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PubMed1986

Rib radiographs for trauma: useful or wasteful?

In trauma to the chest, the clinical impression and the physical findings of rib fractures are nonspecific. Fractures often are not seen on initial films. The principal diagnostic goal should be the detection of significant complications (pneumothorax, hemothorax, major vascular injury, or pulmonary contusion) requiring admission. The therapeutic effort should be to provide pain relief and prevent the delayed development of atelectasis or pneumonia in patients with painful chest wall injuries, whether or not a fracture is detected initially. An upright posteroanterior chest radiograph has the greatest yield in detecting fractures and complications resulting from them. Tomograms and expiratory, oblique, and "coned-down" views should not be done routinely. The use of these more specific examinations may be indicated, however, in such cases as trauma to ribs 1 to 3 or 9 to 12. Their selective use in isolated cases (trauma to ribs 1 to 3 or 9 to 12) and suspected child abuse may indicate the need for these more specific examinations. Because detection of pulmonary complications of chest trauma is most important, a delayed or repeat upright posteroanterior chest radiograph may be the most cost-effective second radiograph. Significant medical care cost savings may be appreciated by limiting the use of specific rib views to instances in which it might influence the patient's therapy.

Adolescent↗
PubMed1988

Ruptured thoracic aneurysm presenting as dyspnea and hypotension.

A 65-year-old woman with a two-day history of progressive back pain presented with acute dyspnea, tachypnea, hypotension, and tachycardia. The patient was being treated for chronic obstructive lung disease and long-standing hypertension. She evidenced unilateral diminished breath sounds and wheezing. A portable chest radiograph in the emergency department revealed a large left pleural effusion. A hemothorax was confirmed by thoracentesis, and a 7-cm descending thoracic aortic aneurysm was demonstrated by angiography. The patient underwent successful surgical resection and Dacron graft repair of the aneurysm. This case emphasizes the need for maintaining a high index of suspicion for atypical presentations of ruptured thoracic aneurysms and for using diagnostic thoracentesis in pleural effusions of unknown etiology.

Aged↗
PubMed1989

Vertical trauma: injuries to patients who fall and land on their feet.

We reviewed the patterns of injuries sustained by 12 consecutive fallers and jumpers in whom primary impact was onto the feet. The fall heights ranged from 20 to 100 ft. The 12 patients sustained 49 significant injuries. Skeletal injuries were most frequent and included 15 lower extremity fractures, four pelvic fractures, and nine spinal fractures. In two patients, paraplegia resulted. Genitourinary tract injuries included bladder hematoma, renal artery transection, and renal contusion. Thoracic injuries included rib fractures, pneumothorax, and hemothorax. Secondary impact resulted in several craniofacial and upper extremity injuries. Chronic neurologic disability and prolonged morbidity were common. One patient died; the patient who fell 100 ft survived. After initial stabilization, survival is possible after falls or jumps from heights as great as 100 feet It is important to recognize the skeletal and internal organs at risk from high-magnitude vertical forces.

Accidental Falls↗
PubMed1989

Post-traumatic pulmonary contusion in children.

We reviewed 35 consecutive cases of post-traumatic pulmonary contusion in children that occurred during a 12-year period. Of these, 19 children (54%) were more than 5 years old, 30 (86%) were involved in motor vehicle accidents, and 29 (83%) had multiple trauma. External thoracic wall contusion, fracture of the bony thorax, tachypnea, hemoptysis, and abnormal breath sounds were frequently absent on presentation. Associated intrathoracic lesions of pleural effusion, pneumothorax, and hemothorax occurred in 20 children (57%) and were particularly prevalent in those with fracture of the bony thorax (93%); the radiographic appearance of these lesions was delayed up to 48 hours in 40% of cases. In 34 children (97%), radiographic evidence of pulmonary contusion was present on admission and did not progress radiographically during hospitalization. No child experienced respiratory deterioration subsequent to presentation or required mechanical ventilation for respiratory insufficiency. Pulmonary contusion in children is usually a consequence of significant-impact injury associated with multiple trauma and has a good prognosis. Despite a paucity of abnormal physical findings, children who sustain high-impact trauma should receive radiographic evaluation of the chest to assess for possible intrathoracic injury. When pulmonary contusion is accompanied by fracture of the bony thorax, serial radiographic evaluation of the chest should be performed during the initial 48 hours of hospitalization.

