We report a case of pulmonary sclerosing pneumocytoma with mediastinal lymph node metastasis. The patient was a 44-year-old woman. Computed tomography (CT) revealed a circular 25-mm nodule with a clear border in the lower right lobe S7. CT-guided biopsy diagnosed non-small cell lung cancer. PET-CT showed accumulation in the primary lesion, but no clear accumulation in the hilar mediastinal lymph nodes. We diagnosed her with right lower lobe lung cancer cT1cN0M0 Stage IA3. Thoracoscopic right lower lobectomy and lymph node dissection were performed. A permanent pathological specimen led to diagnoses of pulmonary sclerosing pneumocytoma and subcarinal lymph node metastasis. Although pulmonary sclerosing pneumocytoma is treated as a benign tumor of the lung, in rare cases, lymph node metastases and recurrence have been reported, and it is considered to have the properties of a low-grade tumor. Surgical resection is the treatment of choice, but the extent of resection is unclear. Although the prognosis of resected cases is good and lymph node metastasis is not a poor prognostic factor, the biological features of this tumor are largely unknown, and careful follow-up is necessary.

Trapped lung is defined as the inability of the lung to expand because of a fibrous membrane overlying the visceral pleura resulting from remote pleural inflammation. A 23-year-old Japanese man was referred to our department with left pneumothorax identified during a medical check-up. Chest radiograph and computed tomography (CT) revealed that his left lung had completely collapsed. In the chest radiograph taken the previous year for a routine medical check-up, there had been no indication of pneumothorax, but a bulla had been identified in the left apex. The onset of the pneumothorax was unclear due to the absence of symptoms. CT after chest tube drainage showed that the left lung could not expand and fill the thoracic cavity due to abnormal thickening of the visceral pleura. Despite chest tube drainage with a suction pressure of −5 cmH₂O, air leakage was prolonged, and expansion of the left lung did not improve. Thus, thoracoscopic surgery was scheduled. A ruptured bulla with air leakage was found in the left apex, and the fibrous membrane overlying the visceral pleura prevented lung expansion. He was diagnosed with a trapped lung related to left pneumothorax. Bullectomy and pleural decortication were performed successfully. The postoperative course was uneventful. Expansion of the left lung gradually improved. Chest radiograph 6 months after surgery showed that there was no residual space in his left chest cavity. This report presents a very rare case of pleural decortication for trapped lung caused by chronic spontaneous pneumothorax.

Takotsubo cardiomyopathy (TCM) is known as stress-induced cardiomyopathy and might occur after surgery for lung cancer. Most patients recover fully and have a good prognosis, but, rarely, some die of complications. An 84-year-old woman underwent thoracotomy for left lower lung lobectomy and mediastinal lymph node dissection for primary lung cancer. On the first postoperative day, ST segment elevation was noted on her electrocardiogram (ECG) and cardiac enzymes were elevated. Suspecting cardiac ischemia, we performed coronary angiography, although it showed no significant coronary stenosis. We diagnosed her with TCM based on the presence of takotsubo-type wall motion on left ventriculography. On postoperative day 5, she suffered cardiopulmonary arrest, for which resuscitation was performed. Unfortunately however, spontaneous circulation could not be resumed despite resuscitative efforts and she was declared dead. We report a case of sudden death with TCM after surgery for lung cancer, and review the relevant literature.

A 16-year-old male experienced pain in the right shoulder one month ago. Since a chest radiograph did not clearly show abnormal findings, he underwent symptomatic treatment. However, during the rehabilitation, he suddenly turned pale and had a cold sweat. A chest radiograph and CT examination revealed right hemothorax. Furthermore, chest CT revealed a highly absorbent structure in the chest cavity near the right 7th rib, and the surrounding thoracic adipose tissue was thickened. The next day, because anemia progressed and pleural effusion increased, we performed thoracoscopic surgery. Osteophytes were found protruding into the thoracic cavity from the right 7th rib. The facing diaphragm surface was uneven and irregular, causing bleeding from that site. The osteophyte was removed, and the pathological diagnosis of the specimen suggested osteochondroma.

The pulmonary vascular anatomy has recently been depicted with marked accuracy using three-dimensional computed tomography (3D-CT) preoperatively. We herein report 3 rare cases of lung cancer in which surgery was safely performed by keeping track of the exceptional branch of the V2 terminalis by 3D-CT. The preoperative findings of 3D-CT revealed that anomalous V2 branches existed dorsal to the intermediate bronchus and drained into the left atrium in two cases, and the superior pulmonary vein in the other one. Although patients with such an anomalous pulmonary vein are very rare, we should keep in mind the existence of these extraordinary segmental veins to avoid pulmonary vascular complications in lung surgery.

