Less than 25 cases of azygous vein lacerations secondary to blunt trauma have been published in the medical literature, most of these injuries were resulting from motor vehicle accidents, but have been described due to falls or assaults. These lesions should be considered as thoracic great vessels injuries and if not recognized promptly carry a high morbidity and mortality. We report a case of a young male involved in a high-speed car collision, admitted to the emergency room in an unstable condition secondary to hypovolemic shock due to azygous vein injury. The patient underwent emergent right antero-lateral thoracotomy followed by sternotomy for surgical control of the vascular injury and resuscitation. Laparotomy and splenectomy were also required, the abdomen was closed. The thoracic cavity was left packed and closure was delayed for 48 h. The patient survived and was transferred to another hospital seven days later.

Congenital anomalies of the inferior vena cava (IVC) are caused by an abnormal persistence or regression of embryonic precursor veins; they are usually incidental findings on imaging studies. These rare conditions have a 0.6% prevalence in individuals with congenital heart diseases and 0.3% in healthy patients. The purpose of this paper was to report two cases of interruption of IVC with hemiazygos continuation and its implications during surgery, highlighting that after recognizing this anomalous drainage the surgeon should be prepared to change the surgical strategies, especially in cardiovascular surgery, in order to obtain adequate circulatory flows or surgical exposure where venous cannulation could be difficult. We have also reported two cases of healthy patients with the same isolated IVC anomaly with no clinical repercussions, which can develop in the future.

While surgical intervention is still the standard, our results show that LIPUS may serve as a nonoperative alternative to scaphoid nonunion in certain cases. The results are encouraging in which these challenging fracture a nonunions can heal without further surgical intervention in the majority of patients.

A 64-year-old man with dilated cardiomyopathy and chronic renal insufficiency (without dialysis) was admitted in cardiogenic shock urgently requiring a circulatory biventricular assist device (Thoratec). Twenty-nine days later we performed orthotopic cardiac and heterotopic renal transplantations with organs from the same donor. Postoperatively secondary renal insufficiency occurred due to rejection of the graft, bleeding ulcer with hypovolemic shock, and peritonitis due to Streptococcus faecalis and Candida. In the postoperative course only one rejection of the cardiac graft was detected. The patient was discharged after 4 months, resuming a normal life.

Fibrovascular polyps (FVPs) are rare, benign tumors of the esophagus; they usually appear as an intraluminal mass within the esophagus, which can grow and reach enormous sizes if left untreated. They can cause a variety of symptoms, from mild dysphagia to life-threatening asphyxia. Diagnosis is challenging because FVPs can resemble any respiratory condition, which can lead to misdiagnosis and potentially dangerous therapies. We present a 47-year-old man who suffered from recurrent episodes of odynophagia. This time he suffered an incident of severe asphyxia and loss of consciousness. After complementary examinations, an FVP was detected and successfully treated.

Mediastinitis secondary to esophageal perforation is usually a life-threatening problem associated with high morbidity and mortality. We present a 44-year-old morbidly obese female who underwent laparoscopic gastric bypass, during which she suffered perforation of the distal thoracic esophagus diagnosed 5 days later during progression of mediastinitis. She was treated with left posterolateral thoracotomy, drainage of a peri-esophageal abscess and primary repair of the esophagus with intercostal muscle reinforcement, and cervical esophagostomy. Thereafter, she had an uneventful hospital course, and remains well on 12-month follow-up.

Background Antiphospholipid syndrome (APS) is a rare coagulation disorder associated with thrombotic events, myocardial infarction, and valvular heart disease. During valvular replacement surgery, the high risk of thrombosis combined with the operative risks in these specific groups of patients poses a challenge to the medical team. Case presentation We present a case of a female patient with APS and mixed aortic valve disease. During surgery, she suddenly developed complete cardiac arrest. Three months later, after she recovered, and while she was still on close follow up, a thrombotic event caused myocardial infarction. After prompt and precise treatment, the patient successfully recovered; one year after surgery patient is doing well. Conclusion Adequate surgical technique along with optimal anticoagulation strategies and long term follow up are of paramount importance to ensure an uneventful recovery. A multidisciplinary team is required to manage these complex scenarios and high-risk patients.

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