Adolescent↗
PubMed2003

[Video-assisted lobectomy through the auscultatory triangle for the surgical treatment of bronchopulmonary carcinoma. Preliminary experience].

OBJECTIVE: To describe a technique for video-assisted lobectomy through the auscultatory triangle (VALAT) and to assess early and medium-term outcome of the procedure in patients with non-small cell bronchopulmonary carcinoma in stage I. PATIENTS AND METHOD: Between April 1999 and May 2002 we performed 25 VALAT procedures (24 lobectomies and 1 bilobectomy) in 25 patients with a mean age of 63.6 years (range 39-80). RESULTS: No deaths occurred during or after surgery. Conversion to conventional thoracotomy was necessary in two cases. One patient was re-operated to resolve hemothorax and one developed a bronchopleural fistula that was treated by pleural drainage. The mean hospital stay was 6.3 days. Twenty-three patients have been disease-free throughout a mean follow-up period of 11.5 months (range 1-36). The two-year actuarial survival rate (Kaplan-Meier) was 93% 7%. CONCLUSIONS: VALAT is a safe procedure that nevertheless requires specific training. The rate of complications was low in our patient series and mortality was nil. The outcome for patients with stage I bronchogenic carcinoma over a two-year follow-up period has been comparable to results obtained with conventional thoracotomy.

Adult↗
PubMed1994

[Thoracic traumatism in a specialized unit. Its epidemiology and morbimortality].

Two hundred forty-eight cases of thoracic trauma arriving at our hospital between 1990 and 1992 are analyzed in this report. Injuries were only thoracic in 29% of the cases. The remaining patients presented associated lesions, mainly in the extremities, followed by head injuries. Single or multiple rib fracture, in 193 (77.8%) patients, was the most frequent thoracic injury, followed by 94 (37.6%) cases of hemothorax and 80 (30.2%) instances of pneumothorax. Pulmonary contusion in 57 (22.9%) cases was a serious consequence with a mortality rate of 35.7%. Eighty six (34.6%) chest tube were placed and 14 (5.6%) thoracotomies were performed. Death occurred in 34 (13.7%) cases and was mainly related to the presence of associated injuries, in 29 (16.7%) patients as opposed to 5 (6.9%) (p < 0.05), and to pulmonary contusion in 20 (35.7%) patients vs. 13 (6.8%) (p < 0.001).

Adolescent↗
PubMed1999

Complications of endomyocardial biopsy in children.

OBJECTIVES: To evaluate the incidence of, and risk factors for, complications of endomyocardial biopsy in children. BACKGROUND: Endomyocardial biopsy (EMB) is a low risk procedure in adults, but there is a paucity of data with regard to performing this procedure in children. METHODS: Retrospective review of the morbidity and mortality of 1,000 consecutive EMB procedures. RESULTS: One thousand EMB procedures (right ventricle 986, left ventricle 14) were performed on 194 patients from July 1987 through March 1996. Indications for EMB included heart transplant rejection surveillance (846) and the evaluation of cardiomyopathy or arrhythmia for possible myocarditis (154). Thirty-seven (4%) procedures were performed on patients receiving intravenous inotropic support. There was one biopsy related death, secondary to cardiac perforation, in a two-week-old infant with dilated cardiomyopathy. There were nine perforations of the right ventricle, eight occurring in patients with dilated cardiomyopathy and one in a transplant recipient. The transplant patient did not require immediate intervention; two patients required pericardiocentesis alone, and six underwent pericardiocentesis and surgical intervention. All nine perforations were from the femoral venous approach (p < 0.01). Multivariate analysis demonstrated that the greatest risk of perforation occurred in children being evaluated for possible myocarditis (p = 0.01) and in those requiring inotropic support (p < 0.01). Other complications included arrhythmia (5) and single cases of coronary-cardiac fistula, flail tricuspid leaflet, pneumothorax, hemothorax, endocardial stripping and seizure. CONCLUSIONS: Risk of endomyocardial biopsy is highest in sick children with suspected myocarditis on inotropic support. However, EMB can be performed safely with very low morbidity in pediatric heart transplant recipients.

Adolescent↗
PubMed2001

Efficacy of follow-up evaluation in penetrating thoracic injuries: 3- vs. 6-hour radiographs of the chest.

