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Recently published #thoracic case report: Robotic-assisted thoracoscopic left secondary carinal resection and reconstruction with lung preservation for bronchial squamous cell carcinoma. Read now in #JTCVS Techniques:

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AATS

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24,956 просмотров • 5 месяцев назад •via X (Twitter)

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✅ CT Reveal – Teaching Case CT pulmonary angiography – Lung and soft-tissue windows In this 22-year-old male with acute hemoptysis and hemoglobin drop, CT shows: ✔ Focal pulmonary hemorrhage involving the right middle and lower lobes. ✔ Expansion of the bronchus intermedius filled with an endobronchial soft-tissue lesion. ✔ Hemorrhage is downstream to the obstructed bronchus, explaining the lobar distribution seen on chest X-ray. 🎥 Lung and mediastinal window clips demonstrate the airway abnormality clearly. This confirms that the bleeding source is airway-related, not primary parenchymal or pulmonary arterial disease. ⸻ ✅ Bronchoscopy and Final Diagnosis Bronchoscopy revealed a large intrabronchial blood clot, and the patient was referred to thoracic surgery with the diagnosis of: 👉 Bronchial Dieulafoy disease. ⸻ ✅ What is Bronchial Dieulafoy Disease? Bronchial Dieulafoy disease is a rare vascular anomaly of the bronchial wall characterized by: •A dilated, tortuous submucosal artery that protrudes into the bronchial lumen. •Normal surrounding mucosa until rupture occurs. •Sudden, often massive hemoptysis, usually in young or middle-aged patients. •CT may show only indirect signs (endobronchial filling, clot, focal hemorrhage), while bronchoscopy and angiography are key for diagnosis and treatment. 📌 Biopsy is dangerous because it can trigger catastrophic bleeding. 📌 Management includes bronchial artery embolization or surgical resection when needed. ⸻ ✅ Teaching Points ✔ Always differentiate focal versus diffuse pulmonary hemorrhage. ✔ Focal, lobar hemorrhage should prompt careful evaluation of the airways. ✔ CT angiography must be reviewed in both lung and mediastinal windows, tracking the bronchi. ✔ Rare entities like Bronchial Dieulafoy disease can mimic tumors or mucus plugs on CT.

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When performing complex lung operations a plan for PA control is critical These bulldog clamps by Scanlan International (I have no COI) are a must have available for every robotic lung case. Extrapericardial proximal PA control on the left & distal PA control at interlobar PA:

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