The Journal of the Japanese Association for Chest Surgery
Online ISSN : 1881-4158
Print ISSN : 0919-0945
ISSN-L : 0919-0945
Volume 29 , Issue 6
Showing 1-23 articles out of 23 articles from the selected issue
  • Hideaki Kojima, Reiko Shimizu, Hiroyuki Kayata, Naoko Miyata, Tomohiro ...
    2015 Volume 29 Issue 6 Pages 678-683
    Published: September 15, 2015
    Released: October 02, 2015
    JOURNALS FREE ACCESS
    In the present study, we performed a retrospective analysis of 36 patients who underwent pulmonary resection between September 2002 and December 2013 at the Shizuoka Cancer Center Hospital, for metastasis that originated from osteosarcoma and soft tissue sarcoma. The 3- and 5-year overall survival rates of all patients were 70.0 and 65.7%, respectively. The 3- and 5-year overall survival rates of 13 patients with osteosarcoma were 63.6 and 63.6% and those of 23 patients with soft tissue sarcoma were 75.5 and 67.1%, respectively. Univariate analysis indicated that the age at the time of pulmonary metastasectomy (age of <45 vs. ≥45 years: 5-year survival rate of 92.3 and 44.3%, respectively; p=0.03) was the only prognostic factor among such patients. The patients who underwent wedge resection, with a disease-free interval (DFI) of ≥12 months, and those with the lung as the first recurrent site showed a more favorable prognosis, although no significant difference was noted. The findings of the present study indicate that surgical resection of pulmonary metastasis from osteosarcoma and soft tissue sarcoma leads to a favorable prognosis, particularly in patients who are younger, undergo wedge resection, have a longer DFI, or in whom the lung is the first recurrent site. Furthermore, repeat pulmonary metastasectomy in certain patients may improve survival.
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  • Hiroshi Yaginuma, Koichi Fujiu, Hideaki Miyamoto
    2015 Volume 29 Issue 6 Pages 684-688
    Published: September 15, 2015
    Released: October 02, 2015
    JOURNALS FREE ACCESS
    We report the case of a 63-year-old female with a displaced anomalous bronchus. An abnormal chest shadow was observed during medical examination. Chest computed tomography (CT) showed ground glass opacity (26×16 mm) in the left S3 segment. In addition, CT showed a displaced anomalous bronchus that branched into the left upper and lingular bronchi. Bronchoscopy showed the same displaced anomalous upper bronchus. The patient was diagnosed with adenocarcinoma and underwent surgery. Hyperlobulation between the upper and lingular segments was noted during surgery. We concluded that the upper and lingular segments were independent of each other, and performed left upper segmentectomy. A displaced anomalous bronchus in the left lung is rare, and there have been only 11 reported cases in Japan that were resected.
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  • Kunihiro Ozaki, Yutaka Nishimura, Ryouzou Hayashida, Toshihiro Matuo, ...
    2015 Volume 29 Issue 6 Pages 689-693
    Published: September 15, 2015
    Released: October 02, 2015
    JOURNALS FREE ACCESS
    A case of collision lung cancer is reported. A 70-year-old male underwent right lower lobectomy for squamous cell carcinoma of the lung. Chest computed tomography (CT) showed a growing lobulated mass located in the right S2 pulmonary segment 5 years postoperatively. A CT-guided biopsy was performed. Pathologically, squamous cell carcinoma was diagnosed. Right segmental partial resection was performed. Pathologically, the diagnosis was collision cancer of adenocarcinoma and squamous cell carcinoma. The p53 staining was useful for the diagnosis of collision cancer and metachronous multiple primary lung cancer.
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  • Atsushi Ito, Takahisa Matsuoka, Shinjiro Nagai, Katsunari Matsuoka, Mi ...
    2015 Volume 29 Issue 6 Pages 694-699
    Published: September 15, 2015
    Released: October 02, 2015
    JOURNALS FREE ACCESS
    We present a 77-year-old male patient in whom posterior mediastinal masses were incidentally detected on chest CT during treatment for pneumonia. Chest CT showed well-circumscribed mass shadows with soft tissue attenuation in the bilateral thoracic vertebral area. A tumor with a diameter of 30×15 mm in the right eighth intercostal space was the largest. Chest MRI revealed a slightly high-intensity area in T1-weighted images. We considered the possibility of a neurogenic tumor due to the location, so we performed thoracoscopic biopsy for a diagnosis. Postoperative pathological examination showed that the tumor was composed of a number of hematopoietic elements, including bone marrow megakaryocytes in adipose tissue. We diagnosed it as a myelolipoma. Multiple mediastinal myelolipoma is very rare, and so we reviewed the literature for the past 24 years and report it along with our case.
