Clinical Analysis of Contralateral Bulla of Lung on HRCT in the Patients Having Video-Assisted Thoracoscopic Surgery for Unilateral Primary Spontaneous Pneumothorax / 대한흉부외과학회지

BACKGROUND: It is controversial whether the presence of bullae on the contralateral lung on HRCT plays a role in occurrence of contralateral primary spontaneous pneumothorax. We analyzed the significance of bullae on the contralateral lung and the risk factors associated with contralateral occurrence of primary spontaneous pneumothorax. MATERIAL AND METHOD: Three hundred ninety four patients who were undergone Video.Assisted Thoracoscopic Surgery for primary spontaneous pneumothorax between January 2004 and December 2009 were reviewed. The clinical features, HRCT and treatment of these patients were analyzed retrospectively. RESULT: Twenty eight of 394 patients had contralateral occurrence (7.10%). The average time was 13.06+/-9.79 months. A presence of contralateral bullae of lung on HRCT may not seem to be significant for occurrence of contralateral primary spontaneous pneumothorax (p=0.059). But bullae numbers were much more in contralateral pneumothorax patients (p=0.011). Younger than 20, being underweight (Body Mass Index<18.5 kg/m2) are independent risk factors for contralateral occurrence (odds ratio, 5.075 (1.679~5.339), 2.366 (1.048~5.339) respectively). CONCLUSION: The presence of bullae on the contralateral lung on HRCT was not significantly influenced the occurrence of contralateral primary spontaneous pneumothorax. However, age, body mass index, and the number of bullae were significant factors for the contralateral pneumothorax. We suggest that those high risk patients may require special attentions and general supportive care to prevent occurrence of contralateral primary spontaneous pneumothorax during the follow-up.

Periosteal Ewing's Sarcoma of the Rib / 대한흉부외과학회지

A 43-yr-old patient visited our department with intermittent chest pain he had suffered with for the past 2 months. Chest CT showed an egg shaped mass in the left chest wall. Local resection was performed for distinguishing the mass from a neurogenic tumor. The diagnosis was periosteal Ewing sarcoma of the rib. Since there was no evidence of metastasis based on the PET-CT, a 2nd operation was done with wide resection and thoracoplasty. The patient was then treated with combined chemotherapy. There has been no local recurrence for the last 1 year. The patient's age and tumor origin were distinct from the usual characteristics of Ewing's sarcoma. Periosteal Ewing's sarcoma of the rib has rarely been reported. We report here on a case of periosteal Ewing's sarcoma of the rib along with a review of the relevant medical literature.

Metastasis of Non-Small Cell Lung Cancer to Ipsilateral Breast: A Case Report / 한국유방암학회지

Breast tissue is an unusual site for metastatic disease, particularly for non-small cell lung cancer (NSCLC). Aside from contralateral breast cancer, the most common tumors metastasizing to the breast are malignant melanoma and hematopoietic malignances. We recently experienced a case of a 49-year-old female patient with solitary metastasis of NSCLC to ipsilateral breast tissue. She was diagnosed as NSCLC of left lung and underwent left upper lobectomy in 2001. She was then treated with etoposide/cisplatin chemotherapy and radiation therapy. After 35 months, she was referred to our breast clinic because of a nodular opacity in the left breast revealed by screening breast ultrasound, which proved to be of pulmonary origin. She was treated by wide excision and with docetaxel/cisplatin chemotherapy. However, 37 months after breast surgery, a metastatic lesion developed in the same breast and she received modified radical mastectomy. We report this case with a review of the literature.

Clinical Review of Totally Implantable Venous Catheter / 대한흉부외과학회지

BACKGROUND: The introduction of central venous catheters in 1979 has aided the administration of chemotherapy to oncologic patients. We analyzed the clinical reviews and complications of totally implantable venous catheters in an effort to achieve optimal management. MATERIAL AND METHOD: We retrospectively studied 100 cases with totally implantable venous catheter at our hospital and we report the results. RESULT: 100 totally implantable venous catheters were placed in the right subclavian vein in 74 cases (74%), the left subclavian vein in 21 cases, the right jugular vein in 3 cases, the left jugular vein in 1 case and the right femoral vein in 1 case. The immediate complications were 5 cases in malposition of the catheter and 5 cases of arterial puncture. The late complications were 1 case of subclavian vein thrombosis, which was treated with anticoagulation, and 2 cases of pinch-off syndrome. There were no other early or late complications. CONCLUSION: The low rate of complications in this study confirms the safety and convenience of using totally implantable venous catheter in patients undergoing prolonged chemotherapy. Yet because Infection, thrombosis, and catheter fracture are the most common long term complications of totally implantable venous catheters, early diagnosis and management of these problems can prevent severe complications.

