• Journal of Chest Surgery
• /
• v.42 no.3
• /
• pp.404-407
• /
• 2009

A 43-yr-old patient visited our department with intermittent chest pain he had suffered with for the past 2 months. Chest CT showed an egg shaped mass in the left chest wall. Local resection was performed for distinguishing the mass from a neurogenic tumor. The diagnosis was periosteal Ewing sarcoma of the rib. Since there was no evidence of metastasis based on the PET-CT, a 2nd operation was done with wide resection and thoracoplasty. The patient was then treated with combined chemotherapy. There has been no local recurrence for the fast 1 year. The patient's age and tumor origin were distinct from the usual characteristics of Ewing's sarcoma. Periosteal Ewing's sarcoma of the rib has rarely been reported. We report here on a case of periosteal Ewing's sarcoma of the rib along with a review of the relevant medical literature.

• Journal of Chest Surgery
• /
• v.41 no.3
• /
• pp.366-368
• /
• 2008

We report there on a 46-year-old male patient whose angina recurred after a coronary bypass graft (CABG). Occlusion of the first diagonal branch was found on performing a coronary angiogram (CAG), and this occlusion had not previously been present. So, a redo-off pump CABG was performed via a left posterolateral thoracotomy. The anastomosis was made between the descending thoracic aorta and the diagonal branch by using the right radial artery. On the Multi-detector computerized tomography (MDCT) coronary angiogram conducted after the operation, it was confirmed that there was no abnormality in the anastomosis site. A Redo-CABG was successfully performed via left posterolateral thoracotomy in the patient whose disease was only at the diagonal branch.

• Journal of Chest Surgery
• /
• v.29 no.9
• /
• pp.1040-1044
• /
• 1996

A case with a bronchial foreign body(wood) which had an uncommon way of entry through a wound In the chest wall was described. A 41-year-old man was admitted to our hospital because of chronic cough and profuse purulent sputum. He had been injured by a fragment of wood which penetrated his anterolateral chest wall at 30 years ago. A chest x-ray film reavealed a calcific foreign body, measuring 3.0 by 1.0 cm, in the posterobasal segment of the left lung. Computed nomograp y of the chest demonstrated a calcific foreign body with bronchiectatic change near the diaphragmatic pleura In the left lower lobe. Left lower lobectomy was performed, and the patient remains well without any thoracic symptoms after the operation.

• Nuclear Medicine and Molecular Imaging
• /
• v.41 no.3
• /
• pp.252-254
• /
• 2007

Image fusion is fast catching attention as Wagner pointed out in his 2006 version of the recent progress and development presented at the annual meeting of Society of Nuclear Medicine. Prototypical fusion of bone scan and radiograph was already attempted at in 1961 when Fleming et al. published an article on strontium-85 bone scan. They simply superimposed dot scan on radiograph enabling simultaneous assessment of altered bone metabolism and local bone anatomy. Indeed the parallel reading of images of bone scan and radiography, CT, MRI or ultrasonography has been practiced in nuclear medicine long since. It is fortunate that recent development of computer science and technology along with the availability of refined CT and SPECT machines has permitted us to open a new avenue to digitally produce precise fusion image so that they can readily be read, exchanged and disseminated using internet. Ten years ago fusion was performed using Bresstrahlung SPECT/CT and it is now achievable by PET/CT and SPECT/CT software and SPECT/CT hardware. The merit of image fusion is its feasibility of reliable assessment of morphological and metabolic change. It is now applicable not only to stationary organs such as brain and skeleton but also to moving organs such as the heart, lung and stomach. Recently, we could create useful fusion image of cardiac SPECT and 64-channel CT angiograph. The former provided myocardial metabolic profile and the latter vascular narrowing in two patients with coronary artery stenosis and myocardial ischemia. Arterial stenosis was severe in Case 1 and mild in Case 2.

• Journal of Chest Surgery
• /
• v.36 no.12
• /
• pp.943-951
• /
• 2003

We are now detecting an increasing number of solitary pulmonary nodules (SPNs) that are difficult to diagnosis. The purpose of this study was to evaluate the useful radiologic findings for differentiating benign from malignant pulmonary nodules. Material and Method: The high-resolution CT (HRCT) findings of SPNs smaller than 3 cm in largest diameter were evaluated in 134 patients with malignant and benign nodules in regard to internal structures, margin characteristics, and surrounding parenchymal responses. Result: The nodules with the area of ground-glass attenuation (GGA) greater then 50% were noted in adenocarcinoma, inflammatory lesions and some of metastatic tumors, and the lesions greater than 90% were noted only in adenocarcinoma. The area of GGA in non-adenocarcinoma, benign tumors and tuberculomas were less than 50%, and mainly less than 10%. The findings of air bronchogram, spiculation, lobulation, vascular involvement, and pleural indentation were some noted at every types of malignant tumors, but especially high over than 30% in adenocarcinomas. Conclusion: Most peripheral lung adenocarcinomas form a characteristic radiologic findings especially in HRCT. Evaluation of these findings would be helpful in differentiating between lung cancer, especially adenocarcinoma, and other lesions.