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  • Tsugumasa Kamata, Shun-ichi Watanabe, Hiroyuki Sakurai, Kazuo Nakagawa
    2015 Volume 29 Issue 6 Pages 700-705
    Published: September 15, 2015
    Released: October 02, 2015
    JOURNALS FREE ACCESS
    Case 1: A 68-year-old woman had undergone partial resection of the left upper lobe for a metastatic lung tumor from uterine cervix cancer 12 years previously. Chest computed tomography (CT) revealed a new pulmonary nodule along the staple-line. Because the nodule showed a decrease in size on follow-up examination, a diagnosis of pulmonary granuloma was favored. Case 2: A 42-year-old woman had undergone segmentectomy of the right lower lobe for primary lung cancer 3 years previously. Chest CT revealed a new pulmonary nodule along the staple-line. A CT-guided needle biopsy was performed, and upon histological examination, the tumor was diagnosed as a pulmonary granuloma. The size of the tumor decreased during follow-up. In both cases, the initial diagnosis of the nodules was pulmonary granuloma occurring along the staple-line; however, it was difficult to distinguish the tumors from local recurrences at the staple-line. We utilized radiological evidence to differentiate between pulmonary granulomas and local recurrences along the staple-line.
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  • Hiroyuki Adachi, Takao Morohoshi, Shizu Saito, Masanori Hashimoto, Mas ...
    2015 Volume 29 Issue 6 Pages 706-712
    Published: September 15, 2015
    Released: October 02, 2015
    JOURNALS FREE ACCESS
    A tall 13-year-old male with simultaneous bilateral pneumothoraces underwent bilateral partial lung resections. Visceral pleural coverage with an oxidized regenerated cellulose sheet was applied to prevent recurrence. He was discharged 3 days after surgery, and was reffered to another institution for genetic analysis for suspected Marfan syndrome. Four months after the surgery, the patient presented to our hospital with sudden-onset chest pain. A chest radiograph revealed recurrent simultaneous bilateral pneumothoraces, and re-operation was carried out. Bullae regrowth along the staple lines was seen bilaterally, and were found to be responsible for the recurrence. No thickenings of visceral pleura were found within the area covered in the first operation. We performed bilateral partial lung resections and a covering technique with polyglycolic acid sheets. He has been recurrence-free for 21 months since the second surgery, and was genetically confirmed as having Marfan syndrome. We consider that the covering technique with an oxidized regenerated cellulose sheet is unfavorable for high-risk patients, like the present case. A large-scale comparison between the use of oxidized regenerated cellulose and polyglycolic acid is needed to resolve this issue.
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  • Takahiro Yanagihara, Mitsuaki Sakai, Yusuke Saeki, Shinsuke Kitazawa, ...
    2015 Volume 29 Issue 6 Pages 713-717
    Published: September 15, 2015
    Released: October 02, 2015
    JOURNALS FREE ACCESS
    We report a surgical case of ectopic mediastinal parathyroid adenoma. A 70-year-old man was admitted to our hospital due to an abnormal shadow on a chest radiograph. Chest computed tomography showed a lobulated tumor in the anterior mediastinum, measuring 25 mm in diameter. The tumor consisted of cystic and solid components with contrast enhancement. 18F-fluorodeoxyglucose positron emission tomography showed a maximum standardized uptake value of 5.17/5.50. The preoperative diagnosis was thymoma. We performed thoracoscopic thymectomy. The surface of the tumor appeared reddish brown, without invasion to the adjacent tissue. The postoperative course was uneventful. Pathological examination confirmed a diagnosis of ectopic mediastinal parathyroid adenoma. We retrospectively measured the serum intact parathyroid hormone, calcium, and phosphorus levels, and found no differences between the pre- and postoperative values. Therefore, we diagnosed the patient with a non-functional tumor.
