Surgical Case Reports最新文献

{"title":"A Case of Induction Chemoimmunotherapy and Sleeve Lobectomy to Avoid Pneumonectomy for Central Squamous Cell Lung Cancer.","authors":"Ayaka Asakawa, Ryota Ishizawa, Yukitaka Sato, Yuya Ishikawa, Ryo Wakejima, Hironori Ishibashi, Kenichi Okubo","doi":"10.70352/scrj.cr.24-0069","DOIUrl":"10.70352/scrj.cr.24-0069","url":null,"abstract":"<p><strong>Introduction: </strong>Recently, neoadjuvant immunotherapy plus chemotherapy has been provided for patients with stage II-III resectable lung cancer. We report a case in which a pneumonectomy was avoided by administrating neoadjuvant chemoimmunotherapy.</p><p><strong>Case presentation: </strong>An 81-year-old man presented with a cough. Examination showed squamous cell lung cancer in the right lower lobe extending to the central side of the upper lobe, which would have required a pneumonectomy for complete resection. Neoadjuvant chemoimmunotherapy was administered to reduce the extent of pulmonary resection due to the patient's advanced age and impaired pulmonary function. Post-treatment examination showed tumor size reduction, and bronchoscopy showed disappearance of right upper bronchial erythema and persistent erythema of the bronchus intermedius. A sleeve right lower lobectomy was performed. Histopathological findings revealed complete resection of the cancerous lesion and a major pathological response.</p><p><strong>Conclusions: </strong>Sleeve lobectomy after preoperative chemoimmunotherapy for an elder patient with low pulmonary function was safe and efficient.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879256/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Survival after Treatment with Induction Therapy and Surgery for Mediastinal Carcinoma of Unknown Primary.","authors":"Yasushi Sakamaki, Naoya Takada, Yuya Kogita, Nanami Hiraiwa","doi":"10.70352/scrj.cr.24-0011","DOIUrl":"10.70352/scrj.cr.24-0011","url":null,"abstract":"<p><strong>Introduction: </strong>Carcinoma of unknown primary (CUP) is rarely located in the mediastinum. Most cases are revealed to be metastatic lymph node carcinoma, which carries a poor prognosis. The optimal treatment for CUP confined to the mediastinum is yet to be established, and the long-term outcome of induction therapy in combination with surgery for mediastinal CUP is unclear.</p><p><strong>Case presentation: </strong>A 46-year-old man with no history of malignancy was diagnosed with anterior mediastinal adenocarcinoma through biopsy. The patient underwent chemoradiation for the tumor, which was initially suspected as invasive T4 lung cancer. After a favorable response to presurgical therapy, the tumor was deemed more likely a mediastinal tumor, and it was completely resected simultaneously with the thymus, the partial left lung, and the partial left innominate vein. The tumor contained histologic features identifiable as a lymph node tissue and lacked any thymic tissue, which led to the final diagnosis as metastatic lymph node adenocarcinoma; however, its origin was unknown. No signs of recurrence were detected for 13 years after surgery.</p><p><strong>Conclusions: </strong>Our case suggests that even patients with mediastinal CUP deemed an advanced disease can achieve long-term survival after undergoing induction therapy and definitive surgery.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11867736/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Usefulness of Intraoperative Indocyanine Green Fluorescence Imaging in Surgical Treatment of Refractory Chylothorax in Pediatric Patients: A Case Report.","authors":"Kanji Ishizu, Kanta Araki, Koji Kagisaki, Hideto Ozawa","doi":"10.70352/scrj.cr.24-0112","DOIUrl":"10.70352/scrj.cr.24-0112","url":null,"abstract":"<p><strong>Introduction: </strong>Chylothorax is one of the complications in cardiovascular surgery. Although prolonged chylothorax leads to critical status and is associated with high mortality, its treatment has not been well established. We present a successful case of surgical treatment of chylothorax in a neonate using indocyanine green to identify the site of lymphatic leakage.</p><p><strong>Case presentation: </strong>The patient with complete atrioventricular septal defect, patent ductus arteriosus, pulmonary hypertension, and chromosomal abnormality with trisomy 21 underwent pulmonary artery banding and patent ductus arteriosus ligation through median sternotomy. The postoperative course was complicated with chylothorax; conservative treatment was not effective, so surgical treatment was selected. Indocyanine green was injected subcutaneously between the first and second toes on the left side 30 min before surgery to identify the site of leakage. We could detect the lymphatic leakage from the para-aortic lymph node by indocyanine green camera in the left thoracic cavity, and the leakage sites could be closed with interrupted sutures.</p><p><strong>Conclusion: </strong>Identification of lymphatic leakage sites using indocyanine green could be an effective technique in the surgical treatment of chylothorax in pediatric patients.