The efficacy of dual pleural covering with a polyglycolic acid sheet and oxidized regenerated cellulose mesh for the prevention of postoperative recurrence in patients with primary spontaneous pneumothorax has been reported. We retrospectively evaluated 12 patients who underwent dual pleural covering with a polyglycolic acid sheet (NEOVEIL^® sheet) and oxidized regenerated cellulose mesh (INTERCEED^®) for primary spontaneous pneumothorax between June and September 2023. No perioperative complications of Clavien-Dindo Grade IIIa or higher were observed, and the thoracic drainage tube could be removed the day after surgery in all patients. The median postoperative observation period was 13 (11-14) months, and the recurrence rate of pneumothorax on the operative side was 8.4% at 1 year postoperatively. The frequency of pneumothorax on the operative side significantly decreased from 1.2±1.4 (before surgery) to 0.0063±0.021 (after surgery) per month (p=0.012), suggesting that the addition of dual pleural covering using the NEOVEIL^® sheet and INTERCEED^® contributed to the decreasing pneumothorax frequency without significant complications.

Recurrence risk factors after acute pyothorax surgery requiring surgical re-intervention are still unclear. We have focused on causative bacteria derived from the oral flora and perioperative intensive oral care (OC) since 2019. Fifty-seven patients who underwent pyothorax surgery at our institution from 2009 to 2022 were divided into two groups: 10 patients underwent re-intervention (R group) and 47 patients underwent surgery alone (S group). Clinical factors were compared between the two groups retrospectively. OC was performed in 15% (n=5/33) of the patients until 2018, while 63% (n=15/24) of the patients received OC after 2019. Of these, tooth extraction was performed in 5% (n=4/20). The preoperative prognostic nutritional index (PNI) (23.8) in the R group was significantly lower than that (28.2) in the S group (p=0.009). The calculated cut-off value of PNI from the ROC curve was 25.5. The rate of patients with OC was lower in the R group (10%, n=1/10) compared with that in the S group (40%, n=19/47). Especially in patients with low PNI (<25.5, n=20), 50% (n=7/14) of patients without OC required re-intervention, whereas no re-intervention was necessary in patients with OC (n=0/6) (p=0.032). Low PNI was associated with surgical re-intervention after pyothorax surgery, and intensive perioperative OC should be provided.

Traumatic diaphragmatic hernia is caused by blunt prolapse of abdominal organs into the thoracic cavity. In 20XX, a 23-year-old woman experienced bilateral lung contusions, right hemopneumothorax, and liver injury after a traffic accident in Scotland. She underwent chest drainage, was placed on mechanical ventilation, and was transported to our hospital one month later. Eight months later, she complained of dyspnea on exertion, and computed tomography (CT) revealed liver herniation in the thoracic cavity through the division of the right diaphragm. We repaired the diaphragmatic hernia by suturing, using video-assisted thoracoscopy. The postoperative course was uneventful, and the patient remained well without signs of recurrence during the 3-year follow-up period.

Most sclerosing pneumocytomas occur peripherally; however, those arising centrally and extending intra-bronchially are rare. A 75-year-old woman presented with abnormal chest radiographic findings. Computed tomography (CT) revealed a 25-mm dumbbell-shaped nodule in the right upper lobe. Positron emission tomography-computed (PET-CT) showed no fluorine-18-deoxyglucose (FDG) accumulation. Bronchoscopy demonstrated a smooth-surfaced, vascular-rich tumor extending into the B3a bronchus. However, biopsy was not performed as the tumor was considered hemorrhagic. A bronchial carcinoid tumor was suspected, and the patient underwent thoracoscopic wedge resection, with the possibility of lobectomy if malignancy was confirmed. The tumor was a well-defined, dark-brown nodule with papillary, hemangiomatous, and solid areas, primarily composed of rounded and cuboidal cells, leading to a diagnosis of sclerosing pneumocytoma. Although sclerosing pneumocytomas are considered to originate from the alveolar epithelium, they rarely extend into the bronchus.

A 73-year-old man was referred to our hospital because of an abnormal shadow detected on a chest roentgenograph during a medical check-up. Chest computed tomography (CT) revealed a solid nodule in the right S². Preoperative 3D-CT and bronchoscopy revealed an aberrant bronchus branching from the right tracheal wall and bronchus intermedius. Multiplanar reconstruction CT revealed displaced bronchi in the right B¹+B²a and B⁶a. In addition, preoperative images revealed incomplete interlobar fissures between the right upper and lower lobes and common trunks of A²b and A⁶. Based on the intra-surgical findings, it was judged that a sufficient surgical margin could be secured; therefore, right upper lobectomy was performed. Very few cases of patients with resected lung cancer with multiple displaced bronchi have been reported. By examining multiplanar reconstruction CT images in detail along with 3D-CT images before surgery, it is considered that the running of the bronchi and blood vessels can be fully understood.

