Key words：pneumatosis cystoides intestinalis(PCI), a-glucosidase inhibitor(a-GI), hemodialysis 〈Abstract〉 We encountered an 88-year-old male hemodialysis patient taking an oral a-glucosidase inhibitor(a-GI)who developed pneumatosis cystoides intestinalis(PCI)accompanied by intra-abdominal free air. In July 2008, the patient was placed on dialysis due to chronic renal failure derived from diabetic nephropathy. During this time, the use of insulin was discontinued and the patient began taking a-GI orally. Around late November 2008, the patient began to notice a bloating sensation in his abdomen, and was admitted to hospital on November 30 after an abdominal CT scan demonstrated the presence of intra-abdominal free air. Since there were no peritoneal symptoms, the patient was only restricted from oral intake and placed under observation. However, this did not yield any improvement in the bloating sensation in the patientʼs abdomen. On December 4, exploratory laparotomy was performed but there was no perforation of the digestive tract dected. However, PCI was found on the side of the ileal mesentery approximately 70 cm to 150 cm from the terminal ileum. Although the cause of PCI in this patient has yet to be resolved, reports of PCI caused by a-GI have recently been encountered on occasion. It was concluded that a-GI may have contributed to PCI in this case as well.

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Myxoma and other neoplasms in the left atrium often show signs and symptoms similar to those of mitral valve stenosis. Malignant fibrous histiocytoma, one of the most common sarcomas, occurs in the deep soft tissue of the limbs and retroperitoneum in adults. With the exception of primary lung cancer, however, sarcomatous intravascular extension in the lung and infiltration into the left atrium are rare. We report a case of overt left upper lobe pulmonary edema observed on chest radiograms and a mass occupying much of the left atrium and exhibiting hemodynamics similar to those of mitral valve stenosis on transthoracic echocardiography. Intraoperative and pathologic examination showed the mass to be a primary malignant fibrous histiocytoma extending from the left upper pulmonary vein into the left atrium.