Malignant primary chest wall tumours: techniques of reconstruction and survival

OBJECTIVES: We analysed our experience in primary malignant chest-wall tumours (PMCWTs) with an emphasis on a new reconstruction technique and on survival. METHODS: From 1998 to 2008, 41 patients (23 (56%) male, mean age 48 years) with PMCWT were operated in our unit: chondrosarcoma n=25; osteosarcoma n=8; Ewing's sarcoma n=2; other n=6. We performed nine sternectomies and 32 lateral chest-wall resections (median number of ribs resected=3.5). Resections were extended to the lung (n=2), diaphragm (n=3), vertebral body (n=3), scapula (n=1) and upper limb (n=1). Stability was obtained by a prosthetic material, rigid and non-rigid and a muscular flap. As non-rigid material, we mostly used a polytetrafluoroethylene patch (n=24). In the past 2 years, two patients (one total sternectomy and one wide anterior chest-wall resection) were reconstructed with a rigid system composed of mouldable titanium connecting bars and rib clips (Strasbourg Thoracic Osteosyntheses System--STRATOS, MedXpert GMbH, Heitersheim, Germany). A muscular flap was added in 12 patients (29.3%). RESULTS: There was no perioperative mortality or significant morbidity and all patients were extubated within first 24h. At a mean follow-up of 60.5 months (range 4-130 months), the overall 5- and 10-year survival was 61% and 47%, respectively. In the chondrosarcoma group, 5- and 10-year survival was 80%. CONCLUSIONS: Wide resection with tumour-free margins is necessary in PMCWT to minimise local recurrence and to contribute to long-term survival. The STRATOS system, developed for chest-wall replacement, allows a firm reconstruction, simple to handle and to fix, avoiding instability or paradoxical movement also in wide chest-wall resections

A conventional multimodality imaging cascade to detect a superior vena cava obstruction

Iatrogenic injuries of the superior vena cava (SVC) following surgical or endovascular treatments are rare but challenging complications and require prompt diagnosis and appropriate treatment. The additional diagnostic value of venography, contrast-enhanced computed tomography, and magnetic resonance imaging has been widely assessed in the clinical setting of the SVC obstruction, whereas the role of conventional transoesophageal echocardiography (TEE) is still uncertain. A 43-year-old female patient was admitted to the echocardiography laboratory because of a superior vena cava syndrome (SVCS) following a balloon SVC venoplasty with stent implantation. A standard transoesophageal echocardiography examination clearly detected the SVC obstruction on previously implanted stents. We found that fundamental steps of early diagnosis of SVCS would benefit from standard TEE

Blood cyst of the mitral valve

Blood cysts of the mitral valve are mostly benign diverticuli lined by endothelium and filled with blood and can be safely monitored with echocardiographic follow-up. We report a case of asymptomatic blood cyst of the mitral valve in a 63-year-old woman referred for a systolic murmur. At 3-year echo follow-up, the patient is free from notable clinical events