The Journal of the Japanese Association for Chest Surgery
Online ISSN : 1881-4158
Print ISSN : 0919-0945
ISSN-L : 0919-0945
Volume 33 , Issue 1
Showing 1-19 articles out of 19 articles from the selected issue
  • Yoshitaka Ito, Tetsuya Takayama, Hideki Shinno, Hideki Miyazawa
    2019 Volume 33 Issue 1 Pages 2-6
    Published: January 15, 2019
    Released: January 15, 2019
    JOURNALS FREE ACCESS

    This study investigated how the speed of tracheal resection affects staple form. A slow mode (SM) group (n=6) and an Adaptive Firing™ technology (AFT) group (n=6) were compared. In both groups, tracheae extracted from pigs were sutured and resected using a Tri-Staple™ black cartridge. After proteolysis of the tracheal stump, staples were collected, and the B-shape form was macroscopically evaluated and given a shape score of 3, 2, 1, or 0 in order from acceptable to unacceptable. The number of staples for each score was multiplied by the shape score and added together. This value was designated as the score for each case. The collected staple count was not significantly different between the two groups (25.5±1.0 vs. 26.3±0.8, respectively, p=0.16), although the resection time was significantly longer in the SM group (20.5±0.3 vs. 14.7±0.9 sec, respectively, p<0.01). The score was significantly better in the SM group than in the AFT group (66.8 vs. 49.3, respectively, p=0.008). For bronchi that are thicker or more rigid than normal, suture and resection were considered safer with SM than with AFT.

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  • Daisuke Okutani, Masafumi Kataoka
    2019 Volume 33 Issue 1 Pages 7-11
    Published: January 15, 2019
    Released: January 15, 2019
    JOURNALS FREE ACCESS

    Prostatic stromal tumor is a rare solid organ mesenchymal tumor classified into two subtypes: stromal tumor of uncertain malignant potential (STUMP) and stromal sarcoma (SS). The patient was a 75-year-old man who had undergone prostate tumorectomy and rectal resection for a prostatic stromal tumor measuring 10 cm in diameter, at the age of 72 years. The tumor was diagnosed as prostatic stromal tumor with an SS portion in the center and peripheral STUMP portion. Metachronous pulmonary metastatic nodules were resected by VATS 1 year and 5 months and 2 years and 7 months after the operation for the stromal tumor, respectively. No similar case of metachronous pulmonary metastasis from prostatic stromal tumor has been reported in the literature.

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  • Yasuto Kondo, Satoru Tamagawa, Dai Sonoda, Yoshio Matsui, Kazu Shiomi, ...
    2019 Volume 33 Issue 1 Pages 12-20
    Published: January 15, 2019
    Released: January 15, 2019
    JOURNALS FREE ACCESS

    Antiphospholipid syndrome (APS) is an acquired autoimmune disease characterized by arterial and/or venous thromboses. Few reports have described patients with APS who have undergone surgery for lung cancer, and the significance is unclear. Case 1: A 75-year-old woman with APS underwent chest computed tomography on follow-up, which showed a 103-mm mass in the right lower lobe and enlarged subcarinal lymph nodes; a diagnosis of squamous cell carcinoma was made. Laboratory tests on admission revealed thrombocytopenia (4.5×104 per cu.mm.). Following platelet transfusion, right lower lobectomy with removal of the regional lymph nodes was performed successfully. Case 2: A 66-year-old man underwent scintigraphy for parathyroid examination, which revealed a 31-mm mass in the left lower lobe; it was diagnosed as squamous cell carcinoma. He was taking aspirin and warfarin for APS and atrial fibrillation. Laboratory tests on admission revealed thrombocytopenia (9.0×104 per cu.mm.), and prolongation of the prothrombin time (37.4 seconds) and activated partial thromboplastin time (47.3 seconds). Before the operation, bridging therapy with unfractionated heparin was administered. Left lower lobectomy with removal of the regional lymph nodes was performed successfully. Surgical treatment for lung cancer patients with APS requires prudent perioperative management.

