A 69-year old male was referred to our hospital for the treatment of coronary artery disease. Preoperative computed tomography (CT) revealed an abdominal aortic aneurysm (AAA) and a giant tumour of the left kidney. He underwent off-pump coronary artery bypass grafting (OPCAB) prior to aneurysmectomy and nephrectomy. Temporary epicardial pacing wires (TEPWs) were placed on the right atrium and right ventricle. The bipolar ventricular wire was removed and the unipolar atrial wire was cut flush with the skin surface on postoperative day 5. CT 7 days after the OPCAB procedure revealed a retained TEPW sutured to the right atrial wall. One month later, the patient underwent a repair of the AAA and left nephrectomy. We found that a TEPW had migrated inside the AAA intraoperatively. The retained TEPW was thus no longer observed on postoperative CT. Migration of the atrial pacing wire through the aortic lumen was suspected, although the detailed mechanism is unknown. This is the first reported case of a migrated temporary pacing wire into the aorta under noninfectious conditions.
We report on the case of a 23-year-old man with simultaneous bilateral spontaneous pneumothorax (SBSP), treated with bilateral video-assisted thoracoscopic surgery (VATS) in a supine position. SBSP is a very rare condition that can be life-threatening when therapeutic techniques fail. We performed a unique operative procedure for SBSP using one-stage bilateral VATS in a supine position. This procedure is less invasive, more effective, and safer for the treatment of SBSP.
resection and revascularization of the carotid artery were successfully performed subsequent to failed endovascular treatment.
Case ReportAn 81-year-old diabetic woman was admitted to a neighboring hospital, complaining of high fever (38-40°C), nausea, appetite loss, and lumbago. White blood cell (WBC) count was 13500/mm 3 and C-reactive protein (CRP) was 19.1 mg/dl. Because pyrogenic spondylitis at Th11/12 was highly suspected on lumbar x-ray, she was transferred to the Department of Orthopedic surgery. On the day following her admission, she had high fever (39°C) with WBC and CRP of 29400/mm 3 and 20.36 mg/dl. A chest x-ray fi lm demonstrated a well-defi ned, noncalcifi ed soft tissue opacity projecting from the right superior mediastinal border. Computed tomography (CT) demonstrated a pseudoaneurysm, 30 mm × 40 mm in diameter, which was initially thought to have originated from the right innominate artery and was surrounded by fl uid with entrapped air (Fig. 1). A nodular mass was incidentally found in the right thyroid gland. She was given the meropenem (1 g/day) and vancomycin (1 g/day) based on a diagnosis of infectious pseudoaneurysm. Blood culture showed Enterobacter cloacae. One week later, although the values of WBC (19600/mm 3 ) and CRP (7.75 mg/dl) were reduced, the pseudoaneurysm was expanded on the chest x-ray, and was associated with sudden onset of hemoptysis. The CT showed that the pseudoaneurysm had increased in size to 60 mm × 70 mm (Fig. 2a) and was found to have originated from the right subclavian artery in the three dimensional image. The ostium of the pseudoaneurysm was very close to the right common carotid arterial bifurcation (Fig. 2b). Emergent coil embolization was performed, but failed because of the wide ostium of the pseudoaneurysm. Despite the continued presence of an infectious condition, the patient underwent an urgent operation to avoid sudden rupture and death. The right femoral artery and vein were exposed in advance, in preparation for rapid establishment of cardiopulmonary Mycotic pseudoaneurysm of the subclavian artery is uncommon and its therapeutic strategy has not been established. We report a case of 81-year-old woman with mycotic pseudoaneurysm in the right subclavian artery. Blood culture showed Enterobacter cloacae. Because of hemoptysis and acute expansion of the pseudoaneurysm, emergent coil embolization was performed, but failed. The patient underwent urgent operation for an en-bloc resection of the pseudoaneurysm after aorto-right common carotid artery bypass followed by omentum packing. The patient underwent continuous wound irrigation for 3 weeks. The postoperative course was uneventful and without recurrence of infection.
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