The Journal of the Japanese Association for Chest Surgery
Online ISSN : 1881-4158
Print ISSN : 0919-0945
ISSN-L : 0919-0945
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Showing 1-19 articles out of 19 articles from the selected issue
  • Hiroshi Hashimoto, Kazuyuki Komori, Kotaro Yoshikawa, Shinichi Taguchi ...
    2021 Volume 35 Issue 4 Pages 264-269
    Published: May 15, 2021
    Released: May 15, 2021
    JOURNALS FREE ACCESS

    A 78-year-old woman visited a local physician with lower leg edema and malaise. She was diagnosed with anemia (serum hemoglobin: 4.6 mg/dL) and was referred to our department of hematology for further evaluation. We diagnosed her with pure red cell aplasia (PRCA), and computed tomography revealed an anterior mediastinal tumor (thymoma). We administered cyclosporine, which led to improvement in anemia, and blood transfusion could be discontinued. The patient was referred to our department for thymoma resection and underwent extended thymothymectomy via a median sternotomy as conducted for patients with myasthenia gravis. Histological evaluation of the anterior mediastinal tumor confirmed a sclerosing thymoma. The patient showed remission of anemia perioperatively and did not require cyclosporine re-administration even after discharge. The patient has not required any treatment and anemia has not progressed. Thymectomy may not effectively treat PRCA accompanied by thymoma, and systemic treatment with cyclosporine and steroids is necessary in these patients. We report a case of remission of PRCA in a patient with thymoma who received adjuvant cyclosporine administration followed by extended thymothymectomy without any systemic treatment.

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  • Fumihiko Hoshi, Nobuyuki Sato, Kazuma Kobayashi, Fumiko Tomiyama, Toru ...
    2021 Volume 35 Issue 4 Pages 270-275
    Published: May 15, 2021
    Released: May 15, 2021
    JOURNALS FREE ACCESS

    <Background> In cases of pneumothorax, it is a routine procedure for thoracic surgeons to extend the collapsed lungs by inserting a thoracic drain and aspirating with negative pressure. We report a case whose respiratory condition was worsened by continuous drainage.

    <Case> A 34-year-old man showed a marked difference between the right and left thorax due to scoliosis. In the terminal phase of facioscapulohumeral muscular dystrophy, he was admitted to a nearby hospital with respiratory management by tracheostomy and ventilation. The patient was transferred to our hospital for treatment of a right pneumothorax, and a drain was inserted into his right thoracic cavity. After the beginning of continuous drainage, his respiratory condition worsened. His tidal volume decreased and we could not improve his respiratory condition by changing the setting of ventilation. Finally, we removed the chest drain's peripheral side from the continuous aspirator and released it to the atmosphere, then his respiratory condition improved.

    <Conclusion> Under special conditions, continuous chest tube drainage worsens the respiratory condition.

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  • Tomohito Tarukawa, Teruhisa Kawaguchi, Daisuke Yamaguchi, Motoshi Taka ...
    2021 Volume 35 Issue 4 Pages 276-280
    Published: May 15, 2021
    Released: May 15, 2021
    JOURNALS FREE ACCESS

    We report the case of a 72-year-old male with a partial anomalous pulmonary venous connection (PAPVC). Chest computed tomography revealed a 3.1 cm part-solid nodule in the left upper lobe as well as right V1 and V2a that drained into the superior vena cava, which was diagnosed as a result of PAPVC. PAPVC in the non-resected lobe led to concerns of right ventricular heart failure resulting from increased left-to-right shunt flow after lung resection. To assess exacerbation of the shunt after left S1+2 segmentectomy, a selective pulmonary artery occulusion test (A1+2a+b was blocked) was done. The pulmonary blood flow/systemic blood flow ratio was 1.23, so we performed left S1+2 segmentectomy without correcting PAPVC. The patient was free from any symptoms of right heart failure for 1 year after discharge.

