UNASSIGNED: Chest wall resection and reconstruction procedures carry high postoperative morbidity. Therefore, successful outcomes necessitate prevention, prompt identification, and appropriate management of ensuing complications. This narrative review aims to provide a comprehensive overview of evidence-based strategies for managing complications following chest wall resection and reconstruction.
UNASSIGNED: A literature search was conducted using the PubMed database for relevant English-language studies published since 1980.
UNASSIGNED: Complications following chest wall resection and reconstruction can be broadly classified into surgical site-related, respiratory, or other systemic complications. Surgical site and respiratory complications are the most common, with reported incidence rates of approximately 40% across some series. Predisposing factors for respiratory morbidity include greater numbers of resected ribs and concurrent pulmonary lobectomy. Definitive correlations between specific prosthetic materials and complications remain elusive. Management should be tailored to the type and severity of the complication, surgical variables, and patient factors. Specific approaches for managing common complications are discussed in detail. Emerging preventive approaches, such as minimally invasive surgical techniques, are also briefly highlighted to help guide future research.
UNASSIGNED: An emphasis on anticipating and judiciously managing complications of chest wall resection and reconstruction, alongside a coordinated multidisciplinary approach, can optimize outcomes for patients undergoing this intrinsically complex surgery.

UNASSIGNED: What is the best material in the case of prosthesis used to replace major chest wall resection is still unknown. We reviewed most significant literature focused on the type of prosthetic materials available by highlighting their relative pros and cons.
UNASSIGNED: We reviewed most significant articles, including clinical results of relevant case series (retrospective studies), published in English in the last 23 years: PubMed, Embase and Scopus databases were used in our search in the period between the 1st January 1999 and 31st December 2022.
UNASSIGNED: Overall, our literature review revealed lack of uniformity or conformity in the surgical strategies described for chest wall reconstruction with no internationally accepted standard in terms of decisions and optimal prosthetic materials and type of prostheses (soft, rigid, biological). Despite the increased interest in chest wall reconstruction, we observed a general lack of substantial prospective and multicentric studies. Likewise, there are not substantial data which may guide to the choice of optimal prosthetics in terms of characteristics and biocompatibility.
UNASSIGNED: A variety of materials are available for reconstruction, including synthetic and biological meshes, flexible and rigid patches, and metal osteosynthesis systems. The material chosen should be optimized to each patient and damaged tissues to be restored. Prospective and multicentric studies are necessary to address current limits in this surgical field.

BACKGROUND: Undifferentiated pleomorphic sarcoma (UPS) accounts for approximately 15% of all soft-tissue sarcoma (STS) cases and have a 5-year survival prognosis of around 60%. Due to its complexity, tumors are often identified by clinical and pathological exclusion. UPS is commonly found in the extremities, so finding them in the trunk and chest wall is rare. The primary objectives of this systematic review are: (I) identifying patient characteristics with lesion; (II) compiling patient outcomes following surgery; (III) identifying best therapy modalities; (IV) characterizing reported lesion histology; (V) assessing current surgical recommendations for resection; (VI) classifying lesions and their association with radiation.
METHODS: The PRISMA framework was utilized to identify case reports and records providing information on UPS in the chest wall. Case reports and articles were screened for relevance, full-text accessibility, and if they contained the terms (\"undifferentiated pleomorphic sarcoma\", \"breast\", \"chest wall\", or \"trunk\") in their title or abstract. The PubMed database was the primary database, and the search criteria was \"(undifferentiated pleomorphic sarcoma) AND ((breast) OR (trunk) OR (chest) OR (chest wall))\" from 01/01/2003 to 05/21/2023. Given that these were case reports, bias risk and heterogeneity was not assessed due to its difficulty. Information from case reports were compiled into a table and a Chi-squared test was performed, but no meta-analysis was completed.
RESULTS: Of 433 studies, 24 case reports and 22 records were selected to inform on UPS in the chest wall. The 24 case reports yielded 32 cases providing information on patient outcomes, tumor characteristics, and treatment. A meta-analysis was not performed, but literature was summarized to inform on treating the condition. Case reports were compiled into a table providing information on patient age, gender, tumor location, treatment modalities, margin distance, and other factors.
CONCLUSIONS: Treatment of UPS involving the chest is extremely complex. Unlike typical UPS, it is more often found in women than in men, which is corroborated by the results of this study. This study also notes no difference in recurrence or metastasis between patient who were treated and those who were not treated with other therapies.

