• Journal of Chest Surgery
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• v.22 no.2
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• pp.357-363
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• 1989

We experienced very rare case of pulmonary blastoma in a 5 year old girl. She complained of right chest pain and productive cough for 3 months. With computerized tomography and echocardiography it is disclosed that huge mediastinal solid tumor is occupied to whole right thoracic cavity and compressed mediastinal structures to left and extended to left atrium. We removed the thoracic tumor and its extended intracardiac portion completely using the technique of intrapericardial pneumonectomy with cardiopulmonary bypass. Postoperatively the patient recovered without any problem and received adjuvant chemotherapy and radiotherapy. But she was succumbed 2 months later because of opportunistic pulmonary infection with pneumocystis carinii.

• Journal of Chest Surgery
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• v.27 no.12
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• pp.1047-1051
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• 1994

Airway obstruction may be caused by extreme mediastinal shift and rotation after right pneumonecotmy or after left pneumonecotomy in the presence of right aortic arch.We experienced such a complication after right pneumonectomy, so called right postpneumonectomy syndrome. The patient was 28 years old female, and 4 month ago she had undergone right pneumonecotomy via video assisted thoracoscopic surgery[VATS] for endobronchial tuberculus dissemination and secondary pulmonary infection. She was treated by mediastinal repositioning which were composed of substernal fixation of pericardium and insertion of expandable prosthesis of 1000 cc capacity. She had good postoperative course and now she feels no obstructive symptoms.

• Journal of Chest Surgery
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• v.18 no.4
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• pp.881-885
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• 1985

This report is an analysis of 183 cases of mediastinal tumors which were experienced in the Department of Thoracic and Cardiovascular Surgery, Yonsei Medical Center from January 1960 to June 1985. In this series, teratoma and neurogenic tumors were found to be the most frequent tumors [24.0%] histopathologically. Male to female sex distribution was 1.2 to 1 with the male predominant. The main clinical symptom was dyspnea, and there was no definitive symptom in 10.9% of all cases. In operating, all of the benign tumors were removed. The most frequent complication was wound infection. [13.7%].

• Journal of Chest Surgery
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• v.21 no.4
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• pp.681-691
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• 1988

Fifty-five patients with primary mediastinal tumors and cysts which were seen at T.S. Dept., HYUH, were analyzed clinically, histologically, in an incidence of anatomic location and therapeutic results. The results were summarized as follows; 1] The ages of the patients in this series ranged from 15 months to 79 years with the highest incidence in the age group of third decade, and there were no sex distribution[M:F=0.96]. 2] The most frequently encountered tumors were teratodermoid tumors[29%] followed by neurogenic tumors[22%], thymomas[15%] and benign cysts[11%] in decreasing order of frequency. 3] Based on the subdivision of the mediastinum, 62% of the tumors were in the antero-superior mediastinum, 7% in the middle mediastinum and 31% in the posterior mediastinum. 4] The most frequent symptom was chest pain and others were dyspnea, cough, chest tightness and dysphagia. Asymptomatic patients were 29%. 5] Benign tumors and cysts were 71% and malignant tumors were 29%. 6] The successful removal was possible in all the benign mediastinal tumors and cysts[39 cases] and partial removal or biopsy was performed in the 12 cases among 16 cases of malignant mediastinal tumors. 7] Postoperative complications were bleeding, chylothorax, vocal cord paralysis, wound infection and hypothyroidism. 8] The most frequent mediastinal tumor in the West is neurogenic tumor but is teratoma in Korea.

• Journal of Chest Surgery
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• v.33 no.8
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• pp.693-696
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• 2000

Descending necrotizing mediastinitis(DNM) is one of the most lethal form of mediastinitis originating from an oropharyngeal infection. It requires an early and aggressive sugical treatment, but the operative approach and optimal form of mediastinal drainage remains controversial. We report a case of DNM in a 45-year-old male who underwent right cervicomediastinotomy to drain the deep neck space, upper mediastinum and anterior mediastinal drainage was accomplished through a subxiphoid approach. After this procedure, he steadily improved and was dischrged on hospital day 36. We report this case with a brief review of the literature.

• Journal of Chest Surgery
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• v.45 no.3
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• pp.171-176
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• 2012

Background: Deep neck infections (DNI) can originate from infection in the potential spaces and fascial planes of the neck. DNI can be managed without surgery, but there are cases that need surgical treatment, especially in the case of mediastinal involvement. The aim of this study is to identify clinical features of DNI and analyze the predisposing factors for mediastinal extension. Materials and Methods: We reviewed medical records of 56 patients suffering from DNI who underwent cervical drainage only (CD group) and those who underwent cervical drainage combined with mediastinal drainage for descending necrotizing mediastinitis (MD group) from August 2003 to May 2009 and compared the clinical features of each group and the predisposing factors for mediastinal extension. Results: Forty-four out of the 56 patients underwent cervical drainage only (79%) and 12 patients needed both cervical and mediastinal drainage (21%). There were no differences between the two groups in gender (p=0.28), but the MD group was older than the CD group (CD group, $44.2{\pm}23.2$ years; MD group, $55.6{\pm}12.1$ years; p=0.03). The MD group had a higher rate of co-morbidity than the CD group (p=0.04). The CD group involved more than two spaces in 14 cases (32%) and retropharyngeal involvement in 12 cases (27%). The MD group involved more than two spaces in 11 cases (92%) and retropharyngeal involvement in 12 cases (100%). Organism identification took place in 28 cases (64%) of the CD group and 3 cases of (25%) the MD group (p=0.02). The mean hospital stay of the CD group was $21.5{\pm}15.9$ days and that of the MD group was $41.4{\pm}29.4$ days (p=0.04). Conclusion: The predisposing factors of mediastinal extension in DNI were older age, involvement of two or more spaces, especially including the retropharyngeal space, and more comorbidities. The MD group had a longer hospital stay, higher mortality, and more failure to identify causative organisms of causative organisms than the CD group.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.18 no.4
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• pp.626-635
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• 1996

