Posterior Basal Segment Research Articles

Acromegaly in Speckle Tracking Echocardiography—A New Cardiac Hypertrophy Phenotype? Case Report and Review

Background: This study aims to provide a comprehensive overview of speckle tracking echocardiography (STE) findings in patients diagnosed with acromegaly, exploring a potential application for the differential diagnosis of cardiac hypertrophy and guiding clinicians in patient management. To our knowledge, this is the first review showcasing changes in the bull’s-eye pattern in myocardial function after acromegaly treatment, suggesting a possible pattern in this aetiology of left ventricular hypertrophy. Methods: A review of PubMed articles using the search term “speckle tracking echocardiography acromegaly” yielded 11 relevant papers published between 2017 and 2023. The final analysis evaluated each paper’s substantial value and summarised pertinent information. A clinical case of myocardial strain changes before and after pharmacological and neurosurgical treatment is also described. Results: The 11 analysed papers, with patient groups ranging from 19 to 50 individuals, revealed varying results in STE parameters between acromegalic and control groups. Left ventricular strain parameters were commonly assessed, showing discrepancies in different studies. Notably, the MAGYAR-Path Study emphasised left ventricular twist and radial strain abnormalities in acromegaly patients. Furthermore, the interplay between acromegaly and diabetes influenced myocardial function. Drug treatment with somatostatin receptor ligands demonstrated a favourable impact on left ventricular systolic function. The case study we describe in this manuscript showed changes in the posterior basal LV segment, which may be a specific pattern of acromegaly remodelling. Somatostatin therapy and neurosurgery led to the normalisation of global longitudinal strain (GLS) and improvement in myocardial work, as well as improved diastolic function, including enhanced left atrial strain (LAS) as well as a visible elastic recoil sign (ERS). Conclusions: While the available literature on STE in acromegaly is limited, our analysis suggests potential applications in differentiating hypertrophy aetiologies and monitoring cardiac function post-treatment. The results underscore the need for more interdisciplinary research to optimise patient management. The bull’s-eye pattern with posterior basal segment strain impairment we describe may be used to differentiate this entity.

Case Report: Aspirated Airway Foreign Body Mimicking Endobronchial Mass: A Diagnostic Challenge

Abstract Introduction/Objective Despite advancements in imaging modalities, identifying retained foreign bodies within the lung remains arduous. Detecting small foreign bodies is crucial as they can serve as a focal point for subsequent infections. Initial assessments may mimic malignancy. Herein, we present a case of a retained foreign body masquerading as an endobronchial mass, accompanied by unilateral pleural effusion and persistent hypoxia. Subsequent bronchoscopy showed a pearly white endobronchial mass partially obstructing the segmental bronchus at the posterior basal segment of the right lower lobe of lung with accompanying right pleural effusion and atelectasis. Methods/Case Report This is a 58-year-old male with history of hypertension, deep vein thrombosis, transient ischemic attack, and a recent motor vehicle accident with blunt chest trauma. He had a thoracic spinal cord transection with grade III blunt thoracic aortic injury, developed anasarca, hypoxia, right pleural fluid requiring multiple thoracentesis, and right sided hemothorax requiring massive transfusion protocol. Subsequent evaluations, including bronchoscopic transbronchial forceps biopsies and bronchial wash and pleural fluid cytologic examinations showed no malignant cells. Repeat bronchoscopy was concerning for enlarging mass and obstruction. Bronchoscopy almost 2 months after MVA revealed an endobronchial foreign body (tooth) lodged in the left lower lobe of lung posterior segment. Results (if a Case Study enter NA) N/A Conclusion While aspiration of foreign bodies into the tracheobronchial tree is not uncommon especially in children, foreign bodies, particularly teeth, are rare in adults. Bronchial foreign body aspiration may occur in trauma, with diagnosis typically relying on history and physical examination. Detection remains challenging despite imaging advancements, with implications including infection nidus formation. In our case, delayed diagnosis highlights the importance of considering unusual etiologies in persistent pulmonary pathology. Retrospective imaging analysis and CT findings suggested a foreign body, emphasizing the utility of imaging in suspected cases. Prompt surgical intervention is crucial to prevent complications such as recurrent infections.