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11850031/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143493538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Unique Case of Intra-Abdominal Diffuse Lymphangiomatosis Mimicking a Pseudomyxoma Peritonei.","authors":"Andreas R R Weiss, Georg F Weber, Maximilian Brunner, Robert Grützmann, Abbas Agaimy, Christian Krautz","doi":"10.70352/scrj.cr.24-0037","DOIUrl":"10.70352/scrj.cr.24-0037","url":null,"abstract":"<p><strong>Introduction: </strong>Localized cystic lymphangiomas (CL) are rare benign tumors deriving from the lymphatic system. CL is diagnosed more frequently in children than in the adult population and, although commonly affecting the cervical and axillary regions, can develop in various parts of the body. Abdominal cystic lymphangioma (ACL) comprises less than 5% of all CL cases.</p><p><strong>Case presentation: </strong>A 35-year-old female patient with a history of benign appendectomy in childhood was transferred to our tertiary center for the operative management of a suspected extensive pseudomyxoma peritonei (PMP). In accordance with the multidisciplinary team discussion, cytoreductive surgery with hyperthermic intraperitoneal chemotherapy was planned. Intraoperatively, a typical \"jelly belly\" with high disease burden throughout the abdominal cavity and the small pelvis was found. A multi-visceral resection with complete cytoreduction (CCR 0) was performed. The postoperative histopathological findings revealed a diffuse, partially cystic lymphangiomatosis involving the peritoneum extensively without evidence of PMP or malignancy.</p><p><strong>Conclusions: </strong>ACLs are uncommon in the adult population, and diffuse peritoneal involvement is even rarer. Surgical management with complete resection is the preferred treatment option. Other benign cysts, as well as infectious diseases and malignancy, should be considered during the preoperative workup.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11865471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longitudinal Pancreatojejunostomy for Pancreaticodigestive Reconstruction in the Resection of Pancreatic Head Malignancy with Chronic Pancreatitis: A Case Report.","authors":"Hironori Hayashi, Yuichiro Furutani, Hiroaki Sugita, Kei Sugano, Takahiro Yoshimura, Tetsuro Oda, Daisuke Fujimori, Koichiro Sawada, Masanori Kotake, Kaeko Oyama, Shintaro Yagi, Takuo Hara","doi":"10.70352/scrj.cr.24-0015","DOIUrl":"10.70352/scrj.cr.24-0015","url":null,"abstract":"<p><strong>Introduction: </strong>With progress in pancreatic surgery, a preservation of residual organ function has become more important. Pancreatic malignancies are occasionally accompanied by chronic pancreatitis (CP) and pancreatolithiasis (PL). Longitudinal pancreatojejunostomy (LPJ) is reportedly a useful method of surgical management in cases of CP with PL. We describe a patient with pancreatic head intraductal papillary mucinous carcinoma (IPMC) concomitant with PL, who underwent subtotal stomach-preserving pancreaticoduodenectomy (SSPPD) and LPJ for reconstruction.</p><p><strong>Case presentation: </strong>A man in his 70s was referred to our hospital with a pancreatic head tumor. He had been treated for CP, diabetes mellitus, and chronic kidney disease. Imaging revealed a cystic pancreatic head tumor with a solid component that was histologically confirmed as IPMC. In addition, multiple calcifications suggestive of PL were observed in the pancreatic body and tail. SSPPD and LPJ were performed to excise the PL as much as possible and preserve the residual pancreatic function. The postoperative course was uneventful, and no abdominal symptoms or tumor recurrences were observed for approximately 8 months after surgery.</p><p><strong>Conclusion: </strong>This patient with IPMC with residual pancreatic PL was treated with SSPPD and LPJ to maximize the residual pancreatic function and reduce the occurrence of postoperative pancreatitis.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11905986/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Acute Pancreatitis after Pancreatectomy in Grade C Leading to Walled-Off Necrosis Successfully Treated with Necrosectomy by Retroperitoneal Approach.","authors":"Makoto Shinohara, Masakazu Hashimoto, Ryo Nagao, Michinori Hamaoka, Masashi Miguchi, Nobuaki Fujikuni, Satoshi Ikeda, Yasuhiro Matsugu, Hideki Nakahara","doi":"10.70352/scrj.cr.24-0002","DOIUrl":"https://doi.org/10.70352/scrj.cr.24-0002","url":null,"abstract":"<p><strong>Introduction: </strong>Grade B or C post-pancreatectomy acute pancreatitis (PPAP) is associated with a higher incidence of postoperative complications and mortality. The reason for this is the activation of proteolytic processes that can lead to pancreatic destruction and the activation of systemic reactions that can have adverse consequences such as systemic inflammatory response syndrome, sepsis, and death. We report a case of a patient with Grade C PPAP with walled-off necrosis (WON) who was successfully treated with necrosectomy using a step-up approach.