[Anomalous systemic arterial supply to normal basal segment of the left lower lobe; report of a case].

A 28-year-old male was referred to our hospital because of hemoptysis. A chest X-ray revealed an increase of vascular marking in the left lower field and a partial defect in the lateral line of the descending thoracic aorta. An aortogram and pulmonary arteriogram showed a large artery arising from the descending thoracic aorta and supplying the left basal segment, which had no normal pulmonary arteries. A bronchoscopy showed no abnormal findings in the bronchial tree. A clinical diagnosis of systemic arterial supply to the basal segment of the left lower lung was made, and a left lower lobectomy and closure of the anomalous systemic artery by video-assisted thoracic surgery (VATS) were successfully performed. Vascular marking of the visceral pleura of left lower basal segment was observed and the anomalous arterial pressure was 84 mmHg, as high as systemic arterial pressure, during the procedure. The histopathological examination revealed normal alveolar structure, and sclerosis and hypertrophy of pulmonary arteries of the lesion (Heath-Edwards V, which means irreversible vascular changes due to pulmonary hypertension). The patient had an uneventful postoperative course and was discharged on postoperative day 8. The VATS procedure is a more useful and less invasive method for cases of systemic arterial supply to the basal segment of the left lower lung than an open thoracotomy.

[A case report of a pseudoaneurysm of the thoracic aorta (thrombotic closure type) showing like a mediastinal tumor--value of endoscopic ultrasonography in differential diagnosis].

A 65-year-old male patient was refered to our hospital for abnormal mediastinal shadow. CT and MRI study showed an inhomogeneous mediastinal tumor simulating neoplasm neighboring the aortic arch. Thoracic aortogram did not revealed the existence of thoracic aortic aneurysm. But the endoscopic ultrasonography (EUS) showed a pseudoaneurysm with a 2 cm entry site. The diagnosis of pseudoaneurysm was therefore proved, so the patient underwent the operation safely with preparation for extracorporeal circulation. Some patients with chronic thoracic pseudoaneurysm has no history of chest trauma and other causes. It is valuable to perform EUS for the differential diagnosis of abnormal mediastinal shadow which shows like a mediastinal tumor.