暂无摘要。

Subcutaneous metastasis from esophageal cancer (EC), particularly to the chest wall, is a very rare phenomenon. The present study describes a case of gastroesophageal adenocarcinoma that metastasized to the chest wall, invading the fourth anterior rib. A 70-year-old female presented with acute chest pain 4 months after undergoing Ivor-Lewis esophagectomy for gastroesophageal adenocarcinoma. A chest ultrasound revealed a solid hypoechoic mass on the right side of the chest. A contrast-enhanced computed tomography scan of the chest revealed a destructive mass on the right anterior fourth rib (7.5x5 cm). Fine needle aspiration revealed a metastatic moderately differentiated adenocarcinoma to the chest wall. Fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography revealed a large FDG avid deposit on the right side of the chest wall. Under general anesthesia, a right-side anterior chest incision was made and the second, third and fourth ribs were resected with overlying soft tissues, including the pectoralis muscle and overlying skin. The histopathological examination confirmed a metastasized gastroesophageal adenocarcinoma to the chest wall. There are two common assumptions regarding chest wall metastasis from EC. The first one states that this metastasis can occur due to the implantation of the carcinoma during tumor resection. The latter supports the notion of tumor cell dissemination along the esophageal lymphatic and hematogenous systems. Chest wall metastasis from EC invading ribs is an extremely rare incident. However, its likelihood of occurrence should not be neglected following primary cancer treatment.

Hepatocellular carcinoma (HCC) is associated with an aggressive behavior and a strong tendency for extrahepatic metastasis. Although 5%-15% patients have metastases at diagnosis, presentation with symptoms exclusively related to extrahepatic metastases is rare. An 82-year-old male presented with an isolated left anterolateral chest wall swelling. Ultrasonography revealed a soft tissue mass involving the anterior chest wall with adjacent rib erosion. Serum protein electrophoresis showed increase in beta-2 region. A clinical diagnosis of multiple myeloma was considered. Fine needle aspiration cytology from the swelling showed loosely cohesive clusters of polygonal cells with traversing blood vessels. Cells showed abundant vacuolated to granular cytoplasm, round nuclei with frequent intranuclear cytoplasmic inclusions. A differential of metastatic HCC and renal cell carcinoma was considered. Subsequent imaging showed a 12 cm mass in the liver. Biopsy from chest wall mass with immunohistochemistry confirmed the diagnosis. Lungs and lymph nodes are the commonest sites for metastatic HCC; presentation as chest wall metastasis is rarely reported. The classical cytomorphology of HCC proved useful in diagnosing metastasis at a rare site. Recent studies have shown that beta-2-globulin is a promising biomarker for early diagnosis of HCC in patients with chronic liver disease.

The diagnostic capabilities of ultrasound extend far beyond the evaluation of the pleural space and lungs. Sonographic evaluation of the chest wall is a classic extension of the clinical examination of visible, palpable, or dolent findings. Unclear mass lesions of the chest wall can be differentiated accurately and with low risk by additional techniques such as color Doppler imaging, contrast-enhanced ultrasound, and, in particular, ultrasound-guided biopsy. For imaging of mediastinal pathologies, ultrasound has only a complementary function but is valuable for guidance of percutaneous biopsies of malignant masses. In emergency medicine, ultrasound can verify and support correct positioning of endotracheal tubes. Diaphragmatic ultrasound benefits from the real-time nature of sonographic imaging and is becoming increasingly important for the assessment of diaphragmatic function in long-term ventilated patients. The clinical role of thoracic ultrasound is reviewed in a combination of narrative review and pictorial essay.