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  • Kenji Kimura, Norihito Okumura, Tomoaki Matsuoka, Takashi Nakashima, A ...
    2019 Volume 33 Issue 1 Pages 21-26
    Published: January 15, 2019
    Released: January 15, 2019
    JOURNALS FREE ACCESS

    We evaluated 9 infant patients with congenital lung disease who underwent surgery between January 2006 and December 2015. Among them, 6 patients had congenital cystic adenomatoid malformation, 1 had lymphangioma, and 2 had pulmonary sequestration. The patients were six boys and three girls. One patient was 28 days after birth, 1 was nine months after birth, 2 were 1 year old, 1 was 3 years old, 2 were 4 years old, 1 was 5 years old, and 1 was 7 years old. Elective surgery was undertaken in 7 patients, and emergency surgery in two. Among these patients, there were 2 patients who underwent emergency surgery. Both were referred to our hospital because of respiratory distress with mediastinal shift due to ballooning of the cyst. The lesion was located in the right upper lobe in 1 patient, the right lower lobe in 3, and the left lower lobe in 5 patients. Lobectomy was performed in all patients, thoracotomy was performed in 5, and video-assisted thoracic surgery was performed in 4. The average operative time was 3 hours and 32 minutes. No patients required blood transfusion during the operation. The average postoperative hospital stay was 9.7 days. All patients had a good postoperative course. If infant patients with congenital lung disease can wait, they should undergo surgery at about 2 years considering residual lung development and the use of thoracoscopy.

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  • Naoko Fukushima, Hideki Matsudaira, Ai Ishikawa, Masaichi Ogawa, Takao ...
    2019 Volume 33 Issue 1 Pages 27-31
    Published: January 15, 2019
    Released: January 15, 2019
    JOURNALS FREE ACCESS

    A 78-year-old man presented with chest tightness on exertion from five years ago. Coronary artery disease was ruled out, but ultrasonography confirmed dilatation of the ascending aorta. Chest computed tomography angiography revealed a fusiform aneurysm of the right pulmonary artery (A1b) measuring 30×18×18 mm. We decided that surgical resection was the best option. The superior trunk was judged to be the responsible blood vessel based on preoperative imaging and intraoperative findings of palpable pulsation of the aneurysm. The superior trunk was ablated with an endoscopic stapler, and the pulsation resolved immediately. He was discharged 10 days after surgery without complications. Macroscopic findings showed fusiform dilation with a maximum diameter of 12 mm and connection to a branch of the superior trunk. Histopathological findings revealed partial thickening of the intima and lacerations in the tunica media of the artery without inflammatory change. Thus, we diagnosed the patient with an idiopathic pulmonary aneurysm. He remains well one year after surgery without recurrence.

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  • Tomoyuki Yamaguchi, Hiroyuki Yoshitake, Hiroshi Shintani
    2019 Volume 33 Issue 1 Pages 32-36
    Published: January 15, 2019
    Released: January 15, 2019
    JOURNALS FREE ACCESS

    An 83-year-old man underwent a left upper lobectomy for primary lung cancer (p-Stage IIB) in January 2012. Eleven months later, abdominal computed tomography showed an isolated tumor, 1.5 cm in diameter, in segment 8 of the liver. Partial hepatic resection was performed in December 2012. The tumor was pathologically diagnosed as squamous cell carcinoma that had metastasized from the lung cancer. Presently, at 5 years after the hepatic resection, the patient is alive and well without recurrence. Few reports have described the outcomes of hepatectomy for liver metastases from lung cancer. We believe that resecting liver metastases from lung cancer may offer the possibility of long-term survival in cases with a negative surgical margin.

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  • Yuki Takahashi, Masahiro Miyajima, Mitsuhiro Tsujiwaki, Makoto Tada, R ...
    2019 Volume 33 Issue 1 Pages 37-41
    Published: January 15, 2019
    Released: January 15, 2019
    JOURNALS FREE ACCESS

    We report 3 cases of thoracic solitary fibrous tumor (SFT) with an unusual pathophysiology. The first patient was a 76-year-old man with a tumor in the right upper lobe of the lung that was 60×45 mm. He underwent right upper lobectomy. Histopathological examination revealed primary SFT of the lung. He is currently doing well without recurrence 5 years after surgical treatment. The second patient was a 46-year-old woman with metastatic lung carcinoma and pleural dissemination of malignant primary SFT of the lung that appeared 4 years after the initial operation. Although she underwent right middle lobectomy with resection of the disseminated tumor, she died of relapse 77 months after the first operation. The third patient was a 63-year-old woman with a giant SFT mimicking a chronic expanding hematoma because of her clinical history of a 190×170×120-mm hematoma projecting into the right thoracic cavity. She underwent preoperative transcatheter arterial embolization, followed by tumor resection. She is currently doing well without recurrence 14 months after surgical treatment.

