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Klippel-Trenaunay syndrome is characterized by a combination of vascular abnormalities and limb hypertrophy. Pleural effusion as a manifestation of this syndrome is almost never mentioned in the literature. We present a case of persistent bilateral pleural effusion in a patient with Klippel-Trenaunay syndrome and share our experiences treating this scenario., (© The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.)

Aim: Lung cancer screening reduces mortality. We aim to validate the performance of Lung EpiCheck, a six-marker panel methylation-based plasma test, in the detection of lung cancer in European and Chinese samples., Methods: A case-control European training set (n=102 lung cancer cases, n=265 controls) was used to define the panel and algorithm. Two cut-offs were selected, low cut-off (LCO) for high sensitivity and high cut-off (HCO) for high specificity. The performance was validated in case-control European and Chinese validation sets (cases/controls 179/137 and 30/15, respectively)., Results: The European and Chinese validation sets achieved AUCs of 0.882 and 0.899, respectively. The sensitivities/specificities with LCO were 87.2%/64.2% and 76.7%/93.3%, and with HCO they were 74.3%/90.5% and 56.7%/100.0%, respectively. Stage I nonsmall cell lung cancer (NSCLC) sensitivity in European and Chinese samples with LCO was 78.4% and 70.0% and with HCO was 62.2% and 30.0%, respectively. Small cell lung cancer (SCLC) was represented only in the European set and sensitivities with LCO and HCO were 100.0% and 93.3%, respectively. In multivariable analyses of the European validation set, the assay's ability to predict lung cancer was independent of established risk factors (age, smoking, COPD), and overall AUC was 0.942., Conclusions: Lung EpiCheck demonstrated strong performance in lung cancer prediction in case-control European and Chinese samples, detecting high proportions of early-stage NSCLC and SCLC and significantly improving predictive accuracy when added to established risk factors. Prospective studies are required to confirm these findings. Utilising such a simple and inexpensive blood test has the potential to improve compliance and broaden access to screening for at-risk populations., Competing Interests: Conflict of interest: M. Gaga has nothing to disclose. Conflict of interest: J. Chorostowska-Wynimko reports grants, personal fees and non-financial support from Grifols, AstraZeneca, Pfizer, CSL Behring and CelonPharma, grants and personal fees from Boehringer Ingelheim, personal fees and non-financial support from MSD and BMS, personal fees from Amgen, GSK, Novartis, Chiesi, Roche and Lekam, outside the submitted work. Conflict of interest: I. Horváth reports personal fees from AstraZeneca, Novartis, CSL Behring, Boehringer Ingelheim, GSK and Berlin-Chemie, outside the submitted work. Conflict of interest: M.C. Tammemagi has served as consultant to Johnson & Johnson/Janssen, Medial EarlySign, Nucleix, bioAffinity Technologies and AstraZeneca. Conflict of interest: D. Shitrit has nothing to disclose. Conflict of interest: V.H. Eisenberg has nothing to disclose. Conflict of interest: H. Liang has nothing to disclose. Conflict of interest: D. Stav has nothing to disclose. Conflict of interest: D. Levy Faber has nothing to disclose. Conflict of interest: M. Jansen has nothing to disclose. Conflict of interest: Y. Raviv has nothing to disclose. Conflict of interest: V. Panagoulias has nothing to disclose. Conflict of interest: P. Rudzinski has nothing to disclose. Conflict of interest: G. Izbicki has nothing to disclose. Conflict of interest: O. Ronen has nothing to disclose. Conflict of interest: A. Goldhaber has nothing to disclose. Conflict of interest: R. Moalem has nothing to disclose. Conflict of interest: N. Arber has nothing to disclose. Conflict of interest: I. Haas has nothing to disclose. Conflict of interest: Q. Zhou has nothing to disclose., (Copyright ©ERS 2021.)

Introduction: Esophageal perforation is a serious disease which entails significant morbidity and mortality. Barogenic perforation (Boerhaave's type perforation) is considered as having a relatively poor prognosis. We present a case of barogenic perforation treated initially with surgery for primary repair leading to the formation of a control fistula. The esophageal fistula was treated successfully with endoscopic vacuum-assisted closure (VAC) system therapy. This case presents a complex condition of esophageal perforation initially treated with surgery for primary repair. After surgery the patient developed a control fistula from the esophagus to the operative drain in the pleural space. We treated the fistula with a VAC (Vacuum Assisted Closure) system that was endoscopically placed in the esophagus at the level of the fistula.

Background: Lung cancer is a leading deadly malignancy, both in men and women, with an increasing cancer diagnosis risk with age. Although thoracic surgery techniques have evolved and now include Video Assisted Thoracic Surgery (VATS), older operable lung cancer patients are still operated on less compared to the younger population. This study aimed at investigating the postoperative morbidity, mortality, and long-term quality of life in our pool of octogenarian patients., Methods: Octogenarians with newly diagnosed lung cancer at a clinical operable stage undergoing VATS procedures were reviewed. All patients had a clinical evaluation of their malignant stage. Patients' long-term quality of life (QOL) and performance status were evaluated using an institutional telephone questionnaire and the Karnofsky score at least 12 months postoperatively., Results: Between January 2009 to April 2012, 22 patients underwent VATS lobectomy (median age: 82 years). In four cases (18%) the procedure was converted to open thoracotomy. Patient follow-up periods ranged from 22 to 52 months. All but one patient were released to their homes. Lung malignancy was diagnosed in 19 patients. Pathological staging ranged from IA to IIB. Three patients had a non-malignant lung lesion on final pathology. Median postoperative hospital stay was 6 days. During the first 18 months post-surgery, no mortalities were recorded in this case study. The Karnofsky performance score yielded a median of 90. A telephone questionnaire revealed that all patients were free of operation-related physical limitations. All but one patient described the surgical experience as nontraumatic., Conclusions: Current findings support the belief that today surgeons should not deny octogenarian patients the possibility of oncological lung surgery based solely on the patients' chronological age.

