Thoracic and Foregut Conditions

Hyperhidrosis is a condition that causes excessive sweating that is not necessarily related to the patient’s amount of activity. While hyperhidrosis is medically benign, it can affect a patient’s life in a negative way. Fortunately, there are ways to treat hyperhidrosis.

Symptoms of Hyperhidrosis
Most people sweat when they exercise, perform strenuous activities, or if they are nervous, anxious, or under stress. People with hyperhidrosis experience much more perspiration, and sometimes sweating can affect the person even while resting. Hyperhidrosis typically affects the hands, feet, underarms, or face. See your doctor if:

• You begin to sweat a lot more than normal
• You experience sweating at night for no apparent reason
• Sweating disrupts your daily life

Sudden excessive sweating may be a sign of a more serious condition. Call your doctor if you are also experiencing:

• Lightheadedness
• Chest pain
• Chills
• Fever
• Nausea

Causes of Hyperhidrosis
If there is no underlying cause, the condition is called primary hyperhidrosis. It may be hereditary, but it can also just be a characteristic of an individual. Another type, secondary hyperhidrosis, is excessive sweating that is caused by another underlying condition. These conditions include:

• Some medications
• Infectious diseases
• Heart attack
• Low blood sugar
• Diabetes
• Menopause
• Overactive thyroid
• Nervous system conditions
• Some cancers

Procedures and Treatments for Hyperhidrosis
Medical professionals can treat this condition with medications or with surgery. Prescription antiperspirants, nerve-blocking medications, Botulinum toxin injections, or even antidepressants can help control hyperhidrosis.

Knowing the underlying cause is sometimes the most important step in determining how to treat the condition, which sometimes involves surgery. The typical surgical treatment for this condition is an Endoscopic Thoracic Sympathectomy.

Endoscopic Thoracic Sympathectomy
This procedure, often abbreviated by ETS, is a minimally invasive procedure that severs the nerves responsible for causing excessive sweating. The surgeon makes small incisions and uses small tools with cameras attached to aid in the clipping of the nerves. This procedure is normally a last resort and is done only if the patient’s hyperhidrosis cannot be controlled with medications.

A diaphragmatic hernia is a condition in which there is an abnormal opening in the diaphragm through which other organs of the body are protruding. Most often, a diaphragmatic hernia is a birth defect, but it can also occur from trauma. It is more common on the left side, and it can also severely affect lung and heart function.

Symptoms of Diaphragmatic Hernias
Some signs of the condition include:

• Rapid breathing
• Fast heart rate
• Blue discoloration of the skin
• Diminished breath sounds

Procedures and Treatments for Diaphragmatic Hernias
Hernias of the diaphragm are a medical emergency and require surgery. Surgeons can perform these repair surgeries as minimally invasive or open procedures. The surgeon will determine the best way to access the diaphragm, put the organs back in the correct placement, and repair the opening in the diaphragm.

Eventration of the diaphragm is an abnormal shape in the dome part of the diaphragm, which causes it to be much higher in the chest cavity than normal. Because of the incorrect placement of the organ, it cannot properly contract and can cause breathing problems or other issues. Normally, this is a congenital condition but can result from nerve issues or a thin diaphragm at birth.

Symptoms and Causes of Diaphragmatic Eventration
This condition is sometimes asymptomatic. Patients may experience the following symptoms:

• Breathlessness
• Cough
• Recurring pneumonia or bronchitis
• Arrhythmias
• Pressure on the stomach
• Chest pain

This condition is typically congenital, so it most often presents in children. In adults, damage to the phrenic nerve, potentially from injury, infection, or cancer, usually causes this condition.

Procedures and Treatments for Eventration of the Diaphragm
Only those with a severe form of the condition typically need surgery. The most common surgery to treat eventration is a diaphragmatic plication. Surgeons can perform this surgery as an open operation or a minimally invasive one.

During this procedure, the patient is put under general anesthesia, and multiple sutures are put into the top of the diaphragm. The diaphragm becomes “pleated” and tauter so that it is lowered to the correct position in the chest.

Mediastinal tumors are cancerous or benign growths in the mediastinum, which is the chest cavity that contains the heart, esophagus, trachea, and aorta. Both benign and malignant mediastinal tumors can be serious due to the pressure they cause on the important surrounding organs. There are three main kinds of mediastinal tumors.

Thymoma
Thymoma is a disease in which malignant cancer cells grow on the surface of the thymus. The thymus is a small organ in the upper chest that makes white blood cells and helps protect the body against infections.