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  • Takashi Ohki, Yoshiki Shigematsu, Kiyoshi Nakashima, Takeo Yagi, Sugur ...
    2019 Volume 33 Issue 1 Pages 42-46
    Published: January 15, 2019
    Released: January 15, 2019
    JOURNALS FREE ACCESS

    Sudden rupture of the intrapulmonary pulmonary artery followed by hemothorax is a rare condition. We report a case in which hemoptysis occurred after pulmonary artery rupture followed by massive hemothorax, which required an emergency thoracotomy. The patient was a male in his 60s. Hemoptysis occurred suddenly at home, and the patient was brought to our hospital by ambulance. Chest computed tomography showed hemopneumothorax, but the cause was unknown at the time of examination. The patient's vital signs worsened, and we performed an emergency thoracotomy, during which we observed extensive lacerations in, and bleeding from, the lateral surface of the S1+2 segments of the left lung. Left upper lobectomy was performed, followed by temporary closure of the lacerations. He was discharged on the 10th postoperative day and is currently under observation. Examination of the resected specimen revealed a rupture of the pulmonary artery in the left upper lobe as the source of bleeding. Although abnormalities in the hemodynamics of the pulmonary circulatory system were suggested, obvious background diseases such as pulmonary arteriovenous fistula and pulmonary hypertension were not identified.

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  • Hideaki Miyamoto, Yasushi Sato, Noritaka Isowa
    2019 Volume 33 Issue 1 Pages 47-51
    Published: January 15, 2019
    Released: January 15, 2019
    JOURNALS FREE ACCESS

    The sternoclavicular joint is an unusual site of infection. We report two surgical cases of pyogenic arthritis of the sternoclavicular joint. Case 1: A 56-year-old man was admitted to our hospital with right chest pain that had worsened during treatment for a diabetic foot ulcer. Computed tomography revealed pyogenic arthritis of the right sternoclavicular joint. Antibacterial drugs and drainage of a chest wall abscess failed to resolve the infection. On the 55th hospital day, we performed partial resection of the right clavicle, first rib, and sternum along with curettage of the abscess of the mediastinum and chest wall. The 8-month follow-up showed no relapse of infection. Case 2: A 67-year-old man was admitted to our hospital with left shoulder pain. Computed tomography showed pyogenic arthritis of the left sternoclavicular joint. On the third hospital day, we performed partial resection of the left clavicle and first rib along with curettage of the abscess of the mediastinum and chest wall. The 3-month follow-up showed no relapse of infection.

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  • Kazunori Koyama, Isao Matsumoto, Shuhei Yoshida, Seichi Kakegawa, Hiro ...
    2019 Volume 33 Issue 1 Pages 52-57
    Published: January 15, 2019
    Released: January 15, 2019
    JOURNALS FREE ACCESS

    A 49-year-old man was admitted to the Department of Neurological and Internal Medicine of our hospital with mild fever and headache, suggestive of meningitis. Computed tomography (CT) showed an approximately 2.1-cm- diameter nodule in the hilum of the left lung. He underwent bronchoscopy, but no diagnosis was made. Because the CT image led to a suspicion of lung cancer, he was referred to our department for diagnosis by therapeutic resection. Left upper lobectomy was performed. Histopathological examination of the resected specimen resulted in a diagnosis of pulmonary cryptococcosis. His cerebrospinal fluid (CSF) was negative for cryptococcal antigen and Cryptococcus neoformans was not grown on mycological culture of the CSF. However, a preserved preoperative blood sample was positive for cryptococcal antigen. Thus, cryptococcal meningitis was diagnosed and he was treated with antifungal therapy, which resulted in marked improvement of his fever and headache. There was no recurrence during the following 2 years. It is difficult to diagnose pulmonary cryptococcosis because the imaging findings vary markedly. We present a patient with pulmonary cryptococcosis diagnosed by resection of the affected lobe of the lung.