Pneumothorax (PTX) in patients with penetrating thoracic trauma is routinely ruled out with serial chest radiographs (CXRs). This study examined the efficacy of a shortened time period between initial and follow-up radiographs. Patients with penetrating torso injuries treated at a Level-1 trauma center received a CXR during their initial evaluation. If no pneumothorax or hemothorax was noted, and the patient did not require immediate admission to the Intensive Care Unit or operating room, a repeat chest film was taken at 3 and 6 h. Findings were treated as clinically indicated, and patients were discharged home if the last radiograph revealed no evidence of pathology. Over a 15-month period, 116 patients were evaluated for penetrating thoracic injuries (93 stabbings, 23 gunshot wounds) and had no pneumothorax detected on initial CXR. Two patients had pneumothorax detectable only by computed tomography. One patient had a normal initial CXR, but developed a PTX on the 3-h film, requiring tube thoracostomy. No patients developed a PTX on the 6-h study that was not present on the initial or 3-h CXR. In conclusion, extending the time between initial and final CXRs to 6 h in patients with penetrating thoracic trauma provided no additional information that was not available on the 3-h film.

Follow-Up Studies↗
PubMedDate not supplied

Stab wound to the chest with acute pericardial tamponade.

A 21-year-old male presented to the trauma unit after he was stabbed once with a knife in the left anterior chest. The patient was awake and combative, very intoxicated, with a systolic blood pressure of 90 mmHg by palpation and a heart rate of 110 beats per min. Physical examination revealed distended neck veins, a single 1.5 cm stab wound to the left parasternal area at the third ICS (noted by clip on x-ray, Fig. 1), poorly auscultated heart sounds, and palpable femoral pulses that went away with inspiration. Chest radiograph (Fig. 1) showed a "pear-shaped" cardiac silhouette, though not markedly enlarged, and a significant left hemothorax. A diagnosis of acute pericardial tamponade was made, and the patient was taken immediately to the operating room for thoracotomy and successful repair of a stab wound of the right ventricle. Figure 2 (courtesy of Richard Wolfe, MD, Massachusetts General Hospital, Boston, MA) presents an example of an echocardiogram depicting a pericardial effusion. Pericardial fluid is imaged as a black (hypoechoic) crescent area separating the apex of the heart from the pericardium, seen as a white ring (arrow) at the inferior aspect of the scan. Tamponade is defined sonographically as the presence of both pericardial effusion (PE) and diastolic collapse of the right ventricle. Figure 3 (courtesy of Michael H. Picard, MD, of Harvard Medical School, Boston, MA) demonstrates the collapse of the right ventricular outflow track (RVOT) and its position relative to the left ventricle (LV), the left atrium (LA), and the aortic valve (AV).

Adult↗
PubMed1996

Upper dorsal thoracoscopic sympathectomy for palmar hyperhidrosis: improved intermediate-term results.

PURPOSE: The purpose of this study was to examine the immediate and mid-term results of thoracoscopic upper dorsal (T2-T3) sympathectomy for primary palmar hyperhidrosis. METHODS: From June 1993 to October 1994 we performed 106 sympathectomies on 53 patients with palmar hyperhidrosis. Thirty-four female patients and 19 male patients ranging in age from 15 to 44 years, (mean 23.1 years) were studied. Both sides were operated during the same surgical procedure. The T2-T3 ganglia were resected by electrocuting with a hook and were removed for histologic examination. Follow-up for a mean of 19.25 months was obtained on 52 patients (104 operated limbs). RESULTS: All limbs were completely dry at the end of the procedure, and hyperhidrosis did not recur during the whole follow-up period. Short-term postoperative complications (mainly atelectasis, pneumonia, pneumothorax, and hemothorax) occurred in six (11.3%) patients. Long-term sequelae were observed in 43 (81.1%) patients and included Horner's syndrome (9 patients, 17.3%, one side only in each patient), neuralgia (7 patients, 13.5%), and compensatory hyperhidrosis (35 patients, 67.3%). These sequelae were not permanent in all cases, and the degree of severity was variable. Six (11.5%) patients, three of whom regretted being operated, were dissatisfied with their results: one because of Horner's syndrome, one because of persisting neuralgia, and four because of compensatory sweating. CONCLUSIONS: Despite the large number of postoperative long-term sequelae, 88.5% of patients expressed subjective satisfaction from the procedure. Obtaining 100% of dry hands on mid-term follow-up makes this approach rewarding.

Adolescent↗
PubMed2006

[Surgical treatment of pulmonary aspergilloma. 278 cases].

