Kyobu Geka. The Japanese Journal Of Thoracic Surgery[JOURNAL]
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200 papers
[Severe Subcutaneous Emphysema Extending up to the Face with Only Minor Traumatic Pneumothorax].
Makita A, Seki Y, Ichihara T … +1 more , Yasuda A
Kyobu Geka · 2025 Jun · PMID 40589020
An 81-year-old man with chest trauma presented with facial swelling and eyes shut due to subcutaneous emphysema. Computed tomography (CT) scans revealed extensive emphysema from the face to the pelvis, including mediasti...
An 81-year-old man with chest trauma presented with facial swelling and eyes shut due to subcutaneous emphysema. Computed tomography (CT) scans revealed extensive emphysema from the face to the pelvis, including mediastinal emphysema, fractures of the left 6th and 7th ribs, minor left pneumothorax, and slight hemothorax. Emphysema was likely caused by lung adhesions or fractured bone fragments penetrating the lung. Surgery was performed under epidural anesthesia in the right lateral decubitus position. The 6-cm incision above the fracture site allowed access to the extrapleural cavity. The lung penetration was relieved, and the fractured bones were realigned. Thoracoscopy revealed no adhesions, and two drains were placed. The patient was discharged on postoperative day nine. Although transfer to general anesthesia was considered, the surgery was successfully completed under epidural anesthesia. Epidural anesthesia may be a viable option for patients with severe subcutaneous emphysema, thereby avoiding the risks associated with positive pressure ventilation.
[Commando Procedure for Redo Aortic Valve Replacement in a Young Woman after Double Valve Replacement].
Kano A, Igarashi T, Ushijima T … +7 more , Takase S, Wakamatsu H, Ishida K, Konnai M, Nagata E, Kawamata R, Imasaka K
Kyobu Geka · 2025 Jun · PMID 40589019
A 29-year-old woman after double valve replacement. She underwent a Commando procedure for aortic valve replacement with annular enlargement due to structural valve deterioration of the bioprosthetic aortic valve and a n...
A 29-year-old woman after double valve replacement. She underwent a Commando procedure for aortic valve replacement with annular enlargement due to structural valve deterioration of the bioprosthetic aortic valve and a narrow valve annulus. In the Commando procedure with annular enlargement, the balance between mitral and aortic valve size is important. If the mitral valve is too small, the aortic valve cannot be enlarged sufficiently, and if the mitral valve is too large, left ventricular deformation and left ventricular outflow tract stenosis may occur. Valve sizing should be performed with this in mind.
[Pseudoaneurysm Arose from the Side Branch of Vascular Graft after Thoracic Aortic Replacement].
Kawamura M, Nishijima I, Senaha S … +2 more , Shimoji M, Kuniyoshi Y
Kyobu Geka · 2025 Jun · PMID 40589018
The patient is a 52-year-old man. He underwent ascending aortic replacement for acute aortic dissection 21 years ago and aortic root replacement 15 years ago. During postoperative follow up, a pseudoaneurysm of the ascen...
The patient is a 52-year-old man. He underwent ascending aortic replacement for acute aortic dissection 21 years ago and aortic root replacement 15 years ago. During postoperative follow up, a pseudoaneurysm of the ascending aorta was found. Cause of the pseudoaneurysm was supposed to be injury of the anastomotic site by a sternal wire. Since the pseudoaneurysm was enlarging, operation was indicated. Incising the pseudoaneurysm, we did not find silk threads that were used for ligation of the side branch of the vascular graft, and there was bleeding from the side branch. It is reported that silk threads lose strength in vivo over time. Previously, we had ligated side branches of vascular grafts only with silk threads. This experience led us to add polypropylene sutures for ligation of side branches.
[Study of the Characteristics of Lung Cancer Surgery Cases in the Elderly and the Usefulness of the Japanese National Clinical Database Risk Calculator].
Kawaguchi T, Watanabe F, Adachi K
Kyobu Geka · 2025 Jun · PMID 40589017
INTRODUCTION: We examined the utility of the National Clinical Database( NCD) risk calculator in assessing the risk of postoperative complications in elderly patients undergoing lung cancer surgery. METHODS: We included...