Lemierre's syndrome (LS) is a rare potentially fatal sequel of head and neck infection, classically described as thrombophlebitis of the internal jugular vein (IJV) with cervical space infection extending into the thorax. Our objective was to answer the clinical question: "Does Lemierre syndrome (LS) from odontogenic infection differ from nonodontogenic LS in regard to clinical sequence, treatment, and survival." We reviewed the literature on the management of LS over the last two decades, with a focus on LS from odontogenic infection. Such a case is presented in order to portray the clinical sequence. Only 10 cases met the inclusion criteria (including the case presented). The recorded data were analyzed in comparison to large case series reviewing LS. Our data reflect the moderate differences in regard to IJV thrombosis and bacteriogram. There is an overall rise in published LS cases in the last 20 years. Odontogenic infection leading to LS is scarce, yet with survival rates similar to nonodontogenic LS. Repeated surgical interventions and aggressive wide spectrum antibiotic therapy remain the treatment of choice.

Objectives: Local breast cancer recurrence is often viewed as an early sign of rapidly progressive metastatic disease for which chest wall resection (CWR) can provide no benefits. We retrospectively reviewed our experience with full-thickness CWR to determine whether long-term outcomes warranted this aggressive procedure., Methods: Between 2001 and 2012, 33 women (mean age, 50.7 years; range, 33-72 years) underwent en-bloc CWR with curative intent. Mean disease-free interval from initial tumour resection was 90.5 months (range, 2-252 months). Resection included skin, muscle and an average of 2.7 ribs (range, 1-8 ribs) and was extended to the sternum (n = 21), subclavian vessels (n = 9), lung (n = 8), pericardium (n = 8), phrenic nerve (n = 2) or T1 nerve root (n = 1). Complete R0 resection was achieved in 31 (94%) patients. Chest wall reconstruction was performed in 28 patients, with polytetrafluoroethylene mesh (n = 17) or titanium ribs (n = 11). A musculocutaneous flap was used in 17 (52%) patients., Results: Postoperative morbidity was 36%, with no deaths. Median follow-up was 33 months (range, 3-96 months). Median survival was 69 months and 1-, 3- and 5-year survival rates were 100, 81 and 63%, respectively. Recurrence developed in 13 patients, including 12 with distant metastases. Disease-free survival rates were 77, 57 and 50% after 1, 3 and 5 years, respectively. By univariate analysis, only resection extended to intrathoracic structures was associated with better survival (P = 0.033)., Conclusions: En-bloc full-thickness CWR eventually extended to adjacent structures provides acceptable morbidity and excellent long-term survival and should be considered the treatment of choice in locally recurrent breast cancer.

Hydatid cysts are usually located in the liver and lungs. Skeletal echinococcosis is relatively rare and that of the rib is exceptional. Less than 50 cases of costal echinococcosis have been reported in the literature so far. To our knowledge, only one case report of thoracic outlet syndrome due to echinococcal cyst in the first rib was described in 1995. Accurate pre-operative diagnosis is important but may be challenging in some cases. Reported here is a case of echinococcosis of the first rib in a young adult who was presented with thoracic outlet syndrome. Plain chest radiograph, CT scan and MRI were performed. The imaging features were suggestive of a solitary aneurysmal bone cyst and the differential diagnosis included echinococcosis of the first rib. The lesion was completely resected and the histopathological examination confirmed the diagnosis of echinococcosis.

Background: Esophageal diseases vary in relation to geographic and behavioral factors. Whether benign or malignant, these diseases interfere with food swallowing. Surgical treatment is variable and aims at restoring the alimentary tract continuity. In this research the authors retrospectively studied esophageal pathologies and their surgical treatment in their department over a 6 year period., Patients and Methods: The records of all patients who underwent surgery for esophageal pathology in a single surgical department at a referral center between January 2002 and December 2007 were reviewed. Data that was collected included patient age, gender, type of pathology, staging, type and length of surgery, length of hospital stay, post-operative morbidity and mortality., Results: During the study period, 186 patients were operated for esophageal pathology, 154 (83%) had malignant disease and 32 (17%) had benign disease. The distribution of malignancy types was: adenocarcinoma 57%, squamous cell carcinoma 27%, signet ring cell carcinoma 8%, and other 8%. Median length of post-operative hospital stay was 27 days. Thirty two percent of the patients experienced complications, including anastomotic leak (10%), respiratory (9.5%) or cardiac (2%) complications, and infection (7.5%), while 3% required re-operation. Postoperative mortality rate in the hospital was 6.5%., Conclusions: The majority of patients undergoing esophageal surgery suffer malignancy, mainly adenocarcinoma. The surgery is extensive and is followed by a long recovery period, during which the patient is subject to a variety of complications. Mortality rate is significant yet comparable to centers around the world with high volume of esophageal operations.