STUDY OBJECTIVES: The purpose of this study was to report the results of surgical treatment of pulmonary aspergilloma in 278 consecutive patients in a hospital using surgical treatment systematically when possible to avoid potentially fatal bleeding. METHODS: Diagnosis required morphological assessment as well as testing of sputum and blood samples. Preoperative studies also included pulmonary function tests for all patients. Surgical intervention was systematic, for treatment or diagnostic purposes. The incision of choice was a standard posterolateral thoracotomy via the 5th intercostal space. Mycological examination of the parenchymatous cavity confirmed the diagnosis. Immediate postoperative surveillance depended on clinical, radiologic, and laboratory findings as well as pleural drainage. Postoperative clinical and radiographic follow-up took place during the first month, the third month and then every 6 months. RESULTS: Between 1982 and 2004, our thoracic surgery department saw 320 cases of pulmonary aspergilloma. In all, 278 patients (161 men and 117 women) underwent pulmonary resection. The mean age was 32 years (range: 16-70 years). The principal underlying disease was tuberculosis (73%), and the most common symptom hemoptysis (83%). Treatment was exclusively surgical in all patients, and there were 279 resections because one patient had staged bilateral segmentectomy. Resections included 130 lobectomies, 51 segmentectomies, 45 pneumonectomies, 33 lobectomies with segmentectomy, 17 bilobectomies and 3 thoracoplasties. There were 16 postoperative deaths (5.7%), 14 of them in patients who had undergone pneumonectomy. Postoperative complications included empyema (12.5%), incomplete reexpansion (9.3%), postoperative bleeding (5%), respiratory infections (4.6%), respiratory failure (4%), bronchial fistula (2.5%) and wound infections (2%). 12 patients had further surgery: 3 for hemothorax, 2 for empyema and 4 for secondary thoracoplasty. The postoperative course was uneventful for 54.1% of cases. CONCLUSION: Surgery for pulmonary aspergilloma is difficult and dangerous. It nonetheless remains the treatment of choice of this opportunistic pulmonary mycosis, despite the high risk of postoperative morbidity and mortality.

Adolescent↗
PubMed2006

Cardiac tamponade in a patient with moderate hemophilia A and factor VIII Inhibitors.

Cardiac tamponade is a rare, life-threatening complication of hemophilia. The management of pericardial bleeding in hemophilia A patients with inhibitors is particularly challenging because antibodies to factor (F) VIII render the use of high-dose FVIII ineffective. Fortunately, the management of uncontrollable bleeding in patients with hemophilia and inhibitors has improved since the introduction of treatments that bypass the need for FVIII and FIX. A case of hemopericardium complicated by cardiac tamponade occurring one month following an upper respiratory tract infection in a patient with hemophilia and FVIII inhibitors is presented. Management of the present case was based on current guidelines on the use of recombinant FVIIa for acute bleeding in patients with hemophilia and inhibitors. The subsequent development of hemothorax in the present case indicates that a more protracted course of recombinant FVIIa is justified following pericardiocentesis for pericardial bleeding in hemophilia with inhibitors. Alternative approaches to the management of this complication are also reviewed.

Cardiac Tamponade↗
PubMed2003

A comprehensive analysis of traumatic rib fractures: morbidity, mortality and management.

OBJECTIVE: A rib fracture secondary to blunt thoracic trauma is an important indicator of the severity of the trauma. In the present study we explored the morbidity and mortality rates and the management following rib fractures. METHODS: Between May 1999 and May 2001, 1417 cases who presented to our clinic for thoracic trauma were reviewed retrospectively. Five hundred and forty-eight (38.7%) of the cases had rib fracture. There were 331 males and 217 females, with an overall mean age of 43 years (range: 5-78 years). These patients were allocated into groups according to their ages, the number of fractured ribs and status, i.e. whether they were stable or unstable (flail chest). RESULTS: The etiology of the trauma included road traffic accidents in 330 cases, falls in 122, assault in 54, and industrial accidents in 42 cases. Pulmonary complications such as pneumothorax (37.2%), hemothorax (26.8%), hemo-pneumothorax (15.3%), pulmonary contusion (17.2%), flail chest (5.8%) and isolated subcutaneous emphysema (2.2%) were noted. 40.1% of the cases with rib fracture were treated in intensive care units. The mean duration of their stay in the intensive care unit was 11.8+/-6.2 days. 42.8% of the cases were treated in the wards whereby their mean duration of hospital stay was 4.5+/-3.4 days, while 17.1% of the cases were followed up in the outpatient clinic. Twenty-seven patients required surgery. Mortality rate was calculated as 5.7% (n=31). CONCLUSIONS: Rib fractures can be interpreted as signs of significant trauma. The greater the number of fractured ribs, the higher the mortality and morbidity rates. Patients with isolated rib fractures should be hospitalized if the number of fractured ribs is three or more. We also advocate that elderly patients with six or more fractured ribs should be treated in intensive care units due to high morbidity and mortality.

