Bovine heterograft was widely used in the past for angio-access, revascular ization, and in some other different vas cular procedures. At first the technique was promising, but it ultimately became discouraging because of a high number of complications related to the use of foreign protein. This report describes a case in which bovine heterograft was used as an angio-access for chronic renal dialysis; its natural course and complication are reviewed in detail.

A bstractBronchogenic carcinoma was suspected in a middle-aged black man who was a heavy smoker, a heavy drinker, and met all criteria for the high-risk group. A mass density was apparent in the superior sulcus, right upper lobe. On thoracotomy a tortuous innominate artery and dilated superior vena cava was found simulating a right apical mass. English literature and sporadic case studies are reviewed. Different noninvasive and invasive diagnostic procedures are described to aid in the diagnosis of possible nonmalignant tumefaction of the thorax mimicking bronchogenic carcinoma, and to help readers avoid unnecessary thoracotomies. Case ReportA 40-year-old black, divorced veteran was admitted to the Medical Center with mild withdrawal symptoms. The patient had been drinking alcohol since the age of 13. For the past 4 or 5 years he had also been having problems holding a job because of absenteeism.He was a thin, alert, and well oriented male with some slight impairment of vision.His teeth were in poor condition, and several were missing. He had bilateral hydroceles in the testes, but the remainder of his physical examination was within normal limits, as were his laboratory studies.On routine posteroanterior chest x-ray, he was noted to have densities in the right base, presumably from aspiration pneumonia. Also, a density was noted in the right part of the vertebral area occupying the superior sulcus of the right upper lobe (Figure 1 ). Laminagrams revealed a somewhat lobulated mass lesion adjacent to the trachea in the right upper mediastinum. There was no pressure on the trachea, and the edges of the lesion were sharply defined (Figure 2).With a diagnosis of bronchogenic carcinoma, the patient underwent bronchoscopy, followed by mediastinoscopy. Both were within normal limits and revealed no evidence of malignant cells. Other laboratory investigations disclosed no abnormalities and failed to demonstrate any evidence of FIG. 1. A posteroanterior chest x-ray demonstrates a lesion in the right upper lung zone.

Buckling and tortuosity of innominate arteries are of no prognostic signifi cance. Correct diagnosis, identification, and differentiation from true vascular pathologies and from mediastinal and pulmonary conditions will eliminate needless surgical procedures. This condition should be especially looked for in women with prolonged hypertension. Arteriography will establish the diagnosis promptly.

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