The pulmonary artery has some variations, and these variations are very important in pulmonary surgery.

A woman in her seventies was suspected to have left upper lobe lung cancer T1aN0M0 clinical Stage IA1 on close examination during an annual medical checkup. We decided to treat the patient surgically. We could not observe any variations of the pulmonary artery on preoperative imaging. Mediastinal A5 and A9-10 was detected during surgery, we could preserve A9-10 and perform the operation by employing complete video-assisted thoracic surgery. The mediastinal common trunk of A5 and A9-10 passed between the left superior pulmonary vein and left upper bronchus. Careful operation was essential, because a mediastinal common trunk of A5 and A9-10 is very rare. A structure between the left bronchus and left superior pulmonary vein on non-enhanced chest CT may indicates a mediastinal basal pulmonary artery.

A 79-year-old man was referred to our hospital with an abnormal shadow on a chest radiograph. Chest computed tomography (CT) showed a solid nodule in the right upper lobe, and a supernumerary anomalous bronchus arising from the trachea in addition to the normal right upper bronchus. Right upper lobectomy was performed with a diagnosis of primary lung adenocarcinoma Stage IA2. The supernumerary bronchus branched from the cranial side of the azygos vein arch through the caudal side to the right upper lobe between S² and S³. After dissecting the azygos vein arch, the supernumerary bronchus was dissected close to the trachea. Three-dimensional (3D) CT was useful for detecting bronchial and vascular anomalies.

The recent development of a new coronal stent and technical advancements in antiplatelet therapy have demonstrated the effectiveness of shortening the period of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI), thus making it possible to perform surgery sooner than had previously been possible. We herein report our efforts to reduce the period for postponing surgery for lung cancer, and thus making it possible to perform surgery as early as one month after coronal stent deployment.

A 77-year-old man was incidentally found to have a nodule lesion of primary lung cancer on computed tomography coronary angiography, which led to a diagnosis of silent myocardial ischemia. The patient underwent video-assisted thoracoscopic lobectomy while the preoperative administration of aspirin was continued following one month of DAPT after coronal drug-eluting stent deployment in the proximal portion of the left coronary artery. Pathological and histopathologic examinations revealed the nodule to be stage IB, pT2aN0M0 acinar adenocarcinoma. No growth of lung cancer has been observed on CT since the patient was admitted to our department.

Thymic adenocarcinoma is a rare subtype (0.2%) of thymic epithelial tumor. Its clinicopathological features are not well-understood and a consensus on the treatment strategy has not yet been established. Here, we report a 46-year-old male patient with pathological stage IV thymic mucinous adenocarcinoma who achieved long-term disease control after primary tumor resection. The patient presented with cough and chest pain, and chest CT showed an anterior mediastinal mass. The tumor was diagnosed as thymic adenocarcinoma by CT-guided needle biopsy. CT showed the suspicious presence of pleural dissemination in the left thoracic cavity. Intraoperative findings also confirmed pleural dissemination, but debulking surgery was performed by total thymectomy and resection of disseminated nodules. The final pathological diagnosis was primary thymic mucinous adenocarcinoma with pT3N2M1a, stage IVB. He developed local recurrence, but systemic chemotherapy was administered, and he is still alive with controlled recurrent lesions at 30 months postoperatively. Although thymic carcinoma that cannot be completely resected is associated with a poor prognosis, debulking surgery during multi-modality therapy may help to gain disease control.

Lower rib fractures are sometimes associated with diaphragm injury, which can be the cause of slight but continuous bleeding. A 73-year-old female complained of general fatigue and dyspnea on the day after she fell down and hit her left chest. Computed tomography revealed left hemopneumothorax and left 8th-10th rib fractures. The 10th rib had a sharp edge. She was treated with thoracic drainage, but a small amount of fresh blood was observed even 12 hours after tube insertion. The possibility of bleeding from the lacerated diaphragm due to the sharp edge of the 10th rib could not be ruled out. An emergency operation by uniportal video-assisted thoracoscopic surgery was performed. The sharp edge of the fractured 10th rib was removed and the lacerated diaphragm about 20 mm was repaired by continuous suture. As lower rib fractures with sharp edges may injure the diaphragm surface, emergency surgical intervention should be considered for patients who have broken ribs with sharp edges.