The patient was a 46-year-old male with anterior chest pain and dyspnea. Chest CT showed a mass in the anterior mediastinum measuring 111×92×56 mm and constriction of the left main bronchus and right main pulmonary artery. He was diagnosed with thymoma by CT-guided biopsy and transferred to our hospital for surgery. In surgery for giant anterior mediastinal tumors, induction of anesthesia and surgical manipulation can cause fatal respiratory and circulatory failure. Therefore, we carefully simulated the induction of anesthesia with the anesthesiologist, cardiovascular surgeon, and other medical staff. PCPS was introduced under local anesthesia with a 15-degree elevation of the head of the bed as the simulation. We started the operation with a clamshell approach after induction of anesthesia under PCPS. We performed anterior mediastinal tumor resection and combined resection of the innominate vein, pericardium, and wedge resection of the right upper middle and left upper lobe. Histopathological examination revealed a diagnosis of thymoma Type B3 pT3N0M0 pStage IIIA. He showed an uneventful postoperative course and was discharged from the hospital 7 days after surgery. The induction of anesthesia, surgical position, and mechanical circulatory support were carefully evaluated before surgery, and the patient could thus undergo the surgery under stable general conditions.

The patient was a 48-year-old man. In June 202X, he visited his family doctor with left groin pain, was diagnosed with inguinal hernia, and referred to our hospital. CT revealed bilateral inguinal hernias and a 15-cm anterior mediastinal tumor, and he was referred to our respiratory medicine department. CT-guided biopsy revealed a suspected teratoma, and he was referred to us. In August 202X, we performed another CT-guided biopsy, but a definitive diagnosis could not be made. In September 202X, a median sternotomy and left intercostal thoracotomy were performed to remove the tumor. The histopathological diagnosis was chondrosarcoma, with a suspected positive margin. In November 202X, an additional resection was performed, and the patient was diagnosed with no residual tumor. Currently, one year after the initial surgical resection, the patient is alive and well without recurrence.

A 74-year-old man was emergently admitted to our hospital because of chest tightness. Computed tomography revealed an anterior mediastinal tumor, leading to referral to our department for surgical intervention. We performed video-assisted thoracoscopic surgery (VATS) to excise and diagnose the tumor. The postoperative course was uneventful. The cut surface of the resected specimen showed pigmentation within the tumor. Histopathological examination and several immunohistochemical studies confirmed the diagnosis of melanin-pigmented thymic atypical carcinoid. Thymic carcinoid is a rare neoplasm, constituting 0.4-2% of all carcinoid tumors. Among these, pigmented variants are very rare, with only a few cases reported. The mechanism underlying pigmentation remains unknown. In this report, we describe a surgical case of pigmented thymic atypical carcinoid, supplemented by a review of the relevant literature.

The patient was a 74-year-old man who had sustained a traumatic chest injury and received left thoracic drainage 4 years earlier.

In 2023, he consulted the referring physician with the chief complaint of left chest pain. Chest CT showed a tumor in the left chest wall, and the patient was referred to our department. Based on the radiological findings, we suspected a chronic expanding hematoma and performed video-assisted thoracic surgery. Intraoperatively, we found an elastic-hard tumor in the dorsal aspect of the left Vth intercostal space where the thoracic drain had been inserted 4 years earlier. As intraoperative pathological examination showed that the tumor was a benign/low-grade-malignant fibrotic tumor, we performed tumor extirpation without concomitant resection of the chest wall. Postoperative histopathological examination revealed the tumor to be desmoid fibromatosis of the thorax. The patient was followed up without additional resection or radiotherapy, and to date, at 6 months after surgery, there has been no recurrence. Desmoid tumor is a rare disease that can occur at sites of trauma or surgical wounds. Because the local recurrence rate of desmoid tumors is high, careful observation is necessary.

