A Pleural Loose Body Mimicking a Pleural Tumor: A Case Report

We present a rare case of a pleural loose body, thought to be a pedunculated pleural tumor, found incidentally in a 58-year-old female. Computed tomography showed a non-enhancing mass, which migrated along the mediastinum and paravertebral area. Thoracoscopic surgery revealed a 4 cm, soap-like mass that was found to be a fibrin body consisting of hyalinized collagen histopathologically. Mobility and the lack of contrast enhancement of a pleural mass are important clues to diagnosing this benign condition.

Treatment of Complete Persistent Sciatic Artery with Distal Thromboembolism by Thromboembolectomy Only

A persistent sciatic artery (PSA) is very rare congenital vascular anomaly which is present in 0.025% to 0.04% of the population by an angiographic study. A PSA is usually combined with aneurismal disease or thromboembolic events because of its arteriosclerosis and vessel wall degeneration. The treatments of symptomatic PSA are comprised of exclusion of PSA from circulation and bypass surgery for the lower limb. However, surgical treatment should be tailored to its anatomy and presentation. We report a successful treatment of PSA with distal thromboembolism by thromboembolectomy without bypass surgery.

An Adult Right-sided Bochdalek Hernia Accompanied with Hepatic Hypoplasia and Inguinal Hernia

We herein report a very rare case of adult right-sided Bochdalek hernia accompanied with hepatic hypoplasia and inguinal hernia. A 29-year-old man was admitted with right-sided pneumothorax. A computed tomography was performed and revealed large right sided Bochdalek hernia with hepatic hypoplasia. Under thoracolaparotomy, the defect was closed with Gore-Tex soft tissue patch. After the operation, left-sided inguinal hernia was found. However, it turned out that it had been present during infancy and spontaneously resolved during adolescence. This is the first report of right-sided Bochdalek hernia with hepatic hypoplasia and inguinal hernia in an adult.

Tuberculous Empyema Necessitatis with Osteomyelitis, a Rare Case in the 21st Century / 소아감염

Empyema necessitatis refers to empyema that extends into the extrapleural space through a defect in the pleural surface. Tuberculous empyema necessitatis is a rare complication of tuberculosis. We experienced a 21-month-old boy with tuberculous empyema necessitatis with osteomyelitis in the right 7th rib. He presented with a mass on the right lateral chest wall, which was soft and nontender, enlarging for one month. He also had mild fever. The plain radiograph of his chest revealed soft tissue swelling and calcified lymph node on the left axilla, and his PPD skin test was positive. CT scan of the chest showed empyema necessitatis at the right lower chest and upper abdominal walls with osteomyelitis of the right 7th rib. He did not have concurrent pulmonary tuberculosis. Surgery was performed for diagnosis and treatment. In histopathologic findings, chronic granulomatous inflammation with caseation necrosis was shown and was positive for acid fast bacilli stain. In addition, M. tuberculosis complex was found as etiology by polymerase chain reaction. The patient has been treated with anti-tuberculous medication without any specific complication.

Subphrenic Abscess Due to Retained Gauze / 대한흉부외과학회지

Eighty-four-year old man who had lapalotomy for stomach ulcer perforation 35 years ago was admitted for left lower chest discomfort. Chest X-ray and CT showed a large mass with air fluid level in left lower lung field. The tentative diagnosis was infected bronchogenic cyst. After a thoracotomy, the mass was confirmed as elevated diaphragm and subphrenic abscess with a foreign body, retained surgical gauze. The pus and gauze were located between stomach and diaphragm. His hospital course was smooth and uneventful, he was discharged with good outcome on postoperative day 9.

Factors Influencing on Early Patency Rate of Autogenous Arteriovenous Fistula for Hemodialysis / 대한흉부외과학회지

BACKGROUND: It is very important for hemodialysis in patients with end stage renal disease to obtain vascular access that resists repeated punctures and maintains adequate blood flow. This study was designed to indentify factors that may influence early patency rate of autogenous arteriovenous fistula. MATERIAL AND METHOD: 49 cases in 47 patients who underwent radiocephalic fistula formation in our hospital from June 2002 through May 2003 were reviewed and analyzed. RESULT: The early patency rate was 79.6%. Age, sex, hypertension, and diabetes mellitus were not significant factors for patency. Body mass index and duration of hypertension and diabetes did not influence the early results either. Cephalic vein diameter measured preoperatively and blood flow at radiocephalic fistula were significantly positive correlative factors. Groups with the vein diameter less than 2.7 mm, or with the blood flow less than 100 mL/min had significantly lower early patency rate than the other groups. CONCLUSION: To improve early patency rate of radiocephalic fistula, large sized cephalic vein should be selected and if the intraoperative flow at radiocephalic fistula is less than 100 mL/min, another arteriovenous fistula formation should be considered.