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  • Keisuke Yokota, Ichiro Fukai, Masayuki Shitara
    2019 Volume 33 Issue 1 Pages 58-62
    Published: January 15, 2019
    Released: January 15, 2019
    JOURNALS FREE ACCESS

    As PAPVC, a rare vascular malformation, forms left-to right shunt, lobectomy exacerbates this shunt, and might cause right heart failure in cases with malformation located in the lobe that should be preserved. A 78-year-old man with PAPVC in the right upper lobe was referred to our hospital because of an abnormal shadow noted on a chest radiograph, suspected of being right lower lobe lung cancer. To simulate the exacerbation of the shunt after the lower lobectomy, a selective pulmonary artery (PA) occlusion test was conducted using a balloon catheter, which actually blocked the inferior pulmonary trunk simulating middle and lower lobectomy. The occlusion test was easier and stricter than the test blocking the lower pulmonary artery super selectively. The oxygen saturation was calculated using blood samples from the atrium and SVC (distal side of PAPVC) to measure O2 step up between those two anatomical sites. Although O2 step up deteriorated after PA occlusion from 3.2% initially to 6.2%, the value was less than 7%, being clinically significant. The calculated pulmonary blood flow/systemic blood flow ratio (Qp/Qs) after the PA occlusion test was 1.07, which was also less than 1.5 requiring a reconstructive vascular operation to reduce the shunt. Right lower lobectomy was performed without any complications as expected, and the patient was free from recurrence and any symptoms of right heart failure as of 2 years and 3 months after uneventful discharge.

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  • Kiyohiko Hagiwara, Masaki Ikeda, Yoshitake Murata, Takuji Fujinaga
    2019 Volume 33 Issue 1 Pages 63-67
    Published: January 15, 2019
    Released: January 15, 2019
    JOURNALS FREE ACCESS

    Based on the tumor size and localization, surgery for an anterior mediastinal tumor commonly involves either sternotomy or video-assisted thoracoscopy; both procedures have their own advantages and disadvantages. Here, we describe a case wherein an inverted L-shaped mini-sternotomy combined with video-assisted thoracoscopy was performed to resect an anterior mediastinal tumor.

    An 81-year old male undergoing a regular medical examination was incidentally diagnosed with an anterior mediastinal tumor. The tumor grew from 25 to 33 mm during a follow-up period of 18 months. Consequently, he was referred to our hospital for a suspected thymoma. The tumor was adjacent to the innominate vein. We decided on an inverted L-shaped mini-sternotomy combined with video-assisted thoracoscopy to secure a good surgical field. The thoracoscopic view did not initially reveal the tumor or any metastasis; however, the tumor and thymic artery were detected following the courses of the right phrenic nerve and right inner thoracic artery and vein. Further, the sternotomy incision, which afforded a good view, revealed that the thymic vein arose from the innominate vein. Hence, we were able to safely and completely remove the tumor and thymus. The postoperative pathological diagnosis revealed the tumor to be an atypical carcinoid of the thymus.

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  • Yusuke Kita, Yoshimasa Tokunaga, Taku Okamoto
    2019 Volume 33 Issue 1 Pages 68-73
    Published: January 15, 2019
    Released: January 15, 2019
    JOURNALS FREE ACCESS

