A 19-year-old man presented with persistent cough and fever, raising the possibility of pneumonia, and the symptoms improved with antibiotics. However, one week later, an abnormal shadow was noted in ...the right hilum, and he was referred to our department. Chest CT showed no continuity between the right B1 and central bronchus, and the interrupted B1 root communicated with a cystic lesion, 4.8 × 3.8 cm in size, with niveau located on the dorsal side of the tracheal bifurcation. In addition, V1+2+3 flowed into the superior vena cava. The mass was diagnosed as bronchial atresia in communication with a mediastinal cyst with partial anomalous pulmonary venous return. The upper right lobe of the lung and mediastinal cyst were resected in a single mass because of repeated pneumonia considered to be caused by bronchial atresia. The diagnoses of mediastinal cyst and bronchial communication were confirmed on examination of the excised specimen, and the cyst was histopathologically diagnosed as an esophageal cyst. We report a rare surgical case of congenital bronchial atresia with an esophageal cyst and partial anomalous pulmonary venous return.
Background Pleural effusion and pleuritis are uncommon manifestations of Mycobacterium avium complex pulmonary disease. Pleuritis caused by Mycobacterium avium complex pulmonary disease presenting as ...a solitary pulmonary nodule is extremely rare. The pathogenesis of Mycobacterium avium complex pleuritis has not been elucidated. However, it has been suggested that secondary spontaneous pneumothorax from Mycobacterium avium complex pulmonary disease is one of the causes of Mycobacterium avium complex pleuritis. Case presentation A 67-year-old Japanese woman who presented with a solitary pulmonary nodule developed a transient pneumothorax after transbronchial biopsy. A definitive diagnosis of solitary pulmonary nodule could not be made on bronchoscopy, so video-assisted thoracoscopic surgery was performed 1 month after bronchoscopy. On the day of hospitalization for the procedure, a left-sided pleural effusion appeared on a chest radiograph. Thickening of the parietal and visceral pleura and numerous scattered white small granules were seen on thoracoscopy. Histologic examination of the resected left lower lobe and a biopsy of the parietal pleura showed Mycobacterium avium complex solitary pulmonary nodule and Mycobacterium avium complex pleuritis. Conclusion Iatrogenic pneumothorax can be a cause of pleuritis in a patient with Mycobacterium avium complex pulmonary disease. Clinicians should watch for the appearance of secondary pleuritis after transbronchial biopsy even in a patient with localized disease such as Mycobacterium avium complex solitary pulmonary nodule. Keywords: Mycobacterium avium complex pulmonary disease, Solitary pulmonary nodule, Pleuritis, Pneumothorax
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Pulmonary artery (PA) sling is a congenital disease in which the left PA abnormally arises from the right PA and is usually diagnosed during the infantile period. We present an adult case of PA sling ...accompanied by tracheobronchomalacia found in a 49-year-old woman with a history of recurrent pneumonia. Computed tomography of the chest showed that the left lung was nourished by two aberrant PAs. Bronchoscopy demonstrated achondroplasia of the trachea and the right bronchus, which we speculate to have resulted in their stenosis. The recurrent pneumonia was attributable to these tracheobronchial structural abnormalities; we therefore stress the importance of focusing on the anatomic abnormalities in such cases.
A man in his 50s who presented an abnormal shadow on chest X-ray was diagnosed with posterior mediastinal tumor that had grown compared to the previous chest X-ray. Computed tomography showed a ...5.7×3.9 cm solid mass with a smooth surface in the posterior mediastinum. A neurogenic tumor was suspected, and the mediastinal tumor was resected through thoracotomy because it was strongly adherent. The postoperative course was good, and he was discharged from the hospital on postoperative day 3. Contrary to preoperative expectations, the tumor was pathologically diagnosed as a desmoid tumor. After 6 months postoperatively without any complications, no recurrence was observed.
Percutaneous transthoracic cryoablation of lung parenchymal tumors offers a potentially less invasive alternative to thoracoscopic tumor resection. In the present study, we investigated the ...feasibility of transthoracic cryoprobe insertion into the lung parenchyma.
Cryoablation was performed in porcine lung through a thoracotomy. A 2-mm diameter cryoprobe was inserted to a depth of 3 cm from the pleura. Cryoablation was performed as one or two cycles of 15-minute freeze followed by 5-minute thaw. Bleeding time and amount, and air leakage pressure from the insertion site was measured and compared between cycles.
The bleeding time and amount significantly increased, and air leakage pressure significantly decreased with two cycles of cryoablation compared with one cycle. Histologically, the primary finding in the cryolesion was localized pulmonary hemorrhage.
Bleeding time, bleeding amount, and air leakage from the insertion site after two cycles (453 ± 202 s, 1.3 ± 0.6 g, and 28 ± 12 cm H
2O, resectively) were considered unlikely to cause acute serious complications. Although long-term studies are needed, the present study provides support for transthoracic cryoablation.
Background. Good's syndrome is a rare immunodeficiency condition that develops in association with thymoma. It has been reported to occur in 0.2-0.3% of thymoma patients in Japan. Case. A 52-year-old ...male underwent an extended thymo-thymectomy at our institution and received a pathological diagnosis of invasive thymoma. After 11 years, follow-up computed tomography results showed signs of pleural dissemination, which was treated with chemotherapy. The disseminated tumor was resected 15 years after the initial diagnosis, and the pathological diagnosis was dissemination of invasive thymoma. There were no postoperative complications. At four months after the second surgery, the patient developed diarrhea, accompanied by weight loss of 5 kg/month. The cause was unclear. The diarrhea remained intractable despite treatment with probiotics and antidiarrheal drugs. During an examination to investigate the patient's condition, early esophageal cancer was incidentally found, for which an endoscopic submucosal dissection procedure was performed. During hospitalization, the patient developed aspiration pneumonia, which led to sepsis. Test results indicated hypogammaglobulinemia, along with a decrease in B cells and CD4-positive T cells, and the patient was diagnosed with Good's syndrome. The patient was diagnosed with Good's syndrome 16 years after the initial diagnosis of thymoma. Immunoglobulin therapy was introduced, but the patient developed sepsis due to pneumonia and died five months later. Conclusion. Chronic diarrhea is known to occur in approximately half of patients with Good's syndrome, and should be kept in mind to avoid delaying the diagnosis.
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