Primary synovial sarcoma of the posterior chest wall

Synovial sarcoma is a malignant soft-tissue tumor that most commonly occurs in the extremities of young adults. Only several cases of synovial sarcomas of the chest wall and pleura had been reported. We present a 24-year-old man who had right back pain, chest pain, dyspnea, and intermittent fever from a huge primary synovial sarcoma of the right posterior chest wall. Multimodality therapies, including surgical resection, and chemotherapy and radiation therapy were applied, but the tumor progressed rapidly and the patient died 6 months after diagnosis. Prompt diagnosis and aggressive surgical resection is mandatory for primary synovial sarcoma of the chest wall because of its aggressive behavior.     

Alternative approach to the surgical management of congenital tracheal stenosis

Congenital tracheal stenosis is a serious disease associated with high operative mortality and morbidity, especially in the newborn period. Its surgical management involves either sliding tracheoplasty, which is associated with extensive dissection and recurrent stenosis, or with pericardial patch tracheoplasty that fails to address recoiling of the stenotic complete ring and collapse of the patch into the tracheal lumen. We report a modification of the latter technique, in which a half ring external stenting device is used to keep the rings from recoiling.     

Aneurysmal bone cyst in the first rib

Aneurysmal bone cyst is a benign tumor of the skeletal system that rarely occurs in ribs. We report two cases of aneurysmal bone cyst in the first rib. The first patient was a 21-year-old woman with an aneurysmal bone cyst in the left first rib that was resected with an L incision. The second patient was a 42-year-old man with an aneurysmal bone cyst in the right first rib that was resected with a posterolateral incision but recurred 1 year later. An en bloc resection was performed, without recurrence to date. We also review this disease with emphasis on the etiology, clinicopathology, and treatment approaches.     

Congenital aneurysm of the left atrial appendage

Aneurysm of the left atrial appendage (LAA) is very infrequent. We present the case of 24-year-old man in functional class I with atrial fibrillation but no other symptoms. Radiology showed an abnormality in the outline of the heart. Echocardiography revealed left appendage aneurysm. After median sternotomy, aneurysmectomy was performed under cardiopulmonary bypass without cross clamping. Atrial fibrillation ceased as soon as the aneurysm had been removed. There were no postoperative complications. Three months later the patient remained asymptomatic and in sinus rhythm.     

Spontaneous restoration of patency in the free gastroepiploic artery graft: the living transplanted vascular system for coronary revascularization

We report an incidence of coronary revascularization with the gastroepiploic artery in which angiography demonstrated patency at 1 month, severe narrowing at 1 year, and restoration of patency associated with progression of proximal coronary disease at 8 years. This report documents the reversibility of the free gastroepiploic artery.     

Mechanical occlusion of the inferior vena cava: an unusual complication after repair of pectus excavatum using the nuss procedure

We describe the case of a 13-year-old girl with a pectus excavatum in whom acute occlusion of the inferior vena cava developed after a nuss repair. In this hemodynamically unstable patient, we evaluated the possibility of a penetrating injury to the thoracic and abdominal structures before confirming the diagnosis of inferior vena cava obstruction with a venogram. Removal of the nuss bar relieved the unexpected problem.