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Local Anesthetic Infiltration, Awake Veno-Venous Extracorporeal Membrane Oxygenation, and Airway Management for Resection of a Giant Mediastinal Cyst: A Narrative Review and Case Report.
J Clin Med
December 2024
Anesthesiology and Operative Intensive Care, Faculty of Medicine, University of Augsburg, 86156 Augsburg, Germany.
Mediastinal mass syndrome represents a major threat to respiratory and cardiovascular integrity, with difficult evidence-based risk stratification for interdisciplinary management. We conducted a narrative review concerning risk stratification and difficult airway management of patients presenting with a large mediastinal mass. This is supplemented by a case report illustrating our individual approach for a patient presenting with a subtotal tracheal stenosis due to a large cyst of the thyroid gland.
View Article and Find Full Text PDFPreservation of the azygos vein versus ligation of the azygos vein during primary surgical repair of congenital esophageal atresia.
Cochrane Database Syst Rev
January 2025
Neonatal Intensive Care Unit, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
Background: Esophageal atresia is one of the most common life-threatening congenital malformations and is defined as an interruption in the continuity of the esophagus with or without fistula to the trachea or bronchi. Definitive treatment is surgical ligation of the fistula if present and esophageal end-to-end anastomosis of the two pouches, thereby reconstructing the continuity of the esophagus. During this procedure, the surgeon may choose to either ligate or preserve the azygos vein, a major draining vein for the esophagus and surrounding structures, but no definitive consensus on the matter exists.
View Article and Find Full Text PDFStaged Hybrid Management of a Mycotic Ascending Aortic Pseudoaneurysm.
Ann Thorac Surg Short Rep
December 2024
Division of Pediatric and Adult Congenital Cardiothoracic Surgery, Geisinger Medical Center, Danville, Pennsylvania.
Ascending aortic pseudoaneurysm may pose significant risk for reoperative repair. We describe an 18-year-old man who presented with bacteremia and a large, mycotic ascending aortic pseudoaneurysm 3 months after redo cardiac surgery. A covered stent graft sealed the pseudoaneurysm neck and facilitated safe reentry into the mediastinum.
View Article and Find Full Text PDFAn Elusive Diagnosis of Castleman Disease.
Ann Thorac Surg Short Rep
September 2024
Department of Thoracic & Cardiovascular Surgery, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio.
We present the case of a 41-year-old man with an anterior mediastinal mass and constellation of clinical symptoms, including dyspnea, pleural effusions, pericardial effusions, renal insufficiency, and pancytopenia. After inconclusive results on several laboratory tests and a nondiagnostic surgical biopsy specimen, a specimen from a second surgical biopsy identified the patient's condition as Castleman disease associated with TAFRO (thrombocytopenia, anasarca, fevers, reticulin myelofibrosis, organomegaly) syndrome. This case highlights the importance of obtaining large tissue biopsy samples, interval follow-up, and acknowledging cognitive biases.
View Article and Find Full Text PDFExtracorporeal Membrane Oxygenation Without Mechanical Ventilation for Recovery From Tracheal Repair.
Ann Thorac Surg Short Rep
June 2024
Division of Cardiothoracic Surgery, Department of Surgery, University of Kentucky, Lexington, Kentucky.
Postoperative positive pressure ventilation (PPV) can contribute to failure of large intrathoracic airway repairs. We report a case of a 67-year-old woman with severe emphysema who presented with an unstable airway and mediastinitis after full-length transmural intrathoracic tracheal intubation injury. After repair, neither extubation nor PPV distal to the repair was feasible.
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