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  • Hidehisa Hoshino, Aki Ishikawa, Chikabumi Kadoyama
    2015 Volume 29 Issue 6 Pages 718-721
    Published: September 15, 2015
    Released: October 02, 2015
    JOURNALS FREE ACCESS
    A 41-year-old man was brought to our hospital by ambulance for blunt chest trauma due to collision with a motorcycle. He had a contused wound and subcutaneous emphysema in his left lateral thoracic region, and received left tube thoracostomy. Chest computed tomography after chest drainage showed intercostal lung herniation. Emergency surgery was performed. In the operation, the herniated lung was reduced into the thoracic cavity by differential lung ventilation. The hernia orifice was thought to be a defect of the bony thorax at the 2nd and 3rd intercostal spaces. The hernia orifice was closed by approximating the ribs with heavy stitches after trimming the fractured ribs. We report the case, considering that hung herniation is relatively rare.
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  • Manabu Kakizoe, Kousuke Suzuki, Noriyuki Saeki
    2015 Volume 29 Issue 6 Pages 722-726
    Published: September 15, 2015
    Released: October 02, 2015
    JOURNALS FREE ACCESS
    A 67-year-old man presented to our hospital with suspected right lung cancer. Chest CT showed a 26-mm nodule with contrast enhancement at the right axilla, in addition to a 15-mm nodule in the right middle lobe of the lung. While we could diagnose the lung nodule as primary lung cancer by transbronchial lung biopsy, the axillary nodule remained undiagnosed following core needle biopsy. After an axillary specimen was diagnosed as a non-malignant neoplasm by open biopsy, the patient underwent right middle lobectomy with lymph node dissection. Pathological examination revealed the lung nodule as adenocarcinoma (pT1aN0M0) and the axillary nodule as Castleman's disease. In cases of the coexistence of lung cancer and Castleman's disease, the accurate estimation of respective lesions is essential to devise a treatment strategy for lung cancer.
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  • Masayuki Hashimoto, Jun Hanaoka, Yasuhiko Oshio, Tomoyuki Igarashi, Yo ...
    2015 Volume 29 Issue 6 Pages 727-731
    Published: September 15, 2015
    Released: October 02, 2015
    JOURNALS FREE ACCESS
    Introduction: Partial anomalous pulmonary venous connection (PAPVC) is a malformation of the pulmonary vein characterized by abnormal venous return to the right side of the heart, which should be taken into consideration during surgery for lung cancer. Case: In January 2013, infiltration to the right S2 lung was discovered in a 79-year-old man by postoperative chest computed tomography (CT) following colon cancer surgery. In July, a tumor diagnosed as cT1bN0M0 stage 1A lung squamous cell carcinoma was observed close to the bronchus of the right B2 lumen. He was then referred to our hospital for treatment. Preoperative chest CT revealed abnormal venous return from the right upper lobe to the azygos vein and superior vena cava, which was diagnosed as PAPVC. Transthoracic echocardiography revealed an increased right ventricular pressure of 46.4 mmHg, but cardiac dysfunction of the left ventricle was not observed. Since the patient's general condition was good and the PAPVC and lung cancer were confined to the same lobe, we considered that the risk of postoperative heart failure was low. In August 2013, we performed a right upper lobectomy. After surgery, there were no heart complications, and one month later, the right ventricular pressure improved to 41.0 mmHg. Conclusion: PAPVC is a rare congenital anomaly that is difficult to diagnose preoperatively; thus, it is often initially observed intraoperatively. In this case, we were able to diagnose PAPVC preoperatively and plan a suitable surgical method using three-dimensional CT.
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  • Yoshitomo Ozaki, Shuhei Inoue, Shoji Kitamura, Keiko Ueda, Takuya Fuji ...
    2015 Volume 29 Issue 6 Pages 732-736
    Published: September 15, 2015
    Released: October 02, 2015
    JOURNALS FREE ACCESS
    Myocobacterium abscessus infection is a rare, rapidly growing mycobacterial infection in Japan, associated with a poor prognosis because of its rapid progression and resistance to many antibiotic drugs. A 62-year-old woman, who had a history of bronchiectasis for 40 years, was diagnosed with pulmonary M. abscessus infection on sputum culture. Despite multidrug treatment for one year, bacillus discharge continued and the disease was uncontrollable. We performed a combined resection of the left lower lobe and S4+5 segments, a likely source of bacterial excretion. She had a late-onset lung fistula, and we performed latissimus dorsi muscle flap patch closure of the fistula. Now, at more than 3 years after lung resection, no recurrence has been observed.