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  • Masahisa Miyazawa, Hiroyasu Matsuoka, Daisuke Nakamura, Nobutaka Kobay ...
    2021 Volume 35 Issue 4 Pages 281-285
    Published: May 15, 2021
    Released: May 15, 2021
    JOURNALS FREE ACCESS

    We report a case of diaphragmatic hernia complicated by diaphragmatic resection. A 71-year-old male underwent lower lobectomy of the left lung for squamous cell carcinoma. The invaded diaphragm was resected, involving an area of 5.2×4.5 cm, and closed with interrupted direct sutures. On the fourth postoperative day he complained of nausea and appetite loss, and a chest film on the next day showed a markedly dilated stomach in the left hemithorax. Computed tomography revealed that the diaphragm was ruptured and the stomach with omentum had herniated into the left thoracic cavity. Emergent thoracotomy was performed, revealing that the diaphragm had partially split along the suture line, and the stomach and omentum without ischemic change were incarcerated. After hernia reduction, the diaphragmatic defect was repaired with a monofilament polypropylene mesh patch. No recurrent sign of the diaphragmatic hernia was seen for 13 months after the operation. We should be careful when repairing with direct sutures after diaphragmatic resection.

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  • Akira Ogihara, Yutaka Miyano, Hideyuki Maeda, Satoru Morita, Shuji Sak ...
    2021 Volume 35 Issue 4 Pages 286-291
    Published: May 15, 2021
    Released: May 15, 2021
    JOURNALS FREE ACCESS

    We report the case of a woman in her twenties with systemic arterial supply to the basal segment of the left lower lobe (LLL). The patient was referred to our hospital due to hemoptysis. Chest enhanced computed tomography (CT) showed an aberrant artery branching from the celiac artery, which penetrated the diaphragm and fed the normal basal segment of the LLL. In 3D-CT, the pulmonary venous and bronchial branches in the basal segment of the LLL were normal. However, the pulmonary artery was partially absent in the laterobasal segment. We considered surgical treatment, but she was young and unmarried; therefore, we performed embolization of the aberrant artery with a vascular plug. No complications such as pneumonia or pulmonary infarction were observed after the treatment. Twenty-six months after the embolization, she has had no recurrence of symptoms; the aberrant artery has not reopened, and no aneurysm formation has been noted.

    We suggest that patients with systemic arterial supply to the basal segment of the lung could be successfully treated by embolization of an aberrant artery in a narrow perfusion area. However, the long-term prognosis associated with embolization of an aberrant artery is unknown.

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  • Hiroaki Harada, Makoto Fujiwara, Mai Nishina, Satoshi Shibata
    2021 Volume 35 Issue 4 Pages 292-296
    Published: May 15, 2021
    Released: May 15, 2021
    JOURNALS FREE ACCESS

    An 80-year-old man was transported to our hospital because of a pneumothorax caused by migration into the thoracic cavity of Kirschner steel wire used to fix a humerus fracture. About a month previously, fixation of a fracture of the proximal portion of the humerus by Kirschner steel wire was performed under local anesthesia. Subcutaneous emphysema appeared 4 days after removing two of the steel wires used for fixing, and a radiograph revealed that one of the remaining steel wires had migrated into the thoracic cavity. CT showed the steel wire in the right middle lobe and slight pneumothorax with subcutaneous emphysema, although neither hemothorax nor bleeding in the lung parenchyma was observed. Emergency surgery was performed on the same day, and the steel wire was removed through a thoracoscopic approach. Although intrathoracic migration of Kirschner steel wire used for fixing fractures around the collarbone or shoulder joint is rare, it has the potential to be a fatal complication; here, we report a case along with a literature review.

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  • Kozo Yamamoto, Motohisa Kuwahara, Satoshi Yamamoto
    2021 Volume 35 Issue 4 Pages 297-302
    Published: May 15, 2021
    Released: May 15, 2021
    JOURNALS FREE ACCESS

    Systemic chemotherapies, several molecular-targeted agents, or immune checkpoint inhibitors are selected as main treatments for advanced non-small lung cancer. However, with molecular-targeted agents, most patients eventually experience tumor progression due to acquired resistance. The role of residual or recurrent tumor resection after the treatment is unclear.

