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Lee GM, Carroll M, Marquis KM, Walker CM. Lymphatic Drainage of Thoracic and Extrathoracic Malignancies. Radiol Clin North Am 2025; 63:537-552. [PMID: 40409934 DOI: 10.1016/j.rcl.2024.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2025]
Abstract
This review article details the lymphatic drainage pathways for both thoracic and extrathoracic cancers within the chest. The major lymphatic pathways into and through the thorax are reviewed, along with their impact on the spread of cancers. Defects or damage to lymphatic channels and variant anatomy may alter how cancer cells spread through the lymphatic system. Monitoring specific lymph node stations can help in the early detection of lymph node metastases. When an abnormal lymph node is detected without a known primary malignancy, understanding lymphatic drainage pathways can help target the search for the most likely origin of the abnormality.
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Affiliation(s)
- Gregory M Lee
- Department of Radiology, University of Kansas Medical Center, 4000 Cambridge Street, MS 4032, Kansas City, KS 66160-8501, USA.
| | - Melissa Carroll
- Department of Radiology, University of Kansas Medical Center, 4000 Cambridge Street, MS 4032, Kansas City, KS 66160-8501, USA
| | - Kaitlyn M Marquis
- Department of Radiology, University of Kansas Medical Center, 4000 Cambridge Street, MS 4032, Kansas City, KS 66160-8501, USA
| | - Christopher M Walker
- Department of Radiology, University of Kansas Medical Center, 4000 Cambridge Street, MS 4032, Kansas City, KS 66160-8501, USA
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Campisi A, Dell’Amore A, Fang W, Roca G, Silvestrin S, Nicotra S, Chen Y, Gabryel P, Sielewicz M, Piwkowski C, Rocca EL, Patirelis A, Ambrogi V, Giovannetti R, Rea F, Infante M. Impact of Pulmonary Ligament Resection in Upper Lobectomies: A Multicenter Matched Cohort Study. J Clin Med 2024; 13:6950. [PMID: 39598094 PMCID: PMC11594900 DOI: 10.3390/jcm13226950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2024] [Revised: 11/04/2024] [Accepted: 11/14/2024] [Indexed: 11/29/2024] Open
Abstract
Background: Division of the pulmonary ligament is standard in lower lobectomies, but its application in upper lobectomies remains controversial due to potential complications like atelectasis and bronchial kinking. This retrospective matched cohort study aimed to evaluate the efficacy and safety of ligament resection in upper lobectomies for oncological purposes. Methods: From January 2015 to December 2020, 988 patients who underwent minimally invasive upper lobectomies across multiple centers were identified. They were categorized into ligament resection and no ligament resection groups, with propensity score matching (PSM) to minimize confounding factors. Endpoints included operative time, pleural effusion, complications (frequency and Clavien-Dindo scores), chest drainage removal, length of stay, pleural space, collapse rate, and bronchial kinking. Results: Following PSM, 276 patients were included in each group, with no significant differences in baseline characteristics. Ligament resection correlated with longer operative times, increased lymphadenectomy sampling at station #9 (p < 0.001), and a bigger change in the bronchial angle (p < 0.001). No statistically significant differences were observed for the other endpoints. Conclusions: Ligament resection during upper lobectomy may impact the bronchial angle without immediate postoperative outcome changes. Further research is necessary to comprehensively assess the risks and benefits of ligament resection in upper lobectomies for neoplastic disease.
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Affiliation(s)
- Alessio Campisi
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China; (W.F.); (Y.C.)
- Thoracic Surgery Unit, Cardiovascular and Thoracic Department, University and Hospital Trust-Ospedale Borgo Trento, 37126 Verona, Italy; (R.G.); (M.I.)
| | - Andrea Dell’Amore
- Department of Cardiothoracic Surgery and Vascular Sciences, Padua University Hospital, University of Padua, 35128 Padua, Italy; (A.D.); (G.R.); (S.S.); (S.N.); (F.R.)
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China; (W.F.); (Y.C.)
| | - Gabriella Roca
- Department of Cardiothoracic Surgery and Vascular Sciences, Padua University Hospital, University of Padua, 35128 Padua, Italy; (A.D.); (G.R.); (S.S.); (S.N.); (F.R.)
| | - Stefano Silvestrin
- Department of Cardiothoracic Surgery and Vascular Sciences, Padua University Hospital, University of Padua, 35128 Padua, Italy; (A.D.); (G.R.); (S.S.); (S.N.); (F.R.)
| | - Samuele Nicotra
- Department of Cardiothoracic Surgery and Vascular Sciences, Padua University Hospital, University of Padua, 35128 Padua, Italy; (A.D.); (G.R.); (S.S.); (S.N.); (F.R.)
| | - Yang Chen
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China; (W.F.); (Y.C.)
| | - Piotr Gabryel
- Department of Thoracic Surgery, Poznan University of Medical Sciences, 60-569 Poznan, Poland; (P.G.); (M.S.); (C.P.)
| | - Magdalena Sielewicz
- Department of Thoracic Surgery, Poznan University of Medical Sciences, 60-569 Poznan, Poland; (P.G.); (M.S.); (C.P.)
| | - Cezary Piwkowski
- Department of Thoracic Surgery, Poznan University of Medical Sciences, 60-569 Poznan, Poland; (P.G.); (M.S.); (C.P.)
| | - Eleonora La Rocca
- Thoracic Surgery Unit, Tor Vergata University Polyclinic, 00133 Rome, Italy; (E.L.R.); (A.P.); (V.A.)
| | - Alexandro Patirelis
- Thoracic Surgery Unit, Tor Vergata University Polyclinic, 00133 Rome, Italy; (E.L.R.); (A.P.); (V.A.)
| | - Vincenzo Ambrogi
- Thoracic Surgery Unit, Tor Vergata University Polyclinic, 00133 Rome, Italy; (E.L.R.); (A.P.); (V.A.)
| | - Riccardo Giovannetti
- Thoracic Surgery Unit, Cardiovascular and Thoracic Department, University and Hospital Trust-Ospedale Borgo Trento, 37126 Verona, Italy; (R.G.); (M.I.)
| | - Federico Rea
- Department of Cardiothoracic Surgery and Vascular Sciences, Padua University Hospital, University of Padua, 35128 Padua, Italy; (A.D.); (G.R.); (S.S.); (S.N.); (F.R.)
| | - Maurizio Infante
- Thoracic Surgery Unit, Cardiovascular and Thoracic Department, University and Hospital Trust-Ospedale Borgo Trento, 37126 Verona, Italy; (R.G.); (M.I.)
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Thamkittikun C, Tovichien P. Clinical approach for pulmonary lymphatic disorders. World J Clin Cases 2024; 12:6020-6026. [PMID: 39328863 PMCID: PMC11326095 DOI: 10.12998/wjcc.v12.i27.6020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 06/20/2024] [Accepted: 06/25/2024] [Indexed: 07/29/2024] Open
Abstract
In this editorial, we discuss the clinical implications of the article "Lymphatic plastic bronchitis and primary chylothorax: A study based on computed tomography lymphangiography" published by Li et al. Pulmonary lymphatic disorders involve abnormalities in the lymphatic tissues within the thoracic cavity. Specifically, pulmonary lymphatic perfusion syndrome describes a condition where the flow of lymphatic fluid in the lungs is redirected towards abnormally widened lymphatic vessels. Clinically, individuals with this syndrome may experience symptoms such as chyloptysis, plastic bronchitis (PB), chylothorax, chylopericardium, and interstitial lung disease. These disorders can be caused by various factors, including PB, chylothorax, and complex lymphatic malformations. Advancements in lymphatic imaging techniques, such as intranodal lymphangiography, computed tomography lymphangiography, and dynamic contrast-enhanced magnetic resonance lymphangiography, have enabled the detection of abnormal lymphatic flow. This has enhanced our understanding of the pathophysiology of these conditions. Additionally, innovative minimally invasive treatments, such as thoracic duct embolization, selective embolization of lymphatic channels, and surgical procedures aim to improve clinical condition of patients and address their dietary needs.
