Annals of thoracic surgery short reports最新文献

Central venous occlusions are common in the population of dialysis patients and develop as a result of arteriovenous access. Whereas these patients most commonly present with edema and varicosities, a rare presentation is esophageal varices. Here we present the case of a young man with life-threatening esophageal hemorrhage as a result of central venous occlusions, successfully treated with an azygos vein to right atrial bypass.

A 55-year-old woman with no significant medical history or symptoms was incidentally diagnosed with a mediastinal tumor during a routine health checkup. The intraoperative findings of robot-assisted thoracoscopic surgery led to the diagnosis of extralobar pulmonary sequestration (EPS), with multiple vessels connecting to the pulmonary artery and superior pulmonary vein. EPS, an extremely rare condition, is typically supplied with blood from the aorta. Whereas it is uncommon for blood to be supplied from the pulmonary artery and to drain into the pulmonary vein in EPS, it is safely excised through robot-assisted thoracoscopic surgery.

Foley balloons have been used to secure emergency hemostasis for cardiac or vascular injuries since the 1960s. However, using a single large balloon may have drawbacks, such as insufficient hemostasis and blood flow impairment. We have encountered 3 major intraoperative laceration cases since 2011. The laceration sites (lengths) were at the inferior vena cava (2.5 cm), main pulmonary artery (2 cm), and right ventricle (5 cm). We successfully managed these patients by using multiple small (10F-14F, half-inflated) Foley balloons. Using small Foley balloons may overcome the drawbacks of using 1 large balloon and effectively manage large lacerations.

We present the case of a 72-year-old man diagnosed with an aortic root aneurysm who was then diagnosed with Marfan syndrome. The patient suffered an intraoperative type B dissection with lower extremity malperfusion managed with an axillary-bifemoral extra-anatomic bypass.

Pleomorphic carcinoma of the lung is highly malignant and occurs mostly in the upper lobes of smokers; however, no reports exist of new occurrences from the resection margins of the previous ground-glass opacities. In our case, a 73-year-old man underwent an initial partial resection of the left upper lung for ground-glass opacities, with progressive thickening of the resection margin during the following 10 months. Radical resection was performed, resulting in the diagnosis of a newly arising pleomorphic carcinoma from previously resected margins.

Systemic artery–to–pulmonary artery fistula (SAPAF) is an uncommon abnormal vascular connection between systemic and pulmonary arteries. SAPAF with 3 or more inflow vessels has rarely been reported. The definitive diagnosis is made by selective arterial angiography, but 3-dimensional computed tomography angiography is useful for delineating abnormal vessels. Embolization is currently performed as a less invasive treatment option, but surgical treatment remains an essential treatment option for preventing recurrence, especially in cases with many abnormal vessels. Herein, we report a case of successful treatment of SAPAF by sparing the lung parenchyma through abnormal inflow vessel dissection and peripheral lung abnormal tissue resection.

Thoracic duct embolization has gained widespread acceptance as an effective treatment of postoperative chylothorax. We describe a patient with chylothorax after pneumonectomy requiring thoracic duct embolization who presented again with a pneumonectomy space infection. Bacterial culture was positive for gastrointestinal flora, which suggests that the pleural space was inoculated at the time of thoracic duct embolization. We highlight the available literature that may explain the mechanism behind this occurrence and emphasize the need for expanded awareness of this potential complication.