By Dr. Kamran Ali, Senior Consultant, Thoracic & Robotic Surgeon The Invisible Heritage of Tuberculosis: A War That Rages On Tuberculosis (TB) can be cured, but for millions of people worldwide, and especially here in India, it leaves behind a ruinous, life-changing legacy: the Tuberculosis-Ruined Lung (TDL). TDL is not an active infection state but the aftermath of the body’s intense, scarring response to the initial fight. It consists of widespread, irreversible damage—collapsed airways, huge cavities, hardened, fibrotic tissue, and shrunk lung lobes that are functionally useless. This devastation leaves behind a ticking time bomb of major complications, pushing patients into a cycle of fear and chronic illness. If you or a relative are living with a ruined lung, you understand the daily experience: the chronic cough, the fight for air, and the debilitating fear of hemoptysis. I want to provide a message of simplicity and, most importantly, hope. For these multifaceted, end-stage complications of TB, expert thoracic surgery quite often is the sole hope for an absolute cure, enhanced quality of life, and long-term liberation. Part I: Defining the Destroyed Lung Syndrome The “destroyed lung” is a term applied when one or more lobes, or even a whole lung, are structurally collapsed, permanently scarred, and unable to function normally as a result of post-infectious scarring. Why Does the Destroyed Lung Need Surgery? A destroyed lung is more than dead weight; it is a cause of serious, life-threatening complications. These are: For uncontrolled hemoptysis patients, recurrent infections on maximal drug therapy (particularly MDR/XDR-TB), or chronic empyema, an exclusively medical solution is inadequate. Surgical excision of the affected tissue becomes a life-saving imperative. Part II: The Pre-Operative Imperative – A Strict Assessment Surgery on a destroyed lung is technically challenging and has a more risky profile than standard lung surgery. Why? Because pathology is old—the scarring is dense, structures are distorted, and blood supply is frequently massive and abnormal. So our multi-modal assessment is the most important phase. The Three Pillars of Pre-Surgical Clearance: Part III: The Surgical Strategy – Resection and Reconstruction The operation itself is based on the degree of injury. Our desire is always for maximal parenchymal-sparing operation—taking away only that which is required to be rid of infection and bleeding source, but leaving every last functioning air sac intact. 1. Lobectomy (The Preferred Lung-Sparing Approach) In more than 70% of post-TB sequelae cases, damage is limited to one or two lobes (usually the upper lobes). 2. Pneumonectomy (The Last, Life-Saving Resort) This is the total removal of one entire lung. This is reserved for situations in which the disease has destroyed all lobes of a single lung, or in a situation in which a massive, potentially life-threatening hemorrhage cannot be arrested otherwise. 3. Decortication and Thoracoplasty Part IV: The Technical Challenge: Operating in a “Frozen Chest” Surgical treatment of a collapsed lung is a far cry from surgical treatment of cancer. Cancer entails dissecting clean tissue, whereas TB surgery entails working in a thick field of fibro-vascular adhesion—a “frozen chest” situation. The Role of Advanced Minimally Invasive Techniques (VATS) Although a standard Thoracotomy (open chest procedure) is usually necessary because of the thickness of the scarring and the necessity for emergent control of catastrophic bleeding, my staff makes every effort to use Video-Assisted Thoracoscopic Surgery (VATS) when possible. Part V: Recovery, Risk, and Long-Term Outcomes The postoperative course during the initial time is intense, though the long-term prognosis of meticulously selected patients is significantly improved. Most Significant Post-Operative Complications and Prevention Surgery on a destroyed lung is risky, and we need to be open about possible complications. The three main issues are Bronchopleural Fistula (BPF), Post-Pneumonectomy Empyema (PPE), and Respiratory Failure. To actually reduce these risks, we use careful, specialized procedures. The danger of BPF, a feared complication that occurs when there is a leak from the bronchial stump into the chest space, is reduced by our Careful Stump Closure and Reinforcement technique. To leave a second, strong sealing layer, this involves not just employing a surgical staple line but buttressing the stump with healthy tissue, like an intercostal muscle or pericardial flap. Moreover, Post-Pneumonectomy Empyema (PPE), infection of the cavity the lung once occupied, is avoided through Meticulous Hemostasis and Prevention, involving strict infection control practices, the employment of specific chest drains, and individually customized post-operative antibiotic protocols. Lastly, the danger of Respiratory Failure—the second lung being incapable of fulfilling the load—is best avoided by strictly following Rigorous Pre-operative PFTs. We don’t operate on patients who have an established, safe level of predicted post-operative lung function, preserving their existing lung capacity, which is sufficient to live a healthy life. The Long-Term Promise: A New Lease on Life Although difficult, the results affirm the curative potential of this operation: Select Specialized Expertise for This Defining Surgery Surgery on a destroyed lung is perhaps one of the most demanding procedures in the entire field of thoracic surgery. It demands not only a skilled surgeon in complex resection but also an experienced surgeon at working within the fibrotic, high-risk environment that tuberculosis creates. My global education in high-volume thoracic surgery, my expertise with high-volume cases, and my commitment to multi-drug resistant TB surgery ensure that your case is treated with a sole emphasis on safety, technical perfection, and long-term cure. If you are surviving with a damaged lung, do not surrender to the fate of chronic disease. Operative therapy, when undertaken by a committed thoracic expert, provides a strong route back to wellness.