Primary Pulmonary Meningioma With Associated Multiple Micronodules: A Case Report With Comprehensive Diagnostic Overview

ABSTRACTBackgroundPrimary pulmonary meningioma (PPM) is an exceedingly rare neoplasm originating in the meninges within the lung. Despite sharing similarities with its central nervous system (CNS) counterparts, PPM presents unique diagnostic challenges and therapeutic considerations owing to its infrequent occurrence.CaseThis case report describes a 73‐year‐old male who underwent chest computed tomography (CT), which revealed a mass in the posterior basal segment of the right lower lobe, suggestive of a low‐grade malignant tumor approximately 30–40 mm in size. Single‐port video‐assisted thoracoscopic surgery (VATS) was performed to resect the mass via localized lesion excision (lung wedge resection). Intraoperative frozen section pathology indicated a low‐grade malignant epithelial tumor, leading to a decision for maximal lung function preservation, considering the patient's advanced age. The surgical team opted for a localized excision to ensure negative margins. Histopathological analysis confirmed the diagnosis of epithelioid PPM, a rare subtype even among PPM cases (World Health Organization [WHO] Grade I). The patient was discharged 9 days after surgery without complications and resumed normal daily activities 1 month postoperatively. The rarity of PPM precludes a standardized treatment protocol, with surgical resection as the primary approach. However, the efficacy of adjunctive therapies remains uncertain due to limited evidence.ConclusionThis case report contributes to a better understanding of PPM and emphasizes the importance of a comprehensive diagnostic evaluation and individualized treatment planning for this rare entity.

Chest CT Scan Features of COVID-19 in a Hospitalized High-Altitude Population

There is a lack of knowledge regarding the type of lung compromise in high-altitude residents with COVID-19. This study aims to evaluate the lung compromise in chest CT scans of high-altitude dwellers hospitalized with COVID-19. Retrospective study that took place in "Daniel Alcides Carrión" Regional Hospital, located 3,250 meters above sea level in the city of Huancayo, Perú. 464 medical charts and chest CT images of hospitalized patients with confirmed COVID-19 from January to March 2021 were reviewed. The mean age was 56 years, 63.1% of the patients were male, and 85.8% of individuals had a CORADS 5. Ground glass infiltrates were found in 93.8% of the patients; alveolar consolidations were present in 86% and were usually bilateral. Thickened septa were described in 46%, lattice pattern in 38.8%, reticular components in 39%, and the crazy paving pattern in 36.9%. Most patients (84.5%) had central and peripheral lesions; only 4% had limited peripheral compromise, and 10% solely central distribution. The left posterior basal segment was the most affected pulmonary segment in 27% of the cases, and the right basal posterior in 26%. Less affected segments were the right and left apical (14% and 13%, respectively). Lung compromise in patients with COVID-19 in this high-altitude population was severe, with mostly bilateral compromise, increased diameter of the pulmonary artery, periaortic and subaortic lymph nodes enlargement, and extensive ground glass and alveolar lesions.

Research on Anatomical Types and Variations of Lung Segment Bronchi Based on Artificial Intelligence 3D Reconstruction Technology

