Surgical repair of an idiopathic pulmonary artery aneurysm

We report a rare case of idiopathic pulmonary artery aneurysm (PAA) in a 56-year-old woman without any causative conditions, such as congenital heart disease, inflammation, pulmonary artery hypertension, or systemic vasculitis. She presented with sudden back pain, and examination revealed the PAA. She electively underwent resection of the aneurysm and graft replacement. Pathology examination revealed cystic medial necrosis, which was considered the underlying pathology of the aneurysm.     

Pulmonary dirofilariasis resected by video-assisted thoracoscopy; report of a case

A 35-year-old female was admitted for biopsy of abnormal shadow on chest X-ray. She was operated on for partial wedge resection of the right lower lobe by video-assisted thoracoscopy without complication. Pathological findings in operation showed inflammatory benign tissues and suggested pulmonary dirofilariasis. Serologic examination was negative after operation, however histological diagnosis supported pulmonary dirofilariasis because a pulmonary artery embolism of calcified tissues consisted of non-human cells. There may be many cases due to old infections like this one, so it is important to consider it for diagnosis and perform more positive surgical procedures. We review a case of pulmonary dirofilariasis safely resected by video-assisted thoracoscopy for diagnosis by exclusion.     

Abdominal aortic aneurysm in a 3-year-old child: a case report and review of the Japanese-language literature

A case of abdominal aortic aneurysm associated with renovascular hypertension in a 3-year-old boy is reported. The child was treated by resection of the aneurysm and replacement with a 12 mm polyester (Dacron) bifurcated graft. The cause of the aneurysm was not revealed by clinical and pathologic examination. In addition to the case report, the Japanese-language literature is reviewed. The most frequently reported etiologic factor was Kawasaki disease; we could not find any evidence of connective-tissue disorder as a cause for abdominal aortic aneurysms occurring in children.     

A case of localized nodular pulmonary amyloidosis diagnosed by video-assisted thoracoscopic surgery

Pulmonary amyloidosis is a rare pulmonary lesion. We report a 42-year-old male admitted for further evaluation of abnormal chest shadow. A chest CT demonstrated a nodular shadow in right S3. We tried transbronchial and percutaneous lung biopsy, but could not diagnose. We performed partial lung resection by video-assisted thoracoscopic surgery. Pathological diagnosis of the lesion was pulmonary amyloidosis. Immunohistochemical examination revealed this amyloid composed of AL kappa protein. No clinical evidence of amyloid deposits were found in other organs. We finally diagnosed this case as a localized nodular pulmonary amyloidosis.     

Mitral regurgitation with concomitant atrial septal aneurysm; report of a case

A 64-year-old female was admitted to our hospital because of severe dyspnea. Echocardiography revealed mitral valve regurgitation and atrial septal aneurysm (ASA). After instituting medical treatment for congestive heart failure, euvolemic status was achieved, and the patient underwent; (1) prosthetic patch repair for ASA; (2) mitral valvuloplasty with partial quadrangular resection of the posterior mitral leaflet; and (3) mitral annuloplasty using Physio ring. Pathological examination revealed myxomatous degeneration of the mitral valve, but the resected atrial septum was without any abnormality. ASA can lead to cerebral or pulmonary embolism even in the absence of an atrial septal defect. However, ASA without atrial septal defect is typically asymptomatic and rarely requires surgical correction. By contrast, ASA with concomitant mitral valve prolapse is associated with a high risk of cerebral or pulmonary embolism. Aspirin therapy is indicated for the prevention of thromboembolism in patients with ASA who do not undergo surgical management, and these patients also require careful observation.     

Neurofibromatosis associated with renovascular hypertension due to stenosis and aneurysm of the left renal segmental artery: report of a case

We report a case of renovascular hypertension due to renal segmental artery stenosis and aneurysm seen in a 16-year-old boy with neurofibromatosis. Hypertension was successfully treated with partial nephrectomy. Histopathologic examination disclosed proliferation of arterial intima not only in the stenotic portion and the aneurysm but also in intralobular arteries of the kidney. Review of the literature revealed that treatment for such patients has varied.     