Odontogenic infections are usually locally confined, self-limiting processes. However, under certain circumstances, they may break through the bony, muscular, and mucosal barriers and spread into contiguous fascial spaces or planes far from the initial site of involvement, resulting in severe life-threatening complications, such as retropharyngeal spread, suppurative mediastinal extension, airway obstruction, pleuropulmonary suppuration, and hematogenous dissemination to distant organs. The mortality arte for mediastinitis from odontogenic infection ranges from 40% to 60%. Therefore rapid evalution and treatment is essential with a combination of life support, antibiotic therapy, and surgical intervention. Recently, we experienced three cases of retropharyngeal and mediastinal abscesses secondary to odonogenic infections. In all patients, early diagnosis was possible by CT scanning and physical examination. The prognosis was good in all patients by using urgent aggressive surgical and antibiotic therapy.

• Journal of Chest Surgery
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• v.56 no.1
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• pp.35-41
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• 2023

Background: We analyzed our experience with descending necrotizing mediastinitis (DNM) treatment and investigated the efficacy of video-assisted thoracoscopic surgery (VATS) for mediastinal drainage. Methods: This retrospective analysis included patients who underwent surgical drainage for DNM at our hospital from 2005 to 2020. We analyzed patients' baseline characteristics, surgical data, and perioperative outcomes and compared them according to the mediastinal drainage approach among patients with type II DNM. Results: Twenty-five patients (male-to-female ratio, 18:7) with a mean age of 54.0±12.9 years were enrolled in this study. The most common infection sources were pharyngeal infections (60%). Most patients had significantly increased white blood cell counts, elevated C-reactive protein levels, and decreased albumin levels on admission. The most common DNM type was type IIB (n=16, 64%), while 5 and 4 patients had types I and IIA, respectively. For mediastinal drainage, the transcervical approach was used in 15 patients and the transthoracic approach (VATS) in 10 patients. The mean length of hospital stay was 26.5±23.8 days, and the postoperative morbidity and in-hospital mortality rates were 24% and 12%, respectively. No statistically significant differences were found among patients with type II DNM between the transcervical and VATS groups. However, the VATS group showed shorter mean antibiotic therapy duration, drainage duration, and hospital stay length than the transcervical group. Conclusion: DNM manifested as severe infection requiring long-term inpatient treatment, with a mortality rate of 12%. Thus, active treatment with a multidisciplinary approach is crucial, and mediastinal drainage using VATS is considered relatively safe and effective.

• Tuberculosis and Respiratory Diseases
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• v.44 no.4
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• pp.935-941
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• 1997

Mediastinal fibrosis is pathologically characterized by chronic inflammation and fibrosis of mediastinal soft tissue. Mediastinal fibrosis is local expression of a family of systemic fibrosing syndroms. This can result in compression of adjacent mediastinal structures. Idiopathic fibrosing syndromes include retroperitoneal fibrosis, sclerosing cholangitis of the orbit and fibrosis of the thyroid gland(Riedel's struma). The cause of these disorders is obscure, in some instance there is an underlying malignancy, infection, history of drug ingestion, or trauma with retroperitoneal bleeding. Treatment of mediastinal fibrosis depends on structures involved by the fibrotic process. The disease is self limited in most case or improved by steroids uses. We experienced a case of idopathic sclerosing mediastinitis with orbital fibrous dysplasia of unknowm cause, which was confirmed by open lung biopsy, so reported it with a review of literature.

• Journal of Chest Surgery
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• v.23 no.1
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• pp.141-145
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• 1990

Author made a clinical study of 48 cases of primary mediastinal tumors experienced in the dept. of the thoracic and cardiovascular surgery of Pusan National University Hospital during the 12 years period from march 1978 to march 1989. There were 34 males and 14 females. Their age distribution was from 4 months to 70 years, with the mean age of 34.4 years. 8.3 % of the patients were younger than 15 years old. There were teratoma 14 cases[29%], thymoma 11 cases[23%], neurogenic tumor 10 cases[21 %], lymphoma 6 cases[13 %], benign cyst 6 cases[13 %], and one case of fibrous histiocytoma in the histological distribution. The malignant tumors were 12 cases[25 %]. The common symptoms were chest pain and discomfort[35.4], coughing[18.8], general weakness and dyspnea. 16.7% of the patients were asymptomatic at admission. The successful removal was done in all cases of benign mediastinal tumors. In malignant cases, the surgical removal could be done in 5 cases. There was not postop. mortality. The frequent complications were atelectasis, infection, bleeding.