UNASSIGNED: Desmoid Fibromatosis (DF) represents a rare neoplasm developing from fascial and musculoaponeurotic structures. Preoperative diagnosis of DF is a challenge because of its rarity and nonspecific presentation. Imaging may be helpful for determining the correct diagnosis. Currently there are different clinical treatments of DF including surgical treatment, drug treatment and radiotherapy.
METHODS: A 43-year-old Caucasian male presented to the Emergency Department with a 6-month history of recurrence of post-traumatic chest wall hematoma. Physical examination revealed a partially solid, painless mass on the right anterior chest wall. Laboratory tests reported and neutrophilic leukocytosis. Thoracic contrast-enhanced computed tomography showed a smooth contour, heterogeneous and hypodense subcutaneous soft tissue mass anterior to the right pectoral muscles and to the right 4th-7th rib. The patient underwent surgery: a solid suprafascial neoplasm was completely excised. The postoperative course of the patient was uneventful.
UNASSIGNED: DF is a soft tissue neoplasm with a tendency for local invasion and recurrence. The course of DF cannot be predicted, being fatal if DF infiltrates vital structures. Diagnosis of DF is difficult and imaging may be helpful for determining the correct diagnosis. Currently the treatment for DF has shifted from surgery (post-operative recurrence rates of 20%-70%) to conservative therapy including watchful waiting.
CONCLUSIONS: DF is a myofibroblastic proliferative soft tissue tumor and classified as an intermediate malignancy. Preoperative diagnosis of DF needs a high index of suspicion and is facilitated by imaging. Surgery, among different treatments, represents a potentially curative treatment of DF.

A heterogeneous group of tumors can affect the posteromedial chest wall. They form diverse groups of benign and malignant (primary or secondary) pathologies that can arise from different chest wall structures, i.e., fat, muscular, vascular, osseous, or neurogenic tissues. Chest radiography is very nonspecific for the characterization of chest wall lesions. The modality of choice for the initial assessment of the chest wall lesions is computed tomography (CT). More advanced cross-sectional modalities such as magnetic resonance imaging (MRI) and positron emission tomography (PET) with fluorodeoxyglucose are usually used for further characterization, staging, treatment response, and assessment of recurrence. A systematic approach based on age, clinical history, and radiologic findings is required for correct diagnosis. It is essential for radiologists to be familiar with the spectrum of lesions that might affect the posteromedial chest wall and their characteristic imaging features. Although the imaging findings of these tumors can be nonspecific, cross-sectional imaging helps to limit the differential diagnosis and determine the further diagnostic investigation (e.g., image-guided biopsy). Specific imaging findings, e.g., location, mineralization, enhancement pattern, and local invasion, occasionally allow a particular diagnosis. This article reviews the posteromedial chest wall anatomy and different pathologies. We provide a combination of location and imaging features of each pathology. We will also explore the role of imaging and its strengths and limitations for diagnosing posteromedial chest wall lesions.

OBJECTIVE: The optimal age for minimally invasive repair of pectus excavatum (MIRPE) is unclear; this study investigates the differences in complication rates among different age groups undergoing repair.
METHODS: PubMed and Embase databases were searched from inception to October 2020. To assess age as a risk factor for complications, odds ratios from relevant studies were analyzed using the Mantel-Haenszel method with a random-effects model for younger vs older patients. Specific complication rates were compared between the two cohorts using a chi-squared test.
RESULTS: Of the 4448 studies retrieved, 25 studies stratified complication data by age groups. From these studies, ten studies compared groups at ages < 18 and ≥ 18 and four studies compared ages < 20 and ≥ 20, and one study compared ages < 19 and ≥ 19. These fifteen studies reported on 5978 patients, with 1188 complications, for a complication rate of 19.87%. Older patients were more likely to have complications in a pooled analysis of studies comparing older vs younger patients (OR = 1.66, 95% CI = 1.28-2.14, heterogeneity I2 = 49%). Specifically, older patients were significantly more likely to experience pneumothorax, pleural effusion, wound infection, bar displacement, and reoperations.
CONCLUSIONS: Increased age is a risk factor for complications of MIRPE. This supports repair of pectus excavatum prior to late adolescence.