A male in his 80s complaining of fever and neck pain was admitted to a local hospital. Enhanced chest computed tomography revealed bilateral multilocular abscesses around the first and second thoracic vertebrae. Short TI inversion recovery (STIR) and T2-weighted magnetic resonance imaging (MRI) revealed a high signal intensity in the intervertebral discs between the first and second and second and third thoracic vertebrae. In addition, the STIR image revealed a high signal intensity in the first vertebral body. Blood culture yielded methicillin-susceptible Staphylococcus aureus. Based on these findings, the patient was diagnosed with mediastinal abscess caused by purulent spondylitis and sepsis. Since conservative treatment with antibiotics was ineffective, he was referred to our hospital. He underwent bilateral thoracoscopic drainage of the mediastinal abscess 14 days after onset. The inflammatory reaction gradually improved, and the patient was transferred to a different hospital without complications on postoperative day 55.

Pyogenic spondylitis, which can lead to severe complications including quadriplegia, should be suspected in cases of mediastinal abscesses. MRI is recommended to confirm pyogenic spondylitis in the presence of paraspinal abscess formation on CT, as the findings of pyogenic spondylitis may not be evident on CT.

The subject was a 63-year-old male. Three years previously, he had been diagnosed with right lower lobe pulmonary adenocarcinoma, accompanied by multiple sites of brain metastasis and right adrenal metastasis. Following cerebral tumor removal and cranial irradiation, treatment using pembrolizumab was started. During the first course of treatment, pneumonia occurred in the right upper lobe, and an area of irregular ground-glass opacity remained even after treatment. After 9 courses of treatment, the primary lesion decreased to 0.6 cm, and all metastatic lesions disappeared. After 48 courses of treatment, the area of ground-glass opacity which remained in the right upper lobe suddenly increased in size. A transbronchial biopsy showed glandular cancer with a different form than that of the right lower lobe pulmonary cancer, and this was suspected to be secondary cancer. Regarding the right lower lobe pulmonary cancer, a partial response was maintained by immunotherapy. As a result, surgery was performed for the right upper lobe pulmonary cancer, with the goal of achieving long-term survival. The #12L lymph node that had become swollen and had been identified at the first visit had changed into scar-like tissue that had attached itself to the right upper lobe and pulmonary trunk, which made it difficult to remove. Therefore, the right upper lobe was removed while dividing the lymph nodes in question along with the pulmonary trunk. Transitory atrial fibrillation was confirmed on the fifth day with no other complications, and the patient was discharged from the hospital on the tenth day. The pathological findings confirmed the cancer to be right upper lobe pulmonary adenocarcinoma ypT1cN1MX.

A 53-year-old man presented to a previous hospital for evaluation of a 1-month history of back pain. Contrast-enhanced computed tomography revealed a 3.5-cm azygos vein aneurysm (AVA) and massive pleural effusion, suggestive of AVA rupture. The patient was referred to our hospital on the same day and underwent emergency AVA resection.

A massive hematoma and bleeding from the aneurysm were confirmed in the thoracic cavity. Thoracotomy was performed because it was difficult to stop the bleeding. The patient's postoperative course was uneventful, and he was discharged 8 days postoperatively.

AVAs are extremely rare, and indications for surgical resection remain unclear. AVAs have risks of thromboembolism and rupture. Aneurysm enlargement, saccular structure, and a history of connective tissue disease have been reported as risk factors of rupture. The saccular structure of the aneurysm might have been a risk factor in our case. In the case of AVA rupture, bleeding control is difficult; therefore, surgical resection is recommended to avoid aneurysm rupture even if there are no signs of thromboembolism or rupture.

We present a case of incidentally detected intrapericardial ectopic goiter. A 76-year-old women presented with abdominal pain, prompting a workup to rule out malignancy. A chest CT showed a mediastinal tumor measuring 25 mm located on the anterior surface of the proximal ascending aorta, and she was referred to our hospital. We approached the tumor with robot-assisted surgery, but converted to median sternotomy because the tumor was considered to have possibly infiltrated the wall of the ascending aorta. The tumor was surgically resected and discovered to be an adenomatous goiter on histologic examination.

Partial anomalous pulmonary venous connection is a congenital anomaly of the pulmonary veins whereby blood incorrectly returns to the circulatory system. A tracheal bronchus is a bronchial abnormality, branching from the trachea at a site located more centrally than the normal tracheal bifurcation. In this manuscript, we report a patient with concomitant lung cancer, who we treated using uniportal video-assisted thoracic surgery.

