• Journal of Chest Surgery
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• v.35 no.7
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• pp.560-563
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• 2002

Unilateral diaphragmatic paralysis due to a phrenic nerve injury is not rare after cardiothoracic surgery and may range from an asymptomatic radiographic abnormality to severe pulmonary dysfunction and even mortality in patients with reduced lung function. The most effective treatment for symptomatic unilateral diaphragmatic paralysis has been known to be a plication of the paralyzed hemidiaphragm. A 38 year-old male patient with asthma received a phrenic nerve reconstruction with a sural nerve for right phrenic nerve injury during resection of the anterior mediastinal tumor. Ten months later, chest PA showed good result and we report this case with literature.

• Journal of Chest Surgery
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• v.36 no.8
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• pp.623-626
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• 2003

Desmoid tumors are benign neoplasms with high rates of recurrence. A case of huge desmoid tumor of the intrathoracic and intraabdominal space is presented. The patient was treated with resection, which involved hepatic left lobectomy and diaphragmatic resection and partial pericardiectorny and wedge resection of left lower lobe of lung. The resulting defect over the pericarium and diaphragm was reconstructed by bovine pericardium and Marlex mesh. Prevention of presumed local recurrence of desmoid tumors requires wide excision margin.

• Journal of Chest Surgery
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• v.35 no.7
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• pp.568-572
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• 2002

We present a case of a 47-year-old woman with benign solitary fibrous tumor of the pleura originated in the diaphragm which was discovered incidentally on a chest radiograph. Chest radiograph, sonograph, computed tomographic scan and magnetic resonance image studies proved a well circumscribed and lobulated fibrous tumor of the pleura. During the subsequent right thoracotomy, the tumor was found to be encapsulated and consisted of firm mass. It was connected to the diaphragm with $5{\times}4$cm area by pedicle. Most of the tumor was free of adhesion. It was excised completely together with attached diaphragm. The tumor measured $23.5{\times}13.5{\times}8.0$cm and the pathologic diagnosis was benign solitary fibrous tumor and the attached diaphragm was free of disease.

• Progress in Medical Physics
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• v.15 no.4
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• pp.179-185
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• 2004

To deal with tumor motion from respiration is one of the important issues for the advanced treatment techniques, such as the intensity modulated radiation therapy (IMRT), the image guided radiation therapy (IGRT), the three dimensional conformal therapy (3D-CRT) and the Cyber Knife. Studies including the active breath control (ABC) and the gated radiation therapy have been reported. Authors have developed the device for reducing the respiration effects and the diaphragm motions with this device were observed to determined the effectiveness of the device. The device consists of four belts to immobilize diaphragm motion and the vacuum cushion. Diaphragm motions without and with device were monitored fluoroscopically. Diaphragm motion ranges were found to be 1.14 ～ 3.14 cm (average 2.14 cm) without the device and 0.72～1.95 cm (average 1.16 cm) with the device. The motion ranges were decreased 20 ～ 68.4% (average 44.9%.) However, the respiration cycle was increased from 4.4 seconds to 3.7 seconds. The CTV-PTV margin could be decreased significantly with the device developed in this study, which may be applied to the treatments of the tumor sited diaphragm region.

• Journal of Chest Surgery
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• v.36 no.12
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• pp.985-990
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• 2003

Bilateral diaphragmatic paralysis is a rare disease. It is caused by trauma, cardiothoracic surgery, neuromuscular disorders, corvical spondylosis, and infection. A 60 year-old male patient developed bilateral diaphragmatic paralysis after an on-bloc resection of thymic carcinoma which invaded the right upper lobe, pericardium, superior vena cava and innominate vein. Severe respiratory difficulty developed and ventilator weaning was impossible. We performed bilateral diaphragmatic plication. After the operation, satisfactorily ventilator weaning and sleeping in supine position were possible; therefore, we report this case.

• Journal of Chest Surgery
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• v.40 no.11
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• pp.802-804
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• 2007

Although intrathoracic liver in association with a congenital diaphragmatic hernia has been well documented, the finding of intrathoracic ectopic liver tissue in the presence of an intact diaphragm is an extremely rare congenital anomaly. We have experienced a case of intrathoracic ectopic liver without any diaphragmatic hernia. A 37-year-old woman was admitted for the treatment of an incidentally detected right lung mass, A chest computed tomography scan revealed a right lower lobe lung mass close to the diaphragm, and this was suspicious for bronchial carcinoid tumor. Upon surgery, 2 round solid masses $3.5{\times}3.5 cm$ and a $2.0{\times}2.0 cm$ in size were noted, with their bottoms attached to the diaphragm dome. The masses were completely resected. Histologically, they were confirmed to be intrathoracic ectopic livers. The patient had an uncomplicated postoperative course.

