Left atrial thrombus without mitral disease; report of a case

A 76-year-old man was admitted to our hospital because of surgical treatment for mass in the left atrium(LA). Echocardiography and computed tomography(CT) revealed mobile mass in LA which had stalk at the left atrial appendage. It was difficult to distinguish myxoma from thrombus. LA mass has risk of sudden circulatory collapse and systemic emboli, so it is indicated for emergent operation. Mass resection with appendage was performed through the transseptal superior incision using cardiopulmonary bypass. Pathological diagnosis was thrombus. Most of LA thrombus were complicated with mitral stenosis, LA thrombus without mitral disease is rare. A few authors reported the useful of CT and echocardiography, but we could not lead to precise diagnosis from preoperative image.     

Left atrial appendage occlusion device-related thrombus: a case report and review of the literature

A 75-year-old male with persistent atrial fibrillation underwent implantation of a left atrial occlusion device. After 6?weeks, a scheduled trans-esophageal echocardiogram showed a 1.1-cm?×?1.1-cm mass within the occluded left atrial appendage, suspected to be thrombus. He was continued on warfarin for an additional 6?weeks and a repeat trans-esophageal echocardiogram showed obliteration of the left atrial appendage. This report describes an uncommon observation detected at scheduled follow up by trans-esophageal echocardiogram, which sheds some light on the mechanism by which this device ??matures?? after it is implanted inside the left atrial appendage.     

Tubular adenoma of the breast in an 84-year-old woman: report of a case simulating breast cancer

Tubular adenomas of the breast are rare and they mainly occur in young women. They must be differentiated from other benign lesions and from malignant breast cancer. Preoperative diagnosis is difficult because both radiologic and cytohistologic examinations performed before surgery are often not diagnostic; therefore, in most cases, surgical excision is the only way to reach a precise diagnosis and a definitive treatment. This article describes a case of an 84-year-old woman suffering from tubular adenoma of the breast. The authors underline the difficulty in preoperative differentiation between benign and malignant breast lesions.     

Left atrial thrombus without mitral valve disease in a patient with nephrotic syndrome: report of a case

Left atrial (LA) thrombi are rarely seen in patients without mitral valve disease. We report the case of a 71-year-old man found to have a large LA thrombus without mitral valve disease. The patient also suffered from atrial fibrillation and nephrotic syndrome (NS), and had a history of transient ischemic attack. Transesophageal echocardiography showed an LA thrombus attached to the LA wall, and a normal mitral valve. Blood chemistry revealed a total serum protein of 4.6 g/dl, with 2.0 g/dl of albumin and a total cholesterol level of 453 mg/dl. The plasma fibrinogen level was 366 mg/dl and the antithrombin III was 103%. An emergency operation was performed to remove the LA thrombus and a normal mitral valve was confirmed. We believe that several factors, including changes in coagulability related to the NS, steroid therapy, and diuretics, in addition to the dilated LA with atrial fibrillation, may have caused the LA thrombus formation in this patient. Received: December 21, 2001 / Accepted: May 7, 2002 Reprint request to: S. Aoyagi     

Procidentia: a reversible cause of hydronephrosis in an 80-year-old woman

We describe an unusual presentation of hydronephrosis in an 80-year-old woman who was managed conservatively after transfer to a specialist unit. This case highlights the role of accurate history taking and a focused physical examination in elderly female patients presenting with renal failure and hydronephrosis.     

Bentall operation for a 90-year-old man with root aneurysm; report of a case

Open heart surgery in nonagenarians is not common. We reported a successful Bentall operation in a 90-year-old man with aortic root aneurysm and aortic regurgitation. He has lived healthfully and independently without a big problem. He was referred to our hospital for acute heart failure. The aortic root enlarged as a diameter of 60 mm and moderate aortic regurgitation were recognized by echocardiography and aortogram. We excised the aneurysm, implanted a composite graft, directly attached the coronary arteries to the aortic graft (Carrel patch technique), and made the distal anastomosis to the divided aorta. Postoperative course was uneventful. To our knowledge, this is the first successful case of Bentall operation for nonagenarians in Japan. If selective criteria identifying risks and benefits for individual patients is applied, the nonagenarian can safely undergo cardiac surgery.     

Total aortic arch replacement for aortic arch aneurysm in a 90-year-old woman; report of a case

A 90-year-old woman was transferred to our hospital because of severe chest and back pain. Chest computed tomography (CT) scan showed impending rupture of the true aneurysm of the aortic arch. Emergent operation was performed under deep hypothermia and retrograde cerebral perfusion through median sternotomy. Ascending and transverse aorta were totally replaced with arch graft with 4 branches using the arch vessels first technique. Postoperative course was uneventful expect for urinary tract infection. She discharged from our hospital 76 days after the operation and is now doing well.     

Left ventricular-right atrial communication detected by pregnancy; report of a operative case

A 24-year-old pregnant female was admitted to our hospital because of congestive heart failure. When she was 3 month old, she underwent closure of patent ductus arteriosus. Echocardiography, cardiac catheterization and selective angiocardiography showed a left ventricular-right atrial shunt. At the operation, we found a left ventricular right-atrial communication (group I) and repaired the defect directly. The patient was discharged and returned to her social life.     