Facing the Diagnosis: You Are Not Alone Let’s begin here: When you hear the words “lung cancer,” everything shifts in a split second. It’s only human to feel shock, fear, and a thousand questions racing through your mind. If you are reading these words, let me assure you that you are not merely a medical record to me. You are an individual, a parent, a friend, or co-worker, and you deserve an open, supportive explanation of what lies ahead. My aim in writing this isn’t to enumerate procedures. It’s to enable you with knowledge we apply daily to combat this disease. For most people, particularly if detected early, surgery is the best hope to defeat lung cancer and get your life back. We’re here in Delhi, delivering world-class skill to your bedside, poised to take this journey along with you. Our commitment is not only to your tumor, but to your overall well-being, so that you are not only seen and heard, but cared for, as well, during this gargantuan battle. What We’re Fighting: Knowing Your Enemy Inside and Out We must learn about the enemy before we attack. Look, lung cancer is really abnormal cell growth, but knowing the type and the stage determines our exact, customized strategy. Look, this intimate knowledge is the key to our curative mission. The Two Primary Forms of Lung Cancer: Risk Factors: Beyond Smoking Although tobacco use is still the number one offender, it is essential to recall that lung cancer can hit anyone. Other important risk factors we discuss are: Catching It Early: The Power of Proactive Screening The worst thing about early lung cancer is that it rarely screams. It whispers, or occasionally, it’s silent. That’s why if you’ve had a history of excessive smoking (30 pack-years or greater) or prolonged exposure to risk factors, inquiring with your physician regarding Low-Dose Computed Tomography (LDCT) Screening isn’t being cautious—it’s being a hero for your own future. This straightforward, once-a-year, painless scan has been shown in large clinical trials to save lung cancer lives by as much as 20% by detecting tumors when they are still small, localized “dots” that are completely curable with minimal invasiveness. If you develop a cough that simply refuses to go away (particularly if it changes character), pain in the chest (not due to strained muscles), or, worst of all, coughing up blood (hemoptysis), don’t wait. Have us see you at once. The Road Map: Highly Detailed Diagnosis, Staging, and Personalized Teamwork Your treatment starts long before you ever go into the operating room. It starts with a close, detailed examination to determine your cancer and how well your body can heal. Getting the Final Answers: The role of the pathologist: When diagnosing cancer, our pathologists don’t take it easy. They pinpoint the specific genetic alterations (such as PD-L1 expression, ROS1, ALK, or EGFR). Whether you require immunotherapy or targeted therapy prior to (adjuvant) or following (neoadjuvant) surgery, this genetic signature will serve as the guiding light. Our Multidisciplinary Huddle We never make a plan in isolation in our Delhi practice. Each patient’s case is presented to our weekly Thoracic Oncology Tumor Board meeting. We build a dedicated team—Thoracic Surgeons, Medical Oncologists, Radiation Oncologists, Pulmonologists, and Pathologists—and we all sit together with you to talk about your stage, genetic profile, and medical condition until we create the best, most personalized, evidence-based plan for you. This integrated, team-based process is the global standard of care for cancer treatment. The Surgical Strategy: Resecting the Threat and Sparing Function If surgery is warranted, our initial goal is simple: remove the cancer completely (the oncological priority) while preserving as much healthy lung function as possible (the quality-of-life priority). Range of Lung Resection Procedures: Key Step: Systematic Lymph Node Dissection Regardless of the extent of lung resection performed, we consistently perform a methodical and complete dissection of all of the lymph nodes in the chest space, commonly 6-12 stations. This is a significant step: it irrevocably tells us the true stage of the cancer and destroys possible microscopic disease, much reducing the chance of recurrence and directing the need for follow-up therapy. Why Less is More: Our Commitment to Minimally Invasive Excellence The era of large, painful chest incisions is rapidly fading. My commitment, refined through advanced fellowships, is to use the least invasive method possible. The transition from open surgery (thoracotomy) to VATS and Robotics is the biggest advancement in thoracic surgery in the last three decades. Instead of a single large incision that spread the ribs, we use three or four small finger-sized cuts (keyholes) and a high-definition camera (thoracoscope). The highest level of VATS is robotic surgery, which uses sophisticated platforms. I operate from a console using tiny, articulated robotic arms that convert my hand motions into tiny movements inside your chest. By far the majority of our patients are suitable for these minimal access methods, and the benefits—speedier return to work, earlier resumption of any future follow-up chemotherapy that might prove necessary, and reduced pain—are undeniable to improve both physical and emotional recovery. Potential Risks and How We Prevent Them Though we stress the positives, we must warn of the possible dangers of any major surgery to the chest. Honesty is the essence of informed consent. Our experts are trained to identify and treat these complications quickly, providing the utmost level of safety during your hospitalization. The Adjuvant and Neoadjuvant Choice: An Over-all Strategy Surgery is rarely the last word in therapy, but instead an essential piece within a multi-modal approach. This decision is tailored to your own tumor status, your own genetic data, and your own general health, so that every resource of modern oncology is marshaled in your service. The Healing Journey: Recovery, Physiotherapy, and Inner Resilience Surgery is successful if the tumor is removed. The process is successful when you are well, you are recovered, and you are living your life. This phase of the journey is personal and requires a fullness of time. The

