General Thoracic and Cardiovascular Surgery Cases最新文献

{"title":"Minimally invasive coronary artery bypass grafting via a left lateral mini-thoracotomy in severe hemophilia A: a case report.","authors":"Katsuhiro Hosoyama, Minami Yamada-Fujiwara, Kota Itagaki, Tatsuya Tago, Kentaro Yuda, Koki Ito, Yusuke Suzuki, Shintaro Katahira, Goro Takahashi, Kiichiro Kumagai, Yoshikatsu Saiki","doi":"10.1186/s44215-026-00254-5","DOIUrl":"10.1186/s44215-026-00254-5","url":null,"abstract":"<p><p>BACKGROUND: Life expectancy in patients with hemophilia A has increased owing to advances in factor VIII replacement, and the prevalence of age-related comorbidities such as coronary artery disease (CAD) is rising. However, coronary revascularization in severe hemophilia A remains challenging because both antithrombotic therapy and surgery can precipitate serious bleeding. We report a case of minimally invasive coronary artery bypass grafting (MICS-CABG) in a patient with severe hemophilia A, focusing on perioperative factor VIII management. CASE PRESENTATION: A 50-year-old man (height 167 cm, weight 81 kg) with severe hemophilia A (baseline factor VIII activity < 1%) was followed at our institution. His bleeding history included mucosal and gastrointestinal hemorrhage requiring on-demand factor VIII replacement. He presented with exertional chest pain, and coronary angiography revealed single-vessel CAD involving the left anterior descending (LAD) and diagonal territory. Surgical revascularization was selected to avoid the need for long-term dual antiplatelet therapy after percutaneous coronary intervention involving an indwelling drug-eluting stent. Preoperative echocardiography showed preserved left ventricular function. MICS-CABG via a left lateral mini-thoracotomy was performed, with the left internal thoracic artery (LITA) used as a sequential graft to the diagonal branch and LAD. Perioperative hemostasis was managed in collaboration with the hematologists using recombinant factor VIII. A preoperative bolus was followed by continuous infusion and scheduled dose adjustments based on serial factor VIII activity measurements. Total operative time was 5 h 32 min, and intraoperative blood loss was 407 mL without transfusion. No major bleeding or thrombotic events occurred. Postoperative coronary computed tomography confirmed excellent graft patency, and the patient was discharged without complications. CONCLUSIONS: Even in severe hemophilia A, MICS-CABG can be performed safely when combined with meticulous perioperative factor VIII replacement and activity monitoring. A minimally invasive surgical approach may help limit blood loss and transfusion requirements, and represents a useful revascularization option for selected patients with hemophilia and CAD. </p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13169817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147597445","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":"Saccular common iliac artery aneurysm associated with HLA-A26 and HLA-B27 in a young adult patient: a surgical case report and literature review.","authors":"Hiroto Yasumura, Kenichi Arata, Koichiro Shimoishi, Yuki Ogata, Tomoyuki Matsuba, Yoshihiro Fukumoto, Goichi Yotsumoto, Yoshiharu Soga","doi":"10.1186/s44215-026-00250-9","DOIUrl":"10.1186/s44215-026-00250-9","url":null,"abstract":"<p><p>BACKGROUND : The human leukocyte antigen (HLA) is a major histocompatibility complex antigen found in almost all human cell membranes. Half of the HLA alleles are inherited from each parent. However, little is known about the relationship between HLA and abdominal aortic aneurysms. Herein, we present a rare surgical case of a saccular common iliac artery aneurysm associated with HLA-A26 and HLA-B27 in a young adult patient, along with a literature review. CASE PRESENTATION: A 26-year-old Japanese man presented with high fever and right lower abdominal pain. Contrast-enhanced computed tomography revealed appendicitis, a 20-mm saccular aneurysm at the origin of the left common iliac artery, and an 8-mm gastric varix. After undergoing laparoscopic appendectomy, the patient was referred to our institution for management of this rare aneurysm. His mother had a history of uveitis and ankylosing spondylitis treated with steroids, suggesting that he may have inherited HLA-B27. Endovascular aortic repair was performed using an AFX2 stent graft under general anesthesia. The patient’s postoperative course was uncomplicated, and he was discharged on postoperative day three. Postoperative HLA typing revealed HLA-A11, HLA-A26, HLA-B27, and HLA-B35 positivity. CONCLUSIONS: When aortic aneurysms are incidentally found in young patients, HLA typing should be considered in addition to specific antibodies for collagen diseases. Patients with a medical or family history of collagen disease–related vasculitis and specific HLA types should undergo careful cardiovascular follow-up. </p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13179634/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147597438","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 