Aims: To investigate the anatomic type and variation of segmental bronchus based on artificial intelligence 3D reconstruction technology. Methods: The image data of 200 patients who underwent thin-layer enhanced chest CT examination in the Department of Thoracic Surgery of Shandong Public Health Clinical Center from December 2021 to December 2022 were selected. The bronchi and blood vessels of the affected side of the lung were reconstructed according to the CT scanning data of the patients, and the anatomic types and anatomic variations of the bronchi of each lung segment on the affected side were observed and statistically analyzed. Results: There were basically four anatomical types of the right superior lobar bronchus, of which the three branching subtypes B1, B2 and B3 are the most common anatomical types. There are two types of right middle lobe bronchus, of which the B4 and B5 subtypes are the most common anatomic types. For the left lung, 4 types of segmental bronchus were found and (B1+2a+b, B1+2c), (B3a, B3b+c) was the most common anatomical type. Two types of bronchus were found in the left superior lobe of the lung. Type B4 and type B5 were the most common anatomical types. In addition, there were 3 types of bronchi in the dorsal segment of the left inferior lobe, and 3 types in the anterior, external and posterior basal segment bronchi of the left inferior lobe, among which B8, B9+B10 (57.6%) were the most common. Conclusion: The anatomical types of segmental and subsegmental bronchus are complex and varied, and there may be rare anatomical variations. Therefore, before performing relevant operations, it is necessary to be familiar with the relevant operations and the branch types of corresponding bronchus in advance to ensure the smooth operation.

The first reported pulmonary nocardiosis caused by Nocardia gipuzkoensis resisted to trimethoprim/sulfamethoxazol (TMP-SMZ) in an immunocompetent patient

Nocardia gipuzkoensis was first described as a novel and distinct species in 2020 by Imen Nouioui and pulmonary nocardiosis associated with N. gipuzkoensis was once reported in two bronchiectasis patients. Noteworthy, both reported N. gipuzkoensis cases showed sensitivity to trimethoprim/sulfamethoxazol (TMP-SMZ), which are usually recommended for empirical therapy. We reported the third case of N. gipuzkoensis infection in a 16-year-old girl with chief complaints of cough and persistent chest and back pain. No underlying immuno-suppressive conditions and glucocorticoid use was revealed. Patchy lesions next to the spine and located in the posterior basal segment of the lower lobes of the left lung were seen in thorax computed tomography (CT), but no pathogenic bacteria were detected according to routine laboratory testings. Metagenomic next-generation sequencing (mNGS) combined with whole-genome sequencing (WGS) was used to classified our isolate from bronchoalveolar lavage fluid (BALF) as N. gipuzkoensis. It is worth mentioning that drug susceptibility testing of our isolate showed resistance to TMP-SMZ, which was never reported before. The patient improved remarkably both clinically and radiographically according to the treatment with imipenem-cilastatin infusion alone. mNGS and WGS showed excellent performance in identifying the Nocardia genus to the species level and improving the detection rate of N. gipuzkoensis ignored by traditional culture. Different from previously reported cases, the N. gipuzkoensis infection case showed resistance to TMP-SMZ, which is an unprecedented finding and a crucial addition to our understanding of the antibacterial spectrum of N. gipuzkoensis. The successful treatment with imipenem-cilastatin infusion alone in this case is a testament to the importance of precise identification and tailored antibiotic therapy.

Radiological “Triangle sign” in chest imaging in left lower lobe tuberculosis: A real puzzle

Abstract Pulmonary tuberculosis is the most common etiology for lobar or multilobar atelectasis of the lung followed by foreign body and lung malignancy in the list. The left lower lobe atelectasis is underdiagnosed due to presentation as retrocardiac opacity, which is commonly missed by treating physicians. In this case report, a 46-year-old female presented with constitutional symptoms and retrocardiac triangular opacity in the chest cardiograph. High-resolution computed tomography thorax documented collapse with consolidation and necrosis in the posterior basal segment with loss of lung volume. Bronchoscopy documented purulent secretions coming out from the left lower lobe posterior basal segment without endobronchial abnormality. Bronchoscopy-guided bronchoalveolar lavage showed acid-fast bacilli, and nucleic acid amplification tests documented Mycobacterium tuberculosis genome without rifampicin resistance. She is treated with antituberculosis treatment for 6 months and observed good clinical, bacteriological, and radiological outcomes as “cure.” We recommend basic regular training of family physicians for common radiological signs for early diagnosis and timely treatment with a successful outcome.

Quantitative analyzes of the variability in airways via four-dimensional dynamic ventilation CT in patients with chronic obstructive pulmonary disease: correlation with spirometry data and severity of airflow limitation.