Comparison of the Effectiveness of Oral Doxycycline, Homologous Blood and Talc as Pleural Sclerosing Agents in Rats / 대한흉부외과학회지

BACKGROUND: Parenteral tetracycline is no longer available for pleural sclerosing agent for pleurodesis in Korea due to the discontinuation of the production. The purposes of this study were to determine whether oral doxycycline (ODC) could be used as an effective sclerosing agent for pleurodesis, and to compare the effectiveness of ODC to other agents, such as homologous blood and talc. MATERIAL AND METHOD: Twenty male rats were divided into four groups (A to D). Following agents were given to each group intrapleurally; 10 ml/kg of 0.9% saline to group A, 10 mg/kg of ODC to group B, 2 ml/kg of homologous blood to group C, and 70 mg/kg of talc slurry to group D. All animals were sacrificed 28 days after instillation. The pleural spaces were assessed grossly and microscopically and were graded from 0 to 3, and the thicknesses of the pleura were measured. RESULT: The gross score of group A was 0.0, group B was 1.4+/-0.9, group C was 1.0+/-0.7, and group D was 2.2+/-0.8. Significant adhesion were examined in group B and D grossly (p<0.05). The pleural thickness of group A was 0.7+/-0.2 /10(2) mm, group B was 1.2+/-0.4 /10(2) mm, group C was 1.4+/-0.4 /10(2) mm, and group D was 3.5+/-0.9 /10(2) mm. Group D showed pleural thickening significantly (p<0.05). The microscopic score of group A was 1.0, group B was 1.7+/-0.5, group C was 1.5+/-0.4, and group D was 2.8+/-0.4. Group B and D showed significant inflammations and depositions of collagen (p<0.05). CONCLUSION: ODC showed significant pleurodesis grossly and microscopically, and homologous blood did not show adhesion. Talc was a significant sclerosing agent for pleurodesis causing extensive inflammation and collagen depisotion.

Malignant Gastrointestinal Stromal Tumor of Esophagus: A case report / 대한흉부외과학회지

Stromal tumors of the gastrointestinal tract, especially of the esophagus, are rare. We had a case of malignant gastrointestinal stromal tumor(GIST) of the esophagus. A 46 years old woman was admitted for abnormal mass shadow in the chest radiograph. The mass was originated from the lower thoracic esophagus, and compressed the right lower pulmonary vein and the inferior vena cava. We removed the tumor externally without injuring of the esophageal mucosa via right posterolateral thoracotomy. The tumor was positive for CD 34 and CD 117, and diagnosed malignant GIST of the esophagus.

Primary Giant Cell Tumor of Rib-Unusual Location / 대한흉부외과학회지

Giant cell tumor rarely occurs in ribs. Usually it is located in the posterior arc. We reported a very rare case of primary giant cell tumor of rib in the anterior arc with review of literatures.

Thrombolytic Therapy for Thrombosis of Prosthetic Mitral Valve: A Case Report / 대한흉부외과학회지

Prosthetic valve thrombosis(PVT) may be a life-threatening complication requiring prompt intervention. This is a case report of thrombolytic therapy for thrombosis of prosthetic mitral valve. A 47 year-old male admitted to the emergency room for abrupt onset of dyspnea. He had undergone mitral valve replacement(On-X valve, 29mm) for mitral stenosis 8 months ago. The patient's international normalized ratio(INR) on admission was 1.09. The mechanical clicks were muffled and rales were heard in both lung fields. A transesophageal echocardiography(TEE) revealed prosthetic valve thrombosis with increased transvalvular pressure gradient(34 mmHg). The patient's condition needed to intubation for mechanical ventilation due to hemodynamic compromise, however his wife and relatives refused the surgical intervention due to financial problems. The patient was transferred to the cardiac care unit and we decided to perform thrombolytic therapy. A bolus of 1,500,000 IU of urokinase was given, followed by a drip of 1,500,000 IU for 1 hour. The patient did not improved hemodynamically; therefore, we gave 100 mg of tissue plasminogen activator(t-PA) for over 2 hours. During that time mechanical clicks were audible and hemodynamics of the patient improved progressively. A TEE showed disappearance of thrombus and decreased pressure gradient(1.7 mmHg) after 6 hours of thrombolytic therapy. The patient was recovered without any neurologic sequale and was discharged with administration of warfarin.