surgical case of posterior mediastinum chordoma requiring differentiation from neurogenic tumor.","authors":"Morimichi Nishihira, Yoko Karube, Yusuke Shimizu, Toru Harasawa, Natsumi Ishikawa, Satoru Kobayashi","doi":"10.1186/s44215-026-00241-w","DOIUrl":"10.1186/s44215-026-00241-w","url":null,"abstract":"<p><p>INTRODUCTION: Chordoma is a malignant bone and soft tissue tumor derived from remnants of the embryonic notochord. It accounts for 1–4% of all malignant bone tumors and most commonly arises in the sacrum and skull base. Mediastinal chordomas are extremely rare, comprising only 1–3% of all chordomas. CASE PRESENTATION: A 46-year-old male patient presented to the clinic for a routine check-up and was referred to our hospital after an abnormal chest shadow was detected during a routine physical examination. A contrast-enhanced computed tomography scan revealed a spindle-shaped lesion with an extrapleural sign adjacent to the vertebral body at the Th2-3 level. The lesion was predominantly cystic with no contrast enhancement. There was no evidence of surrounding invasion, bone destruction, or extension into the intervertebral foramen. We suspected a neurogenic tumor with cystic degeneration. Complete resection was considered feasible, and we performed a robot-assisted mediastinal tumor resection. The lesion was cystic, soft, and showed no apparent connection to the nerves. It was excised through total circumferential dissection, with no evident invasion into the surrounding tissue. Complete resection was successfully achieved, and the patient was discharged without complications during the postoperative course. Pathological examination confirmed the diagnosis of chordoma. Two years post-surgery, the patient remains alive without recurrence. CONCLUSION: We report a case of a primary posterior mediastinal chordoma that was successfully resected using robot-assisted surgery. </p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":"5 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13036969/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147583454","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":"Pancreaticoduodenal artery aneurysms and cerebral aneurysms in a patient of Sjögren's syndrome: a surgical case report and literature review.","authors":"Hiroto Yasumura, Koichiro Shimoishi, Sho Ijuin, Kenichi Arata, Yoshihiro Fukumoto, Goichi Yotsumoto, Yuki Ogata, Tomoyuki Matsuba, Yoshiharu Soga","doi":"10.1186/s44215-026-00253-6","DOIUrl":"10.1186/s44215-026-00253-6","url":null,"abstract":"<p><p>INTRODUCTION: Pancreaticoduodenal artery aneurysms (PDAAs) are associated with celiac axis stenosis and occlusion. PDAAs carry a risk of sudden rupture and therefore require prompt treatment. Sjögren’s syndrome (SS), a systemic autoimmune disease, has recently been reported in association with various arterial aneurysms. To our knowledge, no previous report has described concurrent PDAAs and cerebral aneurysms (CAs) associated with SS. Here, we present a rare case of PDAAs and CAs associated with SS. CASE PRESENTATION: A 69-year-old Japanese woman with a history of chronic hepatitis was referred to our hospital. She had a 20-year history of dry mouth, a one-month history of taste disturbance, and joint pain. Laboratory tests revealed she was SS. Abdominal ultrasonography performed for chronic hepatitis incidentally revealed aneurysms around the pancreas. Contrast-enhanced computed tomography (CECT) demonstrated multiple PDAAs, including two anterior superior PDAAs, three anterior inferior PDAAs, one inferior PDAA, and two dorsal pancreatic artery aneurysms. The origin of the celiac axis was occluded. CECT also revealed three CAs: an anterior communicating artery (AcomA) aneurysm with a bleb, a right middle cerebral artery aneurysm, and a right M1 bifurcation aneurysm. We planned a three-stage treatment strategy. First, an aorto-hepatic bypass using a reversed great saphenous vein graft was performed. The graft was proximally anastomosed to the abdominal aorta 15 mm above the inferior mesenteric artery, routed through the mesocolon near the ligament of Treitz, and passed between the stomach and pancreas. It was then distally anastomosed to the common hepatic artery. The gastroduodenal artery (GDA) was ligated to prevent competitive flow between the GDA and the graft. The postoperative course was uneventful, and the patient was discharged on postoperative day 9. Twenty days later, coil embolization of the PDAAs was performed as the second treatment. Fifty days thereafter, stent-assisted coil embolization of the AcomA aneurysm was performed as the third treatment. Twelve months after the aorto-hepatic bypass, the graft remained patent, and the sizes of the remaining CAs were unchanged. CONCLUSIONS: Our case highlights the potential for systemic aneurysm formation in patients with SS and demonstrates that staged multidisciplinary treatment can be safely and effectively performed. </p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13049707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147577434","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":"Wide