In chronic obstructive pulmonary disease (COPD) patients, the diagnosis and assessment of disease severity are mainly based on spirometry, which may lead to misjudgments due to poor patient compliance. Thoracic four-dimensional dynamic ventilation computed tomography (4D-CT) provides more airway data approximating true physiological function than conventional CT. We aimed to determine dynamic changes in airways to elucidate the pathological mechanism underlying COPD and predict the severity of airflow limitation in patients. Forty-two COPD patients underwent 4D-CT and spirometry. The minimum lumen diameter changed with the breathing cycle in 4th-generation airways and was continuously measured in the apical (RB1), lateral (RB4) and posterior basal segments (RB10) of the right lung. The minimum lumen diameter in the peak inspiration and peak expiration as well as the peak expiratory/peak inspiratory ratio (E/I ratio), and dynamic coefficient of variance (CV) were calculated. Correlations of FEV1% with the CV of minimum lumen diameter in RB1 (ρ=-0.473, P=0.002) and in RB10 (ρ=-0.480, P=0.005) were observed, suggesting that the dynamic variability in 4th-generation airways was associated with airflow limitation in COPD patients. The CV of the minimum lumen diameter in RB1 significantly differed between the GOLD I + II and GOLD III + IV groups {8.59 [interquartile range (IQR), 6.63-14.86] vs. 14.64 (10.65-25.88), respectively; P=0.016}, suggesting that the dynamic CV in RB1 increased significantly in the GOLD III + IV group, which had worse pulmonary ventilation function. Based on the receiver operating characteristic (ROC) curve analysis, CV-RB1 predicted FEV1% <50% with an optimal cut-off of 9.43% [sensitivity 85.7%, specificity 57.1%, area under the curve (AUC) 0.717]. 4D-CT might be an available method to help diagnose and evaluate the severity of COPD.

Fissural Pleural Effusion Presenting As ‘Pseudotumor Lung, Phantom Tumour or Round Pneumonia’ In Primary Pulmonary Tuberculosis: Bronchoscopy is Point of Care Test in Presence of Satellite Nodules in Chest Imaging!

Pulmonary Tuberculosis has diverse radiological presentations such as consolidation, cavitation, airway disease, pleural effusion and lymphadenopathy. Pneumonia-like presentation in tuberculosis is very commonly reported in Pulmonary Tuberculosis. Fissural effusion is common in cardiac failure and isolated fissural effusion is rarely described in literature with etiology as tuberculosis. Round pneumonia is commonly described in pediatric cases with community acquired pneumonia and also frequently reported in childhood pulmonary tuberculosis. Round pneumonia is very infrequently reported in adults with pneumonia and to very few published data as due to tuberculosis. In this case report, a 21-year female, presented with constitutional symptoms for 3 months duration with partial response to medical treatment received in line with pneumonia, bronchial asthma and bronchitis. Radiological investigations documented round opacity in right mid-zone with no adventitious breath sound on clinical examination. Recurrent, progressive and partially responding constitutional symptoms was the reason for referral to our center. We have further evaluated with HRCT thorax and documented loculated right horizontal fissural effusion with subpleural parenchymal opacity in right upper lobe posterior segment and right middle lobe lateral basal segment with peri-consolidation satellite nodules in right posterior segment. We have done bronchoscopy due to negative induced sputum microbiological workup. Bronchoscopy guided BAL microbiological workup documented MTB genome with rifampicin sensitivity in cartridge based nucleic acid amplification test and negative BAL smear for AFB. Treatment initiated with anti-tuberculosis (ATT) and recorded near complete radiological resolution, bacteriological cure after six months with good compliance. High index of suspicion is required while managing these cases with constitutional symptoms and typical radiological features such as ‘round pneumonia or fissural effusion’ in absence of other causes for the same. Fissural effusion or round pneumonia due to tuberculosis is rare in adults but not uncommon. Bronchoscopy is a gold standard test to confirm etiological diagnosis due inadequate or poor quality of induced sputum sample in cases with round pneumonia and fissural effusion. Isolated Fissural effusion secondary to pulmonary tuberculosis is extremely rare in medical literature and this will be first case reported till date.

