Kartagener syndrome is a rare autosomal recessive inherited disorder with a triad of chronic sinusitis, bronchiectasis, and situs inversus. There have been no reports of thymic cancer associated with Kartagener syndrome. A 69-year-old man, with a history of chronic sinusitis and bronchiectasis had sputum. He had a past history of situs inversus. Chest computed tomography (CT) showed an anterior mediastinal tumor, and he was referred to our department. Chest contrast enhanced CT showed a 31-mm anterior mediastinal tumor suspected of invading the right brachiocephalic vein and pericardium. He underwent thymectomy with combined resection of the right brachiocephalic vein and pericardium through median sternotomy. Histochemical and immunohistochemical findings confirmed the resected tumor to be thymic cancer. He underwent postoperative radiation therapy and had no recurrence. We report a surgical case of thymic cancer associated with Kartagener syndrome.

Subcutaneous or mediastinal emphysema due to air leakage may occur after thoracic surgery. Most cases are asymptomatic and may present with chest pain and dyspnea but rarely affect cardiodynamics. The patient was a woman in her 60s. Thoracoscopic parietal pleural biopsy was performed to confirm the diagnosis of pleural dissemination due to the recurrence of breast cancer. Immediately after surgery, no air leakage was observed, but four hours after the surgery, subcutaneous emphysema appeared and extended to the neck. The patient experienced two episodes of sinus bradycardia with a heart rate of 20 beats/min the day after surgery. A percutaneous pacing lead was implanted because of suspicion of sinus node failure syndrome. Chest CT performed after implantation revealed marked subcutaneous and mediastinal emphysema, which improved after the insertion of a chest tube. The patient was diagnosed with bradycardia caused by carotid sinus stimulation due to mediastinal emphysema along the brachiocephalic artery. The pacing lead was removed on the day after the operation. At six months after discharge, there was no evidence of recurrent bradycardia.

Racemose hemangioma of the bronchial artery and bronchial artery aneurysm are rare vascular abnormalities associated with chronic inflammation-induced neovascularization. Here, we present a 49-year-old man with concurrent racemose hemangioma of the bronchial artery and intrapulmonary arteriovenous malformation in the left lower lobe. He was referred to our hospital for persistent symptoms of left chest pain. Examination revealed the presence of a racemose hemangioma of the bronchial artery coexisting with a mediastinal bronchial artery aneurysm. Subsequently, a bronchial artery aneurysm resection was performed and, in the follow-ups, the hemangioma and arteriovenous malformation were monitored. Such combined occurrences are exceedingly rare, with consequent paucity of available literature. Given the absence of established treatment modalities for these conditions, further accumulation of clinical cases is imperative.

A 68-year-old man underwent thoracoscopy-assisted right lower lobectomy and lymph node dissection. The chest tube was removed on the second post-operative day, and a constriction sound appeared in the right anterior chest on the third day. CT showed stenosis of the right upper lobe and middle lobe bronchi, as well as infiltrative shadows and ground-glass opacities in the right upper lobe, and the upper lobe was located dorsally and the middle lobe ventrally. In addition, the staple line of the middle lobe when the middle and lower lobes were separated was present between the upper and middle lobes. Bronchoscopy revealed mild stenosis at the right upper and middle lobe bronchial entrances, and we suspected middle lobe torsion, and reoperated. The middle lobe was twisted 90 degrees clockwise around the bronchus, and the upper lobe was located dorsally and the middle lobe ventrally. We diagnosed middle lobe torsion, and the torsion was removed. It is important to be aware that middle lobe torsion can occur even after lower lobe resection, and that in middle lobe torsion, abnormalities may be found in areas other than the middle lobe. In addition, focusing on the position of the staple line is useful for diagnosis, and contrast-enhanced CT examination is useful for determining the treatment plan.