INTRODUCTION: We examined the utility of the National Clinical Database( NCD) risk calculator in assessing the risk of postoperative complications in elderly patients undergoing lung cancer surgery. METHODS: We included 360 cases of primary lung cancer surgery involving lobectomy or more resection performed at our department from May 2012 to December 2021. We divided the patients into two groups based on age (75 years and older, or less than 75 years) and retrospectively analyzed the correlation between the four risk scores of the NCD risk calculator, the incidence of postoperative complications, and the NCD risk calculator. RESULTS: In the group aged 75 years and older, there was a significant decrease in respiratory function and significantly higher scores on the NCD risk calculator. When comparing the correlation between the presence of postoperative complications and the "death or severe complication score," the area under the curve( AUC) as a risk scoring system was 0.710. CONCLUSION: The NCD risk calculator is suggested to be a useful tool for assessing the risk of surgical complications in elderly patients.
[Maze Surgery Using the General-purpose Cryosurgical Unit 'Freeze Stick M'].
Matsuo T, Takeda T, Kawatou M … +9 more , Takai F, Takatoku K, Kira H, Fujimoto Y, Fujimoto H, Nakanishi R, Kanno K, Ikeda T, Minatoya K
Kyobu Geka · 2025 Jun · PMID 40589016
BACKGROUND: Maze surgery for atrial fibrillation (AF) has increasingly utilized disposable cryoablation and radiofrequency devices. However, reusable ablation devices are preferred for reducing healthcare costs. At our d...
BACKGROUND: Maze surgery for atrial fibrillation (AF) has increasingly utilized disposable cryoablation and radiofrequency devices. However, reusable ablation devices are preferred for reducing healthcare costs. At our department, the general-purpose cryosurgical unit "Freeze Stick M" has been used for maze surgery and intercostal nerve block during left thoracotomy, effectively minimizing postoperative pain. PATIENTS AND METHODS: Between August 2016 and July 2024, 44 patients underwent arrhythmia surgery for AF (36 chronic AF, 8 paroxysmal AF). The mean age was 71.9±7.6 years, with 66% males. Surgical procedures included biatrial maze (25 cases), pulmonary vein isolation (16 cases), left atrial maze (2 cases), and right atrial maze (1 case), all with left atrial appendage closure. Outcomes were compared between the SIM group( Freeze Stick M) and AC group( AtriCure). RESULTS: The 30-day mortality rate was 2.3%. Postoperative survival was 90.0% at 1 year, 81.0% at 3 and 5 years, and 67.5% at 7 years. AF-free rates at discharge were 76.2%( SIM) vs. 73.9%( AC). For chronic AF, AF-free rates at 5 years were 41.9%( SIM) vs. 38.5%( AC)(p=0.168). CONCLUSION: The general-purpose cryosurgical unit "Freeze Stick M" performed similarly to the Atri-Cure device as a lesion-creation device.
[How to Avoid Reoperation for Complications Associated with Durable Mechanical Circulatory Support Therapy].
Ooka T, Minamida T, Sugiki H … +2 more , Shingu Y, Wakasa S
Kyobu Geka · 2025 Apr · PMID 40494530
Since April 2011, durable mechanical circulatory support (DMCS) has been used for bridge to transplant (BTT-DMCS) in Japan, with its success leading to insurance coverage for destination therapy (DT-DMCS) in 2021. Despit...
Since April 2011, durable mechanical circulatory support (DMCS) has been used for bridge to transplant (BTT-DMCS) in Japan, with its success leading to insurance coverage for destination therapy (DT-DMCS) in 2021. Despite advancements, managing DMCS-related complications remains challenging, with high readmission rates impacting patients' quality of life and healthcare facilities' workloads. Key complications include de novo aortic insufficiency (dnAI), driveline infections (DLI), and external outflow graft obstruction( EOGO). dnAI contributes significantly to chronic right heart failure, with no consensus on optimal intervention timing. Techniques such as bioprosthetic aortic valve replacement (bioAVR) and central aortic valve closure( CAVC) are employed, each with distinct benefits and limitations. DLI, often caused by mechicillin-resistant Staphylococcus aureus (MRSA), multidrug-resistant bacteria, or Mycobacterium abscessus, necessitates advanced wound management, driveline translocation, and prolonged antibiotic therapy. Imaging modalities like 18-FDG PET/CT are crucial for accurate diagnosis and treatment planning. EOGO, frequently caused by seroma compression, can lead to circulatory failure and often requires surgical intervention or catheter-based treatments. Preventing reoperations, optimizing intervention timing, and ensuring multidisciplinary collaboration are essential strategies for improving patient outcomes and enhancing the long-term effectiveness of DMCS therapy.
[Long-term Management of Implantable Left Ventricular Assist Device for Maintaining Quality of Life].