    Cystic lesions of the mediastinum are often found incidentally. Differential diseases include bronchial and esophageal cysts, pericardial cysts, and Mullerian cysts. A mediastinal Mullerian cyst is a mediastinal cystic disease initially reported by Hattori et al. in 2005. Differentiation from bronchogenic cysts is important based on histological findings. The most important finding is that estrogen and progesterone receptors are positive in the cystic wall by immunohistochemistry. The patient was a 50-year-old woman with a mediastinal cyst detected on a chest radiograph during a medical examination; she was then referred to our thoracic surgery department. Chest computed tomography (CT) showed a posterior mediastinal tumor, which was a low-absorption nodule of 23 mm with no contrast effect at the left 4/5 thoracic vertebra level; cystic lesions were suspected. We performed thoracoscopic resection for diagnosis and treatment. The mediastinal tumor had a cystic structure, and pathological examination showed its inner surface was composed of a cuboidal / cylindrical monolayer epithelium, a part of which was found to be ciliated epithelium. This finding was similar to tubal epithelium. On immunohistological examination, estrogen and progesterone receptors were positive in lining cells. We diagnosed it as a Mullerian cyst. There has been no recurrence in the 3 years since surgery.

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  • Akihiro Ike, Naoko Ose, Yasushi Shintani, Meinoshin Okumura
    2019 Volume 33 Issue 1 Pages 74-79
    Published: January 15, 2019
    Released: January 15, 2019
    JOURNALS FREE ACCESS

    Here, we describe a case of catamenial pneumothorax in the ovulatory phase. A 40-year-old female developed right chest pain and dyspnea on the day preceding menstruation approximately 1 year prior to coming to our department, and was diagnosed with right pneumothorax. Following thoracic drainage, continuous air leakage was present; thus, wedge resection of the right upper lobe was performed using a thoracoscopic method, whereby thinning lesions observed in the diaphragm were covered with a polyglycolic acid sheet. However, recurrence of pneumothorax was seen at 4 months after surgery during the ovulatory phase; thus, pleurodesis was performed. Again, 2 months after pleurodesis, recurrence of pneumothorax occurred and a re-operation was performed. Intraoperative findings during the re-operation revealed multiple perforations around the central tendon of the right diaphragm, through which the liver could be visualized. We performed a resection and diaphragm procedure in the area with multiple holes, and additionally covered the total pleural and diaphragm with a regenerative oxidized cellulose membrane. A histopathological examination confirmed the presence of endometrial tissue on the diaphragm, while immunohistochemical staining revealed positivity for both estrogen and progesterone receptors. The results obtained in this case suggest the existence of catamenial pneumothorax independent of the menstrual cycle.

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  • Shinji Yuhara, Tadasu Kohno, Sakashi Fujimori, Souichiro Suzuki, Takes ...
    2019 Volume 33 Issue 1 Pages 80-84
    Published: January 15, 2019
    Released: January 15, 2019
    JOURNALS FREE ACCESS

    Synovial sarcoma is an aggressive soft-tissue tumor. While the proximal part of the extremity joints is the most favorite site of involvement, primary pulmonary synovial sarcoma is uncommon. We report a case of five-year relapse-free survival after thoracoscopic right upper lobectomy and lymph node dissection. The patient was a 42-year-old male who had no significant medical history. A chest radiograph showed a nodule in the right upper lung field and computed tomography revealed a smooth nodule with dimensions of 12×9 mm in segment 2 of the right lung. He had suspected primary lung cancer and was referred to our department for an operation. Thoracoscopic wedge resection of the right upper lobe was performed. Intraoperative pathological diagnosis showed spindle cell neoplasm with slight mitosis and no necrosis. Since the tumor was diagnosed as spindle cell neoplasm with a differential diagnosis between solitary fibrous tumor and synovial sarcoma, additional resection was not performed. The final diagnosis of synovial sarcoma was confirmed based on histology and the presence of the SYT-SSX2 fusion gene demonstrated by reverse transcription polymerase chain reaction. No primary site was detected other than the lung; therefore, we diagnosed the patient with primary pulmonary synovial sarcoma. One month after the first operation, thoracoscopic right upper lobectomy and lymph node dissection were performed. Pathological findings showed no residual tumor and lymph node metastasis. The patient was followed by PET-CT and survived for five years after the surgery without relapse. The imaging range of PET-CT should include the peripheral extremities, because the most frequent site of involvement is an extremity joint. In this case, a definite diagnosis of synovial sarcoma was not confirmed at the time of the first surgery; therefore, two-stage surgery was performed. Improvement of the accuracy of intra- and preoperative pathological diagnosis is important.