    A 65-year-old man was referred to our hospital due to an abnormal radiographic image. Chest CT revealed a 50-mm solid mass in the right upper lobe. The tumor involved the hilar lymph node and extended to the upper lobar bronchus. Head MRI revealed a 10-mm brain metastasis in the left parietal lobe. He was initially diagnosed with adenocarcinoma (cT2bN1M1b Stage IVA) by transbronchial lung biopsy. Then, brain metastasis was removed surgically. He was finally diagnosed with ALK-rearranged adenocarcinoma from tissue of the brain metastasis.

    Alectinib (600 mg/day) was started as the first-line therapy. After 14 months of alectinib therapy, chest CT revealed marked reduction of the tumor and two other lesions in the right upper lobe. One was a 10-mm nodule close to the scar of the primary tumor, which had not been found on chest CT three months ago. The other was a 14-mm nodule apart from the scar, which existed before alectinib treatment and had gradually enlarged. We performed complete VATS right upper lobectomy and mediastinal lymph node dissection for treatment and diagnosis.

    Histopathlogical diagnoses: No residual viable cell was found in the primary lesion. The lesion close to the scar of the primary lesion was a recurrent lesion. The lesion apart from the scar was primary lung cancer.

    When we find a new lesion, it is important to try to make a histopathological diagnosis and decide on the course of treatment actively, if possible.

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  • Yuki Yamada, Junichi Maeda, Tatsuhiro Hoshino, Toshiya Yokota, Shigeki ...
    2021 Volume 35 Issue 4 Pages 303-308
    Published: May 15, 2021
    Released: May 15, 2021
    JOURNALS FREE ACCESS

    A 71-year-old woman was found to have an abnormal shadow on a chest radiograph during a medical checkup. Chest computed tomography (CT) showed a solid nodule in the right S4a segment. The nodule was 1.0×0.9 cm in diameter. She had been treated by chemotherapy for malignant lymphoma at age 49 and achieved complete remission at age 66. Looking back at her previous chest CT performed during the treatment of malignant lymphoma, the solid nodular shadow had been increasing slowly over the last 13 years. Therefore, she was referred to our department for more detailed examination and treatment. Although percutaneous CT-guided transthoracic needle biopsy (CTNB) was performed for diagnostic purposes, a definitive diagnosis was not made. From the chest CT findings and clinical course, inflammatory disease was suspected. However, we decided to perform surgery due to the high risk of carcinogenesis after treatment for malignant lymphoma. We performed right middle wedge resection, and the intraoperative rapid pathological diagnosis was adenocarcinoma. Therefore, we added right middle lobectomy with nodal dissection. From the findings, the tumor was suggested to be secondary malignancy due to chemotherapy for malignant lymphoma. It is extremely rare because it showed a solid nodular shadow from the time of tumor appearance, and there are no reports of slow growing lung adenocarcinoma suggesting secondary malignancies.

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  • Yasuki Hachisuka, Shinji Fujioka, Masashi Uomoto
    2021 Volume 35 Issue 4 Pages 309-314
    Published: May 15, 2021
    Released: May 15, 2021
    JOURNALS FREE ACCESS

    A 48-year-old man who was pointed out as showing an abnormal shadow on a chest radiograph during a medical check-up was admitted to another hospital. Because an anterior mediastinal tumor was detected on computed tomography (CT), he was referred to us for surgical treatment.

    Contrast enhanced CT revealed a tumor with markedly enhanced effect measuring 7.5×5.8×3.4 cm in the anterior mediastinum, which was diagnosed as invasive thymoma.

    Intraoperative findings showed many inflowing vessels branching from the internal thoracic artery in the tumor, and extended thymectomy was performed.