Thrombolytic Therapy for Thrombosis of Prosthetic Mitral Valve: A Case Report / 대한흉부외과학회지

Prosthetic valve thrombosis(PVT) may be a life-threatening complication requiring prompt intervention. This is a case report of thrombolytic therapy for thrombosis of prosthetic mitral valve. A 47 year-old male admitted to the emergency room for abrupt onset of dyspnea. He had undergone mitral valve replacement(On-X valve, 29mm) for mitral stenosis 8 months ago. The patient's international normalized ratio(INR) on admission was 1.09. The mechanical clicks were muffled and rales were heard in both lung fields. A transesophageal echocardiography(TEE) revealed prosthetic valve thrombosis with increased transvalvular pressure gradient(34 mmHg). The patient's condition needed to intubation for mechanical ventilation due to hemodynamic compromise, however his wife and relatives refused the surgical intervention due to financial problems. The patient was transferred to the cardiac care unit and we decided to perform thrombolytic therapy. A bolus of 1,500,000 IU of urokinase was given, followed by a drip of 1,500,000 IU for 1 hour. The patient did not improved hemodynamically; therefore, we gave 100 mg of tissue plasminogen activator(t-PA) for over 2 hours. During that time mechanical clicks were audible and hemodynamics of the patient improved progressively. A TEE showed disappearance of thrombus and decreased pressure gradient(1.7 mmHg) after 6 hours of thrombolytic therapy. The patient was recovered without any neurologic sequale and was discharged with administration of warfarin.

Endocarditis with Intracardiac Migration of Transvenous Permanent Pacing Lead: 1 Case Report / 대한흉부외과학회지

When any part of the pacemaker system is infected, all pacemaker hardware should be removed, because reinfection rates of 51% to 77% have been noted in patients whose infected pacemaker system has been only partially explanted. The removal of infected leads during cardiopulmonary bypass prevents mechanical injury as well as the spread of infection and vegetation. We report one case of endocarditis by staphylococcus aureus with infected transvenous pacing lead which was migrated into the heart from the left subclavian vein. We removed the migrated pacing lead and vegetation under cardiopulmonary bypass.

Endocarditis with Intracardiac Migration of Transvenous Permanent Pacing Lead: 1 Case Report / 대한흉부외과학회지

When any part of the pacemaker system is infected, all pacemaker hardware should be removed, because reinfection rates of 51% to 77% have been noted in patients whose infected pacemaker system has been only partially explanted. The removal of infected leads during cardiopulmonary bypass prevents mechanical injury as well as the spread of infection and vegetation. We report one case of endocarditis by staphylococcus aureus with infected transvenous pacing lead which was migrated into the heart from the left subclavian vein. We removed the migrated pacing lead and vegetation under cardiopulmonary bypass.

Redo Konno Procedure / 대한흉부외과학회지

A 28 year-old male who had received Konno procedure twelve years ago with 23mm mechanical aortic valve and bovine pericardium with which his small aortic annulus, ventricular septum and right ventricular outflow tract had been enlarged was transferred due to sudden congestive heart failure. There were perforations on aortic and interventricular portion of bovine pericardial patch above and below the aortic valve, respectively, which was calcified and denaturated severely. The perforations seemed to be attributed to the cracks, resulting from mobility of mechanical aortic valve itself and stiffness of calcified and denaturated bovine patch. We performed a redo Konno procedure applying PTFE patch.

Cardiac Malignant Mesenchymoma: Two Cases Report / 대한흉부외과학회지

Primary cardiac tumors are rare and about 20~25% of primary cardiac tumors are malignant. Moreover, primary malignant mesenchymoma of the heart is extremely rare. Recently, we have experienced two cases of cardiac malignant mesenchymoma. In the first case, malignant mesenchymoma which was originated from the posterior wall of the left atrium obstructing the mitral orifice was revealed pathologically in a 61-year-old woman with mitral regurgitation. The mass, which was 2.7 X 3.7cm in size on the posterior wall of left atrium, was extended to the posteromedial commissure and annulus of the mitral valve. The mass was resected partially without excision of the left atrial free wall. She was discharged after 30 days without any problems and she received chemotherapy and followed up for 19months. The second case was a 4 X 5cm in size, friable, yellow-whitish multilobulated mass in the left atrium which was originated from the left lower pulmonary vein. Multiple minor tumor nodules were found in the wall of the left atrium and the posterior leaflet of mitral valve. Partial mass excision and mitral valve replacement were performed.