Lymphoma
Lymphoma is cancer that begins in lymphocytes, or the infection-fighting cells of the immune system. Non-Hodgkin and Hodgkin are the two types of lymphoma; they each affect different types of lymphocytes and require different courses of treatment.

Germ Cell Tumor
Germ cell tumors form from the type of immature cells which later would develop into eggs or sperm. These tumors can be malignant, but most are noncancerous.

Symptoms of a Mediastinal Tumor
Symptoms often present as a result of the pressure that the tumor is causing on other surrounding organs. Some possible signs of a mediastinal tumor include:

• Chills
• Fever
• Chest pain
• Shortness of breath
• Coughing (sometimes with blood)
• Hoarseness
• Unexplained weight loss
• Swollen lymph nodes
• Wheezing
• Stridor (high-pitched noise while breathing)

Procedures and Treatments for Mediastinal Tumors
The type of treatment will depend on the type of tumor, whether or not it is cancerous, the patient’s general health, and the technique of the physician.

Thymomas usually require surgery after chemotherapy or radiation. Lymphomas typically are treated with both chemotherapy and radiation. Germ cell tumors are treated with surgery and may be coupled with other treatments if the tumor is cancerous. Most often, these surgeries are minimally invasive approaches, but they can also be performed as open operations.

Lung nodules are small masses of tissue in the lungs that may or may not be cancerous. They are fairly common and are benign in most cases. The larger the nodule, the more likely it is to be malignant. Noncancerous lung nodules can be caused by previous infections and don’t always require treatment.

Symptoms of Lung Nodules
Benign nodules usually don’t have symptoms and are most often found during routine scans or exams. However, nodules can cause the following symptoms:

• Coughing
• Wheezing
• Shortness of breath
• Fever
• Pneumonia

Procedures and Treatments for Lung Nodules
More often than not, lung nodules are benign, small, and don’t need treatment. Your doctor will probably observe the nodule over time to look for changes and growth that might suggest cancer. If cancer is present, treatment may include chemotherapy, radiation, or targeted drug therapy.

If you need surgery for the benign or cancerous nodule, it probably will be done with a minimally invasive approach if possible. Your surgeon may remove a small section of the lung that contains the tumor, a larger section, a whole lobe, or an entire lung. Your physician will decide the best course of treatment.

Pectus Excavatum is a condition in which a person’s breastbone is sunken into the chest, sometimes leaving a deep visible dent in the center of the chest. Usually, the condition is noticed at birth but becomes more severe as growth into adolescence occurs.

This condition is more common in males than females, and its exact cause is unknown. If the condition is severe enough, it can interfere with heart and lung function.

Symptoms of Pectus Excavatum
Patients with this condition might need treatment if they experience the following symptoms:

• Recurrent respiratory infections
• Coughing and wheezing
• Chest pain
• Heart murmur
• Heart palpitations
• Decreasing exercise tolerance
• Fatigue or weakness

Procedures and Treatments for Pectus Excavatum
Physical therapy might be enough to treat mild cases of the condition, but most often, surgery is required to relieve the patient of their symptoms.

Pectus excavatum can be surgically repaired by removing deformed cartilage and placing the breastbone in the proper location with structural supports, or by placing curved metal bars under the breastbone to lift it. The bars are typically removed about two years later if the sternum has raised to a normal position.

Pectus carinatum is an uncommon congenital condition that causes the sternum to protrude outward. This condition sometimes isn’t apparent until after an adolescent growth spurt. Most often, this condition is an aesthetic concern, but it can affect breathing and cause shortness of breath.

Procedures and Treatments for Pectus Carinatum
For children whose bones are still growing, and for those who have a less severe form of the condition, a brace that helps flatten the chest is typically the best treatment option. When the condition is severe or the bones are no longer growing, pectus carinatum may need to be treated surgically by altering the placement of cartilage and bone inside the chest.

Chest wall tumors are masses in the chest that can interfere with lung function. About half of all chest wall tumors are benign (noncancerous). There are many kinds of these tumors, but most malignant chest wall tumors are caused by metastasis from cancer in other organs.

Symptoms of Chest Wall Tumors
Oftentimes, these tumors are made up of soft tissues and do not cause symptoms, aside from those associated with cancers. Patients may have fevers and pain when the tumor has advanced. Hard tissue tumors, like those made of cartilage or bone, are usually very painful at the site.

Procedures and Treatments for Chest Wall Tumors
If the tumor is cancerous, the patient will usually undergo chemotherapy or radiation for treatment. Both benign and malignant masses may need to be surgically removed. With details depending on the type of mass and its location, the tumor will be surgically resected and the area will be reconstructed. These procedures can be either minimally invasive or open operations.