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Rationale:Congenital absence of the right coronary artery (RCA) is a rare congenital malformation of the cardiovascular system which may have fatal consequences.Patient concerns:A 63-year-old man with a 5-year history of chest pain after exertion which had aggravated for >1 month was advised for admission and computed tomography angiography (CTA) examination of the coronary artery to screen for coronary artery disease (CAD).Diagnoses:The coronary artery CTA showed absence of RCA arising form the aortic root after which a selective coronary angiography (SCA) examination was done that confirmed the diagnosis of congenital absence of RCA.Interventions:As the patient refused to receive a coronary artery stent implantation citing his financial condition, only symptomatic treatment was given.Outcomes:The patient requested to be discharged from the hospital against the advice of his doctors 1 week later. A query made by the telephone suggested that the patient's symptoms were under control by use of prescribed medications only.Lessons:Although being a rare condition, a coronary artery CTA examination can be utilized to screen for congenital absence of RCA and other varieties of cardiovascular malformation whereas SCA can be performed to confirm the diagnosis.

Rationale:Even though barium sulphate aspiration during upper gastrointestinal examination is a well-known phenomenon, complication such as long-term lung injury and death may still occur. This may depend upon the concentration, amount, anatomy, or certain predisposing factors.Patient concerns:A 47-year-old woman who had a barium swallow to screen for foreign body in esophagus.Diagnoses:Chest radiographs demonstrated massive barium sulphate depositions in her trachea and inferior lobe of right lung.Interventions:A chest x-ray was done that revealed massive barium sulphate depositions in her trachea and lower lobe of right lung. As the patient did not have further complaints, she requested a transfer to West China Hospital of Sichuan University, the hospital being near her residence, for further treatment. She eventually recovered and was discharged after 1 week.Outcomes:There were 23 articles (22 English and 1 Chinese with 17 men and 11 women) included in the study. The risk factors of barium sulphate aspiration are dysphagia (10/28, 35.71%) followed by esophageal obstruction caused by tumor (5/28, 17.86%) and foreign body in esophagus (3/28, 10.71%). Infants (5/28, 17.86%) are also one of the high-risk population. Both the lungs were affected in most of the patients (21/28, 75%). Majority of the presentation in patients (21/28, 75%) were dyspnea, hypoxemia, acute respiratory distress syndrome (ARDS), or respiratory failure. Few patients (7/28, 25%) showed no symptoms or mild symptoms such as cough and fever. Barium sulphate aspiration can be life-threatening with a high risk of death (nearly 40%).Lessons:When performing an upper gastrointestinal examination with barium sulphate, careful consideration of concentration and amount of barium sulphate and that of risk factors should be undertaken so as to avoid life-threatening aspiration.

BackgroundPulmonary sequestration is a rare congenital pulmonary dysplasia, which requires surgical resection (either via open thoracotomy or video-assisted thoracoscopic surgery [VATS] or via endoluminal occlusion of the abnormal feeding vessel).Case presentationWe described a 51-year-old female patient with a history of recurrent cough and repeated pneumonia. She was referred to our hospital for further work-up of pulmonary sequestration. We performed a hybrid surgery (i.e., embolization of the aberrant feeding vessel of the sequestration combined with wedge resection of the left lower lobe lesion through VATS). The patient was discharged on the sixth postoperative day in good condition and without complications.ConclusionsWe believe that a hybrid operation is safer, more feasible, and more comprehensive than other treatments.

Mediastinal cystic lymphangioma is an extremely uncommon benign tumor. The patients with mediastinal cystic lymphangioma are often misdiagnosed because of no specific symptoms. The cysts usually are incidentally found and preoperative diagnosis is difficult due to their atypical appearance on imaging studies. Most cases are diagnosed during or after the operation. Moreover, the standard surgical approach for resection has not yet been well established. We report a case of an adult patient with a giant mediastinal cystic lymphangioma that was successfully resected by video-assisted thoracoscopic surgery (VATS). This case report shows that resection by VATS is feasible when mediastinal cystic tumor is suspected, even if they are huge, and that VATS may be an alternative to open thoracotomy to treat mediastinal cystic lymphangioma.