Covering a bronchial stump with a free pericardial fat pad (FPFP) may be a useful preventive measure against the development of a bronchopleural fistula (BPF), a serious postoperative complication. A 66-year-old woman underwent a video-assisted thoracoscopic right lower lobectomy for lung adenocarcinoma. During the procedure, the bronchial stump was covered with an FPFP. On postoperative day 21, she presented with respiratory distress, and examination revealed right pneumothorax. We immediately inserted a chest drainage tube; however, because of a severe air leakage, her respiratory status did not improve. The patient was intubated, and the air leakage disappeared shortly thereafter. Subsequently, her respiratory status stabilized. Bronchoscopy revealed a BPF, which was closed with an FPFP from the thoracic side. Displacement of the FPFP occurred during the intubation process. The patient was treated conservatively with trafermin drops around the fistula under bronchoscopy. On hospital day 70, complete healing of the fistula was observed. Although an FPFP did not prevent the development of a BPF, in this case, FPFP prevented the progression of the BPF, and as a result, the fistula healed completely.

A teenage female with palmar hyperhidrosis, which had started at an early age, visited our department. Video-assisted thoracoscopic bilateral sympathectomy was performed, and an increase of the surface temperature of both palms by at least 0.5°C was confirmed before termination. The symptoms of both palms were improved immediately after the procedure, and compensatory hyperhidrosis was mild. However, approximately one week after the procedure, hyperhidrosis had worsened on the right palm, and about one month later, the hyperhidrosis of the right hand relapsed to the same degree as before the operation. Re-operation was performed with thoracoscopic right sympathectomy. Intraoperative findings confirmed that a thicker sympathetic trunk, which differed from the previously resected sympathetic trunk, existed along with the dorsal side of the intercostal vein. The previously resected sympathetic nerve was considered to be a branch from the sympathetic trunk. The sympathetic trunk was resected, and it was confirmed that the right palm temperature had increased by at least 1.0°C. The palmar hyperhidrosis subsided immediately after the operation, with no compensatory hyperhidrosis. There have been few reports of re-operation for recurrence of palmar hyperhidrosis after thoracoscopic sympathectomy, and this case is reported along with a review of the literature.

A 55-year-old man was found to have chest radiographic abnormalities during a routine health examination. Chest computed tomography revealed multiple nodules in the upper and anterior mediastinum. Because of the presence of multiple nodules, we suspected simultaneous multiple thymoma, thymoma with lymph node metastasis, or malignant lymphoma. Computed tomography-guided percutaneous needle biopsy was performed, but the tissue was very hard and a specimen could not be extracted. Therefore, we performed total thymectomy and resection of the surrounding multiple nodules for diagnostic and therapeutic purposes. The postoperative histopathological diagnosis was multiple cholesterol granulomas. Multiple cholesterol granulomas in the mediastinum are rare. There are no reports of preoperative biopsy. We herein report a rare case of mediastinal cholesterol granulomas with extremely hard tissue that could not be obtained by computed tomography-guided percutaneous needle biopsy despite showing soft tissue shadows without calcification and suggesting solid tumors.

The patient was a 68-year-old man who presented with acute lower leg edema and was found to have hypertension, hyperglycemia and hypokalemia. The laboratory tests showed elevated serum adrenocorticotropic hormone (ACTH) and cortisol levels, indicating ACTH-related Cushing's syndrome. Chest computed tomography revealed the an 8 mm nodule in the upper lobe of the right lung, which was suspected to be an ectopic ACTH-releasing tumor. Right upper lobectomy with lymph node dissection was performed and the tumor was histologically diagnosed as a typical carcinoid. After resection, the serum ACTH levels decreased immediately and the patient showed favorable recovery without recurrence.

The case involved an 85-year-old man. We diagnosed him with dehydration and pneumonia in the lower lobe of the right lung, and started treatment with antibiotics. However, on day 11, computed tomography showed right pleural effusion and a cavitary abscess in the right lower lobe. Pleural fluid culture revealed growth of Gram-positive bacilli, and Bacillus cereus was detected on day 18. We performed thoracic drainage, but his symptoms did not improve. On day 20, we carried out debridement and drainage for pyothorax and right lower lobectomy by thoracotomy. Intraoperatively, we found extensive necrosis of the right lower lobe and diagnosed him with acute pyothorax due to a lung abscess caused by B. cereus.