Breathing is a silent, essential part of life until it isn’t. It starts quietly, with a bit of shortness of breath or a lingering cough. For a long time, you might think it’s normal to feel winded on the stairs. But eventually, it affects your life. You stop engaging in activities you love. You avoid walks, decline family outings, and may even hesitate to play with your grandkids. The world feels smaller, and a quiet panic sets in. That’s when you realize you need a real solution. Honestly, searching for a specialist for something as serious as a lung or chest problem can be terrifying. You want someone who can literally hold your life in their hands. That’s why I want to introduce you to Dr. Kamran Ali as leading thoracic surgeon in gurugram. He’s the kind of doctor who doesn’t just treat the issue; he understands what you’re going through. The Master of a Delicate Chamber: The Role of a Thoracic Surgeon In the complex world of medicine, specialists are crucial. But when it comes to your chest and lungs—literally the most delicate area of your body—you can’t just see a general doctor. You need a thoracic surgeon. They’re the unique experts whose job is entirely focused on this vital, fragile space, and that’s what makes them different. A thoracic surgeon dedicates their career to the intricate network of organs within the chest, such as the lungs, windpipe, esophagus, and diaphragm. They have the specialized knowledge and surgical precision needed for vital and sensitive procedures. Dr. Kamran Ali’s expertise in this field ensures you are in the most qualified hands. The big reason Dr. Kamran Ali has such a strong reputation isn’t luck—it’s because he has a tireless drive to master his craft. After more than a decade as a surgeon, he knew he had to seek out the best global knowledge. He went all the way to Austria to study the difficult process of lung transplants, and he was even part of the team for one of Europe’s first lung transplants on a patient recovering from a severe COVID case. He is a surgeon ready for any challenge! He personally brought back new skills, learning cutting-edge cancer techniques in Japan and mastering minimally invasive surgery in Korea. He truly brings that world-class experience right to our doorstep. This global experience means Dr. Ali brings an international standard of care to his practice in Gurugram. Patients don’t have to travel far to receive cutting-edge treatment. He has been recognized for his contributions to the field, publishing over 25 articles in medical journals and representing “Team Asia” in international competitions—a testament to his expertise. The Surgical Approach: Precision that Changes Lives For many patients, the thought of traditional surgery—with large incisions and long recovery—can be scary. Dr. Kamran Ali and his team follow a ‘less is more’ philosophy, using the most advanced, minimally invasive techniques available. When Dr. Ali approaches any case, his core principle is gentleness. When he can, he uses modern methods like VATS (keyhole surgery). It lets him do complex procedures using just a tiny camera and small cuts, which means a lot less pain, tiny scars, and you get back on your feet much faster. He also uses Robotic Surgery, which is incredible. He operates from a console, and the robot mirrors his movements, but with unmatched steadiness and 3D precision inside your body. It’s the highest level of care and precision you can get. And if you’re ever dealing with an extreme emergency—say, lungs that need a total break—Dr. Ali has the expertise to use ECMO. This is basically a temporary artificial lung outside the body. It highlights his readiness for the absolute highest-risk situations, giving your body a critical chance to rest and recover. Of course, minimally invasive is his goal, but safety is the first priority. If a complex tumor means an open surgery (thoracotomy) is the safest and most effective way to save your life, he’ll explain exactly why. He never rushes; he makes sure you and your family are partners in that big decision. The Human Side of Care: A Commitment to a Full Recovery What really sets Dr. Kamran Ali apart is this: he treats the person, not just the file. He gets that this entire medical journey is terrifying, and he treats the emotions and the family right alongside the diagnosis. He Listens to Your Story: Forget just reports. He starts by listening to you. He wants to know your biggest worries, what your life looks like, and what your goals are. This human-first conversation is the starting point for everything. Dr. Ali believes that a confused patient is never a confident patient. That’s why he never throws around medical jargon. Instead, he uses simple, straightforward words—and often a quick diagram—to walk you through your condition and all your options. The result? You leave the consultation feeling completely empowered and clear about your next steps. Dr. Ali sees a serious diagnosis as a team effort, not a burden you carry alone. He includes your loved ones as essential partners in your care, making sure they have the knowledge they need. This inclusion helps strengthen your entire support system at every stage of your treatment. His care is continuous; it absolutely follows you home. The team sets you up for success right away, handing you a complete recovery plan loaded with specific breathing exercises and tailored physical therapy to guide your healing process. They guide you every step of the way, making sure you don’t just heal, but that you regain your full strength and independence. Stories of Transformation: Lives Reclaimed The true impact of Dr. Ali’s work shines through his patients’ stories—the real people who got their futures back. We all have heard a proverb doctors are like a God so I can say that Dr Kamran Ali is like God for us My husband was suffering from a disease since childhood and we didn’t know anything. Suddenly

