Spontaneous pneumothorax occurring in patients with pulmonary arteriovenous malformations (PAVMs) caused by hereditary hemorrhagic telangiectasia (HHT) is extremely rare. We report a case of spontaneous pneumothorax in a PAVM patient. A 26-year-old man with previously diagnosed HHT and multiple small PAVMs presented with chest pain and dyspnea and was referred to our hospital. Chest X-ray showed a left-sided pneumothorax. Computed tomography (CT) showed apical bullae on both sides of the upper lobe. We clarified the location of PAVMs by 3D-CT to avoid the massive bleeding caused by careless grasping of PAVMs and unintentional incomplete resection of the PAVMs during the pneumothorax surgery. Considering the risk of exacerbation, the patient underwent bullectomy of the left upper lobe. The postoperative histopathological examination indicated that the pneumothorax occurred spontaneously in the HHT patient. We should clarify the location of PAVMs to avoid bleeding caused by the grasping of PAVMs during surgery.

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Currently, there are no clear indications for laparoscopic splenectomy for cases involving splenomegaly accompanied by malignant disease. Here, we report the safe and successful execution of laparoscopic splenectomy in two patients with massive splenomegaly. Two male patients were in their 40 s and 70 s. Computed tomography revealed the long diameters of their spleens to be 24 and 21 cm, and the operation times were 324 and 271 min. Intraoperative blood loss were 10 and 56 cc. Both spleens weighed approximately 1,500 g. Pathological diagnoses were splenic marginal zone lymphoma and mantle cell lymphoma. Manipulation of the splenic hilum was a safe and effective approach for laparoscopic splenectomy in the two patients with massive splenomegaly (diameter ＞ 20 cm).