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Background Mediastinal teratoma is an uncommon disease, nevertheless they represent the most common mediastinal germ cell tumors. It may grow silently for several years and remain undiagnosed until the occurrence of a complication. Aim The main aim of this article is to illustrate the silent evolution of an anterior mediastinal teratoma for over 70 years without presenting any notable complications. Case presentation We present the case of a 70-year-old female, treated for hypertension referred to our department for managing a voluminous mediastinal mass, discovered fortuitously by a general practitioner in a chest X-ray. The anamnesis didn’t relate any chest pain, cough, dyspnea nor hemoptysis. The clinical examination, in particular pleuropulmonary, was unremarkable. The workup (Chest X-Ray and CT scan) demonstrated a voluminous pleural mass at the expense of the right mediastinal pleura, rounded in shape, with calcified wall and fluid content. Blood tests did not demonstrate eosinophilia, and hydatid IgG serology was negative. serum human chorionic gonadotropin (hCG) and alpha fetoprotein (AFP) levels were found to be normal. The patient subsequently underwent a right posterolateral thoracotomy with resection of the lesion. The mass was dissected very carefully and then resected in toto. The macroscopic and microscopic histological examination demonstrated a mature cystic teratoma. Surgical resection was an adequate treatment and the prognosis was excellent for the patient. Conclusion Cystic mature teratomas are rare thoracic tumors, often recognized by radiological examination. This article relates the silent evolution that a teratoma could have, and the late appearance of symptoms that it could have.

Castleman´s disease (CD) is a rare lymphoproliferative disorder often presenting as a hypervascular mass. This case highlights the unique challenges of surgically managing a posterior mediastinal CD mass adherent to vital structures. A 58-year-old woman was incidentally diagnosed with an asymptomatic posterior mediastinal mass during routine imaging for COVID-19. Computed tomography angiography revealed a 34 x 26 mm hypervascular mass closely associated with the esophagus, pulmonary artery, and bronchus. Initial surgical resection via VATS was converted to a posterolateral thoracotomy due to significant bleeding and adhesions. Histopathological examination confirmed hyaline vascular Castleman´s disease. The patient experienced an uneventful recovery and demonstrated a one-year remission. This case underscores the importance of advanced imaging and intraoperative flexibility in managing rare mediastinal masses. It also highlights the excellent prognosis achievable with complete resection, even in anatomically challenging cases.

Morgagni hernia is a rare condition characterized by a congenital retrosternal defect of the diaphragm, leading to the protrusion of abdominal organs into the thoracic cavity. Here, we report the case of a 72-year-old woman with a Morgagni hernia incidentally discovered during evaluation for persistent dyspnea following COVID-19 pneumonia. The diagnosis was made by imaging, including a chest X-ray and a thoracic CT scan, which showed an ascent of the transverse colon and omentum through an anterior retrosternal defect. Surgical exploration via right posterolateral thoracotomy revealed an anterior diaphragmatic hernia with a small defect containing the greater omentum and transverse colon, which was repaired by resecting the hernia sac and closing the diaphragmatic defect by fixing the anterior rim of the diaphragm to the retrosternal fascia with interrupted silk sutures. Postoperative recovery was uneventful, and follow-up examinations revealed no abnormalities on chest X-rays obtained at one, three, and six months. This case highlights the incidental discovery and successful surgical management of a Morgagni hernia in an elderly patient through a thoracic approach.

Hydatid disease is a parasitic zoonosis caused by Echinococcus granulosus, typically transmitted through contact with infected dogs or ingestion of contaminated food. Although the liver and lungs are the most commonly affected organs, mediastinal localization is extremely rare and presents diagnostic and therapeutic challenges. This report describes the case of a 48-year-old man with a history of hepatic and pulmonary hydatid disease who developed a retrocardiac mediastinal hydatid cyst (HC). The patient presented with cough, dyspnea, and back pain. Imaging (computed tomography (CT) and magnetic resonance imaging (MRI)) revealed a 9.3 × 7.0 cm cyst compressing mediastinal structures, including the atria and aorta. Surgical removal via posterolateral thoracotomy was performed successfully, and the patient recovered without complications. Albendazole was administered to the patient over a six-month period as part of the postoperative antiparasitic treatment. Echinococcus granulosus causes HCs, a significant zoonotic and pulmonary parasitic disease that can mimic various pathologies and is often harder to manage than the disease itself. HC is considered a significant health problem in India, Iran, China, and Mediterranean countries, which lack satisfactory environmental health, preventive medicine, and veterinarian services. Echinococcosis continues to be a major community health burden in several countries, and in some terrains, it constitutes an emerging and re-emerging disease. Cystic echinococcosis is the most common human disease of this genus, and it accounts for a significant number of cases worldwide. Imaging plays a key role in diagnosis and surgical planning, while surgery remains the mainstay of treatment, supported by medical therapy.