Introduction Thoracic surgery is a branch of medicine that deals with surgical conditions of the chest — including the lungs, esophagus, mediastinum, and chest wall. For many patients, diseases such as lung cancer, pleural infections, or esophageal tumors require timely and advanced surgical treatment. However, access to specialized thoracic care can be limited or very expensive in certain countries. Over the last decade, India has gained recognition as one of the leading destinations for thoracic surgery worldwide. The combination of internationally trained surgeons, modern hospital infrastructure, and affordable treatment costs has made it a preferred choice for patients from the Middle East, Africa, Europe, and beyond. At Dr. Kamran Ali’s practice, we understand that traveling abroad for surgery can feel overwhelming. That’s why our team provides not just medical care, but a step-by-step, supportive pathway for international patients. This guide outlines every stage of the journey — from the very first consultation to long-term recovery — so patients know exactly what to expect. Step 1: Initial Consultation and Medical Records Review Your treatment begins before you even arrive in India. Through online consultations (video or phone), international patients can connect with our team and share their medical information. Typically, patients send us: What this step achieves: 📌 Example: A patient from Kenya once shared CT scans and lab reports through email. Within 48 hours, we provided a detailed opinion, suggested a minimally invasive thoracoscopic surgery, and guided the family on what to expect next. Step 2: Cost Estimate and Treatment Planning For many patients, the cost of surgery is a major concern. One of the strongest reasons people choose India is the value for money — the same world-class care at a fraction of the price charged in the US, UK, or Middle East. Here’s what we provide upfront: 📊 Approximate Cost Comparison: This allows patients to plan their journey with confidence, knowing there are no hidden surprises. Step 3: Visa and Travel Assistance To come to India for medical treatment, most international patients need a Medical Visa (M-Visa). This process can feel complicated, but our international patient desk makes it simple. We assist with: This ensures that patients and their families can focus on treatment, while we take care of the logistics. Step 4: Arrival in India and Pre-Surgical Evaluation After arriving in India, patients undergo a detailed pre-surgical assessment. This ensures surgery is both safe and effective. Common evaluations include: These tests allow the surgical team to fine-tune the treatment plan and choose the safest surgical approach. Step 5: Surgical Procedure The type of thoracic surgery depends on the patient’s condition. Indian hospitals offer both traditional and advanced approaches. Options include: Common procedures performed in India: All surgeries are performed under strict international safety protocols, ensuring high standards of care and outcomes comparable to leading global centers. Step 6: Post-Surgery Care and Recovery Surgery is just one part of the journey — recovery is equally important. At our center, post-operative care is personalized and comprehensive. Patients receive: 📌 Typical Recovery Timeline: Step 7: Discharge and Long-Term Follow-Up Before patients are discharged, we provide: For long-term support, patients can schedule telemedicine consultations with Dr. Kamran Ali even after returning home. This ensures continuity of care without the need for another international trip. Why International Patients Prefer India Patients across the world choose India for thoracic surgery not just because of cost, but because of the overall quality of care. 1. Globally Trained Surgeons Many Indian specialists, including Dr. Kamran Ali, have trained in prestigious institutions abroad and bring that expertise back to their practice. 2. World-Class Technology Hospitals in Delhi, Mumbai, and Chennai use advanced technology such as robotic surgery platforms, state-of-the-art ICUs, and modern imaging systems. 3. Cost-Effective Care Patients can save up to 70% compared to treatment in Western countries — without compromising safety or outcomes. 4. Complete International Support From translators to cultural dietary options, hospitals provide tailored services for patients coming from different parts of the world. 5. Compassionate, Patient-Centered Approach What sets India apart is not just the science, but the human touch. Surgeons like Dr. Kamran Ali believe in guiding patients with empathy, ensuring both medical and emotional needs are met. Frequently Asked Questions (FAQs) 1. How long will I need to stay in India for thoracic surgery? Most patients stay in the hospital for about a week, followed by an additional 2–4 weeks in India for observation before flying home. 2. Is thoracic surgery in India safe? Yes. Accredited hospitals in India follow global safety standards. Surgeons are internationally trained, and advanced techniques like VATS and robotic surgery ensure excellent results. 3. What is the cost of thoracic surgery in India? Depending on the procedure, the cost typically ranges between $8,000–$15,000, which is significantly more affordable compared to Western countries. 4. Can I bring a family member with me? Yes. Hospitals encourage patients to bring attendants and also help with accommodation and visa support. 5. How will follow-up care be managed once I return home? You will receive complete medical documentation and can continue follow-ups with Dr. Kamran Ali through online consultations. 6. Why choose Dr. Kamran Ali? Dr. Kamran Ali is recognized for his expertise in minimally invasive and robotic thoracic surgery, high success rates, and compassionate patient care. He combines modern surgical skills with a patient-first philosophy. Conclusion Traveling abroad for surgery is a big decision, but India has become a trusted choice for patients worldwide thanks to its blend of advanced expertise, affordability, and personalized care. At Dr. Kamran Ali’s practice, we go beyond simply treating a disease — we focus on the entire patient journey. From the first online consultation to safe travel back home, our goal is to make the process clear, comfortable, and successful. 🌍 If you or a loved one are considering thoracic surgery in India, let us guide you every step of the way. With world-class care and compassionate support, you can begin your journey to better health with confidence. 📞 Contact Dr.

