[Esophageal Perforation on Transesophageal Echocardiography in Open-heart Surgery:Report of a Case].

A 70-year-old woman, who was taking prednisolone to treat Takayasu arteritis, underwent surgery for aortic regurgitation and aneurysm of the ascending aorta. The probe of the transesophageal echocardiography (TEE) could not be inserted due to resistance during anesthesia induction and was inserted after starting cardiopulmonary bypass. The right pneumothorax was observed during surgery. After surgery, fever and a high C-reactive protein level continued, and a computed tomography (CT) examination revealed right thoracic empyema together with free air around the esophagus. The esophageal perforation diagnosis was confirmed by upper endoscopy. Esophageal leakage continued despite emergency esophageal repair and enterostomy. Although esophagectomy was performed 2 months later, the patient died 6 months after cardiac surgery due to sepsis. Thus, esophageal perforation related to TEE in open-heart surgery was considered to be associated with a poor prognosis.

Video-assisted thoracoscopic right upper lobectomy in a patient with a displaced bronchus and vascular abnormalities.

Bronchial abnormalities are rare, and they are infrequently associated with pulmonary vascular abnormalities. It is important to identify such abnormal anatomical structures before lobectomy of the lung under thoracoscopy. There have been only three reports on video-assisted thoracoscopic lobectomy in patients with anomalous bronchi and vascular abnormalities to date. Here, we present a report of video-assisted thoracoscopic right upper lobectomy performed in a patient with bronchial and vascular abnormalities. Both preoperative imaging and intraoperative findings revealed a displaced anomalous B2 bronchus arising from the bronchus intermedius, as well as abnormal distribution of the aberrant vein V2 draining into vein V6 . It is critical to understand the precise anatomical structures preoperatively to perform video-assisted thoracoscopic pulmonary lobectomy safely.

Thoracoscopic right middle lobectomy for Mycobacterium abscessus in a young patient suspected of having congenital immunodeficiency.

Mycobacterium abscessus (M. abscessus) infection is resistant to multi-antibacterial treatment, and surgical resection is often recommended. We report a case of M. abscessus infection in a young patient suspected of having a GATA2 mutation. A 19-year-old woman with a medical history of severe sinusitis and a family history of non-tuberculous mycobacteriosis presented at our hospital. M. abscessus was confirmed by sputum culture. The patient received multidrug therapy, including clarithromycin. CT scan demonstrated bronchodilation and capacity decrease due to non-obstructive atelectasis in the middle lobe. We performed thoracoscopic resection without complications. Congenital immunodeficiency was suspected given the patient's past medical and family history. The result of lymphocyte subset analysis revealed a GATA2 mutation, but no genetic mutation was detected by a next-generation sequencer. The patient followed a good clinical course. This paper reports the successful treatment of an M. abscessus infection and the importance of checking the genetic background of young patients.