Surgical Treatment of Renal Cell Carcinoma with IVC Tumor Extension Using Deep Hypothermic Circulatory Arrest: A Case Report / 대한흉부외과학회지

A 64-year-old man was admitted for gross hematuria. Preoperative study revealed right renal cell carcinoma with inferior vena cava(IVC) tumor thrombus. Right radical nephrectomy was performed, and deep hypothermic circulatory arrest(DHCA) with retrograde cerebral perfusion(RCP) was used for extraction of tumor thrombus in the IVC. The thrombus originated from the right kidney, which extended the orifice of the gonadal vein in the left renal vein laterally, the hepatic vein superiorly, and 3 cm below the right renal vein inferiorly. The thrombus was removed completely without caval wall injury under DHCA with RCP, and the postoperative course was uneventful. He received immunotherapy with interferon, and followed up without any surgical problem.

Efficacy of Intra-Aortic Balloon Pump in Postcardiotomy Cardiogenic Shock / 대한흉부외과학회지

BACKGROUND: Intra-aortic balloon pump (IABP)is well known for its hemodynamic benefit but still has its own complications.Proper use of IABP is the best way t o obt ai n maximum benefit with low complication rate. MATERIALS AND METHOD: Twenty one(men 10,female 11) patients were included in this study among the 100 consecutive adult cardiac surgery patients in our hospital.Eighteen(85.7%)were ischemic heart disease patients.They all received IABP therapy due to postcardiotomy cardiogenic shock according to the well-known indications.Their preoperative conditions,intraoperative factors including hemodynamics, postoperative conditions and IABP-related complications were analyzed. RESULT: Nineteen patients(90.5%)were successfully weaned from IABP.There were 2 patients of operative death and the mortality rate was 9.5%.Duration of IABP use was 40.7+/-24.3 hours.There were 2 cases(9.5%)of IABP-related vascular complications that required surgical intervention. CONCLUSION: We concluded that IABP could be used effectively and safely for postcardiotomy cardiogenic shock patients with low complication rate.

Application of th Total Artificial Heart as an Implantable Biventricular Assist Device by Left Thoracotomy in an Ovine Model / 대한흉부외과학회지

BACKGROUND: The purpose of this study was to investigate the possibility of using the moving-actuator type total artificial heart as a biventricular assist device(BVAD) and to establish a safe and effective animal model for the implantation of a BVAD. MATERIAL AND METHOD: Seven Corridale sheep were used in this study wherein left thoracotomy was performed. The left and right outflow cannulas were anastomosed to the descending thoracic aorta and the main pulmonary artery, and the left and right inflow cannulas were inserted to the left atrium and the right atrial appendage. The devices were positioned in the preperitoneal pocket in 4 sheep, in the left pleural cavity in 2 sheep, and externally in 1 sheep. The aPTT was maintained between the 2 and 2.5 times the range that of the baseline. RESULT: Cannulation was carried out successfully in all cases. There was no case of operative death or immediate postoperative death. Three sheep expired postoperatively on the 2nd day because of thromboembolism, an artificial ventilator accident, and device and respiratory failure. Three other sheep died postoperatively on the 4th day because of acute renal and respiratory failure following thromboembolism. One sheep survived for 28 days. Experimentation on this animal terminated due to an electrical short-circuit caused by motor wire erosion. Thrombi were found on the valves of 4 out of 7 animals, especially on the connection between valves and the device. However , there was no thrombus in the cannulas. CONCLUSION: In conclusion, left thoracotomy for insertion of 4 cannulas and placement of device in the preperitoneal space is the safe and effective operative technique in ovine for testing in-vivo biocompatibility of the BVAD. Furthermore, it may be possible to use a moving-actuator type total artificial heart as a BVAD if technical improvements for reducing thromboembolism are carried out.

Pulmonary Arteriovenous Fistula presented by Brain Abscess: A case report / 대한흉부외과학회지

Pulmonary arteriovenous malformations(PAVM) are uncommon diseases. Brain abscesses could be a rare and devastating complication of PAVM. Central nervous complaints may be the first manifestations of PAVM. We report a case of PAVM presented by brain abscess, which was treated by craniotomy.

Anatomical Repair of Double-Outlet Left Ventricle with Ventricular Septal Defect and Pulmonary Stenosis by Reight Ventricular Outflow Patch Reconstruction / 대한흉부외과학회지

Double-outlet left ventricle with ventricular septal defect and pulmonary stenosis was conventionally repaired with extracardiac conduit or pulmonary artery translocation. Here, we report an anatomically repaired double-outlet left ventricle without extracardiac conduit or pulmonary artery translocation in an 11 month old patient who had undergone palliative systemic-pulmonary shunt at a nonatal period. The location of ventricular septal defect, both great arteries and coronary arteries made it possible to reconstruct the right ventricular outflow tract using on-lay patch after incision and undercutting the tissue between the ventriculotomy and the pulmonary arteriotomy.