Bilateral pulmonary nodules caused by Dirofilaria immitis.

The unusual case of bilateral lung nodules caused by Dirofilaria immitis in a 44-year-old woman is presented. A brief discussion of the life cycle of this parasite, the clinical and epidemiological features of human infestation, and the roentgenographic and laboratory findings is given.

Descending thoracic aorta to femoral artery bypass.

Two patients have been presented for whom the selection of a thoracic aorta to bifemoral artery bypass graft was necessary because the abdominal aorta was too compromised to be used as an outflow conduit. Both patients gained a most satisfactory result. The indications and contraindications for this procedure and its technique are cited. It is stressed that this operation should be selected for those patients for whom the more conventional bypass routes are not feasible or are hazardous. This merely gives the surgeon another option where circumstances are complicated. The surgical approach is usually straightforward and is associated with low morbidity and mortality. Patency rates and flow rates compare equally with the abdominal aortic to femoral bypass grafts.

Utility of lesser saphenous vein as a substitute conduit.

The lesser saphenous vein provides a useful alternative graft conduit for both cardiac and peripheral vascular procedures. Its gross appearance and handling characteristics are similar to greater saphenous vein, and its patency rates appear comparable. It is harvested with minimal difficulty. Harvesting is well tolerated, even in the absence of the greater saphenous system. Its use should be strongly considered when standard conduits are inadequate or unavailable.

Dirofilaria immitis (dog heartworm) as a pulmonary lesion in humans.

Dirofilaria immitis, the dog heartworm, has been identified in the pulmonary granulomas of 5 patients from the greater Charleston area; this is the largest series of such cases from one medical center. The patients had no pulmonary symptoms. On roentgenogram the lesions were all about 2 cm in size, of uniform light opacity, and located near the pleural surface. Thoractomy was performed in each instance because of the possiblity of carcinoma. The association of granuloma formation, pulmonary infarct, and eosinophilic infiltration led to the suspicion of dirofilaria, which was confirmed in each case.

Spontaneous perforation of the cervical esophagus.

A rare case of spontaneous rupture of the cervical esophagus occurred during vomiting after eating. The plain x-ray film showed air in the neck, but barium swallow did not reveal the perforation. Operation performed two days later because of bleeding consisted of suturing two rents in the anterior wall of the cervical esophagus distal to the cricopharyngeus muscle, and the patient did well. The mechanism causing such a perforation is not well understood. With the absence of bleeding, treatment would ordinarily consist of drainage without suture.