Mycotic aneurysm of the left subclavian artery presented with hemoptysis in an immunosuppressed man: Case report and review of literature

We report the case of a 32-year-old man with a mycotic aneurysm of the left subclavian artery. This patient had immunosuppression caused by chemotherapy administered for treatment of leukemia. This aneurysm was revealed by two episodes of hemoptysis caused by a lung parenchyma fistulization. The patient was treated successfully by simple ligation and exclusion via a thoracotomy with partial lung resection. Histologic examination confirmed the presence of aspergilloma filaments in the false aneurysm. We suspect that aspergilloma could have been the cause of the mycotic aneurysm in this particular case. The literature on subclavian artery mycotic aneurysms is reviewed. (J VASC SURG 1995;21:697-702.)     

Interesting pulmonary metastasis from spindle cell carcinoma of the breast

We experienced a case of interesting pulmonary metastasis from spindle cell carcinoma of the breast. A 68-year-old female who had undergone a radical mastectomy 32 months earlier was admitted to our hospital for the pulmonary tumor in the left S10 in January 2005. Pathological study of the breast tumor revealed mixture of carcinomatous portion and sarcomatoid portion with spindle cells. Because of the presence of transitional areas from one portion to the other, the tumor was diagnosed as spindle cell carcinoma of the breast. Partial resection of the left lower lobe was performed. Pathological examination of the pulmonary tumor revealed that the tumor was composed of the component similar to carcinomatous element of the breast cancer. In June 2005, She was admitted to our hospital again for the pulmonary tumor in the right S7. Partial resection of the right lower lobe was performed. The tumor was composed of both carcinomatous and sarcomatoid elements. After operation, as she complained of epigastralgia, a gastroscopic examination was performed. It showed 2 white polypi of the stomach. The biopsy specimen of the polypi were composed of the tumor similar to the sarcomatoid element of the breast cancer. She died of widespread metastasis 43 months after mastectomy.     

Ureteral stenosis secondary to common iliac aneurysm: a case report and review of the literature in Japan

A case of right ureteral obstruction secondary to right common iliac aneurysm presenting as right hydronephrosis is reported and the literature is reviewed. A 66-year-old man was admitted to our hospital with lower abdominal pain and was treated by bypass operation with artificial vessel and uretero-ureterostomy of right ureter under the diagnosis of right ureteral stenosis secondary to right iliac aneurysm. Histological examination showed arteriosclerotic aneurysm and a fibrillary inflammatory change in peri-ureteral tissue without any hemosiderin-laden macrophages. Intravenous pyelography showed improvement of right hydronephrosis 45 days after operation. To date 11 cases including our case have been reported in Japan, 10 in males and the other in a female. Initial symptoms were either lumbago or an abdominal mass with palpitation in many cases. The treatment was by resection of aneurysm with bypass grafting or ureterolysis.     

A surgical case of methotrexate-associated lymphomatoid granuloma

We reported a surgical case of methotrexate-associated lymphomatoid granuloma. A 69-year-old female had been treated with methotrexate for rheumatoid arthritis for 35 months. The patient underwent partial resection of the right upper pulmonary lobe for lung cancer when she was 67 years old. A nodule was detected in the left lung field on a chest radiograph performed during the postoperative follow-up period. Computed tomography revealed a 28-mm nodule in the lower left pulmonary lobe. A transbronchial biopsy examination did not lead to a diagnosis. The pulmonary nodule subsequently increased in size. We suspected a malignant tumor and performed lower left lobectomy. A pathological examination revealed lymphomatoid granuloma. Finally, the patient was diagnosed with methotrexate-associated lymphomatoid granuloma based on her history of oral methotrexate treatment.     