Accidental Falls↗
PubMed1996

Surgical treatment of spontaneous pneumothorax by wedge resection without pleurodesis or pleurectomy.

OBJECTIVE: Evaluation of wedge resection of the lung without pleurodesis or pleurectomy as a method of surgical treatment for spontaneous pneumothorax in terms of complications, recurrence rate and postoperative complaints. METHODS: Retrospective study of 132 operations for spontaneous pneumothorax in 120 patients (84 men and 36 women: mean age 34 years, range 14-77) performed between 1974 and 1993. The mean observation time was 84 months (range 6-229) and a 100% follow-up rate of all survivors (97%) was achieved. RESULTS: The indications for surgery were recurrent pneumothorax (52%), persisting air leak during first episode (45%), or hemothorax (3%). Perioperative findings were single bullous disease (86%), 2-3 bullae (6%), diffuse bullous disease (5%) and no bullous disease in 3% of the cases. The overall complication rate was 16% (30-day mortality 1%, reoperation for postoperative bleeding 2%, bronchopneumonia 8%, new pneumothorax during hospital stay 5%). The late recurrence rate (operated lung) was 5%. All recurrences were successfully treated by drainage (n = 3), exsufflation (n = 1) or observation only (n = 3). Reoperation was not necessary. Thirty-seven percent of the patients had postoperative complaints which they associated with the operation. CONCLUSION: Lung resection without pleurodesis or pleurectomy is a simple, safe and effective method of the surgical treatment of spontaneous pneumothorax in terms of complications and recurrence rate in patients with limited bullous disease.

Adolescent↗
PubMed1999

Complications in the native lung after single lung transplantation.

OBJECTIVES: Single lung transplantation is a viable option for patients with end-stage pulmonary disease; despite encouraging results, we observed serious complications arising in the native lung. We retrospectively reviewed 36 single lung transplants to evaluate the incidence of complications arising in the native lung, their treatment and outcome. METHODS: Between 1991 and 1997, 35 patients received 36 single lung transplants for emphysema (16), pulmonary fibrosis (14), lymphangioleiomyomatosis (4), primary pulmonary hypertension (1) and bronchiolitis obliterans (1). The clinical records were reviewed and the complications related to the native lung were divided into early (up to 6 weeks after the transplant) and late complications. RESULTS: Nineteen complications occurred in 18 patients (50%), leading to death in nine (25%). Early complications (within 6 weeks from the transplant) were bacterial pneumonia (1), overinflation (3), retention of secretions with bronchial obstruction and atelectasis (1), hemothorax (1), pneumothorax (1) and invasive aspergillosis (3); one patient showed active tuberculosis at the time of transplantation. Two patients developed bacterial pneumonia and invasive aspergillosis leading to sepsis and death. The other complications were treated with separate lung ventilation (1), bronchoscopic clearance (1), chest tube drainage (1) and wedge resection and pleurodesis (mechanical) by VATS (1). One patient with hyperinflation of the native lung eventually required pneumonectomy and died of sepsis. The patient with active tuberculosis is alive and well after 9 months of medical treatment. Late complications were recurrent pneumothorax (4), progressive overinflation with functional deterioration (2), aspergillosis (1) and pulmonary nocardiosis (1). Recurrent pneumothorax was treated with chest tube drainage alone (1), thoracoscopic wedge resection and/or pleurodesis (2) and pneumonectomy (1); hyperinflation was treated with thoracoscopic lung volume reduction in both cases; both patients with late infectious complications died. CONCLUSIONS: After single lung transplantation, the native lung can be the source of serious problems. Early and late infectious complications generally result in a fatal outcome; the other complications can be successfully treated in most cases, even if surgery is required.

Adolescent↗
PubMed2004

The management of asymptomatic congenital lung malformations.

