Zentralblatt fur Chirurgie最新文献

We report on an 70-year old male patient with progressive dyspnoea. For further differential diagnosis he underwent a CT thorax in the pulmonary arterial phase. This revealed a solid, pleural round lesion. The lesion was located paravertebrally in the area of the distal aortic arch. Initially the dignity of the round lesion was undetermined. A subsequent examination conducted three months later, utilising HRCT, revealed no alterations in the dimensions or configuration of the mass. A change in position was observed. In this case of idiopathic phrenic nerve paralysis with diaphragmatic atrophy, diaphragmatic elevation and chronic progressive exertional dyspnoea, the surgical intervention involved a diaphragmoplasty and the surgical removal of the voluminous thoracolith by means of a muscle-sparing limited lateral thoracotomy. The diagnosis of a thoracolith was confirmed on the basis of morphologic criteria and a change in position.

Postoperative wound infections are a serious complication in thoracic surgery. At the same time, excessive use of antibiotics poses the risk of multi-resistant pathogens. The article highlights evidence-based strategies for perioperative antibiotic prophylaxis (PAP) and provides specific recommendations for action.

CT-guided transthoracic lung biopsy (CT-TTNB) is an essential method for the diagnosis of pulmonary nodules and masses. With a sensitivity of 85-97% and a specificity of 85-100%, it offers high diagnostic accuracy. By using core-needle biopsies, high-quality tissue samples can be obtained that enable molecular analyses for personalised therapy.At the same time, lung ablation has established itself as a valuable minimally invasive therapy. Procedures such as radiofrequency ablation (RFA), microwave ablation (MWA) and cryoablation enable targeted tumour destruction, particularly in inoperable patients with NSCLC or lung metastases. Studies have shown a high level of local tumour control with acceptable complication rates. The combination of imaging and interventional technique significantly improves patient safety and treatment outcomes and offers good results with low complication rates.Overall, CT-guided puncture and ablation are integral components of modern lung cancer diagnostics for primary and secondary lung tumours, while offering a new treatment option and therapy. They offer precise, low-risk alternatives to invasive procedures and can therefore make a significant contribution to effective patient care.

In cases where conservative treatment for COPD with emphysema has been unsuccessful and a lung transplant is not a viable option, reducing the lung volume may be the most appropriate therapeutic course of action. Lung volume reduction surgery (LVRS) employs a range of techniques, including apical shaving, targeted resection of a target zone and complete flap resection. In addition to these LVRS techniques, minimally invasive, bronchoscopically guided therapy with one-way valves, endobronchial coils or water vapour ablation is also a possibility. All surgical and bronchoscopic procedures have one thing in common: they all require critical patient selection and meaningful radiological diagnostics for treatment planning. This encompasses the acquisition of a data set for computed tomography of the lung, the software-supported quantification of the proportion of empyema in the lung tissue, and the assessment of fissure integrity. Nuclear medicine examinations have been shown to provide valuable additional information, particularly in cases of complex constellations of findings. The interdisciplinary emphysema conference is then convened to determine the most appropriate treatment procedure for each patient, taking into account all preliminary diagnostic findings.

The use of radiological imaging has gained increasing importance in thoracic surgery, due to the development of new modalities. In particular, computed tomography (CT) not only offers significant diagnostic value but has also become essential for preoperative planning and postoperative follow-up in thoracic surgery. This review is intended to serve as a practical reference and guide for the indication, planning, and interpretation of thoracic CT imaging. It not only explains diagnostic aspects, such as the evaluation of specific conditions in CT imaging, but also provides practical guidance on how to formulate specific clinical questions. The appropriate indication for contrast-enhanced CT versus non-contrast imaging is evaluated. Additionally, the various contrast phases in CT imaging and their diagnostic relevance are discussed using specific thoracic surgery cases. The goal is to provide a structured guide for the application and assessment of radiological diagnostics in thoracic surgery.