Vascular-type Ehlers-Danlos syndrome (vEDS) is a rare inherited autosomal dominant disorder. Although the majority of individuals with vEDS are identified because of family history, those remaining present with major complications such as vascular dissection or rupture, gastrointestinal perforation, or organ rupture. Only a few vEDS patients develop spontaneous pneumothorax as an initial complication.

Herein, we report a rare case of hemopneumothorax secondary to vEDS. A 14-year-old female was admitted to our hospital for left-sided chest pain, cough, and hemoptysis. A chest radiograph revealed left-sided pneumothorax, and chest computed tomography showed small nodules in the lower lobes. A chest tube was inserted for the left pneumothorax, and the air leakage stopped immediately; however, she developed right-sided pneumothorax six days after hospitalization. Video-assisted thoracic surgery (VATS) was performed for bilateral pneumothorax. Bloody pleural effusions and several intrapulmonary hemorrhages were detected. Although systematic hormone therapy was initiated with a diagnosis of catamenial pneumothorax, bilateral pneumothorax relapsed several times. Chest computed tomography one year after the initial hospitalization revealed multiple thick-walled cavities in both lungs. This led us to question our initial diagnosis, and prompted us to carefully review her past medical history. The patient's history of dislocation of a knee joint and hypermobility of joints led us to suspect a connective tissue disorder. Genetic investigation revealed a COL3A1 gene splicing site mutation and confirmed a diagnosis of vEDS.

A 69-year-old man who had been treated with a steroid and immunosuppressive agents for polymyalgia rheumatic was admitted to our hospital complaining of back pain. Chest CT showed osteolytic vertebral bodies of the thoracic spine adjacent to a mass shadow in the right lung S2. Spine invasion of lung cancer and pyogenic spondylitis were differential diagnoses. Open surgical biopsy for diagnosis was performed. Intra-operative findings suggested pyogenic spondylitis. We performed partial lung resection, curettage, and debridement of infected thoracic vertebral bodies and intervertebral disk and anterior fusion using autologous right 6th rib bone transplantation. Staphylococcus aureus was cultured from intraoperative tissue samples. A favorable outcome was achieved by antibiotics therapy and posterior thoracic vertebrae fusion. Open surgical biopsy and debridement were useful for diagnostic treatment of pyogenic spondylitis mimicking spine invasion of lung cancer.

Plasmacytoma is an uncommon type of plasma cell disorder. It is characterized by a localized proliferation of neoplastic plasma cells. Most plasmacytomas develop multiple myeloma at some point in their clinical course. We report a resected case of plasmacytoma of the rib complicated with smoldering multiple myeloma. A 49-year-old man presented with a history of repeated rib fractures induced by coughing and a solitary mass shadow on the right chest wall on a chest radiograph. Chest CT showed an 8-cm mass over the right fifth rib, and PET-CT showed abnormal uptake only in that lesion. Plasmacytoma was diagnosed by CT-guided needle biopsy. Iliac bone marrow biopsy showed the presence of 15% plasma cells, and he was diagnosed with smoldering multiple myeloma. The patient underwent surgical resection of the chest wall as local treatment for plasmacytoma. Macroscopic complete resection was achieved, and the microscopic margins were negative. However, a skip lesion was noted in the bone marrow of the resected fifth rib. In this case, the complication of smoldering multiple myeloma made it difficult to determine the indication for surgery and extent of resection required.

A woman in her 60s was referred to us for a thorough examination of an anterior mediastinal tumor. A non-invasive thymoma was suspected based on imaging results, but a low neutrophil count was observed. Hence, computed tomography-guided biopsy was performed to determine the treatment plan. The pathological diagnosis was type B1 thymoma. Red blood cell and platelet counts were normal, and bone marrow puncture did not show any decrease in the granulocyte count, but the neutrophil count remained around 300/μL. Because the neutrophil count increased with granulocyte colony-stimulating factor (G-CSF) treatment, G-CSF was administered just before surgery, in which an extended thymectomy was performed. The final pathological diagnosis was type B1 thymoma (Masaoka classification stage II). The patient was discharged from the hospital on the 10th day after surgery, without complications of infection. However, 1 month after surgery, her neutrophil count decreased to the same level as before surgery (300/μL). Blood tests revealed positive antineutrophil antibodies. Two years after surgery, joint symptoms, such as morning stiffness, were observed, and a medical examination was performed again, but there was no definitive diagnosis of collagen disease. We report this case because thymoma with neutropenia because is extremely rare. We thus present an extremely rare case of thymoma with neutropenia.

