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      Pericardial fat pad plombage for pulmonary cavity causing massive air leakage

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          Abstract

          Background

          Secondary pneumothorax after chemotherapy for a malignant pulmonary tumor is a complication from a large cavity causing refractory pneumothorax.

          Case presentation

          A 61-year-old man was referred due to prolonged air leakage from a pulmonary cavity that developed after treatment for pulmonary metastases from renal cell carcinoma. As air leakage continued after thoracic drainage and endobronchial occlusion, we planned thoracoscopy-assisted surgery. Intraoperatively, a large cavity opening to the pulmonary cavity was found in the left upper lobe. As it was difficult to repair the fistula using staplers or direct sutures because the pleura around the cavity was thick and hard, we attempted to plombage the cavity with a pericardial fat pad. After the operation, air leakage immediately disappeared and no recurrence of the pneumothorax was found.

          Conclusion

          This novel method can be useful to seal a large bronchopleural fistula that causes refractory pneumothorax.

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          Most cited references 6

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          Spontaneous pneumothorax in metastatic thyroid papillary carcinoma.

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            Spontaneous pneumothorax in malignancy: a case report and review of the literature.

            Pneumothorax occurring in the absence of obvious lung disease is defined as spontaneous pneumothorax. Spontaneous pneumothorax occurs in a variety of settings in patients with malignancies. We present a case report of spontaneous pneumothorax in malignancy and review the literature. No correlation was found between the occurrence of pneumothorax with age, sex or smoking history. Pneumothorax occurred with a variety of primary tumors. However it was always associated with lung metastases or lung involvement with tumor. In certain cases the metastases were detected after the occurrence of pneumothorax. The occurrence of pneumothorax in a patient with malignancy should prompt a search for lung metastases.
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              Use of a pericardial fat pad flap for preventing bronchopleural fistula: an experimental study focusing on the angiogenesis and cytokine production of the fat pad.

               T Ueda,  Y Ichinose,  H Asoh (1995)
              An experimental study was conducted to determine whether pericardial fat tissue could induce neovascularization and produce cytokines related to tissue repair. Neovascularization was examined using chick chorioallantoic membranes. Pieces of pericardial fat tissue, omentum, and intercostal muscle were individually placed on a number of chorioallantoic membranes and neovascularization induced by each material was assayed 6 days after the implantation. The intensity of neovascularization was in the order of pericardial fat > or = omentum > muscle. Cytokines, such as interleukin 1 (IL-1) alpha and beta, tumor necrosis factor-alpha (TNF alpha), interferon-gamma (IFN-gamma), and interleukin 6 (IL-6) were assayed in a culture supernatant of pericardial fat tissue. The latter was obtained 24 h after the addition of lipopolysaccharide (LPS) following various incubation times. All cytokines other than IFN gamma are known to play a part in tissue repair, whereas IFN gamma is negatively related to tissue repair because it inhibits fibroblast growth. The pericardial fat tissue incubated with LPS produced a certain amount of IL-1 on day 1, and TNF alpha on days 1 and 8, whereafter these values decreased to an undetectable level. Irrespective of the addition of LPS, a large amount of IL-6 was observed in the supernatant of pericardial fat tissue and it was detectable until day 29. On the contrary, INF gamma was not detected at any assay time. These observations suggest that a pericardial fat pad flap could possibly be beneficial in the prevention of bronchopleural fistula after pulmonary resection.
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                Author and article information

                Contributors
                tcvnknt@jichi.ac.jp
                Journal
                Surg Case Rep
                Surg Case Rep
                Surgical Case Reports
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                2198-7793
                1 July 2020
                1 July 2020
                December 2020
                : 6
                Affiliations
                [1 ]GRID grid.410804.9, ISNI 0000000123090000, Department of General Thoracic Surgery, Saitama Medical Center, , Jichi Medical University, ; Saitama, Japan
                [2 ]GRID grid.410804.9, ISNI 0000000123090000, Department of General Thoracic Surgery, , Jichi Medical University, ; 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498 Japan
                Article
                917
                10.1186/s40792-020-00917-7
                7329944
                32613463
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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                © The Author(s) 2020

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