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INTRODUCTIONThe Azygos lobe is a well-known but rare variant of the lung. This case reports the use of video-assisted thoracic surgery to diagnose and treat presumptive lung cancer of the azygos lobe.PRESENTATION OF CASEA 67-year old female with known severe Chronic Obstructive Pulmonary Disease presented with increasing shortness of breath. Chest x-ray revealed a lung nodule in the right lung field. PET/CT imaging delineated a 1.6 x 1.2 cm speculated lesion in an aberrant azygos lobe. After appropriate preoperative testing and evaluation, the patient was taken to the operating room where the azygos lobe was removed using video-assisted thoracic surgery.DISCUSSIONThe Azygos lobe is a well-known anatomical variant but such a lobe is rarely found to contain a malignant lesion. Azygos lobe removal alone may not be the best therapeutic option given the risk of locally recurrent disease, but in a select group of patients such as those with impaired lung function as this article describes, it may be the best available option in order to preserve postoperative pulmonary function.CONCLUSIONThis case illustrates that gentle caudal traction on the azygos lobe will allow circumferential exposure to the lobe and identification of the bronchovascular pedicle thereby eliminating the need for thoracotomy and or extensive azygos vein dissection/division.

We present the case of a 42-year-old male cirrhotic chronic alcoholic who was admitted during the height of the COVID pandemic with a large right pleural effusion. Thorough investigation revealed a large right-sided distal esophageal rupture near the gastroesophageal junction and he was diagnosed with Mallory Weiss tear converted to Boerhaave’s syndrome. He successfully underwent endoscopic placement of a covered esophageal stent, but had a protracted recovery with presumed empyema continuing to require chest tube drainage. He eventually required surgical intervention with a right thoracotomy, decortication, and wash out. Our case provides an excellent example of the risk of distraction during a global pandemic secondary to nonspecific symptomatology being attributed to COVID-19 and significant critical care requirements leading to a significant delay in diagnosis of an esophageal rupture. However, our patient is also uniquely impressive when compared to similarly published cases of Mallory Weiss conversion to Boerhaave’s Syndrome given his survival with excellent clinical outcome leading to discharge home on oral diet despite his increased risk of morbidity based on his prolonged critical illness disease course.

Tracheal perforation is a rare complication of intubation and is associated with high mortality. Here we describe a case of large, full-thickness tracheal perforation from traumatic intubation after an elective procedure. The injury was managed with prolonged intubation that bypassed the site of injury, and the patient was successfully extubated after 11 days. Conservative management of tracheal perforation after traumatic intubation is an option in select patients that avoids need for surgery.

Acute aortic dissection is an emergent and life-threatening condition. Retrograde Type A dissection (RTAD) can occur primarily or due to a complication of Type B dissection that often requires open repair, a highly morbid operation. While management of Type A and Type B dissections is clear, the literature is sparse regarding management of RTAD. We describe a case where the patient presented with a Type B dissection complicated by retrograde propagation, resulting in RTAD. We performed a Thoracic Endovascular Aortic Repair (TEVAR) as an alternative to standard open repair. The patient tolerated the procedure well and was discharged with resolution of the false lumen. Instead of treating a radiographic finding with a highly morbid operation, it is important to evaluate if an endovascular approach is a reasonable option to treat RTAD. Each case must be evaluated individually, but we believe that TEVAR may be an alternative intervention in specific cases.