Journal of Chest Surgery最新文献

{"title":"Paragonimiasis Mimicking Malignancy: A Case Report of a Diagnostic Challenge in Pulmonary Nodule Evaluation.","authors":"Ali Ahmad Korairi, Yeong Jeong Jeon","doi":"10.5090/jcs.26.036","DOIUrl":"https://doi.org/10.5090/jcs.26.036","url":null,"abstract":"<p><p>Paragonimiasis is a parasitic infection that can closely mimic lung malignancy on imaging, creating a significant diagnostic challenge. We report the case of a 60-year-old man from South Korea who presented with hemoptysis and was found to have a suspicious pulmonary nodule. Despite antibiotic therapy and serial imaging, the nodule persisted, and the patient subsequently developed a large pleural effusion. Radiologic findings raised concern for malignancy; however, noninvasive diagnostic evaluations were inconclusive. The patient ultimately underwent video-assisted thoracoscopic surgery, which revealed diffuse pleural thickening and numerous parasitic ova. Histopathologic and laboratory findings confirmed paragonimiasis. Following treatment with praziquantel, the patient achieved full clinical recovery. This case illustrates the potential for paragonimiasis to mimic malignancy and underscores the importance of including parasitic infections in the differential diagnosis, particularly in endemic regions. In selected cases, surgical intervention may be required to establish a definitive diagnosis.</p>","PeriodicalId":34499,"journal":{"name":"Journal of Chest Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Favorable Mid-Term Outcome after Coronary Artery Ostioplasty Using a CardioCel Patch for Anomalous Aortic Origin of the Coronary Artery: A Case Report.","authors":"Suhair Shebani, Riyanka Gupta, Saravan Durariraj, Branko Mimic","doi":"10.5090/jcs.26.013","DOIUrl":"https://doi.org/10.5090/jcs.26.013","url":null,"abstract":"<p><p>We report the case of a previously healthy 10-year-old girl who experienced sudden cardiac arrest during a cross-country event. Prompt bystander cardiopulmonary resuscitation was initiated and continued until ambulance arrival. The initial rhythm was polymorphic ventricular tachycardia, which converted to sinus rhythm after cardioversion. Cardiac computed tomography (CT) confirmed anomalous origin of the left main coronary artery from the non-facing sinus, with a slit-like ostium and acute take-off. Coronary artery ostioplasty using a CardioCel patch was performed. Postoperative recovery was excellent; mid-term surveillance with CT, magnetic resonance imaging, Holter monitoring, and stress echocardiography demonstrated a patent left main coronary artery, no evidence of ischemia, and normal cardiac function. This case highlights rapid resuscitation, early recognition, individualized surgical management, and mid-term follow-up in rare coronary artery anomalies. To our knowledge, this is the first reported use of a CardioCel patch in coronary ostioplasty for anomalous aortic origin of the coronary artery.</p>","PeriodicalId":34499,"journal":{"name":"Journal of Chest Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined Wang Procedure and MatrixRIB Reconstruction for Severe Type II Asphyxiating Thoracic Dysplasia: A Case Report.","authors":"Ahmed Gamal Elkhouly, Ayman Fahad Yousef, Wenlin Wang","doi":"10.5090/jcs.26.052","DOIUrl":"https://doi.org/10.5090/jcs.26.052","url":null,"abstract":"<p><p>Asphyxiating thoracic dysplasia (ATD), also known as Jeune syndrome, is a rare, potentially fatal genetic disorder characterized by a constricted thoracic cavity that can lead to respiratory failure. Standard thoracic expansion techniques are often inadequate for severe variants with deep lateral depressions. We report the case of an 11-year-old boy with type II ATD who presented with severe bilateral chest wall depressions and chronic hypoxia. The patient underwent a combined surgical approach using the Wang procedure and MatrixRIB plates. The third through eighth costochondral junctions were resected bilaterally, followed by rigid reconstruction. The postoperative course was uncomplicated, with a marked increase in chest volume and resolution of the chest wall depressions. The patient was weaned from mechanical ventilation and discharged home on postoperative day 25 without supplemental oxygen. At the 3-month follow-up, he remained asymptomatic, with no signs of hypoxia. This case highlights the technical feasibility and potential utility of combined reconstruction techniques for managing type II ATD.</p>","PeriodicalId":34499,"journal":{"name":"Journal of Chest Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extent of Lymphadenectomy in Esophageal Cancer Surgery: Unresolved Issues in Prophylactic 3-Field Dissection.","authors":"Shigeru Tsunoda, Masazumi Sakaguchi, Shintaro Okumura, Shoichi Kitano, Kazutaka Obama","doi":"10.5090/jcs.26.080","DOIUrl":"https://doi.org/10.5090/jcs.26.080","url":null,"abstract":"<p><p>Esophagectomy with regional lymphadenectomy is a central component of treatment for resectable esophageal cancer, particularly esophageal squamous cell carcinoma. Because esophageal cancer can spread longitudinally through the lymphatic system, the optimal extent of lymphadenectomy has long been debated, particularly regarding 2-field lymphadenectomy (2FL) and 3-field lymphadenectomy (3FL). However, historical changes in terminology and inconsistent definitions of these procedures have complicated the interpretation of the available