Search

Background: Cholesterol granuloma (CG) is a benign entity characterized by the presence of cholesterol crystals and foreign body giant cells. This condition can be attributed to cholesterol crystals that are deposited in the tissues and react with foreign body giant cells, resulting in granuloma formation. Lesions commonly develop in the otolaryngeal region, such as the middle ear. However, crystals rarely form in the thymus, accounting for 1% of all mediastinal tumors. Herein, we present five cases of mediastinal CG., Case Presentation: The patients were aged 49-61 (mean, 55.4) years. Among them, three were men and two women. One patient had fever, and four patients were asymptomatic. The patients' lesions were detected during follow-up of other diseases or medical examinations showing the presence of abnormal chest shadows. The patients did not have a history of trauma or surgery. All lesions were located within the thymus gland. Three patients presented with multifocal lesions and two with a single lesion. Four patients had contrast effect on computed tomography scan. Four patients had abnormal fluorodeoxyglucose accumulation (mean maximum standardized uptake value, 4.67) on positron emission tomography-computed tomography. Four patients underwent complete surgical resection. The size of the resected lesions ranged from 1.8 to 5.1 (mean, 3.24) cm. Histologically, all patients presented with small nodules with cholesterol clefts and foreign body giant cells and histiocyte infiltration within the thymic tissue. The postoperative course was excellent. None of the patients who underwent complete resection presented with recurrence. Moreover, the patient who underwent partial resection did not have lesion enlargement., Conclusions: CG in the thymus is clinically challenging to differentiate from malignant lesions, and histologic diagnosis via surgical resection is required., (© 2024. The Author(s).)

Background: Mediastinal lymphatic tumors are relatively rare. The prognosis is poor but has improved due to recent advances in treatment strategies. Herein, we report a case of mediastinal lymphoma diagnosed using surgical biopsy, which was complicated by mediastinal mass syndrome due to general anesthesia., Case Presentation: A 25-year-old man with cough, fever, dyspnea, and night sweats was transferred to our hospital for resection of a large anterior mediastinal tumor. Although his preoperative diagnosis was WHO type B1 thymoma, the clinical findings suggested a lymphoma. A repeat surgical biopsy was performed under general anesthesia. Immediately after extubation, the patient developed acute respiratory failure with hypolucency of the right lung field on chest radiography. He was reintubated immediately and was diagnosed with negative pressure pulmonary edema in the right lung. He was managed with positive-pressure ventilation and his respiratory distress resolved within 5 days. Pathological examination of surgical specimens confirmed the diagnosis of lymphoma., Conclusion: Surgical biopsy is useful for the diagnosis of mediastinal tumors. However, the risk of perioperative mediastinal mass syndrome should be carefully assessed before administering general anesthesia., (© 2024. The Author(s).)

Background: Congenital bronchial atresia (CBA) is a rare bronchial abnormality. Adult patients with CBA generally do not show any symptoms. Although surgical resection is the first-line treatment, the indication for the surgical intervention is controversial, especially in mildly symptomatic or asymptomatic patients. Recently, thoracoscopic surgery is the commonly preferred approach to treat this condition., Case Presentation: Case 1: A woman in her 20s suffered from repeating episodes of fever and cough due to left CBA with the interruption of B9 and B10. Uniportal thoracoscopic left lower lobe wedge resection was performed, following which the symptoms disappeared. Case 2: A woman in her 40s presented to the clinic with dyspnea on exertion, and the computed tomography image revealed the absence of B2. Multiportal thoracoscopic right S2 segmentectomy was performed on her, after which the symptoms of dyspnea improved. Case 3: A woman in her 40s visited the hospital with symptoms of intermittent cough, sputum, and slight fever for 7 months. The examinations identified the absence of B6a. Right S6 segmentectomy and S2 wedge resection were carried out by multiportal thoracoscopic approach. The patient is now asymptomatic., Conclusions: Based on our experiences in the three adult CBA surgery cases, the three-dimensional image reconstruction system is very useful for diagnosis and surgical decisions with regard to this disease. Even for CBA patients with subtle symptoms, early surgical treatments may be beneficial from the point of view of minimally invasive interventions, and sublobar resection will be sufficient for treatments and preservation of respiratory function., (© 2023. The Author(s).)

Background: In lung transplantation, vascular complications are relatively rare. However, severe pulmonary artery stenosis after lung transplantation can cause clinical symptoms and lead to graft dysfunction., Case Presentation: The present patient underwent right lung transplantation for severe chronic obstructive pulmonary disease. After lung transplantation, pulmonary blood flow scintigraphy showed a decreased blood flow to the transplanted lung, and contrast-enhanced computed tomography showed pulmonary artery anastomotic stenosis. As the initial treatment, balloon dilation of the pulmonary artery was attempted and unsuccessful. Right pulmonary artery plasty was then performed 5 months after lung transplantation. Following the procedure, the pulmonary artery stenosis was released, and the blood flow to the transplanted lung improved., Conclusion: Surgical treatment should be considered for pulmonary artery stenosis after lung transplantation if minimally invasive intervention is not effective., (© 2023. The Author(s).)