An uncommon presentation of cystic pachypleuritis successfully treated by uniportal VATS—case report

Marco Chiappetta, Dania Nachira, Maria Teresa Congedo, Gian Maria Ferretti, Amedeo Iaffaldano, Leonardo Petracca Ciavarella, Elisa Meacci, Stefano Margaritora

Abstract

We herein report the uncommon presentation of a cystic pleuritis affecting a young woman. The patient presented chronic and continuous right posterior interscapular pain, so a chest X-ray detected an apical superior mass confirmed at the computed tomography. In particular, it was 8×6.5 centimeters, occupying the right apex with compression on the right upper lobe, also if it was difficult to determinate if it originated form the lung or from the pleura. Considering the dimension and the presence of symptoms, surgery was indicated performing an uniportal video assisted thoracic surgery (VATS) approach to investigate the nature and to provide to the resection. Intraoperatively, the mass presented a smooth hyaline surface and had a large implant on the parietal pleura, completely covering the apex, while a small tenacious region of contact with the lung parenchyma was present. So, after a small wedge resection and aspiration of the fluid content, obtaining more operative space and easier mobilization of the mass, a complete resection was possible through an uniportal access, despite the initial dimension and rigidity. The histologic exam described the presence of a chronic cystic pleuritis, un uncommon pleural disease that in this case was characterized by a single giant symptomatic pleural cyst, successfully treated using an uniportal VATS approach. We present the following case in accordance with the CARE guideline.