Key result
Cardiac surgery after remote thoracic radiotherapy is linked to severe pleural thickening and fatal ventilatory failure.
Case Report (n=1)
No
This case highlights that cardiac surgery in patients with a history of mediastinal radiation and thymectomy can trigger or exacerbate severe diffuse pleural thickening, leading to fatal restrictive ventilatory impairment even in the absence of asbestos exposure.
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May precipitate fatal restrictive failure after cardiac surgery in remote radiotherapy patients; hypothesis-generating case leaves causal role and screening needs open.
A 64-year-old Japanese man presented with dyspnea and shortness of breath during exertion. Chest computed tomography revealed bilateral pleural effusion. He was drowsy because of CO2 storage and died due to ventilatory impairment. His past medical history included a thymectomy and adjuvant radiotherapy with thymoma. He had undergone cardiac surgery and permanent pacemaker implantation. The autopsy examination revealed extensive bilateral pleural adhesions and diffuse visceral pleural thickening. An inspection of multiple lung sections failed to detect any asbestos body formation or mesothelioma. The patient's pleural effusion and diffuse pleural thickening may have exacerbated after cardiac surgery. In this case, the progression and pathophysiology of the pleural thickening could be traced by imaging and an autopsy, and we were able to estimate the factors that exacerbated the pleural thickening and ventilation impairment.
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Touma et al. (2021) conducted a case report in Diffuse pleural thickening and ventilation impairment after cardiac surgery (n=1). Prior cardiac surgery (CABG, AVR, MVR) and thoracic radiotherapy was evaluated on Progression of diffuse pleural thickening and fatal ventilatory impairment. Cardiac surgery following remote thoracic radiotherapy was associated with severe diffuse pleural thickening (>3 mm) and fatal hypercapnic ventilatory failure (PCO2 76 mm Hg) on hospital day 90.
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