Paragonimiasis with Simultaneous Multifocal Lesions / 대한흉부외과학회지

A 42-years-old man was referred to our department due to his hemoptysis. Chest CT showed a cavitary lung lesion in the apical segment of the RUL and an anterior mediastinal mass. The patient underwent wedge resection for the cavitary lesion and complete resection for the mediastinal mass. The pathologic finding was Paragonimus Westermani infestation in both the lung and thymus. The abdomen CT taken postoperatively showed an inflammatory mass involving the transverse colon and a small nodular lesion around the descending colon, which strongly suggested paragonimiasis. Postoperatively, the patient took Praziquantel for 2 days and he was discharged without any complications. There was no evidence of recurrence for the last 2 years.

Primary Cardiac Lipoma Combined with Chest Pain Like Angina Pectoris / 대한흉부외과학회지

A 60-year-old male was admitted because of dyspnea and angina like chest pain. Noninvasive findings showed a mass at the posterior aspect of the left atrium. The mass was removed under cardiopulmonary bypass. An encapsulated adipose mass, which originated from the left atrium without any invasion to the pericardium, was completely excised. Histological examination showed mature adipose tissue with partial necrosis, confirming the diagnosis of lipoma. We report a rare of case of massive left atrial lipoma occupying the pericardial space.

Complete Fracture of Totally Implantable Venous Catheter / 대한흉부외과학회지

The patient was a 42-year-old female with breast cancer who had an implantable central venous catheter inserted percutaneously into left subclavian vein for chemotherapy. The postinsertion chest x ray revealed that there was no compressive sign of catheter. Three months after insertion of the catheter, the patient was admitted to the hospital for 4th chemotherapy. The port was accessed but blood could not be aspirated and the catheter could not be flushed. A chest x ray revealed that the catheter was completely transected at the point where the catheter passed under the clavicle. Percutaneous removal of the distal fragment of the catheter was accomplished. The patient was discharged after successful removal of fragment of catheter.

A Case of Infiltrating Lipoma Combined with Nevus Lipomatosus Cutaneous Superficialis / 대한피부과학회지

Infiltrating lipoma is one of the most deep-seated benign soft tissue tumor which occupies less than 1% in lipomas. There are two different types of infiltrating lipoma, one intramuscular lipoma, and the other intermuscular lipoma. Nevus lipomatosus cutaneous superficialis is a very rare skin disease which is characterized by the ectopic presence of mature adipose tissue in the dermis. In this disease two clinical types are distinguished: The first classic type is the multiple lesions of zonal distribution usually on the buttocks or on the lower back area. The second type is the solitary papule or nodule with less restricted tendency in its distrubution. We described a 31-year-old man who had a relatively well-defined localized, skin colored, 20x20cm sized, subcutaneous mass partially covered with brown colored papules and plaque on the left subscapular area. The skin lesion began about 11 years ago with brown colored papules and gradually increased in size to 20x20cm mass. Histopathological and clinical findings showed ectopic fat lobules consisted of almost mature cells in the dermis, between the each muscle fibers, and each muscle bundles.

A case of pulmonary epithelioid hemangioendothelioma / 대한내과학회지

Epithelioid hemangioendothelioma(EH) is a rare vascular tumor of low-grade malignancy. It was previously described as intravascular bronchioloalveolar tumor (IVBAT). But electron microscopic study and immunohistochemical staining results have proved endothelial origin. Patients are usually asymptomatic and the tumors are found incidentally on routine chest X-rays. Most patients show a slowly progressive clinical course, even though some patients occasionally die as results of respiratory failure or extrathoracic complications. Confirmative diagnosis is made through thoracoscopic or open-lung biopsy. There is still no effective therapeutic modality for pulmonary EH. We have experienced a 55-year-old woman whose simple chest x-ray film revealed bilateral multiple small nodules. The nodules were histopathologically and immunohistochemically diagnosed as primary epithelioid hemangioendothelioma of the lung. The possibility of metastatic disease was excluded thorough clinical, laboratory and radiological studies. Comparison of radiographic chest film taken 3 years ago showed no significant progression of the pulmonary nodular lesions. Conservative management was instituted and careful 4 months follow-up showed no significant changes.