Inafuku H
Kyobu Geka · 2025 Apr · PMID 40494529
The outcomes of implantable left ventricular assist device( iVAD) treatment in Japan are favorable; however, the high rate of re-hospitalization due to complications remains a significant issue. This report details the p...
The outcomes of implantable left ventricular assist device( iVAD) treatment in Japan are favorable; however, the high rate of re-hospitalization due to complications remains a significant issue. This report details the procedures for iVAD treatment conducted at our hospital. Specifically, we focus on:1. driveline( DL) infection, 2. stroke, and 3. right heart failure. 1. As part of DL infection control, the DL was assumed to enter through the upper umbilicus, and an incision was made from the right side, passing through the left rectus abdominis muscle to the left side. All patients are treated with a simple omental covering, and a new disinfectant, Prontosan, which contains both a surfactant and an antibacterial agent, is used to manage exit site infections involving biofilm. 2. To prevent stroke, all patients are provided with a CoaguChek XS device at discharge, which is adjusted to extend the time required to reach target prothrombin time-international normalized ratio (PT-INR) values. 3. As an innovative approach to treating right heart failure, we have developed a simple or unidirectional valved anastomosis between the superior vena cava and the right pulmonary artery, allowing blood to flow into the pulmonary artery under elevated venous pressure. This procedure is part of a collaborative research project with the School of Science and Engineering at Waseda University( TWIns).
[Outcomes of Implantable Left Ventricular Assist Device for Treating Advanced Heart Faire in Our Institute and Outlook for Long-term Use].
Ezure M
Kyobu Geka · 2025 Apr · PMID 40494528
From 2011, 13 patients with implantable ventricular assist device (VAD) have followed in our institute, 11 as a bridge to transplant (BTT), and two as destination therapy (DT). All patients were implanted left VAD (LVAD)...
From 2011, 13 patients with implantable ventricular assist device (VAD) have followed in our institute, 11 as a bridge to transplant (BTT), and two as destination therapy (DT). All patients were implanted left VAD (LVAD) in INTERMACS profile level 2 to 4, except two as a bridge to bridge (BTB) cases. The EVAHEART LVAD was selected in four, Jarvic2000 was in four, and HeartMate3 was in five patients. There were no major complications in perioperative period. Outpatient cares were provided by VAD team members every week. Of the 13 patients, six underwent transplant, two died during support and five are ongoing. Support averaged 38 months( three cases over 60 months). Eight patients required rehospitalization for more than one time. First three patients had cerebral hemorrhages in four, 10 and 25 months. One patient suffered severe right heart faire, and was repeatedly hospitalized( 22 times). There was no driveline infection, and no aortic regurgitation over moderate level. Several patients have continued cardiac rehabilitation, and improved physical strength and ventilatory power. Complications caused implantable VAD have been decreasing due to progressions of the device and appropriate managements for outpatient care. The current implantable LVAD can be used safely in advanced heart failure patients not only as BTT but also as DT. We can look forward to improve the technology of implantable VAD system in the future too. However, aging changes will be considered for long term follow-up of the DT patients.
[Current Status of Destination Therapy in Non-heart Transplant Facilities and Our Unique Management].
Fujiwara T, Fujita T
Kyobu Geka · 2025 Apr · PMID 40494527
Although our hospital is not a heart transplant facility, we accept many patients requiring temporary mechanical circulatory support (T-MCS), such as extracorporeal membrane oxygenation (ECMO), as part of our role as a d...
Although our hospital is not a heart transplant facility, we accept many patients requiring temporary mechanical circulatory support (T-MCS), such as extracorporeal membrane oxygenation (ECMO), as part of our role as a destination therapy (DT) facility. From May 2021 to December 2024, we performed 17 cases of DT using HeartMate 3. The patients' average age was 58±7 years. The underlying conditions included ischemic heart disease (nine cases), idiopathic dilated cardiomyopathy (seven cases), and drug-induced cardiomyopathy( one case). The average J-HeartMate risk score was 1.52. In this paper, we discuss the current status and challenges of DT at non-heart transplant facilities and present our unique approach to T-MCS strategies and patient education.
[Current State of Right Heart Failure after Implantable Ventricular Assist Device].
Eguchi N, Sezai A, Tanaka M
Kyobu Geka · 2025 Apr · PMID 40494526
Japanese registry for Mechanically Assisted Circulatory Support (J-MACS) reports on the results of implantable ventricular assist devices (VADs) in Japan show that the survival rates have stabilized at 93% at one year, 9...
