Recurrent wheezing is very common in infants. When these symptoms appear early without a free interval, a pulmonary malformation should be investigated. Congenital lobar emphysema is a rare abnormality of the lower respiratory tract. Here, we report a case series of six cases of congenital lobar emphysema between 2015 and 2023. Clinical and radiological data were collected according to an operating sheet previously established in our pediatric pneumo-allergology unit. They all had recurrent wheezing and dyspnea. Chest radiography and chest CT were consistent with the diagnosis of congenital lobar emphysema. All patients had lobectomy without complications.

UNASSIGNED: We report two cases of acute proximal anterior circulation occlusion after pulmonary lobectomy.
UNASSIGNED: Case 1 was a 64-year-old male who presented with occlusion of the right middle cerebral artery (MCA) one day after left lower lobectomy. Case 2 was a 68-year-old male who presented with occlusion of the right internal carotid artery (ICA). In both cases, mechanical thrombectomy was performed for complete recanalization and symptoms were improved.
UNASSIGNED: Prompt mechanical thrombectomy in the acute phase after pulmonary lobectomy improved the prognosis of patients with acute proximal anterior circulation occlusion. It is important to share information about ischemic complications with medical staff engaged in thoracic surgery.

Cerebral embolic stroke caused by a thrombus in the pulmonary vein stump after left pulmonary lobectomy is a serious complication. We retrospectively analyzed four patients who underwent mechanical thrombectomy for large-vessel occlusion after left pulmonary lobectomy between January 2014 and March 2022. Two cases occurred after left upper lobectomy and the others occurred after left lower lobectomy. All patients presented with cerebral embolic stroke from the day after surgery to the 9th postoperative day, and successful reperfusion was achieved in all cases. Two patients had good outcomes at 90 days. Thrombus in the pulmonary vein stump is the probable cause of cerebral embolism, and mechanical thrombectomy is effective. Further studies are required to establish preventive measures and perioperative management strategies.

OBJECTIVE: We analyzed the outcomes of patients suffering acute ischemic stroke (AIS) with large vessel occlusion (LVO) soon after pulmonary lobectomy.
METHODS: We retrospectively reviewed the clinical records of patients who underwent pulmonary lobectomy to treat primary lung cancer. We retrieved clinical characteristics and the incidence of AIS with LVO. The clinical courses of patients who experienced AIS were reviewed.
RESULTS: In 10 (0.3%) of 3406 patients, AIS with LVO developed soon (within 3 days) after pulmonary lobectomy. The lung resection site was on the left in eight patients (80%). All patients underwent thrombectomy and achieved complete recanalization (Thrombolysis in Cerebral Infarction [TICI] 3). The average time between symptom onset and recanalization was 165.5 min. Nine (90%) patients exhibited favorable outcomes (modified Rankin scale [mRS] score ≤ 2) at the 3-month follow-up.
CONCLUSIONS: Endovascular therapy effectively treats AIS with LVO that develops after lung surgery, and direct aspiration is a promising strategy. A large, multicenter study is warranted to further confirm these findings.

The coexistence of situs inversus totalis (SIT) and lung cancer is exceedingly rare; therefore, only a single case report about this exists in the literature. Recent technological advancements in endoscopic surgery have allowed the execution of videothoracoscopic lung resection in these cases. However, the distinct placement of thoracic structures, bronchovascular anatomy, and additional anomalies in SIT should be investigated using bronchoscopy and contrast-enhanced computed tomography (CT). We present a case report of a videothoracoscopic left upper lobectomy with mediastinal lymph node dissection in a 50-year-old female patient with SIT.