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Affiliation(s)
- Chalisa Thamkittikun
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Prakarn Tovichien
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
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Szewczuk O, Szewczuk W, Walędziak M, Różańska-Walędziak A. Spontaneous regression of fetal pleural effusion in pregnancy complicated with Herpes simplex infection: Clinical presentation and literature review. Eur J Obstet Gynecol Reprod Biol 2024; 299:193-198. [PMID: 38885560 DOI: 10.1016/j.ejogrb.2024.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 06/11/2024] [Indexed: 06/20/2024]
Abstract
Fetal primary hydrothorax is a rare congenital anomaly with an estimated incidence of 1:10,000-15,000 pregnancies, with an unpredictable clinical course, ranging from spontaneous resolution to fetal death. A case of unilateral fetal pleural effusion was diagnosed at 35th week of gestation during a routine ultrasonographic fetal assessment in an uncomplicated pregnancy. A large echogenic collection of fluid was revealed in the right pleural cavity, together with atelectasis of the right lung, as well as displacement of heart and mediastinal structures to the left side of thorax. The patient was also diagnosed with polyhydramnios and there was a disproportion of heart ventricles volume. No other fetal structural abnormalities were detected and there were no symptoms of edema. Fetal biometrics was consistent with the gestational age. In echocardiography, fetal heart was structurally and functionally normal. Screening tests for congenital infections of the fetus were negative. Autoimmune fetal hydrops was excluded after laboratory tests. There was no parents' consent for the analysis of the karyotype. The patient presented clinical symptoms and was diagnosed with Herpes simplex virus infection and was treated with oral acyclovir. Serial fetal ultrasound exams showed gradual decrease in pleural fluid volume up to complete resolution in 38th week of pregnancy. Pregnancy was ended in the 38th week of gestation with a cesarean delivery of a healthy neonate. It is yet to be determined if there is a direct association between Herpes simplex virus infection in pregnancy and the risk of fetal pleural effusion. The incidence of fetal pleural effusion is low and the neonatal outcome difficult to be predicted. The optimum management of fetal pleural effusion should be subject to further studies to determine the best clinical practice.
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Affiliation(s)
- Oksana Szewczuk
- 2nd Department of Obstetrics and Gynecology, Medical University, Princess Anna Mazowiecka Hospital, Karowa st. 2, 00-315 Warsaw, Poland
| | - Wiktor Szewczuk
- Department of Pathology, Military Institute of Medicine-National Research Institute, Szaserow st. 128, 04-141 Warsaw, Poland
| | - Maciej Walędziak
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine-National Research Institute, Szaserów 128 st., 04-141 Warsaw, Poland.
| | - Anna Różańska-Walędziak
- Department of Human Physiology and Pathophysiology, Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, 01-938 Warsaw, Poland
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Zhu LM, Li CX, Gong XL, Xu ZM, Liu JL, Zhang HB. Clinical features of plastic bronchitis in children after congenital heart surgery. Ital J Pediatr 2024; 50:74. [PMID: 38637856 PMCID: PMC11027272 DOI: 10.1186/s13052-024-01650-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 04/07/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Plastic bronchitis (PB) can occur in patients who have undergone congenital heart surgery (CHS). This study aimed to investigate the clinical features of PB in children after CHS. METHODS We conducted a retrospective cohort study using the electronic medical record system. The study population consisted of children diagnosed with PB after bronchoscopy in the cardiac intensive care unit after CHS from May 2016 to October 2021. RESULTS A total of 68 children after CHS were finally included in the study (32 in the airway abnormalities group and 36 in the right ventricular dysfunction group). All children were examined and treated with fiberoptic bronchoscopy. Pathogens were detected in the bronchoalveolar lavage fluid of 41 children, including 32 cases in the airway abnormalities group and 9 cases in the right ventricular dysfunction group. All patients were treated with antibiotics, corticosteroids (intravenous or oral), and budesonide inhalation suspension. Children with right ventricular dysfunction underwent pharmacological treatment such as reducing pulmonary arterial pressure. Clinical symptoms improved in 64 children, two of whom were treated with veno-arterial extracorporeal membrane oxygenation (ECMO) due to recurrent PB and disease progression. CONCLUSIONS Children with airway abnormalities or right ventricular dysfunction after CHS should be alerted to the development of PB. Pharmacological treatment such as anti-infection, corticosteroids, or improvement of right ventricular function is the basis of PB treatment, while fiberoptic bronchoscopy is an essential tool for the diagnosis and treatment of PB. ECMO assistance is a vital salvage treatment for recurrent critically ill PB patients.
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Affiliation(s)
- Li-Min Zhu
- Department of Cardiac Intensive Care Unit, Shanghai Children' s Medical Center, Shanghai Jiaotong University School of Medicine, 1678 Dongfang Road, 200127, Shanghai, PR China
| | - Chun-Xiang Li
- Department of Cardiac Intensive Care Unit, Shanghai Children' s Medical Center, Shanghai Jiaotong University School of Medicine, 1678 Dongfang Road, 200127, Shanghai, PR China
| | - Xiao-Lei Gong
- Department of Cardiac Intensive Care Unit, Shanghai Children' s Medical Center, Shanghai Jiaotong University School of Medicine, 1678 Dongfang Road, 200127, Shanghai, PR China
| | - Zhuo-Ming Xu
- Department of Cardiac Intensive Care Unit, Shanghai Children' s Medical Center, Shanghai Jiaotong University School of Medicine, 1678 Dongfang Road, 200127, Shanghai, PR China
| | - Jin-Long Liu
- Institute of Pediatric Translational Medicine, Shanghai Children' s Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dongfang Road, 200127, Shanghai, PR China
| | - Hai-Bo Zhang
- Department of Cardiothoracic Surgery, Shanghai Children' s Medical Center, Shanghai Jiaotong University School of Medicine, 1678 Dongfang Road, 200127, Shanghai, PR China.
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Qian J, Cai S, Lin P, Chi W, Chen C, Xu G, Xu C, Wu W, Zheng W, Zheng B. Preservation vs. dissection of inferior pulmonary ligament for thoracoscopic upper lobectomy: a prospective randomized controlled trial. World J Surg Oncol 2023; 21:313. [PMID: 37805593 PMCID: PMC10559397 DOI: 10.1186/s12957-023-03190-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/17/2023] [Indexed: 10/09/2023] Open
Abstract
OBJECTIVES The proper procedure for inferior pulmonary ligament (IPL) during upper lobectomy remains a topic of debate. To address this matter, we carried out a trial comparing the clinical outcomes of IPL preservation versus IPL dissection during thoracoscopic upper lobectomy (TUL). METHODS Patients undergoing thoracoscopic left/right upper lobectomy (TLUL/TRUL) were assigned to either the dissection group (Group D) or the preservation group (Group P). Our primary objective was to quantify and compare the alterations in postoperative residual bronchial angle and lung volume changes between the two groups. Our secondary objective encompassed the assessment of various other intraoperative and postoperative outcomes. RESULTS Following adherence to the inclusion and exclusion criteria, we enrolled 100 patients (41 left and 59 right) in Group P and 108 patients (41 left and 67 right) in Group D for the study. Our findings revealed that in TLUL, Group P was able to reduce the degree of postoperative residual bronchial angle change (P < 0.05). Conversely, the situation was distinct for TRUL. We found no notable disparity between the two groups (P > 0.05) with regard to alterations in lung volume or the occurrence of postoperative complications-except for the duration of postoperative hospital stay (P < 0.05). CONCLUSIONS Our study suggests IPL preservation especially for TLUL when compared to TRUL, which have important implications for the clinical management of patients undergoing upper lobectomy.
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Affiliation(s)
- Jiekun Qian
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China
- Fujian Key Laboratory of Cardiothoracic Surgery (Fujian Medical University), Fuzhou, China
| | - Shixian Cai
- Department of Thoracic Surgery, Jinjiang Hospital of Traditional Chinese Medicine, Quanzhou, China
| | - Pinghua Lin
- Department of Thoracic Surgery, Fuqing City Hospital, Fuzhou, China
| | - Wanzhong Chi
- Department of Thoracic Surgery, Sanming Second Hospital, Sanming, China
| | - Chun Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China
- Fujian Key Laboratory of Cardiothoracic Surgery (Fujian Medical University), Fuzhou, China
| | - Guobin Xu
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China
- Fujian Key Laboratory of Cardiothoracic Surgery (Fujian Medical University), Fuzhou, China
| | - Chi Xu
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China
- Fujian Key Laboratory of Cardiothoracic Surgery (Fujian Medical University), Fuzhou, China
| | - Weidong Wu
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China
- Fujian Key Laboratory of Cardiothoracic Surgery (Fujian Medical University), Fuzhou, China
| | - Wei Zheng
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China
- Fujian Key Laboratory of Cardiothoracic Surgery (Fujian Medical University), Fuzhou, China
| | - Bin Zheng
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China.
- Fujian Key Laboratory of Cardiothoracic Surgery (Fujian Medical University), Fuzhou, China.
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Yang P, Han R, Zhu B, Wu Y, Han B. Delayed chylopericardium after radical surgery for esophageal cancer: a case report. Front Oncol 2023; 13:1163618. [PMID: 37503311 PMCID: PMC10369179 DOI: 10.3389/fonc.2023.1163618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/19/2023] [Indexed: 07/29/2023] Open
Abstract
Background Postoperative chylpericardium is a rare clinical disease that often manifests as chest tightness, shortness of breathdyspnea, and other symptoms of pericardial tamponade. The etiological spectrum of chylopericardium is complex, but the disease is mainly idiopathic. Chylopericardium caused by thoracic surgery is rarely reported, both at home and abroad. Case summary We report a case of a 65-year-old male patient who developed chylopericardium after thoracoabdominal combined incision and partial esophagogastric anastomosis plus lymph node dissection for 1 month. After pericardiocentesis and drainage, low-fat enteral nutrition, and parenteral nutrition, the patient was cured. Based on this case, this article reviews the literature on the diagnosis and treatment of chylopericardium after thoracic surgery. Conclusion In conclusion, thoracic surgery (excluding cardiac surgery) can cause delayed chylopericardium. This condition is rarely reported in China, and only a few cases have been reported abroad. Thus, the diagnosis is likely to be missed or misdiagnosed. Early diagnosis and treatment are important to reduce patient discomfort as much as possible.