A 16-year-old man was admitted due to an abnormal shadow observed in a chest radiograph during a regular medical checkup. Follow-up chest computed tomography revealed a localized high-density area in the right S9 and S10 with surrounding hyperlucency, suggestive of air trapping. Chest magnetic resonance imaging revealed a well-circumscribed tumor with high signal on both T1WI and T2WI. Congenital bronchial atresia was suspected based on the medical history and imaging findings. Due to the risk of intractable infections, we performed thoracoscopic resection. The visceral pleura of the right S8, 9, and 10 were thickened. The S7 region showed no gross abnormality. However, the B7 peribronchial area showed severe inflammatory changes and was difficult to dissect. Therefore, a basal segment resection was performed. His postoperative condition was good. Here, we report a case of asymptomatic congenital bronchial atresia treated by video-assisted thoracoscopic right basal segmentectomy.

Background: The prognosis of patients with type A thymoma is favorable after curative resection, with the incidence of distant metastases being rare. We report two cases of type A thymoma with lung metastases following curative thymectomy.

Case 1: A female in her 40s was found to have an anterior mediastinal nodule. The patient underwent a thoracoscopic thymectomy; the pathological diagnosis of the nodule was Masaoka stage I type A thymoma. Follow-up computed tomography (CT) 4 years after surgery showed bilateral multiple lung nodules. A thoracoscopic wedge resection of the left lung including one of the nodules revealed metastatic thymoma with the same histologic findings as the primary site.

Case 2: A female in her 70s was found to have a nodule in the superior mediastinum with bilateral thyroid nodules. The patient underwent resection of the superior mediastinal nodule and bilateral enucleation of the thyroid nodules. The pathological diagnosis of the superior mediastinal nodule was Masaoka stage II type A thymoma. Follow-up CT 5 years after surgery showed bilateral lung nodules. A thoracoscopic wedge resection of the left upper lobe including one of the nodules revealed a metastatic thymoma with the same histologic findings as the primary site.

Conclusions: Although rare, attention should be paid to possible multiple lung metastases after curative resection for non-invasive or locally invasive type A thymoma.

The patient was a 79-year-old man who was treated for moderate COVID-19 and later discharged home. After 1 week, he was admitted to our hospital because of right pneumothorax that was treated with a chest tube. During treatment, methicillin-resistant Staphylococcus aureus (MRSA) was detected in pleural fluid culture. We operated for MRSA empyema with a fistula. However, the fistula was not detected by the water submersion test. We washed the thoracic cavity with 0.1% pyoktanin^® solution to sterilize MRSA. After the operation, we performed OK-432 pleurodesis for prolonged postoperative air leaks. The chest tube was removed on postoperative day 23, and the patient was discharged on postoperative day 26. COVID-19-related pneumothorax may develop even after remission, and there is a risk of developing empyema if the patient is susceptible to infection. Therefore, appropriate treatment for each case is considered necessary.

We report a case of postoperative Aspergillus empyema successfully treated with a combination of open-window thoracostomy (OWT) without rib resection and interpleural negative pressure wound therapy (NPWT). A 66-year-old man with a poor general condition due to cerebral palsy underwent surgery for a left pneumothorax and developed localized Aspergillus empyema in the apex of the left lung. OWT without rib resection was performed in the second intercostal space of the anterior chest, then a Lap Protector™ (FF0504, Hakko Co., Ltd, Japan) was inserted and NPWT was started on the same day. The patient underwent thoracoscopic observation and debridement three times, and the dressing was changed every few days. On day 34 after OWT, the thoracostomy window was closed using major pectoral muscle plombage. The patient remained free from recurrence for one year after surgery.

A 51-year-old man underwent video-assisted thoracoscopic (VATS) bullectomy for right pneumothorax. Although preoperative computed tomography showed no nodule in a bulla, the pathological diagnosis based on a surgical specimen was pulmonary spindle cell carcinoma with tumor invasion beyond fibrous thickened pleura. No cancer cells were found in the resection stump. In addition, we performed VATS right upper lobectomy with hilar and mediastinal lymphadenectomies.

Microscopic examination showed no remnant cancer cells in either the resected right upper lobe or lymph nodes. The patient was eventually diagnosed with spindle cell carcinoma, pT2aN0M0, Stage IB. He started taking oral uracil/tegaful 4 weeks after the additional surgery. He complained of dyspnea and backache 16 weeks postoperatively, and was diagnosed with recurrence of pleural dissemination and distant metastases. We immediately performed chemotherapy, but he died 18 weeks postoperatively. Lung cancer pathologically identified by pneumothorax surgery is rare. Thus, it is important to be aware of the coexistence of lung cancer and pneumothorax and consider early radical surgery owing to the poor prognosis.