Traumatic Right Diaphragmatic Rupture Combined with Avulsion of the Right Kidney and Herniation of the Liver into the Thorax

Right-sided diaphragmatic rupture is less common and more difficult to diagnose than left-sided lesion. It is rarely combined with the herniation of the abdominal organs into the thorax. High level of suspicion is the key to early diagnosis, and a delay in diagnosis is implicated with a considerable risk of mortality and morbidity. We experienced a case of right-sided diaphragmatic rupture combined with complete avulsion of the right kidney and herniation of the liver into the thoracic cavity.

Retrohepatic Inferior Vena Cava Injury by Gunshot: A case report / 대한흉부외과학회지

Injury to the inferior vena cava (IVC) is associated with a high mortality rate, and little progress has been made for improving the treatment for this since the 1970s. Injury to the retrohepatic IVC, in particular, has been associated with up to a 75% mortality rate due to the difficulty in gaining adequate exposure and controlling the bleeding. Both the severity of injury and anatomic accessibility has been directly correlated with survival in IVC injury. We have experienced a patient with retrohepatic IVC that was ruptured by a penetrating gunshot injury and we managed to save this patient's life.

A Communicating Bronchopulmonary Foregut Malformation Associated with Absence of the Left Pericardium: A case report / 대한흉부외과학회지

A communicating bronchopulmonary foregut malformation (CBPFM) is a rare congenital anomaly that is characterized by a fistula between isolated respiratory tissue and the esophagus or stomach. The presence of accessory lung tissue arising from the primitive gastrointestinal tube is a common factor in the development of all forms of bronchopulmonary foregut malformations. Recurrent pneumonia associated with cystic radiographic structures is a characteristic of the condition. Further imaging studies using esophagogram, bronchography, computerized tomography, MRI, and arteriography can help in making a diagnostic evaluation. The treatment is a surgical resection of the involved lung tissue, and fistula closure with a good prognosis. We encountered a case of CBPFM, who presented with an extralobar pulmonary sequestration and bronchogenic cyst communicating with a tubular esophageal duplication that was associated with a complete left pericardial defect.

A Communicating Bronchopulmonary Foregut Malformation Associated with Absence of the Left Pericardium: A case report / 대한흉부외과학회지

A communicating bronchopulmonary foregut malformation (CBPFM) is a rare congenital anomaly that is characterized by a fistula between isolated respiratory tissue and the esophagus or stomach. The presence of accessory lung tissue arising from the primitive gastrointestinal tube is a common factor in the development of all forms of bronchopulmonary foregut malformations. Recurrent pneumonia associated with cystic radiographic structures is a characteristic of the condition. Further imaging studies using esophagogram, bronchography, computerized tomography, MRI, and arteriography can help in making a diagnostic evaluation. The treatment is a surgical resection of the involved lung tissue, and fistula closure with a good prognosis. We encountered a case of CBPFM, who presented with an extralobar pulmonary sequestration and bronchogenic cyst communicating with a tubular esophageal duplication that was associated with a complete left pericardial defect.

Intrathoracic Ectopic Live: A case report / 대한흉부외과학회지

Although intrathoracic liver in association with a congenital diaphragmatic hernia has been well documented, the finding of intrathoracic ectopic liver tissue in the presence of an intact diaphragm is an extremely rare congenital anomaly. We have experienced a case of intrathoracic ectopic liver without any diaphragmatic hernia. A 37-year-old woman was admitted for the treatment of an incidentally detected right lung mass. A chest computed tomography scan revealed a right lower lobe lung mass close to the diaphragm, and this was suspicious for bronchial carcinoid tumor. Upon surgery, 2 round solid masses 3.5x3.5 cm and a 2.0x2.0 cm in size were noted, with their bottoms attached to the diaphragm dome. The masses were completely resected. Histologically, they were confirmed to be intrathoracic ectopic livers. The patient had an uncomplicated postoperative course.

Intrathoracic Ectopic Live: A case report / 대한흉부외과학회지

Although intrathoracic liver in association with a congenital diaphragmatic hernia has been well documented, the finding of intrathoracic ectopic liver tissue in the presence of an intact diaphragm is an extremely rare congenital anomaly. We have experienced a case of intrathoracic ectopic liver without any diaphragmatic hernia. A 37-year-old woman was admitted for the treatment of an incidentally detected right lung mass. A chest computed tomography scan revealed a right lower lobe lung mass close to the diaphragm, and this was suspicious for bronchial carcinoid tumor. Upon surgery, 2 round solid masses 3.5x3.5 cm and a 2.0x2.0 cm in size were noted, with their bottoms attached to the diaphragm dome. The masses were completely resected. Histologically, they were confirmed to be intrathoracic ectopic livers. The patient had an uncomplicated postoperative course.