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Affiliation(s)
- Pengjie Yang
- Department of Thoracic Surgery, Peking University Cancer Hospital Inner Mongolia Hospital/Cancer Hospital Affiliated to Inner Mongolia Medical University, Hohhot, China
| | - Rui Han
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Benben Zhu
- Department of Pharmacy, Peking University Cancer Hospital Inner Mongolia Hospital/Cancer Hospital Affiliated to Inner Mongolia Medical University, Hohhot, China
| | - Yu Wu
- Department of Nuclear Medicine, Peking University Cancer Hospital Inner Mongolia Hospital/Cancer Hospital Affiliated to Inner Mongolia Medical University, Hohhot, China
| | - Bater Han
- Department of Thoracic Surgery, Peking University Cancer Hospital Inner Mongolia Hospital/Cancer Hospital Affiliated to Inner Mongolia Medical University, Hohhot, China
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Zhang G, Liu T, Liang C. Chylothorax and chylopericardial tamponade following lobectomy and lymphadenectomy: a rare presentation. J Cardiothorac Surg 2023; 18:25. [PMID: 36647154 PMCID: PMC9841673 DOI: 10.1186/s13019-023-02126-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 01/02/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Although postoperative chylothorax following lung cancer surgery is rare, it is a recognized complication in 0.25-3% of patients. However, cases of cardiac tamponade caused by chylopericardium after lung cancer surgery are extremely rare. CASE PRESENTATION We describe hitherto unreported sequelae of chyle leak following lobectomy and systematic mediastinal lymph node dissection (SLND) causing pericardial tamponade and cardiovascular compromise. The patient was successfully treated with minimally invasive surgical repair and ligation. We also discuss the development of chylopericardium as a potential complication of lobectomy and SLND. CONCLUSIONS The anatomical characteristics of the thoracic duct warrant special attention in postoperative chyle leak management in patients who undergo definitive mediastinal lymph node dissection. Surgeons should be aware that chylopericardium is a rare but potential complication of lobectomy and SLND as it may help with early diagnosis, management, and prevention of cardiac tamponade.
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Affiliation(s)
- Guofei Zhang
- grid.412465.0Department of Thoracic Surgery, The Second Affiliated Hospital of the Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009 China
| | - Tianshu Liu
- grid.412465.0Department of Thoracic Surgery, The Second Affiliated Hospital of the Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009 China
| | - Chengxiao Liang
- grid.417400.60000 0004 1799 0055Department of Surgery, Zhejiang Hospital, # 12 Lingyin Road, Hangzhou, 310013 China
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Effectiveness of lymphadenectomy along the thoracic duct for radical esophagectomy. Esophagus 2022; 19:85-94. [PMID: 34333712 DOI: 10.1007/s10388-021-00868-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 07/29/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND There has been much debate on whether to perform TD resection in radical esophagectomy for esophageal cancer from the perspectives of metastatic rate, effect on postoperative hemodynamics, and other factors. The objective of this study was to determine whether TDLN dissection contributes to improved prognosis. METHODS This study involved 1211 patients who underwent D2/D3 dissection with TD resection for thoracic esophageal cancer between 1984 and 2020. The lymph nodes along the TD were defined as TDLNs and the remaining No. 112 nodes as non-TDLNs. The metastatic rate in TDLNs and non-TDLNs and their outcomes were compared with those of other thoracic lymph nodes. Correlation with the invasion depth of the main lesion was also analyzed (T0-2 545 patients, T3-4 666 patients). RESULTS The metastatic rates in TDLNs/non-TDLNs in all patients were 7.3%/7.5%, respectively, while those in T0-2 were 2.2%/3.9%, and those in T3-4 were 11.5%/10.6%, with both having higher rates in advanced cases. The efficacy index (EI) for lymphadenectomy in T3-4 was 2.94 for TDLNs and 3.44 for non-TDLNs, with no significant difference. The metastatic rate in TDLNs by tumor site was as follows: Ut/Mt/Lt = 1.1/2.4/2.4% (T0-2) and 7.7/14.5/8.4% (T3-4), being especially high (~ 15%) in patients with advanced cases in Mt region. The EI was comparable or higher for TDLNs compared with other group-2 (Mt/Lt) and group-3 (Ut) regional lymph nodes, regardless of site. CONCLUSIONS The significance of TD resection was low in T0-2 due to the low metastatic rate but became evident in cases with invasion depth of T3-4. TDLN resection was at least as effective as dissection of other group-2 or -3 lymph nodes, including No. 112 nodes.
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Korpes K, Kolenc M, Trbojević Vukičević T, Đuras M. Anatomical variations of the thoracic duct in the dog. Anat Histol Embryol 2021; 50:1015-1025. [PMID: 34632615 DOI: 10.1111/ahe.12745] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/12/2021] [Accepted: 09/18/2021] [Indexed: 11/26/2022]
Abstract
Anatomical variations can be frequently found in the lymphatic system, which is also true for the shape and course of the thoracic duct (ductus thoracicus), the biggest lymph vessel in the body. From 2012 to 2019, the thoracic duct was successfully dissected in 43 dog carcasses that were used in the anatomy course at the Faculty of Veterinary Medicine, University of Zagreb. The thoracic duct originated from the cranial border of the cisterna chyli as one lymph vessel in 36 dogs (83.7%), as two vessels in six dogs (14%) and as three vessels in one dog (2.3%). We divided the observed thoracic duct variations into six groups according to their anatomical similarities. Considering the specific embryonic development, we can conclude that all observed variations are the result of minor deviations from the standard ontogenesis. However, the importance of thoracic duct variations is significant in surgical procedures done in the thoracic cavity to prevent or cure the chylothorax. Since this research showed variations in 39 out of 43 dogs (90.7%) throughout the whole course of the thoracic duct, great care must be taken while performing the ligation or embolization of the thoracic duct.
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Affiliation(s)
- Kim Korpes
- Department of Anatomy, Histology and Embryology, Faculty of Veterinary Medicine, University of Zagreb, Zagreb, Croatia
| | - Magdalena Kolenc
- Department of Anatomy, Histology and Embryology, Faculty of Veterinary Medicine, University of Zagreb, Zagreb, Croatia
| | - Tajana Trbojević Vukičević
- Department of Anatomy, Histology and Embryology, Faculty of Veterinary Medicine, University of Zagreb, Zagreb, Croatia
| | - Martina Đuras
- Department of Anatomy, Histology and Embryology, Faculty of Veterinary Medicine, University of Zagreb, Zagreb, Croatia
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Ishida H, Nakazawa K, Yanagihara A, Umesaki T, Taguchi R, Yamada A, Nitanda H, Sakaguchi H. Chylothorax associated with lymphatic reflux in a thoracic duct tributary after lung cancer surgery. Thorac Cancer 2021; 12:2221-2224. [PMID: 34152082 PMCID: PMC8327699 DOI: 10.1111/1759-7714.14062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/05/2021] [Accepted: 06/09/2021] [Indexed: 12/25/2022] Open
Abstract
Chyle leaks are attributed to damage to the thoracic duct itself or its tributaries during surgery. Chylothorax after lung cancer surgery can occur due to damaged thoracic duct tributaries; however, little is known of the mechanism involved. A 71-year-old female underwent a left upper lobectomy with hilar and mediastinal lymphadenectomy for a 1.8-cm primary squamous cell carcinoma, and developed a chylothorax a day later. Catheter lymphangiography revealed high-flow chyle leaks from a damaged thoracic duct tributary, known as a bronchomediastinal lymph trunk, due to a lymphatic reflex from the thoracic duct. Subsequently, catheter embolization of the tributary repaired the chylothorax. The potential for persistent chylothorax after lung cancer surgery and successful lymphatic intervention should be noted.