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  • Taito Uchi, Hiroto Komori, Takayuki Okuyama, Sumio Okuda, Tohru Sakura ...
    2015 Volume 29 Issue 6 Pages 737-744
    Published: September 15, 2015
    Released: October 02, 2015
    JOURNALS FREE ACCESS
    We performed perioperative pulmonary rehabilitation for a patient who was considered as medically inoperable prior to radical surgery for lung cancer. The patient showed combined impairment, an advanced age, renal dysfunction, anemia, malnutrition, and infection from a cavity caused by the cancer. We considered that these factors would decrease the patient's activity, and so we performed pulmonary rehabilitation before the operation, including giving advice to the patient. As a result, we succeeded in maintaining his performance status. The patient underwent right upper and middle lobectomy with combined resection for the chest wall invasion. From the first day after the operation, we started pulmonary rehabilitation twice a day (almost every day). We could maintain the amount of activity to provide rehabilitation frequently. As a result, he was discharged using a walking cane 45 days after the operation. After 3 months, he could walk 276 meters in the 6-minute walk test, and his activities of daily living are independent.
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  • Hiroaki Komatsu, Nobuhiro Izumi, Shinjiro Mizuguchi, Hidetoshi Inoue, ...
    2015 Volume 29 Issue 6 Pages 745-750
    Published: September 15, 2015
    Released: October 02, 2015
    JOURNALS FREE ACCESS
    In Japan, pulmonary Mycobacterium xenopi infection is rare, and only 8 resected cases have been reported. We report two resected cases of pulmonary Mycobacterium xenopi infection. Case 1: A 70-year-old man underwent right upper lobectomy due to lung cancer in 2008. Postoperative chest computed tomography in 2013 demonstrated a nodule with a small cavity in the right S6 region. Partial resection of the right S6 region was performed to rule out the recurrence of lung cancer. In the resected specimen, Mycobacterium xenopi was identified by DNA-DNA hybridization. Histological findings revealed no malignancy. Case 2: A 45-year-old man was referred to our hospital with an abnormal shadow on a chest radiograph. Chest computed tomography demonstrated a cavity with bronchial dilatation in the right S1/2 region. In his sputum, Mycobacterium xenopi was identified by DNA-DNA hybridization. Right upper lobectomy was perfomed, and histological findings revealed caseous granuloma. In both cases, no recurrence was present at one year postoperatively.
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  • Mariko Fukui, Yukio Watanabe, Kazuya Takamochi, Shiaki Oh, Kenji Suzuk ...
    2015 Volume 29 Issue 6 Pages 751-755
    Published: September 15, 2015
    Released: October 02, 2015
    JOURNALS FREE ACCESS
    Case. A 67-year-old man with a right lung tumor was referred to our hospital. The clinical diagnosis was lung cancer cT3N2M0 stage IIIA with interruption of the right main pulmonary artery and obstruction of the right main bronchus. He had no symptoms on admission, but he complained of dyspnea the next day. Computed tomography on searching for the cause of hypoxia showed enlargement of the right pulmonary artery and the absence of pneumothorax, pneumonitis, atelectasis, and carcinomatous lymphangiosis. The hypoxia was reversed in a left lateral position. We considered that the cause of the respiratory failure was ventilation-perfusion mismatch by recanalization of the pulmonary artery. Right carinal pneumonectomy was performed, and the patient was discharged without oxygen eight days after surgery. Conclusion. We reported a case of ventilation-perfusion mismatch due to hilar lung cancer. In the management of acute respiratory failure in patients with central lung cancer, the probability of improvable hypoxia such as ventilation-perfusion mismatch should be considered.
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  • Keigo Okamoto, Ryosuke Kaku, Makoto Motoishi, Satoru Sawai, Jun Hanaok ...