Congenital Pulmonary Airway Malformation (CPAM) and lung sequestration are often discovered on routine prenatal sonography. While some lesions may be large and cause serious complications in the fetus or newborn, many will be asymptomatic at birth. Some authors advocate simple observation because of the lack of data on the incidence of long-term complications. However, there are very few described cases where CPAM and intralobar sequestration (ILS) have remained asymptomatic throughout life; complications eventually develop in virtually all patients. The most common complication is pneumonia, which may respond poorly to medical treatment. Other complications include the development of malignancies (carcinomas and pleuropulmonary blastomas), pneumothorax and hemoptysis or hemothorax. Since lung resection will be required sooner or later for CPAM and ILS, it is best not to wait for complications to occur. We recommend surgery at 3 to 6 months of life at the latest, to allow compensatory lung growth to occur. At this age the postoperative course is usually smooth and long-term follow- up has shown normal respiratory function. The management of small non- communicating extralobar sequestrations is more controversial; it is known that these can remain asymptomatic throughout life but complications may develop and they are sometimes difficult to differentiate from neuroblastoma.

Cystic Adenomatoid Malformation of Lung, Congenita↗
PubMed2004

[Thoracoscopic sympathectomy for palmar hyperhidrosis. Immediate results and postoperative quality of life].

OBJECTIVE: Primary palmar hyperhidrosis is a socially and occupationally debilitating disorder characterized by excessive sweating. The purpose of this study was to evaluate the results, complications, and degree of satisfaction among patients who underwent video-assisted bilateral thoracoscopic sympathectomy of the second and third ganglia (T2-T3) to treat primary palmar hyperhidrosis at the Department of General and Thoracic Surgery of the Hospital Universitario Virgen Macarena in Seville, Spain. MATERIAL AND METHOD: A study of 226 thoracoscopic sympathectomies was undertaken based on case histories and a prospective pre- and postoperative questionnaire survey. The sample was composed of 113 patients (47 males and 66 females), ranging in age from 14 to 50 years, with primary palmar and axillary hyperhidrosis, in some cases severe. Bilateral video-assisted thoracoscopic T2-T3 sympathectomy was performed under general anesthesia in all cases. Follow up included a questionnaire on pre- and postoperative quality of life and degree of satisfaction. Descriptive statistics on the surgical procedure, quality of life, and postoperative changes were compiled and frequency analyzed. A nonparametric Wilcoxon test for paired variables was performed to contrast significant differences between pre- and postoperative quality of life related to hyperhidrosis and its complications. RESULTS: The therapeutic success rate was 100%. Complications were seen in 14.2% of the cases and included hemothorax in two, hemopneumothorax in three, pleural hemorrhage in two, and minimal apical airspace in nine. Of the 106 patients who were monitored over a period of 6 to 12 months through follow-up interviews and questionnaires, 67% developed compensatory sweating, 95% reported improvement in quality of life, and 4% experienced no change in quality of life, mainly because of the emergence of compensatory sweating. Of the patients interviewed, 97.2% said that they would undergo the operation again. CONCLUSION: Video-assisted thoracoscopic sympathectomy for the treatment of primary palmar hyperhidrosis is effective, with low rates of morbidity and no mortality. Despite the appearance of postoperative changes such as compensatory sweating, patient satisfaction with the procedure is high and their quality of life improves.

Adolescent↗
PubMed2004

[Video-assisted thoracoscopic surgery in 3 cases of adult cystic adenomatoid malformation].

Congenital cystic adenomatoid malformation involving the lung is a rare hamartomatous condition that is usually diagnosed in the neonatal period. The presentation of this malformation in older patients is exceptional and usually manifests in a series of recurrent lung infections affecting a single lobe or segment. The treatment of choice is complete surgical exeresis. This report of 3 cases of late presentation focuses on the surgical approach used and the unusual manifestation of recurrent spontaneous pneumothoraces in 1 patient. The patients were females aged 15, 16, and 25 years with histories of various respiratory diseases (extrinsic asthma, recurrent pneumonias, and pneumothoraces). The patients were referred to us for surgery with suspected diagnoses that were different from the final diagnoses in all cases. All underwent diagnostic video-assisted thoracoscopy to explore the affected hemothorax, and definitive treatment was possible during the procedure for 2 patients (a lobectomy and an atypical segmentectomy) by video-assisted surgery. The third patient underwent lobectomy by lateral thoracotomy after exploratory video-assisted thoracoscopy. Short- and long-term outcomes were excellent for all 3 patients.

Adolescent↗