When we think about breathing difficulties we typically think of asthma, lung infections, or heart disease to name a few. Eventration is one of the many issues that could cause the muscle responsible for most of our breathing (the diaphragm) to provide insufficient respiratory support leading to chronic shortness of breath and negative impact on daily quality of life. As a thoracic surgeon Dr. Kamran Ali sees many patients with unexplained breathlessness. Too often these patients are shocked that their breathlessness is due to some issue with the diaphragm which they never associated with the breathing issues they have. This article will explain how diaphragm problems (such as diaphragmatic eventration) can cause breathlessness, what symptoms to look for, how they are diagnosed, and what the treatments are. What Is the Diaphragm and Why is it Important? The diaphragm is a large dome-shaped muscle underneath the lungs, which separates the heart and lungs in the chest cavity from the abdominal cavity. Every breath we take relies on the diaphragm; it contracts and flattens so that our lungs can fully expand and fill with air, while elastic recoil (breathing out) results from the diaphragm relaxing, and our lungs can then expel carbon dioxide. In short: Therefore, even though the lungs themselves may be normal if the diaphragm is abnormal, the diaphragm has the potential to cause breathlessness or fatigue or poor exercise tolerance. What is Diaphragmatic Eventration? Diaphragmatic eventration is when part of the diaphragm or the diaphragm is abnormally elevated due to a thinning or weakness of the muscle. In contrast to a diaphragmatic hernia, in which an actual defect or hole is present, the diaphragm is intact with eventration but is just not functioning well. Characteristics of eventration are: The decreased movement means that there is less room for the ipsilateral lung to expand, meaning that the individual will perceive shortness of breath to a greater extent in situations requiring exertion. Causes of Diaphragm Eventration Eventration of the diaphragm can either be congenital (present at birth) or acquired (after birth). 1. Congenital Causes •Incomplete development of the diaphragm muscle while in utero. •Often found in children but can lay latent until found in adulthood. 2. Acquired Causes •Fracture of the phrenic nerve (the nerve that controls movement of the diaphragm) which can occur following: •Surgery (notably heart surgery, thoracic or chest surgery). •Trauma or accident. •Tumors found that press on the nerve. – Infections : polio, viral, and neuropathy. – Idiopathic : no cause. What Does Eventration Do to Breathing? Breathing changes (bio-medical term: Dyspnea) come about as your diaphragm can no longer contract and/or relax. Mechanism: In patients with severe chest wall difficulties, you may also find that they now experience orthopnea (difficult breathing when lying flat), if chest wall mechanics is affected so severely, that lung expansion is poor and the patient has repeated bouts of chest infections. Signs of Diaphragmatic Eventration While not everyone will experience symptoms (especially those with mild cases), many people have clear symptoms, including: •Persistent shortness of breath (especially on exertion)                        •Difficulty lying flat or requiring extra pillows to sleep                            •Tight or discomfort in the chest                 •Repeated respiratory infections •Loss of physical capacity •Fatigue and inattentiveness due to low oxygen readings •In children, symptoms may include: failure to thrive, repeated pneumonia, or noisy breaths. How does diagnosis of Eventration occur? Proper diagnosis is crucial, as symptoms can resemble a lung or heart issue. Thoracic surgeon, Dr. Kamran Ali, will likely use some or all of the following tests: 1. Chest X-Ray – This will show an abnormal rise of one side of the diaphragm. 2. CT Scan or MRI – Provides detail for ruling out hernia, tumour, or other lung pathology. 3. Fluoroscopy with Sniff Test – Observes the diaphragm in real-time. – If the diaphragm was not moving correctly, or moves in a paradoxical fashion (i.e. opposite direction during breathing), this would indicate suspicion for eventration. 4. Ultrasound of the Diaphragm – Is non-invasive test looking at diaphragm thickness and movement. 5. Pulmonary Function Tests (PFTs) – Measures lung capacity, which is usually decreased in eventration. 6. Electromyography (EMG) in selected cases (neurogenic causes?) – Tests nerve supply to the diaphragm. No, not all diaphragm problems can cause breathlessness. • A mild eventration may be without symptoms and found incidentally on x-ray. • Severe eventration or bilateral involvement will almost always cause breathlessness. • Other diaphragm related conditions that can cause breathing problems include: So generally, not all elevations of the diaphragm cause problems for the patient, but if an eventration is diagnosed, then if any symptoms develop the patient should seek medical attention. Treatment Considerations for Diaphragmatic Eventration Treatment is guided by symptom severity and the underlying cause. •Surgery is not needed right away if the eventration is mild and the patient has no symptoms. •Changes in activity and lifestyle: Surgical treatment may be appropriate for patients that have marked breathlessness or recurrent infections. Diaphragmatic plication is the procedure most commonly performed: •The paralyzed diaphragm is folded and stitched to itself, shortening it. •Lowering the elevated diaphragm results in the lung having more room to expand. •Surgery is then performed using one of two approaches: either open surgery or minimally invasive thoracoscopic (VATS). Benefits of surgery: Life After Treatment – Expectations for Patients  Most patients notice a quick improvement in their symptoms, and are able to:  •Breathe easier  •Continue with their daily activiites  •Exercise with less fatigue  Recovery includes:  •Short hospital length of stay (3-5 days, depending on the type of surgical procedure)  •Physio-assisted breathing exercises  •Follow-up with the surgeon during regular intervals Frequently Asked Questions (FAQ) 1. Is diaphragmatic eventration fatal? Mild cases are not fatal, however if serious there may also be a secondary respiratory disease that could develop and make the patient susceptible to infections or respiratory failure that would be untreated. 2. Can children also have eventration? Yes, congenitally. We see this in infants and children born with eventration; this is a recognized entity in radiology