Pulmonary lobectomy is the gold standard intervention for lung cancer removal and consists of the complete resection of the affected lung lobe, which, coupled with the re-adaptation of the remaining thoracic structures, decreases the postoperative pulmonary function of the patient. Current clinical practice, based on spirometry and cardiopulmonary exercise tests, does not consider local changes, providing an average at-the-mouth estimation of residual functionality. Computational Fluid Dynamics (CFD) has proved a valuable solution to obtain quantitative and local information about airways airflow dynamics. A CFD investigation was performed on the airway tree of a left-upper pulmonary lobectomy patient, to quantify the effects of the postoperative alterations. The patient-specific bronchial models were reconstructed from pre- and postoperative CT scans. A parametric laryngeal model was merged to the geometries to account for physiological-like inlet conditions. Numerical simulations were performed in Fluent. The postoperative configuration revealed fluid dynamic variations in terms of global velocity (+23%), wall pressure (+48%), and wall shear stress (+39%). Local flow disturbances emerged at the resection site: a high-velocity peak of 4.92 m/s was found at the left-lower lobe entrance, with a local increase of pressure at the suture zone (18 Pa). The magnitude of pressure and secondary flows increased in the trachea and flow dynamics variations were observed also in the contralateral lung, causing altered lobar ventilation. The results confirmed that CFD is a patient-specific approach for a quantitative evaluation of fluid dynamics parameters and local ventilation providing additional information with respect to current clinical approaches.

Unrecognized intrathoracic gastric volvulus can be a life-threatening condition, especially in elderly individuals undergoing major surgical procedures. We herein report the first case of a gastric volvulus after a robot-assisted left upper lobectomy for non-small-cell lung cancer in a patient with a known paraesophageal hernia. The operative procedure was performed by Dr Jacques Fontaine a senior thoracic surgeon at Moffitt Cancer Center in Tampa Florida a major academic institution. This operation was complicated by a large type-III hiatal hernia, with most of the stomach having herniated into the left pleural cavity and demonstrating organo-axial torsion one day after the indexed operation for the lung cancer. The patient required emergency surgery due to gastric ischemia. The patient underwent exploratory laparotomy with reduction of the volvulus and closure of the esophageal hiatus at that time. The patient was taken back to the operating room for a planned relook 24 h after the exploratory laparotomy to assess viability of the stomach. Unfortunately, the second look revealed necrotic areas of the stomach, which required to be resected. Given her age and poor nutritional status, we elected to place a feeding jejunostomy tube. Her postoperative course was marred by an abdominal wound infection treated with a wound vacuum-assisted closure device. Ultimately she was discharged home on POD#19 tolerating a regular diet. This case report highlights that in the elderly patients undergoing left lung resection with a known large hiatal hernia, the index of suspicion for herniation must be high and prompt recognition can avert mortality or morbidity.

The clinical course of our two patients highlights the feasibility of using venovenous extracorporeal membrane oxygenation (ECMO) with heparin for multitraumatic patients needing thoracic surgery. Further research is required to determine if surgery can be performed with totally heparin-free vv-ECMO. All ICU teams should become familiar with this technique.

Postoperative cerebral embolism after left upper or lower lobectomy caused by the thrombus in the pulmonary vein stump (PVS) is a rare complication. However, it is still unclear how the cerebral embolism develop after lobectomy, and how can we prevent further embolism after thrombus removal. We present a case of a 55-year-old man without cardiovascular disease history suffering cerebral embolism 2 days after left upper lobectomy. Patient underwent endovascular thrombectomy and discharged hospital 10 days later with proper recovery. No thrombus was detected in an enhanced pulmonary CT after 1 month of aspirin intake, but the length of PVS was measured.

BACKGROUND: Pulmonary sclerosing hemangioma (PSH) is a rare tumor that usually develops in middle-aged Asian women. PSH has four histological types (hemorrhagic, sclerotic, solid, and papillary) and often grows slowly in a lower lobe of the lung. Preoperative misdiagnosis frequently occurs because of the absence of specific clinical manifestations and imaging findings. Few reports have described PSH in women of advanced age. Case presentation: A 75-year-old woman presented to our hospital in China with a 5-day history of productive cough and intermittent hemoptysis. Computed tomography indicated bronchiectasis and a large mass in the left inferior lobe of the lung. Treatment of the bronchiectasis provided no symptom relief. The hemoptysis resolved following left lower pulmonary lobectomy, and PSH was pathologically diagnosed following surgery. At the time of this writing (after 6 months of follow-up), the tumor had not recurred, no metastases had been detected, and close follow-up was ongoing.
CONCLUSIONS: Both bronchiectasis and PSH can cause hemoptysis. This case demonstrates that PSH should be included as a differential diagnosis of hemoptysis in women of advanced age. For patients with chronic hemoptysis, the diagnosis of PSH should be considered if the therapeutic effect of bronchiectasis is poor.