• The Korean Journal of Emergency Medical Services
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• v.9 no.1
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• pp.89-93
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• 2005

Penetrating chest trauma by stab injury may result in massive hemothorax from damage to single or multiple intrathoracic organs such as heart, aorta, internal mammary artery, intercostal artery or pulmonary parenchyme. Prognosis of massive hemothorax necessitating emergency thoracotomy is fatal especially so if there exists concomitant underlying compromise of cardiopulmonary function. A 56 year old man with destroyed left lung due to old pulmonary tuberculosis was stabbed in right parasternal lesion through third intercostal space. Intubation with cardiopulmonary resuscitation and closed thoracostomy were performed to resuscitate from cardiac asystole from hemorrhagic shock and acute respiratory distress. Midsternotomy was made to expose active bleeding foci in right mammary artery, subclavian vein, intercostal artery and anterior segment of right upper lung showing severe bullous change and pleural adhesion. Postoperative care included ventilator support, inotropic instillation and cautious, balance fluid therapy ; successful extubation was done on third postoperative day and patient was discharged on tenth postoperative day without any complication.

• Journal of Chest Surgery
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• v.56 no.2
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• pp.140-142
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• 2023

The azygos vein sometimes merges abnormally across the right upper lobe of the lung and it hangs at the lower edge of a membranous septum, called the meso-azygos. The septum invaginates the lobe and makes a fissure. The smaller medial part of the right upper lobe is called an azygos lobe. A 16-year-old male patient was diagnosed with right-sided pneumothorax, and a closed thoracostomy was done in the emergency room. During elective wedge resection including the bulla, the meso-azygos, abnormal azygos vein, and azygos lobe were detected. We reviewed the computed tomography images and found that the azygos lobe had re-expanded laterally, not medially, to the meso-azygos after the closed thoracostomy in the emergency room. The patient had been diagnosed with left-sided pneumothorax a year ago, and no one noticed the azygos lobe at that time. We report the intraoperative findings and comparative images of a migratory azygos lobe.

• Journal of Chest Surgery
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• v.54 no.5
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• pp.404-407
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• 2021

We present a case study of necrotizing fasciitis (NF), a very rare but dangerous complication of chest tube management. A 69-year-old man with shortness of breath underwent thoracostomy for chest tube placement and drainage with antibiotic treatment, followed by a computed tomography scan. He was diagnosed with thoracic empyema. Initially, a non-cardiovascular and thoracic surgeon managed the drainage, but the management was inappropriate. The patient developed NF at the tube site on the chest wall, requiring emergency fasciotomy and extensive surgical debridement. He was discharged without any complications after successful control of NF. A thoracic surgeon can perform both tube thoracostomy and tube management directly to avoid complications, as delayed drainage might result in severe complications.

• Journal of Chest Surgery
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• v.54 no.5
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• pp.436-438
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• 2021

• Journal of Trauma and Injury
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• v.25 no.2
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• pp.37-43
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• 2012

Purpose: A tube thoracostomy is an invasive procedure that places patients at risk for complications. Tube thoracostomies are frequently performed by emergency medicine residents. Thus, the purpose of the study was to assess both the complication rate for tube thoracostomies performed by emergency medicine residents and the factors associated with these complications. Methods: A retrospective chart review of all patients who had undergone a tube thoracostomy performed by emergency medicine residents between January 2008 and February 2009 was conducted at a university hospital. Complications were divided into major and minor complications and into immediate and delayed complications. Complications requiring corrective surgical intervention, requiring the administration of blood products, or involving situations requiring intravenous antibiotics were defined as major. Complications that were detected within 2 hours were defined as immediate. Results: Tube thoracostomies were performed in 189 patients, and 70 patients(37%) experienced some complications. Most complications were immediate and minor. In multiple logistic regressions, BMI, hypotension and resident seniority were significantly associated with complications. Conclusion: The prevalence of complications was similar to these in previous reports on the complications of a tube thoracostomy. Most complications from tube thoracostomies performed by emergency medicine residents were immediate and minor complications. Thus, emergency medicine residents should be allowed to perform closed tube thoracostomies instead of thoracic surgeons.

• Journal of Chest Surgery
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• v.43 no.6
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• pp.816-819
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• 2010

We report one case of Horner's syndrome, a rare complication of closed thoracostomy. A 17 year-old girl with a second attack of left side primary spontaneous pneumothorax visited an emergency room. After closed tube thoracostomy, she was admitted to a general ward for elective video-assisted thoracosopic bullectomy, which was delayed due to incidental right side acute otitis media. On the third day of admission, she presented with pain and discomfort in the left eye. Further examination revealed left side ptosis and miosis and led to a diagnosis of Homer's syndrome. The chest tube was pulled back 2 to 3 cm for repositioning. After two days she underwent video-assisted thoracoscopic bullectomy and mechanical pleurodesis and was discharged at postoperative day 7. Symptoms and signs of Homer's syndrome gradually resolved, and she had fully recovered at the 2 month postoperative outpatient follow-up.