Primary Pericardial Fibrosarcoma Presenting as Cardiac Tamponade: A case report / 대한흉부외과학회지

Primary malignant neoplasm of the pericardium is very rare. Neoplastic involvement of the pericardium may result in rapidly developing hemorrhagic effusion. A 30-year-old male who occasionally suffered from chest tightness was referred to our hospital under the diagnosis of unstable angina. He presented with acute chest pain and severe dyspnea that had developed one day previously. The diagnostic investigations such as echocardiography, chest CT and magnetic resonance image suggested cardiac tamponade that was caused by rupture of the pericardial teratoma. An operation to remove the tumor and effusion was performed. The pericardial mass was completely excised, and the result of the frozen biopsy favored malignancy. The final pathologic report was malignant fibrosarcoma of the pericardium and no malignant cells were found on the cytology of the pericardial effusion. The patient had a smooth postoperative course and was referred to another hospital for additional radiation therapy. We report here on this case of cardiac tamponade that was caused by primary pericardial fibrosarcoma, and this required urgent diagnosis and surgical management.

Bilateral Popliteal Artery Entrapment Syndrome / 대한흉부외과학회지

Bilateral popliteal artery entrapment syndrome is a rare vascular disease, which leads to ischemic claudication as a result of disturbance to the blood flow from the abnormal relationship of the popliteal artery to the gastrocnemius muscle, a fibrous band or the popliteus muscle in the young male population. A 58-years-old male patient, complaining of ischemic claudication, coldness and 3rd toe gangrene of left leg of 1 month's duration was admitted to our institution. His left ankle-brachial index was decreased; therefore, a femoral artery angiography was performed, which revealed a total occlusion below the distal superficial femoral artery of the left leg. An EKG revealed atrial fibrillation, suggestive of a thromboembolism of the popliteal artery due to atrial fibrillation; therefore, Urokinase thrombolysis was attempted. After the Urokinase thrombolysis, popliteal artery entrapment syndrome was diagnosed, with MRI then performed for an anatomical diagnosis. The popliteal artery entrapment was type I, where the popliteal artery was displaced medial to the Gastrocnemius head. After complete removal of the popliteal artery aneurysm, interposition was performed with a contra lateral greater saphenous vein graft. A mild right popliteal artery aneurysm still remained, but surgery was not performed. Currently, the patent is surviving, without complications. Herein, the good results obtained for the surgical treatment of a severely affected leg, and the conservative treatment of a mildly affected leg, are reported.

Dysfunction of the Prosthetic Aortic Valve in Idiopathic Hypereosinophilic Syndrome: A case report / 대한흉부외과학회지

Idiopathic hypereosinophilic syndrome is a rare systemic, leukoproliferative disorder characterized by eosinophil- mediated tissue injury causing multiple organ failure, including the heart. Cardiac involvement occurs in more than 75% of patients with hypereosinophilic syndrome. Cardiac manifestations include subendocardial fibrosis, thrombus leading to peripheral emboli, restrictive cardiomyopathy, and valvular dysfunction. It is more common in men than in women (9:1), and trends to present between the ages of 20 and 50 years. Presentation in childhood is unusual. We report for the first time a case of a 58-year-old man with idiopathic hypereosinophilic syndrome manifested by prosthetic aortic valve dysfunction that was successfully treated by steroid and hydroxyurea therapy after surgical valvular replacement.

Lemierre Syndrome with Septic Pulmonary Embolism: A case report / 대한흉부외과학회지

Lemierre syndrome is caused by an acute oropharyngeal infection with secondary septic thrombophlebitis of the internal jugular vein and frequent metastatic infections. The usual etiologic agent is Fusobacterium necrophorum. Lemierre syndrome was a common disease with a high mortality rate in the pre-antibiotic era. Since the advent of antibiotics and their widespread use for the treatment of pharyngeal infections, there has been a substantial decrease in the incidence of this malady and it has become a "forgotten disease". Prompt diagnosis and antibiotic therapy for Lemierre syndrome is essential to avoid morbidity and mortality. We describe here a case of Lemierre syndrome with multiple septic pulmonary emboli.