</p><p><strong>Case presentation: </strong>A 73-year-old man was referred to our hospital with elevated biliary enzymes. Results of blood tests, computed tomography (CT), and magnetic resonance imaging led to the diagnosis of distal bile duct cancer. He underwent a pyloric ring-sparing pancreaticoduodenectomy with lymph node dissection. Postoperative P-AMY (pancreatic amylase) was high at 1766 U/L, and contrast-enhanced CT showed increased density of peripancreatic fatty tissue and fluid accumulation on the pancreatic resection surface, leading to the diagnosis of postoperative pancreatitis and pancreatic fistula. On postoperative day (POD) 9, continuous washing with saline solution was started through the drain at the pancreatic anastomosis. Contrast-enhanced CT showed increased fluid retention in the pancreatic body tail. On POD 43, endoscopic ultrasonography drainage was performed for pancreatic necrosis encapsulated in the retroperitoneum; however, the patient self-extracted the drainage tube. On POD 50, CT-guided drainage was performed for a retroperitoneal subcapsular abscess. On POD 69, the patient underwent necrotomy with guided retroperitoneal drainage, a drain was inserted, and continuous flushing was performed. On POD 76, fecal discharge was observed from the drain, and drainage and enterography were performed; a fistula with the colon was confirmed, and an ileal bifurcation colostomy was performed on the same day. On PODs 83, 85, and 100, endoscopic necrotomy was performed through a retroperitoneal incision wound because a contrast-enhanced CT showed a residual abscess on the gastric dorsum. The patient's general condition improved, and his inflammatory response also improved. On POD 139, the patient was transferred for rehabilitation.</p><p><strong>Conclusion: </strong>We describe a case of successful postoperative nutritional management and necrosectomy for Grade C PPAP leading to WON.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11868872/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reconstruction of a Complex Posterior Tracheal Wall Defect via Transtracheal Running Suture and Pedicled Pectoralis Major Muscle Flap.","authors":"Tomoyuki Nakagiri, Alaa Selman, Tobias Goecke, Hayan Merhej, Akylbek Saipbaev, Arjang Ruhparwar, Patrick Zardo","doi":"10.70352/scrj.cr.24-0009","DOIUrl":"10.70352/scrj.cr.24-0009","url":null,"abstract":"<p><strong>Introduction: </strong>A tracheal membranous injury is a known complication of tracheostomy. After esophageal resection, such injury may prove fatal. No natural buttressing of the lesion occurs, and severe sepsis and mediastinitis may occur. In these situations, a circumferential tracheal resection is the treatment of choice, sometimes on cardiopulmonary bypass. However, the outcome is not always favorable.</p><p><strong>Case presentation: </strong>We report a case of a long tracheal membranous wall defect (> 7cm) after esophageal resection. We successfully performed a transtracheal direct repair of the defect through a partial sternotomy, and reconstructed the ventrolateral wall with a muscle flap using the right pectoralis major muscle.</p><p><strong>Conclusion: </strong>Tracheal reconstruction through a T-shaped incision and anastomotic buttressing using a pectoralis major muscle flap could prove to be useful when reconstructing a posterior tracheal wall injury, especially after esophageal resection.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11850052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143493532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Laparoscopic Resection of Gastric Cancer Using Novel Laparoscopic Fluorescence Spectrum System and Near-Infrared Fluorescent Clips.","authors":"Shion Uemura, Yuma Ebihara, Kazuya Konishi, Satoshi Hirano","doi":"10.70352/scrj.cr.24-0028","DOIUrl":"10.70352/scrj.cr.24-0028","url":null,"abstract":"<p><strong>Introduction: </strong>In laparoscopic gastrectomy, accurate marking of the lesion site is essential in determining the resection line of the stomach, owing to the lack of haptics and the direct link between negative pathological margins and prognosis. Intraoperative endoscopy may require personnel and prolong the operation time, whereas preoperative endoscopic tattooing using India ink faces problems related to the spread of ink and visibility. ZEOCLIP FS (Zeon Medical, Tokyo, Japan) is a clip made of fluorescent resin, covered by insurance since March 2019. It can be visualized from the serosal side using a near-infrared scope; however, its weak fluorescence intensity often poses viewing difficulties. Lumifinder (ADVANTEST, Tokyo, Japan) is a laparoscopic fluorescence spectrum system available for clinical use since February 2023. It can measure fluorescence intensity using a near-infrared laser and detect weak fluorescent signals. We report a case of gastric cancer in which the location of the lesion was confirmed intraoperatively using ZEOCLIP FS and Lumifinder.