• Journal of Medicine and Life Science
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• v.18 no.3
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• pp.61-65
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• 2021

Although re-expansion pulmonary edema (RPE) is rare (incidence rate <1%), it is associated with a mortality rate of >20%; therefore, early diagnosis and treatment are important. We report a case of RPE following chest tube insertion in a patient with spontaneous pneumothorax. We have specifically focused on the mechanism underlying RPE and the possible etiology. An 82-year-old man with a history of chronic anemia, chronic obstructive pulmonary disease, diabetes mellitus, and hypertension was referred to the emergency department for management of recurrent right-sided pneumothorax. We performed emergency closed thoracostomy for suspected tension pneumothorax, which led to stabilization of the patient's vital signs; however, he coughed up frothy pink sputum accompanied by severe right-sided chest pain 30 min postoperatively. The patient showed new-onset right pulmonary consolidation on chest radiography, as well as desaturation, tachycardia, and tachypnea and was diagnosed with RPE. He was transferred to the intensive care unit for mechanical ventilation and supportive treatment using diuretics, ionotropic agents, and prophylactic antibiotics. RPE gradually resolved, and the patient was extubated 3 days after admission. He has not experienced recurrent pneumothorax or pulmonary disease for 4 months. We emphasize the importance of RPE prevention and that aggressive ventilator care and supportive treatment can effectively treat RPE following an accurate understanding of the underlying pathogenetic mechanisms and risk factors.

• Journal of Chest Surgery
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• v.14 no.2
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• pp.140-143
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• 1981

Thymolipoma is extremely uncommon benign mediastinal tumor consisting of fatty and thymic tissue. Only 50 verified cases have been reported in the world literatures. This one case is the first reported example of surgically treated thymolipoma associated with spontaneous pneumothorax. A thirty-two year old male patient had been in good health until two days prior to admission, when he noted sudden dyspnea associated with an aching pain over the left precordium. The dyspnea and chest pain had become progressively worse. The physical examination revealed that left hemithorax was tympanic sound on percussion and absence of breathing sound on auscultation and point of maximal impulse was located on the 4th intercostal space at the left sternal border. Emergency closed thoracostomy was performed under the impression of tension type spontaneous pneumothorax of the left lung. After closed thoracostomy, point of maximal impulse was not changed inspire of full expansion of the left lung and chest X-ray was strongly suggested pericardial effusion or cardiomegaly which couldn`t account for by clinical course and hemodynamic evidence. EKG, echocardiogram, bronchofiberoscophy, bronchogram and diagnostic thoracentesis was performed. On Dec. 8, 1980, operation was performed under the impression of mediastinal tumor in the anterior mediastinum. At left posterolateral thoractomy, a large fatty mass, measuring 35 x 27 x 13 Cm in dimension and weighing 3350 gm, was resected and multiple bullae on the apicoposterior segment of the left upper lobe was resected and continuously sutured. The pathologic diagnosis of the fatty mass was thymolipoma. The postoperative course was uneventful and discharged in good general conditions.

• Journal of Chest Surgery
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• v.14 no.2
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• pp.135-139
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• 1981

Thymolipoma is extremely uncommon benign mediastinal tumor consisting of fatty and thymic tissue. Only 50 verified cases have been reported in the world literatures. This one case is the first reported example of surgically treated thymolipoma associated with spontaneous pneumothorax. A thirty-two year old male patient had been in good health until two days prior to admission, when he noted sudden dyspnea associated with an aching pain over the left precordium. The dyspnea and chest pain had become progressively worse. The physical examination revealed that left hemithorax was tympanic sound on percussion and absence of breathing sound on auscultation and point of maximal impulse was located on the 4th intercostal space at the left sternal border. Emergency closed thoracostomy was performed under the impression of tension type spontaneous pneumothorax of the left lung. After closed thoracostomy, point of maximal impulse was not changed inspire of full expansion of the left lung and chest X-ray was strongly suggested pericardial effusion or cardiomegaly which couldn`t account for by clinical course and hemodynamic evidence. EKG, echocardiogram, bronchofiberoscophy, bronchogram and diagnostic thoracentesis was performed. On Dec. 8, 1980, operation was performed under the impression of mediastinal tumor in the anterior mediastinum. At left posterolateral thoractomy, a large fatty mass, measuring 35 x 27 x 13 Cm in dimension and weighing 3350 gm, was resected and multiple bullae on the apicoposterior segment of the left upper lobe was resected and continuously sutured. The pathologic diagnosis of the fatty mass was thymolipoma. The postoperative course was uneventful and discharged in good general conditions.

• Journal of Chest Surgery
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• v.19 no.3
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• pp.385-390
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• 1986

Empyema is a severe infection encountered in the pediatrics. With advance of the antibiotics and chemotherapeutics, there was a marked decrease in number of empyema. Empyema complicated by staphylococcal pneumonia in infant and children has been distressing problem, and the management of this complication has been discussed repeatedly in the past. In Korea, tuberculous empyema is also troublesome. If empyema is localized within thick capsule, tube thoracostomy and closed drainage alone is unacceptable, and early open thoracotomy to eliminate the empyema has proved good result. A clinical analysis of 39 patients with thoracic empyema was done. They were managed surgical intervention at Dept. of Thoracic & Cardiovascular Surgery at Kyung-Hee University Hospital from Jan. 1974 to December, 1984. 1. Age and sex distribution, infancy 9, early childhood 11. late childhood 9, puberty 10. The male to female ratio was 21:18. 2. The highest seasonal incidence was winter [21 cases]. 3. Cardinal symptoms were cough [76%], fever and chill [66%], and dyspnea [40%]. 4. The location of the empyema was right in 27 cases [69%] and 12 cases in left side. 5. The most frequent lesion to predisposing factor was pneumonia [67%]. 6. The commonest organism was Staphylococcus aureus in 15 [38%] cases, and Mycobacterium tuberculosis in 10 cases [26%]. 7. The surgical treatment was performed in all patients. The surgical procedure was closed tube thoracostomy in 25 cases [64%], decortication in 7 cases [18%], pulmonary resection in 4 cases [10%], and decortication with curettage in 2 cases. 8. One patient died from sepsis complicated by lymphoma and in one patient bronchopleural fistula was developed postoperatively.