    2015 Volume 29 Issue 6 Pages 756-760
    Published: September 15, 2015
    Released: October 02, 2015
    JOURNALS FREE ACCESS
    A 69-year-old man had an abnormal chest shadow pointed out and consulted our hospital. Computed tomography revealed a round and lobulated mass shadow located at S10 of the right lung, with abnormal uptake on 18F-fluoro-deoxy-glucose positron emission tomography. A bronchoscopic smear did not provide a definite diagnosis. To excise the tumor, we performed hybrid VATS (video-assisted thoracoscopic surgery) right lower lobectomy and node dissection. Histological examination revealed the tumor to be well-circumscribed and almost all of the cancer cells had clear cell components with nuclear variant and adenocarcinoma components. The tumor cells were positive for TTF-1 and negative for CD-10. Clear cell adenocarcinoma of the lung was finally diagnosed, because other organs had no lesions. Postoperative follow-up showed no recurrence for at least 15 months. We examined other reported cases, including our case, suggesting that clear cell adenocarcinoma of the lung may show characteristic imaging findings and be associated with a prognosis comparable with complete surgical resection.
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  • Sachiko Ota, Fumiaki Gochi, Tomoya Kono, Takashi Yoshimura, Yasuji Ter ...
    2015 Volume 29 Issue 6 Pages 761-764
    Published: September 15, 2015
    Released: October 02, 2015
    JOURNALS FREE ACCESS
    Simultaneous bilateral spontaneous pneumothorax is rare and most reported cases are not serious. A 13-year-old male with dyspnea and wheezing was diagnosed with asthma at another hospital; however, dyspnea deteriorated. The next day, he visited the pediatrics department of our hospital. A chest radiograph showed a bilateral pneumothorax with a completely collapsed right lung and 50% collapse of the left lung. When he came to our department, his respiration was shallow and cyanosis was observed in spite of oxygen therapy. Chest tubes were immediately inserted, and his oxygenation recovered. Chest computed tomography demonstrated blebs in the upper lobes of both lungs. We performed bilateral bullectomy by video-assisted thoracoscopic surgery (VATS).
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  • Daisuke Taniguchi, Ryotaro Kamohara, Akihiro Nakamura
    2015 Volume 29 Issue 6 Pages 765-769
    Published: September 15, 2015
    Released: October 02, 2015
    JOURNALS FREE ACCESS
    A 71-year-old woman with non-tuberculous mycobacteriosis (NTM) and hypertrophic cardiomyopathy was emergently admitted to another hospital due to a right secondary spontaneous pneumothorax. Chest drainage was performed, but air leakage from the drainage tube continued. The patient was transferred to our hospital for surgery. Although we performed an operation under video-assisted thoracic surgery, partial lung resection was considered impossible since the responsible lesion was a bulla located on the interlobar surface of an indurated lung because of NTM. So, we performed electroablation of the bulla using the SOFT COAG electrosurgical output system, and air leakage consequently disappeared. The SOFT COAG electrosurgical output system was suggested to be appropriate and effective for the treatment of pneumothorax if partial lung resection is difficult.
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  • Kenji Kimura, Norihito Okumura, Kotaro Kameyama, Tomoaki Matuoka, Taka ...
    2015 Volume 29 Issue 6 Pages 770-774
    Published: September 15, 2015
    Released: October 02, 2015
    JOURNALS FREE ACCESS
    A 47-year-old woman was referred to our hospital because of an anterior mediastinal tumor identified by chest computed tomography (CT). We suspected that the tumor was a thymoma, and removed it through a standard midline sternotomy incision. The tumor was completely resected with the total thymus. Regarding pathological findings on an immunohistochemical study, the tumor was diagnosed as thymic MALT lymphoma. On whole-body examination, gastric MALT lymphoma was also diagnosed by endoscopic examination. We report a surgical case of thymic and gastric lymphoma and a review of the literature.
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  • Yoshifumi Shimada, Jun Kawamukai, Hideki Shinnou, Yoshitaka Ito, Hidek ...
    2015 Volume 29 Issue 6 Pages 775-780
    Published: September 15, 2015
    Released: October 02, 2015
    JOURNALS FREE ACCESS
    A 76-year-old woman was admitted to our hospital for sudden right chest pain. CT showed massive right hemothorax with extravasation from the right fifth intercostal artery. Although emergency thoracotomy was performed, surgical hemostasis was difficult because of the fragility of vessels and tissues. Bleeding was stopped by direct pressure with a tissue sealing sheet. Transcatheter arterial embolization (TAE) was performed immediately, as an additional hemostasis procedure. The patient was subsequently diagnosed with neurofibromatosis type 1 (NF-1) on further examination during the postoperative course. We should recognize that surgical intervention is very difficult and TAE is a more beneficial procedure for hemothorax with NF-1.