Introduction Chest infections are among the most frequent forms of respiratory complaints worldwide, affecting millions of people every year. Infections often happen when seasons change especially when the weather turns cold, or the infected person has a weakened immune system. Most chest infections get better with appropriate antibiotics, rest, hydration and, some time; nevertheless, a small number of these patients have ongoing symptoms. In some patients, this ongoing illness can indicate possible complications. In particular, empyema and aspergilloma can be a significant complication of chest infection. The rationale of this detailed blog is to help identify and characterize the two processes from a patient’s perspective and a doctor’s perspective. If patients learn more about their disease and have the warning signs, diagnostic process, and treatment options in mind they are likely to seek care sooner. Doctors’ understanding of the changes to the pulmonary system that allows for empyema and/or aspergilloma allow for better management of these very difficult cases. Recognizing Chest Infections: What Is Normal and What Is Not? Chest infections represent infections of the lungs and lower airways. Infections may be viral, bacterial or fungal and may be as mild as bronchitis or as severe as pneumonia. Common Symptoms: •     managed or worsening cough •     chest discomfort or pain •     difficulty breathing •     fever or chills •     mucus or phlegm production •     fatigue and generalized body aches How long do chest infections last? Generally, you can expect symptoms to improve in 7-21 days with typical treatment course. If symptoms continue to linger past three weeks or even worsen over that time period, it may suggest that there is some residual or involved infection. It is important to understand that not all chest infections are benign and you need to distinguish a simple chest infection from an atypical type of chest infection with possible long-standing sequelae. When Shall We Consider Further Investigation? •     Fever lasting longer than 7 days •     hemoptysis (blood in sputum) •     Night sweats and unexplained weight loss •     Difficulty breathing which progressively worsens •     Repeated episodes of chest infections in the same lung segment Any persistent infection could point to more sinister underlying diseases; such as tuberculosis, malignancies, or fungal colonization. Emphypečnęma and aspergilloma are two illustrative cases of persistent infections which are misleadingly “innocent” but deadly if untreated. Potential Problems with Infections in the Chest that are Not Managed If a chest infection is not resolved it can lead to severe lung damage. The more common problems from a chronic chest infection include: •     Empyema (pus in the pleural space) •     Aspergilloma (fungus ball in a lung cavity) •     Bronchiectasis (dilation of the bronchi with chronic damage) •     Lung abscess •     Post-infectious fibrosis •     Pulmonary embolism Timely identification and management of these problems is critical to avoiding potential long-term lung injury. ________________________________________ What is Empyema? For Patients Empyema is infected pus accumulating in the pleural space, which is the thin space between the lung and inner chest wall. This is a complication of pneumonia in most instances, but can also occur due to trauma to the chest, surgery to the chest, or direct spread of the infection from surrounding infected structures. Causes: •     Untreated or partially treated pneumonia •     Tuberculosis •     Post-surgical infection •     Trauma to the chest •     Complication of a lung abscess Symptoms: •     Severe chest pain that is worsened with breathing •     Persistent cough with foul smelling sputum •     High fever with chills •     Shortness of breath, especially when lying down •     Being unable to get comfortable •     Night sweats and poor weight. Diagnostic Workup: Chest X-ray: May show fluid accumulation CT Scan: Offers a detailed image of the pleural space Ultrasound: Guides thoracentesis (fluid sampling) Thoracentesis: Confirms pus and identifies the causative organism Treatment Options: Intravenous Antibiotics: To combat the infection Chest Tube Insertion: To drain the pus (tube thoracostomy) Fibrinolytic Therapy: Enzymes may be used to break up loculations Surgical Intervention: VATS (Video-Assisted Thoracoscopic Surgery) for drainage Open Thoracotomy or decortication in severe or chronic cases Prognosis: With appropriate treatment, a sizeable portion of patients recover completely, although persistent symptoms may result in reduced lung function. ______________________________________ What is Aspergilloma? To Patients: An aspergilloma is a compact cluster of fungus, mainly of the species Aspergillus fumigatus, that is growing inside an existing cavity in the lungs. Cavities of the lung can occur from other sickness, such as tuberculosis, sarcoidosis, and lung cancer. How does it grow? Inhalation of fungal spores can lead to the colonization of a lung cavity and at that point, the cluster begins to form a tangled mass of fungal hyphae, inflammatory cells, and mucus. Over time the tangled mass becomes ball-like in form. Symptoms: •     Hemoptysis: Mild to life-threatening •     Persistent dry or productive cough (hypoxia, cough brush response to sputum being stuck) •     New chest discomfort or tightness •     Fever (intermittently bright and broke all week) •     General malaise, fatigue, and weight loss Diagnostic tools: •     High-Resolution CT Scan (best imaging tool for fungus ball) •     Chest X-ray (may show the mass, can see cavity with a mobile mass of) •     Sputum Culture (if fungal mass with Aspergillus) •     Serology (testing for IgG antibodies to Aspergillus) Treatment Options: 1. Observation: o Appropriate for the asymptomatic patient with a small Aspergilloma. 