Painful chestwall swellings: tietze syndrome or chest wall tumor?

Objective Tietze syndrome (TS) is an inflammatory condition characterized by chestpain and swelling of costochondral junction. Primary chest wall tumors maymimic TS. Inthis article, we report our experience of approximately 121 patients initially diagnosedas TS and determined chest wall tumor in some cases at the follow-up.Methods This is a retrospective review of patients diagnosed as TS by clinicalexamination, chest X-ray, electrocardiogram, routine laboratory tests, and computedtomography (CT) of chest: all treated and followed up between March 2001 andJuly 2012. There were 121 cases (41males and 80 females;mean age, 39.6 3.2 years)of TS.Results In 27 patients with initial normal radiological findings, the size of swellings haddoubled during the follow-up period (mean, 8.51 2.15 months). These patients werereevaluated with chest CT and bone scintigraphy and then early diagnostic biopsy wasperformed. Pathologic examination revealed primary chest wall tumor in 13 patients(5 malignant, 8 benign). CT had a sensitivity of 92.3% and a specificity of 64.2% indetection of tumors (kappa: 0.56, p ¼ 0.002), whereas the sensitivity and the specificityof bone scan were 84.6 and 35.7%, respectively (kappa: 0.199, p ¼ 0.385).Conclusion Primary chest wall tumors could mimic TS. Bone scintigraphy or CT is notspecific enough to determine malignant and other benign disorders of costochondraljunction. Therefore, clinicians should follow TS patients more closely, and in case ofincreasing size of swelling, early diagnostic biopsy should be considered

Bilateral sympathicotomy for hyperhidrosis without using single-lung ventilation

Background/aim: The goal of this retrospective study was to evaluate the outcomes and complications of bilateral videothoracoscopic sympathicotomy without using single-lung ventilation in the treatment of primary hyperhidrosis and facial blushing. Materials and methods: We retrospectively reviewed 154 consecutive patients (70 females and 84 males) who underwent bilateral sympathicotomy for palmar, axillary, and facial/scalp hyperhidrosis or facial blushing from February 2005 to June 2013. The patients were intubated with single-lumen endotracheal tube, and then sympathicotomies were performed via videothoracoscopy during controlled apnea periods. Results: Sympathicotomies were performed at costal levels 2, 3, and 4. No perioperative mortality or conversion to open surgery was recorded. Mean operation time was 31.2 ± 2.4 min and mean hospital stay was 1.1 ± 0.6 days. One patient experienced a unilateral pneumothorax that required treatment. There were no abnormal hemodynamic parameters measured during the perioperative apnea periods. The long term follow-up period was 21.4 ± 5 months. Twenty-nine cases (18.8%) were complicated by compensatory sweating. No recurrence was observed during the follow-up period. Conclusion: Video-assisted thoracoscopic sympathicotomy without lung isolation provides effective cure of primary hyperhidrosis and facial blushing. This procedure can shorten the operative time without any aberrant hemodynamic shifts

Do the hydatid cysts have unusual localization and dissemination ways in the chest cavity?

We wanted to report our two cases of intrathoracic extrapulmonary hydatid cyst in pleural cavity due to its rarity.Our first case is a 24-year-oldmale patient who was admitted with a cysticmass lesion consistent with hydatid cyst which was incidentally detected in inferior lobe of the right lung neighboring to thoracic wall and diaphragm. Our second case is a 32-year-old male patient who was admitted with chest pain and a cystic lesion in apex of the right hemithorax and intercostal field in basal after he had beenmedically treated due to hydatid cyst of the dome of the liver for two years. The cysts were removed with thoracotomy. Extrapulmonary intrathoracic hydatid cysts were evaluated with regard to invasion ways and treatment indications and methods

Extraordinary presentation of elastofibroma dorsi after a thoracotomy procedure

Elastofibroma dorsi is a reactive pseudotumor of connective tissue, typically located in the infrascapular region. Awareness of this benign entity is crucial for radiologists, as well as clinicians, to avoid misdiagnosis and potential patient harm. In this report, we present clinical and imaging findings of an elastofibroma dorsi after a thoracotomy procedure

Aort yaralanması riski oluşturan kaburga kırığı

A 50-year-old female patient was referred to emergency department with findings of shortness of breath and flail chest after a traffic accident. Her chest and abdomen computed tomography scan showed left hemopneumothorax, suspicious splenic bleeding, and multiple rib fractures. The fractured edge of the left sixth rib was posing a laceration threat against the descending aorta. After diagnostic laparotomy, left thoracotomy was performed, the fractured rib edge was resected before occurrence of any aortic injury, and the flail chest was stabilized. This article aims to draw attention to the importance of early intervention in posterior rib fractures posing injury threat against aorta and explain the possible mechanism