A 68-year-old woman was referred to our department after computed tomography (CT) at a nearby hospital revealed an enlarging pulmonary nodule in the right upper lobe. Contrast-enhanced chest CT showed a 1.6-cm partially solid nodule in the periphery of the right anterior segment (S³) and V^1-3 being drained into the superior vena cava. The right B¹ bronchus was abnormally placed as it originated from the trachea, and B² and B³ bronchi branched from the right main bronchus. The patient was diagnosed with suspected lung cancer; right upper lobectomy was performed under uniportal video-assisted thoracic surgery.

Cases such as this are rare, although other types of tracheal bronchus concomitant with abnormal vascular patterns have been reported. Because tracheal bronchi are relatively easy to detect, the presence or absence of an abnormal vascular pattern must be investigated when findings reveal a tracheal bronchus.

A 72-year-old woman was admitted to the hospital complaining of left back pain. She underwent total hysterectomy for endometrial cancer at the age of 32 and partial resection for metastatic lung tumors from endometrial cancer at the age of 68. Chest computed tomography showed a mass lesion from the left 9^th to 11^th intercostal space. The lesion and left 10^th and 12^th ribs were resected, and the lesion was diagnosed as endometrial cancer. Although the occurrence rate of chest wall metastasis of endometrial cancer is reportedly almost 1% and these recurrences occurred within 3 years after initial surgery, the present case showed chest wall metastasis of endometrial cancer at 40 years after total hysterectomy. There has been no report of such a delayed recurrence to our knowledge.

A 79-year-old woman underwent chest computed tomography (CT) after a traffic accident. CT revealed an anterior mediastinal nodule suspected to be a thymic epithelial tumor, and she was referred to our hospital for surgery. Chest contrast CT showed left brachiocephalic vein hypoplasia and a collateral vein flowing into the accessory hemiazygos vein. Video-assisted thoracoscopic thymectomy was performed via a right thoracic approach. The narrow left brachiocephalic vein and very narrow anomalous vessels were identified, running from the upper left lobe of the thymus. Only the thymic veins were cut, and the tumor and thymus were resected. The pathological diagnosis was thymoma of type B2 (Masaoka stage I). The postoperative course was uneventful, and she was discharged on day 5 postoperatively.

In adults without cardiac malformation, anomaly of the left brachiocephalic vein is rare. However, in those with these anomalies, there are some risks of injury when performing thymus dissection or misidentifying the left brachiocephalic vein as the thymic vein. Therefore, care should be taken when checking pre-operative CT. In this case, pre-operative contrast CT revealed vessel abnormalities, which enabled safe resection of the tumor.

A caucasian male in his 40s was diagnosed with acquired immunodeficiency syndrome (AIDS) in X-7 following bilateral pneumocystis pneumonia. He was treated with antiretroviral therapy, and was doing well until May X, when he was referred to our department with a diagnosis of first-ever left pneumothorax. Conservative treatment including chest tube drainage failed to achieve complete lung expansion, and thoracoscopic surgery was performed in July X. Preoperative blood tests indicated that AIDS was under good therapeutic control. Intraoperative findings showed air leakage from the apex of the lung and small nodules scattered throughout the visceral and parietal pleura. Partial resection of the left upper lobe and sampling from the parietal pleura were performed. Bacterial culture of the nodules was positive for Achromobacter Sp. Histopathology revealed that the superficial layer of the nodule was covered with mesothelial cells, while the interior layer showed inflammatory cell infiltration and fibroblast proliferation. Although it is known that severe pneumothorax can occur in the acute phase of pneumocystis pneumonia, we encountered a case of pneumothorax in the late phase with a good course of treatment. Opportunistic pleural infection with Achromobacter Sp. was considered as a possible cause.

Müllerian cysts arising in the posterior mediastinum are considered benign and good candidates for minimally invasive surgery. We encountered a patient with a posterior mediastinal Müllerian cyst, resected by uniportal video-assisted thoracoscopic surgery. The patient was a 36-year-old woman. Her body mass index was 39.2. She visited a local doctor with back pain. A detailed examination revealed no underlying cause of the back pain, but she was referred to our department because of a cystic lesion in the left posterior mediastinum. A cystic lesion was located adjacent to the seventh thoracic vertebra and descending aorta. Based on our experience, we suspected a neurogenic tumor or intrathoracic meningocele as a cause of the cyst, and performed uniportal thoracoscopic resection. The lesion was a cystic lesion surrounded by a thin wall and was not related to nerves or the intervertebral foramen. Based on the immunopathological features, we diagnosed it as a Müllerian cyst.