2. Antifungal Therapy: o Oral or intravenous antifungal therapy, such as Voriconazole or Itraconazole. 3. Surgical Intervention: o Lobectomy or segmentectomy may be required for larger or bleeding lesions. 4. Bronchial Artery Embolization (BAE): o Control of bleeding in patients not suitable for surgical intervention. Risks: • Severe bleeding (life-threatening hemoptysis). • Risk of invasion is high in immunocompromised patients. • Potential compromise of lung function. Doctors Perspective: A Clinical Perspective on Empyema & Aspergilloma Classic presentations can be difficult to distinguish from other respiratory illnesses. The diagnosis can be overlooked, and therefore, it requires a high index of suspicion, especially in patients with a history of TB, immunocompromised patients, and those to not improve with standard antibiotics. Red Flags: • Recurrent infections within

Signs: When to Think Thymoma Thymomas are usually not detected until they are quite large or accidentally found on imaging studies done for other reasons. Any pressure signs (from size): –     Chest pain or tightness –     Cough –     Shortness of breath –     Hoarseness of voice –     Difficulty swallowing (dysphagia) –     Swelling of face or neck (due to superior vena cava obstruction) Constitutional: –     Weakness of muscle, particularly high in the body (around the eyes), or high or low in the limbs (suggestive of myasthenia gravis) –     Fatigue –     Anemia / infections (if whole immune system is impaired) If, in doubt, you should seek evaluation with a thoracic specialist if any of these symptoms persist or worsen. Diagnosis: How Is Thymoma Diagnosed? 1.   Studies –     Thymomas can be found on a chest x-ray as opacity in the mediastinum –     CT Scan (chest) is the gold standard and provides the most data regarding size, invasion, and anatomy in regard to local structures –     MRI or PET-CT can also be done for more data or to just stage the cancer 2.   Lab work –     Can be autoimmune markers (e.g. anti-acetylcholine receptor antibodies for myasthenia) –     Regular blood counts and immunoglobulin too 3.   Biopsy (sometimes) –     Possibly unnecessary, if proved mathematically to be resectable –     For biopsy, usually with a CT. Staging and Classification The Masaoka-Koga system is the most commonly used to describe extent of disease: •     Stage I: tumor is completely encapsulated with no invasion. •     Stage II: tumor has invaded local fat or pleura. •     Stage III: tumor has invaded an adjacent organ (pericardium, lung, major vascular structures). •     Stage IV: tumor has spread to other places (pleura, lymph nodes, or distant organs). Masaoka-Koga system is not the only thing to consider. Thymomas are also categorized by histology (WHO classification: Types A, AB, B1–B3, and C), which is important for treatment and disposition. When do we recommend surgery? Surgical resection is the cornerstone of therapy for nearly every thymoma, especially the early-stage tumors. The aim is complete, margin-negative resection. Surgery is suggested for: •     Thymoma confirmed/suspected on imaging •     Tumors with causing symptoms of pressure •     Autoimmune conditions like myasthenia gravis that are associated •     Recurrent/residual disease after other treatments It is critical to consult a thoracic surgeon to evaluate operability, the optimal surgical approach, and safely handle intraoperative situations. Surgical Approaches: Minimally Invasive to Open 1. Minimally Invasive Surgery • VATS (Video-Assisted Thoracoscopic Surgery) or • RATS (Robotic-Assisted Thoracic Surgery) Best for small, early-stage thymomas that don’t invade any adjacent organs. Advantage: They are less painful, smaller incision, shorter hospital stay, and quicker return to normal activity than traditional surgery. 2. Open Surgery (Median Sternotomy) Indicated when: • Large or invasive tumor • Involvement of vessels or heart • Resection can’t be performed with minimally invasive techniques. Surgery Risks and Complications Surgery is relatively safe, but there is always a risk for: • Bleeding • Infection • Damage to surrounding structures (lungs, heart, major vessels) • Persistent myasthenia symptoms (in autoimmune associated thymoma) • Postoperative respiratory complications Selecting an experienced thoracic surgeon such as Dr. Kamran Ali, significantly reduces these risk factors. What Happens After Surgery? 1. Recovery       •     Hospital stay: 2–5 days (if open surgery, potentially longer)       •     Returning to work: 2–4 weeks (depending on surgical method and patient health)       •     Working on pain management, performing breathing exercises and physical activity are vital during recovery. 