B. cereus is a spore-forming Gram-positive rod widely distributed in the environment. It often causes food poisoning, but rarely lower respiratory tract infection. It is also known to produce tissue-destructive exotoxin, which can lead to severe pneumonia. In this report, we describe a patient with right lower lobe pneumonia treated with antibiotics, which resulted in a lung abscess of the right lower lobe and acute pyothorax after 2 weeks of treatment, but the patient was successfully treated by decortication and lobectomy.

A woman in her 70s who presented with right chest pain and fever was diagnosed with acute right empyema. Her general condition did not improve with antibiotic treatment, resulting in her referral to our hospital. Ultrasound examination revealed pleural effusion with septations, prompting us to select thoracoscopic debridement of the empyema. Intraoperative evaluation revealed a fistula in the right lower lobe with pus discharge, leading to the diagnosis of fistulous empyema due to ruptured lung abscess. After removing the septations in the pleural cavity to create a single cavity, we harvested free pericardial fat to close the fistula. The patient's postoperative course was favorable, with rapid improvement of inflammation and no recurrence. Closure of the fistula with free pericardial fat can be considered useful for empyema due to a ruptured lung abscess.

A 55-year-old man was transported to the emergency department of our hospital because he had developed quadriplegia and cysto-rectal disorder since a single trigger point injection several days previously at another hospital for neck and back pain. The patient was diagnosed with spinal epidural abscess (SEA), and underwent emergency orthopedic surgery for decompression of the spinal cord. Postoperative computed tomography revealed that the residual abscess extended over the paraspinal region, and the patient was referred to our department 3 days after emergency surgery. Since conservative treatment with antibiotics was ineffective, he underwent bilateral thoracoscopic drainage for the mediastinal abscesses 9 days after the emergency surgery, and generally recovered thereafter with the need for additional surgical debridement because of surgical site infection following the initial emergency surgery. The patient was transported to another hospital 37 days after the thoracoscopic surgery for the purpose of rehabilitation with already improved conditions for walking and excretion. Although SEA is rarely initially treated by thoracic surgeons, early transthoracic drainage of the abscess should be performed in cases of extensive lesions involving the mediastinum.

We report the case of a 77-year-old man with a 28-mm nodule in the right middle lobe detected on chest computed tomography (CT). Although bronchoscopy did not lead to a diagnosis, follow-up CT showed that the tumor had increased to 35 mm in 4 months, and positron emission tomography-CT revealed increased uptake in the tumor; consequently, surgery was performed. Intraoperative rapid pathological diagnosis by needle biopsy was inconclusive. Video-assisted right middle lobectomy was performed due to a suspicion of lung cancer, given the tumor's hard texture on palpation. The tumor was elastic-hard, with a lobulated surface of yellowish-white. Additional rapid pathological diagnosis was an inflammatory pseudotumor with no evidence of malignancy. Pathological examination showed a granulomatous nodule surrounded by a prominent lymphocytic infiltrate with a high IgG4/IgG ratio and obliterative phlebitis. The serum IgG4 level was elevated, leading to a diagnosis of IgG4-related disease. One year postoperatively, the patient was being followed without any new lesion.

A 35-year-old man was found to have an abnormal chest shadow during a medical checkup. Computed tomography (CT) revealed a 3.0-cm nodular lesion surrounded by multiple small nodules in the anterior mediastinum. The initial suspected diagnosis was thymoma and possible pleural seeding lesions of thymoma. The patient underwent surgery for both definitive diagnosis and treatment, and was subsequently diagnosed with multiple mediastinal hemangiomas. At 5 years after surgery, there had been no recurrence. Multiple cavernous hemangiomas in the anterior mediastinum are exceedingly rare.