Completion lobectomy is a complex procedure performed mostly in tumor recurrences or after the presence of complications like lobar torsion or bronchopleural fistula. This operation is generally done via re-thoracotomy. Here, we present a case of completion middle lobectomy via videothoracoscopy after an upper lobectomy by thoracotomy.

Background: Mediastinal lymphadenopathy (MLAP) is observed in various conditions of malignant or benign diseases. The two common diseases leading to MLAP are mediastinal lymphomas and sarcoidosis. The aim of study is to describe distinctive lymph node involvement patterns with sarcoidosis and lymphoma defined by PET-CT. Materials and Methods: 82 patients (45 women and 37 men) with a median age of 53.5 (21-88) years who had PET-CT for differential diagnose for MLAP were evaluated retrospectively. 31 (37.8%) patients diagnosed sarcoidosis, and 51 (62.2%) lymphoma that had histologically proven by various surgical procedures. Results: There were no statistical difference between gender, age and average SUV max of groups (p = 0.068, p = 0.846, p = 0.338). 26 of 31 patient (83.9%) of sarcoidosis group had abnormal findings compared the lymphoma group (51.0%) which showed statistically significant difference (p = 0.003). Meanwhile there were no statistical difference between hilar lymph nodes and liver involvement among the groups (p = 0.239 and p = 0.917), cervical, axillary, abdominal lymph nodes and spleen involvement was significantly higher in the lymphoma group (p = 0.008, p < 0.001, p < 0.001 and p = 0.001). Bone marrow (BM) involvement were also significantly higher in lymphoma group (p < 0.001). Conclusions: There are no specific MLAP findings to differentiate sarcoidosis from lymphomas by PET-CT. It is more likely that the pathological conclusion will be consistent with lymphoma rather than sarcoidosis, in case of involvement of cervical, abdominal and axillary lymph nodes, spleen and BM involvement; however abnormal pulmonary parenchymal findings are in the favor of the diagnosis of sarcoidosis.

Congenital lobar emphysema (CLE) is a rare developmental anomaly of the lower respiratory tract, which generally presents during the neonatal/pediatric period. Lobectomy is the only curative treatment for CLE. An 18-year-old male with enlarging left anterior chest wall deformity and progressive breathlessness for the last 2 years admitted to our clinic. Physical examination revealed asymmetrical expansion of left hemithorax. Chest radiography and thoracic computed tomography demonstrated hyperinflation of the left upper lobe and a mediastinal shift to the right side. FEV1 was 1.70 L (50%). Ventilation-perfusion scintigraphy showed reduced perfusion and ventilation in the right lung to 33.4% (upper zone, 1.9%; middle zone, 10.0%; lower zone, 22.5%). Patient underwent a successful video-assisted thoracoscopic surgery (VATS) left upper lobectomy, and was discharged on postoperative day 5. He is still being followed-up on fifth year, asymptomatically, with normalized chest wall appearance. VATS lobectomy is a feasible, safe and effective treatment for congenital pulmonary disorders, even for delayed cases.