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Cardiothoracic Surgery |

Mixed Minimal Access Techniques for Giant Mediastinal Resection

Francina Bolaños*, MD; Hugo Luna, MD; Sylvain Collura, MD; Herrera Zamora Julio de J, MD; Luis Marcelo Argote, MD
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National Institute for Medical Science and Nutrition “Salvador Zubirán”, México, Mexico


Chest. 2012;142(4_MeetingAbstracts):46A. doi:10.1378/chest.1387244
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Abstract

SESSION TYPE: Surgery Student/Resident Case Report Posters

PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM

INTRODUCTION: The neurofibromatosis type 1 is an autosomal dominant, hamartomatous, characterized by the presence of multiple neurogenic tumors, usually neurofibromas associated with skeletal lesions.

CASE PRESENTATION: A 33-year-old female with a 14x7 cm right upper mid-mediastinal mass with neck extension through the thoracic outlet was resected with limited access techniques. She has Von Recklinghausen disease. Complained since 2007, of a left cervical 3 cm hard, painless, mobile tumor. This mass increased in size for the last 4 years, limiting cervical mobility; hoarseness, dyspnea and progressive dysphagia to liquids and paresthesias in the left upper limb. A contrast chest and neck CT showed two main tumors., One in level II, III and IV on left side of the neck and a second 14x7cm heterogeneous mass arising from the right mid upper mediastinum with intrathoracic and neck extension.During assessment, left vocal cord paralysis with compensatory movement of right vocal cord was observed.A month later she was readmitted for resection of her right mediastinal mass.

DISCUSSION: Initially right VATS evaluation and dissection of the thoracic portion of the mediastinal mass was performed. After manuvering the thoracic outlet limited dissection a partial upper sternotomy to the 2nd ICS with right sternal split and cervical extension was performed, Tumor dissection in the anterior mediastinum and cervical area was completed, removing the tumor completely en-bloc with the right phrenic nerve. A 24 Fr Blake drain was left in the right chest and mediastinum. The histopathological report confirmed the diagnosis of neurofibroma of the intrathoracic frenic nerve. Postoperatively, the patient had asymptomatic right diaphragmatic paralysis.Discharged from our service on the seventh day

CONCLUSIONS: We present this case to present the application of minimal access techniques (right VATS) in large mediastinal tumors can minimize the extent to a single incision (median sternotomy) with subsequent faster recovery and decreased postoperative complications and hospital stay

1) Osborn A. Neurorradiología diagnóstica. Madrid: Mosby; 1996. p. 72- 85. 2. Dones Carvajal JJ, Camacho Pastor MA, Lea Pereira MC, García To- rrecillas JM, Fernández Reyes JL, Molina Molina F. Varón de 62 años con lesiones cutáneas de larga evolución: un diagnóstico a primera vista. Rev Clin Esp 2001;201:53-5.

2) Kreel L, Al-Kutoubi M. Two varieties of rib notching. Postgrad Med J 1991;67:568-70. 4. Bourgouin P, Shepard J, Moore E, McLoud T. Plexiform neurofibro- matosis of the mediastinum: CT appearance. AJR 1988;151:461-3.

3) Felson B. Radiología Torácica. 2.a ed. Filadelfia. WB Saunders Com- pany; 1994. 6. Dacher JN, Zakine S, Monroc M, Eurin D, Lechevallier J, le Dosseur P. Rib displacement threatening the spinal cord in a scoliotic child with neuro- fibromatosis. Pediatr Radiol 1995;25:58-9.

DISCLOSURE: The following authors have nothing to disclose: Francina Bolaños, Hugo Luna, Sylvain Collura, Herrera Zamora Julio de J, Luis Marcelo Argote

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