    The histopathological diagnosis was Castleman's disease, hyaline-vascular type. Because no lesions were found in any region other than the mediastinum, this patient was diagnosed with unicentric Castleman's disease occurring only in the anterior mediastinum. We report a case of Castleman's disease that was difficult to distinguish from thymoma by both preoperative diagnostic imaging and intraoperative findings.

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  • Shinji Kaneda, Sachiko Tochii, Hiroshi Kawai, Daisuke Tochii, Takashi ...
    2021 Volume 35 Issue 4 Pages 315-319
    Published: May 15, 2021
    Released: May 15, 2021
    JOURNALS FREE ACCESS

    Introduction: Pleuroperitoneal communication is a serious complication of continuous peritoneal dialysis (CAPD). We report a patient undergoing CAPD who developed pleuroperitoneal communication that was successfully treated via thoracoscopic partial resection of the diaphragm, including a transmural fistula containing ectopic endometrial tissue.

    Case: A 42-year-old woman who developed right pleural effusion after CAPD started treatment for endstage renal failure due to endocapillary proliferative glomerulonephritis. Pleural effusion testing revealed a high glucose concentration, and contrast medium injected into the peritoneal cavity entered the right thoracic cavity; therefore, pleuroperitoneal communication was diagnosed. Thoracoscopic surgery was performed under general anesthesia with differential lung ventilation. When peritoneal dialysate mixed with 10 mL of indigo carmine was injected into the peritoneal cavity, leakage of blue liquid was observed from a brown fistula near the central tendon of the right diaphragm. The right diaphragm (including fistula) was partially resected using an automatic suturing device, and the resected end was reinforced with knotted sutures and wide coverage with a polyglycolic acid sheet. Pathological examination revealed ectopic endometrial tissue in the diaphragmatic fistula. Peritoneal dialysis was resumed on postoperative day 7, and hormone therapy was administered to prevent recurrence of the diaphragmatic fistula owing to ectopic endometriosis. There has been no recurrence in 1.5 years of follow-up.

    Conclusion: Thoracoscopic surgery is useful for identifying and treating the site of pleuroperitoneal communication. Ectopic endometriosis may contribute to the development of pleuroperitoneal communication. Histopathological examination should be done to confirm the diagnosis and guide further treatment to prevent recurrence.

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  • Hiroki Watanabe, Yoshito Imamura, Toshiki Okasaka, Yoshinori Hiramatsu
    2021 Volume 35 Issue 4 Pages 320-325
    Published: May 15, 2021
    Released: May 15, 2021
    JOURNALS FREE ACCESS

    A 36-year-old woman, with a history of pelvic endometriosis, was referred for right chest pain on 2 days after an uneventful cesarean section. A chest roentgenogram and computed tomography revealed a right pneumothorax. She had seven prior episodes of pneumothoraxes on the right related to the onset of menstruation, which were treated conservatively with observation.

    The insertion of a chest tube into the thoracic cavity was required because pneumothorax was progressing on the 7th day after childbirth. Thoracoscopy revealed the presence of thickening pleura on the right upper lobe and multiple holes in the central tendon of the right diaphragm. Thoracoscopic partial resection of the right upper lobe and diaphragm including the lesions was performed. Postoperatively, she has been symptom-free for two years on hormonal therapy.

    The mechanism of catamenial pneumothorax is unclear. It is suggested that the hormonal withdrawal in the postpartum period caused a recurrence and worsening catamenial pneumothorax. It is important to keep in mind that a person with a history of catamenial pneumothorax might develop a serious pneumothorax in the postpartum period.

