Search

Objective: This study aimed to compare the contribution of 18 F-fluorodepxyglucose (FDG) positron (PET)/ computed tomography (CT) acquisition of early and delayed scans in patients with cardiac sarcoidosis (CS)., Methods: Twenty-three patients with CS (median age: 69 years; 11 women) were retrospectively evaluated using dual-phase FDG PET/CT. All patients were instructed to consume a low-carbohydrate diet followed by fasting for 18 h before FDG injection to reduce physiological myocardial uptake. PET/CT was acquired at 60 min (early) and 100 min (delayed) after FDG administration. Focal and focal on diffuse uptake on visual analysis was considered positive for CS. A semi-quantitative analysis was performed using the maximum standardized uptake value (SUVmax) of the cardiac lesion and the mean SUV (SUVmean) of the blood pool., Results: Significant myocardial FDG uptake was observed in 21 patients (91.3%) in the early acquisition group and in 23 patients in the delayed scan group (100%). Compared to the early scan, the delayed scan showed a significantly higher SUVmax of the cardiac lesion [median, 4.0; IQR (interquartile range, 2.9 to 7.0) vs. 5.8 (IQR 3.7 to 10.1); P = 0.0030] and a significantly lower SUVmean of blood pool [median, 1.3 (IQR, 1.2 to 1.4) vs. 1.1 (IQR, 0.9 to 1.2); P < 0.0001]., Conclusion: Delayed FDG PET/CT acquisition improves detection accuracy in patients with CS compared to early scans with washout of the blood pool activity. Therefore, it can contribute to a more accurate assessment of CS., (© 2023. The Author(s) under exclusive licence to The Japanese Society of Nuclear Medicine.)

A surgical option is commonly chosen when conservative medical therapy for empyema is impossible. The muscles used include the latissimus dorsi, trapezius, and pectoris major, based on the size and location of the empyema cavity. However, these volumes are decreased in patients suffering from malnutrition, and flap dissection and elevation are sometimes invasive. Therefore, we developed an alternative method, and present three successful cases in which we used a pedicled paraspinous muscle flap to fill the dead space caused by empyema fenestration in the medial region of the back. The paraspinous muscle flap remains an important tool in reconstruction. However, such flaps should be created only in selected cases, such as those with empyema in the posterior region. Also, if the pleural space is large, additional muscle flaps will be required.

Objectives: Our objective was to evaluate the validity of surgery for secondary spontaneous pneumothorax (SSP) by comparison with other treatments or with perioperative results for primary spontaneous pneumothorax (PSP)., Methods: Between January 2009 and March 2015, 144 patients with SSP, aged 60 years or over, were treated in our institution. We reviewed the patients' characteristics, perioperative results, and relapse rate. Treatment to arrest air-leakage included surgery (n = 79), drainage only (n = 30), and pleurodesis (n = 35), and the pneumothorax relapse rate or mortality before discharge was compared for each. Additionally, we compared the perioperative results or relapse rate between SSP (n = 70) and PSP (n = 70) in patients who underwent 3-port thoracoscopic surgery., Results: There was a significant difference in the relapse rate between the surgery and non-surgery groups (5.3 vs. 27.4 %, p = 0.0006). However, no significant difference in mortality before discharge was determined (p = 0.66). Significant differences were identified between the SSP and PSP groups for operation time, duration of chest drainage, and the length of postoperative hospitalization, and the postoperative morbidity were greater in the SSP group (p < 0.0001 for all). However, there was no significant difference in postoperative 30-day mortality or the relapse rate (p = 0.5, p = 0.68, respectively)., Conclusions: Surgical treatment under general anesthesia for SSP is effective for arresting persistent air leaks or avoiding pneumothorax relapse, compared with drainage or pleurodesis, and is feasible if the appropriate perioperative management is performed.

Objectives: Our objective was to evaluate the efficacy of pulmonary metastasectomy for postoperative colorectal cancer with hepatic metastasis, and to investigate the role of clinicopathological factors as predictors of outcome., Methods: Consecutive patients undergoing pulmonary metastasectomy for colorectal cancer with (group PH, n = 27) or without (group P, n = 46) a history of hepatic metastasis were included in the study. Clinicopathological variables, including sex, age, site, carcinoembryonic antigen in the primary tumor, disease-free interval, prior hepatic resection, timing of pulmonary metastases, preoperative chemotherapy, type of pulmonary resection, and number, size, and location of pulmonary metastases were retrospectively collected and investigated for prognostic significance., Results: Five-year survival rates were 59.5 and 70.0 % for patients with and without a history of hepatic metastasis, respectively; these values did not differ significantly. Among all investigated prognostic variables, sex and number of pulmonary metastases (1 vs. >1) were the most important factors affecting the outcome after colorectal and pulmonary resection. There was no significant difference in overall survival whether it was calculated from the time of resection of the primary colorectal cancer or of pulmonary metastases., Conclusions: Pulmonary resection is not contraindicated in clinical practice. Significant factors indicating a good prognosis were female sex and the number of pulmonary metastases. Special attention should be paid to comparison of survival among studies.

Purpose: Most thoracic surgeons have experienced difficulty dissecting the pulmonary hilus because of scarring. In such potentially dangerous situations, we advocate a method of clamping and severing the pulmonary lobar root structure en masse. The aim of this study was to evaluate en masse lobectomy, particularly considering the constellation of pulmonary vessels and the bronchus., Methods: Twelve patients (median age 70 years) underwent en masse lobectomy. We retrospectively evaluated the surgical procedures and clinical outcomes. Care was taken to consider the remaining vessels and bronchus, which regulate the direction of device placement., Results: Seven patients had inflammatory lung disease, four had primary pulmonary carcinoma, and one had suffered blunt chest trauma. Ten operations were elective and two were emergent. Lobectomy included the right upper lobe in two cases, the right middle lobe in three, the right lower lobe in two, the right middle-lower lobe in two, and the left lower lobe in three. A stapler was used in ten patients, and sutures were applied in three (both were used in one case). Morbidities included a pyothorax and a persistent air leak; both made a recovery. Mortality included one emergency case of acute respiratory distress syndrome. No bronchopleural or bronchovascular fistulas occurred., Conclusions: We believe that the en masse lobectomy is an alternative and necessary technique in critical or unexpected situations, possibly as a last resort. Trauma and severe inflammation may be good indications for en masse lobectomy.