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Affiliation(s)
- Hironori Ishida
- Department of General Thoracic SurgerySaitama Medical University International Medical CenterSaitamaJapan
| | - Ken Nakazawa
- Department of Diagnostic RadiologySaitama Medical University International Medical CenterSaitamaJapan
| | - Akitoshi Yanagihara
- Department of General Thoracic SurgerySaitama Medical University International Medical CenterSaitamaJapan
| | - Tetsuya Umesaki
- Department of General Thoracic SurgerySaitama Medical University International Medical CenterSaitamaJapan
| | - Ryo Taguchi
- Department of General Thoracic SurgerySaitama Medical University International Medical CenterSaitamaJapan
| | - Akiko Yamada
- Department of General Thoracic SurgerySaitama Medical University International Medical CenterSaitamaJapan
| | - Hiroyuki Nitanda
- Department of General Thoracic SurgerySaitama Medical University International Medical CenterSaitamaJapan
| | - Hirozo Sakaguchi
- Department of General Thoracic SurgerySaitama Medical University International Medical CenterSaitamaJapan
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12
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O'Leary CN, Khaddash T, Nadolski G, Itkin M. Abnormal Pulmonary Lymphatic Flow on Novel Lymphangiographic Imaging Supports a Common Etiology of Lymphatic Plastic Bronchitis and Nontraumatic Chylothorax. Lymphat Res Biol 2021; 20:153-159. [PMID: 34077679 DOI: 10.1089/lrb.2021.0008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: This study evaluates whether dynamic contrast-enhanced magnetic resonance lymphangiography (DCMRL) and thoracic duct lymphangiography (TDL) findings in adults with lymphatic plastic bronchitis (PB) and/or nontraumatic chylothorax (NTC) support a shared pathophysiology. Materials and Results: Retrospective review of clinical and imaging findings in patients who underwent DCMRL and TDL at a single institution from March 2017 to March 2019. Categorical variables were compared with Fisher's exact test. Twenty-eight patients (median age 61 ± 21 years, 15 women) presenting with lymphatic PB (n = 13), NTC (n = 10), or both (n = 5) were included. Lymphatic imaging demonstrated pulmonary lymphatic perfusion (PLP) in all patients. A patent thoracic duct (TD) with retrograde flow was seen in 53.4% (7/13) of patients with PB, 60% (6/10) of patients with NTC, and 20% (1/5) of patients with both (p = 0.69). An occluded TD with retrograde flow was seen in 30.8% (4/13) of patients with PB, 30% (3/10) of patients with NTC, and 80% (4/5) of patients with both (p = 0.12). Similar patterns of PLP between DCMRL and TDL were seen in 96.2% (25/26) of patients. Conclusions: DCMRL and TDL demonstrated similar findings in patients with lymphatic PB and/or NTC, supporting a common etiology. This supports the hypothesis that the clinical presentation depends on the proximity of abnormal lymphatic vessels to the pleural cavity, resulting in chylothorax, or bronchial mucosa, resulting in PB.
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Affiliation(s)
- Cathal N O'Leary
- Department of Radiology, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Tamim Khaddash
- Department of Radiology, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Gregory Nadolski
- Department of Radiology, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Maxim Itkin
- Department of Radiology, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
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Abstract
Lymph node (LN) removal during pulmonary metastasectomy is a prerequisite to achieve complete resection or at least collect prognostic information, but is not yet generally accepted. On average, the rate of unexpected lymph node involvement (LNI) is less than 10% in sarcoma, 20% in colorectal cancer (CRC) and 30% in renal cell carcinoma (RCC) when radical LN dissection is performed. LNI is a negative prognostic factor and presence of preoperative mediastinal disease usually leads to exclusion of the patient from metastasis surgery. Nonetheless, some authors found excellent prognoses even with mediastinal LNI in colorectal and RCC metastases when radical LN dissection was performed (median survival of 37 and 36 months, respectively). Multiple metastases, central location of the lesion followed by anatomical resections are associated with a higher LNI rate. The real prognostic influence of systematic LN dissection remains unclear. Two positive effects were described after radical lymphadenectomy: a trend for improved survival in RCC patients and a reduction of mediastinal recurrences from 23% to 0% in CRC patients. Unfortunately, there is a great number of studies that do not demonstrate any positive effect of lymphadenectomy during pulmonary metastasectomy except a pseudo stage migration effect. Future studies should not only focus on survival, but also on local and LN recurrence.
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Affiliation(s)
- Stefan Welter
- Department of Thoracic Surgery, Lung Clinic Hemer, Theo-Funccius-Str. 1, 58675 Hemer, Germany
| | - Varun Gupta
- Department of Thoracic Surgery, Lung Clinic Hemer, Theo-Funccius-Str. 1, 58675 Hemer, Germany
| | - Ioannis Kyritsis
- Department of Thoracic Surgery, Lung Clinic Hemer, Theo-Funccius-Str. 1, 58675 Hemer, Germany
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14
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Abstract
OBJECTIVE. This article reviews thoracic lymphatic pathways and tributaries, discusses lymphatic anatomic variants and their clinical implications, and emphasizes common patterns of thoracic lymphadenopathy from extrapulmonary malignancies. CONCLUSION. Recognition of common patterns and pathways of thoracic lymphatic drainage can help identify the site of tumor origin and allow a more focused examination of disease extent, both of which are important for disease prognosis and management.
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Jha P, Marshall C, Maldonado E, Wu T. Isolated Chylopericardium in an Infant With Hypoplastic Left Heart Syndrome. JACC Case Rep 2020; 2:2115-2119. [PMID: 34317119 PMCID: PMC8299758 DOI: 10.1016/j.jaccas.2020.09.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/02/2020] [Indexed: 11/22/2022]
Abstract
Isolated chylopericardium is an exceedingly rare complication in any age group. Review of the limited published case series shows the most common cause of isolated chylopericardium to be cardiac surgery. We present a case of isolated chylopericardium after a bidirectional Glenn procedure in an infant with hypoplastic left heart syndrome. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Prashant Jha
- Division of Critical Care, Department of Pediatrics, UMC Children’s Hospital, University Medical Center, Las Vegas, Nevada
- Department of Pediatrics, University of Nevada at Las Vegas Schools of Medicine, Las Vegas, Nevada
| | - Callie Marshall
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
- Department of Pediatrics, St. Louis Children's Hospital, St. Louis, Missouri
| | - Elaine Maldonado
- Pediatric Services, University Health System, San Antonio, Texas
- Division of Pediatric Cardiology, Department of Pediatrics, UT Health San Antonio, San Antonio, Texas
| | - Theodore Wu
- Pediatric Services, University Health System, San Antonio, Texas
- Division of Pediatric Critical Care, Department of Pediatrics, UT Health San Antonio, San Antonio, Texas
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16
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Chia AXF, Pang PYK. Isolated Chylopericardium: An Unusual Cause of Late Cardiac Tamponade After Mitral Valve Repair. Ann Thorac Surg 2020; 110:e497-e500. [PMID: 32454020 DOI: 10.1016/j.athoracsur.2020.04.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 04/14/2020] [Accepted: 04/22/2020] [Indexed: 11/26/2022]
Abstract
Isolated chylopericardium after cardiac surgery is extremely rare, but potentially fatal. We present an unusual case of late postoperative chylopericardium causing cardiac tamponade 6 weeks after mitral valve repair, tricuspid annuloplasty, and left atrial appendage closure through median sternotomy. Emergent pericardiocentesis was performed. Microscopic analysis confirmed the chyle. The patient was successfully managed conservatively with oral dietary manipulation and intravenous octreotide.
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Affiliation(s)
- Alicia X F Chia
- Department of Cardiothoracic Surgery, National Heart Center Singapore, Singapore.
| | - Philip Y K Pang
- Department of Cardiothoracic Surgery, National Heart Center Singapore, Singapore
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17
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Li Y, Williams RJ, Dombrowski ND, Watters K, Daly KP, Irace AL, Visner GA, Rahbar R, Fynn-Thompson F. Current evaluation and management of plastic bronchitis in the pediatric population. Int J Pediatr Otorhinolaryngol 2020; 130:109799. [PMID: 31812839 PMCID: PMC9187852 DOI: 10.1016/j.ijporl.2019.109799] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/20/2019] [Accepted: 11/22/2019] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To describe a multidisciplinary approach for the treatment of plastic bronchitis (PB) in children. METHODS Retrospective chart review of children with PB between 1997 and 2017. Data regarding clinical presentation, diagnosis, management, and outcomes were analyzed. RESULTS Of 34 patients presenting with PB, 24 had single ventricle (SV) heart disease, 9 had pulmonary disease, and one had no underlying disease. Median (IQR: interquartile range) age at the time of PB diagnosis was 5.5 years (IQR: 9.0). Presenting symptoms included cough productive of casts (n = 27, 79%), wheezing (n = 5, 15%), dyspnea (n = 18, 53%), hypoxia (n = 31, 91%), and respiratory failure (n = 9, 26%). Diagnosis was made based on clinical evaluation, bronchoscopy findings, and/or pathology of casts. Treatment methods included bronchoscopy for cast removal (25% of SV patients, 91% of non-SV patients), chest physiotherapy (SV: 92%, non-SV: 45%), albuterol (SV: 79%, non-SV: 73%), inhaled steroids (SV: 75%, non-SV: 18%), nebulized hypertonic saline (SV: 29%, non-SV: 9%), nebulized heparin (SV: 8%, non-SV: 55%), nebulized tissue plasminogen activator (tPA; SV: 33%, non-SV: 9%), inhaled Dornase Alfa (SV: 54%, non-SV: 9%), antibiotics (SV: 46%, non-SV: 45%), systemic steroids (SV: 13%, non-SV: 45%), and lymphatic embolization (SV: 8%, non-SV: 45%). Of SV patients, 11 had no recurrence, 5 underwent heart transplantation, one awaits transplant, and 3 died due to cardiac disease. Three patients with respiratory disease had recurrent PB and one died from MRSA pneumonia. CONCLUSION PB is a highly morbid disease with limited treatment options. Bronchoscopy and chest physiotherapy for airway clearance are among the most-utilized therapies.