Assessment of segmental lung involvement in covid-19 patients using biochemical parameters

This study is to investigate the segmental involvement of lung in COVID-19 individuals using high resolution computed tomography (HRCT) and to correlate with serum inflammatory markers. Retrospective study done in 100 COVID 19 RTPCR positive patients with radiological images were collected and analyzed for lobar involvement, bronchopulmonary segments in 3D and CT Scores and it was compared with serum inflammatory markers (SIM). Variables like gender, involvement of segments and co-morbid conditions were summarized as frequency and percentage. Sub group analysis was done using independent t test, Chi-Square. Findings revealed that males were commonly affected than females with the mean age 57.47 ± 13.0. Lower lobes and posterior basal segment of both the lungs were affected with preponderance on the left side. Additionally, SIM were up regulated in the COVID-19 individuals. Serum IL-6, D-dimer and Ferritin showed upsurge in right lung and CRP and LDH elevated in left lung in the COVID-19 and it was statistically correlated with CT severity score. Chest HRCT and biochemical parameters individually and in combination help in identifying the COVID 19 severity among individuals for preventing or reducing the mortality rate in adults.

Comparison of different approaches in complete thoracoscopic segmentectomy of lung lower lobe.

Safe and oncologically acceptable segmentectomy outcomes were reported for early-stage lung cancer. The high-resolution computed tomography allowed us to find detailed structures inside the lungs, such as the pulmonary ligaments (PLs). Hence, we have presented the relatively anatomically challenging thoracoscopic segmentectomy, for the resection of the lateral basal segment, the posterior basal segment, and both segments through the PL as a PL approach. This study aimed to retrospectively examine the lung lower lobe segmentectomy, excluding the superior and basal segments (from S7 to S10), using the PL approach as an option to treat the lower lobe tumors of the lung. We then compared the efficacy of the PL approach in terms of safety with the interlobar fissure (IF) approach. The characteristics of the patients, intra- and postoperative complications, and surgical outcomes were analyzed. Of the 510 patients who underwent segmentectomy for malignant lung tumors from February 2009 to December 2020, 85 were included in this study. Among them, 41 underwent a complete lung lower lobe thoracoscopic segmentectomy, excluding S6 and basal segments (from S7 to S10), using the PL approach, and the remaining 44 used the IF approach. The median age in 41 patients in the PL group was 64.0 years (range, 22-82), and that in 44 patients in the IF group was 66.5 years (range, 44-88), with significant differences in gender between these groups. Video-assisted thoracoscopic surgery and robot-assisted thoracoscopic surgery were performed on 37 and 4 patients in the PL group and 43 and 1 patient in the IF group, respectively. Postoperative complication frequency was not significantly different between these groups. The most common complications were the air leaks that persisted for over 7 days in 1 and 5 patients in the PL and IF groups, respectively. Complete thoracoscopic segmentectomy of the lower lobe, excluding S6 and basal segments, using the PL approach is a reasonable option for lung lower lobe tumors compared with the IF approach.

Surgical Treatment of Lung Abscess Due to an Awn Aspiration in a 9-Year-Old Child: A Case Report