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  • Shun Iwai, Aika Funasaki, Nozomu Motono, Atsushi Sekimura, Katsuo Usud ...
    2019 Volume 33 Issue 1 Pages 85-89
    Published: January 15, 2019
    Released: January 15, 2019
    JOURNALS FREE ACCESS

    A nodule shadow of the right apex area was pointed out on a chest rodiograph of a woman in her 30s during a health examination. Three nodular lesions that were clearly bounded and internally heterogeneous were observed in the right first and second intercostal spaces on chest CT. On chest T2-weighted MRI, the interior showed a high signal intensity. Surgery was performed based on the suspicion of a neurogenic tumor with lymphangioma or cystic change. During surgery, smooth-surfaced nodular lesions that were continuous with the first intercostal and second intercostal nerves were observed, and all lesions were removed under specular conditions. A pathological examination revealed a mixture of Antibiotic Arrangement (Antoni A) showing spinal cells of spindle cells with poor dysplasia and a part that mainly contained mucous organisms (Antoni B), some of which showed cystic changes and vitreous wall glass. Thus, the patient was diagnosed with schwannoma. Intrathoracic nerve sheath tumors account for only 1% of resected chest wall tumors and are relatively rare. In most cases, schwannoma occurs as an isolated tumor; reports of multiple schwannomas occurring in multiple intercostal spaces are extremely rare. We herein review the literature on multiple schwannomas located in the thoracic cavity.

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  • Ryusuke Sumiya, Keigo Sekihara, Yuki Ishiguro, Satoshi Nagasaka, Satsu ...
    2019 Volume 33 Issue 1 Pages 90-94
    Published: January 15, 2019
    Released: January 15, 2019
    JOURNALS FREE ACCESS

    Swyer-James syndrome is a rare disease known as unilateral hyperlucent lung syndrome. It is caused by decreased pulmonary vascularity and hyperinflation.

    Most patients have no symptoms. Although patients are usually followed up without medical care, few cases have surgical indications. Case: A 24-year-old male patient who has been followed up for Swyer-James syndrome since 1 year and 8 months old. He underwent pneumonectomy for infection control. During the operation, we identified no congenital anomaly involving the pulmonary artery or bronchus. There was no adhesion between the left lung and visceral pleura. He was discharged 12 days after the operation and the post-operative course has been uneventful. Most patients are followed up with no medical care. However, few cases, such as patients with marked hemoptysis or infection that show resistance to medical treatment, are recommended for surgery. In this case, the patient had bronchiectasis and repeated infection that destroyed the lung. This is rare case requiring pneumonectomy for Swyer-James syndrome, but we could achieve a good outcome by pneumonectomy. We have to consider the surgical indication cautiously.

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  • Hirotsugu Yamazaki, Yasuto Kondo, Masahito Naito, Yoshio Matsui, Kazu ...
    2019 Volume 33 Issue 1 Pages 95-100
    Published: January 15, 2019
    Released: January 15, 2019
    JOURNALS FREE ACCESS

    Sternoclavicular pyogenic arthritis is a rare infectious disease reported particularly in patients with poorly controlled diabetes mellitus, intravenous drug use, and trauma.

    Here, we report a case of pyogenic arthritis of the sternoclavicular joint in which we performed drainage of a wide abscess in the chest wall and mediastinum.

    A 55-year-old man presented with malaise and swelling in the right anterior chest wall lasting for one month without any symptom improvement.

    Computed tomography revealed abscess formation around the anterior chest wall, mainly near the right intrapleural area and neck, and was transferred to the hospital.

    Laboratory tests showed that his C-reactive protein level was markedly elevated, and he had untreated diabetic mellitus as indicated by increased glycosylated hemoglobin levels, being as high as 10.7%.

    Prior to surgery, we punctured the right anterior chest wall and confirmed the presence of an abscess.

    Drainage was first performed for an abscess of the anterior chest wall by otolaryngologists, subsequently, it was performed for the right intrapleural by thoracic surgeons, and finally, a tracheostomy was performed due to edema of the airway after cervical surgery.

    Following the operation, the intrapleural space was washed every day and the patient was administered antibiotics.

    The infection and his general condition improved gradually.

    The patient was discharged on the 55th postoperative day.

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