Retroperitoneal ganglionörom

Nöroblastom, ganglionöroblastom ve ganglionörom sempatik sinir sistemini oluşturan, değişik derecelerde olgunlaşmış, primordial nöral krest hücrelerinden köken alan heterojen bir grup tümördür. Abdominal distansiyon, sol üst kadran ağrısı ve daire şikayetleriyle başvuran 12 yaşındaki erkek hastaya yapılan tetkikler sonucu rastlantısal olarak primer retroperitoneal ganglionörom saptanmıştır.Neuroblastoma, ganglioneuroblastoma and ganglioneuroma are tumors of varying maturity derived from the primordial neural crest cells that form the sympathetic nervous system. A primary extraadrenal retroperitoneal ganglioneuroma was found incidentally in a 12-year-old boy during a series of examinations for abdominal distension, left upper quadrant pain and diarrhoea

A rare entity bilateral first rib fractures accompanying bilateral scapular fractures

First rib fractures are scarce due to their well-protected anatomic locations. Bilateral first rib fractures accompanying bilateral scapular fractures are very rare, although they may be together with scapular and clavicular fractures. According to our knowledge, no case of bilateral first rib fractures accompanying bilateral scapular fractures has been reported, so we herein discussed the diagnosis, treatment, and complications of bone fractures due to thoracic trauma in bias of this rare entity

Coexistence of three malignancies: Two different lung cancers synchronous with lymphoma

Epithelial tumors synchronous with hematologic malignancies are very rare. The hystopathologic type and stage of synchronous tumors are very important for prognosis. A 77-year-old male patient was diagnosed with lymphoma after an excisional biopsy was taken from the retroauricular region. Positron emission tomography, performed for lymphoma staging, revealed a positive solid nodule (SUVmax: 24.3) in the posterobasal segment of the right lower lobe and a negative subsolid nodule in the anterior segment of the upper lobe. Right lower lobectomy and wedge resection for subsolide nodule in the upper lobe were performed. Histopathological examination revealed mildly differentiated squamous cell carcinoma for the solid nodule and mildly differentiated adenocarcinoma with lepidic pattern for the subsolid nodule. The patient was treated for only lymphoma according to the decision of the tumor board, and his condition is stable for 1 year without any evidence of lung cancer recurrence. This case presents the treatment approach and the fact that triple synchronic malignant cases are rare in the literature

A rare and serious syndrome that requires attention in emergency service: traumatic asphyxia

Traumatic asphyxia is a rare syndrome caused by blunt thoracoabdominal trauma and characterized by cyanosis, edema, and subconjunctival and petechial hemorrhage on the face, neck, upper extremities, and the upper parts of the thorax. Traumatic asphyxia is usually diagnosed by history and inspection; however, the patient should be monitored more closely due to probable complications of thoracoabdominal injuries. Treatment is conservative, but the prognosis depends on the severity of the associated injuries. Herein we present a traumatic asphyxia due to an elevator accident in a 32-year-old male patient and discuss the diagnosis, treatment, and prognosis by reviewing the relevant literature

The importance of costoclavicular space on possible compression of the subclavian artery in the thoracic outlet region: a radio-anatomical study

OBJECTIVES: The purposes of this study were to identify possible compression points along the transit route of the subclavian artery and to provide a detailed anatomical analysis of areas that are involved in the surgical management of the thoracic outlet syndrome (TOS). The results of the current study are based on measurements from cadavers, computed tomography (CT) scans and dry adult first ribs. METHODS: The width and length of the interscalene space and the width of the costoclavicular passage were measured on 18 cervical dissections in 9 cadavers, on 50 dry first ribs and on CT angiography sections from 15 patients whose conditions were not related to TOS. RESULTS: The average width and length of the interscalene space in cadavers were 15.28 ± 1.94mm and 15.98 ± 2.13 mm, respectively. The widths of the costoclavicular passage (12.42 ± 1.43mm) were significantly narrower than the widths and lengths of the interscalene space in cadavers (P < 0.05). The average width and length of the interscalene space (groove for the subclavian artery) in 50 dry ribs were 15.53 ± 2.12mm and 16.12 ± 1.95mm, respectively. In CT images, the widths of the costoclavicular passage were also significantly narrower than those of the interscalene space (P 0.05). CONCLUSIONS: Our results showed that the costoclavicular width was the narrowest space along the passage route of the subclavian artery. When considering the surgical decompression of the subclavian artery for TOS, this narrowest area should always be kept in mind. Since measurements from CT images and cadavers were significantly similar, CT measurements may be used to evaluate the thoracic outlet region in patients with TOS