evidence. This review summarizes the historical development of lymphadenectomy in esophageal cancer surgery and current perspectives on its appropriate extent. We highlight the evolving definitions of 2FL and 3FL in the Japanese Classification of Esophageal Cancer and their implications for interpreting previous studies. Previous studies have used inconsistent definitions of 2FL, ranging from limited mediastinal dissection to total mediastinal dissection, which limits the applicability of direct comparisons with 3FL. Under the current definition, 2FL includes cervical paraesophageal lymph node dissection, whereas 3FL essentially involves the additional dissection of the bilateral supraclavicular lymph nodes. Recent evidence, including meta-analyses and large multicenter retrospective studies, has not demonstrated a clear survival benefit of prophylactic 3FL over contemporary 2FL. Given these uncertainties, the current Japanese guidelines weakly recommend 3FL for upper and middle thoracic esophageal cancer. The ongoing randomized phase III JCOG2013 trial is expected to clarify the therapeutic value of prophylactic supraclavicular lymph node dissection. A precise understanding of procedural definitions is essential for interpreting the literature and determining the appropriate extent of lymphadenectomy in esophageal cancer surgery.</p>","PeriodicalId":34499,"journal":{"name":"Journal of Chest Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aseptic Thermochemical Shock after Hyperthermic Intrathoracic Chemotherapy: Pathophysiological Mechanisms and a Translational Framework for Perioperative Management.","authors":"Erlon de Avila Carvalho","doi":"10.5090/jcs.25.160","DOIUrl":"https://doi.org/10.5090/jcs.25.160","url":null,"abstract":"<p><p>Hyperthermic intrathoracic chemotherapy has emerged as a promising locoregional therapy for pleural malignancies. However, the combination of surgical trauma, intrathoracic hyperthermia, and cytotoxic exposure to cisplatin can trigger a complex systemic inflammatory response that resembles septic shock, vasoplegic syndrome, and major burn injury. This review proposes the concept of aseptic-thermochemical shock as a pathophysiological framework for understanding the systemic inflammatory response induced by hyperthermic intrathoracic chemotherapy and outlines a perioperative management protocol that integrates strategies from burn and sepsis care. A narrative review was conducted using PubMed, Scopus, Embase, and LILACS to identify relevant studies on hyperthermic intrathoracic chemotherapy, systemic inflammation, vasoplegic syndrome, and cisplatin nephrotoxicity. Clinical analogies with septic and burn physiology were analyzed to develop a framework for perioperative management. Hyperthermic intrathoracic chemotherapy induces a sterile thermochemical inflammatory response characterized by endothelial dysfunction, vasodilation, capillary leak, and hemodynamic instability. The proposed management strategy includes prophylactic hydration, gastric protection, and nephroprotective agents during the preoperative phase; temperature control, goal-directed fluid therapy, and selective use of methylene blue for refractory vasoplegia during the intraoperative phase; and fluid resuscitation based on modified Parkland-derived principles with hemodynamic optimization guided by Surviving Sepsis Campaign principles during the postoperative phase. These measures are intended to reduce vasoplegic and nephrotoxic complications and improve perioperative outcomes. Hyperthermic intrathoracic chemotherapy can produce a systemic inflammatory response that combines physiological features of major burns, vasoplegic syndrome, and septic shock. The proposed paradigm of \"aseptic-thermochemical shock\" provides a conceptual and practical basis for perioperative management. Adapting selected critical care principles from burn and sepsis medicine may support recovery and survival in patients undergoing thoracic oncological surgery.</p>","PeriodicalId":34499,"journal":{"name":"Journal of Chest Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stepwise Transmural Migration of an Azygos Vein Polymer Locking Clip after Ivor Lewis Esophagectomy: A Case Report.","authors":"Jeongyeon Shin, Youna Sim, Yooyoung Chong","doi":"10.5090/jcs.26.037","DOIUrl":"https://doi.org/10.5090/jcs.26.037","url":null,"abstract":"<p><p>Polymer locking clips are commonly used for azygos vein division during esophagectomy; however, clip-related complications involving the gastric conduit are rarely reported. We report the case of a 71-year-old man who developed dysphagia after Ivor Lewis esophagectomy for cT1N0 squamous cell carcinoma. During surgery, the azygos vein was divided using polymer locking clips, and an esophagogastric anastomosis was created with a 25-mm circular stapler. The early postoperative course was uneventful. At 2 months postoperatively, endoscopy revealed partial extrusion of a clip through the gastric conduit wall, without bleeding or fistula. Endoscopic removal was deferred because the clip remained embedded. At 5 months postoperatively, repeat endoscopy demonstrated complete intraluminal migration of the clip, which was removed endoscopically without immediate adverse events; balloon dilation was then performed for anastomotic narrowing. This case provides longitudinal endoscopic evidence that clip migration may occur as a stepwise transmural process. When partial extrusion is observed, delayed removal with interval monitoring may be safer than immediate traction.