Thoracolithiasis without any history of chest traumas or interventions is pathologically rare, with only 9 cases including our 2, reported thus far in the literature. Case 1: A 76-year-old man admitted to our hospital had an abnormal shadow in chest radiography that gradually enlarged. Serum carcinoembrionic antigen was slightly elevated during follow-up. A milky white tumor 1.5 cm in diameter with many projections was found in the thoracic cavity and removed by thoracoscopy. Histopathological examination showed the tumor to consist of fibrous tissue with fatty necrosis at the core. Case 2: A 54-year-old woman admitted to our hospital had an abnormal shadow in chest screening radiography in 1998. Transbronchial biopsy showed this shadow to be lung adenocarcinoma. A small trigonal pyramid-shaped milky white nodule 5 mm in diameter was found in the thorax during lobectomy for lung cancer. Histopathological examination showed this nodule also to consist of fibrous tissue with fatty necrosis.
Background
Bacillus cereus
is a gram-positive rod bacterium that is responsible for food poisoning. It is naturally widely distributed, and thus often contaminates cultures. Although it is rarely considered responsible, it can cause serious infections under certain conditions. However, lethal infections, especially in immunocompetent patients, are rare.
Case presentation
A healthy 60-year-old man developed community-acquired
B. cereus
pneumonia and alveolar hemorrhage unveiled by abrupt chest pain and hemoptysis with no other advance symptoms.
B. cereus
induced silent alveolar destruction without any local or systemic inflammatory response. Although the lesion resembled lung anthrax, there was no evidence of
Bacillus anthracis
toxin.
Conclusions
Some isolates of
B. cereus
can cause anthrax-like fulminant necrotizing pneumonia in immunocompetent patients. If this type of
B. cereus
were used as a means of bioterrorism, it may be quite difficult to recognize as bioterrorism. We should keep
B. cereus
in mind as a potential pathogen of fulminant human infectious disease.
Splenic artery aneurysms account for about 60% of all visceral aneurysms. The treatment include surgical procedures that sometimes require pancreatectomy. This report describes the case of a 64-year-old woman who had multiple splenic artery aneurysms with various visceral artery dilatations. Because there was no obvious cause for the splenic artery aneurysms and other arterial abnormalities, we suspected an anomaly of the connective tissue, which was subsequently confirmed by a postoperative histopathologic examination. Thus, we decided to remove the whole splenic artery, to eliminate the formation of any further aneurysms, as well as a splenectomy. During the operation, the largest splenic artery aneurysm was found to be adhered to the pancreas too tightly to ablate. It initially appeared that pancreatectomy would be necessary, but considering the associated risk of postoperative complications, we tried to avoid this. Thus, we cut open the aneurysm and excised it, leaving the anterior wall which was adhered to the pancreas. Our procedure proved the best way to preserve the pancreas and eliminate further aneurysmal formation.
Surgery for constrictive pericarditis was conducted through a transsternal bilateral thoracotomy in a 45-year-old man who developed the condition 12 months after coronary artery bypass grafting with left internal thoracic artery and vein grafts. The grafts ran just beneath the sternum. To avoid injury to the bypass grafts during sternotomy and mediastinal dissection, we conducted a transsternal bilateral thoracotomy, which provided excellent exposure of the heart. Complete pericardiectomy was done safely without cardiopulmonary bypass. Constrictive pericarditis following cardiac surgery is an uncommon complication posing difficult problems for the surgeon. The presence of a patent left internal thoracic artery bypass is particularly challenging. Transsternal bilateral thoracotomy is a useful approach in patients with constrictive pericarditis in whom a median sternotomy is contraindicated.
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