• Journal of Chest Surgery
• /
• v.40 no.12
• /
• pp.871-873
• /
• 2007

A rupture of an innominate artery caused by blunt trauma is relatively rare because this artery is short and protected by the chest bony cage. This report describes a 25-year-old man who suffered a traffic accident, that resulted in an innominate artery rupture, which was detected by a chest computed tomogram and angiogram. This patient underwent urgent surgery through a right clavicular incision and median sternotomy without a cardiopulmonary bypass due to multiple injuries. An approximately 3 cm sized injury was found from the innominate artery to the proximal right subclavian artery and the origin of the common carotid artery. The injured lesion was repaired with a saphenous vein patch. After surgery, he was discharged from hospital without complications.

• Journal of Chest Surgery
• /
• v.39 no.5 s.262
• /
• pp.403-406
• /
• 2006

Infarction of the lung usually results from pulmonary arterial obstruction. Pulmonary infarcts often become infected from bronchial contamination and may become lung abscesses, empyema, or bronchopleural fistula causing sepsis. Diagnosis is important for intensive therapy, since infection is prone to spread. Resection of the infarcted lung should be considered early in an attempt to control infection. A sixty-seven-year-old man was hospitalized with dyspnea. A computed tomographic scan of the chest showed left lower lobe infiltration and mild pleural effusion with pleural thickening. There was a thrombus in the left pulmonary artery leading from the lower lobe to the upper lobe artery. At operation, the left lower lobe was found to have complete hemorrhagic infarction. The left lower lobectomy was performed. The remaining thrombus was removed after the left main pulmonary arteriotomy. He has been followed up for 15 months and has done well with no recurrence of thrombus and infarction of the lung.

• Journal of Chest Surgery
• /
• v.31 no.3
• /
• pp.324-328
• /
• 1998

Esophageal hemangioma is an extremely rare benign tumor that causes dysphagia and massive upper gastrointestinal bleeding. Although certain abnormalities seen on a barium swallow esophagography or at endoscopy may suggest an esophageal hemangioma, a contrast CT and radionuclide angiography using a blood-pool radiopharmaceutical can characterize the intense vascularity of the tumor. We experienced the ase of a 7$\times$7$\times$3.5 cm in size giant cavernous hemangioma of the lower 1/3 of esophagus in a 40 year old man. A mural cavernous hemangioma was diagnosed with a barium swallowed esophagogaphy, endoscopy, and a contrast CT. It was treated successfully by transthoracic esophagectomy including the tumor and esophagogastrostomy.

• Journal of Chest Surgery
• /
• v.42 no.2
• /
• pp.263-267
• /
• 2009

A pancreatico-pleural fistula (PPF), caused by rupture of a pancreatic pseudocyststectomy or obstruction of the pancreatic duct, is a rare condition. A 48-year-old man with chronic alcoholism was admitted with a massive pleural effusion. Pleural fluid studies revealed elevated amylase and lipase. A PPF complicated by a ruptured pancreatic pseudocyststectomy was diagnosed by computerized tomography scan. Although the symptoms improved with conservative management, (chest tube drainage, NPO, total parenteral nutrition, and a pancreatic secretion inhibitor), a distal pancreatectomy, including a pseudocystectomy and thoracotomy, were performed for an increasing size of the hemorrhagic pancreatic pseudocyststectomy and a recurrent hemorrhagic pleural effusion. There were no post-operative complications and the patient was discharged on post-operative day 27.

• Journal of Chest Surgery
• /
• v.41 no.5
• /
• pp.636-639
• /
• 2008

An abnormal origin of the right coronary artery can be responsible for sudden death, myocardial ischemia, arrhythmia and syncope, and it may be associated with the accelerated development of atherosclerotic disease. The mechanisms of ischemia in the case of an abnormal origin of the right coronary artery are currently unclear and several surgical methods have been proposed to treat this malady. Multidetector Computed Tomography shows the course of the abnormal coronary artery, it helps to clarify the mechanism of the ischemia and it aids in choosing the best surgical approach. We report here on a case of acute myocardial infarction with an abnormal origin of the right coronary artery. Coronary artery bypass grafting was subsequently carried out to treat this patient.