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Affiliation(s)
- Youjin Li
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Ryan J Williams
- Department of Cardiology, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Natasha D Dombrowski
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Karen Watters
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Boston, MA, 02115, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA, 02115, USA
| | - Kevin P Daly
- Department of Cardiology, Boston Children's Hospital, Boston, MA, 02115, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, 02115, USA
| | - Alexandria L Irace
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Gary A Visner
- Department of Pediatrics, Harvard Medical School, Boston, MA, 02115, USA; Division of Pulmonary and Respiratory Diseases, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Reza Rahbar
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Boston, MA, 02115, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA, 02115, USA
| | - Francis Fynn-Thompson
- Department of Cardiology, Boston Children's Hospital, Boston, MA, 02115, USA; Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, 02115, USA; Department of Surgery, Harvard Medical School, Boston, MA, 02115, USA.
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18
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Lv H, Zhou R, Zhan X, Di D, Qian Y, Zhang X. The choice of dissection or preservation of the inferior pulmonary ligament after an upper lobectomy: a systematic review and meta-analysis. World J Surg Oncol 2020; 18:5. [PMID: 31901232 PMCID: PMC6942349 DOI: 10.1186/s12957-019-1777-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 12/23/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The necessity of the inferior pulmonary ligament (IPL) dissection after an upper lobectomy remains controversial. This meta-analysis aimed to evaluate whether this accessional procedure could reduce the postoperative complications and improve outcomes. METHODS PubMed, Embase, Ovid, Cochrane Library, CBM, and CNKI databases were searched for the relevant studies which compared the dissection with preservation of IPL during the upper lobectomy. The Review Manager 5.3 software was used for this meta-analysis. RESULTS Three RCTs and five CCTs were included in this meta-analysis. These studies contained a total of 610 patients, in which 315 patients received a pulmonary ligament dissection (group D) after the upper lobectomy, while the other 295 patients preserved the pulmonary ligament (group P). No significant difference was demonstrated between the group D and group P in terms of drainage time after surgery (MD 0.14, 95%CI - 0.05 to 0.33, P = 0.15), rate of postoperative dead space (OR 1.33, 95%CI 0.72 to 2.46, P = 0.36), rate of postoperative complications (OR 1.20, 95%CI 0.66 to 2.19, P = 0.56). However, the pooled comparison revealed a greater change of the right main bronchial angle (MD 5.00, 95%CI 1.68 to 8.33, P = 0.003) in group D compared with group P, indicated that the dissection of IPL may lead to a greater distortion of bronchus. CONCLUSIONS This meta-analysis confirmed that the dissection of IPL do not effectively reduce the postoperative complications and improve the prognosis. Therefore, it is not necessary to dissect the IPL after an upper lobectomy.
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Affiliation(s)
- Hao Lv
- Department of Cardiothoracic Surgery, The third affiliated hospital of Soochow University, 185 Juqian street, Changzhou, 213000, Jiangsu Province, China
| | - Rui Zhou
- Department of Cardiothoracic Surgery, The third affiliated hospital of Soochow University, 185 Juqian street, Changzhou, 213000, Jiangsu Province, China
| | - Xianghong Zhan
- Department of Cardiothoracic Surgery, The third affiliated hospital of Soochow University, 185 Juqian street, Changzhou, 213000, Jiangsu Province, China
| | - Dongmei Di
- Department of Cardiothoracic Surgery, The third affiliated hospital of Soochow University, 185 Juqian street, Changzhou, 213000, Jiangsu Province, China
| | - Yongxian Qian
- Department of Cardiothoracic Surgery, The third affiliated hospital of Soochow University, 185 Juqian street, Changzhou, 213000, Jiangsu Province, China
| | - Xiaoying Zhang
- Department of Cardiothoracic Surgery, The third affiliated hospital of Soochow University, 185 Juqian street, Changzhou, 213000, Jiangsu Province, China.
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Capdevielle P, Guerrera F, Caput B, Siat J, Lyberis P, Oliaro A, Renaud S. Right chylothorax complicating videothoracoscopic management of recurrent pneumothorax. Chirurgia (Bucur) 2019. [DOI: 10.23736/s0394-9508.18.04845-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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20
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Breslin JW, Yang Y, Scallan JP, Sweat RS, Adderley SP, Murfee WL. Lymphatic Vessel Network Structure and Physiology. Compr Physiol 2018; 9:207-299. [PMID: 30549020 PMCID: PMC6459625 DOI: 10.1002/cphy.c180015] [Citation(s) in RCA: 210] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The lymphatic system is comprised of a network of vessels interrelated with lymphoid tissue, which has the holistic function to maintain the local physiologic environment for every cell in all tissues of the body. The lymphatic system maintains extracellular fluid homeostasis favorable for optimal tissue function, removing substances that arise due to metabolism or cell death, and optimizing immunity against bacteria, viruses, parasites, and other antigens. This article provides a comprehensive review of important findings over the past century along with recent advances in the understanding of the anatomy and physiology of lymphatic vessels, including tissue/organ specificity, development, mechanisms of lymph formation and transport, lymphangiogenesis, and the roles of lymphatics in disease. © 2019 American Physiological Society. Compr Physiol 9:207-299, 2019.
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Affiliation(s)
- Jerome W. Breslin
- Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Ying Yang
- Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Joshua P. Scallan
- Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Richard S. Sweat
- Department of Biomedical Engineering, Tulane University, New Orleans, LA
| | - Shaquria P. Adderley
- Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - W. Lee Murfee
- Department of Biomedical Engineering, University of Florida, Gainesville, FL
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21
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Zhang X, Patil D, Odze RD, Zhao L, Lisovsky M, Guindi M, Riddell R, Bellizzi A, Yantiss RK, Nalbantoglu I, Appelman HD. The microscopic anatomy of the esophagus including the individual layers, specialized tissues, and unique components and their responses to injury. Ann N Y Acad Sci 2018; 1434:304-318. [PMID: 29761508 DOI: 10.1111/nyas.13705] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 02/27/2018] [Accepted: 03/11/2018] [Indexed: 02/05/2023]
Abstract
The esophagus, a straight tube that connects the pharynx to the stomach, has the complex architecture common to the rest of the gastrointestinal tract with special differences that relate to its function as a conduit of ingested substances. For instance, it has submucosal glands that are unique and have a specific protective function. It has a squamous lining that exists nowhere else in the gut except the anus and it has a different submucosal nerve plexus when compared to the stomach and intestines. All of the layers of the esophageal wall and the specialized structures including blood and lymphatic vessels and nerves have specific responses to injury. The esophagus also has unique features such as patches of gastric mucosa called inlet patches at the very proximal part and it has a special sphincter mechanism at the most distal aspect. This review covers the normal microscopic anatomy of the esophagus and the patterns of reaction to stress and injury of each layer and each special structure.
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Affiliation(s)
- Xuchen Zhang
- Department of Pathology, Yale University, New Haven, Connecticut
| | - Deepa Patil
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio
| | - Robert D Odze
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
- Department of Pathology, Harvard University, Boston, Massachusetts
| | - Lei Zhao
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
- Department of Pathology, Harvard University, Boston, Massachusetts
| | - Mikhail Lisovsky
- Department of Pathology, Dartmouth University, Lebanon, New Hampshire
| | - Maha Guindi
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Hospital, Los Angeles, California
| | - Robert Riddell
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario
| | - Andrew Bellizzi
- Department of Pathology, University of Iowa, Iowa City, Iowa
| | - Rhonda K Yantiss
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Ilke Nalbantoglu
- Department of Pathology, Yale University, New Haven, Connecticut
| | - Henry D Appelman
- Department of Pathology, University of Michigan, Ann Arbor, Michigan
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Wang Y, Zhu L, Xia W, Wang F. Anatomy of lymphatic drainage of the esophagus and lymph node metastasis of thoracic esophageal cancer. Cancer Manag Res 2018; 10:6295-6303. [PMID: 30568491 PMCID: PMC6267772 DOI: 10.2147/cmar.s182436] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The lymphatic drainage of the inner layers (mucosa and submucosa) and the outer layers (muscularispropria and adventitia) of the thoracic esophagus is different. Longitudinal lymphatic vessels and long drainage territory in the submucosa and lamina propria should be the bases for bidirectional drainage and direct drainage to thoracic duct and extramural lymph nodes (LN). The submucosal vessels for direct extramural drainage are usually thick while lymphatic communication between the submucosa and intermuscular area is usually not clearly found, which does not facilitate transversal drainage to paraesophageal LN from submucosa. The right paratracheal lymphatic chain (PLC) is well developed while the left PLC is poorly developed. Direct drainage to the right recurrent laryngeal nerve LN and subcarinal LN from submucosa has been verified. Clinical data show that lymph node metastasis (LNM) is frequently present in the lower neck, upper mediastinum, and perigastric area, even for early-stage thoracic esophageal cancer (EC). The lymph node metastasis rate (LNMR) varies mainly according to the tumor location and depth of tumor invasion. However, there are some crucial LN for extramural relay which have a high LNMR, such as cervical paraesophageal LN, recurrent laryngeal nerve LN, subcarinal LN, LN along the left gastric artery, lesser curvature LN, and paracardial LN. Metastasis of thoracic paraesophageal LN seems to be a sign of more advanced EC. This review gives us a better understanding about the LNM and provides more information for treatments of thoracic EC.