There are few reports of pathological evidence of hemorrhagic symptoms caused by vascular degeneration associated with anomalous systemic arterial (ASA) supply to the normal basal segment. We present the case of a 59-year-old man with left ASA supply to the normal basal segment who underwent video-assisted thoracoscopic surgery (VATS). The patient was admitted to our hospital with complaints of bloody sputum. Contrast-enhanced computed tomography demonstrated an anomalous artery originating from the descending aorta and supplying the basal segment of the left lower lobe. Furthermore, ground-glass opacity was observed in the relevant lung field. There were no morphological abnormalities in the bronchus of the patient. We diagnosed the patient with left ASA supply to the normal basal segment, and performed VATS dissection of the anomalous artery and left basal segmentectomy. After surgery, there were no serious complications. Pathological findings showed irreversible vascular degeneration and pulmonary alveolar hemorrhage. This case reveals interesting pathological findings associated with ASA supply to the normal basal segment. On selecting treatment for ASA supply to the normal basal segment, it is important to consider the problem of tissue degeneration.

For refractory infected pulmonary cysts, the usefulness of transbronchial or percutaneous drainage and fenestration has been reported. Here, we report a case of an infected pulmonary cyst that recurred 13 years after fenestration of a pulmonary cyst. The patient, a 32-year-old man, underwent fenestration of an infected pulmonary cyst in the right upper lobe at another hospital 13 years ago. Postoperatively, the pulmonary fistula persisted and the window was closed. The patient had been doing well, but the infected pulmonary cyst recurred and the patient came to our hospital. Since the recurrence occurred after fenestration of the pulmonary cyst, a right upper lobectomy was performed, and the patient was doing well postoperatively. Infection of unilocular pulmonary cysts can be effectively treated with transbronchial or percutaneous drainage or cyst fenestration. However, in cases of refractory infection of multilocular cysts, we believe that surgical resection that does not leave any connection between the cyst and airway is an option that should be considered.

Background. Fibroepithelial polyp is a benign polypoid lesion covered with normal respiratory epithelia that contains increased fibrous stroma with proliferative collagen fibers, and its occurrence in the bronchus is rare. Here, we present a case of bronchial fibroepithelial polyp resected by right upper lobectomy. Case. The patient was a 75-year-old man. An endobronchial tumor in the right upper lobe was incidentally detected on contrast-enhanced chest computed tomography conducted for preoperative evaluation of bladder cancer. Bronchoscopy and biopsy were conducted, but a definitive diagnosis was not made. Bronchoscopic resection was deemed difficult due to the tumor's elongated presence, extending from the entrance of the upper lobe bronchus towards periphery. We performed right upper lobe lobectomy and identified a fibroepithelial polyp. Conclusion. We encountered a patient with a fibroepithelial polyp of the bronchus that required surgical resection.

Spontaneous regression of primary lung cancer is a rare phenomenon. A male patient in his sixties underwent allogeneic hematopoietic stem cell transplantation for malignant lymphoma. Subsequently, a nodule was detected in the right lower lobe during follow-up CT, tending to enlarge. Consequently, the patient was referred to our hospital in August-X. A 25-mm nodule was identified in the right S⁹ segment via chest CT. Transbronchial lung biopsy was performed, raising suspicion of lung cancer; however, a definitive diagnosis remained elusive. By October, the tumor had reduced to 13 mm, prompting the cancellation of the scheduled operation. In December, a further reduction to 10 mm occurred, leading the patient to be placed on follow-up observation as per protocol. Nevertheless, in April of the subsequent year, the tumor re-grew to 38 mm, prompting referral back to our care. Initially diagnosed with non-small cell lung cancer, the patient underwent right middle and lower lobectomy, subsequently being diagnosed with pleomorphic lung cancer. Advanced infiltration of CD8+T cells was observed in biopsy and surgical specimens. While HLA class I was highly expressed in the biopsy specimen, it exhibited a decrease in surgical specimens. The involvement of an immunological mechanism is suspected to be the cause of spontaneous regression and subsequent re-enlargement. Thus, we present our findings herein.

We report a 58-year-old woman who underwent right-sided thoracoscopic surgery with collar incision of the neck for ectopic mediastinal parathyroid adenoma. The patient showed elevated serum calcium levels and normal parathyroid hormone levels starting from 5 years after the surgery. Furthermore, computed tomography revealed a tumor in the right upper mediastinum, with positive uptake of ^99mTc-MIBI. Hence, recurrence of the ectopic mediastinal parathyroid adenoma was suspected, and the patient was referred to our department for tumor resection. We selected a transmanubrial approach because the tumor was located near the right common carotid artery, right subclavian artery, trachea, and esophagus. The tissue surrounding the tumor was significantly thickened, likely a result of the previous surgery. The tumor was resected with a good surgical view. Her postoperative course was uneventful. Thus, the transmanubrial approach could provide a good surgical view of the upper mediastinum, facilitating safe dissection of ectopic parathyroid adenomas.