Abstract
Introduction: Thoracoscopic-assisted resection of thoracic aneurysmal bone cyst has never been described in the literature. Infantile cartilaginous hamartoma of the rib is a large tumor characterized by cartilaginous, vascular, and mesenchymal elements. Most cases are diagnosed before the age of one year due to their rapid rate of growth and expansion. Aneurysmal bone cysts usually arise secondary to a pre-existing tumor, and are known for their hypervascularity. Use of preoperative embolization is one technique that has been described in the literature to facilitate resection of aneurysmal bone cysts and to avoid complications from hemorrhage. This is a presentation of the case of a ten-month-old boy with a large chest wall mass, confirmed by computed tomography guided biopsy to be a chest wall hamartoma with secondary aneurysmal bone cyst. Preoperatively the patient had an episode of hemorrhage into the mass requiring blood transfusion. Due to the concern for major hemorrhage during the procedure, the mass was first evaluated thoracoscopically and control of its major blood supply was planned for prior to open resection.
Methods: The patient was taken to the operating room, where three thoracoscopic ports were placed in the left chest. Using blunt dissection and electrocautery, three separate intercostal neurovascular bundles were isolated anterior and posterior to the mass. The neurovascular bundles were then divided using a harmonic scalpel. All thorascopic ports were then removed and formal open resection of the rib from which the mass was emanating was performed.
Results: It was found that the blood supply had been adequately controlled with the thorascopic ligation of the intercostals with an estimated blood loss of 40 cc for the entire procedure.
Conclusion: The use of thoracoscopy can facilitate obtaining control of the blood supply of large chest tumors prior to open resection.
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