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Affiliation(s)
- Yichun Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui, P.R. China, ;
| | - Liyang Zhu
- Department of Radiation Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui, P.R. China, ;
| | - Wanli Xia
- Department of Thoracic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui, P.R. China
| | - Fan Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui, P.R. China, ;
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Zhou P, Lan Y, Qin X, Huang X, Zeng F. Bilateral chylothorax and pericardial effusion following subtotal gastrectomy in a patient with situs inversus totalis. ANZ J Surg 2018; 89:E480-E481. [PMID: 30192067 DOI: 10.1111/ans.14783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 06/20/2018] [Accepted: 06/28/2018] [Indexed: 02/05/2023]
Affiliation(s)
- Peng Zhou
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yunping Lan
- Department of Intensive Care Unit, Hospital of the University of Electronic Science and Technology of China, Sichuan Provincial People's Hospital, Chengdu, China
| | - Xianpeng Qin
- Department of Gastrointestinal Surgery, Hospital of the University of Electronic Science and Technology of China, Sichuan Provincial People's Hospital, Chengdu, China
| | - Xiaobo Huang
- Department of Intensive Care Unit, Hospital of the University of Electronic Science and Technology of China, Sichuan Provincial People's Hospital, Chengdu, China
| | - Fan Zeng
- Department of Intensive Care Unit, Hospital of the University of Electronic Science and Technology of China, Sichuan Provincial People's Hospital, Chengdu, China
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24
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Affiliation(s)
- Olatunde Falode
- Cardiothoracic Surgery Centre, St Thomas' Hospital, London SE1 7EH, UK.
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25
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Kamata T, Shiba M, Fujiwara T, Nagato K, Yoshida S, Inoue T, Iida T. Chylopericardium following thoracoscopic resection of a mediastinal cyst: A case report. Int J Surg Case Rep 2017; 39:126-130. [PMID: 28837916 PMCID: PMC5567976 DOI: 10.1016/j.ijscr.2017.07.058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Revised: 07/29/2017] [Accepted: 07/30/2017] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Thoracic duct cysts are very rare, and diagnosis is often difficult. We report a rare case of chylopericardium following thoracic duct cyst resection. There are no established guidelines on the management of such cases. We reviewed the literature on postoperative complications after thoracic duct cyst resection, and conducted the first thorough review of the etiology and management of chylopericardium in surgical cases. PRESENTATION OF CASE A 54-year-old male presented with cardiac tamponade due to chylopericardium. He had undergone resection of a thoracic duct cyst 2 years previously, which was complicated by postoperative chylothorax. Chyle accumulation resolved with conservative treatment. DISCUSSION Chylothorax is a frequent complication following thoracic duct cyst resection, especially in cases where no intraoperative diagnosis is reached. Diagnosis may be difficult due to anomalous location of the cyst, as in our case. Chylopericardium is rarely reported, and may have occurred in our case because of prior pleurodesis. Chyle accumulation can reportedly be managed with diet restrictions in over half of reported cases, especially in cases of lung or mediastinal tumor resection. CONCLUSION The most important points highlighted by this rare case of chylopericardium secondary to thoracic duct cyst resection are: 1) pedicles should be ligated in cyst resections, regardless of location; 2) careful assessment in the initial surgery may help identify the point of leakage; 3) low-fat diet is the first choice in the initial management of postoperative chylopericardium, but surgical repair may be considered in cases with no response after>2 weeks of conservative treatment.
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Affiliation(s)
- Toshiko Kamata
- Department of Thoracic Surgery, Kimitsu Chuo Hospital, Japan.
| | | | - Taiki Fujiwara
- Department of Thoracic Surgery, Kimitsu Chuo Hospital, Japan
| | - Kaoru Nagato
- Department of Thoracic Surgery, Kimitsu Chuo Hospital, Japan
| | - Shigetoshi Yoshida
- Department of Thoracic Surgery, International University of Health and Welfare, Japan
| | - Toru Inoue
- Department of Surgical Pathology, Kimitsu Chuo Hospital, Japan
| | - Tomohiko Iida
- Department of Thoracic Surgery, Kimitsu Chuo Hospital, Japan
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Hart CM, Haisley KR, Lanciault C, Dolan JP. Node-Negative Esophageal Cancer With Short-Interval Isolated Metastasis to the Gallbladder: A Case Report. Semin Thorac Cardiovasc Surg 2017; 29:115-117. [DOI: 10.1053/j.semtcvs.2017.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2017] [Indexed: 12/12/2022]
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28
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Wierzbicki K, Mazur P, Węgrzyn P, Kapelak B. Life-Threatening Cardiac Tamponade Secondary to Chylopericardium Following Orthotopic Heart Transplantation-A Case Report. Ann Thorac Cardiovasc Surg 2016; 22:264-6. [PMID: 26548537 DOI: 10.5761/atcs.cr.15-00233] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Chylopericardium is a rare complication in cardiac surgery, and an extremely rare occurrence in patients following orthotopic heart transplantation (OHT), which, however, can lead to cardiac tamponade. Here we present a case of a 59-year-old man who underwent OHT and suffered from chylopericardium resulting in cardiac tamponade late in the postoperative course, despite the initially uneventful early postoperative period (decreasing blood drainage was observed directly after the procedure, and the drains were safely removed). After the diagnosis of chylopericardium was made, the conservative treatment was initiated, which turned out to be insufficient, and eventually invasive approach for the recurrence of tamponade secondary to chylopericardium was required. We discuss the available therapeutic options for chylopericardium and demonstrate the successful invasive therapeutic approach with use of the absorbable fibrin sealant patch.
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Affiliation(s)
- Karol Wierzbicki
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
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Breast Metastasis in Esophagus Cancer: Literature Review and Report on a Case. Case Rep Surg 2016; 2016:8121493. [PMID: 27340587 PMCID: PMC4906172 DOI: 10.1155/2016/8121493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 05/02/2016] [Accepted: 05/11/2016] [Indexed: 11/18/2022] Open
Abstract
Esophagus cancer metastases often involve locoregional lymph nodes, lung, bone, liver, and brain. Metastatic involvement of the breast from esophagus cancer is uncommon, but if it happened, it usually presents as a part of multiple organ distal metastases. Here we report a case of the largest metastatic esophagus cancer of the breast and the chest wall, and we review the similar reported cases.
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Nagai T, Oshiro H, Sagawa Y, Sakamaki K, Terauchi F, Nagao T. Pathological Characterization of Ovarian Cancer Patients Who Underwent Debulking Surgery in Combination With Diaphragmatic Surgery: A Cross-Sectional Study. Medicine (Baltimore) 2015; 94:e2296. [PMID: 26683966 PMCID: PMC5058938 DOI: 10.1097/md.0000000000002296] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 11/18/2015] [Accepted: 11/19/2015] [Indexed: 11/27/2022] Open
Abstract
Despite exhaustive efforts to detect early-stage ovarian cancers, greater than two-thirds of patients are diagnosed at an advanced stage. Although diaphragmatic metastasis is not rare in advanced ovarian cancer patients and often precludes optimal cytoreductive surgery, little is known about the mechanisms and predictive factors of metastasis to the diaphragm. Thus, as an initial step toward investigating such factors, the present study was conducted to characterize the pathological status of ovarian cancer patients who underwent debulking surgery in combination with diaphragmatic surgery. This is a retrospective and cross-sectional study of patients who underwent debulking surgery in combination with diaphragmatic surgery at our institution between January 2005 and July 2015. Clinicopathological data were reviewed by board-certified gynecologists, pathologists, and cytopathologists. The rates of various pathological findings were investigated and compared by Fisher exact test between 2 groups: 1 group that was pathologically positive for diaphragmatic metastasis (group A) and another group that was pathologically negative for diaphragmatic metastasis (group B). Forty-six patients were included: 41 patients pathologically positive and 5 pathologically negative for diaphragmatic metastasis. The rates of metastasis to the lymph node (95.8% vs 20%, P = 0.001) and metastasis to the peritoneum except for the diaphragm (97.6% vs 60.0%, P = 0.028) were significantly increased in group A compared with group B. However, no significant differences between the 2 groups were found for rates of histological subtypes (high-grade serous or non-high-grade serous), the presence of ascites, the presence of malignant ascites, exposure of cancer cells on the ovarian surface, blood vascular invasion in the primary lesion, and lymphovascular invasion in the primary lesion. Our study demonstrated that metastasis to the lymph node and nondiaphragmatic metastasis to the peritoneum are significantly associated with metastasis to the diaphragmatic peritoneum, indicating that these factors may be pathological predictors of diaphragmatic metastasis in patients with ovarian cancer. However, as the data available are not sufficient to demonstrate the predictive power of these factors, a further comprehensive, large-scale study should be performed.
