Left Posterior Mediastinum Research Articles

ESOPHAGEAL CYST RESECTED UNDER THORACOSCOPIC SURGERY

Esophageal cyst is a rare congenital cystic disease that usually occurs in the posterior mediastinum. Recently we experienced a case of esophageal cyst which was removed under thoracoscopic surgery. A 36-year-old man was admitted to our hospital because of an abnormal electrocardiogram, and pointed out an abnormal shadow on his chest roentgenogram. Chest CT showed a 4.8×3.2cm oval-shaped tumor in the left posterior mediastinum. Magnetic resonance imaging of the chest revealed that the tumor had iso signal intensity on T1-weighted image and had low to iso signal intensity on T2-weighted image. We surgically removed the tumor with suspicion of neurogenic tumor. The tumor was 6.0×4.0×3.5cm in size with smooth surface. The tumor had 0.5-2.0mm thick wall and structure of unilocular cyst. The content of the tumor was brown dreg-like. Pathologically, the tumor was diagnosed as an esophageal cyst lined by squamous epithelium ovelying double smooth muscle layers.

A CASE OF THORACOSCOPIC TREATMENT FOR EXTRALOBAR PULMONARY SEQUESTRATION

A 49-year-old female was admitted to the hospital because of an abnormal shadow on a chest X-ray film. Chest X-ray examination revealed an about 3×2 cm an sharply circumscrived tumor overlapping cardiac shadow and chest CT showed a tumor in the left lower posterior mediastinum. Neurogenic tumor or congenital cyst was suspected. We performed thoracoscopic surgery when the polypiform tumor wlas found arising from the parietal pleura of the discending aorta near the diaphragm. This tumor was diagnosed as extralobar pulmonary sequestration because of abnormal artery fed from the aorta and postoperative microscopic findings. The postoperative course was uneventful, and she was discharged 5 days after the operation without wound pain. Thoracoscopic surgery is very useful for diagnosis and treatment of intrathoracic tumors, because it provides minimal surgical intervention and pain.

Prolonged Partial Remission of Malignant Fibrous Histiocytoma in Posterior Mediastinum by Immunotherapy

The case of a 16-year-old female patient with the giant cell type of malignant fibrous histiocytoma (MFH) in the left posterior mediastinum is reported. This is a very unusual site for MFH. Immunotherapy induced a prolonged partial remission lasting 15 months with a marked reduction in tumor size. The usefulness of immunotherapy for MFH needs to be evaluated.

VON RECKLINGHAUSEN DISEASE RELATED TO THE FIELD OF THORACIC SURGERY

Recent experience with 3 patients with von Recklinghausen disease who manifested specific symptoms related to thoracic surgery is described.Case 1: A 31-year-old woman was diagnosed as having a neurogenic tumor in the left posterior mediastinum and operated on, however, the correct diagnosis proved to be meningcele.Case 2: A 25-year-old woman, with swelling and pain of the left arm as well as an abnormal shadow in the left posterior mediastinum, was diagnosed as having a ganglioneuroma originating from the Th1 sympathetic ganglion. In the eighth year after resection, an intradural-extramedullary tumor was found at the level of C3 to C7 of the cervical vertebrae. The resected tumor was pathologically diagnosed as neurofibroma. In the ninth postoperative year, subtotal resection of the ulnar nerve was performed because of multiple neurofibroma, and the patient has been doing well.Case 3: A 31-year-old woman who developed sudden onset of right backpain and dyspnea was diagnosed as massive hemothorax on the right side, and underwent an emergency operation. A tear of the tenth intercostal artery and vein with venous bleeding from the tenth intervertabral foramen were found.

A case of intrathoracic meningocele accompanied by Recklinghausen's disease

A 56-year-old woman with Recklinghausen's disease was admitted to our hospital due to the abnormal findings on the chest X-ray. On the chest X-ray there was a homogeneous large round mass in the left posterior mediastinum and an enlargement of the left intervertebral foramen at the level of Th5/6. Cardiac gated cinematography (CINE) MRI demonstrated the pulsatile movement of the fluid in the posterior mediastinal mass during the cardiac cycle. The diagnosis of intrathoracic meningocele accompanying Recklinghausen's disease was based on these findings

Management of Acute Hyperparathyroidism in a Community Hospital

Primary hyperparathyroidism is a common entity that routinely lends itself to prompt surgical cure. Infrequently, multiple surgical explorations are required to effect a cure. A case is reported of a 27-year-old man with hypercalcemia and nephrocalcinosis. The initial surgical exploration failed to identify the abnormal parathyroid tissue. Hypercalcemia necessitated rigorous antihypercalcemic therapy; three subsequent operations, including a mediastinal exploration, were unsuccessful. On the fifth exploration, which took barely an hour, a 35-g adenoma was removed from the left superior posterior mediastinum. This report illustrates that a detailed knowledge of the possible locations of aberrant parathyroid tissue and the skills of the operating surgeon are the sine qua non for those patients requiring one or more parathyroid reexplorations. (<i>JAMA</i>1981;246:1334-1336)