Solitary fibrous tumor of the pleura (SFTP) is a rare mesenchymal tumor, making up a small fraction of primary pleural tumors. It is typically benign but can display malignant features. This case presents a 59-year-old patient with a giant malignant SFTP located in the right posterior inferior mediastinum, which caused significant compression of adjacent structures, including the lung, heart, and esophagus. The patient initially presented with dyspnea, chest pain, and weight loss. Imaging studies revealed a voluminous mass with heterogeneous characteristics, calcifications, and pleural effusion, while biopsy and histopathological analysis confirmed a mesenchymal proliferation consistent with a solitary fibrous tumor. Despite partial resection, due to the tumor's size and extensive adhesions, complete removal was not feasible. Postoperative histological findings revealed features indicative of malignancy, including a high mitotic index and slight nuclear atypia. The patient declined adjuvant chemotherapy and radiotherapy, and experienced recurrence within four months. Despite the lack of chemosensitivity, the tumor progressed locally, and the patient's clinical condition worsened. This case highlights the challenges in diagnosing and managing malignant SFTPs, emphasizing the importance of individualized treatment plans and the necessity for long-term follow-up due to the risk of recurrence and poor prognosis following incomplete resection.

Primary pulmonary Hodgkin's lymphoma (PPHL) is an uncommon condition that accounts for less than 1% of all lymphomas. The clinical and radiological presentation of PPHL is nonspecific. This case report aimed to highlight the misleading presentation of PPHL, which initially manifested as a pulmonary cavitary lesion. The presented case report describes a perplexing presentation of PPHL in a 24-year-old female patient. Initially suspected to have necrotizing pneumonia or pulmonary tuberculosis due to symptoms including cough, hemoptysis, and weight loss, the patient underwent various diagnostic procedures, including bronchoscopy and CT-guided biopsy, which failed to provide a definitive diagnosis. Surgical resection was eventually pursued, leading to the conclusive identification of PPHL. This case highlights the diagnostic challenges associated with PPHL, emphasizing the importance of considering this rare entity in the differential diagnosis of pulmonary nodular or cavitary lesions. Prompt recognition and accurate diagnosis are essential for optimal management and improved patient outcomes. PPHL is an infrequent neoplasm that often presents diagnostic dilemmas. It requires consideration within the appropriate clinical framework to ensure timely diagnosis and intervention.

L’hémothorax spontané demeure une pathologie rare. Ses étiologies sont multiples mais restent parfois inconnues. Chez certains patients, la thoracotomie peut être le seul recours pour déterminer son origine. Les vascularites n’ont pas été rapporté comme cause habituelle des hémothorax spontanés. La grossesse ne semble pas avoir d’effet causal, ni aggravant des hémothorax spontanés, ni des vascularites. Nous rapportons une observation assez particulière d’une jeune patiente, présentant au cours de sa grossesse un hémothorax spontané secondaire à une vasularite de type Wegener, diagnostiquée par la biopsie pleurale faite au cours d’une thoracotomie exploratrice et confirmée par le dosage des ANCA.

L'hamartochondrome est une tumeur bénigne de l'arbre trachéo-bronchique de découverte fortuite le plus souvent et rarement symptomatique. Elle est plus fréquente chez l'homme que chez la femme. L'aspect radiologique est souvent évocateur. Le recours à la chirurgie est indiquée quand la tumeur est de grande taille et/ou symptomatique. Le diagnostic histologique ne pose en règle pas de difficulté. Nous rapportons l'observation d'une jeune patiente de 30 ans, sans antécédents pathologiques particuliers. Qui avait présenté un pneumothorax spontané, révélant un hamartochondrome pulmonaire de grande de taille. Association assez rare, mais pourrait être expliqué par le fait que ces tumeurs de composition assez anarchique, contiennent parfois des formations kystiques qui peuvent se rompre dans la plèvre et être à l'origine d'épanchements.

Difficulties have risen while managing Acute Respiratory Distress Syndrome (ARDS) caused by COVID-19, although it meets the Berlin definition. Severe hypoxemia with near-normal compliance was noted along with coagulopathy. Understanding the precise pathophysiology of this atypical ARDS will assist researchers and physicians in improving their therapeutic approach. Previous work is limited to postmortem studies, while our report addresses patients under protective lung mechanical ventilation. An open-lung minithoracotomy was performed in 3 patients who developed ARDS related to COVID-19 and were admitted to the intensive care unit to carry out a pathological and microbiological analysis on lung tissue biopsy. Diffused alveolar damage with hyaline membranes was found, as well as plurifocal fibrin microthrombi and vascular congestion in all patients’ specimens. Microbiological cultures were negative, whereas qualitative Reversed Transcriptase Polymerase Chain Reaction (RT-PCR) detected SARS-CoV-2 in the pulmonary parenchyma and pleural fluid in two patients. COVID-19 causes progressive ARDS with onset of severe hypoxemia, underlying a dual mechanism: shunt effect through diffused alveolar damage and dead space effect through thrombotic injuries in microvascular beds. It seems reasonable to manage this ventilation-perfusion ratio mismatch using a high dose of anticoagulant combined with glucocorticoids.