Japanese registry for Mechanically Assisted Circulatory Support (J-MACS) reports on the results of implantable ventricular assist devices (VADs) in Japan show that the survival rates have stabilized at 93% at one year, 90% at two years and 81% at four years. However, the incidence of neurological dysfunction, hemorrhage and infection, the three major complications, has not been resolved, although it has decreased. Right heart failure has also been improved by implantable left VAD (iLVAD) in patients with preoperative biventricular failure. The J-MACS reported right heart failure free rates of 95% at 90 days, 92% at one year, 90% at two years and 84% at four years. Most cases are in the acute phase after iLVAD and often improve with nitric oxide( NO), drugs or a temporary right VAD( RVAD). In Japan, the waiting period for heart transplantation is long due to the shortage of donors, and the period of RVAD support is much longer than in the West. Right heart failure is sometimes observed in the remote period after iLVAD. Severe cases requiring RVAD and biventricular assist device( BiVAD) are treated with early cardiac transplantation in Europe and the United States of America (USA), while cases requiring long-term BiVAD therapy are extremely rare. Therefore, there are currently no clear standards for the indications and management of RVAD. In this report, we discuss domestic and foreign reports on right heart failure after left VAD (LVAD) and report a valuable case in which RVAD was performed three and a half years after iLVAD in our department, and BiVAD management was required for more than one year for heart transplantation.
[Driveline Infection of Implantable Left Ventricular Assist Devices].
Tanaka H, Seto T
Kyobu Geka · 2025 Apr · PMID 40494525
In Japan, the median waiting period from implantable left ventricular assist device( iLVAD) implantation to heart transplantation is 5.1 years, with driveline infections occurring in approximately 20% of cases within the...
In Japan, the median waiting period from implantable left ventricular assist device( iLVAD) implantation to heart transplantation is 5.1 years, with driveline infections occurring in approximately 20% of cases within the first year. At our institution, we implemented the triple tunnel method and a structured care protocol to mitigate infection risk. This protocol includes meticulous monitoring, the use of sterilized kits, chlorhexidine, and caregiver training. Among 25 patients, driveline infections occurred in 12% (three cases), but none progressed to pump infections. Kaplan-Meier analysis showed infection-free rates of 100% at one year and 85% at three years, slightly surpassing national benchmarks. These outcomes highlight the importance of early detection, multidisciplinary follow-up, and consistent care in ensuring successful long-term management of iLVAD patients.
[Prevention of Driveline Infection in the HeartMate 3 Era].
Yoshizumi T, Mutsuga M
Kyobu Geka · 2025 Apr · PMID 40494524
The current European and United States durable left ventricular assist device( LVAD) registry with HeartMate 3 did not show the improvement of device related infection in the long-term period, even though the early resul...
The current European and United States durable left ventricular assist device( LVAD) registry with HeartMate 3 did not show the improvement of device related infection in the long-term period, even though the early result was getting better because of the improvement of patient selections and surgical techniques. Driveline management protocol was crucial to prevent long-term driveline infection, however, there is no common one and each facility needs to make own protocol. We present our own driveline management protocol derived from our historical experiences and evaluate the effectiveness of our protocol for the prevention of driveline infections.
[Treatment Strategy for Implantable Ventricular Assist Device Infections:Is Omental Flap Useful?].
Fukuzumi M
Kyobu Geka · 2025 Apr · PMID 40494523
Infection of implantable ventricular assist device( iVAD) is one of the serious complications for which there is still no established treatment strategy. We evaluated the usefulness of omental flap for device infections....
Infection of implantable ventricular assist device( iVAD) is one of the serious complications for which there is still no established treatment strategy. We evaluated the usefulness of omental flap for device infections. Five of 20 patients of iVAD underwent omental flap for device infections extending to the pump site. Two patients underwent simultaneous omental flap and iVAD exchange, and three patients underwent device sparing. All of the device-sparing cases eventually required iVAD exchange due to recurrent infection. By covering the new pump with an omental flap at the time of iVAD exchange, there were no recurrent infections in any of the cases. Isolated omental flap is difficult to cure the device infections that extend the pump site alone, and iVAD exchange should also be performed, however, it might prevent recurrence of infection on new devices.
[Long-term Outpatient Management and Shared Care Practices to Prevent Rehospitalization and Improve Quality of Life in Patients with Implantable Ventricular Assist Device].
Kishimoto Y, Yoshikawa Y
Kyobu Geka · 2025 Apr · PMID 40494522
According to a statistical report from the Japanese registry for Mechanically Assisted Circulatory Support, the readmission rate is 85% at three years, mainly due to driveline infection. The prevention of adverse events...