• Journal of Chest Surgery
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• v.35 no.3
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• pp.244-247
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• 2002

Pulmonary sequestration is a very rare congenital malfomation, especially when it is located in the infradiaphragmatic retroperitoneal space. The patient was a 56-year-old man with no respiratory symptom but had some postprandial epigastric discomfort for several days. Plain chest x-ray revealed mild elevation of left diaphragm and abdominal CT scan showed large cystic retroperitoneal mass with some calcification. We performed the operation through the thorachoabdominal incision and the mass was proven to be a pulmonary sequestration. Therefore, we report the case with review of literatures.

• Korean Journal of Head & Neck Oncology
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• v.30 no.2
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• pp.74-78
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• 2014

갑상선 암 진단과 치료기술이 발전하면서 최근 그 수술 건 수가 급격하게 증가하고 있다. 하지만이와 관련된 합병증과 부작용을 면밀하게 평가해야 할 필요 역시 점차 늘어나고 있다. 갑상선 암 수술 후 발생할 수 있는 드문 합병증의 하나로 횡격막 신경마비(phrenic nerve paralysis)가 있다. 이러한 횡격막신경마비는 대부분 증상이 경미하고 쉽게 호전되어 임상적으로 크게 중요하게 다루어지지 않았다. 하지만, 갑상선 수술 후 갑작스런 호흡곤란이 발생한다면 횡격막 신경마비에 의한 횡격막 마비(diaphragmatic paralysis)와 관련되었을 가능성을 놓치지 말아야 한다. 저자들은 최근 갑상선암 수술 후 발생한 호흡곤란으로 2년 동안 심각한 호흡곤란을 호소하던 73세 여자환자에서 투시촬영(fluoroscopy) 상 편측으로 상승되고 운동성이 저하된 횡격막을 확인하여 일측성 횡격막신경마비(Unilateral phrenic nerve paralysis)를 확진 하였다. 갑상선수술 후 발생하는 일측 횡경막 신경마비는 임상에서 드물게 관찰되는 수술 합병증이기에 환자는 상당기간 이에 대한 감별이 제대로 이루어지지 않았다. 우리는 횡격막 마비의 조기 진단과 적극적인 치료를 통하여 심한 호흡곤란을 호소하는 환자의 증상 및 병의 경과를 호전 시킬 수 있었다.

• Journal of Chest Surgery
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• v.37 no.12
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• pp.1025-1028
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• 2004

Epithelioid hemangioendothelioma (HE) is a very rare malignant tumor that is pathologically benign tumor originating from endothelial cell but clinically presents metastasis and recurrence. A 29-year-old asymptomatic man, preoperatively diagnosed as lung cancer in the left lower lung, underwent a lobectomy, a wedge lung resection of left upper lung, and partial resection of diaphragm. Left lower lobar lesion was confirmed as pulmonary epithelioid hemangioendothelioma, but the lesions of the left upper lung and diaphragm were remained calcified by spontaneous regression of HE. We report a case of subcutaneous metastasis that occurred two times at 10 months and 19 months after previous surgical treatment of pulmonary EH.

• Journal of Chest Surgery
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• v.36 no.2
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• pp.118-121
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• 2003

A 25-year-old female patient was adimitted due to discomfort in the right chest and left epigastric area. Chest X-ray and chest CT showed a round 4$\times$4$\times$4cm sized mass located in the right lower lobe and abutted on the right diaphragm and metastatic lesions in the right lower lobe and right middle lobe. In exploratory thoracotomy, we discovered a mass originating from the right diaphragm which directly invaded the right lower lobe and metastatic subpleural lesions in the right lower lobe and right middle lobe. The mass was diagnosed as sarcoma by frozen section biopsy and we removed the mass by on bloc resection of the right diaphragm and right lower lobe. Metastatic subpleural lesions in the right lower lobe and right middle lobe were removed by wedge resection. The mass was malignant fibrous histiocytoma of the diaphragm in permanent pathologic examination and chemotherapy was done as adjuvant measure. We report one extremely rare case of malignant fibrous histiocytoma of the diaphragm with literature.