resection and reconstruction using the sandwich technique for primary undifferentiated pleomorphic sarcoma of the sternum: a case report.","authors":"Masao Kobayashi, Satoshi Takenaka, Kei Shinyashiki, Ryu Kanzaki, Tomohiro Maniwa, Hidetoshi Satomi, Keiichiro Honma, Jiro Okami","doi":"10.1186/s44215-026-00251-8","DOIUrl":"10.1186/s44215-026-00251-8","url":null,"abstract":"<p><p>BACKGROUND: Primary undifferentiated pleomorphic sarcoma (UPS) of the sternum is rare, and surgical resection remains the mainstay of treatment. Extensive sternal resection necessitates reconstruction to preserve respiratory function, protect mediastinal structures, and maintain upper limb support. Various reconstruction techniques have been described, but optimal methods for high-risk patients remain unclear. We report a case of total sternal resection reconstructed using a sandwich technique with polymethyl methacrylate (PMMA) and polytetrafluoroethylene (PTFE) sheets. CASE PRESENTATION: A 79-year-old man with multiple comorbidities presented with a painful anterior chest wall mass. Imaging revealed a 3-cm localized sternal lesion, and biopsy confirmed UPS. Total sternal resection was performed, preserving the left pectoralis major muscle for flap coverage. A PMMA sheet sandwiched between PTFE sheets was anchored to the ribs, providing rigid yet lightweight chest wall support. A pedicled pectoralis major musculocutaneous flap covered the defect. Postoperative recovery was uneventful, with preserved pulmonary and upper limb function. Histopathology confirmed negative margins. At 8 months, a solitary left supraclavicular lymph node metastasis was treated with radiotherapy. The patient remains progression-free at 18 months. CONCLUSION: Total sternal resection followed by sandwich technique reconstruction can provide stable chest wall support while preserving respiratory and upper limb function, even in elderly patients with comorbidities. This case highlights atypical metastatic patterns of sternal sarcomas, emphasizing the need for careful follow-up. The sandwich technique is a safe and reproducible option for extensive sternal reconstruction in high-risk patients. </p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13137505/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147518095","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":"Norwood procedure with left coronary artery reimplantation for hypoplastic left heart syndrome combined with Anomalous left coronary artery from the right pulmonary artery: a case report.","authors":"Yuya Yamazaki, Junichi Koizumi, Tatsunori Tsuji, Daiki Saitoh, Naoya Sakoda, Azuma Tabayashi, Kazuki Yakuwa, Naoki Masaki, Hirofumi Saiki, Hajime Kin","doi":"10.1186/s44215-026-00252-7","DOIUrl":"10.1186/s44215-026-00252-7","url":null,"abstract":"<p><p>BACKGROUND: Anomalous origin of the left coronary artery from the pulmonary artery is a rare congenital heart defect associated with high mortality during infancy if not surgically corrected. Its occurrence combined with hypoplastic left heart syndrome is highly uncommon, presenting considerable diagnostic and technical challenges. Identifying such an anomaly before surgery can be challenging, particularly in patients with complex cardiac anatomy. Intraoperative recognition requires immediate adjustments of the surgical approach, especially regarding myocardial protection and coronary artery reconstruction. CASE PRESENTATION: A female infant was delivered at 39 weeks of gestation with a birth weight of 3038 g. She was prenatally diagnosed with a variant of hypoplastic left heart syndrome, which was characterized by mitral and aortic stenosis, double-outlet right ventricle, and moderate tricuspid regurgitation. At birth, she underwent bilateral pulmonary artery banding to manage heart failure symptoms. Preoperative imaging did not provide sufficient visualization of the coronary arteries. At 15 days of age, she underwent the Norwood procedure with right ventricle-to-pulmonary artery shunt and tricuspid valve repair. During surgery, it was observed that the left coronary artery originated from the right pulmonary artery. To maintain coronary perfusion, a cannula was inserted into the main pulmonary artery, connecting it to a cardiopulmonary bypass circuit. Subsequently, the left coronary artery was reimplanted into the neoaorta to preserve alignment and minimize tension. The postoperative course included extracorporeal membrane oxygenation for 3 days because of right ventricular dysfunction, with sternal closure on postoperative day 13. At 7 months, she underwent a bidirectional cavopulmonary shunt. At 2 years of age, she continues to be monitored on heart failure medication and exhibits a stable clinical status. CONCLUSIONS: In patients with complex congenital heart disease, a thorough assessment of the coronary artery anatomy is essential for surgical planning. In cases of unfeasible preoperative diagnosis, prompt intraoperative management must ensure myocardial