Schwannoma is the most frequent mediastinal tumor after thymoma and teratoma, and most often arises in the posterior mediastinum. It usually originates from sympathetic or intercostal nerves, and schwannoma of phrenic nerve origin is rare. The patient was a woman in her 40s who was referred to our department for surgery after computed tomography (CT) in 2021 revealed a mediastinal mass of 4 cm in diameter. Review of previous CT from 2017 identified the mass and confirmed an increase in size over time. Thoracic magnetic resonance imaging showed a low signal intensity on T1-weighted imaging, while T2-weighted imaging showed a high signal intensity at the margins and inhomogeneous low signals in the interior. Positron emission tomography-CT showed focal accumulation of fluorodeoxyglucose (maximum standardized uptake value, 3.95). Based on these imaging results, we suspected a thymoma and performed robot-assisted thymectomy. Since invasion of the left phrenic nerve by a malignant tumor could not be ruled out, we performed combined resection. Rapid pathology revealed schwannoma. The postoperative course was uneventful and the patient was discharged from the hospital on postoperative day 6. We report our experience of a rare case of robot-assisted surgery for schwannoma of phrenic nerve origin.

A 78-year-old woman fell and presented to her previous doctor with chief complaints of an abrasion on her left arm, posterior neck pain, and anterior chest pain.

She was transferred to our department for further evaluation and treatment, diagnosed with cellulitis of the left arm, Th2-3 spondylolisthesis, sternum body fracture, sternal osteomyelitis with a chest wall abscess, an anterior mediastinal abscess, and right-sided pleural empyema caused by methicillin-susceptible Staphylococcus aureus infection. Surgical debridement including resection of the infected sternum body and pleural curettage and lavage with video-assisted thoracic surgery were performed. The sternal body defect was managed by negative-pressure wound therapy with instillation and dwelling (NPWTid) following debridement. Reconstruction of the chest wall with the pedicled rib-latissimus dorsi (RLD) osteo-muscle flap was performed in the 2^nd-stage operation. She showed an uneventful postoperative course, and was discharged home on the 39^th day after admission. This case suggests that reconstruction with a pedicled RLD osteo-muscle flap and NPWTid are useful options for sternal osteomyelitis and mediastinitis.

As of July 2022, the cumulative number of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection cases was reported to be more than 10 million in Japan. With such a large number of infected patients, post-treatment residual symptoms have become a problem. In addition, the remission duration after infection varies. Here, we report a case of wedge resection for primary lung cancer after COVID-19 pneumonia. A 71-year-old man was infected with COVID-19, exhibited fever, and was admitted to our hospital for treatment due to worsening of his respiratory condition. Chest computed tomography (CT) showed ground-glass shadows predominantly in both basal lungs, and a 1.6-cm nodular shadow was incidentally noted in the right upper lobe. After COVID-19 pneumonia treatment, CT-guided biopsy was performed, and it was diagnosed as primary lung adenocarcinoma. Wedge resection was conducted due to decreased oxygen saturation and residual ground-glass shadows, and the patient could be discharged from the hospital without postoperative complications. This report focuses on the treatment strategy including the timing of surgical intervention for primary lung cancer surgery after COVID-19 pneumonia, and presents a literature review.

Among respiratory surgeries, carinal reconstruction is a rare surgical procedure. In addition, it requires advanced techniques; thus, it is often performed after repeated preoperative simulations, especially in collaboration with the anesthesiology department. Here, we report a case of tracheal cancer that required emergency surgery with carinal reconstruction.

The patient was a 76-year-old man who was transferred to our department following the diagnosis of tracheal cancer. After transfer to our hospital, complete atelectasis of the left lung was confirmed during the preoperative examination; therefore, emergency surgery was decided for life-saving purposes. The surgery was performed under extracorporeal membrane oxygenation (ECMO). Carinal resection was conducted via right-sided thoracotomy, and double-barrelled reconstruction was performed. After the surgery, postoperative complications, such as aspiration pneumonia, interstitial pneumonia, and anastomotic dehiscence of the carina, were noted, and perioperative management was challenging. Nonetheless, the patient was safely transferred approximately 4 months after the surgery. It is rare to have an emergency operation that requires carinal reconstruction; thus, we present this case along with a review of the literature.