Solitary fibrous tumor (SFT) is an uncommon neoplasm arising from mesenchymal cells, most likely involving the pleura. Although the majority of these tumors show benign courses, malignant variants with a high risk of recurrence and metastases are found. Thus, it is important to conduct a long-term follow-up. We herein report 7 patients with surgically resected SFT and a comparative review we conducted clinicopathologically. Based on the results, the standardized uptake value (SUV) max of preoperative FDG-PET and Ki-67 proliferation index could help to evaluate the malignant potential of SFT.

Intrapleural fibrinolytic therapy for acute empyema has been indicated as effective for patients not cured by thoracic drainage. However, its degree of efficacy has not yet been fully investigated. We retrospectively studied 7 patients (6 males, 1 female) who were treated with intrapleural fibrinolytic therapy by urokinase for acute empyema at our hospital. The mean age was 65.0 years old. There were 5 patients with pre-existing conditions, such as schizophrenia, alcoholism, or hypertension. The performance status (PS) was 1 in 3 patients, and more than 2 in 4 patients. The mean number of urokinase instillations was 2.9 times in 7 patients, and 6 patients were cured by intrapleural fibrinolytic therapy. The mean drainage time in the 6 patients who were cured by intrapleural fibrinolytic therapy was 6.7 days. All 7 patients recovered without major complications such as bleeding or anaphylactic shock. We suggest that intrapleural fibrinolytic therapy by urokinase should be considered as a suitable treatment when surgical treatment for acute empyema is not appropriate.

We report the case of a patient with single lung metastasis after gastric cancer surgery. A 66-year-old man was diagnosed with gastric cancer and underwent total gastrectomy. We diagnosed him with poorly differentiated adenocarcinoma T3 (SS) N0M0 p-StageIIA according to the Japanese Classification of Gastric Carcinoma 14^th edition. Surveillance chest CT revealed a nodule in the middle lobe of the right lung. The nodule showed an increasing size. Suspecting a metastatic lung tumor, we performed thoracoscopic right middle lobectomy. Pathological examination revealed that the tumor was consistent with metastasis from gastric cancer. He is currently alive and has not experienced recurrence during the 39 months since the lung resection.

A 21-year-old woman was admitted to our hospital because an abnormal shadow in the left lower lung field was pointed out on a health check-up chest radiograph. Chest computed tomography (CT) showed an anomalous artery of 1.5 cm in diameter arising from the descending aorta, diagnosed as an anomalous systemic arterial supply to a normal basal segment of the left lung. The bronchial system was normal and the left basal segmental pulmonary veins were congested. Video-assisted thoracoscopic surgery was performed considering the risks of pulmonary hypertension and hemoptysis. Dissection of the anomalous artery without lung resection was performed because the lung tissue was radiographically normal without sequestration. The postoperative course was uneventful and she was discharged 3 days after the operation. Chest CT six months after the operation revealed only an organized bundle of the anomalous artery, without pseudoaneurysm or congestion in the left basal segment. We suggest that some patients with an anomalous systemic arterial supply to a normal basal segment of the lung could be successfully treated only by dissection of the anomalous artery with a stapler if the bronchial system is normal.

CASE: An 84-year-old man was admitted to our hospital with bloody sputum. He had undergone right upper lobectomy combined with lymph node resection (ND1) for squamous cell carcinoma 3 years earlier. Computed tomography of the chest showed a 25×18×16-mm³ tracheal tumor, and bronchoscopy showed an irregular polypoid lesion, 16 mm in diameter, in the lower trachea. The pathological diagnosis was squamous cell carcinoma. No distant metastases were identified. Primary tracheal cancer was considered, and it was decided to remove the tracheal tumor as a life-saving measure. To approach the lower trachea, a right fourth intercostal posterolateral thoracotomy was conducted. The tumor side of the caudal trachea was separated, and intubation to the left main bronchus was performed in the surgical field. After tumor removal, reconstruction was carried out with end-to-end anastomosis. The tracheal tube was extubated immediately after the operation, and a soft cervical collar was attached. Extension and left/right movements of the neck were restricted. The patient was discharged without any other problems. The surgical margin was negative, but local irradiation (50 Gy/25 fr) was performed because the margin was close to the tumor. Seven years after the operation, no local recurrence was observed.