According to a statistical report from the Japanese registry for Mechanically Assisted Circulatory Support, the readmission rate is 85% at three years, mainly due to driveline infection. The prevention of adverse events such as driveline infections is important to improve the quality of life of patients, an issue that needs to be emphasized more in these days when longer waiting periods for transplantation and destination therapy are becoming more common. In addition to monthly outpatient visits, we provide weekly e-mail consultations and promote collaboration with shared care facilities. Our driveline infection rate was 20% at three years, and the readmission rate was an excellent 27% at three years. The results suggest that our long-term outpatient management may have contributed to the improvement of quality of life by reducing adverse events such as driveline infections and preventing rehospitalization.
[Era of Major Transformation in Implantable Ventricular Assist Device Therapy].
Oda K, Katahira S
Kyobu Geka · 2025 Apr · PMID 40494521
Our hospital received certification as an implantable ventricular assist devices( iVAD) facility in 2018, and as of 2024, we continue to maintain this certification. We provide outpatient and inpatient care through a mul...
Our hospital received certification as an implantable ventricular assist devices( iVAD) facility in 2018, and as of 2024, we continue to maintain this certification. We provide outpatient and inpatient care through a multidisciplinary heart team. Our team has implanted HeartMate 3 in three patients, and we also manage five patients with devices implanted at other facilities, for a total of eight iVAD patients under outpatient care. Fortunately, we have had no cases of readmissions due to driveline infections or cerebrovascular events. We recognize that, in addition to advancements in surgical techniques and device technology, close collaboration between patients and the heart team, as well as the involvement of wound, ostomy, and continence( WOC) nurses, are essential. Recently, this field has entered a major transformation. With improvements in heart failure treatment by the' fantastic four' and the advancements in Impella technology, the need for extracorporeal ventricular assist device (EVAD) has significantly declined, and cases achieving a bridge to recovery are not uncommon. Furthermore, as the number of stable iVAD patients grows, not only are destination therapy (DT) cases increasing, but elderly patients are effectively becoming DT cases, underscoring the importance of iVAD facilities in providing end-of-life case for these patients.
[Our Challenge of Implantable Left Ventricular Assist Device in Private Local Hospital].
Ohashi T
Kyobu Geka · 2025 Apr · PMID 40494520
Our hospital is a 350-bed private institution located in Kasugai City, Aichi Prefecture. In 1998, we established a cardiovascular surgery department, and in 2006, we began performing surgeries to implant extracorporeal l...
Our hospital is a 350-bed private institution located in Kasugai City, Aichi Prefecture. In 1998, we established a cardiovascular surgery department, and in 2006, we began performing surgeries to implant extracorporeal left ventricular assist devices( LVAD). In 2007, we urgently installed an extracorporeal LVAD (left atrial drainage and aortic blood return) for a patient experiencing acute heart failure exacerbation following mitral valve replacement (MVR) due to dilated cardiomyopathy (DCM). Under LVAD support, the patient was able to achieve mobility and oral intake. Based on this achievement, our hospital was certified as a facility authorized to perform implantable LVAD procedures in 2012. In June 2013, we performed the first implantable LVAD surgery in the Tokai region for a patient with ischemic cardiomyopathy following redo coronary artery bypass grafting (CABG) and extracorporeal LVAD implantation. To date, we have conducted a total of four implantable LVAD surgeries. None of these cases involved complications such as surgical site infections. One of the patients successfully lived a normal life for five years before undergoing heart transplantation at another hospital.
[Durable Left Ventricular Assist Device Therapy for Patients with a Prior MitraClip or Impella Intervention].
Ushijima T, Fujino T, Matsunaga S … +3 more , Kimura S, Sonoda H, Shiose A
Kyobu Geka · 2025 Apr · PMID 40494519
Some patients have undergone implantation of a durable left ventricular assist device( LVAD) following heart failure treatment with Impella( Abiomed) or MitraClip( Abbott). Impella may carry a potential risk of de novo a...
