1/16. Gastrojejunal interposition for esophageal replacement.The main considerations in replacing the esophagus are to avoid postoperative necrosis of all or part of the graft, leakage or stenosis of the anastomoses, and complications related to acid-peptic or alkaline reflux. A 5-year-old boy, after two unsuccessful thoracic operations for atresia and then stenosis of the esophagus, underwent resection of the esophagus because of duodeno-gastroesophageal reflux. The continuity of the alimentary tract was restored by gastrojejunal interposition. We recommend this method of reconstruction when the esophago-gastrostoma is created in the chest, and the possibility of alkaline reflux must be considered.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
2/16. Stridor in a 6-week-old infant caused by right aortic arch with aberrant left subclavian artery.BACKGROUND: Persistent infant stridor, seal-like cough, and difficulty feeding can be the initial signs of right aortic arch with an aberrant left subclavian artery. This congenital cardiovascular abnormality results in the development of a vascular ring that encircles the trachea and esophagus. methods: A case report is presented that describes the evaluation and care of a 6-week-old male infant whose condition was diagnosed as right aortic arch and aberrant left subclavian artery after he was brought to the family practice clinic with a history of persistent stridor. This case report involved a patient seen in the author's outpatient clinic during a well-child check. Data were obtained from the patient's medical record and review of his radiologic diagnostic tests. medline and Index Medicus literature searches were conducted for the years 1966 to the present, using the key words "stridor" and "vascular ring," with cross-references for earlier articles. RESULTS AND CONCLUSIONS: Persistent or recurrent stridor associated with feeding difficulties should prompt an investigation for a vascular ring. In general, an anteroposterior and lateral neck radiograph and a posteroanterior and lateral chest radiograph are usually the initial diagnostic tests to evaluate stridor. Persistent stridor and new-onset regurgitation of formula in a 6-week-old infant prompted an escalation of the patient's workup to include a barium swallow, which subsequently showed compression of the esophagus caused by a vascular ring. In some cases direct observation with a laryngoscope or bronchoscope might be necessary to determine the cause of stridor. Indications for hospitalization of patients with stridor include stridor at rest, dyspnea, actual or suspected epiglottis, repeatedly awakening from sleep with stridor, a history of rapid progression of symptoms, toxic appearance, and apneic or cyanotic episodes. The primary care provider should be familiar with the evaluation and management for patients with the complaint of persistent or recurrent stridor.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
3/16. Esophageal intramural pseudodiverticulosis associated with esophageal perforation.We report a rare case of esophageal intramural pseudodiverticulosis with lower esophageal stricture which perforated into the peritoneal cavity after the patient vomited. A 61-year-old man was admitted with severe chest and epigastric pain after dysphagia and vomiting. Under a diagnosis of upper gastrointestinal perforation, laparotomy was performed. The anterior wall of the abdominal esophagus was found to have ruptured, and proximal gastrectomy with abdominal esophagectomy was performed. Histological examination revealed esophageal intramural pseudodiverticulosis with esophageal stricture distal to the site of rupture, and postoperative endoscopy showed diffuse pseudodiverticulosis in the remaining esophagus. The patient is free of symptoms 5 years after the surgery. This case suggests that careful treatment may be indicated in patients with esophageal intramural pseudodiverticulosis with stricture and elevated intraluminal pressure, to minimize the possibility of severe complications such as esophageal perforation.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
4/16. A large mediastinal tumor with spontaneous regression 30 years after esophageal bypass surgery.We describe the case of an 80-year-old man admitted to the hospital for the first time with chest pain and progressive respiratory difficulty. Radiographic findings of the chest showed a large, cystic mediastinal mass from the jugulum to the diaphragm. The patient's history revealed bypass operation for a benign esophageal stricture 30 years ago. During the hospital stay, clinical symptoms resolved within 48 hours without specific treatment. Seven days after admission a chest roentgenogram showed almost complete regression of the tumor, which was supposed to be a mucocele of the colon bypassing the esophagus.- - - - - - - - - - ranking = 6.9393321440117keywords = chest pain, chest (Clic here for more details about this article) |
5/16. Unusual cause of dysphagia: inflammatory pseudotumor of the lung.Inflammatory pseudotumor (IPT) is a rare disease that usually occurs in the lung. patients with IPT are usually asymptomatic, with a solitary pulmonary nodule or mass detected on routine chest roentgenogram. IPT can behave as a malignant tumor both clinically and radiologically. cough, fever, dyspnea, and hemoptysis are the usual presenting symptoms. This report describes the case of a 37-year-old man with a 4-month course of dysphagia secondary to lower esophageal invasion by the posterior mediastinal extension of a lung IPT.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
