Congenital and Acquired Chest Pathology
Two complex cases involving esophageal atresia, tetralogy of Fallot, spontaneous pneumothorax, and subpleural blebs were presented and analyzed, with emphasis on the importance of multidisciplinary collaboration and the need to prioritize patient survival. The team also discussed the pathology of subpleural blebs, the long-term effects of talc pleurodesis, and the need for standardization in care for spontaneous pneumothorax.
Case 1. Two-stage Repair of Tetraology of Fallot
The team discussed a case of a patient with esophageal atresia and tetralogy of Fallot. The patient underwent three operations: bronchoscopy, ligation of the tracheoesophageal fistula, and repair of the tetralogy of Fallot. The decision to prioritize the ligation of the tracheoesophageal fistula over the esophageal anastomosis was made due to concerns about the patient's cardiac condition and the potential for complications. The team emphasized the importance of multidisciplinary collaboration and the need to prioritize the patient's survival in the first week. The decision to avoid a more invasive procedure, such as thoracoscopy, was also discussed, with the team valuing the opinions of their colleagues and prioritizing the patient's physiological reserve.
Case 2. Spontaneous Pneumothorax
The next case presented a severe case of spontaneous pneumothorax not caused by tension pneumothorax. The team noted the presence of air in the lung and a shift of the trachea, indicating increased pressure. The presenter suggested that the pneumothorax was likely caused by a ruptured bleb. The team also discussed the follow-up films, including one taken on day 4, that showed the lung still not fully re-expanded. The presenter clarified that the lung was not fully re-expanded prior to discharge from the emergency room.
October 30, 2024 S - R - P Patient Case Discussions