Positron emission tomography can identify malignant pleural mesothelioma and appears to be a useful noninvasive staging modality for patients being considered for aggressive combined modality therapy.

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The hybrid minimally invasive Ivor Lewis esophagectomy approach results in low perioperative morbidity and mortality and is well tolerated after neoadjuvant chemoradiation. Good long-term overall survival rates likely resulted from combined concurrent neoadjuvant chemoradiation in the majority of patients, which did not impact the ability to safely perform the operation or postoperative complications rates. J. Surg. Oncol. 2016;114:838-847. © 2016 2016 Wiley Periodicals, Inc.

A case of giant bullous disease with pulmonary transmogrification is described in which the bulla was initially mistaken for a pneumothorax. This report reviews the possible pitfalls in the diagnosis of this rare histologic subtype of bullous emphysema, which has been described in only 8 patients. The patient course including successful surgical resection and management options are reviewed.Emphysema occurs most commonly in smokers and patients with α 1 -antitrypsin deficiency. A rare congenital form of giant bullous emphysema was described in 1979 and termed pulmonary placental transmogrification. 1 It is rare and has been described once in the surgical literature. 2 Clinical summary. The patient is a 39-year-old white woman who underwent a left modified radical mastectomy for ductal carcinoma in situ with immediate reconstruction with a saline implant. A preoperative chest x-ray film revealed a "hyperinflated right lung, with decreased vascular markings." At the time of subpectoral prosthetic implantation, the pleura was violated and a thoracostomy tube placed. A postoperative chest radiograph revealed good expansion on the left side and what was believed to be a right pneumothorax. A thoracostomy tube was placed in the right side of the chest. She was then referred for definitive management after the left pneumothorax resolved but the right-sided abnormality, which was, in reality, a giant bulla persisted (Fig 1 ). A computed tomographic scan revealed a giant right upper lobe bulla with partial right middle and lower lobe inflation (Fig 2). The mediastinal structures were shifted to the left, but the patient tolerated this well. She underwent video-assisted thoracoscopic surgery with successful staple resection of this giant bulla. On postoperative day 3 a small air leak had sealed. On postoperative day 4, however, she had a new, significant air leak that persisted and culminated in re-exploration on postoperative day 7. At thoracotomy, a very small, previously obscured bulla originating from the lower lobe was found to have a 2-mm hole. The bulla was stapled and a generous parietal pleurectomy was performed. Her subsequent recovery was uneventful and she was discharged 3 days later with a fully expanded right lung.

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