6/16. High-grade congenital esophageal stenosis owing to a membranous diaphragm with tracheoesophageal fistula.Gross E-type congenital esophageal atresia associated with congenital esophageal stenosis is extremely rare. In a male infant born at 36 weeks of gestation, bubbly vomiting was noted after birth. X-ray films of the chest and abdomen showed coil-up sign of the nasogastric tube and gas in the stomach and small intestines were recognized, so gross C-type esophageal atresia was suspected and surgery was performed on the first day of life. Surgery revealed the presence of a tracheoesophageal fistula in the upper esophagus and membranous stenosis on the distal side.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
7/16. Dysphagia associated with an aortic arch anomaly in adults.Aortic arch anomalies typically become evident in early childhood with clinical manifestations such as cyanosis and feeding problems. Although uncommon and therefore not often considered, this developmental defect can cause dysphagia in the adult. The double aortic arch is the most common vascular ring in infants. Less well-known vascular rings in the adult are a right aortic arch with constricting left ligamentum arteriosum and an aberrant right subclavian artery. Dysphagia is common secondary to the constriction of the esophagus. Two patients recently presented to the Metropolitan Nashville General Hospital with prolonged history of dysphagia. Studies included barium swallow and aortogram, which showed right aortic arch in both patients with constricting left ligamentum arteriosum. The treatment for these symptomatic anomalies was division and excision of the ligamentum arteriosum and freeing of the esophagus. A right aortic arch on the chest roentgenogram in a patient with dysphagia should suggest a vascular ring as the etiology. If this is suspected, diagnosis is easily made and surgical treatment is effective. The relevant embryology will be discussed.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
8/16. Intrathoracic fundoplication for shortened esophagus. Treacherous solution to a challenging problem.Intrathoracic fundoplication was used in 12 patients with acquired shortening of the esophagus secondary to gastroesophageal reflux. While several patients had excellent results using this approach, five major complications occurred. One patient developed a paraesophageal hernia, while four had ulceration within the wrap itself. One had serious hemorrhage, while another required reoperation to dismantle the intrathoracic wrap. One patient developed a gastrobronchial fistula and eventually died from pulmonary sepsis. The cause of these problems is unknown, but delayed gastric emptying was implicated in two patients. Even though leaving a Nissen fundoplication in the chest seems to be an attractive alternative when the surgeon cannot reduce the wrap below the diaphragm, this alternative is fraught with treacherous complications in a large percentage of patients.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
9/16. Complications of intrathoracic Nissen fundoplication.This report details our experience with 30 patients who had Nissen fundoplication. Six underwent transabdominal Nissen fundoplication, and 10 had transthoracic Collis-Nissen with the gastric wrap in a subdiaphragmatic position. Ten patients had a transthoracic Nissen with the wrap in a supradiaphragmatic position. Four patients had a transthoracic Thal-Nissen procedure. In 1 of 4 patients with a Thal-Nissen procedure, intrathoracic rupture of the stomach with gastro-bronchial fistula developed and necessitated left lower lobectomy. Four of 10 patient in whom the gastric wrap was left in the chest experienced severe complications: in 1 patient a lesser curvature ulcer developed and required hemigastrectomy; 1 patient had herniation of the fundoplication with gastric outlet obstruction and required operation for its correction; 2 patients had intrathoracic rupture of the gastric wrap and ultimately died. The 6 patients with transabdominal Nissen and the 10 with transthoracic Collis-Nissen with wrap placed in the abdomen did well This experience severely condemns the practice of leaving the fundoplication above the diaphragm.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
10/16. Heightened sensitivity of the esophagus to radiation in a patient with AIDS.Esophageal stricture is an uncommon complication in hiv-negative patients treated with radiation to the chest for lung cancer. There have been a number of recent reports on the association of cancer and hiv-positive patients, as well as a greater sensitivity to radiation therapy of the mucous membranes in hiv/AIDS patients. This article reflects a review of the literature on the risk of major complications and morbidity of the esophagus in hiv /AIDS patients whose chests are treated with radiation for lung cancer. Included is a report of a previously unpublished case of an early and severe esophageal reaction to radiation therapy in an AIDS patient.- - - - - - - - - - ranking = 2keywords = chest (Clic here for more details about this article) |
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