Revista portuguesa de cirurgia cardio-toracica e vascular : orgao oficial da Sociedade Portuguesa de Cirurgia Cardio-Toracica e Vascular最新文献

This review will focus on whole-body functional imaging applied to lung cancer disease and patient management. Lung cancer needs to be avoided… (but if not well succeeded), suspected, screened, histologically confirmed, anatomically inventoried, prognostically staged, molecularly characterized, genetically studied and finally, therapeutically managed. Functional imaging using 18F-fluoro-deoxy-glucose (FDG) is a non-invasive method that is widely used in oncologic disease, mainly for clinical staging and re-staging, with impact on therapy planning. For lung cancer, the functional imaging with FDG-PET/CT is used for clinical staging and also to provide information on a pre-diagnostic phase, to categorize lung nodules according to the metabolic risk of malignancy. Clinicians need to be aware of the different possibilities of the functional imaging information, to provide the better use of it. This review will focus on data from the different medical fields that are considered important to informed decision making when asking for functional imaging in the daily clinical routine of a lung cancer patient.

A 31-year-old-woman with an etonogestrel implant on her left upper arm presented with unfavorable change in her menstrual bleeding pattern and requested for its removal. The non-palpable device was perceptible in the left hemithorax by radiography. Thoracic computed-tomography showed migration to a sublobar branch of the left lower pulmonary artery. Despite the absence of thoracic symptoms and the lack of management guidelines, the device was removed by a lung sparing approach with videoassisted thoracic surgery, due to the unknown long-term effect of the embolized implant.

Axillary artery injuries due to penetrating trauma are relatively uncommon. Management of these injuries is challenging due to the complex local anatomy, rigid chest walls, and associated injuries. Open exposure with direct open vascular repair has been the mainstay of operative management. We report a clinical case of a 51-year-old man victim of penetrating trauma to the axillary artery caused by a chain-saw and repaired by open surgery with a great saphenous vein interposition graft.

Patients undergoing angioplasty and stent insertion require double prophylactic anti-aggregation or monotherapy. This is a challenging procedure with a high risk of morbidity and coronary mortality. The aim of this protocol is to provide guidelines for a presurgical approach to patients with a coronary stent who will be undergoing non-coronary surgery. This protocol highlights potential complications that may occur, namely those related with the cardiac stent and the evaluation of cardiac risk, and notes the thrombotic and hemorrhagic risks associated with the surgical procedure and the decision algorithms for both elective surgery and urgent surgery involving the suspension and re-introduction of antiplatelet therapy. Our main goal is to outline an optimized approach to these cases in order to improve cardiac outcomes and to minimize the risk of complications.

During placement of a central venous catheter into the right subclavian vein it was found to be impossible to extract the guidewire. An Angio-Computed Tomography was performed, showing an aberrant guidewire path, as the image shows. An urgent mini-sternotomy was performed to extract both catheter and guidewire under direct visualization.

Computed tomography showing portal and mesenteric venous gas and intestinal pneumatosis, rare radiological signs that, together, favor the diagnosis of mesenteric ischemia (70% of cases). When present, mortality is around 40-90%. Surgical exploration is mandatory with assessment of the extent of intestinal ischemia and appropriate treatment.