A 61-year-old man was transferred to our institution because of blunt chest trauma after accidentally falling. A chest roentgenogram (CXR) and computed tomography (CT) revealed bilateral hemopneumothorax and fractures of multiple left ribs, the pelvis, and the left femur. On the second day in hospital, the patient suddenly complained of dyspnea. Emergency CXR and CT revealed elevation of the left diaphragm, suggestive of a traumatic diaphragmatic hernia; emergency surgery was performed. We confirmed rupture of the diaphragm and pericardium with cardiac herniation: the pleural pericardium and diaphragm were torn individually, and the heart and abdominal organs had herniated into the pleural cavity. They were repaired, and there were no cardiopulmonary complications during or after the operation. Pericardiodiaphragmatic rupture with cardiac herniation after multiple blunt traumas is rare. We describe the successful treatment of a diaphragmatic and pericardial rupture with cardiac herniation, with special reference to pericardial injuries.

In the lung cancer case described here, we resected the right upper lobe, right middle lobe, and superior segment of the right lower lobe with concomitant resection of the pulmonary artery and bronchoplastic and pulmonary arterial reconstruction. The basal segmental bronchus was anastomosed to the right main stem bronchus using a novel, specific technique: The tumor was extirpated with division of the upper and middle lobe bronchus and the superior segmental bronchus. Parts of the middle bronchus and superior segmental bronchus on the distal side were used to expand their orifice. The cut end of the pulmonary artery was sutured, reversing the long and short axes, to shorten and adjust the pulmonary artery.

A 34-year-old woman had complained of dyspnea on exertion for 3 months and was found to have a volume loss of the left lung. A smooth, vascularized, whitish nodular mass obstructing the orifice of the left main bronchus was noted on bronchoscopy. We performed a deep wedge resection of the main bronchus, preserving the lung parenchyma. Histopathologically, the tumor specimen was compatible with pleomorphic adenoma. To our knowledge, only two cases of pleomorphic adenoma arising from the main bronchus have been reported in the English-language literature, and ours is the first report of lung-preserving surgery.

Detecting a rib metastasis as a first manifestation before identifying hepatocellular carcinoma (HCC) is rare. We report an HCC with massive bleeding from the biopsied rib tumor. A 68-year-old man was referred for right chest pain. Computed tomography showed a mass in the rib and two small masses in the liver. The biopsied rib continued to bleed, so we removed the entire tumor, including the rib. We histologically confirmed the diagnosis as rib metastasis from the HCC. The patient died 3 months after the onset. We caution against performing an incisional biopsy without due consideration.

No study has discussed the application of video-assisted thoracoscopic surgery (VATS) to bronchoplasty or the handling of a needle and forceps in a bronchial anastomosis. We use the following steps for bronchial anastomosis: Insert the needle and forceps vertical to the bronchial wall, move them in such way as to scoop something up, rotate and turn around, repeat the second step, and pull from the bronchial wall along the curvature of the needle. Handling the needle forceps along the curvature of the needle is critically important.

In Japan, little is known about using the Cell Saver in treating blunt or penetrating chest trauma. We therefore report the utility of this autologous blood salvage device. Two patients underwent emergency thoracotomies with the Cell Saver to treat massive hemothorax and made full recoveries. The first was a 29-year-old man who suffered a stab injury to his chest; 5000 ml blood was collected from the thorax, of which about 3000 ml was reinfused. The second was a 51-year-old man involved in a car crash; 1600 ml blood was collected from the thorax, of which about 500 ml was reinfused. When no banked blood is available for an emergency thoracotomy, the Cell Saver is an extremely useful machine. This device is also effective in treating progressive hemorrhagic shock and helpful when the rate of blood loss exceeds the supply available from the blood bank.

A 30-year-old man was admitted to our hospital because of refractory pneumonia. He had been repeatedly hospitalized owing to pneumonia recurring in the left lower lung field and had a 7-day history of hemoptysis at the age of 11. Chest computed tomography demonstrated reduced volume of the left lower lobe with parenchymal consolidation. The patient preferred surgery as first-line treatment rather than other interventions because he had suffered from refractory pneumonia or local pleuritis for a long time. Left lower lobectomy was performed. The resected specimen revealed obstruction of the posterior basal segment bronchus in which a foreign body (FB) was found embedded in granulation tissue. The FB was a plastic air-pistol pellet. After further questioning, the patient remembered aspirating the pellet while playing with the pistol at the age of 5. When it is difficult to remove a long-standing intrabronchial FB, we recommend surgery.

We report the case of a patient who survived after a pulmonary tractotomy. A 54-year-old man was stabbed in the back with a knife and was admitted to our emergency department. Imaging findings showed that there was hemopneumothorax of the right lung. After inserting a chest tube, a massive air leakage from the chest drain continued, and a serial chest roentgenogram showed progressive lung collapse. The patient therefore underwent an emergency thoracotomy. It was found that the wound penetrated through a middle lobe to the surface of an upper lobe of the right lung. A right middle lobe tractotomy was performed, and the patient's postoperative course was uneventful. Selected patients can be rescued without resection of a massive amount of lung tissue.