protection and long-term coronary artery function. This case demonstrates that careful intraoperative decision-making can lead to successful outcomes, even in cases of unexpected anatomical findings. </p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13023204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147506000","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":"Single-stage concomitant extended thymectomy for myasthenia gravis and enucleation of a left recurrent laryngeal nerve schwannoma via median sternotomy.","authors":"Go Kamimura, Koki Maeda, Masaya Aoki, Satomi Imamura, Shoichiro Morizono, Yuto Nonaka, Aya Takeda, Toshiyuki Nagata, Kazuhiro Ueda","doi":"10.1186/s44215-026-00248-3","DOIUrl":"10.1186/s44215-026-00248-3","url":null,"abstract":"<p><p>BACKGROUND: Myasthenia gravis (MG) without thymoma is often treated with extended thymectomy to improve symptom control and reduce immunotherapy requirements. Schwannoma of the recurrent laryngeal nerve (RLN) is rare, and surgical resection is usually curative. However, operative manipulation carries a risk of temporary or permanent vocal fold paralysis. When these conditions coexist, choosing staged versus single-stage surgery is non-trivial. A synchronous operation can consolidate perioperative care and recovery but demands careful planning to prevent respiratory complications, particularly if RLN palsy or myasthenic crisis occur. CASE PRESENTATION: A 65-year-old woman with generalized, thymoma-negative MG (acetylcholine-receptor antibody positive) had no hoarseness or dysphagia. Flexible laryngoscopy confirmed mobile vocal folds bilaterally. Chest radiography showed mediastinal widening without diaphragmatic paralysis. Contrast-enhanced CT and MRI revealed a right anterior mediastinal cystic lesion and a solid mass in the left tracheoesophageal groove abutting the RLN. ^18F-fluorodeoxyglucose positron emission tomography demonstrated uptake in the solid lesion (SUV_max 4.89). Transesophageal endoscopic ultrasound–guided fine-needle aspiration yielded spindle cells compatible with schwannoma, and the mass was considered RLN-derived. A single-stage median sternotomy was undertaken. Extended thymectomy was performed with bilateral phrenic exposure and en bloc removal of thymic/perithymic fat, followed by nerve-sparing enucleation of the left RLN tumor through a longitudinal epineurial window and meticulous intracapsular dissection, preserving macroscopic neural continuity. The postoperative intensive care unit course was uneventful: no dyspnea or dysphagia, normal voice, and laryngoscopy confirmed intact vocal fold mobility. A chest radiograph on postoperative day 5 was unremarkable, and the patient was discharged on day 7. Histopathology showed alternating Antoni A/B areas with virtually no mitoses; tumor cells were strongly S-100–positive, confirming schwannoma. CONCLUSIONS: In carefully selected patients with stable MG and no preoperative vocal fold dysfunction, single-stage median sternotomy enables safe concomitant extended thymectomy and RLN schwannoma enucleation. Success hinges on nerve-sparing technique and proactive perioperative planning for airway protection and potential MG crisis. </p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13085531/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147392079","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":"Lung cancer surgery with partial anomalous pulmonary venous connection presenting an inverted Scimitar sign.","authors":"Koki Maruyama, Mitsuhiro Isaka, Daisuke Yamaguchi, Keigo Matsusima, Tatsuya Masuda, Momoko Asami, Kazuki Hayasaka, Sinya Katsumata, Hayato Konno, Hideaki Kojima, Naoya Yokomakura, Yasuhisa Ohde","doi":"10.1186/s44215-026-00245-6","DOIUrl":"10.1186/s44215-026-00245-6","url":null,"abstract":"<p><p>BACKGROUND: Partial anomalous pulmonary venous connection (PAPVC) is a congenital anomaly in which a part of the pulmonary veins drain into the right heart system. Many cases of PAPVC remain asymptomatic and often do not present clinical problems. However, when performing a lung resection, it becomes important in terms of surgical techniques and complications. CASE PRESENTATION: A 70-year-old woman was referred to our hospital for evaluation of an abnomal shadow on chest radiography performed during medical check-up. A contrast-enhanced chest computed tomography (CT) revealed a part-solid nodule in the right upper lobe (RUL). Additionally, PAPVC was observed, in which almost all pulmonary veins, except for a small part of the basal segmental pulmonary vein (PV), drained into the azygos vein. The patient was diagnosed with suspected primary lung cancer (cT1miN0M0, stageⅠA1) with PAPVC. We performed righit upper wedge resection while preserving the PAPVC. CONCLUSION: We reported rare PAPVC presenting an inverted Scimitar sign. To the best of our knowledge, this is the first case report of its kind. The tumor was located very close to the main trunk of the anomalous PV. Resection of the main trunk would have resulted in the loss of all pulmonary veins except for