Radiofrequency modified maze operation for chronic atrial fibrillation with ASD; report of a case

A 61-year-old man with congestive heart failure was referred to our hospital and diagnosed as atrial septal defect (ASD) [Qp/Qs = 1.6] with chronic atrial fibrillation. Occurrence of atrial fibrillation was supposed to be the cause of heart failure rather than L-R shunt of ASD. The patient was successfully operated on with the use of routine cardiopulmonary bypass. Radiofrequency modified maze procedure was done, and then small ASD (1 cm of diameter) was closed with patch. Postoperative transthoracic Doppler echocardiography confirmed clear A wave for transmitral and transtricuspid flow. The patient recovered uneventfully and was discharged in stable sinus rhythm and has been drug free since then.     

Curative resection of hilar cholangiocarcinoma in a 25-year-old woman: report of a case

A 25-year-old woman was referred to our hospital with persistent upper abdominal pain. Preoperative imaging studies revealed a hilar bile duct stricture with portal venous encasement, and the patient underwent curative resection involving extended left hepatectomy and segmental portal vein resection. The pathological findings demonstrated a well-differentiated tubular adenocarcinoma of the bile duct with regional lymph node metastasis (stage IIIB according to the UICC TNM classification), as well as the overexpression of p53 proteins and the K-ras gene mutation in tumor cells. The patient has shown no evidence of recurrence in the 10 months since the operation. Although there are several reports of relatively young adults with cholangiocarcinoma, the majority of such patients demonstrate either an anomalous arrangement of the pancreaticobiliary duct system or primary sclerosing cholangitis. The absence of any morphological abnormalities in this patient’s biliary system implicates de novo carcinogenesis as the most likely cause of the cholangiocarcinoma.     

Solid pseudopapillary tumor of the pancreas in a 39-year-old woman: case report

Solid pseudopapillary tumor (SPT) is a rare pancreatic tumor with low malignancy, constituting 1-2% of exocrine pancreatic tumors, occurring mostly in young women. SPT, despite the achievement of large size gives scant clinical symptoms. The authors present the case of 39-year-old woman with SPT, diagnosed at intraoperative biopsy. The aim of this study is to describe the clinicopathological feature, diagnosis and surgical treatment of SPT.     

Pulmonary benign metastasizing leiomyoma from the uterus in a postmenopausal woman: report of a case

Benign Metastatic Leiomyoma (BML) is a disease that stems from pulmonary smooth muscles and it is generally observed in multiple locations, including uterine leiomyomas. Apart from lungs it has been reported in lymph nodes, peritoneum, myocardium, eye, brain and spinal cord. We report a case of pulmonary BML from the uterus in a 50-year-old woman. Multiple nodules were identified in the lung fields by computed chest tomography of the patient, who presented with hemoptysis for 2 months. Endobronchial lesion was not observed by bronchoscopy. Cytopathological and immunocytochemical results confirmed the diagnosis of leiomyoma after the exploratory thoractomy. She had undergone hysterectomy with oophorectomy for uterine leiomyoma 5 years earlier, at the age of 45. Primary origin was from the uterus because hysterectomy and oophorectomy were performed 5 years ago for the leiomyoma. We present this case because it is a rare entity.     

Larrey hernia complicated with colonic obstruction in a 77-year-old woman: a case report

Congenital Larrey hernia has a rare incidence and is frequently diagnosed in the later decades of life. This case study presents a 77-year-old woman with Larrey hernia and an intestinal obstruction complication, treated with laparatomic surgery.     

A case report of coronary artery bypass surgery (3-SVG) in 80-year-old woman with acute respiratory failure

A successful operation for a patient of unstable angina with hypoxia is reported. A 80-year-old woman was admitted with severe chest oppression. The selective coronary angiogram revealed 3-vessel disease. Symptoms were uncontrolled by medical therapy. Aorto-coronary bypass surgery (with 3-saphenous vein grafts) was followed by excellent post-operative course. The patient has been asymptomatic for more than 1 year after operation.     

Left atrial myxoma in a 16-year-old girl following acute myocardial infarction--a case report and a review of 17 cases in the world

A 16-year-old girl had clinical signs of an acute myocardial infarction. Echocardiography revealed left atrial myxoma and coronary angiography demonstrated a complete obstructive lesion at LAD. Coronary arterial embolization from myxoma was strongly suggested. The tumor was removed successfully 32 days after acute coronary embolization. Coronary embolization from left atrial myxoma is extremely rare. There are only 17 reports in the world and we reviewed these reports.     

Lung cancer associated with bulla found during an operation of pneumothorax; report of a case

A 50-year-old man was admitted to our hospital because of dyspnea. His chest X-ray and computed tomography (CT) showed right pneumothorax and multiple bullae. His pneumothorax was drained with a chest tube, however, because of a persistent air leak, bullectomy was performed 18 days after the occurrence of pneumothorax. Intraoperatively, we found a palpable tumor in the bulla approximately 10 mm in diameter and resected it with the bullae. Histologically, the tumor was diagnosed as a large cell carcinoma.