SESSION TITLE: Cardiothoracic Surgery Posters
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM
PURPOSE: A 45 year old laborer, chronic smoker (10 bidis/day), non-diabetic, non-hypertensive presented to the emergency department with a 3 month h/o progressive breathlessness, right side chest pain, cough with expectoration and low grade fever, sleeping towards right side. No h/o hemoptysis or weight loss. He was presumptively started on anti-tuberculosis treatment based on his chest x ray findings. However his symptoms continued and he was referred for further management.
METHODS: On examination, he was febrile with Temp of 99.8 F. He was tachycardiac (110/min) and tachypneic (28/min). Blood pressure was 126/88 mmHg and oxygen saturation as 91% on room air. General examination revealed clubbing grade 2 with no other significant abnormality. R/s examination revealed decreased movements on right side with a dull note on percussion and decreased breath sounds on auscultation. CVS, CNS and P/A were WNL. Laboratory evaluation revealed thrombocytosis (10,500) with raised esr (78).
RESULTS: Chest x-ray revealed a large lobulated and opaque right side hemithorax noted which is collapsing the right upper lobe with shift of heart and mediastinum towards left. Subsequent C.T.Scan suggested lobulated heterogenous lesion in the right hemithorax with mediastinal extension and collapse of right middle and lower lobe and mediastinal shift to left side, p/o primary pleural lesion rather than primary lung tumour. The patient was subjected to C.T.Guided Biopsy. Biopsy revealed -Solitary fibrous tumour (Pleura). Cardio-thoracic opinion was taken and patient was subjected to surgery. At last follow up patient has shown significant clinical, radiological recovery and has been declared cured.
CONCLUSIONS: 45/M patient presenting with solitary homogenous mass and histopathology specimen show -total 34 whitish soft tissue masses, weighing 7.5 kg. Largest mass measuring 17x18x15 cm and smallest mass measuring 6x5x4 cm. Thickened pleura measures 1 cm. -External surface is smooth and shiny. On c/s whitish whorled like pattern seen. -Right thorax involved (> 40% of area), 7.5 kg. -M/s - proliferation of uniform elongated spindle cells intervening with various amount of connective tissue. Impression was made as Benign Giant Solitary Fibrous tumour of Pleura.
CLINICAL IMPLICATIONS: Solitary fibrous tumor of pleura are rare with apporixmately only 800 case reported till date. Occurs in all age groups with male:female ratio equal. No genetic predisposition seen. No history of exposure to asbestosis, tobbaco or any other environmental agents.
DISCLOSURE: The following authors have nothing to disclose: Umang Shah, Dr. Arpan Shah, Dr. Chandrakant Shah, Dr. Vihang Shah, Dr. Apurva Vaidya
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