A case of tuberculous aneurysm of the descending thoracic aorta

A case of a 55-year-old female with tuberculous false aneurysm of the descending aorta is reported. She was admitted to our hospital on February, 1989 with hemoptysis and lumbago. Active pulmonary tuberculosis, caries of the 1st and 2nd abdominal vertebrae, and abnormal left lower mediastinal tumor shadow were confirmed by roentgenogram. Aortography and computer tomography revealed a false aneurysm of the descending aorta. After anti-tuberculous chemotherapy, fist sized false aneurysm was resected and the punch out hole of the descending aorta, 8 mm in diameter was closed successfully using partial extracorporeal circulation. Histologic examination of the aneurysmal wall revealed granulomatous formation containing numerous giant cells. She is doing well, 7 months after surgery.     

Pulmonary pleomorphic carcinoma

Pleomorphic carcinoma is a rare primary pulmonary malignancy. We report 2 surgical cases of pulmonary pleomorphic carcinoma. The first case was a 71-year-old male. Chest computed tomography (CT) showed a rapidly growing tumor with irregular density. Transbronchial lung biopsy revealed the tumor to be malignant. Left lower lobectomy was performed. Pathological diagnosis was pleomorphic carcinoma (pT2N2M0, stage IIIA). He died 8 months after surgery due to brain metastasis and mediastinal lymph node metastasis. The second case was a 74-year-old male who complained of bloody sputum. Chest CT showed a tumor with cavity in the right middle lobe. Brushing cytology under bronchofiberscopy revealed atypical cell. Right middle lobectomy and partial resection of the right lower lobe were performed. Pathological diagnosis was also pleomorphic carcinoma (pT2N0M0, stage IB). He has no findings of recurrence nor metastasis 15 months after the operation.     

Non-tuberculous mycobacterial infection along the staple-suture line after segmentectomy for small peripheral lung cancer; report of a case

A 60-year-old non-immunocompromised man who had undergone right upper lobectomy and subsequent left superior segmentectomy for small peripheral lung cancers (stage I well-differentiated adenocarcinomas) 2 years earlier, was referred to us for further investigation of an asymptomatic abnormal shadow observed on a chest radiograph. Chest computed radiography showed air-space consolidation along the staple-suture line associated with the left superior segmentectomy, the abnormality was 4 x 5 x 5 cm. Completion lower lobectomy was performed because transbronchial biopsy did not provide for a definite diagnosis. Pathological examination revealed a large granuloma infected by Mycobacterium intercellulare. The lung parenchyma may be exposed along the staple-suture line and somewhat vulnerable to infection in cases of partial pulmonary resection. We should be aware of this possibility after lesser pulmonary resection for small peripheral lung cancer.     

A case of large congenital right ventricular outflow aneurysm]

A rare case of large congenital right ventricular outflow aneurysm is reported. A 5-year-old girl had been diagnosed as having atrial septal defect and pulmonary valvular stenosis. A large cavity in front of right ventricular outflow was noticed by her follow-up echocardiography. The non-contracting cavity was confirmed as an aneurysm originating from right ventricular outflow tract by angiocardiogram. Surgical resection was performed successfully with concomitant atrial septal defect closure and pulmonary valvular commissurotomy. Histological examination revealed that the wall of the ventricular outflow aneurysm consisted of dense fibrous tissue, contained no myocardium, and the cavity was lined with endocardium. It is reported that rupture of congenital ventricular aneurysm may occur even if there is no symptom. Surgical resection will be recommended especially when increasing in size is diagnosed.     

A case report of a successful surgical treatment for infective endocarditis involving four valves in a elderly patient with ventricular septal defects

A 72-year-old female was examined because of acute congestive heart failure. Echocardiogram revealed vegetations on aortic and pulmonary valve, regurgitation of four valves, and perimembraneous ventricular septal defect. Aortic valve replacement, mitral valve replacement, repair of tricuspid valve using a Carpentier ring, partial resection of pulmonary valve, and direct closure of VSD was performed. Pathological finding of resected valves showed acute endocarditis. A patient resumed social activities after surgery.     

