Primary pulmonary intimal sarcoma is rare. Differentiating it from pulmonary thromboembolism is difficult because of similarities in clinical symptoms and imaging findings. Positron-emission tomography-computed tomography has been useful for diagnosing primary pulmonary intimal sarcoma. We describe a rare case of primary pulmonary intimal sarcoma that showed no abnormal 18F-fluorodeoxyglucose uptake on positron-emission tomography. We resected the mass and performed right ventricular outflow tract reconstruction. Proper diagnosis is necessary to determine appropriate therapy, Clinicians must consider the possibility of primary pulmonary intimal sarcoma even if imaging findings are inconsistent with the disease.

A 92 year-old-female with melena was admitted to our hospital. She underwent Y-graft replacement of the abdominal aorta at the age of 65. Gastroduodenal fiberscopic examination and computed tomography CT confirmed the diagnosis of aortoduodenal fistula. The fistula in the proximal anastomotic site was occluded with a suture ligature and omentopexy was performed. On the 15th post-operative day she developed high-grade fever. CT revealed a pseudoaneurysm formation at the proximal anastomosis site. She underwent emergency endovascular aneurysmal repair EVAR . Her postoperative course was uneventful. She is doing well without symptoms of recurrent infection. Jpn. J. Cardiovasc. Surg. 47 : 298 302 2018 secondary aortoenteric fistula ; AAA ; graft infection ; EVAR sAEF

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Background Aortopulmonary mediastinal paragangliomas are rare. Complete resection of the tumor is desirable regardless of tumor size in view of the risk of sudden death induced by adjacent organ compression and poor prognosis after partial resection or untreated observation. Due to the hypervascularity of the tumor, the risk of intraoperative bleeding is significant, and cardiopulmonary bypass is often required for complete resection. Case presentation The patient was diagnosed as having bilateral carotid body tumors and supposedly an aortic body tumor at the age of 43 and eventually underwent resections of bilateral carotid body tumors at the age of 52. The pathology of the carotid body tumors was compatible with paraganglioma on both sides. A familial succinate dehydrogenase subunit D mutation was subsequently identified. Five years later, a contrast-enhanced computed tomography scan showed an enlarged tumor of 45 mm in size in the aortopulmonary mediastinum. Based on the previously known genetic mutation, the tumor was thought to be a paraganglioma. After confirming with an endocrinologist that the aortic body tumor was non-functional, radiologists performed preoperative embolization of the feeding vessels. Subsequently, a surgical team consisting of thoracic and cardiovascular surgeons resected the aortic body tumor using a video-assisted small left thoracotomy approach combined with a median sternotomy approach. The procedure was completed without cardiopulmonary bypass or blood transfusion. The patient was discharged home on postoperative day 9 uneventfully. Conclusions After conduction of preceding interventional embolization of multiple feeding vessels, we employed a video-assisted thoracoscopic surgical approach to dissect the aspects of the tumor adjacent to the esophagus, descending thoracic aorta, and left pulmonary artery, followed by a median sternotomy approach to dissect the other aspects of the tumor adjacent to the ascending aorta, aortic arch, right pulmonary artery, and trachea. There have been no reports on scheduled preoperative embolization of feeding vessels to an aortopulmonary mediastinal paraganglioma. Multidisciplinary approach was effective for complete resection of this challenging rare mediastinal tumor.

Patent foramen ovale, sometimes associated with clinical manifestation, is frequently detected during adulthood. Platypnea-orthodeoxia syndrome, a rare condition characterized by dyspnea and hypoxia aggravated in the upright position, is caused by a right-to-left shunt across a patent foramen ovale. We present a case of a 73-year-old man with severe hypoxia caused by an aortic arch aneurysm that distorted the atrial septal geometry and worsened the right-to-left shunt. Clinicians should consider a right-to-left shunt via a patent foramen ovale when an aortic arch aneurysm causes counterclockwise cardiac rotation. Furthermore, the alveolar-arterial oxygen difference can be used to diagnose platypnea-orthodeoxia syndrome.