the common complications of median sternotomy. This condition leads to mediastinitis. Mediastinitis is a serious condition which increases morbidity, mortality and hospital costs. The correct time for surgical treatment is contraversial in cases who have sternal dehiscence and discharge due to superficial infection. In this study, patients received sternal stabilization as soon as a diagnosis was made and monitored for the development of mediastinitis. Methods: Among the 1440 patients who had undergone elective CABG, a total of 85 patients who developed sternal dehiscence and superficial wound discharge were included in this study. These patients were re-operated on as soon as diagnosed and early sternal stabilization was provided. Results: The ratio of overall dehiscence was 5.9%. Mediastinitis developed in only 2 of the 85 patients. These patients were treated with VAC (Vacuum Assisted Closure) therapy. The ratio of overall mediastinitis was 0.13. Mediastinitis-related mortality was not detected. Conclusion: The ratio of mediastinitis decreases when patients who have discharge due to sternal dehiscence and superficial wound infection are immediately reviewed without waiting for the results of conventional methods such as antibiotic treatment and chest binder support.
文摘In spite of advances in the management of mediastinitis following sternotomy,mediastinitis is still associated with significant morbidity.The prognosis is much better in pediatric surgery compared to adult surgery,but the prolonged hospital stays with intravenous therapy and frequent required dressing changes that occur with several therapeutic approaches are poorly tolerated.Prevention includes nasal decontamination,skin preparation,antibioprophylaxis and air filtration in the operating theater.The expertise of the surgical team is an additional factor that is difficult to assess precisely.Diagnosis is often very simple,being made on the basis of a septic state with wound modification,while retrosternal puncture and CT scan are rarely useful.Treatment of mediastinitis following sternotomy is always a combination of surgical debridement and antibiotic therapy.Continued use of numerous surgical techniques demonstrates that there is no consensus and the best treatment has yet to be determined.However,we suggest that a primary sternal closure is the best surgical option for pediatric patients.We propose a simple technique with high-vacuum Redon's catheter drainage that allows early mobilization and short term antibiotherapy,which thus decreases physiological and psychological trauma for patients and families.We have demonstrated the ef-ficiency of this technique,which is also cost-effective by decreasing intensive care and hospital stay durations,in a large group of patients.
文摘BACKGROUND Endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA)is a safe and minimally invasive diagnostic tool for mediastinal and hilum evaluation.However,infectious complications may occur after EBUS-TBNA.Among these,mediastinitis and pericarditis are rare.CASE SUMMARY A 67-year-old woman was referred to our hospital due to paratracheal lymph node enlargement on chest computed tomography(CT).EBUS-TBNA was performed on the lymph node lesions,and prophylactic oral antibiotics were administered.Seven days after EBUS-TBNA,the patient visited the emergency room with a high fever and chest pain.Laboratory test results revealed leukocytosis with a left shift and elevated C-reactive protein level(25.7 mg/dL).Chest CT revealed the formation of a mediastinal abscess in the right paratracheal lymph node and pericardial and bilateral pleural effusions.The patient received intravenous antibiotic treatment,cardiac drainage through pericardiocentesis,and surgical management.The patient recovered favorably and was discharged 31 d after the operation.CONCLUSION Mediastinitis and pericarditis after EBUS-TBNA are rare but should be considered even after the use of prophylactic antibiotics.
文摘This is a very unusual case with unexpected findings. In spite of sophisticated investigation tests such as MRI and pul?monary angiogram, it may be very difficult to identify the nature of pulmonary artery stenosis or occlusion.
文摘Background：Fibrosing mediastinitis （FM） is a rare disease.FM is thought to be related to prior granulomatous mediastinal infection,such as histoplasmosis or tuberculosis.The majority of cases have been reported in endemic regions for histoplasmosis.The characteristics of cases of FM in China,where the prevalence of tuberculosis is high,have not been reported.We analyzed the clinical,imaging,and bronchoscopic features of Chinese patients with FM to promote awareness of this disease.Methods：Between January 2005 and June 2015,twenty patients were diagnosed with FM in our hospital.Medical records and follow-up data were collected.Imaging and biopsy findings were reviewed by radiologists and pathologists.Results：A total of 20 patients were analyzed （8 males and 12 females）.The age ranged from 43 to 88 years with a mean age of 69.5 years.Previous or latent tuberculosis was found in 12 cases.Clinical symptoms included dyspnea （18/20）,cough （17/20）,expectoration （7/20）,and recurrent pneumonia （3/20）.Chest computed tomography scans showed a diffuse,homogeneous,soft tissue process throughout the mediastinum and hila with compression of bronchial and pulmonary vessels.Calcification was common （15/20）.Pulmonary hypertension was present in 9 of 20 cases.Diffuse black pigmentation in the bronchial mucosa was frequently seen on bronchoscopy （12/13）.The patients＇ response to antituberculosis treatment was inconsistent.Conclusions：FM in Chinese patients is most likely associated with tuberculosis.Some characteristics of FM are different from cases caused by histoplasmosis.