</p>","PeriodicalId":34499,"journal":{"name":"Journal of Chest Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tumor Spread through Air Spaces in Early-Stage Lung Adenocarcinoma: Surgical Implications and Patient Management Strategies.","authors":"Jin-Haeng Chung","doi":"10.5090/jcs.26.062","DOIUrl":"10.5090/jcs.26.062","url":null,"abstract":"<p><p>Tumor spread through air spaces (STAS) is a recently recognized, clinically relevant invasive pattern in lung adenocarcinoma with important prognostic implications. Recognition of STAS has influenced ongoing discussions regarding the surgical management of non-small cell lung cancer. The International Association for the Study of Lung Cancer Staging Project recently recommended adopting STAS as a histologic T descriptor in the 9th edition of the tumor-node-metastasis (TNM) classification. Moving beyond its role as a morphological risk factor, recent studies suggest that STAS may serve not only as a prognostic marker but also as a potential indicator of divergent evolutionary trajectories shaped by underlying driver mutations. This review summarizes the morphological definitions of STAS, its observed impact on outcomes after sublobar resection, optimization of surgical margin distance, challenges in intraoperative diagnosis, differential prevalence according to genetic alterations, and proposed integration into the 9th edition of the TNM classification. Potential clinical considerations for risk stratification and patient management based on STAS are also discussed.</p>","PeriodicalId":34499,"journal":{"name":"Journal of Chest Surgery","volume":" ","pages":"150-158"},"PeriodicalIF":1.5,"publicationDate":"2026-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13351376/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148259783","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":"Commentary: Drain Amylase Trend as a Noninvasive Gatekeeper for Oral Intake after Esophagectomy.","authors":"Woo Sik Yu","doi":"10.5090/jcs.26.103","DOIUrl":"10.5090/jcs.26.103","url":null,"abstract":"","PeriodicalId":34499,"journal":{"name":"Journal of Chest Surgery","volume":" ","pages":"175-176"},"PeriodicalIF":1.5,"publicationDate":"2026-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13351389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148266290","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":"Comment on: Outcomes of Pleural Sealant Application in Pneumothorax Surgery: A Comparative Analysis.","authors":"Muhammad Danish","doi":"10.5090/jcs.26.040","DOIUrl":"10.5090/jcs.26.040","url":null,"abstract":"","PeriodicalId":34499,"journal":{"name":"Journal of Chest Surgery","volume":" ","pages":"188-189"},"PeriodicalIF":1.5,"publicationDate":"2026-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13351373/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147783416","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":"Detection of Anastomotic Leaks Following Esophagectomy with Cervical Anastomosis Using Drain Fluid Amylase Testing: A Retrospective Study in Taiwan.","authors":"Ying-Che Ting, Ling-I Chien, Chia Liu, Yi-Ying Lee, Chien-Sheng Huang, Yu-Chung Wu, Po-Kuei Hsu","doi":"10.5090/jcs.25.108","DOIUrl":"10.5090/jcs.25.108","url":null,"abstract":"<p><strong>Background: </strong>Anastomotic leak at the cervical anastomosis following esophagectomy remains a significant problem. However, diagnostic accuracy for this condition is limited, and interpretation varies. This study aimed to share our institution's experience regarding the diagnostic value of esophagram and drain fluid amylase testing.</p><p><strong>Methods: </strong>We retrospectively reviewed patients with esophageal cancer who underwent McKeown esophagectomy. Esophagram was scheduled on postoperative day (POD) 7. Drain fluid amylase levels were measured twice, on POD 3 and POD 7. Diagnostic criteria were established based on the values measured at these time points and the relationship between them.</p><p><strong>Results: </strong>Overall, 103 patients were eligible for evaluation. Of these, 48 underwent drain fluid amylase testing, 67 underwent esophagram, and 12 received both examinations. The sensitivity and specificity of esophagram for detecting anastomotic leak were 28.6% and 95%, respectively. The positive predictive value, negative predictive value, and diagnostic accuracy were 40.0%, 91.9%, and 88.1%, respectively. Among patients who underwent drain fluid amylase testing, the criteria for detecting leaks were defined as follows: (1) an increasing trend (i.e., an amylase level higher on POD 7 than on POD 3) and (2) an amylase level >80 IU/L on POD 7. The sensitivity and specificity of these criteria were 75% and 96.5%, respectively, while the positive and negative predictive values were 75% and 96.5%. The diagnostic accuracy was 93.9%.</p><p><strong>Conclusion: </strong>Compared with esophagram, drain fluid amylase testing is easier to perform and may represent a more accurate method for predicting anastomotic leak.</p>","PeriodicalId":34499,"journal":{"name":"Journal of Chest Surgery","volume":" ","pages":"165-174"},"PeriodicalIF":1.5,"publicationDate":"2026-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13351375/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147487204","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}