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  • Hayato Nanami, Ryo Miyoshi, Kyoko Hijiya, Toshiaki Moriki, Akinori Mae ...
    2021 Volume 35 Issue 4 Pages 326-331
    Published: May 15, 2021
    Released: May 15, 2021
    JOURNALS FREE ACCESS

    We report four patients (3 females and 1 male, mean age of 62 years) with pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma confirmed by lung resection, and followed by chemotherapy. They had various CT features such as a well-circumscribed mass, nodule, or consolidation mimicking lung cancer. Bronchoscopy was performed for three of the four, but failed to result in a definitive diagnosis in any case. Lung resection was performed in all patients for the purposes of diagnosis and treatment, and pathological examination led to a definitive diagnosis of pulmonary MALT lymphoma. Adjuvant chemotherapy was performed in two patients, while it was administered as treatment for newly appearing lesions in other organs during the long-term follow-up period. One of the four patients died of another cancer 25 years after surgery. Three patients survived for 11 years, 2 and a half years, and 1 year and 8 months after surgery, respectively. We believe that pulmonary resection combined with close follow-up and treatment by a hematologist is effective to treat patients with pulmonary MALT lymphoma.

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  • Fumiaki Kato, Satoshi Makihata, Yuichirou Sato, Kazuki Nabeshima, Akin ...
    2021 Volume 35 Issue 4 Pages 332-336
    Published: May 15, 2021
    Released: May 15, 2021
    JOURNALS FREE ACCESS

    We report a case of metastatic pulmonary leiomyosarcoma, which was initially diagnosed as a primary pulmonary tumor. The case involved a 53-year-old female who came to our hospital with an abnormal shadow on a chest radiograph. Bronchoscopic biopsy did not confirm the diagnosis, and VATS partial resection of the right lung was performed. The patient had a surgical history of uterine leiomyoma 17 years ago. We re-evaluated the surgical specimen of the uterus, and saw the proliferation of atypical tumor cells and central necrosis. These findings did not completely rule out malignancy, and we diagnosed the patient with pulmonary metastasis from a uterine smooth muscle tumor. In this case, we had difficulty differentiating the primary organ.

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  • Shinobu Katagiri, Hideki Endoh, Takahiro Tachibana, Nobuhiro Nishizawa ...
    2021 Volume 35 Issue 4 Pages 337-343
    Published: May 15, 2021
    Released: May 15, 2021
    JOURNALS FREE ACCESS

    A 77-year-old man who had chronic empyema after thoracoscopic left upper lobectomy had been treated with thoracic drainage and pleural lavage. Thirty months after surgery, just after finishing pleural lavage with saline solution in an outpatient setting, the patient suddenly lost consciousness and fell into a state of shock. We diagnosed him with coronary air embolism because ECG showed ST elevation and echocardiography and chest CT showed air in vessels, and cardiac catheterization was performed emergently. Air existed in the ascending aorta and right coronary artery, and the patient's condition recovered after aspirating the air with a cardiac catheter. Although he developed mild cerebral air embolism, he improved by conservative treatment and rehabilitation, and was finally discharged. Although there are some reports of air embolism caused by pleural lavage for chronic empyema, the mechanism of how it occurs remains unknown. This case suggests the usefulness of cardiac catheterization for air embolism, since a severe condition could be prevented in the present case by aspirating a large amount of air in vessels with a cardiac catheter.

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  • Hitoshi Nishikawa, Doufu Hayashi
    2021 Volume 35 Issue 4 Pages 344-348
    Published: May 15, 2021
    Released: May 15, 2021
    JOURNALS FREE ACCESS

    For penetrating chest trauma, it is necessary to judge the surgical indication and treat it promptly. Here, we report a case of thoracoscopy-assisted pulmonary tractotomy (PT) Performed for a lung puncture caused by a crossbow. A 50's-year-old man set the crossbow himself and shot an arrow into his left precordial area. He consequently developed chest pain and respiratory distress while maintaining consciousness, and was emergently transported to our hospital with an arrow stuck in his chest. The arrow in the left chest penetrated the left back. Chest CT revealed a left moderate pneumothorax and a small amount of pleural effusion, and the arrow penetrated the left lingular segment and S6. We decided to remove the arrow and repair the damaged part while observing with a thoracoscope. The penetrated part of S6 was partially resected using automatic staplers. Since the penetrated part of the lingular segment was deep and long, PT was performed using automatic staplers and repaired. The postoperative course was without any complications. Thoracoscopy-assisted PT could be used to quickly treat the injured part and was also useful for shortening the operative time.