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  • Yoshihito Iijima, Kyoji Hirai, Shingo Takeuchi, Takayuki Ibi, Chie Tak ...
    2015 Volume 29 Issue 6 Pages 781-785
    Published: September 15, 2015
    Released: October 02, 2015
    JOURNALS FREE ACCESS
    A 27-year-old woman has been followed up for the previous 12 years because of an abnormal shadow in the left middle lung field on a chest radiograph. Although there was no enlargement of the tumor, she was referred to our hospital for diagnostic and therapeutic purposes. Chest CT showed a 30-mm oval solitary tumor in the left S10 that had no contrast effect. Left lower lobectomy was performed thoracoscopically, because the tumor was large and proximal to the left inferior pulmonary vein. The tumor was diagnosed as a granular cell tumor. As a granular cell tumor is associated with a favorable prognosis and juvenile-onset, thoracoscopic surgery is a suitable operation for this tumor.
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  • Norikazu Kawai, Takeshi Kawaguchi, Motoaki Yasukawa, Takashi Tojo
    2015 Volume 29 Issue 6 Pages 786-791
    Published: September 15, 2015
    Released: October 02, 2015
    JOURNALS FREE ACCESS
    We report two cases of lower lobectomy with a mediastinal inferior lobar branch of the pulmonary artery. Case 1 involved the mediastinal branch (A4b+A. basalis) from the right main pulmonary artery, passing between the superior and inferior vein and along the mediastinal side of the intermediate bronchus. Case 2 involved the mediastinal branch (A. basalis) from the left main pulmonary artery, taking the same course as case 1. As mediastinal inferior lobar branching is rare and its variations are diverse, we consider it appropriate to confirm the pathway before resection. Although such branching of the pulmonary artery is atypical, we were able to proceed with surgery as usual in these cases.
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  • Takuya Inoue, Hiroyasu Kinoshita, Yuki Nakajima, Fumio Maitani, Hirohi ...
    2015 Volume 29 Issue 6 Pages 792-797
    Published: September 15, 2015
    Released: October 02, 2015
    JOURNALS FREE ACCESS
    A female in her 20's, who had previously undergone surgery for epithelioid sarcoma of the vulva, presented at our hospital with left pneumothorax, and chest CT revealed multiple thin-walled cavities. Because left pneumothorax repeatedly occurred, partial resection of the left lower lobe was performed. Pathologically, a thin-walled cavity lesion was found to be pulmonary metastasis from epithelioid sarcoma. We also diagnosed other thin-walled lesions to be pulmonary metastasis from epithelioid sarcoma. As a result, a partial resection of the right lower lobe and a left S6 segmentectomy were performed. The final pathological diagnosis was pulmonary metastasis from epithelioid sarcoma. We thought that the multiple thin-walled cavities had developed due to a check-valve mechanism.
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  • Daisuke Yuki, Osamu Kawano, Ichiro Fukai
    2015 Volume 29 Issue 6 Pages 798-802
    Published: September 15, 2015
    Released: October 02, 2015
    JOURNALS FREE ACCESS
    We report a case of life-threatening systemic air embolism (SAE) involving a young patient receiving bullectomy for recurrent pneumothorax. The operation required apical adhesion dissection and re-expansion of the lung to visualize the bullae close to the adhesion, resulting in successful wedge staple resection. Although the vital signs were stable during the procedure, re-positioning to supine for recovery from general anesthesia caused acute myocardial ischemia shock by SAE, which was confirmed by echocardiography. He successfully recovered from the cardiac shock as well as higher brain dysfunction due to cerebral air embolism 21 days after the shock event. We suggest that the adhesion dissection caused minor injury of the lung parenchyma and possible communication between the peripheral pulmonary vein and airway, and lung inflation to detect the bullae led to air embolism. Re-inflation of the lung is often required during pulmonary surgery. However, general thoracic surgeons and anesthesiologists should refamiliarize themselves with the fact that the common procedure might cause SAE, especially in the case of injured lung re-expansion.
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