Some patients have undergone implantation of a durable left ventricular assist device( LVAD) following heart failure treatment with Impella( Abiomed) or MitraClip( Abbott). Impella may carry a potential risk of de novo aortic insufficiency (AI), while MitraClip may pose hemodynamic issues under LVAD circulation. In this report, we present the outcomes of durable LVAD therapy in patients with these prior treatments. Seventeen patients had previously received Impella support, and five had undergone MitraClip implantation. Among the 17 post-Impella patients, seven underwent aortic valvuloplasty during LVAD implantation, and one required surgical intervention due to AI progression 10 months postoperatively. Of the nine non-interventional patients, one with moderate AI underwent heart transplantation without intervention five years after the LVAD implantation, while the remaining eight patients had mild or less AI. Four of the five post-MitraClip patients underwent mitral valve replace ment with a bioprosthetic valve during LVAD implantation. The remaining non-interventional patient experienced no hemodynamic problems. The number of LVAD therapies for patients with a prior Impella or MitraClip intervention is expected to increase in the future. It is essential to establish an appropriate therapeutic strategy based on detailed and careful evaluations of individual cases.
[Current Status of Implantable Ventricular Assist Device].
Lee Y, Ando M, Ono M
Kyobu Geka · 2025 Apr · PMID 40494518
Implantable ventricular assist device( iVAD) was initially approved in Japan as bridge-to-transplantation( BTT) indication in 2011. Since then, 1,458 iVAD implants were performed as BTT, and this number per year is rapid...
Implantable ventricular assist device( iVAD) was initially approved in Japan as bridge-to-transplantation( BTT) indication in 2011. Since then, 1,458 iVAD implants were performed as BTT, and this number per year is rapidly increasing, especially after the approval of iVAD implant as destination therapy (DT) indication in 2021. Some of DT patients will be eventually registered for heart transplantation, once their exclusion criteria are cleared, thus extending waiting time of BTT patients in the setting of serious donor shortage in Japan. Therefore, to improve the outcome of iVAD patients, both BTT and DT, it is imperative to manage device-associated complications that can occur during prolonged longterm iVAD support. In the present review, we summarize the recent updates on the iVAD treatment in Japan, in terms of device-associated complications, especially driveline infection, right ventricular failure and aortic regurgitation.
[Pulmonary Cryptococcosis Treated with Antifungal Drugs After Surgical Resection:Report of a Case].
Fujimura T, Nakamura S, Kiriyama R … +5 more , Oyamatsu H, Okagawa T, Fukami J, Niimi S, Chen-Yoshikawa TF
Kyobu Geka · 2024 Dec · PMID 39676050
The patient is an 81-year-old man. He underwent surgery for pancreatic body cancer in 201X and was followed up every six months with computed tomography (CT) imaging. A CT scan in 201X+5 showed a new nodule in S6 of the...
The patient is an 81-year-old man. He underwent surgery for pancreatic body cancer in 201X and was followed up every six months with computed tomography (CT) imaging. A CT scan in 201X+5 showed a new nodule in S6 of the right lung. The nodule grew in the latter half of the year and was diagnostically resected on suspicion of being a metastatic lung tumor. A histopathological examination of the resected lung revealed pulmonary cryptococcosis. The postoperative course was uneventful, and the patient was treated with fluconazole 200 mg/day for six months. The patient is currently alive and recurrence-free three years after surgery. Pulmonary cryptococcosis can recur and may be complicated by meningitis. Postoperative antifungal therapy should be considered because of the poor prognosis of meningitis. Postoperative treatment should be performed with caution, especially in patients who are susceptible to infection, have positive preoperative serum cryptococcal antigen levels or have a high standardized uptake value (SUV) max on positron emission tomography (PET)-CT scanning, and are considered to have high fungal loads or activity.
[Treatment of Secondary Spontaneous Pneumothorax due to Tumor Rupture:Report of a Case].
Tobari K, Sano A
Kyobu Geka · 2024 Dec · PMID 39676049
A 64-year-old man undergoing chemoradiotherapy for lung adenocarcinoma with systemic metastases was admitted for a malignant pleural effusion in the left thoracic cavity that necessitated a drainage and pleurodesis with...
A 64-year-old man undergoing chemoradiotherapy for lung adenocarcinoma with systemic metastases was admitted for a malignant pleural effusion in the left thoracic cavity that necessitated a drainage and pleurodesis with talc. After pleurodesis, an air leak occurred, which led to surgical intervention. Preoperative computed tomography (CT) scans and intraoperative findings revealed multiple nodules in the lungs and a fistula due to ruptured tumor. Extensive adhesions by pleurodesis made typical resection difficult. As a result, the patient was treated with absorbable tissue repair material and adhesive. No persistent air leaks were observed postoperatively. The patient underwent a subsequent pleurodesis with picibanil. This case illustrates the challenges, which emphasize the need for alternative air leak management strategies when resection is not feasible.
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