A 76-year-old man presented with an abnormal shadow on a chest roentgenogram. After a comprehensive radiographic examination and transbronchial lung biopsy, the preoperative diagnosis was lung adenocarcinoma Stage IA2 (cT1bN0M0).

Chest computed tomography showed a partial anomalous pulmonary venous connection from the right upper and middle lobe and a right B1 bronchus branching from the trachea simultaneously. We attempted to perform complete video-assisted thoracic surgery (VATS) for right upper lobectomy. However, we required a small window incision to complete VATS lobectomy to improve our understanding of the intraoperative anatomy. In cases with uncommon anomalies such as the present patient, enlargement of the port incision to improve intraoperative understanding of the anatomy is important to perform a safe and minimally invasive procedure.

An 83-year-old man fell and hit his left chest hard on the day of hospitalization for the treatment of pneumonia. Chest drainage was performed since computed tomography (CT) revealed a fracture of the left ninth rib and pneumothorax. The drained discharge became turbid and with the diagnosis of acute empyema, the patient was transferred to our hospital. Thoracoscopic decortication followed by open window thoracotomy was performed; however, the discharge continued. Contrast-enhanced CT revealed a fistula between the thoracic cavity and transverse colon via the diaphragm. The fistula was located on the diaphragm close to the costophrenic recess. A tube was inserted through the fistula and double barrel transverse colostomy was performed. Thereafter, the infection in the thoracic cavity reduced promptly and the pyothorax spontaneously improved. Diaphragmatic injury due to rib fractures can cause hemothorax and diaphragmatic hernia, but the ends of fractured bones usually do not penetrate the diaphragm or intestine. This patient had a history of surgery for gastric cancer, and it was suspected that the acute empyema was caused by penetration of the fractured rib end into the transverse colon because the transverse colon had adhered to the left diaphragm.

The patient was a 48-year-old woman who was examined at a neighborhood clinic because of a chief complaint of anorexia. The patient was referred to her previous internal medicine department with Candida esophagitis. Blood tests revealed leukocytosis, and based on a bone marrow biopsy, the patient was diagnosed with acute myeloid leukemia. During chemotherapy, the patient experienced a fever, and a mass shadow in the right upper lobe was identified. Based on the patient's response to antifungal treatment and imaging characteristics, pulmonary mucormycosis was suspected. As it became difficult to continue chemotherapy treatment for leukemia, the patient was referred to our department to undergo surgery, and right upper lobectomy was performed. The histological diagnosis was invasive pulmonary aspergillosis (IPA). The postoperative course was favorable, such that chemotherapy could be reinstated. Both IPA and pulmonary mucormycosis are life-threatening diseases that commonly occur in immunocompromised patients. When developing during leukemia treatment, there have been cases wherein intensive treatment consisting of a combination of antifungal drug treatment and surgical resection have been effective.

Type A thymoma in the World Health Organization (WHO) histological classification is a tumor with a low malignant potential, and most cases show non-infiltrative behavior with defined margins. We report the surgical case of a female in her 60s who had an abnormal shadow pointed out on a chest radiograph. Contrast-enhanced computed tomography (CT) and magnetic resonance imaging revealed an anterior mediastinal mass measuring 6 cm in diameter, and suspected left brachiocephalic vein (BCV) infiltration. Fluorodeoxyglucose-positron emission tomography showed accumulation in the lesion, and the maximal standardized uptake value was 3.5. The results of a CT-guided biopsy indicated type A thymoma. The preoperative diagnosis was invasive thymoma, type A, clinical T3N0M0 stage IIIA, Masaoka stage IIIA. As preoperative treatment, two cycles of chemotherapy (adriamycin, cisplatin, vincristine, and cyclophosphamide: ADOC) were administered; however, the therapeutic response was stable disease. We performed thymo-thymectomy with combined resection of the left BCV and wedge resection of the upper lobe of the right lung followed by the left BCV-right auricle bypass operation through a median sternotomy. Postoperative histopathological examination confirmed the diagnosis of type A thymoma with direct infiltration of the left BCV; ypT3N0M0 stage IIIA, Masaoka stage IIIA. She did not wish to receive additional radiotherapy. At the time of writing, tumor recurrence had not been detected for more than 16 months since surgery. Even with histological type A thymoma, there is a possibility of great vessel infiltration. This should be kept in mind when deciding on the best treatment strategy for thymoma.