the basal segmental PV. Furthermore, the surgical margin would have been unchanged when comparing right upper lobectomy with wedge resection. Therefore, wedge resection of the RUL was selected. The resection margins were negative. </p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13081505/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147373770","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 contrast-induced encephalopathy after thoracic endovascular aortic repair for a ruptured thoracic aortic aneurysm.","authors":"Jumpei Tokutome, Yuichiro Kishimoto, Takeshi Onohara, Hiromu Horie, Tsuyoshi Sasami, Rikuto Nii, Naoki Sumi, Nozomi Kishimoto, Kenichi Morimoto, Junya Nakashima, Yasushi Yoshikawa","doi":"10.1186/s44215-026-00244-7","DOIUrl":"10.1186/s44215-026-00244-7","url":null,"abstract":"<p><p>BACKGROUND: Contrast-Induced Encephalopathy (CIE) is a rare complication, most commonly reported after carotid or coronary interventions, possibly due to reporting bias. CASE PRESENTATION: We present a case of CIE following two-debranching thoracic endovascular aortic repair (TEVAR). A 79-year-old man with hypertension, hyperlipidemia, stage 4 chronic kidney disease (CKD), and prior cerebral infarction underwent emergency 2-debranching TEVAR for a ruptured thoracic aortic aneurysm (TAA). A total of 200 mL of contrast medium was used pre- and intraoperatively. On postoperative day (POD) 1, the patient remained unconscious despite sedation cessation. Non-contrast brain Computed tomography (CT) showed left hemispheric cerebral edema and high-density areas suggestive of contrast extravasation, raising suspicion for CIE. Conservative management with hydration and supportive care led to gradual recovery, with imaging on POD9 showing near-complete resolution. CONCLUSIONS: Although rare, CIE should be considered in cases of delayed consciousness recovery after TEVAR, particularly in high-risk patients. Early diagnosis and conservative treatment are essential for good outcomes. </p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":"5 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12964712/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147367942","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":"Successful surgical management of sudden acute obstruction of the bronchus intermedius via an interlobar approach following bilateral lung transplantation: a case report.","authors":"Kosuke Otsubo, Chihiro Konoeda, Gouji Toyokawa, Mitsuaki Kawashima, Masaaki Sato","doi":"10.1186/s44215-026-00246-5","DOIUrl":"10.1186/s44215-026-00246-5","url":null,"abstract":"<p><p>BACKGROUND: Lung transplantation (LTx) is an established treatment for end-stage lung disease. However, bronchial complications after LTx remain a major challenge. Bronchial stenosis is the most common bronchial complication, for which the main treatment strategies are endoscopic and surgical interventions. This report describes a case of sudden-onset bronchial stenosis following bilateral LTx that was successfully managed by surgery. CASE PRESENTATION: A 46-year-old man underwent bilateral LTx from a brain-dead donor for pulmonary Langerhans cell histiocytosis and pulmonary hypertension. He was discharged 1 month later without any complications. Although there were no significant abnormal findings on chest computed tomography (CT) scans obtained 3 months after LTx, he complained of sudden-onset dyspnea at 5 months following LTx. Chest radiography showed decreased lucency in the right lower lung field, and CT demonstrated severe stenosis of the right bronchus intermedius, with the stenotic segment measuring approximately 0.8 cm in length. Limited aeration remained in the middle and lower lobes. His respiratory condition deteriorated rapidly, and he was intubated and admitted to the intensive care unit. Repeat CT performed on the following day revealed complete obstruction of the bronchus intermedius and total atelectasis of the right middle and lower lobes. After urgent transfer to our hospital, bronchoscopy revealed complete obstruction of the bronchus intermedius, indicating a need for urgent surgical intervention. Right thoracotomy was performed via the fifth intercostal space. After division of the main pulmonary artery through the interlobar fissure, sleeve resection with end-to-end reconstruction was performed for the stenotic segment of the bronchus intermedius. The postoperative course was uneventful, and the patient was discharged on postoperative day 15. No restenosis has been observed on repeat CT or bronchoscopy, and he has remained well during 2.5 years since surgery. CONCLUSIONS: Bronchial stenosis can occur after LTx even distal to the anastomotic site, particularly in the right bronchus intermedius, and may progress rapidly to complete obstruction. Surgical intervention may be an effective strategy when endoscopic management is not feasible. </p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13037015/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147278014","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}