No abstract

Ruptured pulmonary hydatid cyst may sometimes cause complications like empyema, bronchopleural fistula, and collapsed lung. These complications may mislead the diagnosis and treatment if prior evidence of cyst has not been documented before rupture. We present a case of a young male who presented with complete collapse of left lung with pyopneumothorax and bronchopleural fistula which was misdiagnosed as pulmonary tuberculosis. He was referred to us from peripheral hospital for pneumonectomy when his condition did not improve after six months of antitubercular chemotherapy and intercostals drainage. On investigation, CT scan revealed significant pleural thickening and massive pneumothorax restricting lung expansion. Decortication of thickened parietal and visceral pleura revealed a ruptured hydatid endocyst, and repair of leaking bronchial openings in floor of probable site of rupture in left upper lobe helped in the complete expansion of the collapsed lung followed by uneventful recovery.

Idiopathic pulmonary artery aneurysm rupture was diagnosed in a 79-year-old man who presented with a dry cough. He was considered unlikely to tolerate extensive pulmonary artery reconstruction or lung resection; hence, he was salvaged by timely ligation of the distal pulmonary artery at the origin of the aneurysm.

Introduction: Predictable intrathoracic course, anatomical proximity to heart and long-term patency has made Internal thoracic artery (ITA) a conduit of choice in coronary artery bypass grafting (CABG). Its frequent bilateral use has necessitated the need to have a comparative knowledge of surgical anatomy of ITA on both sides.Methods: A random study was conducted on 100 adult human cadavers. Sternocostal wall was removed and fixed in 10% formalin and dissected for detailed anatomy of ITA. All observations were expressed as mean ± 2SD and appropriate statistical analysis conducted.Observations: ITA originated in common trunk with other branches of subclavian artery in 12% on right side and 4% on left . Mean length of right ITA was 20.15 ± 1.22 cm, left 19.83 ± 1.66 cm in 28% of cases where bilateral ITA terminated in 6th Intercostal space (ICS). On pattern of origin of sternal branches from ITA 3 groups were observed. Group-I-some sternal branches arising from common trunk of ITA on both sides (24%), Group-II-some sternal branches arising from common branch of ITA on one side only (54%), Group-III-all sternal branches arising directly from ITA on both sides (22%). Phrenic nerve crossed anterior to ITA on both sides in 52%, posteriorly in 14% and in remaining it crossed anteriorly on one side and posteriorly on other.Conclusion: Variations as described in our study in relations to phrenic nerve, level of bifurcation and sternal blood supply must be kept in mind while harvesting bilateral ITA to reduce risk of sternal dehiscence by preserving the sternal blood supply from common trunk and to prevent post operative phrenic nerve palsy. (Ind J Thorac Cardiovasc Surg, 2007; 23: 192-196)

Background Incidence of atherosclerosis in coronary arteries is increasing rapidly affecting young Indians. Many individuals require early bypass surgery for critical coronary occlusion and internal mammary artery is considered ideal conduit because of its long term patency. Present autopsy study aims at finding the prevalence of atherosclerosis in coronary and Internal Thoracic Arteries (ITA) in different age groups in north-west India.Material & method This autopsy study was conducted on 100 cadavers of age ranging from 17 years to 63 years. One cm long segment of each coronary artery and of internal thoracic artery from origin, termination and at level of 3rd costal cartilage was removed for histopathological examination. Rest of the arteries were thoroughly examined and any suspicious area was also subjected to histopathological examination. All sections were examined after staining with hematoxylin and eosin. Atherosclerosis was graded according to luminal narrowing from grade 0 to IV. Results Mean age was 34.58±11.83 years, atherosclerotic changes were found in 86% of all cases. All specimens of coronary artery had evidence of atherosclerosis by end of third decade. Grade IV changes in 24% coronary arteries were seen and their mean age was 42.92±10.31 years. Atherosclerosis was found only unilaterally in 6% of all ITA specimens. Increase in severity with age in ITA were minimal. Conclusion The progression and severity of coronary artery atherosclerosis in our population is faster. Atherosclerosis in ITA though less frequent is also early in our population but progression is slow. Risk factors causing such rapid onset and progression of atherosclerosis in coronary arteries in the region need to be studied to formulate appropriate preventive strategies.