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  • Mitsue Suzuki, Yoshihiro Ishikawa, Tetsuya Isaka, Akitomo Kikuchi, Koj ...
    2021 Volume 35 Issue 4 Pages 349-354
    Published: May 15, 2021
    Released: May 15, 2021
    JOURNALS FREE ACCESS

    A 62-year-old woman was revealed to have a posterior mediastinal tumor with a diameter of 20×12×30 mm on the back of the diaphragm of the lower thoracic aorta on computed tomography (CT), which was performed to investigate left back pain and left-sided abdominal pain. Contrast thin-section CT and magnetic resonance imaging (MRI) showed no abnormal blood vessels from the aorta. She was suspected of having a pleural tumor and extrapulmonary sequestration of the lungs, and underwent thoracoscopic surgery. We diagnosed her with extrapulmonary sequestration with an aberrant artery protruding from the front of the descending aorta from the operative results. Several abnormal blood vessels with a diameter of about 1 mm were ligated and the sequestrated lungs were resected. In this paper, we report a summary of the case with a literature search on diagnostic imaging of extrapulmonary sequestration.

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  • Yujiro Kubo, Toshiya Fujiwara, Kazuhiro Okada, Ryuji Nakamura, Yuho Ma ...
    2021 Volume 35 Issue 4 Pages 355-362
    Published: May 15, 2021
    Released: May 15, 2021
    JOURNALS FREE ACCESS

    A solitary fibrous tumor (SFT) is a rare tumor derived from mesenchymal cells. We encountered two cases of malignant SFT of the pleura showing unique clinical courses. Case 1 was a woman in her 70s. A tumor shadow in the left thoracic cavity had been observed for 8 years. Then, it suddenly began to enlarge rapidly from 1 year ago. Tumor resection was performed as extensively as possible under thoracotomy. There were numerous nodules on the pleura, and complete resection was difficult. Histopathological examination revealed malignant SFT. Case 2 was a woman in her 60s. Right middle lobectomy and basal segmentectomy were performed for the pulmonary tumor, and histopathological examination revealed a malignant SFT. Three years later, a cholecystectomy for acute cholecystitis was performed and a tumor was found in the gallbladder. Histopathological examination confirmed SFT. One more year later, retroperitoneal tumor resection was performed, and it was also diagnosed as SFT metastatic recurrence. Considering that SFT exhibits various pathological conditions, it may be necessary to consider surgery or perform careful follow-up.

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  • Mikito Suzuki, Kyohei Masai, Keisuke Asakura, Tomoyuki Hishida, Yasufu ...
    2021 Volume 35 Issue 4 Pages 363-368
    Published: May 15, 2021
    Released: May 15, 2021
    JOURNALS FREE ACCESS

    Blunt trauma causes multiple rib and sternal fractures, which result in flail chest. Flail chest is a disorder in which instability and fluctuation of the chest wall induce paradoxical breathing. Common flail chest treatment includes external fixation or internal fixation using positive airway pressure. However, there are a few reports of using the Nuss procedure as the method of surgical fixation for flail chest.

    An 81-year-old man suddenly developed cardiopulmonary arrest and received cardiopulmonary resuscitation. He had multiple rib and sternal (horizontal manubrium and body of sternum fractures) fractures due to chest compression, resulting in flail chest. He experienced extubation failure twice by paradoxical breathing. We considered the Nuss procedure to be an effective surgical treatment for flail chest. We inserted two titanium bars in the third and fourth intercostal spaces and performed the Nuss procedure for surgical fixation. His postoperative course was uneventful, and mechanical ventilatory support was removed on postoperative day 15. Therefore, we suggest that the Nuss procedure is efficacious and offers minimally invasive surgical fixation for flail chest patients, especially with sternum fracture.

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