Introduction: Foreign body aspiration is a common condition in the child population and is one of the leading causes of accidental deaths in children. The aspiration of an awn (grass inflorescences) is extremely rare. Aim of the study: This study aims to describe the symptoms, diagnosis, therapeutic difficulties, and results of the aspiration of grass inflorescence. They are all related to the shape of the awn’s head and its behavior in the tracheobronchial tree. Case description: We present a 9-year-old boy with a history of an awn aspiration and recurrent respiratory infections. After antibiotic and symptomatic treatment, two bronchoscopies were performed, and both showed stenosis and obturation of the segmental and subsegmental bronchi of the left posterior basal segment, but no foreign body was found. After recanalization and continuous medicamentous treatment, a computed tomography (CT) verified the lung abscess. Video-assisted thoracoscopic surgery (VATS) was performed, and an atypical lung resection was conducted. During the surgery, a foreign body—grass inflorescence from the species Hordeum murinum—was found in the resected tissue. The patient recovered uneventfully after the surgery. Conclusions: Grass inflorescence aspiration in the child population is an extremely rare event, and it represents a diagnostic and therapeutic issue. The exact timing of surgery is very important to reduce complications and avoid death.

P162 ARRHYTHMIC MITRAL VALVE PROLAPSE OCCURRING AS ABORTED SUDDEN CARDIAC DEATH

Abstract Mitral valve prolapse (MVP) is the common valvular heart disease, with a prevalence about 1–3% in the population. MVP is characterized on echocardiography by an abnormal systolic displacement of mitral valve leaflets into left atrium (LA) ≥ 2 mm above the mitral annulus. We described a clinical case of a 15 years–old boy with a first clinical presentation of out–of–hospital cardiac arrest related to ventricular fibrillation (VF) with a successful resuscitation after 2 DC shocks. Retrospectively, an episode of loss of awareness reported as post–minational. No familiar history of sudden cardiac death (SCD) or MVP was noticed. In the emergency room, the patient was hemodynamically unstable and was sedated and intubated. The surface electrocardiogram (ECG) showed sinus rhythm, QRS with fragmentation, and frequent monomorphic isolated premature ventricular contractions (PVCs) with RBBB/LAFB configuration.Frequent monomorphic PVCs with bigeminy was observed during continuous ECG monitoring, so the patient was treated with magnesium sulphate and metoprolol. The patient was subsequently weaned from ventilation support, presenting good gas exchange and without neurological sequalae. The 24h Holter monitoring showed an average of 53 bpm, extremely rare supraventricular extrasystoles, high incidence of monomorphic PVCs (23% of the total beats) with 4 couplets. Transthoracic echocardiography documented normal size and thickness with systolic function (GLS –21%, mild asynchrony of posterior basal segments), bi–leaflet prolapse associated to mild–moderate mitral regurgitation, and mitral annular disjunction (MAD) of 6.2 mm. The late gadolinium enhancement cardiac magnetic resonance showed bi–leaflet prolapse with mild insufficiency and maximum MAD 9 mm, mild LA dilatation, and slightly dilated both ventricles, without regional wall motion abnormalities; no scar or fibrosis at the late gadolinium enhancement was observed. According to guidelines, the patient received a subcutaneous implantable cardiac defibrillator for the secondary prevention of SCD and maintained under betablockers in order to control the arrhythmic burden. The genetic sampling did not show any pathogenetic mutation potentially related to cardiomyopathies or channelopathies. This case show an arrhythmic MVP complex with probably posterior papillary muscle source. The early PVCs with R/T constituted a possible trigger of VF. The betablocker therapy exhibited a full suppression of extrasystolic burden.

High resolution computed tomography guided anatomico-pathological scoring system for stratifying and prognosticating pulmonary manifestations of COVID-19

Computed Tomography (CT) chest plays a critical role in early identification &amp; stratification of disease burden and prognostication of COVID-19 disease. We compared in-house created CT based scoring system based on ground glass opacities (G-Score), consolidation (C- Score), and atelectasis A-score (i.e. GCA score) with contemporary CT severity scores &amp; validated it against world health organization (WHO) COVID-19 disease severity scale. Patients confirmed with real time polymerase chain reaction confirmed COVID-19 infections that underwent CT chest investigations as a part of standard of care were recruited. A compound GCA score based on the lung involvement was developed and validated. Five-hundred patients of which 249 had mild, 220 with moderate, and 31 with severe COVID-19 disease were recruited.Most involved segments were superior (65%), lateral basal (56%) and posterior basal segments (64%) of right lower lobe and anteromedial (62%) and posterior basal segments (57%) of left lower lobe.Patchy non-confluent peripheral ground-glass opacities with apicobasal gradient is the most common finding (47%) in mild cases. Bilateral lower lobes were most commonly involved (72%).In moderate cases ground-glass opacities with consolidation is the predominant finding (82%).In severe cases ground-glass opacity, consolidation as well as linear platelike atelectasis and reticular opacities may represent with apicobasal gradient (80%).HRCT Chest has certainly come up as a versatile aid for our war against COVID -19. Firstly it helps to diagnose the pulmonary involvement of the disease and when complimented with a good scoring system furthermore it stratifies the disease burden.