</p><p><strong>Case presentation: </strong>A man in his 80s was diagnosed with gastric cancer following an examination for anemia. Two lesions were found: a 0-IIc type (cT1) at the lesser curvature of the gastric angle and a type 1 tumor (cT2) at the anterior wall of the upper gastric body. The preoperative assessment indicated no lymph node or distant metastasis. The tumor was diagnosed as cStage I and laparoscopic distal gastrectomy was planned. Two ZEOCLIP FS clips were placed on the oral side of the tumor on the anterior wall of the upper gastric body on the day before surgery. During surgery, fluorescent signals from the clips were detected using Lumifinder, enabling easy confirmation of the lesion location and determination of the gastric resection line.</p><p><strong>Conclusions: </strong>The combined use of ZEOCLIP FS and Lumifinder was a useful new method for identifying the appropriate resection line of the stomach. We plan to evaluate this method further in additional cases to enhance the detection efficacy.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11842931/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic Segmentectomy in a Patient with a Displaced Left Upper Division Bronchus and Fused Fissure.","authors":"Hironobu Wada, Ryo Karita, Yuki Hirai, Yuki Onozato, Toshiko Kamata, Hajime Tamura, Takashi Anayama, Ichiro Yoshino, Shigetoshi Yoshida","doi":"10.70352/scrj.cr.25-0039","DOIUrl":"10.70352/scrj.cr.25-0039","url":null,"abstract":"<p><strong>Introduction: </strong>In thoracic surgery, anatomical anomalies and a fused fissure can cause inaccurate intraoperative recognition of anatomy and lead to accidental injury of pulmonary vessels and bronchi that should be preserved. A displaced left upper division bronchus (B¹⁺²⁺³), also known as a left eparterial bronchus, is a rare anomaly that can present in combination with abnormal pulmonary arteries positioning and lobulation. Herein, we report a case of lung cancer in S¹⁺² of the left fused lung that was successfully resected by robotic left upper division segmentectomy following a detailed preoperative simulation using 3-dimensional computed tomography.</p><p><strong>Case presentation: </strong>A female octogenarian presented for the treatment of simultaneous bilateral lung cancer. Three months after surgery for right lung cancer, a surgery for left lung cancer was performed. Preoperative computed tomography identified several broncho-arterial anomalies and a completely fused fissure, including a displaced left upper division bronchus and a pulmonary artery running anteriorly to the left main bronchus, similar to those in the right lung. Robotic left upper division segmentectomy with lymph node dissection was performed using a \"hilum first, fissure last\" approach with fine dissection of the hilar structures and minimal bleeding. The postoperative course was uneventful.</p><p><strong>Conclusions: </strong>Preoperative simulation and robotic-assisted thoracoscopic surgery enabled the safe and precise anatomical pulmonary segmentectomy for a patient with lung cancer, despite several bronchial and arterial anomalies, including a displaced left upper division bronchus.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11949726/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Confronting Upside-Down Video-Assisted Thoracic Surgery Approach for Hemorrhagic Bronchogenic Cyst Manifested by Sudden Back Pain.","authors":"Masato Kambe, Tomonari Oki, Shuhei Iizuka, Yoshiro Otsuki, Toru Nakamura","doi":"10.70352/scrj.cr.24-0126","DOIUrl":"10.70352/scrj.cr.24-0126","url":null,"abstract":"<p><strong>Introduction: </strong>Bronchogenic cysts, arising from an aberrant bronchial primordium inclusion during the fetal period, are typically located in the mediastinum but can develop in ectopic regions. While generally asymptomatic, these cysts may become symptomatic due to infection or, rarely, hemorrhage. This report details a case of a hemorrhagic bronchogenic cyst in the supradiaphragmatic region, successfully resected using video-assisted thoracic surgery (VATS) with a confronting upside-down monitor setting.</p><p><strong>Case presentation: </strong>An 18-year-old female presented with a fever and sudden left-sided back pain. Blood tests revealed leukocytosis and an elevated C-reactive protein. Imaging studies identified a well-circumscribed cyst along the left diaphragm, suspected to be an infected bronchogenic cyst. Magnetic resonance imaging 2 days later indicated disease progression with concomitant empyema, prompting emergency surgery. Using the confronting upside-down monitor setting, the cyst was resected. Thoracoscopic findings revealed a dark red cyst and bloody pleural effusion. The surgery was uneventful, and the patient was discharged on postoperative day 2. Bacterial cultures of the pleural effusion and cystic content were negative, and histopathological analysis confirmed the diagnosis of a hemorrhagic bronchogenic cyst.</p><p><strong>Conclusions: </strong>Hemorrhagic bronchogenic cysts should be considered in the differential diagnosis of intrathoracic cysts presenting with sudden pain. Upfront surgery is recommended for symptomatic bronchogenic cysts, irrespective of the location or etiology. VATS via the confronting upside-down monitor setting is the feasible option alongside the conventional approach.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11861584/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143516781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}