A case of giant chronic expanding hematoma involving 6 to 10th rib flip-thoracotomy

DOI Web Site 6 References
  • Tochii Sachiko
    Department of Minimally Invasive Thoracic Surgery, School of Medicine, Fujita Health University Okazaki Medical Center
  • Nagano Hiromitsu
    Department of Minimally Invasive Thoracic Surgery, School of Medicine, Fujita Health University Okazaki Medical Center
  • Negi Takahiro
    Department of Minimally Invasive Thoracic Surgery, School of Medicine, Fujita Health University Okazaki Medical Center
  • Tochii Daisuke
    Department of Minimally Invasive Thoracic Surgery, School of Medicine, Fujita Health University Okazaki Medical Center
  • Suda Takashi
    Department of Minimally Invasive Thoracic Surgery, School of Medicine, Fujita Health University Okazaki Medical Center

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Other Title
  • 肋軟骨融合部を離断した第6-10肋骨跳ね上げ開胸により肺および横隔膜とともにen blocに切除できた巨大chronic expanding hematomaの1例

Abstract

<p>The patient, a 65-year-old man, visited our hospital with chief complaints of cough, hemoptysis, and chest pain. Contrast-enhanced chest computed tomography showed an increase in the size of a previously detected mass in the left thoracic cavity. Chronic expanding hematoma was diagnosed based on imaging findings. The patient underwent surgery after preoperative embolization of the feeding vessels from the chest wall. With the patient placed in the right lateral decubitus position, an arcuate incision was made from the left fifth intercostal space to lower edge of the costal arch. The costal cartilage attached to ribs 6 to 10 was cut, and the 6 to 10th ribs were flipped up to open the chest. This ensured a good visual field around the pulmonary hilum and the left diaphragm. The mass firmly adhered to the chest wall, lung, and the left diaphragm. The left lower lobe, left lingular segment, the left diaphragm, and hematoma were resected en bloc. Since the residual lung was small, there were concerns about postoperative lung torsion and pulmonary fistula. Thus, intrathoracic septation using a polytetrafluoroethylene sheet (ePTFE sheet) and diaphragmatic reconstruction were performed. Since surgery, the patient has been followed up without recurrence for 1 year and 2 months.</p>

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