Anastomotic Leakage and Stricture Relating to Anastomotic Level and Methods in Esophageal Resection and Reconstruction for Esophageal Cancer / 대한흉부외과학회지

BACKGROUND: The prevalence of anastomotic complication is related to anastomotic procedure or site in esophageal cancer operation. We studied the anastomotic leakage and stricture related to the anastomotic procedure &site in patients who received the esophageal resection and reconstruction for esophageal cancer. MATERIAL AND METHOD: The anastomotic procedure, site and complication of 321 patients who received the esophageal reconstruction from August 1993 to May 2003 were investigated. Mean age was 64.5+/-4.9 (37~94) years, 300 patients (93.5%) were male and 21 patients were female (6.5%). RESULT: There were 7 anastomotic leakages (2.2%) and no difference in anastomotic site (cervical anastomosis 4.1%, thoracic anastomosis 1.6%) and procedure (stapler technique 1.6%, semi-staple technique 9.1%, hand-sewn technique 0.0%). There were 52 anastomotic strictures (16.2%), differences in sites (cervical anastomosis 2.7%, thoracic anastomosis 20.2%) (p <0.001) and procedure (stapler technique 20.0%, semi-stapler technique 3.0%, hand-sewn technique 4.7%). And the stapler technique showed higher stricture rate (p <0.001). CONCLUSION: Anastomotic technique was less related to anastomotic leakage in esophageal reconstruction for esophageal cancer. However, stapler technique had higher stricture rate than other techniques. Therefore, we suggest that the anastomotic technique be improved to reduce anastomotic stricture.

Score System for Operative Risk Evaluation in Coronary Artery Bypass Surgery / 대한흉부외과학회지

BACKGROUND: The purpose of this study is to assess a score system for operative risk evaluation of CABG. MATERIAL AND METHOD: From January 2001 to September 2005, retrospective study for various perioperative factors of 2993 cases was done. RESULT: The early operative mortality was 2.4% and the beta coefficients of 7 core variables related to it (preoperative LV dysfuction, preoperative renal failure, MI within 1 week, reoperation, combined surgery, preoperative atrial fibrillation, preoperative IABP) were adjusted to score system. ROC curve and Hosmer and Lemeshow goodness of fit test was done. CONCLUSION: This score system was effective in assessing operative risk of CABG. But It is necessary to gather larger volume of case and perform multicenter study.

Coronary Artery Bypass Grafting in Elderly Patients Older Than 75 Years / 대한흉부외과학회지

BACKGROUND: The number of elderly patients undergoing coronary artery bypass grafting (CABG) is increasing. Elderly patients are at increased risk for a variety of perioperative complications and mortality. We identified determinants of operative complications and mortality in elderly patients undergoing CABG. MATERIAL AND METHOD: Between January 1995 and July 2003, 91 patients older than 75 years underwent isolated CABG at Asan Medical Center. There were 67 men and 24 women with mean age of 77.0+/-2.4 years. Thirty clinical or hemodynamic variables hypothesized as predictors of operative mortality were evaluated. RESULT: CABG was performed under emergency conditions in 5 patients. The internal thoracic artery was used in 85 patients and 10 patients received both internal thoracic arteries. The mean number of distal anastomosis was 3.7 per patient. Operative mortality was 3.3%. Twenty-two patients had at least one major postoperative complication. Low cardiac output syndrome was the most common complication, followed by reoperation for bleeding, pulmonary dysfunction, perioperative myocardial infarction, stroke, acute renal failure, ventricular arrhythmia, upper gastrointestinal bleeding, infection, and delayed sternal closure. None were the predictors of mortality. Renal failure, peripheral vascular disease, emergency operation, recent myocardial infarction, congestive heart failure, New York Heart Association (HYHA) class III or IV, Canadian Cardiovascular Society (CCS) angina scale III or IV, and low left ventricle ejection fraction below 40% were univariate predictors of overall complications. Actuarial probability of survival was 94.9%, 89.8%, and 83.5% at postoperative 1, 3 and 5 years respectively. During the follow-up period 93.3% of patients were in NYHA class I, or II and 91.1% were free from angina. CONCLUSION: Although operative complication is increased, CABG can be performed with an acceptable operative mortality and excellent late results in patients older than 75 years.

Three-dimensional Reconstruction of Tricuspid Annulus with the Duran Ring / 대한흉부외과학회지

Tricuspid annuloplasty with the flexible Duran ring may result in a physiologic repair while maintaining the dynamic morphology of the tricuspid annulus. A method for a durable three-dimensional tricuspid annular reconstruction, which retains the plasticity and orifice area of the tricuspid annulus, is described.