Pleuroparenchymal fibroelastosis (PPFE) is a rare bilateral idiopathic interstitial pneumonia defined by pleuro-parenchymal involvement. We encountered a postoperative patient with upper lung field fibrosis that was radiologically consistent with PPFE, but limited to the unilateral lung. The patient was a man aged sixty years old. His medical history included a middle and lower lobectomy under thoracotomy for a lung squamous cell carcinoma seven years ago. He had a low body mass index, a flattened thoracic cage, and severe restrictive pulmonary impairment. Chest CT conducted 7 years after surgery showed subpleural consolidations with bronchiectases and parenchymal lesions in the remaining right lung. Pulmonary apical cap (PAC), defined as a wedge- and triangle-shaped opacity with broad pleural contact, was also observed on chest CT prethoracotomy, which was considered to have deteriorated and progressed into the PPFE lesion over time. PAC is likely to be a consequence of a combination of repeated low-grade infection and chronic ischemia. Thoracotomy itself has a markedly negative impact on thoracic movement on the operated side, which may subsequently lead to pulmonary ischemia. We suggest that the impaired thoracic movement caused by thoracotomy and pathophysiological factors of PAC development could collectively lead to unilateral upper field fibrosis development. PPFE is an irreversible lesion, so we should decide on the operative method carefully, especially in a PAC patient.

A 47-year-old woman who was under medical treatment for rheumatoid arthritis was referred to our hospital due to respiratory distress pleural effusion. It was diagnosed as rheumatoid pleuritis. After unsuccessful treatment with steroid therapy and pleural drainage, we perfomed thoracoscopic pleural decortication. After almost full expansion of the trapped lung and improvement of dyspnea, she was discharged from our hospital without complications. Her pulmonary function showed improvement without relapse of pleural effusion and dyspnea one year after surgery. Thoracoscopic pleural decortication is a good indication for non-infectious subacute or chronic pleuritis.

We report a case of pulmonary resection of lung cancer after percutaneous coronary intervention performed under aspirin monotherapy after dual antiplatelet therapy.

The case was a 70-year-old man. Two weeks prior to referral to our department, he was admitted to a cardiovascular facility for exertional angina, and a drug-eluting stent was placed. Immediately after this, he was started on aspirin and clopidogrel. During hospitalization, a left lung tumor was detected, and so he was referred to our department. Three months after completion of the dual antiplatelet therapy, coronary angiography confirmed good patency of the stent, and the patient was continued on aspirin therapy alone. During the clinical course, the size of the left lower lobe lung tumor increased from 23 to 46 mm, and a diagnosis of squamous cell carcinoma was obtained using ultrasound-guided percutaneous needle biopsy. No new lesions associated with suspected lymph node or distant metastasis were found on contrast-enhanced computed tomography (CT) or positron emission tomography (PET) CT. Left lower lobectomy+ND2a-1 was then performed under continuous aspirin therapy alone. The postoperative course was good, and he was discharged home 6 days after the operation.

The patient was a 43-year-old male long-distance truck driver. Two days before admission to our hospital, he visited a local doctor complaining of fever and back pain and was admitted to the hospital with a diagnosis of right acute empyema. Right chest tube drainage was performed. On the day after admission, he developed rapidly progressive bilateral lower limb paralysis. Re-reading of an earlier image obtained by computed tomography (CT) revealed suspected pyogenic vertebral osteomyelitis, and so he was transferred to our hospital. Decompression was considered urgent and a laminectomy was performed. Despite drainage, the permeability of the right lung field gradually decreased, and the permeability of the left lung field also decreased. Considering pyogenic vertebral osteomyelitis, early effective drainage was necessary. On the 5th day after posterior decompression, we successfully performed video-assisted thoracoscopic surgery. The postoperative course was good, and thoracic drainage was removed bilaterally 13 days after the operation. On the 27th postoperative day, he had recovered and was able to walk with a cane and was transferred to a rehabilitation facility.