文摘Mediastinitis is a life-threatening condition caused by purulent effusion in the mediastinum.Rapid surgical treatment and proper clinical approach are the cornerstones for healing.This case report highlights an unusual cause of onset for this condition and describes how various approaches for this disease could be complementary.A 39-year-old man was referred to our department,with a history of recurrent pneumonia and upper left lung lobe’s opacity,from the intensive care unit(ICU)for the CT finding of mediastinitis.We performed a video-assisted left mini-thoracotomy and subxiphoid access to drain the purulent collection from mediastinum and pleural cavities.Then we started an unprecedented off-label multi-drug antibiotic treatment with ceftolozane/tazobactam plus fosfomycin and,after 15 days,we performed an upper left lobectomy.The histological finding was suggestive of the presence of a lung’s teratoma,which had caused the mediastinitis.The patient was dismissed and is,nowadays,in good health.Identifying mediastinitis is essential for his rapid and proper treatment,and the surgical approach is not always sufficiently effective.The present case report underlines that it is mandatory to remember that rapid surgical intervention,with the right timing,right clinical approach,and multidisciplinary approach,are critical factors for mediastinitis treatment.
文摘Cystic lesions of the anterior mediastinum in children suggest a well-known group of benign lesions that are comparatively frequent.Thymic cysts(TCs)are mostly positioned in the anterior mediastinum and some patients in the neck.Benign TCs classified as congenital intra-thoracic mesothelial cysts are commonly asymptomatic and have slight clinical significance.Multilocular TC,which can mimic another anterior mediastinal cystic tumor and is seen in adults,is more clinically important.It is a sporadic mediastinal lesion thought to arise in the course of acquired inflammation.Congenital mediastinal cysts represent 3%-6%of all mediastinal tumors and 10%-18%of radiologically reported mediastinal masses.Mediastinal TCs are uncommon and it is hard to know their true incidence.About 60%of cases with mediastinal TCs are asymptomatic,and the remainder of patients complains of nonspecific symptoms(e.g.,chest pain,dyspnea,or cough).The literature suggests that most cysts are benign,but an indefinite percentage may have a neoplastic process and result in significant compressive symptoms over time.Clinical symptoms of TCs vary depending on the location.In addition,frequent symptoms at the appearance of enlarged benign thymic and mediastinal cysts generally contain compressive symptoms(e.g.,respiratory distress,thymic pain,and symptoms related to Horner syndrome,hoarseness,dysphonia,dyspnea,orthopnea,wheezing,and fever).Many TCs have cystic density and a neat border and are simple to diagnose with radiological imaging.However,some TCs are hard to identify before surgery and may be misidentified as thymomas depending on their site and computed tomography results.Excision by thoracotomy,median sternotomy,or video-assisted techniques is essential for conclusive diagnosis,management,and abolition of relapse of anterior mediastinal masses and TCs.Histopathologic examination may be required after surgery.Considering the extent of the mass and the preliminary inability to make a definitive diagnosis,en bloc excision of the cyst was thought to be preferred to circumvent likely complications(e.g.,perforation,spillage of the contents,or incomplete excision).
文摘A recent case report provided a patient scenario,wherein,a 39-year-old male patient presented with occasional palpitations,headache,and fever.Evaluation of tumor markers did not show any abnormal results.Subsequently,a computed tomography(CT)scan was undertaken,and its findings were affirmative of thymic cancer.Finally,the postoperative histopathological assessment of the mass,after its resection,confirmed it as an anterior mediastinal multilocular thymic cyst(MTC),with concurrent acute upper respiratory tract infection and acute myocarditis.Accordingly,this case report advocates the need for a preoperative histopathological examination with CT imaging to minimize the risk of confusing an MTC with a malignant thymic tumor.
文摘BACKGROUND Mediastinal lymph nodes(MLNs)can be enlarged due to various benign or malignant causes.Endoscopic ultrasound(EUS)is often employed for the acquisition of tissue specimens of the enlarged MLN(EMLN).AIM To determine the causes,document the symptoms,and determine factors predicting good yield of EUS-guided EMLN biopsy.METHODS All patients having EMLN(>10 mm)on thoracic imaging and referred for EUSguided biopsy were included in this retrospective observational study.Adequacy of the tissue specimen was assessed by the endoscopist with macroscopic on-site evaluation(MOSE)and then sent to a histopathologist for final diagnosis.Analysis for factors predicting good biopsy yield was then performed.RESULTS Of the total 243 patients with EMLN,131(53.9%)were males.The mean age was 47.6(±14.7)and range 14-86 years.Commonest causes of EMLN were tuberculosis 82(33.7%),anthracosis 53(21.8%),neoplastic disease 43(17.7%)and sarcoidosis 14(5.8%).Among the 43 patients with neoplastic diseases:40 had metastatic disease(breast 9,lung 7,pancreatobiliary 6,esophagus 5,kidney 5,hepatocellular 2,neuroendocrine 2,gastrointestinal stromal 1,undetermined 3)and 3 had primary malignancies(lymphoproliferative disorder 2,Kaposi sarcoma 1).Chest related clinical symptoms were absent in more than half the patients with tuberculosis 51/82(62.2%),anthracosis 31/53(58.5%)and neoplastic disease 28/43(65.1%).Factors associated with good biopsy yield were:Subcarinal location of MLN(P=0.026),MLN size>12 mm(P<0.0001),use of fine-needle biopsy(vs fine-needle aspiration)(P=0.049)and satisfactory MOSE(P<0.0001)on univariate analysis;while MLN size>12 mm(P=0.005)and satisfactory MOSE(P<0.0001)on multivariate analysis.CONCLUSION Tuberculosis,anthracosis and metastatic disease were the commonest causes of EMLN.More than half the cases with EMLN had no chest-related symptoms.Large MLN size and satisfactory MOSE observation predicted a good biopsy yield.