A case of tracheal neurilemoma

A 54-year-old woman was admitted to our hospital with a complaint of cough and severe exertional dyspnea. Her pulmonary function was remarkably decline, especially forced expiratory volume in 1 second was 410 ml (28.7%). A chest X-ray film showed an abnormal shadow in the right tracheobronchial portion. Chest CT and MRI scans showed a 38 x 46 mm round tumor in the carina involving the lower trachea and right main bronchus. Bronchoscopic examination revealed a submucosal tumor which obstructed the orfice of the right main bronchus. Pathological examination of tissue obtained by open excisional biopsy revealed a benign neurilemoma. Then we performed a tumor extirpation with tracheal partial resection and the defect of tracheobronchial wall was repaired by direct suture. Postoperative course was uneventful and her pulmonary function was improved. The tracheobronchial neurilemomas are rare. In this report we discuss the therapeutic management of a neurilemoma of the trachea on the basis of 12 domestic cases reviewed.     

Late recurrence of cardiac sarcoma presenting as giant pulmonary artery aneurysm

We report the case of a 46-year-old woman who had undergone cardiac transplantation for a malignant, right ventricular sarcoma. Five years later, she experienced pulmonary hypertension and a pulmonary artery aneurysm. Medical management of the pulmonary hypertension being unsuccessful, she underwent surgical exploration of the pulmonary artery aneurysm and bilateral pulmonary endarterectomy. Intra-operative findings revealed pulmonary artery sarcoma and an unresectable pulmonary artery aneurysm.     

A case of primary adenocarcinoma of the female urethra

A 53-year-old female visited our hospital with a complaint of acute urinary retention. Transvaginal ultrasonography, computed tomography and magnetic resonance imaging showed extreme thickening of the urethral wall. Histopathological examination of the transvaginal needle biopsy suggested well-differentiated adenocarcinoma. She underwent total cysto-urethrectomy with partial vaginal wall resection and ileal conduit urinary diversion. Pathological diagnosis of the tumor was columnar adenocarcinoma invading into the vaginal wall and periurethral connective tissue. Fifty-eight cases of primary adenocarcinoma of the female urethra in the Japanease literature are briefly reviewed.     

Aneurysm of the transverse cervical artery occurring in association with a cavernous hemangioma as a complication of Klippel-Trénaunay syndrome: Report of a case

We report herein the case of a 14-year-old girl with Klippel-Trénaunay syndrome who developed an aneurysm of the transverse cervical artery. Because it was continuing to increase in size, with an associated risk of rupture, an aneurysmectomy was performed. Pathological examination of the resected specimen revealed a cavernous hemangioma located near the aneurysm. To our knowledge no other case of an aneurysm occurring in association with a cavernous hemangioma as a complication of Klippel-Trénaunay syndrome has ever been reported.     

The saccular coronary aneurysm associated with coronary artery to pulmonary artery fistulae

Coronary artery fistulae are relatively rare congenital anomalies. Those associated with saccular coronary artery aneurysms are even rarer. Including the current case, only 65 such cases have been reported in Japan. A 62-year-old female was admitted to our hospital for evaluation of abnormal shadow on the chest X-ray. The enhanced chest computed tomography (CT) scan demonstrated a giant saccular coronary aneurysm on the left side of the pulmonary artery. Multi-detector row CT (MDCT) scan demonstrated the coronary artery aneurysm was connected to the left anterior descending artery. Coronary angiography revealed 2 aneurysms with bilateral coronary artery to pulmonary artery fistulae. The patient underwent aneurysmectomy and ligation of fistulae under cardiopulomonary bypass. The postoperative course was uneventful and postoperative coronary angiography revealed complete resection of the aneurysms and only slight blood flow through the fistulae. She was discharged on the 10th postoperative day.