We reported a surgical case of bilateral acute empyema due to pyogenic vertebral osteomyelitis.

This report presents two cases of foreign bodies in the bronchus requiring bronchotomy. The first case was an 84-year-old man, referred to our hospital due to a denture in the bronchus, which he aspirated while being treated at a dental office. The denture was removed via a bronchotomy incision along the short axis of the left basal bronchus. The second case was a 60-year-old man with mental retardation, referred to our hospital due to a foreign body in the bronchus first noted on a chest radiograph. The foreign body was removed via a longitudinal bronchotomy incision of the left main bronchus. We suggest that the surgical approach of bronchotomy incision should be decided after careful consideration of the material, shape, and location of the foreign bodies, as well as the intervention time and surrounding bronchopulmonary conditions in cases of foreign bodies in the bronchus requiring surgery.

A 75-year-old man had undergone videothoracoscopy-assisted subtotal esophagectomy, two-field lymph node dissection, and posterior mediastinal reconstruction using a gastric tube for lower thoracic esophageal cancer. One year and three months after the esophagectomy, chest computed tomography suggested the enlargement of the lung nodule in the right upper lobe and right hilar lymph node, so we suspected primary lung cancer (cT1bN1M0, StageIIB). Videothoracoscopy-assisted right upper lobectomy was planned. We peeled off severe adhesion between the lung and reconstructed gastric tube carefully to avoid injuring the gastric tube. We could complete right upper lobectomy and lymph node dissection at the superior mediastinum under videothoracoscopy. We report the pre- and intraoperative cautionary points and measures for right upper lung cancer after esophageal cancer resection, with a review of the literature.

An appropriate approach is key in surgical intervention for cervicothoracic tumors because of their anatomical complexity. We present the case of a 75-year-old female who had a type AB thymoma (6.8×6.2×5.8 cm) associated with myasthenia gravis and cervicothoracic schwannoma (6.0×5.0×5.0 cm) with C7/8-Th1 paralysis. The patient simultaneously underwent extended thymectomy and resection of the schwannoma with a transmanubrial approach and median sternotomy. This procedure could provide a sufficient surgical view of both cervicothoracic tumors located on the cranial side of subclavicular vessels and mediastinal disorders requiring extended thymectomy.

Colorectal cancer recurs at a frequency of 30-50% within 2 years after curative resection. A 71-year-old male patient, who received sigmoidectomy for sigmoid cancer 20 years previously and liver resection for liver metastasis 16 years previously, took an anticancer agent, and finished periodical examination, presented with an abnormality noted on a chest image acquired during a medical examination and an irregular and relatively well-defined nodule of 7 mm in the right upper lobe S1a on computed tomography (CT). Although positron emission tomography (PET) -CT showed no uptake in the tumor, thoracoscopic partial resection of the right upper lobe was performed for the purposes of diagnosis and therapy for the slowly growing tumor. Frozen examination suggested adenocarcinoma; however, the final examination identified lung metastasis from colon cancer, suggesting that a lung tumor with colorectal cancer has to be differentiated from colon metastasis regardless of the time elapsing since diagnosing the primary lesion.

Tube drainage of a pneumothorax when pleural adhesion is present is associated with the risk of causing pulmonary injury due to adhesion between the chest wall and lung. Choosing the insertion point of a chest tube, therefore, requires careful scrutiny. Even a CT image taken with the patient in the supine position cannot always clarify if adhesion is present in a case of mild or occult pneumothorax, because the lung surface is touching the parietal pleura of the chest wall. Recently, it was reported that percutaneous lung ultrasound tomography via the chest wall can accurately confirm a pleural adhesion area, and it is markedly accurate for diagnosing pneumothorax. In this report, we describe a pilot study of five cases of tube drainage of a pneumothorax with pleural adhesion using lung ultrasound tomography. In all five cases, we were able to detect the pleural adhesion point as well as free air spaces. There were no complications in any of the cases. The study results suggest that lung ultrasound tomography can safely support the decision on where to insert chest tubes.