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Affiliation(s)
- Takeshi Nagai
- From the Department of Anatomic Pathology (TN, HO, TN); Department of Obstetrics and Gynecology, Tokyo Medical University, Tokyo (YS, FT); Department of Biostatics and Epidemiology, Yokohama City University Graduate School of Medicine, Kanagawa, Japan (KS)
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Bex A. Integrating metastasectomy and stereotactic radiosurgery in the treatment of metastatic renal cell carcinoma. EJC Suppl 2015. [PMID: 26217128 PMCID: PMC4041303 DOI: 10.1016/j.ejcsup.2013.07.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Axel Bex
- The Netherlands Cancer Institute, Department of Urology, Amsterdam, The Netherlands
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Oshiro H, Osaka Y, Tachibana S, Aoki T, Tsuchiya T, Nagao T. Retrograde Lymphatic Spread of Esophageal Cancer: A Case Report. Medicine (Baltimore) 2015; 94:e1139. [PMID: 26166121 PMCID: PMC4504565 DOI: 10.1097/md.0000000000001139] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The concept of the retrograde lymphatic spread of cancer cells appears to account for a subset of the essential mechanisms of cancer metastasis in various organs. However, no adequate data currently exist to illustrate the pathology of the retrograde lymphatic metastasis of cancer cells in human bodies. To shed light on this phenomenon, we report a case of a 63-year-old Japanese man who underwent an esophagectomy and lymph node dissection for early-stage esophageal cancer.The patient's clinical information was evaluated by board-certified surgeons and internists. Surgically excised materials were histopathologically evaluated by attending pathologists.Postoperative pathological examination revealed that the patient's tumor was a well-differentiated squamous cell carcinoma with negative surgical margins (T1N0M0, stage I). Apart from the primary lesion, a single lymphatic vessel invasion was found between the lamina propria and lamina muscularis of the esophagus where intralymphatic cancer cells had spread against the direction of backflow prevention valves and skipped beyond these valves without destroying them.The present case demonstrated that the retrograde lymphatic spread of cancer cells can occur in valve-equipped lymphatic vessels. Our study may not only provide a scientific basis for the concept of retrograde lymphatic metastasis but also explain a portion of the complexities associated with the lymphogenous metastasis of esophageal cancer.
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Affiliation(s)
- Hisashi Oshiro
- From the Departments of Anatomic Pathology (HO, TN), Gastrointestinal and Pediatric Surgery (YO, ST), and Gastroenterology and Hepatology (TA, TT), Tokyo Medical University, Tokyo, Japan
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Abstract
Adrenal gland metastases are common in lung cancer. It is well recognized that aggressive treatment of solitary adrenal metastases leads to improved outcomes but the exact nature of adrenal deposits is not well understood. Controversy exists as to the routing of cancer cells to the adrenal gland with some believing that this transmission is lymphatic, in contrast to the more generally accepted theory of hematogenous spread. Recently published mathematical modeling of cancer progression strongly supports the lymphatic theory. With that in mind, we performed a literature review to look for biological plausibility of simulation results and believe that evidence supports the contention that metastases to the adrenal gland can be routed by means of lymphatic channels. This could explain improved survival for patients in whom solitary adrenal metastases are managed aggressively with surgical or radiation modalities. We are calling for clinical trials prospectively testing this hypothesis.
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Dabestani S, Bex A. Metastasectomy. KIDNEY CANCER 2015. [DOI: 10.1007/978-3-319-17903-2_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Riquet M, Mordant P, Pricopi C, Achour K, Le Pimpec Barthes F. [Anatomy, micro-anatomy and physiology of the lymphatics of the lungs and chest wall]. REVUE DE PNEUMOLOGIE CLINIQUE 2013; 69:102-110. [PMID: 23523433 DOI: 10.1016/j.pneumo.2012.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 12/09/2012] [Indexed: 06/02/2023]
Abstract
The thoracic lymphatic vessels are pulsating channels which drain actively the fluid of lung parenchyma interstitium and pleural cavities. Their unidirectional valves that avoid reflux of contents, direct the current of fluid to the connection of thoracic duct to subclavian vein or to the thoracic duct itself by these pulsations. The ascending parietal and visceral currents have anastomoses between them. The parietal currents (internal thoracic anteriorly, external axillaries in lateral and paravertebral in posterior) drain the lymph of thoracic wall. Pleural cavities and the visceral currents, drain that of lungs and mediastinal organs. The thoracic duct goes upward in the posterior mediastinum and usually connects to the venous confluent of the left subclavian vein. It receives a part of thoracic lymph and also drains the lymph of trunk and inferior limbs. About a half or two thirds of thoracic duct lymph is originated from liver and intestines. The intestines have the lymph of digestion with the fatty elements, i.e., the chyle.
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Affiliation(s)
- M Riquet
- Service de Chirurgie Thoracique, Hôpital Européen Georges-Pompidou, 20-40, rue Leblanc, 75015 Paris, France.
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Brotons ML, Bolca C, Fréchette E, Deslauriers J. Anatomy and physiology of the thoracic lymphatic system. Thorac Surg Clin 2013; 22:139-53. [PMID: 22520281 DOI: 10.1016/j.thorsurg.2011.12.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The thoracic lymphatic system is one of the most complex and poorly understood systems of the human body, and much is still to be learned, especially in lymphatic physiology. Knowledge of the normal anatomy of this system as well as of its variations is nevertheless important for thoracic surgeons investigating and treating patients with lung or esophageal neoplasms.
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Affiliation(s)
- Matias Losano Brotons
- Department of Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ), 2725 Chemin Sainte-Foy, Quebec City, Quebec G1V 4G5, Canada
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37
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Negrini D, Moriondo A. Pleural function and lymphatics. Acta Physiol (Oxf) 2013; 207:244-59. [PMID: 23009260 DOI: 10.1111/apha.12016] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 07/24/2012] [Accepted: 09/17/2012] [Indexed: 11/26/2022]
Abstract
The pleural space plays an important role in respiratory function as the negative intrapleural pressure regimen ensures lung expansion and in the mean time maintains the tight mechanical coupling between the lung and the chest wall. The efficiency of the lung-chest wall coupling depends upon pleural liquid volume, which in turn reflects the balance between the filtration of fluid into and its egress out of the cavity. While filtration occurs through a single mechanism passively driving fluid from the interstitium of the parietal pleura into the cavity, several mechanisms may co-operate to remove pleural fluid. Among these, the pleural lymphatic system emerges as the most important one in quantitative terms and the only one able to cope with variable pleural fluid volume and drainage requirements. In this review, we present a detailed account of the actual knowledge on: (a) the complex morphology of the pleural lymphatic system, (b) the mechanism supporting pleural lymph formation and propulsion, (c) the dependence of pleural lymphatic function upon local tissue mechanics and (d) the effect of lymphatic inefficiency in the development of clinically severe pleural and, more in general, respiratory pathologies.
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Affiliation(s)
- D. Negrini
- Department of Surgical and Morphological Sciences; University of Insubria; Varese; Italy
| | - A. Moriondo
- Department of Surgical and Morphological Sciences; University of Insubria; Varese; Italy
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38
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Jeon JS, Ryu HG, Lee H, Yoo DH. Chylopericardial Tamponade in a Patient with Chylothorax after Pulmonary Lobectomy. Korean J Crit Care Med 2013. [DOI: 10.4266/kjccm.2013.28.4.327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Jin Sue Jeon
- Department of Neurosurgery, Seoul University Hospital, Seoul University College of Medicine, Seoul, Korea
| | - Ho Geol Ryu
- Department of Anesthesiology and Pain Medicine, Seoul University Hospital, Seoul University College of Medicine, Seoul, Korea
| | - Hannah Lee
- Department of Anesthesiology and Pain Medicine, Seoul University Hospital, Seoul University College of Medicine, Seoul, Korea
| | - Da Hye Yoo
- Department of Anesthesiology and Pain Medicine, Seoul University Hospital, Seoul University College of Medicine, Seoul, Korea
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Early repair of large infant ventricular septal defect despite respiratory syncytial virus-induced respiratory failure with postrepair chylous pericardial effusion requiring pleuropericardial window: a case report and review of the literature. Pediatr Emerg Care 2012; 28:1072-7. [PMID: 23034497 DOI: 10.1097/pec.0b013e31826cedc6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The surgical correction of congenital cardiac lesions that are complicated by intercurrent respiratory syncytial virus (RSV) pneumonitis has traditionally been deferred for at least 6 to 8 weeks. The presumption is that using cardiopulmonary bypass will increase the risk of postoperative pulmonary complications. We present an infant who developed acute respiratory failure related to RSV pneumonitis and required urgent mechanical ventilation. Cardiac evaluation revealed a large nonrestrictive ventricular septal defect (VSD), aortic arch hypoplasia, normally functioning bicuspid aortic valve, and hemodynamic instability associated with markedly increased pulmonary blood flow. Separation from mechanical ventilation was unsuccessful preoperatively. He underwent VSD repair with cardiopulmonary bypass less than 4 weeks after initial RSV infection. He was extubated successfully within 72 hours of VSD repair. Approximately 6 weeks postoperatively, he developed a circumferential chylous pericardial effusion of unclear etiology--an exceedingly rare complication of VSD repair in early infancy in a non-Down syndrome patient. The chylous effusion was initially managed unsuccessfully with Portogen/Monogen and a percutaneously placed pericardial drain. Two weeks later, he underwent creation of a pleuropericardial window with successful resolution of the chylous effusion. It is of interest to pediatricians to be able to correctly time the repair of congenital heart disease lesions after RSV infection to minimize post-bypass pulmonary complications and yet avoid morbidity from undue delays in repair. In addition, chylopericardium can occur in infants after VSD repair, and dietary modification and catheter drainage may not be adequate.