基金Supported by the National Natural Science Foundation of China,No.82170103Natural Science Foundation of Fujian Province,No.2024J011325+1 种基金Young People Training Project from Fujian Province Health Bureau,No.2020GGB057 and No.2023QNB008Xiamen Medical and Health Guidance Project,No.3502Z20224ZD1060,No.3502Z20214ZD1043,and No.3502Z20224ZD1058.
文摘BACKGROUND To evaluate the diagnostic utility of endobronchial ultrasound(EBUS)-guided mediastinal lymph node fenestration biopsy in atypical sarcoidosis using fine biopsy forceps[i.e.,EBUS-transbronchial forceps biopsy(TBFB)].CASE SUMMARY In this case series,two atypical sarcoidosis cases admitted in 2024 were retrospectively analyzed,both of whom lacked classical clinical manifestations.After chest computed tomography/positron emission tomography-computed tomography imaging and serum angiotensin-converting enzyme testing,EBUStransbronchial needle aspiration was performed using a 21-G needle.Subsequently,tissue sampling was performed at the enlarged puncture site by means of a 1.2-mm fine biopsy forceps.At the same time,bronchoalveolar lavage fluid lymphocyte subset analysis was conducted.CONCLUSION Both cases demonstrated non-caseating granulomatous inflammation on histopathology,elevated serum angiotensin-converting enzyme levels,and markedly increased CD4/CD8 ratios in bronchoalveolar lavage fluid.Case 1 was observed after confirmation of stage II sarcoidosis,whereas case 2 required glucocorticoid therapy due to the involvement of multiple systems.EBUS-TBFB can be used to make a definitive pathological diagnosis.For radiologically atypical sarcoidosis,EBUS-TBFB improves diagnostic accuracy by obtaining larger histological samples,thereby addressing the limitations of transbronchial needle aspiration cytology.This approach significantly improves differential diagnostic efficacy and holds substantial clinical relevance for broader adoption.
文摘The clinical treatment of severe trauma withsternoclavicular joint injury is challenging,primarilydue to the irregular shape of the bones surrounding thesternoclavicular joint,as well as the posterior clavicle beingclose to the aorta and mediastinal organs.^([1])These patientsnot only suffer direct injuries to the sternoclavicularjoint,but also frequently experience severe injuries toother body parts.The systemic physiological disordersand multi-organ dysfunction caused by severe traumaincrease the surgery di?culty and mortality risk.^([2])
文摘AIM: To investigate possible predictors for failed self-expandable metallic stent (SEMS) therapy in consecutive patients with benign esophageal perforation-rupture (EPR).
基金Supported by grant from CGMH, Taoyuan, Taiwan, No. CMRPG 33014
文摘A seven-month-old infant was admitted to our hospital with a 1-wk history of shortness of breath, dysphagia, and fever. Diagnosis of esophageal perforation follow- ing fish vertebra ingestion was made by history review, pneumomediastinum and an irregular hyperdense lesion noted in initial chest radiogram. Neck computed tomo- graphy (CT) confirmed that the foreign body located at the cricopharyngeal level and a small esophageal tra- cheal fistula was shown by esophagogram. The initial re- sponse to treatment of fish bone removal guided by pan- endoscopy and antibiotics administration was poor since pneumothorax plus empyema developed. Fortunately, the patient’s condition finally improved after decortica- tion, mediastinotomy and perforated esophagus repair. To our knowledge, this is the first case report of esopha- geal perforation due to fish bone ingestion in infancy. In addition to particular caution that has to be taken when feeding the innocent, young victim, it may indicate the importance of surgical intervention for complicated esophageal perforation in infancy.
文摘Various degrees of esophageal injury have been described after radiofrequency ablation performed for treatment of atrial fibrillation. The main mechanism of injury is thermal and may lead to a range of esophageal mucosal changes, some clinically insignificant, however when deep ulceration occurs, this may be further complicated by perforation and mediastinitis, a rare but life threatening sequelae. We present a case of a severe esophageal injury leading to mediastinitis, with interesting endoscopic findings.
