Kyobu geka. The Japanese journal of thoracic surgery
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Case Reports
[Bilateral pneumothorax of an amyotrophic lateral sclerosis patient under mechanical ventilation].
Amyotrophic lateral sclerosis (ALS) is a progressive and fatal disease. To support breathing of some patients with ALS in its severe condition, mechanical ventilation is indispensable. However, mechanical ventilation has been known to induce pneumothorax by the damage of lung cells in response to mechanical stretch. ⋯ On 42nd POD, a drainage pressure was increased up to -15 cm H2O. Then an air leak disappeared, and the lung expansion was obtained. The adjustment of a chest tube drainage pressure seems to be important, especially when a pneumothorax patient on mechanical ventilation is treated.
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Video-assisted thoracic surgery (VATS) is increasingly being used for congenital cystic lung diseases but there are very few reports of VATS lobectomy because of its technical difficulties. Congenital pulmonary airway malformations (CPAM) is a rare congenital developmental abnormality; an immediate and proper surgical resection must be performed for prevention of malignant transformation and recurrent pulmonary infection. Here, we report a case of a 1-year-old girl with type II-CPAM who was successfully treated with VATS lobectomy. ⋯ An ultrasonic cutting and coagulating surgical device was used to incise the incomplete fissure. Histological examination showed type II-CPAM of the right lower lobe accompanied with lung abscess and S10 hypoplasia. For a certain category of patients, surgical lobectomy using the thoracoscopic approach can be a safe and effective treatment for infants with CPAM.