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Chylopericardial tamponade masquerading as hemopericardium: an uncommon complication of cardiac surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2012; 6:129-32. [PMID: 22437898 DOI: 10.1097/imi.0b013e318216af7e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Chylopericardial tamponade occurs very rarely after heart surgery. It may be the result of lymphatic duct interruption during mammary artery harvest, division of a large thymic remnant, or thrombosis of the subclavian or internal jugular vein by an indwelling central line. Although relatively straightforward when the pericardial aspirate has the usual milky appearance, the correct diagnosis can easily be overlooked particularly early after surgery when the patient is still fasting. We present a case report that illustrates the importance of sending all aspirates for chemical analysis irrespective of their color to arrive at the correct diagnosis and institute the appropriate medical management of this rare condition.
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41
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Bex A. Metastasectomy. KIDNEY CANCER 2012. [DOI: 10.1007/978-3-642-21858-3_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Abstract
Carinal resection is defined as the resection of tracheo-bronchial bifurcation, with or without lung parenchyma resection. It represents one of the most challenging areas of airway resection and reconstruction, basically due to the variability in the location and extent of the lesions. Main indications for this procedure are primary tumours of the carina or the distal trachea or, more frequently, bronchogenic carcinoma with carinal involvement. Very different approaches and reconstruction techniques have been experimentally and clinically described in the last 50 years, with some corner stone procedures in the history of modern thoracic surgery. Despite many technical and oncological difficulties encountered in this field, encouraging results have been reported in recent series, in particular an excellent 5-year survival rate of 50% in pN0 patients suffering form carinal infiltration form lung cancer. Several aspects of the multimodality approach to neoplastic carinal involvement still remain debatable like radio-chemotherapeutic approach instead of the extremely rare left carinal pneumonectomy as well as the role of induction treatments before embarking in such demanding procedures, according to the -pathological nodal status.
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Affiliation(s)
- Lorenzo Spaggiari
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy
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43
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Riquet M, Berna P, Arame A, Mordant P, Das Neves Pereira JC, Foucault C, Dujon A, Le Pimpec Barthes F. Lung cancer invading the fissure to the adjacent lobe: more a question of spreading mode than a staging problem. Eur J Cardiothorac Surg 2011; 41:1047-51. [DOI: 10.1093/ejcts/ezr143] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
The esophagus spans three body cavities and has no mesentery, continually borrowing or sharing vessels, lymphatics, and nerves with associated organs. However, constant along this path is an intricate mural structure. An understanding of the esophageal wall, its blood supply, lymphatic drainage, and innervation is essential for successful esophageal surgery.
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Affiliation(s)
- Thomas W Rice
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, East 100 Street, Cleveland, OH 44106, USA.
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45
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46
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Tabry IF, Zacharoudis A, Constantini EM. Chylopericardial Tamponade Masquerading as Hemopericardium An Uncommon Complication of Cardiac Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2011. [DOI: 10.1177/155698451100600210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Imad F. Tabry
- Sections of Cardiac Surgery, Fort Lauderdale, FL USA
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47
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Intraoperative sentinel node identification and sampling in clinically node-negative renal cell carcinoma: initial experience in 20 patients. World J Urol 2010; 29:793-9. [DOI: 10.1007/s00345-010-0615-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2010] [Accepted: 11/08/2010] [Indexed: 10/18/2022] Open
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48
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Cui Y. The role of lymphatic vessels in the heart. PATHOPHYSIOLOGY 2010; 17:307-14. [DOI: 10.1016/j.pathophys.2009.07.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Revised: 03/12/2009] [Accepted: 07/08/2009] [Indexed: 10/20/2022] Open
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Bex A, Vermeeren L, de Windt G, Prevoo W, Horenblas S, Olmos RAV. Feasibility of sentinel node detection in renal cell carcinoma: a pilot study. Eur J Nucl Med Mol Imaging 2010; 37:1117-23. [PMID: 20111964 DOI: 10.1007/s00259-009-1359-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Accepted: 12/07/2009] [Indexed: 12/14/2022]
Abstract
PURPOSE Lymphatic drainage from renal cell carcinoma is unpredictable and the therapeutic benefit and extent of lymph node dissection are controversial. We evaluated the feasibility of intratumoural injection of a radiolabelled tracer to image and sample draining lymph nodes in clinically non-metastatic renal cell carcinoma. METHODS Eight patients with cT1-2 cN0 cM0 (<6 cm) renal cell carcinoma prospectively received percutaneous intratumoural injections of (99m)Tc-nanocolloid under ultrasound guidance (0.4 ml, 225 MBq at one to four intratumoural locations depending on tumour size). Lymphoscintigraphy was performed 20 min, 2 h and 4 h after injection. After the delayed images a hybrid SPECT/CT was performed. SPECT was fused with CT to determine the anatomical localization of the sentinel node. Surgery with sampling was performed the following day using a gamma probe and a portable mini gamma camera. RESULTS Eight patients, seven with right-sided renal cell carcinoma, were included with a mean age of 55 years (range: 45-77). The mean tumour size was 4 cm (range: 3.5-6 cm). Six patients had sentinel nodes on scintigraphy (two retrocaval, four interaortocaval, including one hilar) with one extraretroperitoneal location along the internal mammary chain. All nodes could be mapped and sampled. In two patients no drainage was visualized. Renal cell carcinomas were of clear cell subtype with no lymph node metastases. CONCLUSION Sentinel node identification using preoperative and intraoperative imaging to locate and sample the sentinel node at surgery in renal cell carcinoma is feasible. Sentinel node biopsy may clarify the pattern of lymphatic drainage and extent of lymphatic spread which may have diagnostic and therapeutic implications.
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Affiliation(s)
- Axel Bex
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
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50
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Intrathoracic lymph node metastases from extrathoracic carcinoma: the place for surgery. Ann Thorac Surg 2009; 88:200-5. [PMID: 19559225 DOI: 10.1016/j.athoracsur.2009.04.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Revised: 03/31/2009] [Accepted: 04/01/2009] [Indexed: 11/24/2022]
Abstract
BACKGROUND Intrathoracic hilar or mediastinal lymph node metastases (HMLNMs) of extrathoracic carcinomas are infrequent. Their treatment strategy is not established and their prognosis poorly known. We reviewed the place of surgical intervention in their management. METHODS Among 565 patients with mediastinal lymph node enlargement, 37 had a history of extrathoracic carcinoma. The enlargement consisted in HMLNMs in 26 (15 men, 11 women), with a mean age of 57.6 (range 19-78) years. Surgical procedures were reviewed. RESULTS Diagnostic procedures, comprising mediastinoscopy in 9, anterior mediastinotomy in 2, and video-assisted thoracic surgery (VATS) in 4, were performed mainly because of unresectability due to diffuse and bilateral HMLNMs. Cancer location was breast in 6, kidney or prostate in 2 each, and bladder, rectum, testis, melanoma, and larynx in 1 each. Median survival was 21 months. Resection was performed in 11 patients, comprising posterolateral thoracotomy in 6, muscle sparing thoracotomy in 2, and VATS in 3. Seventeen involved LN stations were removed; of these, primary were kidney in 3, testis or thyroid in 2 each, and larynx, nasopharynx, and intestinum in 1 each. Five-year survival was 41.6% (median, 45 months). CONCLUSIONS HMLNMs of extrathoracic carcinoma may be isolated, probably in the context of a particular lymphatic mode of spread. Our experience demonstrates that operation is mainly diagnostic but resection may safely achieve local control of the disease and deserves being advocated in patients with isolated and resectable HMLNMs.
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