A concept video of thoracoscopic segmentectomy of the lateral basal segment, the posterior basal segment, or both segments performed using a pulmonary ligament approach.

A concept video of thoracoscopic segmentectomy of the lateral basal segment, the posterior basal segment, or both segments performed using a pulmonary ligament approach.

Complete thoracoscopic S9 and/or S10 segmentectomy through a pulmonary ligament approach: a retrospective study

BackgroundThe high resolution of computed tomography has found the pulmonary ligaments that consists of a double serous layer of visceral pleura, forms the intersegmental septum, and enters the lung parenchyma. This study aimed to investigate the clinical feasibility of thoracoscopic segmentectomy (TS) of the lateral basal segment (S9), posterior basal segment (S10), and both through the pulmonary ligament (PL).MethodsBetween February 2009 and November 2021, 542 patients underwent segmentectomy for malignant lung tumors at Tokyo Women’s Medical University Hospital (Tokyo, Japan). This study included 51 patients. Among them, 40 underwent a complete TS of the S9, S10, or both by the PL approach (PL group), and the remaining 11 by the interlobar fissure approach (IF group).ResultsPatients’ characteristics did not significantly differ between the two groups. In the PL group, 34 underwent video-assisted thoracoscopic surgery (VATS), and 6 underwent robot-assisted thoracoscopic surgery. In the IF group, all 11 underwent VATS. Operation duration, estimated blood loss, and postoperative complication frequency were not significantly different between these groups, but the maximum tumor diameter showed a significant difference.ConclusionsComplete TS of the S9, S10, and both through the PL is a reasonable option for tumors located in such segments. This approach is a feasible option for performing TS.

Thoracoscopic subxiphoid right S9+10 segmentectomy: a case report

: Thoracoscopic segmentectomy of posterior (S10) and lateral basal (S9) segments is highly challenging, because of the frequency of anatomical variations and the particularly complex intersegmental plane delimitation, due to the pyramidal shape of the lower lobe. We report here the case of a 77-year-old male presenting with a colorectal metastatic evolutive centimetric nodule deeply located between S9 and S10 segments, requiring a sub-lobar resection. A thoracoscopic right S9+10 segmentectomy was performed through an original subxiphoid approach, combining interlobar fissure and inferior pulmonary ligament approaches and assisted by both three-dimensional computed tomography (3D-CT) anatomical reconstruction and fluorescence imaging. Pathological examination confirmed metastatic nature and complete resection of the nodule with sufficient margin. The patient was integrated in an enhanced recovery after surgery (ERAS) programme and discharge on postoperative day 1 with an uneventful follow-up. Subxiphoid approach appears quite efficient for such complex right S9+10 segmentectomy, particularly when designed in a personalized way, based on an accurate anatomical planning strategy for an optimal oncological lung sparing resection.