2. Pathology Report       •     Provides confirmation of the diagnosis       •     Reports on margins, histological subtype, and level of invasion       •     Indicates if further treatment is necessary Do All Patients Get Chemotherapy or Radiation? Not necessarily. Post-operative Radiation Therapy (PORT):       •     Recommended often in Stage II/III thymomas or incomplete resections       •     Decreases risk of recurrence Chemotherapy:       •     Used for unresectable, advanced (Stage IV), or recurrent disease       •     Chemotherapy is often cisplatin-based protocol These treatments are often provided in coordination with an oncologist and radiation specialist — forming part of a multidisciplinary care team. Long-Term Follow-Up and Outlook Patients who have undergone complete resection of thymomas generally do extremely well, particularly when they are diagnosed at earlier stages of thymoma. Prognosis:       •     Stage I–II: Excellent prognosis (90% 5-year survival)       •     Stage III: Reasonable prognosis with complete resection and adjuvant treatment       •     Stage IV: Prognosis varies; patients will likely require long-term systemic treatment Follow-Up Care:       •     CT scans every 6–12 months (with initial follow-up scans)       •     Monitor for recurrent symptoms or new symptoms       •     Neurological assessment should continue if the patient has Myasthenia Living with Thymoma: Patient recommendations       •     Do not ignore mild or unusual chest symptoms. Early diagnosis will achieve better outcomes.       •     If you have a thymoma, get a thoracic surgical opinion early, regardless of whether you are symptomatic.       •     If you have an autoimmune medical condition (e.g., Myasthenia Gravis), make sure your surgical team is aware of this condition and has sufficient experience managing similar cases.       •     Be active in your care – ask questions, discuss all treatment options, and clarify personal and medical goals of surgery and follow-up. Why Choose Dr. Kamran Ali for Thymoma Surgery? As a dedicated thoracic surgeon, Dr. Kamran Ali has significant experience with difficult to navigate chest tumors such as thymomas. He has access to advanced surgical techniques, top facilities, and a formal multidisciplinary team, meaning that he offers a personalized, precise, and compassionate approach, every step of the way. Whether it is a newly discovered mass, a complicated recurrence, or an autoimmune-associated thymoma, getting involved with an experienced expert in timely manner can make all the difference. Conclusion The diagnosis of thymoma tends to be rare. However, thymoma is very treatable with excellent thoracic surgical expertise – especially if detected early. If you, or someone you know, have been diagnosed with a mediastinal tumor or are having unexplained chest complaints, see a thoracic surgery consultant who can iosenuate. Your chest houses some very important organs –

When recovering from an injury to the chest or undergoing lung surgery or sufferng from a collapsed lung, an important part of treatment is to insert a chest tube. This very small but crucial device actioning the removal of air or fluid, or pus from the space around the lungs (pleural cavity) and it enables full lung expansion and subsequent healing. What happens if the chest tube has to remain inserted longer than expected? In this article, Dr. Kamran Ali will explain why the chest tube drainage may be prolonged, what it implies, and how it is trated to enhance your ability to understand your recovery process. What Is a Chest Tube and Why Is It Used? A chest tube (sometimes also called intercostal drain) is a flexible plastic tube that is inserted between the ribs and into the pleural space, which is the area between the lungs and chest wall. It drains air, blood, fluid, or pus to allow the lungs to expand adequately. Chest tubes are commonly used after: What Is Considered “Prolonged” Chest Tube Drainage? Typically, a chest tube remains for 2 to 5 days, depending on your condition, while when it remains for longer than 5–7 days, it is referred to as prolonged chest tube drainage. It is not always that something has gone wrong — it usually means that your body is taking longer to heal, or that there is some other matter that requires attention. Why Does Prolonged Drainage Happen? There are several reasons why a chest tube may need to stay in longer: 1. Persistent Air Leak This has been one of the most common reasons. Air leaks form if your lung continues to let air out into the pleural space and the lung has not yet sealed adequately. This typically occurs after surgery for lung diseases like Lobectomy, Segmentectomy or Decortication or in patients with fragile lungs (for example, COPD). 2. Excessive Fluid or Pus Accumulation Continuous accumulation of fluid can occur with pleural effusion, empyema, or tubercular pleuritis, causing the need for prolonged drainage. 3. Incomplete Lung Expansion Sometimes the lung doesn’t get fully expanded, especially if it’s surrounded by thick pus, fluid, or fibrous tissue. The chest tube remains in longer as part of the treatment. 4. Ongoing Infection If there’s an ongoing infection in the pleural space (like in an empyema), the chest tube is placed to drain infected fluid. The tube stays in till the infection resolves. What Happens During This Time? If your chest tube needs to remain in longer than expected, your doctor will: You’ll also be encouraged to move, do breathing exercises, and sit upright often — these help the lungs expand and the drainage process to improve. When Is Surgery Needed? In some cases, if the problem doesn’t resolve with time and conservative care, your doctor might suggest a surgical solution. This is more likely in cases of: Surgical options include: At Dr. Kamran Ali’s thoracic surgery practice, we prioritize minimally invasive techniques whenever possible, which means smaller incisions, less pain, and faster recovery. How Is Recovery Managed? Recovery with prolonged drainage involves: Most importantly, patients are supported with education and emotional care throughout the process. Final Thoughts Frustration may mount from having a chest tube for longer than anticipated, yet it could signify that the body needs a little longer to heal-or that the doctors are still working towards the best possible outcome. Almost every patient achieves full recovery after being on drainage for a very long time, with timely interventions and expert care. At Dr. Kamran Ali’s clinic, we know how important being informed and supported during your recovery period is for you. If you or somebody close to you is battling long chest tube drainage, we will give you holistic care, the best surgical choices, and a peace of mind.