953: INFLAMMATORY MYOFIBROBLASTIC TUMOR PRESENTING AS A LUNG NODULE: A CASE REPORT

Introduction: Inflammatory Myofibroblastic Tumors are a group of soft tissue neoplasms constituting a mixture of spindle-shaped myofibroblasts or fibroblasts and a variable amount of inflammatory cells with a predilection for the lung often presenting with non-specific symptoms. They represent less than 1% of adult lung tumors. Histopathologic and immunohistochemical analysis of a biopsy specimen is the mainstay of diagnosis. Description: A 30-year-old male presented to the ER with flank pain and episodes of small volume hemoptysis intermittently for the last six years. At presentation, a computed tomography angiography (CTA) of the chest revealed a cavitary nodule of 24 mm at the largest diameter containing rounded soft tissue mass arising adjacent to the right posterior basal segmental bronchus along with adjacent ground glass airspace opacities likely reflecting pulmonary haemorrhage which was confirmed on bronchoscopy revealing fresh blood emanating from the posterior basal segment of the right lower lobe with no endobronchial lesion. Bronchoalveolar lavage (BAL) of the segment was performed with cultures ultimately turning negative. At a later date, a robot-assisted navigational bronchoscopy-guided transbronchial needle aspiration of the lesion was performed. Histopathology results were significant for spindle cells arranged in a storiform to a haphazard pattern. The spindle cells had basophilic cytoplasm and elongated nuclei with fine chromatin. Immunostains of the tumor cells were positive for CD56, CD68, and CD34 (focal), SMA and ALK and negative for cytokeratins AE1/AE3, CK8/18, TTF-1, synaptophysin, chromogranin, S100, desmin, and CD117, SS18-SSX, STAT6, HHV-8, SOX10, CD30, and langerin. These findings supported the diagnosis of an inflammatory myofibroblastic tumor. Discussion: Chest imaging is crucial for early identification. Complete surgical excision provides long-term survival benefits, preventing local recurrence and metastasis. Corticosteroids can be used when the mass is unresectable. If ALK-1 is positive, crizotinib is beneficial in some cases. Our case highlights the need for further investigative studies to establish the natural history of this neoplastic disease and discover appropriate medical management for it.

Inferior pulmonary ligament approach and/or interlobar fissure approach for posterior and/or lateral basal segment resection: a case-series of 31 patients.

Thoracoscopic posterior and/ or lateral basal segment resection is a major difficult segmentectomy for thoracic surgeons, because of its high surgical difficulty and high incidence of postoperative complications. Here we describe the surgical procedure and techniques of the transpulmonary ligament approach and/or interlobar fissure approach for the thoracoscopic posterior and/or lateral basal segment resection. The clinical data of 31 patients who underwent thoracoscopic posterior and/or lateral basal segment resection from January 2020 to June 2022 were included. All patients underwent posterior and/or lateral basal segment resection via the inferior pulmonary ligament and/or interlobar fissure approach. Follow-up was continued to September 2022. All patients including 7 males and 24 females, with a median age of 51 [31-62] years, completed the operation successfully. One patient was converted to lobectomy due to insufficient margins intraoperatively. Two patients were treated using the interlobar fissure approach, 25 patients were treated via the inferior pulmonary ligament approach, and four patients were treated by employing both methods. Also, 20 patients had a single lesion and 1 patient had two lesions. Eleven patients underwent surgical resections on other lesions when posterior and/or lateral basal segment lesions resected. The median operation time was 120 [50-290] minutes, the median intraoperative blood loss was 50 [10-100] mL, the median postoperative drainage time was 4 [2-10] days, and the median postoperative hospital stay was 4 [2-13] days. There was no perioperative death. Postoperative complications included five cases of persistent air leakage longer than 5 days (7, 7, 8, 9, and 10 days), and one patient developed a pulmonary infection and abnormal liver function after the operation. The median maximum diameter of the lesion was 0.8 [0.2-1.5] cm, lymph nodes were resected in a median of 8 [4-15] case. The approach of the inferior pulmonary ligament to resect posterior and/or the lateral basal segment can optimize the surgical procedure. The surgical trauma and postoperative complications are reduced, which is worthy of popularization and application.

ACCIDENTAL ASPIRATION AFTER INTENTIONAL INGESTION OF A NAIL IN A YOUNG FEMALE

ACCIDENTAL ASPIRATION AFTER INTENTIONAL INGESTION OF A NAIL IN A YOUNG FEMALE